STo 22 . . THE . . Metropolitan Borough of Sroke Newington Report of the Medical Officer of Health and Public Analyst, for the YEAR 1913. by HENRY KENWOOD, m.b., f.r.s.e., dph., f.c.s., Chadiwick Professor of Public Health, University of London, Fellow and Member of Council of the Royal Sanitary Institute, &c., Medical Officer of Health and Public Analyst. table of contents- Vital Statistics— Page Population of the Borough and of each of the two Divisions 97 Number of people to the acre 97 Births and Birth-rate 97-98 Mortality, Death-rates and causes of Mortality—with notes thereon 99-117 Infantile Mortality 103-110 The Mortuary 115 Inquests held during the Year 117 Infectious Diseases and the Measures taken to Prevent their spread— The Infectious Sickness Returns for the Year 117-121 Scarlet Fever 122-123 Erysipelas 123 Enteric Fever 123-124 Diphtheria 124-126 Measles and Whooping Cough 126-128 Puerperal Fever 128 Consumption 129-137 Cerebro-Spinal Fever and Acute Polio-Myelitis 137 The Disinfecting and Cleansing Station 137-138 Notes upon Sanitary Work Performed during the Year 138-147 Food Inspection 139 Houses let in Lodgings 139-140 The Housing and Town Planning Act 140-142 Factories and Workshops 143-147 The Public Health Legislation of 1913 147-150 Food and Drugs 150-158 Report of the Chief Sanitary Inspector 159-169 Streets in the Borough of Stoke Newington—(Appendix) 170-171 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1913. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen, The vital statistics of the Borough for the year 1913 were of their usual satisfactory nature. The general death-rate of 13.1, though somewhat higher than that for the preceding year, compares favourably with the corresponding rate of 14.2 for the Metropolis as a whole. The death-rate from the chief infectious diseases (0.85) was the second lowest on record, and it is well below the corresponding rate for the Metropolis generally. The rate of infantile mortality (the number of deaths under one year of age to every thousand births) was 82.7, as against a rate of 105 for the Metropolis; this is the third lowest rate of infantile mortality since the formation of the Borough, and there were only three Metropolitan Boroughs with a lower rate. It is obvious, however, from our experience, that continuous and increasing efforts are necessary in order to permanently reduce the wastage of infant life which still goes on. The notifications of infectious diseases (excluding those from Tuberculosis) were during 1913 higher than in the preceding year; but the prevalence of each separate notified disease, including Consumption, compares favourably with that for the Metropolis. I would direct your special attention to the remarks on Infant Mortality (pp. 103-110) and those on Consumption (pp. 129137). The year 1914 promises to witness the provision at your hands of some needed extension of our efforts in respect to these two important items of public health work. 96 The report bears testimony to the fact that a large amount of public health work has been performed by the workers in the Public Health Department during the past year, and I have pleasure in testifying to the efficiency and zeal of each member of the staff. I am, Gentlemen, Your obedient Servant, HENRY KENWOOD. February 5th, 1914. 97 POPULATION. According to the Census of 1901 the population of the Borough was then 51,247. By the recent Census of 1911 the population for the same area was shown to have decreased during the 10 years to the extent of nearly 600. In this Report the rates are based on the estimated population for the middle of the year 1913, and the figure, calculated logarithmically, amounts to 5O,454. The estimated population for each of the Sub-districts is as follows:— The Northern Division of the Borough (lying North of the middle line of Church Street) has a population of about 16,980; and in the Southern Division the population is approximately 33.474. The natural increase of population by excess of births over deaths during the year amounted to 416, as against 446 in the preceding year. Number of people to the acre.—The area of the Borough amounts to 863 acres, and this houses about 58 people to the acre. BIRTHS During the year 1913 there were 1,112 births, viz.—591 males and 521 females. The birth-rate per 1,000 per annum was therefore 22.0, as against 20.4 for the preceding year. The births in the Northern Division of the Borough numbered 215 and the birth-rate was 12.7, while those in the Southern Division were 897, and the birth-rate was 2.8. 98 Year. Birth-rate, Rate for London generally. Rate for England and Wales. 1901 21.6 29.0 28.5 1902 22.0 28.5 28.6 1903 21.5 28.5 28.4 1904 22.3 28.0 27.9 1905 20.9 27.1 27.2 1906 21.2 26.6 27.0 1907 20.5 25.8 26.3 1908 20.2 25.4 26.5 1909 19.5 24.4 25.6 1910 18.8 23.6 24.8 1911 20.7 25.0 24.4 1912 20.4 24.7 23.8 1913 22.0 24.5 23.9 The illegitimate bliths numbered 24 : 11 males and 13 females. During the past three years the Registrar-General has made arrangements whereby particulars of those births (of Stoke Newington parents) which occurred outside the Borough, and were not, therefore, locally registered, are now transferred to us; so that 34 such births had to be added to the number registered within the Borough in 1913. It was impossible in previous years to make this addition, and so the birth-rates for Stoke Newington for the last three years must not be taken as comparable with those of former years. It may be noted that the excess of the birth-rate over the death-rate for the year 1901 was 8.5; whereas for the year 1913 (both rates being considerably lower), the figure was 8.9. During the year the births notified under the Notification of Births Act have been compared with the births registered by the Registrar of Births, and the comparison (947 as against 1,112) has revealed the fact that the requirements of the Notification of Births Act are still not fully complied with, notwithstanding the efforts which have been made to make these requirements known. In many cases I have taken steps to ascertain the cause of the failure of notification and to draw the attention of the responsible party to his or her legal default. 99 MORTALITY. General Mortality.—There were 445 deaths of residents registered in the Borough, and 217 of residents who died in Public Institutions outside of the Borough, making a total of 662 deaths. Of these 334 were of females and 328 were of males. Year. General Death-rate. Rate for London generally. Rate for England and Wales. 1901 13.1 17.6 16.0 1902 13.3 17.2 16.3 1903 12.6 15.2 15.4 1904 13.4 16.1 16.2 1905 13.0 15.1 15.2 1906 12.0 15.7 15.4 1907 11.8 14.6 15.0 1908 12.9 13.8 14.7 1909 11.7 14.0 14.5 1910 11.8 12.7 13.4 1911 12.5 15.0 14.6 1912 11.6 13.6 13.3 1913 13.1 14.2 13.7 The recorded general death-rate is therefore 13.1, as against 11.6 for the preceding year. This ordinary death-rate, however, cannot be taken as a true index of the healthiness of the Borough, nor can it be justly compared with the rates of other Sanitary areas, unless some allowance is made for the relative proportions of males and females at different ages in the districts compared. Death-rates vary very much in different districts according to the 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. 100 There is, therefore, calculated by the Registrar-General from the Government Census returns, a corrective factor for each district in the County of London, which varies with 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 fairer 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 sex distribution is 13.1 x 1.0438 = 13.6 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 somewhat higher than any recorded for the previous few years. The death-rate for the whole of London was 14.2. District Mortality.—The deaths among residents of the Northern Division of the Borough numbered 194 and furnished a recorded death-rate of 11.4 per 1,000 per annum. The deaths among the residents, of the Southern Division of the Borough numbered 468, and furnished a recorded death-rate of 13.7 per 1,000 per annum 101 TABLE I. CAUSES OF AND AGES AT DEATH DURING THE YEAR 1913. Causes of Death. Nett Deaths at the subjoined ages of " Residents" whether occurring within or without the Borough. Total Deaths whether of "Residents" or "Non-Residents in Institutions in the Borough All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11. All causes Certified - - - - - - - - - - Uncertified — — — — - - — — - — Enteric Fever 2 - - - - 1 - 1 - - Small Pox - - - - - - - - - - Measles 11 1 8 - 2 - - - - - Scarlet Fever 1 - 1 - - - - - - - Whooping Cough 6 3 — 3 - - - - - - Diphtheria and Croup 6 — — 2 4 - - - - - Influenza 8 — - — 1 1 - 1 5 - Erysipelas 2 - - - - - 1 — 1 - Phthisis (Pulmonary Tuberculosis) 47 - - 2 1 5 22 15 2 1 Tuberculous Meningitis Other Tuberculous 6 — — 4 1 1 — — — - Diseases 9 — 3 2 3 - 1 - - - Cancer, malignant disease 67 — — 1 — - 3 29 34 4 Rheumatic Fever - — — — - — - - - - Meningitis 4 2 — 1 - - 1 - - - Organic Heart Disease . 63 1 — 1 2 1 7 20 31 10 Bronchitis 64 3 — - 1 - 2 14 44 5 Pneumonia (all forms) 60 16 8 5 1 9 5 10 13 2 Other Diseases of Respiratory organs 7 - - - - - - 4 3 - Diarrhœa and Enteritis. 17 10 3 2 - - 1 1 - Appendicitis and Typhlitis 3 — — 1 — 1 1 — - 3 Cirrhosis of Liver 15 - - - - - 1 11 8 - Alcoholism - — — — - - — - - - Nephritis and Bright's Disease 32 - - - 1 - 4 14 13 1 Puerperal Fever 3 — — — — 2 1 — - — Other accidents and diseases of Pregnancy and Parturition - - - - - - - - - - Congenital Debility and Malformation, including Premature Birth 38 38 - - - - - - - - Violent Deaths, excluding Suicide 11 1 1 - - 1 2 3 3 - Suicide 4 — — — — 1 3 — — 1 Other Defined Diseases 176 17 — 1 1 7 14 36 100 14 Diseases ill-defined or unknown - - - - - - - - - - 662 92 24 25 18 23 68 159 253 42 102 TABLE II. SHOWING THE DISTRIBUTION OF THE DEATHS IN THE NORTHERN AND SOUTHERN DIVISIONS OF THE BOROUGH DURING EACH OF THE QUARTERS OF THE YEAR 1913. DISEASES. NORTH. Total SOUTH. Quarters Quarters. Total 1 2 3 4 1 2 3 4 Enteric Fever - - - - - - - 1 1 2 Small Pox - - - - — - - - - - Measles — — — — - 6 5 — — 11 Scarlet Fever — — — — - — — — 1 1 Whooping-cough — 1 — — 1 1 3 1 — 5 Diphtheria and Croup 1 — — — 1 — 1 1 3 5 Influenza 2 1 — — 3 1 3 1 — 5 Erysipelas 1 — — — 1 — 1 — - 1 Phthisis (Pulmonary Tuberculosis) 3 1 5 2 11 12 10 7 7 36 Tuberculous Meningitis — — — — - 1 — 3 2 6 Other Tuberculous Diseases — 2 1 — 3 1 1 3 1 6 Cancer, malignant disease 6 9 3 7 25 14 6 11 11 42 Rheumatic Fever — — — — — — — — — — Meningitis — — 1 1 2 — — — 2 2 Organic Heart Disease 10 4 3 7 24 12 8 12 7 39 Bronchitis 11 4 1 3 19 19 5 2 19 45 Pneumonia (all forms) 2 4 — 4 10 18 12 6 14 50 Other Diseases of Respiratory Organs - 1 1 1 2 1 2 6 Diarrhœa and Enteritis - - - - - - 1 9 7 17 Appendicitis and Typhlitis 1 — 1 - 2 — -I - — 1 Cirrhosis of Liver 2 — — 1 3 2 3 3 4 12 Alcoholism - - - - - - - - - - Nephritis and Bright's Disease 2 3 3 4 12 6 3 7 4 20 Puerperal Fever — — 1 — 1 — — 1 1 2 Other accidents and diseases of Pregnancy and Parturition - - - - - - - - - - Congenital Debility and Malformation, including Premature Birth 1 - 1 2 4 3 9 9 13 34 Violent Deaths, excluding Suicide 2 2 _ 4 5 2 - - 7 Suicide — 1 - — 1 2 1 — — 3 Other Defined Diseases 23 14 10 19 66 31 26 22 31 110 Diseases ill-defined or unknown - - - - - - - - - - Totals 67 47 30 50 194 135 103 100 130 468 103 DISTRICT MORTALITY. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Rate per 1,000 per annum. Northern Division 67 47 30 50 194 11.4 Southern Division 135 103 100 130 468 13.7 Totals 202 150 130 180 662 13.1 INFANTILE MORTALITY. There were 92 deaths registered of infants under one year of age, as against 1,112 births; the proportion which the deaths under 1 year of age bear to 1,000 deaths is, therefore, 82.7, as against 70.7 in the preceding year. The deaths under 1 year of age form 13.9 per cent. of the total deaths at all ages, whereas those for the preceding year formed 12.4 per cent. Year. Rate of Infantile Mortality. Rate for London generally. Rate for England and Wales. 1901 117 9 149 151 1902 114.7 139 133 1903 120.3 130 132 1904 115.6 144 146 1905 124.7 129 128 1906 108.0 130 133 1907 97.9 115 118 1908 98.3 113 121 1909 84.9 107 109 1910 66.1 103 106 1911 106.2 128 130 1912 70.7 90 95 1913 82.7 105 109 104 TABLE III.—INFANT MORTALITY. 1913. Nett Deaths from stated causes at various Ages under 1 Year ot Age. CAUSE OF DEATH. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year All causes Certified Uncertified. Small Pox - - - - - - - - - - Chicken-pox — — — — — — — — — — Measles — - — — — — — — 1 1 Scarlet Fever — - — — — — — — — - Whooping-cough — - — 2 2 1 — — — 3 Diphtheria and Croup - - - - - - - - - - Erysipelas — — — — — — — — — — Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis (b) - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - 1 1 — — 2 Convulsions — 1 1 — 2 2 — — - 4 Laryngitis — — — — — — — — — — Bronchitis — — — 1 1 — 1 1 — 3 Pneumonia, all forms - - - - - 6 1 2 7 16 1 Diarrhœa — — 1 — 1 — — — 2 3 1 Enteritis - - - - - 2 — 4 1 7 Gastritis — — — — — — — — - Syphilis — — — — — 1 — — — 1 Rickets — — — — — — — 1 - 1 Suffocation, overlying — — 1 — 1 2 3 — — 6 Injury at birth — — — — — — — — — — Atelectasis — — — — — — — — — - Congenital Malformations (c) 1 - — — 1 1 — — - 2 Premature Birth 18 — — — 18 3 — — - 21 Atrophy, Debility and Marasmus 5 — 1 1 7 5 3 — — 15 Other causes 2 — 1 1 4 1 — 1 — 6 26 1 5 6 37 25 9 9 11 92 Nett Births in the year—Legitimate 1,088. Illegitimate 24. 105 It is well known that the conditions prevailing in most urban communities are unfavourable to infant life. There are sufficient grounds for believing that the urban infant is almost as healthy at birth as is the rural. Indeed, during the first month of life, when more than one-third of the total infant mortality occurs, the urban excess over the rural is only about 8 per cent. ; during the first three months the urban excess is 11.6 per cent.; in the next three months it is 43 per cent. ; while in the second half of the first year it is 67 per cent. higher in the urban than in the rural districts. Generally, as Dr. Newsholme has pointed out, the towns having respectively high or low rate of infant mortality have similarly a high or low mortality in the next 4 years of life, and those with excessive infant and child mortality continue to experience excessive mortality, though in less degree, at the higher ages. A steady improvement in this rate from 1901 onwards is one of the most striking features of recent statistical history. Some conception of the life-saving thus secured may be gathered from the following illustration. In the seven years 1906-12 the deaths of 736,682 infants occurred in England and Wales, equivalent to an average rate of 115 per 1,000 births. Had the infant death-rate been 144 per 1,000, as it had been in the seven years 1899-1905, there would have perished 922,454 infants in the years 1906-12. Thus the improved conditions imply a saving of 185,772 lives during these seven years. Infant mortality increases as the social position of the community declines; but that the excessive death-rates associated with urban poverty are not necessarily due to poverty is proved by the fact that the rate amongst the infants of agricultural labourers is quite low. We are thus driven to the conclusion that artificial feeding, connoting unsatisfactory arrangements for the protection of food from contamination and the consumption of faultily prepared as well as contaminated food, is mainly responsible for the high urban infant mortality among the poorer class. 106 The substantial saving of child-life which is going on must be credited to an improvement in the sanitary standard of domestic life, and to the missionary work on infant-care by health visitors who provide parents with advice which conduces to the reducing of minor ailments, to their prompt discovery, and to the early treatment necessary for the prevention of more serious disease, as well as to the raising of the standard of physical fitness in later life. Our Advice Card strongly presses breast feeding, and purposely omits any advice as to artificial feeding, in order to influence the mother, the doctor, the midwife, the nurse, the help, or any other person in attendance, so that breast-feeding may be persevered with until the Health Visitor comes upon the scene, after the doctor or midwife or student has ceased to attend the lying-in, which is generally 10 days after. It is clearly the duty of the Local Sanitary Authority to do what is possible to stem this wastage of infant life, and Urban Authorities are, therefore, doing special work to this end. It follows, of course, that the scope and the methods adopted vary with the proportion and nature of the population; but valuable work in the direction of advising mothers upon infant care is now being carried on in every Metropolitan Borough but one. The essential provision is a well-qualified official woman Health Visitor, who is assisted and directed in her work by a qualified medical man who has devoted some special study to infant hygiene. Then with the information obtained by the Sanitary Authority under the Notification of Births Act, the Health Visitor (assisted if necessary by a few voluntary workers of experience) can get into touch with the poorer mothers who have recently borne children, immediately after the medical practitioner ceases his attendance; and by practical advice and stimulation much may be done to ensure that the child is tided over the most dangerous first 12 months of life. While much may be done by home visitation, it is obvious that great advantages accrue to the provision of a small Infant Care or Child Welfare Centre to which parents may bring their infants on certain 107 afternoons. Not only can the infant weighing and recording of the results (which furnish the best clue to the infant's physical progress, and greatly interest and stimulate the mothers) be better and more expeditiously performed, but the arrangement results in a great saving of the time of the Health Visitor. Furthermore, the establishment of a Centre admits of the temporary assistance of a medical man to co-operate with the Health Visitor, and furnishes valuable opportunities for giving collective information and to make some telling exhibits. We are hoping to establish a small Centre for this purpose at Stoke Newington. It will serve to usefully promote a branch of public health work in Stoke Newington which is the most worth doing at the present time. DEATHS UNDER ONE YEAR OF AGE IN THE DIFFERENT WARDS OF THE BOROUGH DURING THE YEARS 1903, 1904, 1905, 1906, 1907, 1908, 1909, 1910, 1911, 1912 and 1913. N ame of Ward 1903 11104 1905 1906 1907 1908 1909 1910 1911 1912 1913 Lordship Ward 4 6 9 8 1 6 2 1 2 2 1 Clissold Ward 7 8 12 6 11 4 5 4 6 5 5 Church Ward 30 24 24 18 23 19 18 18 27 14 17 Manor Ward 10 9 8 3 8 3 6 3 4 6 10 South Hornsey Ward 65 66 66 56 36 47 35 32 48 35 41 Palatine Ward 20 21 14 26 23 22 18 5 19 11 18 Totals 136 134 133 117 102 101 84 63 106 73 92 A comparison of the causes of infantile mortality in 1913 with those of the preceding year shows an increase during last year in the deaths from diarrhœal diseases, and diseases of the lungs. It is also noteworthy that the deaths from suffocation in bed were 6, as compared with 2 in the preceding year. 108 "Maternity benefit" is almost always paid in cash to the husband where he is insured; in few cases does the Insurance Committee retain a part of the benefit to make direct payment either to the midwife or to the Maternity Hospital. While, in some cases, where the woman has made a direct application and explained that her husband would abuse the benefit, the money has been paid to her on her application, abuse of the benefit money is unhappily very common. THE WORK OF THE OFFICIAL AND VOLUNTARY HEALTH WORKERS. Miss Aldridge reports that:— During 1913, 639 infants were visited shortly after birth; 43 of these were visited by the Voluntary Health Visitors. These visits were followed by 762 revisits. These visits were appreciated, and often much needed; particularly is this so in the case of hand-fed infants; for, although there is much to be done to improve the condition of the naturallyfed infant, there is even more to be done for the hand-fed ones. Their food is generally carelessly mixed, and not gradually strengthened as the child grows older. It is only by carefully watching these infants and rousing up the mothers' interest in them, that we can get more intelligent care bestowed on them. The work of trying to improve the conditions of infant life is being very much helped by the present Mayor, who has kindly arranged for a grant to be made to us from the London Medical Charities Fund. This money is being used to supply nourishment to carefully selected cases of the poorest mothers with young infants. It is relieving an urgent need, and is being very much appreciated. It is often very difficult for these women to obtain sufficient nourishment when their infants are very young. The father may be temporarily out of work (sometimes through illness), or working only part time, owing to bad weather; and, when, added to this the mother is requiring extra rest and nourishment, the conditions are not favourable for the rearing of a healthy naturallyfed infant. 109 59 infant deaths were investigated ; of these— 22 were naturally fed. 29 were hand fed. 8 were too young to have had any food. Infant Weighing.—During last year 149 infants were brought to the Town Hall to be weighed, and their total visits numbered 572. 7 children came from neighbouring Boroughs and 142 from Stoke Newington. It is a striking fact that while the infant deathrate for Stoke Newington last year was 82.7, only 2 of the children who attended the weighing died; one of these had only attended once, and one was born delicate in very distressing home circumstances. The death-rate among these 149 children (a large percentage of whom were hand fed) was therefore only 13.4 per 1,000. I am sure that if every infant born could be weighed at regular intervals and the mother taught step by step how best to feed and care for her baby, the infant death-rate amongst children born healthy would be an exceedingly small one. That great ignorance in infant rearing does prevail is all too evident from the cases which come to our notice in this way. I quote the following case, which is only one of many others : An infant born outside this Borough moved into Stoke Newington at the age of 9½ months, and within a week was brought here to be weighed. She was fed every hour on Nestle's milk diluted with very thick barley water (made eight times too strong), and because she cried incessantly she was fed between these feeds on nursery biscuits. She had only gained 2½ lb. since birth, and was the weight of a normal child of between 2 and 3 months old. When fed upon proper lines the child soon began to improve. We are greatly indebted to Dr. New, Miss Eve, Miss Webb, Miss Stevens, and Mrs. Barker, for their valuable assistance, as Voluntary Workers, in this infant-care work. SENILE MORTALITY.—Of the 662 deaths, 253 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, 110 fore, 38.2 per cent. There were 188 deaths of persons over 70 years of age, and 70 of persons over 80, 12 of whom reached 90 years of age—the oldest being 97. This is a remarkably high proportion of deaths over 65 years of age, which indicates that there is a relatively large number of old persons in the Borough. SENILE MORTALITY DURING 1913. (65 to 70 70 to 80 80 to 90 90 and over Total 65 118 58 12 253 The respective ages of those over 90 were 90, 90, 90, 90, 90, 91, 91, 92, 92, 93, 95, 97. THE CAUSES OF DEATH.—These are fully set forth in Table I., in which it will be noted that the deaths are also apportioned to different age-periods. Table II. is supplementary to Table I., 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 marked increase in the deaths from Measles, Whooping Cough, Diphtheria, Zymotic or Summer Diarrhoea, Diseases of the Lungs and Cancer; a decrease in the deaths from Heart Diseases. It will be noted (Table II.) that the mortality of the Southern Division exceeds that of the Northern (after due allowance is made for the different figures of the population in each Division), mainly in respect to the deaths from Tuberculosis, Measles and Whooping Cough, Premature Birth and Infant Wasting, Summer Diarrhoea, and Lung Diseases. 111 TABLE IV. DEATHS IN PUBLIC INSTITUTIONS WITHIN THE BOROUGH, 1913. Nursing Home, 17 Queens Road Invalid Asylum, 187 High Street St. Anne's House, Manor Road Northumberland House, Green Lanes. Nursing Home, 6/8, Alexandra Road. Nursing Home, 21 Stamford Hill. Total. 1 4 18 9 9 1 42 I. II. III. Institutions within the Borough receiving sick and infirm persons from outside the Borough. Institutions outside the Borough receiving sick and infirm persons from the Borough. Other Institutions, the deaths in which have been distributed among the two divisions of the Borough. St. Anne's House, Manor Road. London Hospital. N.E. Fever Hospital. Hackney Infirmary. Claybury Asylum. Northumberland House, Green Lanes. Islington Infirmary. Darenth Asylum. Mildmay Cottage Hospital. Tooting Bec Asylum. Nursing Home, 6/8, Alexandra Road. Colney Hatch Asylum. German Hospital. Banstead Asylum. Nursing Home, 21, Stamford Hill. Children's Hospital, Caterham Asylum. Great Ormond Street. Leavesden Asylum. Invalid Asylum, 187 High Street S.E. Fever Hospital. Great Northern Hospital. Long Grove Asylum. Nursing Home,17 Queens Road North Eastern Hospital for Children. St. Bartliohuew's Hospital Metropolitan Hospital. Royal Free Hospital. St. Luke's House. Shoreditch Infirmary. Queen's Hospital. St. Mary's Hospital. Middlesex Hospital. St. Joseph's Hospital. Friedenham Hospital. The Babies' Home. Brook House. Hospital for Women (Soho). Brompton Hospital. St. Pancras Infirmary. St. Mark's Hospital. Holborn Infirmary. St. Pancras Infirmary. 112 ZYMOTIC MORTALITY. Included in the Zymotic death.rate are the deaths from the seven principal Zymotic Diseases, viz., Small.pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, "Fever" (including Enteric Fever, Typhus Fever, and Simple Continued Fever), and Diarrhoea. In Table IV. the deaths from each of the Infectious Diseases (including Erysipelas, Puerperal Fever, and Influenza) are given. The Zymotic Death.rate for the Borough was 0.85 per 1,000 per annum, as against 0.34 in the preceding year. Year. Zymotic Death-rate. Rate for London generally. Rate for England and Wales. 1901 1.26 2.25 2.05 1902 1.56 2.21 1.64 1903 1.70 1.76 1.46 1904 1.62 2.14 1.94 1905 1.35 1.70 1.52 1906 1.39 1.94 1.73 1907 1.33 1.42 1.26 1908 1.18 1.35 1.29 1909 0.87 1.30 1.12 1910 0.93 1.14 0.99 1911 1.69 2.20 1.88 1912 0.34 1.42 0.99 1913 0.85 1.82 1.20 By comparison with the preceding year there were more deaths from Measles, Whooping Cough, and Diarrhoeal Diseases. The warmer and drier summer was indirectly responsible for the increase in the Diarrhoeal group of diseases. 113 Deaths from Zymotic Diseases (including Influenza, Puerperal Fever, and Erysipelas) in the year 1913. Scarlet Fever. Diphtheria. Small Pox. Enteric Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhoea and Dysentery. Influenza. Erysipelas. Total. First Quarter — 1 — — 1 6 1 — 3 1 13 Second ,, — 1 — — - 5 4 1 4 1 16 Third „ — 1 — 1 2 — 1 9 1 — 15 Fourth „ i 3 — 1 1 - — 7 - - 13 1 6 - 2 4 11 6 17 8 2 57 1912 1 — - — 1 6 2 8 3 1 22 ZYMOTIC DIARRHCEA. As pointed out in my last annual Report, there is a district which is (roughly speaking) enclosed by Church Path, Clissold Road, Cowper Road, and Watson Street, inside of which almost half of the total deaths from Zymotic Diarrhoea during the past eight years have occurred; and practically the whole of the mortality occurs there in August and September. As in former years, this area was specially scavenged during August and September of last year, and arrangements were also made for the weekly flushing of the gullies situated in different courts. CONSUMPTION. The following table serves to show how Stoke Newington stands among the Metropolitan Boroughs in respect to this Disease:— 114 METROPOLITAN BOROUGHS. Standardised death-rates from Consumption per 1,ooo living at all ages, 1911:— Names of Metropolitan Boroughs. Male. Female. Holborn 2.53 1.09 Finsbury 2.51 1.18 Betllnal Green 2.36 1.08 Stepney 2.26 1.40 Bermondsey 2.16 1.45 Slioreditch 2.15 1.62 Southwark 2.12 1.33 St. Marylebone 1.97 0.80 St. Pancras 1.92 1.05 City of London 1.87 0.54 Fulham 1.83 1.15 Lambeth 1.78 0.97 Chelsea 1.76 0.88 Hackney 1.72 1.02 Battersea l.65 1.02 Camberwell 1.61 1.10 Poplar 1.61 1.14 Hammersmith 1.56 0.89 Greenwich 1.54 1.02 Westminster 1.53 0.63 Woolwich 1.51 1.15 Deptford 1.50 0.94 Paddington 1.43 0.85 Islington 1.41 0.97 Stoke Newington 1.35 0.82 Kensington 1.26 0.61 Wandsworth 1.09 0.72 Lewisham 0.82 0.46 Hampstead 0.81 0.39 115 TABLE V. The chief vital statistics of the Borough of Stoke Newington since its formation. Year. Population estimated to middle of year. Birth-rate. Rule of Infantile Mortality. General Death-rate. Zymotic Death-rate. Infectious Sickness rate. 1901 51,328 21.6 117.9 13.1 1.26 7.9 1902 51,188 22.0 114.7 13.3 1.56 7.8 1903 51,130 21.5 120.3 12.6 1 70 3.8 1904 51,072 22.3 115.6 13.4 1.62 5.7 1905 51,015 20.9 124.7 13.0 1.35 5.8 1906 50,957 21.2 108.0 12.0 1.39 5.1 1907 50,899 20.5 97.9 11.8 1.33 7.8 1908 50,841 20.2 98.3 12.9 1.18 5.8 1909 50,784 19.5 84.9 11.7 0.87 3.5 1910 50,726 18.8 66.1 11.8 0.93 3.6 1911 50,669 20.7 106.2 12.5 1.69 4.4 1912 50,581 20.4 70.7 11.6 0.34 3.7 1913 50,454 22.0 82.7 13.1 0.85 4.6 THE MORTUARY. During the year 63 bodies were deposited in the Public Mortuary; 32 of these were females and 31 were males. Post mortem examinations were performed upon 39 of these cases, and inquests were held upon 53. 116 TABLE VA. Showing certain rates of the Metropolitan Boroughs and of the City of London for the year 1913. Cities and Boroughs Estimated Population in the middle of 1913 Annual Rate per 1,000 Living Rate of Infantile Mortality Death rate Pulmonary Tuberculosis Notifiable Diseases Attack-rate LONDON 4,518,191 14.2 1.30 6.7 105 West Districts. Paddington 142,210 13.4 1.09 6.5 100 Kensington 171,284 13.6 1.08 5.0 112 Hammersmith 123,745 13.8 1.20 6.3 103 Fulham 157,117 12.9 1.31 7.6 96 Chelsea 64,598 13.2 1.23 4.9 90 City of Westminster 154,810 13.3 1.31 4.4 96 North Districts. St. Marylebone 114,532 14.3 1.36 5.6 91 Hampstead 86,346 11.3 0.57 4.4 73 St. Pancras 214,330 15.2 1.50 5.9 92 Islington 325,585 14.8 1.33 6.6 107 Stoke Newington 50,454 13.1 0.93 4.6 83 Hackney 223,353 13.5 115 6.2 99 Central Districts. Holborn 46,949 14.7 1.87 4.8 104 Finsbury 84,679 18.1 20.1 6.3 138 City of London 17,916 15.8 1.48 5.1 96 East Districts. Shoreditch 109,654 19.2 1.79 6.6 155 Bethnal Green 127,824 16.1 1.55 7.2 118 Stepney 275,300 15.6 1.68 6.4 112 Poplar 160,913 16.1 1.46 8.2 112 South Districts. Southwark 188,487 17.6 1.85 8.0 115 Bermondsey 124,739 17.8 1.61 9.1 132 Lambeth 297,139 14.0 1.29 7.0 102 Battersea 167,464 14.0 1.13 8.2 111 Wandsworth 330,395 106 0.86 5.3 88 Camberwell 261,805 13.6 1.15 7.0 106 Deptford 109,280 15.2 1.30 10.1 112 Greenwich 96,015 14.0 1.17 7.4 103 Lewisham 168,822 10.4 0.74 7.2 78 Woolwich 122,382 13.0 1.50 9.2 79 117 INQUESTS. The following Inquests upon deaths of Parishioners were held during the year 1913:— 1st quarter 2nd quarter 3rd quarter 4th quarter Totals Accidents (Due to Falls) 2 5 1 - 8 „ (Suffocation) 1 1 1 3 6 „ (Motor) 1 2 — — 3 ,, (Crushed in Lift) 1 — — — 1 Suicide (Cut Throat) 1 1 — — 2 „ (Hanging) 1 1 — — 2 ,, (Drowning) — — 1 — 1 Kidney Disease 3 - 2 3 8 Cancer 2 1 — 1 4 Heart Disease 3 1 3 5 12 Senile Decay 2 — — 2 4 Debility 1 — — — 1 Asthma 1 — — — 1 Strangulated Hernia 1 — — — 1 Pneumonia 2 1 1 2 6 Bronchitis 1 — — — 1 Apoplexy - 3 1 — 4 Asphyxia — 1 — — 1 Phthisis — 2 1 — 3 Diphtheria — — — 1 1 Premature Birth — — 1 1 2 Convulsions — — 1 1 0 General Tuberculosis — 1 — — 1 Misadventure — — — 1 1 Tubercuious Meningitis — — — 1 1 Septicemia — — 1 — 1 Totals 23 20 14 21 78 INFECTIOUS DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table VI. that 424 Notification Certificates of Infectious Illness were received from medical practitioners, as against 343 during the preceding year. These figures include notifications of Consumption, acute Polio.myelitis, and Ophthalmia Neonatorum; and they represent a marked increase in the prevalence of communicable disease, as compared with the figures for 1913. TABLE VI. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1913. NOTIFIABLE DISEASE. Number of Cases Notified. Total Cases Notified in each Locality—(e.g., Parish or Ward) of the District Total Cases removed to Hospital At all Ages At Apes—Years. Under 1 1 to 5 5 to 15 16 to 25 25 to 45 45 to 65 65 and upwards 1 North Division. 2 South Division. Small Pox — — — — — — - - - - - Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Diphtheria, including Membranous croup 83 3 22 48 5 4 1 — 10 73 67 Erysipelas 35 - 1 4 4 12 13 1 7 28 3 Scarlet Fever 102 3 20 64 10 6 — — 23 79 82 Typhus Fever - - - - - - - - - - — Enteric Fever 9 — — — 5 4 — — 3 6 5 Relapsing Fever - - - - - - - — — — — Continued Fever - - - - - - - - — — - Puerperal Fever 2 — — — 2 — — - 1 1 2 Cerebro-spinal Meningitis 1 — — — 1 — - — — 1 1 Poliomyelitis 6 1 3 2 — — — - — 6 4 Pulmonary Tuberculosis 142 — 4 7 19 80 31 1 31 111 32 Other forms of Tuberculosis 43 — 7 26 5 4 1 - 6 37 - Ophthalmia Neonatorum 1 1 — — — — — — 1 — — Totals 424 8 57 151 51 109 46 2 82 342 196 119 These 424 cases represent infection in 409 different houses. In all homes the disinfection was performed by the Sanitary Authority. A visit was paid to every house, and it was ascertained that cases of infectious illness occurred in 6 houses where there were " grave " sanitary conditions. In arriving at these conclusions I have considered whether any sanitary defect was of a nature which is generally believed to predispose to 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 409 premises. Table VII. shows the number of cases, and of deaths, from the Infectious Diseases notified during each year since the constitution of the Borough; and Table VIII. shows the cases of Infectious Diseases notified during each month of the year 1913. The Infectious Sickness Rate of the Borough, excluding the notifications from Consumption, Cerebro.spinal Meningitis, Acute Polio.myelitis, and Ophthalmia, so as to make the rate comparable with that of former years, was 4.6 to each 1,000 of the population, as against 3.7 for the preceding year. The rate in the Northern Division was 2.6; while that in the Southern Division was 5.6. Year. Infectious Sickness Rate. Rate for London generally. 1901 7.9 8.9 1902 7.8 9.9 1903 3.8 6.0 1904 5.7 6.1 1905 5.8 7.0 1906 5.1 7.5 1907 7.8 8.6 1908 5.8 7.4 1909 3.5 6.1 1910 3.6 4.5 1911 4.4 5.3 1912 3.7 5.2 1913 4.6 6.7 120 TABLE VII. 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. Erysipelas. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1001 26 3 174 4 137 14 29 - 1902 41 8 192 5 91 5 50 3 1903 1 — 88 — 37 7 30 — 1904 8 — 153 3 60 10 53 7 1905 1 — 178 3 75 4 28 1 1906 — — 137 1 45 4 48 3 1907 - — 238 7 109 6 29 1 1908 - — 195 5 60 1 21 2 1909 — — 108 2 28 1 28 2 1910 — — 84 1 53 2 31 2 1911 — — 97 3 77 3 41 7 1912 - — 92 1 55 — 32 1 1913 — — 102 1 83 6 35 2 Puerperal Fever. Enteric Fever. Membranous Croup. Cerebro-Spinal Fever. Cases. Deaths.j Cases. Deaths. Cases. Deaths. Cases. Deaths. 1901 4 2 26 4 4 1 - - 1902 1 — 22 4 2 — — — 1903 2 2 34 5 2 — — — 1901 3 3 14 6 2 — — — 1905 1 — 10 — 4 1 — — 1906 1 1 10 — 1 — — — 1907 2 1 14 3 5 — 1 1 1908 4 2 10 4 — — 2 — 1909 4 1 11 1 1 1 — — 1910 3 2 10 2 — — 1 — 1911 — — 6 1 1 — — — 1912 3 1 3 — — — 5 — 1013 2 3* 9 2 — — 1 — *One of these cases was not notified. 121 TABLE VIII. Cases of Infectious Disease notified during each month of the year 1913. Small-pox. Scarlet Fever. Diphtheria. Membranous Croup. Enteric Fever. Puerperal Fever. Continued Fever. Erysipelas. Anterior Polio-Myelitis. Phthisis. Ophthalmia Neonatorum. Cerebro-Spinal Meningitis Other Forms of Tuberculosis Totals. January — 6 3 — — — — 1 — 11 — — — 21 February — 1 5 — 1 — — 5 — 22 — — 13 47 March — 6 6 — — — — 1 — 12 — — 8 33 April — 2 6 — — — — 1 — 10 — — 9 28 May — 5 7 — — — — 3 — 7 — — 5 27 June — 1 10 — — — — 4 2 6 — — 3 26 July — 1 9 — 2 1 — 4 — 10 — — 2 29 August — — 3 — 1 — — 2 1 10 1 — — 25 Sept. — — 8 — 1 — — 3 2 19 — 1 1 42 October — — 5 — 2 1 — 6 — 15 — — — 52 November — 19 11 — 1 — — 3 — 17 — — 1 52 December — 24 10 — 1 — — 2 1 3 — — 1 42 Totals — 102 83 — 9 2 — 35 6 142 1 1 43 424 The Infectious Sickness Rate for London generally was 6.7. Of the 29 Sanitary Areas situated within the Metropolis, the lowest rates were those of Westminster and Hampstead (4.4), Stoke Newington (4.6), and Holborn (4.8), and the highest rates were those of Deptford (10.1), Woolwich (9.2), and Bermondsey (9.1). 196 of the cases notified were removed from their homes to Isolation Hospitals. 122 SCARLET FEVER. The 102 cases of Scarlet Fever occurred in 93 houses, in 3 of which there were grave insanitary conditions. There were slight insanitary conditions in 7. 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 0.03 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 0.03 1910 0.32 0.04 0.06 1911 0.06 0.04 0.05 1912 0.02 0.04 0.05 1913 0.02 0.04 0.06 This Table illustrates the progressive decline in the death. rate from Scarlet Fever which has been in evidence for many years. This is not due to decreased prevalence, but to the greater mildness of the attacks. School attendance was ascribed as the origin of the infection in 4 cases. The infection was imported into the Borough in at least 3 instances, by visits from or to infected persons dwelling outside. In at least 8 cases the infection appeared to be secondary to the infection in another member of the household. 123 In 3 cases the infection following recent operations upon the tonsils, and in 2 cases it was attributed by parents to visits to Picture Palaces. It is of interest to record 1 case of this disease which was admitted to Hospital, and went through a typical attack, being again notified as suffering from a fresh attack within 14 days after discharge; and that in another case a child was notified as suffering from this disease who had gone through a typical attack only 16 months previously. The increased prevalence of Scarlet Fever and Diphtheria in London, made it impossible for the Managers of the Fever Hospitals to admit all cases for whose admission applications were made in the late Autumn of last year, and it was only with considerable delay that several sufferers from Stoke Newington gained admittance to Hospital. ERYSIPELAS. The 35 cases of this disease represent infection in 33 different premises. In 1 of these, insanitary conditions of a slight nature existed, and in no case were the sanitary defects grave. ENTERIC OR TYPHOID FEVER. The 9 cases notified during the year all occurred in different houses. In none of these houses did insanitary conditions exist. The origin of the infection remained quite obscure in each case, and in one case the patient had been ailing for several weeks before he took to his bed and the disease was diagnosed. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.08 0.12 0.15 1902 0.08 0.12 0.13 1903 0.09 0.08 0.10 1904 0.11 0.06 0.09 1905 0.00 0.05 0.09 1906 0.00 0.05 0.09 1907 0.06 0.04 0.07 1908 0.08 0.05 0.07 1909 0.02 0.03 0.06 1910 0.04 0.04 0.05 1911 0.02 0.03 0.07 1912 0.00 0.03 0.04 1913 0.04 0.02 0.04 124 Two of the notified cases were of sufferers who became infected away from London, and the probability of shell.fish infection arose in these cases. DIPHTHERIA. The 83 cases of Diphtheria occurred in 79 houses, 8 of which were more or less insanitary. The sanitary defects were grave in 1 instance, and slight in 7. 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 1908 013 016 0.18 1904 019 0.16 0.17 1905 0.09 0.12 0.16 1906 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 0.14 1910 0.04 0.09 0.12 1911 0.06 0.13 0.13 1912 0.00 0.10 0.11 1913 0.12 0.09 0.12 This Table shows the considerable and progressive decline in the death-rate from Diphtheria which has occurred for many years. This decline is to be mainly attributed to the use of antitoxin, as the virulence of Diphtheria has not become reduced to anything approaching the same degree as in the case of Scarlet Fever. School attendance is alleged by the parents to be the cause of attack during the year. Two cases appear to have caught the infection from previous cases in the same household. In 2 cases it was very clear that a preceding Tonsilitis predisposed to an attack of Diphtheria. One case was imported into the Borough. It is of further interest to record the great number of instances in which we were informed by the parent that the children had histories of "weak throats," with frequently recurring attacks of Tonsilitis; the very mild nature of several of the attacks, and the fact that 1 case was only diagnosed and notified as suffering from 125 tlx; disease when the symptoms of Post-diphtheritic Paralysis appeared; that I case had suffered from a serious attack only 18 months previously; and that, as with Scarlet Fever, several cases occurred shortly after an attack of Measles. Many applications have been made at the offices for tubes of "antitoxin," which I store for the convenience of local practitioners. In this disease the spread of the infection (and by conscquence the mortality) is 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 supplied by the Council to the medical practitioners in Stoke Newington continue to be much appreciated. Every practitioner has been kept provided 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 statement of the applications received during 1913, together with the results of the examinations performed at the Lister Institute of Preventive Medicine, London:— Disease. Results. Total. Positive. Negative. Phthisis 45 14 59 Diphtheria 51 237 288 Enteric 3 4 7 Total 99 255 354 Since the Local Government Board has placed the matter on a satisfactory basis, by issuing an Order authorising the provision of antitoxin for both curative and prophylactic purposes, the Borough Council has availed itself of this .power in necessitous 126 cases, for the prompt administration of the remedy, before patients are removed to hospital and pending report of the bacteriological examination of swabs taken from the throats, often . goes far in the direction of preventing a fatal termination to the disease. 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 0.0l 0.38 1903 0.39 0.44 0.27 1904 0.13 0.49 0.36 1905 0.21 0.37 0.32 1906 0.19 0.40 0.27 1907 0.13 0.38 0.36 1908 0.19 0.32 0.23 1909 0.17 0.48 0.35 1910 0.22 0.41 0.23 1911 0.53 0.57 0.36 1912 0.12 0.40 0.35 1913 0.22 0.34 0.48 Whooping Cough. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.04 0.35 0.31 1902 0.27 0.41 0.29 1903 0.36 0.35 0.27 1901 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 0.20 1910 0.13 0.28 0.24 1911 0.37 0.23 0.21 1912 0.04 0.22 0.23 1913 0.12 0.17 0.14 127 ZYMOTIC DIARRHOEA. 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 0.29 1910 0.22 0.28 0.29 *1911 0.57 1.18 1.06 *1912 0.04 0.29 0.20 *1913 0.26 0.66 0.56 *Calculated from deaths occurring under two years of age. MEASLES. As compared with the preceding year, there was an increased prevalence of Measles. In the early part of the year great difficulty was experienced by the Metropolitan Asylums Board in securing a sufficient number of competent nurses for their Infectious Hospitals. This was due to the fact that the number of patients under treatment continued to be much higher than was customary in past years, mainly on account of the reception into the Managers' Hospitals of cases of Measles and Whooping Cough. We were, therefore, advised that it had been found imperative to restrict somewhat the admission of cases, and for about a fortnight the admission of non-pauper cases of Measles and Whooping Cough to the Managers' Hospitals had to be suspended. Now that some Hospital provision has been made available by the Metropolitan Asylums Board in respect to cases of Measles and Whooping Cough, the question as to whether these two diseases should be made compulsorily notifiable calls for further consideration. Seeing that the extent of this accommodation is very limited, and, therefore, soon becomes exhausted, I am disposed to believe that the prompt visitation of as many as possible of the cases which come to our knowledge from the Education Authority and other sources, and the home visitation and 128 bution of handbills of advice in those streets occupied by the poorer classes, may furnish as good results as compulsory notification, under the present circumstances. As instancing the serious nature of Measles and Whooping Cough, it may be pointed out that of the cases admitted to the Hospitals of the Metropolitan Asylums Board in 1912, 10.5 per cent. of the Measles cases died, and 8.5 per cent. of those suffering from Whooping Cough. While allowing that only the more serious cases of these diseases were admitted to Hospital, it is still noteworthy that the percentage death.rate of the cases admitted was some 2½ times higher than it was among those admitted with Scarlet Fever and Diphtheria.. PUERPERAL FEVER. Under Puerperal Fever are included the deaths from Pyasmia and Septicaemia occurring in the lying.in women. Two cases were notified during the year. Friends and relations are often found to be acting in the capacity of midwives, and thus the value of the Midwives' Act, which was passed to reduce the dangers from the practice of midwifery by unqualified persons, is materially reduced. It is satisfactory to note that the mortality among puerperal women, both from puerperal sepsis and from accidents at childbirth, is steadily decreasing. 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 1910 0.92 1.14 1911 1.02 1.34 1912 0.91 1.26 1913 0.93 1.23 129 PHTHISIS (CONSUMPTION) AND OTHER FORMS OF TUBERCULOSIS. All the ascertainable facts seem to justify the conclusion that a widespread infection of Tuberculosis takes place in infancy and early childhood, when the infection while partly of bovine origin is generally derived from human sources. The conclusion also appears to be warranted that the direct communication of the disease from a sufferer to a healthy individual rarely, if ever, occurs in adult life, under good sanitary conditions, except maybe where the contact has been very close and prolonged. Again, there can be little doubt that the wide prevalence of the disease has resulted in an increased resistance to its attack in the population generally, and that the fall in the death-rate from the disease is not only due to improved hygienic conditions, but also to this increased resistance. The mode of attack which promises the best measure of success is that which seeks to raise the sanitary standard of living. 142 cases of Consumption were notified under the Public Health (Tuberculosis) Regulations, 1912. A few facts may be worthy of record in connection with the cases notified during the year. There was certainly no family history of Consumption in 79 of the cases investigated; and it seems probable that the history was negative in some other instances. There were, therefore, about 56 per cent. of the total cases notified whose family history furnished no instance of the disease. The parental history was often in other cases suggestive of Phthisis, although one was informed that the death of the father or mother was attributed to Bronchitis or some other Pulmonary complaint. Excluding such doubtful cases of parental history of the disease, it was found that in 26 cases the father or mother (and in two cases both) had either died, or were suffering from Consumption at the time of the inquiry; and that in 12 other cases there was a history of Consumption in the brothers or sisters of the parents. Where the parent's themselves had either died or were living and suffering from the disease, in 17 cases it was the father, in 9 cases the mother, and in 2 cases both parents, who were consumptive. 130 Brothers or sisters were consumptive in 25 instances, brothers in 14, sisters in 11, and both in 5. Special reference may be made to the case of a child aged 3 years, who was notified as suffering from Tuberculosis of the Peritoneum. The father was consumptive, and the father's mother and grandmother both died of the disease. Several of his brothers had also died of Phthisis, and six cousins, living or dead, had also fallen victims to the disease. Two other young children in this family were found to be suffering from Consumption. In another case, of an adult female, the mother, the father, and three brothers had all died from Consumption; and of her two children, one had died of the disease and the other was a sufferer from it. It was found that the period during which the various individuals notified had been suffering from the disease varied considerably; from two or three weeks to as long as fourteen years in one case. It is impossible to even approximately define the period in a large number of cases, so insidious is the disease in its early stages when it is commonly regarded as nothing more than a cough. Probably 91 patients had suffered from the disease for less than 12 months, and 51 for over 12 months at the time when the inquiries were made. In 16 cases the duration of the disease had exceeded 3 years. Five of the patients had previously been in Sanatoria. The most frequent causes of the disease, in the opinion of the patients themselves, were exposure to dampness, wet and cold, influenza, repeated colds, pleurisy, pneumonia, and winter coughs. Contact with a previous case was alleged to have been the source of infection in 3 cases, and the special circumstances of 2 cases made this very probable. The occupations of the persons notified were very various. Indeed, almost all kinds of employment are entered upon the inquiry forms; and there is nothing to indicate any special prevalence of the disease in any particular form of occupation, when one bears in mind the varying extent to which different occupations attract the working.class population. 131 The compulsory notification of the disease has disclosed several instances (3) in which the patients had not been informed by the doctor notifying the disease that they were suffering from it. It is unfair to place the onus of conveying this information upon the sanitary official; and the advice which he can offer is not likely to be heeded if the patient doubts whether he is suffering from the disease. In 1 case the request was made that I should not visit, because it was undesirable to acquaint the. patient of his condition. Where this is the wish of a medical practitioner the request is, of course, complied with. The diagnosis of the medical attendant was disputed by the patient in 1 case, but a bacteriological examination proved the medical attendant to be in the right; the correctness of the diagnosis was subsequently disproved in four other instances. In practically all the cases the diagnosis was confirmed by a bacteriological examination of the sputa. In 3 instances the patients were dead within two or three days of notification; and in 5 instances the patient had been removed to the Infirmary or to Hospital by the time a notification certificate reached us. In 5 cases the patient had left the address from which they were notified; and in 2 cases false addresses were given. Some further points of interest in connection with the notified cases of Consumption are: That in 1 case the patient had spat blood occasionally for 25 years; that one individual ascribed his infection to having shared a bed for 9 months with a consumptive, and another individual to having worked at a small bench for 2 years with a sufferer from the disease; that in the case of the non-pulmonary forms of Tuberculosis, in which the bones and joints were affected, parents commonly attributed the onset of the condition to falls and injuries; and that, to instance what is probably one of the chief determining causes of consumption, namely, poverty, a consumptive mother (a widow with three children) was found to be living upon a total income of 15s. 6d. per week, 6s. 6d. of which had to go in rent. Tuberculosis is a symptom of social pathology, and those optimists who talk of exterminating the disease in the near future 132 certainly do not appreciate the magnitude of the social problems which will also have to be solved, foremost of which is that of poverty. Our efforts will in the future, as in the past, reduce the prevalence of the disease considerably, but that the standard of living (and often of working) of the poorer section of the community is ever likely to reach such a high uniform level as to lead to a total eradication of the seeds of the disease, is difficult indeed to believe. Seventy-nine of the notified cases were recorded as insured under the Insurance Act. Judging from the deaths from Consumption, which numbered 47, there must have been, at least, 200 sufferers from the disease in the Borough during the year, and of those 142 were notified. On February 1st, 1913, the Notification and Treatment of Tuberculosis Order, 1912, came into operation. Every medical practitioner is now required to notify to the Medical Officer of Health of the sanitary area in which the patient lives any case of Tuberculosis which he diagnoses. All forms of the disease have to be notified, except cases which are diagnosed solely from tests with Tuberculin. In the absence of sufficient provision to isolate or even to adequately supervise the advanced cases which are notified to me, the infection spreads in some of the homes of Stoke Newington, and this will remain so until more comprehensive measures are adopted. It is obvious that the project of dealing with Consumption on both the preventative and curative side, on anything approaching a useful scale, would entail a cost which would represent a considerable increase upon the local rates. But this difficulty has been partly met, so far as the provision of Institutions is concerned, by a Government grant of one and a-half million pounds. The special difficulties in the way of the provision of a Tuberculosis Dispensary in Stoke Newington are considerable, and they form a good argument in favour of the County Council drawing up a scheme which meets the needs of the Metropolis as a whole, 133 and which will not necessarily be hampered by considerations of Municipal boundary lines. When, therefore, the Borough Council learnt that the Local Government Board had asked the London County Council to prepare a scheme for the Metropolis, the Borough Council decided to proceed no further with their consideration of the subject until the issue of the County Council scheme. It was not before the end of the year that the County Council decided to leave the matter in the hands of the Borough Councils, subject to those bodies making provisions satisfactory to the County Councils. In the circumstance, I again reported upon this subject, and after considering the alternative scheme of obtaining premises and making suitable provisions within the Borough, the Committee came to the conclusion that the most economical and efficient scheme for Stoke Newington was one by which the advantages of the Metropolitan Hospital, Kingsland Road, may be utilised. The Borough Council of Hackney had already approached the Metropolitan Hospital Directors, and obtained an expression of their willingness and desire to co-operate with that Council in the establishment of a Tuberculosis Dispensary, and a scheme embracing both Hackney and Stoke Newington is at present under discussion. The aim of a Dispensary System is to secure that not a single case of Tuberculosis shall occur unobserved or remain uncared for in the community. The patient is either treated directly by his medical adviser or at the Dispensary or is sent for treatment to the proper Institution. In the latter case every effort is made with reference to his after-care when he leaves the Institution. In the words of Sir Robert Philips, one of the most valuable functions of Tuberculosis Dispensaries is to trace the patient to his home, to get at the "tuberculous nests," to investigate faulty environment, and to search out tuberculous disease among the other members of the household, and in turn to see that these are cared for. It will be seen that neither the Out-patient Department of a Hospital, nor the Charity Organisation Offices, nor even the 134 office of the Medical Officer of Health is sufficient for these results. With all these the Dispensary must be in closest touch, but the necessary operations are so extensive and varied as to demand the provision of a special department of Public Health activity. In connection with the work of the Tuberculosis Dispensary it will be most desirable to obtain the assistance of a small Aftercare Committee to secure for patients who have been discharged from Sanatorium or who have received satisfactory treatment at the Dispensary, that advice and help about their future life and work shall be given. This necessity for after-care is set out in the Interim Report of the Departmental Committee on Tuberculosis. It will endeavour, in addition to giving advice, in some cases to obtain suitable occupation, to combat the fear of infection often felt by employers and fellow employes and to prevent relapses. At the start it may only be possible to examine suspected contacts, but the ideal to aim at later on will be an examination of every willing contact who has run substantial risks, either at the Dispensary or at home. As to finance, when preparing the scheme the Borough Council will have to arrange with the London Insurance Committee the terms on which the services of the Dispensary will be available for insured persons in the Borough. After deducting the payment made by the Insurance Committee in respect to the treatment of insured persons, the expenditure of the Borough would be met as follows:— (a) 50 per cent. from the Local Government Board. (b) 25 per cent. from the London County Council. (c) 25 per cent. out of the Borough rates. In the 42nd Annual Report of the Local Government Board, 1912-13, it is stated that a Main Dispensary with its branches for every 100,000 of the population should cost about £1,000 per annum, or 2.4d. per head of the population; sanatorium or hospital beds, on the scale of 1 for every 5,000 of the population, and at 30s. per week for sanatorium beds, and 27s. 6d. per week for hospital beds, should represent a further annual cost of about 135 7.1d. per head of population, for residential treatment. On this reckoning the gross annual cost of a complete local scheme is about 9½d. per head of population. Towards this, in the case of the insured, the repayment possible from insurance funds is about 8d. per insured person. The deficit has to be added to the cost of treating non-insured tuberculous cases (including the dependents of insured persons), the total forming a charge on the local rates, of which Government funds contribute half if the Local Government Board is satisfied with the local arrangements. The report states that up to August 30th local schemes for tuberculosis treatment had been submitted which relate to over 75 per cent. of the population of England. What are termed "complete" schemes of institutional treatment had been prepared by 34 out of the 50 English county councils and by 50 out of 72 English county borough councils. Approval had been given to the appointment of 108 "tuberculosis officers," 63 in counties and 45 in county boroughs. In nine of the cases the approved tuberculosis officer is also the local medical officer of health, but the report indicates that this arrangement must necessarily be exceptional. The present financial aspect of the scheme for "sanatorium benefit" is by no means satisfactory from the standpoint of County Councils and County Boroughs. The original is. 3d. provided for the treatment of insured patients in sanatorium and tuberculosis dispensaries promised to enable the scheme to pay its way without being bolstered up by local rates; but now that the amount for such treatment has been reduced to 8d., the Councils have a considerable expense to face, and a liability which is not definitely fixed. It is made clear in the Insurance Act that the liabilities of Insurance Committees are strictly limited to the amount of the insurance funds available; and the liability of the Treasury is limited to the payment of a share of such expenses as they may have sanctioned; but Councils are to share with the Treasury the difference between the estimated cost of treating consumptives and the amount available in insurance funds for the treatment of the insured, and for all expenditure in excess of the estimated 136 amount they are alone responsible. It is clear, therefore, that estimates as to cost, based upon the grant originally mentioned, must be revised in the light of the altered circumstances, and that these altered circumstances are responsible for a large sum from the local rates being necessary to provide for the treatment of persons who should have been paid for out of insurance funds. In my last report I offered some criticism upon the provision of "sanatorium benefit" made under the National Insurance Act. I suggested that the income of the Local Insurance Committee was not likely to prove sufficient to include the dependents of insured persons, and that the number of different and independent agencies concerned in the handling of tuberculosis individuals, each acting more or less independently of the other, was a weak point in our administration. The work of the past year shows an increasing demand for sanatorium treatment amongst the people, a demand which the Act has created and which the authorities are unable at present to supply; and the London Insurance Committee has been severely hampered by lack of funds. The organisation of the treatment of tuberculosis in London is still far from satisfactory, and progress is very slow. Both the London County Council and the Local Government Board have expressed the opinion that, so far as possible, the large general and special hospitals should be utilised. The advantages they can offer in the way of experienced staff, special departments, clinical laboratories, and beds for observation, exceed in their completeness any provisions that can be made by local authorities in the shape of dispensaries. The dispensary physician gives such information to the Borough Medical Officer as may be required, and he receives from the Borough Medical Officer such information as he desires and as may be arranged for. But apart from the provision of dispensaries, the need of many hospital beds for advanced, emergency, observational, educational and surgical cases is very great. These may be provided in separate pavilions at isolation hospitals in conveniently accessible sanatoria or in special hospitals, while arrangements may be made with general hospitals for receiving operative and other special cases. 137 The Metropolitan Asylums Board has recently expressed its willingness to enter into agreement with the London County Council and the London Insurance Committee for the provision of residential institutional accommodation for insured persons and their dependents as well as for non-insured persons. They have agreed to find accommodation in existing institutions where possible, to provide one or two new sanatoriums for early adult cases, and to refer to a Committee the desirability of purchasing the Mount Vernon Hospital. More than half the deaths from non-pulmonary tuberculosis are of children under 5 years of age; and it is probable that a much higher percentage of the total number of persons suffering from non-pulmonary tuberculosis are children of this age. It is hoped that notification of these cases will facilitate the investigation of the sources of infection, and assist in securing improvement in the conditions under which the children live. ACUTE POLIO-MYELITIS AND CEREBRO-SPINAL FEVER. These two diseases, which had previously been made compulsorily notifiable by many Local Authorities, were required to be generally notified by a General Order of the Local Government Board, which took effect on September 1st, 1912. The reasons for making these diseases compulsorily notifiable were discussed at length in my Annual Report for 1912. Cerebro-spinal fever is by far the more fatal of the two. THE DISINFECTING AND CLEANSING STATION. During the year ending December 31st, 1913, the following disinfecting and cleansing work was performed at the station:— Total number of textile articles disinfected 14,311 Total number of books from Public Library disinfected 121 Total number of verminous persons cleansed 417 138 Of the verminous persons cleansed, 415 were children of school ages, and 2 were adults. In addition to the disinfection of rooms on account of the notified infectious diseases, 163 were fumigated on account of vermin, 26 on account of consumption, and 19 on account of cancer. During the year the Borough Council continued its agreement with the Education Department of the London County Council to bathe and cleanse verminous school children. On receiving application from the London County Council, the Borough Council, desirous of extending the utility of its Cleansing Station to school children attending elementary schools on the borders of Stoke Newington and within easy access of the Cleansing Station, decided that in addition to providing for the cleansing of verminous school children attending the elementary schools within the Borough, it was prepared to undertake the cleansing of children attending the Newington Green School, the Hindle Street, High Street (Hackney), and St. Jude's Schools (Islington), subject to the undertaking that in no one week are more than 20 children to be dealt with. The Shelter has been maintained during the year. The Borough Council is under a statutory obligation to maintain this provision, and in the event of an epidemic of certain diseases, it. will prove a useful auxiliary means of checking the spread. The Shelter was never quite suitable for the purpose, and as it became increasingly difficult to adequately deal with the dilapidations of the old premises so used, the Council decided during the year to provide more suitable accommodation. NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR 1913. 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; 4,369 premises were inspected for conditions injurious or dangerous to health, and insanitary conditions varying in their nature from slight to very grave were discovered 139 in a large number of instances; 610 Intimation Notices, followed in 22 cases by Statutory Notices, were complied with. Of 4,369 premises inspected, only 195 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. In the case of 49 of the complaints received, no nuisance existed at the time of inspection. 3,823 re-inspections were made, making a total for the year of 8,192 inspections. The slaughter-houses, bakehouses, cowsheds and dairies, the common lodging-house and the registered houses let in lodgings, situated in the Borough, were all inspected during the year. FOOD INSPECTION. The amount of unwholesome food seized in Stoke Newington 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 has been surrendered for destruction during the year, the particulars of which are shown in the Report of the Chief Sanitary Inspector. It is to be hoped that in the near future all obviously unsound food will be thus surrendered. During the year many systematic efforts were made to detect the sale of diseased meat within the Borough, and I am glad to say that, with few exceptions, our inspections have not called for any seizures. STABLE MANURE. In recent years there has been a constant decrease in the amount of stable manure in London owing to the displacement of horse by motor traffic. Nuisance from this source is therefore very much less than formerly, a fact which is also partly due to the enforcement of the regulations requiring periodical removal. 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 public health, that they should be registered and inspected at frequent intervals. 140 By the end of the year 1913, 220 such premises were on the Register. THE HOUSING AND TOWN PLANNING ACT, 1909. During 1913 the houses in Allan, Shakespeare, and Spenser Roads were inspected under the Act. All the facts were duly entered in the Special Register kept. No action beyond the abatement of such nuisances as were discovered was necessary in respect to these dwellings; that is to say, as no house was considered to be in a state so dangerous or injurious to health as to be unfit for human habitation, no representations had to be made to the local authority with a view to making Closing Orders, the general character of the defects found to exist being of a nature remediable under notices for the abatement of nuisances. No new houses were erected in the Borough during 1913. A large number of houses built for one family are now occupied by three, or often four, families of the poorer class. In many cases these separate homes contain no proper scullery, and there is but one copper for the use of all of them. These circumstances, by handicapping cleanliness, often lead to the dirtiness of person, clothing and rooms; and in face of a marked increase in the "tenementation" of houses in the Southern Division of Stoke Newington, the provision of Public Washhouses will, it is hoped, do something to prevent the lowering of the sanitary standard of living which is so often involved in these adverse circumstances. The proper washing and drying of body clothing, bedding and household linen is always difficult in these circumstances, and in many cases it is impossible. The one copper in the basement or on the ground floor has to be approached through someone else's kitchen or scullery; there are few, if any, conveniences in the shape of mangles, washing-board, etc., and the drying has to be done in the small room which must often serve as a living room, and which is crowded at times throughout the day. The circumstance that provision is made at their doors, by the local authority, of every convenience and contrivance to lighten and shorten labour in washing and to obtain rapid drying, and this at the price of 1½d. an hour, should be much appreciated, 141 and will be, by many who under most adverse circumstances are struggling to maintain a decent standard of living. The standard of public health is essentially the standard of cleanliness, and therefore the Public Washhouses are an important public health provision in the Borough. In such tenement houses it is common to see a complete home constituted of 2 rooms only—one with kitchen fireplace and a copper set in the wall; the other, a small room, maybe with no fireplace and no cupboard. The most serious deficiences are in respect to the inadequate space for healthy reasonable comfort and for children to play, the lack of any provision for storing food, the absence of a scullery sink for washing up, no provision for washing of body, clothing, etc., or means of storing coal or wood. When such accommodation is let to a married couple with a family such provisions represent, in my judgment, the minimum requirements of health, decency and comfort. But the problem is, how are they to be provided? Many of these tenement houses are owned by landlords who are themselves poor, and many others show a very poor return in the rentals charged for the capital they represent; and if the law is made much more stringent with reference to them, such accommodation can scarcely be available at the existing low rentals. Nevertheless, the present state of things urgently demands some betterment, and there should be an established minimum standard of requirement for any separate family dwelling. We are able to enforce water-supply on each floor so occupied, but this is often from a tap only, and (in default of slopsinks) all the dirty water has generally to be carried down one or more flights of steps. It should be made possible to demand that in addition to a water-supply there should be a proper scullery sink upon each floor. If the total number of lodgers in a tenement house exceeds 12, the landlord is required to provide 2 waterclosets, but the second water-closet is almost invariably situated against the other water-closet in the back yard. It should be a legal requirement that the second water-closets in these cases should be placed upon the first floor, where it could also serve, if necessary, 142 as a slop-sink. Provision should be required to be made for the proper storage of food in respect to each tenement. However small this may be, it should be against an external wall through which the small cupboard compartment should be lighted and ventilated. It should also be made an offence for a landlord to let 2 small rooms to a family who must necessarily overcrowd them ; and the landlord should be required to maintain his property in a sanitary state under a penalty. At present he has no obligation to do anything until insanitary conditions are belatedly discovered by the Sanitary Inspector and a notice is served upon him. The question arises whether poor-class tenements should not be annually licensed under strict and well-defined conditions as to the licensing and continuation of the license. Observing as I frequently do the dirty occupants of many of these dirty tenements, and noting the filthy and insanitary conditions for which they themselves are responsible, and the misuse and wanton destruction at their hands of the sanitary provisions which the landlord makes, one often feels much sympathy for the landlord. Practically all our demands arc made upon the landlord, but the insanitary tenant is treated as an innocent victim. Additional powers in bye-laws relating to tenement houses are needed whereby tenants themselves are made more responsible for cleanliness and proper maintenance of sanitary provisions. No legislation and no inspection will serve to maintain a proper standard of sanitary practice, but the exercise of the legal powers suggested would aid towards the one and only solution—education. Compared with previous years, the provision of new workingclass dwellings by local authorities (in the absence of private enterprise) has shown during the past two years a marked increase both in urban and rural districts, and from the Census returns it appears that there has been a notable diminution since 1901 in the proportion of the population living in 1-room and in 2-room tenements, and a corresponding increase of those living in tenements of 3 and 4 rooms. 143 FACTORIES AND WORKSHOPS. At the end of the year 1913, 272 factories, workshops ana workplaces were on the Register. As the result of the inspection of the workrooms and workplaces in the Borough, it was found that for the most part they were in a satisfactory condition, and that the requirements of the Factory and Workshops Act of 1901 were duly observed. There was 1 case of overcrowding to be dealt with, and there were 7 instances in which it was necessary to require cleansing. There were 3 occasions to require an increase in the water-closet accommodation. In 16 cases the Abstract of the Factory Acts was not affixed in the workrooms, and the Home Office was notified accordingly. There are altogether about 800 domestic workrooms in the Borough in which textile material of various kinds is being dealt with. A complete list of all out-workers has been kept in the office; the information has often been obtained by calling at the workshops, 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. 1—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions 1 2 3 4 Factories (including Factory Laundries) 54 ... ... Workshops (including Workshop Laundries) 201 52 ... Workplaces (Other than Outworkers' premises included in Part 3 of this Report). 17 ... ... Total 272 52 Nil 144 2—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Nuisances under the Public Health Acts:—* Want of Cleanliness 7 7 ... ... Want of Ventilation ... ... ... ... Overcrowding 1 1 ... ... Want of drainage of floors 3 3 ... ... Other nuisances ... 0 ... ... Sanitary accommodation insufficient 2 2 ... ... unsuitable or defective ... ... ... ... not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ... ... ... ... Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report) 50 50 ... ... Total 64 64 Nil Nil Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act as remediable under the Public Health Acts. NATURE OF WORK* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLE some Premises, Section 108. Outwork in Infected Premises, Sections 109,110. 3—HOME WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made S. (110). Prosecutions (Sections ' 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of Lists. Failing to send lists. Lists.† Outworkers.† Lists. Outworkers. Contractors Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, &c. 42 289 (2) cleaning and washing Household Linen 43 Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery 1 4 Electro-plate P ile making Brass and brass articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c. Artificial Flowers Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls Paper Bags and Boxes Brush making Pea Picking Feather sorting Carding, &c., of Buttons, &c. Stuffed Toys Basket making Total 43 293 43 *If an occupier gives out work of more than one of the classes specified in column 1. and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principle class ONLY, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in columns a, 3 and 4 are the TOTAL number of the lists received from those employers who comply strictly with the statutory duty of sending TWO lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be Even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated 146 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. N umber (1) (2) Important classes of workshops, such as workshop bake houses, may be enumerated here Miscellaneous 218 Bakehouses 23 Total number of workshops on Register 241 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) 16 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified to H.M. Inspector 5 Reports (of action taken) sent to H.M. Inspector 5 Other 2 Underground-Bakehouses (s. 101)— Certificates granted during the year Nil In use at the end of the year 18 During the year the homes of all out-workers have been inspected. Sometimes in these home-workrooms the most unsatisfactory conditions under which industrial employment is maintained are to be found, and our existing powers are insufficient, in some respects, to bring about the necessary improvements. The lighting, for instance, is often most unsatisfactory where basement rooms are used. It is true that we rarely find more than one or two engaged as out-workers in any one room, but when these work close to the window of a small basement room, and thus obtain sufficient light for working purposes, the rest of the room, sometimes occupied by children and others, is very poorly lighted, and this may be bad for them both from the standpoint of vision and of general health. Moreover, the available light, which is little enough, is often reduced on account of the windows 147 being glazed or covered for privacy, and they are sometimes further obstructed by articles being hung by the side or front of them. On these and other grounds the requirements of the Public Health (London) Act, 1891, with reference to underground rooms which are separately occupied, should be made to apply to underground workrooms. THE PUBLIC HEALTH LEGISLATION OF 1913. The year 1913 was not very fruitful in Public Health legislation. An important Act was passed to make further and better provision for the care of feeble-minded and other mentally defective persons and to amend the Lunacy Acts, and a very short Act to amend the law relating to Public Health as respects the provision and treatment of disease. This latter Act (the Public Health Prevention and Treatment of Disease Act, 1913) was passed with a view to removing some administrative difficulties which have been experienced in connection with the law relating to Public Health. Section 130 of the Public Health Act, 1875, enables the Local Government Board to make regulations for preventing the spread of Cholera or other epidemic, endemic, or infectious disease, and to declare by what authority or authorities these regulations shall be enforced. As County Councils had not been established when the Act was passed, it was considered that such Councils could not properly be declared to be authorities for carrying any such regulations into effect. But in dealing with some diseases it may be found desirable that some functions should be carried out by an authority having jurisdiction over a large area. Section 2 of the Act accordingly enables the Local Government Board to declare that one of the authorities to execute and enforce the Board's regulations, made with a view to the treatment of persons affected with Cholera or any other epidemic, endemic, or infectious disease, shall be the Council of a County, and Section 130 of the Act of 1875 will have effect accordingly as if a County Council were an 148 authority within the meaning of that section. It is, however, provided that a County Council shall not, except in case of emergency, be required to execute and enforce any such regulations without their consent. The purpose of Section 3 of the Act is to give extended powers in regard to the treatment of Tuberculosis by Local Authorities. It will enable County Councils to make any such arrangements as the Local Government Board may sanction for the treatment of this disease. It will be noted that the power thus conferred will be in addition to, and not in derogation of, any other power. Section 4 of the Act directs that any expenses incurred under the Act are to be defrayed, in the case of a Sanitary Authority, as part of the expenses incurred in the execution of the Public Health Acts, and, in the case of a County Council, as expenses for general county purposes; or, if the Local Government Board by order so direct, as expenses for special county purposes charged on such part of the county as may be provided by the order. Unfortunately no further progress with Pure Milk legislation was made during the year in review. The Board of Agriculture, however, brought into operation in May a Tuberculosis Order under the Diseases of Animals Act, which requires that the existence of bovine tuberculosis, when accompanied by emaciation or udder disease, shall be notified to the Local Authority, which is then charged with the duty of causing a veterinary inspection to be made and of securing in certain cases the slaughtering of the infected animal. A partial compensation for compulsory slaughter is payable, a State contributon of one-half of the cost of such compensation being provided for the first five years. The Publc Health Committee had under consideration in the early part of the year the Milk and Dairies Bill, which nad been introduced into the House of Commons by the President of the Local Government Board. By Section 25 of the Bill, its provisions were to apply to London, subject to such modifications as might be made by Regulations of the Local Government Board; and such Regulations might provide for any of the powers and duties of Sanitary Authorities and their Medical Officers of Health, 150 under those provisions with respect to Dairies, being exercised and performed by the London County Council and the Medical Officer of Health of the London County Council. Upon the recommendation of the Committee, the Council resolved that, whilst of opinion that it is desirable that the provisions of the Bill dealing with the danger from Tuberculous Milk, and any Regulations of the Local Government Board relating thereto, should, in so far as the appointment of Veterinary Inspectors and the inspection of cows for Tuberculosis are concerned, be exercised and performed by the London County Council, this Council strongly urges that the power to require dairymen to furnish lists of their sources of supply should be given to the Borough Councils, and the Local Authorities who administer Section 71 of the Public Health (London) Act, 1891, which deals with the danger of conveying in milk "dangerous infectious disease" within the meaning of that Act. A copy of this resolution was forwarded to the President of the Local Government Board, the local Members of Parliament, and the several Metropolitan Borough Councils. FOOD AND DRUGS. Under the Sale of Food and Drugs Act, 154 samples of food and drugs were taken and analysed. The results are shown in Table IX. 11 of the samples purchased in the Borough in 1913 were not satisfactory; and, therefore, the percentage of non-genuine samples amounted to 7.1 per cent., a figure which is below that of the preceding year, when it was 9.0 per cent. The figure for the whole country was 8.4 per cent. during the year 1912, and that for London for the same year was 8.8. 7.7 per cent. of the 65 Milk samples were unsatisfactory, as against 14.4 per cent. during the preceding year; but in some cases the deficiency below the legal limits was very slight. 30 per cent. of the milk samples were purchased on Sundays. The percentage of adulteration of milk for the whole country during 1912 was 11.9. In London the percentage of Milk samples reported against was 9.3 during 1912, as compared with 11.2 during 1911. 151 It should be added that many of the samples purchased were below the quality of the average milk supply of London, although they are a trifle above the low legal limits which have been fixed. During the year the Milk samples furnished evidence of the very general practice of "toning down," a large proportion of the samples containing fat and non-fatty matter very near to the low legal limits. Many of the samples purchased under the Sale of Food and Drugs Acts have been obtained through the employment of a deputy, for the Sanitary Inspectors are well known to tradesmen and others. All the samples of Milk, Butter, Cream and Margarine were tested for antiseptics, with the result that 2 of the samples of Milk, 4 of Cream, and 6 of Margarine were found to contain them. In no case was the amount sufficient to warrant a prosecution, and in each case boric acid was found; but in one or two instances the vendors were cautioned. Salicylic acid to the extent of five and a half grains to the pint was found in a sample of Raisin Wine. The makers were communicated with and cautioned. The objectional practice of adding preservatives to Milk is most in evidence in the summer months; and of the 23 samples purchased in Stoke Newington during July, August, and September, 1912, eleven were found to have been so drugged. The 23 Butter samples taken throughout the year were found to be satisfactory. With the exception of one which contained nearly 47 per cent. of foreign fat, I have not succeeded, in the limited number of samples with which I have had to deal, in discovering anything to take exception to. Since the use of coconut oil has extended in connection with the adulteration of butter, a careful test for this material has been made, but always with negative results. In addition to the employment of this oil in the making of Margarine it has been retailed as a substitute for lard. In my last Report I referred to the practice of "informal sampling" which may be employed by Local Authorities to discover where adulteration is being practised, without arousing 152 the suspicions of the traders; so that where matters are not found to be satisfactory subsequent samples may be obtained under the formalities of the Act with a view to the exposure and punishment of the offender. Several informal samples have been taken during the year, and it is hoped to increase this number in future years. The informal samples collected did not lead to the detection of adulteration. In Metropolitan London, as a whole, during 1912 one sample was analysed for every 179 persons, being at the rate of 5.6 per 1,000 of the population. In Stoke Newington, one sample is taken for every 324 persons, being at the rate of 3 per 1,000 of the population. The heavy fine of £100, with costs, with the alternative of 3 months' imprisonment, was imposed at Old Street Police Court during the year against a vendor of Milk containing 8 per cent, of added water. There were several previous convictions against the defendant. The persistence with which some persons continue to pursue their calling and to repeat the offence of adulteration is clear evidence that the practice is a profitable one, and that the likelihood of being convicted rarely suffices to deter the dishonest milkman. The infliction of such fines as the above is a great service to the community, because they generally have the effect of driving out of the trade an unworthy and dangerous individual. THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. It will be recalled that these Regulations restrict the use of preservatives in Milk and Cream ; no preservative may be added to Milk in any case nor to fresh Cream which contains less than 35 per cent, by weight of fat. The Regulations, however, do not prohibit the sale of Cream containing a chemical preservative, provided (a) that the material is sold as "preserved" cream; (b) that the preservatives employed are either Boric Acid, Borax, a mixture of these substances, or Hydrogen Peroxide; and (c) that the vessel in which the preserved Cream is sold is labelled in a prescribed form with the amount and nature of the particular 15 3 preservative added. The object of the Regulations in regard to Cream is to secure that " preserved Cream " shall be distinguished, at all stages of sale, from Cream which is free from preservative. It is thus open to the Council to take action with reference to samples of Milk and Cream either under the Sale of Food and Drugs Acts or under the Regulations; and the Local Government Board expresses the view that it is generally desirable that in cases in which it appears that the Regulations have been infringed, that such action as may be necessary should be taken under the Regulations, rather than under the Sale of Food and Drugs Acts. All the samples of Milk were examined for preservatives. The samples were all taken under the Sale of Food and Drugs Act, and in two instances in which Boric Acid was discovered the vendors were duly cautioned. The 6 samples of Cream, although procured under the Sale of Food and Drugs Acts, were specially examined with regard to the provisions of the Regulations. That is to say, in every case the precise amount of fat was estimated, and the nature and amount of the preservatives also. In addition, it was seen whether each of the vessels containing the Cream was duly labelled " Preserved Cream containing Boric Acid," since the 6 samples of Cream contained fat varying from 38 to 49 per cent, by weight and Boric Acid varying from 0.18 per cent, to 0.35 per cent. Boric Acid was the only preservative employed. The vendors of the Cream containing the higher amounts of Boric Acid were cautioned. No thickening substances were found to be added to the samples of Cream examined; such addition is now made illegal by the above Regulations. Whereas it seems that in future the observance of the Regulations, in so far as they relate to Milk, can generally be tested by the ordinary operation of the sampling and analyses under the Sale of Food and Drugs Acts, it will be well to provide for the taking of a few further samples of Cream under the Regulations, and to submit these to the particular partial analyses which the circumstances seem to demand, in order to learn whether the Regulations are being carried out. 154 TABLE IX. Analyses performed under the Sale of Food and Drugs Acts during the year 1913. No. Sample Analysed. Opinion Formed. Action Taken. *1 Milk Genuine Nil. *2 Butter „ ,, *3 Milk „ „ *4 Butter „ „ *5 Milk „ „ *6 Milk 19% of added water Defendant fined £1 and 12/6 costs. *7 Milk Genuine Nil. 8 Butter „ „ 9 Milk „ „ 10 Milk „ „ 11 Milk „ „ 12 Milk „ „ 13 Gin „ „ 14 Whiskey „ „ 15 Milk „ 16 Milk „ 17 Milk „ „ 18 Butter „ „ 19 Milk „ „ 20 Butter „ „ 21 Milk 22 Milk „ „ 23 Coffee „ „ 24 Milk „ „ 25 Milk „ „ 26 Butter „ „ 27 Cream Borie acid 0*16% ... „ 28 Coffee Genuine „ 29 Brawn „ 30 Beef Sausage „ „ 31 Butter „ „ 32 Coffee „ „ 33 Flour „ 34 Oatmeal „ „ 35 Beef Sausage „ „ 36 Gin „ 37 Milk „ „ 38 Milk „ „ 39 Milk „ „ 40 Milk „ „ 41 Milk „ „ 42 Butter „ „ 43 Margarine Trace of boric acid „ 44 Milk Contains 10% less than the legal limit for fat Defendant fined 30/and 23/-. * Sunday Samples. 155 TABLE IX.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 45 Milk Genuine Nil. 46 Milk „ „ 47 Milk „ „ 48 Milk „ „ 49 Milk „ „ 50 Beef Sausage „ „ 51 Cream „ „ 52 Porter „ „ 53 Demarara Sugar „ „ 54 German Sausage 4 9 grains per lb. of boric acid „ 55 Milk Genuine „ 56 Milk Trace of boric acid Vendor cautioned. 57 Milk Genuine Nil. 58 Milk „ „ 59 Milk „ „ 60 Milk „ „ 61 Lard „ „ 62 Beef Sausage About 5 grains per lb. of boric acid „ 63 Gin Genuine „ 64 Sausage „ „ 65 Lime Water Only strength laid down in the B.P. Vendor cautioned. 66 Coffee Genuine Nil. 67 Oatmeal „ „ 68 Flour „ „ 69 Milk Slight deficiency in non-fatty solids „ 69a Butter Genuine „ 70 Milk „ „ 70a Margarine Trace of boric acid „ 71 Butter Genuine „ 72 Milk „ „ 73 Milk „ „ 74 Cream Contains 28 grains per lb. boric acid Vendors cautioned. 75 Sausage Roll Genuine Nil 76 Milk „ „ 77 Whiskey „ „ 78 Butter „ „ 79 Margarine „ „ 80 Gin „ „ 81 Butter „ „ 82 Coffee „ „ 83 Cream „ „ 84 Milk „ „ 85 Flour „ „ 86 Milk „ „ 87 Milk „ „ 88 Lime Water „ „ 156 TABLE IX.—continued. No. Sample Analysed. Opinion Formed Action Taken. 89 Milk Trace of boric acid Vendor cautioned. 90 Butter Genuine Nil 91 Milk „ „ 92 Milk „ „ 93 Lemonade Crystals „ „ 94 Milk „ „ 95 Milk „ „ 96 Milk „ „ 97 Butter „ „ 98 Milk „ „ 99 Flour „ „ 100 Milk (Informal) „ „ 101 Milk „ „ 102 Milk „ „ 103 Milk Very poor Vendor cautioned 104 Milk Contains just upon 20% of added water Defendant ordered to pay 1/13/6 costs 105 Milk Genuine Nil. 106 Milk ,, „ 107 Raisin Wine (Informal) Salicylic acid 5½ grs. per pint „ 108 Butter Genuine „ 109 Margarine „ „ 110 Coffee „ „ 111 Demarara Sugar „ „ 112 Butter „ „ 113 Margarine Trace of boric acid „ 114 Oatmeal Genuine „ 115 Cocoa „ „ 116 Gin „ „ 117 Stout „ „ 118 Steedman's Powders „ „ 119 Raisin Wine ,, „ 120 Sausages (Informal) Boric acid 10 3/10 grs. to lb „ 121 Butter Genuine „ 122 Milk „ „ 123 Butter „ „ 124 Butter Contained 46.75% of foreign fat Defendant fined £4 and £1 Is. costs. 125 Milk Genuine Nil. 126 Beef Sausage Boric 5.6 grs. to lb. „ 127 Milk Genuine „ 128 Milk „ „ 129 Milk „ „ 130 Butter „ „ 131 Cream Boric acid 0.21% „ 132 Butter Genuine „ 133 Margarine Trace of Boric acid 0.1% „ 134 Lard Genuine „ 157 TABLE IX.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 135 Butter Genuine Nil. 136 Milk „ „ 137 Salmon „ „ 138 Tongues „ „ 139 Salmon „ „ 140 Herrings „ „ 141 Potted Meat & Fish „ „ 142 Sardines Trace of tin „ 143 Separated Milk Genuine „ 144 Milk „ „ 145 Lard „ „ 146 Margarine Boric acid 0.14% „ 147 Milk Genuine „ 148 Margarine Trace of boric acid „ 149 Cheese Genuine „ 150 Sweets „ „ 151 Butter „ „ 152 Vinegar „ „ 153 Baking Powder „ „ 154 Cream Boric acid 018% „ 158 TABLE X. Showing the results of Analysis of Samples taken under the Sale of Food and Drugs Acts, during the years 1911-12 in England and Wales. Percentage Adulterated. 1912. 1911. Milk 10.9 11.9 Butter 6.0 5 1 Cheese 2.5 1.5 Margarine 2.1 2.8 Lard 0.4 0.5 Bread 0.0 0 .2 Flour 2.6 3.7 Tea 0.0 0.0 Coffee 4 .8 5.7 Cocoa 3.4 5.9 Sugar 6 .1 4.0 Mustard 2.5 2.1 Confectionery and Jam 5.5 3 .0 Pepper 0.8 0.7 Wine 10.6 4.5 Beer 5.5 5.5 Spirits 9.6 10.4 Drugs 9.0 8.5 Other Articles 10.8 9.5 All Articles 8.4 8.7 159 REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1913. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen,— I beg to present my Annual Report for the year ending December 31, 1913 :— HOUSES AND PREMISES INSPECTED. By house-to-house inspection 608 Upon complaint, under Sec. 107 (3), Public Health (London) Act, 1891 195 After notification of infectious disease 424 After Notices from builders, under By-law 14 (London County Council) 151 Stables and mews 329 Slaughter houses 9 Milkshops, dairies, and cowsheds 96 Bakehouses 45 Factories and workshops 830 Other premises inspected 1,682 4,369 Re-inspections made to examine and test work, etc 3.832 Total inspections 8,201 INTIMATION NOTICES SERVED. (Sec. 3, Public Health (London) Act, 1891.) After house-to-house inspection 227 After inspection on account of complaint 131 After infectious illness 63 With reference to stables and mews 4 ,, ,, milkshops, dairies, and cowsheds 1 ,, ,, bakehouses 7 ,, ,, factories and workshops 45 ,, ,, slaughter houses — After sundry other inspections 132 610 160 STATUTORY NOTICES. Twenty-two statutory notices were authorised by your Committee, and eighteen were served under Sec. 4, Public Health (London) Act, 1891. In the other four cases the nuisance was abated previous to the service of the notice. PROSECUTIONS ORDERED BY SANITARY AUTHORITY UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891, AND BYE-LAWS OF THE LONDON COUNTY COUNCIL. No. in Report Book Situation of Premises Nature of Offence Result of Proceedings 13057 29, Cowper Road Defective roof, dirty walls of rooms and staircase NUISANCES ABATED AND SANITARY DEFECTS REMEDIED. Dirty premises, cleansed and whitewashed 168 Dampness in dwellings remedied 77 Dilapidated ceilings, stairs, etc., repaired 57 Bell-traps and small dip-traps removed and replaced by stoneware gulleys 2 Foul traps and pans of w.c.'s cleansed or new ones substituted 50 Public-house urinals cleansed (after intimation) 2 Flushing cisterns to w.c.'s provided or repaired, and w.c.'s with insufficient water supply made satisfactory 62 Defective w.c. basins and traps removed and replaced by approved patterns 74 Stopped or choked w.c. traps cleared 13 External ventilation to w.c.'s improved 5 W.c.'s removed to more sanitary positions 3 Carried forward 513 161 Brought forward 513 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 34 Defective soil-pipes reconstructed 32 Unventilated soil-pipes ventilated Soil-pipes improperly ventilated, improved and 25 Dirty yards cleansed 22 Yards paved or re-paved with impervious material 49 Yards drained 2 Gully and other traps inside houses removed 1 Sink waste-pipes directly connected to drain, made to discharge in open-air over proper syphon gullies — Long lengths of sink, bath, and lavatory waste-pipes trapped, and made to discharge in open-air over gullies 20 Defective waste-pipes repaired 33 Foul water-cistern cleansed 3 Water-cisterns without close-fitting covers provided with proper coverings 40 Defects in water-cisterns remedied 9 Cisterns removed to more sanitary position 3 New portable dust-bins provided 112 Defective drainage re-constructed in accordance with bylaws of London County Council 147 Choked or stopped drains cleared and repaired 115 Drains ventilated or defective ventilating pipes renewed 2 Rain water pipes disconnected from drains or soil-pipes and made to discharge over gully-traps 18 Proper water-supply provided to houses 28 Defective roofs repaired 57 Defective guttering and rain water pipes repaired or renewed 47 Defective paving to floors of wash-houses repaired or renewed 17 Dirty walls of work-rooms cleansed 7 Carried forward 1,336 162 Brought forward 1,336 Proper manure receptacles provided (London County Council by-laws) 3 Cases of over-crowding abated 16 Accumulations of refuse, etc., removed 14 Areas re-paved and drained 1 Insufficiently ventilated space under wooden floors, remedied by insertion in outer walls of proper air bricks 12 Underground dwellings improved 6 Nuisances from animals abated 7 Smoke nuisance abated 5 Dirty walls and ceilings of bakehouses cleansed 6 Total 1,406 This list refers only to work carried out on notice, and does not include a large number of improvements carried out which were suggested to the owners while complying with notices. SLAUGHTER-HOUSES. The four Licensed Slaughter-houses at present in use in the Borough, are:—Nos. 118, Church Street; 165, High Street; 70, Mountgrove Road; and 55, Nevill Road. The results of inspections have been satisfactory, and the Licenses of each were renewed by the London County Council in October. COMMON LODGING-HOUSE. The one Common Lodging-house in the Borough, situate at No. 81, Church Street, is under the control of the London County Council, and is conducted in accordance with the by-laws. Your Inspectors have visited the house on several occasions. BAKEHOUSES. There are 26 bakehouses in the Borough, 20 of these being underground. Two of the latter were not in use at the end of the year. It was only found necessary to serve 7 intimation notices on the occupiers for cleansing. 163 DAIRIES, COWSHEDS, AND MILKSHOPS. 96 visits were paid to the Milkshops and Cowsheds. There are 58 Milk Vendors registered in the Borough and I Licensed Cowkeeper. During the year the cowshed at rear of 6, Allen Road had been remodelled and re-drained, and new dairy premises have been built in connection with same. COMPLAINTS. Sec. 107 (3) Public Health (London) Act, 1891. 195 complaints were received during the year, relating to 203 premises. In 49 cases, on inspection of the premises to which the complaint related, no nuisance which could be dealt with under the Pubilc Health Acts was found. 131 intimation notices were served, and a number of improvements were carried out on advice to the occupiers at the time of inspection. The Metropolitan Water Board have been notified of a number of houses where your Inspectors found waste of water occurring. STABLES AND MEWS. 329 inspections were made of the Stables and Mews in the Borough. As a result of the inspections, 4 intimation notices were served on occupiers to remove accumulations, and 3 notices to provide proper receptacles for manure. These notices were complied with. The importance of a regular inspection of these prespecially during the summer months, cannot be over-e HOUSES LET IN LODGINGS. There were 220 premises on the Register at the end of the year. The Register has been revised, and all the premises inspected. 164 In revising- The Register it is necessary to make a house-tohouse inspection in the smaller roads and streets, as the conditions of tenancy in weekly property is always changing. Re-inspections are made of all houses which are found to be badly kept. Full advantage has been taken of the London County Council General Powers Act, 1907, for enforcing the provision of a watersupply on each floor of houses let to more than one family. SALE OF FOODS AND 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 pages 154 to 157 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 Dealers in Margarine or Butter-substitutes. HOUSE-TO-HOUSE INSPECTION. House-to-house inspections were made in the following roads and streets during the year :— Adolphus Road. Allen Road. Barn Street. Barrett's Grove. Boleyn Road. Bouverie Road. Cressington Road. Hayling Road. Hewling Street. Howard Road. Leonard's Place. Martaban Road. Mason's Court. Mason's Place. Nevill Road (Tenements). Oldfield Road. Reedholm Villas. Rochester Place. Shakespeare Road. Spenser Road. S. Andrew's Mews. White Hart Court. Lordship Park Mews. It will be seen that several of the Streets which were dealt with last year under the Housing and Town Planning, etc., Act are included in the above list, as it is found necessary to make, at least, one annual inspection of this class of property. In all, 165 608 inspections were made and 227 Notices were served. In a number of houses it is found necessary to serve two Notices, one on the owner for defects in sanitary fittings, etc., and one on the occupier for dirty cisterns, yards, w.c., basins, etc., or for keeping animals under such conditions as to be a nuisance. Therefore, the proportion of Notices served to the number of houses inspected cannot be taken as an indication of the proportion of insanitary houses found. BUTCHERS', GREENGROCERS', AND FISHMONGERS' SHOPS, STALLS, Etc. The following is a list of articles of food seized or surrendered during the year :— Tinned Food. No. of Tins. cwts. qrs. lbs. Beef 134 7 0 20 Salmon 170 1 2 2 Milk 12 0 0 12 316 Other Articles :— Haddocks 100 Haddock Roes 1 0 Skate 2 20 Beef 10 Mutton 10 8 Rabbits 25 Grapes 4 Carrots 2 11 Cwt. 11 3 2 Eggs, 1,500. 3 Pairs of Kippers. 492 inspections were made during the year of premises where food is sold or prepared for sale in the Borough, the food, material, and trade utensils being thoroughly examined. The times of these inspections were varied as much as possible. The wares of a large number of itinerant vendors were also examined, with satisfactory results. 166 SMOKE ABATEMENT. Only 2 complaints were received of black smoke being emitted from chimney shafts, but upon observation being taken sufficient evidence could not be produced to recommend your Committee to take proceedings against the offenders. Cautionary Letters were written to the owners of the chimneys complained of, and visits were paid to the premises from time to time to ascertain the quality of fuel and method of stoking. Several complaints were received as to nuisances from bacon curing works and fish frying. The owners were interviewed in each case, and as a result structural improvements have been carried out which will, no doubt, prevent a recurrence of the nuisance. ICE CREAM MANUFACTURERS AND VENDORS. The premises of all ice-cream manufacturers in the Borough were visited from time to time during the summer months, as also were the barrows and utensils of itinerant vendors. In most cases the manufacture and sale of the substance was found to be carried on under satisfactory conditions. Several itinerant vendors were cautioned as to the condition of their utensils. RESTAURANT KITCHENS AND EATING HOUSES. There are 28 of these premises in the Borough. The results of the inspections, both of the food and the kitchens, have been satisfactory. Inspections have been made at various times in order to see the food in different stages of preparation. FACTORIES AND WORKSHOPS. The Register of Factories and Workshops has been maintained. There are at present 272 Factories, Workshops, and Workplaces in the Borough. These have all been inspected during the year. In addition 408 homes of outworkers have been inspected. It was found necessary to serve 54 Intimation and Statutory Notices, principally for cleansing and unsuitable or defective W.C. accommodation. In every case the nuisances were abated. 167 Of the outworkers notified from firms whose places of business are in Stoke Newington— 187 reside in Stoke Newington. 36 ,, ,, Hackney. 29 ,, ,, Islington. 27 ,, ,, Tottenham. 3 ,, .. Stepney. 2 ,, ,, Edmonton. 2 ,, ,, Shoreditch. 2 ,, ,, Ilford. 3 ,, ,, Wood Green. 2 ,, ,, Walthamstow. 1 ,, ,, Leyton. 1 ,, ,, Willesden. 1 ,, ,, West Ham. 1 ,, ,, Bethnal Green. Total 297 Notifications were received from Medical Officers of Health of persons residing in Stoke Newington but who work for firms in other Districts, as follows :— Bethnal Green 2 Camberwell 1 Chelsea 2 City of London 301 Finsbury 113 Hackney 72 Hornsey 2 Ilford 2 Islington 53 Kensington 4 Paddington 1 Shoreditch 36 Southwark 2 Greenwich 1 St. Marylebone 11 Stepney 4 168 Southgate 1 Westminster 8 Total 616 Outworkers' addresses received in error from other Boroughs, &e., and forwarded to the proper destination : — 67 forwarded to Hackney. 14 ,, ,, Islington. 3 ,, ,, Tottenham. Total 84 NOTIFICATION OF INFECTIOUS DISEASE. 424 cases were notified during the year, and in every instance an inspection of the infected premises was made; 63 intimation notices were served for insanitary conditions found. All the houses where the cases of infectious illness occurred have been disinfected; 188 by the Department, and the remainder under the supervision of the Medical Practitioner attending the case. The bedding, clothing, etc., were removed, steam disinfected, and returned in 184 instances. 196 patients were removed to Hospital. It was found necessary to strip and cleanse 19 rooms after removal or recovery of patients. 121 books which had been borrowed from the Public Library were collected from infected houses, disinfected, and returned to the Public Library. DRAINAGE PLANS AND APPLICATIONS. 37 drainage plans and applications were considered and approved by your Committee. URINALS IN CONNECTION WITH LICENSED PREMISES. There are 26 of these conveniences in the Borough, 16 of which are flushed and cleansed by the Borough Council's men. Frequent inspections were made, and generally they were found to be in a satisfactory condition. 169 TABLE OF PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS AND MARGARINE ACTS. No. of Sample Article Purchased. Result of Analysis. Result of Proceedings. 6 Milk 19 % of added water Defendant fined £1 and 12/6 costs 44 Milk Contains 10 % less than the legal limit for fat Defendant fined 30/- and 23/cosrs 104 Milk Contains just upon 20% of added water Defendant ordered to pay £1 13s. 6d. costs 124 Butter Contained 46 75 % of foreign fat Defendant fined £4 and £l 1s. costs By your direction, vendors of poor samples of food taken under the above Acts have been cautioned by the Medical Officer of Health, and further samples taken from them have given satisfactory results. I am, Gentlemen, Your obedient Servant, D. W. Matthews. 170 A LIST OF THE STREETS SITUATED IN THE BOROUGH OF STOKE NEWINGTON. (For the Guidance of Medical Practitioners, Midwives, &c.) A DEN Grove Aden Terrace Adolphus Road Allen Road Allerton Road Albion Road ,, Grove Alexandra Road Alexandra Buildings Amhurst Park (90-100 even Nos. and 93) Arthur Road Ayrsome Road Aldham Place 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 Broughton Road Brownswood Park, Green Lanes „ Road Burma Road Crossway (1 to 30) N. Side 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 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) „ „ (271 to 327) Grove Lodge Yard Hamilton Place Harcombe Road Hawksley Road Hayling Road Heathland Road Henry Road Hermitage Road 1 to 25a,2 to 14 Hewling Street High Street (17-217) Hornsey Place Howard Road Imperial Avenue 171 Kersley Road King's Road Knebworth Road Kynaston Road „ Avenue Lancell Street Laver's Road Lavell Street Leconfield Road (1-33) Leonard Place Lidfield Road Lillian Street Listria Park Londesborough Road Lordship Road „ Grove ,, Park „ Terrace Lordship Park Mews Manor Road Martaban Road Marton Road Mason's Court ,, Place Matthias Road (2-122) Millard Road Milton Road Mountgrove Road (2-98) Nevill 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) Portland Road Prince George Road Princess Road „ May Road Queen Elizabeth's Walk Queens Road Reedholm Villas Rochester Place Riversdale Road (92-104) Sandbrook Road Salcombe Road Seven Sisters Road :—From Blackstock Road to Amhurst Park Shakespeare Road Shelgrove Road Shipway Terrace Somerfield Road Spenser Road Springdale Road St. Kilda's Road St. Andrew's Road ,, Mews ,, Pavement, S. Side Selsea Place Stamford Hill (1-39) Stoke Newington Road (1-135) Statham Grove Summerhouse Road Truman's Road Victoria Grove Victoria Grove West Victoria Road Walford Road Warwickshire Road Watson Street White Mart Court Wiesbaden Road Wilberforce Road Winston Road Wordsworth Road Woodland Road Woodlea Road Woodberry Down ,, Grove