AC 4361 1SL72 1932 SEVENTY SEVENTH ANNUAL REPORT on the Health and Sanitary Conditior 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.G. 1. SEVENTY-SEVENTH ANNUAL REPORT on the Health and Sanitary Condition OF THE METROPOLITAN Borough of Islington. G. CLARK TROTTER, M.D., D.P.H., F.R.S.E. MEDICAL OFFICER OF HEALTH. London: Vail & Co., Printers, 170, Farringdon Road, E.C. 1. ii MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1982, to November, 1933.) Mayor. Councillor LEONARD McCLANE, J.P. Deputy Mayor. Alderman GEORGE HENRY BULL. J.P. ✓ A litrmtn. HERBERT SAMUEL JORDAN WALTER FREDERICK NOKES FRANK LEYDEN SARGENT EDWARD HENRY TOMKINS, J.P. Councilors. CHARLES BUNDOCK 1 ESSIE MAY LEE CHARLOTTE CLIFFORD JOHN MURRAY FREDERICK C. COOKSEY HENRY PENN FREDERICK COPPING WILLIAM T. RICKETTS WILLIAM H. GALE MATILDA SOUTHGATE, J.P. WALTER HARPER FRANCIS JOHN GEORGE ARTHUR JAS. KENT BRUCE WATSON Chairman Alderman JORDAN Vice-Chairman Councillor BUNDOCK MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE (November, 1932, to November, 1933) A Idei men. WM. EDWIN MANCHESTER, J.P. ALBERT EDWARD PETTET Councillors. GEORGE BEESLEY JAMES T. HOARE VIOLET E. BOATRIGHT JESSIE MAY LEE CHARLOTTE CLIFFORD WINIFRED L. LE MESSURIER RONALD C. DOWDESWELL MAUD A. MANCHESTER ROSA ESSEX MARTHA PANNELL WILLIAM H GALE EDITH URSULA SAY H. J. GRIFFITHS MARGARET SUMMERS Members appointed by the Council from outr.ide their own body. Lady ANDKEWES, Windy Gap, Merton Lane, Highgate, N6 Dr. ALICE VANCE INGRAM, 10, North Hill, Highgate, N.6 Dr. ELEANOR PIJLLEINE, 5, Hamilton Terrace, N.W.8 Mrs. N. WATT, 60, Highbury New Park, N.5 Chairman-, Councillor MAUD A. MANCHESTER Vice Chairman : Councillor ROSA ESSEX iii SUMMARY of Vital Statistics in the Registration Year 1932 Population (Enumerated at Census, 1931) 321,795 persons „ Estimated Mid Year 1931 and 1932 324,600 persons Decrease on Census population, 1921 8,942 persons Mean Population, ten years (1922-1931) 331,240 persons Area 3,092 acres Density (Mid-year 1932) 105 persons per acre Births Males 2,505 Females 2,445 ( persons 4,950 Birth rate 15.25 per 1,000 inhabitants Deaths from All Causes Males 2060 Females 1,953 } persons 4,013 Death rate 12.36 per 1,000 inhabitants Deaths from Principal Epidemic Diseases Males 99 Females 83 } 182 persons Death rate 0.56 per 1,000 inhabitants Deaths trom All Tuberculosis Males 177 Females 131 } 308 persons Death rate 0.95 per 1,000 inhabitants Deaths from Respiratory Tuberculosis Males 152 Females 112} 264persons Death rate 0.81 per 1,000 inhabitants Infantile Deaths under 1 year Males 208 Females 137 } Total 340 Infantile mortality rate 68 per 1,000 birchs Excess of Births over Deaths 987 Rateable value of Borough of Islington £2,182,044 Sum represented by a penny rate £8,715 iv Public Health Department, Town Hall, Upper Street, N.l. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the Health and Sanitary Condition of the Borough for the year 1932. The death-rate for the year was 12.36, as against 12.6 in the previous year. The infantile mortality rate was 68 per 1,000 births, the rate for the previous year being 64. Note is made in the report of the changes which have taken place in recent years which tend to produce some slight increase in the infantile mortality rate, not that this rate is expected to reach the old figure now that so much work is done on infant care, but the steadily decreasing birth-rate is a factor which is discussed in the report. Smallpox cases this year continued to be of the same mild type, which has been designated " Variola Minor." The notified cases numbered 162, as against 66 in the previous year, and 244 in the year 1930. For some years past it has been the habit to report on the work of the Voluntary Welfare Centres up to the 31st March of the year after that to which the Medical Officer of Health's report refers, e.g., the Annual Report for the year 1931 dealt with the Centres up to the end of March, 1932. This has been a factor in delaying the issue of the report, because the Centre Reports may not appear until some time after the following 31st March. This year, such information as has come to hand is given up to the end of 1932 only, and in the report for 1933 the work of the Centres will be reported on up to the 31st March of that year. Last year as the report was late the Census Statistics were given, and they are therefore not repeated in this report. Mr. C. E. Horsman, a District Sanitary Inspector in the service of the Council since April, 1902, died after a very few days illness in October, 1932. Mr. Horsman was one of the Sanitary Inspectors loaned to the Ministry of Health just after the War for special housing work. The unexpected and sudden loss of one who had so long been associated with the Borough, and one who was respected by all, was keenly felt by his colleagues and all associated with him. I desire to thank the Chairman and Members of the Council and Committees for the keen interest taken in the work of the department; and the Superintendent and members of my staff generally for their ready help in all the work. Your obedient Servant, G.blark Trootter Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1932. SPECIAL REPORTS (OTHER THAN THE HEALTH OF THE BOROUGH) AND OUTSTANDING MATTERS BROUGHT BEFORE THE PUBLIC HEALTH, MATERNITY AND CHILD WELFARE, OR HOUSING COMMITTEES DURING THE YEAR. 1. Extract of Vital Statistics and Population, Births and Deaths, pages 3, 4, 5. 6. Summary, page iii. 2. Infectious Diseases, etc , pages 26-33. Dysentery page 32. 3. Tuberculosis, pages 34-41. Venereal Diseases, page 24. 4. Accidental Deaths page 24. Inquests, page 25. Coroner's Court, pages 25-26. 5. Bacteriological Work etc., pages 42, 43. (a) Tetanus in Toy Pistols, page 43. 6. Meat, Food and Drugs, pages 64-69. Food Poisoning Regulations, pages 67-68. 7. Workshops, pages 49-52. Housing, pages 59-64. Scavenging page 52. Summary of Legal Proceedings, page 73. 8. Health Visitation and Work of Voluntary Welfare Centres pages 14-17. 9. Hospitals, Institutions, etc., page 73. Open Spaces 74. 10. Index to Report, pages, 83-87. 1932 2 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.t Inspector of Workshops and Bakehouses and Senior Inspector. Harry John James Watson, Cert. Sanit. Inst. Inspectors of Workshops, 6-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. John W. Aiken, Cert. Sanit. Insp. Ex. Bd. Donald V. Watkins, Cert. Sanit. Insp. Ex. Bd.f Inspector of Food and Drugs, &-c. Gilbert Stanley Green, Cert. Sanit. Insp. Ex. Bd.f Sanitary Inspectors. District 1. Thos. Wallace Agar, Cert. Sanit. Inst. „ 2. Thomas H. Hancock, Cert. Sanit. Insp. Ex. Bd.f 3. Allen Bagshaw, Cert. Sanit. Inst.f „ 4. Colin W. S. Lewis, Cert. Sanit. Insp. Ex. Bd.f „ 5. *Chas. Edwin Horsman, Cert. Sanit. Inst. „ 6. Stanley P. Marks, Cert. Sanit. Insp. Ex. Bd.f „ 7. Leonard H. Pearson, Cert. Sanit. Insp. Ex. Bd. „ 8. Harry Raymond Homewood, Cert. Sanit. Insp. Ex. Bd. „ 9. Arthur Moxon, Cert. Sanit. Insp. Ex. Bd. „ 10. Alfred E. Wood, Cert. Sanit. Insp. Ex. Bd.f „ 11. Harold H. Uren, Cert. Sanit. Insp. Ex. Bd. „ 12. Wm. C. Bartlett, Cert. Sanit. Insp. Ex. Bd.f 13. Edward G. Holmes, Cert. Sanit. Insp. Ex. Bd. 14. James Stephenson Ashworth, Cert. Sanit. Insp. Ex. Joint Bd. f Also Meat Inspector's Certificate. * Chas. E. Horsman, died 12th Oct., '32. Vaccination Officers. J. Jennings, *L. Stevens (Temporary). * C. W. Bellis, resigned 31 Aug., '32 Tuberculosis Visiting Nurse. Miss Emily McGoldrick, State Regd. Nurse, Cert. General Training. Health Visitors. Miss Gwenyth Sarah Lewis, Cert. C.M.B. ; Cert. H.V. ; Sanit. Inspr. Ex. Bd. Mrs. Amy Main, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Rosina Palmer, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Ellen Oliver, Cert. C.M.B. ; S.R.N. Miss Julia Devine, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Hilda Frances Harris, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss May Ritson, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Miss Lily Flower, Cert. C.M.B. ; Cert. H.V. ; S.R.N. Clerical Staff. Henry Angel (Chief Clerk), Edward A. Abbott, Walter J. Wolfe, William G. Bunch, Clement M. Wheble, Arthur R. Wittrick, William R. Causton, Laurence W. Edis, Alfred E. Vanstone, Charles J. Cridland, Leslie P. J. Regan, George F. Kimmis, (Fredk. C. Green, S. A. Brown, Daisy Francis) (Milk Grants). Disinfecting Station. A. Lewis (Engineer), W. G. Jollie (Handyman Stoker), Mrs. Lewis (Caretaker, Shelter Housei. Mrs. Reid (Cleansing Station Attendant), G. Cooper (Motor Driver), E. Norman (Assistant Driver). Disinfectors. W. Hardwick, J. Brown, A. Taylor, C. Holcombe. Mortuary Keeper. S. Maxwell. Public Vaccinators (See pages 47). Public Analyst. ALAN W. STEWART, D.Sc., 37, Russell Square, W.C.I. Solicitor. NORMAN ROBERTSON, 3, Bond Court, Walbrook, E.C.4, 3 1932 EXTRACT OF VITAL STATISTICS. Total. M. F. Live Births. Legitimate 4,754 2,408 2,346 Birth Rate per 1,000 of the estimated Illegitimat 196 97 99 resident population, 15.25. Stillbirths 114 Rate per 1,000 total (live and still) births, 15.5. Deaths 4,018 Death Rate per 1,000 of the estimated resident population, 12.36. Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List) :— Deaths Rate per 1,000 total (live and still) births. No. 29. Puerperal sepsis 7 1.3 No. 30. Other puerperal causes 6 1.1 Total 13 2.5 Death rate of infants under one year of age :— All infants per 1,000 live births 68 Legitimate infants per 1,000 legitimate live births 65 Illegitimate infants per 1,000 illegitimate live births 153 Deaths from Measles (all ages) 52 ,, Whooping Cough (all ages) 23 ,, Diarrhoea (under 2 years of age) 73 There was no unusual or excessive mortality during the year. POPULATION (ESTIMATED). The number of the population at mid-year 1932 is estimated at 324,600 persons. There was, therefore, a decrease in the population of 6,137, when compared with the number of inhabitants ascertained at the census in 1921. For tables giving the distribution of the population in the several sub-registration districts and wards, together with particulars of their areas and densities, see Annual Report 1931. MARRIAGES. Marriages, 2,857 ; Marriage Rate, 17-6.—There were 5,714 persons married or 2,857 marriages, in 1932, and the marriage rate, that is to say, the number of persons married per 1,000 of the population was 17.6. Compared with the previous year these figures show a decrease of 200 in the number of persons married, or of 100 marriages; and of 0.6 per 1,000 in the rate. The following statement shows the figures for the previous ten years 1922-31. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 1922 2,877 17.23 1927 2,844 17.01 1923 2,764 16.42 1928 2,883 17.80 1924 2,872 17.03 1929 2,967 18.56 1925 2,788 16.44 1930 3,063 18.80 1926 2,749 16.21 1931 2,957 18.21 1932] 4 BIRTHS. During. the year there was 4,950 live births registered, of which 2,505 were boys and 2,445 girls. Of this number, however, 1,027 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 15.25 per 1,000 of the population, as compared with a mean birth.rate of 18.96 in the preceding ten vears. This is the lowest birth.rate recorded. Showing the Births (distinguishing Males and Females) and Birth.rates of Islington in 1932, and in the four quarters of the year and of the County ol London and the Great Towns during the same period: also in the year 1931 ; together with the mean Borough Birth.rates for the 10 years 1922.31. Quarter. Males. Females. Total. Birth Rates. Islington, 1932. Islington, 1922.31. London, 1932. 117 Great Towns, 1932. First 654 635 1,289 15.9 19.6 14.3 15. 6 Second 676 612 1,288 15.9 19.7 15.3 16.7 Third 645 639 1,284 15.8 18.9 14.2 15.5 Fourth 530 559 1,089 13.4 17.8 12.8 13.9 The Year 1932 2,505 2.445 4,950 15.25 18.9 14.1 15.4 1931 2,731 2,550 5,281 16.27 19.7 15.0 16. 0 Increase or decrease 226 105 331 1.02 0.8 0.9 0.6 N.B.—The total registered births given by the Registrar.General for the Calendar year, 1932. will be found at the foot of table on p. 79. Showing the Births of Mal.s and Females and tin Birth.rates in each quarter and for the year, 1932. and in the several Sub.Registration Districts. Tufnell. Upper Holloway. Tollington. Lower Hoiloway. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 65 53 118 14.4 118 98 216 28.1 60 50 110 14.6 70 72 142 14.1 2nd „ 63 57 120 14.6 101 98 199 25.8 55 52 107 14.2 100 85 185 18.4 3rd „ 53 46 99 12.6 80 92 172 22.3 60 69 129 17.2 83 70 153 15.2 4th„ 39 57 96 11.7 71 67 138 17.9 32 51 83 11.0 70 68 3 38 13.7 Year 220 213 433 13.2 370 355 725 23.5 207 222 429 14.3 323 295 618 15.3 Showing the Births of Males and Few ales and the Birth-rates in each quarter and for the year 1932, and in the several Sub-Registration Districts.—centd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total Birth rates. 1st Ouarter 110 112 222 15.0 114 99 213 15. 9 117 151 268 13.8 654 635 1,289 15.9 2nd„ 105 70 175 11.9 120 105 225 16.8 132 145 277 14.2 676 612 1,288 15 .9 3rd „ 110 105 215 14.6 118 114 232 17.3 141 143 284 14.6 645 639 1,2S4 15.8 4th„ 95 91 186 12.6 109 108 217 16.2 114 117 231 11.9 530 559 1,089 13.4 Year 420 378 798 13.5 461 426 887 16.6 501 556 1,060 13.6 2,505 2,445 4,950 15.2 5 [1932 Illegitimate Birth3 (196).—The illegitimate births numbered 196 and show an increase of 2 on the return of the year 1931. They were equal to a rate of 4.0 per cent, of the total registered births. Notification of Births Act, 1907.—3,825 live births were notified (exclusive of 80 stillborn), or 77 per cent, of the total number that were 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. 1932. 1st Quarter 153 5 594 13 249 4 996 22 2nd „ 150 8 688 13 207 2 1,045 23 3rd„ 138 6 578 6 216 1 932 13 4th„ 127 4 544 16 181 2 852 22 Year 568 23 2,404 48 853 9 3,825 80 Of the total number (114) registered still-births, 16 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 130 (i.e., 114 + 16) or 26.3 per 1,000 total births (including- still-born). REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still-born)./###[] 1932. 1st Quarter 9 14 4 27 21.0 2nd „ 24 30 — 34 26.4 3rd„ 16 6 — 22 17.1 4th „ 17 14 — 31 28.5 Year 66 44 4 114† 230 DEATHS. The deaths registered during the year numbered 4,013 (exclusive of stillbirths), while the death-rate was equal to 12.36 per 1,000 of the estimated population, or 0.2 below that of the previous year (12.6), and 0.3 below the mean of the preceding ten years; whilst the death-rate of England and Wales was 12.0 and the 117 Great Towns 11.8. 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 124 15.1 96 11.7 69 8.4 94 11.4 383 11.6 Upper Holloway 161 20.9 106 13.8 78 10 .1 85 11.0 430 13.9 Tollington 142 18 .9 90 12. 0 78 10.4 118 15.7 428 14.2 Lower Holloway 148 14.7 108 10.7 92 9 1 104 10.3 452 11.2 Highbury 243 16.5 165 11.2 134 9.1 161 10.9 703 11.9 Barnsbury 228 17. 0 148 11.1 122 9. 1 135 10.1 633 11. 8 Islington (SouthEast) 322 16 .5 223 11.4 197 10.1 242 12.4 984 12.6 The Borough 1,368 16.8 936 11.5 770 9.5 939 11.6 4,013 12.4 1932] 6 Showing the Deaths and Death Rates of Islington in 1932, 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 1922-31 and the deaths and death-rates in the year 1931. Quarter. Males. Females. Total. Death Rates. Islington, 1932. Islington, 1922-31. London, 1932. 117 Great Towns, 1932. First 672 696 1,368 16.8 17.3 16.0 15.3 Second 493 443 936 11.5 11.3 11.4 11.3 Third 407 363 770 9.5 9.4 9.3 9.3 Fourth 488 451 939 11.6 130 11.4 11.5 The Year 1932 2,060 1,953 4,013 12.4 12.7 12.0 11. 8 1931 2,025 2,078 4,103 12.6 12.7 12.4 12.3 Increase or Decrease + 35 — 125 — 90 — 0. 2 - — 0.4 — 0.5 • 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, 1932. Mean Deaths (10 years, 1922-31.) Increase or Decrease on mean. 0-1 year 340 418 — 78 1-5 years 141 245 — 104 Under 5 years 481 663 — 182 5-15 years 87 101 — 14 15-25„ 132 155 — 23 25-35„ 163 187 — 24 35-45„ 212 270 — 58 45-55„ 405 455 — 50 55-66„ 657 662 — 5 65-75„ 883 830 + 53 75- 85„ 775 693 + 82 85 upwards 218 190 + 28 All Ages. 4,013 4,206 — 193 There was a decrease of 182 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 5-65 years, were also below the decennial average. The deaths of aged people between the age period 65 years and upwards showed a decrease of 23 in the number of deaths when contrasted with the previous year 1931, and were 163 above the ten years' average (1922-31). INFANTILE MORTALITY. Infant Deaths, 340; Mortality Rate, 68.—The deaths ot 340 infants under twelve months old were registered during the year, or 78 below the decennial average (418), and they were equal to the infantile rate of 68 per 1,000 births. The lowest rate on record, however, is 53 per thousand births in the year 7 [1932 1927. The rate was 2 per 1,000 births above the mean annual record of the preceding ten years, and is 4 per 1,000 above the rate of last year (1931). In the quarters the mortality ranged from 80 per 1,000 births in the first quarter, 72 in the second, 48 in the third, and 75 in the fourth. In the sub-registration districts the infant mortality was as follows :— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 21 48 Upper Holloway 22 30 Tolling ton 38 88 Lower Holloway 48 77 Highbury 66 83 Barnsbury 68 76 Islington South East 77 72 In London the infantile mortality was 64 per 1,000 births. The rate for England and Wales was 65 per 1,000 births. Infantile Mortality during each of the Ten Years 1922-31 and 1932. Deaths at various ages under One Year of Age. Years. Under one week. Weeks. Total under four weeks. 4 weeks and under 3 mths. Months. Total Deaths under one year. Deaths per 1,000 Births. 1-2 2-3 3-4 3-6 6-9 9-12 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 1928 108 10 14 9 141 60 73 58 42 374 64 1929 103 18 15 11 147 64 68 73 51 403 73 1930 115 13 11 11 150 60 68 66 55 399 70 1931 93 17 10 19 139 50 51 62 35 337 64 Mean 10 years 107 23 17 14 161 62 75 62 58 418 66 1932 92 15 9 8 124 66 66 49 35 340 68 Increase or decrease on meau — 15 — 8 — 8 — 6 — 37 +4 — 9 —13 — 23 — 78 + 2 Showing the Deaths among Infants per 1,000 Births during the Year 1932. and also the mortality rates for the Years 1922-1931. Sub Districts. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Mean 10 years 1932 Increase or decrease on mean Tufnell 83 46 54 47 64 52 65 75 78 43 61 48 —13 Up. Holloway 59 64 70 57 30 31 44 42 26 35 46 30 —16 Tollington 58 55 60 65 92 63 85 71 106 90 74 88 + 14 Lr. Holloway 81 81 85 78 82 74 77 95 57 84 79 77 — 2 Highbury 64 61 60 54 48 52 47 60 58 64 57 83 + 26 Barnsbury 86 59 77 75 90 59 75 87 95 66 77 76 — 1 Islington, S.E. 88 82 55 58 64 49 67 78 76 68 68 72 + 4 The Borough 77 66 66 63 66 53 64 73 70 64 66 68 + 2 The following table shows the diseases that proved most fatal in the hrst year of child life, together with the mortality rates per 1,000 births. 1932] 8 Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1922-31 : and in 1932 from certain specified causes. Causes of death. 1932. Rate per 1,000 Births. Mean rate 10 years 1922-31 per 1,000 Births. Difference. Premature Birth and Congenital Defects 23.2 19.4 + 3.8 Bronchitis and Pneumonia 11 .3 14. 5 — 3.2 Atrophy and Marasmus 3 .6 4 .1 — 0.5 Diarrhoeal Disease (all forms) 13.1 4 .3 + 9.2 Convulsions 1.0 1.0 same Whooping Cough 2.4 3.3 — 0.9 Measles 2 .8 2-8 same Diphtheria 0 .4 0.3 + 0.1 Phthisis - 0.3 — 0.3 Other forms of Tuberculosis 0.8 0.8 same Total of above 58.6 50.8 + 7.8 All other causes 9 .4 15.2 — 6.8 Total 68 .0 66.0 + 2.0 INFANTILE MORTALITY during the Year 1932. 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 Death under 1 year. 1-2 2-3 3-4 4 weeVs and under 3 months 3-6 6-9 9-12 All i Certified - - - - - - - - - Causes. 1 Uncertified - - - - - — - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - — - - - Measles - - - - - - - 3 11 14 Scarlet Fever - - - - - - - 1 - 1 Whooping-Cough — — — — — 2 5 3 2 12 Diphtheria, Croup - - - - - - 1 — 1 2 Erysipelas — — — — — 1 — — — 1 Tuberculous Meningitis - - - - - - - 4 4 Abdominal culosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - — Meningitis (not Tuberculous) - 2 3 2 2 9 Convulsions 3 - — — 3 — 1 — 1 6 Laryngitis - - - - - - - - 1 1 Bronchitis - - - - - 2 2 3 — 7 Pneumonia (all forms) 1 1 2 1 5 17 9 10 8 49 Diarrhoea - - — 1 1 1 8 3 1 14 Enteritis — - 1 2 3 8 22 12 6 51 Gastritis — - — — — — — — — — Syphilis — 1 — — 1 4 - — — 5 Rickets - - - - - - - - - - Suffocation, overlying - - - - - 1 1 - - 2 Injury at birth 3 - — — 3 — — — 3 Atelectasis 8 - — — 8 — — 1 — 9 Congenital Malformations 10 3 1 14 8 - - 22 Premature birth 59 7 4 2 72 6 1 — — 78 I Atrophy, Debility I and Marasmus 1 2 1 4 6 6 2 - 18 Other causes 7 3 — — 10 9 7 5 2 33 Totals 92 16 9 8 124 66 66 49 35 340 BIRTHS. Nett Births legitimate ...4,754\4,950 Nett Deaths in / legitimate infants ...310 340 in the vear \illegitimate... 196( ' the year of \illegitimate infantt ... 30 9 [1932 REPORT ON MATERNITY AND CHILD WELFARE WORK. Municipal Health Visitors. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. 94 cases of Ophthalmia Neonatorum were notified, compared with 87 cases last year. 124 cases of Ophthalmia were reported by the London County Council and Health Visitors as against 128 cases during the previous year. 18 out of the 94 cases of Ophthalmia Neonatorum were attended at birth by midwives. The cases occurred in the sub-registration districts as follows Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough. Ophthalmia Neonatorum. 5 11 3 16 11 31 17 94 Ophthalmia. Cases reported by L.C.C. 6 4 15 18 8 35 30 116 Cases reported by Health Visitors 1 — — 1 2 4 — 8 Of the 94 cases investigated, both of the infants' eyes were affected in 72 instances, whilst in 8 the right eye was involved, and in 14 the left. Treatment.—19 of the 94 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital, 37 being treated at other hospitals. 38 cases were treated at home by private Doctors. 30 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £33 4s. Od. In 1931 61 cases were nursed at the cost of £84 17s. Od. Results.—Of the 94 Ophthalmia Neonatorum cases, vision was unimp in all cases. Ophthalmia iNeonatorum Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. hospital. 94 38 56 94 Nil Nil Nil MATERNAL DEATHS. The number of women dying in, or in consequence of, child-birth during the year 1932 was 16, or 3.2 per 1,000 registered births. Of this number 7 occurred from Sepsis Puerperal Septicaemia); whilst 9 died from other disease of childbirth. 1932] 10 The deaths for the preceding year numbered 28, and were equal to the proportion of 5.3 per 1,000 births. MATERNAL DEATH RATES FOR ISLINGTON. Year. No. of Births. No. of Maternal Deaths. Rate. 1911 8,113 17 2.1 1912 8,211 11 1.3 1913 8,359 26 3.1 1914 8,177 22 2.7 1915 7,537 17 2.3 1916 7,262 21 2.9 1917 5,837 12 2.1 1918 5,197 7 1.3 1919 6,278 23 3.7 1920 9,404 22 2.3 1921 7,886 17 2.2 1922 7,506 20 2.7 1923 7,100 15 2.1 1924 6,799 17 2.5 1925 6,580 18 2.7 1926 6,455 20 3.1 1927 6,108 24 3.9 1928 5,790 25 4.3 1929 5,509 27 4.9 1930 5,685 22 3.9 1931 5,281 28 5.3 1932 4,950 16 3.2 11 [1932 METROPOLITAN BOROUGH OF ISLINGTON MATERNAL DEATHS, 1932. (For those in 1931, see p. 11 of Medical Officer of Health's Report for that year) 1932. Month. Cause of Death. Ages at Death. Totals. 15 to 25 25 to 35 35 to 45 45 and upwd. Total From Puerperal Sepsis. other Diseases of Childbirth. Jan. Streptococcal peritonitis. Probably post-Inflnenzal (eight months' pregnancy.) P.M .. 1 .. .. 1 .. (a)l " Influenzal pneumonia Five months' miscarriage .. 1 .. .. 1 .. (b)l Feb. Broncho - Pneumonia. Premature labour .. .. 1 .. 1 .. (c)l Mar. Post-partum haemorrhage, P.M. .. 1 .. .. 1 .. 1 " Broncho Pneumonia and Septic endometritis following full term labour .. 1 .. .. 1 1 .. (Week April 2nd.) Pulmonary embolus. Child-birth. P.M 1 .. .. .. 1 •• 1 1st Qr. 1 4 1 .. 6 1 5 April Atrophy of liver. Puerperal Sepsis. Mitral stenosis. P.M. .. 1 .. .. 1 1 .. May Shock following manual removal of placenta. Toxaemia 1 .. .. .. 1 .. 1 June Puerperal septicaemia. Placenta praevia .. .. .. 1 1 1 .. »» Pyaemia. Pelvic peritonitis. Salpingitis. Sapraemia following parturition. P.M. .. .. 1 • • 1 1 .. It General peritonitis. Septic endometritis (following full term labour) .. 1 .. .. 1 1 .. •f Pulmonary embolism. Thrombosis of Femoral vein, following otherwise normal labour. P.M. Natural 1 .. .. .. 1 .. 1 2nd Qr. 2 2 1 1 6 4 2 Aug. Intraperitoneal rupture of vessel on surface of uterus. Overdistension of uterus. Twin pregnancy and hydramuis. After P.M. .. .. 1 .. 1 .. 1 Abortion. Septic infection of genital tract and general peritonitis. Wound of uterus. Open verdict 1 .. .. .. 1 1 •• 3rd Qr. 1 .. 1 .. 2 1 1 Dec. Shock. Spontaneous rupture uterus .. .. 1 .. 1 .. 1 Septicaemia (Haemolytic streptococcal). Puerperal Pyrexia .. .. 1 .. 1 1 •• 4th Qr .. .. 2 .. 2 1 1 (a) Classified as " Peritonitis." (b) Classified as " Influenza." (c) Classified as "Lobular Pneumonia." 1st Quarter ... ... 6 = 4.6 2nd Quarter 6 = 4.7 _ Rate per 1,000 3rd Quarter ... ... 2=1.5 registered live 4th Quarter 2 = 1-8 births. Total (Year) ... 16 = 3.2 1932] 12 PUERPERAL FEVER. Of the 35 cases coming to the knowledge of the Medical Officer of Health during 1932, 16 were notified by Medical Practitioners. The proportion of total cases to births was 7.0 per thousand. The notifications were 6 above the average (29) of the preceding ten years and showed an increase of 2.45 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1932. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 3 3 4 3 5 8 9 35 Private Practitioners' Cases 1 2 1 2 2 1 7 16 Hospital Cases 2 1 2 1 3 6 1 16 Certified Mid wives' Cases - — 1 — 1 1 3 Cases inquired into 3 3 4 3 5 8 9 35 Cases treated in Hospital 3 3 3 3 5 8 9 34 Cases treated at Home - - 1 - - - — 1 All of the 34 cases were treated in Hospitals. 16 of these contracted the disease in Hospital; 16 cases were removed to London County Council Hospitals; and 18 cases were removed to the St. Mary's Islington Hospital and other London Hospitals. Deaths.—7 deaths were registered as being due to Puerperal Fever. PUERPERAL PYREXIA. Notification of Puerperal Pyrexia Regulations, 1926.—There were 64 cases notified, as against 67 last year. Of these, 9 were Private Medical Practitioners' cases; 52 occurred in Hospital, while 3 were certified Mid wives' cases. The notifications were in the proportion of 12.9 per 1,000 births. Cases of Puerperal Pyrexia notified and inquired into during the year 1932. Tufnell. Upper Hollo way. Tollington. Lower Holloway, Highbury. Barnsbury. SouthEast. The Borough Cases notified 5 15 5 8 9 10 12 64 Private Practitioners'Cases — 1 1 1 — 3 3 9 Hospital rases 5 13 4 6 9 6 9 52 Certified Mid wives' Cases — 1 1 — 1 — 3 Cases inquired into 5 15 5 8 9 10 12 64 Cases treated in Hospital 5 14 5 6 9 9 11 59 Cases treated at Home — 1 - 2 - 1 1 5 The services of the Consultant were sought on two occasions during the year. PEMPHIGUS NEONATORUM. During the year 1932, 1 case which died in Hospital came to the knowledge of the Medical Officer of Health (after death), and the circumstances were investigated. 13 [1932 THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1932, 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 £3,671 l1s. 4d., as against £2,934 7s. 1d. in 1931. The total amount expended since the Order came into operation in 1918 is £59,697 7s. 2d. The total recipients during the year numbered 13,392, and the quantity of milk supplied to them was equal to 300,916 pints (37,614½ gallons). DISTRIBUTION OF MILK TO NECESSITOUS MOTHERS AND CHILDREN. Scale of Income adopted by the Council, 17th June, 1932 :— Per head. 5/- a week and under, after allowance for rent, Free. 5/1 to 6/5 a week, after allowance for rent, Quarter Cost. 6/6 to 7/- a week, after allowance for rent, Half Cost. Children living at home and earning not to be counted as members of the family for the purpose of the scale. The Milk Sub-Committee to have discretionary powers to deal with any particular case which may arise. SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1932. District 1 2 3 4 5 6 7 8 Totals. I. Births, First Visits, Infants under 1 Year 600 459 662 797 791 386 395 409 4,499 II. Births, Re-Visits, Infants under 1 Year 532 434 736 709 941 588 631 380 4.951 III. Visits to Children, between 1st and 2nd Years 442 383 580 673 1,226 509 497 352 4,662 IV. Visits to Children, between 2nd and 5th Years 1,174 1,035 1,381 1,527 998 1,015 1,350 1,161 9,641 V. Visits re Still Births 22 21 17 23 24 12 12 7 138 VI. Deaths, Visits, re Infants under 1 Year 8 7 6 4 23 8 4 3 63 VII. Deaths, Visits, re Children 1 to 5 years — 3 2 — — — — 1 6 VIII. IAnte-Natal, Home Visits f/149 166 f/118 156 f/229 285 f/ 230 247 F/133 165 f/130 177 f/117 151 f/161 180 f/l,267 1,527 IX. Puerperal Fever, Home visits Pyrexia F/3 5 f/6 12 f/3 8 f/5 9 f/7 12 f/2 4 F/4 13 f/3 5 f/33 68 - - - — — — — — — Totals 2,949 2,510 3,677 3,989 4,180 2,699 3,053 2,498 25,555 X. Attendances at Welfare Centre 29 28 48 46 44 44 48 33 320 XI. Other Work by Direction 761 433 959 777 1,003 676 1,443 993 7,045 XII. Visits Declined 2 1 2 __ 1 1 7 XIII. Visits, House Shut 1,120 539 524 912 435 1,043 471 441 5,485 XIV. Visits, Inopportune 13 7 14 2 15 15 12 42 120 Grand Total of Visits 4,874 3,517 5,223 5,726 5,679 4,477 5,028 4,008 38,532 Specify nature of work—e.g., M.O. Consultation, Weighing babies, Dressings, Temperature taking. Selling of Dried Milk. Talk to Mothers, subject dealt with and time occupied. 15 [1932 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1931-Continued. District 1 2 3 4 5 6 7 8 Totals. Analysis of Visits included in I.-IX. relating to †Reported Ophthalmia f/8 18 F/15 27 f/23 38 f/6 16 F/29 60 f/12 31 f/4 13 f/19 40 F/116 243 (a) †Ophthalmia Neonatorum F/8 20 f/8 13 F/12 24 f/8 15 F/24 50 f/ll 24 f/6 13 f/9 21 f/86 180 (b) †Epidemic (Summer) Diarrhoea — 6 — — — — — — 6 (c) Other Digestive Diseases 1 1 — — — — — — 2 (d) Pneumonia and Bronchitis 6 32 4 8 4 10 64 (e) Rickets 15 9 11 28 7 4 2 14 90 (f ) †Measles and German Measles f. 21 F/47 63 f. 37 f. 11 f. 18 f. 12 f/38 47 f/24 27 f/208 236 (g) †Whooping Cough f. 4 F/9 10 f. 23 - f. 9 f. 17 f/14 16 f. 4 F/80 83 (h) Tuberculous Disease—P=Pulmonary; 0=0ther . — p. I — — - — — p. 1 (i) Convulsions — — — - — — — (j ) †Polio-myelitis — — — - — — — (k) Premature Birth 5 1 22 9 3 7 24 15 86 (l) Atrophy, Debility and Marasmus — — 1 — - — 1 — 2 (m) All other investigations (♦♦Specify) 8 25 14 — 2 11 6 12 78 (n) Routine Visits included in I. to IX. and not included in (a) to (m) 2,851 2,322 3,503 3,910 4,031 2,585 2,927 2,355 24,484 Totals (a) to (n) 2,949 2,510 3,677 3,989 4,180 2,699 3,053 2,498 25,555 Total Families Visited 2,164 1,715 2,736 3,152 3,362 2,059 2,433 1,827 19,448 Registered Births. New Cases Handed to H V's for Visitation. Infant Mortality. Maternal Mortality. Puerperal Fever. Puerperal Pyrexia. almia Neonatorum. No. Rate. Notified Births Non-Notified Births. Transfers In. No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. 4950 15 25 5,026 101 616 340 68 16 3.2 35 33 64 56 94 21 *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." 1932] 16 THE VOLUNTARY WELFARE CENTRES. As indicated in the introductory letter to this report, it has been found awkward, owing to the reports of the Voluntary Centres being up to the 31st March, and not a calendar year, to include reports really in advance of the year under consideration. These reports of the Voluntary Centres will be, of course, made use of in preparing next year's report. Advantage has, however, been taken of certain figures supplied by the Centres up to the close of the calendar year, 1932. It must be noted, of course, that the Table here given cannot be compared exactly with the Table in last year's report as the periods do not coincide. North. South. East. West. Total. 1. Ante-Natal Clinics. Number held weekly 3 1 Ctr. 1 1 7 1 Rose „ of Expectant Mothers l_ Br'ch. who attend 742 162 248 102 1,254 „ of attendances 2,088 475 670 363 3,596 2. Consultations for Children up to 5 Years of Age. Total No. of children attending for First time during year:— i. Under 1 year 894 730 601 512 2,737 ii. 1—5 years 199 137 158 64 558 Number of attendances :— i. Children under 1 year 11,128 11,554 8,943 6,753 38,378 ii. 1—5 years 5,997 8,679 8,266 4,481 27,423 3. Home Visiting. Number of visits made to :— i. Expectant mothers :— (a) First Visits 583 116 216 56 971 (b) Total Visits 2,504 347 826 210 3,887 ii. Children under 1 year :— (a) First Visits 873 757 540 499 2.669 (b) Total Visits 5,690 5,661 3,734 2,570 17,655 iii. Children 1—5 years 8,160 7,088 5,723 4,597 25,568 4. Wards and Homes. Number of beds 18 6 — 8 32 Number of patients received :— i. Mothers and Babies :— (a) Mothers 41 86 — — 127 (b) Babies 42 90 — — 132 ii. Babies only 69 — — 69 138 5. Number of Children who were in attendance at end of Year:— i. Under 1 year 670 567 340 416 1,993 ii. 1—5 years 1,387 1,175 1,004 688 4,254 6. Convalescence. Number of cases :— i. Mothers 24 7 74 18 123 ii. Children 34 53 136 24 247 Plus one extra Clinic per month. 17 [1932 REPORT ON THE WORK OF THE DAY NURSERIES RECEIVING GRANTS FROM THE BOROUGH COUNCIL.. There are three Day Nurseries in the Borough. No. of places No. of attendances provided during 1932 i. Lower Holloway Day Nursery, 547, pool Road, N. 50 9,842 ii. South Islington Pro Patria Day Nursery, 9, Canonbury Lane, N.1 55 11,463 iii. St. Luke's Day Nursery, 29 and 30, Penn Road, N.7 45 5,477 Total 150 26,772 As regards the Lower Holloway Day Nursery children are received from one month to five years of age where the mothers are at work. The Nursery is open from 7.30 a.m. to 6.30 p.m. (Saturdays to 1.30 p.m.). On arrival, the children are bathed, teeth cleaned, heads examined, and dressed in Nursery clothes. The fees charged are 1/- daily. Unmarried mothers or necessitous cases 10d. Halfdays 8d. or 6d. There is a Nursery School for twenty children under a trained voluntary teacher. Two students from the Norland Institute attend daily for practical training. The staff consists of a Matron, a Sister and four probationers, a non-resident cook and a cleaner. The South Islington Pro Patria Day Nursery is open from 7 a.m. to 7 p.m. (Saturdays to 1 p.m.), and the charges are 10d. per day and 5d. per half-day. The staff consists of a Matron, a Sister, a Nursery Teacher, nine probationers, a cook and housemaids. The St. Luke's Day Nursery is open from 7.45 a.m. to 6.30 p.m. on weekdays, but is closed on Saturdays and Bank Holidays. The average charge is 1/- per day, but no child is turned away if the circumstances are poor. The staff consists of a Matron, a Sister, a Staff-nurse, two probationers, two students, a cook, a charwoman, and an odd man. It might be remarked in connection with this Day Nursery, which is beautifully situated, that it is generally possible to secure a vacancy. At the other Day Nurseries the accommodation is very pressed, and there are waiting lists. There is a possibility of the opening of a " Guest House " in connection with this Day Nursery next year, which will enhance the value of the services of this institution to the community, the payment being moderate. MATERNITY AND CHILD WELFARE. Contributions by the Borough Council. Year ending 81st March, 1938. Voluntary Welfare Centres. Day Nurseries. £. £. North Centre . 5,098 Lower Holloway ... ... ... 244 South Centre 2,330 St. Luke's ... ... ... ... 229 East Centre 1,712 South Islington ... ... ... 712 West Centre 1,868 Total £1,185 Total £11,008 * This Nursery is a municipally owned building. (No rent charged for its use). 1932] 18 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 £45 8 Of Under Public Health £25 8 0 Total £70 16 0 Contributions under arrangements for maternity cases admitted to beds at Maternity Hospitals, the contributions being a grant of 10s. per case, were : City of London Maternity Hospital, £79 0s. Od. ; Royal Free Hospital, £17 0s. Od. In addition to these cases of Ophthalmia Neonatorum and Marasmus are admitted to the London County Council's Hospital (St. Margaret's), Camden Town, N.W. and Queen Mary's Hospital, Carshalton. † Includes also adult nursing (pneumonia). DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—2,447 persons died in the Public Institutions located in Islington, of whom 1,618 belonged to this Borough, the remaining 829 having come here for treatment or relief. Of this latter, 458 died in the Archway Hospital, 199 in the Royal Northern Central Hospital, 50 in the London Fever Hospital, and 47 in the Islington Hospital and Islington Institution. Of the 1,618 deaths of inhabitants, 1,117 occurred in the Islington Hospital, 249 in the Islington Institution, and 124 in the Royal Northern Central Hospital. The proportion which the 1,618 deaths in the Public Institutions bore to the Borough mortality was 40.3 per cent. Without the Borough. — 946 deaths of persons belonging to Islington were registered as occurring in Public Institutions in districts of London outside the Borough and in various provincial towns. They included, among others, 37 in the North-Western Fever Hospital, 30 in the Children's Hospital, Great Ormond Street, 76 in St. Bartholomew's Hospital, 27 in the Infirmary, Friern Barnet, 61 in the Royal Free Hospital, 73 in the University College Hospital, 47 in the North-Eastern Fever Hospital, 8 in the Eastern Fever Hospital, 30 in the Middlesex Hospital, 13 in the City of London Maternity Hospital, 22 in the Metropolitan Hospital, and 26 at la, Manor Road, Ilford (Claybury). These 946 deaths represented 23.6 per cent. of all the deaths registered in the year. 19 [1932 Within and Without the Borough.—The deaths of Islingtonians numbered 2,564, and were equal to 63.9 per cent, of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— 21 inhabitants died from accidental deaths, or suddenly, in places outside Islington. During the previous year (1931) the total deaths in Local Institutions numbered 2,419, being 1,629 inhabitants of Islington in Local Institutions, plus 790 non-inhabitants of Islington in Local Institutions, the number in Islington Hospital being 1,187, the number in the Royal Northern Hospital 130. The deaths of inhabitants of Islington in Institutions outside the Borough were 895. The total deaths of Islingtonians in all Institutions were 2,524, and the proportion per 100 deaths from all causes equalled 61.5. Transferable Deaths,—During the year 51 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 Diarrhceal Diseases. During the year 182 persons died from these diseases, the death-rate being 0.56 per 1,000 inhabitants, as contrasted with 0.21 in the corresponding period last year, and a decennial average mortality of 234 and a death-rate of 0.70 per 1,000. In London the death-rate from the epidemic disease was 0.40. Locally the deaths in the Sub-Registration Districts and Wards were as follows :— Showing tht Deaths from each of the principal Epidemic Diseases in the several Wards uni Sub-Registration Districts during the Year 1932. SubRegistration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Enteritis and Diarrhoea. Totals. Tufnell Tufnell 1 1 1 1 10 Up. Holloway Up. Holloway — — 9 — 1 — 5 15 Tollington Tollington — — 4 — 3 2 9 18 Lr. Holloway Lr. Holloway — — 7 2 4 5 13 31 Highbury Highbury — — 1 1 1 — 7 10 Mildmav — — 1 — 3 1 5 10 Barnsbury . Thornhill — — 5 — 2 2 19 28 Barnsbury — — 5 — 1 1 3 10 Islington South East St. Mary's — — 2 — 1 4 3 10 Canonbury — — 11 2 3 — 4 20 St. Peter's — — 6 1 3 4 6 20 The Borough — — 52 7 23 20 80 182 Total Death Rates — — 0.16 0.02 0.07 0.06 0.25 0.50 1932] 20 Shewing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1922-31 and for the Year 1932. Enteric Fever 1922 1923 1924 1925 1926 1927 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates.[/##] — — 4 0.01 4 0.01 1 0.00 Small Pox — — — — — — — — — — — — Measles 134 0.40 16 0.05 103 0.30 22 0.06 69 0.20 29 0.09 Scarlet Fever 29 0.09 13 0.04 10 0.03 8 0.02 12 0.03 8 0.02 Whooping Cough 98 0.29 38 0.11 57 0.17 61 0.20 29 0.09 45 0.14 Diphtheria 59 0.18 21 0.06 33 0.09 21 0.06 31 0.09 25 0.07 Diarrhoea and Enterit is (under 2 years) 71 9.46 per 1,000 births 103 14.51 per 1,000 births 521 7.65 per 1,000 births 69 10.54 per 1,000 births 69 10.68 per 1,000 births 48 7.79 per 1,000 births 1928 1929 1930 1931 Mean 10 years 1932 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 2 0.00 2 0.01 — — — — 1 0.00 — — Small Pox — — — — 1 0.00 — — — — — — Measles 156 0.48 11 0.03 140 0.43 7 0.02 69 0.21 52 0.16 Scarlet Fever 8 0.03 8 0.03 14 0.04 4 o.o1 11 0.03 7 0.02 Whooping Cough 21 0.06 126 0.39 10 0.03 32 0.10 52 0.16 23 0.07 Diphtheria 25 0.08 32 0.10 42 0.13 15 0.04 30 0.09 20 0.06 Diarrhoea and Enteritis (under 2 years) 67 11.57 per 1,000 births 68 12.34 per 1,000 births 97 17.1 per 1,000 births 67 12.7 per 1,000 births 71 11.3 per 1,000 , births 73 14.7 per 1,000 births Showing the Deaths from Diarrhoeal Diseases together with those classed under Enteritis and its Sub-headings, arranged in quarterly periods, and in three groups of ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Ages. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 3 8 11 27 27 — 14 14 13 13 3 62 65 1 to 5 years — 1 1 — 2 2 — 2 2 — 3 3 — 8 8 Over 5 years 1 — 1 — — — 3 — 3 3 — 3 7 — 7 Totals 4 9 13 — 29 29 3 16 19 3 16 19 10 70 80 INFLUENZA. Influenza caused 103 deaths during the year and showed an increase of 13 on the return for the year 1931, and were 2 above the average of the preceding ten years 1922-31. The death-rate was equal to 0.31 per 1,000 inhabitants. 21 [1932 Showing the Deaths from Influenza in the Quarters of the Year 1932, together with the averages of the corresponding periods, 1922-31. Years. Quarters. Totals. First. Second. Third. Fourth. 1922 200 10 3 8 221 1923 21 22 7 8 58 1924 70 15 1 15 104 1925 47 3 1 21 72 1926 15 24 3 9 51 1927 118 15 7 12 152 1928 18 12 3 8 41 1929 190 13 1 3 207 1930 5 4 3 4 16 1931 68 4 4 14 90 Average 75 12 4 10 101 1932 82 9 4 8 103 Increase or Decrease +7 —3 — —2 +2 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 1932. Ages. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Mean 10yrs 1932 Difference. 0- 6 22 5 11 6 8 3 5 1 4 6 5 1 5-10 1 1 2 1 4 1 1 — — 1 — — 1 10-15 — 2 2 — 1 — — 1 — — 1 15-25 11 10 2 2 3 3 2 — 4 4 3 — 1 25-35 14 6 7 1 4 13 1 9 — 4 6 9 + 3 35-45 18 4 10 3 8 21 6 19 — 14 10 4 — 6 45-55 42 12 12 11 6 22 4 38 5 16 17 10 — 7 55-65 37 5 19 11 12 28 6 43 3 16 18 18 — — 65-75 43 16 16 19 8 34 7 52 2 15 21 25 + 4 75 & upwards 33 8 16 17 10 18 10 38 5 17 17 29 + 12 All Ages 221 58 104 72 51 152 41 207 16 90 101 103 + 2 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the notifiable diseases of this class. Erysipelas.—19 deaths were returned from this disease, or 2 more than in the year 1931, and 8 above the average of the preceding ten years 1922-31. Puerperal Diseases.—These comprise Puerperal Pyaemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 13 deaths, being 6 above the number in 1931, and were 4 above the average of the ten years 1922-31. The death-rate was equal to 2.6 per 1,000 births. Septicaemia (non-notifiable purulent infections) deaths numbered 12. CANCER. Cancer.—534 deaths were registered from this malignant disease during the year compared with 519 in 1931, and with an average of 478 in the previous decennium. The deaths represent a death-rate of 1.64 per 1,000 of the civil 1932] 22 population and is 0.20 above the average rate (1.44) of the last ten years; 277 deaths occurred among males and 257 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 1932:— Ages. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Mean 10yrs 1932 Difference 0- 5 1 1 1 1 3 2 1 2 +1 5-15 — — 1 2 — 1 3 1 1 — 15-25 4 6 4 3 3 1 3 1 1 1 3 2 —1 25-35 8 10 9 5 6 5 14 10 6 10 8 12 +4 35-45 34 27 38 40 27 24 36 22 26 25 30 19 —11 45-55 88 88 77 93 73 74 83 84 72 85 82 78 —4 55-65 124 138 131 168 142 137 147 153 123 138 140 157 +17 65-75 110 125 149 144 144 135 155 106 139 167 137 158 +21 75-85 47 68 52 71 51 65 71 81 90 83 68 92 +24 85 & upwards 6 9 8 7 7 7 9 10 8 7 8 13 +5 Totals 421 472 470 534 453 449 518 471 467 519 478 534 +56 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1932. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 14 18 16 17 29 18 24 136 Second 11 12 13 15 28 17 27 123 Third 15 11 17 17 21 18 29 128 Fourth 16 17 12 18 30 20 34 147 The Year 56 58 58 67 108 73 114 534 TUBERCULOSIS. Tuberculosis caused 308 deaths, which were 63 below the average of the last decennium, and were 24 below the number registered in 1931. The deathrate resulting from them was equal to 0.95 per 1,000 of the civil population, and represented 7.7 per cent. of the deaths from all causes during the year. Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 264 deaths, as contrasted with the decennial average of 322, while the death-rate was 0.81 per 1,000 of the civil population as against the decennial rate of 0.97 per 1,000. There was a decrease of 58 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. 1922 378 1.13 8.19 13.8 1923 337 1.00 8.64 11.6 1924 340 0.99 8.05 12.3 1925 382 1.13 9.18 12.3 1926 289 0.85 7.06 12.0 1927 314 0.94 7.61 1928 309 0.95 7.43 12.8 1929 314 0.98 6.59 14.8 1930 280 0.86 7.03 12.1 1931 281 0.87 6.85 12.6 Average 10 years 322 0.97 7.66 12.7 1932 264 0.81 6.58 12.4 23 [1932 The following return gives the deaths at each age period:— Age Periods. Males. Females. Total. 0-5 2 2 5-15 2 4 6 15-25 14 33 47 25-35 31 21 52 35-45 31 20 51 45-55 34 15 49 55-65 25 9 34 65 upwards 13 10 23 Total 152 112 264 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1932. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 10 11 5 7 15 16 20 84 Second 6 8 7 8 9 9 15 62 Third 7 7 4 5 7 9 12 51 Fourth 5 4 16 6 8 10 18 67 The Year 28 30 32 26 39 44 65 264 Showing the Deaths from all forms of Tuberculosis during 1932. Form. Ages. Sex. Districts. Total Deaths. 0-1 1-5 over 5 M. F. Tuf. U. H. Toll. L.H. H. B. S.E. Respiratory 2 262 152 112 28 30 32 26 39 44 65 264 Meningeal 4 12 8 15 9 2 5 4 2 2 4 5 24 Abdominal — — 2 2 — Batch4-231 1 — — — 1 — 2 General 1 2 2 1 — — — — — — 3 3 Other forms — 4 11 6 9 2 — — 1 2 3 7 15 All Tuberculosis 4 19 285 177 131 32 36 36 29 43 52 80 308 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 521 deaths, 217 less than in 1931. They were equal to a death-rate of 1.60 per 1,000 of the civil population, and represented 12.9 per cent. of the total deaths registered in the Borough. Acute Bronchitis—There were 90 deaths as compared with 207 in the previous year, 49 occurred among males, and 41 among females. The deaths of 7 infants under 12 months were registered. Chronic Bronchitis—69 deaths were ascribed to it, 37 being males and 32 females. This return is 40 below that of 1931. Pneumonia (All forms).—329 deaths were registered, of which 179 were males and 150 females, and were 58 below the year 1931. 49 infants under a year old died from this disease, while between the ages of 1 and 5 years 23 died from it. Above 5 years of age the deaths numbered 257. 171 deaths occurred in Public Institutions, chiefly the Islington Hospitals. 1932] 24 Pleurisy—There were 14 deaths registered from this disease, 6 deaths occurred in Public Institutions. Asthma and Emphysema—No death was recorded from these diseases. Other Diseases of the Respiratory System—19 deaths were registered, as contrasted with 12 in 1931. VENEREAL DISEASES. Nineteen deaths were ascribed to these diseases, as compared with 12 in 1931. Of these, 12 were males and 7 females. They were 5 below the mean deaths (14) of the preceding ten years 1922-31. The three groups of ages at death were as follows:—Under 1 year, 5 deaths; 1-5 years, no death; and over 5 years, 14 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. Mr. George Jewsbury, 39, Kelvin Road, N.5. the Secretary of the local branch of the British Social Hygiene Council, reports that the chief work of the local branch in 1932 was during the summer months, when fortnightly meetings were held in the open air at Highbury Corner. These meetings were well attended; the average audience being about 200. Mr. Lyons and Mr. Butler, from the British Social Hygiene Council, were the speakers. DEATHS FROM COAL-GAS POISONING. During the year 21 deaths were registered from asphyxia caused by the inhalation of carbon-monoxide gas. Nineteen deaths from the same cause occurred in 1931. Twenty of these deaths were attributable to suicide, while the cause of the remaining death was accidental. Of the 21 deaths, 13 were males and 8 females, the ages ranging from 25 to 75 years. ACCIDENTAL DEATHS. The deaths due to accident numbered 122. Of this number 42 deaths were ascribed to vehicular traffic and may be summarised as follows:— Motor Car Other or Lorry. Bus or Tram. Taxi-cab. Vehicles. Total. 27 5 2 8 42 Of this number, 21 deaths occurred to Islington residents when in outlying districts. In addition to these, 21 non-residents were also killed by vehicles within the borough. 25 [1932 CORONER'S COURT, INQUESTS, AND MORTUARY. In December, 1930, the Borough Council received a memorandum from the Coroner pointing out some disadvantages connected with the existing buildings and containing suggestions for improving the Court and Mortuary. The cost involved in carrying out the Coroner's suggestions was estimated at £2,350, excluding the cost of fittings. The Borough Council later had before them amended plans to carry out improvements estimated to cost £1,500. In November, 1931, the London County Council informed the Borough Council that they were considering the question of inquest accommodation in the County of London, and that under the Coroners' Amendment Act of 1926 the districts of these Coroners had been re-arranged and reduced in number from seven to six; that the exercise of the extended powers conferred on the Coroners had resulted in a large reduction in the number of inquests held, and that consequently some of the courts had become redundant. After consulting the Coroner for the northern district, the London County Council intimated that they proposed to retain the St. Pancras Coroner's Court and Hackney Coroner's Court and to cease to utilise the Islington and Hampstead Courts in the future, but before coming to a final decision, asked the views of the Islington Borough Council on the matter. On the 19th December, 1931, the Islington Borough Council informed the County Council that they strongly objected to the proposal to discontinue the holding of inquests at the Islington Coroner's Court having regard to the population and importance of the Borough, its central position among the boroughs on the north side of the Thames, its accessibility by tube, tram, bus and railway, and the additional facilities that could be made available in the Coroner's Court and Mortuary both for the Coroner and the medical profession for inquest purposes, at comparatively small expense. As the result of representations made, representatives of the London County Council met representatives of the Islington Borough Council at the Coroner's Court and Mortuary, and suggestions were made on behalf of the Borough Council in regard to effecting improvements estimated to cost, as before-mentioned, £1,500. On the 18th March, 1932, the London County Council intimated that having given careful consideration to the representations made, it had been decided that on the understanding that the Coroner might in special circumstances make other arrangements, the Islington Court should be one of the places at which inquests should in future be held in the northern district. Since then, however, no inquests have been held at the Islington Coroner's Court, and upon the London County Council being so informed, they intimated in June, 1932, that they were advised that a Coroner appeared to have absolute discretion as to the places at which an inquest should be held, provided it was not held at premises licenced for the sale of intoxicating liquor. At the same time the Coroner informed the Town Clerk that he found no need to use the building, that he was not waiting for any improvements to be put in hand, and that he did not feel this was a time for expenditure of public money on a Court which is not used simply to make it possible to use it. During the year 52 bodies were received into the Mortuary, as compared with an average of 288 in the preceding 10 years. The daily average number of bodies received was 0.1, whilst in 1931 the average was 0.6. No inquests were held, as contrasted with an average of 245 in the ten years 1922-31. 1932] 26 [###}Year. Bodies received into Mortuary. Inquests. 1922 316 307 1923 288 279 1924 294 317 1925 275 306 1926 308 305 1927 309 240 1928 274 206 1929 306 246 1930 279 177 1931 230 65 Average 288 245 1932 52 ... Nil PREVENTION OF INFECTION. Notification, Isolation, Fatality, or Specified Diseases under the Provisions of the Public Health (London) Act, 1891. The Principal Diseases Include:— Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus Fever, Puerperal Fever and Erysipelas. 1,962 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 31. The total cases notified are 149 less than those of the previous year (2,111), and 266 below the average (2,228) of the preceding ten years. The decreases when contrasted with the decennial averages are to be found in the returns from Scarlet Fever, Diphtheria, Membraneous Croup and Enteric Fever, which were respectively 171, 293, 1 and 2 below the average, while Erysipelas and Puerperal Fever showed increases of 32 and 6 respectively on the ten years' average. The 1,962 cases were equal to an attack-rate of 6.04 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. 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 1928 2,260 6.96 1929 2,439 7.62 1930 3,057 9.38 1931 2,111 6.50 10 years average 2,228 6.72 1932 1,962 6.04 27 [1932 Registration Sub-Districts—The total number of cases notified in these districts was as follows:— Total cases notified. Tufnell 153 Upper Holloway 187 Tollington 160 Lower Holloway 294 Highbury 312 Barnsbury 402 Islington South-East 454 Total 1,962 SMALL POX. There were 162 cases notified during the year, of which number 6 were unco firmed. Of the 156 confirmed cases, 129 were unvaccinated, 25 were vaccinated infancy, and two were doubtful, there being no evidence of vaccination. Of the six unconfirmed cases, 4 were unvaccinated and two had been vaccinated in infancy. The type of small pox was Variola Minor as in the previous year, and its extreme mildness no doubt tended to be a cause of its spread, as there was considerable reluctance among contacts in regard to accepting the advice to get vaccinated, many delaying until the second or third case had occurred. Classification as to source of infection. Infection from previous cases 50 Infection from common lodging houses — Infection from school 14 Smallpox in the neighbourhood 6 Infection from workplace 1 Infection not traced 73 Contact with cases in other Boroughs 4 Infection in hop fields — Infection from hospital 3 Infection possibly from "missed case" 5 Unverified cases 6 Total 162 State of vaccination of persons notified to be suffering from Smallpox during the year 1932. Age. Unvaccinated. Vaccinated in Infancy. Doubtful. 0- 5 years 16*** — — 5-10 „ 24 — — 10-15 „ 31 — — 15-20 „ 28 1 — 20-30 „ 20* 3 — 30-40 „ 8 5** — 40-50 „ 4 11 — 50-60 „ 2 7 2 and upwards 133 27 2 ***3 unconfirmed, **2 unconfirmed, * 1 unconfirmed. 1932] 28 In the month of January 13 cases were notified, 13 in February, 26* in March, 5 in April, 13 in May, 31** in June, 17 in July, 11** in August, 5 in September, 14* in October, 10 in November and 4 in December. *Signifies unconfirmed case. In consequence of the occurrence of cases of Smallpox among scholars in the public elementary schools, arrangements were made, in conjunction with the London County Council Schools Medical Officer, for the Public Vaccinators of the district to attend at the following schools and vaccinate children where the consent of the parents had been obtained:— Gilford Street School (7 cases of Smallpox among scholars). York Road School (9 cases of Smallpox among scholars). St. Mary Magdalene School (15 cases of Smallpox among scholars). The Public Vaccinator also attended at a Laundry in the Borough and vaccinated the employees, as a member of the staff had been removed to hospital suffering from Smallpox. Of the cases notified during the year, 8 were notified from St. Mary's (Islington) Hospital (one of which was unconfirmed), 1 from the Middlesex Hospital and 2 from the Royal Northern Hospital, Islington. Diphtheria was responsible for 598 cases of illness, which were 293 below the average (891) of the preceding ten years. The attack rate was equal to 1.84 per 1,000 of the civil population annually, and was 0.86 below the mean rate (2.70) of the decennial period. In London the attack-rate was 1.8 per 1,000. DIPHTHERIA ANTI-TOXIN; IMMUNISATION. Under the Special Order of 15th August, 1910, the then Local Government Board sanctioned the provision by the Sanitary Authority, in pursuance of section 77 of the Public Health (London) Act, 1891, of a temporary supply of Diphtheria Anti-toxin "for the poorer inhabitants of the district, subject to the following conditions, that is to say, the arrangements with respect to the keeping, distribution and use of the Diphtheria Anti-toxin shall be made in accordance with the advice of the Medical Officer of Health." The section of the Public Health Act referred to is that which enables the authority, with the sanction of the Local Government Board, to provide a temporary supply of medicine, etc., for the poorer inhabitants of their district. (See also page 33. Applications in respect of 3 children were received for Diphtheria immunisation (Schick Test) during the year. ANTI-TOXIN TREATMENT. During the year 14,000 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 6,000 units were sold, the total amount received by the Council being 8s. Od. The remaining 8,000 units were given free, owing to the patients' limited means. Scarlet Fever.—983 cases were notified, and they showed a decrease of 171 on the average (1,154) of the ten years 1922-31. The attack-rate was equal to 3.03 per 1,000 of the civil population annually, which is a decrease of 0.44 per 1,000 of the mean rate (3.47) of the preceding ten years. In London the attackrate was 3.2 per 1,000 of the civil population. 29 [1932 Enteric Fever.—15 cases were notified which showed a decrease of 2 on the average (17) that obtained during the ten years 1922-31. The attack-rate was 0.04 per 1,000 annually, a decrease of 0.01 on the mean rate 0.05 of the last ten years. In London the rate was 0.04. Puerperal Fever.—See page 12. Erysipelas.—165 cases were notified, and were 32 above the average of the preceding ten years, the attack-rate being 0.51 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 1,962 cases notified, 50 deaths occurred, or 2.7 per cent., which contrasts with an average percentage of 2.7 in the preceding ten years 1922-31. Years. Cases. Deaths. Fatality. 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 1928 2,260 60 2.7 1929 2,439 57 2.3 1930 3,057 80 2.6 1931 2,111 43 2.0 Mean 2,276 63 2,7 1932 1,962 50 2.7 *Including 2 cases not notified. ‡Includes 1 case not notified. Hospital Isolation.—Of the 1,962 cases of infectious disease notified, 1,879 were isolated in hospital, equal to a percentage of 95.7, while only 4.3 percent. 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. 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 1929 2,337 95.8 1930 2,879 94.2 1931 2,015 95.4 1932 1,879 95.7 1932] 30 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated. Percentage of known cases. Small-pox 162 162 100.0 Scarlet Fever 983 961 97.7 Diphtheria 601 600 99.8 Enteric Fever 15 15 100.0 Erysipelas 165 107 64.9 Puerperal Fever 35 33 94.3 Continued Fever 1 1 100.0 1.962 1,879 95.7 Summary of Infectious Sickness and of Deaths arising therefrom, distinguishing the Gases 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 1932 Notified Cases Treated. Percentage of Notified Cases Treated. Deaths Occurring. Percentage of Deaths Occurring. In Hospital At Home Total In Hospital At Home In Hospital At Home Total In Hospital At Home Total Small-pox Scarlet 162 — 162 100.0 0.0 — — — — — — Fever 961 22 983 97.7 2.3 7 — 7 0.7 0.7 Diphtheria Enteric (Typhoid 600 1 601 99.8 0.2 19 1 20 3.0 0.1 3.1 Fever) Typhus 15 — 15 100.0 0.0 — — — — — — Fever — — — — — — — — — — Erysipelas Puerperal 107 58 165 64.9 35.1 17 2 19 10.0 1.2 11.2 Fever Continued 33 2 35 94.3 5.7 4 — 4 11.7 — 11.7 Fever Relapsing 1 — 1 100.0 — — — — — — Fever — — — — — — — — — — — Cholera — — — — — — — — — — — Total 1,879 83 1,962 95.7 4.3 47 3 50 2.5 0.2 2.7 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1922-31 and in 1932. DISEASES. YEARS. Average number of cases, 1922 31 1932 Increase or Decrease 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Small-pox Cases — 1 4 71 244 66 †— 162 — Rate — — — — 0.00 — 0.01 0.22 0.75 0.21 — 0.50 — Diphtheria Cases 1126 889 854 911 743 716 756 1004 1242 710 891 598 —293 Rate 3.37 2.64 2.48 2.69 2.19 2.14 2.33 3.14 3.81 219 2.70 1.84 —0.86 Membranous Cases 4 2 2 2 — 4 4 4 6 4 4 3 -1 Croup Rate 0.01 0.00 0.00 0.00 — 0.01 0.01 0.01 0.01 0.01 0.01 0.01 — Scarlet Fever Cases 1496 1080 1077 1139 1010 909 1305 1155 1310 1093 1154 983 —171 Rate 4.48 3.21 313 3.36 2.98 2.72 4.02 3.61 4.02 3.37 3.47 3.03 —0.44 Enteric Fever Cases 9 16 14 10 18 12 19 18 31 16 17 15 _2 Rate 0.03 0.05 0.04 0.03 0.05 0.03 0.06 0.06 0.09 0.05 0.05 0.04 —001 Continued Cases — — 3 — 1 — 1 — — — 1 +1 Fever Rate — — 0.01 — 0.00 — 0.00 0.00 — — 0.00 — Puerperal Cases 20 22 19 23 27 33 38 38 36 45 29 35 +6 Fever* Rate 2.68 3.10 2.79 3.50 4.18 5.40 6.56 6.89 6.3 8.52 4.62 7.07 +2.45 Erysipelas Cases 132 87 116 109 118 139 134 148 188 177 133 165 +32 Rate 0.39 0.26 0.34 0.32 0.35 0.42 0.41 0.46 0.58 0.54 0.40 0.51 +0.11 Totals Cases 2787 2096 2085 2194 1918 1813 2260 2439 3057 2111 2228 1962 — 266 Rate 8.34 6.22 6.06 6.47 5.65 5.42 6.96 7.62 9.38 6.50 6.72 6.04 — 0.68 * Per 1,000 Registered Births. † Average where there has been continuance of disease during 10 years. 31 [1932 Showing the Cases of the Notifiable Infectious Diseases notified, in the SubRegistration Districts and the Wards during the Year 1932. Registration Districts. Wards. Small pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell 1 83 46 — 1 — 18 4 — — — 153 Up. Holloway Up. Holloway 1 102 58 — 2 — 22 2 — — — 187 Tollington Tollington 3 88 47 — 2 — 16 4 — — — 160 Lr. Holloway Lr. Holloway 46 126 94 — 2 — 23 3 — — — 294 Highbury Highbury 22 81 40 1 1 10 3 1 — 159 MiMmay 4 100 37 — 1 — 9 2 — 153 Barnsbury Thornhill 48 109 80 — — — 17 5 259 Barnsbury 17 50 51 2 2 — 18 3 — — 143 Mington, S.E. J St. Mary's 11 90 40 — 1 11 1 — — — 154 Canonbnry 4 68 43 — — — 12 5 — — — 132 St. Peter's 5 86 62 — 3 — 9 3 — — — 168 Totals 162 983 598 3 15 — 165 35 1 — — 1,962 Attack-Rates per 1,000 population 0.50 3.03 1.84 0.01 0.04 — 0.51 0.11 — — 6.72 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 Poliomyelitis, Acute Encephalitis Lethargica, Acute Polio-Encephalitis, Acute Primary Pneumonia, Acute Influenzal-Pneumonia, Cerebro-spinal fever or Epidemic Cerebro-spinal Meningitis, Dysentery, Glanders or Farcy, Hydrophobia or Rabies, Malaria, Ophthalmia Neonatorum, Plague, Tuberculosis, Puerperal Pyrexia, and Chicken-pox (except in the vaccinated under 10 years of age). Acute Poliomyelitis. Four cases were notified from this disease during the year, as contrasted with four in 1931, and four in 1930. 1932 1931 Cases. Deaths. Cases. Deaths. 1st Quarter 1 Nil Nil Nil 2nd 1 „ „ „ 3rd 1 „ 1 „ 4th 1 1 3 » 4 1 4 Nil Epidemic Cerebro-Spinal Meningitis. Nineteen cases came to the knowledge of the Medical Officer of Health, although only 13 were notified, as against 10 in 1931. During the ten years 1922-31 the cases averaged 9 per annum. 1932] 32 A return of attacks of the disease during the past ten years is given in the following statement:— 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Average 10 yrs. 1922-31 1932 Total Deaths, 1922.31. 1st Quarter 1 3 — 2 3 3 1 2 4 4 2 7 18 — 2 — 1 3 3 4 2 5 9 3 3 26 3rd „ — 2 2 2 3 — 2 2 2 1 2 3 10 4th — 1 4 1 2 1 1 3 2 2 2 6 12 Year 3 8 6 6 11 7 8 9 13 16 9 19 66 The deaths during the year numbered 12, and were equal to the very high rate of 63 per cent. of the cases notified. INFECTIOUS DISEASES (LONDON) REGULATIONS, 1927. Malaria, Dysentery, Acute Primary Pneumonia and Acute Influenzal Pneumonia. Schedule dealing with Typhus, Relapsing and Enteric Fevers. Regulations dealing with these diseases came into force on the 7th January, 1919. Dysentery; and the alterations of the Regulations, to suit London, were fully dealt with in the Annual Report for 1927, pages 34 and 35. During the past five years the following cases were notified by medical practitioners to the Medical Officer of Health. 1928 1929 1930 1931 1932 Malaria — 2 Nil 1 2 Dysentery 1 6 Nil 6 15 Acute Primary Pneumonia 288 397 323 370 254 Acute Influenzal Pneumonia 50 122 36 115 87 Total 339 527 359 492 358 ISLINGTON (CHICKEN-POX) REGULATIONS, 1930. The regulations came into operation on the 24th March, 1930, and from that time to the end of this year 1,441 cases had been notified. In 1932 the notifications were 429. DYSENTERY. Fifteen cases were notified during the year. Cases of this disease, especially those occurring from Sonne Bacillus, are fairly frequently diagnosed if the child is in attendance at the Hospital for Sick Children, Great Ormond Street, where special investigations are made. On the 16th February a Casualty Officer at the Royal Northern Hospital informed the Medical Officer of Health by telephone that it had been noted that a number of cases with diarrhoea had been attending the out-patient department for treatment, and it was noted they came from a house in Hampden Road, Holloway. Investigations were made, and as a result the District Sanitary Inspector found that there had been in this particular building a long series of cases of diarrhoea, which dated back to the 29th January, 1932, when a child aged 14 months suffered from diarrhoea; he received no professional medical attendance whatever, and had recovered. From personal investigations made by 33 [1932 the Medical Officer of Health, interviews with the parents of three families living in the house, and the examination of the various children, the circumstances appeared to indicate Dysentery. A bacteriological examination of a specimen from one of the children, aged 8 years, revealed the Sonne bacillus, and upon this confirmation the other cases were removed to hospital. The cases from this particular household numbered six altogether. 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 2Gth April, 1909.) No case was 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 4 cases of Acute Encephalitis Lethargica were known, but only 3 were notified. They are the same as the return of the previous year, whilst 1 death was registered. The following summary shows the number of cases, and also the fatality of recent years:— Acute Encephalitis Lethargica. Years. 1922 1923 1924 1925 1926 1927 1928 3929 1930 1931 Average (10 years). 1932 Cases 3 10 39 17 21 7 5 8 4 4 12 4 Deaths 3 5 4 6 9 4 3 3 2 4 1 Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. See page 9. SUPPLY OF INSULIN TO NON-INSURED PERSONS. Under Section 77 of the Public Health (London) Act, 1891, a temporary supply of medicine, etc., for the poorer inhabitants of a district may with the sanction of the Minister of Health, be made. Under this section, the Minister on the 9th December, 1929, granted authority to the Islington Borough Council to make such provision for the poorer inhabitants. The sanction was given provisionally for a period of twelve months, and was extended for a further period of 12 months. It is laid down by the Minister that practitioners applying for supplies of Insulin should state:— (a) the name and address, age and sex of each patient for whom it is wanted, and (b) to furnish a quarterly report in respect of each patient treated, giving the following information:— (1) The number of doses of Insulin administered; (2) Whether any tests were made of the urine or of the blood of the patient, and, if so, by whom and with what results. 1932] 34 The Minister of Health has to be furnished with a quarterly report by the Medical Officer of Health giving an abstract of the reports forwarded by the medical practitioners, the cost of the Insulin supplied by the Borough Council, and any general remarks as to the working of the arrangements. So far the demand for such assistance for patients comes through the Almoners of three of the largest hospitals. During the year under review 8 cases have received this assistance from the Borough Council, the cost of the Insulin supplied being £26 2s. Od. BLIND PERSONS ACT, 1920. Under this heading the number of "Totally Blind" and "Partially Blind" children under 5 years of age coming to the knowledge of the Medical Officer of Health, and under supervision either of the H.Vs. or Voluntary Welfare Centres in the Borough, during the year 1932 were:—" Totally Blind," 2 (one of whom reached the age of 5 years in August);" Partially Blind," 8 {including 3 new cases). One of the former cases reached the age of 5 years in July. TUBERCULOSIS. 577 cases of Tuberculosis in its different forms were notified during the year. The attack-rate was equal to 1.78 per 1,000 of the civil population. This number was a decrease of 11 on the return of the previous year, and of 0.03 per 1,000 on the attack-ratc. Respiratory (Pulmonary) Tuberculosis.—474 notifications were received, of which 272 referred to males and 202 to females, and represented an attack-rate of 1.46 per 1,000 inhabitants. Showing the Notified Cases of Tuberculosis in the Wards during 1932. 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 31 19 50 1 6 7 57 1.74 Up. Holloway Up. Holloway 26 26 52 7 5 12 64 2.08 Tollington Tollington 33 20 53 8 1 9 62 2.06 Lr. Holloway Lr. Holloway 26 22 48 6 2 8 56 1.39 Highbury Highbury 24 14 38 4 12 50 1.61 Mildmay 17 14 31 4 3 7 38 1.36 Barnsbury Thornhill 22 9 31 3 6 9 40 1.36 Barnsbury 18 16 34 4 3 7 41 1.70 Islington, S.E. St. Mary's 19 11 30 5 3 8 38 2.14 Canonbury 28 23 51 6 4 10 61 1.95 St. Peter's 28 28 56 7 7 14 70 2.42 Totals 272 202 474 55 48 103 577 1.78 35 [1932 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1932. Tubercular Diseases. Cases Notified in Whole District. Sex. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 272 — 4 17 54 107 83 7 F. 202 — 1 10 68 95 20 8 Tubercular Meningitis M. 2 — 2 — — — — — F. 3 — 2 1 — — — — Tabes Mesenterica M. 1 — — 1 — — — — F. 1 — — 1 — — — — General Tuberculosis M. — — — — — — — — F. — — — — — — — — Other forms of Tuberculosis M. 52 1 8 14 15 13 1 — F. 44 2 6 10 7 18 1 — All Tubercular Diseases M. 327 1 14 32 69 120 84 7 F. 250 2 9 22 75 113 21 8 Totals 577 3 23 64 144 233 105 15 Percentages at each life period to total cases 0.52 3.98 9.36 24.97 40.38 18.19 2.59 From the above statement it will be seen how the disease attacked people at the various ages, viz.: In every hundred cases 0.52 were under 1 year of age. „ „ 8.98 were aged 1 to 5 years. „ „ 9.36 were aged 5 to 15 years. Prime ,, 24.97 were aged 15 to 25 years.* of „ „ 40.38 were aged 25 to 45 years. Life „ „ 18.19 were aged 45 to 65 years. ,, 2.59 were aged 65 and upwards. *Referring to the first Table above, it will be seen under "Respiratory Tuberculosis" that between the ages of 15 and 25, the males attacked number 54, while the females reached 68. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1925. These Regulations provide that no person suffering from respiratory tuberculosis who is in an infective condition shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk, or the handling of containers. No case came to the notice of the Medical Officer of Health during the year which called for action. ISLINGTON INTERIM TUBERCULOSIS CARE COMMITTEE. The character of the work of this Committee was fully exemplified in the Medical Officer of Health's Annual Report for 1929, page 39, when individual cases and methods of help were given. During the year the work of the Committee has increased steadily in scope and extent. The new cases received numbered 236, the number of visits were 1,362, letters written 1,200, and interviews held 527. 1932] 36 Besides the more typical activities of a Care Committee, a Home Library has been started this year for patients and this has been much appreciated. Islington was the first London Borough to start a library of this kind and it has proved a great success. Gifts of books for the Library are always welcome. Islington was also the first Borough to start an Allotments Scheme for ex-sanatorium patients. Three plots are now rented which provide six men with a useful and absorbing hobby, and one which keeps them out in the open ait. Keen interest is shown, and this piece of pioneer work has proved well worth while. Two jumble sales were held in aid of the scheme during the year with satisfactory results, £5 7s. 9d. being raised. The Handicraft Class continues to be held weekly in the Royal Chest Hospital and is a source of much interest to many patients on whose hands time is otherwise apt to hang heavily. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 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, removed during that period, and the actual number remaining at the close of the year, 1932. Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1932 1,279 1,118 426 397 3,220 Notified cases added during the year 1933 272 202 55 48 577 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1932 49 55 23 13 140 1,600 1,375 504 458 3,937 No. of cases removed from the register during the year 1932 281 259 60 60 660 1,319 1,116 444 398 3,277 Showing the Notified Gases of Tuberculosis in the Quarters during 1932. 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 80 65 145 80 47 127 60 47 107 52 43 95 272 202 474 Tubercular Meningitis ... ... ... 1 2 3 1 1 2 ... ... ... 2 3 5 Tabes Mesenterica ... ... ... ... ... ... ... ... ... 1 1 2 1 1 2 General Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 19 11 30 13 13 26 9 15 24 11 5 16 52 44 96 TOtals 99 76 175 4 62 156 70 63 133 64 49 113 327 250 577 37 [1932 Disinfection of Houses and Rooms after Tuberculosis,—The following statement gives the particulars for the year:— Houses. Rooms. 1st quarter 102 129 2nd „ 80 106 3rd ,, 88 109 4th „ 91 125 Total 361 469 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 4th January, 1932, to the 31st December, J932, in the Metropolitan Borough of Islington. Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. Age-periods 0 1 5 10 15 20 25 35 45 55 65 Total to to to to to to to to to to and Primary 1 5 10 15 20 25 35 45 55 65 up. Notifications. Pulmonary Males ... 4 12 5 19 35 61 46 51 32 7 272 430 „ Females ... 1 6 4 25 43 61 34 14 6 8 202 342 Non-pulmonary Males 1 10 10 5 8 7 9 4 1 — — 55 69 „ „ Females 2 8 7 5 4 3 13 5 1 ... ... 48 59 Showing New Cases of Tuberculosis and all Deaths during 1932. Age Periods. New Cases. Deaths, Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary M. V. M. F. M. F. M. F. Under 1 year — — 5 2 — — 3 1 1-5 5 2 16 12 2 — 8 8 5-10 13 6 13 10 3 10-15 5 6 6 8 2 4 2 2 15-20 20 29 10 4 5 12 1 1 20-25 42 56 8 3 9 18 25-35 72 76 10 14 32 20 3 2 35-45 53 44 4 5 27 19 — — 45 55 62 18 4 3 30 15 5 1 55-65 36 11 1 — 25 10 65 and upwards 13 9 1 — 13 9 2 — Totals 321 257 78 61 145 107 24 18 75 Deaths not notified or 25 5 per cent. of Total Deaths. 1932] 38 TUBERCULOSIS DISPENSARIES. RETURN SHOWING THE WORK OF THE NORTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1932. Diagnosis. Pulmonary. Non-pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): (a) Definitely tuberculous 62 64 4 2 9 7 5 2 71 71 9 4 155 (b) Diagnosis not completed — — — — — — 2 6 — — 8 (c) Non-tuberculous — — — — — — — — 57 68 18 7 150 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 — 2 — — 2 — 1 1 2 2 6 (b) Diagnosis not completed — — — — — — — — 1 — — 1 2 (c) Non-tuberculous — — — — — — — — 42 60 41 6H 206 C.—Cases written oft the Dispensary Register as (a) Recovered 9 6 — — 4 0 2 1 13 12 2 1 28 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as — — — — — — — — 99 128 59 70 356 D.—Number of Casks on Dispensary Register on December 31st:— (a) Definitely tuberculous 274 245 10 8 26 34 39 19 300 279 49 27 655 (b) Diagnosis not completed — — — — — — — — 3 7 — — 10 1. Number of cases on Dispensary Register on January 1st 761 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 172 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 32 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,567 3. Number of cases transferred to other areas. cases not desiring further assistance under the scheme and cases "lost sight of" 183 10. Number of (а) Specimens of sputum, &c., examined (b) X-ray examinations made in connection with Dispensary work 244 218 4. Cases written off during the year as dead (all causes) 88 5. Number of attendances at the Dispensary (including contacts) 3,041 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 1 6. Number of Insured persons under Domiciliary Treatment on the 31st December 7. Number of consultations with medical practitioners:— (а) Personal (b) Other (c) Hospital staff 12 404 97 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 325 G. CLARK TROTTER Chief Tuberculosis Officer. 39 [1932 RETURN SHOWING THE WORK OF THE SOUTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1932. Diagnosis. Pulmonary. Non-pulmonary. Total. Grand Total. Adults. Children. Adults. Children, Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): (a) Definitely tuberculous 61 36 6 4 10 9 7 7 71 45 13 11 140 (b) Diagnosis not completed — — — — — 1 1 1 3 (c) Non-tuberculous — — — —- — — — — 60 64 21 41 186 B.—Contacts examined during the year:— (a) Definitely tuberculous 14 15 4 1 — — 3 14 15 4 4 37 (b) Diagnosis not completed — — — 1 1 (c) Non-tuberculous — — — — — — — — 32 69 63 45 209 C.—Cases written oft the Dispensary Register as:— (a) Recovered 4 9 2 — 7 5 2 3 11 14 4 3 32 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 93 135 86 88 402 D.—Number of Cases on Dispensary Register on Decern ber 31st:— (a) Definitely tuberculous 277 217 24 29 38 38 35 36 315 255 59 65 694 (b) Diagnosis not completed — — — — — — — — 2 1 — 1 4 1. Number of cases on Dispensary Register on January 1st 721 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 40 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 130 4. Cases written off during the year as dead (all causes) 75 Number of attendances at the Dispensary (including Contacts) 4,566 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 179 7. Number of consultations with medical practitioners:— (a) Personal 5 (b) Other 148 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 149 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,601 10. Number of (a) Specimens of sputum, &c., examined 622 (b) X-Ray examinations made in connection with Dispensary work 135 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 312 G. CLARK TROTTER, Chief Tuberculosis Officer. During the year 1,169 persons were examined by the Tuberculosis Officers, and the patients made 7,586 attendances. At the Northern Dispensary there were 601 new cases, and at the Southern 568, while the attendances at the former were 3,041 and at the latter 4,545. The examination of contacts with tuberculous cases showed that 33 were suffering from 1932] 40 tuberculosis, 25 were suspects, and 420 were not suffering. The nurses of the Northern Dispensary paid 815 visits, and those of the Southern 2,177, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 172 visits, and of the Southern 149 visits to the patients' homes for the purpose of examining them. Pneumothorax Treatment was also administered to thirty-one patients at a cost of £158 9s. 6d. Finsen Light Treatment.—One case at a cost of £1 10s. 0d. Artificial Sunlight Treatment. No case under treatment in the year under review. TUBERCULOSIS. The number of persons in attendance at the Dispensaries in each year was as follows:— 1928 1929 1930 1931 1932 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy Pouth Dispy North Dispy South Dispy New Cases Actual Number of 558 659 539 638 563 585 641 609 60 568 Attendances 2616 5802 2634 5899 2910 5443 3153 5001 3041 4545 Totals 3174 6461 3173 6537 3473 6028 3794 5610 3642 5113 A summary of the combined dispensaries is given for the following years:— Cases. Attendances. 1928 1,217 8,418 1929 1,177 8,533 1930 1,148 8,353 1931 1,250 8,154 1932 1,169 7,586 Totals 5,961 41.044 Table showing the number of Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1932. Date. Dispensary Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 298 265 235 232 263 224 236 232 266 287 263 240 3,041 7,586 Southern 458 413 419 324 377 377 301 364 393 393 398 328 4,545 New Cases Including Contacts Northern 59 45 46 59 60 41 45 34 50 45 53 64 601 1,169 Southern 62 55 64 56 44 42 43 46 47 40 37 32 568 Contacts. Tuberculous Northern 1 3 1 5 33 Southern 2 3 2 4 4 1 5 1 1 3 2 28 Suspects Northern 1 2 2 1 2 2 3 3 4 2 22 25 Southern 1 2 3 Non-Tuberculous Northern 25 11 7 22 20 12 10 12 6 16 15 35 191 420 Southern 29 22 29 30 20 17 14 15 11 14 11 17 229 Nurses' Visits Northern 63 49 68 40 72 63 42 80 117 57 84 80 815 2,992 Southern 201 172 171 128 187 200 168 215 209 179 186 161 2,177 Tuberculosis Officers' Visits Northern 19 17 12 16 10 13 13 14 12 18 15 13 172 321 Southern 9 10 13 11 10 13 13 9 17 15 13 16 149 Cases of TUBERCULOSIS IN ISLINGTON During 1932 BLACK denotes Pulmonary Tuberculosis WHITE" Other Forms of Tuberculosis 41 [1932 HOME VISITATION—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1932, to 31st December, 1932. Month. North Dispensary. South Dispensary. Total. January 152 109 261 February 149 131 280 March 164 139 303 April 158 138 296 May 123 125 248 June 160 131 291 July 129 114 243 August 146 137 283 September 62 31 93 October 170 128 298 November 175 136 311 December 164 105 269 Totals 1,752 1,424 3,176 TUBERCULOSIS—HOUSING. During the year 574 visits were made to premises in which resided a person notified during 1932 as suffering from Tuberculosis. These visits were made with a view to ascertain the sanitary condition generally of the residences of tuberculous patients and the following statement gives some idea of the conditions which were found to exist. It is satisfactory to note the large proportion of houses in a good sanitary condition; in no case could it be said that the home conditions were very bad. Houses in good sanitary condition 307 Houses in which minor defects were discovered 32 Patient removed to another address 102 Patient deceased (no visit paid to house) 112 Patient in Mental Hospital 18 Patient in L.C.C. Hospital (Nursing Staff) or Government Building Staff 3 574 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,194 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 567 were Scarlet Fever and 316 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 62 - + 62 Scarlet Fever 567 686 — 119 Diphtheria 316 403 — 87 Enteric Fever 2 — 2 Chicken-pox 249 - + 249 Total 1,191 1,091 + 103 1932] 42 Non-Notifiable Diseases.—5,071 cases came to the knowledge of the Medical Officer of Health during the year, viz., 2,470 cases of Measles, 815 cases of Chicken-pox, 533 of Whooping Cough, and 1,253 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.— 3,418 children were excluded from classrooms of various schools owing to the presence of an infectious disease, chiefly Diphtheria and Scarlet Fever, in the houses wherein they lived. The non-notifiable diseases among children attending the Public Elementary Schools were:— Disease. Notifications by Teachers. Average of preceding 10 years. Increase or Decrease. Measles 2,470 1,755 + 715 Chicken-pox 815 988 — 173 Whooping Cough 533 631 — 98 *Other Diseases 1,253 2,077 — 824 Total 5,071 5,451 — 380 *Note.—"Other Diseases" include Mumps, Scabies, Ophthalmia, Itch, etc. BACTERIOLOGICAL EXAMINATIONS. 2,793 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 a decrease of 18 on that of the preceding year. It was, however, 109 above the decennial average. Of the total examinations, 354, or 12.6 per cent. gave positive results. Diphtheria. 1,984 specimens were examined for Diphtheria, of which 238, or 11.9 per cent., were found to contain Diphtheria bacilli. Enteric Fever.—14 specimens of blood were examined, 5 of which gave positive results. Tuberculosis.—795 specimens of sputum were examined, 111, or 13.9 per cent., of which showed that the patients were suffering from pulmonary tuberculosis. These are in addition to routine examinations at the two Tuberculosis Dispensaries. DIPHTHERIA—PATHOGENICITY TESTS. 1932. No. Submitted for Examination. Negative Resu't. (Bacilli) Positive Result. (Bacilli) Non-Virulent. Virulent. 14 9 5* 2 1 *2 not tested for Pathogenicity as clinically confirmed. 43 [1932 Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1922-31, and in 1932. 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. 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 1.634 3 9 12 148 691 839 2,535 1927 260 1,573 1,833 3 21 24 111 661 772 2,629 1928 276 1,478 1,754 4 32 36 137 723 860 2,650 1929 412 1,888 2,300 2 15 17 119 693 812 3,129 1930 492 2,274 2,766 1 18 19 127 652 779 3,564 1931 280 1,663 1,943 2 8 10 131 727 858 2,811 Average 10 years 291 1,565 1,856 2 16 18 135 675 810 2,684 1932 238 1,746 1,984 5 9 14 111 684 795 2,793 TETANUS. On the 2nd January a sewerman in the employ of the Islington Borough Council died from Tetanus infection of a wound of the right hand sustained on the 25th December, 1931 at home. There was a Coroner's Inquest, and a verdict of accidental death was returned. The cause of this man's death was specially noted, and the details here given with the results of the special investigation made by the Public Health Department are put forward, because the risk of contracting this disease is not generally appreciated by the public. The history was as follows:— On the 24th December, 1931, he bought a toy pistol, and when firing it at home injured the right hand at the base of his first finger. He was treated in the outpatient department of the local hospital until the 31st December, when he was admitted with lockjaw. Large doses of anti-tetanus serum were given, but he died on the day stated about 48 hours after admission. An endeavour was made by the Medical Officer of Health to purchase a similar toy pistol, and some blank cartridges as used, immediately afterwards, but without success. Owing to the publicity of the Coroner's Inquest the pistols and blank cartridges had been withdrawn from sale and could not be purchased at any of the usual shops which had been in the habit of selling them. Tetanus resulting from toy pistol and blank cartridge wounds has not received a great deal of attention in this country, although the cause has received consideration in the United States of America, where it is known as "Fourth of July Tetanus," because a large number of cases occur during the Independence Day celebrations. It is recorded that in 1903 in spite of official warnings of this danger of Tetanus, over 400 deaths were reported. The infection is extremely virulent, the incubation period being only 4 to 5 days, and death occurring within 72 hours. The vast majority of cases of wounds were in the hands. Owing to the recognition of this danger in America, special instructions had been issued in regard to dealing with such wounds, and the necessity of giving prophylactic doses of anti-tetanus serum. These measures appear to have been fairly successful, as in 1914 only 1932] 44 three deaths were reported from Tetanus after the Independence Day rejoicing's. Besides our Islington case, other cases from toy pistol injuries with infection of the wound by Tetanus have been reported in May, 1928, a youth, 18 years old, in York, who recovered; a butcher's assistant, aged 17 years, in London, in April, 1932, who died; and a man, aged 50 years, in London, in March, 1932, who died. How the Infection is caused.—The bacilli appear to enter the wound in the part of the charge which penetrates to the deeper tissues or to be carried in from the skin, or to be introduced at a later date, although the last seems least likely. The wad which keeps the powder in the end of the cartridge is said to be made of hair felt, which might convey spores. Several samples of the same brand of blank cartridge marked with "E" were purchased for investigation. Some of the boxes containing them were marked "Made in France," the others appeared to be British made, but each was impressed with the mark of the same maker. These cartridges were submitted for bacteriological examination. At first, although a number were examined, Tetanus was not found, but later it was obtained in several cartridges, these being the ones with the hair felt, not necessarily the foreign make. The important point is that the rough finish of the toy pistol is very apt to cause an abrasion of the skin of the hand or finger, or in the firing when pulling the trigger. The number of cases is small, and fatalities can be avoided if proper surgical treatment is obtained and prophylactic treatment with antitetanus serum is given at an early stage. The cartridges which had apparently paper material as a wad did not show Tetanus. The strain of Tetanus obtained from the cartridges was a very virulent one. The question, quite apart from taking precautions after an accident which occurs to one, is that it would be better if hair felt is used in making these wads that it should be first thoroughly sterilized. REPORT ON THE STERILITY OF MATERNITY OUTFITS EXAMINED IN ISLINGTON DURING THE YEAR 1932. An enquiry was made as regards the sterility of maternity outfits commercially sold. It was ascertained as regards practising midwives that it was usual not to buy the outfits as sold, but to prepare their own if occasion required. A sample maternity outfit was obtained from two places. As it happened, the maker was the same, a wholesale firm not in this Borough. These outfits were sent for bacteriological examination to separate bacteriologists, one on the 10th December and the other on the 16th December. The Medical Officer of Health received a telephone message regarding the non-sterility shortly after the first was sent, and later from the same source intimation was given that the Bacillus Welchii had been found, and that therefore the outfit could not be considered safe. Meanwhile, upon receipt of the first message on the non-sterility, the whole stock of the outfits had been handed over to me by request and were properly sterilized at our disinfecting station, and returned. Upon intimating to the manufacturer who had supplied the outfits that these alleged sterilized outfits were not sterile (that when cultures were made growths of the following bacteria were obtained from the cotton wool, Bacillus Welchii; from the lint, Bacillus Subtilis; from sanitary towels examined, Bacillus Welchii), and asking for an explanation, the reply was that the question of efficient sterilization had had their close attention for several months, and that as a result of tests made, the firm had decided towards the end 45 [1932 of October, 1932, to replace their apparatus with up-to-date plant, which had duly been carried out. It would appear that the firm themselves had become cognisant, whether from other complaints we know not, that their sterilization was ineffective. BACTERIOLOGICAL EXAMINATIONS MADE FOR OTHER SPECIAL PURPOSES DURING THE YEAR 1932. (See also Table, Diphtheria, etc. and Milk). Specimen. Examined for. No. of Examinations. No. Positive. No, Negative. Food Poisoning 6 6* Pistol Cartridges Tetanus 1 1 — Bee Wine — 1 — 1 Anchovy Paste — 1 — 1 Maternity Outfits Sterility 2 2 — * Including one specimen (fish paste) too decomposed for examination, BACTERIOLOGICAL EXAMINATION OF MILK. During the year 1932, sixteen samples of milk were taken in various parts of the Borough, as supplied to the consumer. In addition to the bacterial count to see whether the specimen complied with the Grade, if any, under which it was sold, the specimens were examined for tubercule bacilli by animal inoculation. These samples were duly reported and roughly classified as "clean" and "dirty" milks. Six were "clean" and 10 "dirty," the report of the bacteriologist being that in his opinion the samples did not comply with the prescribed conditions; that Coliform Bacilli, pus cells, or dirt, some, or all, were found Four of these "dirty" samples were taken from milk supplied to local institutions. The bacteriological reports of the 10 "dirty" samples revealed the presence of coliform bacillus in 1/100 c.c. in two samples, the presence of coliform bacillus in 1/100 c.c. plus many pus cells and particles of dirt in two samples, the presence of coliform bacillus in 1/10 c.c. and dirt in one sample; the presence of coliform bacillus in 1/10 c.c. and pus cells in one sample; the presence of coliform bacillus in 1/10 c.c. in one sample; the presence of pus cells in three samples. VACCINATION. At the end of January Dr. T. Evans, the Medical Superintendent of Archway Hospital, resigned his appointment as Public Vaccinator for that Institution. Mr. C. W. Bellis terminated his appointment as Vaccination Officer on the 30th September, 1932, as he had been appointed Superintendent Registrar, and Mr. Leonard Stevens commenced his duties, having been appointed Temporary Vaccination Officer on the 7th November, 1932. No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917, as it was possible to refer each case immediately to the Public Vaccinator of the district or institution. Vaccinations.—Of the 4,145 births registered in 1931, the returns of vaccination show that only 1,980 infants were successfully vaccinated, while 9 were found to be insusceptible. There were also 178 who died unvaccinated, and 1,477 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians; 56 vaccinations were postponed under medical authority 1932] 46 203 were removed to other districts or places unknown, thus leaving 73 unaccounted for. The return of certificates of exemption, therefore, represents 35 per cent, of the registered births. Years. Vaccination per 100 births, less infants who died unvaccinated. 1922 46.3 1923 54. 8 1924 54.0 1925 50.4 1926 51.5 1927 49. 9 1928 46.5 1929 49.5 1930 51.2 1931 50.0 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 1,896 1927 1,845 1928 1,755 1929 1,642 1930 1,584 1931 1,477 A statement is given of the prosecutions by the Vaccination Officers since the transfer from the Guardians in 1930. Prosecutions. Year. Northern Islington (No. 1 District) Southern Islington (No. 2 District) Total. 1930 (from 1st April) 4 3 7 1931 2 — 2 1932 7 4 11 13 7 20 Return furnished, by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1931. Registration Sub-Districts. Number of Births registered in 1931. 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 1932. Number of Statutory Declarations of Conscientious Objection received during year 1932. 1 2 3 4 5 6 7 8 9 10 12 Tufnell 339 166 2 — 109 19 6 14 17 6 78 Up. Holloway 804 390 3 — 228 33 5 93 45 7 1.557 226 Tollington 320 163 — — 104 13 8 7 15 10 108 Highbury 735 322 2 285 25 7 35 46 13 218 Lr. Holloway ... 486 256 — — 170 23 6 5 18 8 160 Barnsbury 674 328 1 — 254 32 10 6 33 10 1,759 233 Islington, S.E. 787 355 1 — 327 33 14 9 29 19 301 The Borough 4145 1980 9 1477 178 56 169 203 73 3,316 1,324 47 [1932 Return showing the numbers of persons successfully vaccinated and re-vaccinated at the cost of the rates by the Public Vaccinators during the year ended 30th September, 1932:— Name of the Institution or Vaccination District. Name of the Medical Officer or Public Vaccinator. Number of successful primary vaccinations of persons, Number of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under one year. One year and upwards. Total. Tollington Dr. M. J. Healy 200 43 243 41 Upper Holloway Dr. P. Inwald 191 16 207 30 Tufnell Dr. M. Hynes, P. Inwald and D. W. F. Latham 184 18 202 9 E. Lower Holloway Dr. H. E. Whitehead and Dr. J. E. Jackson and Dr. F. E. Clay 192 218 410 86 W. Lower Holloway Dr. S. N. Forbes 184 26 210 13 Highbury and W. Mildmay Dr. T. Galbraith 212 95 307 79 Canonbury, E Mildmay, E. St. Mary and E. St. Peter Dr. J. Lynch 284 60 344 34 Thornhill Dr. S. J. Rowntree 175 74 249 58 Barnsbury and W. St. Mary Dr. L. M. Leventon 203 173 376 68 S. St. Mary and W. St. Peter Dr. G. Madden 130 34 164 6 St. Mary, Islington, Hospital* Dr. W. R. Turtle 11 14 25 58 St. John's Road L.C.C. Institution* Dr. K. A. Anklesaria — — — — L.C.C. Schools, Andover Rcw* Dr. P. J. C.MacDonnell — 26 26 — L.C.C. Children's Homes, Hornsey Rise* Dr. P. J. C. MacDonnell — 3 3 — Total 1,966 800 2,766 482 Archway Hospital* Dr. T. Evans, April 1st to 30th September, 1932 1 3 4 — Grand Total 1,967 803 2,770 482 *Institutions. Vaccinations and re-vaccinations performed by the Public Vaccinators of the Council during the year 1932:— Children entered in Form H by the Vaccination Officers 1,853 Children not included in such lists, but vaccinated 491 Successful vaccinations performed at Surgery or elsewhere than at the homes of the persons vaccinated 602 Successful re-vaccinations performed at Surgery or elsewhere than at the homes of the persons vaccinated 408 Successful vaccinations or re-vaccinations performed at the homes of the persons vaccinated or re-vaccinated 2.302 Total 5,656 DISINFECTION. Disinfection of Rooms.—3,598 rooms were disinfected, as contrasted with 3,323 in 1931. For this purpose formaldehyde in solution was employed, although it was sometimes augmented by sulphur fumigation, when it was necessary to kill 1932] 48 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, and in certain cases special insecticide fluids or sulphur dioxide were employed. The above figures also include the disinfection of houses and rooms after Tuberculosis, vide p. 37. Rooms Disinfected. 1932 1931 1st Quarter 940 787 2nd 874 760 3rd 883 766 4th 901 1,010 The Year 3,598 3,323 Work at the Disinfecting Station.—35,675 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 46,683 similar articles disinfected during the previous year. In addition to the above articles 50,783 second-hand garments were disinfected for clothing contractors trading in the Borough, who paid the Council for the work, amounting to the sum of £42 4s. 0d. Altogether 86,458 articles described in the two paragraphs preceding were disinfected. Since the disinfection station was established 2,549,381 large articles have been disinfected. Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1932, and also in the preceding year 1931. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1932 1931 Beds 488 407 268 422 1,585 1,721 Blankets 1,157 937 720 1,126 3,940 4,215 Bolsters 294 273 240 282 1,089 1,422 Carpets 9 7 3 — 19 25 Chair Bed Cushions 131 79 79 109 398 127 Mattresses 352 296 273 364 1,285 1,484 Palliasses — — — — — 3 Pillows and Cases 1,739 1,477 1,181 1,615 6,012 6,099 Quilts 539 445 336 526 1,846 2,059 Sheets 1,013 820 643 996 3,472 3,841 Other Articles 4,736 4,060 3,107 4,126 16,029 25,687 Totals 10,458 8,801 6,850 9,566 35,675 46,683 The nature of the articles disinfected for the clothing contractors is shown below:– 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Blankets — — 750 750 Garments 4,402 8,802 11,870 22,078 47,152 Other Articles 100 640 490 1,651 2,881 Total 4,502 9,442 12,360 24,479 50,783 49 [1932 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 Cwts. 10 Gallons. 80 Gallons. Gallons. Nil. Disinfection of Premises — — — 30 Cost = £14 0s. 0d. Shelter House.—The Shelter House was not occupied during the year; baths were given to 7 verminous persons, while their clothing was disinfected. Four handywomen attended for the purpose of disinfection after attendance on cases of Puerperal Fever; and 38 other persons who had been in contact with cases of infectious diseases also had their clothing disinfected. Baths were provided for 20 persons who were suffering from Scabies (a series of 3 baths in each case), making a total of 60 baths. Disinfestation of School Children (Cleansing from lice and other vermin)—During the year 5,261 (including 885 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 disinfestation. The amount paid during the year by the London County Council for the baths given to the children was £570 7s. 0d. No proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, during the year. 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 1932. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under:— Factories, including Factory Laundries 882 Workshops, including Workshop Laundries 689 Workplaces, other than outworkers' homes 434 Domestic Workshops 68 Bakehouses 316 Restaurant Kitchens (see also p. 66) 707 Outworkers' premises 1,138 Miscellaneous re-inspections and calls 5,025 Total 9,259 1932] 50 Notices Served.—In consequence of the 1,190 sanitary defects discovered as the result of the inspections above, 324 intimation and 8 statutory notices were served. Of these notices 118 were served on the owners of factories, 90 on the owners of the workshops and workplaces, and 33 on the owners of bakehouses and 74 of restaurant kitchens. Two of the bakehouses were in an exceedingly dirty and neglected condition, and the Medical Officer of Health had to adopt strong measures in regard to them. They were, however, when pressure was brought to bear, effectively cleansed, and the conditions improved, so no prosecutions were taken. In addition to these nuisances, 100 were discovered on Outworkers' premises, necessitating the service of 12 notices. Most of these defects were remedied and it was not found necessary to resort to legal proceedings. Registers.—There were 2,630 workshops on the Registers as contrasted with 2,598 in 1931, while the total number of workrooms were 3,710, as compared with 3,674 in the previous year; 131 workshops were added to the Registers, while 98 were removed from it. The various workshops and workplaces are tabulated as below:— 1932. Workshops and Workplaces. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1,245 1,934 54 32 Workshops where Women are employed 518 816 23 44 Laundries 39 52 — 1 Bakehouses 234 250 1 4 Restaurant Kitchens 503 567 45 18 Other Workplaces 91 91 8 — Total 2,630 3,710 131 98 Outworkers' Premises 3,362 — 382 446 Workshops Notified to Home Office during Year 1932. Trade. Number of Workshops. Women. Male Young Persons. Totals. Dressmaking 11 24 — 24 Soft Toys 1 12 — 12 Hair Clips 1 1 — 1 Tailoring 1 1 — 1 Millinery 1 1 — 1 Furriers 1 2 2 Ties 3 4 4 Mantles 1 3 3 Upholstery 1 2 — 2 Confectionery 1 1 — 1 Umbrella Handles 1 1 — 1 Total 23 52 — 52 51 [1932 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices (3) Prosecutions. (4) Factories (Including Factory Laundries) 882 118 3 Workshops (Including Workshop Laundries) 689 90 — Workplaces (Other than Outworkers' premises) 434 39 — Miscellaneous Re-Inspections and calls 5.025 — — Total 7,030 247 3 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecu tions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts*— Want of cleanliness 364 361 — — Want of ventilation 25 25 1 — Overcrowding 5 5 — — Want of drainage of floors 7 7 — — Other nuisances 463 456 2 3 Sanitary Accommodation insufficient 29 33 — — unsuitable, foul or defective 290 284 — — not separate for sexes 7 7 — — Offences under the Factory and Workshop Arts— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) — — — — Total 1,190 1,178 3 3 * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Acts, 1901 as remediable under the Public Health Acts. 29 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) 92 12 92 Nil Outwork in infected premises (s. 109, 110) 8 — — — Total 100 12 92 Nil OUTWORKERS' LISTS (s. 107) : Lists received from Employers 1,059 Addresses received from Other Councils 1,799 Addresses forwarded to Other Councils 553 Firms failing to send in lists (No. letters sent) 321 1932] 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) 23 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 6 Reports (of action taken) sent to H.M Inspector 6 Other (New Factories reported under Home Office Memorandum, 1912) 23 Underground Bakehouses (s. 101) in use at the end of the year. 69 OUTWORK IN UNWHOLESOME PREMISES. SECTION 103. Nature of Work. (1) Instances. (2) Notices served. (3) Prosecutions. (4) Wearing Apparel— Making, &c. 40 4 — Cleaning and washing — — — Household linen — — — Lace, lace curtains and nets — — — Curtains and furniture hangings 4 — — Furniture and upholstery — — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and Grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, &c. 2 — — Artificial flowers 8 2 — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, &c., boxes, paper bags 19 5 — Brush making 8 — — Pea picking — — — Feather sorting — — — Carding, &c., of buttons, &c. — — — Stuffed Toys 1 — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas Crackers, Christmas stockings, &c. 10 1 — Textile weaving — — — Lampshades — — — Total 92 12 — SCAVENGING. Particulars are required in the Annual Report of any extension or improvement during the year of methods of scavenging or refuse disposal, and a statement as to the character and efficiency of the arrangements for the removal and disposal of house refuse. Mr. Wigfield, the Borough Cleansing Superintendent, kindly supplied me with the following statement:— (1) Street Sweeping. No material alteration has taken place with regard to the mileage of streets swept during 1932 as compared with the previous year. (2) Two "Electricar" 3-ton hygienic, low-loading refuse collecting vehicles were purchased and put into commission during the year. 53 [1932 (3) The method of refuse collection is on the same principle as for the past few years. During 1932 81% was collected by mechanical vehicles and 19% by horses and vans, the same percentage as for 1931. (4) Both house and trade refuse and street sweepings are sent to the contractors' dumps at Blackbridge and Holwell Hyde, Hertfordshire, where it is deposited in layers of approximately 6 feet in depth, each layer being covered with 9 inches of soil, and otherwise treated in accordance with the Ministry of Health's recommendations. As you know, the dumps are frequently inspected by the Cleansing Committee and myself and by the Local Sanitary Officers. (5) The arrangements for both collection and disposal of refuse are, I think, generally satisfactory, and compare favourably with those which exist in other Boroughs. The motor vehicles purchased and already in use during 1932 in Islington were:—22 Electricars, Ltd.; 4 General Vehicles; 1 Ransomes, Refuse; 1 Karrier, Refuse; 1 Commercial Car, Refuse; 4 Shelvoke, Refuse; 1 Dennis, Refuse; 2 Dennis, Cleansing; 3 Karrier, Cleansing; 2 Laffley; 5 Morris, Staff Cars; 1 Austin, Staff Car. REMOVAL OF DUST. 44 applications were received during the year by the Public Health Department for the removal of dust. The applications received for the previous ten years were as follows:— 1922 15 1927 25 1923 16 1928 25 1924 33 1929 21 1925 21 1930 40 1926 20 1931 36 Dust Receptacles Provided.—During the year 1,335 dust receptacles were provided by owners of property under notice. DISTRICT INSPECTORS' WORK. During the year the fourteen district inspectors made a total of 51,506 inspections and calls, an increase of 806 inspections on the corresponding period of 1931; while 13,869 improvements were effected in 5,375 premises; as against 12,815 improvements in 5,299 premises for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the district inspectors' work in 1932:— House to bouse inspections 2,937 Other inspections of dwelling houses 3,949 Re-inspections and calls made 41,983 Visits of inquiry re notifiable infectious diseases 1,962 Butchers' shops, stalls, etc. (Saturday nights) 83 Ice cream shops and factories 267 Dairies and Milkshops 1,068 Stables and yards 495 Urinals attached to Public Houses 229 Smoke observations 133 1932] 54 Notices Served—There were 4,662 intimation notices served by the inspectors with respect to nuisances. In 629 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.—88 rooms which were found to be in a verminous condition were fumigated. In 18 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Bag Flock Acts, 1911 and 1928.—In the routine inspections, the Sanitary Inspectors found no cause for action to be taken. Smoke Nuisances—115 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 133 observations were made by the District Inspectors, and 16 notices served upon the owners of the businesses requiring the abatement of the nuisance. In two cases it was, however, found necessary to institute legal proceedings, when convictions were obtained and penalties of £10 10s. Od. and £5 5s. Od. imposed. Water Certificates.—Seven water certificates were granted in accordance with the provisions of sec. 48 (2) Public Health (London) Act, 1921, in respect of 65 separate tenements newly erected or rebuilt during the year. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1928. MERCHANDISE MARKS ACT, 1926. All the District Sanitary Inspectors are officially appointed for this work. Special inspections for this particular duty under the Merchandise Maiks Act and under the Agricultural Produce (Grading and Marking) Act, by these and by the Food Inspector numbered 1,444. 11 prosecutions were taken under the Merchandise Marks Act, 1926, of which number 10 were successful and one was dismissed. No premises have been registered for the cold storage or chemical storage of eggs. WIDOWS', ORPHANS' AND OLD AGE (CONTRIBUTORY) PENSIONS ACT, 1925. Since these powers were delegated by the London County Council, no case has arisen so far under Section 6, so none falls to be reported on in 1932. 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. 55 [1932 Summary of Sanitary Work from Inspectors' Reports for the year 1932. Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 184 319 215 230 96 150 200 296 376 194 193 111 162 211 2937 Other premises inspected 186 261 162 406 97 305 349 311 216 306 385 445 252 268 3949 Re-inspections, Calls made, etc. 2370 3423 3369 3679 1791 3445 3024 2683 2906 2981 3425 3039 3320 2523 41983 Ice Cream Premises inspected 1 65 40 30 2 25 — 18 8 39 19 7 11 2 267 Dairies and Milk Purveyors inspected 11 137 124 72 58 121 88 60 44 71 34 88 21 139 1068 Stables „ 35 16 21 20 3 18 13 10 1 16 6 4 — 9 172 Yards „ 57 22 85 4 106 7 — 8 1 13 2 2 — 16 323 Agricultural Produce (Grading and Marking) Act, 1928 — — — — — — — — — — — — — — — Merchandise Marks Act, 1926 2 93 63 46 39 2 13 7 1 8 4 8 30 — 316 Urinals attached to P.H.'s inspected — 11 87 2 15 12 3 7 1 56 3 14 4 14 229 Premises (re Certificate Customs and Inland Revenue Acts) inspected — — — — — — — — — — — — — — — Premises (re Water Certificates) inspected — — — 1 — 11 19 — — — — — — — 31 Rag and Bone Dealers — 1 2 — — — 2 1 — — — 1 — 8 15 Rag and Flock Acts — — — — — — — — — — — — — — — Smoke observations — 12 — 38 — — 14 14 4 24 9 1 13 — 133 Shops, Stalls and Markets (Saturday evening) 4 6 6 5 5 8 7 7 7 5 6 6 6 5 83 Total Inspections and Calls 2850 4366 4174 4533 2212 4108 3732 3422 3565 3718 4086 3726 3819 3195 51506 Notices Served. Intimation Public Health (London) Act. 1891 163 427 234 496 62 367 272 388 421 420 425 506 177 304 4662 Housing Acts — 22 16 2 — — 2 5 10 — — 4 — 2 63 Ice Cream Shops — — — — — — — — — — — — — — 2 Dairies, etc. 1 2 2 2 — 1 1 3 8 — 2 13 — 1 36 Statutory Public Health (London) Act, 1891 17 77 36 51 5 42 31 55 57 54 48 114 18 14 629 Housing Acts — — — — — — — — — — — — — — — L.C.C. (General Powers) Acts — 7 1 — — — — — — — — 2 — — 10 Improvements. Drains— Constructed — — — — — — — — — — — — — — — Re-constructed 5 13 10 7 1 7 2 8 2 14 5 5 3 1 83 Repaired 15 6 3 28 1 19 4 14 1 23 20 3 1 7 145 Ventilated 8 22 12 8 — 10 3 5 — 16 3 2 — 2 91 Gully and other traps fixed 11 42 13 13 3 17 4 7 — 33 11 2 2 1 159 Urinals— Water supply—cleansed 2 8 3 2 1 4 3 3 7 — 8 — 2 43 Water Closets— W.C. erected with pan, trap and water supply 2 — 4 5 — 7 1 1 — 4 2 3 — — 29 Pan and trap only provided 26 42 44 48 — 35 20 37 27 66 58 28 12 33 476 Flushing apparatus repaired 30 43 28 33 — 27 11 27 31 18 26 31 12 20 337 Ventilated 1 1 — — — 2 — 1 — — — 2 — — 7 Walls, etc , cleansed 16 36 8 23 — 13 23 41 32 62 86 89 8 27 464 Position altered — — 1 — — — — — — — — — — — 1 Dust Bins provided 97 82 75 173 2 81 74 133 101 152 81 140 69 75 1335 Areas paved 2 10 7 5 — 2 — 5 — 10 3 10 — 3 57 Yards paved or repaved 9 45 24 38 1 24 11 26 15 30 16 61 3 4 307 Sinks Provided 23 52 15 13 1 15 10 50 11 45 19 5 — 7 266 Waste pipe repaired 14 48 26 55 3 13 28 88 45 39 16 62 6 12 455 Domestic Water Supply— Cisterns repaired aid cleansed 5 13 18 7 1 3 4 14 5 — 5 14 — 1 90 Water supply provided to dwelling house — — — — — — — — — — — — — — — Water supply provided to tenement house 5 37 — 12 — 5 2 4 4 26 5 2 — 3 105 Walls and ceilings of Rooms cleansed and redecorated 99 253 130 435 9 279 191 314 336 289 422 677 70 194 3698 1932] 56  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 27 60 26 70 2 41 38 88 75 54 102 158 19 56 816 Floor space ventilated 3 44 3 2 — 6 6 7 4 10 13 5 — 3 106 Floors repaired 26 67 27 56 1 35 18 52 50 36 51 128 8 19 574 Guttering and rain water pipes repaired 35 37 14 73 3 60 31 59 19 53 34 69 10 22 519 Roofs repaired 38 88 53 206 4 91 44 87 74 82 104 164 32 73 1140 Overcrowding abated — 6 8 19 — 9 1 — 4 3 12 6 1 3 72 Illegal use of underground rooms for sleeping discontinued — 2 — — — — 1 3 2 — 5 29 — — 42 Other improvements, or Nuisances abated 52 128 52 201 6 118 73 157 111 105 243 286 41 95 1668 Rooms Disinfected 229 2 170 120 9 — — — — — 143 — 111 — 784 Total improvements 778 1181 779 1653 49 920 604 1231 952 1177 1485 1989 408 663 13869 Total premises improved 383 377 449 699 23 348 244 373 331 433 661 486 276 292 5375 HOUSES LET IN LODGINGS. The hous.es which come under the operation of the bye-laws received 2,235 inspections during the year, followed by 4,220 subsequent re-inspections and calls, so that the total visits amounted to 6,455. These inspections resulted in 869 intimations being served on the persons responsible, which were followed by 150 statutory notices to demand the abatement of the nuisances discovered by the Inspectors especially engaged upon this work. 15 summonses were issued for non-compliance with Statutory Notices. In 3 cases Orders were made for the work to be done in specified periods. In 9 cases fines were inflicted. The amount of fines and costs in these cases totalled:—Fines, £28 18s. 0d., and costs, £26 0s. 0d. One summons was issued for illegally letting an underground room as a dwelling and the defendant was fined £1 1s. 0d. Altogether 3,812 improvements were effected in 892 premises. Synopsis of Inspector s Work:— Improvements. Drains: Constructed — Reconstructed 3 Repaired 14 Ventilated 3 Gully and other traps fixed 12 Water Closets: W.C. erected with pan, trap and water supply 9 Pan and trap only provided 38 Flushing apparatus repaired 107 Ventilated — Walls, etc., cleansed 133 Position altered 2 Dust Bins : Provided 160 Areas: Paved 7 Yards: Repaved 44 7 [1932 Sinks: Provided 19 Waste pipe repaired 34 Domestic Water Supply : Cisterns repaired and cleansed 14 Water supply provided to tenement house 11 Walls and Ceilings of Rooms cleansed and redecorated 1374 Other Improvements: Staircase and passages repaired, cleansed and redecorated 441 Floor space ventilated 2 Floors repaired 103 Guttering and rain water pipes repaired 85 Roofs repaired 233 Overcrowding abated 4 Illegal use of underground Rooms for sleeping discontinued 8 Other Improvements, or Nuisances abated 926 Rooms Disinfected 26 Total Improvements 3812 Total Premises Improved 892 SEWER EMANATIONS. See page fit), Medical Officer of Health's Report for 1929, and page 70, Report for 1930. During 1932 as in 1931 the London County Council were still conducting experiments. RATS AND MICE (DESTRUCTION) ACT, 1919. (9 and 10 Geo. 5. Ch. 72.) Rat Week in Islington this year was treated in a somewhat different way from previous years, inasmuch as our Committee decided in the place of public posters throughout the Borough, as formerly, to issue handbills as widely as possible. We exhibited of course the usual transparencies at the Town Hall, but in place of 300 large posters, 5,000 small handbills were ordered, and of these 4,000 were actually issued, leaving 1,000 in reserve for occasional callers or enquirers at the Town Hall. The handbills were distributed from the enquiry counter of the Public Health Department, and also left by the Sanitary Inspectors during the course of their visitation in the various districts. A number were also distributed by the Health Visitors in the homes and also at the workplaces by the Inspectors of Workshops. There was not this year quite the same demand for rat poison. Personally, I feel that there is a decided opening, if it were placed on the market, for a good rat poison put up in a collapsible tube to sell at not more than sixpence per tube. The majority of small households are quite willing to experiment with something at that cost, but if the cost is 9d. or 1/-, they are not so ready to take it. We did during the past year try a proprietary poison issued at sixpence in collapsible tubes, but it appeared to have the disadvantage that it did not keep potent once it had been opened, therefore it is ineffective for a second or subsequent bait. During our Rat Week in November I was indirectly approached as to whether my department could give good advice to a very large educational institute in the Borough. On investigation it was found that the rats complained of were possibly 1932] 58 finding their way out of the drains and sewers by way of an uncovered ventilating pipe to the drain. The only parts of the building which seemed to be affected were the kitchen and a workshop, which were not very much over-run. It was suggested that the windows leading into the building from the roofs should be closed during the time there were no attendants in that part of the building. These matters were attended to, and we were later informed that no further rats had been seen. Traps, however, were set about the building to catch any stray rats which might come. As there is a railway close to the establishment, and there was a possibility of rats also coming from there, it was recommended that the gateways be protected at the bottom by iron meshing. At the same time as this investigation was going on, we received complaints of rats from buildings adjacent to a refuse depot, and it was found that rats were gaining access to adjacent properties through holes in the walls underneath the footings of the buildings, which were very old. This was remedied by a protective course of bricks, put in below the footings, and concrete, and the walls were repaired. Upon subsequent visitation to the premises from which the complaints came, we were told that the protective measures had proved successful. The depot in question is in direct communication with the railway, and it was found upon making enquiries at the depot that it would be inexpedient to put down poison for the following very interesting reason. This depot is visited by a number of cats and dogs from the neighbourhood, a curious but easily explained association. One would have thought that cats and dogs would not be in agreement, but here they have a common interest, they greatly assist in keeping down the rat trouble, and because of their assistance, which is considered to be of great value, it is not expedient to use poison. Traps are, however, in continual use at the depot, looked after by the foreman and his men. Summary of Work under the Rats and Mice (Destruction) Act during the years 1925-32:— 1925 1926 1927 1928 1929 1930 1931 1932 Number of Streets visited 96 217 235 203 144 166 223 250 Number of Private Houses visited 133 320 368 349 223 387 385 391 Number of Shops and Factories visited 14 61 81 56 36 37 48 17 Total Premises inspected 147 381 449 405 259 424 433 408 Found Rat Infested 66 174 191 154 101 142 178 169 Found Mice Infested 2 5 8 2 4 3 10 9 Defective Drains Repaired (Cause of Rat trouble) 51 49 48 49 23 45 50 63 Number of Complaints received 105 173 202 150 124 176 216 203 MILK AND DAIRIES ORDER, 1926. Under this Order, 8 summonses were taken against 6 individuals or firms (in two cases there being two summonses). Two summonses were for filling milk bottles in the street. In spite of frequent warnings, the habit of doing this, which is contrary to the law, persists, the individuals taking the risk when they think they are safe, presuming no Inspector is about. It is obvious that such craftiness in avoiding the law is difficult to detect, and only a very small proportion is found out. One company was fined £5 for failing to cleanse vessels and appliances. One summons was for carrying on the trade of purveyor of milk without being registered; three summonses for using premises as dairies contrary to the Order were successful; (in one case a fine of £20 was inflicted, with £5 5s. Od. costs, in another a fine of £5, and the third was dismissed on payment of £1 1s. 0d. costs). 59 [1932 HOUSING. REPORT BY THE MEDICAL OFFICER OF HEALTH ON THE INSPECTION OF CERTAIN PROPERTIES IN THE BOROUGH. On pages 61-65 of the Medical Officer of Health's Annual Report for 1931 is a full report of the housing surveys undertaken by the Public Health Department. This report was considered by the Joint Public Health and Housing Committees on the 15th June, 1931, when several areas were personally inspected by members of the Committee with a view to further consideration. RE-CONDITIONING OF HOUSES. During the year in respect of some of these areas visited, as the result of intimations, re-conditioning of houses was effected. 63 intimations for re-conditioning were served under Secton 17 of the Housing Act, 1930, the Council being satisfied that the houses were occupied or were of a type suitable for occupation by persons of the working classes, and were unfit for human habitation. Notices were served on the owners of the property in respect of particulars which were set out in separate schedules. Among these, the particular houses which had been viewed by the Committee in 1931 were:—Fairbridge Road, 6 houses re-conditioned. Ellenborough Road, 2 houses, and the houses in Cornelia Street were voluntarily re-conditioned by the owner. Apart from these districts, however, notices under the Housing Act were served against houses in the following roads:—Blenheim Road, Nicholay Road, Cornwallis Road, Lysander Grove, Windsor Road (2), Grovedale Road, Kiver Road, Hornsey Road, Mulkern Road, Marlborough Road, Duncombe Road; these are all in Upper Holloway Ward. As regards Tollington Ward, notices under the Housing Acts were served on houses in the following roads:—Beaumont Road, Hanley Road, Bracey Street (4), Almington Street, Hornsey Road (2), Hazellville Road, Hornsey Rise Gardens, Regina Road, Turle Road, Tollington Place, Thorpedale Road and Shaftesbury Road. In Highbury Ward a notice was served in respect of premises in Hamilton Road. In Mildmay Ward notices were served in respect of houses in Caroline Cottages and Mayville Street. In Thornhill Ward, Freeling Street (3), Outram Street, Havelock Street, Caledonian Road, Lyon Street, Blundell Street (2), York Road, Charlotte Terrace, Winchester Street. In the Barnsbury Ward notice was served in respect of a house in Barnsbury Road. In St. Mary's Ward, one notice was served in respect of a house in Allen Street, and in St. Peter's Ward, one house in Remington Street. UNDERGROUND ROOMS. On the 21st October the Borough Council issued a Closing Order under Section 20 of the Housing Act, 1930, in respect of two underground rooms at 100, Newington Green Road. In compliance with the Order the rooms were vacated on the 5th December, 1932, and have not been re-let. Action was taken under the Public Health (London) Act, 1891, in respect of an underground room at 7, Gifford Street, let as a dwelling. The person letting was fined £1 1s. 0d. Action was also taken here against the occupier for occupying the said underground room. The summons was withdrawn when the premises were vacated. 1932] 60 As regards another underground room at 484, Caledonian Road, the person letting was fined £5 and ordered to pay £2 2s. 0d. costs, the person occupying was fined £1 1s. 0d. and ordered to pay £1 1s. 0d. costs. At 488, Caledonian Road, where an underground room was let, the person letting was fined 20/- and ordered to pay 20/- costs. Summary of Housing from 1919 to 1932 (inclusive):— The number of houses or flats provided by the Islington Borough Council, the London County Council and by private enterprise in the Borough, was as follows:— 1919 to 1931. 1932 Total since 1919. Number of houses or flats provided by the Islington Borough Council 896 4 900 Number of flats provided by the London County Council 371 6 377 Number of houses or flats provided by private enterprise 454 87 541 1,721 97 1,818 Particulars of houses or flats provided under the Council's Housing Schemes 1919 to 1931. 1932. Total since 1919. Halton Mansions (8 more flats to be erected on lease of two houses falling in during 1932). 160 — 160 City Mansions 47 — 47 Queen's Mansions 43 — 43 Warltersville Mansions 46 — 46 Manchester Mansions 31 — 31 Addington Mansions 107 — 107 Avenell Mansions 40 — 40 Leyden Mansions 111 — 111 585 — 585 *Conversion of 16 houses into 62 dwellings 4 66 Tyndale Mansions 102 — 102 Laycock Mansions 132 — 132 Houses, etc., Highbury Station Road 15 — 15 896 4 900 *Includes:—27, Rupert Road 8, Barnsbury Street 27 and 28 Canonbury Villas Not converted 2, Highbury Grange 61 [1932 The number of overcrowding cases recorded as dealt with by service of notice during the years 1923 to 1932 was:— 1923 17 1924 13 1925 19 1926 26 1927 24 1928 37 1929 21 1930 32 1931 59 1932 72 Total 320 others were dealt with by housing recommendations to L.C.C. HOUSING RECOMMENDATIONS FROM THE PUBLIC HEALTH DEPARTMENT. During the year 1932, recommendations were made to the London County Council regarding housing accommodation for "special hardship" cases. In all, 36 were recommended for special consideration. The basis on which these recommendations were made consisted of families living under overcrowded conditions, but in a number of cases ill-health of members of the family was the main reason for the support given to enable them to receive favourable consideration of their efforts to secure better housing conditions. Of the 36 cases recommended by the Medical Officer of Health, 14 of which were given on account of overcrowding, during the year:— 11 were provided with accommodation by the London County Council. 8 removed to an unknown address. 3 secured better accommodation in Islington. 14 still remained in their Islington occupation. In addition to these 36 cases in which a "special hardship" recommendation was given, several investigations were made into cases brought to the notice of the Medical Officer of Health which called for much sympathy, but which fell short of the standard of "hardship" laid down, namely, gross overcrowding, ill-health of members of the family, and the difficulty of the separation of the sexes. In some of these cases a recommendation was given for consideration should there be any spare accommodation apart from that allocated for "special hardship" cases. Since the scheme was inaugurated in January, 1929, the total number of "special hardship " recommendations given is 252. WATER SUPPLY. Number of houses which have not an adequate internal water supply, i.e., water supply from taps only, in yard, 131. Premises on which notices have been served under the London County Council (General Powers) Act, 1907 (Additional Water Supply), 105. 1932] 62 DEMOLITION OF HABITABLE DWELLINGS. During the year 16 houses have been demolished, having been taken for new business premises. METROPOLITAN BOROUGH OF ISLINGTON. Housing Statistics for the Year, Ministry of Health Table. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b) 93 (b) With State assistance under the Housing Acts. (i) By the Local Authority, Nil (ii) By other bodies or persons Nil 1.—Inspection of Dwelling-houses during the Year. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,886 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,425 (a) Houses inspected on complaint or after illness 1,883 (b) Registered tenement houses inspected 2,235 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,512 2.—Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 612 3.—Action under Statutory Powers during the Year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs, 63 (2) Number of dwelling-houses which were rendered fit— (a) by owners 63 (b) By Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5,291 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 5,375 (b) by Local Authority in default of owners — 63 [1932 c. Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — D. Proceedings under Section 20 of the Housing Act, 1930— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit E. Proceedings under Section 17 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) by owners 3 (b) by Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close, F. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Closing Orders were made — (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (3) Number of dwelling-houses in respect of which Demolition Orders were made — (4) Number of dwelling-houses demolished in pursuance of Demolition Orders — G. Housing Act, 1930, Section 19. (Power to Local Authority to order demolition of insanitary house). Sub-section 2 provides for undertaking to demolish by owner or mortgagee. Number dealt with thus Nil 1932] 64 NUMBER OF HOUSES OWNED BY THE LOCAL AUTHORITY, DISTINGUISHING THOSE BUILT IN THE LAST TWO YEARS, AND HELD UNDER:— (1) Part III. of the Housing Act, 1925. (2) Part II. of the Housing Act, 1925, and (3) Other powers. Held under Total at 31st Dec., 1929 Erected in 1930 & 1931 Total Part III of Housing Act 1925 Nil. Nil. Nil. Part II of Housing Act 1925 Nil. Nil. Nil. Other Powers 749 151 900 Total 749 151 900 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 1929 59 Nil 17 3 79 1930 68 2 27 2 99 1931 35 4 22 1 62 1932 26 4 11 — 41 Totals 1,163 151 195 29 1,538 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Inspector Wilkinson reports that the use of the private slaughterhouses within the Borough is still on the wane. In the 12 private slaughterhouses on the register at the beginning of 1932, only 192 oxen and 3,695 sheep and lambs were killed, as 65 [1932 shown by the returns of the licencees and the 424 visits paid to them, moreover, two of that number were allowed to lapse in October at the Annual Licensing by the London County Council. There is in addition one slaughterhouse (knacker's yard) where horses for export only are killed; here, during the year, 1,558 were slaughtered. This also is a reduction in number during recent years. The quality of the animals killed in the Borough slaughterhouses is beyond reproach; no part of any carcase was found unfit during the year. The diseased internal organs (offal) were mainly parasitic livers, far too common in otherwise healthy and young stock, due to grazing on badly drained pastures, where they are reared prior to the feeding period. Tables are appended showing the unsound and diseased food destroyed and the number of visits to particular classes of shops. At one butcher's shop 286 lbs. of beef, mutton and lamb were seized as being unsound and unfit for human food. The meat was found in the refrigerator and chopping room, and the defendant appeared at the Local Petty Sessions Court where he was fined £5 5s. 0d. and £5 5s. 0d. costs. A tinned foods dealer in the Caledonian Market was summoned for having in his possession 62 lbs. of tinned food in a blown or otherwise unsound condition. He was fined at the same Court £25 and £5 costs. A pig's carcase and also one small pig's head were seized at the Caledonian Market, but owing to certain extenuating circumstances no legal proceedings were taken. SALE OF FOOD ORDER, 1921. One prosecution was taken for exposing for sale imported meat not properly labelled. The summons was dismissed on payment of £1 1s. 0d. costs. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. No prosecutions for the year. CERTIFICATION OF MEAT FOOD PRODUCTS FOR SHIPMENT ABROAD. The Medical Officer of Health, as Designated Officer for Food Certification, issued 14 certificates in respect of foods prepared in Islington and exported abroad and to the Dominions. UNSOUND FOOD DESTROYED. The food destroyed or otherwise disposed of so as to prevent its use for human food was as follows:— Tons. cwts. qrs. lbs. Diseased organs from slaughter-houses (surrendered) 3 3 11 Meat and Tinned Hoods from shops and stalls (seized) — 3 3 3 Various Meats and Poultry from shops and stalls (surrendered) .. — 2 0 9 Fish from shops, fryers and wholesale dealers (surrendered) 6 12 0 14 Fruit and Vegetables 3 6 1 12 Total 10 8 0 21 The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 10 tons 8 cwt. 21 lbs. The diseases which affected animal food are set out in detail on page 66. 1932] 66 LICENSED STREET TRADERS IN THE BOROUGH OF ISLINGTON FOR THE YEAR 1931. Meat, etc., 30, Fish, Poultry, Rabbits, 46, †Ice Cream 48, Confectionery, Minerals, etc., 29, *Grocery, Provisions, Tinned Food, etc., 71, Coffee Stalls, etc., 12, Fruit, Vegetables, Greengrocery, etc., 266. t Some also,sell confectionery and minerals. *One tinned food only. Shops, etc., Inspection of.—21,027 visits were made to shops and places in the Borough where foodstuffs are sold. Butchers, Provision Dealers, etc., Shops 7,087 visits Butcher, Provision, etc., Stalls 2,432 „ Meat, etc., Preparation Factories, 114 „ Fish Shops 1,322 „ Fish Stalls, 1,029 „ Fruit Shops 2,174 „ Fruit Stalls 6,869 ,, Total 21,027 ,, Offensive Trades include 3 tripe dressers, 4 gut scrapers, 4 fur skin dressers, and Knacker's Yard, which received a total of 45 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 1932:— No. of Cases. Description of Animal affected. Nature of Disease. Extent of Disease. How disposed of. 1 Ox Tuberculous Lungs and Costal Pleura .. Destroyed on premises 42 Oxen Parasitic (Dis. Hep.) Livers Council's Destructor 1 Sbeep Acute Congestion Lungs Destroyed on premises 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 105 81 Coffee and Dining Rooms 263 62 Refreshment Rooms 170 42 Provision (Cooked Meats, cooked but not consumed on premises) 169 55 707 190 67 [1932 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1932. UNSOUND FOOD AS PRIZES.—In the Medical Officer of Health's Annual Report for Islington for the year 1930, pages 76 and 77, a summarized report was given of an investigation in Islington where unsound food (chocolates) was distributed as prizes. A prosecution could not be undertaken as the "food" was not "exposed for sale." The matter was duly reported and later came before the Standing Joint Committee of the Metropolitan Borough Councils, with the result that the case has now been met by legislation in the London County Council (General Powers) Act, 1932. The Act, which came into force on the 12th July, 1932, in Section 8, provides an extension of Section 47 of the Public Health (London) Act, 1891, in respect of the inspection and destruction of unsound meat, etc., and now any animal or any article whether solid or liquid which is intended for the food of man is deemed to be sold or exposed for sale or deposited in such premises or place for the purpose of sale or preparation for sale as the case may be even when no money passes if it is offered as a prize or reward. PRESERVED FOOD AND ICE CREAM. In this Act also preserved food and ice cream (the latter was previously dealt with under the London County Council (General Powers) Act, 1928) come under review as regards the registration of premises. Any premises in a district of any sanitary authority used or proposed to be used (1) for the sale or manufacture for the purpose of såle of ice cream or other similar commodity or the storage of ice cream or other similar commodity intended for sale; or (2) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale, shall be registered by the owner or occupier or intending occupier thereof with the sanitary authority. It will be noted that this involves the registration of premises where the following articles are made:— SAUSAGES and allies, large and small, with or without skins. Saveloys, Black Puddings, White Puddings, Haggis, Rissoles, Bladders of Lard and sausage skins alone. Meat, potted, pressed, pickled, preserved. —Potted meat or head, tongues, etc., Meat Pastes, Meat Extracts, Faggots, Cooked Meats, Sheep's Head, etc., Pork, Meat Pies, Pork Pies, Dripping, Brawn, Brisket (pressed), Meat and Pork (pressed), Meat and Pork (pickled), Trotters (pickled), Hams and Bacon (boiled, cooked, smoked or cured or otherwise preserved). Fish, potted, pickled, preserved.—Pastes, various. Fish, cured or dried, Eel Pies' and Jellied Eels, pickled or soused fish, canned fish. OTHER FOODS.—Potted, Pressed, Pickled, Preserved. Canned soups containing meat, hors d'oeuvres, if containing meat or fish. As a consequence of this legislation, 64 premises for preserved food were registered during the six months ending the 31st December, 1932. In addition, of course, the ice cream premises, numbering 336, remained registered and all the premises come under the provisions of the new Act. NOTIFICATION OF FOOD POISONING. Section 7 of the London County Council (General Powers) Act, 1932, requires : —Every registered medical practitioner attending on any person shall if he suspects 1932] 68 or becomes aware that such person is suffering from food poisoning forthwith send to the Medical Officer of Health of the district in which such person is, a certificate stating the full name and the age and sex of such person, the full postal address of the house or premises at which such person is and particulars of the food poisoning from which such person is or is suspected by such practitioner to be 'suffering and stating also whether the case occurs in the private practice of such practitioner or in his practice as a Medical Officer of any public body or institution. DEFINITION OF FOOD POISONING. For the convenience of medical practitioners, the Medical Officer of Health issued a circular to the local medical practitioners giving details of the requirements of the Act, and intimating that the purpose of the notification of food poisoning is obviously to trace poisoned food. Food poisoning therefore is where the food itself is poisoned either by bacteria or other poison and the individual is poisoned by partaking of the same. When a person suffers from faulty digestion or otherwise and partakes of food which disagrees owing to the particular idiosyncracy of the individual, this is not food poisoning. Many individuals are susceptible to certain articles, such as strawberries, tinned salmon, shell fish, etc., and after partaking of these show an eruption or rash on the skin, and are rendered unwell. These are technically classed as " allergic " cases and should not be notified as food poisoning, as they are merely the reaction of the sensitive individual to something which disagrees with him. The food poisoning notifiable under this Act is, as stated, a matter of the food itself being affected by bacteria or other poison, and owing to this the partaker being in turn poisoned. During the portion of the year the Act was in force, six such cases of food poisoning were notified, the alleged poisoned foods being, 2 fish, 2 fish paste, 1 roast pork, and 1 shrimps. ARTIFICIAL CREAM ACT, 1929. This Act is for regulating the manufacture and sale of reconstituted cream, a subject to which reference was made in the Annual Report of the Medical Officer of Health, 1929, page 74. This "cream " is made by emulsifying butter with dried skimmed milk powder and water. The number of applications received during the year was one (for temporary registration only). At the end of the year the number still remaining on the register was 2. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. During the year 4 informal samples were taken under the above Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. Seven informal samples were taken and found in order. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. For prosecutions under this Act see page 78. Milk Purveyors and Dairies.—At the close of the year there were 698 milk purveyors and dairies on the register, 69 having been added to it, while 27 were removed. The District Sanitary Inspectors paid 1,068 visits to them, and served 36 notices for the carrying out of various sanitary improvements and the cleansing of dirty utensils. 69 [1932 THE MILK AND DAIRIES (AMENDMENT) ACT, 1922; THE MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year 1932 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. t of Fees received. 1932. 1932. £ s. d. Certified 9 9 2 5 0 Grade A (Tuberculin tested) 26 26 6 5 0 „ (Pasteurized) 3 3 15 0 Grade A 7 7 1 15 0 „ (Bottling Licence) 1 1 2 2 0 Pasteurized (Dealer) 14 14 2 12 6 „ (Pasteurizer) 4 4 4 4 0 Supplementary:— Pasteurized 2 2 4 0 Grade A (Tuberculin Tested) 1 1 2 0 67 67 £20 4 0 ADULTERATION OF FOOD AND DRUGS—FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year 1,181 samples of foods and drugs, including 573 informal samples, were submitted for analysis by Mr. Green, the Food and Drugs Inspector, who purchased the samples for submission to our Analyst, Dr. Alan W. Stewart. Of the total samples, 1,143 were reported to be genuine and 38 adulterated, or 3.2 per cent. This percentage is 0.8 below the previous year, and 4.0 below the average rate during the preceding 10 years. There were 22 prosecutions under the Food and Drugs (Adulteration) Act, 1928, of which 17 were successful, 15 relating to milk. Seven samples of milk were taken at the request of other Local Authorities, and sixteen samples of milk were submitted by the Inspector for bacteriological examination. Four informal samples were taken under the Public Health (Condensed Milk) Regulations, 1923 and 1927 ; and seven informal samples under the Public Health (Dried Milk) Regulations, 1923 and 1927, all of which were found to be satisfactory. In addition to this work, Inspector Green made 1,128 visits under the Merchandise Marks Act; 3 special visits in connection with food poisoning; 42 visits respecting the Departmental Enquiry on Shop Assistants, and instituted prosecutions other than under the Food and Drugs Act as follows :— Merchandise Marks Act, 1926 13 Milk and Dairies Order, 1926 1 Milk and Dairies Amendment Act, 1922 2 Milk and Dairies (Consolidation) Act, 1915 5 No proceedings were taken under the Public Health (Preservatives in Food) Regulations, 1925-1927, as such, but under the Food and Drugs (Adulteration) Act, 1928. 1932] 70 Proceedings which would have come under the Public Health (Preservatives, etc., in Foods) Regulations, and amending Regulations, 1925, 1926 and 1927, can now be taken under the Food and Drugs (Adulteration) Act, 1928, in which provision is made, Section 2 (4)—" Where any Regulations made under the Public Health (Regulations as to Food) Act, 1907, as amended by any subsequent enactment and the enactments mentioned in that Act prescribing the composition of any article of food intended for sale or prohibiting or restricting the addition of any preservative, etc., the purchaser of such article shall unless the contrary is proved be deemed for the purpose of this Section to have demanded an article complying with the provisions of such Regulations. The Public Health (Preservatives in Foods) Regulations replace the Milk and Cream Regulations, and, among other foods, no cream may contain preservative. During the year 1932, 23 informal samples of cream were taken, and one was found to be adulterated; a formal sample was taken, which however proved to be genuine. 38 informal samples of sausages and 8 informal samples of breakfast sausage were taken. Four of the informal samples of sausages were found to be adulterated and three formal samples were subsequently taken. Proceedings were taken in Court in these cases, which were in respect of sausages sold by three different vendors in the Caledonian Market without any declaration that the articles sold contained preservatives. During the year 1932 in addition to the samples taken and submitted to the Public Analyst there was a total of 126 informal samples which were examined by the Food and Drugs Inspector. These informal samples comprised a number of varied articles. The greatest amount of detected adulteration occurred in the first quarter of the year, as shown by the figures given in the statement below, when it was 7.0 per cent. and contrasted with 4.1 and 1.3 per cent., respectively, in the first, second and fourth quarters. Examined. Genuine. Adulterated. Per Cent. Formal Informal Formal Informal Formal Informal Adulterated. 1st Quarter 173 139 159 131 14 8 7.0 2nd „ 151 140 143 136 8 4 4.1 3rd „ 110 165 110 165 - - - 4th „ 174 129 172 127 2 2 1.3 The Year 608 573 584 559 24 14 3.2 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 111 8.83 3.56 12.39 Milk purchased on Week-days 806 8.82 8.60 12.42 Milk procured in transit at Finsbury Park Station 179 8.89 3.72 12.61 Official Standard 8.50 3.00 11.50 71 [1932 Sophistication of Milk.—The particulars as to the genuineness or otherwise of the samples procured or purchased on Sundays, Weekdays, and at Finsbury Park Railway Station are as follows :— Number taken. Genuine. Adulterated. Percentage Adulterated. On Sundays 111 109 2 1.8 On Week-days 306 303 8 1.0 At Railway Stations 179 167 12 6.7 (Farmers' Milks) 596 579 17 2.8 Giving the particulars of the Milks taken during each quarter of 1932 on Sundays Week-days, and at the Railway Stations. 1932. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Weekdays. Railway Stations. All Milks. Sundays. week-days. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. 1st Quarter 20 98 46 164 20 96 41 157 - 2 5 7 - 2.0 10.8 4.2 2nd „ 36 63 50 149 36 62 43 141 - 1 7 8 - 1.6 14.0 5.3 3rd „ 19 62 29 110 19 62 29 110 - - - - - -- - - 4th „ 36 83 54 173 34 83 54 171 2 - - 2 5.5 - - 1.1 The Year 111 306 179 596 109 303 167 579 2 3 12 17 1.8 1.0 6.7 2.8 The number of samples of milk purchased was 596, of which 579 were genuine, and 17, or 2.8 percent. were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1932 :— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 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 1928 664 638 26 3.9 1929 539 523 16 3.0 1930 672 661 11 1.6 1931 610 595 15 2.5 Average 10 yrs. 649 621 28 4.3 1932 596 579 17 2.8 1932] 72 Showing the analysis of 6,490 milks examined in Islington during the 10 years 1922-31 and 1932, and distinguishing those purchased on Sundays, on Week-days, and procured at the Railway Stations whilst in transit from the Farmer to the London Milk Purveyor :— Sunday Milks. Week-day Milks. Railway Milks (Farmers). Years. No. of Samples Percent. of nonfatty solids. Percent. of fat. No. of Samples Percent. of nonfatty solids. Percent. of fat. No. of Samples Percent. of nonfatty solids. Percent. of fat. 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 1928 124 8.95 3.52 362 8.93 3.49 178 8.92 3.67 1929 142 9.02 3.50 236 8.99 3.41 161 9.01 3.80 1930 110 8.86 3.69 439 8.85 3.61 123 8.90 3.90 1931 95 8.82 3.63 329 8.83 3.64 186 8.93 3.79 Total samples and average constituents (10 years) 1,151 8.84 3.53 3,680 8.86 3.53 1,659 8.88 3.70 1932 111 8.83 3.56 306 8.82 3.60 179 8.89 3.72 WARNING REGARDING " MIGRATORY " VENDORS OF MILK AND THE SALE OF MILK ROUNDS BY THESE AND OTHERS. During the year 1922 the Borough suffered from what was apparently an organized attempt on the part of itinerent vendors to foist upon the poorer population sophisticated milk. Numerous prosecutions ensued and the offenders were so severely dealt with by the Magistrates that the gang left the neighbourhood, and the Borough has been practically free from the " cheap " milkman until 1932, the year under review, when the two persons who were at the head of the gang in 1922 attempted to purvey milk on a number of rounds in Islington. As in 1922, the procedure was to work up rounds in poor neighbourhoods by selling milk at a very low price. Five or six weeks later the rounds were then advertised for sale, usually roughly £100 each with a guaranteed profit of £5 and £6 per week. Needless to say, the purchasers (who were usually unemployed men with small savings and no knowledge of the milk trade), were quickly disillusioned and found that they had lost their savings, and moreover were in trouble with the local authority, as the formalities regarding registration had in no case been carried out. When enquiries were made by the Council's Inspectors, false names were usually given by the vendors, but in two instances the Food and Drugs Inspector was able to recognize the men, although a period of ten years had elapsed, and when they were prosecuted for breach of the Regulations, it was possible to prove previous convictions. Other Boroughs have been troubled similarly, and several prosecutions initiated by the victims have been reported in the public press. Misleading Descriptions. —During the latter part of 1931 and the early part of 1932, numerous mixtures of what purported to be a mixture of wine with whisky, brandy and rum were placed on the market at what appeared to be a very low price, when the label on the bottle was taken into consideration. This label in nearly every instance stated that the article was blended to a strength of 40 73 [1932 degrees. To the ordinary customer it appeared that he was getting spirits to a strength of 40 degrees under proof. Owing to the high price of spirits, people were induced by the misleading description to speculate in these articles. When analysed the strength was found to be 60 degrees under proof. Proceedings were taken in respect of two of these blends, when the defence was that what the label really meant was 40 degrees proof of wine measure. The cases were dismissed after a lengthy hearing. The Council's prosecutions were justified, inasmuch as the Finance Act, 1932, has now dealt with the matter and made the sale of these blends illegal. Summary of Prosecutions during the year 1932. Total Prosecutions Successful. Dismissed. Withdrawn. Amount of Penalties Costs Received. £ s. d. £ s. d. "Public Health (London) Act, 1891 " 34 32 - 2 89 10 0 64 13 0 " Food and Drugs (Adulteration) Act, 1928" 24 20 1 3 22 15 0 30 3 0 " Milk and Dairies Order, 1926 " 8 8 - - 32 10 0 7 16 0 " Milk and Dairies (Consolidation) Act, 1915" 5 5 - - 7 0 0 2 4 0 Merchandise Marks Act, 1926 11 10 1 - 3 5 0 2 11 6 L C.C. By-laws, 1930 5 4 - 1 3 0 0 4 1 0 " Public Health (Smoke abatement) Act. 1926" 2 2 - - - 15 15 0 " Milk and Dairies (Amendment Act) 1922" 2 2 - - 3 1 0 2 1 0 " L.C.C, (General Powers) Act, 1902" 1 1 - - 0 10 0 0 10 0 " Sale of Food Order, 1921" 1 1 - - - 110 Totals 93 85 2 6 £161 11 0 £130 15 6 ISLINGTON HOSPITALS, CLINICS, Etc. Beds. St. Mary's (Islington) Hospital 878 Archway Hospital, Archway Road 628 Royal Northern Hospital 286 Mildmay Memorial Hospital 30 Mildmay Maternity Home 17 London Fever Hospital 200 In addition, all the Central and North London Hospitals are used by Islington residents. OTHER INSTITUTIONS. Islington Institution, St. John's Road, N.—Accommodation for 1,528 (plus 23, for " Petty Officers," that is, those inmates who are employed in the Institution). In " Sick " Ward : Males, 196 beds; females, 292 ; and 18 cots. In "Infirm" Ward: Males, 120 beds; females, 183. In Main body of the Institution (including the " Petty Officers " accommodation) for the able-bodied cases : Males, 465 beds; females, 231; and 23 cots. Duchess of York Centre (Maternity), Essex Road.—No "beds," but clinic, and receives cases for Royal Free Hospital. North Islington Nursery School, 110, Tollington Park, N.4.—Opened 28th May, 1930.50 (possible extension to 80) children under 5 years. Islington Dispensary, 303, Upper Street. Islington Medical Mission, Britannia Row, 1932] 74 The Almeric Paget Massage Corps, Islington Centre, Britannia Row, N.l.—The number of attendances were 13,151 ; number of treatments given 34,124, in respect of 6,224 adults, 3,902 children and 3,025 infants. An interesting part of the above is the Nasal Hygiene Clinic conducted by Dr. Octavia Lewin. 215 children attended this clinic. Child Guidance Clinic, Tudor House, Canonbury Place, N.l.—The attendances at this Clinic, in addition to those referred there by the London County Council from schools, etc., numbered 297, as follows:—Under 5 years, 34 boys and 19 girls ; over 5 years, 127 boys and 117 girls. The children referred through the London County Council numbered 173, of whom 107 were boys and 66 were girls. Clinics, etc., not including Public Assistance, were enumerated on page 79 of the Report for 1931. PUBLIC HEALTH CONGRESS.—14th-19th November, 1932. Royal Agricultural Hall. The Medical Officer of Health was sent by the Council as Delegate, and a separate report by him on the proceedings was circulated to the members of the Council. PROPAGANDA WORK by the Public Health Department. The following booklets and literature were issued during the year, and are available on application at the Public Health Department Town Hall:— Hints on the Care and Feeding of Infants, with addresses of Welfare Centres, Tuberculosis Dispensaries, Registrars, Public Vaccinators, etc., Smallpox and Vaccination, Notes on Tuberculosis, Flies and Gnats, Measles, Whooping Cough, Diphtheria, Scarlet Fever, Infectious Diseases—Law. GARDENS, SQUARE AND OTHER ENCLOSURES IN THE BOROUGH. Area in acres. Alwyne Square .2 Arlington Square .878 Arundel Square 1.252 *Astey's Row 1.06 Barnsbury Square .995 Caledonian Road Enclosure .07 *Canonbury Square Gardens .6 Compton Terrace 1.128 *Duncan Terrace, Garden .87 Duncan Terrace, enclosure .29 *Edward Square Garden .2 Essex Road Enclosure .23 Fieldway Crescent Enclosure .017 Gibson Square .722 Highbury Park, enclosure .17 Highbury Fields 27.25 *Islington Green .8 *Kingsdown Road Enclosure .023 Lonsdale Square .47 75 [1932 Area in acres. Loraine Place .633 *Market Road Garden 2.7 *Market Road Playground 2.7 Milner Square .502 *Morton Road Playground .5 Mountford Crescent Enclosure .109 Mountford Terrace Enclosure .18 *Newington Green Gardens 1.7 Northampton Park 1.31 *Penn Road Gardens .3 Prebend Square Enclosure .09 *St. Mary's Church Gardens 1.7 *St. Mary Magdalene Gardens 4.5 *Thornhill Gardens .7 Thornhill Square Gardens 2.385 Thornhill Crescent .469 Tibberton Square Enclosure .127 Union Square .44 Wilton Square .268 *Maintained by the Borough Council under powers conferred by the Open Spaces Act, 1906. Finsbury Park and Waterlow Park are just outside the northern, and Clissold Park the eastern, boundary of the Borough. APPENDIX. Vital and Sanitary Statistics, 1932 TOGETHER WITH THE PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 1932] 78 STATISTICAL APPENDIX Showing Deaths from all Causes in Islington during the year 1932. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. DISEASES. Sex All ages AGES. DISTRICTS. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 & up Tuf. U.H. Toll. L.H H. B. S.R. AU, CAUSES M. 2,060 203 71 23 17 23 43 83 118 243 366 473 323 74 179 226 222 242 354 350 487 F. 1,953 137 70 21 26 27 39 80 94 162 291 410 452 144 201 207 206 210 349 283 497 Typhoid and paratyphoid fevers (1-2) M. - - - - - - - - - - - - - - - - - - - - - F. Measles (7) M. 34 12 38 2 - - - - - - - - - - 1 8 4 8 2 9 20 F. 18 - Scarlet Fever (8) M. 3 1 4 1 1 - - - - - - - - - 1 - - 2 1 3 F. 4 Whooping Cough M. 11 12 10 1 - - - - - - - - - - 1 1 4 4 4 3 6 F. 12 Diphtheria (10) M. 8 2 7 5 5 - - 1 - - - - - - 1 - 2 5 1 2 9 F. 12 Influenza (11) M. 49 3 2 - - 1 2 9 4 10 18 25 27 2 14 15 6 22 11 12 23 F. 54 Encephalitis lethargica (17) M. 1 - - - - - 1 - - - - - - - - - - - - - 1 F. - Cerebro-spinal Fever (18) M. 8 6 1 1 1 1 - 1 1 - - - - - 1 1 1 1 1 5 2 F. 4 Tuberculosis of Respiratory Svstem (23) M. 152 - 2 - 6 18 29 52 51 49 34 17 5 1 28 30 32 26 39 44 65 F. 112 - Other Tuberculous diseases (24-32) M. 25 4 17 3 4 2 - 5 1 5 1 1 1 - 4 6 4 3 4 8 15 F. 19 Syphilis (34) M. 12 5 - - - - 2 - 2 4 2 3 1 - - 2 3 O 4 2 6 F. 7 General Paralysis of the Insane— tabes dorsalis. (83) M. 9 - - - - - - 2 3 5 3 - - - - 1 3 - 1 3 5 F. 4 Cancer M. 277 - 2 - 1 1 1 12 19 78 157 158 92 13 56 58 58 67 108 73 114 Malignant disease (45-53) F. 257 Diabetes (59) M. 6 - 1 - - - 1 - - 3 6 13 2 - 3 4 1 2 4 5 7 F. 20 Cerebral haemorrhage, &c. (82) M. 85 1 - - - - 2 2 2 21 37 71 57 14 24 28 29 21 37 22 46 F. 122 Heart disease (90-95) M. 394 2 2 2 4 11 7 24 27 68 160 249 237 62 75 86 92 77 149 142 234 F. 461 Aneurysm (96) M. 13 - - - - - 1 - 1 4 5 5 1 - 1 1 1 5 1 4 4 F. 4 Other circulatory diseases (97-103) M. 65 - - - - - 1 - - 9 27 36 48 15 17 10 10 16 23 28 32 F. 71 Bronchitis (106) M. 86 7 1 1 - - 1 1 6 15 15 37 57 18 14 12 16 26 21 31 39 F. 73 Pneumonia (all forms) (107-109) M. 179 49 23 5 1 1 5 6 20 39 49 71 50 10 26 36 44 29 54 56 84 F. 150 Other respiratory diseases (110-114) M. 13 3 1 3 2 - - 1 1 2 10 6 4 - 2 2 5 4 5 5 10 F. 20 Ulcer of Stomach and duodenum (117) M. 36 1 - - - - - 3 4 16 16 12 5 - 4 5 4 5 12 12 15 F. 21 Diarrhoea, etc. (119-120) M. 43 65 9 - - - 1 1 1 1 - - 1 1 6 5 9 13 12 22 13 F. 37 Appendicitis (121) M. 15 - 6 1 4 - 2 2 2 2 3 3 - - 2 6 3 2 5 2 5 F. 10 Cirrhosis of liver (124) M. 9 — — — — - - - 1 3 2 4 - - - 1 1 1 2 1 4 F. 1 Other diseases of Liver, &c. (125) M. - - - - - - - - - - 2 1 1 - - - - - 1 1 2 F. 4 Other digestive diseases (115, 116, 122, 123, 126-129) M. 19 4 - 2 - - 1 2 3 7 8 12 7 1 7 5 4 7 7 10 7 F. 28 Acute and Chronic Nephritis (130-132) M. 65 1 - - 2 - 4 - 13 13 27 34 27 5 14 13 11 13 29 16 30 F. 61 Puerperal sepsis (140-145) F. 7 - - - - - 4 4 4 1 - - - - 2 - 1 1 4 2 3 Other puerperal causes (146-150) F. 6 Congenital debility, Premature birth, M. 76 115 1 - - - - - - - - - - - 8 9 8 12 33 19 28 Malformations, &c. (157-159) F. 41 Senility (162) M. 64 - - - - - - - - - - 12 96 59 14 44 14 13 26 19 37 F. 103 Suicide (163-171) M. 26 - - - - - 2 6 6 7 13 11 1 1 8 2 6 1 12 10 8 F. 21 Other Violence (172-198) M. 74 10 6 6 2 6 6 11 9 6 15 20 19 5 12 12 13 16 27 13 29 F. 48 Other defined diseases M. 203 37 8 11 10 9 9 18 31 37 47 81 36 10 34 30 39 48 63 52 78 F. 141 Causes ill-defined or unknown M. - - - - - - - - - - - - - - - - - - - - F. 79 [1932 (Ministry of Health Return.) Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1932. Causes of Death. Sex All ages 0— 1— 2- 5— 15— 25— 35— 45- 55— 65— 75— All Causes M 2081 207 47 25 41 66 83 118 244 370 477 403 F 1985 138 42 30 47 66 80 96 168 291 414 613 Measles M 34 9 16 8 1 - - - - - - - F 18 3 10 4 1 - - - - - - - Scarlet Fever M 4 - 1 1 2 - - - - - - - F 4 1 - 2 1 - - - - - - - Whooping Cough M 14 7 4 3 - - - - - - - F 16 7 4 4 1 - - - - - - - Diphtheria M 7 2 - 3 1 - 1 - - - - - F 12 - - 4 8 - - - - - - - Influenza M 52 1 1 - 1 1 4 1 6 14 12 11 F 59 2 - 1 - 2 5 4 6 5 15 19 Encephalitis Lethargica M 2 - - - - 1 - - 1 - - - F 1 - - - - - - - - 1 - - Cerebrospinal fever M 8 4 - - 1 1 1 1 - - - - F 3 1 1 - 1 - - - - - - - Tuberculosis of respiratory system M 153 - 1 1 2 16 31 31 33 25 10 3 F 118 - - 1 5 32 23 21 17 9 7 3 Other Tuberculous Diseases M 25 3 7 1 2 1 3 - 4 2 1 1 F 17 1 4 2 4 1 2 1 - - 1 1 Syphilis M 19 2 - - - 1 - 3 4 5 4 - F 11 3 - - - 1 1 2 - 3 1 - General paralysis of the insane, tabes dorsalis m 21 - - - - - 2 4 5 5 4 1 F 7 - - - - - - - 4 3 - - Cancer, malignant disease m 284 - 1 - - 1 5 7 37 89 99 45 F 262 - 2 - 1 2 0 12 44 71 62 63 Diabetes M 12 - - - — - - 1 - 3 7 1 F 28 - 1 - - 1 - - 3 8 13 2 Cerebral haemorrhage, &c. M 70 - - - - - - 1 7 16 19 27 F 98 - - - - - - - 8 14 35 41 Heart Disease M 374 - - - 2 6 4 11 37 85 115 114 F 445 - - - 3 10 20 13 24 60 125 190 Aneurysm M 20 - - - - 1 - 1 4 7 6 1 F 14 - - - - 1 - 1 1 4 3 4 Other circulatory diseases M 60 - - - - 1 - - 5 8 18 28 F 66 - - - - - - - 4 14 20 28 Bronchitis M 88 8 - 1 1 1 1 3 14 9 20 30 F 77 4 1 - - - 1 - 3 7 16 45 Pneumonia (all forms) M 180 25 6 6 5 3 6 14 29 28 35 24 F 156 21 14 3 1 2 2 8 9 27 32 37 Other respiratory diseases M 40 1 1 - 2 1 - 2 2 2 9 20 F 35 - - - 3 - - 1 4 3 7 17 Peptic ulcer M 32 1 - - - - 1 3 12 9 4 2 F 15 - - - - - - 1 3 5 6 1 Diarrhoea, &c m 40 34 2 - - - - 1 - - - 3 F 33 24 2 1 - - 1 - 1 - 2 2 Appendicitis M 16 - 2 1 3 2 - 2 3 2 1 - F 8 - - 3 2 - - - - 1 2 - Cirrhosis of Liver M 13 - — 2 2 5 4 - F 1 - - - - - - 1 - - - Other diseases of liver, etc. M 5 - - - - - - - - 1 3 1 F 6 - - - - - - - - 2 1 3 Other digestive diseases M 30 1 - - - 2 2 3 7 5 5 5 F 39 4 1 1 2 2 1 2 2 6 11 7 Acute and Chronic Nephritis m 55 - - - - 2 - 6 5 14 16 12 F 69 - - - 1 2 - 6 9 15 17 19 Puerperal Sepsis F 7 - - - - - 5 1 1 - - - Other puerperal causes F 7 - -- - - 4 - 3 - - - - Congenital Debility and Premature Birth, Malfornations, etc M 93 92 - - 1 - - - - - - - F 55 54 - 1 - - - - - - - - Senility M 35 - - - - - - - - - 1 34 F 79 - - - - - - - - - 1 78 Suicide M 32 - - - - 3 4 3 3 7 11 1 F 17 - - - - - 2 4 3 7 - 1 Other violence M 71 6 2 1 7 9 9 5 7 6 12 7 F 49 4 2 1 1 1 2 1 I 6 9 21 Other Defined Diseases M 192 11 3 - 10 13 9 13 17 23 61 32 F 150 8 - 2 12 5 10 15 20 20 29 29 causes Ill-defined or unknown M - - - - - - - - - - - - F 3 1 - - - - - - - - - 2 Legitimate. Illegitimate. Deaths under 1 year M. 189 18 Registered Births M. 2577 F. 125 13 F. 2529 (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1932. 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 45-65 65 and upwds Small Pox Notifications 1 5 3 6 2 25 29 30 32 8 19 2 162 162 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever Notifications 12 52 79 85 95 363 166 47 66 14 4 .. 983 961 Deaths 1 1 1 2 .. 1 1 .. .. .. .. .. 7 7 Diphtheria Notifications 17 27 51 51 60 216 82 24 55 9 8 1 601 600 Deaths 2 .. 6 1 .. 5 5 .. 1 .. .. .. 20 19 Enteric Fever Notifications .. .. .. .. .. 2 1 3 7 1 .. .. 15 15 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerpeial Fever Notifications .. .. .. .. .. .. .. 2 26 7 .. .. 35 33 Deaths .. .. .. .. .. .. .. 1 3 2 1 .. 7 7 Puerperal Pyrexia Notifications .. .. .. .. .. .. .. 5 50 9 .. .. 64 56 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Primary and Influenzal Pneumonia Notifications 6 19 14 8 9 39 13 25 62 40 76 30 341 206 Deaths 5 3 1 .. .. 3 1 .. 10 10 32 30 95 11 OphthalmiaNeonatorum Notifications 91 .. .. .. .. .. .. .. .. .. .. .. 94 21 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica Notifications .. .. .. .. .. .. .. .. 1 .. 1 1 3 3 Deaths .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 Cerebro spinal Fever Notifications 3 3 .. .. .. 2 1 1 1 2 .. .. 13 13 Deaths 6 1 .. .. .. 1 1 1 1 1 .. .. 12 5 Acute Poliomyelitis Notifications .. 2 .. .. .. .. .. .. .. .. 1 .. 4 4 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax Noiificatiors .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery Notifications 1 3 2 .. 3 4 2 .. .. .. .. .. 15 15 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria Notifications .. .. .. .. .. .. .. .. 1 1 .. .. 2 2 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas Not fications .. 1 1 4 .. 6 6 7 30 21 59 30 165 107 Deaths 1 1 .. .. .. 1 .. .. .. 2 3 11 19 17 Continued Fever Notifications .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox (except in the vaccinated under 10 years) Notifications 13 23 26 20 38 217 58 17 14 1 2 .. 429 .. Deaths •• .. •• •• •• •• .. .. .. .. .. •• .. .. 1932] 80 81 [1932 (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1932. Premises. No. on Register at end of 1932 No. Added in 1932 No. Removed in 1932 Number of Inspections 1932 Number of Notices 1932 Number of Prosecutions 1932 Milk Premises +698 - - 1,068 36 4 Cowsheds Nil Nil Nil Nil - Nil Slaughter-Houses 13 ,, ,, 424 - ,, *Other Offensive Trade Premises 12 ,, ,, 57 - ,, Ice Cream Premises 336 ,, ,, 267 2 1 Registered Houses Let in Lodgings 1,006 - - 2,235 869 15 * Including the Knackers Yard, 4 Fur Skin Dressers, 3 Tripe Boilers, 4 Gut Scrapers + Including 293 Bottle Milk only. Housing of the Working ClassesNumber of houses inspected — (а) On account of complaints or illness (P.H. Act) 6,886 (b) House-to-house (Housing Consolidated Regulations, 1925) 1,425 Number of notices served— (a) Under P.H. Act:— (i) Intimation 4,662 (ii) Statutory 629 (A) Under Housing Act 63 Number of houses repaired or nuisances remedied under P.H. Act 5,375 Number of houses repaired under Section 3 of Housing Act— (a) By owners 63 (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— (а) Erected during year 93 (b) In course of erection Nil Number of representations by Medical Officer or other person Nil Number of houses included in such representations Nil Number of Closing Orders made Nil Number of Closing Orders determined (i.e. Houses made fit) Nil Number of Demolition Orders Nil Number of houses demolished — (a) In pursuance of Orders Nil (b) Voluntarily Nil Total number of houses in the Borough about 46,000 Number of houses occupied by the working classes about 29,000 Underground Rooms— Number illegally occupied 42 Number closed or illegal occupation discontinued 42 Overcrowding— Number of cases of overcrowding found 72 Number remedied 71 Number of prosecutions 1 1932] 82 Smoke nuisances— Number of observations 133 Number of complaints 115 Number of notices served 16 Number of legal proceedings 2 Cleansing and Disinfection— Number of adults cleansed 75 Number of children cleansed 6,146 Number of premises cleansed :— (a) After infectious diseases 2,789 (b) For vermin 88 Water supply to tenement houses— Number of premises supplied 105 Number of prosecutions Nil Sanitary officers— Chief Sanitary Inspector (Whole time) 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. Tables and Reports have appeared in previous Annual Reports of the Medical Officer of Health. Reference is made here to 1931 only. Annual Report 1931. Page 9 Report on Maternity and Child Welfare Work. Page 17 Work of the Day Nurseries. Pages 17, 18 and 19 Report of the Work of Voluntary Centres. Page 30 Prosecution non-notification of Infectious Disease. Pages 39 and 40 Islington Interim Tuberculosis Care Committee. Pages 60, 61, 62, 63, 65, Housing. 66 and 67. Pages 63 and 64 Basement Rooms. Pages 69 and 70 Census. Page 75 Cheese Sandwiches, Black Currant Pastilles. 83 [1932 INDEX Paee Accidental Deaths 19. 24 Acreage i" Acute Poliomyelitis 31 Adulteration of Food 69 Ages at Death 7, 8 Agricultural Produce (Grading & Marking) Act, 1928 54, 73 Anti-toxin treatment 28 Anthrax 33 Appendix 77 Area iii Artificial Cream 68 „ Sunlight Treatment 40 Bacteriological Examinations 42,43, 45 Diphtheria 42, 43 Bakehouses 50 Basement Rooms 59, 60 Births iii, 4, 5 ,, Illegitimate 5 „ Notification of 5 „ Stillborn 5 Blind Persons Act, 1920 34 Cancer 21, 78, 79 Cattle Market 70 Certification of Meat Food Products 65 Census Information iii Chicken Pox Regulations 32 Cleansing of Verminous School Children 49 Clinics 73 Coal gas Poisoning 24 Condensed Milk Regulations 68 Congress (Public Health) 74 Consumption (see Tuberculosis) iii, 22, 23, 24, 37 Coroner's Court, &c 25 Cow Sheds 81 Cream 70 Day Nurseries 17 Dairies and Milkshops (Inspection of) 55 Deaths from all causes during the year iii, 5, 78, 79 Deaths from Epidemic Diseases iii, 19, 20 „ „ Respiratory Diseases iii, 22, 23, 24, 78, 79 „ in Public Institutions 18, 19 „ Maternal 9, 10, 11 „ Age at 6, 7, 8, 78, 79 Definition of Food Poisoning 68 Demolition of Habitable Dwellings 62 Density iii Diarrhoeal Diseases 20 Diphtheria 28, 78, 79 „ Anti-toxin treatment immunisation 28 1932] 84 Page Diphtheria Bacteriological 42, 43 Diseases Treated in Hospital 29, 30 Disinfectants distributed and used 49 Disinfecting Station 48, 49 Disinfection Work 37, 47,48 Disinfestation of School Children 49 District Inspectors' Work 63, 54, 55 Dried Milk Regulations 68 Dust, removal of 62, 53 Dust receptacles provided 55,56 Dysentery 32 Emanations, Sewer 57 Encephalitis Lethargica 33, 78, 79 Enteric Fever (Typhoid) 29, 42, 43, 78, 79 Epidemic Diseases "i. 1®. 20 „ Cerebro-Spinal Meningitis 31, 32, 78, 79 Exemption Certificates 45, 46 Extract of Vital Statistics 3 Erysipelas 21, 29 Factories and Workshops Administration 49-52, 66 Fatality from Notifiable Infectious Diseases 25 Finsen Light Treatment 40 Food, Inspection of, Unsound, Adulteration of 61,65,66 Food Licensed Street Traders 66 Food Order 65 Food Poisoning 68 Food (Preservatives) Regulations 1925, 1927 69 Gas (Coal) Poisoning 24 Glanders, Anthrax and Hydrophobia in Man 33 Health Visitots (Municipal) 14, 15 Home Visitations—Tuberculosis 41 Hospitals—Clinics 73 Hospital Isolation of Infectious Diseases 29, 30 Housing 59-64 „ Accommodation and Recommendations 60, 61 Houses Let in Lodgings 56, 57 Ice Cream Premises 55, 67 Illegitimate Births 5 Infantile Mortality iii, 6, 7, 8 Infant Welfare Work 14-17 Infection, Prevention of 26 Infectious Diseases (London) Regulations, 192 32 Infectious Diseases in Schools 41, 42 „ „ (Non-Notifiable) in Schools 42 Informal Sampling 69, 70 Influenza 20, 21, 78, 79 Inspection of Food 64, 65 „ „ Houses 53, 55,56 „ „ Kitchens of Restaurants 49, 50, 66 „ „ Milkshops and Dairies 55 „ „ Slaughter Houses and Cow Houses 64, 65, 81 „ „ Workshops 49, 50. 51 Institutions 73 Institutions (Deaths in) 18,19 Increase of Rent (Restrictions) Acts 64 Inquests 25, 26 Insulin (Supply of) 33, 34 Invalid Children's Aid Association 18 Isolation of Infectious Diseases 29 85 [1932 Page Islington Chickenpox Regulations 32 Islington Interim Tuberculosis Care Committee 35 Kitchens and Restaurants 49, 50, 66 Legal Proceedings 73 L.C.C, Bylaws, 1930 73 Public Health (Lond.) Act, 1891 73 Public Health (Preservatives in Food) Regulations 70 Food and Drugs (Adulteration) Act, 1928 69, 73 Sale of Food Order 192 65, 73 Meat Regulations, 1924 65 Milk and Dairies Order 1926 69, 73 Merchandise Marks Act, 1926 54,69,73 Milk and Dairies (Consolidation) Act, 1915 68, 73 Light Treatment—Artificial Sunlight and "Finsen" 40 London County Council Return of Sanitary Work 81 London County Council (General Powers Act) 1902. 1932 67,73 Malaria 32 Malignant Diseases 21, 22 Marriages 3 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work 9, 17, 18 Maternal Deaths 9, 10, 11 Maternity Outfits 44 Measles (Deaths) 8, 78, 79 Measles, Notifications by School Teachers 42 Meat Inspection 64, 65, 66 Meat, labelling of 65 Medicines, Provision of 33, 34 Merchandise Marks Act, 1926 54, 73 Ministry of Health Returns 79, 80 Milk and Dairies (Consolidation) Act, 1915 68, 73 Milk and Dairies Order, 1926 58, 73 Milk, Bacteriological Analyses 45 Milk Scheme 13 „ Adulteration 70, 71, 72 Milk Purveyors and Dairies 68 „ Special Designations Order—Licences 69 Mortuary and Coroner's Court 25, 26 Notification of Infectious Diseases 26—33 „ „ Tuberculosis 34, 36 „ „ Births Act 5 ,, „ Still-births 5 Non-notifiable Infectious Diseases in Schools 42 Notices served 54, 55, 56 Nursery School 79 Offensive Trades 66 Open Spaces 74 Ophthalmia Neonatorum 9 Outworkers' Premises 51, 52 Other Notifiable Diseases 31 Pathogenicity Tests (Diphtheria) 42 Pemphigus Neonatorum 12 Phthisis 34-41, 43 „ Notification of 35-37 Places where Food is Prepared 64, 65 Pneumonia 23, 32, 78, 79 Pneumothorax treatment 40 Poisoning (Gas) 24 Polioencephalitis 33 1932] 86 Piee Population at the Census, 1931 iii „ estimated, 1932 iii,3 Potted Meat and Fish 67 Preserved Food (a) Inspectors Visits 66,67 (6) Registration of Premises 67 (c) London County Council Table 81 Prevention of Infection 26 Propaganda 74 Prosecutions, Summary of 73 Public Health Committee ii Public Health (Meat) Regulations, 1924 65 Public Health (Preservatives, etc., in food) Regulations, 1925, 1927 69 „ Staff 2 „ „ (Tuberculosis) Regulations 1930 36, 37 1925 35 Public Vaccinators 47 Puerperal Diseases 11, 12, 21 Puerperal Fever and Pyrexia 12 Polio-Myelitis, Acute 31 Pulmonary Tuberculosis 22, 23, 43 Rag a d Flock Act (1911-1928) 54, 55 Rats and Mice (Destruction) Act, 1919 57, 58 Rateable Value iii Reconditioning of Houses 59 References—M.O.H. Reports 82 Regulations, Chickenpox Notification 32 Removal of Dust 52, 53 Rent and Mortgage Interest (Restrictions) Acts 64 Report on Housing 59-64 Report on Maternity and Child Welfare 9 Report on Work of Day Nurseries 17 Respiratory Diseases iii, 22, 23, 24, 78, 79 ,, Tuberculosis 34—41, 78, 79 Restaurant Kitchens 49, 50, 66 Sale of food Order—Labelling of Meat 65 Samples Analysed in 1932 69 Sanitary Inspectors' Work 53, 54, 55 Scavenging 52,53 Scarlet Fever 28 Schools 41, 42, 49 Septic Diseases 21 Sewer Emanations 57 Shelter House 49 Shop Inspections 66 Slaughterhouses 64, 65, 81 Small Pox 27 Smoke Nuisances 64 Sophistication of Milk 71 Specialist Consultations 12 Statistics 77 Sterility of Maternity Outfits 44 Still Births, Registration 5 Street Accidents 19, 24 Street Traders 66 Summary of Housing 60 Summary of Vital Statistics iii Synopsis of Inspectors' Work 53 Tetanus (Toy Pistol) 43, 44 Tuberculous Diseases iii. 22, 23, 42, 43 87 [1932 Page Tuberculous Meat 66 Tuberculosis (Interim Care Committee) 35 Tuberculosis Dispensaries 38, 39,40 „ Notification of 34 ,, Respiratory, All forms. Deaths iii, 22, 23, 24, 37, 78, 79 „ (Public Health) Regulations, 1930 36, 37 „ Visiting Nurse 41 „ Public Health (Prevention of Tuberculosis) Regulations, 1925 35 Typhoid Fever (see Enteric) 29 Underground Rooms and Basements 59, 60 Unsound Food, Destroyed 66 Unsound Food as Prizes 67 Vaccination 45-47 Vaccination Officers 47 Venereal Diseases 24 Verminous Children, Disinfcstation of 49 „ Premises 55 Voluntary Maternity and Child Welfare Centres 16. 17 Water Certificates 54 Water Supply 55, 61 Welfare Work by Health Visitors 15, 16 Whooping Cough 42 (Deaths) 78, 79 Widows', Orphans' and Old Age (Contributory) Pensions Act, 1925 54 Workshops and Factories, Inspection of 49-52