ISL 76 LIBRARY 1937 EIGHTY-SECOND ANNUAL REPORT ON THE Health and Sanitary Condition OF THE METROPOLITAN Borough of Islington. G. CLARK TROTTER, M.D., D.P.H., F.R.S.E. MEDICAL OFFICER OF HEALTH. Chief Executive Tuberculosis Officer; Chief Executive Officer under the Maternity and Child Welfare Act. London: Chas. Knight & Co., Ltd., Printers, Suffolk Lane, Cannon Street, E.C. 4. 1937 EIGHTY-SECOND ANNUAL REPORT ON THE Health and Sanitary Condition OF THE METROPOLITAN Borough of Islington. G. CLARK TROTTER, M.D., D.P.H., F.R.S.E. MEDICAL OFFICER OF HEALTH. Chief Executive Tuberculosis Officer; Chief Executive Officer under the Maternity and Child Welfare Act. London: Chas. Knight & Co., Ltd., Printers, Suffolk Lane, Cannon Street, E.C.4. ii MEMBERS OF THE PUBLIC HEALTH COMMITTEE (1st January to 31st December, 1937). Mayor. *Councillor GEORGE BRYANT NAISH, J.P., L.C.C. †Councillor Mrs. JESSIE LEONIE BLYTHE, J.P. AIdermen. *HERBERT SAMUEL JORDAN HERBERT JAMES LOWTON LYGOE Councillors. *WILLIAM AWCOCK, J.P. †GEORGE BENNETT, J.P. *STANLEY CECIL BOWERMAN *JOHN BRUCE †Mrs. GLADYS DOROTHY CANTWELL *HENRY JAMES EDWIN CARTER ‡*GEORGE WILLIAM ELMER †ALBERT EVANS *STANLEY BENJAMIN FIDOE ||WILLIAM HERBERT GALE WALTER HARPER †FREDERICK THOMAS HERRINGTON †WILLIAM GEORGE KEER ALFRED CECIL KNIGHT †PATRICK McCOLGAN †CHARLES EDWIN RATCLIFFE WILLIAM THOMAS RICKETTS †ALBERT JOHN ROGERS FRANK LEYDEN SARGENT *WILLIAM GEORGE SCOTT *ALBERT EDWARD SMITH *Mrs. MATILDA SOUTHGATE, J.P. †Mrs. MARGARET SUMMERS FRANK STONHAM †Mrs. ELIZABETH CLARA THURTLE EDWARD ALBERT WILLIS Chairman Alderman HERBERT JAMES LOWTON LYGOE Vice-Chairman. *Councillor HENRY JAMES EDWIN CARTER †Councillor CHARLES EDWIN RATCLIFFE *To November, 1937 †From November, 1937 ||Died 7th January, 1937 ‡Appointed 16th April, 1937 MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE (1st January to 31st December, 1937). Mayor. *Councillor GEORGE BRYANT NAISH, J.P., L.C.C. †Councillor Mrs. JESSIE LEONIE BLYTHE, J.P. Aldermen. †GWYN DAVID JONES †Mrs. JOSEPHINE JULIET JONES HERBERT JAMES LOWTON LYGOE Councillors. *Miss ELEANOR MARION ADAMS *Mrs. ROSE ANNIE ALLEN *WILLIAM AWCOCK, J.P. *Mrs. JESSIE LEONIE BLYTHE, J.P. †JOHN JEFFREY DENNISON BOWD Mrs. FLORENCE HILDA CANTWELL *Miss FLORENCE MARY ELIZABETH CLARKE *Mrs. MIRIAM PRICE COLEMAN *ARTHUR NORMAN DOVE GEORGE WILLIAM ELMER *Mrs. ROSA ESSEX †Mrs. AMY MERSEY GRIFFITHS WALTER HARPER †FREDERICK THOMAS HERRINGTON †Mrs. MARTHA RACHAEL JENNER *Miss ETHEL MARGARET LITTMAN WILLIAM JOHN MITCHELL †Mrs. HENRIETTA LOUISE REES †Mrs. CATHERINE STONHAM †Miss ADA MARIA THACKRAY †Mrs. ELIZABETH CLARA THURTLE ||LESLIE BRUCE VENNING HENRY BLOOMFIELD VORLEY, J.P. *EDWARD ALBERT WILLIS Members appointed by the Council from outside their own body. †Mrs. E. E. BAKER, 201, Junction Road, N.19. †Mrs. E. CHILDS, 3, Clayton Street, N.l. †Mrs. K. DOWSE, 27, Gordon Place, W.8. †Dr. A. V. INGRAM, 10, North Hill, N.6. *Mrs. M. R. JENNER, 58, Thornhill Road, N.l. *Mrs. J. J. JONES, 88, Aldington Mansions, Highbury Grange, N.5. †Mrs. F. G. JOSEPH, 53, Linden Gardens, W.2. †Mr. D. MOSS, 51, Holloway Road, N.7. *Mrs. H. L. REES, 28, Manchester Mansions, Sunnyside Road, N.19. †Mrs. E. SMITH, 33, Riversdale Road, N.5. *Mrs. C. STONHAM, 9. Aberdeen Road, N.5. †Mrs. N. WATT, 60, Highbury New Park, N.5. Chairman *Councillor Mrs. MIRIAM PRICE COLEMAN †Councillor Mrs. FLORENCE HILDA CANTWELL Vice-Chairman *Councillor Mrs. FLORENCE HILDA CANTWELL †Councillor GEORGE WILLIAM ELMER *to November, 1937 †from November, 1937. ||from 17th December, 1937 iii Public Health Department, Town Hall, Upper Street, N.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Madam 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 1937. Vital Statistics. The death-rate for the year was 12.90, which is calculated on the estimated population of the Registrar General—295,400. The infantile mortality rate was 66 per 1,000 births ; both these figures are slightly higher than the previous year, and it may be remembered that in 1935 we had the lowest figures up to then recorded, namely: death-rate 10.99, infantile mortality rate 52. A summary of statistics will be found on page 2. Infectious Disease. The principal notifiable infectious diseases were below the average taken on the figures for the previous ten years, puerperal fever being 21 below, as against 14 in the preceding year. Hospital isolation was taken advantage of to the extent of 96.1 of the notified cases. The hospital and ambulance services were adequate, both being provided by the London County Council. In connection with the occurrence of enteritis in an institution in the Borough, enquiries were made by the Officers of the Ministry of Health, and as a result of the investigations and recommendations, it is hoped that the possibility of further such occurrences may be obviated. Maternity and Child Welfare. The Miriam Price Coleman Day Nursery and Sunlight Clinic, Scholefield Road, was opened in October, and marks an advancement in Child Welfare, as hitherto the Borough Council, although it has subsidised similar institutions, had not a Municipal Day Nursery. Towards the end of the year the .Council had under consideration the establishment of a Maternity Emergency Unit, and the question of a Consultative Pre-natal and Post-natal Clinic, which would also deal in this connection with minor ailments of women. Housing. The Medical Officer of Health represented, for clearance, areas in Gaskin Street (late Church Street), and to be dealt with later by the Borough Council, areas in Cornelia Street, St. Clement Street, and City Garden Row. Five Demolition Orders were made in respect of premises, and underground rooms continued to be dealt with. During the year three retirements of members of the staff of the Public Health Department occurred, Mr. T. W. Agar, Sanitary Inspector for 35 years, and Mr. A. Lewis, Engineer, and Mrs. E. L. Lewis, Caretaker, at the Disinfecting Station. I should like to express my thanks to the Members of the Council, and especially to the Chairmen and Vice-Chairmen of the Committees, Public Health, Maternity and Child Welfare, and Housing, for the great interest taken in the work of my department during the year, and to the Assistant Medical Officer, t he Superintendent, and the members of my staff generally for the competent manner in which they have co-operated throughout the year. I have the honour to be, Your obedient servant, Medical Officer of Health. 1 [1937 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. (a, 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) (d) A. Moxon (c, d) W. C. Bartlett (c) I. W. Aiken Sanitary Inspectors. (c, d) H. R. Homewood (c, d) A. W. Haydock (Inspector of Meat) (c) N. Lightowlers (c) W. Riding (c, d) K. C. Holden (c, d) R. W. Norman (Dairies, etc.) (e) L. Nash (s, d) H. P. Price (c, d) J. W. S. Baxter (c, d) S. G. F. Ford (c, d) T. C. Hopkins 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 (6, e, f) Miss G. S. Lewis (Child Life Protection) (e, /, g) Miss E. Paley (e, /, g) Miss S. H. Prentice (g) Miss E. McGoldrick, Tuberculosis Visiting Nurse. (а)= Cert. Sanit. Inst. (e) — S.C.M. (b)= Cert. Sanit. Insp. Exam. Board (/) = Cert. H.V. (c)= Cert. Sanit. Insp. Exam. Joint Board (g) = S.R.N. (d)= Meat Inspector's Certificate. 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, N. A. Rogers, C. J. Moore, F. C. Green, A. E. Vanstone, Miss d. Francis, d. A. Owen (Temporary), Miss d. Egginton (Temporary). Vaccination Officers. J. Jennings L. Stevens Members of the Staff of the Miriam Miss K. S. Edwards Miss Nellie Elliott Miss Joyce Holland Miss Irene L. Bickell Miss Olive F. Richardson Miss Joan A. Woodhouse Miss Marjorie Hyde Mrs. Katherine Cant Mrs. Norton Mr. Furness Mrs. Mant Miss Beatrice Gammons Price Coleman Day Nursery. Matron, S.R.N., S.C.M. Senior Nurse, S.R.N., S.C.M. Kindergarten Teacher (part time) Senior Probationer Senior Probationer Junior Probationer Junior Probationer Cook Cleaner (Temporary) Part-time Assistant Caretaker Resident Domestic (Temporary) Domestic (Temporary) Disinfecting Station. W. Hampshire (Engineer), W. G. Jollie (Handyman Stoker), Mrs. N. Hampshire (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 Analyst. ALAN W. STEWART, D.Sc., 23, Queen's Square, W.C.1. Public Vaccinators (See page 39). Members of Staff of Public Health Department, retired in 1937. Mr. T. W. Agar Sanitary Inspector Mr. A. Lewis Engineer at Disinfecting Station Mrs. C. L. Lewis Caretaker, Shelter House 1937] 2 SUMMARY of Vital Statistics in the Registration Year, 1937. Population (Enumerated at Census, 1931) 321,795 persons ,, Estimated Mid-year 1937 295,400 persons Decrease on Census population, 1931 26,395 persons Mean Population, ten years (1927-1936) 317,267 persons Area 3,092 acres Density (Mid-year, 1937) 95.5 persons per acre Births Males 2,365 4,504 person Females 2,139 Birth rate 15.25 per 1,000 inhabitants Deaths from All Causes Males 1,875 1 Females 1,938 3,813 Persons Death Rate 12.90 per 1,000 inhabitants Deaths from Principal Epidemic Diseases Males 69 Females 51 120 Persons Death rate 0.40 per 1,000 inhabitants Deaths from Tuberculosis (all forms) Males 136 Females 92 228 person Death rate 0.77 per 1,000 inhabitants Deaths from Respiratory Tuberculosis Males 126 Females 77 203 persons Death rate 0.69 per 1,000 inhabitants Infantile Deaths under 1 year Males 168 Females 131 total 299 Infantile mortality rate 66 per 1,000 births Excess of Births over Deaths 691 Rateable value of Borough of Islington £2,219,712 Sum represented by a penny rate £8,988 Number of inhabited houses (approximate) 45,296 3 [1937 EXTRACT OF VITAL STATISTICS. Total. M. F. Live Births Legitimate 4,286 2,258 2,028 Birth Rate per 1,000 of the estimated Illegitimate 218 107 111 resident population, 15.25. Stillbirths 139 ... ... Rate per 1,000 total (live and still) births, 29.94. Deaths 3,813 ... ... Death Rate per 1,000 of the estimated resident population, 12.90. 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 9 1.94 No. 30. Other puerperal causes 5 1.07 Total 14 3.01 Death rate of infants under one year of age:— All infants per 1,000 live births 66 Legitimate infants per 1,000 legitimate live births 64 Illegitimate infants per 1,000 illegitimate live births 114 Deaths from Cancer (all ages) 515 ,, Measles (all ages) 1 ,, Whooping Cough (all ages) 18 ,, Diarrhoea (under 2 years of age) 69 POPULATION (ESTIMATED). The population at mid-year 1937 is estimated at 295,400 persons, a decrease in the population of 26,395, when compared with the number of inhabitants ascertained at the census in 1931. Social Conditions.—The year 1937 from the point of view of betterment in unemployment seemed to show some decided improvement, inasmuch as when employment was lost the workpeople seemed to be able in a shorter time than in former years to be able to get taken on sooner, and on the whole the workers seemed less depressed than formerly when they happened to lose their work, this changed attitude, no doubt, being due to the knowledge that work would be obtained again within a reasonable time. During the year it was noticed that there was much less hesitancy on the part of those out of work to make an application for milk under the Council scheme (Maternity and Child Welfare). Previously, even when out of work, the workers were very reluctant to apply. In the case of a small wage earner and a large family it was noticed that applications were made in greater numbers than before. The result of the greater consumption of milk distributed by the Council has been noted to be excellent where the grant has been made and continued for several months. If in certain unfortunate families the milk is continued for a very extended period the results are not so apparent, the improved condition being most noticeable in the earlier period in which the milk is given. Probably the general catering of such households is at fault; the other food, milk excepted, may not have been wisely chosen as regards its nutritive value. The problem of the education of the people in a simple and effective way as to what is best to buy in the way of food for the home is one on which health visitors are continually giving advice. It has been noted that the older people have a much better idea of what to buy than the younger generation. The men and women on the whole appear to be better nourished than in former years. The factory workers seem to be brighter than in the past few years; they do not seem under-nourished, are well groomed, and well dressed. I 1937] 4 am indebted, as in former years, to the Local Unemployment Exchange for figures showing the principal industries in the Borough of Islington and the numbers there registered as unemployed at the two exchanges. These figures are particularly interesting as showing in the various industries enumerated the number of men and women and juveniles who were unemployed during the 12 months ending midyear 1937. MID-YEAR 1937. (a) Number of workpeople, residing in the Borough of Islington, registered as unemployed at Holloway and King's Cross Exchanges. Men. Women. Juveniles. Total. Holloway Exchange 3,273 910 85 4,268 King's Cross Exchange 2,221 704 31 2,956 5,494 1,614 116 7,224 (b) Principal industries in the Borough of Islington. Building, General Engineering, Motor Engineering, Cabinet Making, Radio and Battery Making, Heating and Ventilating Apparatus Manufacturing, Metal industries, Pianoforte Making, Hotel and Catering, Laundries, Transport, Printing:, Dressmaking and Millinerv, Bakerv, Distributive. Principal industries in the Borough of Islington. Men. Women. Juveniles. . Building 3,819 34 105 3,958 General Engineering 955 103 305 1,363 Motor Engineering 361 29 55 445 Cabinet Making 1,354 134 230 1,718 Radio and Battery Making 2,364 3,454 620 6,438 Heating and Ventilating Apparatus Manufacturing 487 27 183 697 Metal Industries 624 631 372 1,627 Pianoforte 462 35 72 569 Hotel and Catering 942 1,346 69 2,357 Laundries 438 1,578 423 2,439 Transport 1,637 23 84 1,744 Printing. 1,010 469 290 1,769 Dressmaking and Millinery 74 862 254 1,190 Bakery 1,101 336 155 1,592 Distributive 5,750 3,782 1,633 11,165* *Shop assistants. MARRIAGES. Marriages, 2,987; Marriage Rate, 20.22.—There were 5,974 persons married, or 2,987 marriages in 1937, and the marriage rate, that is to say, the number of persons married per 1,000 of the population, was 20.22. Compared with the previous year these figures show an increase of 48 in the number of persons married, or of 24 marriages, and of 0 73 per 1.000 in the rate. The following statement shows the figures for the previous ten years, 1927-1936. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 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 1931 2,957 18.21 1936 2,963 19.49 5 [1937 BIRTHS. During the year there were 4,504 live births registered, of which 2,365 were boys and 2,139 girls. Of this number, 527 were "transfers in," that is, children of mothers whose usual residence is Islington, the births taking place in Lying-in Institutions and other homes outside the Borough. The annual birth-rate was equal to 15.25 per 1,000 of the population, as compared with a mean birth-rate of 16.34 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 1937 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 1936; together with the mean Borough Birth-rates for the 10 years 1927-36. Quarter. Males. Females. Total. Birth Rates. Islington, 1937. Islington, 1927-36. London, 1937. Great Towns, 1937. First 623 552 1,175 15.91 16.58 13.2 14.5 Second 636 595 1,231 16.66 16.78 14.3 16.1 Third 535 498 1,033 13.98 16.48 13.2 15.3 Fourth 571 494 1,065 14.42 15.35 12.5 13.8 The Year 1937 2,365 2,139 4,504 15.25 16.34* 13.3 14.9 1936 2,415 2,309 4,724 15.24 16.68 13.6 14.9 Increase or decrease - 50 -170 — 220 + 0.01 - 0.34 - 0.3 — N.B.—The total registered births given by the Registrar-General for the Calendar year, 1937, will be found at the foot of table on p. 101. *Mean annual birth-rate for preceding 10 years. Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1937, 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 195 180 375 50.2 57 47 104 14.8 34 23 57 8.3 46 62 108 11.8 2nd ” 228 197 425 56.9 45 42 87 12.4 34 31 65 9.5 46 52 98 10.7 3rd ” 169 162 331 44.3 40 37 77 10.9 38 31 69 10.1 69 49 118 12.8 4th ” 201 179 380 50.9 49 53 102 14.5 30 24 54 7.9 54 33 87 9.5 Year 793 718 1,511 50.58 191 179 370 13.17 136 109 245 8.96 215 196 411 11.20 Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1937, and in the several Sub-Registration Districts—contd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females Total. Birth rates. Males. Females 1 Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 101 84 185 13.7 90 66 156 12.8 100 90 190 10.7 623 552 1,175 15.91 2nd 102 104 206 15.3 81 81 162 13.3 100 88 188 10.6 636 595 1,231 16.66 3rd 77 72 149 11.1 48 57 105 8.6 94 90 184 10.4 535 498 1,033 13.98 4th 65 58 123 9.1 69 61 130 10.6 103 86 189 10.6 571 494 1,065 14.42 Year 345 318 663 12.30 288 265 553 11.34 397 354 751 10.58 2,365 2,139 4,504 15.25 1937] 6 Illegitimate Births.—The illegitimate births numbered 218 and show a decrease of 4 on the return of the year 1936. They were equal to a rate of 4.7 per cent. of the total registered births. Notification of Births.—3,905 live births were notified under the Public Health (London) Act, 1936 (exclusive of 92 stillborn), or 87 per cent. of the total number that were registered during the year. Notified by : Doctors. Midwives. Parents and other Persons. Total. Alive. Stillborn. Alive. Stillborn. Alive. Stillborn. Alive. Stillborn. 1937. 1st Quarter 411 13 461 8 124 3 996 24 2nd „ 434 12 466 9 102 2 1,002 23 3rd ” 408 13 463 11 74 2 945 26 4th „ 501 15 375 4 86 — 962 19 Year 1,754 53 1,765 32 386 7 3,905 92 REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still-born). 1937. 1st Quarter 28 1 3 32 26.5 2nd ,, 31 8 — 39 30.7 3rd „ 31 1 — 32 30.0 4th „ 23 8 5 36 32.7 Year 113 18 8 139 29.94 The above are the corrected figures. The actual number of stillbirths registered in Islington was 108, plus 49 which took place outside the Borough, but belonging to it, minus 18 non-residents which took place in the Borough. DEATHS. The deaths registered during the year numbered 3,813 (exclusive of still-births), while the death-rate was equal to 12.90 per 1,000 of the estimated population, or 0 46 above that of the previous year (12.44), and 0.29 above the mean of the preceding ten years; whilst the death-rate of England and Wales was 12 4 and the 121 Great Towns 12.5. The Deaths and Death-rates from All Causes in the Sub-Registration Districts were as follows:— Sub-Districts. Quarters. The Year. 1 2 3 4 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Tufnell 147 19.7 85 11.3 56 7.5 84 11.2 372 12.45 Upper Holloway 152 21.6 79 11.2 67 9.5 103 14.7 401 14.28 Tollington 148 21.6 80 11.7 62 9.1 100 14.6 390 14.26 Lower Holloway 149 16.2 105 11.4 77 8.4 98 10.7 429 11.69 Highbury 236 17.6 154 11.4 147 10.9 178 13.2 715 13.30 Barnsbury 211 17.3 123 10.1 106 8.7 131 10.7 571 11.71 Islington (South. East) 345 19.4 206 11.6 167 9.4 217 12.2 935 13.17 The Borough 1,388 18.79 832 11.27 682 9.23 911 12.33 3,813 12.90 7 [1937 Showing the Deaths and Death Rates of Islington in 1937, 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 1927-36 and the deaths and death-rates in the year 1936. Quarter. Males. Females Total. Death Rates. Islington, 1937. Islington, 1927-36. London, 1937. Great Towns, 1937. First 669 719 1,388 18.79 17.18 16.4 16.1 Second 414 418 832 11.27 11.38 10.9 110 Third 330 352 682 9.23 9.35 8.9 9.2 Fourth 462 449 911 12.33 12.32 12.4 12.2 The Year 1937 1,875 1,938 3,813 12.90 12.61* 12.3 12.5 1936 1,982 1,874 3,856 12.44 12.53 12.5 12.3 Increase or decrease - 107 + 64 - 43 + 0.46 + 0.08 - 0.2 + 0.2 *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, Mean Deaths Increase or Decrease 1937. (10 years, 1927-36.) on mean. 0-1 year 299 329 — 30 1-5 years 75 167 - 92 Under 5 years 374 496 - 122 5-15 ” 37 86 - 49 15-25 ” 91 135 - 44 25-35 ” 153 174 - 21 35-45 ” 172 225 - 53 45-55 ” 375 411 - 36 55-65 ” 641 672 - 31 65-75 ” 922 860 + 62 75-85 „ 799 734 + 65 85 upwards 249 208 + 41 All Ages 3,813 4,001 — 188 There was a decrease of 122 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 5-65 years, were also below the decennial average. The deaths of aged people between the age period 65 years and upwards showed an increase of 72 in the number of deaths when contrasted with the previous year 1936, and 168 above the ten years' average (1927-36). It is of interest to note that two residents, both widows, lived for over 100 years, one dying at the age of 103 years. INFANTILE MORTALITY. Infant Deaths, 299; Mortality Rate, 66.—The deaths of 299 infants under twelve months old were registered during the year, or 30 below the decennial average (329), and they were equal to the infantile rate of 66 per 1,000 births. The rate was 3 per 1,000 births above the mean annual record of the preceding ten years, and is 5 per 1,000 above the rate of last year (1936). 1937] 8 In the quarters the mortality ranged from 94 per 1,000 births in the first quarter, 57 in the second, 45 in the third, and 66 in the fourth. In the sub-registration districts the infant mortality was as follows:— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 43 28 Upper Holloway 26 70 Tollington 41 167 Lower Holloway 54 131 Highbury 36 54 Barnsbury 42 76 Islington South East 57 76 In London the infantile mortality was 60 per 1,000 births. The rate for England and Wales was 58 per 1,000 births. Infantile Mortality during each of the Ten Years 1927-36, and 1937. 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 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 1936 89 11 11 11 122 34 57 42 36 291 61 Mean 10 years 95 13 12 10 130 53 57 51 38 329 63 1937 89 13 4 16 122 39 59 50 29 299 66 Increase or decrease on mean - 6 - - 8 + 6 - 8 -14 + 2 - 1 - 9 -30 + 3 Showing the Deaths among Infants per 1,000 Births during the Year 1937, and also the mortality rates for the Years 1927-1936. Sub-Districts. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Mean 10 years. 1937 Increase or decrease on mean Tufnell 52 65 75 78 43 48 26 31 31 26 47 28 - 19 Upper Holloway 31 44 42 26 35 30 54 52 30 78 42 70 + 28 Tollington 63 85 71 106 90 88 101 78 51 83 82 167 + 85 Lower Holloway 74 77 95 57 84 77 68 81 98 104 81 131 + 50 Highbury 52 47 60 58 64 83 51 58 52 85 61 54 - 7 Barnsbury 59 75 87 95 66 76 80 76 85 77 77 76 - 1 Islington, S.E. 49 67 78 76 68 72 72 69 41 49 64 76 + 12 The Borough 53 64 73 70 64 68 63 62 52 61 63 66 + 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. 9 [1937 Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1927-36: and. in 1937 from certain specified causes. Causes of death. 1937. Rate per 1,000 Births. Mean rate 10 years 1927-36 per 1,000 Births. Difference. Premature Birth and Congenital Defects 19.5 20.2 - 0.7 Bronchitis and Pneumonia 16.4 12.7 + 3.7 Atrophy and Marasmus 1.3 2.7 - 1.4 Diarrhoeal Disease (all forms) 14.2 5.6 + 8.6 Convulsions — 0.8 - 0.8 Whooping Cough 2.4 2-9 - 0.5 Measles — 2.6 - 2.6 Diphtheria 0.2 0.3 - 0.1 Phthisis - 0.2 - 0.2 Other forms of Tuberculosis 0.4 0.6 - 0.2 Total of above 54.4 48.6 + 5.8 All other causes 11.8 14.7 - 2.9 Total 66.2 63.3 + 2.9 INFANTILE MORTALITY during the Year 1937. 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. deaths under 1 year 1-2 2-3 3-4 4 weeks & under 3 mths. 3-6 6-9 9-12 All causes Certified - - - - - - - - - - Uncert'd - - - - - - - - - - Small-pox - - - - - - - - - Chicken-pox - - - - — - - — — — Measles - - - - - - - — — — Scarlet Fever - - - - — - - — — — Whooping-Cough - — — — — 3 1 2 5 11 Diphtheria & Croup - - - - - - 1 - - 1 Erysipelas - — — — — — - 1 — 1 Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis (b) - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - 1 — 1 2 Meningitis (not Tuberculous) - - - - - - 1 3 - 4 Convulsions - — — — — — - — — — Laryngitis. - — — — — — - — — — Bronchitis - — — — — 3 1 — — 4 Pneumonia (all forms) 6 5 - 1 12 10 15 18 15 70 Diarrhoea — — — — — — — 1 — 1 Enteritis — — 4 4 9 22 22 6 63 Gastritis — — — — — — — — — Syphilis 1 — — — 1 2 1 — — 4 Rickets — — — —, — — — — — — Suffocation, overlying - - - - - - - - - - Injury at birth 8 1 — 1 10 — — — — 10 Atelectasis 10 — 1 — 11 — — — — 11 "Congenital Malformations (c) 8 1 1 2 12 - 5 1 - 18 Premature birth 51 4 1 7 63 5 2 — — 70 Atrophy, Debility and Marasmus - - - - - 4 2 - - 6 Other causes 5 2 1 1 9 3 7 2 2 23 TOTALS 89 13 4 16 122 39 59 50 29 299 Nett Births legitimate 4,286 4,504 Nett Deaths in legitimate infants 274 299 in the year illegitimate 218 the year illegitimate infants 25 Report on Maternity and Child Welfare work, see pages 76-98. 1937] 10 Deaths in Public Institutions in the Borough during 1937 and 1936. Institutions. 1937. 1936. Residents. NonResidents. Total Residents. Residents. Total. Archway Hospital 215 474 689 106 547 653 Royal Northern Hospital 88 201 289 102 209 311 London Fever Hospital — 37 37 — 40 40 St. Mary, Islington, Hospital 1,180 58 1,238 1,139 46 1,185 Islington Institution 152 45 197 162 37 199 Mildmay Memorial Hospital 22 21 43 23 22 45 Other smaller Institutions 22 47 69 16 41 57 Totals 1,679 883 2,562 1,548 942 2,490 Percentage of Borough Mortality 440 — — 40.1 — — Deaths in Public Institutions outside the Borough of persons resident in Islington. 1937. 1936. North Western Fever Hospital 31 49 North Eastern Fever Hospital 9 29 Eastern Fever Hospital 17 22 Children's Hospital, Great Ormond Street. 10 14 St. Bartholomew's Hospital 30 44 Royal Free Hospital 47 60 University College Hospital 37 51 City of London Maternity Hospital 7 7 Metropolitan Hospital 8 16 The Infirmary, Friern Barnet 6 22 Middlesex Hospital 20 16 la, Manor Road, Ilford (Claybury) 19 10 Tooting Bee Hospital 29 31 Other Institutions 643 720 Totals 913 1,091 Percentage of Borough Mortality ... 23-9 28-3 Fatal Accidents and Sudden Deaths outside the Borough.—27 inhabitants died from accidents, or suddenly, in places outside Islington. Transferable Deaths.—During the year 60 deaths of residents that had occurred in outlying Institutions and other places in Provincial Boroughs were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Fevers— Typhus, Enteric and Continued—and Diarrhceal Diseases. During the year 120 persons died from these diseases, the death-rate being 0.40 per 1,000 inhabitants, as contrasted with 0.65 in 1936, and a decennial average mortality of 163 and a death-rate of 0.51 per 1,000. In London the death-rate from epidemic diseases was 0.29. 11 [1937 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 1937. SubRegistration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Enteritis and Diarrhoea. Totals. Tufnell Tufnell - - - 1 1 2 12 16 Up. Holloway Up. Holloway - - - - - 2 8 10 Tollington Tollington - - - - 1 5 13 19 Lr. Holloway Lr. Holloway — — — — 2 2 17 21 Highbury Highbury — — 1 — — 2 6 9 Mildmay — — — — 4 1 5 10 Barnsbury Thornhill 1 - — — 1 1 4 7 Barnsbury - - - 1 3 1 4 9 Islington South East St. Mary's - - - - 4 1 2 7 Canonbury — - — — 2 2 2 6 St. Peter's — - — 1 — 1 4 6 The Borough 1 — 1 3 18 20 77 120 Total Death Rates — — — 0-01 0 06 0-07 0-26 0-40 Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1927-36 and for the Year 1937. 1927 1928 1929 1930 1931 1932 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. .Deaths. Death Rates. Enteric Fever - - 2 0.00 2 0.01 . . . . . . Small Pox — . — . . . 1 0.00 . . — — Measles 29 0.09 156 0.48 11 003 140 0.43 7 0.02 52 0.16 Scarlet Fever 8 0.02 8 0.03 8 0.03 14 0.04 4 0.01 7 0.02 Whooping Cough 45 0.14 21 0.06 126 0.39 10 0.03 32 0.10 23 0.07 Diphtheria 25 0.07 25 0.08 32 0.10 42 0.13 15 0.04 20 0.06 Diarrhoea and Enteritis (under 2 years) 48 7.79 per 1,000 births 67 11.57 per 1,000 births 68 12.34 per 1,000 births 97 17.1 per 1,000 births 67 12.7 per 1,000 births 731 14.7 per 1,000 births 1933 1934 1935 1936 Mean 10 years 1937 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 1 0.00 Small Pox Measles 14 0.04 39 0.12 - — 58 0.19 50 0.16 1 0.00 Scarlet Fever 4 0.01 5 0.02 - — 7 0.02 6 0.02 3 0.01 Whooping Cough 23 0.07 15 0.05 9 0.03 18 0.05 32 0.10 18 0.06 Diphtheria 33 0.10 32 0.10 13 0.04 31 0.10 27 0.08 20 0.07 Diarrhoea and Enteritis (under 2 years) 63 13.7 per 1,000 births 47 10.2 per 1,000 births 65 14.2 per 1,000 births 84 17.8 per 1,000 births 68 13.2 per 1,000 births 69 15.3 per 1,000 births 1937] 12 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. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Ages. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea, Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals Under 1 year 1 24 25 - 10 10 - 18 18 - 11 11 1 63 64 1 to 5 years — — — - 2 2 - 1 1 — 2 2 - 5 5 Over 5 years — — — - — — - 4 4 — 4 4 - 8 8 Totals 1 24 25 — 12 12 — 23 23 — 17 17 1 76 77 INFLUENZA. Influenza caused 142 deaths during the year and showed an increase of 108 on the return for the year 1936, and were 54 above the average of the preceding ten years 1927-36. The death-rate was equal to 0.48 per 1,000 inhabitants. Showing the Deaths from Influenza in the Quarters of the Year 1937, together with the averages of the corresponding periods, 1927-36. Years. Quarters. Totals. First. Second. Third. Fourth. 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 1936 15 10 1 8 34 Average 68 10 2 8 88 1937 128 3 — 11 142 Increase or Decrease ... + 60 - 7 - 2 + 3 + 54 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 1937. Ages. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Mean 10 yrs. 1937 Difference. O- 5 8 3 5 1 4 5 4 3 1 3 6 + 3 5-10 4 1 1 — — — — 1 1 — 1 — - 1 10-15 1 15-25 3 3 2 4 3 3 — 3 — 2 2 — 25-35 13 1 9 4 9 10 2 — 5 5 3 - 2 35-45 21 6 19 — 14 4 24- 1 3 3 10 5 - 5 45-55 22 4 38 5 16 10 27 6 3 4 14 17 + 3 55-65 28 6 43 3 16 18 32 5 6 7 16 36 + 20 65-75 34 7 52 2 15 25 33 11 8 9 20 38 + 18 75 & upwards 18 10 38 5 17 29 37 13 2 5 17 35 + 18 All Ages 152 41 207 16 90 103 170 39 29 34 88 142 + 54 13 [1937 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the notifiable diseases of this class. Erysipelas.— 6 deaths were returned from this disease, or 4 less than in the year 1936, and 10 below the average of the preceding ten years 1927-36. Puerperal Diseases.— These comprise Puerperal Pyaemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 14 deaths, this being 6 above the number (8) in 1936, and were 4 above the average of the ten years 1927-36. The death-rate was equal to 3.01 per 1,000 births. Anthrax, Glanders or Farcy, Tetanus, etc.— One death from Anthrax was recorded during 1937. INDUSTRIAL DISEASES. Lead Poisoning, Chrome, etc.— No death from any of these causes was recorded. CANCER. Cancer.—515 deaths were registered from this malignant disease during the year compared with 554 in 1936, and with an average of 508 in the previous decennium. The deaths represent a death-rate of l.74per 1,000 of the civil population and is 0.14 above the average rate (1.60) of the last ten years; 243 deaths occurred among males and 272 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 1937:— Ages. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Mean 10 yrs. 1937 Difference. 0-5 1 - 3 2 - 2 2 1 3 2 1 - - 1 5-15 — — 1 — 3 1 1 1 2 1 1 1 — 15-25 1 3 1 1 1 2 3 - 1 3 1 1 — 25-35 5 14 10 6 10 12 9 11 13 13 10 7 - 3 35-45 24 36 22 26 25 19 23 24 24 25 25 23 - 2 45-55 74 83 84 72 85 78 84 83 45 69 76 72 - 4 55-65 137 147 153 123 138 157 160 160 149 168 149 133 -16 65-75 135 155 106 139 167 158 146 200 162 181 155 168 + 13 75-85 65 71 81 90 83 92 70 87 75 85 80 95 + 15 85 & upwards 7 9 10 8 7 13 11 10 15 7 10 15 + 5 Totals 449 518 471 467 519 534 509 577 489 554 508 515 + 7 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1937. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 11 11 16 16 27 25 38 144 Second 12 12 8 11 28 19 30 120 Third 8 18 9 12 27 15 37 126 Fourth 12 10 11 13 30 17 32 125 The Year 43 51 44 52 112 76 137 515 TUBERCULOSIS. Tuberculosis caused 228 deaths, which were 77 below the average of the last decennium, and were 6 below the number registered in 1936. The death-rate resulting from them was equal to 0.77 per 1,000 of the civil population, and represented 5.98 per cent. of the deaths from all causes during the year. 1937] 14 Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 203 deaths, as contrasted with the decennial average of 270, while the death-rate was 0.69 per 1,000 of the civil population as against the decennial rate of 0.85 per 1,000. There was a decrease of 67 on the ten years' average number of deaths, and of 0.16 on the mean death-rate. Tuberculosis (Respiratory System). Y ears. Deaths. Death rates per 1,000 inhabitants. Proportion of Deaths from Tuberculosis per 100 Deaths from All Causes. Death rates from all Causes per 1,000 inhabitants. 1927 314 0.94 7.61 12.3 1928 309 0.95 7.43 12.8 1929 314 0.98 6.59 14.8 1930 280 0.86 7.03 12.1 1931 281 0.87 6.85 12.6 1932 264 0.81 6.58 12.4 1933 274 0.86 6.92 12.4 1934 253 0.81 6.80 11.8 1935 202 0.65 5.96 10.9 1936 210 0.68 5.44 12.4 Average 10 years 270 0.85 6.75 12.6 1937 203 0.69 5.32 12.90 The following return gives the deaths at each age period:— Age Periods. Males. Females. Total. 0-5 - - - 5-15 - - — 15-25 12 13 25 25-35 35 20 55 35-45 14 19 33 45-55 28 10 38 55-65 21 9 30 65 upwards 16 6 22 Total 126 77 203 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1937. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 6 8 10 11 9 10 9 63 Second 4 6 4 5 8 11 11 49 Third 5 3 2 2 5 10 10 37 Fourth 7 10 1 3 10 9 14 54 The year 22 27 17 21 32 40 44 203 Showing the Deaths from all forms of Tuberculosis during 1937. 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 - - 203 126 77 22 27 17 21 32 40 44 203 Meningeal - 6 5 5 6 1 1 - 1 - 1 7 11 Abdominal - - 1 1 - 1 - - - - - 1 General 1 — 1 1 1 1 - - - - - 1 2 Other forms 1 1 9 4 7 1 — 3 3 2 — 2 11 All Tuberculosis 2 7 219 136 92 25 29 20 25 34 41 54 228 15 [1937 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 731 deaths, 108 above that of 1936. They were equal to a death-rate of 2.47 per 1,000 of the civil population, and represented 19 2 per cent. of the total deaths registered in the Borough. Acute Bronchitis.— There were 88 deaths as compared with 59 in the previous year, 35 occurred among males, and 53 among females. The deaths of 3 infants under 12 months were registered. Chronic Bronchitis.— 142 deaths were ascribed to it, 70 being males and 72 females. This return is 8 above that of 1936. Pneumonia (all forms).— 418 deaths were registered, of which 216 were males and 202 females, and were 81 above the year 1936. 67 infants under a year old died from this disease, while between the ages of 1 and 5 years 27 deaths were recorded. Above 5 years of age the deaths numbered 324. 318 deaths occurred in Public Institutions, of which number 239 occurred in Institutions situated in Islington. Pleurisy,— 8 deaths were registered from this disease, 6 of which occurred in Public Institutions. Asthma and Emphysema,— 4 deaths were recorded from Asthma, and 1 from Emphysema. Other Diseases of the Respiratory System.— 71 deaths were registered, as contrasted with 82 in 1936. VENEREAL DISEASES. Eighteen deaths were ascribed to these diseases, 6 more than last year. Of these, 12 were males and 6 females. They were 2 above the mean deaths (16) of the preceding ten years 1927-36. The three groups of ages at death were as follows:— Under 1 year, 4 deaths; 1-5 years, no death; and over 5 years, 14 deaths. The nearest treatment centres for 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 from the Public Health Department, and if desired the Medical Officer of Health personally advises applicants as to what they should do to secure the necessary confidential treatment. 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 notes on the work of the Local Branch in 1937:— "Our activities have been somewhat limited by the adoption of a three-year plan, but the following engagements are recorded:— (i) Capt. Buckley, the official organiser, addressed the Rotary Club in Islington on the specific work of the British Social Hygiene Council. 1937] 16 (ii) Open air meetings at Highbury Corner were held by Capt. Buckley which were attended by audiences varying from 100 to 150 persons, who listened attentively to the details of the work, the particulars and purposes of the British Social Hygiene Council. (iii) It is proposed to terminate the year's work with two meetings, one for women at the Central Library, Holloway Road, and the other for men at the Caledonian Road Baths ; the speaker at the women's meeting being Miss M. H. Bennett, and at the men's meeting, Dr. Robert Forgan, D.P.H." DEATHS FROM COAL-GAS POISONING. During the year, 21 deaths, 12 males and 9 females, were registered from asphyxia caused by the inhalation of carbon monoxide gas. Twenty of these deaths were attributable to suicide and one was accidental. In 1936 the same number of deaths (21) was registered from this cause. ACCIDENTAL DEATHS. The deaths of Islington residents due to accident numbered 92. Of this number 35 deaths were ascribed to vehicular traffic and may be summarised as follows:— Motor Car Other or Lorry. Bus or Tram. Taxi-Cab. Vehicles. Total 27 6 Nil 2 35 Of this number, 26 deaths occurred to Islington residents when in outlying districts. In addition to these, 8 non-residents were killed by vehicles within the Borough. CORONER'S COURT, INQUESTS AND MORTUARY. During the year 33 bodies were received into the Mortuary, as compared with an average of 159 in the preceding 10 years. No inquest was held, as contrasted with an average of 93 in the ten years 1927-36. Year. Bodies received into Mortuary. Inquests. 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 1936 32 Nil Average 159 93 1937 33 Nil 17 [1937 PREVENTION OF INFECTION. Notification, Isolation, Fatality, of Specified Diseases under the Provisions of the Public Health (London) Act, 1936. The Principal Diseases Include:— Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus, Continued Fever, Puerperal Fever and Erysipelas. 1,527 cases of the principal diseases which are notifiable under the Public Health (London) Act, 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 22. No case of Typhus, but one case of Continued Fever, was notified. The total cases notified are 23 more than those of the previous year (1,504), and 575 below the average (2,102) 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 324, 151, 2, 6 and 21 below the average. The 1,527 cases were equal to an attack-rate of 5.7 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. 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 1936 1,504 4.84 Average 2,102 6.54 1937 1,527 5.17 Registration Sub-Districts.—The total number of cases notified in these districts was as follows:— Total cases notified. Tufnell 126 Upper Holloway 137 Tollington 192 Lower Holloway 195 Highbury 224 Barnsbury 308 Islington South-East 345 Total 1,527 Small Pox.— No case was notified in 1937 or during the preceding year. Diphtheria was responsible for 619 cases of illness, which were 151 below the average (770) of the preceding ten years. The attack rate was equal to 2.10 per 1,000 of the civil population annually, and was 0.33 below the mean rate (2.43) of the decennial period. In London the attack rate was 1.93 per 1,000. 1937] 18 DIPHTHERIA ANTI-TOXIN. The Minister of Health continued to sanction the provision—by the Sanitary Authority, now under Section 227 of the Public Health (London) Act, 1936—of a temporary supply of Diphtheria Anti-Toxin "for the poorer inhabitants of the district, subject to the following conditions, that is to say, the arrangements with respect to the keeping, distribution and use of the Diphtheria Anti-Toxin shall be made in accordance with the advice of the Medical Officer of Health." The section of the Public Health Act referred to is that which enables the authority, with the sanction of the 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 24,000 units were sold, the total amount received by the Council being £1 5s. 2d. The remaining 10,000 units were given free owing to the patients' limited means. DIPHTHERIA PREVENTION. Report of Assistant Medical Officer of Health. Very considerable progress has to be recorded in this field of preventive work during the year 1937. A large increase in the number of applications from parents who desire to have their children immunised has to be recorded, and this increase developed at such a rapid rate during the latter half of the year that it became necessary to hold two clinic sessions per week in order to deal with the large numbers applying. The notice by which the London County Council Education Department agreed to this Council's leaflets on Diphtheria Immunisation being distributed to their schools was published in the L.C.C. Gazette of 11th January, 1937. Since leaflets are apt to go astray or get lost sight of, a number of Consent Cards were also distributed through the schools so that the parent could give his consent and notify the Public Health Department immediately after having read the leaflet. Schools in various parts of the Borough have been circulated from time to time and the response was good in many cases. Later in the year the children's Out-patient Departments of the following hospitals also agreed to give publicity by means of leaflets to this Council's Immunisation Clinic. These hospitals are:— Royal Northern Hospital. St. Bartholomew's Hospital. University College Hospital. Great Ormond Street Children's Hospital. Royal Free Hospital. Elizabeth Garrett Anderson Hospital. Since the necessity for immunisation arises when the child is about 12 months' old, it was also decided that all Islington children upon attaining their first birthday should be sent a birthday greeting card from the Medical Officer of Health, together with a general advice card on normal development and feeding, etc., and an Immunisation leaflet drawing the attention of parents at this stage to the protection which can be afforded against Diphtheria at a susceptible age. This has produced a very good response indeed, and a large number of applications come from parents whose children are just over a year old. As mentioned previously the number of applications increased very rapidly during the latter half of the year, and it became necessary to consider a second clinic session per week. The premises of the Miriam Price Coleman Day Nursery 19 [1937 in Scholefield Road became available in October, and it was decided that since a considerable proportion of requests came from the Northern part of the Borough, this would justify the extra clinic session being held in the Nursery building. This arrangement proved very convenient to a considerable number of parents and the percentage of absentees at this clinic is very small indeed. The other clinic is continued as arranged in the first place at the Town Hall. During the year there are also to be recorded two minor outbreaks in the Northern part of the Borough. In the early autumn the occurrence of a succession of cases of Diphtheria in an Institution for girls caused considerable anxiety to those in charge of the home, and the Public Health Department was asked to advise. Following an investigation, the whole of the girls and staff to the number of 51 were Schick-tested at the Town Hall, and the susceptible ones as discovered by the test were given immunising injections by the Medical Officer to the Home. Swabbing also indicated several possible carriers and these were isolated and one case removed to hospital until they were certified to be free of virulent germs. During the latter part of the Autumn an undue proportion of cases of Diphtheria occurred in one of the Council's blocks of flats. As soon as this became apparent the attention of every single family with children in this block was drawn to the Council's facilities for protection. As a result of this, together with the enthusiastic co-operation of Miss Keith, the Assistant Housing Manager, Consent Cards were returned for 115 of the children residing in the flats, i.e., approximately 50 per cent. The material used for the large majority of children is Alum Precipitated Toxoid in two doses. In the case of older children and those showing undue re-action after the first injection of A.P.T., Toxoid Anti-toxin Floccules is used as the immunising agent. All cases, of course, are post Schick-tested, but only the older children are Ante Schick-tested. The report of the work done at the Immunisation Clinics is presented below:— DIPHTHERIA IMMUNISATION CLINICS. Report for Year 1937. Total number of sessions— 46 at Town Hall, 5 at Miriam Price Coleman Day Nursery 51 Total attendances at clinics 2,026 Average attendance per session 39'7 New cases commenced 518 Cases immunised and completed 281 Children Schick-negative after two injections 276 Children Schick-positive after two injections and Schick- negative after three injections 5 Children ante-Schick-tested and found positive 145 Children ante-Schick-tested and found negative 105 Cases commenced elsewhere and referred to I.B.C. for completion 31 Number of children who contracted Diphtheria (a) After injections, but before re-Schick test 1 (b) After a negative finding Nil Age Group Summary of Cases Immunised and Completed. 1-4 years 155 5 and 6 years 87 7 years and over 39 Total 281 1937] 20 Scarlet Fever,— 723 cases were notified, and they showed a decrease of 324 on the average (1,047) of the ten years 1927-36. The attack-rate was equal to 2.45 per 1,000 of the civil population annually, which is a decrease of 0.85 per 1,000 of the mean rate (3.30) of the preceding ten years. In London the attack-rate was 2.09 per 1,000 of the civil population. Enteric Fever.— 12 cases of Enteric Fever were notified. This is a decrease of 2 on the average (14) that obtained during the ten years 1927-36. The attackrate was 0.04 per 1,000 annually, which is the same as the mean rate (0.04) of the last ten years. In London the rate was 0'05. In November, as a result of the Croydon outbreak in October onwards, notices regarding alleged workmen contacts were received from the Croydon Health Department. Each of these was followed up and the persons kept under observation by re-visitation. The matter was the subject of a special report presented by the Medical Officer of Health to the Public Health Committee on the 29th November, 1937. Puerperal Fever.— See pages 13 and 89. Erysipelas,— 151 cases were notified, and were 6 below the average of the preceding ten years, the attack-rate being 0.51 per 1,000 of the civil population. FATALITY FROM THE PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES. By "Fatality" is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that of the 1,527 cases notified, 38 deaths occurred or 2.4 per cent., which contrasts with an average percentage of 2.6 in the preceding ten years 1927-36. Years. Cases. Deaths. Fatality. 1927 1,813 55 3.0 1928 2,260 60 2.7 1929 2,439 57 2.3 1930 3,057 80 2.6 1931 2,111 43 2.0 1932 1,962 50 2.7 1933 2,016 67 3.3 1934 2,227 65 2.9 1935 1,639 30 1.8 1936 1,504 57 3.1 Mean 2,103 56 2.6 1937 1,527 52 2.4 Hospital Isolation.— Of the 1,527 cases of infectious disease notified, 1,468 were isolated in hospital, equal to a percentage of 96T, while only 3.9 per cent. of the patients were nursed at home. 21 The following tabular statement shows the number of cases treated in the various public institutions :— Year. Cases treated in Hospital. Percentage of cases treated. 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 1937 1,468 96.1 In December a communication was received from the Medical Officer of Health of the London County Council regarding the utilisation of the hospital accommodation to the greatest advantage in view of the difficulty of securing hospital nurses and the selection for admission of cases of Scarlet Fever, Measles, Whooping Cough, and Dysentery. Particular cases of these diseases were to be chosen, having regard to the severity of the case and the home conditions, and particularly in the case of Measles, the selection of children under two years of age be recommended owing to the high mortality at this early age. Only under very exceptional circumstances was it considered that Chicken Pox, Rubella, or Mumps, should be admitted. Up to the end of the year, effects of the change had not made themselves felt, but the results will be reported on from the experience gained during the following vear. DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated in Hospital. Percentage of known cases. Scarlet Fever 723 711 98.3 Diphtheria 623 622 99.8 Enteric Fever 12 12 100.0 Erysipelas 151 107 70.8 Puerperal Fever 17 15 88.0 Continued Fever 1 1 100.0 1,527 1,468 96.1 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 1937. 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 711 12 723 98.3 1.7 3 - 3 0.4 . 0.4 Diphtheria 622 1 623 99.8 0.2 20 - 20 3.2 3.2 Enteric Typhoid Fever 12 - 12 100.0 - 1 - 1 8.3 - 8.3 Erysipelas 107 44 151 70.8 29.2 5 1 6 3.3 0.7 4.0 Puerperal Fever 15 2 17 88.0 12.0 8 - 8 47.0 - 47.0 Continued Fever 1 - 1 1000 - - - - - - - Total 1,468 59 1,527 961 3.9 37 1 38 2.4 0.0 2.4 1937 22 1937 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1927-36 and in 1937. DISEASES. YEARS. † Average number of cases, 1937 Increase or Decrease. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1927-36 4 Smallpox Cases - 4 71 244 66 162 11 70 - - - - Rate - 0.01 0.22 0.75 0.21 0.50 0.03 0.22 - - - - - Diphtheria Cases 716 756 1004 1242 710 598 547 811 760 583 770 619 -151 _ Rate 214 2.33 314 3.81 2.19 1.84 1.72 2.58 2.46 1.88 2.43 2.10 -0.33 Membranous Croup Cases 4 4 4 6 4 3 4 4 2 1 2 4 - 2 _ Rate 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 - Scarlet Fever Cases 909 1305 1155 1310 1093 983 1220 1089 716 760 1,047 723 -324 _ Rate 2.72 4.02 3.61 4.02 3.37 3.03 3.82 3.49 2.32 2.45 3.30 2.45 -0.85 Enteric Fever Cases 12 19 18 31 16 15 15 6 7 7 14 12 - 2 Rate 0.03 0.06 0.06 0.09 0.05 0.04 0.05 0.02 0.05 0.02 0.04 0.04 - Continued Fever Cases - - 1 - - 1 - - - - - 1 + 1 _ Rate - - 0.00 - - 0.00 - - - - - 0.00 - Puerperal Fever* 1 Cases 33 38 38 36 45 35 36 54 24 25 38 17 - 21 Kate 5.40 6.56 6.89 6.3 8.52 7.07 7.86 11.68 5.24 5.29 7.33 3.77 -3.56 Erysipelas 'Cases 139 134 148 188 177 165 183 193 130 128 157 151 - 6 Rate 0.42 0.41 0.46 058 0.54 0.51 0.57 0.61 0.41 0.41 0.49 0.51 + 0.02 Totals "Cases 1813 2260 2439 3057 2111 1962 2016 2227 1639 1504 2,028 1527 -501 Rate 5.42 6.96 7.62 938 6.50 6.04 632 7.08 5.32 4.84 6.39 5.17 -1.22 * Per 1,000 Registered Births, † Average only where there has been continuance of disease during 10 years. Showing the Cases of the Notifiable Infectious Diseases notified in the SubRegistration Districts and the Wards during the year 1937. 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 - 70 33 - 2 - 18 3 - - - 126 Up. Holloway Up. Holloway - 59 54 1 2 - 17 3 1 - - 137 Tollington Tollington - 84 82 - 2 - 22 2 - - - 192 Lr. Holloway Lr. Holloway - 84 92 - 1 - 18 - - - - 195 Highbury Highbury - 73 40 - - - 19 1 - - - 133 Mildmay - 46 30 - 1 - 12 2 - - - 91 Barnsbury Thornhill - 89 92 - 3 - 8 2 - - - 194 Barnsbury - 40 56 3 - - 14 1 - - - 114 Islington, S.E. St. Mary's - 55 48 - - - 8 1 - - - 112 Canonbury - 83 43 - 1 - 7 2 - - - 136 St. Peter's - 40 49 - - - 8 - - - - 97 Totals - 723 619 4 12- - 151 17 1 - - 1527 Attack-Rates per 1,000 population - 2.45 2.10 0.01 - - 0.51 0.06 0.00 - - 5.17 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). 23 [1937 Acute Poliomyelitis. One case of this disease was notified during the year, as contrasted with one in 1936, and six in 1935. EPIDEMIC CEREBRO-SPINAL MENINGITIS. Ten cases were notified during the year to the Medical Officer of Health as against 6 in 1936. During the ten years 1927-36 the cases averaged 8 per annum. INFECTIOUS DISEASES (LONDON) REGULATIONS, 1927. Malaria, Dysentery, 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. 1933 1934 1935 1936 1937 Malaria - - - - - Dysentery 5 5 36 35 39 Acute Primary Pneumonia 179 189 151 154 131 Acute Influenzal Pneumonia 125 71 59 56 84 Totals 309 265 246 245 254 DYSENTERY. 39 cases of Dysentery were notified during the year, 34 were bacteriologically confirmed to be " Sonne " Dysentery, in 4 cases the diagnosis of Dysentery was not confirmed, and in one case the type of the disease was finally diagnosed as Enteritis. Of the 34 confirmed cases, 2 occurred in the Royal Northern Hospital, 5 in St. Mary, Islington, Hospital, 6 in Archway Hospital, and 21 were notified from various sources (home and other hospitals). All these cases had been carefully watched, as also had cases of persistent diarrhoea or enteritis in view of a possibility of any being Typhoid Fever. In connection with dysentery, it may be noted that the London County Council did not admit cases at once to hospital, but only on the order of the Medical Officer of Health of the Borough. Two of the cases of dysentery occurred in a children's Home. This Home did not come under the Child Protection work as it was one of those exempted by the Home Office, but it had been visited by the Medical Officer of Health in view of the dysentery cases. It was obvious that owing to the shortage of hospital accommodation, cases of illness in such a Home would need largely to be treated there and only such cases as were absolutely necessary removed to hospital. The dysentery cases were admitted to hospital, but cases of indefinite diarrhoea or slight enteritis were treated in the Home itself, and new admissions were stopped. Two points of interest arose in regard to other illnesses in this Home. There had been from the end of October, 7 cases notified as Scarlet Fever ; one of these was a nurse, the remainder being patients between 2½ and 5 years old, of whom one was found to be a carrier only. These cases arose through some insidious source of infection which was not traced—perhaps a visitor. This was suspected because the real re-infections occurred not within a week, but in about a fortnight's time. There was an interval of over a fortnight without a fresh case, and this small outbreak ended. 1937] 24 Another interesting point was that there had been five cases of catarrhal jaundice in the year, and one just within the New Year, all occurring in the probationers staff (not of British Nationality) ; curiously, British members of the staff escaped. The theory of the Medical Officer of the Home was that these new members of the staff arrived from abroad in a poorly nourished condition, and were therefore apparently susceptible. PNEUMONIA. Home nursing is carried out for cases of Acute Primary Pneumonia and Acute Influenzal Pneumonia, and during the year 16 patients had nursing attendance provided, which at a cost of 1s. 3d. per visit (raised towards the end of last year from 1s.) amounted to £15 18s. 9d. Besides the cases so nursed, others, of course, were taken to hospital. Among the facilities afforded for bacteriological examinations, specimens from suspected pneumonia cases are given a general examination for pneumococci when sent in by the doctor. This examination, however, is of limited value and the decision for hospital treatment has to be made early. An exhaustive examination to find the strain of the particular pneumococcus is done when thought necessary at the hospital. ISLINGTON (CHICKEN-POX) REGULATIONS, 1930. These regulations came into operation on the 24th March, 1930, and from that time to the end of this year 3,468 cases had been notified. In 1937 the notifications numbered 425. 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.) One case of Anthrax (fatal) came to the knowledge of the Medical Officer of Health during the year. The history of the case is interesting, as it shows how this disease can be so overshadowed by other conditions that it may not be suspected. An instance of a case being similarly missed (not in man but in an elephant) was recorded in the Medical Officer of Health's Annual Report for 1927, page 36. The last previous case of a death of a man in Islington from Anthrax was that of a horse slaughterer's roundsman in 1933. In the particular case under review, the man suffered from an affection of the skin of the face near the eye, which simulated Erysipelas. He was sent by the doctor he consulted to an eye hospital, and was there recommended to another hospital and from this admitted to a London County Council Infectious Hospital. The rather sudden fatal issue of this case warranted a postmortem examination being made, and anthrax was cultivated from the spleen. This man worked (outside the Borough) in a seed warehouse where canary seed was " blended " with dead flies imported from abroad. Acute Encephalitis Lethargica and Acute Polio-Encephalitis. These diseases became notifiable under an Order of the Ministry of Health on the 1st January, 1919. During the year one case of Acute Encephalitis Lethargica came to our notice ; three deaths were registered. No case of Polioencephalitis was notified, and no death was registered. 25 1937 The following summary shows the number of cases, and also the fatality of recent years:— ACUTE ENCEPHALITIS LETHARGICA. Years. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1930 Average (10 years). 1937 Cases (notified) 7 5 8 4 4 4 4 2 - - 3 1 Deaths 4 3 3 - 2 1 3 - - - 2 3 Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. See page 96. SUPPLY OF INSULIN TO NON-INSURED PERSONS. Under 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. Applications for such assistance for patients are made by the Almoners of three of the largest hospitals. During the year under review 15 patients received this assistance from the Borough Council, the cost of the Insulin supplied being £31 7s. 6d. TUBERCULOSIS. 574 cases of Tuberculosis in its different forms were notified during the year. The attack-rate was equal to 1.94 per 1,000 of the civil population. This number was an increase of 44 on the return of the previous year, and of 0.20 per 1,000 on the attack-rate. Respiratory (Pulmonary) Tuberculosis.—490 notifications were received, of which 270 referred to males and 220 to females, and represented an attack-rate of 1.66 per 1,000 inhabitants. Showing the Notified Cases of Tuberculosis in the Wards during 1937. 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 30 41 71 6 5 11 82 2.75 Up. Holloway Up. Holloway 28 28 56 3 7 10 66 2.35 Tollington Tollington 18 23 41 8 2 10 51 1.86 Lr. Holloway Lr. Holloway 28 14 42 8 7 15 57 1.55 Highbury Highbury 30 24 54 3 4 7 61 2.16 Mildmay 19 16 35 2 - 2 37 1.45 Barnsbury Thornhill 30 18 48 3 1 4 52 1.94 Barnsbury 19 13 32 1 5 6 38 1.73 Islington, S.E. St. Mary's 16 13 29 1 2 3 32 1.98 Canonbury 18 15 33 3 3 6 39 1.37 St. Peter's 34 15 49 8 2 10 59 2.24 Totals 270 220 490 46 38 84 574 1.94 26 1937 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1937. Cases Notified in Whole District. Tubercular Diseases. Sex. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 270 - 1 6 42 120 79 22 F. 220 1 5 7 75 100 29 3 Tubercular Meningitis M. 2 - - 1 - 1 - - F. 1 - 1 - - - - - Tabes Mesenterica M. - - - - - - - - F. - - - - - - - - General Tuberculosis M. - - - - - - - - F. - - - - - - - - Other forms of Tuberculosis M. 44 - 2 17 16 7 2 - F. 37 - 5 7 12 8 5 - All Tubercular Diseases M. 316 - 3 24 58 128 81 22 F. 258 1 11 14 87 108 34 3 Totals 574 1 14 38 145 236 115 25 Percentages at each life period to total cases 0.17 2.45 6.63 25.26 41.11 20.03 4.35 From the above statement it will be seen how the disease attacked people at the various ages, viz. :— In every hundred cases 2.45 were aged 1 to 5 years. ,, ,, 6.63 were aged 5 to 15 years. Prime"-! ,, ,, 25.26 were aged 15 to 25 years.* of ,, ,, 41.11 were aged 25 to 45 years. Life ,, ,, 20.03 were aged 45 to 65 years. ,, ,, 4.35 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 42, while the females reached 75. TUBERCULOSIS. Year. Notified Cases. Coming to knowledge. Total. Deaths. 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 1937 574 140 P. 598 714 P. 203 O.F. 116 O.F. 25 228 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. 27 1937 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. One such case came to our knowledge during the course of the year. The patient did not continue his work and was admitted at once to hospital, after which he did not return to Islington. ISLINGTON TUBERCULOSIS CARE COMMITTEE. Much good work is being done by this Committee, and since it has now completed one year of its newly constituted form, the present appears to be a suitable opportunity of summarising the aims and composition of the Committee. To quote from the Annual Report of the Care Committee Secretary, " It is the function of the Committee in each area to render effective assistance to tuberculous persons and their families when needed. Such help varies according to the individual needs and it has been the constant aim of the Committee to study the individual and to obtain appropriate aid, but this involves knowledge of, and co-operation with other social agencies. . . . The Committee consists of representatives of the Borough Council and social workers in the district. Bringing together many persons connected with social welfare, in one way and another, it has been possible to assist and advise in a variety of ways. " The Committee has at its disposal the money raised locally by the Annual Seal Sale Appeal run under the auspices of the National Association for the Prevention of Tuberculosis. So valuable has the fund proved to be that the number of appeal circulars issued in 1937 was doubled, with the result that £127 was taken, and a net profit of £99 11s. 9d. made as compared with £54 9s. 4d. the previous year. " There have been many calls on the fund, but the most frequent request has been for fares to visit patients in sanatoria. The following list will give an idea of the different ways in which the Committee has been able to give financial help to tuberculous patients and their families from the Care Committee fund :— £ Fares to sanatoria 60 Removal expenses 2 Cases helped in co-operation with other agencies 12 Pocket money 8 Beds and bedding 2 Extra nourishment 1 Payment of rent 2 Holidays 3 Grants from other agencies administered by Care Committee 4 Miscellaneous 8 28 1937 "It is not in financial matters alone that the Committee is called upon to advise and assist, but help has been given in a variety of other ways. The Secretary during a morning's work may be consulted on any point ranging from a matrimonial difficulty to the supply of a very necessary pair of boots, the boarding-out of children under the Tuberculosis Scheme, or co-operation with a Relieving Officer as to the helping of a family." The following list gives the constitution of the Committee at the end of 1937. together with the organisations or bodies represented :—- CONSTITUTION OF CARE COMMITTEE (to 31st October, 1937). Chairman : Alderman H. J. L. LYGOE. Vice-Chairman : Councillor H. J. E. CARTER. Secretary : Miss K. I. C. HADLEY Hon. Treasurer : Mr. G. H. MEAKIN. The members of the Public Health Committee of the Borough Council Aldermen Jordan, Lygoe and Tomkins ; Councillors Awcock, Bowerman, Bruce, H. J. E. Carter, Elmer, Fidoe, Gale, W. Harper, Knight, Miss Littman, Ricketts, Rutherford, Sargent, Scott, Mrs. Southgate, Stonham and Willis. The Borough Medical Officer of Health r. G. Clark Trotter. The Assistant Medical Officer of Health Dr. V. Freeman. The Tuberculosis Officers Dr. W. E. Snell, Dr. A. Leitch. The Tuberculosis Visiting Nurse Miss E. McGoldrick. The Divisional School Medical Officer Dr. M. C. Polhill. The Children's Care Organiser for Islington Miss O. W. Cram. A representative of the Public Assistance Area Committee Mrs. E. E. Bull, L.C.C. A representative from the local panel practitioners Dr. J. Liddell. Representatives of the London Insurance Committee Mr. J. C. Gilbert, Mr. C. W. Shaw. A representative of the local hospitals Miss E. M. Howes, Lady Almoner, Royal Northern Hospital. Islington Invalid Children's Aid Association Mrs. E. E. Watt. North London (Islington) District Nursing Association Miss H. F. G. Piper. British Legion and United Services Fund Miss M. J. Michael. Islington Charity Organisation Society Miss L. E. Hartley. The Friends of the Poor Miss B. Deanesley. Other social workers Mrs. A. Twidell. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. In accordance with the above Regulations, a tuberculosis register is kept. This register calls for constant revision and corrections are made quarterly. Information of any change is forwarded not only to the London County Council but to the administrative districts to which the patients have removed and to the Islington ruberculosis Officers. With such a large population as obtains in this Borough and the practice of a number of patients not informing the Public Health Department of their removal and new address, it has been found impossible to trace everyone, but in all the circumstances the proportion of those untraced cannot be said to be unduly large. The work of endeavouring to find where those patients 29 1937 have gone who have not intimated to us their removal gives unnecessary trouble to the Sanitary Inspectors, Tuberculosis Visiting Nurses, and to the After Care Secretary. The patients, who should realize the advantages obtainable from and the help afforded by the Care Committee as well as the dispensaries, should not leave the Borough without intimating the new address so that there can be an even continuance of the facilities they have already enjoyed. 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 1937. Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1937 975 740 298 299 2,312 Notified cases added during the year 1937 270 220 46 38 574 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1937 47 61 11 21 140 Number of cases removed from the register during the year 1937 1,292 1,021 355 358 3,026 437 369 120 103 1,029 Number of cases remaining on register at close of year 1937 ... 855 652 235 255 1,997 Summary of Notifications during the period from 1s January, 1937, to the 31st December, 1937, in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. 0 1 5 10 15 20 25 35 45 55 65 Total Primary Notifications. to to to to to to to to to to and 1 5 10 15 20 25 35 45 55 65 up. Pulmonary Males - 1 5 1 18 24 80 40 44 35 22 270 404 ,, Females 1 5 3 4 24 51 73 27 19 10 3 220 318 Non-pulmonary Males - 2 11 7 9 7 5 3 2 - - 46 55 „ „ Females - 6 4 3 7 5 8 - 3 2 - 38 63 30 1937 Showing the Notified Cases of Tuberculosis in the Quarters during 1937. 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 83 54 137 64 47 111 55 67 122 68 52 120 270 220 190 Tubercular Meningitis 1 - 1 - - - 1 1 2 - - - 2 1 3 Tabes Mesenterica - - - - - - - - - - - - - - - General Tuberculosis - - - - - - - - - - - - - - - Other forms of Tuberculosis' 9 12 21 9 7 16 15 7 22 11 11 22 44 37 81 Totals 93 66 159 73 54 127 71 75 146 79 63 142 316 258 574 Showing New Cases of Tuberculosis and all Deaths during 1937. Age Periods. NEW cases. DEATHS. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year - 1 - - - - - 2 1-5 1 5 2 6 - - 2 5 5-10 5 3 11 4 - - 2 - 10-15 1 4 7 3 - - 1 1 15-20 18 24 9 7 3 6 1 3 20-25 24 51 7 5 9 7 - 1 25-35 80 73 5 8 35 20 1 1 35-45 40 27 3 - 14 19 3 - 45-55 44 19 9 3 28 10 - - 55-65 35 10 - 2 21 9 - - 65 and upwards 22 3 - - 16 6 - 2 Totals 270 220 46 38 126 77 10 15 55 Deaths not notified or 24 1 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 . 69 98 2nd ,, 65 84 3rd „ 60 76 4th „ 40 59 Total 234 317 31 1937 TUBERCULOSIS DISPENSARIES. 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 and one in the Southern part of the Borough. RETURN SHOWING THE WORK OF THE NORTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1937. 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 con- (a) Definitely tuberculous 76 67 - - 8 10 8 6 84 77 8 6 175 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 118 124 8 15 265 B.—Contacts examined during the year:— (a) Definitely tuberculous 8 4 2 - - - 2 4 8 4 4 4 20 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 64 112 77 76 329 C.—Cases written off the Dispensary Register as :— (a) Recovered 4 8 1 2 1 4 1 - 5 12 2 2 21 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 182 236 85 91 594 D.—Number of Cases on Dispensary Register on December 31st :— (a) Definitely tuberculous 328 296 24 18 39 56 33 36 367 352 57 54 830 (b) Diagnosis not completed - - - - - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 812 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 83 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases " lost sight of " 141 4. Cases written off during the year as Dead (all causes) 98 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 481 5. Number of attendances at the Dispensary (including Contacts) 4,934 7. Number of consultations with medical practitioners :— (а) Personal. (б) Other 22 615 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 287 9. Number of visits by Dispensary Nurses to homes for Dispensary purposes Municipal Tuberculosis Visiting Nurse 1,215 1,748 10. Number of :— (a) Specimens of sputum, etc., examined (b X-ray examinations made in connection with Dispensary work 327 440 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 2 12. Number of " T.B. Plus " cases on Dispensary Register on December 31st 421 32 1937 RETURN SHOWING THE WORK OF THE SOUTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1937. 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 51 28 2 2 5 6 5 - 56 34 7 2 99 (b) Diagnosis not completed - - - - - - - - 1 3 - - 4 (c) Non-tuberculous - - - - - - - - 97 99 31 26 253 B.—Contacts examined during the year:— (a) Definitely tuberculous 10 9 - 1 - - 1 1 10 9 1 2 22 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 35 69 47 48 199 C.—Cases written oft the Dispensary Register as :— (a) Recovered - 1 3 1 5 1 2 2 5 2 5 3 15 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 133 172 78 76 459 D.—Number of Cases on Dispensary Register on Dec- (a) Definitely tuberculous 252 183 18 15 23 26 30 18 275 209 48 33 565 (6) Diagnosis not completed - - - - - - - - 1 3 - - 4 1. Number of cases on Dispensary Register on January 1st 562 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 61 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases " lost sight of " 102 4. Cases written off during the year as Dead (all causes) 55 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 155 5. Number of attendances at the Dispensary (including Contacts) 4,621 7. Number of consultations with medical practitioners :— (a) Personal (b) Other 16 227 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 247 10. Number of :— (a) Specimens of sputum, etc., examined (b) X-ray examinations made in connection with Dispensary work 579 291 9. Number of visits by Dispensary Nurses to homes for Dispensary purposes Municipal Tuberculosis Visiting Nurse 1,992 1,511 11. Number of " Recovered " cases restored to Dispensary Register, and included in A(a) and A(6) above 1 12. Number of " T.B. Plus " cases on Dispensary Register on December 31st 298 33 1937 At the Northern Dispensary there were, including contacts, 882 new cases, and at the Southern 594, while the attendances at the former were 4,934 and at the latter 4,621. The examination of contacts with tuberculous cases showed that 35 were suffering from tuberculosis, 28 were suspects, and 486 were not suffering. The nurses of the Northern Dispensary paid 1,215 visits, and those of the Southern 1,992, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 265 visits, and of the Southern 231 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 :— 1933 1934 1935 1936 1937 North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. New Cases (including contacts) 668 469 742 554 819 470 845 611 882 594 Actual Number of Attendances 3,426 4,091 3,775 4,294 3,808 4,210 4,353 4,505 4,934 4,621 Totals 4,094 4,560 4,517 4,848 4,627 4,680 5,198 5,116 5,816 5,215 A summary of the combined dispensaries is given for the following years :— .Cases. Attendances. 1933 1,137 7,517 1934 1,296 8,069 1935 1,289 8,018 1936 1,456 8,858 1937 1,476 9,555 Totals 6,654 42,017 Table showing the number of Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1937. Date. Dispensary. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern Southern 377 412 360 424 332 394 488 503 378 345 398 349 478 388 345 318 420 396 431 365 531 371 396 356 4934 4621 9,555 New Cases, includ ing Contacts Northern 66 91 69 100 67 83 84 45 56 63 96 62 882 1,476 Southern 74 76 50 57 32 48 40 41 51 49 41 35 594 Contacts. Tuberculous Northern - 4 2 - 1 2 - - - 1 1 - 13 35 Southern 1 2 3 1 1 2 . 3 2 4 1 - 2 22 Suspects Northern 1 1 2 1 1 1 1 2 2 3 3 1 19 28 Southern - 2 - 1 - - 1 - - 4 1 - 9 Non-Tuberculous Northern 25 38 26 35 19 24 32 16 15 19 38 16 303 486 Southern 26 20 9 20 11 18 12 26 22 19 12 8 183 Nurses' Visits Northern 50 113 108 111 83 108 106 121 89 116 116 94 1215 3,207 Southern 180 161 163 160 168 157 179 202 150 166 154 152 1992 Tuberculosis Officers' Visits Northern 22 22 24 23 21 18 23 13 26 26 24 23 265 496 Southern 21 21 20 18 16 14 18 16 18 21 25 23 231 * See, in addition, Municipal Tuberculosis Visiting Nurse, page 35. 34 1937 SUPPLY OF EXTRA NOURISHMENT TO TUBERCULOUS PATIENTS. Report of Assistant Medical Officer of Health. The Council's scheme for the supply of extra nourishment to certain patients suffering from tuberculosis, which was begun in 1936, has been extended during the past year. Following the inception of the scheme, it became obvious at an early stage that more extensive provision would have to be made owing to the increasing number of applications for nourishment made by patients through the Tuberculosis Officers. The extra nourishment granted consists of one egg and one pint of milk daily, and, in accordance with the directions to Local Authorities issued by the Minister of Health, the Council decided that the following arrangements should apply to all cases in which application was made for extra nourishment:— 1. That cases recommended by the Tuberculosis Officers should fall generally into these categories :— (a) Ex-sanatorium cases where the medical condition is such that a grant of extra nourishment is necessary to enable patients to maintain or recover full working capacity ; and (b) Patients with prospects of ultimate arrest of the disease who are awaiting admission to sanatoria. 2. A simple income scale was also adopted on the following basis After deduction of rent, but not other outgoings from the total family income, the maximum income per head per week shall not exceed 12s. 6d. If the income is greater than this, then the following circumstances shall be taken into favourable consideration :—- (a) Where the number in the family for the purpose of estimating income does not exceed 2. (b) Where there is a special recommendation on clinical grounds from the Tuberculosis Officer. 3. That extra nourishment grants be limited to a period of three months, subject to the power of the Public Health Committee to extend this period after consideration of special circumstances. During the year, 87 patients received extra nourishment under the Council's scheme, and the cost amounted to £145 3s. 9d. Pneumothorax Treatment was administered to seventy-six patients at a cost of £250 14s. 0d. Finsen Light Treatment.—No patient was treated by Finsen Light during the year. Artificial Sunlight Treatment.—One patient was given " Kromeyer Lamp " treatment during the year at a cost of 16s. 35 1937 HOME VISITATION.—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1937, to 31st December, 1937. North South Month. Dispensary. Dispensary. Total. January 161 112 273 February 146 126 272 March 144 139 283 April 158 116 274 May 97 83 180 June 164 139 303 July 174 160 334 August 151 153 304 September 72 63 135 October 153 132 285 November 193 146 339 December 135 142 277 Total 1,748 1,511 3,259 TUBERCULOSIS—HOUSING. The practice of visiting houses in which tuberculous patients reside to ascertain the sanitary conditions was continued during the year, and 495 visits were made for this purpose. Most of the houses visited were found to be in a good state of sanitation, but in 15 instances the conditions were considered very unsatisfactory, and in 48 minor defects were discovered. In each instance a notice was served for the defects to be remedied. The following statement will give an idea of the state of the premises when visited :— Houses in bad sanitary condition 15 Houses in good sanitary condition 338 Houses in which minor defects were discovered 48 Patients removed to another address 94 495 Patients deceased (and where immediate enquiry was not considered necessary) 53 Patients in Mental Hospital 2 Resident in a clearance area 5 Not visited (by request) 15 Duplicate notifications 3 Visit postponed 1 574 INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,048 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 471 were Scarlet Fever and 342 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 471 642 -171 Diphtheria 342 380 - 38 Enteric Fever Nil 2 - 2 Total 813 1,024 -211 In addition to the above, 235 notifications of Chicken-pox, which was made notifiable in Islington in 1930, were received. 36 1937 Non-Notifiable Diseases.—3,356 cases came to the knowledge of the Medical Officer of Health during the year, viz., 976 cases of Measles, 923 cases of Chicken-pox not notifiable under the Chicken-pox (Islington) Regulations, 1930 ; 354 of Whooping Cough, and 1,103 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.—2,041 children were excluded from classrooms of various schools owing to the presence of infectious disease, chiefly Scarlet Fever and Diphtheria, 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 976 1,679 -703 Chicken-pox 923 941 - 18 Whooping Cough 354 600 -246 *Other Diseases 1,103 1,670 -567 Total 3,356 4,890 - 1,534 * Note.—" Other Diseases " include Mumps, Scabies, Ophthalmia, etc. Measles.—In December the Medical Officer of Health of the London County Council circularised the Metropolitan Borough Medical Officers of Health in regard to hospital accommodation for measles and other diseases. The working of this temporary scheme did not materialise in Islington until the early part of 1938, and will be dealt with in the report for that year. Chicken-pox, 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. BACTERIOLOGICAL EXAMINATIONS, OTHER THAN FOOD. Examinations numbering 2,441 were made in infections 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 an increase of 59 on that of the preceding year and 365 below the decennial average. Of the total examinations, 257, or 10.5 per cent., gave positive results. Tuberculosis.—509 specimens of sputum were examined, 48, or 9 4 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.—1,914 specimens were examined for Diphtheria, of which 209 or 10. 9 per cent., were found to be " positive." Enteric Fever.—18 specimens of blood were examined, none of which gave a positive result. 37 DIPHTHERIA—PATHOGENICITY TESTS. 1937. No. of Swabs Submitted for Examination. Negative Result (Bacilli). Positive Result (Bacilli). Non-Virulent. Virulent. 29 27 2 Nil 2 Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1927-1936, and in 1937. Diphtheria. Enteric Fever. Pulmonary Tuberculosis. Periods. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Totals. 1927 260 1,573 1,833 3 21 24 1ll 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 1936 198 1,630 1,828 1 9 10 50 494 544 2,382 Average 10 years 290 1,767 2,057 3 16 19 105 625 730 2,806 1937 209 1,705 1,914 - 18 18 48 461 509 2,441 1937 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, 7, all negative ; Dysentery 3, all negative ; Food poisoning, 4 specimens, 3 positive and 1 negative ; Pyrexia of unknown origin, negative. LEPTOSPIRAL JAUNDICE. No case of this disease is known to have occurred in Islington, but during the year the Public Health Committee decided that facilities should be afforded for bacteriological examination of the blood of Islington sewermen on the application of local medical practitioners. 38 1 937] VACCINATION. No vaccination was required to be performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. VACCINATIONS—Of the 3,884 births returned on the " Birth List Sheets " in 1936, the returns of vaccination show that only 1,758 infants were successfully vaccinated while 7 were found to be insusceptible. There were also 161 who died unvaccinated and 1,173 statutory declarations of conscientious objection were obtained by the parents or guardians; 53 vaccinations were postponed under medical authority, 487 removed to districts the vaccination officers of which were duly apprised, and 197 removed to other districts or places unknown, thus leaving 48 unaccounted for. The return of certificates of exemption, therefore, represents 30.2 per cent. of the 3,884 births above-mentioned. Vaccination per 100 Years, births, less infants who died unvaccinated. 1927 49.9 1928 46.5 1929 49.5 1930 51.2 1931 50.0 1932 50.0 1933 47.0 1934 47.2 1935 47.4 1936 47.2 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years. 1927 1,845 1928 1,755 1929 1,642 1930 1,584 1931 1,477 1932 1,299 1933 1,198 1934 1,241 1935 1,226 1936 1,173 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 - - - 1937 - - - 13 7 20 39 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1936. Registration Sub-Districts. Number of Births returned in "Birth List Sheets" in 1936. 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 1937. Number of StatutoryDeclarations of Conscientious Objection received during year 1937. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 1250 470 1 - 308 86 11 280 89 5 Upper Holloway 675 289 1 - 233 10 3 110 16 1 1,361 872 Tollington 189 82 1 - 71 5 2 3 21 4 Highbury 6ll 260 2 - 239 13 4 62 34 7 l.ower Holloway 160 87 - - 44 7 5 8 5 4 Barnsbury 529 330 1 - 127 12 16 17 14 12 982 488 Islington, S.E 470 240 1 - 151 22 12 11 18 15 The Borough 3884 1758 7 - 1173 101 53 487 197 48 2343 1360 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, 1937 :— Name of the Vaccination District (or Institution). 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. Tufnell Dr. D. W. Latham 236 10 246 6 Upper Holloway Dr. P'. Inwald 161 15 176 4 Tollington Dr. M. J. Healy 152 14 166 5 Highbury Dr. T. Galbraith 205 8 213 14 Lower Holloway (W.) Dr. S. N. Forbes 128 1 129 5 Lower Holloway (E.) Dr. C. V. Spark 74 5 79 7 Mildmay Dr. J. E. Ambrose 176 23 199 5 Barnsbury Dr. B. Kessel 77 15 92 5 Thornhill Dr. H. D. Christie 112 6 118 4 St. Mary Dr. G. Madden 47 4 51 4 St. Mary, Islington, Hospital Dr. W. R. Turtle 73 - 73 - Total 1,441 101 1,542 59 Vaccinations and re-vaccinations performed by the Public Vaccinators of the Council during the year 1937 :— Successful vaccinations performed at the surgery or elsewhere than at the homes of the persons vaccinated 149 Successful re-vaccinations performed at surgery or elsewhere than at the homes of the persons vaccinated 62 Successful vaccinations or re-vaccinations performed at the homes of the persons vaccinated or re-vaccinated 1,355 The Vaccination Officers in the course of their duties forwarded the names of 1,489 children to the Public Vaccinators on Form " H." Another 382 children were vaccinated at the " request " of parents or guardians before Form " H " was issued. 1937 40 1937 DISINFECTION. Disinfection of Rooms.—2,173 rooms were disinfected, as contrasted with 2,521 in 1936. 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. 30. Rooms Disinfected. 1937 1936 1st Quarter 463 602 2nd „ 502 730 3rd „ 547 572 4th „ 661 617 The Year 2,173 2,521 Work at the Disinfecting Station.—39,296 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors at the Council's Disinfecting Station, compared with 27,008 similar articles disinfected during the previous year. In addition to the above articles, 200,502 second-hand garments were disinfected for clothing contractors trading in the Borough, who paid the Council the sum of £74 18s. 0d. for the work. Altogether 239,798 articles described in the two paragraphs preceding were disinfected Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1937, and also in the preceding year 1936. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1937. 1936. Beds 393 391 317 460 1,561 1,062 Blankets 1,044 1,040 808 1,463 4,355 3,196 Bolsters 256 231 236 347 1,070 703 Carpets 15 - 6 - 21 4 Cushions 265 147 194 195 801 269 Mattresses 459 526 313 561 1,859 1,292 Pillows 998 1,069 818 1,349 4,234 2,888 Pillow and Bolster Cases 639 638 436 914 2,627 1,902 Quilts 435 419 293 576 1,723 1,368 Sheets 822 777 742 1,122 3,463 2,819 Other Articles 4,343 4,538 2,822 5,879 17,582 11,505 TOTALS 9,669 9,776 6,985 12,866 39,296 27,008 41 The nature of the articles disinfected for the clothing contractors is shown below :— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Blankets 2,050 550 1,150 6.580 10,330 Garments 37,593 43,735 75,825 29,619 186,772 Other Articles 300 2,100 300 700 3,400 Total 39,943 46,385 77,275 36,899 200,502 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, 5 cwts. * Disinfectant fluid, 20 galls. * 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, 20 galls. The total cost of disinfectant was £6 2s. 6d. together with £3 18s. 2d. 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 30 verminous persons, while their clothing was disinfected, 2 of whom were sent from a Common Lodging House. 50 other persons who had been in contact with cases of infectious diseases, 30 of whom were employed in handling food, also had baths and their clothing disinfected. Baths were provided for 41 persons who were suffering from Scabies (a series of 3 baths in each case), making a total of 123 baths. DISINFESTATION. Eradication of Bed Bugs.—A circular is issued to householders on the bed bug, directing where it is to be sought and how it is to be fought. The Council had under consideration during the year the provision of a special disinfestation building, and the proposals were submitted to the Minister of Health. This building will function in the summer of 1938, and will dispense with the engagement of disinfestation contractors. During the year, 67 Council houses and 106 other houses, comprising 107 and 170 rooms respectively, were found to be bug infested, and were subsequently disinfested. The methods employed for freeing the houses from bugs were :—causing the paper to be stripped from the walls, and, if necessary, the removal of architrave mouldings, picture rails and skirtings, scorching the surfaces with a blow-lamp, fumigating the rooms with sulphur, spraying the walls with an insecticide, the fumigation and spraying being repeated if required after fourteen days; the furniture being sprayed or treated with paraffin or an insecticide. The belongings, except the bedding, etc., of tenants removing to Council houses were treated with hydrogen cyanide gas by a contractor. The bedding and personal clothing of these tenants were disinfested by steam at the Council's Disinfecting Station. 1937 1937 42 The supervision of the tenants to prevent infestation and re-infestation after cleansing is effected primarily by the attendance of a Sanitary Inspector (Housing) at the removal, the tenants having previously been warned that all effects must go in the van. They are also warned in respect of new purchases in case they might be inclined on arrival at the new premises to purchase second-hand articles. The bedding does not go into the contractor's van, but is removed by the Council's staff and treated by steam at another place, namely, the Council's Disinfecting Station. With regard to bedding, 846 bundles of bedding were removed from houses which were under orders for demolition, and in addition 42 bundles were taken from houses not under clearance orders, as well as 14 bundles of bedding disinfested for the Council's Housing Department, the total being 902 bundles dealt with for disinfestation. During the year the arrangement for the issue of sprayers and insecticide was continued, 105 (16-oz.) tins being supplied. Six applications for the loan of sprayers were received, and the distribution of the special leaflet was continued. These facilities continue to be appreciated by tenants who are troubled with these pests. In the case of infested rooms the Council undertakes on the application of the occupier to carry out a process of fumigation on payment of the sum of 5s. per room. Under the Public Health (London) Act, 1936, on the report of the Medical Officer of Health the Local Authority 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. Disinfestation of School Children (Cleansing from Lice and other Vermin).—During the year 6,222 baths (including 1,425 for Scabies) were given to children from the London County Council Schools, who attended the Disinfecting Station and were cleansed 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 19s. 0d. There was an increase in the number of children treated for head lice, and a decrease 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 64 instances. In 4 cases no fines were imposed and in 60 cases fines ranging from 2s. to 10s. were imposed. The total fines amounted to £14. FACTORY AND WORKSHOP ADMINISTRATION. The Medical Officer of Health submits the annual report on the manner in which the provisions of the Factory and Workshop Act, 1901, were carried out in his district during the year 1937. The inspection of factories, workshops and bakehouses is systematically carried out by one male Inspector, who supervises places where men are employed, and by two female Inspectors whose duty it is to inspect places where women are employed. The female Inspectors also supervise restaurant kitchens and outworkers' premises. 43 1937 During the year these Inspectors made 861 visits to factories (including factory laundries and factory bakehouses), 1,180 visits to workshops (including workshop laundries and workshop bakehouses), 1,650 visits to workplaces (other than outworkers' premises) and restaurant kitchens, 1,433 visits to outworkers' premises, and 4,611 miscellaneous re-inspections and calls. Notices Served.—In consequence of the 897 sanitary defects discovered as the result of the inspections above, 290 intimation and 10 statutory notices were served. Of these notices, 61 were served on the owners of factories, 110 on the owners of workshops and workplaces, 28 on the owners of bakehouses, and 95 on the owners of restaurant kitchens. In addition to these nuisances, 45 were discovered on Outworkers' premises, necessitating the service of 6 notices. All the defects were remedied, but it was necessary in one instance to resort to legal proceedings. Registers.—There were 2,777 workshops on the Registers as contrasted with 2,754 in 1936, while the total number of workrooms was 3,869 as compared with 3,872 in the previous year ; 97 workshops were added to the Registers, while 74 were removed from them. The various workshops and workplaces are tabulated below:— Workshops and Workplaces. 1937. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1,358 2,114 27 10 Workshops where Women are employed 502 763 22 15 Laundries 35 45 - - Bakehouses 216 216 - 14 Restaurant Kitchens 544 609 37 33 Other Workplaces 122 122 11 2 TOTALS 2,777 3,869 97 74 Workshops Notified to Home Office during Year 1937. Trade. Number of Workshops. Women. Male Young Persons. Totals. Clock Making 1 3 - 3 Chemists' Sundries 2 13 - 13 Rag Sorting 1 6 1 7 Dressmaking 8 56 - 56 Gramophone Cases 1 6 - 6 Art Florists 2 23 - 23 Cap Manufacturers 1 1 - 1 Millinery 1 2 - 2 Leather Coats 1 2 - 2 Stationery 1 18 - 18 Tailoring 1 6 - 6 Upholstery 1 3 - 3 Mantles 3 17 - 17 Work-bags 1 1 - 1 Suitcases 1 1 - 1 Lampshades 1 5 - 5 Leather Goods 4 20 - 20 Total 31 183 1 184 44 1937] INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors. Premises. (1) Inspections. (2) Number of Written Notices. (3) Prosecutions. (4) Factories 861 78 1 (Including Factory Laundries) Workshops 1,180 68 - (Including Workshop Laundries) Workplaces 1,650 148 - (Other than Outworkers' premises) Miscellaneous Re-Inspections and calls 6,044 6 - Total 9,735 300 1 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars, (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts*— Want of cleanliness 305 299 - - Want of ventilation 16 15 - - Overcrowding 1 1 - - Want of drainage of floors 10 10 - - Other nuisances 356 331 - - Wanting 14 13 - - Dust Bins Defective 11 11 - - insufficient 6 7 - - Sanitary foul 81 83 - - Accommodation unsuitable or defective 86 86 - - not separate for sexes 11 10 - - Offences under the Factory and Workshop A ct— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of Special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences - - - 1 (Excluding offences relating to outwork) Total 897 866 - 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. Notices Served. Remedied. Prosecutions. Outwork in unwholesome premises (s. 108) 45 6 45 Nil Outwork in infected premises (s. 109, 110) 1 - 1 Total 46 6 46 Nil OUTWORKERS' LISTS (s. 107) : Lists received from Employers 1,065 Addresses received from Other Councils 1,837 Addresses forwarded to Other Councils 548 Firms failing to send in lists (No. letters sent) 324 45 1937 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factory and Workshop Act (s. 133), 1901 31 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 30 Reports (of action taken) sent to H.M. Inspector 22 Other (New Factories and Workshops reported under Home Office Memorandum, 1912) 31 Underground Bakehouses (s. 101) in use at the end of the year 65 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing apparel— Making, &c. 18 4 - Cleaning and washing - — - Household linen — — - Lace, lace curtains and nets — — - Curtains and furniture hangings 2 — - Furniture and upholstery — — - Electro-plate — — - File making — — - Brass and brass articles — — - Fur pulling — — - Cables and chains — — - Anchors and grapnels — — - Cart gear — — - Locks, latches and keys - — - Umbrellas, &c. 2 — - Artificial flowers 5 — - Nets, other than wire nets — — - Tents — — - Sacks — — - Racquet and tennis balls — — - Paper, &c., boxes, paper bags 9 2 - Brush making 1 — - Pea picking — — - Feather sorting — — - Carding, &c., of buttons, &c. — — - Stuffed toys — — - Basket making — — - Chocolates and sweetmeats — — - Cosaques, Christmas crackers, Christmas stockings, &c. 8 - - Textile weaving — — - Lampshades — — - Total 45 6 — SCAVENGING. The Medical Officer of Health is required to give particulars of any extension or improvement during the year in the arrangements for refuse collection and disposal, and a statement regarding the efficiency of the methods employed for the removal and disposal of house refuse. During the year the Medical Officer of Health visited the dumping grounds where the contractors dispose of Islington refuse. 1937 46 Mr. Browning, the Cleansing Superintendent, has kindly supplied the following statement regarding the work of his department during the year (i) Street Sweeping.—A further mechanical vehicle of the S.D. freighter hygienic low-loading type (formerly used for house refuse collection), was re-conditioned and put into service on the Northern district for receiving the contents of galvanised containers installed in orderly trucks. Five motor vehicles in all (including four "Bedford" lorries) are now engaged on this service, leaving only two open type horse-drawn vans still in use, which supplement the motor vehicles operating on the South-Eastern and South-Western districts of the Borough. (ii) Gully Cleansing.—A further hand propelled gully sludge truck (closed container type) was purchased and put into service. Two such vehicles are now used in conjunction with the mechanical gully emptiers for cleansing gullies in cul-de-sacs and narrow thoroughfares and at housing estates, etc., where access for the large motor vehicles is limited or unobtainable. This work has hitherto been carried out by means of open type horse-drawn vans. (iii) Refuse Collection.—The Container system of refuse removal from blocks of flats, etc., was put into operation at certain properties of the Council and the L.C.C. in October, 1937. Two "Scammell" motive units (of 10 h.p. and 15 h.p. capacity respectively) are used to haul the Bin Carriers which are of the flat platform type. One hundred and five containers of the "Outside" type (each 1½ cubic yards capacity) and 54 "Inside" type bins (each 1¼ cubic yards capacity) are installed at the various premises where the system is in operation. This system results in a more hygienic method of collection as, formerly, the refuse had to be shovelled out from fixed receptacles and emptied into baskets prior to loading into vehicles. Generally.—During the year ended 31st March, 1937, 82.8 per cent. of refuse was collected by mechanical vehicles and 17.2 per cent. by horses and vans. (iv) Refuse Disposal.—The reconstructed Refuse Disposal Works at Ashburton Grove Depot were officially opened on the 17th April, 1937, and, with the exception of certain final modifications and adjustments necessary in connection with the electrical installations in course of completion by the contractors, the Plant is in full working order to the Council's requirements. The Improvements and extensions carried out at Ashburton Grove may be summarised as follows:— Steel-framed and sheeted buildings housing patent overlapping belt plate elevators arranged to receive the refuse as tipped from the collecting vehicles and to pass it to a belt conveyor system for loading into railway trucks; Drum-type electro-magnetic separators for extracting ferrous scrap metals from the refuse, and also a dust extraction system; New roadway connecting the entrance at Victoria Place and exit at Ashburton Grove; New office, transfer of weighbridge to new position, and brick shelter for the gatekeeper; New salt store; Sludge lagoon for gully slop; 47 1937 Steel-framed shed for paper baling and baling apparatus; Steel-framed drying chamber for workmen's clothes; Concrete platform for washing vehicles and offal bins, with a steel framed shed over it; Steriliser for offal bins; Small incinerator to deal with mattresses and light combustible material; Boiler to raise steam for sterilising and drying purposes; Fifty feet high firebrick lined self-supporting steel chimney; Brick-built combined electrical sub-station and switch and meter house. All refuse is sent by rail to contractors' dumps and dealt with in accordance with the recommendations of the Ministry of Health, as heretofore. The dumps are frequently inspected by the Cleansing Committee and the Superintendent of the Cleansing Department and by the local sanitary authorities. REMOVAL OF DUST. Twenty-five 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:— 1927 25 1932 44 1928 25 1933 21 1929 21 1934 23 1930 40 1935 23 1931 36 1936 23 During this year the Council's Scheme (under which attention is drawn to damaged dustbins through the Cleansing Department's staff) came into effective operation. The Cleansing Superintendent reports that as a result 1,527 dustbins were provided by owners of property. In addition, 288 were provided in consequence of the service of nuisance notices by the Public Health Department. DISTRICT INSPECTORS' WORK. During the year the fourteen District Inspectors made a total of 44,482 inspections and calls, a decrease of 4,165 inspections on the corresponding period of 1936; while 13,706 improvements were effected in 5,215 premises; as against 15,365 improvements in 6,307 premises for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the inspectors' visits in 1937:— House to house inspections 2,715 Other inspections of dwelling-houses 3,444 Re-inspections and calls made 36,401 Visits of inquiry re notifiable infectious diseases 1,527 Butchers' shops, stalls, etc. (Saturday nights) 103 Ice cream shops and factories *701 Dairies and Milkshops *1,947 Stables and yards 111 Urinals attached to Public Houses 23 Smoke observations 69 * Visits by Dairies and Milkshops Inspector. 1937 48 Notices Served.—There were 4,535 intimation notices served by the inspectors with respect to nuisances. In 583 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.—In the routine inspection, the Sanitary Inspectors found no cause for action to be taken. Three samples of rag flock were examined by the Public Analyst, and reported to be satisfactory. Smoke Nuisances.—Thirty-three complaints of smoke issuing from factory chimneys in the Borough were investigated. As a result 69 observations were made by the District Inspectors, and 7 notices requiring the abatement of the nuisances were served upon the owners concerned. Water Certificates.—Twenty-four water certificates were granted in accordance with the provisions of section 95 (2) of the Public Health (London) Act, 1936, in respect of 499 separate tenements and 11 shops 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, 32. Premises on which notices have been served under the Public Health (London) Act, 1936 (Additional Water Supply), 289. 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 8 15 2 148 1924 117 6 19 — 142 1925 96 5 12 3 116 1926 68 4 26 2 100 1927 67 7 19 2 95 1928 53 6 15 6 80 1929 59 — 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 1937 16 — 7 3 26 Totals 1,292 154 265 50 1,761 49 1937 AGRICULTURAL PRODUCE (GRADING AND MARKING) ACTS, 1928 and 1931. 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 and the Agricultural Produce (Grading and Marking) Acts made by the Sanitary Inspectors, by the Food and Drugs Inspector and the Meat Inspector numbered 819. Prosecutions taken under the Merchandise Marks Act, 1926, numbered 5, all of which were successful. The Orders which have been made relate to:— Agricultural Produce (Grading and Marking) Acts, 1928 and 1931. Asparagus, apples, artichokes, beef, broad beans, broccoli, brussels sprouts, blackcurrants, cabbages, carrots, celery, chicory, cherries, cider, cheese (Derby, Leicester, Lancashire, Wensleydale), cauliflower, creamery butter, dressed poultry, endive, eggs, fruits (canned and bottled), fruit juice syrups, fruit products, gooseberries, green peas, grapes (hot house), horseradish, honey, jam, kidney and runner beans, loganberries, leeks, lettuce, mustard and cress, marrows, mint, malt extract and malt flour, rhubarb (natural and forced), potatoes, pears, parsley, perry, plums, raspberries, red currants, radishes, red beet, red cabbage, strawberries, spring onions, stilton cheese, seakale, spinach, Scotch kale, sage, swedes (table), thyme, turnips, tomatoes, vegetables (bottled and canned), wheat flour and wheat flakes. Merchandise Marks Act, 1926. Apples (fresh), butter, beef (boneless), beef (chilled), bacon, currants, dead poultry, dried eggs, eggs in shell, frozen beef and veal, frozen mutton, lamb and pork, honey, malt products, maize starch (including maize starch cornflour), oat products, prepacked salt, raisins, raw tomatoes, sultanas, salmon and trout, salted beef, salted pork, veal (boneless). Eggs: Cold or Chemical Storage. In May, one application was approved for premises to be registered for the cold storage or chemical storage of eggs. The premises were vacated in December. RAG AND BONE DEALERS. During the year 35 visits were paid to 24 premises upon which is carried on the business of a rag and bone dealer. In one instance the conditions were not satisfactory ; cleansing was ordered, and the necessary work was carried out. Summary of Sanitary Work from Inspectors' Reports for the year 1937. Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 180 234 222 200 201 145 202 223 181 165 128 211 150 273 2715 Other premises inspected 221 308 119 217 182 323 225 308 175 224 270 380 268 224 3444 Re-inspections, Calls made, &c. 2593 2221 2693 2517 2830 2850 2471 2560 1629 2585 3098 2553 2954 2841 36401 Ice Cream Premises inspected - - - - - - - - - - - - - - - Dairies and Milk Purveyors in- - - - - - - - - - - - - - - - Inspections—Council's property — — 41 1 2 1 4 6 — —. — —. 65 68 188 Stables inspected 6 — 2 9 — 6 1 — 1 5 4 3 - - 37 Yards „ 6 3 40 - 1 1 3 6 — 9 — 2 2 1 74 1937 50  Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Agricultural Produce (Grading and Marking) Act, 1928 - - - - 16 - - - - - - - - - 16 Merchandise Marks Act, 1926 3 1 2 1 8 4 3 3 2 3 3 2 4 4 43 Urinals attached to Public Houses inspected - - - 2 5 4 - - - 11 1 - - - 23 Children and Young Persons Acts — 8 6 4 4 3 4 3 1 — 1 1 2 1 38 Premises re Vermin 24 25 33 13 30 31 45 63 7 13 9 17 18 32 360 Premises re Rats and Mice 23 99 43 30 53 79 44 69 35 41 27 19 41 49 652 Preserved Food Premises - - - - - - - - — - — — — — — Premises (re Water Certificates) inspected - 15 40 - 16 2 2 90 - 20 - 54 - 70 309 Rag and Bone Dealers — 1 — - - 2 - - 5 — 1 1 — — 10 Rag and Flock (p. 48) - - - - - - - - - - - - - - - Smoke observations — 1 — 3 12 1 17 5 — 1 — — 26 3 69 Shops, Stalls and Markets (Saturday evening) 8 7 9 6 7 7 6 7 4 7 7 9 10 9 103 Total Inspections and Calls 3064 2923 3250 3003 3367 3459 3027 3349 2040 3084 3549 3252 3540 3575 44482 Notices Served—Intimation:— Public Health (London) Act, 1936 245 324 248 314 336 435 266 456 271 323 283 322 302 322 4447 Housing Acts — 3 24 17 6 2 1 — 3 — 8 — 9 15 88 Ice Cream Shops - - - - - - - - - - - - - - - Dairies, &c. - - - - - - - -' - — — — — — — Notices Served—Statutory:- Public Health (London) Act, 1936 35 33 18 33 40 103 45 65 44 48 15 15 38 51 583 Housing Acts - - - - — - - - - — — — — — — L.C.C(General Powers) Act - - - - - - - - - - - - - - - Improvements. Drains:— Constructed — - - - — - - - - — — — — — — Re-constructed 5 9 6 2 3 4 2 2 1 12 8 — 4 4 62 Repaired 5 13 7 - 10 3 4 8 3 17 13 1 4 1 89 Ventilated 4 4 6 — 2 - 5 10 — 10 9 — 8 3 61 Gully and other traps fixed 13 5 6 1 10 — 2 6 — 35 22 1 14 2 117 Urinals—Water supply (cleansed) — — 1 1 — — — — — 3 — - — — 5 Water Closets:— W.C. erected with pan, trap and water supply 4 - - - - 1 - - - - - - - - 5 Pan and trap only provided 28 33 37 22 39 9 28 46 9 45 115 9 35 9 464 Flushing apparatus repaired 11 12 15 20 30 16 19 26 23 15 21 8 28 14 258 Ventilated 2 4 1 1 4 72 2 1 1 — 3 2 — 1 94 Walls, &c., cleansed 18 17 23 26 26 49 26 20 16 53 75 10 11 21 391 Position altered - - - - — - - — — — — — — — — Dust Bins provided 18 34 8 16 24 17 15 20 17 44 16 18 18 23 288 Areas paved 19 7 21 3 16 16 12 14 11 15 1 7 2 4 148 Yards paved or re-paved 22 25 19 23 21 36 46 8 11 21 9 9 12 4 266 Sinks:— Provided 45 77 58 33 39 42 58 64 14 75 212 10 40 45 812 Waste pipe repaired 16 57 37 21 55 39 24 57 12 21 14 10 15 21 399 Domestic Water supply:— Cisterns repaired and cleansed 3 1 3 2 2 5 3 5 1 2 1 2 1 — 31 Water supply provided to - - - - - - - - - - - - - - - Water supply provided to tenement house 17 51 10 3 16 29 16 7 8 26 80 5 13 8 289 Walls and Ceilings of Rooms cleansed and re decorated 134 170 219 268 325 390 184 260 152 288 334 195 138 188 3245 Other improvements:— Staircase and passages repaired, cleansed and re-decorated 33 53 43 73 28 74 34 58 31 60 93 41 35 47 703 Floor space ventilated 10 3 1 4 10 — 11 29 — 7 7 1 — 4 87 Floors repaired 53 46 41 53 48 46 47 73 38 53 28 69 16 46 657 Guttering and rain water pipes repaired 31 20 36 21 73 45 53 65 10 36 21 13 24 23 471 Roofs repaired 50 96 60 85 56 80 37 72 50 91 75 54 78 63 947 Overcrowding abated — — — — 5 4 — — 5 1 1 18 — 1 35 Illegal use of underground Rooms for sleeping discontinued 14 2 3 - - 6 2 2 10 2 2 48 22 22 135 Other Improvements, or Nuisances abated 186 265 124 148 159 235 173 200 92 173 205 176 192 213 2541 Rooms Disinfected 86 103 69 86 68 82 29 47 65 73 68 130 108 92 1106 Total Improvements 827 1107 854 912 1069 1300 832 1100 580 1178 1433 837 818 859 13706 Total Premises Improved 288 437 300 313 343 394 293 389 252 412 573 448 392 381 5215 51 1937 HOUSES LET IN LODGINGS. The houses which come under the operation of the by-laws received 828 inspections during the year, followed by 5,181 subsequent re-inspections and calls, so that the total visits amounted to 6,009. These inspections resulted in 524 intimations being served on the persons responsible, which were followed by 155 statutory notices to demand the abatement of the nuisances discovered by the Inspectors specially engaged upon this work. Altogether 2,844 improvements were effected in 491 premises. Synopsis of Inspectors' Work — Improvements. Drains: Constructed - Reconstructed 2 Repaired 30 Ventilated 6 Gully and other traps fixed 6 Water Closets: W.C. erected with pan, trap and water supply — Pan and trap only provided 22 Flushing apparatus repaired 68 Ventilated 10 Walls, etc., cleansed 84 Position altered 1 Dust Bins: Provided 50 Areas: Paved 2 Yards: Repaved 69 Sinks: Provided 30 Waste pipe repaired 49 Domestic Water Supply: Cisterns repaired and cleansed 2 Water supply provided to tenement house 8 Other Improvements: Walls and Ceilings of Rooms cleansed and redecorated 501 Staircases and passages repaired, cleansed and redecorated 112 Floor space ventilated 12 Floors repaired 154 Guttering and rain water pipes repaired 42 Roofs repaired 255 Overcrowding abated 4 Illegal use of underground Rooms for sleeping discontinued 24 Other Improvements, or Nuisances abated 1,259 Rooms Disinfected 42 Total Improvements 2,844 Total Premises Improved 491 1937 52 COMMON LODGING HOUSES. The registration, licensing, inspection and regulation of these is provided for by sections 156 to 166 of the Public Health (London) Act, 1936. The Council has delegated the powers under these sections to the Public Health Committee, and the inspection is carried out systematically by Sanitary Inspectors. During the year the Committee considered applications and granted 17 licences, representing 24 premises. 359 visits of inspection were made by male Inspectors and 66 by women Inspectors, making a total of 425 inspections. In the promotion of the welfare of unemployed applicants who apply for assistance to the Unemployment Assistance Board, information has been supplied to the Board regarding the facilities offered by the licensed common lodging houses in the Borough. Appended is a list of the accommodation, charges, etc.:— Beds. Charge per Night. For Women: 13-14, Duncan Terrace 63 1s. 2d. Provision for cooking meals. 47, 49 and 51, Wharfdale Road 65 1s. 0d. Tea and biscuits only provided. For Men : 104 and 106, Georges Road 34 10d. Provision for cooking meals. 14, 16, 18, 20 and 22, Barnsbury St. 126 10d. & 1s. 0d. Do. 87 and 89, Essex Road 87 9d., 10d., 11d. and 1s. 6d. Do. 155, Englefield Road 62 9d. Do. 8, Flowers Mews 30 10d. Do. 1, 2, 3, 4, 5, 6, 7 and 13, Gordon Place 53 8d. Do. PUBLIC HEALTH (LONDON) ACT, 1936, SECTION 224. DISEASED OR INFIRM PERSONS. Under section 224 of the Public Health (London) Act, 1936, before action can be taken the Medical Officer of Health of the District must certify in writing to the Sanitary Authority that a person— (a) is suffering from a chronic disease, or (b) is aged, infirm or physically incapacitated and resides in premises which are insanitary owing to neglect on the part of the occupier of the premises or resides under insanitary conditions, and (c) that the person is unable to attend to himself or to receive from persons with whom he resides proper care and attention, and (d) that enquiry has shown that in the interests of the health of that person and to prevent injury to the health of or serious nuisance to other persons he should be removed from the premises in which he is residing. If the Medical Officer of Health submits such a certificate to the Sanitary Authority, he may make an application to a Petty Sessional Court, and the Court upon proof of the allegations in the certificate, and subject to the examination of the person in question by a legally qualified medical practitioner to be nominated by the Court, may make an order for the removal of that person to a suitable hospital 53 1937 or institution and his detention therein for a period not exceeding three months and for such further period or periods, not exceeding three months in the case of any one period, as may be determined by a further order made under this section. During the year 16 cases were investigated by the Medical Officer of Health under this section, 3 males and 13 females. Of these persons, two were admitted to the Islington Institution on a Justice's order, 7 entered institutions without Court proceedings, 1 removed to another address, and further action was not deemed to be necessary; 6 cases after investigation were reported on as not coming within the scope of section 224 of the Act. RATS AND MICE (DESTRUCTION) ACT, 1919. During Rat Week, double-crown posters issued by the Ministry of Agriculture and Fisheries were exhibited on selected sites and boards in the Borough. The Ministry of Agriculture leaflets No. 49, "Simple Suggestions—How to Kill Rats"; Bulletin No. 30, and special leaflets issued by the Borough Council were distributed from the Public Health Department, and rat baits were distributed free to applicants. The reports of the result of baits laid according to instructions given by the Sanitary Inspectors appear to be both satisfactory and interesting. In one case a large factory was infested and baits were supplied. It was later reported that the poison appeared to have effected a considerable reduction in the number of rats, but that it was not certain re-infestation would not recur because of the proximity of the buildings to the Metropolitan Cattle Market. In six other instances private houses were badly infested. The following is a short summary of the results attained by laying baits:— (a) Premises badly infested ; coal-cellars, etc., cemented, and baits used. No sign of rats observed for ten weeks after action. (b) Top floor room only infested. One dose of rat poison cleared the place. No sign of rats for two months. (c) Badly infested. Rat poison laid, floor of cellar concreted. No rats seen for seven weeks. (d) Badly infested. Coal cellar concreted, one set of baits cleared the rats. The occupier of these premises is a fish merchant and often leaves fish boxes at the house; these of course attract the rats, and this practice has been discontinued. No rats seen for six weeks. (e) Badly infested. Two doses of poison necessary. No rats seen for ten weeks, but occupier states they had been heard up to two weeks ago. Since then no sign of rats. (f) Slightly infested. One set of baits cleared the premises of rats. In all these cases the closing of rat-runs was effected and advice given in case of re-appearance of the rodents. During the year 1937 the number of complaints received was 228 Number of private houses visited under the Rats and Mice (Destruction) Act 359 Number of shops and factories visited 63 Total premises inspected 422 Street work visits numbered 251 Number of premises proved to be rat infested 185 Number of premises in which infestation was due to mice 6 Number of notices served 134 Drain defects remedied as a result of complaint of rat trouble 28 1937 54 The following Table summarises the work under the Act during the years 1929 to 1937:— 1929 1930 1931 1932 1933 1934 1935 1936 1937 Number of Streets visited 144 166 223 250 244 236 239 203 251 Number of Private Houses visited 223 387 385 391 388 364 412 329 359 Number of Shops and Factories visited 36 37 48 17 38 46 37 46 63 Total Premises inspected 259 424 433 408 426 410 449 375 422 Found Rat Infested 101 142 178 169 168 178 190 133 185 Found Mice Infested 4 3 10 9 8 6 9 6 6 Defective Drains Repaired (cause of Rat trouble) 23 45 50 63 37 55 42 31 28 Number of Complaints received 124 176 216 203 194 212 199 191 228 SCHOOLS. 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. In the public and private schools no sanitary defects were found, and no criticism of water supply was called for during the year. The number of private schools is now 10; (2 in use in 1936 ceased to be used during the year 1937). SWIMMING BATHS AND POOLS. There are three establishments, baths and washhouses, in the Borough which belong to the Borough Council, situated at Hornsey Road, Essex Road and Caledonian Road. The London County Council have an open-air swimming pool at Highbury Fields, the Highbury County School at Highbury Grove has a swimming bath for the scholars, and one of the large boarding-houses in Highbury has a small private open-air swimming pool. Eight samples of water were taken from the Municipal Swimming Baths, five were submitted to bacteriological examination, and the report in each case was that no exception could be taken to the use of the water for swimming bath purposes on bacteriological grounds, as the water in each case was comparable to a potable water. Three samples were submitted for chemical examination; two of these were reported to contain free chlorine slightly in excess of 0.5 parts per million, but not sufficient to cause inconvenience or complaint. Two samples were taken from a private open-air swimming pool; one submitted for chemical examination was reported to contain free chlorine slightly below 0.2 parts of chlorine per million of water. With regard to the bacteriological examination of the same water, the report stated it not to be of a high standard for a modern swimming pool, particularly if chlorination is employed, and that it did not approximate to a bacteriological standard of a potable water. The owners of this private swimming pool were made acquainted with the results and advised. HOUSING. Appointed Day.—As the Minister of Health has not fixed the "Appointed Day" for Islington no further action was taken during the year on the Overcrowding Survey. 55 1937 Underground Rooms.—Progress continued during the year in making underground rooms comply with the Regulations of the Council made under section 18 (1) of the Housing Act, 1925. Upon a basement room becoming empty an intimation is forwarded to the owner that the room does not comply with the Regulations governing underground rooms. As a result of this action 275 underground rooms were made fit. Closing Orders were made in respect of an additional 274 underground rooms. The majority of these rooms remained closed for human habitation but in 63 cases the rooms were made to comply with the Regulations and the Closing Orders were determined. In two cases where Undertakings had been given under the 1930 Housing Act that the rooms would not be used for sleeping purposes, the Undertakings were cancelled as the rooms were rendered fit for human habitation. Demolition Orders.- Five Demolition Orders were made with respect to the following premises:— 2 and 4, Muriel Street. 25, Wedmore Street. 12 and 14, Newington Green Road. Undertakings were accepted that the premises would not be used for the purposes of human habitation with respect to:— 130, Devonshire Road Annex. 192 and 194, Blackstock Road. Of these premises 25, Wedmore Street, 12 and 14, Newington Green Road and 1, 2, 3 and 4, Webb's Cottages were demolished. These latter cottages were the subject of Demolition Orders during the preceding year. Demolition of Habitable Dwellings.—During the year 314 houses have been demolished, on the sites of 71 of these new business or non-domestic premises have been erected. Housing Accommodation—London County Council.—Seven hundred and forty-seven applications for housing accommodation on London County Council estates were dealt with during the year. 392 were direct applications referred back by the L.C.C. for investigation and 355 were applications made through the Public Health Department. As a result of the visits made by the Sanitary Inspectors it was found that 420 families were living in overcrowded conditions, and "orange forms" recommending preferential treatment on these grounds were forwarded to the Valuer. Included in the overcrowded cases were 10 families in which there was a notified case of tuberculosis. Sixty-eight blue forms, where there was chronic ill-health but no overcrowding, were submitted, 47 of which were on the grounds of tuberculosis. Bronchitis, rheumatism, and heart disease were the grounds on which the remaining recommendations were made. There were no grounds for special treatment in 192 cases but the L.C.C. were asked to give consideration to these applicants if accommodation were available. The remaining 67 families were found to be occupying basement rooms subject to representations under the Housing Act, 1936. On the above recommendations 165 families so far have been re-housed. Fortytwo in the Borough and 123 on estates outside Islington. 1937 56 During the year 522 families have been accommodated by the London County Council, 167 inside the Borough and 355 outside the Borough. Re-housing consequent upon action under the Housing Acts.— 1.—Rehousing in Borough Council flats:— Families. (a) as a result of underground rooms closed 77 (b) as a result of parts of buildings closed 7 (c) as a result of demolition orders made 5 (d) as a result of clearance orders confirmed by Minister of Health 70 Total 159 2.—Rehousing in London County Council flats:— (a) as a result of underground rooms closed 4 (b) as a result of part of building closed 1 (c) as a result of demolition orders made Nil (d) as a result of clearance orders confirmed by Minister of Health 4 Total 9 3.—Rehousing in Islington and Finsbury Housing Association flats:— (a) as a result of underground rooms closed 13 (b) as a result of parts of buildings closed Nil (c) as a result of demolition orders made Nil (d) as a result of clearance orders confirmed by Minister of Health 27 Total 40 PARTICULARS OF HOUSES OR FLATS PROVIDED UNDER THE COUNCIL'S HOUSING SCHEMES. 1919 to 1936. 1937. Total since 1919. 1919 Act Halton Mansions (Nos. 1-160) 160 — 160 City Mansions 47 — 47 Queen's Mansions 45 — 45 Warltersville Mansions 46 — 46 Manchester Mansions 31 —. 31 Addington Mansions 107 - 107 10 houses comprising 34 dwellings - 34 470 — 470 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 Halton Mansions (Nos. 161-168) 8 — 8 1930 Act Wakelin House 109 — 109 Blythe Mansions — 119 119 Coleman Mansions — 40 40 1,058 159 1,217 57 1937 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., 1935. Erected in 1936 and 1937. Total. Part III of the Housing Act, 1925 79 Nil 79 Part II of the Housing Act, 1925 Nil Nil Nil Other Powers 979 159 1,161 *23 Total 1,081 159 1,240 (less *23) * 7 houses comprising 23 tenements sold in 1936. SUMMARY OF HOUSING FROM 1919 TO 1937 (INCLUSIVE). 1919 to 1936. 1937. Total since 1919. *Number of houses or flats provided by the Islington Borough Council 1,081 159 1,240 Number of flats provided by the London County Council 1,012 178 1,190 Number of houses or flats provided by private enterprise 887 273 1,160 2,980 610 3,590 * 7 houses comprising 23 tenements sold in 1936. RECONDITIONING OF HOUSES. Section 9 of the Housing Act, 1936.—This enacts that "Where a local authority, upon consideration of an official representation, or a report from any of their officers, or other information in their possession, are satisfied that any house which is occupied, or of a type suitable for occupation, by persons of the working classes is in any respect unfit for human habitation, they shall, unless they are satisfied that it is not capable at a reasonable expense of being rendered so fit, serve upon the person having control of the house a notice requiring him, within such reasonable time, not being less than twenty-one days, as may be specified in the notice, to execute the works specified in the notice and stating that, in the opinion of the authority, those works will render the house fit for human habitation." The result of the Department's work during the year in regard to section 9 of the Housing Act, 1936, is as follows:— Number of informal notices served 175 Number of formal notices served Nil Number of dwellings rendered fit 95 1937 58 WORK OF THE SANITARY INSPECTORS (HOUSING). This work was carried out by Messrs. Hancock and Ashworth. House-tohouse inspections were made in the following thoroughfares:— Barnsbury Grove, Charlton Place, Edward Square, Newhall Street, Pemberton Terrace, Queen's Place, Raynor Place, St. Clement Street and Salisbury Road. In consequence of these inspections 175 informal notices were served requiring 5,171 re-inspections and calls, which resulted in 1,617 improvements being effected in 117 premises where the work required by the notices had been completed by the end of the year, including 22 premises which were made fit by the owners without the service of notices. A considerable amount of time was spent by these Inspectors in an Area taken over by the London County Council in Liverpool Road, and also in the survey of properties which were represented by the Medical Officer of Health for clearance. HOUSING ACT, 1936. REPRESENTATIONS, ETC., by the MEDICAL OFFICER OF HEALTH. Gaskin Street (late Church Street) was dealt with by the Borough Council; No. 1 Area (comprising Nos. 31, 33 and 35, Gaskin Street) as a Clearance Area and No. 2 Area (comprising Nos. 9, 11, 13, 15, 17, 19, 21, 23, 25, 27 and 27a, Gaskin Street) as a Compulsory Purchase Order on behalf of the Islington and Finsbury Housing Association. In regard to the L.C.C. Boleyn Road Area, inspections were made of a large number of houses for the purpose of giving supporting evidence. A representation was made in 1937 of the properties comprising the Cornelia Street, St. Clement Street and City Garden Row (Nos. 1, 2 and 3) Areas to be dealt with in due course by the Borough Council under Part III of the Housing Act, 1936. 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) 6,987 (b) Number of inspections made for the purpose 27,778 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,469 (b) Number of inspections made for the purpose 3,856 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 14 (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 406 59 1937 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 613 3.-Action under Statutory Powers during the year:- (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 175 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 7 (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 4,447 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 4,447 (b) By local authority in default of owners Nil (c) Proceedings under sections 11 and 13 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which Demolition Orders were made 5 + 4 Undertakings accepted not to let premises for human habitation. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 + 4 in which undertakings under section 11 were given. (d) Proceedings under section 12 of the Housing Act, 1936— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 274 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 63 + 2 Undertakings. 4.—Housing Act, 1936, Part IV—Overcrowding:— The "appointed day" not having been fixed by the Minister of Health for the Borough, correct information cannot be given under this item, as in last year's report the statistics specified were from the Preliminary Survey carried out in the years 1935-36, and the information now given follows the same lines, but the figures for overcrowding are reduced by the number of families who have been re-housed elsewhere because of their overcrowded conditions:— (a) (i) Number of dwellings overcrowded at the end of the year 6,652 (ii) Number of families dwelling therein 6,652 (iii) Number of persons dwelling therein 19,694 1937 60 (b) Number of new cases of overcrowding reported during the year Nil (c) (i) Number of cases of overcrowding relieved during the year 155 (ii) Number of persons concerned in such cases 965 (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 THE SHOPS ACT, 1934. Inspections were continued systematically during the year for any contraventions of the provisions of the Shops Acts and 634 premises were added to the number already on the register. As the requirements of the Act have now become better known to the shopkeepers, little difficulty has been experienced in carrying out its provisions. The practice of asking traders to execute necessary repairs voluntarily has been continued with marked success, and is appreciated by the traders. In many instances shop-keepers have gone beyond what would have been required by notices. Proceedings in the Police Court have been necessary only in one instance. This was rather in the nature of a test case as to what was reasonable alternative accommodation under the Act, following on the refusal of the Council to grant a certificate of exemption for sanitary conveniences. The case was withdrawn on the Council granting a certificate of exemption, which was given for other alternative accommodation than that at first offered. Experimental work at the suggestion of the Inspector (Mr. G. S. Green) in connection with the heating of butchers', greengrocers' and fruiterers' premises is still being carried out, in many instances very successfully, while in the grocery and provision trade no further difficulties have been experienced. In connection with the latter trade, some particularly good systems are now being installed following experimental work during last winter. No solution has yet been found for the fish trade, although hot water, and suitably heated rooms to which the staff can retire are provided in most instances. The following table shows the number of shops on the register at the end of 1937, visits paid, etc.:— Number of shops on Register, 31st December, 1936 2,570 Number of shops removed from Register during 1937 70 2,500 Number of shops added to Register during 1937 634 Total number of shops on Register, 31st December, 1937 3,134 Total number of visits to shops 4,008 Number of intimation notices served 42 Statutory notices served 14 Number of cases in which work was carried out voluntarily 129 Exemption certificates issued in 1937 5 61 1937 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Slaughter Houses.—The Inspector of Meat (Mr. A. W. Haydock) reports that during the year 1937, 7 private slaughterhouses for local supplies and 1 slaughterhouse for the slaughter of horses for export, held licences. The visits to these premises numbered 305, and the following is a statement of the number of animals slaughtered in them. Oxen. Sheep and Lambs. Pigs. Horses (for export) 167 1,105 2 870 The following Table records the diseases found in slaughterhouses:— Number of Cases. Description of animal. Nature of disease. Extent of disease. How disposed of[ 13 Oxen Distomatosis Liver Destructor or on premises. 1 „ Tuberculosis Head, Tongue, Lungs and three portions of carcase. Destructor. 10 „ „ Lungs ,, 3 „ „ Heads and Tongues „ 1 ,, „ Lungs and Liver ,, 1 „ Multiple Abscesses. Liver „ 1 „ Pneumonia Lungs ,, 1 „ Actinomycosis Head and Tongue „ 1 „ „ Tongue " CARCASES INSPECTED AND CONDEMNED. Cattle, excluding cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) 167 — — 1,105 2 Number inspected 167 — — 951 2 All diseases except Tuberculosis: Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 17 — — — — Percentage of the number inspected affected with disease other than Tuberculosis 10.2 — — Tuberculosis only: Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 15 — — — — Percentage of the number inspected affected with Tuberculosis 8.9 — — — — 1937 62 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) — 4 2 22 Meat and Tinned Food from shops and stalls (surrendered) — 2 3 3 „ ,, (seized) — 3 1 15 Fish from shops, fishmongers and fryers (surrendered) — 3 1 — Fruit and Vegetables (surrendered) — 19 — — Provisions (seized) — — — 14 „ (surrendered) — — 2 6 Total 1 13 3 4 Food Inspection.—The number of visits made to shops, etc., were as follows :— Butchers, Provision Dealers, etc., shops 2,129 Meat, etc., Preparation Factories 65 Fish Shops 481 Fruit Shops 1,485 Markets 249 Stalls 654 Offensive Trades 123 Total 5,186 Merchandise Marks Act, 1926.—The marking of imported food with an indication of origin is regulated by various orders made under this Act. Three years have now elapsed since imported meat was brought within the scope of this Act requiring, in the majority of cases, the use of a large number of tickets and a corresponding amount of time to comply with the Order. Islington butchers generally are to be congratulated on the manner in which they have observed the requirements of this legislation. During the year six traders were warned for failing to mark imported meat, five for tomatoes and four for apples. Prosecutions taken under Merchandise Marks (Imported Goods) Orders.-Five prosecutions were taken, which were successful, against four traders who failed to comply with these Orders. Two were due to omitting to mark imported meat with the name of the country of origin, one for marking Chilian lamb with the word "Empire" and two for failing to mark imported tomatoes. One of these last named cases concerned a stall on which was exhibited a quantity of Jersey tomatoes that were not marked in accordance with the appropriate Order. The vendor was heard by the Inspector to describe them as " English he refused to give his name and address when asked. His name and place of abode were afterwards ascertained, but as he was seen at the same market some weeks later the summons was served while he was carrying on business there. He was ultimately fined £3. The aggregate of penalties in the above cases was—Fines, £6 12s. ; Costs, £3 2s. 63 1937 Prosecutions for exposing for sale Unsound Food.—During the year two cases occurred relating to unsound food, one concerning unsound chestnuts, and one regarding a meat stall at which the Inspector was able "to relieve" the proprietor of all the meat he had for that day's trade. The meat was "boned out" cow beef with most lymphatic glands removed. Owing to the difficulty of making a proper examination in the confined space of the stall, the Inspector seized the meat on account of the emaciation and later, at the Council's disinfecting station, where a thorough inspection was made, traces of tuberculosis were found. On the stall were a number of parcels containing portions of this meat which had been sold but awaiting collection by the purchaser and while the Inspector was waiting for the arrival of a conveyance to remove the meat, one of these purchasers asked to be allowed to take her parcel "at her own risk." This was refused. Everyone— lodgers included—is entitled to sound and wholesome meat. On enquiries being made it was learned that one of the assistants on the stall had left a knackery outside London on the previous day with a car-load of meat answering this description, ostensibly to be used for cat meat. Efforts were made to have the vendor's assistant's responsibility considered but the magistrate ruled that the assistant acted only as the proprietor's agent. The weight of this meat was 362 lbs., excluding bones, and the proprietor was fined £5 5s. with £5 5s. costs on each of three counts. The aggregate of penalties in these cases was fines, £16 15s. and costs, £16 5s. Public Health (Meat) Regulations, 1924.—A proprietor of a stall was prosecuted under these regulations for failing to effectually screen the meat from dust, etc., blown off the roadway. He was fined 21s. with 21s. costs. One other case was authorised by the Public Health Committee against a shopkeeper for omitting to observe due cleanliness with his utensils. He closed his shop and left the district, however, before a summons could be served. Four traders were also warned for infringing the above regulations. Diseases of Animals Acts -Anthrax Order, 1928.—On two occasions during the period under review the above order relating to animals was applied in this borough. In one case, however, the Ministry did not confirm the diagnosis of Anthrax. Slaughter of Animals Act, 1933.—Of the 43 slaughtermen who were licensed under this Act during 1936, 33 applied for them to be renewed, and five new applications for licences were received, all of which were granted after investigation, making a total of 38 licensed slaughtermen on our register at the end of the year. Offensive Trades.—The offensive trades placed under the Meat Inspector's supervision consist of three tripe dressers, five gut scrapers and one knacker's yard. One hundred and twenty-three visits were made during the year, and no breach of the regulations was observed. To these fall to be added three skin dressers under the supervision of the Inspector of Workshops. By-laws for the Protection of Food.—These by-laws, which are designed, as the name suggests, for the prevention of contamination of food are made under the Public Health (London) Act, 1936, and came into operation on 1st January, 1937. In practice this has resulted in proprietors of stalls who sell certain foods not packed in containers or packets adopting methods of screening their goods, either by the use of glass show-cases, or in a manner similar to that required of meat purveyors under the Public Health (Meat) Regulations. Traders have readily complied with these requirements and no prosecution has been necessary. 1937 64 CERTIFICATION OF MEAT FOOD PRODUCTS FOR SHIPMENT ABROAD. The Medical Officer of Health, as Designated Officer for Food Certification, issued one certificate in respect of foods prepared in Islington and exported to the United States of America. LICENSED STREET TRADERS IN THE BOROUGH OF ISLINGTON FOR THE YEAR 1937. Meat, etc., 16 ; Fish, Poultry, Rabbits, etc., 27 ; flee Cream, 24 ; Confectionery, Minerals, etc., 27 ; Grocery, Provisions, etc., 17 ; Coffee Stalls, etc., 9 ; Fruit, Vegetables, Greengrocery, etc., 181. † 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. The following is a tabulated statement of the premises examined, and the Hotel and Restaurant Kitchens 142 32 Coffee and Dining Rooms 331 70 Refreshment Rooms 290 64 Provision (Cooked Meats, cooked but not consumed on premises) 126 34 Totals 889 200 NOTIFICATION OF FOOD POISONING. During the year 26 cases of food poisoning were notified, the alleged poisoning foods being pressed pork, bacon, " Ham or similar meat," corned beef, fried fish, fresh fish, kippers, ham rolls, crab, meat pie, and " Shepherd's Pie," containing tinned peas, meat and potatoes. On the 2nd June, six persons, all of one family, were reported from St. Mary Islington, hospital, to be suffering from food poisoning, the suspected food being pressed pork. Very careful and exhaustive enquiries were made at the shop where it was alleged the pressed pork was purchased, but no evidence was obtained to indicate that the food sold was responsible for the illness. It was ascertained that potatoes and " soaked " peas also formed part of the meal, and samples of both pork and peas were bacteriologically examined, with negative results, but it may be noted that the bacillus aertryche was found in the stools of the patients under treatment at St. Mary, Islington, Hospital. These six notifications were followed on the 5th June, 1937, by three relating to the members of another family in the same district, who it was ascertained had partaken of pressed pork said to have been purchased from the same shop as in the previous instance. No material for examination could be obtained for cases 7, 8 and 9. The tenth case was an adult who attended a wedding reception and although the Bacillus Newport was isolated no evidence of the particular food which caused the illness was produced. Likewise no particular material was obtained for examination. As regards the primary examinations before mentioned, the pork 65 1937 was examined at the Ministry of Health Laboratory and the peas at the Bland Sutton Institute. Cases 11 to 20 were all traced to the consumption of food (ham or bacon) purchased at a shop in Finsbury, in which Borough 82 persons were affected, 40 in St. Pancras, 10 in Islington, and 1 each in Holborn and Bethnal Green. At the commencement of the outbreak it was discovered that the sufferers had obtained ham from a provision shop in the Borough of Finsbury and a thorough investigation of the conditions under which the ham was prepared for sale was carried out. From the investigations made by Dr. N. D. Dunscombe, Medical Officer of Health for Finsbury, to whom I am indebted for notes of his enquiries, it appeared that the outbreak was due to the food cooked at the shop in question being infected with the B. Enteritidis Gaertner, the breakfast sausage and corned beef being infected secondarily from infected knives or hands, but it was impossible to say with any certainty by what means the food became first infected, although the possibility of infection from a human source cannot be excluded. Case No.21, was ascribed to fish, alleged to have been purchased, in Caledonian Market, No.22 to kippers, No.23 to ham purchased at a cafe, No.24 to the consumption of dressed crab, No.25 to meat pie, and the last case notified, No.26, was alleged to have been caused by pie made from cold meat which had been kept in a refrigerator from Sunday until Wednesday, and made into a pie with potatoes and green peas. It was ascertained that six persons living in various parts of London were taken ill after partaking of this pie. A specimen of faeces was sent to the Ministry of Health Laboratory, and Dr. Scott reported : " I have failed to identify any of the usual pathogenic bacteria, but it is curious that in all the specimens (except that of faeces from Mr.-, Hamp- stead, which contained B. Coli only), a non-lactose-fermenting bacillus resembling Morgan's bacillus was present. I cannot say whether this bacillus was the cause or not, and as it agglutinates spontaneously in salt solution, I fear that any wider tests would fail. The specimens examined were:— Shepherd's Pie ? Morgan + Vomit Morgan + Mr. -, Hampstead Morgan Negative. Mrs. -, Hampstead Morgan + Miss -, Lambeth Morgan + Miss. -,Islington Morgan + " PRESERVED FOOD AND ICE CREAM. Registration of these premises was brought under the Public Health (London) Act, 1936, Section 187, during the year 1936. In 1936, 275 premises were on the register for preserved food ; five were registered during the year 1937, and none was removed from the register. The total on the register at the end of the year, therefore, was 280, all of which were visited. The number of ice cream premises in 1936 was 494 ; 80 premises were removed from the register in 1937, 66 additional registered, so that the ice cream premises on the register at the end of the year numbered 480. 1937 66 MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. MILK AND DAIRIES (AMENDMENT) ACT, 1922. MILK AND DAIRIES ORDER, 1926. Dairies and Milk Shops. Number on Register 31/12/36. Additions to Register. Removals from Register. Number on Register 31/12/37. Dairies 256 1 17 240 Purveyors of Milk in sealed containers only 448 48 32 464 Registered Purveyors of Milk dealing from registered premises outside the Borough 83 4 — 87 During the year 17 dairies were removed from the Register, due to the fact that on routine inspections being made it was found that nine premises had ceased to exist as dairies, and eight had become unsuitable for the purpose. There were two prosecutions taken under the Milk and Dairies Order, 1926, and one under section 10 of the Milk Act, 1934. The aggregate of penalties in all cases was : fines, £2 and costs £6 6s. In one instance there were three summonses against a firm, for carrying on the trade of Dairyman at premises without being registered, failing to give one month's notice in writing of intention to use the premises as a Dairy, and thirdly for exposing for sale and selling "Pasteurised Milk" as such without a licence. The other case was in regard to a registered "Purveyor of Milk in sealed containers only" selling loose milk on premises not registered as a Dairy. The number of visits paid by the Dairies, etc., Inspector, Mr. R. W. Norman, during the year 1937 was as follows:— Dairies: Routine inspections 845 Inspections for registration of 33 878 Milk Shops (Milk sold in sealed containers only): Routine inspections 508 Inspections for registration of 38 546 Dairies and Milk Shops inspected under the Milk (Special Designations) Order, 1936 141 Ice Cream Premises : Routine inspections 601 Inspections for registration of 100 701 Artificial Cream Premises: Routine inspections 11 Vehicles inspected 54 Miscellaneous visits 317 Total Visits 2,648 As a result of these visits, 67 notices intimating nuisances or defects were served, and 55 warning letters sent to Dairymen, Milk Purveyors, Ice Cream Vendors, and Artificial Cream Vendors, drawing their attention to the contravention of the Acts and Regulations relating to their businesses. 67 [1937 During the year the following nuisances were abated and improvements made to Dairies and Ice-Cream Premises:— Drains and waterclosets—cleansed, reconstructed or repaired 16 Dust-bins provided 13 Yards paved or repaired 11 Yard walls limewashed 13 Sinks provided 3 Sink waste-pipes trapped or repaired 8 Water supply provided 1 Walls and ceilings cleansed and repaired 74 Floors repaired 13 Roof repaired 10 Accumulations removed 8 Utensils cleansed or renewed 20 Permanent ventilation provided 5 Other nuisances abated or improvements made 35 Total improvements 230 Total Premises Improved 141 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 27. THE MILK AND DAIRIES (AMENDMENT) ACT, 1922. THE MILK (SPECIAL DESIGNATIONS) ORDER, 1936. During the year 1937 the following applications were made for licences under the provisions of the above Order, to enable the persons to sell Specially Designated Milk:— Licences Granted Under Milk (Special Designations) Order, 1936. Designation. No. of applications. Number granted. Amount of Fees received. £. s. d. Tuberculin Tested (Dealer) 33 33 7 15 0 ,, (Supplementary) 4 4 8 0 Tuberculin Tested (Pasteurised) — — — Accredited (Dealer) 8 8 2 0 0 ,, (Supplementary) — — — Pasteurised (Pasteuriser) 3 3 3 3 0 „ (Dealer) 82 82 20 2 6 „ (Supplementary) 7 7 14 0 137 137 34 2 6 Ice Cream Premises: Number of premises on the Register at end of 1936 494 „ „ added during the year 66 ,, ,, removed during the year 80 ,, ,, on register at end of year 1937 480 Artificial Cream Act, 1929: Number of premises on the Register at the end of 1936 7 „ ,, added during the year 1 ,, ,, removed during the year 1 ,, „ on the register at the end of 1937 7 1937 68 PHARMACY AND POISONS ACT, 1933, AND THE POISONS RULES, 1935-37. PART II.—POISONS. Number of persons entered on list of sellers of Part II, Poisons, at the end of 1936 169 Number of persons who ceased selling poisons during the year, and were removed from the Register 17 Number of new entries made to the List during the year 13 Number of persons entered on the list of sellers of Part II, Poisons, at the end of 1937 165 The reason for the removal of 17 persons from the List of sellers of Part II Poisons was as follows:— Renewal fee not paid 8 Premises unoccupied 4 Business changed hands and ceased selling poisons 4 Premises demolished 1 Number of visits made by the Mr. Norman during the year was as follows:— Visits re applications for entry on List of sellers 13 Other visits *819 832 During the year, six cases of contravention of the Act and Rules were reported to the Public Health Committee ; four were in respect of non-listed sellers of Poisons selling Part II Poisons, and for not labelling same in accordance with the provisions laid down in the Poisons Rules, and two were in respect of Listed sellers selling poisons not properly labelled. In three cases warning letters were sent to the offenders on the instruction of the Committee, and the other three were successfully prosecuted—total fines being £7 2s. and costs £5 3s. One of the cases reported was very interesting in regard to its ingenuity—an itinerant vendor was found hawking a disinfectant fluid in the street. A sample was purchased, which on analysis was found to contain 2.14 per cent. Phenols. The disinfectant fluid was purchased as carbolic, but the vendor thought that it was quite in order for him to sell it, and produced a letter from the manufacturers of a certain carbolic disinfectant tablet, wherein it was stated that the disinfectant could be sold either in a solid or diluted form. Naturally the itinerant vendor thought it would be safe for him to sell this disinfecting fluid made from the dissolved tablets. A warning letter was sent to the manufacturers and also to the itinerant vendor, and no further fluid has been found on the hawker's barrow. * In addition to these, 888 visits under the Act were made by the Food and Drugs Inspector. (See p. 70.) EXAMINATION 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 1,237, including 582 informal samples ; and 10 under the Pharmacy and Poisons Act. All the purchases were made by Inspector Lewis or his agent and were submitted to the Islington Public Analyst, Dr. Alan W. Stewart. Of the total samples 1,216 were reported to be genuine and 21 adulterated, or 1.7 per cent. 69 1937 This percentage is 1.3 below the previous year and 2.6 below the average rate for the preceding 10 years. Bacteriological Examination of Milk and Water.—Apart from the above chemical analyses, certain foods, including water, were submitted for bacteriological examination. During the year 1937, 37 samples of milk taken in various parts of the Borough as supplied to the consumers and schools were tested bacteriologically, three of these samples being "Pasteurised" Milk in course of delivery to schools, and six of "Pasteurised" Milk in course of delivery to London County Council Institutions (St. Mary, Islington, Hospital, and Islington Institution). For tubercle, 26 samples were tested, and in no case was the bacillus discovered. The samples were examined for "bacterial count," or subjected to methylene blue or coliform tests according to the designation of the milk. Sixteen samples showed unsatisfactory results, two of "Tuberculin Tested" Milk showing the presence of coliform bacillus. In addition to the above-mentioned 37 samples, six samples of "Pasteurised" Milk were taken for phosphatase test, and four of these gave unsatisfactory results. The matter of the faulty samples was taken up with each dairyman, the possible causes gone into, and an endeavour made to trace the exact causes. At the same time the dairyman were warned of the necessity of everything being done with a view to preventing recurrence. During the year two samples of water were examined, one bacteriologically and one chemically, and in both instances it was reported that no exception could be taken to the use of the water for domestic purposes. Prosecutions under the Food and Drugs (Adulteration) Act.—In most cases prosecutions were instituted, but in a few where exceptional circumstances existed, a strong warning was given. There were seven prosecutions under the Food and Drugs (Adulteration) Act, 1928, of which six were successful, one being withdrawn. These are included in the complete list (page 72). A prosecution taken under the Public Health (London) Act, 1936, was one in which iron filings were found in tea. Two quarter-pound packets of the tea were purchased, and on examination by Inspector Lewis were found to contain iron filings. A formal sample was taken under the Food and Drugs Act and submitted to the Public Analyst, whose report confirmed our findings. To prevent further sale of this commodity the remainder of the stock was examined, seized and taken before a Magistrate, who ordered it to be destroyed. The vendor eventually surrendered 61 lbs. of the same brand of this tea collected from his branch shops. At the hearing of the case the Magistrate reserved his decision, but finally decided to dismiss the case under the Probation of Offenders Act on payment of costs. During the year 1937, eleven informal samples of cream and two samples of artificial cream were submitted to the Public Analyst ; all proved to be genuine. A wide selection (the varieties numbering 145) 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 103, cheese 28, pepper 18, bacon 22, sausages 20, lard 30, dripping 7, vinegar 6, margarine 8, tinned fish 8, minced beef 9, raisins 6, currants 6, sultanas 10, fish paste 19, mustard 7, flour 5, cooked ham 8, skimmed condensed milk (sweetened) 8 and 262 of various other articles, making a total of 590. 1937 70 During the year 1937, in addition to the samples taken and submitted to the Public Analyst, there was a total of 60 informal samples of various articles examined by Inspector Lewis. Summary of visits in special work made by Mr. C. W. Lewis, the Food and Drugs Inspector:— Food and Drugs (Adulteration) Act 1,237 Merchandise Marks Act 760 Pharmacy and Poisons Act 888 Bacteriological samples and miscellaneous visits, calls, etc. 74 Total 2,959 The greatest amount of detected adulteration occurred in the first quarter of the year, as shown by the figures given in the following statement:— Examined. Genuine. Adulterated. Per Cent. Formal. Informal. Formal. Informal. Formal. Informal. Adulterated 1st quarter 167 137 162 134 5 3 2.6 2nd ,, 168 173 165 170 3 3 1.8 3rd ,, 125 139 123 139 2 - 0.7 4th ,, 187 141 184 139 3 2 1.5 The Year 647 590 634 582 13 8 1.7 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.p Milk purchased on Sundays 78 8.66 3.55 12.52 Milk purchased on Weekdays 403 8.73 3.60 12.32 Milk procured in transit (Farmers' Milks) 78 8.85 3.57 12.55 Official Standard — 8.50 3.00 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 78 77 1 1.3 On Weekdays 403 401 2 0.5 In transit (Farmers' Milks) 78 78 — — 559 556 3 0.5 Table giving the particulars of the Milks taken during each quarter of 1937 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 22 109 13 144 21 108 13 142 1 1 — 2 4.54 0.92 — 1.39 2nd ,, 21 92 37 150 21 92 37 150 — — — — — — — — 3rd ,, 17 68 20 105 17 67 20 104 — 1 — 1 — 1.47 — 0.96 4th „ 18 134 8 160 18 134 8 160 The Year 78 403 78 559 77 401 78 556 1 2 — 3 1.28 0.50 — 0.50 71 [1937 Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1937 :— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated. Per cent. Adulterated. 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 1936 576 560 16 2.8 Average 10 years 587 570 17 2.7 1937 559 556 3 0.5 Showing the analysis of 5,867 milks examined in Islington during the 10 years 1927-36 and 1937, 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. 1927 129 8.7 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 - - - 1936 24 8.59 3.52 499 8.60 3.54 53 8.64 3.74 Total samples and average constituents (10) years. 1.059 8.81 3.55 3,449 8.80 3.56 1,359 8.87 3.74 1937 78 8.66 3.55 403 8.73 3.60 78 8.85 3.57 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. During the year sixteen informal samples were taken under the above Regulations and found to be genuine. MILK AND DAIRIES (CONSOLIDATION) ACTS, 1915-1934. For prosecutions under these Acts see page 72. 1937] 72 SUMMARY OF PROSECUTIONS DURING YEAR, 1937. Statute. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties. Costs Received. £ s. d. £ s. d. Public Health (London) Act, 1936 17 15 1 1 32 9 0 33 7 0 Food and Drugs (Adulteration) Act, 1928 7 6 - 1 5 19 0 11 0 0 Milk and Dairies (Consolidation) Acts, 1915-34 3 3 - - 2 0 0 6 6 0 Milk and Dairies (Amendment) Act, 1922 1 1 - - London County Council (Drainage) By-laws 2 2 - - 2 0 0 - Merchandise Marks Act, 1926 5 5 - - 6 12 0 3 2 0 Shops Act, 1934 1 - - 1 - - Housing Act, 1936 2 - - 2 - - Public Health (Meat) Regulations, 1924 1 1 - - 1 1 0 1 1 0 Pharmacy and Poisons Act, 1933 4 4 - - 7 2 0 5 3 0 Totals 43 37 1 5 57 3 0 59 19 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 1,516. In " Sick " Ward : Males, 81 beds ; females, 156. In " Infirm " Ward : Males, 206 beds ; females, 343. In Main body of the Institution for the healthy cases and Receiving Ward : Males, 475 beds ; females, 213 ; and 42 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. 52 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. 73 [1937 NEW LEGISLATION. (Enacted or coming into force during 1937.) London County Council (General Powers) Act, 1937. Hydrogen Cyanide (Fumigation) Act, 1937. Factories Act, 1937 (comes into operation 1st July, 1938). London County Council By-laws (Protection of Food). Public Health (Imported Food) Regulations. Agricultural Produce (Grading and Marking) Order re— Cabbages. Canned Vegetables. Certain Plums. Fruit Products. Lancashire Cheese. Wheat Flour and Wheat Flakes. Poultry (Exposure for Sale) Order, 1937. The Poisons List (Amendment) Order, 1937. The Poisons (Amendment) Rules, 1937. Housing, Order No. 2, dated 17th June, 1937. The Housing Act, 1936 (Operation of Overcrowding Provisions), Order No. 3. Memo. 166/Med., Ministry of Health. Memo. 62/A (Foods) Meat Inspection. Circular 1643a. Ministry of Health, Local Health Services. Circular 1519, Ministry of Health. Milk, Meat and other Foods to Expectant and Nursing Mothers and Young Children. Circular 1621, Ministry of Health, Prevention of Blindness. Circular 1622, Ministry of Health. Maternal Mortality. PROPAGANDA. Propaganda work previously undertaken by the Public Health Department continued during the year. In addition, there were some features of note which distinguished 1937 from previous years. The Central Council for Health Education, in conjunction with the Ministry of Health and with the assistance of Local Authorities, launched a winter campaign and a special propaganda effort by means of leaflets, talks, etc., from October, 1937, and the Islington Borough Council co-operated in this campaign. A booklet entitled " Summary of the Health Services provided for Islington Citizens" was prepared and issued during the year, and 9,471 copies were distributed ; this is being continued and it is intended to revise the booklets from time to time as changes occur in the services. A new two-coloured poster on Diphtheria Immunisation was widely exhibited among other health propaganda posters, and a leaflet explaining briefly the dangers of, and the need for protection against. Diphtheria was also issued; over 13,000 copies of the leaflet were distributed, the large majority through the schools by arrangement with the London County Council. An innovation which is proving of interest is the sending out on the occasion of a child's first birthday of a greeting from the Medical Officer of Health, together with a card on which is summarised, simply and briefly, what a parent might reasonably expect of his child in the way of normal physical and mental progress after the age of twelve months, together with some hints on dieting and feeding. The immunisation leaflet previously mentioned is also included with the first birthday greeting card. Facsimiles of the cards are given here :— 1937] 74 METROPOLITAN BOROUGH OF ISLINGTON Public Health Department. Advice on Children's Development and Feeding after the age of 12 months. When a child is growing out of his babyhood into the toddler stage at about 1 year of age, many parents are uncertain as to how fast baby should progress with regard to teething, walking, talking, and so on. The question of feeding also becomes more complicated, and it is hoped that the information on this card will act as a guide to proper progress. Parents must realise, however, that no information of this general character can replace a personal examination by a doctor, where there is any doubt about the child's health. The figures here given must be regarded only as general indications; children may be 2 or 3 months earlier or later and yet be quite normal, but if they depart further than this, such as not walking or talking at the age of 2 years, they should most certainly see a good children's doctor. The average child at :— Age. Months. Speech. Teeth. Weight [Boys). Height. 12 Stands with support. Says single words 6 21 lbs. 29 J in. (e.g., mum, dad, ta, bye-bye). 14 Stands alone. 15 Walks alone. Begins talking. 22} „ 30½ „ 18 May stand on one leg. Puts 2 or 3 words 12 24} „ 32 „ together. 21 May walk backwards. Says short sentences. 24 Runs freely. Obeys simple com- 16 27} „ 34 „ mands, and has a 250 word vocabulary. 30 20 Girls are about ½ lb. lighter and ½ in. shorter than boys at these ages, although, of course, individual girls may be taller and heavier than individual boys. In both boys and girls, there may be considerable differences from the figures given above, with the child in perfectly normal health, but it is advisable to obtain a doctor's confirmation if the departure from the average is very marked. Fontanelle : The Fontanelle—or "soft spot" on top of a baby's head— should close between the fifteenth and eighteenth months. Fundamentals of Daily Diet—Required by all children every day, soon after reaching one year of age :— Milk, about 1 pint. Unsuitable Foods— 1 Egg (if tolerated). sausages and cooked meats, bottled Leafy Vegetables—greens, brussels, soft drinks, ginger ale, coconut and kale, lettuce, etc. chocolate, cucumber and radishes, Root Vegetables—potato, carrot, dried fish and meat, fried foods, turnip, etc. iced foods, pies, pastries, fish cakes, Raw Fruits—apple, pear, orange, spices, pickles, mustard, pepper, grape-fruit, banana. Cooked fruit— apple, pear, prunes, raisins, figs. Meat, Fish or Fowl—liver, brains, kidney, scraped-meat, fine fish, e.g., plaice. Butter— Additional foods are optional. Cod-Liver or Halibut Oil should be given regularly throughout the winter months. For Healthy Development a Child Requires : Good Food, Regularity in Habits, 12-14 Hours Sleep per day, and Daily Fresh Air. Keep this Card for reference. 75 [1937 METROPOLITAN BOROUGH OF ISLINGTON (Public Health Department). First Birthday Greeting Card. The Medical Officer of Health wishes your child many happy returns on the occasion of his/her first birthday, the day of 193 and feels sure that you will be interested in the health literature enclosed. The foundations of health development are laid down in early childhood. The Council have purchased a film on Diphtheria Immunisation which has been exhibited at the Town Hall. A two-page summary of the booklet on the Islington Health Services was distributed through the medium of the Post Offices to the extent of 10,000 copies; also at the request of the Libraries Committee leaflets giving a list of books dealing with maternity and child welfare subjects were issued to the Voluntary Welfare Centres and Day Nurseries for distribution. In the early part of the year the Assistant Medical Officer of Health addressed a Conference, held at the Central Library, Holloway Road, on Maternity and Child Welfare work in Islington, with particular reference to infant mortality. Representatives of the Welfare Centres and organisations both inside and outside the Borough dealing with this branch of work were present, and many interesting suggestions were forthcoming. A similar talk was given to the City Division of the British Medical Association in June, 1937. A number of other talks and lectures were given by the Medical Officer of Health and the Assistant Medical Officer of Health. The Voluntary Welfare Centres continue to give health talks, and this feature would appear to be an interesting aspect of the educational work within the Borough. 1937] 76 MATERNITY AND CHILD WELFARE. Report by Assistant Medical Officer of Health. A considerable number of developments and activities have to be reported in connection with Maternity and Child Welfare during the year 1937. This year saw the opening of the Council's first Municipal Day Nursery, the Miriam Price Coleman Day Nursery and Sunlight Clinic. There was also an extension to the Home Help Scheme, an extension of the facilities under which the Council might make Milk Grants to expectant and nursing mothers and children under the age of five, and also, arising out of the Ministry of Health's Circular 1622, consideration was also given to the establishment of an Emergency Unit and a Consultative Maternity and Gynaecological Clinic. In addition, the appointment of an additional Assistant Medical Officer in connection with the administration of the wards at the North and West Islington Welfare Centres, and to carry out other work at the Council's Day Nursery, was also under consideration. Miriam Price Coleman Day Nursery and Sunlight Clinic, Scholefield Road, AT.19. This building was opened by Councillor G. B. Naish, J.P., L.C.C., Mayor of Islington, on October 23rd, 1937, and the Day Nursery portion has been designed to accommodate 45 children. It was erected on a site having an area of approximately 8,000 sq. ft., and the main Nursery frontage faces South East. The Nursery building consists of two functionally distinct portions, (a) the Nursery, and (b) the Clinic section. (a) The Nursery.'—The entrance from Scholefield Road leads into the Reception Hall with an Isolation Room and Matron's office adjoining. A corridor leads from the Reception Hall to the three Nursery rooms, and opening out from one side of the corridor is a room for children's clothing and a laundry, whilst on the other side there is a bath room and children's w.c. accommodation. The three Nursery rooms for toddlers, tinies and babies respectively are separated from each other by glazed sliding Esavian partitions, and lead at the other end to the infants' changing room and milk room. The walls of the Nursery are tiled and the floors are laid with cork tiles. The Nursery rooms open out on the Southern aspect to a glass roofed verandah and beyond this to the playground covered with green asphalt. The doors separating the Nursery from the playground can be folded back completely. This portion of the building also contains kitchen and scullery on the ground floor, and on the first and second floors residential accommodation for the Nursery staff. The Nursery staff consists of a Matron, Senior Nurse, four Probationers and a parttime Kindergarten teacher. There is also a resident cook, non-resident cleaner and domestic. Each Probationer is provided with a separate bedroom containing a lavatory basin and hot and cold running water. The Nursery is intended primarily for the reception of children whose mothers are obliged to go out to work, but consideration may also be given to the admission of cases where there is ill-health or difficult home circumstances, or where children are specially recommended by the Medical Officer of Health on account of other exceptional circumstances. Nursery Hours. The Nursery is open every day from 8 a.m. to 6.30 p.m. and until 1 p.m. on Saturdays. 77 [1937 Charges for Admission. One child 9d. per day. Two children from one family 1s. 3d. ,, Three children from one family 1s. 9d. ,, 6d. per child for half-days including Saturday mornings. Weekly charges payable in advance :— One child 3s. 6d. plus 6d. for Sat. morning. Two children from one family 5s. 9d. plus 1s. for ,, ,, Three children from one family 8s. 0d. plus 1s. 6d. for Sat. morning. (b) Clinic Section.— On the ground floor, with a separate entrance from Zoffany Street, the premises include an Examination room, Waiting room, Doctor's and Nurse's rooms, and dressing cubicles. The first floor houses the Sunlight Clinic which consists of a Solarium with vita-glass on three sides, changing rooms, and a room for artificial sunlight treatment. The artificial sunlight equipment consists of one Centrosol unit with two vertical Mercury Vapour tubes and a standard Duotherapy unit. The advantage of the Centrosol unit is that children can be placed around this in a circle as in treatment by carbon arc. A low two-bank crib has been specially designed for the treatment of infants. There is also a supplementary heat radiation from ceiling suspended lamps. The Sunlight Clinic is intended not only for Day Nursery children who may be found to need such treatment, but also for other children under school age recommended from other sources, such as Welfare Centres, and also for expectant and nursing mothers who may be recommended by their doctors. Report of Attendances, Income, Etc., at Miriam Price Coleman Day Nursery during 1937. Number of attendances from November 15th to December 31st, 1937 :— Whole day 350 Half-day 19 Total 369 Total amount received from parents from opening of Day Nursery to end of year November 15th to 30th £5 12 9 To December 31st 7 16 6 Total £13 9 3 The Sunlight Clinic did not commence to function until the beginning of 1938. 1937] 78 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1937. District No. 1 2 3 4 5 6 and 8 7 9 CLP. Not included in totals. Totals. I. Births, First Visits, Infants under 1 Year 515 463 534 728 570 646 496 327 2 4,279 II. Births, Re-Visits, Infants under 1 Year 414 378 590 652 589 860 607 693 10 4,783 III. Visits to Children, between 1st and 2nd Years 457 319 565 476 532 942 422 413 10 4,126 IV. Visits to Children, between 2nd and 5th Years 980 1,182 1,364 1,224 1,133 1,595 1,098 1,403 26 9,979 V. Visits re Still Births 8 17 14 19 15 30 11 6 2 120 VI. Deaths, Visits, re Infants under 1 Year 13 16 24 22 18 19 15 11 - 138 VII. Deaths, Visits, re Children 1 to 5 Years 1 - 1 - 2 1 2 2 - 9 VIII. †ANTE-NATAL, HOME VISITS f/265 299 f/354 434 f/316 404 f/327 372 f/304 334 f/292 351 f/269 343 f/149 201 2 f2,276 2,738 IX. †Puerperal Fever, Home Visits f / 1 f/l 3 re/1 F/2 4 f/2 8 F/2 3 f/l 2 - f/9 22 Pyrexia, Home Visits - f/3 6 - f/ 1 f / 1 - - - - f/5 8 Totals 2,688 2,818 3,497 3,498 3,202 4,447 2,996 3,056 52 26,202 X. Attendances at Welfare Centre 41 24 46 47 §45 - 46 44 24 293 XI. Other Work by Direction 746 550 1,118 739 700 955 496 185 1 5,489 XII. Visits Declined - - 1 - - - - 1 - 2 XIII. Visits, House Shut 1,097 1,190 840 787 1,030 719 1,357 979 - 7,999 XIV. Visits, Inopportune 58 5 2 - 5 22 - - - 92 Grand Total of Visits 4,630 4,587 5,504 5,071 4,982 6,143 4,895 4,265 77 40,077 Continued. 79 [1937 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1937—continued. District No. I 2 3 4 5 6 and 8 7 9 C.L.P. Not included in totals ‡. Totals. Analysis of Visits included in I.-IX. relating to— f/10 20 f/9 24 f/19 31 f/11 22 f/18 37 f/22 54 re/ 1 f/100 215 (aa) † Reported Ophthalmia f/11 26 (a) †Ophthalmia Neonatorum f/2 5 f/2 8 F/4 6 f/5 11 f/2 6 f/10 14 f/2 3 - f/27 53 (6) †Epidemic (Summer) Diarrhœa - - - - - - - - - - (c) Other Digestive Diseases - - - - - - - - - - (d) Pneumonia and Bronchitis 8 3 1 - 5 9 - - - 26 (e) Rickets 20 6 - 4 4 20 - - - 54 (/) †Measles and German Measles f/ 1 f 1 1 - - f/ 2 f/ 6 - f/ 3 - f/ 13 (g) †Whooping Cough f/ 12 f/10 15 f / 7 f/ 3 f/ 17 f/17 18 f/ 4 f/ 1 - f/62 67 (h) Tuberculous Disease—P=Pulmonary; 0 = 0ther - - - - - - - - - (i) Convulsions - - - - - - - - - - (j) †Polio-myelitis - - - - - - - - - - (k) Premature Birth 16 3 15 11 14 11 - 3 - 73 (iAtrophy, Debility and Marasmus - - - - - - - - - - (m) All other investigations (**Specify) 26 15 10 - 34 20 2 - - 107 (n) Routine Visits included in I.-IX. and not included in (aa) to (m) 2,580 2,743 3,427 3,447 3,093 4,295 2,961 3,048 52 25,594 *** Totals (aa) to (n) 2,688 2,818 3,497 3,498 3,202 4,447 2,996 3,056 52 26,202 Total Families Visited 2,186 1,975 2,671 2,905 2,567 3,614 2,362 2,154 45 20,434 Registered Births. New Cases Handed to H.V.'s for Visitation. Infant Mortality. Maternal Mortality. Puerperal Fever. Puerperal Pyrexia. Ophthalmia Neonatorum. No. Rate. Notified Births. NonNotified Births. Transfers In. No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. 4,504 12.90 4,587 44 769 299 66 14 301 15 14 71 62 42 32 * Specify nature of work— e.g., M.O. Consultation, Weighing babies, Dressings, Temperature taking, Selling of Dried Milk. Talk to Mothers, subject dealt with and time occupied. ** e.g.— Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. Illegit, etc. *** Totals (aa) to («) should correspond with Totals I to IX. †Add F. in front of figures to denote " First Visit." J Child Life Protection Visits. § 45 Attendances at Municipal Diphtheria Immunisation Clinic in addition were made. 1937] 80 THE WORK OF THE FOUR VOLUNTARY WELFARE CENTRES. Maternity and Child Welfare Clinics in Islington are conducted by the four Voluntary Welfare Centres, North, South, East and West, with the assistance of grants from the Council. Each Welfare Centre has a definite Islington area allocated to it and appoints its own Medical Officers, Health Visitors, Clerical Staff, etc., subject to the general supervision of the Medical Officer of Health. Each Centre has a considerable degree of autonomy which has permitted individual development. The Centres are responsible for visiting in the homes of those attending. The Borough Council are represented upon the respective Committees of the four Welfare Centres by two members and the Assistant Medical Officer of Health, and reciprocally the Welfare Centres are represented on the Maternity and Child Welfare Committee by a representative from each Centre. Co-ordination between the Centres is effected through the Conjoint Committee of the Islington Voluntary Welfare Centres on which the Borough Council is also represented. Another body, the Islington Committee of Co-operation for the Welfare of Mother and Child, consisting of representatives from the Centres, Borough Council, General Practitioners, Midwives and Social Workers, forms a link with interested lay bodies and persons. The continued occurrence of cases of enteritis called for special enquiry and investigation, and the opinion and report of a leading expert was obtained. A further measure of co-ordination has been introduced during the past year by the recommendation for the appointment of an Administrative Medical Officer on the Council's staff, in connection with the Wards at the North and West Islington Welfare Centres. 81 [1937 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, 1937. North. South. East. West. Total. 1. Pre-Natal Clincs— Number held weekly 3 11 ctr. 1 Rose 1 Branch, 1 1 7 „ of expectant mothers who attend 514 173 157 159 1,003 „ of attendances 1,834 503 488 411 3,236 2. Post-Natal Clinics— Number held weekly 1 2 †l †l 5 „ of expectant mothers who attend 261 143 70 45 519 „ of attendances 603 228 107 62 1,000 3. Consultations for Children up to 5 years of age Total number of children who first attended at the centres during year, and who, on the date of their first attendance were:— (i) Under 1 year 907 704 534 598 2,743 (ii) 1-5 years 165 119 112 90 486 Number of attendances :— (i) Children under 1 year 12,157 11,987 8,053 7,466 39,663 (ii) Children 1-5 years 5,821 7,992 6,287 5,705 25,805 4. Home Visiting— Number of visits made to :— (i) Expectant mothers— (a) First visits 382 93 161 119 755 (6) Total visits 2,233 271 772 269 3,545 (ii) Children under 1 year— Total visits ... 5,838 5,467 3,839 3,749 18,893 (iii) Children 1-5 years 7,865 7,277 5,033 5,556 25,731 5. Wards and Homes— Number of beds 18 12 - 8 38 Number of patients received— (i) Mothers and babies— (a) Mothers 24 80 - - 104 (b) Babies 25 86 - - 111 (ii) Babies only 55 - - 88 143 6. Number of children who attended at the Centres during the year, and who, at the end of year, were :— (i) Under 1 year 776 566 383 469 2,194 (ii) 1-5 years 1,674 1,969 836 890 5,369 7. Convalescence— Number of cases :— (i) Mothers 46 20 100 42 208 (ii) Children 65 93 238 98 494 † East and West Centres. Post-Natal Clinics are held with their pre-natal clinics. 1937] 82 Whilst the routine work of the Welfare Centres has continued as usual, it is gratifying for them to be able to record the increasing use made of such additional outside facilities as the Centres offer in the form of dinners for Mothers, holidays for Centre families and so forth. A particularly interesting innovation has been the experimental establishment at the East Islington Welfare Centre of a Child Guidance Clinic conducted by Dr. Mildred Creak, who undertook research work into the frequency of behaviour problems in infants and toddlers. By the time behaviour difficulties become apparent at school, habits may be well established, and seeing the children in the early stages, or in other words before they are really " difficult " and during the course of Welfare Centre attendances, is a development which will be watched with a good deal of interest. The garden of this Centre is utilized for special attention to delicate children during the summer. At West Islington Welfare Centre special effort has been made to maintain the attendances of toddlers by special birthday examinations. The Ante-Natal Clinics at the North Islington Welfare Centre continue to work in close co-operation with St. Mary, Islington, Hospital, and a large number of expectant mothers are dealt with. The Convalescent Home in connection with the South Islington Welfare Centre continues to supply much needed convalescence for mothers and babies, and a morning Nursery (" Garden School") at this Centre also appears to satisfy a demand, judging by the use which is made of it. I am indebted to the Welfare Centres for the following summaries and observations on the work done during the past year :— NORTH ISLINGTON WELFARE CENTRE, 6 and 7, Manor Gardens, N.7. The Committee of the North Islington Infant Welfare Centre is pleased to report a steady increase in the volume of work accomplished during the year. A visit paid to the Centre by Her Worship the Mayor of Islington was deeply appreciated, as showing her sympathy and interest in the work. The assistance given by the Medical Officer of Health and the staff of the Public Health Department has been very helpful and has always been given most readily. An outstanding feature of the work of the Centre during the past year has been the number of dinners that have been given to necessitous mothers and children which amounted to 3,243—an increase of 1,306 over the previous year. The beneficial effects of these dinners cannot easily be expressed in statistics, but are clearly manifested in the increased vigour and well being of the recipient. The number of new cases of children is the highest on record since the Centre started in 1913, being 1,185. The attendances at the Children's Clinics, the Light Department, the Dental Clinics, "Morning Callers" and the visits of the Nurses to the homes have all steadily increased in number from the previous year. The physical culture class for Mothers continues to be as popular as last year. A new development of the Centre's work has been established during the year, which takes the form of a physical culture class for toddlers. The total number of children attending was 34, who made 255 attendances. 83 [1937 SOUTH ISLINGTON MOTHERS' AND 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. The number of Mothers and children attending the Clinics during 1937 has increased in spite of some fall in recent years in the estimated population in the Centre's district. This points to an ever-growing appreciation among the Mothers of the advice they can obtain from the Centre Doctors ; from the Health Visitors and home visits. The recent practice of sending periodic cards of invitation to children between two and five years old, who have not attended recently, has helped to maintain the attendance of the toddlers until they go to school. The Garden School, which was started in June, 1937, and is held from 9.30 to 11.30 each morning, has filled a real want and has helped both the health and character training of many difficult children whose home conditions were not giving them a fair start. The Centre's Convalescent Cottage has been full during the season and the holidays there have proved most beneficial to the health of Mothers and babies, and have also given the Mothers practical lessons in the care of their babies. The Centre has also been able to obtain convalescent treatment for one month or longer, if necessary, for 93 delicate children between 2½ and 5 years old. Much conservative work is done by the Centre's Dentist for the Mothers' teeth and, when necessary, the Mothers are helped with the cost of dentures. They are urged to bring their toddlers for regular dental inspection. The dinners, which the Centre provides through the Invalid Kitchens for necessitous expectant and nursing Mothers, have been much appreciated by the Mothers, especially as the Kitchens are able to provide a well-balanced meal or any special diet recommended by the Doctors. The Committee much appreciate the practical benefits resulting from having a representative co-opted on to the Maternity and Child Welfare Committee of the Council and are very glad of the helpful co-operation of the Council's representatives on the Centre's executive Committee. EAST ISLINGTON MOTHERS' AND BABIES' WELFARE CENTRE. Centre, 32, Drayton Park, N.5. Branch, at Highbury Quadrant Mission Hall, Hurlock Street, N.5. The work during the year has been one of increased activity. A Child Guidance Clinic was started in September as an experimental piece of work under the auspices of the Child Guidance Clinic, by whom Dr. Mildred Creak was appointed to undertake research into the frequency of behaviour problems in infants and toddlers. The work of a Child Guidance Clinic lies with those children who have failed to make a satisfactory adjustment at home or at school, or who are behaving in society at large in an anti-social manner. So often a long history lies behind such trouble, going back to babyhood, when the child was already "difficult to handle." By getting early access to the home conditions, Dr. Creak hopes to learn how far it is possible to prevent the problem baby becoming the problem child. 1937] 84 Judging by the steady flow of cases referred to Dr. Creak, there is no dearth of material needing psychological investigation in the Maternity and Child Welfare Clinics. It is hoped that, in many of these cases, a friendly talk with the mother will prevent the difficulty becoming permanent. The regular Maternity and Child Welfare work is shown in the table of statistics, in addition to which much social work was done, such as arrangements for holidays for 100 mothers and 238 children. Many of these were sent to bungalows rented for the purpose during the summer months. Help was also given at Christmas in the form of parcels of groceries and coal tickets, and during the year 1,610 dinners were provided for expectant and nursing mothers and 894 for toddlers. During the summer delicate children were referred by our Medical Officers for garden treatment, i.e., they attended every morning and played in the garden, under supervision, from 9.30 to 12.30 p.m., being gradually undressed as the weather permitted in order to obtain the full benefit from the air and sunshine. Very satisfactory therapeutic results were obtained and the children responded not only with improved health but by improved behaviour as a result of happy occupation, kindly discipline and friendly companionship. WEST ISLINGTON INFANT WELFARE CENTRE, Centre, 42 & 44, Richmond Avenue, N.l. Branch, held at St. Luke's Mission Hall, Goodinge Road, N.7. The routine work at the Centre and Branch has been well maintained with a steady increase in attendances, and visits paid. The re-establishment of the Ultra-Violet Light Clinic during the winter months is proving of great value and the attendances are good, with a noticeable improvement in the general health of the children treated, particularly those suffering from catarrhal conditions. In an effort to keep the toddler in attendance after the arrival of the new baby, a special birthday examination—in addition to any ordinary attendance—is now given by the Doctors and the mothers are encouraged to bring the toddler for this yearly overhaul. A birthday case sheet is used on that day and it is hoped to have a valuable record of each child when it leaves to attend school. The scheme is still in its infancy but the response is good. Dinners for necessitous expectant and nursing mothers continue to be provided and are greatly appreciated by those mothers whose home circumstances permit of their daily attendance. The consequent improvement in health is most marked. 85 [1937 Attendances, etc., at the various Departments of the Four Voluntary Centres, year ending March 31st, 1937. North. South. East. West. Total. 1. Pre-Natal Clinics and Ailing Mother Clinics. Number held weekly 4 2 1 1 8 ,, of attendances 2.538 864 462 412 4,276 2. Consultations for Children up to 5 Years of Age. Number held weekly 10 11 **10 7 38 ,, of attendances 22,692 18,415 14,312 11,242 66,661 3. Home Visiting. Number of visits made 17,210 13,322 10,729 8,674 49,935 4. Dental Clinics. Number attending 698 177 85 83 1,043 „ of attendances or arrangements made for attendances 2,068 470 - - 2,538 5. Morning Callers. Number of attendances 1,646 554 ‡- 762 2,962 6. Massage Clinics. Number of cases given massage or sent for massage 93 108 (& Sunlight treatment) 109 43 353 7. Wards. Number of beds 18 - - 8 26 „ of patients received 208 - - 88 296 8. Number of Children on Books 2,122 1,603 1,217 1,043 5,985 ** Including two Observation Clinics. ‡Not recorded. MATERNITY AND CHILD WELFARE. Contributions by the Borough Council year ended 31st March, 1938. Voluntary Welfare Centres. North Centre 5,661 South „ 2,776 East „ 2,137 West „ 2,154 Total £12,728 EMERGENCY MATERNITY UNIT. Arising out of Circular 1622 on Maternal Mortality and the various recommendations made in this Circular, the Council decided to investigate the possibility of the establishment of a Maternal Emergency Unit in Islington. The importance of such a Unit was indicated in the report on Maternal Mortality presented to Parliament in 1937, and which showed that lives were lost through women being sent to hospital in certain types of cases, where it might have been more desirable for the services of a skilled hospital staff to be brought to the patient in her own home. 1937] 86 An Emergency Unit consists of at least one Obstetrician and a Nurse, who are available, with all the necessary equipment for dealing with emergencies, for attendance at short notice at any home within a certain radius. The Unit may be summoned by a Doctor or by a Midwife attending a case with, whenever possible, the approval of a Doctor. It is best operated from a Maternity Hospital or the Maternity Department of a General Hospital, and should, of course, be available at all times of the day or night. The number of cases for which the need for such an Emergency Unit would apply is strictly limited, and in all probability they would be patients with acute and severe haemorrhage. The service is not meant to be used for treatment in the home in ordinary cases or as a substitute for treatment which could be carried out more efficiently in hospital, but by the very nature of its purpose, such a Unit might be the means of saving a life in a large proportion of the cases for which it was called out. Following consideration of this proposal by the Maternity and Child Welfare Committee and the Council, an arrangement was arrived at with University College Hospital. The Hospital agreed to provide a staff for the Unit which would comprise a Physician of Consultant standing with three alternative Consultants to act as deputies, one Medical Officer to act as Assistant to the Consultant and one Qualified Nurse. The fee to be paid by the Council upon each occasion on which the Unit is called out is 7 guineas, and this fee covers all treatment which may have to be carried out in the patient's home by the members of the Emergency Unit. The Council also made a grant to the hospital in respect of the initial cost of the requisite equipment. Arrangements have been made for Doctors and Midwives attending Islington patients to be informed of the establishment of the Emergency Unit and the conditions of its use. Doctors and Midwives are required to inform the Medical Officer of Health as soon as possible after the Unit has been called out, and arrangements have also been made to obtain the assistance of the Police if there should be any difficulty in calling the Unit. CONSULTATIVE ANTE-NATAL AND POST-NATAL AND MINOR GYNECOLOGICAL CLINIC. A further matter arising out of Circular 1622 on Maternal Mortality to which favourable consideration was given by the Committee was the Consultative Clinic as indicated above. Such a Clinic is not intended to deal with routine cases but is one to which Medical Officers at Ante-Natal Clinics or General Practitioners could refer difficult cases or cases where there was any doubt as to treatment or diagnosis. Whilst it is possible to refer such patients to Maternity Hospitals or to the Maternity Departments of General Hospitals, it was felt that such a clinic established locally would serve a useful purpose, not the least of which would be a saving to some mothers of having to wait lengthy periods in a hospital. It is also particularly hoped that post-natal attendances will be increased. It was proposed that this clinic should be held in the Clinic portion of the Miriam Price Coleman Day Nursery and be conducted by an Obstetric Specialist, and arrangements were made for the Clinic to commence in 1938. 87 [1937 MATERNAL DEATHS. The number of women dying, pregnancy being a factor, during the year 1937 was 20. Our investigations showed 9 to be classifiable as Puerperal Sepsis and 5 from other puerperal causes. These 14 cases would give a Maternal Mortality Rate of 3 01 per 1,000 registered ("live" and "still") births. In addition, there were 6 deaths of pregnant women from the following :—2 from Forms of Violence, 1 from Acute Pneumonic Phthisis, 1 from Lobar Pneumonia, 1 from Non-malignant Tumour of Uterus, and 1 from Heart Disease. Taking the deaths as 20 would give a rate of 4-3. (See Table p. 89.) A Table showing such investigations from 1911 is given. For details of the Maternal Deaths for the year 1937 see p. 88. The deaths for the preceding year numbered 16, and were equal to the proportion of 33 per 1,000 registered 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* 1937 4,504 20 4.3* *Rate per 1,000 registered live births and still births. † 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. 1937] 88 METROPOLITAN BOROUGH OF ISLINGTON. MATERNAL DEATHS, 1937. (For those in 1936, see p. 72 of the Medical Officer of Health's Annual Report for that year.) 1937. Month. Cause of Death. Ages at Death. Totals. 15 to 25 25 to 35 35 to 45 45 and upwd. Total. From Puerperal Sepsis. From other Diseases of Childbirth. Jan. Necrosis of Uterus Injection of Ammonia to procure abortion. Circumstance unknown. Open Verdict P.M. ... ... 1 ... 1 ... 1 (a) Feb. la. Br. Pneumonia following local uterus sepsis and bacteremia, following full time labour. P.M. ... 1 ... ... 1 1 ... Mar. la. Multiple venous thrombosis, b. Delivery ... 1 ... ... 1 ... 1 " 1a Obstetrical Shock, b. Retained Placenta. II Twin pregnancy ... 1 ... ... 1 ... 1 1. Broncho Pneumonia and Empyæmia uterine sepsis after precipitate labour at term. II Mitral Stenosis old Rheumatic Carditis Coroner. P.M. Without Inquest 1 ... ... ... 1 1 ... 1st Qr. 1 3 1 ... 5 2 3 April la. General Peritonitis, b. Childbirth ... 1 ... ... 1 1 ... " 1. Acute Pneumonic Phthisis. II. Ectopic Pregnancy (24 weeks). Coroner. P.M. Without Inquest ... ... 1 ... 1 ... 1 (b) May Pulmonary Embolism Femoral Thrombosis Parturition. Coroner. After P.M. Without Inquest ... ... 1 ... 1 ... 1 June Uterine Sepsis Premature Labour. Old Rheumatic Mitral Stenosis. Coroner. P.M. Without Inquest ... 1 ... ... 1 1 ... •• la. Lobar Pneumonia double 2. Pregnancy resulting premature birth. Stillborn 1 ... ... ... 1 ... 1 (c) Paralytic Ileus, following cæsarean hysterectomy. Toxaemia of pregnancy. Coroner. After P.M. without Inquest ... 1 ... ... 1 ... 1 2nd Qr. 1 3 2 ... 6 2 4 July Puerperal Pyaemia Prolonged Labour (Operation Cæsarean Section). Coroner. P.M. Without Inquest ... 1 ... ... 1 1 ... Aug. la. Puerperal Sepsis, b. Aplastic Anæmia. P.M. ... 1 ... ... 1 1 ... " Shock of injection of hot soap solution into uterus self-induced. Miscarriage (4½ months pregnant). P.M. Inquest 1 ... ... ... 1 ... 1 (d) Sept. Obstetric shock and post-partum haemorrhage. Prolonged Labour (breech delivery of toxamia of pregnancy—twins). Coroner. After P.M. Without Inquest ... 1 ... ... 1 ... 1 Septic Parametritis (Cæsarean Section). Obstructed labour by Dermoid Cyst of Ovary. Coroner. P.M. Without Inquest ... 1 ... ... 1 1 ... 3rd Qr. 1 4 ... ... 5 3 2 89 [1937 METROPOLITAN BOROUGH OF ISLINGTON MATERNAL DEATHS, 1937.—Contd. (For those in 1936, see p. 72 of the Medical Officer of Health's Annual Report for that year.) 1937. Month. Cause of Death. Ages at Death. Totals. 15 to 25 25 to 35 35 to 45 45 and upwd. Total. From Puerperal Sepsis. From other Diseases of Childbirth. Oct. General Peritonitis Septic metritis. Cæsarean Section. Coroner. After P.M. Without Inquest ... 1 ... ... 1 1 ... " General Peritonitis Parametric Abscess Abortion (3rd month). Coroner. P.M. Without Inquest ... 1 ... ... 1 1 ... Nov. Hæmoperitoneum Rupture of Spleen due to pressure by pregnant Fibroid Uterus. Natural. P.M. Inquest ... 1 ... ... 1 ... 1 (e) Dec. 1. Septic Endocarditis following childbirth (full term). II Chronic Rheumatic Endocarditis. Coroner. P.M. Without Inquest ... 1 ... ... 1 ... 1 (f) 4th Qr. ... 4 ... ... 4 2 2 Classifications :—(a) Violence. (d) Suicide. (b) Phthisis. (e) Non-malignant Tumour. (c) Lobar Pneumonia. (f) Malignant endocarditis. 1st Quarter 5 = 4.14 2nd Quarter 6 = 4.72 Rate per 1,000 3rd Quarter 5 = 4.69 registered Live 4th Quarter 4 = 3.63 births and Still- births Total (Year) 20 = 4-30 PUERPERAL FEVER. Of the 17 cases coming to the knowledge of the Medical Officer of Health during 1937, 3 were notified by Private Practitioners. The proportion of total cases to births was 3 77 per thousand. The notifications were 21 below the average (38) of the preceding ten years and showed a decrease of 3.56 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1937. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 3 4 2 - 3 3 2 17 Private Practitioners' Cases - - - - 1 - '2 3 Hospital Cases 3 4 2 - 2 3 - 14 Certified Midwives' Cases - - - - - - - - Cases inquired into 3 4 2 - 3 3 2 17 Cases treated in Hospital 3 4 2 - 3 3 2 17 Cases treated at Home - - - - - - - - All of the 17 cases were treated in hospitals, 11 having the "onset" there, and the remaining 6 were subsequently removed to hospital. Of the cases, 2 were dealt with in London County Council Infectious Diseases Hospitals, and 15 in either St. Mary, Islington, Hospital, or other London Hospitals. Deaths.—9 deaths were registered as being due to Puerperal Fever. 1937] 90 PUERPERAL PYREXIA. Notification of Puerperal Pyrexia Regulations, 1926.—There were 75 cases notified, as against 57 last year. Of these, 7 were Private Medical Practitioners' cases ; 68 occurred in Hospital. The notifications were in the proportion of 16-6 per 1,000 births. Cases of Puerperal Pyrexia notified and inquired into during the year 1937. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 6 9 11 9 14 14 12 75 Private Practitioners' Cases 2 - 1 - 2 1 1 7 Hospital Cases 4 9 10 9 12 13 11 68 Certified Midwives' Cases - - - - - - - - Cases inquired into 6 9 11 9 14 14 12 75 Cases treated in Hospital 4 9 10 9 12 13 11 68 Cases treated at Home 2 - 1 - 2 1 1 7 The services of the Council's Consultant were sought on 3 occasions during the year. All the cases were on account of difficult confinements. MIDWIVES ACT, 1936. This Act, so far as London including Islington, is concerned, came into force on January 1st, 1938, but in view of the considerable changes in midwifery practice necessitated by this, a very considerable amount of preparatory work had to be done in connection with it during the year 1937. The Local Supervising Authority for midwives is the London County Council, and for midwifery purposes Islington forms part of Area B, which is comprised of the City of London, Finsbury, Holborn, Islington and St. Pancras. Under the provisions of the Act it is the duty of the Local Supervising Authority " to secure, whether by making arrangements with Welfare Councils or voluntary organisations for the employment by those councils or organisations of certified midwives as whole-time servants or by itself employing such midwives, that the number of certified midwives so employed who are available in its area for attendance on women in their own homes as midwives, or as maternity nurses during childbirth and from time to time thereafter during a period not less than the lying-in period, is adequate for the needs of the Area." The London County Council proposed to appoint four whole-time midwives for Area B, and in addition the following Hospitals and Nursing Associations, by arrangement with the London County Council, employ midwives to undertake the work in this district :—City of London Hospital, Elizabeth Garrett Anderson Hospital, Maternity Nursing Association, Middlesex Hospital, Royal Free Hospital, Royal Northern Hospital, St. Bartholomew's Hospital and University College Hospital. Every woman who so desires may therefore apply from January 1st, 1938, for the services of a London County Council certified midwife, and if a doctor has been engaged for the confinement then application may be made for the midwife to act as a Maternity Nurse. In this connection attention is drawn particularly to that section of the Act dealing with the prohibition of unqualified persons acting as maternity nurses for gain. After the adoption of the Act in the area concerned no 91 [1937 person being a woman neither certified under the principal Act nor registered in the general part of the Register of Nurses kept under the Nurses' Registration Act, 1919, nor a male person, may receive any remuneration for attending in that area as a nurse on a woman in child-birth or during a period immediately following child-birth. Another change which has been introduced with this Act is the extension of the normal lying-in period from ten days to fourteen days. So far as Islington is concerned, arrangements have been made during the year for the interchange of information, reports, etc., as between the London County Council midwives and the Medical Officers of the Ante-natal and Post-natal Clinics of the Voluntary Welfare Centres through the medium of the Medical Officer of Health. Arrangements have also been made to co-ordinate reports on domiciliary conditions made by the Borough Council's Health Visitors with recommendations which may have been made by the London County Council midwives, so that the best possible conditions for the ensuing confinement may be ascertained. 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 the Medical Officer of Health's Annual Report for the year 1935, 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. HOSPITAL GRANTS. Contributions made under arrangement for maternity cases admitted to beds at Maternity Hospitals at the rate of 10s. per case were City of London Maternity Hospital £37 10s., Royal Free Hospital £l 10s., and University College Hospital £28. HOME HELPS. The Home Help Scheme which commenced to function in the early part of 1936, and which has been described in the reports for 1935 and 1936, has proved very successful, and, as will be seen by the figures, has appealed to an increasingly large number of mothers. The original scheme, however, was limited to the provision of Home Helps during the lying-in period only. During the past year the Council decided that on and from October 1st, 1937, expectant mothers might also obtain the services of a Home Help if they were incapacitated during pregnancy. A medical certificate is required stating the condition causing incapacity. The charges which an applicant for a Home Help under this extended scheme may be required to pay are the same as is now charged for a Home Help during the lying-in period, and the same conditions apply with regard to the Home Help, viz. : that she shall be concerned only in domestic duties in the home, and must refrain from doing anything which properly belongs to the sphere of a trained nurse or midwife. 1937] 92 The Council also made some slight amendment in the assessment scale for Home Help charges, whereby the charges in the case of small-size families were made a little more lenient. Home Help work in 1937 : 96 women had Home Helps during their period of confinement during the year 1937. (This includes one case which was commenced in 1936.) On assessment under the Council's Scheme, 32 paid varying amounts towards the cost of the Home Help, and, owing to their circumstances, in 64 cases the Home Help was provided free of cost to the patient. The Council paid to Home Helps the sum of £215 5s. 3d. towards which patients contributed £26 10s. The actual cost of the scheme to the Council was therefore £188 15s. 3d. MILK GRANTS FOR NECESSITOUS, EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. Reconsideration of the Income Scale for the granting of milk free or at partial cost adopted by the Council on the 18th January, 1935, was made during the past year, arising out of the recommendations in Circular 1519, whereby Local Authorities were requested to review their arrangements so as not to render it difficult for any mothers to take advantage of the Local Authorities' Scheme. The scale was accordingly revised as follows :— Scale of Income Adopted by the Council January 18th, 1935. Per Head. 6s. a week and under, after allowance for rent, Free. 6s. Id. to 7s. 5d. a week, after allowance for rent, Quarter Cost. 7s. 6d. to 8s. a week, after allowance for rent, Half Cost. Scale of Income adopted by the Council to operate as from October 1st, 1937. No. in Family. Free. Quarter cost. Half cost. Nett weekly income per head after deduction of rent, not exceeding :— s. d. s. d. s. d. 1 14 0 15 6 17 0 2 10 6 11 9 13 0 3 9 0 9 6 10 0 4 8 0 8 6 9 0 5 7 6 8 0 8 6 6 and over 7 6 7 9 8 0 In addition certain minor restrictions were removed such as children up to five years (in place of 3 years) not attending school becoming eligible ; expectant mothers becoming eligible on presentation of a medical certificate or midwife's certificate giving expected date of confinement, in place of the previous restriction of the last three months only of pregnancy, and an increase in the amount of milk which might be granted to any one family. During the year 1937, the sum expended in the provision of fresh and dried milk for necessitous, expectant and nursing mothers and children under five years of age, amounted to £3,347 4s. 9d., as against £2,364 18s. 2d in 1936. The total amount expended since the Order came into operation in 1918 is £71,874 11s. 9d. The total recipients during the year numbered 11,169 and the quantity of milk supplied to them was equal to 256,861 pints (32,105 1/8 gallons). The corresponding figures for 1936 were 8,147 and 182,206 pints. 93 1937 CHILD LIFE PROTECTION. (Public Health (London) Act, 1936, Sections 256-272.) The number of foster-children on the Register during the year 1937 shows a diminution on the previous year to 401 from 427. The number between 5 and 9 years has increased from 57 to 61 so that the decrease is entirely among those fosterchildren under 5 years of age. Of this decrease the chief proportion is due to a diminution in the number of children with foster-mothers, children in Institutions under 5 years of age being fewer by 5 only. The number of satisfactory foster-mothers still continues to be rather smaller than the actual demand for them. Many mothers who have to arrange for another person to take care of their child or children are in poor circumstances and are not in a position to offer adequate payment to a foster-mother. Mothers who go out to work frequently arrange to have their children looked after during the day only, and women who undertake "daily minding" are more difficult to control than fostermothers. A good deal of this function of " daily minding " is of course undertaken in another way for these mothers who go out to work by the Day Nurseries, Municipal and Voluntary, in the Borough. During the year 1937, 32 applications for foster-mothers were received but only 18 were recommended as suitable. The remaining 14 were advised to refrain from taking a child and eventually alternative arrangements were made by co-operation with the mother in respect of these children. Legal proceedings were instituted in one case on account of the person being an unregistered foster-mother. She was fined £7 and £4 4s. Od. costs. There were 8 deaths of foster-children during the year as against Nil in the previous year. Six of these deaths occurred in hospitals, one at home, and one in a residential nursery. Of the six deaths occurring in hospital the following were the certified causes:—Bronchial Pneumonia; Whooping Cough and Cerebral Haemorrhage; Bronchial Pneumonia and Marasmus; Werdnig-Hoffman Myopathic Dystrophy; Gastro Enteritis; Acute Bronchitis and Gastro Enteritis; all these children were 6 months or under. An inquest was held in one of these cases. The certified cause of death in the case of the foster-child aged 15 months dying at home was Acute Tonsillitis and Toxaemia, and the 5 months' old infant at a residential nursery died of Infective Enteritis. No inquests were required. The Child Protection Visitor continued to co-operate with the National Society for the Prevention of Cruelty to Children where the circumstances made this desirable. Annual Return of Child Life Protection Work. Number of foster-mothers on the Register who were receiving children on the 1st January, 1937 192 Do. do. on the 31st December, 1937 185 Number of foster-mothers added to the Register during the year 18 Number of foster-mothers removed from the Register by the Committee during the year Nil Number of foster-mothers removed or lapsed 25 Number of foster-children on the Register at 31st December, 1937 170* Number of foster-children attending Child Welfare Clinics 64 ,, ,, under private medical practitioners, 7 * Includes those in institutions, etc. 1937 94 Total number of visits paid by Child Protection Visitor 1,733 Special visits paid by Child Protection Visitor 2 Children removed compulsorily Nil Children removed to hospital (including infectious disease) 36 Children removed voluntarily 7 Deaths reported (Inquests-1) 8 Children for whom medical attention arranged 5 Cases recommended for prosecution 1 Desertions by parents-Children removed from foster-mothers to Public Assistance Institutions 1 Other cases in which there was cause for complaint 11 Number of foster-children under 5 years on Register during 1937 340 (with foster-mothers 187) (with Institutions 153) Number of foster-children between 5 years and 9 years on Register during 1937 61 (with foster-mothers 60) (with Institutions 1) Total number of foster-children dealt with during 1937 401 (with foster-mothers 247) (with Institutions 154) Institutions, including Schools.—153 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. St. Luke's Guest House, 29-31, Penn Road, N.7, now has accommodation for 24 children plus 4 cots for emergency cases. Children are kept for a limited period, and may be admitted where the mother, for instance, has to go into hospital, or on account of other difficult home circumstances. There is a very considerable demand for the cots at the Guest House. During the year ending 31st March, 1937, admissions numbered 90. VOLUNTARY DAY NURSERIES. Apart from the usual Annual Report Summary, in the year 1935 a special report was presented to the Maternity and Child Welfare Committee on the Day Nurseries, in the Borough (3 in number) which received grants from the Borough Council. In 1937 it was thought useful to again follow up this report for the sake of comparison after a full year's interval. As regards the Lower Holloway Day Nursery, 547, Liverpool Road, N.7, it was found that there had been a very extraordinary demand from March onwards with the exception of August, in which month the Nursery was closed for over two weeks. The clientele is drawn almost exclusively from the surrounding district, and the Day Nursery remained open on Saturday mornings. This was an innovation which had been justified by the numbers attending. At these times of pressure the Day Nursery had to refuse about 20 applications a week. It was noted that this Day Nursery still has its voluntary teacher who has so long given Kindergarten instruction. 95 1937 St. Luke's Day Nursery and “Guest House,” 29-31, Penn Road, N.7. As noted, this Day Nursery differs from the others in that it has a residential portion. The "Guest House" is inundated with requests for admission and careful selection is made. Islington cases are admitted at a reduced fee, but, notwithstanding, the applications from outside at the higher fee are very numerous. The nursing staff can only undertake six babies under nine months, but the general experience of the Day Nursery proper is that there appears to be a tendency to bring young infants with feeding difficulties, which unduly increases the proportion of "bottle babies." Applications in respect of tinies and toddlers are not in excess, as are applications for the very young infants. South Islington (Pro Patria) Day Nursery, 9 Canonbury Place. As a contrast in this Day Nursery more toddlers are being taken owing to their being fewer "young baby" applications. The Nursery is divided into "those under two" and "those over two" years of age. This Nursery's experience is that there are more applications for younger babies in the Spring, the mothers going out to work at that season. Good use is made of the grounds for the toddler and this Day Nursery provides artificial sunlight. Forty-seven of the older children of this Day Nursery were taken for a holiday to Norfolk. The education of the toddlers includes Kindergarten teaching, organised games and a children's " band." DAY NURSERIES RECEIVING GRANTS FROM THE BOROUGH COUNCIL. No. of places provided. No. of attendances during 1937. Council grant (year ending 31st March, 1938.) i. Lower Holloway Day Nursery 50 12,984 £ 260† ii. South Islington (Pro Patria) Day Nursery 50 10,287 600 iii. St. Luke's Day Nursery 30 4,731* 250 Total 130 28,002 £1,110 * Excluding Guest House. † This Nursery is a municipally owned building. (No rent charged for its use.) Grants given in respect of work in premises outside the Borough boundary:— The Claremont Central Mission Day Nursery, White Lion Street, N.l.—£50. INVALID CHILDREN'S AID ASSOCIATION. The Association continues to perform good work for Islington children by providing convalescence and obtaining treatment in recommended cases. The Borough Council contributes £25 per annum to the Local Branch of this Association. During the year, 94 Islington children under five years were given periods of convalescence either in the country or by the sea, and 15 crippled children of like ages were provided with surgical appliances, splints, special boots, etc. 1937 96 NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN. This Society has again demonstrated its usefulness during the year in dealing with difficult conditions. 60 cases were visited by the Society's three Inspectors in this area at the request of the Public Health Department. Supervision was continued in 12 cases from the previous year and 4 were in co-operation with the Child Protection Visitor. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. 34 cases of Ophthalmia Neonatorum were notified, compared with 45 cases last year. 124 cases of Ophthalmia were reported by the London County Council and Health Visitors as against 121 cases during the previous year. 14 out of the 34 cases of Ophthalmia Neonatorum were attended at birth by midwives. Of the 34 cases investigated, both eyes of the infant were affected in 24 instances, whilst in 4 the right eye was involved, and in 6 the left. The cases occurred in the sub-registration districts as follows:— Tufnell. Upper Hollo- way. Tollington Lower Holloway. Highbury. Barnsbury. South East. The Borough. Ophthalmia Neonatorum. 1 2 4 7 5 6 9 34 Ophthalmia. Cases reported by L.C.C. 10 3 18 26 13 35 19 124 Cases reported by Health Visitors — — — — — — — — Ophthalmia Nursing.—7 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £15 13s. 9d. In 1936 18 cases were nursed at the cost of £27 14s. 9d. phthalmia Neonatorum Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In-Patients. Hosp. Outpatients. Own Doctor. St. Margaret's Hosp. Other Hosps. 34 17 7 9 1 34 Nil. Nil. Nil. 97 1937 BLIND PERSONS' ACT, 1920. Circular No. 1621 on the "Prevention of Blindness," issued by the Ministry of Health on the 6th August, 1937, drew the attention of local authorities to the necessity for making adequate arrangements for assisting in the prevention of blindness and for the treatment of persons suffering from any disease or injury to the eyes. The report of the Standing Committee on the Prevention of Blindness emphasised that expert examination of the fundus of the eye is called for in cases of failure of reading sight during pregnancy, and the presence of albuminuria may indicate serious retinal changes. Prophylactic Drugs for newly born infants are not insisted upon as a routine measure, but if used, then a 1 per cent, solution of silver nitrate is recommended. Ophthalmia Neonatorum in the view of the Committee is best treated in hospital and the ideal arrangement is to admit both mother and child to the hospital. The following table gives 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:— Totally Blind. Partially Blind. No. of cases at the end of year 1936 3 12 No. of cases coming to the knowledge of M.O.H. during the year 1937 0 4 No. of cases which left during the year 1937 *1 †2 No. of cases under supervision at the end of the year 1937 2 14 *Died. † Reached 5 years of age. PREVENTION OF DEAFNESS. Circular 1337a, Ministry of Health, dated 22nd May, 1933, on "Prevention of Deafness." The following gives an analysis of the cases under this heading which have come to the knowledge of the Medical Officer of Health during the year, and the deaths in which Ear affection was mentioned as a contributory cause:— Number of cases of Discharging Ear after Scarlet Fever 15 ,, . ,, ,, Diphtheria 10 „ ,, ,, Scarlet Fever and Diphtheria 1 Other cases visited by Health Visitors and Centres 125 Number of above patients who died 10 The causes of death in these cases were:— (i) Acute Gastro Enteritis, Septicaemia, Broncho Pneumonia, Bilateral Otitis Media, Toxic Hepatitis; (ii) Diarrhoea and Vomiting, Broncho Pneumonia and Otitis Media, P.M.; (iii) Toxic Myocarditis, Laryngeal Diphtheria, Lobar Pneumonia, Double Suppurative Mastoiditis; (iv) Streptococcal Meningitis, Mastoiditis! Appendix Abscess, Peritonitis; (v) Pyaemia, Mastoiditis, Peritonitis, Whooping Cough, P.M.; (vi) Acute Bronchitis, Acute Middle Ear Disease, P.M.; (vii) GastroEnteri'tis, Otitis Media; (viii) Acute Bronchitis, Broncho-Pneumonia, Acute Middle Ear Disease, Acute Meningitis; (ix) Heart Failure, Pneumonia, Diarrhoea and Vomiting, Otitis Media; (x) Toxaemia, Bilateral Otitis Media, P.M, 1937 98 PEMPHIGUS NEONATORUM. During the year 1937 seven cases came to the knowledge of the Medical Officer of Health, and six recovered. One died, the certified cause of death being given as Dermatitis Exfoliativa Infantum. HOME NURSING. The Islington Borough Council has an arrangement with the North London Nursing Association for the attendance, by visitation, in cases of Ophthalmia Neonatorum, Acute Primary Pneumonia, Acute Influenzal Pneumonia, Measles, Whooping Cough and Epidemic Diarrhoea and Maternity complications. Grants.—Payment is made to the Association at the rate of Is. 3d. per visit in necessitous cases ; this amounted to:— £ s. d. For Maternity and Child Welfare Visits 37 17 6 For Public Health Visits 1518 9f Total. £53 16 3 † Includes also nursing of pneumonia (adult). 99 1937 APPENDIX. -o- Vital and Sanitary Statistics, 1937 together with the PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 1937 100 STATISTICAL APPENDIX Deaths registered in the Borough of Islington during the year ending 1937. 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. 1,875 168 42 12 12 15 30 85 84 199 353 481 331 63 182 200 174 230 347 293 449 F. 1,938 131 33 8 5 17 29 68 88 176 288 441 468 186 190 201 216 199 368 278 486 Typhoid and paratyphoid fevers (1-2) M - - - - - - 1 - - - - - - - - - - - - 1 - F. 1 - - Measles (7) M. 1 — 1 — - - - - - - - - - - - 1 - - F. Scarlet Fever (8) M. 2 — 1 — 1 1 - - - - - - - 1 - - - - 1 1 F. 1 Whooping Cough (9) M. 7 11 7 - - - - - - - - - - - 1 - 1 2 4 4 6 F. 11 Diphtheria (10) M. 14 1 8 5 5 1 - - - - 2 3 5 2 3 2 3 F. 6 Influenza (11) M. 61 3 3 — — 1 1 3 5 17 36 38 24 11 15 18 14 11 22 21 41 F. 81 Encephalitis lethargica (17) M. 2 - - - - - - 2 - 1 - - - - - 1 - 1 1 - - F. 1 Cerebro-spinal Fever (18) M. 4 3 1 - - 2 - - - 1 - - - - - 1 1 - 1 2 2 F. 3 Tuberculosis of Respiratory System (23) M. 126 — — — — 9 16 55 33 38 30 16 5 1 22 27 17 21 32 40 44 F. 77 Other Tuberculous diseases (24 -32) M. 10 2 7 2 2 4 1 2 3 2 - - 3 2 3 4 2 1 10 F. 15 Syphilis (34) M. 12 4 — — — - 1 7 4 2 - - 0 1 3 3 4 5 F. 6 General Paralysis of the Insane-tabes dorsal is. (83) M. 5 2 - - 2 2 4 - - - - 3 1 1 3 1 1 F. 5 Cancer M. 243 — — 1 1 7 23 72 133 168 95 15 13 51 44 52 112 76 137 Malignant disease (45-53) F. 272 Diabetes (59) M. 3 - - - - - - 1 - - 2 7 4 - 1 1 3 4 1 2 2 F. 11 Cerebral hemorrhage, etc. (82) M. 67 — — — — - - 1 3 9 33 50 45 10 14 17 23 15 26 15 41 F. 84 Heart disease (90-95) M. 408 — — — 1 6 8 16 20 65 142 258 271 91 75 86 95 90 196 115 221 F. 470 Aneurysm (96) M. 17 — — — — 3 1 6 3 7 6 1 4 3 2 6 3 2 7 F. 10 Other circulatory diseases (97-103) M. 75 - - - - - 1 - 3 8 22 63 53 11 18 23 10 18 29 27 36 F. 86 Bronchitis (106) M. 106 4 — — — — - 3 3 20 42 53 78 27 19 18 18 27 43 49 56 F. 124 Pneumonia (all forms) (107-109) M. 216 67 27 2 1 — 5 8 15 34 67 95 77 20 41 49 50 52 61 62 103 F. 202 Other respiratory diseases (110-114) M. 31 1 1 1 — - 1 2 5 7 4 14 32 16 7 18 7 4 19 15 14 F. 53 Ulcer of Stomach and duodenum (117) M. 41 - - - - - - 2 2 8 17 17 3 - 5 4 5 3 10 7 15 F. 8 Diarrhoea, etc. (119-120) M. 45 64 6 - - - - - 1 2 2 1 1 - 12 8 13 17 11 8 8 F. 32 Appendicitis (121) M. 10 — — 1 1 1 1 - 1 5 2 2 1 1 3 1 3 2 2 3 F. 5 Cirrhosis of liver (124) M. 6 - - - - - - - - 2 3 3 1 1 2 - - 2 3 2 1 F. 4 Other diseases of Liver, etc. (125) M. 1 1 - - - - - - 1 - - 1 - - - - - 1 1 1 - F. 2 Other digestive diseases. (115, 116, 122, 123, 126-129). M. 31 4 2 — 2 1 3 8 13 28 16 3 10 4 6 15 11 15 19 F. 49 Acute and Chronic Nephritis (130-132) M. 43 1 — — — 1 3 6 7 11 17 24 19 12 9 10 9 12 18 18 25 F. 58 Puerperal sepsis . (140 and 145) F. 9 - - - - - 1 6 2 - - - - - - 1 2 2 2 - 2 Other puerperal causes (141-144) and (146-150) F. 5 - - - - - - 3 2 - - - - - - - - 1 2 - o Congenital debility, Premature birth, Malformations, etc. (157-101) M. 61 108 1 - 1 - - - - - - 19 10 14 18 12 14 23 F. 49 Senility (162) M. 16 - - - - - - - - - - 7 25 23 7 7 4 8 9 7 13 F. 39 Suicide (163-171) M. 30 — — — 2 7 9 14 9 8 1 7 6 9 3 8 6 11 F. 20 Other Violence . (172-198) M. 57 2 2 5 3 3 9 5 7 14 12 10 17 3 10 8 11 9 10 14 30 F. 35 Other defined diseases M. 124 23 9 3 3 2 5 19 21 29 41 46 23 4 24 17 21 22 54 37 53 F. 104 Causes ill-defined or unknown . M. — — — — - - - - - - - - - - - - - - - - - - - - F. - The numbers in brackets in Col. 1 indicate the classification in the International List of Causes of Death, adopted by the Registrar General for England, 101 1937 (Ministry of Health Return.) Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1937. Causes of Death. Sex All ages. 0- 1 2— 5- 15- 25- 35- 45- 55- 65- 75- All Causes M. 1,884 170 21 20 24 45 88 83 202 357 478 396 F. 1,981 132 22 11 13 46 68 90 179 293 455 672 Typhoid and paratyphoid fevers ... M. — — — — — — — — — — — — F. 1 — — — 1 — — — — — Measles M. 1 — 1 — — — — — — — — — F. - - - - - - - - - - - - Scarlet fever M. 2 — — 1 1 - - - - - - - F. 1 — — — — 1 — — — — — — Whooping cough M. 8 6 1 1 - - - - - - - - F. 12 7 5 - - - - - - - - - -Diphtheria M. 14 — 1 5 8 — — — — — — - F. 6 1 1 1 2 — — — 1 — Influenza M. 61 1 — 3 — — 1 1 10 16 19 10 F. 86 2 — — — 2 2 5 8 20 20 27 Encephalitis lethargica M. 2 — — — — — 1 — 1 — — — F. 1 — — — — 1 — — — Cerebro-spinal fever M. 4 3 1 - F. 3 - 1 — — 1 — — 1 Tuberculosis of respiratory system M. 128 — — — — 12 38 15 28 20 12 3 F. 78 — —i — 1 13 20 20 9 9 3 3 Other tuberculous diseases M. 9 — — 2 3 1 — 3 — — — F. 13 2 2 3 — 4 1 — — — 1 Syphilis M. 11 3 - - - - - - 1 3 4 — F. 6 1 - - - - - - - 3 — 2 General paralysis of the insane, tabes dorsalis M. 7 — — — — 2 — 1 2 1 1 — F. 5 — — — — — — 1 — 4 — — Cancer, malignant disease M. 251 — — — 1 1 2 12 28 72 92 43 F. 278 - - - - - 5 12 47 64 79 71 Diabetes . M. 11 - - - - - - - - 3 4 4 F. 25 — — — — 1 1 — — 6 11 6 Cerebral haemorrhage, etc. M. 54 - - - - - - 1 2 13 13 25 F. 72 - - - - - - 1 4 13 29 25 Heart disease M. 435 — — — — 3 6 8 37 80 142 159 F. 518 — — — 2 12 11 10 29 65 141 248 Aneurysm. M. 20 - - - - - 3 1 4 5 4 3 F. 18 - - - - - - - 4 1 8 5 Other circulatory diseases M. 77 1 — — — — — 3 4 13 29 27 F. 84 - - - - - - 2 3 7 28 44 Bronchitis. M. 93 1 — — — — 2 3 16 24 23 24 F. 89 3 — — — — — 1 4 10 18 53 Pneumonia (all forms) M. 192 38 13 4 1 3 5 8 18 31 45 26 F. 184 33 6 6 3 2 2 6 12 28 32 54 Other respiratory diseases M. 24 — — — — — 1 3 3 3 2 12 F. 39 — 1 — 1 — 1 1 - 5 3 27 Peptic ulcer M. 41 — — — — — 2 2 8 13 15 1 F. 7 - - - - - - - 1 3 2 1 Diarrhoea, etc. M. 41 32 4 - - - - - - 2 3 — F. 35 24 1 — — — — 1 2 1 3 3 Appendicitis M. 10 — — 1 1 2 — — 1 2 2 1 F. 5 — — — — — — 1 3 — 1 — Cirrhosis of liver M. 7 - - - - - - - 2 3 2 — F. 5 - - - - - - - - 1 2 2 Other diseases of liver, etc. M. 6 - - - - - - - - 3 2 1 F. 14 — — — — 1 — 1 1 3 6 2 Other digestive diseases M. 32 2 — 1 1 1 2 1 1 6 10 7 F. 41 2 1 — — 1 1 3 5 4 15 9 Acute and chronic nephritic M. 40 1 — — — 2 2 3 4 10 6 12 F. 71 1 — — — 2 3 4 9 10 17 25 Puerperal sepsis F. 7 - — — — 1 5 1 — — — — Other puerperal causes F. 6 - - - - - 5 1 — — — — Congenital debility, premature birth, malformation, etc. M. 74 72 — — — 1 1 - - - - - F. 48 48 - - - - - - - - - - Senility M. 12 - - - - - - - - - 4 8 F. 33 - - - - - - - - - 1 32 Suicide M. 29 — — 1 5 5 7 6 5 - F. 20 — — — — 1 2 3 7 3 3 1 Other violence M. 63 3 — 1 6 12 6 4 9 8 3 11 F. 39 1 — 1 2 — — 3 5 4 9 14 Other defined diseases . M. 124 7 1 1 2 3 11 9 15 20 36 19 F. 131 7 4 — 2 3 8 13 24 29 23 18 Causes ill-defined, or unknown. M. 1 — — — — — — — 1 — — — F. - - - - - - - - - - - - Legitimate. Illegitimate. Deaths under 1 year M.159 11 F. 113 19 Registered Births. M. 2,364 F. 2152. (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1937. Disease. Ages. Totals. Total Cases removed to Hospital Under 65 and 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 upwds Small Pox Notifications ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever Notifications 2 41 49 61 70 304 104 28 47 12 5 ... 723 711 Deaths ... ... ... 1 ... ... 1 ... 1 ... ... ... 3 3 Diphtheria Notifications 10 34 50 54 52 261 81 22 46 6 7 ... 623 622 Deaths 1 2 2 1 3 5 5 ... ... ... 1 ... 20 20 Enteric Fever Notifications ... ... ... ... 1 2 1 2 1 5 ... ... 12 12 Deaths ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Puerperal Fever Notifications ... ... ... ... ... ... ... ... 14 3 ... ... 17 15 Deaths ... ... ... ... ... ... ... ... 6 2 ... ... 8 8 Puerperal Pyrexia Notifications ... ... ... ... ... ... ... ... 42 33 ... ... 75 69 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary and Influenzal Pneumonia Notifications 10 5 5 11 7 12 10 8 34 37 51 25 215 61 Deaths 5 3 1 1 ... ... ... 1 7 11 57 75 161 82 Ophthalmia Neonatorum Notifications 34 ... ... ... ... ... ... ... ... ... ... ... 34 23 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica Notifications ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Deaths ... ... ... ... ... ... ... ... 2 ... 1 ... 3 3 Cerebro Spinal Fever Notifications 2 1 ... ... ... 2 ... 2 2 ... 1 ... 10 10 Deaths 3 1 ... ... ... ... ... 2 ... ... 1 ... 7 7 Acute Poliomyelitis Notifications ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 Deaths ... ... ... ... ... ............ ... ... ... 1 ... ... 1 1 Anthrax. Notifications ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Deaths ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Dysentery . Notifications ... 9 2 3 5 8 2 ... 5 1 2 2 39 39 Deaths 1 ... ... ... ... ... ... ... ... ... ... 1 2 2 Malaria Notifications ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas Notifications 8 1 2 1 ... 2 2 11 16 37 41 30 151 107 Deaths 2 ... ... ... ... ... ... ... ... ... 3 1 6 5 Continued Fever Notifications ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox (except in the vaccinated under* 10 years) Notifications 13 33 21 22 31 207 70 16 12 ... ... ... 425 30 l_ Deaths ... ... ... ... ... ... ... ... ... ......... ... ... ... ... 102 1937 103 1937 (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1937. SANITARY AREA. Premises. No. in Borough on 31st December, 1937. No. of Inspections. No. of Prosecutions. Common Lodging Houses 24 425 - Seamen's Lodging Houses — - - Cowsheds (licensed) - - - Slaughterhouses (licensed) 8 (7 local supplies) (1, horses for export) 305 Other Offensive Trades. 12 (Includes knackers) 135 - Milkshops 240 878 3 Ice Cream Premises 480 701 — Restaurants and Eating Houses 544 889 — Registered Foster Mothers 192 1,299 1 Nurse Children kept 170 1,420 - Smoke Nuisances: (1) Number of observations 69 (2) „ intimations served 22 (3) ,, complaints received *33 (4) „ Statutory Notices served 2 (5) „ legal proceedings 1 (6) ,, convictions 1 (7) Amount of penalty and costs imposed in each case (costs) £110 * In respect of 25 premises. Cleansing and Disinfection : Number of adults cleansed 55 ,, children cleansed 6,237 ,, premises cleansed (a) After infectious diseases 2,173 (b) For vermin 173 Water Supply to Tenement Houses : Number of premises supplied 289 ,, prosecutions — Sanitary Officers: Chief Sanitary Inspector—(whole time) 1 Number of Sanitary Inspectors—(whole time) Male, 23 Female 2 ,, ,, ,, (part time) Male, Nil Female Nil „ Health Visitors—(whole time) 8 ,, ,, ,, (part time and Child Protection Visitor) 1 Municipal Tuberculosis Visiting Nurse—(whole time) 1 1937 104 HOUSING. 1. Total number of houses in the Borough about 46,296 Public Health Act: 2. Number of houses inspected on account of complaints or illness 6,159 3. „ Statutory Notices served 4. „ houses—(a) Repaired (b) Nuisances remedied 583 5,215 13,706 Housing Act, 1936 : 5. Number of houses inspected- House to house (Housing Consolidated Regulations, 1925) 1,489 6. (a) Number of houses included in representations by the Borough Medical Officer under section 25 of Housing Act, 1936 14 (b) Number of houses demolished following representation by Borough Medical Officer under section 25 of Housing Act, 1936 122 7. Number of houses repaired under sections 9 and 10 of Housing Act, 1936— (a) By owners 95 (b) By Local Authority in default of owners Nil 8. Number of houses demolished— (a) In pursuance of orders under section 11 of the Housing Act, 1936 9 (b) Voluntarily 130 9. Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 19 10. Number of Closing Orders determined (i.e., houses made fit) Nil 11. Overcrowding (Housing Act, 1936): Number of families found to be living in overcrowded conditions 6,652 Number of overcrowded families who have obtained alternative accommodation 193 12. Number of houses erected by the Borough Council for working classes during year (flats) 159 13. Underground Rooms: Number occupied but unfit Inspection not completed. Number closed or modified occupation approved 260 14. Houses Let in Lodgings: Number in Borough 983 Number of inspections 6,009 Number of prosecutions 3 Number of complaints remedied under the By-laws (not included under any other heading) 491 105 1937 References—Former M.O.H. Reports. Tables and Reports have appeared in previous Annual Reports of the Medical Officer of Health. See reference, page 91, Report for 1929 for years 1921-29, and page 93 of Report for 1936 for years 1930-34. Annual Report 1935. Pages 9 and 10 Maternal Mortality. Page 13 Home Helps. Pages 17-19 Voluntary Welfare Centres. Page 29 Venereal Diseases. Page 32 Diphtheria Immunisation. Page 47 Bacteriological Examination of Milk. Page 51 Disinfestation of Rooms. Page 62 Infirm Persons. Pages 62 and 63 Rats and Mice Destruction. Page 64 Church Lane Clearance Area. Page 64 Underground Rooms. Page 68 Overcrowding Survey. Page 69 Shops Act. Page 69 Swimming Baths and Pools. Page 73 Food Poisoning. Annual Report 1936. Pages 7 and 8 Infantile Mortality. Page 17 Diphtheria Prevention. Pages 23 and 24 Tuberculosis Care Committee. Pages 35 and 36 Disinfestation. Pages 39, 40 and 41 Scavenging. Page 46 Se.wer Emanations. Pages 50 to 55 Overcrowding Survey. Pages 57 and 58 Shops Act. Page 61 Food Poisoning. Page 64 Pharmacy and Poisons Act. Page 69 Propaganda Work. Pages 71 and 72 Maternal Mortality. Pages 74 and 75 Home Helps. Pages 79 and 80 Voluntary Welfare Centres. Pages 83 and 84 Child Life Protection. Pages 84 and 85 Day Nurseries. Page 86 Grants to Midwives. 1937 106 INDEX Page Accidental Deaths 10, 16 Acute Poliomyelitis 23 Adulteration of Food 68, 69 Ages at Death 7 Agricultural Produce (Grading & Marking) Acts, 1928 & 1931 49 Ambulance Service iii Anthrax 13, 24, 63 Anti-toxin treatment 18 Appendix 99-104 Area of Borough 2 Artificial Cream Act 66 Artificial Sunlight Treatment 34 Attack Rates—Infectious Diseases 22 Bacteriological Examinations 36, 37 Bakehouses 43 Basement Rooms 55 Births 2, 3, 5, 6 „ Illegitimate 6 ,, Notification of 6 ,, Stillborn 6 Blind Persons Act, 1920 97 Bugs, Eradication of 41, 42 Cancer 3, 13 Census Information 2 Centenarians 7 Certification of Meat Food Products 64 Chicken Pox Regulations 24 Child Life Protection 93, 94 Clearance Areas 58 Clinics 72, 76, 77, 78 Coal gas Poisoning 16 Common Lodging Houses 52 Condensed Milk Regulations 71 Coroner's Court, &c. 16 Cream 69 Dairies and Milkshops (Inspection of) 66, 67 Day Nurseries 76, 77, 94, 95 Deaths from all causes during the year 2, 3, 6 Deaths from Epidemic Diseases 2, 10-12 „ —Infants 2, 3, 7, 8, 9 „ Respiratory Diseases 15 ,, in Public Institutions 10 „ and Death Rates 2, 3, 6, 7 „ Maternal 87-89 ,, Ages at 7 Demolition Orders 55 Density 2 Diarrhceal Diseases (see also Enteritis) 3, 12 Diphtheria 17 „ Anti-toxin treatment and immunisation 18, 19 Diseases of Animals Acts 63 Diseases Treated in Hospital 21 107 1937 Page Disinfectants distributed and used 41 Disinfecting Station 40 Disinfection Work 30, 40, 41 Disinfestation of bedding and rooms 41, 42 Disinfestation of School Children 42 District Inspectors' Work 47, 48 Dried Milk Regulations 71 Dust, removal of 47 Dysentery 23 Eggs-Storage of 49 Emergency Maternity Unit 85, 86 Encephalitis Lethargica 24, 25 Enteric Fever (Typhoid) 20 Enteritis (see also Diarrhoeal Diseases) iii, 12, 80 Epidemic Cerebro-Spinal Meningitis 23 „ Diseases 11 Erysipelas 13, 20 Extra Nourishment 34 Factories and Workshops Administration 42-45 Fatality from Notifiable Infectious Diseases 20 Finsen Light Treatment 34 Food and Drugs, Inspection of 68-71 Food, Inspection of. Unsound 61, 62 Food; Licensed Street Traders 64 Food Poisoning 64, 65 Food : Protection of 63 Gas (Coal) Poisoning 16 Glanders, Anthrax and Hydrophobia in Man 13, 24 Health Propaganda 73-75 Health Visitors (Municipal) 78, 79 Home Helps 91, 92 Home Visitations-Tuberculosis 35 Hospital Grants 91 Hospitals—Clinics 72 Hospital Isolation of Infectious Diseases 20, 21 Houses Let in Lodgings 51 Housing 54-60 „ —Accommodation and Recommendations 55 ,, —Tuberculosis 35 Ice Cream Premises 65, 66 Illegitimate Births 3 Immunisation, Diphtheria 18, 19 Industrial Diseases 13 Infantile Mortality 2, 3, 7, 8, 9 Infant Welfare Work 76-98 Infection, Prevention of 17 Infectious Diseases—Deaths 20 Infectious Diseases (London) Regulations, 1927 23 Infectious Disease (Notifiable) 17-25 Infectious Diseases in Schools 35 „ „ (Non-Notifiable) in Schools 36 Infirm Persons 52, 53 Informal Sampling 69 Influenza 12 Inhabited houses. Number of 2 Inspection of Food 61, 64 „ „ Houses 49-52 1937 108 Page Inspection of Kitchens of Restaurants 64 „ „ Milkshops and Dairies 66, 67 „ „ Slaughter Houses 61 ,, ,, Workshops 42-45 Institutions 72 „ (Deaths in) 10 Inquests '6 Insulin (Supply of) 25 Invalid Children's Aid Association 0o Islington (Chickenpox) Regulations 24 Islington Tuberculosis Care Committee 27, 28 Isolation of Infectious Diseases 20, 21 Kitchens and Restaurants 64 Laboratory Facilities 36, 37 Lead Poisoning, Chrome, etc. " Legal Proceedings, Summary of 72 Legislation, New 73 Leptospiral Jaundice 37 Light Treatment—Artificial Sunlight and "Finsen" 34 London County Council Return of Sanitary Work 103, 104 Malaria 23 Malignant Diseases 3, 13 Marriages 4 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work 76-98 Maternal Deaths 87-89 Measles (Deaths) 3, 9, 101 Measles, Notifications by School Teachers 36 Measles, Scheme of Control 36 Meat, labelling of 62 Meat Inspection 61, 64 Medicines, Provision of 25 Merchandise Marks Act, 1926 49. 62 Mid wives Services—Mid wives Act, 1936 90, 91 Ministry of Health Returns 59, 101, 102 Milk and Dairies Acts 66,67 Milk and Dairies Order, 1926 66 Milk, Bacteriological Analyses 69 Milk Adulteration 70, 71 „ Scheme 92 Milk Purveyors and Dairies 66, 67 „ Special Designations Order 67 Mortuary and Coroner's Court 16 National Society for the Prevention of Cruelty to Children 93, 96 Non-notifiable Infectious Diseases in Schools 36 Notices served 43, 47, 48, 50,51, 53, 66 Notification of Births 6 „ „ Infectious Diseases 17 ,, „ Still-births 3, 6 „ „ Tuberculosis 28-30 Nursery School 82 Nursing 24, 96, 98 Offensive Trades 63 Ophthalmia Neonatorum 96 Outworkers' Premises 44, 45 Overcrowding (Survey) 54, 59, 60 Pathogenicity Tests (Diphtheria) 37 109 1937 Page Pemphigus Neonatorum 98 Pharmacy and Poisons Act 68 Pneumonia 15, 23, 24 Pneumothorax treatment 34 Poisoning (Gas) 16 (Lead) 13 Polioencephalitis 24 Poliomyelitis, Acute 23 Population at the Census, 1931 2 „ estimated, 1937 2,3 Preserved Food (a) Inspectors' Visits 65 (b) Registration of Premises 65 Prevention of Deafness 97 Prevention of Infection 17 Propaganda 73-75 Prosecutions, Summary of 72 Prosecutions—Unsound Food 63 Public Health Committee ii Public Health (Meat) Regulations, 1924 63 ,, ,, (Tuberculosis) Regulations, 1930 28-30 Public Vaccinators 39 Puerperal Diseases (Deaths) 3, 13, 89 Puerperal Fever and Pyrexia 13,89,90 Pulmonary Tuberculosis 25-27 Rag and Bone Dealers 49 Rag Flock 48 Rateable Value 2 Rats and Mice (Destruction) Act, 1919 53, 54 Recommendations—Housing 55 Reconditioning of Houses 57 References—M.O.H. Reports 105 Rent and Mortgage Interest (Restrictions) Acts 48 Representations of Medical Officer of Health 58 Respiratory Diseases (Deaths) 15 „ Tuberculosis 25-27 Restaurant Kitchens 64 Rooms Disinfected and Disinfested 40, 41 Samples Analysed in 1937 68-71 Sanitary Inspectors' Work (District) 47—50 Scavenging 45-47 Scarlet Fever 20 Scholefield Road Day Nursery 76, 77 Schools 54 Septic Diseases 13 Shelter House ' 41 Shops Act, 1934 60 Shops, Inspections of 62 Slaughterhouses 61 Slaughter of Animals Act, 1933 63 Small Pox 17 Smoke Nuisances 48 Social Conditions 3 Sophistication of Milk 70, 71 Specialist Consultations 90 Staff 1 Statistics 2, 3 Still-Births, Registration 3, 6 1937 110 Page Street Accidents 10, 16 Street Traders 64 Swimming Baths and Pools 54 Tetanus 13 Tuberculosis 25 Tuberculosis Care Committee 27, 28 Tuberculosis Dispensaries 31, 32, 33 Tuberculosis—Disinfection and Housing 30, 35 „ Notification of 25, 26, 28-30 „ (Public Health) Regulations, 1930 28-30 „ Respiratory, All forms. Deaths 2, 13, 14 „ Visiting Nurse 35 Tuberculous Meat 61 Typhoid Fever (see Enteric) 20 Underground Rooms 55 Unemployment 3, 4 Unsound Food, Destroyed 61, 62 Unsound Food-Prosecutions 63 Vaccination 38, 39 Vaccination (Public Vaccinators) 39 Venereal Diseases 15 Verminous Children, Disinfestation of 42 „ Premises and bedding 41, 42 Vital Statistics—Summary 2 ,, „ Extract 3 Voluntary Maternity and Child Welfare Centres 80-85 Water Certificates 48 Water Supply 48 Water (Swimming bath and domestic supply) 54, 69 Welfare Work by Health Visitors 78, 79 Whooping Cough 3, 9 (Deaths) 3, 9 Workshops and Factories, Inspection of 42-45