BER 39 Metropolitan Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY, For the Year 1920. BY R. KING BROWN, B.A., M.D., D.PH. Medical Officer of Health. TABLE OF CONTENTS. VITAL STATISTICS— p age Population 7 Births 7 Marriages 8 Deaths 8 Infantile Mortality 9 Zymotic Diseases 9 Measles 10 Whooping Cough 10 Enteric Fever 10 Tubercular Diseases 10 Phthisis 10 NOTIFICATION OF INFECTIOUS DISEASE— Diphtheria 11 Scarlet Fever 11 Measles 12 Enteric Fever 12 Puerperal Fever 12 Opthalmia Neonatorum 12 Cerebrospinal Meningitis 12 Polio-Myelitis 12 Bacteriological Laboratory 12 SANITAIIY ADMINISTRATION — Pood Inspectors' Work 14 Unsound Food 15 Milk Premises 15 Slaughterhouses 15 Ice Cream Premises 15 Food and Drugs 16 General Sanitary Work 16 Smoke Nuisances 16 House Refuse 16 Offensive Trades 16 Cleansing of Persons Act, 1897 17 Disinfection 17 Proceedings during year 17 Mortuary 19 Work of District Inspectors 20 Insanitary Areas 21 Housing of the Working Classes Act, 1890, Part II., Section 39 (1) (b) 22 Salisbury Street Area 22 Housing 23 Assistant Medical Officers' Report 23 Rats and Mice (Destruction) Act, 1919 30 Outworkers 31 MATERNITY AND CHILD WELFARE — Lady Assistant Medical Officer's Report on Maternity and Child Welfare 32 Health Visitors 36 Municipal Dentist 38 Municipal Midwives 38 District Nurse 39 Municipal Lying-in Hostel 39 TUBERCULOUS — Tuberculosis Dispensary 40 Tuberculosis Scheme 40 Prevalence of Tuberculosis in the Borough 40 Tuberculosis Dispensary 43 APPENDIX TABLES— Local Government Board Tables 54-60 Outworkers 61 Deaths from Zymotic Diseases 62 Prosecutions (Foods and Drugs) 63 Marriages 66 Factories and Workshops 67 Bakehouses 68 Unsound Food and Foreign Meat Regulations 69 PUBLIC HEALTH DEPARTMENT. Public Health Committee, 1920. Chairman—Councillor STOKES. Alderman Salter, M.D., J.P., Councillor Monk, Councillor Baker, „ Salter, „ Broughton, „ Stephen, „ Sullivan, „ Gamble, „ Gledhill, „ Vezey, „ Jeffery, „ Wallsgrove, „ Lawrence, G. C., „ Weightman. „ Lyon, Ex-officio: W C. BUSTIN, Esq., J.P. Mayor of Bermondsey. Maternity and Child Welfare Committee, 1920. Chairman-Councillor LYON. Alderman Salter, M.D., J.P., Councillor Stephen, „ Squires, „ Stokes, Councillor Baker, „ Broughton, Co-opted Members: „ Gledhill, Mrs. A. Bustin (Mayoress), „ Jeffery, „ W. G. L. Hawke, „ Jones, „ M. Nix, „ Lawrence, G. C., „ J. E. Scriven. „ Salter, Ex-officio: W. C. BUSTIN, Esq., J.P. Mayor of Bermondsey. STAFF: Medical Officer of Health—R KING BROWN, B.A., M.D., D.P.H. Lady Assistant Medical Officer of Health—Dr. Stella Churchill, M.R.C.S., L.R.C.P., D.P.H. Municipal Dentist—Mr. Grantley Smith, H.D.D., L.D.S. Sanitary Inspectors: District. District. No. 1.—Mr. J. G. Francksen. No· 5. —Mr. E. C. Freeman. No. 2. — „ J. W. Wood. No. 6.— „ T. W. Golds. No. 3— „ A. H. Merryman. No. 7. — „ W. Davis. No. 4— „ H. J. Toogood. No. 8. — „ W. J. Luke. Food Inspectors: Mr. T. Ashdown, Mr. G. A. Hoskins and Mr. G. L. Scott. Health Visitors: District. District. No. 1.—Miss Child, No. 5. —Miss Bache, No. 2.—Mrs. Smith, No. 6.— „ Sumner, No. 7.— „ Carlton. No. 3.—Miss Islip, No. 4.— „ Sharman, No. 8.— „ Wadds. District Nurse —Miss Gibson. Clerical Staff: Mr. H. W. Bush, Chief Clerk. Mr. E. J. Pitts, Second Clerk. Mr. A. Manning, M. & C.W. „ A. I. Fair, Third „ Clerk „ F. W. Smith, Fourth „ „ C. F. Yaxley, General „ „ H. E. Butcher, Junior „ „ E. F. Walsh, General „ Master W. C. Tapsfield, Office Lad. Municipal Lying-in Hostel —Matron: Miss A. E. Sewell. Nurses —Miss Megson, Miss Wright, Miss Booth. Municipal Midwives—Miss Helden, Miss Middleton. PUBLIC HEALTH DEPARTMENT, TOWN HALL, SPA ROAD, S.E. Metropolitan Borough of Bermondsey. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bermondsey. Ladies and Gentlemen, — I have the honour to submit my Twentieth Annual Report on the sanitary condition of the Borough of Bermondsey during the year 1920. The death-rate was 12.7, compared with 14.1 in 1919, and 22.0 in 1918. The death-rate is discussed in an early section. The sections of the report are, as usual, divided into:— I.—Vital Statistics. II.—Notification of Infectious Diseases. III.—Sanitary Administration. IV.—Factories and Workshops. In the appendix will be found the Local Government Board Tables, including a special Table on Infantile Mortality. The year under report was specially notable for increased activity in all departments of the Housing question. Extra medical assistance was engaged, also extra Sanitary Inspectors, and a special clerk to look after Housing. The details will be found in the body of the report. The question of Maternity and Child Welfare also takes a very prominent place, and reports will also be found on several schemes which were initiated during the year under report. There was nothing unusual to record in other departments except that the special activities referred to caused a general increase in the work of the Department. I wish once more to record that between the Chairman and Members of the Public Health Committee and myself, there has been the usual cordial co-operation during the year under report. The staff of the Department has also shown itself most willing to fall in with the various new and additional duties cast upon them, and have done their part loyally in the promotion of the Public Health of Bermondsey. I am, Ladies and Gentlemen, Your obedient servant, R. ING BROWN 1 .—VITAL statistics. Population. The populations of the Borough of Bermondsey and its registration sub-districts, as enumerated in the Census of 1901 and 1911, and the estimate of the year under report are as follows:— Estimated 1901. 1911. to June 30th, 1920 Berraondsey 82,483 81,959 84,099 Rotherhithe 38,460 35,247 36,167 St. Olave 9,817 8,697 8,923 Borough 130,760 125,903 129,189 The population of Bermondsey for 1920 lias been estimated by the Registrar-General as 129,189, and this figure has been utilised in estimating the birth and death rates. Births. The total number of births registered in the Borough for the 53 weeks ended January Ist, 1921, was 4,038, consisting of 2,058 males and 1,980 females. This is 677 above the average for the last 10 years, and 1,401 above the figure for 1919. In Table 11. of the Appendix will be seen the figures for the last 10 Years in the three registration sub-districts, and in Table I. figures for the whole Borough. The birth-rate for 1920 was 81.2 per thousand persons living, which is 10.8 above that for 1919 and 4.1 above the average for the last 10 years. Marriages. The total number of marriages in the Borough in 1920 was 1,383, being 141 above the number for 1919, and 164 above the average for the last 10 years. In Table X. of Appendix will be found further particulars as to sub-districts. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 21.4 per 1,000 of the population, compared with a marriage rate last year of 19.2 per 1,000 of the population 129.189. Deaths. In Tables 111. and IV. of Appendix will be found tables dealing with deaths in the Borough. The total number of deaths registered in the Borough for the year ended December 31st, 1919, was 1,466, which is 134 less than in 1919, and 297 below the average for the last 10 years. When this figure is corrected by exclusion of deaths of nonparishioners occurring in the district, and the inclusion of deaths of parishioners occurring outside the district, the number is raised to 1,642. This is 106 less than in 1919, and 532 less than the average for the last 10 years. The death-rate for the Borough in 1920 was 12.7 per thousand living inhabitants, being 1.4 below that recorded in 1919, and 5.5 below the average for the last 10 years. In column 1, foot of Table I. of the Appendix will be found a list of places where deaths of non-parishioners occurred in the districts. There were 105 such deaths in all, against 165 in 1919 and 191 in 1918. 72 such deaths occurred in the infirmary; 1 in the workhouse, 27 in the River Thames and the Surrey Commercial Docks, 1 at a Railway Station, 4 in the street, and 1 in a factory. 281 persons belonging to this Borough died in outlying institutions, against 313 in 1919, and 439 in 1918. The names of the various places where the deaths occurred will be found in columns 2 and 3 at foot of Table I. of Appendix. Infantile Mortality. The figure for this is 83 deaths under one year to every 1,000 births. Table A. —Infantile Mortality. Whole Borough. London. Year. No. of Deaths. Rate per 1,000 Births. Rate per 1,000 Births. No. of Deaths. 502 11,809 1910 127 103 1911 611 159 14,440 129 114 10,056 1912 433 91 11,869 105 1913 505 131 487 129 11,395 1914 104 537 11,369 1915 154 104 364 8,819 88 1916 108 335 125 8,273 103 1917 322 139 7,965 107 1918 262 7,039 85 1919 99 Average for years 1910 1919. 436 129 10,303 102 75 1920 83 337 - Deaths from Zymotic Diseases. There has been an increase in the deaths from these diseases, the figures being 163 against 113 in the previous year, and 258 the average for the last ten years. This gives a zymotic death-rate of 1.3. Measles. There were 56 deaths due to this disease, which is 22 below the average for the last ten years, and 38 above the number for 1919. Whooping Cough. 41 deaths were due to this cause, against 4 in 1919. Enteric Fever. 1 death was due to this cause in Rotherhithe There were 3 deaths in 1919. Tubercular Diseases. The number of deaths from all forms of tubercular disease in 1920 was 170, against 229 in 1919. Phthisis. In Table B will be found particulars of deaths from phthisis since the year 1910. There were 137 deaths due to this cause, which is 37 less than the number recorded in the previous year. Table B — Phthisis. Sub. District. Bermondsey. Rotherhithe. St. Olave. Whole Borough. London. Year. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. 219 5555 1·14 1910 148 1·82 50 1·31 1·73 21 2·91 1·68 1911 141 1·72 52 1·48 18 2·08 211 6084 1·35 1·69 1912 138 1·68 57 1·64 17 1·98 212 6069 1·35 1913 125 1·53 64 1·86 12 1·42 201 1·61 5981 1·30 21 1·63 6281 1·39 1914 136 1·66 46 1·35 2·53 203 156 57 2·42 233 1·97 6782 1·54 1915 1·76 1·77 20 1·78 6288 1.45 1916 126 1·70 4 4 1·38 14 184 1·61 123 61 2·02 1·88 198 1·83 6658 1·57 1917 1·75 14 117 1·42 9 1.20 169 1·56 7048 1·78 1918 1·66 43 104 1.28 58 1·66 12 1.39 174 1·40 5332 - 1919 Averages for years 1910 - 1919 131 53 1·59 200 1·67 6208 1·42 1·66 16 1·96 1920 10 81 46 1·06 137 - - 96 1·27 1·12 10 II. —NOTIFICATION OF INFECTIOUS DISEASE. In Table V. of Appendix will be found particulars of infectious diseases notified during the year under report. The number of cases notified, exclusive of notifications of tuberculosis, which numbered 438, was 1,486 compared with 1,390 in 1919 and 2,659 in 1918. The disease showing the principle increase was scarlet fever. The attack rate per thousand inhabitants was 11.5 against 15.2 in 1919. 25 cases were returned from hospital as not suffering from the disease for which they were notified, but if allowance is made for mild unreported cases, the recorded notifications would, if anything, understate the actual number of cases. Diphtheria. There were 268 cases of diphtheria notified in 1920 as against 278 cases in 1919. The attack-rate per thousand inhabitants was 2.07, against 2.24 in 1919. The case mortality was 9.3 per cent., against 7.6 per cent, in 1919, and 6.1 per cent, in 1918. 11 cases were returned as not suffering from this disease. Scarlet Fever. The notifications of scarlet fever in 1920 were 976 against 388 in 1919. This is an increase of 588. The distribution of the disease in the various Wards, as shown in Table V. of Appendix was fairly uniform. 11 cases were returned from hospital as not suffering from scarlet fever. There were 7 deaths, which gives the very low case mortality of 0.72 per cent., against 1.3 per cent, in 1919. The disease, as in recent years, was of a very mild type. The attack rate per thousand inhabitants was 7.56 against 3.12 in 1919. The sources of infection were mostly previous cases. There was no outbreak traceable to any common cause such as infected milk or school contagion. Measles. The number of deaths for 1920 was 56, against 18 in 1919, 71 in 1918, and 72 in 1917. Enteric Fever. 7 cases of enteric fever were notified, being 5 for Bermondsey, 1 for Rotherhithe, and 1 for St. Olave. Two cases were returned as not suffering. The total number of cases notified in the previous years was 6. Puerperal Fever. 21 cases of puerperal fever were notified. Death resulted in 9 cases. Ophthalmia Neonatorum. There were 37 cases of this disease notified during the year. Under this heading is included every kind of " sore eyes " occurring in the newly-born. They were all visited by the Health Visitors who instructed the mother in each case to imme-diately seek medical advice. Cerebrospinal Meningitis. 6 cases were notified in 1920, no cases were returned as not suffering. Most of them consisted of the sporadic form known as posterior-basic meningitis. Three cases occurred in children under one year of age. Polio-Myelitis. No cases were notified in 1920, against 2 in 1919. Bacteriological Laboratory. The total number of specimens examined in 1920 was 1,422 as compared with 954 in 1919, and 1055 in 1918. Table C. Nature of Spacimen. Total Examinations. Results of Examination. Positive. Negative. 1919 1920 1919 1920 1919 1920 Diphtheria (specimens taken by Medical Officer of Health) 320 524 22 30 298 494 Ditto (taken by general practitioners) 301 484 440 66 44 235 Diphtheria (total specimens taken) 1,008 88 533 621 74 934 Phthisis 331 402 64 74 - 267 328 Enteric 2 - 2 - 2 2 Various 10 - 1 - 9 954 1,422 802 1,273 152 Total specimens taken 149 Food Inspectors. Table E. Particulars of Work, 1919. ! / Visits. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Bakehouses. Food Factories. Butchers Fishmongers, Friers and Curers Food Stores. Food Wharves and Depots Ice Cream Markets. Milk Sellers. Restaurants and Eating Houses Slaughterhouses. Destruction of Food. Nuisances Reported. Fruiterers and Greengrocers. Various. Number of Samples taken Jam. Butter and Margarine. Other. Sanitary Administration. Re-visits ... 269 1214 ... ... ... 27 Mr. Ashdown ... 2 1 208 26 36 ... 3 1014 ... ... D.O.R.A. 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I New occupiers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I ~ Premises ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I Closed... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mr. Scott Re-visits 237 111 56 64 318 ... 72 207 265 49 139 .. 56 171 41 65 245 143 72 D.O.R.A. 14 2 5 28 85 13 24 18 12 13 2 4 ... 6 54 ... New occupiers ... 4 1 11 ... ... 8 5 3 ... 13 4 4 ... ... ... ... ... ... „ Premises ... ... 1 1 2 2 1 1 ... ... ... ... ... ... ... ... ... ... Closed 2 3 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Re-visits 49 Mr. Hoskins 114 573 123 164 277 326 105 ... 41 192 274 58 ... 149 321 78 234 1 D.O.R.A. 8 14 55 ... ... ... ... 6 ... 4 ... 30 ... ... ... New occupiers ... ... ... 7 1 5 20 3 6 9 1 7 4 ... ... ... ... ... ... ... ~ Premises ... ... 3 4 7 1 9 5 4 3 ... ... 1 ... ... ... ... ... Closed... ... 1 1 3 2 13 7 ... 10 ... ... ... ... ... ... ... ... ... Unsound Food. The following were brought to the notice of the Department, found to be unfit for human food, and destroyed as trade refuse: Meat— tons. cwts. qrs. lbs. Fresh /-I .1 2 6 0 10 Canned 3 19 Fish— Fresh • 2 1 16 Canned 11 2 2 Vegetable— o Fresh Canned 1 0 0 Fruit— Fresh 19 0 20 Canned 26 16 2 7¾ Dairy Produce— Various ... 3 18 2 21 Various- Various Canned Goods 1 10 1 4¾ 36 6 2 16½ Milk Premises. There were 294 milk premises on the Register at the end of 1919. 42 were added and 31 removed during 1920, making a total of 305 at end of the year under report. Slaughterhouses. There is one slaughterhouse in the Borough, 64 inspections were made. No notices were served. Ice Cream Premises. There were 89 premises where ice cream is manufactured on the Register at the end of 1919. 18 were added and 2 removed during the year under report, making a total of 105; 305 inspections were made. FOOD AND DRUGS. In Table IX. of Appendix will be found a list of the samples taken in 1920, and the action taken; 1,200 samples were taken, compared with 1,258 in 1919, and 1,186in 1918. Of these 5.3 per cent.were found adulterated, compared with 8.2 per cent, in the previous year, and 9.1 per cent.in 1918. GENERAL SANITARY WORK. Inspections. In Tables F. and G. (pages 26 and 29) will be found particulars of the general sanitary work by the District Inspectors during 1920. The house-to-house inspections numbered 5,955. This is 4,198 above the total for the previous year. 7,125 intimation notices were served, compared with 4,163 in the previous year. Smoke Nuisances. 15 observations were kept on chimneys and 10 notices served. House Refuse. The following table shows the amount of house and trade refuse disposed of during the year ended December, 1920: — Loads. Tons. Cwts. Qrs. Dust to Destructor 4374 6765 12 3 951 1518 10 0 „ „ Barge 466 10 0 „ „ Shoots 313 ,, ,, Lightning Crusher 6985 11778 9 2 861 490 9 1 Trade Refuse to Destructor 438 12 „ „ „ Shoots 291 0 2342 1800 5 0 „ „ „ Barge 16117 23259 8 2 Offensive Trades. The offensive trades on the Register are as follows: — Glue and size makers... 4 Tripe boiler 1 Fatmelters 4 Fellmongers 3 Manure Manufacturer.. 1 16 DISINFECTION. The following table shows the number of articles passed through the steam disinfector during the year under report: Quilts 1377 Beds 1269 Blankets 2110 Sheets 1357 Books 720 Bolsters 726 Miscellaneous 4586 Carpets 2 Cushions 294 Verminous Clothing 271 „ Bedding 287 Mattresses 46 Overlays 338 Hair (bundles) 17323 „ (cases) 72 Pillows 2280 8086 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Cleansing of Persons Act, 1897. During the year under report 11 male and 20 female adults used the Verminous Baths and had their clothing disinfected. The total number of articles disinfected for this purpose was 271. Table F. — Proceedings during 1920. Number of Places. Number of Inspections, 1920. Number of Prosecutions, 1920. Number of Notices, 1920. On Register at end of 1919. Added in 1920. Removed in 1920. On Register at end of 1920. Premises. 294 42 31 305 Milk Premises ... ... 450 ... ... ... Cowsheds ... ... ... ... ... 1 64 ... ... Slaughter-houses 1 ... 13 ... Other offensive trade premises ... 73 ... 13 ... 105 305 Ice-cream premises 89 18 2 ... ... 223 Registered houses let in lodgings 223 446 ... ... ... ... Total number of Intimation Notices served for all purposes 7125 Overcrowding, 1919— Number of dwelling rooms overcrowded - Number remedied - Number of prosecutions - Underground rooms— Illegal occupation dealt with during year - Number of rooms closed - Insanitary houses — Number closed under the Public Health (London) Act, 1891 - Number closed under the Housing of the Working Classes Act - Number of premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 - Number closed under the Housing, Town Planning, etc., Act, 1909 15 Shelters provided under Sec. 60 (4) of the Public Health Act, 1891 — Number of persons accommodated 20 Revenue Acts — Number of houses for which applications were received during the year - Number of tenements for which certificates were granted - Number of tenements for which certificates were deferred - Housing Town Planning, etc., Act, 1909, Sec. 35 — Number of houses for which applications were received during the year - Number of houses for which certificates were granted - Number of prosecutions under Bye-laws under Public Health Act, 1891 — (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (f) AS to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act. Sec. 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (Bye-laws) Act. 1899) 1 Mortuary— Total number of infectious bodies removed 8 Total number of bodies removed 117 19 Table G. Work of District Inspectors, 1920. 1 2 3 4 5 6 7 8 9 10 11 12 House to House. Special Inspections. Complaints. Infectious Diseases. Factories and Workshops specially Inspected. Outworkers' Bi-Annual Inspection. Underground Conveniences. Drains Tested. Other Calls and Visits. Offensive Trades. Chimneys Watched. Re-inspections. Ints. No. Ints. Ints. IntS. ints. No. No. No. Ints. No. Ints. No. No. No. No. No. Ints. No. No. 812 229 107 295 204 173 55 65 31 2 - - - 55 2848 708 5 1 Mr. Wood 534 7 7 Mr. Merryman 723 337 140 76 379 292 244 42 26 3 22 2 61 22 3052 314 2 1 - Mr. Toogood 846 561 176 20 486 389 351 62 6 4 10 - - 2 3206 554 1 1 - 86 Mr. Freeman 809 41 236 234 58 15 7 5 - 2 2 758 112 319 - 155 2869 273 - — 71 4 47 1771 Mr. Golds 365 231 285 75 331 204 261 67 37 2 48 - 75 95 - - 14 Mr. Davis 747 608 63 3 293 260 235 102 1 - - 148 66 2902 231 - - - — Mr. Franksen 385 105 187 56 31 1 7 - 219 55 5 526 51 231 157 1 2118 467 5 - 7 66 57 Mr. Luke 240 99 59 50 103 98 94 19 - - 44 22 1492 - - - - Mr. Pitts 40 22 7 77 56 72 40 5 1 4 44 18 576 31 - - - - - - 182 - - 2 Mr. Mayhew - - — - - - 287 534 - - - - - - - - 638 Mr. Baker 428 247 144 164 95 59 29 3 2 1 1 91 123 1905 532 - - - - Mr. Crandell 27 79 9 8 26 1 - 1 - 271 300 - - - - - - - - - 574 - 5955 3941 202 73 14 642 23297 4096 1517 1936 531 145 Totals 1999 56 15 2687 723 10 Insanitary Areas. Below will be found particulars of Representations of Insamtary Areas made during the year. At first a representation was made to the London County Council, which included 7 areas. It was then thought advisable to amalgamate Areas 3 and 4 into one larger area, which included some farther houses, and it was thought advisable that only this large and important area should be taken up under Part (1) by the County Council. The remaining areas, five in number, were withdrawn from the original representation to the County Council, and transferred under Part (2) of the Housing of the' Working Classes Act of 1890 to the Borough Council. The County Council are at present engaged in completing their enquiries as to the first area for proceeding to the acquisition of the houses and land with a view to its reconstruction. The Borough Council decided to proceed at present only with two of the areas, namely Leroy Street and Salisbury Street, and plans and estimates have already been submitted to the Ministry of Health for the latter. The great, and one might almost say, insuperable, difficulty in dealing with insanitary areas at the present time is the want of alternative accommodation where the displaced inhabitants can be housed during its clearance. The other difficulties are mainly financial. In an industrial Borough like Bermondsey, where there is practically no vacant land or houses, the difficulties of the preliminary stages of the re-housing are extremely difficult. The Council, therefore, pending the erection of alternative accommodation in other less crowded parts of London, have adopted the temporary expedient of getting the worst defects in some of these areas remedied, so that the inhabitants can remain in them a little longer without serious prejudice to their health. This, of course, is only a temporary expedient, and will merely postpone the more drastic methods which must be undertaken to improve the housing of the Borough before many years are past. Housing of the Working Classes Act, 1890, Part II., Section 39 (1) (b). The following representations under Part II. of the above Act were made during the year: — (a) I beg hereby to make an official representation to the Bermondsey Borough Council, being the Local Authority within the meaning of the above Act and Sections, that the closeness, narrowness, and bad arrangement and bad condition of the buildings, the want of light, air, ventilation or proper conveniences, and many other sanitary defects in the building situated in the areas marked “ red ” on accompanying maps, are such as to render them dangerous and prejudicial to the inhabitants, and that to remedy the said evils, demolition or re-construction or re-arrangement of the said buildings or some of them is necessary, and further that the area comprising those buildings and the yards, out-houses and appurtenances thereof, and the site thereof, is too small to be dealt with as an unhealthy area under Part I. of this Act. The areas are marked on the maps, and are known by the following numbers and names: — No. 1.—Bethel Place Area. No. 2. —Leroy Street „ No. 5. —Salisbury Street „ No. 6. —Prospect Street „ No. 7.—Spa Road „ Salisbury Street Area. (b) I, Richard King Brown, Medical Officer of Health for the Metropolitan Borough of Bermondsey, do hereby report that in my opinion the closeness, narrowness, and bad arrangement or bad condition of the buildings comprised in the area coloured red in the Schedule hereto, or the want of light, air, ventilation or proper conveniences, or other sanitary defects in such buildings, are dangerous and prejudicial to the health of the inhabitants of the said buildings, or of the neighbouring buildings, and that the demolition, or the re-construction and re-arrangement of the said building, or of some of them is necessary to remedy the said evils. Housing. In the Spring of the year under report the Council decided to appoint two Assistant Medical Officers of Health and four temporary Sanitary Inspectors, so as to facilitate the complete survey of the housing conditions of the Borough, to be followed by such action as was thought necessary after the survey was completed. As a result they appointed in May, 1920, two Assistant Medical Officers of Health—Drs. W. E. Cooke, M.D., M.R.C.P.Ed., D.P.H., and Dr W. E. Fox, M.B. Lond., D.P.H. There was a great deal of activity displayed, especially under Section 28 of the Housing, Town Planning, etc., Act, 1919, and I beg to submit the following joint report by the Assistant Medical Officers. Their appointment was for one year, and at the time of writing (June, 1921), they have left at the end of their term of engagement. They have brought to light a great many interesting facts as to the housing conditions of the Borough, and at the present time the survey is rapidly nearing completion, when we hope to have got the Borough into some normal condition as regards the repair and general sanitary conditions of the houses occupied by members of the working classes. The following report of the Assistant Medical Officers of Health will best explain the present position. ASSISTANT MEDICAL OFFICERS' REPORT. "We beg to present our report on the Housing of the Borough for the year ending 31st December, 1920. (I.) Staff. The additions to the staff for the definite purpose of Housing were two Assistant Medical Officers of Health and four Temporary Sanitary Inspectors; these were appointed in May, 1920. Owing to sickness and resignations in the permanent staff, all the four Temporary Inspectors have never actually been available, and for some part of the time only two have been doing the work for which they were definitely appointed. The vacancies on the districts caused by absence and resignations have had to be filled by one of the Temporary Inspectors. (II)) Housing. The population of the Borough in the number of dwelling houses of all classes, including tenements, is 19,140, and the number of working class dwelling houses is 18,850. The latter figure is given to make this report tally with the figures originally used, but, in view of the definiton of “ houses suitable for occupation by the working classes,” as given in the Rent Restriction Act of 1920, it is probable that the figure of 18,850 will have to be revised. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 12,055, and the total number of re-inspections 23,297. The total number of dwelling houses inspected and recorded under the Housing Inspection of Districts Regulations of 1910 was 5,915. The number of dwelling houses found not to be in all respects reasonably fit for human habitation was 7,115, of which 1,082 were rendered fit in consequence of informal notice being given by the Sanitary Inspectors, and did not necessitate formal action by the Council. Action under Statutory Powers. (a) Proceedings under the Public Health Acts. The number of notices served under the Public Health Acts in respect of dwelling houses was 3,515, and the number in which the defects were remedied the same. (b) Proceeding under Section 28 of the Housing, Town Planning, etc., Act of 1919. During the year a great amount of work has been done under this Section. For the greater uniformity of the notices, lists of terms of requirement were drawn up, and are now used by all the Sanitary Inspectors. At the beginning of the year the procedure then in force was laborious, entailing much clerical work and a great many re-inspections by the Sanitary Inspectors. The procedure finally adopted by the Council, and now in force, is: — (1) The Inspector visits the house, and makes notes of the defects in his note-book. (These note-books are numbered and filed away for reference). (2) The Inspector writes an official notice, which comes before the Public Health Committee, and finally before the Council. If the work is not carried out in the time specified, a notice is sent to the owner informing him that, if the work is not put in hand, the Council will be asked to instruct the Surveyor to carry it out. The number of dwelling houses in respect of which notices were served requiring repairs under Section 28 was 3,857, and the number of dwelling houses rendered fit by the owners 2,015. In the cases of 61 houses, the work was carried out in default of the owner by the Council. The cost of work done by the Council has been recovered through the Court of Summary Jurisdiction for the district in all cases where it has been necessary to put this action into force. (III.) Closing Orders. During the year proceedings were taken under Sections 17 and 18 of the Housing and Town Planning Act of 1909, with a view to the making of Closing Orders. The houses at present under Closing Orders are: — Lynton Mews 12 Sarnell's Court 5 Tilbury Place 5 Gedling Street 1 Wilderness Street 9 White Lion Court 9 Faustin Place 15 56 (IV.) Insanitary Areas. A great deal of work has been done on the Insanitary Areas mentioned below: — Dockhead: Houses 730; Population 4,552; Area 6 acres „ Salisbury Street: 155; 1,035; „ 4 „ „ Leroy Street: 64; 346; „ 1⅛ „ „ „ Bethel Place: 49; 195; „ ¾ „ „ „ Prospect Street: 55; 291; „ ⅝ „ „ „ Vauban Street: 121; 600; 2¼ „ „ „ 1,174; 7,019; „ 14¾ „ The amount of work done will be realised from the number of houses, which total 1,174, having a population of 7,019, and covering an area of 14¾ acres. At the beginning of the work on the Insanitary Areas it was found that the form hitherto used was not quite satisfactory. Further particulars were required about each house to give in full, and for a permanent record for future reference, the defects found on inspection. A glance at the forms attached will give some idea of the amount and the detailed nature of the work involved in the inspections. The difficulty in dealing with condemned houses and insanitary areas is the entire absence of suitable and sufficient building land in the Borough, and, until, unless arrangements can be made with the London County Council or neighbouring Boroughs for the provision of accommodation for the population displaced, demolition of any of the property cannot be carried out. The London County Council have taken the Dockhead Area, and are making provision for housing some of the people living there, and the Council is erecting flats in Faustin Place for the people displaced under the Closing Order mentioned above. These, with the exception of a few isolated cottages, are the only schemes for re-housing in hand. During the course of the work, certain matters have arisen which required special investigation. These matters all have special reference to the sanitary state of houses, and may be mentioned here: — (1) Enquiries into the mortality of tenement dwellings and the encroachment of industrial buildings on dwelling houses. (2) A large number of houses in the Borough are sub-let, and the landings on the first doors contains gas stoves, and are used as kitchens. In many cases there is no light or ventilation on the landing, the result being that the temperature of the landing during cooking is very high, and the atmosphere polluted by the fumes from the gas stove and foul. The provision of adequate light and venulation on the landing has been insisted upon in the Borough for some years, but, with the existing prevalence of sub-letting, we feel that attention should again be drawn to the matter. (3) Dust Shoots. A request from the London County Council for information on the removal of house refuse from tenement dwellings resulted in an investigation into the construction of the inlets and receptacles of dust shoots. A report was furnished, the results of which, we believe, the London County Council has adopted. (4) Verminous Dwellings. During the summer an enormous number of rooms was found to be infested with bugs. Various methods for their extermination are used by occupiers and builders in the Borough. These were investigated, and although it is too early to speak definitely on the result, yet observations tend to show that any methods such as the use of strong carbolic mixture of hydrochloric acid are useless, and the only method offering any hope of success is the one that has been in use for some considerable time, and that is disinfection by SO2. If every house or room infested with bugs were to be thoroughly disinfected by SO2, the staff of the Disinfecting Station would have to be greatly increased in the summer months, and the cost would be great. The suggestion might be put forward that a charge might be made for the disinfection of verminous rooms. The parasite found—and thousands were examined —was exclusively the cinex lectularius. (5) Fleas. In July, August and September, the quantity of fleas found in houses was enormous, and far exceeded the numbers found in any other years within the experience of the present disinfecting staff. The species of flea found was almost exclusively the pulex irritans, or the common flea of man. Very occasionally the ceratophyllus fasciatus and the ctenocephalus canis or dog flea were found. It is interesting to note that this epidemic of fleas coincided with the epidemic of Scarlet Fever. Dr. Hamer of the London County Council has commented on the relationship between the number of fleas and epidemics of Scarlet Fever, but, up to the present, no direct relationship has been shown. (6) Rats. A great many complaints of rats have been received from all parts of the Borough. In the majority of cases the presence of rats in the houses has been found to be connected with defective drains and the reconstruction of sewers in various parts of the Borough has increased the numbers of rats in the houses. The subject of the prevention of rats resolves itself, to a large extent, into the provision of properly-constructed drains. A great many rats have been examined from all parts of the Borough, and in no cases were they found to be suffering from any disease communicable to man, and in no case was the xenopsylla cheopis, or the rat flea, which is the vector of plague in the tropics, found. (7) Sinks. In a great many houses sinks made of Yorkshire stone have been found, many of which were untrapped. The rough stone, however useful it may be for sharpening knives, its use as a sink is unwise. The surface is rough, and, in a very short time, the uneven bottom allows water to accumulate in it. The roughened projections and depressions afford an excellent hold for decomposing fats and all kinds of bacteria. It is desirable that these sinks should be abolished, and their place, taken by glazed stoneware sinks. (8) Flies. Although the presence of flies in a dwelling house cannot be said to render that dwelling house insanitary, yet in effect it does. During last summer flies were not greatly in evidence on account of the low atmospheric temperature, but, if we are to enjoy any degree of immunity from these pests, active steps will have to be taken in the quick removal of household refuse, the removal of dung and the removal of trade refuse in those trades in which animal matter enters. Some interesting points were observed in connection with this subject during last summer. As is well known, the breeding places preferred by the musca domestica, or common house fly and the homalomyia canicularis or lesser house fly are dung heaps, stable refuse, and the like, and their play-grounds are domestic dwelling houses. The dangers of the fly are, of course, too well-known to be recapitulated here, but the point we wished to draw attention to was the possibility of dwelling houses becoming infested by the protocalliphora groenlandica, or green fly, whose special home seems to be Bermondsey. Its usual breeding place we found corroborated previous observers in the fact of its breeding in some decomposing animal matter in the yards of glue and size works. The additional fact was gleaned that these flies infested the premises where fish-curing was taking place, and an even more preferable breeding ground than the glue and size works was found to be the fishheads and rejected entrails; here the larvae were found in enormous numbers. The play-ground of these flies appears to be gardens and open sheds; they do not appear to frequent houses to any extent, but we found occasional specimens in houses, and its occurrence in numbers in houses has been noted before, and there is no reason why it should not infest houses again. The method of prevention lies in the frequent removal and destruction of any waste animal matter and any fish heads, etc., from the premises where businesses are carried on." W. E. COOKE, M.D. W. E. FOX, M.B. Rats and Mice (Destruction) Act, 1919. During the year the Council had under consideration the carrying out of the provisions of the above Act, and also the question of the appointment of the necessary staff. It was decided that, until more need was shown for the appointment of a special Eat Officer, each District Sanitary Inspector should be appointed to serve notices under Section 5 of the Act. An attempt was made to organise a rat service in the Borough, and the owners and occupiers of factories, wharves, and all premises likely to be troubled with rats were circularised, but no support was given to the scheme, and it was decided to abandon it for the time being. There is one difficulty in putting the Eat Act into force in individual Boroughs, which no Authority seems to have faced yet, and that is the migration of rats through the County Council sewers. If one excludes complaints about rats in the various grain stores along the wharves and warehouses by the river's edge, 99 per cent, of the complaints concerning rats in other parts of the Borough show that these vermin find their way into the houses from the large and small sewers in the Borough. It seems somewhat useless, therefore, for one Borough to have an active Bat Campaign, because, if the rats are banished locally, it is only a matter of a very short time when a complete fresh supply migrates from other parts of London through the London County Council sewers. It seems to me, therefore, that the Engineers of the London County Council should consider the question of preventing these migrations of rats through their sewers, and adopt some plan which would be applicable to the whole of London. The question is, no doubt, a very difficult one, but still it ought not to be insuperable. Outworkers. There were 281 outworkers on the Register at the end of 1920. 64 lists were sent in by firms in this Borough employing outworkers. Table VI. of the Appendix shows the various trades followed by outworkers in this district. Maternity and Child Welfare. As there were so many Voluntary and Municipal Centres for Maternity and Child Welfare Work in the Borough, and the number of the Health Visitors had been increased from four to eight, it was decided to have a whole-time Assistant Medical Officer of Health to organise and supervise the whole work, and, at the same time, attend to as many Centres as convenient, instead of having several part-time officers who were engaged by the Council to look after the Municipal Centres. As a result, the Council appointed, in the autumn, Dr. Stella Churchill, M.R.C.S., L.R.C.P., D.P.H., and I have much pleasure in submitting the report she has made to me on the general subject of Maternity and Child Welfare. The infantile mortality has shown a great decrease, not only in Bermondsey, but in the country generally, for the year 1920, and though I think one is justified in claiming some part of this decrease as due to increased activity on the part of Sanitary Authorities, one must be careful not to claim too much, or a disillusionment might occur as a result of infectious epidemics among children or a very hot summer increasing the illnesses which usually cause such a high mortality among young babies. There is no doubt in my mind that all this propaganda about Child Welfare which has been going on during the last few years s beginning to tell on the infantile mortality through the education of the mothers, for, when all is said and done, one cannot get over the fact that infantile mortality is much less among the educated than among the uneducated classes, and, when the latter come up to the standard of education of the mothers of the better classes, we may expect a permanent and big reduction in the infantile mortality. Writers on health matters are accustomed to argue against this that some of the uneducated mothers in certain districts, such as the West of Ireland and Scotland, show a very low infantile mortality, but this is no doubt due to favourable climatic conditions, and the absence of overcrowding. Urban districts, especially large manufacturing towns and the Midlands and North of England, furnish by far the largest percentage of our high infantile mortality figures, and these will never be permanently reduced until the mothers in these districts have learned to counteract the unfavourable environments which these manufacturing centres impose on the infant population. Sanitary Authorities will also have to do their part in the way of reducing smoke and other conditions which pollute the atmosphere. LADY ASSISTANT MEDICAL OFFICER'S REPORT ON Maternity and Child Welfare. This branch of the Public Health work has been much extended by the appointment of four additional whole-time Health Visitors, making the total now up to eight, and Bermondsey is now in the front rank of Municipal Boroughs in this respect. There have been over 1,500 children in regular attendance at the clinics during the past year, but, apart from these, many children have been visited at their homes, and the parents advised as to health troubles and the need of medical attention. It is rare for the Health Visitors to be refused admission to the homes, and this is the highest testimony to the tact and zeal with which they carry out their work. During the year under report it was arranged to open clinics for children over a year old and under school age, which are known as Toddlers' Clinics, and in this way to keep in touch with the babies who are brought in the first instance to the Welfare Centres. In this way one expects to prevent or alleviate some of the disabling disorders of school life, such as enlarged tonsils and adenoids, eye affections, including squint, effects of rickets, and last, but by no means least, dental caries. This intention has now been carried out. and the results will not be available till next year. There were three Municipal Infant Welfare Centres in the Borough, but early in the year the Council decided to take over the medical side of the Oxley Street Centre, and, at the time of writing, the whole Centre has been transferred to the Borough. The work there has been considerably extended. A new Welfare Centre was opened in July, 1920, at the Manor Chapel, Roseberry Street, and, at the end of the year, there were over 100 mothers in regular attendance. This Centre was very badly needed in this area, which is somewhat isolated from the other Centres. The alterations at 98, Rotherhithe New Road, which was taken over during the year under report, are now well underway, and the offices of the Assistant Medical Officer of Health and Health Visitors and the Dental Clinic have been transferred there. The Infant Welfare Centre, which was carried on during the year 1920 at the Lady Gomm Dispensary, has also been transferred to this building. When finished it is thought that this will be a model Centre, so far as the building is concerned. A new Municipal Ante-natal Centre was begun in October, 1920, at the Lady Gomm Dispensary, and at the beginning of the present year this has been transferred to 98. Rotherhithe New Road, where it is held on the second and fourth Friday afternoons. There were not many attendances at first, but they soon averaged 16 a session, and a keen interest was shown in the work both by the patients themselves, and by the Health Visitors. It is our aim to ensure for each mother a healthy and happy state during pregnancy, and to detect any early symptoms of disease which may interfere with this ideal, and in this work we have been much helped by the willing co-operation of many of the midwives resident in the Borough. There is considerable need for early change of air in the case of children who have just recovered from one of the debilitating diseases, such as Measles, Whooping Cough, Bronchitis or Scarlet Fever. We have been much helped to get over 20 such children away during the past year by the kindness of the Invalid Children's Aid Association, and a warm word of thanks is due to their local secretary, Miss Armstrong. Other children have had similar and much needed visits to the seaside or country through the agency of the Secretary, Babies' Home Department, 4, Tavistock Square. Four of the Bermondsey mothers, with their babies, have been most kindly entertained through the same means at the Lady Forster Guest House at Sydenham. The results in every case have been most satisfactory, but it is sad to notice how quickly some of the children relapse. The power to provide milk free or at cost price to nursing or expectant mothers and to children under five years, has been of immense help in checking some of the ill-health due to a condition of chronic under-feeding. Child Welfare work is so intimately associated with the social and moral conditions of the people that we can only assert here —what every woman knowsthat it is the mother who makes or mars the home, and to the mothers of Bermondsey is due ultimately the credit for the relatively high standard of child life. Enquiries were made late in the year as to the possibility of providing cheap or free dinners for nursing mothers and children under school age. This scheme did not meet with the approval of the Ministry of Health, but if unemployment remains at its present level an attempt will be made next winter to make some similar provision. Voluntary Centres. Three out of the four voluntary centres are associated with the activities of a religious and social order, so that their work covers ground that cannot be undertaken by the Municipal Authorities. The numbers at the Central Hall increased so rapidly during the past year that a new session was to be opened early in 1921. The Princess Club has now three sessions a week for children under a year, and a fortnightly session for " Toddlers," as well as a weekly Ante-Natal Class. The work at the Alice Barlow House, Fulford Street, and St. George's Hall is doing a great deal to help those Mothers who live in the more crowded parts of the Borough. In addition, there is a day Nursery at Fulford Street to accommodate about 15 children, and this fills a crying need, especially at the present time, when some mothers are obliged to go out to work as the fathers cannot find employment. This report would not be complete without a respectful word of thanks to the Medical Officer of Health for all the kindly support and advice he is always ready to give to workers in this Department. STELLA CHURCHILL. Table H. Health Visitors. The following tables show the work done by the Health Visitors during the year 1920: — The first table is for the first 6 months, and the second table for the remaining 6 months. The method of reporting the work of the Health Visitors was altered in June. Bermondsey Wards. Rotherhithe Wards. St. Olave Ward. Whole Borough. St. Olave. St. Thomas 1 2 3 4 5 6 St, John. 1 2 3 88 1 1 76 ... ... 9 11 109 Births Notified: — By Guy's Hospital 468 152 21 ... 21 26 68 39 28 5 1 „ Midwives 604 26 55 95 112 128 28 10 1 „ Doctors 238 7 14 30 27 34 43 36 7 1 5 177 11 50 36 9 26 21 1 „ Parents 9 8 ... 96 14 1,487 142 201 184 173 120 137 TOTAL 177 171 57 15 DISTRICTS. January to December. Whole Borough. VISITS:- 2 3 4 5 Attendances at Classes for Mothers. 1 102 24 29 31 18 2 Ante-natal Abbeyfield Road. Town Hall. Trinity Road. Births (first) 1,385 398 353 333 301 40 74 „ (subsequent) 493 51 48 320 169 Measles (first) 8 20 39 15 ... 82 5,667 1,283 6,158 „ (subsequent) 30 ... 19 3 8 ... Ophthalmia Neonatorum (first) 9 3 4 1 ... 1 „ „ (subsequent) 4 ... 4 ... ... ... Oxley Street. ... Roseberry Street. Puerperal Fever 2 1 1 ... ... Influenzal Pneumonia (first) ... ... ... ... ... ... „ „ (subsequent) ... ... ... ... ... ... 1,993 799 Polio-Myelitis ... ... ... ... ... ... ... ... Diarrhœa Various ... ... ... ... 388 110 142 42 94 ... Various 2,495 211 593 531 614 546 191 253 336 172 12 - 7 62 27 80 304 229 241 89 16 - 18 - 290 302 286 83 16 3 4 46 21 250 208 186 28 50 1 3 128 16 221 - 273 150 38 44 7 207 24 20 - 216 203 550 7 9 179 31 236 - 269 296 55 15 2 63 10 1,923 43 1,129 579 168 4 1,903 2,178 180 Municipal Dentist. To complete the Maternity and Child Welfare Scheme for the Borough, the Council decided to appoint a Municipal wholetime Dentist. An excellent dental surgery, together with waiting and recovery rooms, has been fitted up at 98, Rotherhithe New Road, and also a dental workshop. Mr. Grantly Smith, H.D.D., Edin., L.D.S., Lond: was appointed Municipal Dentist, and commenced duty a few days before the close of the year. A dental nurse and dental mechanic were also appointed. Two sessions are held daily, and the numbers attending are steadily increasing. A full report of this branch of the work will be given in the next Annual Report. Municipal Midwives. The Council early in the year had under consideration the inadequate midwifery service in the Borough, and decided to overcome this by appointing two Municipal Midwives. The local midwives were consulted as to the districts in which the shortage was most acute, and also as to the fees to be charged. It was ultimately decided to make the Rotherhithe end of the Borough the headquarters for the Municipal Midwives, and rooms for them were rented over the Public Baths, Lower Road. Owing, however, to the publicity given to this matter in the press, a number of new midwives commenced practising in the Borough, and, in a few months, the original number was more than doubled. In addition, several doctors took up this work, and it soon became evident that the Municipal Midwives would not get sufficient bookings to keep them fully occupied. The Council, thereupon, carefully reconsidered the matter, and came to the conclusion that as their action had had the desired effect of increasing the number of midwives in the Borough, they might now discontinue the municipal service. District Nurse. In January, 1920, representations were made to the Public Health Committee that the number of nurses available for ordinary cases of illness in the Borough was insufficient. We had decided a couple of years previously to pay for the nursing of cases of Bronchial Pneumonia in connection with Measles, which were notified to us under the Prevention of Measles Order of the Ministry of Health, but the additional duties imposed on the Borough Council by the Influenza and Primary Pneumonia Orders decided the Council to appoint a District Nurse. This lady—Miss Gibson, of Guy's Hospital—took up her work in January, 1920. MUNICIPAL LYING-IN HOSTEL. Report from January 1st to December 31st, 1920. (1) Total Number of Cases Admitted 155 (2) Average Duration of Stay 14 days (3) Number of Cases Delivered by Midwives 144 (4) Number of Cases Delivered by Doctors 11 (5) Number of Cases in which Medical Assistance was sought by Midwives 34 (a) Ante-Natal 1 (b) during Labour 15 (c) after Labour 7 (d) for Infant 11 (6) Number of Cases of Puerperal Sepis with Result of Treatment 0 (7) Number of Cases in which Temperature rose above 100.4 for 24 hours with Rise of Pule Rate 1 (8) Number of Cases notified as Opthalmia Neonatorum, with Result of Treatment 2 1st. Not known. 2nd. Completely cured. (9) Number of Cases Inflammation of the Eyes, however slight 2 (10) Number of Infants not entirely Breast-fed while in the Institution, with the reasons why they were not Breast-fed 1 (Mother had Tubercular Disease). (11) Number of Maternal Deaths with Causes 1 Post Partum Haemhorrhage between second and third week after delivery, due to Polypus of the Uterus. Died after operation for Removal in Bermondsey and Botherhithe Hospital. (12) Number of Foetal Deaths, Stillborn or within 10 days of Birth, and their Causes, and the results of PostMortem Examination, if obtainable 1 Premature TUBERCULOUS. Tuberculosis Dispensary. The following reports conce1rning the Tuberculosis Dispensary were submitted to the Council in July of last year, and January of the present year respectively, and, as a result, the Council decided to take over the Dispensary at the beginning of the financial year, April Ist, 1921. The salaries suggested in these reports were not adopted at the time of writing (June, 1921), and instructions were given that the matter should be brought up after a period of probation. Several alterations in the administration have been brought about by the Tuberculosis Act of 1921, and the consequent re-arrangements for the treatment of insured patients and soldiers, and a report of the working of the Dispensary will be submitted in 1922. Tuberculosis Scheme. I regret that there has been so much delay in bringing the present report before the Committee, but I understand that the Medical Officer of the London County Council has in preparation a review of the administrative schemes for Tuberculosis in London, with certain recommendations, and I delayed matters in the hope that the report would be in print, and that it might be possible to incorporate the recommendations of the London County Council with our scheme. This report is not yet published, but I do not think it advisable to delay any longer in placing our own scheme before the Council. Prevalence of Tuberculosis in the Borough. During the year 1919 the total number of deaths from Tuberculosis in this Borough was 233, which gives a death rate of 1.9 per 1,000 per annum. The death rate from Phthisis, or the pulmonary form of Tuberculosis, for the year 1919 was 1.4, and this has shown a steady decrease during the last 10 years, with the exceptions of the years 1915 and 1917, when there was a slight increase. This death rate, however, does not give a fair indication of the amount of disablement which is caused by Tuberculosis, since the illnesses due to this disease are usually very protracted, and people may go about for a considerable portion of their lives suffering from the more or less crippling effects of Tuberculosis. The following table will give some idea of the general prevalence: — 1919. 1. Number of Primary Notifications 500 2. Number of deaths from Tuberculosis 233 3. Death rate per 1,000 per annum 1.9 4. Number of cases removed to Sanatoria 153 5. Estimated number of contacts 2000 The number of notifications, of course, does not represent the total number of cases of Tuberculosis existing in the borough at any one time. It is difficult to arrive at a correct figure, but I think one would be justified in stating that the number of cases of Tuberculosis in the Borough at any one time is somewhere between 750 and 1,000. For Administrative, as distinct from clinical purposes, it is convenient to classify patients as follows: — (A.) INSURED PERSONS. These may be sub-divided into: (1). Men. (2). Women. Insured persons are under the care of the London Insurance Committee, who have contracts with three different bodies, according to the nature and stage of the disease. Early eases requiring sanatorium treatment are dealt with, under agreement, by the London County Council. Cases requiring domiciliary treatment are at present attended to by the panel doctors and the Tuberculosis Dispensary, and cases requiring special treatment are sent to one of the hospitals. Surgical cases are generally admitted free to one of the large general hospitals, and cases for observation, or any other purpose to one of the Hospitals for consumption, such as Brompton, where they are paid for by the Insurance Committee, either directly or through the medium of the London County Council. (B). NON-INSURED PERSONS. These may be sub-divided into: — (1). Housewives. (2). Children over 16 years and unemployed. (3). Children under 16 years—boys and girls. (4). People over 65 years. (5). Employed, but non-insured persons. Non-insured persons requiring institutional treatment are taken charge of by the London County Council, who have a certain number of beds, scattered over the different parts of the southern counties, for women, boys and girls. The non-pulmonary cases in children are generally handed over to the Invalid Children's Aid Association, commonly described as the I.C.A.A. For treatment of children, the London County Council and the I.C.A.A. require that payment should be made by the parents or guardians, and this is arranged by the Interim Tuberculosis Care Committee, who act as an Assessment Committee, the weekly payments ranging from 2s. to 10s. 6d., according to the ability to pay of the persons responsible. For the institutional treatment of Tuberculosis in women the London County Council do not ask payment, but they have very few beds, and not many cases are got away. Non-insured persons who do not want institutional treatment are not very well provided for at the present time, the free treatment available consisting of general hospitals, Tuberculosis Dispensaries, some special hospitals, Poor Law Institutions) and, if able to pay, they can go to private practitioners. (C). SOLDIERS AND SAILORS. The War Pensions Committee appears to be responsible for their treatment but, should any institutional treatment be required, they have special beds in various sanatoria all over the country. They also avail themselves of treatment at the Tuberculosis Dispensaries, and domiciliary treatment is arranged for by the Pensions Committee through the panel doctors. For Clinical purposes, the population may be divided as follows: — (A.) Pulmonary cases, of which there are: — (1). Early cases which ought to be sent away to sanatoria. (2). Cases of established disease which would benefit by a short stay at sanatoria and who require special provision and treatment. (3). Advanced cases which should, for their own good and the benefit of others, be segregated. (B). Non-pulmonary cases. Of these there are three classes : Cerebral cases, glandular cases, and bone and joint cases. (C). Finally, we have Suspected cases, who have some of the signs and symptoms of Tuberculosis, but in whom the diagnosis is doubtful, and " Contacts," who, though apparently healthy, are living with tuberculosis patients, and require to be kept more or less under observation. At the present day, no scheme for the control of Tuberculosis is complete without a Tuberculosis Dispensary, and it may be well, at this stage, to recapitulate the functions of this institution. The original idea of the founder—Sir Robert Philip—was that these dispensaries should form a kind of centre to co-ordinate all the activities in connection with the prevention of Tuberculosis, classify the patients from a clinical point of view, keep in touch with various voluntary and other bodies who undertake the treatment of Tuberculosis, and generally to act as a kind of clearing house for everything connected with Tuberculosis in the district. The officers were intended to be experts in the clinical work of diagnosis and able to help general practitioners with advice in doubtful cases. They were also intended to undertake the examination of " contacts " and supervise, in conjunction with the general practitioners, cases receiving domiciliary treatment. They were further expected to be able to give special treatment in certain cases, such as in those requiring tuberculin or other specific treatment. The Tuberculosis Dispensary at 108, Grange Road, carries out most of these duties, but there are certain directions in which improvement will be necessary if the scheme is to fulfil modern requirements. In the first place, there is not a close enough connection between the Dispensary and the Public Health Department, and to make any improvement it will be necessary for the Council to consider the question of taking over the Dispensary, and making it a branch of the Public Health Department. I think this is most essential, since the real work of the Council in the matter of Tuberculosis is preventive, and this cannot be done effectually unless the whole of the activities of the Council in this direction are brought under one Department. As regards the examination of contacts, this is not carried out as systematically and as thoroughly as it should be. Only 353 were examined in 1919, and if the estimate of 2,000, at the very low rate of 4 contacts to every notified case, is correct, the percentage of these who have been examined is only about 15. The arrangements for diagnosis are not complete, since there Is no X-ray apparatus, an appliance absolutely necessary for modern work. Some definite arrangement should also be made with Guy's Hospital for applying special diagnostic methods in certain cases. Further, there is no provision for the treatment of dental cases at the Dispensary. At the present time there is too much attention paid to the purely clinical side of Tuberculosis as distinct from the preventive side, and there is a tendency for Dispensaries to become simply kinds of Out-patients' Departments of general hospitals, where people come to receive bottles of mixture for coughs, dyspepsia, etc. If the time spent in prescribing cough mixtures and things of that kind were spent in visiting and examining contacts, the Dispensary would serve a much more useful purpose. The present staff consists of a Tuberculosis Officer and Assistant Tuberculosis Officer, two nurses, one dispenser, one secretary, and one caretaker. The finances during 1919 were derived from the following sources: — £ s. d. Central Fund 765 0 0 Insurance Committee 325 0 0 Borough Council 600 0 0 Voluntary Subscriptions 259 18 6 £1949 18 6 The cost of running the Dispensary in 1919 was £1,862. There is no provision at present for attending people at the far end of the Borough in Rotherhithe, and a branch of the Dispensary should be formed down there. I estimate the cost of running the Dispensary as a branch of the Public Health Service will be £2,400 0s. 0d., made up as follows: — Salaries: £ s . d. Senior Assistant Medical Officer 700 0 0 Junior Assistant Medical Officer 500 0 0 Secretary 208 0 0 Two Nurses 440 0 0 Dispenser (part time) 80 0 0 Caretaker (with free quarters, coal and gas) 60 0 0 Rent, Rates and Insurance 80 0 0 Telephone, Gas and Water 40 0 0 Coal 30 0 0 Drugs 166 0 0 Repairs 40 0 0 Stationery and Postage 40 0 0 National Health Insurance 3 0 0 Cleaning and Sundries 13 0 0 £2400 0 0 I recommend, therefore, that the following changes in the administration of the Tuberculosis work in the Borough be made: (1). That the Dispensary be taken over by the Borough Council, and be run as a part of the Public Health Service. (2). That the Medical Officer of Health be the Chief Tuberculosis Officer. (3). That Dr. Darroch be Assistant Tuberculosis Officer at the Dispensary, and have the status of an Assistant Medical Officer of Health. (4). That Dr. Connan be Second Assistant Tuberculosis Officer. (5). That the two nurses and the dispenser be retained, and that the present Secretary, Miss Dutch, be given the status of an Assistant Clerk in the Public Health Department. (6). That an extra Centre be provided somewhere in Rotherhithe, where attendance would be made two or three times a week. (7). That an X-ray apparatus be provided. If the Dispensary be taken over, the question of affiliation with Guy's Hospital for special diagnotic purposes can, no doubt, be easily arranged. The dental treatment would be provided by the Borough Council's whole-time dentist, who could devote one or two days a week to the Dispensary. The Dispensary will thus become part of the Public Health work of the Borough, and I think, under the circumstances, special committees, such as the Interim Tuberculosis Care Committee and the Dispensary Committee, will not be necessary, since everything could be referred to the Public Health Committee. The " following up " and supervision of eases, instead of being relegated to a special committee as now, will be a part of the routine work of the Public Health Department. There are many details in the administration of Tuberculosis work in Bermondsey which I might have discussed in this report, but they are all implicated in the taking over of the Dispensary, which is, therefore, an indispensable preliminary to a general improvement in this work." On 6th July, 1920, the following resolutions were passed by the Council and recommended by the Public Health Committee, namely: — Subject to the approval of the Ministry of Health and the London County Council, and also the Finance Committee submitting any necessary estimate: (a) That the Dispensary be taken over by the Borough Council, and be run as a part of the Public Health Service. (b) That the Medical Officer of Health be the Chief Tuberculosis Officer. (c) That Dr. Darroch be Assistant Tuberculosis Officer at the Dispensary, and have the status of an Assistant Medical Officer of Health. (d) That Dr. Connan be Second Assistant Tuberculosis Officer. (e) That the two nurses and the dispenser be retained, and that the present Secretary, Miss Dutch, be given the status of an Assistant Clerk in the Public Health Department." These resolutions still stand, so all that is necessary now is for the Committee to get the sanction of the Ministry of Health and the London County Council to complete the necessary arrangements for carrying out the original intentions of the Council. As some nine months have elapsed since that period, it will be necessary to make one or two additions to the above resolutions, and also to reconsider the expenses of running the Dispensary, in the light of the experience of the Dispensary Committee since that date. It will also be necessary, in order to complete the scheme, to have the Dispensary linked up with some hospital or hospitals for various purposes, and, for this reason, I have interviewed the Medical Superintendent of Guy's Hospital, as this is much the most convenient institution for the proposed linking up; it has a large consulting and specialist and all the latest means at its disposal for diagnosing Tuberculous and other diseases. There are other reasons also for linking up with Guy's; ft is one of the largest teaching institutions in the country, and it is most important that the coming generation of medical men should be thoroughly equipped to deal with medical problems, and this can only be done by making use of the hospital, and sending cases, which are difficult, and requires special means for diagnosis. Among the matters discussed with the Medical Superintendent were the following: — (1). The provision of six observation beds, where obscure cases can be kept for a short time for the the purpose of investigating the nature of the complaints. (2). The provision of X-ray reports on cases of suspected tuberculosis. (3). Special examinations other than X-ray, such as bacteriological investigations of urine and other discharges, and special examinations in eye and laryngeal cases. (4). Treatment of special tuberculous cases, such as tuberculous skin diseases and glands by X-rays, Finsen light and Radium. (5) Special medical and surgical treatment, such as the production of artificial pneumothorax, the performance of renal nephrectomy, treatment of tuberculous diseases of the joints, spine, meninges, peritoneum, intestines, and other organs liable to be attacked by tuberculosis. It is evident from this that there is a very large field for utilising the skill and resources of Guy's Hospital. It was further proposed to the Medical Superintendent, that as they have a special Tuberculosis Department, in charge of Dr. Marshall, our whole dealing with the hospital should be through that officer, and, further, that he should keep a register of all the cases of tuberculosis, from whatever source, occurring in the hospital, with the results of the treatment. In this way we will not only benefit from linking up with the hospital, but the hospital will be able to enlarge the scope of their investigations on this important disease. The Medical Superintendent agreed .with the suggestions I put forward here, and promised to bring the matter before the Medical Committee, and the Governors of the Hospital. who, I trust, will see their way to adopt these or some similar suggestions. With regard to the X-ray, it was suggested by the Committee that another institution in this Borough could do this work, but this would be of doubtful utility, since, in the taking of X-ray photographs two things are required, namely, good technique in the photographs themselves and also skilled interpretation; the former requirement would be fulfilled in the institution referred to. but not the latter. In Guy's Hospital they have a skilled radiologist, who interprets the results of the photographs, a factor of really more importance than the taking of the photographs themselves. As regard institutional treatment, both for insured and noninsured, namely, the provision of beds in sanatoria for suitable cases, and, also, the provision of beds in hospitals for surgical and other cases, this will be undertaken, as hitherto, by the London County Council. I understand they are increasing their beds and, with the additional provision, institutional treatment will become gradually more efficient. The special duties of the officers of the Dispensary will be to take complete charge of the whole of the tuberculous patients in the Borough. It will be their duty to receive notifications and to visit the patients at their homes. The Tuberculosis Officer will also act as general consultant in cases of Tuberculosis for private practitioners, and the question of sanatorium and special treatment, whether in hospital or domiciliary, will be decided on by the officers of the Dispensary, in the first place, and they will have every opportunity—as officers of this Department—of becoming fully cognisant of every case of Tuberculosis in the Borough. They will examine contacts and discover new cases, and, in this way, we hope that no tuberculous person will escape attention. If extra food is required, the recommendation will come to the Committee through the Department. The scheme, on first examination, appears somewhat elaborate and expensive, but I think it will be found that the efficiency of the administration and the care which is bestowed on the patients will amply repay the small net expenditure on what might be called the most prevalent disease in the Borough In considering the question of running the Dispensary, os the remuneration of the staff will have to be reconsidered on taking them over, this will add considerably to the running expenses, and I make the following suggestions regarding the salaries, which form the chief item. Should the Committee agree to these suggestions, the expenses will be:— Dr. Darroch, Assistant Tuberculosis £ s. a. Officer 750 0 0 Dr. Connan, Second Do. 600 0 0 Miss Dutch, Clerk, £112 0s. 0d. (basic salary), £155 16s. 0d. (bonus) 267 16 0 Two Nurses, each £121 4s. 7d. (basic salary), £190 19s. 9d. (bonus) 624 8 8 Caretaker, plus lodging, gas and coal 100 0 0 Miss Deighton (part time dispenser) 80 0 0 Other expenses 414 13 7 Contingencies 163 1 9 £3000 0 0 This makes a total of running expenses in round figures of £3,000. Some further sums will have to be put in for equipment, and should the Council wish to purchase the premises, a further contingent sum will be necessary, but this could probably be obtained in the nature of a loan. 2836 18 3 The question of appointing a sub-committee or special committee to deal with the question of the working of the Dispensary, the assessment of children going away to sanatoria and convalescent homes, and after-care is a very difficult one to decide just now, and I recommend that, for a short time, these questions be decided by the Public Health Committee, or the Interim Tuberculosis Care Committee, and that afterwards they can reconsider the appointment of a special committee, when the Ministry of Health has given some definite decision as to the future organisation of Care Committee work in London. APPENDIX. APPENDIX. Table I.—Vital Statistics of Whole District during 1920 and Previous Years. Year. Births. Total Deaths registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non- Residents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Net Deaths at all Ages belonging to the District. Population estimated to Middle of each Year. No. 3 Under 1 Year of Age. Rate.* 4 At all Ages. Rate.* 13 No. 12 No. 5 No. 7 Rate.* 8 Rate per 1,000 Births. registered. 6 542 2,229 17.6 126,634 403 102 1,717 13.5 30 1910 3,957 31.2 550 497 2,320 125,840 3,842 30.5 130 1,782 14.2 515 22 560 18.4 1911 1912 3,799 433 114 1,601 12.8 483 20 538 2,119 16.9 125,388 30.3 505 13.9 529 21 534 2,243 17.9 1913 124,739 3,842 30.8 131 1,730 1,694 2,184 17.6 1914 124,213 3,757 30.2 487 129 13.6 615 26 516 123,665 3,482 29.6 537 154 2,053 17.5 654 38 542 2,514 21.4 1915 608 155 453 1,960 17.2 1916 123,665 3,361 27.1 364 108 1,507 13.2 1,807 186 411 2,032 18.8 1917 2,613 21.7 329 125 18.8 840 119,983 439 2,390 22.0 1918 19.1 322 139 2,142 19.8 1,007 191 121,465 2,323 124,239 212 80 1,600 709 165 313 1,748 14.1 1919 2,637 20.4 12.8 485 121 1,763 651 2,174 123,983 409 Averages for years 1910-1919 85 18.2 3,361 27.1 15.0 689 105 281 1,642 12.7 1920 129,189 31.2 280 4,038 69 1,466 11.3 * Rates in columns 4, 8 and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 1336.1. At Census of 1911 —Total population of all ages, 125,903. Do. Number of inhabited houses, 14,967. Do. Average number of persons per house, 8.41. TABLE I: — continued. I. Institutions within the District receiving sick and infirm persons from outside the District. No of Deaths. Bermondsey Infirmary, 72 Bermondsey Workhouse, 1 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc. 27 Street, 4 S. Bermondsey Station, 1 Factory, 1 Total 105 II. Institutions outside the District receiving sick and infirm persons from the District. III. Other institutions, the deaths in which have been distributed among the several localities in the District. No .of Deaths. Banstead Asylum 3 Bermondsey Military Hospital 1 Brook Hospital 3 Colney Hatch 1 Colindale Hospital 3 Cane Hill Asylum 4 Caterham Asylum 8 Children's Hospital, Great Ormond Street 2 City of London Maternity Hospital 1 Charing Cross Hospital 2 Chest Hospital, Bethnal Green 1 Darenth Industrial Colony 1 Dartford Heath Asylum 3 East London Hospital 4 Evelina Hospital 5 Fountain Temp. Ment. Hospital 2 Guy's Hospital 165 Grove Hospital 1 London Hospital 2 Leavesden Asylum 1 Long Grove Asylum 1 Poplar Hospital 1 Park Hospital 9 Queen Mary's Hospital, Carshalton 6 St. Bartholomew's Hospital 2 St. Anthony's Hospital, Cheam 1 St. Luke's Hostel 1 St. George's Hospital, St. Pancras 1 St. David's Home. Ealing 1 St. Thomas's Hospital 7 Seamen's Hospital 1 South Eastern Hospital 13 South Western Hospital 2 Southwark Infirmary 6 Tooting Bee Asylum 16 West London Hospital 1 Total 281 Table II.—Vital Statistics of Separate Localities in 1920 and Previous Years. St. Olave. Bermondsey. Rotherhithe. Population estimated to middle of each year. Deaths at all Ages. Deaths under 1 year. Births registered. Deaths at all Ages. Population estimated to middle of each year. Population estimated to middle of each year. Deaths under 1 year. Births registered. Deaths at all Ages. Deaths under 1 year. Births registered. Year. 27 1910 81,304 2,661 1,441 38,125 134 341 1,040 603 7,205 256 185 35,059 666 1911 82,110 2,528 1,470 403 1,067 167 8,671 247 184 41 82,073 1,439 290 34,747 1,065 511 113 8,568 232 169 30 1912 2,502 118 8,429 220 158 30 1913 81,833 2,548 1,501 357 34,477 1,074 584 8,298 173 36 1914 81,781 2,502 1,409 333 34,134 1,023 554 116 232 2,306 1,665 349 32,194 991 642 153 7,839 185 207 35 1915 77,155 1916 233 34,620 479 102 8,542 211 140 29 80,503 2,200 1,341 950 33,590 8,275 136 25 1917 78,118 1,716 1,328 215 762 568 89 135 8,377 79,083 1,589 209 34,005 694 640 91 142 161 22 1918 1,487 874 36,232 486 67 8,939 167 155 18 1919 84,249 1,672 177 798 34,718 115 8,314 174 80,821 2,212 1,406 291 946 589 203 Averages of years 1910 - 1919 29 1920 227 1140 155 84,099 1,001 36,167 486 90 8,923 226 20 2,672 Table III. —Abbreviated TABLES of Causes of Death. Causes of Death. Under 1 week 1 - 2 weeks. 2 - 3 weeks. 3 - 4 weeks. Total under 1 mth. 1 - 3 months. 3 - 6 months. 6 - 9 months. 9 - 12 months. Total Deaths under 1 year. 1920. Total Deaths under 1 year. 1919. 70 48 53 28 14 9 104 64 337 262 All causes Certified 51 Uncertified ... ... ... ... ... ... ... ... ... ... ... small-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... 4 6 10 Measles 1 ... ... ... ... ... ... ... Scarlet Fever 1 ... ... ... ... ... ... ... ... ... ... Whooping-Cough 1 1 2 5 11 7 26 1 ... ... ... 1 3 4 5 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 Erysipelas 1 2 ... ... ... ... ... ... ... Tuberculous Meningitis 1 3 2 1 7 7 ... ... ... ... ... 1 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... 1 1 1 3 3 ... ... ... ... ... Meningitis (not Tuberculous) 1 1 3 3 2 9 7 ... ... ... ... 4 1 1 6 5 Convulsions 3 1 ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 2 3 8 5 2 1 19 15 1 ... ... 7 14 19 12 69 39 Pneumonia (all forms) 2 1 1 3 17 1 3 Diarrhœa 2 3 ... ... ... ... ... ... ... 29 Enteritis 2 3 7 3 10 6 3 37 2 ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... Syphilis 3 1 1 4 2 ... ... ... ... ... ... ... Rickets 1 1 ... ... ... ... ... ... ... ... Injury at birth 6 6 1 4 1 1 ... ... ... ... ... 1 6 Atelectesis 4 2 ... 7 1 8 ... ... ... 14 Congenital Malformations 4 1 1 6 4 4 11 ... ... ... Premature birth 35 4 1 39 58 26 7 2 ... .. ... Atrophy, Debility and - 3 5 3 15 12 12 4 2 45 44 Marasmus 4 11 9 4 4 33 12 Other Causes 7 4 5 ... ... 262 53 28 9 104 64 51 48 337 Totals 14 70 Nett births in the year—Legitimate, 3,979; Illegitimate, 59 Table IV.—Causes of and Ages at Deaths during the year 1920. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Causes of Death. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. All Ages. All Causes Certified 1642 337 68 66 84 381 401 107 198 Uncertified ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Enteric Fever 1 ... ... ... Small Pox 58 ... ... ... ... ... ... ... ... ... Measles 56 29 15 10 2 ... ... ... ... Scarlet Fever 7 3 2 2 ... ... ... ... ... Whooping Cough 41 26 9 6 ... ... ... ... ... Diphtheria and Croup 25 4 10 6 5 ... ... ... Influenza ... 32 2 1 3 1 8 15 2 2 ... Erysipelas 1 1 ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 137 2 1 8 28 55 37 6 16 ... Tuberculous Meningitis 7 1 1 4 3 ... ... ... 17 2 1 1 2 Other Tuberculous Diseases 7 3 1 ... Cancer, Malignant Disease 143 1 1 1 9 77 54 ... ... Rheumatic Fever 2 1 ... 1 ... ... ... ... ... Meningitis 10 21 2 3 3 2 1 ... ... Organic Heart Disease 143 ... 1 5 8 20 48 61 ... 135 19 8 2 33 70 Bronchitis 3 ... .. 223 69 Pneumonia 33 17 6 13 28 32 25 Other Diseases of Respiratory Organs 15 2 11 2 ... ... ... ... ... 1 Diarrhœa & Enteritis under 2 yrs 33 32 ... ... ... ... ... ... 3 1 Appendicitis and Typhlitis 5 1 ... ... ... ... ... Cirrhosis of Liver 12 2 6 4 ... ... ... ... ... 1 Alcoholism 1 ... ... ... ... ... ... ... 1 9 11 8 Nephritis and Bright's Disease 32 1 2 ... ... 9 2 7 Puerperal Fever ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 5 6 1 ... ... ... ... ... ... 59 Congenital Debility and Malformation, including Premature Birth 1 108 101 5 1 ... ... ... ... Violent Deaths, excluding Suicide 6 6 4 3 6 13 44 6 ... 6 10 Suicide 17 1 ... ... ... ... ... 336 45 6 2 11 21 31 102 155 Other Defined Diseases 2 1 1 Diseases ill-defined or unknown 3 ... ... ... ... ... 68 66 84 198 381 All Causes 1,642 337 107 401 TABLE V. — CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1920. NUMBER OF CASES NOTIFIED. BERMONDSEY. ROTHERHITHE. Total. 1 At Ages - Years. 6 1 NOTIFIABLE DISEASE Total. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 65 and upwards. At all ages. 45 and under 65 years. 2 3 4 5 2 3 Under 1 ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... 170 30 35 33 31 22 19 39 27 82 Diphtheria (including Membranous Croup) 268 16 91 134 17 9 1 16 4 31 24 16 4 6 5 7 2 4 17 3 Erysipelas 59 6 2 7 5 19 7 617 24 285 ... 80 85 118 109 129 96 163 74 48 Scarlet Fever 976 8 207 688 47 2 ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 1 2 2 1 Cerebro-Spinal Meningitis 6 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... Polio Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... 6 2 10 Ophthalmia Neonatorum ... ... 2 4 7 3 6 24 3 1 37 37 ... ... ... 3 3 1 ... 1 1 ... 1 1 1 Anthrax 5 ... ... ... ... ... ... ... 3 ... 5 Enteric Fever 1 2 1 1 1 2 1 ... 1 7 ... ... ... ... ... 4 1 3 18 19 2 Puerperal Fever ... 3 ... ... 3 3 5 1 1 21 ... ... ... 2 ... 3 Encephalitis Lethargica 4 1 1 ... 1 2 1 ... ... ... .. ... ... ... ... 3 ... 3 ... Dysentry 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 18 ... 3 13 5 Malaria 1 4 12 1 1 1 3 5 3 1 1 ... ... ... 1 ... 1 ... Continued Fever ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 81 7 16 28 17 8 47 Pneumonia (Acute Primary & Acute Influenzal) 24 16 8 7 2 5 13 9 5 11 1 7 339 33 2 41 219 92 2 4 82 66 140 43 31 39 39 43 26 35 24 Pulmonary Tuberculosis 99 Other forms of Tuberculosis 14 70 6 20 17 11 3 ... 13 10 17 4 12 8 6 1 65 2 Totals 1924 347 994 251 78 8 169 199 233 224 235 178 166 169 1229 273 552 80 101 TABLE VI.— FACTORIES, WORKSHOP, LAUNDRIES, WORKPLACES, AND HOMEWORK continued). Home Work. Nature of Work. OUTWORK IN UNWHOIESOME PREMISES, Section, 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. -I— : OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. (8) Instances. (11) Notices served. (12) Prosecutions. (13) Prosecutions. Instances. (14) Order made (S.110). (15) Prosecutions (Sections 109,110). (16) Sending twice in the year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Sending once in the year. Lists. (2) Outworkers. Lists. (5) Outworkers. Contractors. (6) Workmen. (7) Contractors. (3) Workmen. (4) Wearing Apparel:— .... I (1) Making, &c 39 10 388 5 13 21 1 1 ... ... ... ... ... .. ... (2) Cleansing and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 File making ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, latches and keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Umbrellas, &c. 3 2 ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents 3 6 3 ... ... ... ... ... ... ... ... ... ... ... ... 8 79 7 ... ... Sacks ... ... ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags ... 4 44 3 ... ... ... ... ... ... ... ... ... ... ... Brush making 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of Buttons, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Surgical Instruments 14 1 ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and Sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas ... ... Stockings, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Textile Weaving ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 59 10 536 5 13 40 ... ... 1 1 ... ... ... ... ... Table VII. —Deaths from Zymotic Diseases, 1920. Year. All Causes. Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Pyrexia (origin uncertain) Diarrhoea Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Rate. Rate. Rate. Rate. No. No. No. No. No. Rate. No. - 1.12 44 .34 - 4 .03 - - 87 .68 2229 310 - 1910 17.6 2.44 143 14 .11 18 .14 - 1911 2320 18.4 352 2.79 51 .41 6 .05 15 .12 48 .38 - - - - 6 .05 - - 226 1.80 1912 2119 16.9 252 1.21 - 101 .81 .06 17 36 .29 .00 .04 - 8 .14 1 5 - - 84 .67 1913 2243 17.9 320 2.56 - - .70 .38 88 5 .04 16 .13 47 - 2 .02 - - 162 1.30 - 1914 184 17.6 262 2.11 - 79 .64 9 .07 17 .14 14 .11 - 2 .02 - 1.14 - - - 141 21.4 3.13 1915 2514 367 - 110 .93 9 20 .17 .67 .03 - - .07 79 3 146 1.24 - - - 1916 17.2 155 1.36 .36 5 29 .14 1960 - - 42 .04 .25 16 - 2 .01 - 61 .53 - - 1917 2032 218 - .66 1 - 18.8 2.02 72 .01 18 .16 32 .29 6 .05 - - 89 .82 - - 1918 2390 22.0 229 2.11 - - 71 .66 3 .03 23 .21 84 .78 - - - - - 48 .44 - 1919 1748 113 .91 - - 18 .14 .17 4 14.1 5 .04 21 .03 3 .02 62 .49 - - - - Average for years 1910 to 1919 2174 .64 7 19 40 18.2 258 .16 3 2.06 .34 .03 - - - - - 78 .05 111 .91 - 1920 1642 163 12.7 56 .44 7 .06 25 41 .32 - - 1 .01 - - 33 .26 1.26 - Table VIII. —Prosecutions in connection with Samples taken during 1920. No. Sample. Adulteration or Infringement. Remarks. Vinegar Deficient in acetic acid 15.2 per cent. Ordered to pay costs, 15/6 588H Vinegar 47H Ordered to pay costs, 15/6 Deficient in acetic acid 12.1 per cent. 61s Milk Deficient in fat 8.3 per cent. Ordered to pay costs. 15/6 79s 75s Vinegar Milk Deficient in acetic acid 9.0 percent. Fined 5/- and 17/- costs Deficient in fat 8.0 per cent. Fined 40/- and 17/- costs 154s Vinegar Deficient in acetic acid 9.0 per cent. Ordered to pay costs. 15/6 Malt Vinegar 178H Deficient in acetic acid 43.0 per cent. Dismissed. Warranty proved. 226H Shredded Suet Deficient in beef fat percent. Fined 20/- and 17/6 costs 197s Milk Deficient in fat 7.0 per cent. Fined 30/- and 17/6 costs 260H Milk Deficient in fat 5.3 per cent. Withdrawn 220s Vinegar Deficient in acetic acid 7.0 per cent. Ordered to pay costs, 17/6 Milk 221s Dismissed. Warranty proved. Deficient in milk fat 15.3 per cent. 253s Vinegar Deficient in acetic acid 13.0 per cent. Dismissed. Warranty proved. Margarine 328H Wrapper Ordered to pay costs 17/6 351H Malt Vinegar Dismissed. Warranty proved. Deficient in acetic acid 19.7 per cent. Vinegar 477H Deficient in acetic acid 7.0 per cent. Ordered to pay costs, 17/6 Vinegar 459s Deficient in acetic acid 7.0 per cent. Ordered to pay costs. 17/6 490s Vinegar Deficient in acetic acid 8.5 per cent. Adjourned Sine die A case of obstruction or impeding an Inspector in the course of his duties was dismissed. Held not proved wilful. The Assistant fined 10/6 and 2 - costs each. Summary. £ s. d. Fines 5 5 6 Costs 10 3 0 TOTAL £15 8 6 64 TABLE IX.—FOOD AND DRUGS. Articles submitted for Analysis. Total Samples Taken. Number Genuine Number Adulterated. Percentages of Articles Adulterated. Apricot Jam 1 1 - - 1 1 Arrowroot - - 1 Baking Powder 1 - - 1 Bicarbonate of Soda 1 - - 1 Black Currant Cordial 1 - - 1 Blanc Mange Powder 1 - - 100.0 Brandy 1 - 1 Breakfast Sausage 1 1 - - Butter 133 132 1 .8 1 Camphorated Oil 1 - - Cayenne Pepper 1 1 - - 1 Coarse Oatmeal 1 - - 47 8.0 Cocoa 5 1 4 2 Cod Liver Oil 2 - - 7 Coffee 7 - - „ Camp 1 1 - - „ French 1 1 - - 2 - Cokernut 2 - 1 Cook's Eggs 1 - - 2 2 - Cornflour - 1 „ Maize 1 - - 1 Damson Jam 1 - - 3 3 - Desiccated Cocoanut - „ Soup 1 1 - - 1 Dried Eggs 1 - - 33 Dripping 36 3 8.3 1 Egg Substitute 1 - - 1 Egg Powder Substitute 1 - - 4 4 - Eucalyptus Oil - 4 4 - Fish Paste - 1 1 Flour - - 1 - Ginger Wine 1 - 2 2 - Gravy Salt - 1 - Golden Syrup 1 - 1 - Glycerine 1 - 1 1 - Ground Carraway Seed - Ground Ginger 3 3 - - 1 Jelly Crystals 1 - - 1 1 - Kaola - 1 Karo Syrup 1 - - 49 - Lard 49 - Lard Compound 2 2 - - 1 Lemonade 1 - - 1 Lemon Curd 1 - - 2 Lemon Squash 2 - - Lemon Squash Powder - 1 1 - 1 - Lime Juice Cordial 1 - .1 Linseed Meal 1 - - 1 1 - Lobster Paste - 1 Margarine 146 145 7 413 382 31 7.5 Milk Mincemeat 1 1 - - 19 Mustard 19 - - Mustard Compound 3 3 - - Table IX.—FOOD AND DRUGS.—continued. Total Samples Taken. Number Adulterated. Percentages of Articles Adulterated. Articles submitted for Analysis. Number Genuine. 2 2 Olive Oil - - Orange Marmalade 1 1 - - Ox Tail Soup 1 1 - - - Paisley Flour 1 1 - Parmesan Cheese 1 1 - - Pepper 40 39 1 2.5 Raspberry and Apple Jam 1 1 - - Raspberry Jelly 1 1 - - Rice 16 - 16 - Rishio Margarine 1 1 - - Salmon and Shrimp Paste 1 1 - - Sarsaparilla Wine 1 1 - - Seidlitz Powder 1 1 - - Self-Raising Flour 1 - 1 - Shredded Suet 10 8 2 20.0 1 1 - Strawberry - - Strawberry Jam 1 1 - - Sugar 1 1 - Sugaroids 1 1 - - Sweetened Cake Flour 1 1 - - Tapioca 7 7 - - Tapioca Flake 1 1 - - Tomato Ketchup 1 1 - - Turmoric 1 1 - 10.0 Vinegar 122 110 12 57 Vinegar Malt 65 8 12.3 - 1200 1136 64 5.3 Year. Bermondsey. Rotherhithe. St. Olave. Whole Borough. No. Rate. Rate. Rate. Rate. No. No. No. 754 1,149 18.14 1910 18.55 315 16.52 80 22.21 1911 757 284 16.20 89 20.53 1,130 17.96 18.44 31.51 1,182 18.81 1912 722 325 18.71 135 17.59 1,203 19.21 1913 748 18.28 323 18.74 132 31.32 23.86 1,236 19.90 1914 759 18.56 378 22.15 99 198 1,714 1915 1066 26.16 450 26.18 50.50 28.12 18.83 26.92 1,215 19.65 1916 774 19.23 326 115 676 285 16.96 54 13.05 1,015 16.92 1917 17.31 19.27 20.23 1,106 18.21 1918 762 344 ... ... 19.68 413 18.29 1,242 19.19 1919 829 ... ... 19.31 19.28 1,219 19.61 Average for years 1910 - 1919 785 344 ... ... ... 21.40 22.59 433 23.92 1920 950 ... 1,383 Table XI.-Factories, Workshops, Laundries, Workplaces and Homework. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions Factories (including Factory Laundries) 116 45 1 Workshops (including Workshop Laundries.) 65 24 ... Workplaces (other than Out-workers' Premises) 59 31 2 100 3 Total 240 Defects found. Number of Defects. Number of Prosecutions. Particulars. Referred to H.M. Inspector. Found. Remedied Nuisances under the Public Health Acts — Want of Cleanliness 24 24 ... ... Want of Ventilation ... 1 1 ... Overcrowding ... ... ... ... Want of Drainage of Floors 1 1 ... ... 66 66 Other Nuisances 1 ... Sanitary Accommodation — Insufficient 8 8 2 ... Unsuitable or Defective 31 31 ... ... 3 Not separate for Sexes 3 ... ... Offences under the Factory and Workshop Act — Illegal Occupation of Underground Bakehouse (s. 101) ... ... ... Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) ... ... ... ... Other Offences ... ... ... ... ... Total 134 134 3 ... Table XII.—No. of Bakehouses in the Borough. Inspector. In Use. Not in Use. Underground. Above Ground. Above Ground. Underground. 10 Mr. Scott 20 2 2 3 11 5 23 Mr. Hoskins 10 of these are Factory Bakehouses. Other Matters. Number Class. Matters notified to H.M. Inspectors of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) ... Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factories Act (3 7) Notified by H.M, Inspectors 26 Reports (of action taken sent to H.M. Inspectors) 24 Other ... Underground Bakehouses (s. 101) Certificates granted during 1919 ... In use at end of 1919 21 Workshops on the Register (s. 131) at the end of 1919 336 Workshop Bakehouses 64 400 Total Number of Workshops on Register UNSOUND FOOD AND FOREIGN MEAT REGULATIONS. The following articles of food were dealt with under the above regulations during the period under report. Article. Quantity Unsound. Removed for Sorting under S.A. Exported. Destroyed. Disposed of for other Purposes than Human Food. Quantity Weight Weight. Quantity. Quantity. Weight. Quantity. Apples 47 barrels and 2 loads Tons. Cwt. qr. lbs. Tons. cwt. qr. lbs. Tons. cwt. qr. lbs. Tons. 3 16 21 65 packages 3 1 3 - - - - - - - - - - 25 boxes 8 1 - Apples and Pears - - - - - - - - - - - - - 6 boxes 2 2 25 - - Apricots - - - - - - - - - - - 1 10 - Barley - - - - - - - - - - - - - - 7 crates 5 1 - - Bananas - - - - - - - - - - - 2196 boxes, 20 barrels, 14 hams, 2 gammon - 8 Bacon and Hams 627 6 9½ 187 boxes, 135 barrels 129 14 3 1,687 boxes 484 - - - - - - Beans, Butter - 2 10 - - - - - - - - - - - - - 16 bags 16 Cabbages - - - - - - - - - - - - - - - - Cauliflower in brine 163 casks 29 15 - - - - - - - - - - - - - 13 12 8½ Cheese - - - - - - - - - - - - - - Cucumbers - 4 loads 5 14 - - - - - - - - - - - - - 6¼ cases Currants - - - - - 2 1 - - - - - - - - - Dates - 7 14 - 17 6 - - - - - - - - - - - Desiccated Cocoanut. - - - - - 1 case - 1 - 18 - - - - - - - Eggs 5 18 3 241 17 3 22 - - - - - - - - - - - Egg Yolk - - 9 2 25 — 811 casks *963 casks 183 198 - - - - - - - - - 264 bundles 8 Figs 3 12 1 8 - 24 bundles 1 2 1 - - - - - Flour 1 - - - - - - - - - - - - - - - - Fruit - 12 bundles 12 - - - - - - - - - - - - - - Gherkens 37 boxes 5 - - - - - 13 - - - - - - - - - Honey 2 4 - - - - - - - - - - - - - - - In accordance with declaration. UNSOUND FOOD AND FOREIGN MEAT REGULATIONS— continued. Quantity Unsound. Article. Disposed of for other Purposes than Human Food. Destroyed. Removed for Sorting under S.A. Exported Quantity. Weight. Quantity. Weight. Quantity. Weight. Quantity. Weight. Jam - 14 eases, 379 tins, 17 1 6 - - - - - - - - - - - - - - - - Lard - - 4 boxes - 2 - - - - - - - - - - - - - - - - 30 boxes 10 Livers - - - - - - - - - - - - - - - - 776 cases 3 Meat 8,449 cases 2,457 tins 305 14 3 7¼ - - 24 - - - - - - - - 1 - - 22 cases 1 - Melons - 25 cases 5 2 - - - - - - - - - - - - Macaroni 12 1 3 24 - 49 boxes 2 3 3 271 boxes - - - - - - - - - - 70 2 380 tins Milk 12,972 cases 933 tins 290 1 24 3 1 16 - - - - - - - - - - - 24 - Nut Butter - 37 boxes - 3 2 - - - - - - - - - - - - - - 27 boxes 1 7 - - - Oranges - - - - - - - - - - - - - 5 16 Ox Tongues 6cs. 111 tins 6 3 - - - - 9 2 - - - - - - - - - 1 box 25 - - Peaches - - - - - - - - - - - - - - - - Peel in brine - 2 14 1 - - - - - - - - - - - - - - - - 375 boxes 8 14 38 boxes - 3 7 - - Plums 16 - 8 - - - - - - - - 1 2 Pomegranates - 137 cases 6 6 - 30 boxes - - - - - - - - - - - - 4 17 4 3 - - - Potatoes - - - - - - - - - - - - - - Prunes 16 17 2 - - - - - - - - - - - - - - - - Rabbits 127 tins 3 10½ - - - - - - - 5 - - - - - - - - 9 Rice 4 11 3 - - - - - - - - - - - - - - - - 4 2 42 cases - 18 Syrup - - - - - - - - - - - - - - - 2 bags Sugar 4 - - - - - - - - - - - - - - - - - - - 15½ - Turkey - - - - - - - - - - - - - - - - - - Tinned Fruit 72 cases 14 tins 1 11 24 77 cases 189 cases 20,851 tins 9,196 tins 35 61 4 - 1 2 25 12 - - - - - - - - - - - 1 - - - Tinned Fish - - - 3,803 tins 17 3 4 - - - - - - - - - 7 - „ Vegetables - - - - 3 3 1 - - - - - - - - - - „ Various - - 81,921 tins 104 12 13 - - - - - - - - - - - - - - 234 3 1 7 - Wheat - 7 - 5 - 12 - - - - - - - -