STO 66 THE Metropolitan Borough of Stoke Newington Report OF THE Medical Officer of Health and Public Analyst, FOR THE YEAR 1917. BY HENRI: KENWOOD, c.m.g., m.b., f.r.s.e., dph., f.c.s., Chadwick Professor of Public Health, University of London, Medical Officer of Health and Public Analyst. LONDON: Printed by WILKINSON BROS., LTD., 1-9, Green Lanes, N. 16. TABLE OF CONTENTS. Vital Statistics— Page Population of the Borough and of each of the two Divisions 226 Births and Birth-rate 226 Mortality, Death-rates and causes of Mortality—with notes thereon 227—232 Infantile Mortality 229-231 Infant Care Work 231 The Mortuary and Inquests 233-234 Infectious Diseases and the Measures taken to Prevent their Spread— The Infectious Sickness Returns for the Year 234-242 Scarlet Fever 236 Enteric Fever 236 Diphtheria 237 Measles and Whooping Cough 238 Puerperal Fever 239 Consumption 239-241 Cerebro-Spinal Fever and Acute Polio-Mvelitis 242 The Disinfecting and Cleansing Station 242 Notes upon Sanitary Work Performed during the Year 242-245 Food Inspection 243 The Housing and Town Planning Act, 1909 243 Factories and Workshops 243-245 Food and Drugs246-248 Report of the Chief Sanitary Inspector 248-253 Streets in the Borough of Stoke Newington—(Appendix) 254-255 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1917. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen,— The vital statistics of the Borough for the year 1917 are less satisfactory than those for 1916. The general death-rate of 14*1 is a low one, but there were 9 of the 28 Metropolitan Boroughs with rates lower than this. The death-rate from the chief infectious diseases was also low; and the rate of infant mortality (the number of deaths under one year of age to every thousand births) was 85'6, as compared with 103 for London generally. An epidemic of measles and whooping-cough and a much increased number of deaths among those of 70 years and upwards, were mainly responsible for the less favourable vital statistics of the Borough for 1917 as compared with the preceding year. In accordance with a suggestion from the Local Government Board, the report has been made as short as possible. It is little more than a bare statistical record of the mortality and sickness within the Borough during the year 1917. It will be seen that, in all the circumstances, a satisfactory amount of public health work has been performed during the past year. I have pleasure in testifying to the efficiency and zeal of the workers in my department. I am, Gentlemen, Your obedient Servant, April, 1918. HENRY KENWOOD. 226 POPULATION. In this Report the rates are based on an estimated civil population of 49,776. The estimated population for each of the Sub-districts is as follows :— The Northern Division of the Borough (lying North of the middle line of Church Street) has a population of about 16,755 ; and in the Southern Division the population is approximately 33,021. The natural increase of population by excess of births over deaths during the year amounted to only 71, as against 377 in the preceding year. BIRTHS. During the year 1917 there were only 771 births, viz. :—410 males and 361 females. The birth-rate per 1,000 per annum was therefore 15.5, as against 20.1 for the preceding year. Year. Birth-rate Kate for London generally. Rate for England and Wales. 1912 20.4 24.7 23.8 1913 22.0 24.5 23.9 1914 20.4 24.6 23.6 1915 18.4 22.6 21.8 1916 20. 1 22.2 21.6 1917 15.5 17.5 17.8 The illegitimate births numbered 26 ; 11 males and 15 females. During the year the births notified under the Notification of Births Act have been compared with the births registered by the Registrar of Births, and the respective figures are 620 and 771. 227 MORTALITY. General Mortality.—There were 440 deaths of residents registered in the Borough, and 260 of residents who died in Public Institutions outside of the Borough, making a total of 700 deaths. Of these 365 were of females, and 335 were of males. Year. General Death-rate. Rate for London generally. Rate for England and Wales. 1912 11.6 13.6 13.3 1913 13.1 14.2 13.7 1914 12.3 14.4 13.6 1915 14.6 16.1 15.1 1916 12.6 14.3 14.0 1917 14.1 15.0 14.4 The recorded general death-rate is therefore 14.1, as against 12'6 for the preceding year. The so-called " factor for correction" for the Borough of Stoke Newington is 0.9512, and the death-rate corrected for age and sex distribution is 14.1 x0.9512=13.4 per 1,000 per annum. The recorded rate is above that for the preceding year, when it was 12.6. This increase is almost entirely due to more deaths from Measles, Cancer, and Senility. The death-rate for the whole of London was 15.0. District Mortality. — The deaths among residents of the Northern Division of the Borough numbered 212, and furnished a recorded death-rate of 12.6 per 1,000 per annum. The deaths among the residents of the Southern Division of the Borough numbered 488, and furnished a recorded death-rate of 14.8 per 1,000 per annum. 228 TABLE I. CAUSES OF AND AGES AT DEATH DURING THE YEAR 1917. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Total Deaths whether of Residents " or " NonResidents" in Institutions in the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Cerebro-spinal Meningitis 4 2 1 — — 1 — — — — Enteric Fever — — — — — — — — — — Acute Polio-myelitis 1 — — — — — — 1 — — Measles 18 3 9 4 2 — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough 6 5 1 — — — — — — — Diphtheria and Croup 10 1 1 4 4 — — — — — Influenza 8 — — 1 — — 1 2 4 2 Erysipelas — — — — — — — — — — Phthisis (Pulmonary Tuberculosis) 53 — — — 5 6 23 15 4 — Tuberculous Meningitis 9 1 2 3 2 1 — — — — Other Tuberculous Diseases 8 2 1 1 2 — 2 — — — Cancer (Malignant Disease) 87 — — — — 1 8 39 39 6 Rheumatic Fever 2 — — — 2 — — — — — Meningitis 5 2 — 2 — — — — 1 — Organic Heart Disease 70 1 — — — 1 6 20 42 5 Bronchitis 61 4 — — — — 2 13 42 10 Pneumonia (all forms) 31 4 7 1 1 — 2 9 7 — Other Diseases of Respiratory Organs — — — — — — — — — — Diarrhoea and Enteritis 11 7 2 — — — 1 — 1 — Appendicitis and Typhlitis 3 — — — — — 1 1 1 — Cirrhosis of Liver 3 — — — — — — 3 — — Alcoholism 4 — — — — — — 3 1 — Nephritis and Blight's Disease 22 — __ 1 — 4 6 11 1 Puerperal Fever 2 — — — — 1 1 — — — Other Accidents and Diseases of Pregnancy and Parturition 3 — — — — — 3 — Congenital Debility and Malformation (including Premature Birth) 26 24 1 1 — — — — — — Violent Deaths (excluding Suicide) 15 — — 1 2 1 1 2 8 — Suicide 2 — — — — — — 2 — 1 Other Defined Diseases 164 5 — — 2 — 7 19 131 11 Diseases ill-defined or unknown 72 5 1 — 3 3 7 31 22 1 Totals 700 66 26 18 26 15 69 166 314 37 229 THE CAUSES OF DEATH.—These are fully set forth in Table I., in which it will be noted that the deaths are also apportioned to different age periods. Comparing this table with the corresponding table of the preceding year, the following facts are noteworthy : An increase in the deaths from Measles, Cancer, and Ill-defined Diseases (including Senility); and a decrease of those from Consumption. INFANTILE MORTALITY. There were 66 deaths registered of infants under one year of age, as against 771 births ; the proportion which the deaths under one year of age bear to 1,000 births is, therefore, 85.6, as against 59.8 in the preceding year. The deaths under one year of age form 9.4 per cent. of the total deaths at all ages, whereas those for the preceding year formed 9.6 per cent. Year. Rate of Infantile Mortality. Rate for London generally. Rate for England and Wales. 1912 70.7 90 95 1913 82.7 105 109 1914 78.7 104 105 1915 99.8 112 110 1916 59.8 89 91 1917 85.6 103 97 230 TABLE II.—INFANT MORTALITY. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER ONE YEAR OF AGE, 1917. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months.! 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Ccrebro - spinal Meningitis — — — — — — 1 — 1 2 Chicken Pox — — — — — — — — — — Measles — — — — — — — — 3 3 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — 1 1 3 5 Diphtheria and Croup — — — — — — — — 1 1 Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — 1 — 1 Abdominal Tuberculosis — — — — — 1 — 1 — 2 Other Tuberculous Diseases — — — — — — — — — — Meningitis (not culous) — — — — — — 1 1 — — Convulsions — 1 — — 1 — — — — 1 Laryngitis — — — — — — — — — — Bronchitis — — — — — 2 1 1 — 4 Pneumonia (all forms) — — — — — — — 1 1 4 Diarrhoea — — — — — 1 — — 1 Enteritis — — — — — — 2 2 1 3 Gastritis — — — — — — — — — — Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlying — — — — — 1 — — — 1 Injury at Birth — — — — — — — — — — Atelectasis — — — — — — — — — — Congenital Malformation 1 — — — 1 1 — — — 2 Premature Birth 16 — — — 16 1 — — — 17 Atrophy, Debility, and Marasmus 3 1 1 1 6 2 1 — — 9 Other causes — 1 1 1 3 2 — — — 5 Totals 20 3 2 2 27 11 9 8 11 66 231 A comparison of the causes of Infantile Mortality in 1917 with those of the preceding year shows an increase during last year in the deaths from Measles, Whooping-cough and Premature Birth ; and a decrease in those from Wasting and Debility. THE INFANT CARE WORK. Miss Reeve reports as follows :— " During the year 659 infants were visited in their homes. These visits were followed by 1,987 re-visits, making a total of 2,646. " The Milk Fund has been of great service throughout the year ; without it we should have had a larger number of babies hand fed, and much of the advice given to the mothers would have been useless. Seventy mothers were helped out of this fund during the year. These were nearly all soldiers' and sailors' wives. WORK AT THE CHILD WELFARE CENTRE. " During the year 352 children were brought to be weighed and for advice, and their total visits numbered 1,664. This branch of the work is still growing ; on some of the Thursday afternoons last year over 40 children attended. We are much indebted to Miss Sandeman, who gave her help on these afternoons throughout the year. " The number of attendances at the Mothers' Sewing Class was 500. This class is held on Tuesday afternoons, and during the year 383 garments were made. " Miss Baxter's help at this Sewing Class has been most valuable. She has superintended all the cutting out, and has entirely made many garments for mothers and children who have been unable—generally through illness—to attend. "We are also indebted to Mrs. Price and Miss Bray, who arrange to give the mothers tea on these afternoons." 232 SENILE MORTALITY.—Of the 700 deaths, 248 were of persons over 70 years of age. The proportion of deaths occurring among those of over 70 years of age to the total deaths is, therefore, 35*4 per cent. There were 98 deaths of persons over 80 years of age, and 10 of persons over 90—the oldest being 99. This is a remarkably high proportion of deaths over 70 years of age, which indicates that there is a relatively large number of old persons in the Borough, who contribute largely to our death-rate. SENILE MORTALITY DURING 1917. 70 to 80 80 to 90 90 and over Total 150 88 10 248 ZYMOTIC MORTALITY. Included in the Zymotic death-rate are the deaths from the seven principal Zymotic Diseases, viz.: Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, "Fever" (including Enteric Fever, Typhus Fever, and Simple Continued Fever), and Diarrhoea. The Zymotic Death-rate for the Borough was 0.90 per 1,000 per annum, as against 0.42 in the preceding year. The rate for London generally was 1.1. In 7 Metropolitan Boroughs this rate was lower than in Stoke Newington. CONSUMPTION. The death-rate for Consumption (Pulmonary Tuberculosis) in the Borough for 1917 was 1.0 per 1,000, as against 1.1 for London generally. 233 TABLE III. The chief vital statistics of the Borough of Stoke Newington since its formation. Year. Population estimated to middle of year. Birth-rate Rate of Infantile Mortality. General Death-rate Zymotic Death-rate Infectious Sickness rate. (Videp.234) 1901 51,328 21.6 117.9 13.1 1.26 7.9 1902 51,188 22.0 114.7 13.3 1.56 7.8 1903 51,130 21.5 120.3 12.6 1.70 3.8 1904 51.072 22.3 115.6 13.4 1.62 5.7 1905 51,015 20.9 124.7 13.0 1.35 5.8 1906 50,957 21.2 108.0 12.0 1.39 5.1 1907 50,899 20.5 97.9 11.8 1.33 7.8 1908 50,841 20.2 98.3 12.9 1.18 5.8 1909 50,784 19.5 84.9 11.7 0.87 3.5 1910 50,726 18.8 66.1 11.8 0.93 3.6 1911 50,669 20.7 106.2 12.5 1.69 4.4 1912 50,591 20.4 70.7 11.6 0.34 3.7 1913 50,514 22.0 82.7 13.1 0.85 4.6 1914 50,454 20.4 78.7 12.3 0.55 8.3 1915 50,527 18.4 99.8 14.6 1.21 7.0 1916 49,776 20.1 59.8 12.6 0.42 4.4 1917 49,776 15.5 85.6 14.1 0.90 3.6 THE MORTUARY. During the year 53 bodies were deposited in the Public Mortuary; 31 of these were females and 22 were males. Postmortem examinations were performed upon 37 of these cases, and inquests were held upon 51. 234 INQUESTS. 57 Inquests were held upon Deaths of Parishioners during the year 1917. INFECTIOUS DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table IV. that 1,224 Notification Certificates of Infectious Illness were received from medical practitioners. These figures include for the first time the notifications of cases of Measles. If we exclude these latter the Notifications of Infectious Diseases compare favourably with those during the preceding year (306 as compared with 347). In all infected homes the disinfection was performed by the Sanitary Authority. A visit was paid to every house, and it was ascertained that cases of infectious illness occurred in 4 houses where there were "grave" insanitary conditions. In 18 houses less serious insanitary conditions were found. The Infectious Sickness Rate of the Borough, excluding the notifications from Consumption, Cerebro-Spinal Meningitis, Acute Polio-Myelitis, Ophthalmia and Measles, so as to make the rate comparable with that of former years, was 3.6 to each 1,000 of the population, as against 4.4 for the preceding year. The rate in the Northern Division was 2.7 ; while that in the Southern Division was 4.0. Year. Infectious Sickness Rate. Rate for London generally. 1912 3.7 5.2 1913 4.6 6.7 1914 8.3 8.9 1915 7.0 8.3 1916 4.4 5.1 1917 3.6 4.2 TABLE IV. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1917. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality—(e.g., Parish or Ward) of the District. Total Cases removed to Hospital. 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 upwards 1 North Division 2 South Division Small Pox — — — — — — — — — — — Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Diphtheria, including Membranous Croup 110 2 30 61 9 7 1 — 27 83 96 Erysipelas 24 — — 2 1 11 5 5 9 15 — Scarlet Fever 38 1 9 22 5 1 — — 6 32 36 Typhus Fever — — — — — — — — — — — Enteric Fever 4 — — 1 — 1 2 — 2 2 3 Relapsing Fever — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 2 — — — — 2 — — 1 1 2 Cerebro-spinal Meningitis 4 2 1 — 1 — — — 1 3 4 Poliomyelitis 2 — 1 — — — 1 — 1 1 1 Ophthalmia Neonatorum 5 5 — — — — — — 1 4 — Pulmonary Tuberculosis 101 — — 5 20 58 16 2 27 74 47 Other forms of Tuberculosis 16 1 2 5 2 6 — — 3 13 4 Measles 918 20 301 492 60 40 5 — — — 38 Totals 1221 31 344 588 98 126 30 7 — — 231 236 The Infectious Sickness Rate for London generally was 4.2. Two hundred and thirty-one of the cases notified were removed from their homes to Isolation Hospitals. SCARLET FEVER. The 38 cases of Scarlet Fever occurred in 29 houses. Year. Death Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.02 0.04 0.05 1913 0.02 0.04 0.06 1914 0.06 0.07 0.08 1915 0.14 0.07 0.06 1916 0.08 0.03 0.04 1917 o.oo 0.02 0.02 ENTERIC OR TYPHOID FEVER. The 4 cases notified during the year all occurred in different houses. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 o.oo 0.03 0.04 1913 0.04 0.02 0.04 1914 0.00 0.03 0.05 1915 0.04 0.03 0.04 1916 o.oo 0.02 0.03 1917 0.00 0.02 0.03 237 DIPHTHERIA. The 110 cases of Diphtheria occurred in 82 houses. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.00 0.10 0.11 1913 0.12 0.09 0.12 1914 0.06 0.16 0.15 1915 0.20 0.16 0.15 1916 0.12 0.14 0.14 1917 0.20 0.14 0.13 Many applications have been made at the offices for tubes of "antitoxin," which I store for the convenience of local practitioners. The "diagnosis outfits" supplied by the Council to the medical practitioners in Stoke Newington are of great service. The following is a statement of the applications received during 1917, together with the results of the examinations performed at the Lister Institute of Preventive Medicine, London :— Disease. Results. Total. Positive. Negative. Phthisis 20 78 98 Diphtheria 53 60 113 Enteric 6 2 8 Cerebro-Spinal Meningitis Nil Nil Nil Total 79 140 219 238 MEASLES AND WHOOPING COUGH. Measles. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.12 0.40 0.35 1913 0.22 0.34 0.48 1914 0.02 0.31 0.24 1915 0.47 0.50 0.43 1916 0.02 0.19 0.15 1917 0.36 0.48 0.30 Whooping Cough. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.04 0.22 0.23 1913 0.12 0.17 0.14 1914 0.12 0.20 0.21 1915 0.14 0.25 0.21 1916 0.02 0.18 0.16 1917 0.12 0.13 0.13 MEASLES. As compared with the preceding year, there was a greatly increased prevalence of Measles. Nurse Ager paid 903 visits for advice and assistance. ZYMOTIC DIARRHCEA. Calculated from deaths occurring under 2 years of age per 1,000 births. Stoke Newington 11.67 London generally 18.70 England and Wales 12.18 239 PUERPERAL FEVER. Under Puerperal Fever are included deaths from Pyaemia and Septicemia occurring in lying-in women. Two cases were notified during the year ; and there were 2 deaths from this disease. PHTHISIS (CONSUMPTION) AND OTHER FORMS OF TUBERCULOSIS. One hundred and one cases of consumption were notified under the Public Health (Tuberculosis) Regulations, 1912. Sixty-four of the notified cases were insured under the Insurance Act. Nurse A. Ager, who is appointed to give part-time services in connection with the Tuberculosis work within the Borough, has, acting under the instruction of the Medical Officer of the Tuberculosis Dispensary, and myself, dealt with 83 different cases, making in all 366 visits during 1917. The value of our present measures against Tuberculosis is seriously discounted by the failure to make the scheme sufficiently comprehensive. The persons who disseminate large quantities of the germs of Consumption during coughing and expectoration, while living in intimate contact with their families, are the most serious element of danger in the spread of the disease ; for the close association of Tuberculosis with bad housing is admitted by all. Therefore, the preventive measures of first importance are (1) better housing ; (2) effective measures to render the spread of infection impossible when once the infective person has been discovered. For advanced (non-sanatorium) cases, homes should be provided which are local, inexpensive, and conducted on hospital tines ; and these should be under the care of the Dispensary Medical Officer. 240 THE WORK OF THE TUBERCULOSIS DISPENSARY IN 1917 IN REFERENCE TO STOKE NEWINGTON. The following tables show the work done in connection with the Dispensary, so far as Stoke Newington is concerned, during the year 1917. The figures in all the particulars recorded show a material increase over those of the preceding year. (Vide my annual report for 1916.) METROPOLITAN BOROUGH OF STOKE NEWINGTON. Year ending December 31st, 1917. RETURN SHOWING THE RESULT OF THE EXAMINATION OF PERSONS FOR THE PURPOSE OF DIAGNOSIS. Number of persons found to be suffering from Number of Persons found to be NonTuber culous. Number in whom the diagnosis was doubtful. Totai. Pulmonary Tuberculosis NonPulmonary Tuberculosis Persons who before examination at the Dispensary were— T.B. have been found T.B. have never been found Diagnosed to be tuberculous 18 27 8 3 8 64 Suspected cases and others not diagnosed to be tuberculous 2 9 1 22 11 45 Contacts of persons diagnosed to be tuberculous 1 2 1 17 15 36 Totals 21 38 10 42 34 145 241 Number of doubtful cases remaining on books on December 31st, 1916 9 Number of doubtful cases which have occurred during 1917 34 Total 53 Number of above found to be suffering from Tuberculosis 6 Number of above found to be non-Tuberculous 1 Total 7 Number of doubtful cases remaining on books on December 31st 1917 — 46. METROPOLITAN BOROUGH OF STOKE NEWINGTON Year ending December 31st, 1917. CLASSIFICATION AND DETAILED STATISTICS OF ATTENDANCES, Etc. Insured Persons Male Insured Persons Female Uninsured Persons Male Uninsured Persons Female Contacts. Total. M F I. I. I. U. Attendances of new patients 57 8 21 20 9 10 1 19 138 Attendances of old patients 190 61 124 178 0 28 0 38 619 Consultations with doctors 5 0 0 7 0 1 0 3 16 (second consultations). Specimens of sputum examined 24 2 5 1 0 0 1 0 33 242 ACUTE POLIO-MYELITIS AND CEREBRO-SPINAL FEVER. Cerebrospinal Fever is by far the more fatal of the two. Four cases were notified in the Borough during 1917 ; and 2 cases of Polio-myelitis. There were 4 deaths from the former and 1 from the latter. THE DISINFECTING AND CLEANSING STATION. During the year ending December 31st, 1917, the following disinfecting and cleansing work was performed at the station :— Total number of textile articles disinfected 12,201 Total number of books from Public Library disinfected 53 Total number of verminous persons cleansed 255 All the verminous persons cleansed were children of school age, with the exception of 4 adults. In addition to the disinfection of rooms on account of the notified infectious diseases, 70 were fumigated on account of vermin, 24 on account of Consumption, 6 on account of Cancer, and 31 on account of Measles. During the year the Borough Council continued its agreement with the Education Department of the London County Council to bathe and cleanse verminous school children. NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR 1917. It will be seen from the accompanying Report of the Chief Sanitary Inspector that a large amount of sanitary work has been performed during the year; 2,372 premises were inspected for conditions injurious or dangerous to health, and insanitary conditions trying in their nature from slight to grave were discovered 243 to the number of 634 ; 293 Intimation Notices, followed in 5 cases by Statutory Notices, were complied with. 3,084 re-inspections were made, making a total for the year of 5,456 inspections. The slaughter-houses (3), bake-houses (26), cowshed (1), and dairies (65), the common lodging-house (1) and the registered houses let in lodgings (259), situated in the Borough, were all inspected during the year. FOOD INSPECTION. During the year many systematic efforts were made to detect the sale of diseased meat within the Borough, and I am glad to say that, with few exceptions, our inspections have not called for any seizures. 1 ton and 7 cwts. of unsound food was voluntarily surrendered during the year. HOUSES LET IN LODGINGS. By the end of the year 1917, 259 such premises were on the Register. THE HOUSING AND TOWN PLANNING ACT, 1909. During 1917 no action was taken under this Act. FACTORIES AND WORKSHOPS. At the end of the year 1917, 301 factories, workshops and workplaces were on the Register. As the result of the inspection of the workrooms and workplaces in the Borough, it was found that for the most part they were in a satisfactory condition, and that the requirements of the Factory and Workshops Act of 1901 were duly observed. There are altogether about 800 domestic workrooms in the Borough in which textile material of various kinds is being dealt with. A complete list of all out-workers has been kept in the office. 244 1—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. 1 Number of Inspections 2 Written Notices. 3 Prosecutions 4 Factories (including Factory Laundries) 57 — — Workshops (including Workshop Laundries) 229 23 — Workplaces 15 — — (Other than Outworkers' premises included in Part 3 of this Report) Total 301 23 Nil. 2—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 * Nuisances under the Public Health Acts :— Want of Cleanliness 6 6 — — Want of Ventilation — — — — Overcrowding 1 1 — — Want of Drainage of Floors 1 1 — — Other nuisances 2 2 — — Sanitary accommoda- tion insufficient — — — — unsuitable or defective 22 22 — — not separate for sexes — —• — — Offences under the Factory and Workshops Act:— Nil Total 32 32 Nil Nil * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act as remediable under the Public Health Acts 245 3—HOME WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. NATURE OF WORK. Sending twice in the year. Lists. Outworkers. Contractors. Workmen. (1) (2) (3) (4) (5) Wearing Apparel— (1) Making, &c 28 253 28 (2) Cleaning and Washing Household Linen 4—REGISTERED WORKROOMS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bake- houses, may be enumerated here. Miscellaneous 229 Bakehouses 24 Total number of workshops on Register 253 5—OTHER MATTERS. Class, (1) Number. (2) Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s.133) 1 Underground Bakehouses (s. 101) — Certificates granted during the year Nil In use at the end of the year 18 During the year the homes of all outworkers have been inspected. 246 TABLE V. ANALYSES PERFORMED UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1917. Article submitted for Analysis (156) No. of Genuine Samples (147) No. of Adulterated Samples (9) Remarks as to Adulteration. Baking Powder 2 — Bread 1 — Butter 13 1 Mixture of about 10% of Margarine. Vendor cautioned. Castor Sugar 1 — Cheese 2 — Coffee 4 — Cocoa 2 — Cream 2 1 Not sold as " Preserved " Vendor cautioned, as small amount — (0*173%) of boric acid present. Custard Powder ... 1 — Epsom Salts 2 — Flour 15 — Ground Ginger 1 — Lard 7 — Margarine 10 — Milk 69 8 (1) Added water 2-J%. Vendor cautioned. (2) Slight deficiency in fat. Vendor cautioned. (3) Added water 3£%. Vendor cautioned. (4) Deficiency in fat 3%. Vendor cautioned. (5) Added water 5*4% Vendor fined £\ and costs, £\ Is. (6) Added water 2%. Vendor cautioned. (7) 14% less than the legal amount of milk fat. Defendant fined £\ Is. and costs, £1 Is. (8) Added water 1*5%. Vendo." cautioned. Paregoric 1 — Pepper 3 — Quinine, Ammoniated. 2 — Sausages 2 — Spirit of Nitre 1 — Sweets 2 — Tea 2 — Vinegar 2 — 247 FOOD AND DRUGS. Under the Sale of Food and Drugs Act, 156 samples of food and drugs were taken and analysed. The results are shown in Table V. Ten of the samples purchased in the Borough in 1917 were not satisfactory ; and, therefore, the percentage of non-genuine samples amounted to 6.4 per cent., as compared with 7.7 per cent, for the preceding year. This is below the figure for London as a whole. 10*4 per cent, of the 77 Milk samples were unsatisfactory, as against 8*3 per cent, during the preceding year ; but in some cases the deficiency below the legal limits wras very slight. In London the percentage of Milk samples reported against was about 11 during 1917. It should be added that many of the samples purchased were below the quality of the average milk supply of London, although they were a trifle above the low legal limits which have been fixed. All the samples of Milk, Butter, Cream and Margarine were tested for antiseptics, with the result that 0 of the samples of Milk, 3 of Cream, 11 of Margarine, and 10 of Butter were found to contain them. In no case was the amount sufficient to warrant a prosecution, and in each case boric acid was found ; but in one or two instances the vendors were cautioned. All but one of the 14 Butter samples taken throughout the year were found to be satisfactory. 248 Two informal samples have been taken during the year. The informal samples collected did not lead to the detection of adulteration. THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. All the samples of Milk were examined for preservatives. The samples were all taken under the Sale of Food and Drugs Acts, and in no instance were the Regulations infringed. The 3 samples of Cream, although procured under the Sale of Food and Drugs Acts, were specially examined with regard to the provisions of the Regulations. That is to say, in every case the precise amount of fat was estimated, and the nature and amount of preservatives also. In addition, it was seen whether each of the vessels containing the Cream was duly labelled " Preserved Cream containing Boric Acid." The 3 samples of Cream contained fat varying from 38 to 52 per cent, by weight and Boric Acid varying from 0*17 per cent, to 0'29 per cent. Boric Acid was the only preservative employed. No thickening substances were found to be added to the samples of Cream examined. REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1917. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen,— I beg to present my Annual Report for the year ending December 31st, 1917 :— INTIMATION NOTICES SERVED. (Sec. 3, Public Health (London) Act, 1891.) House-to-house inspection 110 After inspection on account of complaint 92 After infectious illness 34 With reference to stables and mews 11 ,, ,, milkshops, dairies and cowsheds — ,, ,, bakehouses 4 ,, ,, factories and workshops 23 ,, ,, slaughterhouses 1 After sundry other inspections 18 293 STATUTORY NOTICES. Five statutory notices were served by direction of your Committee to be served under Sec. 4, Public Health (London) Act, 1891. 634 nuisances have been abated under Intimation an Statutory Notices. In addition, a large number of improvements have been made on advice to owners and occupiers. 249 HOUSES AND PREMISES INSPECTED. By house-to-house inspection 326 Upon complaint, under Sec. 107 (3), Public Health (London) Act, 1891 124 After notification of infectious disease — After Notices from Builders, under Bye-law 14 (London County Council) 73 Stables and mews 321 Slaughterhouses 19 Milkshops, dairies and cowsheds 96 Bakehouses 42 Factories and workshops 452 Other premises inspected 919 Re-inspections made to examine and test work, etc. 3,084 Total inspections 5,456 250 SLAUGHTER-HOUSES. The three Licensed Slaughter-houses at present in use in the Borough, are:—Nos. 118, Church Street; 165, High Street; and 70, Mountgrove Road. The results of inspections have been satisfactory, and the Licenses of each were renewed by the London County Council in October. COMMON LODGING-HOUSES. The one Common Lodging-house in the Borough, situate at No. 81, Church Street, is under the control of the London County Council, and is conducted in accordance with the bye-laws. Visits have been made from time to time by your Inspectors. BAKEHOUSES. There are 26 bakehouses in the Borough, 20 of these being underground. Two of the latter were unoccupied at the end of the year. Four Notices were served on the occupiers. The usual standard of cleanliness has been maintained. DAIRIES, COWSHEDS AND MILKSHOPS. There are at present 65 Milk Vendors registered in the Borough, and one Licensed Cowkeeper. 96 inspections were made during the year, with satisfactory results. COMPLAINTS. Sec. 107 (3) Public Health {London) Act, 1891. One hundred and twenty-four complaints were received during the year, and the premises to which they related were promptly inspected. In 36 cases, on inspection of the premises to which the complaint related, no nuisance which could be dealt with under the Public Health Acts was found. Ninety-two Intimation Notices were served, and complied with. 251 The Metropolitan Water Board have been notified of a number of cases of waste or misuse of water in the Borough. STABLES AND MEWS. Three hundred and twenty-one inspections were made during the year. Eleven Intimation Notices were served for accumulations of manure. HOUSES LET IN LODGINGS. There were 259 premises on the Register at the end of the year. HOUSE-TO-HOUSE INSPECTION. Three hundred and twenty-six Inspections were made during the year, mostly in the poorer streets of the Borough. One hundred and ten Intimation Notices were served on Owners and occupiers. FOOD INSPECTION. The following is a list of articles of food surrendered during the year:— Tinned Food. No. of Tins. Tons. cwt. qrs. lbs. Beef 19 — 1 0 2 Salmon 9 — — — 9 Milk 148 — 1 1 8 Total 176 — — — — Other Articles :— Bacon 1 3 0 0 Fish — 1 1 12 Bread — 1 0 8 Mutton — — — 7 Total 1 7 3 18 252 387 Inspections were made during the year, attention being directed both to the quality of the food exposed or deposited for sale and also the enforcement of the various orders of the Food Control Board. Your Inspectors attend the meetings of the Food Control Committee and submit a weekly report. RESTAURANT KITCHENS AND EATING HOUSES. There are 10 of these premises in the Borough. The results of the inspections, both of the food and the kitchens, have been satisfactory. The times of the inspections were varied as much as possible. FACTORIES AND WORKSHOPS. Four hundred and fifty-two inspections were made in the 301 workshops and factories in the Borough during the year, and it was found necessary to serve 23 Notices, chiefly for the cleansing and defects in the flushing arrangements of water closets, etc. The Register has been revised. M.H. Inspector of factories was notified of one case where the occupier of a workshop had failed to affix the Abstract of the Factory and Workshops Acts. The outworkers Lists from the various firms in the Borough employing outside labour were dealt with. NOTIFICATION OF INFECTIOUS DISEASE. Excluding Measles, 306 cases were notified during the year, and in every instance an inspection of the infected premises was made ; 34 Intimation Notices were served for insanitary conditions found. All the houses where the cases of infectious illness occurred have been disinfected by the department. 253 No complaints were received of any damage to, or loss of, textile articles during the process of disinfection. DRAINAGE PLANS AND APPLICATIONS. Eleven drainage plans and applications were considered and approved by your Committee. I am, Gentlemen, Your obedient Servant, D. W. Matthews. 254 A LIST OF THE STREETS SITUATED IN THE BOROUGH OF STOKE NEWINGTON. (For the Guidance of Medical Practitioners, Midwives, Etc.) ^DEN Grove Aden Terrace Adolphus Road Allen Road Allerton Road Albion Road „ Grove Alexandra Road Alexandra Buildings Amhurst Park (90-100 even Nos. and 93) Arthur Road Ayrsome Road Aldham Place J$ARN Street Barrett's Grove Belgrade Road Bethune Road (1 to 145) „ (2 to 106) Blackstock Road (5 to 175) Bouverie Road Boleyn Road (94 to 192) Brighton Road Brodia Road Broughton Road Brownswood Park (Queen's Rd. to Brownswood Rd.) Green Lanes Brownswood Road Burma Road PROSSWAY (late Castle St.) (2 to 50) N. Side Carysfort Road Chalmers Terrace Chapel Place Chesholm Road Church Path Road ,, Street Clonbrock Road Clissold Road Coronation Avenue Cowper Road Cressington Road J)EFOE Road Digby Road Dumont Road Dynevor Road J? ADE Road (2 to 66) and 1 to 27 odd Nos. Edward's Lane pAIRHOLT Road Finsbury Park Road Fleetwood Street QAINSBORO Road Gloucester Road Goldsmith Square Gordon Road Grange Court Road Grazebrook Road Grayling Road Green Lanes ,, ,, (from 2 to 388) „ ( „ 45 „ 109a) „ (271 to 327) Grove Lodge Yard J-£AMILTON Place Harcombe Road Hawksley Road Hayling Road Heathland Road Henry Road Hermitage Road, 1 to 25a, 2 to 14 Hewling Street High Street (17 to 217) Hornsey Place Howard Road JMPERIAL Avenue 255 KERSLEY Road King's Road Knebworth Road Kynaston Road „ Avenue LANCELL Street Laver's Road Lavell Street Leconfield Road (1-33) Leonard Place Lidfield Road Lilian Street Listria Park Londesborough Road Lordship Road „ Grove Park Terrace Lordship Park Mews MANOR Road Martaban Road Marton Road Mason's Court ,, Place Matthias Road (2-122) Millard Road Milton Road Mountgrove Road (2-98) ]\EVILL Road Newington Green (33-42) QLDFIELD Road Osterley Road pAGET Road Painsthorpe Road Palatine Road Paradise Row Park Crescent ,, Lane ,, ,, Terrace ,, Street Pellerin Road Petherton Road (106 to 138) Portland Road Prince George Road Princess Road ,, May Road QUEEN Elizabeth's Walk Queens Road REEDHOLM Villas Rochester Place Riversdale Road (92-104) gANDBROOK Road Salcombe Road Seven Sisters Road :—From Blackstock Road to Amhurst Park Shakespeare Road Shelgrove Road Ship way Terrace Somerfield Road Spenser Road Springdale Road St. Kilda's Road St. Andrew's Road ,, Mews Pavement, S. Side Selsea Place Stamford Hill (1-39) Stoke Newington Road (1-175) Statham Grove Summerhouse Road TRUMAN'S Road Town Hall Approach. VICTORIA Grove Victoria Grove West Victoria Road ^/ALFORD Road Warwickshire Road Watson Street White Hart Court Wilberforce Road Winston Road Wordsworth Road Woodland Road Woodlea Road Woodberry Down ,, Grove