1927 SEVENTY-SECOND ANNUAL REPORT on the Health and 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: Vail & Co., Printers, 170, Farringdon Road, E.C. 1. 1927 SEVENTY-SECOND ANNUAL REPORT ON THE Health and 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: Vail & Co., Printers, 170, Farringdon Road, E.C. 1. II MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1927, to November, 1928.) Mayor. Councillor WALTER FREDERICK NOKES, J.P. Aldermen. HERBERT SAMUEL JORDAN EDWARD HENRY TOMKINS, J.P. Councilhrs. LESLIE BOYNE WILLIAM J. MITCHELL CHARLES BUNDOCK HENRY PENN FREDERICK COPPING WILLIAM T. RICKETTS LUCY ELLIOTT HARRY I. ROLF GEORGE L. W. FRANKS FRANK L. SARGENT WILLIAM H. GALE WILLIAM T. SMITH WALTER HARPER HERBERT TICE LEONARD McCLANE Chairman Councillor JORDAN Vice-Chairman Councillor SMITH MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1927, to November, 1928.) Councilhrs. PHILIP R. BEECH SARAH JOHNSON CHARLES BUNDOCK Mrs. MANCHESTER LUCY ELLIOTT WILLIAM J. MITCHELL EDWARD FITZGERALD Mrs PANNELL WILLIAM H. GALE ALBERT E. PETTET ALBERT H. JACKSON GEORGE RUST GEORGE P. JARRETT Mrs. M. SOUTHGATE, J.P. HENRY JOHNSON GRACE WATSON Members appointed by the Council from outside their own body. Lady ANDREWS, "Windy Gap," Merton Lane, Highgate, N.6 Dr. ALICE VANCE KNOX. 15, South Grove, Highgate, N.6 Dr. ELEANOR PULLEINE, 5. Hamilton Terrace, N.W. 8. Mrs. WATT, 60, Highbury New Park, N.5 Chairman Councillor Mrs. M SOUTHGATE, J.P. Vice-Chairman Councillor Mrs. M. A. MANCHESTER. III SUMMARY of Vital Statistics in the Registration Year 1927. Population (Enumerated at Census, 1921) 330,737 persons „ Estimated Mid Year 1927 334,300 persons Increase on Census population, 1921 3,563 persons Mean Population, ten years (1917-1926) 326,174 persons Area 3,092 acres Density (Mid-year 1927) 108 persons per acre Males 3,104 ) Births Females 3,004 Persons 6'108 Birth rate 18.3 per 1,000 inhabitants Males 2,102 Deaths from A11 Causes Females 2,022 Persons 4,124 Death rate 12.3 per 1,000 inhabitants Males 68 Deaths from Principal Epidemic Diseases Females 58 126 persons Death rate 0.38 per 1,000 inhabitants Males 205 Deaths from All Tuberculosis Females 143 348 Persons Death rate 1.04 per 1,000 inhabitants Males 187 ) . Deaths from Respiratory Tuberculosis Females 127 314 persons Death rate 0.94 per 1,000 inhabitants Males 195 Infantile deaths under 1 year Females 129 Total 324 Infantile mortality rate 53 per 1,000 births Excess of Births over Deaths 1,984 Rateable value of Borough of Islington £2,130,819 Sum represented by a penny rate £8,880 IV Public Health Department, Municipal Buildings, Upper Street, N.1. Mr Mayor, Ladies and Gentlemen. I have the honour to submit the Report on the Health and Sanitary Condition of the Borough for the year 1927. The death-rate for 1927 was 12.3 per 1,000 of the inhabitants, as against 12.0 in the previous year, which however, was the lowest recorded since 1923; the figure being in that year 11.6. The rate of 12.3 must, therefore, be considered with satisfaction as being a continuation of the low rates obtained. The infantile mortality rate this year is exceptional. The rate is 53 per 1,000 births; it is the lowest on record, and 24 per 1,000 births below the mean annual record of the preceding ten years. As compared with the previous year it is 13 less. In the Report this year an effort has been made to facilitate reference by giving in addition to the index a reference to legal proceedings and matters specialy dealt with in previous reports, as well as to such Tables as were deleted in order to save space for new matter. I am Your obedient Servant, Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1927. 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 and Baby Week.—Opportunity was taken of this special educational propaganda to distribute a leaflet setting forth the various activities of the Public Health Department and the Welfare Centres. See pages 10, 17-20. 2. Infectious Diseases. Page 29.—(a) Occurrencc of Dysentery, page 34. (b) Occurrence of Anthrax, page 85. (c) " Bacteriological" Diphtheria, p. 43. 3. Meat, Food and Drugs.—(a) The Labelling of meat and eggs (Food. Order 1921) page 61. (b) Unsound Chocolate page 60. (c) Tinned Food of doubtful quality, page 60. (d) Sophistication of Milk, page 66. (e) Laboratory, page 65 (/) Restaurant Kitchens, page 61. 4. Workshops, etc., page 48. 5. Cleansing of Persons, page 47. Baths and Washhouses page 47. Gas heaters, page 27. 6. Health Visitation and work of Voluntary Centres, Artificial Sunlight, etc., pages 15-21, 40. 7. Legal Proceedings, pages 69, 77-81 . Recent Legislation, page 52. 8. Index to Report, page 85. 2 1927] POPULATION. The population of the Borough at mid-year 1927 is estimated at 334,300, and when compared with the number of inhabitants of the previous year there is a total decrease of 4,900 persons. The following tables give the distribution of the population 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 year 1927, also the Populations at the Census 1921. Sub-Districts. Area. Acres. Estimated Acres to a person. Estimated Persons to an Acre. 1927 Estimated Population Mid-year 1927. Enumerated Population at Census 1921. Tufnell 411 0.0121 82 33,820 33,750 Upper Holloway 299 0.0094 106 31,720 35,721 Tollington 315 0.0102 98 30,943 30,832 Lower Holloway 406 0.0098 102 41,522 40,139 Highbury 749 0.0123 81 60,810 58,850 Barnsbury 316 0.0057 175 55,185 53,859 South East Islington 596 0.0077 135 80,300 77,586 The Borough 3,092 0.0092 108 334,300 330,737 Showing the Areas Densities and Estimated Populations <f the Wards at the Middle of the year 1927, also the Populations at the Census 1921. WARDS. Area in Acres. Estimated Persons to an Acre or Density of Population. Estimated Population Mid-year, 1927. Enumerated Population Census, 1921 No. 1—Tufnell 411 82 33,820 33,750 2—Upper Holloway 299 106 31,720 35,721 3—Tollington 315 98 30,943 30,832 4—Lower Holloway 406 102 41,522 40,139 5—Highbury 417 77 31,970 33,417 6—Mildmay 332 87 28,840 25,433 7—Thornhil 178 170 30,299 31,301 8—Barnsbury 138 180 24,886 22,558 9—St. Mary's 150 122 18,254 17,363 10—Canonbury 290 111 32,245 29,997 11—St. Peter's 156 191 29,801 30,226 The Borough 3,092 108 334,300 330,737 Showing the Estimated Number of Persons living in Islington at the Mid-year 1927, at Nine Age Periods, and distinguishing Males and Females. Ages. Males. Females. Persons. 0—5 14,710 14,372 29,082 5—15 30,754 30,081 60,835 15—25 25,740 31,425 57,165 25—35 24,738 30,086 54,824 35—45 21,394 25,752 47,146 45—55 18,721 20,396 39,117 55—65 12,035 13,705 25,740 65—75 6,352 8,356 14,708 75 and upwards 2,006 3,677 5,683 All ages 156,450 177,850 334,300 3 1927 MARRIAGES. Marriages, 2,844; Marriage Rate, 17.0.—The number of person married was 5,688, as contrasted with 5,498 in the preceding year, which is an increase of 190. The marriage rate was 17.0 per thousand inhabitants, as compared with 16.2 in 1926. The following statement shows the figures for the previous ten years 1917-26. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 1917 2,689 16.23 1922 2,877 17.23 1918 2,971 18.51 1923 2,764 16.42 1919 3,306 19.28 1924 2,872 17.03 1920 3,370 20.05 1925 2,788 16.44 1921 3,141 18.86 1926 2,749 16.21 BIRTHS. During the year there was 6,108 live births registered, of which' 3,104 were boys and 3,004 girls. Of this number, however, 1,779 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 18.3 per 1,000 of the population, as compared with a meant birth-rate of 20.6 im the preceding ten years. There has been a steady decline in the birth-rate since the year 19120, when it was 27.9. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1927, 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 1926 ; together with the mean Borough Birth-rates for the 10 years 1917-1926. Birth Rates. Quarter. Males. Females. Total. Islington, 1927. Islington, 1917-26. London, 1927. 107 Great Towns, 1927. First 812 776 1,588 19.0 21.4 17.2 18.0 Second 790 782 1,572 18.8 21.1 17.4 18.2 Third 798 756 1,554 18.6 20.2 16.4 17.2 Fourth 704 690 1,394 16.7 19.9 15.2 16.1 The Year 1927 3,104 3,004 *6,108 18.3 20.6 16.1 17.1 1926 3,283 3,172 6,455 19.0 18.3 17.1 18.2 Increase or decrease — 179 — 168 — 347 1 — 0.7 — 2.3 — 1.0 — 1.1 * These include 1,779 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, 1927, will be found at the foot of table on p. 9. Showing the Births of Malts and Females and the Birth-rates in each quarter and for the year, 1927, 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 73 65 138 16.3 110 116 226 28.5 67 66 133 17.2 99 82 181 17.4 2nd 72 78 150 17.7 107 93 200 25.2 63 64 127 16.4 87 92 179 17.2 3rd 67 63 130 15.4 122 93 215 27.1 54 59 113 14.6 81 82 163 15.7 4th „ 50 53 103 12.2 101 104 205 25.8 56 64 120 15.5 82 84 166 16.0 Year 262 259 521 15.4 440 406 846 26.7 240 253 493 15.9 349 340 689 16.6 4 1927] Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1927, and in the several Sub-Registration Districts.—ccntd. 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. Birtl rates. 1st Quarter 132 130 262 17.2 139 122 261 18.9 192 195 387 19.3 812 776 1,588 19.6 2nd ,, 138 123 261 17.2 161 125 286 20.7 162 207 369 18.4 790 782 1,572 18.8 3rd „ 133 147 280 18.4 156 138 294 21.3 185 174 359 17.9 798 756 1,554 18.6 4th „ 110 111 221 14.5 128 115 243 17.6 177 169 336 16.7 704 690 1,394 16.7 Year 513 511 1,024 16.8 584 500 1,084 19.6 716 735 1,451 181 3,104 3,004 6,108 18.3 Illegitimate Births (182).— The illegitimate births numbered 182 and show a decrease of 26 on the return of the year 1926. They were equal to a rate of 3.0 pet 100 registered births. Notification of Births Act, 1907 . 4,552 live births were notified (exclusive of 140 stillborn), or 74 per cent. of the total number that was registered during the year. Notified by: Doctors. Midwives. Parents and other Persons. Total. Alive. Still born. Alive. Still born. Alive. Still born. Alive. Still born. 1927. 1st Quarter 212 10 659 19 300 8 1,171 37 2nd „ 170 9 711 9 303 5 1,184 23 3rd „ 229 10 629 18 248 5 1,106 33 4th „ 197 5 626 17 268 7 1,091 29 Year 808 34 2,625 63 1,119 25 4,552 122† Still-Births (Registration). The registration of still-births came into operation on the 1st July, 1927, under the "Births and Deaths Registration Act, 1926." The definition of "stillbirth" for this purpose in section 12 of the Act is as follows:— (i) "'Still-born' and 'Still-birth' shall apply to any child which has issued forth from its mother after the twenty-eighth week of pregnancy and which did not at any time after being completely expelled from its mother, breathe or show any other signs of life." (ii) For the purposes of the Births and Deaths Registration Acts a child which, whatever the period of pregnancy, breathes or shows any other signs of life after complete expulsion from the mother, is a live-born child; and if it dies even within a brief period only after birth, both the birth and the death must be registered by the Registrar of Births and Deaths. (iii) A "still-born" child may not be buried in a burial ground until a certificate of the registration of the still-birth has been obtained from the Registrar of Births and Deaths and delivered to the person having control over the burial ground. In certain circumstances a certificate (which will serve the same purpose) can be obtained from the Registrar that he has received notice of the still-birth. † vide p. 5. 5 1927] (iv) Section 7 of the Act requires that when a still-birth is registered, the relatives giving information must either (i) deliver to the Registrar of Births and Deaths a written certificate that the child was not born alive, signed by a registered medical practitioner or certified midwife who was in attendance at the birth or who has examined the body of the child; or (ii) make a declaration in the prescribed form to the effect that no registered medical practitioner was present at the birth or has examined the body, or that his or her certificate cannot be obtained, and that the child was not born alive. (v.) In a case where neither a registered medical practitioner nor a certified midwife has been in attendance or present at the birth, or where his or her certificate cannot be obtained, and it is brought to the notice of the Local Authority by the Registrar, the Medical Officer of Health is required to have inquiries made by a Health Visitor and to inform the Registrar whether he is satisfied that the child was really still-born, or whether there are any suspicious circumstances attaching to the case. REGISTERED STILL-BIRTHS.* Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births. 1927. 3rd Quarter 37 8 1 46 28.0 4th 17 13 - 30 21.0 Total—six months 54 21 1 †76 25.0 *Registration came in force on 1st July, 1927. † Of the total number (76) registered still-births, 18 were not notified under the Notification of Births Act, 1907; therefore, the total still-births coming to the knowledge of the Medical Officer of Health during the year was 140, (i.e. 122 + 18) or 22.4 per 1,000 total births (including still born). DEATHS. The deaths registered during the year numbered 4,124 (exclusive of stillbirths), while the death-rate was equal to 12.3 per 1,000 of the estimated population, or 0.3 above that of the previous year (12.0), and compares favourably with the death-rate of England and Wales (12.3) and the 107 Great Towns (12.2). A noteworthy feature of the death-rate is that it has been continually falling since 1918, when the rate was 20.4. 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 150 17.7 80 9.5 76 8.9 104 12.3 410 12.1 Upper Holloway 149 18.8 72 9.1 93 11.7 107 13.5 421 13.3 Tollington 148 19.1 81 10.5 63 8.1 87 11.2 379 12.2 Lower Holloway 163 15.7 102 9.8 76 7.3 119 11.5 460 11.1 Highbury 241 15.8 150 9.9 141 9.3 194 12.8 726 11.9 Barnsbury 240 17.4 145 10.5 118 8.5 210 15.2 713 12 9 Islington (SouthEast) 362 18.0 216 10.8 174 8.7 263 13.1 1,015 12.6 The Borough 1,453 18.3 846 10.1 741 8.9 1,084 13.0 4,124 12.3 6 Showing the Deaths and Death Rates of Islington in 1927, and. in the four quarters of the year, and of the County of London and the Great Towns during the same period, the mean Borough Death Rates for the 10 years 1917-26 and the deaths and death-rates in the year 1926. Death Rates. Quarter. Males. Females. Total. Islington, 1927. Islington, 1917-26. London, 1927. 107 Great Towns. 1927. First 697 756 1,453 18.3 17.5 16.8 17.4 Second 452 394 846 10.1 12.2 10.0 10.7 Third 399 342 741 8.9 10.3 8.7 9.2 Fourth 554 530 1,084 13.0 15.0 11.7 11.9 The Year 1927 2,102 2,022 4,124 12.3 13.8 11.9 12.2 1926 2,065 2,025 4,090 12.0 12.3 11.6 11.6 Increase or Decrease + 37 — 3 + 34 + 0 3 + 1.5 + 0.3 + 0.6 Causes of Death (Classified).—The following table shows the deaths arranged in classes of Disease from All Causes during the ten years 1917-26 and in 1927. Classified Causes of Death. Years. Mean 10 Difference. 1917,1918 1919 1920 1921 1922 1923 1924 1925 1926 Yrs. 1927 I. Specific or Febrile Causes 391 1361 579 552 464 639 273 391 286 285 522 355 - 167 1. Miasmatic Diseases 293 1258 466 437 301 546 155 316 191 204 417 266 - 151 2. Diarrhoeal ,, 56 51 36 28 85 29 40 20 15 29 39 19 - 20 3. Malarial „ - 2 2 2 - - — — — — — — - - 4. Zoogenous „ 2 — 1 2 1 — — 2 3 — 1 — - 1 5. Venereal „ 15 15 13 13 17 17 20 9 8 5 13 12 - 1 6. Septic ,, 25 35 61 70 60 47 58 44 69 47 52 58 + 6 II. Parasitic Diseases 1 — 1 1 - 3 1 2 1 1 1 - - 1 III. Dietetic 3 4 2 2 4 7 2 3 3 2 3 4 + 1 IV. Constitutional Diseases 1114 1101 973 918 985 935 945 945 1054 882 985 878 - 107 V. Developmental 486 520 657 556 486 477 377 396 404 467 483 289 - 194 VI. Local 2344 2596 2177 2172 2203 2362 2106 2290 2211 2255 2272 2415 + 143 1. Diseases of Nervous System 351 330 322 341 345 330 294 290 291 307 320 213 — 107 2. „ Organs of Special Sense 14 10 11 20 13 9 16 14 10 16 13 16 + 3 3. ,, Circulatory System 681 691 654 592 651 734 745 822 740 802 711 929 + 218 4. ,, Respiratory „ 887 1156 770 822 717 903 598 797 756 709 812 835 + 23 5. „ Digestive ,, 243 246 215 224 260 204 259 192 225 223 229 203 - 26 6. ,, Lymphatic ,, 9 3 11 10 14 11 11 8 7 19 10 10 - 7. „ Urinary ,, 130 137 151 129 168 134 157 136 142 142 144 179 + 35 8. ,, Reproductive ,, 18 8 17 20 13 20 10 15 20 19 16 19 + 3 a ,, Orgs, of Generation 12 2 7 7 8 5 4 6 10 3 5 7 + 2 b ,, of Parturition 6 6 10 13 5 15 6 9 10 16 11 12 + 1 9. ,, Bones and Joints 5 9 12 5 3 8 8 10 10 11 8 8 - 10. „ Integumentary System 6 6 14 9 19 9 8 6 10 7 9 3 - 6 VII. Violence 159 156 162 179 142 137 151 156 169 169 158 168 + 10 1. Accident or Negligence 122 115 132 140 99 94 105 115 124 124 117 136 + 19 2. Homicide 1 3 2 2 3 3 8 2 2 3 3 — — 3 3. Suicide 11 27 28 37 40 39 38 39 42 42 34 32 — 2 4. Execution - - - - - 1 — — 1 — — — - 5. By Bombs (Enemy Aircraft) 25 11 - - - - - - - — 4 — — 4 VIII. Ill-Defined Causes 102 103 89 95 84 54 47 39 32 29 67 15 — 52 All Causes 4600 5841 4640 4475 4368 4614 3902 4222 4160 4090 4491 4124 — 367 7 1927] 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, 1927. Mean Deaths (10 years, 1917-26.) Increase or Decrease on mean. 0-1 year 324 532 — 208 1-5 years 202 330 — 128 Under 5 years 526 862 — 336 5-15 years 104 154 — 50 15-25 „ 149 186 - 37 25-35 „ 190 249 — 59 35 45 „ 281 320 — 39 45-55 „ 488 487 + 1 55-65 „ 646 634 + 12 65-75 ,, 830 806 + 24 75 85 „ 704 623 + 81 85 upwards 206 170 + 36 All Ages. 4,124 4,491 — 367 From the foregoing summary it, will be seen that the decrease in the number of deaths under 5 years of age is very marked when compared with the average deaths at those ages during the preceding ten years. There was also a decrease in the number of registered deaths at the several age periods up to, between 35-45 years, after which there was an increase. Whilst, however, it would appear that the death-rate of the aged people of Islington is increasing, the records for the past year disclose the fact that 1,740 deaths occurred between the age period 65 years and upwards; but a number of these old people attained ages of unusual longevity, as instanced by two females, whose ages were given as 100 and 101 years respectively. It may also be of interest to record that during the second week of December, 1927, the actual ages at death of the following eight persons averaged 93 years:— Sex. Age. Where Died. F 100 years At Home. M 97 „ „ F 97 ,, Islington Institution. F 94 „ „ F 92 „ „ F 89 „ „ F 87 „ „ F 86 ,, „ Total Ages 742 Years. Average 93 years. INFANTILE MORTALITY. Infant Deaths, 324; Mortality Rate, 53.—The deaths of 321 infants under twelve months old were registered during the year, or 208 below the decennial average (532), and they were equal to the low infant mortality rate of 53 per 1,000 births. This rate is the lowest on record and 24 per 1,000 births below the mean annual record of the preceding ten years, and is 13 per 1,000 below the rate of last year (1926). 8 1927] In the quarters the mortality ranged from 75 per 1,000 births in the first quarter, 53 in the second, 29 in the third, and 54 in the fourth. Ire the sub-registration districts the infant mortality was as follows:— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 27 52 Upper Holloway 26 31 Tollington 31 63 Lower Holloway 51 74 Highbury 53 52 Barnsbury 64 59 Islington South East 72 49 In London the infantile mortality was 59 per 1,000 births, while in the six boroughs encircling Islington it was 62. The rate for England and Wales was 69 per 1,000 births. Infantile Mortality during each of the Ten Years 1917-26 and 1927. Deaths at various ages under One Year of Age. Weeks. Months. Total Years. Under one week. 1-2 2-3 3-4 Total under four weeks. 4 weeks and under 3 mths. 3-6 6-9 9-12 Deaths under one year. Deaths per 1,000 Births. 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 1923 128 35 20 11 194 72 104 54 49 473 66 1924 110 33 23 21 187 59 61 64 76 447 66 1925 105 25 20 20 170 70 72 58 44 414 63 1926 98 19 16 10 143 63 96 56 69 427 66 Mean 10 years 121 34 24 17 196 88 101 74 73 532 77 1927 90 19 13 9 131 46 56 38 53 324 53 Increase or decrease on mean — 31 —15 —11 — 8 — 65 — 42 — 45 — 36 — 20 —208 — 24 Showing the Deaths among Infants per 1,000 Births during the Year 1927. and also the mortality rates for the Years 1917-1926. Sub-Districts. 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Mean 10 years 1927 Increase or decrease on mean Tufnell 99 93 50 41 53 83 46 54 47 64 63 52 —11 Up. Holloway 68 83 79 69 76 59 64 70 57 30 65 31 —34 Tollington 102 135 98 58 83 58 55 60 65 92 80 63 —17 Lr. Holloway 121 130 101 66 93 81 81 85 78 82 92 74 —18 Highbury 83 99 83 67 93 64 61 60 54 48 71 52 —19 Barnsbury 114 122 91 89 87 86 59 77 75 90 89 59 —30 Islington, S.E. 89 107 81 79 77 88 82 55 58 64 78 49 —29 The Borough 97 110 83 72 81 77 66 66 63 66 77 53 —24 9 1927] 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 1917-26 : and in 1927 from certain specified causes. Causes of death. 1927. Rate per 1,000 Births. Mean rate 10 years 1917-26 per 1,000 Births. Difference. Premature Birth and Congenital Defects 15.1 19.9 — 4.8 Bronchitis and Pneumonia 13.0 16.6 — 3.6 Atrophy and Marasmus 2.3 8.4 — 6.1 Diarrhoeal Disease (all forms) 1.9 4.8 — 2.9 Convulsions 0.6 1.4 — 0.8 Whooping Cough 3.7 3.0 + 0.7 Measles 1.1 2.9 — 1.8 Diphtheria 0.2 0.3 — 0.1 Phthisis - 0.4 — 0.4 Other forms of Tuberculosis 0.7 1.3 — 0.6 Total of above 38.6 69.0 —20.4 All other causes 14.0 18.0 — 4.0 Total 52.6 77.0 —24.4 INFANTILE MORTALITY during the Calendar Year 1927. Nett Deaths from, stated causes at various Ages under One Year of Age. Cause of Death. Under 1 week Weeks. Total under 4 weeks Months. Total Deaths under 1 year 1-2 2-3 3-4 4 weeks and under 3 months 3-6 6-9 9-12 All Certified 90 19 13 9 131 46 56 38 53 324 Causes. Uncertified Nil - - - - - - - - Nil Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - 2 5 7 Scarlet Fever - - - - - - - - 1 1 Whooping-Cough - - - - - 5 6 4 8 23 Diphtheria, Croup - - - - - - - - 1 1 Erysipelas - - - - - - - 1 - 1 Tuberculous Meningitis - - - - - - - 1 1 2 Abdominal Tuberculosis - - - 1 1 - - - 1 2 Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - 1a 2a 3a 1 7 Convulsions 2 1 - - 3 1 - — — 4 Laryngitis — 1 - - 1 — — — — I Bronchitis. - - - - - 1 4 3 2 10 Pneumonia (all forms) 3 3 2 1 9 10 15 12 24 70 Diarrhoea - - - - - 5 2 5 - 12 Enteritis - 1 - 1 2 5 15 4 - 26 Gastritis - - - - - - - - - - Syphilis - 1 - - 1 — — — — 1 Rickets - - - - - - 1 — — 1 Suffocation, overlying - - - - - - - - - - Injury at birth 8 1 - - 9 - - - - 9 Atelectasis 8 1 - - 9 - - - - 9 Congenital Malformations 16 - 1 1 18 3 3 1 - 25 Premature birth 45 7 7 2 61 4 — 1 2 68 Atrophy, Debility and Marasmus 3 1 - 1 5 6 3 - - 14 Other causes 5 2 3* 2 12 5 5 2 0 6b 30 Totals 90 19 13 9 131 46 56 38 53 324 *Ophthalmia Neonatorum (1) Nett Births legitimate 5,9211 in the year illegitimate 242 6,163 a. Cerebro-Spinal F. (4) b. Influenza (4) Nett Deaths in legitimate infants 296 the year illegitimate infants 28 10 1927] EDUCATIONAL PROPAGANDA. As formerly, a Special Committee, composed of members of both the Public Health and Maternity and Child Welfare Committees, considered propaganda, especially in relation to Health and Baby Week. The week was inaugurated, Friday 30th September, by a special lecture on "Ultra Violet Rays, Clean Air, and Health," by Professor Leonard Hill, M.B., F.R.S. (National Institute of Medical Research), preceded at 7.30 p.m. by a musical programme in the Large Hall of the Central Library, Holloway Road. The Mayor, Councillor T. L. Harrold, J.P., presided. A circular was widely issued in the Borough, and through the agency of the schools, by the kind permission of the Education Officer of the London County Council. From the Centres a special flag was issued to the mothers, the one side indicating "Health Week" on a representation of sunrise, and on the other side the wording: "Fresh Air and Sunlight Bring Health." Owing to the difficulty of obtaining permission to hold a regular flag day, and the onus of the control of such outside distribution, these flags were only given out within the precincts of the various welfare centres. The Committee, as a special subject for the week, laid emphasis on the Health Promoting Effects of Sunlight and Fresh Air. Sunshine is a cure for tuberculosis. Sunshine prevents and cures rickets. "Your Son and Heir, Needs Sun and Air." The back of the leaflet issued was a copy of one of our Health Week Posters, entitled " Health Election." ISLINGTON. Health ELECTION. Vote For the following candidates. 1. Mr. FRESH AIR. 2. Miss SUNSHINE. 3. Mr. PURE MILK. 4. Mr. GREEN VEGETABLE. 5. Mr. DAILY EXERCISE. G. Mr. CLEAN TEETH. 7. Mr. FULL SLEEP. The principal issue is Good Health. The Planks in the platform are Physical and Mental well-being and long life. The Slogans are "Health First," and "Home Rule for Health." Issued by the Metropolitan Borough of Islington Health and Baby Week Committee. REPORT ON MATERNITY AND CHILD WELFARE WORK. Municipal Health Visitors. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. 136 cases of Ophthalmia Neonatorum were notified. 74 cases of Ophthalmia were reported by the London County Council. 11 1927] 67 out of the 136 cases of Ophthalmia Neonatorum were attended at birth by midwives. The cases occurred in the sub-registration districts as follows :— Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough Ophthalmia Neonatorum. 11 17 27 22 16 18 25 136 Cases notified by Doctor 9 12 28 17 15 10 11 102 Ophthalmia. Cases reported by L.C.C. 3 4 6 7 10 10 21 61 Cases reported by Health Visitors - 1 - - - 1 - 2 Reported by others 4 1 1 - - 2 3 11 Of the 136 cases investigated, both of the infants' eyes were effected in 101 instances, whilst in 13 the right eye was involved, and in 21 the left. Treatment.—24 of 136 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital. 72 of 136 Ophthalmia Neonatorum cases were treated at home by private Doctors. 54 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £59 12s. In 1926 54 cases were nursed at the cost of £47 14s. Results.—Of the 136 Ophthalmia Neonatorum cases, in 132 instances vision was unimpared and in 3 cases the sight was affected. The remaining case left the district. There was one fatal case during the year. Ophthalmia Neonatorum Cases. Vis'on unimpaired. Vision impaired. Total Blindness. Deaths. Notified, Treated. At home. In hospital. 136* 112 24 132 3 Nil 1 *N.B.—One case left the district and was untraceable. MATERNAL DEATHS. The number of women dying in, or in consequence of, child-birth during the year 1927 was 24, or 3.9 per 1,000 registered births. Of this number 12 occurred from Sepsis (Puerperal Septicaemia); whilst 12 died from other diseases of childbirth. Cause of Death. No. of Deaths. Puerperal Septicaemia (Sepsis) 12 Abortion, Miscarriage 3 Puerperal Convulsions 1 Placenta Praevia-Other causes - 5 Puerperal Thrombosis 1 Other diseases of child-birth 2 Total 24 The deaths for the preceding year numbered 27 and were equal to the proportion of 4.1 per 1,000 births. 12 1927] PUERPERAL FEVER. Definition.—The Royal College of Physicians' definition of Puerperal Fever is : Septicemia, Pyaemia, Septic Peritonitis, Septic Metritis, and other acute septic inflammation in the pelvis occurring as the direct result of child-birth. Of the 34 cases coming to the knowledge of the Medical Officer of Health during 1927, 33 were notified by Medical Practitioners. The proportion of total cases to births was 5.5 per thousand. The notifications were 12 above the average (22) of the preceding ten years and showed an increase of 2.3 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1927. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 4 3 5 2 6 7 6 33 Private Practitioners' Cases 2 2 3 2 3 5 4 21 Hospital Cases - 1 2 — 2 2 — 7 Certified Midwives' Cases 3 1 — — 1 — X 6 Cases inquired into 5 3 5 2 7 7 5 34 Cases treated in Hospital 5 3 4 2 5 6 4 29 Cases treated at Home - - 1 - 2 1 1 5 Of the 34 cases, 29 were treated in Hospitals. Seven of these contracted the disease in Hospital; 11 cases were removed to Metropolitan Asylums Board Hospitals; and 18 cases were removed to the Islington Infirmary and other London Hospitals. Deaths.—Twelve deaths were registered as being due to Puerperal Fever, but of these, four cases were notified as Puerperal Pyrexia. PUERPERAL PYREXIA. The Notification of Puerperal Pyrexia Regulations, 1926; made by the Ministry of Health, which came into operation on the 1st October, 1926, resulted in 84 cases being notified. Of these, 35 were Private Medical Practitioners' cases; 43 occurred in Hospital, while 6 were Certified Midwives' cases. The notifications were in the proportion of 13.7 per 1,000 births. Four patients subsequently died from Pueperal Fever. Cases of Puerperal Pyrexia notified and inquired into during the year 1927. Tufnell. Upper Hollo way. Tollington. Lower Holloway, Highbury. Barnsbury. SouthEast. The Borough Cases notified 11 9 11 8 17 15 13 84 Private Practitioners' Cases 5 3 7 2 3 9 6 35 Hospital Cases 6 6 4 5 13 5 4 43 Certified Midwives' Caces — — — 1 1 1 3 6 Cases inquired into 13 13 8 12 15 14 9 84 Cases treated in Hospital 10 9 5 11 10 14 6 65 Cases treated at Home 3 4 3 1 5 - 3 19 In connection with research into the cases of Puerperal Fever and Puerperal Pyrexia, the Metropolitan Asylums Board have very kindly offered facilities for examination of swabs taken from persons who have been in attendance on confinement cases. The following is the circular which was issued by the Medical Officer of Health to medical practitioners in the Borough:— 13 1927] December 14th, 1927. Dear Sir, The Clerk of the Metropolitan Asylums Board has intimated a proposed investigation into the method of infection in Puerperal Fever or Puerperal Pyrexia, as follows:— In the course of the research which is now in progress into the method of infection in women suffering from puerperal fever or puerperal pyrexia, who are admitted to the special accommodation which the Board have set apart for such cases in certain of their infectious hospitals, evidence has been obtained from which it would appear that the contamination does not arise from the hands but probably from the throat of the attendant, as an airborne infection. The Board's Obstetric Consultant and their Director of Research and Pathological Services have, therefore, suggested that examination should be made of the organisms in the nose and throat of those who attended the puerperal case before admission to the Board's hospitals in order to ascertain if the same type of organism responsible for the puerperal infection is present in the upper respiratory tract of the nurse or midwife attending the case. The Board have approved of this suggestion and, in order to give effect to it, it is proposed that, when the medical practitioner telephones to the Metropoitan Asylums Board to make application for the admission of a case of puerperal fever or puerperal pyrexia to one of the Board's hospitals, he shall be asked to swab the throat of the nurse or midwife in attendance and to forward the swab direct to the Director of Research and Pathological Services, at the Board's Southern Group Laboratory, Park Hospital, Hither Green, S.E. 13. I have replied that I am in agreement that the investigation might prove a useful one, although there may be difficulties in getting swabs from some of the attendants, and that I would intimate the matter to the medical practitioners in the Borough, with a view to getting their co-operation. I am, Yours faithfully, G. CLARK TROTTER, Medical Officer of Health. N.B.—Please particularly note that the special swab marked definitely what it is, that is, from a case of Puerperal Fever or Puerperal Pyrexia, is to be sent direct to the Director at the address, Hither Green, given above, and not to this office, as is done in the case of other specimens. [Please Keep This for Reference.] PEMPHIGUS NEONATORUM. During the year 1927, 24 cases which came to the knowledge of the medical Officer of Health were investigated. Of this number 6 cases occurred in the Royal Northern Hospital. 14 1927] THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1927, the sum expended in the provision of fresh and dried milk for necessitous, expectant and nursing mothers, and children under five years of age, amounted to £2,144 10s. 5d., as against £3,253 14s. 3d. in 1926. The total amount expended since the Order came into operation in 1918 is £48,253 0s. Id. The total recipients during the year numbered 8,860, and the quantity of milk supplied to them was equal to 196,850 pints (24,6061/4 gallons). The amended scheme for the distribution of milk adopted by resolution of the Council, on the 21st January, 1927, is given below:— DISTRIBUTION OF MILK TO NECESSITOUS MOTHERS AND CHILDREN. Necessitous Cases Only. Net family income after deduction of rent. Number in family —excluding children earning:— 1 2 3 4 5 6 7 8 9 10 11 12 Up to 13s, F F F F F F F F F F F f 13s. 1d. to 15s. 1/4 F F F F F F F F f F F 15s. 1d. to 20s. N 1/2 1/4 F F F F F f F f f 20s. 1d. to 25s. n 3/4 1/2 1/4 F F f F f f F F 25s. 1d. to 30s. n N 1/2 1/4 F f F F F F F F 30s. 1d. to 34s. 11d n N 3/4 1/2 1/4 F F f f F f F 35s. to 39s. 11d. n N N 3/4 1/2 1/4 F f F f f F 40s. to 44s. 11d. N n n n 1/4 1/2 1/4 F f f F f 45s. to 49s 11d. n N n N N 3/4 1/2 1/4 F f F f 50s. to 54s. 11d. N n N n N N 3/4 1/2 1/4 f f F F = Free. N = Nil. The Fractions 3/4, 1/2 and 1/4 represent the amount of cost charged to each recipient. Children living at home, and earning, NOT counted as members of family in this scale. SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1927. District 1 2 3 4 5 6 7 8 Totals. I. Births, First Visits, Infants under 1 Year 527 756 665 807 853 629 510 403 5,150 II. Births, Re-Visits, Infants under 1 Year 428 672 669 567 800 766 745 686 5,387 III. Visits to Children, between 1st and 2nd Years 522 687 693 671 766 659 622 419 5,039 IV. Visits to Children, between 2nd and 5th Years 1,774 1,888 1,621 1,008 1,700 1,239 1,502 850 11,582 V. Visits re Still Births 10 23 21 12 33 17 15 4 135 VI. Deaths, Visits, re Infants under 1 Year 8 12 5 11 15 10 7 9 77 VII. Deaths, Visits, re Children 1 to 5 years 2 2 1 - 1 - - 1 7 VIII. †ante-natal, home visits F/102 186 F/213 248 F/212 263 F/ 140 147 F/183 227 F/142 180 F/120 147 F/95 129 F/1,207 1,527 IX. †Puerperal Fever, or Pyrexia, Home Visits p.f. f/7 14 p.f.f/5 11 p.f.f/4 5 p.p.f/2 5 pf. f/3 5 p.f. f/1 3 p.f.f/1 2 p.f. f/4 8 p.f.f/26 53 p.p. f/1 2 pp.f/2 2 p.p. f/3 4 Totals 3,525 4,301 3,943 3,228 4,402 3,503 " 3,550 2,509 28,961 X. Attendances at Welfare Centre 21 21 50 48 46 51 28 33 298 XI. Other Work by Direction 504 853 981 501 285 574 734 371 4,803 XII. Visits Declined 1 4 3 7 5 - 4 1 25 XIII. Visits, House Shut 545 1025 488 964 500 906 740 655 5,823 XIV. Visits, Inopportune 12 180 8 19 38 11 45 9 322 Grand Total of Visits 4,608 6,384 5,473 4,767 5,276 5,045 5,101 3,578 40,232 15 1927] SUMMARY OF VISITS BY MUNICIPAL HEALTH VISITORS—Continued. District 1 2 3 4 5 6 7 8 Totals. Analysis of Visits included in I.-IX. relating to Reported Ophthalmia F/4 9 F/3 9 F/1 6 F/3 5 F/5 14 F/7 11 F/5 16 F/3 11 F/31 81 (a)† Ophthalmia Neonatorum F/13 39 F/37 94 F19 37 F 5 F/10 19 F/11 16 F/7 26 F/10 27 F/112 263 (b) †Epidemic (Summer) Diarrhoea F/3 F/2 3 - F/l - - - - F/6 7 (c) Other Digestive Diseases - 10 12 - - 1 24 5 52 (d) Pneumonia and Bronchitis 15 51 5 14 20 1 43 33 182 (e) Rickets 2 34 19 81 83 84 180 60 543 (f) †Measles and German Measles F/2 F/7 F/1 F/2 F/63 - F/2 F/2 F/79 (g) †Whooping Cough F/14 16 F/ 73 F/1 5 F/27 F/38 - F 63 65 F/36 /266 270 (h) Tuberculous Disease—P=Pulmonary; O=Other - p/1 o/l 2 - - - - - - /lo/l 2 (i) Convulsions 1 - 1 - - - - - 2 (j ) †Polio-myelitis - - - - - - - - - (k) Premature Birth - 55 17 21 14 3 6 4 120 (l) Atrophy, Debility and Marasmus - 17 1 1 31 - - 7 57 (m) All other investigations (**Specify) 21 33 15 29 14 10 34 25 181 (n) Routine Visits included in I. to IX. and not included in (a) to (m) 3,417 3, 13 3,814 3,042 4,106 3,377 3,154 ,299 27,122 ***Totals (a) to (n) 3,525 4,301 3,943 3,228 4,402 3,503 3,550 2,509 2 8,961 Total Families Visited 2,160 3,128 2,726 2,217 2,842 2,563 2,544 1,777 19,957 Registered New Cases Handed to Infant Puerperal Puerperal Ophthalmia Births. H .V's for Visitation. Mortality. Fever. Pyrexia. Neonatorum. No. Rate. Notified Non-Notified Transfers Rate. Cases. Removals. Cases. Removals. Cases. Removals. Births. Births. In. 6108 180 5671 302 331 324 53* 33 28 84 53 137 24 *Lowest Rate on Record. **e.g.—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. Illegit, etc. ***Totals (a) to (b) should correspond with Totals I. to IX. †F. in front of figures denotes a "First Visit." 1927] 16 17 1927 REPORT OF WORK OF VOLUNTARY CENTRES. A table, which summarises the work of the Centres for the year ending 31st March, 1928, is given on page 20. It will be noted that the year for the Centres ends on this particular date, the other matter in this annual report being for the year ending 31st December, 1927. The Conjoint Committee of the Centres during the year suffered the loss of one who had taken a very keen interest for years in infant welfare work. The late Mr. Henry Mills, J.P., L.C.C., an ex-Mayor of Islington, was also VicePresident of the South and West Centres. Owing to his influence and great interest in the West Islington Welfare Centre, the National Sunday League presented, it may be remembered, that Centre with their artificial " Sunlight " lamp. North Centre.—The various departments of the Centre include (1) two antenatal clinics weekly for expectant mothers; (2) one clinic weekly for ailing mothers; (3) ten post-natal clinics weekly (consultations for children up to five years of age); (4) visiting (professional and voluntary) daily in the homes; (5) morning callers daily (mothers that come for advice); (6) two dental sessions weekly, and dental club; (7) two massage clinics; (8) " Light " clinics daily— these were run on the same lines as set out in last year's report. This clinic was, unfortunately, closed for seven months during re-building operations; (9) four wards—three wards for ailing children under two years of age and one for three mothers and their babies; (10) sewing classes weekly; (11) " Health Talks " during the week; (12) Home helps and Home Help Club and Convalescent Fund. There are, in addition, a Mothers' Committee and a Fathers' Committee, comprised of the parents of the children attending the Centre. Besides the other activities of the Centre, as mentioned, the statistical records of this Centre call for very special comment. It is impossible in a short review to deal adequately with all the information which is put forward after very careful investigation and tabulating. For this detailed information, which is of great interest and use, reference should be made to the Centre's Annual Report. " The Light " clinic records show that 192 children and 59 mothers, a total of 251, were dealt with, the attendances being: Children, 2,179; mothers, 499; and, in addition, 23 were rejected at consultation; the total attendances at the clinic were thus 2,701. The Wards contain twelve beds for children under two years of age and six beds, which accommodate three mothers with their babies—a total of eighteen beds. The number of mothers and babies resident during the year were 144 and the average days of residence was 35.33. Convalescence, etc.:Arrangements were made for convalescence or holidays in respect of 29 mothers and 31 children. Several of these were assisted to seaside or country through the Women's Country Holiday Fund. New Buildings: The new buildings, which were opened by H.R.H. The Duchess of York, on February 28th, 1928, are only a portion of a scheme which is intended to extend the full length of the gardens of the four existing houses. The ground floor of the portion now built comprises two large and well-equipped Light " treatment rooms and a large room, which is the main assembly hall. Above these rooms, on the first floor, are three doctors' rooms, with a large waiting room adjoining each of them, and on the second floor there are nine nurses' bedrooms. It was found necessary to carry out some alterations on the old houses meanwhile, and heating apparatus has been installed in two of them; the material, however, will be used when the re-building is carried out. 1927 18 In consequence of the extended accommodation at the new buildings, the Branch Centre at the Highgate Presbyterian Church's Mission Hall, Elthorne Road, N., has been given up. "Health Week."—During "Health Week" flags, provided by the Borough Council, were distributed to those attending the centre. Special talks during the week were given at the Centre, attention being concentrated on the subjects of " Fresh Air and Sunlight." South Centre.—The routine work of this Centre might be summarised thus: Ten sessions are held each week for children under five years old; three sessions are held each fortnight for expectant and ailing mothers, and, in addition, one dental session per fortnight. There is also, of course, the home visitation work, and mothers and babies are sent away for convalescence to Clephane Cottage, Flamstead, Bedfordshire. This cottage was open from the 1st March to the 29th November, 1927, and during that time 77 mothers and 79 babies stayed there—70 mothers and 71 babies came from the South Centre and 7 mothers and 8 babies from other Centres. Through the kindness of Miss Fleetwood and others, the Centre sent 43 children between the ages of three and five years for a stay of four to six weeks at Miss Fleetwood's house at the seaside. In addition, a number of cases were dealt with by means of convalescent home letters, the total result was that 211 of the Centre's mothers and children were sent away. A Building Fund has been started, for the Centre Committee finds that the Centre has outgrown the accommodation, and they hope to solve their housing problem as modestly as possible. The policy has been to bring the work near to the mothers' homes by means of Branches in different parts of the district, but the central building to co-ordinate the work has now to be re-adapted. In connection with the maternal mortality, one of the Medical Officers of the Centre reports that "the chief difficulty is in bringing home to prospective mothers in the district the necessity for early examination and advice, so that they may keep in good health during the ante-natal period and that their children may have the best possible start in life." In view of the renewed interest taken in ante-natal treatment and its bearing upon possible mortality of both mother and child, the importance of expectant mothers placing themselves under observation at the clinic cannot be too greatly stressed. "Health Week. —I he doctors at the Centres and Branches gave special talks on the "Health Week" subjects, "Sunlight and Fresh Air," and, as at the other Centres, flags were distributed. East Centre.—At this Centre a special department for observation and test feeding has been started, to which any baby who is not doing well may be brought for the day, or, if necessary, for several) days, the mother taking the child home at night. This gives the Superintendent the opportunity of carefully watching the children and of giving the mothers any necessary advice. The primary clinic for examination of the children is held on Wednesdays. At this clinic, apart from Test Feeding and teaching, an effort is made to help suitable mothers to restore the flow of breast milk and thus be able successfully to nurse their infants. The Medical Officer reports it is scarcely possible to over-estimate the value of such an Observation Clinic in this respect. " It is like making two blades of grass to grow where only one grew before—or where none grew—and it has a far-reaching importance, out of all proportion to what would appear on the surface. It is not only the benefit to the individual babies, 19 1927 though that is enormous, but to enable a mother to breast-feed her baby when she could not otherwise have done so, is of national importance, both from a social and economic standpoint. It is better for the child and for the mother, gives the future citizen a better start in life, and makes for more normal maternal health. There are, of course, cases where suckling is not good for either mother or child, but they are very rare, and it is part of child welfare work to make them even more rare than they are. It is unnecessary to dilate on the benefits of breast-feeding. The educative side of the test-feeding days is of supreme importance. Our very able Superintendent is most expert at this real education, this drawing out of the power of the mother to do all for her baby as she sees it demonstrated and is taught at the Centre." Through the agency of the Centre and special donations given for the purpose, 67 mothers and 140 children were sent into the country for holidays and convalescence. This was accomplished through the generosity of the various institutions which have convalescence arrangements who very kindly gave facilities to the Centre's cases. The Centre was visited on the 8th July by 25 delegates from the National Conference on Maternity and Child Welfare. One of the original founders of the Centre, Lady Henry, a Vice-President, died during the year, and the Centre lost Dr.J. Lorimore Hawthorne, their energetic Medical Officer, who resigned through ill-health. During the year under review Dr. Gaffikin gave two interesting lectures on how to keep fit. Mothercroft lectures were also given during the winter, while Dr. Naomi Dancy gave a lecture in the Drayton Hall during "Health Week" under the auspices of the Health and Cleanliness Council. West Centre.—The outstanding feature of the activities of this Centre was the starting of a new Branch at Goodinge Road in St. Luke's Mission Hall on the 5th January, 1928. This part of the district has always been difficult to attract, as the distance is considerable to Richmond Road. A large proportion of the mothers therefore attending the new centre have never before been to a Welfare Centre. The numbers at the Centre this year show a slight decrease on those during the preceding year. This has been accounted for by (i) a drop in the birth-rate, which automatically reduces the number of new entrants, (ii) the epidemic of measles which prevented the mothers for many weeks from bringing their babies to the Centre, and (iii) the bad weather conditions in December. A Fathers' Council was inaugurated on January 31, 1928—the meetings take place monthly. Dr. Percy With led a discussion on Vaccination, and Dr. Octavia Lewin one on Home Hygiene. The fathers showed enthusiasm and were very ready to join ire the debates. The "Sunlight" Clinic continues to do useful work among the debilitated and rickety babies. The number of children dealt with were 92 and the attendances 1,252. During the year 120 mothers and children were sent for convalescence treatment and Miss Lee-Warner secured a bed at St. Mary's Home, Birchington, for the summer. Others were sent through the Centre's Convalescent Fund, with the help of various institutions. With regard to the Centre. Ward, many of the babies admitted were seriously ill, requiring great care on the part of the nursing staff. On two occasions the 1927 20 Ward had to be closed on account of infectious illness. A total of 113 were admitted into the ward, the average length of stay being 18¾ days. "Health Week." During "Health Week" Dr. Hector Munro spoke on "Sunlight and Fresh Air." There was a good attendance of mothers, who took a real interest and asked many questions. The various Departments of the Four Voluntary Centres, with the attendances for 1927, may be summarised thus :— North. South. East. West. Total. 1. Ante-Natal Clinics and Ailing Mothers Clinics. Number held weekly 3 1½* 1 2 7½ Number of attendances 1,505 731 402 326§ 2,964 2. Consultations for Children up to 5 Years of Age. Number held weekly 10 10† 8† 7 35 Number of attendances 14,843 19,187 13,808 18,536 66,374 3. Home Visiting. Number of visits made 14,842 13,011 11 126 7,481 46,460 4. Dental Clinics. Number attending 460 182 64 42 748 Number of attendances or arrangements made for attendances 1,160 336 108 58 1,662 5. Morning Callers. Number of attendances 1,040 675 318 913 2,946 6. Massage Clinics. Number of cases given massage or sent for massage 77 (& Sunlight treatment) 104 92 29 302 7. Wards. Number of beds 18 - - 8 26 Number of patients received 144 - - 113 257 8 Number of Children on Books 1,882 1,549 1,186 1,062 5,679 *2 Clinics one week, one following week = 1½ weekly. †2 Ministry of Health Special Consultations per month to be added. ‡Including 1 Observation Clinic. § Attendances of Expectant Mothers only. WELFARE CENTRES' DISTRICTS. 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. Ward 7, 8 and Part of 4. Total. 1927 (Approximate Estimate) 516,483 96,004 53,160 88,653 334,300 29,082 up to 5 years old. BIRTHS. 1926 1927 1,951 (Actual) 1,860 (Actual) 1,478 (Approximate) 1,451 (Approximate) 1,021 (Approximate) 1,024 (Approximate) 2,005 (Approximate) 1,773 (Approximate) 6,455 6,108 Number on Books 31st March, 1928, 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" 18,582 21 1927 MATERNITY AND CHILD WELFARE. Contributions by the Borough Council. Year ending 31 March, 1928. Voluntary Welfare Centres. £. Day Nurseries. £. North Centre 2,155 Lower Holloway 80* South Centre 837 St. Luke's 40 East Centre 766 South Islington 100 West Centre 1,042 Total £220 Total £4,800 * This Nursery is a municipally owned building. (No rent charged for its use.) A contribution of £25 was made to the Islington Branch of the Invalid Children's Aid Association in respect of convalescence of invalid children under five years of age. Contributions for Maternity and Child Welfare Work per Case in Respect of Work Done. The Islington Borough Council has an arrangement with the North London Nursing Association for the attendance, by visitation, in cases of Ophthalmia Neonatorum, Acute Primary Pneumonia, Acute Influenzal Pneumonia, Measles, Whooping Cough and Epidemic Diarrhoea. The payments made to this Association, at the rate of one shilling per visit, were :— Under Maternity and Child Welfare... £105 9 0 Under Public Health £68 2 0* Total £173 11 0 * Includes also adult nursing (pneumonia). Contributions under arrangements for maternity cases admitted to beds at Maternity Hospitals, the contribution being a grant of 10s. per case, were : City of London Maternity Hospital, £2 10s. 0d. ; Royal Free Hospital, £16 10s. 0d. In addition to these cases of Ophthalmia Neonatorum and Marasmus are admitted to the Metropolitan Asylums Board's Hospital (St. Margaret's), Camden Town, N.W. DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—2,081 persons died in the Public Institutions located in Islington, of whom 1,385 belonged to this Borough, the remaining 696 having come here for treatment or relief. Of these, 436 died in the Archway House, 123 in the Royal Northern Central Hospital and 61 in the London Fever Hospital. Of the 1,385 deaths of inhabitants, 1,004 occurred in the Islington Infirmary, 224 in the Islington Institution, and 124 in the Royal Northern Central Hospital. The proportion which the 1,385 deaths in the Public Institutions bore to the Borough mortality was 33.6 per cent. Without the Borough.—821 deaths of persons belonging to Islington were registered as occurring in Public Institutions in district of London outside the Borough and in various provincal towns. They included, among others, 32 in the North-Western Fever Hospital, 36 in the Children's Hospital, Great Ormond Street, 101 in St. Bartholomew's Hospital, 38 in the Colney Hatch Mental Hospital, 68 in the Royal Free Hospital, 57 in the University College 1927 22 Hospital, 21 in the North-Eastern Fever Hospital, 16 in the Eastern Fever Hospital, 17 in the Middlesex Hospital, 10 in the City of London Maternity Hospital, and 40 in the Metropolitan Hospital. These 821 deaths represented 19.9 per cent, of all the deaths registered in the year. Within and Without the Boroughs—The deaths of Islingtonians numbered 2,206 and were equal to 53.5 per cent, of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— 104 inhabitants died from accidental deaths, or suddenly, in places outside Islington. During the previous year (1926) the total deaths in Local Institutions numbered 2,075, being 1,385 inhabitants of Islington in Local Institutions, plus 690 non-inhabitants of Islington in Local Institutions, the number in Islington Infirmary being 974, the number in the Royal Northern Hospital 118. The deaths of inhabitants of Islington in Institutions outside the Borough were 755. The total deaths in all Institutions, 2,140; and the proportion per 100 deaths from all causes, 52.3. Transferable Deaths.—During the year 50 deaths that had occurred in outlying Institutions and other places outside the Borough were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Whooping Cough, Fevers—Typhus, Enteric and Continued—and Diarrhceal Diseases. During the year 126 persons died from these diseases, the death-rate being 0.38 per 1,000 inhabitants, as contrasted with 0.50 in the corresponding period last year, and a decennial average mortality of 243 and a death-rate of 0.74 per 1,000. In London the death-rate from the epidemic diseases was 0.39, while in the six Boroughs encircling the death-rate was 0.32. Locally the deaths in the Sub-Registration Districts and Wards were as follows :— Shewing the Deaths from each of the principal Epidemic Diseases in the several Wards and Sub Registration Districts during the Year 1927. SubRegistration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea. T otals. Deaths Deaths Deaths Deaths Deaths Deaths Deatns Deaths Tufnell Tufnell - - - - 4 2 3 9 Up. Holloway Up. Holloway - - - - 2 4 2 8 Tollington Tollington - - 1 2 4 4 4 15 Lr. Holloway Lr. Holloway - - 2 1 7 1 1 12 Highbury Highbury - - - 1 3 1 1 6 Mildmav - - 1 - 3 2 1 7 Barnsbury Thornhill - - 8 1 8 3 2 32 Barnsbury - - 6 1 1 5 4 17 Islington South East St. Mary's - - - - 3 1 - 4 Canonbury - - - 1 7 - - 8 St. Peter's - - 1 1 3 2 1 8 The Borough - - 29 8 45 25 19 126 Total Death Rates - - 0.09 0.02 0.14 0.07 0.06 0.38 23 1927 Shewing the Deaths and Death.Rates from the Principal Epidemic Diseases during the ten years 1917.26 and for the Year 1927. 1917 1918 1919 1920 1921 1922 Deaths. Death Rates. Deaths. Death Rates, Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 4 0.01 7 0.02 5* 0.02 3* 0.01 1 0.00 - - Small Pox - - - - 1 0.00 - - - - - - Measles 149 0.50 114 0.39 12 0.04 92 0.27 27 0.08 134 0.40 Scarlet Fever 4 0.01 8 0.03 14 0. 4 12 0.04 19 0.06 29 0.09 Whooping Cough 45 015 147 0.51 17 0.05 70 0.21 43 013 98 0.29 Diphtheria 33 0.11 45 0.16 51 0.16 1.35 0.40 110 0.33 59 0.18 Diarrhoea and Enteritis (under 2 years) 106 18.16 per 1,000 births 4 15.78 per 1,000 births 85 13.53 per 1,000 births 77 8.19 per 1,000 births 156 19.78 per 1,000 births 71 9.46 per 1,000 births 1923 1924 1925 1926 Mean 10 years 1927 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates, Deaths. Death Rates. Deaths. Death Rates. Enteric Fever - - 4 0.01 4 0.01 1 0.00 3 0.09 - - Small Pox - - - - - - - - - - - - Measles 16 0.05 103 0.30 22 0.06 69 0.20 74 0.23 29 0.09 Scarlet Fever 13 0.04 10 0.03 8 0.02 12 0.03 13 0.04 8 0.02 Whooping Cough 38 0.11 57 0.17 61 0.20 29 0.09 60 0.18 45 0.14 Diphtheria 21 0.06 33 0.09 21 0.06 31 0.09 54 0.17 25 0.07 Diarrhoea and Enteritis (under 2 years) 103 14.51 per 1,000 births 52 7.65 per 1,000 births 69 10.54 per 1,000 births 69 10.68 per 1,000 births 87 12.60 per 1,000 births 48 7.79 per 1,000 births * Including 2 Malarial Fever. Showing the Deaths from, Diarrhoeal Diseases together with those classed under Enteritis and its Sub.headings, arranged in quarterly periods, and in three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The year Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea, Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. under 1 year 1 5 6 - 10 10 4 6 10 7 5 12 12 26 38 1 to 5 years - 1 1 - - - 1 - 1 2 6 8 3 7 10 Over 5 years - 1 1 - - - 1 2 3 3 - 3 4 3 7 Totals 1 7 8 - 10 10 6 8 14 12 11 23 19 36 55 INFLUENZA. Influenza caused 152 deaths during. the year and showed an increase of 101 on the return for the year 1926, but were 52 below the average of the preceding ten years 1917-26. The death-rate was equal to 0.45 per 1,000 inhabitants. 1927 24 The Medical Officer of Health, in connection with Influenza and the 43 deaths from this cause during January, issued to the local Press some notes of warning and advice, with particular reference to child sufferers. Showing the Deaths from Influenza in the Quarters of the Year 1927, together with the averages of the corresponding periods, 1917-26. Years. First. Quarters. Fourth. Totals. Second. Third. 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 1923 21 22 7 8 58 1924 70 15 4 15 104 1925 47 3 1 21 72 1926 15 24 3 9 51 Average 77 19 9 99 204 1927 118 15 7 12 152 Increase or Decrease + 41 — 4 — 2 — 87 — 52 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 1927 :— Ages. 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Mean 10 yrs 1927 Difference. 0- 5 1 106 19 10 5 22 5 11 6 - 19 8 — 11 5-10 — 52 5 3 - 1 - 1 2 1 6 4 — 2 10-15 — 32 8 3 1 - 2 2 - - 5 1 — 4 15-25 — 141 48 12 5 11 - 10 2 2 23 3 — 20 25-35 2 252 82 21 9 14 6 7 1 4 40 13 — 27 35 45 2 109 47 18 15 18 4 10 3 8 23 21 — 2 45-55 7 93 48 17 18 42 12 12 11 6 27 22 — 5 55-65 8 69 42 17 13 37 5 19 11 12 23 28 + 5 65-75 10 50 36 13 14 43 16 16 19 8 23 34 + 11 75 & upwards 6 27 21 4 13 33 8 16 17 10 15 18 + 3 All Ages ... 36 931 356 118 93 221 58 104 72 51 204 152 — 52 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the principal diseases of this class. Erysipelas.—10 deaths were returned from this disease, or 2 more than in the year 1926, and 1 above the average of the preceding ten years 1917-26. Puerperal Diseases.—These comprise Puerperal Pyaemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 12 deaths, which is 1 above the return of 1926 and 3 above the average of the ten years 1917-26. The death-rate was equal to 1.95 per 1,000 births. CANCER. Cancer.—449 deaths were registered from this malignant disease during the year compared with 453 in 1926, and with an average of 449 in the previous decennium. The deaths represent a death-rate of 1.34 per 1,000 of the civil population and is 0.04 below the average rate (1.38) of the last ten years; 225 deaths occurred among males and 224 among females. The following statement shows the ages at death of the persons attacked during the past ten years, and the return for the year 1927 :— 25 1927 Ages. 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Mean l0yrs 1927 Difference. 0- 5 2 - 2 3 2 - 1 1 1 - 1 1 - 5-15 2 - 1 - 1 - - 1 2 - 1 - — 1 15-25 5 - 4 1 1 4 6 4 3 3 3 1 - 2 25-35 8 8 5 10 10 8 10 9 5 6 8 5 — 3 35-45 31 27 36 32 34 34 27 38 40 27 32 24 — 8 45-55 73 75 101 74 98 88 88 77 93 73 84 74 — 10 55-65 131 99 120 110 140 124 138 131 168 142 130 137 + 7 65-75 120 126 123 124 131 110 125 149 144 144 130 135 + 5 75-85 55 52 39 43 52 47 68 52 71 51 53 65 + 12 85 & upwards 5 6 7 5 6 6 9 8 7 7 7 7 - Totals 432 393 438 402 475 421 472 470 534 453 449 449 - Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1927. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South Hast. The Borough First 9 14 14 13 16 16 28 110 Second 13 6 13 14 18 16 19 99 Third 13 10 11 11 28 15 32 120 Fourth 10 16 11 17 26 19 21 120 The Year 45 46 49 55 88 66 100 449 TUBERCULOSIS. Tuberculosis caused 348 deaths, which were 106 below the average of the last decennium, but were 3 below the number registered in 1926. The deathrate resulting from them was equal to 1.04 per 1,000 of the civil population, and represented 8.4 per cent, of the deaths from all causes during the year. Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 314 deaths, as contrasted with the decennial average of 382, while the death-rate was 0.94 per 1,000 of the civil population as against the decennial rate of 1.18 per 1,000. There was a decrease of 68 on the ten years' average number of deaths, and of 0.24 on the mean death-rate. Tuberculosis (Respiratory System). Proportion of Deaths Death rates Death rates from Tuberculosis from All Causes Years. Deaths. per 1,000 Per 100 Deaths per 1,000 inhabitants. from all Causes. inhabitants. 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 1923 337 1.00 8.64 11.6 1924 340 0.99 8.05 12.3 1925 382 1.13 9.18 12.3 1926 289 0.85 7.06 12.0 Average 10 years 382 1.18 8.50 13. 8 192 7 314 0.94 7.61 12.3 1927 26 The following return gives the deaths at each age period :— Age Periods. Males. Females. Total. 0-5 3 2 5 5-15 3 1 4 15-25 25 33 58 25-35 31 39 70 35-45 43 24 67 45-55 44 17 61 55-65 33 9 42 65 upwards 5 2 7 Total 187 127 314 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1927. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 5 14 6 12 15 12 27 91 Second 3 5 6 5 8 15 19 61 Third 4 14 4 8 10 15 14 69 Fourth 10 6 9 12 15 20 21 93 The Year 22 39 25 37 48 62 81 314 Showing the Deaths from all forms of Tuberculosis during 1927. 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 - 5 309 187 127 22 39 25 37 48 62 81 314 Meningeal 2 8 5 7 8 - 1 2 1 2 6 4 15 Abdominal 2 1 6 5 4 1 - 1 - 1 3 3 9 General - - 2 1 1 - - - 1 1 - - 2 Other forms - - 8 5 3 - 1 - - 1 2 4 8 All Tuberculosis 4 14 330 205 143 23 41 28 39 53 72 92 348 DEATHS FROM THE DISEASES OF THE RESPIRATORY SYSTEM. (Exclusive of Tuberculosis and Influenza.) These diseases, which include Chronic and Acute Bronchitis, Pneumonia, Pluerisy and Asthma, caused 835 deaths, or 126 more than in 1926. They were equal to a death-rate of 2.5 per 1,000 of the civil population, and represented 20 per cent, of the total deaths registered in the Borough. Acute Bronchitis.—There were 96 deaths as compared with 78 in the previous year, 34 occurred among males, and 62 among females. The deaths of 4 infants under 12 months were registered. Chronic Bronchitis.—241 deaths were ascribed to it, 118 being males and 123 females. This return is 53 above that for 1926. Pneumonia (All forms).—376 deaths were registered, of which 209 were males and 167 females. 8 less died than in the year 1926. It was very fatal to infants under a year old, among whom it caused 70 deaths, while between the ages of 1 and 5 years 63 died from it. Above 5 years of age the deaths numbered 243. 136 deaths occurred in Public institutions, chiefly the Islington Infirmaries. 27 1927 Pleurisy.—There were 19 deaths registered from this disease, 3 deaths occurred in Public Institutions. Asthma and Emphysema.—Twenty-three deaths were recorded from these diseases, all of which were adults. Other Diseases of the Respiratory System— Eighty deaths were registered, as contrasted with 25 in 1926. VENEREAL DISEASES. Twelve deaths were ascribed to these diseases, as compared with 5 in 1926. Of these 11 were males and 1 female. The mean deaths of the preceding ten years, 1917-26, were 13. The annual average number of deaths recorded during ten years from them at three groups of ages has been as follows : Under 1 year, 6 deaths; 1-5 years, 0 deaths ; and over 5 years, 7 deaths, making an average total of 13 per annum. The nearest treatment centres of these diseases are the Royal Northern Hospital, Holloway Road, N., and the Royal Free Hospital, Gray's Inn Road, W.C. DEATHS FROM COAL-GAS POISONING. During the year 18 deaths were registered from asphyxia caused by the inhalation of carbon-monoxide gas. Twenty-three deaths from the same cause occurred in 1926. Eleven of these deaths were attributable to suicide, while the cause of the remaining 7 deaths was accidental. Of the 18 deaths, 9 were males and 9 females, the ages ranging from 20 to 82 years. The Medical Officer of Health has on several occasions emphasized the dangers arising from the careless use of gas. A common source of trouble at the present time is the custom of fixing gas cookers in unsuitable positions. Cases are known where these have been fixed on landings. These cookers, although provided at the back or side with an opening for the purpose, are seldom ventilated to the outside air. Very frequently indeed the cleanliness of the gas cookers is not considered by the householder. At one time—in pre-war days—the Gas Company would change a hired gas cooker, and there was a means of getting a clean one for a dirty one, but this opportunity has now ceased. Apart from the danger of a tap being left slightly on, the want of Ventilation of even a gas cooker makes an appreciable difference in the purity of the air in an apartment. An even greater danger, which needs all the emphasis it is possible to give, is the lack of knowledge of the precautions necessary in using a geyser or water heater. In these appliances, in which the burning, or rather the attempted burning, of any gaseous mixture containing carbon takes place, there may be an imperfect oxidisation and formation of carbon monoxide. The danger ever present in such highly efficient water apparatus as geysers can apparently never be overc&me with certainty, even by arrangements intended to lead the products of combustion outside the building, an absolutely necessary precaution. The very small bathrooms now provided in flats certainly add to the danger of 1927 28 ing. This danger can be very much reduced if people using geysers and water heaters for hot baths would :— 1. Open the window a little at the top and leave the door wide open while the water is heating. 2. Undress in their bedrooms, and on entering the bathroom turn out the gas before starting to bathe. 3. Hang on the door a notice to say "occupied" rather than bolt the door. ACCIDENTAL DEATHS. The deaths due to accident numbered 136. Of this number 60 deaths were ascribed to vehicular traffic and 32 to accidental falls, including 22 aged people. The 60 deaths due to accidents in vehicular traffic may be summarised as follow :— Motor Car Other or Lorry. Bus or Tram. Taxi-cab. Vehicles. Total. 36 10 3 11 60 Of this number, 28 deaths occurred to Islington residents when in outlying districts. In addition to these, 17 non-residents were also killed by vehicles within the borough. INQUESTS AND MORTUARY. During the year 309 bodies were received into the Mortuary, as compared with an average of 352 in the preceding 10 years. Only three infectious bodies were received during the year. The daily average number of bodies received was 0.8, and equalled that of 1926. In 240 cases inquests were held, as contrasted with an average of 315 in the ten years 1917-26. Bodies received into Mortuary Inquests. 1917 479 359 1918 476 348 1919 429 321 1920 340 312 1921 313 299 1922 316 307 1923 288 279 1924 294 317 1925 275 306 1926 308 305 Average 352 315 1927 309 240 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1927 and 1926 :— 1927 No. of bodies received. Daily Average. No. of Inquests held. 1926 No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 74 08 81 1st Quarter 79 0.8 84 2nd „ 68 0.7 69 2nd „ 60 06 54 3rd „ 76 0.8 32 3rd „ 89 0.9 76 4th „ 91 1.0 58 4th „ 81 0.9 91 Total for year 309 08 240* Total for year 308 0.8 305* * Inclusive of Inquests held by the Coroner upon bodies of deceased persons who died in Public Institutions in the borough. 29 1927 PREVENTION OF INFECTION. Notification, Isolation, Fatality, of Specified Diseases under the Provisions of the Public Health (London) Act, 1891. The Principal Diseases Include : Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus Fever, Puerperal Fever and Erysipelas. 1,813 cases of the principal diseases which are notifiable under the Public Health (London) Act, 1891, came to the knowledge of the Medical Officer of Health. This number does not include other communicable ailments, which are also notifiable. The complete list of infectious diseases which are notifiable in Islington will be found on page 33. The total cases notified are 105 less than those of the previous year (1,918), and 452 below the average (2,265) of the preceding ten years. The decreases when contrasted with the decennial averages are to be found in the returns from Small Pox, Diphtheria, Scarlet Fever, Enteric Fever and Continued Fever, which were respectively 1,195,263.5 and 1 below the average, while the other diseases all showed a slight increase. The 1,813 cases were equal to an attack-rate of 5.42 per 1,000 of the civil population. The returns for the preceding ten years are given in the following statements :— Year. Cases. Attack-rates per 1,000 civil population. 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 1923 2,096 6.22 1924 2,085 6.06 1925 2,194 6.47 1926 1,918 5.65 10 years average 2,265 6.94 1927 1,813 5.42 Registration Sub-Districts.—The total number of cases notified in these districts was as follows :— Total cases notified. Tufnell 182 Upper Holloway 168 Tollington 157 Lower Holloway 258 Highbury 216 Barnsbury 365 Islington South-East 467 Total 1,813 SMALLPOX. No case was notified during the year. Diphtheria was responsible for 720 cases of illness, which were (195) below the average (914) of the preceding ten years. The attack rate was equal to 2.15 per 1,000 of the civil population annually, and was 0.65 below the mean rate (2.80) of the decennial period. In London the attack-rate was 2.70 per 1,000, and the Encircling Boroughs 2.47. 1927 30 DIPHTHERIA ANTI-TOXIN. Under the Special Order of 15th August, 1910, the then Local Government Board sanctioned the provision by the Sanitary Authority, in pursuance of section 77 of the Public Health (London) Act, 1891, of a temporary supply of Diphtheria Anti-toxin "for the poorer inhabitants of the district, subject to the following conditions, that is to say, the arrangements with respect to the keeping, distribution and use of the Diphtheria Anti-toxin shall be made in accordance with the advice of the Medical Officer of Health." The section of the Public Health Act referred to is that which enables the authority with the sanction of the Local Government Board to provide a temporary supply of medicine, etc., for the poorer inhabitants of their district. ANTI-TOXIN TREATMENT. During the year 108,000 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 65,000 units were sold, the total amount received by the Council being £4 16s. The remaining 43,000 units were given free, owing to the patients' limited means. Scarlet Fever—909 cases were notified, and they showed a decrease of 263 on the average (1,172) of the ten years 1917-1926. The attack-rate was equal to 2.72 per 1,000 of the civil population annually, which is a decrease of 0.87 per 1,000 of the mean rate (3.59) of the preceding ten years. In London the attackrate was 2.92 per 1,000 of the civil population, while in the Encircling Boroughs it was 3.18. Enteric Fever.—Only 12 cases were notified which were 5 less than the average that obtained during the ten years 1917-1926. The attack-rate was 0.03 per 1,000 annually, or 0.02 per 1,000 below the mean rate(0.05) 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. Typhus Fever —No case was notified. Puerperal Fever.—See page 12. Erysipelas.—139 cases were notified, or 1 above the average 138 of the preceding ten years, the attack-rate being 0.42 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 1,813 cases notified, 55 deaths occurred, of 3 per cent., which contrasts with an average percentage of 3.8 in the preceding ten years 1917-26. Years. Cases. Deaths. Fatality. 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 1923 2,096 48 2.3 1924 2,087* 66 3.2 1925 2,194 51 2.3 1926 1,919‡ 63 3.3 Mean 2,265 87 3.8 1927 1,833 55 3.0 * Including 2 cases not notified. ‡ Includes 1 case not notified. 31 1927 SCHICK TESTING AND IMMUNISATION BY TOXIN ANTI-TOXIN. This question had a few years ago been before the Public Health Committee, and as two Islington mothers had applied to the Medical Officer of Health to have their children Schick tested and immunised, the Public Health Committee authorised if necessary the expense for a limited number of applicants, but no further requests have been received. The matter of Schick Testing and Immunisation was again before the Public Health Committee, when Dr. Graham Forbes' Report on the Prevention of Diphtheria was supplied to the members of the Committee, who had also received from the National Anti-Vaccination League copies of a booklet on the subject. The Medical Officer of Health further obtained for the Committee information regarding the work of Schick Testing and Immunisation, and presented a report on this work in Edinburgh, and other information. In the provinces it was found that Schick testing was most conveniently done at the schools when the children had entered for their education, and were under supervision. It transpired that the London County Council, as School Authority, although the matter had been under discussion, were meanwhile taking no action, and the Committee in the circumstances decided on a similar policy. Hospital Isolation.—Of the 1,818 cases of infectious diseases notified, 1,722 were isolated in hospital, or a percentage of 95.0 while only 5.0 per cent, of the patients, therefore, were nursed at home. The following tabular statement shows the number of cases treated in the various public institutions :— Year. Cas es treated in Hospital. Percentage of cases treated. 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 1924 1,975 94.6 1925 2,105 95.9 1926 1.852 96.5 1927 1,722 95.0 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated. Percentage of known cases. Small Pox - - - Scarlet Fever 909 890 97.9 Diphtheria 720 710 98.6 Enteric Fever 12 6 50.0 Erysipelas 139 90 64.7 Puerperal Fever 33 26 78.8 Continued Fever - - - 1,813 1,722 95.0 1927 32 Summary of Infectious Sickness and of Deaths arising therefrom, distinguishing the Cases treated at Home and in Hospitals ; and showing the percentage of notified Cases removed to Hospitals, together with the Fatality among cases treated at Home and in Hospitals during the year 1927. Notified Cases Treated. Percentage of Notified Cases Treated. Deaths Occurring Percentage of Deaths Occurring. In Hospital At Home Total In Hospital At Home In Hospital At Home Total In Hospital At Home Total Small Pox . . . . . . . . . . . Scarlet Fever 890 19 909 979 21 7 1 8 0.8 5.0 0.8 Diphtheria 710 10 720 98.6 1.4 24 1 25 3.3 10.0 3.4 Enteric (Typhoid Fever) 6 6 12 50.0 60.0 . . . . . . Typhus Fever Erysipelas 90 49 139 64.7 35.3 7 3 10 7.7 6.1 7.2 Puerperal Fever 26 7 33 78.0 21.2 11 1 12 42.3 14.2 36.4 Continued Fever . . . . . . . . . . . Relapsing Fever . . . . . . . . . . . Cholera . . . . . . . . . . . Total 1,722 91 1.813 95.0 5.0 49 6 55 2.8 6.6 3.0 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1917.26 and in 1927. DISEASES. YEARS. Average number of cases, 1917.26 1927 Increase or Decrease 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Small Pox Cases . 2 2 . . . . . . 1 1 . — 1 Rate . 0.00 0.00 . . . . . . 0.00 0.00 . . Diphtheria Cases 556 514 645 1324 1548 1126 889 854 911 743 911 716 — 196 Rate 1.87 1.80 1.96 3.94 4.65 3.37 2.64 2.48 2.69 2.19 2.79 2.14 — 0.65 Membranous Croup Cases 5 4 4 4 5 4 2 2 2 - 3 4 + 1 Rate 0.02 0.01 001 001 0.02 0.01 0.00 000 0.00 - 0.01 0.01 - Scarlet Fever Cases 478 432 1084 1307 2622 1496 1080 1077 1139 1010 1172 909 — 263 Rate 1.61 1.51 3.29 3.89 7.87 4.48 3.21 313 3.36 2.98 3.59 2.72 — 0.87 Enteric Fever Cases 23 30 16 24 10 9 16 14 10 18 17 12 — 5 Rate 0.08 0.10 0.05 0.07 0.03 0.03 0.05 0.04 0.03 0.05 0.05 0.03 — 0.02 Continued Fever Cases - - 1 - - - - 3 - 1 1 - — 1 Rate - - 0.00 - - - - 0.01 - 0.00 0.00 - - Puerperal Fever* Cases 16 4 29 29 34 20 22 19 23 27 22 33 + 11 Rate 2.74 0.77 0.46 3.08 4.31 2.68 3.10 2.79 3.50 4.18 3.19 5.40 + 2.21 Erysipelas Cases 173 141 212 165 125 132 87 116 109 118 138 139 + 1 Rate 0.58 0.49 0.64 0.49 0.38 0.39 0.26 0.34 0.32 0.35 0.42 0.42 - Totals Cases 1251 1127 1993 2853 4344 2787 2096 2085 2194 1918 2265 1813 — 452 Rate 4.21 3.93 6.05 8.49 1305 8.34 6.22 6.06 6.47 5.65 6.94 5.42 — 1.52 * Per 1,000 Registered Births. 33 1927 Showing the Cases of the Notifiable Infectious Diseases notified in the SubRegistration Districts and the Wards during the Year 1927. SubRegistration Districts. Wards. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric Typhoid' Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell - 102 59 - 3 - 12 6 - - - 182 up. Holloway Up. Holloway - 74 70 1 - - 20 3 - - - 168 Tollington Tollington - 80 62 - 1 - 10 4 - - - 157 Lr. Holloway Lr. Holloway - 142 94 - 5 - 15 2 - - - 258 Highbury Highbury - 49 55 2 - - 8 3 - - - 117 Mildmay - 58 30 - 2 - 5 4 - - - 99 Barnsbury Thornhill - 113 77 - - - 26 6 - - - 222 Barnsbury - 48 84 1 1 - 8 1 - - - 143 Isington, S.E. St. Mary's - 44 62 - - - 8 - - - - 114 Canonbury - 100 57 - - - 14 1 - - - 172 St. Peter's - 99 66 - - - 13 3 - - - 181 Totals - 909 716 4 12 - 139 33 - - - 1813 Attack-Rates per 1,000 population - 2.72 2.14 0.01 0.03 - 0.42 0.10 - - - 5.42 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 disease 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 Lethargica, Acute Polio-Encephalitis, Acute Poliomyelitis, Acute Primary Pneumonia, Acute Influenzal Pneumonia, Cerebrospinal fever or Epidemic Cerebro-spinal Meningitis, Dysentery, Glanders or Farcy, Hydrophobia or Rabies, Malaria, Ophthalmia Neonatorum, Plague, Trench Fever, and Tuberculosis. Acute Poliomyelitis. Six cases were notified from this disease during the year, as contrasted with 12 in 1926, and 1 in 1925. No death was registered during the year. 1927 1926 Cases. Deaths. Cases. Deaths. 1st Quarter Nil Nil 2 Nil 2nd 1 ” 1 ” 3rd 3 ” 3 ” 4th 2 ” 6 ” 6 Nil 12 Nil Epidemic Cerebro-Spinal Meningitis. Seven cases were notified, as against eleven in 1926. During the ten years 1917-1926, the cases averaged 12 per annum. 1027 34 A return of attacks of the disease during the past ten years is given in the following statement :— 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Average 10 yrs. 1917-26 1927 Total Deaths, 1917-26. 1st Quarter 15 7 8 5 3 1 3 - 2 3 5 3 37 2nd 11 4 7 5 3 2 2 - 1 3 4 3 30 3rd „ 1 1 1 2 - - 2 2 2 3 1 - 8 4th” 3 4 - 2 1 - 1 4 1 2 2 1 10 Year 30 16 16 14 7 3 8 6 6 11 12 7 85 The deaths during the year numbered 6 and were equal to the very high rate of 86 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 past 5 years the following cases were notified by medical practitioners to the Medical Officer of Health :— 1923 1924 1925 1926 1927 Malaria 2 1 Nil Nil 2 Dysentery 3 Nil Nil Nil 5 Acute Primary Pneumonia 120 119 93 190 202 Acute Influenzal Pneumonia 58 65 41 55 124 Pneumonia - - - - - Total 183 185 134 245 333 DYSENTERY. (Tollington Ward.) During the year under review it will be noted that there were five cases of dysentery. These occurred in one family in Tollington Ward. My attention was drawn by a medical practitioner to three children who were ill in a family, and at his request they were seen by me. At the same time 1 had the question of the food partaken gone into and the drains inspected. The drainage was found to be defective. At the time of my visit there was also another child isolated in an ante-room. 1 was of opinion that the three children were suffering from Dysentery, and with the concurrence of the medical attendant they were removed to hospital the next day. The other child and the mother subsequently developed the disease. Meanwhile the stools were examined and the " Flexner " Bacillus of Dysentery found, confirming the diagnosis. The bacteriological history is interesting. The clinical diagnosis was confirmed in all cases of this family sent to hospital by serological or bacteriological means. An organism of the "Flexner" type of the bacillus dysenteriae was isolated from the mother, a daughter and a son, whilst another daughter and son gave serological evidence of suffering from the same infection. The organism in one case gave reactions of a "W" strain of Flexner, while in another case reactions of the "X" "V" or "W" type were given. The subsequent history of these cases as mentioned is interesting as showing that in a small house such cases cannot be adequately attended to. First of all we had the three cases, then another child taken ill a few days afterwards, and then a week afterwards the mother, but we think the mother may have been 35 1927 ill a day or two before she admitted it. There remained at home the father, who kept well all through, although he did a considerable amount of the early nursing. Another child of school age, 14 years, who was from home, escaped infection. The source of infection of this family was never satisfactorily cleared up. There was, of course, a drain defective, but one looks in dysentery for infection from another case, or through contaminated food. Regulations.—During the year the Ministry of Health brought out new regulations to come into force in 1928, entitled the Public Health (Infectious Disease) Regulations, 1927. It was noticed that these regulations, proposed by the Minister of Health on 12th October, 1927, applied provisions of Section 308 of the Public Health Act, 1875, to Article 17 of the Regulations. Now the Public Health Act of 1875 does not apply to London. On the 15th November, 1927, the Ministry issued Circular 836, stating that it would be necessary to issue fresh Regulations in respect of London, as these should have been made under the powers conferred by Section (1) (b) of the Public Health (Regulations as to Foot') Act, 1907. On receipt of this Circular reference was made to the Act of 1907, which was stated to be an Act to enable Regulations to be made for the prevention of danger arising to public health from the importation, preparation storage, and distribution of articles of food, and paragraph (b) of sub-section (1) of section 1 of the Act is to the effect that the regulations may "apply, as respects any matters to be dealt with by the regulations, any provision in any Act of Parliament dealing with the like matters with the necessary modifications and adaptations." The Act relates to matter in respect of food, although the terms of paragraph (b) appear to be somewhat wide. It appeared that it might be argued that the power of making regulations under this Act is confined to regulations for the purpose of preventing danger to public health from the importation, etc., of food, and that the application of the powers given by paragraph (b) of subsection (1) of section 1 to regulations relating to infectious diseases might be challenged in the event of any case being taken to Court arising from the administration of the regulations. The Minister of Health was further written to on the matter, as there appeared to be some doubt as to the question of compensation. A reply was received from the Minister on the 22nd November, 1927, that his department contemplated the likelihood of claims for compensation arising only under Part III of the First Schedule of the Regulations, the object of which is the protection of food supplies. It was further stated, however, that it may be possible that claims might arise under Part II of the Schedule, and if such claims did not relate to action taken for the protection of foods, the Minister was advised that it is doubtful whether they could be properly allowed, and that Article 17 would be amended to avoid this. GLANDERS, ANTHRAX AND HYDROPHOBIA IN MAN. Order under Section 55 of the Public Health (London) Act, 1921, by the London County Council. (Came into operation on the 26th April, 1909.) During the year 1927 a case of Anthrax, a lad, aged 17 years, was notified in the Lower Holloway Ward. The case is of some interest, as Anthrax is usually spread by infection from working with infected hair, hides, and such like material. Another common source is infection with the disease through anthrax infected shaving brushes, the material of which the brush was made not having 1927 36 been effectively sterilized. In this particular instance, however, the infection was traced to contact with material from an animal house. I he lad had assisted, with others, in the removal of an elephant which had died, and been cut up. While he was the only infected case in this Borough, there were others elsewhere. A careful watch was kept for possible contacts developing the disease. I here were, however, no others. After hospital treatment the lad made a good recovery. The Public Health Committee had under consideration a report by the Medical Officer of Health on the case, and it was found that under the Orders relating to Anthrax, which have been made by the Minister of Agriculture and Fisheries, pursuant to the Diseases of Animals Act, it is the duty of a Veterinary Surgeon to notify cases in respect of cattle, sheep, goats, swine, horses, asses, mules, dogs and cats only. It is known, however, that Veterinary Surgeons are called in to attend other animals than those specified, and the Committee were of opinion that it is desirable that the precautions against anthrax should be applied to any animal. The attention of the Secretary of the Ministry of Agriculture and Fisheries was drawn to the matter, also the London County Council, who were asked to support the representation which has been made to the Ministry. Acute Encephalitis Lethargica and Acute Polio-Encephalitis. These diseases became notifiable under an Order of the Local Government Board on the 1st January, 1919. During the year 7 cases of Acute Encephalitis Lethargica were notified, which is a decrease of 14 cases on the return of the previous year, whilst 4 deaths were registered ; or 57 per cent, of the notified cases. The following summary shows the number of cases, and also the fatality of recent years :— Acute Encephalitis Lethargica. Years. 1919 1920 1921 1922 1923 1924 1925 1926 Average (8 years). 1927 Cases 5 8 11 3 10 39 17 21 15 7 Deaths 1 7 2 3 5 4 6 9 4 4 No case of Acute Polioencephalitis was known in the Borough. Ophthalmia Neonatorium. Purulent Disease of the Eyes of Newly-born Children. See p. 10. Tuberculosis. 640 cases of Tuberculosis in its different forms were notified during the year. The attack rate was equal to 1.91 per 1,000 of the civil population. This number shows a decrease of 64 on the return of the previous year, and of 0.17 per 1,000 on the attack-rate. This is the lowest number recorded since the compulsory notification of this disease. Respiratory (Pulmonary) Tuberculosis.—536 notifications were received, of which 314 referred to males and 222 to females, and represented an attack-rate of 1.6 per 1,000 inhabitants. This number was a decrease of 6 on that of 1926. CASES or TUBERCULOSIS INI SLINGTON DURING 1927. BLACK denotes Pulmonary Tuberculosis WHITE Other Forms ofTuberculosis. 37 1927 Showing the Notified Gases of Tuberculosis in the Wards during 1927. Registration Sub-Districts. Wards. Respiratory Tuberculosis. Other Forms of Tuberculosis. Grand Totals Tuberculosis Rate per 1,000 of Population. Males Females Total Males Females Total Tufnell Tufnell 24 17 41 2 4 6 47 1.39 Up. Holloway Up. Holloway 31 27 58 4 4 8 66 2.08 Tollington Tollington 21 20 41 3 6 9 50 1.62 Lr. Holloway Lr. Holloway 39 26 65 4 3 7 72 1.73 Highbury Highbury 37 20 57 1 7 8 65 2.03 Mildmay 22 15 37 5 3 8 45 1.56 Barnsbury Thornhill 32 16 48 6 10 16 64 2.11 Barnsbury 33 16 49 11 4 15 64 2.57 Islington, S.E. St. Mary's 21 16 37 5 3 8 45 2.47 Canonbury 29 18 47 5 2 7 54 1.67 St. Peter's 25 31 56 8 4 12 68 2.28 Totals 314 222 536 54 50 104 640 1.91 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1927. Tubercular Diseases. Sex. At all ages. Cases Notified in Whole District. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 314 - 2 9 56 136 102 9 F. 222 - 4 9 74 97 30 8 Tubercular Meningitis M. 5 2 1* 1 - 1 - - F. 2 - 1 - 1 - - - Tabes Mesenterica M. 8 1 2 2 3 - - - F. 6 - 1 1 3 1 - - General Tuberculosis M. 1 - - - - 1 - - F. - - - - - - - Other forms of Tuberculosis M. 40 1 8 21 4 4 2 - F. 42 - 6 14 11 9 1 1 All Tubercular Diseases M. 368 4 13 33 63 142 104 9 F. 272 - 12 24 89 107 31 9 Totals - 610 4 25 57 152 249 135 18 Percentages at each life period to total cases - - 0.03 3.91 8.91 23.75 38.90 21.09 2.81 From the above statement it will be seen how the disease attacked people a the various ages, viz. : In every hundred cases 0.63 were under 1 year of age „ „ 8.91 were aged 1 to 5 years. „ „ 8.91 were aged 5 to 15 years. Prime „ ,, 23.75 were aged 15 to 25 years of „ ,, 38.90 were aged 25 to 45 years Life „ ,, 21.09 were aged 45 to 65 years ,, ,, 2.81 were aged 65 and upwards. 1927 38 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. The provisions of these Regulations continue to be systematically carried out with regard to the Register of Notified Cases of Tuberculosis. A quarterly revision of the Register is made by the removal of the names of patients who have died, left the district, and those, who in the opinion of the Tuberculosis Officer, confirmed by the L.C.C. Medical Officer, should be denotified. The following is a statistical statement showing the number of cases of Notified Tuberculosis on the register at the commencement of the year, the numbers, removing during that period, and the actual number remaining at the close of the year, 1927 (i.e., ending 31st December, 1927) :— Lungs. Other Forms. Total. M. F, M. F. Numbers on register at the commencement of the year 1927 966 787 313 269 2,335 Notified cases added during the year 1927 314 222 54 50 640 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1927 61 60 16 24 161 No. of cases removed from the register during the year 1927 1,841 1,069 383 343 3,136 311 231 52 53 647 1,030 838 331 290 2,189 Showing the Notified Cases of Tuberculosis in the Quarters during 1927. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Males Females Total Males Females Total Males Females Total Males Females j Total Males Females Total Respiratory Tuberculosis 84 55 139 71 54 125 74 66 140 85 47 132 314 222 536 Tubercular Meningitis 1 ... 1 2 ... 2 2 1 3 ... 1 1 5 2 7 Tabes Mesenterica 3 1 4 2 1 3 2 2 4 1 2 3 8 6 14 General Tuberculosis ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 Other forms of Tuberculosis 14 15 29 9 13 22 6 7 13 11 7 18 40 42 82 Totals 102 71 173 85 68 153 84 76 160 97 57 154 368 272 640 Disinfection of Houses and Rooms after Tuberculosis,—The following statement gives the particulars for the year :— 1st quarter Houses. Rooms. 129 153 2nd ,, 125 164 3rd ,, 91 119 4th ,, 127 171 Total 472 607 + 39 1927 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 3rd January, 1927, to the 31 December, 1927, 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 Total and Primary up. Notifications. Pulmonary Males - 2 5 4 20 36 70 66 72 30 9 314 470 Females - 4 3 6 31 43 62 35 24 6 8 222 339 Non-pulmonary Males 4 11 12 12 4 3 5 1 2 - — 54 68 „ „ Females - 8 12 3 11 4 9 1 1 - 1 50 65 Number of Notifications Notifications on Form B. On form c Number of Primary Notifications. Total Notifications Poor Law Total on Institutions. Sanatoria. Age-periods Un- 6 10 Primary Form B. der 5 to 10 to 15 Notifications Pulmonary Males Nil Nil 74 233 „ Females 66 129 Non-pulmonary Males 5 35 „ „ Females 4 30 TUBERCULOSIS. Showing New Cases of Tuberculosis and all Deaths during 1927 Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non Pulmonary. M. F. M. F. M. F. M. F. Under 1 year - - 5 2 - - 2 2 1-5 4 6 12 11 3 2 4 5 5-10 5 3 14 13 2 - 2 1 10-15 5 7 12 5 2 2 3 2 15-20 20 35 4 12 11 18 - 2 20-25 39 47 4 4 16 13 2 2 25-35 79 72 6 11 31 39 1 35-45 70 37 1 1 45 21 1 1 45 55 79 27 2 1 44 16 - 1 55-65 40 13 - - 31 11 - 1 65 and upwards 10 10 1 1 5 3 1 1 Totals 351 257 61 61 190 125 16 18 71 Deaths not notified or 20 3 per cent, of Total Deaths. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. During the year 1927 only one person was notified as suffering from Tuberculosis of the respiratory tract who had been employed or occupied in connection with a dairy. The case was one in which the sputum on repeated examination was found negative, and the Tuberculosis Officer reported that the man had never shown any convincing active physical signs, although he might possibly be regarded as having a quiescent lesion of the left apex. The matter will be taken up with a view of having the case de-notified if the conditions so justify. 1927 40 TUBERCULOSIS DISPENSARIES. The work of the Tuberculosis Dispensaries still progresses very satisfactorily. Dr.Leitch, the Tuberculosis Officer for the northern 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. 1 have to congratulate these two Assistant Medical Officers (Tuberculosis) upon the good results which they have obtained. During the year 1,156 persons were examined by the Tuberculosis Officers, and the patients made 8,887 attendances. At the Northern Dispensary there were 574 new cases, and at the Southern 582, while the attendances at the former were 2,847 and at the latter 6,040. The examination of contacts with tuberculous cases showed that 28 were suffering from tuberculosis, 20 were suspects, and 381 were not suffering. The nurses of the Northern Dispensary paid 1,050 visits, and those of the Southern 2,140, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 168 visits, and of the Southern 431 visits to the patients' homes for the purpose of examining them. Finsen Light Treatment.—One patient received treatment by the Finsen Light at the London Hospital at a cost to the Council of £3. Pneumothorax Treatment was also administered to four patients at a cost of £39 18s. Artificial Sunlight Treatment.—The treatment of Tuberculosis by artificial sunlight came into operation on the 1st April, 1927. Light treatment was given to eight patients at a cost of £12 1s. The number of persons in attendance at the Dispensaries in each year was as follows :— TUBERCULOSIS. 1920 1921 1922 1923 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 655 760 615 758 600 581 721 562 Actual number of Attendances Totals 3921 6895 3212 7030 3297 6659 4001 6825 4576 7655 3827 7788 3897 7240 4722 7387 1924 1925 1926 1927 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 502 549 543 656 542 670 574 582 Actual Number of Attendances 3374 6122 3394 6176 3366 6672 2847 6040 Totals 3876 6671 3937 6832 3908 7342 3421 6622 41 1927 A summary of the combined dispensaries is given for the following years : Cases. Attendances. Cases. Attendances. 1920 1,415 10,816 1924 1,051 9,496 1921 1,373 10,242 1925 1,199 9,570 1922 1,181 9,956 1926 1,212 10,038 1923 1,283 10,826 1927 1,156 8,887 Totals 9,870 79 831 Table showing the number of Tuberculous Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1927. Date. Dispensary Jan. Feb. Mar. Apr. May. June July Aug. Sept. Oct. Nov. Dec. Year. Total. Attendences Northern 333 249 285 231 237 177 202 220 199 290 229 195 2,847 8,891 Southern 552 518 524 479 491 433 504 459 536 581 523 444 6,044 New Cases including Contacts Northern 51 37 47 50 43 31 53 60 47 64 54 37 574 1,156 Southern 54 47 49 44 40 39 53 43 62 64 59 28 582 Concacts lberculosis Northern - - - 1 - 1- 1 2 2 1 - 8 28 Southern - 1 - 1 1 5 3 3 - 3 2 1 20 inspects Northern 1 1 - 3 1 2 2 | - 1 1 1 1 14 20 Southern - 1 - - 1 1 -i 1 1 - - 1 6 on-Tuberculous Northern 23 6 15 13 9 4 1 24 1 23 14 28 16 7 182 381 Southern 13 12 12 12 12 6 26 18 30 25 28 5 199 nurses ' Visits Northern 78 58 94 75 101 85 74 114 94 88 103 86 1,050 3,190 Southern 191 171 195 180 213 195 179 - 222 203 211 180 2,140 berculosis Officers'Visits Northern 19 16 14 9 16 14 13 18 3 16 17 13 168 599 Southern 34 31 45 34 31 28 50 28 37 38 41 34 431 HOME VISITATION—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1927, to 31 December, 1927. Month. North Dispensary. South Dispensary. Total. January 139 138 277 February 135 120 235 March 120 131 251 Apiil 99 91 190 May 131 136 267 June 77 49 126 July 101 113 214 August 124 121 245 September 135 118 253 October 119 118 237 November 131 116 217 December 144 115 259 1,455 1,366 2,821 The Municipal Tuberculosis Visiting Nurse works under the direction of the Tuberculosis Officers of the North and South Islington Tuberculosis Dispensaries in accordance with the arrangements made in Conference with the Chief Executive Tuberculosis Officer, Dr. G. Clark Trotter. Her visits are made in regard to the "treatment" of patients notified to be Milk-ring from the disease; patients attending the Dispensaries; Ex-Service Tuberculosis War Pensioners, etc. 1927 42 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 871 caes of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 516 were Scarlet Fever and 348 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 516 694 — 178 Diphtheria 348 424 — 76 Enteric Fever 4 1 + 3 Other Diseases 3 - + 3 Total 871 1,119 — 248 Non-NotifiableDiseases.—4,984 cases came to the knowledge of the Medical Officer of Health during the year, viz.: 919 cases of Measles, 1,458 cases of Chicken Pox, 632 of Whooping Cough, and 1,975 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.—2,920 children were excluded from classrooms of various schools owing to the presence of an infectious disease, chiefly Diphtheria and Scarlet Fever, in the houses wherein they lived. The non-notifiable diseases among children attending the Public Elementary Schools were :— Disease. Notifications by Teachers. Average of preceding 10 years. Increase or Decrease. Measles 919 1,759 — 840 Chicken Pox 1,458 834 + 624 Whooping Cough 632 564 + 68 Other Diseases 1,975 2,334 — 359 4,984 5,491 — 507 * Note.—"Other Diseases" include Mumps, Scabies, Ophthalmia, Itch, etc. BACTERIOLOGICAL EXAMINATIONS. 2,629 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 Tuberculosis, Diphtheria and Enteric Fever, respectively. The number is an increase of 94 on that of the preceding year. It was also 845 above the decennial average. Of the total examinations, 374 or 14.2 per cent, gave positive results. Diphtheria —1,833 specimens were examined for Diphtheria, of which 260 or 14 per cent., were found to contain Diphtheria baccilli. Enteric Fever.—24 specimens of blood were examined, 3 of which gave negative results. Tuberculosis—772 specimens of sputum were examined, 111, or 14.3 per cent., of which showed that the patients were suffering from pulmonary tuberculosis. 43 1927 "BACTERIOLOGICAL" DIPHTHERIA. The difficulties of dealing with children who show that they are harbouring Diphtheria bacilli, but who may be quite well, was exemplified during the year in an alleged "epidemic" of Diphtheria at the Claremont Day Nursery, in Finsbury. A letter was received from the Medical Officer of Health of Finsbury on the 1st [une stating that the doctor who attended the Claremont Mission had decided to take swabs from all the children in the creche. The Public Health Departmnt of Islington did not consider that the financial responsibility for these swabbings of Islington children in Finsbury lay with them. The nine children, however, were kept under observation. On the 13th September the Medical Officer of Health of Finsbury stated that recently there had been another " epidemic " of Diphtheria amongst the toddlers attending the creche, but at that time we had knowledge of only one Islington case. As regards the occurrence of this "bacteriological" Diphtheria, which might come under the designation of an "outbreak" (it certainly was not an epidemic), the first case was said to have been an Islington child, aged 3 years, 10 months, stated to have been languid on the 11th May. The case was removed to hospital. This was a verified case of Diphtheria. An alleged second, case on the 15th May, of the same age, was also removed to hospital, but it was considered to be only a case of tonsillitis ; the cultures were all negative. This information was furnished to us by the hospital authorities. Virulence tests were carried out on such Islington cases as the Islington Medical Officer of Health thought necessary. The virulence test, although more costly, is of definite value, inasmuch as a child who shows an alleged positive result may be non-virulent, and therefore noninfective while in this condition. It has been alleged that occasionally such cases may become virulent, but as to whether this is a fresh infection or a change in the bacilli present is a moot point. In any case, if the test shows non-virulence, one may disregard the bacteria and consider the child safe. It was, therefore, considered of greater value in Islington to do a few virulence tests. This has been our practice now for some years. I understand that the outbreak at Claremont Mission was complicated by a nurse being found to be a carrier in July, as well as carrier cases among probationers and voluntary workers, in addition to toddlers, these cases being found in the course of the investigation of the Medical Officer of Health of Finsbury. The Ministry of Health some years ago issued among reports on public health subjects, No. 10 Dr. Copeman's Report on Diphtheria, and Sir George S. Buchanan, in his preliminary note to this report to the Chief Medical Officer, Sir George Newman, in November, 1921, then emphasised the futility of notifying "bacteriological" cases of Diphtheria. The following extract from the Ministry Report has been circulated by the Islington Health Department for some years to the medical practitioners of Islington :— MINISTRY OF HEALTH REPORT ON DIPHTHERIA. "Notifiable Diphtheria.—The notification of cases of Diphtheria should be limited to persons actually suffering from Diphtheria, i.e., those exhibiting clinical signs of the disease, with or without bacteriological evidence of the presence of Diphtheria bacilli. In the practice of some districts and of many medical practitioners, including, often, the medical officers of hospitals and residential schools, notification is frequently extended to include Diphtheria carriers who themselves present no signs of illness. It 1927 44 is doubtful whether this practice is justifiable. Statistically it leads to much confusion ; indeed, comparisons between Diphtheria notification rates in different areas and in different parts of the country have for some years been rendered very unreliable by reason of uncertainty in this respect. Administratively, the effect may be equally unsatisfactory. The healthy carrier, as a result of his notification as a victim of Diphtheria is frequently removed to hospital where he may stay to the exclusion of persons urgently requiring treatment (a matter of great importance during the stress of an epidemic) and at unnecessary cost to the public authorities. Further enquiry and consideration might have shown that no benefit to the community or to the individual was likely to result from his segregation. A child attending school, for example, who is found to be a carrier, may merely have acquired that condition in common with the majority of the other children in his class at a time when Diphtheria infection has been prevalent in the school for many months, and himself have no signs of illness ; his bacilli may be nonvirulent, and consequently he does not in all probability constitute a danger to others. Non-virulent Diphtheria bacilli are not known to be capable of changing into virulent organisms." The outbreak at the Claremont Mission would appear to have been a few cases of genuine Diphtheria, but the number was swelled and much anxiety caused by the "bacteriological" cases found by swabbing the whole staff and the children in attendance. Amongst the general public, if such swabbing were carried out, there would also be found a considerable number of "carriers," the majority of them non-virulent. DIPHTHERIA—PATHOGENICITY TESTS. 1927. No. Submitted for Negative Result. Positive Result. Non-Virulent. Virulent. Examination. (Bacilli) (Bacilli) 36 29 7* 2 4 *1 not tested for Pathogenicity Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1917-27. Periods. Diphtheria. Enteric Fever. Pulmonary Tuberculosis. Totals. Positive Results. Negative Results. Total Examined Positive Results. Negative Results. Total Examined Positive Results. Negative Results Total Examined 1917 100 216 316 12 8 20 165 420 585 921 1918 74 171 245 3 21 24 111 358 469 738 1919 116 352 468 5 15 20 92 348 440 928 1920 261 677 938 3 20 23 83 375 458 1,419 1921 238 969 1,207 3 19 22 127 421 548 1,777 1922 291 953 1,244 - 9 9 139 472 611 1,864 1923 306 1,371 1,677 5 15 20 152 719 871 2,568 1924 180 1,333 1,513 - 17 17 127 650 777 2,307 1925 232 1,618 1,850 2 12 14 160 762 922 2,786 1926 183 1,501 1,684 3 9 12 148 691 839 2,535 Average 10 years 198 916 1,114 4 14 18 130 522 652 1,784 1927 260 1,573 1,833 3 21 24 111 661 772 2,629 45 1927 VACCINATION. Of the 5,357 births registered in 1926, the returns of vaccination shows that only 2,631 infants were successfully vaccinated, while 13 were found to be insusceptible. There were also 256 who died unvaccinated, and 1,896 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians; 30 vaccinations were postponed under medical authority, 231 were removed to other districts or place unknown, thus leaving 300 unaccounted for. The return of certificates of exemption, therefore, represents 35 per cent, of the registered births. Vaccination per 100 Years. births, less infants who died unvaccinated. 1921 44.9 1922 46.3 1923 54.8 1924 64.0 1925 50.4 1926 51.5 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years :— 1921 2,508 1922 2,347 1923 1,751 1924 1,755 1925 1,973 1926 1,951 1927 1,896 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1926. Registration Sub-Districts. Number of Births registered in 1926 Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Statutory Declarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children remaining Unvaccinated. or not accounted for (Defaulters). Total Number of Certificates of Primary Vaccination of children under 14 years received during year 1927. Number of Statutory Declarations of Conscientious Objection received during year 1927. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 447 233 3 - 133 30 6 16 19 8 l 1,687 129 Up. Holloway 790 398 2 - 238 39 6 36 61 10 198 Tollington 447 231 3 - 143 26 4 6 19 15 159 Highbury 791 370 1 - 310 32 3 20 34 21 295 Lr. Hollowav 722 327 2 - 268 31 3 7 18 66 1,660 234 Barnsbury 969 518 - - 491 61 5 6 36 30 317 Islington, S.E. 1191 554 2 - 313 37 4 7 44 52 491 The Borough 5367 2631 13 - 1896 256 30 98 231 202 3,247 1,823 DISINFECTION. Disinfection of Rooms—3,114 rooms were disinfected, as contrasted with 3,533 in 1926. For this purpose formaldehyde in solution, was employed, although it was sometimes augmented by sulphur fumigation, when it was 1927 46 necessary to kill vermin, for which purpose sulphur has been found effective. For the extermination of bugs, in addition all the architrave mouldings and skirting boards behind whch they breed are removed, and the walls washed wth hot lime. The above figures also include the dininfection of houses and rooms after Tuberculosis, vide P. 38. Rooms Disinfected. 1927 1926 1st Quarter 711 921 2nd 790 807 3rd 640 736 4th 973 1,069 The Year 3,114 3,533 Work at the Disinfectin Station.—46,606 large articles of bedding, ets., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 42,950 similar articles disinfected during the previous year. In addition to the above articles, 11,733 second-hand garments, mostly overcoats, jackets, tunics and British warms were disinfected for clothing contractors trading in the Borough, who paid the Council for the work, amounting to the sum of £81 15s. 0d. Altogether 58,339 articles described in the two paragraphs preceding were disinfected. Since the disinfection station was established 2,217,584 large articles have been disinfected. Summary of the chief article of Clothing, Bedding, etc., disinfected during the year 1927, and also in the preceding year 1926. 1st Quarter. 2nd Quarte r. 3rd Quarter. 4th Quarter. The Year 1927 1926 Beds 468 481 433 462 1,844 1,893 Blankets 1,269 1,389 1.059 1,247 4,964 5,293 Bolsters 522 496 385 532 1,935 1,595 Carpets 7 1 8 16 32 14 Chair Bed Cushions 30 30 10 36 106 169 Mattresses 405 407 311 392 1,515 1,934 Palliasses 2 2 5 5 14 17 Pillows 1,544 1,530 1,140 1,332 5,546 5,703 Quilts 490 4 4 411 462 1,857 2,031 Sheets 1,002 978 859 1,024 3,863 4,231 Other Articles 7,673 7,106 4,916 5,235 24,930 20,070 Totals 13,412 12,914 9,537 10,743 46,606 42,950 The nature of the articles disinfected for the clothing contractors is shown below :— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Overcoats 1,320 1,777 966 710 4,773 Jackets 400 1,289 550 350 2,589 Tunics - - 100 - 100 British Warms 470 526 68 50 1,114 Other Articles 272 2,281 509 50 3,112 Bales of Horsehair 23 - - 22 45 Total 2,485 5,873 2,193 1,182 11,733 47 1927 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 Solution Ordinary. Special. To Householders Tons. 2 cwts. 0 Gallons. 160 Gallons. Nil, Gallons. Disinfection of Premises - - - - 100 Cost = £47 Is. 8d. Shelter House.—The Shelter House was not occupied during the year, but baths were given to 8 verminous persons, and 4 persons suffering from scabies, while their clothing was disinfected. Eight midwives attended for the purpose of disinfection after attendance on cases of Puerperal Fever; and 17 other persons who had been in contact with cases of infectious diseases also had their clothing disinfected. Disinfestation of School Children (Cleansing from lice and other vermin).— During the year 5,035 (including 332 for Scabies) 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 59. The agreement entered into between the London County Council and the Borough Council from the 1st January, 1921, for the cleansing of verminous children, is a payment at the rate of 2s. for each attendance of each child at Cleansing Station, except when such child is, or is suspected to be, suffering from Scabies, in which case payment by the London County Council will be at the rate of 1s. for each bath given. The minimum payment to be paid to the Borough Council in respect of such cleansing shall not be less than £100 per annum. The amount paid during the year by the London County Council for the baths given to the children was £486 18s. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, in 19 instances during the year, when fines ranging from 5s. to 10s. were inflicted. The total fines received amounted to £7 10s. PUBLIC BATHS AND WASHHOUSES IN ISLINGTON. The Municipal Baths and Washhouses are situated in Hornsey Road, N.7, Caledonian Road, N.l, and Greenman Street, N.I. At each of these three establishments, in addition to private baths (warm, cold and shower) there are swimming baths in separate departments for men and women. Each has also a large washhouse, fitted with appliances for washing, boiling, drying, mangling and ironing. In October, 1927, a Water Filtration Plant was installed at the Hornsey Road Swimming Baths. Plant had already been installed at Caledonian Road and Essex Road Baths since 1906. At that time it was not found necessary to instal plant at Hornsey Road because art abundant supply of water was procurable from artesian wells. During recent years, however, the volume of water thus obtained had diminished gradually; therefore, to conserve the supply 1927 48 a filtration plan was called for. Large quantities of water had for some time been taken from the mains of the Metropolitan Water Board, and a saving will be effected from the aspect of finance as well as a gain in purity by filtration. The sanction of the Ministry of Health was obtained. The plant is capable of treating 400,000 gallons of water in 2 to 5 hours. It consists of eight 8 feet diameter Bell's Patent Pressure Filters, having a filtration area of 402 square feet, capable of filtering 100,000 gallons of water per hour, at a rate ranging from 100 to 174 gallons of water per square foot area per hour according to the number of swimming baths in use. The filtering material is Leighton Buzzard sand, as is used in waterworks plant, the depth of each filter bed, which contains approximatelv seven tons of sand, is about 3 feet 4 inches. The filters are cleansed by means of a special reverse flow, secured by the arrangement of the strainers and by additional agitation of the bed by the revolving of wash arms, carried inside the filter, which are rotated horizontally by means of gearing. The plant has apparatus for adding to the water suitable chemicals for coagulating the impurities, so that they can be arrested on the top of the filter bed, for sterilizing the water, and for preventing the water from becoming acid. 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 Acts, 1901, were carried out in his district during the year 1927. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under :— Factories, including Factory Laundries 677 Workshops, including Workshop Laundries 902 Workplaces, other than outworkers' homes 362 Domestic Workshops 82 Bakehouses 324 Restaurant Kitchens (see also p 61) 432 Outworkers' premises 1,184 Miscellaneous re-inspection and calls 4,887 Total 8,850 Notices Served —In consequence of the 1,348 sanitary defects discovered as the result of the inspections above; 219 intimations and 14 statutory notices were served. Of these notices 60 were served on the owners of factories, 102 on the owners of the workshops and workplaces, and 10 on the owners of bakehouses and 33 of restaurant kitchens. In addition to these nuisances, 134 were discovered on Outworkers' premises, necessitating the service of 28 notices. Most of these defects were remedied and it was only found necessary in one instance to resort to legal proceedings. In this case the defendant completed the work before the summons was heard, but was ordered by the Magistrate to pay £5 5s. costs to the Council. Registers. —There were 2,367 workshops on the Registers, as contrasted with 2,280 in 1926, while the total number of workrooms were 3,291, as compared with 3,136 in the previous year; 173 workshops were added to the Registers, while 86 were removed from it. 49 1927 The various workshops and workplaces are tabulated as below :— 1927. Workshops and Workplaces. Total Workshops , on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1,064 1,629 101 38 Workshops where Women are employed 531 825 49 45 Laundries 43 55 2 1 Bakehouses 234 243 - - Restaurant Kitchens 440 484 13 2 Other Workplaces 55 55 8 - Total 2,367 3,291 173 86 Outworkers' Premises 3,160 - 481 378 Workshops Notified to Home Office during Year 1927. Trade. Number of Workshops. Women. Male Young Persons. Totals. Overalls 1 2 - 2 Dressmaking 16 73 - 73 Mantles 2 5 - 5 Costumes 1 2 - 2 Tailoring 4 9 - 9 Artificial Florist 2 10 - 10 Pattern Cards 1 6 - 6 Millinery 9 34 - 34 Leather Goods 1 10 - 10 Furriers 4 8 1 9 Blocking Hats 1 8 - 8 Carnival Novelties 1 4 - 4 Powder Puffs 1 8 - 8 Dressing Gowns 1 1 - 1 Tie Making 1 2 - 2 Piano Making 1 - 1 1 Cabinet Making 1 - 6 6 Motor Repairs 1 - 1 1 Sheet Metal Work 1 - 1 1 Upholstering 1 1 - 1 Cinema Slides 1 1 - 1 Toupees I 5 - 5 Motor Accessories 1 6 - 6 Brushes 1 5 - 5 Total 55 200 10 210 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Inspections. (2) Number of WrittenNotices (3) Prosecutions. (4) Factories 677 60 1 (Including Factory Laundries) Workshops 902 85 Nil. (Including Workshop Laundries) Workplaces 1,200 60 - (Other than Outworkers' premises) Miscellaneous Re-Inspections and calls 4,887 - - Total 7,666 205 1 1927 50 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Number of Prosecutions. Particulars. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*— Want of cleanliness 396 397 - Nil. Want of ventilation 34 34 - ” Overcrowding 7 7 - ” Want of drainage of floors 12 11 - ” Other nuisances 500 500 - ” Sanitary Accommodation insufficient 47 44 - ” unsuitable, foul or defective 338 329 - 1 not separate for sexes 12 12 - - Offence9 under the Factory and Workshop Arts— Illegal occupation of underground bakehouse (s. 101) 1 - 1 - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) 1 1 - - Total 1,348 1,335 1† 1 * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 155 Workshops were also notified H.M. Inspector, of failing to affix Abstract of Factory and Workshop Act (s. 133). OUTWORKERS' PREMISES. Noticcs Instances. Served. Remedied. Prosecutions. Outwork in unwholesome premises (s. 108) 134 28 134 Nil Outwork in infected premises (s. 100, 110) 21 Total 155 28 134 Nil OUTWORKERS' LISTS (s. 107) : Lists received from Employers 1,670 Addresses received from Other Councils 1,958 Addresses forwarded to Other Councils 942 Firms failing to send in lists (No. letters sent) 313 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories • Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 55 Action taken in matters referred by H.M Notified by H.M. Inspector 13 Inspector as remediable under the Public Health Acts, but not under the Reports (of action taken) sent to Factory and Workshop Act (s. 5, 1901). H.M Inspector 13 Other (New Factories reported under Home Office Memorandum, 1912) Nil Underground Bakehouses (s. 101) in use at the end of the year. 77 51 1927 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing Apparel— Making, &c. 62 13 Nil Cleaning and washing - - - Household linen - - - Lace, lace curtains and nets - - - Curtains and furniture hangings 2 - - Furniture and upholstery 6 - - Electro-plate - - File making - - - Brass and brass articles - - - Fur pulling - - - Cables and chains - - - Anchors and Grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, &c. - - - Artificial flowers 16 1 - Nets, other than wire nets - - - Tents - - - Sacks 1 - - Racquet and tennis balls - - - Paper, &c., boxes, paper bags 27 9 - Brush making 15 6 - Pea picking - - - Feather sorting - - - Carding, &c., of buttons, &c. - - - -Stuffed Toys Basket making 1 - - Chocolates and sweetmeats - - - Cosaques, Christmas Crackers, Christmas stockings, &c 2 - - Textile weaving - - - Total 134 29 Nil DISTRICT INSPECTORS' WORK. During the year the fourteen district inspectors made a total of 56,399 inspections and calls, or an increase of 188 inspections on the corresponding period of 1926; while 13,761 improvements were effected in 6,105 premises; as against 14,299 improvements in 6,115 premises for the preceding year. Synopsis of Inspectors' Work,—The following statement gives a brief synopsis of the district inspectors' work in 1927 :— House to house inspections 2,939 Other inspections of dwelling houses 5,468 Re-inspections and calls made 44,437 Visits of inquiry re notifiable infectious diseases 2,166 Butchers' shops, stalls, etc. (Saturday nights) 50 Ice cream shops and factories 78 Dairies and Milkshops 900 Stables and yards 1,328 Manure depots 7 Smoke observations 232 Notices Served.— There were 4,664 intimation notices served by the inspectors with respect to nuisances. In 513 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.—25 premises which were found to be in a verminous condition, were cleansed by the owners or 1927 52 occupiers upon receiving the Inspectors' intimations. In 8 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Smoke Nuisances.—60 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 232 observations were made by the District Inspectors, and 10 notices served upon the owners of the businesses requiring the abatement of the nuisance. It was not, however, found necessary to institute legal proceedings. Report on the Facilities for the Practical Training of Candidates for the Sanitary Inspectors' Certificates. The Medical Officer of Health reported fully to the Public Health Committee on the method adopted in Willesden, where the scheme is dignified by being termed a "scholarship," and also on the method, which was considered rather better, adopted in Brighton. After considering the subject very fully, the Committee resolved : "That the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board be informed that the Committee do not propose to take any action in the matter at the present time, but that in the event of any application being received from an Islington resident for facilities for practical training in the duties of a sanitary inspector to enable the applicant to comply with the regulations of the Joint Board, such application will be considered on its merits by the Committee. New Legislation. Among other items of legislation, the Bakehouses, Welfare Order, 1927, directed more particularly against Bakers' Dermatis, the so-called "Bakers' Itch," came into force. Washing facilities and other suitable safeguards for the workers are now compulsory. The Nursing Homes Registration Act, 1927, provides for the registration and inspection of Nursing Homes (including Maternity Homes) as from the 1st July, 1928. The London County Council (General Powers) Act, 1927, deals, inter alia, with street trading, consents as to offensive businesses, the lighting of staircases in tenement buildings, this last coming into force on the 1st August, 1928. REMOVAL OF DUST. 25 applications were received during the year for the removal of dust, which is 5 above the number recorded last year. The applications received for the previous ten years were as follows :— 1917 30 1922 15 1918 11 1923 16 1919 19 1924 33 1920 36 1925 21 1921 21 1926 20 Dust Receptacles Provided.—During the year 1,738 dust receptacles were provided, while 6 were repaired after the service of sanitary notices, 63 1927 Summary of Sanitary Work from Inspectors' Reports for the year 1927. Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 196 200 *239 209 170 217 132 80 376 226 242 283 167 202 2939 Other premises inspected 272 266 271 581 268 338 287 377 481 355 359 676 398 539 5468 Re-inspections, Calls made, etc. 2551 2583 3296 3839 2098 3574 2713 3083 4125 3200 3553 3555 3893 2374 44437 Ice Cream Factories inspected - 1 26 - - 21 - 1 18 1 5 2 3 - 78 Dairies and Milkshops „ 5 44 110 69 1ll 88 93 73 74 57 58 41 46 31 900 Stables 25 4 12 2 143 5 5 - 3 7 - - 1 3 210 Yards 107 77 164 33 389 11 193 12 35 54 - 9 19 15 1118 Manure Depots „ 1 - - - - - - - 2 - - - - - 7 Vacant land, Passages and Courts inspected 20 6 1 99 1 44 2 1 4 1 1 - 2 184 Urinals attached to P.H.'s inspected - 56 85 12 20 118 96 - 14 36 1 1 - 209 648 Premises (re Certificate Customs and Inland Revenue Acts) spacted - - - - - - - 5 - - - - - - 5 Premises (re Water Certificates) inspected - - *91 - - - 3 5 - - - - - 24 123 Visits re Sale of Food and Drugs Acts - - h.toh - - - - - - - - - - - - Smoke observations 2 22 12 8 8 5 18 1 112 2 6 9 16 13 232 Shops, Stalls and Markets (Saturday evening) 4 4 4 5 4 2 3 3 3 3 5 3 4 3 50 Total Inspections and Calls 3183 3263 4 11 4764 3310 4380 3585 3642 5244 3945 4230 4580 4547 3415 56399 Notices Served. Intimation Public Health (London) Act. 1891 194 254 262 554 70 347 244 282 518 397 385 595 273 273 4648 Housing &T.P. Act - - - 1 - - - - 1 - - - - - 2 Ice Cream Shops - - - - - - - - - - - - - - 4 Milk shop & Dairies - - 1 1 1 2 - - 7 - - - - - 12 Statutory Public Health (London) Act, 1891 16 19 23 54 8 49 31 24 89 71 20 56 28 25 513 Housing Act, 1925 - - - - - - - - - - - - - - - Improvements. Drains— Constructed 2 - - - 2 - - - - - - 3 1 - 8 Re-constructed 10 19 8 1 4 2 3 8 4 10 1 8 1 3 82 Repaired 17 14 24 40 7 41 21 15 14 34 46 39 17 16 345 Ventilated 7 18 9 12 5 7 6 6 4 7 2 13 3 - 99 Gully and other traps fixed 54 81 30 15 26 27 15 37 35 52 11 22 1 3 409 urinals— Water supply—cleansed - 1 7 1 - 4 1 - 5 2 1 1 - 2 25 Cesspools—Abolished - - - - - - - - - - - - - - - Vater Closets— W.C. erected with pan, trap and Water Supply 3 3 - - 2 2 - - 3 2 - 4 1 3 27 Pan and trap only provided 21 46 22 43 13 8 25 31 22 36 50 30 5 20 372 Flushing apparatus repaired 24 30 20 58 - 27 24 25 37 20 58 59 16 18 416 Ventilated - 1 - - 1 1 - 1 1 32 2 1 - - 10 Walls, etc . cleansed 11 10 8 29 4 7 26 4 42 38 85 29 16 5 314 Position altered - - 3 4 - - - - - - - - - - 7 Dust Bins Provided 92 106 52 231 8 82 180 143 185 124 92 261 103 79 1738 Repaired - - - 2 - - - - 3 - 1 - - - 6 Areas Constructed - - - - - - - - - - - - - - - Paved 1 1 - 5 2 3 8 2 2 11 - 6 - - 41 Yards Paved 3 - - - - - - 1 3 - - - - - - 7 Repaved 22 24 22 89 5 17 18 11 31 37 11 461 2 7 342 Sinks Provided 11 21 9 3 6 2 4 7 21 31 17 8 - 3 143 Waste pipe repaired 19 31 31 34 9 17 18 15 31 59 15 26 8 12 325 Domestic Water Supply— Cisterns Provided - - 1 - - - - - - - 1 1 - - 3 Cisterns repaired aid cleansed 6 13 16 28 4 8 14 - 20 5 7 21 2 3 149 Water supply provided to dwelling house 3 8 - - - 2 - 4 1 - 2 2 - - 22 Water supply provided to tenement house 1 3 - 5 1 7 - 3 14 9 - 7 3 2 55 Walls and ceiling of Rooms Cleansed and redecorated 85 104 165 485 44 264 188 153 376 328 325 377 149 153 3196 Carried forward 1927 54 HOUSES LET IN LODGINGS. The 1,011 houses which come under the operation of the bye-laws received 727 inspections during the year, followed by 3,556 subsequent re-inspections and calls, so that the total visits amounted to 4,283. These inspections resulted in 457 intimations being served on the persons responsible, which were followed by 38 statutory notices to demand the abatement of the nuisances discovered by the inspector especially engaged upon this work. No prosecutions' for non-compliance with the notices served were found necessary. Altogether, 1,077 improvements were effected in 304 premises. Of recent years it will be noted that the figures cannot be compared with the time when we had two inspectors on this work. No matter how hard the Inspector of Houses Let in Lodgings may work, it is of course impossible to do the work of two men, and only the very worst houses can from urgency receive systematic visitation. Synopsis of Inspectors' Work:— Improvements. Drains : Constructed Reconstructed 2 Repaired Ventilated Gully and other traps fixed 8 Urinals : Water supply—cleansed Cesspools : Abolished Water Closets : W.C. erected with pan, trap and water supply Pan and trap only provided 11 Flushing apparatus repaired 18 Ventilated 1 Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Other improvements— /Staircase and passages repaired, cleansed and redecorated 12 19 27 85 8 40 47 21 78 58 58 70 27 22 572 Floor space ventilated 1 1 6 7 1 2 5 2 7 17 3 9 - 1 62 Floors repaired 14 14 23 82 7 34 17 15 54 22 29 77 12 14 414 Guttering and rain water pipes repaired 27 42 16 78 6 53 42 31 24 56 30 59 14 18 496 Roofs repaired 18 48 55 228 11 60 51 55 115 101 115 198 75 57 1187 Overcrowding abated - 1 - 3 - 1 3 2 6 1 2 3 - - 22 Illegal use of underground rooms for sleeping discontinued - - - - - 1 2 - 1 1 1 4 - - 10 Other improvements, or Nuisances abated 36 48 96 213 36 116 67 73 172 139 190 265 48 90 1589 Rooms Disinfected 189 158 132 184 31 47 60 11 24 34 181 29 104 84 1268 Total improvements 689 865 786 1965 243 882 846 680 1332 12361336 1678 608 615 13761 Total premises improved 353 421 384 756 99 356 408 315 555 448 668 628 362 352 6105 55 1927 Walls, etc., cleansed Position altered 1 Dust Bins : Provided 77 Repaired Areas : Constructed Paved Yards : Paved Repaved 8 Sinks : Provided 16 Waste pipe repaired Domestic Water Supply : Cisterns provided Cisterns repaired and cleansed 1 Water supply provided to dwelling house Water supply provided to tenement house Walls and Ceilings of Rooms cleansed and redecorated 328 Other Improvements : Staircase and passages repaired, cleansed and redecorated 63 Floor space ventilated Floors repaired 63 Guttering and rain water pipes repaired Roofs repaired 89 Overcrowding abated 2 Illegal use of underground Rooms for sleeping discontinued Other Improvements, or Nuisances abated 389 Rooms Disinfected Total Improvements 1077 Total Premises Improved 304 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. Summary of Work under the Rats and Mice (Destruction) Act during the years 1922-27 :— 1927 1926 1925 1924 1923 1922 Number of Streets visited 235 217 96 91 544 711 Number of Private Houses visited 368 320 133 176 650 1.023 Number of Shops and Factories visited 81 61 14 19 712 1,009 Total Premises inspected 449 381 147 195 1,362 2,032 Found Rat Infested 191 174 66 61 787 1,331 Found Mice Infested 8 5 2 1 66 72 Defective Drains Repaired (Cause of Rat trouble) 48 49 51 60 13 52 Number of Complaints received 102 173 105 118 67 177 1927 56 HOUSING. Summary of Housing from 1919 to 1927 (inclusive) :— The number of houses or flats provided by the Islington Borough Council, the London County Council and by private enterprise in the Borough, was as follows :— 1919 to Total since 1926. 1927. 1919. Number of houses or flats provided by the Islington Borough Council 721 24 745 Number of flats provided by the London County Council 161 161 Number of houses or flats provided by private enterprise 276 10 286 997 195 1,192 Particulars of houses or flats provided under the Council's Housing Schemes : 1919 to Total since 1926. 1927. 1919. Halton Mansions 160 — 160 (8 more flats to be erected on lease of two houses falling in during 1932). City Mansions 47 47 Queen's Mansions 44 44 Warltersville Mansions 46 46 Manchester Mansions 31 31 Addington Mansions 107 107 435 435 *Conversion of 16 houses into 61 dwellings 61 Tyndale Mansions 78† 24† 102† Laycock Mansions 132 132 Houses, etc., Highbury Station Road 15 15 721 24 745 *Includes :—27, Rupert Road 8, Barnsbury Street 27 and 25, Canonbury Villas converted 2, Highbury Grange † The figure 78 in the 1919-1926 column is a corrected figure, as 24 houses, although practically completed in that year, had not really had the water certificates granted, and these, properly speaking, are now placed in the year 1927. This accounts for the total figure 102 being the same as was given in the previous report. Ten houses of the rateable value of over £50 have been converted into 26 flats. The number of overcrowding cases recorded as dealt with during the year 1919 to 1927, was :— 57 1927 1919 11 1920 7 1921 6 1922 10 1923 17 1924 13 1925 19 1926 26 1927 24 Total 133 These figures, of course, represent only the number of cases which have been dealt with officially. The number encountered was numerous, but in view of the difficulties of finding other accommodation, proceedings were not instituted in the majority of cases met with. HOUSING RECOMMENDATIONS FROM THE PUBLIC HEALTH DEPARTMENT. During the year 1927 representations were made to the London County Council regarding housing accommodation for "special hardship" cases. These were cases in which there was gross overcrowding, and in all 30 were so recommended for special consideration. In addition to these recommendations letters were written on behalf of 21 other families who were considered to deserve consideration, owing to illness or other causes, for any spare accommodation after the "special hardship" quota had been dealt with. Thus in all 51 cases were written about to the Housing or Public Health Departments of the London County Council. DEMOLITION OF HABITABLE DWELLINGS. In section 6 of the Housing (Additional Powers) Act of 1919 power was given to prevent houses being converted into business premises. The section, however, was repealed by the Housing Act of 1925. During the year 1927 1 consider it would probably be under-estimated if we were to put the number of families thus de-housed, and compelled to find accommodation elsewhere, at about 72 families. METOPOLITAN BOROUGH OF ISLINGTON. Housing Statistics for the Year. Number of new houses erected during the year :— (a) Total (including numbers given separately under (b).) 195 (b) With State assistance under the Housing Acts. (i) By the Local Authority 24 (ii) By other bodies or persons 171 Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,498 1927 58 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing consolidated Regulations, 1925 1,296 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,734 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority of their Officers 1,457 3. Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 1 (b) By local authority in default of owner Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,666 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 4,666 (b) By local authority in defaut of owners Nil (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 59 1927 RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920, 1923 and 1925. Number of applications for certificates and "reports" under above Acts. Year. House or part of the house not kept in a reasonable state of repair. House or part of the house kept in a reasonable state of repair. "Report" re completion of work mentioned in schedule issued with certificate. Certificates not issued Total 1920 25 28 . 1 54 1921 269 52 1 5 327 1922 157 25 11 2 195 1923 123 8 15 2 148 1924 117 6 19 . 142 192S 96 5 12 3 116 1926 68 4 26 2 100 1927 67 7 19 2 95 T otals 922 135 103 17 1,177 STATE OF PAUPERISM IN THE BOROUGH. There was a decrease of 1,266 in the number of paupers relieved during the year for the weekly average was 9,326 compared with 10,592 in 1926. Appended is a statement furnished by the Clerk to ths Islington Guardians :— Showing the State of Pauperism in the Borough during the year 1927. Quarters. 1 Average number Relieved during each week. Borough Death rates, 1927. 8 Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals, 1927 5 Totals corresponding periods 1926. 6 Children Boarded out. 7 Adults. 3 Children under 16. 4 1st Quarter 3,100 4,852 2,892 10,844 10,725 30 18.3 2nd „ 2,921 4,279 2,260 P,460 11,175 28 10.1 3rd” 2,851 3,876 1,772 8,499 10,063 26 8.9 4th ” 2,934 3,837 1 732 8,503 10,404 23 13.0 The Year 2,951 4,211 2,164 9,326 10,592 27 12.3 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Food—Inspection of.—Inspector Wilkinson reports that during the year he has paid 710 visits to the 13 Slaughter Houses now on the register, including one Horse Slaughter House, and that he has ascertained that 9,588 animals were killed therein, namely 469 oxen and cows, 12 calves, 5,259 sheep and lambs, and 3,848 horses for human consumption, these latter being entirely for export. The quality and sound condition generally of the animals is shown by the fact that no carcase, or part thereof, was found unfit for human food ; whilst the number of diseased organs were very few, being due mainly, to parasitic affections, as will be seen in the table on page 63. 1927 60 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 - 3 - 27* Fish surrendered in bad condition - 14 1 25 Tinned and bottled foods surrendered in bad condition - 12 1 12 Fruit and Vegetables do do. 3 3 1 20 Sundry small quantities of foods - - - 20 Total 4 13 2 20 * Of this quantity 14 lbs. was Tuberculous. The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 4 tons 13 cwt. 2 qrs. 20 lbs. The diseases which affected animal food are set out in detail on page 63. UNSOUND FOOD. In connection with unsound food it is of interest to mention in some detail one or two instances. In May a dealer purchased from a City firm three tons of a special brand of chocolate at a penny per pound for cattle food only. While we could trace no absolute evidence that this particular consignment; of chocolate was being sold, the fact remained that one of our Inspectors traced in a confectioner's shop in the borough a quantity of rancid chocolate of the same brand, which had been purchased from a dealer in South Tottenham. There was a strong suspicion that this Tottenham dealer was an agent of the person who had received the chocolate for cattle food, but as generally happens in these cases, the matter was so involved that no particular person could be proceeded against, but we obtained a surrender of as much of the chocolate as we could trace in the borough. It is believed that the chocolate was made with oil in Belgium and was either rancid when made, or rapidly became so. UNSOUND TINNED FOOD. BLOWN TINS OF LOGANBERRIES. During the year a further report on tinned food of doubtful quality was submitted by the Medical Officer of Health to the Public Health Committee. Shops, etc., Inspection of.-The 716 shops and places where foodstuffs are sold may be approximated for the year as follows :— Butchers, provision dealers, etc., shops, 250; meat, provisions, rabbits, tinned foods, etc., stalls, 28; food preparation establishments, 14; fish shops, 110; fish stalls, 10; fruit shops, 214; and about 90 fruit, etc., stalls and barrows, including stalls in the Metropolitan Cattle Market inspected on Tuesdays and Fridays. To these 23,563 visits were paid, apportioned as follows :— Butchers, Provision Dealers, etc., Shops 7,985 visits Food Preparation Establishments 132 ,, Butcher, Provision, etc., Stalls 2,317 ,, Fish Shops 1,461 ,, Fish Stalls 706 ,, Fruit Shops 2,706 ,, Fruit Stalls 8,256 ,, Total 23,563 ,, No summonses were taken out under Sec. 47 of the Public Health (Lond.) Act, 1891, during the year. 61 1927 Restaurant Kitchens.—The work of inspecting restaurant kitchens is tabulated under Workshops. This work is done by the two women inspectors, whose work was reviewed fully in the Report of 1926, p. 58. 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 Inspected. Number found Unsatisfactory. Hotel and Restaurant Kitchens 65 16 Coffee and Dining Rooms 190 52 Refreshment Rooms 89 40 Provision (Cooked Meats, cooked but not consumed on premises) 88 25 432 133 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Three Butchers were summoned for having an uncovered meat stall on the pavement in front of their shops and were convicted at the North London Police Court under the Public Health (Meat) Regulations, 1924. In two instances fines of £2 with £1 1s. costs were inflicted; while in the remaining case a fine of £1 was imposed. Full summaries of action previously taken by the Publc Health Department will be found on pp. 59-60 Report for 1926. SALE OF FOOD ORDER, 1921.—THE LABELLING OF MEAT AND EGGS. Four summonses were issued under the "Sale of Food Order, 1921," for exposing for sale "Imported Meat," not duly labelled, and resulted in fines of £1 with 20s. costs; 10s. with 10s. costs; and £2 2s. with £2 2s. costs respectively, in three cases. The fourth summons, however, was withdrawn, being an alternative summons against the proprietors in the last-named charge, where the Justices held the manager responsible. Ten summonses were taken out for exposing or selling " Imported Eggs " as new laid, one wholesaler being fined £2 2s., with £2 2s. costs. Six retailers were prosecuted, in one case the fine inflicted being £10, with £2 2s. costs. One defendant was fined £2 2s. and ordered to pay £2 2s. costs. Another retailer, who had three summonses against him, was mulcted in £3 3s. costs on the first summons, with £1 1s. on each of the remaining two summonses. One defendant was ordered to pay £2 2s. costs, another retailer, whose case was not pressed, was fined 5s. with 5s. costs. Two other summonses were dismissed against one person owing to there being insufficient evidence and a difficulty of proving origin of the imported eggs. This Order is commented on in Annual Report 1926, pp. 60-61. Enquiry re Marking of Imported Eggs. The Medical Officer of Health and the Inspector of Meat and Food gave evidence at the enquiry on the marking of imported eggs held by the Standing Committee appointed under the Merchandise Marks Act of 1926 for the consideration of applications relating to agricultural produce. The Medical Officer described his experience in the administration of the existing Food Order. The difficulty was to distinguish between English and imported eggs, and since it was impossible to swear to an egg in Court, it was difficult to secure convictions. There was a good deal of mixing by small traders, although it was not widespread, 1927 62 because everything was done to check it. His opinion was that it was very little use proceeding under the present Order, and he was aware of the need for a measure that would enable them to identify imported eggs by definite marks. All imported eggs, however, were not inferior. There were instances where Dutch brown eggs were mixed with English eggs to improve the sample. With regard to stamping with an indelible ink, he considered the ink would have no detrimental effect on the contents of the egg, nor would it lead to deterioration if stamped eggs were put into preservative. Some interesting points had come out through the proceedings taken. Three of the cases were against wholsale dealers, as we refrained from taking action against the retailer, who has been misled in his purchases. In another case the purchase was. made of eggs which were unticketed, but the Inspector distinctly asked for "New Laid Eggs," and no mention was made of the fact that the eggs were imported. The defendant's manager and assistant, both at the time and in Court, maintained that no offence had been committed, as no written label had been used. With the remark that the defendant had been too clever, the Magistrate convicted. In other cases the word "imported" had been written on the back of the label or else in small letters at the foot, so as to be concealed by the eggs. The following additional notes may be of interest. In the Food Order of 1921 it seems to be no offence "under the Order" to mark eggs of any nationality "English" so long as the words" new laid" or "fresh" are not used in the description. This came forcibly to the mind of our Inspector when he saw Dutch eggs marked up "English," and priced with nothing else on the description. Descriptions of eggs are varied : "Direct from the farm," etc. A man had a large board exhibited with his name on it, and the name of a farm in Kent. He sells English eggs with some foreign eggs mixed with them. Needless to say, the! eggs do not come from any farm in Kent. Other terms used are : " Special Selected," " Best," " Very Best," etc. Dutch eggs are frequently higher priced than English eggs, so with Danish. There was at one time probably no more reliable egg on the market than the Danish. In the past the English farmer very frequently kept his eggs anticipating a better price, and it was a drawback to English eggs that they were small and not properly graded. Under the Food Order also, as far as it is concerned, it is no offence to apply an incorrect nationality to eggs. For instance, if it is a foreign description, Canadian marked as Danish, it is merely a misdescription. An English egg should be the best value. It is up to the English producer to grade properly to meet foreign competition. During the year 1927 ten summonses were taken in respect of eggs improperly labelled. Convictions were obtained in each case, and fines with cost amounting to £28 7s. Od. were imposed. Year. Fines. Costs. Total Fines and Costs. £ s. d. £ s. d, £ s. d. 1922 2 cases dismissed. 1923 17 4 0 13 17 6 31 1 6 1924 35 19 0 17 0 6 52 19 6 1925 35 11 0 26 15 6 62 6 6 1926 11 l0 0 4 10 0 16 0 0 1927 14 9 0 13 18 0 28 7 0 114 13 0 76 1 6 190 14 6 63 1927 SUMMARY of RESULTS of EGG CASES. Year. Fined, or fined and costs awarded. Costs only awarded. Dismissed. Total. 1922 - - 2 2 1923 15 6 - 21 1924 12 6 - 18 1925 18 5 1 24 1926 4 - - 4 1927 4 4 2 10 53 21 5 79 Cowsheds.—Only one cowshed is now within the Borough and it received 10 visits by the Inspector, who found it to be in a satisfactory condition. Offensive Trades include 4 tripe dressers, 2 gut scrapers, 1 fat melter and gut schaper; and the knackers' yard which received a total of 64 visits. The Inspector reports that he found no cause for complaint in the conduct of the business carried on in them. Tabulation of meat and organs diseased as found in slaughter-houses during the year 1927 :— No. of Cases. Description of Animal Affected. Nature of Disease. Extent of Disease. How disposed of. 17 Oxen Parasitic (Dis. Hep.) Liver (whole or part) Council's Destructor. 6 Oxen Necrosis do. ” ” 6 Oxen Abscess do. ” ” 1 Ox Tuberculosis (incipient stage) Lungs and adjacent membranes ” ” 1 Ox Parasitic (Dis. Hep.) Liver and lungs ” ” Milkshops and Dairies.—At the close of the year there were 540 milkshops and dairies on the register, 52 having been added to it, while 8 were removed. The District Sanitary Inspectors paid 900 visits to them, and served 12 notices for the carrying out of various sanitary improvements and the cleansing of dirty utensils. REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE MINISTER OF HEALTH UNDER THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 and 1917. During the past year (1927) 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. 1927 64 1. Milk and Cream Not Sold as Preserved Cream. Milk. Total number of samples Number in which Milk. Separated Milk, of milk examined for the preservative was presence of preservatives, found to be present. 740 Nil. 740 Nil. 2. Cream Not Sold as Preserved Cream. Number in 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 statesment on the label as to preservatives were correct : Correct statement made One. Statements incorrect Nil. (b) Determination of Milk Fat in cream sold as preserved cream. Above 35 per cent Nil. (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream have not been observed Nil. THE MILK AND DAIRIES (AMENDMENT) ACT, 1922 ; THE MILK (SPECIAL DESIGNATIONS) ORDER, 1922-23. During the year 1927, the following applications were made for licences under the provisions of the above Order to enable the persons to sell Specially Designated Milk :— LICENCES GRANTED UNDER MILK (SPECIAL DESIGNATIONS) ORDER, 1922-23. Designation. No. of applications. Number granted. Amount of Fees received. 1927. 1927. £ s. d. "Certified " 4 4 1 0 0 "Grade A." 7 7 5 9 0 (Tuberculin tested) "Grade A." Nil - - "Pasteurized" Nil — - (Dealer) "Pasteurized" 3 3 3 3 0 (Pasteurizer) "Pasteurized" (Supplementary) 2 2 0 4 0 16 16 £9 16 0 ADULTERATION OF FOOD AND DRUGS. During the year 1,395 samples of foods and drugs, including 394 informal samples, were submitted for analysis by Mr. Green, the Food and Drugs Inspector, who purchased the samples for submission to our Analyst Mr. A. Pinchin. B.Sc. Of the total samples 1,294 were reported to be genuine and 101 adulterated, or 7.2 per cent. This percentage is 3.5 above the previous year and equals the average rate during the preceding 10 years. During the year 1927, in addition to the official samples taken and submitted to the Public Analyst there was a total of 294 informal samples which were+ 65 1927] either submitted to the Public Analyst or examined by the Food and Drugs Inspector. These informal samples comprised about 40 varied articles. The Public Health Committee had under consideration the necessity for a room to be used by the Meat and Food Inspector for the retention of articles of food and by the Food and Drugs Inspector when informal samples were taken, and in the latter case the necessity of being able to perform a few simple tests. As mentioned in the report of last year, when informal samples are taken, the usual procedure of dividing the sample and leaving a portion with the vendor is not gone through, and therefore the possible delinquent is not aware that he is being tested. From the knowledge thus gained by the taking of informal samples, a concentration of the machinery, as it were, of the official sampling can be made where it is more likely to be protective and a deterrent, inasmuch as the person who is found to be breaking the law can be afterwards caught with official sampling, having revealed himself through the informal samples taken. The Committee, in view of this, sanctioned the gradual equipment of the laboratory room with a few simple reagents, etc. The greatest amount of detected adulteration occurred in the fourth quarter of the year, as shown by the figures given in the statement below, when it was 15.9 per cent. and contrasted with 5.0, 5.2 and 3.5 per cent., respectively, in the first, second and third quarters. Examined. Genuine. Adulterated. Per Cent. Formal Informal Formal Informal Formal Informal Adulterated 1st Quarter 353 29 335 28 18 1 50 2nd „ 290 55 272 55 18 - 5.2 3rd 230 110 219 109 11 1 3.5 4th 128 200 116 160 12 40 15.9 The Year 1,001 394 942 352 59 42 7.2 Prosecutions.-37 summonses were issued under the "Sale of Food and Drugs Acts," of which 32 were successfully prosecuted. Altogether penalties and costs to the amount of £136 12s. 6d. were obtained. Nine prosecutions were also taken under the "Milk and Dairies Order, 1926," resulting in convictions in each case with penalties and costs amounting to £27 6s. b—The informal samples purchased included the following:— Article. No. of Samples. A rticle. No. of Samples. Milk 2 Condensed Machine Skimmed Milk 1 Butter 27 Buns 1 Coffee 2 Cream 1 Strawberry Jam 4 Dried Pears 1 Ground Almonds 4 Mixed Fruit 1 Honey 1 Olive Oil 1 Sweets 51 Salmon and Shrimp Paste 1 Meat 5 Prescription 57 Sultanas 15 Calomel Ointment 16 Prawns 4 Biscuits 9 Shrimps 1 Ham 4 Full Cream Dried Milk 2 Tea 4 Bacon Ham and Tongue 3 Crystallised Fruits 1 Calamine Ointment 3 Cakes 19 Apricot Jam 1 Sausages 31 Brisket of Beef 1 Sponge Cakes 19 Mince Meat 1 Liniment of Turpentine 58 Meat Roll 1 Peel 3 Margarine 3 394 Full Cream Condensed Milk Sweetened 2 1927] 66 Milk.- The qualitative result of the Analyses of the Milk samples, which have now been published for many years, are as follows:— No. of Samples. Soldis not Fat. Fat. Total Solids. Milk purchased on Sundays 83 8.87 3.49 12.36 Milk purchased on Week-days 409 8.86 3.73 12.59 Milk produced in transit at Finsbury Park Station 94 8.84 3.69 12.53 Official Standard 8.50 3.00 11.50 Sophistication of Milk- The particulars as to the genuineness or otherwise of the samples procured or purchased on Sundays, Weekdays, and at Finsbury Park Railway Station are as follows:— Number taken Genuine. Adulterated. Percentage Adulterated. On Sundays 129 128 1 0.7 On Week-days 378 370 8 2.1 At Railway Stations 233 212 21 9.0 Farmers' Milks) 740 710 30 4.0 Giving the particulars of the Milks taken during each quarter of 1927 on Sundays, Week-days, and at the Railway Stations. 1927. No. of Samples Taken, Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Week- days. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. 1st Quarter 31 145 67 243 30 140 59 229 1 5 8 14 3.2 3.4 12.0 5.7 2nd „ 41 104 71 216 41 101 63 205 - 3 8 11 2.8 11.2 5.1 3rd „ 31 96 58 185 31 96 53 180 - - 5 5 - - 8.6 2.7 4th „ 26 33 37 96 26 33 37 96 - - - - - - - - The Year 129 378 233 740 128 370 212 710 1 8 21 30 0.7 2.1 9.0 4.0 The number of samples of milk purchased was 740, of which 710 were genuine and 30, or 4 per cent. were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1927:- MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 1917 592 526 66 11.1 1918 634 537 97 15.3 1919 638 579 59 9.2 1920 642 605 37 5.7 1921 644 605 39 6.0 1922 638 576 62 9.7 1923 676 644 32 4.7 1924 681 646 35 5.1 1925 684 652 32 4.7 1926 586 565 21 3.6 Totals 10 yrs. 641 593 48 7.5 1927 740 710 30 4.0 67 1927] Showing the analysis of 7,155 milks examined in Islington during the 10 years 1917-26 and 1927, and distinguishing those purchased on Sundays, on Week-days, and procured at the Railway Stations whilst in transit from the Farmer to the London Milk Purveyor:— Years. Sunday Milks. Week-day Milks. Railway Milks (Farmers). No. of Samples Per cent. of nonfatty solids. Per cent. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat. 1917 150 8.63 3.45 322 8.60 3.41 120 8.84 3.59 1918 136 8.39 3.60 377 8.44 3.53 121 8.61 3.65 1919 166 8.56 3.56 331 8.56 3.61 141 8.67 3.68 1920 162 8.71 3.42 338 8.76 3.52 142 8.86 3.66 1921 151 8.83 3.34 371 8.79 3.37 122 8.91 3.73 1922 120 8.78 3.39 356 8.76 3.34 162 8.75 3.60 1923 120 8.82 3.55 388 9.08 3.63 168 8.90 3.63 1924 120 8.74 3.42 399 8.78 3.48 162 8.87 3.65 1925 108 8.71 3.41 384 8.71 3.37 192 8.79 3.67 1926 83 8.81 3.65 409 8.78 3.63 94 8.88 3.62 Total samples and average constituents 10 years) 1,316 8.69 3.48 3,675 8.73 3.49 1,424 8.81 3.65 1927 189 8.87 3.49 378 8.86 3.73 233 8.84 3.69 68 1927] The Public Analyst, during the year reported on the genuineness of the articles examined as follows:— Showing the Samples of Foods and Drugs submitted to the Public Analyst dining the Year 1927. Article. Number examined. Number adulterated. Formal Informal Private Total Formal Informal Private Total *Milk (a) 738 2 - 740 30 1 - 31 Butter 136 27 — 163 3 — — 3 Lard 34 — — 34 - — — — Dripping 2 — — 2 - — — — Cocoa 9 — — 9 - — — — Pepper 17 — — 17 - - — — Arrowroot 4 — — 4 - — — — Mustard (d.) 6 — — 6 - — — — Coffee 4 2 — 6 - — — — Strawberry Jam (b c.) — 4 — 4 - — — — Ground Almonds 2 4 — 6 - — — — Honey (b.d.) 4 1 — 5 - — - — Sweets (b.c.) — 51 — 51 - — — — Meat (b.) — 5 — 5 - —. — — Sultanas (b.) — 15 — 15 - — — — Prawns (b.) — 4 — 4 - — — - Shrimps (b.) — 1 — 1 - — — — Full Cream Dried Milk — 2 — 2 - — - - Bacon (b.) — 33 — 33 - — - — Crystallised Fruits — 1 — 1 — - - — Cakes (b d.) — 19 — 19 - — — — Whisky 22 - — 22 15 — — 15 Sausages (b.) 1 31 — 32 - 1 — 1 Sponge Cakes (b.c.) — 19 — 19 — — — — Liniment of Turpentine 13 58 — 71 9 13 — 22 Peel (b.) — 3 — 3 — — — — Full Cream Condensed Milk (Sweetened) - 2 - 2 - - - - Buns (b.c.) — 1 — 1 — — — - Cream — 1 — 1 — — - Dried Pears (b) — 1 — 1 — - - Mixed Fruit (b) — 1 — 1 — — — - Condensed Machine Skimmed Milk (Sweetened( - 1 - 1 - - - - Olive Oil — 1 — 1 — — — - Salmon and Shrimp Paste (b) — 1 — 1 — — — — Prescription — 57 — 57 — 26 — 26 Calomel Ointment .. — 16 — 16 — 1 — 1 Biscuits (b.d.) — 9 — 9 — — — — Ham (b) — 4 — 4 — — — — Tea — 4 — 4 — — — — Ham and Tongue (b.) — 3 — 3 — — — — Calamine Ointmenj — 3 — 3 — — — — Apricot Jam (b.c.) — 1 — 1 — — — — Brisket of Beef (b) — 1 — 1 — — — — Mince Meat (b) — 1 — 1 — — — — Meat Roll (b) — 1 - 1 - — — — Margarine (b) 992 391 - 1,383 57 42 - 99 9 3 - 12 2 - — 2 Total samples 1,001 394 Nil 1,395 59 42 Nil 101=7 2% (а) All milk samples free from Boric Acid and Formalin. (b) Tested for Preservatives. (c) Free from prohibited dyes. (d) Prohibited colour absent. *Including 3 Milks taken in Paddington Station (Milk and Dairies Consolidation Act.) 69 1927] Milk Prosecutions. The summary of prosecutions showed that during the year 19 prosecutions were taken, of which number 17 were successful and 2 were withdrawn. Summary of Prosecutions during year 1927. (vide p.p. 77-81) Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties. Costs Received. £ s. d. L s. d. '' Public Health (London) Act, 1891" 22 21 1 24 10 0 38 17 0 '' Sale of Food and Drugs Acts, 1875-99 " 37 32 - 5 16 10 6 120 2 0 ''Margarine Act, 1887" — — - — - — - - — - ''Sale of Food Order, 1921" 14 11 2 1 18 1 0 17 10 0 "Milk&Cream Regulations, 1912-17" — — — — - — - - — - "Milk & Dairies Order 1926" 9 9 — — 14 6 0 13 0 0 "Public Health Meat Regulations, 1924 " 3 3 - - 5 0 0 2 2 0 "L.C.C. General Powers Act, 1922" 1 1 — — 4 0 0 1 0 0 '"L.C.C. By-Laws" 1 1 - - - - - 1 1 0 Totals 87 78 2 7 82 7 6 193 12 0 PUBLIC HEALTH STAFF. The staff of the Medical Officer of Health is constituted as follows:— Chief Sanitary Inspector and Superintendent.-George James Bridel, Sani. Insp. Ex. Bd. *Sanitary Inspectors.—T. W. Agar, A. J. Bicknell, A. Bakshaw, S. P. Marks, E. I. Fortune, J. Metcalf, T. H. Hancock, C. E. Horsman, A. E. Wood, E. G. Holmes, W. G. Neale, H. H. Uren, C. W. Lewis, †H. Dewhurst. L. H. Pearson. *Senior Sanitary Inspector, Inspector of Workshops and Bakehouses.- H. J. J. Watson. *lnspectors of Workshops, etc., in which Females are Employed.-Miss Eleanor H. Daniell, Mrs. S. Undery. *Inspector of Meat, etc.-H. Wilkinson. *Inspector of Food and Drugs, etc.-G. S. Green. *Inspector of Houses Let in Lodging.-R. C. Thorpe. *Health Visitors.-Mrs. Main, Misses V. A. Lainton, R. Palmer, L. Flower, E. Foot, E. Neale, †N. W. Dudfield, E. O. Oliver, M. Ritson. Tuberculosis Visiting Nurse.-Miss E. Mc Goldrick. Clerical Staff.-G. H. King (First Clerk), H. Angel, A. E. Abbott, W. J. Wolfe, W. G. Bunch, A. R. Wittrick, C. M. Wheble, ‡A. E. Booker, W. R. Causton, *C. J. Cridland, L. W. Edis, W. A. McAdam, L. P. J. Regan. Milk Grants.-* F. C. Green, *A. E. Vanstone, *Daisy Francis. Disinfecting Station.-A Lewis (Engineer), W. G. Jolllie (HandymanStoker), Mrs. Home (Cleansing Station Attendant), Mrs. Lewis (Caretaker, Shelter House), G. Cooper (Motor Driver). Disinfectors.-F. Webb, J. Brown, W. Hardwick, W. Woodley, A. Taylor. Mortuary Keeper.-S. Maxwell. *Those marked with an asterisk indicates contribution was expected either under the Public Health Acts or by Exchequer Grants. †Resigned. ‡ Died 3 Feb., 1927. The Medical Officer of Health expresses his thanks to the Town Clerk and the Chiefs of the other departments for their courtesy and assistance, which, together with the hearty co-operation of his staff, has meant so much in attaining the results reported on. APPENDIX. -0- Vital and Sanitary Statistics, also Legal Proceedings. 1927. TOGETHER WITH THE PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 72 1927] STATISTICAL APPENDIX Showing Deaths from all Causes in Islington during the Year 1927. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. Institutions within Borough. DISEASES. AGES. Under 5 Over 5 Tuf. U.H. DISTRICTS. Males. Female. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Toll. I,.H. H. B. S.E. Small Pox - - - - - - - - - - - - - - - - - - - - - - - - (a) Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - (b) Unvaccinated - - - - - - - - - - - - - - - - - - - - - - - - (c) No Statement - - - - - - - - - - - - - - - - - - - - - - - - Measles 7 21 1 28 1 — — 1 2 1 24 1 15 14 Scarlet Fever 1 5 2 - - - - - - - - - - 6 2 — — 2 1 1 2 2 4 4 - - - - - - - - - - - — — — — — — — — — — — — - Epidemic Influenza 4 4 4 1 2 1 13 21 22 28 34 17 1 8 144 15 13 18 18 32 16 40 79 73 0 Whooping Cough 23 20 2 — — — — — — — — — — 43 2 4 2 4 7 6 9 13 26 19 Diphtheria 1 14 9 1 - - - - - - - - - 15 10 2 4 4 1 3 8 3 11 14 Enteric Fever — — — — — — — — — — — — — — — — — — — — - - - - Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — - 4 Diarrhoea. Dysentery 4 3 1 - - - - - - - - 2 — 7 3 1 1 3 — 1 3 1 6 4 7 Epidemic Enteritis 8 - - - - - - - - - - - - 8 1 2 1 1 1 1 - — 6 3 2 Other Allied Diseases ab5 2 a — — — — — — — — — — — 7 — 1 1 — 2 1 - 2 5 2 Hydrophobia - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - Cow Pox - - - - - - - - - - - - - - - - - - - - - - - - 7 Syphilis 1 - - - - - 1 — 2 3 2 2 — 1 10 - 1 1 1 1 4 3 10 1 Gonorrhoea 1 — — — — — — — — — — — — 1 — — — — — 1 - - 1 - Phagedaena - - - - - - - - - - - - - - - - - — — — — — — - 7 Erysi pelas 1 1 — — — — 1 1 3 1 1 1 — 2 8 — 1 1 3 1 2 2 2 8 5 - - - - - 2 7 3 — — — — — — 12 2 1 3 2 2 — 2 - 12 7 Pyaemia - 4 — — — 1 4 2 — 5 3 1 — 4 16 1 2 2 5 1 1 8 13 7 7 Infective Endocarditis — — — 3 1 2 2 2 2 1 1 — — — 14 2 — 1 1 2 3 5 6 8 1 Other Allied Diseases — - — — 1 — — — 1 — — — — — 2 — — 1 — 1 - - - 2 Malarial Fever — — — — — — — — — — — — — — — — — — — — - - 1 Rheumatic Fever — — — 1 1 — 1 — — 1 — 1 — — 5 — — — — 2 - 3 4 1 2 Rheumatism of Heart — — — 2 4 1 1 2 1 - - - - - 11 1 3 2 — 2 2 1 5 6 3 Tuberculosis of Brain 2 8 — 3 — 1 1 - - - - - - 10 5 — 1 2 1 2 5 4 7 8 1 - — — — 1 — 1 — — — — — — — 2 — — - — 1 1 — - 2 89 Phthisis - 5 1 3 28 29 69 07 61 42 6 1 — 5 307 22 39 25 37 47 61 81 187 125 3 Abdominal Tuberculosis 2 l 1 1 2 2 — — — — — — — 3 6 1 — 1 — 1 3 3 5 4 General Tuberculosis — — 1 1 — — — — — — — — — — 2 — — — 1 1 - - 1 1 1 Other forms Tuberculosis - - 2 1 - 1 1 1 - - 1 1 - - 8 — 1 — — 1 2 4 5 3 Other Infective Diseases - - - - - - - - - - - - - - - - - - - - - - - - Thrush - - - - - - - - - - - - - - - - - - - - - - - - Actinomycosis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scurvy - - - - - - - - - - - - - - - - - - - - - - - - Other Diseases due to Altered Food - - - - - - - - - - - - - - - - - - - - - - - - 1 Acute Alcoholism - - - - - - - - 1 - - - - - 1 - - - - 1 - - 1 - Chronic Alcoholism — — — — — — 1 — 1 1 — — — — 3 1 1 — — 1 - - 2 1 Chronic Industrial Poisonings - - - - - - - - - - - - - - - - - - - - - - - - Other Chronic Poisonings - - - - - - — — — — — — — — — — — — — — - - - - Osteo-arthritis - - - - - - - - - 1 7 2 — — 10 — 1 1 - 2 3 3 2 8 - - — — — — — — — — 1 — - — 1 — — — — - - 1 1 - 177 Cancer — l — — 1 — 5 24 74 137 135 65 7 1 448 45 46 49 55 88 66 100 225 224 Diabetes Mellitus - - - - - - 1 — 6 7 7 6 - - 27 3 3 2 1 6 5 7 9 18 Purpura Haemorrhagica 1 — 1 — — — — — — — — — — 1 1 — — - - 1 1 - 2 - Haemophilia — — — — — — — — - - - - - - - - - - - - - - - - - - 1 - 2 - - 1 4 7 3 - - - 18 3 2 1 2 4 3 3 7 11 Lymphadenoma — — — — 1 1 1 1 — 1 — — — — 5 1 1 1 — 1 - 1 3 2 Premature Birth 68 - - - - - - - - - - - - 68 — 5 / 7 11 12 11 15 46 22 Injury at Birth 9 — — — — — — — — — — — — 9 — — 1 2 2 - 2 2 4 5 Debility at Birth 2 — — — — — — — — — — — — 2 - - - - - - 1 1 1 1 Atelectasis 9 - - - - - - - - - - - - 9 — 1 1 1 - - 5 1 4 5 Congenital Defects 25 l - - - - - - - - - - - 26 — 1 2 2 6 4 5 6 15 11 Want of Breast Milk — — — — - — — — — — — — — — — — — - - - - - - - Atrophy, Debility, Marasmus 12 l - - - - - - - - - - - 13 - - 1 1 1 3 3 4 7 6 a Cerebro-spinal Fever (6). b Ophthalmia Neonatorum (l) 73 1927] Continued. Institutions! BorougiiT| diseases. ages. Under 5 Over 5 DISTRICTS. Males. Females, i Totals 0- 1- 5- 10- 15- 20- 25- 35 45- 55- 65- 75- 85- Tuf. U.H. Toll. I*.H. H. B. S.E. Dentition _ _ _ _ _ Rickets 1 1 — — — — — — — — — — — 2 — — — — — — 2 2 — 2 Old Age, Senile Decay 2 15 91 69f — 177 23 21 13 22 32 32 34 55 122 177 Convulsions ... 4 1 — — — — — — — — — — — 5 — — 1 — 1 2 — 1 3 2 5 Meningitis 3 6 1 1 — — — 3 1 — — — — 9 6 2 2 1 2 2 2 4 9 6 15 Encephalitis 1 — 1 1 1 — 1 2 — — — — — 1 6 1 1 1 — 1 — 3 5 2 7 Apoplexy 1 1 1 12 29 29 25 6 1 103 13 9 11 16 21 16 18 39 05 104 Softening of Brain ... — — — — — — — — — 1 — 1 — — 2 — 1 — — — —• 1 1 1 2 Hemiplegia — — — — — — — — — 1 2 3 — — 6 — 2 — 1 — 2 1 1 5 6 General Paralysis of Insane ... ... 4 5 3 1 13 1 3 1 1 2 2 3 10 3 13 Other forms of Insanity — — — 1 1 1 1 4 8 1 1 1 3 2 4 4 8 Cerebral Tumour — 1 1 — — — 1 3 4 — — — — 1 9 — 2 2 1 1 2 2 7 3 10 Epilepsy — — — 1 — 2 3 1 2 1 1 2 — — 13 1 1 2 1 3 1 4 6 7 13 Laryngismus Stridulus — — — — — — — — — — — — — — — — — — — — — — — — Locomotor Ataxy 1 3 1 __ 5 1 2 2 4 1 5 Paraplegia ... ... 2 1 5 2 1 ix 3 3 2 4 Other Forms, Brain Diseases 1 lc 1 7c 3c lc 1 13 1 1 6 1 5 5 9 14 Otitis 1 1 3 2 1 — 1 1 3 1 — — — 2 12 — — 3 1 1 1 8 5 9 14 Disease of Nose, Epistaxis 1 Disease of the Eye ... 1 2 Pericarditis ... — — 1 — — — — 2 1 — — 1 5 1 1 1 2 5 5 5 Endocarditis ... — — 1 2 — — 3 — 3 3 7 1 — — 20 2 3 — 3 5 7 5 15 20 1 Hypertrophy of Heart — — — — — — — — 1 — — — — — 1 — — — — — 1 — 1 1 1 Angina Pectoris — — — — — 1 — 2 2 4 3 1 — — 13 5 2 1 2 1 2 10 13 5 Aneurism 5 7 6 o 20 2 4 3 3 3 16 4 20 6 Senile Gangrene — — — — — — 1 — 3 2 3 4 13 1 1 2 1 O 4 4 2 11 13 29 Embolism, Thrombosis — 1 1 — — — 1 2 6 12 20 20 3 1 65 12 6 5 8 16 12 7 26 40 66 1 Phlebitis 1 1 1 Varicose Veins — — — — — — — — — 1 — — — 1 — — — — — 1 1 1 £40 Other Diseases, Heart and Vessels 1 2 3 8 7 19 41 83 123 235 211 56 3 786 105 80 63 80 142 11 n 201 367 AOO 789 1 Laryngitis 1 1 1 1 2 2 1 2 1 1 lo 3 1 4 Croup — — — — 1 Other Diseases, Larnyx and Trachea 1 1 1 1 1 11 Acute Bronchitis 4 4 — — — — 2 4 7 7 31 32 5 8 88 14 9 9 10 20 14 20 34 62 96 60 Chronic Bronchitis ... 6 — — 1 — — — 17 20 37 67 76 17 6 235 23 24 20 23 37 46 08 118 123 241 30 Lobar Pneumonia 5 6 2 2 2 2 6 10 17 22 19 5 1 11 88 11 8 7 4 15 23 31 56 43 'of/ 102 Lobular Pneumonia ... CO 55 3 — — 2 6 4 17 25 33 28 3 115 121 11 23 27 38 35 51 51 136 100 236 4 Pneumonia 5 2 1 1 — 1 10 5 8 5 3 7 34 3 3 8 8 4 2 lo 17 24 41 11 Emphysema Asthma 3 5 5 8 1 1 23 1 2 1 2 6 5 0 19 4 23 3 Pleurisy 1 3 1 1 1 1 3 5 3 4 15 5 2 1 3 2 6 11 19 49 Other Diseases, Respiratory System 2 2 1 1 4 4 21 21 12 2 73 5 6 5 6 12 14 27 39 36 75 Diseases of Mouth and Annexi 1 _ _ _ 1 1 1 1 1 1 1 2 Diseases oi Pharynx — 1 1 1 Diseases of (Esophagus Ulcer of Stomach and Duodenum 1 9 16 13 6 1 46 4 3 4 2 9 11 13 3C 13 4 i Other Diseases of the Stomach _ _ _ o 1 1 4 1 2 1 4 4 15 Enteritis 26 7 — — — — — — — — — 2 1 33 3 3 7 6 5 6 7 23 13 36 9 Appendicitis ... 1 1 3 4 — 4 3 1 5 6 2 1 — 2 29 3 3 2 3 5 5 10 17 14 31 Obstruction of Intestines 7 2 5 3 5 8 2 25 4 6 1 4 7 3 7 18 14 32 Other Diseases of Intestines 2 1 o 1 1 1 2 i 3 9 Cirrhosis of Liver — — — — — — — 2 6 9 4 1 — — 22 2 5 — 3 3 4 5 10 12 22 Other Diseases of Liver — — — — — — 1 1 2 2 1 1 8 1 3 2 2 1 7 8 Peritonitis — 4 1 1 2 2 2 2 1 4 11 1 3 2 1 2 c 5 10 15 Other Diseases, Digestive System 1 1 1 2 3 Diseases, Lymphatic System and Glands 1 2 2 2 1 2 1 9 1 1 1 0 2 1 2 o 4 10 1 Acute Nephritis __ 2 1 1 1 5 2 2 A 26 Bright's Disease 2 1 1 2 8 9 23 27 30 11 1 115 8 16 8 13 24 12 34 •i 60 L 115 Calculus 3 1 3 2 11 1 1 1 2 1 4 1 2 i) 11 Diseases of Bladder and Prostate 1 c 1 7 Q Q g o A Q Other Diseases, Urinary System 1 1 2 1 1 0 1 X 1 4 O 5 I 1 0~i 15 O 3 3 Lt 4 2 y 1 1 5 10 2 30 9 7 32 16 Diseases of Testis and Penis 1 Diseases of Ovaries ... 1 1 2 A 4 1 Diseases of Uterus and Appendages 1 1 1 3 2 1 •i 3 3 Diseases of Vagina and External Genitals ... Diseases of Breast ... 1 Abortion, Miscarriage 1 1 1 3 1 1 1 3 3 Puerperal Mania 1 Puerperal Convulsions 1 1 1 Placenta Prajvia.Floodmg — - — — - 1 1 3 5 2 — — - 1 1 - i 5 5 c Encephalitis Lethargica (4) t I F. 101 ; :-F. 100 yrs. 74 1927] Continued. Deaths in Institutions within Borough. DISEASES. AGES. Under 5 Over 5 DISTRICTS. Males. | Females. Totals. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H H. B. S.E. Puerperal Thrombosis - - - - - 1 - - - - - - - - 1 - - - - 1 - - - 1 1 Other Diseases, Pregnancy and Childbirth - - - - - 1 1 - - - - - - - 2 - - 2 - - - - - 2 2 Arthritis, Ostitis, Peri- - - - - - - - - - - - - - - - - - - - - - - - - - Other Diseases, Osseous System - 3 - - - 1 - - 2 1 - — 1 3 5 - 2 1 - 1 3 1 7 1 8 Ul:er, Bedsore - - - - - - - - - - - - 1 - 1 - - - 1 - - - - 1 1 Eczema — — — - - — — — — — 1 — — 1 — — - - — 1 — 1 1 Pemphigus - - - - - - - - - - - - - - - - - - - - - - - - - Other Diseases, mentary System - - - - - - - - - - - - - 1 - - 1 - - - - - 1 - 1 Accidents and Negligence. - - 20 In Vehicular Traffic — 3 r> 3 8 4 2 3 3 10 7 10 2 3 57 4 7 10 5 10 10 14 46 14 60 2 On Railways - — — - - - 1 1 - 1 - - — - 3 - - 1 - - - 2 2 1 3 On Ships, Boats, etc. (not drowning) - - - - - - - - - - - - - - - - - - - - - - - - - 2 In Building Operation — - - - - - 1 - 1 - 2 - - - 4 - - - - 1 2 1 4 - 4 By Machinery — — — - — 1 - - 1 — 1 - - — 3 — — 1 — 1 1 — 3 - 3 By Weapons and Implements - - - - - - 1 - 1 - - - - - 2 - - - - - - 2 2 - 2 4 Burns and Scalds — 3 — — - - — — — 1 3 - 3 4 — — 1 — 2 3 1 3 4 7 1 Poisons, Poisonous Vapours - - - - — - 2 1 1 - 1 1 - — 6 — 1 2 — 2 1 — 2 4 6 1 Surgical Narcosis - - - - - - - - - - - - - - - - - - - - - - - 1 1 Effects of Electric Shock - - - - - - - - - - - - - - - - - - - - - - - - - Corrosions by Chemicals - - - - - - - - - - - - - - - - - - - - - - - - - Drowning — — 3 — - 2 — 1 — 1 1 - — — 8 — — — 2 1 4 1 6 2 8 Suffocation, Overlaid - - - - - - - - - - - - - - - - - - - - - - - - - Suffocation, Otherwise 4 - - - - - - - - - - 1 - 4 1 1 1 1 — 2 — — 2 3 5 15 Falls, not specified - 3 — 2 1 — — 3 1 3 7 9 3 3 29 4 3 2 3 7 9 4 17 15 32 Weather Agencies - - — — — — - — 1 — — — — — 1 1 — — — - — — 1 — 1 1 Otherwise, not stated 1 — 1 — — — — — 1 — 1 — — 1 3 — — — 1 1 — 2 4 — 4 Homicide Suicide - - - - - - - - - - - - - - - - - - - - - - - - - By Poison - — — — 1 1 2 4 2 4 6 — — — 20 1 — 2 2 3 1 11 12 8 20 By Asphyxia - - - - - - - - - - - - - - - - - - - - - - - - - By Hanging and Strangulation - - - — — — - 2 — 2 1 — — — 5 1 — — — — — 4 3 2 5 By Drowning - — — — — — - — — 2 1 — — — 3 — — 1 1 — — 1 2 1 3 By Shooting - - - - - - - - - - - - - - - - - - - - - - - - - By Cut or Stab - - - - - - - - 2 - - - - - 2 - - - - - 1 1 2 — 2 1 By Precipitation from Elevated Places - - - - - - - - - - 2 - - - 2 - 1 - - - - 1 2 — 2 By Crushing - - - - - - - - - - - - - - - - - - - - - - - - - By other and unspecified methods - - - - - - - - - - - - - - - - - - - - - - - - - Execution - - - - - - - - - - - - - - - - - - - - - - - - - Sudden Death, cause not ascertained - - - - - - - - - - - - - - - - - - - - - - - - - Ill-defined and unspecified causes - - - - - - - - - - - - - - - - - - - - - - - - - Males 195 120 30 25 33 45 88 158 289 355 419 291 55 315 1788 206 212 190 243 340 375 536 — - 2100 Females 129 82 28 21 36 35 102 123 199 291 411 413 151 211 1810 204 209 189 217 38G 338 479 — — 2023 1,049 TOTAL DEATHS 324 202 58 46 69 80 190 281 488 646 830 704 206 526 3598 410 421 379 460 726 713 1015 2102 2022 4124 75 1927] (Ministry of Health Return.) Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1927. Causes of Death. Sex All ages 0- 1- 2- 5- 15- 25- 46- 65- 75- All Causes M 2118 195 66 56 55 78 249 650 4 22 347 F 2044 129 41 43 49 74 226 494 417 571 Enteric Fever M - - - - - - — — — — F - - - - - - - - — — Small Pox M - - - - - - - - — — F - - — — — — — - — — Measles 7 M 16 3 4 8 1 — — — — - F 14 4 6 4 — — — — — - Scarlet Fever M 4 1 1 1 1 — — — — — F 6 - 1 3 1 - — 1 — — Whooping Cough M 27 11 10 5 1 - - - - - F 20 12 4 3 1 — — — — - Diphtheria M 10 1 2 5 2 — — — — - F 13 - 1 4 8 — — — — — Influenza M 76 - - 1 4 2 18 29 17 5 F 75 3 1 2 1 1 16 22 17 12 Encephalitis Lethargica M 2 - - - - - - 2 — - F 3 — — — — 1 — 1 1 - Meningococcal Meningitis M 6 5 — 1 — — — — — - F 1 - - 1 — — — — — - Tuberculosis of respiratory system M 193 - 3 1 3 27 78 76 5 - F 128 - 1 1 1 31 62 29 2 1 Other Tuberculous Diseases M 18 1 1 3 7 2 2 1 — 1 F 16 2 1 4 4 4 — — 1 - Cancer, malignant disease M 238 - — — — 4 11 114 72 37 F 228 — — 1 — — 18 107 66 36 Rheumatic Fever M 10 — — — 5 3 — 1 1 - F 10 — — — 1 5 3 1 -— — Diabetes M 13 - - - - - 2 6 4 1 F 22 - - - - - 1 10 4 7 Cerebral hæmorrhage, &c M 59 - - - - - 4 17 22 16 F 101 - - - - 1 - 35 23 42 Heart Disease M 278 - - - 2 6 31 88 91 60 F 406 - 1 - 5 10 33 83 132 142 Arterio-sclerosis M 116 - - - - - 1 36 27 52 F 63 - - - - - - 17 22 24 Bronchitis M 142 5 1 1 1 - 17 35 42 40 F 173 2 2 - - - 6 27 40 96 Pneumonia (all forms) M 227 45 31 13 2 2 22 57 35 20 F 179 29 16 11 6 3 12 35 38 29 Other respiratory diseases M 58 1 - 1 1 1 2 14 16 22 F 52 1 - 1 1 - 1 4 5 39 Ulcer of stomach or duodenum M 30 - - - - 1 6 21 1 1 F 12 - - - - - 1 7 4 — Diarrhoea, &c M 29 22 5 - - - — — — 2 F 20 13 2 - 2 — 1 — — 2 Appendicitis and Typhlitis M 18 - - 1 5 3 4 3 1 1 F 14 - - 1 2 1 1 9 — — Cirrhosis of Liver M 13 - - - - - - 11 2 — p 15 - - - - - 2 8 3 2 Acute and Chronic Nephritis M 63 - - - 1 1 13 25 12 11 F 69 - - 1 2 2 8 34 14 8 Puerperal Sepsis M — - — — — — — — — — F 12 - — — — 2 10 — — - Other accidents and diseases of Pregnancy and Parturition M - - - - - - - - — - F 10 - - — — 4 6 — - - Congenital Debility and Malformation, Premature Birth M 78 76 1 — — 1 — — — — F 47 46 - - - - - 1 - - Suicide M 22 - - - - 2 3 8 9 — F 12 - - - - - 5 4 2 1 Other deaths from violence M 89 2 2 4 12 14 11 19 14 11 F 38 - 2 1 2 2 5 6 4 16 Other Defined Diseases M 281 22 4 11 7 9 24 87 51 66 F 285 17 3 5 12 7 35 53 39 114 Causes Ill-defined or unknown M 2 — 1 — — — — — - 1 F - - - - - - - - - - Legitimate. Illegitimate. Deaths under 1 year M. F- 180 116 15 13 76 1927] (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1927. Disease. Ages. Totals Total Cases removed to Hospital Under 1. 1-5 5-15 15-25 25-45 15-65 65 and upwds Small Pox Notifications .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. Scarlet Fever Notifications 9 221 507 127 38 7 .. 909 890 Deaths 1 6 2 .. .. 1 .. 10 .. Diptheria Notifications 11 225 366 67 38 13 .. 720 710 Deaths .. 1 12 10 .. .. .. .. 23 .. Enteric Fever Notifications .. .. 5 3 3 1 .. 12 6 Deaths .. .. .. .. .. .. .. .. .. Puerperal Fever Notifications .. .. .. 11 22 .. .. 33 26 Deaths .. .. .. 2 10 .. .. 12 .. Puerperal Pyrexia Notifications .. .. .. 23 60 l .. 84 53 Deaths .. .. .. .. • • .. .. •• •• Acute Primary and Influenzal Pneumonia Notifications 5 22 51 47 96 81 24 326 .. Deaths .. 2 .. .. 16 21 11 50 .. OphthalmiaNeonatorum Notifications 137 .. .. .. .. .. .. 137 24 Deaths 1 .. .. .. .. .. .. 1 .. Encephalitis Lethargica Notifications .. .. .. 2 2 2 1 7 4 Deaths .. .. .. 1 .. 3 1 5 .. Cerebrospinal Fever Notifications 2 4 1 .. .. .. .. 7 7 Deaths 4* 2 .. .. .. .. .. 6 .. Acute Poliomyelitis Notifications .. 4 .. 1 .. .. .. 5 4 Deaths .. .. .. .. .. .. .. .. .. Anthrax Notifications .. .. .. 1 .. .. .. 1 .. Deaths .. .. .. .. .. .. .. .. .. Dysentery Notifications .. 2 2 .. 1 .. .. 5 5 Deaths .. .. .. .. 1 .. .. 1 .. Malaria Notifications .. .. .. .. 3 .. .. 3 .. Deaths .. .. .. .. .. .. .. .. .. Erysipelas Notifications 2 7 5 10 34 49 32 139 90 Deaths 1 1 •• .. 2 4 2 14 .. *2 Cases not notified. 77 1927] LEGAL PROCEEDINGS 1927 Name and address of Defendant. Offence. Result. 1927. Public Health (London), Act, 1891. Jan.14th Nicholas, Wm. Holberton, "Stoneleigh," Patching Hall Lane, Chelmsford. Non-compliance with Statutory Notice re 3, Cornelia Street. Ordered to abate the nuisance within 28 days. Fined £2 2s. Od. and £2 2s. 0d. costs. Jan. 28th Lionel Cridford and W. M. Skilliter, 29, College Road, Harrow. Disobedience of Magistrate's Order re 15, Lavina Grove. Fined £1 1s. 0d. and £1 1s. 0d. costs. Mar, 4th Philip Abrahams, 59, New Road, Whitechapel. Non-compliance with Statutory Notice re 92, Wellington Road. Fined £5 or 1 month. Mar. 25th Gordon Sydney Brady and Eric Bert Richards (trading as Gordon & Richards), 131, Caledonian Road. Letting or knowingly suffering to be occupied an underground room as a dwelling at 164, Caledonian Road. Fined £2 and £1 2s. 0d. costs Mar. 25th George King, 10, Wimbourne Road, Bruce Grove, Tottenham. ditto. Summons withdrawn (alternative summons) Mar. 25th Horace Barfoot, 164, Caledonian Road. Occupying an underground room as a dwelling. Summons withdrawn (room vacated). May 5th Louis L. Stean, Ltd., 2, Drayton Park Non-compliance with Notice re 35, Florence Street. Summons withdrawn on payment of £1 1s. 0d. costs. Apr. 8th Peter Gallagher and Alice Gallagher (trading as S. Wood & Co.), 221, Archway Road. Non-compliance with Statutory Notice re 88, Bemerton Street. Fined £1 1s. and £l 1s. 0d costs. Apr. 8th Mrs. Daisy L. Hall, 186, North Avenue, Southchurch, Southend. Non-compliance with Statutory Notice re 164, Georges Road. Ordered to abate the nuisance within 28 days. Fined £1 2s. 0d. and £2 2s. 0d. costs. Apr. 8th ditto. Non-compliance with Statutory Notice re 166, Georges Road. Ordered to abate the nuisance within 28 days. Fined £2 2s. 0d. and £2 2s. 0d. costs. Apr. 8th ditto. Non-compliance with Statutory Notices re 168, Georges Road Ordered to abate the nuisance within 28 days. Fined £2 2s. 0d. and £2 2s. Od. costs. May 6th Mr. J. Cooper, 153, St. John Street, Hoxton. Non-compliance with Notice requiring a new dustbin at 10, Rothery Place. Fined £5 and £2 2s 0d. costs. May 27th Charles Wm. Flack, 73, New North Road. Non-compliance with Statutory Notice re 1, Mildmav Street. Ordered to pay £2 2s. 0d. costs. May 27th Mrs. Jessie Nelson, 34, Newington Green Road. Letting or knowingly suffering to be occupied an underground room as a dwelling at 38, Newington Green Road Ordered to pay £2 2s. 0d. costs. May 27 th James Emmett, 38, Newington Green Road. Occupying an underground room as a dwelling. Ordered to pay £1 1s. Od. costs. June 24th July 8th July 15th Charles Wm. Sweeting, 72, Dartmouth Park Hill. Non-compliance with Statutory Notice re 35, Story Street. Summons withdrawn on payment of £2 2s. 0d. costs. July 29th Sep. 2nd Walter Reeve; Walter E. Reeve & C. C. Reeve (trading as Heaps, Son & Reeve), 4, Old Jewry, E.C.2. Non-compliance with Statutory Notice re 12, Wakeham Street. Ordered to pay £2 2s. 0d. costs. Oct. 7th Name and address of Defendant. Offence. Result. 1927. Oct. 7th Arthur Benabo, 57, High Street, Whitechapel, E. l. Non-compliance with Statutory Notice re 112, Rotherfield Street. Ordered to abate the nuisance within 14 days and fined £2 2s. 0d. Oct. 7th ditto Non.compliance with Statutory Notice re 34, Ecclesbourne Road. Ordered to pay £2 2s. 0d. costs. Oct. 21st Moses Aaron Sukmanski, 12, Woodberry Down, Non-compliance with Statutory Notice re 2, Carmarthen Street. Ordered to abate the nuisance within 14 days and to pay £2 2s. 0d. costs. Nov. 4th Finsbury Park, N.4. Oct. 21st ditto. Non-compliance with Statutory Notice re 5,Carmarthen Street. Ordered to abate the nuisance within 14 days and to pay £2 2s. 0d. costs. Nov. 4th Oct. 21st ditto. Non-compliance with Statutory Notice re 6, Carmarthen Street. Ordered to pay £2 2s 0d. costs. Nov. 4th Oct, 28th Alfred Brittain, Ltd., 234, York Road. Non-compliance with Notice re 234 to 238, York Road. Ordered to pay £5 5s. 0d. costs. Nov. 25th Sale of Food and Drugs Acts, 1875 to 1927. Jan. 14th Nathaniel Gluckstein, "The Mitre" P.H.,130, Upper Street. Selling Whisky 38.4 degrees under proof. Summons dismissed under Probation of Offenders Act on payment of £10 10s. costs. Jan. 14th William Bryen Maynard, "The Florence" P.H., 50 Florence Street. Selling Whisky 36.65 degrees under proof. Summons withdrawn on payment of £5 costs. Feb. 11th Thomas Mumford, 134, Barnsbury Road. Selling Milk from which 9% original fat had been abstracted., Fined 10s. 6d. and 10s. 6d. costs. Feb. 25th Ernald Chas., Whitehurst, "Offord Arms" P.H., 388, Caledonian Road. Selling Whisky 37.9 degrees under proof. Ordered to pay £10 10s. 0d. costs. Feb. 25th Charles Harwood (Secy.), Arthur Clark, Ltd., 8, High Street, Camden Town. ditto. Summons withdrawn (alternative summons) Mar. 18th David Evans, 25, Lowman Road. Selling Milk from which 11% original fat had been abstracted. Fined £1 and £1 1s. costs. Mar. 18th Cambridge Farmers' Co-operative Creamery, Ltd., Ditton Walk, Cambridge. Selling and proceeding to deliver at Finsbury Park Station Milk from which 16% original fat had been abstracted. Summons withdrawn on payment of £3 3s. Od. costs. Apr. 22nd Mr. E. G. Riches, Manor Farm, Shereford, Norfolk. Selling and proceeding to deliver at Finsbury Park Station Milk from which 16% original fat had been abstracted. Ordered to pay £2 2s. 0d. costs. Apr. 22nd ditto. ditto. Ordered to pav £2 2s. 0d. costs. 14% fat abstracted Apr. 22nd ditto. ditto. Ordered to pay £2 2s. 0d. costs. 16% fat abstracted. May 6th Edward Thomas Cross, 18, Rheidol Terrace. Selling Milk from which 6% original fat had been abstracted. Summons withdrawn on payment of £2 2s. 0d. costs. May 13th James Wrathall, East Mammerton Farm, Longford, Derby. Selling and proceeding to deliver at Finsbury Park Station Milk from which 10% original fat had been abstracted. Ordered to pay £4 4s. 0d. costs. 1927] 78 79 1927]  Name and address of Defendant. Offence. Result. 1927. May 20th Frederick Ernest White, "Angel and Crown" P.H., 235, Upper Street. Selling Whisky 36.9 degrees under proof. Ordered to pay £5 5s. 0d. costs. May 20th Henry George Wilson, "Hare and Hounds" P.H., 181, Upper Street. Selling Whisky 38.2 degrees under proof. Ordered to pay £5 5s. 0d. costs. May 20th Ernest Block, "Hare & Hounds" P.H., 181, Upper Street. Selling Whisky 38.2 degrees under proof. Summons withdrawn (alternative summons). May 27th Frank Barley, "General Havelock" P.H., 292, Hornsey Road Selling Whisky 40.2 degrees under proof. Ordered to pay £5 5s. 0d. costs. July 8th Isidore, Abraham Harris, King's Arms" P.H., 71, Durham Road. Selling Whisky 36.4 degrees under proof Ordered to pay £2 2s 0d. costs. July 8th Mr. W. R. Harvey, Illington, Thetford. Selling and proceeding to deliver at Finsbury Park Station Milk from which 23% original fat had been abstracted. Ordered to pay £2 2s. 0d. costs. July 8th ditto. ditto. 21% fat abstracted. Ordered to pay £2 2s. costs. July 8th Mr. W. Ashlin, Cherry Farm, Minting Horncastle. Selling and proceeding to deliver at Finsbury Park Station Milk from which 13% original fat had been abstracted Ordered to pay £1 l1s. 6d. costs. July 8th Mrs. Monk, Mill Farm, Watton at Stone, Herts. Selling and proceeding to deliver at Finsbury Park Station Milk from which 18% original fat had been abstracted. Ordered to pay £2 2s. 0d. costs. July 15th D. O. Jones & H. J. Neely (trading as E. Jones), 88, Roman Road. Selling Milk from which 11% original fat had been abstracted. Fined £5 and £5 5s. 0d. costs. Jnly 15th George Parker, 88, Rhodes Street. Selling Milk from which 15% original fat had been abstracted and from which 13% original fat had been abstracted (2 summonses). Summonses adjourned Sine Die. July 22nd Mr. W. H. Snow, Foxt Froghall, Stoke-onTrent, Staffs. Selling and proceeding to deliver at Finsbury Park Station Milk from which 8% original fat had been abstracted. Ordered to pay £2 2s. 0d. costs. July 22nd ditto. ditto. 29% fat abstracted. Ordered to pay £2 2s. 0d. costs. July 22nd Henry Weinberg, "The Old Pied Bull" P.H.., 188. Hollowav Road. Selling Whisky 37.4 degrees under proof. Ordered to pay £3 3s 0d. costs. Aug. 5th Abraham Abrahams, 13, Green Lanes, Selling as Butter an admixture of Margarine and Butter. Fined £5 and £5 5s. 0d. costs. Aug. 26th Stanley Porter, "Lord Hampden" P.H., 71, Hampden Road. Selling Whisky 40.8 degrees under proof. Summons withdrawn on payment of £2 2s. 0d. costs. Aug. 26th Messrs. Olley Brothers, 95, London Road, Brandon, Suffolk. Selling and proceeding to deliver at Finsbury Park Station Milk from which 10% original fat had been abstracted. Ordered to pay £4 4s. 0d. costs. 80 927  Name and address of Defendant. Offence. Result. 1927. Aug. 26th Mr. A. B. Shillitoe, Long Stowe, Old North Road, Cambridge. Selling and proceeding to deliver at Finsbury Park Station Milk from which 20% and 6% original fat had been abstracted (2 summonses) . Summonses withdrawn as contract could not be proved. Aue;. 26th Hugh Dillon McBlain, "Sussex Arms" P.H., 119, Grove Road. Selling Whisky 37.9 degrees under proof. Fined £5 and £5 5s. 0d. costs. Aug, 26th Frederick Geo. Belshaw, "Stanley Arms" P.H., 37, Landseer Road. Selling Whisky 36.4 degrees under proof. Ordered to pay £3 3s. 0d. costs. Sep. 80th Gordon Lamer, " Prince of Wales" P.H., 144, St. James's Road. Selling Whisky 38.4 degrees under proof. Ordered to pay £5 costs. Sep. 30th Mrs. Emily Caroline Hunter, "Holloway Station Hotel," 295, Holloway Road. Selling Whisky 37.4 degrees under proof. Ordered to pay £5 costs. Oct. 21st George Howlett, South Farm, Hargham, Norfolk. Selling and proceeding to deliver at Finsbury Park Station Milk from which 8% original fat had been abstracted. Summons dismissed on payment of £3 3s. 0d. costs. Dec 9th Nathan Cohen, "Builder's Arms" P.H., 140, St. Paul's Road. Selling Whisky 37.9 degrees under proof. Summons withdrawn on payment of 5s. 0d. costs Sale of Food Order, 1921. Jan. 28 th Mr. A. Hannah and Fredk. Hill (trading as Hannah & Hill), 6, Euston Market, N.W.I. Selling by wholesale imported eggs not properly described (to Albert Edwards, 38a, Cross Street). Fined £2 2s. 0d. and £2 2s. 0d. costs. Feb. 18th Mr. L. J. Weston, 56, St. Jude Street. Exposing for sale imported meat not properly labelled. Fined 10s. and 10s. costs. Feb. 18th Edward Arthur Johnson, 212, Blackstock Road. Exposing for sale imported eggs not properly labelled. Fined 5s. and 5s. costs. Feb. 18th George H. Maler, 68, King Henry's Walk. Exposing for sale imported meat not properly labelled. Fined 20s. and 20s. costs. Feb. 25th William Edwin Childs, 159, Drury Lane, W.C.2. Exposing for sale imported eggs not properly labelled (at 48, Cross Street). Fined £2 2s. 0d. and £2 2s. 0d. costs. Mar. 4th June 24th Frank Hammond, 154, Holloway Road. Exposing for sale imported eggs not properly labelled. Ordered to pay £3 3s. 0d. costs. June 24th ditto. ditto. Ordered to pay £1 1s. 0d. costs. June 24th ditto. ditto. Ordered to pay £1 1s. 0d. costs. July 1st The Star Tea Co., Ltd., 290, Old Street, E.C.2. Exposing for sale imported eggs not properly labelled (at 161, Caledonian Road). Fined £10 and £2 2s. 0d. costs. Sep. 30th Walter Edward Prideaux, 45, Josephine Avenue, Brixton, S.W.2. Selling imported eggs as "New Laid" (in Metropolitan Cattle Market). Summons dismissed. Oct. 3rd Sep. 30th ditto. ditto. Summons dismissed. Oct. 3rd Oct. 7th E. Baker & Co., Ltd., 77, Stroud Green Road. Exposing for sale imported eggs not properly libelled. Ordered to pay £2 2s. 0d. costs. 81 1927} I  Nam and Address of Defendant. Offence. Result. 1927, Nov. 25th London Co-operative Society, Ltd., 54, Maryland Street, E.15. Exposing for sale imported meat not properly labelled (at 167, Upper Street). Summons withdrawn (alternative summons). Nov. 25th Stephen Edward Paddon, 167, Upper Street. ditto. Fined £2 2s. 0d. and £2 2s. 0d. costs. Milk and Dairies Order, 1926. Feb. 11th George Head, 28, Sutterton Street. Delivering Milk in bottles which had not been filled and closed on Registered premises. Fined £3 and £1 2s. 0d. costs. Mar. 4th Charles Edwd. Meyers, 19, Denmark Road. ditto. Fined £1 and £1 costs. Mar. 18th Harry Heyde, 7, Stanley Terrace. ditto. Fined £1 and £2 2s. 0d. costs. Apr. 8th James Evans, 88, Richmond Road. ditto. Fined £2 2s. 0d. and £2 2s. 0d. costs. Apr. 8th William Alfred Norton, 6, Bampton House, Pleasant Place. Keeping milk in a room used as a living room. Fined £1 1s. 0d. and £1 2s. 0d. costs June 24th Stephen Ralph Harrison, 76, Grove Road. Delivering milk in a bottle which had not been filled and closed on Registered premises. Fined £1. July 1st David John George, 117, Hemingford Road. ditto. Fined £3 3s. 0d. and £2 2s. 0d. costs. Sep. 30th John Hughes, 5, Cottenham Road. Filling a bottle with Milk in street instead of on Registered premises. Fined 10s and £1 costs Sep. 30th Arthur Taylor, 14, Southampton Street. Carrying on the trade of Purveyor of Milk without being registered. Fined 10s. and 10s. costs. Public Health (Meat) Regulations, 1924. Feb. 11th Messrs. West (Butchers), Ltd., 4, West Smithfield, E.C.I. Meat exposed for sale not protected from mud, etc. (at 309, Caledonian Road). Fined £2 and £1 1s. 0d. costs. Feb. 11th Messrs. Lipton, Ltd., 196, City Road, E.C.I. Meat exposed for sale not protected from mud, etc. (at 281, Caledonian Road). Fined £2 and £1 1s. 0d. costs. Feb. 18th Mr. L. D. Weston, 56, St. Jude Street. Meat exposed for sale on a Stall which was not suitably covered and screened at the sides and back. Fined £1. London County Council Bylaws. July 8th Edward Albert Kirk, 48, Medina Road. Constructing a water-closet without making provision for ventilating of the trap (at 55, Birnam Road). Ordered to pay £1 1s. 0d. costs. London County Council (General Powers) Act, 1922. Sep. 9th Donald H. Horton (trading as Gregory & Co.), 297, Hornsey Road. Non-compliance with Notice re 34a, Alsen Road. Fined £4 and £l 1s. 0d. costs. 82 1927] (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1927. Premises. No. on Register at end of 1927 No. Added in 1926 No. Removed in 1927 Number of Inspections 1927 Number of Notices 1927 Number of Prosecutions 1927 Milk Premises 510 52 8 900 12 Nil Cowsheds 1 Nil Nil 10 Nil ,, Slaughter Houses 13 ,, ,, 710 ,, ,, *Other Offensive Trade Premises 19 ,, ,, 64 ,, ,, Ice Cream Premises 238 ,, ,, 78 4 ,, Registered Houses Let in Lodgings 1,011 ,, ,, 4,283 495 1 *Including the Knacker's Yard, 8 Fur Skin Dressers and 1 Fat Melter. Housing of the Working Classes— Number of houses inspected— (a) On account of complaints or illness (P.H. Act) 8,498 (b) House-to-house (Housing Consolidated Regulations, 1925) 1,296 Number of notices served— (a) Under P.H. Act:— (i) Intimation 4,666 (ii) Statutory 518 (b) Under Housing Act 1 Number of houses repaired or nuisances remedied under P,H. Act 6,105 Number of houses repaired under Section 3 of Housing Act— (a) By owners Nil (b) By L.A. in default of owners Nil Number of houses closed on notice by owner that they could not be made fit Nil Number of houses for the working classes— (a) Erected during year 195 (b) In course of erection 78 Number of representations by Medical Officer or other person Nil Number of houses included in such representations Nil Number of Closing Orders made Nil Number of Closing Orders determined (i.e. Houses made fit) Nil Number of Demolition Orders Nil Number of houses demolished— (а) In pursuance of Orders Nil (b) Voluntarily *49 Total number of houses in the Borough about 45,250 Number of houses occupied by the working classes about 28,600 *Including houses in Brand Street and George's Road Area Improvement Scheme (L.C.C.). 83 1927] Underground Rooms— Number illegally occupied 10 Number closed or illegal occupation discontinued 10 Overcrowding— Number of cases of overcrowding found 24 Number remedied 24 Number of prosecutions Nil Smoke nuisances— Number of observations 232 Number of complaints 60 Number of notices served 10 Number of legal proceedings Nil Cleansing and Disinfection— Number of adults cleansed 12 Number of children cleansed 5,035 Number of premises cleansed:— (a) After infectious diseases 3,089 (b) For vermin 25 Water supply to tenement houses— Number of premises supplied 55 Number of prosecutions Nil Sanitary officers— Chief Sanitary Inspector (Whole time) 1 Number of Sanitary Inspectors (Whole time) Male, 19 Female 2 ,, ,, (Part time) Male, Nil Female Nil Number of Health Visitors (Whole Time) 8 „ ,, (Part time) Nil Tuberculosis Visiting Nurse (Whole time) 1 References—Former M.O.H. Reports. The following Tables and Reports have appeared in the Annual Reports of the Medical Officer of Health enumerated. Reference is made to them here as they have not been reprinted to save space for other matters:— Annual Report 1921. Page 3 Illegitimate births in the Borough since 1851. Page 11 Deaths of inhabitants in local institutions and m institutions outside the Borough, deaths of non-inhabitants in local institutions from 1911. Page 46 Births and Birth-rate (Islington) 1841 to 1920 Page 46 Illegitimate births (Islington) 1841 to 1920. Page 47 Deaths and Death-rate (Islington) 1841 to 1920. Page 47 Infantile Mortality Returns, 1841-1920. Page 48 Cases of infectious disease (Islington) in quinquennial periods, 1891 to 1920. Annual Report 1922. Pages 1, 54 and 55 Cheap Milk Frauds. Pages 1 and 51 Inflation of Meat. Pages 2 and 57 Preservatives in Food. Pages 2 and 60 Dispensing of Prescriptions. Pages 2, 50 and 51 Unsound Food, Conference in Islington. Pages 12-21 Report on Maternity and Child Welfare Work, including Assistant Medical Officer of Health's Report on the Maternity and Child Welfare Scheme. Page 38 Vaccination. Pages 41 and 42 Employed population. Page 50 Sale of unsound fruit by street traders. Pages 54, 58 and 59 Artificial Colouring Matter in Milk. 84 1927] Annual Report 1923. Pages 40 and 41 Summary of Rat Officer's reports. Page 41 Housing, representation to the London County Council re Georges Road and Brand Street Areas. Page 43 Food contamination by dust. Pages 45 and 46 Preservatives and colouring matter in food. Pages 46 and 47 Small shopkeepers, warnings. Page 47 Dispensing of prescriptions. Annual Report 1924. Page 13 Artificial Sunlight Treatment. Page 40 Smoke Nuisance. Page 43 Housing. Evidence of M.O.H. at Local Enquiry re Brand Street and George's Road Areas. Page 47 Houses occupied by two or more families. Census of 1921. Population 1921, numbers living per room. Page 48 Overcrowding. Page 50 Sale of Food Order. Labelling of Meat and Eggs. Page 53 Special designated milk. Pages 54 and 55 Dispensing of prescriptions. Page 58 Petty Sessions Court established. Wrapping of Food. Annual Report 1925. Pages 2-5 Historical Survey, "Islington—Past and Present." Page 17 Artificial Sunlight Treatment. Pages 34-36 Tuberculosis, control and procedure. Page 51 Increase of Rent and Mortgage Interest (Restrictions) Acts. Page 52 Nuisance by Dogs. Pages 53 and 54 Licensed Premises. Page 55 Public Health (Meat) Regulations. Health Department Circular. Page 59 Boric Acid in Cream. Annual Report 1926. Page 9 Educational Propaganda. Page 13 Pemphigus Neonatorum. Page 16 Artificial Sunlight. Page 26 Occurrence of Smallpox. Page 29 Hospital Isolation. Secondary infections. Page 48 Disinfection of refuse dumps. Page 49 Dust nuisance, grinding of bricks and rubble. Page 58 Restaurant Kitchens. Page 58 Meat stored in bedroom. Pages 59 and 60 Meat Regulations, enforcement of, and Deputation of Traders. Pages 60 and 61 Labelling of eggs, Sale of Food Order. 85 1927] INDEX Page Accidental Deaths 28 Acreage 2 Adulteration of Food 64 Ages at Death 7 Anti-toxin treatment 30 Anthrax, occurrence of 35 Area 2 Bacteriological Examinations 42 Diphtheria 43 Baths and Washhouses 47 Births 3, 4 „ Illegitimate 4 „ Notification of 4 „ Stillborn 4 Cancer 24 Chicken Pox 42 Cleansing of Verminous School Children 47 Coal gas Poisoning 27 Consumption (see Tuberculosis) 25 Cow Sheds 63 Deaths from all causes during the year 5, 72-74 Deaths from Epidemic Diseases 22 „ „ Respiratory Diseases 26 „ in Public Institutions 21 „ from Classified Causes 6 „ Maternal 11 ,. Age at 7 Demolition of Habitable Dwellings 57 Density 2 Diphtheria 29 „ Anti-toxin treatment 30 „ Bacteriological 43 Diseases Treated in Hospital 31 Disinfectants distributed and used 47 Disinfecting Station 46 Disinfection Work 38, 45 Disinfestation of School Children 47 District Inspectors' Work 51-54 Drugs 65 Dust, removal of 52 Dysentery 34 Education Propaganda 10 Eggs, labelling of 61 „ Enquiry re-marking Imported 61 Encephalitis Lethargica 36 Enteric Fever (Typhoid) 30 Epidemic Diseases 22 ,, Cerebro-spinal Meningitis 33 86 1927] Page Erysipelas 24 Factories and Workshops Administration 48-51 Fatality from Notifiable Infectious Diseases 30, 32 Food. Inspection of, Unsound, Adulteration of 59, 60, 64 Food Order 61 Gas (Coal) Poisoning 27 „ Heaters 27 Glanders, Anthrax and Hydrophobia in Man 35 Health Visitors (Municipal) 14 Health and Baby Week 10, 18-20 Home Visitations—Tuberculosis 41 Hospital Isolation of Infectious Diseases 31-32 Housing 56-58 ,, Accommodations 57 Houses Let in Lodgings 54 Infantile Mortality 7-9 Infant Welfare Work 10-21 Infection, Prevention of 29 Infectious Diseases in Schools 42 „ „ (Non-Notifiable) in Schools 42 Informal Sampling 65 Influenza 23-24 Inspection of Food 59 „ „ Houses 53, 54 „ „ Kitchens of Restaurants 48, 61 „ „ Slaughter Houses and Cow Houses 59, 63 „ „ Workshops 48-51 Institutions 21 Increase of Rent (Restrictions) Acts 59 Inquests 28 Isolation of Infectious Diseases 31, 31 Kitchens and Restaurants 48, 61 Laboratory 65 Legal Proceedings 69. 77-81 Public Health (Lond.) Act 69. 77 Sale of Food and Drugs Acts 62,78-80 „ „ Food Order 1921 69, 80, 81 Milk and Dairies Order 1926 69, 81 Meat Regulations 1924 69, 81 L.C.C. Genera) Powers Act 1922 69, 81 L.C.C. By-Laws 69, 81 Light Treatment—Artificial Sunlight and "Finsen" 40 London County Council Return of Sanitary Work 82 Malaria 34 Malignant Diseases 24 Marriages 3 Maternity and Child Welfare Committee 11 Maternity and Child Welfare Work 10-21 Measles, Notifications by School Teachers 42 Meat Inspection 59-63 Meat Regulations, 1924 61 Meat, labelling of 61 Ministry of Health Returns 75, 76 „ „ Report on Diphtheria 43 Milk Scheme 14 „ Adulteration 66 „ Shops and Dairies 63 „ and Cream Regulations 63 87 1927} Page Milk Special Designations Order—Licences 64 Mortuary and Coroner's Court 28 New Legislation 52 Notification of Infectious Diseases 29 „ „ Tuberculosis 36 „ „ Births Act 4 „ Still-births 4 Non-notifiable Infectious Diseases in Schools 42 Offensive Trades 63 Ophthalmia Neonatorum 10 Outworkers' Premises 50 Other Notifiable Diseases 32 Pauperism 59 Pathogenicity Tests (Diphtheria) 44 Pemphigus Neonatorum 13 Phthisis 25, 36 „ Notification of 36 Places where Food is Prepared 61 Pneumonia 26 Pneumothorax treatment 40 Population at the Census, 1921 2 „ estimated, 1927 2 Preservatives 68 Prevention of Infection 29 „ ,, Tuberculosis Regulations 1925 39 Prosecutions, Summary of 69 Public Health Committee 11 „ „ Milk and Cream Regulations 63 „ „ Meat Regulations 1924 61 ,, ,,Staff 69 „ „ (Tuberculosis) Regulations 1924 38 Puerperal Diseases 12, 24 „ Pyrexia 12 Polio-Myelitis, Acute 33 Pulmonary Tuberculosis 25, 36 Rats and Mice (Destruction) Act, 1919 55 Rateable Value 111 References—M.O.H. Reports 83 Rent and Mortgage Interest (Restrictions) Acts 59 Respiratory Diseases 26 „ Tuberculosis 25, 36 Restaurant Kitchens 48, 61 Sale of food Order—Labelling of Eggs 61 Samples Analysed in 1927 68 Sanitary Inspectors' Work 53 Schick Testing 31 Schools 42 Septic Diseases 24 Shelter House 47 Slaughterhouses 59 Small Pox 29 Smoke Nuisances 52 Sophistication of Milk 66 Statistics 72 Still-Births, Registration 4 Street Accidents 28 Sanitary Inspector's Certificates—Training of Candidates for 52 Tuberculous Diseases 25, 36 88 1927] Page Tuberculosis Dispensaries 40, 41 „ Notification of 36 Tuberculosis Deaths from 25 „ (Public Health) Regulations, 1912 39 „ Visiting Nurse 41 Typhoid Fever (see Enteric) 30 Unsound Food 60 Vaccination 45 Venereal Diseases 27 Verminous Children, Disinfestation of 47 „ Premises 47 Voluntary Maternity and Child Welfare Centres 17-21 Workshops and Factories, Inspection of 48-61 Welfare Work by Health Visitors 14