With H. kenwood's Compliments. TOWN HALL, MILTON ROAD. STOKE N E WINGTON, N. 16. THE Metropolitan Borough of Stoke Newington Report OF THE Medical Officer of Health and Public Analyst, FOR THE YEAR 1920. BY HENRY KENWOOD, c.m.g., m.b., f.r.s.e., dph., f.c.s., Chadwick Professor of Public Health, University of London, Medical Officer of Health and Public Analyst. LONDON: Printed by WILKINSON BROS., LTD., 37-43, Green Lanes, N 16. STO 25 TABLE OF CONTENTS. Page The Borough of Stoke Newington 316 Vital Statistics— Population of the Borough and of each of the two Divisions 347 Births and Birth-rate 347-8 Mortality, Death-rates and causes of Mortality—with notes thereon 348-56 Infantile Mortality 350-2 Senile Mortality 352 Zymotic Mortality 352-4 Consumption Mortality 354 Cancer Mortality 354 The Mortuary and Inquests 355-6 Communicable Diseases and the Measures taken to Prevent their Spread— The Infectious Sickness Returns for the Year 356-8 Scarlet Fever 358 Enteric or Typhoid Fever 359 Diphtheria 359-61 Measles and Whooping Cough 361-2 Zymotic Diarrhoea and Enteritis 363 Influenza 363-4 Puerperal Fever 364 Tuberculosis 364-70 Cerebro-Spinal Fever and Acute Polio-Myelitis 370 Venereal Diseases 371-4 Maternity and Child Welfare 371-83 The Milk Order, 1918 383 Notes upon Sanitary Work performed during the Year 383-4 The Disinfecting and Cleansing Station 383-4 Food Inspection 385 Houses Let in Lodgings 385 Housing 385-9 Areas which are being, or may have to be, dfalt with as Unhealthy under Part 1. or Part II. of the Act of 1890 388-9 Scavenging 389-90 Factories and Workshops 390-2 Food and Drugs 392-5 Report of the Chief Sanitary Inspector 395-406 Streets in the Borough of Stoke Newington—(Appendix) 407-8 345 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1920. To the Mayor, Aldermen, and Councillora of the Metropolitan Borough of Stoke Newington. Ladies and Gentlemen,— The vital statistics of the Borough for the year 1920 are less satisfactory than those for 1919; for the general death-rate of 12'4, while low, is above that for fourteen other Metropolitan Boroughs. 1920 was a year of remarkably low death-rates for London, and indeed for the whole country; but the circumstances which favoured low death-rates over the Metropolis generally, were counterbalanced in Stoke Newington by an exceptionally heavy incidence of whooping-cough, scarlet fever and diphtheria, as compared with most of the other Boroughs of London. Therefore the Borough death-rates, while not higher than in an average year, do not show the usual satisfactory results when they are brought into comparison with those of the other Metropolitan Boroughs. The rate of Infant Mortality (the number of deaths under one year of age to every thousand births), was exactly the same as that for the Metropolis as a whole. Valuable services have been rendered by those medical officers associated with me in the work of Maternityand Child Welfare and in the prevention and cure of Tuberculosis. Considerable arrears of sanitary inspection have been made up, and the record of work by the sanitary and clerical officials of the Public Health Department is a particularly good one. I am, Ladies and Gentlemen, Your obedient Servant, HENRY KENWOOD. March, 1921. 346 THE BOROUGH OF STOKE NEWINGTON. The Borough of Stoke Newington is mainly a residential area, a considerable proportion of the population being employed elsewhere. The residences comprise those of the well-to-do and the tenements of the low-wage earner. There is no special industry carried on in the Borough, the factories and workshops are for the most part small, and the work engaged upon is of various kinds. A notable feature of the Southern portion of the Borough has been the considerable amount of tenementation within recent years of houses which were originally built for and occupied by one family. There are 8,028 dwelling houses in the Borough, the area of which comprises 863 acres. There are two very large open spaces in the Borough, viz., Clissold Park and the area of the New River Water deposition ponds, filter beds and works. The density of population is therefore only 9 3 houses per acre. THE STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health—Dr. H. R. Kenwood. Sanitary Inspectors—D. W. Matthews (Chief). A. P. Piggott. R. F. Rogers. Clerks—R. F. Rogers and S. G. Armstrong. Disinfector, &c.—F. C. Screacli. maternity and child welfare- Clinic's Medical Officers—Dr. J. S. New and Dr. M. Muncey. Superintendent—Miss H. Reeve. Health Visitors—Nurse F. Stamford. Miss Sandeman. Matron, Day Nursery—Miss Toogood. tuberculosis- Dispensary Medical Officer—Dr. L. U. Young. Tuberculosis Nurse—Nurse Ager. MEASLES, WHOOPING COUGH, Etc. Borough Nurse (Ranyard Nurse) and Nurse Ager. 347 POPULATION. The population at the last census (1911) was 50,689. The following estimate of population has been adopted by the Registrar-General for the calculation ot the death-rates and birth-rate of the borough for the year 1920:—52,984. This may prove to be a considerable under-estimate of the population, now that the National Service Registers and the Food Ticket issues are no longer available as means for arriving at the number of the population; and the disturbing effects of the war have discounted the value of the method of estimating the population on the assumption that the rate of increase which took place between the last two Censuses has been maintained (the RegistrarGeneral's method); and so the estimate is a speculative one only. An alternative method of taking the number of occupied houses in the Borough and allotting to each house the average number of persons found to be occupying a house at the last Census (1911), would doubtless under-estimate the population, having regard to the fact that a higher figure must now be taken to represent the average occupancy of each house. I believe that the present-day population of Stoke Newington exceeds 55,000. There has been no time in the history of the Borough when a Census enumeration was more needed than now, and it is a fortunate circumstance that 1921 is a Census year. The estimated population far each of the Sub-districts is as follows:— The Northern Division of the Borough (lying North of the middle line of Church Street) has a population of about 18,340; and in the Southern Division the population is approximately 34,644. BIRTHS. During the year 1920 there were 1,223 births, viz.:—642 males and 581 females. The birth-rate per 1,000 per annum was therefore 23 1, as against 16'8 for the preceding year. 348 Year. Birth.rate Rate for London generally. Kate for England and Wales. 1912 20.4 24.7 23.8 1913 22.0 24.5 23.9 1914 20.4 24.6 23.6 1915 18.4 22.6 21.8 1916 20. 1 22.2 21.6 1917 15.5 17.5 17.8 1918 14.0 16.1 17.7 1919 16.8 18.3 18.5 1920 23.1 26.5 25.4 The illegitimate births numbered 41; 24 males and 17 females. When a diminishing birth-rate is accompanied by a diminishing death-rate, a fairly satisfactory annual natural increase in the population (by excess of births over deaths), may still be maintained. The excess of the birth-rate over the death-rate for the year 1920 was 10 7 per 1,000 ; as against 13 0 for England and Wales. The Registrar.General now provides particulars of any births which occur outside of the district to which the parents belong, and which are not therefore locally registered. So that now such extra births figure in the returns of the total births allotted to the Borough. It was impossible in earlier years to make this addition, and so the birth.rates for the past few years must not be taken as strictly comparable with those of former years. 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 respective figures are 1,122 and 1,223. MORTALITY. General Mortality.—There were 396 deaths of residents registered in the Borough, and 263 of residents who died in Public Institutions outside of the Borough, making a total of 659 deaths. 349 Of these 332 were of females, and 327 were of males. Year. General Death-rate. Rate for London generally. Rate for England and Wales. 1912 11.6 13.8 13.3 1913 13.1 14.2 13* 7 1914 12.3 14.4 13.6 1915 14.6 16.1 IS.1 1916 12.6 14.3 14.0 1917 14. 1 15.0 14.4 1918 16.0 18.9 17.6 1919 12.2 13.4 13.8 1920 12.4 12.4 12.4 The recorded general death-rate is therefore 124, as against 12.2 for the preceding year. The so.called "factor for correction" for the Borough of Stoke Newington is 09512, and the death-rate corrected for age and sex distribution is 12.4X0.9512=118 per 1,000 per annum. The corrected rate is slightly above that for the preceding year, when it was 11.6. The death.rate for the whole of London was 12.4 and that for Stoke Newington is exceeded by 14 of the other 28 Metropolitan Boroughs:—The Boroughs with the lowest rates being Hampstead and Wandsworth (9.0 and 100 respectively) and the highest being Shoreditch, with 15.4. District Mortality.— The deaths among residents of the Northern Division of the Borough numbered 194, and furnished a recorded death-rate of 10 6 per 1,000 per annum. The deaths among the residents of the Southern Division of the Borough numbered 465, and furnished a recorded death-rate of 13.4 per 1,000 per annum. 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. Comparing this table with the corresponding table of the preceding year, the following facts are noteworthy: An increase 350 in the deaths from Measles and Whooping Cough, Cancer, Heart Disease, Puerperal Fever and Premature Birth: and a decrease of those from Influenza, Consumption and Kidney Disease. INFANTILE MORTALITY. There were 98 deaths registered of infants under one year of age, as against 1,223 births; the proportion which the deaths under one year of age bear to 1,000 births is, therefore, 80 1 as against 62 6 in the preceding year. The deaths under one year of age form 14 9 per cent, of the total deaths at all ages, whereas those for the preceding year formed 9 0 per cent. Year. Rate of Infantile Mortality. Rate for London generally. Rate for England and Wales. 1912 70.7 90 95 1913 82.7 105 109 1914 78.7 104 105 1915 99.8 112 110 1916 59.8 89 91 1917 85.6 103 97 1918 87.2 107 97 1919 62.6 85 89 1920 80.0 75 80 There were nine other Metropolitan Boroughs with higher Rates of Infantile Mortality, the highest being Bethnal Green, with 95. Last year the Stoke Newington Rate was the second lowest in the Metropolis. Why it should occupy such a comparatively poor position in 1920 is difficult to account for. There was certainly a considerable prevalence of Whooping Cough during a part of the year, and this affected a considerable number of Infants. The fact that this Disease appeared to affect Stoke Newington more than the adjoining Boroughs, and that it also contributed to the exceptional number of Infant Deaths from Lung Diseases, go far to explain why Stoke Newington in 1920 dropped from the excellent position among the Metropolitan Boroughs which it has always held 351 TABLE I. CAUSES OF AN AGES AT DEATH DURING THE YEAR 1920. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Total Deaths whetherof "Residents" or "NonResidents " 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. Cerebro-spinal Meningitis 1 1 - - - - - - - - Encephalitis Lethargica - - - - - - - 1 - - Enteric Fever - - - - - - - - - - Acute Polio-myelitis - - - - - - - - - - Measles 5 - 3 2 - - - - - - Scarlet Fever 4 - - 2 - 1 - 1 - - Whooping Cough 9 5 2 2 - - - - - - Diphtheria and Croup 19 - 1 5 11 2 - - - - Influenza 23 1 1 - 2 3 9 4 3 - Erysipelas - - - - - - - - - - Phthisis (Pulmonary Tuberculosis) 37 - - 2 - 6 13 11 5 1 Other Tuberculous Diseases 7 - 1 1 1 1 2 1 - - Cancer (Malignant Disease) 69 - - - - - 11 22 36 6 Rheumatic Fever 1 - - - - - 1 - - - Meningitis 4 - 1 1 1 - 1 - - - Organic Heart Disease 73 - - 1 3 1 9 20 39 4 Bronchitis 62 8 - - - 1 2 14 37 9 Pneumonia (all forms) 58 17 2 1 2 3 11 15 7 1 Other Diseases of Respiratory Organs 10 - - - - - 2 3 5 - Diarrhoea and Enteritis 13 10 - - - 1 1 - 1 - Appendicitis and Typhilitis 1 - - - 1 - - - - 1 Cirrhosis of Liver 5 - - - - - - 3 2 - Alcoholism - - - - - - - - - - Nephritis and Bright's Disease 17 1 - - - - - 4 7 - Puerperal Fever 3 - - - - 2 1 - - - Other Accidents and Diseases of Pregnancy and Parturition 3 2 - - - - 1 - - 1 Congenital Debility and Malformation (including Premature Birth) 37 36 1 - - - - - - 3 Violent Deaths (excluding Suicide) 12 - 1 2 2 1 3 1 2 - Suicide 2 - - - - - - 1 1 - Other Defined Diseases 173 15 - 3 5 4 13 38 95 20 Diseases ill-defined or unknown 10 2 - - - - - 5 3 - Totals 659 98 13 22 28 26 85 144 243 46 352 A comparison of the causes of Infantile, Mortality in 1920 with those of the preceding year shows an increase during last year in the deaths from Wasting and Debility, Congenital Malformation, Bronchitis and Pneumonia, and Whooping Cough. The causes contributing to a high rate of mortality have been discussed in previous reports, and it will suffice to call attention to the fact that of 98 children who died under the age of one year, 40 deaths were ascribed to prematurity, wasting, and congenital defects, and 24 to bronchitis and pneumonia, a total of 64 deaths resulting from these two groups. SENILE MORTALITY.—Of the 659 deaths, 185 were of persons over 70 years of age. The proportion of deaths occurring among those of over 70 years of age to the total deaths is, therefore, 28 0%. There were 63 deaths of persons over 80 years of age, and 7 of persons over 90—the oldest being 98k. This is a high proportion of deaths over 70 years of age, which indicates that there is a relatively large number of old persons in the Borough, who contribute largely to our death-rate. SENILE MORTALITY DURING 1920. 70 to 80 80 to 90 90 and over Total 115 63 7 185 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, and Enteritis. 353 TABLE II.—INFANT MORTALITY. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER ONE YEAR OF AGE, 1920. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Influenza - - - - - - - - 1 1 Cerebro - spinal Meningitis - - - - - - - 1 - 1 Chicken Pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 2 1 - 2 5 Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - Convulsions - 1 - - 4 1 - - - 5 Laryngitis - - - - - - - - - - Bronchitis - - 1 - 1 4 1 1 - 7 Pneumonia (all forms) 1 2 1 - 4 3 4 - - 17 Diarrhœa - - - - - - 1 - - 1 Enteritis - - 1 - 1 3 3 1 1 9 Gastritis - - - - - - 1 - - 1 Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, overlying - - - - - 1 - - - 1 Injury at Birth - - - - - - - - - - Atelectasis - - - - - - - - - - Congenital Malformation 9 1 - - 3 1 1 - - 3 Premature Birth 9 2 8 1 20 2 2 - - 24 Atrophy, Debility, and Marasmus 1 2 1 - 4 6 - 1 - 11 Other causes 4 - - - 4 2 2 1 1 10 Totals 20 8 12 1 41 25 16 5 11 98 354 The Zymotic Death-rate for the Borough was 0.94 per 1,000 per annum, as against 0.61 in the preceding year. MORTALITY FROM CONSUMPTION The death-rate for Consumption (Pulmonary Tuberculosis) in the Borough for 1920 was 0.70 per 1,000, as against l.0 for London generally. CANCER. The returns for the whole country maintain the increase, as compared with former years, in the mortality from malignant disease. The tendency to exceptional increase in the mortality of males has been noteworthy in the records of the last few years. For the purpose of enabling the true comparative incidence of cancer on the populations of different sanitary areas to be precisely stated, factors would have to be calculated for correcting the deathrates, as far as possible, for the differences in the age and sex constitution of the several populations concerned. Certain predisposing factors in the causation of Cancer are now pretty generally accepted. Some of these are beyond individual control ; others, however, such as occupation and habits of life, determining a localised chronic irritation or inflammation (as the prolonged irritation caused by broken, lagged teeth, etc., and suspicious growths in connection with old scars and simple Tumours) call for greater recognition among the general public, in order that preventive measures and early treatment may be put in operation. To this end the public should also be cautioned against losing valuable time by resorting to quack remedies. The changes which take place when normal tissue cells become cancerous is a very subtle one, and is not yet disclosed by the large body of research work which is constantly undertaken in this connection. We anxiously await more knowledge; and meanwhile we can do no more than act upon the knowledge which we possess of one greatly predisposing factor and avoid all causes of oft-repeated local irritation, and take advantage of the fact that very early operative treatment affords the only prospect of relief. 355 THE MORTUARY. During the year 54 bodies were deposited in the Public Mortuary ; 23 of these were females and 31 were males. TABLE III. 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 20.9 124.7 130 1 . 35 5.8 1906 50,957 21.2 108.0 120 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 1915 50,527 18'4 99.8 14.6 1.21 7.0 1916 49,776 20.1 59.8 12.6 0.42 4.4 1917 49,776 15.5 85.6 14.1 0.90 3.6 1918 47,426 140 87.2 16.0 0.93 3.8 1919 50,954 16.8 62.6 12.2 0.61 5.4 1920 52,984 23.1 80.0 12.4 0.94 8.0 356 mortem examinations were performed upon 38 of these cases, and inquests were held upon 38. INQUESTS. 38 Inquests were held upon Deaths of Parishioners during the year 1920. COMMUNICABLE DISEASES AND THE MEASURES TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table IV. that 502 Notification Certificates of Infectious Illness were received from medical practitioners. In all infected 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 5 houses where there were "grave" insanitary conditions. In 28 houses less serious insanitary conditions were found. The Infectious Sickness Rate of the Borough, excluding the notifications from Consumption, Cerebro.Spinal Meningitis, Acute Polio.Myelitis, Ophthalmia and Measles, so as to make the rate comparable with that of former years, was 8.0 to each 1,000 of the population, as against 5'4 for the preceding year. The rate in the Northern Division was 60; while that in the Southern Division was 91. Year. Infectious Sickness Rate for London Rate. generally. 1912 3.7 5.2 1913 4.6 6.7 1914 8.3 8.9 1915 7.0 8.3 1916 4.4 5.1 1917 3.6 4.2 1918 3.8 4.4 1919 5.4 5.9 1920 8.0 8.4 TABLE IV. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1920. 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 5 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 169 1 44 101 13 8 1 1 29 140 142 Erysipelas 24 - 1 3 2 6 8 4 7 17 4 Scarlet Fever 224 - 36 163 17 6 2 - 68 156 157 Typhus Fever - - - - - - - - - - - Enteric Fever 2 - - 2 - - - - 1 1 1 Relapsing Fever - - - - - - - - - - - Continued Fever - - - - - - - - - - - Puerperal Fever 2 - - - - 2 - - 1 1 1 Cerebro-spinal Meningitis 1 1 - - - - - - - 1 1 Poliomyelitis 1 - 1 - - - - - - 1 - Ophthalmia Neonatorum 8 8 - - - - - - 1 7 - Pulmonary Tuberculosis 56 - 2 2 12 24 14 2 10 46 12 Other forms of Tuberculosis 14 - 1 8 1 2 1 1 5 9 4 Measles - - - - - - - - - - - Influenza - - - - - - - - - - - Pneumonia - - - - - - - - - - - Malaria - - - - - - - - - - - Dysentery - - - - - - - - - - - Encephalitis I.ethargica 1 - 1 - - - - - 1 - 1 Totals £02 10 86 279 45 48 26 8 123 379 323 358 The Infectious Sickness Rate for London generally was 8.4. Two hundred and sixty eight of the cases notified were removed from their homes to Isolation Hospitals, and at times there was delay in securing the hospital isolation of cases of Diphtheria and Scarlet Fever, owing to the hospital accommodation being overtaxed. BACTERIOLOGICAL DIAGNOSES. There is no gainsaying the advantages which bacteriological examination affords for the purposes of judging the purity of drinking-water, for facilitating that prompt diagnosis of certain communicable diseases which enables the earliest adoption of the necessary precautionary measures, and for ascertaining when children and others who have been exposed to the infection of, or who have suffered from, diphtheria may safely be allowed to mix with others. This provision is now a general one throughout the country— to the extent of affording facilities to general practitioners for the diagnosis of diphtheria, enteric fever and consumption. The "diagnosis outfits" supplied by the Council to the medical practitioners in Stoke Newington are of great service. The following is a statement of the applications received during 1920, together with the results of the examinations performed at the Lister Institute of Preventive Medicine, London — Disease. Results. Total. Positive. Negative. Phthisis 15 62 77 Diphtheria 77 141 218 Enteric - 5 5 Total 92 208 300 SCARLET FEVER. The 224 cases of Scarlet Fever occurred in 190 houses. 359 Two "return cases" were notified. The case.rate (notified) and the death rate from this disease were both about double the corresponding rates for 1919. The cases were mostly of a very mild type, and the case mortality was below 2 per cent. Year. Death Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.02 0.04 0.05 1913 002 0.04 006 1914 0.06 0.07 0.08 1915 0.14 0.07 0.06 1916 008 0.03 0.04 1917 0.00 0.02 0.02 1918 0.00 0.03 0.03 1919 0.04 0.03 0.03 1920 008 0.05 0.04 Like Diphtheria the infection of Scarlet Fever is in all probability most frequently spread by personal contact with mild unrecognised cases, and the circumstance that so many of the cases are very mild accounts for most of the spread of Scarlet Fever which is in evidence throughout the country. ENTERIC OR TYPHOID FEVER. Year. Death Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.00 0.03 004 1913 004 0.02 0.04 1914 0.00 0.03 0.05 1915 0.04 0.03 004 1916 000 0.02 0.03 1917 0.00 0.02 0.03 1918 0.06 0.02 0.03 1919 0.00 0.01 001 1920 0.00 0.01 0.0! DIPHTHERIA. The 169 cases of Diphtheria occurred in 143 houses 360 The prevalence of this disease was over 50 per cent. greater than in 1919. The case mortality was about 11 per cent. Year. Death Bate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.00 0.10 0.11 1913 0.12 0.09 0.12 1914 0.06 0.16 0.15 1915 0•20 0.16 0.15 1916 0.12 0.14 014 1917 0.20 0.14 0.13 1918 0.3(5 0.17 0.14 1919 0.27 018 013 1920 0.36 0.22 0.15 In two cases the patients had previously suffered from an attack of the disease. Many applications have been made at the offices for tubes of " antitoxin," which I store for the convenience of local practitioners. A limited amount of "antitoxin" is supplied free of cost to those who are judged to be unable to pay for it. The expenditure on this account is limited to £10 per annum, except in years of epidemic prevalence of diphtheria. During the year there were occasions on which there was delay in securing the removal to hospital of notified cases of Scarlet Fever and Diphtheria, as these two diseases were exceptionally prevalent not only in Stoke Newington but in London generally. As soon as it was realised by the Metropolitan Asylums Board that there would be difficulty in securing the admittance to hospital of all cases for whom application was made, the Metropolitan Medical Officers of Health were asked (in order to secure that those cases which by virtue of their condition, environment or special circumstances most urgently needed hospital isolation and treatment, should receive priority) to select such cases and notify them to the Clerk of the 361 Board. It is fair to say that under this arrangement the specially urgent cases were promptly removed, so that it was only a few of the less urgent cases which suffered from the delay referred to. A visit and enquiry was at once made to the patient's home, and we based our conclusions on considerations of risks to other members of the family if the sufferer was not isolated in hospital, where satisfactory home isolation was impossible ; the state of the patient and severity of attack; industrial and wage.earning circumstances of the family, and the possibility of work being stopped or curtailed in respect of one or other member of the family, if the patient were nursed at home ; the ability and competence of the mother or other adult to give the sufferer reasonably proper attention and services if kept at home. Measles. Year. Death Kate for Stoke Nowington. Rate for London generally Rate for England and Wales. 1912 0.12 0.40 0.35 1913 0 22 0 .34 0.48 1914 0.02 0 .31 0 .24 1915 0.47 0 .50 0 .43 1916 002 0 .19 0.15 1917 0.36 0.48 0.30 1918 0.15 0 .42 0.28 1919 0.02 0.08 010 1920 010 0.22 0.19 Whooping Cough. Year. Death Rate for Stoke Newington. Rate for London generally. Rate for England and Wales. 1912 0.04 0.22 0.23 1913 0.12 0.17 0.14 1914 0 .12 0.20 0.21 1915 0.14 0.25 0.21 1916 0 .02 0.18 016 1917 0.12 0.13 0.13 1918 0.10 0.43 0.29 1919 0.08 0.05 0.07 1920 0.17 0.17 0.11 362 MEASLES AND WHOOPING COUGH. As compared with the preceding year, there was a greatly increased prevalence of Measles and of Whooping Cough. Nurse Ager paid 27 visits of advice and assistance, and the Health Visitors and the Ranyard Nurse visited many other infants and children. In view of the decision of the Ministry of Health to rescind the Order for the compulsory notification of Measles as from the end of 1919, it is necessary that the earliest possible information should reach the Medical Officer of Health regarding cases having (or suspected of having) Measles, which come to the knowledge of the officials of the Education Authority. Accordingly, the L.C.C., as the Education Authority for London, has made arrangements whereby if any school or schools are threatened by exceptional Measles prevalence the School nurse is to make a daily visit to the Infant Department of any such School in which there are children under five years of age in attendance requiring to be kept under observation. The school nurse has to inspect the children in the class specially affected, and any actual or suspected cases are immediately to be reported to the Medical Officer of Health. The Head Teacher will also notify at once all cases sent home by the school nurse. This procedure will probably give us as much information of the existence of Measles as was obtained under the Order for its compulsory notification; and so we shall continue to be able to put into force the arrangements for visitation and occasional nursing assistance which were previously made by the Borough Council. The arrangement made in 1919 for securing the services of a visiting nurse in connection with cases of Measles, Whooping Cough, Summer Diarrhcea and Ophthalmia, occurring amongst infants and young children, will inevitably lead to a reduced mortality from these cases by ensuring nursing advice and attention for selected cases. It is, however, inevitable that during a severe epidemic of Measles or Whooping Cough the arrangement with a nurse who is already undertaking other nursing duties will not suffice, and the Ranyard Nurses Mission have undertaken on these occasions, if and when so ordered by the Borough Council, to provide temporarily an additional nurse at the low cost of two guineas per week. 363 ZYMOTIC DIARRHŒA. There were 10 deaths from this disease among children under two years of age. The death rate is best expressed as the proportion which the deaths under two years of age from this disease form to a thousand births. The rate is only 8.2, which compares with 9 5, the rate for London generally. In 1920 meteorological conditions favoured a low rate. The protection of food from flies and dust, cleanliness in the home and of feeding utensils, the covering and frequent removal of household rubbish, would save most of the lives lost from this complaint. INFLUENZA. The deaths directly ascribed to this disease numbered 23. Nurse Ager paid visits to a few cases reported to various Officials of the Council. In the event of Influenza again becoming prevalent, the Ministry of Health have made arrangements for the preparation of a stock of anti-influenza vaccine which is to be made available for distribution, through Medical Officers of Health, to those medical practitioners who may wish to use it. The vaccine is not guaranteed to ward off an attack of the disease, but it has a protective value in a large proportion of instances of its application, and there are excellent grounds for maintaining that life will be saved, for the use of such vaccines materially lessen the risk of the attack being complicated by the secondary infections which are so fatal. Thus it is mainly with the intention of mitigating or preventing these secondary infections that vaccines have hitherto been employed. The London County Council, as the Education Authority, has granted permission to Borough Medical Officers of Health, to use the school organisation for the purpose of distributing influenza leaflets. This is a valuable concession, for there is no method which is equally effective in rapidly bringing before the notice of the large section of the community which needs such information most than through the school children in elementary schools. 364 It is certain that the suffering and mortality could be materially reduced by nursing assistance; a provision of fuel and of food and clothing to really necessitous cases; by hygienic advice (more particularly as to ventilation and the spacing out of the rest of the family) the distribution of a suitable disinfectant with advice and directions as to its use; and the provision of more hospital isolation and treatment. PUERPERAL FEVER. Under Puerperal Fever are included deaths from Pyæmia and Septicæmia occurring in lying-in women. Two cases were notified during the year; and there were three deaths from this disease. PHTHISIS (CONSUMPTION) AND OTHER FORMS OF TUBERCULOSIS. Seventy cases of Phthisis were notified under the Public Health (Tuberculosis) Regulations, 1912. Twenty-six of the notified cases were insured under the Insurance Act. Six of the notified cases ascribed the onset of the disease to exposure while in the army; in 8 cases there was a history of Phthisis in parents or grand-parents. In two cases the notifications reached us after the death of the Sufferer. Nurse A. Ager, who is appointed to give part-time services in connection with the Tuberculosis work within the Borough, has, acting under the instruction of the Medical Officer of the Tuberculosis Dispensary and myself, dealt with 49 different cases, making in all 699 visits in 1920. 365 The Tuberculosis After-Care Committee appointed by the Borough Councils of Hackney and Stoke Newington rendered valuable services during the year. The address of the Secretary (Mrs. Hebert), is 38, Pembury Road, Clapton, E.5. During the year a Tuberculosis Dispensary Advisory Committee was formed, as provided for the original Agreement between the parties concerned. This Committee consists of representatives of the Boroughs of Hackney and Stoke Newington, and of the Metropolitan Hospital. The Stoke Newington representatives on this Committee are Councillors Barnard and Eve and Alderman Ostlere. At the end of the year the Ministry of Health issued a Circular which directed attention to certain deficiencies in the existing Dispensary services in London, and at the same time offered suggestions as to the lines on which the services should be improved. These criticisms and suggestions will be duly considered by the recently appointed Tuberculosis Sub-Committee, but it may be well to here point out that the Circular suggests that as a normal basis there should be one whole-time Tuberculosis Officer to about every 160 deaths from tuberculosis per annum; that it is desirable that at least one evening session in each week should be arranged at each Dispensary, and the question should be considered of instituting a special session on Saturday morning, or at some other suitable time out of school hours for children attending schools; that efforts should be made to introduce at Dispensaries a system by which patients would be seen, if practicable, by individual appointment, or other means should be adopted to reduce to a minimum the time during which patients are kept waiting at the Dispensary; and that the Tuberculosis Medical Officer should actually visit, at least once, the home of each patient, unless he considers that in the interests of the patients such a visit would be undesirable. 366 In my last Report I discussed at some length the circumstances which make our direct attack upon Tuberculosis furnish results which have not realised our earlier hopes and expectations. Our direct and special measures for dealing with Tuberculosis, useful and necessary as they are, are quite subordinate in their value to the general hygienic improvements which have taken place in the past, and which are destined for a considerable extension in the near future in respect of dwellings. It is of primary importance to provide for visitations to the homes of sufferers by a skilled person, in order to detect early (incipient) cases, and thus to reduce as far as practicable the present large expenditure of time and money upon cases in which the disease is advanced before it comes under proper treatment. Medical practitioners in Stoke Newington may be said to be notifying the disease far better than in many districts—for whereas the number of notifications of Tuberculosis is sometimes only about that of the deaths registered from that disease, in Stoke Newington they are nearly double. It is, however, probable that the actual number of sufferers in any year approximates to three times the number of deaths. THE WORK OF THE TUBERCULOSIS DISPENSARY IN 1920 IN REFERENCE TO STOKE NEWINGTON. The following facts show the work done in connection with the Dispensary, so far as Stoke Newington is concerned, during the year 1920. The figures in the particulars recorded compare favourably with those of the preceding year. (Vide my annual report for 1919.) The number of attendances of Stoke Newington patients were 1356 during 1920, as compared with 1402 during 1919. The total number of contact cases examined at the Dispensary was 273, out of which Stoke Newington contributed 48. 367 TABLE I. RETURN SHEWING THE RESULTS OF THE EXAMINATION OF PERSONS SENT TO THE DISPENSARY. Original Cases found Pulmonary Tuberculosis 71 Contact „ „ „ „ 71 Original ,, ,, Non-Pulmonary Tuberculosis 9 Contact „ „ ,, ,, 9 Original „ ,, Doubtful 20 Contact „ „ „ 10 30 Original „ „ Non-Tubercular 11 Contact ,, „ „ 38 49 Total of new cases 159 TABLE II. CLASSIFICATION AND DETAILED STATISTICS OF ATTENDANCES, Etc. Insured Persons Male Insured Persons Female Uninsured Persons Male Uninsured Persons Female Contacts. Total M F I. U. i. U. New patients attending 49 16 22 20 1 19 6 22 155 Attendances of old patients 506 188 164 204 — 46 6 87 1,201 Patients visited in their homes 9 2 – 10 – – — – (new) (old) 4 17 =21 Specimens of Sputa examined 68 20 11 14 — 1 — 3 117 368 THE FOLLOWING IS THE STATEMENT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1920. January 31st, 1921. To the Committee of Management, Metropolitan Hospital Tuberculosis Dispensary. Gentlemen, I beg to present the Report for the year 1920, the sixth since the Dispensary opened. During the year greater facilities have been afforded for the treatment of tuberculosis persons, and the Dispensary, acting as a clearing centre, has been placed in a better position than formerly for allocating cases for appropriate Institutional treatment. Male advanced cases are now accommodated at Colindale Hospital, Hendon, which was opened during the year. Stormont House Open-Air School, at Hackney Downs, opened in September, 1919, has now its full complement of seventy-five children. The beneficial results observed in those children attending the School from this Dispensary are very gratifying. There is still scope for further measures in Open-Air School treatment, especially for pre-tubercular children. The lack of proper housing accommodation has formed a great drawback in the Domiciliary treatment of many cases, as under present conditions over-crowding inevitably occurs. With the consent and approval of the Medical Officers of Health for Hackney and Stoke Newington, to whom I accord my grateful thanks for their kind co-operation, the visiting Tuberculosis nurses of the respective Boroughs now attend the Dispensary once a week, and submit reports on the home conditions of the patients in the Dispensary area; personally supply information as to their progress, social environments and needs; and receive suggestions with regard to "following-up" cases, arrangements for the attendance of contacts for examination, etc. These weekly conferences are most 369 valuable and keep the work of the Dispensary in close touch with the Public Health Departments of the Borough Councils, and will be the means of developing to a greater extent the preventive measure so essential to a Tuberculosis Scheme. Ex-service men still continue to form a good proportion of the cases dealt with. The additional clerical work required in these cases has not been lightened by the instructions issued in November, 1919, whereby all tuberculosis ex-service men, whether insured or not, must be dealt with through the London Insurance Committee, and certificates, supplied by the Tuberculosis Officer (as Medical Referee) for the information of the War Pensions Committee, must be sent through the L.I.C. These certificates in their circuitious route, sometimes go astray, or get held back, and duplicates have to be supplied, causing unnecessary trouble, delay, and inconvenience to the patients, who are deprived of their treatment allowances, extra diet, etc., until another certificate is forthcoming. Several insured patients, who had been attending for some considerable time, and receiving symptomatic medicinal treatment, were referred to their panel doctors. The treatment by drugs is gradually being discontinued, and reliance placed more on preventive measures and instruction of the patients in general hygiene, dietetics, etc. Many cases have been referred, through the Almoner, to the special departments of the Hospital for treatment, especially to the Dental and Throat Departments; while the X-Ray Department has been fully utilised for the purpose of diagnosis. I beg to express my thanks to the members of the medical and surgical staff in charge of the various departments of the Hospital for their ever willing and valuable assistance. Several medical practitioners have taken advantage of the Dispensary as a consulting centre, and 1 desire to thank them for their cordial co-operation. 370 My thanks are due to Matron for her kindness in supplying the Dispensary, as in the past, with an efficient staff of nurses, whose services have been much valued. Miss Fellowes has performed her duties as Secretary-Dispenser with entire satisfaction. The total attendances for the year were 5,363 (including home visits), of which 4,756 were "old" cases, and 607 new. There was an increase of 182 on the "old" cases, but a decrease of 114 on the new cases. The contacts examined numbered 273, of whom three were found to be suffering from pulmonary tuberculosis, and 13 from nonpulmonary tuberculosis; 31 were doubtful and 226 non-tubercular. In all 312 sessions were held, with an average attendance of 1703. Of 383 specimens of sputa examined, 141 were found to be positive. The amount of medicines, etc., dispensed was a little over half that of the preceding year. I cannot conclude without referring with deepest regret to the great loss the Hospital sustained in December, by the tragic and untimely death of Mr. Guy B. Dale, whose interest in the welfare of the Dispensary was shown by his energetic endeavours to improve its position with regard to finance and administration. I am, Gentlemen, Yours faithfully, L. UNWIN YOUNG, Medical Tuberculosis Officer. ACUTE POLIO-MYELITIS AND CEREBRO-SPINAL FEVER. Cerebro-spinal Fever is by far the more fatal of the two. One fatal case was notified in the Borough during 1920; and one non-fatal case of Polio-myelitis. 371 VENEREAL DISEASES. Advice upon the prevention and treatment of these Diseases has been provided by posters on notice boards and public conveniences, and by handbills distributed in factories and workshops. It was found necessary to frequently renew the posters in the public urinals, and Sir Herbert Ormond supplied frames with glass coverings to the notices exhibited in both the male and female departments of the two large public conveniences within the Borough. Every man should realise the terrible consequences of these diseases; and he should be told the following facts: Syphilis is responsible for the presence of more than one-tenth of all the patients in Lunatic Asylums; it is the chief cause of paralysis; it is responsible for a large proportion of all the diseases of the heart and blood-vessels; and it leads to the birth of diseased children. Gonorrhœa is not the trivial disease which many believe it to be. If not skilfully and promptly treated it may be followed by stricture, which prevents or impedes the flow of urine and often necessitates a serious operation. It may result in inability to beget children. With this Knowledge How Should a Sensible Man Act. The Right Course, the cleanest, the most manly and the only safe one, is to abstain from exposure to infection. Male chastity is consistent with perfect health, but it demands an effort of selfdiscipline, strict moderation in alcoholic drinks and the avoidance of all unnecessary exposure to temptation. If promiscuous intercourse is indulged in he will almost certainly be caught sooner or later; but the right precautions taken within an hour or two may save him. It is his duty to himself and others to take such precautions. For this purpose a thorough washing of the private parts with soap and water, followed by bathing them in a disinfectant prepared by dissolving five or six crystals of permanganate of potash in a pint of water, is recommended. A supply of the crystals can be obtained from any chemist for a few pence. 372 The above application is useless for the Treatment of the disease itself; and notwithstanding its use you should be careful to notice as promptly as possible any itching or smarting or any slight or superficial sore or discharge, in connection with the private parts. When these or any other unusual signs appear it is the greatest folly not to consult a medical man or apply at a Treatment Centre at the earliest possible moment. Both these diseases may be cured by early and skilled treatment. Delay or neglect will increase their severity and may lead to the results set out above. N.B.— It is now illegal for persons other than qualified doctors to treat these diseases. There is a growing realisation of the strict limitation that attaches to official efforts in default of the co-operation of the public in promoting public health; and therefore the importance of the diffusion of knowledge concerning health by wisely conceived educational measures is generally recognised. Indeed, an organised national effort to impress the simple facts of healthy living (at home and at work) and to create a greater concern for this and for the early treatment of disease, would generally be admitted to be a development of paramount value to public health. The public must be told, made to think, and led to act; for a substantial public health reform is only possible by the people themselves becoming the reformers. The public ignorance is mainly responsible, for public ill-health has been preached for generations; its truth is so self-evident that there is no one to dispute it; yet we have done so little to educate the people on matters concerning their health that less than half-measures are the most that have been attempted with either school children or adults. Surely it is the business of ths State to provide hygienic information in the best way. In default of this we must continue to do much tinkering with the consequence, of our neglect. The training of the child is of paramount importance. The public health problems most under consideration during recent years have been Housing, Infant Mortality, Clean Milk 373 Venereal Disease and Tuberculosis. Let me remind you how each justifies the old contention that, above all, the public needs educating. As to Housing: We are not going to secure decent homes by merely building decent houses; decent tenants are even more essential than decent houses. We seriously discount the value of removing slums if we neglect the ignorant and careless slummers. As to Infant Mortality: The preventable part of this must be attributed mainly to defective knowledge of "mothering." Good mothering protects a child against almost every handicapping circumstance but poverty; on the other hand, nothing protects a child against bad and ignorant mothering; therefore it is of prime importance to educate the mothers. As to Clean Milk: Elaborate premises will secure very little without the practice of elaborate cleanliness. As it is impossible to ensure this by official supervision, we must educate those who collect and deal in milk to an enlightened concern for guarding its purity; and the public must be educated to demand clean milk, and to keep it clean after it enters the home. Short of such education an Act of Parliament will, in my judgment, have no more success in securing cleanliness of milk than other Acts have had in securing its freedom from adulteration with water. As to Venereal Disease: In our campaign against this disease our most effective weapon consists of efforts to raise the standard of public knowledge and morals. The "Hidden Scourge" must be dragged into public light and the evils and perils of impurity generally recognised. Meanwhile the costly Treatment Centres are little more than palliatives. As to Tuberculosis: The admitted fact that the prevention of Tuberculosis is a matter of healthy living must be made the property of everybody. The training of the young to healthy habits of life and a broadcast dissemination throughout the community of knowledge to this end, are essentials to the solution of the problem of the prevention of this disease. Indeed, the need for and value of propaganda in reference to preventable disease is so great that to neglect it is indefensible. All 374 disease should be brought into the campaign of popular education. Just as the modern work performed in connection with child mortality has been essentially educational, so must education become the main objective in the whole field of public health. Hitherto the propaganda of Health Authorities in this country has been quite unworthy of a matter of such fundamental importance. Such work has attained to a carefully conceived and fairly organised general effort only in respect to Venereal Disease and the short intensive campaign of "Baby Week," and in both cases this was at the instance of outside non-official bodies. Nowhere has a deliberate and comprehensive scheme been adopted for keeping before the country the facts that must be widely known before the public health can be greatly improved, our public health problems simplified and our public health efforts and provisions made more productive. Such continuous propaganda will still be necessary even after the time arrives when every school child will receive teaching and training in health matters. MATERNITY AND CHILD-WELFARE WORK. As in past years, Maternity and Child Welfare took a very prominent place in the public health work of the Borough Council, and I have pleasure in testifying to the fact that all those officials employed upon it rendered high-quality services. The work is of outstanding value. Coincident with its development the cost has, of course, increased considerably; but there is nothing so blameworthy as economy which results in a wastage of health and efficiency due to ignorance and neglect in reference to the early development of human life, when any possible expenditure can reduce this wastage. That fact is well appreciated in Stoke Newington, not only by the members of the Maternity and Child Welfare Committee, but also by every member of the Borough Council. The most noteworthy events in connection with Maternity and Child Welfare work in the Borough during 1920 were as follows: An additional official Health Visitor was appointed (Miss Sandeman). 375 A second Maternity and Child Welfare Centre was opened at the beginning of September, at Barton House, Albion Road. At this Centre the Ante-Natal Clinic is held. "Baby Week" was duly celebrated. The Maternity and Child Welfare Centre and Day Nursery were open for visitation by the general public; a most successful Entertainment was provided for mothers and children, at which, in addition to an amusement programme and refreshments, certificates of merit were awarded to mothers by Mr. and Mrs. Pett-Ridge. A well-attended Public Lecture was also given on the subject of "Flies in Relation to Health and Disease." In addition to agreeing to pay, where necessary, one-half of the fees incurred by women who are in need of special maternity treatment and who are therefore sent to the Home Hospital for Women, High Street, Stoke Newington, contributions were also paid towards the expenses of maintenance of Stoke Newington women in the Mothers' Maternity Hospital of the Salvation Army, in Hackney. Although the Committee fully considered the subject of "Home Helps," no definite decision was arrived at upon this very difficult matter. It is interesting to note that, while the rate of infantile mortality for all the children born in Stoke Newington during 1920 was 80.1, the rate for those attending the Centres did not exceed 30. Dr. J. S. New, who is in medical charge of the Child Welfare Clinics, makes the following statement with reference to the work during 1920: "I have been much impressed with the gradual and steady reduction in the number of those cases requiring immediate reference to Hospital. My explanation is the developing intelligent concern among the mothers who come to the Centres. I find this to be more in evidence in Stoke Newington than in another Metropolitan Borough in which I render similar services. There can be no doubt that in my experience fewer hospital conditions arise at the present day than was formerly the case. It is a remarkable fact that if I exclude a case which moved into the Borough, we have not had a single case of acute rickets for a long period. 376 "It has become clear to me that the mothers need more advice and attention at the critical period of about 9 months since the birth of the child; and I have made arrangements whereby I shall in future see all the mothers at this period." Miss Reeve, the Chief Health Visitor, reports as follows:- "During the year 1,156 infants born in the Borough were visited; these visits were followed by 1,932 re-visits, making a total of 3,088 visits paid. "The Child Welfare Work continues to increase. Not only do the attendances reach a greater number, but a larger proportion of mothers come to, and appear greatly to value, the Centre. "The number of children on the register was 853 (last year's figure being 566). These made a total number of 6,727 attendances at the sessions, which are now held on Mondays, Thursdays and Fridays. (The figure for the previous year was 4,957.) "In last year's Report a great point was made of the overcrowded state of the Milton Road Centre, especially on 'Doctor's Days.' Arrangements were therefore made that a second Centre should be opened at 233, Albion Road (first floor). This necessitated dividing the Borough into two districts, each to be served by one Centre. The division was made by Miss Stamford reserving her visits and advice for those who live in one area, and Miss Sandeman taking on those in the second area. Consequently, when the new Centre was opened, on September 6th, it was only necessary to send Miss Sandeman and her mothers and children there. In a word, the new Centre started, to some extent, 'ready-made!' During its first four weeks 298 children attended the sessions there, these increasing in the next eight weeks to 382 and 415. "As a result of the opening of the new Centre it became necessary to increase the number of voluntary workers and they are mostly becoming extremely efficient. In this connection our thanks are due to Mrs. King, Miss C. A. Masters, Misses D. and H. Miller, Miss Williams and Mrs. Yates. "During the year 26 still-births and infant deaths (under one year) were visited, the object being the giving of useful advice. 377 "There are now two Needlework Classes, one at each Centre, both meeting on Tuesdays. That at the old Centre is presided over by the Chief Health Visitor, and that at the new by Miss Sandeman and Miss E. Ross Baxter, the latter a most valued voluntary worker. It is charming to see some of the toddlers in pretty knitted frocks, coats, overall knickers, etc., and the babies now wear knitted frocks, in addition to other woollies. A special effort is made to induce those expecting a first baby to attend, in order that their infant's clothes shall be made of suitable material and from good patterns. Several have taken advantage of this. Mothers are taught to cut out and make up their children's clothes and are encouraged to do things on their own at home, and to show the results at the Class. Also attention is given to the making of new garments from old—a favourite economy being the making of Liberty Bodices from 'father's Army pants!' "There were 608 attendances at the Needlework Classes, and about 480 garments were made. The afternoons are made enjoyable by tea and cakes, being supplied at cost price. Mrs. Price and Miss Blay, at the old, and Miss Williams, at the new, Centre, very kindly manage the teas. It is a fact that the social side of the Needlework Class is a very valuable feature. To many mothers it is the one bright item in the week. "It is appropriate to mention here that we sell hand-knitted, long-sleeved, woollen vests for babies. These are made for us according to our instructions, with wool supplied by the Centres. We are much indebted to the following for their help in this connection: Lady Baddeley, Miss Biggs, Mrs. Collen, Miss Gardiner, Mrs. Smyth, Mrs. Shepherd, Miss Thorne, Miss Turner and Mrs. Walters. Also the Head Mistresses of the following schools, who have vests knitted for us in some of the classes: Southgate County School, Palmer's Green; Princess May Road L.C.C. School; Wordsworth Road L.C.C. School. "With regard to Voluntary Societies operating in the Borough, most useful to the Centres is the Dispensary, which does extremely good work among uninsured patients. Many of the mothers and children attending the Centres attend there for treatment. There 378 is a good deal of co-operation between the Dispensary and the Centres, the results of which are very beneficial to the patients concerned. Our thanks are due to The Mayor (Councillor F. E. Manley, J. P.), Sir Herbert Ormond and Mr. F. A. Dod, for the necessary 'letters.' "Other Voluntary Societies are the Home Hospital for Women, to the maternity ward of which, we are, by arrangement made by the Committee, able to send suitable patients at a low cost. There is also a Female Guardian Society's Home and a Babies' Hotel in the Borough, the latter taking children of professional class only, and so barely touching the work of the Centres. "In conclusion, it needs to be recorded that, by the opening of the new Centre, the terrible over-crowding of the Milton Road Centre, reported last year, has been greatly reduced. Furthermore, a larger proportion of the children born are brought to the Centre; also a stricter look-out is being kept on the toddlers, their records now being sent to their schools when they leave us at five years of age. These factors mean increased attendances and more work. Therefore, at some not very distant date, more staff and more space will be needed." It appears that the neo-natal death-rate (or deaths within the first month of life to every 1,000 births) was nearly 2½ times heavier among the infants of labourers (general and casual) than among those of medical men. This fact impresses the need for ante-natal work among the poorer section of the community, and the scope of its possibilities. The midwife is evolving, and before long we shall see her status raised and her services extended. She does important work; work that is essential to the community; and she is a much better trained and educated worker than formerly. More fully trained still, she will become the ideal ante-natal Health Visitor. She delivers quite 90 per cent. of the poorer mothers, and ante-natal care falls properly within her province, if she can be trusted to seek medical aid whenever it is necessary. The fuller training to more fully prepare her for ante-natal work will only come when we can 379 reasonably demand it by ensuring a comfortable living wage in return for her services. It is not too much to state that £200 a year is the remuneration which should be provided nowadays to any properly trained woman Health Worker. There is at the present day no midwife living within the Borough of Stoke Newington; and the provisions for maternity nurses are unsatisfactory from the standpoints both of quality and quantity. The Infant and Child Welfare work in the country must be exerting a beneficial influence on the general health of the school children. The work will undoubtedly raise the physical standard of "entrants" in a few years' time. Dr. Mabel Muncey reports as follows upon her useful work in connection with expectant mothers:— "The work of the Ante-Natal Clinic has increased during the last 12 months. The number of new cases has risen from 66 in the first year to 76 during the second year, and the attendances from 100 in 1919 to 167 in 1920. "These figures may seem small in comparison with attendances at Infant Welfare Clinics, but the work is completely different. It is impossible to examine and advise expectant mothers in less than 20 to 30 minutes each. A general examination of heart, lungs and kidneys is given to each patient to diagnose conditions in the general health which would be fatal or harmful to the patient or the baby, and a special examination is made to gauge the type of labour which is probable and any special conditions likely to cause trouble at the confinement or during the lying-in period. "The majority of cases coming to the Clinic have already engaged a midwife (cases having booked with a doctor are referred at once to the doctor), and as a routine measure the midwife is advised by letter of any abnormality found. 380 "A summary of cases attending the Clinic from its inauguration may be of interest. Of the 142 new cases who attended the Clinic from January, 1919, to the end of December, 1920—128 names have been removed from the list of current cases—six because on examination the patients were found to be non-pregnant; 122 because of the termination of the pregnancy. Two only of these miscarried. With 120 mothers the pregnancy progressed favourably for at least seven months. We have no knowledge of seven of these cases later than this because of their removal from the district, etc. In the other 113 many details are available through the courtesy of the midwives and also from the Health Visitors' and Infant Welfare Records. The cases, therefore, which we know and can classify are 113 in number; 110 of these mothers gave birth to 111 living children, i.e. one case of twins occurred. The confinements were normal. One only needed instrumental assistance. In the remaining three cases the confinements were normal but the children were still-born, although all were full-term. In two cases the children were well developed and only still-born because labour was rapid and the children were born before the arrival of the midwife. In the third case no details could be obtained from the patient or the midwife. "Of the live births, five were premature. Twins were born in a Maternity Hospital. Both babies were very small and both died within a month. The other three premature babies are alive and well. Of the full term births one only died (of jaundice) at 10 days, in a Maternity Hospital. "Advice is given to the mother to encourage breast-feeding and promote this possibility; and in cases of necessity, assistance is provided under the Milk Order to improve the mother's general nutrition; 10 such cases have been helped during the year. Babies who are known to have been entirely breast-fed for nine months number 70 (out of a possible 108 of which we have complete records), and in many other cases mixed feeding was successful. "It has been found necessary to advise trusses in four cases, and bandages for varicose veins in 10. 381 "Numerous cases need dental treatment. We have only been able to secure hospital treatment for two of the worst cases. Distance and long waiting mean more to the expectant mother than to the average dental patient. "A number of cases come to the Clinic who need courses of medicine for various ailments. Such cases are drafted to their local doctors, or in the event of the patient's inability to meet this expense are given dispensary or hospital letters; 19 needed treatment this year. "No case of puerperal sepsis occurred amongst the patients who attended the Clinic, although in 42 mothers conditions were found which made its occurrence very probable. Advice was given to each patient, and was evidently acted upon, with success. "Three cases of ophthalmia reonatorum were notified in babies. In two of these cases the mother attended the Clinic only two weeks before the birth of the children, when it was found probable that the condition would occur, and the midwife was warned. The third mother attended once only—three months before the confinement— when she was apparently normal. "During the year it has been our aim to evolve a maternity belt which can be easily made for a shilling or two and which can be easily adjusted for any patient. We have now been able to make one in two sizes, which gives adequate support but which does not require boning or fitting. No doubt improvements will be suggested from time to time. In all cases the cost has been borne by the mother. "Several expectant mothers with bad family histories have come to the Clinic with a request for us to do all we can to give them living, healthy babies. In one case, where a premature baby died a day or two after birth, the mother now has a lovely baby—born rather prematurely, but otherwise normal. One mother came in the sixth week of her pregnancy because she had lost two out of four children at or just after birth; and another mother who had reared two out of five. Both have fine healthy babies now. "Medical aid was called in by the midwife for help in the confinement, or the subsequent 10 days, in five cases: In two of these 382 the confinement was normal, but prolonged; one case needed instrumental delivery; one case, acute bronchitis; one case, pleurisy. "The work of the Clinic has been carried on under very adverse surroundings, but we shall soon have an additional room, which means more comfortable accommodation for the patients awaiting examination." Dr. Muncey, in her reference to the great need for dental work in connection with expectant mothers is voicing a real need which is equally felt by those who have to deal with nursing mothers and their children, and Tuberculosis. There is a vast amount of handicapping and unnecessary suffering, malnutrition and disease, resulting from the neglect of dental advice and treatment; and so many Health Authorities are now providing for the services of Dental Clinics in connection with all the above-mentioned branches of public health work. Under paragraph 24 of the Maternity and Child Welfare Circular of the Local Government Board of the 9th August, 1918, a grant of half the expenditure on dental treatment is repayable by the Board, and the Board states that "a dental clinic should, whenever practicable, be available for expectant and nursing mothers and for children under five." In Stoke Newington the establishing of a Dental Clinic would be a costly method of providing the necessary treatment; and the most economical method would appear to be either by arranging with the Education Authority for the use of a joint clinic, or by making special arrangements with a local dentist, by which he would treat at his own consulting room patients sent by the Medical Officer of the Welfare Centres. The latter arrangement would save all expenses of equipment and maintenance of dental instruments and appliances, and could be probably be put into operation more quickly. THE DAY NURSERY. The Day Nursery did not escape trouble resulting from the introduction of infectious disease, but this trouble was less than in the previous year. The number of children in attendance was 383 rather above that for 1919; and as the Nursery is costing the Borough over £400 a year, the Maternity and Child Welfare Committee considered as to whether it should not be closed, seeing that this was judged to be possible without inflicting any material hardship on more than 9 or 10 mothers. During 1920 the Day Nursery was open upon 237 days, and in all there were 5,020 attendances of children, as compared with 4,770 during the preceding year. The average number of children in daily attendance when the Nursery was open during the year 1920 was therefore 21. Altogether the Day Nursery was closed for 18 out of a total of 255 working days. On two occasions a short closure was necessitated by the introduction of the infection of Measles. THE MILK (MOTHERS AND CHILDREN) ORDER, 1918. In the early part of the year it was decided by the Committee that any cost in this connection should be incurred only in respect to families whose income does not exceed 10s. per head, but that where there are only one or two children in the family the rent paid should first be deducted in arriving at the amount of income per head. Under the Order we have been able to help necessitous mothers and their children, with raw or dried milk, either free or half-price. The number of cases helped was 234. Not all were originally Centre cases, but all become so on milk being allowed them. This part of the work is entirely carried out by the Chief Health Visitor, who reports monthly on cases to the Maternity and Child Welfare Committee, and uses a scale laid down by them. The amount expended during the year was £453 4s. 3½d., this amount being larger than was anticipated on account of the prevailing distress due to unemployment. THE DISINFECTING AND CLEANSING STATION. During the year ending December 31st, 1920, the following disinfecting and cleansing work was performed at the station:— 384 Total number of textile articles disinfected 17,451 Total number of books from Public Library disinfected 103 Total number of verminous persons cleansed 383 All the verminous persons cleansed were children of school age. In addition to the disinfection of rooms on account of the notified infectious diseases, 65 were fumigated on account of vermin, 20 on account of Consumption, 9 on account of Cancer, and a few on account of Measles and Whooping Cough. 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, and 383 of such children were cleansed. NOTES UPON SANITARY WORK PERFORMED DURING THE YEAR 1920. It will be seen from the accompanying Report of the Chief Sanitary Inspector that a very large amount of sanitary work has been performed during the year; 3,087 premises were inspected for conditions injurious or dangerous to health, and insanitary conditions varying in their nature from slight to grave were discovered to the number of 2,570; 918 Intimation Notices, followed in 41 cases by Statutory Notices, were complied with. 3,184 re-inspections were made, making a total for the year of 6,271 inspections. The slaughter-houses (4), bake-houses (27), cowshed. (1), and dairies (68), the registered houses let in lodgings (259), situated in the Borough, were all inspected during the year. The Common Lodging House was closed in the year 1918. 385 FOOD INSPECTION. 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. Over a ton of unsound food was voluntarily surrendered during the year. Premises where food is prepared and stored have been kept under supervision. The Dairies have been systematically inspected during the year. One of the most important functions that Sanitary Officers can perform is to do what is possible to stimulate the local producers and retailers to a higher standard of cleanliness in the collection and distribution of milk. HOUSES LET IN LODGINGS. By the end of the year 1920, 259 such premises were on the Register, but these will be greatly increased as the result of the greater number of house-to-house inspections which can now be undertaken. HOUSING. No material industrial development of Stoke Newington is likely, and the demand for houses will continue to come from those who are industrially employed elsewhere. But there is an urgent need of more dwellings in Stoke Newington in order to reduce the excessive occupation of many existing ones. Of the dwelling houses in the Borough (8,028), 3,978 are of a working class rental and type. Although the average annual increase of population for the five years before the War was about 8 per thousand, no new working class dwellings have been erected for some ten years. About 6,000 of the houses are at present tenemented and, especially in the South Hornsey Ward, there are many tenements with more than two occupants per room. Many up-to-date facts as to the circumstances of occupancy of these houses are being ascertained by the house-to-house inspection, which it has been possible to extend in recent months. 386 During the year 1920 many of the least satisfactory dwellings within the Borough were inspected and the facts duly entered in the special Register which has to be kept under the Housing and Town Planning Act of 1909. The inspections included a large number of houses in the South Hornsey Ward, Rochester Place, Masons Court and Place, White Hart Court, Kynaston Avenue, St. Andrews Pavement, Cressington Road, Carysfort Road, Lordship Grove, Wordsworth Road and Defoe Road. These inspections dealt with nearly 650 separate houses. Some of these are old and unsatisfactory in sanitary respects. It cannot be said that their closure and demolition is urgent. They are kept under frequent inspection and in most of them we have imposed restricting conditions as to occupancy. Certainly these premises in all the circumstances may be continued in occupation for another year or two. All local sanitary authorities realise that the provision of more and better homes is a public health need that must claim their first and most earnest consideration at the present time. As the poorer-class dwellings in the Borough had markedly deteriorated during the war, it was found necessary to call for a considerable amount of remedial work, which, at the high cost of labour and material, imposed a heavy tax upon the owners. Certain dwellings in reference to which the question of closure had been raised just before the war have been given a fresh (although it is to be hoped a short) lease of life in consequence of the war. The dearth of homes would make it a great hardship to dispossess present occupants, and the most than can be done in the meantime is to keep such premises under regular and frequent inspection, with the object of securing that they are maintained as well as can reasonably be demanded, and to provide the benefits of a more frequent scavenging. If this were done the next few years may possibly be tided over without the occupants of these dwellings suffering in their health, especially if they would assist in keeping their homes as sanitary as possible. Unfortunately, this assistance cannot be counted upon. It is probably true that even when the structure of the home is most 387 faulty from the sanitary standpoint, ill-health results quite as much from the acts or defaults of the tenants themselves as from the faulty structure. One is frequently impressed with the fact that the filthy and insanitary conditions of many of the poorer-class homes result from the neglect and default of the dirty tenants and from the misuse and wanton destruction at their hands of the sanitary provisions made by the landlord. The tenant of insanitary dwellings is not always the innocent victim of the landlord's neglect and rapacity, and I have long been of opinion that additional powers in bye-laws are needed whereby tenants themselves should be made more responsible for maintaining cleanliness and the efficiency and proper use of sanitary provisions. It is certain that no legislation and no practical measure of sanitary inspection can serve to maintain a proper standard of sanitarypractice in the intimate circumstances of the dwelling. But the power suggested of penalising dirtiness and neglect on the part of the tenant would achieve something in this direction, and it would help towards the great remedy—education. There is much present-day evidence of overcrowding in the Borough. In some cases the occupants of the dwellings are occupying beds in rooms which before the war were never used for sleeping purposes, and in very many cases the number in the bedrooms which were so used before the war is too great for healthy occupation, although the low legal demands of cubic space may just be satisfied. The shortage of housing accommodation explains this and justifies it, and the only remedy is more houses. As the Borough of Stoke Newington is so largely residential, it may be argued that its contribution to the present-day housing requirements need only be a very modest one. As a matter of fact, it is not possible to provide many new houses in Stoke Newington without the demolition of existing ones, for the Borough presents available sites for only a very few dwellings. However, what is 388 possible should be done, not only to relieve the present local congestion, but also as a contribution towards the need of the metropolis as a whole. At present 18 dwellings (Flats) are almost completed at Lordship Grove, and it is proposed to erect others in the near future. There is a long waiting list of persons who require houses and when those in course of construction are occupied there will be left a considerable unsatisfied demand. STATEMENT ON HOUSING CONDITIONS. Statistics. Year ended 31st December, 1920. 1.—GENERAL. (1) Estimated population 52,984 (2) General death-rate 12.4 (3) Death-rate from tuberculosis 0.70 (4) Infantile mortality 80.0 (5) Number of dwelling-houses of all classes 8,028 (6) Number of working-class dwelling-houses 3,978 (7) Number of new working-class houses erected 18 in course of construction. 2.— UNFIT DWELLING-HOUSES. I.— Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,117 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 70 389 II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 907 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, etc., Act., 1919. Nil B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 907 (2) N umber of dwelling-houses in which defects were remedied:— (a) by owners 907 (b) by Local Authority in default of owners Nil C. Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. Nil 3.—UNHEALTHY AREAS. Areas represented to the Local authority, with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890 Nil 1.—Number of houses not complying with the building byelaws erected with consent of Local Authority under section 25 of the Housing, Town Planning, &c., Act, 1919 Nil 2.—Staff engaged on housing work with, briefly, the duties of each officer:— Two Sanitary Inspectors One Clerk and part-time Sanitary Inspector. SCAVENGING. The Scavenging of the Borough is satisfactorily provided for and carried out by an efficient weekly collection of the house refuse, 390 which is brought in covered carts to the Destructor in Church Walk. Trade refuse is collected and disposed of on terms agreed upon. The streets and yards are well scavenged. FACTORIES AND WORKSHOPS. At the end of the year 1920, 394 factories, workshops and workplaces were on the Register. As the result of the inspection of the workrooms and workplaces in the Borough, it was found that for the most part they were in a satisfactory condition, and that the requirements of the Factory and Workshops Act of 1901 were duly observed. There are several hundred 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. It is important that the lists of " outworkers" should be obtained twice yearly and that the homes of outworkers should be periodically inspected, more particularly when the work undertaken deals with wearing apparel, textile material (curtains, etc.), used in dwellings, and upholstery work. The Factories and Workshops Act, 1901, makes provision for this. 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) 74 20 _ Workshops (including Workshop Laundries) 305 50 - Workplaces 15 2 - (Other than Outworkers premises included in Part 3 of this Report) Total 394 72 Nil. 391 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 *Nuisanccs under the Public Health Acts:— Want of Cleanliness 37 37 Want of Ventilation 2 2 Overcrowding — — — Want of Drainage of Floors — — — — Other nuisances 32 32 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 64 64 - not separate for sexes — - - - Offences under the Factory and Workshops Act:— Total 137 137 Nil Nil • Including those specified in sections 2, 3, 7 and 8 of the Factory and Work shops Act as remediable under the Public Health Acts 3—HOME WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Outworkers. Notices served on Occupiers as to keeping or sending lists. NATURE OF WORK. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) Wearing Apparel— (1) Making, &c (2) Cleaning and Washing Household Linen 3 ) - 197 30 392 4—REGISTERED WORKROOMS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Miscellaneous 259 Bakehouses 27 Tailoring. 20 Mantle Makers 14 Dressmaking 12 Total number of workshops on Register 332 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) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901)— Notified by H.M. Inspector 14 Reports (of action taken) sent to H.M. Inspector 6 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 outworkers have been inspected. FOOD AND DRUGS. Under the Sale of Food and Drugs Act, 175 samples of food and drugs were taken and analysed. The results are shown in Table V. 393 Twelve of the samples purchased in the Borough in 1920 were not satisfactory; and, therefore, the percentage of non-genuine samples amounted to 7 percent., as compared with 8 percent, for the preceding year. This is below the figure for London as a whole. 9.8 percent, of the 92 Milk samples were unsatisfactory, as against 17 percent, during the preceding year; but in some cases the deficiency below the legal limits was very slight. In London as a whole, the percentage of Milk samples reported against was practically the same as in Stoke Newington. It should be added that many of the other samples purchased were below the average quality of the milk supply of London, although they were a trifle above the low legal limits which have been fixed. All the samples of Milk, Butter and Margarine were tested for antiseptics, with the result that no sample of Milk, 6 of Butter, and all the samples of Margarine were found to contain boric acid. In no case was the amount sufficient to warrant a prosecution; but in one or two instances the vendors were cautioned. Five informal samples have been taken during the year. The informal samples collected did not lead to the detection of adulteration. Fifteen samples of milk were purchased on Sunday mornings. 394 TABLE V. ANALYSES PERFORMED UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1920. Article submitted for Analysis (175) No. of Genuine Samples (163) No. of Adulterated Samples (12) Remarks as to Adulteration. Ale 1 - Butter 13 — Corn Flour 1 — Coffee 10 — Cream 3 1 One sample of fresh Cream contained 10½ grains per 1lb. Boric Acid. Vendor cautioned. Dripping 2 — Flour 4 — Green peas 1 — Lard 4 — Lime Water 1 — Milk 83 9 (1) Fat & non fat slightly deficient. Vendor cautioned. (2) 7% deficiency in fat. Vendor cautioned. (3) Slight deficiency of non-fatty solids. Vendor cautioned. (4) Slight deficiency in fat. Vendor cautioned. (5) Slight deficiency in fat. Vendor cautioned (6) 11 % added water. Summons dismissed on Warranty. (7) 5% added water. Summons withdrawn. (8) Slight deficiency in non-fatty solids. Vendor cautioned (9) 3% deficiency in fat. Vendor cautioned. Margarine 13 — Mixed Sweets 1 — Oatmeal 3 — Pepper 3 — Prescription 2 — Sausage Meat 1 — Sausages 4 — Boric Acid 0.28% in Beef Sausage. Salt Petre 1 1 Consisted of potash Alum. Vendor — fined 10/- and (2 2s. costs. Sugar 1 Separated Milk 3 — Spirits of Nitre 1 1 8% deficiency in Ethyl Nitrite. Vendor cautioned. Turkey and Tongue Paste 1 — Vinegar 3 — Whiskey 3 — 395 THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS It will be remembered that by these Regulations a definite restriction has been placed on the use of preservatives by producers, retailers and others concerned in the milk and cream trade; no preservative is to be added to milk in any case, and no preservative is to be added to cream which is not sold as preserved cream. The addition to cream of any other preservative substances than those mentioned is prohibited. The object of the Regulations in regard to cream is to secure that preserved cream sold in compliance with the Regulations shall be distinguished at all stages of sale from cream to which no preservative has been added; this distinction is important in the interests of the public generally, and particularly in the interests of infants and invalids. During the year 1920 three samples were taken under these Regulations. Of two samples of fresh cream purchased one contained 10½ grains per pound of boric acid. The samples was not labelled as preserved cream nor was any declaration of this fact made at the time of purchase. The vendor was interviewed by the Public Health Committee and cautioned. A sample sold as "preserved" was found to contain 0.18 percent, of boric acid It was sold in full compliance with the Regulations. REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1920. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stoke Newington. Ladies and Gentlemen,— I beg to present my Annual Report for the year ending December 31st, 1920:— 396 HOUSES AND PREMISES INSPECTED. After Notification of Infectious Diseases 615 By house-to-house inspection 638 Upon complaint, under Sec. 107 (3), Public Health (London) Act, 1891 467 After Notices from Builders, under Bye-law 14 (London County Council) 79 Stables and mews159 Slaughter houses 12 Milkshops, dairies and cowsheds 86 Bakehouses 40 Factories and workshops 394 Other premises inspected 597 Re-inspections made to examine and test work, etc. 3,184 Total inspections 6,271 NUISANCES ABATED AND SANITARY DEFECTS REMEDIED. Dirty premises, cleansed and whitewashed 389 Dampness in dwellings remedied 247 Dilapidated ceilings, stairs, etc., repaired 142 Defective drain inlets remedied 6 Foul traps and pans of w.c.'s cleansed 61 Public-house urinals cleansed (after intimation) 2 Flushing cisterns to w.c.'s provided or repaired, and w.c.'s with insufficient water supply made satisfactory 76 Defective w.c. basins and traps removed and replaced by approved patterns 160 Stopped or choked w.c. traps cleared 24 External ventilation to w.c.'s improved 2 W.C.'s removed to more sanitary positions 3 Carried forward 1,112 397 Brought forward 1,112 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. accomodation 3 Defective soil-pipes reconstructed 25 Unventilated soil-pipes ventilated and 68 Soil-pipes improperly ventilated, improved Dirty yards cleansed 7 Yards paved or repaved with impervious material 120 Yards drained 4 Gully and other traps inside houses removed 3 Sink waste-pipes directly connected to drain, made to discharge in open-air over proper syphon gullies 4 Long lengths of sink, bath, and lavatory waste-pipes trapped, and made to discharge in open-air over gullies 45 Defective waste-pipes repaired 75 Foul water-cisterns cleansed 14 Water-cisterns without close-fitting covers provided with proper coverings 40 Defects in water-cisterns remedied 12 Cisterns removed to more sanitary position 1 New portable dust-bins provided 159 Defective drainage reconstructed in accordance with bye- laws of County Council 91 Choked or stopped drains cleared and repaired 90 Drains ventilated or defective ventilating pipes renewed 6 Rain water pipes disconnected from drains or soil-pipes and made to discharge over gully-traps 14 Proper water-supply provided to houses or tenements 16 Defective roofs repaired 246 Defective guttering and rain water pipes repaired or renewed 224 Defective paving to floors of wash-houses repaired or renewed 42 Dirty walls of work-rooms cleansed 37 Carried forward 2,476 398 Brought forward 2,476 Proper manure receptacles provided (London County Council bye-laws) 5 Cases of overcrowding abated 1 Accumulation of refuse, etc., removed 23 Areas re-paved and drained 5 Space under wooden floors insufficiently ventilated, remedied by insertion in outer walls of proper air bricks 20 Underground dwellings improved 4 Nuisances from animals abated 7 Smoke nuisance abated 2 Miscellaneous nuisances abated 27 Total 2,570 The above list refers only to work carried out on Intimation and Statutory Notices. In addition, a large number of improvements have been made on advice to owners and occupiers. INTIMATION NOTICES SERVED. Sec. 3, Public Health (London) Act, 1891. House-to-house inspection 380 After inspection on account of complaint 340 After infectious illness 91 With reference to stables and mews 11 ,, ,, milkshops, dairies and cowsheds 1 „ ,, bakehouses ,, ,, factories and workshops 72 „ „ slaughter houses After sundry other inspections 23 918 STATUTORY NOTICES. Forty-one statutory notices were served by direction of your Committee under Sec. 4, Public Health (London) Act, 1891. Over 2,500 nuisances have been abated under Intimation and Statutory Notices. In addition, a large number of improvements have been made on advice to owners and occupiers 399 SLAUGHTER-HOUSES. The four Licensed Slaughter-houses at present in use in the Borough, are:—Nos. 118, Church Street; 165, High Street; 55, Nevill Road and 108, Green Lanes. The results of inspections have been satisfactory, and the Licenses of each were renewed by the London County Council in October. HOUSE-TO-HOUSE INSPECTION. Six hundred and thirty-eight Inspections were made during the year, in the following streets of the Borough, and 380 Intimation Notices were served on Owners and Occupiers:— Kynaston Avenue. Nevill Road (Tenements). Howard Road. Masons Court and Place. Spenser Road.White Hart Court. Hewling Street. Rochester Court. St. Andrew's Pavement. Leonard Place. Watson Street. Hornsey Place. Cressington Road. Lordship Grove. Victoria Road. Wordsworth Road. Carysfort Road. Woodberry Down. Lordship Park Mews. Defoe Road. FOOD INSPECTION. BUTCHERS', GREENGROCERS' and FISHMONGERS' SHOPS, STALLS, ETC. The following articles of food were seized or surrendered during the year; Meat— cwt. qrs. lbs. Tins of Beef 2 0 22 Ox Hearts 0 2 14 Calves' Plucks 0 1 11 Sheeps' Heads and Plucks 0 2 0 Bacon 0 0 22 400 Fish— cwt. qrs. lbs Haddock 1 2 8 Herrings 0 1 12 Lemon Soles 0 1 20 Bream 0 1 20 Plaice 0 0 8 Skate 0 1 20 Halibut 0 0 16 Salmon 0 0 8 Mackerel 0 3 12 Kippers 0 1 22 Other Articles— Butter 0 0 8½ Chestnuts 0 2 5 Asparagus 0 0 10 Tinned Milk 10 0 16 Rabbits 0 3 16 Total Ton 1 0 1 18½ Frequent inspections were made of the premises in the Borough where food is sold or prepared. The contents of barrows of itinerant vendors and the stalls in the Market Place in Wordsworth Road also has considerable attention with satisfactory results. BAKEHOUSES. There are 27 bakehouses in the Borough, 20 of these being underground Inspections were made twice during the year. In three instances it was found necessary to require the owners to lime white and cleanse walls. DAIRIES, COWSHEDS AND MILKSHOPS. There are at present 68 Milk Vendors registered in the Borough, and one Licensed Cowkeeper. The premises were all inspected during the year. It was only found necessary to serve two notices for cleansing. 401 COMPLAINTS. Sec. 107 (3) Public Health (London) Act, 1891. Four hundred and seventy-one complaints were received during the year, and the premises to which they related were promptly inspected. In 31 cases, on inspection of the premises to which the com plaint related, no nuisance which could be dealt with under the Public Health Acts was found. Three hundred and forty Intimation Notices were served, and complied with. The Metropolitan Water Board have been notified of a number of cases of waste or misuse of water in the Borough The number of complaints constitute a record for the Borough, and these may be explained by the fact that tenants expect that all the extra rent paid under the Act (which allows of certain increases in the rent) should be immediately spent on the premises. Another factor was the postering of a neighbouring Borough inviting occupiers of houses to apply to the Public Health Department at the Town Hall to have their premises inspected. This policy is sound from a Public Health point of view when the staff is sufficient to cope with the increased work. STABLES AND MEWS. One hundred and fifty nine inspections were made during the year. Eleven Notices were served in respect of accumulations of manure. HOUSES LET IN LODGINGS. There were 259 premises on the Register at the end of the year The Register is now under revision. RESTAURANT KITCHENS AND EATING HOUSES. There are 11 of these premises in the Borough. The results of the inspections, both of the food and the kitchens, have been satisfactory. 402 RATS AND MICE (DESTRUCTION) ACT, 1919. In April, 1920, at the request of the Board of Agriculture and Fisheries your two Sanitary Inspectors, Mr. A. P. Piggott and myself were appointed Officers under the above Act. Particulars of the action taken by them since this appointment are appended : Situation of Premises. Action Taken. Remarks. 1, Adolphus Rd. Drains reconstructed. Poison supplied Premises still under observation at close of 3, Adolphus Rd. Infestation presumably from No. 1. Poison supplied. 5, Warwickshire Rd. Drains tested and found satisfactory. Poison supplied year Apparently a few stray rats. No further complaints 35, Palatine Rd. Rat runs traced to defect in drain near outer W.C. No further complaints 4, Milton Rd. Drainage modern. Poison supplied 1 rat caught No further complaints 53, Lordship Park Infestation by mice. Poison supplied Premises cleared 71, Spenser Rd. A few stray rats caught Ditto. 61, Harcombe Rd. Drains tested and found satisfactory. A few stray rats caught Ditto. Kemble's Piano Works 7, Belgrade Rd. Drainage modern. Poison supplied Drains tested and amended. Poison supplied. Rats apparently strays No further complaints Ditto. 30, Nevill Rd Drains tested and found satisfactory. 32, Nevill Rd Rats run under party wall, but no evidence of source of infestation. Drains relaid Case still in hand 40, Defoe Rd Rat runs traced to defective drains, which were reconstructed No further complaints 29, Defoe Rd Ditto. Ditto. 403 Situation of Premises. Action Taken. Remarks 9, Wordsworth Rd. Rat runs traced to defective drain. Drain repaired No further complaints 5, Carysfort Rd. Rat runs traced to defect in front inspection chamber. Intercepting trap fitted, and drain repaired Ditto. 7, Carysfort Rd. 70, Park Lane Drains tested and found satisfactory. Rats are apparently strays from banks of New River. Advised tenant to remove old sheds from yard, and pave same Ditto. 5, Lilian Street One or two strays, traps set and poison supplied No further complaints 79, High Street Poison supplied and holes stopped. The source of infestation is at No. 81. These premises and also No. 83 are being dealt with. The drain between Nos. 83 and 85 has been examined, and the paving through Courtwav (Rochester Court) and in front of shops taken up and concrete put in Further work being carried out 81, High Street 83, High Street 69, Princess May Rd. Drains tested and runs traced to broken drain pipe. Defect remedied. Two old rats and nest of young strays No further complaints 2, Hewling Street r Several rats destroyed ; evidently strays No further complaints 97, Park Lane Drains tested and found satisfactory. Poison supplied Matter still in hand 92, Amhurst Park Advised occupant to remove disused fowl-house No further complaints 1, Kynaston Avenue These premises were badly infested ; rats had obtained ingress through broken airgrids and had burrowed under party walls, finally nesting in disused brick drain running under No. 1. The brick drain was taken out and all broken airgrids renewed No further complaints 2, Kynaston Avenue 3, Kynaston Avenue 4, Kynaston Avenue 5, Kynaston Avenue 6, Kynaston Avenue 143, Bethune Rd. Mountgrove Mews Complaint of rats seen in garden. Drains in order. Poison supplied Rats in stables. Poison supplied No further complaints Ditto. Lordship Grove and Depot Two drains defective. Rat runs discovered. Drains of Nos. 4 and 5 were relaid and an interceptor fixed. Drainage of Depot apparently satisfactory, but drains of stables adjoining were untrapped. Bad | weather brought wall down on to catchpit. Wall rebuilt, and stone cover fixed on the catchpit. No further complaints 404 In dealing with the rat question in the Borough several kinds of poison have been used. It is difficult to estimate the value of any poison as an exterminator, as the result is not apparent. In the majority of cases we have been able to trace the source of the infestation and provide a remedy; then trapping the rats left behind in the house. The Inspector of the Board of Agriculture and Fisheries has paid two visits to the Borough during the year, and discussed the work with your Inspectors. SALE OF FOOD AND DRUGS AND MARGARINE ACTS. One hundred and seventy-five samples were taken and submitted to the Public Analvst during the vear. List of Prosecutions. No. of Sample. Article. Nature of Offence. Result of Proceedings. 35 Ground Salt Petre Potash Alum Vendor fined 10s and £ 2 2s costs. 106 Milk 11 % added water Summon withdrawn Analysis disputed 107 Milk Selling milk from a receptacle which had not inscribed upon it the Vendor's name and address Selling margarine from an un labelled parcel Defendant fined 30s Summons dismissed Several vendors of poor samples of food and drugs were cautioned by order of your Committee. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920. SECTION 2 (2). This sub-section provides that "at any time or times not being less than three months after the date of service of notice of increased rent the tenant is entitled to apply to the County Court for an order 405 suspending the increases if he considers that the premises are not in all respects reasonably fit for human habitation, or otherwise not in a reasonable state of repair. He will be required to satisfy the County Court by a report of the Sanitary Authority, or otherwise that his application is well founded, and for this purpose is entitled to apply to the Sanitary Authority for a certificate." Nine applications were made to your Authority during the year, and in six instances certificates were granted. It is the practice in Stoke Newington, on application being made for a certificate under the above Section, for an inspection of the premises to be made and an intimation notice served on the owner or occupier for any nuisance or repair which can be dealt with under the Nuisance Section of the Public Health (London) Act, 1891, and Housing Acts. FACTORIES AND WORKSHOPS. During the year under review, every factory, workshop and workplace in the Borough was inspected, and on the whole a good general sanitary condition was found. The factories, however, had been allowed to fall into a dirty condition so far as the walls of the workrooms were concerned, the laxity of the war period causing this. Notices were served, and matters have now been remedied. An all-round improvement should be maintained. A large number of refreshment rooms and eating houses were inspected. On the whole, the kitchens were kept in a cleanly condition, and in no case was unsound food found upon the premises. One hundred and ninety-four outworkers were notified from firms whose places of business are in Stoke Newington. Of these out-workers 67 dwelt in Stoke Newington. Seven hundred and ninety-seven notifications of out-workers were received from Medical Officers of Health of persons residing in Stoke Newington, but who work for firms in other districts. Therefore, there are at present 864 out-workers dwelling in Stoke Newington. The outworkers Lists from the various firms in the Borough employing outside labour were dealt with. 406 NOTIFICATION OF INFECTIOUS DISEASE The houses where 615 cases of Infectious Disease occurred were inspected by your Inspectors during the year; 91 Intimation Notices were served for insanitary conditions found. No complaints were received of any damage to, or loss of, textile articles during the process of disinfection DRAINAGE PLANS AND APPLICATIONS Thirteen plans and applications were considered and approved by your Committee for alterations to and reconstruction of drains. PUBLIC HEALTH (LONDON) ACT, 1891, AND BYE-LAWS. List of Prosecutions. No. in Report Book. Address Nature ot Offence. Result of Proceedings. 17,015 12, Manor Rd. 1. Altering drainage without previously giving notice. 2. Failure to deposit plans of such alteration. 3. Carrying out work not in compliance with the L.C.C. drainage byelaws Summons heard at North London Police Court, 14/10/20. Defendant fined 20s. on each ot three summonses 17,070 1A, Nevill Rd. Exposing unsound meat for sale Fined 10s. and £ 1s. costs I am, Ladies and Gentlemen. Your obedient Servant, D. W. Matthews, Chief Sanitary Inspector. 407 A LIST OF THE STREETS SITUATED IN THE BOROUGH OF STOKE NEWINGTON. (For the Guidance of Medical Practitioners, Midwives, Etc.) ADEN Grove Aden Terrace Adolphus Road Allen Road Allerton Road Albion Road ,, Grove Alexandra Road Amhurst Park (90-100 even Nos. and 93) Arthur Road Ayrsome Road Aldham Place BARN Street Barrett's Grove Belgrade Road 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 (Queen's Rd. to Brownswood Rd.) Green Lanes Brownswood Road Burma Road ROSS WAY (late Castle St.) (2 to 50) N. Side Carysfort Road Chalmers Terrace Chapel Place Chesholm Road Church Walk Street Clonbrock Road Clissold Road Coronation Avenue Cowper Road Cressington Road DEFOE Road Digby Road Dumont Road Dynevor Road EADE Road (2 to 66) and 1 to 27 odd Nos. Edward's Lane FAIRHOLT Road Finsbury Park Road Fleetwood Street GAINSBORO Road Gloucester Road Goldsmith Square Gordon Road Grange Court Road Grazebrook Road Grayling Road Green Lanes ,, „ (from 2 to 388) „ ( „ 81 „ 147) „ (203 on.) 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 to 217) Hornsey Place Howard Road IMPERIAL Avenue 408 KERSLEY Road King's Road Knebworth Road Kynaston Road „ Avenue LANCELL Street Laver's Road Lavell Street Leconfield Road (1-33) Leonard Place Lidfield Road 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 Osterley Road PAGET Road Painsthorpe Road Palatine Road Paradise Row Park Crescent ,, Lane „ Terrace „ Street Pellerin Road Petherton Road (106 to 138) Portland Road Prince George Road Princess Road „ May Road QUEEN Elizabeth's Walk Queens Road REEDHOLM Villas Rochester Place Riversdale Road (92-104) SANDBROOK Road Salcombe Road Seven Sisters Road:—From Blackstock Road to Amhurst Shakespeare Road [ Park Shelgrove Road Shipway Terrace Somerfield Road Spenser Road Springdale Road St. Kilda's Road St. Andrew's Road ,, Mews „ Pavement, S. Side (11 to 20). Selsea Place Stamford Hill (1-39) Stoke Newington Road (1-175) Statham Grove Summerhouse Road TRUMAN'S Road Town Hall Approach VICTORIA Grove Victoria Grove West Victoria Road WALFORD Road Warwickshire Road Watson Street White Hart Court Wilberforce Road Winston Road Wordsworth Road Woodland Road Woodlea Road Woodberry Down „ Grove