STO 23 THE Metropolitan Borough of Stoke Newington Report OF THE Medical Officer of Health and Public Analyst, FOR THE YEAR 1914. BY HENRY KENWOOD, m.b., f.r.s.e., dph., f.c.s., Chadwick 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 99-115 Infantile Mortality 103-108 Infant Care Work 105-108 The Mortuary 114 Inquests held during the Year 116 Infectious Diseases and the Measures taken to Prevent THEIR SPREAD 116-140 The Infectious Sickness Returns for the Year 118-120 Scarlet Fever 121-122 Erysipelas 122 Enteric Fever 122-123 Diphtheria 123-125 Measles and Whooping Cough 123-126 Puerperal Fever 127 Consumption 127-139 Cerebro-Spinal Fever and Acute Polio-Myelitis 139 The Disinfacting and Cleansing Station 139-140 Notes upon Sanitary Work Performed during the Year 141-167 Food Inspection 141 Houses let in Lodgings 142-143 The Housing and Town Planning Act 143 Factories and Workshops 143-147 The Public Health Legislation of 1914 147-148 Food and Drugs 148-156 Report of the Chief Sanitary Inspector 157-167 Streets in the Borough of Stoke Newington—(Appendix) 168-169 . REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1914. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Gentlemen,— The vital statistics of the Borough for the year 1914 were of a satisfactory nature. The general death-rate of 12.3 compares favourably with the corresponding rate of 14.4 for the Metropolis as a whole. The death-rate from the chief infectious diseases (0.55) 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 78.7, as against a rate of 103 for the Metropolis; this is the second lowest rate of infantile mortality since the formation of the Borough, and there were only two 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 1914 higher than in the preceding year, owing to an epidemic of Scarlet Fever which persisted for many months, and which embraced the whole of the Metropolitan area; 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 Infantile Mortality (pp. 103-108) and those on Consumption (pp. 127-139). The year 1915 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 outbreak of war led to some forebodings of an increased prevalence of disease following upon the general privation likely to result to the civil population. Fortunately, this has not hitherto been the case, and the general health of the population at home has remained quite good up to the present. The influx of Belgian refugees, many of whom were destitute, involved a danger of the importation of infectious disease into the community; but so far practically nothing of serious importance has resulted. During the latter half of the year the ordinary routine of public health administration was naturally disturbed. In common with many others, 1 was called upon to render certain duties in connection with the Military Forces; but, fortunately, the duties assigned to me have been such that I have been able to keep well in touch with the work of my Department, and for some periods was able to give my full services to it. In Stoke Newington we are not called upon to assist the Military Authorities by co-operating in the provision of Sanitary Billets, as so far no troops have been billeted within the Borough. 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. March, 1915. 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 1914, and the figure, calculated logarithmically, amounts to 50,454. 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 408, as against 416 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 1914 there were 1,029 births, viz.—524 males and 505 females. The birth-rate per 1,000 per annum was therefore 20.4, as against 22.0 for the preceding year. The births in the Northern Division of the Borough numbered 193, and the birth-rate was 11.4; while those in the Southern Division were 836, and the birth-rate was 24.9. 98 Rate for London Rate for England Year. Birth-rate. generally. 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 1914 20.4 24.6 23.6 The illegitimate births numbered 24; 13 males and 11 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 42 such births had to be added to the number registered within the Borough in 1914. It was impossible, prior to 3 years ago, 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 1914 (both rates being considerably lower), the figure was 8.1. 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 (871 as against 1,029) 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 407 deaths of residents registered in the Borough, and 214 of residents who died in Public Institutions outside of the Borough, making a total of 621 deaths. Of these 331 were of females and 290 were of males. Year. General Death-rate. Rate for London generally. Rale 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 1900 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 1914 12.3 14.4 13.6 The recorded general death-rate is therefore 12.3, as against 13.1 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 deatli-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 12.3 x 1.0438 = 12.8 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 recorded rate is below that for the preceding year, when it was 13.1. The death-rate for the whole of London was 14.4. District Mortality.—The deaths among residents of the Northern Division of the Borough numbered 179, and furnished a recorded death-rate of 10.5 per 1,000 per annum. The deaths among the residents of the Southern Division of the Borough numbered 442, and furnished a recorded death-rate of 13.2 per 1,000 per annum. 101 TABLE I. CAUSES OF AND AGES AT DEATH DURING THE YEAR 1914. 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 — — — — — — — — — — Small Fox — — — — — — — — — — Measles 1 — 1 — — — — — — — Scarlet Fever 3 — — 2 — — 1 — — — Whooping Cough 6 4 2 — — — — — — — Diphtheria and Croup 3 1 — 1 1 — — — — — Influenza 6 — — — — — 1 1 4 2 Erysipelas 2 — — — — — — 1 1 — Phthisis (Pulmonary Tuberculosis) 56 1 — — — 7 33 15 — 3 Tuberculous Meningitis 8 2 3 2 — 1 — — — — Other Tuberculous Diseases 5 2 1 — 1 1 — — — 1 Cancer, malignant disease 71 — — — — — 4 31 — 8 Rheumatic Fever 1 — — — — — 1 — — — Meningitis 7 3 1 1 1 — — 1 — — Organic Heart Disease 65 1 — — 2 1 10 20 31 3 Bronchitis 51 1 — — — — 5 8 37 10 Pneumonia (all forms) 40 10 3 1 2 — 6 7 11 — Other Diseases ot Respiratory organs 8 — — — — — — 3 5 — Diarrhœa and Enteritis. 15 12 — — — — 3 — — 1 Appendicitis and Typhlitis 4 — — 1 1 1 — — 1 — Cirrhosis of Liver 8 — — — — — — 6 2 — Alcoholism — — — — — — — — — — Nephritis and Bright's Disease 23 — — — — — 6 10 7 2 Puerperal Fever 2 — — — — — 2 — — — Other accidents and diseases of Pregnancy and Parturition 2 — — — — — 2 — — — Congenital Debility and Malformation, including Premature Birth 30 29 — 1 — — — — — 2 Violent Deaths, excluding Suicide 7 — — — — — — 4 2 — Suicide 8 — — — — — 2 3 3 — Other Defined Diseases 189 15 3 1 4 5 18 32 111 34 Diseases ill-defined or unknown — — — — — — — — — — 621 81 14 10 13 16 94 142 251 66 102 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 1914. DISEASES. NORTH. SOUTH. Quarters Total Quarters. Total 1 2 3 4 1 2 3 4 Enteric Fever — — — — — — — — — — Small Fox — — — — — — — — — — Measles — — 1 — 1 — — — — — Scarlet Fever — — — 2 2 — 1 — — 1 Whooping-cough — — 1 — 1 2 2 1 — 5 Diphtheria and Croup — — — — — 3 — — — 3 Influenza 1 — — — 1 2 1 1 1 5 Erysipelas — — — 1 1 — — — 1 1 Phthisis (Pulmonary Tuberculosis) 2 — 3 5 10 12 14 9 11 46 Tuberculous Meningitis — 1 1 — 2 1 1 — 4 6 Other Tuberculous Diseases — — — — — 2 1 2 — 5 Cancer, malignant disease 7 8 5 10 30 4 13 13 11 41 Rheumatic Fever 1 — — — 1 — — — — — Meningitis — 1 — — 1 1 —. 2 3 6 Organic Heart Disease 3 4 3 6 16 15 13 11 10 49 Bronchitis 8 2 — 3 13 15 7 4 12 38 Pneumonia (all forms) 2 1 2 9 8 8 5 8 11 32 Other Diseases of Respiratory Organs 1 — — 2 3 2 1 2 — 5 Diarrhœa and Enteritis — — 1 1 2 1 2 8 2 13 Appendicitis and Typhlitis 1 — 1 — 2 1 — — 1 2 Cirrhosis of Liver — — 1 4 5 1 — 2 — 3 Alcoholism — — — — — — — — — — Nephritis and Bright's Disease 4 1 3 2 10 5 2 2 4 13 Puerperal Fever — — — — — — — 1 1 2 Other accidents and diseases of Pregnancy and Parturition — — — — — — — — 2 2 Congenital Debility and Malformation, including Premature Birth — 2 1 2 5 3 11 8 3 25 Violent Deaths, excluding Suicide 1 — 1 — 2 1 1 1 2 5 Suicide 1 — 1 1 3 3 — 2 — 5 Other Defined Diseases 20 16 12 12 60 33 39 26 31 129 Diseases ill-defined or unknown — — — — — — — — — — Totals 52 36 37 54 179 115 114 103 110 442 103 DISTRICT MORTALITY. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Rate per 1,000 per annum. Northern Division 52 30 37 54 179 10.5 Southern Division 115 114 103 110 442 13.2 Totals 167 150 140 164 621 12.3 INFANTILE MORTALITY. There were 81 deaths registered of infants under 1 year of age, as against 1,029 births; the proportion which the deaths under 1 year of age bear to 1,000 births is, therefore, 78.7, as against 82.7 in the preceding year. The deaths under 1 year of age form 13.0 per cent. of the total deaths at all ages, whereas those for the preceding year formed 13.9 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 1914 78.7 104 105 104 TABLE III.—INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks t 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 — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping-cough — — — — 1 2 — — 1 4 Diphtheria and Croup — — — — — 1 — — — 1 Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — 2 — 2 Abdominal 4 Tuberculosis (b) — — — — — — — — 1 1 Other Tuberculous Diseases — — — — — — — — 1 1 Meningitis (not Tuberculous) — — 1 — 1 — 1 1 — 3 Convulsions 1 — — — 1 — — — — 1 Laryngitis — — — — — — — — 1 1 Bronchitis — — — — — 1 — — — 1 Pneumonia, all forms 1 — — — 1 3 2 3 1 10 Diarrhœa — — — — — — 2 1 1 4 Enteritis — — — — — 4 2 2 — 8 Gastritis — — — 1 1 1 — — — 2 Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlying 2 — — — 2 — — — — 2 Injury at birth 2 — — — 2 — — — — 2 Atelectasis 1 — — — 1 — — — — 1 Congenital Malformations (c) 2 1 — — 3 — — 1 — 4 Premature Birth 14 — 1 — 16 1 — — — 17 Atrophy, Debility and Marasmus 2 1 1 — 4 2 — 1 1 8 Other causes 2 1 — 1 4 — 2 — 2 8 27 3 3 4 37 15 9 11 9 81 105 DEATHS UNDER 1 YEAR OF AGE IN THE DIFFERENT WARDS OF THE BOROUGH DURING THE YEARS 1904, 1905, 1906, 1907, 1908, 1909, 1910, 1911, 1912, 1913 and 1914. Name of Ward 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Lordship Ward 6 9 8 1 6 2 1 2 2 1 3 Clissold Ward 8 12 6 11 4 5 4 6 5 5 1 Church Ward 24 24 18 23 19 18 18 27 14 17 17 Manor Ward 9 8 3 8 3 6 3 4 6 10 3 South Hornsey Ward 66 66 56 36 47 35 32 48 35 41 43 Palatine Ward 21 14 26 23 22 18 5 19 11 18 14 Totals 134 133 117 102 101 84 63 106 73 92 81 A comparison of the causes of Infantile Mortality in 1914 with those of the preceding year shows an increase during last year in the deaths from tuberculous conditions. It is also noteworthy that the deaths from Pneumonia and Convulsions are fewer than those recorded in the preceding year. THE INFANT CARE WORK. Miss Aldridge reports as follows :— "During 1914, 670 infants were visited shortly after birth; of these 34 were visited by the Voluntary Health Visitors. These visits were followed by 843 revisits. " It has seemed even more important since the beginning of the War to keep in close touch with every baby born in the Borough. Not only have family circumstances altered so that the poor require help to better adapt themselves to new conditions, but it is in time of War that we can best realise the great importance of the nation's physique. It is upon the infants of to-day that we shall rely for the strong men of the future, and it is much more economical to guard against illness in childhood than to treat it later in life. 106 "The grant from the London Medical Charities Fund has been of great service to the Infant Care Work throughout the year, and so have the Mayor's untiring efforts to procure warm clothing and other necessities for many infants in the Borough, who would otherwise have been without them. "Infant Weighing.—During the year 235 infants were brought to be weighed, and their total visits numbered 1,031. This branch of the Infant Care Work is growing rapidly; during last year it nearly doubled the amount of 1913. "It is satisfactory that this work should be growing, for it is the best way of keeping in touch with the mothers, and teaching them how best to look after their children and to guard them against illness. There is no doubt that much of the ill-health at present existing amongst Elementary School children could be prevented by medical supervision of the child and a better knowledge of infant care on the part of the mother during the child's earlier life. In this way both expense and suffering can be saved. "It is seldom, if ever, that when a child first attends the Weighing Centre it is fed, clothed, and generally cared for on the best lines. The greatest pitfalls naturally lie in the path of the hand-fed infants, partly because their milk has to be frequently altered in strength to meet the requirements of the growing child, and this is not an easy matter. "Patent foods are often used too early in life. A mother will tell you that she is giving her baby a patent food because milk did not satisfy him; but this is because she has not diluted the milk according to the child's requirements. For the same reason one finds bread, biscuits, and sometimes even oatmeal added to the milk of a very young baby. "The worst case of ignorant feeding that came to our knowledge during the year was that of a child, 3 months old, who came to be weighed. He was fed on the following mixture:— 2 teaspoonfuls of ground barley. 2 teaspoonfuls of condensed milk. 107 1 teaspoonful of Sugar. A bottle full (8 oz.) of water. The child only attended the Weighing Centre once; he died a few weeks later in Hospital; but one wonders what his chance of surviving would have been had he been fed on more intelligent lines. "There is great scope for Infant Care Work in Stoke Newington. The mothers are anxious to learn, and they appreciate the advice given to them; but it is becoming difficult to cope with the work and impossible to extend it (as it should be extended) without the services of a trained and experienced woman worker for about two days a week. Half of this expense could doubtless be recovered from the Local Government Board, but the other half would have to be obtained from some private source. "Of the infants brought to the Town Hall during the year, the partially or wholly artificially-fed children amounted to about 50 per cent. "A Baby Show, which was the outcome of efforts put forward by the Mayor, was held on June 18th, 1914. 41 of the children who had been attending the Infant Care Centre competed. It was not possible to dmit a larger number of the children owing to limited space. "The children's ages were from 6 months to 2 years and 4 months. They were divided into five classes for the purpose of judging. Three classes were for children under 1 year and two for children over that age. "The infant competitors included 27 breast-fed, 10 hand-fed, and 4 partly breast-fed children, and the 12 prizes given were awarded to 9 breast-fed, 2 hand-fed, and 1 partly breast-fed infants. The judging was done by Dr. Sophia Seekings, who stated that she had never seen such a fine batch of children." 108 The National Death Returns furnish conclusive evidence of the need for more maternity work whether one compares the figures of infantile or maternal mortality. Nearly all the deaths in the first week of life, and most of those in the first month of life, are due to natal or ante-natal causes, and that this sacrifice of lives is largely avoidable is shown by the great variations in the above death rates in different districts of the country. As Miss Aldridge says in her statement upon the Infant Care Work, the necessity of safeguarding child life at its origin, upon which depends the health and vigour of survivors at adult ages, appeals with tenfold earnestness when we are called upon to face the heavy losses of our nation's manhood in times of war. Recognising the inability of many Authorities to bear the entire cost of adequate schemes for the promotion of maternity and child-welfare, the Local Government Board has applied for Treasury sanction for the apportionment of drafts in respect of this work. This wise action of the Central Authority is much needed if Infant Care Work is to be extended as fully as its great public health importance demands. During the year it is proposed, with the co-operation of the local midwives, to extend the work of the Infant Care Department to expectant mothers. 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 621 deaths, 251 were of persons over 65 years af age. The proportion of deaths occurring among those of over 65 years of age to the total deaths is, therefore, 40.4 per cent. There were 187 deaths of persons over 70 years of age, and 68 of persons over 80, 12 of whom reached 90 years of age—the oldest being 96. 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. 109 SENILE MORTALITY DURING 1914. 65 to 70 70 to 80 80 to 90 90 and over Total 64 119 56 12 251 The respective ages of those over 90 were go, 90, 91, 91, 91, 91, 91, 92, 92, 94, 95, 96. 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 : An increase in the deaths from Consumption, Cancer and Scarlet Fever; a decrease in those from Lung Diseases, Premature Birth and Infant Wasting, Measles and Diphtheria. 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, Whooping Cough, Premature Birth and Infant Wasting, Summer Diarrhoea, and Lung and Heart Diseases. 110 TABLE IV. DEATHS IN PUBLIC INSTITUTIONS WITHIN THE BOROUGH, 1914. Nursing Home, Warwick House, Church St. 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. Total. 2 1 4 29 15 15 66 I. Institutions within the Borough receiving sick and infirm persons from outside the Borough. II. Institutions outside the Borough receiving sick and infirm persons from the Borough. III. Other Institutions, the deaths in which have been distributed among the two divisions of the Borough. St. Anne's House, Manor Road. Northumberland House, Green Lanes. Nursing Home, 6/8, Alexandra Road. Nursing Home, 21, Stamford Hill. Invalid Asylum, 187 High Street Nursing Home,17 Queens Road London Hospital. Hackney Infirmary. Islington Infirmary. Mildmay Cottage Hospital. German Hospital. Children's Hospital, Great Ormond Street. Great Northern Hospital. North Eastern Hospital for Children. St. Bartholmew'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. N.E. Fever Hospital. Claybury Asylum. Darenth Asylum. Tooting Bec Asylum. Colney Hatch Asylum. Banstead Asylum. Caterham Asylum. Leavesden Asylum. S.E. Fever Hospital. Long Grove Asylum. 111 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 0.55 per 1,000 per annum, as against 0.85 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 1.32 . 1.20 1914 0.55 1.43 1.21 By comparison with the preceding year there were more deaths from Scarlet Fever; but fewer deaths from Measles, Diphtheria and Enteric Fever. The lower rate is mainly due to the great reduction of the deaths from Measles. 112 Deaths from Zymotic Diseases (including Influenza, Puerperal Fever, and Erysipelas) in the year 1914. Scarlet Fever. Diphtheria. Small Pox. Enteric Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhoea and Dysentery. Influenza. Erysipelas. Total. First Quarter — 3 — — — — 2 1 3 — 9 Second ,, 1 — — — — — 2 2 1 — 6 Third „ — — — — 1 1 2 9 1 — 14 Fourth „ 2 — — — 1 — — 3 1 2 9 3 3 — 2 1 6 15 6 2 38 1913 1 6 — 2 4 11 6 17 8 2 57 ZYMOTIC DIARRHŒA. As pointed out in my last annual Report, there is a district which is (roughly speaking) enclosed by Church Walk, 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:— 113 METROPOLITAN BOROUGHS. Corrected death-rates from Consumption per 1,000 living at all ages, Metropolitan Borough. Factor for correction for age aud sex distribution. Corrected Death-rate. 1908-12. 1913. London 0.9628 1.29 1.25 Paddington 0.9198 0.96 1.00 Kensington 0.9217 0.90 1.00 Hammersmith 0.9510 1.16 1.14 Fulham 0.9779 1.29 1.28 Chelsea 0.9151 1.28 1.13 Westminster, City of 0.8422 1.04 1.10 St. Marylebone 0.8932 1.15 1.21 Hampstead 0.9021 0.61 0.51 St. Pancras 0.9322 1.47 1.40 Islington 0.9573 1.23 1.27 Stoke Newington 0.9329 0.93 0.87 Hackney 0.9730 1.27 1.12 Holborn 0.8577 1.81 1.60 Finsbury 0.9976 2.04 2.01 London, City of 0.8219 1.35 1.22 Shoreditch 1.0270 1.90 1.84 Bethnal Green 1.0436 1.66 1.62 Stepney 1.0282 1.74 1.73 Poplar 1.0222 1.45 1.49 Southwark 0.9786 1.85 1.81 Bermondsey 1.0123 1.82 1.63 Lambeth 0.9548 1.36 1.23 Battersea 0.9829 1.24 1.11 Wandsworth 0.9627 0.87 0.83 Cambervvell 0.9902 1.26 1.14 Deptford 0.9820 1.28 1.28 Greenwich 1.0040 1.23 1.17 Lewisham 0.9693 0.70 0.72 Woolwich 0.9781 1.20 1.47 114 TABLE V. The chief vital statistics of the Borough of Stoke Newington since its formation. Year. Population estimated to middle of year. Birth-rate. Rate of Infantile Mortality. General Death-rate. Zymotic Death-rate. Infectious Sickness rate. 1901 51,328 21.6 117.9 13.1 1.26 7.9 1902 51,188 22.0 114.7 13.3 1.56 7.8 1903 51,130 21.5 120.3 12.6 1.70 3.8 1904 51,072 22.3 115.6 13.4 1.62 5.7 1905 51,015 20.9 124.7 13.0 1.35 5.8 1906 50,957 21.2 108.0 12.0 1.39 5.1 1907 50,899 20.5 97.9 11.8 1.33 7.8 1908 50,841 20.2 98.3 12.9 1.18 5.8 1909 50,784 19.5 84.9 11.7 0.87 3.5 1910 50,726 18.8 66.1 11.8 0.93 3.6 1911 50,669 20.7 106.2 12.5 1.69 4.4 1912 50,591 20.4 70.7 11.6 0.34 3.7 1913 50,514 22.0 82.7 13.1 0.85 4.6 1914 50,454 20.4 78.7 12.3 0.55 8.3 THE MORTUARY. During the year 54 bodies were deposited in the Public Mortuary; 30 of these were females and 24 were males. Post mortem examinations were performed upon 26 of these cases, and inquests were held upon 43. 115 TABLE Va. Showing certain rates of the Metropolitan Boroughs and of the City of London for the year 1914. BOROUGHS Per 1,000 Persons Living Rate per 1000 Births Births Deaths from All Causes Enteric Fever Small-pox Measles Scarlet Fever Whooping Cough Diphtheria Pulmonary Tuberculosis Diarhœa and Enteritis (uuder 2 years) Total Deaths under 1 year Standardized County of London 24.3 14-4 0.03 - 0.31 0.07 0.20 0.16 1.39 27.64 104 West. Paddington 20.9 12.9 0.02 — 0.03 0.06 0.18 0.14 1.02 26.64 95 Kensington 18.8 13.1 0.01 — 0.09 0.10 0.04 0.08 1.10 19.63 94 Hammersmith 23.8 13.7 0.04 — 0.33 0.04 0.17 0.13 1.38 22.83 94 Fulham 26.5 13.8 0.06 — 0.20 0.13 0.27 0.14 1.31 30.33 113 Chelsea 20.2 12.9 0.05 — 0.05 0.08 0.09 0.12 1.35 16.17 67 City of Westminster 14.0 13.2 0.06 — 0.04 0.06 0.14 0.10 1.33 16.24 80 North. St. Marylebone 18.7 14.1 0.05 — 0.02 0.08 0.18 0.16 1.28 27.67 98 Hampstead 14.8 11.0 0.05 — 0.02 0.02 0.19 0.12 0.64 8.64 80 St. Pancras 24.5 15.6 0.02 — 0.26 0.08 0.24 0.14 1.77 23.17 92 Islington 25.2 14.8 0.05 — 0.30 0.07 0.26 0.13 1.45 27.90 105 Stoke Newington 20.4 12.8 0.00 — 0.02 0.06 0.12 0.06 1.15 15.31 78 Hackney 24.5 14.0 0.04 — 0.48 0.04 0.24 0.18 1.36 23.26 92 Central. Holborn 16.4 16.2 0.13 — 0.24 0.04 0.19 0.09 1.97 17.02 90 Finsbury 30.1 19.4 0.02 — 0.90 0.07 0.53 0.11 1.98 34.63 123 City of London 10.2 14.0 0.06 — 0.06 0.06 0.17 0.11 1.12 5.52 94 East. Shoreditch 32.1 19.6 0.02 — 1.02 0.05 0.50 0.18 2.14 42.15 141 Bethnal Green 29.7 16.6 0.03 — 0.53 0.05 0.38 0.22 1.65 45.96 137 Stepney 29.4 17.3 0.03 — 0.66 0.10 0.26 0.26 1.70 33.26 124 Poplar 31.6 16.9 0.04 — 0.41 0.06 0.19 0.21 1.67 38.44 116 South. Southwark 29.8 17.9 0.01 — 0.51 0.12 0.31 0.20 1.76 36.94 124 Bermondsey 31.0 17.4 0.02 — 0.65 0.06 0.11 0.14 1.63 36.37 125 Lambeth 23.7 14.3 0.05 — 0.20 0.05 0.14 0.17 1.42 28.77 104 Battersea 25.8 13.4 0.02 — 0.30 0.07 0.16 0.10 1.26 28.35 93 Wandsworth 20.2 11.0 0.02 — 0.08 0.04 0.17 0.12 0.90 22.17 89 Camberwell 25.2 13.6 0.02 — 0.25 0.09 0.18 0.15 1.43 21.73 99 Deptford 28.6 14.3 0.03 — 0.47 0.08 0.08 0.23 1.38 29.21 99 Greenwich 25.1 14.5 0.05 — 0.49 0.07 0.06 0.17 1.38 22.01 98 Lewisham 19.8 10.7 0.04 — 0.04 0.05 0.11 0.14 0.75 16.49 74 Woolwich 23.3 14.1 0.02 — 0.20 0.07 0.22 0.28 1.40 10.57 85 116 INQUESTS. The following Inquests upon Deaths of Parishioners were held during the year 1914. 1st quarter 2nd quarter 3rd quarter 4th quarter Totals Accidents (Bicycle) 1 - - — 1 „ (Motor) 1 — 1 — 2 „ (Suffocation) 1 2 1 1 5 „ (Overlain) 1 1 — — 2 „ (Blow on Face) — 1 — — 1 „ (Face) — 1 2 2 5 Suicide (Poisoning) 2 — 1 — 3 „ (Hanging) 1 — 1 — 2 „ (Face) 1 — — — 1 „ (Cut Throat) — — 1 1 2 Kidney Disease 5 — — 1 6 Senile Decay 4 1 — 1 6 Apoplexy 1 — — — 1 Heart Disease 4 1 6 6 17 Pneumonia 1 — 1 1 3 Bronchitis 1 — — — 1 Cerebral Softening 1 — — — 1 Congenital Defects — — 1 — 1 Convulsions — — 1 — 1 Tuberculosis — — 1 — 1 Melancholia — — 1 — 1 Misadventure — — 1 — 1 Diabetes — — — 1 1 Cancer — — — 1 1 Totals 25 7 19 15 66 INFECTIOUS DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table VI. that 545 Notification Certificates of Infectious Illness were received from medical practitioners, as against 424 during the preceding year. These figures include notifications of Consumption and Ophthalmia Neonatorum; and they represent a marked increase in the prevalence of communicable disease, as compared with the figures for 1914. This increase is due to the epidemic of Scarlet Fever which was prevalent in the Metropolitan area, more particularly during the latter part of the year. TABLE VI. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1914. NOTIFIABLE DISEASE. Number of Cases Notified. Total Cases Notified in each Locality—(e. g., Parish or Ward) of the District Total Cases removed to Hospital At all Ages At Ages—Years. Under 1 1 to 5 6 to 15 15 to 25 25 to 45 45 to 65 65 and upwards 1 North Division. 2 South Division. Small Pox - - - - - - - - - - - Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Diphtheria, including Membranous croup 99 — 27 55 7 10 — — 19 80 82 Erysipelas 49 — 3 4 3 10 19 10 10 39 1 Scarlet Fever 263 2 51 175 21 14 — — 67 196 213 Typhus Fever — — — — — — — — — — — Enteric Fever 4 — — — 2 2 — — 1 3 6 Relapsing Fever — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 3 — — — 1 2 — — — 3 2 Cerebro-spinal Meningitis — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — Ophthalmia Neonatorum 10 10 — — — — — — 4 6 — Pulmonary Tuberculosis 91 — — 4 19 52 16 — 27 64 48 Other forms of Tuberculosis 26 2 8 8 2 4 2 — 5 21 2 Totals 545 14 89 246 55 94 37 10 133 412 354 118 These 545 cases represent infection in 444 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 10 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 444 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 1914. 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 8.3 to each 1,000 of the population, as against 4.6 for the preceding year. The rate in the Northern Division was 5.7; while that in the Southern Division was 9.6. 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 1914 8.3 8.9 119 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. 1901 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 24 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 1914 — — 263 3 99 3 49 2 Puerperal Fever. Enteric Fever. Membranous Croup. Cerebro-Spinal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1901 4 2 26 4 4 1 - - 1902 1 — 22 4 2 — — — 1903 2 2 34 5 2 — — — 1904 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 — 1913 2 3* 9 2 — — 1 — 1914 3 2 4 - - - - - * One of these cases was not notified. 120 TABLE VIII. Cases of Infectious Disease notified during each month of the year 1914. 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. Jauuary — 23 14 — 1 — — 1 — 6 — 2 47 February — 8 12 — 1 — — 3 — 6 1 — 2 33 March — 15 10 — — — — 5 — 10 1 — 7 48 April — 15 10 — — — — 3 — 7 3 — 3 41 May — 18 10 — — — — 7 - 11 2 — 5 53 June — 16 3 — — — — 1 — 7 — — 1 28 July — 15 11 — 1 1 — 1 — 9 1 — — 38 August — 13 4 — — — — 2 — 6 1 — — 26 Sept. — 38 4 — — — — 2 — 6 — — — 50 October — 47 7 — 1 2 — 9 — 9 — — 1 76 November — 35 9 — — 1 — 10 — 6 — — 3 64 December — 20 5 — — — — 5 — 8 1 — 2 41 Totals — 263 99 — 4 3 — 49 — 91 10 — 26 545 The Infectious Sickness Rate for London generally was 9.0. Of the 29 Sanitary Areas situated within the Metropolis, the lowest rates were those of Holborn (5.9), Chelsea (6.4), and Hampstead (6.8); and the highest rates were those of Stepney (12.7) and Deptford (12.5). 433 of the cases notified were removed from their homes to Isolation Hospitals. 121 SCARLET FEVER. The 263 cases of Scarlet Fever occurred in 198 houses, in 5 of which there were grave insanitary conditions. There were slight insanitary conditions in 21. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.08 0.13 0.13 1902 0.09 0.12 0.15 1903 0.00 0.08 0.12 1904 0.06 0.08 0.11 1905 0.06 0.12 0.11 1906 0.02 0.11 0.10 1907 0.13 0.14 0.09 1908 0.09 0.11 0.08 1909 0.04 0.08 0.08 1910 0.02 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 1914 0.06 0.07 0.08 School attendance was ascribed as the origin of the infection in 15 cases. The infection was imported into the Borough in at least 6 instances, by visits from or to infected persons dwelling outside. In at least 18 cases the infection appeared to be secondary to the infection in another member of the household. In 4 cases the infection following recent operations upon the tonsils, and in 3 cases it was attributed by parents to visits to Picture Palaces. 122 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 in London, made it impossible for the Managers of the Fever Hospitals to admit all cases for whose admission applications were made, and it was only with considerable delay that several sufferers from Stoke Newington gained admittance to Hospital on several occasions. ERYSIPELAS. The 49 cases of this disease represent infection in 49 different premises. In 2 of these, insanitary conditions of a slight nature existed, and in no case were the sanitary defects grave. ENTERIC OR TYPHOID FEVER. The 4 cases notified during the year all occurred in different houses. In two of these houses slight insanitary conditions existed. 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 0.08 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 1914 0.00 0.03 0.05 123. In one case the infection was probably imported; the patient complaining of feeling ill ever since arriving from Japan, some seven weeks previously. DIPHTHERIA. The 99 cases of Diphtheria occurred in 79 houses, 9 of which were more or less insanitary. The sanitary defects were grave in 1 instance, and slight in 8. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.27 0.30 0.27 . 1902 0.09 0.25 0.23 1903 0.13 0.16 0.18 1904 0.19 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 1914 0.06 0.16 0.15 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 was alleged by the parents to be the cause of attack during the year in 8 instances. Two cases appear to have caught the infection from previous cases in the same household. In 3 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 - and the very mild nature of several of the attacks. 124 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 consequence 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 1914, together with ihe results of the examinations performed at the Lister Institute of Preventive Medicine, London:— Disease. Results. Positive. Negative. Total. Phthisis 51 123 174 Diphtheria 55 139 194 Enteric 3 4 7 Total 109 266 375 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 cases; for the prompt administration of the remedy, before patients are removed to hospital and pending report of the 125 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 0.51 0.38 1903 0.39 0.44 0.27 1904 0.13 0.49 0.36 1905 0.21 0.37 0.32 1906 0.19 0.40 0.27 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 1914 0.02 0.31 0.24 Whooping Cough. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.04 0.35 0.31 1902 0.27 0.41 0.29 1903 0.36 0.35 0.27 1904 0.25 0.32 0.34 1905 0.17 0.32 0.25 1906 0.32 0.26 0.23 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 1914 0.12 0.20 0.21 126 MEASLES. As compared with the preceding year, there was a much reduced prevalence of Measles. 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 distribution of handbills of advice in those streets occupied by the poorer classes, may furnish as good results as compulsory notification, under the present circumstances. In view of the increasing number of Scarlet Fever patients requiring to be admitted to the Hospitals and of the necessity of having sufficient accommodation for such patients, the admission of cases of Measles and Whooping-cough had to be temporarily suspended in 1914. ZYMOTIC DIARRHŒA. Year. Death-Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1901 0.31 0.87 0.92 1902 0.39 0.54 0.38 1903 0.25 0.63 0.50 1904 0.49 1.03 0.86 1905 0.74 0.72 0.59 1906 0.50 0.95 0.87 1907 0.24 0.32 0.30 1908 0.35 0.54 0.51 1909 0.11 0.33 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 *1914 0.24 0.69 0.48 * Calculated from deaths occurring under two years of age. 127 PUERPERAL FEVER. Under Puerperal Fever are included the deaths from Pyaemia and Septicæmia occurring in lying-in women. Two cases were notified during the year. Friends and relations are sometimes 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. The death-rate, as expressed as a rate per 1,000 registered births, was 1.9, as compared with 2.7 for the preceding year. PHTHISIS (CONSUMPTION) AND OTHER FORMS OF TUBERCULOSIS. 118 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 52 of the cases investigated; and it seems probable that the history was negative in some other instances. There were, therefore, about 44 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 10 cases the father or mother (and in 3 cases both) had either died, or were suffering from Consumption at the time of the inquiry; and that in 10 other cases there was a history of Consumption in the brothers or sisters of the parents. Where the parents themselves had PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 4th January, 1914, to the 2nd January, 1915, in the Metropolitan Borough of Stoke Newington. Age Periods Notifications on Form A Notifications on Form B Number of Notifications on Form C Number of Primary Notifications* Total Notifications on Form A Number of Primary Notifications* Total Notifications on Form B Poor Law Institutions Sanatoria 0-1 1-5 5-10 10-15 15-20 20-25 25-36 35 45 45-55 55-65 65 and wards Total Primary Notifications Under 5 5-10 10-15 Total Primary Notifications Pulmonary Males - - 1 1 2 9 20 10 3 7 - 53 75 - - - - - 12 26 „ Females — — 2 — 4 4 14 8 4 2 — 38 54 — — — — — 5 5 Non-pulmonary Miles 2 7 2 1 — 1 3 1 — 9 — 19 19 — — — — — — 1 „ Females — 1 4 1 1 — 1 — — — — 8 13 — — 1 1 1 — 1 Col. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease should be included among the "pulmonary" returns only. * PRIMARY NOTIFICATIONS relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in the area to which the return relates. Any additional notification of a case which has been previously notified in the area are regarded as duplicate. ‡ A School Medical Inspector, or the Medical Officer of Health of a county, county borough, or other district, if acting as a School Medical Inspector, is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have previously been notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, are included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification of the same case occurs on Form A, and all notifications on Form A, whether duplicate or not, should be included in this column. Cols. 15-18. Only those cases which have been notified for the first time during the year on Form B in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, are included in these columns. Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B, are included in this column. Col. 21. Only notifications on Form C made by the Medical Officers of Sanatoria, as defined in the Tuberculosis Regulations, are entered in this column. 129 either died or were living and suffering from the disease, in 6 cases it was the father, in 4 cases the mother, and in 3 cases both parents, who were consumptive. Grand-parents were infected in 6 cases. Brothers or sisters were consumptive in 11 instances, brothers in 6, sisters in 4, and both in 1. Special reference may be made to one case, in which the father, mother, 2 brothers, and 2 sisters had died of the complaint. 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 fifteen and sixteen years in 2 cases. 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 50 patients had suffered from the disease for less than twelve months, and 37 for over twelve months at the time when the inquiries were made. In 13 cases the duration of the disease had exceeded three years. Four 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. It was frequently in evidence that overwork, confinement at work, shortage of food, or alcoholism, played a part in determining the onset of the disease. Contact with a previous case was alleged to have been the source of infection in 2 cases. The occupations of the persons notified were very various. Indeed, almost all kinds of industrial employment are entered upon the inquiry forms; and there is nothing to indicate any special prevalence of the disease in any particular form of such occupation, when one bears in mind the proportions in which different occupations attract the working-class population. 130 The compulsory notification of the disease has disclosed two instances 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. In practically all the cases the diagnosis was confirmed by a bacteriological examination of the sputa. In 4 instances the patients were dead within two or three days of notification; and in 4 instances the patient had been removed to the Infirmary or to Hospital by the time a notification certificate reached us. In 3 cases the patient had left the address from which they were notified; and in 2 cases false addresses were given. Sixty-nine of the notified cases were recorded as insured under the Insurance Act. Judging from the deaths from Consumption, which numbered 56, there must have been, at least, 300 sufferers from the disease in the Borough during the year, and of those 118 were notified. 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. The Public Health Committee has long favoured the provision of a Tuberculosis Dispensary, and after considering the alternative scheme of obtaining premises and making suitable provisions within the Borough, they 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 131 obtained an expression of their willingness to co-operate with that Council in the establishment of a Tuberculosis Dispensary, and a scheme embracing both Hackney and Stoke Newington has now been adopted. 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. I share the view with many others that no measure of attack upon Tuberculosis has much chance of success unless it begins and ends with the home; unless the patient is followed there, and both he and his surroundings are appropriately dealt with. Examination of contacts, for instance, often discovers patients in an earlier stage of disease than the notified patient, and the probability of effecting a cure is much greater in the case of the discovered patient than in the case of the notified patient. It follows, then, that the success of any scheme will depend very largely upon a prompt and accurate diagnosis of those infected. The subjoined Report of the Public Health Committee was recently adopted by the Borough Council:— (D)—TUBERCULOSIS DISPENSARY. The question of providing a Dispensary to promote the early diagnosis, treatment and care of persons residing in the Borough and suffering from Tuberculosis had been considered by the Public Health Committee. When it came to the knowledge of the Committee that the London County Council was about to formulate a scheme of Dispensary Provision for the whole of the Metropolis, the Committee adjourned the further consideration of this matter until the County Council scheme was issued; but, owing mainly to the fact that several Metropolitan Boroughs had already made the provision, the County Council abandoned the proposal to formulate a scheme, and intimated to the Borough Councils that they should make their own provision, subject to compliance with certain requirements which were specified. In the circumstances, the Medical Officer of Health again reported to 132 the Committee upon this subject, and, after considering the alternative scheme of obtaining premises and making suitable provision within the Borough, the Committee came to the conclusion that the most efficient and economical scheme for Stoke .\ewington was, one by which the advantages of the Metropolitan Hospital, Kingsland Road, might be utilised. The Borough Council of Hackney had already approached the Metropolitan Hospital Authorities, and had obtained an expression of their willingness and desire to co-operate with that Council in the establishment of a Tuberculosis Dispensary, and the conditions had been brought under discussion. Before proceeding further in this matter, the Committee considered that the action which it proposed should receive the approval of the Council. It therefore asked the Council for its general approval on February 17th, 1914, when the Council resolved— "That the Council approve of the principle of providing "a Dispensary in connection with the Metropolitan Hospital, "Kingsland Road, for the diagnosis, treatment, etc., of Stoke "Newington residents suffering from Tuberculosis; and that "the Public Health Committee be authorised to negotiate with "the Hackney Borough Council and the Directors of the "Metropolitan Hospital as to terms, and then to submit to "the Council a complete scheme, with estimates as to cost." In compliance with this resolution, and upon the advice of a Sub-Committee appointed to deal with this matter, the Committee now report and recommend as follows: — (1). That the proposed Metropolitan Hospital Dispensary would serve the needs of Stoke Newington as well as the following Hackney Wards, viz.:— Areas. Population. Stamford Hill Ward 32,790 West Hackney 19,018 Kingsland 23,045 Downs 17,076 91,929 Borough of Stoke Newington 50,454 Total 142,383 133 (2). That the following be the Conditions of Agreement with the Metropolitan Hospital:— 1. The Hospital Governors are prepared to institute a Tuberculosis Dispensary in connection with the Hospital, separate and distinct from their Outpatient Department, for the examination and treatment of patients from the Boroughs of Hackney and Stoke Newington. The Dispensary shall be open to patients on at least two evenings in every week. 2. They will appoint a whole-time Medical Tuberculosis Officer, at a salary of not less than £500 per annum. The officer appointed will be "a man of experience not only in dealing with Tuberculosis affection, but also in general medicine." 3. The Dispensary will be properly equipped with apparatus by the Borough Authorities, the premises and the whole arrangements being satisfactory to the Local Government Board, the London County Council, and the Insurance Committee of the County of London. 4. The Dispensary will be under the control of the Hospital Authorities, except such administrative control as devolves on the Medical Officers of Health of the Boroughs of Hackney and Stoke Newington, as Chief Administrative Tuberculosis Officers of the Tuberculosis Scheme. 5. The Hospital shall appoint a special Advisory Committee in relation to the Tuberculosis Dispensary, consisting of certain Members of the Committee of the Hospital, together with the Medical Officers of Health for Hackney and Stoke Newington, two representatives to be nominated by each of the Borough Councils of Hackney and Stoke Newington and two to be nominated by the London Insurance Committee, of whom one shall be a Panel Doctor. 134 6. The Medical Tuberculosis Officer, upon the request of the Medical Officer of Health, shall examine at their homes persons either suffering from Tuberculosis or suspected to be suffering from this disease who are unable, or cannot be persuaded, to attend the Dispensary. He shall be available (either at the Dispensary or in the patients' own homes) for consultation and diagnosis on application being made through the Medical Officer of Health for his services by any medical practitioner practising within the Boroughs of Hackney and Stoke Newington. Where the Tuberculosis Officer has any doubt or difficulty in diagnosis or treatment of any cases of Tuberculosis, he shall have the right of consultation with Members of the Visiting Staff of the Hospital, whose decision shall be for the time being binding. 7. For the first year, as a temporary measure, subject to subsequent revision, a charge of 2s. per head for each patient's attendance at the Dispensary will be made, attendances in separate departments to be counted as separate attendances. The examination, for the detection of tubercle bacilli, of specimens of sputa of patients not attending the Dispensary, and each domiciliary visit to each patient will be charged as an attendance in each case. 8. No patient shall be treated at the Dispensary who is already under the care of a general practitioner, unless and until such general practitioner's consent or request to treat the patient has first been received. 9. The Dispensary shall be linked up to the Public Health work of the Borough and the panel work of the general practitioners in connection with the treatment of Tuberculosis under the National Insurance Act, and shall be open for inspection by the 135 London Insurance Committee, in accordance with the conditions laid down by the Insurance Committee of the County of London in their Memorandum of the 23rd April, 1914. 10. The Dispensary Scheme shall provide that the general principles set out by the London County Council in their Memorandum of the 18th November, 1913, shall be observed. 11. The Tuberculosis Officer shall carry out such duties as are prescribed by the Local Government Board's General Order of the 26th July, 1912; or any subsequent Order referring to insured persons suffering from Tuberculosis, and receiving domiciliary treatment under Panel Practitioners. (4). STATEMENT AS TO FINANCE The following extract from the Circular Letter of the Local Government Board, dated 19th December, 19131 indicated how the cost of the Dispensary would be met:— "The expenditure of the Borough Council on their Dispensary Scheme, after deducting the payment made by the Insurance Committee in respect of the treatment of insured persons, and any other contribution, will be met as follows:— (a) 50 per cent. from the Board; (b) 25 per cent. from the London County Council; (c) 25 per cent. out of the rates of the Borough. "The Board may observe that the promise of the grant of 50 per cent. of the net cost of schemes is subject to the expenditure being kept within reasonable limits." The Insurance Committee are prepared to enter into an agreement with the Borough Council for the treatment in Dispensaries of tuberculous persons who are recommended by the Committee for Sanatorium Benefit; and, in 136 tion thereof, to contribute towards the cost of maintenance of the Dispensary in proportion to the attendances made by insured patients as compared with the total number of attendances made at the Dispensary, together with an agreed sum in respect of other services rendered to the Committee. The cost of alterations and equipment to instal the Metropolitan Hospital Dispensary was estimated to be about £400. Four-fifths of this would probably be contributed by the Local Government Board, leaving £80 to be found by the two Boroughs of Hackney and Stoke Newington. About £30 would be Stoke Newington's share of this. The estimated number of sufferers from Tuberculosis in Stoke Newington is 350. If each case averaged 15 visits per year, the cost at 2s. per visit would be £525. Sundry additional expenses (including shelters) should be added, amounting to about £50, making a total annual cost of £575. Taking the contribution by the Insurance Committee as one-fifth of the total annual expenditure (viz., £115); the contribution of the Local Government Board as £230; the contribution of the London County Council as £115, there would remain an annual sum of to be met out of Local Rates. In addition it would be necessary to incur some further expenditure for the part-time services of a specially trained nurse. (5). As to Part-time Services of a Trained Nurse and the appointment of an After-care Committee:— The following is an extract from the Circular Letter of the Local Government Board, dated December 5th, 1912:— "The Board wish to emphasise the fact that it is the "duty of the Medical Officer of Health for the Sanitary "District, upon the receipt of a notification under the 137 "Tuberculosis Regulations, either himself or through an "officer acting under his instructions to make such "enquiries and take such steps as may appear to him "necessary or desirable for preventing the spread of "infection and for removing conditions favourable to "infection. These enquiries will necessarily include "investigations into sources of infection, search for con"tacts, and enquiry into housing conditions." It is hardly necessary to add that these enquiries constitute an extremely important branch of the preventative work for dealing with Tuberculosis, and that the general Scheme would be robbed of much of its value if measures were not taken to get promptly in touch with the home, and to maintain the necessary advice and assistance—even after a sufferer returned from a Sanatorium. The present staff could not adequately discharge these duties. They are otherwise fully employed. Hitherto the Medical Officer of Health has made it his practice to visit at least 90 per cent. of the cases notified, and this he would continue to do; but it would be quite impossible for him to make the large number of "followingup" visits demanded under a complete Dispensary Scheme. At least the part-time services of a specially trained nurse would be necessary. In connection with the work of the Tuberculosis Dispensary it would be most desirable to obtain the assistance of an After-care Committee, to secure for patients who had been discharged from Sanatoria or who had received satisfactory treatment at the Dispensary that advice and help about their future life and work should be given. This necessity for After-care was set out in the Interim Report of the Departmental Committee on Tuberculosis. Such Committee would endeavour in some cases, in addition to giving advice, to obtain suitable occupation, to combat the fear of infection often felt by employers and fellow employes, and to obtain relief. The Committee should be representative of all the charitable and official bodies in the Borough. 138 The Committee now begged to submit the complete scheme. The Committee had given a great deal of time and consideration to this scheme, and was of opinion that it was one which in every way met the needs of the Borough and complied with all the requirements of the various central authorities, whose approval it had every reason to believe would be given in the scheme. It promised to obtain the best and most economical results. Recommending— (a) That the complete scheme, as set out, be approved and adopted. (b) That a copy of the scheme be forwarded to the Local Government Board, the London County Council, and the London Insurance Committee for their approval. Adopted. 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. Apart from the provision of Dispensaries, the need of manyhospital 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. 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 139 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. 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. Gerebro-spinal fever is by far the more fatal of the two. No case of these diseases was notified in the Borough during 1914. THE DISINFECTING AND CLEANSING STATION. During the year ending December 31st, 1914, the following disinfecting and cleansing work was performed at the station: — Total number of textile articles disinfected 20,450 Total number of books from Public Library disinfected 233 Total number of verminous persons cleansed 375 Of the verminous persons cleansed, 374 were children of school ages, and 1 was an adult. In addition to the disinfection of rooms on account of the notified infectious diseases, 195 were fumigated on account of vermin, 30 on account of consumption, and 23 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 140 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. In connection with this work a very handicapping circumstance is the fact that many children are repeatedly found to be in a verminous condition. This is explained by the persistently verminous state of members of the household who are above or below the school age; and it seems that further powers are desirable in order to cope with such individuals. The difficulties in dealing with such people would be very great indeed. Many of them are engaged in work of some sort from early morning till late at night, and it would be necessary to take many cases before the Courts, when there would often be a great difficulty in satisfying the Magistrate that the particular person charged was in a verminous condition. While, however, we continue to get the same children back to our cleansing station, and despite what we do for such children and to their homes the vermin are "carried over" in the bodies of other members of the family not of the school age, the circumstance demands serious consideration as to what remedies are available. From the educational standpoint the work upon verminous children is of such importance that considerable efforts to' free them are warranted. A Shelter has been maintained during the year. The Borough Council is under a statutory obligation to maintain this provision. 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 make other arrangements. 141 NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR 1914. 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; 4,497 premises were inspected for conditions injurious or dangerous to health, and insanitary conditions varying in their nature from slight to very grave were discovered in a large number of instances; 557 Intimation Notices, followed in 17 cases by Statutory Notices, were complied with. Of 4,497 premises inspected, only 182 inspections were made as the result of complaints by householders and others, and this circumstance will serve to accentuate the importance of prosecuting a fairly constant system of house-to-house inspection in at least the poorer parts of the Borough. In the case of 52 of the complaints received, no nuisance existed at the time of inspection. 4,369 re-inspections were made, making a total for the year of 8,866 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 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 142 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. By the end of the year 1914 231 such premises were on the Register. During the year Dr. Sherwood New, in addition to rendering services in connection with the Child Welfare Centre, undertook an investigation into the dwellings now let as Tenements in the South Hornsey Ward of the Borough. It may be recalled that as the result of many inspections made by myself in the previous year I commented upon the circumstance of such dwellings in my Report for the year 1913. Dr. New restricted his visits to houses which had been changed from their original purpose of serving as private residences for one family to houses certain floors of which are let out to second families. It is frequently stated that this change represents the first step towards the formation of a "Slum"; but Dr. New found that the prevailing type of tenant was a good one, self-respecting and industrious, and well above the pauper line; and he gives testimony to the fact that the premises being as good as they are is due rather to the tenant than the dwelling arrangements provided. He finds, as 1 have found, that practically nothing is done to adapt the property to its new conditions. That is to say, it is rare to find any structural alterations undertaken as the result of the newconditions of occupation. He finds that it is exceptional to see any special provision for food storage and preparation, that the tenant sometimes hangs a meat safe outside the back wall, less often on the landings, but sometimes the food is stored in the living rooms; that the drying of clothes is generally done in a 143 living room or kitchen; that there is, generally speaking, a dearth of any suitable 'provision for coal storage, and it is, therefore, to be seen collected in all sorts of undesirable places; he finds that the neglect of coal storage provision in the yard or basement is due to the fear of the coal being stolen; and that the w.c. provision in many of these dwellings does not satisfy the demands either of sanitation or decency. Finally, he was impressed by the rarity of the occasions on which he saw the lid properly applied to a dust-bin, and he makes the suggestion that it is far better to use the square bin with a sloped and hinged lid attached. THE HOUSING AND TOWN PLANNING ACT, 1909. During 1914 the houses in Cressington Road, Barn Street, and Leonard's Place were specially inspected under this Act, and all the facts were duly entered in the special Register kept. No action beyond the abatement of such nuisances as were discovered was called for 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 unfit it for human habitation, no representations were made to the Local Authority with the view to obtaining Closing Orders, the general character of the defects found being of a nature remediable under notices for the abatement of nuisances. Certain other streets (Allen Road, Shakespeare Road, Milton Road, and Spenser Road), and the Courts in Stoke Newington, which were reported upon in previous years, were reinspected during the year. No new houses were erected in the Borough during 1914. The houses in Hewling Street were also inspected under this Act, and it was considered by the Committee as to whether the time had come for dealing with this street in a small Improvement Scheme. It was decided to postpone any action under the Housing and Town Planning Act, 1909, until after the end of the war. FACTORIES AND WORKSHOPS. At the end of the year 1914, 284 factories, workshops and workplaces were on the Register. 144 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 no case of overcrowding to be dealt with, but there were 10 instances in which it was necessary to require cleansing. There were 18 occasions to require improvements in the watercloset accommodation. In 4 cases the Abstract of the Factory Act 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. 1 Number of Inspections. 2 Written Notices. 3 Prosecutions 4 Factories (including Factory Laundries) 55 ... ... Workshops (including Workshop Laundries) 213 27 ... Workplaces (Other than Outworkers' premises included (in Part 3 of this Report). 16 ... ... Total 284 27 Nil 145 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 10 10 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 12 12 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 18 18 ... ... not separate for sexes ... ... ... ... 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) ... ... ... ... Total 40 40 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 Unwholesome 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, t Outworkers, t Lists. Outworkers. Contractors Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (16) (16) Wearing Apparel— (1) making, &c. 35 269 (2) cleaning and washing Household Linen 86 Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery 1 4 Electro-plate File 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 36 273 86 * If an occupier gives out work of more than one of the classes specified in column I. 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 2, 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 147 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Important classes of workshops, such as workshop bake houses, may be enumerated here Miscellaneous 229 Bakehouses 23 Total number of workshops on Register 252 5—OTHER MATTERS. Class. (1) Number (2) Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s 133) 4 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 1 Reports (of action taken) sent to H.M. Inspector 1 Other 2 Underground Bakehouses (s. 101) — Certificates granted during the year Nil In use at the end of the year 19 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 cases, to bring about the necessary improvements. 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. PUBLIC HEALTH LEGISLATION DURING 1914. The Mental Deficiency Act, 1913, came into operation during the year. 148 Ophthalmia Neonatorum (or Ophthalmia of the newly-born) was made a disease compulsorily notifiable by an Order of the Local Government Board, which took effect in April. The Elementary Education (Provision of Meals) Act, 1914, amended the Act of 1906 by legalising the provision of meals by Education Authorities during holidays, and by removing the limitation of expenditure on meals to a halfpenny rate; part of the expenditure is now repayable through Government grants. Other legislation during the year included a short amending Housing Act and New Milk and Dairies Acts for England and Scotland. It is not certain when the new legislation on milk will be put into operation. FOOD AND DRUGS. Under the Sale of Food and Drugs Act, 156 samples of food and drugs were taken and analysed. The results are shown in Table IX. 13 of the samples purchased in the Borough in 1914 were not satisfactory; and, therefore, the percentage of non-genuine samples amounted to 8.3 per cent., a figure which, is above that of the preceding year, when it was 7.1 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. 13.6 per cent. of the 81 Milk samples were unsatisfactory, as against 7.7 per cent. during the preceding year; but in some cases the deficiency below the legal limits was very slight. 22 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. It should be added that many of the samples purchased were below the quality of the average milk supply of London, although they were a trifle above the low legal limits which have been fixed. 149 Thus 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 none of the samples of Milk, but 2 of Cream, 3 of Margarine, and 10 of Butter were found to contain them. In no case was the amount sufficient to warrant a prosecution, and in each case boric acid was found; but in one or two instances the vendors were cautioned. The 24 Butter samples taken throughout the year were found to be satisfactory. With the exception of small amounts of boric acid, 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 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 150 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 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 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 is cases in which it appears that the Regulations have been infringed, 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 no instance were the Regulations infringed The 3 samples of Cream, although procured under the Sale of Food and Drugs Acts, were specially examined with regard to the provisions of the Regulations. That is to say, in every case the precise amount of fat was estimated, and the nature and amount of the preservatives also. In addition, it was seen 151 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. 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. There is extremely little fresh Cream sold in Stoke Newington. 152 TABLE IX. Analyses performed under the Sale of Food and Drugs Acts during the year, 1914. No. Sample Analysed. Opinion Formed. Action Taken. 1 Cocoa (informal) Genuine Nil. 2 Coffee „ „ 3 Butter „ „ 4 Vienna Sausage „ „ 5 Flour „ „ 6 Baking Powder „ „ 7 Bread (informal) „ „ 8 Milk „ 9 Milk 4% less than the legal limit for fat Vendor cautioned. 10 Milk Genuine Nil. 11 Milk „ „ 12 Butter „ „ 13 Milk „ „ 14 Milk „ „ 15 Milk „ „ 16 Butter Trace of boric acid „ IT Milk Genuine „ 18 Butter Trace of boric acid „ 19 Tea Genuine „ 20 Milk „ „ 21 Seidlitz Powders „ „ 22 Seidlitz Powders „ „ 23 Flour „ „ 21 Milk „ „ 25 Milk (informal) Fat 17% below legal limit „ 26 Milk Genuine „ 27 Milk „ „ 28 Milk „ „ 29 Milk „ „ 30 Milk „ „ 31 Milk „ „ 32 Ground Rice „ „ 33 Cream „ „ 34 Butter „ „ 35 Pickled Cabbage „ „ 36 Treacle „ „ 37 Stout „ „ 38 Soda Water „ „ *39 Milk „ „ *40 Milk „ „ *41 Milk „ „ *42 Milk „ „ *43 Milk „ „ *44 Milk „ „ * Sunday Samples, 153 TABLE IX.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 45 Quinine and Iron Genuine Nil. 46 Tinned Peas Trace of copper „ 47 Coffee Genuine „ 48 Demerara „ „ 49 Butter Trace of boric acid „ 50 Butter „ 51 Milk Genuine „ 52 Butter Boric acid 016% ... „ 53 Milk 3% of added water Vendor cautioned. 54 Milk Genuine Nil. 55 Milk „ „ 56 Margarine (unlabelled) Boric acid 0.2% Defendant fined £1 and 12/6 costs. 57 Milk Genuine Nil. 58 Butter „ „ 59 Olive Oil „ „ 60 Gin „ „ 61 Butter Trace of boric acid „ 62 White Pepper Genuine „ 63 Milk „ „ 64 Milk (informal) „ „ 65 Milk (informal) „ „ *66 Milk „ „ *67 Butter „ „ *68 Milk Contains 10% less than the proper amount of buttcrfat Summons withdrawn —Warranty proved. *69 Milk Genuine Nil. *70 Milk „ „ *71 Milk „ „ *72 Milk „ „ 73 Butter Borjc acid 0-28% ... „ 74 Butter „ 75 Butter Tra,pe of boric acid „ 76 Milk Genuine „ 77 Milk „ „ 78 Milk „ „ 79 Butter „ „ 80 Butter „ „ 81 Cream Boric acid 0.2% „ 82 Cream Boric acid 0.22% „ 83 Milk Genuine „ 84 Milk ,, „ 85 Milk Slight deficiency in non-fatty solids „ 86 Milk Slight deficiency in non-fatty solids „ 87 Milk Genuine „ 88 Milk „ „ * Sunday Samples. 154 TABLE IX.—continued. No. Sample Analysed. Opinion Formed Action Taken. 89 Milk Genuine Nil 90 Butter Boric acid 0.21% „ 91 Milk Genuine „ 92 Milk Slight deficiency in non-fatty solids „ 93 Milk „ 94 Milk Slight deficiency in non-fatty solids „ 95 Salmon Genuine „ 96 Salmon „ „ 97 Salmon „ „ 98 Salmon „ „ 99 Milk „ „ 100 Milk „ „ 101 Milk „ „ 102 Milk „ „ 103 Milk Slight deficiency in non-fatty solids Vendor cautioned. 104 Milk Genuine Nil. 105 Milk „ „ 106 Lard „ „ 107 Milk „ „ 108 Butter „ „ 109 Milk „ „ 110 Milk „ „ 111 Milk „ „ 112 Butter „ Vendor cautioned. 113 Milk 4 3/4% of added water 114 Milk Genuine Nil. 115 Butter „ „ 116 Milk „ „ 117 Dried Milk (informal) „ „ *118 Milk „ „ *119 Milk „ „ *120 Milk „ „ *121 Milk „ „ *122 Milk About 6% of added water Vendor cautioned 123 Milk Genuine Nil. 124 Scotch Whisky „ „ 125 Gin „ „ 126 Cocoa „ „ 127 Liquorice Powder „ „ 128 Baking Powder „ „ 129 Milk „ „ 130 Butter Boric acid 0.25% „ 131 Margarine Boric acid 0.3% „ 132 Coffee Genuine „ 133 Butter Boric acid 0.22% „ 134 Margarine (unlabelled) Boric acid 0.3% Defendant ordered to pay 23/- costs * Sunday Samples. 155 TABLE IX.—continued. No. Sample Analysed. Opinion Formed. Action Taken. 136 German Sausage Genuine Nil. 136 Milk „ „ 137 Irish Whisky „ „ 138 Milk „ „ 139 Milk „ „ 140 Lard „ „ 141 Milk „ „ 142 Butter Contains 23 grains per pound of boric acid Vendor cautioned. 143 Mixed Sweets Genuine Nil. 144 Milk „ „ 145 Milk „ „ 146 Butter „ „ 147 Margarine Flour Boric acid 0.25% „ „ 148 Genuine „ 149 Demerara Sugar „ „ 150 Vinegar „ „ 151 Milk „ „ 152 Paregoric „ „ 153 Glycerine and Borax „ „ 154 Milk „ „ 155 Cheese „ „ 156 Milk „ „ 156 TABLE X. Showing the results of Analysis of Samples taken under the Sale of Food and Drugs Acts, during the years 1912-13 in England and Wales. Percentage Adulterated. 1912. 1913. Milk 10.9 Butter 6.0 Cheese 2.5 Margarine 2.1 Lard 0.4 Bread 0.0 Flour 2.6 Tea 0.0 Coffee 4.8 Cocoa 3.4 Sugar 5.1 Mustard 2.5 Confectionery and Jam 5.5 Pepper 0.8 Wine 10.6 Beer 5.5 Spirits 9.6 Drugs 9.0 Other Articles 10.8 All Articles 8.4 * Owing to the delay in the publication o the Official Report for 1913, these figures cannot be given at the time of going to press. 157 REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1914. 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, 1914:— HOUSES AND PREMISES INSPECTED. By house-to-house inspection 486 Upon complaint, under Sec. I07 (3), Public Health (London) Act, 189I 182 After notification of infectious disease 695 After Notices from builders, under By-law 14 (London County Council) 171 Stables and mews 351 Slaughter houses 15 Milkshops, dairies, and cowsheds 93 Bakehouses 48 Factories and workshops 671 Other premises inspected 4.497 Re-inspections made to examine and test work, etc 4,369 Total inspections 8,866 INTIMATION NOTICES SERVED. (Sec. 3, Public Health (London) Act, 1891.) After house-to-house inspection 188 After inspection on account of complaint 130 After infectious illness 74 With reference to stables and mews 3 „ „ milkshops, dairies, and cowsheds „ „ bakehouses 8 „ „ factories and workshops 27 „ „ slaughter houses After sundry other inspections 127 557 158 STATUTORY NOTICES. Seventeen statutory notices were authorised by your Committee, and fourteen were served under Sec. 4, Public Health (London) Act, 1891. In the other three 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 Nuisance abated previous to issue of summons 13157 15a, Shakespeare Rd. Rooms dirty and damp, no water supply to water closet. Defective yard paving Ditto 13249 60, Bouverie Road Defective drains Ditto NUISANCES ABATED AND SANITARY DEFECTS REMEDIED. Dirty premises, cleansed and whitewashed IO2 Dampness in dwellings remedied 87 Dilapidated ceilings, stairs, etc., repaired 40 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 19 Public-house urinals cleansed (after intimation) 5 Flushing cisterns to w.c.,'s provided or repaired, and w.c.'s with insufficient water supply made satisfactory 67 Defective w.c. basins and traps removed and replaced by approved patterns 66 Stopped or choked w.c. traps cleared 11 External ventilation to w.c's improved 3 W.c.'s removed to more sanitary positions 1 Carried forward 403 159 Brought forward 403 Separate flushing cisterns fixed to w.c's which were previously flushed directly from dietary cisterns Additional w.c.'s provided in case of insufficient w.c. accommodation 27 Defective soil-pipes reconstructed 35 Unventilated soil-pipes ventilated Soil-pipes improperly ventilated, improved and 35 Dirty yards cleansed 7 Yards paved or re-paved with impervious material 44 Y ards drained 2 Gully and other traps inside houses removed 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 25 Defective waste-pipes repaired 32 Foul water-cisterns cleansed I7 Water-cisterns without close-fitting covers provided with proper coverings 37 Defects in water-cisterns remedied 4 Cisterns removed to more sanitary position 2 New portable dust-bins provided I36 Defective drainage re-constructed in accordance with bylaws of London County Council I42 Choked or stopped drains cleared and repaired I29 Drains ventilated or defective ventilating pipes renewed 8 Rain water pipes disconnected from drains or soil-pipes and made to discharge over gully-traps 6 Proper water-supply provided to houses I9 Defective roofs repaired 48 Defective guttering and rain water pipes repaired or renewed 58 Defective paving to floors of wash-houses repaired or renewed 32 Dirty walls of work-rooms cleansed II Carried forward 1,259 160 Brought forward 1,259 Proper manure receptacles provided (London County Council by-laws) 1 Cases of overcrowding abated 11 Accumulation of refuse, etc., removed II Areas re-paved and drained 2 Insufficiently ventilated space under wooden floors, remedied by insertion in outer walls of proper air bricks 8 Underground dwellings improved 3 Nuisances from animals abated 3 Smoke nuisance abated 4 -Dirty walls and ceilings of bakehouses cleansed 7 Obstructive building removed 1 Public-house urinals reconstructed 2 Total 1,312 The above list refers only to work carried out on Intimation and Statutory Notices, and does not include a large amount of improvements which were suggested to the owners of properties by your Inspectors while engaged in supervising the work entailed in abating the nuisances specified in the 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. There are still several Slaughter-houses in the Borough connected with butchers' shops, for which Licenses have not been applied for. Inspections are made from time to time to ensure that no slaughtering is carried on at these premises. 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. Unofficial visits have been made from time to time by your Inspectors, 161 BAKEHOUSES. There are 26 Bakehouses in the Borough, 20 of these being underground. 2 of the latter were uhoccupied at the end of the year. There are 4 Factory Bakehouses, the remainder being registered as Workshops. 8 Notices were served on the occupiers of Bakehouses during the year to cleanse walls and ceilings. Generally, the Bakehouses in the Borough are well kept as regards cleanliness, ventilation, etc. An examination in each case was made of the materials used by bakers and pastry cooks, and proved satisfactory. DAIRIES, COWSHEDS, AND MILKSHOPS, 93 visits were paid to the Milkshops and Cowshed. There are 64 Milk Vendors registered in the Borough and I Licensed Cowkeeper. In taking of samples at a milkshop, under the Sale of Food and Drugs Acts, it is usual to make a thorough inspection of the conditions under which the Milk is stored previous to sale, and many suggestions for improvements in the method of storage have been acted upon. COMPLAINTS. Sec. 107 (3) Public Health (London) Act, 1891. 182 complaints were received during the year, relating to 196 premises. In 51 cases, on inspection of the premises to which the complaint related, no nuisance which could be dealt with under the Public Health Acts was found. 130 intimation notices were served, and a number of improvements were carried out on advioe to the occupiers at the time of inspection. The Metropolitan Water Board have been notified of a number of cases of waste or misuse of water in the Borough. STABLES AND MEWS. 351 inspections were made during the year, and in very few cases were nuisances found to exist. Only 3 intimation notices were served for accumulations of manure and I for the absence of a proper manure receptacle. All these notices were promptly complied with. 162 HOUSES LET IN LODGINGS. There were 231 premises on the Register at the end of the year. The Register has been revised and all the premises inspected. In revising the Register each year it is necessary to make a house-to-house 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 by the owners or tenants. A number of houses occupied by more than one family have been provided with a water supply on each floor as required by the London County Council's General Powers Act, 1907. 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: — Allen Road. Leonard's Place. Bann Street. Lordship Park Mews. Barrett's Grove. Mason's Court. Boleyn Road. Mason's Place. Bouverie Road. Nevill Road (Tenements), etc. Clonbrock Road. Oldfield Road. Cowper Road. Queen Elizabeth's Walk. Cressington Road. Rochester Place. Eade Road. Salcombe Road. Hawksley Road. Shakespeare Road. Hayling Road. Spenser Road. Hewling Street. Watson Street. Howard Road. White Hart Court. Lanoell Street. Wordsworth Road. 163 It will be seen that several of the Streets which were dealt with in previous years 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. 486 inspections were made and 188 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. 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 152 to 155 showing the result of proceedings taken in respect of adulterated samples. SALE OF FOOD AND DRUGS ACT. BUTTER AND MARGARINE ACT. 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. cwt. qrs. lbs. Beef 46 2 1 24 Salmon 308 2 3 0 Milk 580 5 0 20 934 Other Articles: — Bacon 0 16 Codlings 1 0 Haddock 3 12 Skate 1 4 Cod-roes 10 164 Herrings 10 Strawberries 14 Raspberries 8 Tomatoes 6 Gooseberries 4 Cherries 3 Ton 1 10 1 19 Eggs, 100. 401 inspections were made of premises where food is sold or prepared for sale in the Borough, the food, material, and trade utensils being thoroughly examined. It will be seen that a large amount of Bacon was destroyed. The bulk of- this formed part of a cargo of Danish Pork, which was delayed in transit during the early stages of the war. The contents of a large number of fishmongers' and fruiterers' stalls were inspected and found satisfactory. 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 were found to be carried on under satisfactory conditions. Several vendors were cautioned as to the condition of their utensils and premises. RESTAURANT KITCHENS AND EATING HOUSES. There are 30 of these premises in the Borough. The results of the inspections, both of the food and the kitchens, have been satisfactory. The times of the inspections were varied as much as possible. FACTORIES AND WORKSHOPS. The Register of Factories and Workshops has been revised. There are at present 284 Factories, Workshops, and Workplaces in the Borough. These have all been inspected during the year. In addition, 404 homes of outworkers have been inspected. 165 It was found necessary to serve 27 Intimation and Statutory Notices, principally for cleansing and unsuitable or defective W.C. accommodation. In every case the nuisances were abated. Of the outworkers notified from firms whose places of business are in Stoke Newington— 109 reside in Stoke Newington. 38 „ Hackney. 26 „ „ Islington. 24 „ „ Tottenham. 3 „ „ Stepney. 1 „ „ Edmonton. 3 „ „ Shoreditch. 2 „ „ Ilford 3 „ „ Wood Green. 4 „ „ Walt hams tow. 4 „ „ Ley ton. 1 „ „ Willesden. 1 „ „ Poplar. 1 „ „ Holborn. Total 220 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 6 Bermondsey 1 Chelsea 1 City of London 309 Croydon 1 Finsbury 105 Hackney 133 Horrisey 3 Islington 150 Kensington 4 Paddington 1 166 Shoreditch 38 Southwark 2 Greenwich I St. Marylebone I I Stepney 3 St. Pancras I Tottenham 4 City of Westminster 12 786 Outworkers' addresses received in error from other Boroughs, etc., and forwarded to the proper destination: — 53 forwarded to Hackney. 16 „ „ Islington, 1 „ „ Tottenham. Total 70 NOTIFICATION OF INFECTIOUS DISEASE. 545 cases were notified during the year, and in every instance an inspection of the infected premises was made; 74 intimation notices were served for insanitary conditions found. All the houses where the cases of infectious illness occurred have been disinfected by the Department. The bedding, clothing, etc., were removed, steam disinfected, and returned in 444 instances. 354 patients were removed to Hospital. It was found necessary to strip and cleanse 31 rooms after removal or recovery of patients. 233 books which had been borrowed from the Public Library were collected from infected houses, disinfected, and returned to the Public Library. No complaints were received of any damage to, or loss of textile articles during the process of disinfection. DRAINAGE PLANS AND APPLICATIONS. 27 drainage plans and applications were considered and approved by your Committee. 167 URINALS IN CONNECTION WITH LICENSED PREMISES. There are 26 of these conveniences in the Borough, 17 of which are flushed and cleansed by the Borough Council's men. Frequent inspections have been made, and generally they were found to be in a satisfactory condition. One of these conveniences has been reconstructed an:l enlarged on advice to the owners of the property by your Inspector. TABLE OF PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS AND MARGARINE ACTS. No. of Sample Article Purchased. Result of Analysis. Result of Proceedings. 56 Margarine (unlabelled) Genuine Defendant fined £1 and 12/6 costs 68 Milk Contained 10% less than theproperamount of butter-fat Summons withdrawn— Warranty proved 134 Margarine (unlabelled) Genuine Defendant ordered to pay 23/- 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. 168 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 DARN 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, (Queen's Rd. to Brownswood Rd.) Green Lanes Brownswood Road Burma Road CROSS WAY (late Castle St) (2 to 50) N. Side Carysfort Road Chalmers Terrace Chapel Place Chesholm Road Church Path ,, Road ,, Street Clonbrock Road Clissold Road Coronation Avenue Cowper Road Cressington Road DEFOE Road Digby Road Dumont Road Dynevor Road EADE Road (2 to 66) and 1 to 27 odd Nos. Edward's Lane pAIRHOLT 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 3.S8) „ ( „ 45 „ 109a) „ (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 169 KERSLEY Road King's Road Knebworth Road Kynaston Road „ Avenue LANCELL Street Layer's Road Lavell Street Leconfield Road (1-33) Leonard Place Lidfield Road Lilian Street Listria Park Londesborough Road Lordship Road „ Grove „ Park „ Terrace Lordship Park Mews MANOR Road Martaban Road Marton Road Mason's Court „ Place Matthias Road (2-122) Millard Road Milton Road Mountgrove Road (2-98) NEVILL Road Newington Green (33-42) OLDFIELD Road OsterleyRoad 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 QEEDHOLM 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 (1-175) Statham Grove Summerhouse Road TRUMAN'S Road YICTORIA Grove Victoria Grove West Victoria Road WALFORD Road Warwickshire Road Watson Street White Hart Court Wiesbaden Road Wilberforce Road Winston Road Wordsworth Road Woodland Road Woodlea Road Woodberry Down „ Grove