ISL 64 1922. SIXTY-SEVENTH ANNUAL REPORT on the HEALTH & SANITARY CONDITION of the METROPOLITAN Borough of Islington. G. CLARK TROTTER, M.D., D.P.H., F.R.S.E. MEDICAL OFFICER OF HEALTH. London : Wilkinson Bros., Ltd., 37-43, Green Lanes, Stoke Newington, N. 16. ii 302 1254767 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1922, to November, 1923.) Aldermen. FREDERICK EDWARD BRADSHAW FREDERICK MONTAGUE Councillors. Ward Ward 1. WILLIAM H. GALE 5. FRANK E. W1DDOWSON 2. EDWARD TOMK1XS 6. REGINALD FRANKLIN 3. WALTER FREDERICK NOKES 6. ABRAHAM LEVISON 3. WILLIAM THOMAS SMITH 7. JAMES SKINNER 4. JAMES T. HOARE 8. WILLIAM J. MITCHELL 4. HERBERT S. JORDAN 10. SARAH JOHNSON 5. WILLIAM P. BALL 11. HENRY JOHNSON 5 FREDERICK COPPING Chairman Councillor JORDAN Vice-Chairman Councillor SMITH MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1922, to November, 1923.) Aldermen. RICHARD MONTFORD HENRY B. VORLEY Councillors. Ward Ward 1. HERBERT TICE 6. KATE SHARP 3. ROSA ESSEX 7. JAMES SKINNER 3. GRACE WATSON 8. WILLIAM J. MITCHELL 4. VINCENT P. CATTERMOLE 10. SARAH JOHNSON 6. REGINALD FRANKLIN 11. HENRY JOHNSON Members appointed by the Council from outside their own body. LADY ANDREWES, 1, North Grove, Highgate, N. 6 Dr. ALICE VANCE KNOX, 15, South Grove, N. 6 Miss MIRIAM PRICE, 76, Plimsoll Road, N. 4 Mrs. MATILDA SOUTHGATE, J.P., 507, Caledonian Road, N. 7 Mrs. F. S. TAIT, 48, Highbury Park, N. 5 Mrs. VORLEY, "Fern Bank," Holly Park, Crouch Hill, N. 4 Chairman Councillor TICE Vice-Chairman LADY ANDREWES iii SUMMARY of Vital Statistics in the Registration Year 1922. Population (Enumerated at Census, 1921) 330,737 persons „ Estimated Mid Year 1922 333,900 persons Increase on Census population, 1921 3,163 persons Mean Population, ten years (1912-1921) 317,779 persons Area 3,092 acres Density (Mid-year 1922) 108 persons per acre Males 3,788 Births Females 3,718 persons 7,506 Birth rate 22 47 per 1,000 inhabitants Males 2,334 Deaths from All Causes Females 2,280 persons 4,614 Death rate 13.82 per 1,000 inhabitants Males 185 Deaths from Principal Epidemic Diseases Females 164 349 persons Death rate 1.05 per 1,000 inhabitants Males 223 Deaths from All Tuberculosis Females 174 433 persons Death rate 1.30 per 1,000 inhabitants Males 233 Deaths from Respiratory Tuberculosis Females 145 378 persons Death rate 1.13 per 1,000 inhabitants Males 309 Infantile deaths under 1 year Females 270 Total 579 Infantile mortality rate 77 per 1,000 births Excess of Births over Deaths 2,892 Rateable value of Borough of Islington £1,872,092 Sum represented by a penny rate £7,808 iv Public Health Department, Municipal Offices, Tyndale Place, N. 1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. I have the honour to submit the Annual Report on the Health and Sanitary Conditions of the Borough for the year 1922. Included are the statistical tables as prescribed by the Ministry of Health. Since the draft Report was submitted to the Public Health Committee in May, further Census information has become available, and opportunity has been taken to add to the Report information regarding workplaces, and the daily inward and outward movement of workers, as Islington is becoming each year more and more an outlet for the congestion of the City. Much progress was made during the year in reorganising the work of Health Visitation and co-relating this work with that of the Voluntary Infant Welfare Centres. I am, Ladies and Gentlemen, Your obedient Servant, G Clark Frotter Medical Officer of Health. REPORT of the Medical Officer of Health FOR THE YEAR 1922. SPECIAL REPORTS (OTHER THAN THE HEALTH OF THE BOROUGH) AND OUTSTANDING MATTERS BROUGHT BEFORE THE PUBLIC HEALTH OR MATERNITY AND CHILD WELFARE COMMITTEES DURING THE YEAR. SUMMARY. 1. Health Week.— The activities in Islington for arousing public interest in the subject of health and child welfare by demonstrations, lectures, and exliibits, are reported on page 12. Neglect of Vaccination, page 38. 2. Smoke Nuisance, etc.— The special investigations of the Inspectors, and action taken, are set out on page 46. Steam Whistle Act, 1872, page 41. Workshops, pages 42-46. Street Accidents, page 27. 3- Rats and Mice (Destruction) Act, 1919.— A summary of the supervisory work of the Rat Officer will be found on page 48. 4. Food and Drugs.— (a) Sophistication of Milk.— During the latter months of 1921, continuing into the year under report, the Borough of Islington received considerable attention from vendors of "cheap milk." It became necessary to issue a public warning on the matter. The methods employed in the sophistication of milk and the steps taken before the clique of itinerent vendors was forced to desist within the bounds of Islington arc reported, page 54. (b) Inflation of Meal.—During the course of inspections, the Meat Inspector observed a butcher in the act of inflating meat by means of the mouth. At the direction of the Committee, the Medical Officer of Health wrote the Ministry of Health on the matter, and was informed "that the question had from time to time been under the consideration of the Local Government Board and the Ministry of Health. The inflation of carcases is prohibited, either absolutely or unless effected by mechanical means by the local acts of several local authorities, but there is no general legislation making the 1922] 2 practice illegal. The matter has, however, been noted for consideration in the event of a Bill being introduced into Parliament for the amendment of the Public Health Acts." Further information will be found page 51. (c) Preservatives in Food. The Medical Officer of Health, in reporting to the Committee on preservatives in food (page 57), suggested that representations should be made to the Ministry of Health for definite inquiry under the following heads: (1) whether certain preservatives are harmless: (2) the proposed standards as regards the amount, if any, to be permitted; (3) the class of food in which such preservatives, if so found necessary, may be used (as at present some manufacturers use such, while others produce a satisfactory preparation without); id) Unsound Food.—The risk involved of unsound food being sold, through the wholesaler selling fruit, unexamined and unsorted was considered by the Public Health Committee, and a Conference met at Islington at which representatives attended from Metropolitan Boroughs. Snbsequcntlv a Deputation was received by the Ministry on the matter (page 50). (e) Dispensing of Prescriptions.Just towards the end of the year, a commencement was made b\ taking samples under the Sale of Food and Drugs Acts to test the accuracy of the dispensing of medicine-- in the Borough (page 60). 5. Health Visitation.— A report on reorganisation of the work of health visitation will bo found page 13. 6. Index to Report.— Page 73. POPULATION. The population of the Borough in 1922, estimated by the Registrar-General, is 333,900 persons, of whom 156,280 were males and 177,620 females. These figures show a total increase of 900 persons as compared with those of the preceding year. The following tables give full information respecting the sex, age and distribution of the population of the several sub-registration districts and wards, together with particulars of their areas and densities, also inhabited houses, private families, and conditions of occupation, which have been abstracted from the Census returns recently issued. Showing the Areas, Densities and Populations of the Sub-registration Districts at the Census 1921, also the Estimated Populations at the middle of year 1922. Sub-Districts. Area. Acres. Acres to a person. Persons to an Acre at Census 1921 Enumerated Population at Census 1921. Estimated Population Mid-year 1922. Tufnell 411 0.0122 82 33,750 33,962 Upper Holloway 299 0.0084 119 35,721 34,398 Tollington 315 0.0102 98 30,832 31,044 Lower Hollowav 406 0.0101 99 40,139 40,885 Highbury 749 0.0127 79 58,850 59,916 Barnsbury 316 0.0059 170 53,859 54,654 South East Islington 596 0.0077 130 77,586 79,041 The Borough 3,092 0.0093 107 330,737 333,900 3 [1922 Showing the Areas, Densities and Populations of the Wards at the Census, 1921, also the Estimated Populations at the middle of the year, 1922. WARDS. Area in Acres. Persons to an Acre or Density of Population at Census, 1921. Enumerated Population Census, 1921 Estimated Population Mid-year, 1922 No. 1—Tufnell 411 82 33,750 33,962 2—Upper Holloway 299 119 35,721 34,398 3—Tollington 315 98 30,832 31,044 4 —Lower Holloway 406 99 40,139 40,885 5—Highbury 417 80 33,417 33,050 6—Mildmay 332 77 25,433 26,866 7—Thornhill 178 176 31,301 31,092 8—Barnsbury 138 163 22,558 23,562 9—St. Mary's 150 116 17,363 17,795 10—Canonbury 290 103 29,997 31,017 11—St. Peter's 156 194 30,226 30,229 The Borough 3,092 107 330,737 333,900 Showing the Number of Persons living in Islington at the Census, 1921, at Nine Age Periods, and distinguishing Males and Females. Ages. Males. Females. Persons. 0— 5 14,569 14,010 28,579 5—15 30,269 30,052 60,321 15-25 25,645 30,767 56,412 25-35 24,404 29,730 54,134 35—45 21,240 25,410 46,650 45—55 18,528 20,281 38,809 55—65 11,928 13,615 25,543 65—75 6,172 8,450 14,622 75 and upwards 1,906 3,761 5,667 All ages 154,661 176,076 330,737 Showing the Number of Persons living at Nine Groups of Ages in every thousand of the Population in the Census Years, 1881-1921. Census Years. Age Periods of Life. 0—5 —15 —25 —35 —45 —55 —65 —75 75 and upwards. 1881 133 206 198 172 122 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 1921 86 182 171 164 141 118 77 44 17 1922] 4 CENSUS RETURN. Showing the number of Inhabited Houses and Buildings used as Dwellings, the Separate Occupiers, and Populations in Islington, at the Census, 1921. Buildings. Structurally separate Dwellings occupied by Private Families, or vacant. Total Rooms. In course of Erection. Completed. Population at Census, 1921. 1-3 Rooms. 4-5 Rooms. 6-8 Rooms. 9 or more Rooms. Total Dwellings. Not Containing Dwellings. Containing Dwellings. 15 - 32,520 274,748 I. Undivided Private Houses 823 3,952 20,384 7,195 32,354 235,638 - - 272 1,520 II. Structurally divided Private Houses 146 237 65 7 455 1,947 38 - 1,465 19,799 III. Blocks of Flats, Tenements, etc. 3,892 1,110 133 — 5,135 15,195 1 714 4,431 26,081 IV. Shops 463 1,861 1,846 235 4,405 24,203 4 1,086 394 8,589 V. Others 141 90 57 26 314 1,421 58 1,800 39,082 330,737 Total 5,465 7,250 22,485 7,463 42,663 278,404 Principal Buildings in Group V. (Others) above: Unoccupied or Vacant on Census night 132 202 166 73 573 3,145 1 676 131 543 Offices, Factories, Dwellings occupied by 1 private family 5,222 4,408 4,059 1,505 15,194 75,801 Warehouses, „ „ 2 „ families 98 2,065 8,722 1,719 12,604 86,249 Workshops „ „ 3 or more private families 13 575 9,538 4,166 14,292 113,209 — — 5 53 Hotels - —1 40 5,841 Institutions Total Inhabited Dwellings occupied by private No. 5,333 7,048 22,319 7,390 42,090 275,259 — 89 15 families Per cent. 13 17 52 18 100 — 126 Placcs of Worship. - 11 5 12 Places of Amusement. Total separate private families therein 5,457 10,359 53,399 20,209 89,424 — N.B.— The total rooms in dwellings occupied by private families as shown in above table is usually slightly in excess of the total rooms occupied (vide Table pp. 5 and 6), owing to the fact that in certain dwellings inhabited by two or more families, part of the dwelling was unoccupied on Census night. 5 [1922 BOROUGH OF ISLINGTON. Census Return showing the Acreage, Population, Private Families and Dwellings in Islington at the Census 1921, together with the total persons at Census 1911. Wards. Area in Statute Acres (Land and Inland Water. TOTAL POPULATION. PRIVATE FAMILIES AND DWELLINGS 1911. 1921. Private Families. Population in Private Families. Structurally Separate Dwellings occupied. Rooms occupied. Rooms per Person. Persons. Persons. Males. Females. Persons per Acre. Cols. a b c d e f g h i j k l 1. Tufnell 411 33,526 33,750 14,994 18,756 82 9,274 32,031 4,540 32,493 1.01 2. Upper Holloway 299 37,116 35,721 16,770 18,951 119 9,150 32,704 4,195 28,631 0.88 3. Tollington 315 30,609 30,832 14,261 16,571 98 8,197 30,104 3,999 26,881 0.89 4. Lower Holloway 406 39,352 40,139 19,494 20,645 99 10,202 38,972 4,753 30,289 0.78 5. Highbury 417 33,805 33,417 15,262 18,155 80 9,293 32,590 4,561 30,752 0.94 6. Mildmay 332 23,923 25,433 11,338 14,095 77 6,944 24,132 3,629 26,346 1.09 7. Thornhill 178 31,522 31,301 15,198 16,103 176 8,187 31,267 3,571 20,172 0.65 8. Barnsbury 138 21,499 22,558 10,757 11,801 163 6,274 22,532 2,504 16,380 0.73 9. St. Mary 150 16,908 17,363 8,210 9,153 116 4,891 16,862 2,503 13,389 0.79 10. Canonbury 290 28,921 29,997 14,018 15,979 103 8,783 29,756 3,776 25,794 0.87 11. St. Peter 156 30,222 30,226 14,359 15,867 194 8,229 30,092 4,059 20,822 0.69 The whole Borough 3,092 327,403 330,737 154,661 176,076 107 89,424 321,042 42,090 271,949 0.85 1922] 6 BOROUGH OF ISLINGTON. Census Return showing Private Families, classified by size of Family, Rooms occupied, and Density of Occupation. number of Persons in Family. Number of Private Families occupying the following Number of Rooms. Total Private Families. Population in Private Families Rooms occupied Density of Occupation. Average Number of Rooms per Person. Population at following densities of occupation (rooms per person). 1 2 3 4 5 6-7 8-9 10 and over. No. % under -3 -3 and under -5 -5 and under -7 -7 and under 1-0 1 7,987 2,170 916 316 137 83 34 5 11,648 13.0 11,648 17,879 1.54 - - 8 - 2 4,653 7,607 4,748 1,890 667 483 226 78 20,352 22.9 40,704 50,774 1.25 4 - 9,302 4 3 2,151 6,210 5,155 2,964 1,091 688 319 132 18,710 20.9 56,130 55,774 0.99 3 6,450 18,630 3 4 772 4,029 3,911 2,870 1,278 808 359 163 14,190 15.9 56,760 48,310 0.85 3,088 12 16,116 15,632 5 216 2,229 2,578 2,224 1,078 820 288 171 9,604 10.7 48,020 36,183 0.75 1,080 11,145 12,890 11,125 6 65 1,167 1,622 1,577 789 596 235 138 6,189 6.9 37,134 24,707 0.67 390 7,002 19,194 4,734 7 16 604 1,029 967 550 424 145 77 3,812 4.3 26,684 15,687 0.59 4,340 7,203 6,769 5,950 8 3 297 556 689 364 277 120 61 2,367 2.6 18,936 10,259 0.54 2,400 4,448 8,424 2,216 9 - 98 312 381 247 185 66 45 1,334 1.5 12,006 6,136 0.51 882 6,237 3,357 945 10 1 30 143 208 146 116 40 27 711 0.8 7,110 3,427 0.48 310 3,510 2,290 730 11 - 7 61 100 66 56 20 14 324 0.4 3,564 1,635 0.46 748 1,826 616 253 12 - 2 4 36 22 30 10 4 108 0.1 1,296 590 0.46 72 696 432 72 13 — - 3 10 12 7 1 7 40 0.0 520 238 0.46 39 338 52 78 14 - - 1 3 3 5 2 7 21 0.0 294 168 0.57 56 112 28 84 15 and over - - - 1 1 1 1 10 14 0.0 236 182 0.77 15 30 65 77 Total Private Families 15,864 24,450 21,039 14,236 6,451 4,579 1,866 939 89,424 100.0 — - — - - - - Population in Private Families 28,450 78,164 80,804 64,559 31,628 23,182 9,094 5,161 - - 321,042 - - 13,427 49,009 98,173 4l,903 Rooms Occupied. 15,858 48,895 63,110 56,941 32,251 28,816 15,500 10,578 - - - 271,949 0.85 - - - - 17.7 27.4 23.5 15.9 7.2 5.1 2.1 1.1 100.0 1921 Percentage of families living in various units of occupation 17.8 24.3 21.7 13.7 7.4 8.2 4.4 2.5 100.0 1911 „ „ „ „ „ „ 7 [1922 MARRIAGES. Marriages, 2,877; Marriage Rate, 17.23.- The number of persons married was 5.754. as contrasted with 6.282 in the preceding year, which is a decrease of 264. The marriage rate was 17.23 per thousand inhabitants, as compared with 18.86 in 1921. The following statement shows the figures for the previous ten years 1912-21. Years. Marriages. Marriage Rate Years. Marriages. Marriage Rate. 1912 3,091 18.94 1917 2,689 16.23 1913 2,984 17.98 1918 2,971 18.51 1914 3,188 19.63 1919 3,306 19.28 1915 4,252 26.12 1920 3,370 20.05 1916 3,080 18.30 1921 3,141 18.86 BIRTHS. There were 7,506 births registered, of which 3,788 were boys, and 3,718 girls. Of this number, however, 886 were born of mothers living in Islington, although they were confined in Lying-in Institutions, and in other homes situated outside the Borough. The annual birth rate was equal to 22.47 per 1,000 of the population, as compared with a mean birth rate of 22 33 in the preceding ten years. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1922, 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 1921; together with the mean Borough Birth-rates for the 10 years 1912-1921. Quarter. Males. Females. Total. Birth Rates. Islington, 1922. Islington, 1912-21. London, 1922. 105 Great Towns, 1922. First 993 969 1,962 23.51 23.07 22.7 23.0 Second 971 998 1,969 23.59 22.70 22.2 22.2 Third 929 926 1,855 22.22 21.65 21.2 21.4 Fourth 895 825 1,720 20.60 21.88 19.5 19.4 The Year 1922 3,788 3,718 *7,506 22.47 22.33 21.0 21.4 1921 4,068 3,818 7,886 23.68 22.47 22.3 23.3 Increase or decrease - 280 - 100 - 380 - 1.21 + 0.14 - 1.3 - 1.9 * These include 886 births which occurred in Lying-in Institutions, etc., outside the Borough. N.B. —The total registered births given by the Registrar General for the Calendar year, 1922, will be found at the foot of table on p. 70, in the appendix. Showing the Births of Males and Females and the Birth-rates in each quarter and for the year, 1922, and in the several Sub Registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females. Total. Birth rates. 1st Quarter 80 81 161 18.96 111 93 204 23.72 74 97 171 22.03 143 137 280 27.39 2nd „ 82 98 180 21.20 109 93 202 23.48 82 87 169 21.77 115 129 244 23.87 3rd „ 83 75 158 18.61 102 100 202 23.48 81 85 166 21.38 118 137 255 24.95 4th „ 84 75 159 18.73 86 73 159 18.48 78 86 164 21.13 133 120 253 24.75 Year 329 329 658 19.37 408 359 767 22.30 315 355 670 21.58 509 523 1,032 25.24 1922] 8 Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1922, and in the several Sub-Registration Districts.—contd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 146 156 302 20.16 214 181 395 28.91 225 224 449 22.72 993 969 1,962 23.51 2nd „ 150 155 305 20.36 186 173 359 26.27 247 263 510 25.81 971 998 1,969 23.59 3rd „ 140 155 295 19.70 176 166 342 25.03 229 208 437 22.11 929 926 1,855 22.22 4th „ 134 131 265 17.69 176 148 324 23.71 204 192 396 20.04 895 825 1,720 20.60 Year 570 597 1,167 19.47 752 668 1,420 25.98 905 887 1,792 22.67 3,788 3,718 7,506 22.47 Illegitimate Births (207).—The number of illegitimate births, 207, shows an increase of 2 on the return of the year 1921. They were equal to a rate of 2.76 per 1,000 registered births. A table for former decennial periods was given in Report 1922. Notification of Births Act, 1907.- 5,928 births were notified or 78.5 per cent. of the total number that was registered during the year. They were notified by doctors, midwives, parents and guardians as follows: Notified by : Doctors. Midwives. Parents and other Persons. Total. Alive. Still born Alive. Still born. Alive. Still born. Alive. Still born. 1922. 1st Quarter 117 10 795 22 578 7 1,490 39 2nd ,, 123 6 789 22 593 13 1,505 41 3rd „ 126 8 729 14 593 14 1,448 36 4th „ 96 4 675 16 564 14 1,335 34 Year 462 28 2,988 74 2,328 48 5,778 150 DEATHS. The deaths numbered 4,614, while the death-rate was equal to 13.82 per 1,000 of the population, or 0.70 lower than that of the preceding year (1312), and was 1.55 less than the average of the previous 10 years. The Deaths and Death-rates from All Causes in the Sub Registration Districts were as follows:— Sub-Districts. Quarters. The Year. 1 2 3 4 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Tufnell 170 20.02 122 14.37 78 9.19 90 10.60 460 13.54 Upper Holloway 174 20.23 118 13.72 76 8.83 105 12.20 473 13.75 Tollington 178 22.93 104 13.40 75 9.66 86 11.08 443 14.27 Lower Holloway 250 24.46 125 12.23 93 9.10 111 10.86 579 14.16 Highbury 278 18.56 173 11.55 152 10.15 167 11.15 770 12.85 Barnsbury 332 24.30 181 13.25 121 8.85 175 12.80 809 14.80 Islington (South. East) 391 19.78 265 13.41 188 9.51 236 11.94 1,080 13.66 The Borough 1,773 21.24 1,088 13.03 783 9.38 970 11.62 4,614 13.82 * 9 [1922 showing the Deaths and Death Rates of Islington in 1922, and in the four quarters, of the year, and of the County of London and the Great Towns during the same period, the mean Borough Death Rates for the 10 years 1912-21, and the deaths and death-rates in the year 1921. Quarter. Males. Females. Total. Death Rates. Islington, 1922. Islington, 1912-21. London, 1922. 105 Great Towns, 1922. First 887 886 1,773 21.24 18.67 19.7 18.3 Second 530 558 1,088 13.03 14.00 13.1 12.7 Third 419 364 783 9.38 11.85 8.9 9.3 Fourth 498 472 970 11.62 17.01 12.0 11.8 The Year 1922 2,334 2,280 4,614 13.82 15.37 13.4 13.0 1921 2,212 2,156 4,368 13.12 13.82 12.4 12.3 Increase or Decrease + 122 + 124 + 246 + 0.70 + 1.55 + 1.0 + 0.7 Causes of Death (Classified). —The following table shows the deaths arranged in classes of Disease from All Causes during the ten years 1912-21. and in 1922. Classified Causes of Death. Years. Mean 10 Yrs. 1922 Difference. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 I. Specific or Febrile Causes 397 448 572 618 380 391 1361 579 552 464 576 639 + 63 1. Miasmatic Diseases 300 284 299 451 268 293 1258 466 437 301 436 546 + 110 2. Diarrhœal „ 36 99 174 94 56 56 51 36 28 85 71 29 - 42 3. Malarial „ 1 - 1 - - - 2 2 2 - 1 - - 1 4. Zoogenous „ - 4 2 - 3 2 - 1 2 1 1 - - 1 5. Venereal 17 19 21 23 15 15 15 13 13 17 17 17 - 6. Septic „ 43 42 75 50 38 25 35 61 70 60 50 47 - 3 II. Parasitic Diseases - 1 - — 1 1 — 1 1 - - 3 + 3 III. Dietetic 19 17 11 36 3 3 4 2 2 4 10 7 - 3 IV. Constitutional Diseases 1023 1032 1056 1132 1095 1114 1101 973 918 985 1043 935 - 108 V. Developmental 396 468 512 554 522 486 520 657 556 486 516 477 - 39 VI. Local 2500 2718 2488 2847 2457 2344 2596 2177 2172 2203 2450 2362 - 88 1. Diseases of Nervous System 260 376 363 418 339 351 330 322 341 345 344 330 - 14 2. „ Organs of Special Sense 4 20 14 17 12 14 10 11 20 13 13 9 - 4 3. „ Circulatory System 754 733 660 722 669 681 691 654 592 651 681 734 + 53 4. „ Respiratory „ 980 958 896 1147 1006 887 1156 770 822 717 934 903 - 31 5. „ Digestive „ 290 362 304 319 233 243 246 215 224 260 270 204 - 66 6. „ Lymphatic „ 6 10 15 9 16 9 3 11 10 14 10 11 + 1 7. „ Urinary „ 166 213 193 182 149 130 137 151 129 168 162 134 - 28 8. „ Reproductive „ 25 26 18 18 24 18 8 17 20 13 19 20 + l 9. „ Bones and Joints 10 6 10 8 9 5 9 12 5 3 8 8 - 10. „ Integumentary System 5 14 15 7 - 6 6 14 9 19 9 9 - VII. Violence 227 195 201 234 183 159 156 162 179 142 184 137 - 47 1. Accident or Negligence 177 157 165 194 156 122 115 132 140 99 146 94 - 52 2. Homicide 5 3 3 3 4 1 3 2 2 3 3 3 - 3. Suicide 45 34 33 37 23 11 27 28 37 40 32 39 + 7 4. Execution - 1 - - - - - - - - - 1 + 1 5. By Bombs (Enemy Aircraft) — - - — — 25 11 — — — 3 - - 3 VIII. Ill-defined Causes 120 149 98 125 111 102 103 89 95 84 108 54 - 54 All Causes 4682 5028 4938 5546 4752 4600 5841 4640 4475 4368 4887 4614 - 273 1922] 10 AGES AT DEATH. The following statement gives the ages at which persons died in the borough, and contrasts them with the returns for the preceding ten years: Ages. Number of Deaths, 1922. Mean Deaths (10 years), 1912.21. Increase or Decrease on mean. 0-1 year 579 687 - 108 1-5 years 452 424 + 28 Under 5 vears 1,031 1,111 - 80 5-15 years 115 190 - 75 15-25 „ 172 194 - 22 25-35 „ 213 282 - 69 35-45 „ 316 367 - 51 45-55 „ 506 540 - 34 55-65 „ 658 644 + 14 65-75 „ 824 796 + 28 75-85 „ 611 598 + 13 85 upwards 168 165 + 3 4,614 4,887 - 273 INFANTILE MORTALITY. Infant Deaths, 579; Mortality Rate, 77.—There were 579 deaths among infants under twelve months old during the year, or 108 below the decennial average (687), and they represented an infant mortality rate of 77 per 1,000 infants born. This rate is 17 per 1,000 births below the mean annual record of the preceding ten years, and only upon one occasion has a lower rate been recorded in Islington, viz: 72 per 1,000 births in 1920. In the quarters the mortality ranged from 107 per 1,000 births in the first quarter, 74 in the second, 52 in the third, and 74 in the fourth. In the sub-registration districts the infant mortality was as follows : Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 55 83 Upper Holloway 45 59 Tollington 39 58 Lower Holloway 84 81 Highbury 75 64 Barnsbury 123 86 Islington South East 158 88 In London the infant mortality was 74 per 1,000 births, while in the six boroughs encircling Islington it was 77. The rate for England and Wales was 77 per 1,000 births. 11 [1922 Infantile Mortality during each of the Ten Years 1912-21, and 1922. Deaths at various ages under One Year of Age. Years. Under one week. Weeks. Total under four weeks. Months. Total Deaths under one year. Deaths per 1,000 Births. 1-2 2-3 3-4 4 weeks and under 3 mths. 3-6 6-9 9-12 1912 190 41 25 24 280 133 121 81 95 710 86 1913 195 49 47 29 320 187 178 111 102 898 107 1914 179 40 39 33 291 159 181 118 100 849 104 1915 155 49 35 31 270 142 152 125 116 805 107 1916 129 32 27 21 209 128 116 92 89 634 87 1917 93 38 23 7 161 106 108 99 91 565 97 1918 123 31 19 14 187 87 112 78 107 571 110 1919 158 32 22 21 233 95 92 60 45 525 83 1920 142 54 37 22 255 141 120 79 81 676 72 1921 131 34 35 22 222 104 148 96 71 641 81 Mean 10 years 149 40 31 22 242 128 133 94 90 687 94 1922 125 37 29 22 213 80 97 96 93 579 77 Increase or decrease on mean - 24 - 3 - 2 - - 29 - 48 - 36 + 2 + 3 - 108 - 17 showing the Deaths among Infants per 1,000 Births during the Year 1922 and also the mortality rates for the Years 1912-1921. Sub-Districts. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Mean 10 years 1922 Increase or decrease on mean Tufnell 61 108 93 65 84 99 93 50 41 53 75 83 + 8 Up. Holloway 85 119 86 118 67 68 83 79 69 76 85 59 -26 Tollington 88 104 92 135 93 102 135 98 58 83 99 58 - 41 L.r. Holloway 94 121 134 118 107 121 130 101 66 93 108 81 - 27 Highbury 80 89 93 109 74 83 99 83 67 93 87 64 - 23 Barnsbury 98 128 119 107 103 114 122 91 89 87 106 86 - 20 Islington, S.E. 94 98 105 108 91 89 107 81 79 77 93 88 - 5 The Borough 86 107 104 107 87 97 110 83 72 81 94 77 - 17 The following table shows the diseases that proved most fatal in the first year of child life, together with the mortality rates per 1,000 births. Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1912-21; and in 1922 from certain specified causes. Causes of death. 1922. Rate per 1,000 Births. Mean rate 10 years 1912-21 per 1,000 Births. Difference. Premature Birth and Congenital Defects 20.25 20.71 — 0.46 Bronchitis and Pneumonia 17.58 18.70 — 1.12 Atrophy and Marasmus 6.13 13.40 — 7.27 Diarrhœal Diseases (all forms) 2.93 6.27 — 3.34 Convulsions 1.60 1.77 — 0.17 Whooping Cough 3.86 3.41 + 0.45 Measles 4.93 2.86 + 2.07 Diphtheria 0.40 0.41 — 0.01 Phthisis 0.27 0.41 — 0.14 Other forms of Tuberculosis 0.67 2.18 — 1.51 Total of above 58.62 70.12 — 11.50 All other causes 18.52 23.57 + 5.05 Total 77.14 93.69 — 16.55 1922] 12 REPORT OX THE MATERNITY AND CHILD WELFARE WORK. In March the Council appointed an Assistant to the Medical Officer of Health (the position, occupied by the late Mr. Leggatt, of Superintendent of the department and Chief Sanitary Inspector, not being refilled). This has enabled the work of reorganising the health visitation in the Borough to be carried out, and also the co-relation of this work with that of the Voluntary Centres to be more effectively undertaken. Dr. Beatrice Garvie, in the Maternity and Child Welfare work, has had a task of no inconsiderable difficulty, having had the supervising and arranging to avoid the overlapping with the voluntary work, and at the same time the directing of the Council's Health Visitors to the other poor or necessitous cases in the borough—supervision work which was long overdue. I need hardly say that the Assistant Medical Officer has accomplished this admirably, and we now possess records of the cases visited and a system which has received the approval of the Ministry of Health Inspector. In October an effort was made to arouse public interest in the subject of maternity and child welfare by demonstrations, lectures, and exhibits, during Health Week. The title chosen to describe the arrangements was "Islington Health and Baby Week." This was an extension of what had been done the previous year, when the Medical Officer of Health had given one of the series of Library Lectures on a health subject. The following programme was carried out: Exhibition of Hand-coloured Panels on Child Welfare (during the Week, Monday, October 9, 1922. Tuesday, October 10, 1922. Wednesday, October 11, 1922. Thursday, October 12, 1922. In the Central Library, Holloway Road. Lecture at South Islington Welfare Centre, 6, Clephane Road, N. 1, at 7.30 p.m. Dr. Gertrude Dearnley. "How to Give Baby a Good Start in Life." Centre open for inspection. Lecture at 10, Drayton Park (opposite East Islington Welfare Centre), at 7.30 p.m. Dr. Hawthorne. "The Future Citizen." Lecture at Central Library, Holloway Road, 8 p.m. Miss Margaret McMillan, C.B.E. "The Nursery School and its Relation to the Education of To-morrow." Lecture at East Islington (Branch) Welfare Centre, Hurlock Street, Blackstock Road, 7.30 p.m. Dr. Gaffakin. "Cause and Effect of Health in Everyday Life." 3 p.m. Visit to Disinfecting Station and Cleansing Station, Seven Sisters Road (limited by ticket, obtainable at 20, Compton Terrace, N. 1.). Evening Lecture at North Islington Library, Manor Gardens, Holloway Road. Dr. Sloane-Chesser, 7.30 and 9 p.m. "Health Lecture." North Islington Welfare Centre open for inspection. Lantern Lecture at Trinity Hall, Richmond Road, N. 1, 7.30 p.m. "Good Teeth and Good Health." Mr. Wallis, M.R.C.S., L.D.S. West Islington Centre open for inspection. 13 [1922 Lantern Lecture at Central Library, Holloway Road. Dr. G. Clark Friday, October 13, 1922. Trotter, 8 p.m. "Self Help in Heailth and the Citizen's Duty to His Neighbour." (In the Chair, His Worship The Mayor of Islington, Alderman H. G. Coleman, J.P.) Lecture at South Islington (Branch) Centre, 28, Duncan Terrace, N. 1. 7.30 p.m. Dr. Barbara Tchaykovsky. "Infant Welfareand After." (In the Chair, Councillor Miss M. Price.) Saturday, 3 p.m. Visit to Disinfecting and Cleansing Station, Seven Sister? October 14, 1922. Road, N. (limited by ticket, obtainable at 20, Compton Terrace, N.I.). The routine maternity and child welfare work has been summarised by Dr. Garvie, and I submit her covering letter and report, with the relative Tables. August 31, 1923. Dear Sir,—Herewith I enclose a report on the working of the Maternity and Child Welfare Scheme for the year ending 31-12-1922, along with a digest of the VoluntaryCentres' Annual Reports, being the duties you assigned to me after my appointment on the 9th March, 1922, as Assistant to the Medical Officer of Health. Hoping this will meet with your approval. I am, Yours faithfully, Beatrice Garvie, Assistant to the Medical Officer of Health. G. Clark Trotter, Esq., M.D., Medical Officer of Health, Metropolitan Borough of Islington. ASSISTANT MEDICAL OFFICER'S REPORT ON THE MATERNITY AND CHILD WELFARE SCHEME. YEAR ENDING 1922. The Scheme has been re-arranged so as to bring it, as far as possible, into accordance with the Regulations laid down in the Maternity and Child Welfare Act, 1918, and the Maternity and Child Welfare Circulars issued by the Ministry of Health. Work in the Metropolitan Borough of Islington under this Scheme is Municipal and Voluntary. The Municipal part of the Scheme may roughly be divided into three headings: 1. Home visitation of mothers and children up to 5 years of age. 2. Co-ordination and co-operation with voluntary and other agencies to whom grants are made by the Council. These include the Islington (Voluntary) Welfare Centres (4), Day Nurseries (3), North London Nursing Association, Royal Free Hospital and City of London Maternity Hospital (ante-natal and lying-in patients in connection with applicants for maternity grants), Invalid Children's Aid Association, omen's League of Service for Motherhood, and Field Lane Institution. Co-operation is carried out as far as possible with the Charity Organisation Society, 1922] 14 the National Society for the Prevention of Cruelty to Children, Maternity and Rescue Homes, with the numerous other Welfare Centres in and adjoining the Borough attended by Islington mothers and children, as well as the Almoners of the Hospitals where Islington children are under treatment. Co-operation with the Guardians respecting children under their care has had considerable attention, and it is hoped that this will be satisfactorily arranged by next year. 3. Milk Scheme.—Irrespective of whether applicants are on Council or Voluntary Centres' Registers (see page 17). The Staff (Maternity and Child Welfare, exclusive of Milk Scheme) includes 7 Health Visitors, 1 part-time Clerk, and 1 whole-time (temporary) Clerk. The yearly summary of Health Visitors' work is submitted in tabular form on page 19. 12,292 families were visited. 18,661 being the grand total of visits paid. Comparing the totals for 1921 and 1922 (19,279 against 18,661 visits), the difference is only 607 less for 1922 in spite of the loss of time for visiting due to increase of clerical work on account of re-organisation as well as longer periods of absence of Health Visitors on account of accidents and sickness. On March 31, 1923, it was found that the total number of cases on the visiting list was 12,794 the number of cases on the Voluntary Centre books being 4,469 17,263 The estimated population of children under five years is of age 28,860 The Voluntary Centres in Islington Borough hold ante-natal and post-natal clinics, with educational and other activities, and carry on home visitation of mothers and children attending these clinics. As the Council realise and appreciate the valuable work of the voluntary centres they have allocated an estimated grant of £4,400 for the year ending December 31, 1923. The number of cases on the Voluntary Centres' books at the end of the year was 4,469 (according to the Medical Officer of Health's reading)—see table under "Tabular Statistics.'' On the other hand, the Council's seven Health Visitors had 12,794 cases on their books. This is at the proportion roughly of 1 : 3. The Municipal part of the Scheme, deducting that carried on under the Milk Scheme, does not cover such a wide area of activities, yet the administrative and Health Visitors' work occupies the entire energies of the Maternity and Child Welfare staff, and if the work were reckoned on the basis of children dealt with the grant should be £12,000, but the estimated grant is £3,378, or roughly one quarter (J) of this amount. The figure is arrived at as follows: Total estimated grant £12,380 Estimated grant to Voluntary Centres £4,400 Estimated grant to Milk Scheme 4,602 9,002 £3,378 15 [1922 In Circular M. & C.W. 4, dated August 9, 1918, the Ministry of Health state "that the district with about 400 births a year will be as much as one Health Visitor can undertake, unless the district is very compact, or is of such a class that many infants do not need visiting." Regarding the factor- compactness of the district this can be disregarded, as compact, moderately scattered, and widely scattered are equally balanced in Islington. In 1921, 7,886 births were registered, about 2,550 infants have to be deducted, as they are of such a class that they did not need to be visited by the Health Visitors. This 2,550 is made up of 350 children under one year in our records marked as attending the four voluntary Welfare Centres, and the balance, 2,200, are marked as "Visits declined" or "unnecessary" or "above standard." Deducting 2,550 from 7,886 leaves 5,336, for the 7 Municipal Health Visitors, or the average for each Health Visitor was over 750 for the current year instead of 400. If £2,000 extra were granted for the Council's side of the scheme, this would provide on the present lines for double the staff, including administrative expenses, and would carry out the work according to the Ministry of Health's standard. A plea for more money during this present economy campaign may appear unreasonable and unwise, but if the public could recognise that an increased expenditure now for [Maternity and Child Welfare work means in the future an increase in population, and an increase in economic value of the future citizen, then they would realise that this is true economy. Carrying on the work under present conditions means that over 12,000 children are not visited as often as necessary, and that the infant mortality and "damaged" rate is higher than it ought to be for the lack of stall. It is against human nature not to worry over this seemingly preventable loss amongst Islington children, and further the work of the Council's Health Visitors is disheartening, as about one-third of the mothers have lapsed from attending the Voluntary Centres, and are either indifferent or out when visited, or unable to act on advice given because, owing to financial stress, they are compelled to go out to work. The following are instances of several seemingly preventable infant deaths: (1) a baby died, age 46 days, two days after the birth had been registered, death being due to enteritis and marasmus. As this was a non-noticed birth, the Health Visitor had no opportunity of calling and advising the mother regarding her own health or the baby's feeding; (2) the Health Visitor called to see twins and advised the mother respecting feeding; further visits were declined, and one of the twins died four months later from diarrhaa and vomiting. Nox-Notified Births.—Non-notified births have largely occurred in the practices of a few Doctors and Certified Midwives who are being urged to fulfil the requirements of the Notification of Births Act, and it is hoped further action will be unnecessary. The difference between Registered Births and Notified Births was 585 (still-births are deducted as these are not as yet registerable). 26 non-notified births were untraced, and 559 were investigated. The parents mostly pleaded ignorance of the Act, and a few that they understood it was the Doctor's or Certified Midwife's duty to notify. 16 1922] Still-Births.— Enquiries are made and advice given to the mother about her health and means to be taken to prevent, if possible, future still-births. One hundred and fifty still-births were notified, but only 104 were investigated. Owing to pressure of work these enquiries sometimes cannot be made until a considerable interval after the lying-in period, and on the Health Visitor calling no answer is obtained as the patient may have returned to work, or, especially where the still-birth has been illegitimate, her visits arc not desired. Ante-Natal Work.—The importance and value of this work is now recognised. The Health Visiting staff get into touch with as many expectant mothers as possible. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. 116 cases of Ophthalmia Neonatorum were notified (162 in 1921). 62 cases of Ophthalmia were reported (31 in 1921) by the London County Council. 69 out of the 116 cases of Ophthalmia Neonatorum were attended at birth by midwivea 54 of these 69 were unconfirmed as Ophthalmia Neonatorum by the London County Council's Medical Inspectors. The cases occurred in the sub-registration districts as follows: Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough Cases notified by Doctor . 8 9 10 9 8 17 22 83 Cases notified by Certified Midwives - 8 6 8 10 - 1 33 Cases reported by L.C.C.. 3 5 3 2 5 7 17 42 Cases reported by Health Visitors. - 3 — 2 1 7 7 20 Of the 178 cases investigated, both of the infants' eyes were affected in 108 instances, whilst in 46 the right eye was involved and in 24 the left. Treatment.—16 of 116 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital. 25 of 116 Ophthalmia Neonatorum cases were treated at home by private Doctors. 63 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at the cost of £53 l0s. (In 1921, 78 cases were nursed at the cost of £66 1s.). This was money well spent, as skilled attention decreases the possibility of partial or complete blindness. Results.— Of the 116 Ophthalmia Neonatorum cases : 113 cases completely clear. 2 cases partial impairment of the left eve. 1 case partial impairment of the left eye and complete blindness of the right eye. 17 [1922 Deaths.— One case was certified, as due to Ophthalmia Neonatorum and also Enteritis, but the Doctor who signed the certificate reported in writing to the Medical Officer of Health that the eyes were clear before death. In one case of Ophthalmia Neonatorum, notified by a private practitioner, the mother had removed into Islington to be confined at her relative's home. PUERPERAL FEVER. Definition.— The Royal College of Physicians' definition of Puerperal Fever is: Septicemia, Pyæmia, Septic Peritonitis, Septic Metritis, and other acute septic inflammation in the pelvis occurring as the direct result of child-birth. 34 cases were notified in 1921, and 20 during the current year, being in the proportion of 2 66 per 1,000 births. The notifications were 3 below the average (23) of the preceding 10 years, and showed a decrease of 0.47 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1922. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East The Borough Cases notified - 1 5 - 1 7 6 20 Private Practitioners' Cases — 1 2 - 1 — 3* 7 Hospital Cases — — — —- — 5 1 6 Certified Midwives' Cases. — — 3 - — 2 2 7 Cases inquired into — 1 5 - 1 7 6 20 Cases treated in Hospital — 1 5 - 1 6 6 19 Cases treated at Home - - - - - 1 - 1 * There was one case which occurred after a reported "6 months' abortion"—no Still-birth was notified—therefore, it is questionable, whether this case comes within the College of Physicians' definition of Puerperal Fever. Of the 20 notified cases, 19 were treated in Hospitals. Three of these contracted the disease in Hospitals; 6 cases were removed to Metropolitan Asylums Board Hospitals; and 10 cases were removed to other London Hospitals. Deaths.— Five deaths were registered as being due to Puerperal Fever. One of these was not notified, and 2 were notified after death, and these three were not included in the 20 notified cases. The diagnosis in 2 of the 20 notified cases was not confirmed in the Medical Officer of Health s opinion. This, along with other cases that were notified some time after the date of onset, points to the advisability of reporting suspected cases and of having some arrangement for admitting such to an observation ward. THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. I he total amount expended in the provision of fresh and dried milk for necessitous expectant and nursing mothers and children under live years of age since the Order came into operation is £32,946 3s. 5d. 18 1922] The sum expended for 1922 was £2,729 3s. 7d. (£15,822 3s. 9d. in 1921). The result of the introduction of a more stringent scale, which commenced in July, 1921, showed that of this £15,823 3s. 9d., 80 per cent. was spent in the first half of the year and 20 per cent. in the second half; hence the lesser amount in 1922 was due to this decrease in the latter half of last year continuing; and also to the decrease in the cost of milk, and to the continuance of the improved industrial conditions which existed during the last six months of the year 1921. The scheme for the distribution of milk was again altered by resolution of the Council at their meeting on the 26th October, 1922. This resolution was passed as the Ministry of Health wished a uniform scheme for the distribution of milk in the Metropolitan Boroughs, and considered that in relation to the falling cost of liv ing the Islington scale was too high The scale now is: No. in family. Free. Half-cost. 1 13/- after deduction of rent 15/- after deduction of rent 2 10/6 per head after deduction of rent 12/6 per head after deduction of rent 3 8/6 „ „ 10/- „ „ 4 7/6 „ „ 8/6 „ „ 5 7/- „ „ 8/- „ „ 6 6/6 „ ,, 7/6 ,, „ CO-ORDINATION between the Voluntary Centres and the Medical Officer of Health has been strengthened. Public Health Department.— The Medical Officer of Health on receiving a notification of birth sends to the parents a Centre leaflet inviting mothers in necessitous circumstances to attend. Copies are sent to the Centres weekly of returns of deaths of children under five years received from the local Registrars. When a lapsed case re-attends the Centre, a report on the condition of the child in the intervening period is sent. The Council's Health Visitors attend the Centre clinics once every week or every two weeks to help in weighing babies, doing dressings, giving short health talks, selling dried milk, or taking notes for the Medical Officer of the clinic at the consultations. By this last item the Health Visitors arc enabled, in their district visitation, to give advice on similar lines to mothers of babies who will attend or have keen attending. The Voluntary Centres.—The Centres send weekly returns of new attendances and re-attendances, giv ing names, address, date of birth, and since October for the purpose of more easily tracing these children in our records, birth address and previous address have been added. Monthly returns of children who are attending school and of those who have lapsed are also sent. Weekly returns of "left the district" cases have been agreed to by the Conjoint Centres Committee, and for those who have moved to a known address, a short report as to illnesses and present condition is sent. By means of returns, as far as possible, overlapping in visiting is prevented. In closing, I wish to place on rccord my thanks to those of the Public Health staff who have given me much willing assistance and more especially my appreciation of the Medical Officer of Health's invaluable advice and guidance. 19 [1922 POPULATION. NORTH. Wards 1, 2, 3. SOUTH. Wards 9, 10, 11, and Part of 6. EAST. Ward 5, and Parts of 4 and 6. WEST. Wards 7, 8, and Part of 4. Total. 1922 (Approximate Estimate) 99,400 95,000 52,140 87,360 333,900 28,860 up to 5 years old. BIRTHS. 1921 2,437 (Actual) 1,805 (Approximate) 1,176 (Approximate) 2,468 (Approximate) 7,886 1922 2,095 (Actual) 1,792 (Approximate) 1,167 (Approximate) 2,452 (Approximate) 7,506 Number on Books 1st April, 1923, i.e., Record Cards of Children to be visited. Exclusive of Record Cards marked "Attending Centre," and "Above Standard," "Visits declined," and "Visits not necessary" 12,794 No complete Tables of Ante-Natal or Children "Put on" (Births, Transfers in, Lapsed from Voluntary Centre) or Children "Taken off " (Left Islington, Reached School Age, Deaths, Declined Visits, Children attending Voluntary Centres) as Re-Organisation began in May, 1922. SUMMARY OF VISITS BY HEALTH VISITORS. District 1 2 3 4 5 6 7 Totals. I. Births, First Visits, Infants under 1 Year 557 881 815 884 1,357 1,110 934 6,538 II. Births, Re-Visits, Infants under 1 Year 667 1,076 972 323 509 274 411 4,232 III. Visits to Children, between 1st and 2nd Years 200 218 348 326 655 123 169 2,039 IV. Visits to Children, between 2nd and 5th Years 65 58 169 227 206 59 11 795 V. Visits re Still Births 19 22 13 20 15 8 7 104 VI. Deaths, Visits, re Infants under 1 Year 38 24 25 14 39 26 21 187 VII. Deaths, Visits, re Children 1 to 5 Years 6 4 - 7 7 3 2 29 VIII. Ante-Natal, Home Visits 37 35 48 40 78 10 15 263 IX. Puerperal Fever, Home Visits 2 6 — — 7 5 5 25 Totals 1,591 2,324 2,390 1,841 2,873 1,618 1,575 14,216 X. Attendances at Welfare Centre 17 20 47 44 29 20 30 207 XI. Other Work by Direction 90 99 36 65 40 58 40 428 XII. Visits Declined 46 74 30 68 5 16 26 265 XIII. Visits, House Shut 593 568 466 779 545 187 411 3,549 Grand Total of Visits 2,337 3,085 2,969 2,797 3,492 1,899 2,082 18,661 1922] 20 SUMMARY OF VISITS BY HEALTH VISITORS—Continued. 1 2 3 4 5 6 7 Totals. Analysis of Visits included in I.-IX. relating to (a) Ophthalmia Neonatorum 69 79 29 61 63 68 55 424 (b) Epidemic (Summer) Diarrhœa 2 14 1 — 2 — 2 21 (c) Other Digestive Diseases 1 16 13 1 8 — 9 48 (d) Pneumonia and Bronchitis 10 37 10 17 48 16 11 149 (e) Rickets 5 5 6 — 18 1 16 51 (f) Measles and German Measles 3 23 12 — 14 — 8 60 (g) Whooping Cough 11 5 8 15 25 — 4 68 (h) Tuberculous Disease 2 — 3 1 5 1 — 12 (i) Convulsions - 2 — — 1 — 2 5 (j) Polio-myelitis 1 — — — — — 3 4 (k) Premature Birth 8 10 15 7 11 3 26 80 (l) Atrophy, Debility and Marasmus 20 1 2 — 5 - 1 29 (m) All other investigations** 10 19 18 4 24 22 7 104 (n) Routine Visits included in I. to IX. and not included in (a) to (m) 1,449 2,113 2,273 1,735 2,649 1,507 1,431 13,157 ***Totals (a) to (n) 1,591 2,324 2,390 1,841 2,873 1,618 1,575 14,212 Total Families Visited 1,491 2,063 1,945 1,482 2,280 1,499 1,532 12,292 **e.g.— Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhœa,Polio-myelitis, etc. Syphilis. Rheumatism, Non-notified birth, etc. ***Totals (a) to (n) correspond with Totals I. to IX. 21 [1922 VOLUNTARY CENTRES, STATISTICAL TABLES. North. South. East. West. Totals. Number on Books. 1st April, 1922— Printed Annual Reports of Centres 1,786 Page 12 1,847 Page 11, Table 3 1,115 Page 8, Table 5 1,244 Page 11, Table 4 5,992 New Cases, per Annual Report 828 Page 12 770 Page 11, Table 3 528 Page 8, Table 5 679 Page 11, Table 4 Printed. M.O.H.'s Reading. 2,805 2,614 Children making one attendance only since October 66 Included in above 50 Page 11, Table 3 Not included in above 57 Page 8, Table 5 Not included in above 77 Included in above 250 Returned Cases: 1 Lapsed previous to current year 23 Page 12 35 Page 11, Table 3 66 Page 8, Table 5 15 Table 3, Typed Statistics 139 2 Lapsed during the current year 29 Page 12 95 Page 12, Table 6 24 Page 8, Table 5 70 Page 12, Table 6 218 3 Irrespective of when Lapsed 52 130 90 85 357 Total: "Ceased to Attend" or "Lapsed," Irrespective of Returned Cases, as per Printed Annual Report 1,034 Page 12, Table 14 1,393 Page 11, Table 3 Page 12, Table 6 910 Page 9, Table 9 Page 8, Table 5 891 Page 12, Table 6 4,228 4,375 Number on Books, 1st April, 1923— From Printed Annual Report 1,632 Page 12 1,259 Page 11, Table 3 823 Page 8, Table 5 1,088 Page 11, Table 4 4,802 4,469 Centre, Branch, and Wards. Centre and Branch. Centre and Branch. Centre and Wards. Totals. Individual Children: (1) On the Books. 1st April, 1922 1,786 1,847 1,115 1,244 5,992 A (2) New cases, year ending 31st March, 1923 828 770 528 679 2,805 (3) Returned Cases lapsed previous to current year 23 35 66 15 139 Total of A 2,637 2,652 1,709 1,938 8,936 B Total number of Individual Children* 1,975 (Annual Report, p. 14) 2,705 823 2,000 7,503 Difference between A and B —662 +53 —886 +62 —1,433 Total number of Individual Mothers attending— Comparing these Totals A and B the difference will give either the number of Children on the Books who failed to attend during the year, or the number of Children who attended and whose names were not on the Books. (a) Ante Natal Sessions 381 215 157 150 (300*) 903 (b) Post Natal Sessions 147 No figures available No figures available 345 Home Visits paid by Salaried Workers to: (1) Expectant Mothers 1,012 396 226 343 1,977 (2) Children 12,211 8,351 4,908 7,350 32,820 (3) Ailing Mothers 357 Included in Children's visits. — 863 — * From Returns made to the Ministry of Health. N.B —Page references are to Centres Annual Reports. 1922] 22 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.- 1975 persons died in the Public Institutions located in Islington, of whom 1,344 belonged to this Borough, the remaining 631 having come here for treatment or relief. Of these, 426 died in the Archway House and 112 in the Royal Northern Central Hospital. Of the 1,344 deaths of inhabitants, 977 occurred in the Islington Infirmary, 218 in the Islington Institution, and 116 in the Royal Northern Central Hospital. The proportion which the 1,344 deaths in these Public Institutions bore to the Borough mortality was 29-1 per cent. Without the Borough.—817 deaths of persons belonging to Islington were registered as occurring in Public Institutions in districts of London outside the Borough and in various provincial towns. They included, among others, 24 in the Northwestern Fever Hospital, 42 in the Children's Hospital, Great Ormond Street. 99 in St. Bartholomew's Hospital, 32 in the Colney Hatch Asylum, 57 in the Royal Free Hospital, 53 in the University College Hospital. 42 in the North-Eastern Fever Hospital, 19 in the Eastern Fever Hospital, and 38 in the Middlesex Hospital. These 817 deaths represented 17.7 per cent. of all the deaths registered in the year. Within and Without the Borough.- The deaths of Islingtonians numbered 2,232 and were equal to 46 8 per cent. of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.—Seventy-six inhabitants died from accidental deaths, or suddenly, in places outside Islington, During the previous year (1921) the total deaths in Local Institutions numbered 1868, being 1,340 inhabitants of Islington in Local Institutions, plus 528 non-inhabitants of Islington in Local Institutions, the number in Islington Infirmary being 936, the number in the Royal Northern Hospital 131. The deaths of inhabitants of Islington in Institutions outside the Borough were 793. The total deaths in all Institutions, 2,133 ; and the proportion per 100 deaths from all causes, 48.8. A table showing the Institutional deaths of former years appeared in Report, 1922. Transferable Deaths.—During the year 60 deaths that had occurred in outlying Institutions and other places outside the Borough were transferred by the RegistrarGeneral to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles. Scarlet Fever, Whooping Cough Fevers—Typhus, Enteric and Continued—and Diarrhæal Diseases. During the year 349 persons died from these diseases, the death-rate being 1.05 per 1,000 inhabitants, as contrasted with 0.86 in the corresponding period last year, and a decennial average mortality of 319 and a death rate of 1.00 per 1,000. In London the death-rate from the epidemic diseases was 1.08, while in the six Boroughs encircling Islington the death-rate was 1.00. 23 [1922 Locally the deaths in the Sub-Registration Districts and Wards were as follows: Showing the Deaths from each of the principal Epidemic Diseases in the several Wards and Sub-Registration Districts during the Year 1922. Sub- Registration Districts. Wards. Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarrhœa. Totals. Deaths Deaths Deaths Deaths Deaths Deaths Deaths Deaths Tufnell Tufnell - — 5 2 7 9 4 27 Up. Holloway Up. Holloway — — 9 3 3 3 — 20 Tollington Tollington — — 15 4 8 8 4 39 Lr. Holloway Lr. Holloway — — 32 5 17 7 1 62 Highbury Highbury - — 12 2 8 7 4 33 Mildmay - — 2 — 3 4 2 11 Barnsbury Thornhill - — 21 4 16 4 3 48 Barnsbury - — 9 2 18 5 — 34 Islington South East St. Mary's - — 3 2 6 1 — 12 Canonbury - — 9 1 2 2 1 15 St. Peter's — — 17 4 10 7 10 48 The Borough — — 134 29 98 59 29 349 Total Death Rates — — 0.40 0.09 0.29 0.18 0.09 1.05 Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1912-21 and for the Year 1922. 1912 1913 1914 1915 1916 1917 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 8 0.02 4 0.01 14 0.04 5 0.01 9 0.03 4 0.01 Small Pox — — — — — — — — — — — — Measles 151 0.46 101 0.31 97 0.30 153 0.48 80 0.26 149 0.50 Scarlet Fever 9 0.03 19 0.06 23 0.07 38 0.12 18 0.06 4 0.01 Whooping Cough 54 0.16 62 0.19 83 0.26 103 0.32 60 0.19 45 0.15 Diphtheria 38 0.12 37 0.11 44 0.13 57 0.18 45 0.14 33 0.11 Diarrhœa and Enteritis (under 2 years) 84 10.96 per 1,000 births 210 25.12 per 1,000 births 217 26.53 per 1,000 births 154 20.4 per 1,000 births 117 16.11 per 1,000 births 106 18.16 per 1,000 births 1918 1919 1920 1921 Mean 10 years 1922 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rales. Deaths. Death Rates. Enteric Fever 7 0.02 5* 0.02 3* 0.01 1 0.00 6 0.02 - — Small Pox - — 1 0.00 — — — — — — — — Measles 114 0.39 12 0.04 92 0.27 27 0.08 1ll 0.35 134 0.40 Scarlet Fever 8 0.03 14 0.04 12 0.04 19 0.06 19 0.06 29 0.09 Whooping Cough 147 0.51 17 0.05 70 0.21 43 0.13 78 0.24 98 0.29 Diphtheria 45 0.16 51 0.16 135 0.40 110 0.33 65 0.20 59 0.18 Diarrhœa and Enteritis (under 2 years) 82 15.78 per 1,000 births 85 13.53 per 1,000 births 77 8.19 per 1,000 births 156 19.78 per 1,000 births 129 17.57 per 1,000 births 71 9.48 per 1,000 births *Including 2 Malarial Fever. 1922] 24 Showing the Deaths from Diarrhœal Diseases together with those classed under Enteritis and its Sub-headings, arranged in quarterly periods, and in three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhœa. Enteritis, &c. Totals. Diarrhœa. Enteritis, &c. Totals. Diarrhœa Enteritis. &c Totals. Diarrhœa. Enteritis, &c. Totals. Diarrhœa. Enteritis, &c. Totals. Under 1 year 5 9 14 3 7 10 4 7 11 10 15 25 22 38 60 1 to 5 years — 8 8 — 1 1 1 1 2 2 — 2 3 10 13 Over 5 years 1 2 3 - 1 1 2 2 4 1 2 3 4 7 11 Totals 6 19 25 3 9 12 7 10 17 13 17 30 29 55 84 INFLUENZA. During the year Influenza caused 221 deaths, which is an increase of 128 on the return for the year 1921; and 45 above the average of the preceding ten years 1912-21. The death rate was equal to 0.66 per 1,000 inhabitants. Showing the Deaths from Influenza in the Quarters of the Year 1922, together with the averages of the corresponding periods, 1912-21. Years. Quarters. Totals. First. Second. Third. Fourth. 1912 14 4 2 8 28 1913 25 18 5 10 58 1914 17 5 3 5 30 1915 52 11 3 5 71 1916 9 7 2 18 36 1917 22 8 1 5 36 1918 14 8 60 849 931 1919 294 35 6 21 356 1920 56 43 7 12 118 1921 33 17 2 41 93 Average 54 16 9 97 176 1922 200 10 3 8 221 Increase or Decrease + 146 - 6 - 6 - 89 + 45 The following statement gives the ages at death of the persons who suffered from Influenza during the preceding ten years as compared with the return for the year 1922: Ages. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Mean 10 yrs 1922 Difference. 0-5 1 5 1 3 — 1 106 19 10 5 15 22 + 7 5-10 — — 1 — — — 52 5 3 - 6 1 - 5 10-15 — — — — — — 32 8 3 1 4 - - 4 15-25 2 2 1 5 — — 141 48 12 5 22 11 - 11 25-35 1 4 1 4 — 2 252 82 21 9 38 14 - 24 35-45 5 8 6 7 1 2 109 47 18 15 22 18 - 4 45-55 1 17 5 15 6 7 93 48 17 18 23 42 + 19 55-65 4 5 7 12 6 8 69 42 17 13 18 37 + 19 65-75 7 7 7 11 10 10 50 36 13 14 16 43 + 27 75& upwards 7 10 1 14 13 6 27 21 4 13 12 33 + 21 All Ages 28 58 30 71 36 36 931 356 118 93 176 221 + 45 25 1922 SEPTIC DISEASES. Erysipelas and Puerperal Septicæmia are the principal diseases of this class. Erysipelas. 9 deaths were returned from this disease, or 4 more than in the year 1921 and 1 below the average of the preceding ten years 1912-21. Puerperal Diseases. —These comprise Puerperal Pyæmia, Septicæmia, Septic Intoxication and Puerperal Fever, and they caused 5 deaths, which is 7 below the return 1521, and 3 less than the average of the ten years 1912-21. CANCER. Cancer.—There were 421 deaths from this malignant disease during the year compared with 475 in 1921, and with an average of 410 in the previous decennium. The deaths represent a death-rate of 126 per 1,000 of the civil population and is 0 03 above the average rate (1.29) of the last ten years; 197 deaths occurred among males and 224 among females. The following statement shows the ages at death of the persons attacked during the past ten years, and the return for the year 1922 : Mean Ages. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 10yrs 1922 Difference 0- 5 1 1 — — — 2 — 2 3 2 1 — — 1 5-15 2— 2 132 — 1— 11— — 1 15-25 4 7 2 2 — 5 — 4 1 1 4 4 — 25-35 7 13 11 7 4 8 8 5 10 10 8 8 — 35-45 25 31 37 24 30 31 27 36 32 34 31 34 + 3 45-55 71 83 69 75 86 73 75 101 74 98 80 88 + 8 55-65 130 99 121 120 124 131 99 120 110 140 119 124 + 5 65-75 86 115 96 105 114 120 126 123 124 131 114 110 — 4 75-85 51 49 40 39 48 55 52 39 43 52 47 47 — 85 & upwards 5 6 6 4 3 5 6 7 5 6 5 6 + 1 382 404 384 377 412 432 393 438 402 475 410 421 +11 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1922. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 11 8 12 19 19 23 25 117 Second 17 11 5 7 15 14 31 100 Third 12 15 11 17 18 18 27 118 Fourth 12 8 5 13 15 13 20 86 The Year 52 42 33 56 67 68 103 421 TUBERCULOSIS. Tuberculosis caused 433 deaths, which were 100 below the average of the last decennium, but were 23 above the number registered in 1921. The death-rate resulting from them was equal to 1.30 per 1,000 of the civil population, and represented 9.4 per cent. of the deaths from all causes during the year (vide p. 66). Tuberculosis of the Respiratory System (Phthisis is Pulmonary Tuberculosis), caused 378 deaths, as contrasted with the decennial average of 435, while the death-rate was 1.13 per 1,000 of the civil population, as against the decennial rate 1922] 26 of 1.37 per 1.000. There was a decrease of 57 on the ten years' average number of deatlis, and of 0 24 on the mean death-rate. 'Tuberculosis (Respiratory System). Proportion of Dcatlis Death rates Death rates from Tuberculosis from All Causes Years. Deaths. per 1,000 per 100 Deaths per 1,000 inhabitants. from All Causes. inhabitants. 1912 427 1.31 9.12 14.3 1913 420 1.26 8.35 15.1 1914 461 1.42 9.33 15.2 1915 496 1.57 8.98 17.0 1916 458 1.48 9.64 15.3 1917 485 1.63 10.54 15.5 1918 516 1.80 8.83 20.4 1919 388 1.18 8.56 14.1 1920 349 1.04 7.80 13.3 1921 355 1.07 8.13 13.1 Average 10 years 435 1.37 8.90 15.4 1922 378 1.13 8.19 13.8 The following return gives the deaths at each age period: Age Periods. Males. Females. Total. 0-5 4 3 7 5-15 1 5 6 15-25 38 34 72 25-35 46 31 77 35-45 54 25 79 45-55 49 28 77 55-65 35 13 48 65 upwards 6 6 12 Total 233 145 378 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1922. Quarters. Tufnel1. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough. First 11 13 8 11 21 24 29 117 Second 7 12 12 13 14 22 22 102 Third 7 6 6 8 18 12 19 76 Fourth 3 10 9 10 17 11 23 83 The Year 28 41 35 42 70 69 93 378 Showing the Deaths from Tuberculosis during 1922. Form. Ages. Sex. Districts. Total Deaths. 0-1 1-5 over 5 M F Tuf. U.H. Toll. [ L.H. H. B. S.F. Respiratory 2 5 371 233 145 28 41 35 42 70 69 93 378 Meningeal 4 25 7 14 22 4 2 2 4 8 4 12 36 Abdominal 1 6 0 7 5 — 2 2 2 3 1 2 12 General — — 3 3 — - — 1 — 1 — 1 3 Other forms - - 4 2 2 - — 1 — 1 — 2 4 All Tuberculosis 7 36 390 259 174 32 45 41 48 83 74 110 433 27 [1922 deaths from the diseases of the respiratory system. (Exclusive of Tuberculosis and Influenza). These diseases, which include Chronic and Acute Bronchitis, Pneumonia, Pleurisy and Asthma. caused 903 deaths, or 186 more than in 1921. They were equal to a death-rate of 2.70 per 1.000 of the civil population, and represented 19.6 per cent. of the total deaths registered in the Borough. Acute Bronchitis.-There were 130 deaths as compared with 96 in the previous year 64 occurred among males, and 66 among females. The deaths of 18 infants under 12 months were registered. Chronic Bronchitis. 277 deaths were ascribed to it, 145 being males and 132 females. This return is 43 above that for 1921. Pneumonia (All forms).—442 deaths were registered, of which 247 were males and 195 females. They are 110 more than the number who died in 1921. It was very fatal to infants under a year old, among whom it caused 97 deaths, while between the ages of 1 and 5 years 134 died from it. Above 5 years of age the deaths numbered 211. 111 Deaths occurred in Public Institutions, chiefly the Workhouse Infirmaries. Pleurisy—Of this disease 12 deaths were registered. 4 deaths occurred in Public Institutions. Asthma and Emphysema.—Seventeen deaths were recorded from these diseases, 16 of which were adults. Other Diseases of the Respiratory System.—Twenty five deaths were registered, as contrasted with 28 in 1921. VENEREAL DISEASES. Seventeen deaths were ascribed to these diseases, as compared with an equal number in 1921. Of these 12 were males and 5 females. The mean deaths of the preceding ten years 1912-21, were also 17. The annual average number of deaths recorded during ten years from them at three groups of ages has been as follows: Under 1 year, 10 deaths, 1-5 years, 1 death, and over 5 years, 6 deaths, making an average total of 17 per annum. The treatment centres for these diseases are the Royal Northern Hospital, Holloway Road, N., and the Royal Free Hospital, Gray's Inn Road, W.C. DEATHS FROM COAL-GAS POISONING. During the year 16 deaths were registered from asphyxia caused by the inhalation of carbon-monoxide gas. Fifteen of these deaths were attributable to suicide, while the cause of the remaining death was doubtful as to whether it was accidental or otherwise. Of the 16 deaths. 11 were males and 5 females, the ages ranging from 24 to 70 years. ACCIDENTAL DEATHS. The deaths due to accident numbered 94. Of this number 32 deaths were due to vehicular traffic. Although the number due to this cause is showing a reduction in recent years, it is notorious that in London the regulation of street traffic still permits the passage of vehicles on the near side while passengers are alighting from tramcars and buses. In other large cities there are special by-laws, and the ruthless action of drivers in dashing past standing public vehicles can be summarily dealt with. 1922] 28 INQUESTS AND MORTUARY. During the year 316 bodies were received into the Mortuary, as compared with an average of 490 in the preceding 10 years. Only one infectious body was received during the year. The daily average number of bodies received was 0.9 as compared with 0.8 in 1921. In 307 cases inquests were held, as contrasted with an average of 370 in the ten years 1912-21. Bodies received into Mortuary. Inquests. 1912 634 443 1913 575 384 1914 537 369 1915 612 475 1916 507 394 1917 479 359 1918 476 348 1919 429 321 1920 340 312 1921 313 299 Average 490 370 1922 316 307 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1922 and 1921. 1922 No. of bodies received. Daily Average. No. of Inquests held. 1921 No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 103 1.1 83 1st Quarter 74 0.8 69 2nd „ 81 0.9 83 2nd ,, 64 0.7 56 3rd ,, 69 0.7 53 3rd „ 90 1.0 76 4th „ 63 0.7 88 4th ,, 85 0.9 98 Total for year 316 0.9 307 Total for year 313 0.8 299 PREVENTION OF INFECTION. Notification, Isolation, Fatality, of Specified Diseases under the Provisions of the Public Health (London) Act, 1891. The Principal Diseases Include : Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus Fever, Puerperal Fever and Erysipelas. There were 2,787 cases of the diseases which are notifiable under the Public Health (London) Act, 1891, in addition to which there were other communicable ailments, such, as Tuberculosis, Ophthalmia Neonatorum, Acute Poliomyelitis, Cerebro-Spinal Fever, Encephalitis Lethargica, Acute Influenzal Pneumonia, Acute Primary Pneumonia, Malaria and Dysentery, which are notifiable either under Orders of the late Local Government Board, or of the London County Council with the approval of that Board. The total cases notified are 1,557 less than those of the previous year (4,344), and 596 above the average (2191) of the preceding ten years. The largest increases when contrasted with the decennial averages are to be found in the returns from Diphtheria and Scarlet Fever which were respectively 376 and 309 in excess, while the other diseases all showed a decrease. The 2,787 cases were equal to an attack-rate of 8.34 per 1,000 of the civil population. 29 [1922 In London the attack-rate was 773 per 1,000 of the civil population, or 0.61 less than in Islington, while in the Encircling Boroughs it was 7.88 or 0.46 Below the local rate- The returns for the preceding ten years are given in the following statement: Year. Cases. Attack-rates per 1,000 civil population. 1912 1,577 4.83 1913 2,171 6.54 1914 2,947 9.08 1915 2,210 6.98 1916 1,439 4.65 1917 1,251 4.21 1918 1,127 3.93 1919 1,993 6.05 1920 2,853 8.49 1921 4,344 13.05 10 years average 2,191 6.89 1922 2,787 8.34 Registration Sub-Districts.—The total number of cases notified in these districts was as follows: Total cases notilied. Tufnell 256 Upper Holloway 361 Tollington 415 Lower Holloway 293 Highbury 366 Barnsbury 447 Islington South-East 649 Total 2,787 Small Pox.—No case was notified in the Borough during the year. The average number of cases during the preceding ten years was only 0.4. Diphtheria was responsible for 1,126 cases of illness, which were 376 above the average (750) of the preceding ten years. The attack-rate was equal to 3.37 per 1,000 of the civil population annually, and was 1.01 above the mean rate (2.36) of the decennial period. In London the attack-rate was 3.40 per 1,000, and the Encircling Boroughs 3.31. Scarlet Fever.—1,496 cases were notified, and they showed an increase of 309 or 26 per cent. on the average (1,187) of the ten years 1912-21. The attack-rate was equal to 4.48 per 1,000 of the civil population annually, which is an increase of 0 75 per 1,000 of the mean rate (3.73) of the preceding ten years. In London the attack rate was 3.83 per 1,000 of the civil population, while in the Encircling Boroughs it was 3.95. Enteric Fever.—Only 9 cases were notified, a decrease of 25 on the average (34) that obtained during the ten years 1912-21. The attack-rate was 0.03 per 1,000 annually, or 0.08 per 1,000 below the mean rate (0.11) of the last ten years. In London the rate was 0.06, and in the Encircling Boroughs 0.04 per 1,000 of the eivil population. 1922] 30 Typhus Fever.— No case was notified. Puerperal Fever.-See page 17. Erysipelas.—132 cases were notified, or 60 below the average 192 of the preceding ten years, the attack-rate being 0.39 per 1,000 of the civil population, as compared with 0 43 in London and 0 52 in the Encircling Boroughs. FATALITY FROM THE EIGHT PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES. By " Fatality " is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that of the 2,787 cases notified, 102 deaths occurred, or 3.7 per cent., which contrasts with an average percentage of 4.5 in the preceding ten years 1912 21. Years. Cases. Deaths. Fatality. 1912 1,577 62 3.9 1913 2,171 76 3.5 1914 2,947 113 3.8 1915 2,210 118 5.3 1916 1,439 87 6.0 1917 1,251 55 4.4 1918 1,125 67 6.0 1919 1,993 96 4.8 1920 2,870 173 6.0 1921 4,344 146 3.3 Mean 2,191 99 4.5 1922 2,787 102 3.7 Hospital Isolation.—Of the 2,787 cases of infectious diseases notified, 2,621 were isolated in hospital, or a percentage of 94.0, while only 6 per cent. of the patients, therefore were nursed at home. With one exception this is the highest number on record. The following tabular statement shows the number of cases treated in the various public institutions: Year. Cases treated in Hospital. Percentage of cases treated. 1912 1,577 84.1 1913 1,866 85.9 1914 2,543 86.3 1915 1,991 90.1 1916 1,269 90.0 1917 1,099 87.8 1918 982 87.1 1919 1,772 88.9 1920 2,642 92.0 1921 4,117 94.8 1922 2,621 94.0 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated. Percentage of known cases. Scarlet Fever 1,496 1,432 95.7 Diphtheria 1,130 1,109 98.1 Enteric Fever 9 8 88.9 Erysipelas 132 58 43.9 Puerperal Fever 20 14 70.0 2,787 2,621 94.0 31 [1922 Summary of Infectious Sickness and of Deaths arising therefrom, distinguishing the Cases treated at Home and in Hospitals; and showing the parcentages of notified Cases removed to Hospitals, together with the Fatality among eases treated at Home and in Hospitals during the year 1922. Notified Cases Treated. Percentages of Notified Cases Treated. Deaths Occurring. Percentage of Deaths Occurring. In Hospital At Home Total In Hospital At Home In Hospital At Home Total In Hospital At Home Total small Pox - - - - - - - - - - - Scarlet Fever 1,432 64 1,496 95.7 4.3 29 - 29 2.0 — 1.9 Diphtheria 1,109 21 1,130 98.1 1.9 56 3 59 5.0 14.3 5.2 Enteric (Typhoid Fever) 8 1 9 88.9 11.1 - - - - - - Typhus Fever - - — — — — - — — — — Erysipelas 58 74 132 45.9 56.1 8 1 9 13.8 1.3 6.8 Puerperal Fever 14 6 20 70.0 30.0 4 1 5 28.6 16.6 25.0 Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Cholera - - - - - - - - - - - Total 2,621 166 2,787 94.0 6.0 97 5 102 3.7 3.0 3.7 Shoving the number of Cases and Attack-Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1912-21 and in 1922. DISEASES. YEARS. Average number of cases, 1912-21 1922 Increase or Decrease 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Small Pox Cases - - - - - - 2 2 - - - - - Rate — — - - - — 0.00 0.00 — - - - - Diphtheria Cases 512 546 651 620 587 556 514 645 1324 1548 750 1126 + 376 Rate 1.57 1.65 2.01 1.96 1.90 1.87 1.80 1.96 3.94 4.65 2.36 3.37 + 1.01 Membranous Croup Cases 4 4 8 4 6 5 4 4 4 5 5 4 — 1 Rate 0.01 0.01 0.02 0.01 0.02 0.02 0.01 0.01 0.01 0.02 0.02 0.01 - 0.01 Scarlet Fever Cases 811 1317 1853 1332 638 478 432 1084 1307 2622 1187 1496 + 309 Rate 2.49 3.97 5.71 4.21 2.06 1.61 1.51 3.29 3.89 7.87 3.73 4.48 + 0.75 Enteric Fever Cases 49 50 76 28 32 23 30 16 24 10 34 9 - 25 Rate 0.15 0.15 0.23 0.09 0.10 0.08 0.10 0.07 0.07 0.03 0.11 0.03 - 0.08 Continued Cases - - - — — - - 1 - - - - - Rate — - — - - — — 0.00 — — — - - Puerperal Fever* Cases 16 28 25 23 21 16 4 29 29 34 23 20 — 3 Rate 1.95 3.41 3.10 3.48 2.89 2.74 0.77 0.46 3.08 4.31 3.13 2.68 -0.45 Erysipelas Cases 185 226 334 203 155 1 .73 141 212 165 125 192 132 - 60 Rate 0.57 0.68 1.03 0.64 0.50 0.58 0.49 0.64 0.49 0.38 0.60 0.39 -0.21 Totals Cases 1577 2171 2947 2210 1439 1251 1127 1993 2853 4344 2191 2787 + 596 Rate 4.83 6.54 9.08 6.98 4.65 4.21 3.93 6.05 8.49 13.05 6.89 8.34 + 1.45 *Per 1,000 Registered Births. .5. £V 5 1 t; * £ 1922] 32 Showing the Cases of the Notifiable Infectious Diseases notified in the SubRegistration Districts and the Wards during the Year 1922. SubRegistration Districts. Wards. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell - 125 116 - 1 - 14 - - - - 256 Up. Holloway Up. Holloway - 200 136 - 1 - 23 1 - - - 361 Tollington Tollington - 259 140 - 1 - 10 5 - - - 415 Lr. Holloway Lr. Holloway - 141 138 1 1 - 12 — - - - 293 Highbury Highbury - 122 105 - — - 8 - - - - 235 Mildmay - 68 56 - 2 - 4 1 - - - 131 Barnsbury Thornhill - 148 110 1 — - 17 3 - - - 279 Barnsbury - 82 72 - - - 10 4 - - - 168 Islington, S.E. St. Mary's - 95 63 — 1 - 3 1 - - - 163 Canonbury - 128 83 — — - 13 2 - - - 226 St. Peter's - 128 107 2 2 - 18 3 - - - 260 Totals — 1496 1126 4 9 — 132 20 - - — 2787 Attack-Rates per 1,000 population — 4.48 3.37 0.01 0.03 - 0.39 0.06 - — — 8.34 OTHER NOTIFIABLE DISEASES. Acute Poliomyelitis. No case was ascribed to this disease during the year, as contrasted with 3 in 1921, and 7 cases in 1920. 1922 1921 Cases. Deaths. Cases. Deaths. 1st quarter Nil Nil - - 2nd „ ,, ,, 2 — 3rd ,, ,, ,, - — 4th „ ,, ,, 1 1 Nil Nil 3 1 Epidemic Cerebro-Spinal Meningitis. Three cases were notified, or four cases less than in 1921. During the ten years 1912-21, the cases averaged 19 per annum. A return of attacks of the disease during the past ten years is given in the following statement: 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Average 10 yrs. 1912-21 1922 Total Deaths, 1912-22. 1st quarter 1 1 2 12 7 15 7 8 5 3 6 1 41 2nd ,, 6 3 3 13 17 11 4 7 5 3 7 2 57 3rd ,, 3 1 2 11 8 1 1 1 2 — 3 - 14 4th „ 3 1 — 4 7 3 4 - 2 1 2 — 11 Year 13 6 7 40 39 30 16 16 14 7 18 3 123 The deaths during the year numbered 3, and were equal to the very high rate of 100 per cent. of the cases notified. 33 [1922 Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. These Regulations came into force on the 7th January, 1919, and during the 4 years. the following cases were notified by medical practitioners to the Medical Officer of Health: 1922 1921 1920 1919 Maleria 2 8 17 193 Dysentery 1 - 4 14 Acute Primary Pneumonia 77 47 34 12 Acute Influenzal Pneumonia 67 25 22 12 Pneumonia - - 3 29 Total 147 80 80 260 Acute Encephalitis Lethargica and Acute Polio-Encephalitis. These diseases became notifiable under an Order of the Local Government Board on the 1st January, 1919, and during the year 3 cases of Acute Encephalitis Lethargica were notified, all of which proved fatal. No case of Acute Polio-Encephalitis was known in the Borough. Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. See p. 16. Tuberculosis. During the year 707 cases of Tuberculosis in its different forms were notified. The attack-rate was equal to 2.12 per 1,000 of the civil population. This number shows a decrease of 54 on the return of the previous year, and of 016 per 1,000 on the attack-rate. It was also 73 below the number in 1920. Respiratory (Pulmonary) Tuberculosis.—570 notifications were Received, Of which 339 referred to males and 231 to females, and represented an attack-rate of 1.71 per 1,000. The return was a decrease of 82 on that of 1921, and 93 on 1920. Showing the Notified Cases of Tuberculosis in the Wards during 1922. Registration Sub-Districts. Wards. Pulmonary Phthisis. Other Forms of Tuberculosis. Grand Totals Tuberculosis Rate per 1,000 of Population. Males Females Total Males Females Total Tufncll Tufnell 27 18 45 4 5 9 54 1.59 Up. Holloway Up. Holloway 30 22 52 3 6 9 61 1.77 Tollington Tollington 29 23 52 13 6 19 71 2.29 Lr. Holloway Lr. Holloway 34 28 62 14 6 20 82 2.01 Highbury Highbury 31 18 49 6 8 14 63 1.91 Mildmay 24 14 38 9 4 13 51 1.90 Barnsbury Thornhill 25 32 57 6 6 12 69 2.22 Barnsbury 27 17 44 4 5 9 53 2.25 Islington. S.E. St. Mary's 17 15 32 6 6 12 44 2.47 Canonbury 47 15 62 4 3 7 69 2.22 St. Peter's 48 29 77 8 5 13 90 2.98 Totals 339 231 570 77 60 137 707 2.12 G I 1922; 34 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS. NOTIFIED DURING 1922. Tubercular Diseases. Sex. Cases Notified in Whole District. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Phthisis (including Tuberculosis of Larynx) M. 339 1 5 8 74 159 86 6 F. 231 - 1 11 67 114 31 7 Tubercular Meningitis M. 7 — 6 1 — — — — F. 10 1 5 4 - - - — Tabes Mesenterica M. 15 1 — 11 2 1 — — F. 10 1 2 5 2 — — — General Tuberculosis M. 1 — — — 1 - — — F. 1 — — - - - 1 - Other forms of Tuberculosis M. 54 1 7 24 10 8 4 - F. 39 1 2 15 8 10 3 — All Tubercular Diseases M. 416 3 18 44 87 168 90 6 F. 291 3 10 35 77 124 35 7 Totals 707 6 28 79 164 292 125 13 Percentages at each life period to total cases 100 0.9 3.9 11.2 23.2 41.3 17.7 1.8 From the above statement it will be seen how the disease attacked people at the various ages, viz.: In every hundred cases 0.9 were under 1 year of age. „ „ 3.9 were aged 1 to 5 years. „ „ 11.2 were aged 5 to 15 years. Pr me ,, „ 23.2 were aged 15 to 25 years of „ „ 41.3 82.2 were aged 25 to 45 years Life „ „ 17.7 were aged 45 to 65 years „ ,, 1.8 were aged 65 and upwards. Showing the Notified Cases of Tuberculosis in the Quarters during 1922. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Males Females Total Males Females Total Males Females Total Males Females Total Males Females Total Phthisis 109 63 172 81 68 149 76 42 118 73 58 131 339 231 570 Tubercular Meningitis 2 3 5 4 5 9 1 — 1 - 2 2 7 10 17 Tabes Mescntcrica 3 3 6 5 3 8 5 3 8 2 1 3 15 10 25 General Tuberculosis — 1 1 1 — 1 — — — — — — 1 1 2 Other forms of Tuberculosis 16 10 26 13 19 32 13 4 17 12 6 18 54 39 93 Totals 130 80 210 104 95 199 95 49 144 87 67 154 416 291 707 Disinfection of Houses and Rooms after Phthisis. The following statement gives the particulars for the year: Houses. Rooms. 1st quarter 67 8 22nd „ 55 77 3rd „ 55 73 4th ,, 77 96 Total 254 328 35 [1922 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912 Summary of Notifications during the period from the 1st January, 1922, to the 30th December, 1922, in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up. Total Primary Notifications Pulmonary Males 1 5 3 4 23 51 83 76 62 24 6 338 468 ,, Females — 1 2 7 27 40 69 45 27 4 7 229 302 Non-pulmonary Males 2 13 17 11 7 6 8 1 1 3 — 69 72 „ „ Females 2 9 13 6 6 4 8 2 3 1 - 54 68 Age-periods Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions Sanatoria. Under 5 5 to 10 10 to 15 Total Primary Notifications Pulmonary Males - - 1 1 1 76 194 Females — — 2 2 2 69 128 Non-pulmonary Males — 3 5 8 8 9 35 „ „ Females. 1 3 2 6 6 7 26 TUBERCULOSIS DISPENSARIES. The work of the Tuberculosis Dispensaries has been very satisfactorily performed. Dr. McFarland, the Tuberculosis Officer for the southern portion of Islington, and Dr. Comyn, the Tuberculosis Officer for the northern portion, have been constantly in touch with the Public Health Department, and co-ordination has thus been most satisfactorily maintained. I have to thank personally these two Assistant Medical Officers (Tuberculosis) for the good results obtained. During the year 1,181 persons were examined by the Tuberculosis Officers, and the patients made 9,956 attendances. At the Northern Dispensary there were 600 new cases, and at the Southern 581, while the attendances at the former were 3,297 and at the latter 6,659. The examination of contacts with tuberculous cases showed that 30 were suffering from tuberculosis, 33 were suspect, and 396 were not suffering. The nurses of the Northern Dispensary paid 1,222 visits, and those of the Southern 2,398, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 215 visits, and of the Southern 377 visits to the patients' homes for the purpose of examining them. 1922] 36 The number of persons in attendance at them in each year is as follows: TUBERCULOSIS. 1917 1918 1919 1920 1921 1922 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 628 717 635 872 585 756 655 760 615 758 600 581 Actual number of Attendances 2279 4291 3798 6511 4057 6782 3921 6895 3212 7030 3297 6659 Totals 2907 5008 4433 7383 4642 7538 4576 7655 3827 7788 3897 7240 A summary is given for the following years: Cases. Attendances. Cases. Attendances. 1916 312 944 1920 1,415 10,816 1917 1,345 6,570 1921 1,373 10,242 1918 1,507 10,309 1922 1,181 9,956 1919 1,341 10,839 Totals 8,474 59,676 Table showing the number of Tuberculous Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1922. Date. Dispensary Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 302 265 302 215 293 282 252 239 252 358 314 223 3,297 9,956 Southern 632 581 628 527 604 535 508 511 518 566 558 491 6,659 New Cases IncludingContacts Northern 47 64 64 43 64 39 43 40 36 62 57 41 600 1,181 Southern 73 63 53 46 64 41 35 38 49 40 44 35 581 Contacts. Tuberculosis Northern — — 1 1 — 1 — — 2 — — — 3 30 Southern 1 3 3 3 1 1 2 3 1 2 — 5 25 Suspects Northern 2 — 3 1 1 — 1 1 3 4 - 2 18 33 Southern 2 2 2 2 1 1 2 1 2 — - - 15 Non-Tuberculous Northern 11 29 28 13 23 10 14 14 13 36 26 20 237 396 Southern 22 15 15 7 16 13 13 15 9 8 17 9 159 Nurses' Visits Northern 102 116 103 84 116 98 108 106 112 99 101 77 1,222 3,620 Southern 219 187 267 225 238 21 186 213 227 198 214 203 2,398 Tuberculosis Officers' Visits Northern 13 18 25 18 14 17 19 19 16 20 18 18 215 592 Southern 26 29 30 31 36 24 32 33 35 34 33 34 377 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,359 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 885 were Scarlet Fever, and 472 Diphtheria. The number of notifications of the several diseases are given below: Disease. No. of Notifications. Average of preceding 10 years. Increase or Decrease. Small Pox - - - Scarlet Fever 885 686 + 199 Diphtheria 472 359 + 113 Enteric Fever 2 3 - 1 Other Diseases — 1 - 1 Total 1,359 1,049 + 310 37 [1922 Non-Notifiable Diseases.—6,453 cases came to the knowledge of the Medical Officer of Health during the year, viz.: 2,703 cases of Measles, 478 cases of Chicken Pox, 539 of Whooping Cough, and 2,733 of other diseases. The information respecting these cases was received from the teachers of 60 schools. Exclusion of Scholars from Schools.—4,812 children were excluded from classrooms of various schools owing to the presence of an infectious disease, chiefly Diphtheria and Scarlet Fever, in the houses wherein they lived. The non-notifiable diseases among children attending the Public Elementary Schools were: Disease. Notifications. by Teachers. Average of preceding 10 years. Increase or Decrease. Measles 2,703 1,382 + 1,321 Chicken Pox 478 822 - 344 Whooping Cough 539 618 - 79 Other Diseases 2,733 2,565 + 168 6,453 5,387 + 1,066 Note.—"Other Diseases" include Mumps, Scabies, Ophthalmia, Itch, etc. BACTERIOLOGICAL EXAMINATIONS. 1,864 examinations were made for the medical profession of the sputum, of swabs from the throat and of the blood of patients suspected to be suffering from Phthisis, Diphtheria and Enteric Fever, respectively. This number is an increase of 87 on that of the preceding year. It is also 675 above the decennial average. Of the total examinations, 430 or 23 per cent. gave positive results. Diphtheria.—1,244 specimens were examined for Diphtheria, of which 291, or 23.4 per cent., were found to contain Diphtheria bacilli. Enteric Fever.—9 specimens of blood were examined, all of which gave negative results. Phthisis.—611 specimens of sputum were examined, 139, or 22.7 per cent., of which showed that the patients were suffering from this disease. DIPHTHERIA—PATHOGENICITY TESTS. 1922. No. Submitted for Negative Result. Positive Result. Non-Virulent. Virulent. Examination. 20 7 13 5 8 See also Bacteriological Examinations of Milk, p. 54. 1922] 38 Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Phthisis, 1912.22. Periods Diphtheria. Enteric Fever. Phthisis. Positive Results. Negative Results. Total Examined Positive Results. Negative Results Total Examined Positive Results. Negative Results. Total Examined Totals. 1912 137 298 435 23 27 50 119 341 460 945 1913 163 418 581 24 28 52 183 546 729 1,362 1914 178 518 696 15 44 59 243 567 810 1,565 1915 123 360 483 16 19 35 198 568 766 1,284 1916 127 277 404 10 12 22 135 390 525 951 1917 100 216 316 12 8 20 165 420 585 921 1918 74 171 245 3 21 24 111 358 469 738 1919 116 352 468 5 15 20 92 348 440 928 1920 261 677 938 3 20 23 83 375 458 1,419 1921 238 969 1207 3 19 22 127 421 548 1,777 Average 10 years 152 425 577 12 21 33 146 433 579 1,189 1922 291 953 1,244 . 9 9 139 472 611 1,864 VACCINATION. Of the 7,044 births registered in 1921, the returns of vaccination show that only 2,961 infants were successfully vaccinated, while 16 were found to be insusceptible. There were also 456 who died unvaccinated, and 2,506 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians ; 17 vaccinations were postponed under medical authority, 357 were removed to other districts or places unknown, thus leaving 731 unaccounted for. The return of certificates of exemption, therefore, represents 35 6 per cent. of the registered births. Certificates of Exemption.—The following tabular statement shows the increase of these certificates, more especially since 1909 : '906 123 1911 1,241 1916 1,796 1907 259 1912 1,646 1917 1,341 1908 588 1913 1,942 1918 1,027 1909 824 1914 2,124 1919 1,583 1910 1,080 1915 1,710 1920 2,866 1921 2,506 Vaccination per 100 Vaccination per 100 Vaccination per 100 Years. births, less infants who Years. births, less infants who Years. births, less infants who died unvaccinated. died unvaccinated. died unvaccinated. . 1880 89.8 1894 84.0 1908 72.4 1881 90.8 1895 70.9 1909 70.7 1882 91.1 1896 73.9 1910 66.7 1883 90.4 1897 73.3 1911 62.3 1884 90.5 1898 64.9 1912 54.1 1885 90.6 1899 66.4 1913 51.1 1886 90.8 1900 67.9 1914 46.8 1887 90.4 1901 75.8 1915 49.0 1888 88.4 1902 80.0 1916 47.5 1889 89.0 1903 81.2 1917 46.7 1890 89.3 1904 82.3 1918 46.4 1891 87.4 1905 80.5 1919 46.0 1892 85.5 1906 79.9 1920 49.3 1893 85.0 1907 76.9 1921 44.9 39 [1922 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub Registration Districts during the previous year 1921. Registration Sub.Districts. Number of Births registered in 1921. 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 (cols. 3 to 9). Total Number of Certificates of Primary Vaccination at All Ages received during year 1922. Number of Statutory Declarations of Conscientious Objection received during year 1922. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 869 382 4 - 301 52 1 44 26 59 16,44 184 Up. Holloway 712 324 — — 247 45 — 21 22 53 237 Tollington 677 279 2 — 225 37 3 13 25 93 227 Highbury 996 409 4 — 360 66 2 8 46 101 379 J.r. Holloway 938 371 3 — 285 72 — 3 41 163 2,053 311 Barnsbury 1265 619 1 — 380 87 2 2 55 119 454 Islington, S.E. 1587 577 2 — 708 97 9 4 47 143 688 The Borough. 7044 2961 16 — 2,506 456 17 95 262 731 3,697 2,480 DISINFECTION. Disinfection of Rooms. —2,694 rooms were disinfected, as contrasted with 4,081 in 1921. For this purpose formaldehyde, either in a gaseous form or in solution, was employed, although it was sometimes augmented by sulphur dioxide, when it was necessary to kill vermin, for which purpose it has been found most effective. For the extermination of bugs, however, all the architrave mouldings and skirting boards behind which they breed are removed, and the walls washed with hot lime. The above figures also include the disinfection of houses and rooms after Phthisis, vide p. 34. The Cleansing and Spraying of Rooms.—1,474 rooms, as contrasted with 1,653 in 1921, were cleansed and sprayed. Rooms Disinfected. Rooms Sprayed. 1922. 1021. 1922. 1921. 1st Quarter 813 858 423 463 2nd ,, 730 664 404 442 3rd ,, 589 955 258 390 4th „ 562 1,604 389 358 The Year 2,694 4,081 1,474 1,653 1922] 40 Work at the Disinfecting Station.—71,148 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 75,327 similar articles disinfected during the previous year. In addition to the above articles 13,199 old or second-hand garments, mostly overcoats, jackets, vests and trousers were disinfected for clothing contractors trading in the borough, who paid the Council for the work, amounting to the sum of £36 13s. 11d. Altogether, 84,347 articles described in the two paragraphs preceding were disinfected, which bring the number of large articles disinfected since the disinfecting station was established to 1,847,841. Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1922, and also in the preceding year 1921 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. The Year 1922 1921 Beds 960 759 631 705 3,055 4,220 Blankets 1,836 1,306 1,225 1,455 5,822 8,367 Bolsters 877 621 548 628 2,674 3,559 Carpets 9 6 — 3 18 126 Chair Bed Cushions 183 36 30 69 318 346 Mattresses 927 720 658 700 3,005 3,200 Palliasses 15 4 2 4 25 147 Pillows 2,079 1,471 1,411 1,502 6,463 8,680 Quilts 944 676 582 621 2,823 3,637 Sheets 1,726 1,218 1,043 1,216 5,203 6,778 Other Articles 13,443 10,682 8,304 9,313 41,742 36,267 Totals 22,999 17,499 14,434 16,216 71,148 75,327 The nature of the articles disinfected for the clothing contractors is shown below: 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Overcoats . 74 617 1,222 1,400 3,313 Jackets 782 572 525 652 2,531 Blankets 72 — — 403 475 Trousers 156 200 — — 356 Vests 300 2,196 576 1,074 4,146 Other Articles — 528 1,850 — 2,378 1,384 4,113 4,173 3,529 13,199 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. lbs. Gallons. To Householders 2 0 240 - - Disinfection of Premises — — — 2 14 65 Cost = £117 5s. 6d. 41 Shelter House.—The Shelter House was occupied by 10 persons during the disinfection of their homes after infectious diseases. Baths were given to 17 verminous persons ; and to 2 persons suffering from Scabies whilst their clothing was disinfected. One midwife also attended for the purpose of disinfection after attendance on a case of Puerperal Fever. Verminous School Children.—During the year 4,243 baths were given to children from the London County Council Schools, who attended the Disinfecting Station, and were cleansed by the nurse whom the Borough Council appointed for the work, while their clothing was undergoing disinfection. The daily attendance ranged from 7 to 32. The agreement entered into between the London County Council and the Borough Council from the 1st January, 1921, for the cleansing of verminous children, is a payment at the rate of 2s. for each attendance of each child at Cleansing Station, except when such child is, or is suspected to be, suffering from Scabies, in which case payment by the London County Council will be at the rate of 1s. for each bath given. The minimum payment to be paid to the Borough Council in respect of such cleansing shall be not less than £100 per annum. The amount paid during the year by the London County Council for the baths given to the children was £390 3s. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, in 76 instances during the year, when fines ranging from 2s. 6d. to 10s. were inflicted. EMPLOYED POPULATION. From the Census of 1921, interesting figures reveal the change in character in recent years of the population of Islington. The Borough is becoming more and more a factory and workshop area. This is brought to our notice also by the number of complaints received where some subtle change has taken place in the character of the business carried on, for instance, in a quite secluded place at the back of dwelling houses, there may have existed, say, a large stable with out.houses. During the war, a business has been started for the making of small castings. This building is in time sold, and the next occupant carries on a more extensive business; then complaints come of smoke or fumes, but the business has been insidiously established, and the change in the character of the business has been so gradual that the neighbouring tenants of houses in the past made no complaint, and it is only after the population round the factory has changed, and the final stage of the business indicated is reached, that complaints become general. There is apparently no legislation to effectively prevent the establishment of a factory in this manner in previous residential districts. The ground landlord, if there is one, may be an interested party, and very frequently if very persistent complaint only comes from one or two tenants near the outlet of a smoke or vapour vent, the proprietor settles that matter by securing the leases of these houses. One of the most curious requests received by the Workshop Inspector was a letter asking for action to be taken under the Steam Whistle Act of 1872 (35 and 36 Vic, C. 61). As the request had been made after legal advice, the matter was looked into, and it was found that the applicant was apparently relying on Clause 2 of the Act which states that " no person shall use or employ in any manufactory or any other place any steam whistle or steam trumpet for the purpose of summoning or dismissing workmen or persons employed without the sanction of the sanitary authority," etc. The Act is apparently still in force, but it is difficult to say why the duties under it should come to a health department, as 1922] 42 obviously "sanitary authority" should be hold to bo a mere substitution for the municipal Council or other administration, possibly as the sanitary authority at the date was the only one universally established throughout the country. The incident is mentioned as illustrating the many curious calls which arc made upon a health department in its daily routine, and which sometime give no little trouble. The following is the enumerated census population, the day population (persons with "no fixed workplace," or "with workplace not stated" being treated as working within the Borough), the gross movement in and out of the area and the net movement. Night population numbered 330,737; persons per acre, 107. Day population (this is exclusive of those persons who work in the Borough, but who were enumerated outside London, and the five home counties), 270,568; persons per acre, 88. The aggregate of daily inward and outward movements (exclusive, as before) numbered 122,765. Ratio per cent. of enumerated population, 37.1. Net outward daily movement (exclusive, as before), numbered 60,169; ratio per cent. of the enumerated population, 18.2. The total population of Islington was 154,661 males and 176,076 females. The occupied persons over twelve years of age were 104,925 males and 55,988 females; those having a workplace in Islington were 30,895 males and 22,709 females. With no fixed workplace, 7,155 males and 1,943 females. With workplace not stated, 4,703 males and 2,041 females. With workplace outside Islington, 62,172 males and 29,295 females. The persons working in Islington, but enumerated elsewhere in London or the Home Counties were 21,071 males and 10,227 females. The excess of those with a workplace outside the area over those working in the area, but enumerated elsewhere was 60,169 persons, being a ratio to the total population per cent. 18.2. These particular figures gleaned from the Census, are given as being of importance, as the ordinary resident basis, which it is usual to use as an index to important aspects of the home conditions and surroundings is rather apt to overshadow the fact that fully half of an individual's time not spent in repose—indeed, it might be said, half of the life of the worker is generally spent amidst entirely different surroundings from what is called his home. These surroundings—where he works—must leave their imprint upon him. Persons to the number of 84,519, whose homes were in Islington worked elsewhere in London; 4,447 worked in Middlesex, 837 in Essex, 312 in Surrey, 210 in Hertfordshire, 126 in Kent, 739 in other parts of England and Wales, and 277 beyond England and Wales. People working in Islington whose homes were elsewhere in London or the Home Counties were allocated thus: Homes elsewhere in London, 16,925; homes in Middlesex, 10,753; in Essex, 3,009; in Hertfordshire, 605; in Surrey, 543; and in Kent, 463. FACTORY AND WORKSHOP ADMINISTRATION. The Medical Officer of Health submits the annual report on the manner in which the provisions of the Factory and Workshops Act, 1901, were carried out in his district during the year 1922. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under : Factories, including Factory Laundries 637 Workshops, including Workshop Laundries 941 Workplaces, other than outworkers' homes 369 Bakehouses 285 Restaurant Kitchens 336 Outworkers' premises 1,145 Miscellaneous re.inspections and calls 5,162 Total 8,875 43 Notices Served.—In consequence of the 1,217 sanitary defects discovered as the result of the inspections above; 228 intimations and 28 statutory notices were served. Of these notices 67 were served on the owners of factories, 101 on the owners of workshops and workplaces, and 39 on the owners of bakehouses and restaurant kitchens. In addition to these nuisances, 99 were discovered on Outworkers' premises, necessitating the service of 49 notices. Prosecutions were instituted in 4 instances, with the result that fines and costs amounting to £44 9s. were imposed. Registers.—There were 1,831 workshops on the Register, as contrasted with 1,691 in 1921, while the total number of workrooms was 2,621 as contrasted with 2,392 in the previous year; 275 workshops were added to the Register, while 135 were remove 1 from it. The various workshops and workplaces are tabulated as below: Workshops and Workplaces. 1922. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 788 1,184 202 62 Workshops where Women are employed 421 730 51 66 Laundries 18 46 - 3 Bakehouses 240 252 - — Restaurant Kitchens 364 409 22 4 Total 1,831 2,621 275 135 Outworkers' Premises 2,404 — 710 517 Workshops Notified to Home Office, 1922. Trade. Number of Workshops. Protected Employed Persons. Women. Male Young Persons. Total. Embroidery 2 13 - 13 Blouses 3 11 — 11 Millinery 4 10 — 10 Trunks 2 9 6 15 Furrier 5 9 - 9 Tailoring 6 11 - 11 Dressmaking 10 51 - 51 Chemists Sundries 1 3 - 3 Knitting 1 2 - 2 Spice Making 1 5 - 5 Stuffed Toys 1 3 - 3 Mantles 3 12 - 12 Costumes 1 3 - 3 Christmas Crackers 2 4 - 4 Underclothing 2 7 - 7 Rag Sorting 1 4 - 4 Clock Cases 1 5 - 5 Mattress ripping 1 8 - 8 Confectionery 1 15 - 15 Cabinet Making 1 1 - 1 Tennis Racquets 1 1 - 1 Leather Goods 1 3 - 3 51 190 6 196 1922] 44 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 637 67 4 (Including Factory Laundries) Workshops 941 71 - (Including Workshop Laundries) Workplaces 369 30 - (Other than Outworker's premises) Restaurant Kitchens 336 22 - Bakehouses 285 17 - Outworkers' Premises 1,145 49 - Miscellaneous Re-Inspections and calls 5,162 — - Total 8,875 256 4 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 283 254 - — Want of ventilation 17 17 - — Overcrowding 8 8 - — Want of drainage of floors 11 11 - — Other nuisances 416 421 1 2 Sanitary Accommodation insufficient 17 15 - — unsuitable, foul or defective 446 452 - 2 not separate for sexes 16 15 - — Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) — — - — Breach of Special sanitary requirements for houses (ss. 97 to 100) 3 3 - - Other offences — — - — Total 1,217 l,196† 1 4 * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. † Defects found left over from previous year are also included in this total. OUTWORKERS' PREMISES. Instances. Notices Served. Remedied. Prosecutions. Outwork in unwholesome premises (s. 108) 77 49 71 - Outwork in infected premises (s. 109, 110) 22 22 22 — Total 99 71 93 — OUTWORKERS' LISTS (s. 107): Lists received from Employers 1,820 Addresses received from Other Councils 2,374 Addresses forwarded to Other Councils 956 Firms failing to send in lists (No. letters sent) 174 45 OTHER MATTERS. [1922 Number. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 71 Action taken in matters referred by H.M. Notified by H.M. Inspector 13 Inspector as remediable under the Public Health Acts, but not under the Reports (of action taken) sent to Factory and Workshop Act (s. 5, 1901). H.M. Inspector 13 Other (New Factories reported under Home Office Memorandum, 1912) nil Underground Bakehouses (s. 101) in use at the end of the year 85 SANITARY CONVENIENCES IN FACTORIES, WORKSHOPS AND WORKPLACES. The London County Council By-laws, under Section 39 (1) of the Public Health (London) Act, 1891, with respect to water-closets, states that a person who constructs a water-closet shall so construct it that one of its sides at least shall be an external wall, which must abut on to an open space of not less than 100 super feet, etc. In December a letter was received from the London County Council complaining of the reduction of the open space in connection with the water-closet at a factory in this Borough, and stating that the Council had decided to take no action under the London Building Act, 1894, in respect of the erection of a brick enclosure referred to, but referring to the Borough Council the question arising out of the infringement of the by-laws. The by-laws do not provide for such a case as the subsequent reduction of the area afterwards. The Public Health nuisances sections would not appear to cover the matter, and, if proceedings were taken under Section 38 of the Public Health (London) Act, which provides a case of insufficient or unsuitable accommodation, it is doubtful if the magistrate would convict, especially if the deficiency in area was small. I communicated with the London County Council suggesting that the by.law should be amended to cover such a case, and they replied that the Council were advised that no action can be taken under the by-laws to obtain a reinstatement of the required space, and that the matter had been noted in connection with any necessary amendment of the by-laws in question. During the year the Borough Engineer submitted to me 77 (seventy-seven) plans of proposed drainage work at factories, workshops and workplaces in the Borough. These plans were examined as regards the sufficiency and suitability of the sanitary conveniences; where the proposed work appeared to be unsatisfactory, the plans were returned for amendment, or approved subject to certain conditions being complied with. In connection with this work, the Workshops Inspector, Mr. Watson, visited most of the premises, and in some cases the architect or builder personally called to discuss points in question. On the 28th June a summons was heard at Clerkenwell Police Court for non.compliance with the statutory notice. The summons was adjourned till the 5th July, when the magistrate made an order for the work to be carried out in ten days, and the defendant to pay three guineas costs. The order not being carried out, application was made for a summons for disobedience, which came on for hearing on the 18th October, when it was adjourned till the 15th November, and on that date adjourned till the 22nd November, when the magistrate still further adjourned it till the 29th November, on which date, having been informed that the work had only just been completed, said that as the work was done he would "dismiss the case under the Probation of Offenders Act," and ordered the defendant to pay two guineas costs. The above matter, including the application for the summonses, necessitated the attendance of the Workshops Inspector at the Court on seven occasions, 1922 46 LEGAL PROCEEDINGS IN CONNECTION WITH WORKSHOPS, FACTORIES, Etc., in 1922. No. of Summonses. Act of Parliament under which Proceedings were taken. Result of Proceedings. 1 Public Health (London) Act. Sec. 38. Fined £5 and £1 1s. costs. 1 ,, ,, ,, Fined £30 and £3 3s. costs. 1 ,, ,, Nuisances Order made to comply with Notice, and £3 3s. costs. 1 ,, ,, Disobedience of Magistrate's Order Dismissed under Probation of Offenders Act. £2 2s. costs. 4 Total tines and costs, £44 9s. DISTRICT INSPECTORS' WORK. The fourteen district inspectors made a total of 54,292 inspections and calls during the year, a decrease of 8,055 inspections on the corresponding period of 1921; while 14,173 improvements were effected in 5,836 premises; as against 19,462 improvements in 7,599 premises for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the district inspectors' work in 1922: House to house inspections 1,740 Other inspections of dwelling houses 5,921 Re-inspections and calls made 43,930 Visits of inquiry re notifiable infectious diseases 2,786 Butchers' shops, stalls, etc. (Saturday nights) 48 Ice cream shops and factories 95 Dairies and Milkshops 710 Stables and yards 845 Manure depots 14 Smoke observations 209 Notices Served.—There were 3,821 intimation notices served by the inspectors with respect to nuisances, of which 485 were delivered personally, and 3,336 by post. In 639 instances it became necessary, as the intimations to owners or occupiers of the properties had been ignored, to report the nuisances to the Public Health Committee, who ordered statutory notices to be served. Verminous Premises Bedding and Clothing.—150 premises which were found to be in a verminous condition, were cleansed by the owners or occupiers upon receiving the Inspectors' intimations. In 28 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Smoke Nuisances. 46 complaints of smoke issuing from factory chimneys in the borough were investigated, and as a result of the Inspectors' observations 24 warnings were given and 9 intimations and 7 statutory notices served upon the owners of the businesses requiring the abatement of the nuisance. REMOVAL OF DUST. Fifteen applications were received during the year for the removal of dust, which is 6 below the number recorded last year. The applications received for the previous ten years were as follows: 1912 47 1917 30 1913 32 1918 11 1914 26 1919 19 1915 28 1920 36 1916 21 1921 21 Dust Receptacles Provided.—During the year 1,204 dust receptacles were provided, while 10 were repaired after the service of sanitary notices, 17 [1922 Showing the summary of Sanitary Work from District Inspectors' Reports for The year 1922. Districts. Totals 1 * 2 3 4 5† 6 7 8 9 10 11 12 13 14 House to House Inspections 16 178 189 106 10 104 177 53 265 76 136 149 129 152 1740 Other premises inspected 236 576 311 606 46 553 324 421 535 393 463 518 547 401 5924 Re-inspections, Calls made, etc. 907 2878 3682 3095 657 3397 3774 4322 3988 2780 3132 4094 3345 3869 43930 Ice Cream Factories inspected 7 1 16 10 — 7 12 3 15 — 3 13 4 4 95 Dairies and Milkshops „ 35 16 107 98 7 17 106 84 87 6 70 18 19 40 710 Stables ,, 2 3 17 26 3 5 23 — 3 8 2 — 1 8 101 Yards „ 37 47 265 94 2 4 178 4 25 26 7 4 19 32 744 Manure Depots ,, — - — 14 — — — — — — — — — — 14 Vacant land, Passages and Courts inspected 2 2 - 7 - 1 27 3 - 15 - - 13 3 73 Urinals attached to P.H.'s inspected 1 36 85 20 33 13 45 1 6 2 1 - 7 33 283 Premises (re Certificate Customs and Inland Revenue Acts) inspected - - 92 - 10 47 6 108 - - - - - 81 344 Premises (re Water Certificates) inspected 14 - - - 1 7 - - - - - 55 77 Visits re Sale of Food and Drugs Acts - - - - - - - - - - - - - - - Smoke observations 2 19 9 10 — 10 9 2 25 47 13 41 3 19 209 Shops, Stalls and Markets (Saturday evening) 1 3 4 4 1 4 5 4 5 5 4 3 4 1 48 Total Inspections and Calls 1246 3759 4791 4090 763 4162 4687 5012 4954 3358 4131 4750 4091 4498 54292 Notices Served. Intimation Personally 3 4 18 1 11 83 23 21 187 2 57 15 12 48 485 By Post 126 343 197 428 9 285 276 252 310 11 296 362 224 217 3336 Statutory Personally — 1 9 6 — 39 8 2 32 3 7 5 5 15 125 By Post 5 25 17 64 1 49 27 24 101 7 76 50 16 52 514 Improvements. Drains— Constructed 1 — - - - - - 1 4 — — - 1 1 8 Reconstructed 3 12 10 10 4 7 4 8 5 3 23 - 14 16 116 Repaired 5 22 15 31 2 35 23 12 13 17 34 11 23 37 28 Ventilated 3 22 4 12 7 9 1 6 12 3 10 2 9 16 116 Gully and other traps fixed 10 88 28 62 19 12 33 26 44 15 26 4 48 39 454 Urinals— Water supplied, cleansed — - 2 7 — — 2 — 1 — 1 — 2 1 16 Cesspools—Abolished. — - - — — — — — — — — — - — - Water Closet— W.C. erected with pan, trap and Water Supply — 1 1 5 — 3 — — 9 — — — 2 2 23 Pan and trap only provided 12 51 10 45 7 27 21 23 21 12 72 10 31 58 398 Water supply provided 15 58 19 25 6 43 41 42 58 4 25 35 42 20 433 Ventilated — 1 3 2 — 1 — — 2 1 1 - - 2 13 Position altered - 1 1 - — - — - - 1 2 — - - 5 Dust Bins Provided 69 133 77 145 11 87 110 65 72 11 85 72 48 45 1030 Repaired 1 — 1 — — - 1 — — — 6 — — — 9 Areas—Constructed — — - - — 1 — 2 - — — - 1 - 4 Yards' Paved. 1 — 3 1 — - 3 2 1 1 3 — - 1 16 Repaved 9 31 15 52 7 19 53 15 38 8 25 20 31 17 340 Sinks—Provided — 24 2 12 1 2 13 4 17 2 3 — 3 6 89 Domestic Water Supply— Cisterns provided 1 — 1 - - - 1 - - — 0 - 1 - 6 Cisterns repaired & cleansed 6 43 42 42 1 18 34 6 21 3 16 5 6 16 259 Water supply provided to dwelling house 2 6 8 3 - 3 10 4 2 3 10 4 5 2 62 Water supply provided to tenement house - 5 - 13 - 3 1 - 48 2 3 2 1 3 81 Other improvements— Rooms cleansed & limewashed 55 136 295 440 36 231 343 229 527 119 394 476 260 319 3860 Walls and passages repaired, cleansed and limewashed 19 60 79 157 6 60 76 76 158 24 118 128 100 75 1136 Floor space ventilated - 3 3 6 - 4 5 4 12 — 25 1 4 — 67 Floors repaired 7 18 18 50 1 26 18 29 59 8 27 54 46 46 407 Roofs repaired 30 115 65 139 6 103 140 106 110 42 135 144 106 119 1366 Overcrowding abated. — — 1 — — — 1 1 2 — — 2 1 — 8 Illegal use of underground rooms for sleeping discontinued - - - 1 - - - - 1 - — — 1 - 3 Other improvements, or Nuisances abated . 39 144 99 199 20 154 147 96 246 41 139 162 170 178 1834 Rooms Disinfected 69 273 235 266 25 18 134 86 141 51 18 27 197 194 1734 Total improvements 357 1247 1037 1725 159 872 1215 843 1624 371 1200 1159 1153 1211 14173 Total premises improved 191 630 514 714 53 337 484 351 575 176 418 404 503 516 5866 •From August when Mr. Agar took over District. †3 Months only. District vacant from March. n1 'yAr, 1922] 48 HOUSES LET IN LODGINGS. There were 1,012 houses under the operation of the bye-laws at the end oi the year 1922; 640 inspections were made during the year, followed by 7,819 subsequent re-inspections and calls, so that the total visits amounted to 8,459. These inspections resulted in 315 intimations being served on the persons responsible, which were followed by 48 statutory notices to demand the abatement of the nuisances discovered by the two inspectors especially engaged upon this work. Four summonses were taken out for non-compliance with the notices served. Altogether, 3,446 improvements were effected in 740 premises. Synopsis of Inspectors' Work:— Improvements. Districts. Total. North. South. Drains: Constructed — — — Reconstructed 2 2 4 Repaired 9 2 11 Ventilated — — — Gully and other traps fixed 2 15 17 Water Closets: W.C. erected with pan, trap and water supply — 3 3 Pan and trap only provided 23 30 53 Water supply provided — — — Ventilated — — — Position altered — — — Dust Bins: Provided 118 56 174 Repaired 1 — 1 Areas: Constructed - — - Yards: Paved 1 — i Repaved 23 32 55 Sinks: Provided 2 — 2 Domestic Water Supply: Cisterns provided — 4 4 Cisterns repaired and cleansed — — — Water supply provided to dwelling house — — — Water supply provided to tenement house 8 3 11 Other Improvements: Rooms cleansed and limewashed 551 517 1,068 Walls and passages repaired, cleansed and limewashed 57 109 166 Floor space ventilated — — — Floors repaired 55 54 109 Roofs repaired 145 98 243 Miscellaneous improvements 786 738 1,524 Total Improvements 1,783 1,663 3,446 Total Premises Improved 383 357 740 RATS AND MICE (DESTRUCTION) ACT, 1919. (9 and 10 Geo. 5. Ch. 72.) This Act came into operation on the 1st January, 1920, to make further provision for the destruction of rats and mice. The temporary appointment of a Rat Officer was made by the Council on the 26th January, 1920, to carry out the provisions of the Act. The Rat Officer supervised an organised "Rat Hunt" in Swan Yard, Highbury Corner, towards the close of the year. The premises had been under observation for some time, as they were known to be infested, and the occupiers had been persuaded to take action 49 and employ rat catchers. The proceedings attracted considerable attention from the local press. An account of the early part of the work appeared in The Islington Gazette. Altogether 344 rats were accounted for. The following statement shows the work performed by the Rat Officer since he was appointed: SUMMARY OF WORK FROM RAT OFFICER'S REPORTS DURING THE YEARS 1920-22. 1922 1921 1920 Number of Streets visited 711 669 607 Number of Private Houses visited 1,023 805 945 Number of Shops and Factories visited 1,009 1,034 1,326 Total Premises inspected 2,032 1,839 2,271 Found Rat Infested 1,331 1,406 1,355 Found Mice Infested 72 55 196 Defective Drains Repaired (Cause of Rat trouble) 52 45 34 Number of Complaints received 177 175 172 1,740 150 HOUSING, INSPECTIONS, ETC. A special table will be found on page 71. See also the statement of Sanitary Inspectors* work, page 47. Special House to House Inspections Insanitary Houses— No. of premises cleansed No. of orders issued for repairs under Section 28 by Housing Committee (* Relating to 5 dwelling houses.) No. of closing orders Housing of Working Classes— Houses— (a) Inspected (under £40 per annum rental) (b) Erected during year (flats) (c) In course of erection (flat tenements) Revenue Acts— Certificates granted (sanitary requirements) Water Supply to Tenement Houses— Premises supplied Water certificates to new premises 5,560 165 48 293 92 77 STATE OF PAUPERISM IN THE BOROUGH. During the year the increase in Pauperism was considerable, for the number of paupers relieved weekly averaged 11,646, as contrasted with 8,257 in 1921 and 5,620 in 1920. Appended is a statement furnished by the Clerk to the Islington Guardians: Showing the State of Pauperism in the Borough during the year 1922. Quarters. Average number Relieved during each week. Borough Death rates, 1922. Indoor Paupers, Adults and Children. Outdoor Paupers. Totals. Totals corresponding periods 1921. Vagrants Relieved. Children Boarded out. Adults. Children under 16. 1 2 3 4 5 6 7 8 9 1st Quarter 2,916 5,988 5,610 11,598 6,346 No Wards 70 21.2 2nd „ 2,770 6,492 5,851 12,343 6,754 68 13.0 3rd „ 2,711 5,791 5,065 10,856 8,521 69 9.4 4th „ 2,808 6,260 5,527 11,787 11,408 66 11.6 The Year 2,801 6,133 5,513 11,646 8,257 - 68 13.8 1922] 50 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Sale of Unsound Fruit by Street Traders.—It is by no means unusual for wholesale dealers to sell quantities of packages of fruit at from 25 per cent. to 75 per cent. below the prevailing price of sound goods. Costermongcrs seek the aid of the Public Health Department with a view to obtaining the refund of money paid by asserting that they bought the goods which have not turned out according to samples shown. These goods they desire to surrender as unfit for human consumption. In such a case a surrender note is given on the deposit of the unsound foods with us. This note is then taken back to the wholesale dealer, who, as a rule, accepts it, and refunds the money. Occasionally the wholesale dealer demurs and asserts that the goods were sold with all faults, the purchaser taking the risk, but this is rare, as apparently they do not care to face County Court proceedings, when the Inspector granting the surrender note would be subpoenaed. There being thus a regular traffic in fruit which should be unsaleable, there is always a danger of unsound goods being palmed off with sound fruit, both from the rear portions of the piles of fruit on fruit stalls and barrows and the smaller fruit shop stands. The purchase of such parcels, as has been referred to, from the wholesaler is of a very speculative nature, but on the whole the transactions would appear to satisfy the particular class of dealer, as, generally speaking, there is a fairly keen competition. It is only when the percentage of bad fruit is excessive that the aid of the Inspector is sought. When a request is made it is necessary that all the fruit should be carefully sorted, and only the unsound reserved for destruction. In some cases the whole may be too bad to justify any attempt at sorting. Cases are not unknown where the costermonger tries to steal a march on the inspector —who has left him for a time to sort out the goods—by submitting at the finish a number of boxes of alleged unsound fruit, and it is necessary to make sure that the cases are not filled up chiefly with packing, with some fruit distributed in it. Such requests entail a lot of careful supervision and extra work for the Food Inspector, and there is always a considerable risk of leakage of unsound fruit. Quite recently a costermonger was detected in Islington through an Inspector's attention being directed to some unsound fruit in a house being visited in the ordinary course of the Sanitary Inspector's duties. From the description given the particular barrow was with some considerable difficulty traced and the person in charge alleged that he was only temporarily in charge, and did not know the proper owner's name. The proper owner eventually turned out to be his own brother. It is thus easily seen that the tracing of unsound fruit and the taking of proceedings against the particular class who deal in the cheap packages disposed of by the wholesaler involves much detective inspection, and, owing to the false statements made, a great deal of enquiry and verification on the part of the Inspector has to be made, the end result being frequently a very inadequate fine. All this could be avoided if there were sufficient protection against the sale of such fruit without sorting by the wholesaler. The difficulty is not confined to fruit, for quite recently damaged and blown tinned goods have been similarly distributed in Islington by a wholesale dealer to small obscure shops at a ridiculously small sum, and the shopkeeper enticed by the possible profit to dispose of what should be unsaleable. On tracing the wholesale dealer he has replied that the goods were sold on the condition that they were sorted. 51 The extent to which this class of trade is carried on appeared to the Public Health Committee to justify approaching other Metropolitan Boroughs with a view to a Conference on the subject. FOOD CONFERENCE IN ISLINGTON. A Conference of Representatives of Metropolitan Borough Councils was held at the Islington Town Hall on the 18th July to consider the question of the sale of unsound fruit, vegetables, tinned foodstuffs, etc., by wholesalers to retailers and the subsequent sale to the public. The Conference was well attended, and the following resolution was adopted: "That the attention of the Minister of Health be drawn to the necessity of the law relating to the sale of unsound food being amended by the addition of the following words at the end of Section 47, Subsection 3 of the London Public Health Act 1891, 'and had taken reasonable steps to ascertain that the article was not in such a condition as to be liable to be seized and condemned under this section.'" It was also resolved that the Minister of Health be asked to receive a deputation from the Conference in support of the resolution. This deputation was received on the 7th December, and the reply of the Minister on the 15th February, 1923, was to the effect that the Minister was not satisfied that the difficulties were such as to make an amendment of the law necessary. It appeared that the imposition of a universal obligation to sort the contents of packages of perishable goods before selling would be to limit supplies and increase prices, even in the case of sound articles. The subject was considered one in which efficient administration of the existing law would more likely produce satisfactory results than new legislation. INFLATION OF MEAT. The question of the artificial inflation of meat was before the Public Health Committee, the Meat Inspector having detected an instance of inflation by the mouth. At their request, the Ministry of Health were written on the subject, and the following reply was received: Ministry of Health, Whitehall, S.W. 1, 5th October, 1922. Sir, In reply to your letter on the subject of the inflation of carcases, I am directed by the Ministry of Health to state that this question has from time to time been under the consideration of the Local Government Board and this Ministry. The inflation of carcases is prohibited, either absolutely or unless effected by mechanical means, by the local Acts of several local authorities, but there is no general legislation making the practice illegal. The matter has, however, been noted for consideration in the event of a Bill being introduced into Parliament for the amendment of the Public Health Acts. I am, Sir, Your obedient servant, (Signal) D. Maclean. The Medical Officer of Health, Metropolitan Borough of Islington. It was decided to request the London County Council to include in their next General Powers Bill proposals prohibiting the inflation of meat or fish by mechanical means or otherwise. The mechanical blowing is apt to give a false impression as to the quality of the meat. It is not really necessary. It is done to give the meat a better appearance ; in hot weather, especially, one can conceive that meat might be adversely affected by the process. The purity of the air which is pumped into the carcase is a matter for serious consideration. As regards the inflation of fish, I understand this is uncommon now, for two reasons: (1) it is hardly worth while for the labour involved; (2) fish are now mostly gutted before being exposed for sale It need hardly be said that the inflation by the mouth is a disgusting practice, and ought to be suppressed. Food—Inspection of.—Inspector Wilkinson reports that during the year he has paid 982 visits to the 18 Slaughter Houses now on the register, including one Horse Slaughter House, and that he has ascertained that 9,810 animals were killed therein, namely, 844 oxen and cows, 50 calves, 6,585 sheep and lambs, and 2,331 horses for human consumption, practically the whole of which were exported. These were mostly of good quality and free from disease, but in 42 cases meat and organs found to be diseased were destroyed (vide table on page 53). The food destroyed or otherwise disposed of (chiefly for pigs' food) so as to prevents its use for human food was as follows: Tons cwts. qrs. lbs. Diseased meat and organs from slaughter-houses — 11 2 18* Diseased or unsound meat, etc., from other sources — 2 3 11 Fish — 16 3 24 Fruit, Vegetables, etc. 9 14 1 6 Unwholesome Fruit Pulp, Jam, etc. — 13 3 23 Total 11 19 2 26 * Of this quantity 6 cwt. 1 qr. 10 lbs. was Tuberculous. The total amount of unsound or diseased meat, fish, fruit, and other food destroyed Was 11 tons 19 cwts. 2 qrs. 26 lbs. The diseases which affected animal food are set out in detail on page 53. Shops, etc., Inspection of.— The number of shops and places where foodstuffs are sold may be approximated for the year as follows: Butchers, provision dealers, etc., shops, 210; meat, provisions, rabbits, tinned foods, etc., stalls, 24; food preparation establishments, 18; fish shops, 100; fish stalls, 12; fruit shops, 194; and about 60 fruit, etc., stalls and barrows. To these 17,590 visits were paid, apportioned as follows: Butchers, Provision Dealers, etc., Shops 7,101 visits. Food Preparation Establishments 223 „ Butcher, Provision etc., Stalls 1,438 „ Fish Shops 1,377 „ Fish Stalls 734 „ Fruit Shops 2,404 „ Fruit Stalls 4,313 „ Total 17,590 53 [1922 Restaurant Kitchens.— The work of inspecting restaurant kitchens is tabulated under Workshops. This work is done by two Lady Inspectors. Cleanliness in the preparation of food is of the utmost importance, as any contamination may result in food poisoning, and though undoubtedly many cases of food poisoning arc very slight, only resulting apparently in a transient attack of diarrhoea, occasionally public attention is drawn to rapid and fatal cases. It is thus apparent that the inspection of places where food is prepared is work of great importance. The inspection is made for unsatisfactory storage conditions, dirty utensils, and other nuisances. The following is a tabulated statement of the premises examined, and the results. In each case the unsatisfactory conditions were remedied without having to resort to prosecution: Number Number found Inspected. Unsatisfactory. Hotel and Restaurant Kitchens 50 11 Coffee and Dining Rooms 135 50 Refreshment Rooms 60 18 Provisions (Cooked Meats, cooked but not consumed on premises) 91 18 336 97 Prosecutions.—A seizure made by one of the District Inspectors, of a case of unsound Apples exposed for sale, resulted in the offender being fined 10s., with 10s. 6d. costs. Seven summonses were taken out under the Sale of Food Order, 1921, for improperly labelled imported meat, bacon and eggs. Six of these were successful, while one summons was dismissed. The fines and costs amounted to £34 5s. Cowsheds.—The 4 cowsheds within the Borough received 31 visits, and were found generally satisfactory. Offensive Trades include 4 tripe dressers, 3 gut scrapers, and the knackers' yard which received a total of 67 visits. The Inspector reports that he found no cause for complaint in the conduct of the business carried on in them. Tabulation of meat and organs diseased as found in slaughter-houses during the year 1922: No. of Cases. Description of Animal Affected. Nature of Disease. Extent of Disease. How disposed of. 1 Cow Tuberculosis Lungs Council's Destructor 1 Cow Tuberculosis Carcase and all Organs „ „ 1 Ox Tuberculosis Liver, Lungs, Tongue and Mesentery „ „ 1 Ox Tuberculosis Lungs, Diaphragm and Membranes „ „ 1 Ox Actinomycosis Tongue „ „ 1 Heifer Abscess Flank (56 lb.) „ „ 7 Oxen Abscess Liver (whole or part) „ „ 29 Oxen Parasitic (Dis. Hep.) Liver (whole or part) „ „ 3 Oxen Cirrhosis (Dis. Hep.) Liver (whole or part) „ „ 2 Sheep Parasitic (Ech. Vet.) Liver Destroyed on premises Milkshops and Dairies.—At the close of the year there were 623 milkshops and dailies on the register, 37 having been added to it, while 39 were removed. 1922] 54 They received 710 visits from the District Sanitary Inspectors, who served 36 notices, for the execution of various sanitary improvements and the cleansing of dirty utensils. BACTERIOLOGICAL EXAMINATIONS OF MILK. Three milks were bacteriologically examined. The gelatine count at room temperature of 48 hours being 12,600,000 organisms per c.c., 5,900,000 and 4,900,000. Bacillus coli was absent from -0001 c.c. and present in 001 c.c., and acid-fast bacilli negative in all three milks. The cream and the centrifuge deposits from 10 c.c. of each sample were injected intra-p.eritoneally into guinea pigs. No loss of weight occurred in any animal from week to week. Post-mortem examination of the 3 animals upwards of five weeks after, inoculation was negative for tuberculosis. ADMINISTRATION OF FOOD AND DRUGS ACTS, PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, MILK AND DAIRIES ACT, 1922. FOOD ORDERS, Etc. The purity of the food supply as protected by the above Acts was the subject of special concern during the year, more especially as the Borough suffered from an apparently organised attempt on the part of itinerant vendors to foist upon the poorer population sophisticated milk. In Islington special examination was made for the presence of artificial colouring matter. It would not appear that general action was taken throughout the country, at least to any great extent, to examine for colouring matter, for it is recorded that the total number of samples reported on by Public Analysts to local authorities in England and Wales of milk and separated milk as showing this particular form of sophistication was 183 while of these 34 were from the Borough of Islington out of 46 specially examined. While it is quite true that the Borough was unfortunate in the attention it received from the particular organised vendors referred to, it is difficult to believe that the Borough alone suffered more than the rest of the country in the proportion here represented of artificially coloured milk. Reference is made in the Report to the Ministry of Health under the Public Health (Milk and Cream) Regulations, page 58, to the sale of colouring matter and preservative in Islington for addition to milk. At my request, Inspector Green has classified, according to his experience in the Borough, the cheap milk sellers and their methods. The three groups were connected with each other more or less. The information obtained was put by my Committee at the disposal of the public Press, and considerable attention was thereby drawn to the matter, more especially to the fact of how important it was to ask for milk, and not say " pint" or " quart " merely. A summary is here given, including special prosecutions from September to December of the previous year, 1921, as this is necessary to show the proceedings of the particular milk sellers who continued their operations into the year 1922, when their system somewhat changed, inasmuch as they began adding to the milk mixtures an infinitesimal quantity of annatto, a vegetable dye, which gives the milk a rich, creamy appearance. Particular attention is drawn to the last paragraph of Group "A," which illustrates the clever manner in which legal consequences were evaded. The proper price for milk 55 [1922 at the commencement was 9d. per quart, and the inference regarding anything at less than this would necessarily be that the article was either skimmed milk, or a mixture. GROUP "A." About July, 1921, a milkman commenced to tour the poorer streets of the northern part of the Borough retailing presumably genuine milk at 7d. per quart. The suspicions of the Inspector were aroused, and this milkman was kept under close observation for some time. His procedure was to drive along the streets with a horse and cart, together with an assistant, both loudly shouting "pure new milk," or "new milk," price 7d. per quart, or 3½d. per pint, and making every effort to capture the trade of established dairymen in the locality by just preceding them on their rounds. His cart was smartly painted, and inscribed with the name "Guernsey Farm Dairy" in large letters, while it contained two churns and two hand-cans. Fresh customers were invariably served from a hand-can inside the cart, established ones from a can at the rear. In every instance the customer's jugs were fetched from the doors and carried to the cart, where the milk was measured out. In the first week in August, the first sample was purchased from this vendor, and the Inspector was served from the can inside the cart. On analysis it proved to have had 12 per cent, of its fat abstracted. A summons was issued, and the man who appeared was fined /I, with two guineas costs. The lenient manner in which the offence was treated was responsible to a certain extent for what followed, for during the following week, no less than five carts, all hailing from the same address in an adjoining borough, appeared on the scene. These carts were similar in every way to the one described above. From about the middle of October, until the end of Xovember, practically the whole time of the Inspector was taken up with tracking these men down, in some cases nearly a whole day being spent on obtaining one sample. Between the 3rd August and the 9th November, 1921, a total of 18 official samples were purchased from these vendors, of which four were sold as "separated," leaving 14, of which 8 were adulterated. In addition, 36 informal samples were purchased, of which 18 proved genuine, and 18 adulterated. With regard to the 8 adulterated samples above mentioned, proceedings were instituted, with the following results: Date of Hearing. Samples marked. Result of Analysis. Offence. Result of Prosecution. (1921) G 16th September . 155 11 per cent, fat abstracted Fined £1 and £2 costs. 2nd December 31 36 „ „ Summons not served, Servant 2nd „ — No name and address on cart Fined 10s. fined £3 2nd „ 61 41 per cent, fat abstracted Fined £5 16th „ 98 46 „„ Dismissed. 16th „ 118 49 „„ „ 16th „ 136 40 „„ Fined £9 9s. and £1 1s. costs. 16th „ 99 12 „„ Fined £3 3s. and 10s. costs. 16th „ — No name and address on cart Dismissed. 16th and 30th 83 51 per cent, fat abstracted Fined £9 9s. and £1 1s. costs. December 83 No name and address on cart Fined 7s. 6d. 1922] 56 During the year under review (1922), the campaign against this group of milk vendors was continued, with the following results: Date of Hearing. Samples marked. Result of Analysis. Offence. Result of Prosecution. (1922) 22nd February G No name and address on cart Fined £1 1s. 22nd — „ „ Defendant absconded. 3rd March 349 Skimmed milk coloured with annatto. Fined £7 and £1 1s. costs. 3rd „ 395 „ „ „ Fined £1 and £1s. costs. 3rd „ 432 „ „ „ „ „ 3rd „ 418 „ „ „ „ „ 3rd „ 479 „ „ „ „ „ 3rd „ 351 „ „ „ Fined £4 and £1 1s. costs. 3rd „ 352 „ „ „ Defendant absconded to New Zealand. 3rd „ 393 „ „ „ Fined £4 and £l 1s. costs. 3rd „ 403 „ „ „ „ „ 3rd „ 396 „ „ „ „ „ 3rd „ 482 „ „ „ „ „ 15th „ 428 „ „ „ Fined £4 and £2 costs. 15th „ 428 „ „ „ Fined 7s. 6d. 15th „ 381 „ „ „ „ 15th „ 381 „ „ „ Fined £4. 17th „ 404 „ „ „ Fined £5 and £1 1s. costs. 17th „ 405 „ „ „ Fined £2 and £1 1s. costs. 17th „ 419 „ „ „ Fined £5 and £1 1s. costs. 17th „ 441 „ „ „ Fined £2 and £1 1s. costs. 17th „ 442 „ „ „ „ „ 17th „ 443 „ „ „ „ „ 19th May — No name and address on vehicle Fined £2 and £1 1s. costs. 19th „ 659 90 per cent, fat abstracted Fined £10. One defendant admitted in Court that as a general rule all customers who asked for "a pint" or "a quart" were served with the separated, or mixed milk, while those who distinctly specified "milk" were served with the genuine article. It also came out in Court that one man was at the back of the whole concern, and he supplied the milk in bulk to cach retailer. GROUP "B." This group sold mixed milk only, at 6d. per quart. A number of official samples were purchased, all of which were, with the exception of two, sold as "separated." These two were sold without any declaration. One proved 79 per cent, deficient in fat, and the other 94 per cent. Proceedings were instituted, and one summons was dismissed under the Probation of Offenders Act on payment of one guinea costs, and the other summons was dismissed. Several informal samples were taken, but the purchaser was in every instance informed that it was "separated" or "skimmed" milk. This group made their headquarters in an urban district in Middlesex, but they left the neighbourhood towards the latter end of the year. GROUP "C." In this case the vendors were registered in the Borough. They carried both "new" and "separated" milk, but distinguished with great nicety between the customers who asked for "milk" and those who did not specify, the former got the "new" and the latter "separated." A number of official samples were purchased, and all proved to be genuine on analysis. The Milk and Dairies (Amendment) Act, 1922, came into force on the 1st September, 1922. This act makes it an offence to mix separated or skimmed milk with whole milk, and also prohibits the adding of colouring matter. From the experience of Islington it is needless to say how necessary and opportune the passing of this Act was.- 57 [1922 REPORT ON PRESERVATIVES IN FOOD. The question of preservatives and colouring matter in food was before the Public Health Committee during the year. The Medical Officer of Health reported in May that the position at present was unsatisfactory; that inquiry into the matter was not only required for cream in respect of boric acid, but for preservatives in other foods. Such an inquiry should deal definitely with : (1) Whether certain preservatives arc harmless; (2) The proposed standards as regards amount, if any, to be permitted; (3) The class of foods in which such preservatives, if so found necessary, may be used (as at present some manufacturers used such, while others produce a satisfactory preparation without). The Committee's attention was directed to the fact that although cream is now labelled in accordance with the regulation to contain an amount of boric acid not exceeding 0.4 per cent., and the words "not suitable for infants or invalids" preparations other than cream are not so labelled, nor are sausages, etc., besides, preparations and food often contain other preservatives, such as salicylic acid. Similar preparations by other makers do not contain preservatives. The Medical Officer of Health is strongly of opinion that if a preservative—with the labelling and precautions quoted in the manner similar to what has been done in the case of cream—be permitted for other foods, that the least possible amount of preservative should be allowed, and the particular foods for which it will be allowed should be specified and the amount declared on the label with a similar proviso regarding infants or invalids. If this were done, the position would be clear and prosecutions for illegal use would be a straightforward matter, depending upon the result of the analysis. ISLINGTON ANALYSES. PRESERVATIVES AND COLOURING MATTER IN FOOD. Year. Article. Quantity of Preservative or Addition of Colouring Matter. 1917 Milk 0.0002% Formaldehyde „ „ „ „ „ „ „ „ „ Mustard 12% Wheat Flour, 0.2% Powdered Turmeric 1918 Baking Powder 0.07 grains Arsenic per lb. „ Milk Coloured with Annatto „ „ „ „ „ „ „ „ „ Self-raising Flour 0.63 Calcium Sulphate 1919 Mustard 4% Wheat Flour and trace of Turmeric „ „ 5% „ „ „ „ 33% „ „ 1920 „ 29% „ coloured with trace of Turmeric „ Skim Milk 11 grains of Boric Acid per pint „ Milk 5 „ „ „ „ „ 4.7 „ „ „ „ Mustard 67 % Wheat Flour coloured with Turmeric 1921 Liquid Eggs 1.75% Boric Acid „ Melange 1.02 „ Butter 0.17 „ Margarine 0.31 „ Mustard 25% Wheat Flour coloured with Turmeric 1922 Pork Sausages 0.26% Boric Acid= 18.2 grains per lb. „ Separated Milk 24 Samples coloured with Annatto „ Milk 10 „ „ „ „ „ 0.0002% Formaldehyde „ Mustard 15% Wheat Flour coloured with Turmeric „ „ 17% „ „ „ „ 20% „ „ „ „ 23% „ „ „ Cream 0.30% Boric Acid „ „ 0.32% „ 1922] 58 REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE MINISTRY OF HEALTH UNDER THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS. 1912 and 1917. During the past year (1922), samples of Milk, Cream and Preserved Cream have been obtained to ascertain the extent to which the provisions of the Regulations are being carried out by the vendors. (1) Milk and Cream NOT Sold as Preserved Cream : Milk. Milk 593 Separated Milk 45 Total number of samples of milk examined for the presence of preservatives 638 Number in which preservative was found to be present 1 Cream. (2) Cream NOT Sold as Preserved Cream: Number of which preservative was found to be present 2 Cream Sold as Preserved Cream: (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservative were correct— Correct statements made 1 Statements incorrect 2 (b) Determination of Milk Fat in cream sold as preserved cream— Above 35 per cent 3 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream have not been observed. Nil (d) Particulars of each case in which the regulations have not been complied with, and action taken — In two instances the cream did not bear any label or declaration of preservative. These were found on analysis to contain 0.30 and 0.32 per cent, of boric acid. Note.—A further informal sample was purchased, but not analysed. It had the orthodox preservatives label. The third cream which was analysed and was correctly labelled was found on analysis to be within the margin stated. A total of four creams was taken, of which three were submitted for analysis. COLOURING MATTER IN MILK. Forty-six samples of milk, including separated milk, were submitted to the Analyst for the detection of colouring matter, of which 34 were found to be coloured with annatto (10 milk, 24 separated milk). 59 [1922 Action Taken re Colouring Matter in Milk. Sample No. 349. Fined £7 mul £1 1s. 0d. costs. 351 Fined £4 and £1 1s. 0d. costs. 352 Summons not served; defendant gone to New Zealand. 353 Fine included in No. 351. (Taken as one summons). 381 Fined £4. 393 Fined £4 and £1 1s. 0d. costs 395 Fined £1 and £1 1s. 0d. costs. 396 Fined £4 and £1 1s. 0d. costs. 403 Fined £4 and £1 1s. 0d. costs. 404 Fined £5 and £1 1s. 0d. costs. 405 Fined £2 and £1 1s. 0d. costs. All separated milk. Sample No. 407 Fined £2 and £2 2s. 0d. costs. 418 Fined £1 and £1 1s. 0d. costs. 419 Fined £5 and £1 1s. 0d. costs. 424 Fined 7s. 6d. 428 Fined £4 and £2 costs. 432 Fined £7 and £1 costs. 438 Fined £4 and £2 costs. 441 Fined £2 and £1 1s. 0d. costs. 442 Fined £2 and £1 1s. 0d. costs. 443 Fined £2 and £1 1s. 0d. costs. 479 Fined £1 and £1 1s. 0d. costs. 482 Fined £4 and £1 1s. 0d. costs. All separated milk. Sample No. 511 Withdrawn. Dismissed. 516 Withdrawn. Dismissed. 576 Ordered to pay £2 2s. 0d. costs. 631 Fined £7 and £2 2s. 0d. costs. 743 Summons dismissed. All milk. The other cases were warned. In spite of the attention drawn in the Press, several of these prosecutions having been reported, it was a little disconcerting that an Inspector from Islington should discover that at the Dairy Show in the Royal Agricultural Hall, early in October, 1922, leaflets were distributed and free samples given, of both colouring matter and preservative, recommended to be added to milk without any warning that the sale of such milk would be illegal. A representative from the firm responsible, after attention had been called to the matter, interviewed the Medical Officer of Health, but no satisfactory explanation has so far been forthcoming. No action could be taken in respect of such propaganda, for although it is illegal to sell milk with colouring matter or preservative, it is not illegal to sell or recommend the colouring matter or preservative for addition to milk. 1922] 60 ADULTERATION OF FOOD AND DRUGS. During the year 1,209 samples of foods and drugs were submitted for analysis by Mr. Green, the Food and Drugs Inspector, who purchased the samples for submission to our Analyst, Dr. F. L. Teed, and to the additional Analyst, Air. A. Pinchin, B.Sc. Of the total samples 1,096 were reported to be genuine and 113 adulterated, or 9.3 per cent. This percentage is 4.4 higher than in the previous year, and 1.4 per cent, above the average rate during the preceding 10 years. The greatest amount of adulteration occurred in the first and third quarters of the year, as is seen by the statement given below, when it was 13.9 and 90 per cent, respectively, and contrasted with 5.5 and 8.8 per cent, respectively in the second and fourth quarters. Examined. Genuine. Adulterated. Per cent. 1st Quarter 323 278 45 13.9 2nd 325 307 18 5.5 3rd „ 310 282 28 9.0 4th „ 251 229 22 8.8 The Year 1,209 1,096 113 9 3 Prosecutions.—48 summonses were issued under the Sale of Food and Drugs Acts, of which 40 were successfully prosecuted. Altogether penalties and costs to the amount of £84 3s. 6d. were obtained. 38 prosecutions were also taken under the "Milk (England and Wales) Order, 1921," resulting in 29 convictions with penalties and costs amounting to £114 3s. 6d. DISPENSING OF PRESCRIPTIONS. Attention has been drawn to the desirability of testing the accuracy of the dispensing of prescriptions. The National Health Insurance Committee had offered to supply test insurance prescriptions, but at the suggestion of the Medical Officer of Health the Public Health Committee decided, in the meantime at any rate, that the results as regards ordinary prescriptions be tried. It was known through analyses carried out by the Stepney Borough Council, and also by the City of London, that there was considerable variance and inaccuracy. It was therefore desirable that the position as regards Islington should be known. The testing of medicinal preparations has not in the past received the same amount of attention as, for instance, milk, and lias mainly been confined to articles such as Gregory Powder, Olive Oil, Blaud's Pills, etc. The actual testing of a Physician's prescription, which" might vary (if inaccurately dispensed) not only at every shop to which it were taken, but even at the same establishment on different occasions, has formed a very small proportion of the total number of the analyses made by Public Anatysts. As the Physician may in certain cases rely upon the medicine he prescribes as an aid to confirm diagnosis—for should the medic ne not take the expected effect on the patient, he might be deceived as regards the actual condition, not suspecting the medicine to be defective—the matter is a very important one, quite apart from the fact that the public 61 [1922 naturally expccts medicines to be measured with a degree of accuracy far superior to the ordinary weighings of say, for example, groceries, etc. In December a commencement was made in taking prescription samples, and from four dispensed, two were taken to Court, the one being deficient (1T2 per cent.) in bromide of potash, and (5 2 per cent.) in the spirit of sal volatile. The other, a simple solution of sodium salicylate was 10 8 per cent, deficient. In Court the Analyst who appeared on behalf of the defendant in the first mentioned case, stated that the stock solution of bromide had in error been made up by avoidupois weight instead of apothecaries. The Magistrate remarked that a firm with many branch shops could by this make a considerable gain in the course of a year. As stated, it was towards the close of the year that these special samples began to be taken ; therefore necessarily the complete report can only be adequately dealt with in the review of the work for 1923. Milk.—The qualitative results of the Analyses of the Milk samples, which have now been published for many years, are as follows: No. of Samples. Solids not Fat. Fat. Total Solids. Milk purchased on Sundays 120 8.78 3.39 12.17 Milk purchased on week-days 356 8.76 3.34 12.10 Milk procured in transit at Finsbury Park Station 162 8.75 3.60 12.35 Official Standard — 8.50 3.00 11.50 The particulars as to the genuineness or otherwise of the samples procured or purchased on Sundays, Week-days, and at Finsbury Park Railway Station are as follows: Number taken. Genuine. Adulterated. Percentage Adulterated. On Sundays 120 110 10 8.3 On Week-days. 356 319 37 10.4 At Railway Stations. (Farmers' Milks) 162 147 15 9.2 638 576 62 9.7 Giving the particulars of the Milks taken during each quarter of 1922 on Sundays, Week-days, and at the Railway Stations. 1922 No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. 1st Quarter 30 90 30 150 25 62 30 117 5 28 — 33 16.6 31.1 — 22.0 2nd „ 30 90 58 178 29 87 55 171 1 3 3 7 3.3 3.3 5.2 3.9 3rd „ 30 90 45 165 27 86 36 149 3 4 9 16 10.0 4.4 20.0 9.7 4th „ 30 86 29 145 29 84 26| 139 1 2 3 6 3.3 2.3 10.3 4.1 The Year 120 356 162 638 110 319 147 576 10 37 15 62 8.3 10.4 9.2 9.7 1922] 62 The number of samples of milk purchased was 638, of which 576 were genuine and 62, or 9 7 per cent, were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 30 years MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 1893 213 173 40 18.7 1909 605 563 42 6.9 1894 206 169 37 17.9 1910 621 563 58 9.3 1895 413 343 70 16.9 1911 601 542 59 9.8 1896 468 418 50 10.6 1912 606 573 33 5.4 1897 513 464 49 9.5 1913 600 555 45 7.5 1898 543 492 51 9.4 1914 595 539 56 9.4 1899 532 477 55 10.3 1915 605 531 74 12.2 1900 541 485 56 10.3 1916 599 506 93 15.5 1901 632 556 76 12.0 1917 592 526 66 11.1 1902 586 528 58 9.9 1918 634 537 97 15.3 1903 508 458 50 9.8 1919 638 579 59 9.2 1904 600 553 47 7.8 1920 642 605 37 5.7 1905 594 549 45 7.6 1921 644 605 39 6.0 1906 634 560 74 11.8 Totals 16,166 14,558 1,608 9.9 1907 597 557 40 6.7 1908 604 552 52 8.6 1922 638 576 62 9.7 Showing the analyses of 6,155 milks examined, in Islington during the 10 years 1912-1921 and 1922 and distinguishing those purchased on Sundays, on Week-days, and procured at the Railway Stations whilst in transit from the Farmer to the London Milk Purveyor. Years. Sunday Milks. Week-day Milks. Railway Milks (Farmers). No. of Samples Per cent. of nonfatty solids. Per cent. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat. 1912 160 8.70 3.67 326 8.76 3.61 120 8.84 3.86 1913 162 8.74 3.56 318 8.72 3.52 120 8.92 3.80 1914 155 8.60 3.42 320 8.71 3.52 120 8.88 3.78 1915 165 8.64 3.43 320 8.76 3.49 120 8.86 3.67 1916 160 8.60 3.53 319 8.56 3.43 120 8.83 3.63 1917 150 8.63 3.45 322 8.60 3.41 120 8.84 3.59 1918 136 8.39 3.60 377 8.44 3.53 121 8.61 3.65 1919 166 8.56 3.56 331 8.56 3.61 141 8.67 3.68 1920 162 8.71 3.42 338 8.76 3.52 142 8.86 3.66 1921 151 8.83 3.34 371 8.79 3.37 122 8.91 3.73 Total samples and average constituents (10 years). 1,567 8.64 3.50 3,342 8.67 3.50 1,246 8.82 3.70 1922 120 8.78 3.39 356 8.76 3.34 162 8.75 3.60 63 [1922 The Public Analysts, in the quarterly reports during the year, reported on the genuineness of the articles examined as follows:— Showing the Samples of Foods and Drugs submitted to the Public Analysts during the year 1922. Description. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Totals. Genuine. Adulterated. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Totals 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Totals. Milk 117 173 162 141 593 108a 166a 146a 135a 555 9a 7ad 16a 6a 38 Milk (separated) 33 5 3 4 45 9a 5a 3a 4a 21 24a — — — 24 Butter 50 51 50 47 198 50 50 50 47 197 — 1 — — 1 Lard 10 9 10 6 35 10 9 10 6 35 — — — — — Dripping 5 4 4 — 13 5 4 4 — 13 — — — — — Coffee 11 5 2 — 18 11 5 2 — 18 — — — — — Cocoa 9 1 5 7 22 8 1 5 7 21 1 — — — 1 Pepper 11 6 7 6 30 11 6 7 6 30 — — — — — Cheese 10 11 5 3 29 10 11 5 3 29 — — — — — Tea 1 — — — 1 1 — — — 1 — — — — — Mustard 13 19 28 9 69 11 17 26 9 63 2 2 2 — 6 Arrowroot 4 2 1 1 8 4 2 1 1 8 — — — — — Malt Vinegar 16 3 2 1 22 13 3 1 — 17 3 — 1 1 5 Vinegar 3 — 1 1 5 3 — 1 1 5 — — — — — Self-Raising Flour 4 2 3 — 9 4b 2b 3 — 9 — — — — — Ground Ginger 3 6 4 1 14 3 6 4 1 14 — — — — — Crushed Linseed 2 1 — — 3 2 1 — — 3 — — — — — Rice 2 2 3 1 8 2 2 3 1 8 — — — — — Custard Powder. 2 5 1 — 8 2b 5b 1b — 8 — — — — — Curry Powder 2 1 — — 3 2 1 — — 3 — — — — — Lemonade Powder 1 4 3 — 8 1 4c 3 — 8 — — — — — Baking Powder — 1 3 1 5 — 1b 3b 1b 5 — — — — — Cayenne Powder — 1 — — 1 — 1 — — 1 — — — — — Bread and Butter — — 1 — 1 — — 1 — 1 — — — — — Ice Cream Brick — — 1 — 1 — — 1 — 1 — — — — — Compound Mustard — — 1 — 1 — — 1 — 1 — — — — — Cayenne Pepper — — — 1 1 — — — 1 1 — — — — — Plum Jam — — — 1 1 — — — 1e 1 — — — — — Olive Oil 2 1 — 1 4 2 1 — l 4 — — — — Gregory's Powder — 1 — — 1 — 1 — — 1 — — — — — Camphorated Oil — — — 2 2 — — — 2 2 — — — — — Prescriptions — — 4 4 — — — 2 2 — — — 2 2 Margarine 311 314 300 238 1,163 272 304 281 229 1,086 39 10 19 9 77 12 11 10 13 46 6 3 1 — 10 6 8 9 13 36 Totals 323 325 310 251 1,209 278 307 282 229 1,096 45 18 28 22 113 a All samples tree from Boric Acid and Formalin. b Conformed with the Local Government Board's recommendations as to Arsenic and Calcium Sulphate. c All samples free from Lead and Arsenic. d Free from Boric Acid but not Formalin. (1) e Salicylic Acid absent. No injurious constituents could be detected. N.B.—46 samples of milk examined under the Milk Order 13, are included in above totals. Milk Prosecutions. The summary of prosecutions showed that during the year 60 prosecutions were taken, of which number 36 were successful, and 17 were dismissed, while 7 were withdrawn. Summary of Prosecutions during year 1922. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties Received. £. s. d. "Public Health (London) Act, 1.891" 48 43 1 4 181 15 6 "Sale of Food and Drugs Acts, 1875-99" 31 23 6 2 62 6 6 "Margarine Act, 1887" 17 17 — — 21 17 0 "Milk (England and Wales). Order 1921" 38 29 2 7 114 3 6 "Sale of Food Order" 13 10 3 — 35 5 0 Total 147 122 12 13 415 7 6 1922] 64 PUBLIC HEALTH STAFF. The staff of the Medical Ofliccr of Health is constituted as follows: *Sanitary Inspectors.—T. W. Agar, H. J. Bicknell, A. Bagshaw, G J. Bridel, S. P. Marks, E. I. Fortune, J. Metcalf, T. H. Hancock, C. E. Horsman, A. E. Wood, E. G. Holmes, E. J. Nether, F. H. Clniter. (Houses let in Lodgings), H. H. Uren, C. W. Lewis. Resigned: W. Cook and W. H. Flood. *Senior Sanitary Inspector. Inspector oj Workshops and Bakehonses.—H. J. J. Watson. *Inspectors of Workshops, etc., in which Females are Employed.—Eleanor H. Daniell, Mrs. S. Undery. *Inspector of Meat, etc.—H. Wilkinson. *Inspector of Food and Drugs, etc.—G. S. Green. Rat Officer.—A. Butlin. Disinfecting Station.—A. Lewis (Engineer), C. Sadgrove (Stoker), .Mrs. Home (Cleansing Station Attendant), Mrs. Lewis (Caretaker, Shelter House). Disinjectors.—J. Brown, W. Hardwick, W. Woodley, A. Taylor. Mortuary Keeper.—S. Maxwell. Clerical Staff.—G. H. King (First Clerk), H. Angel, A. E. Abbott, W. J. Wolfe, W. G. Bunch, A. R. Wittrick, *C. M. Wheble, A. E. Booker, W. R. Causton, *C. J. Cridland, L. W. Edis. Milk Grants.—*F. C. Green, *A. E. Vanstone, *Daisy Francis. *Health Visitors.—Mrs. F. Looker, Miss V. A. Lainton, R. Palmer, L. Flower, E. Foot, A. Taylor, E. Neale. *Assistant to Medical Officcr of Health.— Beatrice Garvie, L.R.C.P. & S. (Edin.), D.P.H. Those marked with an asterisk indicates contribution was expected either under the Public Health Acts or by Exchequer Grants. The following Tables appeared in the Annual Report for 1921. Reference is made here to them as they have not been reprinted to save space this year for other matter: PAGE Illegitimate births in the Borough since 1851 3 Deaths of inhabitants in local institutions and in institutions outside the Borough, deaths of non-inhabitants in local institutions from 1911 11 Births and birth-rates (Islington) 1841 to 1920 46 Illegitimate births (Islington) 1841 to 1920 46 Deaths and death-rate (Islington) 1841 to 1920 47 Infantile mortality returns, 1841 to 1920 47 Cases of infectious disease (Islington) in quinquennial periods, 1891 to 1920 48 The Medical Officer of Health expresses his thanks to the Town Clerk, C. G. E. Fletcher, Esq., C.B.E.; the Solicitor, Arthur M. Bramall, Esq.; the Borough Engineer, J. P. Barber, Esq.; the Public Analysts, Dr. F. L. Teed and A. E. Pinchin, Esq., B.Sc., and to the Heads of other Departments, for their courtesy and assistance in various matters. He takes this opportunity of expressing his indebtedness to the staff for the efficient work and thorough co-operation which has meant so much in attaining the results reported on. APPENDIX. VITAL AND SANITARY STATISTICS, 1922. together with the PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 66 STATISTICAL APPENDIX. Showing the Deaths from all Causes in Islington during the Year 1022. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. Deaths in Institution 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 Tnf. U.H Toll. L..H H B S.E. Small Pox (a) Vaccinated - - - - - - - - - - - - - - - - -- - - - - - - (b) Unvaccinated - - - - - - - - - - - - - - - - - - - - - - - - (c) No Statement - - - - - - - - - - - - - - - - - - -_- - - - - - 42 Measles 37 90 7 - - - - - - - - - 127 7 5 9 15 32 14 30 29 73 61 134 Scarlet Fever 2 13 9 1 1 1 2 — — — — — — 15 14 2 3 4 5 2 6 7 14 15 29 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - 47 Epidemic Influenza 8 14 1 5 6 14 18 42 37 43 26 7 22 199 20 37 21 27 37 26 53 103 118 221 38 Whooping C'.ugh 29 67 1 1 - - - - - - - 96 2 7 3 8 1 7 11 34 18 48 50 98 Diphtheria 3 33 18 3 - 1 1 - - - 36 23 9 5 8 7 11 9 10 34 25 59 Enteric Fever . — — — — — — — — — — — — — - - - - - - - - - - - - Asiatic Cholera — — — — — — — — — — — — — - - - - - - - - - 2 Diarrhoea, Dysentery 14 2 — — — — 1 - j _ 1 16 3 2 - 3 1 4 1 8 13 6 19 5 Epidemic Enteritis 8 1 - - - - - - - - 1 - - 9 1 2 - 1 - 2 2 3 3 7 16 - Other Allied Diseases. ‡ tl 1 — — 1 — — — — — — 3 2 1 - 1 2 1 4 1 16 5 Hydrophobia - - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - - Tetanas - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - Cow Pox - - - - - - - - - - - - - - - - - - - -- - - 5 Syphilis 5 — — — — — — 1 4 — — — — 5 5 2 1 2 2 3 5 5 10 Gonorrhcpa - - 1 2 2 1 1 - 7 1 1 1 1 1 2 7 - 7 Phased aena — 1 — 1 1 / 1 6 Erysipelas 2 — — — — — - 1 1 3 2 - 2 7 1 - 2 1 - 2 3 5 4 o 1 Puerperal Fever — — — — — — 2 2 1 - - - -- 5 1 1 - - 1 1 1 - 5 5 5 Pyaemia 2 — 2 — - - - 3 1 1 2 3 - - 2 12 2 - 2 2 1 1 6 5 9 14 1 Infective Endocarditis — — — 1 — 1 3 5 2 1 - 1 — - 14 - 1 1 - 4 4 3 10 4 14 Other Allied Diseases. — — — — 1 — 2 — — 1 — — — 4 — — — 1 2 — 1 3 1 4 Malarial Fever - - - - - - - - - - - - - - - - - - -- -- - - - 1 Rheumatic Fever - 4 2 - 2 3 - - - - - 11 - 1 2 1 1 - 5 4 7 11 Rheumatism of Heart. 1 1 - - - 1 1 - - - 1 3 2 1 1 - - _ 4 4 5 Tuberculosis of Brain . 4 25 3 2 - - 1 - - - - 1 — 29 7 4 2 2 4 8 4 12 14 22 36 Tuberculosis of Larynx — — — — — — — — •— — — — — — __- - - - - - - - 81 Phthisis 2 5 4 2 26 46 77 79 77 48 9 3 7 371 28 41 35 42 70 69 93 233 45 378 3 Abdominal Tuberculosis 1 6 - - - 1 2 - 1 1 - - - 7 5 - 2 2 2 3 1 2 7 5 12 1 General Tuberculosis . — — 1 — — 1 - 1 - - — — — - 3 — - 1 - 1 - 1 3 - 3 1 Other forms Tuberculosis - - - 2 - - - 1 - - 1 - - - 4 - - 1 - 1 -_ 2 2 2 4 Other Infective Diseases - - - - - - - - - - - - - - - - - - - - - - - - - Thrush 1 — — — — - - — — — - — — 1 — — - - 1 - - 1 1 Actinomycosis . - - - - - - - 1 - - - - - - 2 - - - - 1 - 1 2 - 2 Hydatid Diseases - - - - - - - - - - - - - - - - - - - - - - - - - Scurvy - - - - - - - - - - - - - - -- - - - - - - - - - - Other Diseases due to Altered Food - - - - - - - - - -- - - - - - - - - - - - - - - - 1 Acute Alcoholism - - - - - - - - 1 - - - - - 1 1 - - - - - - 1 - 1 Chronic Alcoholism. - - - - - - - - - - - - - - - - - - - - - - Chronic Industri il Poisonings - - - - _ - - - - - - - - - - - - - - - - - Other Chronic Poison- ings - - - - - - - - - - - - - - - - - - - - - - - - - Osteo-arthritis . - - 1 1 - 1 - 3 7 2 1 - 16 - 3 1 2 4 3 3 Q 10 16 Gcut — - - — - - - - - 1 - - 1 - - 1 - - - - 1 - 1 128 Cancer - — — — 1 3 8 34 88 124 110 47 6 — 421 52 42 33 56 67 18 103 197 221 421 1 Diabetes Mellitus — — — — 1 — 3 6 11 7 1 -_ 29 4 3 2 2 5 2 11 12 17 29 Purpura Hemorrhagica - - - - - - -- - - - - - - - - - - - - - - - - - - Haemophilia — — — — - - - - - - - - - - - - - - - - - - - - - Anaemia — 1 — — — — 1 4 4 3 2 - - 1 14 2 - 7 1 - 1 4 4 11 15 Lyinphadenoma - - _ 1 - - 1 - - - - 2 - - - - 1 1 - 1 - 2 Premature Birth 118 - — — — — - - - - - — — 118 - 12 13 9 17 18 20 29 49 69 118 Injury at Birth 2 — — — — - - - - - 2 - - - - - - 1 1 2 - 2 Debility at Birth 6 — — — — — — - — — — - 6 — I - 1 1 1 - 2 1 5 6 Atelectasis 9 — _ — _ = _ - - - 9 - 2 2 1 1 - 1 2 4 5 9 Congenital Defects. 34 3 - - - - - 37 - 2 4 2 5 11 6 7 17 20 37 Want of Breast Milk 6 — — - — — - - - - 6 1 - 1 1 1 1 1 2 4 6 Atrcphy, Debility, asmus 46 2 - - - - - - - - - - - 48 - 4 5 5 8 9 6 11 31 17 48 • Cercbro-Splnal Fever (3). f Chickcn Pol. { Ophthalmia Neonatorum (1). 1922] 6/ [1922 Continued. Deaths in Institution- n Borough. DISEASES. AGES. Unclt:r 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 Dentition 2 1 - - - - - - - -- - - - 3 - - 1 -_- - - - 2 - 3 3 Rickets ~\ 2 - - — — — — — 3 — 1 1 - 1 - 2 1 3 Old Age, Senile Decay — - — — - — 3 48 182 78 — 311 35 38 30 39 60 50 53 109 202 311 Convulsions 12 3 - - — - - - - - - - — 15 - — — 3 4 6 2 7 8 15 Meningitis 7 5 1 1 - 1 1 1 — - — - 12 5 1 1 1 2 5 2 5 13 4 17 Encephalitis — — - 1 1 1 1 3 — - — — — 7 1 - 3 — 1 1 1 3 4 7 Apoplexy 2 — — 1 2 3 18 33 50 40 3 2 150 22 22 16 16 33 14 35 61 97 158 Softening of Brain — — — — — 1 — - — 2 — — — 3 — 2 — 1 - 2 1 3 Hemiplegia — — — — — —- - — 1 2 5 4 — — 12 — 2 2 2 3 3 4 8 General Paralysis of the Insane - - - - - 2 5 10 2 1 - - - 20 2 - 4 2 - 7 5 13 7 Other forms of Insanity — - - 1 1 2 5 5 1 - 15 1 1 2 3 3 - 5 9 6 15 Chorea - - - - - - - - - - - - - - - Cerebral Tumour 2 1 — 4 1 3 1 — — — 2 10 2 1 - 2 4 2 1 8 4 12 Epilepsy — 1 2 — 1 2 2 5 5 3 1 — — 1 21 — 7 2 1 4 5 3 8 14 22 Laryngismus Stridulus — — — — — — - - — — - — — — — — - - — - — — - - - Locomotor Ataxy — — — — — — 1 1 1 9 9 — — — 21 — 2 3 6 3 2 5 17 4 21 Paraplegia — — 1 1 — - — 3 3 10 4 1 — 23 4 - 3 2 4 5 4 13 10 23 Other forms, Brain Diseases - - 1 - 11 - - 11 - - 11 1 - - 5 - 1 1 2 - 1 - 2 3 5 Ot'.tis 1 2 1 2 — — 3 — — — — — 3 0 — 3 — — 1 3 2 5 4 9 Disease of Nose, Epis- taxis - - - - - - - - - - - - - - - - - - - - - - - - Disease of Eye - - - - - - - - - - - - - - - - - - - - - - - - - 1 Pericarditis - 1 — — 1 — 1 1 — — 4 — 1 1 1 1 3 1 4 2 Endocarditis 1 1 1 3 3 4 1 4 — — 18 1 2 7 8 5 13 18 Hypertrophy of Heart. - - - - - - - - - - - - - - - - - - - - - - - - - Angina Pectoris — — — — — — — — — 1 3 — — — 4 2 — - 1 — — 1 3 1 4 1 Aneurism — 1 4 2 2 — — 9 1 1 2 1 3 1 5 4 9 4 Senile Gangrene — — 1 - 4 3 4 12 1 2 - 1 4 1 3 8 4 12 12 Embolism, Thrombosis _ 1 — 2 3 4 11 14 7 3 45 2 7 6 6 9 7 8 10 29 45 Phlebitis - - 1 - 1 - - - 1 - 1 1 Varicose Veins - - - - - - - - - - - - - - - - - - - - - - - - - 156 Other Diseases, Heart and Vessels 2 - 1 6 7 4 21 38 75 142 190 123 b 2 039 00 20 58 68 118 108 153 313 328 641 1 Laryngi tis 1 — 1 1 — — — — 1 — — - — 1 3 1 — — 1 1 1 — 2 2 4 Croup — — — — — — — — — - — — — — — — — — — 1 — — — — - Other Diseases, Larynx and Trachea . - - - - 1 - - - - - - - - - 1 - 1 - - - - - 1 - 1 29 Acute Bronchitis 18 5 — — — 1 1 5 10 20 33 20 5 23 107 10 12 6 24 13 28 31 04 66 130 69 Chronic Bronchitis 17 7 — — — 2 9 20 45 93 63 15 24 253 22 21 21 35 41 71 66 145 132 277 23 Lobar Pneumonia 4 9 1 — 1 3 12 14 15 20 17 4 — 13 93 14 11 15 12 16 10 28 09 37 106 78 Lobular Pneumonia 88 118 2 — 3 2 1 3 10 17 19 9 2 206 68 20 21 22 45 27 67 66 142 132 274 10 Pneumonia 5 7 1 — - — 1 10 13 13 9 3 — 12 50 6 6 8 6 10 5 21 36 26 62 3 Emphysema, Asthma . — 1 — — — 1 1 5 4 4 1 — 1 16 1 — 2 5 4 — 5 11 6 17 4 Pleurisy 1 3 1 - - - - - 1 3 2 — 1 4 8 1 3 1 1 2 — 4 7 5 12 1 Other Disease Respir- atory System 3 - - - 1 1 1 2 1 4 4 3 3 17 2 3 1 3 3 3 5 10 10 20 Diseases of Mouth and Annexa 1 - - - - - 1 - - - - - - 1 - - - - 1 - - 1 - 2 2 Diseases of Pharynx. - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 Diseases of (Esophagus - - - - - - - - — - - - - - - - - - - - - - - - - 1 Ulcer of Stomach and Duodenum — - - - 1 - 1 6 5 5 5 - - - 23 3 2 4 1 5 4 4 14 9 23 Other Diseases of the Stomach 4 - - - 1 - 1 - 1 - 2 1 - 4 7 3 1 1 - 3 2 1 5 6 11 28 Enteritis 38 10 — — — — 1 2 1 — 2 1 48 7 9 4 7 4 4 14 13 34 21 55 5 Appendicitis 1 2 1 1 2 6 3 2 2 — - — 1 19 3 2 1 2 4 8 11 9 20 Obstruction of Intestine 13 1 - 1 2 1 1 2 4 6 6 5 2 14 30 5 4 8 3 11 3 10 23 21 44 Other Diseases of Intestine - 1 - - - 1 - 1 - 1 2 - - 1 5 1 2 - 1 1 1 - 3 3 6 3 Cirrhosis of Liver. — 1 1 2 5 4 3 — — 16 1 1 3 1 3 3 4 11 5 16 Other Diseases of Liver — __ — — 1 — — I 1 2 2 - — — 7 2 — — 2 2 — 1 1 6 7 Peritonitis — 1 3 1 — 1 2 1 — 1 1 — 1 10 — 3 1 2 1 1 3 3 8 11 Other Diseases, Digestive System - - - — 1 - 1 1 - 2 - 5 1 - 1 - 1 1 1 - 5 5 Diseases, Lymphatic System and Glands 3 - - - - 1 1 3 - 1 1 1 - 3 8 1 - 1 2 2 3 2 3 8 11 Acute Nephritis — 1 — 1 1 — 1 — 1 — 1 — — 1 5 1 — — 3 2 — 4 2 6 25 Bright's Disease — 1 — — 2 2 4 8 13 18 30 11 2 1 90 14 14 5 12 18 13 15 51 40 91 7 Calculus — 1 — 1 1 2 — 1 1 — 7 — 2 — 1 1 2 1 1 6 7 Diseases of Bladder and Prostate - - - - - - 1 - 2 2 9 9 - _ 23 2 _ 4 3 7 2 5 21 2 23 Other Diseases, Urinary System - - - - - 1 - 1 - - 2 3 - 7 - 1 - - 1 2 3 2 5 7 Diseases of Testis and Penis - - - - - - - - - - - - - - - - - - - - - - - - Diseases of Ovaries. — 1 — 1 — — — — — 2 1 — — — — 1 — 2 2 Diseases of U terus and Appendages . - - - - - - - - - 1 - - - 2 - - 1 - 1 - - 2 2 1 Diseases of Vagina and External Genitals 1 - - - - - - - - - - - - 1 - 1 - - - - - - - 1 1 Diseases of Breast - - - - - - - - - - - - - - - - - - - - - - - - - Abortion, Miscarriage. - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Mania - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Convjlsions - - - - - 1 - - - - - - - - - - - - - 1 - 1 1 1 Placenta Prsevia, Flooding - - - - 1 3 - - - - - - 4 - - - 1 - 1 2 - 4 4 || Encephalitis Lethar^ica (3). 68 1922 Continued. Deaths In Institutions! within Borcugh DISEASES. AGES. Under 5 Over 5 DISTRICTS. Male Female [ Total 0 1 5 10 15 20 25 35 45 55 65 75 85 Tuf U..H. Toll. L.H. H B S.E. Puerperal Thrombosis. - - - - 1 - - - - - - - - - 1 - - 1 - - - _ - 1 1 Other Diseases, Preg- - - - - _ 3 2 4 - _ - _ 9 1 2 1 2 3 9 9 Arthritis, Ostitib, Periostitis - - - - - - - - - - - - - - - - - - - - - - - - - Other Diseases, Osseous S vstem _ - 4 - 1 - 1 1 1 _ — —- — 8 1 1 1 _ 3 2 3 5 8 nicer, Bedsore - - - - - - - - 1 1 2 1 — 5 — 2 — 1 - — 1 3 2 5 Eczema - - - - - - - - - - 1 - - - 1 - - - - - - 1 1 — 1 Pemphigus 1 — - - - - - - - - - - - 1 - - - - — — 1 — 1 — 1 Other Diseases, Integument iry System 1 - - - - 1- - - - - - - - 1 1 - - - - - 1 1 2 — 2 Accidents and Negligence. In Mines am! Quarries. - - - - - - - - - - - - - - - - - - 12 In Vehicular Traffic. 1 — 2 2 1 — 2 1 3 5 8 4 1 31 5 3 4 4 5 5 6 25 7 32 On Railways — — — — — — — J —. 1 - — — 3 — 1 — — 2 — — 3 — 3 On Ships, Boats, etc (not drowning) - - - - - - - - - - - - - - - - - - - - - - - - - In Builiing Operations — — — — — — — - - 1 1 — — — 2 — — 1 — — 1 — 2 — 2 By Machinery . — — — — — — — — 1 - - — — 1 - — — — — — 1 — 1 1 By Weapons and Implements - - - - - - - - - 1 - - - - 1 - - - - - - 1 1 _ 1 3 Burns and Scalds — 3 1 — 2 — — — — 1 - — 3 4 — — 2 — 1 3 1 4 3 7 1 Poisons, Poisonous Vapours - - _ - - - 1 1 - 1 - 3 1 2 - - 1 2 3 Surgical Narcosis - - - - - - - - - - - - - - - - - - - - - - - - - Effects of Electric Shock - - - - - - - - - - - - - - - - - - - - - - - - Corrosions by Chemicals - - - - - - - - - - - - - - - - - - - - - - - - - Drowning — — — 1 — — 1 1 - — 1 — — 4 — — 1 2 — 1 — 4 — 4 Suffocation, Overlaid in Bed 5 - - - - - - 5 - 1 - - 2 1 1 3 2 5 Suffocation, Otherwise 4 1 — - - - - - - - - - - 5 - - - - - 1 2 2 3 2 5 8 Falls not specified 1 — — 1 — 1 — 1 6 — 6 4 4 1 23 2 2 2 1 9 2 6 15 9 24 Weather Agencies. - - - - - - - - - - - - - - - - - -—- - - - - - - - 3 Otherwise, not stated . 1 1 — 1 I — 1 1 — — 1 — — 2 5 — 1 2 — 1 3 — 6 1 7 Homicide Suicide. — — — — — I 1 1 - - - - 3 - 1 - - I 1 — 2 1 3 2 By Poison - - - - - 3 6 1 4 5 5 1 — — 25 4 2 1 4 5 4 5 18 7 25 BY Asphyxia - - - - - - - - - - - - - - - - - - - - - - - - By Hanging and Strangulation - - - - - - - 1 - 2 - - - - 3 - - - - - - 3 3 — 3 By Drowning - - - - - - 1 1 — - 1 — — — 3 — — 2 — — — 1 2 1 3 By Shooting - - - - - - - - - - - - - - - - - - - - - - 1 — I By Cut or Stab - - - - - - 2 - 1 - - - - - 3 - - - - - - 2 3 — 3 1 By Precipitation from Elevated Places - - - - - - 1 - 1 1 - - - - 3 1 - - - 1 1 - 1 2 3 By Crushing - - - - - - 1 - 1 - - - - - 2 - - - 1 - - 1 2 — 2 By other and unspeci- fied methods - - - - - - - - - - - - - - - - - - - - - - - - - Execution - - - - - 1 - - - - - - - - 1 - - - 1 - - - 1 — 1 Sudden Death, cause not ascertained - - - - - - - - - - - - - - - - - - - - - - - - - Ill-defined and unspecified causes - - - - - - - - - - - - - - - - - - - - - - - - - Males 309 238 35 19 41 53 110 172 287 381 399 241 49 547 1787 219 254 226 298 383 412 542 — _ 2334 Females 270 214 42 19 33 45 103 144 219 277 425 370 119 484 1796 241 219 217 281 387 397 538 - - 2280 864 TOTAL DEATHS 579 452 77 38 74 98 213 316 506 658 824 611 168 1031 3583 460 473 443 579 770 809 1080 2334 2280 4614 69 1922 Metropolitan Borough of Islington. CAUSES OF, AND AGES AT DEATH DURING THE CALENDAR YEAR, 1922. Causes of Death. Nett Deaths at the subjoined Ages of " Residence " whether occurring within or without the District. All ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and upwards Total Deaths i whether of " Resi- 1 dents " or " Non- , residents" in Institutions in the District. 1 2 3 4 5 6 7 8 9 10 11 All Causes Certified 4563 580 258 193 114 163 515 1147 1593 1512 Uncertified 1 1 — — — — — — — — Enteric Fever - - - - - - - - - - Small Pox — — - — — — — - — — Measles. 133 37 57 32 7 — - — — 50 Scarlet Fever 29 2 5 8 10 2 2 — - 7 Whooping Cough . 98 29 44 23 1 1 — — - 63 Diphtheria and Croup 60 3 12 21 22 1 1 — - 5 Influenza 215 8 9 5 1 9 31 76 76 78 Erysipelas . 9 2 — - — — — 2 5 6 Phthisis (Pulmonary Tuberculosis) 359 2 2 3 6 68 151 115 12 144 Tuberculous Meningitis. 36 4 13 12 5 — 1 - 1 12 Other Tuberculous Diseases 19 1 2 4 3 2 4 2 1 10 Cancer, malignant disease 418 — — - - 4 41 210 163 228 Rheumatic Fever . 9 — — - 2 2 2 3 - 5 Meningitis 21 7* 1 5 4* 1* 2 1 — 4 Organic Heart Disease 599 1 — - 6 10 62 194 326 234 Bronchitis . 416 34 6 7 — 1 17 112 239 161 Pneumonia (all forms) 438 99 79 54 4 8 39 92 63 155 Other diseases of respira- tory organs 54 5 3 1 3 3 5 18 16 14 Diarrhoea and Enteritis 85 61 10 3 - 2 4 5 34 Appendicitis and Typhlitis 20 — — 1 3 3 9 4 - 9 Cirrhosis of Liver . 16 — - 1 - 7 8 4 Alcoholism 1 — - — — — 1 — — Nephritis and Bright's Disease 97 - - 2 1 4 13 33 44 40 Puerperal Fever 5 — — — - — 4 1 — 1 Other accidents and diseases of Pregnancy and Parturition 15 - - - - 5 10 - - 3 Congenital Debility and Malformation, including Premature Birth 215 210 4 1 - - - - - 14 Violent Deaths, excluding Suicide 102 13 3 2 9 7 14 23 31 55 Suicide 40 - - - - 2 16 14 8 10 Other Defined Diseases . 1055 63* 8* 9 27* 29 89 235 595 166 Diseases ill-defined or unknown - - — - - - - — — Totals 4564 581 258 193 114 163 515 1147 1593 1512 Sub-entries.—Included in above figures: Cerebro-spinal Meningitis 3 1* - 1* 1* - - - - Chicken Pox 1 — 1* — — — - — - — Ophthalmia Neonatorum 1 1* - — - - - - - - Encephalitis Lethargica 1 - - - 1* - - - - - 70 Metropolitan Borough of Islington. INFANTILE MORTALITY DURING THE CALENDAR YEAR 1922. Nett Deaths from stated Causes at Various Ages under One Year of Age. Cause of Death. Weeks. Total under 4 weeks Months. Total Deaths under 1 year Under 1 week 1-2 2-3 3-4 4 weeks and under 3 months 3-6 6-9 9-12 All -Certified .. 126 37 29 22 214 79 98 96 93 580 Causes. -Uncertified — - — — — 1 — — — 1 Small-pox - - - - - - - - - - Chicken-pox - -- - - - - - - - - Measles — - — — — 1 2 8 26 37 Scarlet Fever — - — — — — — 1 1 2 Whooping Cough — - — 1 1 2 8 6 12 29 Diphtheria, Croup — - 1 — 1 — — 2 — 3 Erysipelas — - 1 — 1 1 — — — 2 ' Tuberculous Meningitis - - - - - - - 1 3 4 Abdominal Tuberculosis - - - - - - 1 - - 1 Other Tuberculous Diseases - - - - - - - - 2 2 Meningitis (not Tuberculous). - 1 - - 1 - 2 3† 1 7 Convulsions 3 2 1 1 7 2 3 2 — 14 Laryngitis — — — — — — — 1 — 1 Bronchitis 1 2 — 1 4 6 12 7 5 34 Pneumonia (all forms). - 1 2 3 6 16 24 32 21 99 Diarrhoea 1 1 — — 2 5 5 7 3 22 Enteritis 2 2 1 1 6 8 9 10 6 39 Gastritis - - - - - 1 1 1 — 3 Syphilis — — 1 1 2 2 1 — — 5 Rickets — — - — — — — 1 — 1 Suffocation, overlying 1 _ - _ 1 3 1 - 5 Injury at birth . 1 1 - — 2 — — - — 2 Atelectasis 8 — - — 8 — — - — 8 Congenital Malformations 17 3 4 2 26 2 4 1 1 34 -j Premature birth 71 13 14 8 106 9 4 - — 119 Atrophy, Debility and Marasmus 14 5 2 3 24 11 13 5 4 57 Other Causes 7 6 2 1 16 11* 8 8 8 51 Totals. 126 37 29 22 214 80 98 96 93 581 LONDON COUNTY COUNCIL RETURN. Borough of Islington. PROCEEDINGS DURING 1922. Premises. Number of Places. Number of Inspections 1922 Number of Notices 1922 Number of Prosecutions 1922 On Register at end of 1921 Added in 1922 Removed in 1922 On Register at end of 1922 Milk Premises 625 37 39 623 710 36 Nil Cowsheds. 4 _ — 4 31 — — Slaughter-Houses Other Offensive Trade 18 — — 18 982 — - ises 7 7 67 — Ice Cream Premises 242 — 242 95 19 Registered Houses Let in Lodgings 1,033 - 21 1,012 8,549 363 4 Nett Births /legitimate ... 7,273 Nett Deaths in / legitimate infants ... 558 in the year \illegitimate ... 276 the year of I illegitimate infants ... 23 * Ophthalmia Neonatorum (1). t Cerebro-Spinal Fever (1). 1922] 71 [1922 Total number of intimation notices served for all purposes 4,364 Insanitary houses— Number closed under the Public Health (London) Act, 1891 Nil Number of premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 150 Housing of the Working Classes— Number of houses inspected 5,560 Number of representations by householders Nil Number of representations by Medical Officer 1 Number of houses included in such representations 2 Number of houses remedied without Closing Orders Nil Number of Demolition Orders Nil Number of houses dealt with under Section 15 of the Housing, Town Planning, etc., Act, 1909 Nil Number of Closing Orders 2 Number of houses included in such Closing Orders 2 Number of Closing Orders determined. Nil Number of houses demolished—(a) in pursuance of Orders 1 (b) voluntarily Nil 01 structive buildings— Number of representations under Section 38 of the Housing Act, 1890 ... Nil Number of representations still under consideration Nil Number of buildings demolished Nil Number of Orders for repairs issued under Section 28 of the Housing Act, 1919 5 notices relating to 5 dwelling houses Number of houses repaired by local authorities Nil Number of houses closed on notice by owner that they could not be made fit ... Nil Total number of houses in the Borough 42,633 Number of houses for the working classes— (a) Erected during year (Flats) 165 (b) In course of erection (Flats) 48 Number of houses occupied by the working classes 26,896 Smoke nuisances— Number of observations 209 Number of warnings (letters sent) 24 Number of notices 9 Number cf nuisances and complaints 46 Number of summonses Nil Underground Rooms— Number illegally occupied 5 Number closed or illegal occupation discontinued 5 Overcrowding— Number of rooms overcrowded 10 Number remedied 10 Prosecutions Nil 1922] 72 Cleansing— Number of adults cleansed 19 Number cf children cleansed 4,243 Cleansing— Number of rooms or premises cleansed 4.928 Water supply to tenement houses— Premises supplied 92 Prosecutions Nil Sale oj Food— Number of premises used other than ice cream premise?, milk shops and cowsheds 818 Number of inspections 17.590 Ophthalmia neonatorum regulations— Number of Notifications received during the year from certified midwives ... 45 Sanitary officers— Number of Sanitary Inspectors (Whole time) Male, 18 Female 2 „ „ (Part time) Male, Nil Female Nil Number of Health Visitors Whole time, 7 Part time Nil Disinfection Shelter provided under Sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 10 Revenue A els— Number of houses for which application were received during year ... ... 59 Number of tenements comprised therein 361 Number of tenements for which certificates were (a) granted 293 (b) refused 4 (c) deferred . 64 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc Nil (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. Nil (i*) 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 (_/') As to cesspools and pi ivies, removal and disposal of refuse, e tc Nil (g) For securing the cleanliness of tanks, cisterns, etc. Nil (h) With respect to water closets, earth closets, etc. Nil (i) With respect to sufficiency of water supply to water closets Nil (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) Nil (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) Nil Number of prosecutions under L.C.C. General Powers Act, 1907— (I) With respect to water supply to tenement houses Nil Mortuaries— Total number of bodies removed Total number of infectious bodies removed 316 1 73 INDEX. Page Accidental Deaths 27 Acreage Adulteration of Food 60, 63 Ages at Death '0 Area Baby Week '2 Bacteriological Examinations 37, 38, 54 Births „ Illegitimate 8 „ Notification of 8 Stillborn 8, I6 Cancer. 25 Census Returns 4-6 Chicken Pox 37 Cleansing of Verminous School Children 41 Coal gas Poisoning 27 Colouring matter in Milk 58 Cow Sheds 53 Death irom all causes during the year 10, 66 Deaths from Epidemic Diseases 22 „ ,, Respiratory Diseases 27 „ „ in Public Institutions 22 „ „ Classified Causes 9 Density 2 Disinfectants distributed and used 40 Disinfecting Station 40 Disinfection Work 39 Dispensing of Prescriptions 2, 60 District Inspectors' Work 46-47 Drugs 60, 63 Dust, removal of 46 Dysentery 33 Education Propaganda 12 Employed Population 41 Encephalitis Lethargica . 33 Epidemic Diseases 22 „ Cerebro-Spinal Meningitis 32 Erysipelas 25 Factories and Workshops Administration 42 Families 4, 5, 6 Fatality from Notifiable Infectious Diseases 30 Food, Adulteration of. Inspection of. Unsound 50, 52, 60 „ Conference 51 „ Orders 54 Fumes from Business Premises 41 74 Page Health Visitation 13, 19, 20 Health Week 1-12 Hospital Isolation of Infectious Diseases 30 Housing 49, 71 Houses Let in Lodgings 48 Infant Mortality 10 Infant Welfare Work 13 Infection 28 Infectious Diseases in Schools 36 „ „ (Non-Notifiable) in Schools 37 Inflation of Meat 1,51 Influenza 24 Inhabited Houses 4 Inspection of Food 52 ,, „ Houses 46, 47, 49 „ „ Kitchens of Restaurants 53 „ „ Slaughter Houses and Cow Houses 52-53 „ „ Workshops 42 Institutions 22 Inquests 28 Isolation of Infectious Diseases 30 London County Council Return of Sanitary Work 70 Malaria 33 Malignant Diseases 25 Marriages 7 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work. 13 Measles, Notifications by School Teachers 37 Meat Inspection 52 Ministry of Health Returns 69-70 Milk Scheme 17 Milk Adulteration 61-62 „ Shops and Dairies 53 „ and Dairies Act 56 „ and Cream Regulations 54-58 Mortuary and Coroner's Court 28 Notification of Infectious Diseases 28 „ „ Tuberculosis 33 „ „ Births Act. 10 Non-notifiable Infectious Diseases in Schools 37 Nursing 17 Offensive Trades 53 Ophthalmia Neonatorum 16, 33 Outworkers' Premises 42-44 Other Notifiable Diseases 32 Pauperism 49 Pathogenicity Tests (Diphtheria) 37 Phthisis 25, 33 „ Notification of 33 Places where Food is Prepared 42, 50,53 Pneumonia 27, 33 r ,£ ... 75 Page Population at tile Census, 1921 2.6 Population, estimated, 1922. 2.3 Prescriptions, Dispensing of <50 Preservatives 2, 57 Prevention of Infection 28 Prosecutions, Summary of 63 Public Health Committee ii „ „ Milk and Cream Regulations 54 Puerperal Diseases 17, 25 Polio-Myelitis, Acute 32 Pulmonary Phthisis 33 ^Jats and Mice (Destruction) Act, 1919 1, 48 Rateable Value iii Respiratory Diseases 27 „ Tuberciilosrs 25 ReStaurant Kitchens 42, 53 Samples Analysed in 1922 60, 63 Sanitary Inspectors' Work 46-47 „ Conveniences—Factories, Workshops and Workplaces 45 Septic Diseases 25 Shelter House 41 Slaughterhouses 52 Smoke Nuisances 1,46 Sophistication. 1,54 Steam Whistle Act 41 Street Accidents 27 Tuberculous Diseases 25 Tuberculosis Dispensaries 35 „ Notification of 33 „ Deaths from 25 Unsound Food 2,50 Vaccination 38 Venereal Diseases 27 Verminous Children, Cleansing of 41 „ Premises 46 Voluntary Maternity and Child Welfare Centres 13, 18, 19, 21 Workshops and Factories, Inspection of 42 Welfare Work by Health Visitors 14, 19