AC 436 ISL 68 1928 SEVENTY-THIRD 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. 1928 SEVENTY-THIRD ANNUAL REPORT ON THE Health and Sanitary Condition OF THE METROPOLITAN Borough of Islington. G. CLARK TROTTER, M.O., D.P.H., F.R.S.E. MEDICAL OFFICER OF HEALTH. London: Vail & Co.. Printers, 170, Furringdon Road, E.C. 1. ii MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1928, to November, 1929.) Mayor. Alderman SIDNEY CHARLES HARPER, J.P. A Idermen. HERBERT SAMUEL JORDAN WALTER FREDERICK NOKES FRANK LEYDEN SARGENT EDWARD HENRY TOMKINS, J.P. Councillors. WILLIAM AW COCK, J.P, WALTER BLOUNT JOHN BRUCE CHARLES BUNDOCK MIRIAM P. COLEMAN FREDERICK C. COOKSEY GEORGE L. W. FRANKS WILLIAM H. GALE WALTER HARPER WILLIAM J. MITCHELL HENRY PENN WILLIAM T. RICKETTS EDWARD A. WILLIS Chairman ALDER MAM JORDAN Vice-Chairman Councillor BUNDOCK MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1928, to November, 1929.) Alderman. ALBERT EDWARD PETTET Councillors. ROSE ANNIE ALLEN JESSIE L. BLYTHE CHARLES BUNDOCK WILLIAM H. BURGESS MIRIAM P. COLEMAN FREDERICK M. COLLIS ARTHUR N. DOVE ROSA ESSEX WILLIAM H. GALE ALBERT H. JACKSON Mrs. MAUD MANCHESTER WILLIAM J. MITCHELL WILLIAM J. NORTH Mrs. M. SOUTHGATE, J.P. THOMAS TAYLOR 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 Chairmen 1) Alderman PETTET (resigned). (2) Councillor Mrs. M. SOUTHGATE, J.P. Vice-Chairman : Councillor Mrs. M. A. MANCHESTER. iii SUMMARY of Vital Statistics in the Registration Year 192tfcv Population (Enumerated at Census, 1921) 880,787 persons ,, Estimated Mid Year 1928 824,700 persons Decrease on Census population, 1921 6,087 persons Mean Population, ten years (1918-1927) 329,894 persons Area 8,092 acres Density (Mid-year 1928) 105 persons per acre Births Males 2,945 Females 2,845 persons 5,790 Birth rate 17.8 per 1,000 inhabitants Deaths from All Causes Males 2,076 Females 2,085 persons 4,161 Death rate 12.8 per 1,000 inhabitants Deaths from Principal Epidemic Diseases Males 139 Females 98 237 persons Death rate 0.73 per 1,000 inhabitants Deaths from All Tuberculosis Males 205 Females 153 358 persons Death rate 1.10 per 1,000 inhabitants Deaths from Respiratory Tuberculosis Males 182 Females 127 809 persons Death rate 0.95 per 1,000 inhabitants Infantile Deaths under 1 year Males 200 Females 174 Total 374 Infantile mortality rate 64 per 1,000 births Excess of Births over Deaths 1,629 Rateable value of Borough of Islington £2,136,391 Sum represented by a penny rate £8,900 iv Public Health Department, Municipal Buildings, Upper Street, N.l. Mr. Mayor, Ladies and Gentlemen, 1 have the honour to submit the report on the Health and Sanitary Condition of the Borough for the year 1928. The death-rate for 1928 was 12.8 per 1,000 inhabitants, as against 12.3 in the previous year. It can be considered with satisfaction as being a low rate. The Infantile Mortality Rate was. 64. The rate in the previous year, 1927, was 53, but this was an exceptional rate, the lowest on record. The rate for 1926 was 66. In the report for this year some matters are dealt with which have at the moment a special interest. These do not fall to be commented on annually. 1 refer particularly to the occurrence of Smallpox, a disease which may be apt to linger; to the inspection of food, analysis of drugs, etc., and to the note on scavenging, particularly as regards waste paper and broken bottles. It will be noted that as regards the report on the work of the Voluntary Infant Welfare Centres, the year reported on ends on the 31st March, 1929. Thus the Centre work is reported on in advance. It is found, however, each year to be increasingly difficult to do this. In future years the Report on the Centre work, I fear, will have to be slightly in arrears rather than in advance. It is proper here (rather than as an item in a bulky Report) to express my appreciation of the help the Department has received from the Members of the Council and Committees, the assiduity of my Chairmen, and not least from the hearty co-operation of my staff and the courtesy and assistance of the Chiefs of the other departments, all of which has meant so much in attaining the results here reported. Your obedient servant, Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1928. 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 ofthe Public Health Department and the Welfare Centres. Cinema Display. See pages 9, 10, 18—21. 2. Infectious Diseases. Pages 80—39. — Occurrence of Smallpox, pages 31—34. 3. Meat, Food and Drugs.—(a) Food poisoning, page 67. (b) Sophistication of Milk, Dairy Show, page 73. (c) Liniment of Turpentine, page 72. (d) Restaurant Kitchens, page 69. (e) Broken Milk Bottles, page 54. 4. Workshops, etc., page 49. Fried Fish Vendors, page 58. Scavenging, page 52. 5. Tenement Dwellings, lighting and ventilation of staircases, page 58. 6. Health Visitation and work of Voluntary Centres, Artificial Sunlight, etc., pages 18—22. Maternal Mortality, pages 11—11. 7. Legal Proceedings, pages 85—89. Recent Legislation, page 55. 8. Index to Report, page 93. 1928] 2 POPULATION. The number of the population at mid-year 1928, is estimated at 324,700 persons. There was, therefore, a decrease in the population of 6,037 when compared with the number of inhabitants ascertained at the census in 1921. The following tables give the distribution of the population in 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 1928, also the Populations at the Census 1921. Sub-Districts. Area. Acres. Estimated Persons to an Acre. 1928 Estimated Population Mid-year 1928. Enumerated Population at Census 1921. Tufnell 411 80 32,848 33,750 Upper Holloway 299 103 30,805 35,721 Tollington 315 95 30,060 30,832 Lower Holloway 406 99 40,330 40,139 Highbury 749 79 59,066 58,850 Barnsbury 316 170 53,595 53,859 South East Islington 596 131 77,996 77,586 The Borough 3,092 105 324,700 330,737 Showing the Estimated Number of Persons living in Islington at the Mid-year 1928, at Nine Age Periods, and distinguishing Males and Females. Ages. Males. Females. Persons. 0—5 14,284 13,966 28,250 5—15 29,870 29,230 59,100 15—25 25,002 30,518 55,520 25—35 24,030 29,220 53,250 35—45 20,780 25,003 45,783 45—55 18,180 19,810 37,990 55—65 11,690 13,312 25,002 65—75 6,170 8,115 14,285 75 and upwards 1,944 3,576 5 520 All ages 151,950 172,750 324,700 [1928 3 MARRIAGES. Marriages, 2,883; Marriage Rate, 17-8.—There were 5,766 persons married or 2,883 marriages, in 1928, and the marriage rate, that is to say, the number of persons married per 1,000 of the population was 17.8. Compared with the previous year these figures show an increase of 78 in the number of persons married, or of 39 marriages; and of 0.8 per 1,000 in the rate. 'I he following statement shows the figures for the previous ten years 1918-27. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 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 1922 2,877 17.23 1927 2,844 17.01 BIRTHS. During the year there was 5,790 live births registered, of which 2,945 were boys and 2,845 girls. Of this number, however, 1,021 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 17.8 per 1,000 of the population, as compared with a mean birth-rate of 20.6 in the preceding ten years. It was the lowest birth-rate since the year 1918, when it was 16.2. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1928, 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 1927 ; together with the mean Borough Birth-rates for the 10 years 1918-1927. Quarter. Males. Females. Total. Birth Rates. Islington, 1928. Islington, 1918-27. London, 1928. 107 Great Towns, 1928. First 780 723 1,503 18.5 21.3 17.3 16.7 Second 734 716 1,450 17.9 21.1 17.6 16.4 Third 735 712 1,447 17.8 20.4 17.0 15.7 Fourth 696 694 1,390 17.1 19.9 16.1 15.1 The Year 1928 2,945 2,845 *5,790 17.8 20.6 16.9 15.9 1927 3,104 3,004 6,108 18.3 17.8 16.1 17.1 Increase or decrease — 159 — 159 — 318 — 0.5 — 2.8 + 0.8 — 1.2 * These include 1,021 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, 1928, will be found at the foot of table on p. 9. Showing the Births of Males and, Females and the Birth-rates in each quarter and for the year, 1928, 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 69 56 125 15.2 97 83 180 23.4 60 52 112 14.9 104 99 203 20.1 2nd „ 62 57 119 14.5 118 94 212 27.5 62 54 116 15.4 96 102 198 19.6 3rd „ 46 52 98 11.9 96 93 189 24.5 63 51 114 15.2 106 101 207 20.5 4th „ 61 59 120 14.6 92 84 176 22.9 52 55 107 14.2 86 87 173 17.2 Year 238 224 462 14.1 403 354 757 24.6 237 212 449 14.9 392 389 781 19.4 1928 ] 4 Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1928, and in the several Sub-Registration Districts.—contd. Highbury. Barnsbury. Islington South-F.ast. The Borough. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 130 140 270 18.3 139 135 274 20.4 181 158 339 17.4 780 723 1,503 18.6 2nd 110 124 234 15.8 135 144 279 20.8 151 141 292 15.0 734 716 1,450 17.9 3rd 128 122 250 16.9 132 128 260 19.4 164 165 329 16.9 735 712 1,447 17.8 4th 112 114 226 15.3 148 134 282 21.0 145 161 306 15.7 696 694 1,390 17.1 Year 480 500 980 16.6 554 641 1,095 20.4 641 625 1,266 16.2 2,945 2,845 5,790 17.8 Illegitimate Births (249). The illegitimate births numbered 249 and show a decrease of 67 on the return of the year 1927. They were equal to a rate of 4.3 per cent, of the total registered births. Notification of Births Act, 1907. 4,398 live births were notified (exclusive of 126 stillborn), or 76 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. 1928. 1st Quarter 209 11 642 14 285 9 1,136 34 2nd ,, 199 8 657 20 245 6 1,101 34 3rd „ 209 5 617 20 289 3 1,115 28 4th „ 199 9 569 12 278 9 1,046 30 Year 816 33 2,485 66 1,097 27 4,398 126† REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still-born). 1928. 1st Quarter 29 8 3 40 25.9 2nd „ 31 8 — 39 26.2 3rd „ 31 6 — 37 24.9 4th „ 25 4 1 30 21.1 Year 116 26 4 †146 24.6 † Of the total number (146) registered still-births, 33 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 159 (i.e., 126 + 33) or 26.9 per 1,000 total births (including still-born). CO-ORDINATION WITH LOCAL REGISTRARS. False and Inaccurate Registrations. The notifications of births are by special arrangement open to the inspection of the local registrars, and likewise † vide p. 4. [1928 5 the particulars of registration are made use of by this department. By this means it is at times possible to detect false or inaccurate information which has been given. A rather striking instance occurred during the year. A birth was registered as having taken place in Highbury New Park, the father was stated to be a seaman in the mercantile marine. As no notification of this birth was received, our usual enquiries were made, and it was found that no birth had in reality taken place, but a child had been "adopted," and the woman concerned had represented herself to the registrar as the mother, and "re-registered" the birth as a child of her own and her husband, an absent seaman. The local Superintendent Registrar was written to on the matter, and the Registrar-General considered the case so serious that he instituted a prosecution. The Magistrate took a very lenient view, as he thought the motive was well intentioned, although distinctly wrong, and a modest fine of 10/- and costs was imposed. The RegistrarGeneral subsequently directed the cancellation of the false entry of birth. We are frequently appealed to to provide proof, if possible, for people who have been unable to trace their births, but have some knowledge of the date and place in Islington where they were born. These are cases in which registration has been omitted entirely, and not been detected apparently by the local registrars in their inspection of our notifications. An appeal was made on behalf of a young woman commencing work who was required by a firm of some standing to produce her birth certificate. The mother of this young person had omitted registration, probably on account of illegitimacy. We were able to trace the notification of the birth received from a midwife, also eventually to trace the midwife, who had left the district, and to give this information to the Registrar-General on behalf of the woman so that he could have even late evidence for possible registration. DEATHS. The deaths registered during the year numbered 4,161 (exclusive of stillbirths), while the death-rate was equal to 12.8 per 1,000 of the estimated population, or 0.5 above that of the previous year (12.3), and 0.7 below the mean of the preceding ten years; whilst the death-rate of England and Wales was 11.7 and the 107 Great Towns 11.6. 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 148 18.0 99 12.1 80 9.7 115 14.0 442 13.5 Upper Holloway 125 16.2 111 14.4 76 9.9 96 12.5 408 13.2 Tollington 123 16.4 83 11.0 80 10.6 108 14.4 394 13.1 Lower Holloway 165 16.4 131 13.0 81 8.0 135 13.4 512 12.7 Highbury 232 15.7 168 11.4 130 8.8 185 12.5 715 12.1 Barnsbury 214 16.0 170 12.7 128 8.5 187 14.0 699 13.0 Islington (SouthEast) 328 16.8 227 11.6 187 9.6 249 12.8 991 12.7 The Borough 1,335 16.4 989 12.2 762 9.4 1.075 13.9 4,161 12.8 1928] 6 Showing the Deaths and Death Rates of Islington in 1928, 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 1918-27 and the deaths and death-rates in the year 1927. Quarter. Males. Females. Total. Death Rates. Islington, 1928. Islington, 1918-27. London, 1928. 107 Great Towns. 1928 First 657 678 1,335 16.4 17.2 14.4 14.2 Second 502 487 989 12.2 11.8 11.5 11.5 Third 380 382 762 9.4 10.0 9.1 9.3 Fourth 537 538 1,075 13.9 14.8 11.6 11.6 The Year 1928 2,076 2,085 4,161 12.8 13.5 11.6 11.6 1927 2,102 2,022 4,124 12.3 12.8 11.9 12.2 Increase or Decrease - 26 + 63 + 37 + 0 5 - 0.7 — 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 1918-27 and in 1928. Classified Causes of Death. Years. Mean 10 Yrs. Difference. 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 I. Specific or Febrile Causes 1361 579 552 464 639 273 391 286 285 355 518 371 — 147 1. Miasmatic Diseases 1258 466 437 301 546 155 316 191 204 266 414 258 — 156 2. Diarrhœal „ 51 36 28 85 29 40 20 15 29 19 35 25 — 10 3. Malarial „ 2 2 2 — — — — — — — — — — 4. Zoogenous „ — 1 2 1 — — 2 3 — — 1 3 + 2 5. Venereal „ 15 13 13 17 17 20 9 8 5 12 13 19 + 6 6. Septic „ 35 61 70 60 47 58 44 69 47 58 55 66 + 11 II. Parasitic Diseases — 1 1 — 3 1 2 1 1 — 1 2 + 1 iii. Dietetic 4 2 2 4 7 2 3 3 2 4 3 3 — iv. Constitutional Diseases 1101 973 918 985 935 945 945 1054 882 878 962 950 — 12 V. Developmental 520 657 556 486 477 377 396 404 467 289 463 248 — 215 vi. Local 2596 2177 2172 2203 2362 2106 2290 2211 2255 2415 22782363 + 85 1. Diseases of Nervous System 330 322 341 345 330 294 290 291 307 213 306 212 — 94 2. ,, Organs of Special Sense 10 11 20 13 9 16 14 10 16 16 14 11 — 3 3. „ Circulatory System 691 654 592 651 734 745 822 740 802 929 736 1073 + 337 4. Respiratory „ 1156 770 822 717 903 598 797 756 709 835 806 653 — 153 5. „ Digestive „ 246 215 224 260 204 259 192 225 223 203 225 205 — 20 6. „ Lymphatic „ 3 11 10 14 11 11 8 7 19 10 10 8 — 2 7. „ Urinary „ 137 151 129 168 134 157 136 142 142 179 148 167 + 19 8. ,, Reproductive ,, 8 17 20 13 20 10 15 20 19 19 16 27 + 11 a „ Orgs, of Generation 2 7 7 8 5 4 6 10 3 7 6 12 + 6 b „ of Parturition 6 10 13 5 15 6 9 10 16 12 10 15 + 6 9. ,, Bones and Joints 9 12 5 3 8 8 10 10 11 8 8 4 — 4 10. „ Integumentary System 6 14 9 19 9 8 6 10 7 3 9 3 — 6 vii. Violence 156 162 179 142 137 151 156 169 169 168 159 199 + 40 1. Accident or Negligence 115 132 140 99 94 105 115 124 124 136 119 156 + 37 2. Homicide 3 2 2 3 3 8 2 2 3 — 3 8 + 5 3. Suicide 27 28 37 40 39 38 39 42 42 32 36 35 — 1 4. Execution — — — 1 — — 1 — — — — — 5. By Bombs (Enemy Aircraft) 11 — — — — — — — — — 1 — —1 viii. Ill-Defined Causes 103 89 95 84 54 47 39 32 29 15 59 25 — 34 All Causes 5841 4640 4475 4368 4614 3902 4222 4160 4090 4124 4443 4161 — 282 [1928 7 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, 1928. Mean Deaths (10 years, 1918-27.) Increase or Decrease on mean. 0-1 year 374 507 — 133 1-5 years 284 309 — 25 Under 5 years 658 816 — 158 5-15 years 104 151 - 47 15-25 ,, 144 184 40 25-35 ,, 180 243 — 63 35 45 „ 270 314 — 44 45-55 „ 433 486 — 53 55-65 „ 685 636 + 49 65-75 ,, 828 809 + 19 75—85 ,, 684 629 + 55 85 upwards 175 175 — All Ages. 4,161 4,443 — 282 There was a decrease of 158 deaths in the number of deaths under 5 years of age when compared with the average deaths at those ages during the preceding ten years; whilst the number of registered deaths at the several age periods up to between 45-55 years, were also below the decennial average. The deaths of aged people between the age period 65 years and upwards showed a decline of 53 in the number of deaths when contrasted with the previous year 1927, but were 123 above the ten years' average (1918-27). INFANTILE MORTALITY. Infant Deaths, 374; Mortality Rate, 64.—The deaths of 874 infants under twelve months' old were registered during the year, or 134 below the decennial average (508), and they were equal to the infantile rate of 64 per 1,000 births. The lowest rate on record, however, is 53 per thousand births in the year 1927. The rate was 9 per 1,000 births below the mean annual record of the pieceding ten years, and is 11 per 1,000 above the rate of last year (1927). In the quarters the mortality ranged from 82 per 1,000 births in the first quarter, 51 in the second, 49 in the third, and 76 in the fourth. In the sub-registration districts the infant mortality was as follows:— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 30 65 Upper Holloway 33 44 Tollington 38 85 Lower Holloway 60 77 Highbury 46 47 Barnsbury 82 75 Islington South East 85 67 In London the infantile mortality was 67 per 1,000 births, while in the six boroughs encircling Islington it was 73. I he rate for England and Wales was 65 per 1,000 births. 1928] 8 Infantile Mortality during each of the Ten Years 1918-27 and 1928. Deaths at various ages under One Year of Age. Years. Under one week. Weeks. Total under four weeks. Months. Total Deaths under one year. Deaths per 1,000 Births. 4 weeks and under 3 mths. 3-6 6-9 9-12 1-2 2-3 3-4 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 1927 90 19 13 9 131 46 56 38 53 324 53 Mean 10 years 121 32 23 17 193 82 96 68 69 508 73 1928 108 10 14 9 141 60 73 58 42 374 64 Increase or decrease on mean — 13 — 22 — 9 — 8 — 52 — 22 — 23 — 10 — 27 —134 — 9 Showing the Deaths among Infants per 1,000 Births during the Year 1928. and also the mortality rates for the Years 1918-1927. Sub-Districts. 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Mean 10 years 1928 Increase or decrease on mean Tufnell 93 50 41 53 83 46 54 47 64 52 58 65 + 7 Up. Holloway 83 79 69 76 59 64 70 57 30 31 62 44 —18 Tollington 135 98 58 83 58 55 60 65 92 63 77 85 + 8 Lr. Holloway 130 101 66 93 81 81 85 78 82 74 87 77 —10 Highbury 99 83 67 93 64 61 60 54 48 52 68 47 —21 Barnsbury 122 91 89 87 86 59 77 75 90 59 83 75 — 8 Islington, S.E. 107 81 79 77 88 82 55 58 64 49 74 67 — 7 The Borough 110 83 72 81 77 66 66 63 66 53 73 64 — 9 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 1918-27: and in 1928 from certain specified causes. Causes of death. 1928. Rate per 1,000 Births. Mean rate 10 years 1918-27 per 1,000 Births. Difference. Premature Birth and Congenital Defects 18.0 19.9 — 1.9 Bronchitis and Pneumonia 12.9 15.9 — 3.0 Atrophy and Marasmus 4.1 7.2 — 3.1 Diarrhœal Disease (all forms) 3.8 4.6 — 0.8 Convulsions 0.7 1.3 — 0.6 Whooping Cough 2.6 3.2 — 0.6 Measles 3.8 2.5 + 1.3 Diphtheria 0.3 0.3 Phthisis — 0.4 — 0.4 Other forms of Tuberculosis 0.9 1.1 — 0.2 Total of above 47.1 56.4 — 9.3 All other causes 17.5 16.9 + 0.6 Total 64.6 73.3 — 8.7 [1928 9 INFANTILE MORTALITY during the Calendar Year 1928. 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 Causes. Certified — — — — — — — — — — Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — 7 14 22 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — — — 6 3 4 2 15 Diphtheria, Croup — — — — — — — 2 — 2 Erysipelas — — — 1 1 1 — 1 — 3 Tuberculous Meningitis — — — — — — 1 1 2 4 -i Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — 1 — — 1 Meningitis (not Tuberculous) — — — — — 2* 1 1 4 Convulsions 2 2 — — 4 — — — — 4 Laryngitis — — — — — — — — — — Bronchitis — 1 — — 1 3 3 — — 7 Pneumonia (all forms) 2 1 1 2 6 15 18 17 12 68 Diarrhœa — — — — 2 9 8 3 22 Enteritis — — — 1 1 7 21 7 4 40 Gastritis — — — — — — — — — — Syphilis — — — — — 1 1 — — 2 Rickets — — — — — — — — — — Suffocation, overlying 2 — — — 2 2 — — — 4 Injury at birth 5 — — — 5 — 1 — — 6 Atelectasis 8 — — — 8 1 — — — 9 Congenital Malformations 19 1 3 1 24 7 2 — 1 34 Premature birth 61 3 2 1 67 1 1 1 — 70 Atrophy, Debility and Marasmus 4 2 3 1 10 6 4 3 1 24 Other causes 5 — 5 2 12 8 5 †§6 2 33 Totals 108 10 14 9 141 60 73 58 42 374 * Cerebro-Spinal Fever (1). † Acute Polioencephalitis (1). § Influenza (2). Nett Births in the year legitimate 5,561 illegitimate 249 5,810 Nett Deaths in the year of legitimate infants 347 illegitimate infants 27 EDUCATIONAL PROPAGANDA. (Health Week). In addition to the routine information afforded from the Public Health Department, and the leaflets issued to the public, a special effort was made during Health Week to interest the citizens in health. 1 he special subject taken by the Welfare Centres this year was "The Care of the Mother and Child." A special cinema display was arranged through the kindness of the proprietors of the Empress Picture Theatre, Upper Street, on Friday, 5th October, at 10.30 a.m. Councillor F. W. Nokes, J.P., Mayor of Islington, presided. The films shown were "A Dangerous Handicap," "Giro the Germ," "Where there's Life there's 'Ope," followed by a local film The poster entitled "Islington Health Election" was re-issued during Health Week, and a Health Week Leaflet as in previous years 1928] 10 was circulated in the Borough giving- particulars of the cinema display and the other activities during Health Week, together with a number of health axioms. During the year the Public Health Committee, Maternity and Child Welfare, and the Conjoint Committee of the Islington Welfare Centres had before them the revised draft, prepared by the Medical Officer of Health, of the booklet issued to Islington mothers upon receipt of the notification of a birth. This booklet now contains information of the special services of the department, the names and addresses of the Registrars of Births and Deaths, of the Relieving Officers, the District Medical Officers and Public Vaccinators, and the Vaccination Officers, how to apply for food or milk under the Maternity and Child Welfare Scheme, visitation by Health Visitors, the address of the Islington Voluntary Welfare Centres and the Tuberculosis Dispensaries. The following are the leaflets issued from the department:—" Hints on the Care and Feeding of Infants, for the guidance of Mothers," "Flies and Gnats," "Measles," "Whooping Cough," " Diphtheria," "Scarlet Fever," "Infectious Disease—Law," " Smallpox and Vaccination." The Maternity and Child Welfare Committee sent two delegates, Councillors Miss Grace Watson and Mrs. Pannell, to the Conference of the Women Sanitary Inspectors' and Health Visitors' Association held at Caxton Hall, Westminster, in February. At the same meeting the Medical Officer of Health introduced a discussion on the registration of Health Visitors. REPORT ON MATERNITY AND CHILD WELFARE WORK. Municipal Health Visitors. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthamia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. 78 cases of Ophthalmia Neonatorum were notified, compared with 136 cases last year. 59 cases of Ophthalmia were reported by the London County Council and Health Visitors as against 74 cases during the previous year. 35 out of the 78 cases of Ophthamia 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. 10 14 7 8 7 20 12 78 Cases notified by Doctor 10 10 5 4 5 10 2 46 Ophthalmia. Cases reported by L.C.C. 9 2 5 9 4 10 20 59 Cases reported by Health Visitors — 1 — — 1 — — 2 [1928 11 Of the 78 cases investigated, both of the infants' eyes were effected in 58 instances, whilst in 9 the right eye was involved, and in 10 the left. One case subsequently left the district. Treatment.—11 of the 78 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital, 27 being treated at other hospitals. 40 cases were treated at home by private Doctors. 36 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £34 2s. In 1927 54 cases were nursed at the cost of £59 12s. Results.—Of the 78 Ophthalmia Neonatorum cases, vision was unimpaired in all cases. There was one fatal case during the year. Ophthalmia Neonatorum Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 78 40 38 78 Nil Nil 1 MATERNAL DEATHS. The number of women dying in, or in consequence of, child-birth during the year 1928 was 25, or 4.3 per 1,000 registered births. Of this number 10 occurred from Sepsis (Puerperal Septicaemia); whilst 15 died from other diseases of childbirth. The deaths for the preceding year numbered 24 and were equal to the proportion of 3.9 per 1,000 births. 1928] 12 MATERNAL DEATHS, 1928. 1928. Ages at Death. Totals. Month. Cause of Death. 15 25 25 35 35 45 45 upwd. Total From Puerperal Sepsis From other Diseases of Childbirth. Jan. Puerperal Septicaemia .. 1 1 .. 2 2 .. Premature Labour and Acute Nephritis .. 1 .. .. 1 .. 1 Feb. Abortion—Septicaemia .. 1 .. .. 1 2 .. Puerperal Peritonitis .. .. 1 •• 1 .. •• Mar Puerperal Pyrexia .. .. .. 1 1 1 .. Obstructed Labour, rupture of Uterus 1 .. .. .. 1 .. 1 1st Qr. 1 3 2 1 7 5 2 April Puerperal Septicaemia .. .. 1 .. 1 .. .. Peritonitis Rupture of Uterus during Parturition .. 1 .. .. 1 2 1 Miscarriage—Lobar Pneumonia .. 1 .. .. 1 .. .. N.B.—There was also one death (age 30 years), from Septic Abortion, illegally produced; whereupon a verdict of Murder was brought in at Inquest. This death is, therefore, not included in above totals. May Nil. .. .. .. •• •• •• •• June Obstructed labour, contracted Pelvis .. 1 .. .. 1 .. .. Hyperemesis gravidarum .. .. 1 .. 1 .. 3 Pulmonary Embolus, following recent labour .. .. 1 .. 1 •• •• 2nd Qr. .. 3 3 .. 6 2 4 July Toxæmia of Pregnancy .. 1 .. .. 1 .. 1 (a) Post Operative Shock (b) Parturition .. .. 1 .. 1 .. 1 Aug. Septicæmia—Obstructed Labour 1 .. .. .. 1 1 .. Eclampsia-Pregnancy 1 .. .. .. 1 .. 2 Post partum Hæmorrhage .. .. 1 .. 1 .. .. Sept. General Peritonitis—Miscarriage .. .. 1 .. 1 1 •• 3rd Qr. 2 1 3 .. 6 2 4 Oct. Septicæmia following Miscarriage .. .. 1 .. 1 1 .. Childbirth—Inertia of Uterus .. .. 1 .. 1 .. 2 Dilatation of Stomach following operation for Ruptured Ectopia Gestation .. 1 .. .. 1 .. .. Nov. Internal Haemorrhage. Tubal Gestation and Rupture .. 1 .. .. 1 .. 1 Obstetric Shock .. 1 .. .. 1 .. 1 Dec. Puerperal Eclampsia 1 .. .. .. 1 •• 1 4th Qr. 1 3 2 .. 6 1 5 Total (Year) 4 10 10 1 25 10 15 1st Quarter 7 = 4.7 per 1,000 Births 2nd Quarter 6 — 4.1 ,, ,, ,, 3rd Quarter 6 = 4.1 ,, ,, ,, 4th Quarter 6 = 4.3 ,, ,, ,, Year 25 — 4.3 per 1,000 Births [1923 13 MATERNAL MORTALITY. Towards the end of the year the medical practitioners of the Borough were circularised on the matter of their co-operation in supplying confidential particulars in cases of maternal deaths. To each doctor was sent an explanatory note by Sir George Newman, together with a copy of the form on the lines of which information was desired by the Ministry of Health. This information would afterwards be classified and " considered by some competent body which will issue a report upon any facts and conclusions derived from the investigation." PUERPERAL FEVER. Definition.—The Royal College of Physicians' definition of Puerperal Fever is : Septicaemia, Pyaemia, Septic Peritonitis, Septic Metritis, and other acute septic inflammation in the pelvis occurring as the direct result of child-birth. Of the 38 cases coming to the knowledge of the Medical Officer of Health during 1928, 13 were notified by Medical Practitioners. The proportion of total cases to births was 6.5 per thousand. The notifications were 14 above the average (24) of the preceding ten years and showed an increase of 3.1 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1928. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 6 2 2 5 5 11 7 38 Private Practitioners' Cases 3 — 1 2 2 1 4 13 Hospital Cases 3 2 1 3 3 10 3 25 Cases inquired into 6 2 2 5 5 11 7 38 Cases treated in Hospital 4 2 2 5 5 11 6 35 Cases treated at Home 2 — — — — — 1 3 Of the 38 cases, 25 were treated in Hospitals. 18 of these contracted the disease in Hospital; 13 cases were removed to Metropolitan Asylums Board Hospitals; and 12 cases were removed to the Islington Infirmary and other London Hospitals. Deaths.—Ten deaths were registered as being due to Puerperal Fever. 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 77 cases being notified, as against 84 last year. Of these, 20 were Private Medical Practitioners' cases; 37 occurred in Hospital, while 20 were certified Midwives' cases. The notifications were in the proportion of 13.3 per 1,000 births. Cases of Puerperal Pyrexia notified and inquired into during the year 1928. Tufnell. Upper Hollo way. Tollington. Lower Holloway, Highbury. Barnsbury. SouthEast. The Borough Cases notified . 7 10 12 7 14 8 19 77 Private Practitioners'Cases 2 4 6 2 1 1 4 20 Hospital Cases 2 3 2 5 10 6 9 37 Certified Midwives' Cases 3 3 4 — 3 1 6 20 Cases inquired into 7 10 12 7 14 8 19 77 Cases treated in Hospital 5 8 6 7 11 7 19 63 Cases treated at Home 2 2 6 — 3 1 — 14 19281 14 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. Following- the circular which was issued by the Medical Officer of Health to medical practitioners in the Borough, four swabs were examined during the year. Cases which died of Puerperal Septicaemia. i. A swab from the eye of the handywoman in attendance revealed streptococci veridans. ii. A swab from the septic finger of a handywoman showed Haemolytic streptococci, Haemolytic staphylococci Albus, Haemolytic Aureus. The other two were non-fatal cases of " Pyrexia." (a) A swab from the septic finger of a handywoman showed a mixed growth of Haemolytic streptococci and staphylococci. (b) A swab from the throat of a nurse in attendance showed Non- haemolytic staphylococci albus, Streptococci veridans, Diphtheroid bacilli. No Haemolytic streptococci present. It will be noted that two of these cases, notified as "Pyrexia" were registered as dying of Puerperal Sepsis. The advantage of the notification of Puerperal Pyrexia is therefore apparent. The term takes in, of course, many cases which are not real Puerperal Fever, but occasionally what is considered simply as Pyrexia may eventually prove to be Puerperal Fever (Sepsis). PEMPHIGUS NEONATORUM. During the year 19.28, 16 cases which came to the knowledge of the Medical Officer of Health were investigated. THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1928, 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 £1,702 14s. 2d., as against £2,144 10s. 5d. in 1927. The total amount expended since the Order came into operation in 1918 is £49,955 14s. 3d. The total recipients during the year numbered 6,968, and the quantity of milk supplied to them was equal to 134,941 pints (16,867½ gallons). The scheme for the distribution of milk adopted by resolution of the Council on the 21st January, 1927, given below, was in operation from the 1st January, 1928, up to 30th June, 1928. [1928 15 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. ¼ f F F F F F F F f f f 13s 1d. to 20s. N ½ ¼ F F F f F f F F F 20s. 1d. to 25s. N ¾ ½ ¼ F f F f F f f f 25s 1d. to 30s. N N ½ ¼ F F F f f f f F 30s 1d. to 34s. l1d N N ¾ ½ ¼ f f f f f F f 35s to 39s. l1d. N N N ¾ ½ ¼ F f F f F F 40s. to 44s l1d. N N N N ¾ ½ ¼ F F f F F 45s. to 49s l1d. N N N N N ¾ ½ ¼ F F f F 50s. to 54s. l1d. N N N N N N ¾ ½ ¼ f f f F = Free. N = Nil. The Fractions ¾, ½ and ¼ represent the amount of cost charged to each recipient. Children living at home, and earning, NOT counted as members of family in this scale. A revised scale of income was adopted by the Council on the 18th May, 1928, upon the recommendation of the Maternity and Child Welfare Committee, in view of a reduction of £486 on the Council's estimate of the cost of supplying Milk during the year 1928-29, by the Ministry of Health. The amended scheme which has been in operation since the 1st July, 1928, is as follows:— REVISED SCALE OF INCOME. Supply of Milk to Necessitous Cases. Net family income after deduction of rent. Number in family—excluding children earning:— 2 3 4 5 6 7 8 9 10 11 12 Up to 20s. N ¾ ½ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ 20s. Id. to 25s. N N ¾ ½ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ 25s. Id. to 30s. N N N ¾ ½ ¼ ¼ ¼ ¼ ¼ ¼ ¼ 30s. Id. to 35s. N N N N ¾ ½ ¼ ¼ ¼ ¼ ¼ ¼ 35s. Id, to 40s. N N N N N ¾ ½ ¼ ¼ ¼ ¼ ¼ 40s. Id. to 45s N N N N N N ¾ ½ ¼ ¼ ¼ ¼ 45s. Id. to 50s. N N N N N N N ¾ ½ ¼ ¼ ¼ The fractions ¾, ½ and ¼ represent the amount of cost to be charged to each recipient. Children living at home and earning are NOT counted as members of family in this scale. All milk generally to be charged for, but discretionary power given to the Milk Sub-Committee (1) to grant free milk in certain cases and (2) to deal with applications where the gross family income is £3 a week or more. 1928] 16 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1928. District 1 2 3 4 5 6 7 8 Totals. I. Births, First Visits, Infants under 1 Year 658 564 788 814 791 490 513 437 5,055 II. Births, Re-Visits, Infants under 1 Year 751 416 608 493 887 869 934 556 5,514 III. Visits to Children, between 1st and 2nd Years 565 472 525 591 445 762 656 487 4,503 IV. Visits to Children, between 2nd and 5th Years 1,520 1,287 1,455 1,047 1,093 1,435 1,860 1,644 11,341 V. Visits re Still Births 22 25 25 20 16 16 12 13 149 VI. Deaths, Visits, re Infants under 1 Year 10 12 14 12 21 9 13 7 98 VII. Deaths, Visits, re Children 1 to 5 years 8 3 8 3 6 — 3 2 33 VIII. † Ante-Natal, Home Visits f/112 176 f/150 190 f/181 219 f/136 143 F/112 146 f/169 204 f/97 198 F/ 134 152 F/1,091 1,428 IX. † Puerperal Fever, Home Visits f/8 20 f/l 3 f/7 11 F/4 5 f/7 17 f/3 4 f/5 18 f/35 78 Pyrexia, do f. 1 f. 2 f. 1 f. 1 f. 5 Totals 3,731 2,974 3,654 3,129 3,422 3,789 4,207 3,298 28,204 X. Attendances at Welfare Centre 24 21 56 42 41 50 49 45 328 XI. Other Work by Direction 717 533 1,083 877 984 627 759 1,032 6,612 XII. Visits Declined — 3 2 5 2 1 1 1 15 XIII. Visits, House Shut 614 688 535 863 580 898 550 469 5,197 XIV. Visits, Inopportune 9 81 15 63 29 35 24 41 297 Grand Total of Visits 5,095 4,300 5,345 4,979 5,058 5,400 5,590 4,886 40,653 [1928 17 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/8 22 F/5 9 F/4 12 F/3 6 F/5 10 F/5 10 F 11 42 f/5 10 f46 121 (a) †Ophthalmia Neonatorum F/16 37 F/7 24 F/6 20 F/6 10 F/12 32 F/9 11 F/6 17 F/l 4 F/63 155 (b) † Epidemic (Summer) Diarrhœa — — F/l — — — — — F/l (c) Other Digestive Diseases — 1 7 1 — — 3 1 13 (d) Pneumonia and Bronchitis 45 44 4 25 13 — 9 49 189 (e) Rickets 9 17 20 48 37 89 1 84 305 (f ) † Measles and German Measles F/89 122 F/94 97 F/23 24 F/19 20 f/32 f/11 F/111 128 f/24 26 F/403 460 (g) † Whooping Cough f/2 f/ 12 f/43 f/27 f/19 f/2 f/17 F/11 f/ 133 (h) Tuberculous Disease—P=Pulmonary; 0 = 0ther o/l p/1 — p/1 — — — — p/4 o/l 5 (i) Convulsions — — 1 — — — — — 1 (j ) Polio-myelitis — — — F/l — — — — f1 (k) Premature Birth 10 20 23 35 6 6 11 33 144 (l) Atrophy, Debility and Marasmus 2 7 3 8 13 — — 1 34 (m) All other investigations (**Specify) 19 5 18 9 3 — 2 26 82 (n) Routine Visits included in I. to IX. and not included in (a) to (m) 3,462 2,737 3,478 2,938 3,257 3,660 3,975 3,053 26,560 ***Totals (a) to (n) 3,731 2,974 3,654 3,129 3,422 3,789 4,207 3,298 28,204 Total Families Visited 2,626 2,121 2,562 2,247 2,437 2,855 3,042 2,277 20,067 Registered Births. New Cases Handed to H.V's for Visitation. Infant Mortality. Maternal Mortality. Puerperal Fever. Puerperal Pyrexia. Ophthalmia Neonatorum. No. Rate. Notified Births. Non-Notified Births. Transfers In. No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. 5810 17 4 5606 233 372 374 64 24 4 1 33 34 77 58 78 17 "e.g.—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. Illegit, etc. •♦•Totals (a) to (») should correspond with Totals I. to IX. F. in front of figures denotes a " First Visit." 1928] 18 REPORT OF WORK OF VOLUNTARY CENTRES. A Table, summarising this work for the year ending 31st March, 1929, follows. The Centre year ends on this particular date, while the other matter in this Annual Report is up to the year ending 31st December, 1928. The Conjoint Committee of the Centres has continued their Quarterly meetings during the year under the Chairmanship of Alderman H. B. Vorley, J.P. I his Conjoint Committee forms a valuable link in co-ordinating the work of the four Centres and their Branches and enables matters to be brought up for discussion about which the Centres may desire a general expression of opinion. The Medical Officer of Health is a member of this Committee. The Centres during the year had seriously under consideration the milk scale in force in the Borough re- the provision of milk by the Local Authority, under the Maternity and Child Welfare scheme, to necessitous mothers and infants. This revised scale, which came into force in July, 1928, was stated by this Committee to have had the result that many mothers did not consider it worth while to make application. The matter continued under the consideration of the Committee with a view to representations being made to the Maternity and Child Welfare Committee of the Borough Council. North Centre.—During the year the Borough Council approved the extension of the ante-natal work at this Centre. The premises, already described in last year's Report, have been supplemented by the gift of a new surgery, fully equipped, in memory of the late Dr. Nancy Hield. The activities of this Centre, coming within the Maternity and Child Welfare scheme, apart from the work as a training centre and special dental work for school children, were reviewed (p. 17) of last report. A note on the ante-natal work is of interest :—At the clinics the mothers are given advice by a Lady Doctor before the baby is born and, if it is considered necessary, the case is referred to a consultative Ante-natal Clinic at a Hospital. Nurses from the Welfare Clinic visit these mothers to help them to carry out the medical advice given. When the confinement is over and the medical attendance is ended, or attendance of the midwife has ceased, a visit is paid with a view to any necessary after care. The after care is so arranged that each mother can be seen by the doctor at the Welfare Clinic six weeks after her confinement, unless she is attending a hospital or her private doctor. To the Post-natal Clinics the mothers bring their children for medical advice in regard to healthy upbringing. It will be seen in the Summary of the Municipal Health Visitors' work, Borough Council Health Visitors attend some of the clinics at the Centre to keep the necessary co-ordination between the Centre work in the district and that of the Maternity and Child Welfare Sections of the Public Health Department. Five Home-Helps are employed by this Centre to go into the homes and do the work of the mothers during their confinements, etc. The mothers pay weekly sums into a " Home-Help Club " for use of a Home-Help when needed. The " Light " Clinic of this Centre had, for children, 259 clinic days, and for mothers 143 days; the attendances were, " For consultations without treatment," 21 children, 8 mothers; " For treatment," children 5,724, mothers 1,711; a total of 7,464. The average numbers treated daily were children 22.1, mothers 11.9; the average number of treatments given, children 14.3, mothers 11.8. In regard to the number of cases treated and the reasons for treatment, the particulars are : Children—malnutrition 221, catarrhal conditions 96, rickets 72, restlessness and [1928 19 irritability 9, a total of 398; Mothers—nursing and ailing 92, expectant 53, a total of 145. Total treatments by "Light"—children and mothers, 643. Both children and mothers received three treatments a week from a carbon arc lamp, the exposure beginning with two or three minutes, and being gradually increased to twenty minutes. A very few had treatments varying from half an hour to an hour. In suitable weather, in addition, the children are exposed to the actual rays of the sun, with the effect that their bodies became much browner. It is stated that very good results have been obtained with catarrhal children and rickety children by treating with the Carbon Arc twice weekly before exposure to the Mercury Vapour lamp. The Medical Officers state that they are impressed with the results of the treatment, the appetites are improved, there is increased vitality and contentedness. The number of attendances have largely increased this year. An endeavour has been made at this Centre to enlist the aid of mothers in keeping records where "Test-feeds" are being used. One test-feed at the Centre, was an insufficient guide to the Medical Officers of the mother's capacity to feed her child. In 58 of the cases the mothers were found to have kept the record?, satisfactorily. From these records are calculated the average amount of milk obtained by the child in 24 hours, and the doctor is able to judge with more accuracy what supplementary feeds are required, and whether it is necessary that the child should be weaned. In connection with this scheme six scales were lent out for use at home. These were lent 77 times. In 33 cases supplementary feeding was shown to be necessary, in 26 the breast milk was shown to be sufficient, 13 cases were weaned, and in 5 cases the scales were still on loan. The Infant Welfare Wards.—The number of beds is 12 for children under two years of age and 6 for three mothers and their babies, a total of 18 beds. From the 1st April, 1928, to the 31st March, 1929, a total of 49 cases were treated —Babies: Malnutrition 13, Dietetic trouble 24, Education 18, Observation 6, Rickets 3, Babies with mothers 46; Mothers: Restoration of failing breast milk and Education 19, Restoration of failing breast milk and observation 20. The average number of days per patient, 40.19; the maximum 217, and the minimum 2. There was one death from gastric enteritis, aged 15 weeks, of a child under treatment for 27 days. 12 cases are reported as having been discharged without improvement, 100 in good health, 30 improved, and there were 7 still in residence at the end of the year. "Health Week."—During "Health Week" at this Centre there were short talks on the "Value of Ante-natal Care," given in the afternoons, Tuesday to Friday (inclusive). South Centre: New Buildings.—An extension of this Centre by utilising the ground of the back garden has been completed. This consists of Doctors' Consulting Rooms, Waiting and Weighing Rooms, Dispensaries, Dressings Room, Sister's Office and a Special Room. These are all on the ground floor, while the first floor is now used as follows:—Staff Sitting-room, Committee Room, and Voluntary Workers' Cloak Room, etc. The second floor provides a small flat for the housekeeper. A further lease of forty years was granted by the ground landlord (Lord Northampton), and the approval of the Ministry of Health was obtained. For five months during this construction the work of the Centre was carried on in spite of the great inconvenience of the building operations. (The new premises weie opened by H.R.H. Princess Mary in June 1929.) The new building is proving a great help in increasing the efficiency of the Clinic, especially its Ante-natal Department. 1928] 20 At the Duncan Terrace Branch the use of the ground floor room as a Dispensary was obtained, and this obviated the mothers having to climb stairs. The Canonbury Branch draws mothers from the Buildings recently erected in the neighbourhood, and relieves the pressure on the main Centre. As in former years, massage and "Sunlight" treatment was carried out by the Almeric Paget Massage Corps at Britannia Row. Convalescent Treatment: 245 mothers were sent for Convalescence through the Centre's help. Each case is assessed and money collected from the mothers. The mothers and babies are sent for a fortnight, either to the Centre's Cottage at Flamstead, Bedfordshire, or to the seaside through the help of the Women's Holiday Fund. The children were either sent to Miss Fleetwood's Home for four or six weeks or sent away through the Invalid Children's Aid Association. As regards mothers, 19 went to the seaside, 68 to Flamstead, and as regards children and babies, 72 to Flamstead, 60 to Miss Fleetwood's Home and 26 elsewhere. "Health Week": During "Health Week" "Health Talks" were given during each consultation afternoon. East Centre.—During the past year an extra Consultation has been carried on on Friday afternoons. Advantage was taken of the possession of a garden by the Centre by allowing the children the benefit of the sun during the warm months of July, August and September, the children being selected by the Medical Officers. The results were justified by a definite improvement in the general health. The Special Department of the Centre for "Observation and Test-feeding" has proved very successful and is now being held on two days a week. The mother brings the child at 9 a.m. and calls to take it away at 5 p.m. She goes at mid-day for baby's feed and in this way she nurses it three times at the Centre. Baby is weighed before and after each feed, and the quantity taken is recorded. Should the amount be insufficient, the mother is taught how to increase her supply of milk and a suitable supplementary feed is prescribed for the baby should this be required. Should the case absolutely call for artificial feeding, the method of preparing and giving the food is taught the mother. At the same time that the mother is attending regarding the test-feeding, opportunities are taken of instructing her respecting the bathing and handling of the infant and other details of infant care. The Medical Officer of this Centre reports that following the instruction of mothers in feeding the babies most gratifying results have ensued for the percentage of breast-fed babies is very high and is steadily increasing and undoubtedly the department for test-feeding has proved of great service. During the year arrangements were made for 70 mothers and 150 children to go to the seaside or country. The numbers were as follows : Mothers—Centre 43, Branch, 27 ; Children—Centre 92, Branch 58. Health Week.—The Activities of this Centre during "Health Week" included a lecture by Dr. Vance Knox of the North Centre on " The General Care of the Mother's Health during Pregnancy." After the lecture an opportunity was given for discussion, in which the mothers took part. West Centre.—The balcony at the Centre was, during the year, fitted with " Vita Glass." Convalescence.—This year 26 mothers and 56 children were sent for convalescence during the summer. In a large number of cases the mothers contribute towards this, the others are helped from various agencies. 2l [1928 The "Sunlight" lamp was used in respect of 89 children who made 924 attendances. The conditions calling for its use were in connection with Debility, Malnutrition, Rickets, Impetigo, Chronic bronchitis, Urticaria, Chronic Coryza, Adenitis, etc. Ward.—During the year as regards numbers there were fewer admissions to the Ward because of the longer average stay of each patient. The Medical Officer reports that the cases are very largely those of defects of feeding and of malnutrition and that these require prolonged treatment if they are to receive any permanent benefit. Number of patients treated, 97; Transferred to a "Home," 1; Transferred to a hospital, 1; Death, 1; Discharged (inclusive of Transfers), 89; Remaining, 7. The average length of stay was 21¼ days. "Health Week" and Educational Propaganda. Through the courtesy of the Milk Publicity Council a special lecturer spoke to the mothers on Tuesdays for a period. Lectures on "Hygiene in the Home" were also given through the Health and Cleanliness Council; these were in addition to the special "Health" lectures on the 2nd October. The various Departments of the Four Voluntary Centres, with the attendances for 1928 may be summarised thus:— North. South. East. West. Total. 1. Ante-Natal Clinics and Ailing Mothers Clinics. Number held weekly 31 1½* 1† 2 7½ Number of attendances 1,827 786 555 389§ 3,557 2. Consultations for Children up to 6 Years of Age. Number held weekly 10 10 10** 7 37 Number of attendances 20,971 18,835 13,794 19,159 72,759 3. Home Visiting. Number of visits made 14,183 12,377 9,440 8,853 44,853 4. Dental Clinics. Number attending 492 172 76 37 777 Number of attendances or arrangements made for attendances 1,351 312 155 - 1,818 5. Morning Callers. Number of attendances 1,286 815 87 972 3,160 6. Massage Clinics. Number of cases given massage or sent for massage 75 (& Sunlight treatment) 132 86 16 309 7. Wards. Number of beds 18 - - 8 26 Number of patients received 149 — — 97 246 8. Number of Children on Books 1,834 1,555 1,135 1,112 5,636 *2 Clinics one week, one following week = 1½ weekly. **Including 2 Observation Clinics. †One Extra Ante-Natal Clinic on 2nd Thursday in month to be added. ‡Extra Ante-Natal Clinics have had to be held on account of numerous attendances. § Attendances of Expectant Mothers only. 1928] 22 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. 1928 (Approximate Estimate) 93,713 93,270 51,630 86,087 324,700 28,250 up to 5 years old. BIRTHS. 1927 1,860 (Actual) 1,451 (Approximate) 1,024 (Approximate) 1.773 (Approximate) 6,108 1928 1,668 (Actual) 1,266 (Approximate) 980 (Approximate) 1,876 (Approximate) 5,790 Number on Books 31st March, 1929, i.e., Record Cards of Children to be visited. Exclusive of Record Cards marked "Attending Centre," and "Above Standard," "Visits declined," and "Visits not necessary" 16,653 MATERNITY AND CHILD WELFARE. Contributions by the Borough Council. Year ending 31 March, 1929. Voluntary Welfare Centres. £. North Centre 2,155 South Centre 837 East Centre 766 West Centre 1,042 Total £4,800 Day Nurseries. £. Lower Holloway 80* St. Luke's 40 South Islington 100 Total £220 *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 £59 18 0 Under Public Health £47 19 0* Total £107 17 0 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 0s. 0d.; Royal Free Hospital, £10 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. *Includes also adult nursing (pneumonia). 23 [1928 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—2,167 persons died in the Public Institutions located in Islington, of whom 1,452 belonged to this Borough, the remaining 715 having come here for treatment or relief. Of these, 421 died in the Archway House, 122 in the Royal Northern Central Hospital, 91 in the London Fever Hospital, and 29 in the Islington Institution and Islington Infirmary. Of the 1,452 deaths of inhabitants, 1,062 occurred in the Islington Infirmary, 236 in the Islington Institution, and 113 in the Royal Northern Central Hospital. The proportion which the 1,452 deaths in the Public Institutions bore to the Borough mortality was 34.9 per cent. Without the Borough.- 883 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, 34 in the North-Western Fever Hospital, 38 in the Children's Hospital, Great Ormond Street, 80 in St. Bartholomew's Hospital, 28 in the Colney Hatch Mental Hospital, 80 in the Royal Free Hospital, 64 in the University College Hospital, 38 in the North-Eastern Fever Hospital, 23 in the Eastern Fever Hospital, 33 in the Middlesex Hospital, 11 in the City of London Maternity Hospital, and 39 in the Metropolitan Hospital. These 883 deaths represented 21.2 per cent. of all the deaths registered in the year. Within and Without the Borough,—The deaths of Islingtonians numbered 2,335 and were equal to 56.1 per cent. of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— 91 inhabitants died from accidental deaths, or suddenly, in places outside Islington. During the previous year (1927) the total deaths in Local Institutions numbered 2,081, being 1,385 inhabitants of Islington in Local Institutions, plus 696 non-inhabitants of Islington in Local Institutions, the number in Islington Infirmary being 1,004, the number in the Royal Northern Hospital 124. The deaths of inhabitants of Islington in Institutions outside the Borough were 821. The total deaths in all Institutions, 2,206; and the proportion per 100 deaths from all causes, 53.5. Transferable Deaths.— During the year 38 deaths of residents that had occurred in outlying Institutions and other places in Provincial Boroughs were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Fevers— Typhus, Enteric and Continued—and Diarrhœal Diseases. During the year 237 persons died from these diseases, the death-rate being 0.73 per 1,000 inhabitants, as contrasted with 0.38 in the corresponding period last year, and a decennial average mortality of 226 and a death-rate of 0.68 per 1,000. In London the death-rate from the epidemic diseases was 0.67, while in the six Boroughs encircling the death-rate was 0.75. 1928] 24 Locally the deaths in the Sub-Registration Districts and Wards were as follows:— Showing the Deaths from each of the principal Epidemic Diseases in the several Wards and Sub Registration Districts during the Year 1928. SUBRegistration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea. Totals. Deaths Deaths Deaths Deaths Deaths Deaths Deaths Deaths Tufnell Up. Holloway Tufnell 1 — 13 1 1 2 1 19 Up. Holloway — — 16 2 — 1 3 22 Tollington Tollington — — 21 1 3 3 4 32 Lr. Holloway Lr. Holloway 1* — 29 1 5 5 4 45 Highbury Highbury — — 12 1 1 2 3 19 Mildmay — — 3 1 1 2 — 7 Barnsbury Thornhill — — 12 — 2 4 6 24 Barnsbury — — 10 1 1 1 1 14 Islington South East St. Mary's — — 8 — 1 2 — 11 Canonbury — — 16 — 3 2 2 23 St. Peter's — — 16 — 3 1 1 21 The Borough 2 — 156 8 21 25 25 237 Total Death Rates 0.00 — 0.48 0.03 0.06 0.08 0.08 0.73 * Paratyphoid. Showing the Deaths and Death Rates from the Principal Epidemic Diseases during the ten years 1918-27 and for the Year 1928. 1918 1919 1920 1921 1922 1923 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 7 0.02 5* 0.02 3* 0.01 1 0.00 — — — — Small Pox — — 1 0.00 — — — — — — — — Measles 114 0.39 12 0.04 92 0.27 27 0.08 134 0.40 16 0.05 Scarlet Fever 8 0.03 14 0.04 12 0.04 19 0. 0.06 29 0.09 13 0.04 Whooping Cough 147 0.51 17 0.05 70 0.21 43 0.13 98 0.29 38 0.11 Diphtheria 45 0.16 51 0.16 135 0.40 110 0.33 59 0.18 21 0.06 Diarrhoea and Enteritis (under 2 years) 82 15.78 per 1,000 births 85 13.53 per 1,000 births 77 8.19 per 1,000 births 156 19.78 per 1,000 births 71 9.46 per 1,000 births 103 14.51 per 1,000 births 1924 1925 1926 1927 Mean 10 years 1928 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 — — 2 0.00 2 0.00 Small Pox — — — — — — — — — — — — Measles 103 0.30 22 0.06 69 0.20 29 0.09 62 0.19 156 0.48 Scarlet Fever 10 0.03 8 0.02 12 0.03 8 0.02 13 0.04 8 0.03 Whooping Cough 57 0.17 61 0.20 29 0.09 45 0.14 61 0.18 21 0.06 Diphtheria 33 0.09 21 0.06 31 0.09 25 0.07 53 0.6 25 0.8 Diarrhoea and Enteritis (under 2 years) 52 7.5 per 1,000 births 69 10.4 per 1,000 births 69 10.8 per 1,000 births 48 7.9 per 1,000 births 81 11.2 per 1,000 births 67 11.7 per 1,000 births * Including 2 Malarial Fever. 25 [1928 Showing the Deaths from Diarrhœal Diseases together with those classed, under Enteritis and its Sub-headings, arranged in quarterly periods, and in three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Under 1 year 5 10 16 3 5 8 7 8 15 7 17 24 22 40 62 1 to 5 years 1 3 4 — — — — — — 1 — 1 2 3 5 Over 5 years — 2 2 1 1 2 — 1 1 — 2 2 1 6 7 Totals 6 15 21 4 6 10 7 9 16 8 19 27 25 49 74 INFLUENZA. Influenza caused 41 deaths during the year and showed a decrease of 111 on the return for the year 1927, and were 174 below the average of the preceding ten years 1918-27. The death-rate was equal to 0.13 per 1,000 inhabitants. Showing the Deaths from Influenza in the Quarters of the Year 1928, together with the averages of the corresponding periods, 1918-27. Years. First. Quarters. Fourth. Totals. Second. Third. 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 1927 118 15 7 12 152 Average 87 19 10 99 215 1928 18 12 3 8 41 Increase or Decrease —69 —7 —7 —91 —174 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 1928:— Ages. 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Mean 10 yrs 1928 Difference. 0- 5 106 19 10 5 22 5 11 6 — 8 19 3 —16 5-10 52 5 3 — 1 — 1 2 1 4 7 1 —6 10-15 32 8 3 1 — 2 2 — — 1 5 — —5 15-25 141 48 12 5 11 — 10 2 2 3 23 3 —20 25-35 252 82 21 9 14 6 7 1 4 13 41 1 —40 35-45 109 47 18 15 18 4 10 3 8 21 25 6 — 19 45-65 93 48 17 18 42 12 12 11 6 22 28 4 —24 55-65 69 42 17 13 37 5 19 11 12 28 25 6 — 9 65-75 50 36 13 14 43 16 16 19 8 34 25 7 —18 75 & upwards 27 21 4 13 33 8 16 17 10 18 17 10 —7 All Ages 931 356 118 93 221 58 104 72 51 152 215 41 —174 1928] 26 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the principal diseases of this class. Erysipelas. 14 deaths were returned from this disease, or 4 more than in the year 1927, and 5 above the average of the preceding ten years 1918-27. Puerperal Diseases.—These comprise Puerperal Pyæmia, Septicæmia, Septic Intoxication and Puerperal Fever, and they caused 9 deaths, being 3 below the return of 1927 and equalled the average of the ten years 1918-27. The deathrate was equal to 1.05 per 1,000 births. CANCER. Cancer.—518 deaths were registered from this malignant disease during the year compared with 449 in 1927, and with an average of 451 in the previous decennium. The deaths represent a death-rate of 1.59 per 1,000 of the civil population and is 0.21 above the average rate (1.38) of the last ten years; 229 deaths occurred among males and 289 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 1928:— Ages. 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Mean10 yrs 1929 Difference. 0-5 — 2 3 2 — 1 1 1 — 1 — — 1 5-5 — 1 — l — l 2 — — — — — 15-25 — 4 1 1 4 6 4 3 3 1 3 3 — 25-35 8 5 10 10 8 10 9 5 6 5 8 14 + 6 35-45 27 36 32 34 34 27 38 40 27 24 32 36 + 4 45-55 75 101 74 98 88 88 77 93 73 74 84 83 — 1 55-65 99 120 110 140 124 138 131 168 142 137 131 147 + 16 65-75 126 123 124 131 110 125 149 144 144 135 131 155 + 24 75-85 52 39 43 52 47 68 52 71 51 65 64 71 + 17 85 & upwards 6 7 5 6 6 9 8 7 7 7 7 9 +2 Totals 393 438 402 475 421 472 470 534 453 449 451 518 +67 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1928. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 12 10 9 19 27 25 37 139 Second 11 16 12 16 23 24 19 121 Third 10 10 13 13 24 23 32 125 Fourth 18 10 15 17 26 21 26 133 The Year 51 46 49 65 100 93 114 518 TUBERCULOSIS. Tuberculosis caused 358 deaths, which were 171 below the average of the last decennium, but were 10 above the number registered in 1927. The deathrate resulting from them was equal to 1.10 per 1,000 of the civil population, and represented 8.6 per cent. of the deaths from all causes during the year. Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 309 deaths, as contrasted with the decennial average of 365, while the death-rate was 0.95 per 1,000 of the civil population as against 27 [1928 the decennial rate of 1.11 per 1,000. There was a decrease of 56 on the ten years' average number of deaths, and of 0.16 on the mean death-rate. Tuberculosis (Respiratory System). Proportion of Deaths from Tuberculosis per 100 Deaths from All Causes. Death rates from All Causes per 1,000 inhabitants. Years. Deaths. Death rates per 1,000 inhabitants. 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 355 107 8.13 13.1 1922 378 1.13 8.19 1.38 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 1927 314 0.94 7.61 12.3 Average 10 years 365 1.11 8.21 13.5 1928 309 0.95 7.43 12.8 The following return gives the deaths at each age period:— Age Periods. Males. Females. Total. 0-5 1 2 3 5-15 2 2 4 15-25 31 25 56 25-35 29 42 71 35-45 42 22 64 45-55 47 17 64 55-65 22 8 30 65 upwards 8 9 17 Total 182 127 309 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1928. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 6 9 5 10 15 19 27 91 Second 8 9 6 8 14 14 23 82 Third 8 5 5 4 8 11 18 59 Fourth 5 7 3 8 13 24 17 77 The Year 27 30 19 30 50 68 85 309 Showing the Deaths from all forms of Tuberculosis during 1S28. Form. Ages. Sex. Districts. B. S.E. Total Deaths 0-1 1-5 over 5 M. F. Tuf. U.H. Toll. L.H. H. Respiratory — 3 306 182 127 27 30 19 30 50 68 85 309 Meningeal 4 13 8 11 14 2 1 7 I 3 7 4 25 Abdominal — 1 6 5 2 2 1 — 2 2 — — 7 General — 2 5 3 4 — — 1 — — 1 5 7 Other forms 1 3 6 4 6 1 — 1 2 1 — 5 10 All Tuberculosis 5 22 331 205 153 32 32 28 35 56 76 99 358 1928] 28 DEATHS FROM THE DISEASES OF THE RESPIRATORY SYSTEM. (Exclusive of Tuberculosis and Influenza.) These diseases, which include Chronic and Acute Bronchitis, Pneumonia, Pleurisy and Asthma, caused 653 deaths, or 182 less than in 1927. They were equal to a death-rate of 2.0 per 1,000 of the civil population, and represented 15.7 per cent. of the total deaths registered in the Borough. Acute Bronchitis.—There were 70 deaths as compared with 96 in the previous year, 33 occurred among males, and 37 among females. The deaths of 5 infants under 12 months were registered. Chronic Bronchitis.—118 deaths were ascribed to it, 59 being males and 59 females. This return is 123 less than that for 1927. Pneumonia (All forms).—329 deaths were registered, of which 183 were males and 146 females. 47 less died than in the year 1927. 68 infants under a year old died from this disease, while between the ages of 1 and 5 years 53 died from it. Above 5 years of age the deaths numbered 208. 140 deaths occurred in Public Institutions, chiefly the Islington Infirmaries. Pleurisy.—There were 19 deaths registered from this disease, 6 deaths occurred in Public Institutions. Asthma and Emphysema.—Nineteen deaths were recorded from these diseases, all of which were adults. Other Diseases of the Respiratory System.—Ninety-seven deaths were registered, as contrasted with 80 in 1927. VENEREAL DISEASES. Nineteen deaths were ascribed to these diseases, as compared with 12 in 1927. Of these, 14 were males and 5 females. They were 6 above the mean deaths (13) of the preceding ten years 1918-27. The three groups of ages at death were as follows:—Under 1 year, 2 deaths; 1-5 years, 1 death; and over 5 years, 16 deaths. 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.1. A complete list is exhibited in the public conveniences under the control of the Council. Information and leaflets are distributed on application by letter or otherwise by the Medical Officer of Health, and if desired, he personally advises applicants as to what they should do to secure the necessary confidential treatment. Applicants of both sexes have taken advantage of these facilities for information. The Local Executive Committee of the British Social Hygiene Council have for some years carried on an active propaganda in Islington. There have been lectures and women's meetings in Church Rooms and London County Council Schools by Miss Dugdale; open-air meetings at Highbury Corner on Thursday evenings; addresses given by Dr. Feldman, Dr. Turner, and Mr. Spence Duncan; on November 29th a Lecture at the Caledonian Road Baths by Mr. Spence Duncan. The Local Honorary Secretary is Mr. George Jewsbury, 39 Kelvin Road, Highbury, N.5 29 [1928 DEATHS FROM COAL-GAS POISONING. During the year 19 deaths were registered from asphyxia caused by the inhalation of carbon-monoxide gas. Eighteen deaths from the same cause occurred in 1927. Seventeen of these deaths were attributable to suicide, while the cause of the remaining 2 deaths was accidental, both of which were investigated at the request of the Ministry of Health. Of the 19 deaths, 12 were males and 7 females, the ages ranging from 15 to 75 years. ACCIDENTAL DEATHS. The deaths due to accident numbered 156. Of this number 56 deaths were ascribed to vehicular traffic and 55 to accidental falls, including 34 aged people. The 56 deaths due to accidents in vehicular traffic may be summarised as follow:— Motor Car or Lorry. Bus or Tram. Taxi-cab. OtherVehicles. Total. 33 14 3 6 66 Of this number, 15 deaths occurred to Islington residents when in outlying districts. In addition to these, 14 non-residents were also killed by vehicles within the borough. RETENTION OF DEAD BODIES (BODIES OF PERSONS DYING OF INFECTIOUS DISEASE IN HOSPITAL). Hearses Used for Conveying Bodies of Persons Dying from Dangerous Infectious Diseases. Owing to the admission of children suffering from Measles and Bronchopneumonia, Whooping Cough and other non-notifiable infectious diseases into the infectious disease hospitals, it has become increasingly necessary to see that the provisions of the Public Health (London) Act, 1891, are consistently complied withAs is well known, in the present housing shortage it is difficult to reserve a room for the reception of the body when it is brought to the home from hospital. The Metropolitan Asylums Board do not now permit the removal of the body to the house until permission has been received from the Public Health Department, and the Medical Officer of Health causes a special enquiry to be made as regards the accommodation, and in many cases has been able to persuade the parents to take advantage of the facilities provided at the Public Mortuary provided for this purpose at the Islington Coroner's Court. The provisions of the law are contained in sections 72 and 73 of the Public Health (London) Act, 1891. Section 74 of this Act deals with the use of or hire of a public conveyance other than a hearse for conveying the body of a person who has died of any dangerous infectious disease, and in contrast to the spirit of this provision it is disconcerting that there is now on the market, advertised, and in considerable use, a conveyance known as a "Double Purpose" hearse. This is used either as a hearse or at other times as a hired conveyance. Should the body conveyed in this be that of a person who has died of a dangerous infectious disease, and without disinfection and proper precautions the same vehicle is used for another purpose, besides the possibility of the conveyance of infection, it would appear that it is an ingenious way of getting over the provisions of the section, the vehicle being a hearse 1928] 30 at one time and not a hearse at another. The matter is one which seems to be worthy of public attention for legislation to compel hearses only to be used as such, or the notification of the use of such a conveyance otherwise to the Local Authority so that the disinfection might be properly supervised. INQUESTS AND MORTUARY. During the year 274 bodies were received into the Mortuary, as compared with an average of 335 in the preceding 10 years. Only five infectious bodies were received during the year. The daily average number of bodies received was 0.7; whilst in 1927 the average was 0.8. In 206 cases inquests were held, as contrasted with an average of 303 in the ten years 1918-27. Bodies received into Mortuary Inquests. 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 1927 309 240 Average 335 303 1928 274 206 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1928-27:— 1928 No. of bodies received. Daily Average. No. of Inquests held. 1927 No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 82 0.9 64 1st Quarter 74 0.8 81 2nd „ 72 0.8 46 2nd „ 68 0.7 69 3rd „ 57 0.6 43 3rd „ 76 0.8 32 4th „ 63 0.7 53 4th „ 91 1.0 58 Total for year 274 0.7 206* Total for year 309 0.8 240* *Inclusive of Inquests held by the Coroner upon bodies of deceased persons who died in Public Institutions in the borough. 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. 2,260 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 37. 31 [1928 The total cases notified are 447 more than those of the previous year (1,813), and 61 below the average (2,321) of the preceding ten years. The increases when contrasted with the decennial averages are to be found in the returns from Small Pox, Membranous Croup, Scarlet Fever, Enteric Fever and Puerperal Fever, which were respectively 3, 1, 89, 3, 14 above the average, while Diphtheria showed a decrease of 171 cases on the ten years' average. The 2,260 cases were equal to an attack-rate of 6.96 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. 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 1927 1,813 5.42 10 years average 2,321 7.03 1928 2,260 6.96 Registration Sub-Districts.—The total number of cases notified in these districts was as follows:— Total cases notified. Tufnell 198 Upper Holloway 249 Tollington 281 Lower Holloway 293 Highbury 327 Bamsbury 408 Islington South-East 504 Total 2.260 SMALLPOX. We had during the year in Islington a rather serious outbreak of Smallpox not as regards the number of cases, which one may assume, owing to the precautions taken, were small, but owing to the fact that cases occurred in a large Institution, the Holborn and Finsbury Hospital, Archway Road. As these cases are allocated to their respective home addresses, statistically they are not credited to Islington. One verified case of Smallpox amongst the cases notified during the year is credited to Islington, as the home address was in Englefield Road. The disease, however, was contracted by this man at his workplace, where he had been in contact with a lad who is supposed to have contracted the disease in Southwark. Our Islington case was not the only one who was infected at the particular workplace in Westminster. The Medical Officer of Health saw the case at the request of the patient's doctor, together with the London County Council s expert, Dr. Wanklyn. As the family occupied two rooms on two floors of a fully occupied house, which comprises in addition to this family two other families, the premises were not left in order that the movements of the inmates might be controlled until vaccination had been offered to them all. The Superintendent, Mr. G. J. Bridel, made the necessary telephonic communications for removal, and immediately afterwards proceeded to Colindale for vaccine lymph. Dr. Lynch, the Public Vaccinator for the district, carried out the vaccinations as soon as the lymph was obtained, the same night 1928] 32 The Medical Officer of Health was able to persuade all the inmates with the exception of an old lady of over 80 years, who stated that she had actually had smallpox, and one man, to be vaccinated or re-vaccinated. There were no fresh cases in this house, or in Islington. The landlord of the house saw the Medical Officer of Health, and the room occupied by the patient was stripped. It had previously been disinfected, and the walls were re-papered. From the occurrence of the case until the period of 15 days was passed, the Sanitary Inspector of the District, Mr. Wood, paid a daily visit to the house and reported from time to time to the Medical Officer of Health, who kept the patients under observation until it was certain their vaccination was established. As regards cases notified, and not confirmed (there were three of these in Islington), one, a girl of 13 years of age, had been brought by her parents from Grays, Essex, where she had been staying, was seen by a doctor on arrival in Islington, certified as Smallpox, and removed, but the hospital did not confirm the diagnosis. The incident, however, shows what happens in many cases of infectious disease in the country, how the patients are rushed away. Another case unverified was an infant who was packed off to hospital before the Medical Officer of Health received information from the Metropolitan Asylums Board and got to the house. This case was returned forthwith from the hospital. The third unverified case was a man who was seen by the Medical Officer of Health and Dr. Sturdee, of the Ministry of Health, at the request of the patient's doctor. On the advice of the Ministry's Specialist this case was certified and sent to hospital. After being retained for some days the diagnosis was not confirmed. The circumstances of this patient's return was the subject of correspondence, at the request of the Public Health Committee, with the Metropolitan Asylums Board. On Sunday evening, the 12th February, 1928, the Medical Officer of Health was telephoned by the Medical Superintendent, Dr. Evans, of the above Hospital, and forthwith went to the hospital, where he saw in Ward 9 a Hawker who had been in the hospital since the 12th September, 1927, when he was admitted from the City Road Institution, Shepherdess Walk. He was suffering from Smallpox. On going into the matter he ascertained that the Medical Superintendent had received a communication from the Medical Officer of Health of Holborn regarding a man who had been discovered in a Hostel in Holborn suffering from Smallpox. It was ascertained that this man had left Ward 10 of the Holborn and Finsbury Hospital on the 30th January, 1928, and further ascertained by telephone that same evening (12th February) that there was a case of Smallpox in City Road Institution, Shepherdess Walk. This last case had left Ward 10 of the Holborn and Finsbury Hospital on the 26th January, 1928. Here then were, besides the new case discovered, two other men suffering from Smallpox who had been in the hospital. It was evident that there must be some common source of infection. It was discovered later that according to statements made by the two men suffering elsewhere, that another man had been dismissed on the 26th January The assistance of the Police was invoked by us to try if possible to trace this man in case he should be suffering from Smallpox and have been the cause of the outbreak. This was proved rather elusive. He was reported by the Police to have been in Westminster and St. Marylebone, but was at last located on the 16th February at the Metropolitan Asylums Board Casual Ward, Gainsborough Road, Hackney. He was seen by Dr. Sturdee, of the Ministry of Health, and removed to the Metropolitan Asylums Board Hospital. 33 [1928 The inference, as stated, is that these cases had been caused by a sufferer from unrecognised Smallpox either in the person of this suspect or some other person about the same time. On the 20th February the Medical Officer of Health again at the call of the Medical Superintendent went to the Holborn and Finsbury Hospital. This date was a critical time, as it was nearing the time when one would expect infection in those not protected sufficiently by vaccination. As he had indications from the Ministry of Health that it would be advisable, rather than isolate there for observation, to send suspects to the Metropolitan Asylums Board Hospital (which is now permitted) seven cases which showed new illness in the shape of temperature, eruption, etc., were transferred. On the 21st February other cases were examined, and one being definitely certified as Smallpox, was removed. This case appeared in another ward (Ward 12), the patient had evidently been largely protected by his re-vaccination, and was only retained in the Smallpox Hospital for a week. The Wards, 9, 10, 11 and 12, are all in the same block, and communicate by lift and staircase. Ward 10 had harboured the two cases which occurred elsewhere, and probably also the original suspect. Ward 9 had the first case diagnosed. Ward 12 the second case diagnosed. The seven observation cases had after varying periods of detention been returned, their re-vaccination having been proved efficient. One of these observation cases was an unvaccinated lad of 14 years, he was retained the longest for observation. The first notified case had been vaccinated in infancy, one scar. The second case had also been vaccinated in infancy, four good marks. The following are the particulars regarding the steps taken in respect of the Holborn and Finsbury Hospital:—All the nurses and cleaners engaged in the hospital, and practically all the officials and employees were promptly vaccinated or re-vaccinated by Dr. Thomas Evans, the Medical Superintendent. All the patients, except those whose illness rendered it inexpedient, were also re-vaccinated. With the assistance of the hospital staff, a list of recent visitors to the particular wards was prepared, together with particulars respecting recently dicharged patients from these affected wards. The addresses of these contacts were forwarded to the health authorities concerned in order that the visitors, etc., might be kept under observation. Measures were also taken to segregate the nursing staff of the particular wards. A smaller ward, situated in the top floor of the north wing, which had a connection by an external iron bridge, was cleared and transformed into temporary quarters for the nurses and cleaners, and these three wards were as far as possible isolated from the rest of the building during the period of quarantine. The hospital was closed to the public, only near relatives of "slated," that is, dangerously ill, patients, being admitted. These were obliged to don an overall before entering the ward, and whenever possible they were prevailed upon to submit to vaccination, or re-vaccination. At the suggestion of the Ministry of Health, if they refused re-vaccination, they were permitted to visit upon signing a statement to the effect that they had refused. Fortunately the laundry work of the institution is done on the premises, and much of the refuse is burned in the boiler house. Special precautions were taken regarding the nursing staff. and their movements when off duty were curtailed. It would be impossible in a brief report to detail precisely the work entailed in a large institution like this, but the following may prove of interest. 1928] 34 Over 600 persons were re-vaccinated by Dr. Evans; some 211 domicilliary visits were paid to "contacts" by the Sanitary Inspectors of my department alone, many of these visits having to be paid after usual working hours, as the persons were engaged at their usual vocations during our office hours. Arrangements were made for the Steward of the Hospital to immediately notify my department whenever the employees of the hospital residing outside the Institution failed to report for duty, and these absentees were visited at their homes to fully ascertain the cause of absence. This visitation had to be carried out on Sundays as well as weekdays. A large amount of correspondence was necessary in connection with the contacts living outside the Borough. As far as possible these were telephoned and confirmed by writing afterwards. One hundred and eighty-five mattresses, over 200 pillows, and an equal amount of bedding have been stoved, in addition to a vast amount of clothing. Books, papers and articles which could not be effectively disinfected have been burned. One interesting item in the disinfection was the disinfection of 100 grampohone records, which had to be separately washed with disinfectant. This gramophone had been in common use in the wards, and was a possible source of infection from one ward to the other. I feel that the Hospital Committee of the Guardians (this is a joint hospital for Holborn and Finsbury) have shown great foresight, and have met the requirements most sympathetically. They have taken the opportunity after the disinfection of the four large wards to have them thoroughly cleansed and renovated. The redecoration of these wards, although an expensive matter, is money well spent, and after an outbreak like this, the time was most opportune for it being undertaken. The Medical Superintendent, Dr. Thomas Evans, has had a most anxious time, but the success which has followed his painstaking and arduous work must be regarded as in a large part due to the rapidity with which he carried out the initial vaccination and re-vaccination of such a large number of people at the hospital, and to the very thorough supervision which he exercised in having all our requirements carried out. Mr. Bicknell, the District Sanitary Inspector, had for the second time recently a very onerous and exacting task. The Royal Northern Hospital, where we had an outbreak before, also fell to him, but this institution was a task of even greater magnitude, as naturally a hospital of this class has a different clientele, and the supervision more difficult. Diphtheria was responsible for 760 cases of illness, which were (170) below the average (930) of the preceding ten years. The attack rate was equal to 2.34 per 1,000 of the civil population annually, and was 0.48 below the mean rate (2.82) of the decennial period. In London the attack-rate was 2.77 per 1,000, and the Encircling Boroughs 2.77. 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." 35 [1928 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 156,000 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 116,000 units were sold, the total amount received by the Council being £9 7s. 6d. The remaining 40,000 units were given free, owing to the patients' limited means. Scarlet Fever.—1,305 cases were notified, and they showed an increase of 89 on the average (1,216) of the ten years 1918-27. The attack-rate was equal to 4.02 per 1,000 of the civil population annually, which is an increase of 0.34 per 1,000 of the mean rate (3.68) of the preceding ten years. In London the attackrate was 3.44 per 1,000 of the civil population, while in the Encircling Boroughs it was 3.83. Enteric Fever.—19 cases were notified which were 3 more than the average that obtained during the ten years 1918-27. The attack-rate was 0.06 per 1,000 annually, or 0.01 per 1,000 above the mean rate (0.05) of the last ten years. In London the rate was 0.01, and in the Encircling Boroughs 0.08 per 1,000 of the civil population. Typhus Fever.—No case was notified. Puerperal Fever.—See page 13. Erysipelas.—184 cases were notified, and equalled the average of the preceding ten years, the attack-rate being 0.41 per 1,000 of the civil population. FATALITY FROM THE PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES. By "Fatality" is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that of the 2,260 cases notified, 60 deaths occurred, or 2.7 per cent., which contrasts with an average percentage of 3.7 in the preceding ten years 1918-27. Years. Cases. Deaths. Fatality. 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 1927 1,813 55 3.0 Mean 2,321 87 3.7 1928 2,260 60 2.7 *Including 2 cases not notified. ‡Includes 1 case not notified. 1928] 36 Hospital Isolation.—Of the 2,260 cases of infectious diseases notified, 2,153 were isolated in hospital, equal to a percentage of 95.3 while only 4.7 per cent. of the patients were nursed at home. The following tabular statement shows the number of cases treated in the various public institutions:— Year. Cases treated in Hospital. Percentage of cases treated. 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 1928 2,153 95.3 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated. Percentage of known cases. Small Pox 4 4 100.0 Scarlet Fever 1,305 1,272 97.5 Diphtheria 760 752 98.9 Enteric Fever 19 17 89.5 Erysipelas 134 77 57.4 Puerperal Fever 38 31 81.6 Continued Fever — — — 2,260 2,153 95.3 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 1928. 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 4 - 4 100.0 - - - - - - - Scarlet Fever 1,272 33 1,305 97.5 2.5 7 1 8 0.5 3.0 0.6 Diphtheria 752 8 760 98.9 1.1 22 3 25 3.0 37.5 3.3 Enteric (Typhoid Fever) 17 2 19 89.5 10.5 2 - 2 11.0 - 10.5 Typhus Fever - - - - - - - - - - - Erysipelas 77 57 134 57.4 42.6 12 3 15 15.6 5.3 11.2 Puerperal Fever 31 7 38 81.6 18.4 9 1 10 29.0 14.3 26.3 Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Cholera - - - - - - - - - - - Total 2,153 107 2,260 95.3 4.7 52 8 60 2.4 7.5 2.7 37 [1928 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred, during each of the Ten Years 1918-27 and in 1928. DISEASES. YEARS. Average number of cases, 1918-27 1928 Increase or Decrease 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Small Pox Cases 2 2 - - - - - - 1 - 1 4 +3 Rate 0.00 0.00 - — - — - — 0.00 — 0.00 0.01 +0.01 Diphtheria Cases 514 645 1324 1548 1126 889 854 911 743 716 927 756 —171 Rate 1.80 1.96 3.94 4.65 3.37 2.64 2.48 2.69 2.19 2.14 2.81 2.33 -0.48 Membranous Croup Cases 4 4 4 5 4 2 2 2 — 4 3 4 +1 Rate 0.01 0.01 0.01 0.02 0.01 0.00 0.00 0.00 — 0.01 0.01 0.01 — Scarlet Fever Cases 432 1084 1307 2622 1496 1080 1077 1139 1010 909 1216 1305 +89 Rate 1.51 3.29 3.89 7.87 4.48 3.21 3.13 3.36 2.98 2.72 3.68 4.02 +0.34 Enteric Fever Cases 30 16 24 10 9 16 14 10 18 12 16 19 +3 Rate 0.10 0.05 0.07 0.03 0.03 0.05 0.04 0.03 0.05 0.03 0.05 0.06 +0.01 Continued Fever Cases — 1 — — — — 3 — 1 — — — — Rate — 0.00 - - — — 0.01 — 0.00 — — — — Puerperal Fever* Cases 4 29 29 34 20 22 19 23 27 33 24 38 +14 Rate 0.77 0.46 3.08 4.31 2.68 3.10 2.79 3.50 4.18 5.40 3.47 6.56 +3.09 Erysipelas Cases 141 212 165 125 132 87 116 109 118 139 134 134 — Rate 0.49 0.64 0.49 0.38 0.39 0.26 0.34 0.32 0.35 0.42 0.41 0.41 — Totals Cases 1127 1993 2853 4344 2787 2096 2085 2194 1918 1813 2321 2260 —61 Rate 3.93 6.05 8.49 13.05 8.34 6.22 6.06 6.47 5.65 5.42 7.03 6.96 —0.07 * Per 1,000 Registered Births. Showing the Cases of the Notifiable Infectious Diseases notified in the SubRegistration Districts and the Wards during the Year 1928. 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 1 117 63 - 3 - 8 6 - - - 198 Up. Holloway Tollington Up. Holloway - 144 89 - 3 - - 2 - - - 249 Tollington - 175 83 1 4 - 16 2 - - - 281 Lr. Holloway Highbury Lr. Holloway - 187 90 2 — - 9 5 - - - 293 Highbury - 84 61 1 1 - 16 2 - - - 165 Mildmay - 97 47 — 2 - 12 4 - - - 162 Bamsbury Thornhill - 157 85 — — - 17 6 - - - 265 Barnsbury - 71 63 — — - 5 4 - - - 143 Islington, S.E. St. Mary's - 79 61 — 2 - 10 2 - - - 154 Canonbury 2 92 45 — 3 - 17 3 - - - 162 St. Peter's 1 102 69 — 1 - 13 2 - - - 188 Totals 4 1,305 756 4 19 — 134 38 — — — 2,260 Attack-Rates per 1,000 population 0.01 4.02 2.33 0.01 0.06 — 0.41 0.12 — - - 6.96 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, and Tuberculosis. 1928] 38 Acute Poliomyelitis. No case was notified from this disease during the year, as contrasted with 6 in 1927, and 12 in 1926. 1928 1927 Cases. Deaths. Cases. Deaths. 1st Quarter Nil Nil Nil Nil 2nd „ „ „ 1 „ 3rd „ „ „ 3 „ 4th „ „ 2 „ Nil Nil 6 Nil Epidemic Cerebro-Spinal Meningitis. Eight cases came to the knowledge of the Medical Officer of Health, although only 4 were notified, as against seven in 1927. During the ten years 1918-1927, the cases averaged 9 per annum. A return of attacks of the disease during the past ten years is given in the following statement:— 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Average 10 yrs. 1918-27 1928 Total Deaths, 1918-27. 1st Quarter 7 8 5 3 1 3 - 2 3 3 3 1 25 2nd „ 4 7 5 3 2 2 — 1 3 3 3 4 26 3rd „ 1 1 2 - - 2 2 2 3 — 1 2 8 4th „ 4 — 2 1 — 1 4 1 2 1 2 1 10 Year 16 16 14 7 3 8 6 6 11 7 9 8 69 The deaths during the year numbered 5 and were equal to the very high rate of 62 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:— 1924 1925 1926 1927 1928 Malaria 1 Nil Nil 2 - Dysentery Nil Nil Nil 5 1 Acute Primary Pneumonia 119 93 190 202 288 Acute Influenzal Pneumonia 65 41 55 124 50 Total 185 134 245 333 339 DYSENTERY. Only one case of Dysentery was notified during the year. It occurred in the Highbury Ward, and the patient was a male aged 31 years. The Infectious Diseases (London) Regulations, 1927, came into force in 1928, superseding the regulations to which attention was drawn on page 35 of the Medical Officer of Health's Report for the year 1927. These amended regulations overcome the difficulties referred to. 39 [1928 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.) No cases were known in Islington during the year. 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 5 cases of Acute Encephalitis Lethargica were known, but only 3 were notified. They showed a decrease of 2 on the return of the previous year, whilst 3 deaths were registered; or 60 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 1927 Average (9 years). 1928 Cases 5 8 11 3 10 39 17 21 7 13 5 Deaths 1 1 2 3 5 4 6 9 4 4 3 Three cases of Acute Polioencephalitis were known in the Borough, and one of these ended fatally. Ophthalmia Neonatorium. Purulent Disease of the Eyes of Newly-born Children. See p. 10. BLIND PERSONS ACT, 1920. SCHEME FOR THE WELFARE OF BLIND PERSONS IN THE CITY OF LONDON, AS APPROVED BY THE MINISTRY OF HEALTH. This scheme is administered by the London County Council. As regards children of school age, that is, up to five years, the London County Council, through the several Metropolitan Boroughs, communicate with the Borough Medical Officers of Health for the home visitation of such cases to be carried out by the Municipal Heatlh Visitors. A watch is kept on the home conditions in case these should be unsuitable for the blind child. It is recognised, except in very exceptional circumstances, a blind child should not be removed from his or her home. In the event, however, of this being necessary, some watch is required as regards the arrangements which are proposed to be made with the consent of the parents or guardians. At present we know of two blind children in Islington, both girls, under five years of age, one born in March, 1925, and the other in August, 1927, the latter being a transferred case from another Borough. In both instances there have been no calls for special report on the conditions. TUBERCULOSIS. 694 cases of Tuberculosis in its different forms were notified during the year. The attack rate was equal to 2.14 per 1,000 of the civil population. This number was an increase of 54 on the return of the previous year, and of 0.23 per 1,000 on the attack-rate. 1928] 40 Respiratory (Pulmonary) Tuberculosis.— 563 notifications were received, of which 338 referred to males and 225 to females, and represented an attack-rate of 1.73 per 1,000 inhabitants. Showing the Notified Cases of Tuberculosis in the Wards during 1928. 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 34 25 59 9 8 17 76 2.31 Up. Holloway Tollington Up. Holloway 28 22 50 6 5 11 61 1.98 Tollington 27 11 38 9 5 14 52 1.73 Lr. Holloway Lr. Holloway 43 20 63 8 7 15 78 1.93 Highbury Highbury 26 21 47 3 4 7 54 1.74 Mildmay 17 23 40 3 9 12 52 1.86 Bamsbury Thornhill 40 16 56 3 8 11 67 2.28 Bamsbury 36 18 54 2 4 6 60 2.48 Islington, S.E. St. Mary's 24 13 37 3 2 5 42 2.37 Canonbury 24 26 50 7 8 15 65 2.08 St. Peter's 39 30 69 4 14 18 87 3.01 Totals 338 225 563 57 74 131 694 2.14 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1928. 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. 338 - 4 12 75 133 107 7 F. 225 — 3 10 80 93 33 6 Tubercular Meningitis M. 1 — 1 - — - - - F. 2 1 1 - - - - - Tabes Mesenterica M. 5 - - 4 - 1 - - F. 8 - - 1 5 2 - - General Tuberculosis M. 2 - - - 1 - 1 - F. 1 - - - 1 - - - Other forms of Tuberculosis M. 49 - 11 18 6 9 4 1 F. 63 — 7 20 20 13 1 2 All Tubercular Diseases M. 395 - 16 34 82 143 112 8 F. 299 1 11 31 106 108 34 8 Totals 694 1 27 65 188 251 146 16 Percentages at each life period to total cases 0.14 3.89 9.36 27.10 36.16 21.04 2.31 From the above statement it will be seen how the disease attacked people at the various ages, viz.: In every hundred eases 0.14 were under 1 year of age „ „ 8.89 were aged 1 to 5 years. „ „ 9.36 were aged 5 to 15 years. Prime „ ,, 27.10 were aged 15 to 25 years of „ ,, 36.16 were aged 25 to 45 years Life ,, ,, 21.04 were aged 45 to 65 years „ „ 2.31 were aged 65 and upwards. 41 [1928 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, 1928 (i.e., ending 31st December, 1928):— Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1928 1,030 838 331 290 2,489 Notified cases added during the year 1928 338 225 57 74 694 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1928 53 43 23 21 140 No. of cases removed from the register during the year 1928 1,421 1,106 411 385 3,323 287 210 47 45 589 1,134 896 364 340 2,734 Showing the Notified Cases of Tuberculosis in the Quarters during 1928 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Males Females Total Males Females Total Males Females Total Males Females Total Males Females Total Respiratory Tuberculosis 114 49 163 75 63 138 79 58 137 70 55 125 338 225 563 Tubercular Meningitis ... 1 1 ... 1 1 1 ... 1 ... ... ... 1 2 3 Tabes Mesenterica 2 2 4 2 6 8 1 ... 1 ... ... ... 5 8 13 General Tuberculosis ... ... ... ... 1 1 2 ... 2 ... ... ... 2 1 3 Other forms of Tuberculosis 12 14 26 12 15 27 5 14 19 20 20 40 49 63 112 Totais 128 66 194 89 86 175 88 72 160 90 75 165 395 299 694 Disinfection of Houses and Rooms after Tuberculosis,—The following statement gives the particulars for the year:— Houses. Rooms. 1st quarter 183 164 2nd „ 128 160 3rd „ 78 95 4th „ 119 149 Total 458 568 1928] 42 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1928, to the 29th December, 1928, in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Total Notifications on Form A. Number of Primary Notifications. 0 to 1 1 to 6 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up. Total Primary Notifications. Pulmonary Males - 4 4 6 32 43 72 61 73 34 7 336 517 „ Females — 3 6 5 42 38 57 36 17 16 6 225 358 Non-pulmonary Males — 10 11 7 5 2 5 5 3 2 1 51 72 „ „ Females 1 8 13 5 17 9 13 2 1 - 2 71 90 Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Age-periods Under 6 5 to 10 10 to 15 Total Primary Notifications Pulmonary Males - 1 1 2 2 86 218 Females — - - — — 84 124 Non-pulmonary Males 2 2 2 6 13 6 32 „ „ Females - 1 2 3 9 4 39 Showing New Cases of Tuberculosis and all Deaths during 1928 Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmona Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year - - 1 4 1 - - 4 1-5 5 5 20 15 3 4 7 7 5-10 7 5 17 18 2 — 3 3 10-15 7 5 9 8 1 2 — 3 15-20 33 44 6 18 13 14 1 - 20-25 44 39 4 9 18 15 3 - 25-35 76 62 5 13 29 41 1 1 35-45 66 38 6 3 40 20 — — 45-55 79 21 3 1 50 15 — 1 55-65 42 18 2 1 23 7 — 2 65 and upwards 10 9 1 2 8 9 — 1 Totals 369 246 74 92 188 127 15 22 81 Deaths not notified or 23.0 per cent. of Total Deaths. NATIONAL ASSOCIATION FOR THE PREVENTION OF TUBERCULOSIS. By direction of the Borough Council, the Medical Officer of Health attended the Conference of the National Association for the Prevention of Tuberculosis which was held in London from the 15-16th October, 1928, and submitted a report on the proceedings to the Public Health Committee. 43 [1928 TUBERCULOSIS DISPENSARIES. The work of the Tuberculosis Dispensaries still progresses very satisfactorily. Dr. Leitch, the Tuberculosis Officer for the southern portion of Islington, and Dr. Comyn, the Tuberculosis Officer for the northern portion, have been constantly in touch with the Public Health Department, and co-ordination has thus been most satisfactorily maintained. I have to congratulate these two Assistant Medical Officers (Tuberculosis) upon the good results which they have obtained. During the year 1,217 persons were examined by the Tuberculosis Officers, and the patients made 8,418 attendances. At the Northern Dispensary there were 558 new cases, and at the Southern 659, while the attendances at the former were 2,616 and at the latter 5,802. The examination of contacts with tuberculous cases showed that 40 were suffering from tuberculosis, 30 were suspects, and 399 were not suffering. The nurses of the Northern Dispensary paid 916 visits, and those of the Southern 1,988, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 78 visits, and of the Southern 426 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 fourteen patients at a cost of £84. 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 £13. The number of persons in attendance at the Dispensaries in each year was as follows:— TUBERCULOSIS. 1924 1925 1926 1927 1928 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 502 549 543 656 542 670 574 582 558 659 Actual Number of Attendances 3374 6122 3394 6176 3366 6672 2847 6044 2616 5802 Totals 3876 6671 3937 6832 3908 7342 3421 6626 3174 6461 A summary of the combined dispensaries is given for the following years: Cases. Attendances. 1924 1,051 9,496 1925 1,199 9,570 1926 1,212 10,038 1927 1,156 8,891 1928 1,217 8,418 Totals 5,835 46.413 1928] 44 Table showing the number of Tuberculous Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1928. Date. Dispensary Jan. Feb. Mar. Apr. May. June July Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 315 237 240 200 190 226 234 188 191 225 203 167 2,616 8,418 Southern 597 534 502 416 497 470 499 410 447 557 500 373 5,802 New Cases Including Contacts Northern 81 42 46 42 44 52 52 39 37 54 43 26 558 1,217 Southern 56 72 75 53 53 56 53 33 43 62 68 35 659 Contacts. Tuberculosis Northern 3 1 2 2 1 1 1 - 2 1 1 - 15 40 Southern 1 2 2 3 — 5 1 3 — 2 3 3 25 Suspects Northern 2 1 2 1 1 6 5 - 1 1 - 1 21 30 Southern - - - 1 1 - 3 1 - 1 1 1 9 Non-Tuberculous Northern 27 15 13 10 16 18 12 3 8 11 20 4 157 399 Southern 29 29 33 19 21 16 14 10 16 23 24 8 242 Nurses' Visits Northern 83 67 94 97 95 80 80 52 71 76 72 49 916 2,904 Southern 189 187 180 153 182 76 177 178 88 200 213 165 1,988 Tuberculosis Officers' Visits Northern 2 11 13 11 1 1 5 9 12 5 6 2 78 504 Southern 33 43 42 28 45 37 32 23 24 41 38 40 426 HOME VISITATION—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1928, to 31st December, 1928. Month. North Dispensary. South Dispensary. Total. January 153 130 283 February 148 121 269 March 152 122 274 April 143 99 242 May 143 108 251 June 80 88 168 July 151 124 275 August 143 133 276 September 126 106 232 October 147 135 282 November 155 125 280 December 139 94 233 1,680 1,385 3,065 The Municipal Tuberculosis Visiting Nurse works under the direction of the I uberculosis 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 suffering from the disease; patients attending the Dispensaries; Ex-Service Tuberculosis War Pensioners, etc. 45 [1928 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,072 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 749 were Scarlet Fever and 320 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 749 722 +27 Diphtheria 320 434 —114 Enteric Fever 3 2 +1 Other Diseases — — — Total 1,072 1,158 —86 Non-Notifiable Diseases.—6,035 cases came to the knowledge of the Medical Officer of Health during the year, viz.: 3,310 cases of Measles, 997 cases of Chicken Pox, 483 of Whooping Cough, and 1,245 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.—3,315 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 3,310 1,668 +1,642 Chicken Pox 997 921 +76 Whooping Cough 483 584 — 01 *Other Diseases 1,245 2,381 —1,136 Total 6,035 5,554 +481 *Note.—"Other Diseases " include Mumps, Scabies, Ophthalmia, Itch. etc. BACTERIOLOGICAL EXAMINATIONS2,650 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 21 on that of the preceding year. It was also 695 above the decennial average. Of the total examinations, 417, or 15.7 per cent. gave positive results. Diphtheria.—1,754 specimens were examined for Diphtheria, of which 276, or 15.7 per cent., were found to contain Diphtheria bacilli. Enteric Fever.—36 specimens of blood were examined, 4 of which gave negative results. Tuberculosis—860 specimens of sputum were examined, 137, or 15.9 per cent., of which showed that the patients were suffering from pulmonary tuberculosis. 1928] 46 "BACTERIOLOGICAL" DIPHTHERIA. Early in 1928 a letter was received from the Medical Officer of Health of a Rural District in Middlesex. A visitor from Islington had stayed in the district for a week end with her child. This child had recovered some considerable time from Diphtheria, after treatment in hospital and afterwards had been in a convalescent home. He had also been at home after convalescence a considerable period. No children had apparently been infected from him since his return to the household, at home, or among his companions. Still, there was a shrewd suspicion that he was the cause of the Diphtheria cases in the country household, who were relatives. The Medical Officer of Health had this child's throat swab examined, with negative results, but not being satisfied with the one examination, later had another swab taken and examined, which was positive, and this was further confirmed by being tested for toxicity, the guinea pig dying in five days. The circumstances of this country visit to relatives was particualrly sad, as one of he two children who contracted the disease died. It also is interesting, as it gives an example of what has been known in recent years, namely, that town children owing to their contact with other children in schools and crowded assemblies, acquire through contact with infectious cases a degree of immunity which the country child does not possess. Briefly this may be stated thus, that the town child requires a fair amount of contact and a fair dose of infection to acquire Diphtheria, whereas the country child is peculiarly susceptible to the least infection. This infectivity I have referred to being thus proved by the toxicity test, had to be specially dealt with. The District School Attendance Officer in Islington, knowing the circumstances of the case from our reports, took a keen interest in the child, and he was sent to a special clinic at Guy's Hospital which had been established for the purpose of giving special treatment to clear up these carriers. DIPHTHERIA—PATHOGENICITY TESTS. 1928. No. Submitted for Examination. Negative Result. (Bacilli) Positive Result. (Bacilli) Non-Virulent. Virulent. 15 9 6* 3 1 *2 not tested for Pathogenicity Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1918-28. 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 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 1927 260 1,573 1,833 3 21 24 111 661 772 2,629 Average 10 years 214 1,052 1,266 3 15 18 125 546 671 1,955 1928 276 1,478 1,754 4 32 36 137 723 860 2,650 4 47 [1928 VACCINATION. Of the 4,903 births registered in 1927, the returns of vaccination shows that only 2,355 infants were successfully vaccinated, while 9 were found to be insusceptible. There were also 189 who died unvaccinated, and 1,845 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians; 29 vaccinations were postponed under medical authority, 198 were removed to other districts or place unknown, thus leaving 278 unaccounted for. The return of certificates of exemption, therefore, represents 37 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 54.0 1925 50.4 1926 51.5 1927 49.9 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years:— 1921 2,506 1922 2,347 1923 1,751 1924 1,755 1925 1,973 1926 1,951 1927 1,896 1928 1,845 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1927. Registration Sub-Districts. Number of Births registered in 1927 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 1928. Number of Statutory Declarations of Conscientious Objection received during year 1928. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 389 220 1 - 126 16 1 7 15 3 1,471 136 Up. Holloway 747 397 1 - 218 29 2 45 40 15 250 Tollington 409 197 1 — 158 14 1 6 14 18 150 highbury 782 366 2 - 292 28 4 21 38 31 281 Lr. Holloway 568 248 1 - 226 30 7 7 14 35 1,625 206 Barnsbury 858 428 - - 322 36 6 8 29 29 303 Islington, S.E. 1150 499 3 — 503 36 8 12 48 41 436 The Borough 4903 2355 9 — 1845 189 29 106 198 172 3,096 1,762 DISINFECTION. Disinfection of Rooms.—3,644 rooms were disinfected, as contrasted with 3,114 in 1927. For this purpose formaldehyde in solution was employed, although it was sometimes augmented by sulphur fumigation, when it was 1928] 48 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 which they breed are removed, and the walls washed with hot lime. The above figures also include the disinfection of houses and rooms after Tuberculosis, vide p. 41. Rooms Disinfected. 1928 1927 1st Quarter 842 711 2nd „ 870 790 3rd „ 779 640 4th „ 1,153 973 The Year 3,644 3,114 Work at the Disinfecting Station.—48,135 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 46,606 similar articles disinfected during the previous year. In addition to the above articles, 9,605 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 £51 12s. 6d. Altogether 57,740 articles described in the two paragraphs preceding were disinfected. Since the disinfection station was established 2,275,324 large articles have been disinfected. Summary of the chief article of Clothing, Bedding, etc., disinfected during the year 1928, and also in the preceding year 1927. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1928 1927 Beds 396 404 426 499 1,725 1,844 Blankets 1,296 1,217 1,099 1,350 4,962 4,964 Bolsters 456 403 444 496 1,799 1,935 Carpets 11 3 15 1 30 32 Chair Bed Cushions 34 52 24 54 164 106 Mattresses 493 399 354 410 1,656 1,515 Palliasses — 2 2 6 10 14 Pillows 1,700 1,200 1,115 1,303 5,318 5,546 Quilts 463 429 459 593 1,944 1,857 Sheets 985 875 869 1,080 3,809 3,863 Other Articles 9,936 5,480 5,663 5,639 26,718 24,930 Totals 15,770 10,464 10,470 11,431 48,135 46,606 The nature of the articles disinfected for the clothing contractors is shown below:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Overcoats 725 548 1,497 441 3.211 Jackets 551 528 904 411 2,394 Tunics 251 351 — — 602 British Warms 150 118 - — 268 Other Articles 344 2,588 103 63 3,098 Bales of Horsehair 11 14 2 5 32 Total 2,032 4,147 2,506 920 9,605 49 [1928 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. cwts. 1 10 Gallons. 120 Gallons. Nil. Gallons. Nil. Disinfection of Premises - — — 70 Cost =£34 17s. 6d. Shelter House. The Shelter House was not occupied during the year, but baths were given to 15 verminous persons, while their clothing was disinfected. Nine midwives attended for the purpose of disinfection after attendance on cases of Puerperal Fever; and 18 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 5,213 (including 270 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 5 to 47. 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 £507 16s. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, in 63 instances during the year. Of this number 53 parents were fined, when penalties ranging from 3s. to 10s. were inflicted. The total fines received amounted to £15. 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 1928. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under:— Factories, including Factory Laundries 750 Workshops, including Workshop Laundries 1,049 Workplaces, other than outworkers' homes 335 Domestic Workshops 84 Bakehouses 209 Restaurant Kitchens (see also p. 69) 530 Outworkers' premises 1,362 Miscellaneous re-inspections and calls 5,420 Total 9,739 1928] 50 Notices Served.—In consequence of the 1,157 sanitary defects discovered as the result of the inspections above, 259 intimations and 20 statutory notices were served. Of these notices 88 were served on the owners of factories, 121 on the owners of the workshops and workplaces, and 11 on the owners of bakehouses and 34 of restaurant kitchens. In addition to these nuisances, 137 were discovered on Outworkers' premises, necessitating the service of 25 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 asked for an adjournment to carry out the work, and the summons was subsequently withdrawn, but he was ordered by the Magistrate to pay £2 2s. cost to the Council. Registers.—There were 2,469 workshops on the Registers, as contrasted with 2,367 in 1927, while the total number of workrooms were 3,446, as compared with 3,291 in the previous year; 178 workshops were added to the Registers, while 76 were removed from it. The various workshops and workplaces are tabulated as below:— Workshops and Workplaces. 1928. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1,110 1,704 100 54 Workshops where Women are employed 562 864 37 6 Laundries 43 55 — — Bakehouses 234 244 1 1 Restaurant Kitchens 454 513 29 15 Other Workplaces 66 66 11 — Total 2,469 3,446 178 76 Outworkers' Premises 3,161 — 438 437 Workshops Notified to Home Office during Year 1928. Trade. Number of Workshops. Women. Male Young Persons. Totals. Dressmaking 13 57 - 57 Underclothing 1 1 — 1 Knitting 1 3 — 3 Tailoring 7 18 — 18 Millinery 3 3 — 3 Picture Mouldings 1 2 - 2 Embroidery 1 8 — 8 Furrier 7 16 - 16 Gramophone Cases 1 5 - 5 Clinical Thermometers 1 1 - 1 Artificial Florist 1 2 - 2 Toilet Requisites 1 1 - 1 Tyre Repairs 1 - 1 1 Metal Goods 1 - 1 1 Metal Toys 1 2 - 2 Glass Signs 1 — 1 1 Total 42 119 3 122 51 [1928 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Inspections. (2) Number of Prosecutions. (4) WrittenNotices (3) Factories 750 88 1 (Including Factory Laundries) Workshops 1,049 99 Nil. (Including Workshop Laundries) Workplaces 1,158 67 „ (Other than Outworkers' premises) Miscellaneous Re-Inspections and calls 5,420 — — Total 8,377 254 1 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*— Want of cleanliness 333 329 - - Want of ventilation 29 27 - - Overcrowding 11 11 - - Want of drainage of floors 13 12 - - Other nuisances 412 391 - 1 Sanitary Accommodation insufficient 36 34 - - unsuitable, foul or defective 316 323 - - not separate for sexes 5 6 - - Offences under the Factory and Workshop Arts— Illegal occupation of underground bakehouse (s.101) — — - - Other offences 2 2 - - (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.) Total 1,157 1,135 42† 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. †42 Workshops were also notified H.M. Inspector, of failing to affix Abstract of Factory and Workshop Act (s.133). OUTWORKERS' PREMISES. Instances. Notices Served. Remedied. Prosecutions. Outwork in unwholesome premises (s.108) 125 25 125 Nil Outwork in infected premises (s.109, 110) 12 - 12 — Total 137 25 137 Nil OUTWORKERS' LISTS (s.107): Lists received from Employers 1,051 Addresses received from Other Councils 2,001 Addresses forwarded to Other Councils 861 Firms failing to send in lists (No. letters sent) 350 1928] 52 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories. Failure to affix Abstract of the Factory and Workshop Act (s.133; 1901) 42 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s.5, 1901). Notified by H.M. Inspector 14 Reports (of action taken) sent to H.M Inspector 14 Other (New Factories reported under Home Office Memorandum, 1912) Nil Underground Bakehouses (s.101) in use at the end of the year. 77 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. (1) Instances. (2) Notices served. (3) Prosecutions. (4) Wearing Apparel- Making, &c. 62 14 Nil Cleaning and washing - - — Household linen - - — Lace, lace curtains and nets - - — Curtains and furniture hangings 1 - — Furniture and upholstery 4 - — Electro-plate — - — File making — - — Brass and brass articles — - — Fur pulling — - — Cables and chains — - — Anchors and Grapnels — - — Cart gear — - — Locks, latches and keys — - — Umbrellas, &c. 3 - - Artificial flowers 14 3 - Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, &c., boxes, paper bags 23 7 — Brush making 10 1 — Pea picking — - — Feather sorting — - — Carding, &c., of buttons, &c. 1 - — Stuffed Toys 3 - — Basket making — - — Chocolates and sweetmeats 4 - — Cosaques, Christmas Crackers, Christmas stockings, &c — - — Textile weaving - - - Total 125 25 Nil SCAVENGING. Scavenging.—The expenditure from the rates could be materially reduced if individual householders would themselves destroy, instead of putting into the bin, much material, which they could readily do. There has been a Ministry of Health investigation into the whole of the methods of Disposal of Refuse in the London Area, and as a result of the report, possibly in the near future pressure will be brought to bear upon the Metropolitan Boroughs and adjacent authorities with the object of having established an "ad hoc" authority to deal with the whole of the scavenging to secure both general efficiency and economy. The short summary here given is derived from the "Dawes" report, and although the information is only up to the year 1926, it gives Islington information (which in the report is compared with other boroughs), and is the only information generally available. 53 [1928 Dumps.— From Islington great quantities of refuse are forwarded to large dumps in Hertfordshire. The Council's officers inspect these dumps and insist on reasonable management on the lines of the tipping precautions (recommended by the Ministry of Health), for which the Council has to pay rather heavily. A few years ago these dumping grounds were much complained of; but the conditions have since been greatly improved as the result of changes in methods of formation and management. In 1925-26, 71,335 tons from Islington were carried by the London and North Eastern Railway. This was made up of 69,635 tons of house refuse and 1,700 tons of trade refuse. The area of Islington in acres is 3,092, the mileage of streets 121.40, and the population mid-year, 1925, 339,200. The approximate area of carriageways in square yards for the borough is 2,023,000, the tonnage of street debris collected was 13,012. There are 7,317 street gullies, consisting of 5,154 in brick, 2,129 in stoneware, and 34 in iron. Gullies are cleansed approximately every two months. As regards the cost, the house, trade and market refuse costs for collection £46,892, disposal £35,701, a total of £82,593, being a rate of 10.5d. in the £. The street cleansing; costs £62,342, giving a rate of 7.8d., and the total cost of the cleansing service £144,935, giving a rate of 18.3d. There were employed 10 horse vans and 26 mechanical vehicles, and the staff consisted of 126 collectors and drivers, 4 clerical, 56 others, a grand total of 186, including supervisory staff. The net cost of collection per ton was 32s. 2d., the dumping rail contract rate 7s. 6d., net inclusive cost of disposal 10s. As regards the premises from which the refuse was collected, these numbered 48,043, the number of collection calls made per week, 54,179; the weight of the refuse collected per man (collectors and drivers) per day (300 to the year), 37.7 cwts., the approximate number of premises per man per day, 72. Taking 300 days to the year, the refuse yield per 1,000 of the population was 14.02 cwts., and the percentage of the total yield 5.9. Coming to the places served, 43,896 were served weekly, 2,170 twice weekly, 1,973 three times per week, and 4 daily. As regards trade refuse, 42 were served weekly, 27 twice weekly, 10 three times weekly, two daily, and one five times per week. In the Dawes Report are two illustrations of the London and North Eastern Railway siding at Ashburton Grove, with the inscription, "Railway Siding littered with refuse," presumably to indicate how much paper and like combustible rubbish might possibly be incinerated. The Seasonal Analysis of Islington refuse is interesting from the variation in Winter, Spring and Summer. Paper, tins, broken glass, rags predominating in the Summer. Percentages of 10 Tons. Winter. Spring. Summer. Fine dust passing 5/16 inch mesh 35.80 28.48 20.01 small cinders passing ¾ inch mesh 22.61 22.31 11.25 Large cinder passing 1½ inch mesh 21.30 15.35 7.94 vegetable and Putrescible matter 1.46 2.72 1.57 Bones .77 .90 .96 Rags, bagging and textile 1.56 1.43 2.13 Paper and Cardboard 7.34 12.74 20.06 Metal containers 1.33 1.78 3.66 Other metal 1.46 1.90 .96 Unbroken glass bottles and jars 1.20 1.39 .67 Broken glals 1.69 1.88 2.63 Wood, straw, leather, &c. (combustible debris) 2.07 6.63 24.82 Brick, stone, pottery (incombustible) 1.41 2.49 3.34 1928] 54 The provisions of the law relating to public cleansing are contained in the Public Health (London) Act, 1891, Sections 16, 22, and 29 to 36, and Section 141, definitions; the London County Council By-laws, allowed 28th June, 1923, paragraphs 4 to 12; the London Traffic (Collection of Refuse) Regulations 1927. Litter in Streets.—Careless littering of the streets is fairly common throughout London. There are by-laws in operation, which deal with litter, made by the London County Council in 1906, as to waste paper, refuse, advertisement bills, fruit rinds, broken glass, etc., and "street" here includes any road, approach, lane, path, footway, mews, square, court, alley, or passage to which the public have access for the time being, but the co-operation of the public is badly needed to ensure a much higher standard of tidiness. In October the Medical Officer of Health had his attention drawn by the Superintendent of the Cleansing Department to the practice of dairymen's roundsmen depositing broken milk bottles occasionally in the channels of the roads, thereby endangering the staff of the cleansing department to the risk of personal injury when removing the refuse to collecting vans. Children also frequently play about the pavement, and who even kick articles in the channels, run grave risk from broken glass. Damage is also caused to motor vehicles. A circular was sent by the Public Health Department to the dairymen in the Borough requesting their kind co-operation in the prevention of this practice by asking their roundsmen to refrain from depositing broken glass in the roadway. REMOVAL OF DUST. 25 applications were received during the year by the Public Health Department for the removal of dust, which is equal to the number recorded last year. The applications received for the previous ten years were as follows:— 1918 11 1923 16 1919 19 1924 33 1920 36 1925 21 1921 21 1926 20 1922 15 1927 25 Dust Receptacles Provided.—During the year 1,444 dust receptacles were provided, while 14 were repaired after the service of sanitary notices. NUISANCES BY DOGS. During the year we issued as usual, and displayed throughout the Borough, the poster which was approved by the Public Health Committee in 1925, pointing out that the fouling of footways by dogs can be very considerably diminished if proper care is exercised by those in charge. During the year we had a number of enquiries from other places regarding our procedure, and asking for copies of the poster. DISTRICT INSPECTORS' WORK. During the year the fourteen district inspectors made a total of 55,706 inspections and calls, or a decrease of 693 inspections on the corresponding period of 1927; while 12,587 improvements were effected in 5,818 premises; as against 13,761 improvements in 6,105 premises for the preceding year. 55 [1928 Synopsis of Inspectors' Work,—The following statement gives a brief synopsis of the district inspectors' work in 1928:— House to house inspections 2,911 Other inspections of dwelling houses 5,493 Re-inspections and calls made 44,255 Visits of inquiry re notifiable infectious diseases 2,615 Butchers' shops, stalls, etc. (Saturday nights) 64 Ice cream shops and factories 82 Dairies and Milkshops 808 Stables and yards 1,238 Manure depots 5 Smoke observations 114 Notices Served.—There were 4,459 intimation notices served by the inspectors with respect to nuisances. In 576 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.—39 premises which Were found to be in a verminous condition, were cleansed by the owners or 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.—43 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 114 observations were made by the District Inspectors, and 16 notices served upon the owners of the businesses requiring the abatement of the nuisance. It was not, however, found necessary to institute legal proceedings. Water Certificates.—Seven water certificates were granted in accordance with the provisions of sec. 48 (2) Public Health (London) Act, 1921, in respect of 83 separate tenements newly erected or rebuilt during the year. New Legislation. During the year there was again additional work thrown on the department owing to duties rendered necessary by recent legislation. Particularly may be mentioned the Merchandise Marks Act, 1926, and the Agricultural Produce (Grading and Marking) Act, 1928, and the Orders under these Acts; Orders as regards imports, 1928, in reference to Honey, Apples, Currants, Sultanas, Raisins, Eggs in Shell, Dried Eggs and Oat Products; Rag Flock Act, 1928, Food and Drugs. (Adulteration) Act, 1928. During the year under the London County Council (General Powers) Act, 1928, special provisions were made regarding premises in which lay the body of a person dying of an infectious disease, strenghtening the powers under section 89 of the Public Health (London) Act, 1891; for the cleansing of verminous persons; removal of infirm and diseased persons in certain cases. Provision was also made for the registration of premises used for the manufacture, etc., of ice cream. In this Act also there is an important provision in regard to disused drains (which it is hoped may in the future lessen the work to some extent of our Sanitary Inspector and Rat Officers) requiring notice to be given of the existence of disused drains. The provisions of section 20 are as follows:— 1928] 56 (1.) The owner or (in default of the owner) the occupier of any premises in, under or attached to which there is to his knowledge a disused drain, shall give notice in writing of the existence of such disused drain to the council of the metropolitan borough in which the disused drain is situate. (2.) Any such notice as is required by subsection (1) of this section shall be given by the person required by that subsection to give the same— (a) where any channel work or apparatus is a disused drain at the commencement of this Part of this Act forthwith after such commencement or so soon after such commencement as the existence of such disused drain comes to the knowledge of such person; or (b) where a drain or any channel work or apparatus provided for use as a drain becomes a disused drain at any time after the commencement of this Part of this Act forthwith after it becomes to the knowledge of such person a disused drain. (3.) Any person who fails to comply with the foregoing provisions of this section shall be liable to a penalty not exceeding five pounds. Provided that the occupier of any premises (not being also the owner thereof) shall not be liable to a penalty under this section for Tailing to give any such notice as aforesaid if he satisfies the court that he had reasonable cause to believe that the notice had been given by the owner of the premises. (4.) Proceedings for any offence under this section may be taken by the council of the metropolitan borough in which the disused drain in respect of which the offence is committed is situate. WIDOWS', ORPHANS' AND OLD AGE (CONTRIBUTORY) PENSIONS ACT, 1925. In 1926 the Maternity and Child Welfare Committee had under consideration the offer of the London County Council to refer the administrative powers and duties conferred by Section 6 of this Act to the Borough Committee. Since these powers were delegated, no case has arisen so far under Section 6, so none falls to be reported on in 1928. The Section deals with the special provisions as to additional allowances and Orphans' Pensions, and in certain cases the Orphan's Pension payable in respect of a child would in the interest of the child be administered by the local authority or some other person for the benefit of the child, where a representation is made to the Minister by the local authority, or otherwise. 57 [1928 Summary o] Sanitary Work from Inspectors' Reports for the year 1928. Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 170 238 204 231 136 201 145 107 368 221 226 239 179 246 2911 Other premises inspected 185 290 272 583 309 430 306 431 396 334 413 632 510 402 5493 Re-inspections, Calls made, etc. 1636 2558 3567 3767 2102 3257 3053 2869 4179 3376 3880 3750 3635 2626 44255 Ice Cream Factories inspected — 6 16 16 - 11 — 2 14 5 2 — 6 4 82 Dairies and Milkshops „ 7 20 99 90 72 145 63 35 61 60 55 60 22 19 808 Stables ,, 27 3 23 1 162 14 2 — 1 1 2 6 1 3 246 Yards „ 107 40 139 36 289 29 212 4 14 63 5 7 39 8 992 Manure Depots „ 1 — — 2 1 — 1 — — — — - — — 5 Vacant land, Passages and Courts inspected 10 2 2 5 110 1 87 - 1 9 1 4 1 — 233 Urinals attached to P.H.'s inspected — 26 98 12 10 95 115 - 10 45 2 2 45 460 Premises (re Certificate Customs and Inland Revenue Acts) inspected - - - - - - - 1 - - - - - - 1 Premises (re Water Certificates) inspected — — h.to h 34 — 2 — 1 4 — - - — — - 41 Visits re Sale of Food and Drugs Acts - — - - 1 - - - - - - - - - 1 Smoke observations — 6 7 18 30 2 1 2 23 1 10 2 7 5 114 Shops, Stalls and Markets (Saturday evening) 3 3 4 5 6 5 4 5 6 4 5 5 5 4 64 Total Inspections and Calls 2146 3192 4465 4766 3230 4190 3990 3460 5073 4119 4601 4707 4405 3362 55706 Notices Served. Intimation Public Health (London) Act, 1891 110 234 265 533 99 350 228 279 478 381 385 474 295 333 4444 Ice Cream Shops — - — 1 - 4 — — — — — - - — 5 Milk shop & Dairies - — 1 - — 5 - - 4 - - - - - 10 Statutory Public Health don) Act, 1891 5 20 26 62 6 54 23 27 109 81 41 38 36 48 576 Housing Act, 1925 — — — — — — — — — — — — — — — Improvements. Drains— Constructed 1 — — — 1 — — — 1 — — — — — 3 Re-constructed 3 14 8 8 5 3 9 1 5 12 — 4 5 1 88 Repaired 9 14 22 45 10 23 15 19 30 37 43 16 6 24 313 Ventilated 3 19 9 4 4 7 7 6 10 7 5 3 2 2 88 Gully and other traps fixed 21 87 26 14 18 20 29 32 41 40 9 1 1 4 343 Urinals— Water supply—cleansed — 2 4 4 1 2 5 1 3 2 2 1 — 1 28 Cesspools—Abolished — — — — — — — — — — — — — — — Water Closets— W.C. erected with pan, trap and Water Supply 3 2 2 3 2 1 — — 3 3 2 — — — 21 Pan and trap only provided 11 49 36 48 14 25 19 34 34 47 59 14 5 13 408 Flushing apparatus repaired 14 30 39 50 5 19 22 18 58 28 46 34 15 37 415 Ventilated — 5 2 4 — 10 — 1 1 — 2 — — 3 28 Walls, etc . cleansed 8 9 7 25 2 10 14 7 39 41 49 34 16 20 281 Position altered — — 5 — — —! — — 1 — — — — — 6 Dust Bins Provided 27 57 62 203 17 74 171 135 107 103 91 167 134 96 1444 Repaired — — — 2 2 — 1 3 3 1 1 — — 1 14 Areas Constructed 1 — 1 — 2 — — — —i — — — — — 4 Paved 4 1 10 1 4 — 4 — 7 3 2 1 — — 37 Yards Paved — 2 1 — — — 12 7 — — — — — — 22 Repaved 7 15 18 93 6 9 25 8 32 45 19 11 5 8 300 Sinks Provided 7 15 4 5 1 6 6 4 34 17 5 3 — 1 108 Waste pipe repaired 10 24 26 40 13 23 15 19 47 49 16 21 4 13 320 Domestic Water Supply— Cisterns Provided — 1 — — — — — — 1 — — — — 2 5 Cisterns repaired and cleansed 9 8 11 28 3 4 14 4 9 6 10 3 3 6 118 Water supply provided to dwelling house 2 5 5 1 1 1 1 5 3 2 1 3 — 1 31 Water supply provided to tenement house 1 4 1 12 1 1 1 1 18 12 1 — 2 1 56 Walls and ceilings of Rooms cleansed and redeccrated 43 102 103 365 58 145 141 131 366 273 376 243 151 225 2722 Carried forward 1928] 58 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 9 16 15 74 6 31 22 17 73 55 71 57 35 38 519 Floor space ventilated 2 — 5 6 2 3 — 1 21 13 6 2 — — 61 Floors repaired 10 15 23 51 3 19 19 9 56 32 55 46 16 20 374 Guttering and rain water pipes repaired 11 48 25 68 9 32 37 28 20 49 28 38 19 18 430 Roofs repaired 18 62 61 230 15 53 50 53 104 121 115 91 55 79 1107 Overcrowding abated 1 — — 14 — 3 1 3 4 2 7 — — 1 36 Illegal use of underground rooms for sleeping discontinued 2 — — — — 1 — 1 1 4 1 1 — — 11 Other improvements, or Nuisances abated 24 12 82 157 23 119 72 77 190 112 202 137 42 116 1385 Rooms Disinfected 164 230 140 246 33 61 62 12 91 55 135 35 103 94 1461 Total improvements 425 868 753 1801 261 705 774 647 1413 1171 1359 966 619 825 12587 Total premises improved 236 445 410 794 121 324 395 314 545 430 595 415 378 416 5818 In connection with the work of the Sanitary Inspector, some reference has already been made as to new legislation. The following additional references to duties as regards food, etc., show how widespread his work is. Dairies and Milkshops. Under the Milk and Dairies Order of 1926 provision is made for registration. Contamination of milk is dealt with under the following heads:— 1. Lack of cleanliness. 2. Keeping of animals in dairy. 3. Insufficient light and ventilation. 4. Dampness. 5. Defective milk vessels. 6. Prohibition of bottling of milk in the street. 7. Defective, or ill-designed churns, lids permitting entrance of dirt, Regulations in force October, 1928. Special Designated Milk Licences. Bacteriological examination of milk. Food.—Section 8 of the London County Council (General Powers) Act, 1908— storage of food. Condensed Milk Regulations, 1923-1927. Dried Milk Regulations, 1923-1927. Public Health (Preservatives in Food) Regulations, 1925, and the Public Health (Preservatives in Food) Amendment Regulations, 1926-27. The supervision of Fried Fish Shops and Fish Curers. Street Traders, dealing in food stuffs, storage. Bakehouses. Ice Cream premises. Butchers' shops and stalls. Duties other than routine inspections, and ordinary nuisances Tenement Houses, Lighting of staircases. Houses let in lodgings, underground rooms, Rag and Bone Dealers. Water supply, withdrawal notices from Water Board. Water supply to tenement houses. Smoke abatement. 59 [1928 About the only provision under an Act under which no action had to be taken might be mentioned the provisions in the London County Council (General Powers) Act, 1927, which provides for nuisances by pigeons. Unlike some of the neighbouring boroughs, no action was called for. HOUSES LET IN LODGINGS. The 1,011 houses which come under the operation of the bye-laws received 787 inspections during the year, followed by 3,785 subsequent re-inspections and calls, so that the total visits amounted to 4,572. These inspections resulted in 570 intimations being served on the persons responsible, which were followed by 119 statutory notices to demand the abatement of the nuisances discovered by the inspector especially engaged upon this work. Two prosecutions for non-compliance with the notices served were instituted, and an order was made by the magistrate for the necessary work to be done with payment of £1 1s. costs. Altogether 2,329 improvements were effected in 471 premises. We have had now for some years a vacancy in this specialised department, the work being done by one Inspector, where formerly there were two. Synopsis of Inspector's Work:— Improvements. Drains: Constructed — Reconstructed 2 Repaired 10 Ventilated 1 Gully and other traps fixed 5 Urinals: Water supply—cleansed — Cesspools: Abolished — Water Closets: W.C. erected with pan, trap and water supply — Pan and trap only provided 30 Water supply provided 96 Ventilated — Walls, etc., cleansed — Position altered — Dust Bins: Provided 147 Repaired — Areas: Constructed — Paved — Yards: Paved — Repaved 35 Sinks: Provided 47 Waste pipe repaired — 1928] 60 Domestic Water Supply: Cisterns provided — Cisterns repaired and cleansed 5 Water supply provided to dwelling house — Water supply provided to tenement house 15 Walls and Ceilings of Rooms cleansed and redecorated 655 Other Improvements: Staircase and passages repaired, cleansed and redecorated 93 Floor space ventilated 3 Floors repaired 103 Guttering and rain water pipes repaired — Roofs repaired 171 Overcrowding abated 1 Illegal use of underground Rooms for sleeping discontinued — Other Improvements, or Nuisances abated 910 Rooms Disinfected — Total Improvements 2329 Total Premises Improved 471 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. During Rat Week our usual transparencies announcing Rat Week were used in the places visited by the Public in the Public Health Department. There was sold from our department a vermicide for rats put up in convenient containers with full directions. SUMMARY OF WORK, 1922-1928. During the year 1928, among the reports of work done under the above Act, points of interest may be noted. For example: 1. Advice was asked regarding the extermination of rats from a dogbreeding establishment extensively infested. In this case a particular vermicide was recommended and the clearance effected in three weeks. 2. A butcher's shop: the nuisance here was overcome by concreting the site and pointing the party walls. 3. In a private house in one instance "rat varnish" was used with good results. 4. In a series of adjacent houses, more or less affected by rats, the rats were eventually located in a shed in a garden at the rear of another house, where the occupants carried on surreptitiously a business of white mice breeding for the bacteriological department of a hospital. Undoubtedly, the food for these mice attracted the rats. 5. In investigating an invasion of rats in a house where the site was concreted and it would be presumed impossible for the rats to get through, it was found that when the site had been concreted thirty-five years ago a short-end of 9in. x 3in. deal had been left embedded in the concrete. Rats 61 [1928 had eaten through this deal, had eaten round a hard knot that was in it, and thus made a tunnel to get through. Upon this portion being re-concreted, but without wire, the rats dug through the soft concrete in a day. 6. In a house where investigation was made, rats were found to be coming down from the roof space and here were found holes leading to an adjacent house in one direction. There was a valley gutter running across the house from front to back, and access could only be gained to the other half of the roof space by cutting through the ceiling or opening the roof frorr. the outside. Such inaccessible places under the roof form "ideal" dens for rats to take up their abode. 7. At another house, where the drainage seemed to have been properly relaid and jointed in cement, and the site cemented without getting rid of the rat invasion, rats were found invading the house, coming right up to the roof space. Ultimately, the ground in front of the house was opened up and a chamber was found connected with the forepart of the drain, but no interceptor. Rats had been getting out under the covering stone and had dug through the surrounding ground and also the concrete laid on the site. The trouble was abated by a proper interceptor being provided to the drain. 8. In another house rats were found to have made their home deep down under the hearth in the sitting-room. The deep holes were filled in with dry grey lime and lime was dug into the site. This put an end to the trouble. The drainage in this house was modern. 9. In investigating another house extensive rat-runs were found. These contained a set of false teeth, taken six weeks before from the dressing table in the ground floor room. Nests were found in the solid clay. In this case grey lime was used and a cure effected. 10. A butcher's shop with divided roof space gave considerable trouble. A bait was laid on the end of a reel of thread and the rats traced to the roof. Clearance by bait was tried, but the valley roof is to be replaced by a flat roof —rat-proof. In rat work a considerable number of cases have been dealt with where the caps to the clearing arm of the interceptors have been displaced or left off, and the rats have then come through the drain and, seeing light, through a yard gulley or W.C. trap, they have come out. going back by the same route when suddenly surprised. The replacement of the cap to the interceptor and the proper fixing of it have ended the trouble in these cases. There were also the usual cases of houses found infested with rats from defective drains. Mice.—The attention of the Medical Officer of Health was drawn during the year to the infestation of several rooms of a building by mice. These mice were sometimes found dead, from disease apparently, the body in parts showing a peculiar erosion. The tenants were spoken to with a view to persuading them to catch the mice alive if possible, and they were provided with traps for that purpose. The landlord, however, who sub-let the premises, adopted a peculiar attitude, and through dread of him we could not get any active assistance from the tenants of the infested rooms. Professor Topley, of the London School of Hygiene, very kindly allowed one of his Assistants to examine such material as could be obtained, but owing to not being able to get a mouse alive with the disease, the investigation was necessarily incomplete. Disease 1928] 62 among rats or mice is not without coniderable interest at the present time, as quite apart from it being important to know a disease that kills off these pests, a disease thus spread may lead when investigated to some knowledge which might have a bearing, even on Cancer Research. Summary of Work under the Rats and Mice (Destruction) Act during the years 1922-28:— 1928 1927 1926 1925 1924 1923* 1922 Number of Streets visited 203 235 217 96 91 544 711 Number of Private Houses visited 349 368 320 133 176 650 1,023 Number of Shops and Factories visited 56 81 61 14 19 712 1,009 Total Premises inspected 405 449 381 147 195 1,362 2,032 Found Rat Infested 154 191 174 66 61 787 1,031 Found Mice Infested 2 8 5 2 1 66 72 Defective Drains Repaired (Cause of Rat trouble) 49 48 49 51 60 13 52 Number of Complaints received 150 202 173 105 118 67 177 *Appointment of temporary Rat Officer terminated 15th June, 1923. HOUSING. Towards the end of the year considerable difficulty was experienced in regard to the conditions of Nos. 1 to 7, Mildmay Avenue. Several notices served had been outstanding for some time, and there was overcrowding. The Medical Officer of Health made the following representation. 22nd Novmber, 1928. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Mr. Mayor, Aldermen and Councillors. Housing Act, 1925, 1 to 7 Mildmay Avenue. I beg to represent pursuant to the provisions of the Housing Act, 1925, that within the area in the Metropolitan Borough of Islington shown by a pink tint on the plan annexed hereto houses are unfit for human habitation and/or the narrowness, closeness and bad arrangement of the houses within such area or the want of light, air ventilation or proper conveniences or any other sanitary defects or one or more of such cases are dangerous or injurious to the health of the inhabitants of the said buildings in the said area and that the most satisfactory method of dealing with the evils connected with such houses and the sanitary defects in such area is an improvement scheme for the rearrangement and reconstruction of the houses within the area. I am Your obedient servant, G. CLARK TROTTER, Medical Officer of Health for the Metropolitan Borough of Islington. A schedule was submitted with the representation setting forth the conditions in detail. 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:— 63 [1928 1919 to 1927. 1928. Total since 1919. Number of houses or flats provided by the Islington Borough Council 745 nil 745 Number of flats provided by the London County Council 161 75 236 Number of houses or flats provided by private enterprise 286 22 308 1,192 97* 1,289 *Including 12 converted Flat Dwellings. Particulars of houses or flats provided under the Council's Housing Schemes 1919 to 1927. 1928. Total since 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 102 — 102 Laycock Mansions 132 — 132 Houses, etc., Highbury Station Road 15 — 15 745 nil 745 *Includes:—27, Rupert Road 8, Barnsbury Street 27 and 25, Canonbury Villas 2, Highbury Grange Not converted The number of overcrowding cases recorded as dealt with during the years 1919 to 1928, was:— 1919 11 1920 7 1921 6 1922 10 1923 17 1924 13 1925 19 1926 26 1927 24 1928 37 Total 170 1928] 64 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 1928 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 158 were so recommended for special consideration. In addition to these recommendations letters were written on behalf of 16 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 174 cases were written about to the Housing or Public Health Departments of the London County Council. In addition to above 58 special investigations were made, but as these did not come within the definition of "special hardship" they were not recommended. DEMOLITION OF HABITABLE DWELLINGS. During the year 1928, seventy-six houses have been demolished. Of these 52 came under the Improvement Scheme of the London County Council, re George's Road Area, and comprised the following:— George's Road (26 houses), Nos. 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 60, 62, 64, 68, 70, 72. Milton Place (18 houses), Nos. la, 1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18. Hartnoll Street (8 houses), Nos. 1, 3, 5, 7, 9, 11, 13, 15. The remaining 24 houses demolished have been converted into business premises. 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).) 97 (b) With State assistance under the Housing Acts. (i) By the Local Authority Nil (ii) By other bodies or persons 97 Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,438 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing consolidated Regulations, 1925 1,360 (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 65 [1928 (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 1,585 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 1,170 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 Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners Nil (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 4,459 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 4,459 (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 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 8 (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 1928] 66 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 1925 96 5 12 3 116 1926 68 4 26 2 100 1927 67 7 19 2 95 1928 53 6 15 6 80 Totals 975 141 118 23 1,257 STATE OF PAUPERISM IN THE BOROUGH. There was a decrease of 1,507 in the number of paupers relieved during the year for the weekly average was 7,819 compared with 9,326 in 1927. Appended is a statement furnished by the Clerk to the Islington Guardians:— Showing the State of Pauperism in the Borough during the year 1928. Average number Relieved during each week. Borough Death rates, 1928. 8 Quarters. Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals corresponding periods 1927. 6 Children Boarded out. 7 Adults. 3 Children under 16. 4 Totals, 1928 5 1st Quarter 3,048 3,937 1,917 8,902 10,844 22 16.4 2nd „ 2,923 3,502 1,492 7,917 9,460 22 12.2 3rd „ 2,854 3,145 1,090 7,089 8,498 19 9.4 4th „ 2,983 3,266 1,120 7,369 8,503 17 13.9 The Year 2,952 3,462 1,405 7,819 9,326 20 12.8 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Food—Inspection of.—Inspector Wilkinson reports that during the year he has paid 751 visits to the 13 Slaughter Houses now on the register, including one Horse Slaughter House, and that he has ascertained that 9,781 animals were killed therein, namely 477 oxen and cows, 7 calves, 5,908 sheep and lambs, and 3,389 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, as will be seen in the table on page 67. 67 [1928 The Medical Officer of Health, as Designated Officer for Food Certification, issued 24 certificates in respect of foods prepared in Islington and exported abroad and to the Dominions. FOOD DESTROYED. 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 3 7* Fish surrendered in bad condition — 13 1 — Fruit, Vegetables and Sweets surrendered when received in bad condition 2 15 — 17 Decomposing Shoulder of Mutton surrendered by Butcher at Meat Factory — — — 4 One Pig's Head (Tuberculous) surrendered by Butcher at Meat Factory — — — 12 Tinned Foods, Corned Beef and Salmon — — — 27 Seven Rabbits surrendered (decomposing) — — — 9 Total 3 12 2 20 *Of this quantity 12 lbs. was Tuberculous. The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 3 tons 12 cwt. 2 qrs. 20 lbs. The diseases which affected animal food are set out in detail on page 70. The Metropolitan Cattle Market, which is estimated to have roughly 60 per cent. of the total slaughterings in the metropolitan area, is situated within the borough and is administered by the City of London Corporation. Since it was established the meat inspection within the abattoir has also been ably carried out by the city officers, never having been taken over by the borough although legally it comes within the Borough Council province. The "arrangement" has worked excellently and there has been no cause for any criticism. If the work had' been undertaken by the borough, a staff of at least two additional meat inspectors. would have been required. Cattle brought to the Monday market are killed on Tuesday or Wednesday. In hot weather the killing is finished if possible by 8 or 9 a.m., avoiding the sun's heat. After an hour or two in the cooling rooms, for the loss of animal heat and for completion of dressing, the carcases are transferred to the chilling rooms (temperature 40 degrees to 42 degrees Fah.). At about midnight they are taken in vans to Smithfield for sale the following morning. Such treatment renders the meat bright with firm fat, no trace of "sweating" and with the "bloom" the retailer appreciates. A proportion of the cattle, however, are "Kosher-Killed," the hindquarters going to Smithfield and the fore-quarters going direct to Jewish retailers in the East End. The number of cattle killed was 54,282 (including 3,960 Irish animals) in 1928, as against 66,074 in 1927. UNSOUND FOOD. In May a full report was submitted to the Public Health Committee of an enquiry by the Medical Officer of Health into reported cases of Food Poisoning in two households. In one household the father and mother were apparently infected from eating sliced boiled ham. The baby, who was breast fed, was infected through 1928] 68 the mother's milk. The shop where the purchase was made was apparently clean. The information came too late to get any of the particular ham. The yard, in which there was a large gas copper used for cooking the ham, was open to criticism inasmuch as the dustbins a few feet away were without covers, and an intimation regarding these had been served a month previously. They were stated to be still on order. A store in the shed behind where the cooked hams were on shelves, was also open to criticism, as the condition of the shelves and shed required attention, cobwebs being abundantly present. In the second household affected, an inmate of which was stated to have had so-called ham, purchased from a branch shop of the same firm, on investigation the food was alleged to have been pork boiled in pickle. The "ham" was stated to have had a sticky feel on cutting and to have tasted bitter. Two of the inmates threw their portions away after tasting it, but the affected person finished hers. Visitation of this branch shop did not reveal any condition to be criticised, as at the first, nor could a specimen of the pork be obtained. The question was taken up with the Managers of the shops in regard to the presence of rats or mice and the use of poisons. It was stated that these premises, together with the other branches of the firm, had all been cleared by a professional rat-catcher a year ago, and that this rat-catcher had used Virus. The Manager was asked, if he had any mice what he would do, and he promptly replied that he would put down Virus. He, however, had only very recently come to the shop, and therefore no history could be obtained as to what was done just previously to his coming. The firm were warned that Virus should not be used where there are food stuffs, as there is a danger of the Virus being carried by the rats, and they in their turn infecting the food stuffs. The particulars were forwarded to the Ministry of Health together with material for exmination from the patients. In the first case, where several were affected, the bacillus Enteritidis (Gaertner) was found, and blood taken from the patients confirmed this as the source of infection, as it gave the necessary agglutination reaction against this bacillus. In the case of the second patient, the examination and reaction revealed another food poisoning bacillus, bacillus Aertrycke. A Medical Inspector of the Ministry of Health visited the various premises with the Medical Officer of Health. The conditions in the one had by that time been put right. The evidence in these cases, while not absolutely conclusive as to the source of infection from contamination, point rather to bacilli which may be used as rat virus having got access to the food. Shops, etc., Inspection of.—The 726 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, 26; food preparation establishments, 12; fish shops, 112; fish stalls, 11; fruit shops, 220; and about 95 fruit, etc., stalls and barrows, including stalls in the Metropolitan Cattle Market inspected on Tuesdays and Fridays. To these 23,434 visits were paid, apportioned as follows:— Butchers, Provision Dealers, etc., Shops 8,040 visits Food Preparation Establishments 142 „ Butcher, Provision, etc., Stalls 2,057 „ Fish Shops 1.511 „ Fish Stalls 730 „ Fruit Shops 2,879 „ Fruit Stalls 8,075 „ Total 23,434 „ 69 [1928 No summonses were taken out under Sec. 47 of the Public Health (Lond.) Act, 1891, during the year. Unsound Chocolate.—Included under the heading "sweets" was a small quantity of "Milk" Chocolate of Belgian manufacture which had gone rancid. It was necessary to trace this consignment, which had been distributed to several shops, and as it was a wrapped article, to draw the attention of the consignors to its condition. FOODSTUFFS AND SOUND NUTRITION. It is convenient here to emphasise the need for more attention by the public generally to recent knowledge of the vital properties of foods. Much food, including milk, is "processed." Very probably some milk is "pasteurized" or heated more than once ere it reaches the consumer. "All foodstuffs may be classified as "Quick" or "Dead." "Dead" foods are products devitalised to an imporant extent by modern processes of preparation and preservation. These constitute the bulk of the national dietary. "Quick" foods include good fresh untreated milk, fresh eggs, fresh fish, fresh home-grown meat, fresh vegetables, fresh fruit, and whole-meal bread." 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 66 14 Coffee and Dining Rooms 222 58 Refreshment Rooms 118 40 Provision (Cooked Meats, cooked but not consumed on premises) 124 30 530 142 SALE OF FOOD ORDER, 1921.—THE LABELLING OF MEAT AND EGGS. Five summonses were issued under the "Sale of Food Order, 1921," for exposing for sale "Imported Meat," and "Imported Eggs" not duly labelled, resulting in total fines and costs amounting to £19 9s. being inflicted. Of the three summonses taken out for imported meat not being properly labelled, a fine of £2 2s. with £2 2s. costs was inflicted in one case; whilst a fine of £10 with £5 5s. costs was obtained in the other, against the manager of the shop, who the Justices deemed to be guilty of the offence. The alternative summons against the firm was withdrawn. Imported Eggs.—Two summonses were taken out against one person but owing to there being insufficient evidence and a difficulty of proving origin of the imported eggs, the cases were dismissed. 1928] 70 This Order is commented on in Annual Report 1926, pp. 60-61. 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 19'24 35 19 0 17 0 6 52 19 6 1925 35 11 0 26 15 6 62 6 6 1926 11 10 0 4 10 0 16 0 0 1927 14 9 0 13 18 0 28 7 0 1928 nil nil — 114 13 0 76 1 6 190 14 6 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 1928 — — 2 2 53 21 7 81 Cowsheds.—Only one cowshed is now within the Borough and it received 6 visits by the Inspector. It was found to be in a satisfactory condition. Offensive Trades include 4 tripe dressers, 2 gut scrapers, 1 fat melter and gut scraper, and the knacker, which received a total of 61 visits. There was 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 1928:— No. of Cases. Description of Animal Affected. Nature of Disease. Extent of Disease. How disposed of. 1 Calf Tuberculosis Carcase and all organs Council's Destructor. 1 Ox Tuberculosis Lungs and Costal Pleura „ „ 1 Ox Abscess on Larynx Head, ex Cheeks „ „ 29 Oxen Parasitic (Dis. Hep.) Liver (whole or part) Some on premises and 4 Oxen Abscess do. do. Council's Destructor 71 [1928 Milkshops and Dairies—At the close of the year there were 561 milkshops and dairies on the register, 30 having been added to it, while 9 were removed. The District Sanitary Inspectors paid 808 visits to them, and served 10 notices for the carrying out of various sanitary improvements and the cleansing of dirty utensils. THE MILK AND DAIRIES (AMENDMENT) ACT, 1922; THE MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year 1928, 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, 1923. Designation. No. of applications. Number granted. Amount of Fees received. 1928 1928. £ s. d. "Certified" 4 4 1 0 0 "Grade A." (Tuberculin tested) 12 12 6 14 0 "Grade A." Nil – – "Pasteurized" (Dealer) 3 3 15 0 "Pasteurized" (Pasteurizer) 4 4 3 13 0 "Pasteurized" (Supplementary) 2 2 4 0 25 25 £12 6 6 ADULTERATION OF FOOD AND DRUGS. During the year 1,218 samples of foods and drugs, including 369 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 1,145 were reported to be genuine and 73 adulterated, or 6 per cent. This percentage is 1.2 below the previous year, and 0.8 less than the average rate during the preceding 10 years. During the year 1928 in addition to the official samples taken and submitted to the Public Analyst there was a total of 369 informal samples which were either submitted to the Public Analyst or examined by the Food and Drugs Inspector. These informal samples comprised about 60 varied articles. Three samples of milk were also submitted to the Analyst by private purchasers. The greatest amount of detected adulteration occurred in the third quarter of the year, as shown by the figures given in the statement below, when it was 6.7 per cent, and contrasted with 3.2, 4.7 and 2.1 per cent., respectively, in the first, second and fourth quarters. Examined. Genuine. Adulterated. Per Cent. Formal Informal Formal Informal Formal Informal Adulterated 1st Quarter 240 87 208 85 32 2 3.2 2nd „ 232 132 215 132 17 – 4.7 3rd „ 200 39 186 37 14 2 6.7 4th „ 177 111 172 110 5 1 2.1 The Year 849 369 781 364 68 5 6.0 72 1928] Prosecutions. 49 summonses were issued under the "Sale of Food and Drugs Acts," of which 47 were successfully prosecuted. Altogether penalties and costs to the amount of £194 7s. 6d. were obtained. 13 prosecutions were also taken under the "Milk and Dairies Order, 1926," resulting in convictions in 11 cases with penalties and costs amounting to £30 2s. One summons was taken under the Milk and Dairies (Consolidated) Act, 1915, and a conviction was obtained with a fine of £1 and £1 costs. There was also a case under the Public Health (Condensed Milk) Regulations, 1923, when the defendant was fined £2 2s. with £2 2s. costs. Liniment of Turpentine.— In the beginning ot the year the Medical Officer of Health reported upon the sampling results of Liniment of 1 urpentine, which was taken in 1927. 58 informal samples were taken in that year, see Report for 1927, page 65, and 13 formal samples, see page 68, a total ol 71. lhe results show that a large mass of the general public have to be protected in their own purchases of common household remedies. The composition of Liniment of Turpentine is fixed by the British Pharmacopoeia by its name, namely, Liniment of Turpentine. In addition to the samples taken, 6 chemists refused to supply, and two supplied substitutes, these being labelled as being something else. When it was ascertained by informal «iimpling where "adulterated" samples were most likely to be obtained, we afterwards officially sampled. Of these, 9 again substituted some other preparation without disclosing the fact to the agent purchasing. In regard to this practice of substituting some other embrocation in place of Liniment of Turpentine asked for, I may point out that the Liniment of Turpentine in the British Pharmacopoeia contains camphor, and this makes it a somewhat more costly preparation than the article generally substituted. In addition, Liniment of Turpentinel has twice the quantity of turpentine that was in most of the "substituted" samples. Other important points are that most of the substituted samples were preparation containing ammonia, and it is an unfortunate experience that if there is any abrasion of the skin or cut where these substituted embrocations are used, they cause very severe smarting and pain. The Liniment of the British Pharmacopoeia has a larger proportion of Turpentine of a different nature, namely, Rectified Oil of Turpentine, a superior article to that ordinarily used in embrocations, which are made up with commercial turpentine, and the Pharmacopoeial preparation having also Camphor, has a more lasting effect. The result of the proceedings taken against the nine chemists who "substituted" are detailed in the Table of legal proceedings on pages 86, 87. Prescriptions.—Whilst speaking of chemists, I may mention that the taking of prescription samples in Islington is attended with difficulties which may not be so common elsewhere. There is a strong disinclination to dispense prescriptions for strangers, and once an official sample is taken, it would appear that all chemists in the district get to know of it and are at once on their guard. In regard to prescriptions inaccurately dispensed where the discrepancy was small and might possibly have been due to deterioration, the managers of the firms were personally warned that the dispensing of prescriptions had to be carried out with drugs that came up to the standard of the British Pharmacopoeia. With regard to the more serious cases, legal proceedings were taken, see Table, page 87-88. 78 [1928 Informal Sampling.—The informal samples purchased included the following:— Article. No. of Samples. Milk 3 Butter 109 Coffee 5 Jam 8 Ground Almonds 2 Honey 4 Sweets 36 Lard 6 Sultanas 8 Prawns 2 Icing Sugar 1 Full Cream Dried Milk 4 Bacon 4 Cakes 21 Sausages 42 Bread 1 Liniment of Turpentine 1 Liniment of Mustard 1 Full Cream Condensed Milk 2 Preserved Sausages 17 Pepper 6 Ginger Beer 1 Liniment of Turpentine Alba 1 Valencia Kaisins 1 Jam and Marmalade 5 Pearl Barley 2 Macaroni 1 Pork Pie 1 Tripe 2 Liver Pills 1 Brawn 5 Article. No. of Samples. Half Cream Dried Milk 1 Condensed Machine Skimmed Milk 2 Buns and Cakes 7 Cream 2 Fruit Jelly 1 Olive Oil 1 Fish Paste 7 Prescription 1 Biscuits 18 Ham 3 Tea 1 Ham and Beef Rissole 1 Corned Beef 1 Margarine 5 Iodised Sarsparilla 1 Lemon Cheese 1 Mint Sauce nnd Malt Vinegar 1 Liquid Sugar Bleach 1 Preservative Powder 1 Sausage Rolls 1 Custard Powder 1 Tapioca 2 Brisket 1 Malted Milk 1 Puff Pastry 1 Arrowroot 1 Mixed Peel 1 Evaporated Milk 1 369 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. Solids not Fat. Fat. Total Solids. Milk purchased on Sundays 124 8.95 3.52 12.47 Milk purchased on Week-days Milk produced in transit at 362 8.93 3.49 12.42 Finsbury Park Station 178 8.92 3.67 12.59 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 Finsburv Park Railwav Station are as follows:— Number taken Genuine. Adulterated. Percentage Adulterated. On Sundays 124 120 4 3.2 On Week-days 362 350 12 3.3 At Railway Stations Farmers' Milks 178 168 10 5.6 664 638 26 3.9 Dairy Show.— During the Dairy Show at the Agricultural Hall, Islington, the Medical Officer of Health received complaints regarding very indifferent milk sold there, the complainants stating that they were quite sure it was "skimmed milk." The Food and Drugs Inspector was instructed to sample the milk. He went to a stall over which were two notices, "Pure New Milk, 2d. per glass," and "Milk with cream added, 6d. per glass." The 2d. glass ot milk was purchased and the contents analysed. There was only 1.37 per cent, of fat instead of 3 per cent., that is, there was a deficiency of 54 per cent. 74 1928] It is quite unnecessary, perhaps, to say that as a result of action now taken, the sale of milk at the Dairy Show, which had thus proved a very distressingoccurrence to the Promoters, will be properly supervised and efficiently conducted in future. Giving the particulars of the Milks taken during each quarter of 1928 on Sundays, Week-days, and at the Railway Stations. 1928. No. of Samples Taken, Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. ; All Milks. Sundays, j Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. 1st Quarter 48 102 44 194 47 99 41 187 1 3 3 7 2.1 3.0 7.0 3.6 2nd „ 30 104 54 188 29 99 52 180 1 5 2 8 3.3 4.8 3.7 4.3 3rd „ 16 103 45 164 14 100 40 T54 2 3 5 10 12.5 2.9 11.1 6.1 4th „ 30 53 35 118 30 62 35 117 – 1 – 1 – 1.9 – 0.8 The Year 124 362 178 664 120 350 168 638 4 12 10 26 3.2 3.3 5.6 3.9 The number of samples of milk purchased was 664, of which 638 were genuine and 26, or 3.9 per cent, were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1928:— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 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 1927 740 710 30 4.0 Totals 10 yrs. 656 612 44 6.7 1928 664 638 26 3.9 75 [1928 Showing the analysis of 7,227 milks examined in Islington during the 10 years 1918-27 and 1928, 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. 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 1927 129 8.87 3.49 378 8.86 3.73 233 8.84 3.69 Total samples and aveiage constituents no years 1,295 8.72 3.48 3,731 8.75 3.52 1,537 8.81 3.66 1928 124 8.95 3.52 362 8.93 3.49 178 8.92 3.67 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 during the Year 1928. Article. Number of Samples examined Samples adulterated. Formal Informal Private Total Formal Informal Private Total Milk 661* 3 3† 634 26 – 3† 29 Butter 63 109 – 172 1 – – 1 Lard 25 6 – 31 – – – – Cream – 2 – 2 – – – – Cakes – 21 – 21 – – – – Sweets 1 36 – 37 1 2 – 3 Jam – 8 – 8 – – – – Biscuits – 18 – 18 – – – – Preserved Sausages – 17 – 17 – – – – Whisky 15 – – 15 11 – – 11 Cocoa 3 – – 3 – – – – Coffee 4 5 – 9 – – – – Fish Paste 1 7 – 8 – – – – Pepper 8 6 – 14 – – – – Sausages – 42 – 42 – 3 – 3 Ginger Beer – 1 – 1 – – – – Prescription 25 1 – 26 20 – – 20 Iodised Sarsaparilla – 1 – 1 – – – – Lemon Cheese – 1 – 1 – – – – Liniment of Turpentine – 1 – 1 – – – – Do. Alba. – 1 – 1 – – – – Mint Sauce and Malt Vinegar – 1 – 1 – – – – Liquid Sugar Bleach – 1 – 1 – – – – Preservative Powder (New Hexalbo) – 1 – 1 – – – – Sausage Rolls – 1 – 1 – – – – Tea – 1 – 1 – – – – Valencia Raisins – 1 – 1 – – – – Jam & Marmalade – 5 – 5 – – – – Pearl Barley 2 2 – 4 – – – – Full Cream Dried Milk – 3 – 3 – – – – Bacon – 4 – 4 – – – – Custard Powder 1 1 – 2 – – – – Tapioca – 2 – 2 – – – – Brisket – 1 – 1 – – – – Gripping 1 – – 1 – – – – 76 1928] Article. Number of Samples examined. Samples adulterated. Formal Informal Private Total Formal Informal Private Total Fruit Jelly – 1 – 1 – – – – Full Cream Condensed Milk 3 2 – 5 1 – – 1 Macaroni – 1 – 1 – – – – Ham & Beef Rissole – 1 – 1 – – – – Honey – 4 – 4 – – – – Malted Milk – 1 – 1 – – – – Olive Oil – 1 – 1 – – – – Pork Pie – 1 – 1 – – – – Puff Pastry – 1 – 1 – – – – Tripe – 2 – 2 – – – – Arrowroot 6 1 – 7 1 – – 1 Buns & Cakes – 7 – 7 – – – – Liver Pills – 1 – 1 – – – – Mixed Peel – 1 – 1 – – – – Sultanas – 8 – 8 – – – – Brawn – 5 – 5 – – – – Ham – 3 – 3 – – – – Mustard 3 – – 3 – – – – Condensed Machine Skimmed Milk – 2 – 2 – – – – Ground Almonds – 2 – 2 – – – – Prawns – 2 – 2 – – – – Bread – 1 – 1 – – – – Corned Beef – 1 – 1 – – – – Evaporated Milk (unsweetened) – 1 – 1 1 – – – – Full Cream Dried Milk – 1 – 1 – – – – Half Cream Dried Milk – 1 – 1 – – – – Icing Sugar – 1 – 1 – – – – Liniment of Mustard – 1 – 1 – – – – Margarine 27 5 – 32 7 – – 7 Total samples 849 369 3 1,221 68 5 3 N.B.—All samples tested in conformity with The Public Health (Preservatives, etc. in Food) Regulations, 1925-1927. * 2 samples taken under the Milk & Dairies Consolidation Act. f Adulterated—Action taken by' Islington Guardians—Summonses dismissed on payment of £3 3s. Od. costs. Milk Prosecutions. The summary of prosecutions showed that during the year 14 prosecutions were taken, of which number 12 were successful. Of the remaining two summonses, one was not served owing to death of defendant, whilst the other defendant absconded. Summary of Prosecutions during year 1928. (vide p.p. 85—89.) Total Prosecutions Successful. Dismissed. Withdrawn. Amount of Penalties. Costs Received. 30 27 – 3 a £ s. d £ s. d. b 28 3 0 47 4 0 "Sale of Food and Drugs Acts, 1875-1927." 46 44 2 c. f. – 68 10 0 113 5 6 "Margarine Act. 1887" 3 3 d. – 6 6 0 6 6 0 "Sale of Food Order, 1921" 5 2 2 f. 1 a. 12 2 0 7 '7 "Milk and Dairies Order, 1926" 13 11 1 f. 1 a. 16 11 0 14 11 "Milk and Dairies (Consolidated) Act, 1915" 1 1 – – 1 0 0 1 0 0 "Public Health (Condensed Milk) Regulations, 1923." 1 1 – – 2 2 0 2 2 0 Totals 99 89 5 5 134 14 0 190 15 6 (a.) Alternative Summons, (b.) Work Completed, (c.) Technical Objection. (d.) Appeal against Justices decision allowed. (e.) Adjourned sine die. (f.) Defendant given benefit of doubt. 77 [1928 Public Health Staff. The staff of the Medical Officer of Health (*G. CLARK TROTTER, M.D.; D.P.H.; F.R.S.E.) is constituted as follows :— * Superintendent of Public Health Department and Chief Sanitary Inspector. GEORGE JAMES BRIDEL,f Cert. Sanit. Insp. Ex. Bd., Cert. San. Inst. *Inspector of Meat. Hargreaves Wilkinson, Cert. Sanit. Inst.† *Inspector of Workshops and Bakehouses and Senior Inspector. Harry John James Watson, Cert. Sanit. Inst. *Inspectors of Workshops, &-c., in which Females are Employed. Miss Eleanor Harriet Daniell, Cert. Sanit. Insp. Ex. Bd. ; C.M.B. ; Cert. H.V. Mrs. Susannah Undery, Cert. Sanit. Insp. Ex. Bd. ; C.M.B. ; Cert. H.V. *Inspector of Houses Let in Lodgings. Robert Cecil Thorpe, Cert. Sanit. Insp. Ex. Bd. *Inspector of Food and Drugs, &-c. Gilbert Stanley Green, Cert. Sanit. Insp. Ex. Bd. *Sanitary Inspectors. District 1. Thos. Wallace Agar, Cert. Sanit. Inst. „ 2. Harry Jas. Bicknell, Cert. Sanit. Inst. 3. Allen Bagshaw, Cert. Sanit. Inst.† „ 4. Colin W. S. Lewis, Cert. Sanit. Insp. Ex. Bd.† „ 5. Chas. Edwin Horseman, Cert. Sanit. Inst. ,, 6. Stanley P. Marks, Cert. Sanit. Insp. Ex. Bd.† „ 7. Edward I. Fortune, Cert. Sanit. Inst. „ 8. John Metcalf, Cert. Sanit. Inst. „ 9. Thomas H. Hancock, Cert. Sanit. Insp. Ex. Bd.† „ 10. Alfred E. Wood, Cert. Sanit. Insp. Ex. Bd.† „ 11. Harold H. Uren, Cert. Sanit. Insp. Ex. Bd. „ 12. Leonard H. Pearson, Cert. Sanit. Insp. Ex. Bd. „ 13. Edward G. Holmes, Cert. Sanit. Insp. Ex. Bd. ,, 14. William Jas. Gallagher, Cert. Sanit. Insp. Ex. Joint Bd. f Also Meat Inspector's Certificate. Tuberculosis Visiting Nurse. Miss Emily McGoldrick, State Regd. Nurse, Cert. General Training. *Health Visitors. Miss Rosina Palmer, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Lily Flower, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Valerie Lainton, Cert. H.V. ; S.R.N. Mrs. Amy Main, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Ellen Oliver, Cert. C.M.B. ; S.R.N. Miss May Ritson, Cert. C.M.B. ; Cert. H.V. ; S.R.N. §Miss Hilda McCarthy, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Rosa Burgess, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Prudence Baker, Cert. C.M.B. ; Cert. H.V . ; S.R.N. §Resigned 27/Octr./28. Clerical Staff. George Harold King (Chief Clerk), Henry Angel, Edward A. Abbott, Walter J. Wolfe, William G. Bunch, Clement M. Wheble, Arthur R. Wittrick, William R. Causton, Laurence W. Edis, William A. McAdam, *Charles J. Cridland, Leslie P. J. Regan (Milk Grants) : *Fredk. C. Green, *Albert E. Vanstone, *Daisy Francis. Disinfecting Station. A. Lewis (Engineer), W. G. Jollie (Handyman Stoker), Mrs. Lewis (Caretaker, Shelter House), Mrs. Horne (Cleansing Station Attendant), G. Cooper (Motor Driver). Disinfectors. F. Webb, W. Hardwick, W. Woodley, A. Taylor. J BKowr Mortuary Keeper. S. Maxwell. Public Analyst. ERNEST A. PINCHIN, B.Sc. (Lond.), F.I.C., 9, Mincing Lane, E.C.3. Solicitor. NORMAN ROBERTSON, 3, Bond Court, Walbrook, E.C.4. * Those marked with an asterisk indicates contribution was expected either under the Public Health Acts or by Exchequer Grants. I APPENDIX. Vital and Sanitary Statistics, also Legal Proceedings. 1928. together with the PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 80 1928] STATISTICAL APPEN DIX Showing Deaths from all Causes in Islington during the Year 1928. 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 DISTRICTS. Males. ???| 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. w B. S.E. 39 Small Pox – – – – – – – – – – – – – – – – – – – – – – – – (a) Vaccinated – – – – – – – – – – – – – – – – – – – – – – – – (b) Unvaccinated – – – – – – – – – – – – – – – – – – – – – – – – (c) No Statement – – – – – – – – – – – – – – – – – – – – – – – – Measles 22 125 8 1 – – – – – – – – – 147 9 13 16 21 29 15 22 40 97 59 2 Scarlet Fever – 5 2 – – – – 1 5 3 1 2 1 1 2 1 – 4 4 Typhus Fever – – – – – – – – – – – – – – – – – – – – – – – – Epidemic Influeuza 2 1 1 – – 3 1 6 4 6 7 7 3 3 38 1 2 4 7 7 7 13 18 28 ??? Whooping Cough 15 6 – – – – – – – – – – - – 21 – 1 – 3 5 2 3 7 9 12 1 Diphtheria 2 13 10 – – – – – – – – – – 15 10 2 1 3 5 4 5 5 11 14 1 Enteric Fever – – – – – – 1 1 – – – – – – 2 1 – – 1 – – – 1 1 4 Asiatic Cholera – – – – – – – – – – – – – – – – – – – – – – – – Diarrhoea. Dysentery 9 1 – – – – – – – – – 1 – 10 1 – 3 – 2 2 4 – 7 4 10 Epidemic Enteritis 13 1 – – – – – – – – – – – 14 – 1 – 4 2 1 3 3 10 4 1 Other Allied. Diseases la 2a – – – – – la – la – – – 3 2 1 – – 1 – 1 2 1 4 8 Hydrophobia – – – – – – – – – – – – – – – – – – – – – – – – Glanders – – – – – – – – – – – – – – – – – – – – – – – – Tetanus 2 – – – – – – – 1 – – – – 2 1 – 1 – 1 – – 1 1 2 Anthrax – – – – – – – – – – – – – – – – – – – – – – – – Cow Pox – – – – – – – – – – – – – – – – – – – – – – – – Syphilis 2 1 – – 1 1 – 2 4 4 3 – – 3 15 1 2 2 1 3 4 5 13 3 9 Gonorrhoea – – – – – – – – – – – – – – – – – – – – 1 – 1 – Phagedaena – – – – – – – – – – – – – – – – – – – – – – – – Erysi pelas 3 1 – – – 1 – 2 2 3 2 4 10 – 1 3 2 3 1 4 6 8 2 Puer peral Fever – – – – – 2 3 4 1 – – – – – 10 3 – 1 – 1 – 5 – 14 12 Pyaemia 3 1 – 1 1 1 6 4 3 3 5 – – 4 24 3 1 2 9 5 6 16 12 3 Infective Endocarditis – – – – – 1 5 5 – – – – – – 11 1 1 1 4 2 2 – 3 ??? 4 Other Allied Diseases 1 – – – – – – – 1 – – 1 – 1 2 – 1 – – 1 1 – 2 ??? Malarial Fever – – – – – – – – – – – – – – – – – – – – – – – ??? Rheumatic Fever – – 4 1 – 1 – 2 5 – 1 1 – – 15 2 1 1 1 2 3 5 6 ??? 5 Rheumatism of Heart – 1 2 – – – 3 1 – – – – – 1 6 1 2 – 1 1 1 1 4 ??? Tuberculosis of Brain 4 13 6 1 1 – – – – – – – – 17 8 2 1 7 1 3 7 4 11 ??? 100 Tuberculosis of Larynx – – – – – – – – 1 1 – – – – 2 – – – – 1 – 1 1 ??? Phthisis – 3 1 3 25 31 71 04 63 29 14 3 – 3 304 27 30 19 30 49 68 84 181 ??? 1 Abdominal Tuberculosis – 1 – 1 – 2 1 1 — 1 – – – 1 6 2 1 – 2 2 – – 5 ??? 2 General Tuberculosis – 2 1 1 2 1 – – – – – – – 2 5 – – 1 – – 1 5 3 ??? 4 Other forms Tuberculosis 1 3 – – – 1 1 1 2 _ 1 – 4 6 1 1 2 1 – 5 4 ??? 1 Other Infective Diseases – – – – – – – – – – – – – – – – – – – – –– – ??? Thrush – – – – – – – – – – – – – – – – – – – – – ' – ??? Actinomycosis – – – – 1 – – – – – – – – – – – – – – 1 – 1 1 ??? Hydatid Diseases – – – – – – – – – – – – – – – – – – – – – – – ??? Scurvy – – – – – – – – – – – –– – – – – – – – – – – – ??? Other Diseases due to Altered Food – – – – – – – – – – – – – – – – – – – – – – – ??? Acute Alcoholism – – – – – – – – – 1 – – – – 1 1 – – – – – – 1 ??? 188 Chronic Alcoholism – – – – – — — — 1 — — — — 1 – – – – 1 – – – ??? Chronic Industrial Poisonings – – – – – – – – – – 1 – – – 1 – – – – – – 1 1 ??? Other Chronic Poisonings – – – – – – – – – – – – – – – – – – – – – – – ??? Osteo-arthritis – – 1 – – – – – – 1 4 2 – – 8 2 1 3 – 2 – – 3 ??? Gout – – – – – – – – – – – – – – – – – – – – – – – ??? Cancer – – – – 2 1 14 36 83 147 155 71 9 – 518 51 46 49 65 100 93 114 229 ??? Diabetes Mellitus – – 1 – 1 – – 2 2 7 4 5 – – 22 1 2 2 2 7 3 4 ??? Purpura Haemorrhagica – – – 1 1 – – – – – – – – – 2 – 1 – 1 – – 1 ??? Haemophilia – – – – – – – – – – – – – – — – – – – – – ??? Anaemia – 1 – – 1 – 1 – 3 3 2 2 – 1 12 – 3 1 2 4 2 5 ??? Lymphadenoma 1 – 1 – 1 1 1 2 – – – – – 1 6 1 – 1 2 1 1 6 ??? Premature Birth 70 – – – – – – – – – – – – 70 – 11 7 10 8 8 10 18 38 ??? Injury at Birth 6 – – – – – – – – – – – – 6 – – 2 – 2 2 – 2 ??? Debility at Birth 4 – – – – – – – – – – – – 4 – – – – 3 – – J 3 ??? Atelectasis 9 – – – – – – – – – – – – 9 – – – – 2 1 3 7 ??? Congenital Defects 34 1 – – – – – – – – – – – 35 – 1 3 2 2 5 8 17 ??? Want of Breast Milk – – – – – – – – – – – – – – – – – – – – – – – ??? Atrophy, Debility, Marasmus 20 – – – – – – – – – – – – 20 – 2 1 2 6 3 3 3 12 ??? a Cerebrospinal Fever (5). * Paratyphoid. 81 [1928 Continued. Borough. I DISEASES. AGES. Under 5 Over 5 DISTRICTS. Males. Females. Totals 0- 1- 5- 10- 15- • 20- 25- 35 45- | 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. 1 B. 1 S.E. Dentition 1 _ 1 1 - 1 Rickets — — — — — — — — — — ~ KA A A 1 9fl 1 7 1 7 1 R 12 21 16 27 42 86 128 Old Age, Senile Decay 8 40 A IZo 11 j 1 / io 1 2 4 4 Convulsions ... 4 — _ T t A in J Q 5 2 3 2 8 8 16 Meningitis 3 3 2 2 — 2 z 1 i O 0 i O K 2 2 5 6 11 Encephalitis ... 2( — — 3 1 1 1 2 1 ~ 2 y 1 Q 1 1 Q Q 0 i n i 9K 11 16 44 55 99 Apoplexy 1 — — — 1 — 1 4 9 17 30 27 9 1 98 lo lo O 1U 1 it 1 1 2 Softening of Brain ... — — 1 — — — — — 1 - 2 Q 1 1 J 6 2 7 9 Hemiplegia 1 1 0 2 ' y 1 i General Paralysis of Insane — — — — 7 9 1 — — — — 17 3 — 2 1 2 4 9 5 3 13 3 4 4 17 7 Other forms of Insanity 2 1 2 — 1 1 7 ' 1 1 Z Chorea — — — — — — 1 9 4 7 8 15 Cerebral Tumour — 2 1 — — 2 4 3 1 2 ~~ 15 Q 3 1 o 1 o Z 2 2 6 3 9 Epilepsy — j — — — 1 1 3 1 1 1 1 O i Z Z Laryngismus Stridulus — — — — — — i 2 4 1 5 Locomotor Ataxy — — — — — — 1 1 "7 1 ~~ ~ 5 1 9 1 1 1 2 2 1 2 6 8 Paraplegia 1 — — 1 — — 2 2 2 1 ( 1 Z i Other Forms, Brain Diseases 1 — 2 b lb 2 3 — 1 — — — 10 1 — 3 2 1 2 1 Q 3 3 7 2 10 10 Otitis — 2 1 1 1 1 1 2 — 1 — — — 2 8 1 3 2 l O Disease of Nose, Episi taxis 1 — — — — — — 1 — — — 1 — — — — — z — 1 1 — 1 1 Disease of the Eye ... — — — — — — — — — — — — — 9 2 7 9 7 16 7 1 Pericarditis 1 o 3 — 1 1 1 — 2 3 1 1 1.) 1 7 o z 1 l * i 1 2 0 7 10 17 2 1 Endocarditis — — 1 2 — — 2 2 2 5 3 1 ( 1 O X Hypertrophy of Heart — — — — — — — — — ~Z ~~ 1 A 9 p. Q 2 10 6 16 Angina Pectoris — — — — — — — — 1 7 6 2 lo 4 Z o Q o A I 9 7 16 3 Aneurism 4 5 5 2 — 16 4 1 4 9 o K t- 2 5 7 12 6 i Senile Gangrene 2 6 3 1 12 2 1 Z Q J 1 7 12 18 37 50 87 44 i Embolism, Thrombosis 3 4 7 14 30 29 — 87 15 9 4 y 1 < ; Phlebitis — — — — — — — — — — — — 1 1 Varicose Veins — — — — — — — — — — — 1 — — 1 ' 1 Other Diseases, Heart and Vessels 3 3 4 3 5 4 8 35 94 193 276 230 50 6 902 110 98 92 97 166 Q 132 213 409 3 499 908 3 2 Laryngitis — 1 — — — — 1 — — 1 — — 1 2 O j Croup — — — — — — — — — — _ — Other Diseases, Larnyx and Trachea _ __ 1 — — 1 — — — 1 1 — 1 7A t Acute Bronchitis 5 4 1 — — — 1 2 3 12 15 19 8 9 61 9 8 4 7 1 7 7 91 20 18 15 24 33 59 37 59 /U 118 Chronic Bronchitis ... 2 2 — — — — 1 1 7 13 43 41 8 4 114 12 19 4 1/ 7 1 9 20 23 51 29 80 Lobar Pneumonia 7 4 2 1 1 6 9 14 15 16 5 11 69 9 5 4 1Z Lobular Pneumonia ... 60 4<J 3 1 1 1 4 6 15 32 32 26 3 109 124 20 28 20 26 35 50 54 123 110 233 i Pneumonia 1 2 2 1 6 1 2 1 1 15 2 3 1 3 — 2 5 9 7 16 I Emphysema Asthma — — — ■— 2 3 5 6 3 — 19 J 2 2 1 3 3 7 11 8 19 | Pleurisy n 1 1 — 1 2 — 2 3 6 3 — 1 18 2 2 3 5 4 3 14 5 19 Other Diseases, Respiratory System 1 1 _ 1 1 2 3 15 23 36 11 — 94 10 9 9 9 20 12 25 52 42 94 Diseases of Mouth and Annexa — — — — — — — — — — — 9 o Diseases ol Pharynx 2 __ — 1 — — — — — — — 2 1 — _2 — — 1 Z i O Diseases of (Esophagus — — — — — — — — — — — — : | Ulcer of Stomach and Duodenum 1 6 10 14 8 4 1 44 6 5 4 8 9 5 7 34 10 44 Other Diseases of the Stomach 1 1 1 _1 _ 1 1 h _ 3 — — 1 1 — 3 2 5 20 Enteritis ... 40 3 — — — 1 1 1 2 1 — 43 6 2 2 8 9 8 12 8 F. 26 1 9 23 49 1 7 4 1 Appendicitis ... — 1 1 1 3 — 1 2 1 & 1 1 — 1 16 3 2 2 4 1 O 1Z O i / l Obstruction of Intes1 tines 2 5 1 4 3 9 8 6 2 r- 4 33 6 2 4 6 8 5 9 15 25 40 I Other Diseases of InI testines 1 1 1 _ 2 1 6 — 1 — 1 4 2 4 6 6 1 Cirrhosis of I,iver !!! 1 — — 1 4 5 9 2 — 22 4 2 4 1 2 5 4 13 9 22 rj 1 1 I 2th.er Diseases of L,iver I Pentonitis — 1 1 1 2 2 4 2 1 1 1 1 1 6 8 2 1 1 4 1 1 3 2 1 3 2 4 7 I 9 I Other Diseases, DigesI tive System I 1 1 2 — 2 | leases, Lymphatic'" 11 system and Glands i 1 1 2 2 _ 1 1 7 1 1 3 1 2 3 5 8 I, Acute Nephritis i 1 _ 2 3 — 1 — 1 — 1 3 — 3 4c H Bright's Disease 1 1 4 5 21 27 21 24 2 1 100 3 6 8 19 17 22 32 59 48 107 1 Calculus X 1 1 4 4 2 12 3 .— 2 — 4 2 1 4 8 12 I! Diseases ot Bladder and 1 5 9 6 3 23 3 1 2 2 5 2 8 20 3 23 1 0 he! leases, Urinary ■ system 1 1 1 2 3 3 8 3 1 21 4 3 1 3 3 8 12 10 22 ■ Dl^*s of Testis and ■ Perns 1 1 _ 1 1 ■ Diseases of Ovaries 2 1 1 1 6 3 1 2 — 6 6 1 Dwases of Uterus and ■ ^APPcndages 2 2 1 5 1 2 2 5 5 H Diseases of Vagina and ■ Di„'m,aJ G«itals ... |ASon°MBreaSt- - |^Sama8?.. i i l |§ Convulsions 1 1 2 1 1 2 2 ■ Placenta pr^ via, F,ood. — — — — 1 — — — - — - 1 - — — — — 1 - 1 b Encephalitis I^ethargica (3) o Acute Polioencephalitis (1) 82 1928] Continued. Deaths in [nstitutions within Borough. DISEASES. AGES. Under 5 Over 5 DISTRICTS. Males. ??? 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. I,.H w B. S.E. 19 Puerperal Thrombosis – – – – – – – 1 – – – – – – 1 – – – – – 1 – – – Other Diseases, Pregnancy and Childbirth – – – – 1 – 7 2 – – – – – – 10 2 1 2 1 2 2 – – 10 Arthritis, Ostitis, Periostitis – – – – – – – – – – – – – – – – – – – – – – – – Other Diseases, Osseous System 1 – – 1 1 – 1 – – – – – – 1 3 – – – – 1 1 2 3 1 Ulcer, Bedsore – 1 – – – – – – – – – – – 1 – – – – – – 1 – 1 – Eczema – – – – – – – – – – – – – – – – – – – – – – – – Pemphigus – – – – – – – – – – – – – – – – – – – – – – – – Other Diseases, Integumentary System 1 – – – – – – – – 1 – – – 1 1 1 – – – 1 – – – 2 Accidcnts and Negligence. In Mines and Quarries – – – – – – – – – – – – – – – – – – – – – – – – In Vehicular Traffic – 5 7 9 2 7 5 2 3 7 7 8 1 – 5 51 10 3 8 10 4 7 14 36 2 On Railways – – – – – 1 1 – – 2 – – – – – 1 – 1 – – 1 1 3 1 On Ships, Boats, etc. (not drowning) – – – – – – – – – – – – – – – – – – – – – – – – In Building Operation – – – – – – 2 1 1 2 1 – – – 7 – 1 2 – – 1 3 7 – 1 By Machinery – – – – – – – – – – – – – – – – – – – – – – – – By Weapons and Implements – – – – – – – – – – – – – – – – – – – – – – – – 5 Burns and Scalds 1 5 – – – – – 1 – 1 – – – 6 3 – 1 1 3 1 3 – 4 5 1 Poisons, Poisonous Vapours – – – – – – – – 1 1 1 – – – 1 – 1 – – – – – – 1 32 Surgical Narcosis – – – – – – 1 – – – – – – – – – – – – – – – – – Effects of Electric Shock – – – – – – – – – – – – – – – – – – – – – – – – Corrosions by Chemicals Drowning 1 – – – – 1 2 – – 1 1 – – 1 6 – – 1 3 – – 3 6 ??? Suffocation, Overlaid in Bed 4 – – – – – – – – – – – – 4 – – 1 – 1 1 1 2 ??? Suffocation, Otherwise 5 1 – – – – – – – – – – – 6 – 1 7 – – 2 1 2 5 ??? Falls, not specified 1 3 – – – – – – – 11 10 15 9 4 51 7 – 4 4 8 8 17 21 ??? 1 Weather Agencies – – – – – – 3 1 – – – – 1 – – – – – – – Otherwise, not stated – – – – – – – – – 2 1 – – – 3 – 1 – – 1 1 – 2 4 1 Homicide Suicide. 1 – – – – – 2 3 1 1 – – – 1 7 1 1 – – 3 2 1 2 6 2 By Poison – – – – 1 2 2 2 6 6 5 – – – 24 2 1 4 1 4 3 9 15 9 1 By Asphyxia – – – – – – – – – – – – – – – – – – – – – – – – By Hanging and Strangulation – – – – – – – – – 1 – – – – 1 – – – – – – 1 1 – By Drowning – – – – – – – – 1 1 – – – – 2 – – – – –– 1 2 By shooting – – – – – – – – – 1 1 – – – 2 – 1 – – – 1 1 2 By Cut or Stab – – – – – – 1 2 – – – – – – 3 – 1 – – – – – 2 1 By Precipitation from Elevated Places – – – – – – – – – 1 – 1 – – 2 – – 1 1 – – – – 1 By Crushing – – – – – – – – – 1 – – – – 1 – – – – – – – – By other and unspecified methods – – – – – – – – – – – – – – – – – – – – – – – – Execution – – – – – – – – – – – – – – – – – – – – – – Sudden Death, cause not ascertained – – – – – – – – – – – 1 – – 1 – – – – 1 – – – 1 Ill-defined and unspecified causes –– – – – – – – – – – – – – – – – – – – – – – – – Males 200 164 39 17 38 40 76 140 223 382 407 303 17 364 1712 209 204 200 270 338 369 489 Females 174 120 31 17 28 38 104 130 210 303 421 381 128 294 1791 233 204 194 242 380 330 102 1,152 TOTAL DEATHS 374 284 70 34 66 78 180 270 433 685 828 684 175 658 3503 442 408 394 812 71# 699 991 2 * Not certified. 83 [1928 (Ministry of Health Return.) Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1928 Causes of Death. Sex All ages 0— 1— 2— 5— 15— 25— 46— 65— 75— All Causes M 2077 201 89 74 55 79 216 607 407 349 F 2095 170 71 52 51 67 230 517 423 514 Enteric Fever M 1 – – – – – 1 – – – F 1 – – – – – 1 – – – Small Pox M – – – – – – – – – – F – – – – – – – – – – Measles M 99 14 48 34 3 – – – – – F 59 8 30 15 6 – – – – – Scarlet Fever M 4 – – 2 1 – 1 – – – F 4 – 2 1 1 – – – – – Whooping Cough M 11 8 2 1 – – – – – – F 14 7 4 2 1 – – – – – Diphtheria M 11 2 3 6 – – – – – F 11 – 3 4 4 – – – – – Influenza M 16 1 – – – 2 2 6 4 1 F 24 1 – – 1 1 5 4 3 9 Encephalitis Lethargica M – – – – – – – – – – F 3 – – – – 2 1 – – – Meningococcal Meningitis M – – – – – – – – – – F 5 2 1 – 1 – 1 – – – Tuberculosis of respiratory system M 184 – – – 3 32 70 71 7 1 F 128 – – 3 2 27 63 24 7 2 Other Tuberculous Diseases M 25 1 6 3 4 5 4 2 – – F 27 4 3 8 5 2 1 3 – 1 Cancer, malignant disease M 237 – – – 1 1 15 103 80 37 F 292 – – – – 3 35 131 78 45 Rheumatic Fever M 10 – – 1 6 – 1 2 – – F 8 – – – 4 – 1 2 1 – Diabetes M 8 – – – – – 1 4 2 1 F 20 – – – 1 1 1 8 5 4 Cerebral hæmorrhage, &c. M 84 – – – – 1 5 21 25 32 F 97 – – – – – 2 21 39 35 Heart Disease M 306 – – – 3 5 24 98 101 75 F 404 – – – 4 7 20 126 108 139 Arterio-sclerosis M 76 – – – – – 1 17 27 31 F 70 – – – – – 1 12 25 32 Bronchitis M 113 1 2 1 1 1 2 35 35 35 F 116 4 1 – 1 – 3 14 35 58 Pneumonia (all forms) M 200 33 23 8 5 1 17 61 30 22 F 150 37 17 11 5 2 14 29 22 13 Other respiratory diseases M 46 – – 2 – 1 5 13 6 19 F 47 – – – – 1 5 6 7 28 Ulcer of stomach or duodenum M 33 – – – – – 6 21 4 2 F 9 – – – – – 2 3 3 1 Diarrhœa, &c. M 46 40 1 – – – – 2 1 2 F 31 24 3 – – – 1 2 1 – Appendicitis and Typhlitis M 12 – – 1 1 1 4 5 – – F 6 – – – 1 1 – 2 1 1 Cirrhosis of Liver M 13 – – – – – 2 5 4 2 F 9 1 – – – – – 5 3 – Acute and Chronic Nephritis M 65 – 1 – – 1 7 26 13 17 F 64 – – – 1 1 6 24 22 10 Puerperal Sepsis M – – – – – – – – – F 9 – – – – 2 6 1 – – Other accidents and diseases of Pregnancy and Parturition M – – – – – – – – – F 15 – – – – 3 12 – – – Congenital Debility and Malformation, Premature Birth M 70 69 – 1 – – – – – – F 68 68 – – – – – – – – Suicide M 23 – – – – 2 4 12 5 – F 11 – – – – 1 3 6 – 1 Other deaths from violence M 91 8 – 9 8 14 14 24 11 3 F 63 3 3 2 3 1 9 14 11 17 Other Defined Diseases M 292 24 3 11 13 12 29 79 52 19 F 329 11 4 6 10 12 37 80 52 117 Causes Ill-defined or unknown M 1 – – – – – 1 – – – F 1 – – – – – – – – 1 Legitimate. Illegitimate. M. 185 16 Deaths under 1 year F 153 17 84 1928] (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1928. Disease. Ages. Totals Total Cases removed to Hospital Under 1. 1–2 2–3 3–4 4–5 5–10 10–15 15–20 20–35 35–45 46–65 65 and upwds Small Pox Notifications 1 .. .. .. .. .. 1 1 1 .. .. .. 4 4 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever Notifications 17 47 81 109 123 589 153 86 81 16 2 1 1,305 1,272 Deaths .. 2 2 1 .. 2 .. .. .. 1 .. .. 8 7 Diptheria Notifications 23 58 76 55 73 250 85 44 73 15 8 .. 760 752 Deaths 2 6 2 2 2 10 1 .. .. .. .. .. 25 22 Enteric Fever Notifications .. .. 2 .. .. 2 2 4 4 2 2 1 19 17 Deaths .. .. .. .. .. .. .. .. 1 1 .. .. 2 2 Puerpeial Fever Notifications .. .. .. .. .. .. .. 3 27 8 .. .. 38 31 Deaths .. .. .. .. .. .. .. .. 5 5 .. .. 10 9 Puerperal Pyrexia Notifications .. .. .. .. .. .. .. 3 58 15 1 .. 77 54 Deaths .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 Acute Primary and Influenzal Pneumonia Notifications 20 20 24 15 13 50 13 28 53 40 44 18 338 .. Deaths .. .. .. .. .. .. .. .. 2 4 3 1 10 4 OphthalmiaNeonatorum Notifications 78 .. .. .. .. .. .. .. .. .. .. .. 78 18 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica Notifications .. .. .. .. .. .. .. .. .. .. 1 1 2 2 Deaths .. .. .. .. .. .. .. .. .. 3 .. .. 3 .. Cerebrospinal Fever Notifications .. 2 .. .. 1 .. .. 1 .. .. .. .. 4 4 Deaths 1 2 .. .. .. .. .. .. .. .. 1 1 .. .. Acute Poliomyelitis Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax Notifications .. .. .... .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery Notifications .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas Notifications 3 1 1 3 .. 5 1 10 23 15 49 23 134 77 Deaths 3 1 .. .. .. .. .. .. .. 1 3 7 15 12 85 [1928 LEGAL PROCEEDINGS 1928 Date. Name and address of Defendant. Offence. Result. 1928. Public Health (London) Act, 1891. Jan. 27th Arlidge, William, 60, William Street, Hampstead Road. Non-compliance with Statutory Notice re 23, Hollingsworth Street. Fined £5 5s. 0d. and ordered to pay £5 5s. 0d. costs. Feb. 3rd Jan. 27th Sullivan, Albert Victor, 21, Clayton Street. Non-compliance with Statutory Notice re 21, Summons adjourned sine die. Jan. 27th Strank, George, 21, Clayton Street. Clayton Street. Non-compliance with Statutory Notice re 21, Clayton Street. Ordered to abate the nuisance within 14 days and to pay 20s. costs. Feb. 3rd Feb. 17th Jan. 27th Barnett, Mrs. Sarah, 329, Caledonian Road. Non-compliance with Notice re 364, Caledonian Road. Fined 40s. and 40s. costs. Jan. 27th Walters, Mrs. Alice, 108, Georges Road. Non-compliance with Notice re 108, Georges Road. Ordered to cleanse the room within 7 days and in default fined 1s. a day during which noncompliance continues. Feb. 10th Foskett, Charles, 86, Mildmay Road. Non-compliance with Statutory Notice re 106, Mildmay Road. Summons withdrawn as nuisance abated. Feb. 10th Tilley, Herbert W., 106, Mildmay Road. ditto. Ordered to pay £1 1s. 0d. costs. Feb. 10th Cole, Thomas, 125, Offord Road. Non-compliance with Statutory Notice re 36, Wyatt Road. Ordered to abate the nuisance within 14 days and to pay £3 3s. 0d. costs. Feb. 24th March 23rd Williams Hyman, 7, Woodberry Down, Finsbury Park, N.4. Non-compliance with Statutory Notice re 240c, Seven Sisters Road. Summons withdrawn on payment of £2 2s. 0d. costs. April 13 th March 23rd Boxall, Arthur S., trading as Boxall & Boxall, 57, Newington Green. Non-compliance with Statutory Notice re 2, Mildmay Grove. Ordered to abate the nuisance within 14 days and to pay £1 1s. 0d. costs. March 30th Sweeting, Charles Wm, 72, Dartmouth Park Hill. Non-compliance with Statutory Notice re 33, Story Street. Ordered to abate the nuisance within 28 days. Fined £5 5s. 0d. and £5 5s. 0d. costs. March 30th Bottazzi Antonio, 41, Winchester Street. Letting an underground room as a dwelling. Fined £3 3s. 0d. and £2 2s. 0d. costs. April 27th March 30th Tulk, William Chas., 41, Winchester Street. Occupying an underground room as a dwelling. Ordered to pay 2s. costs. April 27th April 13 th Bennett, Mr. C. L., 22, High Street, North Finchley. Non-compliance with Statutory Notice re 57, Charteris Road. Ordered to abate the nuisance within 14 days and to pay £2 2s. 0d. costs. April 27th May 11th Glass, Mrs. Ada, 26, North Road. Non-compliance with Statutory Notice re 3, Corporation Street. Ordered to abate the nuisance within 21 days and to pay £2 2s. 0d. costs. May 11th ditto. Non-compliance with Notice re 3, Corporation Street. Summons withdrawn on payment of £2 2s. 0d. costs. June 15th May 11th ditto. Non-compliance with Statutory Notice re 1, Corinth Road. Ordered to abate the nuisance within 21 days and to pay £2 2s. 0d. costs. June 1st Sukmanski, Moses Aaron, 12, Woodberry Down, N.4. Non-compliance with Statutory Notice re 43, Hurlock Street. Summons withdrawn on payment of £1 Is. Od. costs. 86 1928] LEGAL PROCEEDINGS 1928 Date. Name and address of Defendant. Offence. Result. 1928. Public Health (London) Act, 1891—continued. June 15th Sweeting, Charles Wm., 72, Dartmouth Park Hill. Non-compliance with Statutory Notice re 99, Bemerton Street. Ordered to abate the nuisance within 6 weeks. Fined £5 5s. 0d. and £5 5s. 0d. costs. June 15th Strank, George, 21, Clayton Street. Disobedience of Justice's Order re 21, Clayton Street. Fined £5. July 13th July 27th June 29th Walters, Mrs. Alice, 108, Georges Road. Disobedience of Justice's Order re 108, Georges Road. Fined 5s. July 13th Dickerson, Mrs. E. A., 58a, Tufnell Park Road. Non-compliance with Statutory Notice re 28, St. Peter's Street. Ordered to abate the nuisance within 14 days and to pay £i 2s. 0d. costs. July 27th Richford & Co., Ltd., Milner Works, Barnsbury Street. Non-compliance with Statutory Notice re Milner Works, Barnsbury Street. Summons withdrawn on payment of £1 1s. 0d. costs (work completed). Sept. 28th Oct. 5th Miller, William, 13, Crossways, Stoke Newington. Non-compliance with Statutory Notice re 23, Boleyn Road. Ordered to abate the nuisance within 21 days. Oct. 26th Sweeting, Charles Wm., 72, Dartmouth Park Hill. Disobedience of Justice's Order re 99, Bemerton Street. Summons adjourned generally. Nov. 30th Rayson, Oliver, 37, Parchmore Road, Thornton Heath. Non-compliance with Statutory Notice re 5, Hornsey Street. Summons withdrawn on payment of £1 1s. 0d. costs (work completed). Nov. 30th ditto. Non-compliance with Statutory Notice re 9, 1 Hornsey Street. ditto. Nov. 30th ditto. Non-compliance with Statutory Notice re 11, Hornsey Street. ditto. Dec. 7th Miller, William, 13, Crossways, Stoke Newington. Disobedience of Magistrate's Order re 23, Boleyn Road. Fined £2 and £2 2s. 0d. costs. Dec. 14th Wagstaff, Charles, 129, Bemerton Street. Non-compliance with Statutory Notice re 129, Bemerton Street. Ordered to abate the nuisance within 1 month and to pay £1 1s. 0d. costs. Dec. 14th Wagstaff, William, 129, Bemerton Street. Sale of Food and Drugs Acts. ditto. Summons withdrawn (alternative summons). Jan. 6th Shuttleworth, Alfred Josh., 88, Ashbrook Road. Selling Liniment of Turpentine 53 per cent, deficient in Rectified Oil of Turpentine. Ordered to pay £5 5s. 0d. costs. Jan. 6th Honiatt, Albert Thos., 35, Junction Road. Selling Liniment of Turpentine 69 per cent, deficient in Rectified Oil of Turpentine. Ordered to pay £5 5s. 0d. costs. Jan. 6th Waterhouse, Percy, 404, Essex Road. Selling Liniment of Turpentine 53 per cent, deficient in Rectified Oil of Turpentine. Ordered to pay £5 5s. 0d. costs. Jan. 13th Ascotts Pharmacies, Ltd., 1098, Harrow Road. Selling Liniment of Turpentine 50 per cent, deficient in Rectified Oil of Turpentine, (at 92, Packington Street). Fined £1 and £2 2s. 0d. costs. 87 [1928 LEGAL PROCEEDINGS 1928 Date. Name and Address of Defendant. Offence. Result. 1928. Sale of Food and Drugs Acts—continued. Jan. 13 th Hearle, Mr. J. W., 94, Richmond Road. Selling Liniment of Turpentine 53 per cent. deficient in Rectified Oil of Turpentine. Fined £1 and £2 2s 0d. costs. (Defendant appealed against this decision and appeal was allowed. No order made as to costs). Jan. 13th Bell & Co., Ltd., 186, Essex Road. Selling Liniment of Turpentine 33 per cent. deficient in Rectified Oil of Turpentine. Fined £1 and £2 2s. 0d. costs. Jan. 13th Gluckstein, Nathaniel, " The Mitre" P.H., 130, Upper Street. Selling Whisky 37.1 degrees under proof. Fined £10 10s. 0d. and £10 10s. 0d. costs. Jan. 20th Iies, Sidney Phillips, 30, Highbury Park. Selling Liniment of Turpentine 50 per cent. deficient in Rectified Oil of Turpentine. Ordered to pay £2 2s. 0d. costs. Jan. 20th Bow Drug Stores, Ltd., 39, Devons Road, Bow, E.3. Selling Liniment of Turpentine 53 per cent. deficient in Rectified Oil of Turpentine (at 68, Devonshire Road). Ordered to pay £2 2s. 0d. costs. Jan. 20th John Henry Smith, Ltd., 61, Stroud Green Road. Selling Liniment of Turpentine 56 per cent. deficient in Rectified Oil of Turpentine. Ordered to pay £2 2s. 0d. costs. Feb. 10th Parke's Chemists, Ltd., 65, Harmood Street, Kentish Town. Prescription not of the nature, etc., demanded, (at 804, Holloway Road). Fined 10s. Feb. 24th Feb. 17th ditto. ditto. (at 251, Upper Street). Fined £5 5s. 0d. and £2 2s. 0d. costs. March 2nd Feb. 24th Young, James Clements, and Harrison, Alfred William, 179, Blackstock Road. Prescription not of the nature, etc., demanded. Fined 10s. Feb. 24th Stein, Andrew W., 35, Cottenham Road. ditto. Fined 10s. Feb. 24th Bow Drug Stores, Ltd., 39, Devons Road, Bow, E.3. ditto. (at 68, Devonshire Road). Fined 10s. Feb. 24th Cooper, George D., 27, Crouch Hill. ditto. Fined 10s. Feb. 24th. Everett, Henry Percy, 59, Southgate Road. ditto. Fined 10s. Feb. 24th Wilson & White, Ltd., 281, Essex Road. ditto. Fined 10s. Feb. 24th Wilson, Mrs. Margaret, 356, Essex Road. ditto. Fined 10s. Feb. 24th Lacey, Edgar, 216, St. Paul's Road. ditto. Fined 10s. March 2nd Nicoll, Thomas, 110, Copenhagen Street. ditto. Fined £1 1s. 0d. and £2 2s. 0d. costs. March 2nd Morgan, Richard James, 8, Caledonian Road. ditto. Fined £l 1s. 0d. and £2 2s. 0d. costs. March 2nd Timson's Cash Chemists, Ltd., Tudor Chambers, Station Road, Wood Green. ditto. (at 202, Caledonian Road). Fined £1 1s. 0d. and £2 2s. 0d. costs. March 2nd Ascott's Pharmacies, Ltd., 1098, Harrow Road, Middlesex. ditto. (at 92, Packington Street). Fined £5 5s. 0d. and £2 2s. 0d. costs. March 2nd Carter, John Cox, 86, St. James's Road. ditto. Fined £5 5s. 0d. and £2 2s. 0d. costs. March 2nd Boots' Cash Chemists, Ltd., Station Street, Nottingham. ditto. (at 106, Essex Road). Fined £5 5s. 0d. and £2 2s. 0d. costs. March 2nd Whineray, George Edward, 78, Essex Road. ditto. Fined £1 1s. 0d. and £2 2s. 0d. costs. 1928] 88 LEGAL PROCEEDINGS 1928 Date. Name and Address of Defendant. Offence. Result. 1928. Sale oj Food and Drugs Acts—continued. March 2nd Cartwright & Son, Ltd., 171, Holloway Road. Prescription not of the nature, etc., demanded. Fined £1 1s. 0d. and £2 2s. 0d. costs. March 16th Franks, Sidney Charles, " Old Queen's Head " P.H., 44, Essex Road. Selling Whisky 42.4 degrees under proof. Summons dismissed (wrong date of offence or summons). March 16th Back, Herbert Henry, 40, Howard Road, Stoke Newington. Selling Milk from which 13 per cent. original fat had been abstracted. Ordered to pay £2 2s. 0d. costs. April 27th Jarratt, Charles, " The Rose " P.H., 15, Pophara Road. Selling Whisky 37.4 degrees under proof. Summons dismissed under Probation of Offenders Act on payment of £2 2s. 0d. costs. April 27th Trower, Mrs. Tryphena, " Duchess of Kent " P.H., 72, Prebend Street. Selling Whisky 39.7 degrees under proof. Summons dismissed under Probation of Offenders Act on payment of £5 5s. 0d. costs. June 8th Lucas, Percy William, " Duke of Edinburgh " P.H., 20, Fonthill Road. Selling Whisky 44.3 degrees under proof. Ordered to pay £5 5s. 0d. costs. June 8th Garrood, John Lewted, 120, Fonthill Road. Selling Milk from which 20 per cent. original fat had been abstracted. Fined £3 3s. 0d. and £6 2s. 6d. costs. June 8th ditto. Selling Milk containing 8 per cent. added water. Fined £2 2s. 0d. and £2 2s. 0d. costs. June 8th Spratley, James, 45, Langdon Road. Selling Milk containing 12 per cent. added water. Fined £5 and £5 2s. 0d. costs. June 8th ditto. Selling Milk containing 11 per cent. added water. Fined 10s. June 8th 0 ditto. Selling Milk containing 10 per cent. added water. Fined 10s. June 8th ditto. Selling Milk containing 10 per cent added water. Fined 10s. June 15th Hardiman, James Michael, " Market Tavern " P.H., 144, York Road. Selling Whisky 39.7 degrees under proof. Summons dismissed under Probation of Offenders Act on payment of £10 10s. 0d. costs. July 20th Amis, Alfred John, " Queen's Arms " P.H., 1, Queensland Road. Selling Whisky 37.6 degrees under proof. Summons dismissed on payment of £3 3s. 0d costs. Aug. 10th White, Mr. F., Church Farm, Thorpe, Ashbourne, Derby. Selling and proceeding to deliver at Finsbury Park Station Milk containing 6 per cent. added Summons dismissed on payment of £4 4s. 0d costs. Aug. 17th Roberts, Mr. T. H., Blackwell Lodge, Croxton, Grantham, Lines. water. Selling and proceeding to deliver at Finsbury Park Station Milk from which 23 per cent. original fat had been abstracted. Summons dismissed on payment of £5 5s. 0d costs. Sept. 21st Owen, Evan John, 69, Fonthill Road. Selling milk from which 29 per cent. original fat had been abstracted. Fined £5. Sept. 21st ditto. Selling Milk from which 23 per cent. original fat had been abstracted. Fined £5. Oct. 26th Childs, William Edwin, 48, Cross Street. Selling Margarine in an unstamped wrapper. Fined £2 2s. 0d. and £2 2s. 0d. costs. Oct. 26th Evans, Richard Evan, 285, New North Road. Selling Margarine in an unstamped wrapper. Fined £2 2s. 0d. and £2 2s. 0d. costs. Oct. 26th ditto. Exposing for sale Margarine to which was not attached a proper label. Fined £2 2s. 0d. and £2 2s. 0d. costs. Nov. 30th British Dairy Farmers Association, 28, Russell Square, W.C.I. Selling Milk from which 54 per cent. original fat had been abstracted. (At Royal Agricultural Hall). Fined £5 and £5 costs. 89 [1928 LEGAL PROCEEDINGS 1928 Date. Name and Address of Defendant. Offence. Result. 1928. Milk and Dairies Order, 1926. Jan. 13th Taylor, Arthur, 14, Southampton Street. Carrying on the trade of Purveyor of Milk without being registered. Fined £2 and £2 2s. 0d. costs. Jan. 27th Garnham, George, 16, Clarendon Street, Euston, N.W. Filling and closing Milk bottles in street instead of on Registered premises. Fined £1 and £1 costs. Jan. 27th Soundy, Charles, 78, Aldenham Street, Euston. ditto. Summons withdrawn (alternative summons). April 13th Watts, Frederick John, 12, Cottenham Road. ditto. Ordered to pay £1 1s. 0d. costs. April 13 th White, Frank, 37, Alexander Road. ditto. Ordered to pay £1 1s. 0d. costs. April 27th Freeman, Charles, 98, Bemerton Street. ditto. Fined £1 and £1 costs. June 15th Millington, Alex., 49, Freeling Street. ditto. Summons dismissed, defendant given benefit of doubt. Sept. 21st Owen, Evan John, 69, Fonthill Road. ditto. Fined 5s. or 5 days. Sept. 21st Graham, Bert, 43, Evershot Road. ditto. Fined £3 or 1 month. Sept. 28th Evans, Thomas Lloyd, 29, Wynford Road. ditto. Fined £2 and £2 costs. Oct. 12th Soutar, Benjamin Geo., 41, Ronalds Road. ditto. Fined £2 2s. 0d. and £2 2s. 0d. costs. Oct. 12th ditto. ditto. Fined £2 2s. 0d. and £2 2s. 0d. costs. Nov. 16th Thomas, John, 48, Hollingsworth Street. Sale of Food Order, 1921. ditto. Fined £3 and £1 1s. 0d. costs. June 29th Radford, Reginald Harold, 166, Essex Road. Exposing for sale imported meat not properly labelled. Fined £2 2s. 0d. and £2 2s. 0d. costs. July 6th Finch, Ernest David, 40, Seven Sisters Road. ditto. Fined £10 and £5 5s. 0d. costs. July 6th West (Butchers), Limited, 4, West Smithfield, E.C.I. ditto. (At 40, Seven Sisters Road.) Summons withdrawn (alternative summons). Oct. 12th Prideaux, Walter Edward, 45, Josephine Avenue, S.W.2. Exposing Imported Eggs not properly labelled. (In Metropolitan Cattle Market.) Summons dismissed. Oct. 12th Prideaux, Miss Constance, 35, Vernon Road, Bow, E. Milk and Dairies (Consolidation) Act, 1915. ditto. (In Metropolitan Cattle Market.) Summons dismissed. Sept. 28th Singer, Frederick Joseph, 23, Waterloo Bridge Road, S.E.I. Public Health (Condensed Milk) Regulations 1923 and 1927. Selling Milk from a vehicle which had not his name and address inscribed thereon. (In Cornelia Street). Fined £1 and £1 costs. Oct. 26th Butcher, Alex., 90, Pelham Street, Brick Lane, E.l. Selling Condensed Milk in tins not labelled in the manner prescribed. (In Metropolitan Cattle Market). Fined £2 2s.0d. and £2 2s. 0d. costs. 1928] 90 (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1928 Premises. No. on Register at end of 1928 No. Added in 1928 No. Removed in 1928 Number of Inspections 1928 Number of Notices 1928 Number of Prosecutions 1928 Milk Premises 430 30 9 808 10 Nil Cowsheds 1 Nil Nil 6 — ,, Slaughter Houses 13 ,, ,, 751 — ,, *Other Offensive Trade Premises 19 ,, ,, 77 — ,, Ice Cream Premises 183 ,, ,, 82 5 „ Registered Houses Let in Lodgings 1,011 - - 4,572 689 2 * Including the Knacker s Yard, 8 Fur Skin Dressers and 1 Fat Melter. Housing of the Working Classes— Number of houses inspected— (а) On account of complaints or illness (P.H. Act) 8,488 (б) House-to-house (Housing Consolidated Regulations, 1925) 1,860 Number of notices served— (a) Under P.H. Act:— (i) Intimation 4,459 (ii) Statutory 576 (b) Under Housing Act Nil Number of houses repaired or nuisances remedied under P.H. Act 5,818 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 197 (b) In course of erection *111 Number of representations by Medical Officer or other person 1 Number of houses included in such representations ... 8 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 — (a) In pursuance of Orders *51 (b) Voluntarily 11 Total number of houses in the Borough about 45,900 Number of houses occupied by the working classes about 28,680 *George's Road Area Improvement Scheme (L.C.C.). † Including 12 converted Flat Dwellings. 91 [1928 Underground. Rooms— Number illegally occupied 11 Number closed or illegal occupation discontinued 11 Overcrowding— Number of cases of overcrowding found 37 Number remedied 37 Number of prosecutions 6 Smoke nuisances— Number of observations 114 Number of complaints 43 Number of notices served 16 Number of legal proceedings Nil Cleansing and Disinfection — Number of adults cleansed 15 Number of children cleansed 5,213 Number of premises cleansed : — (a) After infectious diseases 3,605 (b) For vermin 39 Water supply to tenement houses— Number of premises supplied 56 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, small factories, Steam Whistle Act, 1872. Page 50 Sale of unsound fruit by street traders. Pages 54, 58 and 59 Artificial Colouring Matter in Milk. 1928] 92 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 31 Deaths (Tuberculosis) London Table. Page 40 Smoke Nuisance. Page 43 Housing. Evidence of M.O.H. at Local Enquiry re Brand Street and George's Road Areas. Pages 47-48 Houses occupied by two or more families. Census of 1921. Population 1921, numbers living per room. Page 48 Overcrowding. Page 50 Sale of Pood 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. Annual Report, 1927. Pages 4 and 5 "Still Births" (Registration). Pages 12-13 Research work by M.A.B. in cases of Puerperal Fever and Puerperal Pyrexia. Pages 17-20 Work of Voluntary Welfare Centres. Page 31 Schick Testing by Toxin Anti-toxin. Page 34 Dysentery Page 35 Anthrax. Pages 43, 44 Bacteriological Diphtheria. Pages 47, 48 Public Baths and Washhouses in Islington. Pages 61, 62 Enquiry re Marking of Imported Eggs. 93 |1928 INDEX Page Accidental Deaths 23, 29 Acreage 2 Adulteration of Food71 Ages at Death 7 Anti-toxin treatment 35 Anthrax, occurrence of 39 Area 2 Bacteriological Examinations 45 „ Diphtheria 46 Births 3, 4 „ Illegitimate 4 „ Notification of 4 „ Stillborn 4 „ Co-ordination with local Registrars 4 Blind Persons Act, 1920 39 Cancer 26 Cattle Market 67 Chicken Pox 45 Cleansing of Verminous School Children 49 Coal gas Poisoning 29 Consumption (see Tuberculosis) 26, 40 Cow Sheds 70 Dead bodies (infectious) retention of 29 Deaths from all causes during the year 5, 80-82 Deaths from Epidemic Diseases 23 „ „ Respiratory Diseases 28 „ in Public Institutions 23 „ from Classified Causes 6 „ Maternal 11 Age at 7 Demolition of Habitable Dwellings 64 Density 2 Diphtheria 34, 35 „ Anti-toxin treatment 34 „ Bacteriological 46 Diseases Treated in Hospital 36 Disinfectants distributed and used 49 Disinfecting Station 48 Disinfection Work 41, 48 Disinfestation of School Children 49 District Inspectors' Work 64, 57, 58 Drugs 72 Dust, removal of 54 Dysentery 38 Education Propaganda 9 Eggs, labelling of 69 Encephalitis Lethargica 39 Enteric Fever (Typhoid) 35 1928] 91 Page Epidemic Diseases 23 „ Cerebro-Spinal Meningitis 38 Erysipelas 26, 35 Factories and Workshops Administration 49-52 Fatality from Notifiable Infectious Diseases 35, 36 Finsen Light Treatment 43 Food, Inspection of, Unsound, Adulteration of 66, 67-69, 71 Food Order 69 Food Poisoning 67 Gas (Coal) Poisoning 29 Glanders, Anthrax and Hydrophobia in Man 39 Health Visitors (Municipal) 10, 16, 17 Health and Baby Week 9, 19-21 Home Visitations—Tuberculosis 44 Hospital Isolation of Infectious Diseases 36 Housing 62-65 „ Accommodations 64 Houses Let in Lodgings 59 Ice Cream Premises 57 Infantile Mortality 7-9 Infant Welfare Work 10-11, 16-22 Infection, Prevention of 30 Infectious Diseases in Schools 45 „ „ (Non-Notifiable) in Schools 45 Informal Sampling 73 Influenza 25 Inspection of Food 66 „ „ Houses 57, 59 „ „ Kitchens of Restaurants 49, 69 „ „ Slaughter Houses and Cow Houses 66, 70 „ „ Workshops 49 Institutions 23 Increase of Rent (Restrictions) Acts 66 Inquests 30 Isolation of Infectious Diseases 36 Kitchens and Restaurants 49, 69 Legal Proceedings 76, 85-89 Public Health (Lond.) Act 85, 86 Sale of Food and Drugs Acts 86-88 „ „ Food Order 1921 89 Milk and Dairies Order 1926 89 Milk and Dairies (Consolidated) Act 1915 89 Public Health (Condensed Milk) Regulations 1923 and 1927 89 Light Treatment—Artificial Sunlight and "Finsen" 43 Litter in Streets 54 London County Council Return of Sanitary Work 90 Malaria 38 Malignant Diseases 26 Marriages 3 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work 10-22 Maternal Deaths 11-13 Measles, Notifications by School Teachers 45 Meat Inspection 66-68 Meat, labelling of 69 Mice 61 Ministry of Health Returns 83, 84 Milk Scheme 14 „ Adulteration 73 95 [1928 Page Milk Shops and Dairies 71 „ Special Designations Order—Licences 71 Mortuary and Coroner's Court 30 National Association Prevention of Consumption—Conference 42 New Legislation 55 Notification of Infectious Diseases 30 „ „ Tuberculosis 39 „ „ Births Act 4 „ „ Still-births 4 Non-notifiable Infectious Diseases in Schools 45 Nuisances by Dogs 54 Offensive Trades 70 Ophthalmia Neonatorum 10 Outworkers' Premises 51 Other Notifiable Diseases 37 Pauperism 06 Pathogenicity Tests (Diphtheria) 46 Pemphigus Neonatorum 14 Phthisis 26, 40 „ Notification of 40 Places where Food is Prepared 09 Pneumonia 28 Pneumothorax treatment 43 Population at the Census, 1921 2 „ estimated, 1928 2 Preservatives 76 Prevention of Infection 30 Prescriptions 72 Prosecutions, Summary of 76 Public Health Committee ii „ „ Meat Regulations 1924 69 „ Staff 77 „ „ (Tuberculosis) Regulations 1924 41 Puerperal Diseases 13, 26 „ Pyrexia 13 Polio-Myelitis, Acute 38 Pulmonary Tuberculosis 26, 40 Rats and Mice (Destruction) Act, 1919 60-62 Rateable Value iii References—M.O.H. Reports 91 Rent and Mortgage Interest (Restrictions) Acts 66 Respiratory Diseases 28 Tuberculosis 26,40 Restaurant Kitchens 49, 69 Sale of food Order—Labelling of Eggs 60 Samples Analysed in 1928 71 Sanitary Inspectors' Work 54, 57, 58 Scavenging 52 Schools 45 Septic Diseases 26 Shelter House 49 Slaughterhouses 66 Small Pox 31-34 Smoke Nuisances 55 Sophistication of Milk 73 Statistics 77 Still-Births, Registration 4 Street Accidents 29 Summary (Vital Statistics) iii 1928] 96 Page Tuberculous Diseases 26, 30 Tuberculosis Dispensaries 43 „ Notification of 39, 40 „ Deaths from 26 „ (Public Health) Regulations, 1912 42 „ Visiting Nurse 44 Typhoid Fever (see Enteric) 35 Unsound Food 67 Vaccination 47 Venereal Diseases 28 Verminous Children, Disinfestation of 49 „ Premises 65 Voluntary Maternity and Child Welfare Centres 18.22 Water Certificates 65 Welfare Work by Health Visitors 10, 16, 17 Widows', Orphans' and Old Age (Contributory) Pensions Act, 1925 56 Workshops and Factories, Inspection of 40-62