STo 15 THE Metropolitan Borough of Store Remington. REPORT of the Medical Officer of Health and Public Analyst, for the YEAR 1906. by HENRY KENWOOD, M.B., L.E.C.P, D.P.H., F.C.S., Professor of Public Health, University College, London, Fellow and Member of Council of the Royal Sanitary Institute, & c., Medical Officer of Health and Public Analyst. LONDON: Printed by Chas. straker & Sons, Ltd., Bishopbgatb Avbnue, E.C. 1907. 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 7-29 Infantile Mortality and the Public Milk Supply 11-20 Lady Public Health Workers 20-21 The Mortuary 28 Inquests held during the Year 29 Infectious Diseases and the Measures taken to Prevent their spread— The Infectious Sickness Returns for the Year 29-42 Scarlet Fever 34-36 Erysipelas 35 Enteric Fever 35 Diphtheria 36—37 MeasleH and Whooping Cough 38-39 Zymotic Diarrhoea, 39 Consumption 39-41 Cerebro-Spinal Fever 41 Verminous Persons 41-42 Meteorology or the Year 42-46 Notes upon Sanitary Work Performed during the Year 46-56 Food Inspection 47-52 Houses let in Lodgings 52 Factories and Workshops 52-57 The "Sweater" and the "Slum Landlord" 56-57 Food and Drugs 57-65 Report of the Chief Sanitary Inspector (Appendix) 66-76 Streets in the Borough of Stoke Newington—(Appendix) 77-78 A 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1906. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington Gentlemen, The vital statistics of the Borough for the year 1906 are very satisfactory. The general death-rate of 11.5 was the lowest recorded since the formation of the Borough. With the exception of that for the Borough of Hampstead, it is the lowest in the Metropolis, and it compares very favourably with the rate of 15.1 for the Metropolis as a whole. In my last Annual Report, for the year 1905, I drew attention to the circumstance that the deaths among infants under one year of age were the highest recorded since the formationl of the Borough, and that they furnished a rate of 124.7 to every 1000 births. During the year 1906, however, the rate amounted to only 108, and only four other Metropolitan Boroughs had a lower rate. At the present day the effort to stem the wastage of infant lives constitutes the most important branch of public health work. This is now generally recognised, and a very large proportion of sanitary authorities are making special efforts in this direction. To this end they have obtained the services of women-workers, who are mostly salaried officials of the sanitary authority. During the year, five ladies have been giving their services voluntarily to the Borough; under my direction and with the capable assistance of Miss Gardner, of the Charity Organisation Society, they have visited a considerable number of the poorer mothers immediately after their confinement, and followed up their preliminary visit by others, which have beep as frequent as the circumstances appeared to warrant. I have good reason to know that this branch of work has been of great value; 6 but it is, of course, fragmentary, and there is an urgent need in the Borough for a considerable extension of it, by the appointment of one of those paid female officials who are now doing such good work under so many other Sanitary Authorities of the Metropolis. A further reference to this work is made on pp. 20 and 21 of this Report. The Infectious Sickness-Rate for the Borough for the year 1906 is the second lowest in the Metropolis, and the death-rate from every communicable disease (except that of whooping-cough) is below the rate for the preceding year. A considerable reduction in the death-rate from Consumption is a noteworthy feature of the year under consideration, but another year's experience of the Voluntary Notification of the disease adds further testimony to the inadequacy of that measure, and to the necessity for obtaining the compulsory notification of the disease. Again I am able to record my satisfaction with the manner in which the work of the Department has been carried on by the members of the staff and with the good record of work, which is testified to in the appended Report of the Chief Sanitary Inspector. I am, Gentlemen, Your obedient Servant, HENRY KENWOOD. February 26th, 1907. 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 had increased during the 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 1906, and the figure, calculated logarithmically from the increase between 1891 and 1901, amounts to 53,045. I believe this to be a slight over-estimation of the population, having regard to the fact that the number of occupied houses in the Borough in April, 1905, amounted to only 7,292, and the number of occupants to each house averaged only 6.6 at the last Census. It is, however, upon the above figure, obtained by the official method, that the various rates dealt with in this Report are calculated, since, in some parts of the Borough the average number of occupants per house has increased during the past few years ; and when in addition to this circumstance allowance is made for the number of residents in the large block of Industrial Dwellings in Victoria Road, occupied since the last Census enumertion, the estimate should be a very close one. 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 18,500; and in the Southern Division the population is about 34,545. The natural increase of population by excess of births over deaths during the year amounted to 472, as against 401 in the preceding year. Number of people to the acre.—The area of the Borough amounts to 863 acres, and this, divided among the residents, represents 61.5 people to the acre. Births—Birth-rate.—'During the year 1906 there were 1,082 births registered in the Borough, viz.—554 males and 528 females. 8 The birth-rate per 1,000 per annum was therefore 20.4 as against 20.2 for the preceding year. The birth-rate lor the Northern Division of the Borough was about 12.0, while that for the Soulthern Division was 24.9. Year. Birth-rate. Rate for London generally. Rate for England and Wales. 1901 21.6 29.0 28.5 1902 21.8 28.5 28.6 1903 20.9 28.5 28.4 1904 21.8 28.0 27.9 1905 20.2 27.1 2.2 1906 20.4 26.6 27.0 The part which the 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. MORTALITY. General Mortality.—There were 451 deaths of residents registered in the Borough, and 159 of residents who died in Public Institutions outside of the Borough, making a total of 610 deaths. Of these 296 were of females and 314 were of males. Year. General Death-rate. Rate for London generally. Rate for England and Wales. 1901 13.1 17.6 16.0 1902 13.1 17.2 16.3 1903 12.3 15.2 15.4 1904 13.1 16.1 16.2 1905 12.6 15.1 15.2 1906 11.6 15.7 15.4 The recorded general death-rate is therefore 11.5. This ordinary death-rate, however, cannot be taken as a true index of the 9 ness 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 nature 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 containing a larger proportion 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-raite 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 tio sex and age and affording a fair means of comparison, and a truer tesit 0'ft 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 1.04443, and the death-rate corrected for age and sex distribution is (11.5 X 1.04443) 12.0 per 1,000 per annum. In arriving at this corrected death-rate, the deaths of nonresidents, 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 15.1. District Mortality.—The deaths among residents of the Northern Division of the Borough numbered 159 and furnished a recorded death-rate of 8.6 per 1,000 per annum. The deaths among the residents of the Southern Division of the Borough numbered 451, and furnished a recorded rate of 13 0 per 1,000 per annum. TABLE A. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1906. Deaths in or belonging to Whole District at subjoined Ages. Causes of Death. Measles. Scarlet Fever. Whooping Cough. Diphtheria & Membranous Croup. Enteric Fever. Epidemic Influenza. Diarrhoea. Enteritis. Puerperal Fever. Erysipelas. Other Septic Diseases. Phthisis(Pulmonary Tuberculosis). Other Tubercular Diseases. Cancer. Malignant Disease. Bronchitis. Pneumonia. Other Diseases of Respiratory Organs. Alcoholism, Cirrhosis of Liver. Venereal Diseases. Premature Birth. Heart Diseases. Accidents. Suicides. Diseases of the Nervous System. Old Age. All other Causes. All Causes. All Ages 10 1 17 4 .. 9 26 .. 1 3 18 48 14 48 57 27 21 17 2 21 68 8 7 45 47 91 610 Under 1 year 3 .. 4 .. .. 1 19 .. .. .. 2 .. 3 .. 5 4 4 .. 2 21 2 2 .. .. .. 45 117 1 and under 5 6 .. 11 .. .. .. 4 .. .. .. 1 .. 5 1 1 3 2 .. .. .. .. .. .. 1 .. 6 41 5 and under 15 1 .. 2 4 .. .. .. .. .. .. 4 .. 2 .. .. 1 1 .. .. .. 2 .. .. 1 .. 1 19 15 and under 25 .. .. .. .. .. .. .. .. .. .. 1 6 1 1 .. 2 .. .. .. .. 6 .. .. .. .. 2 19 25 and under 65 .. 1 .. .. .. 5 1 .. 1 3 7 42 3 26 16 12 0 16 .. .. 34 3 6 29 .. 20 230 65 and upwards .. .. .. .. .. 3 2 .. .. .. .. .. .. 20 35 5 9 1 .. .. 24 3 1 14 47 17 184 Deaths in ok belonging to Localities at all Ages. North Division .. .. .. .. .. 15 3 .. .. .. 8 11 4 23 10 7 4 5 .. 5 18 2 2 17 15 20 159 South Division 10 1 17 4 .. 4 23 .. 1 3 10 37 10 25 47 20 17 12 2 16 50 6 5 28 32 71 451 Total Deaths in Public Institutions in the District. .. .. .. .. .. 3 .. .. .. .. .. 1 •• 8 9 • • 1 .. •• 1 4 .. •• 13 8 1 49 10 11 DISTRICT MORTALITY. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Rate per 1,000 per annum. Northern Division 39 46 33 42 159 8.6 Southern Division 118 117 106 110 451 13.0 Totals - 157 162 139 152 610 11.5 INFANTILE MORTALITY. There were 117 deaths registered of infants under one year of age, as against 1,082 births; the proportion which the deaths under 1 year of age bear to 1,000 births is, therefore, 108, as against 124.7 in the preceding year. The deaths! under 1 year of age form 19.5 per cent. of the total deaths of all ages, whereas those for the preceding year formed 19.2 percent Year. Kate of Infantile Mortality. Rate for London generally. Rate for England and Wales. 1901 117.9 149 151 1902 114.7 139 133 1903 120.3 130 132 1904 115.6 144 146 1905 124.7 129 128 1906 108 130 133 TABLE A1. Metropolitan Borough of Stoke Newington.—Infantile Mortality during the Year 1906. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Common Infectious Diseases. Diarrhœal Diseases. Wasting Diseases. Tuberculous Diseases. Meni Dgitis (not Tuberculous). Convulsions BroDchitis (including Broncho-Pneumonia) Laryngitis Suffocation Other causes Measles Venereal Diseases Totals Diphtheria. Croup Whooping Cough Diarrhoea, all forms Enteritis (not Tuberculous) Gastritis, Gastrointestinal Catarrh Premature Birth Congenital Defects Injury at Birth Want of Breastmilk Atrophy, Debility, Marasmus Tuberculous Meningitis Other Tuberculous Diseases Under 1 Week .. .. .. .. .. 18 7 .. .. 4 .. .. .. .. 1 .. .. 1 .. .. 33 1-2 Weeks .. .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. 4 2-3 Weeks .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3-4 Weeks .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 6 Total under 1 Month .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 46 1—2 Months .. 1 .. 1 .. 1 .. .. .. 9 .. .. .. 1 2 .. .. 2 .. .. 18 2—3 Months .. .. 1 .. .. .. .. .. .. 2 .. .. .. .. 2 .. .. 1 .. .. 6 3—4 Months .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. 4 4—5 Months .. .. 1 .. 1 .. .. .. .. 2 .. .. .. 1 1 .. .. .. .. .. 8 5—6 Months .. .. 1 .. .. .. .. .. .. .. .. .. .. 2 2 .. .. .. .. .. 6 6—7 Months .. .. 2 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 5 7—8 Months .. .. 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 5 8 — 9 Months .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 4 9-10 Months .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 2 .. 4 10-11 Months .. 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 4 11-12 Months .. •• 2 2 .. .. .. .. .. .. .. .. .. .. 2 .. .. .. 1 .. 7 Total Deaths under 1 Year • • 4 12 7 2 21 8 — — 24 — 1 1 7 12 •• 3 10 3 2 117 12 13 DEATHS UNDER ONE YEAR OF AGE IN THE DIFFERENT WARDS OF THE BOROUGH DURING THE YEARS 1903, 1904, 1905 and 1906. Name of Ward. 1903. 1904. 1905- 1906. Lordship Ward 4 6 9 8 Cliseold Ward 7 8 12 6 Church Ward 30 24 24 18 Manor Ward 10 9 8 3 South Hornsey Ward 65 66 66 56 Palatine Ward 20 21 14 26 Totals 136 134 133 117 Sir Shirley Murphy has pointed out that nearly one-third of the death of children under one year of age occur during the first month of life, and that the numbers of deaths in each successive month decrease until the ninth month is reached, when there is a slight increase, due in all probability to the change from natural to artificial food. He has also' demonstrated in his last Report that the mortality amongst children under one year of age increases with the proportion of the population living under overcrowded conditions, the term "overcrowding" applying to that proportion of the population shown by the Census figures of 1901, to be living more than two in a room, in tenements of less than five rooms. Dr. Sykes, of St. Pancras, has shown that in St. Pancras infants are dying aft a younger and younger age; and he gives it as his opinion that this is apparently due to increased immaturity at birth, diminished viability, and increased artificial feeding- Dr. Howarth, of Derby, has shown that among 8,343 infant deaths the following facts came out on enquiry: —The breast-fed furnished a rate of 8.6 per thousand; 14 those who were first breast-fed and subsequently hand-fed furnished a rate of 21.6, and those who were exclusively hand-fed, a rate of 51.7. As pointed out in my last Report, there are, of course, numerous circumstances contributing to the deplorable infantile mortality in cur large cities, but improper feeding and maternal neglect are two of the most important factors in the problem. As a factor in the reduction of infantile mortality a pure milk supply (comparatively free from dirt and preservatives) is perhaps the greatest public health need of the day. The arguments in support of the frequent veterinary inspection of cows, the milk of which is used for human consumption (whether as milk, cream or butter), is overwhelming. The inspection is more particularly necessary as a precaution against the spread of Tuberculosis. Veterinary Authorities are agreed that some 20 per cent. of milch-cows are tuberculous and that about 1 to 2 per cent. of these have tuberculous deposits in their udders. It is not surprising, therefore, that of the dairy samples of milk taken in our large towns and examined over 10 per cent. of these have been found to contain the tubercle germ. The present Royal Commission, as the result of a mass of most painstaking and exact experimentation, unanimously conclude that the human and bovine diseases are caused by the same germ, and are therefore intercommunicable; and this is the conclusion of practically all living experts, Koch and a few followers being the sole exceptions- Such an inspection cannot be provided by the Rural and small Urban Sanitary Authorities, for many reasons, and it certainly would not be fair to saddle all the expenses involved upon the dairy districts. Failing these authorities, the duties would devolve upon the County Councils, and failing them, upon the Local Government Board, or the Board of Agriculture. Personally, I should favour a system of a quarterly inspection under the latter Board, and it should have power to act quite independently of the local sanitary 15 authorities; but some fair measure of compensation should be provided when animals infected with tuberculosis have to be removed from the herd and slaughtered. I am out of sympathy with the antagonism evinced in many quarters against some measure of compensation in such a scheme. The cost, having regard to the important issues at stake, is small and would tend to grow smaller year by year; and without it the scheme of veterinary inspection will be under a great disability. Under most milk contracts with farmers, the farmer is exempted from any loss which might result from his giving prompt information of the existence of infectious' disease in anyone connected with the cows and the milk. This is found to be a valuable concession, as guaranteeing that the necessary information will not be withheld. It is for a similar reason that I advocate partial compensation for the compulsory slaughter of the milch-cow, and my opinion is strengthened by the circumstance that the clinical diagnosis of Tuberculosis is very often difficult. But the most urgent need at the present day is a cleaner milk supply. To put it mildly, too often only the most rudimentary precautions are taken at the fountain-head, and the slovenly methods of the past must make way for more cleanly ones, which involve the minute attention to detail which comes with educated cleanliness. It is the number of dirt germs and the opportunities afforded to them for multiplying, that largely determine the keeping powers of the milk and its safety or danger to infants. The germs once in the milk, nothing at the farm premises will separate them. The screener or filter will separate coarser dirt but not the tiny germ , a regiment of which could pass through the smallest pores of the finest milk filter. The most that can be done when once they have gained access, is to prevent them from multiplying, by cooling the milk immediately after1 it is drawn to a temperature as much below 60 degrees Fahrenheit as possible and the adoption of increased precautions to prevent the temperature subsequently rising 16 above 60 degrees Fahrenheit. More or less efficient cooling provision is made nowadays alt most dairy farms, but the full churns are still generally taken to the railway station in open carts unprotected from the sun's heat; advantages are not always taken of the railway Company's concession for the use of sealed chums, and when the churns arrive at railway junctions one finds no cool sheds provided in which they can be placed for the possible hour or two of their broken journey ; indeed, they are generally left fully exposed to the sun on the open platform, and the good fruits of the previous refrigeration are enormously discounted as a consequence. All along the line, therefore, there is need for reform, and for reforms which the trade itself should initiate. But although I am confident of great advances in the near future, I do not expect to' see such a measure of improvement as would lead me to recommend the feeding of infants with raw milk in the summer months, when Pasteurisation appeals to me as a measure of enormous Public Health value ; and as the contamination of the milk in the home is a circumstance, which in my opinion is responsible for much of the evil consequences of the consumption of raw milk in the summer months, I am confident that before long all milk will be sold in bottles, for it represents an important advance in the right direction, when the proper means are provided, and the necessary precautions taken for thoroughly cleansing the bottles and filling them ait head-quarters. It has often occurred to me as a most discreditable circumstance in our sanitary administration that the legal powers which it is competent for any rural sanitary authority to execute, have either been so ignored or badly administered, that in the rural districts, where the bulk of our milk comes from, there exists practically nothing worthy of the name of a sanitary supervision of dairy farms. In consequence, the better milk dealers have had to step into the breach, and in order to protect themselves and their customers from the consequences of the neglect of the proper authorities, have to take 17 upon themselves these duties; and it is no exaggeration to state that the requirements and conditions imposed by up-to-date milk vendors under their contracts with the farmers, furnish an object lesson of what can, and ought to be done, to the best organised and most advanced rural sanitary authority in this country. But this is an unfair tax upon the milk trade, and if rural sanitary authorities did their duty it would be unnecessary. Another very necessary reform, is the annual licensing of all premises where milk is sold, or collected, or prepared for the purpose of sale. The conditions of the initial grant of the license must be the suitability of the premises and the sufficiency of the general arrangement for the important purpose to which they are put; and the annual renewal conditional upon their maintenance at a satisfactory sanitary standard. There is already a precedent for this in the annual licensing of Slaughter-houses, and none will dispute the greater claims which! may be urged in favour of licensing Dairies and shops where milk is sold. The provision would of course apply to Dairy Farm premises, none of which should be licensed unless there is an easily available supply of pure water, sufficient in quantity all the year round, unless there is a separate boiler in which abundance of boiling water can be prepared for scalding purposes, and unless adequate arrangements are made for cooling the milk; and under its operations it is to be hoped that milk will no longer be sold in shops fully exposed to dust and flies, and more particularly in such places as chandler's shops. Such a requirement would! not hit anyone who was conducting the business with due regard to the bare necessities of the case, but it would eliminate a few from the trade who should not be allowed to continue to carry it on to the great danger of the community. It is not necessary that the premises licensed should be structurally elaborate, elaborate cleanliness is what is wanted, and the means for maintaining this, and the evidence of a conscientious and intelligent B 18 effort to take full advantage of these means should determine the granting and renewal of such licenses The brands of condensed milk purchased by mothers for feeding their babies is very often what is known as machine-skimmed milk, with at least 70 per cent. of the fat abstracted; and there is a relatively small sale for condensed whole milk. It is difficult to believe that maternal ignorance is so fundamental that this milk is bought under the impression that it is suitable for a baby's nourishment; and one cannot refrain from concluding that in many cases the cheapness of the material is made to outweigh proper considerations for the child's bodily welfare. It would be a most useful piece of legislation if alt machine-skimmed milk in tins had to be labelled, in bold plain letters, as "unsuitable for the feeding of infants." In accordance with the instructions of the Council I attended the Conference upon Infantile Mortality, which was held in London on the 13th and 14th June. The Conference was a very largely attended one, and the resolutions passed were of such importance that it seems desirable to introduce them in this Report. 1. That the Education Department be urged to add instruction in Elementary Hygiene with reference to the dietary and rearing of infants, to their present scheme for systematically training girls in the senior classes in the practice and principles of personal hygiene 2. That, in the opinion of this Conference, immediate legislation is required, enabling Sanitary Authorities to establish or support depots for the supply of pure, or modified, or sterilised milk, and to defray any cost out of the monies available for public health purposes. 3. That, in view of the information submitted, the Conference is of opinion that all still births should be notified within 48 hours to the Medical Officer of Health of the district in which they occur, and that no burial should take place without a medical certificate. 19 4. That notification of all births be given within 48 hours to the Medical Officer of Health of the district in which they occur. 5. That in the opinion of this Conference, the question of the insurance of infant lives under 12 months is one demanding serious consideration, and, with a view to receiving reliable information, the Government should be asked to appoint a departmental committee of enquiry on the whole question. 6. (a) That the period of one month's abstention from factory work away from home, now imposed on mothers, be extended to at least three months, and, that, on their return to work, evidence must be produced, satisfactory to the Local Authority, that proper provision has been made for the care of the child. (b) That no employer of labour shall permit a woman advanced in pregnancy to engage in factory labour unless her ability therefore has been certified to the satisfaction of the Local Authority. 7. (a) That, having regard to the ascertained fact that in centres of industries where women are largely employed away from their homes, an excessive number of deaths of infants takes place, and that this is contributed to by the improper conditions existing at the houses in which infants are placed out to nurse, it is necessary that the persons by whom, and the places into which infants are received, should be under supervision by the Local Sanitary Authority. (b) That the Infant Life Protection Act be amended to remedy abuses which are not at present provided against. 8. That all preparations offered or sold as food for infants should be certified by a Government Analyst as non-injurious, and that each packet should contain his analysis. 9. That the Dairies, Milkshops, and Cowsheds Order is defective, and that any amendment should extend the definition of disease as applied to animals, and should make the provision of Regulations by Local Authorities compulsory. That the scope of the Regulations B 2 20 should be extended to cover dirty milk, and should enable Local Authorities to prohibit the sale of any milk which fails to comply with the conditions of purity agreed upon. That the workings of the Infant Life Protection Act of 1897 are unsatisfactory, is generally recognised, and illustrations of its shortcomings are frequently evident in our midst. During the year the Metropolitan Branch of the Incorporated Society of Medical Officers of Health represented to the Local Government Board that in their opinion Section 2 of the Act should be amended in order to provide for the control of persons receiving for hire or reward, for a period of 48 hours, one or more infants under the age of 5 years. This would be a most useful item of legislation, as under the existing law a person may continue to take one nurse-child at a time, and is then entirely ontside the operations of the Act. THE LADY PUBLIC HEALTH WORKERS. As I pointed out in my last Annual Report, the main duty of the Lady Public Health Workers in Stoke Newington is to visit the poorer houses where babies are born, to show a tactful interest in the child, and to guide the mother in the care, feeding and management of the infanit. There were enquiries and visits made during the year relating to 51 separate births. A little over half of these infants were being breast-fed. Many of the mothers were found to be in great need of advice with reference to the rearing of their offspring, and the advice given was generally welcome and appreciated. These Public Health Workers are asked to meet on the first Thursday of each month, at the Town Hall, in order that Reports may be considered and the work discussed. The arrangements have worked very well during the past 12 months, and I have reason to know that a large amount of most useful work has been done in the 21 extreme Southerly part of the Borough. Before commencing their duties the Public Health Workers attended a Course of Health Lectures, which was arranged by Miss Gardiner, of the Charity Organisation Committee in conjunction with myself. I have expressed my opinion of the great value of this work in the preface to this Report, but in further reference thereto, the statement made in the last Report of the Stoke Newington Branch of the Charity Organisation Society, may aptly be quoted:—"Though few in number, these visitors have done excellent work in the parish of St. Matthias, which is the area to which they have devoted themselves. They visit the mothers of new-born infants from time to time, leaving leaflets, giving simple instruction on infant feeding and management, making suggestions as to the mother's management of her own health and domestic hygiene, and in many cases, we believe their visits are heartily welcomed and most helpful. Our Medical Officer of Health thinks highly enough of their work to devote some of his valuable time one morning in the month to meeting these visitors and discussing their cases with them. In this way he gets much useful statistical information, and the visitor's work is kept at a high level through this contact with one who is so thoroughly alive to the great problem of infant mortality and how it can be met. Special attention has also been given by one visitor to all the notified consumptive cases in the district We should like to see a large extension of this work, and feel strongly that if the Clergy and district visitors realized its great value, more visitors would be forthcoming, and the area enlarged over which the scheme could be worked. It is not a question of relief of distress, but of that far more important branch of social service—prevention." During the year the number of visits paid by these voluntary workers, in respect of births, infant deaths, and sufferers from consumption, amounted to 320. 22 TABLE A2. Showing the Distribution of the Deaths in the Northern and Southern Divisions of the Borough during each of the quarters of the year 1906. Diseases. North. South. Quarters. Total. Quarters. Total. 1 2 3 4 1 2 3 4 Measles .. .. .. .. .. 4 4 2 .. 10 Scarlet Fever .. .. .. .. .. .. .. 1 .. 1 Whooping- cough .. .. .. .. .. 9 6 1 1 17 Diphtheria and Membranous Croup. .. .. .. .. .. 2 .. 1 1 4 Enteric Fever .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 3 .. 1 1 5 1 2 •• 1 4 Diarrhoea 1 •• 2 •• 3 .. 1 18 4 23 Enteritis .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. .. .. 3 3 Other Septic Diseases 1 1 2 4 8 4 1 3 2 10 Phthisis 3 5 1 2 11 13 7 8 9 37 Other Tubercular Diseases 2 1 •• 1 4 1 5 2 2 10 Cancer 5 8 4 6 23 2 7 8 8 25 Bronchitis 3 1 3 3 10 19 8 2 18 47 Pneumonia 2 2 1 2 7 8 5 1 6 20 Other Respiratory Diseases 1 1 1 1 4 9 6 .. 2 17 Alcoholism and Cirrhosis 3 2 .. .. 5 4 4 4 .. 12 Venereal Diseases .. .. .. .. .. .. 1 .. 1 2 Diseases of the Nervous 3 7 3 4 17 9 8 5 6 28 System. Premature Birth 1 2 1 1 5 2 4 6 4 16 Heart Disease 2 7 4 5 18 7 20 8 15 50 Accidents .. 1 1 .. 2 .. 2 3 1 6 Suicides 2 .. .. .. 2 1 2 1 1 6 Old Age 4 2 4 5 15 14 8 4 6 32 All other Causes 3 5 7 5 20 9 16 28 18 71 Totals 39 45 35 40 159 118 117 106 110 451 23 Senile Mortality.—Of the 610 deaths 184 were of persons over 65 years of age- The proportion of deaths occurring among those of over 65 years of age to the total deaths is, therefore, 30.2 per cent. There ware 140 deaths of persons over 70 years of age, and 52 of persons over 80, 6 of whom reached 90 years of age—the oldest being 97. These figures denote an exceptionally high proportion or senile mortality. SENILE MORTALITY DURING 1906. 65 to 70 70 to 80 80 to 90 90 and over. Total. 44 88 46 6 184 The respective ages of those over 90 were 90, 90, 91, 92, 93, 97. 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 A2 is supplementary to Table A, and sets forth the deaths in each Division of the Borough during each of the four quarters of the year. Comparing these tables with the corresponding tables of the preceding year the following facts are noteworthy:—A decrease in the deaths from Diarrhoea, Phthisis, Cancer and Diseases of the Respiratory Organs, and an increase in the deaths from Whooping Cough, Influenza and Alcoholism. It will be noted (Table A2) that the mortality of the Southern Division exceeds that of the Northern (after due allowance is made for the different figure of the population in each Division) mainly in 24 respect of the deaths from Diarrhoea, Phthisis, Diseases of the Respiratory System, Infectious Diseases generally, and Premature Birth. The mortality from Cancer, Influenza and Diseases of the Nervous System, on the other hand, was disproportionately high in the Northern Division. DEATHS IN PUBLIC INSTITUTIONS WITHIN THE BOROUGH, 1906, St. Anne's House, Manor Road. North umber*land House, *Green Lanes. Invalid Asylum, 187, High Street. Nursing Home, 8, Alexandra Road. Nursing Home, 21, Stamford Hill. Total. 36 7 1 3 2 49 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 Enteric Fever, Typhus Fever, and Simple Continued Fever), and Diarrhoea. In Table A3 the deaths from each of the Zymotic Diseases (including Influenza) are given. The Zymotic Death-rate for the Borough was 1.09 per 1,000 per annum, as against 1.27 in the preceding year. Year. Zymotic Death-rate. Hate for London generally. Rate for England and Wales. 1901 1.26 2.25 2.05 1902 1.16 2.21 1.64 1903 1.23 1.76 1.46 1904 1.24 2.14 1.94 1905 1.27 1.70 1.52 1906 1.09 1.94 1.73 25 TABLE A3. Deaths from Zymotic Diseases (including Influenza) in the Year, 1906. Scarlet Fever. Diphtheria. Small Pox. Enteric Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhoea and Dysentery. Influenza. Erysipelas. Total. Rate to every 1 ,000 persons. First Quarter .. 2 .. .. .. 4 9 1 4 .. 20 .. Second „ .. .. .. .. .. 4 6 1 2 .. 13 .. Third „ 1 1 .. .. .. 2 1 20 1 .. 26 • • Fourth „ •• 1 •• •• 1 .. 1 4 2 3 12 •• 1 4 .. •• 1 10 17 26 9 3 71 1.3 1905 3 5 .. .. .. 11 9 39 •• 1 68 1.3 26 TABLE A4. Analysis of the Vital Statistics of the Metropolitan Boroughs and of the City of London, after Distribution of Deaths occurring in Public Institutions, for the Year 1906. Cities and Boroughs. Estimated Population in the middle of 1906. Annual Rate per 1,000 Living. Deaths of Children under one year of age to 1,000'Births. Deaths. Principal Infectious Diseases. Notifiable Diseases Attack-rate. LONDON 4,721,217 15.1 1.93 7.5 130 West Districts. Paddington 148,913 12.5 1.30 7.3 112 Kensington 180,952 13.8 1.56 4.7 137 Hammersmith 120,679 14.8 2.13 7.4 142 Fulham 161,965 13.7 2.40 7.9 136 Chelsea 74,672 15.7 2.03 7.0 141 City of Westminster 173,905 12.9 0.84 5.4 119 North Districts. St. Marylebone 128,580 14.9 1.28 5.8 79 Hampstead 89,633 9.4 0.57 6.3 79 St. Pancras 236,455 15.9 1.65 6.0 131 Islington 344,987 14.7 1.62 6.6 128 Stoke Newington 53,217 11.6 1.09 5.0 108 Hackney 230,721 13.3 1.58 8.1 116 Central Districts. Holborn 55,806 18.9 1.44 5.0 91 Finsbury 97,466 20.7 3.59 8.6 136 City of London 21,367 17.3 1.08 7.5 106 East Districts. Shoreditch 116,108 19.6 3.13 8.3 169 Bethnal Green 130,609 18.9 2.55 9.4 157 Stepney 307,176 17.7 2.74 7.7 133 Poplar 170,673 17.6 2.95 6.6 155 South Districts. Southwark 209,143 18.1 2.23 11.2 147 Bermondsey 128,629 19.7 2.94 12.2 154 Lambeth 315,774 15.0 1.69 6.6 121 Battersea 179,622 13.4 1.82 8.6 129 Wandsworth 273.381 12.8 1.60 7.4 124 Camberwell 274,132 14.6 1.88 7.0 132 Deptford 115,495 16.1 2.69 10.0 145 Greenwich 105,350 13.5 1.87 10.7 119 Lewisham 148,463 12.0 1.45 6.4 113 Woolwich 127,345 13.1 1.52 8.3 110 27 TABLE A 5. 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. 1901 51,328 21.6 117.9 131 1.26 7.9 1902 51,669 21.8 114.7 13.1 1.16 7.7 1903 52,600 20.9 120.3 12.3 1.23 3.7 1904 52,353 21.8 115.6 13.1 1.24 5.6 1905 52,690 20.2 124.7 12.6 1.27 5.6 1906 53,045 20.4 108.0 11.5 1.09 5.0 28 I. II. III. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, the deaths in which have been distributed among the several localities in the District. St. Anne's House, Manor Road. London Hospital. N.E. Fever Hospital. Invalid Home, Highbury Hackney Infirmary. Colney Hatch Asylum. Northumberland House, Green Lanes. Claybury „ Mildmay Cottage Hospital. Horton ,, Invalid Asylum, 187, High Street. Dartford Heath ,, University College Hospital. Bethnal House „ Nursing Home, 8, Alexandra Road. German Hospital. Nursing Home, 21, Stamford Hill. Children's „ (Gt. Ormond Street). Gt. Northern Hospital. North Eastern Hospital for Children. City of London Lying-in Hospital. City of London Lunatic Asylum. St. Bartholomew's Hospital. St. Giles Workhouse. Hackney „ Metropolitan Hospital. Royal Chest „ St. Mark's „ City Road. Guy's Hospital. 8, Southwold Road, Clapton. West London Hospital. Shoreditch Infirmary. Goldsmith's Asylum. Hospital of St. John and Elizabeth. French Hospital. Islington Infirmary. Aged Pilgrim's Society. Cancer Hospital. St. Luke's House. There is no Union Workhouse within the District. THE MORTUARY. During the year 46 bodies were deposited in the Public Mortuary; 18 of these were females and 28 were males. Postmortem examinations were performed upon 33 of these cases, and inquests were held upon 40. 29 INQUESTS. The following inquests upon deaths of parishioners were held during the year 1906:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Chronic Alcoholism and Cirrhosis of Liver 4 2 1 .. 7 Chronic Bronchitis 2 .. .. .. 2 Phthisis 1 .. .. .. 1 Heart Disease, including Syncope . 2 3 1 2 8 Pulmonary Haemorrhage 1 .. .. .. 1 Cerehral Apoplexy 1 1 .. .. 2 Premature Birth and Inanition 1 .. 1 .. 2 Convulsions .. 1 1 .. 2 Measles .. 1 .. .. 1 Pleurisy .. 1 .. .. 1 Kidney Disease .. .. 1 .. 1 Suffocation (want of attention at birth) .. .. 1 .. 1 Diarrhoea .. .. 1 .. 1 Senile Decay .. .. .. 1 1 Haemorrhage following rupture .. .. .. 1 1 Tumour of the Liver 1 .. .. .. 1 Accidents (Shock due to fall) .. .. .. .. 3 „ (Cerebral Haemorrhage due to fall) .. .. 2 .. 2 „ (Fractured Skull) .. .. 1 .. 1 „ (Overlain and Suffocation in Bed) .. .. .. .. 2 „ (Drowning) .. .. 1 .. 1 Suicides (Poisoning) 1 1 .. .. 2 „ (Cut-Throat) l .. 1 .. 2 „ (Drowning) l .. .. .. 1 „ (Fracture of Skull) .. 1 .. .. 1 „ (Injuries Neck and Wrist) • • .. •• 1 1 16 14 12 7 49 INFECTIOUS DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table B that 267 Notification Certificates of Infectious lllness were received from medical practitioners, as against 337 during the preceding year. These figures include notifications received from the voluntary niotification of Consumption. 30 These 267 cases represent infection in 238 different houses. In 239* 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 illiness occurred in 9 houses where there were "grave" sanitary defects, and in 26 in which the sanitary defects were "slight" In arriving at these conclusions I have cousidered 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 238 premises. Table B1 shows the number of cases, and of deaths, from the Infectious Diseases notified during each year since the constitution of the Borough; and Table B2 the cases of Infectious Diseases notified during each month of the year 1906. The Infectious Sickness Rate of the Borough, excluding the notifications from Consumption, was 5.0 to each 1,000 of the population, as against 5.6 for the preceding year. The rate in the Northern Division was 2.5 while that in the Southern Division was 6.4. Year. Infectious Sickness Rate. Rate for London generally. 1901 7.9 8.9 1902 7.7 9.9 1903 3.7 6.0 1904 5.6 6.1 1905 5.6 7.0 1906 5.0 7.5 *This figure inoludes the disinfection after deaths from Consumption and Cancer. TABLE B. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1906. Cases notified in Whole District. 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 .. .. 45 1 48 137 .. 10 .. .. 1 .. .. 25 267 Under 1 .. .. 1 .. .. •. .. .. .. .. .. .. .. 1 2 1 to 5 .. .. 14 1 1 25 .. .. .. .. .. .. .. .. 41 5 to 15 .. .. 27 .. 5 95 .. .. .. .. .. .. .. 1 128 16 to 25 .. .. 2 . . 4 10 .. 4 .. .. .. .. .. 4 24 25 to 65 .. .. 1 .. 37 7 .. 6 .. .. 1 .. .. 18 70 65 and upwards .. .. .. .. 1 •• .. .. .. .. .. .. .. 1 2 Total Cases notified in each Locality. Northern Division .. .. 10 .. 5 24 .. 6 .. .. .. .. .. 2 46 Southern Division •• •• 35 1 43 113 .. 5 •• .. 1 .. .. 23 221 No. of Cases Removed to Hospital from each locality. Northern Division .. .. 7 .. .. 21 .. 1 .. .. .. .. .. .. 29 Southern Division .. .. 29 1 5 92 .. 3 .. .. .. .. .. 4 134 31 32 TABLE B 1. Table showing the number of Cases and Deaths from the Infectious Diseases notified from among residents since the constitution of the Borough. Small-pox. Scarlet Fever. Diphtheria. Continued Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1901 26 3 174 4 137 14 - - 1902 41 8 192 5 91 5 — — 1903 1 — 88 — 37 7 1 — 1904 8 — 153 3 60 10 — — 1905 1 — 178 3 75 4 — — 1906 — — 137 1 45 4 - - Erysipelas. Puerperal Fever. Enteric Fever. Membranous Croup. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1901 29 4 2 26 4 4 1 1902 50 3 1 — 22 4 2 — 1903 30 — 2 2 34 5 2 — 1904 53 7 3 3 14 6 2 — 1905 28 1 1 — 10 — 4 1 1906 48 3 1 1 10 - 1 - 33 TABLE B2. Cases of Infectious Diseases notified during each month of the year 1906. Small-pox. Scarlet Fever. Diphtheria. Membranous Croup. Enteric Fever. Puerperal Fever. Continued Fever. Erysipelas. Chicken-pox. Phthihis. Totals. January .. 10 2 .. 1 .. .. 3 .. 3 19 February .. 7 2 .. .. .. .. 2 .. 4 15 March .. 4 4 .. .. .. .. 3 .. 5 18 April .. 10 9 .. .. .. .. 2 .. .. 21 May .. 7 2 .. •• .. .. 3 .. 2 14 June .. 6 4 .. 1 .. .. 1 .. 2 13 July .. 13 3 1 1 .. .. 2 .. •• 20 August .. 9 1 .. •• .. .. 1 .. 1 12 September .. 10 5 .. 1 .. .. 3 .. 2 21 October .. 29 3 .. 2 .. .. 15 .. .. 49 November .. 16 7 .. 2 1 .. 6 .. 4 36 December .. 17 3 .. .. .. .. 7 .. 2 29 Totals •• 137 45 1 10 1 .. 48 .. 25 267 The Infectious Sickness Rate for London generally was 7'5. Of the 29 Sanitary Areas situated within the Metropolis, the lowest rates were those of Stoke Newington (5), Holborn (5), City of Westminster (5.4), St. Pancras(6), Hampstead (6.3), Lewisham (6.4), and the highest were Bermondsey (12 2), Southwark (11'2), and Greenwich (10'7). 163 of the cases notified were removed from their homes to Isolation Hospitals. o 34 SCARLET FEVER. The 137 cases of Scarlet Fever occurred in 113 houses, in 6 of which there were grave insanitary conditions ; in 13 the insanitary conditions were slight, and in the remaining houses there was an absence of such conditions. Year. Death-Kate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.08 0.13 0.13 1902 0.09 0.12 0.15 1903 0.00 0.08 012 1904 0.06 0.08 0.11 1905 0.06 0.12 0.11 1906 0.02 0.11 0.10 School attendance was ascribed as the origin of the infection in 13 cases; and in two 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 at least 2 instances, and in 5 instances the infection was directly contracted from a preceding case. There has been a very marked prevalence of Scarlet Fever in London and several other parts of the country during the year, and Stoke Newington appears to have suffered less than many other parts of the Metropolis. According to the Report of the Metropolitan Asylums Board for the year 1905, over 19,000 cases of Scarlet Fever were admitted to the Board's Hospitals. To show the growing appreciation of these Hospitals and by consequence the growing extent to which the public 35 have availed themselves of them, it is interesting to note that in the year 1890 only 42 per cent. of the cases notified came into hospital; whereas during the year 1905, over 88 per cent. were admitted. ERYSIPELAS. The 48 cases of this disease represent infection in 48 different premises. In 2 of these, insanitary conditions of a slight nature existed, and in one case the sanitary defects were grave. In 9 cases there was a previous local injury, and in 2 a history of previous attacks. ENTERIC OR TYPHOID FEVER. The 10 cases notified during the year all occurred in different houses. In one of these houses grave insanitary .conditions existed, and in two slight insanitary conditions existed; while in the remaining 7 there were no insanitary conditions. Two of the cases doubtless contracted the disease outside of London during the summer and autumn holidays. 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. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.08 0.12 0.15 1902 0.08 0.12 0.13 1903 0.09 0.08 0.10 1904 0.11 0.06 0.09 1905 0.00 0.05 0.09 1906 0.00 0.05 0.09 c 2 36 DIPHTHERIA. The 45 cases of Diphtheria occurred in 42 houses, 5 of which were more or less insanitary. The sanitary defects were grave in one and slight in four other instances. Year. Death-Rate for Stoke Newington. Kate for London generally. Hate for England and Wales. 1901 0.27 0 30 0.27 1902 0.09 0.25 0.23 1903 0.13 0.16 0.18 1904 0.19 0.16 0.17 1905 0.09 0.12 0.16 1906 0 08 0.14 0.17 School attendance is either alleged by the parents or surmised by myself, on good grounds, to be the cause of at least 4 attacks during the year. One case of infection was imported into the Borough, and at least 3 appear to have caught the infection from previous cases. In several cases it was very clear that a preceding tonsilitis of several weeks' duration predisposed to an attack of Diphtheria. In 7 cases there was a history of previous throat trouble, frequently recurring. The continued decline in the rate of mortality amongst cases of Diphtheria is an extremely satisfactory factor in the statistics. In 1893, the year before the disease was treated with antioxic serum, the death-rate was as high as 30.4 per cent. Since the introduction of the treatment the rate has rapidly declined. At one of the fever hospitals a record has been kept of the mortality-rates according to the day of disease in which the antitoxic serum treatment was commenced. Of 219 cases treated, during the years 1897 to 1905, on 37 the first day of the disease, not a single case died ; amongst 1,364 treated on the second day of the disease the mortality-rate did not rise above 5.4 per cent.; whereas amongst cases not coming under treatment until the fifth day and after, the rate was upwards of 22 per cent. Several applications have been made at the office for tubes of antitoxin, which I store for the convenience of local practitioners. 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 to the medical practitioners in Stoke Newington continue to be much appreciated. Every practitioner has; been kept supplied during the year with such an outfit, and has thus had at his disposal the means of procuring a bacteriological diagnosis of Diphtheria, Enteric Fever, and Consumption. The following is a list of the applications received during 1906, together with the results of the examinations performed at the Lister Institute of Preventive Medicine, London:— Disease. Positive Results. Total. Negative. Phthisis 7 30 37 Diphtheria 16 18 34 Enteric 2 2 4 Total 25 50 75 38 MEASLES AND WHOOPING COUGH. Measles. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.17 0.43 0.28 1902 0.08 0.51 0.38 1903 0.39 0.44 0.27 1904 0.13 0.49 0.36 1905 0.21 0.37 0.32 1906 0.19 0.40 0.27 It has been the practice in this Borough to disinfect in cases of Measles only when an application is made by parents or householders. During an outbreak of this disease it would be quite impossible to carry out the disinfection of all infected premises with the existing staff; and it is interesting to note that during the year the opinions have been sought of Metropolitan Medical Officers of Health as to the value of disinfection after this disease. Twenty.five replies were obtained and of these eight were to the effect that the measure would be effective ; two that it would be non-effective; seven that it was unnecessary; five that the results were doubtful; and three expressed no opinion. During the year there was a considerable outbreak of Whooping Cough in the Borough, and the very low death-rate from this disease in the preceding year was nearly doubled—the rate exceeding that for London generally. There was evidence of a considerable amount of spread through the medium of the schools, despite the precautions taken. It is extremely difficult to control the spread of this disease through any administrative measures which the sanitary 39 authority can adopt, but that the mortality is largely preventable is shown by the circumstance that it is mainly borne by the poor. Whooping Cough. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.04 0.35 0.31 1902 0.27 0.41 0.29 1903 0.36 0.35 0.27 1904 0.25 0.32 0.34 1905 0.17 0.32 0.25 1906 0.32 0.26 0.23 ZYMOTIC DIARRHCEA. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.31 0.87 0 92 1902 0.39 0.54 0.38 1903 0.25 0.63 0.50 1904 0.49 1.03 0.86 1905 0.74 0.72 0.59 1906 0.50 0.95 0 87 PHTHISIS (CONSUMPTION), The 25 cases voluntarily notified during 1906 occurred in 24 different homes. Year. Death-Rate for Stoke Newington. Rate for London generally. 1901 1.30 1.58 1902 1.24 1.62 1903 1.30 1.50 1904 1.70 1.63 1905 1.31 1.46 1906 0.90 1.47 40 It will be seen that the results of the Voluntary Notification of Consumption during the past year have been no more satisfactory than those recorded in previous years. The system of voluntary notification has been tried in Edinburgh, and proved a failure, and in Glasgow the Corporation of that city has lately resolved to add the disease to the list of those compulsorilv notifiable. It is desirable that notification should be made compulsory in London and generally in our large cities; but the Local Government Board are still of opinion that Consumption is not a disease to which compulsory notification should be applied, and this view appears to be shared by the London County Council. Personally, I see no difficulty in its adoption. In Sheffield, where the scheme has been practically applied for some two years, it has been found to give rise to no friction or hardships; and the principle has received the approval of the lnternational Congresses of London and Paris, the Metropolitan Branch of the Society of Medical-Officers of Health, and a host of medical experts. I have no doubt that compulsory notification is essential to success in the administrative control of Phthisis, a disease which is the cause of more suffering and death than the whole of those other diseases the notification of which is compulsory. Judging from the deaths from Consumption, which numbered 48, there must have been at least 150 sufferers from the disease in the Borough during the year, and of these only 25 were notified under the voluntary system. In connection with the Compulsory Notification of Consumption and the difficulty experienced by the Local Government Board in meeting the wishes of Metropolitan Medical-Officers of Health with reference to the adoption of that measure, a very good compromise has been suggested, viz., that such notification should be compulsory at first only with regard to cases coining under the Poor Law MedicalOfficers or attending Public Institutions. In this way we should learn the number and distribution of those cases of Consumption which were most dangerous to the community, and thus extend the application of the necessary precautionary measures. 41 Of the cases voluntarily notified during the year, in 11 or 44 per cent. there was no family history of the disease, and in 3 others the information obtainable as to family history was indefinite. CEREBRO-SPINAL FEVER. This disease occasions serious mortality in America, and in certain localities on the Continent of Europe, but fortunately in this country it is of rare occurrenoe. There is, however, reason to believe that the disease may be less uncommon in the United Kingdom than has hitherto been supposed; and recently the identification of a few cases in London occasioned some alarm. Happily, however, there has been no serious extension of the infection, and, indeed, it is by no means certain that the disease is spread to a great extent by direct infection from person to person. In our present state of knowledge, however, should such cases occur it is most desirable to apply suitable measures of disinfection, and to secure, so far as possible, the isolation of the sick from the healthy. CLEANSING OF PERSONS ACT, 1897. During the year the Public Health Committee decided, in response to a letter from the Education Officer of the London County Council, to undertake to treat children with verminous bodies and clothing as verminous persons have hitherto been treated under the Act. Such children are excluded from school, and often lose the advantages of education for several weeks as a consequence, where it is difficult or impossible for the mother to free the child from vermin. The facilities for such cleansing are not what they might be in Stoke Newington. We have to avail ourselves of the Hackney Borough Installation, which is some distance from us; but there is a prospect that in the future we may have a very central disinfecting station in connection with the Destructor which is being erected near the Town Hall. 42 In 1906 only one verminous person availed himself of the provision we have made for cleansing the body and clothing from vermin. PUBLIC HEALTH LEGISLATION IN 1906. The year has been barren in the matter of general Public Health Legislation. METEOROLOGY IN AND AROUND LONDON DURING THE YEAR 1906. January.—The opening month of the year was exceedingly unsettled and boisterous, and for the first few days the weather was dry and cold. Rain was both frequent and heavy in all districts, and hail, sleet, or snow was experienced very generally at times. For the month as a whole pressure was nearly everywhere in defect; the winds were mostly from between South and West; temperature exceeded the normal in all districts; generally there was a considerable excess of rain. February.—Notwithstanding the generally unsettled type, there were during the month many very fine, sunny periods. For the month as a whole pressure was below the normal; the winds were mainly in the South-West and North-West quarters; temperature was nearly everywhere in defect. March.—Extremely variable weather characterised this period. Early in the month it was extremely brilliant, the duration of bright sunshine for the five days, 3rd to 7 th, reaching the very high proportion of from 80 to 86 per cent. of the possible at some of the southern and south-eastern stations. For the month, as a whole, pressure was above the normal; the winds were Southwesterly to North-Westerly and North-Easterly; temperature was in defect in nearly all localities. 43 April.—The dry weather which set in after the middle of March was maintained with even greater intensity in April. Towards the close of the month a less settled type prevailed, and rain, hail, sleet, or snow showers were of common occurrence. But the most striking feature of April was its remarkable and persistent brilliancy all over the kingdom. For the month, as a whole, pressure exceeded the normal; the winds varied greatly in direction, and were of no great strength; temperature and rainfall were deficient; and bright sunshine showed a considerable excess. May.—The weather during May was of a much more variable and unsettled character than had been experienced in the immediately preceding months, but it was far from being stormy. During the first half the weather was rather dry in the southern districts, but it did not amount to a drought, London returning 12 consecutive rainless days. For the month, as a whole, pressure, temperature, and bright sunshine were below, and rainfall generally above, the normal; and the winds varied greatly in direction. June.—The entire country experienced a great deal of very fine, bright weather, with light variable breezes. Taking the month as a whole, pressure was everywhere well in excess of the normal; the winds varied considerably in direction; temperature was above the average in the North, but below it at most places in the South districts; rainfall was in excess over the south of England, in defect elsewhere. July.—The atmospheric conditions which prevailed over the British Isles during this month were, on the whole, of a quiet and seasonable character. There was a great preponderance of fair to very fine, bright, and dry weather, but, notwithstanding this, there was, in continuation of the same striking feature referred to in the report for the preceding month, a remarkable absence 44 of very high shade temperatures. During the first three weeks there was a marked deficiency in the rainfall, while there was a considerable excess of bright sunshine. For the month, as a whole, pressure was everywhere a little higher than usual; temperature was in defect; the winds were mainly South-Westerly and North-Westerly; rainfall was deficient in nearly all districts, August.—The period was marked by weather of a very variable character. About the middle of the month there was a little coolness noticeable, otherwise there was an almost persistent warmth, and quite at the close the heat increased to an unusual extent, so that at a number of stations shade temperatures as high as 90° to 95° were registered, a further increase taking place in the opening days of September. For the month, as a whole, pressure differed but slightly from the normal; temperature was in excess; the winds were, for the most part, Southerly to Westerly in direction; rainfall was deficient over the greater portion of the kingdom. September.—The most striking feature of the season was the great accession of warmth which occurred at the close of August, when the thermometer, which had previously been maintained at a very moderate level, suddenly rose in many localities well above 8o° on the 30th, and above 90° on the 31st. Although there were a few heavy falls of rain in the course of the month, the first half was, speaking generally, moderately dry, and the remainder very dry; in several localities the last 15 days were rainless. For the month, as a whole, pressure, temperature, and bright sunshine were in excess of the normal; the wind showed a complete anticyclonic circulation; and precipitation was deficient. October.—Very changeable and unsettled atmospheric conditions were in the ascendant during the greater part of the month. For the whole of the month pressure was well below the usual 45 level; there was a decided excess of temperature; the winds were chiefly Southerly to Westerly in direction; rainfall was very frequent and above the normal; and bright sunshine was rather variable, in most places in defect. November.—During the period under review the atmospheric conditions throughout the British Isles were of a very variable character. A period of unseasonable warmth was the most remarkable feature of the month. The rainfall was very unequally distributed. On several occasions hail, sleet, or snow was experienced, but the falls were unimportant. For the month, as a whole, pressure was a little lower than usual; the winds were, for the most part, from between South and West; temperature was well in excess of the normal; rainfall differed very unequally from the normal. December.—During the first week the weather was rather disturbed, rain being of frequent occurrence, varied in places by hail or sleet, while the wind was very brisk. The lowest temperatures of the year were recorded in the closing days. For the month, as a whole, pressure was in excess over the greater part of the kingdom; the winds were mainly from between South, West, and North; temperature was nearly everywhere in defect; precipitation was unequally distributed; and bright sunshine was above the normal in most districts. 46 Meteorological Observations taken during the Year 1906, 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 Temp'rature of Air. Rain. Relative Humidity. Saturation. 100. Highest Lowest Mean. No. of Days it fell. Amnt. Collctd. Of all Highest Of all Lowest. ° ° ° ° ° ins. January 53.0 25.3 47.3 36.4 41.9 18 4. 02 90 February 51.1 26.1 45. 0 33.3 39.2 21 1.89 88 March 65.1 27.3 49.9 35.8 42.9 17 1.08 84 April 73.0 30.1 58.4 36.8 47.6 10 0.51 73 May 78.9 32.1 63.8 45.9 54.9 14 1.09 79 June 80.9 39.8 71.7 49.5 60.6 8 2.89 75 July 83.7 40.2 76.0 54.6 65.3 7 0.61 72 August 93.2 45.7 77.1 55.3 66.2 8 0.87 74 September 94.0 39.0 70.5 50.6 60.6 8 1.75 79 October 71.0 35.4 61.5 47.6 54.6 17 3.15 88 November 60.1 29.7 52.0 41.6 46.8 17 4.20 91 December 55.l 20.9 42.0 32.9 37.5 19 2.21 91 NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR 1906. It will be seen from the accompanying Report of the Chief Sanitary Inspector that a large amount of sanitary work has been 47 performed during the year: 3,573 premises were inspected for conditions injurious or dangerous to health, and insanitary conditions varying in their nature from slight to very grave were discovered in a large number of instances; 910 Intimation Notices, followed in 37 cases by Statutory Notices, were complied with. Of this number, only 189 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 preventible sickness, for over 50 per cent. of such inspections resulted in intimation notices. In the case of 31 of the complaints received, no nuisance existed at the time of inspection. It is found that in Stoke Newington, whenever an intimation is served as the result of house-to-house inspection, the Inspector pays on an average between four and five visits in order to see that the work required is properly carried out. The slaughter-houses, bake-houses, cowsheds and dairies, the common lodging house and the registered houses let in lodgings, situated in the borough were all duly inspected throughout the year. FOOD INSPECTION. The existing provisions for excluding diseased and unwholesome meat from the market are recognised as inadequate in this country, in the absence of a closer inspection at the time of slaughter and a more general and uniform system of inspection of the meat when exposed for sale; and in the case of imported meat, the guarantees are not sufficient that the inspection abroad is efficient and the standards adopted are invariably maintained. But in England the meat offered for sale in the shops is not often found to be of such a nature as to warrant condemnation by the Sanitary Authorities; and the material which is canned in Great Britain is seldom unwholesome. 48 Seeing the dangers of dirt in food, the general exposure of food, unprotected by any covering from the dust of the streets, is a matter which will be remedied as soon as the general public demand food which has not been contaminated with horse-droppings and injurious organisms (street-dust), and the retailer recognises how seriously this exposure impairs the keeping powers of Milk, Meat, Fish, and Fruit. Health considerations also demand that this failure to protect our food from dirt should not continue. During the past year the wholesomeness of preserved meats has been much discussed in this country, and although one read and heard on all sides of the grossest exaggeration of the facts in connection with the dangers of canned meat, etc., the exposure of unsatisfactory American methods has resulted in greater care in the selection of suitable meat and in its manipulation, not only in America but in this and other countries. I have sampled some of the canned material sold in Stoke Newington, and I have found but little more to take exception to than the use of chemical preservatives in these preparations. I inspected the Chicago slaughter-houses some fifteen years ago, and was greatly impressed with the overwhelming dimensions of the undertaking and the way in which the enormous amount of work was rushed through. At that time I saw little evidence of anything in the nature of a satisfactory provision for guarding the public from the risk of consuming diseased meat. In Stoke Newington a vigilant eye is kept upon the food supplied in the Borough. Upon one evening a week, and generally on a Saturday, one inspector is told off exclusively to inspect the foodstuffs exposed for sale at the various shops and stalls. Of course, this inspection is carried out more or less every day, but it has been thought desirable to supplement the day by an evening inspection, lest any dishonest tradesman, believing that he would be free from risk then, might offer unsound food for sale. There is a small amount of unwholesome food seized in Stoke Newington, including, 49 of course, tinned articles, but the quantity is very small, even when regard is had to the size of the Borough. With canned goods it is impossible, without opening and examining the contents, to say whether they are unwholesome or not, except when putrefaction has set in. This is indicated by the tins becoming "blown," and bulging outwards with the pressure of the gas liberated by decomposition, and emitting a drumlike sound when struck. It is, however, by no means easy to check the sale of what might have been diseased food prior to canning, or of food to which harmful amounts of chemical preservative have been added, without opening and examining a portion of each consignment. It is perfectly certain that no system of inspecting the contents of tins can approach in its efficacy and importance a close and scrupulous inspection of the carcase and offal of the animal at the time of slaughter, for many diseased and harmful conditions of meat are not to be detected in the parts which are offered for sale as human food; the evidenoe of disease being confined to certain internal organs which are not used for consumption. On the other hand, it may be said that the process of canning, involving as it does the subjection of the contents to temperatures exceeding the boiling point of water for some two hours or more, is sufficient, when properly performed, to kill any harmful germs which may accompany diseased conditions. Once these germs are destroyed, the contents would only be subject to the effects of the germs of putrefaction, and if these developed, its presence would be betrayed by the "blown" tins, or, failing that, the contents would be palpably and unmistakably unwholesome to the consumer. I think, therefore, that in the matter of canned articles of food, the question of the risk of tuberculosis infection could not be seriously entertained. But there is a rare condition to which canned meats are liable, which results in the development of poisonous bodies, commonly called "toxines," and the contents of the cans in these cases appear to be perfectly wholesome. Occasionally people are poisoned in this way, and fatal consequences have resulted. D 50 Although it is sometimes possible to detect the fact that the meat was diseased at the time it was canned, even this evidence is lacking in sausages made in thr wonderful sausage machines at Chicago and elsewhere. Flesh of almost any animal, including fat, gristle and diseased as well as sound flesh, may be introduced, and emerges from the machine in an extremely finely divided condition—almost as a meal. It then has the consistency of mashed potatoes and it is practically impossible to say whether the sausages were made of sound food or not. The danger is also increased in this case from the fact that much of this class of food is not exposed to the same high temperature for long periods, as is the case with canned meat generally. The public would be well advised to avoid all canned food which is not labelled with the name of the firm which prepares it, and to always eat the contents within 24 hours of the opening of the tin; and until satisfied that the health interests of the consumer are amply safeguarded in the United States or elsewhere, to give their prelerence to home-canned food. Another branch of food inspection which demands more of our attention is that which relates to the sausage-maker. A visit to a butcher's shop where these articles are made never fails to impress me with all the possibilities of dishonest and unwholesome manufacture. Most of the meat made up into sausages, saveloys, black-puddings, etc., is material which, in the first place, sells at a better price in the fresh condition as butchers' meat, and I have good reason to know that sometimes it is only made into sausages, etc., when the possibilities of selling it as fresh meat are very remote or nonexistent. I have on several occasions made seizures of meat which has been set aside for sausage-making, and which has been quite unfit for human consumption; little wonder, then, that in some 40 per cent. of samples one finds antiseptics (sometimes in large quantities) in sausages, and that I have occasionally found two different chemical antiseptics in one and the same sausage. The two chemical antiseptics employed are solutions of sulphurous acid (sometimes in the form of sulphite) and boric acid; and when they co-exist 51 the presumption is warranted that the meat was odorous in the first place, and was therefore drenched with the sulphurous acid solution, and that the boric acid was subsequently added in the form of the preservative powder so frequently employed in the routine of sausage making. Doubtless the flavouring agents which are added to certain sausages also lend themselves to the disguising of unsavoury conditions originally present in the meat. Then, as further circumstances favouring dishonest and unwholesome manufacture, one may refer to the facts that a sausage machine so finely divides the material that it is impossible to judge of the original quality, or even nature, of the various meats introduced, and all naked eye evidence of disease conditions is lost. The poorer people eat a great deal of sausage, for it is one of the cheapest articles of food. Beef sausages are sometimes actually sold at 3d. per pound, and rarely at more than 6d. When wholesome, as they generally are, they are also a valuable article of food. If it is necessary to use preservatives at all in the manufacture of sausages, the drugging of the food should be performed under proper advice and restrictions. Sausage makers are at present advised and, indeed, pressed to use preservative powders and solutions on the market by agents whose commercial interest it is to foster the sale of these articles, and they are often used without any discrimination by butchers who are not informed as to the minimum quantities that will suffice. Hence one finds that where 5 to 10 grains to the pound of boric acid would be sufficient to preserve fresh sausage meat, even in the summer months, as much as 60 grains have been added. There are at present 26 sausage makers in the Borough, and the meat used by them has been found to be wholesome on every occasion of inspection during 1906, but seizures have been made in previous years. 52 During the year the Council approved of the following Recommendations of the Metropolitan Branch of the Incorporated Society of Medical Officers of Health, and so informed the Local Government Board and the Board of Agriculture:— (a) The name and address of the manufacturer and the date of canning shall be impressed on the cans. (b) It shall be unlawful to sell for any purpose canned foods that are unfit for human consumption, and it shall be the duty of any person in possession of unsound canned foods to notify and surrender same to the local authority, who shall destroy such unsound food free of charge. (c) A certain number of tins—say, 1 per cent.—from each consignment shall be opened on importation, and the contents examined under the supervision or instructions of the sanitary authority concerned, prior to such canned foods being placed on the market. (d) Tins which are known in the trade as "doubtfuls" shall be deemed to be unfit for human consumption. (e) Food intended for canning shall be inspected by independent officials prior to being canned, and all foods shall be canned under strictly hygienic conditions. (f) The use of preservatives in canned foods should under no circumstances be permitted. 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 1906, 246 premises were on the Register, and during the year all registered premises were duly inspected. FACTORIES AND WORKSHOPS. At the end of the year 1906 there were on the Register 216 workshops and work-places. 53 As the result of the inspection of the workrooms and work-places 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 was only one case of overcrowding which had to be dealt with, but there were 46 instances in which it was necessary to require cleansing. There was no occasion to require an increase in the water-closet accommodation, but 27 in which the accommodation was unsuitable or defective. In two cases the Abstract of the Factory Act was not affixed in the workrooms, and the Home Office was notified accordingly. There are altogether 221 domestic workrooms in the Borough in which wearing materials of various kinds are being dealt with. During the year no case of notifiable infectious disease occurred on premises in which there was a workshop, but on two occasions the out-workers in connection with certain factories and workshops had to be stopped from carrying on their work. A complete list of all out-workers has been kept in the office; the information has often been obtained on calling at the workshops, for some employers still fail to realise their duty to send in a list of outworkers twice a year, viz., in February and August, as the Act directs. The kitchens of the restaurants and public dining-rooms in the Borough have been thoroughly inspected throughout the year, with satisfactory results. 54 TABLES REQUIRED BY THE HOME OFFICE. FACTORIES, WORKSHOPS, LAUNDRIES, WORK-PLACES AND HOME WORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 16 .. .. Workshops (including Workshop Laundries) 163 103 .. Workplaces (Other than Outworkers' premises included in Part 3 of this Report). 10 .. .. Total 189 103 Nil 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under the Publie Health Acts:— Want of Cleanliness 46 46 .. .. Want of Ventilation .. .. .. .. Overcrowding 1 1 .. .. Want of drainage of floors 5 5 .. .. Other nuisances 84 84 .. .. †Sanitary accommodation insufficient .. .. .. .. unsuitable or defective 27 27 .. .. not separate for sexes .. .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) .. .. .. .. Breach of special sanitary requirements for houses (ss. 97 to 100) 7 7 .. .. Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) .. .. .. .. Total 170 170 Nil Nil † Public Health Acts Amendment Act, 1890, Part 3, adopted Oct., 1890, 55 3. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Order made (S 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, &c. 31 224 — — 387 122 — — 454 — — — 2 1 — (2) cleaning and washing Lace, lace curtains and nets Furniture and Upholstery Far pulling Umbrellas Paper Bags and Boxes Brush making Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Total 31 224 — — 387 122 — — 454 — — — 2 1 — 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Bakehouses 29 Laundries 19 Restaurant Kitchens 24 Miscellaneous 144 Total number of workshops on Register 216 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s, 133) 2 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 Other 0 Underground Bakehouses (s. 101):— Certificates granted during the year 0 In use at the end of the year 19 56 THE "SWEATER" AND THE "SLUM LANDLORD." The two greatest evils of our present day social system are the Slum Landlord and the Sweater; and it is, to put it mildly, an anomaly that they should be allowed to discount the good results so laboriously achieved by our public health machinery. Nothing is more discouraging to the Sanitarian who is desirous of seeing, as the outcome of his labours, a betterment in the hygienic conditions of the very poor, than to witness the sapping of the physical well-being of a large section of the community by these two social evils. And this wastage of human lives and human physique goes on as if we were careless and profligate of both, whereas costly measures of public health policy continue to be directed towards other less fruitful ends. We delay to take the action which will limit the rapacity of the Slum Landlord and prevent him from fattening on the helplessness of those who occupy his highly tenemented dwellings; he is free to exact a rent which is quite out of proportion to the accommodation offeTed, and which often amounts, in my experience, to one-third of the tenants' total earnings, and leaves the toilers unable to provide the necessary accommodation for decent and healthy living; and an expensive public health machinery is largely concerned in abortive attempts to reduce the resulting evils! Again, we spend a very large proportion of our time in providing what are relatively luxuries in sanitary details in homes in which, under the sweating system, the hours of labour and the wage earned are such that the lives of those who occupy them must necessarily offend against every law of hygiene; and the Nemesis of physical deterioration, sickness and death in some parts of our great cities is appalling. During the year an Exhibition of Sweated Industries was held in London, under the auspices of the "Daily News," at which the home life and condition of labour of thousands of Londoners were laid bare to those who cared to know of them; and it must have evoked sentiments of pain and shame to every visitor. So long as pauper aliens are allowed to settle upon our shores in unrestricted numbers it is not difficult to see that a large proportion of them (and, as a 57 necessary consequence, many of our own people) will fall victims to the conditions imposed by the Sweater; and remuneration on the scale of 6s. and 7s. a week for labour from 6 a.m. to 9 p.m. will prevail. Of this wage, the slum landlord will demand 50 per cent. for his one room; and, as a matter of fact, he rarely lets it at less than 4s. 6d. Such hours of work and such a scale of remuneration represents the curse of cheapness. If body and soul are to be kept together, there is no time for housework, and the accommodation obtainable does not admit of decent living; for one room is often kitchen, scullery, bedroom, living-room, sick-room, and workshop for a family. It is not easy to deal with the Slum Landlord and the Sweater. These two social parasites are as cunning as they are unscrupulous, and any legal mesh will have to be woven very small to catch them, but it should be possible to regulate the rapacity of both by law. Honourable labour has a claim for such protection, and until it is satisfied there is no proportion in our public health work. What does it profit us to bring about the best possible environment when an individual must necessarily live a regime which invokes sickness and early death. The Out-worker, that is, the individual who works in his or her own house, and not in the factory, forms the weakest section of the labouring class, and the class in respect of which the State is least able to control the conditions of work. It is surprising that the so-called Labour Party does not concern itself with this lowest stratum of workers, as well as with those who are protected by Trade Unions. FOOD AND DRUGS. Under the Sale of Food and Drugs Acts, 157 samples of food and drugs were taken and analysed. The results are shown in Table C. 58 13 of the samples were not satisfactory, and, therefore, the percentage of non-genuine samples amounted to about 8.3 per cent., a figure which is the same as that of the preceding year. The figure for the whole country was 8.2 per cent. during the year 1905. 15.5 per cent. of the milk samples were unsatisfactory, as against 11.8 per cent. during the preceding year; but in some cases the deficiency below the legal limits was very slight. 25 per cent. of the samples of milk were taken on Sundays, and of these 16.6 per cent. were adulterated. According to the thirty-fifth Annual Report of the Local Government Board, the total number of samples analysed under the Sale of Food and Drugs Act during the official year 1905 shows an increase of 1,504 samples over the figures of the previous year. In London, one sample was analysed for every 211 persons, being at the rate of 4.7 per 1,000 of the population; and in the provinces, one for every 433 of the population, or 2.3 per 1,000. It will be seen from the Table on page 59 that the proportion of samples reported against was 8.2 per cent. of those examined. In 1904 8.5 per cent. of the total samples analysed proved to be adulterated. There was a decrease in the amount of adulterated samples of margarine, beer, milk, win and drugs, and a slight increase in the samples of adulterated butter and cheese. London is at the head of the list again as regards the extent of adulteration of milk, the result showing 10.9 per cent. of samples condemned as against 10.4 per cent. in the 20 next largest provincial towns. It is satisfactory to know that the fines imposed show an increase in individual cases, though still, in many instances, the amounts inflicted are not calculated to check adulteration as effectually as larger sums would do. The rate of butter adulteration in England and Wales was 6.9 per cent., as compared with 5.7 per cent. in 1904. In 1887, the year in which the Margarine Act was passed, the rate of butter adulteration was 17.5 per cent. The percentage of adulterated samples of drugs showed a marked decrease below that recorded in the previous year. 59 Table showing the results of Analyses of Samples taken under the Sale of Food and Drugs Acts, during the year 1905 in England and Wales:— Percentage Adulterated. 1904. 1905. Milk 11.1 10 .5 Butter 5.7 6. 9 Cheese 0.9 2.3 Margarine 7.1 4.8 Lard 0.2 0.4 Bread 0.2 0.2 Flour 0.6 — Tea — — Coffee 6.3 6.6 Cocoa 8.8 5.3 Sugar 5.4 3.7 Mustard 4.8 3.4 Confectionery and Jam 5.5 3.3 Pepper 1.8 0.9 Wine 17.5 11.2 Beer 7.0 2.5 Spirits 12.0 11.5 Drugs 11.3 9.0 Other Articles 7.3 7.7 All Articles 8.5 8.2 In accordance with the suggestion of the Local Government Board, contained in their circular of the nth July, 1906, all the 60 vendors of milk in the Borough were notified that the Public Health Committee of the Metropolitan Borough of Stoke Newington would recommend the Council to take action, under the Sale of Food and Drugs Acts, in all cases where preservatives are found in the milk sold in the Borough. The Official Report of the Local Government Board for the year 1905 shows that the percentage of Spirits condemned was the lowest on record. It is, however, stated in the Report that it does not necessarily follow that spirits are being sold either purer or stronger than formerly. In my opinion, the explanation lies in the circumstance that so many publicans now protect themselves against the operation of the Acts by exposing public notices in their bars. Many of these notices are not easily visible to the public, and it is very certain that the occasions must be rare upon which a customer has the necessary knowledge to put the proper construction upon the facts stated on the notice. The specious manner in which these notices are worded is rather calculated to give the ignorant customer the impression that he is obtaining special value, as, for instance, in the case of the following notice, which has been widely adopted:—"The spirits sold in this establishment are of the same superior quality as heretofore, but, to meet the requirements of the Food and Drugs Adulteration Acts, they are now sold as adulterated spirits, no alcoholic strength being guaranteed." The work of detecting offenders under the Sale of Food and Drugs Acts is undoubtedly becoming more difficult, as the dishonest tradesman is becoming more familiar with our available methods. It is certain that efficient sampling can now nowhere be undertaken except through the employment of deputies, but the value of this precaution is now very largely discounted from the circumstance that the dishonest tradesman looks upon casual customers as possible agents of the Sanitary Authority, and therefore reserves the sale of his adulterated articles to his constant customers. During the year we have on two occasions obtained the services of individuals who have acted as more or less constant customers at two shops which were under suspicion, 61 and, after they had been dealing at these shops for several weeks, we obtained their services as agents; but the samples procured did not prove on analysis to be adulterated. In a few instances we have ourselves purchased samples without going through the formalities prescribed by the Acts; the object being to submit these to analysis, and, if they proved unsatisfactory, to subsequently take samples under the prescribed formalities, so that proceedings might be instituted against the vendor. 62 TABLE C. ANALYSES PERFORMED UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR. No. Sample Analysed. Opinion Formed. Action Taken. 1 Scotch Whisky Genuine Nil. 2 Irish Whisky 30° underproof Vendor cautioned 3 Granulated Sugar Contained some Tartaric Acid—accidentally introduced. Nil. *4 Milk Genuine „ *5 Milk „ „ *6 Milk „ Obstruction to purchase. Vendor fined £3 and 12s. 6d. costs. *7 Milk „ Nil. *8 Milk „ „ 9 Butter „ „ 10 Coffee „ „ 11 Butter „ „ 12 Coffee „ „ 13 Butter „ „ 14 Flour „ „ 15 Licquorice Powder „ „ 16 Lime Water „ „ 17 Milk 22% less than legal limit for butter fat Defendant fined 10s. and 12s. 6d. costs. 18 Milk Genuine Nil. 19 Butt „ „ 20 Gin „ „ 21 Butter „ „ 22 Butter „ „ *23 Milk „ „ *24 Milk „ „ *25 Milk Adulterated, 4% of added water Vendor cautioned. *26 Milk Genuine Nil. *27 Milk „ „ *28 Milk 38% less than legal limit for butter fat Defendant fined £2 and 12s. 6d. costs. 29 Coffee Genuine Nil. 30 Demerara Sugar „ „ 31 Fine Oatmcal „ „ 32 Coffee „ „ 33 Butter „ „ 34 White Pepper „ „ 35 Butter „ „ 36 White Pepper „ „ 37 Flour „ „ *Sunday Samples. 63 TABLE C.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 38 Flour Genuine Nil. 39 Coffee „ „ 40 Milk „ „ 41 Milk „ „ 42 Milk „ „ 43 Milk „ „ 44 Milk „ „ 45 Milk „ „ 46 Milk „ „ 47 Milk „ „ 48 Milk „ „ 49 Milk „ „ 50 Demerara Sugar „ „ 51 Cocoa „ „ 52 Coffee „ „ 63 Flour „ „ 54 Mustard „ „ 55 White Pepper „ „ *56 Milk „ „ *57 Milk „ „ *58 Milk „ „ *59 Milk „ „ *60 Milk „ „ *61 Milk „ „ 62 Scotch Whisky 36° underproof Vendor protected by [label. 63 Scotch Whisky Genuine Nil. 64 Gin „ „ 65 Scotch Whisky „ „ 66 Gin „ „ 67 Gin „ „ 68 Butter „ „ 69 Lard „ „ 70 Margarine „ „ 71 Butter „ „ 72 Lime Water „ „ 73 Mixed Sweets „ „ 74 Condensed Milk (Skimmed) „ All contained under 1% of butter fat. . No chemical preservatives. „ 75 Condensed Milk (Skimmed) „ „ 76 Condensed Milk (Skimmed) „ „ 77 Condensed Milk (Skimmed) „ „ 78 Condensed Milk (Skimmed) „ „ 79 Condensed Milk (Skimmed) „ „ 80 Condensed Milk (Skimmed) „ „ _ . 81 Condensed Milk (Skimmed) „ „ *Sunday Sampler. 64 TABLE C.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 82 Milk Genuine Nil. 83 Milk „ „ 84 Milk 2.75% less than the legal limit for butter fat Vendor cautioned. 85 Milk Genuine Nil. 86 Milk „ „ 87 Milk „ „ 88 Milk „ „ 89 Milk „ „ 90 Milk „ „ 91 Milk „ „ 92 Tinned Salmon Trace of tin.. „ 93 Tinned Rabbit Genuine „ 94 Milk „ „ 95 Milk „ „ 96 Milk „ „ 97 Milk „ „ 98 Milk 2.3% deficiency in solids, non-fat. Vendor cautioned. 99 Milk Genuine Nil. 100 Butter „ „ 101 Butter „ „ 102 Butter „ „ 103 Butter „ „ 104 Milk „ „ 105 Milk „ „ 106 Milk „ „ 107 Milk Adulterated 8% of added water. Defendant fined 2s. 6d. and 12s. 6d. costs. 108 Milk Genuine Nil. 109 Milk Slight deficiency in fat (about 6% on curdled sample). Vendor cautioned 110 Brawn Early decomposition. No preservatives. Nil. 111 Beef Sausage Boric acid 0.27% or 18.9 grains per lb. A sulphite also present. „ 112 Saveloy Boric acid 9.2 grains per pound. „ 113 German Sausage Satisfactory „ 114 German Sausage „ „ 115 Beef Sausage A chlorine preservative present. „ 116 Black Pudding Sulphurous acid present as a preservative „ 117 Faggot Early decomposition. Boric acid 11.3 grains per pound „ 65 TABLE C.—comtinued. No. Sample Analysed. Opinion Formed. Action Taken. 118 Chicken and Tongue Satisfactory Nil. 119 Ham and Tongue „ „ 120 Mock Turtle Soup .. „ „ 121 Milk Genuine „ 122 Butter „ „ 123 Flour „ „ 124 Coffee „ „ 125 Milk „ „ 126 Butter „ „ 127 Milk Adulterated 4% of added water. Vendor cautioned. 128 Milk Slight deficiency in solids non-fat (= 1% of added water). Nil. 129 Butter Genuine „ 130 Milk „ „ 131 Butter „ „ 132 Milk „ „ 133 Milk „ „ 134 Butter „ „ 135 Butter „ „ 136 Milk „ „ 137 Milk „ „ 138 Milk „ „ 139 Milk Slight deficiency in non-fatty solids (= 2% of added water). „ 140 Milk Genuine „ 141 Milk „ „ 142 Licquorice Powder „ „ 143 Tea „ „ 144 Demarara Sugar „ „ 145 Coffee „ „ 146 Scotch Whisky „ „ 147 Gin „ „ *148 Milk „ „ *149 Milk „ „ *150 Milk „ „ •151 Milk Contains 6% less than the legal limit for butter fat. Vendor cautioned. *152 Milk Genuine Nil. *153 Milk „ „ 154 Butter „ „ 165 Milk Slight deficiency in solids non-fat (= 2% of added water) „ 156 Margarine Genuine „ 157 Coffee „ „ *Sunday Samples. E 66 REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1906. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen, I beg to present to you my Annual Report for the year ending 31st December, 1906:— HOUSES AND PREMISES INSPECTED. By house-to-house inspection 640 Upon complaint, under Sec. 107 (3), Public Health Act, 1891 189 After notification of infectious disease 267 After Notices from builders, under Bye-law 14 (London County Council) 201 Stables and mews 463 Slaughter houses 13 Milkshops, dairies and cowsheds 53 Bakehouses 29 Factories and workshops 525 Other premises inspected 1193 3573 Re-inspections made to examine and test work required under intimation and statutory notices 5984 Total inspections 9557 67 INTIMATION NOTICES SERVED. (Sec. 3, Public Health Act, 1891.) After house-to-house inspection 358 After inspection on account of complaint 162 After infectious illness 65 With reference to stables and mews 14 „ „ milkshops, dairies and cowsheds 3 „ „ bakehouses 7 „ „ factories and workshops 103 „ „ slaughter houses 1 After sundry other inspections 197 910 STATUTORY NOTICES SERVED. Thirty-seven statutory notices were authorised by your Committee to be served under Sec. 4, Public Health Act, 1891. NUISANCES ABATED AND SANITARY DEFECTS REMEDIED. Dirty premises, cleansed and whitewashed 141 Dampness in dwellings remedied 54 Dilapidated ceilings, stairs, &c., repaired 52 Bell-traps and small dip-traps removed and replaced by stoneware gulleys 25 Foul traps and pans of w.c.'s cleansed or new ones substituted Public-house urinals cleansed 43 Flushing cisterns to w.c.'s provided or repaired, and w.c.'s with insufficient water supply made satisfactory 104 Defective w.c. basins and traps removed and replaced by approved patterns 134 Stopped or choked w.c. traps cleared 10 External ventilation to w.c.'s improved 1 W.c.'s removed to more sanitary positions Nil Carried forward 564 E 2 68 Brought forward 564 Separate Flushing cisterns fixed to w.c.'s which were previously flushed directly from dietary cistern 3 Additional w.c.'s provided in case of insufficient w.c. accommodation 11 Defective soil-pipes reconstructed 59 Soil-pipes improperly ventilated, improved Unventilated soil-pipes ventilated 152 Dirty yards cleansed 18 Yards paved or re-paved with impervious material 103 Gulley and other traps inside houses removed 32 Sink waste-pipes directly connected to drain, made to discharge in open-air over proper syphon gulleys 10 Long lengths of sink, bath, and lavatory waste-pipes trapped, and made to discharge in open-air over gulleys 105 Defective waste-pipes repaired 57 Foul water-cisterns cleansed Water-cisterns without close-fitting covers provided with proper coverings 59 Defects in water-cisterns remedied 9 Defective dust-bins pulled down and new portable dust-bins provided 129 Defective drainage re-constructed in accordance with the bye- laws of London County Council 374 Choked or stopped drains cleared and repaired 132 Rain water pipes disconnected from drains or soil-pipes and made to discharge over gulley-traps 50 Proper water supply provided to houses 24 Defective roofs repaired 67 Defective guttering and rain water pipes repaired or renewed 112 Defective paving to floors of wash-houses repaired or renewed 39 Dirty walls of work-rooms cleansed 37 Proper manure receptacles provided (London County Council bye-laws) 5 Cases of over-crowding abated 4 Carried forward 2,155 69 Brought forward 2,155 Insufficiently ventilated space under wooden floors, remedied by insertion in outer walls of proper air bricks 26 Underground dwellings improved 1 Nuisances from animals abated 7 Total number of nuisances abated 2,189 In addition to the above a number of nuisances have been abated as the result of personal advice to the owners or occupiers of premises. SLAUGHTER HOUSES. The eight Slaughter-houses in the Borough have been inspected, and are in a satisfactory condition. COMMON LODGING HOUSE. The one common Lodging-house in the Borough is under the control of the London County Council, and is conducted in accordance with the bye-laws. BAKEHOUSES. There are 29 Bakehouses in the Borough, 20 of these being constructed underground. Seven intimation notices were served for limewhiting and cleansing. DAIRIES, COWSHEDS, AND MILKSHOPS. There are 51 Milkshops and 2 Cowsheds in the Borough, all of which have been inspected. It was only necessary during the year to serve three intimation notices on occupiers to cleanse premises. 70 COMPLAINTS. Sec. 107 (3) Public Health Act, 1891. 189 complaints were received during the year, relating to 197 premises. In 31 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 to exist. 2 complaints were referred, after inspection, to the Surveyor's Department. 162 intimation notices were served on the owners and occupiers of premises complained of. STABLES AND MEWS. Considerable attention was given to the inspection of Stables and Mews, especially during the summer months. 463 visits were paid in connection with these premises, and in very few cases were accumulations of manure found. Copies of the Regulations of the Council have been kept posted up at all the Mews in the Borough. HOUSES LET IN LODGINGS. There were 246 premises on the Register at the end of the year. SALE OF FOODS & DRUGS ACTS, 1875-1901. 157 samples of Food and Drugs were submitted to the Public Analyst during the year. A table will be found on pages 62 to 65 showing the result of proceedings taken in respect of adulterated samples. 71 BUTCHERS' GREENGROCERS', AND FISHMONGERS' SHOPS, STALLS, &c. In connection with the inspection of the above, 745 visits have been paid to shops and premises in the Borough. In addition, a large number of Fruit, Fish, and Vegetable Stalls have been inspected. In every instance the food offered for sale on the stalls and barrows of itinerant vendors proved to be satisfactory. The following is a list of the food seized or surrendered during the year:— qrs. lbs. Beef 26 Mutton 9 Pork 25 Fruit 3 14 Total 5 18 also 7 tins of Condensed Milk, 2 tins of Salmon, and 2 of Rabbit. A record is kept of all inspections. SMOKE ABATEMENT. A Register is kept of all factory chimneys in the Borough which have been seen to emit black smoke, or regarding which complaints of a nuisance have been made. These are watched from time to time, and a record made of the result of observations. On several occasions during the year it has been necessary to caution offenders. 72 ICE CREAM MANUFACTURERS AND VENDORS. There are 34 premises in the Borough where ice-cream is manufactured. A Register is kept of all such premises, and the occupiers supplied with copies of the London County Council Regulations. RESTAURANTS AND EATING HOUSES. There are 24 of these premises in the Borough. The inspections are usually made at the time when food is being prepared. The results of the inspection of the food in course of preparation and of the premises have been satisfactory except in one instance, when it was found necessary to caution the proprietor as to the quality of the food being prepared. REMOVAL OF HOUSE REFUSE. A reference to the Report of the Borough Surveyor will show the number of loads removed during the year, with the cost of removal, etc. The Dust Knockers report daily to the Sanitary Inspectors, giving a list of houses where refuse was not removed on the previous day and the cause of such non-removal. Very few complaints of non-removal were received during the year. FACTORIES AND WORKSHOPS. The Register of Factories and Workshops has been maintained. There are at present 232 Factories, Workshops and Workplaces in the Borough, and 221 Workrooms which are used as domestic workshops, all of which were inspected during the year. 73 Of the outworkers working for firms whose places of business are in Stoke Newington— 67 reside in Stoke Newington. 42 „ „ Hackney. 43 „ „ Islington. 12 „ „ Tottenham. 7 „ „ Stepney. 4 „ „ Bethnal Green. 5 „ „ Edmonton. 4 „ „ Shoreditch. 2 „ „ Wood Green. 3 „ „ Walthamstow. Total 189 Notifications were received from Medical-Officers of Health of persons residing in Stoke Newington but who work for firms in other Districts as follows:— 1 from Holborn. 113 „ Finsbury. 79 „ City of London. 94 „ Hackney. 66 „ Islington. 7 „ Shoreditch. 2 „ Southwark. 4 „ Stepney. 3 „ Tottenham. 1 „ Colchester. 1 „ Kensington. 6 „ St. Marylebone. 2 „ Westminster. 4 „ Bethnal Green. 2 „ Walthamstow. 1 „ Hornsey. 1 „ Chelsea. Total 387 74 Outworkers' addresses received in error from other Boroughs, etc., and forwarded to their proper destination:— 42 forwarded to Hackney. 12 „ „ Islington. 4 „ „ Tottenham. Total 58 NOTIFICATION OF INFECTIOUS DISEASE. Two hundred and sixty-seven cases were notified during the year, and in most instances an inspection of the infected premises was made. All the houses where the cases of infectious illness occurred have been disinfected; 239 by the Department, and the remainder under the supervision of the Medical Practitioner attending the case. The bedding, clothing, &c., were removed, steam disinfected, and returned in 232 instances. 163 Patients were removed to Hospital. It was found necessary to strip and cleanse 24 rooms after removal or recovery of patients, Two hundred and five books which had been borrowed from the Public Library were collected from infected houses, disinfected, and returned to the Public Library. 75 PROSECUTIONS ORDERED BY SANITARY AUTHORITY UNDER THE PUBLIC HEALTH ACT, 1891, AND BYE-LAWS OF THE LONDON COUNTY COUNCIL. No. in Report Book. Situation of Premises. Nature of Offence. Result of Proceedings. 6826 40, Eade Road Defective W C. and soil pipe vent. Nuisance abated previous to issue of Summons. 5943 2a, Allen Road Insanitary condition of premises. Order made for abatement of nuisances with 2s. costs in each case. 5944 2, Do. Do. Do. 5946 4a, Do. Do. Do. 5943 2a, Do. Do. For failing to comply with Magistrate's Order—Fined 1s. and 2s. costs. 5944 2, Do. Do. Do. 5946 4a, Do. Do. Fined 40s. and 23s costs. 6033a 162, Boleyn Road D epositing unsound meat for sale. Fined £5 and 2s. costs. 6042 60, Queen's Road Insanitary condition of premises. Nuisance abated previous to issue of Summons. 6206 4, Watson Street Executing work without previously giving notice to Sanitary Authority. Ordered to pay 2s. costs. Do. Improperly executing sanitary work. Fined 20s. and 2s. costs. 6387 14, Cressington Road Defective drains Order made for abatement of nuisance and 4s. costs. 6388 20, Do. Do. Do. 6389 33, Do. Do. Do. 6390 37, Do. Do. Do. 6721 9a, Knebworth Road Do. Order made for abatement of nuisance with 2s. costs. 6773 91, Listria Park Defective drains and soil pipe Nuisance abated previous to issue of Summons. 6808 31, Queen Elizabeth's Walk Foul and defective drain. Summons adjourned 28 days, work completed in the interim—2s. costs paid by owner. 76 DRAINAGE APPLICATIONS. Eighty-five plans were submitted referring to the drainage of 120 premises, and all of these were eventually approved of. Copies of the bye-laws of the London County Council relating to the deposit of plans for drainage work are issued with all plan forms. In October your Committee approved a revised and enlarged drainage application form. This has been adopted. TABLE OF PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS AND MARGARINE ACTS. No. of Sample. Article Purchased. Result of Analysis. Result of Proceedings. 6 Milk Genuine. Obstruction to purchase. Defendant fined £3 and 12s. 6d. costs. 17 Milk 22 per cent. less than legal limit for butter-fat Defendant fined 10s. and 12s. 6d. costs. 28 Milk 38 per cent. less than legal limit for butter-fat Defendant lined £2 and 12s. 6d. costs. 107 Milk 8 per cent. of added water Defendant fined 2s. 6d. and 12s. 6d. costs. By your direction, several vendors of poor samples of food taken under the above Acts have been cautioned. I am, Gentlemen, Your obedient Servant, D. W. Matthews. 77 A LIST OF THE STREETS SITUATED IN THE BOROUGH OF STOKE NEWINGTON. ADEN Grove Aden Terrace Adolphus Road Allen Road Allerton Road Albion Road „ Grove Alexandra Road Amhurst Park (90-100 even Nos and 93) Arthur Road Ayrsome Road Aldham Place BARN Street Barrett's Grove Bethune Road (1 to 145) „ „ (2 to 106) Blackstock Road (5 to 175) Bouverie Road Boleyn Rioadi (94 to 192) Brighton Road Brodia Road Broughton Road Brownswood Park „ Road Burma Road CASTLE Street (1 to 30) Carysfort Road Chalmers Terrace Chapel Place Chesholm Road Church Path „ Road „ Street Clonbrock Road Clissold Road Coronation Avenue Cowper Road Cressington Road DEFOE Road Digby Road Dumont Road Dynevor Road EADE Road (2 to 66) 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 „ „ (from 2 to 388) „ ( „ 45 „ 107) Grove Lodge Yard HAMILTON Place Harcombe Road Hawksley Road Hayling Road Heathland Road Henry Road Hermitage Road High Street (17-217) Hornsey Place Howard Road IMPERIAL Avenue 78 KERSLEY Road Kings Road Knebworth Road Kynaston Road „ Avenue LANCELL Street Layer's Road Lavell Street Leonard Place Lidfield Road Lillian Street Listria Park Londesborough Road Lordship Road „ Grove „ Park „ Terrace MANOR Road Martaban Road Morton Road Mason's Court „ Place Matthias Road (2-122) Millard Road Milton Road Mountgrove Road (2-98) NEVILL Road Newington Green OLDFIELD Road Osterley Road PAGET Road Painsthorpe Road Palatine Road Paradise Row Park Crescent „ Lane „ „ Terrace „ Street Pellerin Road Petherton Road (106-138) Philp Street Portland Road Prince George Road Princess Road „ May Road QUEEN Elizabeth's Walk Queens Road REEDHOLM Road Rochester Court Riversdale Road (92-104) SANDBROOK Road Salcombe Road Seven Sisters Road Shakespeare Road Shelgrove Road Shipway Terrace Somerfield Road Spenser Road Springdale Road St. Kilda's Road St. Andrew's Road „ Mews „ Pavement, S. Side St. John's Place Stamford Hill (1-39) Stoke Newington Road (1-135) Statham Grove Sununerhouise 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 „ Grove