BOROUGH OF BERMONDSEY, Town Hall, Spa Road, S.E.16. PUBLIC HEALTH DEPARTMENT. WITH THE COMPLIMENTS OF THE MEDICAL OFFICER OF HEALTH. BER 40 Metropolitan Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1921. BY R. KING BROWN, B.A., M.D., D.P.H., Medical Officer of Health. TABLE OF CONTENTS. VITAL STATISTICS— Page Population 7 Births 7 Marriages 8 Deaths 8 Infantile Mortality 9 Zymotic Diseases 10 Measles 10 Whooping Cough 10 Enteric Fever 10 Tubercular Diseases 10 Phthisis 10 NOTIFICATION OF INFECTIOUS DISEASE— Diphtheria 11 Scarlet Fever 12 Measles 13 Enteric Fever 13 Puerperal Fever 13 Ophthalmia Neonatorum 13 Cerebrospinal Meningitis 14 Polio-Myelitis 14 Bacteriological Laboratory 14 SANITARY ADMINISTRATION— Food Inspectors' Work 15 Unsound Food 16 Milk Premises 16 Slaughterhouses 16 Ice Cream Premises 16 Food and Drugs 17 General Sanitary Work 17 Smoke Nuisances 17 Page House Refuse 17 Offensive Trades 17 Disinfection 18 Cleansing of Persons Act, 1897 18 Proceedings during year 18 Mortuary 20 Insanitary Areas 20 Work of District Inspectors 21 MATERNITY AND CHILD WELFARE— Health Visitors 22 Municipal Lying-in Hostel 23 Lady Assistant Medical Officer's Report on Maternity and Child Welfare 24 Municipal Dental Officer's Report 29 TUBERCULOSIS— Assistant Tuberculosis Officer's Report 34 APPENDIX TABLES— Local Government Board Tables 39 Outworkers 45 Deaths from Zymotic Diseases 46 Prosecutions (Foods and Drugs) 47 Factories and Workshops 50 Bakehouses 51 Unsound Food and Foreign Meat Regulations 52 PUBLIC HEALTH DEPARTMENT. Public Health Committee, 1921. Chairman —Councillor STOKES. Alderman Salter, M.D., J.P., Councillor Monk, Trott, Councillor Baker, „ Salter, „ Stephen, „ Sullivan, „ Broughton, „ Gamble, „ Vezey, „ Gledhill, „ Wallsgrove, „ Weightman. „ Jeffery, „ Lawrence, G. C., Ex-officio: W. C. BUSTIN, Esq., J.P. Mayor of Bermondsey. Maternity and Child Welfare Committee, 1921. Chairman —Councillor G. C. LAWRENCE. Councillor Stephen, Alderman Squires, Trott, „ Stokes, Councillor Baker, Co-opted Members: „ Broughton, „ Gledhill, Mrs. A. Bustin (Mayoress), „ Jeffery, Mrs. W. G. L. Hawke, „ Jones, Mrs. M. Nix, „ Salter, Mrs. J. E. Scriven. 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. Assistant Tuberculosis Officer —Dr. M. B. S. Darroch, M.B., Ch.B., D.P.H. Second Assistant Tuberculosis Officer—Dr. D.M. Connan, M.B., D.P.H. Assistant Medical Officer of Health (Maternity and Child Welfare) — Dr. Stella Churchill, M.R.C.S., L.R.C.P., D.P.H. Municipal Dental Officer —Mr. Grantley Smith, H.D.D. Edin., L.D.S. Eng. Sanitary Inspectors: District. District. No. 1. —Mr. J.G. Francksen. No. 5 —Mr. E. C. Freeman. No. 2.—Mr. J. W. Wood. No. 6 —Mr. E. J. Pitts. No. 3. —Mr. A. H. Merryman. No. 7.—Mr. W. Davis. No. 4. —Mr. H. J. Toogood. No. 8.—Mr. 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.—Miss Sumner. No. 3.—Miss Islip. No. 7.—Miss Carlton. No. 4.—Miss Sharman. No. 8.—Miss Wadds. Dental Nurse —Miss Helden. Clerical Staff: Mr. H. W. Bush, Chief Clerk. Mr. A. I. Fair, Second Clerk Mr. C. F. Yaxley, General Clerk Mr. F. W. Smith, Third „ Mr. C. W. Whye, General „ Mr. E. F. Walsh, Fourth „ Mr. H. E. Butcher, Junior „ Mr. A. Manning, M. & C. W. Clerk. Master W. C. Tapsfield, Office Lad. Municipal Lying-in Hostel —Matron: Miss A. E. Sewell. Nurses —Miss Megson, Miss Wright, Miss Booth. Tuberculosis Dispensary—Miss Pike and Miss Stevens, Nurses; Miss Deighton, Dispenser; Miss Dutch, Assistant Clerk. 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 Twenty-first Annual Report on the sanitary condition of the Borough of Bermondsey during the year 1921. The death-rate was 13.7, compared with 12.7 in 1920, and 14.1 in 1919. 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. At the end of the Report will be found three Special Reports from Dr. Connan on Tuberculosis, Dr. Stella Churchill on Maternity and Child Welfare, and Mr. Grantley Smith on the Dental Work of the Borough. In the Appendix will be found the Local Government Board Tables, including a special Table on Infantile Mortality. 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. KING BROWN. I.—VITAL STATISTICS. Population. The populations of the Borough of Bermondsey, as enumerated in the Census of 1911 and 1921, and the estimate of the year under report are as follows: — Estimated to June 30th, 1921. 1911 1921 119,455 125,903 120,500 The population of Bermondsey for 1921 has been estimated by the Registrar-General as 120,500, 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 52 weeks ended December 31st, 1921, was 3,231, consisting of 1,682 males and 1,549 females. This is 138 below the average for the last 10 years, and 807 below the figure for 1920. The birth-rate for 1921 was 26.8 per thousand persons living, which is 4.4 below that for 1920 and 0.3 below the average for the last 10 years. Marriages. The total number of marriages in the Borough in 1921 was 1,084, being 299 below the number for 1920, and 158 below the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 17.99 per 1,000 of the population, compared with a marriage rate last year of 21.4 per 1,000 of the population, 120,500. Year. Rate. No. 1,130 1911 17.96 1912 1,182 18.81 1913 1,203 19.21 1014 1,236 19.90 1,714 1915 28.12 1,215 19.65 1916 1917 1,015 16.92 1918 1,106 18.21 1919 1,242 19.19 1020 1,383 21.40 Average for years 1911 - 1920 1,242 19.93 1921 1,084 17.99 Deaths. In Tables III. 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, 1921, was 1,313, which is 153 less than in 1920, and 425 below the average for the last 10 years. When this figure is corrected by exclusion of deaths of non parishioners occurring in the district, and the inclusion of deaths of parishioners occurring outside the district, the number is raised to 1,656. This is 14 more than in 1920, and 459 less than the average for the last 10 years. The death rate for the Borough in 1921 was 13.7 per thousand living inhabitants, being 1.0 above that recorded in 1920, and 4.0 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 district. There were 51 such deaths in all, against 105 in 1920 and 165 in 1919. 19 such deaths occurred in the infirmary; 22 in the River Thames and the Surrey Commercial Docks, 1 at a Railway Station, 3 in the street, 1 in a factory, and 5 in private houses. 394 persons belonging to this Borough died in outlying institutions, against 281 in 1920, and 313 in 1919. 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 95 deaths under one year to every 1,000 births. TABLE A.—Infantile Mortality. London. Whole Borough. Year. No. of Deaths. Rate per 1,000 Births. Rate per 1,000 Births. No. of Deaths. 1911 611 159 14,440 129 1912 433 114 10,056 91 1913 505 131 11,869 105 487 1914 129 11,395 104 537 1915 154 11,369 104 1916 364 108 8,819 88 1917 335 125 8,273 103 1918 322 139 7,965 107 1919 262 99 7,039 85 1920 337 83 - 75 Average for years 1911 - 1920 419 124 - 99 95 1921 306 - 80 Deaths from Zymotic Diseases. There has been an increase in the deaths from these diseases, the figures being 197 against 163 in the previous year, and 243 the average for the last 10 years. This gives a zymotic death-rate of 1.63. Measles. There were 3 deaths due to this disease, which is below the average for the last 10 years, and 53 below the number for 1920. Whooping Cough. 14 deaths were due to this cause, against 41 in 1920. Enteric Fever. 3 deaths were due to this cause. There was 1 death in 1920. Tubercular Diseases. The number of deaths from all forms of tubercular disease in 1921 was 185, against 170 in 1920. Phthisis. In Table B will be found particulars of deaths from phthisis since the year 1911. There were 163 deaths due to this cause, which is 26 more than the number recorded in the previous year. TABLE B— PHTHISIS. Sub. District. Bermondsey. Whole Borough. Rotherhithe. St. Olave. London. Year. Rate. No. Rate. No. Rate. Rate. No. No. Rate. No. 1911 141 1.72 52 1.48 18 2.08 211 1.68 6084 1.35 1912 138 1.68 57 1.64 17 1.98 212 1.69 6069 1.35 1913 125 1.53 64 1.86 12 1.42 201 1.61 5981 1.30 136 1.66 46 1.35 21 2.53 203 1.63 6281 1.39 1914 1915 156 1.76 57 1.77 20 2.42 233 1.97 6782 1.54 1916 126 1.70 44 1.38 14 1.78 184 1.61 6288 1.45 1917 123 1.75 61 2.02 14 1.88 198 1.83 6658 1.57 1918 117 1.66 43 1.42 9 1.20 169 1.56 7048 1.78 1919 104 1.28 58 1.66 12 1.39 174 1.40 5332 - 1920 81 0.96 46 1.27 10 1.12 137 1.06 - - Averages for years 1911-1920 124 1.57 52 1.58 14 1.78 192 1.60 - - 106 - 43 - 14 - 163 1.35 - - 1921 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 445, was 2,045 compared with 1,486 in 1920 and 1,390 in 1919. The disease showing the principal increase was diphtheria. The attack rate per thousand inhabitants was 16.29 against 11.5 in 1920. 55 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 741 cases of diphtheria notified in 1921 as against 268 cases in 1920. The attack rate per thousand inhabitants was 5.90, against 2.07 in 1920. The case mortality was 9.3 per cent., against 9.3 per cent. in 1920, and 7.6 per cent, in 1919. 27 cases were returned as not suffering from this disease. For many years up to September, 1920, the figures for diphtheria, not only for the Borough, but for London, remained very low, and considerably below those of Scarlet Fever, but with the epidemic of scarlet fever, which started in the Autumn of 1920, diphtheria also showed some signs of increasing, and remained on a higher level than previous up to the Autumn of 1921. From the middle of September, 1921, a steady rise in diphtheria occurred, and in the week ending November 21st, the maximum of 44 cases in one week was reached. In the previous week scarlet fever dropped considerably below the level of diphtheria, and has remained so to the present time (middle of 1922). Since the beginning of the present century, the prevalence of diphtheria has always been considerably less than that of scarlet fever, and now, for the first time, the conditions are reversed. It is very difficult to explain the increase in the prevalence of this disease, but I frequently remarked during the years of the war and up to the Autumn of 1921 that both diphtheria and scarlet fever in Bermondsey were remarkably low. This was probably an accidental occurrence, and no doubt a new and susceptible population was growing up at this period, and they have now become the soil for the great increase in these two children's diseases. The case mortality in diphtheria has remained about the same in spite of the increased prevalence, but owing to the great increase in the number of cases it now causes many more deaths than scarlet fever. Scarlet Fever. The notifications of scarlet fever in 1921 were 1,164 against 976 in 1920. This is an increase of 188. The distribution of the disease in the various Wards, as shown in Table V. of Appendix, was fairly uniform. 27 cases were returned from hospital as not suffering from scarlet fever. There were 18 deaths, which gives the very low case mortality of 1.5 per cent., against 0.72 per cent. in 1920. The disease, as in recent years, was of a very mild type. The attack rate per thousand inhabitants was 9.66 against 7.56 in 1920. Many of the remarks made about diphtheria will apply to scarlet fever. The case mortality has been extremely low, and the relative increase has been about in the same proportion. During recent years scarlet fever has become a comparatively mild and innocuous disease, and the question arises as to whether one should not make provision in the hospitals for some more deadly disease, such as measles, by not removing so many cases of scarlet fever into hospital. The question, however, is a difficult one, for although measles causes a large number of deaths —indirectly, through complications—it is doubtful whether the case mortality is as high as that of scarlet fever. Scarlet fever is one of those diseases which is very liable to increase in virulence, and although it has been of a mild character for the past 25 years, one never knows when it may suddenly become virulent, in which case we would require every bit of hospital accommodation. In a borough like Bermondsey also there are very few opportunities of treating cases at home, for lack of accommodation—so it is probably better to still isolate scarlet fever, a disease which we can control to some extent, than endeavour to isolate a disease like measles which has hitherto resisted all attempts to control. 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 1921 was 3, against 56 in 1920, 18 in 1919, and 71 in 1918. Enteric Fever. 8 cases of enteric fever were notified, being 5 for Bermondsey, 1 for Rotherhithe, and 2 for St. Olave. One case was returned as not suffering. The total number of cases notified in the previous years was 7. Puerperal Fever. 7 cases of puerperal fever were notified. Death resulted in 3 cases. Ophthalmia Neonatorum. There were 15 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 immediately seek medical advice. Cerebrospinal Meningitis. 1 case was notified in 1921. Polio-Myelitis. No cases were notified in 1921. Bacteriological Laboratory. The total number of specimens examined in 1921 was 3,284 as compared with 1,422 in 1920, and 954 in 1919. Table C. Total Examinations. Results of Examination. Nature of Specimen. Positive. Negative. 1920 1921 1920 1921 1920 1921 DIPHTHERIA (specimens taken by Medical Officer of Health) 524 1,035 30 58 494 977 Ditto (taken by general practitioners) 484 982 44 148 440 834 DIPHTHERIA (total specimens taken) 1,008 2,017 74 206 934 1,811 402 1,258 328 1,120 Phthisis 74 138 2 6 - 1 2 5 Enteric Various 10 3 1 - 9 3 149 1,273 Total specimens taken 345 1,422 3,284 2,939 FOOD INSPECTORS. TABLE E. PARTICULARS OF WORK, 1921. 1 2 3 14 4 5 6 7 8 9 10 11 12 13 15 16 Food Factories. Butchers. Fishmongers, Friers and Curers. Food Stores. Food Wharves and Depots. Fruiterers and Greengrocers. Ice Cream. Markets. Milk Sellers. Restaurants and Eating Houses. Slaughterhouses. Destruction of Food. Nuisances Reported. Number of Samples taken. Visits. Butter and Margarine. Other. Bakehouses. Various. Jam. Sanitary Administration. Re-visits - - - - - 544 3388 - - - - 542 Mr. Ashdown - 70 - 19 - - D.O.R.A. - - - - - - - - - - - - - - - - - - New occupiers - - - - - - - - - - - - - - - - - - 15 „ Premises - - - - - - - - - - - - - - - Closed - - - - - - - - - - - - - - - - - - - - - Re-visits 225 - 128 442 474 183 349 264 Mr. Scott 62 179 44 152 31 75 157 602 - - D.O.R.A. - - - - - - - - - - - - - - - - - - New occupiers - - 1 5 24 2 1 4 1 - 14 9 - - - - - „ Premises 1 2 - - - 4 3 3 1 - 5 - - - - - - - - Closed - - 4 1 1 - 4 7 - - 1 - - - - - - - 540 158 - 51 113 195 139 935 92 357 - 103 25 276 Mr. Hoskins Re-visits 247 176 221 556 D.O.R.A. - - - - - - - - - - - - - - - - - - New occupiers 3 - - - - 3 31 8 6 - 14 9 - - - - - „ Premises 2 - - - - 5 4 5 1 14 9 18 10 3 - - - - - Closed - - - 1 - 1 3 12 4 - - - - 1 - - Unsound Food. The following were brought to the notice of the Department, found to be unfit for human food, and destroyed as trade refuse: tons. cwts. qrs. lbs. Meat— Fresh 2 5 3 17 Canned 108 1 3 17 Fish — Fresh 12 1 15 Canned 1 18 1 13 Vegetable— Fresh 7 2 4 Canned 2 0 0 26 Fruit — Fresh 3 18 1 18 Canned 67 6 0 4 Dairy Produce — Various 13 13 2 21 Eggs 106 2 3 2 Various — Various Canned Goods 2 19 1 5 309 6 2 2 Milk Premises. There were 305 milk premises on the Register at the end of 1920. 10 were added and 7 removed during 1921, making a total of 308 at end of the year under report. Slaughterhouses. There is one slaughterhouse in the Borough, 31 inspections were made. No notices were served. Ice Cream Premises. There were 105 premises where ice cream is manufactured on the Register at the end of 1920. 17 were added and 6 removed during the year under report, making a total of 116; 136 inspections were made. FOOD AND DRUGS. In Table IX. of Appendix will be found a list of the samples taken in 1921, and the action taken; 1,201 samples were taken, compared with 1,200 in 1920, and 1,258 in 1919. Of these 5.6 per cent. were found adulterated, compared with 5.3 per cent, in the previous year, and 8.2 per cent, in 1919. GENERAL SANITARY WORK. Inspections. In Tables F. and G. (pages 18 and 21) will be found particulars of the general sanitary work by the District Inspectors during 1921. The house-to-house inspections numbered 5,480. This is 475 below the total for the previous year. 6,366 intimation notices were served, compared with 7,125 in the previous year. Smoke Nuisances. 12 observations were kept on chimneys and 8 notices served. House Refuse. The following table shows the amount of house and trade refuse disposed of during the year ended December, 1921:— Loads. Tons. Cwts. Qrs. Dust to Barge 7,674 12,235 9 2 „ Shoots 1,410 2,172 1 1 „ Lightning Crusher 3,435 4,872 0 1 Trade Refuse to Shoots 77 60 0 0 „ Barge 2,290 1,784 7 3 14,886 21,123 18 3 Offensive Trades. The offensive trades on the Register are as follows:- Tripe boiler 1 Glue and size makers 4 Fellmongers 3 Fatmelters 4 Manure Manufacturer 1 DISINFECTION. The following table shows the number of articles passed through the steam disinfector during the year under report:- Beds 1,928 Quilts 2,096 Blankets 3,392 Sheets 2,376 Bolsters 1,283 Books 970 Carpets 6 Miscellaneous 7,479 Cushions 447 Verminous Clothing 497 Mattresses 660 „ Bedding 252 Overlays 949 Hair (bundles) Nil Pillows 3,033 „ (cases) Nil 19,153 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 24 male and 19 female adults used the Verminous Baths and had their clothing disinfected. The total number of articles disinfected for this purpose was 497. TABLE F. —Proceedings during 1921. NUMBER OF PLACES. Number of Notices, 1921. Number of Prosecutions, 1921. Number of Inspections, 1921. On Register at end of 1920. Added in 1921. On Register at end of 1921. PREMISES Removed in 1921. ... ... 10 7 308 804 305 Milk Premises Cowsheds ... 1 ... ... ... ... ... ... 1 ... ... 31 ... ... Slaughter-houses Other offensive trade premises ... ... 13 ... ... 13 ... Ice-cream premises 105 17 6 116 136 ... ... Registered houses let in lodgings ... ... 223 ... ... 223 446 Total number of Intimation Notices served for all purposes 6,366 Overcrowding, 1921 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 — Shelters provided under Sec. 60 (4) of the Public Health Act, 1891 Number of persons accommodated 17 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 (Byelaws) Act, 1899) 1 Mortuary Total number of infectious bodies removed 12 Total number of bodies removed 103 WORK OF DISTRICT INSPECTORS, 1921. 8 1 2 3 4 5 6 7 9 10 11 12 13 Special Inspections. Infectious Diseases. Factories and Workshops specially Inspected. Chimneys Watched. Offensive Trades. Re-inspections. House to House. Drains Tested. Other Calls and Visits. Underground Conveniences. Complaints. Outworkers' Bi-Annual Inspection. Totals. No. Ints. No. Ints. No. Ints. No. Ints. No. Ints. No. Ints. No. Ints. No. No. No. No. No. Ints. Visits Ints. 780 96 163 27 1 - - - - 143 2290 1 4750 724 490 21 226 192 28 38 719 1 - 8 702 559 202 91 264 163 170 45 52 20 3 - 39 2592 627 6 4656 882 - 5 715 360 119 67 307 223 238 34 17 - — 52 35 2573 299 4358 - 3 - - 684 - 703 402 125 17 476 414 2 1 22 5268 364 59 20 1 - 20 2894 591 - 837 - - 80 826 544 28 319 202 270 31 13 3 6 20 1 — 47 2666 414 1 1 4656 818 - 135 87 78 214 150 423 341 290 129 55 4 217 179 2973 357 4929 702 - - - - - 618 494 77 64 276 252 213 52 2 - - 134 3268 173 2 - 46 1 4835 835 - - 492 334 200 158 255 7 3075 307 283 59 13 27 - 56 160 117 2 4803 847 - - - 1 253 - - - - - - 234 30 30 - 548 - - - - - - - - - 256 1 118 44 28 34 9 - 9 202 63 1243 - - - - 523 - 37 - - - 3262 1232 - 77 2 611 1000 22884 3390 12 8 40046 476 181 35 2047 6366 TABLE H. Health Visitors. The following Tables show the work done by the Health Visitors during the year 1921. Births Notified. First Visits. Ophthalmia Neonatorum. Reports to M.O.H. Subsequent Visits. Various Calls and Visits. SUMMARY. HEALTH VISITORS. Ante-Natal. Under 1 year. 1 to 5 years. Miss Child 215 243 289 229 10 2 662 22 117 120 105 48 12 93 8 Mrs. Smith - 177 20 321 13 Miss Middleton 185 160 113 1 401 333 490 227 36 1 230 25 „ Islip 300 28 6 126 42 „ Sharman 381 362 400 285 284 412 264 63 9 208 9 „ Bache 192 45 9 458 33 „ Sumner 348 334 269 333 298 555 196 17 1 318 11 „ Carlton 248 6 1 266 9 „ Wadds 318 320 558 282 60 64 36 564 2 Princess Club - - 376 1 378 2 Central Hall 22 182 166 - 235 138 106 762 Fulford Street - 52 - - 839 166 188 24 St. George's Hall 56 702 - - 49 91 935 566 923 453 19 Salomon's Centre - 22 2,957 5,245 3,650 1,872 67 5,027 219 Totals 2,632 SUMMARY. NAME OF CENTRE. Class for Mothers. Sewing Class. Ante-Natal Clinic. Dental Clinic. New Cases. No. of Sessions. Gas Patients. No. attending Children. No. of Sessions. No. of Sessions. No. attending. No. attending. Revisits. Under 1 year. 1 to 5 years. 1,115 395 Town Hall 49 3,036 25 - - - - - Abbeyfield Road 13 2,364 654 5 99 3 69 - - - 706 430 144 Trinity Road 26 23 - - - - - Oxley Street 33 1,393 236 24 409 29 179 164 - - 299 Roseberry Street 25 1,117 - - - - - - - Princess Club 83 5,208 1,096 34 1,225 22 414 - - - 1,424 1,088 21 222 5 44 Fulford Street 44 - - - - Central Hall 47 3,399 1,080 - - - - - - 26 880 827 24 346 St. George's Hall - - - - - 107 98, Rotherhithe New Road 42 1,725 584 18 7 73 - - - 644 18 111 82 Salomon's Centre 64 273 938 - - - TOTALS 192 3,058 119 1,538 29 179 164 452 21,896 7,682 MUNICIPAL LYING-IN HOSTEL. Report from January 1st to December 31st, 1921. (1) Total Number of Cases Admitted 156 (2) Average Duration of Stay 14 days (3) Number of Cases Delivered by Midwives 145 (4) Number of Cases Delivered by Doctors 11 (5) Number of Cases in which Medical Assistance was sought by Midwives 35 (a) Ante-Natal 1 (b) during Labour 13 (c) after Labour 16 (d) for Infant 5 (6) Number of Cases Puerperal Septis with Result of Treatment 1 complete recovery (7) Number of Cases in which Temperature rose above 100.4 for 24 hours with Rise of Pulse Rate 4 (8) Number of Cases notified as Ophthalmia Neonatorum, with Result of Treatment Nil (9) Number of Cases Inflammation of the Eyes, however slight 3 (10) Number of Infants not entirely Breast-fed while in the Institution, with the reasons why they were not Breast-fed Nil (11) Number of Maternal Deaths with Causes Nil Post Partum Hæmorrhage between second and third week after delivery, due to Polypus of the Uterus. Died after operation for Removal in Bermondsey and Rotherhithe Hospital Nil (12) Number of Fœtal Deaths, Stillborn or within 10 days of Birth, and their Causes, and the results of PostMortem Examination, if obtainable Nil REPORT ON MATERNITY AND CHILD WELFARE, 1921. The following report on the Maternity and Child Welfare Work in the Borough was presented by Dr. Stella Churchill, Assistant M.O.H. for Maternity and Child Welfare Work. I am glad of the prominence given to the co-ordination between the Voluntary and Municipal Centres, which I have always been at great pains to foster. The work has greatly extended during the past two years and the giving of advice both by visiting in the homes and at the Centres is greatly appreciated by the mothers of the Borough. "The year 1921 was remarkable for the prolonged drought and hot weather, yet the number of infants under one year dying from all kinds of gastro-enteritis was only 60, while there was a total of 303 deaths, with 74 due to Respiratory disease. The infantile Death Rate rose to 93 (London 83); and Bronchopneumonia alone accounted for 53 deaths. Among the children brought to the Infant Welfare Centres there were numerous cases of "Summer Diarrhœa," which yielded to prompt treatment, and we have found it a great help to have placards at each weighing centre directing the mothers to seek medical advice at once in such cases. The problem of dealing with respiratory diseases in young children is chiefly to be met by the provision of adequate home nursing and the improvement of housing conditions. Staff. There have been two changes; Mrs. Smith left early in the year, and Miss Sharman gave up Oxley Street at Christmas after five years work at a small but very important centre (taken over by the Borough in March 1920). She was very popular with the mothers, but she has an energetic successor in Miss Child. The vacancies were filled by Miss Helden (No. 1 District) and Miss Middleton (No. 6 District), who were recently Municipal Midwives in the Borough. The numbers attending Municipal Centres were 1,521, of whom 924 were new mothers and babies. Infant Welfare Centres. There were 66 deaths among children under 3 years attending the Municipal Centres, as follows:- Broncho-pneumonia 25 Meningitis 1 Eczema 2 Enteritis 22 Marasmus 13 Prematurity 3 An inquiry was made among the Centre babies to find out how far the normal increase in weight was maintained during the first year of life. The figures throughout shew there is a failure in this, and that it is more marked in the over-crowded areas; but the children are born healthy and above the average weight. (A.) 98, Rotherhithe New Road Centre.—100 Cases. 6 Months. 1 Month. 12 Months. 70 Above average + 59 37 Equal to average = 8 13 17 Below average — 22 28 46 (B.) Town Hall Centre. —100 Cases. 1 Month. 6 Months. 12 Months. Above average + 49 37 36 Equal to average = 19 20 15 Below average — 32 43 49 (C.) Trinity Road Centre.—70 Cases. 1 Month. 6 Months. 12 Months. 14 Above average + 36 29 Equal to average = 12 9 14 Below average — 22 32 42 (D.) Oxley Street Centre.—70 Cases. 1 Month. 6 Months. 12 Months. Above average + 35 37 25 Equal to average = 13 8 3 Below average — 22 25 42 From the last three tables one can see that 50 per cent, are born above the average weight, but at the end of the first year only 33 per cent. (approximately) have kept up this superiority; while conversely 33 per cent, are born below the average, more than 50 per cent, are below at the end of the first year. Toddlers' Clinics. Two were opened in June, 1921, with sessions once a month to meet the need for preventive and educational work with the "Ex-baby," who gets officially no medical attention from infancy until school life is reached. Town Hall "Toddlers' " Clinic had 29 regular attenders, with an average of 14 a session. 98 Rotherhithe New Road had 40 attenders, and an average of 12 at each clinic. The chief needs of the child from 2-5 are:- (a) Sufficient sleep once the midday rest is given up. (6) Suitable clothing; they are found to be smothered in woollen garments, and to have cold, wet, bare feet and legs. Cases wore referred to hospital for treatment on account of: — (a) Anterior Polio-Myelitis 2 cases (b) Rickets requiring orthopedic advice 6 cases (c) Bronchiectasis 1 case (d) Tuberculosis 3 cases Ante-Natal Clinic. 124 mothers attended —average 4 times; 48 primiparæ and 76 multiparæ at the fortnightly session. The local midwives gave valuable support to this new clinic by sending their patients for consultation; only 15 mothers showed really sound teeth, which means that 88 per cent, of these expectant women required dental treatment. Many attended the Municipal Dental Clinic with great benefit to their health, and no disastrous results to the child; the majority do not associate their dental caries with the onset of pregnancy, but very few use a tooth brush, and nearly all live on soft food, and take their fluids "as hot as they can bear it." 124 Mothers Examined. 3 still births—2 per cent. 6 venereal disease. 3 slight albuminuria. 3 ante partum hæmorrhage. 22 severe varicose veins. 18 history of rheumatic fever with heart murmurs and some myocardial defects. Sewing Classes have been held once weekly at the Town Hall, 98, Rotherhithe New Road and Oxley Street. Much health educational work is done by this means, apart from the actual teaching of sewing, knitting, cutting out, and making over garments. Voluntary Centres. There are four Voluntary Infant Welfare Centres in the Borough, and one in connection with Guy's Hospital (Salomon's Centre). Central Hall has two weekly sessions with 521 members in regular attendance. This Centre attracts mothers who have never before attended an Infant Welfare Centre, and copes with large and ever- increasing numbers from some of the most overcrowded areas. St. George's Hall has one weekly session with 205 members, and a sewing class which is attended by 15 or 20 mothers each week. The women are taught to cut down old as well as to make up new garments—a very valuable form of economy. The doctor also gives much-needed "talks" once a fortnight. Princess Club has three weekly sessions for infants; an ante-natal clinic weekly and a Toddlers' Clinic once a fortnight, as well as two well-attended sewing classes at which an L.C.C. teacher gives instruction. This centre serves a wide area, chiefly among the betterhoused mothers, who need, and can apply, the advice given. This is so often impossible in a crowded slum area. Fulford Street, the oldest Centre in the Borough, has 309 mothers on the register; one weekly session and a sewing class at which Health talks are a regular feature, given by the Superintendent. The Day Nursery serves a useful purpose in housing 20 babies from 8 a.m. to 6 p.m. daily. Convalescence. Children and mothers requiring change of air during convalescence have been assisted by the I.C.A.A. and the Association of Infant Welfare Societies. In the cases where the parents are in receipt of Parish relief, the grant for a sick child is stopped if the child is sent away, and widows in receipt of Parish relief cannot receive any "sick leave," or their pay is stopped and food only given to their dependents. This is a great hindrance to the work of preventing continued ill-health in the cases of mothers and young children. Preventive work is so closely connected with the social and economic conditions of the people that one is glad to note the improved nutrition of nursing mothers since the increased scale of poor law relief. An effort has been made to co-ordinate the efforts of all Maternity and Child Welfare workers in Bermondsey by quarterly meetings, which are held in the large hall at 98, Rotherhithe New Road, the idea being to promote discussion on important topics and to hear papers from other sources. The immediate need in this branch of Public Health Administration is to find some method of co-operation between Municipal and Voluntary workers, by which the trained Health Visitor can be freed for more home visiting and talks to mothers. The difficulty has been to find voluntary workers who will attend regularly and refrain from giving unqualified advice. In conclusion, I wish to thank the Medical Officer of Health for his help and encouragement in any efforts made to extend the scope of Maternity and Child Welfare work, and to express my appreciation of the way in which the staff of eight Health Visitors carry out their arduous and difficult tasks." S. CHURCHILL. Assistant Medical Officer. DENTAL TREATMENT. The following report was submitted to me by the Municipal Dental Officer. This speaks for itself, and I hope to make a longer comment next year on the work, which has been most successful in the Borough, mainly due to the enthusiasm of Mr. Grantley Smith, ably assisted by his staff. "I have the honour to submit the first Annual Report of the work carried out at the Dental Treatment Centre during 1921. This centre was open for treatment on April 11th, 1921. Prior to this date dental treatment was carried out at the Oxley Street Centre, the premises and equipment there being entirely unsuitable for any form of comprehensive work. On this date Mr. G. W. Clark, the dental mechanic, and Miss Helden, the dental nurse, commenced duty. Since there was only one qualified dental surgeon in private practice at one end of the Borough of Bermondsey, my instructions were to offer treatment to those who worked or resided in it. Included in these instructions are cases referred from the Municipal and Voluntary Maternity and Child Welfare Centres —the Tuberculosis Dispensary, the Bermondsey Medical Mission, and private medical practitioners. The patients treated in the Centre may be classified as follows: — (1) Children of pre-school age. (2) Children of school age, in need of urgent treatment, and referred by centres or other agencies. (3) Expectant and nursing mothers. (4) Women other than expectant and nursing mothers. (5) Men. (6) Tuberculosis cases. Again, the patients may be classified as: — (1) Those referred by centres. (2) Those who desire treatment on the advice and recommendation of past patients. This class predominates. Little precedent was obtainable for the organisation of such a centre as this. A scale of fees was suggested which was, of necessity, experimental at first. This scale bore a relation to the fees in vogue at the Oxley Street Centre, hospital and local charges, cost of material and overhead expenses. Eventually, for artificial work, a scale was evolved, which in maternity cases covered wages and material; and in other cases, wages, material and overhead charges. Some discontent is caused among the patients on comparing the fees. The nursing or expectant mother pays a fee according to one scale; but the patient who at the time of treatment is neither nursing nor expectant has to pay a fee approximately 75 per cent, more, although she may have a family which may be increased. For operative work, as there is little expenditure for material, the scale suggested bore a relation to the fees charged in hospitals and locally. While this scale is adhered to as far as possible, it is pointed out that cases arise in which one has to exercise one's discretion in estimating the fees to be charged. Every effort has been made to make the centre entirely self-supporting, and at the time of writing (July, 1922), as far as one may gather, practically is so. During the year 17 cases were reported as being unable to pay the full fee. Of this number 9 were treated after assessment by Committee. Table I. gives some indication of the condition of the teeth of the pre-school child. While only a small number were examined, the figures sufficiently indicate that a grave condition exists. Parents lightly consider the value of the temporary dentition, and difficulty is experienced to induce them to bring their children to the centre. To cope with this problem dental inspection is essential, and to carry this out it is necessary that the children be congregated. Inspection by the dental officer has been tried in the Maternity and Child Welfare Centres, but this interferes with their normal routine. Dental inspection, accompanied by the necessary advice and information, in centre and home, by the Health Visitor equipped with a mouth mirror might accomplish much good. Incorrect dietary has much to do with the prevailing dental conditions. Children are not given a diet that either needs masticating or is detergent; and the use of the tooth brush is not frequent. In the adult, caries and gum inflammation exist in varying degrees. With the latter condition, one has observed that, in the younger patients, food debris has been allowed to remain around the gum edge, causing a slight congestion. In older patients the food debris is replaced by a deposition of tartar, with the gum edge in an inflammatory condition, and with slight, if any, pocket formation. These cases usually clear up with thorough scaling and excision of any pockets. Apparently there is an increase of caries during pregnancy, and this may be due to endocrine factors, but evidence tends to show that little, if any, dental care is exercised during this period. With regard to the results of dental treatment, Dr. D. M. Connan, Assistant M.O.H. and Assistant Tuberculosis Officer writes concerning tuberculosis cases: "One or two have undoubtedly shown immediate improvement, and in the majority of cases some general improvement has been noted. There can be no doubt whatever that a clean mouth is a very important asset in assisting the cure of pulmonary tuberculosis, especially as indigestion, which is fostered by disease of the gums and teeth, is an early and very common symptom of tuberculosis. No case is sent to the sanatorium without a clean bill of health as far as the teeth and gums are concerned. The Dental Centre has been particularly valuable to the Dispensary because of the expedition with which dental treatment, necessary as a preliminary to Sanatorium, is carried out." Dr. C. E. Pratt, of the Bermondsey Medical Mission, writes: "With regard to the results...I can only say they are excellent. So many have been patients suffering from chronic indigestion due entirely to their dental condition, and, after this has been treated, report that they have not been so well for years. The cases of rheumatoid arthritis with pyorrhœa also show a vast improvement after a few weeks. In children, too, I have noticed that chronically enlarged tonsils tend to decrease in size after removal of septic teeth, and in some cases tonsillectomy has not been required after this has been done." In conclusion, sir, I desire to thank you for your help and advice in the many difficulties that have arisen. I am indebted to Drs. D. M. Connan and S. Churchill, Assistant Medical Officers of Health, who are responsible for general anaesthesia, and to the medical officers in charge of voluntary centres for their kindly co-operation. I am obliged to Messrs. H. W. Bush and A. Fair of your office staff, and to Mr. Love of the Accountancy Department, for their great help; and to Mr. G. W. Clark and Miss Helden, the dental mechanic and nurse." GRANTLEY SMITH, Municipal Dental Officer. TABLE I. Dental Inspection of the Pre-School Child. Average Number of Carious Teeth per Child of those Diseased. Number Inspected. Number of Children with Diseased Teeth. Age. 16 = 34 per cent. 2.9 47 2 years 3 years 21 14 = 66 per cent. 4.2 4 years 39 34 = 87 per cent. 6.3 27 26 = 96 per cent. 5 years 6 4.3 134 Total 90 = 67 per cent. TABLE II. Dental Treatment of Children. Number referred for Treatment. Number Treated. Number of Children treated by Appliances for Irregularities. Number of Administrations of Anæsthetics. Number of Fillings. Age. Number of Extractions. Local. 5 and under 90 82 General. over 5 37 35 127 117 75 67 Totals 33 5 511 TABLE III. Dental Treatment carried out during 1921. Number of Patients examined Number of Patients Treated Number of Extractions Number of Administrations of Anæsthetics Number of Repairs to Dentures Number of Root Treatments Number of Scalings Number of Dentures Fitted Number of Crowns Number of Fillings Number of Visits for Treatment Local General Maternity Cases 234 204 1047 120 151 91 35 29 108 17 24 Tuberculosis Cases 24 155 8 37 1 6 10 5 Other Cases* 249 234 80 52 24 84 13 2 1111 107 147 Totals including Children 310 58 198 2 680 579 2824 248 30 2183 368 88 *Including 38 men and 26 young girls. TUBERCULOSIS DISPENSARY. The following report on the working of the Dispensary has been given me by Dr. D). M. Connan, Assistant Tuberculosis Officer (Clinical). I consider that the Council did the right thing in making this dispensary a branch of the Public Health Department. There is no object in having an important infectious disease, like Tuberculosis, run by an outside authority, since all the problems for its reduction are problems for the Local Sanitary Authority, and can only be efficiently carried out when the work is part of the Public Health Department. Report on the Work of the Tuberculosis Dispensary for the Year 1921. "During the year under review two important changes have taken place affecting the working of the Dispensary. (1). On April 1st, 1921, the Dispensary, which had hitherto been under the control of a voluntary Committee, was taken over by the Borough Council, and all the members of the Dispensary Staff elected to transfer to the service of the Council. The Dispensary thus became a part of the Public Health Department of the Borough, and much closer co-operation with that department has resulted, and, in addition, the elimination of a considerable amount of overlapping. From the point of view of the Tuberculosis Officer the change has been beneficial, resulting in a wider outlook and a greater interest in the general public health work of the Borough. (2). At the end of April the responsibility for the provision of institutional treatment for Tuberculous insured persons passed from the London Insurance Committee to the London County Council, thus making the latter responsible for the institutional treatment of all cases of Tuberculosis, whether insured or otherwise, adult or children. So far as this Dispensary is concerned the change was effected quite easily, and the scheme appears to work satisfactorily. The following figures will give information as to the prevalence of Tuberculosis in the Borough, and of the work of the Dispensary:— Number of Primary Notifications 455 Number of Deaths 171 Death Rate per 1,000 per annum 1.41 Number of cases admitted to Sanatoria 224 Total number of attendances 10,643 Total number of examinations (including new cases, re-examinations, and contacts) 4,397 Total number of new patients 763 Nurses' Home visits 4,279 Doctors' Home Visits 435 Total number of contacts examined 658 Total number of reports to Public Authorities 1,069 Total number of letters to Doctors 759 One of the nurses has visited every notified case as soon as possible after notification. The home conditions have been investigated, and the risks of infection explained. Advice has been given as to the mode of life the patient should follow, and suggestions made with a view to preventing the infection of other members of the household. A record is kept of the conditions found, and of the number of contacts, and periodically the house is revisited. In the large majority of cases the suggestions are carried out, and it is only rarely that the nurses are met with indifference or hostility. Only two such cases have been met with during the year in this way. Some record of every known case of Tuberculosis in the Borough is kept at the Dispensary, and as far as possible every notified case is persuaded to attend the Dispensary for examination, and during the year 74 per cent, of notified cases did attend. The only other dispensaries in London which had a higher percentage of attendances being Stoke Newington and the City of London. Most of the remaining 26 per cent, comprise persons who were in institutions at the time of notification, and only one case is known to have refused to attend the Dispensary. The permanency or otherwise of the results achieved by Sanatorium treatment depend in large measure on the life lived by the patient after returning home, and this in turn depends largely on economic conditions beyond our control. It is of the highest importance that these persons should be encouraged and helped to regulate their lives in accordance with what they have been taught at the Sanatorium, and in this connection I think the work of the two nurses deserves favourable comment. Another most important function of the Dispensary is the examination of contacts. The number of contacts examined was 658; the proportion of contacts examined to each new case attending the Dispensary being 1.92. While this compares favourably with the results of other dispensaries in London, there is much room for improvement, and an endeavour has been made to increase the number of contacts examined. Mothers sometimes object to bringing their children for examination when there is nothing obviously wrong with them, and in other cases the objection sometimes raised is that the child has recently been examined by the School Medical Officer. The School Medical Officer is informed at once of the names and schools of all contacts, and I suggest that he might in turn inform the Tuberculosis Officer when he has examined any of these contacts, at the same time giving the result of his examination. Tuesday and Saturday mornings are reserved for the examination of school contacts, adult contacts being seen on Monday evening. Many children cannot get permission from school to attend on Tuesday, and it is proposed during this year to concentrate upon the examination of school contacts during the school holidays, and as far as possible examine school contacts every morning during that interval. The provision of institutional treatment except in Guardians' cases, is now entirely in the hands of the London County Council. So far as I know, the London County Council makes no provision whatever for the institutional treatment of female cases of advanced Tuberculosis, and very little provision is made for similar cases amongst non-insured males. Such cases must go to the Bermondsey and Rotherhithe Hospital, or stay at home and remain a very real danger to the other members of the household. Twenty such cases are known to be living at home in Bermondsey at present, and in one house of six rooms, three adults —all suffering from advanced Pulmonary Tuberculosis, with Tuberculosis bacilli in their sputum —are living with nine children and two other adults. These persons always object to going into "the infirmary," regarding that institution as a place from which they are never likely to return. Amicable relations have been preserved with the General Practitioners of the Borough, who send patients to the Dispensary in considerable numbers. In conclusion I wish to express my appreciation of the efficient way in which the Clerk and the Dispenser have worked throughout the year, and to thank the Medical Officer of Health for his kindly advice and help on numerous occasions." D. M. CONNAN, Assistant Tuberculosis Officer. TABLE I.—VITAL STATISTICS OF WHOLE DISTRICT DURING 1921 AND PREVIOUS YEARS. Year. 1 Population estimated to Middle of each Year. 2 Total Deaths in Public Institutions in the District. 9 Deaths of Non- Residents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Births. Total Deaths registered in the District. Net Deaths at all Ages belonging to the District. No. 3 Rate.* 4 Under 1 Year of Age. At all Ages. No. 5 Rate per 1,000 Births registered. 6 No. 12 Rate.* 13 No. 7 Rate.* 8 APPENDIX. 1911 125,840 3,842 30.5 497 130 1,782 14.2 515 22 560 2,320 18.4 125,388 3,799 1912 30.3 433 114 1,601 12.8 483 20 538 2,119 16.9 1913 124,739 3,842 30.8 505 131 1,730 13.9 529 21 534 2,243 17.9 1914 124,213 3,757 30.2 487 1,694 13.6 615 26 2,184 17.6 129 516 1915 123,665 3,482 2,053 2,514 29.6 537 154 17.5 654 38 542 21.4 3,361 1916 123,665 27.1 364 108 1,507 13.2 608 155 453 1,960 17.2 18.8 1917 119,983 2,613 21.7 329 125 1,807 840 186 411 2,032 18.8 1918 121,465 2,323 19.1 2,142 19.8 1,007 191 2,390 22.0 322 139 439 1,600 1919 124,239 2,637 20.4 212 80 12.8 709 165 313 1,748 14.1 1920 129,189 4,038 31.2 280 69 1,466 11.3 689 105 281 1,642 12.7 Averages for years 1911—1920 124,238.6 3,369 27.1 396 1,738 14.8 664 93 458 2,115 117 17.7 120,500 26.8 261 1921 3,231 80 1,313 10.8 657 51 394 1,656 13.7 *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 1921—Total population of all ages, 119,455. Do. Number of inhabited houses, 14,967. Do. Average number of persons per house, 8.41. I. Institutions within the District receiving sick and infirm persons from outside the District. No. of Deaths Bermondsey Infirmary 19 19 Deaths in River Thames, Surrey Commercial Docks, Wharves etc. 22 22 Street 3 Private Houses 5 Railway 1 Factory 1 Total 51 II. Institutions outside the District receiving sick and infirm persons from the District. Ambulances on way to Hospital 2 Banstead Mental Hospital 4 Brook Hospital 3 Brompton Hospital 1 Caterham Mental Hospital 8 Chest Hospital, Victoria Park 1 Cancer Hospital, Chelsea 1 Cottage Hospital, Charlton 1 Cane Hill Mental Hospital 4 Colney Hatch Mental Hospital 2 Colindale Hospital 5 County Mental Hospital 1 Convent Hospital for Children, Shoreditch 1 Consumption Hospital 1 Dollis Hill House Hospital 1 Dartford Heath Mental Hospital 19 Evelina Hospital 4 East London Hospital 2 Edmonton Epileptic Hospital 1 Guy's Hospital 110 Great Ormonde Street Hospital 2 Grove Hospital 5 Hanwell Mental Hospital 1 Horton Mental Hospital 2 High Wood 1 Infants' Hospital 1 Joyce Green Hospital 6 Ladywell Institution 39 London Hospital 4 Leavesden Mental Hospital 10 Long Grove Mental Hospital 6 Ministry of Pensions Hospital, Maghull 1 „ „ Brixton 1 „ „ Orpington 2 „ „ Ruskin Park 1 Miller Hospital 1 Middlesex County Tub. Hospital, Isleworth 2 Northern Hospital 1 North Western Hospital 1 Park Hospital 27 Peckham House Mental Hospital 1 Princess Mary's Hospital for Children 1 Private Houses 17 Queen Mary's Hospital 5 Railway 3 River Thames 4 Royal Hamadyad Seaman's Hospital, Cardiff 1 Royal Waterloo Hospital 3 St. Bartholomew's Hospital 2 St. Thomas's Hospital 5 St. Peter's House, Hampstead 1 South Devon Hospital 1 Street 1 South London Hospital 1 South Western Hospital 4 Seamen's Hospital 3 South Eastern Hospital 36 Southwark Hospital 5 Tooting Bec Mental Hospital 10 West Kent General Hospital 1 West London Hospital 1 Western Hospital 2 Total 394 III. Other Institutions, the Deaths in which have been distributed among the several localities in the District. No. of Deaths TABLE III.—ABBREVIATED TABLES OF CAUSES OF DEATH. Total under 1 mth. Total Deaths under 1 year. 1921. Total Deaths under 1 year. 1920. CAUSES OF DEATH. Under 1 week. 3-4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. 1-2 weeks. 2-3 weeks. All causes 97 58 69 47 35 306 337 {Certified 60 10 13 14 {Uncertified - - - - - - - - - - - Small-pox - - - - - - - - - - - Chicken-pox - - - - - - - - - - - 10 Measles - - - - - - - - - - Scarlet Fever 1 1 2 - - - - - - - - Whooping Cough 2 2 4 26 - - - - - - - 2 2 4 Diphtheria and Croup 4 - - - - - - - Erysipelas 1 1 1 - - - - - - - - Tuberculous Meningitis 1 1 2 7 - - - - - - - 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases 3 - - - - - - - - - - Meningitis (not Tuberculous) 4 2 6 9 - - - - - - - 41 Convulsions 2 1 3 1 1 5 6 - - - - Laryngitis - - - - - - - - - - - 1 1 3 3 3 19 Bronchitis 4 14 - - - 20 13 Pneumonia (all forms) 3 1 1 2 7 14 14 68 69 Diarrhœa 1 1 5 3 9 3 - - - - - 29 1 2 3 Enteritis - - - - - - - Gastritis - - - - - - - - - - - Syphilis 1 1 1 3 1 2 6 4 - - - Rickets 1 - - - - - - - - - - Injury at birth 7 7 7 6 - - - - - - - Atelectesis 3 1 4 4 8 - - - - - - Congenital Malformations 3 1 2 6 1 1 8 14 - - - Premature birth 36 3 1 6 46 3 1 2 52 39 - Atrophy, Debility and Marasmus 2 3 10 6 1 52 45 5 20 15 - Other Causes 1 4 3 1 9 6 23 10 11 59 33 Totals 60 10 13 14 97 58 69 47 35 306 337 Nett births in the year —Legitimate, 3,231; Illegitimate, 52. TABLE IV.— CAUSES OF, AND AGES AT DEATHS, DURING THE YEAR 1921. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. 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. Under 1. All Causes {Certified 1656 306 92 79 90 87 192 389 421 {Uncertified - - - - - - - - - Enteric Fever - - - - - - 3 2 1 Small Pox - - - - - - - - 42 - Measles 3 - 2 1 - - - - - Scarlet Fever 18 2 5 7 4 - - - - Whooping Cough 14 4 6 3 - - - — 1 Diphtheria and Croup 69 4 9 29 27 - - - - Influenza 21 2 1 - 1 3 8 6 - Erysipelas 1 1 1 1 3 - 6 - - 1 2 - 10 33 56 38 10 Phthisis (Pulmonary Tuberculosis) 149 Tuberculous Meningitis 11 2 2 3 3 1 - - - Other Tuberculous Diseases 11 1 2 4 2 1 1 - - Cancer, Malignant Disease 155 - - - 2 11 86 55 1 Rheumatic Fever 8 1 - 5 2 - - - - Meningitis 8 6 1 - - 1 - - - 26 50 Organic Heart Disease 148 - - 5 7 60 - 140 4 1 2 2 14 12 36 69 Bronchitis Pneumonia 190 28 15 3 4 23 33 26 58 Other Diseases of Respiratory Organs 3 - 13 - 1 - 1 3 5 Diarrhœa and Enteritis under 2 years - - - - 60 12 - - 72 11 60 5 3 1 - 2 Appendicitis and Typhlitis - - Cirrhosis of Liver 4 - - 1 - - - - 3 Alcoholism - - - - - 1 1 - - Nephritis and Bright's Disease 41 - 1 - - 1 8 19 12 Puerperal Fever - - 3 - - 3 - - - Other Accidents and Diseases of Pregnaney and Parturition 3 - 1 - - 43 - - - 2 Congenital Debility and Malformation, including Premature Birth 114 - - - - - - 114 - Violent Deaths, excluding Suicide 7 7 5 6 8 44 4 5 2 12 - 7 Suicide - - - - 5 - 10 15 20 97 168 Other Defined Diseases 388 34 14 30 - - - - - - Diseases ill-defined or unknown 1 1 - All Causes 1,656 92 192 421 306 79 90 87 TABLE V. —CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1921. TABLE VI.—FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK Home Work. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Notices served on Occupier as to keeping or sending lists. (8) Instances. (11) Instances. (14) Prosecutions. Notices served. (12) Prosecutions. (13) Order made (S. 110) (15) Prosecutions (Sections 109,110). (16) Sending once in the year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Outworkers. Lists. (5) Outworkers. Contractors. (6) Workmen. (7) Workmen. (4) 388 3 - 13 21 - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45 - - - - - Table VII.—Deaths from Zymotic Diseases, 1921. Year. Principal Zymotic Diseases. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Pyrexia (origin uncertain). All Causes. Diarrhœa. Typhus Fever. Smallpox. Measles. No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate NO. Rate No. Ra te No. Rate 1911 2320 18.4 352 2.79 - - 51 .41 6 .05 15 .12 48 .38 - - 6 .05 - - 226 1.80 1912 2119 1.21 - .06 17 .29 1 5 .04 16.9 252 - 101 .81 8 .14 36 .00 - - 84 .67 2243 5 1913 .04 16 .38 - .02 17.9 320 2.56 - 88 .70 .13 47 - 2 - - 162 1.30 - 1914 2184 - 79 9 17 .11 - - 141 1.14 17.6 262 2.11 .64 .07 .14 14 - 2 .02 - - 2514 21.4 110 .07 1915 367 3.13 - - .93 9 20 .17 79 .67 - 3 .03 - - 146 1.24 - .04 61 1916 1960 17.2 1.36 - - 5 29 .25 16 .14 - 2 .01 - - 155 42 .36 .53 2032 .01 - 1917 18.8 218 72 .66 1 18 32 .29 - - 6 .05 - - 89 .82 2.02 - - .16 2390 1918 2.11 - .66 3 .03 23 .21 - - 48 22.0 229 - 71 84 .78 - - - .44 - 1748 113 - - 5 .04 4 .03 - .02 - 1919 14.1 .91 .14 21 .17 3 - 62 .49 18 - 1.26 .06 41 .32 33 1920 1642 12.7 163 - 56 .44 7 25 .19 - - 1 .01 .26 - - - Average for years 1911-1920 243 5 20 68 .57 2115 17.7 - .04 40 3 - .86 - .03 - 19.4 .17 .34 - - 105 1656 18 1921 197 1.63 3 3 - 87 Table VIII.—Prosecutions in Connection with Samples Taken during 1921. No. Sample. Adulteration or Infringement. Remarks. 441H Deficient in acetic acid 35.5 per cent. Vinegar Not served. False name and address given. 581s Milk Added water 7 per cent. Withdrawn on account of milk being partly frozen on delivery. 592s Vinegar Deficient in acetic acid 5.5 per cent. Ordered to pay costs, 17/6 Deficient in acetic acid 8.5 per cent. 590s Vinegar Ordered to pay costs, 17/6 67H Butter Ordered to pay costs, 17/6 1.22 per cent, water and 14 grains per lb. basic acid in excess 86H Margarine Wrapper Ordered to pay costs, 17/6 115H Milk 8 per cent, added water Ordered to pay costs, £2 2s. 96H Vinegar Deficient in acetic acid 14.5 per cent. Ordered to pay costs, 17/6 Unable to serve Summons. Defendant in Ireland. 132s Butter 0.8 per cent. water in excess 0.9 per cent, water in excess 140s Butter Do. do. 134s 131s 130s 139s 138s 192H 174s 241H 270s 304h 390H 416h 445H 431s Butter 0.9 per cent, water in excess Do. do. Butter 0.9 per cent, water in excess Do. do. Butter 0.9 per cent, water in excess Do. do. Butter Do. do. 0.82 per cent, water in excess Butter Do. do. 1.0 per cent, water in excess Ordered to pay costs, 17/6 Butter 2.5 per cent. water in excess Milk Deficient in fat 9 per cent. Ordered to pay costs, 17/6 Vinegar Deficient in acetic acid 12 per cent. Ordered to pay costs, 17/6 Milk Deficient in fat 10 per cent. Dismissed. Warranty proved. Ordered to pay costs, 17/6 Shredded Suet ... ... ... ... ... ... Dismissed. Warranty proved. Butter 4.8 per cent. water in excess Milk Deficient in milk fat 4.7 per cent. Dismissed. Warranty proved. Milk Deficient in fat 20 per cent. Ordered to pay costs, 17/6 Vinegar Deficient in acetic acid 7.9 per cent. Ordered to pay costs, 17/6 Summary. £ s. d. Fines — Costs 11 14 6 £11 14 6 48 TABLE IX.—FOOD AND DRUGS. Articles submitted for Analysis. Number Genuine Number Adulterated. Percentage of Articles Adulterated. Total Samples Taken. Acid Drops 1 - 1 - Ambrosia 2 2 - - Arrowroot 1 1 - - Black Pudding 1 - 1 - - Brawn 1 1 - Butter 17 209 192 8.1 Cake Flour 2 2 - - Cakeoma 1 1 - - Camphorated Oil 1 1 - - Chocolate 1 1 - - Cocoa 30 30 - - 10 10 Coffee — - 1 Coffee, Camp 1 - - Coffee and Chicory 1 1 - - 1 1 Creman Powder - - Curry Powder 1 1 - - Custard Powder 2 2 - - 1 Desiccated Cokernut 1 - - Dripping 28 22 6 21.4 Egg Substitute 1 1 - - 1 1 Fish Paste - - 1 Frying Fat 1 - - Glaxo 5 5 - - 1 Glycerine - 1 - - Gravy Thick 1 1 - Lard - 69 69 - - Lard Substitute 1 1 - 2 Lemonade 2 - - 1 1 Lemonade Crystals - - Lemonade, Home-made 1 1 - - Lemonade Powder 2 2 - - Lemon Squash 2 2 - - Lemon Squash, Cloudy 1 1 - - Lime Juice Cordial 3 3 - - Linseed Meal 1 1 - - Liqueur Peppermint 1 1 - - Liquorice Powder Compound 1 1 - - - Liver Salts 1 1 - - Lung Syrup 1 1 - Margarine 107 107 - - Milk 453 424 29 6.4 Milk, Dried 1 1 - - 1 Milk, Skim 1 - - Milk, Butter 1 1 - - Mincemeat 4 4 - - 10 10 Mustard - - Mustard Compound - 3 3 - Pepper 31 31 - - Peppermint Cordial 1 1 - - Pea Flour 1 1 - - 49 TABLE IX.—FOOD AND DRUGS.—continued. Articles submitted for Analysis. Total Samples Taken. Number Adulterated. Percentage of Articles Adulterated. Number Genuine 1 1 Petit Pois - - Prepared Groats 1 1 - - Pure Dried Egg 1 1 - - 6 Rice 6 - - Salmon and Anchovy Paste 1 1 - - Self Raising Flour 2 - 2 - Sherbet 3 3 - - 12 7 5 41.7 Suet - Tapioca 5 5 - Tapioca, Flake 1 1 - - 1 1 Tapioca Seed - - Tea 1 1 - - Tomato Sauce 1 1 - - 1 1 - Veal and Ham - 1 Veal and Ham Galantine 1 - - Vi-Lactogen 2 2 - - 111 7 Vinegar 118 5.9 Vinegar Malt 34 34 - - Whisky 1 1 100.0 - Whisky, Scotch 2 - 100.0 2 Worcestershire Sauce 1 1 - - 1202 1134 67 5.6 Table XI. —Factories, Workshops, Laundries, Workplaces and Homework. Inspection. Premises. Factories (including Factory Laundries) Workshops (including Workshop Laundries) Workplaces (other than Outworkers' Premises) Total Number of Inspections. Written Notices. Prosecutions. 71 46 109 226 36 26 42 1 - - 104 1 Defects found. Number of Defects. Number of Prosecutions. Referred to H.M. Inspector. Particulars. Found. Remedied 32 Nuisances under the Public Health Acts— Want of Cleanliness 32 15 - Want of Ventilation 2 2 - - Overcrowding - - - - 1 1 Want of Drainage of Floors 1 - Other Nuisances 67 67 - - Sanitary Accommodation — Insufficient 4 - 4 1 4 4 - - Unsuitable or Defective - - - Not separate for Sexes - Offences under the Factory and Workshop Act — Illegal Occupation of Underground Bakehouse (s. 101) - - - - Breach of Special Sanitary Requirement for Bakehouses (ss. 97 to 100) - - - - - Other Offences - - - 110 1 Total 110 16 Table XII.—No. of Bakehouses in the Borough. Not in Use. In Use. Inspector. Underground. Above Ground. Underground. Above Ground 2 2 10 20 Mr. Scott 5 11 23 3 Mr. Hoskins 23 of these are Factory Bakehouses. Other Matters. Class. Number. 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 (s. 7) Notified by H.M. Inspectors 17 Reports (of action taken, sent to H.M. Inspectors) 17 Other ... Underground Bakehouses (s. 101)— Certificates granted during 1921 ... In use at end of 1921 ... 336 Workshops on the Register (s. 131) at the end of 1921 Workshop Bakehouses 64 400 Total Number of Workshops On Register 51 Unsound Food and Foreign Meat Regulations The following articles of food were dealt with under the above regulations during the period under report. Articles. Quantity Unsound. Disposed of for other purposes than Human Food. Destroyed. Removed for sorting under S.A. Exported. Weight. Quantity. Quantity. Weight. Weigh Quantity. Weight. Quantity. cwts. qrs. lbs. tons tons Cwts. lbs. lbs. qrs. tons cwts. tons 718 Tins qrs. cwts. lbs. Apricots 11 Cases 7 qrs. 2 0 76 8 2 5 1431 Cases Apples 392 Barrels 56 9 2 23 2008 Packages Bananas 31 Crates 3 1 3 10 Bacon & Hams 10 Sides 26 3 10 0 897 Boxes 27 Bales 42 11 2 2 Barley 17 2 0 Cauliflower 2 17 86 Casks 12 3 Cheese 75 Crates 5 3 5 12 1 84 Casks 10 3 1 24 Crates 1 15 1 12 Canned Goods, Various 88 Tins 205 2 Barrels 19 1 4 52 9284 Cases 101 19 2 24 47 Boxes 1 3 2 Coffee & Milk 4736 Cases 0 240 Tins 2 0 16 Dates 0 2 0 1047 Boxes Dried Fruit 26 28 Boxes 255 Bags 16 13 0 11 0 1 Bag 3 3819 Boxes 47 7 3 Eggs 6 Casks 0 0 43 Cases 4 0 1 17 0 10 10 Casks 28 Tins 1 2 5 0 0 326 Casks and Loose 74 18 0 0 Egg Yolk 7 7 0 2 Figs 12 Boxes 3 3 0 0 Fresh & Dried Fruit 60 P'kages 4699 Bags 6986 Tins 293 214 6 1 366 Cases 4 19 0 3 1706 Cases Flour 20 518 14 1 567 Bags 35 8 3 0 Fish, Canned 1491 Tins 6 13 3 Fresh & Frozen Meat 13 3 6 38 26 7 7 0 2 2 0 8 6 0 0 Canned Meat 8524 Tins 938 Cases 16 15 0 16 0 28 4 2 579 Cases Gherkens 1 Pipe 0 4 11 2 18 Casks Honey 2 24 4003 Tins Jam 6 16 0 18 9 Cases 21 Cases 1 0 3 Lemon Milk 8552 Cases 1 3 21 205 19 4 0 220 Tins Milk Powder 4 16 0 0 79 Boxes Macaroni 9 3 0 135 Bags Onions 620 Cases 166 0 3 0 168 P'kages Oranges 419 Cases 20 2 2 18 17 0 0 Offal Meat Peaches 16 Cases 74 Tins 9 0 2 2 0 16 Pears 11 Boxes 18 4 0 6 267 P'kages 2640 Tins 1 24 Peas, Tinned 2 19 6 Cases 16 16 0 0 228 Bags 1 0 Potatoes 186 Bags 26 4 Plums 7 20 18 Packages 0 Poultry 16 Packages 20 4 1 Peel in brine 15 0 9 2 Rabbits 5 2 18 541 Crates 14 Rice 130 Bags 8 0 0 0 16 Boxes Raisins 4 0 0 Sausage Casings 0 18 13 0 Syrup 20 6 Kegs 89 Kegs 2 7 2 9 0 16 Tomatoes 20784 Tins 3 18 59 8 258 Cases 18 0 0 Tea Vegetables, Preserved 4 Tins 1 10 1 1 Case 2 0 Walnuts 4 679 Wheat 13 3 11