.I. Ac 4378 (hi Borough of Bermondsey REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1928 BY D. M. CONNAN, M.B., B.S., D.P.H., Medical Officer of Health. BER 41 Borough of Bermondsey REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1928 BY D. M. CONNAN, M.B., B.S., D.P.H., Medical Officer of Health. TABLE OF CONTENTS. PUBLIC HEALTH DEPARTMENT— PAGE Public Health Committee 4 Maternity and Child Welfare Committee 4 Housing Committee 5 Staff 6 VITAL STATISTICS— Area 9 Dwellings 9 Rateable Value 9 Population 9 Births 9 Deaths 10 Marriages 10 Infantile Mortality 11 Deaths from Tuberculosis 11 Vital Statistics of District 12 Causes of Deaths 15 Deaths from Zymotic Diseases 1-7 INFECTIOUS DISEASES— Diseases Notifiable 18 Diphtheria 19 Scarlet Fever 20 Small Pox 20 Ophthalmia Neonatorum 20 Puerperal Fever and Pyrexia 21 Disinfection 21 Shelter 22 Nursing 22 Bacteriological Laboratory 22 Cases Notified in 1928 23 Cases Notified for last ten years 24 TUBERCULOSIS- Tuberculosis Officer's Report 25 Lady Almoner 36 Public Health (Prevention of Tuberculosis) Regulations, 1925 37 PAGE Work of the Tuberculosis Dispensary 38 Summary of Notifications 39 Cases on the Register 40 LIGHT TREATMENT— Work done in the Solarium 41 Leysin Patients 47 MATERNITY AND CHILD WELFARE— Fairby Grange Convalescent Home 49 Work of the Health Visitors 50 Attendances at Centres 52 Statistics for 1928 54 DENTAL TREATMENT— Particulars of Children Treated 56 Particulars of Treatment and Work for 1928 57 PROPAGANDA 58 SANITARY ADMINISTRATION — Housing 62 Inspections and Proceedings 68 Work of the District Inspectors 72 Factories and Workshops—Homework 73 Factories and Workshops—Inspections 74 Bakehouses 75 House and Trade Refuse 76 Offensive Trades 76 Mortuary 76 Drainage Work 76 Street Markets 76 The Flood 77 FOOD CONTROL — Caseous Lymphadenitis in Mutton 78 Polish Butter 79 Sale of Food and Drugs Act 79 Unsound Food 80 Milk Premises 80 Milk Licenses 80 Work of the Wharves and Food Inspectors 81 Food and Drugs—Samples Taken 82 Food and Drugs —Prosecutions 85 Public Health (Imported Food) Regulations, 1925 86 PUBLIC HEALTH DEPARTMENT. PUBLIC HEALTH COMMITTEE, 1928. Chairman —Councillor WEIGHTMAN. Councillor Meadows Alderman Miss Broughton „ Catchpole Mrs. Nix „ Mrs. Powell „ Wallsgrove Councillor Mrs. Amos Roberts „ Cockett „ Stean „ Miss Henrich Mrs. Stokes, „ Horwood „ Stokes, I. „ Howard „ Sullivan Mrs. Husk „ Mrs. Virgo „ Wayne Kidd „ Loveland Ex-officio: Alderman H. C. BALMAN, J.P., Mayor of Bermondsey, 1927-28. Councillor G. A. HORWOOD, J.P., Mayor of Bermondsey, 1928-29. MATERNITY AND CHILD WELFARE COMMITTEE, 1928. Chairman—Councillor NIX Councillor Ponsford Councillor Mrs. Amos „ Mrs. Powell Catchpole „ Mrs. Fortescue „ Mrs. Purser „ Mrs. George „ Mrs. Salter, L.C.C. Miss Henrich „ Mrs. Stokes, „ Mrs. Homewood „ Stokes, I Mrs. Jagger „ Mrs. Virgo Miss Langley „ Wayne Loveland „ Mrs. Witham „ Mulcahy Co-opted Members: Mrs. E. Campbell Miss D. Plummer Miss E. M. Haslam Miss A. Wardle Lady Hawke Ex-officio: Alderman H. C. BALMAN, J.P., Mayor of Bermondsey, 1927-28. Councillor G, A. HORWOOD, J.P., Mayor of Bermondsey, 1928-29, HOUSING COMMITTEE, 1928. Chairman, 1927-28 Councillor LLEWELLYN Chairman, 1928-29 Councillor STARR Alderman Amos, M.A. Councillor Glasson Kirby „ Harding „ Salter, M.D., „ Miss Langley „ Lynch Smith, M.P. „ Mrs. Newton „ Wallsgrove „ Mrs. Nix Councillor Mrs. Amos „ Plummer Baker „ Ponsford „ Mrs. Salter, L.C.C. „ Bench „ Bradley „ Smith „ Mrs. Fortescue „ Thomas „ Franklin „ Tingle „ Mrs. George Ex-officio: Alderman H. C. BALMAN, J.P., Mayor of Bermondsey, 1927-28. Councillor G. A. HORWOOD, J.P., Mayor of Bermondsey, 1928-29. STAFF MEDICAL OFFICER OF HEALTH. D. M. Connan, M.B., B.S., D.P.H. CHIEF SANITARY INSPECTOR. Mr. E. C. Freeman. SANITARY INSPECTORS: Mr. G. L. Scott, Wharves and Food Inspector. Mr. G. A. Hoskins, Wharves and Food Inspector. Mr. H. J. Toogood, Housing Inspector. Mr. W. Davis, Drainage Inspector. Mr. J. G. Francksen, Markets Inspector Mr. A. H. Merryman, Food and Drugs Inspector. District Inspectors: No. 5.—Mr. G. F. J. Toll No. 1.—Mr. 0. W. R. Smart No. 6.—Mr. H. E. Butcher No. 2.—Mr. E. J. Pitts No. 7—Mr. R. E. Helden No. 3.—Mr. W. G. Luke No. 4.—Mr. J. W. Wood TUBERCULOSIS DISPENSARY. Clinical Tuberculosis Officer—C. H. C. Toussaint, M.R.C.S. Lady Almoner—Miss O. Pike. Tuberculosis Nurses-Miss C. Clapson, Miss L. Brown and Miss A. Wexler. Solarium Nurses—Miss G. Pearce and Miss C. Henniker. Caretaker —Mr. H. J. Madasa. MATERNITY AND CHILD WELFARE: Assistant Medical Officers for Maternity and Child Welfare Ruth W. Plimsoll M.B., B.S., D.P.H.; Florence L. Telfer, M.D., Health Visitors: District. District. No. 5.—Miss R. Bache No. 1.—Miss F. Mercer No. 6.—Mrs. D. Cottier No. 2.—Miss I. White No. 7.—Miss A. Carlton No. 3.—Miss M. Helden No. 8.—Miss F. Wadds No. 4.—Miss J. Child Dental Treatment: Municipal Dental Surgeon—Mr. Grantley Smith, H.D.D. Edin., L.D.S. Eng. Assistant Dental Surgeon (part-time)— Mr. W. H. Shapland, L.D.S. Eng. Dental Nurses—Miss W. Lambert and Mrs. D. Hodgson Prosthetic Assistants—Mr. G. W. Clarke, Mr. W. B. Monger and Mr. T. H. Baggott. Fairby Grange Convalescent Home: Matron—Miss A. E. Sewell Nurse—Mrs. M. A. Barden PUBLIC ANALYST. Mr. A. Prideaux Davson, A.R.C.Sc., F.I.C., F.C.S. PROPAGANDA AND ADMINISTRATIVE OFFICER: Mr. H. W. Bush. CLERICAL STAFF: Mr. A. I. Fair, First Clerk Miss R. Dutch, Clerk and Dispenser Mr. F. W. Smith, Second Clerk Mr. W. C. Tapsfield, General Clerk Mr. E. F. Walsh Third Clerk Mr. F. J. Carpenter, General Clerk Mr. A. Manning M. and C.W. Clerk Mr. C. H. Harris, General Clerk Mr. F. R. Parker. Junior Clerk Mr. C. W. Whye, General Clerk Mr.W. A. Campbell , Junior Clerk Mr C F. Yaxley, General Clerk Mr. A.W. Hancock, junior Clerk MORTUARY KEEPER: Mr. J. C. Stockwell FOREMAN DISINFECTOR: Mr. F. Delacour PUBLIC HEALTH DEPARTMENT, TOWN HALL, SPA ROAD, S.E.16. Borough of Bermondsey. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. To the Mayor, Aldermen and Councillors of the Borough of Bermondsey. Sir, Ladies and Gentlemen, I have the honour to submit the Annual Report of the Medical Officer of Health for the year 1928. The duty of compiling and submitting this report falls upon me, owing to the resignation of Dr. King Brown, which took effect on September 30th, 1928. As his successor, I may be allowed to give expression to the general regret that the passage of time has necessitated his resignation. I have also to thank the staff for their willing and efficient work, and in doing so I would like particularly to mention Mr. F. W. Smith, who is responsible for all the detailed work in connection with this report. I must also acknowledge with gratitude the cordiality of the chairmen and members of the three Committees. I am, Sir, Ladies and Gentlemen, Your obedient Servant, D. M. CONNAN. I.—VITAL STATISTICS. GENERAL. The area of the Borough (exclusive of area covered by water) is 1,336 acres. At the 1921 Census there were 18,266 structurally separate dwellings in the Borough, which were inhabited by 28,610 families or separate occupiers. The rateable value of the Borough on the 31st December, 1928, was £1,102,068, the product of a penny rate being £4,432. POPULATION. Census Estimate of Registrar General 1911 1921 to 30th June, 1927 to 30th June, 1928 125,903 121,000 115,200 119,452 It will be seen from the above table that according to the Registrar General's estimate there has been in one year a decrease in the population amounting to 5,800. The census of 1911 gave the population as 125,903, the corresponding figure for the census of 1921 being 119,452. During the ten year period, which included the war years, there was therefore a decline of 6,451. With this exception the fall of 5,800, which is estimated to have occurred during this year is greater than has ever been recorded in any previous ten years. So far as I have been able to ascertain from the Registrar General, there are no special circumstances to account for this phenomenal fall. BIRTHS. The total number of births registered in the Borough for the fifty-two weeks ended 29th December, 1928 was 2,086, consisting of 1,051 males and 1,035 females. The number for 1927 was 2,233. The birth rate for 1928 was 18.1 per 1,000 persons living, calculated on a population of 115,200. Calculated on a population of 121,000 the rate would have been 17.2 as compared with 18.5 for 1927. DEATHS. The total number of deaths belonging to the Borough registered during 1928 was 1,520, consisting of 813 males and 707 females. The number for 1927 was 1,566. The death rate for 1928 was 13.2 per thousand persons calculated on a population of 115,200. Calculated on a population of 121,000 the rate would have been 12.5 as compared with 12.9 for 1927. MARRIAGES. The total number of marriages in the Borough in 1928 was 1,055, being 34 above the number for 1927, and 40 below the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 18.32 per 1,000 of the population, compared with a marriage rate last year of 16.88 of the population, 121,000. Year No. Rate 1918 1,106 1821 1919 1,242 19-19 192O 1,383 21-40 1921 1,084 17-99 1923 1,056 17-34 1922 1,008 lb*b4 19 24 I 1.015 16-62 i i Ann Ifi.OO 1925 I 1,038 16-88 AA a 1/? It 1926 994 16-15 1927 1.021 16-88 Average for years 1918 —1927 1,095 17-73 1928 1,055 18-32 (10) INFANTILE MORTALITY RATE FOR 25 YEARS. (11) INFANTILE MORTALITY. Whole Borough London Year Rate per 1,000 Births No. of Deaths Rate per 1,000 Births No. of Deaths 1918 322 139 7,965 107 1919 262 99 7,039 85 1920 337 83 9,141 76 1921 306 95 8,077 80 1922 324 102 7,089 75 1923 220 76 5,615 61 1924 229 78 5,904 69 1925 210 79 5,599 68 1926 146 60 5,067 64 1927 149 67 4,357 59 Average for years 1918-1927 250 88 6,585 74 1928 178 4,879 85 67 It will be noted that the Infantile Mortality Rate for 1927 was sixty-seven, and that the Rate for the present year is eightyfive. This unfortunate rise is accounted for by the large number of deaths attributable to Measles and Pneumonia. TUBERCULOSIS OF THE RESPIRATORY SYSTEM In the following Table will be found particulars of deaths from Tuberculosis of the Respiratory System since the year 1918. St. Olave Whole Borough London Bermondsey Rotherhithe Sub-District No. No. Rate No. Rate Year No. Rate Rate No. Rate 1918 117 1.66 43 1.42 9 1.20 169 1.56 7048 1.78 104 1.28 58 1.66 12 1.39 174 1.40 5332 1.22 1919 1920 81 0.96 46 1.27 10 1.12 137 1.06 4791 1.05 1921 106 - 43 - 14 - 163 1.35 4813 1.07 119 1922 - 43 - . 7 - 169 1.39 4888 1.08 1923 95 - 35 14 - 144 1.18 4432 0.97 - 1924 92 - 46 - 11 149 1.22 4486 o.98 - 99 1925 35 11 145 1.18 4361 0.95 - - - 12 1926 100 39 151 1.23 4066 0.88 - - - 1927 87 42 15 144 1.19 4140 0.91 - - - Averages for years 1918-1927 100 - 43 11 - 154 4836 1.09 1.28 - 1928 88 - 43 - 12 - 143 1.24 3985 0.89 VITAL STATISTICS OF WHOLE DISTRICT DURING 1928 AND PREVIOUS YEARS. Year Population estimated to Middle of each Year Total Deaths registered in the District Total Deaths in Public Institutions in the District Deaths of Non- Residents registered in Public Institutions, etc. in the District Deaths of Residents registered in Public Institutions beyond the District Net Deaths at all Ages belonging to the District Births Rale Under 1 Year of Age At all Ages No. No. Rate No. Rate per 1,000 Births registered No. Rate 1 2 3 4 6 6 7 8 9 10 11 12 13 1918 121,465 2,323 19.1 322 139 2,142 19.8 1,007 191 439 2,390 22.0 1919 124,239 2,637 20.4 212 80 1,600 12.8 709 165 313 1,748 14.1 1920 129,189 4,038 31.2 280 69 1,466 11.3 689 105 281 1,642 12.7 1921 120,500 3,231 26.8 261 80 1,313 10.8 657 51 394 1,656 13.7 1922 121,100 3,107 26.1 259 81 1,572 12.9 778 43 496 2,025 16.7 12.1 1923 121,709 2,912 23.9 220 76 1,192 9.7 330 42 288 1,480 1924 122,100 2,913 23.8 200 68 1,277 10.4 720 43 337 1,657 13.6 321 1,554 12.6 1925 2,652 21.6 188 71 669 123,000 1.280 10.4 47 1,484 12.1 1926 123,100 352 2,414 19.6 126 52 1,163 9.4 624 31 12.9 1,566 1927 2,233 18.5 119 53 1,236 10.2 616 22 352 121,000 Averages for years 1918-1927 122,740 2,852 23.1 219 1,424 11.8 680 74 357 1,720 14.2 77 1928 2,086 18.1 143 69 1,230 10.7 671 39 329 1,520 13.2 115,200 (13) OTHER INSTITUTIONS, Etc., Etc. I. Institutions, etc., within the District receiving sick and infirm persons from outside the District. 11. 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 in the District No. of Deaths No. of Deaths No. of Deaths Bermondsey and Rotherhithe Hospital Ladywell Institution Ambulances, etc., on way to Hospital 3 70 Brook Hospital, Shooters Hill 8 19 Bexley Mental Hospital 7 Belgrave Hospital 1 Brompton Hospital 1 Cane Hill Mental Hospital 5 Deaths in River Thames, Surrey Commercial Docks. Wharves, etc. Charing Cross Hospital 2 Colindale Hospital, Hendon 2 Downs Hospital, Sutton 1 14 Eastern Hospital, Homerton 2 East London Hospital for Children 3 Railway 2 Epiletic Colony, Edmonton 1 Evelina Hospital 8 Private Houses 4 Forest, The, Epsom 1 Greenwich and Deptford Hospital 2 Total 39 Grove, The, Epsom 2 Grove Hospital, Tooting 3 Grove Park Hospital, 2 Grosvenor Sanatorium, Kennington, Kent 4 Guy's Hospital 72 High Wood Hospital, Brentwood 2 Hopfields, Staplehurst, Kent 3 Hundred Acres, Epsom 1 Ipswich Docks 1 Isolation Hospital, Loose, Kent 1 Jetty, Reserve Supply Depot, Greenwich 1 Joyce Green Hospital 2 King's College Hospital 1 Ladywell Institution 70 Lewisham Hospital 2 London Fever Hospital 1 London Hospital 2 Lying-in Hospital, York Road 1 Manor, The, Epsom 1 Margate Cottage Hospital 1 Maudsley Hospital Camberwell 1 Metropolitan Asylum, Leavesden 2 Metropolitan Mental Hospital, Caterham 2 Newington Institution, Southwark 1 North Western Hospital, Hampstead 1 Park Hospital, Hither Green 15 Poplar Hospital 2 Private Houses 12 Quarry Hill, Tonbridge 1 Queen Mary's Hospital, Carshalton 1 (14) OTHER INSTITUTIONS, Etc., Etc .—continued Institutions, etc., within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, etc., the Deaths in which have been distributed among the several localities in the District. Queen Mary's Hospital, Wandsworth 1 Queen Mary's Hospital, West Ham 1 River Thames 3 Royal Victoria Hospital, Folkestone 1 Royal Waterloo Hospital 3 St. Bartholomew's Hospital 1 St. George's Home, Chelsea 1 St. Gile's Hospital, Camberwell 1 St. Joseph's Hospice, Hackney 1 St. Peter's House, Hampstead 1 St. Thomas's Hospital 3 Seamen's Hospital, Greenwich 1 South Eastern Hospital, New Cross 19 South Western Hospital, Stockwell 4 Southwark Hospital 2 Streets 4 Tadworth Court, Epsom 1 Tooting Bee Hospital 16 University College Hospital 1 West Park Mental Hospital, Epsom 6 Total 329 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1928. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the District. Causes of Death All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards All Causes Certified 1520 178 102 64 53 80 160 353 530 Uncertified - - - - - - - - - (15) Enteric Fever 1 - - - - - 1 - - Small Pox - - - - - - - - - Measles 77 21 36 18 2 - - - - scarlet Fever 3 - 1 1 - 1 - - - Whooping Cough 26 8 10 5 3 1 - - - Diphtheria 16 4 - - - - 8 4 - Influenza 1 - - - - - - 1 - Encephalitis Lethargica 3 - - 1 1 - - 1 - Meningococcal Meningitis 1 - - - - 1 - - - Tuberculosis of Respiratory System 143 - 1 - 4 36 57 42 3 Other Tuberculous Diseases 21 3 2 5 2 4 4 - 1 Cancer, Malignant Disease 134 1 - 1 1 8 64 59 - Rheumatic Fever 4 - - - 1 1 1 - 1 Diabetes 8 - - - - - 2 3 3 Cerebral Haemorrhage, etc 106 2 - — - 1 3 31 69 Heart Disease 225 2 - 6 8 14 74 121 - Arterio-sclerosis 45 - - - - - 7 38 - CAUSES OF, AND AGES AT. DEATHS DURING THE YEAR IMS—continued Causes of Death Deaths at the subjoined ages of " Residents " whether occurring in or beyond the district All Ages 1 and under 2 2 and under 5 65 and upwards Under 1 5 and under 15 . 15 and under 25 25 and under 45 45 and under 65 Bronchitis 116 4 - 1 - 1 6 22 82 Pneumonia (all forms) 197 59 35 16 3 8 9 35 32 Other Respiratory Diseases 19 - - - 6 3 8 1 1 (16) Ulcer of Stomach or Duodenum 11 1 - - 1 4 5 - - Diarrhcea and Enteritis (under 2 years) 14 11 - - - - 3 - - Appendicitis 6 - - 3 1 - 2 - - Cirrhosis of Liver - - - - - 5 7 2 - 28 2 5 8 11 Acute and Chronic Nephritis 1 1 - - Puerperal Sepsis - - - - - - - - - Other Accidents and Diseases of Pregnancy and Parturition - - 4 - 4 - - - - Congenital Debility and Malformation, Premature Birth 50 - - - - - 49 1 - Suicide 7 - 3 3 - - - - - Other Deaths from Violence 65 4 2 4 11 6 9 O 21 Other Defined Diseases 179 15 1 7 10 9 24 41 72 Diseases ill-defined or unknown 3 - 1 - - - - 1 1 1520 178 102 64 53 80 160 353 530 DEATHS FROM ZYMOTIC DISEASES, 1928. Whooping Cough Enteric Fever Diarrhoea All Causes Principal Zymotic Diseases Smallpox Measles Scarlet Fever Diphtheria No. Rate No. Rate No. Rate No. Rate No Rate No. Rate No. Rate No. Rate No. Rate 1918 2390 22.0 229 2.11 - - 66 3 03 23 21 84 .78 - - 48 .44 71 1919 1748 14.1 113 .91 - - .14 5 .04 21 .17 4 .03 3 .02 62 .49 18 1920 1642 12.7 163 1.26 - - 56 7 .06 25 .19 41 .32 1 .01 33 .26 .44 1921 1656 13.7 197 1.63 - - 3 - 18 .15 69 .57 14 11 3 .03 87 .72 1922 2025 16.7 292 2.41 - - 101 .831 11 .09 90 .74 65 .53 1 24 .19 - 1923 1480 12.1 125 1.02 - - 13 .10 3 .02 33 .27 1 2 09 2 .01 62 .50 1924 1657 13.6 117 .95 - 48 .39 6 .04 25 .20 11 .09 1 26 . 21 - - 1925 1554 12.6 96 .78 - - 20 .16 3 .02 29 .24 27 .22 - 17 .14 - 1926 1484 12.1 94 .76 - - - .19 6 .05 42 .34 1 .01 - 21 .17 - 1927 1566 12.9 45 .37 - 9 .07 - - 13 .11 10 .08 - - 12 .09 - Average for years 1918-1927 1720 147 1.22 - 36 .30 6 37 .30 27 .23 .01 39 .32 14.2 1 - .05 1520 13.2 1.19 - - 77 3 .03 16 .14 I .23 1 14 .12 1928 137 .67 26 .01 II.—INFECTIOUS DISEASES. The following diseases are notifiable:— Anthrax Acute Polioencephalitis Acute Poliomyelitis Acute Primary Pneumonia Acute Influenzal Pneumonia Cholera Cerebro Spinal Meningitis Continued Fever Diphtheria Encephalitis Lethargica Enteric Fever and Typhoid Fever Erysipelas Hydrophobia in Man Glanders Membranous Croup Malaria Puerperal Fever Ophthalmia Neonatorum Relapsing Fever Puerperal Pyrexia Small Pox Scarlet Fever and Scarlatina Typhus Tuberculosis—all forms Owing to the housing conditions of the Borough, it is the practice to remove to hospital nearly all cases of diphtheria and scarlet fever. Only seven cases were nursed at home last year, the accommodation in these instances being satisfactory. Measles is not notifiable, but hospital treatment for patients suffering from this disease can be obtained by the doctor in charge of the case on application, either direct to the Metropolitan Asylums Board or to the Medical Officer of Health. Following notification the District Sanitary Inspector visits the premises at once for the purpose of taking particulars and investigating the source of infection. In the case of diphtheria, the Sanitary Inspector also arranges for the examination of contacts, The number of such visits during 1928 was 1859. NOTIFIED CASES OF DIPHTHERIA FOR 25 YEARS. DIPHTHERIA. For a number of years past diphtheria has been a black spot upon our otherwise fairly clean bill of health. The accompanying chart shows that the number of cases notified actually reached the very high figure of 1,100 in 1922, and although the figure for 1928 is much lower, viz.:- 603, this cannot be regarded as a satisfactory state of affairs. The number of cases returned as not suffering from diphtheria was 51. For the last six years of the decade, 1917—1926, Bermondsey has suffered proportionately more heavily than any other London Borough in respect of incidence and mortality from this disease The average number of notifications has been 509 and the average number of deaths 36. It is a little difficult to suggest an explanation for these figures, and a little dangerous, since so many explanations of similar phenomena have subsequently proved to be wrong. The prevailing conditions of overcrowding leap to the mind as a possible explanation, and I do not think there is much doubt that these conditions do materially influence the figures and tend to the spread of the disease. Another factor is probably lack of knowledge resulting in infection of a second child before the original case is removed to hospital. Possibly also the infection is spread by carriers though the number of carriers known to us is not very large. It is a curious and interesting fact that the attack rate is higher in the "model dwellings" of the Borough than it is in the "condemned areas." No doubt the problem is an interesting one from the statistician's point of view; but the one fact which seems to emerge from the figures is that the disease is very prevalent in the Borough and that the population as a whole shows a high degree of susceptibility. Any means of combating the disease which offers the least hope of success should be adopted and it is hoped that the means provided by the Schick Test and Schick Immunization will soon be available. SCARLET FEVER. The position with regard to scarlet fever is shown in the accompanying tables and chart. The number of cases notified during the year was 493. The average number of cases per annum notified during the past ten years is 570. While the number notified this year is below the average the figure is still too high, and the only compensating feature seems to be that the disease is mild in form. The number of cases returned from hospital as not suffering from scarlet fever was 22. SMALL-POX. One case of small-pox occurred during the year and the circumstances were such as to favour the spread of the disease. The patient had been unwell for several days during which time she continued to serve in the small general shop, of which her husband was the proprietor. There had also been a wedding in the house during this period which a large number of guests had attended. Not unnaturally, I anticipated further cases, but stringent precautions were taken to prevent the spread of the disease, and I am happy to state that no other persons were infected, and the patient made a complete recovery. OPHTHALMIA NEONATORUM. In no case was vision impaired, but the subsequent history of one patient was unobtainable owing to the removal of the family to an unknown address. Cases Notified Treated 1 I In At home Hospital Vision Vision Total Deaths Un- Impaired Blindness Impaired Bi'7— ! — ! — NOTIFIED CASES OF SCARLET FEVER FOR 25 YEARS. PUERPERAL FEVER AND PUERPERAL PYREXIA. The number of cases notified will be found in the accompanying table. Facilities are provided by the Council for assistance in the diagnosis and treatment of these cases. These facilities include the provision of the services of a consultant and of a nurse where necessary. We also undertake bacteriological examinations and arrange for the admission of patients to hospital where this is desired. The total number of cases is small, and these facilities have been utilised during the year, as follows :— Facilities No. of Cases Second Opinions Nil Nursing provided 1 piUViUCU Bacteriological examinations Nil Admitted to Hospital 21 DISINFECTION. Disinfection of premises and of articles exposed to infection is insisted upon in all cases of notifiable infectious disease. Respect is always had as far as possible to the convenience and comfort of the householder. Rooms are sealed up for disinfection and beds, bedding, clothes and other articles are removed and disinfected at the station. Plans for a new disinfecting station have been prepared, and it is hoped that this will be open towards the end of the year. All library books are disinfected before being returned to the library. The cleansing of verminous persons is also undertaken in the disinfecting station. The number of persons cleansed during the year being 1 female and 102 male adults. The following table shows the number of articles passed through the steam disinfector during the year under report:— Beds 1,357 Pillows (cases) 2,210 Blankets 3,879 Quilts 1,886 Bolsters 948 Sheets 2,277 „ (cases) 407 Books 584 Carpets 11 Miscellaneous 8,128 Cushions 348 Verminous Clothing 1,027 Mattresses 277 „ Bedding 119 Hair (Bundles) Nil Overlays 969 Pillows 2,775 „ (cases) Nil 31,297 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Number of rooms disinfected 2,220 (22) SHELTER. Four flats are provided in The Neckinger for the temporary housing of families or persons while their premises are being disinfected. There were 46 persons so accommodated during the year. NURSING. By agreement with the local nursing associations the services of district nurses may be obtained at the expense of the Council, for the nursing of patients in their own homes. At present this arrangement applies to the nursing of cases of acute primary and acute influenzal pneumonia, puerperal fever and pyrexia, measles and whooping cough, but this service can be extended when necessary. The number of cases nursed during the year under this arrangement was 111. BACTERIOLOGICAL LABORATORY. The work of the bacteriological laboratory consists mainly in the examination of sputa for tubercle bacilli and the examination of throat swabs for diphtheria bacilli. Man}' of the throat swabs are sent by general practitioners and sterile outfits for this purpose are supplied free on application to the Medical Officer of Health. All diphtheria contacts of school age are excluded from school until the throat swab is negative. As mentioned above, the Sanitary Inspector makes an appointment for the examination of the contacts at the Town Hall. A positive result of course necessitates a further examination, and treatment in the meantime by the private practitioner. Proved " Carriers " are usually referred to the London County Council " Carriers' " Clinic at Guy's Hospital. In addition to the examination of swabs and sputa, other bacteriological investigations are undertaken when requested. Results of Examination Total Examinations Nature of Specimen Positive Negative 1927 1928 1927 1928 1927 1928 Diphtheria (specimens taken by Medical Officer of Healthy 796 1171 30 102 766 1069 Ditto (taken by general practitioners) 1208 1366 100 180 1106 1186 Diphtheria, (total specimens taken) 2002 2537 130 282 1872 2255 Phthisis 1228 1300 224 237 1004 1063 Various 105 79 7 3 98 76 Total specimens taken 3335 3916 361 522 2974 3394 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1928. NOTIFIABLE DISEASE NUMBER OF CASES NOTIFIED BERMONDSEY ROTHERHITHE ST OLAVE Total Cases removed to Hospital At Ages—Year upwards 3 5 6 Total 1 2 3 Total At all Ages 2 4 St. John St Olave St. Thomas Total Under 1 year 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 65 and upwards Small-pox Diphtheria (including 1 - - - - I 1 - - - - - - - - - 1 - - - - 1 - 1 Membranous Croup) 603 13 214 281 59 31 - 56 79 93 69 53 55 405 72 77 29 178 8 8 5 20 5 602 Erysipelas 43 - - 2 4 14 16 7 3 4 4 3 4 - 18 4 10 8 22 1 1 1 3 2 Scarlet Fever 493 3 157 288 27 18 - - 17 47 59 60 57 304 67 81 23 171 9 1 8 18 64 487 Cerebro-Spinal Meningitis 1 - - - 2 - 1 - - - 1 - - - 2 - - - - - - - - 2 Acute Polio-Myelitis and Acute Polio Encephalitis. 2 - - 2 - - - - - - - - 1 1 1 2 - - - - - - - 1 Ophthalmia Neonatorum 8 8 - I - - - - - - 1 - - - 4 1 1 6 6 - - 1 1 7 Anthrax 2 - - - - 1 1 1 - - - - - 2 - - - - - - - - 2 - Enteric Fever 2 - - - - - 1 - - - 1 1 - - 1 - 1 - 1 1 - - 2 - - Puerperal Fever 7 - - - 1 6 - - - 2 1 1 1 1 6 - - - - - 1 - - 1 7 2 Puerperal Pyrexia 20 - - - 10 10 - - 2 3 4 - 3 14 1 4 4 - 5 1 - 1 14 Encephalitis Lethargica - - - - - 1 1 3 1 - - 1 - - - - 1 1 1 1 - 4 3 - Dysentery - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (Acute Primary and Acute Influenzal) 53 8 10 3 10 8 4 11 7 6 4 1 33 7 8 4 19 1 - - 1 10 4 1 Tuberculosis — Respiratory System 184 - 2 14 60 36 6 6 27 31 18 16 26 124 32 11 55 11 13 5 11 66 13 - Other forms of Tuberculosis 54 2 10 19 12 10 1 9 3 9 7 4 2 34 4 2 7 13 4 2 1 7 - - Totals 1478 34 393 618 185 162 69 17 107 172 210 166 5140 154 949 191 197 84 472 26 15 16 3 1131 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEARS 1919-1928. Notifiable Disease. 1919 1921 1923 1024 1925 1922 1920 - - - 2 - - Small Pox - Diphtheria (including Membranous Croup) Erysipelas 278 268 741 1,111 586 541 535 59 Erysipelas 81 54 50 19 42 35 scarlet Fever 388 976 1,164 652 323 395 353 Cerebro-Spinal Meningitis 4 6 1 5 3 1 3 Acute Polio-Myelitis and Acute Polio- Enceplialitis 2 2 1 - - 2 2 Ophthalmia Neonatorum 32 37 15 12 18 12 15 Anthrax 3 5 1 1 - 2 3 Enteric Fever 6 7 8 4 2 2 5 Puerperal Fever 2 21 7 7 4 2 9 Puerperal pyrexia - - - - - - - Encephalitis Lethargica - 4 2 1 21 8 4 Dysentery 3 - - - 1 - - Malaria — 18 3 1 1 - 1 Continued Fever - 1 - - - - - Pneumonia (Acute Primary and Acute Influenzal) - 81 37 234 125 243 119 Tuberculosis :— 119 Respiratory System 369 376 317 250 226 245 339 Other forms of Tuberculosis 131 99 79 96 86 90 76 1,924 2,490 2,496 1,420 1,408 Totals 1,296 1,580 III.- TUBERCULOSIS. In submitting the report on the Tuberculosis Scheme for the year, I have to point out that this has been written by Dr. C. H. C. Toussaint, who, previously Assistant Tuberculosis Officer, was appointed to succeed me on October 1st, 1928. Coming, as he has done, more or less freshly to problems of administration in connection with tuberculosis, he has been greatly impressed by the need of reform in two particular directions. He is of opinion that there is still far too much delay in the diagnosis and notification of tuberculosis, and he is also impressed by the tremendous need for improved housing conditions. I agree most heartily with him in both these expressions of opinion, and have dealt at some length elsewhere with the appalling housing conditions which distress him. We are very anxious to preserve amicable working relations with all the general practitioners of the Borough, and to provide a service in connection with tuberculosis which shall be of real use to them. They on their.part are anxious to do their best for their patients, and in the case of tuberculosis, the best can only be done, when the patient is seen in the very earliest stages of the disease. This is pre-eminently a matter for the family doctor. It is he to whom the patient first goes, and it is to him that we are bound to look for improvement in the matter of early notification. A further valuable work which he could perform would be to examine contacts himself, or if this be impossible, persuade them to attend for examination at the Dispensary. I have pleasure in submitting Dr. Toussaint's report:- "The number of deaths from all forms of tuberculous disease in 1928 was 164, and in Table I. an analysis of these deaths is shown according to the ages at death. (26) TABLE I. TUBERCULOSIS, 1928 -NEW CASES AND DEATHS. AGE—PERIODS NEW CASES DEATHS Pulmonary Non Pulmonary Pulmonary Non- Pulmonary M . F. M. F. M. F. M. F. 0 - - 2 2 - - 2 1 1 1 1 11 4 1 - 6 1 5 6 3 5 7 1 - 1 1 10 3 3 3 4 - 3 - - 15 12 18 2 8 3 10 - 1 20 15 24 3 1 10 13 3 - 25 29 18 2 5 22 8 1 1 35 20 5 4 1 15 2 - 2 45 13 12 - 1 16 9 - - 13 - - 12 - 3 5 55 - 4 3 - 2 1 1 J - 65 and upwards 1 90 32 34 82 61 16 5 116 There is apparent one striking phenomenon, which is common to the whole country, i.e., the resistance to pulmonary tuberculosis shown by children of the ages of 5 to 15. What are the factors contributing to this ? Are they environmental or constitutional ? A close liason exists between the school medical service and the Tuberculosis Officer, and it is very difficult for a child showing any symptoms or signs of tuberculosis, to escape investigation and treatment when necessary. It might appear that the co-operation of the two services had contributed to this resistance and low incidence of pulmonary tuberculosis in the age groups mentioned, but this phenomenon was observed before the school and tuberculosis schemes came into being. One must therefore look elsewhere for an explanation. Does there occur in childhood a primary infection which is dormant until adult life is reached ? Granted that such a thing may occur it brings one no nearer to the discovery of the factor which enables these children to resist the disease even when living, as is often the case, in close association with advanced cases of tuberculosis. To some of the children, delicate, thin and hirsute the name 'pre-tubercular' was applied, and it has been held that these are cases of primary infection. The appellation was unfortunate and has acted as a cloak for many sins chiefly of omission, in the shape of insufficient investigation of cases of this kind. Very few of them show evidence of tuberculosis in later life, and the condition of some of them would probably be found on closer examination to be due to non-tuberculous causes such as bad housing, malnutrition, intestinal parasites, rheumatism or even specific disease. The question of pulmonary tuberculous infection in childhood is of great importance and the solution of this problem of immunity may well lead to a clearer insight into the disease as a whole. A further point which is shown in Table I. is that the point of maximum mortality for both sexes occurs at the age of 25, i.e., the 'young adult' type of disease is the most fatal. The figures for new cases show that this type of disease is also the most prevalent. In the case of females the mortality curve and the maximum peak conform closely to those for the County of London as a whole. In the case of males, however, the young adult type appears to be more prominent than in London. Since the middle of the nineteenth century there has been a steady drop in the tuberculosis mortality throughout the country. The decline as Brownlee showed is most naturally to be regarded as the ebb of a long epidemic wave to be succeeded perhaps, indeed probably, by the rise of the next wave in its turn—unless science can find the way of interference—and its explanation can only be given by further study. In London, a great change has occurred since the war. If the mortality curves for 1911 and 1926 be compared (Diagram I.) it will be seen that the peak of maximum female mortality has entirely changed from the 'middle age to the young adult type, whereas in the male curve there is now a small though definite peak at the ages of 20 to 25 which in 1911 was hardly noticeable. In England and Wales there has of recent years been an increase in mortality in early adult life, coinciding with a decline at middle age, and it is quite possible that we are now on the threshold of a new epidemic wave (of the early adult type). (28) The mortality in middle age appears to be closely connected with the wear and tear of a hard industrial life, whereas in the young adult it appears to be influenced by what may be termed the irresponsibility of youth. Boys and girls who have recently left school and started work have a natural desire to assert their new independence. They now earn their own livelihood, and there is a tendency to enjoy life while neglecting many of the rules of careful living and hygiene, until finally the resistance of the body is undermined. It must also be borne in mind, that, at a time of life when it is most needed, there is a gap in the provision of medical attention. The School Medical Service ceases to take cognisance of children at the age of 14 and the insurance system does not begin to operate until the age of 16 is reached. It is to be hoped that this will soon be remedied. TABLE 11. TUBERCULOSIS, 1928 PERIOD BETWEEN NOTIFICATION AND DEATH. Period Between Notification and Death Respiratory System Other Forms Males Females Total Percentage of Total Deaths Percentage of Total Deaths Males Females Total Not notified 10 7 IV 11.82 6 3 9 42.86 0-1 month 14 13 27 18.89 6 1 7 33.33 1-3 months 5 8 13 9.10 - - - - 7.00 1 4.76 3-6 months 3 7 10 - 1 6-12 months 10 4 14 9.80 1 - 1 4.76 1-2 years 14 6 20 14.00 1 - 1 4.76 2-5 years 17 10 27 18-89 1 1 2 9.53 Over 5 years 9 6 15 10.50 - 1 — _! L - Totals 82 61 143 100. 00 16 5 21 100 00 Table II. shows the deaths from tuberculosis in relation to the period which elapsed between the date of notification and death. The figures are far from satisfactory, in that 30% of the cases which died of pulmonary tuberculosis were either net notified at all or died within one month of notification. A few of these cases occurred in mental hospitals outside the district, a DIAGRAM I. MORTALITY IN PULMONARY TUBERCULOSIS IN LONDON. few were inhabitants of common lodging houses, with no permanent abode, who did not seek medical attention until the last moment, and a few were inquest cases. As is stated later, there are also, many people, who, through fear, apathy, or ignorance, do not consult their doctor till late in the disease. It must be remembered that notification of tuberculosis is a statutory obligation on the part of every medical man, and practitioners should make every effort to effect this as early as possible. Enquiries are always made by the Medical Officer of Health in all cases of tuberculosis which are not notified at death, or die within a very short time after notification. The figures for 'other forms' of tuberculosis are worse than those for the 'respiratory system.' The former are almost wholly composed of deaths from varieties of miliary tuberculosis in infants. There is admittedly a difficulty in the diagnosis of many of these cases, but as will be shown later (Table III.) early notification is of the utmost importance for it may well lead to the discovery of a new and unsuspected case of tuberculosis in the parents. In view of the unsatisfactory figures shown in Table II., it is well that we should view the tuberculosis scheme, as it exists, and discover if there is any part or condition capable of improvement. The paucity of early cases is revealed at once as the rock on which the whole tuberculosis scheme at present founders, and is well brought out by the following figures of adult cases of pulmonary tuberculosis referred to the Tuberculosis Officer during the past year:— Percentage of Class of case. Number. Total. T.B. —(Early Cases) 33 29-7 T.B. + 1 (Cases in fair condition, but with tubercle bacilli in the sputum) 21 18-8 T. 8.+2 (Late Cases comparatively few of whom do well) 58 51-8 When 50% of the cases referred for treatment are already suffering from advanced disease, it is no wonder that the sanatorium system is sometimes considered to be of little use and hardly worth the large expenditure which is entailed. It must be remembered that early cases of tuberculosis are curable and that a properly organised sanatorium system provides at present the only hope of cure. In 1926 the Medical Officer of Health for the London County Council investigated all the adult pulmonary cases which had received treatment in 1921 and the results indicate clearly the prospect of cure in early cases. Alive 5 years Class. Total. after discharge. Dead. T.B. — 468 83-5% 16-5% T.B. +1 330 61-5% 38-5% T. 8.+2 1,299 34-0% 66-0% T. 8.+3 858 3-7% 96-3% Is it possible to increase the number of early cases? If so, how can this be done ? The sources from which cases are referred for treatment can be divided into three and each considered in its turn. 1. Public Health Propaganda. This will be discussed at greater length elsewhere, and a short space only will be devoted to it here. There arc undoubtedly many people suffering from tuberculosis who because of ignorance and apathy do not consult their medical attendant until the disease is advanced. Propaganda is of great service, in this direction, by advising people to obtain medical advice at the earliest possible moment and by impressing on them the rules of hygiene. The Tuberculosis Officer must be prepared to take his full share in this work —but a word of caution is needed. In Tuberculosis —as perhaps in cancer also, it is an easy matter to defeat one's own ends by so instilling fear into a person that he will hide his disease rather than consult a doctor. It is better to confine oneself to general hygiene rather than to deal at too great a length with one particular disease and so produce an adverse effect. It is significant of our view that in the large number of lectures given in this Borough during the past year there was not a single one devoted solely to tuberculosis. 2. The General Practitioner. Of 21 T.B.+ 1 cases during the past year 16 were referred to the Tuberculosis Dispensary by general practitioners and of 58 T.B. +2 cases 37 were so referred. Through the hands of the general practitioner therefore the majority of pulmonary cases pass before reaching the Tuberculosis Officer. The Dispensary is primarily a centre for diagnosis and general supervision and the Tuberculosis Officer has at his disposal every facility for the early diagnosis of the disease. Many of the practitioners of the district make use of this service and are supplied with full reports on the cases sent for investigation. In some instances, however, there is a tendency to disregard the patient's symptoms and to delay action until finally a sputum test is made and the result found to be positive. Fifty-three sputum positive cases were referred to the Dispensary by general practitioners in 1928 and 29 of these were notified beforehand, the majority of them only after a positive sputum result had been obtained. Eleven cases were not notified until after a positive sputum result and yet they all had pronounced physical signs when seen by the Tuberculosis Officer. It must not be forgotten that a thorough examination of the chest is essential in these cases. It will be seen therefore that, although there may be no delay in notification once a case has been diagnosed as tuberculosis, there has been in some instances a definite delay in arrival at the true diagnosis. In an early active case, particularly in a young adult, any such delay makes a great difference to the prognosis. It is generally regarded as a crime to keep a child with a tuberculous hip on his legs, yet a child with a disorganised hip joint may live, although he be crippled, but an adult with extensive and active infiltration of his lungs will invariably die at an early date. It is the aim of the Tuberculosis Officer to work in the closest harmony with the practitioners of the district. It is his duty to investigate fully every case referred to him, and it is to be hoped that all practitioners will co-operate by referring to him at once any case presenting symptoms suggestive of early tuberculosis. 3. The Tuberculosis Officer. An efficient, full time Tuberculosis Officer, backed by a capable dispensary staff, should be the mainstay of the tuberculosis scheme. It is essential for him to have at his disposal all possible aids to diagnosis and, ideally, he should have control over a certain number of beds, some for the purposes of observation and some for cases needing immediate treatment prior to admission to sanatoria in the country. The examination of contacts provides opportunity for the detection of early cases, and during the year a system was started on the lines described by Doctors E. L. Opie and F. M. McPhedran of the Henry Phipps Institute, University of Pennsylvania. In the "march past" which is usually held soon after the notification of a case of tuberculosis comparatively few new cases are discovered, but there are many families in Bermondsey, and probably in other districts, where subsequent cases have occurred after the lapse of months or even three to five years. Memorandum 121/T, issued by the Ministry of Health in 1926, states that 'many persons suffering, or suspected to be suffering, from tuberculosis who attend at the dispensary of their own accord, or who are referred by a private medical practitioner, may give a history of previous contact with a known case of tuberculosis; but this does not render them 'contacts' for the purpose of Table 1., and they should be regarded as new cases.' As a result of this regulation the number of positive contacts in all districts is low and the amount of infection in the home is held to be small. Opie and McPhedran carried out their investigation by charting all the members of a tuberculous family and followed them up over a number of years. Diagram II. has been drawn up to show the method and illustrates the history of a family in Bermondsey. A full description of the cards and of the conclusions reached by Opie and McPhedran will be found in the 19th Report of the Henry Phipps Institute, 1927. An effort will be made to follow up contacts over a number of years and it seems likely that this will aid in the detection of cases in an early stage of the disease. In Diagram II. are shown two deaths from tuberculous meningitis and in Table III. are set out all the deaths from tuberculosis in children for the year with particulars of contacts. DIAGRAM II. MULTIPLE CASES OF TUBERCULOSIS IN ONE FAMILY. The thin vertical red lines indicate the life lines of the persons while in good health. Tuberculosis, when diagnosed, is indicated by a heavy red column on right of life line, and a positive sputum by an added column on the left. Each small square, vertically, represents a period of six months M= Mother, who developed pulmonary tuberculosis with a positive sputum and died in one year. Five years after her death the elder sou A is notified as a case of pulmonary tuberculosis, and a positive sputum appears three years after notification. B is a younger son who developed pulmonary tuberculosis with a positive sputum three and a half years after his brother had become infectious, a and b are children of A, both of whom have died from tuberculous meningitis. TABLE III. Register No. Initials of Child Sex Age at Death Certified Cause of Death Post Mortem Examination Particulars of Contacts 8012 I A.G. M. Refused examination No 4 yrs. Tuberculous Meningitis M.C. F. No Refused examination 6 yrs. Tuberculous Meningitis 8028 8035 E.C. M. 4 yrs. Tuberculous Meningitis Yes Refused examination 8057 M. Tuberculous Meningitis Yes Father —Pulmonary Tuberculosis J.G. 4 yrs. 8059 M. E.C. 4 yrs. Tuberculous Meningitis No Refused examination 8067 4 mths. Father —Pulmonary Tuberculosis—Sputum positive R.C. F. Miliary Tuberculosis Yes 8115 J.Y. M. 7 mths. Miliary Tuberculosis No Mother —Pulmonary Tuberculosis 8161 Yes Refused examination M. Miliary Tuberculosis S.H. 13 mths. E.S. F. Tuberculous Meningitis Yes Father —Pulmonary Tuberculosis—Sputum positive 8178 4 yrs. W.K. l½ yrs. M. Refused examination Tuberculosis of Lungs No 8180 R.S. M. Tuberculous Meningitis No Refused examination 3 yrs. 8203 J.M. Tuberculous Meningitis Father —Pulmonary Tuberculosis —Sputum positive 8230 M. 13 mths. No 8233 J.C. M. Tuberculous Meningitis 7 mths. No Mother —Pulmonary Tuberculosis —Sputum positive In spite of all efforts in only six cases out of thirteen were the mothers and fathers willing to attend for examination. In all six cases either the father or the mother was found to be suffering from pulmonary tuberculosis, in four cases with a positive sputum. In one sputum negative case, 8115, the diagnosis was confirmed at the Brompton Hospital. In the other case, 8057, nothing was suspected until an X-ray examination revealed definite mottling at one apex. In both these cases it is possible that the parent might at one stage have been an open case of tuberculosis. As was stated earlier the general practitioner can be of great help by urging on the contacts the necessity of attending for examination. It appears to be certain that direct infection from one person to another, often a near relative, plays a very large part in the spread of tuberculosis. In an industrial district overcrowding and poor housing conditions are highly conducive to the occurrence of multiple cases of tuberculosis in a family. Not only are several people forced to live and sleep in too small a space, but the conditions lower their natural resistance and render them more easily a prey to infection. Home environment appears to be of far more importance than occupation or place of work in the majority of cases. The following statement shows the housing conditions of 283 'sputum positive' cases on the Dispensary Register at the end of the year:— HOUSING PARTICULARS OF FAMILIES OF 283 SPUTUM POSITIVE CASES ON THE DISPENSARY REGISTER. Families with one person to a room* 107 Percentage of total 37.8 two persons 135 ,, ,, „ „ 47.7 three „ „ 28 ,, ,, 9.9 four „ „ 8 ,, ,, 2.8 five 5 ,, ,, 1.8 * Available for use as a sleeping room. HOUSING PARTICULARS OF 283 SPUTUM POSITIVE PATIENTS (POTENTIALLY INFECTIOUS). Patients occupying separate bedroom . . 111 Percentage of total 39.2 Patients occupying separate bed but not separate room 44 Percentage of total 15.6 Patients sharing a bed 128 Percentage of total 45.2 The figures demonstrate clearly the seriousness of the problem which confronts us in our attempt to prevent the spread of tuberculosis. Every effort is being made by the Medical Officer of Health to provide fresh accommodation for the worst cases, but the economic position of some of the families is a great stumbling block to the improvement of their conditions. In families where the father is thrown out of work by tuberculosis it may be many years —often not until the children have become wage earners- before better accommodation can be obtained, and those years may add two or three new cases to the roll of tuberculous patients. Much, however, can be done by home visiting on the part of the Tuberculosis Officer and the dispensary nurses. Advice can be given with regard to the alteration of existing accommodation so that infective persons can be provided, where possible, with a room, or at any rate a bed, to themselves. In suitable cases the Tuberculosis Officer can ease the situation by the loan of open-air shelters or of beds, and at the end of 1928 the number of these on loan was—Shelters 26, Beds 55. Stress has been laid in this survey on two points—the paucity of early cases and the poor housing conditions. The problems associated with tuberculosis are legion, but these two are of great importance and both are to a large extent capable of mitigation, if all parties concerned will co-operate whole-heartedly. In conclusion, the writer would like to express his appreciation of the help given by the Dispensary Staff, and by Mr. F. W. Smith and by Mr. F. R. Parker, the former being responsible also for the diagrammatic work." LADY ALMONER. A care committee is usually considered to be an essential part of a dispensary scheme. For a number of years the Tuberculosis Care Committee in Bermondsey existed in a moribund condition. Towards the end of 1927 it was decided by agreement with the London County Council to abolish the care committee and appoint a Lady Almoner. Miss Pike, one of the Tuberculosis Nurses, was appointed to this post on the 18th October, 1927. She has had a long and varied experience, and having been in the service of the Borough Council for eight years has accumulated an intimate knowledge of local conditions which has enabled her to do very useful work in this position during the year. All patients going to Sanatorium under the London County Council Scheme are required to contribute towards the cost of treatment according to their means. The assessments are made and the contributions collected by the Lady Almoner, £246 being the amount collected during the year. In addition, Miss Pike is now responsible for other assessments in connection with the provision of milk under the Maternity and Child Welfare and Tuberculosis Schemes, and she also makes the assessments for admission to Fairby Grange Convalescent Home. It is obvious that the duties attaching to the post are numerous and varied, necessitating in many cases visits to the homes of patients. During the year 287 such visits have been made. Many other visits have been made in attempts to find work for tuberculous persons. These have included visits to various stores, factories, and so on, and to the Labour Exchange. Having regard to the present widespread unemployment amongst the healthy, it is not surprising that great difficulty is encountered in finding work for the tuberculous, and I think Miss Pike has been very successful in managing to place fourteen patients in suitable work during the year. A rather discouraging feature is the fact that so many patients seem to become resigned to the idea of permanent disablement, and are unwilling to make any effort even when work is found for them. Three patients refused work after suitable employment had been found, and two others left work almost immediately. Eight discharged soldiers, pensioners, also refused suitable work for various reasons. In a further attempt to solve this problem of work for tuberculosis patients, a handicraft class was started. This has met every week in the Solarium on Friday afternoons. Altogether there have been thirteen members of this class who have been instructed in raffia and leather work. The Council made a grant of £10 to be in hand for expenses in connection with materials and tools, and a further sum of £4 11s. 7d. was received in donations for the same purpose. Altogether 141 articles have been made and sold. While we do not expect patients to become self-supporting, the class serves a very useful purpose in providing occupation both for mind and hand, and it helps to prevent patients from lapsing into a state of listless hopelessness. Many patients have been helped during the year with clothing owing largely to the kindness of the British Red Cross Society, the Charity Organisation Society and the Guardians. Gifts have also been received from individuals, and a very useful gift of 100 garments was received from the Queen Mary's Needlework Guild for which we were very grateful. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not found necessary to take any action under these Regulations in 1928. Arrangements are made by the Tuberculosis Officer for the voluntary examination of all milkmen in the borough, and it is to be hoped that they will, in view of the importance of a clean milk supply, take advantage of the opportunity offered. RETURN SHOWING THE WORK OF THE DISPENSARY DURING THE YEAR 1928. Diagnosis Pulmonary Non-polmonary Total Children Adult Children Adults Adults Children M. F M. F. M. F. M. F. M . F. M. F. A.—New Cases examined during the year (excluding contacts) :— (a) Definitely tuberculous 52 47 4 1 3 15 11 12 8 55 55 19 (B) Doubtfully tuberculous - - - - - - 61 53 15 10 - - (C) Non-tuberculous - - - - - 53 40 35 - 40 - - B.—Contacts examined during the year:— -— 1 — I (a) Definitely tuberculous 2 1 - - - 2 - - 1 - - (6) Doubtfully tuberculous - - - - - - 3 6 1 3 - - (C) Non-tuberciilous - - - - - - - 21 97 78 89 - C. —Cases written off the Dispensary Register as i I ll II . (a) Cured 11 8 16 1 7 1 1 10 5 12 9 26 22 10) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - 131 196 150 153 - (38) D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 332 237 120 96 41 61 108 86 373 298 228 182 (6) Diagnosis not completed - - - - - - 4 11 4 7 - 1. Number of persons on Dispensary Register on January 1st 1214 10. Number of consultations with medical practitioners:— 2. Number of patients transferred from other areas and of " lost sight of " cases returned 11 (a) At Homes of Applicants 25 (B) Otherwise 143 3. Number of patients transferred to other areas and cases " lost sight of " 69 11. Number of other visits by Tuberculosis Officers to Homes 238 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2697 4: Died during the year 100 5. Number of observation cases under A (b) and B (4) above in which period of observation exceeded 2 months 14 13. Number of:— (a) Specimens of sputum, etc., examined 785 6. Number of attendances at the Dispensary (including Contacts) _ * 2998 (b) X-ray examinations made in connection with Dispensary work 91 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision 14. Number of Insured Persons on Dispensary Register on the 31st December 484 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 83 (a) " Light " treatment 16. Number of reports received during the year in respect of Insured Persons:— (6) Other special forms of treatment 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 32 (a) Form G.P. 17 6 (b) Form G.P. 36 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1928, to the 29th December, 1928. Age Periods Notifications on Form A. Notifications on Form B. No. of Notifications on Form C. No. of Primary Notifications Total Notifications on Form B Poor Law Institutions Sanatoria Total Notifications on Form A Number of Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications 0 to 1 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Primary , Notifications 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 - Pulmonary Males 133 - - - 38 90 1 6 3 12 14 25 18 11 11 3 104 - - - - - 106 — - 15 46 - 1 3 2 18 22 13 4 11 3 3 80 „ Females - - 27 29 - - - - 1 7 5 3 2 2 2 - - - 25 Non-Pulmonary Males 3 - - - - 1 3 7 4 7 1 5 - 1 - — I 30 - — 15 „ Females New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the Ist January, 1928, to 29th December, 1928, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Cases Age Periods Pulmonary Males - - - - - 1 4 2 2 29 1 12 - 1 - 2 1 - - 10 „ Females - 5 1 - Non-Pulmonary Males 1 4 - 1 - 1 7 - - I - - „ Females 1 (40) Returns rendered under the PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. 1st QUARTER, 1928. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 1083 1263 464 419 Number of Cases notified during Quarter 34 21 5 7 Notified Cases Removed to Bermondsey from other Districts - 2 - - Number of Cases removed from the Register 26 15 4 3 Number of Cases remaining on the Register at end of Quarter 1271 1091 423 465 2nd QUARTER, 1928. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 1271 1091 423 465 Number of Cases notified during Quarter 26 23 7 6 Notified Cases removed to Bermondsey from other Districts 1 - - - Number of Cases removed from the Register 35 40 9 4 Number of Cases remaining on the Register at end of Quarter 1202 1074 463 426 3rd QUARTER, 1928. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 1262 1074 463 426 Number of Cases notified during Quarter 23 9 8 18 Notified Cases removed to Bermondsey from other Districts - - - - Number of Cases removed from the Register 30 28 6 3 Number of Cases remaining on the Register at end of Quarter 1255 1064 466 431 4th QUARTER, 1928. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 1255 1064 466 431 Number of Cases notified during Quarter 21 18 8 4 Notified Cases removed to Bermondsey from other Districts 2 1 1 1 Number of Cases removed from the Register 48 37 12 5 Number of Cases remaining on the Register at end of Quarter 1230 1046 459 435 IV. LIGHT TREATMENT. The following table shows the work done in the Solarium during 1928 : — Total attendances 25,644 Total No. of Examinations 2,723 Total No. of New Patients 556 Total No. of Discharges 581 Total No. of Maternity and Child Welfare Patients under treatment during the year 475 Total No. of tuberculous patients under treatment during the year 99 Total No. of all other classes under treatment during the year 441 (The Maternity and Child Welfare patients formed 46.8% of the total number under treatment and the tuberculous patients 9.7%.) It will be seen that there has been a further increase in the work done and this has necessitated a corresponding increase in the number of examination sessions. Almost all the patients are recommended for treatment by general practitioners or by the medical officers of the Maternity and Child Welfare centres, the tuberculosis dispensary or the local hospitals. Every patient is seen by a member of the medical staff before treatment is commenced, and four examination sessions are now held each week. Two of these are attended by the Tuberculosis Officer, and one each by Dr. Plimsoll and Dr. Telfer. In addition, patients who are at work are seen on one evening in the week by the Tuberculosis Officer. Although there has been an increase in the number of examination sessions, the nursing staff remains the same and a great deal of extra work has fallen upon the two Solarium nurses, Miss Pearce and Miss Henniker. A list of the principal diseases treated, with the number of new cases for 1928 is given below: — TUBERCULOSIS. Spine 3 Knee 1 Sternum 2 Cervical Glands 6 Abdominal Glands 2 Bazin's Disease (Skin) 2 Hip 3 Wrist 1 Lungs 2 Bronchial Glands 2 Lupus 4 Dactocystitis 1 MATERNITY AND CHILD WELFARE CASES. Ante-natal 13 Rickets 92 Genu Valgum 2 Post-natal 4 Marasmus, Debility, Malnutrition, etc. 167 OTHER DISEASES. Chronic Rheumatoid conditions 54 Alopecia 17 Abdominal Fistula (post operative) 1 Furunculosis 3 Cervical Adenitis (non-tuberculous) 15 Emphysema 4 Psoriasis 6 Eczema 2 Keloid Scar 1 Fibroid Lung and unresolved pneumonia 2 Acne 2 Asthma 5 Bronchitis (including chronic) 65 Bronchiectasis 2 Malnutrition, Debility, Anaemia, etc. 125 Encephalitis Lethargica 6 Urinary Fistula (post operative) 1 Dermatitis 1 Anterior Poliomyelitis (old) 3 Chronic Onychia 1 Varicose Ulcers 5 The majority of the tuberculous bone and joint cases had already undergone institutional treatment and ultra-violet light was given to prevent relapse and to tide over the sudden change from the ideal environment of a sanatorium to that of an urban home. Experience gained in the Solarium shows that there is no doubt as to the value of ultra-violet light in non-pulmonary tuberculosis, particularly in those cases where the part affected has "broken down" with consequent abscess and sinus formation. The following particulars of four patients are typical of the good results which may be obtained in this class of case: — E.H. (female, aged 21). Multiple tuberculous arthritis of both hips and right shoulder, with discharging sinuses. Bedridden in August, 1924. Ultra-violet light was started in January 1925 and in three months the patient was able to sit by herself on the scales and menstruation started after five years amenorrhoea. July 1925 —Sequestrum extruded from right shoulder. December 1926—Shoulder sinus healed. April 1927 —All sinuses soundly healed and patient able to walk with a high boot. This patient pigmented well and has kept well ever since. No other treatment was given in this case. S.M. (female, aged 34). Operation in April 1924 for tuberculous abscess right hip. Sinus resulted. Another operation in September 1927. Sinus still persisted and ultra-violet light was started, at another institution, just after the second operation. First attended the Solarium in May 1928, with sinus still discharging. July 1928, sinus healed and patient has remained well with no recurrence. J.A. (male, aged 18). Operation in 1922 for excision of tuberculous cervical glands. Remained well until November 1927, when there was a recurrence with the formation of three sinuses. Ultra-violet light treatment was started in May 1928. The sinuses soon began to close and after a further slight relapse are now quite healed. M.C. (female, aged 11). Tuberculosis of Sternum, treated at Princess Mary's Hospital, Margate, from 1925 to 1928. On return home there was still a small sinus present. Ultra-violet light treatment was started in June 1928 and by October the sinus was quite healed and remains so at the time of writing. The results in cases of tuberculous adenitis, without abscess formation, have with two exceptions been satisfactory, but the progress in these cases is slow and not nearly so striking as in the type of case mentioned above. The cases of Bazin's Disease have done well with healing of the ulcers and improvement of the general condition. The four cases of Lupus are doing well. Two of them had already received institutional treatment. One was an early case that had not yet been away and the fourth was a mild relapse in a case that originally started in 1915, and had previously had a prolonged course of treatment elsewhere. The number of cases of pulmonary tuberculosis under treatment is small. In these cases the chest is not exposed to the Ultra-violet Rays and Dr. Rollier's practice of gradual insolation, i.e., exposure first of the ankles only, then of the legs up to the knee and so on, is used. While there have been no adverse effects none of the cases have shown marked improvement. In the Maternity and Child Welfare section 475 patients were treated and made 8,939 attendances. Most of the children were suffering from general debility, chronic bronchitis, and rickets in various stages ; a small number from adenitis, rheumatism, anaemia, chilblains, urticaria, marasmus, knock-knee, enlarged tonsils, poliomyelitis, and naevus. Several patients were sent from Great Ormond Street, the National Orthopaedic and St. Vincent Square Hospitals. All the children who attended regularly showed very definite improvement in the general condition even although no great increase of weight occurred and most of the bronchitis cases showed a decrease in the frequency and severity of the attacks even if these did not entirely disappear. Thirteen ante-natal mothers attended, ten of whom have had normal confinements and exceptionally healthy babies —the remaining three have not yet been confined. It is unfortunate that a number of the worst cases of rickets and general debility attended infrequently or ceased attending before any benefit could be derived from the treatment. Chronic Rheumatic Conditions include cases mostly of rheumatoid arthritis and osteoarthritis, together with others of fibrositis, lumbago and sciatica. In most of these cases there has been some alleviation of the pain, but on the whole there has been no permanent improvement and it does not seem that much lasting benefit can be derived from the use of ultra-violet light alone. This is an extremely important group of diseases, causing a large amount of crippling and loss of work, for which at present there seems to be little remedy in an industrial population. Of the cases of alopecia treated during the year five showed improvement, one to a marked degree, but the majority of cases did not respond well. The one case of abdominal fistula did very well. An operation for appendicectomy was performed in April 1928, and a fistula occurred at the point where a drainage tube had been inserted. This condition persisted till October 1928 when Ultra-violet treatment was started. The patient attended four times a week regularly and in one month the abdomen was quite healed. She has kept perfectly well since that date. The cases of malnutrition, debility, and anaemia were mostly children of school age, some of whom responded well and picked up in a short time. The appetite improved and general muscle tone became better. In others, however, the progress was slow and a few cases did not seem to respond at all. Bearing in mind that bad housing conditions are the predisposing cause of many of these cases, it is probable that the beneficial effects of light treatment were being constantly undermined by the persistance of the unfavourable home environment. Irregularity of attendance, for no apparent reason, amongst all classes of patients is another factor which tends to lead to poor results or slowness in progress. Six cases of Encephalitis Lethargica were put on treatment during the year. Five were of Parkinsonian type and showed little improvement. One, a child, with persistance of mental symptoms, is still under treatment and has had during this time far less frequent "fits of temper," than previously. Of the skin lesions the cases of dermatitis and eczema responded well to treatment and of the varicose ulcers two were cured. Rest is an essential part of any treatment for the latter condition and few of the Bermondsey housewives are in the fortunate position of being able to secure this. In last year's report mention was made of four cases of Herpes Zoster occurring during treatment. During 1928 three patients were found to be suffering from this disease. All three were being treated with mercury vapour lamps, but in view of the small incidence of cases and the increase in the total number of patients there does not seem to be any connection between exposure to Ultra-violet light and the onset of Herpes Zoster. A separate table shows the particulars of patients who have undergone treatment at Dr. Rollier's Clinics at Leysin. The results are good and speak well for the efficacy of natural sunlight in selected cases of non-pulmonary tuberculosis. LEYSIN PATIENTS. In the following table will be found a complete list of patients who have been sent to Leysin by the Borough Council. Age Sex Localisation of Disease Period previously under Medical Treatment prior to going to Leysin Date sent to Leysin Date returned from Leysin Result Initials of Patient S.B. 12 Left Foot 5 years 28/7/24 5/7/27 Keeping well. M. I.R. 10 F. Glands of Neck 5 „ 28/7/24 6/10/25 Removed from District M.S. 15 F. Right Knee 6 „ 28/7/24 6/10/25 Recently seen. Keeping well 19 F. Glands of Neck 2 „ 1/10/24 6/10/25 „ „ „ „ A.L. C.P. 37 F. Forearm and Peritoneum 2 „ 1/10/24 6/10/25 „ „ „ „ (47) M.B. 28 F. Glands of Neck 15 „ 26/10/25 22/2/27 „ „ „ „ E.C. 16 F. Right Knee 5 „ 26/10/25 8/7/27 „ „ „ „ H.C. 10 M. Glands of Neck 2 „ 26/10/25 20/2/27 „ „ „ „ A.H. 21 F. Left Hip 9 „ 17/5/26 29/6/28 No recurrence of Tuberculosis E.W. 23 F. Spine and Right Hip 18 „ 17/5/26 17/9/27 Recently seen. Keeping well G.B. 20 F. Left Ankle 2 „ 9/2/27 - Still at Leysin. L.T. 19 M. Abscess of Ribs 2 „ 9/2/27 8/5/28 Recently seen. Keeping well. Removed from District C.P. 24 M. Spine 7 „ 5/7/27 8/5/28 Recently seen. Keeping well A.R. 26 F. Glands of Neck 3 „ 5/7/27 - Still at Leysin E.G. 16 M. Lupus of Nose 4 „ 20/6/28 - „ „ C.P. 26 M. Tuberculide of Skin 1 „ 20/6/28 — „ „ H.S. 18 M. Right Hip 3 „ 20/6/28 - „ „ V.—MATERNITY AND CHILD WELFARE. Alterations of some importance have been made during the year both in the method of visiting and in the conduction of the Clinics. Prior to the alterations, the Borough was divided into nine districts, one district being allotted to each Municipal Health Visitor in which she was responsible for the visitation of the homes of all persons coming within the scope of the Maternity and Child Welfare Act, the remaining district being allocated to Guy's Hospital. But in addition to the Municipal Clinics and Health Visitors, there are a number of voluntary organisations doing Maternity and Child Welfare work in the Borough, and Health Visitors from these Centres paid visits to the homes of their own mothers. Two defects were apparent in this arrangement. In the first place the same house and sometimes the same family was visited on occasion by both Municipal and Voluntary Health Visitors. A more serious, though less common fault was the fact that some families were missed altogether by the Visitors of both agencies. The Maternity and Child Welfare Act has been in force for some years now, and it was felt that some reconstruction of the scheme was necessary in order to secure regular visitation of the whole district and, if possible, more widespread utilisation of the facilities offered by the scheme. The Borough has therefore been divided into twelve districts— eight Municipal Districts and one district each for the following voluntary agencies:— Princess Club, St. George's Hall, Fulford Street, and the Salomon's Centre. In each District there are approximately 200 births per annum and each Health Visitor is expected to make not less than seventy visits per week, the visits being arranged in her diary and recorded in her register. The chief alteration which has been made in connection with the Clinics has been the introduction of a system of appointments, the object being to eliminate the long wait preceding consultation. These changes took effect from the Ist April, 1928, and experience has already proved their value. I would like at this point to express my thanks to the Committees and Officers of the Voluntary Centres for their willing help in effecting the changes and for their hearty co-operation in the new arrangements. As one consequence of the changes it has been necessary for this year only, to include four tables instead of two, in order to show the work of the Health Visitors. It will be observed that in Table No. 1 no "first visits" are credited to the last four Voluntary Centres mentioned. Under the previous scheme all "first visits" in these areas were paid by the Municipal Health Visitors. Under the revised scheme each Health Visitor, whether Municipal or Voluntary, is responsible for all the visits in her own District, and consequently, such visits are recorded in Table No. 11. for the last nine months of the year. Another point upon which emphasis has been laid in the revised scheme is the giving of health talks at the Centres, and the number shown in the table is gratifying evidence of the interest taken in this work by the Health Visitors. These talks are for ten minutes or longer to audiences of not less than ten, and there may be ana often are, demonstrations with models or the blackboard. Towards the end of the year I arranged to give one Cinema Lecture each month in each of the centres, and this arrangement will, I hope, become a permanent feature. I am glad to be able to record an increase in the numbers attending ante-natal clinics. I regard these clinics as being one of the most valuable parts of the whole scheme, and I trust the time is not very far ahead when every prospective mother will be wise enough to take advantage of these arrangements for examination and supervision during pregnancy. A wisely organised and well arranged "ante-natal" scheme must inevitably play an important part in reducing the Maternal Mortality Rate. To this end we are trying to encourage a close and harmonious working arrangement between these clinics and the doctors and midwives of the Borough. I would like also to mention the fact that the Committee authorised the attendance of two Health Visitors at a post-graduate course this year. The work is apt at times to become monotonous and disheartening and such a course provides the opportunity of gaining fresh ideas and renewed enthusiasm, and I can assure the Committee that the privilege of attendance was very much appreciated by the Health Visitors concerned. FAIRBY GRANGE CONVALESCENT HOME. There is no matter of special importance to report with regard to the Convalescent Home. The Guardians still reserve two beds for women patients throughout the year, and the total numbers, which are set out below, show little variation from last year's figures. No. of women admitted 242 No. of babies admitted 112 No. of toddlers admitted 113 TABLE I.—HEALTH VISITORS The following table shows the work done by the Municipal and Voluntary Centres and Health Visitors during the three months ended 31st March, 1928 :— Health Visitors Subsequent Visits Various Calls and Visits Lost Visits Attendances at Centres Reports to M.O.H. Ophthalmia Neonatorum No. of District Puerperal Fever Antenatal Births Notified First Visits Under 1 year 1 to 5 years Miss Mercer 1 68 78 149 326 12 - - 36 93 43 4 (50) 126 Miss White 2 55 70 499 26 2 - 76 101 44 33 98 Miss Helden 3 69 66 14 3 3 296 15 20 82 - Miss Child 4 60 68 66 148 10 - 1 175 51 62 49 5 40 46 20 52 2 - 78 8 45 2 Miss Bache - Mrs. Cottier 6 65 62 124 286 3 1 72 36 49 7 - Miss Carlton 7 67 56 100 249 - 1 1 73 51 40 7 Miss Wadds 8 74 68 86 168 13 - 43 53 48 3 - Salomon's Centre - 29 39 202 742 252 - - 181 - - - Princesa Club - 43 - 6 - 471 - - - - - - Fulford Street - - 269 290 65 - - - 47 43 2 - 291 310 73 St. George's Hall 43 - - - - - - - - Central Hall - - 130 134 17 - - 79 - 52 - - TABLE II.—HEALTH VISITORS. The following table shows the work done by the Municipal and Voluntary Centres and Health Visitors during the nine months ended 31st December, 1928 :— Health Visitors No. of District Births Notified First Visits Re-visits Ante-natal Puerperal Fever and Puerperal Pyrexia Ophthalmia Neonatorum Other Visits Attendances at Centres Health Talks Cases Visits Cases Visits Miss Mercer 1 106 137 1764 86 3 3 - - 83 136 16 Miss White 2 - 125 2213 169 1 3 - - 54 88 5 Miss Child 3 127 146 1750 261 3 3 - - 294 1 57 42 St. George's Hall 4 46 51 430 50 3 3 1 1 127 23 10 Princess Club 5 111 136 1494 92 2 2 - - 241 342 29 Miss Helden 6 121 108 1698 208 2 5 - - 265 150 84 Mrs. Cottier 7 148 179 2480 29 2 2 - - 39 158 19 Fulford Street 8 173 147 1628 177 1 2 2 4 333 103 23 Miss Carlton 9 133 152 2044 70 1 1 1 1 14 98 20 Miss Bache 10 144 168 1770 40 3 3 - - 42 177 7 Miss Wadds 11 74 90 1177 17 - - - - 15 114 13 Salomons Centre - 57 97 4181 632 - - - - 222 102 - Central Hall - - - 690 60 - - - - 234 147 - Totals - 1359 1536 23319 1891 21 27 4 6 1963 1795 268 TABLE III—ATTENDANCES AT MATERNITY AND CHILD WELFARE CENTRES. The following table shows attendances at Maternity and Child Welfare Centres for the three months ended 31st March, 1928 :— Ante-Natal Clinic Evening Clinic Sewing Class Name of Centre Class for Mothers No. attending No. of Sessions No. of Sessions No. attending No. of Sessions No. of Sessions Nos. attending children No. attending Under 1 year 1 to 5 years (52) 110 Grange Rd. 36 592 10 267 12 90 9 568 77 98 Rotherhithe New Road 29 572 332 7 112 10 94 7 87 *Trinity Road 1 17 13 - - - - - - Oxley Street 23 245 306 - - - - - - Roseberry St. 10 296 8 74 - - - - 161 Salomon's Centre 39 516 217 - - 52 754 - - Princess Club 45 726 716 22 498 13 183 - - Fulford Street 28 718 470 23 344 3 33 - - St. George's Hall 13 188 196 12 221 - - - - Central Hall 52 2550 2391 - - - - - - 6420 82 1516 1154 16 164 Totals 276 5370 90 * Hall under repair. TABLE IV.—ATTENDANCES AT MATERNITY AND CHILD WELFARE CENTRES. The following table shows attendances at Maternity and Child Welfare Centres for the nine months ended 31st December, 1928: — Sewing Class Name of Centre Children's Consultations Ante-natal Clinic No. of Sessions Nos. attending Children No. of Sessions No. attending No. of Sessions No. attending 110 Grange Road 107 4,361 35 695 35 365 98 Rotherhithe New Road 113 35 575 257 3,024 32 - - - - Trinity Road 795 34 2,266 - - - 71 - Oxley Street - - 34 32 299 Roseberry Street 1,317 127 1,893 - - 170 2,753 Salomon's Centre 125 397 4,754 52 35 Princess Club 1,413 Fulford Street 218 8 102 70 2,204 28 469 - - St. George's Hall 11 247 12 - Central Hall 13,387 - - - 145 Totals 838 34,470 193 280 3,874 3,447 (53) Maternity and Child Welfare. STATISTICS FOR THE YEAR, 1928. Borough Council of Bermondsey. POPULATION according to the Census of 1921.—119,452. Births. Total. Males. Females Registered Legitimate 2,048 1,029 1,019 Birth Rate 18.1 Illegitimate 38 22 16 Notified within 36 hours of birth — (1) Live Births, 2,067. (2) Still Births, 57. (3) Total, 2,124. (1) By Midwives, 520. (2) By Parents and Doctors, 1,604. Total. Males. Females. Deaths 1,520 813 707 Death Rate 13.2 Infant Deaths. Number — (1) Legitimate, 178. (2) Illegitimate,— (3) Total, 178. Rate per 1,000 births — (1) Legitimate, 85. (2) Illegitimate, — (3) Total, 85. Maternal Deaths. Number of Women dying in, or in consequence of Childbirth— (1) From Sepsis, — (2) Other causes, 4. Health visitors. Visits paid by Health Visitors during the year: — To Expectant Mothers (1) First Visits, 2,354. (2) Total Visits, 2,354. To Infants under 1 (1) First Visits, 2,089. (2) Total Visits, 11,285. To Children 1-5 Total Visits, 17,327. Municipal Homes and Hospitals for Children under 5. Number of Beds, 16 Number of children under 5 received during the year, 225. Total number of weeks spent in the Homes by such cases, 455. Municipal Day Nurseries. Total number of attendances of Children under 5 during the year— (a) Whole:— (b) Half:— Deaths from Measles (all ages) 77 Deaths from Whooping Cough (all ages) 26 Deaths from Diarrhoea (under 2 years of age) 14 VI. DENTAL TREATMENT. A somewhat lengthy report on this subject was included last year, and there is no point of special interest in this year's work which requires comment. Rather more attention has been given during the year to propaganda work in this subject. Each Health Visitor is required when visiting houses to examine the mouths of all children and women who come within the scope of the Maternity and Child Welfare Scheme, and, of course, to do her utmost by individual persuasion to secure proper attention to the teeth. In addition, lectures have been given at each Maternity and Child Welfare Centre, and I have to thank Mr. Grantley Smith and Mr. Shapland for their willing help in this propaganda work. There has been an increase in the work done at both Centres, in all categories, except those of Maternity and Tuberculosis. The number of the latter is always small, and in both cases expense is a large factor in deciding for or against dental treatment. At 110 Grange Road there has been an increase of 204 children and 246 adults treated, a total of 450, entailing 1,580 attendances more than in 1927. This increase justifies the two extra sessions which were started on February 13th, 1928. There are now thirteen sessions per week at this Clinic, excluding bank holidays— the average attendance per session works out at 10.4. At 98 Rotherhithe New Road there has been an increase of 112 children and 333 adults treated, a total of 445 and a consequent increase in attendances of 948. The average attendance per session at this Centre is 5.2, and the amount of work done in 1928 is nearly twice that of the previous year. (56) TREATMENT OF CHILDREN DURING 1928 Number examined Number Needing Treatment Number Treated Number of extractions Anæsthetics Number of Fillings Number of Scalings Number treated for Orthodontics Number of visits Age Group CENTRE Local General 2 years and under 33 33 32 93 - 30 - - - 49 110, GRANGE ROAD. 3 years 104 97 96 440 3 97 2 - - 175 4 years 222 219 218 965 5 198 7 - - 389 5 years 134 133 131 666 4 124 10 - - 247 Over 5 years 434 432 392 1172 112 258 102 4 12 957 Total 927 914 869 3336 124 707 121 4 12 h1817 98, ROTHERHITHE NEW ROAD. 6 5 5 15 3 — - - 6 2 years and under 2 3 years .. .. 31 30 23 63 11 12 - - - 25 4 years 45 45 32 164 3 30 2 - - 60 5 years 71 70 63 303 22 50 15 - - 98 Over 5 years 128 128 115 329 30 71 67 7 4 243 Total 281 278 874 166 84 7 4 432 238 68 (57) DENTAL TREATMENT CARRIED OUT DURING 1928 CENTRE Type of Case Number of Patients examined Number of Patients Treated Number of Extractions Anæsthetics Number of Fillings Number of Scalings Number of Dentures Fitted Number of Repairs to Dentures Number of visits Local General 110, GRANGE ROAD. 250 Maternity Cases 107 99 314 74 23 9 13 31 5 Women 867 861 2788 762 180 169 77 224 152 2296 Girls (14-21) 380 378 292 226 9 80 4 2 1 398 Men 821 802 1999 913 39 158 78 200 76 2017 Tuberculosis Cases 37 32 232 39 13 11 7 11 7 138 Children (Table I.) 927 869 3336 124 707 121 4 - - 1817 Total 3139 3041 8961 548 183 468 241 6916 2138 971 98, ROTHERHITHE NEW ROAD. 71 65 35 20 4 2 - - 89 Maternity Cases 154 Women 268 246 782 160 61 35 29 96 19 745 Girls 14-21 132 115 191 97 29 88 16 6 - 207 Men 169 497 22 31 52 6 193 177 106 388 Children (Table I.) 281 238 874 68 166 7 - - 84 432 945 833 2498 537 298 317 85 154 25 1861 Total VII.—PROPAGANDA. During the year a Health Exhibition was held for the first time in the history of the Borough. The organisation of the exhibition was in the hands of Mr. Bush, and was undertaken as part of the propaganda work of the Public Health Department. The Exhibition was held in the Hall of the Central Baths, Grange Road, on March 9th, 10th, 12th, 13th, and 14th. A detailed description would be out of place here; but some points in connection with the Exhibition are worth recording. The ground floor of the Hall was reserved for exhibits directly connected with Public Health, the much more limited space in the gallery being allotted to trades interested. Whilst all the stalls were good, one or two of them appeared to have a special attraction for the public. For instance, great interest was taken in the bottle washing, sterilising and filling machines, which were shown actually working in a model Dairy. A fully equipped dental clinic with a dental mechanic at work, attracted much attention, as did also the Light Clinic. Perhaps the most popular stall was that showing microscopic specimens of various kinds dealing with the causation of different diseases and including specimens of contaminated water and infected milk. During the five days on which the Exhibition was open, the mornings were reserved for the attendance of school children. Parties of the older children were taken round the Exhibition by members of the staff. The tour took about an hour, and five or six parties were taken round each day, one of the Medical Officers being in charge of each party. The Exhibition was opened to the public at 2 p.m., and remained open until 9:30 p.m. The total number attending during the five days amounted to 29,500. No attempt was made to provide lectures, but during the course of each evening one or two short films dealing with health matters were shown in the hall. A booklet was issued giving information as to the activities of the various sections of the Public Health Department. A brief description of the work of the Tuberculosis Dispensary, the Solarium, the Maternity and Child Welfare Scheme, and the Dental Clinics was given, and the time and place at which these Clinics are held was set out. The work done in connection with Food Inspection, Housing, General Sanitation, Infectious diseases and Health Education was also outlined. Each responsible visitor was supplied with a copy. The undoubted success of the Exhibition was due almost entirely to the enthusiasm of the staff, and the opinion was generally expressed that such an Exhibition was a valuable means of education, which should form a recognised part of the work of this Department. Owing to the resignation of Dr. King Brown during the year, it became necessary to make some changes in the scheme for carrying on the propaganda work. Mr. Bush was appointed Propaganda Officer, and the whole of this work is now in his hands. All the more senior members of the staff were asked to take part in the actual lecturing work and agreed to do so. This revised arrangement and increased assistance enables us to undertake a much larger number of lectures and thanks are due to the staff for their willing help. The actual number of lectures given during the year, with the approximate audiences, is as follows: — No. Audience. School lectures 60 9,650 Clubs and other Institutions, etc. 27 3,200 Open-air Demonstrations 43 17,500 Health Visitors' talks (to audiences of not less than ten for ten minutes) 264 It will be seen from these figures that a great deal of educational work has been done during the year, and I would like to thank the staff very heartily for their enthusiastic help. So far as the schools are concerned, the aim has been to provide one lecture at least in every school in the Borough each year. This may not seem a very ambitious programme, but it must be remembered that this work is only possible during five months of the year because of the absence of suitably equipped lecture halls in most of the Schools. Only six schools have been omitted from our programme during the year, mainly because it was impossible to arrange suitable dates. In practically every case head masters and head mistresses have given enthusiastic help in arranging these lectures, and the time seems to be rapidly approaching when the teaching of hygiene will be compulsory in all schools, and a properly equipped lecture hall will be provided with suitable apparatus. The primary objection to the use of the Cinema in schools seems to be the risk of fire; and it should be noted that strict instructions are laid down by the London County Council, and are observed by ourselves in the case of each school lecture. It is also worth noting that our apparatus is fire-proof and practically fool-proof. We have now in use twenty-nine pamphlets which are distributed at lectures, through the agency of the various municipal clinics, and occasionally through the post, being at intervals included in letters sent out from the office. The electric sign continues in use, there being at present seven series of pictures. Each series consists of twelve pictures dealing with the following subjects :—"Teeth," "Milk," "Cleanliness," "Habits," "The Fly," "Tuberculosis," and "Electricity and Health." Three new films have been made during the year on the following subjects:- Food Inspection, Clothing, and Milk. Two films have been purchased —"The Rat Menace" — from the Ministry of Agriculture, and a short American film dealing with the subject of Diet and Exercise. A new departure has been the provision of Cinematograph entertainments. The Hall of the Central Baths, Grange Road, was secured for three evenings, November Bth, November 22nd, and December 6th. On these evenings two Cinema shows were given, one from 5.30 to 7.30 for school children, and one from 8 to 10 p.m. for adults. Included in each programme was one film, dealing with a Health subject, a few words of explanation being given by the Medical Officer of Health. The London County Council kindly allowed us to use the school organisation for the purpose of making these shows known, and in each case more seats were applied for than could be allotted; a charge of 2d. per child being made. The adult audiences were poor. It is proposed to arrange for a further series of four similar programmes after Christmas, and it is hoped that the adult audiences will improve as this new effort becomes better known. Another innovation during the year has been the distribution of "Better Health" in this Borough. This is a magazine edited and produced under the auspices of the Society of Medical Officers of Health, and by arrangement with the printers we have been enabled to circulate 2,000 copies a month. The magazine deals lucidly with various aspects of health, the articles being written usually by well-known members of the medical profession. Two pages in each issue are devoted to this Borough in particular. Each issue so far has had a short article by the Medical Officer of Health on one page, and a time-table of the various Maternity and Child Welfare and Dental Clinics on the other page. There has been a very great demand for these magazines and we are endeavouring to arrange with the printers to increase the number of copies available for circulation in the Borough. VIII.—SANITARY ADMINISTRATION. HOUSING. In an industrial district such as our own, the housing conditions must always require serious and sustained attention from the sanitary authority, because health and happiness depend on these conditions. Without doubt the inadequate housing conditions of the people of this Borough constitute the most serious problem with which that authority has to deal at the present moment. It is not a single straight-forward issue, but a many-sided problem in which numerous folk are involved. One aspect of the problem which presents itself is that of education. The tenant, the actual dweller in the house is sadly in need of instruction,, sometimes indeed, of instruction in the elementary duty of cleanliness. But those whose contribution to the solution of the problem consists in criticism of the tenant, should picture to themselves the hopeless and heartbreaking circumstances of the person on whom they lay the blame. So far as the education of the tenant is concerned the sanitary authority has dene and is doing its duty with energy and enthusiasm. There remains the matter of educating landlords and owners. It would be quite wrong to say that there are no landlords as it is to say that there are no tenants, alive to their duties in this matter. There are, however, owners who acquiesce in, if they do not actually encourage, conditions of overcrowding and dilapidation which are deplorable in the property which they own and from which they derive substantial profits. Observed from another aspect altogether, the problem is a dual one. There are two main directions in which the housing conditions of this Borough commonly transgress the postulates of hygiene. A house which is fitted to be a dwelling place for human beings must be properly constructed and in reasonable repair, but it must not, if it is to remain suitable for a dwelling place, be occupied by more than a certain number of people. In other words the problem is one of disrepair and dilapidation on the one hand, and of overcrowding on the other hand. With regard to the first question, that of dilapidation, it is to be observed that much of the property in the Borough is old, and some of it very old. Houses, like human beings, decay and wear out, and there is no doubt that many of our Bermondsey dwellings, having long exceeded their allotted span are now dragging out a weary existence to the great discomfort of their inmates. My predecessor used to teach in private, though I am not aware that he ever expounded the idea in public, that houses should be built to last for a period of fifty years, at the end of which time they should be compulsorily demolished. Though obviously impracticable there is yet something to be said in favour of this idea. Old houses are often unfit as dwelling places, not only on account of their decrepitude, but also because they do not, and frequently cannot be made to, comply with modern requirements as to construction. There is only one satisfactory way of dealing with old and dilapidated property and that is by demolition and reconstruction. This could, of course, be done house by house, but piecemeal methods have nothing to commend them, and it is therefore the practice to mark out definite "areas" for improvement. Procedure in this case is governed strictly by law and is always slow. The average length of time elapsing between the first step in the process and the completion of the new houses is stated to be eight years. The Salisbury Street Improvement Scheme was completed during the year 1928, the formal opening ceremony being held on Saturday, 27th October. This area was first represented as an insanitary area on the 21st September, 1920, so that the period elapsing in this case was almost exactly the average period of eight years. The Dockhead Area was represented on the 9th May, 1919, and the improvement scheme which is that of the London County Council is now partially completed. The Vauban Street Area was represented on 4th May, 1926, but no agreement has yet been arrived at in connection with the improvement scheme for this area. On December 4th the Rotherhithe Street (West) Area was represented and the Council gave instructions for the preparation of an improvement scheme. (64) In addition to the areas which have been named, the following areas have already been represented and urgently require attention, and it should always be borne in mind that the process of senile decay steadily pursues its relentless course in property throughout the Borough. Area Acreage No. of house population (Approximate) Bethel Place ¾ acre 49 195 Leroy Street 1⅛ „ 64 346 Prospect Street ⅝ „ 55 291 It is this latter factor which renders the situation somewhat disquieting, and unless more speedy acticn is undertaken with regard to rebuilding, there is no prospect cf overtaking the precess of decay. Some property can of course be rendered reasonably fit by less drastic methods than demolition and reconstruction, and many owners do take care to see that their property is kept in good order. During the year, in 2,089 cases, informal action has been successful in keeping houses in a reasonable state of repair. Where informal action fails, action under statutory powers becomes necessary and such action has been taken in 3,401 cases. It was observed above that a second factor in the housing problem was that of overcrowding. This factor was considered at length by Dr. King Brown in last year's Annual Report, but it is so serious a problem that it cannot be passed without notice. That it is a menacing feature in this Borough will be gathered by anyone sufficiently interested to glance at the statistics shown in connection with Infectious Diseases, and the report on tuberculosis in particular reveals a very serious state of affairs. Energetic steps have been taken to deal with this matter, but the serious nature of the situation shows but little sign of abatement. Practically the whole of the work in connection with housing devolves upon Mr. Freeman, the Chief Sanitary Inspector, and I must here pay a tribute to his remarkable ability and assiduity. Naked figures scarcely give any idea as to the enormous amount of work involved. During the year suitable accommodation has been found for 250 overcrowded families. This seems and indeed is a small number, yet there is scarcely a day of the week when the number of his callers has been less than thirty, with his or more often her, pitiable tale of deplorable conditions. Of these 250 families, 147 have been accommodated on London County Council Estates, the remainder being found suitable domiciles within the Borough. Practically all the available vacant sites in the Borough suitable for housing have been purchased and utilised already, and in many cases houses and factories have been bought and reconditioned and converted into flats for two or more families ; in other cases houses have been leased and, after being put into proper repair, have been used for the abatement of overcrowding. Full particulars are given in the table below of the work done in this direction since 1919 : — No. of families accommodated. New premises erected. Salisbury Street Area 54 cottages 54 Rotherhithe Street 10 „ 10 Brunel Road 11 „ 11 „ „ 4 bungalows 4 Albion Street 5 cottages 5 „ „ 1 bungalow 1 Paulin Street 5 cottages 5 Orange Place 3 „ 3 Corbett's Lane 4 bungalows 4 Silver Street 30 flats 30 Premises purchased or leased and converted. Parish St. Institution 47 flats 47 Grange Walk(l factory) 8 8 The Grange (6 empty cottages) (4 cottages and (2 flats) 4 2 Maze Pond(l house) 3 flats 3 Maze Pond Terrace(l house) 2 „ 2 Old Kent Road (1 house) 4 „ 4 Rotherhithe Street (3 houses) 8 „ 8 Rotherhithe Old Road (1 house) 4 „ 4 Premises purchased or leased and renovated. No. of families accommodated. Rotherhithe Street 2 houses 4 Dartmouth Road 2 „ 5 Derrick Street 3 „ 3 Dockley Road 2 „ 3 Bermondsey Wall 1 house 1 Clarence Street 1 „ 1 Esmeralda Road 1 „ 1 Fendall Street 1 „ 1 Freda Street 1 „ 1 Neptune Street 1 „ 1 Odessa Street 1 „ 2 Paradise Street 1 „ 1 Reverdy Road 1 „ 2 Ridge Street 1 „ 1 St. James's Road 1 „ 2 Silver Street 1 „ 2 Millstream Road 3 houses 3 Neston Street 2 „ 2 Union Road 2 „ 4 Rock Grove (3 cottages and 3 (2 flats) 2 It will be seen that careful attention has been given to this problem which yet is far from solution. Its very solution raises other difficulties which must be mentioned. When action has been successful and overcrowding has been abated, if care is not taken, the rooms may be re-let and the nuisance created afresh. This is done not merely as the result of ignorance and stupidity, but often under the pressure of economic conditions. The rent of the whole house being too great for the tenant to bear by himself, he takes in a lodger with whose assistance he is enabled to pay the weekly charge. A careful record is kept in all cases where overcrowding has been abated. During the last quarter of the year 374 houses were visited by the Sanitary Inspectors. In 120 cases it was found that the tenant had himself taken over the vacated rooms, while in the remaining 254 cases the rooms had been re-let. In six of these latter cases the premises were again found to be overcrowded, and the necessary steps were taken at once to abate the nuisance. The numbers of persons desiring accommodation on the register at the end of the year was, as follows:— Desiring Willing to go to local London County accommodation Council Estates Overcrowded families 570 170 Other families (not overcrowded) 212 270 Total 782 440 This figure does not seem very large, but it represents only a portion of the total number of overcrowded families in the Borough, which as far as we are able to ascertain now number about 2,000, even adopting the somewhat low standard of the London County Council. Another point of importance requires comment. As a result of its attempts to improve these conditions the Council has become a property owner on a considerable scale. Each house or flat purchased, reconstructed or built, becomes a liability entailing additional work. The property must be regularly inspected, and maintained in good condition; complaints have to be dealt with and innumerable small details require attention. Without assuming the role of a prophet, it seems likely that the work of the Department in this connection must steadily increase and that eventually additional staff for the purpose will be required. With regard to houses let in lodgings, there are at present 223 such properties on our register. The conditions in some of these houses are very unsatisfactory, but our powers in this connection are limited. Only a few of the London County Council Bye-laws are at present in force. Briefly those which relate to the "lodger," and refer to questions of cleanliness are at present in force, but those which relate to the "owner" and "tenant" do not come into force until after the removal of the Rent Restriction Act. Consequently it is, in many cases, impossible to secure desirable improvements, such as the provision of proper lighting for staircases, of proper water supply and so on. It is frankly admitted that a great deal of time, thought, and energy, has been expended on the very difficult problem of housing in London, but there have been occasional whispers that the problem, as such, is nearing solution, and that conditions are now showing a steady tendency towards improvement. To whatever extent this may be true, there is no justification for any relaxation of effort in this borough, in fact, as I have already hinted above, our present efforts and activities will have to be redoubled if there is to be any material improvement in the next few years. Hereunder will be found particulars of Inspections, Proceedings, etc., for the year 1928:— Number of new houses erected during the year: — (a) Total (including numbers given separately under (b)) 40 (b) With State assistance under the Housing Acts: — (i.) By the Local Authority 31 (ii.) By other bodies or persons Ni (1) Unfit Dwelling Houses: — Inspection— (i.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,819 (ii.) Number of dwelling-houses (included under sub-head (i.) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,349 (iii.) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 152 (iv.) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,060 (2) Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,089 (3) Action under Statutory Powers. (A) Proceedings under Section 3 of the Housing Act, 1925:— (i.) Number of dwelling-houses in respect of which notices were served requiring repairs 3,060 (ii.) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 965 (b) By Local Authority in default of owners 6 (iii) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (B) Proceedings under Public Health Acts:— (i.) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,430 (ii.) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2,430 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (i.) Number of representations made with a view to the making of Closing Orders Nil (ii.) Number of dwelling-houses in respect of which Closing Orders were made Nil (iii.) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (iv.) Number of dwelling-houses in respect of which Demolition Orders were made Nil (v.) Number of dwelling-houses demolished in Clearance of Insanitary Areas 71 Total number of houses in the Borough 18,177 Number of houses occupied by the working classes 18,027 REGISTERED PREMISES— Premises Number on Register at end of 1928 Number of Inspections Number of Prosecutions 196 594 Milkshops - 220 445 - Houses let in lodgings Ice Cream Premises 107 109 - 63 Offensive Trades (including Poultry Slaughter-houses) 16 - SMOKE NUISANCES— Number of observations 63 Number of notices 5 Number Of complaints 3 Number of summonses Nil UNDERGROUND ROOMS— Number illegally occupied Nil Number closed or illegal occupation discontinued Nil WATER SUPPLY TO TENEMENT HOUSES— Premises supplied 2 Prosecutions Nil SALE OF FOOD- Number of premises used other than ice-cream premises, milk shops and cowsheds 570 Number of inspections 2,778 RAG FLOCK ACTS, 1911 AND 1928— There are three premises in the District where rag flock is used. All premises were inspected during the year, the total number of inspections being seven. There were no prosecutions. NUMBER OF PROSECUTIONS UNDER BY-LAWS UNDER PUBLIC HEALTH ACT, 1891:- (a) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. - (b) For the prevention of keeping of animals in such a manner as to be injurious to health — (c) As to paving of yards, etc., of dwelling houses - (d) In connection with the removal of offensive matter, etc. 4 (e) As to removal and disposal of refuse, etc. — (f) For securing the cleanliness of tanks, cisterns, etc. - (g) With respect to water closets, etc. — (h) With respect to sufficiency of water supply to water closets — (i) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 1 (j) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) - Number of prosecutions under the Public Health (Meat) Regulations, 1924 Nil Number of prosecutions under the Milk and Dairies (Consolidation) Act, 1915 Nil Number of prosecutions under the Milk and Dairies Order, 1926 12 WORK OF DISTRICT INSPECTORS, 1928. 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2 House-to-House Special Inspections Complaints Infectious Diseases Factories & Workshops Specially Inspected Offensive Trades Outworkers' Bi-Annual Inspection Underground Conveniences Drains Tested Other Calls and Visits Chimneys watched Bakehouses Butchers Fishmongers, Friers and Curers Food Stores Fruiterers and Greengrocers Ice Cream Markets Restaurants and Eating Houses Destruction of Food Various TOTALS Visits Ints. 653 600 221 239 18 23 1 58 2150 5 24 154 76 20 95 68 1 8 4734 844 86 16 218 72 120 6 2 5518 713 267 968 771 343 220 18 24 - 25 2210 14 29 259 31 90 31 18 4216 520 22 1841 1 52 139 34 186 107 33 133 73 - 22 661 207 460 190 40 - 15 - 5448 872 600 393 728 362 122 20 27 - 56 2673 32 52 65 34 102 32 14 90 45 1 - 15 118 14 4378 604 345 567 274 75 - 43 - 64 1881 8 31 68 30 163 39 35 4 867 25 4 47 35 3408 820 388 393 214 78 - 14 1 34 1786 2 9 17 14 35 2 - 310 7 9 74 70 4066 856 366 237 86 2272 25 29 49 254 471 66 7 11 - 1 29 1 2 3349 3267 3611 1859 687 63 157 2 345 14813 63 226 727 248 645 336 109 602 596 15 48 31768 5492 Mr. Davis, Drainage Inspector :—Drains tested, 486 ; Nuisances, 4 ; Ints., 4 j Visits to Underground Conveniences, 425. Special Inspections, 592 ; Special Smoke Observatiions, 11; Other Visits 3830. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. HOMEWORK. NATURE OF WORK (1) Outwork in Unwholesome Premises Section, 108 Outwork in Infected Premises (Sections 109, 110) Outworkers' Lists, Section 107 Lists received from Employers Notices served on Occupiers sis to keeping or sending lists (8) Prosdcutions 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 , (19) Failing to send lists (10) Lists (2) Lists (5) Outworkers Outworkers Contractors (6) Workmen (7) Contractors (3) Workmen (4) Wearing Apparel:— I .. I I I T _ I I I I I I - I I I I I i - 5 8 (1) Making, etc. 24 12 127 - - - - - 8 - - - - (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 sudries - - 1 - - - - - - - - - - - - Cart gear - - - - - - - - - - - - - - - Locks, latches and keys - - - - - - - - - - - - - - - Umbrellas, etc. 2 - - - - - - - - - - - - - - Artificial flowers - - 1 - - - - - - - - - - - - Nets, other than wire nets - - - - - - — - - - - - - - - Tents 2 - 2 - - - - - - - - — — - - - - - - - - - - - - Sacks 4 - 13 - - Racquets and Tennis Balls - - - - - - - - - - - - - - - Paper, etc., Boxes, Paper Bags 1 1 2 - 4 - - - - - - - - - - Brush making - - 2 — - - - - - - - — - - - Pea Picking - - — - - - - — - - - - - - - Feather Sorting - - - - - - - - - - - - - - - Carding, etc., of Buttons, etc. 2 - 6 - - - - - - - - - - - - Surgical Instruments 2 - - _ - - - - - - - - - - - Basket making - - - - - - - - - - - - - - - Chocolates and Sweetmeats - - - — - - - - - - - - - - - Cosaques, Christmas Crackers, Christmas Stockings, etc. 1 - - - - - - - - - - - - - - Textile Weaving - - - - - - - - - - - - - - - Leather Goods 2 - 6 - - - - - - 1 1 - - - - Coat hangers - - - - - - - - - - - - - - - Total 12 163 - - - - - 10 10 - - - - 40 (74) FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. INSPECTION. Number of Premises Inspections Written Notices Prosecutions Factories (including Factory Laundries) 6 - 304 Workshops (including Workshop Laundries) 316 10 - Workplaces (other than Out workers' Premises) 67 3 - Total 687 19 - DEFECTS FOUND. Particulars Number of Defects Number at Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts — Want of Cleanliness 7 7 - - Want of Ventilation 1 1 - - Overcrowding - - - — Want of Drainage of Floors - - - - Other Nuisances 26 26 - - Sanitary Accommodation — 2 Insufficient 2 - - Unsuitable or Defective 9 9 - - Not separate for Sexes - - - - Offences under the Factory and Workshop Act- Illegal Occupation of Underground Bakehouse (s. 101) - - - - Breach of Special Sanitary Requirements for Bake houses (ss. 97 to 100) 25 25 - - Other Offences 3 3 - - 73 73 - - Total (75) OTHER MATTERS. Class. Number Matters notified to H.M. Inspectors of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters re ferred by H.M. Inspectors as remediable under the Public- Health Acts, but not under the Factories Act (s. 7) Notified by H.M. Inspectors 7 7 Reports (of action taken sent to H.M. Inspectors) Other 1 Underground Bakehouses (s. 101) :— Certificates granted during 1927 - In use at end of 1927 17 Workshop Bakehouses 27 413 Workshops on the Register (s. 131) at the end of 1927 440 Total Number of Workshops on Register No. OF BAKEHOUSES IN THE BOROUGH. In Use Not in Use Underground Above ground Above ground Underground 17 42 1 1 34 of these are Factory Bakehouses. HOUSE AND TRADE REFUSE. The following table shows the amount of house and trade refuse disposed of during the year ended December, 1928:— Disposal Loads tons cwts. qrs. 2,761 17 1 House Refuse to Barge 5,385 11 „ „ „ Destructor 9,751 17,465 2 9 3 Trade Refuse to Barge 2,908 3,274 „ „ „ Destructor 580 468 3 3 Totals 16,000 26,594 2 1 OFFENSIVE TRADES. The offensive trades on the Register are as follows :— Tripe boiler 2 Glue and size makers 3 Fellmongers 3 Fatmelters 4 Dresser of Fur Skins 4 MORTUARY. Total number of infectious bodies removed 15 Total number of bodies removed 65 DRAINAGE WORK. In 1926 the supervision of all drainage work in the borough was placed under the control of the Medical Officer of Health. This involved the transfer from the Surveyor's Department to this Department of the inspection of all new drainage work. This arrangement has worked very satisfactorily and has resulted in the elimination of overlapping. Mr. Davis, the Drainage Inspector, is responsible for the whole of this work, and carries out his duties very efficiently. STREET MARKETS. The market scheme continues to work smoothly and satisfactorily. Number of Licences in operation 593 Applications on waiting list 19 Income £2,510 12s. There have been twenty-nine prosecutions during the year for infringements of the Act. The total amount of refuse collected by the Market Cleaners is, as follows: — Tons Cwts. 713 Van Loads 901 15 354 Barrow Loads 53 2 Total 954 17 The Market Inspector is Mr. Francksen, who works under the supervision of the Chief Inspector. I am pleased to say that during the past year I have received the hearty co-operation of the police authorities, especially in the matter of preventing unlicensed traders from occupying pitches allotted to licence holders, and from selling from the footway. THE FLOOD. In one respect this has been an altogether exceptional year. As is well known, a large part of the borough is very low-lying, and is in many places actually below river level. On the night of January 6th, 1928, to be precise at about 1 a.m., on January 7th, owing to an unfortunate and unusual combination of high tide and powerful winds, the river overflowed its banks, and consequently a large number of riverside houses and premises were flooded. The height reached by the flood water varied according to the district, and was at its worst in the Silver Street Area where the flood level reached four feet. The misery and discomfort caused by the flood were intensified in this Area by the derangement of the electric light sub-station, and by the bursting of some large tanks of creosote and tar. These substances, of course, floated on the surface, and as the water subsided they coated everything with a sticky mess which it was almost impossible to remove. Prompt action was taken by the Mayor (Alderman H. C. Balman) and a corps of relief workers was organized and actually at work in the district within a few hours. Fortunately no lives were lost, but great damage was done to house property and to furniture, and for a long time afterwards the inhabitants went in fear and trembling, anticipating further floods. Altogether seventy streets, 1,213 dwelling houses and 1,285 families were affected. Following the energetic action of the Mayor, the Council appointed a Flood Committee which held its first meeting on the Sunday morning, the 8th January, making arrangements for temporary accommodation and for the supply of bedding, fuel, food and clothing. A complete inventory was later made of all the damage done both to houses and to furniture. In order to make this inventory, a Sanitary Inspector and a Health Visitor visited every one of the houses affected in company with a clerk. In the meantime the Mayor had opened a Relief Fund, which ultimately reached a total of £8,836 6s. 11d. To this were added generous grants from Funds raised by the Lord Mayor, the Mayor of Westminster, and the Mayor of Greenwich, and altogether a sum of £22,619 6s. 2d. was reached. In addition a gift of £500 worth of furniture was received from Messrs. Drage, and very large numbers of smaller gifts took the form of clothing and boots. While most of the work of repairs fell to the Works Department, the flood provided additional work for officers of this Department for nearly five months. IX.—FOOD CONTROL. The work of food inspection falls naturally into two sections, that which is done under the Imported Food Regulations by the Wharves Inspectors, and the work entailed in the administration of the Public Health (London) Act and the Sale of Food and Drugs Acts. Ours is a riparian Borough and a large amount of food is imported through its wharves. In effect, Bermondsey is a port, and requires the same arrangements for food inspection as any other port. Two officers are employed for the whole of their time in connection with the inspection of food at the wharves, and of wholesale food premises. Their work is onerous, skilled and responsible. They meet boats, examine cargoes, and are generally responsible, under the Medical Officer of Health, for seeing that all food imported is sound and complies strictly with the conditions laid down by law. They "stop" unsound food and it is their duty to make certain that such food is destroyed or otherwise disposed of, so that it cannot be used as human food. In the ordinary course of their work, the Wharves Inspectors exercise a general supervision over all imported food. It is impossible to examine every package and the Inspectors therefore make a practice of examining a certain percentage of all parcels. The value of a food cargo sometimes represents a very large sum, and the problems which arise are many and various. CASEOUS LYMPHADENITIS IN MUTTON. Towards the latter part of last year a problem arose in connection with the importation of mutton from Australia and South America. Large numbers of carcases showed signs of caseous lymphadenitis, and it became imperative that the importation of these carcases should be strictly controlled. As the result of an arrangement with the Medical Officer of Health of the Port of London, all such carcases were placed under "stop" and each carcase was individually examined before being released. This arrangement, which is still in force at the time of writing, involves a considerable amount of extra work. The figures are given below :— Number Number released as sound Number diseased Method of disposal of diseased carcases 12,753 whole carcases 32 bags Legs 24 bags Fore Quarters 11,732 whole carcases 31 bags Legs 23 bags and 1 pair Fore Quarters 1,021 whole carcases 8 Legs 5 pair Fore Quarters Boiling down into tallow for soap making by approved firms POLISH BUTTER. In December my attention was drawn to consignments of Polish "Butter" coming into this borough, and as a result three parcels of this "butter," over 2,000 casks in all, were placed under "Stop," and samples were taken for the purpose of analysis. In all seventeen samples were taken ; two of these were found to be genuine butter and fifteen were "mixtures." The result of analysis in the latter case showed that the "butter" contained on an average about 36.0 per cent, of butter fat, and the sample showing the highest content of butter fat gave a result of 41.0 per cent. The "butter" was kept under "Stop Notice" pending satisfactory arrangements for its disposal, and at the time of writing the whole quantity has been re-exported. SALE OF FOOD AND DRUGS ACT. Under this Act 1,500 samples were taken during the year, thirty-seven being found on analysis to be adulterated. Mr. Merryman is the Food and Drugs Inspector working under the general supervision of the Chief Inspector, and of course, in close co-operation with the Public Analyst. Mr. Merryman conducts the majority of his own cases in court. Full details of the samples taken are given in the accompanying tables, together with a summary of the results in court cases. I think it can be fairly said that the duties imposed on the Sanitary Authority by this Act, intricate though they be, are carried out with care and efficiency. UNSOUND FOOD. The general inspection of food in shops and on stalls forms part of the duty of the District Sanitary Inspector. The following quantities of food came under the notice of the Inspectors during the year, and being found unfit for human consumption was destroyed : — Weight Description of Food Tons cwts. qrs. lbs. Fresh Meat — 15 2 24 Fresh Fish — 2 3 22 Fresh Fruit - 13 1 23 Poultry 3 11 3 14 Total 5 3 3 27 MILK PREMISES. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Twenty-eight milksellers were registered under the above Act during 1928, and 32 names were removed from the Register, making a total of 196 milksellers on the Register at the end of the year under report. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year under report, the following Licenses were granted : — Dealers' Licenses :— To bottle and sell Grade "A" (Tuberculin Tested) Milk 10 To sell Grade "A" (Tuberculin Tested) Milk 26 To sell " Pasteurised " Milk 3 Supplementary Licenses: — To sell "Certified" Milk 3 3 To sell Grade "A" Milk 3 To sell Grade "A" (Tuberculin Tested) Milk 5 To sell " Pasteurised " Milk 3 All premises used for the sale of milk are regularly inspected to ensure that the standard of cleanliness laid down is maintained. WORK OF THE WHARF AND FOOD INSPECTORS, 1928. 1 2 3 4 5 6 7 8 9 10 11 Food Factories Food Stores Food Wharves and Depots Milksellers Restaurants Destruction of Food Nuisances Found Intimations Served Various Number of Samples taken Visits Fish Curers Other Jam Butter and Margarine Food and Drugs Unsound Food Regulations Milk (Special Designation) Order (81) Mr. Scott 71 - 74 7 376 2432 - - 272 - 44 - 14 - - Mr. Hoskins 360 27 482 57 1108 2243 - 6 346 15 4 124 - 6 - Mr. Merryman - - - - - - 594 - - 7 7 147 1500 - 75 1484 (82) FOOD AND DRUGS. Articles submitted for Analysis Percentages of Articles Adulterated Total Samples Taken Number Genuine Number Adulterated 2 2 Almonds, Ground - - Apples 1 1 - - Apples, Tinned 2 2 - - Apricots 2 2 - - Aspirin Tablets 1 1 - - Bacon 11 11 - - Baking Powder 1 1 - - 23 20 3 13.0 Barley, Pearl Barley, Pot 1 1 - - Beef, Corned 1 1 - - Beef, Minced 1 1 - - Bismarck Brown 1 1 - — Bismuth Dyspepsia Tablets 1 1 - - Black Pudding 1 1 - - 1 1 Borax - - Boric Acid 1 1 - - Boracic Acid Powder 1 1 - - Brawn 1 1 - - Brawn, Beef 1 1 - - Brawn, Pork 2 2 - - Butter 158 155 3 1.9 Cake 2 2 - - Cake, Cream Layer 1 1 - - Cake, Currant 10 10 - - Cake, Dundee 1 1 - - Cake, Lemon Slab 1 1 - - 2 2 - - Cake, Seed 10 10 Cake, Sponge - - Cake, Sultana 1 1 - - Camphorated Oil 1 1 - - Carmine Pink 1 1 - - Castor Oil 3 3 - - Cheese 28 28 - - Cinnamon 1 1 - - Cherries, Tinned 2 2 - - 1 - - Citrate of Magnesia 1 Clover Cream Powder 1 1 - - Cocoa 10 10 - - Cod Liver Oil 1 1 - - Coffee 12 12 - - Coffee Essence 1 1 - - Cordial, Lemon 1 1 - - Cordial, Lime Fruit 1 1 - - Cordial, Lime Juice 2 2 - - Cordial, Raspberry Flavour 1 1 - - Cream 5 5 - - Cream, Clotted 1 1 - - Cream of Tartar 4 4 - - Custard Powder 3 3 - - Cyder 2 2 - - Dripping 68 68 - - Eggs 1 1 - - 1 Egg Colour "C" 1 - - Egg Yolk 1 1 - - Eucalyptus Oil 1 1 - - 3 3 Fat, White - - Fish Paste 20 19 1 5.O (83) FOOD AND DRUQS—continued. Articles submitted for for Analysis Total Samples Taken Number Genuine Number Adulterated Flour 4 4 - Flour, Self-raising 8 8 - Fruits 1 1 - Fruit Salad 1 1 - Fruit Salad, Mixed 4 4 - Galantine 1 1 - Gherkins 1 1 - Giner 1 1 - Ginger, Ground 1 1 - Ginger Beer 1 1 - Glycerine 2 2 - Glycerine, Honey and Lemon 1 1 - Ham and Chicken Roll 1 1 - Honey 2 2 - Ice Cream 1 1 - Jam. Black Currant 4 4 - Jam, Mixed Fruit 2 2 - Jam. Plum 8 8 - Jam, Raspberry 11 11 - Jam, Raspberry Flavour 1 1 - Jam, Strawberry 2 2 - Jam Sponge 1 1 - Jam Sandwich 1 1 - Jellies 1 1 - Jelly Crystals 1 1 - Ketchup 1 1 - Lard 5 5 - Lardine 1 1 - Lemon Curd 1 1 - Lemonade 1 1 - Lemonade Crystals 3 3 - Lemonade Powder 1 1 - Lemon Squash 2 2 - Linseed Meal 1 1 - Loganberries, Tinned 1 1 - London Relish 1 1 - Lung Syrup 1 1 - Malt and Cod Liver Oil, Extract of 1 1 - Margarine 111 111 - Margarine, Cake 1 1 - Margarine, Pastry 1 1 - Marmalade 3 3 - Milk 484 471 13 Milk, Evaporated 2 2 - Milk, Separated 1 1 - Milk, Sterilised 15 15 - Milk, Condensed 3 3 - Milk of Sulphur 1 1 - Mincemeat 1 1 - Mustard 7 7 - Oatmeal 2 2 - Olive Oil 2 2 -- Paŕish's Chemical Food 1 1 - Parrish's Improved Chemical Food 1 1 - Peas 2 2 - Peel, Candied 1 1 - (84) FOOD AND DRUGS —continued. Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated 2 - Piccalilli 2 Pickles 1 1 - Pickled Cabbage 1 1 - Quinine, Ammon., Tincture of 2 2 - Raisins 3 3 - Raisins Muscat, 1 1 - Relish, Breakfast 1 1 - Rice 4 4 - Rice, Flaked 1 1 - Rice, Ground 2 2 - Sauce 2 2 - Sauce Chop 1 1 - Sauce, Tomato 1 1 - Sausage, Breakfast 27 23 4 Sausage, Luncheon 1 1 - Sausages, Beef 35 33 2 Sausages, Pork 13 12 1 Semolina 2 2 - Soda-Mint Tablets 1 1 - Spirits of Nitre, Sweet 1 1 - Suet, Shredded 12 12 - Sugar 8 8 - Sugar, Castor 1 1 - Sugar, Demerara 5 5 - Sugar, Pudding 1 1 - 1 Sugar, Yellow Crystal 1 - Sulphur, Precipitated 1 1 - Sulphur and Limefruit Lozenges 1 1 - Sulphur, Sarsaparilla and Treacle 1 1 - Sultanas 15 15 - Tapioca 1 1 - Tapioca Flaked 1 1 - Tartaric Acid 4 4 - Tea 1 1 - Tea Dust 2 2 - Tea Farmings, Assam 1 1 - Toffees, Rum and Butter 2 - 2 Toffees, Rum and Butter Flavour 1 1 - Vermicelli 2 2 - Vermiline Scarlet R.F. 1 1 - Vinegar, Malt 30 29 1 Vinegar, Wood 108 101 7 Wine, Blackcurrant 3 3 - Wine, British Sherry 1 1 - 5 5 - Wine, Ginger 2 2 Wine, Ginger Essence - 1 1 Wine, Green Ginger - Wine, Orange 3 3 - 1 1 Wine, Orange and Quinine - 2 2 Wine, Port - Wine, Raisin 1 1 - Wine, Raisin Flavour 1 1 - White of Egg, Powdered 1 1 - (85) PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1928. Sample Adulteration or Infringement Remarks No. 604 Pearl Barley Containing Sulphur dioxide 0.006 per cent. Dismissed. Warranty proved. 605 Pearl Barley Containing Sulphur dioxide 0.009 per cent. Dismissed. Warranty proved. 662 Vinegar Containing Zinc 0.51 per cent. Ordered to pay costs 17s. 6d. 689 Milk Deficient in Milk fat, 5.3 per cent. Ordered to pay costs 17s. 6d. 573 Milk Deficient in Milk fat, 12.0 per cent. Fined 40s. Costs 21s. 0d. 779 Vinegar Deficient in acetic acid, 14.0 per cent. Fined 5s. Costs 17s. 6d. 819 Malt Vinegar Vinegar other than Malt Vinegar, 100.0 per cent. Fined £5. Costs 17s. 6d. 572 Milk Added water, 8.7 per cent, and Deficient in Milk fat 9.5 per cent. Fined £20. Costs £2 2s. 0d. 571 Milk Deficient in Milk fat 7.3 per cent. Taken in with above Summons. 570 Milk Deficient in Milk fat 8.3 per cent. Taken in with above Summons. 543 Milk Deficient in Milk fat 24.0 per cent. Taken in with Summons on Sample 572 if Fine is paid. 927 Pearl Barley Containing Sulphur dioxide, 0.0105 per cent. Dismissed. Warranty proved. Milk Deficient in Milk fat, 9.0 per cent. Fined 20s. Costs 17s. 6d. 959 8 Pork Sausages Containing Sulphur dioxide, 0.0225 per cent. Fined 40s. 9 Beef Sausages Containing Sulphur dioxide, 0.0121 per cent. Fined 40s. 110 Vinegar Deficient in acetic acid, 7.0 per cent. Dismissed. Warranty proved. Vinegar Deficient in acetic acid, 15.0 per cent. Fined 2s. 6d. costs 17s. 6d. 172 179 Milk Deficient in Milk fat, 16.0 per cent. Dismissed under Probation of Offenders Act. Ordered to pay costs 178. 6d. 292 Rum and Butter Toffees Butter fat 1.8 per cent Fats other than Butter fat, 11.2 per cent. Dismissed under Probation of Offenders Act. 359 Vinegar Deficient in acetic acid, 20.0 per cent. Fined 2s. 6d. Costs 17s. 6d. 890 Vinegar Deficient in acetic acid. 13.25 per cent. Fined 2s. 6d. Costs 17s. 6d. SUMMARY. £ s. d. Fines 32 12 6 Costs 11 0 6 £43 13 0 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Weight Quantity Weight Quantity Weight Quantity tons cwt qr lbs tons cwt lbs tons cwt lbs Almonds qr qr 1 bag - - - - - - 2 0 0 - - - - - Apple Bits - 2 4 - - - - - - - - - - Apple Rings 13 cases and various packages - 7 1 20 - - - - - - - - - - Apples - 4 0 2 - - - - - - - - - - - Apricot Pulp - - - - - 14 cases and 47 tins - 18 1 16 - - - - - Apricots - - - - - - - 10 3 0 - - - - various parcels Apricots, Dried - - - - - 72 cases and 62 boxes 1 9 3 8 62 boxes - 13 3 0 Bacon 28 sides 2 backs and trimmings - 17 2 6 - - - - 11 2 0 0 - 100 bales Barley Pearl - - 5 0 2 - - - - - - - - - - Beans Mixed 22 bags 1 0 0 0 - - - - - - - - - - Beef, Corned 2022 tins 5 5 1 6 - - - - - - - - - - Beef, Fresh - 13 2 26 - - - - - 2 bodies 2 hind qtrs. 2 bags and various packages - - - - - Blackcurrant Pulp - 28 cases and 3 tins 1 5 0 0 18 cases and 23 tins 1 4 1 0 - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925.—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Weight Quantity Quantity Weight Quantity Weight tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs Bran 216 cases 3 8 0 4 - - - - - - - - - - Brawn 45 tins - 2 1 26 - - - - - - - - - - Bulls Hoofs - 1 bag 10 - 2 - - - - - - - - - - Butter - - - - - 1 box and trimmings - 2 0 2 25 boxes - 12 2 0 Butter Beans 3,303 bags and various packages 206 6 0 0 - - - - - - - - - - Calf Tongues - - - - - - - - - - - - - - - Canary Seed - - - 179 bags 8 19 0 0 - - - - - - - Canned Goods (various) - - - - - various packages 65 7 0 12 1 case - - 3 0 Carrots 55 baskets - 0 - - - - - 13 3 - - - - - Cauliflower - - - - - 3½ crates - - 3 0 - - - - - Caviare - - - 3 casks - 3 0 0 - - - - - - - Cheese 1 3 19 - - - - - - - - - - - - Cheese, Stilton - - 62 cheeses - 3 1 14 - - - - - - - - Chickens - - - - - 4 baskets 1 case and 21 birds - 1 0 11 - - - - - Chicken and Ham Roll - - - - - 1 case and 7 tins - - 3 10 - - - - - Chicory - - - 32 bags 3 2 0 - - - - 0 - - - Chocolate - - - 1 16 0 0 - - - - - - - - Chocolate Biscuits - - - 10 cases 12 2 0 - - - - - - - - Cocoanut - - - - - - - 262 cases and 28 boxes 14 10 0 0 - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs tons cwt lbs qr Cocoanut, Desiccated - - - - - - - 337 cases 19 11 0 0 - - — - - - - - Cocoanuts - - 345 bags - - - - 17 1 0 0 - - - - - - - - - Cod Fish - - - 1 case 1 0 0 - - - - - - - - - - - - - Coffee - - 6 bags - - 6 0 0 - - - - - - - - - - - - Coffee Camp - 29 cases 13 0 0 - - - - - - - - - - - - - - - Cones - - - 59 bags 0 - 3 3 0 - - - - - - - - - - - Coriander Seed - - - - 147 bags 7 7 0 0 - - - - - - - - - - - Corn Flakes 405 cases 5 2 0 0 246 bags 12 6 0 0 - - - - - - Corn Flour - - - - 235 cases and 19 bags 9 14 0 0 1 3 27 - - - - - - - - - - - - Currants 16 cases 1 bag and Various packages 2 19 0 0 - - - - - - - - - - - - - - - Cucumbers, Salted - - 246 casks 0 - - - 37 10 0 - - - - - - - - - - Dates 14 cases and 1 parcel 17 0 0 various packages 9 1 13 - - - - - - - - - - - Dates, Carton 34 cases 15 2 0 29 cases - 13 0 0 - - - - - - - - - - - Dates, Tunis - 30 cases - 12 3 12 - - - - - - - - - - - - - - Eggs - - 3436 tins and 2750 eggs 194 13 0 0 - - - - - - - - - - - - - Egg Yolk - - 2 cases - 3 0 0 - - - - - - - - - - - - - 3 15 0 21 1 12 1 7 116 bags Figs various packages 62 boxes 4 cases and 2 bags - - 1 8 0 0 - - - Fish, Fresh - - - - - 23 cases 2 4 0 0 - - - - - - - - - - 6 cases - 12 0 0 - - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1926—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Weight Quantity Weight cwt qr lbs tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs tons flour 4 bags and various packages 1 9 2 26 - - - - - - - - - - - - - - - Fruit, Canned, Various - - 1 0 - - - - - - 1 load, 4 1 - - - - - - - Fruit, Dried - - - - 54 x ¼ cases - - - - - 6 3 0 - - - - - - - Fruit Pulp, various - various packages 5 7 2 0 - - - - - - - - - - - - - - Fruit Salad - - 24 - - - - - - - - 5 0 - - - - - - - Glucose - 1 cask - 4 2 0 - - - - - - - - - - - - - - Greengage Plums - 10 cases 5 1 2 - - - - - - - - - (89) - - - - - - Greengage Pulp 3 cases and 3 tins - - - - - 3 0 20 - - - - - - - - - - - Ground Nuts 1083 bags and various packages 49 8 2 0 - - - - - - - - - - - - - - - Hams 4 cases and 62 tins 10 2 5 2 tins - 24 1 case 1 1 0 31 cases - - - 1 12 0 0 - Hazelnut Kernels 43 bags 2 10 0 0 - - 116 bags 5 16 0 0 - - - - - - - - Hemp Seed - - - - - - - - - - 4 bags 4 0 0 - - - - - - Horse Radish, - - - - - 22 bags and 14 casks - 18 0 0 - - - - - - - - - - Jellied Veal - 2 tins 12 - - - - - - - - - - - - - - - - - Jellied Pork - - - - - - - - 47 cases 2 7 0 0 - - - - - - - Kernels 491 bags 20 0 0 0 - - - - - - - - - - - - - - - Lamb one - - 3 12 - - - - - - - - - - - - - - - Lambs Livers 2 packs - - 3 10 - - - - - - - - - - - - - - - Lambs Sweetbreads 2 packs - - - 14 - - - - - - - - - - - - Lard - - - - - - - - - - - - 10 cases - 5 0 0 - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs Lemon Skins - - 1 cask 7 2 0 - - - - - - - - - - - - - - Liquorice - - - - - - - - - - - - - - - 2½ cases - 2 2 0 Mandioca Meal 130 bags and 1 parcel 10 15 0 0 - - - - - - - - - - - - - - - Meat Cuttings - - 4 1 4 - - - - - - - - - - - - - - - Meat, Tinned, Various 7 cases and 28 tins - 6 2 14 - - - - - - - - - - - - - - - (90) Melons - - 322 cases 4 7 0 0 - - - - - - - - - - - - - Milk, Condensed - - 16 tins - 16 - - - - - - - - - - - - - - - Milk, Evaporated - - - 64 cases and 311 tins 1 14 2 27 - - - - - - - - - - - - Mutton 773 carcases and 2 packs Trimmings 20 6 2 5 - - - - - - - - - - - - - - - Mutton Broth 170 cases 8 0 0 0 - - - - - - - - - - - - - - - Nectarines - - - 3 0 0 - - - - - - - - - - - - - - Oatmeal Feed - 1 11 2 25 - - - - - - - - - - - - - - - Oats various packages 3 10 1 5 - - - - - - - - - - - - - - - Oats, Flaked - - 8 0 21 - - - - - - - - - - - - - - - Oats, Rolled various parcels 6 5 1 11 - - - - - - - - - - - - - - - Offal - - - 23 - - - - - - - - - - - - - - - - Onions - - 929 bags, 52 cases and 15 baskets 47 5 0 0 - - - - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons lbs lbs tons cwt qr lbs tons cwt qr lbs cwt qr tons cwt qr Ox Kidneys 14 boxes 7½ bags 1 case and 38 Kidneys - 6 1 16 - - - - - - - - - - - - - - - Ox Tongues - 9 tongues - - - - 1 19 - - - - - - - - - - - - Ox Tongues, Tinned 100 tins - 5 3 15 - - - - - - - - - - - - - - - Peaches - 2 cases and various packages - - - - - 3 0 24 - - - - - - - (91) - - - 185 bags and various packages Peas 107 10 0 12 - - - 31 bags 1 11 0 0 - - - - - - - Peas, Split 4 bags and various packages - 13 1 26 - - - - - - - - - - - - - - - Peanuts 725 bags 21 0 0 0 - 90 bags 4 10 0 0 - - - - - - - - - Pea Sweepings 6 bags - 9 0 0 - - - - - - - - - - - - - - - Pears, Tinned - - - - - 3 cases - 1 2 14 - - - - - - - - Pears, Australian - - - - 360 cases 8 3 1 0 - - - - - - - - Pep - - - - - 129 cases 1 15 0 0 - - - - - - - - - - - - - - - Pig and Offal - - 2 3 14 - - - - - - - - - - - - - Pigs 4 carcases - - - 2 1 3 - - - - - - - - - - - Pigs Feet - - - - - - - - 2 - - - - - - - - 25 cases 10 0 0 - - - Pigs Tongues - - - - - - 40 casks and 11 barrels. 4 17 0 0 - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925-continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Quantity Weight Quantity Weight Weight Quantity Weight tons tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs cwt lbs qr Pineapples, Tinned - - 70 cases and 172 tins 5 7 2 10 - - - - - - - - - - - - - Plums 1 case 25 various packages 2 9 0 16 30 cases 6 2 22 - - - - - - - - - Plums, Dried - 90 boxes - 18 2 10 - - - - - - - - - - - - - - Plums, Red - - - - - 12 cases - 19 2 0 - - - - - - - - - - Pork - - 1 piece - 20 1 case - 4 3 2 - - (92) - - - - - - - - Potatoes 211 bags 10 11 0 0 14 0 0 130 bags and 8 boxes 8 - - - - - - - - - - Poultry - - - - 2 2 0 - - - - - - - - - - - - - Prunes - 1 0 0 0 110 boxes 1 0 - - - 5 0 - - - - - - - Pulp, various - - 20 tins - - - - - 1 1 10 - - - - - - - - - Rabbits 1 case - - 2 16 - - - - - - - - - - - - - - - Raisins 40 bags and 1 package 4 8 1 8 6 cases and various packages - 7 3 7 355 boxes 2 4 1 14 - - - - - Raisins, Californian 111 cases 1 5 0 0 - - - - - - - - - - - - - - - Raisins in Cartons - - - - 8 cases - 2 2 8 - - - - - - - - - - - 3 cases and 2 tins - Raspberry Pulp - - - - - - 1 2 12 - - - - - - - - - Rice 322 bags, 7 pockets and various packages 26 5 0 24 - - 1 0 - 28 bags 8 0 - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs 14 Rice Sweepings various packages 1 3 25 - - - - - - - - - - - - - - - - 12 - - 178 bags 0 - - Sago Flour 4 0 - - - - - - - - - - Salmon, Tinned - 8 cases and 139 tins - - - - - 4 0 26 - - - - - - - - - - - Sausages, Tinned, Vienna - - - - - 495 cases 3 1 1 12 - - - - - - - - - Semolina - - 1 1 19 - - - - (93) - - - - - - - - - - - Sheep 24 carcases and packs and Trimmings 1 0 15 5 - - - - - - - - - - - - - - - - Sheep Kidneys - - 2 2 24 - - 2 crates and 10 boxes - - - - - - - - - - - 270 0 0 0 - - - Soups, Tinned, various 10,345 cases - - - - - - - - - - - - Strawberries 15 tubs and 7 trays 6 - - - - - - 6 0 - - - - - - - - - - 3 2 0 - - - - - - Strawberry Pulp 1 barrel - - - - - - - - - - Sugar 83 bags 8 6 0 0 - - - - - - - - - - - - - - - 55 Cases Sugar Small Cube 2 15 0 0 - - - - - - - - - - - 99 boxes and 10 bags - - - - Sultanas 5 18 1 13 2 cases 3 20 - - - - - - - - - - - - 727 13 0 0 - 882 casks, 74 tierces, 86 barrels and 51 packages Tallow 1,394 casks 525 tierces and 160 pipes - - 382 11 0 0 - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925—continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs tons cwt qr lbs tons lbs cwt qr - - - Tea 42 17 3 11 - - - - - - - - Tomato Puree - 96 cases and 10 tins 4 6 2 12 - - - - - - - - - 13 - 14 tins Tongues 2 - - 14 - - - - - - - - Tripe - - 1 box 14 - - - - - - - - - - - - 12 birds 1 0 17 - - Turkeys - - - - - - - - - - 8 cases and 5 tins 4 2 0 - - Veal and Ham Roll - - - - - - - - 0 29 cases - 3 cases 0 Walnuts 1 1 2 2 1 - - - - - Walnuts, Shelled - - 23 cases 2 9 0 0 - - - - - - - various parcels 452 4 3 6 - - - - Wheat - - - - - - - - - - - - - - -