LIBRARY 1938 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, Maternity and Child Welfare. London: Chas. Knight & Co., Ltd., Printers, Suffolk Lane, Cannon Street, E.C. 4. 1938 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, Maternity and Child Welfare. London : Chas. Knight & Co., Ltd., Printers, Suffolk Lane, Cannon Street, E.C. 4. ii CONTENTS. PAGE Public Health and Maternity and Child Welfare Committees iii Introduction iv Staff of Public Health Department 1 Section A—Statistics and Social Conditions of the Area 2-17 Section B—General Provision of Public Health Services—including Maternity and Child Welfare 18-43 Section C—Sanitary Circumstances of the Area 44-60 Section D—Housing 61-72 Section E—Inspection and Supervision of Food and Drugs 73-83 Section F—Prevalence and Control over Infectious and other Diseases 84-111 Appendix 112-114 Index 115-119 STATISTICAL TABLES. PAGE Bacteriological Examinations 95 Births and Birth Rates 2, 4, 5 Cancer 12 Deaths and Death Rates 2, 3, 5-16 Diphtheria 87 Factories 57, 58 Food and Drugs 73-76, 81-83 Health Visitors, Work of 23, 24 Housing 69-71 Infant Mortality 6, 7, 8 Infectious Diseases 9-11,89-94 Maternal Mortality 32, 33, 34 Overcrowding 72 Population 2, 3 Rats and Mice Destruction 50 Sanitary Inspectors, Work of 46 Statistical Summary 2, 3 Tuberculosis 12, 13, 97-103 iii MEMBERS OF THE PUBLIC HEALTH COMMITTEE (1st January to 31st December, 1938). Mayor. * Councillor Mrs. JESSIE LEONIE BLYTHE, J.P. † Alderman DUNCAN McARTHUR JACKSON, J.P., A.C.W.A. Aldermen. HERBERT JAMES LOWTON LYGOE † GEORGE WILLIAM RILEY Councillors. GEORGE BENNETT, J.P. † JOHN JEFFREY DENNISON BOWD Mrs. GLADYS DOROTHY CANTWELL * ALBERT EVANS † CHARLES ALEXANDER GOATCHER || WALTER HARPER * FREDERICK THOMAS HERRINGTON WILLIAM GEORGE KEER ALFRED CECIL KNIGHT PATRICK McCOLGAN * CHARLES EDWIN RATCLIFFE † Mrs. HETTY LOUISE REES WILLIAM THOMAS RICKETTS * ALBERT JOHN ROGERS FRANK LEYDEN SARGENT † FREDERICK SIMPSON FRANK STONHAM Mrs. MARGARET SUMMERS Mrs. ELIZABETH CLARA THURTLE EDWARD ALBERT WILLIS Chairman Alderman HERBERT JAMES LOWTON LYGOE Vice-Chairman *Councillor CHARLES EDWIN RATCLIFFE † Councillor Mrs. ELIZABETH CLARA THURTLE * To November, 1938 † From November, 1938 || Died 16th October, 1938 MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE (1st January to 31st December, 1938). Mayor. * Councillor Mrs. JESSIE LEONIE BLYTHE, J.P. † Alderman DUNCAN McARTHUR JACKSON, J.P., A.C.W.A. Aldermen. GWYN DAVID JONES, J.P. Mrs. JOSEPHINE JULIET JONES HERBERT JAMES LOWTON LYGOE Councillors. † Miss ELEANOR MARION ADAMS * JOHN JEFFREY DENNISON BOWD Mrs. FLORENCE HILDA CANTWELL GEORGE WILLIAM ELMER Mrs. AMY MERSEY GRIFFITHS § WALTER HARPER FREDERICK THOMAS HERRINGTON Mrs. MARTHA RACHAEL JENNER WILLIAM JOHN MITCHELL Mrs. HETTY LOUISE REES † FREDERICK SIMPSON Mrs. CATHERINE STONHAM Miss ADA MARIA THACKRAY Mrs. ELIZABETH CLARA THURTLE LESLIE BRUCE VENNING HENRY BLOOMFIELD VORLEY, J.P. 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. F. G. JOSEPH, 53, Linden Gardens, W.2. Mr. D. MOSS, 51, Holloway Road, N.7. Mrs. E. SMITH, 33, Riversdale Road, N.5. Mrs. N. WATT, 71, Highbury New Park, N.5. Chairman Councillor Mrs. FLORENCE HILDA CANTWELL Vice-Chairman * Councillor GEORGE WILLIAM ELMER † Alderman Mrs. JOSEPHINE JULIET JONES * to November, 1938 † from November, 1938 § Died 16th October, 1938 iv Public Health Department, Town Hall, Upper Street, N.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health and Sanitary Condition of the Borough for the year 1938. Vital Statistics. The death-rate for the year was 11.90, calculated on the estimated population of the Registrar-General (292,300), as against 12.90 in the previous year. The infantile mortality was 65 per 1,000 births, as against 66 in 1937. The summary of statistics will be found on page 2. Infectious Disease. On the 1st October, 1937, a limited notification of Measles and Whooping Cough came into force, the first cases in a house within two months being compulsorily notifiable. From that date to the end of the year only 13 cases of Measles and 112 of Whooping Cough were notified, but the principle is now established which may give preference to the treatment of such cases in hospital, besides drawing attention to the serious character of these two diseases which have in the past too often terminated fatally from complications. Maternity and Child Welfare. The increased clinical work of the Municipal Sunlight Clinic and the Miriam Price Coleman Day Nursery, as well as the necessary supervision of the Wards of the North and West Islington Welfare Centres, was met by the appointment of Dr. K. M. Hirst, of Birmingham, as Assistant Medical Officer, commencing on the 1st June, 1938. The Maternity Emergency Unit referred to in my last Annual Report was definitely established, as also was the Maternity Consultative Clinic. Housing. During the year the areas represented for clearance which were to be dealt with later, namely, Cornelia Street, St. Clement Street, Graham Street and City Garden Row, were the subject of a Public Enquiry, and the Orders were confirmed on the 18th August. Gaskin Street (formerly Church Street) was the subject of a Public Enquiry, and a Clearance Order was obtained in respect of three houses and a Compulsory Purchase Order in respect of thirteen houses. An extensive survey was carried out under the Housing Act for the abatement of overcrowding. This is dealt with on pages 61 to 66. Mr. E. A. Abbott, a senior clerk in the Public Health Department, retired after 47years' service. Dr. W. E. Snell, the Tuberculosis Officer at the North Islington Tuberculosis Dispensary, resigned on his appointment as Superintendent of Colindale Hospital. A report of very interesting work on the subject of " Alleged Cancer Houses" by Dr. Snell appears on page 107 of this report. He was succeeded by Dr. J. W. Craig on the 1st December, 1938. I should like to express my thanks to the Members of the Council, especially to the Chairmen and Vice-Chairmen of the Public Health, Maternity and Child Welfare, and Housing Committees, for their sustained interest in the work of my department during the year. To the Assistant Medical Officer of Health, the Assistant Medical Officer, the Superintendent, and the members of the staff generally praise is due for their efficient services. Although they had multifarious duties in connection with air raid precautions, they did not allow the routine work of the department to suffer, and gave ungrudgingly much of their spare time in the period of national emergency. In this respect I have also to acknowledge the assistance given by the Chief Officers of other departments. I have the honour to be, Your obedient servant, Medical Officer of Health. 1 [1938 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. Assistant Medical Officer. KATHERINE M. HIRST, M.B.; B.S. (Lond.); D.P.H.; M.M.S.A. Superintendent of Public Health Department and Chief Sanitary Inspector, (a, b, d) GEORGE JAMES BRIDEL, M.R.San.I., M.S.I.A. Sanitary Inspectors. (a, b, d) T. H. Hancock (Housing) (c, d) H. R. Homewood (b, d) S. P. Marks (c, d) A. W. Haydock (Inspector of (b) E. G. Holmes (Factories and Meat) Bakehouses) (c) N. Lightowlers (b,d) A. E. Wood (c) W. Riding (b) H. H. Uren (c, d) R. W. Norman (Dairies, etc.) (b, d) G. S. Green (Shops) (c) L. Nash (b, d) C. W. S. Lewis (Food and Drugs) (c, d) H. P. Price (b) L. H. Pearson (c, d) R. B. Girling (c) J. S. Ashworth (Housing) (c, d) T. Lloyd (c) A. Moxon (c, d) B. V. Cryer (c, d) W. C. Bartlett (c, d) F. J. Nutter (c) J. W. Aiken Inspectors of Factories, 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 F. H. Harris [e, f, g) Miss L. Flower (e, f, g) Miss E. Paley (e, f, g) Mrs. A. Main (e, f, g) Miss S. H. Prentice (e, g) Miss E. Oliver (e, f, g) Miss B. K. Anderson (Child Life (e, f, g) Miss J. Devine Protection) (g) Miss E. McGoldrick, Tuberculosis Visiting Nurse. (a) = Cert. Sanit. Inst. (e) = S.C.M. (b) = Cert. Sanit. Insp. Exam. Board (f) = 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), C. M. Wheble, W. R. Causton, W. G. Bunch, A. R. Wittrick, C. J. Cridland, S. A. Brown, L. Edis, W. A. McAdam, F. C. Green, A. E. Vanstone, Miss D. Egginton, Miss D. Francis, P. L. Regan (c), N.A.Rogers, G. W. C. Cassidy, C. J. Moore, E. W. C. George, D. Owen (Temporary). Vaccination Officers. J. Jennings L. Stevens Members of the Staff of the Miriam Price Coleman Day Nursery and Clinics Centre. Miss K. S. Edwards Matron, S.R.N., S.C.M. Miss N. Elliott Senior Nurse, S.R.N., S.C.M. Miss K. Mulcare Staff Nurse Miss O. F. Richardson Senior Probationer Miss J. A. Woodhouse Junior Probationer Miss M. Hyde Junior Probationer Miss S. Taylor Junior Probationer Mrs. K. Cant Cook Mrs. Mant Non-Resident Cleaner Miss B. Gammons Non-Resident General Domestic Mr. F. Jaynoy Non-Resident Caretaker 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). Disinfect ors. 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.l. Public Vaccinators (See page 86). Member of Staff of Public Health Department, retired in 1938. Mr. E. A. Abbott Clerk 1938] 2 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH SUMMARY of Vital Statistics in the Registration Year, 1938 Area 3,092 acres Density (Mid-year, 1938) 94.5 persons per acre Population (Enumerated at Census, 1931) 321,795 persons ,, Estimated Mid-year 1938 292,300 persons Decrease on Census population, 1931 29,495 persons Mean Population, ten years (1928-1937) 313,377 persons Marriages 2,860 Marriage Rate 19.57 Births Males 2,356 Females 2,122 4,478 persons Birth rate 15.32 per 1,000 inhabitants Deaths from All Causes Males 1,831 3,478 persons Females 1,647 3,478 persons Death Rate 11.90 per 1,000 inhabitants Excess of Births over Deaths 1,000 Deaths from Principal Epidemic Diseases Males 99 Females 74 173 persons Death rate 0.59 per 1,000 inhabitants Deaths from Tuberculosis (all forms) Males 153 Females 184 237 persons Death rate 0.81 per 1,000 inhabitants Deaths from Respiratory Tuberculosis Males 138 Females 72 210 persons Death rate 0.72 per 1,000 inhabitants Infantile Deaths under 1 year Males 180 Females 111 Total 291 Infantile mortality rate 65 per 1,000 births Rateable value of Borough of Islington £2,211,786 Sum represented by a penny rate £8,816 Number of inhabited houses (approximate) 45,360 3 [1938 EXTRACT OF VITAL STATISTICS. Total. M. F. Live Births Legitimate 4,241 2,231 2,010 Birth Rate per 1,000 of the estimated Illegitimate 237 125 112 resident population, 15.32. Stillbirths128 Rate per 1,000 total (live and still) births, 27.81. Deaths 3,478 1,831 1,647 Death Rate per 1,000 of the estimated resident population, 11.90. 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 5 1.08 No. 30. Other puerperal causes 7 1.52 Total 12 2-60 Death rate of infants under one year of age:— All infants per 1,000 live births 65 Legitimate infants per 1,000 legitimate live births 62 Illegitimate infants per 1,000 illegitimate live births 122 Deaths from Cancer (all ages) 509 ,, Measles (all ages) 24 „ Whooping Cough (all ages) 14 ,, Diarrhoea (under 2 years of age) 100 POPULATION (ESTIMATED). The population at mid-year 1938 is estimated at 292,300 persons, a decrease in the population of 29,495, when compared with the number of inhabitants ascertained at the census in 1931. MARRIAGES. Marriages, 2,860 ; Marriage Rate, 19'57.—There were 5,720 persons married, or 2,860 marriages in 1938, and the marriage rate, that is to say, the number of persons married per 1,000 of the population, was 19.57. Compared with the previous year these figures show a decrease of 254 in the number of persons married, or of 127 marriages, and of 0 65 per 1,000 in the rate. The following statement shows the figures for the previous ten years, 1928-1937. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 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 1932 2,857 17.60 1937 2,987 20.22 1938] 4 BIRTHS. During the year there were 4,478 live births registered, of which 2,356 were boys and 2,122 girls. Of this number, 600 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 15.32 per 1,000 of the population, as compared with a mean birth-rate of 16.02 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 1938 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 1937; together with the mean Borough Birth-rates for the 10 years 1928-37. Birth Rates. Quarter. Males. Females. Total. Islington, 1938. Islington, 1928-37. London, 1938. Great Towns, 1938. First 602 565 1,167 15.97 16.46 14.0 15.4 Second 623 590 1,213 16.60 16.78 14.1 15.8 Third 563 468 1,031 14.11 16.12 13.4 15.3 Fourth 568 499 1,067 14.60 14.93 12.4 13.9 The Year 1938 2,356 2,122 4,478 15.32 16.02* 13.4 15.0 1937 2,365 2,139 4,504 15.25 16.34 13.3 14.9 Increase or decrease -9 - 17 - 26 + 0.07 - 0.32 + 0.1 + 0.1 N.B.—The total registered births given by the Registrar-General for the Calendar year, 1938, will be found at the foot of table on p. 16. * 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 1938, 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 205 225 430 58.18 40 41 81 11.66 38 37 75 11.08 65 42 107 11.79 2nd 221 224 445 60.21 37 45 82 11.80 30 37 67 9.90 64 62 126 13.89 3rd 199 189 388 52.50 43 32 75 10.79 32 20 52 7.68 56 44 100 11.02 4th 214 183 397 53.72 44 35 79 11.37 36 47 83 12.28 50 44 94 10.36 Year 839 821 1,660 56.15 164 153 317 11.40 136 141 277 10.23 235 192 427 11.76 Showing the Births of Males and Females and the Birth-rates in each quarter and for the year 1938, and in the several Sub-Registration Districts—contd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females. Total. Birth rates. Males. Females. Total. Birth rates. Males. Females. Total. Birth rates. Males. Females. Total. Birth rates. 1st Quarter 80 73 153 11.51 68 55 123 10.20 106 92 198 11.28 602 565 1,167 15.97 2nd 86 74 160 12.04 91 66 157 13.02 94 82 176 10.03 623 590 1,213 16.60 3rd 87 70 157 11.81 60 49 109 9.04 86 64 150 8.54 563 468 1,031 14.11 4 th 68 62 130 9.78 58 56 114 9.45 98 72 170 9.68 568 499 1,067 14.60 Year 321 279 600 11.28 277 226 503 10.42 384 310 694 9.88 2,356 2 122 4,478 15.32 5 1938 Illegitimate Births.—The illegitimate births numbered 237 and show an increase of 19 on the return of the year 1937. They were equal to a rate of 5.3 per cent. of the total registered births. REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still-born). 1938. 1st Quarter 29 3 1 33 27.5 2nd„ 16 10 — 26 21.0 3rd„ 31 1 — 32 30.1 4th 26 11 — 37 33.5 Year 102 25 1 128 27.81 The above are the corrected figures. The actual number of stillbirths registered in Islington was 115, plus 29 which took place outside the Borough, but belonging to it, minus 16 non-residents which took place in the Borough. Notification of Births.—3,834 live births were notified under the Public Health (London) Act, 1936 (exclusive of 100 stillborn), or 85.6 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. 1938. 1st Quarter 557 20 362 4 88 2 1,007 26 2nd,, 535 16 393 7 55 — 983 23 3rd„ 454 17 406 8 51 — 911 25 4th„ 448 15 453 11 32 — 933 26 Year 1,994 68 1,614 30 226 2 3,834 100 DEATHS. The deaths registered during the year numbered 3,478 (exclusive of still-births), while the death-rate was equal to 11.90 per 1,000 of the estimated population, or 1.00 below that of the previous year (12.90), and 0.77 below the mean of the preceding ten years; whilst the death-rate of England and Wales was 11.6 and the 126 Great Towns 11.7. 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 Death Death Death Death Death Deaths. Rates. Deaths. Rates. Deaths. Rates. Deaths. Rates. Deaths. Rates. Tufnell 107 14.48 97 13.13 70 9.47 87 11.77 361 12.21 Upper Holloway 116 16.69 114 16.41 96 13.82 92 13.24 418 15.04 Tollington 94 13.89 101 14.93 69 10.20 89 13.15 353 13.04 Lower Holloway 111 12.23 91 10.03 76 8.37 103 11.35 381 10.50 Highbury 195 14.67 174 13.09 115 8.65 156 11.73 640 12.04 Barnsbury 168 13.93 131 10.86 108 8.95 123 10.20 530 10.98 Islington (South- - East) 238 13.56 193 10.99 155 8.83 209 11.91 795 11.32 The Borough 1,029 14.08 901 12.33 689 9.43 859 11.75 3,478 11.90 1938 6 Showing the Deaths and Death Rates of Islington in 1938, 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 1928-37 and the deaths and death-rates in the year 1937. Quarter. Males. Females Total. Death Rates. Islington, 1938. Islington, 1928-37. London, 1938. Great Towns, 1938. First 551 478 1,029 14.08 17.51 13.7 13.3 Second 465 436 901 12.33 11.50 11.1 11.3 Third 383 306 689 9.43 9.40 9.0 9.5 Fourth 432 427 859 11.75 12.25 10.9 11.2 The Year 1938 1,831 1,647 3,478 11.90 12.67* 11.4 11.7 1937 1,875 1,938 3,813 12.90 12.61 12.3 12.5 Increase or decrease — 44 -291 -335 — 1.00 + 0.06 -0.9 -0.8 * 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, 1938. Mean Deaths (10 years, 1928-37). Increase or Decrease on mean. 0-1 year 291 326 - 35 1-5 years 86 154 - 68 Under 5 years 377 480 - 103 5-15„ 57 79 - 22 15-25„ 96 129 - 33 25-35„ 136 170 - 34 35-45„ 171 214 - 43 45-55„ 317 400 - 83 55-65„ 573 671 - 98 65-75„ 813 869 - 56 75-85„ 734 744 - 10 85 upwards 204 213 - 9 All Ages 3,478 3,969 - 491 There was a decrease of 103 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 a decrease of 219 in the number of deaths when contrasted with the previous year 1937, and 75 below the ten years' average (1928-37). One resident, a female, lived for just over 100 years. INFANTILE MORTALITY. Infant Deaths, 291; Mortality Rate, 65.—The deaths of 291 infants under twelve months old were registered during the year, or 35 below the decennial average (326), and they were equal to the infantile rate of 65 per 1,000 births. The rate was the same as the mean annual record of the preceding ten years, and is 1 per 1,000 below the rate of last year (1937). 7 1938 In the quarters the mortality ranged from 74 per 1,000 births in the first quarter, 71 in the second, 55 in the third, and 57 in the fourth. In the sub-registration districts the infant mortality was as follows:— Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 29 17 Upper Holloway 13 41 Tollington 45 162 Lower Holloway 49 115 Highbury 48 80 Barnsbury 49 97 Islington South East 58 83 In London the infantile mortality was 57 per 1,000 births. The rate for England and Wales was 53 per 1,000 births. Infantile Mortality during each of the Ten Years 1928-37, and 1938. 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 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 1937 89 13 4 16 122 39 59 50 29 299 66 Mean 10 years 95 12 11 11 129 52 57 52 36 326 65 1938 82 3 5 5 95 47 62 54 33 291 65 Increase or decrease on mean -13 — 9 - 6 — 6 -34 - 5 + 5 + 2 - 3 - 35 - Showing the Deaths among Infants per 1,000 Births during the Year 1938, and also the mortality rates for the Years 1928-1937. Sub-Districts. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Mean 10 years. 1938 Increase or decrease on mean Tufnell 65 75 78 43 48 26 31 31 26 28 45 17 - 28 Upper Holloway 44 42 26 35 30 54 52 30 78 70 46 41 - 5 Tollington 85 71 106 90 88 101 78 51 83 167 92 162 + 70 Lower Holloway 77 95 57 84 77 68 81 98 104 131 87 115 + 28 Highbury 47 60 58 64 83 51 58 52 85 54 61 80 + 19 Barnsbury 75 87 95 66 76 80 76 85 77 76 79 97 + 18 Islington, S.E. 67 78 76 68 72 72 69 41 49 76 67 83 + 16 The Borough 64 73 70 64 68 63 62 52 61 66 65 65 - 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. 1938] 8 Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1928-37 : and in 1938 from certain specified causes. Causes of death. 1938. Rate per 1,000 Births. Mean rate 10 years 1928-37 per 1,000 Births. Difference. Premature Birth and Congenital Defects 17.4 20.7 3.3 Bronchitis and Pneumonia 10.9 12.9 - 2.0 Atrophy and Marasmus 1.1 2.6 - 1.5 Diarrhoeal Disease (all forms) 20.3 6.4 + 13.9 Convulsions 0.8 - 0.8 Whooping Cough 1.8 2.8 1.0 Measles 1.5 2.4 0.9 Diphtheria 0.2 0.4 - 0.2 Phthisis 0.2 - 0.2 Other forms of Tuberculosis 0.6 0.6 — Total of above 53.8 49.8 + 4.0 All other causes 10.9 15.1 - 4.2 Total 64.7 64.9 - 0.2 INFANTILE MORTALITY during the Year 1938. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 week Weeks. Total under 4 weeks Months. Total deaths under 1 year 1-2 2-3 3-4 4 weeks & under 3 m'ths. 3-6 6-9 9-12 All causes Certified Uncert'd - - - - - - - - - - - - - - - - - - - - Small-pox - - - - - - - Chicken-pox Measles 1 4 2 7 Scarlet Fever Whooping-Cough — — — — 2 2 2 2 8 Diphtheria & Croup - - - - - - - 1 — 1 Erysipelas. — — — — 1 — — — 1 Tuberculous Meningitis - - - - - - 1 - - 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - 2 2 Meningitis (not Tuberculous) - - - - - 1 - - - 1 Convulsions — — — — — Laryngitis — — — — — — — — — Bronchitis — — — — 3 1 4 Pneumonia (all forms) 2 1 1 2 6 9 10 11 9 45 Diarrhoea — — — — — 1 2 1 1 5 Enteritis — — 16 37 22 11 86 Gastritis — 2 2 Syphilis — — — — — — — — — _ Rickets Suffocation, overlying - - - - - - - - - - Injury at birth 8 — — — 8 8 Atelectasis 10 — — 10 1 — 11 Congenital Malformations 10 - 2 - 12 4 2 3 1 22 Premature birth 47 2 1 2 52 4 — — 56 Atrophy, Debility and Marasmus 2 — — — 2 1 2 — — 5 Other causes 3 — 1 1 5 4 5 5 7 26 TOTALS 82 3 5 5 95 47 62 54 33 291 Nett Births legitimate 4,241 4,478 Nett Deaths in legitimate infants 262 291 in the year illegitimate 237 the year of (illegitimate infants 29 Report on Maternity and Child Welfare work, see pages 20 to 43. 9 1938 Deaths in Public Institutions in the Borough during 1938 and 1937. Institutions. 1938. 1937. Residents. NonResidents. Total. Residents. NonResidents. Total. Archway Hospital 332 423 755 215 474 689 Royal Northern Hospital 78 185 263 88 201 289 London Fever Hospital 1 33 34 — 37 37 St. Mary, Islington, Hospital 904 63 967 1,180 58 1,238 Islington Institution 97 35 132 152 45 197 Mildmay Memorial Hospital 34 19 53 22 21 43 Other smaller Institutions 17 37 54 22 47 69 Totals 1,463 795 2,258 1,679 883 2,562 Percentage of Borough Mortality 420 — - 44.0 — — Deaths in Public Institutions outside the Borough of persons resident in Islington. 1938. 1937. North Western Fever Hospital 23 31 North Eastern Fever Hospital 30 9 Eastern Fever Hospital 18 17 Children's Hospital, Great Ormond Street 15 10 St. Bartholomew's Hospital 46 30 Royal Free Hospital 39 47 University College Hospital 51 37 City of London Maternity Hospital 4 7 Metropolitan Hospital 7 8 Middlesex Hospital 9 20 Friern Hospital, New Southgate, N. 15 6 Claybury Hospital, Woodford Bridge, Essex 12 19 Tooting Bee Hospital, Tooting Bee Road, S.W.17 18 29 Other Institutions 734 643 Totals 1,021 913 Percentage of Borough Mortality 29.3 23.9 Fatal Accidents and Sudden Deaths outside the Borough.—54 inhabitants died from accidents, or suddenly, in places outside Islington. Transferable Deaths.—During the year 42 deaths of residents that had occurred in outlying Institutions and other places in England and Wales were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Fevers— Typhus, Enteric and Continued—and Diarrhœal Diseases. During the year 173 persons died from these diseases, the death-rate being 0.59 per 1,000 inhabitants, as contrasted with 0.40 in 1937, and a decennial average mortality of 163 and a death-rate of 0.52 per 1,000. In London the death-rate from epidemic diseases was 0.31. 1938 10 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 1938. SubRegistration Districts. Wards. Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Enteritis and Diarrhoea. Totals. Tufnell Tufnell 1 1 1 1 10 14 Up. Holloway Up. Holloway — 2 — 1 2 7 12 Tollington Tollington — 4 — 3 4 13 24 Lr. Holloway Lr. Holloway — 3 — 1 3 17 24 Highbury Highbury — 2 — 2 1 13 18 Mildmay — 2 1 1 5 6 15 Barnsbury Thornhill — 4 — 4 3 13 24 Barnsbury 3 2 7 12 Islington South East St. Mary's 1 2 — 4 7 Canonbury - - - - - 1 5 6 St. Peter's — 1 — 1 1 14 17 The Borough 1 — 24 2 14 23 109 173 Total Death Rates — — 008 001 0.05 0.08 0.37 0.59 Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1928-37 and for the Year 1938. 1928 1929 1930 1931 1932 1933 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 _ - 4 0.01 Small Pox — — — — 1 0.00 — — — — — — Measles 156 0.48 11 0.03 140 0.43 7 0.02 52 0.16 14 0.04 Scarlet Fever 8 0.03 8 003 14 0.04 4 0.01 7 0.02 4 0.01 Whooping Cough 21 0.06 126 0.39 10 0.03 32 0.10 23 0.07 23 0.07 Diphtheria 25 0.08 32 0.10 42 0.13 15 0.04 20 0.06 33 0.10 Diarrhoea and Enteritis (under 2 years) 64 11.57 per 1,000 births 681 12.34 per 1,000 births 97 17.1 per 1,000 births 67 12.7 per 1,000 births 73 14.7 per 1,000 births 63 13.7 per 1,000 births 1934 1935 1936 1937 Mean 10 years 1938 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 1 0.00 _ - - - 1 0-00 1 0-00 1 0-00 Small Pox - - - - Measles 39 0.12 58 0.19 1 0.00 48 0.15 24 0.08 Scarlet Fever 5 0.02 — 7 0.02 3 0.01 6 0.02 2 0.01 Whooping Cough 15 0.05 9 0.03 18 0.05 18 0.06 29 0.09 14 0.05 Diphtheria 32 010 13 0.04 31 0.10 20 0.07 26 0.08 23 0.08 Diarrhoea and Enteritis (under 2 years) 47 10.2 per 1,000 births 65 14.2 per 1,000 births 84 17.8 per 1,000 births 69 15.3 per 1,000 births 70 15.6 per 1,000 births 100 22.3 per 1,000 births 11 1938 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 27 27 21 21 2 23 25 3 15 18 5 86 91 1 to 5 years 1 1 3 3 — 3 3 — 1 1 — 8 8 Over 5 years 1 1 1 4 5 — 2 2 — 2 2 1 9 10 Totals — 29 29 1 28 29 2 28 30 3 18 21 6 103 109 INFLUENZA. Influenza caused 16 deaths during the year and showed a decrease of 126 on the return for the year 1937, and were 71 below the average of the preceding ten years 1928-37. The death-rate was equal to 005 per 1,000 inhabitants. Showing the Deaths from Influenza in the Quarters of the Year 1938, together with the averages of the corresponding periods, 1928-37. Years. Quarters. Totals. First. Second. Third. Fourth. 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 1937 128 3 — 11 142 Average 69 8 2 8 87 1938 9 3 3 1 16 Increase or Decrease -60 -5 +1 -7 -71 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 1938. Ages. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Mean 10 yrs. 1938 Difference. 0- 5 3 5 1 4 5 4 3 1 6 3 1 - 2 5-10 1 1 — 1 1 — — 1 — — 1 10-15 - - - - - - - - - - - - - 15-25 3 2 4 3 3 — 3 — 2 2 2 — 25-35 1 9 — 4 9 10 2 — 5 3 4 1 - 3 35-45 6 19 — 14 4 24 1 3 3 5 8 1 — 7 45-55 4 38 5 16 10 27 6 3 4 17 13 3 -10 55-65 6 43 3 16 18 32 5 6 7 36 17 — -17 65-75 7 52 2 15 25 33 11 8 9 38 20 1 -19 75 & upwards 10 38 5 17 29 37 13 2 5 35 19 7 -12 All Ages 41 207 16 90 103 170 39 29 34 142 87 16 -71 1938 12 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the notifiable diseases of this class. Erysipelas.—5 deaths were returned from this disease, or 1 less than in the year 1937, and 10 below the average of the preceding ten years 1928-37. Puerperal Diseases.—These comprise Puerperal Pyæmia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 12 deaths, this being 2 below the number (14) in 1937, and were 2 above the average of the ten years 1928-37. The death-rate was equal to 2.60 per 1,000 births. Anthrax, Glanders or Farcy, Tetanus, etc.—No death was recorded during 1938. INDUSTRIAL DISEASES. Lead Poisoning, Chrome, etc.—No death from any of these causes was recorded. CANCER. Cancer.—509 deaths were registered from this malignant disease during the year compared with 515 in 1937, and with an average of 515 in the previous decennium. The deaths represent a death-rate of 1.74 per 1,000 of the civil population and is 0.10 above the average rate (1.64) of the last ten years; 249 deaths occurred among males and 260 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 1938:— Mean Differ- Ages. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 10 yrs. 1938 ence. 0-5 — 3 2 — 2 2 1 3 2 — 2— -2 5-15 — 1 — 3 1 1 1 2 1 1 1 — 15-25 31 1 123— 131 2— -2 25-35 14 10 6 10 12 9 11 13 13 7 10 8 -2 35-45 36 22 26 25 19 23 24 24 25 23 25 27 +2 45-55 83 84 72 85 78 84 83 45 69 72 75 77 +2 55-65 147 153 123 138 157 160 160 149 168 133 149 139 -10 65-75 155 106 139 167 158 146 200 162 181 168 158 150 - 8 75-85 71 81 90 83 92 70 87 75 85 95 83 93 +10 85 & upwards 9 10 8 7 13 11 10 15 - 7 15 10 14 + 4 Totals 518 471 467 519 534 509 577 489 554 515 515 509 - 6 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1938. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 11 20 8 12 22 22 33 128 Second 19 13 15 10 19 17 26 119 Third 21 15 19 13 20 18 27 133 Fourth 19 15 15 13 25 16 26 129 The Year 70 63 57 48 86 73 112 509 TUBERCULOSIS. Tuberculosis caused 237 deaths, which were 56 below the average of the last decennium, and were 9 above the number registered in 1937. The death-rate resulting from them was equal to 0.81 per 1,000 of the civil population, and represented 6-81 per cent, of the deaths from all causes during the year. 13 1938 Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 210 deaths, as contrasted with the decennial average of 259, while the death-rate was 0 72 per 1,000 of the civil population as against the decennial rate of 0.83 per 1,000. There was a decrease of 49 on the ten years' average number of deaths, and of 0.11 on the mean death-rate. Tuberculosis (Respiratory System). Proportion of Deaths from Tuberculosis per 100 Deaths from All Causes. Death rates from all Causes per 1,000 inhabitants. Years. Deaths. Death rates per 1,000 inhabitants. 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 1937 203 0.69 532 129 Average 10 years 259 0.83 6.52 12.67 1938 210 0.72 6.04 11.90 The following return gives the deaths at each age period:— Age Periods. Males. Females. Total. 0-5 2 2 5-15 2 2 15-25 15 20 35 25-35 23 20 43 35-45 29 10 39 45-55 28 7 35 55-65 30 5 35 65 upwards 11 8 19 Total 138 72 210 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1938. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough. First 7 6 5 9 8 10 14 59 Second 6 7 6 10 9 4 14 56 Third 4 5 3 2 8 7 8 37 Fourth 7 6 9 3 9 7 17 58 The year 24 24 23 24 34 28 53 210 Showing the Deaths from all forms of Tuberculosis during 1938. Ages. Sex. Districts. Total Deaths. Form. 0-1 1-5 over 5 M. F. Tuf. U.H. Toll. L.H. H. B. S.E. Respiratory 2 208 138 72 24 24 23 24 34 28 53 210 Meningeal 1 6 7 9 5 — — 2 1 1 4 6 14 Abdominal — — 1 — 1 — — — — — — 1 1 General Other forms 1 1 2 1 7 6 2 4 1 — 1 1 1 — 1 3 4 2 10 All Tuberculosis 3 10 224 153 84 25 24 26 27 35 36 64 237 1938 14 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 480 deaths, 251 below that of 1937. They were equal to a death-rate of 1.64 per 1,000 of the civil population, and represented 13.8 per cent. of the total deaths registered in the Borough. Acute Bronchitis.—There were 38 deaths as compared with 88 in the previous year, 23 occurred among males, and 15 among females. The deaths of 4 infants under 12 months were registered. Chronic Bronchitis.—86 deaths were ascribed to it, 59 being males and 27 females. This return is 56 below that of 1937. Pneumonia (all forms).—307 deaths were registered, of which 194 were males and 113 females, and were 111 below the year 1937. 45 infants under a year old died from this disease, while between the ages of 1 and 5 years 18 deaths were recorded. Above 5 years of age the deaths numbered 244. 242 deaths occurred in Public Institutions, of which number 151 occurred in Institutions situated in Islington. Pleurisy.—6 deaths were registered from this disease, all of which occurred in Public Institutions. Asthma and Emphysema.—7 deaths were recorded from Asthma, and 2 from Emphysema. Other Diseases of the Respiratory System.—34 deaths were registered, as contrasted with 71 in 1937. VENEREAL DISEASES. Twenty-four deaths were ascribed to these diseases, 6 more than last year. Of these 19 were males and 5 females. They were 8 above the mean deaths (16) of the preceding ten years 1928-37. The three groups of ages at death were as follows:—Under 1 year, no death; 1-5 years, no death; and over 5 years, 24 deaths. DEATHS FROM COAL-GAS POISONING. During the year, 21 deaths, 14 males and 7 females, were registered from asphyxia caused by the inhalation of carbon monoxide gas. Nineteen of these deaths were attributable to suicide, one was accidental, and an open verdict was returned in the remaining case. In 1937 the same number of deaths (21) was registered from this cause. ACCIDENTAL DEATHS. The deaths of Islington residents due to accident numbered 97. Of this number 33 deaths were ascribed to vehicular traffic and may be summarised as follows:— Motor Car Other or Lorry. Bus or Tram. Taxi-Cab. Vehicles. Total 21 4 1 7 33 18 of these 33 deaths occurred to Islington residents when in outlying districts. In addition to these, 9 non-residents were killed by vehicles within the Borough. CORONER'S COURT, INQUESTS AND MORTUARY. Since 1932 the only use made of these premises has been for the reception of bodies into the mortuary prior to transfer elsewhere. During the year 38 bodies were received into the mortuary, as compared with 33 in 1937. 15 1938 Deaths registered in the Borough of Islington during the year ending 1938. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. CAUSE OF DEATH. Sex All ages AGES. DISTRICTS. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 & up Tuf. U.H. Toll. L.H. H B S.E. ALL CAUSES. M. F. 1,831 1,647 180 111 48 38 19 14 10 14 27 17 29 23 73 63 95 76 205 112 350 223 395 418 330 404 70 134 191 170 214 204 177 170 222 159 315 325 296 234 416 379 Typhoid and paratyphoid fevers M. - - • - - - - - - - - - 1 - - - - - - - 1 (1-2) F. 1 Measles M. 15 7 14 3 - - - - - - - - - — 1 2 4 3 4 7 3 (7) F. 9 Scarlet Fever M. 2 1 - - - - - - 1 — 1 — — — 1 — — (8) F. - Whooping Cough M. 4 8 6 - - - - - - - - - - - 1 1 3 1 3 4 1 (9) F. 10 Diphtheria M. 9 1 7 12 1 2 - - - - - - - — 1 2 4 3 6 5 2 (10) F. 14 Influenza M. 9 1 2 1 1 3 1 6 1 2 2 1 2 1 2 6 (11) F. 7 Encephalitis lethargica M. 1 - - - - - - - 1 1 1 — — 1 — — 1 — 1 (17) F. 2 Cerebro-spinal Fever M. 3 2 2 - 1 - - 1 - - 1 - - - 1 1 — — 1 3 1 (18) F. 4 Tuberculosis of Respiratory System M. 138 2 2 15 20 43 39 35 35 12 6 1 24 24 23 24 34 28 53 (23) F. 72 Other Tuberculous diseases M. 15 3 8 3 1 2 1 5 1 3 — — — 1 — 3 3 1 8 11 (24-32) F. 12 Syphilis M. 19 — — — — 3 6 9 3 3 — 7 3 3 1 2 4 4 (34) F. 5 General Paralysis of the Insane—tabes dorsalis. M. 3 - - - - - - - 2 1 2 1 — — — 1 — 1 — 2 2 F. 3 (83) Cancer, Malignant disease M. 249 1 8 27 77 139 150 93 14 70 63 57 48 86 73 112 (45-53) F. 260 Diabetes M. 3 — — — 1 3 6 1 1 1 1 — 2 2 2 4 (59) F. 9 Cerebral haemorrhage, etc. M. 64 2 3 9 24 45 35 8 15 9 14 4 32 14 38 (82) F. 62 Heart disease M. 444 2 1 3 3 4 17 21 63 140 316 331 105 97 155 98 94 196 145 221 (90-95) F. 562 Aneurysm M. 12 2 2 2 7 3 1 — — 1 — 5 3 2 6 (96) F. 5 Other circulatory diseases M. 63 — 1 — 1 5 15 55 42 15 12 12 7 8 36 16 43 (97-103) F. 71 Bronchitis M. 82 4 1 1 1 1 2 4 17 18 36 32 7 8 10 15 22 27 22 20 (106) F. 42 Pneumonia (all forms) M. 194 45 18 2 3 4 3 10 15 24 54 63 60 6 25 35 37 40 51 44 75 (107-109) F. 113 Other respiratory diseases M. 24 2 2 — — — — 1 5 4 10 11 9 5 4 4 6 5 7 10 13 (110-114) F. 25 Ulcer of Stomach and duodenum M. 35 - - - - - - 2 3 10 15 9 7 — 1 4 1 6 10 8 16 (117) F. 11 Diarrhoea, etc. M. 69 92 8 2 1 4 2 — 10 7 13 17 19 20 23 (119-120) F. 40 Appendicitis M. 7 — 1 1 1 — 2 1 2 5 6 — — — 2 3 1 3 3 4 3 (121) F. 12 Cirrhosis of liver M. 4 — 1 1 2 3 1 1 — — — 1 2 1 2 3 (124) F. 5 Other diseases of Liver, etc. M. . — — — — — — — — — (125) F. — Other digestive diseases M. 32 1 1 1 — — 1 4 4 7 13 11 16 4 6 9 5 13 11 5 14 (115, 116, 122, 123, 126-129) F. 31 Acute and Chronic Nephritis M. 52 1 1 2 2 6 5 13 20 26 20 4 8 15 6 12 20 19 20 (130-132) F. 48 Puerperal sepsis F. 5 1 4 1 — 2 1 1 (140 and 145) Other puerperal causes F. 7 1 4 2 — — — — — 1 — — 1 — 3 2 (141-144) and (146-150) Congenital debility, Premature birth, M. 66 104 16 7 12 18 18 14 20 Malformations, etc. F. 39 (157-161) Senility M. 9 - - - - - - - - - - 4 20 18 8 7 1 3 8 9 6 (162) Suicide F. M. 33 27 - - - - - 2 _ 7 8 12 10 2 2 8 4 2 5 9 11 (163-171) F. 14 Other Violence M. 63 2 4 4 3 6 8 14 3 6 10 12 17 8 13 9 10 12 14 18 21 (172-198) F. 34 Other defined diseases M. 114 19 8 13 7 8 4 12 13 18 33 32 28 7 22 22 22 26 35 27 38 F. 78 Causes ill-defined or unknown M. — 1 - - - - - - - - - - - - - - - - - - - F. 2 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. 1938 16 (Ministry of Health Return.) Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1938. Causes of Death. Sex All ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M. 1,831 183 29 19 28 55 71 96 206 348 398 398 F. 1,661 109 14 24 28 40 63 77 112 225 418 551 Typhoid and paratyphoid fevers M. —- — — — — — — — — — F. — — — — — — — — — — — Measles M. 15 6 6 1 2 — — — — — — — F. 9 1 4 3 1 - - - - - - - Scarlet fever M. 2 — — 1 — — — — 1 — — — F. - - - - - - - - - - - - Whooping cough M. 5 2 3 - - - - - - - - - F. 11 7 3 1 - - - - - - - - Diphtheria M. 9 1 — 2 5 1 — — — — F. 14 — 5 8 1 - - - - - - Influenza M. 10 — 1 — — 1 1 2 — 2 3 F. 7 — — — — 1 — 1 1 — — 4 Encephalitis lethargica M. 1 — — — — — — 1 — — — — F. 1 - - - - - - - - - 1 — Cerebro-spinal fever M. 3 — — 1 1 — — - — 1 — — F. 4 2 1 — — — 1 — — — — Tuberculosis of respiratory system M. 137 — 2 1 — 16 23 29 27 28 8 3 F. 75 — — 1 2 20 21 12 7 5 4 3 Other tuberculous diseases M. 12 — 2 2 3 — 2 1 — 2 — — F. 11 2 1 3 1 2 1 1 — — Syphilis M. 14 — — — — — — 4 6 2 2 F. 3 - - - - - - 1 1 1 — — General paralysis of the insane, tabes dorsalis M. 14 - - - - - 2 1 4 6 1 — F. 5 — — — — — — 2 2 1 — Cancer, malignant disease M. 258 - - - - - 6 11 43 77 71 50 F. 271 — — — 1 — 4 21 39 66 81 59 Diabetes M. 13 — — — — — — 5 6 2 F. 25 - - - - - - - 2 5 13 5 Cerebral haemorrhage, etc. M. 53 — — — — — — 5 7 21 20 F. 52 - - - - - - 1 3 10 20 18 Heart disease M. 425 — — — 2 3 6 11 29 74 133 167 F. 543 — — 1 2 4 11 12 22 57 163 271 Aneurysm M. 16 — — — — — 2 3 2 6 3 — F. 12 — — — — 1 4 3 4 Other circulatory diseases M. 65 1 - - - - - - 4 10 25 25 F. 85 - - - - - - 3 5 10 27 40 Bronchitis. M. 82 3 — — 1 1 1 1 16 17 23 19 F. 37 2 — — — 2 — 1 1 1 10 20 Pneumonia (all forms) M. 176 27 6 4 3 5 6 10 19 32 35 29 F. 94 19 2 5 2 — 1 3 3 11 20 28 Other respiratory diseases M. 9 — 1 - - - - - 2 3 3 — F. 9 — 1 — — — 1 1 2 2 2 Peptic ulcer M. 33 — — — — — 1 3 8 13 4 4 F. 10 - - - - - - - - 2 5 3 Diarrhoea, etc. M. 65 57 5 — 1 1 1 F. 36 26 2 — — — — 1 — 4 3 Appendicitis M. 7 — — — 1 1 1 1 3 — — F. 13 — 1 1 1 1 1 3 3 1 1 Cirrhosis of liver M. 3 — — — — — — 1 1 1 — — F. 5 — — — — 1 — — 1 2 — 1 Other diseases of liver, etc. M. 6 - - - - - - - 1 1 1 3 F. 12 1 - - - - - 1 1 3 3 3 Other digestive diseases M. 29 2 1 — — — 4 2 3 7 4 6 F. 23 — — — 2 — 1 2 1 5 3 9 Acute and chronic nephritis M. 40 — — — — 3 — 4 8 12 10 3 F. 47 — — — 1 5 1 5 8 16 11 Puerperal sepsis F. 3 — — — — — — 3 — — — — Other puerperal causes... F. 7 - - 1 4 2 Congenital debility, premature birth, malformation, etc. M. 69 68 1 F. 39 39 - - - - - - - - - - Senility M. 8 — — — — — — 8 F. 28 - - - - - - - - - 3 25 Suicide M. 27 — 1 5 7 6 6 2 F. 13 - - - - - - 3 1 6 3 Other violence M. 69 — 1 1 4 14 11 2 5 9 7 15 F. 41 2 2 2 3 1 1 1 9 20 Other defined diseases M. 156 16 1 6 7 8 5 9 14 21 32 37 F. 116 8 2 6 6 8 4 15 20 26 21 Causes ill-defined, or unknown. M. - - - - - - - F. - - - - - - - - - - - - Legitimate. Illegitimate. Deaths under 1 year M 165 18 F 101 8 Registered Births M 2,352 F 2,135 17 1938 SOCIAL CONDITIONS. The housing activities of both the London County Council and the Borough Council are now strikingly apparent in the Borough owing to the replacement of a large part of the former housing accommodation by large blocks of flats. Careful consideration has been given in the design of these to provide playground space, and in many cases swings and other apparatus for the children. This is a marked contrast with the former conditions, where the children, owing to their environment, played in the streets. The next improvement which may come gradually when all have settled under their new conditions, would be the education of the parents on the necessity of better control over the family in insisting on an earlier bed-time for the younger children. All the amenities which are now added for the social betterment of the flat dwellers are bound in time to have an influence on their health and general well-being. It is difficult in the question of unemployment to pick out cases where it could be definitely said that the health and physique had to a significant degree been affected. With the agencies now at work, the Employment Exchange, the Unemployment Assistance Board, the Public Assistance Committees, and the thorough investigations which are made as regards the money which can be expended on food, it would appear that a careful watch is kept so that the nourishment of the individuals, adults and children, is not lost sight of. I am indebted, as in former years, to the Local Employment Exchange for figures showing the principal industries in the Borough of Islington and the numbers there registered as unemployed at the two exchanges. Number of workpeople, residing in the Borough of Islington, registered as unemployed at Holloway and King's Cross Exchanges on 16th January, 1939 :— Men. Women. Juveniles. Total. Holloway Exchange ... 5,566 1,798 217 7,581 King's Cross Exchange 3,354 1,324 158 4,836 Total 8,920 3,122 375 12,417 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 Millinery, Bakery, Distributive. The figures given below show the number of workpeople employed in the various industries at July, 1938, by employers in the area of the Holloway Exchange, the largest majority being in the Borough of Islington. Figures for Islington Employers in the King's Cross area are not included and cannot readily be obtained. Men. Women. Juveniles. Total. Building 3,941 29 149 4,119 Engineering 918 99 372 1,389 Motor Engineering 362 67 67 496 Cabinet Making 1,287 143 258 1,688 Radio and Battery Manufacture 1,945 2,534 748 5,227 Heating and Ventilating Apparatus Manufacturing 528 26 225 779 Metal Industries 670 517 446 1,633 Pianoforte 428 35 73 536 Hotel and Catering 940 1,474 101 2,515 Laundries 432 1,541 541 2,514 Transport 1,504 28 117 1,649 Printing 861 412 343 1,616 Dressmaking and Millinery 73 856 276 1,205 Bakery 1,114 280 250 1,644 Distributive 5,633 2,862 1,860 10,355 1938 18 SECTION B GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A list of the Staff of the Public Health Department is given on page one. LABORATORY FACILITIES. The Council has an arrangement with the Royal Institute of Public Health and Hygiene, 23, Queen Square, W.C.1, for the examination of specimens to assist the medical profession in the diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, and in addition facilities are afforded at the Bland Sutton Institute of Pathology, Middlesex Hospital, especially for cases requiring pathogenicity tests. The Bland Sutton Institute also makes examinations of specimens sent by the Specialist conducting the Council's Maternity Consultative Clinic. Very considerable help is afforded by the Ministry of Health Laboratory in the examination of certain specimens submitted in cases of suspected food poisoning. Bacteriological and chemical examinations of water used for dietetic purposes and samples of swimming bath water are made at the Royal Institute of Public Health and Hygiene. These arrangements have worked satisfactorily during the year. AMBULANCE FACILITIES. Ambulances are provided by the London County Council for the conveyance of— (a) Cases of sudden illness or accident occurring in the streets, public places, or places of employment, and in the homes. (b) Non-urgent maternity cases if the call is made between the hours of 11 p.m. and 8 a.m. (c) Urgent maternity cases on the application of a doctor or certified midwife, either of whom must accompany the patient. (d) Persons suffering from notifiable infectious diseases. (e) Sick persons to hospitals or any place within the County of London, for which conveyance a standard charge is made. Emergency Maternity Unit—Arrangements with University College Hospital and St. Bartholomew's Hospital. The St. John's Ambulance Brigade, St. John's Gate, E.C.1, also arrange for ambulances on payment. The ambulance service in Islington can be considered satisfactory. NURSING IN THE HOME. Arrangements have been made by the Council with the North London (Islington) District Nursing Association, 6 and 7, Canonbury Place, N.l, to provide assistance in home nursing free of charge to those unable to provide for it privately who are suffering from the following illnesses:—Ophthalmia Neonatorum, Measles and Whooping Cough in children under five years of age ; Summer Diarrhoea in infants, specified cases of Pneumonia in all ages, and special maternity cases. Before nursing assistance can be provided a doctor must be in attendance on the case. Service. Maternity and Child Welfare: North Islington Welfare Centre, 6 & 7, Manor Gardens, N.7. South Islington Welfare Centre, 6, Clephane Road, N.l. East Islington Welfare Centre, 32, Drayton Park, N.5. West Islington Welfare Centre, 42 & 44, Richmond Avenue, N.l. At Miriam Price Coleman Clinics Centre: Maternity Consultative Clinic Evening Maternity Clinic (for Expectant & Nursing Mothers). Duchess of York's Maternity Clinic, 434, Essex Road, N.l. St. Mary, Islington, Hospital, Highgate Hill, N.19. Royal Northern Hospital, Holloway Road, N.7. Day Nurseries: Miriam Price Coleman Day Nursery, Scholefield Road, N.19. Lower Holloway Day Nursery, 547, Liverpool Road, N.7. South Islington (Pro Patria) Day Nursery, 8 & 9, Canonbury Place, N.l. St. Luke's Day Nursery and " Guest House," 29, 30 & 31, Penn Road, N.7. Nursery School: The North Islington Nursery School, 110, Tollington Park, N.4. Tuberculosis Dispensaries: North Islington—Royal Northern Hospital, Holloway Road, N.7. South Islington—Royal Chest Hospital, City Road, E.C.I. Other Dispensaries: Islington Dispensary, 303, Upper Street, N.l. Islington Medical Mission, Britannia Row, N.l. Artificial Sunlight Clinics: Miriam Price Coleman Clinics Centre, Scholefield Road, N.19. Almeric Paget Massage Corps, Islington Centre, Britannia Row, N.l (& Massage). North Islington Welfare Centre, 6 & 7, Manor Gardens, N.7. West Islington Welfare Centre, 42 & 44. Richmond Avenue. N.l. 19 1938 TREATMENT CENTRES AND CLINICS. By whom provided. Voluntary Welfare Centre Committee, subsidised by Borough Council. Ditto. Ditto. Ditto. Islington Borough Council. Ditto. Voluntary Hospital (Royal Free Hospital, St. Pancras). London County Council. Royal Northern Group of Hospitals (Voluntary). Islington Borough Council. Voluntary Committee, subsidised by Borough Council. Ditto. Ditto. Voluntary Committee. Royal Northern Group of Hospitals, subsidised by Borough Gouncil. Ditto. Voluntary Committee. Ditto. Islington Borough Council. Voluntary Committee. Voluntary Welfare Centre Committee, subsidised by Borough Council. Ditto. Hospitals in the Borough also provide this treatment. Diphtheria Immunisation Clinics: Miriam Price Coleman Clinics Centre, Scholefield Road, N.19. Town Hall Clinic, Town Hall, Upper Street, N.l. Venereal Disease Clinic: Royal Northern Hospital, Holloway Road, N.7. School Clinics : Thornhill Road School Treatment Centre Popham Road School Treatment Centre Child Guidance Clinic: Tudor House, Canonbury Place, N.l. Islington Borough Council. Ditto. Royal Northern Group of Hospitals, subsidised by London County Council. London County Council. Ditto. Voluntary Committee. 1938 20 HOSPITALS—PUBLIC AND VOLUNTARY. Islington Hospitals: General:— Beds. By whom provided. St. Mary, Islington, Hospital 834 London County Council. Archway Hospital, Archway Road 564 Ditto. Royal Northern Hospital 277 Royal Northern Group of Hospitals. Mildmay Memorial Hospital 30 Voluntary Committee. Isolation:— London Fever Hospital 209 Voluntary Committee. Public Assistance: Islington Institution, 1,365 London County Council. St. John's Road, N.19. MATERNITY AND CHILD WELFARE. Report by Assistant Medical Officer of Health The services continue to be carried out by the Council's Health Visitors and at the special municipal clinics, and also by the four voluntary Welfare Centres in the borough. As mentioned in the report for 1937, each Welfare Centre has a considerable degree of autonomy and appoints its own Medical Officers, Health Visitors, Clerical Staff, etc., subject to general supervision by the Medical Officer of Health. The Borough Council is represented upon the respective Committees of the four Welfare Centres by two members of the Maternity and Child Welfare Committee 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. Arising out of the necessity for the appointment of an Administrative Medical Officer of the Wards of the North and West Islington Welfare Centres and also the increased clinical work of the Municipal Sunlight Clinic and the Miriam Price Coleman Day Nursery, Dr. K. M. Hirst, of Birmingham, was appointed as an additional Assistant Medical Officer and commenced her duties on 1st June, 1938. Towards the end of the year the Council decided to commence at the beginning of 1939, for an experimental period of six months, a routine Ante-natal and Postnatal Clinic to be held fortnightly in the evening. It is intended to meet the needs of women who are unable to attend at a Welfare Centre or Hospital during the day, and will be held at the Miriam Price Coleman Clinics Centre. Dr. Hirst will be the Medical Officer in charge. Ante-natal, Post-natal and Children's consultation clinics take place at the Centres and Institutions and at the times indicated on page 21. Maternity and Child Welfare Clinics:— Monday. Tuesday. Wednesday. Thursday. Friday. North Islington Welfare Centre, 6 & 7, Manor Gardens, N.7. 9.45 a.m. Ante-natal Clinic — — 1.45 p.m. — 1.45 p.m. Post-natal — — — 9.45 a.m. — Children's Consultations. 1.45 p.m. 1.45 p.m. 1.45 p.m. 1.45 p.m. South Islington Welfare Centre, 6, Clephane Road, N.l. Ante-natal and Post-natal Clinic. 1.30 p.m. - - - - Branch Centre, " The Rose," 15, Popham Road, N.l. — 9.30 a.m. — — At Main Centre—6, Clephane Road, N.l. Children's Consultations — 1.30 p.m. 1.30 p.m. 1.30 p.m. — At Branch Centre—*100, Canonbury Road, N.l. — 1.30 p.m. — — 1.30 p.m. At Branch Centre—15, Popham Road, N.l. (•Temporarily transferred (1939) to 6, Clephane: Road, N.l.) — — 1.30 p.m. 1.30 p.m. 1.30 p.m. East Islington Welfare Centre, 32, Drayton Park, N.5. Ditto. Ante-natal and Post-natal Clinic. 10 a.m. 10 a.m. 2nd. & 4th Children's Consultations 1.45 p.m. 10 a.m. — — 1.45 p.m. — 1.45 p.m. — — Branch Centre—Highbury Mission Hall, Hurlock Street, N.5. — — 10 a.m. 10 a.m. 1.45 p.m. West Islington Welfare Centre, 42 & 44, Richmond Avenue, N.l. Ditto. Ante-natal and Post-natal Clinic. — 9.45 a.m. — Children's Consultations 1.30 p.m. — 1.30 p.m. 1.30 p.m. 1.30 p.m. Branch Centre—St. Luke's Mission Hall, Goodinge Road, N.7. — — — 1.30 p.m. Miriam Price Coleman Day Nursery & Clinics Centre, Scholefield Road, N.19. Maternity Consultation Clinic 10.30 a.m.— 2nd & 4th Monday in month Evening Maternity Clinic (for expectant and nursing mothers) (Commenced January, 1939). Sunlight Clinic (for mothers and children). — — — 6.30 p.m. 8.30 p.m. (fortnightly) — 10 a.m. — — 10 a.m. St. Mary, Islington, Hospital, Highgate Hill, N.19. tAnte-natal Clinic *9.30 a.m. — — *9.30 a.m. *9.30 a.m. *For patients already booked. *2 p.m. †New bookings any day 11 a.m.—4 p.m. Post-natal Clinic 1.45 p.m. — — — — Royal Northern Hospital, Holloway Road, N.7. Ante-natal Clinic 9.0 a.m. 9.0 a.m. 9.0 a.m. Obstetric Clinic 9.0 a.m. — 9.0 a.m. Children's Consultations 2.30 p.m. — — — — 21 1938 1938 22 WORK OF THE COUNCIL'S HEALTH VISITORS. The Council's Health Visitors, nine in number, are responsible for visiting the homes and supervising the mothers and children who are not attending Welfare Centres in the Borough. Every endeavour is made to ensure attendance at the appropriate centre so that there shall be medical, as well as nursing supervision and advice. Child Life Protection work is entrusted to one of the Health Visitors who is responsible for foster-children in the borough as a whole ; the remaining Health Visitors work in their allotted districts. Health Visitors also attend at Municipal Clinics and Clinics held by the subsidised Welfare Centres. The Health Visitors also report on mothers attending ante-natally at various hospitals within the borough or outside, and these reports are forwarded as a matter of routine to the hospital authorities. A close connection is thereby maintained between the hospitals where confinements take place and the Borough Council which is in charge of the welfare of the mothers before they are confined. The work entailed in this co-operation assumes considerable dimensions, particularly in the case of St. Mary, Islington, Hospital, where, during 1938, 1,324 Islington mothers were confined. Children who attend Welfare Centres are transferred for home supervision to the Centres' Health Visitors. Certain difficulties of overlapping have occurred in the past where some children in the same family, usually the younger members, attended the Welfare Centres whilst others were not taken. During the year an arrangement was arrived at by which the Centres' Health Visitors became definitely responsible for supervision of all children in the same family under five years not attending school where at least one of the children was on the Centre register. Children thus supervised, but not attending the Centre, are known as " Centre-Attached Cases." The Council sanctioned the attendance of two Health Visitors at a" Refresher Course" for those engaged in public health work, held at Bedford College for Women, Regent's Park, N.W.1, at the end of the year. Miss Flower and Miss Harris were the Health Visitors who attended this course." Refresher Courses" such as these are extremely useful in acquainting Health Visitors with what has been done in districts other than their own, and in stimulating still further their interest in the work for which they are responsible. 23 [1938 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1938. District No. 1 2 3 4 5 6 7 8 § C.L.P. Not included in totals ‡. Totals. I. Births, First Visits, Infants under 1 Year 368 538 549 576 524 586 410 429 188 5 4,168 II. Births, Re-Visits, Infants under 1 Year 179 331 604 635 484 774 580 897 147 16 4,631 III. Visits to Children, between 1st and 2nd Years 192 312 595 563 434 663 536 549 167 31 4,011 IV. Visits to Children, between 2nd and 5th Years 544 1,028 1,356 1,271 850 1,763 1,122 1,490 382 46 9,806 V. Visits re Still Births 7 21 9 17 12 14 15 5 5 – 105 VI. Deaths, Visits, re Infants under 1 Year 16 27 34 10 27 20 12 10 9 1 165 VII. Deaths, Visits, re Children 1 to 5 Years — — — — — 1 — — — — 1 VIII. †Ante-Natal, Home Visits F/274 300 F/308 403 F/291 392 F/246 304 F/280 302 F/268 327 F/202 315 F/1 76 202 F/136/177 F/ 1 F2,181 2,722 Fever, Home Visits – F/4 5 F/3 4 – F/1 2 F/ 1 – F/ 1 – – F/10 13 ix. †Puerperal Pyrexia, Home Visits — F / 1 F/1 2 — F/1 2 — F / 1 — — F/4 6 Totals 1,606 2,666 3,545 3,376 2,635 4,151 2,990 3,584 1075 100 25,628 X. *Attendances at Welfare Centre and Clinics 27 20 46 46 124 – 47 46 7 20 363 XI. Other Work by Direction 620 417 1,018 692 548 954 444 395 76 2 5,164 XII. Visits Declined 3 – 2 1 – – – – – – 6 xiii. Visits, House Shut 597 911 741 749 846 734 1,137 941 441 1 7,097 XIV. Visits, Inopportune 25 4 — – 4 3 — — — – 36 Grand Total of Visits 2,878 4,018 5,352 4,864 4,157 5,842 4,618 4,966 1,599 123 38,294 [Continued. 1938] 24 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1938—continued. District No. 1 2 3 4 5 6 7 8 § C.L.P. Not included in totals‡. Totals. Analysis of Visits included in I.-IX. relating to— (aa) †[Reported Ophthalmia F/5 11 F/6 10 F/23 39 F/7 14 F/24 48 F/29 51 F/3 16 F/ 5 F/4 27 — F/106 221 (a) †Ophthalmia Neonatorum F / 1 F/2 3 F/3 4 F/3 5 F/2 4 F/4 9 – F/2 6 — — F/17 32 (6) †Epidemic (Summer) Diarrhœa – — — — — — – — — — — (c) Other Digestive Diseases 1 — — — — — – — — — 1 (d) Pneumonia and Bronchitis 4 2 3 1 — — – — — — 10 (e) Rickets 6 3 2 2 4 7 – — — — 24 (f) Measles and German Measles 4 3 25 6 9 12 5 17 — — 81 (g) Whooping Cough 4 30 15 14 12 53 5 13 — — 146 (h) Tuberculous Disease—P = Pulmonary; 0 = 0ther — p / 1 — — — p / 1 — — — — p/ 2 (i) Convulsions — – — — — – — — — — — (j) †Polio-myelitis — — — — — — — — — — — (k) Premature Birth 8 5 10 8 5 22 — 10 — — 68 (I) Atrophy, Debility and Marasmus 1 — 2 — — 1 — — — — 4 (m) All other investigations (**Specify) 8 8 14 3 26 15 9 4 1 — 88 (n) Routine Visits included in I.-IX. and not included in (aa) to (m) 1,558 2,601 3,431 3,323 2,527 3,980 2,955 3,529 1,047 100 24,951 *** Totals (aa) to (n) 1,606 2,666 3,545 3,376 2,635 4,151 2,990 3,584 1,075 100 25,628 Total Families Visited 1,255 1,932 2,679 2,823 2,000 3,357 2,291 2,506 875 94 19,718 Registered New Cases Handed to Infant Maternal Puerperal Puerperal Ophthalmia Births. H.V.'s for Visitation. Mortality. Mortality. Fever. Pyrexia. Neonatorum. Non- No. Rate. Notified Notified Transfers No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. Births. Births. In. 4,478 15.32 4,584 22 653 291 65 12 2.60 19 14 69 57 39 26 * 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 (n) should correspond with Totals I to IX. †F- IN front of figures to denote " First Visit." ‡ Child Life Protection Visits. § Temporary Health Visitor. 25 [1938 CHILD LIFE PROTECTION. (Public Health (London) Act, 1936, Sections 256-272.) The number of foster-children on the Register during the year 1938 shows a further diminution on the previous year to 392 from 401. The number between 5 and 9 years has increased from 61 to 87 so that the decrease is entirely among those foster-children 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 increased by 8. The number of satisfactory foster-mothers continues to be inadequate in relation to the demand for them. The amount that many of the mothers who desire to have their children fostered can afford to pay is insufficient in many cases to cover the cost of maintenance on a reasonable standard in a good home, and there is therefore the tendency, which has to be continually checked, of attempting to place a child in an unsuitable home at lower cost. During the year 1938, 35 applications for foster-mothers were received but only 25 were recommended as suitable. The remaining 10 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. No legal proceedings were instituted. There were 3 deaths of foster-children during the year as against 8 in the previous year. All these deaths occurred in hospitals. The certified causes of the deaths were :—(i) acute infective enteritis ; (ii) acute bronchitis, marasmus, vaccinia (an inquest was held in this case) ; (iii) dehydration from acute gastro-intestinal catarrh. All these children were six months of age or under. 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. During the year an opportunity was taken of thoroughly overhauling the register. 1938] 26 Annual Return of Child Life Protection Work. Number of foster-mothers on the Register who were receiving children on the 1st January, 1938 185 Do. do. on the 31st December, 1938 112 Number of foster-mothers added to the Register during the year 25 Number of foster-mothers removed from the Register by the Committee during the year 1 Number of foster-mothers removed or lapsed 94 Number of foster-children on the Register at 31st December, 1938 159* Number of foster-children attending Child Welfare Clinics 12 under private medical practitioners, 31 43 * Includes those in institutions, etc. Total number of visits paid by Child Protection Visitor 1,559 Special visits paid by Child Protection Visitor 2 Children removed compulsorily Nil Children removed to hospital (including infectious disease) 32 Children removed voluntarily Nil Deaths reported (Inquests—1) 3 Children for whom medical attention arranged Nil Cases recommended for prosecution Nil Desertions by parents—Children removed from foster-mothers to Public Assistance Institutions 5 Other cases in which there was cause for complaint 4 Number of foster-children under 5 years on Register at any time during 1938 305 (with foster-mothers 144) (with Institutions 161) Number of foster-children between 5 years and 9 years on Register at any time during 1938 87 (with foster-mothers 64) (with Institutions 23) Total number of foster-children dealt with at any time during 1938 392 (with foster-mothers 208) (with Institutions 184) Institutions, including Schools.—161 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. Owing to the alteration and enlargement of the premises the accommodation was increased from 28 to 29. 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, 1938, admissions numbered 58. 27 [1938 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 information received from the Centres giving particulars which the Medical Officer of Health has to supply to the Ministry of Health for the calendar year. TABLE—CALENDAR YEAR, 1938. North. South. East. West. Total. 1. Pre-Natal Clinics— Number held weekly 3 11 ctr. 1 Rose Branch. *1 1 *7 „ of expectant mothers who attended 543 235 200 169 1,147 „ of attendances 1,787 704 512 489 3,492 2. Post-Natal Clinics— Number held weekly 1 2 *†l †l *5 „ of mothers who attended 249 163 77 51 540 „ of attendances 592 261 123 80 1,056 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 1,008 630 555 656 2,849 (ii) 1-5 years 187 142 168 116 613 Number of attendances :— (i) Children under 1 year 12,691 12,877 7,987 8,395 41,950 (ii) Children 1-5 years 6,057 8,907 6,180 6,215 27,359 4. Home Visiting— Number of visits made to :— (i) Expectant mothers— (a) First visits 418 199 196 130 943 (b) Total visits 2,403 514 847 299 4,063 (ii) Children under 1 year— Total visits 5,998 5,968 3,768 3,907 19,641 (iii) Children 1-5 years 7,674 7,869 4,864 6,043 26,450 5. Wards and Homes— Number of beds 18 12 - 8 38 Number of patients received— (i) Mothers and babies— (a) Mothers 39 86 — — 125 (b) Babies 39 91 — — 130 (ii) Babies only 104 — — 79 183 6. Number of children who attended at the Centres during the year, and who, at the end of year, were :— (i) Under 1 year 869 581 373 543 2,366 (ii) 1-5 years 1,732 1,488 840 972 5,032 7. Convalescence— Number of cases :— (i) Mothers 52 29 120 35 236 (ii) Children 70 95 310 74 549 † East and West Centres. Post-Natal Clinics are held with their pre-natal clinics. * East Centre = 1 Clinic weekly + 2 others per month. 1938] 28 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 & WARDS, 6-9, Manor Gardens, N.7. The Committee are pleased to report that they have now completed 25 years of work for the welfare of children in North Islington, which continues to show progress and expansion in every phase of the work. The interest taken by the parents in the welfare of their children is evidenced by the increased number of children on the books and in the record number of new cases. The improvement in the education of the mothers is apparent from the increased number of requests that are received for " special " visits to their homes, and the use made of the various clinics of the Centre. The Committee are grateful to the Islington Borough Council for their support and for their generous grant in aid of the work of the Centre and Wards. They deeply value the co-operation of the Medical Officer of Health and his Assistants and of the officials of the Council. They would like to place on record their appreciation of the co-operation that exists between Dr. Hirst, Assistant Medical Officer, Islington Borough Council, and the Medical and Nursing Staff of the Wards. The Committee are fully conscious of their responsibilities in case of a national emergency. The Centre and Ward Staff including most of the domestic staff have attended a course of lectures and obtained Wardens' badges. During the September crisis, both the doctors and staff devoted many hours to the fitting of gas masks and to arrangements for the evacuation of children. In co-operation with His Worship the Mayor, Councillor D. McArthur Jackson, J.P., the Centre supplied 250 free Christmas dinners to necessitous families. A Christmas tree, laden with toys and woollies supplied by the Civil Service, " The Daily Sketch," the Knitting Guild and many other friends, helped to make the distribution a truly festive one which was honoured by the presence of the Mayor and Mayoress of Islington. The friendly address given by his Worship the Mayor was warmly welcomed. 3,486 dinners have been given to necessitous expectant and nursing mothers and their toddlers during the year for which Her Worship the Mayor, Councillor Mrs. J. L. Blythe, J.P., contributed £13 3s. Od. The Mothers' and Fathers' Committees have had regular meetings, when lectures on various subjects affecting Child Welfare have been given. The Mothers' Committee has organised a Sale of Work and a Concert from which the Centre benefited by £57 Is. 8d. They also continue to attend physical culture classes. Also Arts and Crafts classes at the Tollington Park Women's Institute. The Fathers' Committee has organised dances by which they raised £50 in aid of their Benevolent Fund. They also assisted at the distribution of Christmas dinners 29 [1938 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.—(Transferred in 1939 to 6, Clephane Road, N.l.). The Centre has joined the Federated Superannuation Scheme for Nurses. The Centre will be responsible for the Employers' share of the premiums, and two of the present Staff and all the Nurses engaged in future will come under the Scheme. The Committee has made suitable arrangements for the remaining members of the Nursing Staff. The Canonbury Branch will have to move from 100, Canonbury Road as the house is being pulled down to make way for the Community Centre (Mary Ward Settlement). Accommodation is being provided for the Centre's Branch in the new building and in the meantime the Consultations for the Canonbury Mothers will be held at Clephane Road. This is an inconvenient arrangement and will give some of the mothers a long way to come, but is the only arrangement possible for the time being. The Garden School has continued to justify its existence. The children attend regularly and benefit by the fresh air and regular occupations. It has been difficult to find a sufficient number of satisfactory vacancies for the convalescence of small children. The Home at Flamstead has continued to prove beneficial for the Mothers and babies. EAST ISLINGTON MOTHERS' AND BABIES' WELFARE CENTRE. Centre : 32, Drayton Park, N.5. Branch at Highbury Quadrant Mission Hall, Hurlock Street, N.5. Owing to the sudden death of one of our Medical Officers, two vacancies occurred on the staff. Dr. Odling-Smee was appointed for the Clinic for children under 5, and Dr. C. W. Kimbell for the Ante-natal and Post-natal Clinic. Great efforts had been made for some years to persuade all mothers to attend a Post-natal Clinic six or eight weeks after the birth of their babies, unless they were already under medical supervision. During this past year, the Ante-natal and Postnatal Clinics have developed considerably, and six are now held each month. All expectant mothers are weighed at each visit and routine tests for the presence of anaemia are performed. Owing to unemployment, malnutrition and poor social conditions a moderate degree of anaemia is very prevalent. Recognition of the existence of such an anaemia can make considerable difference to the general well-being of the mother after her confinement. Wherever necessary, nursing mothers are helped with regard to diet and also in the arrangement of suitable convalescence. 1938] 30 During the year Dr. Creak continued her child guidance work for children under five. (This work was terminated in 1939.) The Clinics were financed for one year only by the Child Guidance Council, and it is very much regretted that the financial position did not justify the expense of continuing them further, as, at the present moment, very heavy expense has to be met. A serious subsidence of the house made it necessary for structural alterations to be considered for 1939. Further, it has been decided to start a Superannuation Fund for the staff as from 1st April, 1939. During the year 1,192 hot dinners have been given to necessitous expectant and nursing mothers, and they were often accompanied by the toddlers, who were given 476 dinners. Interesting lectures have been given on the Common Difficulties in Child Management, Home Nursing, Food Values, Dental Health, and cooking demonstrations have been held. Holidays were arranged for 120 mothers and 309 children. During the international crisis in September the London County Council had made arrangements for the evacuation of all school children, but no plans were announced in respect of children under the age of five. On the morning of Wednesday, the 28th, however, the Centre received a notification from the London Federation of Women's Institutes, asking for co-operation in their plans which were being carried out at the request of the Home Office. A scheme for visiting every family in the district was immediately organised. All the staff worked at high pressure. Three extra Health Visitors were engaged, and the College of Nursing very kindly sent three students. During the Wednesday and Thursday 766 families were visited, and had the crisis not terminated, all arrangements would have been completed by the Friday evening. WEST ISLINGTON INFANT WELFARE CENTRE. Centre : 42 & 44, Richmond Avenue, N.l. Branch held at St. Luke's Mission Hall, Goodinge Road, N.7. There has been a steady increase in the routine work of the Centre. The work at the Branch Centre has increased greatly and the numbers in regular attendance have become so large that, as a temporary experimental measure, a morning session of weighings and advice by the Health Visitors has been started. This has proved very popular with the mothers who bring their babies to be weighed every week. These children are referred to the doctor periodically or when further advice is necessary. The Ultra Violet Light Treatment has been continued during the winter months and combined with massage treatment on the same day. This has saved the mothers the double journey and the results have been encouraging. The free dinners for necessitous expectant and nursing mothers provided during the year have been much appreciated and have resulted in a marked improvement in health. Dinners are now provided also near the Branch Centre for the convenience of the mothers living in that district. 31 [1938 In the wards greater co-operation with the Borough Council has been sought by the periodic visits of the Assistant Medical Officer, and certain changes have been introduced with a view to minimising the risks of cross infection. The Annual Reports of the four Voluntary Welfare Centres cover the period 1st April, 1937, to 31st March, 1938, and the following table summarises the attendances, etc. of the various departments of the Centres over the twelve months' period indicated:— North. South. East. West. Total 1. Pre-Natal Clinics and Ailing Mother Clinics. Number held weekly 4 2 1 1 8 ,, of attendances 2,488 831 506 559 4,384 2. Consultations for Children up to 5 Years of Age. Number held weekly 10 11 **10 7 38 ,, of attendances 24,000 20,894 14,776 13,487 73,157 3. Home Visiting. Number of visits made 18,070 13,955 10,150 10,261 52,436 4. Dental Clinics. Number attending 773 157 93 69 1,092 ,, of attendances or arrangements made for attendances 2,202 444 – – 2,646 5. Morning Callers. Number of attendances 1,689 972 ‡- 1,627 4,288 6. Massage Clinics. Number of cases given massage or sent for massage 100 92 (& Sunlight treatment) 105 41 338 7. Wards. Number of beds 18 – – 8 26 „ of patients received 124 — — 98 222 8. Number of Children on Books 2,055 1,744 1,230 1,202 6,231 MATERNITY AND CHILD WELFARE. Contributions by the Borough Council year ended 31st March, 1938. Voluntary Welfare Centres. £ North Centre 5,755 South ,, 2,776 East ,, 2,137 West ,, 2,154 Total £12,822 ** Including two Observation Clinics. ‡ Not recorded. 1938] 32 MUNICIPAL MATERNITY CONSULTATIVE CLINIC. This Clinic has been conducted by Mr. R. Christie Brown, F.R.C.S. Two clinics a month were arranged at the Miriam Price Coleman Clinics Centre, Scholefield Road, N.19, the cases being referred by doctors and midwives as under :— Number of Sessions held 8 „ Attendances18 EMERGENCY MATERNITY UNIT. The Emergency Maternity Unit, which is described in the Annual Report for the year 1937, consists of two doctors and a midwife, one of the doctors being of a consultant standing. This staff is prepared to go out with the necessary equipment at any time to a home when it would be dangerous for the mother to be removed to hospital for treatment, as in the case of acute haemorrhage. During the year this arrangement, initiated by the Borough of Islington, in conjunction with University College Hospital, was extended to Area " B " of the London County Council's midwives' districts, comprising, in addition to Islington, the City of London and the Boroughs of Finsbury, Holborn and St. Pancras, and negotiations were completed in 1939 for having a similar unit stationed at St. Bartholomew's Hospital. Each borough in Area " B " can therefore make an " Emergency Call " at either hospital. There were no calls for the Emergency Unit during the year 1938. COUNCIL'S CONSULTANT FOR OBSTETRIC CASES. The services of the Council's Consultant were sought on 1 occasion during the year. This was on account of a difficult confinement. MATERNAL MORTALITY. The number of women dying, pregnancy being a factor, during the year 1938 was 18. Our investigations showed 5 to be classifiable as Puerperal Sepsis and 7 from other puerperal causes. These 12 cases would give a Maternal Mortality Rate of 2.60 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 Intestinal Obstruction, 2 from Heart Disease, and 1 from Pneumonia. Taking the deaths as 18 would give a rate of 3.9. (See Table p. 33.) A Table showing such investigations from 1911 is given. For details of the Maternal Deaths for the year 1938, see pages 33 and 34. The deaths for the preceding year numbered 20, and were equal to the proportion of 4.3 per 1,000 registered births. 33 [1938 † 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* 1938 4,478 18 3.9* *Rate per 1,000 registered live births and still births. t 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 factor. METROPOLITAN BOROUGH OF ISLINGTON. MATERNAL DEATHS, 1938. (For those in 1937, see p. 88 of the Medical Officer of Health's Annual Report for that year.) 1938. 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. Feb. Septicaemia due to Acute Endocarditis following abortion and Infected Uterus. Coroner P.M. without Inquest ... ... 1 ... 1 1 ... " B. Coli Meningitis following purulent metritis (recent Miscarriage). Coroner. Without Inquest ... 1 ... ... 1 1 ... ,, General Peritonitis following instrumental perforation of the Uterus and abortion self induced by the deceased. Felo de se. Coroner. P.M. Inquest ... ... 1 ... 1 ... 1 (a) " Ante Partum Haemorrhage. Coroner. P.M. Without Inquest ... ... 1 ... 1 ... 1 Mar. Pelvic Peritonitis b Hysterotomy for termination of pregnancy, c Acute Psychotic Chorea. P.M. 1 ... ... ... 1 1 ... 1st Or. 1 1 3 ... 5 3 2 1938] 34 METROPOLITAN BOROUGH OF ISLINGTON. MATERNAL DEATHS, 1938.—Contd. (For those in 1937, see p. 88 of the Medical Officer of Health's Annual Report for that year.) 1938. 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. April Toxaemia of Pregnancy ( Operation surgical evacuation of Uterus). Coroner. P.M. Without Inquest 1 ... ... ... 1 ... 1 " 1(a) Toxœmia following small (b) intestinal (gangrenous) obstruction (c) in pregnancy. P.M. ... 1 ... ... 1 ... 1 (b) ,, 1a General Peritonitis, b Puerperal Sepsis (Post Partum). P.M. ... ... 1 ... 1 1 ... June Heart failure due to Myocardial Degeneration and obstetric shock. Coroner. P.M. Without Inquest ... ... 1 ... 1 ... 1 (c) Abortion due to Fibroid Tumour of Uterus, subsequent infective Endocarditis and Pyaemia. Coroner. P.M. Without Inquest ... ... 1 ... 1 1 ... 2nd Qr. 1 1 3 ... 5 2 3 July Rupture of Uterus. Mal presentation of full term infant. Coroner. P.M. Without Inquest ... 1 ... ... 1 ... 1 Aug. 1 (a) Heart failure Pneumonia, (b) Double Mitral disease, (c) Rheumatic Infection. 2. Caesarian Section 1 ... ... ... 1 ... 1 (d) Sept. Ruptured Uterus. Uterine Inertia. Coroner. P.M. Without Inquest ... ... 1 ... 1 ... 1 ' ' Uterine haemorrhage. Forceps Delivery. Child birth. Misadventure. Coroner. Inquest ... 1 ... ... 1 ... 1 3rd Qr. 1 2 1 ... 4 ... 4 Oct. Aspiration Broncho-pneumonia. Normal Labour. Coroner. P.M. Without Inquest ... 1 ... ... 1 ... 1 (e) " Eclampsia. Coroner. P.M. Without Inquest 1 ... ... ... 1 ... 1 Shock and Collapse of Lungs. Gas, Oxygen and Ether Anaesthesia Caesarian Section. Misadventure. P.M. Inquest 1 ... ... ... 1 ... 1 Nov. Septic Infection of Cervix Uteri ducts. Insertion of an instrument in circumstances unknown. Open verdict. P.M. Inquest 1 ... ... ... 1 ... 1 (a) 4th Qr. 3 1 ... ... 4 ... 1 Classifications :—(a) Violence. (b) Intestinal obstruction. (c) Disease of the myocardium. (d) Mitral Valve disease. (e) Pneumonia. 1st Quarter 5 = 4.16 2nd Quarter 5 = 4.03 3rd Quarter 4 = 3.76 4th Quarter 4 = 3.62 Total (Year) 18 = 3.90 , Rate per 1,000 registered Live births and Stillbirths 35 [1938 PUERPERAL FEVER AND PYREXIA. (1) Puerperal Fever.—Of the 19 cases coming to the knowledge of the Medical Officer of Health during 1938, 5 were notified by Private Practitioners. The proportion of total cases to births was 4.12 per thousand. The notifications were 16 below the average (35) of the preceding ten years and showed a decrease of 2.68 in the proportion of attacks to 1,000 births. Of the 19 cases, 18 were treated in hospitals, 11 having the "onset" there, 7 were subsequently removed to hospital, and 1 case was treated at home. Of those treated in hospital 7 cases were dealt with in London County Council Infectious Diseases Hospitals, and 11 in either St. Mary, Islington, Hospital, or other London Hospitals. Deaths.—5 deaths were registered as being due to Puerperal Fever. Table showing cases of Puerperal Fever in 1938. Tufnell. Upper Holloway. Tollington. Lower Hollo- way. Highbury. Barnsbury. SouthEast. The Borough Cases notified 6 2 1 3 3 3 1 19 Private Practitioners' Cases 1 1 – 1 1 1 — 5 Hospital Cases 5 1 1 2 2 2 1 14 Cases inquired into 6 2 1 3 3 3 1 19 Cases treated in Hospital 6 2 — 3 3 3 1 18 Cases treated at Home — — 1 — — — — 1 (2) Puerperal Pyrexia.—There were 69 cases notified, as against 75 last year. Of these, 12 were notified by Private Medical Practitioners, and the other 57 cases by Hospitals. The notifications were in the proportion of 15.0 per 1,000 births. Table showing cases of Puerperal Pyrexia in 1938. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 8 5 11 6 12 11 16 69 Private Practitioners' Cases 1 – 2 2 2 2 3 12 Hospital Cases 7 5 8 5 10 9 13 57 Cases inquired into 8 5 11 6 12 11 16 69 Cases treated in Hospital 8 5 7 6 11 10 15 62 Cases treated at Home — — 3 1 1 1 1 7 OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring in the eyes of infants within three weeks of birth. The following is a summary of cases :— 1938. 1937. No. of Notified Cases of Ophthalmia Neonatorum 39 34 No. of cases of Ophthalmia reported by London County Council and Health Visitors 124 124 1938] 36 Summary of treatment effected for Ophthalmia Neonatorum:— Ophthalmia 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. 39 16 6 10 7 39 Nil. Nil. Nil. The cases occurred in the sub-registration districts as follows Tufnell. Upper Holloway. Tollington Lower Hollo- wav. Highbury. Barnsbury. South East. The Borough. Ophthalmia Neonatorum. 6 4 3 3 4 11 8 39 Ophthalmia. Cases reported by L.C.C. 8 4 13 27 11 40 20 123 Cases reported by Health Visitors — 1 — — — — — 1 Ophthalmia Nursing.—5 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £1 16s. 3d. In 1937, 7 cases were nursed at the cost of £15 13s. 9d. PEMPHIGUS NEONATORUM. During the year 1938 nine cases came to the knowledge of the Medical Officer of Health ; all recovered. The cases were the subject of enquiry and thorough investigation. MIDWIVES ACT, 1936. This Act, administered in London by the London County Council, took effect as from 1st January, 1938. Islington forms part of a district designated by the London County Council for Midwifery purposes as " Area B," which comprises, in addition to the Borough of Islington, the City of London and the Boroughs of Finsbury, Holborn and St. Pancras. There are 4 whole-time midwives for Area B, and the following were appointed as from 1st January, 1938 :— Miss V. A. Cook 21, Elmore Street, N.l. Miss S. E. Kemp 36, St. John's Park, N.19. Miss E. E. Vaughan 11, Barnsbury Square, N.l. Miss R. E. Warren 145, Gray's Inn Road, W.C.I. It will be noted that three of the Midwives are resident in Islington. In addition to the four whole-time midwives mentioned above, the London County Council also has arrangements with the following hospitals and nursing associations employing midwives to undertake similar work in Area B, and expectant mothers may apply to any of these for attention at confinement:—City of London 37 [1938 Hospital, Elizabeth Garrett Anderson Hospital, Maternity Nursing Association (235, Camden Road), Middlesex Hospital, Royal Free Hospital, Royal Northern Hospital, St. Bartholomew's Hospital and University College Hospital. The London County Council's midwives and the midwives of the Maternity Nursing Associations also act as Maternity Nurses where a doctor has been engaged for the confinement. The fee for a first confinement is £2, and for a second or subsequent confinement £1 10s. 0d., but the fees may be remitted by the London County Council where circumstances warrant. The Borough Council co-operated with the London County Council in giving publicity to the new arrangements, and also takes part in the scheme by making appointments for patients to attend ante-natal clinics at the voluntary welfare centres, and exchanges reports with midwives regarding confinements and home conditions. Every endeavour is made to persuade the mother to secure post-natal attention, and it is hoped that this will in due course show itself by an increase in the post-natal attendances at the various clinics. County of London (Midwifery—Prohibition of Unqualified Persons) Order, 1938. Under the above Order notice has been given by the London County Council that, so far as regards the Administrative County of London, any unqualified woman or any male person receiving any remuneration for attending as a nurse on a woman in childbirth or at any time during the ten days immediately after childbirth, becomes liable on summary conviction to a fine not exceeding ten pounds. This Order came into force on 1st November, 1938. The Order, however, excludes from the above prohibition certain persons as under:— (а) Women certified under the Midwives Act, 1902, or registered in the general part of the register of nurses required to be kept under the Nurses Registration Act, 1919. (b) Persons who, while undergoing training with a view to becoming a duly qualified medical practitioner or a certified midwife, attend on a woman as aforesaid as part of a course of practical instruction in midwifery recognised by the General Medical Council or by the Central Midwives Board. (c) Persons attending on a woman as aforesaid in any nursing home which is registered or which is exempt from registration under Part XI of the Public Health (London) Act, 1936, or in any hospital or other premises excluded from the definition of " nursing home " in section 304 of the same Act. (d) Women, who before 1st January, 1937, have been certified by the authorities of a hospital or institution approved by the Minister to have been trained in obstetric nursing and who have notified the local supervising authority in writing accordingly. This Order will, of course, eliminate the " handywoman " as usually understood. 1938] 38 GRANTS TO MIDWIVES. Conditions applicable to these grants were fully set out in the Annual Report of the year 1935, p. 22, but briefly it may be said that a midwife may be granted a compensatory sum where she has referred a case to the Medical Officer of an Islington Welfare Centre and the patient has been sent on by the Medical Officer to hospital for the confinement to take place there. Compensation may also be paid for necessitous cases confined at home by the midwife. Three claims were paid by the Council during the year, all three being on account of the patient having been referred to a hospital. 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 £29 0s. 0d., Royal Free Hospital £8 10s. 0d., and University College Hospital £28. HOME HELPS. The Council's Home Help Scheme has proved increasingly popular as is shown in the increase in the number of applications made and cases granted. During the year 1938 there were 196 Home Help cases, of which 123 were free of cost to the patients and in the remaining 73 cases the patients contributed to the extent of £64 5s. 5d. The cost to the Council in respect of the whole of the cases as enumerated was £465 5s. 2d. MIRIAM PRICE COLEMAN DAY NURSERY AND CLINICS CENTRE, Scholefield Road, N.l9. Owing to the number of clinics which are held in this building the Council decided that the above would be the more appropriate name in place of that originally given, namely, Miriam Price Coleman Day Nursery and Sunlight Clinic. The Clinics held are Ultra-Violet Light Therapy, Diphtheria Immunisation, Maternity Consultative, and from 1939, Evening Ante-natal and Post-natal sessions. DAY NURSERIES. Municipal Day Nursery :—Miriam Price Coleman Day Nursery. This Nursery, the first Municipal Nursery in the Borough, was opened towards the end of 1937, and therefore completed its very successful first year during 1938. The Nursery buildings were described in the Annual Report for 1937, and it has been gratifying to notice the interest taken in new Day Nursery buildings judging by visits paid to the Day Nursery, on request, by interested individual workers, including Architects, Public Health and Maternity and Child Welfare Committees and representatives of various local authorities. The Day Nursery charges have remained unaltered since the opening, and are as follow:— Per day. Weekly, (in advance). One child 0 9 3 6 Two children from one family 1 3 5 9 Three children from one family 1 9 8 0 39 [1938 The Day Nursery, like all new institutions, has had its minor teething troubles, and certain changes were made in the light of experience gained. The part-time Kindergarten Teacher, Miss Holland, left in February to take up a whole-time post, and the Committee eventually decided to appoint a whole-time Resident Staff Nurse, as it was felt that the advantages of a senior member of the staff who could take charge of any section of the children outweighed the advantages of a kindergarten teacher not dealing with children under two years of age. It was also found desirable to appoint a whole-time non-resident caretaker who would be in charge of the boiler-house and perform heavy domestic and handyman's duties. Three Nursery Probationers took their Elementary examination and all were successful. A Senior Probationer left on the 31st March, and was replaced by a Junior Probationer. Summary of Nursery Routine. The children are admitted from 8 a.m. to 9 a.m., and after careful inspection to eliminate the possibility of infectious illness are passed through the bathroom and then changed into nursery clothing. They are served with a light meal at 9 a.m., and there is free and organised play until 11.30 a.m. Play is in the open-air whenever weather permits and during the winter 50 per cent. to 60 per cent. of the children were found to require a course of artificial sunlight treatment. From 11.30 a.m. to 12 noon dinner is served, and the children are rested after this until 2.15 p.m., all the toddlers taking their rest or sleep on stretchers (again in the open-air on all possible occasions). Play follows until tea at 4 p.m., and mothers take their children away at any time between 4.30 p.m. and 6.30 p.m. The following is the average daily menu for a toddler :— 9 a.m. Milk and fruit. 12 noon. Meat (liver, or beef, or lamb) or Fish or Grated cheese and lightly boiled eggs with Creamed potatoes, and Green (and other) vegetables in season. Baked or steamed pudding with dried or fresh fruit, according to season. Egg custard, or junket, or milk and fruit jellies. 3.30 p.m. Milk, and Savoury sandwich to (i.e., egg, cheese, salad, marmite, etc.) 4 p.m. and Sweet to follow—Honey, jam or treacle or Fruit bread or Sponge cake. 1938] 40 Medical Supervision of Children. All children in the Day Nursery are medically examined on the day of their admission or very soon after, and subsequently are examined or inspected at least once a week by one of the Council's Medical Officers. The children are also weighed and measured regularly. In general, it may be said, that the condition of the majority of the children on admission is fairly good, but a certain number of delicate children, not in need of hospital attention, have also been permitted to attend. Any child showing signs of possible infectious disease is, of course, not admitted, and if suspicious symptoms should occur after entry, the child is immediately isolated and the mother communicated with. Though the main function of the Nursery is the care of children whose mothers have to go to work, it has been found that all children attending have benefited very considerably by their stay in the Nursery, as shown by their improved appearance, increase in weight, and rise in the Haemoglobin (colouring matter) of the blood, which has been estimated for several of the children by Dr. Hirst. Children who are fortunate enough to enter the Day Nursery are not only well cared for in a purely physical sense, but are also trained at an early age to cooperate with other children and are educated to good habits where this is sometimes rendered difficult by home circumstances. Arrangements have also been arrived at with the North Islington Welfare Centre whereby children found to be in need of urgent dental attention can be seen at that Centre's Dental Clinic. Day Nursery Statistics. No. of places 45. No. of attendances- Whole day 7,260 Half day 892 Total—8,152. No. of individual children who attended— Under 2 years 71 Over 2 years 66 Total—137. The occurrence of Measles and Whooping Cough restricted new admissions to the Nursery for short periods during the year. Voluntary Day Nurseries. There are three Islington Voluntary Day Nurseries, all of which are in receipt of a grant from the Council. The Lower Holloway Day Nursery, 547, Liverpool Road, N.7. (Matron— Mrs. Johnston), the South Islington (Pro Patria) Day Nursery, 9, Canonbury Place, N.l. (Matron—Miss Campbell) continue to report more applications for Day Nursery places than can be accepted, which would appear to indicate either the increasing appreciation of the functions of a Day Nursery or an increase in the number of women who go out to work and have to arrange for the care of their children whilst they are away. 41 [1938 At the latter nursery during the year there were a few cases of Enteritis which caused some anxiety for a short time, but, fortunately, no further cases occurred. The St. Luke's Day Nursery and "Guest House," 29, 30 and 31, Penn Road, N.7 (Matron —Miss Heath), on the other hand does not find the same demand for Day Nursery places, but the demand there appears to be greater for the " Guest House," which is understandable since there are no other "Guest House" facilities in the Borough. Attendances and Grants. No. of places provided. No. of attendances during 1938. Council grant (year ending 31st March, 1939). £ i. Lower Holloway Day Nursery 50 12,435 260† ii. South Islington (Pro Patria) Day Nursery 50 11,597 600 iii. St. Luke's Day Nursery 30 4,090* 250 Total 130 28,122 £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. ARTIFICIAL SUNLIGHT CLINIC. Miriam Price Coleman Clinics Centre. This Clinic commenced to function in 1938, and during the first half of the year Artificial Sunlight treatment was given under the direction of Dr. W. Beaumont, Hon. Physician and Medical Director of the Institute of Ray Therapy, 152, Camden Road, N. To Dr. Beaumont, upon whom the responsibility fell for initiating the routine of the procedure for treatment to be followed in this new clinic activity undertaken by the Council, every credit is due for his enthusiasm and helpful advice. The Clinic was closed during the summer period, and re-commenced at the beginning of October under the charge of Dr. Hirst. Dr. Beaumont, in reporting upon the results of treatment given under his direction, stated " that the children put on weight, were more energetic and active, and all reported an improvement in appetite. . . . Without exception sleeping after the mid-day meal and at night was considerably improved." It was decided during the year that it would be justifiable to make a small charge for treatment where the family income for children not attending the Day Nursery and for mothers recommended for treatment was above a certain limit. The following scale and charges were adopted Family with no children and income under £3 ,, ,, 1 child ,, ,, ,, ,, „ 2 children ,, ,, ,, and pro rata £3 5s. Od. Free. £3 10s. Od When the income exceeds the above limits, a charge of 2d. per person is made for each treatment given. 1938] 42 Report of attendances, etc. Children under 5 years 1,988 Adults 13 No. of individual children treated 131 „ „ adults „ 1 MILK GRANTS FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. The revised Income Scale and the removal of certain minor restrictions, of which details were given in the Annual Report for 1937 and which arose out of the Council's consideration of Circular 1519 of the Ministry of Health, has enabled a much larger number of mothers and children to take advantage of the provision of milk supplied free or at part cost. Provision of Fresh and Dried Milk. 1938. 1937. No. of Recipients 20,700 11,169 Quantity of milk supplied 503,792 pints (62,974 gallons) 256,861 pints (32,1051/8 gallons) Expenditure £7,077 9s. 5d. £3,347 4s. 9d. 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, 81 Islington children under five years were given periods of convalescence either in the country or by the sea, and 33 crippled children of like ages were provided with surgical appliances, splints, special boots, etc. NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN. As in past years, the Inspectors of this Society have investigated and kept under supervision cases which were brought to their notice by the Public Health Department and their efforts in this respect are warmly acknowledged. Out of the total number of 37 such cases, 24 were those where the supervision was continued from the previous year, and the assistance of these Inspectors was sought by the Child Protection Visitor in 2 of her cases. BLIND PERSONS ACT, 1920. The Borough Council is responsible by arrangements made with the London County Council for visiting in the homes of blind children under the age of 5 years. Where the home conditions are unsuitable for a blind child, the London County Council may make arrangements for its reception into an approved institution with the proviso that the child should not, save in very exceptional circumstances, be removed from its own home. MILK GRANTS (preexisted) 1938. CHARTS SHOWING QUANTITIES. RECIPIENTS & EXPENDITURE 43 [1938 The following table gives the number of "Totally Blind" and "Partially Blind" children under the age of 5 years coming under the supervision of the Council's Health Visitors and those of the Voluntary Welfare Centres in the Borough:— Totally Blind. Partially Blind. No. of cases at the end of year 1937 2 14 No. of cases coming to the knowledge of M.O.H. during the year 1938 0 5 No. of cases which left during the year 1938 †l *12 No. of cases under supervision at the end of the year 1938 1 7 * 6 reached 5 years of age ; 3 removed to unknown addresses ; 2 admitted to homes ; 1 died. † Reached 5 years of age. PREVENTION OF DEAFNESS. The Council's Health Visitors and also those of the voluntary Welfare Centres continued to pay special attention to children under 5 years suffering from disease of the ear, and where particulars of ear trouble are given on a London County Council hospital discharge card a very careful follow-up is always made. The undermentioned cases have come to the knowledge of the Medical Officer of Health during the year:— Number of cases of Discharging Ear after Scarlet Fever 11 ,, „ „ Diphtheria 15 „ ,, „ Scarlet Fever and Diphtheria 2 Other cases visited by Health Visitors and Centres 219 Total 247 The number of deaths out of the above cases in which ear affection was mentioned as a contributory cause was 13. 1938] 44 SECTION C SANITARY CIRCUMSTANCES OF THE BOROUGH 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. Mr. Browning, the Cleansing Superintendent, has kindly supplied the following statement regarding the work of his department during the year :— Street Sweeping.—the last of the horses have now been dispensed with and all street sweepings are now collected from the containers by means of hygienic mechanically-propelled vehicles. Street Watering.—The old-fashioned horse-drawn water carts, which merely sprinkled the surface, are no longer used, and the latest gully emptying machine, which is also equipped for high-pressure street washing is used for this purpose. The much greater volume and pressure of water tends to clean the surface of the road and wash the contents of the channels into the gullies. Refuse Collection, Block Dwellings.—In order to cope with the increase in the number of block dwellings the motive units drawing the special trailers have had higher powered engines fitted. A new trailer has been purchased and the flats belonging to the L.C.C. in the Borough of Stoke Newington are now serviced by this Department. Fish Offal —By arrangement with the contractors who previously purchased the fish offal, the collection is now made directly by them, thereby obviating the transfer of this material at Ashburton Grove, the offal being taken in special containers directly to the factory. General.—There has been an increase in the percentage of house and trade refuse collected by mechanical vehicles as compared with horse-drawn vehicle collection, the figures now being 85.1 per cent. mechanical collection and 14.9 per cent. horse-drawn collection. Refuse Disposal.—Large all-steel wagons are now used in place of wooden trucks for the conveyance of the Council's refuse by rail to the disposal points. These wagons are not used for any other purpose. All refuse is sent by rail to contractors' dumps and dealt with in accordance with the recommendations of the Ministry of Health. The dumps are frequently inspected by the Cleansing Committee and the Superintendent of the Cleansing Department and by the local sanitary authorities. 45 [1938 During the year under review the Borough Council's new scheme for intimations of insufficient or defective dustbins has been in operation. The Cleansing Superintendent on information received from his divisional inspectors intimates to the owner of the property the insufficiency or defect; subsequently lists of the premises to which these intimations relate are sent to the Public Health Department. Fifteen applications were received during the year by the Public Health Department for the removal of refuse. The applications received for the previous ten years were as follows:— 1928 25 1933 21 1929 21 1934 23 1930 40 1935 23 1931 36 1936 23 1932 44 1937 25 The Cleansing Superintendent reports that during 1938, 2,013 dustbins were provided by owners of property. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1937. Section 66. Noise Nuisances which are Injurious to Health.—A noise nuisance as defined under this Act may be dealt with summarily under the Public Health (London) Act, 1936. The noise must be excessive or unreasonable or unnecessary, be injurious or dangerous to health, and it shall be a good defence for the person charged in relation to any trade business or occupation that he has used the best practical means of preventing or mitigating the nuisance having regard to the cost and other relevant circumstances. Complaint to be of any effect must be made by not less than three persons being either householders or occupiers of premises within hearing of the noise nuisance which is the subject of the complaint. During the year 20 complaints were investigated, and numerous inspections were made in respect of the use of a site in Seven Sisters Road as a fair ground, and inspections were still continuing at the end of the year. Special investigations were made with regard to a number of complaints received of alleged excessive noise in factories. DISTRICT INSPECTORS' WORK. During the year the fourteen District Inspectors made a total of 41,279 inspections and calls, a decrease of 3,203 inspections on the corresponding period of 1937 ; while 15,546 improvements were effected in 3,929 premises; as against 13,706 improvements in 5,215 premises for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the inspectors' visits in 1938:— House to house inspections 2,724 Other inspections of dwelling-houses 4,500 Re-inspections and calls made 33,198 Visits of inquiry re notifiable infectious diseases 1,486 Butchers' shops, stalls, etc. (Saturday nights) 95 Stables and yards 18 Urinals attached to Public Houses 4 Smoke observations 29 Notices Served.—There were 4,008 intimation notices served by the inspectors with respect to nuisances. In 898 instances it became necessary to serve statutory notices, as directed by the Public Health Committee, on owners or occupiers of properties to abate nuisances. 1938] 46 Summary of Sanitary Work from District Inspectors' Reports for the year 1938. Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Totals House to House Inspections 181 245 222 199 176 172 135 195 238 151 240 224 165 181 2724 Other premises inspected 215 252 133 260 223 413 297 539 220 354 371 432 414 377 4500 Re-inspections. Calls made, &c. 2626 1845 2272 1989 2517 2595 2249 2491 2514 2270 2591 2761 2141 2337 33198 Inspections—Council's property — 15 77 — 7 — — 7 — — — — 2 10 118 Stables inspected — — 1 — 2 1 1 — — — 1 — — — 6 Yards, inspected .— — 9 — — — — — — 2 — — 1 — 12 Agricultural Produce (Grading and Marking) Act, 1928 — — — — 1 — — — — — — — — — 1 Merchandise Marks Act, 1926 — — — 1 1 — — — — — — — — — 2 Urinals (Public Houses) inspected — — — 1 — — — — — 2 — — 1 — 4 Child Life Protection 3 3 4 3 3 2 3 6 3 4 1 1 2 3 41 Premises re Vermin 5 8 — 3 5 4 10 15 13 5 2 7 7 13 97 Premises re Rats and Mice 11 28 26 13 47 27 6 18 34 15 49 51 10 42 377 Preserved Food Premises — — — — — — — — — — — — — — — Premises re Water Certificates — 2 14 1 33 — 1 16 — — — 1 — 1 69 Rag and Bone Dealers — — 1 — — 1 — — — — 3 — — 1 6 Rag Flock — — — — — — — — — — — — — — — Smoke observations 5 1 1 3 1 3 4 1 — 2 — 4 — 4 29 Shops, Stalls and Markets (Saturday evening) 8 7 8 4 7 6 5 6 6 8 7 7 7 9 95 Total Inspections and Calls 3054 2406 2768 2477 3023 3224 2711 3294 3028 2813 3265 3488 2750 2978 41279 Notices Served—Intimation :— Public Health (London) Act, 1936 294 218 149 259 237 396 170 295 362 298 334 489 263 244 4008 Housing Acts 55 24 84 11 50 40 53 98 23 18 28 9 25 29 547 Notices Served—Statutory:— Public Health (London) Act, 1936 71 49 11 58 33 202 35 37 116 51 42 95 56 42 898 Housing Acts — — — 1 3 7 5 8 9 — — — — — 33 L.C.C. (General Powers) Acts — — — — — — — — — — — — — — — Improvements. Drains :— Constructed — — 2 1 — — — 2 — — — — — — 5 Re-constructed — 2 4 1 5 3 4 8 1 9 14 1 12 3 67 Repaired 3 20 4 5 17 7 7 10 5 21 31 8 8 1 147 Ventilated 2 4 1 — 4 5 8 4 — 11 14 3 1 2 59 Gully and other traps fixed — 1 1 3 10 — 5 5 — 26 34 2 4 1 92 Urinals—Water supply (cleansed) — — — — 2 — — — — 1 1 — 1 — 5 Water Closets :— W.C. erected with pan, trap and water supply — — 1 2 7 2 9 6 — 1 9 — 2 1 40 Pan and trap only provided 17 24 35 37 35 6 31 28 15 47 145 26 33 13 492 Flushing apparatus repaired 39 9 8 25 15 18 4 16 14 13 25 16 10 7 219 Ventilated 3 3 — 2 5 80 1 1 1 — 6 3 1 — 106 Walls, &c., cleansed 20 6 5 36 17 57 8 17 13 39 94 51 22 10 395 Position altered — — — — 1 — — — — — — — — — 1 Dust Bins provided 3 — 1 6 15 — 13 7 8 9 2 — 9 6 79 Areas paved 12 11 5 3 12 9 10 16 6 16 6 14 22 7 149 Yards paved or re-paved 29 20 4 36 18 54 39 17 11 25 16 25 8 1 303 Sinks :— Provided 55 21 22 50 31 25 44 58 25 70 160 60 23 20 664 Waste pipe repaired 42 44 12 27 20 57 23 26 24 24 42 48 25 2 416 Domestic Water supply :— Cisterns repaired and cleansed 1 1 1 1 1 3 7 2 3 3 2 2 2 1 30 Water supply provided to dwelling-house — — — — — 1 — — — — — — — — 1 Water supply provided to tenement house 6 13 7 15 15 31 12 9 9 31 85 21 6 6 266 Walls and Ceilings of Rooms cleansed and re-decorated 200 89 80 289 210 501 126 142 198 203 403 367 95 77 2980 Other improvements :— Staircase and passages repaired, cleansed and re-decorated 44 28 14 55 18 106 21 36 36 47 80 90 33 15 623 Floor space ventilated 9 2 5 2 9 — 13 32 4 15 5 23 35 16 170 Floors repaired 66 38 17 36 47 64 29 57 26 57 62 84 62 46 691 Guttering and rain water pipes repaired 31 12 12 20 37 41 32 42 8 24 36 25 2 7 329 Roofs repaired 76 57 25 73 51 90 27 69 37 67 82 136 24 29 843 Overcrowding abated 3 2 1 2 8 6 — — 3 4 1 4 — 1 35 Illegal use of underground Rooms for sleeping discontinued 3 — — — — 1 — — 5 — — 1 — 7 17 Other Improvements, or Nuisances abated 491 425 136 384 255 729 336 514 259 320 553 672 222 266 5562 Food Cupboards provided 119 77 12 139 31 187 13 7 77 3 20 49 — 26 760 Total Improvements 1274 909 415 1250 896 2083 822 1131 788 1086 1928 1731 662 571 15546 Total Premises Improved 274 257 152 234 198 379 232 296 225 318 568 424 197 175 3929 47 [1938 RAG FLOCK. Three samples were taken under the Public Health (London) Act, 1936, and the Rag Flock Regulations, 1912. Two of the samples were found to be satisfactory, but one did not comply with the Regulations, as the amount of soluble chlorine in the form of chlorides was found to be 61.1 parts per 100,000, whereas the amount of soluble chlorine permitted under the Regulations should not exceed 30 parts per 100,000. After consultation with the Council's Solicitor it was decided that a strong letter of warning would be sufficient to meet the case, and this was done. RAG AND BONE DEALERS. During the year 40 visits were paid to 21 premises upon which is carried on the business of a rag and bone dealer. All the premises were reported to be satisfactory. WATER SUPPLY. Water Certificates.—Eighteen water certificates were granted in accordance with the provisions of section 95 (2) of the Public Health (London) Act, 1936, in respect of 321 separate tenements and 6 shops newly erected or rebuilt during the year. Number of houses which have not an adequate internal water supply, i.e., water supply from taps only, in yard, 30. Premises on which notices have been served under the Public Health (London) Act, 1936 (Additional Water Supply), 266. RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920 to 1938. 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 1938 15 3 8 1 27 Totals 1,307 157 273 51 1,788 1938] 48 HOUSES LET IN LODGINGS. The houses which come under the operation of the by-laws received 624 inspections during the year, followed by 4,299 subsequent reinspections and calls, so that the total visits amounted to 4,923. The decreased number of visits is due to the transfer of the Inspectors to fill vacancies on the districts, and to the interval between the transfer and the appointment of the new Inspectors. These inspections resulted in 396 intimations being served on the persons responsible, which were followed by 56 statutory notices to demand the abatement of the nuisances discovered by the Inspectors specially engaged upon this work. Altogether 1,380 improvements were effected in 321 premises. Synopsis of Inspectors' Work :— Improvements. Drains : Constructed — Reconstructed — Repaired 17 Ventilated 2 Gully and other traps fixed 6 Water Closets : W.C. erected with pan, trap and water supply 10 Pan and trap only provided 30 Flushing apparatus repaired 14 Ventilated 10 Walls, etc., cleansed 46 Position altered 1 Dust Bins : Provided 6 Areas: Paved 1 Yards: Repaved 23 Sinks : Provided 37 Waste pipe repaired 21 Domestic Water Supply : Cisterns repaired and cleansed 1 Water supply provided to tenement house 2 Other Improvements: Walls and Ceilings of Rooms cleansed and redecorated 372 Staircases and passages repaired, cleansed and redecorated 105 Floor space ventilated 1 Floors repaired 38 Guttering and rain water pipes repaired 32 Roofs repaired 81 Overcrowding abated 5 Illegal use of underground Rooms for sleeping discontinued 33 Other Improvements, or Nuisances abated 366 Food Cupboards Provided 120 Total Improvements 1,380 Total Premises Improved 321 49 1938 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 15 licences, representing 21 premises. 236 visits of inspection were made by male Inspectors and 73 by women Inspectors, making a total of 309 inspections. Appended is a list of the accommodation, charges, etc.:— Beds. Charge per Night. For Women: 13-14, Duncan Terrace 63 Is. 2d. Provision for cooking meals. 47, 49 and 51, Wharfdale Road 65 Is. Od. Tea and biscuits only provided. For Men: 16, 18, 20 and 22, Barnsbury Street 100 lOd. & Is. Od. Provision for cooking meals. 87 and 89, Essex Road 87 9d., 10d., lid. and Is. 6d. Do. 155, Englefield Road 62 9d. Do. 8, Flowers Mews 30 lOd. 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. During the year 20 cases were investigated by the Medical Officer of Health under this section, 6 males and 14 females. Of these persons, one was admitted to St. Mary, Islington, Hospital on a Justice's order, 4 entered institutions without Court proceedings, 13 cases after investigation were reported on as not coming within the scope of section 224 of the Act, and in 2 cases it was considered advisable for the Medical Officer of Health to have authority to take action under the Act should such become necessary. RATS AND MICE (DESTRUCTION) ACT, 1919. During Rat Week 500 double crown posters issued by the Ministry of Agriculture and Fisheries were exhibited throughout the Borough, and the following Ministry of Agriculture and Fisheries' publications were distributed from the Public Health Department:— Advisory Leaflet No. 49 How to kill rats—some simple suggestions. Bulletin No. 30 Rats and how to exterminate them. In addition advisory leaflets of the Borough Council were distributed to the residents of the Borough, and rat poison, free of charge, to applicants. It is interesting to note that many enquiries were made at the Public Health Department during Rat Week, and although a supply of poison is gladly accepted, few people appear to respond to our invitation to let us know the result of laying of baits. In a few cases, however, this was done, the report generally being that at the first attempt some of the rats disappeared, but returned ; a second supply of bait is given and generally nothing more is heard of the nuisance. 1938 50 Apparently as a result of our propaganda a resident of the Borough called with two mice he had caught in his premises. One mouse was still alive and the other was dead, and both showed disease of the skin, the dead one very markedly so, particularly about the head. The mice had been caught by a stray cat the previous evening. There was a history in the family extending back about two years previously of a child with a skin affection, loosely stated to be ringworm, and later another child, and at the time of the visit a child was suffering from an affection of the skin of the leg. It being naturally suspected that the affection in the dead mouse was likely to be favus, the mice were sent for bacteriological examination, and the report came back that the infection was favus parasite Achorion Schonleinii ; but the dermatologist who treated the last affected child reported that the particular form of favus . was Achorion Quinckeanum, which particularly affects mice and cats. The particular form of disease thus spread from the mice to the human being is said to be somewhat prevalent in Poland, and there is said to have been a few cases in Scotland. The dermatologist wrote, as my letter, warning the parent of the mice being infected, was produced to him, that he considered the case of the particular infection to be quite unique in his long experience. The mice referred to were brought just after Rat Week, and the investigations continued into the early part of the following year. As regards the work on rats throughout the year, this followed our usual procedure of investigation of complaints received and advice given. Particular attention is drawn in cases where rats and even mice are found due to the neglect of householders who fail to clear away thoroughly food fragments, or who keep their waste consisting of foodstuffs, uncovered, thus attracting rats or mice. The staff made a thorough investigation of a case somewhat of this nature which received some publicity in the public press. Two children received treatment at the out-patients' department of a hospital, having been bitten, although not seriously so, by a rat or rats. From our investigation it is believed that these young children were each given, after being put to bed, a very thick slice of buttered bread. They smeared this well over their faces, only partially eating it, and went to sleep. The family were in the other room, and at first failed to hear the cries from the next room. It would seem that a stray rat had entered and, whilst eating the bread and butter, was apparently disturbed by the involuntary movements of the children, and b't one child on the nose and the other child on the thumb. The complaint regarding rats was 'phoned to the Public Health Department on the following morning. The floors were taken up and a rat's nest was found in the back basement of the building. The drain test gave negative results in this and the surrounding houses, so it is inferred that the nest was that of a stray rat probably from the adjacent canal. Appended is a statistical summary of the rat work done during the year: During the year 1938 the number of complaints received was 251 Number of private houses visited under the Rats and Mice (Destruction) Act 393 Number of shops and factories visited 73 Total premises inspected 466 Street work visits numbered 217 Number of premises proved to be rat infested 156 Number of premises in which infestation was due to mice 18 Number of notices served 113 Drain defects remedied as a result of complaint of rat trouble 23 51 1938 THE SHOPS ACT, 1934. During the year 345 premises were added to the register, while 291 were removed, a net increase of 54. No difficulty was experienced during 1938, although the cold weather in December was a severe test of existing heating systems which in some cases had to be supplemented by other means. Arising from this, the Inspector, Mr. G. S. Green, found on visiting one shop that the staff were complaining of sickness and dizziness which had continued for two or three days. Upon investigation he found that owing to the cold weather a coke brazier had been used in the shop, and the staff had stood over this during intervals of serving. Upon the Inspector's instructions the brazier was removed and an oil stove substituted. There were no further complaints of sickness. Considering that this shop was very well ventilated (half open front) the danger from carbon monoxide poisoning is a point which needs watching on future occasions. A number of shops are now fitted with a roller shutter, and when the shutter is raised free access to the shop is obtained. In the cold weather it is difficult to keep the shop at a reasonable temperature as is possible with the ordinary shop door. Unfortunately the shopkeeper prefers an open door because in his opinion the public regards a closed door as a closed shop. This can be obviated by the exhibition of a card on the door indicating that the shop is "Open." The following table shows the number of shops on the register at the end of 1938, visits paid, etc.:— Number of shops on Register, 31st December, 1937 3,134 Number of shops removed from Register during 1938 291 2,843 Number of shops added to Register during 1938 345 Total number of shops on Register, 31st December, 1938 3,188 Total number of visits to shops 3,727 Number of intimation notices served 38 Statutory notices served 3 Number of cases in which work was carried out voluntarily 238 Exemption certificates issued in 1938 3 SMOKE ABATEMENT. Twenty-nine observations were made by the District Inspectors, and 6 notices requiring the abatement of the nuisances were served upon the owners concerned. In no instance were legal proceedings instituted. During the year two conferences were held with the object of establishing a Greater London Advisory Council for Smoke Abatement, the initiative coming from the established body, the National Smoke Abatement Society. It was felt that progress could be made by propaganda, and keener interest aroused if a metropolitan body could be created. The conference in February was presided over by Lord Snell. the Chairman of the London County Council. Attention was drawn to the fact that in recent years London has suffered from excessive pollution. So far as industrial smoke was concerned there was no technical difficulty in prevention, or at least 1938 52 reducing the quantity, so that no nuisance would be produced. The worst nuisance was from the domestic fire, and the proportion of domestic to industrial smoke in London was in the order of 2.51 to 1. There was no change for betterment, and it was stated that at the Finsbury Park Observation Station the pollution remained constant. For the whole eight metropolitan stations the figures were in 1936-37: total solids 238, sulphates 34, tar 4, the figures being tons per square mile. It is not always realised that there is air " sewage " in London which remains constant, although capable of improvement, and the need for convalescent holidays, etc., required by citizens, is perhaps to a considerable extent due to the air they breathe. A subsequent conference was held at the Ministry of Health in June, when Councillor Mrs. Thurtle also attended at the request of the Public Health Committee, As a result of this conference it was hoped that the new Advisory Body would be formed during the coming year. SWIMMING BATHS AND POOLS. There are three establishments, baths and washhouses, in the Borough belonging to the Council, an open.air swimming pool under the control of the London County Council, a swimming pool at Highbury County School, and a private open.air pool at a boarding house in Highbury. Six samples of water from the Council's swimming baths in the Borough were bacteriologically examined during the year. With the exception of one, all were reported to be satisfactory. In the case of the one considered unsatisfactory, the bacteriologist reported that the absence of coliform bacillus was a satisfactory feature, but the examination seemed to show that the filters were not removing their quota of bacteria. Another sample of water was taken from the same bath under similar conditions as to time, etc., which on examination proved satisfactory. In addition to the above, a sample of water was taken from the open.air swimming pool at Highbury Fields and on examination was reported to be satisfactory. Two samples were taken from the swimming pool at Highbury County School. The first sample showed that the number of organisms of the coliform contents were rather high for modern standards of swimming bath water. This matter was taken up with the Principal of the School and a suggestion for a remedy was made which was adopted, and a further sample was taken and found to be satisfactory. DISINFESTATION. Eradication of Bed Bugs.—The problem of the eradication of bugs has been receiving the serious attention of the Public Health Committee. Towards the end of 1937 a proposal for the provision of a " HCN " disinfestation station was submitted to the Minister of Health, and in January, 1938, the Council received his formal consent to its establishment. This station, which commenced to function during the month of August, 1938, is situated in the South.west corner of Ashburton Grove Depot, and comprises one large and one small chamber, an office, and an iron container for the storage of hydrogen cyanide, the whole enclosed by iron railings covering an area of 330 sq. yards. The procedure adopted is as follows : when a family is being moved, a disinfector attends at the station at 8 a.m. and makes preparations, 53 1938 details of which are set out in the " Instructions to the Officer in Charge " given later in these notes. The Sanitary Inspector visits the house from which the family is moving, sees all bedding placed in the Council's van and satisfies himself that nothing which is required for sleeping purposes that night is placed in the contractor's van. The bedding is taken to the Council's disinfecting station, disinfected by steam, and delivered at the new home. The furniture and effects are loaded into the contractor's van, which is driven to the disinfestation station and placed in the chamber. The Sanitary Inspector directs operations until the gas has been released and a time fixed for the duration of the disinfestation. When the period of disinfestation has elapsed, the disinfector releases the gas from the chamber by operating the exhaust fans and opening up the outlet and inlet shafts. The Sanitary Inspector tests the gas concentration and decides when it is safe for the van to be removed from inside the chamber to the outer airing compartment, and later for the contents to be delivered at the new address. While the disinfested goods are being delivered, the Sanitary Inspector visits and arranges for all soft goods, clothing, etc., to be placed in a spare room, which is locked and sealed with a " Danger " notice until the following morning, when the Inspector again visits, tests the contents of the room and issues a certificate to the Caretaker that the articles may be released for use. Since work commenced at this station the following disinfestations have been carried out:— Furniture of families removed to Council owned flats 85 van-loads ,, ,, privately owned flats 21 ,, 106 Two small privately owned articles of furniture were also disinfested. In addition to the above, 24 van-loads of furniture belonging to families removed from demolition areas, and 13 van-loads of furniture belonging to persons removed to flats in Islington owned by the Islington and Finsbury Housing Association, were disinfested by contractors prior to the commencement of operations at the Council's Disinfestation Station. The following summary shows the total number of bundles of bedding disinfested at the Council's Disinfecting Station during the year:— Removal to Council's flats 434 „ Islington & Finsbury Housing Association flats 112 546 After disinfestation of Council's flats 28 ,, ,, Rooms, L.C.C. 6 „ Private Houses 43 Total 623 Instructions to the Officer in Charge at the Disinfestation Chamber. Preliminary. Open steam valves, close slides to apertures inside chamber, and get temperature inside chamber up to 65 F. at least. Shut and screw down air inlet covers, also test holes. Shut and screw down cover of exhaust shaft. 1938 54 Lubricate, if necessary, the cutting apparatus and see that the blades are operating properly. Place tin of fumigant in position so that the cutting blades just touch the head of tin. Take care that tin is not punctured by the blades. Closing Chamber. Direct driver to back furniture van carefully into the chamber, and guide 6" hose from exhaust fan into the van as far as possible. Secure wheels of van and remove driver's cushions, if any, open slides inside chamber. Shut door of chamber and screw down clamps. Take up position at observation window and direct disinfector to operate cutting apparatus, so as to remove lid of tin and, by reverse action, discharge contents on to the tray. Note time and mark up three hours ahead for opening up. Opening Chamber. After three hours, provided a temperature of 65 F. has been maintained, open up exhaust shaft cover and operate fans inside the chamber. Open up inlet covers. After twenty minutes, unscrew cover of test hole and apply test paper on end of 6-ft. rod to the interior of the chamber, on each side. When slight reaction occurs, but not before, open up door of chamber and test inside the chamber before entry. Test driver's cab before removal of van, and if free of gas, direct driver to start up engine. After five minutes, direct driver to transfer van from the chamber to the airing shed. Remove residue of fumigant and destroy by burning. Test contents of van before dispatch to new premises. To Disinfectors. Gas masks to be worn when opening chamber doors, unless otherwise directed. Entrance to chamber under gas strictly prohibited, unless instructed by Sanitary Inspector on duty. G. Clark Trotter, Medical Officer of Health. Instructions to be observed on Removal of Furniture to or from Disinfestation Chamber. Beds and bedclothing are not to be placed in contractor's van, but are to be removed by Council's employees and disinfested by steam at the Disinfecting Station. On arrival, after disinfestation, at the new premises, all articles in contractor's van of a soft nature, such as blankets, sheets, clothes, cushions, to be placed loosely in one room with window open. Door of this room to be locked by Sanitary Inspector, and a notice " Danger—Do Not Enter " is to be pasted on door. Articles from this room are not to be used until authorised by Sanitary Inspector. G. Clark Trotter, Medical Officer of Health. 55 1938 The infestation of houses has also received increased attention, as a result of which 236 intimation notices and 97 statutory notices were served on owners (and on occupiers when the conditions appeared to be due to their neglect) to rid the stated portions of the premises of vermin. Where it is found to be necessary, the Council insists on the walls being stripped of paper, the removal of architrave mouldings, picture rails and skirtings, and the surface treated with a blow-lamp, or the fumigation of the rooms with sulphur and spraying of the walls with an insecticide ; the fumigation and spraying is repeated if required after fourteen days ; the furniture is sprayed with an insecticide. During the year 24 Council houses and 153 other houses, comprising 46 and 535 rooms respectively, were found to be bug infested, and were disinfested by the Public Health Department. 33 of the Council rooms, and 46 of the privately owned rooms were treated a second time. The arrangement made by the Council for the issue of an insecticide was continued, 76 (16-oz.) tins being supplied. Disinfestation of rooms on payment of the sum of five shillings per room in some cases is also undertaken by the Council, which during the year numbered 74. (This number is included in the 153 houses abovementioned). Disinfestation of School Children (Cleansing from Lice and other Vermin).—During the year 6,769 baths (including 1,894 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 £582 4s. Od. There was an increase in the number of children treated for head lice, and 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. 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 in the Borough is now 10. FACTORIES ADMINISTRATION. The Medical Officer of Health is required to submit a report on the manner in which the provisions of the Factories Ac£, 1937 (which came into operation on the 1st July, 1938) were administered during the year. The new Factories Act of 1937 is a consolidating Act superseding the Factory and Workshop Act, 1901, and other enactments including some provisions of the Public Health Acts. The old distinction between a factory and a workshop is abolished, only one term—" factory "—being employed. 1938 56 In Part I of the Act the most important changes are: (1) that the Provision of Section 7 (as to sanitary conveniences) and any regulations made by the Secretary of State under that Section are to be enforced by the Local Authorities and in all factories (whether mechanical power is used or not); and (2) that the provisions as to temperature (Section 3) are to be enforced by the local authorities in factories in which mechanical power is not used, together with the provisions as to cleanliness, overcrowding, ventilation and drainage of floors. It will thus be seen that the question whether the Local Authority will enforce the provisions of Sections 1, 2, 3, 4 and 6 will in future depend not on whether the premises are a " workshop " as distinct from a " factory," but on whether they are " a factory in which mechanical power is not used." Other provisions of the Act place duties on the Local Authority (a) to secure that the drinking water supplied to a factory shall be supplied from a public main or from a source approved in writing by the Council, approval to be withheld only on the ground of unwholesomeness of the water. (b) to re-examine basement bakehouses in respect of which certificates of suitability have been issued, in the year beginning 1st July, 1938, and in every fifth succeeding year. If the Council is dissatisfied as to the suitability of a basement bakehouse, they may give notice to the occupier that the certificate will cease to have effect within a given period. Alternatively, they must give notice of the continuance of the existing certificate An inspection of the whole of the basement bakehouses in the borough was commenced in the year 1938, and the result of this inspection and action taken will be fully summarised in the Medical Officer of Health's report for 1939. The provisions of the Factory and Workshop Act, 1901, are re-enacted in relation to certain sanitary conditions in bakehouses (such as washing, painting, limewashing), prohibition of certain sleeping places near bakehouses, employment of women in a factory within four weeks of giving birth to a child, repairing or cleaning wearing apparel where there is Scarlet Fever or Smallpox ; prohibition of homework in places where there is infectious disease. The inspection of factories and bakehouses is 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. During the year the Inspectors made 2,197 visits to factories with mechanical power, 1,746 visits to factories without mechanical power, 902 visits to other premises under the Act (other than outworkers' premises) and restaurant kitchens, 1,358 visits to outworkers' premises, and 3,716 miscellaneous re-inspections and calls. Notices served.—In consequence of the 1,061 sanitary defects discovered as a result of inspections, 306 notices were served. Of these notices 158 were served on the owners of factories with mechanical power, 80 on owners of non-power factories, and 68 on the owners of other premises upder the Act. Of the 1,061 defects found, 1,003 were remedied by the close of the year. Registers.—There were 1,772 factories with mechanical power, 665 non-power factories, 35 laundries, 121 bakehouses, and 560 restaurant kitchens (total 3,153) on the registers at the end of the year. During the year 93 were added to and 66 removed from the registers. 57 1938 INSPECTION OF FACTORIES, AND OTHER PREMISES UNDER THE ACT. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories with mechanical power 2,197 130 - Factories without mechanical power 1,746 80 - Other premises under the Act (Other than Outworkers' premises) 902 68 - Miscellaneous Re-Inspections and calls 5,074 28 - Total 9,919 306 — DEFECTS FOUND IN FACTORIES AND OTHER PREMISES UNDER THE ACT Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts and Factories Act, 1937— Want of cleanliness 365 361 - - Want of ventilation 34 31 - - Overcrowding 1 1 - - Want of drainage of floors 2 1 - - Other nuisances 199 177 - - Dust Bins Wanting 16 16 - - Defective 13 14 - - Sanitary Accommodation (insufficient 2 1 - - foul 92 89 - - unsuitable or defective 102 87 - - ^ not separate for sexes 14 8 - - Unsatisfactory utensils 65 65 - - Bad storage 66 65 - - Want of light to w.c. 56 53 - - Unsatisfactory temperatures 25 25 - - Other offences 9 9 - - Total 1,061 1,003 — — Workshops Notified to Home Office during Year 1938. Trade. Number of Workshops. Women. Male Young Persons. Totals. Soft furnishings 1 1 - 1 Chemists' Sundries 2 6 — 6 Wearing apparel 12 59 - 59 Fancy leather goods 1 2 — 2 Flour packing 1 4 — 4 Confectionery 1 6 — 6 Disinfectants 1 4 — 4 Total 19 82 — 82 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factories Act 29 Action taken in matters referred by H.M. ' Inspector as remediable under the Public Health Acts Notified by H.M. Inspector 24 Reports (of action taken) sent to H.M. Inspector 15 Other (New Factories reported under Home Office Memorandum) - Underground Bakehouses in use at the end of the year 56 1938] 58 ISLINGTON SANITARY AREA. SUMMARY OF ACTION TAKEN DURING 1938. Premises. No. in Borough on 31st December, 1938. No. of Inspections. No. of Prosecutions. Common Lodging Houses 21 309 - Seamen's Lodging Houses — — — Cowsheds (licensed) — — — Slaughterhouses (licensed) 8 268 - (7 local supplies) (1, horses for export) Other Offensive Trades 12 94 - (Includes knackers) Milkshops 222 927 3 Ice Cream Premises 511 621 — Restaurants and Eating Houses 560 902 — Registered Foster Mothers 109 947 1 Nurse Children kept 159 1,029 - OUTWORK IN UNWHOLESOME PREMISES, Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing apparel— Making, &c. 17 4 — Artificial flowers 4 — — Paper, &c., boxes, paper bags 6 1 — Brush making 1 — — Chocolates and sweetmeats 3 — — Cosaques, Christmas crackers, Christmas stockings, &c. 1 1 — Total 32 6 - OUTWORKERS' PREMISES. Instances. Notices Served. Remedied. Prosecutions. Outwork in unwholesome premises 6 6 6 Nil Outwork in infected premises — — — — Total 6 6 6 Nil OUTWORKERS' LISTS: Lists received from Employers 900 Addresses received from Other Councils 1,689 Addresses forwarded to Other Councils 578 Failure to send in lists (Number of letters sent) 279 59 [1938 Public Health Act: Number of houses inspected on account of complaints or illness 7,224 ,, Statutory Notices served 898 ,, houses—(a) Repaired 3,929 (b) Nuisances remedied 15,546 Smoke Nuisances: Number of observations 29 ,, intimations served 6 complaints received *31 ,, Statutory Notices served nil ,, legal proceedings 1 „ convictions nil summons withdrawn * In respect of 25 premises. Cleansing and Disinfection: Number of adults cleansed 89 children cleansed 6,769 „ premises cleansed— (a) After infectious diseases 2,099 (b) For vermin 103 Water Supply to Tenement Houses: Number of premises supplied 266 ,, prosecutions nil Houses Let in Lodgings: Number in Borough 983 Number of inspections 5,160 Number of prosecutions nil Number of complaints remedied under the By-laws (not included under any other heading) 321 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 1938 60 PHARMACY AND POISONS ACT 1933, AND THE POISONS RULES, 1935-37. PART II.—POISONS. Number of persons entered on the list of sellers of Part II Poisons at the end of 1937 165 Number of persons who ceased selling poisons during the year, and were removed from the list 16 Number of new entries made to the list during the year 15 Number of persons entered on the list of sellers of Part II Poisons at the end of 1938 164 The reason for the removal of 16 persons from the List of sellers of Part II Poisons was as follows:— Renewal fee not paid 5 Premises vacated 11 Number of visits made during the year was as follows:— Visits re new applications for entry on list of sellers 18 Visits to listed sellers of poisons 299 Other visits *463 780 * In addition to these, 912 visits under the Act were made by the Food and Drugs Inspector. During the year, seven 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 the poisons in accordance with the provisions laid down in the Poisons Rules, and three 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 Public Health Committee ; three were successfully prosecuted—total fines being £i 3s. Od. and costs £4 3s. Od. ; and there was one prosecution pending (to be heard 20-1-39). Four informal samples, 1 Hair Dye, 2 Insecticide and 1 Cooker Cleaner, were examined by the Public Analyst for the purpose of ascertaining whether the substance contravened the Act. 18 other samples were obtained by the Inspector for the purpose of ascertaining whether the provisions of the Act with regard to labelling, marking, etc., were being complied with, and were found to be in order. 61 1938 SECTION D—HOUSING HOUSING ACT, 1936 Abatement of Overcrowding. The Council on the 17th December, 1937, decided to offer no objection to a proposal of the London County Council that it should be suggested to the Minister of Health that the appointed day for the purposes of Section 62 of the Act should be the 1st April, 1938, and the appointed day for the purposes of Sections 59 and 64 and Section 60 and Sub-section 2 of Section 6 of the Act should be the 1st October, 1938. In explanation it may be stated that Section 62 provides for entry in rent books or similar documents of a summary in the prescribed form of certain provisions of the Act relating to overcrowding. Sections 59 and 64 contain provisions as to offences in relation to overcrowding. The power of the Minister of Health to increase the permitted number temporarily to meet exceptional conditions is dealt with in Section 60, and Sub-section 2 of Section 6 indicates that bye-laws for fixing the number of persons who may occupy a house shall cease to have effect after the appointed day. One of the items to be entered in a rent book used in relation to a house is a statement of the permitted number of occupiers of the house and before the information as to this number could be supplied it was necessary for the measurement of rooms to be undertaken. On the 6th January, 1938, the Council authorised the engagement of the requisite temporary survey and clerical assistants with the approval of the London County Council to cope with the work and on the 18th March this was commenced ; the disused Coroner's Court was occupied as an administrative centre. By the end of September the services of the survey assistants were dispensed with but the clerical assistants were retained. At the end of the year 32,104 certificates were issued in respect of 38,610 dwelling-houses. The following explanatory pamphlet of the overcrowding provisions of the Act was forwarded with the certificates. Housing Act, 1936. The Prevention and Abatement of Overcrowding. Metropolitan Borough of Islington. 1. Overcrowding is Illegal. The Housing Act, 1936, provides that, after a date to be fixed by the Minister of Health, it will be an offence for any occupier of a dwelling-house or the landlord thereof to cause or permit the house to be overcrowded. The date fixed by the Minister for the Metropolitan Borough of Islington is the 1st October, 1938. 2. Definitions. Throughout this pamphlet : (a) " DWELLING-HOUSE" means " any premises used as a separate dwelling by members of the working classes or of a type suitable for such use." 1938 62 (6) " LANDLORD " means the immediate landlord of an occupier and includes, in relation to an occupier of a dwelling-house who holds under a contract of employment under which the provision of the house for his occupation forms part of his remuneration, his employer. (c) " AGENT " means, in relation to the landlord of a dwelling-house, a person who collects rent in respect thereof on behalf of the landlord or is authorised by him so to do, or, in the case of a dwelling-house occupied by a person who holds as aforesaid, a person who pays remuneration to the occupier on behalf of the employer or is authorised by him so to do. 3. Minimum Standard of Accommodation. The standard of accommodation laid down by the Act for determining overcrowding consists of two parts. The first aims at securing proper separation of the sexes ; the second restricts the number of persons who may occupy a dwellinghouse. The two requirements are distinct from each other and both must be complied with ; they are more fully explained as follows:— (а) A dwelling-house is deemed to be overcrowded if the accommodation is such that any two persons, being ten years old or more, of opposite sexes and not being persons living together as husband and wife, are obliged to sleep in the same room. (b) The maximum number of persons, irrespective of sex, who may be permitted to sleep in a dwelling-house at one time is fixed in relation to the number and sizes of the rooms in the house. The maximum permitted number is ascertained by reference to the two following tables, and is the number obtained by the application of Table I or Table II, whichever is the less. Table I. No. of Rooms. Permitted No of Persons. 1 2 2 3 3 5 4 7½ 5 10 And two persons extra for each additional room. Table II. Size of Rooms. Permitted No. of Persons. Under 50 sq. ft. nil. 50 or more, but less than 70 sq. ft. ½ 70 or more, but less than 90 sq. ft. 1 90 or more, but less than 110 sq. ft. 1½ 110 or more sq. ft. 2 For the purposes of these tables : (i) A child under one year of age is not counted and a child between the ages of one and ten years counts as half a person. (ii) Only rooms normally used in the locality for sleeping or living purposes are counted as rooms. 63 1938 (iii) No room under 50 square feet is counted. (iv) Rooms occupied by a sub-tenant must be regarded as a separate dwellinghouse. (v) In measuring the rooms, the floor area is measured at the level of the floor, and includes bay window extensions and space taken up by cupboards and projecting chimney-breasts ; but where the height of the ceiling above the floor does not exceed five feet, then the floor area below that part of the ceiling is excluded. 4. Duties of Landlords. (a) It is the duty of the landlord to prevent his dwelling-house from becoming overcrowded, and the landlord will be deemed to have caused or permitted a dwellinghouse to be overcrowded— (i) If, after the Borough Council has notified him or his agent in writing that the house is overcrowded, he fails to take all reasonable steps to secure the abatement of such overcrowding, by the removal of a tenant or tenants, including legal proceedings for the recovery of possession of the house, or (ii) If, when letting the house after 1st October, 1938, he or his agent (a) had reasonable cause to believe that it would become overcrowded, or (b) failed to make inquiries of the proposed occupier as to the number, age and sex of persons who would be allowed to sleep in the house. Where a house is overcrowded, the Rent and Mortgage Interest Restrictions Acts, 1920 to 1933, will not prevent the landlord from recovering possession, but after recovery of possession the Acts will continue to apply to that house. (b) Where, after 1st October, 1938, it comes to the knowledge of the landlord of a house or his agent that the house has become overcrowded, such landlord or agent must within seven days of obtaining such knowledge inform the Borough Council. This provision does not apply to overcrowding which already existed on 1st October, 1938. (See para. 6 hereof.) (c) As from 1st October, 1938, every rent book or other similar document used in relation to a dwelling-house must contain the following summary of the provisions of the Act relating to overcrowding, including a statement of the number of persons permitted to sleep in the house:— (i) After the 1st day of October, 1938, an occupier who causes or permits his dwelling to be overcrowded is liable to prosecution for an offence under the Housing Act, 1936, and, if convicted, to a fine not exceeding five pounds. Any part of a house which is occupied by a separate family is a " dwelling." (ii) A dwelling is overcrowded if the number of persons sleeping in it is more than the " permitted number," or is such that two or more of those persons, being ten years old or over, of opposite sexes (not being persons living together as husband and wife) must sleep in the same room. (iii) The " permitted number " for the dwelling to which this (Rent Book) ( ) relates is persons. In counting the number of persons each child under ten years of age counts as half a person, and a child of less than one year is not counted at all. 1938 64 (iv) The Act contains special provisions relating to overcrowding already existing on the above-mentioned date, or which is due to a child attaining the age of either one or ten years after that date, or which is due to exceptional circumstances. Full information about these special provisions and all provisions as to overcrowding can be obtained free on application to the Medical Officer of Health, Town Hall, Upper Street, N.l. (d) It is important to note that the permitted number entered in the rent book is the permitted number for the dwelling to which the rent book relates and is based on the assumption that the tenant is occupying the whole of the dwellinghouse himself. If the occupier sub-lets part of his dwelling and inserts in his subtenant's rent book the permitted number for the dwelling occupied by the sub-tenant, he must not assume that the permitted number for that part of the house which he retains in his own possession is the difference between the permitted number in the sub-tenant's rent book and the permitted number in his own rent book. For example, if a tenant rents a six-roomed house from his landlord, the permitted number inserted in his rent book may be 12. If the tenant sub-lets three of those rooms to a sub-tenant, the permitted number entered in the sub-tenant's rent book will be 5. The permitted number for the three rooms retained by the tenant will also be 5 and not 7—the difference between 12 and 5. (e) The permitted number of persons in relation to a dwelling-house in the Metropolitan Borough of Islington may be obtained from the Medical Officer of Health, Town Hall, Upper Street, N.l. 5. Duties of Occupier. (a) After the 1st October 1938, it is the duty of an occupier to prevent overcrowding in his dwelling-house. (b) The occupier of a dwelling-house may defend himself from the charge of permitting the house to be overcrowded by proving any of the following facts :— (i) That all persons sleeping there were persons who were living there on 1st October, 1938, and since that date have lived there continuously, or were children born since that date of any of those persons. (ii) That the overcrowding is due solely to the fact that since 1st October, 1938, a child has attained the age of one year and is counted as half a person or has attained the age of ten years and is counted as one person, provided that the occupier has applied to the Borough Council for alternative accommodation. (iii) That the overcrowding is due solely to a member of the occupier's family sleeping temporarily but not living in the house. This will enable an occupier to have a member of his family to visit him on a short stay, without infringing the provisions as to overcrowding. (c) But the above defences are not conclusive, because although he may be able to prove one or other of these facts, the occupier will still have committed an offence if:— (a) He fails to accept an offer of suitable alternative accommodation ; or (b) The removal from the house of some person, not being a member of the occupier's family, becomes reasonably practicable and the occupier fails to require the removal of such person. 65 1938 (d) An occupier must, on request by an authorised officer of the Borough Council, produce for his inspection any rent book or similar document in his custody. (e) To enable the Borough Council to discharge their duties under the Act, the occupier of a house is required to furnish to the Council a statement in writing of the number, ages, and sexes of the persons sleeping in the house, within 14 days of receiving notice from the Council to that effect. 6. Suitable Alternative Accommodation. It will be seen from the foregoing that overcrowding which existed at the 1st October 1938, or which is caused solely by the growth of the occupier's family, does not become an offence until suitable alternative accommodation has been offered to the occupier and refused by him. Such accommodation is defined to mean a dwelling in which the occupier and his family can live without being overcrowded and which has been certified by the Borough Council to be suitable to the needs of the occupier and his family as respects security of tenure and proximity to place of work and to be suitable in relation to his means. If the dwelling belongs to the Borough Council they must also certify that it is suitable as respects accommodation, having regard to the standard in Section 136 of the Housing Act, 1936. 7. Temporary Use in Excess of " Permitted Number." In exceptional circumstances the Borough Council may, on the application of the occupier or intending occupier of a dwelling-house, grant him a licence authorising him to permit the house to be occupied for a limited period by such number of persons in excess of the permitted number as may be specified in the licence. The requirement for securing the proper separation of the sexes must always be complied with. The licence may be revoked by the Borough Council at any time by notice in writing, and in no case can a licence be granted for a longer period than twelve months. 8. Enforcement of the Act. It is the duty of the Borough Council to enforce the provisions outlined above, and to take all proceedings for offences committed under the Act. 9. Penalties. (a) Subject to the limitations and defences set out above, an occupier or landlord of a dwelling-house who causes or permits it to be overcrowded after 1st October, 1938, is liable on conviction to a fine not exceeding £5 and to a further fine not exceeding £2 in respect of every day on which the offence continues subsequent to the date of conviction. (b) The Borough Council may serve on the occupier of a house, which is overcrowded, in such circumstances as to render him guilty of an offence, notice in writing requiring him to abate the overcrowding within fourteen days, and if at any time within three months from the expiration of that period, the house is still occupied by the person on whom the notice was served or by a member of his family, and is still overcrowded in such circumstances as to render the occupier guilty of an offence, the Borough Council may take legal proceedings to compel the occupier to vacate the house, and recover from the landlord the costs incidental to such proceedings. 1938 66 (c) If a landlord of a dwelling-house or his agent fails to notify the Borough Council within seven days after it has come to his knowledge that the house has become overcrowded the landlord or his agent as the case may be is liable on conviction to a fine not exceeding £2. (d) An occupier of a dwelling-house who fails to comply with a request by the Borough Council to furnish a statement in writing of the number, ages and sexes of the persons sleeping in the house or makes a statement which he knows to be false, is liable on conviction to a fine not exceeding £2. (e) If a landlord of a dwelling-house fails to insert in the rent book, or other similar document, the prescribed information as to the overcrowding provisions of the Act and as to the permitted number of persons in relation to the house, he is liable on conviction to a fine not exceeding £10. (f) An occupier of a dwelling-house who, within seven days after having been requested by an authorised officer of the Borough Council so to do, fails to produce for inspection any rent book or similar document in his custody is liable on conviction to a fine not exceeding £2. 10. Inquiries. All inquiries regarding the prevention and abatement of overcrowding in the Borough of Islington and matters dealt with in this pamphlet should be made direct to— The Medical Officer of Health, Town Hall, Upper Street, Islington, N.l. W. ERIC ADAMS, Town Clerk, Town Hall, April, 1938. Upper Street, N.l. DEMOLITION ORDERS. Demolition Orders were made with respect to the following premises:— 9 and 11, Wakeham Street. 147a, Downham Road. An undertaking was accepted from the owner of 43, Colebrooke Row that he would within a specified period carry out such works as in the opinion of the Council would render the house fit for human habitation. Numbers 9 and 11, Wakeham Street were demolished, likewise 2 and 4, Muriel Street, which were the subject of Demolition Orders during the preceding year. No. 2 Aberdeen Lane was rendered fit for human habitation. These premises were the subject of representation under Section 11 of the Housing Act, 1936, and were rendered fit in consequence of the service of notices of the intention of the Housing Committee to consider as to the making of a Demolition Order. DEMOLITION OF HABITABLE DWELLINGS. During the year 299 houses have been demolished, 142 voluntarily by private owners and 157 under statutory powers possessed by the Borough Council or the London County Council. 95 new business or non-domestic premises have been rected on some of the vacant sites. 67 1938 HOUSING ACCOMMODATION—LONDON COUNTY COUNCIL. 591 applications for housing accommodation on London County Council estates were dealt with during the year. 389 were direct applications referred back by the London County Council for investigation and 202 were applications made through the Public Health or Housing Departments. As a result of the visits made by the Sanitary Inspectors it was found that 308 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 5 families in each of which there was a notified case of Tuberculosis. The applications of 45 families in which there was chronic ill-health but no overcrowding were submitted, 38 of these were in respect of Tuberculosis. Rheumatism and neurosis were the grounds on which the remaining recommendations were made. There were no convincing reasons for special'treatment in 158 cases but the London County Council were asked to give consideration to these applicants if accommodation was available. The remaining 80 families were found to be occupying basement rooms subject to representation under the Housing Act, 1936. On the above recommendations 102 families so far have been rehoused, 57 inside the Borough and 45 on Estates outside the Borough. During the year 287 families were accommodated by the London County Council, 95 inside the Borough and 192 outside the Borough. PARTICULARS OF HOUSES OR FLATS PROVIDED UNDER THE COUNCIL'S HOUSING SCHEMES. 1919 to 1937. 1938. 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 1ll — 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 (Hillrise Mansions — 100 100 1,217 100 1,317 1938 68 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., 1936. Erected in 1937 and 1938. Total. Part III of the Housing Act, 1925 79 Nil 79 Part II of the Housing Act, 1925 Nil Nil Nil Other Powers 979 259 1,238 Total 1,058 259 1,317 SUMMARY OF HOUSING FROM 1919 TO 1938 (INCLUSIVE). 1919 to 1937. 1938. Total since 1919. Number of houses or flats provided by the Islington Borough Council 1,217 100 1,317 Number of flats provided by the London County Council 1,190 123 1,313 Number of houses or flats provided by private enterprise 1,160 140 1,300 3,567 363 3,930 RE-CONDITIONING OF HOUSES. The inspections of houses under Section 9 of the Housing Act, 1936, were carried out by two special Housing Inspectors, Messrs. Hancock and Ashworth, and the District Sanitary Inspectors. The practice of serving informal notices was continued with satisfactory results, these during the year being as follows :— Number of informal notices served 833 Number of formal notices served 124 Number of dwellings rendered fit 366 SYNOPSIS OF WORK UNDER SECTION 9 OF THE HOUSING ACT, 1936, FOR THE YEAR ENDING 31st DECEMBER, 1938. Rooms cleansed and redecorated 989 Wall plaster repaired 373 Ceilings repaired or renewed 203 ,, cleansed 300 Floors repaired 425 Floor space ventilated 232 Rooms ventilated 28 Staircases ventilated 30 ,, repaired 128 ,, handrails repaired 113 ,, etc., cleansed and redecorated 161 69 1938 Windows: repaired or renewed 1,051 ,, hinges renewed 87 ,, cords renewed 431 ,, fasteners provided 365 New windows provided 150 Doors: renewed or repaired 173 ,, hinges or fasteners renewed 212 Stoves, etc., repaired or renewed 279 Hearths repaired 90 Rooms rendered fit for habitation 192 Illegal occupation of underground rooms discontinued 37 Rooms disinfested of vermin 331 Houses disinfested prior to demolition 17 Domestic Water Supply: Cisterns repaired and cleansed 26 Water supply provided to house 3 ,, ,, ,, ,, tenement house 83 Drains: Constructed 1 Repaired 56 Ventilated 3 Gully and other traps fixed 167 Water Closets: Erected or provided 5 Pan and trap only provided 49 Flushing apparatus repaired 70 Ventilated 110 Walls, etc., cleansed 200 Damp Proof Course provided 54 Sinks: provided 181 ,, waste pipe repaired 108 Cupboards provided 2 ,, repaired 59 Food Cupboards provided 571 Areas paved or repaved 157 Yards paved or repaved Ill External: Pointing of walls renewed 273 Bulged or unsound walls repaired or rebuilt 140 Damp-course made efficient 45 Percolating or rising dampness abated 145 Plaster repaired or renewed 194 Roofs repaired 280 Guttering and rainwater pipes repaired or renewed 140 Chimneys rebuilt 58 Vents or flues cleared 47 ,, ,, ,, renewed 38 ,, ,, ,, repaired 51 Dustbins provided 20 Other improvements 561 Total Improvements 10,405 Total Premises Improved 366 1938 70 WORK OF THE SANITARY INSPECTORS (HOUSING). In addition to the house-to-house inspection under Section 9 of the Housing Act, 1936, the two Housing Inspectors were engaged in preparing reports in connection with the City Garden Row, Cornelia Street and St. Clement Street Clearance Areas and the Brecknock Road Compulsory Purchase Order, all of which schemes were subsequently dealt with by the Council. Assistance was rendered by these Inspectors to the London County Council in the Boleyn Road and Tufnell Park Schemes. Included in the work of these two Inspectors was that of supervising the disinfestation of the household effects of families removing from clearance areas and unfit rooms to the Council's flats. HOUSING ACT, 1936. REPRESENTATIONS, ETC., BY THE MEDICAL OFFICER OF HEALTH. The following 74 dwelling-houses occupied by 110 families and having a total population of 409 persons were represented to the Council on the 21st January, 1938. Order. Premises. The Metropolitan Borough of Islington (City Garden Row No. 1) Clearance Order, 1938. Nos. 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48 and 50, City Garden Row. Nos. 15, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61 and 63, Graham Street. The Metropolitan Borough of Islington (City Garden Row No. 2) Clearance Order, 1938. No. 52, City Garden Row. Nos. 67, 69, 71, 73 and 75, Graham Street. The Metropolitan Borough of Islington (City Garden Row No.3) Clearance Order 1938. Nos. 58, 60 and 62, City Garden Row. The Metropolitan Borough of Islington (Cornelia Street) Clearance Order, 1938. Nos. 13, 15, 17, 19, 21, 23, 25, 18, 20, 22, 24, 26, 28, 30 and 32, Cornelia Street. Nos. 17 and 19, St. Clement Street. The Metropolitan Borough of Islington (St. Clement Street) Clearance Order, 1938. Nos. 6, 8, 10, 12, 14 and 16, St. Clement Street. A Public Inquiry was held at the Town Hall on the 10th May, 1938, and the Minister of Health after considering the report of his Inspector confirmed the Orders on the 18th August, 1938. In regard to Gaskin Street (formerly Church Street), the subject of Representation the previous year (see page 58, Annual Report, 1937) a Public Inquiry was held at the Town Hall on the 27 th January, 1938, and the Minister of Health on the 20th April, 1938, confirmed the Orders as follows:— Clearance Order— Nos. 31, 33 and 35, Gaskin Street. Compulsory Purchase Order— Nos. 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27 and 27a, Gaskin Street. 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) 7,848 (b) Number of inspections made for the purpose 26,908 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 1,841 (b) Number of inspections made for the purpose 3,717 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 74 (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 518 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 598 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 957 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 36 (b) By local authority in default of owners Nil (b) Proceedings under the Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,008 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 3,929 (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 3 71 1938 METROPOLITAN BOROUGH OF ISLINGTON. Undertakings to the effect that the basement rooms, upon vacation, would not be relet for human habitation until rendered fit for that purpose were acceptcd in connection with 41 unfit underground rooms comprised in 19 houses and undertakings in respect of 3 houses were cancelled after the rooms had been made to comply with the Council's' regulations. In 44 houses, 46 underground rooms were made fit by the owners on being informed that the rooms did not comply in all respects with the regulations following representation by the Medical Officer of Health. As a result of informal action 331 underground rooms were made fit for habitation without representation. Statistics are not available for a complete year under Part IV of the Housing Act, 1936, as the " appointed day " when the overcrowding provisions came into force in Islington was not made until the 1st October, 1938, but the following figures are submitted which give an indication that overcrowding in the Borough is decreasing:— Number of overcrowded families revealed by 1935 Survey 6,757 Number of overcrowded families (1938 Survey) 3,534 Number of cases of overcrowding abated since 1935 3,223 This decrease is attributable to the following:— 1. Families finding their own accommodation. 2. Re-housing by Borough Council. 3. Re-housing by London County Council. During the year 1938 little difficulty was experienced in obtaining the measurements of rooms and it was only necessary to take legal proceedings in regard to one house where permission to enter was refused after 24 hours' notice of the intention to visit was given. This resulted in a fine of 40s. and 40s. costs. During the year 1938 the total number of houses demolished following representation by the Medical Officer of Health under Section 25 of the Housing Act, 1936, was 47 The total number of houses in the Borough in 1938 was considered to be 46,360 1938 72 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 (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 3 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or rooms having been rendered fit 81 73 1938 SECTION E INSPECTION AND SUPERVISION OF FOOD MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. MILK AND DAIRIES (AMENDMENT) ACT, 1922. MILK AND DAIRIES ORDER, 1926. Dairies and Milk Shops. Number on Register 31/12/37. Additions to Register. Removals from Register. Number on Register 31/12/38. Dairies 240 1 19 222 Purveyors of Milk in sealed containers only 464 36 29 471 Registered Purveyors of Milk dealing from registered premises outside the Borough 87 5 - 92 During the year 19 dairies were removed from the Register, due to the fact that on routine inspections being made it was found that ten premises had ceased to exist as dairies and nine had become unsuitable for the purpose. There were two prosecutions taken under the Milk and Dairies Order, 1926, during the year. In one instance it was found that a dairy business had changed hands ; on visiting several times the inspector was refused admittance to the premises at the rear of shop, and the proprietress refused (contrary to Sec. 14 of the Milk and Dairies (Consolidation) Act, 1915) to furnish information. The case was adjourned sine die on the understanding that the defendant signed a letter to the effect that she would cease selling milk from the premises. This was done, and on subsequent visits being made it was found that milk was no longer being sold. The second case was against a person discovered selling milk from a dwellinghouse in the Borough, although not registered as a purveyor of milk. The case was dismissed under the Probation of Offenders Act on payment of 10s. costs. The number of visits paid by the Inspector, Mr. R. W. Norman, during the year 1938, was as follows:— Dairies: Routine inspections 908 Inspections for registration of 19 927 Milk Shops (Milk sold in sealed containers only): Routine inspections 551 Inspections for registration of 35 586 Dairies and Milkshops inspected under the Milk (Special Designations) Order, 1936 143 Vehicles inspected 49 Miscellaneous visits 444 2,149 Ice Cream Premises: Routine inspections 499 Inspections for registration of 122 621 Artificial Cream Premises: Routine inspections 16 Total visits 2,786 1938 74 As a result of these visits 56 notices intimating nuisances or defects were served, and 38 warning letters sent to Dairymen, Milk Purveyors, and Ice Cream Vendors drawing their attention to the contravention of the Acts and Regulations relating to their businesses. During the year the following nuisances were abated and improvements made to Dairies and Ice Cream Premises:— Drains and water closets cleansed, repaired or renewed 21 Yards paved or repaired 6 Yard walls limewashed 10 Sinks provided 1 Sink waste-pipes trapped or repaired 6 Walls and ceilings cleansed and repaired 63 Floors repaired 11 Roofs and guttering repaired 3 Accumulations removed 14 Utensils cleansed or renewed 16 Other nuisances abated or improvements made 53 Total improvements 204 Total premises improved 124 THE MILK AND DAIRIES (AMENDMENT) ACT, 1922. THE MILK (SPECIAL DESIGNATIONS) ORDER, 1936. During the year 1938 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 the Milk (Special Designations) Order, 1936. Designations. No. of applications. Number granted. Amount of Fees received. Tuberculin Tested (Dealer) 28 28 f s. d. 7 0 0 ,, „ (Supplementary) 6 6 12 0 Tuberculin Tested (Pasteurised) — — — Accredited (Dealer) 8 8 1 15 0 ,, (Supplementary) — Pasteurised (Pasteuriser) 2 2 2 2 0 „ (Dealer) 85 85 19 2 6 ,, (Supplementary) 10 10 1 0 0 139 139 31 11 6 Ice Cream Premises: Number of premises on the Register at the end of 1937 480 „ „ added during the year 58 „ „ removed during the year 27 ,, ,, on the Register at the end of 1938 511 Number of visits of inspection made 621 Artificial Cream Act, 1929: Number of premises on the Register at the end of 1937 7 ,, „ removed during the year 2 „ ,, on the Register at the end of 1938 5 Number of visits of inspection made 16 75 1938 MEAT AND OTHER FOODS. The Inspector of Meat and Other Foods (Mr. A. W. Haydock) reports that during the year 7 private slaughterhouses for local supplies and 1 slaughterhouse for the slaughter of horses for export held licences. The visits to these premises numbered 268. The following is a statement of the number of animals slaughtered in them, carcases inspected, and parts of carcases condemned:— Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 176 — — 1,140 — Number inspected 176 — — 956 — All diseases except Tuberculosis— Whole carcases condemned — — — — — Carcases of which a part or organ was condemned. 15 — — — — Percentage 8.52 — — — — Tuberculosis only— Whole carcases condemned — — — — — Carcases of which a part or organ was condemned 8 — — — — Percentage 4.5 — — — — There were also 1,201 horses slaughtered for export. The following table records the diseases found in slaughterhouses:— No. of Cases. Description of animal. Nature of Disease. Extent of Disease. How disposed of. 9 Oxen Distomatosis Liver Destructor or on premises. 3 Tuberculosis Lungs Destructor. 1 ,, " Head, Tongue, Lungs, Mesentery and part of Carcase. " 1 ,, " Head, Tongue, Lungs, Liver and part of Carcase. " 1 ,, ,, Head, Tongue, Lungs, Skirt, Liver, Mesentery, Pancreas, Kidney, Suet and part of Carcase. ,, 2 „ " Lungs, Liver, Mesentery and Pancreas. " 1 Abscesses Lungs ,, 1 ,, , , Liver ,, 2 ,, Actinomycosis Head and Tongue ,, 1 ,, ,, Tongue ,, 1 ,, Peritonitis Spleen and Stomach ,, 1938 76 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) - 6 2 9½ Meat and Tinned Food from shops and stalls (surrendered) — 2 1 6½ Fish from shops, fishmongers and fryers (surrendered) — 1 3 2 Fruit and Vegetables (surrendered) — 16 3 8 Fruit (seized) — 8 2 26 Confectionery and other commodities (surrendered) — — — 19½ Confectionery (seized) — — — 3½ Total 1 16 1 19 UNSOUND FOOD. It is difficult to imagine an occurrence that would cause greater concern to an individual than, having consumed part of a steak and kidney pie, to find portions of a mouse in the remainder. Part of the offending pie was left at the Public Health Office with no comment other than the address of the sender and on examination a foot of a mouse was found amongst the meat and a tail was seen lying across the top crust, one end embedded in the pastry. Enquiries were made and the manufacturer ascertained to be outside the Borough, and the local inspector reported satisfactory conditions. There must have been a lack of supervision in the preparation of the pie as the tail could have been seen on top of the crust from the time the pie entered the oven, yet it was not discovered until examined in this office on the morning after the pie was brought to the Town Hall. Complaints were received of insect infestation of bread rolls and pearl barley. The particular food was brought to the department. The insects infesting the bread were identified as the common red ant or Pharaoh's ant. The bakehouse was thoroughly inspected but found to be in a satisfactory state of cleanliness. The pearl barley was infested with Grain Weevil or Calandra Granaria, and as it had been purchased outside the Borough the information was conveyed to the Authority concerned. On three occasions chocolates infested with the larvae of the dried fruit moth or Plodia Interpunctella were seized and condemned by a magistrate. After further investigations had been made the wholesale firms were invited to a conference at the Town Hall when the various representatives of the firms expressed readiness to co-operate with the local authorities by issuing pamphlets to the retailers on the methods of preventing infestation of their goods. Nearly 1,000 lbs. of unsound oranges were seized at Caledonian Market and proceedings were authorised by the Public Health Committee; the case, however, did not appear before the Court during the period under review. Food Inspection.—The number of visits made to shops, etc., were as follows:— Butchers, Provision Dealers, etc., shops 2,060 Meat, etc., Preparation Factories 51 Fish Shops 347 Fruit Shops 1,475 Markets 232 Stalls 509 Offensive Trades 84 Total 4,758 77 [1938 Merchandise Marks Act, 1926. —The marking of imported food with an indication of the country of origin is regulated by various orders made under this Act. During the year 1 trader was warned for failing to mark imported meat, 3 for tomatoes and 3 for apples. Proceedings were taken against a costermonger for describing foreign tomatoes as "English" on two occasions in one day. On the first occasion a display ticket was prominently displayed bearing the words "English tomatoes," and when spoken to he removed this ticket and marked the fruit with the name of the country of origin. The stall was visited again a few hours later when it was found that this latter mark had been substituted with the words "English Seed." When the case was heard the defendant appealed to the Bench for sympathy and they dismissed the case under Probation of Offenders Act on payment of 20s. costs; he then asked for time to pay and when this was granted thanked the Bench for their kind consideration, adding that he had "a small matter at North London" which he had to settle. Agricultural Produce (Grading and Marking) Acts, 1928 and 1931.— During the year Regulations relating to the grading and marking of beef and cauliflower and broccoli were made. A full list of the Orders and Regulations was given in the Medical Officer of Health's Annual Report for 1937. Public Health (Meat) Regulations, 1924.—Three traders were warned for offences against the above Regulations but no prosecutions were deemed necessary. Diseases of Animals Acts—Anthrax Order, 1928.—On one occasion during the year the above Order relating to animals was applied in the Borough, the infected material was destroyed and the premises disinfected as required by the Ministry. Offensive Trades. —The offensive trades operating in the Borough are three tripe dressers, five gut scrapers and one knackers' yard. Eighty-four visits were made during the period and no breach of the Regulations was observed. Three skin dressers are under the supervision of the Inspector of Workshops. By-laws for the Protection of Food.—By-laws for this purpose were made under Public Health (London) Act, 1936, and came into force during 1937. No prosecution has been taken during the period under review. Slaughtermen's Licences.—Slaughter of Animals Act, 1933.—The Public Health Committee on the 28th November, 1938, authorised the renewal of existing and issue of new licences to cover a period of three years as from the 1st January, 1939, expiring on the 31st December, 1941, at the same fee as hitherto charged for a period of one year. Of the 38 slaughtermen who were licensed under this Act during 1937, 32 applied for them to be renewed and 6 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. 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 results. In each case the unsatisfactory conditions were remedied. 1938] 78 Number Number found Inspected. Unsatisfactory. Hotel and Restaurant Kitchens 130 24 Coffee and Dining Rooms 378 79 Refreshment Rooms 234 53 Provision (Cooked Meats, cooked but not consumed on premises) 160 45 Total 902 201 Preserved Food.—Registration of these premises was brought under the Public Health (London) Act, 1936, Section 187, during the year 1936. In 1937, 280 premises were on the register for preserved food; ten were registered during the year 1938, and one was removed from the register. The total on the register at the end of the year, therefore, was 289, all of which were visited. Certification of Meat Food Products for Shipment Abroad. The Medical Officer of Health, as Designated Officer for Food Certification, issued six certificates in respect of foods prepared in Islington and exported to the United States of America, and one to France. Licensed Street Traders in the Borough of Islington for the year 1938. Meat, etc., 10; Fish, Poultry, Rabbits, etc., 30; †Ice Cream, 30; Confectionery, Minerals, etc., 36; Grocery, Provisions, etc., 22; Coffee Stalls, etc., 9; Fruit, Vegetables, Greengrocery, etc., 186. †Some also sell Confectionery and Minerals. Eggs, Cold or Chemical Storage.—There are no premises in the Borough carrying on this business. Margarine and Margarine Cheese.—There are no premises in Islington where the business carried on comes within this category. Butter Blending. -Only one business now on the register. NOTIFICATION OF FOOD POISONING. During the year, 6 cases of food poisoning were notified to the Medical Officer of Health, the food alleged to be the cause of the poisoning being: pork, ham, bacon (2), and fish (2). The first case was that of a male, age 60 years, and the investigation showed that the patient, who was suffering from diarrhoea, had partaken of cold pork which had been purchased four days previously. Within an hour of the meal the patient was taken with abdominal pains and diarrhoea, and died three days afterwards. This case was duly reported to the Coroner, who ordered a post-mortem examination. No inquest was necessary as it was proved that the man died of necrotic appendicitis which had set up general peritonitis; the severe symptoms starting four hours after having eaten the pork were apparently coincident. This case, therefore, was not food poisoning. The second case, a male, aged 32 years, was alleged to have been due to a meal of ham, which had been placed on a marble-top washstand on the landing. The meal was taken at 6 p.m., and the patient was attacked with vomiting and diarrhoea at 2 a.m. The patient recovered after medical treatment. 79 [1938 The third and fourth cases, females, 10 and 16 years, occurred in one family, and the illness was alleged to have been caused by the consumption of bacon. Both patients were admitted to St. Mary, Islington, Hospital, where an examination of material resulted in the food poisoning bacillus enteritidis Gaertner being isolated. The fifth case, a female, 35 years, was alleged to be due to fish poisoning. It was stated that some haddock was purchased on Saturday, 27th August, part of which was eaten about 7.30 p.m. The remainder was placed in the gas oven, cooked, and eaten by the patient at 7 a.m. on Sunday. At 11 a.m. the patient was attacked with abdominal pains and vomiting occurred at 3 a.m. on Monday. The patient had recovered on visitation on Wednesday, 31st August, the date of the receipt of the notification. The sixth case, a male, aged 54 years, was one of considerable interest. The patient purchased some fish and chip potatoes, which he consumed on Saturday evening. On Sunday morning he awoke with diarrhoea and vomiting, got worse towards the evening, and saw a doctor, who sent him to bed at once, stating he had fish poisoning. His wife was similarly attacked, but recovered in the evening. The patient was said to have been worse on Monday, but went to work, collapsed outside his office, was taken to the Royal Free Hospital, received some treatment, and was sent home. On Tuesday he went to the hospital and was transferred the same evening to Park Hospital, gradually got worse, and died on the Wednesday morning (16th September). The Medical Superintendent of Park Hospital, in reply to enquiries by the Medical Officer of Health, stated that the post-mortem revealed a very acute gastro-enteritis with toxic appearances in liver, spleen and kidneys. During life a food-poisoning bacillus of the group aertrycke was isolated from the patient's blood. Three other patients besides the first mentioned were reported to be suffering from alleged food poisoning, but the diagnosis was not confirmed. 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 1,235, including 585 informal samples. All the purchases were made by Inspector Lewis or his agent and were submitted to the Islington Public Analyst, Dr. Alan W. Stewart. Of the total samples 1,222 were reported to be genuine and 13 adulterated, or 10 per cent. This percentage is 0'7 below the previous year and 2 8 below the average rate for the preceding 10 years. Bacteriological Examination of Milk and Water.—Apart from the above 1938] 80 For tubercle, 12 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. Five samples showed unsatisfactory results, one of "Pasteurised Milk" showing the presence of coliform bacillus. In addition to the above-mentioned 52 samples, 9 samples of milk were taken for phosphatase test, and all were reported to be satisfactory. In the case of faulty samples the matter 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 was warned that every precaution should be taken to prevent recurrence. Three samples of water from the domestic supply of houses where it was suggested illness might be due to the drinking water were examined, but none showed the presence of any pathogenic bacteria. The samples were reported to be of such quality that no exception could be taken to the use of the water for domestic purposes upon bacteriological grounds. One sample of water was taken from an artesian well to ascertain the condition of the underground water supply ; this was reported to be suitable for domestic purposes. Special Food Examination.—Two samples of food—chocolate biscuit and beetroot, both alleged to have caused illness—were examined by the Public Analyst, who in both cases reported that nothing could be traced to account for the symptoms complained of. Prosecutions under the Food and Drugs (Adulteration) Act.—During the year legal proceedings were instituted in six instances under this Act; three being successful, fines amounting to £8 7s. 0d., and costs amounting to £8 7s. Od. being imposed. In three instances the summonses were dismissed under the Probation of Offenders Act on payment of costs amounting to £18 18s. Od. The following is a brief summary of the cases in which legal proceedings were taken:— (a) A sample of "Orange Wine" on examination showed a very small percentage of alcohol, but consisted of a coloured and flavoured solution of sugar. The term "Orange Wine" was a misdescription. The case was dismissed under the Probation of Offenders Act on payment of £3 3s. 0d. costs. (b) "Fresh Cream Buns"; the substance consisted of 95 per cent. of fat not derived from milk, whereas fresh cream should have consisted entirely of milk fat. The defendants pleaded guilty; the case was dismissed under the Probation of Offenders Act, on payment of £10 10s. 0d. costs. (c) Whisky was sold 37 38 degrees under proof, whereas it should not have been more than 35 degrees under proof. Defendant pleaded guilty and the case was dismissed under the Probation of Offenders Act on payment of £5 5s. Od. costs. (d) Milk containing 7.06 per cent. of added water. Defendant fined £2 2s. 0d. and £2 2s. 0d. costs. (e) Selling sausages which contained preservative; statement made that the sausages contained no preservative. Fined £1 and £1 costs. (f) Milk deficient in fat to the extent of 60 per cent. Fined £5 5s. 0d. and £b 5s. 0d. costs. 81 [1938 Prosecution under the Merchandise Marks Act.—Defendant was selling imported butter as English; also exposing it for sale (2 summonses). Defendant fined £1 1s. 0d. and £1 1s. 0d. costs in each case. In addition to the above cases one sample of whisky contained 1.25 per cent. of excess water, one of rum contained 1.0 per cent. excess of water, and one of milk contained 1.76 added water. In each instance a strong letter of warning was sent. A very interesting case of Pineapple and Apricot Jam containing 52 parts per million of sulphur dioxide in excess of the regulations was investigated. This jam was made on the premises of an old-established grocer in accordance with a recipe taken from a well-known cookery book ; it was made with the best quality ingredients (tinned pineapple, dried apricots and granulated sugar). Two thousand parts of sulphur dioxide per million is allowed in dried apricots, sugar 70 parts per million, so that the possible quantity which might have been found in jam made with these ingredients was 2,070, whereas the regulations prescribe that the amount of sulphur dioxide in jam shall not exceed 40 parts per million. As the sample which was taken contained 92 parts per million, it was 52 parts per million in excess of the regulation. The offence obviously was committed in ignorance of the exact nature of commercial dried fruit and a strong warning was given. During the year 1938, eight formal and fourteen informal samples of cream and two samples (one formal and one informal) of artificial cream were submitted to the Public Analyst; all proved to be genuine. A wide selection (the varieties numbering 137) 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 133, cheese 38, pepper 16, bacon 9, sausages 26, lard 11, dripping 3, vinegar 10, margarine 30, tinned fish 6, minced beef 2, raisins 9, currants 9, sultanas 7, fish paste 2, mustard 5, flour 8, skimmed condensed milk (sweetened) 4 and 261 of various other articles, including drugs, making a total of 585. During the year 1938, in addition to the samples taken and submitted to the Public Analyst, there was a total of 78 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 1,235 Merchandise Marks Act 856 Bacteriological samples and miscellaneous visits, calls, etc. 26 Total 2,117 The greatest amount of detected adulteration occurred in the fourth quarter of the year, as shown by the figures given in the following statement:— Examined. Genuine. Adulterated. Per Cent. Adulterated. Formal. Informal. Formal. Informal. Formal. Informal. 1st Quarter 190 159 189 158 1 1 0.5 2nd „ 160 131 158 129 2 2 1.4 3rd „ 113 116 112 116 1 - 0.4 4th „ 187 179 182 178 5 1 1.6 The Year 650 585 641 581 9 4 1.0 1938] 82 Milk.—The qualitative results of the Analyses of the milk samples taken during the year are as follows:— No. of Solids not Total Samples. Fat. Fat. Solids. Milk purchased on Sundays 105 8.78 3.51 12.29 Milk purchased on Weekdays 332 8.72 3.60 12.32 Milk procured in transit (Farmers' Milks) 128 8.84 3.69 12.53 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 Percentage taken. Genuine. Adulterated. Adulterated. On Sundays 105 104 1 0.95 On Weekdays 332 329 3 0.90 In transit (Farmers' Milks) 128 128 565 561 .4 0.71 Table giving the particulars of the Milks taken during each quarter of 1938 on Sundays, Week-days, and in transit (Farmers' Milks). 1938. 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 16 107 42 165 16 106 42 164 - 1 - 1 - 0.93 0.61 2nd „ 23 65 52 140 23 65 52 140 - - - - - - - - 3rd „ 33 61 11 105 32 61 11 104 1 - - 1 3.03 — 0.96 4th „ 33 99 23 155 33 97 23 153 — 2 - 2 2.02 - 1.29 The Year 105 332 128 565 104 329 128 561 1 3 — 4 0.95 0.90 — 0.71 Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1938 :— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated. Per cent. Adulterated. 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 1937 559 556 3 0.5 Average 10 years 568 508 13 2.3 1938 565 561 4 0.7 83 [1938 Showing the analysis of 6,251 milks examined in Islington during the 10 years 1928-37 and 1938, and distinguishing those purchased on Sundays, on Week-days, and procured whilst in transit from the Farmer to the London Milk Purveyor:— Sunday Milks. Week-day Milks. In transit (Farmers). Years. 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. 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 1937 78 8.66 3.55 403 8.73 3.60 78 8.85 3.57 Total samples and average constituents (10) years. 1,008 8.79 3.55 3,474 8.78 3.55 1,204 8.78 3.65 1938 105 8.78 3.51 332 8.72 3.60 128 8.84 3.69 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. During the year fifteen informal samples were taken under the above Regulations and found to be genuine. 1938] 84 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES 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, Measles,* Ophthalmia Neonatorum, Plague, Tuberculosis, Puerperal Pyrexia, Whooping Cough* and Chicken-pox* (except in the vaccinated under 10 years of age). *Limited Notification. The Principal Diseases include:— Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus, Continued Fever, Puerperal Fever and Erysipelas. 1,486 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 is given above. The total cases notified are 41 less than those of the previous year (1,527), and 588 below the average (2,074) 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 331, 167, 6, 2 and 16 below the average. The 1,486 cases were equal to an attack-rate of 5.08 per 1,000 of the civil population. The returns for the preceding ten years are given in the following statements:— Attack-rates per 1,000 Year. Cases. civil population. 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 1937 1,527 5.17 Average 2,074 6.62 1938 1,486 5.08 85 [1938 Registration Sub-Districts.—The total number of cases notified in these districts was as follows:— Total cases notified. Tufnell 129 Upper Holloway 149 Tollington 149 Lower Holloway 176 Highbury 139 Barnsbury 246 Islington South-East 398 Total 1,486 Small Pox.—No case was notified in 1938 or during the preceding year. VACCINATION. No vaccination was required to be performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Vaccinations.—Of the 3,994 births returned on the "Birth List Sheets" in 1937, the returns of vaccination show that only 1,700 infants were successfully vaccinated while 9 were found to be insusceptible. There were also 187 who died unvaccinated and 1,253 statutory declarations of conscientious objection were obtained by the parents or guardians; 36 vaccinations were postponed under medical authority, 560 removed to districts the vaccination officers of which were duly apprised, and 208 removed to other districts or places unknown, thus leaving 41 unaccounted for. The return of certificates of exemption, therefore, represents 31.37 per cent. of the 3,994 births above-mentioned. Vaccination per 100 Vaccination per 100 Years. births, less infants who Years. births, less infants who died unvaccinated. died unvaccinated. 1928 46.5 1933 47.0 1929 49.5 1934 47.2 1930 51.2 1935 47.4 1931 50.0 1936 47.2 1932 50.0 1937 44.6 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years. 1928 1,755 1933 1,198 1929 1,642 1934 1,241 1930 1,584 1935 1,226 1931 1,477 1936 1,173 1932 1,299 1937 1,253 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 — — — 1938 — — — 13 7 20 1938] 86 Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1937. Registration Sub-Districts. Number of Births returned in "Birth List Sheets" in 1937. 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 1938. Number of Statutory Declarations of Conscientious Objection received during year 1938. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 1447 521 2 - 380 93 4 340 97 10 1532 878 Upper Holloway 720 285 1 — 252 28 — 124 26 4 Tollington 137 66 — — 48 9 — 1 11 2 Highbury 010 264 5 - 209 24 4 59 43 2 Barnsbury 669 349 1 - 225 16 20 26 18 14 1254 540 Islington, S.E. 411 215 — — 139 17 8 10 13 9 The Borough 3994 1700 9 — 1253 187 36 560 208 41 2786 1418 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, 1938:— 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 196 19 215 8 Upper Holloway Dr. P. Inwald 185 10 195 9 Tollington Dr. M. J. Healy 206 20 226 14 Highbury Dr. T Galbraith 189 12 201 12 Lower Holloway (W.) Dr. S. N. Forbes 104 - 104 1 Lower Holloway (E.) Dr. C. V. Forbes 89 4 93 7 Mildmay Dr. J. E. Ambrose 141 20 161 6 Barnsbury Dr. B. Kessel 148 4 152 3 Thornhill Dr. H. D. Christie 166 2 168 1 St. Mary Dr. G. Madden 58 8 66 5 St. Mary, Islington, Hospital Dr. W. R. Turtle 6 — 6 — Total 1488 99 1587 66 Vaccinations and re-vaccinations performed by the Public Vaccinators of the Council during the year 1938:— Successful vaccinations performed at the surgery or elsewhere than at the homes of the persons vaccinated 60 Successful re-vaccinations performed at surgery or elsewhere than at the homes of the persons vaccinated 55 Successful vaccinations or re-vaccinations performed at the homes of the persons vaccinated or re-vaccinated 1,495 87 [1938 The Vaccination Officers in the course of their duties forwarded the names of 1,518 children to the Public Vaccinators on Form "H," and 455 children were vaccinated at the "request" of parents or guardians before Form "H" was issued. Diphtheria was responsible for 595 cases of illness, which were 167 below the average (764) of the preceding ten years. The attack rate was equal to 2.03 per 1,000 of the civil population annually, and was 0.41 below the mean rate (2.44) of the decennial period. In London the attack rate was 1.90 per 1,000. 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 55,000 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 34,000 units were sold, the total amount received by the Council being £1 14s. 3d. The remaining 21,000 units were given free owing to the patients' limited means. DIPHTHERIA PREVENTION. Report of Assistant Medical Officer of Health. Arrangements for referring children for protection against Diphtheria from the London County Council schools and from the children's departments of the voluntary hospitals were outlined in the Annual Report of the Medical Officer of Health for 1937. The leaflet and birthday card also continued to be sent out on the occasion of the child's first birthday, and this has resulted in quite a favourable response. During the year it was found necessary to continue two clinics per week, one at the Town Hall with the Assistant Medical Officer of Health in charge, and the other at the Miriam Price Coleman Clinic Centre, taken during the first half of 1938 by Dr. D. S. Murray, and then for the remainder of the year by the Assistant Medical Officer, Dr. Hirst, following her appointment. Alum Precipitated Toxoid (A.P.T.) is the immunising material used in nearly all cases; 0.1 c.c. and 0.5 c.c. are injected with an interval of two weeks between the injections. In a few of the older children it is considered advisable to use Toxoid-Anti-Toxin Floccules (T.A.F.), giving three injections at intervals of a fortnight. There were a few local reactions after A.P.T. but none of them were severe. Ante-Schick-testing is not done as a routine in children under seven years of age, but it is the practice to do this with children over seven. All cases immunised are Schick-tested about three months after immunisation. It is as yet too early to consider the reversion rate to the Schick-positive state among those already immunised, but a start will be made on this during 1939. It will be noted that although the attendances in 1938 were more than double those in 1937 the proportion of children in the Borough who are immunised is still far below that necessary to have any appreciable effect upon the Diphtheria rate. 1938] 88 DIPHTHERIA IMMUNISATION CLINICS. Report for Year 1938. Total number of sessions—44 at Town Hall, 41 at Miriam Price Coleman Day Nursery 85 (1937—51) Total attendances at clinics 4,358 (1937—2,026) Average attendance per session 51.3 (1937—39.7) New cases commenced 942 (1937—518) Cases immunised and completed 1,033 (1937—281) Cases Schick-negative after two injections of A.P.T. 818 (1937—276) Cases Schick-positive after two injections and Schick- negative after three injections of A.P.T. 3 Cases Schick-negative after three injections of T.A.F. 34 Cases Schick-negative after four injections of T.A.F. 3 Cases ante-Schick-tested and found positive 260 (1937—145) Cases ante-Schick-tested and found negative 175 (1937—105) Cases commenced elsewhere and referred to I.B.C. for completion 19 (1937—31) Number who contracted Diphtheria after immunisation and Schick-negative test Nil. Number notified as Diphtheria contracted after immunisation but diagnosis not confirmed 2 Age Group Summary of Cases Immunised and Completed. 1938 1937 1 to 4 years 418 155 5 and 6 years 200 87 7 years and over 415 39 1,033 281 Scarlet Fever.—701 cases were notified, and they showed a decrease of 331 on the average (1,032) of the ten years 1928-37. The attack-rate was equal to 2.40 per 1,000 of the civil population annually, which is a decrease of 0.89 per 1,000 of the mean rate (3.29) of the preceding ten years. In London the attack-rate was 2.05 per 1,000 of the civil population. Enteric Fever (includes Typhoid, Paratyphoid A and Paratyphoid B).— 8 cases of Enteric Fever were notified. This is a decrease of 7 on the average (15) that obtained during the ten years 1928-37. The attack-rate was 0.03 per 1,000 annually, which is a decrease of 0.02 on the mean rate (0.05) of the last ten years. In London the rate was 0.05. In November an outbreak of Typhoid Fever occurred, due to "Carrier" infection, and mainly confined to the Borough of Shoreditch, where a thorough investigation was made. As a result of this—food infection by "carrier"—three cases notified in Islington were associated with food purchased in Shoreditch. One of these, a fatal case, however, was stated to be a Paratyphoid B case. The outbreak in the neighbouring Borough, effectively controlled, resulted in a large number of contacts having to be followed up in Islington. Some of these contacts were suspiciously ill and were admitted to hospital by special arrangements for observation; they, however, proved not to be cases. 89 [1938 Apart from constant visitation by the Sanitary Inspectors at the homes, serum reactions were made and specimens of material were examined at the Government Laboratory. The other cases of Enteric Fever, five in number, were all isolated individual cases of obscure origin. Puerperal Fever.—19 cases were notified, and were 16 below the average of the preceding ten years; the attack rate was 0.44 per 1,000 births. Erysipelas.—158 cases were notified, and were 2 below the average of the preceding ten years, the attack-rate being 0.54 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 1,486 cases notified, 36 deaths occurred, or 2.4 per cent., which contrasts with an average percentage of 2.6 in the preceding ten years 1928-37. Years. Cases. Deaths. Fatility. 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 1937 1,527 38 2.4 Mean 2,074 55 2.6 1938 1,486 36 2.4 Hospital Isolation.—Of the 1,486 cases of infectious disease notified, 1,364 were isolated in hospital, equal to a percentage of 91.8, while 8.2 per cent. of the patients were nursed at home. The following tabular statement shows the number of cases treated in the various public institutions:— Year. Cases treated in Hospital. Percentage of cases treated. 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 1938 1,364 91.8 1938] 90 In December, 1937, an intimation was received from the London County Council regarding the utilisation of hospital accommodation to the greatest advantage for cases of Scarlet Fever, Measles, Whooping Cough and Dysentery. Cases were to be chosen having regard to the severity of the case and home conditions, and particularly in the case of Measles, the selection of children under two years of age was recommended owing to the high mortality at this age. Persons suffering from these diseases were to be received only on the application of the Borough Medical Officers of Health. This scheme continued until 16th May, 1938, when it was discontinued with respect to Scarlet Fever, Measles and Dysentery, but continued with regard to Whooping Cough, German Measles, Mumps and Chicken Pox. The scheme, although necessary in view of the difficulties experienced in obtaining nurses, caused a considerable amount of additional work in the Public Health Department, and also some delays in getting cases into hospital, especially those occurring in out-patient departments of hospitals, as in the absence of a definite statement of medical urgency for hospital treatment, the patient had to be sent home and await decision as to home conditions, etc., before removal to hospital could be effected. DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated in Hospital. Percentage of known cases. Scarlet Fever 701 658 93.8 Diphtheria 600 600 100.0 Enteric Fever 8 8 100.0 Erysipelas 158 81 51.3 Puerperal Fever 19 17 89.5 Continued Fever — — — 1,486 1,364 91.8 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 1938. 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 658 43 701 93.8 6.2 2 - 2 0.3 0.3 Diphtheria 600 - 600 100.0 - 23 - 23 3.8 - 3.8 Enteric (Typhoid Fever) 8 - 8 100.0 - 1 - 1 12.5 - 12.5 Erysipelas 81 77 158 51.3 48.7 5 — 5 3.1 — 3.1 Puerperal Fever 17 2 19 89.5 10.5 5 - 5 26.3 - 26.3 Continued Fever - - - - - - - - - - - Total 1,364 122 1,486 96.1 3.9 36 - 36 2.4 - 2.4 91 [1938 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1928-37 and in 1938. DISEASES. YEARS. † Average number of cases, 1927-36 1938 Increase or Decrease 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 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 756 1004 1242 710 598 547 811 760 583 619 764 595 -169 Rate 2.33 3.14 3.81 2.19 1.84 1.72 2.58 2.46 1.88 2.10 2.44 2.03 — 0.41 Membranous Croup Cases 4 4 6 4 3 4 4 2 1 4 3 5 + 2 Rate 0.01 0.01 0.01 0.01 0.01 0.01 001 0.01 0.00 0.01 0.01 0.01 - Scarlet Fever Cases 1305 1155 1310 1093 983 1220 1089 716 760 723 1,032 701 — 331 Rate 4.02 3.61 4.02 3.37 3.03 3.82 3.49 2.32 2.45 2.45 3.29 2.40 -0.89 Enteric Fever Cases 19 18 31 16 15 15 6 7 7 12 15 8 - 7 Rate 0.06 0.06 0.09 0.05 0.04 0.05 0.02 0.05 0.02 0.04 0.04 0.02 -0.02 Continued Fever Cases — 1 — — 1 — — — — 1 - - — Rate - 0.00 - - 0.00 - - - - 0.00 - - - Puerperal Fever* Cases 38 38 36 45 35 36 54 24 25 17 35 19 - 16 Rate 6.56 6.89 6.3 8.52 7.07 7.86 11.68 5.24 5.29 3.77 6.97 4.24 - 2.73 Erysipelas Cases 134 148 188 177 165 183 193 130 128 151 160 158 - 2 _ Rate 0.41 0.46 0.58 0.54 0.51 0.57 0.61 0.41 0.41 0.51 0.51 0.54 + 0.03 Totals Cases 2260 2439 3057 2111 1962 2016 2227 1639 1504 1527 2,009 1486 - 523 Rate 6.96 7.62 9.38 6.50 6.04 6.32 7.08 5.32 4.84 5.17 6.41 5.08 - 1.33 •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 1938. SubRegistration Districts. Wards. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus l ever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell - 56 50 - 1 - 17 5 - - - 129 Up. Holloway Up. Holloway - 57 61 - - - 29 2 - - - 149 Tollington Tollington - 55 81 - 1 - 11 1 - - - 149 Lr. Holloway Lr. Holloway - 73 76 1 1 - 23 2 - - - 176 Highbury Highbury - 51 46 — 1 - 17 3 - - - 118 Mildmay - 59 48 — — - 13 1 - - - 121 Barnsbury Thornhill - 75 54 — — - 16 2 - - - 147 Barnsbury - 43 44 3 - - 7 2 - - - 99 Islington, S.E. St. Mary's - 54 45 - 2 - 5 - - - - 106 Canonbury - 49 42 — 1 - 11 1 - - - 104 St. Peter's - 129 48 1 1 - 9 — - - - 188 Totals — 701 595 5 8 — 158 19 — — — 1486 Attack-Rates per 1,000 population — 2.40 2.03 0.01 0.02 - 0.54 0.06 — — — 5.08 Puerperal Pyrexia.—69 cases were notified, the attack-rate being 1.54 per 1,000 births. Ophthalmia Neonatorum.—39 cases were notified during 1938, representing an attack-rate of 0.87 per 1,000 births. Measles and Whooping Cough.—The County of London (Measles and Whooping Cough) Regulations, 1938, requiring the notification of these two diseases came into force on the 1st October, 1938. Notification is limited, however, to the first case in the house within two months. From the 1st October to the end of the year, 13 cases of Measles and 112 cases of Whooping Cough were notified. 1938] 92 Acute Poliomyelitis. Four cases of this disease were notified during the year, as contrasted with one in 1937, and one in 1936. Epidemic Cerebro-Spinal Meningitis. Thirteen cases were notified during the year to the Medical Officer of Health as against 10 in 1937. During the ten years 1928-37 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. 1934 1935 1936 1937 1938 Enteric Fever 6 7 7 12 8 Malaria - - - - 1 Dysentery 5 36 35 39 98 Acute Primary Pneumonia 189 151 154 131 166 Acute Influenzal Pneumonia 71 59 56 84 22 Totals 271 253 252 266 295 DYSENTERY. 98 cases of Dysentery were notified during the year; 62 were bacteriologically confirmed to be "Sonne" Dysentery; in three cases the diagnosis of Dysentery was not confirmed; in three the disease was finally diagnosed as "Enteritis." In one other case the type of the disease was diagnosed as "Kleiner"; in 27 cases the exact type was not communicated; and in two cases the diagnosis showed "No obvious disease." Of the 98 notified cases 6 occurred in the Royal Northern Hospital, 6 in St. Mary, Islington Hospital, 14 in Archway Hospital, and 72 were notified from various sources (home and hospitals without the Borough). In addition to the 98 cases quoted above, four cases of "Sonne" Dysentery came to our knowledge through the medium of the Registrar's Death Returns. PNEUMONIA During the year 185 cases of Acute Primary Pneumonia and Influenzal Pneumonia were notified, the attack rate being 0.6 per 1,000 of the inhabitants. The Borough Council has an arrangement with the North London Nursing Association for the attendance, by visitation, in cases of Acute Primary Pneumonia, Acute Influenzal Pneumonia, Epidemic Diarrhœa, Measles, Whooping Cough, Ophthalmia Neonatorum and Maternity Complications. Payment is made at the rate of 1s. 3d. per visit in necessitous cases. 93 [1938 During the year 15 patients suffering from pneumonias were nursed at home under the Council's Scheme, and others were removed to hospital when so recommended by the medical attendant. 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. Grants.-The following payments were made to the Association during the year in respect of nursing services in necessitous cases:— £ s. d. For Maternity and Child Welfare Visits 15 7 6 For Public Health Visits 12 6 3* *Including nursing of pneumonia (adults). 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 4,074 cases had been notified. In 1938 the notifications numbered 606. GLANDERS, ANTHRAX AND HYDROPHOBIA IN MAN. Order under Section 56 of the Public Health (London) Act, 1891, by the London County Council. (Came into operation on the 26th April, 1909.) No case came to the knowledge of the Medical Officer of Health during the year under review. 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 no case of Acute Encephalitis Lethargica was notified; three deaths were registered. No case of Polioencephalitis was notified, and no death was registered. The following summary shows the number of cases, and also the fatality of recent years:— Acute Encephalitis Lethargica. Years. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Average (10 years). 1938 Cases (notified) 5 8 4 4 4 4 2 - - 1 3 - Deaths 3 3 - 2 1 3 - - - 3 1 3 1938] 94 (Ministry of Health Return.) Notifiable Infectious Diseases during the Year 1938. Disease. Ages. Totals. Total Cases removed to Hospital Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwds Small Pox Notifications ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever Notifications 5 39 43 61 85 286 99 44 28 6 5 ... 701 658 Deaths ... ... ... ... 1 ... ... ... ... ... 1 ... 2 2 Diphtheria and Memb. Croup Notifications 12 31 54 57 56 234 61 32 52 7 3 1 600 600 Deaths 1 ... 3 2 2 12 2 1 ... ... ... ... 23 23 Enteric Fever (including Paratyphoid) Notifications ... ... ... ... ... 1 ... 1 1 2 2 1 8 8 Deaths ... ... ... ... ... ... ... ... ... ... ... 1 1 1 Puerperal Fever Notifications ... ... ... ... ... ... ... ... 15 2 ... ... 19 17 Deaths ... ... ... ... ... ... ... ... 1 4 ... ... 5 5 Puerperal Pyrexia Notifications ... ... ... ... ... ... ... ... 54 10 ... ... 69 31 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary and Influenzal Pneumonia Notifications 4 6 7 7 12 19 5 13 29 28 41 17 188 81 Deaths ... ... ... ... ... 1 ... ... 2 2 6 5 16 9 Ophthalmia Neonatorum Notifications 39 ... ... ... ... ... ... ... ... ... ... ... 39 31 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica Notifications ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... 1 ... 2 3 2 Cerebro Spinal Fever Notifications 2 1 1 ... 1 1 ... 1 5 ... 1 ... 13 13 Deaths 2 1 1 ... ... ... 1 ... 1 ... 1 ... 7 7 Acute Poliomyelitis Notifications ... ... ... ... 2 2 ... ... ... ... ... ... 4 2 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax Notifications ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery Notifications 9 17 13 5 9 18 10 1 6 5 4 1 98 83 Deaths 5 ... ... ... ... ... ... ... ... ... ... ... 5 5 Malaria Notifications ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas Notifications 2 2 1 ... 1 2 5 10 33 20 58 24 158 81 Deaths 1 ... ... ... ... ... ... ... ... ... ... 4 5 5 Chicken Pox* Notifications 21 53 36 48 52 247 99 31 18 1 ... ... 606 100 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles*† Notifications 2 3 2 ... 1 2 3 ... ... ... ... ... 13 12 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough*† Notifications 12 24 17 21 17 20 1 ... ... ... ... ... 112 69 Deaths 1 1 ... ... ... ... ... ... ... ... ... ... 2 2 *Limited notification. †From 1st October, 1938. 95 [1938 BACTERIOLOGICAL EXAMINATIONS, OTHER THAN FOOD. Examinations numbering 2,238 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 a decrease of 203 on that of the preceding year and 362 below the decennial average. Of the total examinations, 245, or 10.9 per cent., gave positive results. Tuberculosis.—395 specimens of sputum were examined, 44, or 11.1 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.—1,835 specimens were examined for Diphtheria, of which 201, or 10-9 per cent., were found to be "positive." Enteric Fever.—8 specimens of blood and faeces were examined, none of which gave a positive result. DIPHTHERIA—PATHOGENICITY TESTS. 1938. During the year ten swabs were sent with the object of having pathogenicity tests done if bacilli were found, but in none of these was a pathogenicity test possible owing to failure to isolate suspicious bacilli. Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1928-37, and in 1938. Periods. Diphtheria. Enteric Fever. Pulmonary Tuberculosis. Totals. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. 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 1937 209 1,705 1,914 - 18 18 48 461 509 2,441 Average 10 years 285 1,780 2,065 2 16 18 98 605 703 2,786 1938 201 1,634 1,835 - 8 8 44 351 395 2,238 1938] 96 BACTERIOLOGICAL EXAMINATION IN CASES OF PUERPERAL SEPSIS. During the year no swab 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 5 specimens submitted by practitioners to be examined bacteriologically for streptococci (suspected Scarlet Fever), 4 were positive and I negative; Dysentery 2, both negative, and one specimen of blood for tubercle bacilli—negative. INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,036 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 335 were Scarlet Fever and 291 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 335 618 - 283 Diphtheria 291 400 - 109 Enteric Fever Nil 2 - 2 Total 626 1,020 - 394 In addition to the above, 310 notifications of Chicken-pox, which was made notifiable in Islington in 1930, were received. Non-Notifiable Diseases.—5,012 cases came to the knowledge of the Medical Officer of Health during the year, viz., 1,952 cases of Measles, 1,192 cases of Chickenpox not notifiable under the Chicken-pox (Islington) Regulations, 1930; 467 of Whooping Cough, and 1,401 of other diseases. The information respecting these cases was received from the teachers of schools within the borough, parents, and other sources. Exclusion of Scholars from Schools.—1,578 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 1,952 1,787 + 165 Chicken-pox 1,192 902 + 290 Whooping Cough 467 531 - 64 *Other Diseases 1,401 1,518 - 117 Total 5,012 4,738 + 274 *Note.—"Other Diseases" include Mumps, Scabies, Ophthalmia, etc. 97 [1938 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. TUBERCULOSIS. 521 cases of Tuberculosis in its different forms were notified during the year. The attack-rate was equal to 1.78 per 1,000 of the civil population. This number was a decrease of 53 on the return of the previous year, and of 0.16 per 1,000 on the attack-rate. Respiratory (Pulmonary) Tuberculosis.—457 notifications were received, of which 263 referred to males and 194 to females, and represented an attack-rate of 1.56 per 1,000 inhabitants. Showing the Notified Cases of Tuberculosis in the Wards during 1938. 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 32 26 58 4 5 9 67 2.26 Up. Holloway Up. Holloway 22 22 44 3 4 7 51 1.83 Tollington Tollington 18 22 40 4 — 4 44 1.62 Lr. Holloway Lr. Holloway 37 21 58 4 — 4 62 1.71 Highbury Highbury 25 19 44 6 4 10 54 1.93 Mildmay 28 18 46 4 1 5 51 2.02 Barnsbury Thornhill 21 14 35 2 2 4 39 1.47 Barnsbury 24 9 33 1 1 2 35 1.61 Islington, S.E. St. Mary's 18 12 30 6 1 7 37 2.32 Canonbury 12 18 30 1 6 7 37 1.31 St. Peter's . 26 13 39 2 3 5 44 1.69 Totals 263 194 457 37 27 64 521 1.78 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1938. Tubercular Diseases. Sex. Cases Notified in Whole District. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 263 - 5 15 53 118 59 13 F. 194 2 8 13 75 67 20 9 Tubercular Meningitis M. 1 — — 1 — - — — F. 2 1 — — 1 — — — Tabes Mesenterica M. 1 — — — — 1 — - F. 1 — 1 - - - - - General Tuberculosis M. — — — — — — — — F. - - - - - - - - Other forms of Tuberculosis M. 35 — 1 16 6 9 2 1 F. 24 — 2 3 6 12 1 — All Tubercular Diseases M. 300 - 6 32 59 128 61 14 F. 221 3 11 16 82 79 21 9 Totals 521 3 17 48 141 207 82 23 Percentages at each life period to total cases 0.57 3.26 9.21 27.06 39.73 15.74 4.41 1938] 98 From the above statement it will be seen how the disease attacked people at the various ages, viz.:— In every hundred cases 3.26 were aged 1 to 5 years. ,, ,, 9.21 were aged 5 to 15 years. Prime,, ,, 27.06 were aged 15 to 25 years.* of ,, ,, 39.73 were aged 25 to 45 years. Life „ ,, 15.74 were aged 45 to 65 years. „ ,, 4.41 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 53, while the females reached 75 TUBERCULOSIS. Year. Notified Cases. Coming to knowledge. Total. Deaths. 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 1938 521 102 P. 535 623 P. 210 237 O.F. 88 O.F. 27 The above table shows for the past ten years the totals of the known cases of respiratory tuberculosis (pulmonary), indicated by " P," and other forms of tuberculosis, by " O.F.," the last column showing the deaths. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. In accordance with the above Regulations, a register of notified cases of Tuberculosis is kept. This register calls for constant revision and corrections are made quarterly. Information of any change is forwarded to the Islington Tuberculosis Officers, the London County Council and to the administrative districts to which the patients have removed. 99 [1938 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 1938. Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1938 855 652 235 255 1,997 Notified cases added during the year 1938 263 194 37 27 521 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1938 44 34 12 12 102 Number of cases removed from the register during the year 1938 1,162 880 284 294 2,620 274 192 58 57 581 Number of cases remaining on register at close of year 1938 888 688 226 237 2,039 Summary of Notifications during the period from 1st January, 1938, to the 31st December, 1938, in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up. Total Primary Notifications. Pulmonary Males - 5 5 10 23 30 61 57 34 25 13 263 374 Females 2 8 6 7 26 49 45 22 14 6 9 194 291 Non-pulmonary Males — 1 4 13 2 4 7 3 — 2 1 37 48 ,, ,, Females 1 3 2 1 1 6 5 7 — 1 — 27 35 Showing the Notified Cases of Tuberculosis in the Quarters during 1938. 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 69 47 116 66 53 119 71 57 128 57 37 94 263 194 457 Tubercular Meningitis — — — 1 2 3 - - - - - - 1 2 3 Tabes Mesenterica — — — 1 — 1 — 1 1 — — — 1 1 2 General Tuberculosis — — — — — — — — — — — — — — — Other forms of Tuberculosis 12 9 21 5 4 9 10 9 19 8 2 10 35 24 59 Totals 81 56 137 73 59 132 81 67 148 65 39 104 300 221 521 1938] 100 Showing New Cases of Tuberculosis and all Deaths during 1938. Age Periods. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. Under 1 year - 2 1 1 - - 1 2 1-5 6 8 5 7 2 — 4 4 5-10 5 6 5 4 — — 2 1 10-15 10 7 15 1 - 2 1 — 15-20 27 26 3 4 8 7 — 2 20-25 33 58 4 7 7 13 1 — 25-35 72 55 7 5 23 20 3 2 35-45 68 27 4 7 29 10 1 — 45-55 38 17 — - 28 7 — — 55-65 32 10 4 3 30 5 2 1 65 and upwards 16 12 1 — 11 8 — — Totals 307 228 49 39 138 72 15 12 55 Deaths not notified or 23 2 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 60 77 2nd „ 34 49 3rd „ 20 31 4th „ 43 59 Total 157 216 101 [1938 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 1938. 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 tacts):- (a) Definitely tuberculous 96 69 9 8 9 6 9 4 105 75 18 12 210 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 131 125 12 11 279 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 6 4 4 - - 2 1 6 6 6 5 23 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 67 103 63 81 314 C.—Cases written off the Dispensary Register as:— (a) Recovered 5 5 1 — — 2 4 2 5 7 5 2 19 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 198 228 75 92 593 D.—Number of Cases on Dispensary Register on ember 31st:- (a) Definitely tuberculous 315 307 34 23 46 46 39 29 361 353 73 52 839 (b) Diagnosis not completed - - - - - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 830 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 63 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of" 178 4. Cases written off during the year as Dead (all causes) 90 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 457 5. Number of attendances at the Dispensary (including Contacts) 5,062 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 268 (a) Personal 22 (b) Other 550 10. Number of:— 9. Number of visits by Dispensary Nurses to homes for Dispensary purposes 1,241 (a) Specimens of sputum, etc., examined 315 Municipal Tuberculosis Visiting Nurse 1,620 (b) X-ray examinations made in connection with Dispensary work 471 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 12. Number of "T.B. Plus" cases on Dispensary Register on December 31st 611 1938] 102 Return showing the Work of the South Islington Tuberculosis Dispensary for the Year 1938. 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 57 39 4 4 4 4 3 2 61 43 7 6 117 (b) Diagnosis not completed - - - - - - - - 3 3 3 2 11 (c) Non-tuberculous - - - - - - - - 94 80 14 15 203 B.—Contacts examined during the year:— (a) Definitely tuberculous 8 5 — 1 — 1 — — 8 6 — 1 15 (b) Diagnosis not completed — — — — — —. — — — — -— — — (c) Non-tuberculous - - - - - - - - 48 72 41 37 198 C.—Cases written of the Dispensary Register as:— (a) Recovered 6 10 1 — 2 1 4 — 8 11 5 — 24 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 143 155 55 52 405 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 251 189 15 17 19 27 20 21 270 216 35 38 559 (b) Diagnosis not completed - - - - - - - - 3 3 3 2 11 1. Number of cases on Dispensary Register on January 1st 569 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 57 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of" 113 4. Cases written off during the year as Dead (all causes) 58 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 165 5. Number of attendances at the Dispensary (including Contacts) 4,643 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 192 (a) Personal 11 (b) Other 204 10. Number of:— 9. Number of visits by Dispensary Nurses to homes for Dispensary purposes 1,973 (a) Specimens of sputum, etc., examined 554 Municipal Tuberculosis Visiting Nurse 1,384 (b) X-ray examinations made in connection with Dispensary work 315 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A (b) above - 12. Number of "T.B. Plus" cases on Dispensary Register on December 31st 308 103 [1938 At the Northern Dispensary there were, including contacts, 891 new cases, and at the Southern 557, while the attendances at the former were 5,062 and at the latter 4,643. The examination of contacts with tuberculous cases showed that 32 were suffering from tuberculosis, 30 were suspects, and 495 were not suffering. The nurses of the Northern Dispensary paid 1,241 visits, and those of the Southern 1,976, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 240 visits, and of the Southern 192 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:— 1934 1935 1936 1937 1938 North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. New Cases (including contacts) 742 554 819 470 845 611 882 594 891 557 Actual Number of Attendances 3,775 4,294 3,808 4,210 4,353 4,505 4,934 4,621 5,062 4,643 Totals 4,517 4,848 4,627 4,680 5,198 5,116 5,816 5,215 5,953 5,200 A summary of the combined dispensaries is given for the following years:— Cases. Attendances. 1934 1,296 8,069 1935 1,289 8,018 1936 1,456 8,858 1937 1,476 9,555 1938 1,448 9,705 Totals 6,965 44,205 Table showing the number of Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1938. Date. Dispensary. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Year Total. Attendances Northern 538 420 568 387 453 377 326 444 446 429 416 258 5,062 9,705 Southern 404 407 489 363 415 358 326 313 365 416 457 330 4,643 New Cases, including Contacts Northern 83 77 86 75 89 83 49 77 75 75 70 52 891 1,448 Southern 38 61 71 36 50 39 30 48 36 63 51 34 557 Contacts. Tuberculous Northern 4 1 3 2 — — 2 — 2 — — 3 17 32 Southern 3 1 1 — 1 2 — 2 3 1 1 — 15 Suspects Northern 3 1 — 1 3 — 1 3 2 1 1 — 16 30 Southern — 3 2 3 — — 2 2 — 1 1 — 14 Non-Tuberculous Northern 23 26 35 20 25 31 13 25 23 36 30 11 298 495 Southern 10 19 16 9 24 13 12 20 17 27 22 8 197 *Nurses' Visits Northern 102 89 119 108 121 106 90 114 117 100 95 80 1,241 3,217 Southern 170 153 172 160 160 153 186 180 170 182 168 122 1,976 Tuberculosis Officers' Visits Nothern 30 21 31 25 18 29 6 22 12 16 18 12 240 432 Southern 15 17 20 11 18 15 13 13 16 14 19 21 192 * See, in addition, Municipal Tuberculosis Visiting Nurse, page 104. 104 1938] SUPPLY OF EXTRA NOURISHMENT TO TUBERCULOUS PATIENTS. Report of Assistant Medical Officer of Health. The conditions under which extra nourishment was granted to patients upon the recommendations of the Tuberculosis Officers were set out in the Annual Report for 1937. During the year 1938, the scheme was extended and Tuberculosis Officers are now permitted to recommend, in addition to one pint of milk and one egg per day, an additional pint of milk, one extra egg, butter up to one pound per week, and fish up to two pounds per week, as they consider suitable for the particular case. The Tuberculosis Officers consider the provision of additional nourishment to be valuable, and the number of patients recommended by them shows an increase over the previous year. During 1938, 125 patients were recommended and supplied with nourishment under the Council's scheme at a cost of £298 15s. 3d. Pneumothorax Treatment was administered to 94 patients at a cost of £335 4s. 2d. Light Treatment.—No patient was treated by Finsen Light during the year. One patient was given "Kromeyer Lamp" treatment during the year at a cost of £19s. Od. HOME VISITATION—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1938, to 31st December, 1938. Month. North South Dispensary. Dispensary. Total. January 141 145 286 February 133 131 264 March 153 135 288 April 108 105 213 May 160 119 279 June 118 123 241 July 90 54 144 August 152 148 300 September 134 83 217 October 148 121 269 November 156 136 292 December 127 84 211 Total 1,620 1,384 3,004 TUBERCULOSIS—HOUSING. The practice of visiting houses in which tuberculous patients reside to ascertain the sanitary conditions was continued during the year, and 433 visits were made for this purpose. Most of the houses visited were found to be in a good state of sanitation but in 25 instances the conditions were considered very unsatisfactory, and in 58 minor defects were discovered. In each instance a notice was served for the defects to be remedied. 105 [1938 The following statement will give an idea of the state of the premises when visited:— Houses in bad sanitary condition 25 Houses in good sanitary condition 274 Houses in which minor defects were discovered 58 Patients removed to another address 76 433 Patients deceased (and where immediate enquiry was not considered necessary) 71 Patients in Mental Hospital 2 Resident in a clearance area 10 Not visited (by request) 5 521 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These Regulations provide that no person suffering from respiratory tuberculosis who is in an infective condition shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk, or the handling of containers. No such case came to our knowledge during the course of the year. ISLINGTON TUBERCULOSIS CARE COMMITTEE. A summary giving the aims and examples of the work effected by this Committee was given in last year's report, and a separate report for the year under review was issued by the Committee. The constitution of the Committee up to the 31st October, 1938, is as follows. It will be noted that there is slight variation from year to year, and the Committee have lost, through death, the keen, earnest membership of Councillor W. Harper. Members of Tuberculosis Care Committee. Chairman: Alderman H. J. L. Lygoe. Vice-Chairman: Councillor C. E. Ratcliffe. Secretary: Miss K. I. C. Hadley. Hon. Treasurer: Mr. G. H. Meakin. The members of the Public Health Committee of the Borough Council Aldermen Lygoe; Councillors Bennett, Mrs. G. D. Cantwell, Evans, W. Harper, Herrington, Keer, Knight, McColgan, Ratcliffe, Ricketts, Rogers, Sargent, F. Stonham, Mrs. Summers, Mrs. Thurtle. and Willis. The Borough Medical Officer of Health Dr. G. Clark Trotter. The Assistant Medical Officer of Health Dr. Victor 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. The representative of the Public Assistance Area Committee Mrs. E. E. Bull, L.C.C. Representatives of the London Insurance Committee Mr. C. W. Shaw; Mr. J. C. Gilbert. The representative of the Local Panel Practitioners Dr. J. Liddell. The representative of the Local War Pensions Committee Vacant. The representative of the Local Hospitals Miss E. M. Howes. The representative of the Local Branch of the Invalid Children's Aid Association Mrs. Watt. Member of the North London (Islington) District Nursing Association Miss H. F. G. Piper. British Legion and United Services Fund Mrs. Stevenson; Mr. A. E. Hocking. Islington Committee of the Charity Organisations Society Miss L. E. Hartley. Social Work Mrs. A. Twidell. 106 1938] During the year there have been 407 new cases, as compared with 400 in the previous year; 1,178 visits compared with 1,314; 2,269 letters as compared with 1,650; 1,006 interviews as compared with 855; and 1,266 telephone calls as against 919. It will be seen from these figures that the out-door work is somewhat lessened and the office work very materially increased. Without in any way disparaging the indoor work, much of which is due to "Seal Sale" work and the collection of the voluntary contributions, all very necessary, it must be borne in mind that the real effectiveness of a Care Committee is the personal contact with the patients and families at home; the home visitation must not be allowed to get less, but must tend to increase, and there is room for all the voluntary assistance that can be obtained. Emphasis must be placed on the long and sustained help that has been obtained from the Social Worker Member. All the Committee have been assiduous in their attend ance, and the Islington Committee compares most favourably with any other Care Committee. The financial support from outside sources comprised the Christmas Seal Sale proceeds, the proceeds of a sale held locally by a member of the Committee, special and other donations. VENEREAL DISEASES. 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 the Medical Officer of Health personally advises applicants as to what they should do to secure the necessary confidential treatment. Mr. George Jewsbury, 46 Ibervey Close, Church End, N.3, 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 1938:— "Our activities have been somewhat small compared with previous years, but the following engagements are recorded:— Open air meetings at Highbury Corner were held by Capt. Buckley which were attended by appreciative audiences varying from 100 to 200 persons, who listened attentively to the details of the work of the British. Social Hygiene Council. It appears evident that subjects relating to physical conditions help to a better understanding of human nature." 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 five of the largest hospitals. During the year under review 21 patients received this assistance from the Borough Council, the cost of the Insulin supplied being £41 10s. lOd. LEPTOSPIRAL JAUNDICE. No case of this disease is known to have occurred in Islington during 1938. 107 [1938 CANCER HOUSES—SO-CALLED. While the exact cause of Cancer still remains the subject of research, it has always been deemed expedient to sympathetically consider requests for disinfection after cancer deaths. There are still ardent believers in "Cancer" houses who strive to support their idea that certain premises are prone to recurrence of cancer cases, and that the cases exceed what might be expected as ordinary chance. Dr. W. E. Snell, Tuberculosis Officer for North Islington, was granted permission to search our accumulated death records, and with the assistance of Mr. H. A. Bathurst, B.A., shows that there is no evidence to support belief in cancer houses. The results of this work were published and the main points are here recorded. THE DISTRIBUTION OF CANCER. With Special Reference to the Metropolitan Borough of Islington, by W. E. Snell, M.A., M.D., M.R.C.P., D.P.H., and H. A. Bathurst, B.A. Local variations in the incidence of cancer have always been and still remain a matter of controversial opinion. The question is of obvious importance as having some bearing on the infective theory of cancer. The subject, however, appears to have received little scientific attention in recent years in this country with the exception of a paper by P. Stocks (1935). Previous Investigations. Leeson (1908) investigated the cancer deaths, numbering 248, which had occurred at Twickenham over a period of twenty-one years, and showed that all but four were found in separate houses. L. Sambon (1926), as the result of investigations in Italy, Holland, and other countries, vigorously supported the existence of " cancer houses." P. Stocks (1935) analysed 2,895 cancer deaths at Bristol and 694 deaths at Worcester, and concluded that the distribution of cancer in these districts was a purely random one, taking into account the tendency of persons of cancer age to be grouped in certain houses or districts. More recently Leyton and Leyton (1937) have investigated the regional distribution of cancer in the Oxford area, and conclude from the grouping of cases that this does not follow the laws of chance, but they give no detailed calculation in support of this opinion. The Present Investigation. This comprises the deaths from cancer occurring in the Metropolitan Borough of Islington during the years 1932-6 inclusive. The total cancer deaths during the five years numbered 2,464 cases in which it may fairly be assumed that the disease arose or existed at the address given, the patients dying in their homes or in hospitals for acute diseases in the vicinity. Tables were constructed for the whole of Islington, street by street, comprising about 1,000 streets, terraces, blocks of flats, and mews, and the exact address of each case was noted. For reasons of space it is impossible to reproduce these tables. The summarised results are as follows:— 1 cancer case in a house 2,322 houses. 2 cancer cases in a house 68 ,, 3 „ „ 2 „ 108 1938] Now it is possible to calculate the expected distribution of cases, supposing they were to follow a chance distribution, using the formula : MnCrprqn-', where M denotes the number of inhabited houses (45,000) and n the number of cancer deaths (2,464), p= ^//Mand q = 1 — 1/M. If r has the values 0, 1, 2, 3 in succession, the formula gives the number of houses in which 0, 1, 2, 3 deaths, respectively, may be expected to occur. This formula applied to the spread of cancer is at first sight open to the following objections:— 1. The probability that a case will occur is not constant, but varies from house to house according to the number of occupants who are of "cancer age." 2. Multiple cases cannot occur except in houses where two or more people are of "cancer age." 3. When one death has occurred in a house the probability of a second case in a house will in general be reduced owing to the reduction of the number of persons at risk in the house. Closer mathematical investigation, however, shows that when these three factors are taken into account the formula still gives a very close approximation to the distribution which is to be expected on the hypothesis of chance. Comparison of Observed and Expected Results. The observed results and expected results show the following comparison Observed Distribution. Calculated Distribution if due to Chance. 1 in a house 2,322 houses 1 in a house 2,333 houses 2 ,, ,, 68 ,, 2 ,, 64 ,, 3 ,, ,, 2 ,, 3 ,, 1.16 ,, It must be admitted that these figures reveal a striking similarity, and leave no doubt that the house-to-house distribution of cancer in Islington is of a chance nature. It is interesting to compare the above figures with the results given by the application of the same method to the deaths from cancer which occurred a few years earlier in the two boroughs investigated by P. Stocks. Observed Distribution. Islington Bristol Worcester Totals Houses with 0 case 42,608 69,648 10,879 123,135 „ 1 2,322 2,757 658 5,737 ,, ,, 2 cases 68 64 18 150 „ ,, 3 or more 2 3 0 5 Calculated Distribution. Houses with 0 case 42,602.22 69,634.04 10,880.82 123,117.08 ,, 1 2,332.76 2,781.68 654.45 5,768.89 ,, 2 cases 63.84 55.54 19.63 139.01 ,, ,, 3 or more 1.18 0.75 0.10 2.03 109 [1938 The number of houses having three or more cases is so small that the excess of the observed over the expected number cannot be regarded as significant. However, in the case of Bristol, as we have already noted, this excess can be fully explained by the segregation in certain streets of a number of persons whose ages range from 55 to 75. When we bear in mind that these tables relate to 129,000 inhabited houses it can scarcely be disputed that the incidence of the disease is in accordance with the laws of chance. If there were any appreciable tendency for the disease to spread from one person to another in the same house or to people in adjacent houses a very considerable increase in the number of multiple cases would be expected. The figures for Islington relate to a considerable area of the Administrative County of London, which has similar environmental circumstances to, and merges imperceptibly into, the remainder of London. It therefore seems not unfair to assume that what holds good for this borough will probably hold good for the remainder of London, and not improbably for other areas. Reverting to the paper by Leyton and Leyton (1937) the authors dealt with a mixed urban and rural area, the latter of which cannot be compared with a metropolitan borough, where the environment is comparatively standardised. In the rural area there are possibly variations in water supply, drainage, and other factors in the various areas. But if we consider the figures given for the city of Oxford, 123 only in number, it seems fair to suggest that in the light of the results obtained at Islington and elsewhere no definite conclusions can be drawn from such acomparatively small series of cases ; moreover, it is a mistake to assume that a chance distribution is an even distribution unless a very large number of cases are considered. Summary. 1. The house-to-house distribution of 2,464 cases of cancer occurring in Islington during the years 1932-6 has been analysed. 2. It is shown that this distribution corresponds very closely with the expected distribution calculated according to the laws of chance, the criterion being the number of houses in which multiple cases occur. 3. This correspondence is no less striking when the Islington figures are combined with those obtained (by P. Stocks) at Bristol in the years 1922-7 and at Worcester in the years 1921-30. 4. It is argued that theories based on the grouping of cases in particular areas are often misleading. 5. It is suggested that the distribution of cancer in general follows the laws of chance so closely that it is superfluous to introduce any other hypothesis to account for it. 6. These facts are some evidence against an infective or contagious theory of cancer spread, and invalidate any remaining belief in "cancer houses." References. Leeson, J. p. (1908). Practitioner, 80, 256. Leiper, R. T. (1926). Rep. Brit. Emp. Cancer Camp, for 1925. Leyton, G. B., and Leyton, H. G. (1937). British Medical Journal, 2, 378. Sambon, L. (1926). J. Trop. Med., 29, 233. Stocks, P. (1935). J. Hyg., 35, 46. * The full paper was printed in the British Medical Journal Supplement, 3/9/38, and I am indebted to the Editor for permission to extract the salient points.—G.C.T. 110 1938] DISINFECTION. Disinfection of Rooms.—2,099 rooms were disinfected, as contrasted with 2,173 in 1937. 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. The above figures also include the disinfection of houses and rooms after Tuberculosis, vide p. 100. Rooms Disinfected. 1938 1937 1st Quarter 705 463 2nd ,, 589 502 3rd ,, 376 547 4th ,, 429 661 The Year 2,099 2,173 Work at the Disinfecting Station.—35,791 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors at the Council's Disinfecting Station, compared with 39,296 similar articles disinfected during the previous year. In addition 10 the above articles, 107,866 second-hand garments and 4 tons 18J cwts. Blanket Rags were disinfected for clothing contractors trading in the Borough, who paid the Council the sum of £32 12s. Od. for the work. Altogether 143,657 articles described in the two paragraphs preceding, and 4 tons 18 cwt. 1 qr. of Blanket Rags were disinfected. Summary of the chief articles oj Clothing, Bedding, etc., disinfected, during the year 1938, and also in the preceding year 1937. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1938. 1937. Beds 356 283 282 380 1,301 1,561 Blankets 1,147 1,023 822 1,088 4,080 4,355 Bolsters 246 221 237 245 949 1,070 Carpets — — — — — 21 Cushions 90 81 98 133 402 801 Mattresses 446 467 403 446 1,762 1,859 Pillows 1,024 882 884 1,055 3,845 . 4,234 Pillow and Bolster Cases 699 605 594 634 2,532 2,627 Quilts 548 418 302 405 1,673 1,723 Sheets 925 860 643 804 3,232 3,463 Other Articles 4,761 4,235 2,805 4,214 16,015 17,582 Totals 10,242 9,075 7,070 9,404 35,791 39,296 111 [1938 The nature of the articles disinfected for the clothing contractors is shown below:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Blankets 306 500 700 100 1,606 Garments 4,252 29,666 11,999 25,521 71,438 Other articles 6,040 15,242 3,640 9,900 34,822 Total 10,598 45,408 16,339 35,521 107,866 Blanket Rags — — 79 cwts. 19 1/4 cwts. 98 1/4 cwts. Disinfectants Distributed and Used.—The following statement gives the quantity of disinfectants distributed by the Sanitary Authority, or used in disinfecting and cleansing rooms:— To householders:—Carbolic powder, 10 cwts. *Disinfectant fluid, 20 galls. * Strong disinfectant is diluted before distribution in place of the former weaker disinfectant used. The figure given is as distributed, Formaldehyde Solution, 20 galls., were used for spraying premises after infectious diseases. 4 galls, of concentrated special fluid (increased to 40 galls, by dilution), and 5 cwts. of sulphur candles were used in the fumigation of verminous premises. Shelter House.—The Shelter House was not occupied during the year; baths were given to 28 verminous persons while their clothing was disinfected, 6 of whom were sent from a Common Lodging House, 1 tramp and 1 from Police cells 35 other persons who had been in contact with cases of infectious diseases, 23 of whom were employed in handling food, also had baths and their clothing disinfected. Baths were provided for 72 persons who were suffering from Scabies (a series of 3 baths in each case), making a total of 216 baths. 112 1938] APPENDIX. SUMMARY OF PROSECUTIONS DURING YEAR 1938. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties. Costs received. £ s. d. £ s. d. Public Health (London) Act, 1936 9 8 — 1 13 10 0 13 8 0 Food and Drugs (Adulteration) Act, 1928 6 6 - - 8 7 0 27 5 0 Milk and Dairies (Consolidation) Act, 1915, and Milk and Dairies Order, 1926 3 1 - 2 - 0 10 0 London County Council (Drainage) Bylaws 8 6 1 1 7 0 0 4 0 0 Merchandise Marks Act, 1926 3 3 - - 2 2 0 3 2 0 Housing Act, 1936 5 — — 5 — — Rats and Mice (Destruction) Act, 1919 1 1 - - 1 0 0 1 0 0 Pharmacy and Poisons Act, 1933 4 4 — - 4 3 0 4 3 0 Totals 39 29 1 9 37 2 0 53 8 0 NEW LEGISLATION. (Enacted or coming into force during 1938.) Food and Drugs Act, 1938 (comes into operation 1st October, 1939). London County Council (General Powers) Act, 1938. The Increase of Rent and Mortgage Interest (Restrictions) Act, 1938. The County of London (Measles and Whooping Cough) Regulations, 1938. Public Health (Aircraft) Regulations, 1938. Factories—The Sanitary Accommodation Regulations, 1938. Hydrogen Cyanide (Fumigation of Buildings) Regulation, 1938. The Poisons List (Amendment) Order, 1938. The Poisons (Amendment) Rules, 1938. Milk and Dairies (Amendment) Order, 1938. The Milk (Special Designations) Amendment Order, 1938. The Milk and Dairies Acts and Orders—Tuberculosis Order, 1938. The Factories (Cleanliness of Walls and Ceilings) Order, 1938. The Factories (Transfer of Enforcement) Order, 1938. Circulars 1696 and 1697, and Memo. 212, Housing (Financial Provisions) Act, 1938. Circular 1684—Water Supplies, Ministry of Health. Circular 1724—Ministry of Health—Smallpox. Circular 1755—Ministry of Health—Food and Drugs Act, 1938. Factories Act, 1937. Memorandum of Home Office—(Duties of Local Authorities under the Factories Act, 1937). Memo. 215/Med, Ministry of Health—Smallpox. Agricultural Produce (Grading and Marking) Beef Regulations, 1938. Agricultural Produce (Grading and Marking) (Cauliflower and Broccoli) Regulations, 1938. 113 [1938 PROPAGANDA. The propaganda work, which was extended in 1937, was continued during the year by the issue of the booklet "Summary of Health Services provided for Islington Citizens"; leaflets explaining the need for protection against Diphtheria, and the birthday greeting card, which was accompanied by notes on what a parent might reasonably anticipate of his child regarding normal physical and mental progress after the first twelve months, together with some hints on dieting and feeding. An extended poster propaganda was inaugurated during the year by the exhibition, on selected sites, of posters throughout the Borough; the subjects varied from time to time, and related to "National Hsalth," "Safety Week," "National Baby Week," "Milk," and "The Care of the Teeth." The following is a summary of Posters exhibited, together with the number of special booklets and leaflets distributed. Subject. No. of Posters. 70 " National Health." 48 "Safety First." 54 "National Baby Week." 37 "Milk." 500 "Rat Week." 48 "The Care of the Teeth." No. of Booklets. 14,159 " Health Services of the Borough." ,, Leaflets. 4,000 "Your Teeth, Your Health, and Your Baby's Teeth." 3417 "Diphtheria Immunisation." 3417 "Birthday Greeting Cards." 3417 "Hints on Dieting and Feeding." In addition booklets were distributed on "The Care and Feeding of Infants," also those relating to the prevention of the spread of infectious diseases—flies, rats and mice destruction, etc., and lectures were given by the Medical Officer of Health and members of the staff. Two film displays were given, one on the 7th March at the North Islington Library, Manor Gardens, Holloway, and one at the Central Library, Holloway Road, on the 15th March, when, following an opening address by Alderman H. J. L. Lygoe, Chairman of the Public Health Committee, the following films were exhibited to appreciative audiences:— Sound Film "Citizens of the Future." „ "Progressive Training in Ball-handling Games." „ „ "The Conquest of Tuberculosis." Silent Film "Silver Lining." ,, „ "Food for Thought." 114 1938] 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 Sewer 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. Annual Report 1937. Page 3 Social Conditions. Pages 7-9 Infantile Mortality. Pages 18 and 19 Diphtheria Prevention. Page 23 Dysentery. Page 24 Anthrax. Page 27 Tuberculosis Care Committee. Page 34 Tuberculosis—Extra Nourishment. Page 37 Leptospiral Jaundice. Page 41 Disinfestation. Pages 49 and 62 Merchandise Marks and Agriculture Product (Marking and Grading) Acts. Page 52 Infirm Persons. Page 54 Swimming Baths and Pools. Page 64 Food Poisoning. Page 73 Propaganda. Page 76 Miriam Price Coleman Day Nursery and Sunlight Clinic. Page 85 Emergency Maternity Unit. Page 86 Consultative Ante-Natal and Post-Natal and Minor Gynaecological Clinic. Page 90 Midwives Act, 1936. 115 [1938 INDEX Page Accidental Deaths 9, 14 Acute Poliomyelitis 92 Adulteration of Feod 79—83 Ages at Death 6 Agricultural Produce (Grading & Marking) Acts, 1928 &1931 77 Ambulance Facilities 18 Anthrax. 12, 93 Anti-toxin treatment 87 Appendix „ 112-114 Area of Borough 2 Artificial Cream Act 73, 74 Artificial Sunlight Treatment 19, 41 Attack Rates—Infectious Diseases 91 Bacteriological Examinations 79, 95, 90 Bakehouses 56 Basement Rooms 67 Births 2, 3, 4, 5 ,, Illegitimate 3,5 ,, Notification of 5 ,, Stillborn 5 Blind Persons Act, 1920 42 Bugs, Eradication of 52-55 Butter Blending 78 Cancer 3, 12 Cancer Houses—so-called 107-109 Census Information 2 Centenarians 6 Certification of Meat Food Products 78 Chicken Pox 93,96,97 Child Guidance Clinic 19 Child Life Protection 25, 2fi Clearance Areas 70 Clinics 19, 21, 31, 38, 41, 87, 88 Coal gas Poisoning 14 Common Lodging Houses 49 Condensed Milk Regulations 83 Consultant—Obstetric cases 32 Coroner's Court, &c. 14 Cream 73 Dairies and Milkshops (Inspection of) 73, 74 Day Nurseries 19, 38-41 Deaths from all causes during the year 2,3,5,15 Deaths from Epidemic Diseases 2, 9, 10, 11 „ of Infants 2, 3, 6, 7, 8 ,, Respiratory Diseases 14 „ in Public Institutions 9 „ and Death Rates 2, 3, 5, 6 „ Maternal 32-34 ,, Ages at 6, 16 Demolition Orders 66 Deafness, Prevention of 43 Density 2 Diarrhoeal Diseases (see also Enteritis) 3, 10 Diphtheria 16, 87, 88 „ Anti-toxin treatment and immunisation 19, 87, 88 116 1938] Page Diseases of Animals Acts 77 Diseases Treated in Hospital 89, 90 Disinfectants distributed and used 111 Disinfecting Station 110, 111 Disinfection Work 52-55 Disinfestation of bedding and rooms 55 Disinfestation of School Children 55 Dispensaries 19 District Inspectors' Work 45-50 Dried Milk Regulations 83 Dust, removal of 45 Dysentery 92 Eggs—Storage of 78 Emergency Maternity Unit 32 Encephalitis Lethargica 93 Enteric Fever (Typhoid) 10, 88, 92 Enteritis (see also Diarrhceal Diseases) 10 Epidemic Cerebro-Spinal Meningitis 92 „ Diseases 9 Erysipelas 12, 89 Extra Nourishment 104 Factories Administration 55-58 Fatality from Notifiable Infectious Diseases 89 Finsen Light Treatment 104 Food and Drugs, Examination of 79-83 Food, Inspection of, Unsound 75-76 Food; Licensed Street Traders 78 Food Poisoning 78, 79 Food: Protection of 77 Gas (Coal) Poisoning 14 Glanders, Anthrax and Hydrophobia in Man 12, 93 Grants 31, 38 Health Propaganda 113 Health Visitors (Municipal) 22, 23, 24 Home Helps 38 Home Visitations—Tuberculosis 104 Hospital Grants 38 Hospitals—Public and Voluntary 20 Hospital Isolation of Infectious Diseases 89, 90 Houses Let in Lodgings 48 Housing 61-72 „ —Accommodation and Recommendations 67 „ —Tuberculosis 104 Ice Cream Premises 73, 74 Illegitimate Births 3,5 Immunisation, Diphtheria 87, 88 Industrial Diseases 12 Infantile Mortality 2, 3, 6, 7, 8 Infant Welfare Work 20-43 Infection, Prevention of 84 Infectious Diseases—Deaths 2, 9, 10, 11 Infectious Diseases (London) Regulations, 1927 92 Infectious Diseases (Notifiable) 84-94 Infectious Diseases in Schools 96 „ „ (Non-Notifiable) in Schools 96 Infirm Persons 49 Informal Sampling 81 117 [1938 Page Influenza 11 Inhabited houses. Number of 2 Inspection of Food 73-83 ,, ,, Houses 45-60, 71 ,, „ Kitchens of Restaurants 77 „ Milkshops and Dairies 73 ,, „ Slaughter Houses 75 ,, ,, Workshops 56—58 Institutions 20 ,, (Deaths in) 9 Inquests 14 Insulin (Supply of) 106 Invalid Children's Aid Association 42 Islington (Chickenpox) Regulations 93 Islington Tuberculosis Care Committee 105, 106 Isolation of Infectious Diseases 89, 90 Kitchens and Restaurants 77 Laboratory Facilities 18 Lead Poisoning, Chrome, etc. 12 Legal Proceedings, Summary of 112 Legislation, New 112 Leptospiral Jaundice 106 Light Treatment—Artificial Sunlight and "Finsen" 104 Malaria 92 Malignant Diseases 12 Marriages 3 Margarine and Margarine Cheese 78 Maternity and Child Welfare Committee 111 Maternity and Child Welfare Work 20-43 Maternity Consultative Clinic 32 Maternal Deaths 32-34 Measles (Deaths) 3, 10 Measles (Measles and Whooping Cough Regulation, 1938) 91 Measles, Notifications by School Teachers 96 Meat, labelling of 77 Meat Inspection 75, 76 Medicines, Provision of 106 Merchandise Marks Act, 1926 77, 81 Midwives Services—Midwives Act, 1936 36,37,38 Ministry of Health Returns 16, 71, 72, 94 Milk and Dairies Acts 73, 74, 83 Milk and Dairies Order, 1926 73, 74 Milk, Bacteriological Analyses 79 Milk Adulteration 82, 83 ,, Scheme 42 Milk Purveyors and Dairies 73, 74 „ Special Designations Order 73, 74 Mortuary and Coroner's Court 14 National Society for the Prevention of Cruelty to Children 42 Noise, Nuisance from 45 Non-notifiable Infectious Diseases in Schools 96 Notices served 45, 50, 51, 57, 59, 68, 74 Notification of Births 5 „ „ Infectious Diseases 84 ,, ,, Still-births 5 ,, ,, Tuberculosis 97-100 Nursery School 19 118 1938] Page Nursing in the Home 18, 36, 92 Offensive Trades 77 Ophthalmia Neonatorum 35, 36, 91 Outworkers' Premises 58 Overcrowding, Abatement of 61-66 Pathogenicity Tests (Diphtheria) 95 Pemphigus Neonatorum 36 Pharmacy and Poisons Act 60 Pneumonia 14, 92 Pneumothorax treatment 104 Poisoning (Gas) 14 „ (Lead) 12 Polioencephalitis 92 Poliomyelitis, Acute 92 Population at the Census, 1931 2, 3 estimated, 1938 2, 3 Preserved Food (a) Inspectors' Visits 78 (b) Registration of Premises 78 Prevention of Deafness 43 Prevention of Infection 84 Propaganda 113 Prosecutions 80, 112 Public Health Committee 111 Public Health (Meat) Regulations, 1924 77 „ „ (Tuberculosis) Regulations, 1930 98-100 Public Vaccinators 86 Puerperal Diseases (Deaths) 3,12,35 Puerperal Fever and Pyrexia 12, 35, 89, 91 Pulmonary Tuberculosis 97-100 Rag and Bone Dealers 47 Rag Flock 47 Rateable Value 2 Rats and Mice (Destruction) Act, 1919 49, 50 Recommendations—Housing 67 Reconditioning of Houses 68 References—M.O.H. Reports 114 Rent and Mortgage Interest (Restrictions) Acts 47 Representations of Medical Officer of Health 70 Respiratory Diseases (Deaths) 14 „ Tuberculosis 13, 97 Restaurant Kitchens 77 Rooms Disinfected and Disinfested 55, 110 Samples Analysed in 1938 79-83 Sanitary Inspectors' Work (District) 45-50 Sanitary Work (Summary) 58, 59 Scavenging 44 Scarlet Fever 10, 88 Scholefield Road Day Nursery 38, 39, 40 School Clinics 19 Schools 55 Septic Diseases 12 Shelter House 111 Shops Act, 1934 51 Shops, Inspections of 51 Slaughterhouses 75 Slaughter of Animals Act, 1933 77 Small Pox 10, 85 119 [1938 Page Smoke Abatement 51, 52 Social Conditions 17 Sophistication of Milk 82 Specialist Consultations 32 Staff 1 Statistics 2-16 Still-Births, Registration 3, 5 Street Accidents 14 Street Traders 78 Swimming Baths and Pools 52 Tetanus 12 Treatment Centres and Clinics 19 Tuberculosis 12, 13, 97—106 Tuberculosis Care Committee 105-106 Tuberculosis Dispensaries 19, 101-103 Tuberculosis—Disinfection and Housing 100, 104 ,, Notification of97-100 „ (Public Health) Regulations, 1930 98 „ Respiratory, All forms, Deaths 2, 13 „ Visiting Nurse ••• 104 Tuberculous Meat 75 Typhoid Fever (see Enteric) 10, 88, 92 Unemployment 17 Unsound Food, Destroyed 75, 76 Unsound Food 76 Vaccination 85, 86, 87 Vaccination (Public Vaccinators) 86 Venereal Diseases 14, 19, 106 Verminous Children, Disinfestation of 55 ,, Premises, furniture and bedding 52—55 Vital Statistics—Summary 2 „ Extract 3 Voluntary Maternity and Child Welfare Centres 19, 21, 27-31 Water Certificates 47 Water Supply 47 Water (Swimming bath and domestic supply) 52, 80 Welfare Work by Health Visitors 22, 23, 24 Whooping Cough (Deaths) 3, 10 ,, ,, (Measles and Whooping Cough Regulations, 1938) 91