ISL 65 1923. SIXTY-EIGHTH 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., Lid., 37-43, Green Lanes, Stoke Newington, N. 16. ii 22. 185 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1923, to November, 1924.) Mayor. SIDNEY CHARLES HARPER, J.P. Aldermen FREDERICK EDWARD BRADSHAW FREDERICK MONTAGUE, M.P. Councillors. Ward Ward 1. WILLIAM H. GALE 5. FRANK E. WIDDOWSON 2. HENRY PF.NN 6. WILLIAM T. R1CKETTS 2. EDWARD TOM KINS 6. ABRAHAM LEVISON 3. WALTER FREDERICK NOKES 7. JAMES SKINNER, J.P. 3. WILLIAM THOMAS SMITH 8. WILLIAM J. MITCHELL 4. JAMES T. HOARF. 10. SARAH JOHNSON 4. HERBERT S. JORDAN 11. HENRY JOHNSON 5. FREDERICK COPPING Chairman Councillor JORDAN Vice-Chairman Councillor SMITH MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1923, to November, 1924.) Aliernifn. RICHARD MONTFORD, J.P. HENRY B. VORLEY, J.P. Councillors. Ward Ward 1. WM. HERBERT GALE 6. REGINALD FRANKLIN 1. HERBERT T1CE 6. KATE SHARP, J.P. 2. SIDNEY E. RAMSAY 7. JAMES SKINNER, J.P. 3. GRACE WATSON 8. WILLIAM J. MITCHELL 4. VINCENT P. CATTERMOLE 10. SARAH JOHNSON 5. ALBERT E. PETTET 11. HENRY JOHNSON Members appointed by the Council jrom outside their own body. LADY ANDREWES, 1, North Grove, Highgate, N. 6 Dr. ALICE VANCE KNOX, 15, South Grove, N. 6 Mrs. COLEMAN, 76, Plimsoll Road, N. 4 Mrs. MATILDA SOUTHGATE, J.P., 507, Caledonian Road, N. 7 Mrs WATT, tiO, Highbury New Park, N. 5 Mrs. VORLEY, "Fern Bank," Holly Park, Crouch Hill, N. 4 Dr. KATE PLATT, 59, Queen Anne Street, W. 1 Chairman Councillor TICE Vice-Chairman Councillor KATE SHARP, J.P. iii SUMMARY of Vital Statistics in the Registration Year 1923. Population (Enumerated at Census, 1921) 330,737 persons „ Estimated Mid-Year 1923 336,600 persons Increase on Census population, 1921 5,863 persons Mean Population, ten years (1913-1922) 318,529 persons Area 3,092 acres Density (Mid year 1923) 109 persons per acre Males 3,493 persons 7,100 Births Females 3,607 Birth rate 21.10 per 1,000 inhabitants Deaths from All Causes Females l,984 Persons 3,902 Death rate 11.60 per 1,000 inhabitants Males 62 128persons Deaths from Principal Epidemic Diseases Females 66 Death rate 0.38 per 1,000 inhabitants Deaths from All Tuberculosis Males 234 389 persons Females 155 Death rate l.16per 1,000 inhabitants Deaths from Respiratory Tuberculosis Males 203 337 persons Females 134 Death rate 1.00 per 1,000 inhabitants Infantile deaths under 1 year Males 255 Total 473 Females 218 Infantile mortality rate 66 per 1,000 births Excess of Births over Deaths 3,198 Rateable value of Borough of Islington £1,886,328 Sum represented by a penny rate £7,830 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 1923. Included are the statistical tables as prescribed by the Ministry of Health. The draft Report was submitted to the Public Health Committee in June, 1924. The death rate for 1923 was 116, the lowest recorded in the Borough records, which date from 1841. The Maternity and Child Welfare Scheme, both organisations, Municipal and Voluntary, have worked in unison. The Infantile Mortality rate—66 per 1,000 births—constitutes a record for Islington. Towards the close of the year a Sub-Committee was appointed to consider possible extension of the Municipal activities. I am, Ladies and Gentlemen, Your obedient Servant, Gclark Sfrotter Medical Officer of Health. REPORT of the Medical Officer of Health FOR THE YEAR 1923. 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.—As regards educational propaganda, special efforts were made to arouse the interest of the citizens in Child Welfare and Health matters generally during Health Week. See page 8. 2. Smoke Nuisance, etc.—Observations to the number of 215 were taken during the year, and two cases were proceeded with in Court, pages 38-39. 3. Rats and Mice (Destruction) Act, 1919.—A summary of the supervisory work of the Rat Offtcer will be found on page 40. 4. Meat, Food and Drugs.—(a) Contamination by Dust, page 43. (b) The Labelling of Meat and Eggs (Food Order, 1921), page 44. (c) Unsound Food, page 42. (d) Preservatives and Colouring Matter in Food, page 45-46. (e) Inexperience of many Small Shopkeepers, page 46. (f) Sophistication of Milk, page 49. (g) Dispensing of Prescriptions, page 47. 5. Health Visitation.—Sub-Committee re possible extension of Municipal Work, page 11. 6. Index to Report.—Pages 61-63. 2 1923] POPULATION. The population of the Borough in 1923, estimated by the Registrar-General, was 336,600 persons, of whom 157,530 were males and 179,070 females. Thus it is shown there was a total increase of 2,700 persons as compared with those of the preceding year. In the following tables will be found information respecting the sex, age and estimated populations of the several sub-registration districts and wards, together with particulars of their areas and densities. Showing the Areas, Densities and Estimated Populations of the Subregistration Districts at the middle of the year 1923, also the Populations at the Census, 1921. Sub-Districts. Area. Acres. Estimated Acres to a person. Estimated Persons to an Acre. Estimated Population Mid-year 1923. Enumerated Population at Census 1921. Increase or Decrease on Census. Tufnell 411 0.0120 83 34.143 33,750 + 393 Upper Holloway 299 0.0089 111 33.268 35,721 — 2,453 Tollington 315 0.0101 99 31.225 30,832 + 393 Lower Holloway 406 0.0037 102 41,522 40,139 + 1,383 Highbury 749 0.0123 81 60,825 58,850 + 1,975 Barnsbury 316 0.0057 175 55,333 53,859 + 1,474 South East Islington 596 0.0074 135 80,281 77,586 + 2,698 The Borough 3,092 0.0092 109 336,600 330,737 + 5,863 Showing the Areas, Densities and Estimated Populations of the Wards at the middle of the year, 1923, also the Populations at the Census, 1921. WARDS. Area in Acres. Estimated Persons to an Acre or Density of Population. Estimated Population Mid-year 1923. Enumerated Population Census, 1921 Increase or Decrease on Census. No. 1—Tufnell 411 83 34,143 33,750 + 393 2—Upper Holloway 299 111 33,268 35,721 — 2,453 3—Tollington 315 99 31,225 30,832 + 393 4—Lower Holloway 406 102 41,522 40,139 + 1,383 5—Highbury 417 78 32,736 33,417 — 681 6—Mildmay 332 85 28,089 25,433 + 2,656 7—Thornhill 178 174 30,913 31,301 — 388 8—Barnsbury 138 177 24,420 22,558 + 1,862 9—St. Mary's 150 121 18,164 17,363 + 801 10—Canonbury 290 110 31,888 29,997 + 1,891 11—St. Peter's 156 194 30,232 30,226 + 6 The Borough 3,092 109 336,600 330,737 + 5,863 Showing the Estimated Number of Persons living in Islington at Mid-year, 1923, at Nine Age Periods, distinguishing Males and Females. Ages. Males. Females. Persons. 0— 5 14,812 14,473 29,285 5—15 30,967 30,293 61,260 15—25 25.918 31,641 57,559 25—35 24,908 30,293 55,201 35—45 21,542 25,918 47,460 45—55 18,850 20,532 39,382 55—65 12,118 13,801 25,919 65—75 6,396 8,416 14,812 75 and upwards 2,019 3,703 5,722 All ages 157,530 179,070 336,600 3 [1923 MARRIAGES. Marriages, 2,764; Marriage Rate, 16.4.—The number of persons married was 5,528, as contrasted with 5,754 in the preceding year, which is a decrease of 226. The marriage rate was 16 4 per thousand inhabitants, as compared with 17.2 in 1922. The following statement shows the figures for the previous ten years 1913-22. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 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 1917 2,689 16.23 1922 2,877 17.23 BIRTHS. There were 7,100 births registered, of which 3,493 were boys, and 3,607 girls. Of this number, however, 1,024 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 21.1 per 1,000 of the population, as compared with a mean birth rate of 22.1 in the preceding ten years. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1923, 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 1922; together with the mean Borough Birth-rates for the 10 years 1913-1922. Quarter. Males. Females. Total Islington, 1923. Birth Rates. 105 Great Towns, 1923. Islington, 1913-22. London, 1923. First 935 934 1,869 22.2 22.7 21.4 21.2 Second 968 945 1,913 22.7 22.6 21.7 21.4 Third 851 889 1,740 20.7 21.4 20.4 20.5 Fourth 739 839 1,578 18.7 21.3 18.7 18.9 The Year 1923 3,493 3,607 *7,100 21. 1 22.1 20.2 20.4 1922 3,788 3,718 7,506 22.5 21.1 21.0 21.4 Increase or decrease - 295 - 111 - 406 - 1.4 + 1.0 - 0.8 - 1.0 *These include 1,024 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 1923 will be found at the foot of table on p. 8. Showing- the Births of Males and Females and the Birth-rates in each quarter and for the year 1923, 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 91 89 180 21.1 84 96 180 21.6 86 76 162 20.7 128 130 258 24.8 2nd „ 98 93 191 22.4 100 90 190 22.8 86 95 181 23.2 127 116 243 23.4 3rd „ 59 91 150 17.6 88 112 200 24.0 93 83 176 22.5 105 123 228 22.0 4th „ 59 89 148 17.3 87 71 158 19.0 73 74 147 18.8 84 109 193 18.6 Year. 307 362 669 19.6 359 369 728 21.9 338 328 666 21.3 444 478 922 22.2 4 1923] Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1923, 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 Ouarter 162 139 301 19.8 175 182 357 25.8 209 222 431 21.5 935 934 1,869 22.2 2nd „ 182 145 307 20.2 178 201 379 27.4 217 205 422 21.0 968 945 1,913 22.7 3rd „ 129 133 262 17.2 183 156 339 24.5 194 191 385 19.2 851 889 1,740 20.7 4th „ 118 135 253 16.6 141 170 311 22.5 177 191 368 18.3 739 839 1,578 18.7 Year 571 552 1,123 18.4 677 709 1,386 25.0 797 809 1,606 20.0 3,493 3,607 7,100 21.1 Illegitimate Births (219).—The number of illegitimate births, 219, shows an increase of 8 on the return of the year 1922. They were equal to a rate of 3.1 per 100 registered births. A table for former decennial periods was given in the Report for 1921. Notification of Births Act, 1907.—5,493 births were notified, exclusive of 132 still born, or 77.3 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 Total. Persons. Still Still Still Still Alive. born Alive. born. Alive. born. Alive. born. 1923. 1st Quarter 158 5 721 21 550 10 1,432 36 2nd „ 233 8 730 13 527 9 1,490 30 3rd „ 251 4 6(52 18 370 8 1,283 30 4th „ 326 10 677 20 285 6 1,288 36 Year 968 27 2,793 72 1,732 33 5,493 132 DEATHS. The deaths numbered 3,902, while the death.rate was equal to 116 per 1,000 of the population, or 2 2 lower than that of the preceding year (13.8), and was 37 less than the average of the previous 10 years. Indeed it was the lowest rate to be found in the Borough records since 1841. 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 99 11.6 89 10.4 66 7.7 105 12.3 359 10.5 Upper Holloway 128 15.4 87 10.4 75 90 96 11.5 386 11.6 lollington 117 15.0 89 11.4 84 10.8 102 13 .1 392 12.5 Lower Holloway 140 13.5 128 12.3 102 9.8 123 11.8 493 11.9 Highbury 174 11.4 162 10.7 130 8.5 179 11.8 645 10.6 Barnsburv 178 12.9 151 10.9 149 10.8 168 12 .1 13.3 646 981 11.7 12.2 Islington (South. East) 277 13.8 216 10.8 221 110 267 The Borough 1,113 13.2 922 10.9 827 9.8 1,040 12.4 3,902 11.6 5 [1923 Showing the Deaths and Death Rates of Islington in 1923, 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 {or the 10 years 1913-22, and the deaths and death-rates in the year 1922. Quarter. Males. Females. Total. Death Rates. Islington, 1923. Islington, 1913-22. London, 1923. 105 Great Towns, 1923. First 565 548 1,113 13.2 19.2 12.5 13.1 Second 476 446 922 10.9 14.0 10.8 11.9 Third 421 406 827 9.8 11.5 9.4 9.4 Fourth 516 524 1,040 12.4 15.8 12.1 11.8 The Year 1923 1,978 1,924 3,902 11.6 15.3 11. 2 11.6 1922 2,334 2,280 4,614 13.8 11.6 13.4 13.0 Increase or Decrease — 356 — 356 — 712 — 2.2 — 3.7 — 2.2 — 1.4 Causes of Death (Classified).—The following table shows the deaths arranged in classes of Disease from All Causes daring the ten years 1913-22, and in 1923. Classified Causes of Death. Years. Mean 10 Yrs. 1923 Difference. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 I. Specific or Febrile Causes 448 572 618 380 391 1361 579 552 464 639 600 273 - 327 1. Miasmatic Diseases 284 299 451 268 293 1258 466 437 301 546 460 155 - 305 2. Diarrhœal „ 99 174 94 56 56 51 36 28 85 29 71 40 - 31 3. Malarial ,, - 1 - - - 2 2 2 - - 1 - - 1 4. Zoogenous „ 4 2 - 3 2 - 1 2 1 - 1 - - 1 5. Venereal „ 19 21 23 15 15 15 13 13 17 17 17 20 + 3 6. Septic „ 42 75 50 38 25 35 61 70 60 47 50 58 + 8 11. Parasitic Diseases 1 - - 1 1 - 1 1 - 3 1 1 - III. Dietetic 17 11 36 3 3 4 2 2 4 7 9 2 - 7 IV. Constitutional Diseases 1032 1056 1132 1095 1114 1101 973 918 985 935 1034 945 - 89 V. Developmental 468 512 554 522 486 520 657 556 486 477 524 377 - 147 VI. Local 2718 2488 2847 2457 2344 2596 2177 2172 2203 2362 2436 2106 - 330 1. Diseases of Nervous System 376 363 418 339 351 330 322 341 345 330 351 294 - 57 2. „ Organs of Special Sense 20 14 17 12 14 10 11 20 13 9 14 16 + 2 3. „ Circulatory System 733 660 722 669 681 691 654 592 651 734 679 745 + 66 4. „ Respiratory „ 958 896 1147 1006 887 1156 770 822 717 903 926 598 - 328 5. „ Digestive ,, 362 304 319 233 243 246 215 224 260 204 261 259 - 2 6. „ Lymphatic „ 10 15 9 16 9 3 11 10 14 11 11 11 - 7. ,, Urinary „ 213 193 182 149 130 137 151 129 168 134 159 157 - 2 8. „ Reproductive „ 26 18 18 24 18 8 17 20 13 20 18 10 - 8 9. ,, Bones and Joints 6 10 8 9 5 9 12 5 3 8 7 8 + 1 10. „ Integumentary System 14 15 7 - 6 6 14 9 19 9 10 8 - 2 VII. Violence 195 201 234 183 159 156 162 179 142 137 175 151 - 24 1. Accident or Negligence 157 165 194 156 122 115 132 140 99 94 137 105 - 22 2. Homicide 3 3 3 4 1 3 2 2 3 3 3 8 + 5 3. Suicide 34 33 37 23 11 27 28 37 40 39 31 38 + 7 4. Execution 1 - - - - - - - - 1 - - - 5. By Bombs (Enemy Aircraft) - - - - 25 11 - - - - 4 - - 4 VIII. Ill-defined Causes 149 98 125 1ll 102 103 89 95 84 54 101 47 - 54 All Causes 5028 4938 5546 4752 4600 5841 4640 4475 4368 4614 4880 3902 - 978 6 1923 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, 1923. Mean Deaths (10 years), 1913-22. Increase or Decrease on mean. 0-1 year 473 674 - 201 1-5 years 186 427 - 241 Under 5 years 659 1,101 - 442 5-15 years 108 187 - 79 15-25 „ 147 196 - 49 25-35 „ 197 276 - 79 35-45 „ 279 364 - 85 45-55 „ 461 539 - 78 55-65 „ 593 645 - 52 65-75 „ 709 803 - 94 75-85 „ 602 603 - 1 85 upwards 147 166 - 19 3,902 4,880 - 978 INFANTILE MORTALITY. Infant Deaths, 473; Mortality Rate, 66.—There were 473 deaths among infants under twelve months old during the year, or 201 below the decennial average (674) and they represented an infant mortality rate of 66 per 1,000 infants born. This rate is 26 per 1,000 births below the mean annual record of the preceding ten years, and it is the lowest infant mortality rate hitherto recorded in Islington. In the quarters the mortality ranged from 73 per 1,000 births in the first quarter, 46 in the second, 72 in the third, and 78 in the fourth. In the sub-registration districts the infant mortality was as follows: Sub District. Infant Deaths. Mortality per 1,000 Births. Tufnell 31 46 Upper Holloway 47 64 Tollington 37 55 Lower Holloway 75 81 Highbury 69 61 Barnsbury 82 59 Islington South East 132 82 In London the infant mortality was 60 per 1,000 births, while in the six boroughs encircling Islington it was 63. The rate for England and Wales was 69 per 1,000 births. 7 [1923 Infantile Mortality during each of the Ten Years 1913-22, and 1923. 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 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 1922 125 37 29 22 213 80 97 96 93 579 77 Mean 10 years 143 40 31 22 236 123 130 95 90 674 92 1923 128 35 20 11 191 72 104 54 49 473 66 Increase or decrease on mean — 15 — 5 —11 —11 — 42 — 51 — 26 — 41 — 41 — 201 — 26 Showing the Deaths among Infants per 1,000 Births during the Year 1923 and also the mortality rates for the Years 1913-1922. Sub-Districts. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Mean 10 years 1923 Increase or decrease on mean Tufnell 108 93 65 84 99 93 50 41 53 83 77 46 - 31 Up. Holloway 119 86 118 67 68 83 79 69 76 59 82 64 -18 Tollington 104 92 135 93 102 135 98 58 83 58 96 55 - 41 Lr. Holloway 121 134 118 107 121 130 101 66 93 81 107 81 - 26 Highbury 89 93 109 74 83 99 83 67 93 64 85 61 - 24 Barnsbury 128 119 107 103 114 122 91 89 81 86 105 59 - 46 Islington, S.E 98 105 108 91 89 107 81 79 77 88 92 82 - 10 The Borough 107 104 107 87 97 110 83 72 81 77 92 66 - 26 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 1913-22 and in 1923, from certain specified causes. Causes of death. 1923. Rate per 1,000 Births. Mean rate 10 years 1913-22 per 1,000 Births. Difference. Premature Births and Con genital Defects 18.87 20.73 — 1.86 Bronchitis and Pneumonia 9.72 18.81 — 9.09 Astrophy and Marasmus 5.07 12.49 — 7.42 Diarrhœal Diseases (all forms) 4.93 6.31 — 1.38 Convulsions 1.41 1.65 — 0.24 Whooping Cough 3.10 3.57 — 0.47 Measles 0.28 3.02 — 2.74 Diphtheria 0.28 0.41 — 0.13 Phthisis 0.42 0.41 + 0.01 Other forms of Tuberculosis 0.99 1.78 — 0.79 Total of above 45.07 69.18 —24.11 All other causes 21.53 23.34 — 1.81 Total 66.60 92.52 — 25.92 1923] 8 Metropolitan Borough of Islington. INFANTILE MORTALITY DURING THE CALENDAR YEAR 1923. 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 Causes. Certified 128 35 21 11 195 72 105 54 49 475 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — — 2 2 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 2 9 5 6 22 Diphtheria, Croup — — — — — — — — 2 2 Erysipelas — — — — — — 1 — 1 2 Tuberculous Meningitis — — — — — 1 2 1 2 6 Abdominal Tuberculosis — — — — — — — — 1 1 Other Tuberculous Diseases — — — — — — — 1 2 3 Meningitis (not Tuberculous). — — 1 — 1 1 2 3 — 7 Convulsions 3 3 1 — 7 2 — 1 1 11 Laryngitis — — — — — — — — — — Bronchitis — — — — — 4 5 2 1 12 Pneumonia (all forms) 1 5 2 — 8 11 20 13 6 58 Diarrhœa — 2 — 2 4 9 10 7 6 36 Enteritis — 1 2 — 3 10 30 9 7 59 Gastritis 1 1 — — 2 3 2 — 5 12 Syphilis 2 — — — 2 2 — 2 1 7 Rickets — — — — — — 1 — — 1 Suffocation, overlying — — — — — 3 1 — — 4 Injury at birth 3 1 — — 4 — — — — 4 Atelectasis 5 — — — 5 — — — — 5 Congenital Malformations 27 4 2 2 35 7 6 2 — 50 Premature birth 64 9 2 3 78 3 2 1 — 84 Atrophy, Debility and Marasmus 13 2 6 4 25 10 6 3 2 46 Other Causes 9 7‡ 5 — 21 4 8† 4 4 41 Totals 128 35 21 11 195 72 105 54 49 475 Nett Births (legitimate 6,838 7,117 Nett Deaths in legitimate infants 441 in the year illegitimate 279) the year of illegitimate infants 34 * Cerebro-Spinal Fever (4). †Acute Polio-encephalitis (1). ‡ Ophthalmia Neonatorum (1). REPORT ON THE MATERNITY AND CHILD WELFARE WORK. Education Propaganda.—Work on this was co-ordinated with the efforts as in former years designated " Health and Baby Week." Commencing on 2nd October, 1923, a series of lectures was arranged for in Islington. The first lecture was held in the hall adjoining 10, Drayton Park, opposite the East Islington Welfare Centre, and was given by Dr. Octavia Lewin. The attendance was good, and the subject, "Prevention of a Common Cold," evoked especial interest, judging by the number of questions which were asked. By the kindness of the Public Libraries Committee, a lecture by the Medical Officer of Health was included in the series arranged at the Central Library. This, likewise, was well attended. 9 [1923 A Cinema lecture at the Holy Trinity Hall, Richmond Road, arranged by the West Islington Welfare Centre, was a great success, there being no vacant seats. A lecture on "The Sub-conscious Mind," by Dr. Jessie Campbell Maxwell, was given at the North Islington Welfare Centre, and the Centre was open for inspection. Dr. Nankivell, Medical Officer of Health for Hornsey, at the invitation of the South Islington Centre, gave a lecture at 6, Clephane Road, N., on the 9th October, 1923. A large and appreciative audience listened to a very interesting lecture entitled "Babies of yesterday and to-morrow." There is no doubt that education in health matters, that is, on the preventive side, has made for great improvement in recent years. Not only has this education gone hand in hand with the improvement in sanitation, but in the most recent times a decided advancement has been made in reducing the number of deaths among infants and young children. In this respect, considerable credit is due to the prominence given by the public press to matters of health, to the work done by voluntary associations, and agencies, and not by any means least, to the active interest now taken by local authorities, including Borough Councils, in these matters. It is not the object of "Health Week" to do more than by lectures, addresses, and exhibits, to put people on the right lines to help themselves. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. 66 cases of Ophthalmia Neonatorum were notified as against 116 in 1922. 24 cases of Ophthalmia were reported (62 in 1922) by the London County Council. 22 out of the 66 cases of Ophthalmia Neonatorum were attended at birth by midwives. The cases occurred in the sub-registration districts as follows : Upper TollLower South SouthThe Tufnell. Holloington. Hollobury. bury. East. Borough way. way. Cases notified by Doctor 7 6 10 4 5 11 18 61 Cases notified by Certified Midwives 1 1 — 1 2 — — 5 Cases reported by L.C.C 3 1 — 1 — 8 11 24 Of the 90 cases investigated, both of the infants' eyes were affected in 67 instances, whilst in 13 the right eye was involved and in 10 the left. Treatment.—14 of 66 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital. 19 of 66 Ophthalmia Neonatorum cases were treated at home by private Doctors. 17 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at the cost of £22 3s. (In 1922, 63 cases were nursed at the cost of £53 10s.). As skilled attention decreases the possibility of partial or complete blindness, the cost incurred was very essential. Results.—Of the 66 Ophthalmia Neonatorum cases : 63 cases completely clear. 3 cases partial impairment of the right eye. Deaths. One death was certified as due to Ophthalmia Neonatorum. 1923 10 PUERPERAL FEVER. Definition.—The Royal College of Physicians' definition of Puerperal Fever is: Septicemia, Pyemia, Septic Peritonitis, Septic Metritis, and other acute septic inflammation in the pelvis occurring as the direct result of child-birth. 22 cases were notified in 1921, and 20 during the previous year, being in the proportion of 310 per 1,000 births. The notifications were 1 below the average (23) of the preceding 10 years, and showed a decrease of 0.06 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1923. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East The Borough Cases notified 1 — 3 4 5 7 2 22 Private Practitioners' Cases — — 3 3 3 2 1 13 Hospital Cases 1 — — 1 1 2 1 6 Certified Midwives' Cases . — — — — — 3 — 3 Cases inquired into 1 — 3 4 5 7 2 22 Cases treated in Hospital 1 — 1 4 4 6 2 18 Cases treated at Home — — 2 — 1 1 — 4 Of the 22 notified cases, 18 were treated in Hospitals. 11 cases were removed to Metropolitan Asylums Board Hospitals; and 7 cases were removed to other London Hospitals. Deaths.—Nine deaths were registered as being due to Puerperal Fever. Six of these, however, were not notified, and are not included in the cases given in above tabular summary. THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. The sum expended during the year 1923 in the provision of fresh and dried milk for necessitous expectant and nursing mothers and children under five years of age amounted to £3,581 10s. 11d., as against £2,729 3s. 7d. in 1922. The total amount expended since the Order came into operation is £36,527 14s. 4d. The scheme for the distribution of milk was altered by resolution of the Council at their meeting on the 26th October, 1922. The scale is given below: 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 „ „ Extension of Municipal Work.—The Maternity and Child Welfare Committee on the 12th December appointed a Sub-Committee to consider and report as to the work of the Health Visitors and the necessity (if any) of increasing the staff in the Maternity and Child Welfare section of the Public Health Department. 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. 1923 (Approximate Estimate) 98,630 96,240 53,050 88,680 336,600 29,285 up to 5 years old. BIRTHS. 1922 2,095 (Actual) 1,792 (Approximate) 1,167 (Approximate) 2,452 (Approximate) 7,506 1923 2,063 (Actual) 1,606 (Approximate) 1,123 (Approximate) 2,308 (Approximate) 7,100 Number on Books 1st April, 1924, 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 " 16,563 SUMMARY OF VISITS BY HEALTH VISITORS, YEAR 1923. District 1 2 3 4 5 6 7 Totals. I. Births, First Visits, Infants under 1 Year 634 729 769 849 1,254 878 745 5,858 II. Births, Re-Visits, Infants under 1 Year 325 468 527 191 303 87 200 2,101 III. Visits to Children, between 1st and 2ndYears 263 203 425 214 355 147 245 1,852 IV. Visits to Children, between 2nd and 5th Years 154 189 305 248 375 249 112 1,632 V. Visits re Still Births 14 16 23 19 33 16 20 141 VI. Deaths, Visits, re Infants under 1 Year 5 10 7 12 13 11 16 74 VII. Deaths, Visits, re Children 1 to 5 Years - 1 - - — 2 1 4 VIII. Ante-Natal, Home Visits 31 32 41 46 45 10 16 221† IX. Puerperal Fever, Home Visits 1 3 5 4 6 1 2 22† Totals 1,427 1,651 2,102 1,583 2,384 1,401 1,357 11,905 X. Attendances at Welfare Centre* 16 23 46 41 43 13 37 219 XI. Other Work by Direction 40 79 82 48 23 46 33 350 XII. Visits Declined 38 50 23 41 12 4 21 190 XIII. Visits, House Shut 545 774 492 664 566 497 451 3,989 Grand Total of Visits 2,066 2,577 2,745 2,377 3,028 1,961 1,899 16,653 [1923 1923] 12 SUMMARY OF VISITS BY HEALTH VISITORS—Continued. District 1 2 3 4 5 6 7 Totals. Ana (a) lysis of Visits included in I.-IX. relating to Ophthalmia Neonatorum 13 35 15 14 37 48 11 173 (b) Epidemic (Summer) Diarrhœa 1 — — — 1 — — 2 (c) Other Digestive Diseases 7 5 6 — 2 — 14 34 (d) Pneumonia and Bronchitis 7 11 — — 11 — 5 34 (e) Rickets 8 20 5 1 19 - 19 72 (f) Measles and German Measles 1 3 — — — - 1 5 (g) Whooping Cough 5 18 14 5 12 — 1 55 (h) Tuberculous Disease (Pulmonary & other forms) — 1 — 2 — — — 3 (i) Convulsions 1 — — 3 - — 4 (j) Polio-myelitis — — — — — — — (k) Premature Birth 17 26 38 20 39 14 28 182 (l) Atrophy, Debility and Marasmus 8 3 6 2 11 1 2 33 (m) All other investigations (** Specify) 32 51 68 76 59 62 149 497 (n) Routine Visits included in I. to IX. and not included in (a) to (m) 1,327 1,478 1,950 1,463 2,190 1,276 1,127 10,811 ***Totals (a) to (b) 1,427 1,651 2,102 1,583 2,384 1,401 1,357 11,905 Total Families Visited 1,196 1,376 1,602 1,252 1,758 1,052 1,181 9,417 †These totals include 153 first visits to Ante Natal Cases, and 9 first visits to Puerperal Fever. *Specify nature of work—e.g., M.O. Consultation, Weighing babies, Dressings, Temperature taking. Selling of Dried Milk. Talk to Mothers, subject dealt with and time occupied. **e.g.—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. lllegit, etc ***Totals (a) to (n) should correspond with Totals I. to IX. 13 [1923 REPORT OF WORK—VOLUNTARY CENTRES. Particulars of the activities of the four Islington Voluntary Infant Welfare Centres were received from their Conjoint Committee. Among these, apart from the clinics and consultations for mothers and children, are efforts which show well-organised educational propaganda, comprising clubs for thrift, holidays, home-helps, and dental treatment. Individual centres slightly vary in their social methods. For instance, one has a library for mothers and children, while some, under the auspices of committees of fathers, mothers or parents, provide lectures which are well attended and at which opportunities are given for questions and discussions. These activities are in addition to the routine of health talks and sewing classes for teaching and making of suitable garments, held at all the centres. Several of the centres are recognised for the training of infant welfare students and of infant welfare pupils, scholarship holders of the London County Council. Some provide home-helps; two, indoor treatment for special cases; and all arrange facilities for hospital treatment, convalescence, etc. The work of the centres is carried out systematically, careful records being kept so that the health of the child and the ante-natal history of the mother, as far as available, can be passed on to the education authorities when the child becomes of school age. The routine work of the centres is undertaken by staffs consisting of doctors, dentists, nurses and masseuses, supplemented by voluntary workers, the consultations being held practically daily, when the babies are examined and weighed and the mothers advised. Home visits are made by the nurses and voluntary workers who give guidance and see that the directions of the doctor are followed. The various departments of the four voluntary Centres, with the attendances for 1923, may be summarised thus:— North. South. East. West. Total. 1. Ante-Natal Clinics and Ailing Mother Clinics. Number held weekly- 3 1½ 1 1 6½ Number of attendances 1,561 616" 373 657 3,207 2. Consultation for Children up to 5 Years of Age. Number held weekly 10 8 6 7 31 Number of attendances 14,396 13,796 10,857 13,528 52,577 3. Home Visiting. Number of visits made 14,401 9,198 6,935 9,821 40,355 4. Dental Clinics. Number attending 393 145 33 53 624 Number of attendances or arrangements made for attendances 1,155 270 76 112 1,613 5. Morning Callers. Number of attendances 1,178 538 982 2,698 6. Massage Clinics. Number of cases given massage or sent for massage 98 85 40 302 — 79 — — 7. Wards. Number of beds 18 8 26 Number of patients received 166 — — 101 267 8. Number of Children on Books 1,743 1,387 1,066 1,022 5,218 *Two clinics one week; one following week = 1½ weekly. 1923 14 It will be evident, as the reports of the centres show, that the work must have its culmination in a reduced infantile death rate, a vast improvement in the physical condition of the children who attend, and the removal of much hopeless ignorance of young mothers, which ignorance has in the past been the cause of many avoidable mistakes—too often having fatal results or producing mal-development and ill-health in the offspring. The whole-hearted and sustained efforts of the many ladies who give so much of their time to the betterment of conditions affecting the mother and child must be appreciated by all. This work of supervision, advice and guidance of the mother before the birth of her child, and the health supervision from birth to five years of age, as carried out by the Islington Voluntary Infant Welfare Centres, with the aim of establishing on a sound basis the health of the coming generation, makes a very special appeal for sympathy and com mendation from the Borough Council. DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—1772 persons died in the Public Institutions located in Islington, of whom 1,218 belonged to this Borough, the remaining 554 having come here for treatment or relief. Of these, 382 died in the Archway House and 103 in the Royal Northern Central Hospital. Of the 1,218 deaths of inhabitants, 831 occurred in the Islington Infirmary, 219 in the Islington Institution, and 132 in the Royal Northern Central Hospital. The proportion which the 1,218 deaths in these Public Institutions bore to the Borough mortality was 31.2 per cent. Without the Borough.—706 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, 20 in the Northwestern Fever Hospital, 37 in the Children's Hospital, Great Ormnnd Street. 110 in St. Bartholomew's Hospital, 39 in the Colney Hatch Asylum, 66 in the Royal Free Hospital, 40 in the University College Hospital. 33 in the North-Eastern Fever Hospital, 24 in the Metropolitan Hospital, and 32 in the Middlesex Hospital. These 706 deaths represented 181 per cent, of all the deaths registered in the year. Within and Without the Borough.—The deaths of Islingtonians numbered 1,924 and were equal to 49 3 per cent, of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough-— 91 inhabitants died from accidental deaths, or suddenly, in places outside Islington. During the previous year (1922) the total deaths in Local Institutions numbered 1,975, being 1,344 inhabitants of Islington in Local Institutions, plus 631 non-inhabitants of Islington in Local Institutions, the number in Islington Infirmary being 977, the number 15 [1923 in the Royal Northern Hospital 116. The deaths of inhabitants of Islington in Institutions outside the Borough were 817; the total deaths in all Institutions, 2,161; and the proportion per 100 deaths from all causes, 46 8. Transferable Deaths.—-During the year 57 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 Diarrhœal Diseases. During the year 128 persons died from these disease?, the death-rate being 0.38 per 1,000 inhabitants, as contrasted with 1.05 in the corresponding period last year, and a decennial average mortality of 325 and a death-rate of 1.02 per 1,000. The death-rate of 0.38 per 1,000 of the population was the lowest rate hitherto recorded in Islington. In London the death-rate from the epidemic diseases was 0.54, while in the six Boroughs encircling Islington the death-rate was 0.37. 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 ami Sub Registration Districts during the Year 1923. SubRegistration Districts. Wards. Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarhœa. Totals. Deaths Deaths Deaths Deaths Deaths Deaths Deaths Deaths Tufnell Tufnell - - - 1 1 2 2 6 Up. Holloway Tollington Up Holloway Tollington - — 4 3 1 6 12 2 3 3 2 14 22 Lr. Holloway Lr.Holloway - - 2 2 - 1 9 19 Highbury Highbury - — 1 1 2 1 5 Mildmay - — — — 1 1 2 4 Barnsbury Thornhill - — 1 1 2 6 3 13 Barnsbury - — 1 2 5 4 12 Islington South East St. Mary's - 2 1 1 3 2 9 Canonbury - — 6 1 2 1 2 12 St. Peter's - - — — 9 10 12 The Borough - — 16 13 38 21 40 128 Total Death Rates - — 0.05 0.04 0.11 0.06 0.12 0.38 1S23J l(j Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1913-22 and for the Year 1923. 1913 1914 1915 1916 1917 1918 Deaths. Death Rates. Deaths. , Death Rates. Deaths. Death Rates. Deaths. Death Hates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 4 001 14 0.04 5 0.01 9 0.03 4 0.01 7 0.02 Small Pox - - - - — — — — — — — — Measles 101 0.31 97 0.30 153 0.48 80 0.26 149 0.50 114 0.39 Scarlet Fever 19 0.06 23 0.07 38 0.12 18 0.06 4 0.01 8 0.03 Whooping Cough 62 0.19 83 0.26 103 0.32 60 0.19 45 0.15 147 0.51 Diphtheria 37 0.11 44 013 57 0.18 45 0.14 33 0.11 45 0.16 Diarrhoea and Enteritis (under 2 years) 210 25.12 per 1,000 births 217 26.53 per 1,000 births 154 20.43 per 1,000 births 117 16.11 per 1,000 births 106 18.16 per 1,000 births 82 15.78 per 1,000 births 1919 1920 1921 1922 Mean 10 vears 1923 Deaths. Death Rates. Deaths. Death Rates. Deaths, Death Rates. Deaths. Death Rates. | Deaths. Death Rates. Deaths, Death Rates. Enteric Fever 5* 0.02 3* 0.01 1 0.00 - - 5 0.02 - - Small Pox 1 0.00 — — - - — — - - — - Measles 12 0.04 92 0.27 27 0.08 l.34 0.40 96 0.30 16 0.05 Scarlet Fever 14 0.04 12 0.04 19 0.06 29 0.09 18 0.06 13 0.04 Whooping Cough 17 0.05 70 0.21 43 0.13 98 0.29 73 0.23 38 0.11 Diphtheria 51 0.16 135 0.40 110 0.33 59 0.18 62 0.19 21 0.06 Diarrhoea and Enteritis (under 2 years) 85 13.53 per 1,000 births 77 8.19 per 1,000 births 156 19.78 per 1,000 births 71 9.46 per 1,000 births 127 17.43 per 1,000 births 103 14.51 per 1 000 births ♦Including 2 Malarial Fever. Showing the Deaths from Diarrhœal Diseases together with those c/assed under Enteritis and its Sub headings, arranged in quarterly periods, and in three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhoea. Enteritis, &c. Totals. Dibrrhœa. Enteritis, &c. Totals. Diarrhoea Enteritis, &c. Totals. Diarrhœa. Enteritis, &c. Totals. Diarrhœa. Enteritis, &e. Totals. Under 1 year 5 12 17 4 6 10 19 16 35 7 27 34 35 61 96 1 to 5 years 1 1 2 — 1 1 3 3 6 — 2 9 4 7 11 Over 5 years — 3 3 — 3 3 1 3 4 — 4 4 1 13 14 Totals 6 16 22 4 10 14 23 22 45 7 - 40 40 81 121 INFLUENZA. During the year Influenza caused 58 deaths, which is a decrease of 163 on the return for the year 1922; and 137 below the average of the preceding ten years 1913-22. The death-rate was equal to 017 per 1,000 inhabitants. 17 f1923 Showing the Deaths from Influenza in the Quarters of the Year 1923, together with the averages of the corresponding periods, 1913-22. Years. Quarters. Totals. First. Second. Third. Fourth. 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 1922 200 10 3 8 221 Average 72 16 9 98 195 1923 21 22 7 8 58 Increase or Decrease — 51 + 6 2 - 90 - 137 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 1923: Ages. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Mean 10 yrs 1923 Difference. 0-5 5 1 3 - 1 106 19 10 5 22 17 5 - 12 5-10 — 1 — — — 52 5 3 — 1 6 — - 6 10-15 — — — — — 32 8 3 1 — 4 2 - 2 15-25 9 1 5 — — 141 48 12 5 11 23 — - 23 25-35 4 1 4 — 2 252 82 21 9 14 39 6 - 33 35-45 8 6 7 1 2 109 47 18 15 18 23 4 - 19 45-55 17 5 15 6 7 93 48 17 18 42 27 12 - 15 55-65 5 7 12 6 8 69 42 17 13 37 22 5 - 17 65-75 7 7 11 10 10 50 36 13 14 43 20 16 - 4 75&upwards 10 1 14 13 6 27 21 4 13 33 14 8 - 6 All Ages . 58 30 71 36 36 931 356 118 93 221 195 58 - 137 SEPTIC DISEASES. Erysipelas and Puerperal Septicemia are the principal diseases of this class. Erysipelas.—5 deaths were returned from this disease, or 4 less than in the year 1922; and 5 below the average of the preceding ten years, 1913-22. Puerperal Diseases.—These comprise Puerperal Pytemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 9 deaths, which is 4 above the return of 1922, and one less than the average of the ten years 1913-22. The death-rate was equal to 1.27 per 1,000 births. CANCER. Cancer.—There were 472 deaths from this malignant disease during the year, compared with 421 in 1922, and with an average of 414 in the previous decennium. The deaths represent a death-rate of l.40 per 1,000 of the civil population and is 0.10 above the average rate (130) of the last ten years; 204 deaths occurred among males and 268 among females. 1923J 18 The following statement shows the ages at death of the persons attacked during the past ten years, and the return for the year 1923 : Ages. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Mean 10 yrs 1923 Difference 0- 5 1 - - - 2 - 2 3 2 - 1 1 - 5-15 — 2 1 3 2 — 1 — 1 1 - - 1 15-25 7 2 2 — 5 — 4 1 1 4 3 6 + 3 25-35 13 11 7 4 8 8 5 10 10 8 8 10 + 2 35—45 31 37 24 30 31 27 36 32 34 34 32 27 - 5 45-55 83 69 75 86 73 75 101 74 98 88 82 88 + 6 55-65 99 121 120 124 131 99 120 110 140 124 119 138 + 19 65-75 115 96 105 114 120 126 123 124 131 110 116 125 + 9 75-85 49 40 39 48 55 52 39 43 52 47 47 68 + 21 85&upwards 6 6 4 3 5 6 7 5 6 6 5 9 + 4 404 384 377 412 432 393 438 402 475 421 414 472 + 58 Showing the Deaths from Cancer or Malignant Disease in the several Sub Districts during the Quarters and the Year 1923. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 12 12 9 18 23 17 33 124 Second 9 9 12 13 23 19 25 110 Third 10 10 14 13 24 18 33 122 Fourth 18 11 10 11 24 14 28 116 The Year 49 42 45 55 94 68 119 472 TUBERCULOSIS. Tuberculosis caused 389 deaths, which were 132 below the average of the last decennium, and were 44 less than the number registered in 1922. The death-rate resulting from them was equal to 116 per 1,000 of the civil population, and represented 99 per cent, of the deaths from all causes during the year. Tuberculosis of the Respiratory System (Phthisis is Pulmonary Tuberculosis) caused 337 deaths, as contrasted with the decennial average of 431, while the death-rate was 100 per 1,000 of the civil population, as against the decennial rate of 1.35 per 1,000. There was a decrease of 94 on the ten years average number of deaths, and of 0 35 on the mean death-rate. Tuberculosis (Respiratory System). Proportion of Deaths from Tuberculosis per 100 Deaths from All Causes. Death rates from All Causes per 1,000 inhabitants. Years. Deaths. Death rates per 1,000 inhabitants. 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 1922 378 1.13 8.19 13.8 Average 10 years 431 1.35 8.83 15.3 1923 337 1.00 8.64 11.6 19 1923 The following return gives the deaths at each age period: Age Periods. Males. Females. Total. 0-5 6 6 12 5-15 4 5 9 15-25 26 39 65 25-35 41 29 70 35-45 46 22 68 45-55 53 17 70 55-65 19 11 30 65 upwards 8 5 13 Total 203 134 337 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1923. Quarters. Tufnell. Upper Hollowav. Tollington. Lower Holloway. Highbury. Burnsbury. Islington, S~>uth East. The Borough. First 6 13 5 15 13 19 24 95 Second 9 4 6 13 16 14 14 76 Third 2 9 6 6 16 10 29 78 Fourth 6 10 9 11 12 15 25 88 The Year 23 36 26 45 57 58 92 337 Showing the Deaths from Tuberculosis during 1923. Form. Ages. Sex. Districts. Total Deaths. 0-1 1-5 over 5 M F. Tuf. U.H. Toll. L.H. H. B. S.E. Respiratory 3 9 325 203 134 23 36 2 45 57 58 92 337 Meningeal 6 11 11 15 13 2 4 3 4 5 3 7 28 Abdominal 1 5 8 8 6 1 — I 1 4 3 4 14 General — — 3 2 1 — 2 — — — 1 — 3 Other forms — — 7 6 1 — — 1 1 2 1 2 7 All Tuberculosis 10 25 354 234 155 26 42 31 51 68 66 105 389 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 598 deaths, or 308 more than in 1922. They were equal to a death-rate of 178 per 1,000 of the civil population, and represented 15 3 per cent, of the total deaths registered in the Borough. Acute Bronchitis.—There were 80 deaths as compared with 130 in the previous year. 32 occurred among males, and 48 among females. The deaths of 7 infants under 12 months were registered. 1923J 20 Chronic Bronchitis.- 185 deaths were ascribed to it, 92 being males and 93 females. This return is 92 less than that for 1922. Pneumonia (All forms).—282 deaths were registered, of which 148 were males and 134 females. They are 160 less than the number who died in 1922. It caused 58 deaths to infants under a year old, while between the ages of 1 and 5 years 36 died from it. Above 5 years of age the deaths numbered 127. 82 Deaths occurred in Public Institutions, chiefly the Workhouse Infirmaries. Pleurisy—Of this disease 15 deaths were registered. 3 deaths occurred in Public Institutions. Asthma and Emphysema.—Fourteen deaths were recorded from these diseases, all of which were adults. Other Diseases of the Respiratory System.—Twenty-two deaths were registered, as contrasted with 25 in 1922. VENEREAL DISEASES. Twenty deaths were ascribed to these diseases, as compared with 17 in 1922. Of these 14 were males and 6 females. The mean deaths of the preceding ten years 191322, 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. Ttn deaths were registered from asphyxia caused by the inhalation of carbon monoxide gas. Eight of these deaths were attributable to suicide, while the two remaining deaths were homicidal. Of the 10 deaths, 9 were males and 1 female, the ages ranging from 13 to 61 years. During the year special inquiries were made and reports furnished to the Minitry of Health on deaths from this cause. ACCIDENTAL DEATHS. The deaths due to accident numbered 105. Of this number 31 deaths were due to vehicular traffic, as against 32 in the previous year. The number of deaths from this cause is constantly before the public mind, for in London the regulation of street traffic still permits the passage of vehicles on the near side while passengers are alighting from the 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. 21 1923 Inquests and mortuary. During the year 28S bodies were received into the Mortuary, as compared with an average of 458 in the preceding 10 years. No infectious body was received during the year. The daily average number of bodies received was 0 8 as compared with 0 9 in 1922. In 279 cases inquests were held, as contrasted with an average of 357 in the ten years 1913-22. Bodies received into Mortuary. Inquests. 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 1922 316 307 Average 458 357 1923 288 279 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1923 and 1922. 1923 No. of bodies received. Daily Average. No. of Inquests held. 1922 No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 75 0-8 86 1st Quarter... 103 1.1 83 2nd ,, 57 06 59 2nd 81 0.9 83 3rd „ 81 0-9 65 3rd „ 69 0.7 53 4th „ 75 0-8 69 4th 63 0.7 88 Total for year 288 0-8 279 Total for year 316 0.9 307 PREVENTION OF INFECTION. Notification, Isolation, Fatality, of Specified Diseases under the Provision? 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 2,096 cases of these diseases which are notifiable under the Public Health (London) Act, 1891. This number does not include other communicable ailments which are now notifiable. The complete list of infectious diseases which are notifiable in Islington are enumerated on page 25. The total cases notified are 691 less than those of the previous year (2,787) and 216 below the average (2,312) of the preceding ten years. The only increase when contrasted with the decennial averages is to be found in the return from Diphtheria, which shows 1923 22 74 cases in excess, while the other diseases all exhibit a decrease, Scarlet Fever accounting for 176 cases, Erysipelas 99 cases, and Enteric Fever 14 cases. The 2,096 cases were equal to an attack-rate of 6'2 per 1,0U0 of the civil population. The leturns for the preceding ten years are given in the following statement : Year. Cases. Attack-rates per 1,000 civil population. 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 1922 2,787 8.34 10 years average 2,312 7.26 1923 2,096 622 Registration Sub-Districts.—The total number of cases notified in these districts was as follows: Total cases notified. Tufnell 104 Upper Holloway 214 Tollington 161 Lower Holloway 363 Highbury 309 Barnsbury 466 Islington South-East 479 Total 2.096 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 891 cases of illness, which were 74 above the average (817) of the preceding ten years. The attack-rate was equal to 2 64 per 1,000 of the civil population annually, and was 0 09 above the mean rate (2 55) of the decennial period. In London the attack-rate was 2.28 per 1,000, and the Encircling Boroughs 2.51. Scarlet Fever.—1,080 cases were notified, and they showed a decrease of 176 or 14 per cent. on the average (1,256) of the ten years 1913-22. The attack-rate was equal to 3 21 per 1,000 of the civil population annually, which is a decrease of 0 73 per 1,000 of the mean rate (3 94) of the preceding ten years. In London the attack-rate was 2 22 per 1,000 of the civil population, while in the Encircling Boroughs it was 2 24. Enteric Fever.—Only 16 cases were notified, a decrease of 14 on the average (30) that obtained during the ten years 1913-22. The attack-rate was 0.05 per 1,000 annually, or 0 04 per 1,000 below the mean rate (0.9) of the last ten years. In London the rate was 0.07, and in the Encircling Boroughs 0.06 per 1,000 of the civil population. 23 [1923 Typhus Fever.—No case was notified. Puerperal Fever.—See pages 10 and 17. Erysipelas.—87 cases were notified, or 99 below the average 186 of the preceding ten years, the attack-rate being 0.26 per 1,000 of the civil population. 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 2,096 cases notified, 48 deaths occurred, or 2 3 per cent., which contrasts with an average percentage of 4 4 in the preceding ten years 1913 22. Years. Cases. Deaths, Fatality. 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 1,127 67 6.0 1919 1,993 96 4.8 1920 2,853 173 6.0 1921 4,344 146 3.3 1922 2,787 102 3.7 Mean 2,312 403 4.4 1923 2,096 48 23 Hospital Isolation.—Of the 2,096 cases of infectious diseases notified.. 1,996 were isolated in hospital, or a percentage of 95 2, while only 4.8 per cent. of the patients, therefore, were nursed at home. This is the highest number on record. The following tabular statement shows the number of cases treated in the various public institutions: Cases treated in Percentage of Year. Hospital. cases treated. 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 1923 1,996 95.2 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated. Percentage of known cases. Scarlet Fever 1,080 1,051 97.3 Diphtheria 891 881 98.9 Enteric Fever 16 12 75.0 Erysipelas 87 35 40.2 Puerperal Fever 22 17 77.3 2,096 1,996 95.2 1923] 24 Summary of Infectious Sickness and of Deaths arising therefrom, distinguishing the Cases treated at Home and in Hospitals; and showing the percentages of notified Cases removed to Hospitals, together with the Fatality among Cases treated at Home and in Hospitals during the Year 1923. Notified Cases Treated. Percentages of Notified Cases Treated. Deaths Occurring. Percentage of Deaths Occurring. In At Total In At In At Total In At Total Hospital Home Hospital Home Hospital Home Hospital Home Small Pox Scarlet Fever 1,051 29 1,080 97.3 2.7 13 - 13 1.2 - 1.2 theria 881 10 891 98.8 1.2 20 1 21 2.3 100 2.3 Enteric (Typhoid Fever) 12 4 16 750 25.0 — - — - - - Typhus - - - - - - - - - - - Erysipelas 35 52 87 40. 2 59.8 5 - 5 14.3 - 5.7 Puerperal Fever 17 5 22 77.3 22.7 8 1 9 470 20.0 4.9 Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Cholera - - - - - - - - - - - Total 1,996 100 2,096 95.2 4 8 46 2 48 2.3 2.0 2.3 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1913-22 and in 1923. DISEASES. YEARS. Average number of cases, 1923 Increase or Decrease 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1913-22 Small Pox Cases- - - - - 2 2 - - - - - - Rate — — — — — 0-00 0-00 - - - - - - Diphtheria Cases 546 651 620 587 556 514 645 1324 1548 1 126 812 889 + 77 Rate 1 . 65 201 1.96 1.90 1 .87 1.80 1.96 3.94 4.65 3.37 2.55 2.64 + 0.09 Membranous Croup Cases 4 8 4 6 5 4 4 4 5 4 5 2 — 3 Rate 0 01 002 0.01 0.02 0.02 0.01 0.01 0.01 0.02 0.01 0.02 0.00 -0.02 Scarlet Fever Cases 1317 1853 1332 638 478 432 1084 1307 2622 1496 1256 108) - 176 Rate 3.97 5-71 4 21 2.06 1.61 1.51 3.29 3.89 7.87 4.48 3.94 3.21 -0.73 Enteric Fever Cases 50 76 28 32 23 30 16 24 10 9 30 16 - 14 Rate 0 15 0.23 0.09 0.10 0.08 0.10 0.05 0.07 0.03 0.03 0.09 0.05 -0.04 Continued Cases' — 1 Rate — — — — — - 0.00 - - - -- — — Puerperal Cases 28 25 23 21 16 4 29 29 34 20 23 22 - 1 Rate 3.41 3.10 3.48 2.89 2.74 0.77 0.46 3.08 4.31 2.68 3.16 3.10 -0.06 Fever Erysipelas Cases 2.26 334 2.03 1.55 1.73 1.41 212 165 125 132 186 87 - 99 Rate 0.68 1.03 0.64 0.50 0.58 0.49 0.64 10.49 0.38 0.39 0.58 0.26 -0.32 Totals Cases 2171 2947 2210 14.9 12.51 11.27 1993 12853 4344 2787 2312 2096 - 216 Rate 6.54 9. 08 6.98 4.65 4.21 3.93 6.05 8.49 13.05 8.34 7.16 6.22 1.04 ♦Per 1,000 Registered Births. 25 [1928 Showing the Cases of the Notifiable Infectious Diseases notified in the Sub Registration Districts and the Wards during the Year 1923. Sub- Registration 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 - 56 39 - 2 - 6 1 - - - 104 Up. Holloway Up. Holloway - 101 99 - 1 — 13 — - - - 214 Tollington Tollington - 70 77 - 1 — 10 3 - - - 161 Lr. Holloway Lr. Holloway - 241 108 2 3 —' 5 4 - - - 363 Highbury Highbury - 180 49 — 5 — 7 3 - - - 244 Mildmay - 24 29 — 2 — 3 2 - - - 65 Barnsbury Thornhill - 85 176 — - - 11 2 - - - 274 Barnsbury - 98 83 — - - 6 5 - - - 192 Islington, S.E. St. Mary's - 64 72 — - — 7 — - - - 143 Canonbury - 76 55 — 1 — 12 1 - - - 145 St. Peter's - 80 102 - 1 — 7 1 - - - 191 Totals - 1080 889 2 16 — 87 22 — — - 2096 Attack-Rates per 1,000 population 3.21 2.64 0.00 0.05 — 0.26 0.06 6.22 OTHER NOTIFIABLE DISEASES. The diseases which are notifiable in Islington include those which have since been added by Order, and the complete list is as follows: Small Pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the diseases known as Scarlatina or Scarlet Fever, the fevers known by any of the following names: Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal, and also the following infectious diseases: Anthrax, Acute Encephalitis, Acute Encephalitis Lethargica, Acute Polio-Encephalitis, Acute Primary Pneumonia, Acute Influenzal Pneumonia, Cerebro-spinal fiver or Epidemic Cerebro-spinal Meningitis, Dysentery, Glanders or Farcy, Hydrophobia or Rabies, Malaria, Ophthalmia Neonatorum, Plague, Trench Fever, and Tuberculosis. Acute Poliomyelitis. Only one case was notified during the year, as compared with none in 1922, and 3 cases in 1921. 1923 1922 Cases. Deaths. Cases. Deaths. 1st quarter Nil Nil Nil Nil 2nd ,, ,, ,, 3rd ,, ,, ,, ,, 4th „ 1 ,, ,, ,, 1 Nil Nil Nil Epidemic Cerebro-Spinal Meningitis. Eight cases were notified, or five cases more than in 1922. During the ten years 1913-22, the cases averaged 18 per annum. 1923] 23 A return of attacks of the disease during the past ten years is given in the following statement: 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Average 10 yrs. 1913-22 1923 Total Deaths, 1913-23. 1st quarter 1 2 12 7 15 7 8 5 3 1 6 3 40 2nd 3 3 13 17 11 4 7 5 3 2 7 2 52 3rd 1 2 11 8 1 1 1 2 3 2 10 4th 1 — 4 7 3 4 — 2 1 — 2 1 9 Year 6 7 40 39 30 16 16 14 7 3 18 8 111 The deaths during the year numbered 7, and were equal to the very high rate of 87 per cent, of the cases notified. Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. These Regulations came into force on the 7th January, 1919, and during the 5 years the following cases were notified by medical practitioners to the Medical Officer of Health : 1919 1920 1921 1922 1923 Malaria 193 17 8 2 2 Dysentery 14 4 — 1 3 Acute Primary Pneumonia 12 34 47 77 120 Acute Influenzal Pneumonia 12 22 25 67 58 Pneumonia 29 3 — — — Total 260 80 80 147 183 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 10 cases of Acute Encephalitis Lethargica were notified, 5 of which proved fatal. One case of Acutc Polio-Encephalitis was known in the Borough. The patient was an infant aged 5 months which died. Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. See p. 9. Tuberculosis. During the year 672 cases of Tuberculosis in its different forms were notified. The attack-rate was equal to 2.00 per 1,000 of the civil population. This number shows a decrease of 35 on the return of the previous year, and of 012 per 1,000 on the attack-rate. It was also 89 below the number in 1921. Respiratory (Pulmonary) Tuberculosis.—542 notifications were received, of which 282 referred to males and 260 to females, and represented an attack-rate ef 1'6 per 1,000. The return was a decrease of 28 on that of 1922, and 110 on 1921. 27 [1923 Showing the Notified Cases of Tuberculosis in the Wards during 1923. 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 Tufnell Tufnell 25 17 42 6 6 12 54 1.58 Up. Holloway Up. Holloway 28 24 52 12 6 18 70 2.10 Tolling ton Tollington 29 21 50 5 4 9 59 1.89 Lr. Holloway Lr. Holloway 24 25 49 7 6 13 62 1.49 Highbury Highbury 26 28 54 7 3 10 64 1.95 Mildmay 20 23 43 3 8 11 54 1.92 Barnsbury Thornhill 19 31 50 10 8 18 68 2.20 Barnsbury 25 19 44 2 3 5 49 2.01 Islington, S.F. St. Mary's 18 21 39 5 4 9 48 2.64 Canonbury 30 20 50 4 7 11 61 1.91 St. Peter's Totals 38 31 69 8 6 14 83 2.74 282 20 542 69 61 130 672 2.00 The actual number of cases of Respiratory Tuberculosis coming to the knowledge of the Medical Officer of Health in each year since 1913, has been as follows: Year. Cases. Year. Cases. 1913 1,303 1918 1,006 1914 960 1919 759 1915 780 1920 663 1916 672 1921 652 1917 897 1922 570 Average, 10 years 826 = 2-6 per 1,000 inhabitants. 1923 ... 542 cases = 1 -6 per 1,000 inhabitants. THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS. NOTIFIED DURING 1923. 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 282 - 5 15 45 137 69 11 F. 260 1 2 17 70 114 48 8 Tubercular Meningitis M. 1 — - 1 — - — — F o - - - - - Tabes Mesenterica M. 7 — 2 4 - - 1 — F. 12 - 3 3 1 - - — General Tuberculosis M. 1 - - - - 1 - - F. 1 - - - - 1 - - Other forms of Tuberculosis M. 60 2 5 22 12 9 10 - F. 46 1 2 16 14 10 3 — All Tubercular Diseases M. 351 2 12 42 57 147 80 11 F. 321 2 9 36 85 130 51 8 Totals 672 4 21 78 142 277 131 19 Percentages at each life period to total cases 0.5 3.1 11.6 21.1 41.2 19.5 3.0 From the above statement it will be seen how the disease attacked people at the various ages, viz. : In every hundred cases 0.5 were under 1 year of age. „ „ 3.1 were aged 1 to 5 years. „ „ 11.6 were aged 5 to 15 years. Prime„ „ 21.1 were aged 15 to 25 years of „ „ 41.2 81.8 were aged 25 to 45 years Life ,, ,, 19.5 were aged 45 to 65 years „ „ 3.0 were aged 65 and upwards. 1923j 28 Showing the Notified Cases of Tuberculosis in the Quarters during-1923. 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 72 72 144 76 58 134 66 72 138 68 58 126 282 260 542 Tubercular Meningitis 1 — 1 — 2 2 — — — — — — 1 2 3 Tabes Mesenterica 2 1 3 3 6 9 2 5 7 - - - 7 12 19 General Tuberculosis - - - - - - - 1 1 1 1 1 1 2 Other forms of Tuberculosis 20 16 36 12 9 21 13 6 19 15 15 30 60 46 106 Totals 95 89 184 91 75 166 81 84 165 84 73 157 351 321 672 Disinfection of Houses and Rooms after Phthisis. The following statement gives the particulars for the year: Houses. Rooms. 1st quarter 114 151 2nd „ 108 152 3rd ,, 117 160 4th „ 97 148 Total 436 611 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 3 1st December, 1922, to the 29/// December, 1923, in the Metropolitan Borough of Islington. Notifications on Form A. Age-periods 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 5 8 7 16 29 70 67 46 23 1! 282 396 ,, Females 1 2 7 9 27 42 64 50 36 12 8 258 338 Non-pulmonary Males 2 7 11 11 6 6 7 3 8 3 — 64 77 „ „ Females 1 7 11 7 7 8 13 3 2 1 - 60 55 Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total - Notifications on Form B. Poor Law Institutions Sanatoria. Age-periods Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Male3 - - - - - - 72 230 „ Females — 2 2 2 64 140 Non-pulmonary Males - 4 1 5 7 6 48 „ „ Females. - 1 - 1 3 3 49 29 [1923 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 1,283 persons were examined by the Tuberculosis Officers, and the patients made 10,826 attendances. At the Northern Dispensary there were 721 new cases, and at the Southern 562, while the attendances at the former were 4,001 and at the latter 6,825. The examination of contacts with tuberculous cases showed that 42 were suffering from tuberculosis, 36 were suspect, and 532 were not suffering. The nurse at the Northern Dispensary paid 1,312 visits, and the nurse at the Southern 2,582, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 214 visits, and of the Southern 401 visits to the patients' homes for the purpose of examining them. Finsen Light Treatment.—Five patients received beneficial treatment by Finsen Light at the London Hospital, at a cost to the Council of £49 15s. Od. Pneumothorax Treatment was also administered to one patient at a cost of 10s. 6d. The number of persons in attendance at the Dispensaries in each year is as follows: TUBERCULOSIS. 1918 1919 1920 1921 1922 1923 North Dispy South Dispy North Dispy South Dispy N orth Dispy South Dispy North South Dispy Dispy North Dispy South Dispy North Dispy South Dispy New Cases Actual number of 635 872 585 756 655 760 615 758 600 581 721 562 Attendances 3798 6511 4057 6782 3921 6895 3212 7030 3297 6659 4001 68:5 Totals 4433 7.83 4642 7538 4576 7655 3.-27 7788 3897 7240 4722 7387 A summary is given for the following years: Cases. Attendances. Cases. Attendances. 1918 1,507 10,309 1921 1,373 10,242 1919 1.341 10,839 1922 1,181 9,956 1920 1,415 10,816 1923 1,283 10,826 Totals 8,100 62,988 1923] 30 Table showing the number of Tuberculous Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1923. Date. Dispensary Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 419 357 316 336 334 379 326 304 287 383 312 248 4.001 10.826 Southern 624 54V 602 580 597 521 571 546 504 637 597 499 6,825 New Cases Including Contacts Northern 94 79 46 57 65 69 44 45 77 39 42 721 1,283 Southern 60 37 59 49 49 36 55 46 39 52 41 39 562 Contacts. Tuberculosis Northern 1 - 1 1 - - - - - - 1 1 5 42 Southern 2 5 2 2 1 4 5 2 2 6 3 3 37 Suspects Northern 4 2 1 — 1 2 3 1 - 1 - - 15 33 Southern 3 2 3 2 3 1 1 3 1 2 21 Non-Tuberculous Northern 51 32 26 25 34 32 13 36 23 39 16 12 339 532 Southern 16 10 20 14 20 11 21 19 13 20 16 13 193 Nurses' Visits Northern 90 80 84 95 131 136 91 126 108 141 110 120 1,312 3,894 Southern 282 221 219 226 258 35 216 180 270 277 211 187 2,582 Tuberculosis Officers' Visits Northern 20 18 19 21 12 21 12 22 14 19 18 18 214 615 Southern 35 36 35 35 35 34 33 31 32 33 32 30 401 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,028 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 639 were Scarlet Fever, and 386 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.. 639 732 - 93 Diphtheria 386 386 — Enteric Fever 3 2 + 1 Other Diseases — 1 - 1 Total 1,028 1,121 - 93 Non Notifiable Diseases.—3,401 cases came to the knowledge of the Medical Officer of Health during the year, viz.: 507 cases of Measles, 759 cases of Chicken Pox, 429 of Whooping Cough, and 1,706 of other diseases. The information respecting these cases was received from the teachers of 60 schools. Exclusion of Scholars from Schools.—3,751 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 Average of Increase by Teachers. preceding 10 years. or Decrease. Measles 507 1,514 - 1,007 Chicken Pox 759 755 + 4 Whooping Cough 429 582 - 153 Other Diseases 1,706 2,584 - 878 3,401 5,435 - 2,034 †Note.—"Other Diseases" include Humps, Scabies, Ophthalmia, Itch etc. 31 [1923 BACTERIOLOGICAL EXAMINATIONS. 2,568 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 704 on that of the preceding year. It is also 1,287 above the decennial average. Of the total examinations, 463 or 18 per cent. gave positive results. Diphtheria.—1,677 specimens were examined for Diphtheria, of which 306, or 18 2 per cent., were found to contain Diphtheria bacilli. Enteric Fever.—20 specimens of blood were examined, 5 of which gave positive results. Phthisis.—871 specimens of sputum were examined, 152, or 17 4 per cent., of which showed that the patients were suffering from this disease. DIPHTHERIA—Pathogenicity Tests. 1923. No. Submitted for Examination. Negative Result. (Bacilli). Positive Result. (Bacilli). Non-Virulent. Virulent. 49 40 9 5 4 Showing- the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Phthisis, 1913-23. Diphtheria. Enteric Fever. Phthisis. Periods. Positive Results. Negative Results. Total Examined Positive Results. Negative Results. Total Examined Positive Results. Negative Results. Total Examined Totals. 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 23.8 969 1207 3 19 22 127 421 548 1,777 1922 291 953 1,244 — 9 9 139 472 611 1,864 Average 10 years 167 491 658 9 20 29 148 446 594 1,281 1923 306 1,371 1,677 5 13 20 152 719 871 2,568 VACCINATION. Of the 6,599 births registered in 1922, the returns of vaccination show that only 2,902 infants were successfully vaccinated, while 17 were found to be insusceptible. There were also 338 who died unvaccinated, and 2,347 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians ; 35 vaccinations were postponed 1923] 32 under medical authority, 273 were removed to other districts or places unknown, thus leaving 687 unaccounted for. The return of certificates of exemption, therefore, represents 35 6 per cent. of the registered births. Years. Vaccination per 100 births, less infants who died unvaccinated. Years. Vaccination per 100 births, less infants who died unvaccinated. 1908 72.4 1916 4.5 1909 70.7 1917 46.7 1910 66.7 1918 46.4 1911 62.3 1919 46.0 1912 54.1 1920 49.3 1913 51.1 1921 44.9 1914 46.8 1922 46.3 1915 49.0 Certificates of Exemption.— The following tabular statement shows the increase of these certificates, more especially since 1906: 1906 123 1912 1,646 1917 1.341 1907 259 1913 1,942 1918 1,027 1908 588 1914 2,124 1919 1.583 1909 824 1915 1,710 1920 2.S66 1910 1,080 1916 1,796 1921 2,5 6 1911 1,241 1922 2,347 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the. Sub Registration Districts during the previous year 1922. Registration Sub-Districts. Number of Births registered in 1922. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of StatutoryDeclarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children remaining Unvaccinated, or not accounted for (Defaulters). Total Number of Certificates of Successful Primary Vaccination at All Ages received during year 1923. Number of Statutory Declarations of Conscientious Objection received during year 1923. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 589 273 1 - 176 44 2 25 13 55 2,137 138 Up. Holloway 676 327 2 — 221 34 - 19 20 53 169 Tollington 609 249 2 — 214 14 - 15 13 102 145 Highbury 1002 435 5 - 374 38 - 2 - 112 29 1 Lr. Holloway 925 385 3 - 307 49 3 2 29 147 2,584 228 Barnsbury 1255 617 - - 422 66 8 4 - 93 334 Islington, S.E. 1543 616 4 — 636 93 22 11 39 125 500 The Borough. 6599 2902 17 - 2,347 338 35 78 195 63.7 4,721 1,804 DISINFECTION. Disinfection of Rooms.—2,042 rooms were disinfected, as contrasted with 2,694 in 1922. 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 33 [1923 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. 28. The Cleansing and Spraying of Rooms.—1,525 rooms, as contrasted with 1,474 in 1922, were cleansed and sprayed. Rooms Disinfected. Rooms Sprayed. 1923. 1922. 1923. 1922. 1st Quarter 409 813 373 423 2nd „ 441 730 406 404 3rd „ 564 589 386 258 4th „ 628 562 360 389 The Year 2,042 2,694 1,525 1,474 Work at the Disinfecting Station.—55,693 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 71,148 similar articles disinfected during the previous year. In addition to the above articles 47,956 second-hand garments and bed blankets were disinfected for clothing contractors trading in the borough, who paid the Council for the work, amounting to the sum of £119 14s. 0d. Altogether, 103,649 articles described in the two paragraphs preceding were disinfected, which bring the number of large articles disinfected since the disinfecting station was established to 1,951,490. Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1923, and also in the preceding year 1922. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1923 1922 Beds 525 596 728 753 2,512 3,055 Blankets 1,092 1,117 1,459 1,285 4,953 5,822 Bolsters 478 451 614 347 1,890 2,674 Carpets 14 4 4 8 30 18 Chair Bed Cushions . 73 52 75 59 259 318 Mattresses 556 489 785 578 2,408 3,005 Palliasses - - 4 19 23 25 Pillows 938 1,316 1,922 1,513 5,683 6,463 Quilts 469 408 586 642 2,105 2,823 Sheets 815 784 1,179 1,219 3,997 5,203 Other Articles 7,781 6,227 8,578 9,241 31,827 41,742 Totals 12,741 11,354 15,934 15,664 55,693 71,148 1923] 34 The nature of the articles disinfected for the clothing contractors is shown below : 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Overcoats 2,355 1,5 0 6,070 5,850 15,865 Jackets 842 1,074 2,523 1,550 5,989 Blankets 1,780 5.716 14,550 1,950 23,996 Trousers — - 36 150 186 Tunics — — 880 2 882 Other Articles 265 509 172 92 1,038 Totals 5,242 8,889 24,231 9,554 47,956 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 1 10 150 - — — Disinfection of Premises - - - — 28 65 Cost = £79 15s. 0d. Shelter House.— The Shelter House was occupied by 3 persons during the disinfection of their homes after infectious diseases. Baths were given to 13 verminous persons, also to 11 men under the "Cleansing of Persons Act," whilst their clothing was disinfected. Five midwives also attended for the purpose of disinfection after attendance on cases of Puerperal Fever. Verminous School Children.— During the year 4,886 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 4 to 50. The agreement entered into between the London County Council and the Borough Council fiom 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 £419 14s. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, in 51 instances during the year, when fines ranging from 3s. to 10s. were inflicted, the total amount being £21 11s. 6d. 35 [1923 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 1923. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under: Factories, including Factory Laundries 624 Workshops, including Workshop Laundries 954 Workplaces, other than outworkers' homes 396 Bakehouses 333 Restaurant Kitchens 423 Outworkers' premises 1,235 Miscellaneous re-inspections and calls 5,324 Total 9,289 Notices Served.—In consequence of the 1,147 sanitary defects discovered as the result of the inspections above; 278 intimations and 20 statutory notices were served. Of the-e notices 73 were served on the owners of factories, 139 on the owners of workshops and workplaces, and 57 on the owners of bakehouses and restaurant kitchens. In addition to these nuisances, 156 were discovered on Outworkers' premises, necessitating the service of 29 notices. A summons was taken out in one instance with the result that upon the nuisance having been subsequently abated, the case was withdrawn on payment of £1 1s. costs. Registers.—There were 1,947 workshops on the Register, as contrasted with 1,831 in 1922, while the total number of workrooms was 2,766 as contrasted with 2,621 in the previous year; 237 workshops were added to the Register, while 121 were removed from it. The various workshops and workplaces are tabulated as below: Workshops and Workplaces. 1923. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 873 1,305 156 71 Workshops where Women are ployed 434 739 53 40 Laundries 18 46 Bakehouses 236 245 1 5 Restaurant Kitchens 386 431 27 5 Total 1,947 2,766 237 121 Outworkers' Premises 2,404 — 583 421 1923] 36 Workshops Notified to Home Office, 1923. Trade. Number of Workshops. Women. Mule Young Persons. Total. Blouses 2 6 - 6 Millinery 8 14 - 14 Furrier 7 13 — 13 Tailoring 5 9 - 9 Dressmaking 7 36 - 38 Mantles 3 8 - 8 Costumes l 8 - 8 Christmas Crackers 1 2 - 2 Underclothing 2 2 - 2 Rag Sorting 2 7 - 7 Confectionery 1 3 2 5 Cabinet Making 1 2 2 4 Leather Goods l 5 2 7 Lamp Shades l 1 — 1 Cake Ornament Making 1 - — 6 Handbags l 4 — 4 Weaving 1 1 — i Pleating and Hemstitching 1 5 — 5 Art Florist 1 6 — - 6 Waterproof Making l 2 — o Heel Grips l 4 2 6 Raffia Dyeing 1 3 — 3 Carnival Sundries l 4 — 4 Wax Products l 3 — 3 Bedstead Making l — 3 3 Baker 1 — 2 2 Printer 1 — 1 1 French Polishing 1 — 1 1 Upholsterer l — 1 1 Motor Repairs 1 — 1 1 Pianoforte Making l — 3 3 Chair Making 1 — 3 3 Total 60 154 23 177 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 624 73 - (Including Factory Laundries) Workshops 954 110 1 (Including Workshop Laundries) Workplaces 396 29 - (Other than Outworkers' premises) Restaurant Kitchens 423 30 - Bakehouses 333 27 - Outworkers' Premises 1,235 29 - Miscellaneous Re-Inspections and calls 5,324 — — Total 9,289 298 1 37 [1923 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 254 273 - - Want of ventilation 16 15 - - Overcrowding 5 5 - - Want of drainage of floors 21 21 - - Other nuisances 362 369 - - Sanitary Accommodation insufficient 32 35 - - unsuitable, foul or defective 449 438 - 1 not separate for sexes 5 7 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) — — - - Breach of Special sanitary requirements for bakehouses (ss. 97 to 100) 9 2 - - Other offences 1 1 — - Total 1,147 l,166† - 1 * Including those specified in sections 2, 3, 7 and 5 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) 135 39 135 - Outwork in infected premises (s. 109, 110) 21 — 21 — Total 156 39 156 OUTWORKERS' LISTS (s. 107): Lists received from Employers 1,832 Addresses received from Other Councils 2,164 Addresses forwarded to Other Councils 922 Firms failing to send in lists (No. letters sent) 327 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 16 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901). Notified by H.M. Inspector 17 Reports (of action taken) sent to H.M. Inspector 17 Other (New Factories reported under Home Office Memorandum, 1912) nil Underground Bakehouses (s. 101) in use at the end of the year . 84 DISTRICT INSPECTORS' WORK. The fourteen district inspectors made a total of 57,817 inspections and calls during the year, a decrease of 3,525 inspections on the corresponding period of 1922; while 33,175 improvements were effected in 5,762 premises; as against 14,173 improvements in 5,866 premises for the preceding year. 1923] 38 Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the district inspectors' work in 1923 : House to house inspections 2,535 Other inspections of dwelling houses 5,284 Re-inspections and calls made 46,789 Visits of inquiry re notifiable infectious diseases 2,096 Butchers' shops, stalls, etc. (Saturday nights) 47 Ice cream shops and factories 83 Dairies and Milkshops 823 Stables and yards 1,316 Manure depots 47 Smoke observations 215 Notices Served.—There were 3,489 intimation notices served by the inspectors with respect to nuisances, of which 341 were delivered personally, and 3,148 by post. In 584 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.—122 premises which were found to be in a verminous condition, were cleansed by the owners or occupiers upon receiving the Inspectors' intimations. In 18 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Smoke Nuisances.—32 complaints of smoke issuing from factory chimneys in the borough were investigated, and as a result of the Inspectors' observations 32 warnings were given and 13 intimations and 5 statutory notices served upon the owners of the businesses requiring the abatement of the nuisance. Two summonses were taken out, and orders were made for the defendants to prevent the recurrence of the nuisance, and pay costs amounting to £2 11s. SCHOOLS. Attention was drawn to the condition of Gifford Street School in consequence of several cases of Diphtheria in the district. The Medical Officer of Health of the London County Council was communicated with and the particulars as far as could be ascertained were laid before him, the conditions being considered to be such as required immediate and thorough attention. As a result, the whole of the school premises were thoroughly cleansed, and the whole of the drainage system tested, when several sections were found to be defective, and these were repaired. The conditions at St. Jude's (C.E.) Schools also called for attention from my department, as it did not appear that the London County Council's regulations with regard to the cleanliness of schools was being carried out in its entirety. Other minor items which came to our notice in regard to schools were also dealt with during the year. REMOVAL OF DUST. Sixteen applications were received during the year for the removal of dust, which is 1 above the number recorded last year. The. applications received for the previous ten years were as follows: 1914 26 1919 19 1915 28 1920 36 1916 21 1921 21 1917 30 1922 15 1918 11 Dust Receptacles Provided.—During the year 1,309 dust receptacles were provided, while 8 were repaired after the service of sanitary notices. 39 [1923 Showing the summary of Sanitary Work from District Inspectors' Reports for the. v:ar 1923. Districts. Totals  1 2 3 4 5 6 7 8 9 10 n 12 13 14 House to House Inspections 166 233 152 187 170 159 64 457 127 159 218 229 274 2535 Other premises inspected 424 368 317 506 — 474 334 404 410 289 399 536 481 340 5284 Re-inspections, Calls made, etc. 2759 2881 3666 2984 — 3916 4239 4056 5769 1541 1641 4053 3684 3600 46789 Ice Cream Factories inspected 1 — 12 27 — 4 — — 21 — 5 13 — — 83 Dairies and Milkshops „ 33 23 111 176 — 18 105 1ll 112 11 47 26 26 30 823 Stables ,, 7 3 11 51 — 25 26 9 18 27 1 — 10 38 226 Yards ,, 50 100 298 158 — 10 246 12 53 48 20 6 44 45 1090 Manure Depots ,, 4 — — 29 — 1 — — 13 — 1 — — — 47 Vacant land, Passages and Courts inspected 11 1 3 3 2 39 1 1 35 1 — 16 10 123 Urinals attached to P.H.'s inspected 66 76 48 16 100 6 25 12 7 6 16 45 423 Premises (re Certificate Customs and Inland Revenue Acts) inspected — — — 8 2 — 4 14 — — — — 41 69 Premises (re Water Certificates) inspected — — — 1 14 — — — — — 48 63 Visits re Sale of Food and Drugs Acts — — — — — — — — — — — — — — — 1 Smoke observations — 15 3 40 — 32 18 — 85 0 9 5 2 215 Shops, Stalls and Markets (Saturday evening) 4 4 4 4 — 2 3 5 5 5 3 3 2 3 47 Total Inspections and Calls 3399 3694 4653 4215 — 4672 5270 4686 4983 4100 4292 4866 4512 4475 57817 Notices Served. Intimation Personally 5 1 28 12 — 23 14 10 136 2 62 9 12 27 341 By Post 182 264 172 372 — 231 246 253 291 1 232 399 256 249 3148 Statutory Personally — 2 5 30 — 19 5 2 23 9 18 9 4 7 133 By Post 24 21 25 53 — 53 35 21 36 — 41 62 35 45 451 Improvements. Drains— Constructed — — — 1 — 2 — — 3 — — — — — 6 Reconstructed 18 9 11 9 — 18 18 6 7 3 21 1 3 8 132 Repaired 11 22 8 30 — 39 29 17 24 7 30 15 11 22 265 Ventilated 20 13 4 13 — 25 2 10 2 3 12 1 5 27 137 Gully and other traps fixed loo 55 39 40 — 58 47 25 34 9 14 2 12 42 477 Urinals— Water supplied, cleansed — — 1 7 — 1 3 — 3 — — — 4 1 20 Cesspools—Abolished — — — — — — — — — — — — — — — Water Clos et— W.C. erected with pan, trap and water supply 4 1 3 1 _ 2 2 1 7 _ 3 1 25 Pan and trap only provided 34 31 19 33 — 41 19 23 18 7 59 9 16 47 356 Water supply provided 39 39 16 29 — 43 43 29 53 2 20 28 44 39 424 Ventilated — 1 2 1 — — — 35 — — 1 1 1 42 Position altered — — 7 — — 1 1 1 — — — — 10 Dust Bins Provided. 130 165 _ 112 136 — 103 85 69 76 13 70 134 142 74 1309 Repaired — 2 — — — 3 1 1 — — — 1 — 8 Areas—Constructed — — — — — — — — — — — 1 — — 1 Yards Paved 2 2 2 — 2 10 1 1 1 — 3 — 1 25 Repaved 28 16 14 41 — 32 41 20 28 5 32 24 26 14 324 Sinks—Provided 7 13 — 3 — — 3 — 4 — 2 — 2 8 42 Domestic Water Supply- Cisterns provided 3 — — — — — — — — — — — — 2 5 Cisterns repaired & cleansed 9 17 12 26 — 27 25 3 21 4 7 4 17 24 196 Water supply provided to dwelling house 7 4 5 4 — — 9 2 6 6 1 — 3 3 50 Water supply provided to ment house 1 3 1 8 — 1 4 — 8 — 1 1 3 9 40 Other improvements— Rooms cleansed & limewashed 84 135 254 282 — 335 336 187 408 64 364 342 442 240 3473 W alls and passages repaired. cleansed and limewashed 53 34 52 95 — 70 67 56 107 13 137 91 150 67 992 Floor space ventilated 4 1 5 3 — 1 5 3 8 — 16 1 2 5 54 Floors repaired 28 15 13 36 — 34 16 7 28 8 32 30 32 27 306 Roofs repaired 47 49 42 109 94 123 72 97 28 106 112 135 109 1123 Overcrowding abated — 1 1 1 — 2 4 2 1 — — 2 1 15 Illegal use of underground rooms for sleeping discontinued — — — — — — — 1 2 — 1 1 — 6 Other improvements, or ances abated 95 86 78 144 — 162 144 77 144 24 158 108 208 176 1615 Rooms Disinfected 142 187 134 221 — 30 82 78 197 28 75 158 194 170 1697 Total improvements 866 909 836 1278 — 1127 1119 689 1324 226 1160 1069 1455 1117 13175 Total premises improved 367 485 415 615 — 373 436 296 606 109 431 533 611 485 5762 1923] 40 HOUSES LET IN LODGINGS. There were 1,012 houses under the operation of the bye-laws at the and of the year 1923 ; 510 inspections were made during the year, followed by 8,200 subsequent re-inspections and calls, so that the total visits amounted to 8,710. These inspections resulted in 531 intimations being served on the persons responsible, which were followed by 83 statutory notices to demand the abatement of the nuisances discovered by the two inspectors especially engaged upon this work. Five summonses were taken out for non-compliance with the notices served. Altogether, 4,103 improvements were effected in 755 premises. Synopsis of Inspectors' Work:— Improvements. Districts. Total.  North. South. Drains : Constructed — — Reconstructed — 5 5 Repaired 10 19 29 Ventilated — — — Gully and other traps fixed 16 4 20 Water Closets : W.C. erected with pan, trap and water supply 1 1 2 Pan and trap only provided 15 30 45 Water supply provided — — — Ventilated 2 — 2 Position altered — — — Dust Bins : Provided 100 96 196 Repaired — — — Areas : Constructed — Yards : Paved — — — Repaved 27 63 90 Sinks : Provided 10 2 12 Domestic Water Supply : Cisterns provided — — — Cisterns repaired and cleansed 17 12 29 Water supply provided to dwelling house 1 — 1 Water supply provided to tenement house 17 1 18 Other Improvements: Rooms cleansed and limewashed 581 639 1,220 Walls and passages repaired, cleansed and limewashed 98 188 286 Floor space ventilated — — — Floors repaired 55 74 129 Roofs repaired 142 156 298 Miscellaneous improvements 928 793 1,721 Total Improvements 2,020 2,083 4,103 Total Premises Improved 387 368 755 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 appointment of the temporary Rat Officer was terminated by the Council on 15th June, 1923. 41 [1923 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 1920-23. 1923 Jan,to June 1922 1921 1920  Number of Streets visited 544 711 669 607 Number of Private Houses visited 650 1,023 805 945 Number of Shops and Factories visited 712 1,009 1,034 1,326 Total Premises inspected 1,362 2,032 1,839 2,271 Found Rat Infested 787 1,331 1,406 1,355 Found Mice Infested 66 72 55 196 Defective Drains Repaired (Cause of Rat trouble) 13 52 45 34 Number of Complaints received 67 177 175 172 HOUSING, INSPECTIONS, ETC. On the 31st August, 1923, the Medical Officer of Health made representation to the London County Council on the George's Road and Brand Street Areas, which have been the subject of much investigation, the results of various inquiries having been before the Public Health and Housing Committees of the Borough Council. The representation was as follows : 31 si August, 1923. Sir,—I beg to represent pursuant to the provisions of the Housing Acts 1890 to 1923, that within the areas in the Metropolitan Borough of Islington shewn by a pink tint on the plan annexed hereto houses courts or alleys are unfit for human habitation and/or the narrowness closeness and bad arrangement or the bad condition of the streets and houses or groups of houses within such areas or the want of light air ventilation or proper conveniences or any other sanitary defects or one or more of such causes are dangerous or injurious to the health of the inhabitants either of the buildings in the said areas or of the neighbouring buildings and that the most satisfactory method of dealing with the evils connected with such houses courts or alleys and the sanitary defects in such areas is an improvement scheme for the rearrangement and re-construction of the streets and houses within such areas or of some of such streets or houses. I am, Sir, Your obedient servant, G. Clark Trotter, Medical Officer of Health, Metropolitan Borough of Islington. Sir James Bird, Clerk to the London County Council, The County Hall, S.E. 1. A special table will be found on page 58. See also the statement of Sanitary Inspectors' work, page 39. Special House to House Inspections 2,535 Insanitary Houses— No. of premises cleansed (Sect. 20, L.C.C. (General Powers) Act, 1904.) 122 No. of orders issued for repairs under Section 28 by Housing Committee Nil. No. of closing orders Nil. 1923] 42 housing, inspections, ETC.—Contd. Housing of Working Classes— Houses— (a)Inspected (under £40 per annum rental)3,952 (b)Erected during year (flats) Nil. (c)In course of erection (flat tenements) Nil. Revenue Acts— Certificates granted (sanitary requirements) 8 Water Supply to Tenement Houses— Premises supplied 58 Water certificates to new premises 10† († Relating to 61 dwellings.) STATE OF PAUPERISM IN THE BOROUGH. During the year there was a slight decrease in Pauperism, the number of paupers relieved weekly averaged 13,914, as contrasted with 14,447 in 1922, whilst in 1921 the number was 11,108. Appended is a statement furnished by the Clerk to the Islington Guardians : Showing the Stale of Pauperism in the Borough during the year 1923. Quarters. Average number Relieved during each week. Borough Death rates, 1923. Indoor Paupers, Adults and Children. Outdoor Paupers. Totals. Totals corresponding periods 1922. Children Boarded out. Adults. Children under 16. 1 2 3 4 5 6 7 8  1st Quarter 2,874 6,697 6,098 15,669 14,514 67 13.2 2nd „ 2,836 6,035 5,249 14,150 15,113 66 10.9 3rd „ 2,811 5,446 4,580 12,837 13,567 6o 9.8 4th „ 2,881 5,512 4,610 13,003 14,595 58 12.4 The Year 2,850 5,930 5,134 13,914 14,447 63 11.6 Food—Inspection of.—Inspector Wilkinson reports that during the year he has paid 907 visits to the 17 Slaughter Houses now on the register, including one Horse Slaughter House, and that he has ascertained that 12,200 animals were killed therein, namely, 1,005 oxen and cows, 64 calves, 7,110 sheep and lambs, and 4,021 horses for human consumption, the whole of which were exported. These were mostly of good quality and free from disease, but in 26 cases meat and organs found to be diseased were destroyed (vide table on page 44). The food destroyed or otherwise disposed of (chiefly for pigs' food) so as to prevent its use for human food was as follows : Tons cwts. qrs. lbs.  Diseased meat and organs from slaughter-houses — 11 1 5* Diseased or unsound meat, etc., from other sources 6 0 8 Fish 14 0 24 Fruit, Vegetables, etc. 4 11 1 27 Tomatoes 3 10 0 2 23 Turkeys and 1 Goose — 1 0 1 Unsound Condensed Milk — 2 0 12 Total 9 16 0 23 * of this quantity 9 cwt. 2 qr. 26 lbs. was Tuberculous. 43 [1923 The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 9 tons 16 cwts. 0 qrs. 23 lbs. The diseases which affected animal food are set out in detail on page 44. Shops, etc., Inspection of.—The total 632 shops and places where foodstuffs are sold may be approximated for the year as follows : Butchers', provision dealers', etc., shops, 215 ; meat, provisions, rabbits, tinned foods, etc., stalls, 25; food preparation establishments, 18; fish shops, 103; fish stalls, 11 ; fruit shops, 200 ; and about 60 fruit, etc., stalls and barrows. To these 17,655 visits were paid, apportioned as follows : Butchers, Provision Dealers, etc., Shops 7,363 visits. Food Preparation Establishments 162 „ Butchers', Provision, etc., Stalls 1,502 „ Fish Shops 1,276 „ Fish Stalls 656 „ Fruit Shops 2,559 „ Fruit Stalls 4,137 „ Total 17,655 Contamination by Dust.—There has been an increasing practice of recent years of exposing meat without adequate protection from dust and flies. Not only has this been the custom of the street trader, but the shopkeeper, where the street line permits of it and he has a right to the space in front of his shop, has very frequently by the erection of a stall in front, exposed the cuts of meat he has for sale. A striking ocular demonstration of how such exposed meat is contaminated was provided by a tradesman who called upon the Medical Officer of Health with some pork chops which showed curious spotting. There was a centre black speck surrounded by a ring of dark brown. On going into the matter the cause was traced. The road had been recently tarred and, as a result of weather conditions and the constant traffic, a certain amount of tar dust was formed. Each spot on the fat of the pork represented a small, invisible speck of tar which had been deposited on the pork and dissolved by the fat. The moral was pointed out to the tradesman, who seemed to realise if this could happen with tar it was also happening, although not seen, with other matter with which the street is polluted. The keen competition where one trader exposes the food to the gaze and handling of those marketing, was said to make it impossible for the other trader, who would willingly have his food adequately protected, not to imitate his energetic and thoughtless neighbour. The extent to which this food exposure is carried on makes it absolutely necessary that legislation should be promoted, for until it is compulsory on all to protect the class of food liable to contamination, it seems practically impossible for the majority of the traders to comply with what should be a public demand, namely, the adequate protection of the food from dust and flies. There should be an education of the public conscience to buy from the careful trader. 1923] 44 Restaurant Kitchens.—The work of inspecting restaurant kitchens is tabulated under Workshops. This work is done by two Lady Inspectors. 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 66 16 Coffee and Dining Rooms 204 70 Refreshment Rooms 69 19 Provisions (Cooked Meats, cooked but not consumed on premises) 106 .40 445 145 Prosecutions.—Summonses were taken out against a costermonger for exposing for sale unsound black currants, and he together with the owners of the fruit were fined £2 and £5 respectively. Twenty-nine summonses were taken under the Sale of Food Order, 1921, for exposing for sale imported meat and eggs without the necessary labels. Of this number, eight referred to imported meat, one summons, however, being withdrawn owing to death of defendant. The total fines in the remaining seven cases amounted to £14 15s. with £3 5s. costs. The other 21 summonses were for exposing for sale imported eggs, two of these cases were taken upon information received from the Metropolitan Police, but one of the summonses was not served owing to defendant absconding. The fines and costs in these cases were £17 4s. and £13 17s. 6d. respectively. Cowsheds.—The 4 cowsheds within the Borough received 35 visits, and were found generally satisfactory. Offensive Trades include 4 tripe dressers, 3 gut scrapers, and the knackers' yard which received a total of 52 visits. The Inspector reports that he found the conduct of the business carried on in them satisfactory. Tabulation of meat and organs diseased as found in slaughter-houses during the year 1923 : No. of Cases. Description of Animal Affected. Nature of Disease. Extent of Disease. How disposed of.  1 Ox Tuberculosis Lungs and Costal Pleura Council's Destructor 1 Ox Tuberculosis Carcase and all Organs „ „ 1 Cow Tuberculosis Head. Tongue, Lungs,Tripe and Spleen „ „ 1 Ox Tuberculosis Lungs, Liver, Tripe and Spleen „ „ 1 Ox Pseudo-Tuberculosis Liver (whole or part) ,, „ 11 Oxen Abscess Liver (whole or part) Council's Destructor or on the premises 8 Oxen Parasitic (Dis. Hep.) Liver (whole or part) „„ 2 Sheep Parasitic (Ech. Vet.) Liver Destroyed on premises 45 [1023 Milkshops and Dairies.—At the close of the year there were 630 milkshops and dailies on the register, 25 having been added to it, while 18 were removed. They received 823 visits from the District Sanitary Inspectors, who served 42 notices for the execution of various sanitary improvements and the cleansing of dirty utensils. 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 (1923), 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 673 Separated Milk 3 Total number of samples of milk examined for the presence of preservatives 676 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 Nil 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 2 Statements incorrect Nil (b) Determination of Milk Fat in cream sold as preserved cream— Above 35 per cent 2 (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 Nil Note.—a further 10 informal samples were purchased of cream of which 2 were analysed. They had the orthodox preservatives label. Taking account of these 10 informal samples, and referring to the official samples, it will be seen that 12 creams were taken. Of these 12 creams, 4 were submitted for analysis; two of those analysed appear in the above summary as these were official samples, 1923] 46 COLOURING MATTER. 1st Quarter. Mustard coloured with Turmeric £1 1s. costs. (43% Wheat Flour). Mustard coloured with Turmeric Summons withdrawn. (25% Wheat Flour). Mustard coloured with Turmeric No prosecution. (7% Wheat Flour) 2nd Quarter. Nil. 3rd Quarter. Milk (5% added water) 3.3 grains per pint Boric Acid Fined 10s. and 5s. costs. 4th Quarter. Nil. ADULTERATION OF FOOD AND DRUGS. During the first two quarters of the year the analysis of samples of food and drugs was performed by our Analyst, Dr. F. L. Teed, in conjunction with Mr. E. A. Pinchin, B.Sc., the additional analyst. Dr. Teed resigned his appointment at the end of this period, after 35 years' service. Mr. Ernest A. Pinchin, B.Sc., was subsequently appointed to fill the post of Public Analyst. Of a total of 1,223 samples submitted during the year, 1,147 were reported genuine, and 76 adulterated, or 6.2 per cent. The percentage of adulteration in the four quarters of the year was as follows : Examined. Genuine. Adulterated. Per Cent.  1st Quarter 322 297 25 7.7 2nd ,, 279 263 16 5.7 3rd „ 301 284 17 5 .6 4 th „ 321 303 18 5.6 The Year 1,223 1,147 76 6.2 Prosecutions—Fifty-seven summonses were issued under the "Sale of Food and Drugs Acts," and 47 of these were successfully prosecuted. The total amount of penalties and costs received was £156 12s. 6d. Two other cases were heard under the Public Health (Milk and Cream) Regulations, resulting in the defendants being fined 10s. with £1 6s. costs. Inexperience of Small Shopkeepers—Warnings.—A large proportion of people warned are small shopkeepers who have started business without sufficient experience, while a proportion are also prosecuted, This proportion who are prosecuted 47 [1923 have either been previously warned or the offence is considered to have been deliberate or of too serious a character to enable the Public Health Committee to refrain from bringing action. There is an unceasing change in the proprietorship of small businesses. The taking on of the sale of milk—very frequently only a few pints are sold daily—is with the idea that a customer may buy something else. It has frequently been pointed out to these people the risk they run in taking on a business they do not understand, and they are told that their milk may be sampled at any time. The small shopkeepers in the majority of cases have not familiarised themselves with their duty under the Butter and Margarine Acts. Very numerous first warnings were given to this class of trader during the year. DISPENSING OF PRESCRIPTIONS. A commencement had been made with the sampling of prescriptions towards the close of the previous year (1922) and the results were such that it was found necessary to continue the sampling. Four prescriptions had been sampled, as stated, towards the end of the year, two of these being found inaccurate, one being deficient 11.2 per cent, in bromide of potash and 5.2 per cent, in spirit of sal volatile, and the other, a simple solution of sodium salicylate, was 10.8 per cent, deficient. The same prescriptions were utilised again at the beginning of the year, the object being to gain some general idea as to the relative care taken in dispensing an ordinary prescription. The reason of the results obtained, whether due to striking a series of shops where dispensing was generally done indifferently, or to the particular prescription being entrusted by the proprietor to apparently careless assistants, cannot of course be definitely ascertained. The relatively large number of cases in which the prescription was inaccurately dispensed was certainly no mere accident. The Medical Officer of Health drew attention to the matter in "The Lancet" at the point when 17 prescriptions, including those of the previous year, had been taken, a large number of these having fallen short of accuracy. This letter in "The Lancet" was quoted by a Sunday newspaper, and resulted in the matter receiving very considerable attention from the public press. Attention had previously been drawn to inaccurate dispensing through the analyses carried out by the Corporation of the City of London and the Metropolitan Borough of Stepney. The Public Analyst of Stepney had stated to the press that from January to September, 1922, he analysed 35 prescriptions, and certified 15 as " adulterated." The Public Health Committee authorised the Medical Officer of Health to offer the Pharmaceutical Society facilities for investigating the cases decided by the Courts. The attitude taken by the press was unfortunate, as the public might have applied the strictures therein to all chemists, and although the proportion of inaccuracies was a large one, it was not quite fair that every chemist should be "pilloried." The press propaganda brought out an expression of opinion from one Analyst that the deficiency was usually in the more expensive drugs, but this has not been our experience in Islington, where the errors seem to be more of the nature of carelessness in dispensing. Viewed from the requirements of the Food and Drugs Acts, it was rather disconcerting to 1923] 48 find that the excuse was so often laid on the variation in size of medicine bottles. If a prescription is dispensed properly, in such a manner as is consistent with the training for the examinations of the Pharmaceutical Society, the strength of the solution should not vary, whatever the capacity of the bottle. One of the newspapers, the "Evening Standard," Wednesday, 20th February, 1923, certainly summed up public opinion very well in a leader headed "The Human Chemist," which I take the liberty of quoting in extcnso, because personally I believe it possible that much of the inaccuracy is due to the carelessness of assistants. "The public is apt to forget that there is a great deal of human nature in man, and that solemn men, like the average chemist, are not immune from ordinary weaknesses. Hence the shock caused by the assertions of a very wide 'limit of error -in prescriptions, and the suggestion that one prescription out of every three made up in this country is incorrect. "The suggestion is hotly repudiated, as might be expected, by the Pharmaceutical Society, which represents the interests of chemists. Errors, it is admitted, do occur, but they are hardly avoidable. The chemists are not to blame. It is the medicine bottles, which are not uniform in size. To the layman this seems a singular explanation, since it might be imagined that a mixture remains the same mixture, in its ingredients and its proportions, whether it is put in an eight-ounce bottle or a soup tureen. Indeed, this defence is really an admission. It confesses that in making up a doctor's prescription the chemist aims only at approximate correctness. It is ' not easy to go about things in the leisurely way of a laboratory,' and therefore ' not practicable always to secure strict accuracy in making up the mixture in a measure and then transferring it to a bottle. "In other words, the chemist wants to make his living as easily as possible. There are, no doubt, excuses for him. The public treats the dispensing chemist rather badly. It will not pay the price of professional service, and, on the other hand, it gives as little patronage as possible to the chemist as a tradesman. "But when all allowances are made, it must be said that it is disquieting to read of a prescription made up by one chemist showing a deficiency of 8 per cent, in a single ingredient, while the same prescription made up by another chemist showed an excess of 9 per cent, in the same ingredient. It is still more disturbing to learn that errors of deficiency generally relate to the more expensive drugs. "I am afraid,' says one expert critic, ' that most of these errors result from deliberate profiteering.' The charge is so serious that it behoves the Pharmaceutical Society to offer something more than a denial in general terms. We hesitate to believe that in a matter so vitally affecting health, and perhaps even life itself, members of a highly responsible craft can admit such considerations. If there is such a form of profiteering, it is surely the most immoral kind of profiteering conceivable. Not only is it a fraud on the public, the worse because the average member of the public cannot possibly check it. It may be easily a serious crime. "Yet the words of an expert on the staff of the Public Analyst for the County of London cannot be dismissed too lightly. ' When there is anything wrong,' he says, ' it is usually intentional.' The average dispenser is well trained, or he would not have been able to satisfy the tests of the Pharmaceutical Society. "There is, therefore, a case to be met, and we cannot see that it is met by the statement that ' a chemist, like other employers, is dependent on his employees ' and that ' it 49 [1923 is impossible for him personally to supervise every operation in his shop.' He should certainly be in a position to depend both on the know ledge and the conscientiousness of his assistants, and his shop should not be too big or too inefficiently organised for him to be assured of the greatest possible care in a matter so vitally important to the public." The press propaganda, although unfortunate for the faultless chemists, certainly by the attention drawn to the matter, caused more care to be taken in dispensing in Islington, for the time being at any rate, and it is to be hoped the improvement will be permanent. With a view to bringing out the question of the unqualified assistant, a prescription was sent round for dispensing containing a poison. There was a marked difference in the results. Apparently it would seem as if this prescription was not entrusted to assistants, as in only two cases out of 20 was there inaccuracy, but not to such an extent as to warrant prosecution. The chemists concerned were warned. In none of the cases which have been taken has there ever been an opportunity in the witness box of cross-examining the responsible assistant. It has been noted that this possibility is apparently always very carefully avoided by the defence. The fifteen prescriptions, without the poisonous ingredient, which were taken in the earlier part of the year resulted in a startling proportion of inaccuracies. When the totals altogether are taken for the year, adding on the others tested, of course the relative proportion is markedly diminished, but as stated, there were two different methods adopted for testing the accuracy of dispensing. In the first method (the simple prescription) 15 chemists were tested ; seven were inaccurate. Four prosecutions were instituted, and three of these were successful, while one summons was dismissed upon the merits of the case; it had been taken under Section 6 (Food and Drugs Act, 1875), which requires proof of prejudice. In addition to these four prosecutions that were taken, three chemists were warned. On the second method (i.e., the prescription containing the poison) twenty were tested, and the dispensing was good on the whole; two chemists were warned. The fines and costs awarded the Council amounted to £27 8s. Milk.—The qualitative results of the Analyses of the Milk samples, which have nowbeen published for many years, are as follows : No. of Samples. Solids not Fat. Fat. Total Solids.  Milk purchased on Sundays . 120 8.82 3.55 12.37 Milk purchased on week-days 388 9.08 3.63 12.71 Milk procured in transit at Finsbury Park Station 168 8.90 3.63 12.53 Official Standard — 8.0 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 120 116 4 3.3 On Week-days 388 371 17 4.4 At Railway Stations . 168 157 11 6.5 (Farmers' Milks) – – — – 676 644 32 4.7 1923] 50 Giving the particulars of the Milks taken during each quarter of 1923 on Sundays, Week-days, and at the Railway Stations. 1923 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. Week. days. Railway Stations. All Milks.  1st Quarter 30 88 31 149 30 84 31 145 4 4 4.5 2.7 2nd „ 30 97 45 172 27 93 41 161 3 4 4 11 10.0 41 8.9 6.4 3rd „ 30 113 46 189 29 107 39 175 1 6 7 14 3.0 5.3 15.2 7.4 4th „ 30 90 46 166 30 87 46 163 — 3 — 3 3.3 — 1.8 The Year 120 388 16S 676 116 371 157 644 4 17 11 32 3.3 4.4 6.5 4.7 The number of samples of milk purchased was 676, of which 644 were genuine and 32, or 4.7 per ccnt. were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1923. MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Par cent. Adulterated.  1913 600 555 45 7.5 1914 595 539 56 9.4 1915 605 531 74 12.2 1916 599 506 93 15.5 1917 592 526 66 11.1 1918 634 537 97 15.3 1919 638 579 59 9.2 1920 612 605 37 5.7 1921 644 605 39 6.0 1922 638 576 62 9.7 Totals 10 yrs. 6,187 5,559 628 10.1 1923 676 644 32 4.7 Showing the analyses of 6,187 milks examined in Islington duiring the 10 years 1913-1922 and 1923 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. Sunday Milks. Week-day Milks. Railway Milks (Farmers). Years. No. of Samples Per cent. of nonfatty solids. Per cent of fat. No. of Samples Per cent. of nonfatty solids. Per ccnt. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat.  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 3.49 120 886 367 1916 160 8.60 353 319 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 8.39 360 377 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 1922 120 8.78 3.39 356 8.76 3.34 162 8.75 3.60 Total samples and average constituents (10 years. 1,527 8.65 3.47 3.372 8.67 3.47 1,288 8.81 3.68 1923 120 8. 82 3.55 388 9. 08 3.63 168 8.90 3. 63 51 [1923 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 1923. Description. 1st Qr. 2nd Qr. 3rd Qr. 4 th Qr. Totals. Genuine. Adulterated. 1st Qr. 2nd Qr 3rd Qr. 4th Qr. Totals. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Totals.  Milk 148 172 188 165 673 144a 161a 174a 163a 642a 4a 11 14 ae 2 31 Milk (separated) 1 — 1 1 3 1a — 1a — 2a — — — 1a 1a Butter 59 64 53 39 215 59 64 53 39 215 — — — — — Lard 6 3 5 11 25 6 3 5 11 25 _ — — — — Dripping 5 3 — 2 10 5 3 — 2 10 _ _ _ _ _ Coffee 5 2 3 5 15 5 2 3 5 15 — — — — — Cocoa 7 7 8 15 37 7 7 8 15 37 — — — — — Pepper 8 5 7 6 26 8 5 7 6 26 — — — — — Mustard 18 — 1 — 19 15 — 1 — 16 3 — — — 3 Malt Vinegar 11 — — 1 12 8 — — 1 9 3 — — — 3 Rice 6 — 4 2 12 6 — 4c 2c 12c — — — — — Cheese 5 7 6 18 36 5 7 6 18 36 — - — — — Vinegar 4 — — 1 5 4 — — 1 5 — — — — — Arrowroot 4 5 9 7 18 4 5 2 4 15 — — — 3 3 Self-Raising Flour 3 3 2 6 14 36 36 26 6 146 — — — — Ground Ginger 4 — 4 1 9 4 — 4 1 9 — — — — — Baking Powder 2 — 3 — 5 26 — 36 — 56 — — — — — Tapioca 1 1 2 — 4 1 1 2 — 4 — — — — — Ground Cinnamon 2 — — — 2 2 — — — 2 — — — — — Custard Powder — 2 3 3 8 — 26 36 36 86 — — — Lemonade Powd r — — 3 — 3 — — 3a — 3 — — — — — Egg Powder Substitute — — 1 — 1 — — lb — lb — — — — — Sherbert — — 1 — 1 — — 1d — 1d — — — — — Honey — — — 3 3 — — — 3f 3f — — — — — Bitter Ale — — — 1 1 — — — 1 1 — — — — — Brandy — — — 1 1 — — — 1 1 — — Greengage Jam — — — 1 1 — — — 1f 1f — — — — — Raspberry Jam — — — 1 1 — — — 1f 1f — — — — — Plum Jam — — — 1 1 — — — .1f 1f — — — — — Prescription 15 — — 20 35 8 — — 18 26 7 — — 2 9 Citrate of Magnesia — — 1 — 1 — — 1d — 1d — — — — — 314 274 298 311 1,197 297 263 284 303 1,147 17 11 14 8 50 Margarine 8 5 3 10 26 — — — — — 8 5 3 10 26 Totais 322 279 301 321 1,223 297 263 284 303 1,147 25 16 17 18 76 a All samples free from Boric Acid and Formalin. b Conformed with the Local Government Board's recommendations as to Arsenic and Calcium Sulphate. c All samples conformed to the Local Government Board's requirements for extraneous mineral matters. d Free from Lead and Arsenic. e Free from Formilin (1). f Free from Arsenic and Preservative. Milk Prosecutions. The summary of prosecutions showed that during the year 130 prosecutions were taken, of which number 117 were successful, and 7 were dismissed, while 6 were withdrawn. Summary of Prosecutions during year 1923. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties Received.  £. s. d. " Public Health (London) Act, 1891 " 42 40 2 75 18 3 " Sale of Food and Drugs Acts, 1875-99 " 42 32 7 3 130 13 6 " Margarine Act, 1887 " 15 15 — 25 19 0 "Public Health Milk and Cream Regulations. 1912-1917 " 2 2 — — 1 16 0 " Sale of Food Order. 1921 " 29 28 — 1 49 1 6 Totals 130 117 7 6 283 8 3 1923] 52 PUBLIC HEALTH STAFF. The staff of the Medical Officer 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. If. Hancock, C. E. Horsman, A. E. Wood, E. G. Holmes, E. J. Nether, F. H. Chuter, H. H. Uren (Houses let in Lodgings), C. W. Lewis. *Senior Sanitary Inspector. Inspector of Workshops and Bakehouses.—H. J. J. Watson. *Inspectors of Workshops, etc., in which Females arc Employed.—Eleanor H. Daniell, Mrs. S. Undery. *Inspector of Meat, etc.—H. Wilkinson. *Inspector of Food and Drugs, etc.—G. S. Green. Rat Officer (Temporary)—A. Butlin. (Appointment terminated June 30th, 1923). Disinfecting Station.—A. Lewis (Engineer), C. Sadgrove (Stoker), Mrs. Home (Cleansing Station Attendant), Mrs. Lewis (Caretaker, Shelter House). Disinfectors.—F. Webb, J. Brown, W. Hardwick, W. Wooden, A. Taylor. Motor Van Driver—G. Cooper. Mortuary Keeper.—S. Maxwell. Clerical Staff.—G. II. 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 Officer 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. † Resigned June 30th, 1923. APPENDIX. VITAL AND SANITARY STATISTICS, 1923. TOGETHER WITH THE PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 54 1923] STATISTICAL APPENDIX. Showing the Deaths from all Causes in Islington during the Year 1922. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions arc distributed. Deaths in Insftution 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 Tut. |U.H. Toll. L.H. H. B. S.E. Small Pox (a) Vaccinated — — — — — — — — — — - — — — — - — — — — — — — — — (b) Unvaccinated — — — — — — — — — — — — — — — — — — — — — — — — — (c) No Statement — — — — — — — — Measles 2 13 1 — —— — — — — 15 1 — 4 2 2 8 5 11 16 Scarlet Fever 8 3 1 — — — — 1 — — — _ 8 5 1 3 1 2 1 3 2 8 5 13 Typhus Fever — — — — — — — — — — — — — — — — — — — — — 7 Epidemic Influenza 2 3 _ 2 — — 0 4 12 5 16 7 1 5 53 0 6 7 10 8 5 10 33 25 58 7 whooping Cough 22 10 — — — — — — — — — 38 — 1 6 12 5 2 7 5 15 23 38 Diphtherial 2 12 5 2 — — — — — — — — — 14 7 — 2 3 1 3 6 4 12 9 21 Enteric Fever . — — — — — — — — — — — — — — 1 — — — — — —. — — Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — — — 5 Diarrhoea, Dysentery 13 2 — — — — — — — _ — — — 15 — 1 2 2 3 — — 7 0 9 15 13 Epidemic Enteritis 22 2 — — — — 1 — — — — — — 24 1 1 — — 0 3 7 7 16 9 25 2 Other Allied Diseases *t5 *1 *1 — •1 — — — ‡1 — — — — 0 3 1 I 1 1 3 1 1 3 0 9 H>drophobia — — — _ — — — — — — — — — — — — — — — — Glanders _ — • — — — — — — _ _ — _ — — Texan is — _— _ _ _ _ — — _L _ _ — . _ — — Anthrax — — _ _ _ _ — — — _ — Cow Pox - — — _ _ — — — — — — — — — - — -- — -- — — — 6 Syphilis 8 1 — — — — - — 1 1 — 9 2 | i 1 4 2 — 3 5 6 11 5 Gonorrhoea — — — — — — — v 1 1 5 1 1 9 2 2 1 | 1 — 2 1 9 — 9 Phagedena — — — — — — — — — — — — — — — — — — — — — — — — — 1 Erysipelas 2 2 — — 1 •- _ — — 4 1 — — 2 1 1 1 3 2 5 5 Tuerperrl Fever — — _ — — 3 4 2 — L — — -— 9 — — 1 3 1 1 3 — 9 9 7 Pyemia 1 — 1 1 1 1 2 2 1 1 4 — 1 — 1 I I 1 | 2 2 1 1 5 3 9 0 15 8 Infective Endocarditis 1 — — 2 4 — 4 7 2 — 1 -i- — 1 20 t 2 2 j 4 2 3 4 11 10 21 1 Other Allied Diseases 1 — — — — 1 — — 4 | — 1 — 1 1 7 1 | —1 — 1 1 j 2 3 2 0 8 Malarial Fever — — — — — — — — — — — — — — — — — — — — — — — — — Rheumatic Fever — — 2 1 1 — —- — 1 — — — — — 5 — — 2 1 2 — — 1 4 5 Rheumatism of Heart. — 1 3 3 1 1 — 1 — I — — — — 1 9 1 — | 1 2 2 i 2 2 4 6 10 3 Tuberculosis of Brain . 6 1 1 4 3 3 — — 1 — — — 17 11 2 4 3 , 4 5 I 3 7 15 13 28 Tuberculosis of Larynx — — —- — — — — 1 _ — — 1 — — — 1 — — — 1 — 1 105 Phthisis 3 9 2 7 28 37 70 08 09 30 12 1 — 12 324 23 l 30 26 44 57 j 58 92 202 134 330 5 Abdominal Tuberculosis 1 5 — — — — 2 1 1 3 1 — — 6 8 1 _ 1 1 4 3 4 8 6 14 General Tuberculosis . — — 1 — — 1 — — 1 — — _ — 3 — 2 — — — 1 — 2 1 3 o Other forms Tuberculosis 1 1 — — 2 1 1 — — 7 — 1 1 2 1 2 6 1 7 Other Infective Diseases — — — — — — — — — — — — — — — — — — — — — — — — — Thrush — — — — — — — — — — — — — — — — — — — — — — — — — Actinomycosis — — — — — — — — — — — — — — — — — — — — — 1 1 1 Hydatid Diseases — — — — — — — — — — — — — — — — — — — — — — — — — Scurvy — — — — — — — — — — — — — — — — — — — — — — — — — Other Diseases due to — — — — — — — — — — — — — — — — — — — — — — — — Acute Alcoholism — — — — — — — — 1 — — — — — 1 — — — — — — 1 1 — 1 Chronic Alcoholism — — — — — — — — — — — — — — — — — — — — — — — — — Chronic Industrial Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — Other Chronic Poisonings — — — — — — — — — 1 — — — — 1 — — — — 1 — — 1 — 1 Osteoarthritis . — — — 1 — — 1 3 1 5 5 _ 10 2 2 2 5 2 3 7 9 16 Glut — — — — v v v — — 2 — — — — o — — — — — — — 3 — — — — v 1 ») O 3 134 Cancer — — — — 2 4 10 27 88 38 25 ' 08 9 1 471 49 42 45 55 94 : 08 119 204 268 472 Diabetes Mellitus — v _ — — — 2 2 5 ; 11 9 3 — 32 8 2 5 3 4 3 7 18 14 32 Purpura Hemorrhagica 1 — — — — — — — — — — — — 1 — — — — — 1 | — — — — Hemophilia — — — — — — — — — — — — — — — — — — — — — — — — Anemia 2 —. 1 2 2 3 2 — 12 2 . _ 1 3 — 2 4 1 0 0 12 Lymph adenoma _ 1 . 1 i i I I ] Premature Birth 84 — — — — — — — — — — — — 84 — 0 6 12 10 13 15 22 43 41 84 Injury at Birth 4 — — _ — — — — — — — — — 4 — — 1 j — — 2 1 — 1 2 2 4 Debility at Birth 10 — — — — — — — — — — — — 10 — — 1 1 2 1 1 4 7 3 10 Atelectasis 5 — — — — — — — — — — — — 5 — — 2 — — 1 1 1 3 2 5 Congenital Defects 50 2 — 52 — 3 6 4 7 8* 5 19 20 20 52 Want of Breast Milk .. — — — — — — — — — — — — — — — — — — — — — — — — — Atrophy, Debility, Marasmus 30 — — — — — — — — — — — —- 30 — 3 4 3 2 5 — 13 19 17 36 • cerebrospinal Fever (7). t Ophthalmia Neonatorum (1) ‡Leprosy (1). 55 [1923 Continued. []D###eaths in Institutions within Borough. 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. Dentition 2 1 — — — — — — — — — — — 3 — — — — 1 — — 2 1 2 3 Rickets 1 3 — — — — — — — — — — — 4 — — — 1 1 — 1 1 3 1 4 Old Age Senile Decay — — — — — — — — — i 31 140 160 — 232 1 4 34 21 23 51 39 50 91 141 2.2 Convulsions 10 1 — — — — — — — — — — — 11 3 — — 2 1 1 4 7 4 ".T Meningitis 3 8 — 2 — 1 4 1 I — — — — 11 9 2 3 2 2 1 7 3 9 1 | 20 Encephalitis — 1 — — 2 1 — 1 1 — 2 — — 2 0 — 1 2 1 1 — 3 2 0 8 Apoplexy 1 — — — 1 — 2 — 17 28 39 39 15 1 141 11 22 13 21 21 15 40 60 82 141 Softening of Brain — — 1 — — — — — — — 1 — — — 2 — — — — 1 — 1 1 1 2 Hemiplegia — — — 1 — — — 3 1 4 — — 9 2 I — 2 2 — 2 1 8 9 General Paralysis of the Insane — — — — — — 1 0 7 4 4 1 — — 23 — 4 3 5 2 5 4 15 8 3 Other forms of Insanity — — — — 1 — 1 — 3 1 1 4 1 — 12 1 3 1 3 2 1 1 3 9 12 Chorea — — — — — — — — — — — — — — — — — — — — — — — — — Cerebral Tumour — — — — — — 1 5 3 1 1 — — — 11 1 1 — — 1 3 4 0 5 ii Epilepsy — — — — 2 2 — 3 1 2 2 1 — — 14 2 2 — 3 1 5 1 0 8 14 Laryngismus Stridulus 2 — — — — — — — — — — — — 2 — — 1 — — — — 1 2 — 2 Locomotor Ataxy — — — — — — — — 1 2 6 — — — 9 — — 1 1 — 1 3 7 2 9 Paraplegia 1 — — — — — — 3 2 5 5 — — 1 15 2 1 3 2 2 2 4 7 9 10 Other forms, Drain Diseases §3 111 — — — — 13 2 !,3 || 2 11 — — 4 11 4 2 I 1 2 3 2 0 9 13 Otitis — 3 — 1 1 2 5 2 — — — 1 — 3 12 1 — 1 1 5 3 4 9 15 Disease of Nose, Epistaxis — — — — — — — 1 — — — — — — 1 — — — — — 1 — — 1 1 Diseases of Eye — — — — — — — — — — — — — — — — — — — — — — — — — 3 Pericarditis 1 — 1 — — 1 1 — 1 4 — _ — 1 8 — — — 1 4 1 3 5 4 9 2 Endocarditis — — — — — — 2 — 5 — 1 — — — 8 — 2 1 — — 1 3 5 3 8 Hypertrophy of Heart. — — — — — — — — — — — — — — — — — — — — — — — — Angina Pectoris — — — — — — — 1 5 4 2 — — 12 1 1 2 1 2 — 5 12 — 12 2 Aneurism — — — — — — — 1 3 9 2 — 1 — 10 3 2 — 3 4 3 1 10 0 10 T Senile Gangrene — — — — — — — — - 1 2 4 1 — 8 2 1 2 - 1 — 2 8 8 13 Embolism, Thrombosis — — — 1 — — 1 1 5 5 11 10 1 — 35 1 5 2 5 0 8 8 15 20 35 Phlebitis — — — — — — — — 1 1 1 — — — 3 — — — — — 1 2 1 2 3 Varicose veins — — — — — — — — — — — — — — — — — — — — — — — — — 199 Other Diseases, Heart and Vessels — 1 2 3 3 3 24 42 70 130 193 149 28 1 153 75 03 82 77 101 91 105 306 34S (15 1 Laryngitis — — — — — — — — — — — — — — — — — — — — — — — — — Croup — 1 — — — — — — — — — — 1 — — 1 — — — — — 1 — 1 Other Diseases, Larynx and Trachen — — — — — — — — — — — — — — — — — — — — — — — — — 1 o Acute Bronchitis 7 4 — — — — 2 3 8 13 14 22 7 11 09 5 9 11 11 12 15 17 32 48 8 1 38 Chronic Bronchitis 4 3 1 — — — 1 3 22 28 02 47 14 7 178 18 14 20 22 34 33 44 92 93 181 23 57 Lobar Pneumonia Lobular Pneumonia 3 52 7 20 3 4 1 3 1 4 4 11 7 14 14 17 12 15 21 0 14 2 2 10 78 75 80 7 12 3 1 1 8 12 13 19 18 20 10 42 20 42 49 79 30 79 83 158 2 Pneumonia 3 3 — — 1 1 1 4 8 7 5 0 0 33 4 1 2 4 9 7 12 20 19 3 ) <2 Emphysema, Asthma — — — — — — 1 3 2 2 3 3 — — 14 •2 — 5 — 2 2 3 8 0 I 1 3 Pleurisy — 1 — — 1 1 2 — 4 2 4 — — 1 14 3 1 1 — 2 2 0 10 5 15 5 Other Diseases, Respiratory System 1 1 — — 1 — 2 5 1 0 4 — — — 19 2 3 1 3 3 5 4 15 0 21 Diseases of Mouth and. Annexa 1 1 — — 2 — — 1 — — — — 2 3 — — — 2 3 — — 3 2 5 Diseases of Pharynx — — — — — — — 1 — — 1 — — 2 — 1 — — — 1 1 1 2 Diseases of (Esophagus — — — — — — — — — — 1 1 — — 2 1 — — — 1 — — 2 2 1 Ulcer of Stomach and Duodenum — 1 3 3 5 0 7 7 2 _ 34 2 3 2 I 7 10 9 28 0 34 Other Diseases of the Stomach 0 1 — 1 — — — , 2 5 — 4 — 7 13 3 5 1 5 3 1 2 13 7 20 39 Enteritis 01 7 — 1 1 1 1 \ 3 1 4 — 08 13 0 7 3 4 11 21 19 42 39 81 0 Appendicitis — ■* 7 3 1 4 2 2 1 4 3 — 4 27 5 1 o 5 7 7 17 14 31 Obstruction of Intestines 4 5 1 3 1 - 1 2 1 0 7 4 — 9 20 7 * 4 — 1 7 9 7 20 15 35 Other Diseases of Intestines 1 — — — — — — 2 1 — 3 — — 1 — 1 — — 4 1 1 — 4 3 7 3 Cirrhosis of Liver — — — — — — — 3 — 4 4 — — — 19 3 1 4 1 4 4 2 11 8 9 Other Diseases of Liver — — — — — — 1 — 2 1 1 1 — — — — 1 1 2 1 i 2 4 0 Peritonitis 1 — 1 — — 1 1 1 — — — _ i 4 — — — — — 3 2 2 3 5 Other Diseases, Digestive System 1 — — — — 1 — 1 2 — 2 — 1 i 8 — 3 — — 3 1 1 3 0 9 Diseases, Lymphatic System and Glands. — — — 1 1 — — 5 3 1 — — — — 11 — 2 3 4 1 1 7 4 1 2 Acute Nephritis 1 — — 1 — — — — 2 — — — — i 3 — — — 1 2 — 1 1 3 4 42 Bight's Disease — — — — 1 1 4 12 14 32 29 20 — — 113 14 13 9 10 13 19 29 04 49 1 13 Calculus — — — — — — 1 — — 2 — 3 — — 6 3 — 1 — — 1 1 2 4 0 1 Diseases of Bladder and Prostate — — — — — — 1 — 2 7 10 9 — — 29 1 1 3 5 4 0 9 26 3 29 Other Diseases, Urinary System — — — — — — — — — 1 — 4 — — — 1 — — 1 — 2 1 4 1 5 Diseases of Testis and Penis — — — — — — — — — — — — — — — — — — — — — — — — — Diseases of Ovaries — — — — — — — 1 — — — — — — 1 — — — — — — 1 — 1 1 1 Diseases of Uterus and Appendages . — — — — — — 1 — 1 — — 1 — — 3 1 — — — — — 2 — 3 3 Diseases of Vagina and External Genitals. — — — — — — — — — — — — — — — — — — — — — — — — — Diseases of Breast — — — — — — — — — — — — — — — — — — — — — — — — — Aborts Miscarriage. — — — — — — 1 — — — — — — 1 — — — — — 1 — 1 1 Puerperal Mania — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Convulsion — — — — — — — — — — — — — — — — — — — — — — — — Placenta Previa, Flooding— - - - — 2 2 4 1 1 1 - • - 4 4 § Acute Polio-encephalitis (1). || Encephalitis Lethargica (5). þ 1 Female 101 years. 192.1] 56 Continued. [###[Deaths In Institution within Borough. DISEASES. AGES. Under 5 Over 5 DISTRICTS. Vales. Females. Totals. Tut. U.H. Toll. L.H. H. B. S.E 0- 1- 5- 10- 15- 20- 25- 35 ! 45 55 65 75 85 Puerperal Thrombosis. — — — — — — — — — — — — — — — — — — — — — — — — — Other Diseases Pregnancy and, Childbirth — — — — — — — — — — — — — — 1 — — — — — — — — 1 — Arthritis, Ostitis, Periostitis — — — — — — _ _ _ — — — — — — — — — — — — — — Other Diseases, Osseous System 2 2 _ 1 1 1 1 2 6 1 2 3 1 5 3 8 ulcer, Bedsore — — — — — — — — — — — — — — — — — — — — — — — _ Eczema Pemphigus 3 — — — — — — — — 1 — — 3 1 — — — 2 1 — 1 2 2 4 Other Diseases, ary System 1 — 1 2 _ 1 3 — – I 1 1 — 3 4 Accidents and Negligence. — — — — — — — — — — — — — — — — — — — — — — — — — In vines and Quarries. — — — — — — — — — — — — — — — — — — — — — — — — — 7 In Vehicular Traffic — 3 7 2 3 — 3 2 1 2 7 1 — 3 28 4 1 4 G 3 G 7 18 13 31 On Railways — — — — — — — — 1 2 — — — 3 — — 1 1 1 2 1 3 On Ships, Boats, etc. (not drowning) — — — — .— — — — — — — — — — — — — — — — In BuiI–ling Operations — — — — — — — 1 1 — 2 — — — 4 1 — — — 2 4 — 4 By Machinery . — — — 1 — — — — — 1 — — — — 2 — — — — — 1 1 2 — 2 By Weapons and plements _— — — — — _ — — — — — — — — — — — — — — 5 Burns and Scalds 2 7 1 — — — — — — 1 — 9 2 — 3 3 2 1 7 1 7 4 11 1 Poisons, Poisonous Vapours — — — — — — — 1 1 — — — — 2 — — 1 — — — 1 1 1 — Surgical Narcosis — — — — — — 1 - 1 — — — — 2 — — — — — 2 1 1 2 Effects of Electric Shock — — — — — 1 — — — — — — 1 — — — — — 1 — 1 — 1 Corrosions by Chemi cals — — — — — — _ — — _ — — — — — — — — — — — — — — — Drowning — — 1 — 1 — 2 — — 1 — — — — 5 — 1 — — 2 2 4 1 5 Suffocation, Overlaid in Bed 4 — — — — _ 1 _ _ — — 4 1 1 — 1 _ 1 2 5 — 5 Suffocation, Otherwise 6 — — — — — — 1 — — — . 1 — 6 2 1 — 2 — 2 2 1 G 2 8 11 Falls, not specified 2 1 — 1 — — — 1 4 2 6 3 1 3 18 1 1 5 2 3 1 8 15 6 21 I Weather Agencies — 1 — — — — — — 1 1 1 1 — 1 4 1 — — — — 3 1 3 2 5 2 Otherwise, not stated — — 2 — — — — 2 1 — — — — — 5 1 — — 1 2 1 2 3 5 Homicide Suicide. 3 — — 2 1 2 — — — — — — — 3 5 — 1 2 I 1 — 3 3 5 8 1 By Poison — — — — 1 — 2 3 6 3 2 — — — '7 — 2 2 — 4 5 4 12 5 17 By Asphyxia — — — — — — — — — — — — — — — — — — — — — — — — — By Hanging and Strangulation _ __ 1 2 1 4 1 _ — 2 1 2 2 4 By Drowning — — — — — 2 — — 1 — 2 — _— — 5 — — — _ 1 2 2 4 1 5 By Shooting — — — — — — - 1 1 — — — — I — — 1 _ 1 By Cut or Stab — — — — — — — 3 — 1 — — — — 4 — 1 1 — 1 1 — 4 _ 4 1 By Precipitation from Elevated Places — — — — — — — — — — — — — — — — — — — — — 1 1 1 2 By Crushing — — — — — — — — 2 1 1 — — — 4 — 2 1 1 — — — 3 1 4 By other and unspecified methods. _ — — — 1 _ _ — 1 — — 1 — — — — — 1 1 Execution — — — — — — — — — — — — — — — — — — — — — — — — — Sudden Death, cause not ascertained — — — — — — — — — — — — — — — — — — — — — — — — — Ill-defined and unspecified causes: — — — — — — — — — — 1 — — — 1 — 1 — — — — — 1 — 1 Males 1 255 99 26 26 34 32 102 *6) 270 351 345 235 43 354 1624 — 181 181 190 251 320 346 509 — 1978 _ Females 218 87 32 24 38 43 95 119 191 242 364 367 104 305 1619 178 205 202 242 325 300 472 — — 1924 809 TOTAL DEATHS 473 86 58 so 72 75 197 279 161 593 709 602 147 659 3243 359 386 392 493 645 646 981 1978 1924 3902 57 1923 Metropolitan Borough of Islingion. CAUSES OF, AND AGES AT DEATH DURING THE CALENDAR YEAR, 1923. 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 whether of "Rewdents"or" Non- residents " in institutions in the District 1 2 3 4 5 6 7 8 9 10 11 All Causes Certified 3685 475 94 93 101 142 457 1034 1469 1393 Uncertified Nil — — — — — — — — — Enteric Fever — — — — — — — — — — Small Pox — — — — — — — — Measles 18 2 8 7 1 — — — — 5 Scarlet Fever 13 — 1 7 4 — — 1 — 1 Whooping Congh 38 22 8 8 — — — — 8 Diptheria and Cramp 22 2 6 8 5 — — — 1 4 Influenza 58 2 1 2 2 — 10 18 23 14 Erysipelas 6 2 1 1 — — — 1 1 1 Phthisis (Pulmonary Tuberculosis) 326 3 4 5 8 64 130 99 13 167 Tuberculous Meningitis 28 6 5 6 7 3 — 1 — 4 Other Tuberculous Diseases 23 1 3 2 2 1 3 7 4 10 Cancer, malignant disease 471 — — 1 — 5 38 222 205 221 Rheumatic Fever 5 — — — 3 1 — 1 — — Meningitis 24 *7 3 *6 *2 *2 4 — — 5 Organic Heart Disease 636 — — 1 7 6 56 208 358 271 Bronchitis . 260 12 4 3 1 — 9 67 164 126 Pneumonia (all forms) 282 58 23 14 7 6 30 72 72 121 Other diseases of respiratory organs 51 1 2 — 3 13 18 14 14 "Diarrhœa and enteritis 117 95 8 1 1 1 3 4 4 70 Appendicitis and Typhlitis 31 1 3 10 5 5 4 3 11 Cirrhosis of Liver 17 _ — — 5 9 3 6 Alcoholism __ Nephritis and Bright's Disease 117 1 _ 1 2 23 41 49 72 Puerperal fever 9 — — — — 3 6 — — 6 Other accidents and diseases of Pregnancy and Parturition 8 — 1 — — 1 6 1 2 Congenital Debility and Malformation, including Premature Birth 182 180 2 — — — — — — 15 Violent Deaths, excluding Suicide 108 16 4 7 15 6 12 22 26 51 Suicide 32 — — — — 3 10 14 5 7 Other Defined Diseases .. 983 § 65 12 †9 25 30 f94 †224 †524 181 Diseases ill-defined or unknown — — — — — - — — — — Totals 3865 475 94 93 101 142 457 1034 1469 1393 Sub-entries.—Included in above figures : •Cerebro-spinal Meningitis 7 *4 — *1 *1 *1 __ 3 !! Polio-Encephalitis †Encephalitis Lethargica 1 4 †1 — †1 † 1 — †1 — § Ophthalmia Neonatorum 1 §1 — 1 — 1 — — — 58 1923] LONDON COUNTY COUNCIL RETURN. Borough of Islington. PROCEEDINGS DURING 1923. Premises. Number of Places. Number of Inspections 1923 Number of Notices 1923 Number of Prosecutions 1923 On Register at end of 1922 added in 1923 Removed in 1923 On Register at end of 1923 Milk Premises 623 25 18 630 823 42 Nil Cowsheds 4 — — 4 35 — — Slaughter — Houses 18 — 1 17 907 — — Other Offensive Trade Premises 7 – – 7 52 — — Ice Cream Premises 242 – – 242 83 22 — Registered Houses Let in Lodgings 1,012 — — 1,012 8,710 614 5 Total number of intimation notices served for all purposes 4,298 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 122 Housing of the Working Classes— Number of houses inspected 3,952 Number of representations by householders Nil Number of representations by Medical Officer 1 Number of houses included in such representations 192 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 Nil Number of houses included in such Closing Orders Nil Number of Closing Orders determined Nil Number of houses demolished—(a) in pursuance of Orders Nil (b) voluntarily Nil Ol 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 Nil 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) Nil (b) In course of erection (Flats) Nil Number of houses occupied by the working classes about 27,000 59 [1923 Smoke nuisances— Number of observations 215 Number of warnings (letters sent) 32 Number of notices 18 Number of nuisances and complaints 32 Number of summonses 2 Underground Rooms— Number illegally occupied 6 Number closed or illegal occupation discontinued 6 Overcrowding— Number of rooms overcrowded 17 Number remedied 17 Prosecutions Nil Cleansing— Number of adults cleansed 24 Number of children cleansed 4.886 Cleansing— Number of rooms or premises cleansed 4 693 Water supply to tenement houses— Premises supplied 58 Prosecutions Nil Sale of Food — Number of premises used other than ice cream premises, milk shops and cowsheds 632 Number of inspections 17.655 Ophthalmia Neonatorum regulations— Number of Notifications received during the year from certified midwives 5 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 3 Revenue Acts— Number of houses for which applications were received during year 4 Number of tenements comprised therein 32 Number of tenements for which certificates were (a) granted 8 (b) refused— (c) deferred 24 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 1923] 60 (c) For the prevention of keeping of animals in such a manner as to be injurious to health Nil (d) As to paving of yards, etc., of dwelling houses Nil (e) In connection with the removal of offensive matter, etc. Nil (f) As to cesspools and piivies, removal and disposal of refuse, etc Nil (g) For securing the cleanliness of tanks, cisterns, etc. Nil (h) With respect to water closets, earth closets, etc Nil (i) With respect to sufficiency of water supply to water closets Nil (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) 1 (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 rowers) Act, 1907— (/) With respect to water supply to tenement houses Nil Mortuaries— Total number of bodies removed 288 Total number of infectious bodies removed Nil 61 INDEX. page Accidental Deaths 14-20 Acreage 2 Adulteration of Food 46,51 Ages at Death 6 Area 2 Bacteriological Examinations 31 Births 3 „ Illegitimate 4 „ Notification of 4 Stillborn 4 Cancer 17 Chicken Pox 30 Cleansing of Verminous School Children 34 Coal gas Poisoning 20 Colouring matter in Milk 46 Contamination by dust 43 Cow Sheds 44 Deaths from all causes during the year 4,54 Deaths from Epidemic Diseases 15 „ „ Respiratory Diseases 19 ,, „ in Public Institutions 14 „ „ Classified Causes 5 Density 2 Diseases Treated in Hospital 23 Disinfectants distributed and used 34 Disinfecting Station 33 Disinfection Work 32 Dispensing of Prescriptions 47 District Inspectors' Work 37 Drug 43, 51 Dust, removal of 38 Dysentery 26 Education Propaganda 8 Encephalitis Lethargica 26 Epidemic Diseases 15 „ Cerebro-Spinal Meningitis 25 Erysipelas 17 Factories and Workshops Administration 35 Fatality from Notifiable Infectious Diseases 23 Food, Adulteration of, Inspection of. Unsound 42, 46, 51 Gas (Coal) Poisoning 20 62 Page Health Visitation 11, 12 Health Week 1-8 Hospital Isolation of Infectious Diseases 23 Housing 41, 58 Houses Let in Lodgings 40 Infantile Mortality 6-8 Infant Welfare Work 8 Infection, Prevention of 21 Infectious Diseases in Schools 30 „ „ (Non-Notifiabie) in Schools 30 Influenza 16 Inspection of Food 42 ,, „ Houses 38, 39, 41 „ „ Kitchens of Restaurants 44 „ „ Slaughter Houses and Cow Houses 42-44 „ „ Workshops 35 Inexperience of Small Shopkeepers—Warnings 46 Institutions 14 Inquests 21 Isolation of Infectious Diseases 23 London County Council Return of Sanitary Work 58 Malaria26 Malignant Diseases17-18 Marriages3 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work. 8 Measles, Notifications by School Teachers 30 Meat Inspection 42 Ministry of Health Returns 8,57 Milk Scheme 10 Milk Adulteration 49 „ Shops and Dairies 45 „ and Cream Regulations 45 Mortuary and Coroner's Court 21 Notification of Infectious Diseases 21 „ „ Tuberculosis 26 „ „ Births Act 4 Non-notifiable Infectious Diseases in Schools 30 Offensive Trades 44 Ophthalmia Neonatorum 9, 26 Outworkers' Premises 37 Other Notifiable Diseases 25 Pauperism 42 Pathogenicity Te3ts (Diphtheria) 31 Phthisis 18,27 „ Notification of 27 Places where Food is Prepared 44 Pneumonia 20, 26 Population at the Census, 1921 2 Population, estimated, 1923 2 Prescriptions, Dispensing of 47 63 Page Preservatives 1,45,46 Prevention of Infection 21 Prosecutions, Summary of 51 Public Health Committee ii „ ,, Milk and Cream Regulations 45 Puerperal Diseases 10, 17 Polio-Myelitis, Acute 25 Pulmonary Phthisis 23 Rats and Mice (Destruction) Act, 1919 1, 40 Rateable Value iii Respiratory Diseases 19 „ Tuberculosis 18, 26 Restaurant Kitchens 35, 44 Samples Analysed in 1923 46-51 Sanitary Inspectors' Work 37-40 Schools 38 Septic Diseases 17 Shelter House 34 Slaughterhouses 42 Smoke Nuisances 1,38 Statistics 54,60 Street Accidents 20 Tuberculous Diseases I8, 26 Tuberculosis Dispensaries 29 „ Notification of 28 „ Deaths from 18 „ (Public Health) Regulations, 1912 28 Unsound Food 1, 42 Vaccination 31 Venereal Diseases 20 Verminous Children, Cleansing of 34 „ Premises 38 Voluntary Maternity and Child Welfare Centres 11, 13 Workshops and Factories, Inspection of 35 Welfare Work by Health Visitors 11