AC 4378 BER 46 C Borough of Bermondsey REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1933 BY D. M. CONNAN, M.B., B.S., D.P.H. Medical Officer of Health. Borough of Bermondsey REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1933 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 Staff 5 VITAL STATISTICS— Area 8 Dwellings 8 Rateable Value 8 Population 8 Births 8 Deaths 9 Marriages 9 Infantile Mortality Rates 10 Deaths from Tuberculosis 10 Vital Statistics of District 11 Causes of Deaths 14 Deaths from Zymotic Diseases 16 Infantile Mortality, Causes of Deaths 17 INFECTIOUS DISEASES— Diseases Notifiable 18 Diphtheria 18 Scarlet Fever 19 Small Pox 19 Measles 19 Enteric Fever 20 Ophthalmia Neonatorum 20 Puerperal Fever and Pyrexia 20 Disinfection 20 Cleansing Station 21 Shelter 21 Bacteriological Laboratory 22 Food Poisoning 22 Foot Clinic 23 Insulin for Diabetic Patients 23 Nursing 24 Cases Notified in 1933 25 Cases Notified for last ten years 26 TUBERCULOSIS— New Cases and Deaths 27 Period between Notifications and Deaths 27 Nursing and Extra Nourishment 30 Shelters 30 Lady Almoner 31 PAGE Public Health (Prevention of Tuberculosis) Regulations, 1925 31 Work of the Tuberculosis Dispensary 32 Summary of Notifications 33 Cases on the Register 34 LIGHT TREATMENT— Work done in the Solarium 35 Leysin Patients 42 MATERNITY AND CHILD WELFARE— Fairby Grange Convalescent Home 43 Midwifery Service 43 Obstetric and Puerperal Fever Consultants 43 Infant Life Protection 44 Maternal Mortality 44 Work of the Health Visitors 45 Attendances at Centres 46 Statistics for 1933 47 DENTAL TREATMENT— Particulars of Children Treated 49 Particulars of Treatment and Work for 1933 50 PROPAGANDA 51 SANITARY ADMINISTRATION- Housing 61 Inspections and Proceedings 63 Work of the District Inspectors 68 Factories and Workshops—Homework 69 Factories and Workshops—Inspections 70 Bakehouses 71 House, Trade and Market Refuse 72 Offensive Trades 72 Mortuary 72 Street Markets 72 Drainage Work 72 FOOD CONTROL— Unsound Food —Shops and Stalls 73 Imported Food Regulations—Samples Taken 74 Work of the Wharves and Food Inspectors 76 Milk Premises 77 Milk Licences 77 Milk Sampling 77 Ice Cream 78 Food and Drugs —Samples Taken 79 Food and Drugs—Prosecutions 83 Unsound Food—Wharves, etc. 84 HEALTH SERVICES 88 PUBLIC HEALTH DEPARTMENT. PUBLIC HEALTH COMMITTEE, 1933. Chairman Councillor Mrs. F. I. M. HUSK, 1932-33 „ „ S. R. WEIGHTMAN, 1933-34 Vice-Chairman „ Mrs. A. M. HATCHER, 1932-33 „ „ Mrs. F. A. POWELL, 1933-34 Alderman Miss A. Broughton Councillor A. V. Kidd „ J. A. W. Douglas „ C. J. Lee „ Mrs. D. A. Green „ A. Ponsford „ Miss M. I. Henrich „ W. Shearring, Councillor Mrs. S. C. Amos J.P. „ W. T. Cockett „ J. W. Simmonds „ Mrs. E. V. Coyle „ G. H. Stean „ „ J. Donovan „ J. Sullivan „ Miss K. Groves „ J. C. Wayne „ G. H. Horwood „ Mrs. L. L. White Ex-officio: Councillor Mrs. E. F. GEORGE, J.P., Mayor of Bermondsey, 1932-33. Councillor C. E. PHILPOT, J.P., Mayor of Bermondsey, 1933-34. MATERNITY AND CHILD WELFARE COMMITTEE, 1933. Chairman Councillor Mrs. A. M. FORTESCUE Vice-Chairman „ Mrs. E. V. COYLE Alderman Miss M. I. Henrich Councillor W. A. Phillips, Councillor D. Bradley J.P. „ Mrs. J. Donovan „ Mrs. F. A. Powell „ „ L. F. M. „ „ R. E. Reed Franklin „ E. Roberts „ „ E. F. George „ R. Wedden „ C. Harding „ Mrs. L. L. White „ Mrs. A. M. Hatcher Co-opted Members: Mrs. E. R. Balman Miss D. Plummer Mrs. E. C. Starr Miss E. M. Haslam Ex-officio: Councillor Mrs. E. F. GEORGE, J.P., Mayor of Bermondsey, 1932-33. Councillor C. E. PHILPOT, J.P., Mayor of Bermondsey, 1933-34. STAFF: — MEDICAL OFFICER OF HEALTH. D. M. Connan, M.B., B.S., D.P.H. SANITARY INSPECTORS: G. L. Scott, Wharves and Food Inspector. G. A. Hoskins, Wharves and Food Inspector. J. G. Frankson, Wharves and Food Inspector. A. H. Merryman, Food and Drugs Inspector. E. J. Pitts, Market Inspector. District Inspectors. W. Davis, Senior District Inspector and Drainage Inspector No. 1—G. F. J. Toll No. 5-H.E. Butcher No. 2 —F. L. Richardson No. 6-O. W. R. Smart No. 3 —H. J. Bailey No. 7-F. J. Carpenter No. 4— W. C. Tapsfield TUBERCULOSIS DISPENSARY. Deputy Medical Officer of Health and Clinical Tuberculosis Officer—C. H. C. Toussaint, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health and Assistant Tuberculosis Officer─E. J. MacIntyre, M.D., D.P.H. Lady Almoner—Olive Pike. Tuberculosis Nurses — Celia Clapson, Louise Colbeck and Edith Riley. Solarium Nurses—Constance Clarke and Estelle Jagôt. Caretaker—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. Lucy Brown Rosa Bache Marie Helden Mrs. Dorothy Cottier Sarah Bowles Amy Carlton Elizabeth Lawrence Florence Wadds Gwendolen Riches Isabel White Fair by Grange Convalescent Home: Matron—Florence Child Nurse—Ann O'Meara DENTAL DEPARTMENT: Municipal Dental Surgeon— Grantley Smith, L.M.S.S.A., H.D.D.Edin., L.D.S.Eng. Assistant Dental Surgeon-W. H. Shapland, L.D.S.Eng. Dental Nurses—Winifred Lambert and Mrs. Daisy Hodgson Prosthetic Assistants—G. W. Clarke, W. B. Monger and T. H. Baggott PUBLIC ANALYST. A. Prideaux Davson, A.R.C.Sc., F.I.C., F.C.S PROPAGANDA AND ADMINISTRATIVE OFFICER: H. W. Bush, M.I.H. CLERICAL STAFF: A. I. Fair, Chief Clerk C. H. Harris, General Clerk F. W. Smith, Second Clerk W. A. Campbell, General Clerk C. W. Whye, General Clerk L. T. Knott, General Clerk A. Manning, General Clerk Alice Jones, Solarium Clerk C. F. Yaxley, General Clerk H. E. W. Ellery, General Clerk Rose Dutch, Clerk & Dispenser A. W. Hancock, General Clerk C. F. Lumley, General Clerk Alice Taylor, General Clerk H. J. Smith, General Clerk J. W. J. Saward, Junior Clerk F. R. Parker, General Clerk MORTUARY KEEPER: J. C. Stockwell DISINFECTING AND CLEANSING STATION: A. C. Davidson, Foreman in Charge. PUBLIC HEALTH DEPARTMENT, MUNICIPAL OFFICES, 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 my Annual Report for the year 1933. The arrangement of the report follows that of previous years and no prefatory remarks appear to be necessary. I have again to express my gratitude to the Chairmen and Members of Committees and to the staff for their support and ready help at all times during the year. Although at the time of writing we have entered the new year I would like to express my sense of the loss which the Department has sustained in the resignation of Dr. MacIntyre, who has been appointed Medical Officer of Health for the Sutton district. I have also to record, with great regret, the death of Miss Constance Clarke, which occurred on the 9th January, 1934. I am, Sir, Ladies and Gentlemen, Your obedient Servant, D. M. CONNAN. 1.—VITAL STATISTICS. GENERAL. The area of the Borough (exclusive of area covered by water) is 1,336 acres. The number of inhabited houses at the end of 1933 according to the Rate Books was 18,827. The rateable value of the Borough on the 31st December, 1933 was £874,953, the product of a penny rate being £3,450. POPULATION. Estimate of Registrar General Census 1921 1931 to 30th June, 1932 to 30th June, 1933 111,542 119,452 110,100 107,300 BIRTHS. The total number of births belonging to the Borough registered during 1933 was 1500, consisting of 744 males and 756 females. The number for 1932 was 1,831. The birth rate for 1933 was 14.0 per 1,000 persons living, compared with 16.6 for 1932. DEATHS. The total number of deaths belonging to the Borough registered during 1933 was 1,340, consisting of 716 males and 624 females. The number for 1932 was 1,326. The death rate for 1933 was 12.5 per 1,000 persons living, compared with 12.0 for 1932. MARRIAGES. The total number of marriages in the Borough in 1933 was 1,007, being 71 above the number for 1932, and 6 below th e average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 18.77 per 1,000 of the population, compared with a marriage rate last year of 17.00. Year No. Rate 1923 1,056 17.34 1924 1,015 16.62 1925 1,038 16.88 1926 994 16.15 1927 1,021 16.88 1928 1,055 18.32 1929 994 17.47 1930 1,021 17.94 1931 1932 1,001 936 17.81 17.00 17.24 Average for years 1923—1932 1,013 1933 1,007 18.77 INFANTILE MORTALITY. Whole Borough London Year No. of Deaths Rate per 1,000 Births Rate per 1,000 Births No. of Deaths 1923 5,615 220 76 61 1924 229 78 5,904 69 210 1925 79 5,599 68 1926 146 60 5,067 64 149 1927 67 4,357 59 1928 178 85 4,879 67 1929 160 71 4,995 71 1930 130 63 4,109 59 112 4,270 1931 57 65 1932 103 56 4,143 67 Average for years 1923-1932 164 69 4,894 65 1933 92 61 3,377 60 TUBERCULOSIS OF THE RESPIRATORY SYSTEM. In the following Table will be found particulars of deaths from Tuberculosis of the Respiratory System since the year 1923. Bermondsey Rotherhithe St. Olave Whole Borough London Sub-District Rate Year No. No. No. No. Rate No. 4432 1923 95 35 14 144 1.18 0.97 92 4486 1924 46 11 149 1.22 0.98 1925 99 35 11 145 1.18 4361 0.95 1926 100 39 12 151 1.23 4066 0.88 87 1927 42 15 144 1.19 4140 0.91 88 143 3985 0.89 1928 43 12 1.24 78 31 8 117 1.03 4230 1929 0.96 132 1930 81 81 36 15 1.16 3826 0.87 1.03 1931 30 5 116 3907 0.90 71 34 11 1.05 1932 116 3564 0.82 87 37 Averages for years 1923-1932 1.15 11 136 4100 0.91 68 23 1933 8 99 0.92 3530 0.82 INFANTILE MORTALITY RATE FOR 25 YEARS. VITAL STATISTICS OF WHOLE DISTRICT DURING 1933 AND PREVIOUS YEARS. Population estimated to Middle of each Year 2 Net Deaths at all Ages belonging to the District Year 1 Births Total Deaths registered in the District Total Deaths in Public Institutions in the District 9 Deaths of Residents registered in Public Institutions beyond the District 11 Deaths of Non- Residents registered in Public Institutions, etc. in the District 10 At all Ages Under 1 Year of Age No. 3 Rate 4 No. 12 Rate 13 No. 5 Rate per 1,000 Births registered 6 No. 7 Rate 8 1923 121,700 9.7 42 288 1,480 12.1 2,912 23.9 220 76 1,192 330 1924 122,100 2,913 23.8 200 68 1,277 10.4 720 43 337 1,657 13.6 188 1,280 321 1925 123,000 2,652 21.6 71 10.4 669 47 1,554 12.6 352 1926 123,100 2,414 52 1,163 9.4 624 31 1,484 12.1 19.6 126 1,236 10.2 616 352 12.9 1927 121,000 2,233 18.5 119 53 22 1,566 2,086 39 1928 115,200 18.1 143 69 1,230 10.7 671 329 1,520 13.2 127 11.4 32 378 1929 113,800 2,252 1,304 696 1,650 14.5 19.8 56 1,169 10.3 686 46 365 1,488 13.1 1930 113,800 2,059 18.1 90 44 12.5 1931 112,400 1,958 17.4 91 46 1,169 10.4 596 92 331 1,408 16.6 1,147 1,326 1932 110,100 81 10.4 689 189 368 12.0 1,831 44 Averages for years 1923-1932 117,620 2,331 19.7 138 12.9 58 630 1,513 1,217 58 342 10.3 12.5 1933 107,300 14.0 48 1,216 215 339 1,340 1,500 72 11.3 720 OTHER INSTITUTIONS, Etc., Etc. I. Institutions, etc., within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III Other Institutions, etc., the Deaths in which have been distributed among the several localities in the District No. of Deaths No. of Deaths No. of Deaths Ambulances on way to Hospital 11 St. Olave's Hospital 199 Ladywell Institution 72 Bancroft Lodge, Stepney 1 Beachville, Lancing 1 Belgrave Hospital, Lambeth 1 Bexley Mental Hospital 4 Bermondsey Medical Mission Hospital 1 Bow Institution, Poplar 1 Brompton Hospital 1 Brook Hospital, Shooters Hill 1 Cancer Hospital, Chelsea 1 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc 9 Catholic Nursing Institute, Lambeth 1 1 Claybury Mental Hospital 1 Colindale Hospital, Hendon 4 Constance Road Institution, Camberwell 1 Darenth Training Colony 1 Downs Hospital, Sutton 1 Railway 2 Dulwich Hospital 2 East London Hospital for Children .. 3 Eastern Hospital, Homerton 1 Workplaces 1 Edmonton Colony 2 Eros Road Institution, Lambeth 1 Evelina Hospital 1 Private Houses 3 Forest, The, Epsom 1 Friern Barnet Infirmary 3 Grove, The, Epsom 3 Total 215 Grove Park Hospital, Mottingham 2 Guy's Hospital 79 Hammersmith Hospital 1 Hartley House, Cranbrook 1 High Wood Hospital, Brentwood 2 Horton Hospital, Epsom 2 Hospital, The, Coulsdon 9 Hundred Acres, Epsom 3 Joyce Green Hospital, Dartford 1 King George's Sanatorium, Bramshott 1 King's College Hospital, Brixton 2 Lady well Institution 72 Lambeth Hospital 11 Leavesden Mental Hospital 1 Lewisham Hospital 4 London Jewish Hospital, Bethnel Green 1 1 Lying-in Hospital, York Road 1 Margaret Cottage, Doddington 1 Maternity Hospital, Stepney 1 Memorial Hospital, Teddington 1 Miller Hospital, Greenwich 5 National Sanatorium, Benenden 1 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. Park Hospital, Hither Green 11 Private Houses 5 Public Assistance Institution, Bishops Road, Bethnal Green 1 Queen Mary's Hospital, Carshalton 2 Queen Mary's Hospital. Chislehurst 2 River Thames 1 Royal Waterloo Hospital 1 St. Alfege's Hospital, Greenwich 3 St. Anthony's Hospital, Epsom 1 St. Bartholomews Hospital 1 St. Benedict's Hospital, Wandsworth 1 St. Columba's Hospital, Hampstead 1 St. George's Hospital, Westminster 2 St. Giles Hospital, Camberwell 1 St. Joseph's Hospice, Hackney 4 St. Nicholas Hospital, Woolwich 1 St. Paul's Hospital, Holborn 1 St. Stephen's Hospital, Chelsea 1 St. Thomas's Hospital 6 " Sandhill," Tonbridge 1 Schiff Home of Recovery, Cobham 1 Seamen's Hospital, Greenwich 1 Skin Yard, High Street, Canterbury 1 South-Eastern Hospital, New Cross 13 South London Hospital, Wandsworth 1 Street 2 Tooting Bec Hospital 16 West Park Mental Hospital, Epsom 5 Whipps Cross Hospital 1 Wolverton Avenue Institution, Kingston -on-Thames 1 Total 339 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1933. Causes of Death Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. 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 1340 92 18 27 57 143 366 595 42 - - - - Uncertified - - - - - - - - - - - - - Typhoid and Paratyphoid Fever - 9 - 2 5 2 - - - - Measles (14) Scarlet Fever 4 1 1 - 2 - - - - 5 3 2 - - - - - - Whooping Cough 13 - - 9 4 - - - - Diphtheria Influenza 51 - - 1 - 1 6 23 20 2 - - - - - - 1 1 Encephalitis Lethargica 2 1 - - - 1 - - - Cerebro-spinal Fever Tuberculosis of Respiratory System 99 1 - - 3 18 35 32 10 Other Tuberculous Diseases 20 2 2 2 3 3 2 5 1 3 - - - - - - 3 - Syphilis General Paralysis of the Insane, tabes dorsalis 3 - - - - - 2 1 - 159 - - - - 1 13 77 68 Cancer, Malignant Disease 13 - - - - - 2 2 9 Diabetes 91 1 - - 1 1 1 23 64 Cerebral Hæmorrhage, etc. Heart Disease 219 1 - - 5 6 16 53 138 4 - - - - 1 2 - 1 Aneurysm - - - - - 1 8 23 Other Circulatory Diseases 32 89 2 - 1 - 1 2 32 51 Bronchitis 30 Other Respiratory Diseases - 1 5 7 17 - - - 23 1 Peptic Ulcer - 8 8 6 - - - Diarrhœa, etc. 14 10 2 - - - 2 - - Appendicitis 11 1 3 5 - - - 1 1 Cirrhosis of Liver 2 - 1 1 - - - - - Other Diseases of Liver, etc, - 1 9 1 5 2 - - - Other Digestive Diseases 4 1 18 - 1 2 3 18 7 - Acute and Chronic Nephritis 1 81 - - 1 4 57 Puerperal Sepsis - 1 - 1 - - - - - - Other Puerperal Causes 3 - 3 - - - - - - Congenital Debility, Premature Birth, Malformations, etc, - - - - 46 45 - 1 - Senility 44 - - - - - - - 44 Suicide 15 - - 4 7 - - - 4 Other Violence 33 2 1 4 5 8 5 8 - Other Defined Causes 62 3 2 3 8 - 6 - 12 10 18 Causes ill-defined or unknown 9 1 - - - 4 4 .02 1925 1554 12.6 96 .78 20 .16 3 29 .24 27 .22 - 17 .14 - - - 6 42 1926 1484 12.1 94 .76 - 24 .19 .05 .34 1 .01 - - 21 .17 - 1566 45 9 - 13 .08 1 1927 12.9 .37 - - .07 - .11 10 - 12 .09 1928 1520 13.2 137 1.19 77 .67 3 .03 16 26 .23 1 .01 14 .12 - - .14 1929 1650 14.5 62 .54 - 1 .01 2 .02 6 .05 33 .29 1 .01 19 .17 - 1488 61 8 2 .02 1930 13.1 101 .89 - - .54 7 .06 .07 6 .05 17 .15 1408 12.5 1 .01 6 11 9 08 1931 24 .21 - - 3 .03 .05 5 .04 - - 1932 1326 12.0 67 .61 1 .01 25 .23 - .10 16 .15 - - 14 13 - 1 Average for years 1923-1932 12.9 .73 - .02 .12 3 .01 1513 - 281 19 87 .24 .16 15 21 .18 1340 4 12.5 5 1933 45 .42 - - .12 - .13 9 .04 13 .05 - 14 Measles - - - - - - - - - - Scarlet Fever - - - - 1 1 - - - - Whooping Cough - 1 - - - - - 2 3 - - Diphtheria - - - - - - - - Influenza - - - - - - - - - - - - Cerebro-spinal Meningtitis - - 1 1 - - - - - Tuberculous Meningitis - - - - - - - 2 2 Other forms of Meningitis - - 1 - - - - - - 1 Tuberculosis of Respiratory System - - - 1 1 - - - - - - Other Tuberculous Diseases - - - - - - - - - - Syphilis - - - - - - - - - - Bronchitis - 1 1 1 - - - 3 2 Pneumonia (all forms) - - - 3 7 3 16 - - - - Other Respiratory Diseases - - - - - - - - - - Diarrhoea and Enteritis - 4 - 3 3 10 - - - - Congenital Debility and Malformation, Premature Birth 20 2 1 1 2 24 3 1 1 31 Injury at Birth 4 - 4 - 4 - - - - - Other Causes 12 2 - 1 13 1 2 2 20 - 12 Totals 36 1 3 2 42 11 16 11 92 II.—INFECTIOUS DISEASES, ETC. 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 Membranous Croup Glanders Malaria Puerperal Fever Relapsing Fever Ophthalmia Neonatorum Puerperal Pyrexia Small Pox Scarlet Fever and Scarlatina Tuberculosis —all forms Typhus Owing to the housing conditions of the Borough, it is the practice to remove to hospital nearly all cases of diphtheria and scarlet fever. DIPHTHERIA. The number of cases notified was 386 compared with 263 last year. Twenty-two cases occurred in Vine Street Buildings during the months of July, August and September. With one exception all the patients were of school age. In three instances two members of the same family were removed to hospital. In one of these the date of onset of the second case was 34 days after that of the previous case. In the other instances the second cases occurred well within the incubation period of the disease. In one family there were five cases in seven days ; all were schoolchildren and all I am glad to say recovered. Altogether fifteen flats were involved in this small epidemic, and twelve of these were overcrowded, four of them being two-room flats occupied by eight persons each. The total number of deaths from diphtheria during the year was thirteen, and twenty-five cases were returned from hospital as not suffering from diphtheria. In spite of the fact that an Immunisation Clinic is provided by the Borough Council, the number of patients attending for protection against NOTIFIED CASES OF DIPHTHERIA FOR 25 YEARS. NOTIFIED CASES OF SCARLET FEVER FOR 25 YEARS. this disease is regrettably small, though over double the number for last year. No. of patients examined No. found to be positive and immunised No. found to be negative No. immunised without Test No. of sessions Total attendances 26 7 6 101 13 49 SCARLET FEVER. The number of cases of Scarlet Fever was 640 being a considerable increase as compared with last year when the number was 446; 28 cases were returned as "not suffering" and there were 4 deaths. It is interesting and encouraging to note that the incidence of Diphtheria and Scarlet Fever is considerably lower in the council flats than in flats managed by other bodies. Disease Rate per 1,000. Council Flats. Other Blocks of Flats Diptheria 4.2 7.6 4.6 8.2 Scarlet Fever SMALL-POX. There were 21 cases of Small-pox, all of which were confirmed on admission to hospital. This is again a slight increase as compared with last year when the number was 16. There were no deaths. Twenty primary and 10 re-vaccinations were performed under the Public Health (Small-pox Prevention) Regulations, 1917, in the Public Health Department. MEASLES. Four hundred and thirty cases of Measles were reported, of which 109 were removed to hospital. Nursing was provided in 30 cases, and there were 9 deaths. ENTERIC FEVER. Two cases were notified, but these were found on investigation not to be suffering from Typhoid Fever. OPHTHALMIA NEONATORUM. The following table gives particulars of the number of cases of this disease. In five instances nursing was provided: — Cases Vision Impaired Notified Treated Deaths Vision Unimpaired Total Blindness At home In Hospital - 7 4 3 7 - - PUERPERAL FEVER AND PUERPERAL PYREXIA. The number of cases notified was, as follows:- Puerperal Fever 6 Puerperal Pyrexia 24 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. Facilities No. of Cases Second Opinions 1 Nursing provided Nil 1 Bacteriological examinations 26 Admitted to Hospital 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. The following table shows the number of articles disinfected during the year:— Beds 1,298 Pillows 3,092 Blankets 3,604 Pillows (cases) 2,904 Bolsters 956 Quilts 2,452 „ (cases) 445 Sheets 1,961 Books 388 Miscellaneous 7,523 Cushions 373 Verminous Clothing 4,000 Mattresses 101 „ Bedding 103 Overlays 1,098 Scabies, Clothing 16,850 30,460 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Number of rooms disinfected 2,915 Number of mattresses and other articles destroyed 3,375 CLEANSING STATION. Verminous persons cleansed Adult Females 3 Adult Males 82 Children 2,882 Persons treated for Scabies:— Number treated Number of baths given Adult Females 27 55 Adult Males 15 42 Children—Females 177 1,114 Children—Males 131 812 SHELTER. Four flats are provided in The Neckinger for the temporary housing of families or persons while their premises are being disinfected. The number of families accommodated during the year was 27, 21 for Small-pox, 3 for Scarlet Fever,and 3 for verminous conditions, the total number of persons accommodated, being 92. BACTERIOLOGICAL LABORATORY. As in previous years the work of the laboratory has consisted very largely in the examination of sputa and throat swabs. Many 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. 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. Total Examinations Results of Examination Nature of Specimen Positive Negative 1932 1933 1932 1933 1932 1933 Diphtheria (specimens taken by Medical Officer of Health) 496 777 23 68 473 709 Ditto (taken by general practitioners) 1390 119 220 1905 1271 1685 1744 1886 2682 Diphtheria (total specimens taken) 142 288 2394 1883 261 297 Phthisis 1678 1622 1381 188 158 9 4 179 Various 154 3957 4518 Total specimens taken 412 589 3545 3929 FOOD POISONING. Section 7 of the London County Council (General Powers) Act, 1932, provides that every registered medical practitioner shall send to the Medical Officer of Health a notification for every case, or suspected case, of Food Poisoning. Number of cases notified during 1933 29 FOOT CLINIC. There has been no alteration in the arrangements at these clinics the number of sessions being nine per week and the fee 1/- per treatment. Particulars of the number of attendances during the year are given hereunder. Clinic Men Women Total Bermondsey 1,136 2,584 3,720 Rotherhithe 2,191 5,042 7,233 Totals 3,327 10,953 7,626 INSULIN FOR DIABETIC PATIENTS. Under Section 77 of the Public Health (London) Act, 1891, the Minister of Health has sanctioned the temporary supply of insulin for those poorer inhabitants of the borough who are suffering from Diabetes. Practitioners applying for supplies of insulin are required:— (a) To give the name, address, age and sex of the patient. (b) To supply a quarterly report to the Medical Officer of Health showing:— (1) The number of doses of insulin administered. (2) The results of blood and urine tests. (3) The progress of the patient. Though the number of diabetics is small the cost of insulin is high, and this scheme is a real benefit to them. Five patients have been supplied during the year, either free or at reduced cost, according to circumstances. NURSING. The following table shows the number of patients nursed under the Council's Scheme, the diseases from which these patients were suffering and the number of visits paid. Under this scheme the Council assists in the provision of nursing for expectant and nursing mothers, children under five, and for patients suffering from the following diseases:-Measles, German Measles, Whooping Cough, Puerperal Fever and Puerperal Pyrexia, Epidemic Diarrhoea, Dysentery, Influenza, Ophthalmia Neonatorum, Polio-myelitis, Encephalitis Lethargica, Malaria, Acute Primary and Acute Influenzal Pneumonia and Tuberculosis. There has been a considerable fall in the number of cases nursed during the year for the Borough Council by both Associations. This is partly accounted for by the excellent weather during the year and the consequent drop in the number of cases of respiratory disease. The fee payable by the Borough Council was reduced from 1/4 to 1/- per visit as from the 1st April, 1933 St. Olave's Rotherhithe Totals District Queen's whole Disease Nursing Nursing Borough Association Association Cases Visits Cases Visits Cases Visits Pneumonia 28 592 10 179 38 771 Broncho pneumonia 1 27 — — 1 27 Bionchitis 8 106 1 25 9 131 Influenza 35 574 14 319 49 893 Measles 25 623 5 64 30 687 Whooping Cough 1 12 — — 1 12 Tuberculosis:— (a) Respiratory System 36 1,880 21 1,304 57 3,184 (6) Other Forms 2 164 3 68 5 232 Puerperal Pyrexia — — — — — — Puerperal Fever — — — — — — Pregnancy and Labour 22 492 5 84 27 576 Diseases of the Digestive System 36 312 17 175 53 487 Infantile Diarrhoea (under 2 years) — — — — — — Discharging Ears 5 171 7 130 12 301 Discharging Eyes 10 135 11 220 21 355 Post-operative cases:— (a) Tonsils & Adenoids 17 74 4 16 21 90 (6) Other cases 2 15 — — 2 15 Other diseases 30 621 7 221 37 842 Totals 258 5,798 105 2.805 363 8,603 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1933. NUMBER OF CASES NOTIFIED BERMONDSEY ROTHERHITHE ST OLAVE Total Cases removed to Hospital NOTIFIABLE DISEASE At all Ages At Ages—Year 1 2 3 4 5 6 Total 1 2 3 Total 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 21 - 4 7 5 3 2 - 9 1 7 2 - 1 20 - - - - 1 - - 1 21 Small-pox 24 25 2 64 24 27 115 Diphtheria (including Membranous Croup) 386 115 - 55 46 20 33 220 47 27 51 385 2 35 31 1 194 7 - 8 8 9 8 5 22 1 2 1 4 24 Erysipelas 68 1 7 20 25 7 10 11 3 3 42 206 381 22 7 12 41 Scarlet Fever 640 34 10 1 76 76 79 46 48 50 375 102 84 38 224 629 8 - Cerebro-Spinal Meningitis 4 - 1 1 - 4 1 - - - 1 3 - - 3 - - - - 2 - - - - Acute Polio-Myelitis and Acute Polio Encephalitis. 1 - 1 - - - - 1 1 - - - - - - - - - - - - - - - Ophthalmia Neonatorum - - 7 7 - - 2 - - - - 1 3 2 2 - 4 - - 3 - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - 2 - - 2 1 - 1 - - 2 - - Enteric Fever 2 - - - - - - - - - - 4 1 6 Puerperal Fever 2 1 1 - - 1 - 2 - 2 6 - - - - - - - - 1 3 - 17 2 2 4 3 3 14 4 2 3 9 1 - - 1 20 Puerperal Pyrexia 24 - - 7 - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 Dysentery Malaria 1 - - - - - 1 - - - - 1 - - - - - - - - - - - - - - - - - - - Malaria Pneumonia (Acute - - - - - - - - - - - - - 20 17 1 22 31 16 Primary and Acute Influenzal) 136 29 16 15 24 22 13 42 - - 2 7 16 8 92 7 13 2 - 1 17 38 5 Tuberculosis— Respiratory System 21 20 19 14 110 9 7 3 19 182 63 58 15 24 19 53 - 21 10 4 - 11 3 4 2 9 - 2 3 Other forms of Tuberculosis 34 - 2 5 3 3 22 1 13 4 1 4 5 1 174 181 116 133 112 906 61 43 20 124 - - 1 46 47 - Small Pox - 481 535 Diphtheria (including Membranous Croup) 541 714 603 463 462 Erysipelas 35 43 42 30 25 45 41 Scarlet Fever 395 353 426 601 493 584 507 Cerebro-Spinal Meningitis 1 3 5 3 2 4 5 Acute Polio-Myelitis and Acute Polio─ Encephalitis 1 2 2 1 1 4 2 Ophthalmia Neonatorum 12 15 10 13 8 11 13 Anthrax 2 3 4 - 2 1 1 Enteric Fever 2 5 3 1 2 7 2 5 Puerperal Fever 2 9 9 9 12 14 Puerperal Pyrexia 11 21 20 20 19 - - 21 Encephalitis Lethargica 8 8 5 4 1 4 Dysentery 1 - - - - - - Malaria 1 - 2 - - - - Malaria (induced) - - - - - - III.-TUBERCULOSIS. In Table I are set out particulars of new cases and deaths during the year, and Table II shows the period elapsing between notification and death. TABLE I. TUBERCULOSIS, 1933 NEW CASES AND DEATHS. AGE—PERIODS NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 1 1 1 - 0 1 - 1 1 3 - - 1 1 5 - 2 2 1 - 5 3 5 - 1 - 5 2 1 10 4 7 6 1 1 2 4 - 14 16 3 3 - 1 15 4 - 20 17 18 3 8 7 2 - 3 7 13 1 25 22 15 1 2 35 19 13 1 8 7 1 - - 45 - 6 3 19 6 2 17 - - - 55 15 5 7 2 2 65 and upwards 1 3 3 - 7 3 - 1 21 8 120 86 27 59 40 12 TABLE 11. TUBERCULOSIS, 1933—PERIOD BETWEEN NOTIFICATION AND DEATH. Period Between Notification and Death Respiratory System Other Forms Males Males Percentage of Total Deaths Percentage of Total Deaths Females Total Females Total Not notified 6 3 9 9.09 7 4 11 55.00 3 8 2 3 15.00 0-1 month 5 8.08 1 5.00 1-3 months 9 2 11 11.11 - 1 1 3-6 months 6 2 8 8.08 - - - - 7 1 6-12 months 6 13 13.13 1 - 5.00 17 17.17 1 1 2 10.00 1-2 years 10 7 2-5 years 11 8 19 19.20 1 - 1 5.00 Over 5 years 7 7 14 14.14 1 - 1 5.00 Totals 59 100.00 12 8 20 100.00 40 99 I am pleased to report that the death rate from pulmonary tuberculosis, 0.92, is the lowest ever recorded in the Borough; this rate is still, however, higher than that in many other metropolitan districts. There has also been a considerable fall in the number of deaths from phthisis between the ages of 15 and 25. In Table II. it will be noted that 9 cases of pulmonary tuberculosis and 11 cases of non-pulmonary tuberculosis were not notified to me before death. Of the 9 pulmonary cases, one death occurred in Guy's Hospital, after a sudden hæmoptysis, and the other 8 deaths occurred in St. Olave's hospital. The average age of these 9 patients was 54, and, without exception, they died very shortly after admission. In two of the instances there were investigations by the coroner on account of the sudden death. Of the 11 non-notified cases of non-pulmonary tuberculosis 8 deaths were due to miliary or meningeal tuberculosis, 6 being in infants or children under the age of 5 years. It is extremely difficult, if not impossible, to secure early notification in such cases owing to the obscure mode of onset and to difficulties in diagnosis. In the three remaining cases also the precise diagnosis was in doubt until death. All these 11 patients died in hospital, with the exception of one who was removed home shortly before death, after a period in hospital. The death returns reveal, however, that there are still many patients who die from pulmonary tuberculosis within a few months of notification. On page 32 is a return showing the work done at the Dispensary during the year. There has been a decrease in the total number of new cases examined during the year, and a slight increase in the number of sputum positive cases on the register, and in the number of contacts examined. It is the constant endeavour of both Tuberculosis Officers to arrive at a diagnosis and arrange for treatment at the earliest possible moment. Of 183 new cases of tuberculosis entered on the dispensary register in the year, 34 had already been admitted to the local hospital, on the recommendation of their own practitioners, before examination by the Tuberculosis Officers and 142 were referred from the dispensary for admission to various institutions. In all these cases the average time elapsing between the first attendance at the dispensary and actual admission to an institution was only 10 days. In exactly half these cases admission was secured in under 7 days from the date of their first attendance. Refills for Artificial Pneumothorax treatment have been continued by the Tuberculosis Officers at St. Olave's Hospital. During the year 655 refills were given, and the following table shows the present condition of patients who have had this form of treatment. The small figures in brackets indicate the number of patients in each group, in whom the disease was already bilateral when the treatment was started. Cases started during 1933 are not shewn in the table. Treatment begun. Arrested. Quiescent. Stationary. Dead. 1928 1 1929 2 3 (2) 1930 8 1 2 (1) 3 (2) 1931 8 (1) 7 7 (3) 4 (2) 1932 — 13 (4) 4 (2) Attempts are always made to secure that as far as possible advanced cases of pulmonary tuberculosis are treated in hospital when the home circumstances are such as to make this advisable. Of 99 deaths from advanced disease during the year, 52 occurred in local hospitals, 17 occurred in voluntary hospitals, sanatoria, or other institutions, and 30 occurred at home. 1927 1 1923 1 NURSING AND EXTRA NOURISHMENT. The Tuberculosis Officers have had the continued co-operation of both District Nursing Associations during the year, though the number of cases referred to them is less than it was last year. The district nurse is often able to give material assistance in the matter of diagnosis by preparing a morning and evening temperature chart for the Tuberculosis Officer. In advanced cases of tuberculosis where the patient is living at home, it has been our practice for a long time now to arrange for daily visits from the district nurse where the patient is willing for this to be done. By this means we are often enabled to help the patient and at the same time to reduce the risk of infection to other members of the household. The amount of extra nourishment which the scheme allows us to supply to tuberculous patients is very limited and it usually takes the form of milk and eggs, and is only supplied on the recommendation of the Tuberculosis Officer; a total of 223 patients have been thus assisted during the year. SHELTERS. For many years the Council has loaned shelters free for the use of patients suffering from tuberculosis. The shelters are built by the Works Department and are of the ordinary sanatorium fixed type, so constructed that even when completely closed, ample ventilation through louvres is provided. The use of a shelter diminishes the risk of infection which is so serious in an overcrowded home, but the instances in which a shelter can be erected are few, since the garden space available is usually either insufficient or unsuitable. Beds and bedding are supplied with the shelter and in some cases arrangements have been made for electric light to be installed. There are 19 shelters at present in use, 2 having been erected during the year and 3 dismantled owing to the death or removal of the patient. In addition to the supply of shelters, beds and bedding are supplied on loan for the use of patients at home where suitable use can be made of them. By this means we are often enabled to arrange for a patient to sleep alone and so lessen the risk of infection. Forty-two beds are in use at present. LADY ALMONER. Miss Pike has continued in charge of the care work in association with the Tuberculosis Scheme. There are very few patients attending the Tuberculosis Dispensary who do not require assistance at some time during the course of their illness, and this side of the work is an indispensable element in the Scheme ; during the year 884 visits have been made to the homes of patients. The assessment with regard to patients recommended for sanatorium or hospital treatment under the London County Council Scheme are made by Miss Pike, who is responsible also for the collection of contributions; 298 cases were dealt with during the year, the total sum collected amounting to £390 5s. 6d. Convalescent treatment has been arranged for contacts of tuberculous patients in twelve cases, and seven other persons have been sent to the seaside for a short holiday. Help has been given to many other patients in various ways, such as in the provision of air-cushions, bed-pans, urinals and back-rests. In addition to these duties Miss Pike regulates the supply of Insulin to diabetic patients, and undertakes the arrangements and assessments for patients going to Fairby Grange. She was also appointed Infant Protection Visitor by the Council on the 23rd May, 1933, under the Children Act, 1908 and the Children and Young Persons Act, 1932. Our grateful thanks are due to the following societies for their kind assistance on many occasions :—United Services Fund, Royal Red Cross Society, Friends of the Poor, Charity Organisation Society, Women's Holiday Fund, Personal Service League, Queen Mary's Needlework Guild per Lady Ludlow, Metropolitan Convalescent Institution and the Invalid Children's Aid Association. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not found necessary to take any action under these Regulations in 1933. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — (a) Definitely tuberculous 75 6 4 10 1 78 475 12 54 5 64 3 6 - - 1 (b) Diagnosis not completed - - - - 13 6 - - (c) Non-tuberculous - - - - 115 - - - - 100 44 37 - B.—Contacts examined during the year:— (a) Definitely tuberculous 12 6 2 1 - 1 13 6 3 1 1 2 1 (b) Diagnosis not completed - - - - - - - - - - - 89 (c) Non-tuberculous - - - - 146 197 182 - 639 - - - - C. —Cases written off the Dispensary Register as (a) Recovered 8 - 10 6 6 17 13 17 12 16 1 5 7 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 257 242 - - - - 212 222 - - - 992 D.—Number of Cases on Dispensary Register on December 31st : — (a) Definitely tuberculous 234 - 320 57 (b) Diagnosis not completed 1. Number of cases on Dispensary Register on January 1st 929 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 15 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 62 4. Cases written off during the year as Dead (all causes) 89 5. Number of attendances at the Dispensary (including Contacts) 4,164 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 119 7. Number of consultations with medical practitioners:— (a) Personal 123 (b) Other 201 74 - 68 51 52 38 285 120 358 131 - 1 - - 14 - 6 - 915 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 1,150 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes *3,978 10. Number of:— (a) Specimens of sputum, etc., examined 1,132 (b) X-ray examinations made in connection with Dispensary work 691 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 357 - - 3 77 - 2 11 90* - 6 18 „ Females 15 14 6 2 4 - - 18 19 1 3 3 1 Non-Pulmonary Males 4 - 2 - 1 1 16 19 „ Females - 1 2 4 2 1 - 4 - New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the abovementioned period, otherwise than by formal notification. Age Periods 10 to 15 45 to 55 55 to 65 65 and upwards 1 to 5 15 to 20 20 to 25 25 to 35 35 to 45 0 to 1 5 to 10 Total - 5 15 Pulmonary Males 1 - - 1 3 3 2 - - 2 - - 1 1 1 2 - 9 „ Females 1 1 - - - 9 - 2 1 2 - 1 1 2 - Non-Pulmonary Males „ Females 1 2 1 1 - - 5 - - - - - * Includes 1 re-notification of case originally notified as Non-Pulmonary. side of the Register. This case has been transferred to the Pulmonary Returns rendered under the PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 1st QUARTER, 1933. Number of Cases on Register at commencement of Quarter Other Forms Respiratory System M. F. M. F. 427 295 137 133 18 Number of Cases notified during Quarter 29 7 3 3 Inward Transfers, Un-notified Deaths, etc. 2 3 19 2 Number of Cases removed from the Register 24 5 8 Number of Cases remaining on the Register at end of Quarter 297 142 434 130 2nd QUARTER, 1933. Respiratory System Other Forms F. M. M. F. Number of Cases on Register at commencement of Quarter 297 434 142 130 Number of Cases notified during Quarter 1 28 22 4 4 5 2 2 Inward Transfers, Un-notified Deaths, etc. Number of Cases removed from the Register 35 29 8 10 Number of Cases remaining on the Register at end of Quarter 431 137 295 126 3rd QUARTER, 1933. Respiratory System Other Forms M. M. F. F. Number of Cases on Register at commencement of Quarter 431 137 295 126 22 Number of Cases notified during Quarter 23 5 6 Inward Transfers, Un-notified Deaths, etc. 6 2 - - Number of Cases removed from the Register 22 14 6 5 Number of Cases remaining on the Register at end of Quarter 438 303 138 127 4th QUARTER, 1933. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 138 438 303 127 Number of Cases notified during Quarter. 25 15 5 3 Inward Transfers, Un-notified Deaths, etc. 3 2 2 1 Number of Cases removed from the Register 23 18 9 4 Number of Cases remaining on the Register at end of Quarter 443 302 136 127 IV. LIGHT TREATMENT. The following table shows the work done in the Solarium during 1933: — Number of attendances and general treatments 29,171 „ local treatments 2,898 „ examinations 2,813 „ new patients 581 „ discharges 592 „ maternity and child welfare cases under treatment during the year 281 „ tuberculous patients under treatment durthe year 61 (The Maternity and Child Welfare patients formed 30.5 per cent, of the total number under treatment and the tuberculosis patients 5.7 per cent.) All patients attending for treatment are recommended by general practitioners or by medical officers of the Maternity and Child Welfare Centres, the Tuberculosis Dispensary or Hospitals. Every patient is examined by a member of the medical staff before and during treatment and a medical officer is on duty in the Solarium during six of the sessions each week. There has been a slight decrease in the number of attendances at the Solarium during the year. To a considerable extent this has been due to the limited and inadequate accommodation in the present buildings and I hope work on the new buildings will not now be long delayed. The Centre was closed again for three weeks in August, in order to allow the whole staff to take their summer holiday at a time when attendance is always very irregular, owing to the school holidays. The largest group of cases completing treatment during the year consisted of patients suffering from anemia, debility and malnutrition, the majority being school children. These patients always respond well and frequently show decided improvement in spite of adverse home conditions and a defective dietary. Many patients suffering from rheumatic troubles were under treatment during the year, and at least three-quarters of these showed improvement and obtained some alleviation of their suffering. Beneficial results were obtained also in the greater number of cases of bronchitis under treatment. In this group, while such treatment can not be classed in any way as specific, it does undoubtedly build up resistance and assist the body to overcome infection. In cases of tuberculosis the results were consistently good and the treatment was of great service both from the curative point of view and also in the maintaining of the general condition of the patient after return home from Sanatorium. Many different opinions have been expressed with regard to artificial light treatment and, owing to the comparative lack of standards, it is not easy to produce convincing proof as to its value. I am glad, therefore, to be able to insert the following general statement on the subject by Dr. MacIntyre who is leaving us after five years' work in the borough. During this period he has been employed for a considerable portion of his time in the Solarium, and has taken a great interest in the subject. Report by E. J. MacIntyre, M.D., D.P.H. : Every centre for artificial light treatment should be under the control of a qualified medical practitioner trained to discriminate between cases which are likely to respond to treatment, and those which are unsuitable for treatment. Each case should have a complete physical examination, and any special investigation indicated should be done before active treatment is applied. A survey of new cases coming for treatment shows three distinct groups:— (1.) Those who are suitable for treatment, e.g., rickets ; (2.) those who may be suitable after a period of preliminary rest, convalescence or medical treatment, e.g., subactive rheumatism ; (3.) those who are unsuitable, e.g., active pulmonary tuberculosis. A large number of patients come without any definite diagnosis having been made, but obviously suffering from debility or malnutrition. An attempt should be made to ascertain the causative factors, whether social, mental, or physical. In cases of malnutrition without evidence of organic disease I do not consider that artificial light treatment will do any good unless an adequate diet is provided. Better and quicker results will be obtained by sending the patient to a convalescent home or by correcting and amplifying the diet where the patient cannot go away. A proportion of cases will be found to show signs of mild toxaemia, and the source of this must be traced. If necessary a period of rest in bed under medical supervision may be advised. Mild cases of rheumatism, nephritis, and tuberculosis may thus be found and treatment regulated to suit the patient. Abrasions and wounds of the skin, and ulcers are usually healed by treatment, but care should be taken to investigate fully any condition suggestive of cancer or syphilis. The healing of the syphilitic lesions may be aided, but the treatment of cancer is contraindicated. Skin diseases should be accurately diagnosed, and, if necessary, reference to a specialist should be recommended. Superficial discharges and crusts should be removed before treatment. Moist eczemas are very suitable for treatment. Urticarias are relieved of their itching, but specialised investigation of the cause may be necessary before cure is effected. Psoriasis is usually resistant, but healing does take place slowly and there does appear to be some inhibition of the development of the spots. A long standing case in which I recently tried painting the right arm with Sodium Fluorescin and giving local exposures on both arms, which were equally affected, showed a remarkably rapid healing of the lesions of the right arm within three weeks. This may have been a matter of coincidence. Fibroid lupus is resistant to treatment unless the Finsen lamp is used. No direct exposure of the eyes should be attempted. The nose and throat are good fields for treatment, and inflammatory conditions respond well. It is important to take swabs of inflamed, excoriated, and discharging noses, and suspicious throats, and to exclude carriers of diphtheria bacilli from contact with others in group treatment. Acute bronchitis requires rest in bed and medical treatment, but chronic bronchitis is greatly helped by a prolonged course of ultra violet light. Fibrosis of the lungs following pneumonia may require a period of convalescent treatment in the country, but this should always be followed up by Ultra Violet light treatment. Bronchiectasis is difficult to treat with drugs, and light treatment does help to improve the health of the bronchial musosa. In many children suffering from chronic cough, particularly following whooping cough, a mild degree of emphysema can be detected. Much good can be done by treating such cases by Ultra Violet light, as I have no doubt that the origin of many of the gross cases of emphysema in adults with severe incapacity could be traced back to the untreated cough of childhood. Cases of acute primary pneumonia and broncho-pneumonia may attend a centre in the first stages of their illness and should be referred to their private doctors or to hospitals. The same applies to pleurisy, with or without effusions, but after the acute phase is passed, resolution is aided by the application of Ultra Violet light. It is necessary to exclude cases of active pulmonary tuberculosis from treatment. Carefully selected cases with much fibrosis may receive considerable benefit. Tuberculous ulceration of the larynx can be treated locally without detriment to the patient. It is always necessary to examine carefully the chest of every new patient. If sputum examinations and X-ray examinations are insisted on whenever the slightest suspicion arises, it will occasionally be possible to diagnose pulmonarytuberculosis. I have in mind two cases who had physical examinations of the chest with negative results before reference for treatment and whose sputum was found to contain tubercle bacilli. Patients with haemoptysis often give difficulty. Where tuberculosis has been excluded, the cause may be emphysema, bronchiectasis, neoplasm, or heart disease. Bronchiectasis often causes copious haemorrhages. I have found such patients to receive much benefit from Ultra Violet light treatment, and no increase in the amount or severity of the haemoptysis has been noted. One man, with localised bronchiectasis at the right base and having copious haemorrhages which had reduced him to a very weak state, has received so much benefit from Ultra Violet light that consideration is now being given to the advisability of lobectomy. The periods of active bleeding must be controlled by the usual sedative treatment and rest in bed, but the intervals of freedom from hæmoptysis can be safely used for Ultra Violet light treatment. As a general rule the chest can be exposed to the direct rays of light with benefit, but where it is known that quiescent tuberculosis exists, a margin of safety can be secured by covering the chest, and exposing the rest of the body. It is inadvisable to treat as ambulant cases, patients with heart disease, where there are signs of failure of compensation. Cases of acute and sub-acute rheumatism should not have Ultra Violet light treatment. In convalescence the treatment is of great value in restoring vitality, and in reducing the chances of sequelæ. Mild rheumatism and mild chorea are often cured by treatment. Cases with valvular lesion should be excluded from group treatment and given the quiet and privacy of a cubicle. Some type of foot covering should be worn by all rheumatic patients during treatment. Patients who are subject to attacks of faintness should have special supervision. The pulse rate before and after treatment is helpful in estimating the reaction of the patient. The digestive system can be favourably influenced by treatment. Gingivitis and pyorrhæa show great improvement under local exposures to the Kromayer lamp. The tone of the abdominal muscles is improved, and minor degress of flatulence and constipation are relieved. Anorexia may be abolished by treatment. Where symptoms point to some gross lesion, sunlight cannot be expected to supersede dietetic or operative treatment, but it may be helpful as an adjunct to diet or in improving the general condition of the patient before operation. Cases of diabetes should be excluded. The kidneys, after acute nephritis, are assisted in their repair by Ultra Violet light treatment, especially after a prolonged period of diet and vitamin starvation has reduced their vitality. Chronic nephritis in its milder forms does not react badly, but gross lesions with heavy albuminuria should be excluded. The nervous system reacts favourably to Ultra Violet light treatment. Organic disease is not cured, but symptoms are relieved. Muscle tone is very much improved. The psychological effect is good, and neuresthenic patients are directly and indirectly benefited. One patient, who was very depressed since her husband was killed in the war and was afraid of crossing streets, would not go out of her home unless accompanied. She now comes for treatment regularly, and alone. Mentally backward children, many of whom are immune to suggestion, show a remarkable improvement in aspect and alertness. The Endocrine System is indirectly stimulated by treatment, and slight degress of hypothyroidism are relieved. The dosage given to patients with hyperthyroidism has to be carefully regulated, and a careful record of the pulse rate before and after treatment is desirable. Special prominence must be given to this treatment in tuberculosis of the bones, joints, glands, and serous membrances. It is the specific treatment when combined with orthopædic care. Cases with long standing chronic sinuses, which show evidence of amyloid degeneration, should be excluded from treatment. If one can exclude active pulmonary tuberculosis, severe nephritis, and amyloid degeneration, there is little danger in the application of Ultra Violet rays, provided that doses are graduated to avoid severe local or general reactions. One must remember that hypersensitive patients do exist and may have to be excluded on account of severe reacts after very small doses, but generally they receive benefit within their range of tolerance, which varies with the individual. Age Sex Period previously under Medical Treatment prior to going to Leysin Date returned from Le ysin Result Initials of Patient Localisation of Disease Date sent to Leysin 5/7/27 12 M. Left Foot 5 years 28/7/24 Well and at work S.B. 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 Well. Now married „ „ A.L. 19 F. Glands of Neck 2 „ 1/10/24 6/10/25 C.P. 37 F. Forearm & Peritoneum 2 „ 1/10/24 6/10/25 Well and at work „ „ M.B. F. Glands of Neck 28 15 „ 26/10/25 22/2/27 E.C. 16 F. Right Knee 8/7/27 5 „ 26/10/25 Seen recently. Satisfactory H.C. 16 M. Glands of Neck 2 „ 26/10/25 20/2/27 Well recently „ „ A.H. 21 F. Left Hip 9 „ 17/5/26 29/6/28 E.W. 23 F. 18 „ Spine and Right Hip 17/5/26 17/9/27 Well „ G.B. 20 F. Left Ankle 2 „ 9/2/27 28/4/29 L.T. 19 M. Abscess of Ribs 2 „ 9/2/27 8/5/28 Removed from District C.P. 24 M. Spine 7 „ 5/7/27 8/5/28 Keeping well A.R. 26 F. Glands of Neck 3 „ 5/7/27 8/6/29 Removed from District E.G. 16 M. Lupus of Nose 20/6/28 4 „ 8/6/29 Well and at work C.P. 26 M. Tuberculide of Skin 1 „ 20/6/28 8/6/29) Removed from district H.S. M. 18 Right Hip 3 „ 20/6/28 26/9/30 Well and at work „ I.S. 23 F. Right Hip 8 „ 31/5/29 5/8/32 C.C. 27 F . Multiple Lupus 20/1/30 20 „ 6/5/32 At work A.P. 16 F. Glands of Neck 4 months 20/1/30 20/3/31 Well and working E.W. Left Knee 18 M. 1 year 15/4/30 1/2/33 At home, not working G.L. 15 M. Spine 10 months 13/10/30 Dead (Tuberculous Meningitis) - V.B. 16 F. Lupus of Nose 6/2/31 6/5/32 1 year Well and at work D.R. M. 34 Spine 4 years 4/7/31 - Dead (Cerebro-spinal Meningitis) V.—MATERNITY AND CHILD WELFARE. No change of importance has taken place in the Maternity and Child Welfare section of the department during the year. I regret that the arrangements which were made in connection with the welfare work at the Central Hall in Tower Bridge Road have not proved to be satisfactory and have had to be discontinued ; at the end of the year this matter was still under consideration. FAIRBY GRANGE CONVALESCENT HOME. The number of patients in the home of necessity remains about the same from year to year, and the slight increase this year may in all probability be attributed to the very fine weather. In the early part of the year Miss Sewell retired after nearly ten years' work as matron, and it is appropriate to record here my appreciation of her services. She has been succeeded by Miss Florence Child. Number of women admitted 239 Number of babies admitted 93 Number of toddlers admitted 163 MIDWIFERY SERVICE. Under this scheme 330 patients "booked" during the year. In 200 of these cases the full fee of the midwife was paid by the Council and a proportion of the fee was paid in 122 other cases; the remaining 8 cases were assessed to pay the full fee. OBSTETRIC AND PUERPERAL FEVER CONSULTANTS. The names of the gentlemen who have agreed to act in this capacity will be found on page 89. The number of consultations during the year was as follows:- Obstetric Consultations 1 Puerperal Fever Consultations 1 INFANT LIFE PROTECTION. The duties under the Children Act, 1908, and the Children and Young Persons Act, 1932, were transferred from the County Council to the Borough Council as from the 1st April, 1933, and the Medical Officer of Health and Miss Olive Pike were appointed Infant Protection Visitors under these Acts on the 25th April, 1933 and the 23rd May, 1933, respectively. There are at present 10 foster mothers with charge of 10 children in the borough, and 65 visits have been paid during the year to these homes. MATERNAL MORTALITY. There were four deaths during the year which fall to be classified under this heading ; exactly the same number occurred last year. This gives a mortality rate of 2.57, when calculated per 1,000 total (live and still) births. With the exception of one death which was due to ectopic gestation, the circumstances in each of these cases were investigated fully, a report being made to the Ministry of Health. There were also two deaths in which pregnancy was associated with the cause of death, but which I considered should not be classified under the heading of maternal mortality. HEALTH VISITORS. The following table shows the work done by the Municipal and Voluntary Centres and Health Visitors during 1933:- Visits to Expectant Mothers Puerperal Fever and Puerperal Pyrexia Ophthalmia Neonatorum Health Talks District Births Notified Visits to Infants and Children Other Visits Attendances at Centres First Visits Re-visits Under 1 year 1-5 years Revisits Cases Visits Cases Visits Primary Visits (45) 88 89 425 1126 52 9 - 618 219 2 No 1 132 3 - 199 „ 2 (Central Hall) 162 126 760 862 90 147 - - - - 334 - 251 664 21 „ 3 86 90 583 717 43 106 2 2 - - 1 274 „ 4 97 100 733 914 52 142 1 - 426 - - 771 45 76 „ 5 (St. George s Hall) 117 117 1016 1431 45 222 5 5 - - 749 253 12 „ 6 65 79 554 915 44 132 1 1 - - 1008 214 „ 7 118 85 665 1246 71 146 4 4 1 2 95 643 „ 8 77 81 573 1065 55 - 1 1 281 110 - - 204 725 41 „ 9 147 170 1183 1306 82 251 2 2 - - „ 10(Fulford Street) 156 152 831 1385 95 273 6 7 1 3 440 155 34 211 33 „ 11 124 130 1216 1414 57 177 3 3 2 3 322 186 2 184 249 10 „ 12 120 118 951 1193 55 1 2 2 - 196 201 29 „ 13 117 122 1212 1622 72 400 2 2 - 33 - - - - 344 „ 14 (Salomon's Centre) 88 82 591 3379 693 567 - Totals 1562 1541 11293 18575 1506 2991 38 7 7080 3131 30 11 355 ATTENDANCES AT MATERNITY AND CHILD WELFARE CENTRES. The following table shows attendances at Maternity and Child Welfare Centres during 1933:- Name of Centre Children's Consultations Ante-natal Clinic Sewing Class No. of Sessions Total Attendances No. of Sessions New Cases Total Attendances No. seen by Doctor New Cases No. of Sessions No. of Attendances Under 1 year 1-5 years Under 1 year 1-5 years 110 Grange Road 200 186 53 3,759 3,693 4,553 46 181 899 42 448 4,509 3,269 3,668 101 193 923 - 98 Rotherhithe New Road 152 202 33 - 681 1,218 - - - - 810 Trinity Road 52 36 8 - 1,819 1,769 2,023 - - - - Percy Hall 104 85 21 - Roseberry Street 49 98 41 1,842 973 1,181 - - - - - Salomon's Centre 142 64 2 1,889 1,427 2,206 199 607 2,769 - - Princess Club 172 124 37 2,369 2,455 3,651 51 76 503 97 1,575 Fulford Street 103 156 19 1,947 1,706 2,538 52 95 614 11 203 St. George's Hall 61 76 27 1,180 1,333 1,266 - - - 39 639 Central Hall 203 277 39 5,858 8,498 6,699 - - - - - 1,238 280 Maternity and Child Welfare STATISTICS FOR THE YEAR, 1933. Borough Council of Bermondsey. POPULATION according to the Census of 1931. —111,542. Births. Registered— Live Births Legitimate Illegitimate Total Males Females 1,467 33 727 17 740 16 Birth Rate per 1,000 of the estimated resident population 14.0 Total Males Females Stillbirths 52 27 25 Rate per 1,000 total (live and still) births 34 Notified within 36 hours of birth- (1) Live Births, 1,527. (2) Stillbirths, 48. (3) Total, 1,575. (1) By Midwives, 506. (2) By Parents and Doctors, 1,069. Total. Males. Females Deaths 1,340 716 624 Death Rate per 1,000 of the estimated resident population .. 12.5 Maternal Deaths. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births Puerperal Sepsis Other puerperal causes Total 1 3 4 0.64 1.93 2.57 Infant Deaths. Number— (1) Legitimate, 89. Rate per 1,000 live births- (1) Legitimate, 59. (2) Illegitimate, 3. (2) Illegitimate, 2. (3) Total, 92. (3) Total, 61. Health Visitors. Visits paid by Health Visitors during the year:— To Expectant Mothers To Infants under 1 (1) First Visits, 1,506. (1) First Visits, 1,541. To Children, 1 —5 Total Visits, 18,575 (2) Total Visits, 2,991 (2) Total Visits, 12,834 Convalescent Homes for Children under 5. Number of Beds, 16. Number of Children under 5 received during the year, 256. Day Nurseries. Number of day nurseries 2 (both voluntary). Number of places for children under 5 in the nurseries:— Summer months 60. Winter months 56. Total number of attendances of children at these nurseries during the year:- 9,887. Deaths from Measles (all ages) 9 Deaths from Whooping Cough (all ages) 5 Deaths from Diarrhoea (under 2 years of age) 12 VI. DENTAL TREATMENT. There has been no important change in this scheme during the year, and the figures show slight variations as compared with 1932. The volume of work remains much the same as last year with perhaps a slight increase at the Rotherhithe Centre; there appears also to have been a slight increase in the number of fillings done in children as compared with other years, and this may perhaps mean that parents are becoming more willing to take the Dental Surgeon's advice and conserve teeth, rather than merely to demand the removal of offending teeth. Owing to the desire to exercise economy one gas session was dispensed with in 1932, and it has been possible during this year to manage with one gas session only at Bermondsey and to do practically the same number of extractions as last year. The scale of fees charged has also been modified during the year with the object of securing greater uniformity. (49) TREATMENT OF CHILDREN DURING 1933 CENTRE Number Examined Number of Attendances for Orthodontics Number of Extractions Anæsthetics Total Number of Attendances Age Group Number of Scalings Number of Fillings Number Treated Local General 110, GRANGE ROAD. 18 Under 5 years 451 1883 19 805 - - 432 422 2 545 1160 281 342 184 1293 Over 5 years 336 509 Totals 996 941 3043 354 703 2 184 2098 361 98, ROTHERHITHE NEW ROAD. 227 257 981 17 - - Under 5 years 242 5 480 Over 5 years 952 118 - 272 3 338 334 44 698 1178 576 49 499 135 - 3 Totals 595 1933 (50) DENTAL TREATMENT CARRIED OUT DURING 1933 CENTRE Type of Case Number of Patients Examined Number of Patients Treated Number of Extractions Anæsthetics Number of Fillings Number of Dentures Fitted Number of Repairs to Dentures Number of Attendances Number of Scalings General Local 110, GRANGE ROAD. Maternity Cases 798 840 2410 64 20 72 163 626 195 1642 Women 1129 1276 2074 23 119 1839 124 983 140 55 1971 1977 1864 210 32 206 3100 Men 3261 37 105 115 7 56 19 Tuberculosis Cases 49 3 47 26 153 - Children (Table I.) 3043 703 361 2098 - 996 941 354 2 - Totals 4941 10903 3853 837 77 507 235 8832 5083 1066 Maternity Cases 451 379 2065 26 23 134 21 98, ROTHERHITHE NEW ROAD. 231 1139 226 Women 405 624 58 76 13 40 34 373 275 701 Men 509 69 535 988 471 39 39 17 18 885 2 2 3 1 1 1 - - 5 Tuberculosis Cases - Children (Table I.) 595 1933 135 - - - 576 49 499 1178 Totals 1930 1897 5613 102l 277 54 243 73 3908 828 VII.—PROPAGANDA. Educational work has now formed a recognised section of the work of this Department for close on ten years. During that time we have accumulated a considerable amount of experience, and have also, I think, demonstrated the undoubted value of such work. I have, therefore, great pleasure in including a report by Mr. H. W. Bush, who has charge of this section. Report by H. W. Bush, M.1.H., Propaganda and Administrative Officer: During the year 1924 on the instruction of the Public Health Committee a report was submitted to the Council on the subject of the "Education of the Public in Hygiene." The origin of the idea of including as a part of general public health work a section dealing with this subject was a memorandum addressed to the Minister of Health by Sir George Newman, Chief Medical Officer to the Ministry in which he stated " An essential part of any health policy is the instruction in the principles and practice of hygiene of the great mass of the people. In this, as in any other spheres of human affairs, ignorance is the chief curse. We are only now, as knowledge grows, becoming aware of the immeasurable part played by ignorance in the realm of disease. It is hardly too much to say that in proportion as knowledge spreads in a population, disease and incapacity decline. As in the individual so in the community, knowledge is the sheet anchor of preventive medicine. The great reforms (in the prevention of disease) are dependent for their achievement upon an enlightened and responsive people." The report set out in detail the lines on which a Borough Council could develop health education, some of the suggestions being on entirely new lines. It was thought at that time that something more than compulsory laws and regulations were required to further advance preventive medicine, and that the next step was to obtain the intelligent co-operation of the public by teaching them the reasons and need of health education. One of the essential requirements of the scheme was the necessity of getting into touch with the largest possible percentage of the population, even to the extent of lecturing in the street to the man who could not be enticed to learn by more usual methods. The report was adopted by the Council and instructions given that the suggestions outlined should be put into operation. During the ten years the Propaganda Section of the Department has been in existence, a vast amount of interesting and valuable experience in the subject has been gained. The original scheme has been modified and improved ; methods of getting into touch with the people have altered, as necessity demanded, but the main essential is still the same, i.e., to talk on health subjects on all suitable occasions, whether for five minutes in a Maternity and Child Welfare Centre, a few minutes in the home or in the street, or an hour at a big public meeting. The following is a brief outline of the work done during the past ten years:— Schools. Although not specifically mentioned in the original scheme, it was soon evident that some of the most important teaching of hygiene could be done at the schools, given the cooperation of the County Council and the teaching staffs. Negotiations were opened with the County Council who readily gave the necessary concession and a general permission for such lectures to be given in the elementary schools in the Borough. The first lecture was given on February 4th, 1925, at Thurland Road school, and from that date school lectures have been a regular feature during the winter months, the total number at the time of writing being 411. All lectures are given by doctors on the staff of this department, and without exception are illustrated by lantern slides and films. Immediately the schools re-open after the summer holidays, a member of our staff visits and books suitable dates for the winter months. Owing to the lack in most schools of dark blinds in the halls and class rooms, the work is limited to the winter months, but during this period, five different schools receive lectures each week. At a maximum only fifty to sixty can thus be given annually. A pleasing aspect of this work is the enthusiasm of many of the Head and Assistant teachers, without whose cordial help the scheme could not be carried on. It often happens that at the beginning of the season some schools will ask for a series of six lectures, but owing unfortunately to the limitations previously mentioned, this is impossible. Our endeavour is to visit all boys and girls departments in the Borough once a year and by careful arrangement, it is usually just possible to manage this. School Examinations. During the year 1930, a suggestion was made by one of the schools that the Borough Council should hold examinations in Personal Health Hygiene and grant certificates to the successful candidates. The proposal was agreed to and the necessary arrangements made, the first examination being held in June of that year at Webb Street Girls' School. The children, with the sanction of the London County Council, undergo a recognised course of training approved by the Medical Officer of Health, the teacher selected by the Head Teacher to give the instruction usually holding the Diploma of the Institute of Hygiene or some similar qualification. At the end of the course, a written examination conducted by the Public Health Department is held at the school. Three classes of certificates are given, i.e., Elementary, Intermediate and Advanced, those children who obtain 70 per cent, of marks in the advanced section being presented with a very nice proficiency badge. The certificates granted to date are:— Elementary 255 Intermediate 98 Advanced 23 Proficiency Badges 19 In 1933, the scope of the examinations was widened so as to include simple Home Nursing. Similar regulations were laid down as for personal health hygiene with the addition that for home nursing, a practical examination is held as well as a written one. Any necessary apparatus such as bedsteads and bedding is loaned to the schools for the purpose of demonstration and the practical examination is held at the schools personally by the Medical Officer of Health, assisted by one of the nurses in the department. Forty-four elementary certificates have been presented to successful students. The first examination for the intermediate certificate has just been held and next year the course for the advanced girls will be prepared. The certificates are specially printed for the purpose and signed on behalf of the Council by the Mayor and the Medical Officer of Health, the occasion of the presentation being used for further propaganda. The children are very keen to possess these certificates and a good deal of really sound work is being done. The answers to the questions are often surprisingly good and many of the children in the Borough are leaving school with at least some elementary knowledge of hygiene. Open-Air Demonstrations. From the commencement of the Propaganda Department, it was recognised that the scheme could not be complete without street preaching, and to conform to the general plan, this had to be illustrated by lantern and films. Many difficulties had to be overcome and it was only after a good deal of careful thought and experiment, sometimes unsuccessful, that this was managed. It is not proposed here to set these out in detail. For the first twelve months the motor van used for returning disinfected bedding was converted at night into a cinema van by fitting a glass screen at the rear and using the driver's seat as a stand for the projector. In July 1925 the Council decided that a van specially constructed for the purpose was necessary and instructions were given for one to be built. This van is still in use and although this form of street advertising is commonplace to-day and the modern commercial cinema van is an elaborate and wonderful machine compared to the one we have, we are still able to draw crowds. The electricity required for the projector is obtained from the street lamps by fitting special plugs. Twenty-four sites have been selected in different parts of the Borough for these fittings and in addition we use the open spaces in the Council's blocks of flats. Since the commencement, 401 lectures and demonstrations have been given in this way, and although the "Council's Picture Show" is known everywhere in Bermondsey, the public interest is still maintained with no lessening of the size of'the audience prepared to listen. With this kind of work, the numbers of lectures and demonstrations given in any one year must of necessity depend to a very large extent on the weather. For instance, in 1927, when the summer was very wet, only 19 were given, whereas in 1933 when we were particularly fortunate with the weather, the number was 70. The season for outdoor work is May, June, September and October. Before May and after October it is usually too cold and during July and August the light nights prevent a start until nearly 10 o'clock at night and it is considered unwise to commence at that hour. Before going out, the police are always notified, but never on one single occasion have they had anything more to do than remain as interested spectators. Opportunity has been taken at the time of elections for further outdoor work. On the evening of the poll, crowds stand outside the Town Hall sometimes for several hours waiting for results. This applies particularly to Parliamentary Elections. A screen is fitted in front of the houses opposite and the cinema shown from one of the Town Hall windows. As the results come through, they are shewn by lantern slides and during the intervals of waiting, hygiene films are displayed with short talks by the Medical Officer of Health. As many as six films have been shewn in one evening by this means. Indoor Lectures. —During the period under review the total number of indoor lectures given, exclusive of schools was 414. Our policy with regard to these is to accept every invitation to address audiences large or small, and consequently at some time or other we have spoken to every organisation in the Borough. Every Mission Hall has been visited on a number of occasions and many members of the political parties have been addressed at their meetings. "Old Boys" and "Old Girls" Clubs quite frequently provide interested audiences and Boy Scouts and Girl Guides are very old friends. Several times we have tried big public meetings in the large halls in the Borough and although these meetings are very well attended, on one occasion there were 1,800 present and an over flow meeting outside, one rather doubts whether a "lecture" to that number is as satisfactory as a "talk" to say 50 —100. One thing that is often difficult to arrange at the big meeting is a discussion at the end, but with a limited number this is invariably a part of the programme and frequently elicits some very intelligent questions. Pamphlets.—Our usual procedure with an audience is to give a short talk illustrated by lantern slides, then show a film, invite discussion, and finally give a pamphlet all on the same subject. The pamphlets are carefully written and with all of them an attempt is made to "catch the eye" either by some discreet humour or an amusing illustration. As with all such literature undoubtedly much is thrown away and wasted, but if care is taken in the presentation of the matter, this can be reduced to a minimum. If sufficiently large quantities can be ordered at one time, the cost of printing is extremely small. As an adjunct to other forms of teaching, the pamphlet is well worth serious consideration. Over thirty pamphlets are in regular use in the department on the following subjects:— Baby, Bed Bug, Breast Feeding, Brown Rat, Care of the Teeth (two), Clothing, Cleanliness of the Skin, Constipation, Consumption, Diphtheria, Eyesight, Grade 'A' (T.T.), Milk (four), Fly, Food (hints to purchasers), Food (Inspection), Hints for Expectant Mothers, Influenza, Louse, Mouse, Measles, Rheumatism, Scabies (two), Scarlet Fever, Smallpox, Smoke and Soot, and Tuberculosis. In addition, eleven illustrated book marks have been prepared and these are supplied to the Chief Librarian who very kindly arranges that one should be slipped into each book issued. Films. When the propaganda department commenced its work ten years ago, it was realised that a good deal of the success of the work would depend on the provision of suitable films. It was expected that some difficulty would be experienced in obtaining these because at that time there was no market for them. The difficulty was far greater than anticipated, however, as it was found that not a single useful film was available. Hygiene films to be of real value must be written and produced by a staff with an intimate knowledge of the subject and the film companies were not then employing such a staff. To-day it is quite different and a very large selection of really excellent films both British and Foreign can be bought or hired. However, as films could not be obtained by the usual methods, we decided to produce our own and the first one was completed and shown by the end of November 1924. The subject was "The Production of Grade 'A' 'T.T.' Milk. During the following twelve months, three more were finished on " Sunlight Treatment," "Tuberculosis," and "Maternity and Child Welfare." To-day our library consists of twenty-nine films, nearly all of which are in two sizes, i.e., standard size 35 mm. and a second copy of 16 mm. suitable for projection with a Kodascope or similar machine for use in small halls and schools. The films are always kept up-to-date and topical by "shooting" fresh scenes which can be added to or substituted for those already in the film. In addition there is now an ever increasing field from which new films can be obtained. The following is a list of those at present in use:— FILMS PRODUCED BY BERMONDSEY BOROUGH COUNCIL. Time for Shewing. Title. Synopsis. "Where there's Life there's Soap The Skin and why it should be kept clean 20 minutes Production of Grade 'A' (TT) Milk A demonstration of the care taken to ensure a clean milk supply „ “The Story of our Food Supply” How the public are protected against unsound and adulterated food 25 minutes The value of wool next to the skin, and the advantages of modern dress. Suitable mainly for women and girls “Health and Clothing” 17 minutes “Preparation of Dried Milk” The processes from cow to carton 20 minutes Shows how children can be “brought up” and trained, even in an institution “Shirley Schools” 25 minutes A demonstration of washing, dressing and feeding a baby and toddler with introduction of interest to expectant mothers “Maternity and Child Welfare” 25 minutes “'Oppin" Hop-picking in Kent. Conditions are shown to be very primitive and only the fittest should go 15 minutes “Germs” An attempt to explain the germtheory” in a simple manner 25 minutes “Some activities of the Bermondsey Borough Council A wander around the Borough to see what the Council does for public welfare „ “Children's Exercises” This includes a drill display by an orphanage school 15 minutes “Consumption (Tuberculosis of the Lungs) Of great interest to most people and deals with the subject optimistically 30 minutes OTHER FILMS IN BERMONDSEY BOROUGH COUNCIL FILM LIBRARY. Title. Time for Shewing. Synopsis. The necessity and value of artificial as well as natural sunlight “Sunlight is Life” 25 minutes “nside Out” A diagrammatic film of the digestive system, showing what happens in constipation 15 minutes “Teeth” An easily understood explanation of teeth and their troubles 20 minutes “Ivory Castles” A fairy story about teeth. Very suitable for young children 8 minutes Emphasises the danger of a filthy pest “The Fly” 15 minutes “The Flea, Bug and Louse” Microscopical views of these are shewn 20 minutes „ “The Rat Menace” Ministry of Agriculture Film “Too Many Pounds” On being too fat 15 minutes “Body Framework” Uses of body framework, growth, repair and in action 17 minutes Growth, pores, sweat and oil glands, etc. “The Skin” 18 minutes “Muscles” Structure, action, and development by proper exercise 17 minutes Moving blood under the microscope, and action of the heart, arteries, lungs, etc. “Circulation” „ The mechanics of breathing and the structure of air passages “Breathing” 18 minutes The complete process through the digestive tract “Digestion” „ Compares good and bad positioning and gives methods of correction “Posture” 17 minutes Structure and care “The Feet” 16 minutes Shews good and bad teeth and necessary care “Care of the Teeth” 18 minutes Results.—We are sometimes asked whether all this work is worth while and whether the results justify the efforts. If we were advertising a commodity for sale we could say for certainty that advertising did or did not pay. Business firms invariably maintain that judicious advertisement is an important factor in increasing the amount of trade done and that their success is usually in direct relationship to the amount of advertising. If this is the case with business, is it not reasonable to assume that good results are obtained when advertising health. Unfortunately we cannot prepare a balance sheet, neither can we with ease set down in detail examples of results, but we are certain that this section of the work in conjunction with that of the rest of the Public Health Department is gradually improving the knowledge and conditions of the population. To complete this report without acknowledging the assistance given by Medical Officers, Dental Officers and Sanitary Inspectors would be ungrateful. When asked to give lectures, these officials always do so most willingly, often at considerable inconvenience to themselves and with the able assistance of Mr. Lumley who operates the projector and is responsible for the photography, the service runs most smoothly. VIII.—SANITARY ADMINISTRATION. HOUSING. During the year, work in connection with the Borough Council's housing scheme has proceeded rapidly, and 336 flats and 14 shops have been erected on declared areas and acquired sites. Nine new areas have been declared by the Council, and as indicated in my Annual Report for 1932, the Leroy Street Area which was represented during that year, has been divided into two smaller areas, as shewn in the following table, and the houses on these two areas are now in course of demolition. The following are the areas declared: — Title of Clearance Area Area on sq. ft. (approx.) No. of dwelling houses Population declared by Council persons families Tanner Street 7 40 28/3/33 5,956 28,528 8 40 Leroy Street North 70 305 28/2/33 Leroy Street South and lands adjoining 54 338 39,037 83 28/2/33 Neptune Street and lands adjoining 306 48,475 67 77 25/4/33 Cranbourn Place and lands adjoining 40 5,936 7 12 27/6/33 Clove Place 5,000 9 26 27/6/33 8 Elim Street and lands adjoining 71,522 100 605 150 26/9/33 Cherry Garden Place and lands adjoining Alyton Street and 455 53 54,711 128 25/7/33 20 lands adjoining 33,792 28 113 19/12/33 Renforth Street 44 34,011 52 255 19/12/33 Risdon Street 15,088 12 13 67 19/12/33 During the year the following new premises have been erected by the Council:— Position Number of flats Number of families accommodated Acorn Walk 22 flats 22 families accommodated Amos Estate 34 „ and 3 shops 34 „ „ Lavender House 29 „ „ 29 „ Redriff Estate 42 „ and 6 „ 42 „ „ Silver Street Site 34 „ 4 „ 34 „ „ Millpond Estate 27 „ 27 „ „ Vauban Estate 50 „ 1 shop 50 „ „ Aylwin Estate 14 „ 14 „ „ Stansfield Estate 49 „ 49 „ „ Crosby Row Site 35 „ 35 „ „ The London County Council completed the erection of two blocks of flats on the Dickens Estate, George Row and 32 flats are being erected by private enterprise. The following premises are in course of erection by the Council:— Position. Number of Flats and Cottages. Rotherhithe Street (west) 10 cottages Amos Estate 50 flats and 1 shop Redriff Estate 45 flats and 6 shops Silver Street site 2 flats Millpond Estate 11 flats Albion Yard site 69 flats 69 flats and 3 shops Vauban Estate 5 cottages 1 flat Crosby Row site Harold Estate Extension 38 flats Tanner Street site 26 flats and 1 shop Bethel Place site 29 flats and 3 shops One redundant public-house was purchased and converted into 3 flats. OVERCROWDING. In 1927, my predecessor, Dr. King Brown, caused a census to be taken in order to ascertain the prevalance of overcrowding in the Borough, and found that 2,763 families were living more than two persons to a room. I have had a census taken on similar lines, and in spite of unprecedented activity, on the part of the Council in matters of housing during the last six years, the position is still very unsatisfactory, and there are still well over 2,000 families living in overcrowded circumstances, although a con. siderable number of the worst cases of overcrowding have been found other accommodation. The result of the census is, as follows:— Number of houses 18,470 Total number of rooms 87,566 Total number of rooms (sleeping) 43,775 Total number (living and sleeping) 5,503 Total number (living) 38,288 Number of families 28,571 Number of persons 104,859 Consisting of: — Adults (10 years or over) 87,650 Children (under 10 years) 17,209 Number of families with accommodation of: — 1 person or less to a room 16,444 2 persons to a room 9,781 3 „ „ 1,757 4 „ „ 433 5 „ „ 113 6 „ „ 32 7 „ „ 8 8 „ „ 3 Hereunder will be found particulars of Inspections, Proceedings, etc., for the year 1933: — Inspection of Dwelling Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,359 (b) Number of Inspections made for the purpose 36,344 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 4,483 (b) Number of Inspections made for the purpose 4,483 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 326 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation Nil Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,916 Action under Statutory Powers during the Year: — (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930 (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1 (6) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6,194 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 2,278 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which Demolition Orders were made 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 (D) Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Total number of houses in the Borough 18,827 Number of houses occupied by the working classes 18,683 REGISTERED PREMISES— Number on Register at end of 1933 Number of Prosecutions Premises Number of Inspections Common Lodging Houses 3 50 - Seamen's Lodging Houses 3 15 - Milkshops 298 651 - Houses let in lodgings 200 1,734 - Ice Cream Premises 133 388 - Offensive Trades (including Poultry Slaughter-houses) 14 101 - SMOKE NUISANCES- Number of observations 67 Number of notices 13 Number of complaints 9 Number of summonses Nil UNDERGROUND ROOMS— Number illegally occupied 16 Number closed or illegal occupation discontinued 2 WATER SUPPLY TO TENEMENT HOUSES- Premises supplied 28 Prosecutions Nil SALE OF FOOD— Number of premises used other than ice-cream premises, milk shops and cowsheds 637 Number of inspections 3,281 RAG FLOCK ACTS, 1911 AND 1928— There are four premises in the District where rag flock is used, and each of these premises was inspected twice during the year, the total number of inspections being eight. There were no prosecutions. Two samples of rag flock were taken, and found to conform to the regulations. Water Supply.—Most of the houses in the Borough have the water supply either on the ground floor or in the yard, and many of these houses are, of course, inhabited by more than one family. Quite a number of houses are without a direct supply from the rising main. Water supply has been installed on one of the storeys of 28 tenement houses, after services of notices. Water Closet Accommodation. —Practically every house in the Borough has one water closet, which is, in many cases, shared by two or more families. Many of the flats have one water-closet to two families. Schools. —The sanitary accommodation in each of the schools has been inspected twice during the year. The conditions existing at one school have now been modernized. 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 .. 3 (d) In connection with the removal of offensive matter, etc. 9 (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. 2 (h) With respect to sufficiency of water supply to water closets 1 (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 — Number of prosecutions under the Milk and Dairies (Consolidation) Act, 1915 — Number of prosecutions under the Milk and Dairies Order, 1926 1 WORK OF DISTRICT INSPECTORS, 1933. 1 2 3 4 5 7 8 9 11 12 13 14 15 17 18 19 20 21 22 10 16 6 Houße-to-Houso Complaints Infectious Diseases Factories & Workshops Specially Inspected Offensive Trades Outworkers' Bi-Annual Inspection Common Lodging Houses Drains Tested Other Calls and Visits Chimneys watched Bakehouses Fishmongers, Friers and Curers Food Stores Fruiterers and Greengrocers Markets Restaurants and Eating Houses Destruction of Food Various TOTALS Special Inspections Butchers Ice Cream Visits Ints. 732 1069 361 237 70 22 14 39 2529 34 56 216 109 61 78 216 3 1 5927 944 District No. 1 12 7 61 „ No. 2 558 1285 397 224 24 16 27 15 91I 2641 3 42 62 32 67 16 52 259 25 5 1 5842 770 672 1536 338 152 18 1 „ No. 3 18 - 61 2809 7 37 97 61 81 37 50 77 22 1 1 6076 849 641 1643 436 175 14 52 32 21 43 2682 19 34 59 36 87 45 28 88 52 - - 6187 1013 „ No. 4 583 1327 378 283 75 20 2 „ No. 5 41 - 87 2519 18 37 71 39 203 57 62 100 43 4 5949 1083 3 696 1174 215 246 106 110 6 „ No. 6 - 9 - 45 2770 8 24 132 89 411 133 80 148 6405 881 601 1127 256 178 38 25 - 36 2874 5 18 51 50 154 24 55 130 51 - 8 5681 732 - „ No. 7 Total 4483 2381 1495 345 101 174 50 402 18824 67 226 533 363 1219 421 388 880 519 14 21 42067 6272 9161 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. HOMEWORK. NATURE OF WORK (1) Outworkers' Lists, Section 107 Outwork in Unwholesome Premises Section, 108 Outwork in Infected Premies (Sections 109, 110) Lists received from Employers Prosecutions (11) Notices served (12) Prosecutions (13) Instances (14) Prosecutions (16) Outworkers resident in Bermondaey received from other Districts Notices served on Occupiers as to keeping or sending lists (8) Notices served (15) Lists (2) Outworkers Failing to keep lists Failing to send lists (10) Resident in Bermondsey Resident in other Districts (5) Contractors (3) Workmen (4) Contractors (6) Workmen (7) Wearing Apparel:— I I — I I „ I _ (1) Making, etc. 44 39 6 5 5 - - - 24 - 29 6 - - — - - - - (69) - - (2) Cleansing and washing - - - - - - - - - - - - - - 1 - - Fur pulling 1 - - - - - - - - - - - 2 - Umbrellas, etc. 1 - 1 - - - - - - - - - - - - Sacks 6 4 1 - - - - - 1 - - - - 1 - 1 2 - 4 - Paper, etc., Boxes. Paper Bags 3 8 - - - - - - - 5 - Brush making - - - - - - - - - - - - - - - - - Chocolates and Sweetmeats - - - - - - 1 - - - - - - Leather Goods 4 - 3 4 - 4 - - - - - - Surgical Instruments 2 - - 4 - - - - - - 1 1 - Coathangers 2 - 13 33 - - 1 - - - - - - - - 5 - - - - Carding of buttons, etc - - - - - - - 1 1 - - - - 2 Onion Peeling - - - - - - - - Total 42 - 58 88 7 61 8 - - 8 8 - 1 - - FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. INSPECTION. Number of Premises Inspections Written Notices Prosecutions Factories (including Factory Laundries) 14 523 - Workshops (including Workshop Laundries) 111 13 - Workplaces (other than Out workers' Premises) 109 8 - 743 35 Total - DEFECTS FOUND Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Particulars Nuisances under the Public Health Acts— Want of Cleanliness 16 - - 16 2 Want of Ventilation 2 - - Overcrowding - - - - Want of Drainage of Floors - - - - Other Nuisances 17 17 - - Sanitary Accommodation— Insufficient 5 5 - - 10 Unsuitable or Defective 10 - - 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) 44 - 44 - Other Offences 6 6 - - Total 100 100 - - OTHER MATTERS. Class Number Matters notified to H.M. Inspectors of Factories — Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters re Notified by H.M. Inspectors ferred by H.M. Inspectors as remediable under the Publics Reports (of action taken sent Health Acts, but not under to H.M. Inspectors) the Factories Act (s. 7) 3 3 Other 1 Underground Bakehouses (s. 101):- Certificates granted during 1933 - In use at end of 1933 18 Workshop Bakehouses 18 Workshops on the Register (s. 131) at the end of 1933 415 Total Number of Workshops on Register 433 No. OF BAKEHOUSES IN THE BOROUGH. In Use Not in Use Above ground Underground Underground Above ground 18 36 3 36 of these are Factory Bakehouses HOUSE, TRADE AND MARKET REFUSE. The following table shows the amount of house, trade and market refuse disposed of during 1933: — Disposal Loads tons cwts. qrs. House Refuse to Barge 20,381 14,987 5 2 Trade Refuse „ Barge 2,705 1,958 6 1 Street Markets Refuse to Barge 1,975 2,089 13 1 Totals 19,667 24,429 5 - OFFENSIVE TRADES. The offensive trades on the Register are as follows: Fellmongers 3 Fatmelters 2 Glue and size makers 3 Dresser of Fur Skins 6 MORTUARY. Particulars of bodies removed to the Mortuary during the year are, as follows:— Total number of infectious bodies removed 15 Total number of bodies removed 69 STREET MARKETS. The market scheme continues to work smoothly and satisfactorily. Number of Licences in operation 593 Income £2,911 2s. 6d. There have been 24 prosecutions during the year. DRAINAGE WORK. Hereunder will be found particulars of drainage work, &c., carried out by the Drainage Inspector during 1933: — Drains Tested 710 Intimation Notices served Nil Visits to Underground Conveniences 428 Other Visits 3,575 IX. —FOOD CONTROL. In this section of my report is given tabulated information concerning the work of the three Wharves Inspectors and of the Food and Drugs Inspector. There have been no unusual features in their work this year and there is therefore no need for any special comments. UNSOUND FOOD. The general inspection of food in shops and on stalls forms part of the duty of the District Sanitary Inspector. The following food, in the quantities stated, 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. bs. Fresh Meat Fresh Fish - 5 3 5 Fresh Fruit 1 6 3 24 Bacon - - 1 23 Poultry - 2 1 0 Vegetables - 1 3 0 Total 1 17 0 24 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. Thirty samples have been taken during the year by the Wharves Inspectors. Two of these samples were of tinned cream and were submitted to chemical and bacteriological examination. Seven samples were examined for the presence of metals, and 9 samples for preservative. The remaining samples were examined in order to ascertain the composition. In addition 13 samples have been taken by other officers for special purposes. Article Examined Tinned Cream Rice Sardines Anchovies Fillets Haricot Verts Lard Egyptian Butter Butter Lime Juice Spray Milk Powder Fat (Roseline) Gherkins in brine Strawberry Pulp Raisins No. of Samples 2 3 3 1 1 2 1 3 1 2 1 1 1 1 Examination Bacteriological For the presence of Lead „ „ For the presence of Copper To ascertain composition „ „ „ „ „ Analysis of liquid For preservative „ Result Slightly sour smell and taste. Acidity slightly increased. No growth Genuine „ Lead, 5 parts per million Copper—35 parts per million Genuine „ Mouldy with an increase in the acidity Contained a lot of suspended matter with yeast cells Very dirty Largely, if not entirely, an animal fat Very weak brine with weak vinegar Genuine—685 parts per million of Sulphur Dioxide 1,330 parts per million of Sulphur Action taken Still under detention Released except 2-cwt. stained with Red Lead - - Ships Stores Released „ Released for sorting under the supervision of Sanitary Authority Destroyed Released for cattle feeding Re-exported Released „ „ PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 . —continued Raisins „ Sultanas Bouillon Extract (Toxa) Dried Milk (Ambrosia) Cake Rag Flock Split Peas Chocolates 2 3 „ 1,152 parts per million of Sulphur Dioxide 1,152 parts per million of Sulphur Dioxide 1,203 parts per million of Sulphur Dioxide 1 Genuine 668 parts per million of Sulphur Dioxide „ 1 „ Genuine SAMPLES EXAMINED FOR SPECIAL PURPOSES. 5 To ascertain composition 4 For preservative and colouring matter »» • • • • 2 Conformed Requirements of the Rag Flock Regulations, 1912 1 Genuine .. .. 1 Examination For preservative For the pressence of Arsenic, Copper and Lead, and bacteriolological examination For the presence of Antimony, Arsenic, Copper, Lead, Mercury and Zinc 1,189 parts per million of Sulphur Dioxide 1,041 parts per million of Sulphur Dioxide Genuine Released „ Released for treating under the supervision of Sanitary Authority Released „ No. of Samples Result Article Action taken 4 2 1 3 5 6 7 8 9 10 11 Food Factories Fish Curers Food Stores Food Wharves and Depots Milksellers Restaurants Distruction of Food Nuisances Found Intimations Served Number of Samples taken Various Butter and Margarine Imported Food Regulations Milk (Special Designation) Order Samples of Milk for presence of Tubercle Bacilli Milk (Bacteriological Examination) Ice Cream (Bacteriological Examination) Other Jam Food and Drugs - 35 3 16 2 209 2275 - 232 19 5 - - - - - - - 27 - 307 1757 - 148 10 - 3 113 - 5 2 - 50 - - - 20 61 - 140 1819 - - 135 2 - 1 1 15 - - - 141 - - - - - 366 - - - - - 8 36 102 - 651 1506 - 92 269 657 - 6 3 1506 j 30 92 22 5851 437 102 99 30 651 515 8 36 MILK PREMISES. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Fifty-six milksellers were registered under the above Act during 1933, and 54 names were removed from the Register, making a total of 298 milksellers on the Register at the end of the year under report. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year under report, the following Licences were granted:— Dealers' Licences:— To bottle and sell Grade "A" (Tuberculin Tested) Milk 11 To sell Grade " A " (Tuberculin Tested) Milk 24 To sell " Pasteurised " Milk 6 Pasteuriser's Licence:— To sell Milk as "Pasteurised" 1 Supplementary Licences: — To sell " Certified " Milk 3 To sell Grade "A" (Pasteurised) Milk 3 To sell Grade " A '' (Tuberculin Tested) Milk 5 To sell " Pasteurised " Milk 4 All premises used for the sale of milk are regularly inspected to ensure that the standard of cleanliness laid down is maintained. MILK SAMPLING. A total of 643 milk samples has been taken during the year. This is made up as follows: — "For chemical (i.e., Fat and non-Fatty Solids) Examination." Liquid milk undesignated 473 Condensed milk 6 Evaporated milk 1 Grade "A" (T.T.) milk 1 Separated milk 6 Sterilised milk 8 Pasteurised milk 12 507 "For bacteriological examination." Grade 'A' (T.T.) milk 68 Pasteurised milk 24 Liquid milk undesignated 36 For tubercle bacilli 8 136 ICE CREAM. One hundred and two samples of ice cream have been examined with the following results :— 1. Bacterial Count. Below 100,000 per 1 c.c. Over 100,000 but below 200,000 per 1 c.c. 61 13 Over 200,000 but below 400,000 per 1 c.c. 5 Over 400,000 but below 600,000 per 1 c.c. 4 Over 600,000 but below 900,000 per 1 c.c. 4 Over 900,000 but below 1 million per 1 c.c. 1 Over 1 million but below 2 million per 1 c.c. 5 Over 2 million but below 3 million per 1 c.c. 2 Over 3 million but below 5 million per 1 c.c. 1 Over 5 million per 1 c.c. 1 No tests taken for Bacterial Count in 5 samples. 2. Presence of B. Coli. B. Coli present in 1 c.c. 1/10th c.c. 1/100th and 1/1000th c.c. 1 B. Coli present in 1 c.c. 1/10th c.c. and 1/100th c.c. 51 B. Coli present in 1 c.c. and 1/10th c.c. 18 B. Coli present in 1 c.c. 14 B. Coli absent in tests ranging from 1 c.c. to 1/100th c.c. 18 Examination of ingredients used in the making of Ice Cream. One sample of Gelatine —Genuine —145 parts per million of Sulphur Dioxide. One sample of Milk—B. Coli absent in dilutions ranging from 1/10th to 1/100,000th c.c. One sample of Vanilla Essence —Genuine. One sample of Yelkos (colouring matter). —Sulphur Dioxide 10,000 parts per million. Arsenic 4 parts per million. Lead not exceeding 5 parts per million. (79) FOOD AND DRUGS. Total Samples Taken Number Genuine Number Adulterated Percentages of Articles Adulterated Articles submitted for Analysis Acid, Tartaric 4 4 - - Ale (Informal) 4 4 - - Almonds, Ground 5 5 - - Aspirin Tablets 3 3 - - Aspro Tablets 1 1 - - Baking Powder 5 5 - - Barley, Pearl 12 12 - - Barley, Pot 1 1 - - Beef, Loaf 1 1 - - Beer, Bitter (Informal) 1 1 - - Bicarbonate of Soda 1 1 - - Borax Powder 1 1 - - Borax Purified 1 1 - - Brawn 10 11 1 9.1 Brawn, Pork 4 - 4 - Butter 210 210 - - Butter (Informal) 1 1 - - Cabbage, Pickled 1 1 - - Cake 2 2 - - Cake, Richmond 1 1 - - Cake, Sponge 3 3 - - Cake, Tango 1 1 - - Candied Peel 1 1 - - Cascara Sagrada 1 1 - - Cheese 19 19 - - Cheese, Cheddar 1 1 - - Cheese, Crustless Cheddar 1 1 - - Cheese, Gouda 1 1 - - Chicken and Ham Roll 1 1 - - Cider 2 2 - Cider, Ginger 1 1 - - Cinnamon, Ground 2 2 - - Cocoa 4 4 - - Cocoa, Malted Milk with Eggs (Informal) 1 - - 1 Coffee 15 15 - - Coffee Essence 3 3 - - Coffee Extract - 1 1 - Colts Foot Rock 1 1 - - Cornflour 1 1 - - Cream 10 10 - - Cream Salad 1 1 - - Cream, Tinned 1 1 - - Cream, Tinned (Informal) 2 2 - - Cream of Tartar 5 5 - - Currants 2 2 - - Custard Powder 2 2 - - Dripping 64 64 - - Egg Substitute Powder 1 1 - - Fat, Cooking - 4 4 - Fish Paste 19 19 - - Flour 3 3 - - Flour, Self-raising 10 10 - - Fruit Cup 1 1 - - Fruit, Mixed 2 2 - - (80) FOOD AND DRUGS — continued. Articles submitted for for Analysis Total Samples Taken Number Genuine Number Adulterated Percentages of Articles Adulterated Fruit Salad, Mixed 2 2 - - Gelatin 1 1 - - Gin 1 1 - - Ginger, Ground 3 3 - - Glycerine 4 4 - - Golden Syrup 1 1 - - Goosebe.ries 1 1 - - Grape-a-lade 1 1 - - Grape Fruit Squash 1 1 - - Grape Saline 1 1 - - Highland Cocktail 1 1 - - Honey 3 3 - - - Ice Cream 11 11 - Ice Cream (Informal) 1 1 - - Iodine, Tincture of 1 1 - - Jam, Blackcurrant (Informal) 1 1 - - Jam, Greengage 2 2 50 0 2 Jam, Raspberry 4 2 2 50 0 Jam, Raspberry (Informal) 5 3 2 40.0 Jam, Raspberry and Apple 1 1 - - Jam, Raspberry Flavour 1 1 - - Jam, Raspberry Seedless (Informal) 1 1 - - Jam, Strawberry 1 1 - - Jam, Strawberry (Informal) 1 1 - - Jelly, Calves Feet 1 1 - - Kraft Mayonnaise 1 10 - - Lard 10 10 - - Lemon Cheese 1 1 - - Lemon Crush 1 1 - - Lemon Curd 3 3 - - Lemon Juice 1 1 - - Lemon Squash 3 3 - - Lemonade Powder 4 4 - - Lentils 1 1 - - Linseed Meal 1 1 - - Loganberries (Informal) 1 1 - - Macaroni 1 1 - - Malt Extract and Cod Liver Oil with Cherry's Parrishs Food 1 - 100.0 1 Malt Extract and Cod Liver Oil with Cherry's Parrishs Food (Informal) Malt Extract and Cod Liver Oil 1 1 100.0 1 (Informal) 1 1 - - Margarine 79 79 - - Marmalade 2 2 10 2.1 Milk 473 463 10 2.1 Milk, Condensed 6 6 - Milk, Evaporated 1 1 - - Milk, Grade "A" (T.T.) 1 1 - - Milk, Pasteurised 12 12 - - Milk, Separated 6 6 - - Milk, Sterilised 8 8 - - Mincemeat 2 2 1 - Mint, Dried 2 1 1 50.0 Mint Sauce 1 1 - - Mints, Arctic 1 1 - - Mints, Clear 2 2 - - (81) FOOD AND DRUGS- continued Total Samples Taken Percentages of Articles Adulterated Number Genuine Articles Hubmitted for Analysis Number Adulterated Mints, Glace 2 2 - - Mustard 8 8 - - Nutmegs 1 1 - - Oil, Camphorated 4 4 Oil, Castor 1 1 - - Oil, Cod Liver 1 1 - - Oil, Eucalyptus 1 1 - - Oil, Olive 3 3 - - Ointment, Basilicon 1 1 - - Ointment, Boric 2 2 - - Ointment, Iodine 1 1 - - Ointment, Salicylic 1 1 - - Ointment, Sulphur 1 1 - - Ointment, Zinc 5 5 - - Orange Squash 1 1 - - Parrish's Chemical Food 2 2 - - Peas, Green (Informal) 1 1 - - Pepper 30 30 - - Pepper, Cayenne 1 1 - - Piccalilli 2 2 - - Pickles 2 2 - - Pickle, Sweet 1 1 - - Pickling Spice 1 1 - - Pie Steak 1 1 - - Pilchards (Informal) 1 1 - - Plum Duff (Informal) 1 1 - - Quinine, Ammoniated Tincture of 4 4 Raisins 1 1 - - Raisins (Seedless) 1 1 - - Raisins (Stoneless) 2 2 - - Raspberries, Scotch (Informal) 1 1 - - Relish 1 1 - - Relish, Yorkshire 1 1 - - Rhubarb, Compound Tincture of 1 1 - - Rice 6 6 - - Rice, Ground 1 1 - - Rose, Pink Colouring 1 1 - - Salmon and Lobster Roll (Informal) 1 1 - - Salts, Epsom 1 1 - - Salts, Glauber 1 1 - - Sauce 3 3 - - Sauce, Chop 1 1 - - Sauce, Empire 1 1 - - Sauce, Fruit 2 2 - - Sauce, Worcester 4 4 - - Sardines, (Informal) 5 5 - - Sausage, Breakfast 28 28 - - Sausage, Liver 2 2 - - Sausage, Lunch 7 7 - - Sausage, Pork, Lunch 1 1 - - Sausage, Beef 39 38 1 2.56 Sausages, Beef Chipolata 2 1 1 50.0 Sausages, Garlick 1 1 - - Sausages, Pork 33 32 1 3.3 Sausages, White 1 1 - - Semolina 1 1 - - (82) FOOD AND DRUGS—continued. Total Samples Taken Articles submitted for Analysis Number Genuine Number Adulteated Senna, Confection of 1 1 - Sherry 1 1 - Sodium Bicarbonate 1 1 - Soup Mixture 1 1 - Spice, Mixed 1 1 - Spice, Mixed Ground 1 1 - Spice, Special Brawn 1 - 1 Sponge Mixture 1 1 - Sponge Rolls 1 1 - Stomach Powder 1 1 - Stout (Informal) 1 1 - Strawberries 1 1 - Suet Chopped 3 3 - Suet Shredded 13 12 1 Sugar Demerara 6 6 - Sugar, Lump 1 1 - Sugar Pudding 1 1 - Sultanas 6 6 - Tea 10 10 - Tea Dust 2 2 - Tea Dust (Informal) 1 1 - Tea Liquid 1 1 - Toffees Mint 1 1 - 1 Tomato Ketchup 1 - Vanilla, Essence of 1 1 - Vinegar 31 31 - Vinegar Malt 32 30 2 Virol and Milk 1 1 - Whisky 2 2 - Wine Cocktail 1 1 - Wine Elder 1 1 - Wine Ginger 2 2 - Wine Ginger Essence 1 1 - Wine Ginger Flavour 1 1 - Wine, Meat and Malt 1 1 - Wine Orange 2 2 - 2 2 Wine, Orange Quinine - Wine, Raisin 1 1 - Wine, Raisin Flavour 1 1 - Wine, Raspberry 1 1 - Wine, White 1 1 - Yelkos 1 1 - Total 1,506 1,482 24 PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1933. Remarks Adulteration or Infringement No. Sample. 821 Alcoholic strength 40° under proof Dismissed with a caution on Whisky payment of 40/- costs Dismissed with a caution on payment of 17/6 costs 852 Milk Deficient in milk-fat 14.0 per cent. 160 Milk Deficient in milk-fat 8.0 per cent. Dismissed on payment of 17/6 costs Dismissed on payment of 19/6 costs 211 Milk Deficient in milk-fat 8.0 per cent. Malt Vinegar Deficient in Acetic Acid, 11.5 per cent. 745 Dismissed under the Probation of Offenders Act on payment of 17/6 costs Deficient in milk-fat, 13.3 per cent. 820 Milk Fined £5 and £3 3s. costs 959 Extract of Malt and Cod Liver Oil with Cherry Parrish's Food Malt Vinegar Deficient in Cod Liver Oil 15.0 per cent. Warranty Notice given. Withdrawn. Costs, £2 2s. Deficient in Acetic Acid, 13.7 per cent. 967 Dismissed under the Probation of Offenders Act on payment of £2 2s. costs Containing Sulphur Dioxide 0.01 per cent, (equivalent to 100 parts per million) 36 Beef Chipolata Sausages Two Summonses under Public Health (Preservatives, etc., in Food) Regulations, 1925- 1927. Fined £3 and £2 2s. costs Containing Sulphur Dioxide 0.041 per cent, (equivalent to 141 parts per million) 118 Pork Sausages Two Summonses under Public Health (Preservatives, etc., in Food) Regulations, 1925- 1927. Dismissed under the Probation of Offenders Act on payment of £5 5s. costs Selling Imported Butter not marked 33 Butter Summonsed under the Merchandise Marks Act, 1926 Fined 2/6 and 5/-costs Selling milk without having name and address on vehicle or can 175 Separated Milk Milk and Dairies (Consolidation) Act, 1915. Section 6. Fined £1 and £2 2s. costs 175 Separated Milk Selling "Separated Milk" from churn and can not legibly marked to show contents Milk and Dairies (Consolidation) Act, 1915. Section 1 Sub- Section 3. Fined £1 10s. Costs included in prosecution with above SUMMARY. £ s. d. Fines 10 12 6 Costs 22 13 0 £33 5 6 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. Articles I- Quantity Unsound Disposed of for Purposes other than Human Food Removed for Sorting under S.A. Destroyed Quantity Weight Weight Quantity Weight Quantity tons cwt lbs tons cwt lbs qr lbs tons cwt qr qr - 35 cases 8 3 0 Anchovies, Tinned - - - - - - - - - - 9 - 24 barrels, 81 boxes and 22½ cases 2 2 20 Apples - - - - - - - - - 1 7 1 17 12 Bacon 1 bale, 4 collars, 17 fore-ends, 4 gammons, 10 pieces and 40 sides - - - - - - - - - 4 4 4 - Beef 2 top pieces and rump - - - - - - - - - - 8 Beef, Brisket 2 tins - - - - - - - - - - - - - 1402 tins 3 8 3 26 - - - - Beef, Corned - - - - - - 2 tins 16 Beef Pressed - - - - - - - - - - - - - 71 cases 3 0 3 12 Blackcurrant Pulp - - - - - - - - - - 2 14 Brawn, Tinned 93 tins 4 3 26 56 cases and 16 tins 19 - - - - - - - 4 0 0 338 cases, 9 4 0 0 Butter - - - - - - - 15 casks Cake Meal (Soya Bean) 46 - - - - - - - - - - - - - - 90 14 11 Canned Goods (Various) 3 - - - - - - - - - - - 14 cases and 5 tins 15 1 0 Carrots, Tinned - - - - - - - - - - - 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 Cheese - cwt 'lbs I tons cwt lbs I tons cwt qr lbs tons qr qr Various parcels 16 1 22 - - - - - - - - - Chestnuts 13 bags 9 3 0 - - - - - - - - - - - 6 2 0 Cherries (Tinned) 13 cases 21 tins - - - - - - - - - - - Chickens 12 cases, 7 chickens and 2 tins 2 1 26 - - - - - - - - Citron 1 cask 4 0 0 - - - - - - - - - - - 22 14 0 Cocoanuts 2 - - - - - - - - - - - 1 25 Cocoanuts Desiccated 1 case 2 - - - - - - - - - - - Eggs 2131 tins 11l 12 1 0 - - - - - - - - - - 1 2 0 Fig Paste - - - - - - - - - - - 5 cases 3 0 0 Fish Conserves - - - - - - - - - - - 3 0 0 Fish, Fresh 4 cases - - - - - - - - - - - 3 10 Fowls - - - - - - - - - - - - - 0 Fruit Pulp - 1 9 0 - - - - - - - - - - Gherkins in Brine 7 casks 1 1 0 0 - - - - - - - - - - 8 0 Grapefruit Tinned 26 cases and 43 tins - 22 - - - - - - - - - - Hams, Canned 720½ tins 4 7 1 20 104 cases and 141 tins 4 10 1 7 - - - - - 1 5 0 Lemons 25 cases 0 - - - - - - - - - - Lemons Skins ½-pipe 8 0 0 - - - - - - - - - - - Lime Juice 6 hogsheads 1 10 0 0 - - - - - - - - - - 4 0 0 Loganberries Tinned 23 cases and 1 tin - - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925—continued Articles Quantity Unsound Destroyed Removed for Sorting under S.A. Disposed of for Purposes other than Human Food Quantity Weight Quantity Weight Quantity Weight r ! 1. I tons lbs cwt lbs tons cwt qr lbs tons cwt qr qr - Milk, Evaporated Tinned 51 tins 28 - - - - - - 1 - - - - - 135 cases 2 5 0 1 14 3 0 Milk, Condensed 0 12 cases and 3837 tins - - - - - Milk Powder 10 0 0 0 - - - - - - - - - - - 0 1 carcase and 4 hindquarters 1 22 - Mutton - - - - - - - - - - Nutmegs 1 0 0 0 - - 23 bags - - - - - - - - 157 cases and 1098 bags 59 1 1 0 Onions - - - - - - - - - - 8 cases 10 0 0 Oranges 332 cases and 481 half cases 37 2 0 0 - - - - - - 7 0 0 Oranges, Brazilian 9½ boxes - - - - - - - - - - - 3 125 cases 5 8 0 - - - - - Oranges, Jaffa - - - - - 8 casks 2 0 0 0 Orange Juice - - - - - - - - - - 15 cases and 34 tins 4 3 23 Oranges, Tinned - - - - - - - - - - - Ox Tongue, Tinned 3 tins 18 - - - - - - - - - - - - - 64 tins 1 1 0 Peaches, Sliced - - - - - - - - - - - 2 10 17 Peaches, Canned 7 cases and 304 tins - - - - - - - - - - - 228 bags 22 16 0 0 Peanuts (Fire Damaged) 63 bags 6 6 0 0 - - - - - - Peas, Loose 3 6 - - - - - - - - - - - - 220 cases 18 2 8 Pears 3 - - - - - - - - - - Pineapple, Tinned 48 cases and 42 tins 1 7 0 15 - - - - - - - - - - 66 cases and 119 tins 1 16 2 19 Pineapple Cubes - - - - - - - - - - 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 I cwt < . qr 1 lbs — tons cwt qr lbs I "I tons cwt qr lbs tons cwt 'lbs; qr Plums 65 packages 8 0 14 - - - - - - - - - - - - - - - - 0 Potatoes 3329 bags & 5 baskets 167 10 0 - - - - - - - - - - - - - - - Pressed Pork 6 1 tin - - - - - - - - - - - - - - - - - - Raisins - 3980 cases 24 17 2 0 - - - - - - - - - - - - - - Raspberries 323 21b. chips 5 3 2 - - - - - - - - - - - - - - - - Rice (Damaged) 1 10 - 2 - - - - - - - - - - - - - - - - Rice Sweepings 4 3 0 24 - - - - - - - - - - - - - - - - Sausage Salami - 16 2 0 - - - - - - - - - - - - - - - - 0 Sloeberries - 3 cases 1 0 - - - - - - - - - - - - - - - Soups, Tinned 420 tins 25 0 0 0 - - - - - - - - - - - - - - - 0 151 tierces and 2 casks 38 10 0 10 tierces 2 10 0 0 Tallow - - - - - - - - - - 0 Tapioca Root 170 bags 10 11 0 - - - - - - - - - - - - - - - Tomatoes, Tinned 5 1 0 12 - - - - - 82 cases and 69 tins - - - - - - - - - - Tomato Paste 8 6 0 8 - - - - - 196 cases - - - - - - - - - - Tongue, Lunch 192 tins 10 1 6 - - - - - - - - - - - - - - - - 12 3 26 Turkeys 199 cases and 2 turkeys 9 - - - - - - - - - - - - - - - Turkeys, Frozen 7 cases 7 0 0 - - - - - - - - - - - - - - - - 14 2 4 - Veal, Jellied 273 tins - - - - - - - - - - - - - - - Walnuts. Pickled 73 casks 10 1 1 0 - - - - - - - - - - - - - - - Yeast - - - - - 2 cases - 1 0 0 - - - - - - - - - - 155 7 1 6 2 10 0 0 Total Weights I 558 11 2 10 60 15 1 12 X.-HEALTH SERVICES. MATERNITY AND CHILD WELFARE CENTRES. 110 Grange Road. Monday, 2.0 p.m.-4.0 p.m. Tuesday, 9.45 a.m.-12 noon Wednesday, 9.45 a.m.-12 noon Thursday, 2.0 p.m.-4.0 p.m. Ante-natal Clinics Tuesday, 4.30 p.m.-6.30 p.m. Sewing Class Wednesday, 1.45 p.m.-4.0 p.m. 98 Rotherhithe New Road. Tuesday, 9.45 a.m.-12 noon Wednesday, 2.0 p.m.-4.0 p.m. Friday, 2.0 p.m.-4.0 p.m. Ante-natal Clinics Thursday, 2.0 p.m.-4.0 p.m. and 5.30 p.m.-7.30 p.m. Percy Hall, Abbey Street. Monday, 2.0 p.m.-4.0 p.m. Thursday, 9.45 a.m.-12 noon Roseberry Street. Monday, 2.0 p.m.-4.0 p.m. Trinity Road. Thursday, 2.0 p.m.-4.0 p.m. Princess Club, Jamaica Road. Monday, 2.0 p.m.-4.0 p.m. Tuesday, 9.45 a.m.-12 noon Friday, 2.0 p.m.-4.0 p.m Ante-natal Clinic Thursday, 2.0 p.m.-4.0 p.m. Sewing Classes Tuesday and Wednesday, 2.0 p.m.-4.0 p.m Toddlers Clinic Second and Fourth Wednesday in each month, 2.0 p.m.-4.0 p.m. Alice Barlow House, Fulford Street. Thursday, 2.0 p.m.-4.0 p.m. Friday, 2.0 p.m.-4.0 p.m Ante-natal Clinic Wednesday, 10.0 a.m.-12 noon. St. George's Hall, Old Kent Road. Tuesday 2.0 p.m.-4.0 p.m. Sewing Class Thursday, 2.0 p.m.-4.0 p.m. Toddlers Clinic First Wednesday in each month 2.0 p.m.-4.0 p.m. Salomons Centre, Newcomen Street. Thursday 10.0 a.m.-12 noon and 2.0 p.m.-4.0 p.m Friday 2.0 p.m.-4.0 p.m. Ante-natal Clinics:— Monday, 10.0 a.m.-12 noon. Tuesday, 2.0 p.m.-4.0 p.m. Wednesday, 10.0 a.m.-12 noon. Friday, 10.0 a.m.-12 noon PUERPERAL FEVER CONSULTANTS. Mr. A. J. McNair, F.R.C.S., 10 Queen Anne Street, W.I. (Telephone: Langham 2861.) Mr. G. F. Gibberd, F.R.C.S., 14 St. Thomas's Street, S.E.I. (Telephone: Hop 6618); and 20 Harley Street, W.I. (Telephone: Langham 4032.) Applications for the services of a Consultant should be made to the Medical Officer of Health. OBSTETRIC CONSULTANTS. Mr. A. J. McNair, F.R.C.S., and Mr. G. F. Gibberd, F.R.C.S., as above. Applications for the services of a Consultant should be made to the Medical Officer of Health. DAY NURSERIES. Newcomen Day Nursery, 66-67 Snowsfields. Monday to Friday (inclusive), 7.0 a.m.-7.0 p m. Saturday, 7.0 a.m.-1.0 p.m. "Alice Barlow" Social Welfare Centre, 14 Fulford Street. Monday to Friday (inclusive), 7.30 a.m.-6.30 p.m. Saturday, 7.30 a.m.-12.30 p.m. FAIRBY GRANGE CONVALESCENT HOME, Hartley, near Longfield, Kent, For mothers, and children under 5 only. Application Forms and full particulars can be obtained at any of the Maternity and Child Welfare Centres. DENTAL TREATMENT CENTRES. 110 Grange Road. Monday to Friday (inclusive), 10.0 a.m.-8.0 p.m. 98 Rotherhithe New Road. Monday, Thursday and Friday, 2.0 p.m.-5.0 p.m. Tuesday and Wednesday, 2.0 p.m.-8.0 p.m. From 5.0 p.m. to 8.0 p.m. the Centres are open only for patients who cannot attend during the day. TUBERCULOSIS DISPENSARY, 108 Grange Road. Patients are seen by appointment only. Evening sessions are held for patients at work. LIGHT TREATMENT CENTRE, The Solarium, 108 Grange Road. Monday to Thursday (inclusive), 9.30 a.m.-5.30 p.m. Friday, 9.30 a.m.-1 p.m. Monday and Thursday, 6.30 p.m.-8.0 p.m Patients are seen by appointment only, and only patients who cannot attend during the day are seen at the evening sessions. SCHICK TEST CLINIC, Municipal Offices, Spa Road. Monday and Thursday at 9.30 a.m. DIPHTHERIA "CONTACTS" CLINIC, Municipal Offices, Spa Road. Monday and Thursday at 9.30 a.m. For school-children only. DIPHTHERIA "CARRIER" CLINIC, Guy's Hospital. Wednesday at 2.30 p.m. For school-children only by appointment. L.C.C. SCHOOL TREATMENT CENTRES. Bermondsey School Treatment Centre, Bermondsey Settlement, Farncombe Street, Minor Ailments Monday to Friday (inclusive), 9.30 a.m.- 1.0 p.m. and 3.0 p.m.-6.0 p.m. Saturday, 9.30 a.m.-12 noon. Dental Monday to Friday (inclusive), 9.0 a.m.- 4.30 p.m. (Monday afternoons and alternate Thursday afternoons excepted.) Ear, Nose and Throat Alternate Mondays, 2.0 p.m.-4.30 p.m. Bermondsey Medical Mission Hospital, 44 Grange Road. Minor Ailments Monday to Friday (inclusive), 9.30 a.m. 1.0 p.m. and 3.0 p.m.-6.0 p.m. Saturday, 9.30-12 noon. Dockhead School Treatment Centre, George Row. Minor Ailments Monday to Friday (inclusive), 9.30 a.m.- 1.0 p.m. and 3.0 p.m.-6.0 p.m. Rotherhithe School Treatment Centre, Lady Gomm Dispensary, Hawkstone Road. Minor Ailments Monday to Friday (inclusive), 9.30 a.m - 1.0 p.m. and 3.0 p.m.-6.0 p.m. Saturday, 9.30 a.m.-12 noon. 163 Abbeyfield Road. Dental Monday, 9.30 a.m.-12 noon. Tuesday, 1.30 p.m.-4.0 p.m. Wednesday, 9.30 a.m -4.0 p.m. Thursday and Friday, 9.30 a.m.-12 noon Trinity School Treatment Centre, Redriff Lane. Minor Ailments Monday, Wednesday and Friday, 9.30 a.m.- 12 noon. INVALID CHILDREN'S AID ASSOCIATION (Bermondsey Branch) Municipal Offices, Spa Road. Office hours Monday to Friday (inclusive), 9 30a.m.-5.30 p.m. Saturday, 9.30 a.m.-12.30 p.m. Tuesday, 5.30 p.m.-7.30 p.m. (by appointment only). NURSING ASSOCIATIONS. St. Olave's District Nursing Association, 13 Cherry Garden Street. Rotherhithe Queen's District Nursing Association, 149 Lower Road. FOOT CLINICS. 98 Rotherhithe New Road. Monday and Thursday, 2.0 p.m.-4.30 p.m. and 5.30 p.m.-7.30 p.m. Town Hall, Spa Road. Tuesday and Wednesday, 2.0 p.m. —4.30 p.m. and 5.30 p.m.— 7.30 p.m. Friday, 2.0 p.m. —4.30 p.m. Only patients who cannot attend during the day are seen at the evening sessions. VENEREAL DISEASE CLINIC, Guy's Hospital. Monday to Saturday (inclusive), 9.0 a.m.-8.0 p.m. Bank holidays, 10.0 a.m.-12 noon. PUBLIC VACCINATOR. Dr. V. A. Jaynes, 157 Jamaica Road. Monday to Friday (inclusive), 9.15 a.m.-11.0 a.m. AMBULANCE FACILITIES. The following facilities are afforded by the London Ambulance Service of the London County Council. Ambulances are provided free of cost except where otherwise stated. Infectious Cases. Telephone—Hop 0262. At any hour of the day or night Patients will not be removed to hospital unless a medical certificate stating definitely the nature of the disease is handed to the ambulance nurse. Infectious cases are conveyed to hospitals other than the L.C.C. hospitals for infectious diseases at a minimum fee of 12/6. Non-Infectious Cases. Telephone—Hop 0262. At any hour of the day or night Minimum fee 12/6. Accident Cases. Ask telephone operator for "Ambulance." At any hour of the day or night. Serious Illness. Telephone—Hop 6000, New Cross 2645, Central 6300-1, or Regent 4000. At any hour of the day or night. Ambulances are provided for persons suffering from illnesses in their homes if a medical practitioner certifies that the case is one of life or death, and that arrangements have been made for the reception of the patient in a hospital. Maternity Cases. Telephone—Hop 6000, New Cross 2645, Central 6300-1, or Regent 4000 except where otherwise stated. Urgent Cases At any hour of the day or night on application by a doctor or certified midwife, provided that either a doctor or midwife accompanies the case and that arrangements for the reception of the patient in a hospital have been made. Non-urgent Cases Between 11.0 p.m. and 8.0 a.m.—provided that admission to a maternity bed has been previously arranged and a card (issued by the London County Council to hospitals, maternity homes, etc.) for such admission obtained. This card must be handed to the ambulance attendant at the time of removal. The husband or a female friend must accompany the patient. Between 8.0 a.m. and 11.0 p.m. (Telephone Hop 0262) —by payment (minimum fee 12/6) or by application to the Medical Officer of Health, provided that arrangements for the reception of the patient in a hospital have been made. Cases approved by the Medical Officer of Health will be conveyed to hospital free of charge. The husband or a female friend must accompany the patient. Henry Richardson Ltd., Printers, 4, Church Street, Greenwich, S.E.10, R7/67