STO 18 THE Metropolitan Borough of Stoke Aeluington. REPORT of the Medical Officer of Health and Public Analyst, for the YEAR 1909. by HENRY KENWOOD, M.B., F.E.S.E., 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., Bishopsgate Avenue, E.C. 1910. 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 8-9 Mortality, Death-rates and causes of Mortality—with notes thereon 9-29 Infantile Mortality 13-20 The Work of the "Women Health Workers 17-20 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 29-47 Scarlet Fever 34-35 Erysipelas 36 Enteric Fever 36 Diphtheria 37-39 Measles and Whooping Cough 39-40 Zymotic Diarrhoea 39 Consumption 40-46 Cerebrospinal Fever 46-47 The Disinfecting and Cleansing Station 47-50 Meteorology of the Year 51 Notes upon Sanitary Work Performed during the Year 62-59 Food Inspection 52-54 Houses let in Lodgings 55 Factories and Workshops 56-59 Housing 59 The Public Health Legislation of 1909 59-69 Food and Drugs 69-76 Report of the Chief Sanitary Inspector (Appendix) 77-87 Streets in the Borough of Stoke Newington—(Appendix) 88-89 A 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1909. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen, The vital statistics of the Borough for the year 1909 are of a highly satisfactory nature. The general death-rate of 11.0 was the lowest recorded since the formation of the Borough, and it compares 'favourably with the rate of 14.0 for the Metropolis as a whole; while the death-rate from the chief communicable diseases (0.63) is also the lowest since the formation of the Borough, and amounts to only one half of that for the Metropolis. The rate of infantile mortality (the number of deaths under one year of age to every thousand births) amounted to only 84.9, as against 107 for the whole of the Metropolis of London. It is the lowest infantile mortality rate since the formation of the Borough; but as five other Metropolitan Boroughs have a lower rate, it serves to indicate a direction in which increased efforts in Stoke Newington may be expected to reap good results. The appointment of Miss Aldridge, a salaried part time health worker, has done much to assist the seven voluntary health workers—who continue as in past years to perform a great service to the Borough—and myself, in our efforts to reduce this infantile mortality. Fewer notifications of infectious disease, per thousand of the population, were received in Stoke Newington in 1909 than in any other Metropolitan Borough, and the rate was but little over one half of that for the whole of Metropolitan London. 6 The Disinfecting and Cleansing Station, opened at the commencement of last year, has amply demonstrated the advantages which had been claimed for it; a small well-equipped Station, within the Southern part of the Borough, constitutes a most important addition to the provisions made for the sanitary administration of the Borough. The work of the Public Health Department has been carried on by all of the officials in a thoroughly satisfactory manner, both in respect of the amount of work (vide appended Report of the Chief Sanitary Inspector) and of the way in which it has been performed. I am, Gentlemen, Your obedient Servant, HENRY KENWOOD. February 26th, 1910. 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 1909, and the figure, calculated logarithmically from the increase between 1891 and 1901, amounts to 54,101. 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 Sept., 1909, amounted to only 7,855 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 pf Industrial Dwellings in Victoria Road, occupied since the last Census enumeration, 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 18,875; and in the Southern Division the population is about 35,226. The natural increase of population by excess of births over deaths during the year amounted to 394, as against 369 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 63 people to the acre. 8 Births—Birth.rate.—.During the year 1909 there were 989 births registered in the Borough, viz.—501 males and 488 females. The birth.rate per 1,000 per annum was therefore 18.3 as against 19.1 for the preceding year. The birth.rate for the Northern Division of the Borough was about 10.8, while that for the Southern Division was about 22.3. Year. Birth.rate. Kate 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 27.2 1906 20.4 26.6 27.0 1907 19.5 25.8 26.3 1908 19.1 25.4 26.5 1909 18.3 24.4 25.6 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. The decline of the birth-rate, which has been in evidence throughout the country now for many years, was checked during 1908; but in Stoke Newington the rate for that year (which was the lowest in the records of the Borough) was last year further reduced to a new record figure of only 18.3. More especially in the population of the Southern part of the Borough, which embraces many temporary residents of the poorer classes, is this circumstance of a low birth.rate an important factor determining a low death.rate. 9 As the diminished birthrate is accompanied by a diminishing deathrate, the annual natural increase in the population (by excess of births over deaths), which was 13.5 per thousand for the whole country during 18715, did not fall below 12.1 per thousand during 190105; and the population of England and Wales continues to increase at a greater rate than most European countries. It may be noted that, in Stoke Newington, excess of the birthrate over the deathrate for the year 1901 was 8 5; whereas for the year 1909, (both rates being considerably lower), the figure was as high as 8.0. MORTALITY. General Mortality.—There were 421 deaths of residents registered in the Borough, and 171 of residents who died in Public Institutions outside of the Borough, making a total of 595 deaths. Of these 311 were of females and 284 were of males. Year. General Deathrate. Hate for London generally. Kate 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 11.5 15.7 15.4 1907 11.2 14.6 15.0 1908 12.2 13.8 14.7 1909 11.0 14.0 14.5 The recorded general death-rate is therefore 11.0. This ordinary death-rate, however, cannot be taken as a true index of the healthiness of the Borough, nor can it be justly compared with the rates of other Sanitary areas unless some allowance is made for the relative proportions of males and females at different ages in the districts compared. 10 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-rate of the district by this factor gives the death-rate which would obtain in that district if the sex and age distribution of the population of the district were in the same proportions as it is in the country as a whole—thus eliminating the accidental differences due to sex and age and affording a fair means of comparison, and a truer test of the healthiness of the district. The death-rate so ascertained is known as the corrected death-rate. The so-called "factor for correction" for the Borough of Stoke Newington is 1.0438, and the death-rate corrected for age and sea distribution is 11.0 x 1.0438 = 11.5 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 the lowest recorded since the formation of the Borough. The death-rate for the whole of London was 14.0. The death-rate of London has shown a decline for the past 40 years, and an almost uninterrupted decline year by year for the past 10 years; while in the case of the Birth-rate the fall year by year has been slight but uninterrupted for some 30 years. What this decline in the Death-rate of the population of 4,795,757 persons implies, is very forcibly expressed by Sir Shirley Murphy, the L.C.C. Medical Officer of Health, in terms of "Life Capital." By this expression 11 is implied the years of life saved to the community by a reduction in the Death-rate. The number of lives saved at each age period (as calculated by comparing the number of deaths for the year in each aged period, with the mean Death-rates for these age-periods for 10 years, and crediting each life saved with the years representing the expectation of life at that age) representing a saving of 26,205 lives, and a gain to the community of 1,066,770 years of " life capital." District Mortality.—The deaths among residents of the Northern Division of the Borough numbered 173 and furnished a recorded death-rate of 9.2 per 1,000 per annum. The deaths among the residents of the Southern Division of the Borough numbered 422, and furnished a recorded death-rate ot 11.9 per 1,000 per annum. 12 TABLE A. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1909. Causes of Death. Deaths in or belonging to Whole District at subjoined Ages. Measles. Scarlet Fever. Whooping Cough. Diphtheria & Membranous Croup. Enteric Fever. Epidemic Influenza. Diarrhœa. Enteritis. Puerperal Fever. Erysipelas. Other Septic Diseases. Phthisis(Pulmonary Tuberculosis). Other Tubercular Diseases. Cancer Malignant Disease. Bronchitis. Pneumonia. Other Diseases of Respiratory Organs. Alcoholism, thosis of Liver. Venereal Diseases Premature Birth. Heart, Diseases. Accidents. Suicide. Diseases of the Nervous System. Old Age. All other Causes. All Causes. All Ages 9 2 13 2 1 8 4 2 1 2 11 44 17 53 72 50 14 5 1 9 61 13 3 30 57 111 595 Under 1 year 2 .. 6 .. .. .. 2 1 .. .. 1 .. 9 .. 5 6 2 .. 1 9 .. 2 •• 2 •• 36 84 1 and under 5 5 2 6 1 .. .. 1 .. .. 1 1 •• 4 •• 2 4 4 .. .. .. .. 2 .. .. .. 5 38 5 and under 15 2 .. 1 1 .. .. .. .. .. .. 1 .. 1 .. •• 3 .. .. .. .. 2 1 .. .. .. 2 14 15 and under 25 .. .. .. .. .. .. .. 1 .. .. .. 6 1 •• .. 7 .. .. .. .. 3 .. .. .. .. 3 21 25 and under 65 .. .. .. .. 1 3 .. .. 1 .. 7 35 2 32 25 21 5 3 .. •• 25 2 3 11 •• 43 219 65 and upwards .. .. .. .. .. 5 1 .. .. 1 1 3 •• 21 40 9 3 2 .. •• 31 6 •• 17 57 22 219 Deaths in or belonging to Localities at all Ages. North Division .. .. 3 .. .. 5 1 1 .. 1 1 10 2 28 15 18 4 1 .. 2 12 1 2 10 21 35 173 South Division 9 2 10 2 1 3 3 1 1 1 10 34 15 25 57 32 10 4 1 7 49 12 1 20 36 76 422 Total Deaths in Public Institutions in the District .. .. .. .. .. 1 .. .. .. .. 1 2 •• 8 1 1 .. .. .. .. 7 •• .. 9 5 11 46 13 DISTRICT MORTALITY. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Rate per 1,000 per annum. Northern Division 62 34 34 43 173 9.2 Southern Division 155 93 83 91 422 11.9 Totals 217 127 117 134 595 11.0 INFANTILE MORTALITY. There were 84 deaths registered of infants under one year of age, as against 989 births; the proportion which the deaths under 1 year of age bear to 1,000 births is, therefore, 84.9, as against 98.3 in the preceding year. The deaths under 1 year of age form 14.1 per cent. of the total deaths of all ages, whereas those for the preceding year formed 15.4 per cent. Year. Kate of Infantile Mortality. Rate for London generally. Hate 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 108.0 130 133 1907 97.9 115 118 1908 98.3 113 121 1909 84.9 107 109 14 TABLE Al. Metropolitan Borough of Stoke Newington.— Infantile Mortality during the Year 1909. 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. Meningitis (not Tuberculous). Convulsions Bronchitis (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 Meniogitis Other Tuberculous Diseases Under 1 Week • • • • • • • • • • 9 • • • • • • 1 • • • • • • 2 • • • • • • 3 • • • • 15 1-2 Weeks • • • • • • • • • • • • • • • • • • 1 • • • • 1 1 • • • • • • • • • • • • 3 2-3 Weeks • • • • • • • • • • • • • • • • • • 9 • • • • • • • • • • • • • • 4 • • • • 7 3-4 Weeks • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 • • • • 1 Total under 1 Month • • • • • • • • • • • • • • • • • • 4 • • • • • • 3 • • • • • • 8 • • • • 26 1—2 Months • • • • • • • • • • • • • • • • • • 2 • • • • • • 3 • • • • • • • • • • • • 8 2—3 Months • • • • • • • • 2 • • • • • • • • 4 • • • • • • 1 • • • • • • • • • • • • 12 3—4 Months • • • • • • • • • • • • • • • • • • 3 • • • • • • 1 • • • • • • • • • • • • 8 4—5 Months • • • • • • • • • • • • • • • • • • 1 • • • • • • • • • • • • • • 1 • • • • 3 5—6 Months • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 • • • • • • • • • • 1 6—7 Months • • • • • • • • • • • • • • • • • • • • 1 • • • • • • 1 • • • • • • • • • • 2 7—8 Months • • • • • • • • • • • • • • • • • • • • 2 • • • • • • 1 • • • • • • • • • • 4 8—9 Months • • 1 • • • • • • • • • • • • • • • • 1 • • • • • • 1 • • • • • • • • • • 4 9-10 Months • • 1 • • • • • • • • • • • • • • 1 1 • • • • • • 1 • • • • • • • • • • 4 10-11 Months • • • • • • • • • • • • • • • • • • • • • • • • 1 1 4 • • • • 2 • • • • 9 11-12 Months • • 2 • • • • • • • • • • • • • • • • • • • • • • • • 1 • • • • • • • • • • 3 Total Deaths under 1 Tear • • 6 2 1 2 9 • • • • • • 15 5 4 3 9 12 • • 1 11 2 1 84 15 DEATHS UNDER ONE YEAR OF AGE IN THE DIFFERENT WARDS OF THE BOROUGH DURING THE YEARS 1903, 1904, 1905, 1906, 1907, 1908 and 1909. Name of Ward. 1903. 1904. 1905. 1906. J1907. 1903. 1909. Lordship Ward 4 6 9 8 1 6 2 Clissold Ward 7 8 12 6 11 4 5 Church Ward 30 24 24 18 23 19 18 Manor Ward 10 9 8 3 8 3 6 South Hornsey Ward 65 66 66 56 36 47 35 Palatine Ward 20 21 14 25 23 22 18 Totals 136 134 133 117 102 101 84 A comparison of the causes of infantile mortality in 1909 with those of the preceding year shows an increase during last year in the deaths from whooping cough, and a decrease in those from diarrhœal diseases, premature birth and bronchitis. There are notable differences when the rates of Infant Mortality in Metropolitan districts, well and badly circumstanced socially, are compared, vide Annual Report of Medical Officer of London County Council, for 1908; a fact which sufficiently indicates the results which might be obtained if the infants of the less favoured districts had extended to them the same care as that bestowed upon infants of the better favoured districts. Among Metropolitan Boroughs the loss of infant life has for several years been greatest in Shoreditch and Bermondsey, and least in Hampstead. When the least overcrowded are contrasted with the most overcrowded districts, it is remarkable that the difference is greatest, not among infants within 3 months, but amongst those of from 9 to 12 months; and that at the latter ages the mortality in the most 16 crowded districts exceeds that in the least overcrowded by from 80 to 85 per cent. The infant mortality rate is of course affected by the administrative efforts made to reduce it, but the rate is so extremely sensitive to other influences which vary from year to year, that the value of this work cannot be judged by the mortality of the moment. Among systematic efforts now being made in the Metropolis for the preservation of infant life, the system of visitation by Health Visitorsis generally commended. The much-needed appointment of an official woman Sanitary Inspector and Health Visitor by the Borough, leaves but little reduced the necessity for voluntary help, in order that the infantile mortality in the Borough may be kept as low as possible. The appointment of a salaried individual, who is able as necessity demands to keep in touch with the voluntary workers, has enabled this work to be co-ordinated and promoted in a manner which was found impossible when no such official existed, despite the valuable and generous assistance certain voluntary workers gave in clerical work, etc. The Borough is under a great obligation to the ladies who are discharging the duties of voluntary health workers and aiding Miss Aldridge in. reducing infantile mortality in the Borough. The problem of the reduction of infantile mortality was discussed at great length at the Leeds Congress of The Royal Sanitary Institute, to which I was appointed a Delegate by the Council. The practical lines there most advocated were:— (a) The provision of " Mothers' Welcomes," at which the expectant wife or young mother can obtain advice and help, and where she can buy a small but satisfactory meal for a few pence. (b) The wider enforcement of the practical provisions of the Notification of Births Act, by a wider use of trained sanitary inspectors—and by obtaining the assistance of more voluntary health workers. (c) The importance of sound practical training at school in the domestic work of the home and of practical and simple training in hygiene. 17 (d) The advisability of legislation necessitating the notification of still-births, thus preventing even the possibility of "unwelcome infants" being got rid of. (e) The need for including patent and proprietary foods under the "Adulteration sections" of the Food and Drugs Act. The exemption of those articles, gives the dishonest exploiter the opportunity—often availed of—of supplying an enormous amount of unsuitable or actually dangerous infant tood. THE WORK OF THE OFFICIAL AND VOLUNTARY HEALTH WORKERS. From April to December in last year 662 visits were paid to 227 separate homes after the notification of a birth, 99 were visited by the Voluntary Health Workers and 128 by the official (Miss Aldridge.) In visiting these cases, the visitors were well received, and many of the mothers were found to be greatly in need of advice, which was in many cases eagerly put into practice; but the mothers often do not realise the amount of care their children require. Miss Aldridge reports that the visits paid at the age of 6 weeks and under showed the following conditions:— 87 per cent. of the infants were entirely breast-fed. 4.2 „ „ „ partly „ 8.8 ,, ,, ,, entirely hand fed. In 4.6 per cent. of the cases the mother's were going out to work, which circumstance accounts for a good many of the hand-fed and partly hand-fed infants. In each case this was one of urgent necessity, the fathers being out of work or earning very little at the time. In 5.1 per cent. of the cases the mother's were taking in work to do at home. Fresh Cow's Milk and Condensed Milk (of a full cream brand), were used about equally for the feeding of hand-fed and partly hand- B 18 fed infants, during the first 2 months of life. Figures taken at a later date would show that a far larger number of children were fed on fresh milk. One teaspoonful of Condensed Milk, with varying amounts of water mixed is considered an adequate meal for an infant of any age. It is not surprising to find that infants fed in this way are seldom " satisfied," and that unless fresh milk is resorted to (which is invariably more carefully diluted), bread, biscuits, oatmeal, and patent foods are given at a very early age. Separate cots or cradles are at present the exception rather than the rule, particularly during the cold weather. The dangerous long tube feeding bottle is gradually becoming less popular, but is still to be found; and one generally finds that when used it is because it is cheaper than the more simple boat shaped bottle. During the months of June and July, with the valuable assistance of Mrs. Parsons (one of our Voluntary Health Visitors), another enquiry was made into the methods of feeding 100 babies between the ages of 4 and 8 months. This enquiry was made for the purpose of ascertaining to what extent tinned machine-skimmed milk was used in the feeding of Infants. It was found that, although a very large amount of this milk is consumed in the homes of the poor, in no case did it form any part of an infant's food. The 9 babies fed on condensed milk were in every case fed on a full cream brand, and were doing well. The methods of feeding were as follows:— Breast-fed 52 per cent. Hand-fed 28 ,, Partly hand-fed 20 „ 19 Cow's milk formed the chief artificial food given to hand-fed and partly hand-fed infants, condensed milk being used in only 9 cases. Other food given consisted of patent foods, nursery biscuits, white and whole meal bread, oatmeal, gruel and arrowroot. This enquiry was more satisfactory than I had anticipated, and the information has since been confirmed from another source. The firm of Nestle & Co. has undertaken an investigation in different parts of London upon the effects of feeding infants upon condensed whole milk, and the extent of the use, for this purpose of separated condensed milk. With this object they have established from time to time local "Depots," and one of these was opened during 1909, in the Stoke Newington Road. The representative in charge of this Depot has written as follows :— "As I understand, from yours of the 20th inst., you wish for particulars of the depot work so far undertaken in the poorer neighbourhoods of London, 1 have pleasure in briefly giving you the available figures. "In Poplar and Bow districts, where we had first weighs of nearly three thousand infants, the larger proportion were breast-fed, and fairly healthy; but we found no less than 25 per cent., principally from the districts abutting on East India Dock Road and Crisp Street, were suffering from the ill-effects of machine-skimmed condensed milk feeding. "Condensed Milk was the determining factor of the sale generally, and in many cases "machine-skimmed" conveyed to them some special virtue of quality or cleanly preparation not possessed by "full cream." "In Southwark and Bermondsey about 15 per cent. of the 2,800 babies weighed were proved to be fed on machine-skims (condensed). In Bethnal Green we reached 25 per cent. mark again as to condensed machine-skims, out of 2,000 babies weighed, but dropped to a point below 10 per cent. at Hoxton out of 1,200 babies recorded. Millwall showed even less proportion (750 babies weighed), and at Hackney and Stoke Newington only two babies were found fed on machineskimmed condensed milk out of about 2,000 babies examined. b 2 20 "Altogether we have had 15,000 first weighs of babies, and with re-weighs (mothers have brought infants two or three times for reweighs during the periods of our schemes), we have used the scales on at least forty thousand occasions, and had visits of mothers to a total of twice that number. "As we only desired to record children up to one year old, and as we had hundreds over that age too heavy for our scales (top weight 26 lbs.), all our figures are incomplete as showing the number of infants brought to the depots. "This is to us not a matter of moment, as we obtained our information as to feeding and by object lessons demonstrated the essential difference between "machine skims" and "full cream." "Machine-skimmed milk, other than the condensed variety, was very rarely met with in the districts visited, in so far as infant feeding was concerned." "The ignorance of poor mothers as to what constitutes a proper diet for their offspring, the pitfalls of "fake" foods and colourable imitations of genuine foods, all call for the close and unremitting attention of public authorities; and that the evils are no worse than they are is due to the proper fulfilment of these duties to the letter by responsible officials. The remedy to a greater extent lies with the Legislature, and as great a necessity of the present day is for a " Whole Milk" Bill as for a "Pure Milk" Bill. Stoke Newington offers an instance of an exception to a rule, for whilst other districts have recorded at our depots a considerable proportion of machine-skimmed milk (condensed) fed babies, at our local depot in Stoke Newington Road, we have had practically none but healthy, sturdy babies, well ted and well tended." During the year the number of visits paid by these voluntary workers, in respect of births, infant deaths, and sufferers from consumption, amounted to over 400. Senile Mortality.— Of the 595 deaths 219 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, 36.8 per cent. 21 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 1909. Diseases. North. South Quarters. Total. Quarters. Total. 1 2 3 4 1 2 3 4 Measles .. .. .. .. .. 3 5 1 .. 9 Scarlet Fever .. .. .. .. .. 1 1 .. .. 2 Whooping-cough •• 3 •• •• 3 4 3 3 .. 10 Diphtheria and Membranous Croup .. .. .. .. .. .. .. 1 1 2 Enteric Fever .. .. .. .. .. 1 .. .. .. 1 Epidemic Influenza 4 1 .. .. 5 2 1 .. .. 3 Diarrhoea .. .. .. 1 1 1 .. 1 1 3 Enteritis .. .. 1 .. 1 .. .. 1 .. 1 Puerperal Fever .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. 1 .. 1 .. .. .. 1 1 Other Septic Diseases 1 .. .. .. 1 3 1 .. 6 10 Phthisis 5 3 1 1 10 11 6 10 7 34 Other Tubercular Diseases .. .. .. 2 2 5 6 1 3 15 Cancer 9 6 6 7 28 4 7 10 4 25 Bronchitis 11 .. .. 4 15 39 6 1 11 57 Pneumonia 9 2 6 2 18 17 7 1 7 32 Other Respiratory Diseases 1 1 .. 2 4 2 2 2 4 10 Alcoholism and Cirrhosis .. 1 .. .. 1 1 1 .. 2 4 Venereal Diseases .. .. .. .. .. .. .. .. 1 1 Diseases of the Nervous 1 3 4 2 10 8 2 9 1 20 System Premature Birth .. .. 1 1 2 2 1 4 .. 7 Heart Disease 4 4 4 12 14 13 10 12 49 Accidents 1 .. .. .. 1 2 4 1 5 12 Suicides .. .. .. 2 2 .. .. .. 1 1 Old Age 8 5 3 5 21 14 8 7 7 36 All other Causes 8 5 12 10 35 21 19 20 16 76 Totals 62 34 34 43 173 155 93 83 91 422 22 There were 166 deaths of persons over 70 years ot age, and 50 of persons over 80, 7 of whom reached 90 years of age—the oldest being 95. The actual number of deaths certified as due to old age amounted to 57, or 9.6 per cent. of the total deaths. This is a remarkably high proportion, which indicates that there is a relatively large number of old persons in the Borough, and that the conditions, atmospheric and otherwise, which obtained during last year, were somewhat unfavourable. SENILE MORTALITY DURING 1909. 65 to 70 70 to 80 80 to 90 90 and over. Total. 53 116 43 7 219 The respective ages of those over 90 were 90, 90, 91, 91, 91, 93, 95. 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 considerable decrease in the deaths from Scarlet Fever, Enteric Fever, Influenza, Diarrhoeal Diseases, Consumption, Cancer, Premature Birth, Heart Disease and Diseases of the Nervous System, and an increase in the deaths from Respiratory Diseases and Whooping Cough. 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 respect of the deaths from Phthisis, Diseases of the Respiratory 23 System, Infectious Diseases generally, Alcoholism, Heart Disease, Accidents and Premature Birth. The mortality from Influenza, on the other hand, was disproportionately high in the Northern Division. DEATHS IN PUBLIC INSTITUTIONS WITHIN THE BOROUGH, 1909. St. Anne's House, Manor Road. Nort.li umberland House, Green Lanes. Invalid Asylum, 187, High Street. Nursing Home, 8, Alexandra Road. Nursing Home, 21, Stamford Hill. Total. 18 7 1 12 8 4G I. Institutions within the District receiving sick and infirm persons from outside the District. St. Anne's House, Manor Road. Northumberland House, Green Lanes. Invalid Asylum, 18 7, High Street. Nursing Home, 8, Alexandra Road. Nursing Home, 21, Stamford Hill. II. Institutions outside the District receiving sick and infirm persons from the District. London Hospital. Hackney Infirmary. Islington Infirmary. Mildmay Cottage Hospital. German Hospital. Children's Hospital, Great Ormond Street. Great Northern Hospital. North Eastern Hospital for Children. St. Bartholomew's Hospital Metropolitan Hospital. Royal Free Hospital. Guy's Hospital. Brompton Hospital. St. Luke's House. Shoreditch Infirmary. British Home and Hospital for Incurables. Mt. Vernon, Hampstead. St. Thomas' Hospital. St. Mark's Hospital. National Hospital. King's College Hospital. III. Other Institutions, the deaths in which have been distributed among the two divisions of the District. N.E. Fever Hospital. Clay bury Asylum. Horton Asylum. Dartford Heath Asylum. Bethnal House Asylum. Darenth Asylum. Long Grove Asylum. Peckham House Asylum Tooting Bee Asylum. Cane Hill Asylum. Leavesden Asylum. Colney Hatch Asylum. There is no Union Workhouse within the District. 24 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 Erysipelas, Puerperal Fever and Influenza) are given. The Zymotic Death.rate for the Borough was 0.03 per 1,000 per annum, as against 1.03 in the preceding year. Year. Zymotic Death.rate. Kate 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 1.40 1904 1.24 2.14 1.94 1905 1.27 1.70 1.52 1906 1.09 1.94 1.73 1907 1.03 1.42 1.2G 1908 0.86 1.36 1.29 1909 0.63 1.3 1.12 By comparison with the preceding year there were fewer deaths from Scarlet Fever, Enteric Fever and Diarrhœal Diseases, but a somewhat greater number from Whooping Cough and Diphtheria The lower summer heat was indirectly responsible for the decrease in the Diarrhœal group of diseases. 25 TABLE A3. Deaths from Zymotic Diseases (including Influenza) in the Year, 1909. Scarlet Fever. Diphtheria. Small Pox. Enteric Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhœa and Dysentery. Influenza. Erysipelas. Total. First Quarter 1 • • • • • • • • 3 4 1 6 • • 16 Second ,, 1 • • • • • • • • 5 6 • • 2 • • 14 Third ,, • • 1 • • • • • • 1 3 1 • • 1 7 Fourth ,, • • 1 • • • • 1 • • • • 2 • • 1 6 2 2 • • 1 1 9 13 4 8 2 42 1908 2 1 • • 4 2 10 6 14 14 2 55 26 ZYMOTIC DIARRHŒA. In the Borough of Woolwich the Voluntary Notification of Summer Diarrhoea during the Summer quarter has been in force for the past four years. The Medical Officer of Health, Dr. Sidney Davies, reports that nearly 50 per cent. of all the cases have been notified, that 14 per cent. of the sufferers are attacked with fatal consequences, that breast.fed children show a marked protection against the disease as compared those artificially fed, and that the opportunity to get in contact with parents and offer advice, etc., was of value in many cases. This scheme of voluntary notification of the disease for the Summer quarter has also been adopted in the Town of Huddersfield. There was comparatively little prevalence of Summer Diarrhœa during 1909, the meteorological conditions generally being unfavourable to the development and spread of this disease. Although there can be little doubt that flies may act as carriers of infection in respect of this disease, the extent to which they operate as such is still sub judice. CANCER. The returns for the whole country for 1908 show still further increase as compared with past years in the mortality from malignant disease, the rate among males being equal to 813 per 1,000,000 living of that sex, or 4 per cent. more than in the previous year, whilst that of females remained practically stationary at 1,027 per 1,000,000. This tendency to exceptional increase in the mortality of males has been noteworthy in the records of the last five years. For the purpose of enabling the incidence of Cancer on the several populations of the London sanitary areas to be more precisely stated, factors have been calculated for correcting the death-rates, as far as possible, for the differences in the age and sex constitution of the several populations concerned. When these allowances are made it is found that in the year 1908, St. Pancras(1.17) had the highest rate, and that the lowest obtained in Fulham (0.79). 27 TABLE A4. Analysis of the Vital Statistics of the Metropolitan Boroughs and t>f the City of London, after Distribution of Deaths occurring in Public Institutions, for the Year 1909. Cities and Boroughs. Estimated Population in the middle of 1909. Annual Hate per 1,000 Living. Deaths of Children under one year of age to 1,000 Births. Births. Deaths. Principal Infectious Diseases. Notinable Diseases Attack-rate. LONDON 4,833,938 24.4 14.0 1.3 6.1 107 West Districts. Paddington 151,955 19.1 12.9 0.9 6.3 108 Kensington 183,683 17.4 13.3 1.0 4.3 119 Hammersmith 125,704 23.0 14.3 1.7 5.5 125 Fulham 176,406 23.9 12.0 1.5 5.8 111 Chelsea 75,249 17.5 14.4 1.0 6.1 114 City of Westminster 168,883 13.0 13.1 0.6 5.6 103 North Districts. St. Marylebone 126,027 32.1 14.6 0.8 5.8 64 Hampstead 94,185 13.0 8.9 0.5 3.8 77 St. Pancras 237,422 22.2 14.8 1.0 5.6 109 Islington 351,202 22.8 14.0 1.2 5.9 105 Stoke Newington 54,423 18.3 11.0 0.6 3.3 84.9 Hackney 237,601 23.6 12.6 0.9 5.9 98 Central Districts. Holborn 53,802 26.8 15.6 0.8 3.8 70 Finsbury 95,289 35.8 19.2 2.4 5.9 108 City of London 18,193 13.2 20.3 0.7 4.0 117 East Districts. Shoreditch 114,802 30.5 19.0 2.9 6.4 146 Bethnal Green 131,316 30.5 16.8 2.0 7.3 134 Stepney 312,525 31.5 15.3 1.7 7.1 115 Poplar 171,965 29.3 16.3 2.4 7.0 133 South District. Southwark 211,125 27.2 16.8 1.7 53 124 Bermondsey 127,569 31.8 18.8 2.7 6.6 140 Lambeth 324,188 26.1 14.1 1.2 5.7 97 Battersea 186,036 22.9 13.0 1.3 6.7 112 Wandsworth 297,646 23.4 11.9 1.0 5.6 87 Camberwell 283,022 23.2 13.4 1.1 6.0 102 Deptford 118,583 25.8 13..6 1.5 6.7 104 Greenwich 111,014 22.5 12.2 1.0 6.2 100 Lewisham 160,749 21.9 10.3 0.6 9.0 75 Woolwich 133,374 22.4 11.9 1.0 10.6 81 28 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 21.8 111.7 13.1 1.16 7.7 1903 52,600 20.9 120.3 12.3 1.23 3.7 1904 52,353 21.8 11.5.6 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 1907 53,395 19 5 97.9 11.2 1.03 7.5 1908 53,747 19.1 98.3 12.2 0.86 5.5 1909 54,101 18.3 84.9 11.0 0.63 3.3 THE MORTUARY. During the year 44 bodies were deposited in the Public Mortuary; 23 of these were females and 21 were males. Postmortem examinations were performed upon 22 of these cases, and inquests were held upon 28. 29 INQUESTS. The following inquests upon deaths of parishioners were held during the year 1909: — 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Cerebral Apoplexy 1 1 2 .. 4 Heart Disease 2 3 1 5 11 Pneumonia 2 .. • • .. 2 Erysipelas .. .. 1 .. 1 Old Age 2 .. 1 .. 3 Convulsions 1 .. 1 .. 2 Hæmorrhage 1 .. .. .. 1 Septic Poisoning 1 .. .. .. 1 Cancer .. 1 .. .. 1 Alcoholic Poisoning .. .. .. 1 1 Tuberculosis .. .. .. 1 1 Suicide (By Shooting) .. .. .. l 1 „ (Cut Throat) .. .. .. 3 3 Accidents (Shock of Fall) 2 2 1 2 7 „ (Poisoning) 1 .. .. .. 1 „ (Scalds) 1 .. 1 .. 2 „ (Suffocation iu Bed) 1 .. .. .. 1 „ (Broken Ribs) .. 1 .. .. 1 „ (Suffocation) .. 1 .. .. 1 „ (Fracture of Forearm) .. 1 .. .. 1 „ (Drowned) .. .. .. 1 1 „ (Shock of Operation) .. .. .. 1 1 „ (Shock—Burns) .. .. .. 2 2 15 10 8 17 50 INFECTIOUS DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table B that 224 Notification Certificates of Infectious Illness were received from medical practitioners, as against 312 during the preceding year. These figures include notifications received from the voluntary notification of Consumption, and they represent a very considerable reduction in the prevalence of communicable disease, as compared with the figures for 1908. 30 TABLE B. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1909. Cases notified in Whole District. Small Pox, Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Cerebro-Spinal Fever. Chicken Pox. Phthisis (Voluntary). Totals. At all Ages .. .. 28 1 28 108 .. 11 .. .. 4 .. .. 44 224 Under 1 .. .. .. .. 1 3 .. 1 .. .. .. .. .. .. 5 1 to 5 .. .. 11 .. 1 34 .. 3 .. .. .. .. .. .. 49 5 to 15 .. .. 10 1 1 49 .. 2 .. .. .. .. .. .. 64 15 to 25 .. .. 3 .. 3 12 .. 1 .. .. 1 .. .. 7 27 25 to 65 .. .. 3 .. 16 9 .. 4 .. .. 3 .. .. 35 70 65 and upwards .. .. 1 .. 6 1 .. .. .. .. .. .. .. 1 9 Total Cases notified in each Locality. Northern Division .. .. 8 .. 9 29 .. .. .. .. .. .. .. 4 50 Southern Division .. .. 20 1 19 79 .. 11 .. .. 4 .. .. 40 174 No. of Cases Removed to Hospital from each Locality. Northern Division .. .. 6 .. 1 17 .. .. .. .. .. .. .. .. 24 Southern Division .. .. 16 .. 2 64 .. 9 .. .. 1 .. .. 26 118 31 These 224 cases represent infection in 191 different houses. In every instance the disinfection was performed by the Sanitary Authority. A visit was paid to every house, and it was ascertained that cases of infectious illness occurred in 10 houses where there were "grave" sanitary defects, and in 19 where the sanitary defects were " slight." In arriving at these conclusions I have considered whether any sanitary defect was of a nature which is generally held by health officers to predispose to, or directly bring about, the particular disease in question. Thus, apart from the measures that have been taken to prevent the spread of infectious illness, the notification of such illness was the means during the year of bringing about a sanitary inspection of 191 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 1909. The Infectious Sickness Rate of the Borough, excluding the notifications from Consumption, was 3.3 to each 1,000 of the population, as against 5.5 for the preceding year. The rate in the Northern Division was 2.4 while that in the Southern Division was 3.8. Year. Infectious Sickness Rate. Rate for London generally. 1901 7.9 8.9 1902 7.7 9.9 1903 3.7 6.0 1904 0.6 6.1 1905 5.6 7.0 1906 5.0 7.5 1907 7.5 8.6 1908 5.5 7.4 1909 3.3 6.1 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 — — 1903 1 — 178 3 75 4 — — 1906 — — 137 1 45 4 — — 1907 — — 238 7 109 6 — — 1908 — — 195 5 60 1 — — 1909 — — 108 2 28 1 — — Erysipelas. Puerperal Fever Enteric Fever. Membranous Croup. Cerebro-Spinal Fever. Cases. Deaths. 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 — — — 1907 9 1 2 1 14 3 5 — 1 1 1908 24 2 4 2 10 4 — — 2 — 1909 28 2 4 1 11 1 1 i — — 33 TABLE B 2. Cases of Infectious Diseases notified during each month of the year 1909. Small-pox. Scarlet Fever. Diphtheria. Membranous Croup. Enteric Fever. Puerperal Fever. Continued Fever. Erysipelas. Cerebro-Spinal Fever. Phthisis. Totals. January .. 18 3 .. 4 .. .. 3 .. 8 36 February .. 10 1 .. 2 .. .. 1 .. .. 14 March .. 22 2 .. 2 2 .. 2 .. 3 33 April .. 5 .. .. .. .. .. .. .. 4 9 May .. 15 4 .. 2 .. .. 5 .. 1 27 June .. 4 3 1 .. .. .. 1 .. 2 11 July .. 4 4 .. .. .. .. 1 .. 9 18 August .. 8 1 .. .. 1 .. 2 .. 2 14 September .. 4 4 .. .. .. .. 2 .. 5 15 October .. 4 5 .. .. 1 .. 5 .. 3 18 November .. 8 1 .. .. .. .. 2 .. 6 17 December .. 6 .. .. 1 .. .. 4 .. 1 12 Totals .. 108 23 1 11 4 .. 28 .. 44 224 The Infectious Sickness Rate for London generally was 61. Of the 29 Sanitary Areas situated within the Metropolis, the lowest rates were those of Stoke Newington(3.3), Hampstead (3.8), c 34 City of London (4.0), and Kensington (4.3); and the highest rates were those of Woolwich (10.6), Lewisham (9.0), Bethnal Green (7.3), Stepney (7.1), and Poplar (7.0). 142 of the cases notified were removed from their homes to Isolation Hospitals. SCARLET FEVER. The 108 cases of Scarlet Fever occurred in 85 houses, in 3 of which there were grave insanitary conditions; in 10 the insanitary conditions were slight, and in the remaining houses there was an absence of such conditions. Year. Death-Rate 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 0.12 1904 0.06 0.08 0.11 1905 0.06 0.12 0.11 1906 0.02 0.11 0.10 1907 0.13 0.14 0.09 1908 0.09 0.11 0.08 1909 0.04 0.08 .. 35 some three to four per cent. of Scarlet Fever convalescents upon their return home from hospital are capable of conveying infection to others. The infection was imported into the Borough in at least two instances. With this disease it is interesting to note that when the figures for the period 1891-1900 are compared with those of 1908 it is seen that the death-rate in the latter period has declined 40 per cent., and the fatality rate by 35 per cent., while the attack-rate has only declined 6 per cent. Anyone who approaches the subject in an impartial spirit cannot but be impressed by the fact that fever hospitals are not such useful agents in controlling the infection of Scarlet Fever as they were once believed to be. It is certain that with respect to this disease the isolation hospital must always exercise a useful part in the administrative machinery of public health; but it is equally certain that where the isolation of Scarlet Fever cases is made to prejudice the isolation of Diphtheria and Enteric Fever a false step in the direction of preventive medicine is taken, for Scarlet Fever has for many years furnished a death rate of only about 0'1 as compared with rates of over 0.3 from Measles and Whooping Cough. Indeed, Scarlet Fever is, for the most part, of such a very mild type that there is a good case for exercising greater selection with reference to the patients admitted, and confining the admissions from this disease to those suffering from severe attacks and those who cannot be nursed at home without danger to others. If this selection were exercised in the Metropolis of London, the community would be saved a very considerable expenditure of money for which there is very little return. It is moreover to be hoped that, as the experiment of treating cases of infectious disease in the open air promises to produce such satisfactory results, the cost of construction of fever hospitals will be somewhat reduced in the future. In at least 18 cases the infection appeared to be secondary to the infection in another member of the household and in several cases the infection was introduced into one home by visits from occupants of other infected homes. c 2 36 ERYSIPELAS. The 28 cases of this disease represent infection in 27 different premises. In 2 of these, insanitary conditions of a slight nature existed, and in no case were the sanitary defects grave. In 2 cases there was a previous local injury, and) in 5 a history of previous attacks. ENTERIC OR TYPHOID FEVER. The 11 cases notified during the year all occurred in nine different houses. In three of these houses grave insanitary conditions existed, and in one slight insanitary conditions existed; while in the remaining five there were no insanitary conditions. One 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 several 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. The indirect infection through contaminated mussels appears on good grounds to have been responsible for the disease in one instance. In three cases, the original infection was responsible for the disease, in a second individual in the same dwelling. 'A notable feature in the behaviour of Enteric Fever in London in recent years, has been the manifestation of localised prevalence occurring in poor populations and lasting often for a considerable number of weeks. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Walts 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 1900 0.00 0.05 0.09 1906 0.00 0.05 0.09 1907 0.06 0.04 0.07 1908 0.08 0.05 0.07 1909 0.02 0.03 DIPHTHERIA. The 29 cases of Diphtheria occurred in 27 houses, 22 of which were more or less insanitary. The sanitary defects were grave in 4 and slight in 6 other instances. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate 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 1604 0.19 0.16 0.17 1905 0.09 0.12 0.16 1900 0.08 0.14 0.17 1907 0.11 0.16 0.16 1908 0.02 0.15 0.16 1909 0.02 0.13 School attendance is either alleged by the parents or surmised by myself, on good grounds, to be the cause of at least 2 attacks during the year. At least 3 appear to have caught the infection from previous cases in the same household. In 4 cases it was very clear that a preceding tonsilitis predisposed to an attack of Diphtheria. In 4 cases there was a history of previous throat trouble, frequently recurring. Many 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) axe largely due to the unfortunate circumstance that the early diagnosis of the disease from clinical symptoms is frequently difficult or impossible, and bacteriology alone can solve the difficulty in many cases. The diagnosis outfits provided by the Council 38 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 1909, together with the results of the examinations performed at the Lister Institute of Preventive Medicine, London:– Disease. Results. Total. Positive. Negative. Phthisis 17 34 51 Diphtheria 8 48 56 Enteric 7 8 15 Total 32 90 122 The statistics of the Metropolitan Asylums Board, with reference to the cases of Diphtheria admitted to their Hospitals, demonstrate that, prior to the introduction of the serum or antitoxim treatment, the average Diphtheria mortality in the Board's Hospitals was 30.4 per cent., whereas for the most recent four years, in respect of which statistics are available, the mortality averaged about 10 per cent. The tables furnished in the Annual Reports of the Board furnish clear and emphatic testimony to the importance of the early administration of the serum: During the year 1908, of 202 cases treated on the first day of the disease only 3 per cent. died; whereas of 1,076 cases treated on the second day more than double that number died, and of 1,182 cases treated on the third day more than three times. Of 832 cases treated on the fourth day the increase in the deaths amounted to over four times the figure of those who were treated on the first day, and of 1,249 treated on the fifth day the increase was five-fold. Taking therefore the 30 per cent. case mortality before the introduction 39 of antitoxin, it may be pointed out that if this rate of mortality had obtained in respect of the 29 Stoke Newington cases reported last year the deaths would have numbered eight instead of one; and the death-rate would have been 0.15 in the place of 0.02. 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 0.2l 0.37 0.32 1906 0.19 0.40 0.27 1907 0.13 0.38 0.36 1908 0.19 0.32 0.23 1909 0.17 0.48 Whooping Cough. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.04 0.35 0.3l 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 1907 0.36 0.37 0.29 1908 0.13 0.20 0.28 1909 0.24 0.26 ZYMOTIC DIARRHŒA. 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 1907 0.24 0.32 0.30 1908 0.35 0.54 0.51 1909 0.11 0.33 40 Among the features in our National Mortality Statistics which continue to indicate a preventable waste of life, the mortality from Measles is a striking one. The exceptional prevalence of this disease during the first half of last year was promoted very considerably by unfavourable meteorological conditions, and those conditions are beyond our control; but this is not true of much of the mortality among cases of this disease; this is due to insufficient nursing and care during convalescence and one finds it almost confined to the poorer people. It is seldom that the disease itself kills a child; it is the subsequent bronchitis and pneumonia which do so, and these complaints are so largely the result of a failure to adequately clothe and protect the child from undue exposure during convalescence. PUERPERAL FEVER. Under Puerperal Fever are included the deaths from Pyremia and Septicaemia occuring in the lying.in women. The origin of each of the 4 cases was very obscure, and it was quite impossible to suggest the source of infection when I personally investigated them. It is satisfactory to note that the mortality among puerperal women, both from puerperal sepsis and from accidents of childbirth, is still /continuing to decrease. In the year 1908 the mortality from all causes whatever connected with the puerperal state was equal to a rate of 4.81 per 1,000 births. PHTHISIS (CONSUMPTION). The 44 cases voluntarily notified during 1908 occurred in 4:5 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 1.44 1907 0.88 1.14 1908 1.04 1.11 1909 0.80 1.31 41 Under the Public Health (Tuberculosis) Regulations of 1908 it is required that any person) who is diagnosed as suffering from pulmonary tuberculosis and who is now in receipt of, or compelled for various reasons to seek, any form of Poor-law medical relief, has to be notified to the medical officer of health of the district within 48 hours. The notifications have to be made by medical officers of poor-law institutions, district medical officers, superintending officers of poor-law institutions, and, as to changes of address, by relieving officers. Nothing in the regulations authorises the medical officer of health, directly or indirectly, to put in force, with respect to any poor person in relation to whom a notification has been received, any enactment which renders the poor person, or a person in charge of the poor person, liable to a penalty or subjects him "to any restriction, prohibition, or disability affecting himself or his employment, occupation, means of livelihood, or residence, on the ground of his suffering from pulmonary tuberculosis." Another section of the article which contains this provision confers upon a local authority (subject, of course, to the foregoing proviso) power to take all such measures or to do all such things as are authorised in any case of infectious disease, by any enactment relating to the public health having reference to the destruction and disinfection of infected articles or the cleansing or disinfecting of premises. Certain other powers, as affording assistance (in the form of appliance, apparatus or utensil), to persons suffering from this disease, are also conferred. Judging from the deaths from Consumption, which numbered 44, there must have been some 200 sufferers from the disease in the Borough during the year, and of those only 19 were notified under the voluntary system. Of 28 cases in respect of whom it was possible to obtain full particulars, in only 6 cases (21 per cent.) was there a history of consumption in the parents or grandparents of the patients, whereas in 9 cases (32 per cent.) other brothers and sisters had suffered from the 42 disease. In many cases, want of proper and sufficient food and exposure to wet and cold predisposed to the infection. Although in England and Wales generally the loss of life stated to be caused by tuberculosis is now less than half of what it was some 50 years ago, it still accounts for one in ten of the total deaths registered. Consumption, which causes seven.tenths of tuberculous mortality, selects its victims of both, sexes, whilst in the prime of life, and therefore at precisely that stage when their economic value as mothers or fathers or as breadwinners is highest. From the Registrar. General's Report it appears that in the five years ended 1907 the urban consumption rate at all ages was higher than the rural rate by 25 per cent. among males, but was lower by 1 per cent. among females. The several counties of England and Wales suffering excessively in this respect are tabulated in order in the Registrar-General's: Annual Report for 1908, and from this it will be seen that of the 15 counties known to possess rates of mortality above the average for England and Wales as a whole, not fewer than seven are Welsh. The rates vary remarkably; for whilst in the county of Suffolk the average phthisis-rate in the last five years has not exceeded 1,177 per 1,000,000 living, it was nearly double that amount, or 2,270 per 1,000,000 in the county of Cardigan. The compulsory notification of Consumption has been adopted for a limited period' in the City of Glasgow and it will be useful to compare the experience of this City with that of Sheffield and Bolton. While the voluntary notification of the disease has proved a failure, generally speaking, it has enabled a limited amount of good to be performed by the Sanitary Authority; and it has impressed upon all those who have thus been brought in contact with many cases of this disease among the poorer people, two outstanding matters demanding remedial efforts. In the first place the large proportion of those who come under administrative control are suffering from the disease 43 in too advanced a stage, and our administrative machinery should be so devised that persons may be encouraged to seek medical advice and other help at the earliest possible moment when they are affected or threatened with the disease. There should be little difficulty in getting earlier information, especially if the directions of the Memorandum of the Local Government Board are followed, viz.: "The investigators may not pursue enquiries in a manner or give information that may prevent a consumptive patient from continuing to earn his livelihood." The second matter is the necessity for increased provision for sanatorium treatment of he disease when earlier and more suitable cases can be drafted into such sanatoria for the poorer people, far better results will be obtained from these institutions. With really early and suitable cases the chances of restoration to work for many years become very good. The patients themselves will be able to do a little work in these institutions as a partial set off" to the expense of their maintenance and they will be better able, by a short residence, to learn some suitable work which they can safely undertake on their discharge. With the exception of six Boroughs, namely, Paddington in the West, Stepney, Shoreditch and Bethnal Green in the East, and Deptford and Cambenwell in the South, the voluntary notification of Phthisis is now in force in all the Metropolitan Boroughs. As I have so frequently pointed out in previous reports, the clamant need for the isolation of advanced cases of this disease amongst poor people was demonstrated in many cases which, were notified in Stoke Newington during last year. Although the Workhouse Infirmary plays an important part in providing isolation of this sort, it of course only partially meets the needs. At the present time, in the great majority of cases, we find it impossible to get advanced sufferers from surroundings which are bad for themselves and highly dangerous to their families. There are no Sanatoria available for these people and a proportion of them prefer to die in their squalid surroundings than enter a Poor Law Institution, Phthisis mortality occurs especially 44 among the poor, and measures for its reduction must also include those which afford assistance, not only to the sufferer, but often to the families which are dependent upon him. The notifications under the Public Health Tuberculosis Regulations of 1908 represent the thin end of the wedge of the general compulsory notification of this disease. During the year I received 25 certificates of Consumption amongst paupers under these Regulations. A serious! omission in these certificates is the failure to record the date of the patient's admission to Poor Law Institutions. The Royal Commission which was appointed in 1901 to inquire into the relations of human and animal tuberculosis has issued its Third Interim Report, dated January, 1909. The same Commissioners were responsible for the Second Interim Report which appeared in 1907 and which expressed the conviction that human beings, and especially children, can be infected with bovine tuberculosis, and that in the majority of such cases the infection takes place through the medium of cow's milk. Tuberculosis involving the udder is comparatively common in cows, and in such cases their milk always contains tubercle bacilli, and is therefore dangerous for human beings consuming it. It was, however, undecided as to what is the danger attaching to milk of tuberculous cows in which the udder presents no evidence of disease, and the Royal Commission addressed itself to this subject. None of the cows investigated showed any sign of disease of the udder during life, and in all, after slaughtering, the udder was carefully examined for tuberculous lesions and tubercle bacilli. No tuberculosis was found except in one case (Cow F) in which one quarter of the udder showed four small nodules. These could not possibly have been detected during life. 45 The Commissioners report: "We found that the milk of the cows obviously suffering from tuberculosis (see Appendix; Cows B, C, and F) contained tubercle bacilli whether the milk was obtained in the ordinary way or was withdrawn from the teat by means of a sterilised catheter. The presence of tubercle bacilli in the milk of cows clinically recognisable as tuberculous, confirms the opinion we expressed in our Second Interim: Report that the milk of such cows must be considered dangerous for human beings. "The experiments which we have carried out with regard to the infectivity of the faeces of tuberculous cows were suggested by the knowledge of the fact that dirt of various kinds, from cows and the cow-shed, is almost constantly present in milk as it reaches the consumer. Cows suffering from extensive tuberculosis of the lungs must discharge considerable numbers of bacilli from the air passages in the act of coughing, and some of the bacilli thus expelled may find their way into the milk. But our experiments indicate that the excrement of cows obviously suffering from tuberculosis of the lungs or alimentary canal must be regarded as much more dangerous than the matter discharged from the mouth or nostrils. We have found that, even in the case of cows with slight tuberculous lesions, tubercle bacilli in small numbers are discharged in the faeces; while as regards cows clinically tuberculous, our experiments show that the faeces contain large numbers of living and virulent tubercle bacilli. Investigations into the milk supply of our large towns are demonstrating that a considerable percentage of the milk samples examined contain the germ of consumption. It is not a comfortable reflection that these germs are so commonly being introduced into the digestive tract of children and adults. In a Report to the London County Council in November of last year, it was pointed out that during the six months ending March, 1909, 204 samples of milk were taken under Part IV. of the London 46 County Council (General Powers) Act, 1907, in order to examine these for the germ of tuberculosis. Twenty-three per cent. of the samples examined proved to be so infected; and as the result of a veterinary examination of some of the cows", furnishing this milk, nine were reported by the Council's Veterinary Inspector to have tuberculous udders. More recently the Public Health Committee again reported to the London County Council upon a further 810 samples of milk taken between October, 1909, and January, 1910. Six hundred and seventy-six of these samples had been examined up to the date of the Report, 73 being found to be tuberculous. Altogether, since the Act came into operation the examination of 1,930 samples shows a percentage of 9.6 to contain the germs of consumption, and of the cows examined by the Council's Veterinary Inspector 1.7 per cent. were found to be suffering from tuberculosis of the udder. It is not easy to exaggerate the gravity of the state of affairs disclosed by this research. That nearly 10 per cent. of the milk samples taken at random within the Metropolis should contain the germ of tuberculosis is a very serious reflection upon our existing measures for protecting the public against communicable dilease. It is to be hoped that in the near future the Government will turn its attention to the crying need for dealing with this danger. CEREBRO-SPINAL FEVER. The London County Council, in accordance with the provisions of Section 56 of the Public Health (London) Act of 1891, issued an Older requiring that Cerebro-Spinal Fever should be continued as a compulsorily notifiable disease in London for a further period of 12 months from the 13th, March, 1909. The Council further considered whether the term Cerebro-Spinal Fever includes, for the purpose of notification, cases of Posterior Basal Meningitis; and, on the advice of a Committee appointed by the President of the Royal College of Physicians, it has decided that for notification purposes, the disease known as Posterior Basal Meningitis is included in the term Cerebro. 41 Spinal Fever. That term, however, is not to be interpreted to include cases of Meningitis due to Tuberculosis, Syphilis, Middle. Ear disease, or injury. The London County Council also issued an Order, under Section 55 of the Public Health London Act of 1891, requiring the notification in the Administrative County of London of the diseases known as Glanders, Anthrax and Hydrophobia in Man; these diseases to become compulsorily notifiable from April 26th, 1909. VACCINATION. The London Vaccination returns give food for thought and apprehension; as legislation has made it more and more easy to obtain exemption from vaccination, the) unvaccinated children (including cases postponed) may be expected to1 increase. The latest returns recorded for the whole country are those for the year 1906, when the percentage of unvaccinated children was 21.2, as against 26.4 in 1896; 7.8 in 1886, and 6.5 in 1876. There can be little doubt that the percentage of exemptions for the past three years will, when these are available, demonstrate a. considerable increase. THE DISINFECTING AND CLEANSING STATION. This station was available for working purposes early in January of last year; the total cost of the installation having amounted to about £841. During the year ending December 31st, 1909, the following disinfecting and cleansing work was performed at the station:— Total number of textile articles disinfected 6,430 Total number of books from) Public Library disintected 119 Total number of verminous persons cleansed 145 Of the verminous persons cleansed, 140 were children, mostly of school ages; the 5 adults comprising 3 males and 2 females. 48 The provision, within, the Borough, of this station has justified all the predictions as to its value. The important disinfecting work is now being done far more expeditiously and more satisfactorily than it has ever been performed before; and the important duties; of cleansing verminous persons are being fully discharged, whereas, under the old arrangement is was impossible to induce 50 per cent of such persons to go to the distant Hackney Station. The following legal provisions define the powers and duties of the local Sanitary Authorities in London, with respect to verminous persons and premises. The Cleansing of Persons Act 1897, empowers local authorities to expend any reasonable sum on buildings, appliances and attendants, and empowered them to permit any persons infested with vermin to have the use (free of charge) of such, for the purpose of cleansing their persons and clothing of vermin. The London County Council (General Powers) Act, 1904, section 19, empowers the sanitary authorities, upon the certificate of the Medical Officer of Health that any articles are filthy, dangerous or unwholesome, to cleanse, purify or destroy such articles; section 20 similarly empowers the sanitary authorities to require owners of houses to strip, cleanse, etc., rooms or parts of houses, upon the certificate of the Medical Officer of Health that any house or part is infested with vermin; section 21 applies section 59 of the Public Health (London) Act, 1891, compelling sanitary authorities to provide means for cleansing, purifying and destroying filthy, dangerous or unwholesome articles and for the removal thereof, and for the cleansing of houses infested with vermin. For the purposes of the two preceding sections of the Act, section 24 gives the sanitary authorities power of entry for the purpose of carrying out the afore.mentioned sections and in the interpretation, it is to be observed, that the expression "house" includes "schools." The London County Council (General Powers) Act, 1907, by section 36, empowers the Medical Officer of the London County 49 Council to examine the person and clothing of any child attending a school, and if the child be found to be verminous to require that the parent or other person should properly cleanse such child and the clothing within 24 hours; if the person fail, he may then remove the child from any school and cause the person and clothing of such child to be properly cleansed; by section 37, similar provision is made enabling the Medical Officer of the London County Council to enforce the cleansing of the person and clothing of the inmates; of common' lodging-houses; section 38 enables: the London County Council and any sanitary authorities to make and carry into effect agreements and arrangements for the purpose of cleansing the persons and clothing in the afore-mentioned cases, and section 40 empowers the London County Council to make regulations with respect to the mode of carrying into effect the provisions of the above sections. The Children Act, 1908, by section 122, sub-sections (1) and (2), reproduces the powers of section 36, sub-sections (1) and (2) of the London County Council (General Powers) Act, 1907, with regard to the examination of children attending school, the giving notice and requisitions to cleanse the person and clothing of any child infected with vermin or in a foul or filthy condition, and for the removal and forceable detention and cleansing of such child. And in addition to this, sub-sections (3) and (4) of section 122 of the Children Act, 1908, provide:— "(3) Where any sanitary authority within the district of a local education authority have provided, or are entitled to the use of any premises or appliances for cleansing the person or clothing of persons infested with vermin, the sanitary authority shall, if so required by the local education authority, allow the local education authority to use such premises and appliances for the purpose of this section, upon such payment (if any) as may be agreed between them, or, in default of an agreement, settled by the Local Government Board." D 50 " (4) Where after the person or clothing of a child has been cleansed by the local education authority under this section, the parent or guardian of, or other person liable to maintain the child, allows him to get into such a condition that it is again necessary to proceed under this section, the parent, guardian, or other person, shall, on summary conviction, be liable to a fine not exceeding 10s." In addition to the disinfection of rooms on account of the compulsorily notifiable diseases, 41 rooms were fumigated on account of vermin, 26 on account of consumption, and 10 on account of cancer. The Shelter has been maintained during the year, but has only been used on two occasions;. The Borough Council, however, is under a statutory obligation to maintain this provision, and in the event of an epidemic of certain diseases, it will prove a most useful means of checking the spread. 51 Meteorological Observations taken during the Year 1909, a/ Camden Square (by H. S. Wal/is, 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 Temperature of Air. Rainfall. Relative Humidity. Saturation. 100. Highest Lowest Mean. Of all Highest Of all Lowest January o 51 o 25 o 42.6 o 34.0 o 38.3 ins. 0.71 % 90 February 56 21 43.6 30.3 37.0 0.50 87 March 61 19 45.3 34.2 39.8 2.85 86 April 71 29 60.4 39.9 50.2 1.90 75 May 84 34 65.9 42.8 54.4 1.80 71 June 75 39 63.9 48 5 56.2 3.79 81 July 78 44 70.4 53.1 61.8 3.49 77 August 86 45 73.3 53.4 63.4 1.46 81 September 70 40 63.6 48.6 56.1 2.56 88 October 67 29 59.1 47.8 53.5 4.16 88 November 55 29 47.1 36.3 41.7 0.75 91 December 54 23 45.5 35.1 40.3 2.79 90 D 2 52 NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR 1909. It will be seen from the accompanying Report of the Chief Sanitary Inspector that a large amount of sanitary work has been performed during the year; 3,988 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; 700 Intimation Notices, followed in cases by Statutory Notices, were complied with. Of 3,988 premises inspected, only 177 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. In the case of 48 of the complaints received, no nuisance existed at the time of inspection. It is found that in Stoke Newington whenever an intimation notice is served as the result of house-to-house inspection, the Inspector has to pay on an average between four and five visits in order to see that the work required is properly carried out. The slaughter-houses, bale-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. There is a small amount of unwholesome food seized in Stoke Newington, including, of course, tinned articles; but the quantity is very small, even when regard is, had to the size of the Borough. On the other hand, a not inconsiderable amount of unwholesome food 53 has been surrendered for destruction during the year. It is to be hoped that in the near future all obviously unsound food will be thus surrendered. The City Corporation has provided, in their Islington Market, a new slaughter-house for the use of butchers; and Dr. Collingridge, the Medical Officer of Health for the City, recommends that opportunity should be taken for the marking of meat which has been therein inspected. It is much to be desired that this opportunity should be given and that butchers should avail tnemselves of it. At the present time the purchaser of meat in London has no means of knowing whether it has been subjected to inspection, and the need for this inspection is amply testified to by the records of the amount of diseased and unwholesome meat seized or surrendered within the Metropolis. Adequate inspection can never be provided in the existing private slaughter-houses, and this is the great argument in favour of the provision of municipal abattoirs. A Committee of the Metropolitan Branch of the Society of Medical Officer of Health reported during the year upon the conditions which would justify a local authority in refusing to register premises for the sale or storage1 of milk, or in removing such premises from the register. Generally, the Committee were of opinion that no premises should be registered for the sale or storage of milk unless the following structural conditions are complied with:— The lighting and ventilation should be sufficient. No room which is capable of use as a sleeping room should communicate directly with the room or shop in which the milk is sold or stored. The premises should be so constructed that every part of the interior is capable of being maintained in a satisfactory state of cleanliness. 54 There should be no inlet to any drain in the room in which the milk is sold or stored. Efficient means of cleansing the milk vessels, either by steam or hot water, should be available. A plentiful supply of water should be provided, and where a storage-cistern is necessary such cistern should be properly covered and ventilated, and so placed as to be readily accessible. No premises should be registered where it is possible that milk may be stored in close proximity to any article capable of contaminating such milk—as for instance, paraffin, fish, coal, vegetables, etc. No premises should be registered if there is a manure pit or other offensive accumulation in close proximity. Efficient means for the storage and removal of house or other refuse should be provided. Such action would result in a decrease in the number of chandler's or general shops registered for the sale of milk; and in the interest of the public such a decrease is desirable, unless provision can be made for the storage of the milk in a suitable place, other than the shop itself, where there would be no risk of contamination. STABLES. The question of nuisance From flies in connection with deposits of house refuse and stable manure has again been investigated by the L.C.C. on lines similar to those followed in 1907. One of the centres around which serious nuisance was experienced in 1907 (a dust depot) was not used after June, 1908, and in correspondence with this it was found (judging by the results obtained at 15 places of observation surrounding this centre) that there had been at least 6,000,000 fewer flies in 1908 than in 1907 in houses within a radius 55 of 200 yards from the depot. In 1907, as in 1908, the large part played by collections of horse manure in determining fly prevalence was abundantly apparent, and the need for regulating the sanitary condition of stables was thus again emphasised. 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 1909, 273 premises were on the Register, and during the year most registered premises were duly inspected. During the year Miss Aldridge undertook an investigation of the means of storing food in registered houses let in lodgings, with the following result. 354 houses were inspected:— In 4.0 per cent. the rooms were let furnished and no food was kept in them. In 0.9 per cent. there was proper larder accommodation. In 12.7 per cent. the food was stored in a safe in a landing or passage. In 41.6 per cent. the food was stored in an unventilated kitchen cupboard. In l.5 per cent. the food was kept unprotected on a shelf in kitchen. In 35.7 per cent. the food was stored in bedroom cupboard. In 2 5 per cent. the food was kept unprotected on table or shelf in bedroom. In 1.1 per cent. the food was stored in a bedroom chest of drawers. 56 factories and workshops. At the end of the year 1909 there were on the Register 225factories, workshops and work-places. TABLES REQUIRED BY THE HOME OFFICE. FACTORIES, WORKSHOPS, LAUNDRIES, WORK-PLACES AND HOME WORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors ok Inspectors of Nuisances. Premises. N umber of Inspections. Written Notices. Prosecutions. 1 2 3 4 Factories (including Factory Laundries) 33 - - Workshops (including Workshop Laundries) 176 59 - Workplaces (Other than Outworkers' premises included in Part 3 of this Report). 16 - - Total 225 59 Nil *Including these specified in sections 2, 3, 7 and 8, of the Factory and Workshops Act as remediable under the Public Health Acts. 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. inspector. 1 2 3 4 5 Nuisances under the Public Health Acts :— Want of Cleanliness 24 24 - - Want of Ventilation - - - - Overcrowding 1 1 - - Want of drainage of floors - - - - Other nuisances 36 36 - - †Sanitary accommodation insufficient 1 1 - - unsuitable or defective 30 30 - - 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) - - - - Other offences - - - - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 92 92 Nil Nil 57 3.—HOME WORK. NATURE OF WORK. OUTWORKERS LISTS, SECTION 107. Inspections of ' Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Addresses of Outworkers Prosecutions. Instances. Notices served. Prosecutions. Instances. Order made (8 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of Lists. Failing to send lists. List.† Outworkers.† Lists. Outworkers.† Contractors Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (ID (1&) (16) (17) (18) Wearing Apparel— (1) making, &c 25 251 5 22 663 155 (2) cleaning and washing Lace, lace curtains and nets Artificial Flowers Nets, other than Wire Nets Tents Sacks Furniture and Upholstery 1 4 Fur pulling Feather sorting Umbrellas, &c Carding, &c., of Buttons, &c. .. Paper Bags and Boxes Basket making Brush making Racquet and Tennis Balls Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Pea Picking Total 26 255 5 22 661 155 58 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2.) Bakehouses 27 Miscellaneous 165 Total number of workshops on Register 192 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) 13 Notified by H.M. Inspector 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) Reports (of action taken) sent to H.M. Inspector 2 Other - 25 Underground Bakehouses (s. 101) :— Certificates granted during the year . - 1 In use at the end of the year - 19 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 no case of overcrowding to be dealt with, but there were 24 instances in which it was necessary to require cleansing. There was one occasion to require an increase in the water-closet accommodation, and 30 in which the accommodation was unsuitable or defective. In 13 cases the Abstract of the Factory Act was not affixed in the workrooms, and the Home Office was notified accordingly. There ire altogether 663 domestic workrooms in the borough, in which wearing material of various kinds are being dealt with. A complete list of all out-workers has been kept in the office; the information has often been obtained on calling at the workshops, 59 for some employers still fail to realise their duty to send in a list of out-workers twice a year, viz., in February and August, as the Act directs. Most of the premises occupied by out-workers were inspected during the year. The kitchens of the restaurants and public dning-rooms in the Borough have been thoroughly inspected throughout the year, with satisfactory results. HOME-WORKERS DWELLINGS. These have all been inspected and are on the whole in a very satisfactory condition There are, however, some cases where the work is done in rooms used for both living and sleeping, and these need constant inspection. Dr. Parkes, the Medical Officer of Health for the Borough of Chelsea, has urged that the use of underground rooms as workshops should be prohibited unless they comply with. Regulations to be made by the Secretary of State ; and he points out that if such regulations were in force architects in designing new buildings would cause the underground workrooms to comply with the Regulations, so that the shops and basements might be let at the full rental value. the public health legislation of 1909. the housing and town planning act, 1909. The object of this Act, as stated in its title is "To amend the law relating to the housing of the working classes; to provide for the making of Town Planning schemes; to make further provision with respect to the appointment and duties of County Medical Officers of Health and to provide for the establishment of Public Health and Housing Committees of County Councils." 60 It is divided into four parts. Part I. deals with the Housing of the Working Classes. Parts II. and III., which relate to Town Planning and to County Medical Officers of Health, etc., do not directly concern Metropolitan Borough Councils. The fourth part deals with the provisions as to Commons and Open Spaces and the land in the neighbourhood of Royal Palaces or Parks. The Act, which does not extend to Ireland, came into force in December, 1909. Part I.—Housing of the Working Classes. In the whole country the facilities for the acquisition of land for the purposes of the Housing Acts have been increased. Loans may now be made by the Public Works Loan Commissioners for periods up to 80 years, at a minimum rate of interest. Part III. of the principal Act (the Housing of the Working Classes Act of 1890)—which deals with the provision of houses for the working classes and which is adoptive—is now put into force throughout the whole country. Powers for the compulsory purchase of land for the housing of the working classes may be conferred by Order of the Local Government Board, without confirmation by Parliament; if objection is raised the Board must hold a public enquiry. Land which is the site of an ancient monument or other object of archaelogical interest; as also land which is the property of any local authority or Corporation or Company, for the purposes of a Railway, Dock, Canal or other public undertaking; or which forms part of any park or pleasure ground, or is otherwise required for the amenity of any dwelling house; or is within a prescribed distance of any of the Royal Palaces or Parks; is exempt from compulsory acquisition. A Council may acquire land by agreement, with consent of the Local Government Board; and it may lay out and construct public roads on such land. The Local Government Board has power to call for a report upon any crowded area and may call for joint action by local authorities. No Order of the L.G.B. under Part I. 61 or Part II. of the 1890 Act needs confirmation, in future, by Parliament. Where a complaint is made to the Board— (a) as respects any rural district, by the council of the county in which the district is situate, or by the parish council or parish meeting of any parish comprised in the district, or by any' four inhabitant householders of the district; or (b) as respects any county district, not being a rural district, by the council of the county in which the district is situated, or by four inhabitant householders of the district; or (c) as respects the area of any other local authority, by four inhabitant householders of the area; that the local authorities have failed to exercise their powers under Part II. or Part III. of the principal Act, in cases where those powers ought to have been exercised, the Board may cause a public local enquiry to beheld; and if, after holding such an enquiry, the Board are satisfied that there has been such a failure on the part of the local authority, the Board may declare the) authority to be in, default, and may make an order within a time limited by the order to carry out such works and do such other things as may be mentioned in the order for the purpose of remedying the default. The powers of a, Court of Summary Jurisdiction have now ceased with reference to the closure and demolition of dwellings unfit for human habitation; and the difficulties which have existed in some districts will no longer be present, for the sanitary authority can itself issue a Closing Order. An appeal against such an Order must be made within 14 days, and not to a Court, but to the L.G.B. Houses of a rental double that hitherto fixed (up to £40 in London) are in future to be held as let under the implied condition that they are in a state reasonably fit for habitation, not only at the time of first occupation, but during the whole time they are occupied ; but houses let for three or more years on repairing terms are excluded. The local 62 authority may inspect and, after 24 hours service of a notice in writing to occupier, may specify the necessary works to be carried out within a period of 21 days, and in case of default the authority may do the work and recover costs; here again the appeal is to the L.G.B., and these new functions of the Board should lead to an increase in administrative uniformity and efficiency. In the case of houses intended for the working classes the bye-laws at present in force with respect to houses or parts of houses let in lodgings or occupied by members of more than one family, may be extended to impose any duty which involves the execution of work upon the owner of the property. Where an owner on other person, is in default, the council may, after 21 days' notice in writing, themselves execute the work and recover the costs. The time within which, when a closing order has become operative, an occupying tenant with his family can be required to cease to inhabit the house in respect of which an order has been made, is increased by seetion 17 (4a) from 7 to 14 days after service of notice; and the tenant who makes default, instead of being subjected to a fine, as heretofore, will be liable to, have a summary order to quit made against him. The local authority may make a reasonable allowance to any tenant on account of his expenses in removing; the amount of the allowance will be primarily determinable by the local authority with the owner's consent, though in default of such consent it will be fixed by a Court of Summary Jurisdiction; but an allowance for expenses of removal is not to be given if the house has been made unfit for habitation by the wilful act or default of the tenant, or of some one for whom, as between himself and the owner or landlord, he is responsible (Sub-section 5). The local authority must, under Sub-section (6), determine a closing order made by them if they are satisfied that the dwelling-house has been rendered fit for human habitation; and the owner is given a right of appeal to the Board against a refusal on the part of the authority so to do. A Court of Summary Jurisdiction will no longer have power to enlarge the time for the execution of any works under a closing order (Section 21). 63 Special provisions are made (by Sub-section (7) of Section 17) in regard to underground rooms habitually used as sleeping places ; these, unless they conform to certain conditions, are to be regarded as dwelling-houses unfit for human habitation, and as such liable to have closing orders made in regard to them. These provisions do not, however, come into operation until 1st July, 1910; and a closing order made in respect of any room to which the Sub-section applies, is not to be treated as a closing order in respect of a dwelling-house for the purposes of Section 18 of the Act which deals with demolition orders. A room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, is, for the purpose of Section 17, to be deemed to be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation, if the room either— (a) is not on the average at least seven feet in height from floor to ceiling; or (b) does not comply with such regulations as the council with the consent of the Board may prescribe for securing the proper ventilation and lighting of such rooms, and the protection of the rooms against dampness, effluvia, or exhalation. The Board are empowered, if the local authority, after being required to do so by the Board, fail to make such regulations as above-mentioned, or such regulations as the Board approve, themselves to make regulations; and the regulations, son made, are to have effect as if they had been made by the local authority with the Board's consent. It is, however, provided that a closing order made in respect of a room to' which the Sub-section applies is not to prevent the room being used for purposes other than those of a sleeping place. 64 The subject matter of the Sub-section is one of considerable importance, and the Council will no doubt take an early opportuntty of framing and fonwarding to the Board for their approval a suitable code of regulations. Order for Demolition. Section 18, which supersedes Section 33 of the principal Act, deals with the demolition of dwelling-houses which have been closed by closing orders. Under Sub-section (1) proceedings with a view to an order for the demolition of a dwelling-house cannot be; initiated until a closing order has) been operative for three months; and when that period has elapsed the local authority must, before making a demolition order, give the owner an opportunity of being heard on the matter, at a meeting of which he has had at least one month's notice. Sub-section (2) indicates the circumstances in which a demolition order must be made, and it will be observed that this must now be done if the local authority are of opinion that the dwelling-house has not been rendered fit for human habitation, and that the necessary steps are not being taken with all due diligence to render it so fit, or that the continuance of any building which is, or is part of, the house is a nuisance or is dangerous or injurious to the health, of the public or of the inhabitants of the neighbouring dwelling-houses. Where, however, the case is one in which the local authority consider that the dwelling-house can be made fit for human habitation., they can. under Sub-section (3) give the owner an opportunity to render it so fit, if he undertakes to execute the necessary work, by postponing the operation of the order for a. period not exceeding six months. A house let for the sole purpose of letting lodgings to persons of the working classes at not more than 6d. per night for each person is exempted from Inhabited House Duty, if certified by the Medical Officer of Health as possessing suitable and sanitary accommodation. The erection of back-to-back houses is prohibited for the future, save 65 in respect of the erection or use) of a house containing several tenements in which the tenements are placed back to back, and the Medical Officer of Health for the district certifies that the several tenements are constructed and arranged so as to secure effective ventilation of all the habitable rooms in every tenement. Section 46 repeals Section 63 of the principal Act, which relates to the disqualification of tenants of lodging houses on receiving poor relief. Increased powers of entry are given on giving 24 hours' notice to the occupier and to the owner. An authority for entry given by the Council must be in writing and must state the particular purpose or purposes for which the entry is authorised. The following are the purposes for which entry may be authorised under the Section:— (1) Survey or valuation—in the case of houses, premises, or buildings which the local authority are authorised to purchase compulsorily under the Housing Acts ; and (2) Survey and examination—in the case of any dwelling-house in respect of which a closing order or an order for demolition has been made; or (3) Survey and examination—where it appears to the authority or Board that survey or examination is necessary, in order to determine whether any powers under the Housing Acts should be exercised in respect of any house, premises, or buildings. Notice may be given to the occupier, for the purposes of the Section, by leaving a notice addressed to the occupier, without name or further description, at the house, buildings, or premises in question. By amendments of certain definitions in the principal Act, a house does not cease to be a dwelling-house when it is no longer inhabited; and the term "owner" includes all lessees or mortgagees of any premises required to be dealt with under this part of the new Act, except persons holding or entitled to the rents or profits of the premises under a lease of which the original term is less than 21 years. E 66 Part II.—Town Planning. A town planning scheme may be made as respects any land which is in course of development or appears likely to be used for building purposes, with the general object of securing proper sanitary conditions, amenity, and convenience in connection with the laying out and use of the land, and of any neighbouring lands. The Local Government Board may authorise a local authority to prepare a town planning scheme; or may authorise a local authority to adopt, with or without any modifications, any such scheme proposed by all or any of the owners of any land with respect to which the local authority might themselves have been authorised to prepare a scheme. Where it is made to appear to the Local Government Board that a piece of land already built upon, or a piece of land not likely to be used for building purposes, is so situated with respect to any land likely to be used for building purposes that it ought to be included in any town planning scheme made with respect to the last-mentioned land, the Board may authorise the preparation or adoption of a scheme including such piece of land as aforesaid, and providing for the demolition or alteration of any buildings thereon so far as may be necessary for carrying the scheme into effect. A town planning scheme may be varied or revoked by a subsequent scheme prepared or adopted and approved. The Local Government Board may prescribe a set of general of special provisions for preparing and for carrying out the general objects of town planning schemes. Provided that, before a town planning scheme is approved by the Local Government Board, notice of their intention to do so shall be published in the London or Edinburgh Gazette, as the case may be; and, if within twenty-one days from the date of such publication any person or authority interested objects in the prescribed manner, the draft of the order shall be laid before each House of Parliament for a period of not less than thirty days during the session of Parliament, and, if either of those Houses before the 67 expiration of those thirty days presents an address to His Majesty against the draft, or any part thereof, no further proceedings shall be taken thereon, without prejudice to the making of any new draft scheme. Where laud included in a town planning scheme is in the area or more than one local authority, all necessary provisions may be made by the scheme for constituting the joint body and giving them the necessary powers and duties. Provided that, except with the consent of the London County Council, no other local authority shall, as respects any land in the County of London, prepare or be responsible for enforcing the observance of a town planning scheme. The responsible authority may at any time, after giving such notice as may be provided by a town planning scheme and in accordance with the provisions of the scheme— (a) remove, pull down or alter any building or other work in the area included in the scheme which is such as to contravene the scheme, or in the erection or carrying out of which any provision of the scheme has not been complied with; or (b) execute any work which it is the duty of any person to execute under the scheme, in any case where it appears to the authority that delay in the execution of the work would prejudice the efficient operation of the scheme. Any expenses incurred by a responsible authority under this section may be recovered from the persons in default, in such manner, and subject to such conditions as may be provided by the scheme. If any question arises whether any building or work contravenes a town planning scheme, or whether any provision of a town planning scheme is not complied with in the erection or carrying out of any such building or work, that question shall be referred to the Local Government Board. Compensation may be given in respect of property injuriously affected by the scheme, &c. E 2 68 Where, by the making of any town planning scheme, any property is increased in value, the responsible authority, if they make a claim for the purpose within the time (if any) limited by the scheme, shall be entitled to recover from any person whose property is so increased in value, one-half of the amount of that increase. Any question as to whether any property is injuriously affected or increased in value within the meaning of this section, shall be determined by the arbitration of a single arbitrator appointed by the Local Government Board, unless the parties agree on some other method of determination. There is exclusion or limitation of compensation in certain cases; and powers of compulsory purchase by local authorities, of land comprised in a scheme. In case of default of local authority to make or execute town planning scheme, the L.G.B. may by Order compel action. For the purposes of this Part of this Act, the expression "local authority" means the Council of any Borough or Urban or Rural District: and any expenses incurred under this Part of the Act, shall be defrayed as expenses under the Public Health Acts; and the authority may borrow. In London, the London County Council shall be the local authority. The County Council may promote the formation or extension of, and may assist, societies on a co-operative basis, having for their object (or one of their objects) the erection or improvement of dwellings for the working classes. The County Council, with the consent of and subject to the regulations made by the Local Government Board, may, for the purpose of assisting a society, make grants or advances to the society, or guarantee advances made to the society; but any such advance made on the security of any property shall not exceed two-thirds of the value of the property. 69 In a memorandum issued by the Local Government Board, Borough and Urban Councils are reminded that the object of the Town Planning Part of the Act is "to ensure by means of schemes, which may be prepared by local authorities or landowners, that in future, land in the vicinity of towns shall be developed in such a way as to secure proper sanitary conditions, amenity and convenience in connection with the laying out of the land itself and of any neighbouring land." While a large portion of the Act is in the main concerned with the amendments or development of previously existing enactments on lines which have been suggested by experience or by expediency, that part which has reference to town planning is more or less of an experimental nature, so far as this country is concerned. It cannot have much effect within the County of London, which is to a great extent built on; but should be most beneficial in the development of suburbs and in preventing the creation of new slum areas in Greater London. Consideration of the Bill as a whole leads to the conclusion that it contains amendments of the law which should be of great benefit towards obtaining better housing; and that, if it is wisely administered, it will lead to much valuable work by calling on public authorities for sound administration and judicious control of the development of the urban areas with which they have to deal. FOOD AND DRUGS. Under the Sale of Food and Drugs Acts, 156 samples of food and drugs were taken and analysed. The results are shown in Table C. 70 Table showing the results of Analysis of Samples taken under the Sale of Food and Drugs Acts, during the year 1908 in England and Wales:— Percentage Adulterated. 1907. 1908. Milk 10.5 10.5 Butter 6.6 7.5 Cheese 0.7 1.5 Margarine 42 2.8 0.1 0.8 Bread 0.8 1.0 Flour 1.3 0.0 Tea 0.3 0.0 Coffee 5.0 5.3 Cocoa 5.0 10.0 Sugar 4.0 8.1 Mustard 4.1 3.3 Confectionery and Jam 3.1 3.8 Pepper 1.1 0.6 Wine 10.4 4.3 Beer 5.8 1.8 Spirits 9.3 10.6 Drugs 7.1 9.0 Other Articles 9.0 9.7 All Articles 8.1 8.5 In London, as a whole, one sample was analysed for every 188 persons, being at the rate of 5.3 per 1,000 of the population of 1901 In Stoke Newington the proportion was one sample to every 347, being at the rate of 3 per 1,000 of the present population. 71 8 of the samples purchased in the Borough in 1909 were not satisfactory; and, therefore the percentage of non-genuine samples amounted to about 5.1 per cent., a figure which is slightly above that of the preceding year, when it was 7 per cent. The figure for the whole country was 8.5 per cent. during the year 1908. 8.7 per cent. of the milk samples were unsatisfactory, as against 8.4 per cent. during the preceding year; but in some cases the deficiency below the legal limits was very slight. The percentage of adulteration of milk for the whole country during 1908 was 10.5. In London the percentage reported against was 9.9. 72 TABLE C. ANALYSES PERFORMED UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1909. No. Sample Analysed. Opinion Formed, Action Taken. 1 Milk 6 to 7% of added water Vendor cautioned. 2 Milk Genuine Nil. 3 Milk ” ” 4 Milk ” ” 5 Milk ” ” 6 Milk ” ” 7 Butter ” ” 8 B utter ” ” 9 Mustard ” ” 10 Pepper ” ” 11 Butter ” ” 12 Butter ” ” 13 Butter ” ” 14 Milk ” ” 15 Milk ” ” 16 Seidlitz Powders ” ” 17 Sweets ” ” 18 Milk ” ” 19 Milk ” ” 20 Milk ” ” 21 Butter ” ” 22 Milk ” ” 23 Butter ” ” 24 Milk ” ” 25 Milk ”. ” 26 Butter ” ” 27 Margarine ” ” 28 Milk ” ” 29 Margarine ” ” 30 Milk ” ” 31 Milk ” ” 32 Margarine Not labelled Defendant ordered to pay 12s. 6d. costs. 33 Margarine Not labelled Defendant ordered to pay 12s. 6d. costs. 34 Oatmeal Genuine Nil. 35 Flour ” ” 36 Butter ” ” 37 Margarine ” ” 38 Milk ” ” 39 Milk ” ” 40 Milk ” ” 41 Milk ” ” 42 Milk ” ” 43 Butter ” ” 44 Milk 1% of added water Vendor cautioned. 73 TABLE C.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 45 Gin Genuine Nil. 46 Margarine „ „ 47 Whiskey 33.6% under proof; 8.62% excess of water Defendant fined £10 and 12s. 6d. costs. 48 Lard Genuine Nil. 49 Liquorice Powder ,, „ 50 Milk „ ,, 51 Milk 2½% added water Vendor cautioned. 52 Milk Genuine Nil. 53 Milk „ „ 54 Milk „ „ 55 Milk „ „ 56 Milk „ „ 57 Milk Nearly 2% of added water and fat slightly deficient Vender cautioned. 58 Butter Trace of boric acid Nil. 59 Tinned Peas Genuine „ 60 Gin „ „ 61 Butter „ „ 62 Butter „ „ 63 Milk 22% less than the legal limit for fat Defendant fined £1 and 12s. 6d. costs. 64 Pepper Genuine Nil. 65 Coffee „ „ 66 Mustard „ „ 67 Milk „ „ 68 Margarine „ „ 69 Milk „ „ 70 Butter „ „ 71 Oatmeal „ „ 72 Arrowroot „ „ 73 Butter „ „ 74 Lard „ „ 75 Milk „ „ 76 Milk „ „ 77 Milk „ „ 78 Milk „ „ 79 Milk „ „ 80 Milk „ „ 81 Milk „ „ 82 Milk „ „ 83 Milk „ „ 84 Milk 1% less than the legal limit for fat „ 85 Flour Genuine „ 86 Cheese „ „ 87 Milk „ „ 88 Milk „ „ 89 Butter „ „ 90 Lard „ „ 91 Margarine „ „ 74 TABLE C.—continued. No. Sample Analysed, Opinion Formed. Action Taken. 92 Butter Genuine Nil. 93 Pepper „ „ 94 Mustard „ „ 95 Butter „ „ 96 Milk0 „ „ 97 Milk „ „ 98 Margarine „ „ 99 Milk „ „ 100 Milk Trace of boric acid. „ 101 Milk Trace of boric acid. „ 102 Milk Genuine „ 103 Gin „ „ 104 Coffee „ „ 105 Whiskey „ „ 106 Tartaric acid „ „ 107 Flour „ „ 108 Milk „ „ 109 Milk „ „ 110 Milk „ „ 111 Milk „ „ 112 Milk „ „ 113 Milk „ „ 114 Milk „ „ 115 Milk „ „ 116 Milk „ „ 117 Butter „ „ 118 Butter „ „ 119 Butter Boric acid present in traces „ 120 Milk Genuine „ 121 Coffee „ „ 122 Gin Slightly below legal standard „ 123 Vinegar Genuine „ 124 Oatmeal „ „ 125 Gin „ „ 126 Whiskey „ „ 127 Cream „ „ 128 Cream „ „ 129 Cream „ „ 130 Cream „ „ 131 Butter „ „ *132 Milk „ „ *133 Milk „ „ *134 Milk „ „ *135 Milk0 „ „ *136 Milk „ „ *137 Milk „ „ *138 Milk „ „ 139 Butter „ „ * Sunday Samples, 75 TABLE C.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 140 Margarine Genuine Nil. 141 Butter „ „ 142 Seidlitz Powders „ „ 143 Flour „ „ 144 Coffee „ „ 145 Butter „ „ 14C Oatmeal „ „ 147 Seidlitz Powders „ „ 148 Sweets „ „ 149 Coffee „ „ 150 Margarine „ „ 151 Butter „ „ 152 Coffee „ „ 153 Lard „ „ 154 Pepper „ „ 155 Butter „ „ 156 Seidlitz Powders „ „ It is a remarkable circumstance that in the four years 1905-1908 the proportion of milk samples reported as adulterated in England and Wales, has for three of these years stood precisely at the same figure of 10-5 per cent. Whereas the heavier adulteration practised 30 years ago has practically disappeared, the large number of samples which are found to be poor and only just reaching the low legal limit of 3 per cent. of fat, all of which on this account have to be returned as genuine, clearly indicate that the practice of robbing good average milk (containing nearer 4 per cent. of fat) of a large part of its cream, is very general and probably on the increase. From the Annual Report of the Local Government Board for 1908-1909, attention is drawn to the fact that, throughout the country, in 137 instances the fines inflicted did not exceed 2s. 6d. Yet Magistrates surely realise that the adulteration of food is such a profitable fraud that nothing short of substantial fines can have the effect of materially reducing it! In the same Annual Report of the Local Government Board attention is drawn to the fact that a practice has recently sprung up of selling 76 Margarine as " Butter-Mate." Although the vendors comply with the law in putting the substance in packages labelled "Margarine," it must not be supposed that Margarine sold as " Butter-Mate " contains more butter-fat than Margarine in general. Indeed, the maximum amount of butter-fat which is permitted in any Margarine has been fixed by Section 8 of the Sale of Food and Drugs Act, 1899, at 10 per cent. of the total fat. Most of the samples purchased under the Sale of Food and Drugs Act have been obtained through the employment of a deputy, for the sanitary inspectors are well known to tradesmen and others. In a few instances we have 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, All the samples of Milk, Butter and Margarine were tested for antiseptics, with the result that 11 of the samples of Milk, 8 of Butter, and 3 of Margarine were found to contain them. In no case was the amount sufficient to warrant a prosecution, but in one or two instances the vendors were cautioned. 77 REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1909. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen, I beg to present my Annual Report for the year ending 31st December, 1909:— HOUSES AND PREMISES INSPECTED. By house-to-house inspection 824. Upon complaint, under Sec. 107 (3), Public Health Act, 1891 177 After notification of infectious disease 224 After Notices from builders, under Bye-law 14 (London County Council) 192 Stables and mews 306 Slaughter houses 11 Milkshops, dairies and cowsheds 93 Bakehouses 35 Factories and workshops 685 Other premises inspected 1,441 3,948 Re-inspections made to examine and test work 3,948 Total inspections 7,936 78 INTIMATION NOTICES SERVED. (Sec. 3, Public Health Act, 1891.) After house-to-house inspection 270 After inspection 0n account of complaint 129 After infectious illness 51 With reference to stables and mews 5 „ „ milkshops, dairies and cowsheds 6 „ „ bakehouses 12 „ „ factories and workshops 59 „ slaughter houses — After sundry other inspections 168 700 STATUTORY NOTICES SERVED. Twenty-six statutory notices, authorised by your Committee, were served under Sec. 4, Public Health Act, 1891. NUISANCES ABATED AND SANITARY DEFECTS REMEDIED. Dirty premises, cleansed and whitewashed 190 Dampness in dwellings remedied 79 Dilapidated ceilings, stairs, &c., repaired 34 Bell-traps and small dip-traps removed and replaced by stoneware gulleys 51 Foul traps and pans of w.c.'s cleansed or new ones substituted Public-house urinals cleansed 63 Flushing cisterns to w.c.'s provided or repaired, and w.c.'s with insufficient water supply made satisfactory 63 Defective w.c. basins and traps removed and replaced by approved patterns 109 Stopped or choked w.c. traps cleared 18 External ventilation to w.c.'s improved 2 W.c.'s removed to more sanitary positions . 1 Carried forward 549 79 Brought forward 549 Separate Flushing cisterns fixed to w.c.'s which were previously flushed directly from dietary cistern — Additional w.c.'s provided in case of insufficient w.c. accommodation 20 Defective soil-pipes reconstructed 35 Soil-pipes improperly ventilated, improved Unventilated soil-pipes ventilated 39 Dirty yards cleansed 16 Yards paved or re-paved with impervious material 44 Gulley and other traps inside houses removed 3 Sink waste-pipes directly connected to drain, made to discharge in open-air over proper syphon gulleys 2 Long lengths of sink, bath, and lavatory waste-pipes trapped, and made to discharge in open-air over gulleys 73 Defective waste-pipes repaired 16 Foul water-cisterns cleansed Water-cisterns without close-fitting covers provided with 49 proper coverings Defects in water-cisterns remedied . 10 Defective dust-bins pulled down and new portable dust-bins provided 91 Defective drainage re-constructed in accordance with the bye- laws of London County Council 196 Choked or stopped drains cleared and repaired 168 Drains ventilated or defective ventilating pipes renewed 9 Rain water pipes disconnected from drains or soil-pipes and made to discharge over gulley-traps 11 Proper water supply provided to houses 16 Defective roofs repaired 85 Defective guttering and rain water pipes repaired or renewed 64 Defective paving to floors of wash-houses repaired or renewed 17 Dirty walls of work-rooms cleansed 20 Proper manure receptacles provided (London County Council bye-laws) 1 Cases of over-crowding abated 2 Accumulations of refuse, &c., removed 12 Carried forward 1,548 80 Brought forward 1,548 Areas re-paved and drained — Insufficiently ventilated space under wooden floors, remedied by insertion in outer walls of proper air bricks 7 Underground dwellings improved 1 Nuisances from animals abated 10 Smoke nuisance abated 4 Total number of nuisances abated 1,570 A large number of improvements have been carried out by owners of property on advice. ' SLAUGHTER HOUSES. Visits have been paid to the six Slaughter-houses in the Borough. 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. 35 visits were paid to the twenty-seven Bakehouses in the Borough. 12 intimation notices were served for limewhiting and cleansing. DAIRIES, COWSHEDS, AND MILKSHOPS. 93 visits were paid to the Milkshops and Cowsheds in the Borough. In most instances the premises were found to be in 81 a satisfactory condition. Six intimation notices were served upon occupiers for cleansing and minor sanitary defects. There are 53 milk vendors registered in the Borough. COMPLAINTS. Sec. 107 (3) Public Health Act, 1891. 155 complaints were received during the year, relating to 177 premises. In 16 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. 17 of the complaints were anonymous, and of these only a small percentage proved to be genuine. 129 intimation notices were served on the owners and occupiers of premises complained of. STABLES AND MEWS. 306 inspections were made of the Stables and Mews in tha Borough, special attention being given to those where the employees iive over the stables. Five Intimation Notices were served on Occupiers to remove accumulations of manure. In very few cases were accumulations found. The Council's Regulations have been well observed; and in several instances the paving of stable yards has been repaired or renewed on advice to the occupiers or owners. 82 HOUSES LET IN LODGINGS. There were 273 premises on the Register at the end of the year. SALE OF FOODS & DRUGS ACTS, 1875-1901. 156 samples of Food and Drugs were submitted to the Public Analyst during the year. A table will be found on page 87 showing the result of proceedings taken in respect of adulterated samples. BUTTER AND MARGARINE ACT, 1907. Two firms in the Borough are registered under the above Acts as Wholesale Dealer in Margarine or Butter-substitutes. HOUSE-TO-HOUSE INSPECTION. Inspections have been made in the following roads and streets during the year:— *Aldham Place. *Leonard's Place. Allen Road. Lordship Terrace. Barrett's Grove (Tenements). *Mason's Court. *Boleyn Road (Tenements). *Mason's Place. Bouverie Road. *Nevill Road (Tenements). Broughton Road. Park Street. Church Path. Philp Street. Cressington Road. *Rochester Place. Green Lanes. Shakespeare Road. Hamilton Place. Summerhouse Road. Hayling Road. Thomas Place. Hornsey Place. Watson Street. Howard Road. Woodberry Grove. Kersley Road. Woodland Road. * These have been inspected twice during the year. 83 BUTCHERS', GREENGROCERS', AND FISHMONGERS' SHOPS, STALLS, &c. The following is a list of articles of food seized or surrendered during the year: — Tinned Food. Number of Tins. cwts. qrs. lbs. Beef 72 7 0 8 Salmon 72 2 16 Milk 63 2 7 Pine Apple 5 10 Sardines 6 3 Pears 1 3 219 Other Articles. Beef 8 Mutton 13 Apples 3 Pears Cheese 1 2 Plaice . . I 3 0 Cwt. 10 2 Si Kippers, 107 pairs. Eggs, 6,820. Four Notices were served on occupiers for dirty premises. The food exposed for sale on the barrows and stalls of costermongers has been inspected, and in every case it was found to be satisfactory. SMOKE ABATEMENT. Observations have been made of the factory chimneys in the Borough during the year with satisfactory results. 84 ICE CREAM MANUFACTURERS AND VENDORS. There are 38 premises in the Borough where ice-cream is manufactured. A Register is kept of all such premises, and the shops and premises regularly inspected during the summer months. The conditions under which the manufacture was carried on were in every case found to be satisfactory. RESTAURANTS AND EATING HOUSES. There are 25 of these premises in the Borough. The results of the inspections have been satisfactory. FACTORIES AND WORKSHOPS. The Register of Factories and Workshops has been maintained There are at present 225 Factories, Workshops and Workplaces in the Borough. These have all been inspected during the year. In addition 438 homes of outworkers have been inspected. It was found necessary to serve 59 Intimation Notices, principally for cleansing and unsuitable or defective W.C. accommodation. Reinspections were made in all cases where notices were served, to see that the work was properly carried out. Of the outworkers notified from firms whose places of business are in Stoke Newington— 129 reside in Stoke Newington. 53 „ „ Hackney. 38 „ „ Islington. 25 „ „ Tottenham. 10 „ „ Stepney. 4 „ „ Edmonton. 1 „ „ Shoreditch. 2 „ „ Poplar. 3 „ „ Leyton. 1 „ „ Finchley. 1 „ „ St. Pancras. 2 „ „ Walthamstow. Total 275 85 Notifications were received from Medical Officers of Health of persons residing in Stoke Newington but who work for firms in other Districts, as follows:— Battersea 2 Bethnal Green 7 Camberwell 2 City of London 229 Finsbury 124 Hackney 118 Hornsey 3 Ilford 4 Islington 128 Paddintton r Shoreditch 26 Southwark 2 St. Marylebone 12 Stepney 2 Tottenham 1 Walthamstow 1 Wood Green 1 Total 663 Outworkers' addresses received in error from other Boroughs, etc., and forwarded to their proper destination:— 130 forwarded to Hackney. 6 „ „ Islington. 18 „ „ Tottenham. 1 „ „ Wood Green. Total 155 NOTIFICATION OF INFECTIOUS DISEASE. 224 cases were notified during the year, and in every instance an inspection of the infected premises was made. 86 All the houses where the cases of infectious illness occurred have been disinfected ; 174 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 147 instances. 142 patients were removed to Hospital. It was found necessary to strip and cleanse 19 rooms after removal or recovery of patients. 119 books which had been borrowed from the Public Library were collected from infected houses, disinfected, and returned to the Public Library. DRAINAGE APPLICATIONS. Thirty-five plans were submitted, referring to the drainage of 6.3 premises ; all of these were eventually approved. Twenty-one of the above applications were for drainage on the combined system. URINALS IN CONNECTION WITH LICENSED PREMISES. By your direction, I reported to the Highways and Sewers Committee in February on the condition of the urinals in the Borough. At that time there were 26 of these conveniences, 6 of which were flushed and cleansed by the Borough Council's flusher. As a result of the action taken by the Highways Committee on that Report, an additional flusher has been employ; .1 and 8 further conveniences have been taken over for flushing and cleansing purposes. The flushing, draining or lighting arrangements in several of the remaining 12 have been improved. 87 TABLE OF PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS AND MARGARINE ACTS. No. of Sample. Article Purchased. Result of Analysis. Result of Proceedings. 32 Margarine (unlabelled) Defendant ordered to pay costs. 33 Margarine (unlabelled) Defendant ordered to pay costs. 47 Whiskey 33.6 % under proof ; 8.6 % excess of water Defendant fined £10 and 12s. 6d. costs. 63 Milk 22 % less than legal limit Defendant fined £1 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. 88 A LIST OF THE STREETS SITUATED IN THE BOROUGH OF STOKE NEWINGTON. A DEN Grove Aden Terrace Adolphus Road Allen Road Allexton 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 Road (94 to 192) Brighton Road Brodia Road Brough ton 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) and 1 to 27 odd Nos. 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 89 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 Marton Road Mason's Court ,, Place Matthias Road (2-122) Millard Road Milton Road Mountgrove Road (2-98) N EVILL Road Newington Green (33-42) 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 Rood Princess Road ,, May Road QUEEN Elizabeth's Walk Queens Road REEDHOLM Road Rochester Court Riversdale Road (92-104) SANDBROOK Road Salccmbe 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. SideSelsea Place Stamford Hill (1-39) Stoke Newington Road (1-135)' Statham Grove Summerhouse Road THOMAS Place Truman's Road VICTORIA Grove Victoria Grove West Victoria Road WALFORD Road Warwickshire Road Watson Street White Hart Court Wiesbaden Road Wilbarforce Road Winston Road Wordsworth Road Woodland Road Woodlea Road Woodberry Down ,, Grove