AC 4378. C M BER 47 Borough of Bermondsey REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1934 BY D. M. CONNAN, M.B., B.S., D.P.H., Medical Officer of Health. BER 47 Borough of Bermondsey REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1934 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 Ophthalmia Neonatorum 20 Puerperal Fever and Pyrexia 20 Disinfection 20 Cleansing Station 21 Shelter 22 Bacteriological Laboratory 22 Food Poisoning 22 Foot Clinic 23 Insulin for Diabetic Patients 23 Nursing 24 Cases Notified in 1934 25 Cases Notified for last ten years 26 TUBERCULOSIS- New Cases and Deaths 27 Period between Notifications and Deaths 27 Nursing and Extra Nourishment 31 Shelters 31 Lady Almoner 32 (2) PAGE Public Health (Prevention of Tuberculosis) Regulations, 1925 32 Work of the Tuberculosis Dispensary 33 Summary of Notifications 34 Cases on the Register 35 LIGHT TREATMENT— Work done in the Solarium 36 Leysin Patients 38 MATERNITY AND CHILD WELFARE— Special Report on Scheme 39 Fairby Grange Convalescent Home 51 Midwifery Service 51 Obstetric and Puerperal Fever Consultants 51 Infant Life Protection 52 Maternal Mortality 52 Work of the Health Visitors 53 Attendances at Centres 54 Statistics for 1934 55 DENTAL TREATMENT— Particulars of Children Treated 57 Particulars of Treatment and Work for 1934 58 PROPAGANDA 59 SANITARY ADMINISTRATION- Sanitary Inspectors 62 Housing 68 Inspections and Proceedings 69 Work of the District Inspectors 75 Factories and Workshops—Homework 76 Factories and Workshops—Inspections 77 Bakehouses 78 House, Trade and Market Refuse 79 Offensive Trades 79 Mortuary 79 Street Markets 80 Drainage Work 80 FOOD CONTROL— Unsound Food—Shops and Stalls 81 Imported Food Regulations—Samples Taken 82 Work of the Wharves and Food Inspectors 86 Milk Premises 87 Milk Licences 87 Milk Sampling 87 Ice Cream 88 Food and Drugs—Samples Taken 89 Food and Drugs—Prosecutions 93 Unsound Food —Wharves, etc. 94 HEALTH SERVICES 98 PUBLIC HEALTH DEPARTMENT. PUBLIC HEALTH COMMITTEE, 1934. Chairman Councillor S. R. WEIGHTMAN, 1933-34 „ „ E. J. GIBSON, 1934-35 Vice-Chairman „ Mrs. F. A. POWELL, 1933-34 c. J. LEE, 1934-35 Alderman J. A. Davis Councillor Mrs. F. Humphreys „ Mrs. D. A. Green „ Mrs. F. I. M. Husk „ A. E. Hatcher „ A. V. Kidd „ Miss M. I. Henrich „ Mrs. R. E. Laker „ A. V. Parker „ Miss E. M. Nix Councillor Mrs. S. C. Amos „ A. Ponsford „ H. A. Beal „ W. Shearring, „ W. T. Cockett „ J.P. „ Mrs. E. V. Coyle „ J. W „ Mrs. J. Donovan Simmonds „ Miss K. Groves „ G. H. Stean „ Mrs. A. M. Hatcher „ J. Sullivan „ J. A. Wright Ex-officio : Councillor C. E. PHILPOT, J.P., Mayor of Bermondsey, 1933-34. Councillor S. R. WEIGHTMAN, J.P., Mayor of Bermondsey, 1934-35. MATERNITY AND CHILD WELFARE COMMITTEE, 1934. Chairman Councillor Mrs. A. M. FORTESCUE, 1933-34 „ „ Mrs. E. V. COYLE, 1934-35 Vice-Chairman „ Mrs. E. V. COYLE, 1933-34 Mrs. A. M. HATCHER, 1934-35 Alderman G. R. Balleine, Councillor Mrs. R. E. Laker M.A. „ W. S. McKay J.A. Davis „ Miss E. M. Nix „ Mrs. D. A. Green „ W. A. „ Miss M. I. Henrich Phillips, J.P. Councillor Mrs. J. Donovan „ Mrs. A. E. Pitt „ Mrs. E. F. George „ Mrs. F. A. Powell „ E. J. Gibson " Mrs. R. E. Reed „ Mrs. L. A. Glasson „ E. Roberts c. Harding „ Mrs. L. L. White Co-opted Members: Mrs. E. R. Balman Mrs. E. C. Starr Miss E. M. Haslam Mrs. H. Richardson Miss D. Plummer Ex-officio : Councillor C. E. PHILPOT, J.P., Mayor of Bermondsey, 1933-34 Councillor S. R. WEIGHTMAN, J.P., Mayor of Bermondsey, 1934-35. 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 No, 8 — W. A. Campbell 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. O'Keeffe, M.R.C.S., L.R.C.P., D.P.H. Lady Almoner—Olive Pike. Tuberculosis Nurses— Celia Clapson, Louise Colbeck and Edith Riley. Solarium Nurses—Mrs. Dorothy Cottier 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. Rosa Bache Elizabeth Lawrence Sarah Bowles Gwendolen Riches Lucy Brown Florence Robson Amy Carlton Florence Wadds Marie Helden Isabel White Fairby Grange Convalescent Home : Matron—Florence Child Nurse—Ann O'Meara (5) 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 FOOT CLINIC: Chiropodists—Miss Ethel Cook, Mrs. Florence Rock and E. F. Part. 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 L. T. Knott, General Clerk C. W. Whye, General Clerk Alice Jones, Solarium Clerk A. Manning, General Clerk H. E. W. Ellery, General Clerk C. F. Yaxley, General Clerk A. W. Hancock, General Clerk Rose Dutch, Clerk & Dispenser J. W. J. Saward, General Clerk C. F. Lumley, General Clerk F. Cornwell, Junior Clerk H. J. Smith, General Clerk H. D. White, 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 1934. The year has been uneventful so far as the health of the borough is concerned, and no changes of importance have taken place in the Department. To the Chairmen and Members of Committees I express my gratitude for their support and wise guidance during the year, and to the staff for willing help at all times. I am, Sir, Ladies and Gentlemen, Your obedient Servant, D. M. CONNAN. I.—VITAL STATISTICS. GENERAL. The area of the Borough (exclusive of area covered by water) is 1,336 acres. The number of inhabited houses at the end of 1934 according to the Rate Books was 19,022. The rateable value of the Borough on the 31st December, 1934 was £875,016, the product of a penny rate being £3,450. POPULATION. Census Estimate of Registrar General 1921 1931 to 30th June, 1933 to 30th June, 1934 119,452 111,542 107,300 105,060 BIRTHS. The total number of births belonging to the Borough registered during 1934 was 1557, consisting of 784 males and 773 females. The number for 1933 was 1,500. The birth rate for 1934 was 14.8 per 1,000 persons living, compared with 14.0 for 1933. DEATHS. The total number of deaths belonging to the Borough registered during 1934 was 1,304, consisting of 720 males and 584 females. The number for 1933 was 1,340. The death rate for 1934 was 12.4 per 1,000 persons living, compared with 12.5 for 1933. MARRIAGES. The total number of marriages in the Borough in 1934 was 1,050, being 43 above the number for 1933, and 42 above the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 19.91 per 1,000 of the population, compared with a marriage rate last year of 18.77. Year No. Rate 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 1,001 17.81 1932 936 17.00 1933 1,007 18.77 Average for years 1924 —1933 1,008 17.38 1934 1,050 19.91 INFANTILE MORTALITY. Whole Borough London Year No. of Deaths Rate per 1,000 Births No. of Deaths Rate per 1,000 Births 1924 229 78 5,904 69 1925 210 79 5,599 68 1926 146 60 5,067 64 1927 149 67 4,357 59 4,879 67 1928 178 85 1929 160 71 4,995 71 1930 130 63 4,109 59 1931 112 57 4,270 65 103 4,143 67 1932 56 1933 92 61 3,377 60 Average for years} 1924 - 1933} 151 68 4,670 65 1934 100 3,832 67 64 TUBERCULOSIS OF THE RESPIRATORY SYSTEM. In the following Table will be found particulars of deaths from Tuberculosis of the Respiratory System since the year 1924. Bermondsey Rotherhithe St. Olave Whole Borough London Sub-District Year No. No. No. No. Rate No. Rate 1924 92 46 11 149 1.22 4486 0.98 1925 35 1.18 4361 0.95 99 11 145 1926 100 39 12 151 1.23 4066 0.88 1927 87 42 15 144 1.19 4140 0.91 1928 88 43 12 143 1.24 3985 0.89 1929 117 78 31 8 1.03 4230 0.96 1930 81 36 15 132 1.16 3826 0.87 1931 81 30 5 116 1.03 3907 0.90 1932 71 34 11 116 1.05 3564 0.82 1933 68 23 8 99 0.92 3530 0.82 Averages for years 1924-1933 84 36 131 4010 0.90 11 1.12 90 0.76 1934. 64 22 0.86 3227 4 VITAL STATISTICS OF WHOLE DISTRICT DURING 1934 AND PREVIOUS YEARS. year 1 Population estimated to Middle of each Year 2 Births Total Deaths registered in the District Total Deaths in Public Institutions in the District 9 Deaths of NonResidents registered in Public Institutions, etc. in the District 10 Deaths of Residents registered in Public Institutions beyond the District 11 Net Deaths at all Ages belonging to the District No. 3 Rate 4 Under 1 Year of Age At all Ages Rate 13 No. 12 No. 5 Rate per 1,000 Births registered 6 No. 7 Rate 8 1924 122,100 2,913 23.8 200 68 1.277 10.4 720 43 337 1,657 13.6 1925 123,000 2,652 21.6 188 71 1,280 10.4 669 47 321 1,554 12.6 1926 123,100 2,414 19.6 126 52 1,163 9.4 624 31 352 1,484 12.1 1927 121,000 2,233 18.5 119 53 1,236 10.2 616 22 352 1,566 12.9 1928 115,200 2,086 18.1 143 69 1,230 10.7 671 39 329 1,520 13.2 1929 113,800 2,252 19.8 127 56 1,304 11.4 696 32 378 1,650 14.5 1930 113,800 2,059 18.1 90 44 1.169 10.3 686 46 365 1,488 13.1 1931 112,400 1,958 17.4 91 46 1,169 10.4 596 92 331 1,408 12.5 1932 110,100 1,831 16.6 81 44 1,147 10.4 689 189 368 1,326 12.0 1933 107,300 1,500 14.0 72 48 1,216 11.3 720 215 339 1,340 12.5 Averages for years 1924-1933 116,180 2,190 18.7 124 55 1,219 10.5 669 76 347 1,499 12.9 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 St. Olave's Hospital 214 Ladywell Institution 48 All Saints' Hospital, Southwark 1 Ambulances on way to Hospital 7 Bexley Mental Hospital 7 Bow Institution, Poplar 1 Bermondsey Medical Mission Hospital 2 Broadmoor Criminal Lunatic Asylum, Crowthorne 1 Brompton Hospital 1 Brook Hospital, Shooters Hill 4 Catholic Nursing Institute, Lambeth Road 1 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc. 8 Central London Throat, Nose and Ear Hospital 1 Claybury Mental Hospital 1 Colindale Hospital, Hendon 2 Constance Road Institution, Camberwell 2 Coventry and Warwickshire Hospital, Coventry 1 Workplaces 2 Coxheath Home, Linton, Kent 1 Darenth Training Colony 1 Turkish Baths, Railway Approach 1 Dulwich Hospital 1 Eastern Hospital, Homerton 1 Evelina Hospital 4 Farnborough Hospital, Orpington 1 Private Houses 2 Forest, The, Epsom 1 Golden Square Hospital, Westminster 1 Grand Surrey Canal 2 Total 229 Grosvenor Sanatorium, Kennington, Kent. 1 Grove Park Hospital, Mottingham 2 Guy's Hospital 71 Hanwell Mental Hospital 1 Horton Hospital, Epsom 1 Hospital for Epilepsy and Paralysis, St. Marylebone 1 Hospital, The, Coulsdon 7 Hospital, The, Maidenhead 1 Hundred Acres, Banstead 3 Isolation Hospital, Capel, Kent 1 King's College Hospital 1 Ladywell. Institution 48 Lambeth Hospital 9 Lansdowne Place Mission, Southwark 1 Leavesden Mental Hospital 3 Lewisham Hospital 1 Lying-in Hospital, York Road 1 Middlesex Hospital 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. Mildmay Mission Hospital, Bethnel Green 2 Miller Hospital, Greenwich 2 Newington Institution, Southwark 1 Norwood Children's Hospital 2 Park Hospital, Hither Green 13 Princess Elizabeth of York Hospital, Stepney 3 Private Houses 2 Queen Mary's Hospital, Carshalton 1 Railway 2 River Thames 3 Royal East Sussex Hospital, Hastings 1 Royal Free Hospital, St. Pancras 1 Royal Victoria Hospital, Dover 2 Royal Waterloo Hospital 3 St. Alfege's Hospital, Greenwich 9 St. Bartholomew's Hospital 1 St. George in the East Hospital, Stepney 10 St. Gile's Hospital, Camberwell 4 St. Joseph's Hospice, Hackney 2 St. Luke's Hospital, Lowestoft 1 St. Thomas's Hospital 1 Seaman's Hospital, Greenwich 2 South-Eastern Hospital, New Cross 16 South-Western Hospital, Stockwell 1 Street 2 Test River, Eling, Southampton 1 Tooting Bec Hospital 17 Tuberculosis Colony, Papworth Everard 1 West-End Hospital, St. Pancras 1 West Hill Institution, Dartford 1 West Park Mental Hospital, Epsom 3 Western Hospital, Fulham 1 Workplaces 1 Total 310 (13) CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1934. 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 100 36 50 32 55 120 376 535 All Causes Certified 1304 - Uncertified - - - - - - - - - - - - - - - - - Typhoid and Paratyphoid Fever Measles 38 4 16 14 3 1 - - - (14) Scarlet Fever 1 - 1 - - - - - - Whooping Cough 10 2 3 4 1 - - - - Diphtheria 10 - - 6 4 - - - - Influenza 4 - - - - - 1 3 - Encephalitis Lethargica 1 - - - - 1 - - - Cerebro-spinal Fever 1 - - - - - 3 2 - Tuberculosis of Respiratory System 90 - - 2 1 20 33 28 8 Other Tuberculous Diseases 13 3 3 2 - 3 1 1 - Syphilis 1 - - - - 1 - — - General Paralysis of the Insane, tabes dorsalis 6 - - - 1 2 3 - - Cancer, Malignant Disease 162 - - - 1 8 83 70 - Diabetes 10 - - - - - 7 3 - Cerebral Hæmorrhage, etc. 90 - - - 1 1 32 56 - Heart Disease 239 _ - - 5 4 21 69 140 Aneurysm 11 - - - - - 7 4 - Other Circulatory Diseases 17 - - - - 3 2 12 - Bronchitis 95 2 1 - - - 3 32 57 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1934—continued. 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 Pneumonia (all forms) 135 24 6 13 2 6 7 Other Respiratory Diseases 23 1 - - - 1 4 38 11 39 6 Peptic Ulcer 14 - - - - - 3 9 2 Diarrhœa, etc 22 1 1 - 1 2 - 2 28 3 5 8 18 78 2 1 35 29 15 50 55 4 1304 - - - - - - 35 - - 2 3 - 100 - - - 2 - - - - - 1 1 - 36 1 - - - - - - - - - 3 7 - 50 - - 1 - 1 - - - - - 7 6 - 32 - - - 2 1 - - - - - 7 6 - 55 - 2 - 1 3 2 1 - - 7 9 7 - 120 2 3 3 5 13 - - - - 6 8 10 2 376 - _ 4 8 60 - - - 29 2 13 15 2 535 Appendicitis Cirrhosis of Liver Other Diseases of Liver, etc, Other Digestive Diseases Acute and Chronic Nephritis Puerperal Sepsis Other Puerperal Causea Congenital Debility, Premature Birth, Malformations, etc, Senility Suicide Other Violence Other Defined Causes Causea ill-defined or unknown - - (15) DEATHS FROM ZYMOTIC DISEASES, 1934. Year All Causes Principal Zymotic Diseases Smallpox Measles Scarlet Fever Diphtheria Whooping Cough Enteric Fever Diarrhœa No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate 1924 117 .95 - 26 1657 13.6 - 48 ·39 6 ·04 ·20 11 ·09 1 - .21 25 1554 12.6 1925 96 .78 - - 20 .16 3 .02 29 .24 27 .22 - - 17 .14 1484 12.1 94 .76 - - 1926 - 24 .19 6 .05 42 .34 1 .01 - 21 .17 - 1927 1566 12.9 45 9 .07 .37 - _ 13 .11 10 .08 1 - 12 .09 - .01 1928 1520 13.2 137 1.19 77 .67 .03 16 - 3 .14 26 .23 1 14 .12 - 1929 1650 14.5 62 .54 - 1 .01 .02 6 .05 33 .29 .17 - 2 1 .01 19 1930 1488 13.1 101 .89 61 .54 7 8 .07 6 .05 2 .02 17 .15 - - .06 1931 1408 12.5 24 1 .21 - 1 - 3 .03 .01 6 .05 5 .04 - - 9 .08 1932 1326 12.0 67 .61 .23 - - 16 .15 .01 25 11 .10 - - 14 .13 1340 1933 12.5 45 .42 - - 9 .80 4 .04 13 .12 5 .05 - 14 .13 - Average for years 1924-1933 1499 12.9 .24 17 79 .67 - - 28 3 .03 .14 .12 1 .01 16 .14 14 1304 12.4 - 1934 87 .83 - 38 .36 1 .10 10 .01 10 .10 - 28 .26 - Deaths from Stated Causes at Various Ages under One Year of Age, 1934. Under 1 week 1 — 2 weeks 2 — 3 weeks 3 — 4 weeks Total under 1 month 1 — 3 months 9 — 12 montsh Total under 1 year Cause of Death 3 — 6 months 6 — 9 months Measles - - - - - - - 1 3 4 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - 1 - 1 2 - - Diphtheria - - - - - - - - - - Influenza - - - - - - - - - - Cerebro-spinal Meningitis - - - - - 2 2 - - - Tuberculous Meningitis - - - - - 1 1 1 - - - - Other forms of Meningitis - - - - - 1 - - - Tuberculosis of Respiratory System - - - - - - - 1 - Other Tuberculous Diseases - - - - - 1 1 2 - - Syphilis - - - - - - - - - - Bronchitis - - - - - - 2 1 1 - Pneumonia (all forms) 2 - - 1 3 6 3 6 24 6 Other Respiratory Diseases - - - - - - 1 1 - - Diarrhoea and Enteritis - - - 1 1 5 9 4 3 22 Congenital Debility and Malformation, Premature Birth 15 - 2 1 18 3 23 1 1 - Injury at Birth 1 1 - - 2 - 2 - - - Other Causes 9 1 - 10 1 1 1 1 14 - 27 2 2 3 34 16 17 18 15 100 Totals 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 Dysentery Enteric Fever and Typhoid Fever Encephalitis Lethargica Erysipelas Glanders Hydrophobia in Man Malaria Membranous Croup Ophthalmia Neonatorum Puerperal Fever Puerperal Pyrexia Relapsing Fever Scarlet Fever and Scarlatina Small Pox Typhus Tuberculosis—all forms Owing to the housing conditions of the Borough, it is the practice to remove to hospital nearly all cases of diphtheria and scarlet fever. DIPHTHERIA. The number of cases of Diphtheria notified during the year was 372, of which number 28 cases were returned from hospital as " not suffering " from Diphtheria, leaving a net total of 344. There were 10 deaths from the disease. These figures show a slight reduction as compared with those of last year. I feel that the prevalence of Diphtheria in the borough is rather discreditable, and a comment in this sense was made in my Annual Report for the year 1928, when the hope was expressed that an immunisation clinic would soon be started. In April of the following year a " Schick " clinic was opened at the Municipal Offices, and subsequently the attendances have been as follows :— 1929 148 1930 151 1931 107 1932 101 1933 55 NOTIFIED CASES OF DIPHTHERIA FOR 25 YEARS. NOTIFIED CASES OF SCARLET FEVER FOR 25 YEARS. When it is remembered that each patient makes an average of at least three attendances, it is clear that the number of parents who are alive to this means of protection against the disease is ridiculously small. In September of this year Dr. Teller took control of the clinic, and I am pleased to be able to record in the following table a Large increase in the number of attendances. No. found to be positive and immunised No. found to be negative No. immunised without Test I No. of sessions Total attendances No. of patienta examined Not yet completed 66 33 20 9 4 45 251 SCARLET FEVER. With regard to this disease I regret that I cannot report any improvement. The number of cases notified was 597, of which 29 were returned from hospital as " not suffering." There was one death. This disease is very easily " missed " in its milder form, with the consequent infection of other children. SMALL-POX. There were seven cases of Small-pox, the last one occurring in the beginning of March. There were no deaths. Seven primary and 18 re-vaccinations were performed under the Public Health (Small-Pox Prevention) Regulations,-1917. MEASLES. The epidemic extended from November 1933 to August 1934, and 1,351 cases were reported during the year. In the last epidemic year (1932) the number was 1,730. There was, unfortunately a slightly higher proportion of deaths, the total number being 38 (12 at home and 26 in hospital). Nursing assistance was provided in 179 cases and 278 patients were removed to hospital. OPHTHALMIA NEONATORUM. Although the number of cases of Ophthalmia Neonatorum is small, there has been nevertheless a slight reduction in the number of cases each year for the last few years. The cases were all slight without damage to vision. Nursing was provided in one instance. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At home In Hospital 6 4 2 6 - - - PUERPERAL FEVER AND PUERPERAL PYREXIA. I am glad to be able to record a fall in the number of cases of Puerperal Fever. There were only 2 cases this year as against 6 last year, 8 the year before, and 13 in 1931. As Puerperal Fever is a potent factor in maternal mortality this reduction is gratifying. The number of cases of Puerperal Pyrexia notified was 13, compared with 24 cases last year. 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 Bacteriological examinations Nil Admitted to Hospital 14 DISINFECTION. In May the Council purchased the right to use a proprietary method of disinfection known as " Cimet Azet Phume " in this borough. The method is simple in application, and with reason- able care is free from danger either to the public or to the disinfecting staff. Seventy-one houses have been treated by this method on account of bug infestation, and so far as present information is concerned the results have been satisfactory. Before a definite opinion is expressed, however, it would be well, I think, to review results after another summer's work. In the meantime the method is in frequent use and careful records are being kept of each case. 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 1,284 Pillows 2,939 Blankets 3,124 Pillows (cases) 2,669 Quilts 1,865 Bolsters 921 „ (cases) 413 Sheets 2,273 Books 461 Miscellaneous 7,055 Verminous Clothing 4,118 Cushions 319 „ Bedding 1,855 Mattresses 53 Scabies, Clothing 18,990 Overlays 1,101 32,911 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Number of rooms disinfected 3,083 Number of mattresses and other articles destroyed 3,300 Furniture, Floorcloth, etc. destroyed 53 Loads CLEANSING STATION. Verminous persons cleansed Adult Females 6 Adult Males 112 Children 3,404 Persons treated for Scabies: — Number treated Number of baths given Adult Females 31 71 Adult Males 20 53 Children—Females 191 1,106 Children —Males 160 917 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 60, 10 for Small-pox, 3 for Scarlet Fever, 2 for Diphtheria, 1 for Measles, and 44 for verminous conditions, the total number of persons accommodated being 275. 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. Nature of Specimen Total Examinations Results of Examination Positive Negative 1933 1934 1933 1934 1933 1934 Diphtheria (specimens taken by Medical Officer of Health) 777 537 68 21 709 516 139 Ditto (taken by general practitioners) 220 1685 1687 1905 1826 Diphtheria (total specimens taken) 160 2682 288 2394 2203 2363 Phthisis 1678 1194 193 1001 297 1381 Various 185 4 176 158 9 154 Total specimens taken 4518 589 362 3380 3742 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 1934 24 FOOT CLINIC. The arrangements for the management of the foot clinics were altered towards the end of the year, and the part-time chiropodists were replaced by three whole-time chiropodists, two ladies and a gentleman being appointed. At the same time the fee for treatment was fixed at two shillings per attendance, subject to reduction in the case of inability to pay the full fee. This alteration took effect at the end of the year, and it was anticipated that owing to the new arrangement and the fact that all patients would thereafter be seen by appointment only, there would be a reduction in the number of patients. There has, however, been an increase of more than a thousand in the total number of attendances, and there cannot be any doubt whatever that these clinics fulfil a valuable public service in the borough. Particulars of the number of attendances during the year are given hereunder. Clinic Men Women Total Bermondsey 1,640 4,346 5,986 Rotherhithe 2,026 4,148 6,174 Totals 8,494 12,160 3,666 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. Nine 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. The fee payable by the Borough Council to the Nursing Associations is 1s. per visit. St. Olave's District Nursing Association Rotherhithe Queen's Nursing Association Totals whole Borough Disease Cases Visits Cases Visits Cases Visits 40 22 423 62 1,609 Pneumonia 1186 Broncho pneumonia 12 265 2 47 14 312 Bronchitis 32 491 5 50 37 541 Influenza 6 8 146 84 2 62 Measles 105 2,204 74 1,386 179 3,590 Whooping Cough 2 78 2 78 - - Tuberculosis:— I " I (a) Respiratory System 2,925 50 2,372 14 553 62 (b) Other Forms 1 30 1 14 2 44 Puerperal Pyrexia - - - - - - Puerperal Fever - - - - - - Pregnancy and Labour 32 553 8 226 779 40 Diseases of the Digestive System 550 633 49 11 83 60 Infantile Diarrhoea (under 2 years) - - - - - - Discharging Ears 7 281 4 160 11 441 Discharging Eyes 8 164 8 171 16 335 Post-operative cases:— (a) Tonsils & Adenoids 59 8 55 1 4 9 (b) Other cases 4 28 1 45 5 73 113 Other diseases 23 561 6 29 674 379 3,337 538 12,239 Totals 8,902 159 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1934. NOTIFIABLE DISEASE NUMBER OF CASES NOTIFIED BERMONDSEY ROTHERHITHE ST OLAVE Total Cases removed to Hospital At all Ages At Ages—Year 1 2 Total 5 2 St. Thomas 3 6 Total 1 3 Total St. John St Olave 4 Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards - Small-pox 7 - 1 - 1 2 3 4 - - 7 - - - - - - - - 7 1 2 - Diphtheria (including Membranous Croup) 372 8 115 212 20 17 - 37 46 47 23 23 17 193 59 37 50 146 18 8 7 33 372 - Erysipelas 73 6 9 32 9 11 11 11 2 - 48 6 6 7 19 5 1 1 16 13 6 - - 29 Scarlet Fever 597 4 199 313 54 25 2 - 28 59 74 67 39 40 307 111 77 71 259 18 10 3 31 564 Cerebro-Spinal Meningitis 2 - - 1 2 - - - - - - - 2 1 1 1 - - - - - - - - Acute Polio-Myelitis and Acute Polio Encephalitis. - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 6 6 - - - - - 1 - 1 - - 2 - - 4 4 - - - 2 - - - Anthrax 1 1 - - - - - 1 - - - - - - - 1 - - - - 1 - - — Enteric Fever 2 - - - 1 1 - 1 1 2 - - - - - - - - 2 - - — - - Puerperal Fever 2 - 2 - — - 1 - - - 1 - 1 - 1 — - - - 2 - - - - Puerperal Pyrexia 13 - 5 - 2 2 1 2 1 8 1 3 1 5 - - - - 12 8 - - - - Encephalitis Lethargica 2 2 - - - - - - 2 - - 2 - - - - - - - - - — - _ Dysentery - - - - - - - - - - - - - - - - - - - — - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (Acute Primary and Acute Influenzal) 121 5 32 28 9 19 15 13 12 12 16 18 16 4 78 14 14 6 34 6 2 1 9 - Tuberculosis— Respiratory System 141 2 3 9 44 40 36 19 87 9 5 36 9 18 7 10 20 15 15 8 22 3 6 - Other forms of Tuberculosis 32 1 5 1 20 5 10 1 - 8 13 6 4 4 3 3 4 3 2 - - 1 2 - Totals 1371 27 358 583 148 135 87 33 108 155 181 139 98 75 207 163 146 516 57 24 18 99 993 756 Notifiable Disease. 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 - 1 46 47 3 16 21 7 Small Pox - - Diphtheria (including Membranous Croup) 535 714 481 603 462 463 263 263 386 372 43 Erysipelas 35 30 25 45 41 49 49 68 73 Scarlet Fever 353 426 601 493 584 507 310 446 640 597 Cerebro-Spinal Meningitis 3 5 3 2 5 9 4 9 4 Acute Polio-Myelitis and Acute PolioEncephalitis 1 2 1 4 2 2 1 1 3 1 - Ophthalmia Neonatorum 13 11 15 10 8 13 14 10 7 6 Anthrax 3 4 1 - - 2 1 - Enteric Fever 5 3 - 1 1 2 2 2 5 1 2 2 Puerperal Fever 9 9 9 7 12 14 13 8 2 6 Puerperal Pyrexia 11 21 20 - 20 19 37 27 Encephalitis Lethargica 24 13 8 8 5 1 1 2 4 4 - 2 Dysentery - - - - - - - 1 Malaria - - - - - 2 - - - Malaria (induced) Pneumonia (Acute Primary and Acute - - - - 1 - - - Influenzal) - - 113 126 53 110 119 167 119 102 136 121 245 206 231 184 194 Tuberculosis:— Respiratory System 208 175 177 182 Other forms of Tuberculosis 141 76 1,408 59 1,599 65 1,585 54 1,478 46 1,494 40 1,536 40 1,083 35 1,149 34 1,512 32 1,371 Totals 26 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, 1934 NEW CASES AND DEATHS. NEW CASES DEATHS AGE—PERIODS Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. F. M. F. M. 0 1 1 1 - 1 2 - - 6 2 - 1 1 5 4 1 - 5 4 5 - 2 2 - - - 3 1 10 - 4 - 3 - - 9 - 15 2 10 6 5 3 - 13 - 20 4 16 1 9 - - 6 14 2 14 25 12 2 - - 12 5 - 35 8 10 1 1 - 20 - 45 7 13 4 - - - 8 - 4 55 1 7 4 1 - 9 1 8 - 65 and upwards 1 - - - 22 18 56 34 7 92 67 6 TABLE II. TUBERCULOSIS, 1934— PERIOD BETWEEN NOTIFICATION AND DEATH. Period Between Notification and Death 2 Not notified 0-1 month 9 1-3 months 5 4 3-6 months 7 6-12 months 8 1-2 years 12 2-5 years Over 5 years 9 Totals Respiratory System Males Females Total Percentage of Total Deaths 2 4 4.44 10 11.11 1 4 9 10.00 3 7 7.78 12 13.33 5 6 15.56 14 23.33 21 9 13 14.45 4 56 100.00 90 34 Other Forms Percentage of Total Deaths Total Females Males 38.46 5 2 3 53.85 7 4 3 - - - - - - - - - - - - - - - - - - - - 7.69 1 1 - 100.00 13 6 7 Report by Dr. C. H. C. Toussaint, Clinical Tuberculosis Officer. There has been a further fall in deaths from Pulmonary Tuberculosis, and the death rate for this type of disease, 0.86 is again the lowest ever recorded in the Borough. The fall in the number of deaths from other forms of tuberculosis is also noticeable. During the year there was, in addition, a marked drop in the number of notifications received, amounting to 47 fewer new cases of pulmonary tuberculosis and 8 fewer new cases of other forms. Table II. illustrates that this drop in the number of new cases is really due to a reduction in the amount of the disease, and not to the occurrence of cases in which the illness has not been detected during life. Co-operation with all medical practitioners in the district has been maintained, and during the year only four cases of pulmonary tuberculosis, and five cases of non-pulmonary tuberculosis were not notified before death. Analysis of these non-notified cases, which have appreciably diminished, revealed no lack of care on the part of practitioners. Of the pulmonary cases the two females, aged 60 and 62, were both inmates of a mental hospital and tuberculosis was not discovered till necropsy. Of the two males, one aged 65, died shortly after admission to St. Olave's Hospital. The sudden death was the subject of a coroner's enquiry, and found to have been due to acute phthisis. The other patient, aged 31, died in a municipal hospital elsewhere, and was a pedlar, last resident at a common lodging house in this Borough. Such men are usually on the move from place to place, and this man may have been known to authorities in another district. Of the non-notified deaths from non-pulmonary tuberculosis, three were of infants, dying in hospitals from miliary tuberculosis. As I have previously stated, from the nature of these cases, it is often impossible to secure an accurate diagnosis before death. Whenever possible, however, notification should be made so that adequate investigation may be made into the cause of infection. The two other cases were males, one aged 10, dying in a Throat Hospital after an anaesthetic for operation on lupus of the palate, and another, aged 56, who died in a municipal hospital elsewhere of tuberculous renal disease. Details of the work done at the Tuberculosis Dispensary are set out on page 33, and there has been no material change in this work during the year. Radiological examinations have slightly increased and facilities in this direction are of the utmost importance in enabling the Tuberculosis Officers to effect a diagnosis at the earliest possible moment. It is now commonly recognised that X-ray examination can reveal traces of disease at a stage earlier than that at which it is evident on physical examination. Particularly is this the case amongst contacts who have been exposed to infection. One can maintain, with truth, therefore, that an early radiological examination may be the means of saving life, for tuberculosis, in all its forms, is a disease which can be cured if treatment is commenced at the proper time. Radiological examination is also essential for the proper control of artificial pneumothorax treatment. This form of treatment, in which the lung is rested or immobilised by a " splint " of air around it, has been maintained by the Tuberculosis Officers on patients after return from sanatoria, and during the year 654 refills were given. 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 1934 are not shown in the table. Treatment commenced Total Number Present condition Dead Arrested Quiescent Stationary 1923 - 1 1 - - 1927 1 1 - - - - 1928 1 - - 1 1923 5 2 3 (2)* - - 1 1930 14 8 1 4 (3) 1931 26 3 (1) 8 (4) 9 (1) 6 1932 17 4 (2) 9 (2) 3 (2) 1 (1) 5 (2) 1 (1) 1933 20 - 14 (8) * One of these three deaths was due to suicide in an arrested case. The above table reveals the value of this form of treatment in cases where the disease is confined to one lung only, at the onset of treatment. Of 47 such cases where treatment was started in 1932 or previously, in 37 or 78%, the disease has been brought to a stage of arrest or quiescence. Continued use has been made, where possible, of the services and co-operation of the District Nursing Association. This help has been of value in cases requiring special observation pending a definite diagnosis, and also in the nursing of advanced cases at home. Of the 90 deaths from Pulmonary Tuberculosis, 43 occurred in local municipal hospitals, 11 in voluntary hospitals, sanatoria or other institutions, and 36 occurred at home, some of the latter just after prolonged periods in hospital. Such cases are retained in hospital, as far as possible, in order to minimise the risk of infection to others. 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 temperaure 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 240 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 22 shelters at present in use, 5 having been erected during the year and 2 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-six beds are in use at present. LADY ALMONER. Miss Pike continues as Lady Almoner to do the " are" work in connection with the Tuberculosis Dispensary. Until the system of assessments was abolished recently by the London County Council, she was responsible for this work and for collecting the weekly contributions, and she still receives any voluntary contributions which may be made in connection with the Scheme. She also visits the homes of patients who are away in sanatoria or convalescent homes, and is responsible, on the Tuberculosis Officer's instructions, for supplying extra nourishment to persons suffering from tuberculosis, and the loan of open-air shelters, beds and bedding. Where necessary treatment is arranged in convalescent homes for contacts of cases of tuberculosis, and occasionally it is possible to arrange for short holidays for some of the women and children who are contacts. In a few instances the Lady Almoner has been able to place patients in work. Miss Pike also makes the assessments in connection with Fairby Grange, deals with the supply of Insulin to poor patients, and acts as Infant Protection Visitor under the Children Act, 1908 and the Children and Young Persons Act, 1932. Thanks are due for help in connection with various cases to Bermondsey United Charities, The Friends of the Poor, Charity Organisation Society, British Red Cross Society, Invalid Children's Aid Association, Women's Holiday Fund, Surgical Aid Society, Metropolitan Convalescent Institution, Queen Mary's Needlework Guild and to the Queen Alexandra Rose Day Fund. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not found necessary to take any action under these Regulations in 1934. PULMONARY NON-PULMONARY Total Adults Children Adults Children Adults Children Grand Total DIAGNOSIS A. —New Cases examined during the year (excluding contacts): — M. F. M. F. M. F. M. F. M. F. M. F. 62 37 4 5 4 2 5 4 66 39 460 (a) Definitely tuberculous 9 9 - 5 (b) Diagnosis not completed - - - - - - 7 - 3 2 112 (c) Non-tuberculous B.—Contacts examined during the year:— Il I _ 3 - 7 - 1 - 1 - - 113 52 43 - - 1 - - - 4 7 1 1 545 (a) Definitely tuberculous (b) Diagnosis not completed - - - - - - - 1 1 - - - (c) Non-tuberculous C.—Cases written off the Dispensary Register as ■■ mmm mmm I il i r 1 I I I! II (a) Recovered - 6 130 167 — 6 - 6 - - - 74 159 - 7 - 2 1 7 3 9 7 13 9 910 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) D.—Number of Cases on Dispensary Register on December 31st:— I I - 232 - 306 - 52 - 49 - - 249 200 210 - 213 - 36 48 72 64 342 280 124 113 - 3 (a) Definitely tuberculous - - - 5 7 4 (b) Diagnosis not completed — - - - 878 - 1. Number of cases on Dispensary Register on January 1st 915 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 20 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 69 4. Cases written off during the year as Dead (all causes) 83 5. Number of attendances at the Dispensary (including Contacts) 3,842 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 116 7. Number of consultations with medical practitioners:— (a) Personal 128 (b) Other 228 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 986 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes *4,901 10. Number of:— (a) Specimens of sputum, etc., examined 804 (b) X-ray examinations made in connection with Dispensary work 707 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 352 *In addition to these visits 656 visits were made by the Lady Almoner and 301 visit by the School Nurse. 33 Formal notifications Number of primary notifications of new cases of Tuberculosis Age Periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total (all ages) Total Notifications Pulmonary, Males 1 2 4 - 9 11 11 12 20 8 6 84 112* 1 10 14 9 8 7 1 1 57 78 „ Females 1 2 3 - 4 2 3 5 1 2 1 - - - 18 20 Non-Pulmonary Males - 4 5 3 - - 1 - - - 1 14 15 „ Females 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 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Pulmonary Males - 2 3 3 8 — - - - - - - - - - - - 2 3 2 1 3 - 10 „ Females - 1 - 1 1 - - - - 1 - 4 Non-Pulmonary Males 1 2 - - - - 1 - - - - 4 Females * Includes 1 re-notification of case originally notified as Non-Pulmonary. This case has been transferred to the Pulmonary side of the Register. Returns rendered under the PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 1st QUARTER, 1934. Number of Cases on Register at commencement of Quarter Number of Cases notified during Quarter Inward Transfers, Un-notified Deaths, etc. Number of Cases removed from the Register Number of Cases remaining on the Register at end of Quarter Respiratory System M. F. 443 302 21 25 3 6 19 39 307 435 Other Forms F. M. 127 136 7 5 - - 3 3 131 138 2nd QUARTER, 1934. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 435 307 131 138 Number of Cases notified during Quarter 17 5 4 19 Inward Transfers, Un-notified Deaths, etc. 2 6 2 2 6 Number of Cases removed from the Register 27 16 6 Number of Cases remaining on the Register at end of Quarter 314 139 131 429 3rd QUARTER, 1934. Respiratory System Other Forme M. F. M. F. Number of Cases on Register at commencement of Quarter 314 139 131 429 13 4 Number of Cases notified during Quarter 22 2 1 1 1 Inward Transfers, Un-notified Deaths, etc. 1 Number of Cases removed from the Register 18 1 6 6 Number of Cases remaining on the Register at end of Quarter 434 138 133 322 4th QUARTER, 1934. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 138 133 434 322 4 1 Number of Cases notified during Quarter 18 6 Inward Transfers, Un-notified Deaths, etc. 1 1 - - Number of Cases removed from the Register 21 26 5 4 Number of Cases remaining on the Register at end of Quarter 431 302 138 131 IV. LIGHT TREATMENT. REPORT BY Dr. E. J. O'KEEFFE. ASSISTANT MEDICAL OFFICER OF HEALTH. The following table shows the work done in the Solarium during 1934:- Number of attendances and General Treatments 27,753 „ Local Treatments 3,373 „ Examinations 2,015 „ New Patients 524 „ Discharges 534 „ Maternity and Child Welfare Cases under treatment during the year 329 Number of Tuberculous Patients under treatment during the year 36 Total number of other classes under treatment during the year 558 (The Maternity and Child Welfare patients formed 35.86 per cent. of the total number under treatment and the tuberculosis patients 3.9 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 eight of the sessions each week. A list of the principal diseases treated, together with the number of patients who completed treatment during the year is given below:— TUBERCULOSIS. Pulmonary 7 Glandular 10 Spine - Hip 2 Skin (Lupus and Bazin's Disease) 2 Other non-pulmonary conditions 5 MATERNITY AND CHILD WELFARE. Ante-natal 7 Rickets 41 Marasmus, Debility, Malnutrition, etc. 72 Bronchitis 46 Adenitis (non-tuberculous) 23 Other conditions 4 OTHER DISEASES. Adenitis (non-tuberculous) 18 Alopecia 15 Asthma 4 Bronchiectasis 1 Bronchitis (including chronic) 39 Chronic Rheumatic conditions 54 Dermatitis 1 Emphysema 2 Fibroid Lung 5 Malnutrition, Debility, Anaemia, etc. 123 Miscellaneous conditions 32 Psoriasis 1 The number of attendances and general treatments shows a decrease on that of the previous year; but there was a marked increase in the number of local treatments, which require constant attendance of one of the staff. Children formed a high percentage of the total number treated; and of this group the greater number were treated for nutritional disorders and debility following acute illness. Of the adult group of patients treated those suffering from "rheumatic" affections formed the largest number. At present light treatment is carried out in a temporary building which has served its purpose admirably for several years, but which is now out of date and unsatisfactory in many respects. It is hoped that work will shortly begin on the building of the proposed new clinic, in which a light department having up-todate facilities for light treatment in its varying forms, will form a unit. LEYSIN PATIENTS. In the following table will be found a complete list of patients who have been sent to Leysin by the Borough Council. Initials of Patient Age Sex Localisation of Disease Period previously under Medical Treatment prior to going to Leysin Date sent to Leysin Date returned from Leysin Result S.B. 12 M. Left Foot 5 years 28/7/24 5/7/27 Well and at work 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. 28 F. Glands of Neck 15 „ 26/10/25 22/2/27 ,, ,, E.C. 16 F. Right Knee 5 ,, 26/10/25 8/7/27 ,, ,, H.C. 10 M. Glands of Neck 2 „ 26/10/25 20/2/27 ,, ,, A.H. 21 F. Left Hip 9 „ 17/5/26 29/6/28 ,, ,, E.VV. 23 F. Spine and Right Hip 18 „ 17/5/26 17/9/27 Well ,, G.B. 20 F. Left Ankle 2 „ 9/2/27 28/4/29 Removed from District L.T. 19 M. Abscess of Ribs 2 ,, 9/2/27 8/5/28 ,, ,, 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 4 „ 20/6/28 8/6/29 Well and at work C.P. 26 M. Tuberculide of Skin 1 ,, 20/6/28 8/6/29 ,, ,, H.S. 18 M. Right Hip 3 „ 20/6/28 26/9/30 ,, ,, I.S. 23 F. 31/5/29 5/8/32 ,, ,, Right Hip 8 „ C.C. 27 F. Multiple Lupus 20 „ 20/1/30 6/5/32 At work A.P. 16 F. Glands of Neck 4 months 20/1/30 20/3/31 Well and at work E.W. 18 M. Left Knee 1 year 15/4/30 1/2/33 Well and working G.L. 16 M. Spine 10 months 13/10/30 - Dead (Tuberculous Meningitis) V.B. 16 F. Lupus of Nose 1 year 6/2/31 6/5/32 Well and at work D.R. 34 4/7/31 M. Spine 4 years - Dead (Cerebro-spinal Meningitis) J O'B. 17 M 30/7/32 - Still at Leysin Right Knee 7 months E.B. 20 F. 10/5/33 ,, ,, — Left knee - V. MATERNITY AND CHILD WELFARE. The following special report on the Maternity and Child Welfare Scheme was submitted to the Council during the year:— To the Chairman and Members of the Maternity and Child Welfare Committee. MADAM, LADIES AND GENTLEMEN, I beg to submit the following report:— One of the earliest problems to which my predecessor directed his attention after his appointment as Medical Officer of Health in 1901 was that of Infantile Mortality. While the birth rate had fallen in the previous ten years from 37.7 to 34.2 per 1,000, there had been no corresponding fall in the infantile mortality rate which was 169 in 1901, compared with 165 in 1891. Various explanations were offered for this high infantile mortality rate, and attention was repeatedly drawn to the problem by the Medical Officer of Health, who made many suggestions for its solution. I find that in 1904, 1905, 1906 and 1907 he advocated the education of mothers, the teaching of hygiene in schools, attention to the milk supply of infants, the establishment of a municipal milk depot, the reduction in the period allowed for the registration of births, and the appointment of Health Visitors. An attempt was first made in 1904 to disseminate knowledge amongst mothers by the distribution of pamphlets, and, in 1907, the Notification of Births Act —which was adopted in this Borough —solved one of the difficulties, and provided much more speedily than previously, information which was essential to the establishment of any Maternity and Child Welfare Scheme. At the end of 1908 one Health Visitor was appointed. As the number of births at this time was over 4,000 per annum, it is clear that one Health Visitor was insufficient, and in 1910 the Medical Officer of Health recommended the appointment of an additional Health Visitor. The second Health Visitor was appointed in 1912, but the suggestion that an infant milk depot should be established was not adopted. The two Health Visitors were employed almost entirely in home visiting, and the numbers were so large, and the staff so small, that the home visiting was largely confined to selected cases, and consisted mainly of "first visits," regular visitation for the purpose of instruction being possible. In 1913 a "baby class" was begun, meeting once a week in the Town Hall. This was really of course an infant clinic, at which the Medical Officer of Health acted as Medical Officer. The average weekly attendance for the year was 15. There had previously been established in 1908 the Farncombe Street School for Mothers, which, by the year 1914, had four branches, while in the same year (1914), the Princess Club School for Mothers was opened, and a second weekly municipal "baby class" was begun in Rotherhithe. In 1915, there were altogether two municipal and four voluntary baby clinics held every week, the voluntary clinics being held at Princes Street, West Lane, the Central Hall and the Princess Club, and the municipal centres being at the Bermondsey Town Hall and the Lady Gomm Dispensary. The Medical Officer of Health repeatedly advocated the extension of this work, and the appointment of additional staff. Two additional Health Visitors were appointed in January 1917, making a total of four municipal Health Visitors. In 1918 the Maternity and Child Welfare Act was passed. In December 1919, a sub-committee of the Public Health Committee was appointed to deal with maternity and child welfare matters; prior to this date the Public Health Committee had controlled the work, and it was not until 1920 that an independent Maternity and Child Welfare Committee was appointed. In 1920 the Salomon's Centre was established by the authorities of Guy's Hospital, and in this year the Medical Officer of Health submitted a report in which he recommended the appointment of a whole-time lady Medical Officer, four additional Health Visitors, two municipal midwives, two home helps and a Municipal Dental Surgeon, and with the exception of home helps these officers were all appointed. In this year also, the milk scheme, which had been started as a voluntary scheme, became entirely municipal, and the following centres were at work: St. George's Hall, Central Hall, Princess Club, Fulford Street, Salomon's Centre (voluntary centres); Oxley Street, Roseberry Street, Abbeyfield Road, Trinity Road, and the Town Hall (municipal centres). Ante-natal clinics were held at three of the municipal centres. The municipal Lying-in Hostel was opened at 110 Grange Road at the end of 1919, and during 1920 there were 155 admissions. This hostel was afterwards closed in March 1924, and, in the meantime, the municipal midwives were rendered unnecessary by the influx of midwives in private practice. In September 1923, Fairby Grange was opened as a convalescent home for mothers and children. Each year showed a steady improvement in the work, and at the same time a steady decline in the infantile mortality rate, and in 1925 the appointment of a second wholetime lady medical officer was sanctioned. In 1928 the whole scheme was carefully reconsidered; the midwifery scheme was begun towards the end of 1929, and in 1930 the Council agreed to pay the fees of obstetric consultants. The nursing scheme, which is very largely concerned with mothers and children, came into force in July 1929, and, in the meantime, as from January 1st, 1930, the voluntary centre at the Princess Club had become a municipal centre. BIRTH RATE AND INFANTILE MORTALITY RATE. The infantile mortality rate has shown a steady decline for a number of years now, and certainly the work of the infant welfare centres has played an important part in bringing about this result. In the most well ordered society, infant deaths, which are due to such causes as congenital malformation and prematurity, can hardly be avoided. These deaths, however, constitute only about (42) a third of the total number of infant deaths in the Borough, and it is therefore legitimate to hope that the infantile mortality rate may continue to fall to a still lower level than at present. The birth rate also has declined steadily, but I am not prepared to express an opinion as to whether this should be regarded as a good or a bad sign from a social point of view. MATERNITY AND CHILD WELFARE. GENERAL. For the purpose of the scheme the Borough is divided into two districts, each of which is under the supervision of a wholetime lady medical officer. Dr. Telfer has her headquarters at 110 Grange Road, and controls six municipal Health Visitors, whilst Dr. Plimsoll is at 98 Rotherhithe New Road with four municipal Health Visitors. The lady doctors also supervise the work of the voluntary centres in their districts, those within Dr. Telfer's district being Salomon's Centre, St. George's Hall and the Central Hall, while Fulford Street Centre is in Dr. Plimsoll's district. The weeklv time-table of infant clinics is, as follows :— Centre Day of week Morning Afternoon '110 Grange Road Princess Club Toddlers Percy HallL Monday Tuesday Wednesday Thursday Monday Tuesday Friday Alternate Wednesdays Monday Thursday 9.45—12 9.45—12 9.45—12 9.45—12 2—4 2—4 2-4 2-4 2—4 2—4.30 Municipal Voluntary 'Salomon's Centre St. George's Hall Toddlers Central Hall Thursday Friday Tuesday Ist Wednesday each month Tuesday Wednesday Thursday Friday 10—12 2—4 2—4 2—4 2—4 2 —4 2-4 2—4 2—4 "98 Rotherhithe New Road Trinity Road berry Street Tuesday Wednesday Friday Thursday Monday 2—4.30 2—4.30 2—4.30 2 —4.30 Municipal 9.45—12 Voluntary - Futford Street Tuesday Thursday Friday 2 —4 2—4 2—4 In 1933, 87% of the new babies in the Borough attended the clinics. ADMINISTRATION OF INFANT CLINICS. At each infant clinic a lady doctor is present, and in addition to the two whole-time lady medical officers there are four parttime lady doctors employed by the Borough Council. The voluntary centres pay and employ their own medical officers who are all part-time. At each municipal clinic it is the practice to have three Health Visitors present to assist the doctor, to weigh babies and to advise and teach mothers. Voluntary helpers give assistance to the Health Visitor in most of the voluntary clinics. Mothers are seen by appointment in all the municipal centres and in several of the voluntary centres. The appointment system works well. It avoids the necessity of a long wait on the part of the mother, leads to an orderly working of the clinic, and enables the doctor to plan her time effectively. Mothers with new babies see the doctor by appointment on their first visit to the clinic; subsequent consultations are arranged by the doctor, but in case of need a mother can always see the doctor without special appointment. Babies are weighed at every attendance and mothers are seen by the Health Visitors, who emphasises, and explains if necessary, the doctors' instructions. As often as possible health talks are given at each clinic by the Health Visitors, and these are supplemented by lantern or film lectures given in the centre by members of the staff. A register of attendances is kept at each centre, and consultation cards are provided for every patient. When the child reaches the age of five, or previously if the child goes to school, a summary of its health record is sent to the school medical officer. Each mother has her own" baby card" on which is recorded visit by visit the weight of the infant, and the instructions of the doctor. Attached to each centre is a "shop," at which the mother obtains the baby food or dried milk which has been prescribed. With the exception of one or two elementary medicines, no treatment is given and no drugs are supplied at the centres. If a mother or baby is ill and requires treatment, she is referred with a letter to her own doctor or to a hospital, and there is close co-operation between the centres and the hospitals. All foods supplied at the centre are paid for at cost price, and milk is supplied in accordance with milk scheme. At some of the municipal centres, students are received from Training Colleges for practical training without fee. Not more than two students are received in one term, and they, of course, give a measure of voluntary help in the centre. HOME VISITING. The Borough is at present divided into 13 districts for the purpose of home visiting, 10 of which are allotted to municipal Health Visitors, and one each to the Health Visitors of St. George's Hall, Fulford Street and Salomon's Centre. Each Health Visitor keeps a register and makes a weekly return of visits. The home of each child is visited according to a definite scheme, the first visit being made as soon after the tenth day after birth as possible, and subsequent visits at 1, 2, 3, 4, 6, 8, 10, 12, 15, and 18 months, and at 2 years, 2½, 3, 4, and 5 years. The object of the visiting is twofold; to secure improvement where necessary and possible, in the home conditions, and to keep a watchful eye on the health of the child. A record card is kept for each child, and when a visit has been made and recorded, the card is filed for the date of the next visit. Stillbirths are investigated, and sanitary defects and instances of overcrowding, discovered during visitation are reported by the Health Visitor to the Medical Officer of Health. When a child removes from the Borough to a known address elsewhere, information regarding the child is sent to the Medical Officer of Health of the district. Special visits are often made on the instructions of the lady doctor or the Medical Officer of Health, as, for instance, in the case of patients booking with maternity hospitals for confinement. These patients are visited in their homes by the municipal Health Visitor, a report being made to the hospital. MIDWIFERY SCHEME. Under this scheme the Borough Council may pay the whole or part of the fee of any midwife on the approved list who attends at home any confinement of a Bermondsey mother. The midwife may act either independently as a midwife, or where a doctor is also in attendance, as a maternity nurse. The Council also provides free, or at reduced cost, sterilised confinement outfits. There is an income scale in connection with the scheme, and all patients availing themselves of these benefits must receive ante-natal supervision. The midwives are invited to accompany their own patients to the ante-natal clinic, and many do so. In connection with this scheme, the Council has also authorised the payment of the fees of an obstetric consultant in cases approved by the Medical Officer of Health. There are maternity wards in Guy's Hospital and in St. Olave's Hospital, and a large proportion of mothers now go into hospital for confinement. In 1933 the total number of births was 1,500, and the following figures are of interest: — (a) Births in St. Olave's Hospital 349 Births in Guy's Hospital 205 623 Births in other hospitals 69 (b) Births at home—assisted under midwifery scheme 322 (c) Guy's Hospital extern district 375 Seventy-seven of the births in group (c) are also included in group (b), so that there appear to have been only 257 births last year in which no assistance from a public authority or a voluntary agency was given. ANTE-NATAL CLINICS. The weekly time-table of ante-natal clinics is, as follows: — Centre Day of week Morning Afternoon 110 Grange Road Tuesday 4.30—6.30 Thursday 2—4 Princess Club 98 Rotherhithe New Road Thursday 2-4 5.30—7.30 Wednesday 10—12 Fulford Street Monday Salomon's Centre 10—12 Wednesday 10—12 Friday 10—12 Tuesday 2—4 There are thus 4 morning, 3 afternoon and 2 evening antenatal clinics held every week. In addition there is an ante-natal clinic in connection with the maternity department of St. Olave's Hospital. Home visiting in connection with the hospital antenatal clinics is done by the municipal Health Visitors, and antenatal cases are visited at least once a month at home, and more frequently, if necessary. Health Visitors give each mother individual instruction at these clinics. All the municipal clinics are conducted on the appointment system, and the average attendance during 1933 was 12. The total number of expectant mothers who attended the municipal ante-natal centres during 1933 was 1,152, whilst an additional 349, whose children were born in St. Olave's Hospital, were supervised at the ante-natal clinic attached thereto. Therefore the total number of mothers taking advantage of the ante-natal clinics was 1,501. This figure means that last year practically all the pregnant women in the Borough received some measure of ante-natal supervision before confinement. MATERNAL MORTALITY. The maternal mortality rate for 1933 was 2.57. There were four deaths during the year, exactly the same number as in the previous year. Every case of maternal death is carefully investigated. In two of the four cases last year the births were illegitimate, and, in one of these at least, there was a possibility that artificial means had been used to terminate the pregnancy. In another case the mother refused the treatment advised, until too late. One of the two remaining deaths was due to an obstetric condition which, in the present state of knowledge, cannot be detected before confinement. The fourth death occurred in a case in which, in my opinion, pregnancy should not have been allowed at all. It appears to me that three of these deaths could possibly have been prevented had there been greater knowledge on the part of the parents, and there is obviously room for improvement in this direction. The maternal mortality is higher in the case of illegitimate births than in the case of legitimate births, but it is a striking fact that the percentage of illegitimate births in this Borough is the lowest in London, averaging 2.05 for the last five years as compared with 12.57 for the highest Borough. FAIRBY GRANGE. The Council is fortunate in having its own convalescent home for mothers and babies at Fairby Grange. There is accommodation there for 16 mothers and 16 babies. During the summer months a mother is admitted to the home accompanied by one infant. From October to March mothers are permitted to take a toddler under five in addition to the baby. Admission is for mothers with children under five, or for expectant mothers who live in the Borough, and who are in need of convalescent treatment. All applicants pay a fee in accordance with the approved income scale, and are seen by Dr. Telfer before admission. Mothers usually stay in the home for a fortnight in the first instance, but this period may be extended if necessary. The number of mothers admitted during 1933 was 239. NURSING SCHEME. Under the Maternity and Child Welfare portion of this scheme the Council assists in the provision of nursing for expectant and nursing mothers, and for children under five. Both district nursing associations co-operate, and a fee of 1s. per visit is paid to the nursing associations by the Council. Any person within the category above, living in the Borough, is eligible for assistance under this scheme when recommended by certificate from a doctor. DENTAL TREATMENT. There are two fully equipped municipal dental clinics, one at 110 Grange Road, and the other at 98 Rotherhithe New Road. Patients received at these clinics fall into three classes: (1) Maternity and Child Welfare; (2) Tuberculosis, and (3) General Public Health. The clinics are, however, under the jurisdiction of the Maternity and Child Welfare Committee, and nearly 30% of the patients come within the scope of the Maternity and Child Welfare Act. There is a fixed scale of charges established by the Committee and approved by the Ministry of Health, but special cases are reviewed and assessed by the Committee. DAY NURSERIES. There are two day nurseries in the Borough, the Alice Barlow Day Nursery, Fulford Street, and the Newcomen Day Nursery, Snowsfields; they are both conducted by voluntary agencies. These nurseries receive and care for young children, usually between the ages of 4 weeks and 4 years, during the day time, where the mother is compelled to go out to work. The Alice Barlow Nursery has accommodation for 20 children, and the Newcomen Day Nursery can receive up to a maximum of 60 babies. The mothers pay a small fee, and, in both cases the Borough Council makes a grant towards the expenses of the institution. NURSERY SCHOOL. There is no nursery school in the Borough, and I am of opinion that such a school is urgently needed, and further, that two or three small schools in different parts of the Borough would be of much greater value than one larger one. INVALID CHILDREN'S AID ASSOCIATION. This association has a branch in Bermondsey with accommodation in the municipal offices. The association arranges for sick or ailing children to be sent to convalescent homes in the country or at the seaside. The Borough Council makes an annual grant to the association, but, of course, the Maternity and Child Welfare scheme is only concerned with children under the age of five. MILK SCHEME. The Maternity and Child Welfare Act gives power to provide meals or milk for expectant and nursing mothers. Under the Borough Council scheme one pint of milk per day may be provided for nursing mothers and for expectant mothers during the last three months of pregnancy. From the date of weaning until the age of three years, one pint of milk daily may be provided for the infant. From three months to twelve months the quantity of milk may be increased to 1½ pints daily, and the period during which milk is obtainable may be extended from three to five years, on a special medical certificate. Milk is only supplied on an income scale which has been approved by the Ministry, and it may be obtained cither free or at half price. The milk supplied by this Council may either be Grade "A" (Tuberculin Tested) Milk or Dried Milk, according to the recommendation of the doctor. Applications for assistance must be made in the first instance to the infant welfare centre. Forms of application are issued to mothers by the Health Visitor. who initials the form. At the same time the medical certificate at the bottom of the form is signed by the doctor, who recommends the milk and specifies the amount to be supplied. The completed form must he signed by both parents, and brought in person to the office by one of them. The statements on the form are verified from the office. When the medical certificate is for Grade "A" (Tuberculin Tested) milk, an order for four weeks' supply is then sent to the milkman selected by the mother. If the medical certificate is for Dried Milk, four dated tickets are issued, each ticket entitling the mother to receive one packet of 1½-lbs. of Ambrosia, which is sufficient for one week. The tickets are then exchanged for Ambrosia at the Infant Welfare Centre. LIGHT TREATMENT. This is provided at the Municipal Solarium in Grange Road, and patients are sent for treatment by the lady doctors at the Infant Welfare Clinics, and from hospitals and general practitioners. Of the 29,000 attendances during the year, over 9,000 were classified under the Maternity and Child Welfare scheme. IMMUNISATION AGAINST DIPHTHERIA. A Schick Clinic is conducted at the Municipal Offices once a week by Dr. Telfer at which infants and children may receive protection against diphtheria. GENERAL REMARKS. It will be seen from this report that the Maternity and Child Welfare scheme is comprehensive and it should be noted that, from time to time during its development, various suggestions for improvement have been tried, some of which have later been abandoned. The maternity hostel has been mentioned; this was closed partly on account of the high cost, and partly because other accommodation became available in the Borough. Municipal midwives were also tried, but speedily became redundant. "Home Helps" for the mothers during confinement have never been viewed with favour by the Committee, although for a short time one home help was employed. When a mother goes into hospital for confinement, there is occasionally difficulty in obtaining help in the management of the home and the supervision of the other children during her absence, and sometimes it has been possible to arrange for some of the children to go into a children's home during this period. The Committee might consider giving assistance in such cases. Toddlers' Clinics for children between the ages of two and five are conducted at some of the centres. The attendances are apt to be small, partly because many children go to school at the age of three, and partly because mothers often prefer to have both children seen at one time rather than attend a special clinic for the benefit of the toddler. It is true that when a second baby arrives the toddler is often apt to be somewhat neglected, and this is the reason for urging the establishment of nursery schools in the Borough. The Maternity and Child Welfare Act permits the the provision of meals for mothers, and, so far as I know, this suggestion has never been tried in this Borough. The staff on the whole is adequate, and the falling birth rate has brought about much more intimate and personal contact than was possible only a few years ago. It is satisfactory to know that so large a proportion of expectant mothers receive ante-natal supervision, and that so high a percentage of infants attend the infant welfare centres. This, of course, is partly due to the fact that the Borough is almost wholly industrial in type, but it has been accomplished in the face of at least one severe drawback. Most of the clinics are conducted in premises which are ordinary houses or other buildings adapted for the purpose. They are, in many cases, quite inadequate, and the Council does not possess, at present, one single building specially constructed for the INFANTILE MORTALITY RATES, 1891-1933. BIRTH RATES, 1891 1933. purpose of a clinic. Such a building, besides assisting greatly in the administration of the service, would be of inestimable educational value, and I am glad to think that the defect is likely to be partially remedied in the near future. In particular I would like to draw attention to the lack of proper accommodation in the "down town" area, in which district we have not kept pace with the Housing Department. Your obedient Servant, D. M. CONNAN, Medical Officer of Health. December 1934. FAIRBY GRANGE CONVALESCENT HOME. The number of patients in the home of necessity remains about the same from year to year; particulars of admissions during 1934 are shewn hereunder: — Number of women admitted 233 Number of babies admitted 112 Number of toddlers admitted 157 MIDWIFERY SERVICE. Under this scheme 301 patients "booked" during the year. In 156 of these cases the full fee of the midwife was paid by the Council and a proportion of the fee was paid in 116 other cases; the remaining 29 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 99. The number of consultations during the year was as follows:- Obstetric Consultations 1 Puerperal Fever Consultations 1 INFANT LIFE PROTECTION. The number of foster-mothers and children in this borough is happily very small, and difficulty has been experienced in dealing with only one case during the year. There were 11 foster-mothers with 11 children and 129 visits were paid by the visitor and 3 by the Medical Officer of Health. MATERNAL MORTALITY. There were three deaths during the year, one less than occurred last year. The maternal mortality rate for the year is therefore 1.87 per 1,000 total (live and still) births. Reports were made to the Ministry of Health on two cases, both of septic abortion; the remaining death was due to haemorrhage following ectopic gestation. CENTRAL HALL WELFARE CENTRE. The conduct of this centre has been the subject of a number of reports to the Committee spread over a long period of time. Arrangements were made for Dr. Telfer and a number of municipal health visitors to assist at the centre, but as these proved Unsatisfactory they were terminated as noted in my last Annual Report. A public enquiry was held by the Ministry of Health in October and the matter is still under consideration. HEALTH VISITORS. The following table shows the work done by the Municipal and Voluntary Centres and Health Visitors during 1934: — District Births Notified Visits to Infarts and Children Visits to Expectant Mothers Puerperal Fever and Puerperal Pyrexia Ophthalmia Neonatorum Other Visits Attendances at Centres First Visits Re-visits 1 Under 1 year 1-5 years Primary Visits Revisits Cases Visits Cases Visits Miss Brown 68 78 301 969 38 73 1 2 - - 1120 219 Miss Bowles 77 78 520 769 45 91 - - - - 1293 215 Miss Lawrence 124 145 856 1017 40 111 1 1 1 1 1311 176 St. George's Hall 111 115 796 1408 2 - 1 1553 111 61 175 2 Miss Robson 108 137 735 1053 58 122 2 2 1 1 1337 175 Miss Helden 123 129 472 1033 62 168 1 1 1 1 1540 214 Miss Riches 93 103 1535 201 525 882 50 109 - - - - 125 119 802 1113 90 208 - - - - 902 158 Fulford Street Miss White 125 133 791 1191 82 171 1 1 - - 1723 155 Miss Carlton 131 165 1009 1083 54 145 1 1 1 1 1556 229 Miss Bache 126 128 569 957 56 142 5 5 - - 1128 238 Miss Wadds 78 79 886 1323 38 196 1 1 2 2 1123 158 Salomon's Centre 103 108 724 2767 645 258 570 - - - - - Central Hall 25 28 147 121 35 68 - - - - 332 62 Totals 1417 1545 9133 15686 1354 2349 15 16 6 6 16453 The following table shows attendances at Maternity and Child Welfare Centres during 1934: — Name of Centre 110 Grange Road Children's Consultations Ante-natal Clinic Sewing Class No. of Sessions No. seen by Doctor No. of Sessions New Cases Total Attendances No. of Sessions No. of Attendances New Cases Total Attendances Under 1 year 1-5 years Under 1 year 1-5 years 197 240 53 3,687 3,204 4,482 49 169 820 41 239 848 151 191 2,956 3,396 94 168 - - 98 Rotherhithe New Road 15 3,655 - 50 33 4 548 674 1,004 - - - Trinity Road - 101 - Percy Hall 19 1,823 1,873 2,058 108 - - - - 1,504 - Roseberry Street 48 70 18 1,218 1,203 - - - - 147 1,865 627 - Salomon's Centre 76 1,095 1,536 197 2,820 - 4 125 166 1,960 2,416 3,507 66 462 1,362 Princess Club 53 86 17 101 137 2,088 Fulford Street 1,475 2,375 51 112 504 - 14 - 958 St. George's Hall 61 65 1,224 646 1,144 - - - 37 22 62 1,084 22 1,837 2,370 - - Central Hall 111 2,585 - - - Totals 1,156 188 19,925 18,640 23,155 444 1,142 5,454 164 2,247 Maternity and Child Welfare, STATISTICS FOR THE YEAR, 1934. Borough Council of Bermondsey. POPULATION according to the Census of 1931.—111,542. Births. Registered— Total Males Females Live Births Legitimate Illegitimate 1,515 767 748 42 17 25 Birth Rate per 1,000 of the estimated resident population 14.8 Total Males Females Stillbirths 43 20 23 Rate per 1,000 total (live and still) births 27 Notified within 36 hours of birth— (1) Live Births, 1,505. (2) Stillbirths, 44. (3) Total, 1,549. (1) By Midwives, 397. (2) By Parents and Doctors, 1,152. Total. Males. Females. Deaths 1,304 720 584 Death Rate per 1,000 of the estimated resident population 12.4 Maternal Deaths. Deaths from puerperal causes:— Rate per 1,000 total (live and still) births. Deaths. Puerperal Sepsis 2 1.25 Other puerperal causes 1 0.62 Total 3 1.87 Infant Deaths. Number— (1) Legitimate, 96. (2) Illegitimate, 4. (3) Total, 100. Rate per 1,000 live births— (1) Legitimate, 62. (2) Illegitimate, 2. (3) Total, 64. Health Visitors. Visits paid by Health Visitors during the year:— To Expectant Mothers (1) First Visits, 1,354. (2) Total Visits, 3,703 To Infants under 1 (1) First Visits, 1,545. (2) Total Visits, 10,678 To Children, 1—5 Total Visits, 15,686 Convalescent Homes for Children under 5. Number of Beds, 16. Number of Children under 5 received during the year, 269. 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 : — 9,919. Deaths from Measles (all ages) 38 Deaths from Whooping Cough (all ages) 10 Deaths from Diarrhæa (under 2 years of age) 23 VI. DENTAL TREATMENT. During 1934, 1,640 children and 5,958 adults were treated, an increase of 123 children and 495 adults over 1933. The attendances at the two centres numbered 13,778, a total increase of 1,038. Both centres are working at full pressure having regard to the number of sessions held, and it may be necessary before long to increase the number of sessions at the Rotherhithe Centre. TREATMENT OF CHILDREN DURING 1934 CENTRE Age Group Number Examined Number Treated Number of Extractions Anæsthetics Number of Fillings Number of Scalings Number of Attendances for Orthodontics Total Number of Attendances Local General 110, GRANGE ROAD. Under 5 years 461 418 1717 11 397 14 - - 846 551 969 235 181 192 8 256 270 8 1326 2172 451 - - - 205 205 Over 5 years 552 1013 238 1355 3072 1013 333 730 216 Totals 98, ROTHERHITHE NEW ROAD. Under 5 years Over 5 years 432 107 3 - — 834 436 48 1131 313 529 Totals 670 671 2144 115 3 ! 1285 56 DENTAL TREATMENT CARRIED OUT DURING 1934 CENTRE Type of Case Number of Patients Examined Number of Patients Treated Number of Dentures Fitted Number of Repairs to Dentures Number of Attendances Number of Extractions Anæsthetics Number of Fillings Number of Scalings Local General 110, GRANGE ROAD, Maternity Cases 861 920 2565 736 206 68 14 186 67 1813 Women 1384 2333 1271 130 203 12 82 2257 1518 124 Men 1955 2039 1876 210 38 235 96 3240 3426 45 Tuberculosis Cases 105 - 10 3 31 38 50 10 61 121 Children (Table I.) 1013 969 3072 270 — - - 2172 192 730 Totals 5251 5496 11501 4106 1121 812 64 555 248 9603 98, ROTHERHITHE NEW ROAD Maternity Cases 441 512 1833 233 236 25 14 113 20 1058 796 26 Women 292 39 769 391 444 91 10 56 608 529 589 8 58 Men 1178 85 21 81 1063 2144 - 1285 Children (Table I.) 670 617 56 529 115 3 - Totals 2110 2102 5951 1170 914 264 48 250 54 4175 VII. —PROPAGANDA. REOIRT BY MR. H. W. BUSH, M.I.H., PROPAGANDA AND ADMINISTRATIVE OFFICER. During the year 1934 the following lectures and demonstrations each illustrated by lantern slides and cinema films were given. Lectures. Audiences. Schools 59 13,550 Clubs and other Institutions 50 3,375 Open-air with cinema van 66 26,350 175 43,275 This is the largest number of lectures and demonstrations given in one year, and it is doubtful whether it will be possible to exceed this number. During the same period, the following certificates were gained by children attending Schools in the Borough. Hygiene Elementary 70 Intermediate 29 Final 13 Proficiency medals 11 Home Nursing Elementary 4 Intermediate 19 Final 9 Proficiency medals 8 The most important event of the year to us was the discovery of a satisfactory method of changing our out-of-date silent films into "talkies." As mentioned in previous reports, the cost of an apparatus to make sound films is beyond the reach of any but the largest County Councils, and the cost of having sound films made is even more prohibitive. For instance, we were recently given a quotation of £2,000 for producing a sound film, 1,000 feet in length, taking about ten minutes to show. As an alternative, We decided some years ago that we would have to be satisfied with showing films accompanied by running commentaries on gramophone records. The cost of getting these cut was also excessive, and prevented their use. We then realised that we would have to wait until such time as an apparatus was available that would enable us to make our own records. Such an apparatus is now on the market and one was purchased during the year. A certain amount of experience is necessary before a satisfactory record is cut, but careful experiment over a short period enables the operator to ensure good results. In the first place, a speaker must be selected with a good recording voice. Secondly, the recording room should be small and damped down sufficiently, by blankets or similar material, to prevent echo on the records. The echo in the room must not be eliminated entirely or the record will be "flat"; and thirdly the depth of the cut must be exactly right. While recording, absolute silence, except for the speaker's voice, must be maintained, as every extraneous sound is recorded, the turning of a paper, or the moving of a shoe on the floor will completely spoil a record. It is essential for the speaker to have his part clearly written out, typed for preference, with words to which he wishes to give emphasis underlined. The script must be marked off in sections, each of fifteen seconds or less, and the reading must be done exactly to time with the aid of a stop watch. A mistake in a word, hesitancy or a cough means that the record must be done again. For the reproduction of these records a double gramophone is necessary, i.e., one with two turntables, both capable of running at the same time. A switch must be fixed to enable the operator to swing from one record to the other without a break and then the whole apparatus is coupled up to a loud speaker. An ordinary film will take from six to eight 12in. single-sided records and with an outfit such as this, it is possible, provided that care is taken to switch over to the next record as the last word is spoken on one record, for the whole of them to be run off without a break and probably without the audience knowing that a gramophone is being used. By the end of 1934 two of our films, "The Story of Our Food Supply " and "The Activities of a Borough Council," had been produced and shown as sound films. The writing of the words necessary for a 1,000 foot film is a laborious task and takes many hours of thought. A rate of 140 words per minute is about the correct speed for speaking, and although it is not necessary for the words to synchronise, they must " fit in " exactly to the film. As an example of this, a section in one of the films mentioned above contained eight words too many, and had to be re-written to include only the exact number of words. As a result of our experience, we find it is necessary to get the number of words correct to the nearest half-second. Although this work is difficult and exacting, the result is undoubtedly worth the effort. The fact that one can produce and show films that are nearer the type the public are used to seeing places the work on a different plane altogether. The first of these films shown was to an audience who had no idea that they were listening to anything other than an ordinary sound film and they left apparently satisfied that that was what they had seen and heard. There is an undoubted advantage of using these records in conjunction with the cinema van for street demonstrations. No matter how large the audience, the volume of sound can be increased by merely turning a knob. It is true that the ideal method is to have a lecturer in addition—the spoken word always carries more weight than one out of a box-but the need of a lecturer need not prevent a very good street demonstration being given. There are still twenty-eight films to be transposed, and it is hoped during the present year that quite a number of these will be completed, VIII. -SANITARY ADMINISTRATION. SANITARY INSPECTORS. In September I submitted the following report concerning this subject to the Public Health Committee— "In January, 1932, I reported to the Committee that, in my opinion, it was advisable that an additional Sanitary Inspector should be appointed. The Committee gave this matter full consideration at the time, but decided that it should be allowed to stand over for a further report at a later date, if this should become necessary. In my opinion the time has now come when the matter should be reconsidered. "Since my previous report was made, additional duties have devolved upon the District Sanitary Inspectors, and alterations have been made in connection with house-to-house inspections which have considerably increased their work. " (i) LOCAL GOVERNMENT ACT, 1929 Under the Local Government Act, 1929, the registration of premises where offensive trades are carried on, and the registration of Common Lodging Houses and Seamen's Lodging Houses has been transferred to the Borough Council from the London County Council, and increased inspection on the part of the Inspectors has become necessary. This is a comparatively small addition to the work, and, of itself, would not, of course, necessitate the appointment of an additional inspector. "(ii.) ICE CREAM AND FOOD PREMISES —Under the London County Council (General Powers) Act, 1932, approximately 150 food stores where food is prepared have been registered, and approximately the same number of ice cream premises have also required registration. During the summer of this year 102 samples of ice cream were taken, and, in many cases, the results of the bacteriological examinations revealed a most unsatisfactory state of affairs. I am, personally, of the opinion, that, during the summer months, ice cream premises, and many similar food stores, should be visited at least once a month, and, during this year, more than twice as many visits were paid to such places as were paid in 1932. "(iii.) HOUSE-TO-HOUSE INSPECTION —In the early part of this year I introduced a house-to-house inspection slip, which required the Inspectors to make a much more detailed inspection of each house than had been customary in the past. My object in doing so was to compile, in time, a complete record of the condition and amenities, or lack of amenities, of every house in the Borough. This has, of course, necessitated a considerable amount of extra work, and has meant that the length of time taken for each individual house-to-house inspection has increased, so that a smaller number of such inspections will be done during the year, and the interval elapsing between house-to-house inspections of the same houses will be, consequently, increased. At the present time, houses-to-house inspections of the same houses are made at intervals of approximately 3½ years, and I am of the opinion that this is rather a long period, and that such inspections should be made at intervals of not longer than 3 years. " (iv.) REVISITS AFTER THE SERVICE OF NOTICES —During this year I have impressed upon the Inspectors the necessity of making more frequent visits to see that the requirements of notices are carried out, not only completely, but promptly, so that the delay between the reception of a complaint or the observance of a nuisance and its abatement shall be as short as possible. The number of revisits in the first nine months of this year is nearly 3,000 more than the corresponding number for last year. "(v.) OVERCROWDING —There are, at present, approximately 1,000 cases of overcrowding on the register kept by this Department. New cases are added from time to time as they come to my notice, and where a family is removed from overcrowded circumstances, the case is transferred to the register of de-overcrowded premises, but, hitherto, there has been no systematic visiting of cases on the current register of overcrowding, and I am of opinion that all premises on this register should be visited at least twice a year. " (vi.) DE-OVERCROWDING —A register is kept of all dwelling houses where overcrowding has been abated by action of the Borough Council, London County Council or by any other means, and these premises are visited twice a year. The number of houses on this register was at first small, but the number has increased steadily, and is now just over 1,000. It is an instruction of the Committee that these premises are to be visited twice a year to prevent the recurrence of overcrowding. At the present moment it is almost impossible for the Inspectors to carry out this instruction. " (vii.) HOUSES LET IN LODGINGS—I have been very anxious during the last two years to increase the number of houses registered as houses let in lodgings, and have, on many occasions, spoken to the Inspectors on this subject. I believe that there are in this Borough between 1,000 and 1,200 houses which should properly be registered. lam officially informed that the actual number of registrable houses in the Borough is 1,993. At the present moment there are on the register 204 houses. The inspection and registration of a house in this category takes a considerable amount of time, because it is necessary to measure up the rooms for the purpose of the bye-laws, and to ascertain particulars as to the number of inhabitants of the house. In addition, when a house is once registered it becomes necessary to visit the premises at least once a year, and I have thought that, in many cases, such houses should be visited bi-annually. At the present moment the bye-laws are not in force in their entirety with regard to controlled houses, but I have been surprised at the proportion of houses which are decontrolled, and taking those houses which were registered at the last Council meeting, I find that about 25 per cent. of them are decontrolled. In the case of a decontrolled house, all the bye-laws are applicable, and in my opinion these bye-laws, whether enforceable either wholly or in part, give us very considerable power to assist tenants, and to secure proper cleanliness and increased amenities in the very poorest class of property. I understand that pressure is being placed upon the London County Council to insist upon that body taking action in this matter in default of the Borough Councils. "When I submitted my previous report in January, 1932, recommending the appointment of an additional Sanitary Inspector, I gave as one of the reasons the fact that it would be advantageous to have an Inspector available at mid-day, to attend to urgent matters which arise after the Inspectors have left the office for their districts. It has not been possible to arrange to have this done with the present staff, but with an additional Inspector it would be possible to arrange for a rota of District Inspectors, so that one could be in the office at mid-day and on Saturday mornings to attend to urgent complaints, and I think this is a matter of considerable importance. "With the exception of the last few years there have been eight District Sanitary Inspectors employed in this Borough since 1901, and I am strongly of the opinion that the work cannot be efficiently done with the present number of Inspectors, and I, therefore, recommend the appointment of at least one additional District Sanitary Inspector at a salary of £285 per annum, rising, by annual increments, of €15 to a maximum of £450 per annum. "The above report was submitted to the Public Health Committee at its meeting in January, and, as it is still under consideration, it appears in the agenda today. "Since presenting the report I have obtained further and more definite information with regard to two of the points mentioned, namely:— (1.) Overcrowding. (2.) Houses let in lodgings. "In 1927 Dr. King Brown caused a census to be taken in order to arrive at some definite idea as to the state of the Borough with regard to overcrowding. I have just completed a similar census taken during the last three months, and the two sets of figures are set out below for purposes of comparison. In order to make the two sets of figures strictly comparable, my census has been taken in exactly the same way, and using the same standards as in 1927:— 1927. 1934. Number of houses 18,034 18,470 Total number of rooms 86,720 87,566 „ „ (Sleeping) 43,953 43,775 „ „ (Living and Sleeping) 7,677 5,503 „ „ (Living) 35,090 38,288 Number of families 29,284 28,571 Number of persons 111,784 104,859 Consisting of:— 1927. 1934. Adults (10 years or over) 88,349 87,650 Children (under 10 years) 23,045 17,209 Number of families with accommodation of: — 1 person or less to a room 19,887 16,444 2 persons to a room 6,634 9,781 3 „ 1,902 1,757 4 „ 585 433 5 „ 192 113 6 „ 55 32 7 „ 24 8 8 „ 2 3 9 „ - - 10 „ 2 - 11 „ 1 - "The Committee is well aware that a separate Housing Department has been established, and that it has been probably one of the most active in the country, and yet I cannot believe that the Committee will be satisfied with a comparison of these two sets of figures. I would emphasise the fact that the total number of overcrowded families, using a standard of two or more to a room, is still 2,346, as compared with 2,863 in 1927, and this is in spite of unprecedented activity on the part of the Housing Department. "I would also like to draw attention to the number of houses let in lodgings which is 1,603, a higher figure than I estimated in my report. " I suggest that in order to deal with overcrowding there are four requisites: — (1.) The extent of this form of nuisance must be ascertained, for it must be remembered that overcrowding is a statutory nuisance under the Public Health (London) Act, and the Borough Council is responsible for its abatement. This has been done, and an accurate review of the situation is set out above. (2.) The situation can only be controlled by careful and fairly frequent inspection. (3.) As accommodation is provided by the Borough Council or the London County Council, or in any other way, the nuisance can be abated, and it then becomes essential to keep a watch on de-overcrowded premises to prevent a recurrence of the evil. (4.) Where working-class families are living two or more to a house, steps should be taken to see that their living conditions are at least reasonable, and it is for this purpose that bye-laws for houses let in lodgings have been made. I understand that the application of the bye-laws has, in the past, been the cause of difficulty to the Housing Committee. "I have discussed this matter very fully with the Housing Director, and I am prepared to adopt his suggestions, which will, I think, enable us to avoid these difficulties in the future. "May I respectfully suggest to the Committee that this is a matter of real urgency, and that at least one additional Inspector should be appointed as soon as possible." An additional District Inspector was appointed in November, and the districts have now been re-arranged so that the Inspector within whose district the Town Hall is situated comes into the office daily at one o'clock to attend to any matters of urgency. HOUSING. During the year 1934, six new areas were represented by the Medical Officer of Health. The clearing of these areas necessitated the demolition of 294 houses, and the rehousing of 432 families, comprising 1,796 persons. The following are the areas declared:— Title of Clearance Area Mellicks Place Area in sq. ft. (approx.) 43,431 No. of dwelling houses 47 Population Date declared by Council families persons 74 302 27/2/34 1,132 Alice Street 130,765 184 269 24/4/34 3 Fawcett Court 1,755 5 7 24/4/34 Whites Grounds 6,380 11 11 60 26/6/34 Cherry Garden Street 12,433 16 33 106 24/7/34 31 Trinity Road 26,456 42 189 25/9/34 The building of new houses by the Council in areas which have been previously represented, has been continued, and the following new premises, consisting of 371 flats, 23 cottages and 16 shops, were erected during the year. Number of dwellings Number of families accommodated Position 38 flats 38 families Harold Estate Extension Rotherhithe Street, Block No. 12 10 cottages 10 „ Amos Estate 50 flats and 4 shops 50 „ Millpond Estate 11 flats 11 „ Redriff Estate 45 flats and 2 shops 45 „ Vauban Estate 69 „ 69 flats and 3 shops Silver Street 2 flats and 1 shop 2 „ 14 „ Crosby Row 1 flat, 13 cottages and 1 shop 65 „ Albion Yard 65 flats Tanner House 26 flats 26 „ Bethel Estate 26 flats and 3 shops 26 „ Whites Grounds Estate 13 „ 13 flats Maynard Road 5 flats 5 „ Cherry Garden Place 11 flats and 1 shop 11 „ Leroy Street 9 flats and 1 shop 9 „ Thirty-six flats have been erected by the London County Council on the Dickens Estate, George Row, and 32 flats and 2 houses have been erected by private enterprise. The following premises are in course of erection by the Borough Council:— Position Amos Estate Redriff Estate Albion Estate Bethel Estate Whites Grounds Estate Elim Street Area Cherry Garden Place Area Irwell Estate Tower Bridge Road Site Leroy Street Area Cranbourn House Rotherhithe Street West, Block No. 11 Bryants Alley Area Crosby Row Number of flats and cottages 28 flats 26 „ 4 ,, 23 „ 24 „ 21 „ 3 „ 20 „ 80 „ 23 „ 26 „ 17 „ 38 „ 2 cottages 416 families have been removed by the Borough Council and the London County Council, and it appears, from information in my possession, that whilst the majority of the families rehoused by the Borough Council were previously living in overcrowded conditions, this was not always the case with those relieved by the London County Council. All such re-housing, however, must tend to ease the situation for the remaining occupants. Every removal is noted and the District Sanitary Inspector periodically visits the houses concerned to see that rooms which have been vacated are not re-let in such a manner that they become overcrowded. Hereunder will be found particulars of Inspections, Proceedings, etc., for the year 1934: — INSPECTION OF DWELLING HOUSES DURING THE YEAR:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,936 (b) Number of Inspections made for the purpose 32,381 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,583 (b) Number of Inspections made for the purpose 2,583 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 315 (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 2841 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 dweling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) 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 4,818 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,977 (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 21 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 17 (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 1 (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 19,022 Number of houses occupied by the working classes 18,878 PIGEON NUISANCE. In September of this year a request was received from the Traffic Manager of the Southern Railway for the Council to undertake, at the expense of the Southern Railway, the abatement of a nuisance caused by pigeons in the Bricklayer's Arms Depot. This somewhat unusual work was satisfactorily accomplished, chiefly owing to the initiative of Mr. H. E. Butcher, the District Sanitary Inspector, and Mr. W. Davis, the Senior Sanitary Inspector. Altogether 1,289 pigeons were caught and destroyed, and 224 eggs were taken. STREET CLEANSING. During the very long drought which occurred last year, the restrictions which were placed upon the use of water by the Metropolitan Water Board, lead to consideration by the Housing Committee and the Works Committee of the possible use of well water for the purpose of street cleansing. The Council had recently purchased the "Black Eagle" brewery site, on which there existed a well. Pumping apparatus was installed, and several million gallons of water have been pumped from the well and used for road cleansing, and sewer and gully flushing. This excellent arrangement will become permanent, the flow of water being suffiicent to enable the Council to do all the street cleansing from this source. REGISTERED PREMISES— Number on Register at end of 1934 Number of Prosecutions Premises Common Lodging Houses Number of Inspections 3 65 - 2 5 Seamen's Lodging Houses - Milkshops 298 552 - Houses let in lodgings 1,578 5,737 - 493 - Ice Cream Premises 122 Offensive Trades (including Poultry Slaughter-houses) - 89 14 SMOKE NUISANCES— Number of observations 69 Number of notices 10 Number of complaints 8 Number of summonses Nil UNDERGROUND ROOMS— Number illegally occupied 9 Number closed or illegal occupation discontinued 7 WATER SUPPLY TO TENEMENT HOUSES Premises supplied 36 Prosecutions Nil SALE OF FOOD - Number of premises used other than ice-cream premises, milk shops and cowsheds 651 Number of inspections 1,710 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. RATS AND MICE (DESTRUCTION) ACT, 1919— In the early part of the year four temporary rat-catchers were appointed for six months. In November a report was submitted showing that about 2,500 rats had been caught, and it was then decided to retain the services of two of the men for a further six months and at the same time to make use of pamphlets and posters to draw public attention to this matter, and to the facilities provided by the Council. 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, inhabitated 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 36 tenement houses, after service 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. 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. 1 (b) For the prevention of keeping of animals in such a manner as to be injurious to health 1 (c) As to paving of yards, etc., of dwelling houses 1 (d) In connection with the removal of offensive matter, etc. - (e) As to removal and disposal of refuse, etc .. — (f) For securing the cleanliness of tanks, cisterns, etc. - (g) With respect to water closets, etc. — (h) With respect to sufficiency of water supply to water closets — (i) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (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 1 Number of prosecutions under the Milk and Dairies Order, 1926 1 WORK OF DISTRICT INSPECTORS, 1934. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Special Inspections Complaints Factories & Workshops Specially Inspected Offensive Trades Underground Conveniences Drains Tested Chimneys watched Bakehouses Common and Seamens Lodging Houses Fishmongers, Friers and Curers Fruiterers and Greengrocers Ice Cream Markets Restaurants and Eating Houses House-to-House Infectious Diseases Outworkers' Bi-Annual Inspection Butchers Food Stores Destruction of Food Various TOTALS Other Calls and Visits Visits Ints. 420 1995 398 170 23 19 — 11 2396 10 23 26 35 27 111 49 69 88 144 1 - 6020 5 District No. 1 894 „ No. 2 356 2226 495 163 17 30 46 - 25 2430 7 46 30 47 11 39 13 60 258 27 3 - 6329 716 „ No. 3 428 1832 391 124 4 - 22 - 29 2908 3 26 - 54 24 56 30 100 87 17 2 6137 723 - „ No. 4 405 2356 501 201 7 47 42 - 35 2291 18 42 9 28 9 25 13 67 71 27 2 - 6196 732 „ No. 5 314 2173 432 326 46 7 84 91 2183 16 5983 - 31 - 33 7 73 20 58 69 20 - - 795 „ No. 6 456 2736 253 237 128 - 11 62 1733 6 25 1 99 49 212 65 59 131 99 - 2 554 6364 — „ No. 7 204 1576 413 249 2 - 27 55 2347 9 20 4 7 9 11 - 80 88 7 4 - 5112 536 - 2583 14894 2883 1470 227 89 251 - 308 16288 69 213 70 303 136 527 190 493 792 341 12 2 42141 4950 Total FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. HOMEWORK. NATURE OF WORK (1) Outworkers' Lists, Section 107 Outwork in Unwholesome Premises Section, 108 Outwork in Infected Premises (Sections 109, 110) Lists received from Employers Outworkers resident in Bermondsey received from other Districts Notices served on Occupiers as to keeping or sending lists (8) Prosecutions Instances (11) Notices served (12) Prosecutions (13) Instanees (14) Notices served (15) Prosecutions (16) Lists (2) Outworkers Failing to keep lists (9) Failing to send list (10) Resident in Bermondsey Resident in other Districts (5) Contractors (3) Workmen (4) Contractors (6) Workmen (7) Wearing Apparel:— 1 .. I I I I ' I I _ I I _ I 0 I .. I „ I I I I I I - I I - I I 6 6 - 5 - - (1) Making, etc. 22 - 33 46 6 51 11 - - - (2) Cleansing and washing - - - - - - - - - - - - - - - - Fur pulling - - - - 1 2 - - - - - - - - - Umbrellas, etc. - - - - - 2 - - - - - - - - - Sacks 6 - 5 1 - - 3 - - - - - - 7 2 - - 3 3 - 2 - - Paper, etc., Boxes, Paper Bags 3 - 8 2 - - 1 1 - 1 - - Brush making - - - - - 3 - - Combs, etc. - - - - - 3 - - - - - - - - - Leather Goods 4 - 5 5 - 1 - - - - - - - - - 2 - 3 - - - - - 1 - - - - - Surgical Instruments - 1 Coathangers 2 - 24 23 - - - - 1 - 2 - - - Carding of buttons, etc - - - - - 2 - - - - - - - - - Onion Peeling - - - - 2 - - - - - - - - - - Games and Toys - - - - - 1 - - - - - - - - - 10 Total 39 - 75 80 7 72 16 - - 11 11 - - - FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. INSPECTION. Number of Premises Inspections Written Notices Prosecutions 13 — Factories (including Factory Laundries) 484 Workshops (including Workshop Laundries) 13 1 59 Workplaces (other than Out workers' Premises) 11 - 58 601 37 1 Total DEFECTS FOUND. Particulars Nuisances under the Public Health Acts— Number of Defects Number of Prosecutions - Found Remedied Referred to H.M. Inspector 7 7 - Want of Cleanliness Want of Ventilation - 1 1 - - - - - Overcrowding - - Want of Drainage of Floors - - - - Other Nuisances 25 25 - Sanitary Accommodation— Insufficient 2 2 - - - Unsuitable or Defective 10 10 - Not separate for Sexes - - - - Offences under the Factory and Workshop Act— - Illegal Occupation of Under- ground Bakehouse (s. 101) - Breach of Special Sanitary Requirements for Bake-houses (ss. 97 to 100) 48 48 Other Offences 1 1 Total 94 94 - - - - - - - OTHER MATTERS. Class Number - Matters notified to H.M. Inspectors of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters re- ferred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factories Act (s. 7) Notified by H.M. Inspectors Reports (of action taken sent to H.M. Inspectors) - - 2 Other Underground Bakehouses (s. 101):- - Certificates granted during 1934 In use at end of 1934 18 Workshop Bakehouses 18 Workshops on the Register (s. 131) at the end of 1934 423 Total Number of Workshops on Register 441 No OF BAKEHOUSES IN THE BOROUGH. In Use Not in Use Underground Above ground Above ground Underground 18 37 4 37 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 1934: — Disposal Loads tons cwts. 6 qrs. - House Refuse to Barge 15,867 20,777 2,607 1,981 17 Trade Refuse „ Barge 3 Street Markets Refuse to Barge 2,178 2,138 3 2 20,652 7 Totals 24,897 1 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. For some years past an arrangement has been in force with the local Registrars of Births and Deaths whereby a special notification is sent to the Medical Officer of Health of deaths from infectious diseases and cancer. It has been the practice not to allow the bodies of persons who have died from these diseases to be taken home until the home conditions have been inspected by the district sanitary inspector and pronounced satisfactory. Under these circumstances the Committee decided to provide a small chapel in connection with the mortuary, and this was done by adapting one of the existing rooms according to the design of the architect, a very great improvement having thus been effected. Particulars of bodies removed to the mortuary during the year are, as follows: — Number of infectious bodies removed 26 Total number of bodies removed 87 STREET MARKETS. The market scheme continues to work smoothly and satisfactorily. Number of Licences in operation 575 Income £3,068 17s. Od. There have been 15 prosecutions during the year. DRAINAGE WORK. Hereunder will be found particulars of drainage work, &c carried out by the Drainage Inspector during 1934:- Drains Tested 439 Intimation Notices served 1 Visits to Underground Conveniences 583 Other Visits 3456 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 comment. 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:— Description of Food Weight qrs. lbs. Tons cwts. - - - 3 Fresh Meat 0 Fresh Fish 4 0 - Fresh Fruit 0 0 1 12 16 Shell Fish 4 1 - Rabbits 0 0 5 - 0 Vegetables 4 0 - Total 1 19 2 9 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. Fifty-four samples have been taken during the year by the Wharves' Inspectors. Of this number, 3 samples were submitted to bacteriological examination; 5 were examined for preservative; 12 samples were examined for contamination and 22 samples of tomatoes, tinned or in the form of puree or paste were examined for the presence of copper and tin. An unofficial standard for tin is generally accepted, but there is no standard for copper either official or unofficial, and considerable anxiety was ments. As very large quantities of tomato products were involved it was a matter of some difficulty to decide on a just course of action. After consultation with the firm concerned who were straightforward and helpful in their attitude and with officials of the Ministry of Health, it was decided to release those parcels conditionally for manufacturing purposes or for re-exportation, which did not show an amount of tin above the accepted standard (2 grains per lb.) and which showed less than 20 parts per million of copper. At the same time the firms concerned were urged to take the matter up with their manufacturers and endeavour as far as possible to eliminate both metals from their products, and attention has already been given to this matter. The remaining samples were taken in order to ascertain the composition. In addition, 8 samples have been taken by other officers for special purposes. No. of Samples Examination Action taken Articles examined Result Analysis of brine Kidneys in brine Saltpetre not detected Destroyed as kidneys damaged 1 Brine 1 „ „ Satisfactory - Tinned loganberries 1 Contamination Destroyed Blown. Strong metallic taste attributed to iron For preservative „ Grape fruit juice 1 Sulphur dioxide 442 parts per million „ „ „ 1 „ „ Sulphur dioxide 415 parts per million PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925.—continued Articles examined Lemon juice „ „ Lime „ Tea (Salvage) Sacking for covering bacon Stained bacon and cloth Vegetable compound Lard oil Butter Butter and wrapping paper Salmon spread „ „ Flour „ „ Canned salmon Ox beef cake Tinned tomatoes Tinned tomatoes „ „ „ „ No. of Samples 1 1 1 3 1 1 1 1 6 2 1 1 1 1 1 1 1 2 1 1 1 Examination „ „ „ „ „ „ Contaminated by water Analysis of dye used for colouring Analysis of stain To ascertain composition „ „ „ „ Contamination „ Bacteriological Contaminated with a metallic dust „ „ „ „ Condition To ascertain composition Bacteriological For the presence of copper and tin „ „ „ „ Result Sulphur dioxide 345 parts per million Sulphur dioxide 268 parts per million Sulphur dioxide 350 parts per million No appreciable amount of extraneous water had gained access to the tea Harmless Tarry matter present Genuine „ „ Smeared with black marks due to iron No trace of tin Slight discolouration. No bacteria Particles of lead sulphide detected Specks of dirt present only Faint reaction to lead Satisfactory 1.4 grains per lb. tin Genuine Satisfactory Tin 0.67 grains per lb. copper nil Tin 0.30 grains per lb. copper nil Tin 0.30 grains per lb. copper nil Action taken Released „ „ „ - Released after trimming Released „ „ Butter released after scraping Scraping destroyed Released „ Released for technical purposes only „ „ „ „ - Released „ „ „ „ (83) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. -continued No. of Samples Result Action taken Articles examined Examination 1 „ „ Tin 0.23 grains per lb. copper nil „ Peeled tomatoes „ 1 Tomato paste (Concentrated) Tin 0.45 grains per lb. Copper 72 parts per million „ „ Tomato puree Tin 2.2 grains per lb. Copper 10 parts per million 1 „ „ „ „ „ Destroyed 1 „ „ Tin 3.9 grains per lb. Copper 35 parts per million „ „ 1 Tin 1.1 grains per lb. Copper 10 parts per million Released „ „ Destroyed 1 Tin 3.97 grains per lb. Copper 40 parts per million „ „ „ „ 1 Tin 0.59 grains per lb. Copper 17 parts per million Released „ „ „ „ „ „ 1 Tin 0.44 grains per lb. Copper 55 parts per million „ „ 1 „ „ Tin 0.81 grains per lb. Copper 12 parts per million „ „ 1 „ „ „ „ Tin 0.57 grains per lb. Copper 14 parts per million „ „ 1 Tin 1.33 grains per lb. Copper 15 parts per million „ „ „ „ „ 1 „ „ „ „ „ „ „ „ Tin 1.11 grains per lb. Copper 15 parts per million 1 „ „ Tin 0.77 grains per lb. Copper 30 parts per million „ 1 „ „ Tin 0.88 grains per lb. Copper 15 parts per million „ „ „ „ „ 1 „ „ Tin 0.67 grains per lb. Copper 25 parts per million „ „ „ „ „ 1 Tin 0.88 grains per lb. Copper 18 parts per million „ „ „ 1 Tin 0.55 grains per lb. Copper 13 parts per million „ „ „ 1 Tin 0.55 grains per lb. Copper 20 parts per million „ „ „ „ „ 1 „ „ „ „ Tin 0.23 grains per lb. Copper 17 parts per million „ PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925.— continued SAMPLES EXAMINED FOR SPECIAL PURPOSES. Articles examined No. of Samples Examination Result 1 To ascertain composition Contained permanganate of potash Tea 1 „ „ Genuine No arsenic, antimony, mercury, lead or copper Wine 1 „ „ „ — rr Dried Milk Dried Milk, Ambrosia Vitamin D. 1 Vitamin D „ Ambrosia with added iron 1 Added iron „ Cheese 1 To ascertain composition „ Tin 0.2 grains per lb. Chocolate 1 For the presence of antimony, arsenic, mercury, lead, copper and zinc „ Cod Liver Oil Emulsion 1 Vitamins A. and D. „ WORK OF THE WHARF AND FOOD INSPECTORS, 1934. 1 2 3 4 5 6 7 8 9 10 11 Food Factories Fish Curers Food Stores Food Wharves and Depots Milksellers Restaurants Destruction of Food Nuisances Found Intimations Served Various Number of Samples taken Jam Butter and Margarine Other Food and Drugs Imported Food Regulations Milk(Special Designation) Order Samples of Milk for presence of Tubercle Bacilli Milk (Bacteriological Examination) Ice Cream (Bacteriological Examination) Samples of Milk for presence of Bacillus Abortus 36 2 24 1 176 2069 - - 211 - - 15 - 4 - - - - - 4 18 115 - 280 1965 - - 221 4 3 33 - 16 - - - - - 66 - 109 23 176 1831 127 - - - 23 - 34 - - - - - - - - - - - 552 - - - - 196 1512 - 126 6 20 99 3 - 106 20 248 24 632 5865 552 - 559 4 3 267 1512 54 126 6 20 99 3 MILK PREMISES. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Fifty-one milksellers were registered under the above Act during 1934, and 51 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 9 To sell Grade "A" (Tuberculin Tested) Milk 28 To sell Grade "A" Pasteurised Milk 1 To sell "Pasteurised" Milk 14 Pasteuriser's Licence:— To sell Milk as "Pasteurised" 1 Supplementary Licences:— To sell "Certified" Milk 2 To sell Grade "A" (Pasteurised) Milk 2 To sell Grade "A" (Tuberculin Tested) Milk 4 To sell "Pasteurised" Milk 6 All premises used for the sale of milk are regularly inspected to ensure that the standard of cleanliness laid down is maintained. MILK SAMPLING. Arrangements have been made for the sampling of the milk supplied to all schools in the borough, under the new milk scheme. Samples are taken for both bacteriological and chemical analysis, and so far a good standard has been maintained. Samples have been taken from 38 schools, and a total of 674 milk samples have been examined, as follows: — "For chemical (i.e., Fat and non-Fatty Solids) Examination." Liquid milk undesignated 457 Condensed milk 6 Evaporated milk 2 Machine skimmed milk 1 Homogenized milk 1 Separated milk 6 Sterilised milk 5 Pasteurised milk 2 Pasteurised milk (Informal) 39 519 MILK SAMPLING —continued "For bacteriological examination." Grade 'A' (T.T.) milk 69 Grade 'A' Pasteurised milk 1 Pasteurised milk 56 Liquid milk undesignated 20 For tubercle bacilli 6 For bacillus abortus 3 155 ICE CREAM. Ninety-nine samples of ice cream have been examined with the following results: — 1. Bacterial Count. Below 100,000 per 1 c.c. 73 Over 100,000, but below 200,000 per 1 c.c. 8 Over 200,000, but below 400,000 per 1 c.c. 4 Over 600,000, but below 1 million per 1 c.c. 1 Over 1 million, but below 2 million per 1 c.c. 2 Over 2 million per 1 c.c. 11 2. Presence for B. Coli. B. Coli present in 1 c.c. 1/10th c.c. and 1/100th c.c. 31 B. Coli present in 1 c.c. and l/10th c.c. 20 B. Coli present in 1 c.c. 22 B. Coli absent in tests ranging from 1 c.c. to 1/100th c.c. 26 (89) FOOD AND DRUGS. Articles submitted for Analysis Total samples taken Number genuine Number adulterated Percentages of articles adulterated Acid Tartaric 3 - - 3 Ale (Informal) 2 2 - - Almonds Ground 7 7 - - Apricots Dried 1 1 - - Arrowroot 2 2 - - Aspirin Tablets 2 2 - - Bacon Pressed Boiled 1 1 - - Baked Beans (Informal) 1 1 - - Baking Powder 3 3 - - Barley Pearl 15 15 - - Barley Pot 1 1 - - Beef Corned (Informal) 1 1 - - Beer Bitter (Informal) 1 1 - - Bicarbonate of Soda 1 1 - - Blackcurrant and Aniseed Balsam (Informal) 1 1 - - Blanc-mange Powder 1 1 - - Bloater Paste 1 1 - - Borax Purified 1 1 - - Brandy 2 2 - - Brawn 15 15 - - Brawn Pork 5 5 - - Bread 1 1 - - Burgundy 1 1 - - Butter 216 216 - - Cake 1 1 - - Cake Currant 2 2 - - Cake Dessert 1 1 - - Cake Lemon 1 1 - - Cake Sponge 10 10 - - 21 Cheese 21 - - Cherries 1 1 - - Cherry Coney 1 1 - - Chicken and Ham Roll 2 2 - - Cider 2 2 - - Cinnamon Ground 2 2 - - Citrate of Magnesia 2 2 - - Cocoa 4 4 - - Cocoa-nut Desiccated 1 1 - - Cocoa-nut Ice 1 1 - - Coffee 9 9 - - Coffee Essence 2 2 - - Coffee Extract 1 1 - - Coffee and Chicory 1 1 - - Collared Head 1 1 - - Compound Liquorice Powder 1 1 - - Cornflour 1 1 - - Crab Dressed (Informal) 1 1 - - Cream 2 2 - - Cream Tinned (Informal) 2 2 - - Cream of Celery Soup (Informal) 1 1 - - Cream of Tartar 7 7 - - Cream of Zinc and Castor Oil (Informal) 1 1 - - Currants 3 3 - - Curry Powder 1 1 - - Custard Powder 3 3 - - (90) FOOD AND DRUGS—continued. Articles submitted for for Analysis Number Genuine Number Adulterated Percentage of Articles Adulterated Total Samples Taken Dripping 66 66 - - Egg Substitute Powder 3 3 - - Fat Cooking 7 7 - - Fish Paste 18 18 - - Flour 6 - - 6 Flour Self-Raising 11 11 - French Cream Slices 1 1 - - Fruit Mixed 5 5 - - Fruit Salad (Informal) 1 - - 1 Gherkins 1 1 - - Gin 2 2 - - Ginger 1 1 - - Ginger Ground 3 3 - - Ginger Root 1 - - - Glycerin 5 5 - - Golden Syrup 1 1 - - Grape Fruit (Informal) 2 2 - - Grape Fruit Crush (Informal) 2 2 - - Grape Fruit Juice 1 1 - - Grape Fruit Pastilles (Informal) 1 - - 1 Grape Fruit Squash 4 4 - - Herrings in Tomato Sauce (Informal) 3 - - 3 Honey 1 1 - - Iodine Tincture of 1 1 - - Jam Raspberry 1 - 1 100.0 Jelly Orange 1 1 - - Jelly Raspberry 1 1 - - Lard 11 11 - - Lemon Cheese 1 - - 1 Lemon Curd 1 1 - - Lemonade Powder 1 1 - - Lime Juice Cordial 1 1 - - Linseed Crushed 5 5 - - Loganberries (Informal) 1 1 - - Macaroni Shell 1 1 - - Malt, Extract of (Informal) 1 1 - - Margarine 76 76 - - Marmalade 2 2 - - Marmalade Grape Fruit (Informal) 1 - - 1 Marmite (Informal) 1 1 - - Mayonnaise 1 1 - - Milk 457 446 11 2.4 Milk Condensed 6 6 - - Milk Evaporated 2 2 - - Milk Homogenized 1 1 - - Milk Machine Skimmed 1 1 - - Milk Pasteurised 2 2 - - 39 - - Milk Pasteurised (Informal) 39 Milk Separated 6 6 - - Milk Sterilized 5 5 - - 1 1 - - Milk Pudding Powder Mixed Drops (Informal) 1 1 - - Mustard 12 12 - - Nutmeg Ground 1 1 - - Oatmeal 3 3 - - Oil Camphorated 7 - - 7 Oil Castor 1 - - 1 (91) FOOD AND DRUGS—continued Total Samples Taken Articles submitted f or Analysis Number Genuine Number Adulterated - Oil, Cotton Seed (Informal) 1 1 Oil Olive 3 3 - 1 1 - Oil Soya Bean (Informal) 1 1 - Ointment Basilicon Ointment Boric 4 4 - Ointment Zinc 6 6 - 2 2 Parrish's Chemical Food - - Pears, Tinned (Informal) 1 1 1 1 - Peaches, Sliced (Informal) Peas, Tinned (Informal) 3 3 - Pepper 29 29 - Persian Sherbet 1 1 - Piccalilli 2 2 - Pickles 1 1 - Quinine Ammoniated Tincture of 1 1 - Quinine Tablets 1 1 - Raisins 3 3 - Raisins, Stoneless 1 - 1 Rice 5 5 - Rice, Ground 1 1 - Rissoles, Ham and Tongue 1 1 - - Roll, Ham and Tongue 1 1 Roll, Russian 1 1 - Rum 2 2 - 1 - Saline 1 - Saltpetre 1 1 2 2 - Salts, Epsom Salts, Glauber 2 2 - Sardines (Informal) 1 1 - 5 5 - Sauce Sauce, Chop 2 2 - 5 5 - Sauce, Worcester 33 33 - Sausage, Breakfast Sausage, Ham and Chicken 2 2 - Sausage, Liver 2 2 - - Sausage, Lunch 3 3 1 2 Sausages 3 1 Sausages, Beef 43 42 - 2 Sausages, Beef Chipolata 2 - Sausages, Paris Pork 1 1 - Sausages, Pork 25 25 1 1 Sherry - Sherry, British 1 1 - 2 2 - Spice, Mixed Pickling 1 1 - Sponge Fingers Sponge Rolls - 2 2 Sueflakes 1 1 - Suet, Shredded 7 7 - 4 - Sugar 4 Sugar, Demerara 2 2 - Sugar, Toffee 1 1 - Sugar, Pudding - 1 1 Sultanas 4 4 - Swiss Rolls 1 1 - Tangerine Balls (Informal) 1 - 1 - Tea 3 3 (92) FOOD AND DRUGS— continued Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated Percentages of Articles Adulterated Tomato Catsup (Informal) 3 3 - - Tomato Ketchup 1 1 - - Tomato Ketchup (Informal) 6 6 - - Tomato Sauce 1 1 - - Tomato Sauce (Informal) 8 8 - - Veal, Loaf 1 1 - - Vinegar 32 32 - - Vinegar, Malt 29 27 2 6.88 Vinegar, Raspberry 1 1 - - West Indian Limes (Informal) 1 1 - - Whisky 6 6 - - Wine Australian Red 1 1 - - Wine Blackcurrant Flavoured 1 1 - - Wine Ginger 3 3 - - Wine Green Ginger 1 1 - - Wine, Orange 1 1 - - Wine, Orange Fruit 1 1 - - Wine, Orange Quinine 1 1 - - Wine, Raisin 2 2 - - Wine, White Port 1 1 - - Total 1,512 1,495 17 1.12 PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1934. Sample Adulteration or Infringement Remarks No. 342 Vinegar Deficient in acetic acid, 32.5 per cent. Fined £2 and £1 1s. costs Milk Deficient in milk-fat, 16.0 per cent. Fined £1 10s. and 17s. 6d. costs 549 609 Milk Deficient in milk-fat, 19.7 per cent. Dismissed under Probation of Offenders' Act on payment of £2 2s. costs Beef Sausages Containing Sulphur Dioxide 700 parts per million Two Summonses under Public Health (Preservatives, etc., in Food) Regulations, 1925 — 1927. Fined £10 and £3 3s. costs 549 Sausages Containing Sulphur Dioxide 136 parts per million Two Summonses under Public Health (Preservatives, etc., in Food) Regulations, 1925 - 1927. Retailer fined 20/- Wholesaler fined £2 and £3 3s. costs 794 820 Sausages Sulphur Dioxide, 320 parts per million Two summonses under Public Health (Preservatives, etc., in Food) Regulations, 1925 - 1927. Fined 20/- and £2 2s. costs SUMMARY. £ s. d. Fines 17 10 0 Costs 12 8 6 £29 18 6 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. Article Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs I tons CWt qr lbs tons lbs cwt qr Almonds - - 3 - - - - - - - - - - - - Almond Substitute - - - 2 - - - 2 cases - - - - - - - Anchovy Paste - 9 cases 2 2 14 - - - - - - - - - - Apricot Pulp - 11 cases and 15 tins 13 2 2 - - - - - - - - - - Apricots Tinned - - 141 cases and 24 tins 3 6 2 4 - - - - - - - - Bacon 21 sides, 5 pieces, 1 fore-end and trimmings - 16 1 11 - 10 56 sides 1 8 - - - - - Beef, Corned 1,871 tins 5 58 tins 12 - - 4 1 23 3 - - - - - Beef, Tinned 213 cases 6 16 1 10 - - - - - - - - - - 316 tins Brawn 2 0 1 2 - - - - - - - - - - 4 tins - - - 16 - - - - - - - - - - Brisket Butter 2 boxes and scrapings 2 2 20 - - - - - - - - - - - - - Cauliflower - 5 casks 1 1 2 0 - - - - - - - Caviare - 15 tins 1 17 - - - - - - - - - - Canned Goods - - 119 5 3 9 - - - - - - - - - Canned Meats 36 cases and 390 tins 4 18 2 - 1 - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1915.— continued Quantity Unsound Articles Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Quantity Weight Quantity Weight Quantity Weight tons cwt qr lba tons owt qr lbs tons cwt qr lbs Cheese 1 10 cheese and pieces 6 15 - - - - - - - - - - - Cheese, Gorgonzola 1 3 11 cheese 0 - - - - - - - - - - - Cheese Canadian 1 box 2 7 - - - - - - - - - - - - Cheese Roquefort 16 cases 10 1 - - - - - - - - - 1 cask Cherries in brine 4 - - - - - - - - - - - - Cream 100 cases 8 3 - - - - - - - - - - - - Cucumbers in brine 10 cases 16 - - - - - - - - - - - - - Currants 4 - - - - - - - - - - - - - - Dates 610 cases 16 7 - - - - - - - - - - - - Eggs 2,633 tins 76 hundred, 2 quarter and 6 eggs 125 18 2 14 28 flats 14 - - - - - - - - Fish, Salted 11 barrels 2 - - - - - - - - - - - - - 802 bags Flour 50 2 2 - - - - - - - - - - - Fruit, Tinned 6 cases 3 - - - - - - - - - - - - - 11 cases 2 Game - - - - - - - - - - - - - Gherkins in brine 1 cask 5 - - - - - - - - - - - - - Glands 1 box 1 13 - - - - - - - - - - - - 35 barrels Grape Fruit Juice 8 1 - - - - - - - - - - - - Grape Fruit, Tinned 9 tins 18 - - - - - - - - - - - - - Hams Various 9 19 17 88 tins 9 1 6 - - - - - - - Herring Roes 15 cases 11 2 - - - - - - - - - - - - Kidneys 1 cask 3 - - - - - - - - - - - - - 19 lambs 7 442 lambs 8 3 - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 -continued Quantity Unsound Articles Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Quantity Weight Quantity Weight Quantity Weight -: . tons cwt qr lbs lbs lbs tons CWt qr tons cwt qr Lemons 1 box 3 - - - - - - - - - - - - - Lemon Peel 2 half pipes 14 - - - - - - - - - - - - - 4 tierces Lime Juice 1 - - - - - - - - - - - - - Meat, Canned 78 cases 2 4 - - - - - - - - - - - - Milk, Tinned 108 cases 1 17 3 15 1,764 tins 15 3 25 - - - - - - Milk, Evaporated 144 tins 1 1 12 - - - - - - - - - - - Mutton 6 carcases and hindquarters 3 1 24 - - - - - - - - - - - Oil, Frying 2 tins 1 0 - - - - - - - - - - - - 70 cases and 41 bags 5 1 Onions - - - - - - - - - - - - Oranges 1 case 3 0 - - - - - - - - - - - - Various 1 13 0 0 Oranges, Jaffa - - - - - - - - - - 146 casks 87 10 Orange Juice 0 0 - - - - - - - - - - Orange Pulp 20 cases 18 1 16 - - - - - - - - - - - Oranges, Tinned 253 cases and 265 tins 9 9 2 12 - - - - - - - - - - Partridges 1 tray 1 0 - - - - - - - - - - - - Peaches, Dried 500 boxes 5 11 2 12 - - - - - - - - - - 2 22 Pineapple, Tinned 73 cases and 188 tins 2 10 - - - - - - - - - - Pigs, Tongues - - - - - - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 —continued Quantity Unsound Articles Disposed of for purposes other than Human Food Removed for Sorting under S. A. Destroyed Weight Quantity Quantity Weight Quantity Weight tons lbs lbs cwt qr tons cwt qr tons cwt lbs qr Plums - 6 cases 1 1 10 - - - - - - - - - - Pork 1 hindquarter 20 2 sides 3 3 0 - - - - - - - - - Pork, Corned 9 tins 1 26 - - - - - - - - - - - - Prawns in Glasses 143 glasses 1 2 - - - - - - - - - - - - Rabbits 3 10 4 cases 5 166 cases 3 15 3 12 - - - - - - Rabbits, Tinned 24 tins 1 20 - - - - - - - - - - - - Raisins 25 - - - - - 1 box - - - - - - - - Rice 7 3 26 - - - - - - - - - - - - Rice Sweepings 7 18 2 22 - - - - - - - - - - - Roseline (Fat) - - - - - - - - - - - - - - - Salmon, Fresh 18 cases 10 - 1 basket 1 - - - - - - - - - - Sausage, Breakfast 1 26 - - - - - - - - - - - - - Sausages, Tinned - 6 2 7 - - - - - - - - - - - Sturgeon 35 tins 1 20 - - - - - - - - - - - - Tallow 133 tierces 46 11 - - - - - - - - - - - - Tapioca, Seed Pearl 47 bags 3 6 3 - - - - - - - - - - - Tea 505 cases 30 - - - - - - - - - - - - - Tomatoes, Tinned - - 13 cases and 47 tins - 6 - 25 - - - - - - - - Tomato Paste 105 tins 5 2 21 - - - - - - - - - - - Tomato Puree 11 cases and 36 tins 11 23 - - - - - - - - - - - - - - - - Tongue, Lunch Tinned 128 tins 9 3 5 5 cases and 8 tins 2 3 23 - - - - - - - Tongue, Ox Tinned 8 20 tins 1 18 tins 3 24 - - - - - - - - - - 2 0 Tripe - - - - 1 keg - - - - - - - - 16 birds Turkeys 1 3 1 - - - - - - - - - - Veal, jellied 304 tins 17 1 6 41 tins 2 22 - - - - - - - - Wheat 123 12 1 3 25 - - - - - - - - - - 8 Total Weights I 284 3 2 - 422 15 3 17 6 3 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 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. Monday 2.0 p.m.-4.0 p.m. Thursday 10.0 a.m.-12 noon and 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.1. (Telephone : Langham 2861.) Mr. G. F. Gibberd, F.R.C.S., 14 St. Thomas's Street, S.E.1. (Telephone : Hop 6618) : and 20 Harley Street, W.1. (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.-l 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 at 10.0 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), 10.30 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), 10.30 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), 10.30 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), 10.3 ' 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. 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, 10.30 a.m.- 1.0 p.m. INVALID CHILDREN'S AID ASSOCIATION (Bermondsey Branch) Municipal Offices, Spa Road. Office hours Monday to Friday (inclusive), 9.30 a.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. Town Hall, Spa Road. Monday to Friday (inclusive), 9.30 a.m. to 1.0 p.m. ; 2.0 p.m. to 5.0 p.m. and 5.30 p.m. to 8.0 p.m. Saturday, 9.30 p.m. to 12 noon. 98 Rotherhithe New Road. Monday, Tuesday, Wednesday and Friday, 9.30 a.m. to 1.0 p.m. ; 2.0 p.m. to 5.0 p.m. and 5.30 p.m. to 8.0 p.m. Thursday, 2.0 p.m. to 5.0 p.m. and 5.30 p.m. to 8.0 p.m. ; Saturday, 9.30 a.m. to 12.0 noon. Patients are seen by appointment only. Appointments can he made either by personal call or by letter. 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 6301, 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 6301, or Regent 4000. 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 At any hour of the day or night—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. Henry Richardson Ltd. Printers 4, Church Street, Greenwich. S.E.10