1936 EIGHTY-FIRST 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. Chief Executive Tuberculosis Officer: Chief Executive Officer under the Maternity and Child Welfare Act. London: Vail & Co., Ltd., Printers, 170, Farringdon Road, E.C. 1. 1936 EIGHTY-FIRST 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. Chief Executive Tuberculosis Officer; Chief Executive Officer under the Maternity and Child Welfare Act. London: Vail & Co., Ltd., Printers, 170, Farringdon Road, E.C.1. II MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (1st January to 81st December, 1936) Mayor. * Councillor HENRY GEORGE COLEMAN, J.P. † Councillor GEORGE BRYANT NAISH, J.P., L.C.C. Ald.trmen. HERBERT SAMUEL JORDAN HERBERT JAMES LOWTON LYGOE *EDWARD HENRY TOMKINS, J.P. Councillors. WILLIAM AWCOCK, J.P. * JAMES PATTERSON STANLEY CECIL BOWERMAN RUTHERFORD, LL.B. JOHN BRUCE FRANK LEYDEN SARGENT HENRY JAMES EDWIN CARTER. WILLIAM GEORGE SCOTT STANLEY BENJAMIN FIDOE †LBERT EDWARD SMITH WILLIAM HERBERT GALE. Mrs MATILDA SOUTHGATE, J.P. WALTER HARPER FRANK STONHAM ALFRED CECIL KNIGHT, L.C.C. EDWARD ALBERT WILLIS † WILLIAM THOMAS RICKETTS Chairman Alderman HERBERT JAMES LOWTON LYGOE Vice-Chairman Councillor HENRY JAMES EDWIN CARTER * to November, 1936 † from November, 1936 MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE (1st January to 31st December, 1936) Mayor. *Councillor HENRY GEORGE COLEMAN, J P. †Councillor GEORGE BRYANT NAISH, J.P., L.C-C. Alderman. HERBERT JAMES LOWTON LYGOE Councillors. Miss ELEANOR MARION ADAMS I †ARTHUR NORMAN DOVE † Mrs. ROSE ANNIE ALLEN Mrs. ROSA ESSEX †WILLIAM AWCOCK, J.P. WILLIAM HERBERT GALE Mrs. JESSIE LEONIE BLYTHE WALTER HARPER * JOHN BRUCE Miss ETHEL MARGARET LITTMAN Mrs. FLORENCE HILDA WILLIAM JOHN MITCHELL CANTWELL * REGINALD WALTER MORTON * EDWARD NORMAN CARTER * Mrs. MARGARET SUMMERS Miss FLORENCE MARY † HENRY BLOOM FIELD VORLEY, ELIZABETH CLARKE J.P. Mrs. MIRIAM PRICE COLEMAN EDWARD ALBERT WILLIS * to November, 1936 † from November, 1936 Members appointed by the Council from outside their own body Mrs. M. R. JENNER, 46. Milner Square. N.1. Mrs. J. J. JONES, 88, Addington Mansions, Highbury Grange, N 5. Mrs. H. L. REES, 28, Manchester Mansions, Sunnyside Road, N.19. Mrs. C. STONHAM, 58, Queen's Road. N.4. Chairman: Councillor Mrs. MIRIAM PRICE COLEMAN. Vice-Chairman: Councillor Mrs. FLORENCE HILDA CANTWELL. III SUMMARY of Vital Statistics in the Registration Year, 1936. Population (Enumerated at Census, 1931) 321,795 persons „ Estimated Mid-year 1935 and 1936 304,100 persons Decrease on Census population, 1931 17,695 persons Mean Population, ten years, (1926-1935) 321,087 persons Area 3,092 acres Density (Mid-year, 1936) 98 3 persons per acre Males 2,415 Births Females 2,309 4,724 persons Birth rate 15.24 per 1,000 inhabitants Males 1,982 Deaths from All Causes Females 1,874 3,856 persons Death Rate 12.44 per 1,000 inhabitants Deaths from Principal Epidemic Diseases Males 98 Femalse 104 202 persons Death rate 0.65 per 1,000 inhabitants Males 146 Deaths from All Tuberculosis Females 88 234 Persons Death rate 0.75 per 1,000 inhabitants Males 1,34 Deaths from Respiratory Tuberculosis Females 75 210 persons Death rate 0.68 per 1,000 inhabitants Infantile Deaths under 1 year Males 166 Females 125 Total 291 Infantile mortality rate 61 per 1000 births Excess of Births over Deaths 868 Rateable value of Borough of Islington £2,207,849 Sum represented by a penny rate £8,937 Number of inhabited houses (approximate) 45,000 IV Public Health Department, Town Hall, Upper Street, N.1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health and Sanitary Condition of the Borough for the year 1936. The report is an " ordinary " report as defined in the Circular of the Ministry of Health, but is for a fifty-three weeks' year. The death rate for the previous year, 1935, was the lowest in Islington, and in that same year the infantile mortality rate was also the lowest recorded. The death-rate for the year under review, taking into consideration the last five years, was an average one, and the same remark applies to the infantile mortality rate. The death-rate for 1936 is 12.44; the infantile mortality rate per 1,000 births is 61. Although there was an actual reduction in the compulsorily notifiable jinfectious cases, the deaths from Scarlet Fever and Diphtheria show some increase, and this also was the case with both Whooping Cough and Measles. There was an increase of 65 in the deaths from Cancer. In September the Medical Officer of Health officially represented a number of clearance areas under Section 1 of the Housing Act, 1930. These were adopted by the Council and the result of the Ministry of Health Enquiry will! be reported on next year. In the early part of the year the housing survey work, commenced in 1935, was completed. I would here pay tribute to the Superintendent, Mr. G. J. Bridel, for the very able manner in which the supervision of the temporary assistance and the completion of the statistical summaries of this work was carried out. On the 1st October, Dr. V. Freeman commenced his duties as Assistant Medical Officer of Health. I thoroughly appreciate the value of his work and the much needed relief the council have thus given to enable me to spend more time on housing and general public health matters. Changes in the public health staff during the year involved the retirement of two Sanitary Inspectors, Messrs. Watson and Bagshaw, and the Chief Clerk, Mr. H. Angel, officers with a record of long and valued service. Of former members of the staff, the deaths are recorded of Messrs. Fortune and Cook. To the Members of the Council, and particularly to the Chairmen of Committees, Public Health, Maternity and Child Welfare, and Housing, I express my thanks for their continued interest in the departmental work, and to the Superintendent and members of my staff for their loyal co-operation. In accordance with statutory requirements, copies of this Report have been transmitted to the Ministry of Health, the Home Office and the London County Council. I am, Your obedient servant, Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1936. 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. 2. Infectious Diseases, Dysentery, etc., pages 16-21. Tuberculosis, pages 22-29. Provision of Extra Nourishment for Tuberculous Persons, page 29. 3. Diphtheria Immunisation, pages 17-18. Provision of Antitoxin, page 16. Bacteriological Work, page 31. Swimming Baths and Pools, page 58. 4. Municipal Health Visitation and Work of Voluntary Welfare Centres, pages 70-86. Child Life Protection, page 83. Nursing of Pneumonia, etc., page 85. Dinners, Nursery Schools and Convalescent Homes, page 86. 5. Sanitary Work, pages 41-47. Workshops, pages 36-39. Shops Act, pages 57-58. Verminous Premises, Disinfestation, pages 35-36. Rats and Mice, page 46. Infirm Persons, page 46. 6. Housing, pages 45-57. Clearance Areas, page 47. Demolition Orders, page 48. Overcrowding Survey, pages 50-55. Underground Rooms, page 48. 7. Meat, Food and Drugs, pages 58-67. Inspection of places where Food is prepared, page 58. Food Poisoning, page 61. Pharmacy and Poisons Act, page 64. 8. Staff matters, page 2. Health Propaganda, page 69. Socia Conditions, page 69. New Legislation, page 69. 9. Index to report, page 95. 2 1936] Public Health Staff. The staff of the Medical Officer of Health (G. CLARK TROTTER, M.D. ; D.P.H.; F.R.S.E. ) is constituted as follows:— Assistant Medical Officer of Health. VICTOR FREEMAN, M.R.C.S.; L.R.C.P.; D.P.H. Superintendent of Public Health Department and Chief Sanitary Inspector, (a, b, d) GEORGE JAMES BRIDEL, M.R.San.I., M.S.I.A. Sanitary Inspectors. (a) T. W. Agar. (b, d) T. H. Hancock. (Housing.) (b, d) S. P. Marks. (b) E. G Holmes. (Workshops and Bakehouses.) (b,d) A. E. Wood. (b) H. H. Uren. (b, d) G. S. Green. (Shops.) (b, d) C. W. S. Lewis. (Food and Drugs.) (b) L. H. Pearson. (c) J. S. Ashworth. (Housing.) (e) A. Moxon. (c, d) W. C. Bartlett. (c) J. W. Aiken. (c, d) H. R. Homewood. (c, d) A. W. Haydock. (Inspector of Meat.) (c) N Lightowlers. (e) W. Riding. (c, d) K. C. Holden. (c, d) R. W. Norman. (Dairies, etc.) (c) L. Nash. (c, d) H. P. Price. (Houses let in tenements.) (c, d) J. W. S. Baxter. One Vacancy. (Houses let in tenements.) Inspectors of Workshops, etc., where females are employed, (b, e,f) Miss E. H. Daniell. (b,e,f) Mrs. S. Undery. Health Visitors. (e,f,g) Miss R. Palmer. (e,f,g) Miss L. Flower. (e, f, g) Mrs. A. Main. (e, g) Miss E. Oliver. (e, f, g) Miss J. Devine. (e,f,g) Miss F. H. Harris. (b,e,f) Miss G. S. Lewis. (Child Life Protection.) (e.f.g) Miss E. Paley. One vacancy. (g) Miss E. McGoldrick. Tuberculosis Visiting Nurse. (а) = Cert. Sanit. Inst. (b) = Cert. Sanit. Insp. Exam. Board. (c) = Cert. Sanit. Insp. Exam. Joint Board, (d) = Meat Inspector's Certificate. (e) = S.C.M. (f) = Cert. H.V. (g) = S.R.N. Miss K. I. C. Hadley, Secretary, Tuberculosis Care Committee. Clerical Staff. W. J. Wolfe (Chief Clerk), E. A. Abbott, C. M. Wheble, W. G. Bunch, A. R. Wittrick, W. R. Causton, C. J. Cridland, L. Edis, S. A. Brown, W. A. McAdam, L. P. Regan, G. F. Kimmis, C. J. Moore, F. C. Green, A. E. Vanstone, Miss D. Francis, D. A. Owen (Temporary). Vaccination Officers. J. Jennings, L. Stevens. Disinfecting Station. A. Lewis (Engineer), W. G. Jollie (Handyman Stoker), Mrs. E. L. Lewis (Caretaker, Shelter House), Mrs. E. Reid (Children's Bathing Attendant), Mrs. A. H. Crook (Assistant Bathing Attendant), G. Cooper (Motor Driver), E. G, Norman Assistant Motor Driver). Disinfectors. W. Hardwick, A. Taylor, A. Starling. Disinfector and Caretaker of Mortuary. C. Holcombe. Public Analvst. ALAN W. STEWART, D.Sc., 23, Queen's Square, W.C.1. Public Vaccinators (See page 33). Members of staff of Public Health Department, retired in 193G. Mr. H. J. J. Watson, Inspector of workshops and bakehouses, and Senior Sanitary Inspector. Mr. A. Bagshaw. Sanitary Inspector. Mr. H. Angel. Chief Clerk. Members of staff of Public Health Department, resigned in 1936. Mr. E. Wall. Sanitary Inspector. Mr. A. B. Holloway. Sanitary Inspector. Miss M. Ritson. Health Visitor. Miss M. Livett. Secretary, Tuberculosis Care Committee. 3 [1936 EXTRACT OF VITAL STATISTICS. Total. M. F. Live Births. Legitimate 4,502 2,311 2,191 Birth Rate per 1,000 of the estimated Illegitimate 222 104 1181 resident population, 1524 Stillbirths139 Rate per 1,000 total (live and still) births, 28.58 Deaths 3,856 Death Rate per 1,000 of the estimated resident population, 12 44 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 3 0.62 No. 30. Other puerperal causes 5 T02 Total 8 1.64 Death rate of infants under one year of age:— All infants per 1,000 live births 61 Legitimate infants per 1,000 legitimate live births 60 Illegitimate infants per 1,000 illegitimate live births 76 Deaths from Cancer (all ages) 554 ,, Measles (all ages) 58 ,, Whooping Cough (all ages) 18 ,, Diarrhoea (under 2 years of age) 84 POPULATION (ESTIMATED). The population at mid-year 1936, is estimated at 304,100* persons, a decrease in the population of 17,695, when compared with the number of inhabitants ascertained at the census in 1931. MARRIAGES. Marriages, 2,963; Marriage Rate, 19.49.—There were 5,926 persons married, or 2,963 marriages in 1936, and the marriage rate, that is to say, the number of persons married per 1,000 of the population was 19.49. Compared with the previous year these figures show a decrease of 178 in the number of persons married, or of 89 marriages , and of 0.31 per 1,000 in the rate. The following statement shows the figures for the.previous ten years, 1926-1935. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 1926 2,749 16.21 1931 2,957 18.21 1927 2,844 17.01 1932 2,857 17.60 1928 2,883 17.80 1933 2,486 15.60 1929 2,967 18.56 1934 2,879 18.30 1930 3,063 18.80 1935 3,052 19.80 * M.O.H. figure as used during year. 4 1936] BIRTHS. During the year there were 4,724 live births registered, of which 2,415 were boys and 2,309 girls. Of this number, however, 763 were born of mothers living in Islington, although they were confined in Lying-in Institutions, and in other homes situated outside the Borough. The annual birth-rate was equal to 15.24 per 1,000 of the population, as compared with a mean birth-rate of 16.68 in the preceding ten years. In 1933 the lowest birth-rate (14.35) was recorded. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1936, and in the four quarters of the year and of the County of London and the Great Towns during the same period: also in the year 1935; together with the mean Borough Birth-rates for the 10 years 1926-35. Quarter. Males. Females. Total. Islington, 1936. Birth Rates. Islington, 1926-35. London, 1936. Great Towns, 1936. First 583 564 1,147 14,88 17.07 13,6 14.8 Second 598 596 1,194 15.70 17.21 14.0 15.7 Third 674 574 1,248 16.41 16.71 13.5 15.1 Fourth 560 575 1,135 13.86 15.56 12.6 13.7 The Year 1936. 2,415 2,309 4,724 15.24 16.68* 13.6 14.9 1935 2,303 2,274 4,577 14.85 17.12 13.2 14.8 Increase or decrease + 112 + 35 + 147 +0.39 — 0.44 + 0.4 + 0.1 N.B.—The total registered births given by the Registrar-General for the Calendar year, 1936, will be found at the foot of table on p. 89. *Mean annual birth-rate for preceding ten years. Showing the Births of Males and Females and the Birth-rates in each quarter and for the year, 1936, and in the several Sub-Registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females | Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 156 129 285 37.0 51 59 110 15.2 40 39 79 11.2 57 52 109 11.5 2nd „ 176 175 351 45.6 47 62 109 15.0 34 35 69 8.8 58 54 112 11.8 3rd „ 214 170 384 49.9 55 57 112 15.5 42 27 69 9.8 74 60 134 15.2 4th „ 154 203 357 43.1 46 46 92 11.8 35 26 61 8.0 53 43 96 9.4 Year 700 677 1,377 43.92 199 224 423 14.35 151 127 278 9.69 242 209 451 11.72 Showing the Births of Males and Fewales and the Birth-rates in each quarter and for the year 1936, and in the several Sub-Registration Districts.—centd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females Total. Birth rates. j Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. J Birth rates. 1st Quarter 80 88 168 12.1 85 71 156 12.4 114 126 240 13.1 583 564 1,147 14.88 2nd 96 87 183 13.2 83 79 162 12.9 104 104 208 11.4 598 596 1,194 15.70 3rd 103 95 198 14.3 75 54 129 10.3 111 111 222 12.1 674 574 1,218 16.41 4th 89 76 165 11.1 71 74 145 10.7 112 107 219 11.1 560 575 1,135 13.86 Year 368 346 714 12.66 314 278 592 11.58 441 448 889 11.94 2,415 2,309 4,724 15.24 5 [1936 Illegitimate Births.—The illegitimate births numbered 222 and show an increase of 49 on the return of the year 1935. They were equal to a rate of 4.5 per cent. of the total registered births. Notification of Births.—3,942 live births were notified under the Notification of Births Act, 1907, and the Public Health (London) Act, 1936 (exclusive of 101 stillborn), or 83 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. 1936. 1st Quarter 435 10 431 6 89 1 955 17 2nd ,, 404 12 483 13 133 3 1,020 28 3rd „ 379 14 464 10 129 2 972 26 4th „ 392 17 472 8 131 6 995 30 Year 1,610 53 1,850 37 482 11 3,942 101 REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still-born). 1936. 1st Quarter 22 1 - 23 19.6 2nd „ 34 9 4 47 37.8 3rd „ 26 5 — 31 24.2 4th ,, 26 6 6 38 32.4 Year 108 21 10 139 28.5 The above are the corrected figures. The actual number of stillbirths registered in Islington was 118, plus 36 which took place outside the Borough, but belonging to it, minus 15 non-residents which took place in the Borough. DEATHS. The deaths registered during the year numbered 3,856 (exclusive of still-births), while the death-rate was equal to 12.44 per 1,000 of the estimated population, or 1.45 above that of the previous year (10.99), and 0.09 below the mean of the preceding ten years; whilst the death-rate of England and Wales was 12.1 and the 121 Great Towns 12.3. The Deaths and Death-rates from All Causes in the Sub-Registration Districts were as fellows:— 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 117 15.0 97 12.61 76 9.88 105 12.67 395 12.60 Upper Holloway 129 17.6 97 13.42 84 11.62 117 15.03 427 14.49 Tollington 117 16.4 80 11.36 71 10.09 118 15.57 386 13.40 Lower Holloway 142 14.8 121 12.82 69 7.31 105 10.33 437 11.35 Highbury 231 16.4 180 13.0 142 10.27 173 11.62 726 12.87 Barnsbury 207 16.3 146 11.64 111 8.85 137 10.14 601 11.75 Islington (SouthEast) 276 14.9 214 11.72 163 8.92 231 ll.70 884 11.87 The Borough 1,219 15.82 935 12.30 716 9.42 986 12.04 3,856 12.44 6 1936] Showing the Deaths and Death Rates of Islington in 1936, 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 1926-35 and the deaths and death-rates in the year 1935. Quarter. Males. Females. Total. Islington, 1936. Death Rates. Islington, 1926-35. London, 1936. Great Towns. 1936. First 601 618 1,219 15.82 17.05 15.7 15.2 Second 501 434 935 12.30 11.22 11.7 11.5 Third 376 340 716 9.42 9.37 9.0 9.2 Fourth 504 482 986 12.04 12.29 12.0 11.8 The Year 1936 1,982 1,874 3,856 12.44 12.53* 12.5 12.3 1935 1,673 1,714 3,387 10.99 12.64 11.1 11.4 Increase or Decrease + 309 + 160 + 469 + 1.45 - 0.11 + 14 + 0.9 * Mean Annual death rate for preceding ten years. 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, 1936. Mean Deaths (10 years, 1926-35.) Increase or Decrease on mean. 0-1 year 291 342 - 51 1-5 years 135 175 — 40 Under 5 years 426 517 — 91 5-15 years 59 90 — 31 15-25 „ 112 137 — 25 25-35 „ 166 174 — 8 35-45 „ 193 233 — 40 45-55 „ 335 421 — 86 55-65 „ 667 668 — 1 65-75 „ 902 851 + 51 + 27 75-85 „ 755 728 85 upwards 241 205 + 36 All Ages. 3,856 4,024 — 168 There was a decrease of 91 in the number of deaths under 5 years of age when compared with the average 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 an increase of 209 in the number of deaths when contrasted with the previous year 1935, and 114 above the ten years' average (1926-35). INFANTILE MORTALITY. Infant Deaths, 291 ; Mortality Rate, 61.—The deaths of 291 infants under twelve months old were registered during the year, or 51 below the decennial average (342), and they were equal to the infantile rate of 61 per 1,000 births. The rate was 3 per 1,000 births below the mean annual record of the preceding ten years, and is 9 per 1,000 above the rate of last year (1935). 7 [1936 In the quarters the mortality ranged from 70 per 1,000 births in the first quarter, 73 in the second, 43 in the third, and 61 in the fourth. In the sub-registration districts the infant mortality was as follows :— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 37 26 Upper Holloway 33 78 Tollington 23 83 Lower Holloway 47 104 Highbury 61 85 Barnsbury 46 77 Islington South East 44 49 In London the infantile mortality was 66 per 1,000 births. The rate for England and Wales was 59 per 1,000 births. Infantile Mortality during each of the Ten Years 1926-35 and 1936. Deaths at various ages under One Year of Age. Years. Under one week. Weeks. Total under four weeks. Months. Total Deaths under one year. Deaths per 1,000 Births. % 1-2 2-3 3-4 4 weeks and under 3 mths. 3-6 6-9 9-12 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 1933 88 10 18 15 131 54 32 41 30 288 63 1934 85 7 14 8 114 61 53 36 25 289 62 1935 82 9 6 3 100 32 48 41 19 240 52 Mean 10 years 95 14 13 10 132 56 61 52 41 342 64 1936 89 11 11 11 122 34 57 42 36 291 61 Increase or decrease on mean — 6 — 3 — 2 + 1 — 10 — 22 — 4 — 10 — 5 — 51 — 3 Showing the Deaths among Infants per 1,000 Births during the Year 1936. and also the mortality rates for the Years 1926-1935. Sub. Districts. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Mean 10 years 1936 Increas or decrease on mean Tufnell 64 52 65 75 78 43 48 26 31 31 51 26 —25 Up. Holloway 30 31 44 42 26 35 30 54 52 30 37 78 + 41 Tollington 92 63 85 71 106 90 88 101 78 51 82 83 + 1 Lr. Holloway 82 74 77 95 57 84 77 68 81 98 80 104 + 24 Highbury 48 52 47 60 58 64 83 51 58 52 57 85 + 28 Barnsbury 90 59 75 87 95 66 76 80 76 85 79 77 2 Islington, S.E. 64 49 67 78 76 68 72 72 69 41 66 49 —17 The Borough 66 53 64 73 70 64 68 63 62 52 64 61 — 3 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. 8 1936] Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1926-35 : and in 1936 from certain specified causes. Causes of death. 1936. Rate per 1,000 Births. Mean rate 10 years 1926-35 per 1,000 Births. Difference. Premature Birth and Congenital Defects 18.84 20.1 — 1.26 Bronchitis and Pneumonia 8.46 13.4 — 4.94 Atrophy and Marasmus 0.63 3.2 — 2.57 Diarrhoeal Disease (all forms) 16.09 5.4 + 10.69 Convulsions 0.42 0.7 — 0.28 Whooping Cough 1.90 2.8 — 0.90 Measles 3.38 2.4 + 0.98 Diphtheria — 0.4 — 0.4 Phthisis — 0.2 — 0.2 Other forms of Tuberculosis 0.42 0.6 — 0.18 Total of above 50.14 49.2 +0.94 All other causes 11.4 14. 5 — 3.1 Total 61.54 63.7 — 2.16 INFANTILE MORTALITY during the Year 1936. 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 — — — — — — 1 5 10 16 Scarlet Fever — — — — — — — - 1 1 Whooping-Cough — — — 1 1 - 4 3 1 9 Diphtheria, Croup - - - - - - - - - - Erysipelas — — — 1 1 — — — — 1 Tuberculous Meningitis - - - - - - 1 - 1 2 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) 1 - - - 1 1 1 2 1 6 Convulsions 1 - — — 1 1 — — — 2 Laryngitis - — — — — — — — — — Bronchitis - 1 — — 1 1 1 - - 3 Pneumonia (all forms) 1 - 2 3 6 10 10 7 4 37 Diarrhoea - - — — — 1 3 2 1 7 Enteritis - — 2 — 2 11 30 14 12 69 Gastritis - — — — - - - 1 1 2 Syphilis - - 1 — 1 2 — - - 3 Rickets — — — — — - - 1 1 Suffocation, overlying - - - 1 1 - - - 1 2 Injury at birth 8 — — — 8 - - - - 8 Atelectasis 7 — — — 7 — - - - 7 Congenital Malformations 11 1 1 2 15 3 2 - 1 21 Premature birth 54 8 5 1 68 - - - - 68 Atrophy, Debility and Marasmus - - - - - 1 1 - 1 3 Other causes 6 1 — 2 9 3 3 8 — 23 Totals 89 11 11 11 122 34 57 42 36 291 BIRTHS. Nett Births /legitimate 4,502 4,724 Nett Deaths in legitimate infants 274 291 in the year illegitimate 222 4,724 the year illegitimate infants 17 291 Report on Maternity and Child Welfare work, see page 70. 9 [1936 Deaths in Public Institutions in the Borough during 1936 and 1935. Institutions. 1936. 1935. Residents. NonResidents. Total. Residents. NonResidents. Total. Archway Hospital 106 547 653 91 496 587 Royal Northern Hospital 102 209 311 104 206 310 London Fever Hospital - 40 40 - 42 42 St. Mary, Islington Hospital 1,139 46 1,185 1,075 47 1,122 Islington Institution 162 37 199 169 47 216 Mildmay Memorial Hospital 23 22 45 16 15 31 Other smaller Institutions 16 41 57 31 41 72 Totals 1,548 942 2,490 1,486 894 2,380 Percentage of Borough Mortalit 40.1 43.8 Deaths in Public Institutions outside the Borough of persons resident in Islington. 1936. 1935. North Western Fever Hospital 49 10 North Eastern Fever Hospital 29 7 Eastern Fever Hospital 22 5 Children's Hospital, Great Ormond Street 14 17 St. Bartholomew's Hospital 44 42 Royal Free Hospital 60 42 University College Hospital 51 39 City of London Maternity Hospital 7 6 Metropolitan Hospital 16 27 The Infirmary, Friern Barnet 22 31 Middlesex Hospital 16 29 la, Manor Road, Ilford (Claybury) 10 24 Tooting Bec Hospital 31 18 Other Institutions 720 507 Totals 1,091 804 Percentage of Borough Mortality 28.3 23.7 Fatal Accidents or Sudden Deaths outside the Borough.— 25 inhabitants died from accidents, or suddenly, in places outside Islington. Transferable Deaths.—During the year 46 deaths of residents that had occurred in outlying Institutions and other places in Provincial Boroughs were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Fevers— Typhus, Enteric and Continued—and Diarrhœal Diseases. During the year 202 persons died from these diseases, the death-rate being 0.65 per 1,000 inhabitants, as contrasted with 0.31 in 1935, and a decennial average mortality of 160 and a death-rate of 0.50 per 1,000. In London the death-rate from epidemic diseases was 0.44. 10 1936] 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 1936. SubRegistration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Enteritis and Diarrhoea. Totals. Tufnell Tufnell - - 4 2 3 1 10 20 Up. Holloway Tollington Up. Holloway — — 7 - 2 2 13 24 Tollington 7 - 1 - 6 14 Lr. Holloway Lr. Holloway — - 13 - 4 10 12 39 Highbury Highbury — — 2 1 — 2 13 18 Mildmay — — — 1 — 3 7 11 Barnsbury Thornhill — — 14 1 2 4 9 30 Barnsbury — — 4 — 3 — 3 10 St. Mary's — — — — 1 - 7 8 South East Canonbury — — 2 1 — 5 2 10 St. Peter's — — 5 1 2 4 6 18 The Borough — — 58 7 18 31 88 202 Total Death Rates — — 0.19 00.2 0.05 0.10 0.28 0.65 Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1926-35 and for the Year 1936. 1926 1927 1928 1929 1930 1931 Deaths. Death Rates. Deaths. Death. Rates. Deaths. Death Rates. Deaths Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 1 0.00 - - 2 0.00 2 0.01 - - - - Small Pox — — - - - - - - 1 0.00 - - Measles 69 0.20 29 009 156 0.48 11 0.03 140 0.43 7 0.02 Scarlet Fever 12 0.03 8 0.02 8 0.03 8 0.03 14 0.04 4 0.01 Whooping Cough 29 0.09 45 014 21 0.06 126 0.39 10 0.03 32 0.10 Diphtheria 31 0.09 25 0.07 25 0.08 32 0.10 42 0.13 15 0.04 Diarrhoea and Enteritis (under 2 years) 69 10.68 per 1,000 births 48 7.79 per 1,000 births 67 11.57 per 1,000 births 68 12.34 per 1,000 births 971 17.1 per 1,000 births 67 12.7 per 1,000 births 1932 1933 1934 1935 Mean 10 years 1936 Deaths. Death Rates. Deaths. Death Rates, Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever - - 4 0.01 1 0.00 - - 1 0.00 - - Small Pox - - - - - - - - - - - - Measles 52 0.16 14 0.04 39 0.12 - - 52 0.16 58 0.19 Scarlet Fever 7 0.02 4 0.01 5 0.02 - - 7 0.02 7 0.02 Whooping Cough 23 0.07 23 0.07 15 0.05 9 0.03 33 0.10 18 0.05 Diphtheria 20 0.06 33 0.10 32 0.10 13 0.04 27 0.08 31 0.10 Diarrhoea and Enteritis (under 2 years) 73 14.7 per 1,000 births 63 13.7 per 1,000 births 47 10.2 per 1,000 births 65 14.2 per 1,000 births 66 12.3 per 1,000 births 84 17.8 per 1,000 births 11 [1936 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. Diarrhœa. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 2 8 10 1 25 26 1 16 17 3 23 26 7 72 79 1 to 5 years - — — — 1 1 - 2 2 — 3 3 — 6 6 Over 5 years - 2 2 — — — — — — — 1 1 — 3 3 Totals 2 10 12 1 26 27 1 18 19 3 27 30 7 81 88 INFLUENZA. Influenza caused 34 deaths during the year and showed an increase of 5 on the return for the year 1935, and were 56 below the average of the preceding ten years 1926-35. The death-rate was equal to 0.11 per 1,000 inhabitants. Showing the Deaths from Influenza in the Quarters of the Year 1936, together with the averages of the corresponding periods, 1926-35. Years. Quarters. First. Second. Third. Fourth. Totals. 1926 15 24 3 9 51 1927 118 15 7 12 152 1928 18 12 3 8 41 1929 190 13 1 3 207 1930 5 4 3 4 16 1931 68 4 4 14 90 1932 82 9 4 8 103 1933 162 1 — 7 170 1934 17 12 1 9 39 1935 6 16 1 6 29 Average 68 11 3 8 90 1936 15 10 1 8 34 Increase or Decrease — 53 — 1 — 2 — — 56 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 1936. Ages. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Mean 10 yrs 1936 Difference. 0- 5 - 8 3 5 1 4 5 4 - 3 3 1 — 2 5-10 1 4 1 1 — — — - 1 1 1 — — 1 15-25 2 3 3 2 - 4 3 3 - 3 2 - — 2 25-35 4 13 1 9 — 4 9 10 2 — 5 5 35-45 8 21 6 19 — 14 4 24 1 3 10 3 — 7 45-55 6 22 4 38 5 16 10 27 6 3 14 4 — 10 55-65 12 28 6 43 3 16 18 32 5 6 17 7 — 10 65-75 8 34 7 52 2 15 25 33 11 8 20 9 — 11 75 & upwards 10 18 10 38 5 17 29 37 13 2 18 5 — 13 All Ages 51 152 41 207 16 90 103 170 39 29 90 34 — 56 12 1936] SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the notifiable diseases of this class. Erysipelas—10 deaths were returned from this disease, or 4 less than in the year 1935, and 5 below the average of the preceding ten years 1926-35. Puerperal Diseases.—These comprise Puerperal Pyaemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 8 deaths, being the same number as in 1935, and were 2 below the average of the ten years 1926-35. The death-rate was equal to 1.6 per 1,000 births. Anthrax, Glanders, Farcy, Tetanus, etc.—No death was recorded during 1936. INDUSTRIAL DISEASES. Lead Poisoning, Chrome, etc.— No death from any of these causes was recorded. CANCER. Cancer—554 deaths were registered from this malignant disease during the year compared with 489 in 1935, and with an average of 500 in the previous decennium. The deaths represent a death-rate of 1.8 per 1,000 of the civil population and is 0.24 above the average rate (1.56) of the last ten years; 274 deaths occurred among males and 280 among females. The following statement shows the ages at death of the persons attacked during the past ten years, and the return for the year 1936:— Ages. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Mean 10 yrs 1936 Difference 0-6 - 1 - 3 2 - 2 2 1 3 1 2 + 1 5-15 — - - 1 - 3 1 1 1 2 1 1 — 15-25 3 1 3 1 1 1 2 3 - 1 3 3 — 25-35 6 5 14 10 6 10 12 9 11 13 10 13 + 3 35-45 27 24 36 22 26 25 19 23 24 24 25 25 — 45-55 73 74 83 84 72 85 78 84 83 45 76 69 — 7 55-65 142 137 147 153 123 138 157 160 160 149 147 168 + 21 65-75 144 135 155 106 139 167 158 146 200 162 151 181 + 30 75-85 51 65 71 81 90 83 92 70 87 75 76 85 + 9 85 & upwards 7 7 9 10 8 7 13 11 10 15 10 7 — 3 Totals 453 449 518 471 467 519 534 509 577 489 500 554 + 54 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1936. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 13 14 21 11 34 21 33 147 Second 18 9 9 13 23 22 40 134 Third 16 16 8 9 26 19 33 127 Fourth 15 16 23 19 21 18 34 146 The Year 62 55 61 52 104 80 140 554 TUBERCULOSIS. Tuberculosis caused 234 deaths, which were 83 below the average of the last decennium, and were 11 above the number registered in 1935. The death rate resulting from them was equal to 0.75 per 1,000 of the civil population, and represented 6.07 per cent. of the deaths from all causes during the year. 13 [1936 Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 210 deaths, as contrasted with the decennial average of 278, while the death-rate was 0.68 per 1,000 of the civil population as against the decennial rate of 0.87 per 1,000. There was a decrease of 68 on the ten year's average number of deaths, and of 0.19 on the mean death-rate. Tuberculosis (Respiratory System). Proportion of Deaths from Tuberculosis per 100 Deaths from All Causes. Death rates from All Causes per 1,000 inhabitants. Years. Deaths. Death rates per 1,000 inhabitants. 1926 289 0.85 7.06 12.0 1927 314 0.94 7.61 123 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 1933 274 0.86 6.92 12.4 1934 253 0.81 6.80 11.8 1935 202 0.65 5.96 10.99 Average 10 years 278 0.87 6.91 12.53 1936 210 0.68 5.44 12.44 The following return gives the deaths at each age period:— Age Periods. Males. Females. Total. 0-5 2 2 4 5-15 1 - 1 15-25 13 25 38 25-35 31 20 51 35-45 20 8 28 45-55 26 10 36 55-65 31 7 38 65 upwards 10 4 14 Total 134 76 210 Showing the Deaths from Tuberculosis of Respiratory System in th* Sub-Districts during the Four Quarters of the Year 1936. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 8 7 3 6 11 17 20 72 Second 2 7 4 4 9 9 16 51 Third 5 3 5 3 5 5 9 35 Fourth 8 7 4 9 10 4 10 52 The Year 23 24 16 22 35 35 55 210 Showing the Deaths from all forms of Tuberculosis during 1936. 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 3 206 134 76 23 24 16 22 35 35 55 210 Meningeal 1 7 8 7 9 1 1 2 2 2 6 2 16 Abdominal - - 1 1 - - 1 - - - - - 1 General - - - - - - - - - - - - - Other forms — — 7 4 3 1 — 1 1 2 1 1 7 All Tuberculosis 2 10 222 146 88 25 26 19 25 39 42 58 234 14 1936] 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 623 deaths, 243 above that of 1935. They were equal to a death-rate of 2.01 per 1,000 of the civil population, and represented 16.1 per cent. of the total deaths registered in the Borough. Acute Bronchitis.—There were 59 deaths as compared with 37 in the previous year, 23 occurred among males, and 36 among females. The deaths of 2 infants under 12 months were registered. Chronic Bronchitis.—134 deaths were ascribed to it, 77 being males and 57 females. This return is 58 above that of 1935. Pneumonia (All forms).—337 deaths were registered, of which 202 were males and 135 females, and were 82 above the year 1935. 38 infants under a year old died from this disease, while between the ages of 1 and 5 years 29 deaths were recorded. Above 5 years of age the deaths numbered 270. 160 deaths occurred in Public Institutions, chiefly the Islington Hospitals. Pleurisy.—7 deaths were registered from this disease, 4 of which occurred in Public Institutions. Asthma and Emphysema.—4 deaths were recorded from Asthma. Other Diseases of the Respiratory System.—82 deaths were registered, as contrasted with 10 in 1935. VENEREAL DISEASES. Twelve deaths were ascribed to these diseases, 5 less than last year. Of these, 9 were males and 3 females. They were 2 below the mean deaths (14) of the preceding ten years 1926-35. The three groups of ages at death were as follows:—Under 1 year, 3 deaths; 1-5 years, no death ; and over 5 years, 9 deaths. The nearest treatment centres of these diseases are the Royal Northern Hospital, Holloway Road, N.7, and the Royal Free Hospital, Gray's Inn Road, W.C.I. 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. Advantage has been taken 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, has kindly supplied the following information on the work of the Local Branch in 1936. In the summer months, open-air meetings were conducted at Highbury Corner by Capt. Buckler. Perhaps the subject may be fairly summed up as "The Philosophy of Life"; the attendances were about 150-200. Six lectures were also delivered as set out below, and each was followed by questions and conversations. 15 [1936 West Islington Library, Lofting Road : Lectures were given to men on October 29th, November 5th and 12th, by Mr. Lee, on " How life has been developed—Processes, Stages, Human Responsibility," and to women on November 26th, December 3rd and 10th, given by Miss Bennett, the subject being " The Nature of Woman, and her responsibilities in the growth and development of her physical construction." DEATHS FROM COAL-GAS POISONING. During the year 21 deaths were registered from asphyxia caused by the inhalation of carbon monoxide gas. These were 4 more than in 1935. Eighteen of these deaths were attributable to suicide, while the cause of the remaining three deaths was accidental. Of the 21 deaths, 12 were males and 9 females, the ages ranging from 20 to 75 years. ACCIDENTAL DEATHS. The deaths of Islington residents due to accident numbered 145. Of this number 47 deaths were ascribed to vehicular traffic and may be summarised as follows:— Motor Car Other or Lorry. Bus or Tram. Taxi-cab. Vehicles. Total. 30 11 1 5 47 Of this number, 31 deaths occurred to Islington residents when in outlying districts. In addition to these, 11 non-residents were killed by vehicles within the borough. CORONER'S COURT, INQUESTS, AND MORTUARY. During the year 32 bodies were received into the Mortuary, as compared with an average of 187 in the preceding 10 years. No inquests were held, as contrasted with an average of 124 in the ten years 1926-35. Year. Bodies received into Mortuary. Inquests. 1926 308 305 1927 309 240 1928 274 206 1929 306 246 1930 279 177 1931 230 65 1932 52 Nil 1933 35 Nil 1934 31 Nil 1935 46 Nil Average 187 124 1936 32 Nil 16 1936] PREVENTION OF INFECTION. Notification, Isolation, Fatality, of Specified Diseases under the Provisions of the Public Health (London) Acts, 1891 and 1936. The Principal Diseases Include :— Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus, Continued Fever, Puerperal Fever and Erysipelas. 1,504 cases of the principal diseases which are notifiable under the Public Health (London) Acts, 1891 and 1936, 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 20. No case of either Typhus or of Continued Fever was notified. The total cases notified are 135 less than those of the previous year (1,639), and 578 below the average (2,082) of the preceding ten years. The decreases when contrasted with the decennial averages are to be found in the returns from Scarlet Fever, Diphtheria, Enteric Fever, Erysipelas and Puerperal Fever, which were respectively 319, 206, 7, 31 and 14 below the average. The 1,504 cases were equal to an attack-rate of 4.84 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. 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 1933 2,016 6.32 1934 2,227 7.08 1935 1,639 5.32 10 years average 2,082 6.48 1936 1,504 4.84 Registration Sub-Districts.—The total number of cases notified in these districts was as follows :— Total cases notified. Tufnell 137 Upper Holloway 182 Tollington 128 Lower Holloway 195 Highbury 271 Barnsbury 277 Islington South-East 314 Total 1,504 SMALL POX. There was no case notified in 1936, or during the preceding year. Diphtheria was responsible for 584 cases of illness, which were 205 below the average (789) of the preceding ten years. The attack rate was equal to 1.88 per 1,000 of the civil population annually, and was 0.58 below the mean rate (2.46) of the decennial period. In London the attack rate was 1.87 per 1,000. DIPHTHERIA ANTI-TOXIN. Under the Special Order of 15th August, 1910, the then Local Government Board sanctioned the provision by the Sanitary Authority, in pursuance of 17 [1936 section 77 of the Public Health (London) Act, 1891, and from 1st October 1936, Public Health (London) Act, 1936, Section 227, 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 sections of the Public Health Acts referred to is that which enables the authority, with the sanction of the Ministry of Health, to provide a temporary supply of medicine, etc., for the poorer inhabitants of their district. During the year 34,000 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 20,000 units were sold, the total amount received by the Council being 19s. 10d. The remaining 14,000 units were given free owing to the patients' limited means. DIPHTHERIA PREVENTION. The Assistant Medical Officer of Health has submitted the following report:— During the past year considerable changes have been made in the Council's arrangements for providing facilities for preventive immunisation against Diphtheria. Arrangements for immunisation were first made by the Public Health Department in 1931, since when the number of applications from parents asking for their children to be immunised has increased steadily from year to year. It was felt, however, that in view of the fact that there still are on an average about 700 cases of Diphtheria every year in Islington, with a total of nearly 300 deaths from this cause over the past 11 years, this justified further publicity being given to the Council's Scheme of Diphtheria Prevention. Leaflets and posters were prepared and arrangements set going in conjunction with the Education Department of the London County Council by which Islington school children could be immunised at the Borough Council's Clinic, and attendance for this purpose would be counted as a school attendance. To cope with the increasing numbers of applications which were being received either directly or through such agencies as the Islington Welfare Centres, and also to deal with the anticipated increase owing to the greater knowledge of the public about these facilities, the Council decided to establish a regular weekly clinic at the Town Hall for the express purpose of immunising children against Diphtheria. The clinic sessions conducted by the Assistant Medical Officer of Health were commenced towards the end of the year, in November, 1936, and justified themselves from the very commencement by an immediate increase in the number of cases dealt with. It is not anticipated, of course, that the full effects of such measures will be apparent for some time. Statistical Report for the Year 1936. Number of children given immunising injections under the Council's Scheme 201 Number of children immunised elsewhere and referred to Islington for completion or Schick testing 16 Total number of attendances at Council's Clinic 266 Number of Clinics held 17 Number Schick-tested after immunisation and found negative 32 Number Schick-tested after immunisation and found positive Nil. 1936] 18 Scarlet Fever.—760 cases were notified, and they showed a decrease of 319 on the average (1,079) of the ten years 1926-35. The attack-rate was equal to 2.45 per 1,000 of the civil population annually, which is a decrease of 0.91 per 1,000 of the mean rate (3.36) of the preceding ten years. In London the attackrate was 2.6 per 1,000 of the civil population. Enteric Fever.—7 cases of Enteric Fever were notified. This is a decrease of 7 on the average (14) that obtained during the ten years 1926-35. The attack-rate was 0.02 per 1,000 annually, a decrease of 0.02 per 1,000 of the mean rate, 0.04, of the last ten years. In London the rate was 0.07. Puerperal Fever.—See pages 12 and 73. Erysipelas.—128 cases were notified, and were 31 below the average of the preceding ten years, the attack-rate being 0.41 per 1,000 of the civil population FATALITY FROM THE PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES. By "Fatality" is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that of the 1,504 cases notified, 57 deaths occurred, or 3.1 per cent., which contrasts with an average percentage of 2.7 in the preceding ten years 1926-35. Years. Cases. Deaths. Fatality. 1926 l,919‡ 63 3.3 1927 1,813 55 3.0 1928 2,260 60 2.7 1929 2,439 57 2.3 1930 3,017 80 2.6 1931 2,111 43 2.0 1932 1.962 50 2.7 1933 2.016 67 3.3 1934 2,227 65 2.9 1935 1,639 30 1.8 Mean 2,082 57 2.7 1936 1,504 57 3.1 ‡ Includes 1 case not notified. Hospital Isolation.—Of the 1,504 cases of infectious disease notified, 1,397 were isolated in hospital, equal to a percentage of 92.2, while only 7.8 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. 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 1934 2,064 92.6 1935 1,572 94.7 1936 1,397 92.2 19 [1936 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated in Hospital. Percentage of known cases. Scarlet Fever 760 738 97.1 Diphtheria 584 583 99.8 Enteric Fever 7 5 70.1 Erysipelas 128 47 36.7 Puerperal Fever 25 24 96.0 1,504 1,397 92.2 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 1936. 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 Scarlet Fever 738 22 760 97.1 2.9 12 1 13 1.6 0.1 1.7 Diphtheria Enteric 583 1 584 99.8 0.2 31 - 31 6.3 - 5.3 (Typhoid Fever) 5 2 7 70.1 29.9 - - - - - - Erysipelas 47 81 128 36.7 63.3 9 1 10 7.0 0.7 7.7 Puerperal Fever Continued 24 1 25 96.0 4.0 3 — 3 12.0 — 12.0 Lever - - - - — — — — — - - Total 1,397 107 1,504 92.2 7.8 55 2 57 36 0.2 3.8 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1926-35 and in 1936. DISEASES. YEARS. † Average number of cases, 1926-35 1936 Increase or Decrease 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Small-pox Cases 1 - 4 71 244 66 162 11 70 - - - - _ Rate 0.00 — 0.01 0.22 0.75 021 0.50 0.03 0.22 - — — — Diphtheria Cases 743 716 756 1004 1242 710 598 547 811 760 789 583 — 206 _ Rate 2.19 2.14 2.33 3.14 3.81 2.19 1.84 1.72 2.58 2.46 2.46 1.88 — 0.58 Membranous Croup Cases — 4 4 4 6 4 3 4 4 2 2 1 — 1 Rate — 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 — 0.01 Scarlet Fever Cases 1010 909 1305 1155 1310 1093 983 1220 1089 716 1079 760 — 319 Rate 2.98 2.72 4.02 3.61 4.02 3.37 3.03 3.82 3.49 2.32 3.36 2.45 — 0.91 Enteric Fever Cases 18 12 19 18 31 16 15 15 6 7 14 7 — 7 Rate 0.05 0.03 0.06 0.06 0.09 0.05 0.04 0.05 0.02 0.05 0.04 0.02 — 0.02 Continued Cases 1 — — 1 — - 1 - - — - - - Fever Rate 0.00 — — 0.00 o.oo - 0.00 - - - - - - Puerperal Fever* Cases 27 33 38 38 36 45 35 36 54 24 39 25 — 14 Rate 4.18 5.40 6.56 6.89 6.3 8.52 7.07 7.86 11.68 5.24 7.29 5.29 — 2.00 Erysipelas Cases 118 139 134 148 188 177 165 183 193 130 159 128 - 31 Rate 0.35 0.42 0.41 0.46 0.58 0.54 0.51 0.57 0.61 0.41 0.49 0.41 — 0.08 Totals Cases 1918 1813 2260 2439 3057 2111 1962 2016 2227 1639 2082 1504 — 778 Rate 5.65 5.42 6.96 7.62 9.38 6.50 6.04 6.32 7.08 5.32 6.48 4.84 -1.64 *Per 1,000 Registered Births, † Average only where there has been continuance of disease during 10 Yearst 20 1936] Showing the Gases of the Notifiable Infectious Diseases notified in the SubRegistration Districts and the Wards during the Year 1936. 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 - 73 51 - 1 - 10 2 - - - 137 Up. Holloway Tollington Up. Holloway - 99 54 - - - 25 4 - - - 182 Tollington - 76 37 - 1 - 11 3 - - - 128 Lr. Holloway Lr. Holloway - 89 94 - 3 - 8 1 - - - 195 Highbury - 82 38 - 1 - 9 1 - - - 131 Highbury Mildmay - 69 57 - 1 - 13 - - - - 140 Thornhill - 74 61 - - - 23 7 - - - 165 Barnsbury Barnsbury - 44 59 1 — - 6 2 - — - 112 St. Mary's - 60 31 - - - 6 — - - - 97 Islington, S.E. Canonbiiry - 50 39 - - - 10 - - - - 99 St. Peter's - 44 62 — — — 7 5 - — - 118 Totals 760 583 1 7 - 128 25 - - - 1504 Attack-Rates per 1,000 population — 2.45 1.88 0.00 0.02 — 0.41 0.08 - - - 4.84 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. One case of this disease was notified during the year, as contrasted with six in 1935, and four in 1934. Epidemic Cerebro-Spinal Meningitis. Six cases were notified during the year to the Medical Officer of Health as against 7 in 1935. During the ten years 1926-35 the cases averaged 8 per annum. INFECTIOUS DISEASES (LONDON) REGULATIONS, 1927. Malaria, Dyseniery, Acute Primary Pneumonia and Acute Influenzal Pneumonia. Schedule dealing with Typhus, Relapsing and Enteric Fevers. During the past five years the following cases were notified by medical practitioners to the Medical Officer of Health. 1932 1933 1934 1935 1936 Malaria 2 - - - - Dysentery 15 5 5 36 35 Acute Primary Pneumonia 254 179 189 151 154 Acute Influenzal Pneumonia 87 125 71 59 56 Total 358 309 265 246 245 21 [1936 DYSENTERY. Thirty-five cases were notified during the year. In four instances the diagnosis was not confirmed. Of the remaining 31 confirmed cases, 10 occurred in the Royal Northern Hospital, 3 in St. Mary, Islington, Hospital, and 18 were notified from various sources (home and other hospitals). PNEUMONIA. Acute Primary Pneumonia and Acute Influenzal Pneumonia come within the Council's Scheme for assisted home nursing. During the year 24 patients had nursing attendance at a cost of £17 4s. 6d.; other cases were of course admitted to hospital. When a practitioner in attendance on a case so desires, a general bacteriological examination is made for the presence of pneumococcus. 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 3,043 cases had been notified. In 1936 the notifications numbered 318. GLANDERS, ANTHRAX AND HYDROPHOBIA IN MAN. Order under Section 56 of the Public Health (London) Act, 1891, by the London County Council. (Came into operation on the 26th April, 1909.) No case was recorded during the year. Acute Encephalitis Lethargica and Acute Polio-Encephalitis. These diseases became notfiable under an Order of the Ministry of Health on the 1st January, 1919. During the year no case of Acute Encephalitis Lethargica came to our notice; no death was registered. No case of Polio-encephalitis was notified, and no death was registered. The following summary shows the number of cases, and also the fatality of recent years:— Acute Encephalitis Lethargica. Years. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Average (10 years). 1926 Cases 21 7 5 8 4 4 4 4 2 - 6 - Deaths 9 4 3 3 — 2 1 3 - - 3 — Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. See page 70. SUPPLY OF INSULIN TO NON-INSURED PERSONS. Under Section 77 of the Public Health (London) Act, 1891. and the Public Health (London) Act, 1936, Section 227, a temporary supply of medicine, etc., for the poorer inhabitants of a district, with the sanction of the Minister of Health, is made. (For details of the Scheme see former Reports.) The demand for such assistance for patients comes through the Almoners of three of the largest hospitals. During the year under review 11 patients have received this assistance from the Borough Council, the cost of the Insulin supplied being £26 3s. 6d. 22 1936] TUBERCULOSIS. 530 cases of Tuberculosis in its different forms were notified during the year. The attack-rate was equal to 1.74 per 1,000 of the civil population. This number was a decrease of 12 on the return of the previous year, and of 0.02 per 1,000 on the attack-rate. Respiratory (Pulmonary) Tuberculosis.—439 notifications were received, of which 241 referred to males and 198 to females, and represented an attack-rate of 1.42 per 1,000 inhabitants. Showing the Notified Cases of Tuberculosis in the Wards during 1936. Registration Sub-Districts. Wards. Respiratory Tuberculosis. Other Forms of Tuberculosis. Grand Totals Tuberculosis Rate per 1,000 of Population. Males Females Total Males Females Total Tufnell Tufnell 24 17 41 5 10 15 56 1.79 Up. Holloway Tollington Up. Holloway 34 18 52 - 11 11 63 2.14 Tollington 26 27 53 5 4 9 62 2.16 Lr. Holloway Highbury Lr. Holloway 27 21 48 3 4 7 55 1.43 Highbury 22 12 34 5 2 7 41 1.38 Barnsbury Mildmay 22 19 41 3 7 10 51 1.91 ThornhUl 21 18 39 3 6 9 48 1.71 Barnsbury 18 11 29 1 4 5 34 1.48 St. Mary's 7 8 15 1 1 2 17 1.01 Islington, S.E. Canonbury 16 22 38 4 3 7 45 1.51 St. Peter's 24 25 49 3 6 9 58 2.10 Totals 241 198 439 33 58 91 530 1.71 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1936. Tubercular Diseases. Sex. At all ages. Cases Notified in Whole District. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 241 - 3 11 50 93 77 7 F. 198 - 2 13 73 85 19 6 Tubercular Meningitis M. - - - - - - - F. 4 - 3 - 1 - - - Tabes Mesenterica M. 1 - - 1 - - — — F. 1 - - 1 - — — — General Tuberculosis M. - - - - - - - - F. Other forms of Tuberculosis M. 32 1 3 10 6 5 6 1 F. 53 - 1 12 13 12 7 2 All Tubercular Diseases M. 274 1 6 22 56 98 83 8 F. 256 — 12 26 87 97 26 8 Totals 530 1 18 48 143 195 109 16 Percentages at each life period to total cases 0.19 339 9.06 26.98 36.79 20.57 3.02 23 1936 From the above statement it will be seen how the disease attacked people at the various ages, viz.: In every hundred cases 3.39 were aged 1 to 5 years. „ „ 9. were aged 5 to 15 years Prime„ ,, 26.98 | were aged 15 to 25 years. of „ „ 86.79 were aged 25 to 45 years. Life „ ,, 20.57 were aged 45 to 65 years. „ „ 3.02 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 50, while the females reached 73. TUBERCULOSIS. Year. Notified Cases. Coming to knowledge. Total. Deaths. 1927 640 161 P. 657 801 P. 314 348 O.F. 144 O.F. 34 1928 694 140 P. 659 834 P. 309 358 O.F. 175 O.F. 49 1929 616 105 P. 592 721 P. 314 345 O.F. 129 O.F. 31 1930 590 111 P. 567 701 P. 280 315 O.F. 134 O.F. 35 1931 588 133 P. 590 721 P. 281 332 O.F. 131 O.F. 51 1932 577 140 P. 578 717 P. 264 308 O.F. 139 O.F. 44 1933 565 157 P. 572 722 P. 274 312 O.F. 150 O.F. 38 1934 534 122 P. 544 656 P. 253 280 O.F. 112 O.F. 27 1935 542 128 P. 555 670 P. 202 223 O.F. 115 O.F. 21 1936 530 110 P. 517 640 P. 210 234 O.F. 123 O.F. 24 The above table shows for the past ten years the totals of the known cases of respiratory tuberculosis (pulmonary), indicated by "P," and other forms of tuberculosis, by "O.F" the last column showing the deaths. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These Regulations provide that no person suffering from respiratory tuberculosis who is in an infective condition shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk, or the handling of containers. No case came to the notice of the Medical Officer of Health during the year which called for action. ISLINGTON TUBERCULOSIS CARE COMMITTEE. Miss M. Threfall, who resigned her position as Secretary of the Committee, was succeeded on the 6th January, 1936, by Miss M. E. Livett, who in turn resigned on the 28th November, 1936. On the 14th December, 1936, Miss K. I. C. Hadley took up her duties as Secretary of the Committee. As the Annual Report of the Care Committee has been circulated among the members of the Public Health Committee, in this summary only specially outstanding items are mentioned. 1936] 24 During the year 1936 the Committee, under the Chairmanship of Mr. W. G. Harris, had the benefit of the funds raised by the Christmas Seal Sale, 1935. This money has been used to help patients in need of financial assistance. These numbered about 6 per month, but in October and November the number was practically double. A number of patients have received grants of milk and eggs. As this is Borough Council expenditure, all such applications, after being investigated by the Secretary of the Tuberculosis Care Committee, are considered by the Public Health Committee. The Handicraft Class continues to meet each week at the Royal Chest Hospital, and in June, 1936, a stall was taken at an Exhibition and Sale organised by the Standing Conference of Metropolitan Boroughs Tuberculosis Care Committees, and held at Carpenters Hall. The receipts amounted to £7 5s. Od., and after paying expenses the Committee were able to distribute a small share of the profits to each of the regular Handicraft Students. A Christmas Sale of Handicraft work was also arranged, the proceeds from which amounted to £3 3s. Od. A Christmas Seal Appeal was organised again during 1936 ; about 1,000 Appeal letters were sent by post, and resulted in nett receipts of £54 9s. 4d. The Committee appreciated an allotment of clothes received this year from the Queen Mary's Needlework Guild. This supplemented the parcels which were received from friends and workers. The Committee appeals urgently for clothing suitable for patients in hospital and for small children. £10 was received from the Alexandra Day Fund and twenty recommendations for the Mayor's Christmas Dinner Fund were granted. For the total year's work the statistical records are thus summarised:—370 new cases; 1,008 visits paid; 1,994 letters written; 765 interviews. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. A quarterly revision of the register is made; the necessity for this being systematically carried is justified by the numbers found to have removed from the address originally given, and while every endeavour is made to trace the patient, success in discovering the new address is only occasionally possible. 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 1936. Lungs. Other Forms. Total. M. F, M. F. Numbers on register at the commencement of the year 1936 967 761 303 292 2,323 Notified cases added during the year 1936 241 198 33 58 530 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1936 46 32 17 15 110 No. of cases removed from the register during the year 1936 1.254 991 353 365 2,963 279 251 55 66 651 975 740 298 299 2,312 25 1936 Summary of Notifications during the period from 1st January, 1936, to the 31st December, 1936. in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Number of Primary Notifications. Total Primary Notifications. Total Notifications on Form A. 0 to 1 I to 5 6 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. Pulmonary Males - 3 7 4 11 39 56 37 46 31 7 241 386 Females — 2 8 5 24 49 60 25 15 4 6 198 302 Non-pulmonary Males 1 3 8 3 3 3 5 — 5 1 1 33 51 „ „ Females - 10 8 5 7 7 8 4 4 3 2 68 80 Showing the Notified Cases of Tuberculosis in the Quarters during 1936. 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 58 66 124 65 34 99 59 42 101 59 56 115 241 198 439 Tubercular Meningitis — 2 2 ... 1 1 ... 1 1 ... ... ... ... 4 4 Tabes Mesenterica ... ... ... ... I 1 ... ... ... 1 ... 1 1 1 2 General Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 10 12 22 7 13 20 9 15 24 6 13 19 32 53 85 Totals 68 80 148 72 49 121 68 58 126 66 69 135 274 256 530 Showing New Cases of Tuberculosis and all Deaths during 1936. Age Periods, New Cases. Deaths, Pulmonary. Non-Pulmonarv. Pulmonary. Non-Pulmonary M. F M. F. M. F. M. F. Under 1 year - 2 1 - - 1 - 1 1.5 3 3 7 12 2 1 2 5 5.10 7 8 9 10 — — 1 1 10.15 4 5 6 8 1 — 2 — 15.20 13 27 5 9 1 6 1 1 20.25 41 54 5 8 12 19 — 1 25-35 64 70 7 10 31 20 5 — 35-45 48 30 2 4 20 8 — 1 45.55 59 19 5 5 26 10 — — 55-65 37 5 2 3 31 7 1 — 65 and upwards 11 7 1 4 10 4 - 2 Totals 287 230 50 73 134 76 12 12 56 Deiths not notified or 23 9 per cent. of Total Deaths. Disinfection of Houses and Rooms after Tuberculosis.—The following statement gives the particulars for the year:— Houses. Rooms. 1st quarter 67 75 2nd ,, 77 101 3rd „ 62 84 4th ,, 39 54 Total 245 314 19361 26 TUBERCULOSIS DISPENSARIES. RETURN SHOWING THE WORK OF THE NORTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1936. 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 108 64 6 3 11 14 8 6 119 78 14 9 220 (b) Diagnosis not completed — — — — — — — - — — — — — (c) Non-tuberculous - - - - - - - - 114 104 9 11 238 B.— Contacts examined during the year:— (a) Definitely tuberculous 5 8 3 3 — 1 — 2 5 9 3 5 22 (b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous - - - - — - - - 60 76 71 71 278 C.—Cases written off the Dispen sary Register as:— (a) Recovered 5 18 — — 2 3 4 2 7 21 4 2 34 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 174 180 80 82 516 d.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 323 279 25 21 38 60 36 30 361 339 61 51 812 (b) Diagnosis not completed - - - - - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 753 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 263 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 87 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes. Hospital Sister 1,234 3. Number of cases transferred to other areas. cases not desiring further assistance under the scheme and cases "lost sight of 141 Municipal Tuberculosis Visiting Nurse 1,658 10. Number of (a) Specimens of sputum, &c., examined 295 4. Cases written off during the year as dead (all causes) 95 (6) X-ray examinations made in connection with Dispensary work 432 5. Number of attendances at the Dispensary (including contacts) 4,353 6. Number of Insured persons under Domiciliary Treatment on the 31st December 321 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above - 7. Number of consultations with medical practitioners*:— (a) Personal 22 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 407 (b) Other 480 *Hospital staff, 135. 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 the Borough. G. CLARK TROTTER, Chief Tuberculosis Officer. 27 RETURN SHOWING THE WORK OF THE SOUTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1936. Diagnosis. pulmonary. Non-pulmonary. Total. Adults. Children. Adults. Children, Adults. Children. Grand Total. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): (a) Definitely tuberculous 52 41 5 5 4 4 3 6 56 45 8 11 120 (b) Diagnosis not completed — — — — — — — — 1 3 — — 4 (c) Non-tuberculous - - — - - - - - 105 78 29 24 236 B.—Contacts examined during the year: — (a) Definitely tuberculous 6 8 2 4 — — — 1 6 8 2 5 21 (b) Diagnosis not completed — — — — — — — — — 2 — 2 4 (c) Non-tuberculous - - - - - - - — 48 65 46 43 202 C.—Cases written off the Dispensary Register as:— (a) Recovered 5 3 1 1 3 6 1 3 8 9 2 4 23 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 155 146 75 67 443 D.—Number of Cases on Dispensary Register on Decern ber 31st:— (a) Definitely tuberculous 241 180 24 15 24 24 24 22 265 204 48 37 554 (b) Diagnosis not completed - - - - - - - - 1 5 - 2 8 1. Number of cases on Dispensary Register on January 1st 610 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 205 2' Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 49 9. Number of visits by Nurses to homes for Dispensary purposes. 2,007 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 152 Municipal Tuberculosis Visiting Nurse 1,417 10. Number of (a) Specimens of sputum, &c., examined 613 4. Cases written off during the year as dead (all causes) 66 (ft) X-Ray examinations made in connection with Dispensary work 226 5. Number of attendances at the Dispensary (including Contacts) 4,509 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 2 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 183 7. Number of consultations with medical practitioners:— (a) Personal 9 12. Number of "T.B. plus cases on Dispensary Register on the 31st December 287 (6) Other 228 Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) provided by the Council—One in the Southern part of the Borough G. CLARK TROTTER, Chief Tuberculosis Officer. 1936 28 At the Northern Dispensary there were 845 new cases, and at the Southern 611, while the attendances at the former were 4,353 and at the latter 4,505. The examination of contacts with tuberculous cases showed that 34 were suffering from tuberculosis, 48 were suspects, and 456 were not suffering. The nurses of the Northern Dispensary paid 1,234 visits, and those of the Southern 2,009, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 241 visits, and of the Southern 204 visits to the patients' homes for the purpose of examining them. TUBERCULOSIS. The number of persons in attendance at the Dispensaries in each year was as follows:— 1932 1933 1934 1935 1936 North Dispy South Dispy North Dispy South Dispy North Dispy South pispy North Dispy South Dispy North Dispy South Dispy New Cases 601 568 668 469 742 554 819 470 845 611 Actual Number of Attendances 3041 4545 3426 4091 3775 4294 3808 4210 4353 4505 Totals 3642 5113 4094 4560 4517 4848 4627 4680 5198 5116 A summary of the combined dispensaries is given for the following years:— Cases. Attendances. 1932 1,169 7,586 1933 1,137 7,517 1934 1,296 8,069 1935 1,289 8,018 1936 1,456 8,858 Totals 6,347 40,048 Table showing the number of Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1936. Date. Dispensary Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 388 355 446 333 385 335 369 302 343 385 364 348 4 353 8,858 Southern 428 406 452 367 378 345 334 292 341 386 390 386 4,505 New Cases Including Contacts Northern 61 61 117 66 104 85 64 50 49 71 55 62 845 1,456 Southern 54 48 86 46 57 39 47 30 43 51 57 53 611 Contacts. 34 Tuberculous Northern 2 3 2 1 4 1 3 3 - - 1 3 23 Southern - 3 - 1 1 - 1 — 1 4 - - 11 Suspects Northern 2 — 6 1 1 3 2 1 1 2 2 2 23 48 Southern 3 2 2 3 2 - 3 — 3 2 1 4 25 Non-Tuberculous Northern 18 20 55 19 27 30 15 15 14 11 13 15 252 456 Southern 10 23 35 16 22 4 18 8 19 16 18 15 204 Nurses' Visits Northern 101 110 133 99 86 130 99 100 79 110 87 100 1,234 3,243 Southern 195 157 180 161 165 171 172 174 161 157 160 156 2,009 Tuberculosis Officers' Visits Northern 21 24 22 20 23 17 17 19 19 21 20 18 241 445 Southern 12 17 20 13 17 17 17 12 17 24 12 26 204 29 [1936 SUPPLY OF EXTRA NOURISHMENT TO TUBERCULOUS PATIENTS. Under the Council's Scheme grants of extra nourishment in the form of one pint of milk and one egg per day are made to tuberculous patients, if so recommended by the Tuberculosis Officers. During the year 22 patients received such grants, incurring an expenditure of £20 15s. Od. Pneumothorax Treatment was administered to sixty-four patients at a cost of £245 19s. 3d. Finsen Light Treatment.—One patient received this treatment at a cost of £4 15s. Od. Artificial Sunlight Treatment.—No case came under treatment in the year under review. HOME VISITATION—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1936, to the 31st December, 1936. Month. North Dispensary. South Dispensary. Total. January 182 142 324 February 155 127 282 March 167 125 292 April 57 57 114 May 131 122 253 June 133 118 251 July 163 136 299 August 121 115 236 September 108 100 208 October 145 126 271 November 144 127 271 December 152 122 274 Totals 1,658 1,417 3,075 TUBERCULOSIS—HOUSING. 530 premises in which resided persons notified during 1936 as suffering from Tuberculosis came under our observation. 504 visits were made to premises with a view of ascertaining 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. A large proportion of the houses were found to be in a good sanitary condition ; in five instances it was found that the home conditions were rather bad. Houses in bad sanitary condition 5 Houses in good sanitary condition 279 Houses in which minor defects were discovered 46 Patients removed to another address 103 Patients deceased (no visit paid to house) 71 504 Patients in Mental Hospital 3 Resides in Clearance Area 2 No visit by request 16 Duplicate notification 4 Visit postponed 1 530 1936] 30 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 945 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 440 were Scarlet Fever and 335 Diphtheria. The number of notifications of the several diseases are given below:— Disease. No. of Notifications. Average of preceding 10 years. Increase or Decrease. Scarlet Fever 440 657 217 Diphtheria 335 382 47 Enteric Fever 2 2 — Total 777 1,041 264 In addition to the above, 168 notifications of Chicken-pox, which was made notifiable in Islington in 1930, were received. Non - Notifiable Diseases.—4,959 cases came to the knowledge of the Medical Officer of Health during the year, viz., 2,612 cases of Mealses, 586 cases of Chicken-pox, not notifiable under the Chicken-pox (Islington) Regulations, 1930, 544 of Whooping Cough, and 1,049 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools. 2,105 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 2612 1,623 +989 Chicken-pox 586 984 —398 Whooping Cough 544 587 —43 Other Diseases 1,049 1,838 —789 Total 4,791 5,032 —241 * Note.—"Other Diseases " include Mumps, Scabies, Ophthalmia, etc. Scheme of Measles Control.—In co-operation with the School Medical Officer of the London County Council, 7,700 circulars were distributed to the schools in Islington during the year 1936. This is with a view to early intimation being obtained where possible of children absent from school owing to Measles. The circular draws attention to the necessity for the removal of the seriously ill to hospital and to the Borough Council's arrangements for nursing attendance in the home in special cases, as well as describing the initial symptoms of the disease, and the fact that it is a serious disease in young children. Chiokenpox, Rubella ("German" Measles), and Mumps.—In these diseases where either owing to the home conditions or the severity of the disease there is need for hospital treatment, cases have had hospital treatment afforded them on the recommendation of the Medical Officer of Health. 31 [1936 BACTERIOLOGICAL EXAMINATIONS. Examinations numbering 2,382 were made, for the medical profession, of sputum, of swabs from the throat, and of the blood of patients suspected to be suffering from Tuberculosis, Diphtheria and Enteric Fever, respectively. The number is a decrease of 168 on that of the preceding year and 429 below the decennial average. Of the total examinations, 249, or 10.5 per cent., gave positive results. Tuberculosis.—544 specimens of sputum were examined, 50, or 9.2 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.—1,828 specimens were examined for Diphtheria, of which 198 or 10.8 per cent., were found to be "positive." Enteric Fever—10 specimens of blood were examined, 1 of which gave a positive result. DIPHTHERIA—PATHOGENICITY TESTS. 1936. f Swabs Submitted for Examination. Negative Resu't. (Bacilli) Positive Result. (Bacilli) Non-Virulent. Virulent. 12 10 2 2 1 *Including one negative swab with suspicious bacilli tested for pathogenicity: Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1926-1935, and in 1936. 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. 1926 183 1,501 1,684 3 9 12 148 691 839 2,535 1927 260 1,573 1,833 3 21 24 11 661 772 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 1933 186 1,865 2,051 5 19 24 93 634 727 2,802 1934 268 1,846 2,114 1 21 22 97 522 619 2,755 1935 293 1,710 2,003 3 12 15 74 458 532 2,550 Average 10 years 289 1,744 2,033 3 16 19 115 644 759 2.811 1936 198 1,630 1,828 1 9 10 50 494 544 2,382 BACTERIOLOGICAL EXAMINATION OF MILK. During the year 1936, 14 samples of milk taken in various parts of the Borough as supplied to the consumers and schools were tested bacteriologically, 8 of these samples being Pasteurised Milk in course of delivery to schools, and 2 of Pasteurised Milk in course of delivery to London County Council Institutions (St. Mary, Islington, Hospital, and Islington Institution). All the samples were tested for tubercle, and in no case was the bacillus discovered. All the samples were examined for bacterial count, the majority of them being generally satisfactory. One sample of Grade A (Tuberculin Tested) Milk showed the presence of coliform bacillus. 1930 32 BACTERIOLOGICAL EXAMINATION IN CASES OF PUERPERAL SEPSIS. During the year no swab was submitted. SPECIAL BACTERIOLOGICAL OR CHEMICAL EXAMINATIONS. Most of the work under this heading was in connection with alleged food poisoning, and the Ministry of Health Laboratory gave us very considerable help by examining samples submitted to them. In addition, examinations were made of specimens submitted by practitioners in cases of suspected Scarlet Fever and Dysentery. Scarlet Fever (haemolytic streptococci) suspected, negative result. 1 dystentery, negative result. In regard to food poisoning, the samples were: 1 of tinned pineapple; 1 of tinned peas ; and 1 of ham. VACCINATION. No vaccination was 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 3,747 births returned on the "Birth List Sheets" in 1935, the returns of vaccination show that only 1,715 infants were successfully vaccinated while 7 were found to be insusceptible. There were also 127 who died unvaccinated and 1,226 statutory declarations of conscientious objection were obtained by the parents or guardians; 63 vaccinations were postponed under medical authority, 401 removed to districts the vaccination officers of which were duly apprised, and 174 removed to other districts or places unknown, thus leaving 34 unaccounted for. The return of certificates of exemption, therefore, represents 32.7 per cent. of the 3,747 births above-mentioned. Vaccination per 100 Years. births, less infants who died unvaccinated. 1926 51.5 1927 49.9 1928 46.5 1929 49.5 1930 51.2 1931 50.0 1932 500 1933 47.0 1934 47.2 193 47.4 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years:— 1926 1,896 1927 1,845 1928 1,755 1929 1,642 1930 1,584 1931 1,477 1932 1,299 1933 1,213 1934 1,234 1935 1,197 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 — — - 1934 — — - 1935 — — - 1936 — — - 13 7 20 33 [1936 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1935. Registration Sub-Districts. Number of Births returned in " Birth List Sheets" in 1935. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Statutory Declarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children remaining Unvaccinated. or not accounted for (Defaulters). Total Number of Certificates of Primary Vaccination of children under 14 years received during year 1936. Number of Statutory Declarations of Conscientious Objection received during year 1936. 1 2 3 4 5 0 7 8 9 10 11 12 Tufnell 914 384 2 - 247 45 6 169 57 4 295 Up. Holloway 715 295 1 — 231 14 3 147 22 2 1,357 227 Tollington 227 103 — — 83 8 6 5 20 2 73 Highbury 622 301 1 — 227 15 8 41 25 4 237 Lr. Hollowav 324 155 — — 104 22 10 14 14 5 39 Barnsbury 449 229 3 — 152 16 12 14 17 6 831 164 Islington, S.E. 496 248 — — 182 7 18 11 19 11 162 The Borough 3747 1715 7 — 1226 127 63 401 174 34 2,188 1,197 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, 1936:— 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. Remarks. Under one year. One year and upwards Total. Tollington Dr. M. J.Healy 192 10 202 9 Upper Holloway Dr. P. Inwald 182 10 192 7 Tufnell Dr. D. W. Latham 200 10 210 6 East Lower Holloway Dr. C. V. Spark 101 9 110 6 West Lower Holloway Dr. S. N. Forbes 119 3 122 5 Highbury Dr. T. Galbraith 238 13 251 17 Canonbury Dr. J. M Lynch 198 24 222 10 Thornhill Dr. H. D. Christie 92 6 98 1 Barnsbury Dr. B. Kessel 133 19 152 2 South St. Mary and West St. Peter Dr. G. Madden 73 9 82 10 St. Mary, Islington, Hospital Dr. W. R. Turtle 1 — 1 — Islington Institution, St. John's Road Dr. K. A. Anklesaria 5 1 6 — Total 1,534 114 1,648 73 1936] 34 Vaccinations and re-vaccinations performed by the Public Vaccinators of the Council during the year 1936:— Successful vaccinations performed at the surgery or elsewhere than at the homes of the persons vaccinated 67 Successful re-vaccinations performed at surgery or elsewhere than at the homes of the persons vaccinated 59 Successful vaccinations or re-vaccinations performed at the homes of the persons vaccinated or re-vaccinated 1,512 The Vaccination Officers in the course of their duties forwarded the names of 1,468 children to the Public Vaccinators on Form "H." Another 484 children were vaccinated at the "request" of parents or guardians before Form "H" was issued. DISINFECTION. Disinfection of Rooms.—2,521 rooms were disinfected, as contrasted with 2,898 in 1935. Formaldehyde in solution was employed, although in some cases it was augmented by sulphur fumigation, when vermin were found to be present, 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; in certain cases special insecticide fluids were employed. The above figures also include the disinfection of houses and rooms after Tuberculosis, vide p. 25. Rooms Disinfected. 1936 1935 1st Quarter 602 654 2nd 730 919 3rd 572 661 4th 617 664 The Year 2,521 2,898 Work at the Disinfecting Station.—27,008 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors at the Council's Disinfecting Station, compared with 27,966 similar articles disinfected during the previous year. In addition to the above articles, 309,493 second-hand garments were disinfected for clothing contractors trading in the Borough, who paid the Council for the work, amounting to the sum of £84 Is. Od. Altogether 336,501 articles described in the two paragraphs preceding were disinfected. 35 [1936 Summary of the chiej articles of Clothing, Bedding, etc., disinfected during the year 1936, and also in the preceding year 1935. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1936 1935 Beds 290 266 196 310 1,062 1,192 Blankets 819 979 472 926 3,196 3,353 Bolsters 180 200 134 189 703 861 Carpets — — 4 — 4 — Cushions 54 62 50 103 269 276 Mattresses 333 351 266 342 1,292 1,449 Pillows 736 786 522 844 2,888 3,231 Pillow and Bolster Cases 512 487 285 618 1,902 2,038 Quilts 374 372 209 413 1,368 1,560 Sheets 722 757 472 868 2,819 2,977 Other Articles 4,138 2,649 1,446 3,272 11,505 11,029 Totals 8,158 6,909 4,056 7,885 27,008 27,966 The nature of the articles disinfected for the clothing contractors is shown below:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Blankets 600 700 750 400 2,450 Garments 46,179 33,641 154,614 66,446 300,880 Other Articles 2,250 874 2,027 1,012 6,163 Total 49,029 35,215 157,391 67,858 309,493 Disinfectants Distributed and Used.—The following statement gives the quantity of disinfectants distributed by the Sanitary Authority, or used in disinfecting and cleansing rooms:— To householders:—Carbolic powder, 10 cwts. *Disinfectant fluid, 20 gals. *Strong disinfectant is diluted before distribution in place of the former weaker disinfectant used The figure given is as distributed. Disinfection of premises by Formaldehyde Solution, 30 galls. The total cost of disinfectant was £9 5s. Od. together with £5 15s. 3d. the cost of sulphur candles used in the process of disinfestation of rooms. Shelter House.—The Shelter House was not occupied during the year; baths were given to 31 verminous persons, while their clothing was disinfected, 7 of whom were sent from a Common Lodging House. 33 other persons who had been in contact with cases of infectious diseases, 12 of whom were employed in handling food, also had baths and their clothing disinfected. Baths were provided for 32 persons who were suffering from Scabies (a series of 3 baths in each case), making a total of 96 baths. Disinfestation of Rooms.—361 rooms were specially disinfested during the year and in 38 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. The method of dealing with such rooms was fully set out in the Annual Report of the Medical Officer of Health for 1935. 1936 36 Under the London County Council (General Powers) Act, 1922, and the Public Health (London) Act, 1936, the Local Authority, on the report of the Medical Officer of Health, has power to cleanse, disinfest, or destroy any unwholesome articles in any house; or an owner or occupier may be required to cleanse any house or part of a house in a verminous condition. During the year the arrangement for the issue of sprayers and insecticide was continued, 114 (16-oz.) tins being supplied, 22 applications for the loan of sprayers were received, and the distribution of the special leaflet dealing with the methods of eradication of vermin was continued. This assistance to tenants has been appreciated, and the facilities afforded to obtain this material from the Public Health Department are worthy of encouragement. In the case of vermin infested rooms, the Council undertake on the application of the occupier to carry out a process of fumigation on payment of the sum of 5s. per room. The room is first sprayed with an insecticide and followed by fumigation with sulphur candles, this process being repeated if required after an interval of 10—14 days. Disinfestation of School Children (Cleansing from lice and other vermin)—During the year 6,644 baths (including 2,271 for Scabies) were given to children from the London County Council Schools, who attended the Disinfecting Station, and were cleansed by the nurse whom the Borough Council appointed for the work, while their clothing was undergoing disinfestation. The amount paid during the year by the London County Council for the baths given to the children was £550 17s. Od. There was a decrease in the number of children treated for head lice, but an increase in the number of scabies cases treated. The rate paid by the London County Council is two shillings for head cases and one shilling for scabies. Proceedings were instituted by the London County Council during the year in 63 instances. In 13 cases no fines were imposed and in 50 cases fines ranging from 3s. to 10s. were imposed. The total fines amounted to £12 5s. 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 1936. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under:— Factories, including Factory Laundries 758 Workshops, including Workshop Laundries 460 Workplaces, other than outworkers' homes 444 Domestic Workshops 120 Bakehouses 236 Restaurant Kitchens (see also p. 60) 798 Outworkers' premises 1,391 Miscellaneous re-inspections and calls 4,843 Total 9,050 37 [1936 Notices Served.—In consequence of the 753 sanitary defects discovered as the result of the inspections above, 261 intimation and 13 statutory notices were served. Of these notices, 94 were served on the owners of factories, 83 on the owners of workshops and workplaces, 16 on the owners of bakehouses, and 66 on the owners of restaurant kitchens. In addition to these nuisances, 54 were discovered on Outworkers' premises, necessitating the service of 15 notices. Most of these defects were remedied, but it was found necessary in one instance to resort to legal proceedings. Registers.—There were 2,754 workshops on the Registers as contrasted with 2,726 in 1935, while the total number of workrooms was 3,872. as compared with 3,850 in the previous year; 90 workshops were added to the Registers, while 62 were removed from them. The various workshops and workplaces are tabulated as below:— Workshops and Workplaces. 1936. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1,341 2,097 36 10 Workshops where Women are employed 495 767 19 24 Laundries 35 45 — 1 Bakehouses 230 245 1 4 Restaurant Kitchens 540 605 23 18 Other Workplaces 113 113 11 5 Total 2,754 3,872 90 62 Workshops Notified to Home Office during Year 1936. Trade. Number of Workshops. Women. Male Young Persons. Totals. Tie Making 2 7 — 7 Tailoring 5 13 — 13 Dressmaking 15 97 — 97 Mantles 3 3 — 3 Hat Ornaments 1 2 — 2 Blouses 1 8 — 8 Artificial Florists 1 1 - 1 Mica Goods 1 145 — 145 Dyeing and Cleaning 1 4 — 4 Leather Bags 2 7 — 7 Furriers 2 3 — 3 Wire Winding 1 35 — 35 Cushion Manufacturing 1 3 — 3 Pill do. 1 2 — 2 Upholstery 1 5 — 5 Total 38 335 — 335 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors. Premises. Inspections. Number of WrittenNotices Prosecutions. (1) (2) (3) (4) Factories 879 108 (Including Factory Laundries) Workshops 575 49 (Including Workshop Laundries) Workplaces 1,242 102 1 (Other than Outworkers' premises) Miscellaneous Re-Inspections and calls 8,354 15 — Total 9,050 274 1 1936 38 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 222 220 - - Want of ventilation 12 12 - - Overcrowding — - - - Want of drainage of floors 3 6 - - Other nuisances 274 269 - 1 Dust Bins Wanting 37 38 - - Defective 21 21 - - Sanitary Accommodation insufficient 5 9 - - foul 84 83 - - unsuitable or defective 83 87 - - not separate for sexes 12 10 - - Offences under the Factory and Workshops Arts— Illegal occupation of underground bakehouse (s.101) Breach of Special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences (Excluding offences relating to outwork) - - - - Total 763 755 — 1 *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Acts, 1901 as remediable under the Public Health Acts. OUTWORKERS' PREMISES. Instances. Noticcs Served. Remedied. Prosecutions. Outwork in unwholesome premises (s. 108) 51 15 51 Nil Outwork in infected premises (s. 109, 110) 3 — 3 — Total 54 15 54 Nil OUTWORKERS' LISTS (s. 107): Lists received from Employers 997 Addresses received from Other Councils 1,721 Addresses forwarded to Other Councils 580 Firms failing to send in lists (No. letters sent) 329 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 38 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 15 Reports (of action taken) sent to H.M. Inspector 9 Other (New Factories and Workshops reported under Home Office Memorandum, 1912) 86 Underground Bakehouses (s. 101) in use at the end of the year 62 39 [1936 OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing Apparel— Making, &c. 28 11 - Cleaning and washing — — - Household linen — — - Lace, lace curtains and nets — — - Curtains and furniture hangings 14 — - 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. 1 — - Artificial flowers 5 1 - Nets, other than wire nets — — - Tents — — - Sacks — — - Racquet and tennis balls — — - Paper, &c., boxes, paper bags 2 1 - Brush making 2 — - Pea picking — — - Feather sorting — — - Carding, &c., of buttons, &c. — — - Stuffed Toys 3 — - Basket making — — - Chocolates and sweetmeats — — - Cosaques, Christmas Crackers, Christmas stockings, &c 13 2 - Textile weaving — — - Lampshades — — - Total 51 15 — 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. During the year the Medical Officer of Health visited, with the Cleansing Superintendent, the dumping grounds where the contractors dispose of Islington refuse. Mr. Browning, the Cleansing Superintendent, has kindly supplied me with the following statement regarding the work during the year:— (1) Street Sweeping.—All wooden orderly trucks have been fitted with special rubber tyres and ten metal orderly trucks purchased and put into service on main roads. (2) Gully Cleansing.—One 6-ton mechanical vehicle of 1,000 gallons' capacity water tank for gully cleansing and fitted with special street washing apparatus, purchased and put into commission in July last. The old open type horse-drawn gully van taken out of service and a handpropelled gully sludge truck (closed container type) substituted therefor to work in conjunction with the mechanical gully emptiers. 1936 40 (3) Refuse Collection.—A. further three low-loading hygienic horse-drawn vans have been built to own design by own staff of mechanics and put into service, making a total of 19 of these vans. During the year 1936, 83% of refuse was collected by mechanical vehicles and 17% by horses and vans. (4) Refuse Disposal.—The work of reconstruction at Ashburton Grove Disposal Depot and installation of handling, etc.: Plant was commenced in April, and the first half of the programme completed on the 19th December in time to deal with the Christmas holiday work. The second half of the programme will be finished about the end of March, 1937, and the whole installation officially opened on the 17th April, 1937. Before the completion of the first half, certain auxiliary plant was put into operation, including a small incinerator and fish offal sterilizer, and these have eliminated the nuisances caused by burning light combustible material in the open air and the offensive smell arising from fish offal containers. Also the insanitary sludge lagoons have been abolished and a new structure built which obviates the use of the lagoons. All refuse is sent by rail to contractors' dumps and treated in accordance with the recommendations of the Ministry of Health, as heretofore. The dumps are frequently inspected by the Cleansing Committee and myself and by the local Sanitary Authorities. (5) Generally—Uniforms and Protective Clothing.—All sweepers are now provided with a blue donkey jacket, legging overalls and sou'wester during the winter, and a khaki jacket and black soft felt hat during the summer, biennially. Motor Drivers, Carmen, Dust and Truck Loaders are also provided with a blue serge jumper during the winter and a khaki jacket during the summer, biennially. REMOVAL OF DUST. 23 applications were received during the year by the Public Health Department for the removal of dust. The applications received for the previous ten years were as follows:— 1926 20 1931 36 1927 25 1932 44 1928 25 1933 21 1929 21 1934 23 1930 40 1935 23 During the year the Metropolitan Boroughs' Standing Joint Committee had considered the question of the provision of dustbins of differing types for different classes of premises, and asked the London County Council to include in their next General Powers Bill clauses to enable Metropolitan Borough Councils to (i) supply dustbins at the cost of the owner of premises ; (ii) supply and maintain dustbins upon a rental basis, or (iii) supply and maintain dustbins out of the rates. The Standing Joint Committee also decided that where the Council undertake to supply and maintain bins on a rental or otherwise, they should be given power to enforce the scheme throughout their area, that the definition of bins should include storage containers used in connection with block dwellings, and the existing law relating to the provision of sufficient refuse receptacles should be simplified, so that the Council may be in a position to authorise the officer in charge of their cleansing service immediately to serve the requisite notices, instead of that officer having to obtain specific instructions from the Council or their appropriate Committee. 41 1936 The Council agreed with the decision of the Standing Joint Committee, and resolved that in the meantime the powers in this connection contained in Section 37 of the Public Health (London) Act, 1891, formerly exercised by the Public Health Committee, should be vested in the Cleansing Committee in the future. This section enacts that "if at any time it appears to the sanitary authority that any house whether built before or after the commencement of the Act is without a sufficient ashpit furnished with proper doors and coverings the sanitary authority shall cause notice to be served on the owner and occupier of the house requiring him forthwith or within such reasonable time as is specified in the notice to provide the same in accordance with the directions in the notice; and if the notice is not complied with the said owner or occupier shall be liable to a fine not exceeding £5 and for a further fine of 40s. for each day during which the offence continues." Dust Receptacles Provided.—During the year 1,513 dust receptacles were provided by owners of property under notice. DISTRICT INSPECTORS' WORK. During the year the fourteen District Inspectors made a total of 48,647 inspections and calls, a decrease of 3,164 inspections on the corresponding period of 1935; while 15,365 improvements were effected in 6,307 premises; as against 16,027 improvements in 6,367 premises! for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the inspectors' visits in 1936:— House to house inspections 2,891 Other inspections of dwelling houses 4,826 Re-inspections and calls made 40,072 Visits of inquiry re notifiable infectious diseases 1,504 Butchers 'shops, stalls, etc. (Saturday nights) 103 Ice cream shops and factories 460 Dairies and Milk shops 1,598 Stables and yards 147 Urinals attached to Public Houses 36 Smoke observations 32 Notices Served.—There were 5,495 intimation notices served by the inspectors with respect to nuisances. In 822 instances it became necessary, as the intimations to owners or occupiers of the properties had been ignored, to serve statutory notices as directed by the Public Health Committee. Rag Flock Acts, 1911 and 1928.—In the routine inspection, the Sanitary Inspectors found no cause for action to be taken. It was not considered necessary to take any samples of rag flock for analysis to be certain that they came within the standard. Smoke Nuisances.—45 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 32 observations were made by the District Inspectors, and 7 notices served upon the owners of the businesses requiring the abatement of the nuisance. Water Certificates.—23 water certificates were granted in accordance with the provisions of sec. 48 (2) Public Health (London) Act, 1891, and sec. 95 (2) of the Public Health (London) Act, 1936, in respect of 570 separate tenements newly erected or rebuilt during the year. WATER SUPPLY. Number of houses which have not an adequate internal water supply, i.e., water supply from taps only, in yard, 51. Premises on which notices have been served under the London County Council (General Powers) Act, 1907 and Public Health (London) Act, 1936, (Additional Water Supply), 219. 1936 42 AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1928. MERCHANDISE MARKS ACT, 1926. All the Sanitary Inspectors are officially appointed for this work. Special inspections for this particular duty under the Merchandise Marks Act under and the Agricultural Produce (Grading and Marking) Act, by these and by the Food and Drugs Inspector and the Meat Inspector numbered 948. 3 prosecutions were taken under the Merchandise Marks Act, 1926, all of which were successful. The orders which have been made relate to:—Currants, sultanas, raisins, fresh apples, butter, bacon and ham, eggs in shell and dried eggs, honey, maize, oat products, starch, malt products, salmon and sea trout, dead poultry, raw tomatoes, chilled beef, boneless beef and veal, beef and veal, salted beef, salted pork, frozen mutton, lamb, pork, and edible offals, cream cheese, fruit juice syrups. No premises have been registered for the cold storage or chemical storage of eggs. WIDOWS', ORPHANS' AND OLD AGE (CONTRIBUTORY) PENSIONS ACT, 1925 (SECTION 6). Since these powers were delegated by the London County Council, no case has come under the notice of the Borough Council. 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. 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 Health Visitors or Voluntary Welfare Centres in the Borough, were as follows:— Totally Partially Blind. Blind. No. of cases at the end of year 1935 2 12 No. of cases coming to the knowledge of M.O.H. during the year 1936 1 1 No. of cases which left during the year 1936— (died) 0 1 No. of cases under supervision at the end of the year 1936 3 12 PREVENTION OF DEAFNESS. Circular 1337a, Ministry of Health, dated 22nd May, 1933, on "Prevention of Deafness." Discharging ears after Scarlet Fever, coming to the knowledge of the Medical Officer of Health, 18 cases; after Diphtheria, 6 cases; after continuation of Scarlet Fever and Diphtheria, 1 case. In addition, 212 from other causes were visited by the Health Visitors and Centres, and 6 of these latter died (causes of deaths being (i) Heart failure, Respratory failure, Thrombosis left lateral sinus, Bilateral middle ear disease, Diarrhoea and Vomiting, Collapse of Lung, Bronchitis; (ii) Diarrhoea and Vomiting, Bilateral mastoiditis, P.M.; (iii) Acute Gastro Enteritis, Left Otitis Media ; (iv) Purulent meningitis, Cerebral Abscess, Otitis Media ; (v) Heart failure, Diarrhoea and Vomiting, Double Otitis Media, P.M.; (vi) Broncho Pneumonia, Diarrhoea and Vomiting, Otitis Media (both ears) P.M. 43 [1936 Summary of Sanitary Work from Inspectors' Reports for the year 1936. Districts. Totals. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 118 420 186 265 129 135 229 317 229 222 93 172 166 210 2891 Other premises inspected 247 332 195 309 283 464 311 414 379 390 254 529 369 350 4826 Re-inspections, Calls made, etc. 2079 3455 2618 3041 3197 2680 2749 2863 3392 2788 2410 2752 3162 2886 40072 Ice Cream Premises inspected — — — 1 — — — 1 — 1 2 — - — 5 Dairies and Milk Purveyors inspected - - - - 1 - - 1 - - 1 2 - - 5 Stables „ 5 2 11 1 — 6 2 5 3 2 1 4 3 12 57 Yards „ 12 2 48 3 — 2 3 5 1 2 1 3 4 4 90 Agricultural Produce (Grading and Markingl Act, 1928 Merchandise Marks Act, 1926 3 7 7 5 10 9 3 4 4 4 2 4 3 3 68 Urinals attached to P.H.'s inspected - - 19 - 6 1 - 2 - 4 - 1 1 2 36 Children and Young Persons Acts 3 5 8 5 5 8 2 3 - 2 1 - 3 3 48 Premises (re Water Certificates) inspected - - - - 68 241 2 3 - - - - - 77 391 Rag and Bone Dealers — 1 1 — — 7 — 1 2 — — 4 - 7 23 Rag Flock Acts — — — — - - - - - - - - - - - Smoke observations — 8 1 — 1 3 4 3 — 3 1 — 5 3 32 Shops, Stalls and Markets (Saturday evening 7 10 8 6 7 6 7 7 8 7 5 7 8 10 103 Total Inspections anil Calls 2474 4242 3102 3636 3707 3562 3312 3629 4018 3425 2771 3478 3724 3567 48647 Notices Served. Intimation ' Public Health (London) Acts, 1891 & 1936 161 461 290 461 344 458 299 552 525 460 228 443 331 309 5322 Housing Acts — 35 13 4 — 38 1 17 8 1 8 11 6 27 169 Ice Cream Shop — — — — — — — — — — 1 — — — 1 Dairies, — — — — — — — — — — 3 — — - 3 Statutory Public Health (London) Acts, 1891 & 1936 8 123 11 30 46 104 46 100 142 71 27 20 40 ,30 805 Housing Acts — 2 — — — 1 - — 4 2 - - - - 9 L.C.C. (General Powers) Acts — — — 1 — 5 — — — — — — — 2 8 Improvements. Drains— Constructed — — — — — — — — — — — — — — — Re-constructed 9 13 2 2 1 6 4 9 3 5 3 3 3 2 65 Repaired 8 8 3 6 16 4 3 4 1 14 6 2 2 3 80 Ventilated 12 15 3 1 5 4 3 9 — 10 1 — 1 — 64 Gully and other traps fixed 27 30 2 — 9 5 2 6 — 16 6 — 3 6 112 Urinals— Water supply—cleansed — — 1 — — 1 2 1 — — — — — — 5 Water Closets— 'W.C. erected with pan, trap and water supply - 2 1 - 4 2 2 1 3 2 2 1 1 - 21 Pan and trap only provided 40 54 20 18 45 17 32 48 26 46 40 17 30 17 450 Flushing apparatus repaired 21 19 8 22 20 18 10 25 16 8 15 15 17 18 232 Ventilated — 12 — — 4 57 — 7 2 — — 2 — — 84 Walls, etc., cleansed 14 29 6 19 29 59 32 38 35 52 55 20 12 15 415 Position altered 1 — — — 1 — — — 1 — — — - - 3 Dust Bins provided 69 166 104 179 98 86 92 152 149 99 82 82 79 76 1513 Areas paved 9 24 3 2 12 29 11 10 10 8 1 5 4 1 129 Yards paved or repaved 12 27 18 17 18 49 23 11 33 19 25 14 7 5 278 Sinks Provided 26 114 26 17 42 32 59 64 35 74 82 23 20 7 621 Waste pipe repaired 23 42 30 34 39 64 31 96 45 29 8 12 10 9 472 Domestic Water Supply— Cisterns repaired and cleansed 4 12 8 6 4 5 4 3 5 3 1 1 — - 56 Water supply provided to dwelling house - - - - - - - - - - - - - - - Water supply provided to tenement house 8 46 3 9 9 25 7 - 23 43 27 6 12 1 219 Walls and ceilings of rooms cleansed and redecorated 96 326 138 347 216 445 223 347 386 243 296 253 125 152 3593 1936J 44 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 18 48 31 80 25 70 28 69 56 49 71 62 39 43 689 Floor space ventilated 0 30 1 5 7 9 1 25 8 3 2 5 1 1 104 Floors repaired 31 100 20 54 41 78 30 62 91 62 33 32 23 24 681 Guttering and rain water pipes repaired 17 47 30 26 43 56 27 93 32 37 29 11 25 27 500 Roofs repaired 28 101 52 134 45 135 41 101 154 94 102 71 71 42 1171 Overcrowding abated 1 9 2 2 3 8 2 1 21 1 — 27 4 2 83 Illegal use of underground rooms for sleeping discontinued 2 3 2 - 1 15 2 3 29 4 4 32 8 4 109 Other improvements, or Nuisances abated 91 271 94 182 148 318 147 217 178 108 202 108 128 106 2358 Rooms Disinfected 87 108 43 108 82 62 73 110 85 80 84 91 117 128 1258 Total improvements 660 1656 651 1270 967 1659 891 1512 1427 1169 1177 895 742 689 15365 Total premises improved 287 634 295 537 380 492 394 560 599 473 454 424 433 345 6307 HOUSES LET IN LODGINGS. The houses which come under the operation of the by-laws received 845 inspections during the year, followed by 5,462 subsequent re-inspections and calls, so that the total visits amounted to 6,309. These inspections resulted in 710 intimations being served on the persons responsible, which were followed by 127 statutory notices to demand the abatement of the nuisances discovered by the Inspectors specially engaged upon this; work. Altogether 3,680 improvements were effected in 669 premises. Synopsis of Inspectors' Work:— Improvements. Drains: Constructed — Reconstructed 7 Repaired 29 Ventilated 8 Gully and other traps fixed 6 Water Closets : W.C. erected with pan, trap and water supply 1 Pan and trap only provided 13 Flushing apparatus repaired 66 Ventilated 16 Walls, etc., cleansed 24 Position altered 3 Dust Bins : Provided 155 Areas : Paved — Yards: Repaved., 79 45 [1936 Sinks : Provided 23 Waste pipe repaired 68 Domestic Water Supply: Cisterns repaired and cleansed — Water supply provided to tenement house 8 Other Improvements: Walls and Ceilings ot Rooms cleansed and redecorated 385 Staircases and passages repaired, cleansed and redecorated 214 Floor space ventilated 1 Floors repaired 108 Guttering and rain water pipes repaired 53 Hoofs Repaired 250 Overcrowding abated 13 Illegal use of underground Rooms for sleeping discontinued 25 Other Improvements, or Nuisances abated 2,071 Rooms Disinfected 54 Total Improvements 3,680 Total Premises Improved 669 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 during the year. The Committee considered 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. 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 30 men. 104 and 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. 47, 49 and 51, Wharfdale Road, beds for 65 women. The total number of licences granted was 17; representing 24 premises. Visits of inspection.—525 visits were paid by male Inspectors and 54 by women Inspectors, a total of 579 visits. 1936 46 INFIRM PERSONS. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928, AND THE PUBLIC HEALTH (LONDON) ACT, 1936, SECTION 224. During the year 17 cases, 14 females and 3 males, came to the notice of the Medical Officer of Health and were duly reported to the Public Health Committee, with the result that in 4 cases Orders of the Justices were obtained for removal to an institution; 6 entered an institution voluntarily, 2 died before admission to an institution, 2 were taken care of by relatives. In 2 cases the conditions under which the persons lived were improved and in 1 case the circumstances were such that it did not become necessary to take further action. SEWER EMANATIONS. Complaints were received from persons living in the neighbourhood of Gifford Street of smells emanating from the London County Council's sewer in Gifford Street, and communications were addressed to the London County Council on the subject, who replied to the effect that as experiments made with ozone apparatus with a view to rendering the air extracted from the ventilating shaft near Gifford Street free from unpleasant smells had not been successful, the experiments had been discontinued and the ventilating shaft had been sealed temporarily. When this had been effected the complaints ceased. SCHOOLS. As stated in the Annual Report of the Medical Officer of Health for 1934, the inspection of school children in the Metropolitan Borough of Islington comes under the administration of the London County Council, but the general sanitary inspection is within the purview of the Borough Council's Public Health Department. The number of private schools is now 12, as 3 ceased to be used as such during 1936. RATS AND MICE (DESTRUCTION) ACT, 1919. (9 and 10 Geo. 5, Ch. 72) The activities in connection with Rat Week were similar to those in the previous year ; bills were posted throughout the Borough intimating the distribution of rat baits, and leaflets were distributed giving definite instructions. It was noted this year that the demand for baits did not come immediately in rat week, but the week after, no doubt due to the propaganda. During the year 1936 the number of complaints received was 191 The number of private houses visited under the Rats and Mice (Destruction) Act 329 The number of shops and factories visited 46 The total premises inspected 375 Street work visits numbered 203 Number of premises proved to be rat infested 133 Number of premises in which infestation was due to mice 6 Number of notices served 99 Drain defects remedied as a result of complaint of rat trouble 31 The following Table summarises the work under the Act during the years 1929 to 1936. 47 [1936 1929 1930 1931 1932 1933 1934 1935 1936 Number of Streets visited 144 166 223 250 244 236 239 203 Number of Private Houses visited 223 387 385 391 388 364 412 329 Number of Shops and Factories visited 36 37 48 17 38 46 37 46 Total Premises inspected 259 424 433 408 426 410 449 375 Found Rat Infested 101 142 178 169 168 178 190 133 Found Mice Infested 4 3 10 9 8 6 9 6 Defective Drains Repaired (Cause of Rat trouble) 23 45 50 63 37 55 42 31 Number of Complaints received 124 176 216 203 194 212 199 191 RAG AND BONE DEALERS. During the year 53 visits were paid to 28 premises upon which is carried on the business of a rag and bone dealer. Only 3 were found to be unsatisfactory. PART I—HOUSING ACT, 1930. Representations were made by the Medical Officer of Health to the Housing Committee in respect of 18 small clearance areas under Part I of the Housing Act, 1930, comprising 141 dwelling houses, occupied by 171 families, having a total population of 649 persons. The following are the particulars of the areas so represented:— Area. | Dwelling-houses with lands, outbuildings and appurtenances. The Metropolitan Borough of Islington (Adelaide Square) Clearance Area The Metropolitan Borough of Islington (Baxter Grove) Clearance Area The Metropolitan Borough of Islington (Broad Yard, Essex Road) Clearance Area The Metropolitan Borough of Islington (Bryan Vale) Clearance Area The Metropolitan Borough of Islington (Caroline Court and Hope Place) Clearance Area The Metropolitan Borough of Islington (Georges Road) Clearance Area The Metropolitan Borough of Islington (Haliday Walk) Clearance Area The Metropolitan Borough of Islington (Islington Place) Clearance Area The Metropolitan Borough of Islington (Mildmay Avenue) Clearance Area The Metropolitan Borough of Islington (Nelson Buildings and Nelson Place) Clearance Area The Metropolitan Borough of Islington (Nelson Cottages and Nelson Place) Clearance Area The Metropolitan Borough of Islington (Randells Road) No. 1 Clearance Area The Metropolitan Borough of Islington (Randells Road) No. 2 Clearance Area The Metropolitan Borough of Islington (St. Alban's Place) No. 1 Clearance Area The Metropolitan Borough of Islington (St. Alban's Place) No. 2 Clearance Area The Metropolitan Borough of Islington (Sun Row) Clearance Area The Metropolitan Borough of Islington (Nos. 191a and 192a, Upper Street) Clearance Area The Metropolitan Borough of Islington (York Cottages, Upper Street) Clearance Area Nos. 1, 2, 3, 4, 5, 6, 7, 8, 8a, 9, 10, 11, 12 and 13, Adelaide Square, and No. 159, Shepperton Road Nos. 6, 7 and 8, Baxter Grove. Nos. 1, 2, 3, 4, 5, 6 and 7, Broad Yard, Essex Road Nos. 1, 2, 3 and 4, Bryan Vale Nos. 6, 7 and 8 Caroline Court and Nos. 1, 2, 3, 4 and 5 Hope Place Nos. 95, 97 and 99, Georges Road Nos. 22, 24, 26 and 28, Haliday Walk Nos. 6, 7, 8 and 10, Islington Place Nos. 1, 2, 3, 4, 5, 5a, 6 and 7, Mildmay Avenue Nos. 1, 2, 3, 4, 5, 6 and 7, Nelson Buildings, and Nos. 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16a and 16b, Nelson Nos. 1, 2, 3, 4, 5, 6 and 7, Nelson Cottages and Nos. 1, 2 and 3, Nelson Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53. 55, 57, 59, 61, 63, 65, 67 and 69, Randells Road Nos. 83, 85, 87 and 89, Randells Road Nos. 5, 6 and 7, St. Alban's Place Nos. 11, 12, 13, 14, 15, 16 and 17, St. Alban's Place Nos. 3 and 4, Sun Row Nos. 191a and 192a, Upper Street Nos. 1 and 2, York Cottages, Upper Street 1936 48 HOUSING ACTS, 1925-1935. UNDERGROUND ROOMS. Two Sanitary Inspectors (Messrs. Hancock and Ashworth) were transferred from district work to undertake inspections under the Housing Acts, and together with completing the outstanding work on their districts, made the following inspections under the Housing Acts:— House to house inspections 151 Other premises inspected 383 Re-inspections, calls, etc 1,131 During the year closing orders were made in respect of 162 underground rooms or parts of buildings, under Section 20 of the Housing Act, 1930, as extended by Section 84 of the Housing Act, 1935, prohibiting the use of the underground rooms for human habitation. The Medical Officer of Health reported that the lower front room of 481, 483, 485, 487, 495, 497, 499, 501, 505, Liverpool Road, was in each case unfit for human habitation. Notices were served, and as a consequence orders were made prohibiting the use of the lower front room of the premises mentioned for human habitation. In the following cases, consideration was adjourned pending the carrying out of works to render the room fit for human habitation : 507, 509, 515, 517, 519, 521, 523, 525 and 527, Liverpool Road. In consequence of notices served on the owners of the premises 1 and 2, Bovay Place, that they were considered unfit for human habitation, an undertaking was given that the premises would not be used for human habitation. The premises were subsequently converted into lock-up garages. DEMOLITION ORDERS. No demolition order was made during the year. RECONDITIONING OF HOUSES. During the year under consideration, 8 premises, namely, 2 and 4, Mayville Street, 8, 9, 10 and 11, Gordon Place, and 200 and 204a, Blackstock Road, were reported as having been rendered fit for human habitation consequent upon official action by the Borough Council. 96 dwelling houses were the subject of informal notices requiring the owners to effect repairs, and at the close of the year 28 of these had been satisfactorily carried out. It was found necessary in 5 cases only to serve formal notices, these premises being: 23, Boleyn Road, 34, Ecclesbourne Road, 26, Marlborough Road, 69, Pembroke Street, and 75, Rhodes Street. Summary of Housing from 1919 to 1936 (inclusive):— The number of houses or flats provided by the Islington Borough Council, the London County Council and by private enterprise in the Borough, was as follows:— 1919 to Total since 1935 1936 1919. Number of houses or flats provided by the Islington Borough Council 1081 — 1,081 Number of flats provided by the London County Council 575 437 1,012 Number of houses or flats provided by private enterprise 829 58 887 2,485 495 2,980 49 [1936 Particulars of houses or flats provided under the Council's Housing Schemes:— 1919 to 1935. 1936. Total since 1919. 1919 Act. Halton Mansions 168 — 168 City Mansions 47 — 47 Queen's Mansions 45 — 45 Warltersville Mansions 46 — 46 Manchester Mansions 31 — 31 Addington Mansions 107 — 107 Comprising* 9 houses 34 dwellings — 34 478 478 1924 Act Tyndale Mansions 102 — 102 Laycock Mansions 132 — 132 Houses, etc., Highbury Station Road 15 — 15 Avenell Mansions 40 — 40 Leyden Mansions 111 — 111 1925 Act. The Highlands, Crouch Hill 71 — 71 1930 Act. Wakelin House 109 — 109 1,058 — 1,058 * 7 houses comprising 23 tenements sold in 1936. NUMBER OF HOUSES OWNED BY THE LOCAL AUTHORITY, DISTINGUISHING THOSE BUILT IN THE LAST TWO YEARS, AND HELD UNDER:— (1) Part III. of the Housing Act, 1925. (2) Part II. of the Housing Act, 1925, and (3) Other powers. Held under Total at 31st Dec., 1934 Erected in 1935 & 1936 Total Part III. of Housing Act 1925 Nil. 71 71 Part II. of Housing Act 1925 Nil. Nil. Nil. Other Powers 893 117 1010 Total 893 188 1081 Overcrowding cases recorded annually as dealt with by service of notice since 1925:— 1925, 19; 1926, 26; 1927, 24; 1928, 37; 1929, 21; 1930, 32; 1931, 59; 1932, 72; 1933, 42; 1934, 61; 1935, 76; 1936,83. Commencing in March, recommendations were made to the London County Council on behalf of families living in overcrowded conditions under the standard laid down by the Housing Act, 1935, and the "special hardship" recommendations mentioned below were than made only on the grounds of serious ill-health. The number of families who were found to be overcrowded and recommended for preferential treatment was 363 ; at the end of the year 64 of these families had been provided with accommodation by the London County Council. 19361 50 As the " appointed day " has not yet been fixed for Islington, notices were not served in these cases, but they were merely sent to the London County Council as recommendations. HOUSING RECOMMENDATIONS FROM THE PUBLIC HEALTH DEPARTMENT. During the year 1936, recommendations were made to the London County Council regarding housing accommodation for " special hardship " cases. In all, 96 were recommended for special consideration. The basis of these recommendations was mainly one of overcrowded conditions, but in a number of cases, ill-health of members of the family was the main reason for the support given to enable their applications to receive favourable consideration. Of the 96 cases recommended by the Medical Officer of Health, 33 of which were given on account of overcrowding, during the year :— 13 were provided with accommodation by the London County Council. 17 removed to an unknown address. 9 secured better accommodation in Islington. 53 still remained in their Islington occupation. 4 removed to addresses outside Islington. These 96 recommendations can be classified under the following headings : — 33 were on account of overcrowding; 16 on account of overcrowding and illhealth ; 44 ill-health (including tuberculous sufferers); 3 insufficient accommodation for the sexes; In some cases (not special hardship or overcrowding) a recommendation was given for consideration should there be any spare accommodation. An agreement has been entered into between the Islington Borough Council and the London County Council by which families de-housed under the provisions of the Housing Act, 1930, are accommodated elsewhere by the London County Council. By this agreement the Borough Council undertakes to pay the London County Council a sum of £1 17s. 6d. annually for 40 years, and obtains the right upon the cessation of the tenancy to nominate another family to occupy the vacated premises. During the year, 37 families, comprising 126 adults and 75 children, occupying underground rooms which did not comply with the regulations governing such rooms, and which were the subject of closing orders, were so accommodated. In 1935, there were 10 such families, comprising 41 adults and 21 children. DEMOLITION OF HABITABLE DWELLINGS. During the year 201 houses have been demolished, on the sites of 7 of these new business premises have been erected. OVERCROWDING SURVEY. The Survey of the Borough for the purpose of ascertaining what dwelling houses occupied by members of the working classes were overcrowded was commenced on the 1st November, 1935, and completed on 15th January, 1936. Premises known to be occupied by persons of the professional classes were not visited. The overcrowding standard laid down in the Act consists of two parts. Section 2 (1) (a) provides that a dwelling house shall be deemed to be overcrowded if the accommodation is such that any two persons being ten years old or more, of opposite sexes and not being persons living together as husband and wife, must 51 [1936 sleep in the same room. Section 2 (1) (6), in conjunction with Tables I and II in the First Schedule to the Act, fixes, in relation to the number and size of the rooms in any dwelling house, the maximum number of persons, irrespective of sex, who may be permitted to sleep in that house at one time. The maximum permitted number in the case of each dwelling is the number ascertained by reference to Table I or Table II in the First Schedule, whichever number is the less. These tables are as follows :— Table I. No. of rooms. Permitted No. of persons. 1 2 2 3 3 5 4 7½ 5 10 Table II. Size of rooms. Permitted No. of persons. 110 sq. ft. or over 2 90 sq. ft. or over but under 110 sq. ft 1½ 70 sq. ft. or over but under 90 sq. ft l 50 sq. ft. or over but under 70 sq. ft. ½ Under 50 sq. ft Nil and two persons extra for each additional room. No room under 50 sq. ft. is counted. For the purpose of determining the number of persons in a family, a child under 1 year of age is not counted and a child between the ages of 1 year and 10 years counts as ½ a person. Only rooms normally used in the locality for sleeping or living purposes are counted as rooms, so that sculleries, bathrooms, etc., are not taken into account in determining the permitted number of persons. The survey falls into two stages, the first being a preliminary enumeration to ascertain the number of persons in each family, the number of children under 10 years of age, and the number of rooms occupied. For the purpose of this enumeration each child under 10 years of age was counted as ½ a person. The enumeration, which was made in respect of 44,390 structurally separate houses occupied by 89,428 separate families, showed (i) the families which were overcrowded irrespective of the sizes of the rooms occupied, (ii) the families which were not overcrowded, and (iii) doubtful cases of overcrowding, i.e., those in which families might be overcrowded when the sizes as well as the number of the rooms occupied were taken into consideration. The second stage of the survey consisted of the measurement of the floor area of all the rooms in the houses in which a doubtful case or doubtful cases of overcrowding had been disclosed by the preliminary enumeration, with a view to determining definitely whether the families were or were not overcrowded on the standard laid down in Table II of the First Schedule to the Act. In the second stage of the Survey, the ages of children under 10 years of age were recorded and particulars of the numbers of lodgers living with families were obtained. Room measurements were taken in some 12,886 houses. The result of the survey is shown in the tabulated form on pages 54 and 55, from which figures it will be seen that the total separately occupied dwellings in the Borough number 89,428. Of these, 6,726 were overcrowded according to the standard laid down in the First Schedule of the Housing Act, 1935. In addition, there were 31 families with insufficient accommodation to secure proper sex separation and for that reason were overcrowded, bringing the total up to 6,757 families, or 7-5 per cent, of the total number of families, 1936] 52 In order that the degree of overcrowding can be appreciated an explanation of the tabulated form may be fitting here : The vertical columns of the tables show the sizes of the rooms occupied in terms of the maximum " equivalent numbers " of persons who could be permitted to occupy the dwellings without causing them to be overcrowded. In the cases in which the floor areas of the rooms in dwellings were ascertained it has been possible to determine accurately the permitted numbers of persons in respect of the dwellings. In other cases, the reduced permitted numbers have been used. The horizontal divisions represent the sizes of the families in terms of the " equivalent numbers " of persons occupying the dwellings. In cases in which the ages of children were not ascertained a child under 10 years of age was counted as \ a person. The tables, therefore, give a picture of the housing conditions (so far as density is concerned) of the families enumerated in the Borough at the time the survey was taken. The thick black diagonal line in the tables separates the overcrowded families from those not overcrowded The families recorded on the left of the diagonal line are all overcrowded and the worst cases of overcrowding are those farthest from the line. The families recorded to the right of the line are not overcrowded. Example 1.—Looking at the tables from the point of view of the size of the dwelling occupied, it will be seen that, under each size of the dwelling (in terms of the maximum '' equivalent number " of persons who could be permitted to occupy it), is given the number of families of each size from 1 to 13 and over " equivalent persons." Thus, in the Borough there are living in dwellings large enough on the overcrowding standard to accommodate 4 persons : 1,325 families of 1 person, 40 families of 1½ persons, 8,297 families of 2 persons, 3,245 families of 2½ persons, 5,916 families of 3 persons, 1,362 families of 3½ persons and 81 families with just sufficient accommodation. Example 11.—Looked at from point of view of the size of the family it will be seen by reference to the same table, that the horizontal sections represent each size of family and show the number of families of the various sizes occupying each size of accommodation, expressed in terms of the maximum number of persons who could be permitted to occupy it. Thus, taking families of the size of 4 equivalent persons, there are 22 families occupying rooms which should accommodate 1½ persons only, 1,348 families in rooms for 2½ persons only, 66 families for 3 persons only, and 15 families occupying rooms which should accommodate 3½ persons only. Owing to the dual standard laid down by the Act for determining the maximum permitted number of persons, it is not possible to indicate precisely in the statistical tables the numbers of rooms represented by each permitted number. A close indication is given, however, in the following table which shows also the number of overcrowded dwellings of various sizes:— 53 [1936 Size of Dwelling. Maximum "equivalent number " of persons. Corresponding number of rooms (approx.). Number of dwellings of each size overcrowded. 0-2 1 750 3 2 3,975 3½- 5 3 1,610 5½- 7½ 4 381 8-9 5 30 9½-10½ 6 9 11 -12½ 7 2 13 and over 8 0 6,757 From the tabulated figures and by a process of deduction the approximate number of new buildings required to relieve the overcrowded condition has been ascertained to be 2,504, and are as follows:— 3 rooms 1,248 7 rooms 65 4 „ 543 8 „ 14 5 „ 534 9 „ 5 6 „ 94 10 „ 1 The temporary staff employed in the survey were recruited from the Local Employment Exchanges and comprised 6 clerical assistants, 16 survey assistants and 30 enumerators. The total sum paid in wages to the temporary staff, including National Health Insurance Stamps, was £1,211 8s. 11d., the London County Council contributing £596 14s. 11d. of this sum. 1936] 54 HOUSING ACT, 1935—ISLINGTON— Distribution of working-class families in relation Size of family ("equivalent number'' of persons). Size of dwelling occupied, in terms of the maximum "equivalent number" of persons *0 *½ 1 l½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 1 — — — 9,979 — 3,303 — — 1,325 — — — 443 — — 1½ — — 1 3 59 107 — — 40 — — — 12 — — 2 — — 17 89 † 1,591 10,581 340 — 8,297 — — — 3,028 — — 2½ — — 2 344 16 49 3,211 — 3,245 — — — 820 — — 3 — — 3 169 10 62 3,275 — 5,916 — — — 3,937 — — 3½ — — — 31 — 1,278 16 4 1,362 8 23 — 809 — — 4 — — — 22 — 1,348 66 15 81 176 1,757 — 2,982 — — 4½ — — — 6 1 369 17 6 23 54 427 — 530 — — 5 — — — 2 1 411 20 7 29 79 751 — 1,538 — 1 5½ — — — 2 — 134 — — 421 5 12 1 394 2 1 6 — — — 1 — 137 1 1 492 2 17 12 44 47 99 6½ — — — — 1 46 — — 184 2 7 6 11 14 40 7 — — — — — 36 1 1 154 — 11 8 16 21 54 7½ — — — 1 — 12 — — 65 — 2 1 4 7 21 8 — — — — — 16 — — 44 — — 4 136 3 2 8½ — — — — — 2 — — 15 — — — 51 1 2 9 — — — — — 2 — — 4 — — — 32 — — 9½ — — — — — 1 — — 4 — — — 16 — — 10 — — — — — — — — 4 — — — 12 — — 10½ — — — — — — — — 1 — — — 3 — — 11 — — — — — — — — 3 — — — 2 — — 11½ — — — — — — — — — — — — — — — 12 — — — — — — — — — — — — — — — 12½ — — — — — — — — — — — — — — — 13 & over — — — — — — — — — — — — — — — Totals of dwellings. Overcrowded — — 23 667 †60 3,854 121 30 1,443 88 49 31 283 32 25 Notover crowded — — — 9,982 1,619 14,040 6,826 4 20,266 238 2,958 1 14,537 63 195 Total — — 23 10,649 1,679 17,894 6,947 34 21,709 326 3,007 32 14,820 95 220 * 0 = a dwelling of 1 room under 50 square feet. ½ = a dwelling of 1 room between 60 and 70 square feet (see preamble, p. 51). 55 [1937 OVERCROWDING SURVEY. to size of family and size of dwelling occupied. permitted to occupy it without causing it to be overcrowded. Totals of Families. Overcrowded. Not Overcrowded. Total. 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over — 148 — — 70 — — 26 — — — 18 — 15,312 15,312 — 5 — — 1 — — — — — — 1 1 228 229 — 851 — — 384 — — 111 — — — 87 fl 37 25,239 25,376 — 138 — — 57 — — 18 — — — 24 362 7,562 7,924 — 1,212 — — 564 — — 196 — — — 154 244 15,254 15,498 — 220 — — 74 — — 22 — — — 13 1,325 2,535 3,860 — 1,313 — — 681 — — 212 — — — 149 1,451 7,351 8,802 — 223 — — 103 — — 18 — — — 20 422 1,375 1,797 1 873 — — 504 — 165 — — — 118 549 3,951 4,500 3 160 — — 90 — — 29 — — — 22 574 702 1,276 264 502 — — 317 — — 138 — — — 70 663 1,481 2,144 76 131 — — 58 — — 18 — — — 12 257 349 606 124 224 — 1 168 — — 63 — — — 47 248 681 929 47 83 1 1 47 — — 8 — — — 14 113 201 314 5 7 6 14 97 13 — 38 — — — 29 210 204 414 3 1 7 5 42 3 — 12 — 1 — 6 75 76 151 1 3 5 3 49 7 — 13 1 — — 16 47 89 136 — 1 1 4 3 3 3 9 1 7 — 1 27 27 54 — 1 — 3 1 1 — 8 — 4 — 10 21 23 44 1 5 — 1 — 1 — 4 3 1 — 1 12 9 21 — 2 — — 1 1 1 2 — 3 — 9 10 14 24 — 1 — — — — — 1 — — — 1 2 1 3 — 2 — — — — 1 — — 1 — 6 3 7 10 — — — — — 1 — — — — — — 1 — 1 — — — — 2 — — 1 — — — — 3 — 3 10 16 6 8 4 3 2 2 — — — — †6,757 //////////// //////////// 515 6,090 14 24 3,309 27 3 1,110 5 17 — 828 ////////// 82,671 illinium 525 6,106 20 32 3,313 30 5 1,112 5 17 — 828 ////////// //////////// 89,428 † Including 31 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 1936] 56 METROPOLITAN BOROUGH OF ISLINGTON. Housing Statistics for the Year, Ministry of Health Table. 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,562 (b) Nupber of inspections made for the purpose 31,329 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,464 (b) Number of inspections made for the purpose 3,843 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 141 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 773 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 812 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 96 (2) Number of dwelling-houses which were rendered fit after service of forma] notices— (a) By owners 4 (b) By local authority in default of owners Nil (b) Proceedings under Public Health Acts— (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 5,322 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 5,322 (b) By local authority in default of owners Nil (c) Proceedings under sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (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 162 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 28 57 [1936 4.—Housing Act, 1935—Overcrowding :— (a)—(i) Number of dwellings overcrowded at the end of the year 6,757 (ii) Number of families dwelling therein 6,757 (iii) Number of persons dwelling therein 20,348 (b)—Number of new cases of overcrowding reported during the year 83 (c)—(i) Number of cases of overcrowding relieved during the year 105 (ii) Number of persons concerned in such cases ...—Adults 432 —Children 222 (d)—Particulars of any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil (e)—Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920, 1923, 1925 and 1933. 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 3 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 — 17 3 79 1930 68 2 27 2 99 1931 35 4 22 1 62 1932 26 4 11 — 41 1933 25 2 10 1 38 1934 39 — 19 4 62 1935 28 23 6 57 1936 21 1 11 7 40 Totals 1,276 154 258 47 1,735 THE SHOPS ACT, 1934. This Act came into operation on the 30th December, 1934, and the Sanitary Authority are only concerned with the enforcement of that part of Section 10 dealing with the provision of sanitary conveniences, ventilation and the maintenance of a reasonable temperature. The administration of the Act is carried out by a Sanitary Inspector, who is employed solely for that purpose. It is impossible as yet to state the number of premises to which the Act applies in the Borough, as the primary inspections are not yet complete. On the whole, the requirements of the Act have been fairly well complied with by the shopkeepers, the greatest difficulty arising regarding the maintenance of a reasonable temperature. As no standard is laid down in the Act, each shop has to be judged on its merits. A reasonable view which seems to have been appreciated 1936] 58 by "shopkeepers has been taken by the Council, and it has not yet been necessary to take any proceedings in Court for the enforcement of the provisions of the Act. Many traders have carried out the work required voluntarily, which has obviated the necessity of service of notices. The adequate heating of premises where the following trades are carried on presented some difficulty, namely, grocery and provisions, fishmongers, greengrocers and fruiterers. In these instances it is found that either some local form of heat, the provision of hot water, or a suitably heated room to which the staff can retire form the best solution. In connecticn with this it may be noted that several butchers have mentioned that the keeping qualities and appearance of chilled meat nas been improved since electrical heating has been installed, no doubt due to the drying of the atmosphere. Considerable experimental work has been carried out by some firms in the above-mentioned trades at the suggestion of the Inspector. Owing to the absence of severe weather, it was not, however, possible to test these installations in the manner desired. The following table shows the number of shops on the register at the end of 1936, visits paid, etc.:— Number of shops on the register 31st December, 1936 2,570 Number of shops removed from the register during 1936 13 Number of shops inspected (1935) 333 „ „ „ (1936) 2,250 2,583 Total number of visits to shops 4,187 Number of intimation notices served 142 Statutory notices served 15 Number of cases in which work was carried out voluntarily 35 Exemption certificates issued (1935) 17 „ „ (1936) 12 — 29 SWIMMING BATHS AND POOLS. These were reported on last year. There are three municipal installations, Hornsey Road, Essex Road and Caledonian Road baths, and there is a London County Council Swimming Pool at Highbury Fields and at Highbury Ccunty School, Highbury Grove. In addition, there is a privately owned swimming pool in the rear of Belmont Hotel, Highbury New Park. This is emptied during the winter months, and is frequently emptied and cleansed during the summer months. INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Slaughter Houses.—Inspector Haydock reports that during the year 1936, 7 private slaughterhouses for local supplies and 1 slaughterhouse for the slaughter of horses for export, held licences. The visits to these premises numbered 430. 59 [1936 The following is the tabulated report:— Number of animals slaughtered for human food :— Oxen. Sheep and Lambs. Pigs. Horses (for export) 294 2,548 21 1,170 The following table records the diseases found in slaughterhouses:— Number of Cases. Description of animal. Nature of disease. Extent of disease. How disposed of. 12 Oxen Distomatosis Livers Destructor, etc., on premises. 5 „ Tuberculosis Lungs and Liver Destructor. 16 „ „ Lungs „ 3 „ „ Head, Tongue and Lungs „ 5 „ „ Head and Tongue „ 1 „ „ Lungs, Liver and Mesentery „ 1 „ „ Offal (ex Liver) and three parts of Carcases. „ 1 „ „ Offal and two parts of Carcases „ 1 Pig „ Head, Lungs and Liver „ 4 Oxen Multiple Abscesses Liver „ 4 Lamb „ „ „ „ 1 „ „ „ Liver and two parts of carcase „ 2 Oxen Actinomycosis Tongue „ „ 1 „ Pericarditis Heart „ 4 „ Pleurisy Lungs „ 2 „ Cysts „ „ 1 Sheep Peritonitis Liver and part carcase „ 1 Lamb Bruising Part carcase „ UNSOUND FOOD DESTROYED. The food destroyed or otherwise disposed of so as to prevent its use for human consumption was as follows:— Tons. Cwts Qtrs. lbs. Diseased Meat, including organs from slaughterhouses (surrendered) — 12 3 1 Meat and Tinned Food from shops and stalls (surrendered) 1 13 0 14 „ „ „ „ (seized) — — — 3 Fish from shops, fryers and wholesale dealers (surrendered) — 4 1 4 Fruit and Vegetables (surrendered) — 11 0 24 ,, ,, (seized) — 1 0 18 Confectionery (surrendered) — — — 3 Total 3 2 2 11 Inspection of Shops, etc..—The number of visits made to shops, etc. are as follows:— Butchers, Provision Dealers, etc., shops 2,053 Meat, etc., Preparation Factories 69 Fish Shops 473 Fruit Shops 1,509 Markets 243 Stalls 782 Offensive Trades 157 Total 5,286 1936] 60 Merchandise Marks Act, 1926—The marking of imported food with an indication of origin is regulated by various Orders made under this Act. In cases where the food is retailed in packets the indication of origin is required to be placed on the covering (and is usually done by the printer) when preparing the packet. Thus, it is seldom that any irregularity occurs with this class of goods. Such foods as imported meat, apples, tomatoes, certain fish, currants, etc., displayed in bulk are required to be marked by the retailer when exposed for sale, but omissions do occur and the shopkeeper is either warned or summonsed. During the year 4 traders were warned for failing to mark imported meat, 5 for tomatoes, and 5 for apples. Prosecutions taken under Merchandise Marks (Imported Goods), Orders.—Four prosecutions were taken, which were successful, against 4 traders who failed to comply with these Orders. Two were due to omitting to mark imported meat with the country of origin, 1 for apples, and 1 for describing " Canary " tomatoes as " English." The trader who was selling these so-called " English " tomatoes, and his assistants, maintained that they were such when visited by me, but on my insistance that they were " Canary Island " produce, they admitted the fact. The proprietor was fined 20s. The aggregate of penalties in the above cases were—Fines, £2 10s. Od.; Costs, £3 12s. Od. Prosecutions for exposing for sale Unsound Food.—Two stallholders at the Caledonian Market were successfully prosecuted for exposing for sale unsound nuts. One of the vendors was also summonsed for depositing for sale a similar commodity at the same time. The fines inflicted in these two cases totalled £2 and costs, 10s. Public Health (Meat) Regulations, 1924.—No prosecution was taken under these Regulations during the year. 5 traders, however, were warned for infringing them. Diseases of Animals Act, Orders of the Ministry of Agriculture.— No special Order was made applying to this Borough during the year. Slaughter of Animals Act, 1933.—35 slaughtermen who had held licences under this Act during 1935, applied for them to be renewed, and 8 new applications for licences were received, which after investigation were granted, making a total of 43 granted. Offensive Trades,—The offensive trades inspected consist of 3 tripe dressers 5 gut scrapers and 1 knackers yard. 157 visits were made during the year and no breach of Regulations was observed. CERTIFICATION OF MEAT FOOD PRODUCTS FOR SHIPMENT ABROAD. The Medical Officer of Health, as Designated Officer for Food Certification, issued 6 certificates in respect of foods prepared in Islington and exported to foreign countries or to the Dominions. LICENSED STREET TRADERS IN THE BOROUGH OF ISLINGTON FOR THE YEAR 1936. Meat, etc., 15 ; Fish, Poultry, Rabbits, etc., 26 ; † Ice Cream, 44; Confectionery, Minerals, etc., 19 ; Grocery, Provisions, etc., 27; Coffee Stalls, etc., 9 ; Fruit, Vegetables, Greengrocery, etc., 223. † Some also sell confectionery and minerals. Restaurant Kitchens.—The work of inspecting restaurant kitchens is tabulated under Workshops, and is done by the two women inspectors. 61 [1936 The following is a tabulated statement of the premises examined, and the results. In each case the unsatisfactory conditions were remedied without having to resort to prosecution. Number Inspected. Number found Unsatisfactory. Hotel and Restaurant Kitchens 135 37 Coffee and Dining Rooms 289 77 Refreshment Rooms 244 71 Provision (Cooked Meats, cooked but not consumed on premises) 130 29 i 798 214 NOTIFICATION OF FOOD POISONING. During the year 10 -cases of food poisoning were notified, the alleged poisoning foods being braised kidney, corned beef, fried fish, tinned salmon, winkles, fish cake (made with tinned salmon, tinned peas and potatoes), fish, and sausages. The case of fish poisoning attributed to the consumption of fish cake made with tinned salmon, tinned peas and potatoes, caused some anxiety. Information was received from the Medical Officer of St. Pancras that a number of women employed at the offices of a large company were taken ill during the week-end, supposed to have been caused by food consumed at the staff canteen on the previous Friday. Enquiries revealed that four of these employees resided in Islington; these were followed up, and two were subsequently notified to us to be suffering from food poisoning, stated to be due to a meal of fish cakes as above mentioned. Another case (not notified in Islington) which was the subject of enquiry, related to alleged food poisoning which occurred in September. The patient was employed in the Kent hop fields, and was admitted to a general hospital at Hastings, stated to be suffering from " Paratyphoid Fever." An allegation was made that the illness was due to eating sausage and meat pies which were " objectionable and appeared to be unsound, and had to be thrown away." The County Medical Officer was communicated with and very careful enquiries instituted, but no evidence was found pointing to infection from poisoning by meat pies provided by a firm catering in the particular district whence the patient was removed. An alleged case of poisoning from ham was investigated. The sufferer had eaten at the same time tinned peas and pineapple; when the ham was inspected at the Public Health Department on the following day (Monday) it was certainly " high." The patient was treated at one of the large London hospitals, but the Pathologist found no organism of importance in the patient. The examination of the ham produced a staphylococcal toxin. The condition of the ham when seen was inconsistent with it being in such a state on the Saturday when it was bought, as no one would have purchased such high smelling, offensive food. The ham had been kept overnight, and a considerable part of Sunday, in a gas cooker on the landing, so the inference was that it had got infected in some way and become thoroughly bad. An enquiry was also made into an alleged contamination of beer, but the conditions under which the bottling was carried out at the establshment appeared to be as far as possible perfect. As the beer was purchased in another district, our investigations were limited to where it was alleged to have been bottled. 1936] 62 PRESERVED FOOD AND ICE CREAM. On the 1st October, 1936, registration of these premises was brought under the Public Health (London) Act, 1936, Section 187. In 1935,167 premises were on the register for preserved food ; 109 were registered during the year 1936, and one was removed from the register. The total on the register at the end of the year, therefore, was 275, all of which were visited. The number of ice cream premises in 1935 was 480; 49 cases were removed from the register in 1936, 63 additional registered, so that the ice cream premises on the register at the end of the year numbered 494. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. MILK AND DAIRIES (AMENDMENT) ACT, 1922. MILK AND DAIRIES ORDER, 1926. Dairies and Milk Shops. Number on Register 31/12/35. Additions to Register. Removals from Register. Number on Register 31/12/36. Dairies ... 399 2 145 256 Purveyors of Milk in sealed containers only 385 131 68 448 Registered Purveyors of Milk dealing from registered premises outside the Borough 78 6 — 83 It will be seen from the above table that 145 premises were removed from the Register of Dairies during the year, due to the fact that on routine inspections being made it was found that 57 premises had ceased to exist as dairies, and 88 had either stopped selling milk loose or the premises had become unsuitable for the purpose. Applications were made in these 88 cases for re-registration as purveyors of milk in sealed containers only, and were automatically removed from the Register of Dairies. One dairyman was served with a notice to appear before the Public Health Committee to show cause why he should not be removed from the Register, owing to the unsatisfactory condition of his premises and method of bottling milk. On appearing before the Committee he was severely reprimanded, instructed to carry out such work as was considered to be necessary, and to comply with all the statutory requirements. Two purveyors of milk were reported to the Public Health Committee, under the Milk (Special Designations) Order, 1936, for selling " Pasteurized " milk as such without being licensed. In both cases warning letters were sent on the instructions of the Committee, and the purveyors duly applied for licences to sell " Pasteurized " milk, which were granted. The number of visits of inspection made by the Inspector during the year 1936 is as follows:— Dairies— Routine inspections 819 Inspections for registration of 58 Milk Shops (Milk sold in sealed containers only)— 877 Routine inspections 555 Inspections for registration of 56 Dairies and Milk Shops inspected under the Milk (Special Designations) Order, 1936 611 110 63 [1936 Ice Cream Premises— Routine inspections 390 Inspections for registration of 70 460 Vehicles inspected 24 Miscellaneous Visits 101 Total Visits 2,183 As a result of these visits 116 Intimation Notices and 2 Statutory Notices were served, and 236 letters were sent to Dairymen, Milk Purveyors and Ice-Cream Vendors drawing attention to the condition of their premises and utensils, and to the contravention of the Acts and Orders relating to their businesses. During the year the following nuisances were abated and improvements made to the premises:— Drains and Waterclosets—cleansed, reconstructed or repaired 18 Dust-bins provided 32 Yards paved or repaired 17 Yard walls lime-washed 42 Sinks provided 19 Sink waste pipes trapped or repaired 31 Water supply provided 1 Walls and ceilings cleansed and repaired 110 Floors repaired 32 Roofs and guttering repaired 18 Accumulations of rubbish removed 33 Utensils cleansed or renewed 19 Other nuisances abated or improvements made 65 437 Total premises improved 139 Where a change of occupation of a milkshop or dairy has been effected, or where it is proposed to open a new business, each has been visited by the Superintendent, the total number of visits for the year being 44. THE MILK AND DAIRIES (AMENDMENT) ACT, 1922; THE MILK (SPECIAL DESIGNATIONS) ORDERS, 1923 & 1936. During the year 1936 the following applications were made for licences under the provisions of the above Orders, to enable the persons to sell Specially Designated Milk :— LICENCES GRANTED UNDER MILK (SPECIAL DESIGNATIONS) ORDERS, 1923 & 1936. Designation. No. of applications Number granted. Amount of Fees received. Certified 8 8 £ 2 s. 0 d. 0 Grade A (Tuberculin tested) 26 26 6 7 6 Grade A (T.T.) (Bottling) — — — ,, (Pasteurized) 2 2 10 0 Grade A 6 6 1 10 0 ,, (Bottling Licence) — — — Pasteurized (Dealer) 73 73 15 15 0 „ (Pasteurizer) 4 4 4 4 0 Accredited 1 1 2 6 Supplementary:— Pasteurized 6 6 12 0 Grade A (Tuberculin Tested) 3 3 6 0 Certified 1 1 2 0 130 130 31 9 0 1936] 64 ICE CREAM. Two cases were reported to the Public Health Committee in regard to ice cream vendors using dirty utensils, and in each case a warning letter was sent, and on revisiting the premises they were found to be satisfactory. Number of premises on the Register at end of 1935 480 „ „ added during the year 63 „ „ removed during the year 49 „ „ on the Register at the end of 1936 494 ARTIFICIAL CREAM ACT, 1929. During 1936, two premises were registered under this Act, making a total at the end of the year of 7 premises. PHARMACY AND POISONS ACT, 1933, AND THE POISONS RULES, 1935. PART II.—POISONS. The above-mentioned Act and Rules came into force on the 1st May, 1936, which made it compulsory for all sellers of Part II poisons to become registered as Listed Sellers of Part II Poisons, the statutory fee of 7s. 6d. being payable prior to the entry of name of applicant on the List of Sellers kept by this department. During the year 172 persons were entered on the list of sellers of Part II poisons, and 3 were removed from the list, leaving a total of 169 at the end of 1936. The number of visits paid by the Inspectors during the year were as follows:— Visits, re applications to become listed as sellers of Part II Poisons 320 Other visits 358 Total 678 As the full provisions relating to the labelling of Part II poisons do not come into force until the 1st January, 1937, most of the Inspectors' time was spent advising listed sellers how to have their poisons properly labelled. All premises were inspected on receipt of applications from persons desiring to become listed sellers, and steps were taken to ensure the prevention of contamination of foodstuffs from leaky containers, by securing that the poisons were either stored on bottom shelves or in cupboards set apart for the purpose. All stalls ware periodically inspected, and when poisons were found exposed for sale warning letters were sent to the stall-holders. On following up the previous warnings no Part II poisons were found deposited or exposed for sale on the stalls. 2 offences under the Act and Rules were reported to the Public Health Committee during the year, and in both cases warning letters were sent. No recurrence of the offences was afterwards observed. Altogether, 25 warning letters were sent in connection with offences [under the Act and Rules, and on subsequent visits the matters were found to have been remedied. ADULTERATION OF FOOD AND DRUGS—FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year the number of Samples of Food and Drugs taken for Analysis was 1,182, including 437 informal samples; all the purchases were made by Inspector Lewis or his Agent and were submitted to the Islington Public Analyst, Dr. Alan W. Stewart. 65 [1936 Of the total samples 1,146 were reported to be genuine and 36 adulterated, or 3.0 per cent. This percentage is 2.2 above the previous year and 1.5 below the average rate for the preceding 10 years. There were 22 prosecutions under the Food and Drugs (Adulteration) Act, 1928, 19 of which were successful. 14 samples of milk were submitted by the Inspector for bacteriological examination, see page 31. With the work under the Food and Drugs (Adulteration) Act there is a close co-operation with the work under the Pharmacy and Poisons Act and the Merchandise Marks Act, which are mainly operated by other Inspectors. The reason for this, under the Pharmary and Poisons Act, is to prove that an article is a poison, and to do this it has necessarily to be analysed. It is, therefore, an advantage to make this examination under the Food and Drugs procedure, if possible, and the evidence is then ready if action has to be taken also under the Food and Drugs (Adulteration) Act. The Food and Drugs Inspector, Mr. C. W. Lewis, made visits in special work as follows:— Food and Drugs (Adulteration) Act 1,201 Merchandise Marks Act 880 Pharmacy and Poisons Act 185 Bacteriological samples and miscellaneous visits, calls, etc. 513 Total 2,779 Prosecutions are included in the complete list (p. 68). In most cases prosecutions were instituted, but in a few where exceptional circumstances existed, a strong warning was given. During the year 1936, 1 formal and 3 informal samples of cream were taken; all proved to be genuine. A wide selection (the varieties numbering 106) of informal samples were taken during the year, as these form the basis upon which information is obtained to enable formal samples to be purchased with a view to prosecution. Informal samples of butter numbered 56, cheese 20, pepper 10, bacon 16, sausages 33, lard 23, tea 13, dripping 10, sugar 14, margarine 12, tinned fish 16, minced meat 10, raisins 8, currants 6, sultanas 6, fish paste 6, mustard 7, flour 8, iodine ointment 6, camphorated oil 6, and 151 of various other articles, making a total of 437. During the year 1936 in addition to the samples taken and submitted to the Public Analyst there was a total of 57 informal samples, which were examined by Inspector Lewis. These informal samples comprised a number of varied articles. The greatest amount of detected adulteration occurred in the first quarter of the year, as shown by the figures given in the following statement 1936] 66 Examined. Genuine. Adulterated. Per Cent. Formal Informal Formal Informal Formal Informal Adulterated. 1st Quarter 263 187 250 181 13 6 4.2 2nd 172 88 165 88 7 — 2.7 3rd 130 42 126 41 4 1 2.9 4th 180 120 178 117 2 3 1.6 The Year 745 437 719 427 26 10 3.0 Milk.—The qualitative results of the Analyses of the milk samples taken during the year are as follows:— No. of Samples. Solids not Fat. Fat. Total Solids. Milk purchased on Sundays 24 8.59 8.52 12.11 Milk purchased on Week-days 499 8.60 3.54 12.14 Milk procured in transit (Farmers Milks) 53 8.64 3.74 12.38 Official Standard — 8.50 300 11.5 Sophistication of Milk.—The particulars as to the genuineness or otherwise of the samples procured or purchased on Sundays, Weekdays, and in transit are as follows :— Number taken. Genuine. Adulterated. Percentage Adulterated. On Sundays 24 23 1 4.1 On Week-days 499 488 11 2.2 In transit 53 49 4 7.5 (Farmers' Milks) 576 560 16 2.8 Table giving the particulars of the Milks taken during each quarter of 1936 on Sundays, Week-days, and in transit (Farmers' Milks). 1936. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Weekdays. In transit. All Milks. Sundays. Weekdays. In transit. All Milks. Sundays. Weekdays. In transit. All Milks. Sundays. Weekdays. In transit. All Milks. 1st Quarter 5 202 — 207 5 194 — 199 — 8 — 8 — 3.96 — 3.86 2nd „ 5 120 12 137 5 118 8 131 — 2 4 6 — 1.66 33.3 4.38 3rd „ 5 79 17 101 5 78 17 100 — 1 — 1 — 1.27 — 0.99 4th „ 9 98 24 131 8 98 24 130 1 — — 1 11.1 — — 0.76 The Year 24 499 53 576 23 488 49 560 1 11 4 16 4.1 2.2 7.5 2.8 The number of samples of milk purchased was 576, of which 560 were genuine, and 16, or 2.8 per cent., were adulterated. 67 [1936 Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1936:— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 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 1933 546 524 22 4.0 1934 515 505 10 2.0 1935 409 405 4 0.9 Average 10 yrs. 588 570 18 3.0 1936 576 560 16 2.8 Showing the analysis of 5,877 milks examined in Islington during the 10 years 1926-35 and 1936, and distinguishing those purchased on Sundays, on Week-days, and procured whilst in transit from the Farmer to the London Milk Purveyor:— Years. Sunday Milks. Week-day Milks. In transit (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. 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 3.60 179 8.89 3.72 1933 114 8.79 3.46 263 8.80 3.54 169 8.85 3.67 1934 122 8.74 3.59 316 8.73 3.56 77 8.84 3.69 1935 88 8.65 3.53 321 8.64 3.53 — — — Total samples and average constituents (10 years) 1,118 8.70 3.56 3,359 8.82 3.57 1,400 8.90 3.73 1936 24 8.59 3.52 499 8.60 3.54 53 8.64 3.74 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. During the year five informal samples were taken under the above Regulations, and found in order. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927 2 informal samples were taken and found in order. MILK AND DAIRIES (CONSOLIDATION) ACTS, 1915-1934. For prosecutions under these Acts see page 68, 1936] 68 Summary of Prosecutions during the year 1936. Statute. Total Prosecutions Successful. Dismissed. Withdrawn. Amount of Penalties Costs Received. Public Health (London) Act, 1891 19 19 — — £ 15 s. 5 d. 0 £ 12 s. 19 d. 0 Food and Drugs (Adulteration) Act, 1928 22 19 3 — 2? 9 0 25 0 0 Milk and Dairies (Consolidation) Acts, 1915 to 1934 1 — 1 — — — London County Council (Drainage) By-laws 5 5 — — 3 10 0 4 4 0 London County Council By-laws,1901 2 1 — 1 5 0 — London County Council By-laws (Tenement Houses), 1926 1 1 — — — 5 5 0 Children Act, 1908, and Children and Young Persons Act, 1932 1 — 1 — — Merchandise Marks Act, 1926 3 3 — — 1 10 0 3 13 0 Housing Acts, 1925-1935 1 1 — — — 2 2 0 Totals 55 49 5 1 £42 19 0 £53 2 0 ISLINGTON HOSPITALS, CLINICS, Etc. Beds. St. Mary, Islington, Hospital 844 Archway Hospital, Archway Road 564 Royal Northern Hospital 300 Mildmay Memorial Hospital 30 Mildmay Maternity Home 17 London Fever Hospital 200 In addition, all the Central and North London Hospitals are used by Islington residents. OTHER INSTITUTIONS. Islington Institution, St. John's Road, N.—Accommodation for 1,525 (including those for " Petty Officers," that is, those inmates who are employed in the Institution). In "Sick" Ward: Males, 102 beds; females, 180. In Mental Ward: Males, 14 beds; Females 14. In "Infirm" Ward: Males, 212 beds; females, 245. In Main body of the Institution (including the " Petty Officers " accommodation) for the able-bodied cases and Receiving Ward : Males, 502 beds ; females 205 ; 10 children and 34 cots in " Nursery." 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 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. 69 [1936 NEW LEGISLATION, (Enacted or coming into force during 1936.) The Public Health (London) Act, 1936, came into force on the 1st October, 1936. This consolidating Act took in various portions of London County Council (General Powers) Acts, the Maternity and Child Welfare Act, 1918, and the Children and Young Persons Acts. The Pharmacy and Poisons Act, 1933. Both this Act and the Rules made thereunder came into operation during 1936. These have for their object the closer control of the sale of poisonous substances. Milk (Special Designations) Order, 1936.—This Order came into operation on the 1st June. It reduces the number of designated milks to three, Tuberculin Tested, Accredited, and Pasteurised, and revokes the earlier Order. Tuberculin Tested.—A prescribed methylene blue reduction test for cleanliness has been substituted for the bacteria plate test; Tuberculin Tested milk may be pasteurised, if so, it must be described as " Tuberculin Tested " Milk (Pasteurised), and must not contain more than 30,000 bacteria per m.m. If it is bottled on the farm, the word " Certified " may be added to its designation. Accredited.—The conditions are as in the Order of 1923 for Grade " A " Milk. This is raw milk from cows, subjected to and passing a veterinary examination. It must be bottled either on the farm or at a licensed bottling establishment. This milk must pass the same bacteriological test as " Raw " Tuberculin Tested Milk. Pasteurised.—The conditions imposed are those of the Order of 1923, with additional requirements in regard to thermometers and temperature records. While being pasteurised the milk must be retained at 145-150 F. for a period of at least thirty minutes. The designation "Pasteurised" is applicable where accredited milk or ungraded milk is pasteurised according to the requirements prescribed. SOCIAL CONDITIONS. In the report of the Medical Officer of Health for 1935, under " Social Conditions," it is stated that at the close of that year unemployment had slightly decreased. The conditions appear to have further improved during 1936, as the figures supplied by the Local Unemployment Exchange show that whereas at the end of 1935, the approximate number of unemployed was 7,000, by the end of 1936 this number had been reduced to approximately 6,000. PROPAGANDA WORK. The propaganda work undertaken by the Public Health Department consisted of increased publicity by posters exhibited on boards in various parts of the Borough, some giving a summary of the health services provided by the Borough Council, others of an artistic type drawing the attention of the public to Child Welfare. In addition to the literature mentioned in the Annual Report of the Medical Officer of Health for 1935, leaflets on the subject of precautions to prevent the conveyance of infections to the hop fields were freely distributed. In November a lecture entitled " Public Health and the People," was given by Dr. T. W. Hill, M.D., D.P.H., at the Central Library, Holloway Road, N.7, to an audience of about 200. The lecture was interesting and instructive, not only from the public health but from the social point of view, and at its conclusion, from the questions which were asked, it was clear that the members of the audience were impressed by its importance. 1936] 70 " Health Talks " were given at the four Voluntary Welfare Centres, of which lention is made in the Maternity and Child Welfare Section of this Report, and as in the former year, short lectures were given at the request of several social organizations by the Public Health staff. It is proposed that during the ensuing year increased propaganda work will be undertaken by the department. REPORT ON MATERNITY AND CHILD WELFARE WORK. Municipal Health Visitors. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purluent discharge occurring in the eyes of infants within three weeks of birth. 45 cases of Ophthalmia Neonatorum were notified, compared with 39 cases last year. 121 cases of Ophthalmia were reported by the London County Council and Health Visitors as against 118 cases during the previous year. 14 out of the 45 cases of Ophthalmia Neonatorum were attended at birth by midwives. The cases occurred in the sub-registration districts as follows:— Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough. Ophthalmia Neonatorum. 4 4 3 4 8 11 11 45 Ophthalmia. Cases reported by L.C.C. 10 12 11 25 6 30 25 119 Cases reported by Health Visitors — — — 2 — — — 2 Of the 45 cases investigated, both eyes of the infant were affected in 34 instances, whilst in 4 the right eye was involved, and in 7 the left. Treatment.—12 of the 45 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital, 23 being treated at other Hospitals, and 10 cases were treated at home by private Doctors. 18 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £27 14s. 9d. In 1935 14 cases were nursed at the cost of £10 8s. Od. Results.—Of the 45 Ophthalmia Neonatorum cases, vision was unimpaired in 44 cases, the remaining case being totally blind. Ophthalmia Neonatorum Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified, Treated. At home. In hospital. 45 17 28 44 Nil 1 Nil 71 [1936 MATERNAL DEATHS. The number of women dying, pregnancy being a factor, during the year 1936 was 16. Our investigations showed 3 to be classifiable as Puerperal Sepsis and 5 from other puerperal causes. These 8 cases would give a Maternal Mortality Rate of 1.64 per 1,000 registered ("live" and "still") births. In addition, there were 8 deaths of pregnant women from the following :—1 from General Septicaemia, 4 from Heart Disease, 1 from Thrombosis of vein, 1 from Cancer of the breast, and 1 from Inflammation of the Bladder. Taking the deaths as 16 would give a rate of 3.29. (See Table p. 72). f It has been our practice for some years back to record all deaths of women in which, as a result of our investigations, pregnancy was found to be a complication. A Table showing such investigations from 1911 is given. For details of the Maternal Deaths for the year 1936 see page 72. The deaths for the preceding year numbered 16, and were equal to the proportion of 3.4 per 1,000 births. † GROSS 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 1924 6,799 17 2.5 1925 6,580 18 2.7 1926 6,455 20 3.1 1927 6,108 24 3.9 1928 5,790 25 4.3 1929 5,509 27 4.9 1930 5,685 22 3.9 1931 5,281 28 5.3 1932 4,950 16 3.2 1933 4,581 25 5.3* 1934 4,624 20 4.2* 1935 4,577 16 3.4* 1936 4,724 16 3.3* *Rate per 1,000 registered live births and still births. 1936] 72 METROPOLITAN BOROUGH OF ISLINGTON MATERNAL DEATHS, 1936. (For those in 1935, see p. 11 of the Medical Officer of Health's Annual Report for that year.) 1936. Month. Cause of Death. Ages at Death. Totals. 15 to 25 25 to 35 35 to 45 45 and 1 upwd Total From Puerperal Sepsis. From other Diseases of Childbirth. Jan. Acute streptococcal septicaemia. Coroner. P.M. Without inquest ... 1 ... ... 1 ... 1 (a) „ Thrombosis of superior mesenteric artery. Mitral stenosis. Coroner. P.M. Without Inquest ... ... ... 1 ... 1 ... 1 (b) „ Haemorrhage from Placenta praevia. Coroner. P.M. Without Inquest ... 1 ... ... 1 ... 1 Feb. Syncope. An Acute general peritonitis and pleurisy. Consequent upon abortion and septic infection of Uterus. How caused no evidence to show. P.M. ... 1 ... ... 1 1 ... „ Syncope due to death of Foetus separation of Placenta Antepartum Haemorrhage. Coroner. P.M. Without Inquest ... 1 ... ... 1 ... 1 „ Syncope, Shock and Haemorrhage during difficult Labour, accelerated by toxaemia of pregnancy. Coroner. After P.M. Without Inquest ... 1 ... ... 1 ... 1 1st Qr. ... 5 1 ... 6 1 5 April la. Pulmonary Embolus. Thrombosis of vein of right thigh after normal labour. Coroner. P.M. Without Inquest ... 1 ... ... 1 ... 1 (c) „ la. Cerebral Haemorrhage, b. Malignant endocarditis. c Chronic nephritis. II Toxaemia of pregnancy. Induction of labour. P.M. 1 ... ... ... 1 ... 1 (d) May Confluent Broncho Pneumonia. Mitral stenosis. Pregnancy. Labour. Coroner. After P.M. Without Inquest ... 1 ... ... 1 ... 1 (e) „ Cerebral Haemorrhage. Eclampsia. Coroner. Without Inquest ... 1 ... ... 1 ... 1 June Carcinoma of left breast. Coroner. After P.M. Without Inquest ... 1 ... ... 1 ... 1 (f) 2nd Qr. 1 4 ... ... 5 ... 5 Aug. 1. Double Pleural effusion. Mitral incompetence. 2. Recent normal delivery. Coroner. After P.M. Without Inquest ... ... 1 ... 1 ... 1 (g) Sept. Uterine Haemorrhage. Fibroid remain in uteri complicating normal labour. P.M. Coroner 1 ... ... 1 ... 1 3rd Qr. 1 ... 1 ... 2 ... 2 Nov. Acute General Peritonitis. Necrosis of bladder. Prolonged labour ; normal time. Coroner. P.M. Without Inquest 1 ... ... ... 1 ... 1(h) Dec. la. Septicaemia, b. Parturition, c. Empyema Thoracis. No P.M. ... 1 ... ... 1 1 ... „ General peritonitis consequent upon abortion and Septic infection of the uterus. No evidence to determine the agency through which the infection arose. P.M. ... ... 1 ... 1 1 ... 4th Qr. 1 1 1 ... 3 2 1 Classifications :—(a) As Septicaemia. (b) As Mitral Valve disease. (c) Other Diseases of the Veins. (d) Malignant Endocarditis. (e) Mitral Valve disease. (f) Carcinoma (breast). (g) Mitral Valve disease. (h) Cystitis. 1st Quarter ... ... 6 = 6*12 2nd Quarter ... ... 5 = 4-03 3rd Quarter ... ... 2 = 1-56 4th Quarter ... ... 3 = 2-55 r 1936 Total 9 Rate per 1,000 registered Live and Still-births. 73 [1936 PUERPERAL FEVER. Of the 25 cases coming to the knowledge of the Medical Officer of Health during 1936, 4 were notified by Private Practitioners. The proportion of total cases to births was 5.29 per thousand. The notifications were 14 below the average (39) of the preceding ten years and showed an increase of 0.05 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1936. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 2 4 3 1 1 9 5 25 Private Practitioners' Cases — 1 — — — 3 — 4 Hospital Cases 2 3 3 1 1 0 5 21 Certified Midwives' Cases — — — — — — — — Cases inquired into 2 4 3 1 1 9 5 25 Cases treated in Hospital 2 3 3 1 1 9 5 24 Cases treated at Home — 1 — — — — — 1 24 of the 25 cases were treated in hospitals, 19 having the " onset " there, and the remaining 5 were subsequently removed to hospital. Of the cases, 4 were dealt with in London County Council Infectious Diseases Hospitals, and 20 in either St. Mary, Islington, Hospital, or other London Hospitals. Deaths.—3 deaths were registered as being due to Puerperal Fever. PUERPERAL PYREXIA. Notification of Puerperal Pyrexia Regulations, 1926.—There were 57 cases notified, as against 48 last year. Of these, 8 were Private Medical Practitioners' cases; 49 occurred in Hospital. The notifications were in the proportion of 12.0 per 1,000 births. Cases of Puerperal Pyrexia notified and inquired into during the year 1936. Tufnell. Upper Holloway. Tollington. Lower Holloway, Highbury. Barnsbury. SouthEast. The Borough Cases notified 4 6 5 6 12 10 14 57 Private Praclitioners'Cases — — 1 1 2 1 3 8 Hospital Cases 4 6 4 o 10 9 11 49 Certified Midwives' Cases — — — — — — — Cases inquired into 4 6 5 6 12 10 14 57 Cases treated in Hospital 4 6 4 5 10 9 11 49 Cases treated at Home — — 1 1 2 1 3 8 The services of the Consultant were sought on four occasions during the year. Early last year this service was extended to include cases of Difficult Confinement, and three of these cases were for this purpose. PEMPHIGUS NEONATORUM. During the year 1936 five cases came to the knowledge of the Medical Officer of Health, and all recovered. 1936] 14 THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1936, the sum expended in the provision of fresh and dried milk for necessitous, expectant and nursing mothers, and children under live years of age, amounted to £2,364 18s. 2d., as against £1,967 5s. Id. in 1935. The total amount expended since the Order came into operation in 1918 is £68,527 7s. Od. The total recipients during the year numbered 8,147, and the quantity of milk supplied to them was equal to 182,206 pints (22,775| gallons). DISTRIBUTION OF MILK TO NECESSITOUS MOTHERS AND CHILDREN. Scale of Income adopted by the Council, 18th January, 1935 :— Per head. 6/- a week and under, after allowance for rent, Free. 6/1 to 7/5 a week, after allowance for rent, Quarter Cost. 7/6 to 8/- 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. Discretionary power given to the Milk Sub-Committee to deal with applications for milk where the gross family income is £3 a week or more. HOME HELPS. As stated in last year's Annual Report, the Council adopted a Home Help scheme just at the close of the year. The following are the duties of the Home Helps, from which will be gathered also the limitations of their employment:— Duties of Home Helps. 1. The Home-help shall act, during the time she is employed, under the direct supervision of a Municipal Health Visitor. The Home-help's duties shall be those ordinarily undertaken by the mother, and include—where required—cleaning, cooking, washing, care of children, mending and " marketing." She shall, during her employment, be suitably attired, and must refrain from discussing one mother or home with another or with their personal friends" 2. The Home-help must not undertake any work which properly belongs to the sphere of a Trained Nurse or Midwife, nor assist at Confinements. She may, however, be at hand to take charge of the household and provide the hot water, etc., required. 3. After the confinement, she shall receive and take charge of the " soiled " linen, see; that the mother gets her food and that her room is kept clean and that the mother does not need to exert herself in any way. 4. In a similar way, she shall, when the midwife is not there, see that the infant is properly fed and cared for and put to sleep in a separate cot. 5. She shall be responsible for the washing of the clothes as soon as possible after the confinement is over, and keep the ordinary clothes washed in the usual way. She is not expected to undertake arrears of washing unless unavoidable. 6. She shall get the meals prepared and tidy the house and take care of any other children there may be, and see that those attending school attend punctually and are clean and tidy. 75 [1936 7. It is incumbent on the Home-help to notify the Medical Officer of Health— (a) Immediately she commences at a case ; (b) When she terminates her period of engagement with the case ; (c) Immediately should she become ill or otherwise unable to attend at the home of case ; (d) Accidents, however slight, occurring at home or at work. 8. Infectious Disease.—Should the Home-help at any time, either before taking on her duties or whilst engaged thereon, have been in contact with any case of infection of any kind—including contagious skin affections of children—she must intimate the fact to the Medical Officer of Health. This applies equally, whether the contact has been at her own home, the home of the case, or elsewhere. 9. The maximum period during which the Home-help carries out her duties shall be Two Weeks. The Hours of Duty shall be five each day, for six days in each week, carried out during hours to meet the convenience of the patient. 10. Remuneration.—Upon satisfactory service, the Medical Officer of Health will certify to the Borough Treasurer the sum payable to the Home-help at the termination of each of the two weeks of her employment. The maximum remuneration per week will be 25/- for the full thirty hours and proportionately for an agreed lesser service. The Home-help must produce her National Health Insurance card immediately she commences each case. The Home-help is not entitled to food at the place where she is working, although it may be provided at the option of the patient. The Home-help must not receive any money from the case. It will be noted that the Home-help is chosen by the applicant from names included in a list of " Approved Home Helps " supplied by the Public Health Department. The Maternity and Child Welfare Committee have adopted a scale as a general guide in fixing what the contribution (if any) of the applicant should be towards the cost of the Home-help's services, and the payments may be by instalments if so desired. When the applicant cannot afford the full contribution, the ba'ance is met by a Council. The Committee have wished that a larger number of persons who are suitable would come forward and offer their services as Home-helps. The service is entirely under the Public Health Department to whom applications are made, and after investigation of references and enquiries as to the ability and experience, the person's name is placed on the list and supplied, with others, to applicants in their locality. When the Home-help notifies she is attending a case that has been " booked " the work is supervised by the Municipal Health Visitor of the district. During the year quite a number of letters were received from mothers by the Maternity and Child Welfare Committee expressing appreciation of the services rendered by these Home-helps. In the year under review 28 cases had the services completed, and towards the end of the year applications were becoming very frequent in number, so that it is anticipated that there will be a very much greater demand for Home-helps once the scheme becomes more fully known. 1936] 76 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1936. District No. 1 2 3 4 5 6 & 8 7 9 CI.L.P. Not included in totals‡. Totals. I. Births, First Visits, Infants under 1 Year 493 461 547 718 541 655 417 573 3 4,405 II. Births, Re-Visits. Infants under 1 Year 486 472 609 669 501 816 643 393 15 4.589 III. Visits to Children, between 1st and 2nd Years 396 413 535 531 473 691 528 292 18 3,859 IV. Visits to Children, bet-ween 2nd and 6th Years 1,152 1,425 1,347 1,464 1,240 1,591 1,629 1,170 24 11,018 V. Visits re Still Births 6 14 13 17 9 13 4 10 — 86 VI. Deaths, Visits, re Infants under 1 Year 7 11 12 11 9 14 3 4 — 71 VII. Deaths, Visits, re Children 1 to 5 years 1 1 9 1 — — 12 VIII. † Ante-Natal, Home Visits F/270 316 f/233 322 f/292 362 f/314 346 F/258 295 F/261 327 F/190 257 f/281 356 — F/2,099 2,581 IX. †Puerperal Fever, Home Visits f / 2 re/ 6 f/2 4 F/9 13 f/8 10 F/ — re/ l f1 f/21 36 Pyrexia, do f / 1 f / 1 — — f 1 f/2 3 — — F/5 6 Totals 2,860 3,126 3,438 3,756 3,082 4,120 3,482 2.799 til 26,663 X. Attendances at Welfare Centre* 51 27 46 45 47 — 49 39 24 304 XI. Other Work by Direction 966 599 1,094 734 584 1,012 1,387 590 2 6,966 XII. Visits Declined 1 — 1 — — 3 1 — — 6 XIII. Visits, House Shut 947 1,134 784 801 1,033 598 826 1,182 — 7,305 XIV. Visits, Inopportune 57 10 2 — 4 14 1 — — 88 Grand Total of Visits 4,882 4,896 5,365 5,336 4,750 5,747 5,746 4,610 87 41,332 Continued. SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1936 -Continued. District No. 1 2 3 4 5 6 & 8 7 9 C.L.P.Not included in totals ‡ Totals. Analysis'of Visits included in I.-IX. relating to (aa)† Reported Ophthalmia F/4 11 F/11 15 F/23 46 F/6 13 F/19 50 F/27 58 F/4 9 F/7 11 — F/101 213 (a)† Ophthalmia Neonatorum F/4 6 f/4 7 F/2 3 F/4 12 F/8 20 F/5 10 F/2 5 f/1 8 — F/30 70 (b)† Epidemic (Summer) Diarrhoea — — — - — — — - — — (c) Other Digestive Diseases - - - - - - - - - - (d) Pneumonia and Bronchitis 17 13 3 5 3 12 17 - - 70 (e) Rickets 18 6 2 16 5 19 11 - - 77 (f) Measles and German Measles F/19 22 f/16 19 F/ 15 F/ 9 f / 24 F/24 26 F/45 49 F/87 233 — F/239 397 (g)† Whooping Cough F/ 22 F/29 33 F/ 4 F/ 9 F/ 18 F/28 f/ 3 - - F/113 117 (h) Tuberculous Disease—P= Pulmonary; 0 = 0ther - - - - - - - - - - (i) Convulsions — — — — — — — — — (j)† Polio-myelitis - - - - - - - - - - (k) Premature Birth 12 2 5 20 15 16 12 4 - 86 (l) Atrophy, Debility and Marasmus - - - - - - - - - - (m) All other investigations (**Specify) 19 14 1 1 18 15 6 1 - 75 (n) Routine Visits included in I. to IX. and not included in (aa) to (m) 2,734 3,017 3,359 3,671 2,929 3,936 3,370 2,542 61 25,558 ***Totals (aa) to (m) 2,860 3,126 3,438 3,756 3,082 4,120 3,482 2,799 61 26,663 Total Families Visited 2,089 2,298 2,676 2,992 2,286 2,236 2,745 2,165 59 19,487 77 Registered Births. New Cases Handed to H.Vs. for Visitation Infant Mortality. Maternal Mortality. Puerperal Fever. Puerperal Pyrexia. Ophthalmia Neonatorum. No. Rate. Notified Births. Non-Notified Births. Transfers In. No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. 4724 15.24 4,799 58 816 291 61 8 1.64 25 25 57 45 45 28 *M.O. Consultation, Weighing babies, Dressings, Temperature taking, Selling of Dried Milk. Talk to Mothers. **e.g.—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio myelitis, etc. Syphilis,Rheumatism, N.N.B. Illegit., etc. ***Totals (aa) to (n) should correspond with Totals I. to IX. †- F. in front of figures denotes a "First Visit. ‡ Child Life Protection Visits. 1936] 78 VOLUNTARY WELFARE CENTRES. Each year for comparative purposes a Table is given which summarises as far as possible the work of the Voluntary Welfare Centres. The Table is compiled from the reports provided by the Centres of information which the Medical Officer of Health has to supply to the Ministry of Health for the calendar year. Table—Calendar Year, 1936. North. South. East. West. Total. l. Pre-Natal Clinics. Number held weekly ... 3 1 Ctr. 1* 1 7 1 Rose „ of Expectant Mothers Br'ch. . who attend 929 173 204 129 1,435 „ of attendances 1,985 552 478 358 3,373 2. Post-Natal Clinics. Number held weekly 1 2 † l † l 5 „of mothers who attend 311 170 56 45 582 „of attendances 649 280 100 72 1,101 3. Consultations for Children u p to 6 Years of Age. Total No. of children who first attended at the centres during year, and who, on the date of their First ance, were:— i. Under 1 year 935 741 534 551 2,761 ii. 1—5 years 164 111 104 81 460 Number of attendances:— i. Children under 1 year 12,501 10,963 8,367 6,367 38.198 ii1—5 years 5,743 7,448 6,256 4,283 23,730 4. Home Visiting. Number of visits made to:— i. Expectant mothers:— (a) First Visits 453 110 165 117 945 (b) Total Visits 2,393 268 937 297 3,895 ii. Children under 1 year:— Total Visits 6,032 5,909 2,832 3,280 18,053 iii. Children 1—5 years 8,241 6,350 5,023 5,083 24,697 5. Wards and Homes. Number of beds 18 12 8 38 Number of patients received:— i. Mothers and Babies:— (a) Mothers 54 75 - - 129 (b) Babies 54 80 - - 134 ii. Babies only 104 - - 88 192 6. Number of Children who ded at the Centres during the Year, and who, at end of Year, were :— i. Under 1 year 809 607 371 469 2,256 ii. 1—5 years 1,645 1,234 815 706 4,400 7. Convalescence. Number of cases:— i. Mothers 34 11 98 40 183 ii. Children 51 67 207 49 374 * Plus one extra Clinic per month. † East and West Centres, Post-Natal Clinics are held with their Pre-Natal Clinics. 79 [1936 THE WORK OF THE FOUR VOLUNTARY WELFARE CENTRES. Through a communication early in the year from the Medical Officer of Health of the London County Council, a definite arrangement was come to whereby expectant mothers attending the Clinic at St. Mary, Islington, Hospital, Highgate Hill, could between their first and last pre-natal attendances there pay intervening ones at the nearest local voluntary welfare centre clinic. This hospital has recently increased its maternity department and it is a rule that any mother who wishes to be confined at the hospital must attend its pre-natal and post-natal clinics. It was thought that the arrangement mentioned would prove convenient to the mothers and thus a more frequent supervision of them would be attainable, as the mother in the voluntary welfare centre clinics would have a place nearer at hand and less expenditure of effort and time would be necessary to reach the clinics, and she would not be absent from home and the other members of the family so long, and these being intervening visits the continuity with the actual doctor for the confinement was not lost. As regards infectious and contagious ailments, during the year the Centres did not to any appreciable extent have their attendances reduced, but during the prevalence of diarrhoea towards the close of the year children attending the Centres in common with those of the district, were apparently also affected. Regarding the general work of the voluntary Welfare Centres it might be emphasised, as has been stated in a previous year, that the principle that actuates every department of the work carried out is the establishment of health and the prevention of possible disease, damage and death—by the education of the mother before the birth of the child and continuous supervision after until the child attains school age. The advice given at the Centre is amplified by visits of the Centre nurses at the homes. Cases of definite illness have necessarily to be referred to the family doctor, hospitals and consultative clinics when the occasion arises. "Health Talks" and "Mothercraft Classes" are provided; suitable clothes for children can be seen and the mothers taught how to make them. The following activities are either provided or can be procured by all the Voluntary Welfare Centres:—Pre-natal and Post-natal Clinics; Children's Clinics; visits by Centre nurses to the homes; mothers can attend the Centres in the mornings if in difficulty and obtain advice; various classes and "HealthTalks"; convalescence for mothers and children; dental aid; artificial "Sunlight"; massage; extra nourishment; training of infant welfare students. In addition, there are other special activities peculiar to some of the Centres, for instance—the SouthCentre possesses its own country cottage home for the convalescence of mothers, infants and toddlers; the North and West Centres possess residential observation wards. Home helps are provided by the Centre itself for attenders at the North Centre; "Exercise Classes" were held at the North and East Centres; Infant welfare pupils, in addition to infant welfare students, are trained at the North and South Centres; "Thrift Clubs" are run at the North and South Centres and North also has "Mothers' and Fathers' Committees." The influence of a "Fathers' Committee "may act as a persuasive for something to be better done, for instance, a particular father may object to special treatment being obtained for his child although the mother herself would be willing; it has been known that the influence of other fathers met through the Centre has turned the balance in the child's favour. 1936] 80 In the Autumn a communication was received from the North Islington Welfare Centre forwarding plans of proposed re-building of the older part of the Centre premises in view of its condition due to age and settlement. As this brought forward the question of very substantial expenditure over a number of years, and there was also a request for additional capital grant, the matter was one that could not be taken up without very serious consideration and investigation into the financial commitments and the actual work done at all Centres in the Borough, and was still before the committee at the end of the year. The following notes of general interest have been supplied by the respective Centres:— NORTH ISLINGTON INFANT WELFARE CENTRE. 6 & 7, Manor Gardens, N.7. The Committee of the North Islington Welfare Centre are pleased to report that Her Majesty the Queen has graciously consented to become the Patroness of the Centre and Wards. The help afforded by the Borough Council and their sympathetic interest in the work of the Centre and their generous financial assistance has enabled it not only to maintain, but to increase its work. The assistance given by the Medical Officer of Health and the staff of the Public Health Department has been very much appreciated. The volume of the work accomplished at the North Centre in 1936-1937 has been in excess of that of 1935-1936. The attendances at the Children's Clinics have been over 500 more than in the previous year. Those at the Pre-natal and Post-natal Clinics have also been higher and the number of visits in the homes has increased. The exercise classes for nursing and expectant mothers held at the "Light" clinic have inspired the members of the "Mothers" Committee to arrange a physical culture class themselves, which is held once a week and is most popular and well attended. SOUTH ISLINGTON MOTHERS' & BABIES' WELFARE CENTRE. Centre, 6, Clephane Road, N.l. "Rose" Branch, 15, Popham Road, N.l. Canonbury Branch, held at 100, Canonbury Road, N.l. In addition to the routine work of the Centre which has been carried on as in previous years, special attention has been given this year to the children between two and five years old. The Centre keeps in touch with the schools in its area in order that children under five who start going to school, and then cease attendance owing perhaps to ill-health, or to some other reason, may not fail to get medical supervision. Another development which the Committee has long had in mind is the greater use of the garden in the mornings for toddlers. This has now been made possible by a small addition to the "Block Grant" received from the Borough Council, and mothers may bring a lonely or difficult child, on the recommendation of the Doctor, to play or rest, under the care of a teacher, while she herself gets on with her work. 81 [1936 EAST ISLINGTON MOTHERS' AND BABIES' WELFARE CENTRE Centre, 32, Drayton Park, N.5. Branch, at Highbury Quadrant Mission Hall, Hurlock Street, N.5. The routine work of the Centre and Branch has been carried out with quiet efficiency and attention to detail. The aim of all workers is to educate the mothers in the physical and mental care of their children and teach them to take adequate care of their own health. During 1935-1936 we started a Clinic for Immunisation against Diphtheria. During the twelve months in which it functioned 254 children were successfully immunised and, at the end of this time, we were glad to avail ourselves of the weekly Municipal Clinic which had then been established. In the Autumn of 1936 we anticipated the campaign for Physical Fitness by starting a "Keep Fit Class" for Mothers of Toddlers, under the auspices of the Central Council of Recreative Physical Training. This experiment was not altogether a success for, although a few mothers were very keen, some found it difficult to spare the time to attend; others were too tired after their daily work for further physical exertion and felt that such leisure as they had could be more profitably spent in rest. Very few of them are in an A1 condition, and it is for this reason that we are still absorbed in the question of the health of the expectant and nursing mother. One of the results of the study of Maternal Mortality and Morbidity has been to establish the assumption that some of the ills, which at times attend pregnancy, can be attributed to certain deficiences in diet, and it is thought that treatment directed to the removal of these deficiencies might prove a factor in diminishing the toll of Maternal Mortality and Morbidity. These conclusions have been developed into a practical scheme by the extension of our free dinners to all necessitous expectant and nursing mothers in East Islington, whether attending the Centre or not. The Local Authorities, Public Assistance Committees, the Hospital Almoners and Midwives have all been notified of this arrangement. Although 666 dinners were given to 42 nursing and expectant mothers during the year (in addition to 152 dinners to toddlers) we feel that there is a much larger number whose health would be improved by the provision of a nutritious daily meal. There is no doubt that mothers find it difficult to leave home in the middle of the day, although the hour of 1.45 p.m. was chosen as being the most convenient for them. In addition to the dinners, we are arranging to give ½lb. of Marmite each month to every expectant mother attending the Centre during the last three months of pregnancy. As we are concerned with the mental as well as the physical well-being of children under five, we are hoping to hove regular clinics for difficult children at the Centre sponsored by the Child Guidance Clinic. WEST ISLINGTON INFANT WELFARE CENTRE. Centre, 42 & 44, Richmond Road, N.l. Branch, held at St. Luke's Mission Hall, Goodinge Road, N. 7. The volume of work done, as measured by statistics of visits and attendances, shows an increase over the preceding year, 1936] 82 The Ward continues to play an important part in the medical and nutritional aspect of the work. Special efforts have been made to stimulate interest in other branches of craft by encouraging attendance at the weekly classes for teaching and practical demonstration. These classes have been well attended. Arrangements have been made for the supply of wool, knitting patterns and—in necessitous cases—hand-knitted vests, to improve the standard of clothing amongst the children. Attendances, etc., at the various Departments of the Four Voluntary Centres, year ending March 31st, 1936 North. South. East. West. Total. 1. Pre-Natal Clinics and Ailing Mother Clinics. Number held weekly „of attendances 4 2,505 2 760 † l 573 §1 406 8 4,244 2. Consultations for Children up to 5 Years of Age. Number held weekly „of attendances 10 22,623 11 18,631 **11 14,917 7 10,850 39 67,021 3. Home Visiting. No. of visits made 16,566 12,678 10,920 7,934 48,098 4. Dental Clinics. Number attending „of attendances or arrangements made for attendances 744 2,368 170 438 95 - 72 - 1,081 2,806 6. Morning Callers. Number of attendances 1,422 560 ‡ - 735 2,717 6. Massage Clinics. No. of cases given massage or sent for massage 79 91 (& Sunlight treatment) 100 40 310 7. Wards. Number of beds „of patients received 18 205 - - - - 8 97 26 802 8. Number of Children on Books 2,026 1,544 1,201 1,000 5,771 § Birth Control Clinic took the place of one Pre-natal Clinic on 2nd Tuesday in month till September, 1935, when it was discontinued and reverted again to an Pre-natal Clinic. † Extra Clinic held 2nd Thursday in month. ** Including 2 Observation Clinics. ‡ Not recorded. NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN. The voluntary services of the three local Inspectors of this Society were again taken advantage of and cases were referred to them for further investigation ; among the number were included several brought to the notice of the Medical Officer of Health by the Islington Voluntary Welfare Centres. Altogether, 56 cases came under the supervision of their Inspectors, 15 of which were continued from last year and among the residue were 3 cases coming under Child Life Protection work, where the Inspectors' co-operation has its effect. / 83 [1936 It is indeed very fortunate that this Society permits its Inspectors to undertake investigations of this kind, as a need is undoubtedly filled for a class of case where persuasion has failed and more energetic measures are necessary to avoid, or remedy, neglect of ill-treatment of young children, or even of mothers where cruelty or neglect is likely to have its bad effect on their children. Much credit is due to the Society's Inspectors for the attempted alleviation of both physical and mental pain 'o children in the cases attended by them. PUBLIC HEALTH (LONDON) ACT, 1936—Sections 256 to 272—CHILD LIFE PROTECTION. Under this heading it falls to report the Infant Protection Work, the authority for which in the October of the year under review was incorporated in the Public Health (London) Act, 1936. It will be noted that this work shows a steady increase in the number of cases dealt with. Among the many cases investigated, however, cause for complaint was found in but 8 cases. One of these was put forward for prosecution on the instructions of the Committee; the mother of the child came forward as a witness. The person concerned was not registered as a foster-mother and had obtained her foster-child by means of a window advertisement; after a lengthy hearing the magistrate accepted the evidence of the defendant and dismissed the summons. Two cases were dealt with by the Maternity and Child Welfare Committee who directed warning letters to be sent. In 4 cases the children's mothers were prevailed upon to find foster-mothers of a more satisfactory character and the foster-mother persuaded not to take further children. In the remaining case the foster-mother herself asked the parent to find a new home for the child. As the object of the work, apart from protecting the child, is to have in our Borough a trustworthy number of foster-mothers who can be confidently recommended, only cases which are considered serious are put forward for possible prosecution. The routine procedure in regard to foster-mothers is upon receipt of a notification that the proposed foster-mother intends to take or has taken a child for reward, the Child Protection Visitor makes an investigation as to the suitability of the person and the premises. It was found in 12 cases conditions were such that the applicants were advised to refrain from taking a child, and this advice was followed. There were no known deaths of foster-children during the year, as against 3 in the previous year. Number of foster-mothers on the Register who were receiving children on the 1st January, 1936 198 Do. do. on the 31st December, 1936 229 Number of foster-mothers added to the Register during the year31 Number of foster-mothers removed from the Register by the Committee during the year Nil Number of foster-children on the Register at 31st December, 1936 223* Number of foster-children attending Child Welfare Clinics, 95 „„under private medical practitioners, 6 101 *Includes those in institutions, etc, 1936] 84 Total number of visits paid1,783 Special visits paid12 Children removed compulsorilyNil Children removed to hospital (including infectious disease) 28 Children removed voluntarily9 Deaths reported (Inquests—Nil)Nil Children for whom medical attention arranged9 Cases recommended for prosecution1 Desertions by parents—Children removed from foster-mothers to Public Assistance Institutions8 Other cases in which there was cause for complaint7 Number of foster-children under 5 years on Register during 1936 370 (with foster-mothers212) (with Institutions 158) Number of foster-children between 5 years and 9 years on Register during 1936 57 (with foster-mothers52) (with Institutions5) Total number of foster-children dealt with during 1936 427 (with foster-mother264) (with Institutions163) Institutions, including Schools.—158 children under 5 years of age passed through institutions. These children are medically examined periodically by an appointed Medical Officer. No resident school child under 9 years of age was reported during the year. The St. Luke's "Guest House," Penn Road, N.7, co-operates with the North Islington Welfare Centre, where cod-liver oil, etc., may be obtained. The accommodation of this "Guest House" was extended in September of this year by the inclusion of adjacent premises. REPORT ON THE WORK OF THE DAY NURSERIES RECEIVING GRANTS FROM THE BOROUGH COUNCIL. There are three Day Nurseries in the Borough. No. of No. of places attendances provided. during 1936. i. Lower Holloway Day Nursery, 547, pool Road, N. 5010,442 ii. South Islington Pro Patria Day Nursery, 9, Canonbury Lane, N.l 5011,528 iii. St. Luke's Day Nursery, 29 to 31, Penn Road, N.7 30 4,868* Total13 26,838 *Guest House. 85 [1936 The "Guest House" in connection with St. Luke's Day Nursery has accommodation for 24 children (and four extra in an emergency). During the year ending March 31st, 1936, the admissions numbered 58. The accommodation has always been fully taken up, and there were many demands for admission which could not be complied with. Grants given in respect of work in premises outside the Borough boundary:— The Claremont Central Mission Day Nursery, White Lion Street, N.l.—£50. The Foundling Site Day Nursery, Guilford Street, W.C.I.—£30. SCHOLEFIELD ROAD DAY NURSERY AND SUN CLINIC. In last year's Annual Report reference was made to the Scholefield Road site brought before the Committee by the Medical Officer of Health on the 9th July of that year. During the year 1936 proposals relative to the matter were before the Ministry of Health and a further report was furnished by the Medical Officer of Health in February. Schemes had been put forward both as regards adapting to some extent the old building with necessary additions, and clearing the site for the erection of an entirely new building, but as time went on it was the considered opinion of the Borough Council that the latter was the more desirable. Negotiations as regards this were in progress with the Ministry during the closing part of the year and estimates for a new building were being obtained which would be put forward for the necessary sanctions of the London County Council and the Minister of Health. INVALID CHILDREN'S AID ASSOCIATION. The Borough Council contributes £25 per annum to the Local Branch of this Association. During the year, 103 Islington children under five years were given periods of convalescence either in the country or by the sea, and 28 crippled children of like ages, 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, MATERNITY AND CHILD WELFARE. Contributions by the Borough Council. Year ended 31s£ March, 1937. Voluntary Welfare Centres. Day Nurseries. £. North Centre5,461 Lower Holloway244* South Centre2,500 St. Luke's229 East Centre1,901 South Islington600 West Centre1,926 Total £1,078 Total £11,788 * This Nursery is a municipally owned building. (No rent charged for its use.) 1936] 86 Whooping Cough and Epidemic Diarrhoea. In October, the scheme was extended to include cases of maternity complications. The payments made to this Association, it the rate of one shilling per visit, (increased to Is. 3d. per visit in October 1936) were:— Under Maternity and Child Welfare£51 2 3 Under Public Health £19 5 9f Total£70 8 0 † Includes also nursing of pneumonia (adult). Contributions under arrangements for maternity cases admitted to beds at Maternity Hospitals, the contributions being a grant of 10s per case, were: City London Maternity Hospital, £44 10s. Od.; Royal Free Hospital, £6 10s. Od.; University College Hospital (added to scheme April 1st 1936), £16 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. GRANTS TO MIDWIVES. (i) " Necessitous cases " confined at home. (ii)Where Medical Officer of a Centre has intervened in sending the midwife's patient to hospital. The conditions applicable to these grants were fully set out in last year's report p.22. (1) No application for such compensation was made by any certified midwife during this year. (2) Two claims of a certified midwife were paid by the Council during this year under this section. SPECIAL REPORTS. During 1936, among other special matters reported on to the appropriate Committees were:— March 10, July 14 and October 2.—Reports on" Dinners to Necessitous Expectant and Nursing Mothers." July 9.—Report on "Children under school Age" with special reference to the Minister of Health's Circular of May 1936. October 6.—Report on "Sites for Nursery Schools." December 8.—Special report on a Convalescent Home which was available at St. Leonard's-on-Sea, which was eventually found not suitable for the purposes of the Council. APPENDIX Vital and Sanitary Statistics, 1936 TOGETHER WITH THE PRESCRIBED RETURNS OE THE MINISTRY OF HEALTH. 1936] 88 STATISTICAL APPENDIX Deaths registered in the Borough of Islington during the year (53 weeks) ending 1936. 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. 1,982 166 62 20 10 18 37 96 101 200 389 495 326 62 187 222 184 237 378 324 450 F. 1,874 125 73 15 14 21 36 70 92 135 278 407 429 179 208 205 202 200 348 277 434 Typhoid and paratyphoid fevers (1-2) M. - - - - - - - - - - - - - - - - - - - - - F - Measles (7) M 30 16 37 4 — 1 - - - - - - - - 4 7 7 13 2 18 7 F 28 Scarlet Fever (8) M. 2 1 5 — 1 - - - - - - - - - - - - - 2 2 1 F. 5 Whooping Cough (9) M. 6 9 9 - - - - - - - - - - - 3 2 1 5 - 5 2 F. 12 Diphtheria (10) M. 15 — 14 15 — 1 — 1 - - - - - - 1 3 — 11 5 5 6 F. 16 Influenza (11) M. 20 1 — — — — — 5 3 4 7 9 2 3 7 1 2 5 4 3 12 F. 14 Encephalitis lethargica (17) M. - — — — — — — — — — — — — — — — — — — — F. Cerebro-spinal Fever (18) M. 6 1 4 — 1 1 — 1 — — — — — — 1 1 1 1 1 — 3 F. 2 Tuberculosis of Respiratory System (23) M. 134 1 3 — 1 7 31 51 28 36 38 13 1 — 23 24 16 22 35 35 55 F. 76 Other Tuberculous diseases (24) M. 12 1 7 2 2 2 1 5 1 — 1 2 — — 2 2 3 3 4 7 3 F. 12 Syphilis (34) M. 9 3 — — — — — — 1 1 3 3 1 — — — — 1 3 1 7 F. 3 General Paralysis of the Insanetabes dorsalis. (83) M. 5 — — — — 1 — 2 1 1 — 1 — — — 2 1 1 1 1 - F. 1 Cancer ... M. 274 1 1 — 1 1 2 13 25 69 168 181 85 7 62 55 61 52 104 80 140 Malignant disease (45-53) F. 280 Diabetes (59) M. 4 — — — — — 1 1 1 3 2 3 4 — 3 2 1 3 1 3 2 F. 11 Cerebral haemorrhage, &c. (82) M. 70 1 1 — — — 1 4 7 14 35 50 47 18 17 25 16 17 35 26 42 F 108 Heart disease (90-95) M. 432 — — 1 5 7 6 20 29 61 149 285 275 70 84 95 100 101 193 139 196 F. 476 Aneurysm (96) M. 13 — - — — - - 1 2 5 8 3 3 — 1 1 2 2 5 4 7 F. 9 Other circulatory diseases (97-103) M. 85 — — — — — 1 1 2 12 34 58 60 21 29 20 23 14 36 19 48 F. 104 Bronchitis (106) M. 100 2 1 — — — 2 3 4 17 27 64 53 20 1 24 23 23 34 27 43 F. 93 Pneumonia (all forms) (107-108) M. 202 38 29 3 1 1 4 7 21 32 60 69 50 22 29 44 42 39 67 42 74 F. 135 Other respiratory diseases (110-114) M. 45 — 2 — 2 — — 3 3 4 7 13 38 21 7 19 9 11 16 16 15 F. 48 Ulcer of Stomach and duodenum (117) M. 30 — — — — — — 1 6 12 11 7 — 2 3 1 5 7 5 6 12 F. 9 Diarrhoea, etc. (119-120) M. 45 79 6 — — — — — 1 — — 1 1 — 10 14 5 13 19 12 15 F. 43 Appendicitis (121) M. 10 — 1 1 — — 1 — — 2 5 2 4 — 1 2 3 2 3 1 4 F. 6 Cirrhosis of liver (124) M. 8 — — — — — — 1 — 5 5 6 — — — 3 3 — 4 4 3 F. 9 Other diseases of Liver, &c. (125) M. 1 1 — — — — — — 1 1 — — — — 1 — — — — 1 1 F. 2 Other digestive diseases (115, 116, 122, 123, 126-129) M. 36 1 2 1 2 1 — 5 4 8 12 13 14 4 5 9 6 9 12 12 14 F. 31 Acute and Chronic Nephritis (130-132) M. 56 — — — 1 2 3 1 7 7 19 36 18 5 12 13 6 10 19 21 18 F. 43 Puerperal sepsis (140-145) F. 3 — — — — — — 2 1 — — — — — — — — — 1 2 — Other puerperal causes (140-150) F. 5 — — — — — 1 4 — — — — — — 1 — — — 1 _ 3 Congenital debility, Premature birth, Malformations, &c. (157-159) M. 54 90 — 1 2 — — — — — — — — — 14 11 6 15 22 11 14 F. 39 Senility (162) M. 20 — — — — — — — — — 1 4 38 26 7 13 4 9 11 11 14 F. 49 Suicide (163-171) M. 34 — — — — 1 3 4 13 11 19 4 — — 1 6 7 3 10 12 16 F. 21 Other Violence (172-198) M. 78 3 5 2 1 5 9 8 10 10 18 27 30 17 19 14 15 13 28 19 37 F. 67 Other defined diseases M. 146 42 8 5 4 8 7 22 22 20 37 48 31 5 26 14 18 32 43 56 70 F. 113 Causes ill-defined or unknown M. — — — — — — — — — — — — — — — — — — — — — F. 1 — — — — — — — — — — — — — — — — — — — 89 1936 (Ministry of Health Return.) Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1936. Causes of Death. Sex All ages 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M 1950 163 24 38 31 53 93 100 194 379 494 381 F 1835 126 36 36 29 56 69 92 132 266 395 598 Typhoid and paratyphoid fevers M 1 - - - - - - - - - - - F - - - - - - - - - — — -- Measles M 27 9 7 10 1 - - - - - - - F 28 7 12 6 2 1 - - - - - - Scarlet Fever M 2 - 1 1 - - - - - - - - F 4 1 - 2 1 - - - - - - - Whooping Cough M 10 3 5 1 1 - - - - - - - F 14 8 4 2 Diphtheria M 16 - - 6 9 - - - - - 1 - F 16 - - 7 7 1 1 - - - - - Influenza M 23 2 - - - - 4 2 4 5 3 3 F 15 1 - - - - 3 1 - 3 5 2 Encephalitis Lethargica M 2 - - - - - 1 - - - 1 — F 2 - - - - - - 1 - - 1 - Cerebro-spinal fever M 6 1 1 2 - 1 1 - - - - -. F 2 — - 1 1 - -. - - - - - Tuberculosis of respiratory system M 131 - 1 1 2 14 29 21 25 29 9 - F 78 1 1 - - 25 21 8 10 7 4 1 Other Tuberculous Diseases M 12 - - 2 2 1 5 - - 2 - - F 11 1 2 3 1 2 — 1 — — 1 Syphilis M 11 1 - - - - - 1 2 3 3 1 F 3 2 - - - - - - - 1 - —. General paralysis of the insane, tabes dorsalis M 11 - - - - 1 2 1 2 2 2 1 F 3 - - - - - - - 2 - 1 - Cancer, malignant disease M 282 1 - 1 1 - 5 10 33 93 104 34 F 288 - 1 - 3 3 10 17 36 78 80 60 Diabetes M 11 - - - - - - - 4 - 5 2 F 22 - - - - 1 - 1 1 7 8 4 Cerebral haemorrhage, &c. M 57 - - - - - - 1 4 13 17 22 F 80 - - - - - - 4 3 15 22 36 Heart Disease M 424 - - - 2 3 10 9 29 82 152 137 F 468 - - - 3 8 13 20 23 58 130 213 Aneurysm M 22 - - - - - 3 2 6 8 2 1 F 12 - - - - - 1 - 3 3 2 3 Other circulatory diseases M 82 - - - - - - - 7 18 30 27 F 106 - - - - 1 - 2 5 17 26 55 Bronchitis M 81 1 - 1 - - 3 3 9 13 24 27 F 69 2 - - - 1 - 1 4 4 21 36 Pneumonia (all forms) M 179 25 6 6 2 2 4 12 21 36 41 24 F 114 19 11 7 2 1 1 4 7 14 17 31 Other respiratory diseases M 47 - - - 1 2 2 - 4 2 7 29 F 46 — — 1 1 — — — — 4 3 37 Peptic ulcer M 29 - - - - - 1 6 10 6 4 2 F 12 - - - - - - 1 3 3 2 3 Diarrhoea, &c. M 40 40 - - - - - - — - - - F 35 27 3 1 - - 1 1 - 1 1 Appendicitis M 13 — 1 — 2 — — 1 2 4 1 2 F 6 — — — — 1 — — — 2 1 2 Cirrhosis of Liver M 9 1 — 1 — 2 3 2 - F 6 - - - - - - - 2 1 3 - Other diseases of liver, etc. M 3 - - - - - - - - - 1 2 F 9 - - - - - - 1 1 - 1 6 Other digestive diseases M 31 1 1 — 2 — 4 3 4 3 9 4 F 30 2 — 1 1 1 1 3 • 3 4 6 8 Acute and Chronic Nephritis M 53 - - 1 - 5 1 4 6 7 21 8 F 49 - - - 1 - - 2 4 10 17 15 Puerperal Sepsis F 5 - - \- - 2 2 1 - - - - Other puerperal causes F 5 - - - - - 5 - - - - - Congenital Debility and Premature Birth, Malformation, etc. M 71 68 - 1 1 - - - - 1 - - F 46 43 - - 3 - - - - - - — Senility M 11 - - - - - - - - - 1 10 F 34 - - - - - - - - 1 2 31 Suicide M 29 - - - - 3 - 5 8 9 4 - F 20 — 3 8 4 5 . — Other violence M 76 1 — 2 2 13 8 8 4 10 14 1 F 60 2 - 3 1 2 1 1 3 9 11 27 Other Defined Diseases M 148 9 1 3 3 8 9 11 7 30 36 31 F 136 9 2 2 2 6 7 14 17 20 30 27 Causes Ill-defined or unknown M - - - - - - - - — — — — F 1 1 - - - - - - - - - - Legitimate. Illegitimate. Deaths under 1 year ^ Registered Births 9288 (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1936. Disease. Ages. Totals Total Cases removed to Hospital Under 1. 1-2 2—3 3—4 4-5 5—10 10—15 15-20 20-35 35-45 45-65 65 and upwds Small Pox Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. . . .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever Notifications 7 39 65 59 85 297 95 33 65 13 2 .. 760 738 Deaths 1 1 3 1 3 3 1 .. .. .. .. .. 13 12 Diphtheria Notifications 10 28 37 48 68 248 57 27 40 12 6 3 584 583 Deaths .. 1 4 3 6 13 2 1 1 .. .. .. 31 31 Enteric Fever Notifications 1 .. .. .. .. .. 1 2 2 .. 1 .. 7 5 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever Notifications .. .. .. .. .. .. 1 19 5 .. .. 25 24 Deaths .. .. .. .. .. .. .. .. .3 .. .. .. 3 3 Puerperal Pyrexia Notifications .. .. .. .. .. .. .. 4 47 6 .. .. 57 46 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Primary and Influenzal Pneumonia Notifications 8 11 12 11 4 9 7 12 38 23 54 21 210 36 Deaths 3 4 2 .. .. 1 .. 1 7 8 24 23 73 30 OphthalmiaNeonatorum Notifications 45 .. .. .. .. .. .. .. .. .. .. .. 45 28 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro Spinal Fever Notifications 1 .. 1 .. .. .. .. 2 2 .. .. .. 6 6 Deaths 1 2 1 1 .. .. .. 1 1 .. .. .. 8 8 Acute Poliomyelitis Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery Notifications 3 5 6 1 5 4 4 1 4 1 1 .. 35 34 Deaths .. .. .. .. .. .. .. .. .. .. .. .. 2 2 Malaria Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas Notifications 3 .. 2 1 1 .. 2 6 18 18 49 28 128 47 Deaths 1 .. .. .. .. .. .. .. .. .. 4 5 10 9 Continued Fever Notifications .. .. .. .. .. .. .. . . . . .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox (except in the vaccinated under 10 years) Notifications 9 18 26 22 35 114 53 19 20 1 1 .. 318 21 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. 90 91 [1936 (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1936. SANITARY AREA. Premises. No. in Borough on 31st December, 1936. No. of Inspections. No. of Prosecutions. Common Lodging Houses 24 579 - Seamen's Lodging Houses — - - Cowsheds (licensed) - - - Slaughterhouses (licensed) 8 (7 local supplies) (1, horses for export) 430 - Other Offensive Trades 12 (Includes knackers) 311 - Milkshops 256 877 1 Ice Cream Premises 494 460 - Restaurants and Eating Houses 605 798 - Registered Foster Mothers 229 1,241 1 Nurse Children kept 223 1,581 - Smoke Nuisances— (1) No. of observations 32 (2) No. of intimations served 2 (3) No. of complaints received*45 (4) No. of Statutory Notices served5 (5) No. of legal proceedings— (6) No. of convictions— (7) Amount of penalty and costs imposed in each case— * In respect of 26 premises. Cleansing and Disinfection— No. of adults cleansed81 No. of children cleansed6,656 No. of premises cleansed— (a) After infectious diseases2,898 (b) For vermin361 Water Supply to Tenement Houses— No. of premises supplied219 No. of prosecutions— Sanitary officers— Chief Sanitary Inspector (Whole time) 1 Number of Sanitary Inspectors (Whole time) Male, 23 Female2 ,,,, (part time) Male, Nil FemaleNil Number of Health Visitors(Whole Time)8 „„1 Child Protection Visitor Municipal Tuberculosis Visiting Nurse(Whole time)1 92 [1936 HOUSING. 1. Total number of houses in the Borough about 46,000 2. Number of of houses occupied by the working classes about 40,000 Public Health Act. 3. Number of houses inspected on account of complaints or illness.7,717 4. Number of Statutory Notices served805 5. Number of houses (a) Repaired6,307 (b) Nuisances remedied15,365 Housing Acts (1925-35). 6. Number of houses inspected—House to house (Housing solidated Regs., 1925)1,464 7. (a) Number of houses included in representations by the Borough Medical Officer under Sec. I of Housing Act, 1930141 (b) Number of houses demolished following representation by Borough Medical Officer under Sec. I of Housing Act, 1930Nil 8. Number of houses repaired under Sections 17 and 18 of Housing Act, 1930— (a) By owners36 (b) By Local Authority in default of owners Nil 9. Number of houses demolished— (a) In pursuance of orders under Sec. 19 of the Housing Act, 1930Nil (b) Voluntarily45 8 premises the subject of demolition orders which were not made, as upon undertakings being given repairs were carried out satisfactorily. 10. Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms)9 11. Number of Closing Orders determined (i.e., houses made fit)Nil 12. Number of houses erected by the Borough Council for working classes during year Nil 13. Houses Let in Lodgings. Number in Borough983 Number of inspections6,307 Number of prosecutions Nil Number of complaints remedied under the By-laws (not included under any other heading)669 14. Underground Rooms. Number occupied but unfit under Sec. 18 of Housing 1925 as modified by Sec. 84 of Housing Act, 1935. Survey still in progress Number closed or modified occupation approved under Sec. 84, Housing Act, 193567 15. Overcrowding (Housing Act 1935). Number of houses inspected under Sec. I of Housing Act, 1935 12,886 Number of families found to be living in overcrowded conditions, Sec. of Housing Act, 1935 6,757 Number of overcrowded families who have obtained alternative accommodation105 93 [1936 References—Former M.O.H. Reports. Tables and Reports have appeared in previous Annual Reports of the Medical Officer oc Health. See reference page 91, report 1929, for years 1921-1929. Annual Report 1930. Page 10Public Health Congress. Royal Agricultural Hall. Pages 34, 35 and 36Smallpox. Page 41Islington (Chicken-Pox) Regulations, 1930. Page 52Local Government Act, 1929. Page 57Cleansing (Disinfection) of School Children. L.C.C. Agreement, p. 57. Pages 60, 61, 62, 63, 64Shops—General Investigation Regarding Conditions, Etc. and 65. Page 66Nuisances by Dogs. Rag Flock Acts. Page 67Agricultural Produce (Grading and Marking) Act, 1928. Merchandise Marks Act, 1926. Pages 70 and 71Rats and Mice (Destruction) Act, 1919. Pages 71, 72, 73, 74 and 75Housing. Page 75Rent and Mortgage Interest (Restrictions) Acts. Page 76Unsound Chocolates given as Prizes. Page 78 The Grading of Milk—Bacteriological Examination. Pages 78 and 79The Milk and Dairies (Amendment) Act, 1922; The Milk (Special Designations) Order, 1923. Annual Report 1931. Page9Report on Maternity and Child Welfare Work. Page 17Work of the Day Nurseries. Pages 17, 18 and Report of the Work of Voluntary Centres. Page 30Prosecution non-notification of Infectious Disease. Pages 39 and 40Islington Interim Tuberculosis Care Committee. Pages 60, 61, 62, 63, 65,Housing. 66 and 67. Pages 63 and Basement Rooms. Pages 69 and 70 Census. Page 75 Cheese Sandwiches, Black Currant Pastilles. Annual Report 1932. Page 17 Work of the Day Nurseries. Page 25Coroner's Court and Mortuary. Page 32 Dysentery. Page 43Tetanus. Page 44Sterility of Maternity Outfits. Pages 59-61Housing. Page 67Unsound Food as Prizes ; Preserved Food. Pages 67 and 68Notification of Food Poisoning. Page 68Food Poisoning—Definition. Page 72Migratory Vendors—Warning. Misleading Descriptions—Wine and Spirit Mixtures. Page 74The Almeric Paget Corps; Child Guidance Clinic. Open Spaces. 1936] 94 Annual Report 1933. Page 17Work of the Voluntary Centres. Page 20Day Nurseries. Page 21Invalid Children's Aid Association. Page 21National Society for the prevention of Cruelty to Children Page 22Infant Life Protection. Page 29Death from Copying Ink Pencil. Page 32Typhoid Fever at Camp. Pages 39 and 40Interim Tuberculosis Care Committee. Page 48Food Poisoning. Pages 49 and 50Water Softening. Page 58Scavenging. Page 64Non-compliance with Statutory Notice. Page 65Rats & Mice (Destruction) Act, 1919. Page 67Housing. Page 68Church Lane Clearance Area. Page 71Housing Recommendations. Page 76Unsound Food Prosecution. Page 77Pickled Horse Flesh. Page 78Foot and Mouth Disease Order. Annual Report 1934. Pages 9-11Maternal Deaths. Page 21Infant Life Protection. Page 33Smallpox. Pages 34 and 35Diphtheria Immunisation. Page 40Blind Persons Act. Pages 40 and 41Prevention of Deafness. Pages 42-44 Tuberculosis Care Committee. Page 52Toy Pistol—Toy Pistol-Tetanus. Page 65Sewer Emanations. Page 65Private Schools. Page 67Clearance Areas. Page 77Food Poisoning. Page 83Health Propaganda. Page 83Survey of the Public Health Services of the Borough. Annual Report 1935. Pages 9 and 10Maternal Mortality. Page 13Home Helps. Pages Voluntary Welfare Centres. Page 29Venereal Diseases. Page 32Diphtheria Immunisation. Page 47Bacteriological Examination of Milk. Page 51Disinfestation of Rooms. Page 62Infirm Persons. Pages 62 and 63Rats and Mice Destruction. Page 64Church Lane Clearance Area Page 64Underground Rooms. Page 68Overcrowding Survey. Page 69Shops Act. Page 73Food Poisoning. 95 [1936 INDEX Page Accidental Deaths 9, 15 Acreage iii Acute Poliomyelitis20 Adulteration of Food 64, 67 Ages at Death6, 7, 8 Agricultural Produce (Grading & Marking) Act, 1928.42 Anti-toxin treatment16 Anthrax12, 21 Appendix87 Area iii Artificial Cream Act 64 Artificial Sunlight Treatment29 Attack Rates—Infectious Diseases16-19 Bacteriological Examinations31, 32 Bakehouses 36, 37 Basement Rooms48 Births iii, 4, 5 „ Illegitimate5 „ Notification of5 „ Stillborn5 Blind Persons Act, 1920 42 Cancer 3, 12, 88, 89 Certification of Meat Food Products60 Census Information iii Chicken Pox Regulations21 Child Life Protection83, 84 Clearance Areas47 Clinics 17, 68 Coal gas Poisoning 15 Common Lodging Houses 45 Condensed Milk Regulations67 Coroner's Court, &c15 Cream64 Day Nurseries 84, 85 Dairies and Milkshops (Inspection of) 62, 63 Deaths from all causes during the year iii, 5, 88, 89 Deaths from Epidemic Diseases iii, 9, 10 „—Infants.iii, 8, 7, 8 „Respiratory Diseases iii, 13, 14,88, 89 „in Public Institutions9 ,,and Death Rates5, 6 „Maternal71, 72 „Age at6, 7, 8, 88, 89 Demolition of Habitable Dwellings50 Density iii Diarrhœ al Diseases11,88,89 Diphtheria16, 17, 88, 89 „Anti-toxin treatment and immunisation16,17 Diphtheria, Bacteriological31 Diseases Treated in Hospital18, 19 Disinfectants distributed and used35 Disinfecting Station34, 35 Disinfection Work34, 35 1936] 96 Page Disinfestation of School Children36 Disinfestation of rooms and bedding 35,36 District Inspectors' Work41, 43 Dried Milk Regulations67 Dust, removal of; Receptacles40,41 Dysentery21 Encephalitis Lethargica21 Enteric Fever (Typhoid)18, 20 Epidemic Diseases iii, 9, 10, 11 „Cerebro-Spinal Meningitis 20, 88, 89 Erysipelas12, 18 Extra Nourishment29 Factories and Workshops Administration36, 39 Fatality from Notifiable Infectious Diseases9, 10 Finsen Light Treatment29 Food, Inspection of, Unsound, Adulteration of64-67 Food Licensed Street Traders60 Food Poisoning61 Gas (Coal) Poisoning15 Glanders, Anthrax and Hydrophobia in Man12, 21 Health Propaganda69 Health Visitors (Municipal)76, 77 Home Helps 74, 75 Home Visitations—Tuberculosis29 Hospitals—Clinics68 Hospital Isolation of Infectious Diseases18, 19 Housing47-57 „Accommodation and Recommendations48-50 Housing—Tuberculosis29 Houses Let in Lodgings44, 45 Ice Cream Premises62-64 Illegitimate Births5 Immunisation, Diphtheria17 Industrial Diseases12 Infantile Mortality iii, 6, 7, 8 Infant Welfare Work70-86 Infection, Prevention of16 Infectious Diseases (London) Regulations, 1927 20 Infectious Disease (Notifiable19, 20 Infectious Diseases in Schools30 „„(Non-Notifiable) in Schools30 Infirm Persons46 Informal Sampling64-66 Influenza11, 88, 89 Inhabited houses, Number of iii Inspection of Food58-60 „„Houses41, 43, 44 Inspection of Kitchens of Restaurants36, 60 „„Milkshops and Dairies62, 63 „„Slaughter Houses58, 59 „„Workshops36-39 Institutions68 Institutions (Deaths in)9 Inquests15 Insulin (Supply of)21 Invalid Children's Aid Association85 Isolation of Infectious Diseases18, 19 Islington Chickenpox Regulations21 97 [1936 Page Islington Tuberculosis Care Committee23,24 Kitchens and Restaurants36, 60, 61 Lead Poisoning, Chrome, etc.12 Legal Proceedings, Summary of68 Legislation, New69 Light Treatment—Artificial Sunlight and "Finsen"29 London County Council Return of Sanitary Work91, 92 Malaria20 Malignant Diseases12 Marriages3 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work70, 86 Maternal Deaths71, 72 Measles (Deaths)8,88, 89 Measles, Notifications by School Teachers30 Measles, Scheme of Control30 Meat Inspection58, 60 Meat, labelling of60 Medicines, Provision of16, 21 Merchandise Marks Act, 192642, 60. 65 Ministry of Health Returns56, 88, 90 Milk and Dairies (Consolidation) Acts, 1915-193462 Milk and Dairies Order, 192662 Milk, Bacteriological Analyses31 MilkScheme74 „Adulteration66,67 Milk Purveyors and Dairies62 „Special Designations Order63, 69 Mortuary and Coroner's Court15 National Society for the Prevention of Cruelty to Children82,83 Notification of Infectious Diseases16-20 „„Tuberculosis22-25 „„ Births Act5 ,,„Still-births5 Non-notifiable Infectious Diseases in Schools30 Notices served41 Nursery School68 Nursing85,86 Offensive Trades60 Ophthalmia Neonatorum70 Outworkers' Premises36-39 Overcrowding (Survey)50-55 Pathogenicity Tests (Diphtheria)31 Pemphigus Neonatorum73 Pharmacy and Poisons Act64, 65, 69 Pneumonia14, 20, 21, 85 Pneumothorax treatment29 Poisoning (Gas)15 ,,(Lead)12 Polioencephalitis20 Population at the Census, 1931iii „estimated, 1934 and 19353 Preserved Food (a)Inspectors' Visits62 (b)Registration of Premises62 (c)London County Council able91 Prevention of eafnes42 Prevention of Infection16 Propaganda69 1936] 98 Page Prosecutions, Summary of68 Prosecutions—Unsound Food60 Public Health Committee ii Public Health (London) Act, 193669 Public Health (Meat) Regulations,1924 60 „„(Tuberculosis)Regulations,193024,25 Public Vaccinators33 Puerperal Diseases12, 18 Puerperal Fever and Pyrexia12, 18, 73 Polio-Myelitis, Acute20 Pulmonary Tuberculosis22-27 Rag and Bone Dealers47 Rag and Flock Act (1911-1928)41 Rats and Mice (Destruction) Act, 1919 46 Rateable Value iii Recommendations—Housing 49, 50 Reconditioning of Houses48 References—M.O.H. Reports93, 94 Rent and Mortgage Interest (Restrictions) Acts57 Representations of Medical Officer of Health47 Respiratory Diseasesiii, 14 „Tuberculosis13, 22, 23, 25 Restaurant Kitchens36, 60 Rooms Disinfected and Disinfested34, 35 Samples Analysed in 193664 Sanitary Inspectors' Work43 Scavenging39, 40 Scarlet Fever18, 19, 20 Scholefield Road Day85 Schools30, 46 Septic Diseases12 Sewer Emanations46 Shelter House35 Shops Act, 19345, 58 Shops, Inspections of59 Slaughterhouses58, 59 Slaughter of Animals Act, 193360 Small Pox16 Smoke Nuisances41 Social Conditions 69 Sophistication of Milk 66 Specialist Consultations 73 Staff ... ... 2 Statistics 3, 88 Still-Births, Registration 5 Street Accidents 15 Street Traders 60 Swimming Baths and Pools ... 58 Tetanus ... ... ... 12 Tuberculous Diseases iii, 12, 13, 22-28 Tuberculous Meat 59 Tuberculosis Care Committee 23, 24 Tuberculosis Dispensaries 26-28 Tuberculosis—Housing and Disinfection 25, 29 „ Notification of 22, 25 ,, Respiratory, All forms. Deaths iii, 12, 13 „ (Public Health) Regulations, 1930 ... 24, 25 „ Visiting Nurse ... 20 99 [1936 Page Typhoid Fever (see Enteric)18, 20 Underground Rooms48 Unemployment69 Unsound Food, Destroyed59 Unsound Food-Prosecutions60 Vaccination 32-34 vaccination (Public Vaccinators)33 Venereal Diseases14 Verminous Children, Disinfestation of36 „Premises and bedding35, 36 Vital Statistics—Summary iii ,,,,Extract3 Voluntary Maternity and Child Welfare Centres79-82 Water Certificates 41 Water Supply41 Welfare Work by Health Visitors76, 77 Whooping Cough3, 8 ,,(Deaths) 88, 89 Widows', Orphans' and Old Age (Contributory) Pensions Act,192542 Workshops and Factories, Inspection of 36-39 1 1