BER 42 Metropolitan Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1923. BY R. KING BROWN, B.A., M.D., D.P.H., Medical Officer of Health. TABLE OF CONTENTS. VITAL STATISTICS— Page Population 8 Births 8 Marriages 9 Deaths 10 Infantile Mortality 11 Zymotic Diseases 11 Measles 12 Whooping Cough 12 Enteric Fever 12 Tubercular Diseases 12 Phthisis 12 NOTIFICATION OF INFECTIOUS DISEASE— Diphtheria 14 Scarlet Fever 14 Enteric Fever 15 Puerperal Fever 15 Ophthalmia Neonatorum 15 Cerebrospinal Meningitis 16 Polio-Myelitis 16 Bacteriological Laboratory 16 SANITARY ADMINISTRATION— Food Inspectors' Work 18 Preservatives in Foodstuffs 19 Unsound Food 20 Milk Premises 20 Slaughterhouses 21 Ice Cream Premises 21 Street Markets 21 Food and Drugs 22 Page General Sanitary Work 22 Smoke Nuisances 23 House and Trade Refuse 28 Offensive Trades 28 Disinfection 29 Cleansing of Persons Act, 1897 29 Proceedings during year 29 Mortuary 31 Work of District Inspectors 32 MATERNITY AND CHILD WELFARE— Lady Assistant Medical Officer's Report on Maternity and Child Welfare 33 Health Visitors 39 Municipal Lying-in Hostel 41 Fairby Grange Convalescent Home 45 Municipal Dental Officer's Report 53 TUBERCULOSIS— Clinical Tuberculosis Officer's Report 58 APPENDIX TABLES— Local Government Board Tables 62 Outworkers 66 Deaths from Zymotic Diseases 67 Prosecutions (Foods and Drugs) 68 Factories and Workshops 72 Bakehouses 73 Unsound Food and Foreign Meat Regulations 74 PUBLIC HEALTH DEPARTMENT. Public Health Committee, 1923. Chairman —Councillor STOKES. Alderman Broughton. Councillor Roll. „ Bustin. „ Rudland-Williams. „ Wallsgrove. „ Stephen. Councillor Dennett. „ Sullivan. „ Hatcher „ Vezey, J.P. „ Humphreys. Virgo. „ Lynch. „ Weightman. Ex-officio: Mrs. A. SALTER, J.P. Mayor of Bermondsey. Maternity and Child Welfare Committee, 1923. Chairman—Alderman BROUGHTON. Alderman Trott. Councillor Stokes. Councillor Clark. „ Thorpe. „ George. „ Kedward. Co-opted Members: „ Langley. „ Nix. Mrs. Bustin. „ Renwick. Mrs. Dennett. „ Rudland-Williams. Mrs. Epps. „ Stephen. Mrs. Gledhill. Ex-officio: Mrs. A. SALTER, J.P. Mayor of Bermondsey. Staff: Medical Officer of Health—R. KING BROWN, B.A., M.D., D.P.H. Clinical Tuberculosis Officer and Deputy Medical Officer of Health—Dr. D. M. Connan, M.B., D.P.H. Assistant Medical Officer for Maternity and Child Welfare— Dr. Mildred A. Thynne, M.B., D.P.H. Municipal Dental Surgeon —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. Wharves and Food Inspectors: Mr. G. A. Hoskins and Mr. G. L. Scott. Health Visitors: District. District. No. 6.—Miss Bache. No. 1.—Miss Mercer. No. 2.—Miss White. No. 6. —Mrs. Cottier. No. 3. —Miss Helden. No. 7.—Miss Carlton. No. 4.—Miss Child. No. 8. —Miss Wadds. Tuberculosis Nurses: Miss Pike and Miss Stevens. Dental Nurse—Miss Lambert. 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 ,, Miss Dutch, Clerk and Dispenser. Mr. A. Manning, M. & C. W. Clerk. Mr. H. E. Butcher, Junior Clerk Mr. W. C. Tapsfield, Jun. ,, Municipal Lying-in Hostel—Matron: Miss A. E. Sewell. Nurses—Miss Taylor, Miss Hughes, Miss Wells. PUBLIC HEALTH DEPARTMENT, TOWN HALL, SPA ROAD, S.E.16. 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-third Annual Report on the sanitary condition of the Borough of Bermondsey during the year 1923. The death-rate was 12.1 compared with 16.7 in 1922, and 13.7 in 1921. This is the lowest death-rate yet recorded in Bermondsey. The Infantile Mortality Rate was 76 compared with 102 the previous year, and is also the lowest infantile mortality on record in Bermondsey. This is very satisfactory, and shows that our efforts to improve the sanitary conditions of Bermondsey have not been wasted. The sections of the report are, as usual, divided into:— I.—Vital Statistics. ll.—Notification of Infectious Diseases. lll.—Sanitary Administration. IV. —Factories and Workshops. At the end of the Report will be found three Special Reports, one from Dr. D. M. Connan, the Deputy Medical Officer of Health, on Tuberculosis, one from Dr. Mildred A. Thynne, the Assistant Medical Officer for Maternity and Child Welfare, on Maternity and Child Welfare work, and one from Mr. Grantley Smith, the Municipal Dental Surgeon, on the Dental Work of the Borough. I wish once more to record that between the Chairmen and Members of the Public Health and Maternity and Child Welfare Committees and myself, there has been the usual cordial co-operation during the year under report. Of the technical staff, including the Medical Officers, Sanitary Inspectors and Health Visitors, I cannot speak too highly for their loyalty and help, and of the non-technical staff I should like to mention specially Mr. H. W. Bush, the Chief Clerk, under whose guidance the rest of the clerical staff have done excellent work. I might say that the large part of any success which we have had in this Department, has been due to the general efficiency of the staff, without which it would have been impossible for any Medical Officer of Health to attain the good results which have resulted in the reduction of the general mortality and infantile mortality, which are the best indication of an efficient health administration. If I might single out one person from these it is Dr. D. M. Connan, the Deputy Medical Officer of Health, who had charge of the Department many months last year during my illness, and who discharged his duties in a manner most satisfactory to the Committees, Council and myself. I am, Ladies and Gentlemen, Your obedient servant, R. KING BROWN. 1.—VITAL STATISTICS. Population. The population 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: — 1911. 1921. Estimated to June 30th, 1923. 125,903 119,452 121,700 The population of Bermondsey for 1923 has been estimated by the Registrar-General as 121,700, 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 29th, 1923, was 2,912, consisting of 1,522 males and 1,390 females. This is 333 below the average for the last 10 years, and 255 below the figure for 1922. The birth rate for 1923 was 23·9 per thousand persons living, which is 2·2 below that for 1922 and 2·4 below the average for the last 10 years. The birth rate is unusually low for Bermondsey, but the same may be said of the death rate, and substracting the latter from the former, leaves us with a net increase of population of 11.8. The decrease in the birth rate is probably due to the Birth Control Propaganda, which began many years ago in the upper and middle classes, and has only begun to filter down to the working classes during the last few years. The question crops up every now and then whether we should undertake propaganda in "Birth Control." The answer that I have always given is that it is not part of the duty of the Sanitary Authority. The furthest that Public Health Officials are entitled to go is to direct those who are anxious for information to the proper place whether they can obtain it. There is no doubt from a scientific point of view that, if a woman has a number of births following too close upon one another, injury to the germ plasm takes place, as was explained in a recent lecture by Professor MacBride, and results in a deterioration of the offspring, occasionaly amounting to actual deformity; and another curious fact is that defects due to injury to the germ plasm are likely to be transmitted to the next generation. Professor MacBride, therefore, insists that births in a family should be spaced out, so that sufficient interval for the complete recovery of the mother would be left between each birth, and this of course, could only be done by a certain amount of birth control. Marriages. The total number of marriages in the Borough in 1923 was 1056, being 48 above the number for 1922, and 164 below the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 17.34 per 1,000 of the population, compared with a marriage rate last year of 16.64 of the population, 121,100. Year. No. Rate. 1,203 19·21 1913 1914 1,236 19·90 1915 1,714 28·12 1916 1,215 19·65 1,015 16·92 1917 1,106 18·21 1918 19·19 1919 1,242 1,383 21·40 1920 17·99 1,084 1921 16·64 1,008 1922 Average for years 1913 — 1922 1,220 19·72 17·34 1,056 1923 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, 1923, was 1,192, which is 380 less than in 1922 and 496 below the average for the last ten 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 1,480. This is 545 less than in 1922, and 559 less than the average for the last 10 years. The death rate for the Borough in 1923 was 12.1 per thousand living inhabitants, being 4.6 below that recorded in 1922, and 5.1 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 42 such deaths in all, against 43 in 1922 and 51 in 1921. 9 such deaths occurred in the infirmary; 27 in the River Thames and the Surrey Commercial Docks, 1 in the street, 1 in a factory, 2 in private houses, 1 on a ship in the river, and 1 on a wharf. 288 persons belonging to this Borough died in outlying institutions, against 496 in 1922, and 394 in 1921. 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. The low death rate is very satisfactory, as it is the lowest death rate which has ever been recorded in Bermondsey. It is mainly due to the very low infantile mortality, which has also reached the lowest point on record. This in its turn is low on account of the small number of deaths from summer diarrhoea. This used to be the great scourge of infant life, and there is very little doubt that this has been reduced largely by the increased care on the part of mothers for their young offspring. Where a poor mother has got a large family, with very little interval between the births, it is quite impossible for her to give the individual attention which can be given to a small family, and that itself is sufficient to account for the reduction. Another fact which accounts for the low infantile mortality is the absence of any epidemic in measles or whooping cough. Infantile Mortality. The figure for this is 76 deaths under one year to every 1,000 births. Table A.—Infantile Mortality. Year. Whole Borough. London. No. of Deaths. Rate per 1,000 Births. No. of Deaths. Rate per 1,000 Births. 131 11,869 105 1913 505 487 537 129 11,395 104 1914 11,369 1915 154 104 8,819 1916 364 108 88 8,273 103 1917 335 125 7,965 107 1918 322 139 99 7,039 85 1919 262 1920 337 83 75 - 306 95 80 1921 - 324 102 - 1922 - - Average for years 1913 — 1922 - 377 116 - 1923 220 76 - DEATHS FROM ZYMOTIC DISEASES. There has been a decrease in the deaths from these diseases, the figures being 125 against 292 in the previous year, and 231 the average for the last 10 years. This gives a zymotic deathrate of 1.02. Measles There were 13 deaths due to this disease, which is below the average for the last 10 years, and 88 below the number for 1922. Whooping Cough. 12 deaths were due to this cause, against 65 in 1922. Enteric Fever. 2 deaths were due to this cause. There was 1 death in 1922. Tubercular Diseases. The number of deaths from all forms of tubercular disease in 1923 was 175, against 206 in 1922. Phthisis. In Table B will be found particulars of deaths from phthisis since the year 1913. There were 144 deaths due to this cause, which is 25 less than the number recorded in the previous year. Table B. —Phthisis. St.Olave. Whole Borough. London. Sub. District. Bermondsey. Rotherhithe. Year. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. 12 1913 125 1·53 64 1·42 201 1·61 5981 1·30 1·86 2·53 1·63 1914 136 1·66 46 1·35 21 203 6281 1·39 2·42 6782 1·54 1915 156 1·76 57 1·77 20 233 1·97 1·61 6288 1·70 184 1·45 1916 126 44 1·38 14 1·78 6658 1·75 1·88 198 1·83 1·57 1917 123 61 2·02 14 169 1·78 1·66 1·42 1·20 1·56 7048 1918 117 43 9 5332 104 1·66 1·39 174 1·40 1919 1·28 58 12 - 1·06 - 81 0·96 46 1·27 10 14 112 137 - - 1920 106 163 1·35 43 - 1921 - - - - 169 1·39 1922 119 - 43 - 7 - - - Averages for years 1913 1922 119 - 50 - 183 1·54 - 13 - 144 12 - 1·18 - - 1923 95 - 35 - 12 II.—NOTIFICATION OF INFECTIOUS DISEASE. In Table V. of Appendix will be found particulars of infectious diseases notified during the year under report. There has been a notable falling in these since last year. During the War Bermondsey was particularly free from infectious diseases of all sorts, but during the year 1920 we had a tremendous epidemic of Scarlet Fever. In November, 1921, the cases of diphtheria became more numerous than the cases of scarlet fever, and they have remained so ever since. A fall in both these diseases commenced in February, 1923, and has been maintained up to the time of writing. It is very difficult to explain either the prevalence of these diseases, or why the number of cases of diphtheria (586) should be greater than the number of cases of scarlet fever (323), but we know that all infectious diseases tend to occur in periodical epidemics of longer or shorter intervals, due partly to an accumulation of susceptible material, or from unknown causes, such as the increase in the virulence of the poison producing them. In other cases the explanation may be found in an increase of decrease of household pests, such as lice and fleas. Lice we know cause typhus fever, and Sir William Hamer of the London County Council, thinks that the flea may account for the prevalence of scarlet fever. If casual observations have any value, the frequent one which I have heard during the last year on the remarkable reduction in the number of fleas, suggests a possible factor in the reduction of the prevalence of scarlet fever. The number of cases of infectious diseases notified, exclusive of notifications of tuberculosis, which numbered 461, was 959 compared with 2,077 in 1922 and 2,045 in 1921. The attack rate per thousand inhabitants was 7.88 against 17.15 in 1922. 48 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 586 eases of diphtheria notified in 1923 as against 1,110 cases in 1922. The attack rate per thousand inhabitants was 4.81, against 9.16 in 1922. The case mortality was 5.6 per cent., against 8.1 per cent, in 1922, and 9.3 per cent, in 1921. 32 cases were returned as not suffering from this disease. The case mortality here is low, and would be lower still were it possible to get the cases sent into hospital a little earlier, but unfortunately young children do not always complain of their throats until the disease is fairly advanced. Small Pox. There were no cases notified during 1923. Scarlet Fever. The notifications of scarlet fever in 1923 were 323, against 652 in 1922. This is a decrease of 329. The distribution of the disease in the various Wards, as shown in Table V. of Appendix, was fairly uniform. 16 cases were returned from hospital as not suffering from scarlet fever. There were three deaths, which gives the very low case mortality of .92 per cent., against 1.7 per cent, in 1922. The disease, as in recent years, was of a very mild type. The attack rate per thousand inhabitants was 2.65 against 5.37 in 1922. The case mortality here is extremely low, for the type during the last few years has been very mild. It is one of the peculiarities of scarlet fever that while the prevalence may be very great the mortality may be very low or vice versa. Enteric Fever. 2 cases of enteric fever were notified, being 1 for Bermondsey, and 1 for Rotherhithe. The total number of cases notified in the previous year was 4. Puerperal Fever. 4 cases of puerperal fever were notified. Death resulted in 2 cases. Opthalmia Neonatorum. There were 18 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. Cases. Vision Unimpaired. Vision Impaired. Total Blindness Notified. Treated. Deaths. At Home In Hospital 3 18 6 12 13 2 - Unfortunately there have been 18 cases, but in only 5 cases was the vision impaired, and in two of these it amounted to total blindness. There is apparently no need for any impairment of vision whatever if people would only realise the seriousness of the complaint, and have the patient treated on the first symptoms, and keep her under treatment until complete recovry. A weak solution of Nitrate of Silver put into the eyes of every child at birth, is said to be the best prophylactic, and it is to be hoped that this will be adopted universally by the medical profession and the midwives. Cerebrospinal Meningitis. 3 cases were notified in 1923, Polio-Myelitis 2 cases were notified in 1923. Bacteriological Laboratory. The total number of specimens examined in 1923 was 3,532 as compared with 3,977 in 1922, and 3,284 in 1921. Table C. Nature of Specimen. Total Examinations. Results of Examination. Positive. Negative 1922 1923 1922 1923 1922 1923 Diphtheria (specimens taken by Medical Officer of Health) 1,141 42 1,698 78 1,620 1,099 Ditto (taken by general practitioners) 159 1,092 862 65 933 797 2,790 237 107 Diphthria (total specimens taken) 2,003 2,553 1.896 Phthisis 1,174 1,509 179 198 995 1,311 Various 13 20 7 - 6 20 3,532 423 3,554 3,977 305 3,227 Contacts. We still keep very busy in the laboratory as the above table shows. There was a fall of 500 in the number of school contacts examined, and out of a total of 1,141, 42 were positive. These children came up for re-examination in a week and were not allowed to return to school until the examination proved negative. It has frequently been questioned by School Medical Officers and others, whether these contacts ever give rise to cases, and I am afraid that our experience in Bermondsey does not furnish any answer to this question. There is one thing, however, which can be said and that is that, among the positive cases, we discovered a few who presented the symptoms of diphtheria, and were notified in the usual way. The majority, however, were simply "carriers," and although they had the bacilli in their throats, could not be said to be suffering from the disease. During the year the bacilli in these "carriers" were examined as to virulence, and we discovered that about 50 per cent. were virulent, and the curious part of it is that we have been unable to trace any other cases to these virulent "carriers." From all this the question arises as to whether it is worth the trouble examining all these children, and whether we would not get equally good results by simply excluding them from school for a fortnight. It is very difficult to say, and one is inclined to answer the question in a similar manner to the question as to whether disinfection is any use. We do not know how, in a great many of these infectious diseases, the organisms are transmitted from one patient to another, but we know that articles which have been in close contact with the patient can become infected, and pass on infection for a short time after contact with the patient, but we are in entire ignorance as to how long the clothes, etc., retain infection, and as regards these examinations and disinfection it seems better to continue both, until we are able to give a positive answer to the questions set forth above. Fish Curers. Food Stores. Markets. Restaurants. Nuisances Found. Intimations Served. Nuwber of Samples taken. Various. Food Factories. Jam. Butter and Margarine. Other. Food and Drugs. Food Wharves and Depots. Unsound Food Regulations. Destruction of Food. 220 13 1104 1690 23 - - 112 - - 105 241 4 - 301 23 399 47 25 305 26 6 5 2269 123 15 108 6 521 23 504 60 1227 3959 48 15 546 26 6 220 5 10 Preservatives in Foodstuffs. The Committee referred to me a very important communication on Food Preservatives by the Medical Officer of Health to the Metropolitan Borough of Paddington. The report is an extremely useful one, and among other things points out the very widespread use of preservatives in foodstuffs. In addition to dairy produce, he says that boric acid is found in sausages, potted meats, bacon and brawn; salicylic acid in jams and temperance drinks, sulphites in temperance drinks, and occasionally formalin in the same drinks. He adds also the following paragraph:- "The proportions of added preservatives were found to range widely. In the case of sausages, potted meats and brawn, the amount of boron preservative (calculated as boric acid) ranged from 15 to 66 grains per lb., and in bacon from 8.6 to 46. Salicylic acid was found in jams in amounts varying from 1.7 to 8.5 grains per lb., in temperance drinks from 1.5 to 19 grains per pint. Sulphites in lime juice, ginger wine, etc., ranged from 0.1 to 4.5 grains (SO2) per pint. The proportions of formalin found could not be stated with any accuracy." When the question of boric acid in cream was raised by the Borough of Kensington last autumn, I reported to the Committee the very unsatisfactory state of the question of preservatives generally in food, and I recommended at that time that a Committee be re-appointed to investigate the question, and bring the report of the Departmental Committee of Food Preservatives, issued in 1901, up to date, and that the Ministry of Health be asked to initiate legislation on the lines recommended by the Committee. In the present report the whole question has been raised afresh by Dr. Dudfield, and there is no question that it is time that the use of chemical preservatives, if necessary at all, should be under strict regulation. In cold storage and in suitable cool storage we have ample means of preserving food not only in transit but in all stages until it reaches the consumers' hands, and it seems to me that we might follow the example of many countries which prohibit the use of preservatives altogether, or which have regulations strictly limiting their use. In this respect Great Britain seems to be behind most of the other States, the result being that we are the dumping ground for preserved foods of every description to the detriment of the national health. As pointed out by Dr. Dudfield, the Minister of Health has power under Section 1 of the Public Health (Regulations as to Food) Act, 1907, to make regulations prohibiting or limiting the use of preservatives, and I strongly support his recommendation that this report be forwarded to the Minister of Health, pressing him to exercise the powers conferred upon him by this Section. 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 - 14 — 26 Canned 2 12 3 6 Fish— Fresh 1 15 3 21 Canned — 19 1 27 Fruit— Fresh 25 8 1 15 Canned 5 18 1 14 Dairy Produce— Cheese — 9 3 19 Condensed Milk — 3 1 15 Eggs - 15 - - Lard - - - 6 Various— Various Canned Goods 1 17 1 — I 40 14 3 9 Milk Premises. Milk and Dairies (Amendment) Act, 1922. 200 milksellers were registered under the above Act during 1923 and 10 names were removed from the Register, making a total of 190 milksellers on the Register at the end of the year under report. Milk ( Special Designations) Order, 1923. Dealer's Licences granted during 1923 to:— Mr. Watkin Davies, of 157, St. James' Road, S.E.16. Mr. Jenkin Morgan Evans, of 37, Plough Road, S.E.16. to sell "Certified" Milk. Supplementary Licenses granted during 1923 to:— Messrs. Higgs & Sons, Ltd., of 2-6, Canterbury Road, S.W.9, to sell in this Borough "Certified" Milk from their premises at: — 1/3, New Street, Kennington. 62, Borough High Street. 553, Old Kent Road. 22, Credon Road. Slaughterhouses. There are now no slaughterhouses in the Borough. Ice Cream Premises. There were 131 premises where ice cream is manufactured on the Register at the end of 1922. 20 were added and 25 removed during the year under report, making a total of 126; 109 inspections were made. Street Markets. The following report was made to the Public Health Committee on the 30th January, 1923, and adopted by the Council: — "My attention has been drawn by one of the Inspectors who has been examining the street markets recently, to the difficulty stallholders have of getting rid of unsound food, especially fruit and vegetables, which accumulate as a result of sorting their purchases from Covent Garden. The rejected food is generally stacked in odd boxes which are sometimes placed underneath the stalls, and sometimes on the stalls close to the sound articles. He also noticed in many cases, that these boxes of waste materials did not seem to increase much in size as the day went on, and it appeared quite possible that some of the unsound articles of fruit and vegetables could be "worked off" in small quantities on purchasers, especially those who do their marketing late at night. He therefore suggested, as an experiment, that the Committee should give instructions for a small handcart to visit the markets once or twice during the market days and collect the rejected fruit and vegetables, and that strict injunctions should be given to all stallholders to provide a suitable receptacle for putting waste material into, and that these should be kept as far as possible away from the articles which they are selling. It will require the engagement of a man on a couple of days in the week to take the handcart round, and if the experiment proves successful the work could be extended, or given up if the contrary proves to be the case. I, therefore, recommend that the Committee give instructions for this to be carried out for a period of six months, at the end of which time I will again report on the matter." The work was found to be so successful that the Council has now decided to collect this unsound food permanently. FOOD AND DRUGS. In Table IX of Appendix will be found a list of the samples taken in 1923, and the action taken. 1,206 samples were taken, compared with 1,202 in 1922, and 1,201 in 1921. Of these 3.3 per cent. were found adulterated, compared with 2.9 per cent. in the previous year, and 5.6 per cent. in 1921. GENERAL SANITARY WORK. Inspections. In Tables F and G (pages 29 and 32) will be found particulars of the general sanitary work by the District Inspectors during 1923. The house-to-house inspections numbered 4,319. This is 365 above the total for the previous year. 5,221 intimation notices were served, compared with 5,412 in the previous year. Smoke Nuisances. 35 observations were kept on chimneys and 4 notices served. The following is a report submitted to the Committee on April 24th, 1923: — "In a letter to this Council on the 8th March last the County Council informed us that the Public Control Committee have under consideration the question of atmospheric pollution and fog prevention, and in connection therewith, they had before them the report of the Departmental Committee on Smoke and Noxious Vapours Abatement, issued on the 6th December, 1921. They enclosed a Summary of Recommendations of this report, and drew special attention to No. 4. The following are the recommendations: — (a) With regard to industrial smoke. 1. That the Minister of Health should be given clearly defined power to compel or act in place of any defaulting authority which refuses to perform its duty in administering the law with regard to smoke. 2. That the general legal obligation on all manufacturers, users and occupiers of any business premises or processes, engines or plant of any description whatever should be to use the best practicable means, having regard to all the circumstances of the case, for avoiding the pollution of the air by smoke, grit or any other noxious emissions; that the same law should also apply to all Government establishments and all rail and road locomotives and motor cars of whatever weight or type, and to steamers on rivers, estuaries and lakes. It must be clearly understood that questions of cost must be taken into account in determining what is practicable. 3. That the Minister of Health should be empowered to fix standards from time to time, and in any case in which the emission exceeds the standard so fixed, the onus of proof that the manufacturer is using the best practicable means should be on the manufacturer. 4. That the duty of enforcing the law with regard to pollution of the air by smoke should be transferred from the local sanitary authorities in whose jurisdiction it now rests to the county authorities, i.e., the Councils of counties and county boroughs; minor authorities should still have power to take proceedings if they so desire. 5. That the Minister of Health should be empowered to constitute joint committees consisting of two or more councils in cases where it appears to him that this course would lead to the better administration of the law with regard to smoke in any given area. 6. That the Minister of Health should assign to one or more competent officers the duty of advising and assisting local authorities and manufacturers with regard to difficult smoke problems; these officers should report annually on the steps which are being taken and the progress which has been made in the suppression of avoidable smoke. 7. That the law should enable much larger fines to be imposed than at present. 8. That legislation should be introduced at an early date with a view to consolidating in one measure the various existing statutory provisions with regard to the pollution of the air by smoke, and providing for their amendment where necessary to give effect to the above recommendations. (b) With regard to domestic smoke 9. That the Central Housing Authority should decline to sanction any housing scheme submitted by a local authority or public utility society unless specific provision is made in the plans for the adoption of smokeless methods for supplying the required heat as suggested in our (i.e., the Departmental Committee's) interim report. The only exception to this rule should be when the Central Authority are fully satisfied that the adoption of such methods is impracticable. 10. That the Government should encourage the coordination and extension of research into domestic heating generally. This is a matter of great importance in view of the many outstanding problems which demand inquiry. 11. That local authorities should be empowered to make bye-laws requiring the provision of smokeless heating arrangements in new buildings other than private dwellinghouses, such, for example, as hotels, clubs, offices and the like. (c) General. 12. That gas and electricity undertakers should be given every facility and encouragement to increase and cheapen the supply of gas and electricity, and that the practice at present followed by some municipal authorities of over-charging for gas and electricity in order to allocate the profits thus accruing to the relief of the rates should be discontinued. (d) With regard to noxious vapours. 13. That the Alkali, etc., Works Regulation Act, 1906, should be amended so as to apply generally to all manufactures from which noxious vapours might come. 14. That a list of such noxious vapours should be included in the Act, and the Minister of Health should be empowered to add to this list from time to time other noxious vapours, after due inquiry. 15. That a general obligation should be placed on every manufacturer of using the best practicable means for preventing the escape of noxious or offensive vapours, 16. That the present system of registration should be continued, and the Minister of Health should be empowered to require the registration of classes of works not at present required to be registered. 17. That the Minister of Health should be empowered to fix standards from time to time after due public inquiry with regard to noxious vapours in cases where he finds it desirable; and these standards should have the same legal force as those which we recommend with regard to smoke." The pollution of the atmosphere by smoke in the large towns of Great Britain may be counted as one of the most urgent problems in public health. As our population becomes increasingly urbanised the problem increases in importance. Respiratory diseases including pulmonary tuberculosis accounted for more deaths than any other group of diseases in 1914, i.e., 30 per cent. of the total deaths, and that these are greatly aggravated by the condition of the atmosphere is universally admitted. Here in London the death rate from these diseases mounts up during and immediately after a fog, so that there can be no question of a connection between the two. The problem is a very complicated one, especially as threefourths of the smoke is caused by domestic chimneys, and more than three-fourths of the damage. The reasons for the latter statement is than in industrial smoke the combustion being done in high temperature furnaces is more complete, and there is an absence of tar and acid products, whereas in domestic smoke which is caused by the combustion of ordinary coal at a low temperature, there is a very large proportion of tar and acids, which are the chief causes of the damage, not only to buildings but to people's lungs. It is thus evident that the stopping of industrial smoke, though it will help matters considerably, does not by any means solve the problem of the pollution of the atmosphere, since it leaves domestic smoke untouched. I do not think much good is going to be effected by the transference of the powers of the Sanitary Authorities for smoke abatement to the County Councils, since the reason of the failure of the Smoke Clauses in the Public Acts is not altogether due to unwillingness of Sanitary Authorities to enforce the law, but to the difficulties adherent in the present enactments. In order to abate smoke in the first place it must be "black," and that leaves too much room for interpretation. If the word "black" is omitted you must have some degree of smoke for which a manufacturer can be prosecuted, and this again leaves much room for individual opinion. I think, however, that there should be some alteration in the present law in the direction of defining the kind of smoke for which a manufacturer can be prosecuted, and also for increasing the penalties. I do not see any objection to County Councils having co-ordinate powers with us on the question of smoke abatement, for the more inspectors there are making smoke observations the more careful will manufacturers be not to allow smoke. As regards the more important question of domestic smoke, the problem is mainly an economic one. Until there is a cheap smokeless fuel, equal in efficiency and price to ordinary coal, placed on the market, there seems little chance of doing away completely with the domestic coal fire. Of late years there has been a great increase in the use of gas and electricity in London, and the improvement produced thereby is very noticeable in the diminution of the severe fogs which used to occur regularly about November some 25 years ago. There is no doubt that this points the way to reform in the matter of domestic smoke, and every endeavour should be made to encourage the use of gas and electricity for cooking and heating, and at the same time to discourage the use of raw coal for the same purpose. Experiments have shown that coal can be partly converted into coke by heating in retorts, utilising the by-products that are driven off and converting the residue into a coke briquet. This results in a smokeless fuel, but whether it can be produced on a sufficiently large commercial scale to supersede coal is very difficult to say. English people are wedded to the ordinary open fire, and for continuous burning it is undoubtedly the cheapest form of heating, but taking into consideration the work involved and cleaning grates, removing ashes, etc., it is not at all equal to gas. where heat is required for short periods only. Of all the other recommendations which are set out above the most important is No. 10 because until a plentiful supply of cheap smokeless fuel is discovered and put on the market in sufficient quantities to replace coal, I do not think there is the slightest chance of clearing the atmosphere completely. HOUSE AND TRADE REFUSE. The following table shows the amount of House and Trade Refuse disposed of during the year ended December, 1923:— Loads. Tons. Cwt. Qrs. House Refuse to Barge 12,890 21,749 11 3 „ „ various Shoots 388 640 4 0 Trade Refuse to Barge 1,599 1,455 4 2 „ „ various shoots 183 301 19 0 15,060 24,146 19 1 Totals 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 1,085 Pillows (cases) 1,473 Blankets 2,532 Quilts 1,249 Bolsters 720 Sheets 1,420 (cases) 218 Books 619 Carpets 2 Miscellaneous 3,661 Cushions 260 Verminous Clothing 358 Mattresses 409 Bedding 72 Overlays 645 Hair (bundles) Nil Pillows 2,140 „ (cases) Nil 12,961 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Number of rooms disinfected 1,993 Cleansing of Persons Act, 1897. During the year under report 19 male and 16 female adults used the Verminous Baths and had their clothing disinfected. The total number of articles disinfected for this purpose was 358. Table F. —Proceedings during 1923. Number ok Places. Number of Inspections, 1923 Number of Notices, 1923. Number of Prosecutions, 1923. On Register at end of 1922. Added in 1923. Removed in 1923. On Register at end of 1923. Premises. 312 ... ... Milk Premises ... 586 ... ... Cowsheds ... ... ... ... ... ... 1 ... Slaughter-houses ... ... ... ... ... 37 ... 13 ... Other offensive trade premises 13 ... ... ... 131 Ice-cream premises ... ... 109 ... .. ... Registered houses let in lodgings ... 223 223 446 ... ... ... Overcrowding, 1923— 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 80 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., 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 Acts, Sec. 202) (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (Bye-laws) Act, 1899) Mortuary— Total number of infectious bodies removed 5 Total number of bodies removed 88 Table G. Work of District Inspectors, 1923. Year 1923. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 17 18 19 20 22 23 25 21 24 1 16 House-to-House. Special Inspections. Infectious Diseases. Factories and Workshops Specially Inspected. Offensive Trades. Outworkers' Bi-Annual Inspection Chimneys Watched. Bakehouses. Fishmongers, Friers and Curers. Pood Stores. Fruiterers and Greengrocers. Markets. Milksellers. Restaurants and Eating Houses. Totals Underground Conveniences. Other Calls and Visits. Slaughterhouses. Ice Cream. Destruction of Food. Various. Number of Samples Taken. Complaints. Butchers. Drains Tested. Visits. Ints. Mr. Francksen 556 136 190 86 42 36 188 28 1990 16 25 19 110 35 5 46 73 74 5 22 3682 565 150 - - - „ Wood 567 120 111 238 3 16 6 28 2087 33 31 48 43 109 48 1? 208 122 41 3913 712 150 1041 41 4 - - 3381 4341 330 9 1 59 9 16 66 15 541 „ Merryman 114 138 - 48 2015 - 3 13 10 33 55 6 7 150 6 595 8 10 - 24 62 27 3879 756 143 391 166 21 08 2162 66 27 15 11 36 53 4 150 „ Toogood - - - - Freeman 607 65 329 107 40 12 28 21 2016 37 48 32 104 65 29 194 68 44 8 1 3850 715 150 - - „ Pitts 120 385 136 21 - 168 36 1815 - 31 31 13 109 26 4 285 57 3 29 44 3790 650 150 477 - - 548 203 12 139 39 40 43 15 2 6631 „ Davis 64 165 44 1919 2 33 189 42 100 100 56 3755 150 - - - 72 3718 „ Luke 535 101 300 143 58 117 147 1701 - 21 61 22 16-2 35 19 99 63 47 8 7 619 150 - - Total Inspections by District Inspectors for year 1923 863 263 219 621 4161 209 241 876 109 586 6 81 29968 15705 5221 1001 MATERNITY AND CHILD WELFARE The following report has been submitted by the Assistant Medical Officer for Maternity and Child Welfare: — I have the honour to submit the following report of the work of the Maternity and Child Welfare Department. The visits paid by the Health Visitors are set forth in Table H. The attendances at the Centres will be found in Table I. New Sessions:—If these tables be compared with those for 1922 it will be seen that the work has considerably increased during the year. The Ante-natal Clinic at 98, Rotherhithe New Road, which was formerly held fortnightly has been held weekly for the past nine months. At this clinic 211 cases were examined during the year. Out of the 141 delivered; 122 were normal successful deliveries: 19 being referred to hospital for treatment. There were no maternal deaths- among the 211 ante-natal cases. Two infants died during the first fortnight after birth. Closer co-operation between the midwives and the ante-natal clinic has been evinced during the year, the midwives often finding time to accompany their patients. At the request of the mothers a new sewing class was started at the Manor Chapel Centre in November. Changes in Staff. —Miss Sumner and Miss Taylor resigned during the year, to take up work of a different nature. Their vacancies have been very efficiently filled by Miss White and Miss Mercer. The Birth Rate for the year was 23.9. The Infantile Mortality per 1,000 births was 76. Of these deaths 19 per cent. were due to respiratory diseases, and 17 per cent. to diarrhoea and sickness. During last year a beginning was made of feeding young children, who were not breast-fed, on dried milk instead of liquid cows milk, but this for various reasons could not be continued. An enquiry has been made into the number of babies who are breast fed, and who continue to be so fed. The following figures give a general idea of the proportion of breast feeding to artificial feeding. Out of 2,471 babies of whom I have records, 2,362 were breast fed at 2 weeks; 35 were having feeds, and 74 were fed by bottle only. At 3 months of age 1,852 babies were still breast fed, and at 9 months 989 were at the breast. The last 2 figures, viz., for 3 months and 9 months are incomplete because many of these mothers attend the Voluntary Centres, some have removed, and some of the babies included in the first figure have died. Many mothers who would otherwise cease to breast feed their babies are encouraged and helped to do so by the Health Visitors, and at the Centres. Doubtful cases are given test feeds; the mother is thereby shown whether her baby is having sufficient, and is encouraged to persevere. The fact that a limited supply of breast milk complemented by cows milk is still new to some mothers, but is welcomed by them when explained. Rickets. —An enquiry has recently been made into the number and distribution of cases of rickets throughout the Borough. The following table gives these figures in detail: — District No. 1 32 (incomplete) „ „ 2 32 (incomplete) Cases of children under 5 years of age showing deformities due to rickets. „ „ 3 31 „ „ 4 18 „ „ 5 11 „ „ 6 23 „ „ 7 7 „ „ 8 7 Total 161 The table is interesting in that it shows that the high rate of rickets is in the districts where there are tall tenement buildings, namely, Districts 1, 2 and 3, which include all the high dwellings round about Tooley Street. The lack, and often the complete absence of sunlight from these dwellings is a very strong contributory factor to the incidence of rickets. Whereas in Districts 7 and 8, which border the River, and where sunlight and fresh air are obtainable, the figure is very low. We are much indebted to the Municipal Dental Surgeon for the amount of work which has been done for mothers and toddlers attending Centres. The educational work as regards the care of the teeth is uphill work, and much time and persuasion have to be used to induce mothers to face the terrors of the dental chair. Apart from this, economic conditions, in spite of the low rates charged, prevent many mothers from receiving treatment, but this does not apply to children under 5, whose treatment is free. During last year the total number of expectant and nursing mothers examined was 323, whereas only 268 were treated. Of toddlers 280 were examined and 158 treated. Thanks are due to Dr. Connan, Clinical Tuberculosis Officer, for the reports on cases referred to him for expert opinion. The Invalid Children's Aid Association and The Charity Organisation Society have again been instrumental in getting away children who could not be taken at Fairby Grange. During last Summer four lectures were arranged for the Health Workers of the Borough. They were given by distinguished lecturers, and it was unfortunate that there was not a better attendance at them. With Councillor Mrs. A. Salter, J.P. (then Mayor) in the chair, Professor Kenwood, C.M.G., gave a very interesting talk on "Some aspects of Maternity and Child Welfare Work," and helped us realise the ideals of the work we have to do. Ideals which often are veiled in official routine. With Dr. R. King Brown in the chair, Dr. Jewsbury, the Director of the Truby King Home, gave a helpful lecture on Breast feeding. He described the methods used at the home to re-establish lactation. Professor Louise Mcllroy, Director of the Obstetrical and Gynaecological Unit at the Royal Free Hospital, lectured on the preventive work possible in Midwifery, and the great importance of ante-natal clinics. With Dr. Connan in the chair, Dr. Woolsey Stocks, Medical Officer of Health of West Bromwich, discussed the work of Health Visitors, and pointed out that in Boroughs where consideration was given to the special nature of the work by carefully shortening their hours so as to obtain the maximum efficiency, the sickness rate was lowered and the general standard considerably improved. Voluntary Centres:— The following reports have been sent to me by the Voluntary Centres:— Salomon's Centre. Guy's Hospital. Ante-natal. New cases 1,170; Total attendances, 3,599. Post-natal. New cases, 148; Total attendances, 2,045. There is a special clinic held on Tuesday mornings for difficult cases of breast feeding, the success of which in establishing delayed lactation has shown excellent results with Primiparae, premature babies and post-operative mothers. Dental. —1 Session weekly. New Cases, 95; Total attendances, 169. Convalescent Home.— 16 mothers and babies have been sent for two weeks each to Hambleton, Surrey. Fulford Street. —Dr. Johnson is in attendance at all the Sessions. Ante-natal. 128 new cases. Post-natal. 175 new babies. Total attendances under 1 year 2,185. Over 1 year 808. Sewing Glass. Average attendance per class 9.7. Lectures. Three series of 12 lectures each given during the year on "How to keep well," "Adolescence," "Some Wonders of the Human Body." A Municipal Health Visitor assisted Miss Berry at the Post-natal Sessions. St. George's Hall . —Dr. Alice Hutchison is in attendance at all the Sessions. There is no ante-natal clinic, but 257 heme visits were made by Miss Bowden to expectant mothers and advice given. 99 children under 1 year are attending the Centre regularly and 162 over one year. 132 new cases were visited. A weekly sewing class is held with an average attendance of 11. In addition to the routine work, Miss Bowden, the Superintendent, has given a series of talks to adolescent girls. Great Central Hall.—Mothers on the register, 854. Attendances, 16,537. Home Visits, 1,781. Two sessions weekly are held and on an average six new babies are brought to each session. There are also two medical officers in attendance at each Session, Dr. Grace Pailthorpe and Dr. Cook. A Municipal Health Visitor assisted Miss Bear at each Centre, but the bulk of the work was carried out by voluntary workers who rendered willing service. In the present year, 1924, an enlargement of the programme of sessions has been arranged. Princess Club.— As before, the sessions are attended by Dr. Constance Stoker, Dr. Harry, and Dr. Rose Turner. Total Attendances. Average per session. Ante-Natal Clinics 661 14 Weighing days 8146 46 Sewing Classes 1797 24 190 19 Lectures The total number of babies attending the Club during the year was 748. New babies totalled 349. There were 1,552 visits paid. (Signed) Mildred A. Thynne. Assistant Medical Officer for Maternity and Child Welfare. Table H.— Health Visitors. The following Tables show the work done by the Health Visitors during the year 1923: — Births Notified. First Visits. Ophthalmia Neonatorum. Various Calls and Visits. Subsequent Visits Ante-Natal. Puerperal Fever. 1 to 5 Years. Under 1 Year. 31 - 16 No. 1 District 315 400 778 845 339 „ 2 „ 346 290 837 990 48 270 5 592 - „ 3 „ 361 414 464 71 12 254 - 376 398 377 „ 4 „ 254 57 15 347 323 - 521 „ 5 „ 290 522 66 1 4 205 „ 6 „ 359 397 763 755 229 34 13 - 300 302 1207 7 „ 7 „ 402 14 2 405 352 805 „ 8 „ 343 922 20 3 - 359 Salomon's Centre 174 193 2952 3516 1421 3 1324 - Princess Club 448 - - 45 1014 - - - Fulford Street 500 145 174 587 - - - St. George's Hall - 1857 224 - - 1476 432 - - Central Hall 646 - - 596 55 242 - - 2873 3060 11966 11358 2260 3 Totals 75 6007 * Includes re-visits. Table I. Attendances at Maternity and Child Welfare Centres for the 52 weeks ended December 29th, 1923 Name of Centre. Class for Mothers. Sewing Class. Ante-Natal Clinic. No. of Sessions. No. attending No. of Sessions. No. of Sessions. Nos. Attending Children. Under 1 year 1 to 5 years Town Hall 100 3360 1841 35 446 - 98, Rotherhithe New Road 102 3747 1414 43 275 38 Trinity Road 47 1033 613 - - - Oxley Street 21 94 2186 1490 150 - Roseberry Street 46 1903 918 8 50 - 131 Salomon's Centre 1419 530 192 - - 1629 Princess Club 160 5138 2564 70 43 2576 Fulford Street 94 39 366 931 14 535 St. George's Hall 46 48 1241 1030 - 94 Central Hall 9828 6709 - - - Totals 916 32431 262 287 18046 3451 MUNICIPAL LYING-IN HOSTEL. Report from January 1st to December 31st, 1923. (1) Total Number of Cases Admitted 143 (2) Average Duration of Stay 14 days (3) Number of Cases Delivered by Midwives 138 (4) Number of Cases Delivered by Doctors 5 (5) Number of Cases in which Medical Assistance was sought by Midwives 17 (a) Ante-Natal Nil ( b) during Labour 5 (c) after Labour 12 (d) for Infant 5 (6) Number of Cases Puerperal Sepsis with Result of Treatment Nil (7) Number of Cases in which Temperature rose above 100.4 for 24 hours with Rise of Pulse Rate Nil (8) Number of Cases notified as Ophthalmia Neonatorum, with Result of Treatment 2 (9) Number of Cases Inflammation of the Eyes, however slight 4 (10) Number of Infants not entirely Breast-fed while in the Institution, with the reasons why they were not Breast-fed 10 Badly-formed nipples or milk delayed in primiparæ. Supplementary feeds given. (11) Number of Maternal Deaths with Causes Nil (12) Number of Foetal Deaths, Stillborn or within 10 days of Birth, and their Causes, and the results of Post-Mortem Examination, if obtainable 5 Stillborn —1 Macerated foetus; 2 Complicated breech; 1 Delayed labour. Deaths—1 Premature; Heart 1, The following report on the Municipal Lying-in Hostel was made to the Committee on the 13th November, 1923: — "The Municipal Lying-in Hostel was established in 1919, and equipped and run for nearly twelve months at a cost of £2,000. This was only done owing to the generous action of the American Bed Cross Society in giving us a donation of this amount, through the Secretary of the Federation for Maternity and Child Welfare. The costs for the subsequent years were as follows: — March 31st, 1921, £2,321; March 31st, 1922, £2,520; March 31st, 1923, £2,075; and the estimate for the present year is £1,840. The total net cost per patient per week for the year ended March, 1923, was £7 2s. 8d., and the receipts from patients were £1 14s. 4d. per week, showing a loss per patient of £5 7s. 7d. per week, or a total loss on every patient in the Home of £10 15s. 2d. per fortnight. The number of patients attended to in the first year was 155, and for the year ended March 31st, 1923, 138. The number of patients in the first nine months of 1922 were 102, and in the first nine months of this year 86. The bookings have gradually decreased from 75 in March, 1921, to 28 now. For the year ended March 31st, 1923, only 66 per cent, of the beds in the Hostel were occupied, and the question now comes whether the Borough is getting value for the money expended, for it is evident that the Hostel has been, and is being, run at a very serious loss. The original idea of the Hostel was to provide accommodation for women of the working classes who wished to be confined and had no proper accommodation in their own homes. At that time there was another difficulty, inasmuch as there were only five midwives practising in Bermondsey, as against ten now. Only a very small number of medical practitioners in the Borough were attending confinements at the date of the establishment of the Hostel, partly owing to the large amount of work many had to do on the Panel, and partly owing to many of the practitioners being somewhat advanced in years. Many of these conditions are changed nowadays, and many of the older practitioners have been replaced by younger men, who are anxious to attend, and are taking on, a good many midwifery cases. In addition to these, since the foundation of the Hostel, the Bermondsey Guardians have established a very excellent Maternity Ward in the Bermondsey and Rotherhithe Hospital, at very low fees to the patients, and during the first nine months of 1923 they had 328 cases in the ward. A further factor has come in, inasmuch as Guy's Charity, which used to cover about a third of the Borough, now covers nearly the whole Borough, so that practically every woman living in Bermondsey who is going to be confined, and cannot afford the usual fees, can be attended free from Guy's Hospital. From a consideration of all these factors it is quite evident that the need for the Hostel has passed. From the first almost it was evident that unless we opened the doors free we were hardly likely to get hold of the class of patient who seemed most in need of help, and, as a matter of fact, this has been so. By far the large majority of patients belong to the artisan and clerical class, who apply to be received into the Hostel more as a matter of convenience than of necessity. I think, therefore, that the Committee might seriously take into consideration as to whether it is wise for us to continue the Hostel. It is a great expense for which we do not seem to get an adequate return, and it seems to me that the money we spend here could be laid out with much greater benefit in some other direction. As regards the use of the premises, we are in great need of proper accommodation for the Maternity and Child Welfare Centre, which is now carried on at the Shelter in the Depot. This Shelter was originally built at considerable expense to take contacts, who were unable to stay in their own homes during the process of disinfection, and also for the reception of contacts in the initial stages of dangerous epidemic diseases such as small-pox and typhus, and I can say that we have on several occasions stopped an epidemic, which threatened to spread, by the timely housing of contacts in this Shelter. There are four tenements in the Shelter, and one of them is at present occupied by the Committee for the Unemployed, while the three others are used as a Maternity and Child Welfare Centre. The result of this is that if we are threatened by an epidemic, such as the ease of small-pox which occurred last spring, we have great difficulty in accommodating the contacts, and it means suddenly displacing the present occupants of the Shelter, greatly to their inconvenience. I should be glad if we could have a Centre which could be devoted solely to Maternity and Child Welfare near the Town Hall, and I cannot imagine a more suitable building than the Hostel. No structural alteration will be necessary for this purpose, but figures will be submitted for the redecorations which will be required; but as no money will be required to be expended on this purpose for the present year, it will not make any alteration in our estimates up to March 31st, 1924. The furniture at present there could be redistributed, as there are several articles in the Hostel which would be useful to Fairby Grange, and a few of them may be required in some of the other Centres. Apart altogether from the closing of the Hostel, the present position of the Town Hall Centre is most inconvenient, and is very difficult for the mothers to find, the approaches being through the Depot. There is also a tannery adjacent, which creates a very unpleasant odour, and the road leading to it is frequently blocked up with carts, so that mothers have great difficulty in getting into the Shelter with their perambulators. I recommend, therefore, that the Hostel be discontinued as from March 31st, 1924, as a Lying-in-Home, and that the building be used as a Maternity and Child Welfare Centre from that date onwards." The recommendation contained in the last paragraph of this report was adopted by the Committee and the Council. In April of this year, the Centre which was formerly held in the Shelter, Neckinger, was transferred to 110, Grange Road, and the Dental Surgery, 98, Rotherhithe New Road, was also transferred to this Centre. FAIRBY GRANGE CONVALESCENT HOME, HARTLEY, KENT. The following was presented to the Maternity and Child Welfare Committee in September, 1923: — Short Description of House and Estate. "Fairby Grange is a charming old-world country house. The house, with three cottages and an estate of nearly 20 acres, was offered to the Council by Dr. Salter for the purpose of the establishment of a convalescent home for mothers and babies. The Council accepted the gift with gratitude and instructed the Medical Officer to prepare a scheme. The house contains 25 rooms, including a lounge and three bathrooms. Ground Floor.—The lounge gives access to two short corridors arranged at right angles. Two reception rooms, the billiard room and a cloakroom open on to one corridor. The other corridor leads to the dining-room and to the kitchen and sculleries. First Floor.—The main staircase opens on to the lounge below; above, it leads to two corridors arranged at right angles as on the ground floor. One of these corridors gives access to the nursery, two bedrooms, the linen room and two bathrooms. The second corridor leads to two large bedrooms, two smaller bedrooms and a bathroom. At the end of each of these corridors a smaller staircase leads up to two bedrooms which have evidently been designed for the use of domestic servants. In addition to the house, there is an estate of approximately 20 acres, upon which is situated three cottages. By arrangement with the Beautification Committee, the pleasure grounds immediately surrounding the house will be for the use of patients; the remaining part of the grounds will be let on a rental to the Beautification Committee. Method of adapting Fairby Grange for use as a Convalescent Home. Ground Floor. — The dining-room will seat comfortably 21 persons, i.e., 15 adults and six toddlers, so that all the patients will be able to sit down to each meal at the same time when the home is full. A hatch has been constructed between the dining-room and kitchen thus facilitating the service of meals and avoiding the necessity of extra kitchen staff. The kitchen is large and well lit and ample for the purpose of the home. A recess from the kitchen has been fitted as a small sitting-room for the kitchen staff. Adjoining the kitchen is a scullery and a wash-house, together with a butler's pantry, which will be used as a storeroom. The wash-house is fitted with a copper and two special washing places, which will be utilised for the washing of baby clothes. At the end of the second corridor on the ground floor is the billiard room. This is a large room and will be used as a day room for mothers and babies and toddlers. Next to the billiard room there is a smaller room, which will be shared by the matron and nurse as a sitting-room and office. Like the billiard room, this room has a separate door opening on to the garden. The last room in this corridor is a reception room eminently suitable as a quiet room for the mothers. This room has a door opening on to a verandah, so that it will be possible for mothers to rest in this room while their babies sleep in prams in the open air on the verandah outside. First Floor. —The nursery on this floor will be used as a room in which the babies will be dried and clothed. This room is opposite the two bathrooms in which the babies will be washed. After their bath the babies will be wrapped in towels and taken into the nursery. The first bedroom on this floor will accommodate three mothers and their babies and three toddlers. The second bedroom will take three mothers and babies and one toddler. On the same floor along the other corridor four mothers will sleep in the best bedroom. The small bedroom adjoining the bathroom is the matron's bedroom. Of the remaining two bedrooms on this floor, the larger one will accommodate three mothers and babies and two toddlers and the smaller room two mothers and babies. The bathroom on this corridor will be for the use of the staff. Above this corridor on the second floor the nurse will sleep in one room, the second room being kept empty as an isolation or emergency bedroom. The cook and the two domestic servants will sleep on the second floor above the linen room and bathroom at the end of the other corridor. Accommodation. Accommodation will thus be provided for 15 mothers, 12 babies and 6 toddlers. This estimate of the accommodation is conservative and provisional. The number of births in the Borough last year was 3,167. It is impossible to say what proportion of the mothers require convalescent treatment, but, in my opinion, at least 50 per cent, of them would benefit greatly by such treatment. The accommodation at Fairby Grange will allow for the treatment of approximately 350 to 400 mothers annually, so that, even if the convalescent home is full all the year round, the need will only partially be met. It cannot, of course, be assumed that all those who need treatment will be able to avail themselves of the opportunity offered at Fairby Grange. Probably those whose need is greatest will be the least able to go away, either on account of the expense or because of the impossibility of leaving other young children at home. To meet this obstacle it has been decided to assess the charges to be made according to the circumstances of the family and to allow a mother to take one toddler in addition to her infant. The health visitors have been instructed to make the home known to all their mothers and to give every assistance to the applicants. The success of the scheme will be, to a large extent, dependent on their efforts. Cost of Furnishing. The estimated cost of furnishing and equipping Fairby Grange as a convalescent home was £1,000. At the time of reporting the home has been furnished and equipped at a cost of £740. There remain some items of furniture to purchase and minor alterations to carry out. The furnishing of the home has been carried out with a view to the comfort and happiness of the patients, and while nothing has been done to lessen the amenities of what is a beautiful house, strict regard has been paid to economy. Staff. (1) Matron. —Miss Sewell, matron of the lying-in hostel, has been appointed temporarily as matron at her present salary of £140 per annum. (2) Nurse. —Mrs. Barden has been appointed at a salary of £70 per annum. (3) Cook. —Miss Boutcher, of the lying-in hostel, has been appointed cook temporarily at her present salary of £60 per annum. (4) One housemaid, at £30 per annum, not appointed at time of writing. (5) One between-maid at £26 per annum. Dorothy Francis, age 20, appointed on one month's trial. (6) One gardener at £2 17s. per week, with a cottage on the estate. Estimated Expenditure for the next Seven Months. £ Rates, Taxes, Insurances, Telephone, etc. 140 Water, Fuel and Lighting 104 Provisions and Necessaries 600 Laundry 100 Repairs and Maintenance 50 Furniture and Equipment (renewals) Nil Salaries and Wages 280 Medical Requisites 10 £1,284 Less Income — £ Patients' Fees 100 Rent from Cottages and Grounds 77 £177 £1,107 Method of Admission; Fees; Transport of Patients. Provisional rules to govern the admission of patients, charges to be made, &c., have been drawn up as follows:— (1) The Home is open for the reception of Mothers and Babies. (2) Babies must be at least three weeks old and not more than 12 months old. (3) In addition to the baby, the mother may, in exceptional circumstances, be accompanied by one other child, which must not be more than five years of age. (4) A mother may be admitted unaccompanied provided she is the mother of a child under five years of age, or when convalescent treatment is necessary following miscarriage or a confinement where the infant has died. (5) Expectant mothers in need of convalescent treatment will also be admitted, but admission will, in general, not be allowed after the sixth month of pregnancy. An expectant mother may be accompanied by one child under the age of five. (6) Application for admission is to be made on a form which can be obtained from the Public Health Department, Town Hall, Spa Road, from any of the Maternity and Child Welfare Centres, or from any doctor or clergyman in the Borough. (7) The form, when filled in, should be taken by the applicant personally to Dr. Mildred Thynne at 98, Rotherhithe New Road, on Friday, at 10 a.m. (8) The length of stay in the Home shall be a period, not less than 14 days, recommended by the Medical Officer. (9) A weekly charge will be made which will be assessed according to the financial circumstances of the family. The standard charge will be 10s. per week. In special cases admission may be free. Payments shall be made weekly to the Matron at Fairby Grange. (10) Patients must pay their own railway fares to and from Fawkham, Kent. The return fare from Holborn Viaduct is 6s. (11) Mothers must come provided with suitable clothing, and will require a pair of slippers, a change of underclothing, a brush and comb and toothbrush. (12) A complete outfit of baby clothing will be supplied by the Home for each infant, which shall be for the use of that particular infant during its stay in the. Home. Care will be taken to ensure that the clothing for each infant is kept separate. (13) Where an additional child under five accompanies a mother and baby, the child must come provided with suitable clothing—a change of underclothing, a pair of slippers and a toothbrush. (14) Mothers will be expected to make their own beds and take full charge of their own infants. (15) All patients are required to agree to abide by the rules of the Home and to carry out the instructions of the Matron. The Borough Council does not hold itself liable in any way whatever for any accident or mishap which may occur to any patient while in the Home. A supply of application forms has been sent to every Centre, and to every doctor, clergyman and Mission in the Borough, together with copies of the provisional rules and a covering letter. With regard to Section 9, the assessment will be made by the Medical Officer of Health, using the same scale as that laid down by the Council for the supply of milk. Patients entitled to free milk under the scale will pay ss. per week. Patients entitled to milk at half-price will pay 7s. 6d. per week. Patients above these scales will pay 10s. or more per week according to circumstances. All cases where the assessment is below 5s. per week or above 10s. per week will be referred to the Maternity and Child Welfare Committee. This scale is provisional and will be reported upon to the Maternity and Child Welfare Committee in the near future. Section 10.—With regard to this section, those patients who have already been admitted to Fairby Grange were given careful verbal instructions, reinforced by a typewritten sheet containing full directions for the journey. The generous offer of a motor car has since been made by Mr. Norden, and, if the Committee accepts this offer, the problem of the transport of the patients will be simplified. Local rules for the orderly running of the Home—e.g., fixing bed-time, meal-times, & c.—have been drawn up by the Matron. Treatment while in the Home. Patients will be expected to make their own beds and tidy their bedrooms, and to wash, dress and feed their own babies. Any other help which they give in the Home will be entirely voluntary and at the discretion of the Matron. A certain amount of prejudice exists against convalescent homes on account of the restrictions usually imposed, and at Fairby Grange as great a measure of freedom as is compatible with order and comfort will be allowed. At the same time, the Matron and her assistant will be expected to instruct mothers, individually and tactfully as opportunity occurs, in the general hygiene of pregnancy, of infant life—e.g., feeding, exercise, sleep, &c. It is hoped that a considerable proportion of ante-natal cases will be admitted, and there is no doubt that sympathetic and judicious instruction will be valuable in these cases. Medical Supervision. The Medical Officer of Health will exercise general supervision and visit the convalescent home as often as may be necessary. In case of emergency, arrangements have been made to call in a local practitioner. Patients will be expected to pay their own medical fees. Date of Opening. Up to the date of writing over 40 applications for admission have been received. In order that what remains of Summer weather should not be wasted, six mothers, five babies and two toddlers were admitted on Saturday, Ist September. The number will gradually be increased until the full complement is reached. The date of the official opening has yet to be fixed." At the date of writing the Home has been in full swing for nine months. I might add that it has been very greatly appreciated by the mothers of Bermondsey, and nothing but good has been spoken of it by those who have had the advantage of spending a short holiday there. The farming land in connection with it has been let to the Beautification Committee, who have erected on it four propagating houses at a cost of £900. Prom these the flowers and cuttings necessary for the open spaces in Bermondsey are supplied. The Home is also supplied with fruit and vegetables from the gardens. The grounds immediately attached to the house have been put in the charge of Mr. Rose, and are in excellent condition and very much appreciated by the mothers. When the Home was first started many mothers were allowed to take a toddler besides a baby, but this had to be stopped, as it was found that the mother could not reap any benefit from the holiday if she had to look after two children. The rule, therefore, of only allowing one child to be taken has been rigidly enforced to the advantage not only of the mother but of the management. The Home is being formally opened by the Rt. Hon. J. Wheatley, M.P. (Minister of Health) on the 26th July, 1924. DENTAL TREATMENT. The following report has been submitted by the Municipal Dental Officer which shows a steady advance in so short a period in this branch of the Council's work:— I have the honour to submit the Third Annual Report of the work carried out at the Dental Treatment Centre during the year 1923. I have to record that, in nearly every category of patient, the work has increased over that done in 1922 as under:— Category of Patient. Numbers Treated. 1923. 1922. 223 Children 201 314 Expectant and Nursing Mothers 268 Unmarried Girls (14 — 20 years) 64 145 395 Women 273 Men 193 358 Tuberculosis Cases 55 93 The reduction of the fees in favour of unmarried girls, from the Public Health scale to that of the Maternity and Child Welfare has more than justified itself. A table of numbers of mothers and children referred by the various centres is of interest in comparison with Tables I and II. Centre. Numbers of Children. Mothers. Rotherhithe New Road 45 9 Oxley Street 34 7 8 Roseberry Street - 9 5 Trinity Road Town Hall 17 5 St. George's Hall 1 2 Princess Club 24 33 Fulford Street 12 1 - Central Hall 8 66 Total 154 During 1923 the Medical Mission referred 21 patients, and local medical practitioners 23 for treatment; and 25 cases were treated under Approved Societies' scale of fees. The Wednesday evening session proved so successful that it was found necessary to devote another evening to cope with the work, so a Tuesday evening session was started on September 18th. During the year, 655 visits were made for treatment during these evening sessions. The number of maternity and tuberculosis cases referred for assessment of fees was 75. The total amount being £249 18s., which figure was reduced to £109 2s. 3d. It is considered important to direct attention to the very limited scope in the matter of time allowed for dental treatment under the Maternity and Child Welfare Act. This Act only benefits the mother during the periods of pregnancy and nursing, periods which are the least desirable for dental treatment. In view of the national necessity a healthy mouth is to the mother, the scope of this Act needs to be extended to include benefit to the potential mother, even if legislative measures are necessary. During the year an examination was made into the bacteriology of pyorrhoea. Tubes of nutrient broth and blood agar were inoculated with the organism obtained from the root apices of teeth, freshly extracted under conditions to prevent contamination; and by swabs of the blood from the tooth sockets after extraction. Different strains of streptococci have been classified according to their behaviour on various media in the laboratory, but for the purpose of this investigation streptococci were classified according to the length of chain formation, especially as the S. brevis is considered by some authorities as non-pathogenic and a normal inhabitant. The short chain form usually present itself as an ovoid coccus, while the individual, organism of the S. longus type may be round or bacillary in shape; and the colonies may hæmolyse blood-agar or cause the formation of methæmoglobin. It may be possible on these lines to make a clinical distinction, but the matter needs more experimental elucidation. Of 27 cases of chronic general periodontitis examined: — 14 gave S. longus and M. catarrhalis, 1 gave S. longus in pure culture. 3 gave S. longus, S. brevis and M. catarrhalis, 3 gave S. brevis and M. catarrhalis, 1 gave S. brevis in pure culture. 2 gave Staphylococcus albus in pur culture. 2 gave S. brevis, S. albus and M. catarrhalis, 1 gave S. albus and M. catarrhalis. Vaccines were made up for 6 cases, 4 streptococcal and 2 staphylococcal in which good results were obtained. In conclusion, I desire to express my thanks to you for your continued help and kindness; to Dr. D. M. Connan and Dr. Mildred Thynne, to Messrs. H. W. Bush and A. Fair of your staff; to Messrs. Knott and Rogers of the Accountancy Department; to Miss W. Lambert, the dental nurse, and Messrs. G. W. Clark and W. B. Monger, dental mechanics. GEANTLEY SMITH, Municipal Dental Surgeon. Table I.— Inspection and Treatment of Children. Age Group. Number Examined. Per Cent Needing Treatment. Per Cent Refusing Treatment. Number Treated. Number of Extractions. Number of Administrations of Anæsthetics. Fillings. Number of Root Treatments, etc Number of Orthodontic Cases Treated. Number of Visits for Treatment. Local. General. 2 Years and under 59 32 10 17 60 - 16 25 - - 60 3 Years and under 10 247 7 101 65 59 47 52 148 - - 20 51 123 4 Years and under 77 83 227 2 46 53 - - 5 Years and under 43 28 135 26 - 72 6 5 14 - 49 68 161 21 39 80 86 14 27 9 3 126 Over 5 Years 360 Total 223 830 35 174 171 9 3 506 - - Table II. —Dental Treatment carried out during 1923. Number of Patients Examined. Number of Patients Treated. Number of Extractions. Number of Administrations of Anæthetics. Number of Fillings. Number of Dressings. Number of Root Treatments, etc. Number of Scalings. Number of Other Operations. Number of Dentures Fitted. Number of Repairs to Dentures. Number of Crowns. General. Local. 112 34 Maternity Cases 323 268 172 181 58 11 13 35 10 1,327 ... 7 Women 481 395 157 299 69 9 37 9 141 ... 67 1,878 162 287 55 13 4 3 Unmarried Girls (16 — 20) 7 9 ... 80 72 145 8 358 1,080 70 83 11 11 14 87 31 358 22 Men 501 ... 3 14 103 52 75 9 53 5 34 Tuberculosis Cases ... 9 93 533 Total including Children (Table I) 1,930 680 383 141 1,028 506 47 115 3 50 1,482 5,935 49 TUBERCULOSIS DISPENSARY. Number of Primary Notifications 461 Number of Deaths (all forms) 175 Death Rate per annum 1.43 Number of cases admitted to Sanatorium 229 Total number of attendances 5,652 Total number of examinations (including new cases, re-examinations and contacts) 3,435 Total number of new patients 538 Number of nurses' home visits 4,162 Number of doctors' home visits 66 Number of contacts examined 443 Number of reports to public authorities 1,182 Number of letters to doctors 390 Number of sputum examinations 923 Number of X-ray examinations 81 No. of beds on loan 11 TUBERCULOSIS. New Cases. Deaths. Pulmonary. Non- Pulmonary. Pulmonary. Non- Pulmonary. Age Periods. M. M. F. M. F. M. F. F. 1 1 - 1 1 1 1 0 - 4 4 1 1 13 1 1 2 - 5 4 4 13 19 3 1 1 1 7 10 3 4 8 2 5 1 1 26 11 2 15 12 5 4 8 - 21 22 1 4 1 1 20 7 11 25 32 34 1 16 6 15 - 21 - 1 35 36 4 1 13 1 14 45 20 5 27 7 2 1 - 2 - 1 55 4 10 14 9 5 1 1 65 and upwards 8 7 2 - - - - 159 129 88 8 50 48 13 71 Two changes of some importance have taken place during the year. In January the Tuberculosis Officer was appointed Consultant for tuberculosis cases to the Bermondsey and Rotherhithe Hospital. This appointment has been of very great value to the work of the Dispensary. A considerable number of the patients who would probably not have otherwise entered the Hospital have been persuaded to do so, and timely rest and treatment have been of great help to the patient. Under the London County Council scheme, a patient awaiting sanatorium treatment may. enter the local hospital and be removed from there to sanatorium when a vacancy occurs. The accommodation for patients at the Bermondsey and Rotherhithe Hospital has been improved recently by the erection of verandahs. This is a very satisfactory arrangement, since patients are very often reluctant to enter the hospital because they fear to lose their chance of sanatorium treatment. In January also the Care Committee was given a room at the Dispensary, it being thought that the work of the Committee might be more fully co-ordinated with that of the Dispensary by this means. Unfortunately, the arrangement has not worked very well, and the whole question of the relation between the Public Health Department and the Care Committee is under discussion at the time of writing. Tuberculosis is, of course, an infectious disease caused by the tubercle bacillus. There are two principal ways in which the bacillus is spread—(1) the expectoration of persons suffering from pulmonary tuberculosis, i.e., tuberculous sputum, and (2) tuberculous milk. Tuberculous Sputum.—Attention should be drawn to the prevalence of spitting in the Borough. The expectoration of persons suffering from pulmonary tuberculosis almost always contains the tubercle bacillus; this expectoration dries owing to the action of the sun and air, and the bacilli then blow about in the dust which thus becomes a source of danger to others. It may be argued that the risk is small because most of the germs die during the process of desiccation, and because many people who spit are not suffering from tuberculosis. This, no doubt, is true, but the habit is an objectionable one and has nothing to commend it. It is not tolerated in public vehicles and should not be allowed anywhere, either in public or private. All dispensary patients are carefully instructed as to the dangers of spitting, and supplied with sputum mugs for use at home and pocket flasks for carrying about with them . Antiseptic solution is also supplied for use with the flasks and mugs, and most of our patients readily see the use of these precautions and faithfully carry them out. Tuberculous Milk. — This is derived from cows suffering from tuberculosis, and the milk from a cow with a tuberculosis udder is exceedingly dangerous. Tuberculous milk is responsible for a large amount of the tuberculosis of bones, joints and glands seen in children, i.e., the so-called "surgical tuberculosis." There were 86 cases of this kind notified in Bermondsey during the year. The remedy is in the hands of the public—a pure milk supply should be demanded. In this Borough two other factors operate on the prevalence of the disease: (1) bad housing conditions. This leads to the close contact between healthy persons and tuberculous persons, and sooner or later the healthy person becomes infected. It may be pointed out that, of a total number of 461 persons notified as suffering from tuberculosis during the year, only 20 persons are known to have a sleeping-room to themselves, i.e., 4.3 per cent. (2) Low family income. In almost all cases, unemployment has much to do with the low family income. The provision of extra nourishment for tuberculous persons has been of very great value. The amount of money available for this purpose is, however, very small and could with benefit be increased. Unemployment, in connection with tuberculosis, provides an instance of a vicious circle. The circle has to be broken somewhere and the provision of more extra nourishment, a purer milk supply and better home conditions would go a long way towards breaking the circle, Table I. —Vital Statistics of whole District during 1923 and previous Years. Population estimated to Middle of each Year. 2 Year. 1 Births. Total Deaths Registered in the District Net Deaths at all Ages belonging to the District. Deaths of Residents registered in Public Institutions bevond the District 11 Deaths of Non- Resident' registered in Public Institutions in the District. 10 Rate. * 4 No. 3 At all Ages Total Deaths in Public Institutions in the District. 9 Under 1 Year of age. No. 12 Rate.* 13 Rate per 1,000 Births registered. 6 Rate.* 8 No. 5 No. 7 APPENDIX. 1913 3,842 124,739 30.8 505 131 1,730 18.9 529 21 534 2,243 17.9 1914 124,213 487 129 1,694 13.6 6l5 26 516 2,184 17.6 3,757 30.2 1915 123,665 3,482 29.6 17.5 21.4 537 154 2,053 654 38 542 2,514 123,665 1916 3,361 27.1 364 1,507 13.2 608 155 453 1,960 17.2 108 1917 119,983 2,613 21.7 329 1,807 18.8 840 411 18.8 125 186 2,032 1918 121,465 2,323 19.1 322 139 2,142 1007 2,390 22.0 19.8 191 439 1919 124,239 212 1,600 709 1,748 2,637 20.4 80 12.8 165 313 14.1 1920 129,189 4,038 31.2 280 69 1,466 11.3 689 105 281 1,642 12.7 3,231 1921 120,500 26.8 261 1,313 10.8 51 394 80 657 1,656 13.7 121,100 3,167 26.1 259 81 1,572 12.9 16.7 1922 778 43 496 2,025 Averages for years 1912- 1922 123,275 3,245 26.3 355 109 1,688 14.4 708 98 437 2,039 17.2 1923 2,912 23.9 76 1,192 330 288 1,480 121,700 220 9.7 42 12.1 Other Institutions, Etc., Etc. I. Institutions, etc., within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III Other Institutions, etc., the Deaths in which have been distributed among the several localities of the District. No. of Deaths Bermondsey and Rotherhithe Hospital 9 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc 29 Factory 1 Private Houses 2 Street 1 Total 42 No. of Deaths Ambulance on way to Hospital 3 All Saint's Hospital 1 Banstead Mental Hospital 4 Belgrave Hospital 1 Birchfield House Infirmary, Sundridge 1 Berks Mental Hospital 1 Caterham Mental Hospital 3 Cane Hill Mental Hospital 9 City of London Institution, Bow 1 Camberwell Institution, East Dulwich 2 Charing Cross Hospital 3 Colindale Hospital 4 Camberwell Hospital (St. George's) 1 Cancer Hospital 1 Dartford Heath Mental Hospital 9 Downs Hospital, Sutton 1 Darenth Training Colony 1 Evelina Hospital 7 East London Hospital 3 East Sussex County Asylum 1 Guy's Hospital 68 Grove Hospital 2 Great Ormonde Street Hospital 1 Grand Surtey Canal 1 German Hospital 1 General Hospital, Tunbridge Wells 1 Greenwich and Deptford Hospital 1 High Wood Hospital 1 King's College Hospital 1 Ladywell Institution 42 Long Grove Mental Hospital 7 Leavesden Mental Hospital 6 London Hospital 4 Lewisham Hospital 1 Leicester City Mental Hospital 1 Miller Hospital 1 Mothercraft Training Society's Home 1 Ministry of Pensions Hospital, Orpington 1 Middlesex Hospital 1 Newcomen Street Day Nursery 1 National Hospital, Queen's Square 1 Park Hospital 15 Poplar Institution 1 Private Houses 7 Paddington Hospital for Women & Children 1 Queen Mary's Home, Carshalton 3 River Thames 6 Royal Waterloo Hospital 3 Royal Portsmouth Hospital 1 South-Eastern Hospital 16 Street 4 St. Thomas's Hospital 1 Southern Hospital 1 St. Bartholomew's Hospital 2 Stepney Infirmary 1 Southwark Institution 4 St Marylebone Hospital 1 1 Surrey Commercial Docks St. Joseph's Hospital 3 South-Eastern Hospital for Children 1 Seamen's Hospital, Greenwich 2 St. George's Hospital 1 St. Barnabas Home, Torquay 1 Tooting Bec Mental Hospital 6 Treadar Rocks, Breage 1 University College Hospital 3 Westminster Hospital 1 Total 288 Table IV. —Causes of, and Ages at Deaths, during the Year, 1923. Causes of Death. Deaths at the subjoined ageB of "Besidents" whether occurring in or beyond the District. 25 and under 45. All Ages. Under 1. 1 and under 2 2 and under 5. 5 and under 15. 15 and under 25. 45 and under 65. 65 and upwards. Certified 1,480 220 71 53 62 86 175 365 448 All Causes Uncertified - - - - - - - - - Enteric Fever 2 1 1 63 - - - - - - Small-pox - - - - - - - - - Measles 13 2 7 4 - - - - - Scarlet Fever 3 1 1 1 - - - - - Whooping Cough 12 5 6 1 - - - - - Diphtheria and Croup 33 2 4 18 7 2 - - - Influenza 11 3 5 3 - - - - - 1 Erysipelas 1 - - - - - - - Phthisis (Pulmonary Tuberculosis) 155 2 2 11 37 58 40 5 - Tuberculous Meningitis 4 9 2 3 - - - - - Other Tuberculous Diseases 2 - 1 3 2 11 3 - - 17 Cancer, Malignant Disease 148 2 2 73 54 - - - Rheumatic Fever 7 4 2 1 - - - - - Meningitis 10 1 3 1 1 2 2 - - 6 60 83 Organic Heart Disease 176 5 22 - - - Bronchitis 130 5 4 1 2 6 30 82 - Pneumonia 152 36 25 11 5 5 13 31 26 Table IV. —Causes of, and Ages at Deaths, during the Year, 1928. —continued. 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. Under 1. All Ages. Other Diseases of Respiratory Organs 19 2 4 1 2 9 - - 39 Diarrhoea and Enteritis under 2 years 11 50 - - - - - Appendicitis and Typhlitis 6 2 2 2 - - - - 4 Cirrhosis of Liver 3 - - - - - - 1 Alcoholism 1 - - - - - - 34 1 1 3 2 11 Nephritis and Bright's Disease - Puerperal Fever 2 - - 2 - - - - Other Accidents and Diseases of Pregnancy and Parturition 2 2 - - - - - - Congenital Debility and Malformation, including Premature Birth 96 95 1 - - - - - Violent Deaths, excluding Suicide 49 8 1 2 4 7 8 9 Suicide 7 2 4 - - - - - Other Defined Diseases 337 8 14 19 1 15 30 84 Diseases ill-defined or unknown - - - - - - - - All Causes 1,480 71 53 62 86 175 365 220 Table V.—Cases of Infectious Diseases Notified during the Year 1923. Notifiable Disease. ST. OLAVE. NUMBER OF CASES NOTIFIED BERMONDSEY. ROTHERHITHE. 2 4 5 3 At all Ages. 3 Total. 1 2 Total. St. John. St. Thomas. Total At Ages—Years 1 6 St. Olave. 65 and upwards. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. Under 1 year. - - - - - - - - - - - Small-pox - - - - - - - - - - - - 82 53 58 180 4 77 70 376 69 19 7 30 Diphtheria (including Membranous Croup) 586 17 218 274 47 28 2 49 51 47 - 1 10 6 2 2 - 5 1 2 2 1 3 Erysipelas 19 1 2 3 4 7 2 1 2 - - 65 29 18 24 35 161 44 138 5 132 8 34 12 1 24 Scarlet Fever 323 7 150 25 1 33 23 - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - 1 - - 1 2 - - 1 - - Cerebro-Spinal 3 2 1 1 - - - - - - - - - - - - Meningitis Polio-Myelitis and Polio-encephalitis 2 - - - - - - 2 1 1 1 1 - - - - - - - - 2 2 7 1 4 - - 5 1 - 10 18 18 1 2 1 - Opthalmia Neonatorum - - - - - - _ - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - 2 - - - - - Enteric Fever 2 1 1 1 1 - - - - - - - - - 2 1 - - - 1 3 - - Puerperal Fever 4 1 3 1 - - - - - - - - - - 1 - - 1 - - - - Encephalitis Letbargica 1 1 - - - - - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - - - - - - 1 1 - - Malaria 1 1 - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - 1 23 82 15 8 21 26 11 17 Pneumonia (Acute Primary and Acute Influenzal) 125 7 35 18 12 31 17 5 6 7 7 18 3 5 24 4 29 1 55 35 18 70 37 11 3 25 Pulmonary Tuberculosis 250 1 15 78 113 39 4 16 24 26 23 - 6 7 8 59 18 5 1 Other Forms of Tuberulosis 11 5 3 9 86 15 42 14 11 4 7 11 11 11 - - 405 503 180 201 70 137 193 166 127 121 116 860 182 160 109 451 74 19 109 Totals 1420 50 16 11 TABLE VI.—Factories, Workshops, Laundries, Workplaces and Homework. Homework. Nature of Work. (I) OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTION 109, 110. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Notices served on Occupier as to keeping or sending lists. (8) Prosecutions. Instances. (11) Notices served. (12) Prosecutions. (13) Instances. (14) Order made (S. 110) (15) Prosecutions (Sections 109,110). (16) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Lists. (2) Outworkers. Lists. (5) Outworkers. Contractors. (3) Workmen. (4) Contractlors (6) Workmen. (7) Wearing Apparel— - 12 - - 36 11 - - - 4 4 - (1) Making, &c 249 - - (2) Cleansing and Washing - - - - - - - - - - - - - - - - Household linen - - - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - - - Curtains and furniture hangings - - - - - - - - - - - - - - Furniture and upholstery - - - - - - - - - - - - - - - - Electro-plate - - - - - - - - - - - - - - File making - - - - - - - - - - - - - - - Brass and brass articles - - - - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - Cables and chains - - - - - - - - - - - - - - - Rubber and waterproof sundries - - - - - - - - - - - - 4 - - Cart gear - - - - - - - - - - - - - - - Locks, latches and keys - - - - - - - - - - - - - - - Umbrellas, &c. 2 - 5 - - - 1 - - - - - - - - Artificial flowers - - 9 - - - - - - - - - - - - Nets, other than wire nets - - - - - - - - - - - - - 4 - - Tents - 2 - - - 1 - - - - - - - - Sacks 4 - 45 1 - 7 2 - - - - - - - - Racquets and tennis balls - - 4 - - - - - - - - - - - - Paper, &c., boxes.paper bags 4 - - 28 - - 2 - - - - - - - - - Brush making - 7 - - - - - - - - - - - - Pea picking - - - - - - - - - - - - - - - Feather sorting - - 2 - - - - - - - - - - - - - - 1 - Carding. &c., of buttons &c - - - - - - - - - Surgical instruments - - - - - - - - - - - - - - - - - Basket making - - - - - - - - - - - - - Chocolates and sweetmeats - - - - - - - - - - - - - - - - - Cosaques, Christmas crackers, Christmas stockings, &c. - - - - - - - - - - - - 5 - - Textile weaving - - - - - - - - - - - - - - - Leather goods 2 - 11 1 - 4 - - - - - - - J - Total 52 11 372 4 4 2 - 11 18 - - - - - - TABLE VII. —Deaths from Zymotic Diseases, 1923. Year. All Causes. Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Pyrexia (origin uncertain). Diarrhœa. No, No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate. No. Rate No. No. Rate Rate Rate .02 - 17.9 2.56 88 .70 .04 16 .13 47 .33 - - 2 - 162 1.30 320 5 2243 - 1913 - 1914 2184 17.6 262 2.11 79 9 .07 17 2 .02 141 1.14 .64 .14 14 .11 - - - - - - 2514 21.4 367 3.13 .93 9 .17 79 .67 .03 - 146 1.24 1915 110 .07 20 - - 3 - - - 1960 155 1.36 42 .36 5 .04 .25 .01 1916 17.2 - 29 16 .14 - 2 61 .53 - - - - 2032 18.8 218 .66 .16 .05 89 1917 2.02 - 72 1 .01 18 32 .29 - 6 - .82 - - - 2390 1918 22.0 229 2.11 - 71 .66 3 .03 23 .21 84 78 - - - 48 .44 - - - - 1748 14.1 113 .91 - 18 .14 5 .04 21 .17 3 .02 - 62 .49 1919 4 03 - - - - 1920 1642 163 - 44 .06 41 .01 - 33 .26 12.7 1.26 56 7 25 .19 .32 - 1 - - - 13.7 1.63 - 14 .03 .72 1921 1656 197 - 3 18 .15 69 .57 .11 - 3 - 87 - - - - 1922 2025 16.7 292 101 .83 11 .09 90 .74 65 - 24 .19 2.41 .53 1 - - - - - - .71 Average for years 1913—1922 2039 17.2 231 19.5 - - 64 .53 7 .06 32 .27 39 .33 - - 2 .02 - 85 1480 12.1 125 - - 13 .10 33 .27 .01 - - 62 .50 .02 12 - 1923 1 02 3 .09 2 - TABLE VIII.—PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1923. No. Sample. Adulteration or Infringement. Remarks. Margarine 559 H Wrapper Ordered to pay costs, 17/6. 582 H Fined 1/-. Ordered to pay costs, 17/6. „ Malt Vinegar „ Deficient in Acetic Acid 42.5 per cent. 6 W Fined £2 2s. Costs, £2 2s. 7 L Dripping „ Water 8.25 per cent. Dismissed under Probation of Offenders Act. Ordered to pay costs, £2 2s. Water 26 per cent. 18 F Fined 21/-. Costs, 17/6. 19 F Mist. Sod. Sal. (L.I.P.) Deficient in Sodium Salicylate 27.5 per cent. Mist. Quin. (L.I.P.) Fined 40/-. Costs, 21/-. 20 F Deficient in Quinine Sulphate 16.6 per cent. 68 Fined 7/6. Mist. Quin. Co. (L.I.P.) 21 M Deficient in Quinine Sulphate 10.0 per cent. Mist. Sod. Sal. (L.I.P.) Fined 7/6. 22 M Deficient in Sodium Salicylate 57.0 per cent. Vinegar Fined 40/-. Costs, 21 /-. 22 L Deficient in Acetic Acid 9.2 per cent. Fined 5/-. Costs, 17/6. 25 M Milk Deficient in Milk Fat 17.7 per cent. Dismissed. Warranty proved. 23 P Medicine (Prescription) Deficient in Potassium lodide 76.6 cent. Margarine Ordered to pay costs, £2 2s 25 P Wrapper Fined 10/-. Costs, 10/-. 47 M Malt Vinegar Artificial vinegar containing no Malt Vinegar Dripping „ Fined 10/-. 55 P Oleic Acid 7.6 per cent. Fined 20/-. Costs, £1 18s. 6d. 72 D Oleic Acid 7.3 per cent. Ordered to pay costs, 17/6. 61 W Milk Deficient in Milk Fat 5.3 per cent. Ordered to pay costs, 17/6. Boric Acid 0.18 per cent. Dismissed. 64 W Sponge Cake 69 L Vinegar Deficient in Acetic Acid 6.8 per cent. Fined 2/6. 81 D Shredded Beef Suet Rice Starch 25.2 per cent. Fined 40/-. Costs £2 2s. 69 JF Malt Vinegar Deficient in Acetic Acid 9.8 per cent. Dismissed under Probation of Offenders Act. Ordered to pay costs, 17/6. Milk 85 JF Added Water 3 per cent. Dismissed. Costs against Council, £2 2s. 94 D „ Malt Vinegar Added Water 8.2 per cent. Dismissed. Dismissed under Probation of Offenders Act. 94 T Consisted entirely of Wood Vinegar Wrapper 111 JF Margarine Ordered to pay costs, 10/-. 123 M Vinegar Deficient in Acetic Acid 18.2 per cent. Dismissed. Warranty proved. Summons granted against manufacturer for False Warranty. „ False Warranty Fined 21/-. Costs, 27/6. 132 M „ (on delivery) Deficient in Acetic Acid 24. 1 per cent. Fined 21/-. Costs, 14/6. 133 M Vinegar Deficient in Acetic Acid 27.0 per cent. Dismissed. Warranty proved. 148 T Margarine Wrapper Fined 5/-. Costs, 5/-. 140 P Shredded Beef Suet 3.3 per cent, deficient in fat Dismissed. Warranty pleaded. 69 SUMMARY. £ s. d. Fines 14 13 6 Costs 21 18 0 36 11 6 Costs given against Council 2 2 0 70 FOOD AND DRUGS. Articles submitted for Analysis. Total samples taken. Number Genuine. Number adulterated. Percentage of articles adulterated. Almonds, Ground 1 1 - - Arrowroot 4 4 - - Baking Powder 1 1 - - Beef Paste, Potted 1 1 - - Bismuthated Magnesia 1 1 - - Black Pudding 1 1 - - Blanc Mange Powder 1 1 - - Brompton Lozenges 1 1 - - Bun Powder 2 2 - - Butter 148 147 1 0.7 Cake 12 12 - - 2 Castor Oil 2 - - Cheese 6 6 - - Cheese Cakes 1 - - - 6 Citrate of Magnesia 6 - - Cocoa 19 19 - - Cocoanut, Desiccated 4 4 - - Iced 1 1 - - Coffee 11 11 - - 2 2 Coffee and Chicory - - 1 Cordial, Blackcurrant Flavour 1 - - „ Clove Flavour 1 1 - - ,,Raspberry Flavour 1 1 - - ,,Strawberry Flavour 1 - 1 - Corn Flour 3 3 - - Cream 1 1 - - ,,Preserved 1 1 - - 1 Cream Roll 1 - - Crumpets 1 1 - - Curry Powder 1 1 - - Custard Powder 8 8 - - 1 Dough Nuts 1 - - 75 70 5 6.6 Dripping Egg Powder 3 3 - - 14 Fish Paste 14 - - 1 1 Flour - - 5 „ Self-raising 5 - 1 - Galanteal Veal 1 - - 1 1 Ginger Beer - - 1 ,,Wine 1 - - 1 ,,Wine Essence 1 - - 3 3 - Gravy Soup - 3 Green Peas 5 - - Groats, Prepared 1 1 - - Ground Ginger 3 3 - - Hot Drink Essence 1 1 - - 8 8 Ice Cream - - 71 Food and Drugs—continued. Articles submitted for Analysis. Total samples taken. Number genuine. Number adulterated. Percentage of articles adulterated. - Jam, Blackcurrant 2 2 - 1 1 - „ Mixed Fruit - „ Plum 1 1 - - „ Raspberry 8 8 - - „ Strawberry 3 3 - - Lard 27 27 - - Lemon Cake - 2 2 - „ Curd 1 1 - - Lemonade 5 5 - - „ Powder 10 - 10 - Linseed, Crushed 1 1 - - Liquorice Powder 2 - 2 - Lung Tonic 2 2 - - Maize Flour 2 2 - - 140 Margarine 140 - - Marmalade 3 - 3 - Medicines:— 100.0 Mist. Bismuthi 1 - 1 „ Pot. Bromide 1 1 - - 3 2 „ Quin. L.I.P. 1 33.3 „ Quin. Co. L.I.P. 1 - 1 100.0 „ Sod. Sal. L.I.P. 2 - 2 100.0 5 3 2 Prescriptions, various 40.0 Milk 346 339 7 2.0 1 „ Condensed, Full Cream 1 - - 3 „ „ Skim 3 - - 2 2 „ Separated - 1 - 1 Mincemeat (loose) - - Mustard 11 11 - - „ Compound 1 1 - - Oatmeal 3 3 - - Olive Oil 1 - 1 - Pea Flour 7 7 - - Pepper 40 - 40 - 2 Picallili 2 - - Quinine and Iron Tonic 2 2 - - Rice 19 19 - - Sage 1 1 - - Sago 2 2 - - Salts, Epsom 3 3 - - „ Glauber 1 - 1 100.0 Sausages 4 4 - - Semolina 1 1 - - Sherbert Powder 2 2 - - Sponge Cake 25 22 3 12.0 Suet, Beef 2 2 - - „ „ Shredded 13 23.1 10 3 Tapioca 6 6 - - Vinegar 74 81 7 8.6 29 „ Malt 33 4 12.1 Whisaky, Scotch 1 - 1 100.0 . 1,167 39 3.3 1,206 TABLE X.—Factories, Workshops, Laundries, Workplaces and Homework. Inspection. Inspections. Number of Premises. Written Notices. Prosecutions. Factories (including Factory Laundries) 83 27 - Workshops (including Workshop Laundries) 26 130 - - Workplaces (other than Outworkers' Premises) 102 19 Total 315 72 - Defects found. Particulars. Number of Defects. Found. Remedied Referred to H.M. Inspector Number of Prosecutions. Nuisances under the Public Health Acts:- Want of Cleanliness - 20 20 - 3 - - „ Ventilation 3 - - Overcrowding - - - Want of Drainage of Floors - Other Nuisances - - 40 - 40 - Sanitary Accommodation. Insufficient 1 1 - - - Unsuitable or Defective 15 15 - Not Separate for Sexes 2 2 - - 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) 1 1 - - Other Offences - - - - Total 82 82 - - TABLE XI.—No. of Bakehouses in the Borough. In Use. Not in Use. Underground. Above ground. Above ground. Underground. 43 5 5 19 23 of these are Factory Bakehouses. OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of - 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 23 Reports (of action taken, sent to H.M. Inspectors) 23 Other - Underground Bakehouses (s. 101)— Certificates granted during 1923 - In use at end of 1923 - 336 Workshop Bakehouses Workshops on the Register (s. 131 at the end of 1923 64 Total Number of Workshops on Register 460 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. Removed for sorting under S.A. Destroyed. Quantity. Weight. Quantity. Weight. Quantity. Weight. Quantity. I " i tons cwts. qrs. lbs. •! I. I lbs. tons cwts. qrs. tons cwts. qrs. lbs. 253 cases & 1170 barrels 82 11 2 0 Apples Apples, canned 167 cases 2 13 2 14 174 cases 2 15 3 0 Apricots i ■ 17 cases 6 2 0 228 cases & 6 tins 9 5 2 17 Apricot Pulp ■ m mm m m 12 sides & various pieces 7 2 3 Bacon ■ m ■ Baked Beans 1 15 1 6 40 cases Bananas 6 crates & 4 cases 5 1 14 Barley 11 bags 11 3 0 3363 tins Beef Cubes 16 7 0 6 148 half sieves & 437 skips Black Currants 4 19 1 6 Black Currant Pulp 2 cases 1 3 0 15 boxes 7 2 0 Butter 5758 boxes 143 19 0 0 Butter Beans 1204 bags 45 3 0 0 Canned Goods, Various 3 2 0 0 3 loads, 24"cases & 37939 tins 91 5 3 26 Cauliflower 14 casks 1 11 1 0 Caviare 92 casks I mm 8 4 1 14 Cheese I .. I 3 6 3 20 Condensed Milk 1201 cases 62 tins and 2 barrels 26 20 2 2 1434 tins, 6 cases & 1 cask 15 1 2 Eggs 3350 tins, 389 cases, 442 half cases & 971 packages 380 13 0 27 Evaporated Milk I I 2 tins i 2 1 I Figs 14 bags & 540 boxes I 6 9 3 6 Flour 388 bags 24 14 1 25 Fruit, fresh, various I 3 302 packages 15 0 0 Fruit, canned, various 2 5 3 0 Fruit, pulp, various ?• I m 2985 tins 14 9 1 0 Gherkins mm 2 casks I 6 0 0 m m Haddocks in tins 116 tins 1 0 14 L. . m ■ Hams 24 hams & 1 box ofhams 5 2 0 7 boxes 2 2 0 0 ■ ■ Horseradish 18 bags 2 3 2 0 Intestines m 6 casks 1 10 0 0 1 cask Jams 24 cases & 17 tins 17 2 26 Jelly Crystals and Custard Powder 10 cases 2 2 0 Lemons 160 cases 3 19 2 0 21 cases & 142 half cases 4 1 0 0 Lemons and Tomatoes 7 12 2 0 half cases Liquid Egg 31£ tins 11 0 0 Mandarines 2 manuHiines Meat, canncd. various... 41 cases 11 2 0 278 cases and 5 tins 14 7 3 18 4 cases & 1866 tins 4 8 1 4 I Meat, fresh, various ... 1 7 0 27 1 1 23 Mutton 6 13 1 9 „ 2X9 75 268 q,S ' Oats 8 19 1 27 Olive Oil 4 casks 1 12 0 0 Onions i 14 0 13 3 Oranges • I 381 cases 6 3 12 16 Ox Eye Glands 32 cases 18 1 4 Ox Tongues 1 keg 2 19 Peaches, canned 47 cases & 66 tins 1 17 0 1 Peaches, pulp 20 29 cases & 6 tins 1 16 1 Pears 31 barrels, 81 travs. 27 cases &142halfcases 6 17 2 0 Pears, canned j 139 cases and 9 tins 16 3 16 1 0 3 367 cases & 9 tins 9 0 Pineapple j 8£ cases 2 1 Pines j 24 tins 3 12 UNSOUND FOOD AND FOREIGN MEAT REGULATlONS—continued. Articles. Quantity Unsound. Disposed of for other purposes than Human Food. Destroyed. Removed for sorting under S.A. Exported. Quantity. Weight. Quantity. Weight. Quantity. Weight. Quantity. Weight. tons I tons cwts. qrs lbs. tons cwts. qrs. lbs. lbs. tons cwts. lbs. cwts. qrs. qls. m 4 4 0 0 Plums 120 baskets, 16 hampers, 3 boxes, 1 cask 2 08 packages i Plums, pulp I 1 14 1 0 38 cases & 2 tins Prunes I ■ 0 20 I 2 cases & 12 boxes Pumpkins I 3 0 2 3 bags ■ 13 0 0 Quince, pulp 26 cases 305 cases 3 0 0 Raisins 1 box . 2 0 0 8 19 casks 3 16 0 0 76 Raspberries m ■ Raspberry, pulp 21 casks & 71 cases 5 16 3 4 17 0 0 Red Currants 17 cases & 1 tin m Rice, Pork and Chili I 6 0 2 14 cases m m > m 51 cåses 1 17 0 14 Sardines m ■ Sausage, tinned 16 cases & 26 tins. I 3 2 5 . . . ■ Shredded Wheat 3 14 itu una, TP I 70 cases 16 Shrimp Paste 1 1 0 24 m m 36 hampers . - Soup Mixtures 51 cases 1 1 0 12 Spaghetti, Meat & Chili Sugar Sweepings 205 cases 4 7 3 12 6 9 2 23 127 bags & 2 sachels 92 packages m ■ 18 17 3 0 0 15 bundles & 287 packages Tomatoes 4 0 2 bundles 1 12 0 2 1 I Tomatoes, tinned 8 10 1 0 16 cases and 19 tins 12 cases 0 2 0 Tomato Puree 78 cases & 7 tins 1 0 Turkeys 66 turkeys 5 1 21 Veal Loaf I 48 cases 5 0 16 Wheat 152 6 0 0 2 packages Yeast 3 0 0 [ _1