Ac 4361 M ISL 73 1933 SEVENTY-EIGHTH 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. 1933 SEVENTY-EIGHTH 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 k Co., Printers, 170, Farringdon Road, E.C. 1. ii MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1988, to November, 1984) Mayor. Alderman BERTIE HOLDEN. J.P. Deputy Mayor. Councillor LEONARD McCLANE Aldermen. HERBERT SAMUEL JORDAN FRANK LEYDEN SARGENT CHARLES BUNDOCK CHARLOTTE CLIFFORD FREDERICK C.COOKSEY FREDERICK COPPING WILLIAM H. GALE WALTER HARPER ARTHUR JAS. KENT Ctuncillers. WALTER FREDERICK NOKES EDWARD HENRY TOMKINS, J.P. JESSIE MAY LEE JOHN MURRAY HENRY PENN WILLIAM T. RICKETTS MATILDA SOUTHGATE, J.P. FRANCIS JOHN GEORGE BRUCE WATSON Chairman Alderman JORDAN Vice-Chairman Councillor BUNDOCK MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE (November, 1933, to November, 1934) A Idermen. WM. EDWIN MANCHESTER. J.P. ALBERT EDWARD PETTET Councillors. WILLIAM H BURGESS VIOLET E. BOATRIGHT CHARLOTTE CLIFFORD RONALD C. DOWDESWELL ROSA ESSEX WILLIAM H GALE JAMES T. HOARE ]ESSIE MAY LEE WINIFRED L. LE MESSURIER MAUD A. MANCHESTER JOHN MURRAY MARTHA PANNELL EDITH URSULA SAY MARGARET SUMMERS 'Members appointed by the Council trom outside their own body Lady ANDKEWES, Windy Gap, Merton Lane, Highgate, N 6 Mrs. DOWSE, 27, Gordon Place, Kensington, W.8 Dr. ALICE VANCE INGRAM, 10, North Hill, Highgate, N 6 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 1933 Population (Enumerated at Census, 1981) 321,795 persons ,, Estimated Mid-year 1982 and 1938 319,100 persons Decrease on Census population, 1931 2,695 persons Mean Population, ten years (1923-1932) 329,760 persons Area 3,092 acres Density (Mid-year 1933) 103 persons per acre Blrths male 2,362 Females 2,219 Persons 4,581 Birth rate 14.35 per 1,000 inhabitants Deaths from All Causes Females 1965 Persons 3,957 Death rate 12.40 per 1,000 inhabitants Deathsfrom Principal Epidemic Diseases 71 158 persons Death rate 0.49 per 1,000 inhabitants Deaths from All Tuberculosis Females persons Death rate 0.98 per 1,000 inhabitants Deaths from Respiratory Tuberculosis. Female 274 persons Death rate 0-86 per 1,000 inhabitants Infantile Deaths under 1 year Female 1 Total 288 Infantile mortality rate 63 per 1,000 birchs Excess of Births over Deaths 624 Rateable value of Borough of Islington £2,182,991 Sum represented by a penny rate. £8,675 IV Public Health Department, Town Hall, Upper Street, N.l, To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. 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 1933. The death-rate (12.4) was practically the same as in the previous year (12.36). The infantile mortality rate was 63 as against 68 in the previous year, and 64 in 1931. Smallpox was much less prevalent, only 11 cases being notified, as against 162 in 1932. During the year, commencing on the 1st April, the Borough Council took over from the London County Council under the Transfer of Powers (London) Order, 1933, the following duties which come under the purview of my department. (1) Public Health Services. (a) Licensing, inspection and supervision of Seamen's Lodging Houses. (There are at present, however, none in Islington.) (b) Registration, licensing, inspection and regulation of common lodging houses. (c) Licensing of dairymen to use premises as cowhouses. (d) Licensing and inspection of slaughterhouses and knacker's yards. (e) Sanctioning of establishment or enlargement of premises used for offensive trades. (2) Maternity and Child Welfare Services. Duties concerned with Infant Life Protection under Part 1 of the Children Act, 1908. This work has added considerably to the duties of my staff, and in the case of the health visiting slaff it was found expedient to practically transfer a health visitor to the infant life protection work, while allowing her to continue just a little of the routine health vsitor's work to enable her to be in touch with this also. Mr. Hargraves Wilkinson, Inspector Meat and Foods in Islington for over thirty-one years, died on the 12th June. He was held in high esteem by the traders, the community generally, and by all, with whom he came officially in contact. His passing elicited kindly sympathy from beyond the Borough. My thanks are due to the Chairmen of the Committees and the Members of the Council for the sustained interest they take in the work of the Department, both in its Public Health and Maternity and Child Welfare aspects, and to the Superintendent and Members of my staff generally for their assistance during a year in which we had with added duties more than the average amount of work. I am, Your obedient Servant, Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1933. 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 29-37. Typhoid Fever at camp, page 32. 3. Tuberculosis, pages 38-46. Care Committee, page 39. 4. Accidental Deaths, page 28. Inquests and Coroner's Court, page 29. Death due to Copying Ink Pencil, page 29. Aged and Infirm persons, page 64. 5. Bacteriological Work, etc., pages 47-49. Examination of Peas used in the making of Pease Pudding, page 48. Chemical Analysis Work -Water Softening, page 49. 6. Meat, Food and Drugs, pages 74-82. Inspection of places where Food is prepared, page 79. Food Poisoning, page 79. 7. Housing, Underground Rooms, etc., pages 67-74. Scavenging and Controlled Tipping, page 58. 8. Workshops, pages 55-57. Sanitary Work, pages 59-63. 9. Transfer of Powers, OfFensive Trades, Common Lodging Houses, Slaughterhouses (including Knacker's Yards) Cowhouses, etc., pages 63, 75, 78. 10. Health Visitation and Work of Voluntary Welfare Centres, pages 14-21. Infant Life Protection, page 22. 11. Summary of Legal Proceedings, page 84. 12. Index to Report, pages 93-97. 1933] 2 Public Health Staff. The staff of the Medical Officer of Health (G. CLARK TROTTER, M.D. ; D.P.H. ; F.R.S.F.) 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. Abraham Warren Haydock, Cert. Sanit. Inst., Ex. Joint Bd.f Hargreaves Wilkinson, Cert. Sanit. Inst.f Died 12th June, 193:!. Inspector of Workshops and Bakehouses and Senior Inspector. Harry John James Watson, Cert. Sanit. Inst. Inspectors of Workshops, &-c., in which Females are Employed. Miss Eleanor H. 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. Inspectors of Houses Let in Lodgings. Donald V. Watkins, Cert. Sanit. Insp. Ex. Joint Bd.f Maurice George Crook, Cert. Sanit. Insp. Ex. Joint 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. Allem Bagshaw, Cert. Sanit. Inst.f „ 4. Colin W. S. Lewis, Cert. Sanit. Insp. Ex. Bd.f 5. Stanley P. Marks, Cert. Sanit. Insp. Ex. Bd.f 6. William Charles Bartlett, Cert. Sanit. Inst. Ex. Joint Bd.f 7. Leonard H. Pearson, Cert. Sanit. Insp. Ex. Bd. '8. Harry Raymond Homewood, Cert. Sanit. Insp. Ex. Bd.f 9. Arthur Moxon, Cert. Sanit. Insp. Ex. Joint Bd. 10. Alfred E. Wood, Cert. Sanit. Insp. Ex. Bd.f 11. Harold H. Uren, Cert. Sanit. Insp. Ex. Bd. 12. John William Aiken, Cert. Sanit. Insp. Ex. Joint Bd. 13. Edward G. Holmes, Cert. Sanit. Insp. Ex. Bd. ,, 14. James Stephenson Ashworth, Cert. Sanit. Insp. Ex. Joint Bd. † Also Meat Inspector's Certificate. Vaccination Officers. J. Jennings, L. Stevens (Temporary). Tuberculosis Visiting Nurse. Miss Emily McGoldrick, State Regd. Nurse, Cert. General Training. Health Visitors. 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. Health Visitor and Infant Life Protection Visitor. Miss Gwenyth Sarah Lewis, Cert. C.M.B. ; Cert. H.V. ; Cert. Sanit. Inspr. Ex. Bd. 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, Georc.e F. Kimmis, (Fredk. C Green, S. A. Brown, Daisy Francis) (Milk Grants). Disinfecting Station. A. Lewis (Engineer), W. G. Tollie (Handyman Stoker), Mrs. Lewis (Caretaker, Shelter House), 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 page 52). Public Analyst. ALAN W. STEWART, D.Sc., 23, Queen's Square, W.C.I. Solicitor. GORMAN ROBERTSON, 3, Bond Court, Walbrook, E.C.4. 3 [1933 EXTRACT OF VITAL STATISTICS. Total. M. F. Live Births. Legitimate 4,397 2,262 2,135 Birth Rate per 1,000 of the estimated Illegitimate 184 100 84 resident population, 14.35. Stillbirths 122 Rate per 1,000 total (live and still) births, 14.74. Deaths 3,957 Death Rate per 1,000 of the estimated resident population, 12.40. 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 5 1.06 No. 30. Other puerperal causes 8 1.70 Total 13 2.76 Death rate of infants under one year of age :— All infants per 1,000 live births 63 Legitimate infants per 1,000 legitimate live births 58 Illegitimate infants per 1,000 illegitimate live births 174 Deaths from Measles (all ages) 14 ,, Whooping Cough (all ages) 23 ,, Diarrhoea (under 2 years of age) 63 POPULATION (ESTIMATED). The number of the population at mid-year 1933 is estimated at 319,100* persons. There was, therefore, a decrease in the population of 2,695, when compared with the number of inhabitants ascertained at the census in 1931. MARRIAGES. Marriages, 2,486; Marriage Rate, 15-6.—There were 4,972 persons married or 2,486 marriages, in 1933, and the marriage rate, that is to say, the number of persons married per 1,000 of the population was 15.6. Compared with the previous year these figures show a decrease of 742 in the number of persons married, or of 371 marriages; and of 2.0 per 1,000 in the rate. The following statement shows the figures for the previous ten years 1923-32. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 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 1927 2,844 17.01 • 1932 2,857 17.60 * M.O.H. figure as used during year. 1933] 4 BIRTHS. During the year there was 4,581 live births registered, of which 2,362 were boys and 2,219 girls. Of this number, however, 1,003 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 14.35 per 1,000 of the population, as compared with a mean birth-rate of 18.27 in the preceding ten years. This is the lowest birth-rate recorded. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1933, 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 1932; together with the mean Borough Birth-rates for the 10 years 1923-32. Quarter. Males. Females. Total. Birth Rates. Islington, 1933. Islington, 1923-32. London, 1933. 118 Great Towns, 1933. First 635 622 1,257 15.76 18.83 13.8 15.0 Second 618 569 1,187 14.88 18.99 13.8 15.3 Third 599 563 1,162 14.56 18.30 13.2 14.6 Fourth ... 510 465 975 12.22 17.10 12.9 13.5 The Year 1933 ... 2,362 2,219 4,581 14.35 18.27 13.2 14.4 1932 2,505 2,445 4,950 15.25 18.90 14.1 15.4 Increase or decrease — 143 — 226 — 369 -0-90 — 0.63 — 0.9 — 1.0 N.B.—The total registered births given by the Registrar-General for the Calendar year. 1933, will be found at the foot of table on p. 89. Showing the Births of Males and Females and the Birth-rates in each quarter and for the year, 1933, and in the several Sub-Registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Males. Females Total, j Birth rates. | Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males, Females J Total. Birth rates. 1st Quarter 93 76 169 20.94 71 791 150 19.80 46 52 98 13.27 73 81 154 15.54 2nd 95 91 186 23.05 78 55 133 17.56 40 47 87 11.78 72 72 144 14.53 3rd 85 98 183 22.67 45 54 99 13.07 39 37 76 10.29 78 56 134 13.52 4 th „ 73 65 138 17.10 51 43 99 13.07 43 43 86 11.65 60 50 110 11.10 Year 346 330 676 20.95 245 236 481 15.87 168 179 347 11.75 283 259 542 13.68 Showing the Births of Males and Fewales and the Birth-rates in each quarter and for the year 1933, and in the several Sub-Registration Districts.—contd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total, j Birth rates. 1st Quarter 120 93 213 14.68 108 103 211 16.03 124 138, 262 13.67 635 622 1,257 15.76 2nd 114 97 211 14.54 87 90 177 13.44 139 117 249 13.00 618 569 1,187 14.88 3rd 109 106 215 14.82 90 93 183 13.90 153 119 272 14.20 599 563 1,162 14.56 4th 91 86 177 12.20 82 81 163 12.38 110 92 202 10.54 510 465 975 12.22 Year 434 382 816 14.06 367 367 734 13-94 519 466 985 12.85 2,362 2,219 4,581 14.35 5 [1933 Illegitimate Births (184).—The illegitimate births numbered 184 and show a decrease of 12 on the return of the year 1932. They were equal to a rate of 4.0 per cent, of the total registered births. Notification of Births Act, 1907.—3,491 live births were notified (exclusive of 81 stillborn), or 76 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. 1933. 1st Quarter 229 9 544 13 191 2 964 24 2nd 198 5 546 10 137 3 881 18 3rd 193 5 529 11 132 2 854 18 4th „ 185 4 487 16 120 1 792 21 Year 805 23 2,106 50 580 8 3,491 81 REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still-born). 1st Quarter 1933. 20 7 1 28 22.3 2nd 31 5 1 37 31.2 3rd 17 3 1 21 18.1 4 th „ 22 6 2 30 30.8 Year 90 21 5 116 25.3 DEATHS. The deaths registered during- the year numbered 3,957 (exclusive of stillbirths), while the death-rate was equal to 12.40 per 1,000 of the estimated population, or 0.04 above that of the previous year (12.36), and 0.17 below the mean of the preceding- ten years; whilst the death-rate of England and Wales was 12.3 and the 118 Great Towns 12.2. 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 139 17.22 94 11.65 71 8.80 89 11.03 393 12.17 Upper Holloway 164 21.65 99 13.07 76 10.03 85 11.22 424 14.00 Tollington 136 18.41 85 11.51 66 8.93 82 11.11 369 12.49 Lower Holloway 157 15.84 95 9.58 77 7.77 119 12.01 448 11.30 Highbury 265 18.26 143 9.65 135 9.30 209 14.40 752 12.95 Barnsbury 244 18.53 122 9.27 106 8.05 160 12.15 632 12.00 Islington (SouthEast) 329 17.17 204 10.65 175 9.13 231 12.06 939 12.25 The Borough 1,434 17.98 842 10.50 706 8.85 975 12.22 3,957 12.40 1933] 6 Showing the Deaths and Death Rates of Islington in 1933, 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 1923-32 and the dedths and death-rates in the year 1932: Quarter. Males. Females. Total. Death Rates. Islington, 1933. Islington, 1923-32. London, 1933. 118 Great Towns, 1933. First 735 699 1,434 17-98 16.90 17.3 17.3 Second 414 428 842 10-50 11.25 10.2 10.6 Third 331 375 706 8-85 9.47 8.9 9.0 Fourth 512 463 975 12-22 13.00 11.8 11.9 The Year 1933 1,992 1,965 ?,957 12-40 12.57 12.2 12.2 1932 2,060 1,953 4,013 12-36 12.70 12.0 11.8 Increase or Decrease - 68 + 12 - 56 + 0-04 - 013 + 0.2 + 0.4 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, 1933. Mean Deaths (10 years, 1923-32.) Increase or Decrease on mean. 0-1 year 288 394 - 106 1-5 years 130 214 84 Tinder 5 years 418 608 - 190 5-15 years 89 99 - 10 15-25 „ 133 150 - 17 25-35 „ 193 182 + 11 35-45 „ 222 259 - 37 45-55 „ 422 445 23 55-65 ,, 666 662 + 4 65-75 ,, 834 836 - 2 75-85 „ 766 710 + 56 85 upwards 214 195 + 19 All Ages. 3,957 4,146 - 189 There was a decrease of 190 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 5-55 years, were also below the decennial average. The deaths of aged people between the age period 65 years and upwards showed a decrease of 62 in the number of deaths when contrasted with the previous year 1932, and were 73 above the ten years' average (1923-32). INFANTILE MORTALITY. Infant Deaths, 288; Mortality Rate, 63.—The deaths of 288 infants under twelve month's old were registered during the year, or 106 below the decennial average (394), and they were equal to the infantile rate of 63 per 1,000 births. Ihe lowest rate on record, however, is 53 per thousand births in the vear 17 [1933 1927. The rate was 2 per 1,000 births below the mean annual record of the preceding ten years, and is 5 per 1,000 below the rate of last year (1932). In the quarters the mortality ranged from 78 per 1,000 births in the first quarter, 47 in the second, 43 in the third, and 86 in the fourth. In the sub-registration districts the infant mortality was as follows :— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 18 26 Upper Holloway 26 54 Tollington 35 101 Lower Holloway 37 68 Highbury 42 51 Barnsbury 59 80 Islington South East 71 72 In London the infantile mortality was 59 per 1,000 births. The rate for England and Wales was 64 per 1,000 births. Years. Under one week. Weeks. Total under four weeks. Months. Total Deaths under one year. Deaths per 1,000 Births. 1-2 2-3 3-4 4 weeks and under 3 mths. 3-6 6-9 9-12 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 1932 92 15 9 8 124 66 66 49 35 340 68 Mean 10 years 104 21 15 13 153 61 71 58 51 394 65 1933 88 10 18 15 131 54 32 41 30 288 63 Increase or decrease on mean — 16 -11 + 3 + 2 — 22 — 7 — 39 — 17 — 21 — 106 — 2 Showing the Deaths among Infants per 1,000 Births dining the Year 1933. and also the mortality rates for the Years 1923-1932. Sub-Districts. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Mean 10 years 1933 Increase or decrease on mean Tufnell 46 54 47 64 52 65 75 78 43 48 58 26 —32 Up. Holloway 64 70 57 30 31 44 42 26 35 30 43 54 + 11 Tollington 55 60 65 92 63 85 71 106 90 88 77 101 + 24 Lr. Holloway 81 85 78 82 74 77 95 57 84 77 79 68 —11 Highbury 61 60 54 48 52 47 60 5S 64 83 59 51 — 8 Barnsbury 59 77 75 90 59 75 87 P5 66 76 76 80 + 4 Islington, S.E. 82 55 58 64 49 67 78 76 68 72 67 72 + 5 The Borough 66 66 63 66 53 64 73 70 04 68 65 63 2 The following table shows the diseases that proved most fatal in the first year of child life, together with the mortality rates per 1,000 births. Showing the Mortality per 1,000 Births among Infants under one year of age in the ten yearn 1923-32 : and in 1933 from certain specific! causes. Causes of death. 1933. Rate per 1,000 Births. Mean rate 10 years 1923-32 per 1,000 Births. Difference. Premature Birth and Congenital Defects 21.40 19.60 + 1 80 Bronchitis and Pneumonia 9.82 13.77 - 3 95 Atrophy and Marasmus 3.27 3.82 —- 0-55 Diarrhoeal Disease (all forms) 12.44 4.48 + 7-96 Convulsions 1.75 1.00 + 0-75 Whooping Cough 2.40 3.32 - 0 92 Measles 0.65 2.49 - 1.84 Diphtheria - 0.33 - 0-33 Phthisis 0.22 0. 33 - 011 Other forms of Tuberculosis 1.09 0.83 + 0-26 Total of above 53.04 49. 97 + 307 All other causes 982 15-43 — 5 61 Total 62-86 65 40 — 2-54 1933] 8 INFANTILE MORTALITY during- the Year 1933. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 week Weeks. Total under 4 weeks Months. Total Deaths under 1 year 1-2 2-3 3-4 4 weeks and under 3 months 3-6 6-9 9-12 All Certified Causes, Uncertified — — — — — — — — — — — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — 2 1 3 Scarlet Fever — — — — — — — — — — Whooping-Cou gh. — — 1 — 1 1 5 3 1 11 Diphtheria, Croup — — — — — — — — — — Erysipelas — — — — 1 1 — 1 3 Tuberculous Meningitis — — — — — — 1 2 2 5 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — 2 2 1 5 Convulsions 4 — 2 1 7 1 — — — 8 Laryngitis — — — — — — — — — — Bronchitis — — — — 2 2 — — 4 Pneumonia (all forms) ... 1 1 1 1 4 8 9 9 12 42 /"Diarrhoea — — — — — 1 2 2 1 6 Enteritis ... — — 1 2 3 16 8 16 8 51 Gastritis ... — — — — — — — — — Syphilis ... 1 1 1 1 4 1 — — — 5 Rickets — — — — — — — — — — Suffocation, overlying — — — — — 1 — 1 — 2 Injury at birth 5 — — — 5 — — — — 5 Atelectasis 5 — — — 5 — — — — 5 Congenital Malformations 13 1 5 19 5 1 — 1 26 Premature birth Atrophy, Debility 55 4 5 6 70 2 — — — 72 and Marasmus — 1 — 3 4 8 2 — 1 15 Other causes 4 2 2 1 9 4 1 3 3 20 Totals 88 10 18 15 131 51 34 40 32 288 Nett Births legitimate 4,397 in the year \illegitimate 184, 4,518 BIRTHS. Nett Deaths in legitimate infants 250 the year of illegitimate infants 32 288 9 [1933 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. 87 cases of Ophthalmia Neonatorum were notified, compared with 94 cases last year. 126 cases of Ophthalmia were reported by the London County Council and Health Visitors as against 124 cases during the previous year. 15 out of the 87 cases of Ophthalmia Neonatorum were attended at birth by rnidwives. The cases occurred in the sub-registration districts as follows :— Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough Ophthalmia Neonatorum. 8 3 5 8 11 23 29 87 Ophthalmia. Cases reported by L.C.C. 8 1 3 22 7 30 39 110 Cases reported by Health Visitors 4 3 — 1 1 4 3 16 Of the 87 cases investigated, both of the infants' eyes were affected in 61 instances, whilst in 14 the right eye was involved, and in 12 the left. Treatment.—22 of the 87 Ophthamia Neonatorum cases were admitted to St. Margaret's Hospital, 30 being treated at other Hospitals. 26 cases were treated at home by private Doctors. 23 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £20 18s. Od. In 1932 30 cases were nursed at the cost of £33 4s. Od. Results.—Of the 87 Ophthalmia Neonatorum cases, vision was unimpared in all cases except 3. Ophthalmia Neonatorum Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 87 26 61 84 3 Nil 2 MATERNAL DEATHS. The number of women dying in, or in consequence of, child-birth during the year 1933 was 25, or 5.3 per 1,000 registered (live and still) births. Of this number 5 occurred from Sepsis (Puerperal Septicaemia); whilst 20 died from other causes (see table). 1933] 10 The deaths for the preceding year numbered 16, and were equal to the proportion of 3.2 per 1,000 births. MATERNAL DEATH RATES FOR ISLINGTON. Year. No. of Live 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 1921 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 1933 4,581 25 5.3 *Rate per 1,000 registered live births and still births. ii [i933 METROPOLITAN BOROUGH OF ISLINGTON MATERNAL DEATHS, 1933. (For those in 1932, see p. 11 of the Medical Officer of Health's Annual Report for that year) 1933. Month. Cause of Death. Ages at Death. Totals. 15 to 25 25 tu 35 35 to 45 / 45 an-1 upwd. Total. From Puerperal Sepsis. From other Diseases of Childbirth. Feb. Acute pulmonary oedema. Bronchitis and Asthma. Premature delivery ... 1 ... ... 1 ... 1 (a) „ Bronchial pneumonia. Influenza (labour 4 days after onset of Influenza) ... 1 ... ... 1 ... 1 (b) Mar. General peritonis. Puerperal septicaemia, following full term delivery ... 1 ... ... 1 1 ... „ Pulmonary tuberculosis. Confinement ... 1 ... ... 1 ... 1 (c) „ Pulmonary Thrombosis, following normal labour. P.M. Natural ... 1 ... ... 1 ... 1 „ Bronchial pneumonia. P.M. 1 ... ... 1 ... 1 (d) „ General peritonitis, following Caesarean Section. P.M. ... 1 ... ... ... 1 1st Qr. 1 6 ... ... 7 1 6 April Paralytic ileus due to operation. Total Hysterectomy. Ruptured uterus. Labour. Multiparity breech with extension. Macerated foetus. Premature rupture of membrane ... l.. 1 ... 1 ... 1 May Mediastinitis. Perforating ulcer of the aesophagus ... 1 ... ... 1 ... 1 (e) „ Septicaemia after miscarriage 2½ months. Cause of miscarriage unascertained. Open. P.M. ... 1 ... ... 1 1 ... June Eclampsia. P.M. 1 ... ... 1 ... 1 „ Pulmonary tuberculosis. Confinement six weeks ago ... 1 ... ... 1 1 (c) 2nd Qr. 1 3 1 ... 1 4 July Pyaemia. Septic endometritis abortion (10 weeks pregnant). After P.M. ... 1 ... 1 1 ... Aug. Puerperal septicaemia. P.M. ... 1 ... ... 1 1 ... „ Acute Broncho Pneumonia and heart failure. Cesarean Section 36 hours before. Obstructed labour 1 ... ... 1 ... ] „ Pulmonary embolism. Thrombosis of left femoral vein. P.M. ... 1 ... ... 1 ... 1 (f) „ Pyaemia abortion. (2 months pregnant) . Cause of abortion unknown. P.M. Open ... 1 ... ... 1 ... 1 (g) Sept. Uterine Haemorrhage. Abortion (3 months pregnancy). P.M. Natural ... 1 ... ... 1 1 ... 3rd Qr. 1 4 1 ... 3 3 Oct. Pulmonary tuberculosis. Pregnancy 1 ... ... 1 ... 1 (c) „ Pulmonary embolism following pregnancy (Cesarean Section). Red infarcts in lower lobe of right lung. P.M. Uncert. 1 ... ... 1 ... 1 Puerperal Eclampsia 1 ... ... 1 ... 1 Nov. Acute Pulmonary CEdema. Bronchial pneumonia. Child birth. P.M. ... 1 ... ... 1 ... 1 (h) „ Acute Peritonitis. Pyelitis of Pregnancy. P.M. 1 ... ... 1 ... 1 „ Mitral and Aortic Stenosis. Pregnancy (28 weeks). P.M. ... 1 ... ... 1 ... 1 (i) Dec. Pelvic Cellulitis and Acute General Peritonitis consequent upon Labour. P.M 1 ... ... ... 1 ... 1 (j) 4th Or. 5 2 ... ... 7 ... 7 Classifications :—-(a) As Bronchitis, (b) As Influenza, (c) As Tuberculosis, (d) As Pneumonia, (e) As Disease of Esophagus, (f) As Disease of Veins, (g) As "Violence." (h) Bronchial Pneumonia, (i) As Heart, (i) As " Other diseases of Genital Organs." 1st Quarter 7 = 5.4 2nd Quarter 5 = 4.1 3rd Quarter 6 = 5 0 4th Quarter 7 = 7.0 Total (Year) 25 = 5.3 Rate per 1,000 registered live and still births. 1033] 12 PUERPERAL FEVER. Of the 36 cases coming to the knowledge of the Medical Officer of Health during 1933, 16 were notified by Medical Practitioners. The proportion of total cases to births was 7.8 per thousand. The notifications were 3 above the average (33) of the preceding ten years and showed an increase of 2.30 in the proportion of attacks to 1,000 births. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 5 4 6 4 5 2 10 36 Private Practitioners' Cases 3 3 2 1 4 1 2 16 Hospital Cases 2 1 4 1 1 8 17 Certified Midwives Cases — — — 2 1 — — 3 Cases inquired into 5 4 6 4 5 2 10 36 Cases treated in Hospital 5 4 6 4 5 2 10 36 Cases treated at Home — — — — — — — — All of the 36 cases were treated in Hospitals. 17 of these contracted the disease in Hospital; 19 cases were removed to London County Council Hospitals; and 17 cases were removed to the St. Mary's Islington Hospital and other London Hospitals. Deaths.—5 deaths were registered as being due to Puerperal Fever. PUERPERAL PYREXIA. Notification of Puerperal Pyrexia Regulations, 1926.—There were 74 cases notified, as against 64 last year. Of these, 10 were Private Medical Practitioners' cases; 56 occurred in Hospital, while 8 were certified Midwives' cases. The notifications were in the proportion of 16.1 per 1,000 births. Cases of Puerperal Pyrexia notified and inquired into during the year 1933. T ufnell. Upper Hollo way. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 6 6 10 7 18 11 16 74 Private Practitioners Cases 1 1 — — 1 1 6 10 Hospital Cases 5 5 7 6 14 10 9 56 Certified Midwives Cases — — 3 1 3 — 1 8 Cases inquired into 6 6 10 7 18 11 16 74 Cases treated in Hospital 5 5 9 7 13 6 14 59 Cases treated at Home 1 1 1 — 5 5 2 15 The services of the Consultant were sought on two occasions during the year. Two bacteriological examinations were made in cases of suspected Puerperal Sepsis, with negative results. PEMPHIGUS NEONATORUM. During the year 1933, one case which died in Hospital came to the knowledge of the Medical Officer of Health {after death), and the circumstances were investigated. 13 [1933 THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1933, the sum expended in the provision of fresh and dried milk for necessitous, expectant and nursing mothers, and children under five years of age, amounted to £2,609 17s. 2d., as against £3,671 11s. 4d. in 1932. The total amount expended since the Order came into operation in 1918 is £62,307 4s. 4d. The total recipients during the year numbered 10,525, and the quantity of milk supplied to them was equal to 215,120 pints (26,890 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. 1933] 14 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1933. District 2 3 4 5 6 7 8 Totals. I. Births, First Visits, Infants under 1 Year 509 520 570 849 635 373 371 414 4,241 II. Births, Re-Visits, Infants under 1 Year 312 355 701 740 513 310 567 677 4,175 III. Visits to Children, between 1st and 2nd Years 332 328 617 632 553 377 436 928 4,203 IV. Visits to Children, between 2nd and 5th Years 851 1,401 1,492 1,637 1,254 884 1,514 919 9,952 V. Visits re Still Births 19 20 13 34 30 4 9 10 139 VI. Deaths, Visits, re Infants under 1 Year 8 15 18 4 12 13 4 11 85 VII. Deaths, Visits, re Children 1 to 5 years 5 3 6 2 5 2 — 7 30 VIII. †Ante-Natal, Home Visits f/200 221 f/183 213 f/216 266 f/260 304 F/189 202 f/139 166 f/132 164 f/143 203 f/1,462 1,739 IX. †Puerperal Fever Home Visits f/6 10 f/3 7 f/6 9 f/l 2 f/2 5 f/3 5 f/6 7 f/29 50 Pyrexia, do. F/l 2 f/3 4 f/l 2 f/3 5 f / 3 F/l 3 f/2 4 f/14 23 Totals 2,262 2,867 3,694 4,213 3,211 2,137 3,073 3,180 24,637 X. Attendances at Welfare Centre* 26 26 50 45 45 29 48 45 314 XI. Other Work by Direction 1,030 561 1,186 844 710 884 1,458 692 7,365 XII. Visits Declined 2 — 1 — 2 — — — 5 XIII Visits, House Shut 558 1,139 627 962 1,071 384 553 302 5,596 XIV. Visits, Inopportune 43 7 1 — 21 44 — 2 134 Grand Total of Visits 3,921 4,600 5,559 6,064 5,060 3,478 5,148 4,221 38,051 *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 [1933 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1983—Continued. district 1 2 3 4 5 6 7 8 Totals. Analysis of Visits included in I.-IX. relating to (aa)tReported Ophthalmia f/12 25 f/3 15 f/22 43 f/6 12 f/20 41 f/28 50 f/5 11 f/17 36 f/113 233 (a)†Ophthalmia Neonatorum f/9 15 f/5 10 f/7 15 f/8 16 f/16 40 f/14 26 f/5 10 f/13 28 f/17 160 (b) †{Epidemic (Summer) Diarrhoea — 1 — — f. 1 — — — f/1 2 (c) Other Digestive Diseases — 3 1 — 2 2 — — 8 (d) Pneumonia and Bronchitis 3 16 2 — 2 9 5 3 40 (e) Rickets 16 16 3 25 10 11 — 9 90 (f) †Measles and German Measles f.5 6 f/11 20 f. 4 ^— f. 5 f/2 3 f. 8 f. 1 f/36 47 (g) † Whooping Cough f. 11 f/24 27 f/11 13 f. 1 f. 18 f. 25 f/7 11 f. 6 f/103 112 (h) Tuberculous Disease—P= Pulmonary; 0 = 0ther — — — — — — — — — (i) Convulsions — — — — — — — — (j ) tPolio-myelitis — — — — — — f. 1 — f. 1 (A) Premature Birth 17 1 11 9 17 10 17 2 84 (/) Atrophy, Debility and Marasmus — 2 — — — — 1 — 3 (m) All other investigations ("'Specify) 7 35 19 — 17 11 5 9 103 (») Routine Visits included in I. to IX. and not cluded in (aa) to (m) 2,162 2,721 3,583 4,150 3,058 1,990 3,004 3,086 23,754 ***Totals (aa) to (n) 2,262 2,867 3,694 4,213 3,211 2,137 3,073 3,180 24,637 Total Families Visited ... 1,686 2,075 2,745 3,299 2,373 1,612 2,453 2,501 18,744 Registered Births. New Cases Handed to H V's for Visitation Infant Mortality. Maternal Mortality. Puerperal Fever. I'uerperal Pyrexia. Ophthalmia Neonatorum. No. Rate. Notified Births. Non-Notified Births. Transfers In. 844 No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. 4581 14 35 4,638 80 288 63 13 2-7 36 36 74 59 87 21 **e■£•—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. Illegit., etc. ***Totals to should correspond with Totals I. to IX. tF. in front of figures denotes a " First Visit." 1933] 16 THE VOLUNTARY WELFARE CENTRES. The following Table is issued for comparative purposes with the similar Tabic inserted in last year's Report (1932). This Table is compiled from the returns provided by the Centres for information to be supplied to the Ministry of Health for the Calendar year. The Table therefore contains in tabular form such items as are in the main common to all the Centres, such as Consultations at the Centre, Home Visitation by qualified Health Visitors, etc. Also, where such exist, the return regarding Sick Wards and Convalescent Homes. The later report which is given of the work of the Voluntary Centres is compiled from information in the Annual Reports of the Centres, which go up to the 31st March, 1933, as the Medical Officer of Health's report goes to press and does not cover any of the work of the Centres beyond the year under review. Reports on the Centres therefore show a comparable Table for the Calendar year and a review of the work of the Centres, as contained in their individual reports, for a Centre year of which three months is within the year and nine months, the previous year. Care has therefore to be taken not to confuse the figures of the "Table" with the information given in the "Review " of the work. Table—Calendar Year, 1933. North. South. East. West. Total. 1. Ante-Natal Clinics. Number held weekly 3 1 Ctr. 1* 1 7 1 Rose ,, of Expectant Mothers Br'ch. who attend 625 104 240 99 1,068 „ of attendances 1,981 589 602 271 3,443 2. Consultations for Children up to 6 Years of Age. Total No. of children attending for First time during year, and who, on the date of their First attendance, were:— i. Under 1 year 835 669 475 538 2,517 ii. 1—5 years 191 93 89 77 450 Number of attendances :— i. Children under 1 year 10,531 11,507 8,530 6,876 37,444 ii. 1—5 years 5,842 8,366 7,767 4,658 26,633 3. Home Visiting. Number of visits made to :— i. Expectant mothers :— (a) First Visits 547 94 217 40 898 (b) Total Visits 2,120 194 929 196 3,439 ii. Children under 1 year :— (a) First Visits 798 719 532 471 2,520 (b) Total Visits 4,732 5,013 3,830 2,538 16,113 iii. Children 1—5 years 7,304 7,045 6,311 4,551 25,211 4. Wards and Homes. Number of beds 18 6 8 32 Number of patients received :— i. Mothers and Babies :— (a) Mothers 36 74 110 (b) Babies 37 75 112 ii. Babies only 125 75 200 5. Number of Children who attended at the Centres during the Year, and who, at end of Year, were :— i. Under 1 year 679 468 317 382 1,846 ii. 1—5 years 1,660 1,059 909 926 4,554 6. Convalescence. Number of cases :— i. Mothers 31 8 56 24 119 ii. Children 41 79 110 38 268 * Plus one extra Clinic per month. t Since May, 1933, one Birth Control Clinic a month has taken the place of one weekly Ante-Natal Clinic. 17 [1933 REVIEW.—REPORTS OF THE WORK OF THE VOLUNTARY CENTRES UP TO MARCH 31st, 1933. North Centre.— This Centre issues a general review ol the work, but does not include a special medical report. The activities of the various Departments are summarised thus:—1. Three (sometimes four) Ante-natal Clinics weekly; 2. One Post-natal Clinic weekly for mothers; 3. Ten Children's Clinics weekly (Consultations for children up to five years of age); 4. Visiting (professional and voluntary) daily in the homes; 5. Morning Callers daily (mothers that come for advice); 6. Eleven L.C.C. Dental Sessions weekly. Two, sometimes three, Centre Dental Sessions weekly. A Dental Club; 7. Three Massage Clinics weekly; 8. A Sewing Class weekly; 9. Many Health Talks weekly; 10. The training of Infant Welfare Students; 11. The training of thirteen Infant Welfare Pupils (L.C.C. and M.C.C. Scholarship holders); 12. Five Home Helps and a Home Helps' Club; 13. A Thrift Club and branch of National Savings Association; 14. A Convalescent Fund; 15. Mothers' Committee and Fathers' Committee; 16. "Light" Clinics daily; 17. Four Wards (three wards for ailing children under two years of age, and one for three mothers with their babies); 18. Statistical Records. The work of this Centre which extends over twenty years has been made the occasion for a comparative statement in the Centre Annual Report of the mother of yesterday and to-day. Parents attending the Centre can be pointed to as the children who attended at its early beginning. "Home Helps" have been on the Centre staff for many years. These have an intimate knowledge of the homes and confirm the impression of the Committee that the mothers of to-day exhibit much greater thought and intelligence in the care of their children than those of 1913. Children are without doubt better fed, clothed, trained and cared for, and as a result the standard of health is higher. This, of course, applies to normal circumstances, for it is recorded in the report that unemployment had caused much poverty during the year, leading in many cases to great distress and possible result on the health of the children. The improved standard now observed speaks well for the education, not only at the Centre, but for all agencies and the modern spread of educational propaganda. • The Committee in the previous year had decided not to close down the "Light" Clinic. It was recognised that the straitened circumstances in the homes would prevent many mothers and children getting away for holiday or convalescence during the summer. The actual number of mothers and children sent away by the Centre (aided by the Benevolent Fund when necessary) was 15 less than in the previous year, but the number that attended the "Light" Clinic was increased by 30, and the attendances by 1,066. The Committee therefore have felt that their action was justified in thus supplying a holiday substitute which has been so well taken advantage of. An interesting enquiry was made by the medical staff in regard to holiday taking. 149 cases were enquired into—64 had a holiday during the year, 24 had a holiday last year, 8 two years ago, 6 three years ago, 3 four years ago, 2 five years ago, 15 six years ago, 3 had only a working holiday, and 24 never had a holiday, or could not remember ever having had a holiday. 1933] 18 Dinners to necessitous mothers and children were increased during the year from 1509 to 1793. The cost to the Centre's Benevolent Fund is 7d. for a mother's dinner and 3d. for a child's. The benefit of these dinners is very obvious, for a mother who is below par on account of lack of proper nourishment undoubtedly has this reflected on her child. As regards the nutrition of the babies, six scales were lent out 101 times in the homes to show the result of test feeds. In 45 instances complementary feeding was shown to be required, in 42 the breast feeding was shown to be sufficient, 9 cases were weaned, and in 5 cases the scales were still in use. In 86 per cent, of the cases the records kept by the mothers were satisfactory. North Centre Welfare Wards : With the exception of the period at the end of July and the beginning of August, when the wards were closed for quarantine following a case of whooping cough, these wards functioned throughout the year. The beds for children under two years number 12, and the beds for mothers and their babies, 6, a total of 18. The number of mothers with babies resident, that is, for treatment of the baby, to March 31st, 1933, was 43. The number of babies resident alone was 89, and the number of mothers admitted for their own treatment was 42. The possession of Wards by this Centre is of value, not only on account of the work done as regards the health of those admitted, but in respect of the mothers —there is the educational influence. The wards also are the training school for students and pupils. The course on "Infant Care" lasts from three to six months, and a certificate is given to students at the conclusion in regard to attendance and satisfactory work. South Centre.—In the medical reports for this Centre and its Branches it is recorded that a greater number of cases have been referred to the Ante-natal Clinic by midwives practising in the district. The Branch Clinic at "The Rose," which, at the time the medical report was written, had been opened for about eighteen months, has shown a slightly, but steadily, increased number of attendances. At this and the other Centres the advantage of the early seeking of ante-natal advice is stressed—so much more can be done if any difficulty or weakness is discovered at an early stage. The postnatal cases form a fairly large proportion of the numbers at this clinic. It was hoped in time to persuade each mother to come up for a routine examination six weeks after confinement unless she had been seen elsewhere. The facilities available at the main Centre—when on occasion the mother may have an opportunity of leaving a baby in the Centre garden under skilled care for a whole morning on three days of the week, are a tremendous help to the mother who has no garden at home or has other children to take to a hospital or treatment Centre. The advantage of the exercise of crawling before walking might be better known to mothers. A clean place in which to crawl is, of course, essential; the exercise obviously strengthens the legs without putting all the weight of the body on the leg bones, and when the time comes and baby can bear his weight on his legs, the muscles are more fit. 19 [1933 The Clephane Cottage for the tired and worn-out mother who can have a short rest-holiday there with her child, and the beneficial effect of a short stay at the seaside at Miss Fleetwood's Home, are both emphasised in the medical reports. 86 mothers and 90 children went to Clephane Cottage, Flamstead, 40 children to Miss Fleetwood's Home, while 7 mothers and 12 children were accommodated elsewhere. The advantage of "iron" as a tonic both for mothers and for children is being increasingly realised and anaemia is much less often met with than formerly. It is commented on that a fixed bed-time for the child appears to be most difficult to achieve, as is also a rest during the day for the mother. In the stress of the times, loss of employment, etc., the cases requiring "assisted milk" have increased. A move was made near the end of the Centre year from the South Islington (Pro Patria) Day Nursery premises, where a Branch was held, to 100, Canonbury Road. During the year there were 38 ordinary Dental treatment sessions, 12 with "gas," making a total of 50. 113 mothers made 281 attendances, while 82 children who attended made 120 attendances. 56 "Health Talks " were given during the year. East Centre.—In the medical report it is asserted that progress of the work of the Centre in general has been made. Attendances at the clinic have been well maintained. Emphasis is laid on the matter of teaching regarding the care of "teeth," especially concerning the mothers'. Although they may have their children's teeth looked after, they do not seem to recognise that they require treatment themselves. Severe rheumatism and anaemia and chronic poisoning with its general lowering effect on health are so often traced to septic gums and dead teeth. As in other Centres, the effects on the health of unemployment are noted. Facilities were afforded at this Centre in an investigation in regard to tonsils and adenoids by an Investigator on behalf of the Board of Education. Mothers at this Centre are specially helped to be interested in breast feeding and management. 188 attended and the number of "Test feeds" given were 606, while the number of Sessions held were 54, and there was a total attendance of 300, the average attendance being 5.5. West Centre.—The Medical Officer reports that while the numbers generally remain much the same as last year, certain Departments, such as "Massage" and " Morning Callers " show a large increase. The children for "Light" treatment, owing to the discontinuance of the "Sunlight" lamp, are sent to other "Sunlight" Clinics, more especially to The Camden Road Institute of "Ray " Therapy. The number of admissions to the Wards is considerably lower than the previous year, but, on the other hand, the average length of stay and gain in weight is much increased, so that these two sets of figures are said to balance each other. The Mothers' Club reached its highest total since the Club was started. There were 743 attendances. Practical instruction was given by the Superintendent and the staff. 1933] 20 Convalescent treatment : Various holiday funds helped the Centre and 19 mothers and 25 children had arrangements made for convalescent holidays. The various Departments of the Four Vohmtary Centres, with the attendances ending March 31st 1933, may be summarised thus : North. South. East. West. Total. 1. Ante-Natal Clinics and Ailing Mother Clinics. Number held weekly §5 2 †l 1 9 of attendances 2,453 884 684 *349 4,370 2. Consultations for Children up to 5 Years of Age. Number held weekly 10 11 **11 7 39 ,, of attendances 23,435 20,305 17,044 11,341 72,125 3. Home Visiting. No. of visits made 17,203 13,358 11,357 8,528 50,446 4. Dental Clinics. Number attending 659 195 180 80 1,114 „ of attendances or arrangements made for attendances 1,768 401 _ _ 2,169 5. Morning Callers. Number of attendances 1,593 947 + + 1,185 3,725 6. Massage Clinics. No. of cases given massage or sent for massage 92 132 (& Sunlight treatment) 102 55 381 7. Wards. Number of beds 18 _ _ 8 26 „ of patients received 174 _ _ 63 237 8. Number of Children on Books 2,148 1,651 1,318 1,059 6,176 § Including occasional Ante-natal clinic on Monday afternoon, f Extra Clinic held 2nd Thursday in month. * Attendances of Expectant mothers only. ** Including 2 Observation Clinics, t Not recorded. 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 provided No. of attendances during 1933 i. Lower Holloway Day Nursery, 547, Liverpool Road, N. 50 10,591 ii. South Islington Pro Patria Day Nursery, 9, Canonbury Lane, N.l 55 10,709 iii. St. Luke's Day Nursery, 29 and 30, Penn Road, N.7 30 5,633 Total 135 26,933 Further particulars regarding- the Day Nurseries, hours, etc., were referred to in last year's report. The "Guest House," in connection with St. Luke's Day Nursery, was opened in March. Its accommodation for twelve (and two extra in an emergency) has been fully taken up, and the demand for admission has been such that the question of extension may have to be seriously considered in the near future. 31 [1933 MATERNITY AND CHILD WELFARE. Contributions by the Borough Council. Year ending 31st March, 1934. Voluntary Welfare Centres. Day Nurseries. £. £. North Centre 5,432 Lower Holloway 244* South Centre 2,506 St. Luke's .229 East Centre 1,888 South Islington .600 West Centre 1,962 Total £1,073 Total £11,788 * This Nursery is a municipally owned building-. (No rent charged for its use). INVALID CHILDREN'S AID ASSOCIATION. The Borough Council contributes £25 per annum to the Local Branch of this Association. During- the year, 58 Islington children under five years were given periods of convalescence either in the country or by the sea, and 34 children of like ag-es, crippled, were provided with surgical appliances, splints, special boots, etc. 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 £33 2 0 Under Public Health £20 19 Of Total £54 1 0 Contributions under arrangements for maternity cases admitted to beds at Maternity Hospitals, the contributions being a grant of 10s. per case, were: Cit) of London Maternity Hospital, £58 0s. Od.; Royal Free Hospital, £9 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 nursing of pneumonia (adult). NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN. While in the majority of cases, visited either by the official Health Visitors of the Town Hall or through the Welfare Centres, advice given is accepted and is appreciated, even in the enlightenment of the present age there are cases, few in number, it is true, in which the child is not well looked after at home and advice and warning may be unheeded. In connection with these cases, we are indebted in Islington to active help from the National Society for the Prevention of Cruelty to Children. 20 cases were referred to the Society from the Public Health Department (three of these were Infant Life Protection cases under the duties recently transferred from the London County Council). 22 1933] DUTIES CONCERNED WITH INFANT LIFE PROTECTION UNDER THE CHILDREN AND YOUNG PERSONS ACTS, 1908 to 1932. As mentioned in my introductory letter, this is part of the work taken over by the Borough Council from the London County Council under the Transfer of Powers (London) Order, 1933, and one of our Health Visitors was appointed Infant Protection Visitor. The work dates from the 1st April, and, therefore, has not been undertaken for a complete year. The number of persons on the Register who were receiving children for reward at the end of the year was 160 ; the number of children on the Register at the end of the year was 222 ; three children died during the year. The work takes up fully three-quarters of the appointed officer's time. Other duties devolve upon the Sanitary Inspectors who visit to obtain a proper survey of the accommodation ere the foster-mother is approved by the Committee. Much time is taken up in endeavouring to trace for ourselves and for other Boroughs children whose whereabouts are for the moment uncertain. In spite of the fact that registration has been in force for some considerable time and inspection carried out under the auspices of the London County Council previous to our receiving the transferred powers, there appears to be a great amount of ignorance, real or assumed. When cases of infringement of the Acts are discovered, these plausible excuses of ignorance are generally forthcoming. Efforts are being made by leaflets and otherwise to spread a knowledge of the provisions of the law as regards women who take over the duties of foster-mothers. The National Society for the Prevention of Cruelty to Children has afforded us help in three cases which we referred to them. Next year, being a complete year, a fuller account of the work done will be given. DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—2,335 persons died in the Public Institutions located in Islington, of whom 1,604 belonged to this Borough, the remaining 731 having come here for treatment or relief. Of this latter, 408 died in the Archway Hospital, 163 in the Royal Northern Central Hospital, 37 in the London Fever Hospital, and 54- in the St. Mary's Islington Hospital and Islington Institution. Of the 1,604 deaths of inhabitants, 1,163 occurred in the St. Mary's Islington Hospital, 202 in the Islington Institution, and 108 in the Royal Northern Central Hospital. The proportion which the 1,604 deaths in the Public Institutions bore to the Borough mortality was 40.5 per cent. Without the Borough.— 917 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, 26 in the North-Western Fever Hospital, 26 in the Children's Hospital, Great Ormond Street, 53 in St. Bartholomew's Hospital, 23 in the Infirmary, Friern Barnet, 59 in the Royal Free Hospital, 67 in the University College Hospital, 35 in the North-Eastern Hospital, 5 in the Eastern Fever Hospital, 28 in the Middlesex Hospital, 10 in the City of London Maternity Hospital, 24 in the Metropolitan Hospital, and 18 at la, Manor Road, Ilford (Claybury). These 917 deaths represented 23.2 per cent. of all the deaths registered in the year. 23 [1933 Within and Without the Borough.—The deaths of Islingtonians numbered 2,521, and were equal to 63.7 per cent. of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— 23 inhabitants died from accidental deaths, or suddenly, in places outside Islington. During the previous year (1932) the total deaths in Local Institutions numbered 2,447, being 1,618 inhabitants of Islington in Local Institutions, plus 829 non-inhabitants of Islington in Local Institutions, the number in Islington Hospital being 1,117, the number in the Royal Northern Hospital 124. The deaths of inhabitants of Islington in Institutions outside the Borough were 946. The total deaths of Islingtonians in all Institutions were 2,564, and the proportion per 100 deaths from all causes equalled 63.9. Transferable Deaths.—During the year 43 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 158 persons died from these diseases, the death-rate being 0.49 per 1,000 inhabitants, as contrasted with 0.56 in the corresponding period last year, and a decennial average mortality of 168 and a death-rate of 0.51 per 1,000. In London the death-rate from epidemic disease was 0.36. Locally the deaths in the Sub-Registration Districts and Wards were as follows:— Showing the Deaths from each of the principal Epidemic Diseases in the several Wards and Sub-Registration Districts during the Year 1933. SUBRegistratton Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Enteritis and Diarrhoea. Totals. Tufnell Tufnell - - 1 - 1 2 6 10 Up. Holloway Tollington Up. Holloway - — 2 — 2 2 5 11 Tollington 1 — 1 — 4 — 9 15 Lr. Holloway Lr. Holloway - — — — 1 3 14 18 Highbury Highbury - — — 1 2 2 14 19 Mildmav - — 1 1 2 6 6 16 Barnsbury Thornhill - — 3 — 1 3 8 17 Barnsbury 1 - 2 - 4 1 5 13 Islington South East St. Mary's - - 1 - 3 5 4 13 Canonbury 1 - 2 - - 5 2 10 St. Peter's 1 — 1 2 1 4 7 16 The Borough 4 - 14 4 23 33 80 158 Total Death Rates 0.01 — 0.05 0.01 0.07 0.10 0.25 0.49 24 1933] Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1923-32 and for the Year 1933. 1923 1924 1925 1926 1927 1928 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever - - 4 0 01 4 001 1 0.00 - - 2 0.00 Small Pox - - - - - - - - - - - - Measles 16 0.05 103 0.30 22 0.06 09 0.20 29 0.09 156 0.48 Scarlet Fever 13 0.04 10 0.03 8 0.02 12 0.03 8 0.02 8 0.03 Whooping Cough 38 0.11 57 0.17 61 0.20 29 0.09 45 0.14 21 0.06 Diphtheria 21 0.06 33 0.09 21 0.06 31 0.09 25 0.07 25 0.08 Diarrhoea and Enteritis (under 2 years) 103 14.51 per 1,000 births 52 7.65 per 1,000 births 69 10.54 per 1,000 births 69 10.68 per 1,000 births 48 7.79 per 1,000 births 67 11.57 per 1,000 births  1929 1930 1931 1932 Mean 10 years 1933 Deaths Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 2 001 - - - - - - 1 0.00 4 001 Small Pox — — 1 0.00 - - - - - - - - Measles 11 0.03 140 0.43 7 0.02 52 0.16 61 0.18 14 0.04 Scarlet Fever 8 0.03 14 0.04 4 0.01 7 0.02 9 0.03 4 0.01 Whooping Cough 126 0.39 10 0.03 32 0.10 23 0.07 44 0.13 23 0.07 Diphtheria 32 0.10 42 0.13 15 0.04 20 0.06 27 0.08 33 0.10 Diarrhoea and Enteritis (under 2 years) 68 12.34 per 1,000 births 97 17.1 per 1,000 births 67 12.7 per 1,000 births 73 14.7 per 1,000 births 71 11.7 per 1,000 births 63 13.7 per 1,000 births Showing the Deaths from Diarrhœal Diseases together with those classed under Enteritis and its Sub-headings, arranged in quarterly periods, and in three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 1 10 11 1 4 5 4 10 14 1 26 27 7 50 57 1 to 5 years — 3 3 — 1 1 — — - 1 2 3 1 6 7 Over 5 years 2 — 2 1 1 2 — 9 9 - 3 3 3 13 16 Totals 3 13 16 2 6 8 4 19 23 2 31 33 11 69 80 INFLUENZA. Influenza caused 170 deaths during the Year and showed an increase of 67 on the return for the year 1932, and were 81 above the average of the preceding ten years 1923-32. The death-rate was equal to 0.33 per 1,000 inhabitants. 25 [1933 Showing the Deaths from Influenza in the Quarters of the Year 1933, together with the averages of the corresponding periods, 1923-32. Years. Quarters. Totals. First. Second. Third. Fourth. 1923 21 22 7 8 58 1924 70 15 4 15 104 1925 47 3 1 21 72 1926 15 24 3 9 51 1927 118 15 7 12 152 1928 18 12 3 8 4J 1929 190 13 1 3 207 1930 5 4 3 4 16 1931 68 4 4 14 90 1932 82 9 4 8 103 Average 63 12 4 10 89 1933 162 1 7 170 Increase or Decrease +99 —11 — 4 — 3 + 81 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 1933. Ages. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Mean 10yrs 1933 Difference. 0- 5 5 11 6 - 8 3 5 1 4 5 5 4 - 1 5-10 - 1 2 1 4 1 1 — — — 1 — — 1 10-15 2 2 — — 1 — — — — — — — — 15-25 — 10 2 2 3 3 2 — 4 3 3 3 — 25-35 6 7 1 4 13 1 9 — 4 9 5 10 + 5 35-45 4 10 3 8 21 6 19 — 14 4 9 24 + 15 45-65 12 12 11 6 22 4 38 5 16 10 14 27 + 13 55-65 5 19 11 12 28 6 43 3 16 18 16 32 + 16 65-75 16 16 19 8 34 7 52 2 15 25 19 33 + 14 75 & upwards 8 16 17 10 18 10 38 5 17 29 17 37 + 20 A11 Ages 58 104 72 51 152 41 207 16 90 103 89 170 + 81 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the notifiable diseases of this class. Erysipelas.—20 deaths were returned from this disease, or 1 more than in the year 1932, and 8 above the average of the preceding ten years 1923-32. Puerperal Diseases.—These comprise Puerperal Pyaemia, Septicæmia, Septic Intoxication and Puerperal Fever, and they caused 13 deaths, being the same as in 1932, and were 4 above the average of the ten years 1923-32. The death-rate was equal to 2.8 per 1,000 births. Septicaemia (non-notifiable purulent infections) deaths numbered 17. Anthrax, Glanders, Farcy, Tetanus, etc.— An inquest was held on the death of a horse slaughterman's roundsman who was found to have died from septicæmic anthrax. The Coroner did not presume that the man got the germ while at work. Such cases of anthrax are very infrequent. INDUSTRIAL DISEASES. Lead Poisoning, Chrome, etc.—No death from any of these causes was recorded. CANCER. Cancer.—509 deaths were registered from this malignant disease during the year compared with 534 in 1932, and with an average of 489 in the previous decennium. The deaths represent a death-rate of 1.59 per 1,000 of the civil 26 1933] The following statement shows the ages at death of the persons attacked during the past ten years, and the return for the year 1933:— Ages. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Mean 10 yrs 1933 Difference 0- 5 1 1 1 - 1 - 3 2 - 2 1 2 + 1 5-15 — 1 2 — — - 1 — 3 1 1 1 - - 15-25 6 4 3 3 1 3 1 1 1 2 3 3 - - 25-35 10 9 5 6 5 14 10 6 10 12 9 9 - - 35-45 27 38 40 27 24 36 22 26 25 19 28 23 — a 45-55 88 77 93 73 74 83 84 72 85 78 81 84 + 3 55-65 138 131 168 142 137 147 153 123 138 157 143 160 + 17 65-75 125 149 144 144 135 155 106 139 167 158 142 146 + 4 75-85 68 52 71 51 65 71 81 90 83 92 72 70 — 2 85 & upwards 9 8 7 7 7 9 10 8 7 13 9 11 + 2 Totals 472 470 534 453 449 518 471 467 519 534 489 509 + 20 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1933. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 12 20 13 13 22 21 23 124 Second 17 12 12 11 22 13 35 122 Third 14 12 9 17 25 22 28 127 Fourth 19 9 8 12 39 20 29 136 The Year 62 53 42 53 108 76 115 509 TUBERCULOSIS. Tuberculosis caused 312 deaths, which were 4(5 below the average of the last decennium, and were 4 above the number registered in 1932. The deathrate resulting from them was equal to 0.98 per 1,000 of the civil population, and represented 7.9 per cent. of the deaths from all causes during the year. Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 274 deaths, as contrasted with the decennial average of 311, while the death-rate was 0.86 per 1,000 of the civil population as against the decennial rate of 0.94 per 1,000. There was a decrease of 37 on the ten years average number of deaths, and of 0.08 on the mean death-rate. Tuberculosis (Respiratory System). Proportion of Death'; 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. 1923 337 1.00 8.64 11.6 1924 340 0.99 8.05 12.3 1925 382 1.13 9.18 12.3 1926 289 0.85 7.06 12.0 1927 314 0.94 7.61 12.3 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 1932 264 0.81 6.58 12.4 Average 10 years 311 0.94 7.50 12.6 1933 274 0.86 6.92 12.4 population and is 0.11 above the average rate (1.48) of the last ten years; 255 deaths occurred among males and 254 among females. 27 [1933 The following return gives the deaths at each age period:— Age Periods. Males. Females. Total. 0-5 1 - 1 5-15 2 2 4 15-25 15 35 50 25-35 35 29 64 35-45 25 16 41 45-55 40 13 53 55-65 33 10 43 65 upwards 11 7 18 Total 162 112 274 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1933. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 7 15 7 8 15 22 15 89 Second 6 9 8 4 9 14 13 63 Third 7 6 7 4 2 13 12 51 Fourth 6 8 10 6 10 14 17 71 The Year 26 38 32 22 36 63 57 274 Showing the Deaths from all forms of Tuberculosis during 1933. 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 1 273 162 112 26 38 32 2? 36 63 57 274 Meningeal 5 9 9 8 15 1 2 4 1 2 3 10 23 Abdominal - - 5 - 5 - 2 - 1 1 1 5 General - 1 4 2 3 - 1 2 2 - - - 5 Other forms — 1 4 3 2 — 1 — 1 1 2 5 All Tuberculosis 6 11 295 175 137 27 44 38 25 40 68 70 312 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 565 deaths, 44 above that of 1932. They were equal to a death-rate of 1.77 per 1,000 of the civil poulation, and represented 14.3 per cent. of the total deaths registered in the Borough. Acute Bronchitis.—There were 87 deaths as compared with 90 in the previous year, 43 occurred among males, and 44 among females. The deaths of 2 infants under 12 months were registered. Chronic Bronchitis.—83 deaths were ascribed to it, 46 being males and 37 females. This return is 43 above that of 1932. Pneumonia (All forms).—368 deaths were registered, of which 189 were males and 179 females, and were 39 above the year 1932. 41 infants under a year old died from this disease, while between the ages of 1 and 5 years 33 died from it. Above 5 years of age the deaths numbered 294. 209 deaths occurred in Public Institutions, chiefly the Islington Hospitals. 28 1933] Pleurisy. —There were 5 deaths registered from litis disease, 3 deaths occurred in Public Institutions. Asthma and Emphysema.-2 deaths were recorded from Asthma. Other Diseases of the Respiratory System.—20 deaths were registered, as contrasted with 19 in 1932. VENEREAL DISEASES. Nineteen deaths were ascribed to these diseases, the same as in 1932. Of these, 14 were males and 5 females. They were 5 above the mean deaths (14) of the preceding ten years 1923-32. The three groups of ages at death were as follows Under 1 year, 4 deaths; 1-5 years, no death ; and over 5 years, 15 deaths. The nearest treatment centres of these diseases are the Royal Northerr. 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 on the work of the local branch in 1933 as follows:— In February, a lecture at the Caledonian Road Baths by Dr. Feldman—subject, "Dangerous Lives"; film pictures followed the lecture; attendance 800. During the summer months, May to September, five addresses were delivered at Highbury Corner on "British Social Hygiene Ideals"—addresses by Captain Buckler. In October, two lectures were delivered in the Central Library Hall, one to men and one to women. Attendances averaged 250 each lecture. DEATHS FROM COAL-GAS POISONING. During the year 28 deaths were registered from asphyxia caused by the inhalation of carbon-monoxide gas. (Twenty-one deaths from the same cause occurred in 1932.) Twenty-one of these deaths were attributable to suicide, while the cause of the remaining seven deaths were accidental. Of the 28 deaths, 17 were males and 11 females, the ages ranging from 20 to 75 years. ACCIDENTAL DEATHS. The deaths due to accident numbered 133. Of this number 68 deaths were ascribed to vehicular traffic and may be summarised as follows Motor Car or Lorry. Bus or Tram. Taxi-cab. Other Vehicles. Total. 32 14 5 17 68 Of this number, 23 deaths occurred to Islington residents when in outlying districts. In addition to these, 19 non-residents were also killed by vehicles within the borough. 29 [1933 Death from a "copying-ink" pencil.—Among the "unusual" or rare causes of death in the Borough during the year one caused by analine dye of a copying-ink pencil has been noted. It is not realised by the general public that copying-ink pencils are poisonous, so a few remarks on the case may emphasize the possible dangers, and ensure perhaps earlier treatment. A man (aged 71) was engaged at his place of work stamping papers on his desk; the point of a copyingink pencil, lying alongside, went into his hand. He had the hand dressed at hospital and subsequently looked after at home. The hand did not pain him and appeared neither better nor worse for about ten days, then it became very swollen. He attended hospital again and was admitted, the part was opened under an anaesthetic, and dressed. While waiting afterwards to have his arm put in a sling he collapsed and died in a few minutes. In this case the poison had been retained locally in the hand, but the opening up caused a local distribution and the poison was distributed throughout the body by the blood stream, reached the heart muscle and led to death. Other cases of the same sort have been recorded. CORONER'S COURT, INQUESTS, AND MORTUARY. During the year 35 bodies were received into the Mortuary, as compared with an average of 262 in the preceding 10 years. The daily average number of bodies received was 0.09, whilst in 1932 the average was 0.1. No inquests were held, as contrasted with an average of 214 in the ten years 1923-32. Year. Bodies received into Mortuary. Inquests. 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 1932 52 Nil Average 262 214 1933 35 Nil The continued unsatisfactory state of affairs and the inconvenience to Islington citizens which results from the non-use of the Coroner's Court for enquiries into Islington deaths need not be further commented on here, as the matter was dealt with in the last Report, page 25. 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, Continued Fever, Puerperal Fever and Erysipelas. 2,016 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 35. No case of either Typhus or of Continued Fever was notified. 30 1933] The total cases notified are 54 more than those of the previous year (1,962), and 117 below the average (2,133) of the preceding ten years. The decreases when contrasted with the decennial averages are to be found in the returns from Diphtheria and Enteric Fever, which were respectively 292 and 1 below the average, while Scarlet Fever, Membranous Croup, Erysipelas and Puerperal Fever showed increases of 116, 1, 45 and 3 respectively on the ten years' average. The 2,016 cases were equal to an attack-rate of 6.32 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. 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 1932 1,962 6.04 10 years average 2,133 6.47 1933 2,016 6.32 Registration Sub-Districts.—The total number of cases notified in these districts was as follows:— Total cases notified. Tufnell 192 Upper Holloway 201 Tollington 196 Lower Holloway 252 Highbury 344 Barnsbury 340 Islington South-East 491 Total 2,016 SMALL POX. There were 11 cases notified during the year, of which number 1 was unconfirmed. Of the 10 confirmed cases, 6 were unvaccinated, 4 were vaccinated in infancy. The unconfirmed case had been vaccinated in infancy. The type of small pox as usual was Variola Minor. The first case, on the 3rd of January, was a visitor contact with an Islington case in December, 1932. The second case, on the 15th March, was probably infected at his work at the Oxford Circus Tube Station, as a fellow-workman living in Wandsworth also contracted the disease at this time. The third case, on the 28th March, was this man's w ife, the 4th, 5th, 6th and 7th his children, as vaccination was at first declined. The 8th case and also the 9th case were contacts with this family; No. 10, as stated, was not confirmed as Small Pox. Case No. 11, 11th December, was employed with a Telegraph Firm in the City of London, and the source of infection was obscure for some time until it was discovered that a fellow-worker living at Camberwell had been absent with supposed Chicken Pox. The Medical Officer of Health of Camberwell reports that this supposed Chicken Pox resulted in 14 cases of Small Pox being subsequently notified. 31 [1933 Classification as to source of infection. Infection from previous cases 7 Infection from common lodging houses - Infection from school — Smallpox in the neighbourhood 1 Infection from workplace 2 Infection not traced — Contact with cases in other Boroughs — Infection in hop fields — Infection from hospital — Infection possibly from "missed case" — Unverified cases 1 Total 11 State of vaccination of persons notified to be suffering from Smallpox during the year 1933. Age. Unvaccinated. Vaccinated in Infancy. Doubtful. 0- 5 years — — — 5-10 „ — — — 10-15 „ 2 — — 15-20 „ 1 — — 20-30 „ 1 2* — 30-40 „ 1 — — 40-50 „ — 2 — 50-60 „ 1 1 — and upwards — — — 6 5 — * 1 unconfirmed. Diphtheria was responsible for 547 cases of illness, which were 292 below the average (839) of the preceding ten years. The attack rate was equal to 1.72 per 1,000 of the civil population annually, and was 0.83 below the mean rate (2.55) of the decennial period. In London the attack-rate was 2.2 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 37). Applications in respect of 5 children were received for Diphtheria immunisation (Schick Test) during the year. 32 19331 ANTI-TOXIN TREATMENT. During the year 68,500 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 48,500 units were sold, the total amount received by the Council being £2 7s. 11d. The remaining 20,000 units were given free, owing to the patients' limited means. Scarlet Fever.—1,220 cases were notified, and they showed an increase of 116 on the average (1,104) of the ten years 1923-32. The attack-rate was equal to 3.82 per 1,000 of the civil population annually, which is an increase of 0.47 per 1,000 of the mean rate (3.35) of the preceding ten years. In London the attackrate was 5.0 per 1,000 of the civil population. As will be seen by the Table, page 90, 38 cases of Scarlet Fever were treated at home. A proportion of these of course were due to the London County Council circular stating that the accommodation for Scarlet Fever was limited in view of the increased treatment of Measles. For a time cases of Scarlet Fever were only admitted on the recommendation of the Medical Officer of Health. TYPHOID FEVER AT CAMP. USE OF CONTAMINATED WATER. On the 6th July a young man of 17 years of age, home address, 47, Battledean Road, Islington, was notified to be suffering from Typhoid Fever. Upon investigating the case (he had been admitted to St. Mary, Islington, Hospital, on the 1st July), we were able to get some information from the parents of the lad. It appeared he went on a cycling tour on Whit Monday with several members of a cycling club to New House Farm, situated in the Parish of Sheering, Essex, in the district of the Medical Officer of Health for the Epping Rural District. This New House Farm lets out an adjacent field called "The Moors" to cyclists for camping. The campers apparently take their water supply from a "cascade" which flows from near the river Stort, and which eventually supplies a bathing pool. A case of Typhoid Fever had already been admitted elsewhere in London, but apparently the source of infection was not traced until we got an inkling of the matter by questioning these lads in Islington. We immediately communicated with the Ministry of Health in accordance with their Memorandum on the Duties of Medical Officers of Health, Infectious Diseases, Part 9. This matter was one of considerable importance, because this area is part of the Catchment Area for water supply. The Ministry immediately had an investigation made on the spot. From the Secretary of the Club we obtained as far as he could give it a list of the campers about this time, and we informed the other Health Authorities so that all contacts might be followed up. The Medical Officer of Health of the district stated that it was quite an unofficial camp of which they knew nothing; the farmer had merely permitted camping. The Local Authority stopped the camping at once, as the field had no proper water supply nor any sanitary convenience. He said it was quite reasonable to believe that the campers took water from the river below and quite close to the outfall of the sewage effluent. An unfortunate result of this holiday camp was that one of the Islington lads who contracted the disease died. The other Islington lad who contracted the disease recovered. Another club patient residing in Hackney died of the disease, and there were at least two other cases non-resident in Islington, that is, five cases from this polluted water supply, of whom two died. 33 [1933 Enteric Fever. — A total of 15 cases of Enteric Fever were notified, the others being not traced to any common source. This is a decrease of one on the average (16) that obtained during the ten years 1923-32. The attack-rate was 0.05 per 1,000 annually, an increase of 0.01 on the mean rate, 0.04, of the last ten years. In London the rate was 0.04. Puerperal Fever —See page 12. Erysipelas.—183 cases were notified, and were 45 above the average of the preceding ten years, the attack-rate being 0.57 per 1,000 of the civil population. FATALITY FROM THE PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES. By "Fatality" is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that of the 2,016 cases notified, 67 deaths occurred, or 3.3 percent., which contrasts with an average percentage of 2.6 in the preceding ten years 1923-32. Years. Cases. Deaths. Fatality. 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 1932 1,962 50 2.7 Mean 2,193 57 2.6 1933 2,016 67 3.3 * Including 2 cases not notified. ‡ Includes 1 case not notified. Hospital Isolation.—Of the 2,016 cases of infectious disease notified, 1,911 were isolated in hospital, equal to a percentage of 94.3, while only 5.7 per cent. of the patients were nursed at home. The following tabular statement shows the number of cases treated in the various public institutions:— Year. Cases treated in Hospital. Percentage of cases treated. 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 1933 1,911 94.3 .34 1933] DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated in Hospital. Percentage of known cases. Small-pox 11 11 100.0 Scarlet Fever 1,220 1,182 97.7 Diphtheria 551 544 98.7 Enteric Fever 15 14 93.3 Erysipelas 183 124 67.7 Puerperal Fever 36 36 100.0 2,016 1,911 94.3 Summary of Infectious Sickness and of Deaths arising therefrom, distinguishing the Cases treated at Home and in Hospitals; and showing the percentage of notified Cases removed to Hospitals, together with the Fatality among cases treated at Home and in Hospitals during the year 1933. 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 11 - 11 100.0 o.o - - - - - - Scarlet Fever 1,182 38 1,220 97.7 2.3 4 - 4 0.3 - 0.3 Diphtheria 544 7 551 98.7 1.3 31 2 33 5.6 0.4 6.0 Enteric (Typhoid Fever) 14 1 15 93.3 6.7 3 - 3 20.0 - 20.0 Erysipelas 124 59 183 67.7 32.3 18 2 20 9.8 1.1 10.9 Puerperal Fever 36 - 36 100.0 7 - 7 19.4 19.4 Continued Fever - - - — — - — - — — — Total 1,911 105 2,016 94.3 57 63 4 67 31 0.2 3.3 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1923-32 and in 1933. DISEASES. YEARS. Average number of cases, 1923 32 1933 Increase or Decrease 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Small-pox Cases - - - 1 - 4 71 244 66 162 †- 11 - Rate - — — o.oo — 0.01 0.22 0.75 0.21 0.50 — 0.03 - Diphtheria Cases 889 854 911 743 716 756 1004 1242 710 598 839 547 — 292 Rate 2.64 2.48 2.69 2.19 214 2.33 3.14 3.81 2.19 1.84 2.55 1.72 — 0.83 Membranous Croup Cases 2 2 2 — 4 4 4 6 4 3 3 4 + 1 Rate 0.00 0.00 0.00 — 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 — Scarlet Fever Cases 1080 1077 1139 1010 909 1305 1155 1310 1093 983 1104 1220 + 116 Rate 3.21 3.13 3.36 2.98 2.72 4.02 3.61 4.02 3.37 3.03 3.35 3.82 + 0.47 Enteric Fever Cases 16 14 10 18 12 19 18 31 16 15 16 15 — 1 Rate 0.06 0.04 0.03 0.05 0.03 0.06 0.06 0.09 0.05 0.04 0.04 0.05 + 0.01 Continued Fever Cases — 3 — 1 — — 1 — — 1 1 — — 1 Rate — 0.01 — 0.00 — — 0.00 o.oo — o.oo o.oo — — Puerperal Fever* Cases 22 19 23 27 33 38 38 36 45 35 33 36 + 3 Rate 3.10 2.79 3.50 4.18 5.40 6.56 6.89 6.3 8.52 7.07 5.47 7.86 + 2.39 Erysipelas Cases 87 116 109 118 139 134 148 188 177 165 138 183 + 45 Rate 0.26 0.34 0.32 0.35 0.42 0.41 0.46 0.58 0.54 0.51 0.42 0.57 + 0.15 Total Cases 2096 2085 2194 1918 1813 2260 2439 3057 2111 1962 2133 2016 — 117 Rate 6.22 6.06 6.47 5.65 5.42 6.96 7.62 9.38 6.50 6.04 6.47 6.32 — 0.15 * Per 1,000 Registered Births. † Average where there has been continuance of disease during 10 years. 35 [1933 Showing the Cases of the Notifiable Infectious Diseases notified, in the SubRegistration Districts and the Wards during the Year 1933. SubRegistration Districts. Wards. Small pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell - 116 43 - 3 - 25 5 192 Up. Holloway Up. Holloway 1 118 65 — 2 - 11 4 - - — 201 Tollington Tollington - 128 46 — - 16 6 - - - 196 Lr. Holloway Lr. Holloway - 155 71 1 2 - 19 4 - - - 252 Highbury Highbury - 102 34 — 2 - 14 4 - - — 156 Mildmay - 117 54 — — - 16 1 - - — 188 Barnsbury Thornhill 8 116 61 2 — - 25 1 - - — 213 Barnsbury 2 78 33 — — - 13 1 - - — 127 Islington, S.E. St. Mary's — 76 54 1 3 - 15 1 - - — 150 Canonbury — 111 39 — 1 - 12 3 - - — 166 St. Peter's — 103 47 — 2 - 17 6 - - — 175 Totals 11 1,220 547 4 15 — 183 36 — - — 2,016 Attack-Rates per 1,000 population 0.03 3.82 1.72 0.01 0.05 — 0.57 0.12 — - - 6.32 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. Eight cases were notified from this disease during the year, as contrasted with four in 1932, and four in 1931. 1933 1932 Cases. Deaths. Cases. Deaths. 1st Quarter Nil Nil 1 Nil 2nd „ 3 „ 1 „, 3rd 3 „ 1 „ 4th 2 „ 1 1 8 Nil 4 1 Epidemic Cerebro-Spinal Meningitis. Twelve cases came to the knowledge of the Medical Officer of Health, although only 7 were notified, as against 13 in 1932. During the ten years 1923-32 the cases averaged 10 per annum. 36 1933] A return of attacks of the disease during the past ten years is given in the following statement:— 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Average 10 yrs. 1923-32 1933 Total Deaths, 1923-32. 1st Quarter 3 2 3 3 1 2 4 4 7 3 1 21 2nd „ 2 — 1 3 3 4 2 5 9 3 3 6 26 3rd „ 2 2 2 3 - 2 2 2 1 3 2 3 14 4th „ 1 4 1 2 1 1 3 2 2 6 2 2 14 Year 8 6 6 11 7 8 9 13 16 19 10 12 75 The deaths during the year numbered 7, and were equal to the high rate of 58 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. 1929 1930 1931 1932 1933 Malaria 2 Nil 1 2 Nil Dysentery 6 Nil 6 15 5 Acute Primary Pneumonia 397 323 370 254 179 Acute Influenzal Pneumonia 122 36 115 87 125 Total 527 359 492 358 309 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 1,928 cases had been notified. In 1933 the notifications were 487. DYSENTERY. Five cases were notified during the year, but there was no common source of infection. They were isolated cases occurring throughout the year. GLANDERS, ANTHRAX AND HYDROPHOBIA IN MAN. Order under Section 55 of the Public Health (London) Act, 1921, by the London County Council. (Came into operation on the 26th April, 1909.) One death from Anthrax was recorded in Islington during the year, un-notified. Inquest, see page 25. 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 none were notified, whilst 3 deaths were registered. One case of Polio-encephalitis was notified, but no death was registered. 37 [1933 The following summary shows the number of cases, and also the fatality of recent years:— Acute Encephalitis Lethargica. Years. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Average (10 years). 1933 Cases 10 39 17 21 7 5 8 4 4 4 12 4 Deaths 5 4 6 9 4 3 3 — 2 1 4 3 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. 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 10 cases have received this assistance from the Borough Council, the cost of the Insulin supplied being £39 9s. 9d. 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 1933 were:—"Totally Blind," 2 (one of whom reached the age of 5 years in January); "Partially Blind," 11 (including 4 new cases). One of the former cases removed and his whereabouts were not traced. PREVENTION OF DEAFNESS. Circular 1337a, Ministry of Health, dated 22nd May, 1933, on "Prevention of Deafness." 38 The Islington Voluntary Welfare Centres dealt with cases coming under their supervision; some are treated at Centres, others are sent to hospitals. The Borough Council's and Centres' Health Visitors are instructed to visit such cases and see that the prescribed treatment is being followed. Discharging ears after Scarlet Fever, coming to the knowledge of the Medical Officer of Health—8 cases. In addition, 10 from other causes were visited by the Health Visitors. TUBERCULOSIS. 565 cases of Tuberculosis in its different forms were notified during the year. The attack-rate was equal to 1.77 per 1,000 of the civil population. This number was a decrease of 12 on the return of the previous year, and of 0.01 per 1,000 on the attack-rate Respiratory (Pulmonary) Tuberculosis.—462 notifications were received, of which 275 referred to males and 187 to females, and represented an attack-rate of 1.48 per 1,000 inhabitants. THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1933. Tubercular Diseases. Sex. Cases Notified in Whole District. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 275 - - 9 55 120 85 6 F. 187 - 2 6 61 95 21 2 Tubercular Meningitis M. 3 - 1 2 - - - - F. 2 — 2 - - - - - Tabes Mesenterica M. 3 — — 3 — — — — F. 3 — - 1 1 1 — General Tuberculosis M. - - - - - - - F. - - - - - - - - Other forms of Tuberculosis M. 42 - 6 11 11 8 4 2 F. 50 — 4 21 14 8 1 2 All Tubercular Diseases M. 323 - 7 25 66 128 89 8 F. 242 — 8 27 76 104 23 4 Totals 565 — 15 52 142 232 112 12 Percentages at each life period to total cases - 2.65 9.22 25.12 41.06 19.82 2.12 1933] Showing the Notified Gases of Tuberculosis in the Wards during 1933. 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 22 15 37 4 2 6 43 1.33 Up. Holloway Up. Holloway 32 25 57 - 9 9 66 2.18 Tollington Tollington 28 25 53 8 3 11 64 2.17 Lr. Holloway Lr. Holloway 26 19 45 9 7 16 61 1.54 Highbury Highbury 21 27 48 3 6 9 57 1.87 Mildmay 21 12 33 4 5 9 42 1.38 Barnsbury Thornhill 28 17 45 4 6 10 55 1.90 Barnsbury 30 8 38 4 2 6 44 1.85 Islington, S.E. St. Mary's 22 7 29 1 3 4 33 1.89 Canonbury 20 10 30 5 4 9 39 1.27 St. Peter's 25 22 47 6 8 14 61 2.15 Totals 275 187 462 48 55 103 565 1.77 39 [1933 From the above statement it will be seen how the disease attacked people at the various ages, viz.: In every hundred cases 2.65 were aged 1 to 5 years. „ „ 9.22 were aged 5 to 15 years. Prime of Life „ „25.12 were aged 15 to 25 years.* „ „ 41.06 were aged 25 to 45 years. „ „ 19.82 were aged 45 to 65 years. „ 2.12 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 55, while the females reached 61. TUBERCULOSIS. Year. Notified Cases. Coming to knowledge. Total. Deaths. 1925 885 287 Ph. 881 O.F. 291 1172 Ph. 382 O.F. 56 438 1926 704 186 Ph. 654 O.F. 236 890 Ph. 289 O.F. 62 351 1927 640 161 Ph. 657 O.F. 144 801 Ph. 314 O.F. 34 348 1928 694 140 Ph. 659 O.F. 175 834 Ph. 309 O.F. 49 358 1929 616 105 Ph. 592 O.F. 129 721 Ph. 314 O.F. 31 345 1930 590 111 Ph. 567 O.F. 134 701 Ph. 280 O.F. 35 315 1931 588 133 Ph. 590 O.F. 131 721 Ph. 281 O.F. 51 332 1932 577 140 Ph. 578 O.F. 139 717 Ph. 264 O.F. 44 308 1933 565 157 Ph. 572 O.F. 150 722 Ph. 274 O.F. 38 312 Showing decrease Notified Cases also Deaths in the case of Pulmonary Disease. " Other forms," while lower since 1926 fluctuated (see above table). PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 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 or 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. During the year the work of the Committee has increased steadily in scope and extent. The new cases received numbered 400, the number of visits were 1,424, letters written 1,012, and interviews held 899. Appended is the Honorary Secretary's report; the money collected from patients amounted to £520 3s. 3d. 1933] 40 Report for the year 1933. The year 1933 has shown an increase in the amount of work to be undertaken by the Committee. This is partly due to the change in administration which took place on April 1st, when the assessment of General Hospital Cases became the work of Tuberculosis Care Committees. More patients, accordingly, have come under the purview of the Committee. This means more families also, for since the aim of the work is primarily preventative, the care is not only for the patient, but very largely for the family. This is a formidable work in such a large area as Islington, but a few examples of care work undertaken throughout the year may go to prove that it is worth while. A. was a young girl with tubercular disease of both kidneys. Her father had deserted years ago and her mother went out to work to support herself and the girl. By this means she was able to provide the necessities of life, but the girl needed 2 pints of milk daily and extra nourishing food. The help of the Charity Organisation Society was solicited and the extras needed were provided. B. was a married man who had to go away for Sanatorium treatment leaving a wife and three young children. She had the children cared for by a neighbour and went out to work. Soon, however, her husband needed warm pyjamas which she could not afford to buy. These were supplied out of the Committee's clothing cupboard. C. was also a man with young children. Whilst he was away, the firm from which he had bought furniture on the instalment plan threatened to reclaim this unless payments were kept up to date (there were previous arrears on account of illness). When the firm heard how the family stood they agreed to accept a very small payment weekly until the husband could return to work. D. was worried whilst she was receiving treatment because her husband, from whom she had been separated for some years, had reduced her allowance and she felt he could afford more. By getting into touch with the Women and Children's Protection Society it was able to be proved to the patient that an order for the reduced amount had been made in Court whilst she was ill, and that her husband could not afford more. Efforts have been made to provide that conditions at home are satisfactory for the patient on discharge from Sanatorium. For example:— E. was a young girl in Sanatorium whose mother died of tuberculosis whilst she was still away. An aunt was very willing to give the girl a good home but had not the accommodation, although she had her name down for a house on one of the new estates. By getting into touch with the Housing authorities she was able to be given preferential treatment so that the girl will have a suitable home to which to be discharged. F. was discharged from Sanatorium fit only for light work. He was found to have insufficient to live on and to be sleeping in the same bed as his wife. The circumstances were explained to the Public Assistance Committee who granted Out-Relief, and a bed was obtained by a grant from Regimental funds. The weekly Handicraft Class for patients who are not fit for work continues to be held, and, as one patient put it, "it does keep my mind off things." The library also still provides patients with books instead of their getting them from public libraries which in some cases is perhaps not to be recommended. 41 [1933 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 1933. Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1933 1,319 1,116 444 398 3,277 Notified cases added during the year 1933 275 187 48 55 565 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1933 55 55 19 28 157 No. of cases removed from the register during the year 1933 1,649 1,358 511 481 3,999 301 250 74 70 695 1,348 1,108 437 411 3,304 Showing the Notified Cases of Tuberculosis in the Quarters during 1933. 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 75 50 125 73 52 125 58 50 108 69 35 104 275 187 462 Tubercular Meningitis 3 ... 3 ... ... ... ... 2 2 ... ... ... 3 2 5 Tabes Mesenterica ... ... ... 2 ... 2 1 3 4 ... ... ... 3 3 6 General Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 12 13 25 9 16 25 12 13 25 9 8 17 42 50 92 Totals 90 63 153 84 68 152 71 68 139 78 43 121 323 242 565 Disinfection of Houses and Rooms after Tuberculosis.—The following statement gives the particulars for the year:— Houses. Rooms. 1st quarter 101 135 2nd 80 108 3rd „ 89 126 4th „ 76 98 Total 346 467 42 1933] PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 1st January, 1933, to the 31st December, 1933, in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A 0 to 1 1 to 6 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up. Total Primary Notifications. Pulmonary Males - - 7 2 22 33 77 43 54 31 6 275 455 „ Females — 2 2 4 21 40 66 29 14 7 2 187 304 Non-pulmonary Males — 7 11 5 7 4 2 6 3 1 2 48 65 „ „ Females — 6 13 8 6 9 7 2 1 1 2 55 75 Showing New Cases of Tuberculosis and all Deaths during 1933. Age Periods. New Cases. Deaths Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year 1 - 1 4 1 - 1 4 1-5 — 2 9 12 — — 3 8 5-10 9 4 15 20 1 1 2 2 10-15 4 6 10 10 1 1 1 1 15-20 28 23 9 7 10 12 2 3 20-25 36 50 4 12 5 23 1 3 25-35 85 81 4 9 35 29 1 3 35-45 52 39 6 4 25 16 — — 45 55 64 18 4 1 40 13 1 — 55-65 41 12 2 1 33 10 1 — 65 and upwards 10 7 3 3 11 7 — 1 Totals 330 242 67 83 162 112 13 25 75 Deaths not notified or 24 0 per cent. of Total Deaths. 43 [1933 TUBERCULOSIS DISPENSARIES. RETURN SHOWING THE WORK OF THE NORTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1933. 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 87 70 3 2 7 7 8 6 94 77 11 8 190 (b) Diagnosis not completed — — — — — — — - 1 - - — 1 (c) Non-tuberculous — — - - — - — - 96 84 3 6 195 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 6 — — — — 2 - 6 6 2 - 14 (b) Diagnosis not completed — — — — — — †- — - - — — - (c) Non-Tuberculous — — — — — — — — 36 60 68 70 234 C.—Cases written off the Dispensary Register as (a) Recovered 9 8 1 — 3 5 2 4 12 13 3 4 32 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 137 149 77 76 439 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 269 249 12 6 23 27 42 20 292 276 54 26 648 (b) Diagnosis not completed — — — — — — — — 1 — — — 1 1. Number of cases on Dispensary Register on January 1st 665 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 177 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 37 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,099 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme and cases "lost sight of" 131 10. Number of (a) Specimens of sputum, &c., examined 267 4. Cases written off during the year as dead (all causes) 85 (b) X-ray examinations made in connection with Dispensary work 315 5. Number of attendances at the Dispensary (including contacts) 3,426 6. Number of Insured persons under Domiciliary Treatment on the 31st December 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 1 7. Number of consultations with medical practitioners*:— 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 344 (a) Personal 19 (6) Other 403 * Hospital staff 174. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) provided by the Council—One in the Northern part of Borough. G. CLARK TROTTER Chief Tuberculosis Officer. 44 1933] RETURN SHOWING THE WORK OF THE SOUTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1933. 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 70 41 1 4 7 6 4 7 77 47 5 11 140 (b) Diagnosis not completed — — — — — — — — 3 — — 2 5 (c) Non-tuberculous — — — — — — — — 71 55 30 20 176 B.—Contacts examined during the year:— (a) Definitely tuberculous 11 6 2 1 — — 1 — 11 6 3 1 21 (b) Diagnosis not completed — — — — — — — — — — 1 — 1 (c) Non-tuberculous — — — — — — — — 24 39 35 33 131 C.—Cases written off the Dispensary Register as:— (a) Recovered 8 8 1 1 3 4 4 4 11 12 5 5 33 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 97 96 65 54 312 D.—Number of Cases on Dis pensary Register on Decern ber 31st:— (a) Definitely tuberculous 272 199 25 23 35 31 20 34 307 230 45 57 639 (b) Diagnosis not completed — — — — — — — — 3 — 2 2 7 1. Number of cases on Dispensary Register on January 1st 698 8 Number of visits by Tuberculosis Officers to homes (including personal consultations) 214 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 62 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,634 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 142 10. Number of (a) Specimens of sputum, &c., examined 533 4. Cases written off during the year as dead (all causes) 101 (b) X-Ray examinations made in connection with Dispensary work 124 5. Number of attendances at the Dispensary (including Contacts) 4,185 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above - 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 183 7. Number of consultations with medical practitioners:— 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 310 (a) Personal 7 (b) Other 188 Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special form of treatment) provided by the Council—One in South Islington. G. CLARK TROTTER, Chief Tuberculosis Officer. During the year 1,137 persons were examined by the Tuberculosis Officers, and the patients made 7,517 attendances. 45 [1933 At the Northern Dispensary there were 668 new cases, and at the Southern 469, while the attendances at the former were 3,426 and at the latter 4,091. The examination of contacts with tuberculous cases showed that 24 were suffering from tuberculosis, 35 were suspects, and 350 were not suffering'. The nurses of the Northern Dispensary paid 1,302 visits, and those of the Southern 2,240, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 177 visits, and of the Southern 213 visits to the patients' homes for the purpose of examining them. Pneumothorax Treatment was also administered to thirty-seven patients at a cost of £181 11s. 0d. Finsen Light Treatment. -One case at a cost of five shillings. Artificial Sunlight Treatment.—One case under treatment in the year under review at a cost of seven shillings. TUBERCULOSIS. The number of persons in attendance at the Dispensaries in each year was as follows:— 1929 1930 1931 1932 1933 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 539 638 563 585 641 609 601 568 668 469 Actual Number of Attendances 2634 5899 2910 5443 3153 5001 3041 4545 3426 4091 Totals 3173 6537 3473 6028 3794 5610 3642 5113 4094 4560 A summary of the combined dispensaries is given for the following years:— Cases. Attendances. 1929 1,177 8,533 1930 1,148 8,353 1931 1,250 8,154 1932 1,169 7,586 1933 1,137 7,517 Totals 5,881 40 143 4G 1933] HOME VISITATION—TUBERCULOSIS. Visits paid bv Municipal Tuberculosis Visiting Nurse during the period 1st January, 1933, to 31st December, V933. Month. North Dispensary. South Dispensary. Total. January 157 138 295 February 175 139 314 March 177 144 321 Aptil 117 121 238 May 161 129 290 June 140 85 225 Ju>y 111 80 191 August 160 126 286 September 126 90 216 October 169 131 300 November 199 139 338 December 105 72 177 Totals 1.797 1,394 3,191 TUBERCULOSIS—HOUSING. During the year 561 visits were made to premises in which resided a person notified during 1933 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. House in a bad sanitary condition ... ... ... 1 Houses in good sanitary condition ... ... ... ... 300 Houses in which minor defects were discovered ... ... 30 Patient removed to another address ... ... ... ... Ill Patient deceased (no visit paid to house) ... ... ... 112 Patient in Mental Hospital ... ... ... ... ... 1 Patient in L.C. C. Hospital (Nursing Staff) or Government Building Staff ... ... ... ... ... ... 6 561 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,398 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 783 were Scarlet Fever and 304 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 2 + o Scarlet Fever 783 654 + 129 Diphtheria 304 378 74 Enteric Fever ... 5 2 + 3 Chicken-pox 304 — + 304 Total 1,398 1,034 + 364 [1933 47 Non - Notifiable Diseases.—4,648 cases came to the knowledge of the Medical Officer of Health during the year, viz., 1,888 cases of Measles, 1,131 cases of Chicken-pox, 470 of Whooping Cough, and 1,159 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.—3,640 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 1,888 1,733 + 155 Chicken-pox 1,131 1,022 + 109 Whooping Cough 470 630 — 160 * Other Diseases 1,159 1,929 — 770 Total 4,648 5,314 — 666 * Note.—"Other Diseases " include Mumps, Scabies, Ophthalmia, Itch, etc. BACTERIOLOGICAL EXAMINATIONS. 2,802 examinations were made for the medical profession of the sputum, of swabs from the throat, and of the blood of patients suspected to be suffering from Tuberculosis, Diphtheria and Enteric Fever, respectively. The number is an increase of 9 on that of the preceding year and 25 above the decennial average. Of the total examinations, 284, or 10.14 per cent. gave positive results. Diphtheria.—2,051 specimens were examined for Diphtheria, of which 186, or 9.1 per cent., were found to be "positive." Enteric Fever.—24 specimens of blood were examined, 5 of which gave positive results. Tuberculosis. —727 specimens of sputum were examined, 93, or 12.8 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. 1933. No. Submitted for Examination. Negative Result. (Bacilli) Positive Result. (Bacilli) Non-Virulent. Virulent. 21 17 4 1 1 * 2 not tested for Pathogenicity. ] 933] 48 Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1923-32, and in 1033. 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. 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 1,613 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 1932 238 1,746 1,984 5 9 14 111 684 795 2,793 Average 10 years 286 1,644 1,930 3 15 18 132 696 828 2,776 1933.. 186 1,865 2,051 5 19 24 93 634 727 2,802 SPECIAL BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS. A local doctor sent the Medical Officer of Health a bottle of reputed "Holy Water from Lourdes" which had been used by a Catholic patient to gargle the throat in a case of Tonsilitis. The patient was apparently rendered much worse after the use of the water, and developed Nephritis with Bacillus Coli in the urine. The Bacteriologist upon examining the specimen of alleged Holy Water reported that a culture made from the water showed a heavy infection with Bacilli Coli Communior. The facts are significant; this child's Coli infection was presumably from this alleged "Holy Water." EXAMINATION OF PEAS USED IN THE MAKING OF PEASE PUDDING- FOOD POISONING. At the end of the first week of October six patients were admitted to Highgate Hospital suspected to be suffering from food poisoning, and it was stated that food purchased at certain premises in St. Pancras was thought to be responsible. Another patient was admitted to University College Hospital, and later six other cases were notified; five were adults and eight were children; eleven resided in St. Pancras, and two in Holborn. The food responsible was Pease Pudding; portions of about five ounces were sold for a penny, each portion being in greaseproof paper, and the outer covering, newspaper. This outbreak had an interest for Islington, inasmuch as the peas from which this pudding was made were foreign and had been conveyed first to Holland, processed there, and thence to this country. A list of persons to whom the peas had been consigned in Islington was obtained from the Medical Officer of Health for Stepney. Peas are liable to be contaminated with organisms by dust, handling, contact with sacks, containers, etc., but in the ordinary processes of cooking and in the making of pease pudding, a temperature of 94 centigrade is sufficient to kill the dysentery bacillus Sonne. As a result of two fatal cases (not in Islington) an inquest was held. It was a moot question whether a child who had touched the pudding in the shop, and who was a carrier of dysentery organisms, was the cause, or whether this child was herself a victim [1933 49 of the disease, having also partaken previously. The verdict of the Jury after careful enquiry was that the child had infected the pudding while taking a portion out of the receptacle with her finger and this act was responsible for the outbreak. Nine days had elapsed before this child's blood was tested as it had not been suspected that she had been near the pudding. In the opinion of the bacteriologist it was unlikely that the child's blood would have reacted so strongly if the child had only been infected nine days before. It was recorded that after eating some of the pudding on Saturday evening the child was quite well until the Monday about 4.30 p.m., when she came home complaining of abdominal pain and a feeling of sickness. She had had a school holiday on Monday and the pain and sickness was ascribed to fried fish with vinegar, and ice cream, and a banana she had eaten. The pain and discomfort was cleared up by a dose of castor oil. The position therefore in view of the child's illness is not without an element of doubt, although the consensus of opinion seems to be that the child's illness was not due to her eating pease pudding and that she herself had infected the pudding as stated. A fact deduced as a result of the various bacteriological examinations made of grain and cereals is the importance of these, and tomatoes, fruit and vegetables, being washed to remove contamination. BACTERIOLOGICAL EXAMINATION OF MILK. During the year 1933, twenty-two 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. Eighteen were "clean" and four "dirty," the report of the bacteriologist being that in his opinion the samples did not comply with the prescribed conditions. BACTERIOLOGICAL EXAMINATIONS MADE FOR OTHER SPECIAL PURPOSES DURING THE YEAR 1933. (See also Table, Diphtheria, etc. and Milk). Specimen. Examined for. No. of Examinations. No. Positive. No, Negative. Swabs Puerperal Sepsis 2 2 — Split Peas Food Poisoning 5 5 — Wheat Foecal Contamination 1 1 — Oats do. 1 1 — Shaving Utensils Anthrax 1 — 1 "Holy Water" Presence of Bacteria 1 1 — Air do. Carbon Monoxide 1 — 1 WATER SOFTENING—BASE EXCHANGE METHOD. London water is "hard," that is, it contains calcium and magnesium salts in solution. When the water is used for washing purposes, a much greater quantity of soap, or washing soda, is required than if rain water were used. When the water is heated in domestic utensils a chalky deposit known as" fur is left. After a few years the deposit restricts the flow of water and leads to trouble with the heating system and hot water supply. Laundries and other works, also restaurants 1933] 50 use water softening apparatus. Within recent years smaller "Water Softeners" have been made for domestic use. Questions have been addressed to our department as to the use of these, the change effected on the water, and any possible effect on the health of the person drinking such softened water. A brief nontechnical outline of the principle on which the domestic water softener works and the chemical analysis of such a treated water is therefore of interest. A number of substances or preparations known as "permutits" are used. These, when added to hard water, cause certain chemical changes to occur. They take out of the water the hardness-causing substances, the calcium and magnesium salts and in their turn exchange for these, the soda which the "permutit" preparation contains. This soda readily dissolves in the water and has no effect further than causing the softened water to become slightly alkaline. (This soda will act on aluminium if used as kettles, etc. and blacken the water.) The basic constituents of the "permutit" preparation and the water-hardness substance are exchanged, hence the name "base exchange" given to the method. "Permutit" preparations are artificially produced silicates obtained by melting china clay (Kaolin) with quartz and sodium carbonate, and washing with water. The result is a double silicate of soda and aluminium called Synthetic Sodium—aluminium—silicate, this base exchange material is known by various trade names, such as Permutit, Basex, Doucil, etc. After a base exchange water softener has been in use it gradually loses efficiency and has to be restored or revivified. This is quite a simple matter. A strong solution of common salt in water when passed through the material restores its water softening properties; it is necessary after using the salt to thoroughly wash the material with ordinary water, before use. REPORT ON SAMPLE OF SOFTENED WATER. Total solids 39 parts per 100,000 Total Hardness Nil. Temporary Hardness Nil. Permanent Hardness Nil. Poisonous Metals Absent Reaction to phenolphthalein Alkaline. The above data show that the calcium and magnesium salts have been entirely removed by the softening process adopted. The resulting water contains all the mineral salts in the form of sodium and potassium, thus the calcium bicarbonate naturally present in London water is converted into sodium bicarbonate, hence the water is slightly alkaline. For cooking vegetables, boiling kettles (not aluminium), washing purposes, and for toilet and domestic purposes, the advantages of soft water are well known and appreciated. A better infusion of tea, for instance, is obtained from soft water than from hard water, hence less tea need be used where soft water is available. No deleterious ingredient could be detected in the sample of softened water submitted for examination. A water softened by this process would not be suitable for young children as it is devoid of calcium, an element essential for bone growth. [1933 51 VACCINATION. Dr. Christie was appointed in place of Dr. Rowntree, resigned, as Public Vaccinator for the Thornhill District, and commenced his duties on the 17th July, 1933. Jvlo 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 3,136 births registered in 1932, the returns of vaccination show that only 1,866 infants were successfully vaccinated, while 12 were found to be insusceptible. There were also 164 who died unvaccinated, and 1,213 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians; 32 vaccinations were postponed under medical authority. 476 were removed to other districts or places unknown, thus leaving 87 unaccounted for. The return of certificates of exemption, therefore, represents 33 per cent. of the registered births. Years. Vaccination per 100 births, less infants who died unvaccinated. 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 1932 50.0 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years:— 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 1932 1,299 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 1933 Nil. Nil. Nil. 13 7 20 1933] 52 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1932. Registration Sob-Districts. Number of Births registered in 1932. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of StatutoryDeclarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children remaining Unvaccinated. or not accounted for (Defaulters). Total Number of Certificates of Primary Vaccination of children under 14 years received during year 1933. Number of Statutory Declarations of Conscientious Objection received during year 1933. i 2 3 4 5 6 7 8 9 10 11 12 Tufnell 294 148 3 — 82 19 5 22 13 2 1,340 124 Up. Holloway 871 406 1 — 224 36 4 144 46 10 205 Tollington 330 160 2 — 108 15 » 5 25 12 76 Highbury 631 307 2 — 206 30 3 20 54 9 221 Lr. Holloway 455 234 2 — 164 14 4 1 26 10 855 154 Barnsbury 628 300 — — 232 24 6 2 48 16 171 Islington, S.E. 727 311 2 — 283 26 V 5 65 28 262 The Borough 3936 1866 12 — 1299 164 32 199 277 87 2,195 1,213 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, 1933:— 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 171 25 196 3 Upper Holloway Dr. P. lnwald 156 8 164 2 Tufnell Dr D. W. F. Latham 181 17 198 7 E. Lower Holloway Dr F. E. Clay 150 14 164 4 W. Lower Holloway Dr. S. N. Forbes 162 145 307 88 Highbury and W. Mildmay Dr. T. Galbraith 201 24 225 7 Canonbury, E Mildmay, E. Dr. J. Lynch 248 33 281 5 St. Mary and E. St. Peter Thornhill Dr. S. J. Rowntree and Dr H, D Christie 189 147 336 19 Barnsbury and W. St. Mary Dr. L. M. Leventon 127 29 156 18 S. St. Mary and W. St. Peter Dr. G. Madden 125 24 149 1 St. Mary, Islington, Hospital* Dr. W. R. Turtle 2 9 11 17 St. John's Road L.C.C. Institution* Dr. K. A. Anklesaria — — — — L.C.C. Schools, Andover Row* Dr. P. J C.MacDonnell — 4 4 — L.C.C. Children's Homes, Hornsey Rise* Dr. P. J. C. MacDonnell — 3 3 — Total 1,712 482 2194 171 'Institutions, [1933 53 Vaccinations and re-vaccinations performed by the Public Vaccinators of the Council during the year 1933:— Children entered in Form H by the Vaccination Officers 1,632 Children not included in such lists, but vaccinated 473 Successful vaccinations performed at Surgery or elsewhere than at the homes of the persons vaccinated 98 Successful re-vaccinations performed at Surgery or elsewhere than at the homes of the persons vaccinated 72 Successful vaccinations or re-vaccinations performed at the homes of the persons vaccinated or re-vaccinated 1,892 DISINFECTION. Disinfection of Rooms. 3,265 rooms were disinfected, as contrasted with 3,598 in 1932. For this purpose formaldehyde in solution was employed, although it was sometimes augmented by sulphur fumigation, when it was necessary to kill vermin, for which purpose sulphur has been found effective. For the extermination of bugs, in addition all the architrave mouldings and skirting boards behind which they breed are removed, and the walls washed with hot lime, 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. 41. Rooms Disinfected. 1932 1933 1st Quarter 655 940 2nd „ 876 874 3rd „ 769 883 4th „ 965 901 The Year 3,265 3,598 Work at the Disinfecting Station.—36,647 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 35,675 similar articles disinfected during the previous year. In addition to the above articles, 108,979 second-hand garments and 4 bales of Silk Rags were disinfected for clothing contractors trading in the Borough, who paid the Council for the work, amounting to the sum of £52 19s. Od. Altogether 145,626 articles described in the two paragraphs preceding were disinfected. Since the disinfection station was established 2,695,007 large articles have been disinfected. Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1933, and also in the preceding year 1932. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1933 1932 Beds 373 405 323 513 1,614 1,585 Blankets 866 948 708 1,390 3,912 3,940 Bolsters 59 226 228 333 988 1,089 Carpets — — — — — 19 Cushions 77 91 66 112 346 398 Mattresses 294 348 425 463 1,530 1,285 Pillows 765 833 898 1,235 3,731 3,525 Pillow and Bolster Cases 511 499 523 905 2,438 2,487 Quilts 387 404 426 664 1,881 1,846 Sheets 742 771 798 1,206 3,517 3,472 Other Articles 5,646 3,479 2,851 4,704 16,680 16,029 Totals 9,872 8,004 7,246 11,525 36,647 35,675 1933] 54 The nature of the articles disinfected for the clothing contractors is shown below:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Blankets — — — 941 941 Garments 8,708 4,352 55,763 33,310 102,133 Other Articles 1,560 1,446 700 2,199 5,905 Total 10,268 5,798 56,463 36,450 108,979 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. Cwts. Gallons. Gallons. Gallons. To Householders 10 80 — Nil. Disinfection of Premises — — — 40 Cost = £ 14 8s. ad. Shelter House —The Shelter House was not occupied during the year; baths were given to 8 verminous persons, while their clothing was disinfected, two of whom were sent from a Common Lodging House. One handywoman attended for the purpose of disinfection after attendance on a case of Puerperal Fever and one after a case of Pemphigus neonatorum; and 52 other persons who had been in contact with cases of infectious diseases also had their clothing disinfected. Baths were provided for 17 persons who were suffering from Scabies (a series of 3 baths in each case), making a total of 51 baths. Disinfestation of Rooms.—151 rooms were specially disinfested during the year. The method of dealing with such rooms is that upon the Sanitary Inspector becoming aware of bug infestation of rooms, he serves a notice under the London County Council (General Powers) Act, 1922, on the owner requiring the paper to be stripped from the walls, removal of the architrave mouldings and skirtings, and suitable treatment of the walls. It is advised that a plumber's blow lamp be used on the infested surfaces which are exposed. The occupier is also required to rid infested articles of furniture, etc., of bugs by washing with paraffin or using insecticide, and in some cases it is recommended that the articles be burned. In certain cases where application is made by either the owner or the tenant for the assistance of the local authority, a fee of five shillings per room is asked for. Prior to the room with the furniture remaining therein being sealed at the doors, lireplaces and windows, the walls, etc., are sprayed with an insecticide and sulphur candles in receptacles placed about two feet above the floor level are burned while the air and the surroundings are moist. This process is repeated after a lapse of fourteen days. Disinfestation of School Children (Cleansing from lice and other vermin)—During the year 5,951 (including 1,128 for Scabies) baths were given to children from the London County Council Schools, who attended the 55 [1933 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 £538 14s. Od. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, during the year in 32 instances. In 4 cases no lines were imposed and in the remainder the lines ranged from 2s. to 10s. The total fines amounted to £6 4s. Od. 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 1933. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under :— Factories, including Factory Laundries 897 Workshops, including Workshop Laundries 744 Workplaces, other than outworkers' homes 448 Domestic Workshops 87 Bakehouses 233 Restaurant Kitchens (see also p. 79) 719 Outworkers' premises 1,233 Miscellaneous re-inspections and calls 5,197 Total 9,558 Notices Served —In consequence of the 1,148 sanitary defects discovered as the result of the inspections above, 314 intimation and 17 statutory notices were served. Of these notices 109 were served on the owners of factories, 121 on the owneis of the workshops and workplaces, and 22 on the owners of bakehouses and 61 of restaurant kitchens. In addition to these nuisances, 88 were discovered on Outworkers' premises, necessitating the service of 8 notices. Most of these defects were remedied and it was not found necessary to resort to legal proceedings. Registers.—There wefe 2,658 workshops on the Registers as contrasted with 2,630 in 1932, while the total number of workrooms were 3,756, as compared with 3,710 in the previous year; 121 workshops were added to the Registers, while 93 were removed from them. The various workshops and workplaces are tabulated as below:— Workshops and Workplaces. 1933. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1,273 1,984 54 26 Workshops where Women are employed 506 799 24 36 Laundries 37 50 — 2 Bakehouses 234 250 — — Restaurant Kitchens 516 580 36 23 Other Workplaces 92 93 7 6 Total 2,658 3,756 121 93 Outworkers' Premises 3,460 — 472 374 56 1933] Workshops Notified to Home Office during Year 1933. Trade. Number of Workshops. Women. Male Young Persons. Totals. Dressmaking 10 34 — 34 Picture Mouldings 1 1 — 1 Tennis Caps 1 4 — 4 Tailoring 3 8 — 8 Millinery 2 5 — 5 Chemists Sundries 1 3 — 3 Ties 2 7 — 7 Mantles 2 6 — 6 Underclothing 1 11 — 11 Lampshades 1 4 — 4 Total 24 83 — 83 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 897 109 1 Workshops (Including Workshop Laundries) 831 82 — Workplaces (Other than Outworkers' premises) 1,400 122 1 Miscellaneous Re-Inspections and calls 6,430 8 — Total 9,558 321 2 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*— Want of cleanliness 354 347 — 1 Want of ventilation 36 32 — — Overcrowding — — — — Want of drainage of floors 17 16 — — Other nuisances 393 392 — 1 Sanitary Accommodation insufficient 34 32 — — unsuitable, foul or defective 309 306 — — not separate for sexes 3 3 — — Offences under the Factory and Workshop Art;— 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.) 2 2 — — Total 1,148 1,130 — 2 * 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). 57 [1933 OUTWORKERS' PREMISES. Instances. Notices Served. Remedied. Prosecutions. Outwork in unwholesome premises (s. 108) 82 8 82 Nil Outwork in infected premises (s. 109, 110) 6 — 6 — Total 88 8 88 Nil OUTWORKERS' LISTS (s. 107) : Lists received from Employers 1,114 Addresses received from Other Councils 1,685 Addresses forwarded to Other Councils 508 Firms failing to send in lists (No. letters sent) 333 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factorv and Workshop Act (s. 133, 1901) 26 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 10 Reports (of action taken) sent to H.M Inspector 2 Other (New Factories reported under Home Office Memorandum, 1912) 89 Underground Bakehouses (s. 101) in use at the end of the year. 69 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing Apparel— Making, &c. 43 5 — Cleaning and washing — — — Household linen — Lace, lace curtains and nets Curtains and furniture hangings — — 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 3 Nets, other than wire nets — Tents Sacks Racquet and tennis balls 21 1 — Paper, &c., boxes, paper bags 4 1 Brush making — — Pea picking 1 — Feather sorting — __ Carding, &c., of buttons, &c. — — Stuffed Toys 3 — Basket making — Chocolates and sweetmeats Cosaques, Christmas Crackers, Christmas stockings, &c. 5 1 Textile weaving — Lampshades — — — Total 82 8 1933] 58 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. The Medical Officer of Health on the Kith June visited both the Islington controlled dumping grounds where the contractors dispose of Islington refuse. On this visit, in addition to our own Cleansing Superintendent, Mr. F. E. Browning, there were present Dr. Buchan, of Bradford, Dr. Oldershaw, the Medical Officer of Health for Hampstead, and Mr. Swindlehurst, the Borough Engineer for St. Pancras. Photographs were taken on the following Monday. The visit is the subject of a special report by the Medical Officer of Health to the Cleansing Committee dated the 22nd June. Mr. Browning, the Borough Cleansing Superintendent, kindly supplied me with the following statement :— Street Cleansing.—-A definite alteration has taken place whereby street cleansing comes under the " beat " system; this ensures that every road or street in the Borough is swept at least once daily and that the sweepings are picked up four times per day. Also that, instead of the obsolete open-type orderly trucks previously in use, all these trucks have now been fitted with galvanised sanitary containers and lids. House and Trade Refuse Collection.—The Council recently adopted a new policy with regard to the type of refuse-collecting vehicles and have purchased a large number of "SD" hygienic low-loading freighters (petrol driven) which, when delivered, will take the place of the old electric vehicles now in use and which latter will then be completely disposed of. The remaining fleet of old "SD" freighters have been thoroughly overhauled and brought up to date so that they will come in line with the new fleet now in course of construction. It is expected that the whole of the improved service will be in commission by the end of September next. An arrangement has been put in operation whereby the whole of the highloading open type of horse-drawn vans, both for house refuse and gully work, will be replaced, at the rate of twelve per annum, by low-loading horse-drawn vehicles on pneumatic tyres with roller bearings. This form "of construction will permit a single horse to draw a vehicle having an effective capacity of 6 cubic yards. The anticipated result of these arrangements will mean that by the end of the year 1935 no refuse of any kind will be taken through the streets of the Borough except in hygienic covered vehicles. During the year 1933 85 per cent. of refuse was collected by mechanical vehicles and 15 per cent. by horses and vans. Disposal.—Both the house and trade refuse and road sweepings are sent to the contractor's dumps at Blackbridge and Holwell Hyde, Herts, where it is deposited in layers of approximately 0 feet in depth, each layer being covered with 9-in. of soil. REMOVAL OF DUST. 21 applications were received during the year by the Public Health Department for the removal of dust. 59 The applications received for the previous ten years were as follows:— 1923 16 1928 25 1924 33 1929 21 1925 21 1930 40 1926 20 1931 36 1927 25 1932 14 Dust Receptacles Provided.—During the year 1,391 dust receptacles were provided by owners of property under notice. DISTRICT INSPECTORS' WORK. During the year the fourteen District Inspectors made a total of 49,748 inspections and calls, a decrease of 1,758 inspections on the corresponding period of 1932; while 15,040 improvements were effected in 6,424 premises; as against 13,869 improvements in 5,375 premises for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the district inspectors' work in 1933:— House to house inspections 3.024 Other inspections of dwelling houses 3,972 Re-inspections and calls made 40,137 Visits of inquiry re notifiable infectious diseases 2,016 Butchers'shops, stalls, etc. (Saturday nights) 101 Ice cream shops and factories 283 Dairies and Milkshops 914 Stables and yards 419 Urinals attached to Public Houses 210 Smoke observations 150 Notices Served—There were 4,795 intimation notices served by the inspectors with respect to nuisances. In 599 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.—151 rooms which were found to be in a verminous condition were fumigated. In 24 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—35 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 150 observations were made by the District Inspectors, and 24 notices served upon the owners of the businesses requiring the abatement of the nuisance. Water Certificates.—Nine water certificates were granted in accordance with the provisions of sec. 48 (2) Public Health (London) Act, 1921, in respect of 43 separate tenements newly erected or rebuilt during the year. 1933] 60 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 Marks Act and under the Agricultural Produce (Grading- and Marking) Act, by these and hy the Food Inspector numbered 1,442. 8 prosecutions were taken under the Merchandise Marks Act, 1926, all of which were successful. 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 1933. 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. 61 [1933 Summary of Sanitary Work from Inspectors' Reports for the year 1933. Districts. Totals 1 2 3 4 5 6 7 8 9 10 12 13 14 House to House Inspections 208 338 182 251 149 97 126 243 341 213 199 270 163 244 3024 Other premises inspected 233 293 170 434 167 402 232 420 210 245 316 377 232 241 3972 Re-inspections, Calls made, etc. 2603 3578 3025 3424 3084 2777 1594 2696 2998 2860 3224 2528 3146 2600 40137 Ice Cream Premises inspected 6 38 36 11 23 41 — 6 21 31 20 28 12 10 283 Dairies and Milk Purveyors inspected 16 110 85 77 65 85 42 48 54 62 88 5 19 112 914 Stables „ 51 8 42 12 4 5 16 13 4 15 — 9 2 47 228 Yards „ 63 11 67 5 — 1 2 6 — 14 — 18 2 2 191 Agricultural Produce (Grading and Marking) Act, 1928 — — Merchandise Marks Act, 1926 4 132 41 26 38 59 6 6 2 16 4 4 36 2 374 Urinals attached to P.H.'s inspected 1 6 103 10 8 21 9 2 33 13 1 3 210 Children and Young Persons Acts 8 7 4 8 11 4 12 3 3 2 3 3 68 Premises (re Water Certificates) inspected 28 26 _ — 54 Rag and Bone Dealers — 7 1 8 14 2 1 2 — 4 i 1 1 42 Rag and Flock Act 1 1 150 Smoke observations — 7 3 30 34 — 1 — 9 55 — Shops, Stalls and Markets (Saturday evening) 8 6 9 8 4 7 9 8 7 8 7 7 101 Total Inspections and Calls 3229 4537 3763 4280 3554 3550 2057 3501 3646 3500 3864 3316 3679 3272 497 <8 Notices Served. Intimation Public Health (London) Act, 1891 151 443 257 515 250 454 159 461 456 364 379 333 170 300 4695 Housing Acts — 14 1 — — 1 — — 4 — 1 2 3 — 33 Ice Cream Shops — — 1 1 — 9 — 1 — — — 1 — — 13 Dairies, etc. 1 6 2 3 2 17 2 2 12 — 2 2 2 1 54 Public Health (London) Act, 1891 8 65 32 29 13 78 25 58 107 61 34 51 15 15 591 Statutory Housing Acts L.C.C. (General — — — — — — — — — — — — — — — Powers) Acts — 2 — — — 2 — 3 — — — — — 1 8 Improvements. Drains— 'Constructed — — — — 5 — — — — — — — — — — — Re-constructed 2 17 5 5 4 — 6 1 12 2 1 — 3 63 Repaired 11 12 13 18 12 3 3 11 3 8 23 5 2 11 135 Ventilated 9 11 3 5 5 1 1 9 — 15 1 — 1 4 65 Gully and other traps fixed 6 47 13 5 17 — — 14 — 29 10 3 — 9 153 Urinals— Water supply—cleansed 1 1 3 5 2 6 — 1 — — — 2 — — 21 Water Closets— "W.C. erected with pan, trap and water supply 1 5 3 4 5 3 1 1 5 2 _ _ 30 Pan and trap only provided 74 69 33 72 33 15 11 59 18 66 47 19 10 20 546 • Flushing apparatus repaired 34 38 27 37 13 21 9 18 26 10 23 4 11 27 298 Ventilated — 1 — — 2 — — 1 — — 1 1 — 6 Walls, etc., cleansed 15 46 11 44 9 70 4 39 37 73 67 15 8 12 450 _ Position altered 1 — — — — — — — — — — — — — 1 Dust Bins provided 66 140 110 249 79 116 45 96 113 111 91 91 30 54 1391 Areas paved 1 7 — 7 4 7 — 3 — 8 5 2 1 — 45 Yards paved or repaved 7 44 17 42 26 33 15 34 20 35 14 21 2 6 316 Sinks Provided 43 87 24 41 25 24 22 64 13 55 15 8 1 8 430 Waste pipe repaired 23 58 36 71 48 54 18 90 62 29 9 9 7 20 534 Domestic Water Supply— Cisterns repaired a.nd cleansed 4 16 12 11 2 4 — 8 2 1 2 5 — 67 Water supply provided to dwelling house — — — — — — — — — — — — — — — Water supply provided to tenement house 15 58 8 31 8 13 3 6 7 27 2 11 1 1 191 Walls and ceilings of Rooms cleansed and redecorated 100 309 93 436 175 465 95 360 509 71 335 314 86 191 3739 1933] 62 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 52 27 83 20 90 16 115 74 47 62 70 22 41 746 Floor space ventilated 3 39 2 5 2 5 — 14 i 5 12 1 — 6 95 Floors repaired 23 75 20 64 16 76 16 66 60 44 47 27 6 16 556 Guttering and rain water pipes repaired 22 33 25 50 57 46 10 60 31 45 30 13 13 28 463 Roofs repaired 20 57 34 148 24 75 31 84 136 83 106 53 26 50 927 Overcrowding abated 1 2 — 7 3 1 1 2 1 2 3 14 4 1 42 Illegal use of underground rooms for sleeping discontinued — — — — 1 7 — — 8 2 12 11 — 5 46 Other improvements, or Nuisances abated ... 99 186 68 204 101 222 70 211 175 137 220 125 46 107 1971 Rooms Disinfected 249 136 148 163 89 83 39 89 101 93 171 102 161 89 1713 Total improvements 857 1540 735 1807 781 1446 409 1460 1400 1213 1309 929 439 709 15040 Total premises improved 425 601 417 777 347 449 203 500 506 444 607 457| 304 387 6424 HOUSES LET IN LODGINGS. The houses which come under the operation of the bye-laws received 1,257 inspections during the year, followed by 4,121 subsequent re-inspections and calls, so that the total visits amounted to 5,378 in addition to which 532 visits were made to Common Lodging Houses. These inspections resulted in 784 intimations being served on the persons responsible, which were followed by 140 statutory notices to demand the abatement of the nuisance discovered by the Inspectors especially engaged upon this work. 2 summonses were issued for non-compliance with Statutory Notices. The amount of fines and costs in these cases totalled:—Fines, £2 2s. 0d., and costs, £3 3s. Od. One summons was for keeping a room in a dirty condition but was withdrawn. Altogether 2,539 improvements were effected in 678 premises. Synopsis of Inspector's Work:— Improvements. Drains: Constructed — Reconstructed — Repaired 27 Ventilated 5 Gully and other traps fixed 2 Water Closets: W.C. erected with pan, trap and water supply 1 Pan and trap only provided 30 Flushing apparatus repaired 119 Ventilated 3 Walls, etc., cleansed 90 Position altered — Dust Bins: Provided 161 Areas: Paved 3 Yards: Repaved 41 63 [1933 Sinks: Provided 12 Waste pipe repaired 34 Domestic Water Supply: Cisterns repaired and cleansed 6 Water supply provided to tenement house 5 Walls and Ceilings of Rooms cleansed and redecorated 727 Other Improvements: Staircase and passages repaired, cleansed and redecorated 100 Floor space ventilated 2 Floors repaired 169 Guttering and rain water pipes repaired 61 Roofs repaired 167 Overcrowding abated 7 Illegal use of underground Rooms for sleeping discontinued 5 Other Improvements, or Nuisances abated 756 Rooms Disinfected — Total Improvements 2539 Total Premises Improved 078 COMMON LODGING HOUSES. Another transferred power delegated to the Public Health Committee on the 17th March, 1933, was the registration of common lodging houses, taking over the duties under the Transfer of Powers (London) Order, 1933, of the registration, licensing, inspection and regulation of common lodging houses. The Committee considered the applications and renewed licences in respect of the under-mentioned premises:— 14 and 16, Barnsbury Street, beds for 51 men. 18, 20 and 22, Barnsbury Street, beds for 78 men. 10 and 12, Campbell Road, beds for 45 men. 13 and 14, Duncan Terrace, beds for 63 women. 155, Englefield Road, beds for 62 men. 87, Essex Road, beds for 52 men. 89, Essex Road, beds for 35 men. 8, Flowers Mews, beds for 62 men. 104 to 106, Georges Road, beds for 34 men. 1, Gordon Place, beds for 4 men. 2, Gordon Place, beds for 4 men. 3, Gordon Place, beds for 8 men. 4, Gordon Place, beds for 8 men. 5, Gordon Place, beds for 8 men. 6, Gordon Place, beds for 6 men. 7, Gordon Place, beds for 6 men. 13, Gordon Place, beds for 9 men. 29, Hornsey Road, beds for 76 men (vacated later). 8a, Hornsey Street, beds for 48 men. 47, 49 and 51, Wharfdale Road, beds for 65 women. 1933] 64 The total licences granted was 28; during the year one was vacated, leaving 27 on the register. Visits of inspection.—488 visits were paid by male Inspectors and 44 by women Inspectors, a total of 532 visits. INFIRM PERSONS. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928. During the year no action had eventually to be taken in Court respecting infirm persons, as against 2 in 1932, but five cases were investigated and dealt with without the necessity of proceedings. NON-COMPLIANCE WITH STATUTORY NOTICES, AND APPEALS BY " OWNER " TO QUARTER SESSIONS AND TO THE HIGH COURT. (HANCOCK v. SEGAL). A case of particular interest in which the owner appealed to both Quarter Sessions and to the High Court occurred during this year. The person whose name appeared on the rent book had called at the Public Health Department and admitted to the Medical Officer of Health and Superintendent that he was acting for the owner, whom he stated was "an old gentleman," but he would not divulge anything further. He had likewise refused information to the Stipendiary Magistrate at the North London Police Court. Quarter Sessions upheld the decision of the Stipendiary Magistrate, and in the Divisional Court on the 1st November, 1933, a "rule nisi" calling upon the Justices of the County of London to state a case was discharged with costs. The Lord Chief Justice delivering judgment in favour of the Council, stated that there was ample material on which the Justices could find in the Council's favour. Despite the statement given to our department that he was acting as agent, the "owner" denied this in Court and endeavoured to prove that the property had been conveved to his daughter recently married, whose husband had acted as agent for him. The High Court appears to have considered the case on the common sense basis as to who was the real owner as eventually benefiting from the rack rents. The Borough Council recovered the following sums:—Costs of the Appeals to Quarter Sessions, £57 19s. 6d.; costs of application to the Divisional Court, £62 8s. 3d. Total, £120 7s. 8d. SEWER EMANATIONS. No appreciable progress has been made as regards abatement of sewer emanations in this Borough. The matter was dealt with in the Medical Officer of Health's Annual Report for 1929, page 60, and on page 70 of the Report for 1930. During 1932 and 1933, as in 1931, the London County Council were still conducting experiments, and would appear as yet not to have found a feasible method of sewer ventilation. The sewers are still ventilated, to avoid explosions and danger to the sewermen, by openings in the covers in the streets. When there are veryserious complaints and petitions from the inhabitants, the offending manhole is sealed, and in due course complaint comes from the inhabitants near another. In the year under review, the most serious complaints were regarding the manhole opposite 15, Pleasant Place. In addition to the complaints from tenants of houses adjacent, complaint was addressed to the Town Clerk by a medical practitioner, and one was received from a district nurse, as a child was dangerously ill in a house affected by the emanations. Some little difficulty was experienced in getting immediate effective attention to the nuisance from this manhole. 65 [1933 SCHOOLS. The medical inspection of school children in this, as a Metropolitan Borough, comes under the administration of the London County Council. School premises, however, come under the general sanitary inspection of the department. A school is defined in the interpretation section (141) of the Public Health (London) Act, 1891, thus:—The expression "house" includes schools, also factories and other buildings in which persons are employed. The main cause for visitation to schools by the District Sanitary Inspector, or other investigation by the Public Health Department, is of course enquiries connected with occurrences of infectious diseases and co-operation with the school authority in reference to the control of measles, chicken-pox and small-pox. Occasionally upon an outbreak of modified small-pox it is found convenient to have the vaccinations done at a school, as through the assistance of the school authority the children concerned and the immediate contacts are more readily got together. In addition to the public elementary schools and higher grade schools, there are known to us in the Borough of Islington 15 private schools. RATS AND MICE (DESTRUCTION) ACT, 1919. (9 and 10 Geo. 5, Ch. 72.) As in the previous year, the intimation of Rat Week to the public was made by means of handbills. These were distributed from the various rooms in the Public Health Department to which the public have daily access, and by the District Sanitary Inspectors during the course of their daily visits. The week had just commenced when the problem of a suitable distribution of rat poison in the manner described in last year's report was solved. It had been found that if the cost of a rat poison is 9d. or 1/-, the general public are not so ready to try it, whereas if a collapsible tube to sell at 6d. is available, a much larger number will experiment. We had previously tried such a poison, but the brand was found not to have good keeping qualities. On the opening of Rat Week, the proprietor of one of the poisons approved by the Ministry of Agriculture called upon us with his article made up in collapsible tubes. A supply was immediately obtained, exhibited in the enquiry office and in the waiting-room of the Public Health Department. The demand for these "baits" has steadily increased, and as indicated in last year's report, a suitable make having been obtained, it is likely to be much more saleable than the dearer "baits," at any rate to the small householder. Dealing with some aspects of the District Sanitary Inspectors' work in the course of their duties as Rat Officers, during Rat Week 14 complaints were received in one Inspector's district, which necessitated the inspection of 30 houses and the service of 9 notices. In six cases the whole or part of the drainage system of the respective houses was reconstructed. In some instances where the complaints were justified the rats were found to be strays. In three cases the presence of rats was observed by the sinking of the street pavement, and holes in the drain frontages were found at depths of 3 feet to 5 feet. It is odd that rats instinctively dig upwards to the surface when they escape from a drain, and never downwards. In one instance rats appeared to escape from the drainage system through the top end of a vent pipe which lay on the slope of a roof. From here they were able to get down to the yards via the rainwater pipes and gutters; the drain, of course, was not intercepted, 1933] 66 In another case where rats were prevalent in a house, they were found after diligent search to have gained access through a channel under the footings where the gas pipe entered the premises. When this channel was stopped the menace ceased. A frequent means of access to premises is through perished and broken gratings provided for under floor ventilation and so to burrow and nest under hearths or behind stoves. Re-drainage often results in a few rats being cut off from means of return to the sewer, and many weeks often elapse before the stragglers are either poisoned or caught. The following simple device is often of great assistance in discovering the source of rat infestation, and also of avoiding unnecessary damage to property, inconvenience to the occupiers, and expense to the owners. A reel of black thread is secured to a floor joist by means of a wire nail so that it easily spins round. A small piece of bread with a little beef dripping on it is then tied to the loose end of the thread and laid on the ground under a loose board. If rats are present they invariably take the bait and carry it to their rendezvous or as far as they can in that direction. The thread is then easily traced and the problem dealt with. As stated, this report from one district is given as fairly typical of the work done. Another instance of the problem which has to be faced in tracing where rats come from is instanced in a report from another district. This district borders on our outer boundary, and the intimation came from the Borough Surveyor of the adjoining Borough. An inspection was made of the shop premises, and under the shop floors, public footway and cellars, several rat runs were observed. One of the cellars was used as a furniture store, and great damage had been done to the stock. One of the shops was used a a draper's shop, but nothing was stored below ground, and here no damage had been caused. A notice was served on the owners and the surveyor of the property met the Inspector on the premises. The drain was tested, and a strong result obtained in the cellar of the draper's shop and on the public footway opposite. There was combined drainage with the next premises, and had a manhole and interceptor in the footway. Upon opening the manhole, the cap of the interceptor was found to be out and also there was a defect in the brickwork, giving free access to the premises. These defects were remedied and the main drain was renewed by an iron pipe with a new manhole with an interceptor on the premises in the cellar. The old brick manhole and interceptor were removed. The cellars were bricked and concreted where necessary—result, no further rats. Summary of Work under the Rats and Mice (Destruction) Act during the years 1926-33 1926 1927 1928 1929 1930 1931 1932 1933 Number of Streets visited 217 235 203 144 166 223 250 244 Number of Private Houses visited 320 368 349 223 387 385 391 388 Number of Shops and Factories visited 61 81 56 36 37 48 17 38 Total Premises inspected 381 449 405 259 424 433 408 426 Found Rat Infested 174 191 154 101 142 178 169 168 Found Mice Infested 5 8 2 4 3 10 9 8 Defective Drains Repaired (Cause of Rat trouble) 49 48 49 23 45 50 63 37 Number of Complaints received 173 202 150 124 176 216 203 194 67 [1933 RAG AND BONE DEALERS. A person carrying on the business of a rag and hone dealer has his place of business and the conduct thereof governed by by-laws made by the London County Council under Section 9 of the London County Council (General Powers) Act, 1908. These by-laws are dated 1923 and 1928. In addition to other regulations regarding the premises, etc., a rag and bone dealer in or from any part of the premises or in connection with his business or in the course of his business while carried on from any cart, barrow or other vehicle or receptacle used or in any way connected with his business "shall not sell or distribute or cause or permit to be sold or distributed any article of food or any balloon or toy" under liability of a penalty for every such offence of £5. An investigation during the year showed that there were in the Sanitary Inspectors' districts as follows :—5 rag and bone dealers in No. 2 district; 1 in No. 3; 8 in No. 4; 7 in No. 6; 3 in No. 7; 1 in No. 8; 2 in No. 9; 3 in No. 11; 4 in No. 12, and 3 in No. 14, a total of 37. Of these, 33 were satisfactory, one in district No. 6 was "fair," that is, passable, one was less than this, that is, poor condition and required "stimulation, and one was in a very dirty condition and had to have notice served. In district 11 there was one in a "poor" condition. In all these cases the premises are being kept under extra supervision. HOUSING. Review—The Borough Council appointed a Housing Committee in May, 1919, to exercise the powers and duties conferred upon the Council by the Housing and Town Planning, etc., Act, 1919, and subsequent Housing Acts. From that date up to the end of 1933, the following Housing Schemes have been carried out:— Addington Mansions, 107 flats. On site in Highbury Park and Highbury Grange. Cost-£ 175,262. Halton Mansions, 160 flats. In Halton Road. Cost—£192,546. Manchester Mansions, erected in Sunnyside Road, and No. 88, Hazellvillk Road, an adjacent property acquired for housing purposes. The two properties comprise 41 flats. Cost—£57,484. City Mansions and Queen's Mansions. Situated in North Road. Properties acquired by the Council and necessary alterations made. 92 flats. Cost —£92,094. Warltersville Mansions, erected by the Council in Warltersville Road. 46 flats. Cost—£45,948. Laycock Mansions. 132 flats. Erected by the Council on a site in Laycock Street. Cost—£88,135. Tyndale Mansions. On sites adjoining the Town Hall, Upper Street. 102 flats. Cost—£83,914. Avenell Mansions. In Avenell Road. Erected by the Council. 40 flats. Cost—£25,638. Leyden Mansions. Situated in Warltersville Road. Erected by the Council. 111 flats. Cost—£73,890. The Council also have under their control miscellaneous Dwellings to the number of 66, the cost of which amounted to £35,180. 1933] 68 CHURCH LANE CLEARANCE AREA. REPRESENTATION BY THE MEDICAL OFFICER OF HEALTH. Metropolitan Borough of Islington. (Public Health Department.) Town Hall, Upper Street, N.l. 1st May, 1933. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Mr. Mayor, Aldermen and Councillors, Housing Act, 1930. 2, 4, 6, 8, 10, and 3, 5, 7, 9, 11 and 13, Rothery Street. Nos. 1 to 14, Rothery Place. 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25 and 27, Church Lane. 2, 4, 6, 8, 10, 10a, 12, 14, 16 and 18, Church Lane. 1, 2, 3, 4, 5, 6 and 7, Church Grove, 29, Church Street. Building extreme end of White Horse Yard, No. 8. I beg to represent pursuant to the provisions of the Housing Act, 1930, that in respect of the area in the Borough of Islington as shown on the annexed plan, the dwelling houses in that area are by reason of disrepair or sanitary defects unfit for human habitation, or by reason of their bad arrangement, or the narrowness or bad arrangement of the streets, dangerous or injurious to the health of the inhabitants of the area and that the other buildings, if any, in the area are for a like reason dangerous or injurious to health to the said inhabitants, and that the most satisfactory method of dealing with the conditions in the area is the demolition of all the buildings in the area. I am, Your obedient Servant, (Signed) G. Clark Trotter, M.D., Medical Officer of Health, Metropolitan Borough of Islington. A census of the area showed that its clearance would involve a displacement of 93 families, comprising 432 persons who resided in it on the 12th April, 1933. It was proposed to provide accommodation for the persons who would be displaced in dwellings to be erected by the Council on the Sebbon Street Site, which was being cleared for the purpose. A copy of the Council's resolution confirming was transmitted to the Minister of Health. FIVE YEAR PLAN—CIRCULAR 1331. The Council had under consideration in June, Circular 1331, dated the 6th April, 1933, addressed by the Minister of Health to local authorities stating that His Majesty's Government are anxious that a concerted effort should be made to deal with the question of slum clearance, and intimating that the Metropolitan Borough Councils should confer with and submit their proposals to the London County Council whose duty it will be to co-ordinate such proposals and transmit them to the Minister as part of a general programme which they themselves will prepare for the County of London. As the question of slum clearance is necessarily associated with that of re-housing, the Public Health Committee thought it expedient to ask the Housing Committee to join them in dealing with the matters raised in the above-mentioned circular and that Committee readily agreed to this course. 69 [1933 The London County Council asked for the Borough Council's proposals not later than the 30th June, 1933, and the Borough Council submitted to the London County Council particulars of their five year plan. This plan contains clearance areas, improvement areas and closing orders. The clearance areas concerned houses in Highbury, Lower Holloway, Thornhill and Canonbury Wards, to a total number of 31. The improvement areas deal with houses in Barnsbury, Highbury, Lower Holloway, St. Peter's, Thornhill and Tollington Wards, the total number of houses concerned being 328; the closing orders concerned three two-roomed houses in Highbury. RECONDITIONING OF HOUSES. Thirty-three informal notices were served during the year under Section 17 of the Housing Act, 1930, requiring owners to effect repairs, and in no instance was it necessary for the authority of the Housing Committee to be obtained for the issue of a statutory notice. All the notices were complied with. The premises repaired were:—73, Cheverton Road, 65, 81 and 95, Cornwallis Road, 173, 175, 179 and 181, Fairbridge Road, 192, St. John's Road, 111, Elthorne Road, 50, Grafton Road, 77, Cottenham Road, 13, Kiver Road, 314 and 359, Hornsey Road, 10, Cromartie Road, 35 and 66, Offord Road, 3, Story Street, 28, Market Street, 42, Arthur Road, 14, Rheidol Terrace, 311, Liverpool Road, 27, St. Clement's Street, 17, Cornelia Street, 223, Seven Sisters Road, 21, Church Street, 35, Duncan Terrace, 2, Hanover Street, 28, Canonbury Road, 21, Dagmar Terrace, 32, Andover Road, and 274, St. Paul's Road. UNDERGROUND ROOMS. During the year five communications were received from the London County Council intimating that accommodation on one or other of their Estates would be offered to families illegally occupying underground rooms providing action under Section 20 of the Housing Act, 1930, be taken by the Islington Borough Council. In each case the head of the family had applied to the London County Council for accommodation, and after investigating the application and becoming aware that the family was living in conditions contrary to Section 18 of the Housing Act, 1925, the London County Council sent the communication referred to. Three Closing Orders were made prohibiting the use of the basement rooms at 31, South Street, 4, Bevan Street, and 19, Shepperton Road for sleeping purposes, and two others prohibiting the use of the basement tenements for human habitation at 244 and 246. Hollowav Road. Neither of the Closing Orders was appealed against and accommodation was provided for the various families as follows:— Premises. Occupants. Accommodation provided at:— 244, Holloway Road. 2 adults. 2 children. 205, Wessex Buildings, Islington. 246, Holloway Road. 2 adults. 4 children. 362, Lordship Lane, Tottenham. 4, Bevan Street. 2 adults. 1 child. Additional room at 4, Bevan Street. 19, Shepperton Road. 3 adults. 4 children. Removed to an unknown address. 31, South Street. 2 adults. 2 children. Ditto. 1933] 70 Summary of Housing from 1919 to 1933 (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 1932. Total since 1933 1919. Number of houses or flats provided by the Islington Borough Council 900 900 Number of flats provided by the London County Council 377 28 405 Number of houses or flats provided by private enterprise 541 39 580 1,818 67 1,885 Particulars of houses or flats provided under the Council's Housing Schemes 1919 to 1932. 1933. 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 Mansion's 46 — 46 Manchester Mansions 31 — 31 Addington Mansions 107 — 107 *Conversion of 16 houses into dwellings 66 500 — 500 Tyndale Mansions 102 — 102 Laycock Mansions 132 — 132 Houses, etc., Highbury Station Road 15 — 15 Avenell Mansions 40 — 40 Leyden Mansions 111 — 111 900 — 900 * Includes:—27, Rupert Road 8, Barnsbury Street 27 and 28 Canonbury Villas 2, Highbury Grange Not converted 71 IT 933 The number of overcrowding cases recorded as dealt with by service of notice during the years 1923 to 1933 was :— 1923 17 1924 13 1925 19 1926 26 1927 24 1928 37 1929 21 1930 32 1931 59 1932 72 1933 42 Total 362 others were dealt with by housing recommendations to L.C.C. HOUSING RECOMMENDATIONS FROM THE PUBLIC HEALTH DEPARTMENT. During the year 1933, recommendations were made to the London County Council regarding housing accommodation for "special hardship" cases. In all, 74 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 w as the main reason for the support given to enable them to receive favourable consideration of their efforts to secure better housing conditions. Of the 74 cases recommended by the Medical Officer of Health, 28 of which were given on account of overcrowding, during the year:— 16 were provided with accommodation by the London County Council. 12 removed to an unknown address. 9 secured better accommodation in Islington. 35 still remained in their Islington occupation. 2 removed to addresses outside Islington. These 74 recommendations can be classified under the following headings:— 28 were on account of overcrowding; 27 ill-health (including 9 tuberculous sufferers); 13 insufficient accommodation for the sexes; 3 dark and damp rooms; and 3 special circumstances and scheduled area. In addition to these 74 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 326. 1933] 72 WATER SUPPLY. Number of houses which have not an adequate internal water supply, i.e., water supply from taps o4nly, in yard, 131. Premises on which notices have been served under the London County Council (General Powers) Act, 1907 (Additional Water Supply), 191. DEMOLITION OF HABITABLE DWELLINGS. During the year 25 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) Nil (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) Toted number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,990 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,415 (a) Houses inspected on complaint or after illness 2,163 (b) Registered tenement houses inspected 1,257 (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 1,609 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 1,629 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 33 (2) Number of dwelling-houses which were rendered fit— (a) by owners 33 (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 — 73 [1933 B. Proceeding's under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5,286 (2) Number of dwellings-houses in which defects were remedied after service of formal notices— (a) by owners 6,424 (b) by Local Authority in default of owners — C. Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demo lition 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 5 (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 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) by owners — (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) N umber 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 1933] 74 NUMBER OF HOUSES OWNED BY THE LOCAL AUTHORITY, DISTINGUISHING THOSE BUILT IN THE LAST TWO YEARS. AND HELD UNDER:— (1) Fart III. of the Housing Act, 1925. (2) Part II. of the Housing Act, 1925, and (3) Other powers. Held under Total at 31st Dec., 1931 Erected in 1932 & 1933 Total Part III of Housing Act 1925 Nil. Nil. Nil. Part II of Housing Act 1925 Nil. Nil. Nil. Other Powers 900 Nil. 900 Total 900 Nil. 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 G2 1932 26 4 11 — 41 1933 25 2 10 1 38 Totals 1,188 153 205 30 1,576 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. To succeed Mr. Wilkinson (who died, as stated in my introductory letter, during the year), the Council appointed Mr. A. W. Haydock from the County Borough of Birkenhead. Mr. Haydock had been Assistant Inspector of Meat and 75 [1933 other Foods there for four years; previously he had had experience with Messrs. Morris and Co., Meat Importers, Ltd., Liverpool Wholesale Meat Market. He is a fully qualified Sanitary Inspector, possessing the Meat Certificate, and has the special experience similar to his predecessor. Slaughter Houses. —Inspector Wilkinson records 77 visits and Inspector Haydock 115 visits to these premises, and the following are the number of animals slaughtered for human food :— Oxen. Sheep and Lambs. Horses (for export). 283 5,018 1,952 The standard of meat dressed in these premises was high and in only one case was disease found to have spread from the internal organs to the carcase, and this only to a small extent. The following tables serve to illustrate the incidence of disease and quantity of diseased meat and organs found in slaughterhouses, and the amount of unsound food destroyed. No. of Cases. Description of Animal affected. Nature of Disease. Extent of Disease. How disposed of. 39 Oxen Distomatosis Liver (whole or part) Destructor or on premises. 1 Ox „ Lungs and Liver Destructor 2 Oxen Tuberculosis Head and Tongue „ 5 „ „ Lungs premises. 1 Ox „ Lungs. Liver and Mesentery „ 1 „ „ „ „ „ 1 ,, „ Brisket and Steak Piece „ 1 „ Actinobacillosis Tongue „ 1 „ Pneumonia Lungs On premises. 1 Lamb Cirrhosis Liver „ * Of the same animal UNSOUND FOOD DESTROYED. The food destroyed or otherwise disposed of so as to prevent its use for human comsumption was as follows :— Tons. cwts. qrs. lbs Diseased organs from slaughter-houses (surrendered) 5 3 Meat and Tinned Foods from shops and stalls (seized) — — 3 20 Various Meats and Poultry from shops and stalls (surrendered) — 3 2 26¼ Fish from shops, fryers and wholesale dealers (surrendered) — 7 3 26 Fruit and Vegetables — 17 2 20¾ Total 1 16 0 9 The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 1 ton 16 cwt. 9 lbs. The diseases which affected animal food are set out in detail above. 1933] 76 Shops, etc., Inspection of.—The number of visits made to shops, etc., by Inspectors Wilkinson and Haydock are as follows :— Insp. Wilkinson Insp. Haydock Total Butchers, Provision Dealers, etc., Shops 1,048 699 1,747 Butchers, Provision, etc. ... Stalls 461 — 461 Meat, etc., Preparation Factories 15 39 54 Fish, Shops 109 238 407 Fish, Stalls 212 — 212 Fruit, Shops 266 614 879 Fruit, Stalls 1,197 — 1,197 Markets — 52 52 Stalls — 530 530 Offensive Trades — 55 55 Grand total 5,594 The fall in number may be accounted for by the fact that for part of the year the work was done by the District Inspectors, and is not included in this report, and also that during Mr. Haydock's term of office a number of stalls grouped together in sufficient numbers to form a market has been entered as one visit to a market. During the year 58 warning letters were sent to various shopkeepers and stallholders who omitted to mark certain fresh fruits with the country of origin. Ten Meat Traders were also warned for allowing meat to become contaminated in contravention of the Public Health Meat Regulations. It is interesting to note that on no occasion has a shopkeeper or stallholder committed an offence after being previously warned. Offensive Trades include 2 tripe dressers, 4 gut scrapers, 4 fur skin dressers, and Knacker's Yard, which received a total of 73 visits. There was no cause for complaint in the conduct of the business carried on in them. PROSECUTIONS FOR EXPOSING FOR SALE UNSOUND FOOD. It would appear that butcher meat brought to London is on occasion not always efficiently inspected after slaughter. We had occasion to warn a firm of butchers regarding a diseased pig's head previously, and upon a second occasion for a similar offence a prosecution was taken. The defendants appeared and pleaded guilty, stating that at the time they were not aware of the condition of the meat in question and had not observed it. The Bench considered the answer of the defendants not satisfactory and fined them £10 10s. 0d., and £5 5s. Od. costs. For some time past we have viewed with some concern the conduct of a trader who brought meat for sale in Islington from Pewsey Rural District. We had the active co-operation of the local Sanitary Inspector. The slaughterhouse at Pewsey has within a short distance of it also a knacker's yard, where diseased meat is dealt with. A well-founded suspicion attached to a certain trader that meat from the knacker's yard, which he bought as cat's meat and animal food, could be, and perhaps was, disposed of by him for human consumption. For a considerable time with the help of the Sanitary Inspector of Pewsey, an endeavour was made to trace the ultimate disposal of this trader's meat. In August information was received that a quantity of meat was being conveyed by this particular 77 [1933 trader from a knacker's establishment at Pewsey, Wiltshire, and observations were kept on the trader's home address, but he was not seen to arrive. He was known to purvey meat regularly on Tuesdays and Fridays from a stall in Islington. On the morning following the message instructions were given to two of the Sanitary Inspectors to visit and examine the meat exposed or deposited for the purpose of sale on the trader's stall. The Medical Officer of Health and Superintendent on receipt of a telephone call went and examined a quantity of cow beef on the stall, and in a two-seater motor which was standing in front of the stall. With the exception of two top pieces and two rumps, all the meat had been boned and stripped, that is, the pleura and peritoneum had been removed. Three pieces of meat and a kidney were found to have tuberculous glands, evidently meat from the carcase of a tuberculous cow. A further examination of the meat did not disclose any evidence of disease, but the fact of the meat being boned out was in itself a suspicious circumstance. Twenty-eight pounds' weight of meat was seized and condemned by a Justice. For the purposes of legal action we were confined necessarily to the portions found diseased, as we had not definite proof or information regarding the rest of the meat. Two top pieces showed evidence of bird-dung on the surfaces, but apart from this the meat could not be considered unfit. The evidence, however, of this bird-dung was of use in the subsequent prosecution, as the slaughterhouse proper in Pewsey is protected against such contamination, whereas the knacker's yard is not. The butcher called at the Public Health Department and stated that the carcases had been despatched to him from Pewsey and that the meat which he personally brought up from the knackery was still in his possession, but he refused to say where it was stored, stating it was to be sold to the proprietors of some dog kennels with whom he had regular business. We communicated with the person whom the butcher said had consigned the meat to him, but no reply was received. On the two charges of exposing for sale diseased meat unfit for human food, and for depositing for sale diseased meat unfit for human food, the defendant was fined 25 guineas and five guineas costs on each summons, a total of £63; the defendant was committed to prison in default. PICKLED HORSE FLESH OFFERED TO MEAT PASTE MANUFACTURERS. It came to the knowledge of the Medical Officer of Health that pickled horseflesh was being offered to makers of fish and meat paste in the Borough. Our local firms are of good repute and would not of course think of using horseflesh, as they value their reputation too much to be tempted to buy anything of the sort. The matter seemed of sufficient importance to be investigated, as there does not seem to be any law to prevent the sale of the flesh of horses, asses and mules to meat paste manufacturers, the only proviso being that the place from which the horseflesh is vended must have a notice conspicuously and legibly printed in letters not less than four inches long indicating that horseflesh is sold, and the sale of other meat is prohibited. In the same circular sent to meat paste manufacturers, cow flesh was also being offered. Supposing a meat paste manufacturer were tempted to purchase and add pickled horseflesh to his paste, the only way we could apparently take action would be under the Sale of Horse Flesh, etc., Regulation Act, 1889, for his not having the former mentioned notice up indicating that horseflesh was sold, and if the mixture did not contain wholly horse meat or if he also sold other meat paste, I presume action could be taken. 1933] 78 Enquiry was made regarding the matter at the Ministry of Health, and it was stated " that it would appear that an offence would he committed under Section 2 of the Sale of Horseflesh, etc., Regulations Act, 1889, and Section 2 of the Food and Drugs Act, 1928, if meat paste containing pickled horseflesh were sold to a purchaser who asked to be supplied with meat paste. Section 7 of the 1889 Act makes it clear that meat paste containing horseflesh is 'horseflesh' for the purposes of the Act. Action could of course be taken locally whenever an offence against the Act was being committed." The name and address of the firm who was circularising the meat paste manufacturers was supplied to the Ministry of Health. LICENSED SLAUGHTERHOUSES. As previously mentioned in the report, among the transferred powers taken over there was delegated to the Public Health Committee the licensing of slaughterhouses. During the year there were in use in Islington 8 private slaughterhouses, 1 horse slaughterer for the export of horseflesh for human consumption, and 1 knacker's yard. The knacker's yard and the horse slaughters are under the same management but run as separate establishments. These (10) were licensed during the year. SLAUGHTER OF ANIMALS ACT, 1933. This Act becomes operative on the 1st January, 1934, and under it it is possible by resolution of the Local Authority to exempt sheep from stunning. The matter was still under consideration of the Borough Council during the year. Under this Act also the Local Authority grant the licences to slaughtermen; 45 applications for licences were received, and after investigation all of these were granted. DISEASES OF ANIMALS ACT. ORDER OF THE MINISTRY OF AGRICULTURE IN REFERENCE TO FOOT AND MOUTH DISEASE. REMOVAL OF OFFAL. This matter came under the purview of our department during January, and enquiries were made and the Cleansing Superintendent informed in regard to the precautions to be taken in respect of the removal of suspected infected offal at the Islington Refuse Depot. MARKING OF IMPORTED MEAT. On page 69 of the Medical Officer of Health's Annual Report for 1929 this subject was fully dealt with. At that time a questionnaire had been circulated to the other Metropolitan Boroughs to obtain correct information as to how far the provisions of the Sale of Food Order, 1921, were being complied with. This Food Order has been specially kept in force from year to year by the Expiring Laws Continuance Act passed each Session. The Order provides that imported meat exposed for sale by retail shall bear a label with the word "IMPORTED" or with words disclosing the country of origin, but a general notice exhibited in a shop declaring all meat in the shop (or on a particular rail or counter) to be imported has been generally held to be a sufficient compliance. This has led sometimes to the customer being under the impression that she was getting English meat because a portion near was labelled "ENGLISH." Edible offal does not at present require to be labelled. Many people buy kidneys or liver under the impression that they must be English because the other meat in the shop is labelled English. New legislation to ensure that there is no dubiety about what 79 [1933 the purchaser is receiving is certainly long overdue, and advantage could be taken to provide for foreign meat to he distinguished from meat of Empire origin, which the existing Order does not provide for. Recently the late Mr. Wilkinson and the Medical Officer of Health gave evidence before a Committee of Enquiry on the marking of meat, when the situation as we have found it in Islington was put forward. SALE OF FOOD ORDER, 1921. A firm was prosecuted for selling foreign meat without labels disclosing the country of origin. Two members of the firm appeared as defendants, and on the suggestion of the Magistrates the proceedings were continued against them. The Inspector pointed out that some of the foreign meat had been labelled "ENGLISH." A fine of £5 and 10/6 costs against each of the defendants who appeared was imposed. 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 9 certificates in respect of foods prepared in Islington and exported abroad and to the Dominions. LICENSED STREET TRADERS IN THE BOROUGH OF ISLINGTON FOR THE YEAR 1933. Meat, etc., 44; Fish, Poultry, Rabbits, 45; Ice Cream, 55; Confectionery, Minerals, etc., 25; Grocery, Provisions, Tinned Food, etc., 76; Coffee Stalls, etc., 10; Fruit, Vegetables, Greengrocery, etc., 293. Some also sell confectionery and minerals. One tinned food only. Restaurant Kitchens.—The work of inspecting restaurant kitchens is tabulated under Workshops, and 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 Number found Inspected. Unsatisfactory. Hotel and Restaurant Kitchens 114 29 Coffee and Dining Rooms 246 73 Refreshment Rooms 204 50 Provision (Cooked Meats, cooked but not consumed on premises) 155 35 719 187 NOTIFICATION OF FOOD POISONING. During the year 9 cases of food poisoning were notified, the alleged poisoning foods being Meat Pie (2), Fruit Salad, "Cooked" Pork Brawn, Tinned Corned Beef, Sausages, Mussels, Fish, and "Cheap" Meat. 1933] 80 PRESERVED FOOD AND ICE CREAM. On page 67 of last year's Annual Report the registration of premises in respect of these articles was fully dealt with. In 1932 64 premises were registered, and all of these remained on. 95 in addition were registered, but during the course of the year one of these was vacated. The total on the register at the end of the year", therefore, was 158. The number of ice cream premises in 1932 was 336. All of these continued in 1933, but one was vacated, leaving 335. 73 additional were registered, so that the ice cream premises on the register totalled 408 at the end of the year. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. During the year 14 informal samples were taken under the above Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. Five informal samples were taken and found in order. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. For prosecutions under this Act see page 84. MILK AND DAIRIES ORDER, 1926. Proceedings were instituted for 9 offences under the Milk and Dairies Order, 1926, against 8 persons, service of one summons not being effected. Four of the summons were for carrying on the trade of Purveyor of Milk without being registered, 1 for failing to keep clean the interior of a vehicle used for the conveyance of milk, 2 for filling and closing a milk bottle in the street instead of on registered premises, in one case both the roundsman and his employer were proceeded against, the employer being fined £2 2s. Od. and £2 2s. Od. costs, and the roundsman £1 and £1 costs. The other 2 summonses were for aiding, abetting, counselling and procuring in the commission of an offence, viz., carrying on the trade of purveyor of milk without being registered in the district; in one of these the defendant had absconded, the other was dismissed on the grounds of insufficient evidence. The latter defendant has since left the district. Milk Purveyors and Dairies. At the close of the year there were 734 milk purveyors and dairies on the register, 48 having been added to it, while 12 were removed. The District Sanitary Inspectors paid 914 visits to them, and served 54 notices for the carrying out of various sanitary improvements and the cleansing of dirty utensils. THE MILK AND DAIRIES (AMENDMENT) ACT, 1922; THE MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year 1933 the following applications were made for licences under the provisions of the above Order to enable the persons to sell Specially Designated Milk 81 [1933 LICENCES GRANTED UNDER MILK (SPECIAL DESIGNATIONS) ORDER, 1923. Designation. No. of applications Number granted. Amount of Fees received. £ s. d. Certified 9 9 2 5 0 Grade A (Tuberculin tested) 30 30 7 10 0 Grade A (T.T.) (Bottling) 1 1 2 2 0 „ (Pasteurized) 3 3 15 0 Grade A 2 2 10 0 „ (Bottling Licence) 1 1 2 2 0 Pasteurized (Dealer) 14 14 3 10 0 „ (Pasteurizer) 4 4 4 4 0 Supplementary :— Pasteurized 2 2 4 0 Grade A (Tuberculin Tested) 2 2 4 0 68 68 £23 6 0 ADULTERATION OF FOOD AND DRUGS—FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year 1,221 samples of foods and drugs, including 666 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, 1,187 were reported to be genuine and 34 adulterated, or 2.7 per cent. This percentage is 0.5 below the previous year, and 3.6 below the average rate during the preceding 10 years. There were 18 prosecutions under the Food and Drugs (Adulteration) Act, 1928, all of which were successful, 16 relating to milk. Twenty-two samples of milk were submitted by the Inspector for bacteriological examination, see page 49. Fourteen informal samples were taken under the Public Health (Condensed Milk) Regulations, 1923 and 1927; and five 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 1,068 visits under the Merchandise Marks Act; 3 special visits in connection with food poisoning, and instituted prosecutions other than under the Food and Drugs Act as follows :— Merchandise Marks Act, 1926 2 Milk and Dairies Order, 1926 5 Milk and Dairies Amendment Act, 1922 — Milk and Dairies (Consolidation) Act, 1915 3 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. 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 1933] 82 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. In connection with the food and drug work, 15 warnings were given, 9 warnings under the Milk and Dairies (Consolidation) Act, and 47 warnings under the Marking Orders. During the year 1933, 36 informal samples of cream were taken, and one was found to be adulterated; a formal sample was taken, which however proved to be genuine. 46 informal samples of sausages, 3 informal samples of breakfast sausage, 5 meat pastes, 2 fish cakes, and 4 fish pastes were taken. Four of the informal samples of sausages were found to be adulterated, and one informal sample was subsequently taken, which was found to be genuine. In reference to meat and fish pastes, as much as 60 per cent. of farinaceous material was reported in some of these. During the year 1933 in addition to the samples taken and submitted to the Public Analyst there was a total of 74 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 second and fourth quarters of the year, as shown by the figures given in the statement below. Examined. Genuine. Adulterated. Per Cent. Formal Informal Formal Informal Formal Informal Adulterated. 1st Quarter 199 105 192 104 7 1 2.6 2nd „ 104 174 92 173 12 1 4.6 3rd „ 96 107 96 107 4th „ 156 280 149 274 7 6 3.0 The Year 555 666 529 658 26 8 2.7 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 114 8.79 3.46 12.25 Milk purchased on Week-days 263 8.80 3.54 12.34 Milk procured in transit at Finsbury Park Station 169 8.85 3.67 12.52 Official Standard _ 8.50 3 00 11.50 83 [1933 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 114 111 3 2.6 On Week-days 263 262 1 0.4 At Railway Stations 169 151 18 10.6 (Farmers' Milks) — — — — 546 524 22 4.0 Giving the particulars of the Milks taken during each quarter of 1933 on Sundays Week-days, and at the Railway Stations. 1933. 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 30 116 51 197 30 115 47 192 1 4 5 0.8 8.0 2.5 2nd „ 29 31 43 103 26 31 34 91 3 — 9 12 10.3 — 21.0 11.6 3rd „ 15 53 26 94 15 53 26 94 — — — 4th ,, 40 63 49 152 40 63 44 147 — — 5 5 — — 10.2 3.3 The Year 114 263 169 546 111 262 151 524 3 1 18 22 2.6 0.4 10.6 4.0 The number of samples of milk purchased was 546, of which 524 were genuine, and 22, or 4.0 per cent., were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1933 :— . ' MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 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 1932 596 579 17 2.8 Average 10 yrs. 645 621 23 3.6 1933 546 524 22 4.0 1933] 84 Showing the anlysis of 6,448 milks examined in Islington during the 10 years 1923-32 and 1933, and distinguishing those purchased on Sundays, on Week-days, and procured at the Railway Stations whilst in transit jrom the Farmer to the London Milk Purveyor :— Years. Sunday Milks. Week-day Milks. Railway Milks (Farmers). No. of Samples Per cent of nonfatty solids. Per cent, of fat. No. of Samples Per cent, of nonfatty solids. Per cent of fat. No. of Samples Per cent, of nonfatty solids. Per cent. of fat. 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 1932 111 8.83 3.56 306 8.82 360 179 8.89 3.72 Total samples and average constituents (io years) 1,142 8.84 3.54 3,630 8.86 3.56 1,676 8.89 3.71 1933 114 8.79 3.46 263 8.80 3.54 169 8.85 3.67 Summary of Prosecutions during the year 1933. Statute. Total Prosecutions Successful. Dismissed. Withdrawn. Amount of Penalties Costs Received. £ s. d. £ 5. d. Public Health (London) Act, 1891 21 21 — — 67 14 0 47 3 0 Food and Drugs (Adulteration) Act, 1928 18 18 — — 17 0 0 47 5 0 Milk and Dairies .(Consolidation) Act, 1915 3 3 — — 5 10 0 3 3 0 Milk and Dairies Order, 1926 9 n 1 1 6 5 0 10 8 6 Sale of Food Order, 1921 1 l — — 10 0 0 1 1 0 Merchandise Marks Act, 1926 8 8 — — 3 0 0 6 2 0 London County Council Byelaws 7 6 — 1 6 0 0 8 8 0 London County Council (General Powers) Act, 1902 3 3 _ 0 11 0 1 0 6 London County Council (General Powers) Act, 1932 1 1 — 0 10 0 5 5 0 Totals 71 68 1 2 £116 10 0 £129 16 0 See also appeals p, 64 and unsound food prosecutions p. 76. ISLINGTON HOSPITALS, CLINICS, Etc. Beds. St. Mary's (Islington) Hospital 858 Archway Hospital, Archway Road 568 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. 85 [1933 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. The Almeric Paget Massage Corps, Islington Centre, Britannia Row, N.l (Light treatment, Massage, etc.). Child Guidance Clinic, Tudor House, Canonbury Place, N.l. Clinics, etc., not including Public Assistance, were enumerated on page 79 of the Report for 1931. PROPAGANDA WORK. During the year at special request the Medical Officer of Health gave two talks on the work of the Health Department and the prevention of illness to local organisations, one in the St. Mary's Ward and one in the Thornhill Ward. The Voluntary Welfare Centres continued their usual propaganda and talks to mothers. A system of co-operation was established with the Maternity Department of St. Mary's, Islington, Hospital, whereby each mother leaving there receives our literature regarding the care of her own health and that of the child, with particulars of Welfare Centres. In the early part of the year an important meeting convened by the Medical Officer of Health was held at the Central Library, Holloway Road, to bring together the Welfare Centre representatives, the medical practitioners, midwives, and all associated with the care of the expectant mother. The Chair was taken by Professor Winifred Cullis, C.B.E., M.A., D.Sc., LL.D., and there was a very good attendance, in spite of the fact that Influenza was prevalent at the time which curtailed somewhat the presence of medical men. As a result of this meeting it is hoped that sufficient interest will be aroused to enable a Voluntary Committee to be formed which will deal generally with the question of maternal morbidity, and the general care of the expectant mother. The association thus together of representatives from the very many agencies which at present act independently, and without consulting each other, should in the future emulate a spirit of useful co-operation. The following literature was issued during the year, and is available on application to the Public Health Department, Town Hall: Hints on the Care and Feeding of Infants, with addresses of Welfare Centres, Advicc to Expectant Mothers, Instructions to Foster-parents, Tuberculosis Dispensaries, Registrars, Public Vaccinators, etc., Smallpox and Vaccination, Notes on Tuberculosis, Flies and Gnats, Measles, Whooping Cough, Diphtheria, Scarlet Fever, Infectious Diseases—Law. APPENDIX. Vital and Sanitary Statistics, 1933 TOGETHER WITH THE PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 1933] 88 STATISTICAL APPENDIX Deaths registered in the Borough of Islington during the year ending 1933. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. CAUSE OF DEATH. 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.E. ALL CAUSES M. F. 1,992 1,905 110 118 69 71 25 31 15 18 30 24 29 50 111 82 119 103 250 100 381 285 421 413 314 452 02 152 172 214 221 210 193 170 229 219 304 388 343 289 477 462 Typhoid and paratyphoid fevers (1-2) M. F. 2 2 — — — — — 1 — — 1 — — — — — — 1 — — 1 2 Measles (7) M. F. 0 8 3 10 1 — — — — — — — — — — 1 2 1 — 1 5 4 Scarlet Fever(8) M. F. 1 3 — 2 1 1 — — — — — — — — — — — — — 2 — 2 Whooping Cough(9) M. F. 14 9 11 11 1 — — — — — — — — — — 1 2 4 1 4 7 4 Diphtheria (10) M. F. 19 14 — 14 15 3 — 1 — — — — — — — 2 2 _ 3 8 4 14 Influenza (11) M. F. 95 75 1 3 — 1 2 10 24 27 32 33 20 11 21 12 10 23 29 23 46 Encephalitis lethargica (17) M. F. 2 1 — — — — 1 — — — 1 1 — — — — 1 1 1 — — Cerebro-spinal Fever (18) M. F. 4 3 — 5 2 — — — — — — — — — — 1 1 2 — 1 — 2 Tuberculosis of Respiratory System (23) M. F. 102 112 1 — 2 2 22 28 64 41 53 43 - 13 5 — 26 38 32 22 36 63 57 Other Tuberculous diseases (24) M. F. 13 25 5 11 4 2 5 4 3 1 1 1 1 — — 1 6 6 3 4 5 13 syphills (34) M. F. 14 5 4 — — — — 1 1 1 4 2 3 3 — 1 3 2 1 2 2 8 General Paralysis of the Insane— tabes dorsalis. (83) M. F. 7 1 — — — — — — 1 1 4 2 — — — 2 1 — 2 1 — 2 Cancer Malignant disease (45, 40) M. F. 255 254 — 2 1 — — 3 9 23 84 160 146 70 11 62 53 42 53 108 76 115 Diabetes (59) M. F. 3 14 — — — — — — 1 — — 4 8 4 — 2 3 1 5 3 — 3 Cerebral haemorrhage, &c. (82) M. F. 80 111 1 — — 1 2 — 4 5 5 30 68 61 14 23 23 22 14 35 28 46 Heart disease (90-95) M. F. 308 440 — 2 2 6 6 2 18 36 56 140 259 234 53 83 91 75 91 161 114 199 Aneurysm (96) M. F. 2 0 — — — — — — — 1 1 1 1 4 — — 2 1 — 3 25 1 Other circulatory diseases ( 97-103) M. F. 85 83 — — — — — — 1 — 12 24 49 64 18 19 16 16 16 38 25 38 Bronchitis (106) M. F. 90 80 4 — — — — — 1 9 16 33 36 52 19 12 14 13 27 34 34 36 Pneumonia (all forms) (107-108) M. F. 189 179 41 33 4 1 5 4 9 27 53 52 63 65 11 27 37 21 50 71 61 101 Other respiratory diseases (110-114) M. F. 15 12 1 — 1 — 1 — 1 2 5 6 4 4 2 1 1 4 4 9 3 5 Ulcer of Stomach and duodenum (117) M. F. 38 5 — — — — — — 3 5 12 15 4 4 — 2 8 3 7 4 5 14 Diarrhoea, etc (119-120) M. F. 45 35 57 7 1 — — 1 1 — 4 2 4 2 1 6 5 9 14 20 13 13 Appendicitis (121) M. F. 9 13 — 4 2 2 3 1 1 2 3 2 1 1 — 2 3 1 1 5 4 6 Cirrhosis of liver (124) M. F. 10 7 — — 1 — — — 1 — 2 4 7 2 — 2 2 2 2 4 1 4 Other diseases of Liver, &c. (125) M. F. 4 2 — — — — — 1 — — 1 — — — — 1 — 1 1 — 1 Other digestive diseases (115, 116, 122, 123, 126-129) M. F. 24 39 4 2 1 — 2 — 3 3 5 5 7 18 12 4 6 7 6 10 9 12 13 Acute and Chronic Nephritis (130-132) M. F. 58 49 1 1 l 1 — 2 5 5 9 27 33 14 6 7 13 8 13 26 19 21 Puerperal sepsis (140-145) F. 5 — — — — — — 3 2 — — — — — — 2 — — 1 — 2 Other puerperal causes (146-150) F. 8 — — — — — —— — — — — — — — 2 1 — 2 1 — 1 Congenital debility, Premature birth, Malformations, &c. (157-159) M. F. 07 49 113 2 — — — 1 — — — — — — — 14 9 19 12 12 19 27 Senility (102) M. F. 38 98 — — — — — — — — — — 7 77 52 20 18 14 11 21 25 27 Suicide (163-171) M. F. 32 17 — — — — — 3 6 7 18 11 2 2 — 9 3 7 6 8 9 7 Other Violence (172-198) M. F. 80 53 4 10 6 4 3 12 19 5 10 18 13 21 8 10 13 14 17 27 26 26 Other defined diseases M. F. 159 143 35 11 10 9 4 8 23 17 37 46 59 39 4 27 32 26 34 62 47 74 Causes ill-defined or unknown M. F. 2 1 — — — — — — — — — 2 1 — — — — — — — — 1 (Ministry of Health Return.) Metropolitan Borough of Islington. causes of death at different periods of life during the calendar year 1933. Causes of Death. Sex All ages 0— 1— 2— 5— 15— 25— 35— 46— 55— 65— 75— All Causes M 1992 170 32 27 40 58 110 119 256 380 424 376 F 1977 119 39 32 49 74 81 103 168 283 415 614 Typhoid and paratyphoid fever M 2 — 1 1 — — — F 2 — — —. 1 — — — 1 — — — Measles M 8 2 6 — — — — — — — — — F 8 1 4 2 1 — — — Scarlet Fever M 1 — — — 1 — — — — — — — F 3 2 1 — — — — — — Wnooping Cough M 16 9 5 1 1 — — — — — — — F 10 5 2 3 — — — — — — — — Diphtheria M 18 — 4 4 9 1 — — — — — — F 14 —. 2 3 9 — — — — — — — Influenza M 97 1 2 6 13 22 20 20 13 F 76 1 1 1 1 4 11 6 13 13 25 Encephalitis Lethargica M 3 — — — — — — 1 — 1 1 — F 2 — — — 1 — — — 1 — — Cerebrospinal fever M 3 — 3 — — — — — — — — — F 3 —. 1 1 1 — — — — — — — Tuberculosis of respiratory system M 165 1 — — 3 16 35 24 42 33 8 3 F 112 — — 2 35 29 16 13 10 5 2 Other Tuberculous Discases M 14 1 1 2 2 3 1 1 1 1 1 — F 25 4 3 5 3 6 2 1 — — 1 — Syphilis M 20 4 — — — 1 2 4 2 4 3 F 4 1 — — — 1 — — 1 1 — — General paralysis of the insane, tabes dorsalis M 16 — — — — — 1 3 5 6 1 — F 5 — — — — — — — 1 3 1 — Cancer, malignant disease M 259 1 1 2 6 9 34 92 76 38 F 261 1 — 4 14 55 69 73 45 Diabetes M 10 — 1 1 5 2 1 F 23 — — — — — 1 — 1 6 10 5 Cerebral haemorrhage, &c. M 68 — — — — — 1 1 1 15 29 21 F 91 — — — — — 1 2 2 10 33 43 Heart Disease M 356 2 5 10 21 30 66 122 100 F 439 — — — 8 1 10 16 22 62 123 197 Aneurysm M 8 — — — 1 — — 1 3 1 — 2 F 11 — — — — — — 2 2 2 5 Other circulatory diseases M 73 1 2 9 27 34 F 70 8 11 20 31 Bronchitis M 88 3 1 2 3 12 22 19 26 F 82 2 — 3 4 11 16 46 Pneumonia (all forms) M 179 26 7 4 1 3 5 17 30 26 29 31 F 162 16 19 5 3 6 2 11 16 19 23 42 Other respiratory diseases M 40 1 1 3 6 2 27 F 58 — — — — — — — — 2 9 47 Peptic ulcer M 32 — — 3 3 11 9 3 3 F 7 — — — — — 1 2 1 2 1 — Diarrhœa, &c. M 43 36 2 1 — — — — 2 1 1 — F 28 18 3 — 1 — — — — 3 3 Appendicitis M 9 1 3 2 — 2 — 1 F 12 3 2 — 2 — 3 1 1 — Cirrhosis of Liver M 12 — 1 2 4 5 — F 8 — 1 — 1 1 2 2 1 Other diseases of liver, etc. M 2 1 — 1 — — F 8 — — — — — 2 1 — 2 3 Other digestive diseases ... M 32 2 — 3 1 2 — 2 4 5 7 0 F 37 3 1 3 1 3 4 2 11 9 Acute and Chronic Nephritis M 56 2 1 3 2 6 11 16 15 F 55 — 1 1 4 3 18 18 10 Puerperal Sepsis F 8 — — — 2 4 2 — — — — Other puerperal causes F 9 — 3 6 — — — — — Congenital Debility and Premature Birth, Malfor- mations, etc M 77 75 1 — — 1 — — — — — — F 60 58 — — — — 2 — — — — Senility M 12 — — — — — — — — — 1 11 F 45 — — — — — — — — — 2 43 Suicide M 31 — 1 5 4 13 7 — 1 F 17 — — 2 1 2 5 4 2 1 Other violence M 77 3 3 4 4 11 16 2 ' 9 12 5 8 F 62 2 2 1 5 3 1 2 1 10 10 25 Other Defined Diseases M 162 8 5 11 3 12 6 19 21 45 32 F 159 8 1 5 9 10 9 10 19 24 33 31 Causes Ill-defined or unknown M 3 — 1 — — — 2 — — F 1 — — — — — — — — — 1 — 89 [1933 1933] 90 (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1933. Disease. Ages. Totals Total Cases removed to Hospi tal 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 .. .. .. .. .. .. 2 1 3 1 4 .. 11 11 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever Notifications 9 55 65 109 122 457 241 43 96 15 7 1 1220 1182 Deaths .. .. .. 1 1 1 1 .. .. .. .. .. 4 4 Diphtheria Notifications 9 23 51 53 67 188 83 22 41 7.. 3 1 551 544 Deaths .. 7 1 2 4 15 3 1 .. .. 33 31 Enteric Fever Notifications .. .. .. .. .. 1 4 '2 4 1 3 .. 15 14 Deaths .. .. .. .. .. .. .. 2 1 1 .. 3 3 Puerpetal Fever Notifications .. .. .. .. .. .. .. 2 30 4 .. .. 30 36 Deaths .. .. .. .. .. .. .. •5 2 .. 7 7 Puerperal Pyrexia Notifications .. .. .. .. .. .. .. 5 59 10 .. .. 74 59 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Primary and Influenzal Pneumonia Notifications 5 9 10 5 8 15 13 20 68 52 69 30 304 96 Deaths 2 3 1 .. .. 1 .. 3 9 13 33 38 103 36 OphthalmiaNeonatorum Notifications 87 .. .. .. .. .. .. .. .. .. .. 87 21 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. 1 1 1 3 3 Cerebrospinal Fever Notifications 1 .. 2 .. 1 .. 2 1 .. .. .. .. 7 7 Deaths .. 4 1 .. 2 .. .. .. .. .. .. 7 7 Acute Poliomyelitis Notifications 1 2 1 .. .. 3 .. .. 1 .. .. .. 8 8 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery Notifications 1 .. .. .. .. .. 1 .. 2 1 .. .. 5 5 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas Notifications 5 2 .. 1 .. 4 10 6 36 15 66 38 183 124 Deaths 3 .. .. .. .. 1 .. .. .. .. .. 12 20 18 Continued Fever Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox (except in the vaccinated under 10 years) Notifications 14 14 28 38 28 243 83 22 16 1 .. .. 487 42 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. 91 [1933 (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1933. Premises. No. on Register at end of 1933 No. Added in 1933 No. Removed in 1933 Number of Inspections 1933 Number of Notices 1933 Number of Prosecutions 1933 Milk Premises 734 48 12 914 54 Nil Cowsheds Nil Nil Nil Nil „ *S)aughterHouses 10 „ 4 192 — „ Other Offensive Trade Premises 11 „ 1 73 — „ Ice Cream Premises 408 „ „ 283 13 3 Registered Houses Let in Lodgings 990 „ 16 1,257 784 2 * Including the Knackers Yard. Including 331 Bottle Milk only. Housing of the Working ClassesNumber of houses inspected — (a) On account of complaints or illness (P.H. Act) 6,996 (b) House-to-house (Housing Consolidated Regulations, 1925) 1,415 Number of notices served— (a) Under P.H. Act :— (i) Intimation 4,695 (ii) Statutory 591 (b) Under Housing Act 33 Number of houses repaired or nuisances remedied under P.H. Act 6,421 Number of houses repaired under Section 3 of Housing Act— (a) By owners 33 (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) Elected during year Nil (б) In course of erection 71 Flats Number of representations by Medical Officer or other person 1 Number of houses included in such representations 56 Dwellings & 2 other Buildings 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 30,000 Underground Rooms— Number illegally occupied 16 Number closed or illegal occupation discontinued 16 Overcrowding— Number of cases of overcrowding found 42 Number remedied 42 Number of prosecutions Nil 1933] 92 Smoke nuisances— Number of observations 150 Number of complaints 35 Number of notices served 24 Number of legal proceedings Nil Cleansing and. Disinfection— Number of adults cleansed 76 Number of children cleansed 5,951 Number of premises cleansed (a) After infectious diseases 2,634 (b) For vermin 138 Water supply to tenement houses— Number of premises supplied 191 Number of prosecutions Nil Sanitary officers— Chief Sanitary Inspector (Whole time) Number of Sanitary Inspectors (Whole time) Male, 20 Female 2 ,, (Part time) Male, Nil Female Nil Number of Health Visitors (Whole Time) 7 & 1 Infant Life Protection Visitor „ ,, (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. See reference page 91, report 1929. Reference is made here to 1932 only. Annual Report 1932. Page 17 Work of the Day Nurseries. Page 25 Coroner's Court and Mortuary. Page 32 Dysentery. Page 43 Tetanus. Page 44 Sterility of Maternity Outfits. Pages 59-61 Housing. Page 67 Unsound Food as Prizes; Preserved Food. Pages 67 and 68 Notification of Food Poisoning. Page 68 Food Poisoning—Definition. Page 72 Migratory Vendors—Warning. Misleading Descriptions—Wine and Spirit Mixtures. Page 74 The Almeric Paget Corps; Child Guidance Clinic. 93 [1933 INDEX Page Accidental Deaths 23, 28 Acreage Acute Poliomyelitis 35 Adulteration of Food 81 Ages at Death 6, 7, 8 Agricultural Produce (Grading & Marking) Act, 1928 60, 84 Anti-toxin treatment 31 Anthrax 25, 36 Appeal to Quarter Sessions 64 Appendix 87 Area Artificial Sunlight Treatment 45 Bacteriological Examinations 47, 48, 49 „ Diphtheria 47, 48 Bakehouses 55 Basement Rooms 69 Births iii,4, 5 „ Illegitimate 5 „ Notification of 5 „ Stillborn 5 Blind Persons Act, 1920 37 Cancer 25, 88, 89 Certification of Meat Food Products 79 Census Information iii Chicken Pox Regulations 36 Children and Young Persons Acts 22 Church Lane Clearance Area 68 Cleansing of Verminous School Children 54 Clinics 84 Coal gas Poisoning 28 Common Lodging Houses 63 Condensed Milk Regulations 80 Consumption (see Tuberculosis) iii, 26, 27, 28, 38 "Copying Ink" Pencil—Death from 29 Coroner's Court, &c. 29 Cream 82 Day Nurseries 20 Dairies and Milkshops (Inspection of) 61 Deaths from all causes during the year iii, 5, 88, 89 Deaths from Epidemic Diseases iii, 23, 24 „ „ Respiratory Diseases iii, 26, 27, 28, 88, 89 „ in Public Institutions 22, 23 „ Maternal 9, 10, 11 ,, Age at 6, 7, 8, 88, 89 Demolition of Habitable Dwellings 72 Density iii Diarrhœal Diseases 24 Diphtheria 31, 88, 89 ,, Anti-toxin treatment immunisation 3 1933] 94 Page Diphtheria Bacteriological 47,48,49 Diseases Treated in Hospital 33, 34 Disinfectants distributed and used 54 Disinfecting Station 53 Disinfection Work 41, 53, 54 Disinfestation of School Children 54 District Inspectors' Work 59, 61, 62 Dried Milk Regulations Dust, removal of 58 Dust receptacles provided 59 Dysentery 36 Emanations, Sewer 64 Encephalitis Lethargica 37, 88, 89 Enteric Fever (Typhoid) 33, 47, 48, 88, 89 Epidemic Diseases iii, 23, 24 ,, Cerebro-Spinal Meningitis 35, 36, 88, 89 Exemption Certificates 51 Extract of Vital Statistics 3 Erysipelas 25, 33 Factories and Workshops Administration 55-57 Fatality from Notifiable Infectious Diseases 33 Finsen Light Treatment 45 Five Year Plan 68 Food, Inspection of, Unsound, Adulteration of 74-77 Food Licensed Street Traders 79 Food Order 48 Food Poisoning 81 Food Poisoning—Examination of Peas 48 Food (Preservatives) Regulations 1925, 1927 81 Gas (Coal) Poisoning 28 Glanders, Anthrax and Hydrophobia in Man 36 Health Visitors (Municipal) 15 Home Visitations—Tuberculosis 46 Hospitals—Clinics 84 Hospital Isolation of Infectious Diseases 33, 34 Housing 67-74 „ Accommodation and Recommendations 71 Houses Let in Lodgings 62,63 Ice Cream Premises 61, 80 Illegitimate Births 5 Increase of Rent (Restrictions) Acts 74 Infant Life Protection 22 Infantile Mortality iii, 6, 7, 8 Infant Welfare Work 14-21 Infection, Prevention of 29 Infectious Diseases (London) Regulations, 1927 36 Infectious Diseases in Schools 46, 47 „ „ (Non-Notifiable) in Schools 47 Infirm Persons 64 Informal Sampling 81, 82 influenza 24, 25, 88, 89 Inspection of Food 75 „ ,, Houses 59, 61, 62, 63 „ Kitchens of Restaurants 55, 79 „ ,, Milkshops and Dairies 61 „ Slaughter Houses 75,91 „ Workshops 55, 56, 57 Institutions 85 Institutions (Deaths in) 22, 23 95 [1933 Page Inquests 29 Insulin (Supply of) 37 Invalid Children's Aid Association 21 Isolation of Infectious Diseases 33,34 Islington Chickenpox Regulations 34 Islington Interim Tuberculosis Care Committee 39 Kitchens and Restaurants 55, 79 Legal Proceedings 84 L.C.C. Bylaws 84 London County Council (General Powers) Act 1902-1932 84 Public Health (Lond.) Act, 1891 84 Public Health (Preservatives in Food) Regulations 81 Food and Drugs (Adulteration) Act, 1928 81, 84 Sale of Food Order, 1921 79,84 Meat Regulations, 1924 79 Milk and Dairies Order, 1926 80,84 Merchandise Marks Act, 1926 60,81,84 Milk and Dairies (Consolidation) Act, 1915 80, 84 Light Treatment—Artificial Sunlight and "Finsen" 45 London County Council Return of Sanitary Work 91 Malaria 36 Malignant Diseases 25, 26 Marriages 3 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work 9, 21 Maternal Deaths 9, 10, 11 Measles (Deaths) 8, 88, 89 Measles, Notifications by School Teachers 47 Meat Inspection 74-79 Meat, labelling of 78, 79 Medicines, Provision of 37 Merchandise Marks Act, 1926 60,84 Ministry of Health Returns 89,90 Milk and Dairies (Consolidation) Act, 1915 80, 84 Milk and Dairies Order, 1926 80,84 Milk, Bacteriological Analyses 49 Milk Scheme 13 Adulteration 81-84 Milk Purveyors and Dairies 80 ,, Special Designations Order—Licences 81 Mortuary and Coroner's Court 29 Notification of Infectious Diseases 29-37 „ „ Tuberculosis 38-39 „ ,, Births Act 5 ,, ,, Still-births 5 Non-compliance with Statutory Notices—Appeal 64 Non-notifiable Infectious Diseases in Schools 47 Notices served 59, 61, 62 Nursery School 85 Offensive Trades 76 Ophthalmia Neonatorum 9 Outworkers' Premises 55-57 Other Notifiable Diseases 35 Pathogenicity Tests (Diphtheria) 47 Peas—Examination of 48 Pemphigus Neonatorum 2 Phthisis 38-42, 45, 46 „ Notification of 41, 42 Pickled Horse Flesh 77, 78 1933] 96 Page Places where Food is Prepared 74,79 Pneumonia 27, 36, 88, 89 Pneumothorax treatment 45 Poisoning (Gas) 28 Polioencephalitis 36 Population at the Census, 1931 iii „ estimated, 1932 iii. 3 Preserved Food (a) Inspectors Visits 76 (b) Registration of Premises 80-91 (c) London County Council Table 91 Prevention of Deafness 37,38 Prevention of Infection 29 Propaganda 85 Prosecutions, Summary of 84 Prosecutions—Unsound Food 76 Public Health Committee ii Public Health (Heat) Regulations, 1924 79 Public Health (Preservatives, etc., in food) Regulations, 1925, 1927 81 „ „ (Tuberculosis) Regulations, 1930 41-42 Public Vaccinators 52 Puerperal Diseases 11,12,25 Puerperal Fever and Pyrexia 12 Polio-Myelitis, Acute 35 Pulmonary Tuberculosis 26,27,38-42 Rag and Bone Dealers 67 Rag a d Flock Act (1911-1928) 59 Rats and Mice (Destruction) Act, 1919 65,66 Rateable Value iii Reconditioning of Houses 69 References—M.O.H. Reports 92 Regulations, Chickenpox Notification 36 Removal of Dust 58 Rent and Mortgage Interest (Restrictions) Acts 74 Report on Housing 67-74 Report on Maternity and Child Welfare 9 Report on Work of Day Nurseries 20 Respiratory Diseases iii, 26-27, 88, 89 ,, Tuberculosis 38-42, 88, 89 Restaurant Kitchens 55, 79 Sale of food Order—Labelling of Meat 79 Samples Analysed in 1933 81 Sanitary Inspectors'Work 59,61-63 Scavenging 58 Scarlet Fever 32 Schools 46, 47, 54, 65 Septic Diseases 25 Sewer Emanations 64 Shelter House 54 Shop Inspections 76 Slaughterhouses 75, 78, 91 Slaughter of Animals Act, 1933 78 Small Pox 30 Smoke Nuisances 59 Sophistication of Milk 83 Specialist Consultations 12 Staff 2 Statistics 87 Still-Births, Registration 5 Street Accidents 23, 28 97 [1933 Page Street Traders 79 Summary of Housing 67 Summary of Vital Statistics iii Synopsis of Inspectors' Work 62 Tuberculous Diseases iii, 26. 27, 47, 48 Tuberculous Meat 75 Tuberculosis (Interim Care Committee) 39 Tuberculosis Dispensaries 43 Tuberculosis—Housing 46 „ Notification of 38 „ Respiratory, All forms, Deaths iii, 26, 27, 42, 88, 89 „ (Public Health) Regulations, 1930 39, 41 „ Visiting Nurse 46 Typhoid Fever (see Enteric) 33 Typhoid Fever at Camp 32 Underground Rooms and Basements 69 Unsound Food, Destroyed 75 Unsound Food-Prosecutions 76 Vaccination 51-53 Vaccination Officers 52 Venereal Diseases 28 Verminous Children, Disinfestation of 54 „ Premises 54 Voluntary Maternity and Child Welfare Centres 16, 17 Water Certificates 59 Water Softening 49,50 Water Supply 61,72 Welfare Work by Health Visitors 14, 15 Whooping Cough 47 „ (Deaths) 88, 89 Widows', Orphans' and Old Age (Contributory) Pensions Act, 1925 60 Workshops and Factories, Inspection of 55-57