STO 11 THE Metropolitan Borough of Stoke Newington REPORT of the Medical Officer of Health and Public Analyst, for the YEAR 1902. BY HENKY KENWOOD, M.B., L.R.C.P., D.P.H, F.C.S., Assistant-Professor of Public Health, University College, London, Fellow and Member of Council of the Sanitary Institute, Medical Officer of Health and Public Analyst. LONDON: Printed by A. T. Roberts, Son & Co., Ltd., 5, Hackney Road, N.E. 1903. TABLE OF CONTENTS. Vital Statistics— page Population of the Borough and of each of the two Divisions .. 7 Number of people to the acre 7 Births and Birth-rate 7-8 Mortality, Death-rates and causes of Mortality,—with notes thereon 9-20 The Mortuary 19 Inquests held during the year 20 Infectious Diseases and the Measures taken to Prevent their spread— 21-29 The Infectious Sickness Returns for the Year 21-24 Scarlet Fever 25 Erysipelas 25 Typhoid Fever 25 26 Diphtheria 26-27 Consumption 28-29 Cancer 29-33 Notes upon Sanitary Work Performed during the Year 33 Cremation 34 Ice Creams 34 The Factory Act and Underground Bakehouses 34-39 Food and Drugs 39-42 Meteorology of the Year 43-45 Streets in the Borough of St. Mary, Stoke Newington—(Appendix) 46-47 REPORT OF MEDICAL OFFICER OF HEALTH FOR THE YEAR 1902. To the Mayor, Aldermen, and Councillors of the Borough of Stoke Newington. Gentlemen, The present report maintains the reputation of the Borough for healthiness. The recorded death-rate was, as in the preceding year, only 13.1, as against 17.2 for London generally, while the rate of infantile mortality (i.e., the number of deaths of children under one year of age to every 1,000 births registered) was only 114, as against 139 for London as a whole. With regard to the other 28 Metropolitan Boroughs there was only one with a lower general death rate, namely, Hampstead; the Zymotic death-rate or the death-rate from the seven Principal Communicable Diseases was also the lowest, with the sole exception of that of Hampstead, and the rate of infantile mortality was the third lowest of all the Metropolitan Boroughs. The sickness and mortality rates from the several Infectious Diseases were, without exception, well below those of London generally. The Small-pox epidemic ended, so far as the Borough of Stoke Newington was concerned, in July last, or just a year from its first appearance, and happily the Metropolis is now practically free from the disease. The outbreak formed the subject of a Special Report presented to the Council early in November. 6 In connection with the subject of Small-pox it is impossible to exaggerate the importance of re-vaccination of the community. The recent outbreak brought home to us the fact that if the large majority of individuals postpone the operation until an epidemic is in our midst, our administrative machinery is unable to cope with the difficulty of the preparation of a sufficient amount of suitable lymph n d the prompt performance of re-vaccination. The Report of the work done by the Sanitary Inspectors (Messrs. Matthews, Cox and Taverner) which is appended to this Report, constitutes in my opinion a very satisfactory record of work, and the clerical duties of the Department were most creditably performed by Mr. Rogers. I am, Gentlemen, Your obedient Servant, February, 1903. HENRY KENWOOD. 7 POPULATION. According to the Census of 1901 the population of the Borough was then 51,247. At the previous Census of 1891 the population for the same area was 47,988, so that the population has increased during the past 10 years to the extent of 3,259. In this Report the rates are based on the estimated population for the middle of the year 1902 and the figure, calculated logarithmically from the increase between 1891 and 1901, amounts to 51,669. The number of occupied houses in the Borough in March, 1901, amounted to 7,717, and the number of occupants to each house averages nearly 6.6. The population for each of the Sub-districts is as follows : The Northern Division of the Borough (lying North of the line of Church Street) has a population of about 18,219, and in the Southern Division the population is about 33,450. The natural increase of population by excess of births over deaths during the year amounted to 445, as against 438 in the preceding year. Number of People to the acre.—The area of the Borough amounts to 863 acres, and this, divided among the parishioners, represents 59.9 people to the acre. Births—Birth-rate.—During the year 1902 there were 1,125 births registered in the Borough. The birth-rate per 1,000 per annum was therefore 21.8 as against 21.6 for the preceding year. The rate for England and Wales was 28.6, that for London generally was 28.5 and that for the 76 great towns was 30.0. The part which the rather low birth-rate plays in favouring the low general death-rate of the Borough is duly accounted for in arriving at the corrected death-rate. 8 The birth-rate in London for the past two years has been the lowest since civil registration began. It is noteworthy in connexion with the diminishing birth-rate in London that, although at the last census the population of "Registration London" had increased 7.7 per cent. in the ten years 1891-1901, the number of children under 10 years of age had declined 1.8 per cent. There is an excellent addition to the statement of birth-rates in the report of the Medical Officer of Health for the county of London for the year 1901. This is a statement of births per 1,000 married females aged 15 to 45. By this means the influence in wealthy districts of the excessive number of unmarried domestic servants is eliminated. The result thus obtained is very suggestive. It corrects the erroneous views which might otherwise be entertained as to the magnitude of the difference between the birth-rate in the different Metropolitan Boroughs. It will be observed that Stoke Newington is the fourth lowest on the list. Per Thousand Married Females aged 15 to 45. Finsbury (295) Stepney (294) Bethnal Green (284) Poplar (280) Bermondsey (276) Shoreditch (275) St. Marylebone (275) Southwark (252) Greenwich (245) Holborn (244) Lambeth (240) Hackney (239) Deptford (238) Fulham (233) Camberwell (232) Woolwich (227) Battersea (221) Islington (217) Wandsworth (215) Hammersmith (215) St. Pancras (214) Lewisham (212) Chelsea (206) Paddington (204) Kensington (200) Stoke Newington (184) Hampstead (175) Westminster (160) City of London (162) 9 MORTALITY. General Mortality.—There were 535 deaths registered of parishioners who were resident in the Borough, and 145 of parishioners who died in Public Instutions without the Borough, making a total of 680 deaths of parishioners. Of these deaths 326 were of females and 354 were of males. The recorded general death-rate is therefore 13.1, which was also the rate in the preceding year. This ordinary death-rate, however, cannot be taken as a true index of the healthiness of the Borough, nor can it be justly compared with the rates of other Sanitary areas, unless some allowance is made for the relative proportions of males and females at different ages in the districts compared. Death-rates vary very much in different districts according to the natures of the populations of these districts; for instance, in a district containing a large number of very young or very old people, the rate would be considerably higher than in a district consisting almost entirely of people of middle age. There is, therefore, calculated by the Registrar General from the Government Census returns, a corrective factor for each district in the County of London, according to the sex and age distribution of the population of that district; the multiplication of the recorded death-rate of the district by this factor gives the death-rate which would obtain in that district if the sex and age distribution of the population of the district were in the same proportions as it is in the country as a whole—thus eliminating the accidental differences due to sex and age and affording a fair means of comparison, and a truer test of the healthiness of the district. The death-rate so ascertained is known as the corrected death-rate. The so-called "factor for correction" for the Borough of Stoke Newington is about 1.07283, and the death-rate corrected for age and sex distribution is (13.1 x 1.07283) 14.0 per 1,000 per annum. 10 In arriving at this corrected death-rate, the deaths of nonparishioners who have died in Public Institutions within the Borough have, of course, been excluded. The rate is a very satisfactory one, even for Stoke Newington. The death-rate for the whole of London was 17.2; the death-rate for Croydon was 14.0, and that for Brighton was 15.8. District Mortality.—The deaths among parishioners of the Northern Division of the Borough numbered 196 and furnished a recorded death-rate of 10.7 per 1,000 per annum. The deaths among parishioners of the Southern Division of the Borough numbered 484 and furnished a rate of 14.5 per 1,000 per annum. DISTRICT MORTALITY. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Totals. Bate per 1,000 per annum. Northern Division 59 38 54 45 196 10.7 Southern Division 168 110 81 125 484 14.5 Totals 227 148 135 170 680 13.1 Infantile Mortality.—There were 129 deaths registered of infants under 1 year of age, as against 1,125 births; the proportion which the deaths under 1 year of age bear to the 1,000 births is, therefore, 114.7, as against 117.9 in the preceding year. The corresponding rate in England and Wales was 133, that in London generally 139, and that in the 76 great towns 145. The deaths under 1 year of age form 19.0 per cent, of the total deaths of all ages, whereas for the preceding year they formed 19.5 per cent. 11 Several Acts of Parliament have been passed with a view to protect the lives of infants from baby farmers, and the most recent Act (that of 1897) was certainly an improvement upon its predecessor. The Legislature has recognised the necessity of securing the registration by the local authority of those who undertake the care of infants by hire, so that their action may be to some extent supervised. The Act of 1897 only requires such registration when more than one infant under the age of five years is received, but it also provides that notice shall be given within 48 hours to the local authority by any person retaining or receiving an infant under the age of two years on the consideration of a sum of money not exceeding £20. Evidence as to the necessity of fresh and more drastic legislation for the protection of those children placed out to nurse has been afforded by several cases which have been dealt with at the Central Criminal Court during the last year. The fact that about 100 children's dead bodies are found in London alone by the police every year proves that infanticide is a far more common occurrence than a conviction for the crime. Many such deaths would doubtless be prevented if legislation dealt with all cases of children placed out to nurse, and not only with those in which two or more children are taken. The difference made by the law between the baby farmer, who takes several children at a time, and those who take one only, is not justified by any comparative safety of the single child, and the child adopted in consideration of a larger sum than £20 requires the same protection as that accorded to the infant for whom less is paid. It is most desirable, moreover, that all so-called Nursing Institutions should be brought under the inspection of the local authority. No institution should be allowed to receive women to be confined for gain without being duly licensed, and proper notice of every child who is brought into such establishments and of every child who leaves such establishments should be sent to the authority within 48 hours of the event. In these so-called Maternity Homes and Private Establishments the services of medical men are frequently dispensed with at the birth of a child, so that 12 there is no witness even to the child's existence, except persons whose interest may be served by concealing it,. The cheap and easy access to concoctions containing poison is doubtless also responsible for many infant's deaths. Such preparations as chlorodyne are sold as sedatives for ailing children, and in such a preparation a criminal can find a ready means of disposing of a child. Senile Mortality.—Of the 680 deaths 205 were of persons over 65 years of age. The proportion of deaths occurring among these of over 65 years of age to the total deaths is, therefore, about 30.1 per cent. There were 155 deaths of persons over 70 years of age, and 54 of persons over 80, 7 of whom reached 90 years of age—the oldest being 97. These figures denote an exceptionally high proportion of senile mortality. SENILE MORTALITY. 65 and under 70. 70 and under 80. 80 and under 90. 90 and upwards. Totals. First Quarter 17 35 22 2 76 Second „ 12 25 9 0 46 Third „ 11 18 7 2 38 Fourth ,, 10 23 9 3 45 Totals 50 101 47 7 205 The respective ages of those over 90 were 97, 91, 90, 92, 95, 91, 93. The Causes of Death.—These are fully set forth in table A, in which it will be noted that the deaths are also apportioned to different age-periods. Table A 1 is supplementary to Table A, and sets forth the causes of death during each of the four quarters of the year. TABLE A. CAUSES OP, AND AGES AT, DEATH DURING YEAR 1902. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria & Membranous Croup. Enteric Fever. Epidemic Influenza Diarrhœa. Enteritis. Erysipelas. Other Septic Diseases. Phthisis. Other Tubercular Diseases. Cancer,Malignant Disease. Bronchitis. Pneumonia. Pleurisy. Other Diseases of, respiratory organs Alcoholism Cirrhosis of liver. Venereal Diseases. Premature birth. Heart Diseases. Accidents. Suicides. Senile Decay. All other Causes. All Causes. All Ages 8 4 5 14 5 4 12 20 5 3 25 64 22 44 69 64 1 2 15 2 27 64 11 3 42 145 680 Under 1 .. 1 .. 10 2 .. .. 13 4 .. 6 .. 4 .. 10 14 .. .. .. 1 27 .. 3 .. .. 34 129 1 and under 5 .. 3 1 4 1 .. .. 3 .. .. .. .. 10 .. 6 14 .. .. .. .. .. .. .. .. .. 6 48 5 and under 15 2 .. 3 .. 2 .. .. .. .. .. 5 2 4 .. .. 2 .. .. .. .. .. 10 1 .. .. 4 35 15 and under 25 .. .. 1 .. .. 2 1 .. .. .. 1 15 2 .. .. .. .. 1 .. 1 .. 5 2 .. .. 4 35 25 and under 65 5 .. .. .. .. 2 5 .. 1 2 9 44 2 25 14 27 1 1 11 .. .. 24 3 3 .. 49 228 65 and upwards 1 .. .. .. .. .. 6 4 .. 1 4 3 .. 19 39 7 •• .. 4 •• .. 25 2 .. 42 48 205 Deaths in or belonging to Localities (at all Ages.) Northern Division .. .. .. 3 1 2 4 2 1 6 12 7 18 19 19 .. 1 5 5 23 1 2 14 51 196 Southern Division 8 4 5 11 5 3 10 16 3 2 19 52 15 26 50 45 1 1 10 2 22 41 10 1 28 94 484 Total Deaths in Public Institutions in the District. .. .. .. .. .. .. 2 .. .. .. 1 1 .. 4 12 1 .. .. .. .. .. 3 .. .. 4 7 35 TABLE A 1. Showing the Causes of Death among parishioners in Stoke Newington during each of the four quarters of the year 1902. Causes of Death. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals Small Pox 6 2 .. .. 8 Measles 1 2 1 .. 4 Scarlet 3 1 .. 1 5 Whooping Cough 9 3 2 .. 14 Diphtheria and Membranous Croup 2 .. .. 3 5 Group .. .. .. .. .. Fevers Typhus .. .. .. .. .. Fevers Enteric .. .. 2 .. 4 Other continued. .. 9 •• 1 12 Epidemic Influenza 9 .. .. .. Cholera .. .. .. .. .. Plague 2 2 10 8 20 Enteritis 1 1 2 2 5 Puerperal Fever .. .. .. .. .. Erysipelas 1 1 .. 1 3 Other Septic Diseases 7 9 4 5 25 Phthisis 14 16 17 17 64 Other Tubercular Diseases 6 5 6 5 22 Cancer. Malignant Disease 17 10 7 10 44 Bronchitis 31 15 4 19 69 Pneumonia 25 6 13 20 64 Pleurisy 1 .. .. .. 1 Other Diseases of the Respi- ratory Organs 1 1 .. .. 2 Alcoholism Cirrhosis of Liver 4 3 3 5 15 Venereal Diseases .. .. .. 2 2 Premature Birth 6 11 5 5 27 Diseases and Accidents of Parturition .. .. .. .. .. Heart Diseases 23 11 16 14 64 Accidents 3 3 3 2 11 Suicides 2 1 1 .. 3 Senile Decay 19 7 9 7 42 All Other Causes 34 37 31 43 145 Totals 227 148 135 170 680 14 15 It will be noted that the mortality of the Southern Division exceeds that of the Northern mainly in respect of the deaths from Small-pox, Measles, Diphtheria, Diarrhœa, Scarlet Fever, Phthisis, Influenza, Accidents, and Premature Birth ; and if these deaths were grouped according to the ages at which death occurred, it would be found that by far the largest number would be allotted to the first five years of life. The mortality from Cancer, on the other hand, was disproportionately high in the Northern Division. TABLE A 2. Deaths from Zymotic Diseases (including Influenza) in the Year 1902. Scarlet Fever. Diphtheria. Small-pox. Typhoid Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhoea and Dysentery. Influenza. Erysipelas. Total. Rate to every 1,000 persons. First Quarter 3 2 6 .. .. 1 9 2 9 1 33 2.5 Second „ 1 .. 2 2 .. 2 3 2 1 13 1.;0 Third ,, .. .. .. 2 .. 1 2 10 .. .. 15 1.1 Fourth „ 1 3 .. .. .. .. .. 8 1 1 14 1.1 5 5 8 4 4 14 20 12 3 75 1.4 1901 4 14 3 4 2 9 2 16 3 0 57 1.1 16 Zymotic Mortality.—Included in the Zymotic mortality are the deaths from the seven principal Zymotic Diseases, viz., Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, "Fever" (including Typhoid Fever, Typhus Fever, and Simple Continued Fever), and Diarrhœa. In Table A 3 the Zymotic rate, and the rates for each of the diseases comprising it, are given, along with the corresponding rates of London generally. The comparison with the rates of London generally is very favourable to Stoke Newington in everv instance. TABLE A 3. A comparison of the rates of Stoke Newington with those of England and Wales, the 76 great towns, and London generally, for the Year 1902. General Deathrate. Diseases of Lungs (except Phthisis). Phthisis-rate. Rate of Infantile Mortality. Birth-rate. Zymotic Death rate. * England and Wales 16.3 .. .. 133 28.6 1.64 The 76 great towns 17.4 •• .. 145 30.0 2.12 London generally 17.2 •• 1.62 139 28.5 2.21 Stoke Newington 13.1 2.63 1.24 114.7 21.8 1.16 Small-pox. Measles. Scarlet Fever. Whooping Cough. Typhoid Fever. Diphtheria. Diarrhoea and Dysentery. England and Wales 0.08 0.38 0.15 0.29 0.13 0.23 0.38 London generally 0.29 0.51 0.12 0.41 0.12 0.25 0.54 Stoke Newington 0.15 0.08 0.09 0.27 0.08 0.09 0.39 * The number of deaths under 1 year of age to every 1,000 births. 17 The General Zymotic Death-rate for the Borough was 1.16 per 1,000 per annum, as against 1.26 in the preceding year. The corresponding rate for England and Wales was 1.64, that for London generally was 2.21, and that for the 76 great towns was 2.12. DEATHS IN PUBLIC INSTITUTIONS WITHIN THE DISTRICT. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. St. Anne's House, Manor Rooad 3 5 5 12 25 Northumberland House Asylum, Green Lanes 3 3 1 .. 7 Invalid Asylum, 187, High Street 1 .. 1 .. 2 Nursing Home, 8, Alexandra Road .. .. .. 1 1 The Causes of Infantile Mortality are set forth in Table A 4 Most of these causes are greatly influenced by wholesome surroundings and the proper observance of the laws of health as they apply to infants. The lack of intelligent parental management of the infant in the matter of feeding and nursing, which is responsible for so much infant mortality, is seen reflected in the number of deaths from Disease of the Lungs, Diarrhœa, and Wasting Disease. 18 TABLE A 4. The Causes of Infantile Mortality in 1902. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals. Wasting, Developmental Diseases, and Debility .. 2 5 5 12 Premature Birth and insufficient vitality 8 13 6 8 35 Diarrhœa .. .. 5 7 13 Diseases of Lungs 7 5 2 10 24 Whooping Cough 5 3 2 .. 10 Convulsions 2 2 2 .. 7 Gastric Catarrh and Enteritis 1 .. 2 1 4 Measles 1 .. .. .. 1 Diphtheria 2 .. .. .. 2 Tuberclosis (other than Pulmonary) 3 1 .. .. 4 Overlying • • 1 .. 1 3 Soptic 2 3 .. 1 6 Eczema 1 .. .. .. 1 Laryngeal Spasm .. 1 .. .. 1 Congenital Malformations .. 1 .. .. 1 Peritonitis .. 1 .. .. 1 Whilst under Chloroform :Spinal bifida operation .. 1 .. .. 1 Congenital Syphilis .. .. 1 1 Other causes 1 1 .. .. 2 Totals 34 35 25 35 129 19 TABLE A 5. Analysis of the Vital Statistics of the Metropolitan Boroughs and of the City of London, after Distribution of Deaths occuring in Public Institutions, during the Year 1902. Boroughs. Estimated Population middle of 1902. Annual Rate per 1,000 Living. Deaths of Children under 1 year of age to 1,000 Births. Births. Deaths. Principal Zymotic Diseases. Notifiable Diseases Attack-rate. County of London 4,579,110 28.5 17.2 2.21 9.9 139 Paddington 145,107 22.4 14.6 1.74 6.4 133 Kensington 177,605 19.3 15.3 1.49 5.3 149 Hammersmith 114,210 27.5 16.3 1.90 7.0 143 Pulham 143,102 32.9 17.1 3.13 8.8 148 Chelsea 74,018 22.4 18.0 2.06 6.4 145 City of Westminster 180,800 17.9 16.1 1.28 6.9 136 St. Marylebone 132,145 29.6 18.3 1.98 8.4 107 Hampstead 83,743 18.2 10.8 0.81 5.7 87 St. Paneras 235,521 27.0 18.6 2.46 12.0 147 Islington 337,270 26.9 16.4 1.80 9.4 133 Stoke Newington 51,669 22.0 13.1 1.16 7.7 115 Hackney 221,926 28.3 15.0 1.98 11.4 119 Holborn 58,535 27.7 21.3 2.44 11.3 129 Finsbury 100,487 36.2 22.9 3.18 10.7 154 City of London 25,598 13.1 20.4 1.38 10.3 126 Shoreditch 118,004 33.9 20.7 3.53 10.5 174 Bethnal Green 129,865 34.8 20.8 2.56 13.4 155 Stepney 300,551 38.0 20.6 3.31 13.1 147 Poplar 169,214 34.2 19.3 2.77 12.7 154 Southwark 206,825 32.8 21.4 3.10 13.0 166 Bermondsey 130,218 32.8 20.8 3.06 10.1 155 Lambeth 305,102 29.2 17.1 1.86 9.0 127 Battersea 171,401 28.4 15.0 1.93 9.7 127 Wandsworth 241,810 25.9 13.5 1.62 9.7 127 Camberwell 262,775 28.0 16.3 2.23 10.9 138 Deptford 111,577 29.9 16.5 2.44 11.4 138 Greenwich 98,013 28.1 15.4 1.59 9.5 138 Lewisham 132,432 25.7 13.6 1.79 10.0 125 Woolwich 119,556 30.7 15.1 1.93 7.7 125 TABLE A. 6. The chief vital statistics of the new Borough of Stoke Newington since its formation. Year. Population estimated to middle of y'r. Birth-rate. Rate of Infantile Mortality. General Death-rate Zymotic Death-rate Infectious Sickness rate 1901 5,1328 21.6 117.9 13.1 1.26 7.9 1902 5,1669 21.8 114.7 13.1 1.16 7.9 THE MORTUARY. During the year 42 bodies were deposited in the Public Mortuary; 21 of these were females and 21 were males. Postmortem examinations were performed upon 30 of these cases, and inquests upon 38. 20 SICK NURSING. The importance of good nursing in the treatment of disease can scarcely be exaggerated, and the educational value of a visit of a nurse to the houses of the poor is very great. The nurse (Miss Norton), whose services were secured by the Parish in commemoration of the Jubilee of Her Majesty, has done good work throughout the year. Her services can be obtained by application at the Council Offices, or at her private address 57 Bouverie Road, Stoke Newington. INQUESTS. The following inquests upon deaths of parishioners were held during the year :— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Suicide (cut thoat) 1 .. .. .. 1 „ (bullet wound) 1 .. .. .. 1 „ (poisoning .. 1 .. .. 1 Accidental Injuries 2 1 2 1 6 Poisoning by Misadventure .. .. 1 1 2 Peritonitis , following injury 1 .. .. .. 1 Found Drowned 1 .. .. 1 Overlaying .. 1 1 .. 3 Death whilst under Chloroform .. .. 1 .. 1 Heart Disease 3 2 .. .. .. Heart Failure following Influenza 1 .. .. .. 1 Heart Disease and Chronic Alcoholism .. .. 1 .. 1 Pneumonia, Delirium Tremens .. .. 1 .. 1 Rupture of Aneurism .. .. 1 .. 1 Kidney Disease, Synecpe 1 .. .. .. 1 Acute Nephritis, after accidental fall .. .. 1 .. 1 Cerebral Haemorrhage .. 2 1 .. 3 Epilepsy 1 1 .. .. 2 Tubercular Meningitis .. 1 .. .. 1 Diaphragmatic Hernia 1 .. .. .. l Whooping Cough, Bronchitis, Convulsions .. .. 1 .. 1 Convulsions, Pneumonia .. 1 .. .. 1 Bronchitis, accelerated by shock from fall 1 .. .. .. 1 Atelectasis Pulmonum 1 .. .. .. 1 Premature Birth .. 1 .. .. 1 Pneumonia .. .. .. 3 3 Pericarditis Cardiac Thrombosis .. .. .. 1 Totals 15 11 11 7 44 21 INFECTIOUS DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table B that 399 Notification Certificates of Infectious Illness were received from medical practitioners, as against 410 during tbe preceding year, if the notifications received from the temporary notification of Chicken-pox and the voluntary notification of consumption are excluded. These 399 cases represent infection in 326 different houses. In 343 instances the disinfection was performed by the Sanitary Authority, and in the other cases by the householders, to the satisfaction of their medical attendant. A visit was paid to every house, and it was ascertained that cases of infectious illness occurred in 26 houses where there were "grave" sanitary defects, 31 in which the sanitary defects were "slight," and 269 in which there were no such defects. In forming these conclusions I have considered whether any sanitary defect was of a nature which is generally held by health officers to predispose to, or directly bring about, the particular disease in question. Thus apart from the measures that have been taken to prevent the spread of infectious illness, the notification of such illness was the means during the year of bringing about a sanitary inspection of 326 premises. Table B 1 shows the number of cases, and of deaths, from the Infectious Diseases notified during the years 1891-1902; and Table B 2 the cases of Infectious Diseases notified during each month of the year 1902. The Infectious Sickness Bate of the Borough was 7.7 to each 1,000 of the population, as against 7.9 for the preceding year. The rate in the Northern Division was 4.7, while that in the Southern Division was 9.4 TABLE B. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1902. Notifiable Disease. Cases notified in Whole Distict. Small-pox. Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Plague. Chicken Pox. Phthisis. (Voluntary). Totals. At all Ages 41 .. 91 2 50 192 .. 22 .. .. 1 .. 355 26 780 Under 1 .. .. 2 .. 2 .. .. .. .. .. .. .. 18 .. 22 1 to 5 .. .. 26 2 1 47 .. 8 .. .. .. .. 155 .. 239 324 5 to 15 4 .. 38 .. 1 105 .. 7 .. .. .. .. 169 .. 15 to 25 9 .. 10 .. 9 29 .. 7 .. .. .. .. 7 2 73 25 to 65 27 .. 15 .. 33 11 .. .. .. .. 1 .. 6 23 -i 116 65 and upwards 1 .. .. .. 4 .. .. .. .. .. .. .. .. 1 6 Total Cases notified in each Locality. Northern Division 10 .. 20 .. 13 41 .. 2 .. .. .. .. 91 2 179 Southern Division 31 .. 71 2 37 151 .. 20 .. .. l .. 264 24 601 No. of Cases removed to Hospital from each Locality. .. Northern Division 10 .. 7 .. .. 29 .. 2 .. .. .. .. .. .. 48 Southern Division 30 .. 49 1 1 101 .. 9 .. .. .. .. .. .. 191 METROPOLITAN BOROUGH OF STOKE NEWINGTON, PUBLIC HEALTH DEPARTMENT. Council's Office, Milton Road, 190 23 TABLE B 1*. Table showing the number of Cases and Deaths from the Infectious Diseases notified from among parishioners during the years 1892-1902. Small-pox. Scarlet Fever. Diphtheria. Continued Fever. Cases. Deaths. Cases, Deaths. Cases. Deaths. Cases. Deaths.[/##3] 1892 2 — 232 6 59 9 2 1893 8 — 354 4 84 5 — 1894 3 91 4 55 5 — — 1895 — — 129 1 57 6 — — 1896 1 — 220 7 71 18 — — 1897 2 — 108 1 53 19 — — 1898 — — 146 2 52 4 — — 1899 — — 178 2 31 6 — — 1900 — — 116 5 120 14 1901 26 3 174 4 137 14 — — 1902 41 8 192 5 91 5 — — Erysipelas. Puerperal Fever. Typhoid Fever. Membranous Croup. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1892 30 4 3 2 31 2 2 — 1893 37 — — — 31 2 1 1 1894 25 — 2 2 12 3 2 1 1895 28 — 1 — 29 8 5 4 1896 41 — 1 3 17 5 3 3 1897 22 1 3 1 38 10 1 2 1898 28 2 3 3 18 3 1 — 1899 30 3 8 5 16 5 — 1 1900 28 — 4 1 21 6 2 1 1901 39 — 4 2 26 4 4 1 1902 50 — 1 — 9.1 4 2 *In reading this table it must be borne in mind that the returns prior to those of 1901, relate solely to the old Parish of Stoke Newington and not to the increased area of the present Borough. 24 TABLE B 2. Cases of Infectious Diseases notified during each month of the year 1902. Small-pox. Scarlet Fever Diphtheria MembranousCroup Typhoid Fever. Puerperal Fever. Erysipelas. Chicken-pox. Phthisis. Totals. January 7 24 11 .. 1 1 4 .. 2 50 February 10 15 18 .. .. .. 3 18 1 65 March 12 23 11 .. .. .. 2 34 4 86 April 7 11 3 .. 1 .. 3 50 .. 75 May 1 12 4 .. 3 .. 4 40 3 67 June 3 21 4 .. 4 .. 4 53 2 91 July 1 13 11 .. 2 .. 2 41 2 72 August .. 8 3 .. 4 .. 3 14 1 33 September .. 21 7 .. 2 .. 5 3 3 41 October .. 17 4 .. 3 .. 11 37 3 77 November .. 13 11 .. 2 .. 3 37 3 69 December .. 14 4 .. .. .. 6 28 2 54 Totals 41 192 91 2 22 1 355 26 780 The Infectious Sickness Rate for London generally was 9.9 and of the 29 Sanitary Areas situated within the Metropolis, the lowest rates were those of Kensington (5.3), and Hampstead (5.7), and the highest were Bethnal Green (13.4), and Stepney (13.1). 239 of the cases notified were removed from their homes to Isolation Hospitals. 25 SCAELET FEVER. The 192 cases of Scarlet Fever occurred in houses in 6 of which there were grave insanitary conditions : in 12 the insanitary conditions were slight, and in the remaining houses there was an absence of such conditions. School attendance was ascribed as the origin of the infection in 9 cases ; and in three cases there were strong reasons for believing that the infection was communicated by a patient recently dismissed from a fever hospital. The infection was imported into the Borough in 3 instances, and in 13 instances the infection was directly contracted from a preceding case. EEYSIPELAS. The 50 cases of this disease represented infection in 48 different premises. In one of these, grave insanitary conditions existed, and in 2 the insanitary conditions were of a slight nature. Two cases resulted from injury. TYPHOID FEVER. The 22 cases notified during the year all occurred in different houses. In 3 of these houses grave insanitary conditions existed, and in 1 the insanitary conditions were slight; while in the remaining 18 there were no insanitary conditions. 2 of the cases doubtless contracted the disease outside of London during the summer and autumn holidays. The evidence pointed strongly to the infection having been derived from the eating of cockles in 2 instances and to the consumption of oysters in another instance. The origin of the infection remained quite obscure in the majority of cases, and in many instances, as I pointed out in a previous Report, the patient had been ailing for several weeks before he took to his bed and the disease was diagnosed. A Royal Commission is now turning its attention to the important matter of the infection of shell-fish by sewage, and the recent outbreak of Enteric Fever which followed the Municipal banquets at Winchester and Southampton, will serve to arouse the general public to a sense of the present dangers, and to bring about a much-needed reform in the conditions under which shell-fish are reared and maintained. DIPHTHERIA. The 91 cases of Diphtheria occurred in houses, 22 of which were more or less insanitary. The sanitary defects were grave in 10 and slight in 12 instances. School attendance is either alleged by the parents or surmised by myself, on good grounds, to be the cause of 3 attacks during the year. Three cases of the infection were imported into the Borough. In several cases it was very clear that a preceding tonsilitis of several weeks duration predisposed to an attack of Diphtheria. In six cases the attack was preceded by "sore-throat" in other members of the family. The infection appears to have been contracted outside of the Borough in two instances. In no less than 20 cases there was a history of previous throat trouble frequently recurring. In many of the cases I was unable to trace the origin of the disease in any satisfactory manner ; that is to say, after carefully ascertaining all the facts, the origin of the infection could only be conjectured, and it was impossible to do more. Each year adds to the testimony of the efficacy of Antitoxin in this disease, and many applications have been made at the office for tubes which I store for the convenience of local practitioners. When a case of Diphtheria occurs in a house where there are young children, not only should resort be had to Antitoxin as a Prophylactic, but all the children that have been exposed to the disease should be given small doses of the remedy. In this disease the spread of the infection (and by consequence the mortality) are largely due to the unfortunate circumstance that the early diagnosis of the disease from clinical symptoms is frequently difficult and impossible, and Bacteriology alone can solve the difficulty in many cases. The Diagnosis outfits provided by the Council during the year to the medical practitioners in Stoke Newington continue to be much appreciated. Every practitioner has been kept supplied with such an outfit, and has thus had at his disposal the means of procuring a bacteriological diagnosis of both 27 Diphtheria and Typhoid Fever The following is a list of the applications received, together with the results of an examination performed at the Jenner Institute of Preventive Medicine, London. Date of Application. Suspected Disease. Result of Examination. 1902. January 3rd Diphtheria Diphtheria ,, 6th Diphtheria Not Diphtheria ,, 11th Diphtheria Diphtheria „ 16th Phthisis Not Phthisis „ 16th Diphtheria Not Diphtheria „ 17th Phthisis Not Phthisis February 1st Phthisis Not Phthisis ,, 1st Diphtheria Diphtheria ,, 5th Phthisis Not Phthisis March 3rd Diphtheria Diphtheria „ 4th Phthisis Not Phthisis ,, 7th Diphtheria Not Diphtheria „ 24 th Phthisis Phthisis „ 25th Diphtheria Not Diphtheria. ,, 25th Tuberculosis Tuberculosis April 16th Diphtheria Not Diphtheria May 5th Diphtheria Not Diphtheria ,, 8th Diphtheria Not Diphtheria June 5th Diphtheria Not Diphtheria „ 9th Diphtheria Not Diphtheria „ 11th Tuberculosis Not Tuberculosis „ 11th Diphtheria Diphtheria July 2nd Tuberculosis Tuberculosis August 12th Enteric Not Enteric „ 12th Diphtheria Not Diphtheria „ 12th Diphtheria Diphtheria September 9th Phthisis Not, Phthisis ,, 27th Tuberculosis Tuberculosis ,, 29th Diphtheria Diphtheria ,, 30th Diphtheria Not Diphtheria October 6th Phthisis Phthisis „ 10th Diphtheria Not Diphtheria ,, 20th Phthisis Phthisis November 8th Phthisis Not Phthisis ,, 10th Diphtheria Diphtheria ,, 10 th Diphtheria Diphtheria ,, 10 th Diphtheria Not Diphtheria ,, 12th Diphtheria Not Diphtheria ,, 14 th Diphtheria Not Diphtheria ,, 18th Diphtheria Diphtheria „ 19th Tuberculosis Not Tuberculosis ,, 20 th Tuberoulosis Not Tuberculosis ,, 20th Diphtheria Not Diphtheria December 1st Diphtheria Not Diphtheria ,, 4th Diphtheria Not Diphtheria ,, 20th Tuberculosis Tuberculosis ,, 29th Diphtheria Not Diphtheria „ 31st Tuberculosis Not Tuberculosis 28 CONSUMPTION. As the result of the experience of another year of the voluntary notification of Consumption, one is impressed with the fact that although much good has undoubtedly been achieved by that measure there is a great need for the adoption of further measures. In the first place the voluntary notification of the disease enables the Sanitary Authority to deal with only a limited number of cases. During the year 1902, for instance, we received 26 notifications of this disease ; whereas there must have been in the community many scores of further cases who wou'd have benefited greatly from the little which we are able to do. In the Borough we make provision for bacteriological examination of suspected expectoration, for the disinfection of infected dwellings and articles of clothing, etc., the gratuitous distribution of disinfectant for spittoons, etc., and for the distribution of handbills and placards, and it is doubtless a great pity that the sphere of this useful work should be prescribed or limited to the few cases voluntarily notified to us. It is very desirable therefore that the disease should shortly be made compulsorily notifiable and this fact would considerably aid in the struggle against the disease. The public is in my opinion now educated up to such a measure. Nothing has been more surprising to me than the circumstance that in every one of the houses visited by myself the patient and those about him are fully aware of the communicability of the complaint. Perhaps the fear of infection has gained too great a hold of the public mind and there is a tendency to exaggerate the comparatively slight infectivity of the disease. Doubtless it is better to exaggerate this than to err in the other direction, but there is the risk that it may lead to hardship in the relations and treatment of the patient and so it is most desirable to point out to all concerned, as in the handbill issued by the Council, that if a few simple precautions are taken a consumptive patient need not be a source of danger to anybody. Voluntary notification is still to a great extent a makeshift, but it has served the useful purpose of educating public opinion so as to prepare it for a measure of compulsory notification. 29 In the majority of cases visited, the rooms occupied by the sick persons have been found to be fairly clean and ventilated, but as a rule even in these cases one has been able to make suggestions for improving the existing arrangements and reducing the risk to others. But it has happened in more than one instance that a patient in the last stages of the disease has had to occupy a room shared by several others. In those cases no suggestion which we were able to make could do away with the enormous risks the other occupants were daily called upon to face, and what is urgently required is that some provision should be made in connection with each sanitary authority in London and elsewhere for the isolation of those cases who are a source of great danger to others. It is impossible to get these patients into one of the few Sanatoria for consumption which at present exist. Many of them are patients who will certainly never recover and they are almost paupers. The provision of isolation for these patients is in my opinion more urgently demanded than sanatoria for the cure of patients who are in the earlier stages, and who in the large majority of cases need not be a source of danger to others. CANCER. There are indications that Cancer may possibly be a communicable disease ; not in the same degree as Small-pox or even Consumption, but that healthy individuals may in rare cases be capable of contracting the disease from a previous sufferer. Partly on this account, but mainly because of the increasing prevalence of the disease, a great effort is now being made to learn the origin of the disease. In Cancer we have a terrible disease furnishing a progressive increase in mortality—more especially among males. No one can reasonably doubt the reality of this increase. It can be demonstrated as not due to any altered age and sex distribution of the population of this country and the statistics of other 30 countries (Germany, America, France, Sweden, Holland, Switzerland, Russia and several of our Colonies) furnish records of an increase very similar to our own. The essential matter for us to learn is—how people get Cancer ; and this question is not going to be settled by the tabulation of imperfect, and often faulty, death certificates, any more than it is by work restricted to research in a laboratory ; but, as in the case of so many other diseases, by close observation and full local enquiry into all the circumstances associated with the appearance of the disease in the individual, by those who are trained for such work. Wild theorising from conclusions based upon insufficient and inaccurate premises has recently been much indulged in. Owing to the circumstance that the increase in Cancer has mainly affected the male sex, and especially the gastro-intestinal tract, the food theory of infection has claimed many adherents. Tea, sugar, tomatoes, tiesh, raw vegetables, have their advocates; but though flesh-eating has certainly increased, more especially among the working classes, there is no special increased prevalence of Cancer among those classes, and in Dr. Tatham's Decennial Report for 1881-90, the comparative mortality figure for all occupied males is 44 and that for all unoccupied males is 96. The incidence of Cancer, moreover, upon beef-eating Mohammedans in India is said not to differ very widely from that upon the Hindus. The more general dissemination of arsenic in food, clothing, etc., is also advanced as a cause, and the fact that arsenic is present in soot is held to account for the circumstance of the excessive mortality among chimneysweepers. Flies have been held to act as carriers, and gnats, fleas and bugs as inoculators. Sewage-polluted soil, and attacks of syphilis are said to favour the occurrence of the disease. 31 As possible clues to the etiology of the disease we have the facts that chimney-sweepers suffer out of proportion to the rest of the population (although, in Germany they do not appear to contract Cancer especially frequently, vide report of the German Committee for Collective Investigation of Cancer, analysed and tabulated by Professor C. Hirschberg) while workers with coal enjoy some slight degree of exemption. Local irritation or injury is a strongly predisposing, if not exciting factor, especially among those with congenital vulnerability to the disease ; and when we add that in certain districts Cancer is more rife than in others we have almost exhausted the stock of our present knowledge. This varying prevalence over different areas is found in Germany to be largely accounted for by variations in the average duration of life in the different districts, but in England and Wales, Dr. Tatham has shown in the supplement to his 55th annual report, that if the Cancer rates are corrected for differences in age and sex distribution even then the variations in the rate from 1881-1890 were as great as from 2,250 per million for London to 1,574 for Monmouthshire. We have therefore everything to learn and practically an open field for investigation. Is the excellent working hypothesis of the infection theory correct? Are the related incidences which appear to point to the contagiousness of Cancer (of auto-infection (lip to lip, etc.), and the reported cases of Cancer-a-deux) coincidences merely, or are they due to the slight infectiousness of a generally prevalent micro-organism ? Is the virus formed inside the body or does it gain access from without? What about Cancer houses and Cancer districts? Is our present information sufficient to warrant the conclusions that the disease is most rife in low-lying districts with surface deposits of alluvium and sub-soils of clay, and districts which are liable to flooding? With reference to the existence of Cancer houses the entire evidence in support depends on death certificates and such evidence may very easily lead to erroneous deductions. If there are Cancer houses, what is it that determines a Cancer house ? Is it resistant and persistent infection, or is it something proper to the house or site and quite independent of infection from a preceding 32 case ; and is Behla's opinion correct that the disease occurs in houses with damp basements and cellars ; and is it more frequent in old or new houses? Why does the disease show a preference for the better classes and no excess in areas overcrowded by the very poor ; and why is it prevalent among all domestic mammalia but very rarely in wild animals? Trustworthy facts with reference to these points are wanted. The Committee of the Cancer Research Fund are directing a "Crusade" under the Presidency of H.R.H. The Prince of Wales, and with an Executive Committee which augurs well for success. The Cancer Research Fund now amounts to a large sum and will be expended upon Laboratory investigation, and the collection of statistical, dietetical, topographical and other information with reference to Cancer in Great Britain, the Colonies, India, and other Countries. The Cancer Research Committee in this Country will doubtless collect accurate facts regarding the geographical distribution of the disease and these will be very valuable when considered in relation to the habits, customs and surroundings of the different peoples Hospital Returns possess a special value; diagnoses are more generally correct and necropsies more frequent among hospital patients, and if the Committee collects and deals with all these, a very valuable and important work will be achieved. The matter of the notification of cases of Cancer in order to facilitate our local enquiry is probably out of the question, and I do not believe that the gain would be a very real one —for probably it is safer to deal only with mortality returns of such a disease as Cancer. But to get the best value from those returns more post-mortems are required; when there is reason to doubt the correct diagnosis of fatal internal cases, having regard to the public interests involved, the relatives and friends should be brought to consent to such an examination. Doubtless also the microscope should be far more extensively and generally used in the future than it has been in the past. Recognising how inadequate the information obtained from the present Death Returns is, we shall agree that the information must be very largely supplemented if our investigations into the causes of Cancer are to be given a fair 33 prospect of success. For the past year every death from Cancer in the Metropolitan Borough of Stoke Newington has been investigated. A visit has been paid to the premises on which the death occurred, an enquiry form has been filled in, and a careful inspection has been made of the premises and surroundings. Such enquiries confined to small areas are however of very limited value and do not warrant definite conclusions. We want the facts with reference to the distribution of Cancer collected from as broad a survey as that comprised in the admirable report of Dr. Parsons on Epidemic Influenza. Our information must even go far beyond that which can be collected in Great Britain and Ireland. It is only by such extended observations that we have learned many of the most important facts with reference to other diseases. NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR. It will be seen from the accompanying Report of the Sanitary Inspectors that a large amount of sanitary work has been performed during the year. 2576 premises were inspected for conditions injurious or dangerous to health, and insanitary conditions varyiDg in their nature from slight to very grave, were discovered in a large number of instances. 821 Intimation Notices, followed in 20 cases by Statutory Notices, were complied with. Of this number only 182 inspections were made as the result of complaints by householders and others, and this circumstance will serve to accentuate the importance of prosecuting a fairly constant system of house-to-house inspection in at least the poorer parts of the Borough. It is difficult to over-estimate the value such a measure has in preventing the origin and spread of preventable sickness. The Slaughter-houses, bake-houses, cowsheds and dairies situated in the Borough were all duly inspected throughout the year. 34 HOUSES LET IN LODGINGS. In the Borough of Stoke Newington, more especially in the Southern Division, there is a considerable number of houses let in lodgings under circumstances and conditions which render it desirable, in the interest of personal and public health, that they should be registered and inspected at frequent intervals. By the end of the year 1902, 119 houses were on the Register. CREMATION. The difficulties of disposing of the dead must of necessity increase with the growth of our large towns, and there can be no doubt that the time is not far distant when it will be found difficult and costly to continue the method of earth burial. The recent Cremation Act (of 1902), which legalises the burning of human remains, is therefore a Statute of public health importance. By this Act, on and after April 21st, 1903, the several Crematoriums in the country will be under the control of the Home Office and the Local Government Board, and a Departmental Committee has already drawn up the regulations provided for by the Act for the management and conduct of these establishments. ICE-CREAM. The London County Council (General Powers Act, 1902) provides amongst other things for the registration of Ice Cream Vendors, and for the preparation and storage of their wares. The measure is a welcome addition to the statute book, for it has been abundantly demonstrated that ice-creams are often made and stored under the most filthy conditions imaginable by the aliens who ply the trade. WORKSHOPS AND WORKPLACES. All the Workshops and Workplaces in the Borough have been inspected during the year, the majority of these I have myself visited and I am able to state that in respect of cleanliness, air space, light, ventilation and the provision of suitable and sufficient 35 sanitary conveniences, the workshops and workplaces in the Borough are maintained in a satisfactory state. It has been necessary in a few instances to stop home work on account of the presence of dangerous infectious disease on the premises. A list of outworkers employed is kept in the office, and the name a d places of employment of all those out-workers who do not reside in the Borough, have been forwarded to the Medical Officers of Health of the respective Boroughs in which they work. There are at present 137 workshops registered in the Borough. During the year the whole of the Bakehouses of the Borough were inspected on two occasions. There are at present in the Borough 21 underground bakehouses and as these will have to be certified by the Sanitary Authority as suitable in regard to construction, light, ventilation and all other respects after the end of this year, they have received special attention. The Government of the day was evidently convinced in 1895 that underground bakehouses were unsuitable places for the preparation of food, because Section 27 of the Factory and Workshops Act of that year prohibited their occupation unless they were actually in use before January, 1896. An underground bakehouse is defined in the Act as a bakehouse, any baking room of which is so situated that the surface of the floor is more than three feet below the surface of the footway of the adjoining street, or of the ground adjoining or nearest to the room. With few exceptions the underground bakehouses in the Borough are little more than the kitchen and scullery of an ordinary dwelling house, adapted by the construction of an oven under the footway of the adjoining street, very imperfectly lighted and ventilated; and several of these premises, owing also to other circumstances, cannot in their present condition, be certified as suitable for the purposes of a business demanding the utmost cleanliness. All underground bakehouses differ from each other to some extent, but the first step which it is desirable to make is to agree upon the absolute minimum requirements for all underground bakehouses before they will be certified as satisfactory. The Public Health Committee has given a 36 able amount of consideration to this subject and their recommendations as approved by the Council in February of the present year (1903) are as follows :— THE METROPOLITAN BOROUGH OF STOKE NEWINGTON. As to the conditions under which a Sanitary Authority may properly grant a certificate that an underground bakehouse is suitable, it is not unreasonable to demand that in all essential requisites such a bakehouse shall be rendered equally healthy with a bakehouse of moderately good type, which is entirely above ground. MINIMUM REQUIREMENTS FOR UNDERGROUND BAKEHOUSES. An underground bakehouse shall not be used as such after January 1st, 1904, unless such underground bakehouse be, in the opinion of the Sanitary Authority, suitable and fit on sanitary grounds for use or occupation as a bakehouse, as shown by possessing the following minimum sanitary requirements :— A.—Construction. (1) The bakehouse shall be of a minimum capacity of 1,500 cubic feet, and shall have a mean height of at least 7 feet 6 inches, and in no part a height of less than 7 feet when measured from the floor to the ceiling. (2) The interior face of walls shall be smooth and impervious to damp and dirt throughout. (3) The ceilings shall be properly ceiled with material impervious to damp and dirt. (4) The floors shall be hard, smooth, and impervious to damp and dirt throughout. 37 (5) Any drain or sewer under the bakehouse shall be structed of gas and water-tight pipes, with sound joints. No gulley shall be within the bakehouse, unless the drain connected therewith be made to discharge over a trapped inlet outside the bakehouse, and there be proper access, readily obtainable, to the place of discharge (where this is practicable). No certificate will be granted to any bakehouse which is subject to flooding from drains, sewers, etc. (6) Provision shall be made for safe and suitable means of access to the bakehouse. Every underground bakehouse shall be approached by a suitable staircase, adequately lighted and ventilated. No outside staircase shall terminate within an underground bakehouse. Any opening into the shop above must be so covered as to prevent the entrance of dust. B.—Light. (7) The underground bakehouse shall be adequately lighted, with daylight throughout, to the satisfaction of the Sanitary Authority; and the lighting maintained shall be such that an official copy of the abstract of the Factory Act may ordinarily be read in all parts of such bakehouse between the hours of 11 a.m. and 2 p.m. C.—Ventilation. (8) The bakehouse shall be properly and effectually ventilated by permanent inlets and outlets, communicating directly with the open air, in such a way and at such a height above the street level (or ground adjoining) as to prevent the entrance into the bakehouse 38 of street dust and dirt. Where natural ventilation is not effective, or in the opinion of the Medical Officer insufficient, ventilation by fans or other artificial means shall be provided. Arrangements for ventilation shall be such that the temperature of the underground bakehouse, from October 1st to May 31st, shall not exceed 808 Fahr., except within half an hour after a batch of bread has been drawn. D.—All other Respects. (9) Dough troughs, and other furniture, or fittings (if any) shall be mounted on strong castors, or wheels, so as to be readily moveable for cleansing purposes, or where fixed, shall be raised at least 1 foot from floor, and set sufficiently away from all walls, so as to allow of access to all parts. (10) No bakehouse shall be in direct communication with any coal or other cellar, nor with any wash-house; nor with any room, unpaved yard, or area, which may be a nuisance, or cause contamination by foul air, dust or dirt. (11) Provision shall be made for the storage of flour elsewhere than in the bakehouse itself, in a dry, clean, well lighted and well ventilated room. (12) Conveniences for personal ablution shall be provided in a suitable position, and shall include a watertap, and a sink or lavatory basin of an approved character. (These conveniences shall be outside the under-ground bakehouse.) 39 (13) Free access shall be provided to proper sanitary veniences suitably situated. (14) Proper provision shall be made for the depositing of wearing apparel outside the underground bakehouse. N.B.—Before making any alterations with a view to meet these requirements, the owners or tenants of bakehouses are advised to submit to the Medical Officer of Health a specification of the alterations which they purpose making. It will be seen that these minimum requirements provide against the entry of ground air and moisture, and make provision for ventilation, light, and cleanliness of the premises. In my opinion the regulations are perfectly fair and reasonable and they represent the absolute minimum requirements in order to insure fairly healthy surroundings and cleanliness; and I venture to express the hope that the new Act will be enforced in the spirit of these suggested requirements and that no certificate will be given unless they are carried out in a thoroughly satisfactory manner. FOOD AND DRUGS. Under the sale of Food and Drugs Acts, 118 samples of Food and Drugs were taken and analysed. The results are shown in Table C. Eleven of the samples were not satisfactory and, therefore, the percentage of non-genuine samples amounted to about 9 3 per cent., a figure which is markedly lower than that of the preceding year, when it was 16 per cent. The figure for the whole country was 9 per cent. during the year 1901. 16 per cent. of the milk samples were unsatisfactory, as against 21 per cent. during the preceding year. 18.27 per cent. of the samples of milk taken on Sundays were adulterated. There were three convictions obtained for selling margarine contrary to the provisions of the Act. 40 TABLE C. ANALYSES PERFORMED UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR. No. Sample Analysed. Opinion Formed. Action Taken. 1 Butter Genuine Nil. 2 Butter ,, ,, 3 Margarine (No Label) 81% of Foreign Fat Defendant fined £1 and 12/6 costs 4 Coffee Genuine Nil 5 Flour ,, ,, 6 Oatmeal ,, ,, 7 Irish Whisky ,, ,, 8 Saveloys ,, ,, 9 Preservative Powder ,, ,, 10 *Milk ,, ,, 11 Milk ,, ,, 12 *Milk ,, ,, 13 Milk ,, ,, 14 *Milk ,, ,, 15 *Milk 6% deficiency in fat Defendant fined £1 and 12/6 costs. 16 *Milk Genuine Nil 17 Milk 3% deficiency in fat Cautioned. 18 Mustard Genuine Nil 19 Coffee ,, ,, 20 Pepper ,, ,, 21 Coffee ,, ,, 22 Mustard ,, ,, 23 Golden Syrup ,, ,, 24 Mercurial Ointment ,, ,, 25 Butter ,, ,, 26 Butter ,, ,, 27 Magnesia ,, ,, 28 *Milk 9% of added water Defendant fined £1 and 12/6 costs. 29 *Milk Genuine Nil 30 *Milk ,, ,, 31 Milk ,, ,, 32 Milk ,, ,, 33 Demerara Sugar Crystals coloured with Analine Defendant fined £2 and 12/6 costs. 34 Sweet Spirits of Nitre Genuine Nil 35 Demerara Sugar ,, ,, 36 Gin ,, ,, 37 Gin Weak Sample Vendor cautioned. 38 Castor Oil Genuine Nil. 39 Milk ,, ,, 40 Milk ,, ,, 41 Milk ,, ,, * Sunday Samples. 41 TABLE C.—Continued. No. Samples Analysed. Opinion formed. Action taken. 42 Butter Genuine Nil 43 Butter ,, ,, 44 Demerara Sugar ,, ,, 45 Coffee ,, ,, 46 Demerara Sugar ,, ,, 47 Coffee ,, ,, 48 *Milk ,, ,, 49 *Milk 8% less than legal standard of Fat Case Withdrawn. Warranty Produced. 50 *Milk Genuine Nil 51 *Milk ,, ,, 52 *Flour ,, ,, 53 Flour ,, ,, 54 Oatmeal ,, ,, 55 Sweet Spirit of Nitre ,, ,, 56 Coffee ,, ,, 57 Oatmeal ,, ,, 58 Coffee ,, ,, 59 Sweet Spirits of Nitre ,, ,, 60 *Milk ,, ,, 61 *Milk ,, ,, 62 *Milk Slight deficiency in fat.. ,, 63 *Milk Genuine ,, 64 Coffee ,, ,, 65 Butter ,, ,, 66 Butter ,, ,, 67 Butter ,, ,, 68 Sweets ,, ,, 69 Mustard ,, ,, 70 White pepper ,, ,, 71 Mixed Sweets ,, ,, 72 *Milk ,, ,, 73 *Milk ,, ,, 74 *Milk 8% of added water Defendant fined 5/- and 12/6 costs, 75 *Milk Genuine Nil 76 *Milk ,, ,, 77 *Milk ,, ,, 78 Citrate of Magnesia ,, ,, 79 Flowers of Sulphur ,, ,, 80 Sulphur ,, ,, 81 Citrate of Magnesia ,, ,, 82 Phosphate of Soda ,, ,, 83 Mecurial ,, ,, 84 Ointment Separated Milk ,, ,, 85 Milk ,, ,, 86 Milk ,, ,, 87 Milk ,, ,, 88 Milk ,, ,, 89 Coffee ,, ,, 90 Pepper ,, ,, * Sunday Samples. 42 TABLE C.—Continued. No. Sample Analysed. Opinion Formed. Action Taken. 91 Butter Genuine Nil 92 Mustard ,, ,, 93 Mixed Sweets ,, ,, 94 Scotch Whisky 26 degs. under proof Vendor cautioned 95 Butter 7% excess of water Nil. Sample labelled with Peark's label 96 Butter Genuine Nil 97 Milk ,, ,, 98 Butter ,, ,, 99 Margarine (unlabelled) Margarine Defendant Fined £2 and 12/6 costs 100 Margarine (unlabelled) ,, Defendant Fined £2 and 12/6 costs. 101 Milk 12% of added water Defendant Fined 10/and 12/6 costs 102 Milk Genuine Nil 103 Margarine (unlabelled) Margarine Defendant to pay 12/6 costs 104 Milk 16% of added water Defendant Fined 25/and 12/6 costs 105 Milk Genuine Nil 106 Milk ,, ,, 107 Milk (separated) ,, ,, 108 Milk ,, ,, 109 Milk ,, ,, 110 Unswd. Gin 34.9 deg. under proof ,, 111 Unswd. Gin 34.5 ,, 112 Coffee Genuine ,, 113 White Pepper ,, ,, 114 Demerara Sugar ,, ,, 115 Coffee ,, ,, 116 Flour ,, ,, 117 Flour ,, ,, 118 Butter Margarihe Defendant Fined £1 and 2/- costs 43 METEOROLOGY IN AND AROUND LONDON DURING THE YEAR 1902. January.—The weather in January was for the most part dull and mild, with frequent rain at the beginning and towards the end of the month. The mean daily temperature of the air was generally below its average from the 13th to the 15th, and from the 25th to the 31st, and generally above from the 1st to the 12th, and from the 16th to the 24th. The fall of rain was somewhat below its average. The S. and W. winds were prevalent during the greater portion of the month. February.—The weather in February was mostly cold, dull and cheerless, rain falling frequently at the end of the month. The mean daily temperature of the air was above its average from the 22nd to the 28th, and below on all other days. The fall of rain was below its average. The N. and E. winds were prevalent on 20 days during the month. March.—The weather in March was generally mild and dull, with very little sunshine. The mean daily temperature of the air was below its average from the 4th to the 6th, and from the 22nd to the 26th, and generally above on all other days. The fall of rain was a little below its average. The S. and W. winds were prevalent on 24 days during the month. April.—The weather in April, though of a somewhat changeable character, was mainly fair and dry. The temperature was below the normal in most places. Rainfall varied greatly in amount in different districts ; bright sunshine was, as a rule, in excess of the average. May.—The weather for May was for the most para cold and changeable, with frequent showers in all districts, and with occasional falls of hail, sleet, or snow. At the close of the third week the conditions became for a time much finer and warmer, but at the end of the month unsettled rainy weather set in very generally. The temperature was considerably below the average ; the winds were mainly from between North and West. Rainfall was in excess of the average in most places. 44 June.—The weather in June was extremely cool and unseasonable, with frequent rains and occasional thunderstorms. The temperature was low. The rainfall was very irregularly distributed but was mainly in excess of the average. July.—During the early part of the month the weather was mostly fair. After the middle of the period the conditions became very unsettled, and in the closing week rain was general. The temperature was below the normal. The rainfall was less than the average. August.—The weather in August was for the most part cool and very changeable. The temperature was low. Rainfall was in excess of the average. September.—The changeable weather which had prevailed during the summer months continued throughout the earlier half of September. The temperature was slightly below the normal. October.—The weather of October was mostly cloudy and changeable, especially around the middle of the month, when gales and heavy rains occurred in nearly all districts. Pressure and temperature were above the mean ; the winds were rather variable in the south, but mainly from some Westerly point in the north ; rain-fall was considerably less than the average in, most places ; bright sunshine was very deficient. November.—Until the closing week, when rain fell very generally, the weather of November was mostly fair and dry in the easterly parts of the United Kingdom, with, however, occasional fogs or mists. Pressure was below the average in most places ; temperature was above the normal. The winds were mainly from the Southward and South-eastward ; rain-fall was less than the average; bright sunshine varied considerably in amount in different places, but was deficient at most of our southern stations. 45 December.—After a day or two of mild and very rainy weather, a keen frost extended early in the month from the Continent over nearly the whole of the kingdom, while snow showers occurred in several parts. Pressure and temperature were above the average ; the winds were chiefly Westerly or South-westerly. Rain-fall was deficient in most parts of England; bright sunshine was less than the average. Meteorological Observations taken during the Year 1902, at Camden Square (by H. S. Wallis, Esq.) The observations have been reduced to mean values by Glaisher's Barometrical and Diurnal Range Tables, and the Hygrometrical results from the Sixth Edition of his Hygrometrical Tables. Month. Temperature of Air. Mean Temparature of Air. Rain. Rela- tive Humility. Saturation. 100. Highest Lowest. Mean. No. of Days it fell. Amnt. Collected. Of all Highest Of all Lowest. 8 8 8 8 8 ins. January 52.9 23.8 46.0 36.6 40.5 11 0.76 86 February 52.7 15.8 40.5 31.0 3 5.8 11 1.13 87 March 62.2 29.5 52.9 3.2 45.0 11 1.87 82 April 69.5 29.7 57.6 39.6 48.6 10 0.49 71 May 72.3 31.4 596 41.7 50.7 22 2.60 68 June 84.5 39.2 68.8 50.7 59.8 19 3.13 66 July 85.1 44.9 73.4 53.1 63.3 11 1.40 65 August 79.9 44 0 71.2 53.0 62.1 18 3.69 75 September 76.0 383 67.0 48.7 57.9 9 1.00 80 October 66.2 32.7 57.2 44.7 51.0 17 1.46 87 November 59.3 26.7 50.0 40.0 45.0 11 1.80 91 December 56.8 22.5 44.9 37.6 41.3 12 1.51 91 46 A LIST OF THE STREETS SITUATED IN THE BOROUGH OF STOKE NEWINGTON. ADEN Grove Aden Terrace Adolphus Road Allen Road Allerton Road Albion Road Albion Grove Alexandra Road Amhurst Park Arthur Road Ayrsome Road Barn Street Barrett's Grove Bethune Road (1 to 145) (2 to 106) Blackstock Road Bouverie Road Boleyn Road Brighton Road Brodia Road Broughton Road Brownswood Park Brownswood Road Burma Road Castle Street Carysfort Road Chalmer's Terrace Chapel Place Church Street Chesholm Road Church Path Clonbrock Road Clissold Road Cowper Road Cressington Road Church Road Defoe Road Digby Road Dumont Road Dynevor Road Eade Road Edward's Lane Fairholt Road Falcon Court Finsbury Park Road Fleetwood Street Gainsboro Road Gloucester Road Goldsmith Square Gordon Road Grange Court Road Grazebrook Road Grayling Road Green Lanes Green Lanes (from 22 to 378) ( 45 „ 107) Hamilton Place Harcombe Road Hawksley Road Hayling Road Heathland Road Henry Road Hermitage Road High Street Hornsey Place Howard Road Kersley Road Kings Road Knebworth Road Kynaston Road Kynaston Avenue Lancell Street Laver's Road Lavell Street Leonard Place Lidfield Road Lillian Street Listria Park Londesborough Road Lordship Road 47 Lordship Grove ,, Park „ Terrace Manor Road Martaban Road Marton Road Mason's Court Matthias Road Meadow Street Millard Road Milton Road Mountgrove Road Nevill Road Newington Green Oldfield Road Osterley Road Paget Road Painsthorpe Road Park Street Park Lane Park Lane Terrace Paradise Row Park Crescent Palatine Road Pellerin Road Philp Street Portland Road Prince George Road Princess Road Princess. May Road Queen Elizabeth Walk Queens Road Reedholm Road Rochester Court Sandbrook Road Salcombe Road Seven Sisters Road Shakespeare Road Shellgrove Road Shipway Terrace Somerfield Road Spenser Road Springdale Road St. Kilda's Road St. Andrew's Road St. John's Place Stamford Hill Stoke Newington Road Statham Grove Summerhouse Road Thomas Place Truman's Road Victoria Grove Victoria Grove West Victoria Road Walford Road Warwick Road Watson Street White Hart Yard Wiesbaden Road Wilberforce Road Winston Road Wordsworth Road Woodland Road Woodlea Road Woodberry Down Woodberry Grove