M BER 49 Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1936 BY D. M. CONNAN, M.D., D.P.H., Medical Officer of Health. BER 49 Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1936 BY D. M. CONNAN, M.D., 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 Are a 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 Scheme for the Medical Examination of Children after Infectious Disease 19 Infectious Disease 19 Diphtheria 21 Scarlet Fever 22 Enteric Fever 22 Small Pox 28 Whooping Cough and Measles Regulations, 1936 28 Whooping Cough 28 Measles 28 Ophthalmia Neonatorum 29 Puerperal Fever and Pyrexia 29 Disinfection 29 Cleansing Station 30 Shelter 30 Bacteriological Laboratory 31 Food Poisoning 31 Foot Clinic 32 Insulin for Diabetic Patients 33 Nursing 34 Cases Notified in 1936 35 Cases Notified for last ten years 36 TUBERCULOSIS— New Cases and Deaths 37 Period between Notifications and Deaths 37 Nursing and Extra Nourishment 40 Shelters 41 Lady Almoner 41 2 PAGE Public Health (Prevention of Tuberculosis) Regulations, 1925 42 1925 42 Work of the Tuberculosis Dispensary 43 Summary of Notifications 44 Cases on the Register 45 LIGHT TREATMENT— Work done in the Solarium 46 Leysin Patients 50 MATERNITY AND CHILD WELFARE— Special Clinic for Women 52 Fairby Grange Convalescent Home 53 Midwifery Service 53 Obstetric and Puerperal Fever Consultants 54 Infant Life Protection 54 Maternal Mortality 54 Work of the Health Visitors 55 Attendances at Centres 56 Extracts from Vital Statistics, 1936 57 DENTAL TREATMENT— Particulars of Children Treated 59 Particulars of Treatment and Work for 1936 60 PUBLIC HEALTH CENTRE 61 PROPAGANDA 69 SANITARY ADMINISTRATION— Housing 72 Housing Act, 1935 —Overcrowding 74 Eradication of Bed Bugs 75 Inspections and Proceedings 76 Work of the District Inspectors 79 Factories and Workshops —Homework 80 Factories and Workshops —Inspections 81 Bakehouses 82 House, Trade and Market Refuse 82 Offensive Trades 82 Mortuary 83 Street Markets 83 Drainage Work 83 Work of Factories and Shops Inspector 83 FOOD CONTROL— Unsound Food —Shops and Stalls 84 Imported Food Regulations—Samples Taken 84 Work of the Wharves and Food Inspectors 91 Milk Premises 92 Milk Licences 92 Milk Sampling 92 Ice Cream 93 Pharmacy and Poisons Act, 1933 94 Food and Drugs—Samples Taken 95 Food and Drugs—Prosecutions 100 Unsound Food—Wharves, etc. 102 HEALTH SERVICES 107 (3) PUBLIC HEALTH DEPARTMENT. PUBLIC HEALTH COMMITTEE, 1936. Chairman Councillor E.J. GIBSON, 1935-36 „ „ S. R. WEIGHTMAN, 1936-37 Vice-Chairman „ S. R. WEIGHTMAN, 1935-36 „ „ „ C. J. LEE, 1936-37 Alderman A. E. Hatcher Councillor A. V. Kidd „ A. V. Parker „ Mrs. R. E. Laker Councillor Mrs. S. C. Amos „ F. W. Love „ H. A. Beal „ W. S. McKay „ R.A.W. Butchers „ Miss E. M. Nix „ W. T. Cockett „ Mrs. F. A. Powell „ Mrs. E. V. Coyle „ J. W. Simmonds „ F.J.W. Fielder „ G. H. Stean „ Miss K. Groves „ W. A. Stocker „ Mrs. A. M. Hatcher „ J. A. Wright „ Mrs. F. Humphreys Ex-officio: Councillor G.LOVELAND, J.P., Mayor of Bermondsey, 1935-36. Councillor E. J. GIBSON, J.P., Mayor of Bermondsey, 1936-37. MATERNITY AND CHILD WELFARE COMMITTEE, 1936. Chairman Councillor Mrs. E. V. COYLE, 1935-36, 1936-37 Vice-Chairman „ Mrs.A. M. HATCHER, 1935-36 „ „ „ Mrs. F. A. POWELL, 1936-37 Alderman G. R. Balleine, Councillor Mrs. F. I. M. Husk M.A. „ Mrs. R. E. Laker „ Mrs. D. A. Green „ G. Loveland „ Miss M. I. Henrich „ Miss E. M. Nix „ Mrs. L. Jones „ Mrs. A. E. Pitt Councillor Mrs. A. M. Fortescue „ S. R.Weightman „ E.J. Gibson „ J. A. Wright „ Mrs. L. A. Glasson Co-opted Members: Mrs. E. R. Balman Mrs. W. Miller Miss E. M. Haslam Mrs. H. Richardson Rev. R. M. Kedward Mrs. E. C. Starr Miss J. Langley Ex-officio: Councillor G. LOVELAND, J.P., Mayor of Bermondsey, 1935-36. Councillor E.J. GIBSON, J.P., Mayor of Bermondsey, 1936-37. (4) STAFF: — MEDICAL OFFICER OF HEALTH. D. M. Connan, M.D., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H. SANITARY INSPECTORS: J.G. Frankson, Wharves and Food Inspector. G.A. Hoskins, Wharves and Food Inspector. G.F.J. Toll, Wharves and Food Inspector. E.J. Pitts, Market Inspector. H.E. Butcher, Food and Drugs Inspector. W.C. Tapsfield, Factories and Shops Inspector. District Inspectors. W. Davis, Senior District Inspector and Drainage Inspector No. 1—F.J. Carpenter No. 5 —A.W. Hancock No. 2—H.J. Bailey No. 6 —W.A. Pilson No. 3 —L.T. Knott No. 7—O.W.R. Smart No. 4—W.A. Campbell No, 8—F.L. Richardson 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. Tuberculosis Nurse (Open-Air School)—Celia Clapson LADY ALMONER. Olive Pike. LIGHT TREATMENT CENTRE. Medical Officer in Charge—Florence L. Telfer, M.D., D.M.R.E. Solarium Nurses—Mrs. Dorothy Cottier, Estelle Jagôt, Muriel Coleby, Joyce Hopkins and Gladys Warry. MATERNITY AND CHILD WELFARE. Assistant Medical Officers for Maternity and Child Welfare- Ruth W. Plimsoll, M.B.S., D.P.H.; Florence L. Telfer, M.D., D.M.R.E. Health Visitors. Rosa Bache Gwendolen Riches Sarah Bowles Edith Riley Lucy Brown Florence Robson Amy Carlton Florence Wadds Marie Helden Isabel White Elizabeth Lawrence FAIRBY GRANGE CONVALESCENT HOME. Matron—Florence Child Sister—Ann O'Meara (5) SPECIAL CLINIC FOR WOMEN. Consultant Gynæcologist—Gladys Dodds, M.D., D.P.H., M.C.O.G., F.R.C.S. (Edin.). X-RAY SECTION. Radiologist—Florence L. Telfer, M.D., D.M.R.E. Radiographer—C. F. Lumley. 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—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, F.I.P.A., M.I.H. CLERICAL STAFF: A.I. Fair, Chief Clerk J.W.J. Saward, General Clerk F.W. Smith, Second Clerk Alice Jones, General Clerk C.W. Whye, General Clerk J.A. Blake, General Clerk A. Manning, General Clerk J.F.M. Brooker, General Clerk C.F. Yaxley, General Clerk F. Cornwell, Junior Clerk Rose Dutch, Clerk & Dispenser H.D. White, Junior Clerk H.J. Smith, General Clerk F.H. Mummery, Junior Clerk F.R. Parker, General Clerk J.L. Springett, Junior Clerk C.H. Harris, General Clerk DISINFECTING AND CLEANSING STATION: A.C. Davidson, Foreman in Charge. PUBLIC HEALTH DEPARTMENT. MUNICIPAL OFFICES, SPA ROAD, S.E.16 (6) 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 1936, and in doing so I desire to offer my thanks to the Chairmen and Members of Committees for their unfailing support during the year. It is a pleasure also to express my appreciation to the staff for their loyalty, goodwill and hard work. One event in particular has marked this year, namely the opening of the Bermondsey Public Health Centre, and I am sure that the staff would wish to join with me in expressing thanks to the Council for the greatly improved working conditions. A short statement concerning the new centre will be found on page 61. I am, Sir, Ladies and Gentlemen, Your obedient Servant, D.M. CONNAN. (7) 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 1936 according to the Rate Books was 19,402. The rateable value of the borough on the 31st December, 1936 was £868,889, the product of a penny rate being £3,466. POPULATION. Estimate of Registrar General Census to 30th June, 1935 to 30th June, 1936 1921 1931 119,452 111,542 102,700 100,400 BIRTHS. The total number of births belonging to the borough registered during 1936 was 1545, consisting of 818 males and 727 females. The number for 1935 was 1,487. The birth rate for 1936 was 15.4 per 1,000 persons living, compared with 14.5 for 1935. (8) DEATHS. The total number of deaths belonging to the borough registered during 1936 was 1,289, consisting of 728 males and 561 females. The number for 1935 was 1,201. The death rate for 1936 was 12.8 per 1,000 persons living, compared with 11.7 for 1935. MARRIAGES. The total number of marriages in the borough in 1936 was 970, being 57 below the number for 1935, and 41 below the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 19.32 per 1,000 of the population, compared with a marriage rate last year of 20.00. Year No. Rate 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 1934 1,050 19.91 1935 1,027 20.00 Average for years 1926—1935 1,011 18.02 1936 970 19.32 (9) INFANTILE MORTALITY. Whole Borough London Year Rate per 1,000 Births Rate per 1,000 Births No. of Deaths No. of Deaths 146 5,067 64 1926 60 1927 149 67 4,357 59 1928 178 85 4,879 67 160 1929 71 4,995 71 1930 130 63 4,109 59 1931 112 57 4,270 65 1932 103 56 4,143 67 1933 92 61 60 3,377 1934 100 64 3,832 67 1935 103 69 3,229 58 65 4,226 64 Average for year 1926-1935 127 60 * 1936 92 * TUBERCULOSIS OF THE RESPIRATORY SYSTEM. In the following Table will be found particulars of deaths from Tuberculosis of the Respiratory System since the year 1926. Sub-District Bermond sey Rotherhithe St. Olave Whole Borough London Rate Year No. No. Rate No. No. No. 1926 100 151 4066 0.88 39 1.23 12 1927 87 88 42 15 144 1.19 4140 0.91 1928 43 12 143 1.24 3985 0.89 1929 78 117 1.03 31 8 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 1.05 34 11 116 3564 0.82 1933 68 3530 23 8 99 0.92 0.82 1934 64 22 4 90 3227 0.76 0.86 1935 70 23 5 98 0.95 2847 0.68 Averages for years 1926-1935 79 32 9 121 1.07 3732 0.85 51 22 6 * 1936 79 0.79 * *These figures are furnished by the Medical Officer of Health, London County Council, and were not available at the time of going to press—19th May, 1937. (10) INFANTILE MORTALITY RATE FOR 25 YEARS. VITAL STATISTICS OF WHOLE DISTRICT DURING 1936 AND PREVIOUS YEARS. Year 1 Population pestimated to Middle of each Year 2 Births Total Deaths registered in the District Total Deaths in Public Institutions in the District 9 Deaths of Non-Residents 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 Under 1 Year of Age At all Ages Rate 4 No. 12 Rate 13 No. 5 No. 7 Rate per 1,000 Births registered6 Rate 8 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 1,169 596 92 331 1,408 12.5 46 10.4 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 1934 105,060 1,557 14.8 77 49 1,223 11.6 784 229 310 1,304 12.4 102,700 1,487 14.5 99 67 1,142 11.1 756 255 314 1,201 11.7 1935 Averages for years 1926-1935 112,446 1,938 17.1 102 53 1,200 10.7 684 115 344 1,429 12.7 12.8 (12) 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 Ladywell Institution All Saints' Hospital, Southwark 1 45 Ambulances on way to Hospital 7 Archway Hospital, Islington 1 Battersea General Hospital 1 Bermondsey Medical Mission Hospital Bethlem Royal Hospital, Croydon 1 Bexley Mental Hospital, Bexley 8 2 Brighton Municipal Hospital, Brighton 1 Brook Hospital, Shooters Hill 4 Cancer Hospital, Chelsea 1 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc. Church Army Sanatorium, Heath End 1 City Hospital, Plymouth 1 Claybury Mental Hospital, Woodford Bridge 2 Colindale Hospital, Hendon 2 10 Constance Road Institution, Camberwell 4 Cornelia Hospital, Poole 1 Private Houses 1 County Mental Hospital, Macclesfield 1 Dulwich Hospital 3 Evelina Hospital 3 Total 175 French Hospital, Holborn 1 German Hospital, Hackney 1 Grove, The, Epsom 1 Grove Hospital, Tooting 1 Guy's Hospital 55 Hammersmith Hospital 1 High Wood Hospital, Brentwood 1 Holborn and Finsbury Institution, Shoreditch 1 Horton Hospital, Epsom 6 Hospital, The, Coulsdon 8 Hospital of St. John and St. Elizabeth, St. Marylebone 1 Hundred Acres, Banstead 3 Infants' Hospital, Westminster 2 Infirmary, The, Friern Barnet 1 Italian Hospital, Holborn 1 Joyce Green Hospital 1 Kingston and District Hospital, Kingston-on-Thames 1 Ladywell Institution 45 Lambeth Hospital 9 Leavesden Mental Hospital, Watford 1 Lewisham Hospital 6 London Jewish Hospital, Stepney 1 Maltings Farm Sanatorium, Nayland 1 Metropolitan Hospital, Caterham 2 (13) OTHER INSTITUTIONS, Etc., Etc.—continued Institutions outside the District receiving sick and infirm persons from the District. Institutions, etc., within the District receiving sick and infirm persons from outside the District. Other Institutions, etc., the Deaths in which have been distributed among the several localities in the District. No. of Deaths Metropolitan Hospital, Hackney 1 Miller General Hospital, Greenwich 2 Newington Institution, Southwark 2 Park Hospital, Hither Green 10 Petersfield Hospital, Petersfield 1 Princess Elizabeth of York Hospital, Shadwell 2 Private Houses 10 Queen Mary's Hospital for Children, Carshalton 1 Railway 1 Ramsgate General Hospital, Ramsgate 1 River Thames 2 Royal Hants County Hospital, Winchester 1 Royal Waterloo Hospital 2 St. Alfege's Hospital, Greenwich 8 St. Alfege's Institution, Greenwich 12 St. Andrew's Hospital, Poplar 1 St. Bartholomew's Hospital 1 St. Columba's Hospital, Hampstead 1 St. George-in-the-East Hospital, Stepney 8 St. Gile's Hospital, Camberwell 10 St. John's Hospital, Battersea 1 St. John's Hospital, Lewisham 2 St. Joseph's Hospice, Hackney 2 St. Leonard's Hospital, Shoreditch 2 St. Nicholas Hospital, Woolwich 1 St. Thomas's Hospital 3 Sea at Brighton 1 Seaman's Hospital, Greenwich 3 South-Eastern Hospital, New Cross 14 South-Western Hospital, Stockwell 1 Street 1 Tooting Bec Hospital 21 University College Hospital, St. Pancras 1 Westcliff Nursing Home, Westcliff-on-Sea 1 West Hill Hospital, Dartford 2 Westminster Hospital 1 West Park Mental Hospital, Epsom 1 Total 328 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1936. Causes of Death Deaths at the subjoined ages of " Residents " whether occurring in or beyond the District. All Ages 2 and under 5 5 and under 15 15 and under 25 45 and under 65 65 and up wards Under 1 1 and under 2 25 and under 45 All Causes 1289 92 27 18 37 126 378 588 Certified 23 Uncertified - - - - - - - - - Typhoid and Paratyphoid Fever 4 - - - 2 - 2 - - Measles 20 2 13 5 - - - - - (14) Scarlet Fever - - - - - - - - - Whooping Cough 5 1 2 2 - - - - - Diphtheria 8 - 1 5 2 - - - - Influenza 5 - - - - - - 3 2 Encephalitis Lethargica - - - - - - - - - Cerebro-spinal Fever 2 1 - - - 1 - - - Tuberculosis of Respiratory System 79 1 - 1 2 11 29 29 6 Other Tuberculous Diseases 15 2 - 2 1 3 3 2 2 Syphilis 3 1 - - - - 2 - - General Paralysis of the Insane, tabes dorsalis 3 - - - - 2 1 - - Cancer, Malignant Disease 180 - - - - 3 14 75 88 Diabetes 10 - - - - 1 3 6 - Cerebral Hæmorrhage, etc. 107 2 - - - - 2 35 68 Heart Disease 282 - - - - 3 16 76 187 Aneurysm 5 - - - - - - - 5 Other Circulatory Diseases 11 - - - - - - 2 9 39 Bronchitis 107 5 - - - 6 57 - CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1936—continued. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the district. Causes of Death All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and up wards Pneumonia (all forms) 111 15 10 1 1 3 8 32 41 Other Respiratory Diseases 11 - - - - - - 8 3 Peptic Ulcer 20 - - - - - 4 15 1 Diarrhæa, etc. 19 14 1 - - - 3 1 - Appendicitis 9 - - - - 1 2 3 3 Cirrhosis of Liver 2 - - - - - 1 1 - Other Diseases of Liver, etc, 3 - - - - - 1 2 - Other Digestive Diseases 22 - - - 1 1 1 9 10 Acute and Chronic Nephritis 52 - - - 3 2 5 11 31 Puerperal Sepsis 2 - - - - - 2 - - Other Puerperal Causes 7 - - - 7 - - - - Congenital Debility, Premature Birth, Malformations, etc, 41 41 - - - - - - - Senility 34 - - - - - - 34 - Suicide 15 - - - 1 4 8 2 - Other Violence 35 - - 2 5 8 8 12 - Other Defined Causes 60 7 - 2 9 3 8 14 17 Causes ill-defined or unknown - - - - - - - - - 92 23 37 126 378 588 1289 27 18 DEATHS FROM ZYMOTIC DISEASES, 1936. Year All Causes Principal Zymotic Diseases Smallpox Measles Diphtheria Whooping Cough Enteric Fever Scarlet Fever Diarrhœa No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate 1484 12.1 94 .76 - - 24 6 42 .34 1 - - 21 .17 1926 .19 .06 .01 1927 1566 12.9 45 .37 - 9 .07 - - 13 .11 10 .08 1 - 12 .09 - 1928 1520 13.2 137 1.19 - - 77 .67 3 .03 16 .14 26 .23 1 .01 14 .12 1929 1650 14.5 62 .54 - - 1 .01 2 .02 6 .05 33 .29 1 .01 19 .17 1930 1488 13.1 101 .89 - 61 .54 7 .06 8 .07 6 .05 2 .02 17 .15 - 1408 12.5 24 .21 - 3 1 .01 6 .05 5 .04 - 9 08 1931 .03 - - 1932 1326 12.0 67 .61 1 .01 25 .23 - 11 .10 16 .15 - - 14 13 - 1933 1340 12.5 45 .42 - - 9 .08 4 .04 13 .12 5 .05 - - 14 .13 1304 12.4 87 .83 - 38 .36 1 10 .10 10 .10 - 28 .26 1934 .01 - - 1935 1201 11.7 54 .53 - - 4 .04 - - 10 .10 5 .05 - - 30 .34 Average for years 1926-1935 1429 72 .63 - - 25 .22 2 .02 13 .12 12 .10 - - 18 12.7 .16 1289 56 .56 - - 20 .20 - 8 5 .05 4 0.4 19 INFANTILE MORTALITY. Deaths from Stated Causes at Various Ages under One Year of Age, 1936. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 1 month 1—3 months 3—6 months 6-9 months 9—12 months Total under 1 year Measles - - - - - - - 2 2 - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 1 - - - 1 Diphtheria - - - - - - - - - - Influenza - - - - - - - - - - Cerebro-spinal Meningitis - - - - - - - 1 - 1 Tuberculous Meningitis - - - - - - - 2 - 2 Other forms of Meningitis - 1 - - 1 1 - - - 2 Tuberculosis of Respiratory System - - - - - - 1 - - 1 Other Tuberculous Diseases - - - - - - - - - - Syphilis - - - - - 1 - - - 1 Bronchitis - 1 - 1 2 2 1 - - 5 Pneumonia (all forms) - 2 - - 2 - 5 6 2 15 Other Respiratory Diseases - - - - - - - - - - Diarrhoea and Enteritis - - 2 - 2 2 10 - 14 - Congenital Debility and Malformation, Premature Birth 14 2 5 1 22 3 - - 27 2 4 1 - - 5 - - 5 Injury at Birth - - Other Causes 10 1 - - 11 1 1 1 2 16 II. —INFECTIOUS DISEASES, ETC. The following diseases are notifiable: — Anthrax Acute Polioencephalitis Acute Poliomyelitis Acute Primary Pneumonia Cholera. Acute Influenzal Pneumonia Cerebro Spinal Meningitis Continued Fever Diphtheria Dysentery Encephalitis Lethargica Enteric Fever and Typhoid Fever Erysipelas Glanders Hydrophobia in Man Malaria *Measles Membranous Croup Ophthalimia Neonatorum Puerperal Fever Puerperal Pyrexia Relapsing Fever Scarlet Fever and Scarlatina Small-pox Typhus Tuberculosis —all forms *Whooping Cough *Applies to children under five years of age, and then only to first case in household ; subsequent cases occurring in the same household within a period of two months from the date of first notification are not required to be notified. Owing to the housing conditions of the Borough, it is the practice to remove to hospital nearly all cases of diphtheria and scarlet fever. Before referring to particular diseases under this heading it will be convenient to summarise the methods adopted in the Department for dealing with infectious diseases generally. Cases of infectious disease come to my notice either by notification or by report from various sources. The first step is taken by the District Sanitary Inspector who visits the premises immediately, either on the same day or the morning immediately following. He verifies the particulars already obtained, ascertains the names of contacts together with the names of the schools attended or the place of work. He also investigates the source of infection and arranges for the swabbing of contacts or the disinfection of bedding (18) and premises where these measures are necessary. In appropriate circumstances the head teachers of schools are notified and the London County Council regulations with regard to exclusion of both patients and contacts are enforced. There are two exception to this general arrangement. All cases of tuberculosis are dealt with directly by means of the Tuberculosis Dispensary organisation, visits being paid at regular intervals to the homes of all notified patients, and in the case of measles and whooping cough, since so many of the patients are children, the visiting is done by the Health Visitors and not by the Sanitary Inspectors. Special enquiries of any kind in connection with infectious diseases are made by the Sanitary Inspector, and the body of a person who has died from any infectious disease is not allowed to remain at home or to return home from hospital, unless the Sanitary Inspector is able to satisfy me that this procedure would be absolutely safe and reasonable. In view of the fact that so many children are found on entry to school to be suffering from physical defects more or less serious in nature, a scheme was worked out in the Department for the examination of all children following an attack of infectious disease. Unfortunately it was not possible to put this scheme into operation until comparatively late in the year, and so I am not in a position to make any report upon the subject this year, but I hope to be able to include full details in subsequent annual reports. SCHEME FOR THE MEDICAL EXAMINATION OF CHILDREN AFTER INFECTIOUS DISEASE. All cases of scarlet fever, diphtheria, acute primary and acute influenzal pneumonia, measles and whooping cough, of and below school age, will be visited by the Health Visitor three months after the date of notification, and if she finds any case in which, in her opinion, medical examination is desirable and the child is not already under a doctor or hospital, she will endeavour to obtain the parents' consent for an appointment to be made for the child to be examined. (19) In the case of children under 5 in which the parents' consent has been obtained, the Health Visitor will herself arrange for the child to be examined at the appropriate Maternity and Child Welfare Centre. In the case of children over 5 she will note on the "Following-up" Card that the parents are willing for an appointment to be made. These children will be examined at special clinics, the arrangements for which will be made by the Medical Officer of Health. The names and addresses of children to be visited will be furnished to the Health Visitor by the Medical Officer of Health on special "Following-up" Cards, which will be prepared from the Notification Registers and forwarded weekly. The Health Visitor will note on this card any ailment or disease the child may have as the result of infectious disease; whether she herself has arranged for medical examination in the case of a child under 5, or whether in the case of a child over 5 she wishes the Medical Officer of Health to arrange for examination; the reason for non-examination, e.g., "perfectly well," " under doctor or hospital," "parents refuse," etc. Cards will be returned to the Medical Officer of Health on completion, details recorded in Notification Registers, and arrangements for medical examination made, where necessary. Notification Registers will be frequently scrutinized to ensure that all cases are visited, and that cards are received back from the Health Visitors. Medical Officers carrying out examinations will complete a Medical Examination Form for each case examined, on which will be recorded the history of infectious illness, details of the condition on examination, and of the action taken, if any, to ensure that the patient is receiving proper treatment. These forms, when completed, will be forwarded to the Medical Officer of Health, who will take any action deemed necessary; they will then be classified for statistical purposes and recorded in the Notification Registers. (20) It will be noted that the Health Visitor is to visit three months after the date of notification. This period is, of course, only approximate, and is varied according to circumstances. A child is not normally discharged from hospital unless it is fit to return home, and it appears reasonable to allow a short time to elapse between the attack of illness and the examination, so that sequelae may be distinguished from the actual ill-effects of the disease itself. Although this scheme has only been in operation for a short time, it appears likely to provide some very interesting information, and at the same time achieve beneficial results so far as the children themselves are concerned. It involves also a very considerable increase of work for the Health Visitors and for Mr. F.W. Smith, who has devised and is in charge of the statistical and clerical side of this work. DIPHTHERIA. The number of cases of this disease notified to me during the year was 207, and as 27 cases were returned from hospital as "not suffering "from diphtheria the net total was 180. It is twenty-seven years since the number of cases of diphtheria reached so low a figure (1910), and as this disease has for many years been a cause of anxiety both to the Medical Officer of Health and to the Public Health Committee, the low figure this year is recorded with gratitude. For some considerable time now, I have made a practice of informing the practitioner who notified the case to me, when such a case was returned from hospital as "not suffering" from the disease for which it was notified. I think it would be a decided advantage if a definite diagnosis could be made at the hospital and returned to me where this is possible, instead of the rather vague and negative statement that the patient was found to be "not suffering" from the disease notified. There were eight deaths from diphtheria during the year, and I would take this opportunity of impressing upon practitioners the necessity for speed in the diagnosis and treatment of this (21) disease, and of observing that it is not necessary to wait for the result of a swab before giving antitoxin. Further, I would reiterate the fact that antitoxin will be supplied free on application to this Department. Four of the eight deaths were due to heart failure, the remaining four being caused by toxaemia; there was one tracheotomy. While I am happy to be able to record a reduction in the number of cases of this disease it would give me still greater pleasure to be able to state that there had been no deaths, since a death from this disease almost always means inefficiency in the application of preventive measures which are well established. The accompanying table shows the attendances at the two Schick Clinics, which exceed those of last year by 345 in spite of the fact that the Rotherhithe Clinic was closed for three months on account of the illness of the medical officer of that clinic. No. of No. of new Total Sessions patients Attendances Municipal Offices, Spa Road 58 206 901 98 Rotherhithe New Road 38 132 704 Totals 96 338 1,605 SCARLET FEVER. The number of cases of scarlet fever notified during the year, namely 266, shows a welcome reduction, and is the lowest since 1918. Ten cases were found to be "not suffering" from scarlet fever, giving a net figure of 256. There were no deaths from this disease. (22) NOTIFIED CASES OF DIPHTHERIA FOR 25 YEARS. NOTIFIED CASES OF SCARLET FEVER FOR 25 YEARS. ENTERIC FEVER. Un fortunately while there is cause for a certain measure of congratulation in so far as diphtheria and scarlet fever are concerned, this is not the case with regard to enteric fever, the number of cases for this year being the highest since 1915. In all 15 cases were notified during the year, and of these in 6 cases the diagnosis was inaccurate, so that actually 9 cases of enteric fever occurred in the borough during the year. The first of these cases was notified in March, and in spite of careful investigation the source of infection was not traced ; this patient recovered. The remaining 14 cases were notified between 27th August, 1936 and Ist September, 1936, and a summary of the information relating to these cases is appended, from which it will appear that the source of infection was certainly not within the borough, and that these cases may have derived from the larger epidemic mentioned in the summary. There were some peculiarly sad features associated with this epidemic, small though it was, and I regret to have to record that three of the patients died. There was one other death from enteric fever allocated to the borough this year, that of a patient in Cane Hill Mental Hospital who had formerly lived in Bermondsey. This case was not notified since the diagnosis was only made post mortem. (23) SUMMARY. Observation as to (1)Enteric or other similar recent illness in home; (2) Food supply of infection, and (3) Movements if away at that time Occupation or School Date Of Onset Hospital and date admitted Bacteriological results Age and Sex Intials of Patient Date Notified Result Notifield as Enteric Fever 14 F. P.C. 14/8/36 27/8/36 Biscuit Packer Died in Park Hospital 11/9/36 Certified cause of death : 1. a General Peritonitis b Perforated intestinal ulcer c Typhoid Fever With the exception of D.C. (who contracted the disease from her sister P.C.) all the definite oases were members of a party of the Rotherhithe Girl Guides, who stayed at Brighton during the period 23rd July to 8th August After careful investigation, including the bacteriological exam Enteric Fever 42 F. B.C. 12/8/36 27/8/36 St. Olave's Hospital 26/8/36 Park Hospital— 27/8/36 Blood Culture: B. Typhosus present Faeces and urine: B. Typhosus present St. Olave's Hospital —22/8/36 Park Hospital— 27/8/36 Blood Culture— B. Typhosus present Widal— B. Typhosus "H" 1 in 2000 B. Typhosus "O" 1 in 2000 Faeces and urine- Negative for B. Typhosus Sputum— Negative for B. Typhosus Tinned Fruit Packer Died in Park Hospital 31/8/36 Certified cause of death :— 1. a Broncho pneumonia and toxaemia b Typhoid Fever (24) Initials of Patient Date of Onset Hospital and date admitted Bacteriological results Occupation or School Observations as to (1) Enteric or other similar recent illness in home; (2) Food supply at presumed time of infection, and (3) Movements if away at that time Notified as Age and Sex Date Notified Result Redriff School 6/8/36 St.Olave's Hospital -27/8/36 Park Hospital-27/8/36 Faeces and urine both negative, but shows following agglutinating:- B. Typhosus "H" and "O" 1 in 240 ination of the persons who handled the food of the party 1. No source of this epidemic has been traced in this borough Recovered Enteric Fever 11 F. O.P. 27/8/36 Clerk Enteric Fever 2. Cockles and whells purchased from the beach stalls at Brighton were consumed by several members of the party, and 15 F. H.W. 21/8/36 27/8/36 Recovered Park Hospital— 27/8/36 Blood Culture— B. Typhosus present Faeces and urine— B. Typhosus negative Widal— B. Typhosus "H" 1 in 240 B. Typhosus "0" 1 in 480 (25) Observations as to (1)Enteric or other similar recent illness in home; (2) Food supply at presumed time of infection, and (3) Movements if away at that time Age and Sex Date of Onset Initials of Patient Hospital and date admitted Bacteriological results Occupation or School Notified as Date Notified Result M.L. 13 F. 25/8/36 27/8/36 Park Hospital-27/8/36 Blood C1ulture- B. Typhosus Present Widal-Negative Faeces-Positive B.Typhosus Redriff School it is definitely established that five of the positive cases partook of these shellfish Died Park Hospital 31/8/36 Certified cause of death: 1. a Toxæmia and b Typhoid fever Recovered Enteric Fever 11 F. Redriff School A.W. 16/8/36 Enteric Fever 28/8/36 Park Hospital-28/8/36 Faeces and urine both negative, but shows following agglutinating titre to B. Typhosus "H" and "O" 1 in 240 3. Communication with the Medical Officer of Health, Brighton, has established the fact that cases at Brighton were connected with the Bournemouth epi- A.E. 17/8/36 Recovered Enteric Fever 14 F. 28/8/36 Park Hospital— 28/8/36 Faeces and urine both negative but shows following agglutinating titre to B. Typhosus— B. Typhosus "H" and "0" 1 in 500 Conveyor, Biscuit Factory (26) SUMMARY- (continued). Observations as to (1) Enteric or other similar recent illness in home; (2) Food supply at presumed time of infection, and (3) Movements if away at that time Initials of Patient Hospital and date admitted Bacteriological results Age and Sex Occupation or School Date of Onset Date Notified Result demic, and there may be some connection between the Brighton and Bermondsey cases D.C. 31/8/36 Redriff School Recovered 1/9/36 7 F. Park Hospital— 1/9/36 Blood Culture — Positive for B. Typhosus Faeces and urine— B. Typhosus present All these patients were investigated both clinically and bacteriologically, and all reports were negative. They were all discharged from hospital as "Not suffering" from Enteric Fever E.C. 21/8/36 27/8/36 Park Hospital— 27/8/36 Packer E.C. 26/8/36 29/8/36 Housewife 36 F. Park Hospital— 29/8/36 31/8/36 29/8/36 Housewife 61 F. E.B. Park Hospital— 31/8/36 Church Worker F.W. 27/8/36 29/8/36 Brook Hospital— 29/8/36 Park Hospital— 31/8/36 53 F. P.T. Church Worker 29/8/36 29/8/36 Brook Hospital— 29/8/36 Park Hospital— 31/8/36 29 F. 27/8/36 Maid E.R. 29/8/36 26 F. Brook Hospital— 29/8/36 Park Hospital— 31/8/36 39 F. SMALL-POX. One or two patients in whom there was suspicion of small-pox were seen during the year by the Medical Officer of Health, but no genuine cases occurred and there were no re-vaccinations under the Public Health (Small-pox Prevention) Regulations, 1917. WHOOPING COUGH AND MEASLES REGULATIONS, 1936. The Bermondsey (Whooping Cough and Measles) Regulation, 1936, which came into force on the 1st October, 1936, make these two diseases compulsorily notifiable in certain cases of children under five. These regulations apply to the first case occurring in a household ; subsequent cases occurring in the same household within a period of two months from the date of the first notification are not required to be notified. WHOOPING COUGH. The total number of cases of whooping cough brought to my notice during the year was 407; of this number 103 were notified under the regulations during the last quarter of the year, and 304 were reported to me from various sources. Eighty-seven patients were treated in hospital and nursing was provided for 12 patients at home. There were five deaths, four of which occurred in hospital and one at home; all were due to broncho pneumonia. MEASLES. The total number of cases notified and reported was 1,288, which is very slightly less than the number reported during the last epidemic; 329 patients were removed to hospital and nursing was provided for 117 patients at home. There were 20 deaths from this disease, 17 in hospital and three at home. The deaths all occurred between January and May, and in 16 cases broncho pneumonia was a contributory cause of death. In the remaining cases the contributory causes of death were lobar pneumonia (1), infantile convulsions (1), septicaemia and osteomyelitis (1), and toxaemia and otitis media (1). (28) OPHTHALMIA NEONATORUM. The subjoined table shows the number of cases of this disease notified during the year. The total number of cases last year was five. Nursing was provided in one instance. Cases Vision Impaired Total Blindness Deaths Treated Vision Un Impaired Notified At home In Hospital 5 6 1 6 - - - PUERPERAL FEVER AND PUERPERAL PYREXIA. There were 6 cases of Puerperal Fever this year as compared with 3 last year and 2 in 1934, and 9 cases of Puerperal Pyrexia as compared with 19 last year and 13 in 1934. 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 1 Bacteriological examinations Nil Admitted to Hospital 13 DISINFECTION. Disinfection of premises and of articles exposed to infection is insisted upon in all cases of notifiable infectious disease. Respect is always had as far as possible to the convenience and comfort of the householder. Rooms are sealed up for disinfection and beds, bedding, clothes and other articles are removed and disinfected at the station. Pillows (cases) 1,743 Quilts 1,265 Sheets 1,626 Furniture 2,299 Miscellaneous 6,810 Verminous Clothing 1,511 „ Bedding 4,289 Scabies, Clothing 16,625 Beds 840 Blankets 2,214 Bolsters 650 „ (cases) 271 Books 167 Cushions 281 Mattresses 44 Overlays 777 Pillows 2,105 47,502 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Number of rooms disinfected 3,672 Number of mattresses and other articles destroyed 3,270 Furniture, Floorcloth, etc. destroyed 82 Loads CLEANSING STATION. Verminous persons cleansed Adult Females 10 Adult Males 124 Children 3,383 Persons treated for Scabies: — Number treated Number of baths given Adult Females 70 189 Adult Males 38 78 Children—Females 217 895 Children —Males 172 756 It should be noted that the figures in this table which concern the number of children treated relate to a larger area than that of the borough, because the Department undertakes the treatment of children for the Education Authority and many of these children reside outside the borough. 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 66, 2 for Scarlet Fever, 2 for Scabies, 61 for verminous conditions and 1 for insanitary condition of house, the total number of persons accommodated being 357. BACTERIOLOGICAL LABORATORY. The work of the laboratory consists very largely in the examination of sputa for Tuberculosis and of throat swabs for K.L.B. We are called upon occasionally to do other pathological examinations such as blood counts, Widal or Wassermann tests and to examine urines, but general practitioners do not make as much use as they might of the facilities provided. Sterile outfits for throat swabs and sputum pots for the examination of sputa are supplied free on application to the Medical Officer of Health. All Diphtheria contacts of school age are excluded from school until the swab is negative. A positive result necessitates a further examination, treatment being provided in the meantime by the general practitioner. Proved "carriers" are usually referred to the London County Council "Carrier" Clinic at Guy's Hospital. In addition to the examination of swabs and sputa other bacteriological investigations are undertaken on request, and it will be seen from the accompanying table that the number of these "various" investigations shows a slight decrease this year. Nature of Specimen Total Examinations Results of Examination Positive Negative 1935 1936 1935 1936 1935 1936 Diphtheria (specimens taken by Medical Officer of Health) 430 353 23 25 407 328 Ditto (taken by general practitioners) 1748 1194 111 63 1637 1131 Diphtheria (total specimens taken) 2178 1547 134 88 2044 1459 Phthisis 1244 1280 192 196 1052 1084 Various 355 263 70 34 285 229 Total specimens taken 3777 3090 396 318 3381 2772 FOOD POISONING. Thirteen cases of Food Poisoning were notified to me during the year under the London County Council (General Powers) Act, 1932, section 7. FOOT CLINIC. Three whole-time chiropodists, two ladies and a gentleman, are employed in these clinics. The fee for treatment is two shillings per attendance, which is subject to reduction in the case of inability to pay the full fee. Patients are seen by appointment only. Treatment is given for corns, callosities, bunions, ingrowing and thickened toenails, warts and other similar affections of the feet. Orthopaedic cases are not treated and are referred to private practitioners or to hospital. Particulars of the number of attendances during the year are given in the following table. Clinic Men Women Total Bermondsey 1,968 5,325 7,293 3,824 5,409 Rotherhithe 1,585 12,702 Totals 3,553 9,149 During the whole of this year in addition to the whole-time chiropodists, one part-time chiropodist (Miss Lewis) has been employed. Even with this additional help the clinics have usually been fully booked up with appointments for at least a fortnight ahead, and in some cases for three weeks. The total number of treatments given shows an increase of 1,500 as compared with last year, and of about 500 as compared with 1934, but I am of the opinion that the employment of a part-time chiropodist is a satisfactory method of meeting this situation, and that it would not be wise at present to appoint an additional whole-time officer. The time-table of these clinics will be found at the end of this report, and it should be noted that for the convenience of patients sessions have been opened both at Bryan House and at White s Grounds. It may appear to many readers of this report that the treatment of foot ailments, very minor ailments in most cases, is hardly an activity in which the Public Health Department should be concerned. In support of the view which the Borough Council took in establishing these clinics I would submit the facts that most of the inhabitants of the borough work on their feet all day, that 12,702 treatments were given, that many patients attend at regular intervals for treatment, that there is no other means of obtaining such treatment within the borough and that expressions of appreciation from patients are almost universal. INSULIN FOR DIABETIC PATIENTS. Under Section 227 of the Public Health (London) Act, 1936 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. Twenty-seven patients have been supplied during the year as compared with nineteen patients in 1935. 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. We are very much indebted to the authorities of both Nursing Associations for the valuable help received from them in connection with this scheme and particularly for their invaluable aid in nursing cases of measles and tuberculosis. Disease St. Olave's District Nursing Association Rotherhithe Queen's Nursing Association Totals whole Borough Cases Visits Cases Visits Cases Visits Pneumonia 35 907 16 316 51 1,223 Broncho pneumonia 10 201 1 16 11 217 Bronchitis 26 323 3 45 29 368 Influenza 24 439 3 84 27 523 Measles 76 1,405 41 577 117 1,982 Whooping Cough 8 103 4 58 12 161 Tuberculosis:— (a) Respiratory System 34 1,344 12 705 46 2,049 (b) Other Forms 8 734 1 89 9 823 Puerperal Pyrexia 1 24 — — 1 24 Puerperal Fever - - - - - - Pregnancy and Labour 51 688 14 154 65 842 Diseases of the Digestive System 19 188 8 77 27 265 Infantile Diarrhoea (under 2 years) 2 12 - - 2 12 Discharging Ears 10 262 5 107 15 369 Discharging Eyes 16 425 6 41 22 466 Post operative cases:— (a) Tonsils & Adenoids 9 46 2 17 11 63 (b) Other cases 4 32 3 15 7 47 Other diseases 53 823 5 96 58 919 Totals 386 7,956 124 2,397 510 10,353 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1936. NOTIFIABLE DISEASE NUMBER OF CASES NOTIFIED BERMONDSEY ROTHERHITHE ST OLAVE Total Cases removed to Hospital At all Ages At Ages—Year 1 2 3 4 5 6 Total 1 2 3 Total St. John St. Olave St. Thomas Total Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Diphtheria (including Membranous Croup) 207 - 58 120 22 5 2 - 27 35 7 9 21 111 29 34 14 77 11 4 4 19 12 207 10 3 3 23 4 3 2 5 17 Erysipelas 39 1 - 3 10 19 6 - 4 3 4 3 11 - - 260 2 76 152 23 12 16 31 41 38 14 17 157 39 34 19 92 8 7 2 17 Scarlet Fever 266 1 - Cerebro-Spinal Meningitis 4 2 1 - 1 - - - - - 1 - - - 1 - 1 1 2 - - 1 1 4 Ophthalmia Neonatorum 6 6 - - - - - - - 1 - 2 - - 3 2 - 1 3 - - - - 5 - - 15 Enteric Fever 15 - - 6 1 6 2 - - - - - - - - 1 1 13 15 - - - - - 5 Puerperal Fever 6 - - - 2 4 - - 1 1 1 - 1 - 4 - 1 1 2 - Puerperal Pyrexia 9 - - - 2 7 - - 2 1 1 1 1 1 7 1 1 - 2 - - - - 8 Encephalitis Lethargica 2 - 1 - 1 - I -1 - 1 - - - - 1 1 - 1 - - - - 2 - - 1 Dysentery 1 1 - - - - - - - 1 - - - 1 1 - - - - - - - - Pneumonia (Acute Primary and Acute Influenzal) 125 7 30 25 12 12 26 13 9 20 15 13 10 7 74 18 13 9 40 6 5 - 11 19 Whooping Cough (under 5) 103 26 77 - - - - - 2 16 11 18 4 10 61 4 25 9 38 4 - - 4 23 1 1 4 2 3 - - - - 2 Measles (under 5) 7 2 5 - - - - - 1 - 1 - 1 - Tuberculosis — Respiratory System 142 - 5 13 53 32 30 9 8 21 17 19 13 13 91 12 19 10 41 4 3 3 10 - Other forms of Tuberculosis 34 3 - 11 6 8 5 1 3 4 5 4 4 4 24 2 5 2 9 - 1 - 1 - Totals 966 50 253 327 125 97 85 29 69 135 116 105 60 77 562 115 138 83 336 36 20 12 68 568 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEARS 1927-1936. Notifiable Disease. 1927 1928 1929 1930 1931 1932 1933 Small Pox - 1 46 47 3 16 21 Diphtheria (including Membranous Croup) 481 603 463 462 263 263 386 Erysipelas 25 43 45 41 49 49 68 Scarlet Fever 601 493 584 507 310 446 640 Cerebro-Spinal Meningitis 3 2 4 5 9 9 4 Acute Polio-Myelitis and Acute Polio- Encephalitis 4 2 2 1 3 1 1 Ophthalmia Neonatorum 13 8 11 13 14 10 7 Anthrax - 2 1 1 - - - Enteric Fever 1 2 2 5 1 2 2 Puerperal Fever 9 7 12 14 13 8 6 Puerperal Pyrexia 21 20 20 19 37 27 24 Encephalitis Lethargica 5 4 1 4 1 2 - Dysentery - - - - - - 1 Malaria - - - 2 - - - Malaria (induced) - - 1 - - - - Pneumonia (Acute Primary and Acute Influenzal) 126 53 110 119 167 102 136 Whooping Cough (under 5) - - - - - - - Measles (under 5) - - - - - - - Tuberculosis:— Respiratory System 231 184 194 208 175 177 182 Other forms of Tuberculosis 65 54 40 46 40 35 34 1,585 1,478 1,536 1,494 1,083 1,149 1,512 Totals 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, 1936—NEW CASES AND DEATHS. DEATHS NEW CASES Pulmonary Non- Pulmonary Pulmonary Non- Pulmonary AGE—PERIODS M. F. M. F. M. F. M. F. 0 - 2 1 1 2 - 1 - 1 1 1 1 2 - - - - 3 - 1 2 1 - 3 3 5 - 5 3 3 - 1 - 10 3 3 1 1 - 4 4 12 - 15 1 1 11 3 2 5 20 18 15 - 3 3 - 3 4 25 13 3 16 11 1 10 1 2 7 35 5 2 - 9 13 2 2 45 9 6 - 9 10 5 2 4 55 1 - 5 5 4 65 and upwards 1 - 1 1 1 70 24 91 24 10 5 16 55 TABLE II. TUBERCULOSIS, 1936—PERIOD BETWEEN NOTIFICATION AND DEATH. Period Between Notification and Death Respiratory System Other Forms Percentage of Total Deaths Females Percentage of Total Deaths Total Males Total Males Females 3 20·00 2 1 Not notified 2 2·53 2 - 10 0.1 month 6 16 20.25 5 2 7 46.67 1-3 months 2 3 5 6.33 - 3-6 months - - - 4 1 5 6.33 - - - - 6-12 months 5 1 1 6 7.60 1 6.67 1-2 years 9 5 14 - 17.72 - - - - 2-5 years 14 2 16 20.25 1 1 2 13.33 Over 5 years 11 4 15 18.99 2 2 13.33 - Totals 55 24 79 10 100.00 5 15 100.00 (37) Report by Dr. C.H.C. Toussaint, Clinical Tuberculosis Officer. In spite of an increase of thirteen in the number of new cases of Pulmonary Tuberculosis notified during the year, it is gratifying to be able to record a further fall in the number of deaths from this form of the disease. The death rate from respiratory tuberculosis, .79, is once more a record low figure for this borough. Effort is constantly made to secure notification of all cases at the earliest moment, and during the year there occurred only two deaths from pulmonary disease, and three deaths from other forms of tuberculosis, in cases which had not previously been notified. Of the former, one was a female, aged 46, admitted to the local hospital shortly before death, and the other a girl, aged 14, admitted to hospital with tuberculous meningitis, postmortem examination showing that the bronchial glands were infected —the case being classified as "pulmonary" on this account. It is of interest to record that this girl lived in the same house as a man affected with pulmonary disease, and used to visit his room on occasions. In the absence of disease in the girl's own family there was a strong suspicion that infection was contracted from the case mentioned. Of the un-notified non-pulmonary deaths two were female children, aged 4 and 2, who died from tuberculous meningitis, and one was a male aged 47, who died from Addison's disease (tuberculosis of the supra-renal glands). In these cases a precise diagnosis is, from the nature of the disease, often a difficult matter to secure during life. Attention has been drawn in these reports previously, and by tuberculosis workers in most other districts, to the unfortunate fact that a large number of cases first come to the notice of the Tuberculosis Officer at a stage when disease has already secured a firm hold on the patient. Tuberculosis of the lungs, together with disease of the bones and joints, can undoubtedly be cured, with the proviso only that treatment must be undertaken in an early stage. Pulmonary Tuberculosis, at its onset, produces symptoms and radiological changes, but often few if any physical signs. The latter fact is a stumbling block which often leads to disaster in the absence of true knowledge of the disease. Statements are often made that the fear of loss of employment leads a patient to postpone a visit to his own doctor. Interrogation of patients in the dispensary, however, has not borne this out. Too often there is a history of "influenza" or "bronchitis" some months previously for which attention was sought but, in the absence of physical signs of tuberculosis, the patient was allowed to return to work, only to relapse and show evidence later of advancing pulmonary disease. In order to aid practitioners of the borough and stimulate interest in modern methods of investigation and treatment two meetings were held in the summer of 1936. The first, on "Modern methods of diagnosis in chest diseases " was addressed by Dr. H. V. Morlock, Physician to the City of London Chest Hospital, and the second on "Modern methods of treatment in chest diseases" by Dr. Burton Wood, from the same hospital. Fifteen doctors were present at the first meeting and thirty at the second. It is stated by some sanatorium superintendents that the diagnosis of tuberculosis, in its early stages, has not kept pace with the new methods of treatment. The Borough Council has provided a complete tuberculosis service which now includes a modern X-ray equipment. This makes it possible for the Tuberculosis Officers to arrive at a diagnosis in a very short time after the patient has attended the dispensary. It is hoped that all practitioners in the district will realise, to a still greater extent, the vital importance of making the fullest possible use of this service. It would be an advantage, in the detection of early cases, if all insured patients, aged 16 to 25, incapacitated with influenza, bronchitis, debility or anaemia, could be referred to the Tuberculosis Officer for an opinion. The London County Council has continued the arrangement, whereby the Tuberculosis Officers act as honorary consultants to St. Olave's Hospital. In cases of urgency, and an early case of pulmonary tuberculosis must be regarded as an urgent problem, immediate admission to hospital can be effected, with a view to transfer to sanatorium at a later stage. The visits of the Tuberculosis Officers have also been of considerable assistance in pursuading patients suffering from advanced disease to acquiesce in prolonged periods of hospital treatment, thus reducing the risks of infection at home. Attendance at the hospital is also invaluable to the Tuberculosis Officers who are enabled to see, and discuss with other medical men, patients under observation and treatment in hospital. On page 43 is a table showing the work done at the dispensary during the year. The examination of contacts is an essential part of the work and efforts are being continued to secure a yearly examination of each contact for approximately five years after the original exposure to infection. Artificial pneumothorax refills have been continued at the dispensary (during the year 714 refills were given), and the results obtained in early cases continue to prove the efficacy of this form of treatment. An evening clinic is held for those patients who are at work. NURSING AND EXTRA NOURISHMENT. The aid of the District Nursing Associations has been enlisted in 55 cases during the year. Much can be done by careful nursing to alleviate suffering and improve conditions, and as tuberculosis is notably a slow disease the average number of visits paid to each patient is high. During 1936 nearly 3,000 visits were paid by the district nurses to patients suffering from tuberculosis. 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 181 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 13 shelters at present in use, 2 having been erected during the year and 6 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. Thirty-four beds are in use at present. LADY ALMONER. It is always a matter of difficulty to write an illuminating comment upon the year's work of the Lady Almoner. This is partly due to the fact that the work is so varied in nature, seldom following consistent lines. Partly also the difficulty arises from the very nature of the work which is concerned for the most part with domestic details, and these, while of vital importance to the families concerned, are hard to classify, and do not lend themselves to useful comment in a printed reports. Miss Pike, however, does an invaluable work in smoothing out the difficulties which so often present themselves in any home when a member of the family is forced to leave home on account of ill-health, of whatever nature. She pays regular visits to all such homes which come within the purview of the Council schemes, and during the year for this purpose she paid 760 such visits. As Infant Protection Visitor she paid 104 visits to the homes of 16 foster parents. Fortunately, in my opinion, the number of registered fosterparents in the borough is small, at present eleven, but it is essential that these homes should be kept under regular and close supervision in order to see that the foster-children received into them are well treated, and receive proper care. In all homes at present registered really good conditions are maintained. Throughout the year the Lady Almoner has also interviewed mothers making application for admission to Fairby Grange, and at the same time has collected the first week's payment. Part of her work consists in arranging for the supply of Insulin to diabetic patients and, although these number only 27, yet this work entails many visits and interviews, and, as it seems to me, an undue amount of trouble. The provision of extra nourishment and the supply of garden shelters, bedsteads and nursing requisites come within the scope of her control as do also the arrangement of holidays and the finding of occupation for patients when this is possible. Altogether during the year holidays have been arranged for twenty patients, work has been found for six and fifty-five have been fitted out with necessary clothing. In the latter matter particularly our thanks are due to the British Red Cross Society to Queen Alexandra Rose Day Fund, for a generous grant of £10, to Queen Mary's Needlework Guild per Lady Ludlow, to the Friends of the Poor and the Charity Organisation Society, and to an anonymous donor of £5 to meet expenses in a particular case. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not found necessary to take any action under these Regulations in 1936. RETURN SHOWING THE WORK OF THE DISPENSARY DURING. THE YEAR 1936. Grand Total Diagnosis Pulmonary Non-pulmonary Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — ii 1 —I 6 5 9 9 34 5 2 58 43 8 (a) Definitely tuberculous 53 4 (b) Diagnosis not completed - - - - - - - 8 5 2 2 - (c) Non-tuberculous - - - - - - - - 149 125 47 35 491 B.—Contacts examined during the year:— (a) Definitely tuberculous 5 8 2 2 - - 2 1 5 4 8 3 (b) Diagnosis not completed - - - - - - - - 1 - - 2 (c) Non-tuberculous - - - - - - - 51 107 117 127 425 - (C)—Cases written off the Dispensary Register as I 1 i . Il ~ . r . I! 5 5 5 15 20 4 (a) Recovered 1 3 4 3 8 9 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - 205 235 812 - 166 - 165 (43) D.—Number of Cases on Dispensary Register on December 31st:— H 47 280 229 44 59 (a) Definitely tuberculous 35 51 51 315 280 106 95 (b) Diagnosis not completed - - - - - - - 9 5 2 4 816 - 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 1,112 1. Number of cases on Dispensary Register on January Ist 835 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 16 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes *2,473 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 69 10. Number of:— (a) Specimens of sputum, etc., examined 1,275 4. Cases written off during the year as Dead (all causes) 70 (b) X-ray examinations made in connection with Dispensary work 997 5. Number of attendances at the Dispensary (including Contacts) 3,875 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 115 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 332 7. Number of consultations with medical practitioners:— (a) Personal 93 (b) Other 258 * In addition to these visits 760 visits were made by the Lady Almoner and 214 visits by the School Nurse. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from the 1st January, 1936, to the 31st December, 1936. Formal notifications Total Notifications Number of primary notifications of new cases of Tuberculosis 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 55 to 65 65 and upwards Total (all ages) 45 to 55 Age Periods Pulmonary, Males 4 3 12 17 12 8 8 9 5 81 - 3 97* „ Females - 2 3 11 8 8 5 4 61 70 (44) 3 13 4 2 - 3 - - 3 1 - 1 1 14 16 Non-Pulmonary Males 3 1 - 1 4 3 2 2 2 2 - 20 22 3 „ 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 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards 20 to 25 Total Pulmonary Males - - 1 - 1 1 2 5 - - 10 - 1 - 2 3 1 1 - 9 - 1 - - „ Females - - - - - - - 2 - - - 2 Non-Pulmonary Males - 3 - - - - 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, 1936. Respiratory System Other Forms M. F. F. M. Number of Cases on Register at commencement of Quarter 396 281 122 135 Number of Cases notified during Quarter 3 17 18 1 Inward Transfers, Un-notified Deaths, etc. 1 3 2 - Number of Cases removed from the Register 26 17 6 4 Number of Cases remaining on the Register at end of Quarter 390 284 120 132 2nd QUARTER, 1936. Other Forms Respiratory System M. F. M. F. Number of Cases on Register at commencement of Quarter 284 390 132 120 Number of Cases notified during Quarter 18 18 5 3 Inward Transfers, Un-notified Deaths, etc. 1 1 1 1 Number of Cases removed from the Register 27 15 12 7 Number of Cases remaining on the Register at end of Quarter 288 382 126 117 3rd QUARTER, 1936. Respiratory System Other Forms M. F. M. F. 382 288 126 117 Number of Cases on Register at commencement of Quarter Number of Cases notified during Quarter 5 2 17 9 1 Inward Transfers, Un-notified Deaths, etc. 3 4 - Number of Cases removed from the Register 13 7 13 9 Number of Cases remaining on the Register at end of Quarter 288 117 389 118 4th QUARTER, 1936. Respiratory System Other Forms M. F. M. F. 118 117 288 Number of Cases on Register at commencement of Quarter 389 Number of Cases notified during Quarter 29 5 11 16 Inward Transfers, Un-notified Deaths, etc. 4 2 1 - 5 Number of Cases removed from the Register 37 14 7 123 292 Number of Cases remaining on the Register at end of Quarter 385 117 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 1936: — Number of Attendances and General Treatments 18,788 Number of Local Treatments 2,588 Number of Examinations 1,321 Number of Massage Treatments 454 Number of New Patients 367 Number of Discharges 410 Number of Maternity and Child Welfare Cases under treatment during the year 276 Number of Tuberculous Patients under treatment during the year 17 Total Number of other classes under treatment during the year 432 The Maternity and Child Welfare patients formed 38% of the total number under treatment, and tuberculosis patients 2.34%. Although the number in every group is lower than that for 1935, owing to the Solarium being closed for a time during rebuilding, there was an increase in the numbers when compared with those for a corresponding period of the previous year. The number of attendances and general treatments, massage treatments and new cases show an increase of 18.9 per cent., 42.3 per cent, and 28.5 per cent, respectively. There has been no change in the apparatus in use during the year. The Solarium staff has been increased by the appointment of Miss Joyce Hopkins and Miss Gladys Warry. All patients are recommended for treatment by general practitioners or by medical officers of the Maternity and Child Welfare centres, the Tuberculosis Dispensary or the local 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. Glandular 4 .eritonitis 1 Sacro Iliac Joint 1 MATERNITY AND CHILD WELFARE. Ante-Natal 4 Bronchitis 25 Cervical Adenitis 12 Debility and Malnutrition 58 Rickets 18 Other conditions 3 OTHER DISEASES. Alopecia 16 Anæmia 2 Acne Vulgaris 3 Asthma 1 Bronchitis 14 Cervical Adenitis 3 Chronic Rheumatic conditions 46 Debility 54 Furunculosis 1 Other conditions 12 As in previous years the majority of tuberculous patients had received institutional treatment prior to ultra violet light treatment. Good results were obtained in all but two cases of surgical tuberculosis which completed treatment during the year. Ultra Violet light has been found invaluable in maintaining the general condition of these patients and preventing relapses on return from sanatorium. With few exceptions good results were obtained in cases of chronic bronchitis. Of the 39 cases that completed treatment during the year, 11 showed very marked improvement, 26 were much improved and 2 received no benefit. Again it was noticeable that patients with much dyspnoea due to bronchial spasm obtained much relief. The largest group of cases completing treatment during the year consisted of patients suffering from debility, anaemia and malnutrition, without evidence of organic disease; the majority of patients being school children. The causative factors; adverse home conditions and defective dietary, in many cases acting from its pre-natal existence, produces a child with deficient bone formation and poor musculature ill-fitted to stand the physical strain of school life. The majority of these children suffer from varying degrees of deformity of the chest, kyphosis and scoliosis, and offer a fertile soil for respiratory and bone and joint disease. It is significant that these deformities become more apparent with the strain of school life. These cases are treated with general ultra violet baths which provide a powerful stimulant to the metabolism, causing increase of appetite and muscular tone and bone formation. In addition all cases are given remedial exercises and massage to develop muscles and correct deformities. Dramatic results are not to be expected in these cases, but all showed very marked improvement after prolonged treatment. With regard to the dietary of these patients, in the case of infants this is fully investigated and corrected at the Maternity and Child Welfare Centres, whilst most of the school children referred for treatment have milk at school. Remarkably good results were also obtained with children suffering from rickets, and no case failed to respond to treatment. A number of patients ceased to attend after a few treatments, and it is regrettable that some parents do not realise the necessity for prolonged and regular attendance. Ante-Natal cases treated during the year derived marked benefit from treatment which cannot fail to influence the development of the unborn child. In the adult group, the greatest numbers were treated for chronic rheumatic conditions. Marked improvement was obtained in the majority of cases treated with radiant heat general light baths and massage, as shown by the relief from pain and the return of function to the affected joints. Many cases which would otherwise have been incapacitated were enabled with treatment to remain at work. Alopecia responded well to general and ultra violet light treatment. Sixteen cases completed treatment during the year, eight being cured and were discharged with a normal growth of hair, and six showed very marked improvement. Three cases of Acne completed treatment during the year, and of these one was cured and the other two greatly improved. 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 Period previously under Medical Treatment prior to going to Leysin Date returned from Leysin Result Localisation of Disease Date sent to Leysin S.B. 12 M. Left Foot 5 years 28/7/24 5/7/27 Well and at work I R. 10 F. 5 „ 28/7/24 6/10/25 Removed from District Glands of Neck M.S. 15 F. 6 „ 28/7/24 6/10/25 Well. Now married Right Knee 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.W. 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 „ 5/2/27 8/5/28 Keeping well A.R 26 F. Glands of Neck 3 5/2/27 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 20/6/28 26/9/30 „ „ 3 „ I.S. 23 F. Right Hip 8 31/5/29 5/8/32 „ „ C.C. 27 F. Multiple Lupus 20 „ 20/1/30 6/5/32 Removed from District 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 at work G.L. 15 M. Spine 10 months 13/10/30 - Dead (Tuberculous Meningitis) V.B. 16 1 year F. Lupus of Nose 6/2/31 6/5/32 Well and at work D.R. 34 M. Spine 4 years 4/7/31 - Dead (Cerebro-spinal Meningitis) J O'B. 17 M 7 months Right Knee 30/7/32 30/11/36 Well E.B. 20 F. Left knee - 10/5/33 14/6/35 Seen recently, keeping well. M.L. 11 F. Glands of Neck 3 months 17/5/36 - Still at Leysin F.H. 22 F. Left wrist 3 months 27/1/36 - „ „ H.H. 20 F. Glands of Neck 1 year 17/5/36 - „ „ J.H. 10 F. Glands of Neck 3 months 21/7/36 - „ „ V.—MATERNITY AND CHILD WELFARE. In my Annual Report for last year reference was made to three changes in this scheme which had been considered by the Committee. It was reported that one of the Tuberculosis Nurses having resigned, the other one had been appointed a Health Visitor and the work of visiting tuberculous patients had then been divided amongst all the Health Visitors, each Health Visitor visiting patients on her own district. This arrangement has worked very satisfactorily and is to be continued. Reference was also made to the contemplated establishment of two SubCentres in the borough. During the course of the year 1936 these two centres were established, one at Bryan House in Rotherhithe and the other at White's Grounds in Bermondsey. These two Sub-Centres have now been in operation for several months, and although the response was at first somewhat disappointing, appearances at present suggest that they are growing in popularity; a full report will be submitted at the end of the year. The Special Clinic for Women which was also mentioned in last year's report has now become well established, and a report by Dr. Dodds, the Consultant Gynaecologist in charge, is appended. Naturally a certain number of patients have attended who were found on examination to be suffering from more general diseases unsuitable for treatment at this clinic. Such patients were, of course, examined and advised as to where they should obtain treatment. The report, however, makes it quite clear that a great deal of really valuable work has been done, particularly in the direction of the early detection of disease, and I feel sure that the Committee will be gratified with the year's work. SPECIAL CLINIC FOR WOMEN. Report by Dr. Gladys Dodds, Consultant Gynaecologist. During the year 1936 there were 589 attendances at the Women's Clinic. Of these 240 were new patients and 349 were re-appointments. The complaints from which these patients suffered may be summarised in the following way:— Minor disabilities of the menopause. Forty-three patients complained of headaches, "flushings," giddiness, depression, anxieties, general debility, etc. Displacement of the Uterus. Five patients with retroversion. All were treated at the Clinic. Twelve patients with prolapse. Ten were treated at the Clinic, and 2 were recommended to hospital for operative treatment. Inflammation of the Uterus and Appendages. Fifteen patients with cervicitis were treated at the Clinic. One patient with chronic salpingitis was recommended to hospital. Menstrual Irregularities. Thirty patients reported at the clinic on this account. Eight of these were found to be pregnant; two had fibroids and one had an ovarian cyst. In the remaining 19 patients the irregularity was due to hormonal disturbance of the menopause. Ten of these patients were treated at the Clinic, and 9 were transferred to hospital for artificial termination of menstruation. Disorders of menstrual function. Seven patients were referred to the Clinic by doctors for investigation of sterility and 3 patients for investigation of dysmenorrhœa. Carcinoma of the Uterus. There were 4 patients —3 with carcinoma of the cervix and one with carcinoma of the body of the uterus. With one exception the disease was in an early stage, and the prognosis in these cases is good. Backache. In 14 patients with this symptom no gynaecological cause was found. Two were transferred to hospital for manipulation, and the remainder were either recommended to the Solarium or to the "Keep Fit" classes. Hyperpiesia. Fifteen patients with varying symptoms, but with only this one sign were kept under observation at the clinic during the year. In some it appeared to be of a temporary nature associated with the sudden cessation of menstruation. Breasts. Only 3 patients came specifically complaining of discomfort or pain in the breasts. Two of these had chronic mastitis, and one had advanced carcinoma. Intestines. Three patients were seen who had symptoms suggestive of carcinoma of the intestines —they were all transferred to hospital. Rheumatism. A large number of patients complained of pains in joints and muscles, and had either rheumatoid or osteo-arthritis. They were given general advice about protection and movements of the joints, and, when necessary, they were referred to the Dentist or to the Solarium or to hospital. Eye Defects. Several patients were presbyopic and were suffering from headaches. They were sent to the Eye Hospital. Miscellaneous Group. The remainder of the patients suffered from a variety of conditions such as heart disease, hernia, visceroptosis, varicose veins, varicose ulcers, anaemia, obesity and debility. 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 1936 are shewn hereunder:— Number of women admitted 191 Number of babies admitted 101 Number of toddlers admitted 108 MIDWIFERY SERVICE. Under this scheme 272 patients "booked" during the year, compared with 410 patients last year. In 140 of these cases the full fee of the midwife was paid by the Council and a proportion of the fee was paid in 117 other cases; the remaining 15 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 108. The number of consultations during the year was as follows:— Obstetric Consultations Nil Puerperal Fever Consultations 1 INFANT LIFE PROTECTION. The number of foster-mothers and children in this borough is happily very small, and no difficulty has been experienced in dealing with these cases during the year. There were 16 foster mothers with 17 children and 104 visits were paid by the visitor. MATERNAL MORTALITY. In last year's annual report I had the unusual pleasure of being able to state that no maternal deaths had occurred during the year. The bald fact only was stated, because it was realised that it was entirely exceptional, and could not be ascribed to the activities of the Maternity and Child Welfare department, valuable as these are. This year, I am, with regret, compelled to record nine maternal deaths. A careful investigation has been made by myself into each of these cases. Three of the deaths were due to morbid conditions associated with pregnancy which could probably neither have been foreseen nor prevented by any known means, indeed in one of these cases the pregnancy was apparently not even suspected by the patient herself until the onset of the sudden haemorrhage from which she died. In another case death was certified as being caused by terror following a street accident, and does not appear to have had any direct connection with the pregnancy. In two cases the fatal termination was undoubtedly due in part to the refusal of the patient to carry out instructions. In two instances it is possible that better obstetric care, in one case in the home, and in the other case in hospital, might have prevented death. One death was caused by septicæmia following a criminal abortion induced by the patient herself. The maternal mortality rate for the year is 5·66 per thousand total (live and still) births. HEALTH VISITORS. The following table shows the work done by the Municipal and Voluntary Centres and Health Visitors during 1936:- District Births Notified Visits to Infants and Children Visits to Expectant Mothers Puerperal Fever and Puerperal Pyrexia Ophthalmia Neonatorum Other Visits Attendances at Centres First Visits Re-visits Primary Visits Revisits Cases Cases Visits Under 1 year Visits 1-5 years Miss Robson 96 89 608 1138 57 134 - - - - 762 343 Central Hall 90 80 647 1174 26 112 2 3 - - 768 202 124 1 1 - - 622 256 Miss Bowles 71 76 515 951 52 Miss Lawrence 90 79 503 718 30 53 1 1 1 1 626 190 St. George's Hall 88 100 782 1265 41 147 - - - - 830 161 - - - - 558 223 Miss Riches 92 90 556 949 54 126 Miss Brown 113 94 336 807 52 80 1 1 1 1 635 288 Miss Riley 163 175 955 823 96 118 3 4 1 2 493 206 Miss Helden 128 102 669 1023 62 184 1 1 - - 800 210 - 2 2 478 202 Fulford Street 104 98 748 1000 75 177 - Miss Carlton 110 108 985 1027 81 145 2 2 - - 570 281 1 - - 608 353 Miss White 162 89 714 1267 71 190 1 265 Miss Wadds 71 127 1013 1072 56 166 1 1 1 1 458 Miss Bache 125 123 663 968 85 208 1 2 - - 412 292 Salomon's Centre 93 100 851 3242 539 398 1 1 - - 42 357 Totals 1596 1530 10545 17424 1377 2362 15 18 6 7 8662 3829 ATTENDANCES AT MATERNITY AND CHILD WELFARE CENTRES. The following table shows attendances at Maternity and Child Welfare Centres during 1936:— Children's Consultations Ante-natal Clinic Sewing Class Gynaecological Clinic Name of Centre No. of Sessions New Cases Total Attendances No. seen by Doctor No. of Sessions New Cases Total Attendances No. of Sessions No. of Attendances No. of Sessions New Cases Total Attendances Under 1 year 1-5 years Under 1 year 1-5 years Public Health Centre, Grange Road 159 212 26 3,540 2,483 3,584 44 135 717 10 41 45 130 353 49 120 257 98 Rotherhithe New Road 153 192 24 3,601 2,403 2,790 51 146 742 - - Bryan House 52 41 26 710 844 1,043 - - - - - - - - Bermondsey Gospel Mission 100 101 21 1,663 1,616 2,033 - - - - - - - - Roseberry Street 49 62 10 1,215 984 937 - - - - - - - - Salomon's Centre 152 92 8 2,820 1,211 1,308 205 568 3,174 - - - - - Princess Club 118 139 5 2,480 1,515 2,542 50 85 464 83 990 - - - Fulford Street 103 160 8 2,345 1,259 2,327 53 107 643 - - - - - St. George's Hall 64 54 15 947 896 1,116 - - - 42 743 - - - Central Hall 203 59 9,248 7,734 - - - 28 414 - - - 280 5,553 Totals 1,153 1,333 202 24,874 22,459 25,414 403 1,041 5,740 163 2,188 94 250 610 EXTRACTS FROM VITAL STATISTICS, 1936. Births. Registered— Total Males Females Live Births (Legitimate (Illegitimate 1,501 789 712 44 29 15 Birth Rate per 1,000 of the estimated resident population 15·4 Total Males Females Stillbirths 44 24 20 Rate per 1,000 total (live and still) births 28 Notified within 36 hours of birth — (1) Live Births, 1,558. (2) Stillbirths, 38 (3) Total, 1,596 (1) By Midwives, 413. (2) By Parents and Doctors, 1,183. Total. Males. Females Deaths 1,289 728 561 Death Rate per 1,000 of the estimated resident population 12.8 Maternal Deaths. Deaths from puerperal causes:— Rate per 1,000 total (live and still) births 1·26 Deaths. 2 Puerperal Sepsis Other puerperal causes 7 4·40 Total 9 5·66 Death Rate of Infants under 1 year of age. All Infants per 1,000 live births 60 Legitimate infants per 1,000 legitimate live births 57 Illegitimate infants per 1,000 illegitimate live births 136 Health Visitors. Visits paid by Health Visitors during the year:— To Expectant Mothers (1) First Visits, 1,377. (2) Total Visits, 3,739 To Infants under 1 (1) First Visits, 1,530. (2) Total Visits, 10,545 To Children, 1-5 Total Visits, 17,424 Convalescent Homes for Children under 5. Number of Beds, 16. Number of Children under 5 received during the year, 209. Day Nurseries. Number of day nurseries 2 (both, voluntary). Number of places for children under 5 in the nurseries:— Summer months 60. Winter months 55. Total number of attendances of children at these nurseries during the year:- 8,928. Deaths from Cancer (all ages) 180 Deaths from Measles (all ages) 20 Deaths from Whooping Cough (all ages) 5 Deaths from Diarrhoea (under 2 years of age) 15 VI. DENTAL TREATMENT. The appended table sets out in summary form the work of the two dental centres during the year. There have been no changes in staff and the time-table at both centres remains unaltered. The total number of patients treated during the year was 6,749, which is appreciably below the number for last year. That this reduction in numbers has been due to the building of the new centre and to the consequent partial dislocation of work at the Bermondsey Centre is proved by the fact that there has been a substantial increase of work at the Rotherhithe Centre in each of the categories set out in the table. I do not think that there can be any doubt as to the value of dental work in promoting an improvement in the general health of the borough, and I think that both Dr. Grantley Smith and Mr. Shapland are to be congratulated on the general excellence of their work, the high standard maintained and the extensive nature of their operations. The Rotherhithe Dental Clinic was rebuilt some years ago, and owing to the improved office accommodation which has been provided for Health Visitors at the new Bermondsey Centre, it has been possible to allot more space to the Dental Clinic at Rotherhithe. This will greatly improve the waiting-room accommodation and permit the provision of an office for the Dental Surgeon separate from his Surgery. The dental section of the Bermondsey Centre is described on a later page of this report. (59) DENTAL TREATMENT CARRIED OUT DURING 1936 Type of Case Number of Patients Examined Number of Patients Treated Number of Extractions Anæsthetics Number of Fillings Number of Scalings Number of Dentures Fitted Number of Repairs to Dentures Number of Attendances CENTRE Local General PUBLIC HEALTH CENTRE, GRANGE ROAD Maternity Cases 647 696 497 184 54 122 14 1571 2068 131 Women 1021 1135 1949 949 175 104 101 119 15 1897 Men 1536 1686 2813 1688 57 235 37 185 142 2871 Tuberculosis Cases 24 28 20 7 25 1 13 2 104 66 Children (Table I.) 801 770 2410 235 564 288 - - - 1781 Totals 4029 4315 9306 3389 931 777 433 367 8224 67 581 562 1996 255 49 23 148 34 98, ROTHERHITHE NEW ROAD Maternity Cases 311 1428 305 108 85 15 76 31 917 Women 430 457 947 601 656 1356 599 73 23 95 26 Men 90 1209 Tuberculosis Cases 5 4 14 1 3 4 1 - 11 - Children (Table I.) 755 2392 120 253 11 - - 1616 787 610 2404 2434 6705 1336 1049 73 319 91 Totals (60) TREATMENT OF CHILDREN DURING 1936 CENTRE Age Group Number Examined Number Treated Number of Extractions Anæsthetics Number of Fillings Local General PUBLIC HEALTH CENTRE, GRANGE ROAD. Under 5 years 301 326 1331 10 282 6 Over 5 years 500 1079 225 282 282 444 Totals 801 770 2410 235 564 288 98, ROTHERHITHE NEW ROAD. Under 5 years 254 262 1015 6 236 28 Over 5 years 533 1377 114 374 225 493 Totals 787 755 2392 610 253 120 VII.—PUBLIC HEALTH CENTRE. General. The new public health centre in Grange Road was officially opened on Saturday, November 7th, and the completion of this project has been, of course, an event of great interest to the staff and to the members of both committees. That it has also been a matter of interest to a very much wider circle, is evidenced by the number of visits which have been made by many people from different parts of the country. In September 1927 Dr. King Brown submitted to the Maternity and Child Welfare Committee a report on the question of providing a "Consultative and Treatment Centre for Sick Children" in the borough. This matter was under consideration for some time, and Dr. King Brown's report was followed by a further report on the same subject by myself in November 1928, when a site in Tower Bridge Road was suggested as being suitable for the purpose. There were many difficulties to be overcome, and this site was ultimately abandoned in favour of the Grange Road site which in many ways was more suitable. After vicissitudes innumerable, it was finally decided to erect the new building on the site of the houses Nos. 108, 109, 110 Grange Road, in which the Tuberculosis Service, Solarium, Dental Clinic and Infant Welfare Services were then being carried on. This decision was only made possible by the fact that these old houses had long gardens, and by the willingness of the General Manager, Mr. W. E. Baker, to undertake to carry out this task without serious interference with the work of these clinics. This he did with a remarkable degree of success, and I think that not only Mr. Baker, but the whole of his staff employed on this building are to be congratulated upon a very fine achievement. The plans for the building were drawn by the Council Architect, Mr. H. Tansley, and I am sure that the members of the Council, equally with the staff of the Public Health Department, feel a legitimate pride in the admirable building which has been erected. Site. The building occupies a prominent position at the junction of Grange Road and Alscot Road, and, therefore, having two frontages it has been possible to provide three entrances, a matter of considerable advantage from the point of view of administration. The main entrance is on the Grange Road frontage, the two side entrances being in Alscot Road. The building is on three floors. Ground Floor. —Offices, Foot Clinic, Infant Welfare Section, Tuberculosis. The ground floor is divided into three sections. Access is given by the main entrance to the Health Visitors' Office, the offices of Dr. Plimsoll and the Lady Almoner, and to the Foot Clinic, and waiting room accommodation is provided both for the Lady Almoner and the Foot Clinic. In this part of the building there is also a general dispensary, of sufficient size to meet the needs of all the services carried on in the building, or likely to be provided in the future. The central section on the ground floor is entered by the first door in Alscot Road. This section is separated from both of the other ground floor sections by folding doors, and is devoted to Infant Welfare work and to allied services which include the gynaecological clinic, the children's clinic and ante-natal clinics. There is a direct route from the street, passing the dispensary to the perambulator shelter, which is situated in the open yard. This arrangement enables mothers, after having been seen in the department, to call at the dispensary on their way out from the perambulator shelter, without entering the waiting hall again. It must be remembered that, although all patients come by appointment, ample room for free movement must be allowed where infants and toddlers are concerned, and for this reason a commodious waiting hall has been provided to which there are independent entrances from the perambulator shed. The internal arrangement of this section is such that two consulting rooms, separated by a weighing room, face the waiting hall, so that there is direct access from the hall to each of these rooms. A double door gives admission to the weighing room, from which the patient may pass directly into either consulting room. A very neat arrangement of cubicles which can be folded against the wall when not in use, has been devised by Mr. Bottomley, of the Works Department, and provided in the weighing room. This enables the room to function as a dressing room for patients attending the ante-natal or gynaecological clinics, while its use as a weighing room for infant clinics suffers no diminution. Lavatory accommodation is attached to the waiting hall, and there has also been provided a small room which may be used for urine testing, test feeding and other similar purposes. The consulting rooms have been sound proofed, and the waiting hall has been provided with dark blinds so that it may be used for lantern lectures. The floor surface is of rubber which, while being hygienic, is yet not slippery. This whole section is completely separated from both other sections in the ground floor by two sets of folding doors. The third section on the ground floor comprises a general office, in which is performed clerical work connected with all the the services provided in the building, a reception room and office for the Medical Officer of Health, a consulting room for special clinics and accommodation for the Tuberculosis Service. There are separate sound proofed consulting-rooms for both Tuberculosis Officers, and separate dressing rooms for male and female patients; each dressing room opens directly into one consulting room. Lavatory and waiting room accommodation has been provided, and there is a nurses' room in which case histories, temperatures and weights are recorded. There is easy access to the perambulator shelter, and the independent entrance enables this whole section to be quite separated, so far as patients are concerned, from all the other clinics on the same floor. First Floor —Solarium. The first floor of the building is wholly devoted to physical treatment, consisting of light treatment by means of mercury vapour and arc lamps, radiant heat, galvanism, faradism, diathermy and massage. This floor is so arranged that the male and female sections are separated from one another by a central nurses control room, communicating by a short corridor with a common consulting room for the whole floor. This arrangement makes it possible for patients of both sexes, while being completely separated from one another, to communicate with the nurses' control room, both from the treatment rooms and from the dressing rooms. It also gives the nurses adequate control over both of these rooms, and allows access to the consulting room from both male and female sections. The general arrangements and facilities provided are similar, though not exactly identical, for both sexes. The dressing rooms have an independent entrance from the stairways so that on coming into this department patients first enter the dressing rooms, male patients making use of the main staircase, while female patients enter from the second door in Alscot Road. The dressing rooms are furnished with an admirable arrangement of wall panels and screens of oak, made in the Council's workshops, and to each patient is allotted two clothes hooks and a locker with a lift up seat; in addition in the female side there are three dressing cubicles for ante-natal patients. Lavatory accommodation for patients is attached to the dressing rooms, and each dressing room is fitted with a hot and cold shower. Patients can communicate readily with the nurses' control room by means of a bell and a sliding glass panel, and similarly by means of a system of electric bells and signs, the nurse can call the next patient from the dressing room to the treatment rooms or cubicles without herself making a journey to the dressing room. Slotted case sheet cupboards are fitted on each side of the nurses' control room, so that the patient's case record can be obtained with the minimum of trouble. Adjacent to the nurses' room, on each side, there are four cubicles, properly equipped, for the administration of diathermy, and other forms of local treatment, and on the female side there is provided a specially constructed treatment table, with four compartments, for the irradiation of infants. There is a flooded light room in both male and female sections for collective treatment, especially of groups of children. Each of these floodlight rooms is fitted with sixteen Hanovia lamps distributed, in so far as twelve are concerned, in staggered formation upon the four walls, the remaining four lamps being fitted into a bronze pillar, which rises from the centre of the floor. The elements of these mercury vapour lamps are recessed into the hollow walls of the room, so that the edge of the lamp reflector is flush with the inner wall of the room. Suspended from the ceiling in each of the floodlight rooms there are eight Sollux radiant heat lamps. The floor of the room is marked with a pathway, and the position of the lamps has been so calculated as to give an equal radiation to patients following this path. In the floodlight room on the female side this pathway is bounded on either side by an oak rail, eighteen inches high. Toddlers of both sexes receive collective treatment in this room, and while acting as a guard to prevent the children from touching the lamps, the rail at the same time keeps them within the sphere of optimum radiation. The lamps of the floodlight rooms are operated from a separate small, adjacent control room, so that it is not necessary for the nurse to enter the floodlit area herself in order to switch the lights on or off. On both male and female sides of the Solarium, cubicles are provided in which adult patients receive light treatment. These are seven in number on each side, and are sufficiently large to take a treatment couch, a duotherapy unit or two separate units, and to allow comfortable space for undressing. A commodious room on each side is set aside for massage treatment and for remedial exercises, and these rooms are suitably equipped with the appropriate apparatus. One small sterilising room for the use of the whole floor is situated in the male section, and in addition there is a nurses' room and a small bathroom is attached to the staff lavatory. With the exception of the massage rooms the floor surface of this section is of rubber throughout as in the Maternity and Child Welfare section. Second Floor—X-ray Department, Dental Clinic, Public Analyst. The second floor of the building is occupied by the dental clinic, the X-ray department and the laboratory of the public analyst. The dental clinic comprises a waiting room, dental nurse's office, two recovery rooms, two dental surgeries, dental surgeon's office and mechanics' workshop, to which is attached a separate plaster room. Dental patients enter by the main entrance in Grange Road, and the waiting room and nurse's office face the lift gate and staircase landing on the second floor. Each of the dental surgeries is fully equipped for every variety of dental operation. Both surgeries are of ample size with good natural lighting. One of the surgeries is, however, considerably larger than the other, and was deliberately so designed by Dr. Grantley Smith, in order that it might be used especially for operations under general anaesthesia. Speaking generally, the smaller surgery is intended for the finer operations and for 'clean' cases, and the larger surgery is reserved for gas operations, and for the more septic cases, and for this reason there is direct access from the larger surgery through folding doors to the recovery rooms. The dental equipment from the old clinic at 110 Grange Road has been installed in the large surgery, and this includes a complete dental X-ray outfit. The smaller surgery has been provided with equipment of the very latest type, which I am sure affords the utmost satisfaction to Dr. Grantley Smith. In actual practice, of course, the provision of two surgeries makes it possible for the dental surgeon to deal conveniently and expeditiously with a much larger number of patients than could be given attention in the old dental clinic. The dental workshop which adjoins the dental surgeon's office must be, I think, as nearly as possible ideal for its purpose. It is commodious, has excellent natural lighting, is fully equipped and has a separate plaster and vulcanising room. The latter provision is in itself a great advantage in that it enables the untidiness inseparable from this kind of work to be kept within reasonable bounds. This workshop is occupied by the three prosthetic assistants, who do the whole of the mechanical work, both for Dr. Grantley Smith and for Mr. Shapland at the Rotherhithe Centre. The X-ray department adjoins the dental clinic, being separated from it by Dr. Telfer's office. This department consists of three rooms, an X-ray room, a dark room, and a small viewing room. Patients enter by the second door in Alscot Road, a small waiting room for patients being provided opposite the staircase landing on the second floor. Here patients are interviewed by the nurse and distributed to the dressing cubicles, four in number, each of which is entered from the waiting room and has a second door which gives direct access to the X-ray room. The cubicle doors control an automatic light switch, which extinguishes the light in the cubicle when the door into the X-ray room is opened. The X-ray room is equipped with an X-ray couch for general X-ray work, and a separate vertical screening stand together with a mobile control unit and transformer cabinet. Dark blinds are fitted in box frames to all windows. The dark room is entered by a light trap from the main X-ray room, is fully protected against stray radiation, properly equipped for the development of films and ventilated by means of a suction fan in the roof. The same method of ventilation is also provided as a precautionary measure in the main X-ray room. The viewing room opens directly from the main X-ray room and has an additional door into Dr. Telfer's room. This room is fitted with three viewing boxes, card index record cabinets and a slotted cupboard for patients' slippers and gowns. A fire-proof film store is provided in the open, on the roof of the first floor, and access to this is by a door from the corridor opposite the X-ray department. The remaining portion of the second floor is occupied by the public analyst's laboratory. This consists of the main laboratory with fume cupboard, a fitted central bench and fixed benches on two walls. Adjoining the laboratory is the office of the Public Analyst. Elevation. Having described thus scantily the internal planning of the Health Centre there remain a few general comments which ought to be made. The building itself is largely constructed of steel and concrete, and for this reason those rooms in which quietness is essential, namely the five consulting rooms, have been specially soundproofed. The outer facing is of multi-coloured facing brick, slightly thinner than the standard size, bluish red, almost purple in colour and very pleasing in appearance. I am not competent to discuss the architectural features of the elevation, but the effect is one of severe simplicity which is partly achieved by the continuous lengths of window, which descend vertically from top to bottom in the front elevation, and cross horizontally from front to back on the lateral elevation. The furniture and fixtures, together with the internal decoration, including the very ticklish matter of a properly blended colour scheme, were fully considered by a sub-committee appointed for this purpose. The recommendations of this sub-committee were approved by both full committees, and since they have been the subject of almost universal approbation, it is but fair to mention that the lady members of this sub-committee took a most active part in deciding these very important details. The building is heated by means of hot water radiators, the water itself being heated electrically. For this purpose there has been constructed a small basement in which is installed an electrical sub-station, so that the building, as a whole, is supplied with alternating current, the general supply in the borough being direct current. This, of course, has also been an inestimable advantage in connection with the equipment for the X-ray department and the Solarium. The heating unit, which is automatic in its operation, together with the hot water storage tanks are also in the basement, while the cold water storage tanks are situated on the roof. The caretaker's flat constitutes the third floor, a portion of the roof space being set aside for his use. Public Health Centre, Grange Road. Public Health Centre, Grange Road Ground Floor. Public Health Centre, Grange Road First Floor. Public Health Centre, Grange Road Second Floor. VIII— PROPAGANDA. Report by Mr. H. W. Bush, F.I.P.A., M.I.H., Propaganda and Administrative Officer. During the year 1936, lectures and demonstrations, in each case illustrated by lantern slides and cinema films were given, as follows:— Lectures Audiences Schools 81 10,975 Clubs and other Institutions 36 2,000 Open-air with Cinema Van 67 23,600 184 36,575 As mentioned in the Annual Report for 1935, it is the aim of the Staff to steadily increase the number of school lectures and demonstrations each year. The number given during 1936 was the highest of any year since the inception of the scheme, and was an increase of 11 over the previous year. Every lecture is given by a doctor on the staff of the Department, and in all cases was illustrated by lantern slides and films. During the year 278 children attending elementary schools in the borough entered, after recognised training, for the Borough Council's examination in Personal Hygiene and Home Nursing, and the following certificates were granted:— Primary "A" 179 Primary "B" 18 One of the candidates who passed the Primary "B" examination also gained a Proficiency Medal for obtaining 70 per cent, of marks throughout the examination. One outstanding item of interest during the year was the enthusiastic help given to the work by certain members of the Council. Both Councillor Gibson, Chairman of the Public Health Committee, and Councillor Mrs. Coyle, Chairman of the Maternity and Child Welfare Committee, gave a series of Public Health Lectures throughout the year. As with all other lectures given, they were illustrated by lantern slides and films belonging to the Department. Councillor Gibson gave five lectures entitled "Activities of a Public Health Department " and Councillor Mrs. Coyle six on "The Treatment of Surgical Tuberculosis in Leysin, Switzerland." It is hardly necessary to say how deeply the Staff appreciated this practical assistance in the work of the Propaganda Department by public representatives. It will be noticed that at 36 lectures given in Clubs and other institutions, the audiences totalled 2,000, or an average of 55. We have always considered these small meetings as being very valuable, particularly because they enable questions to be asked at the end of the lecture, and these usually lead to a good deal of constructive discussion. In the early part of the year the Council decided to purchase a new Cinemotor for open-air demonstrations. The previous motor had been in use for eleven years, and was worn out and obsolete. The vehicle consists of a Morris Commercial 2-ton chassis with a body specially built for the purpose by a local firm, "Enid Garages Limited." As a result of our experience with the previous Cinemotors, we have had certain improvements made, but, in the main, the construction is similar. The body itself is considerably longer and higher and has enabled us to raise the height of the viewing screen at the rear, thus making it possible for a much larger audience to obtain a comfortable view of the pictures. The longer body provides ample accommodation for the cinema projector and the sound apparatus, in addition to the films and records and other equipment it is necessary to carry. The loud speakers are fitted under the viewing screen at the rear. One tremendous advantage we have in Bermondsey with this type of motor is that it is unnecessary to equip it with any electricity generating apparatus. The electricity required both for the films and the loud speakers is obtained from the electric standards in the streets by having them fitted with special connecting plugs. This entirely eliminates the main difficulty to be overcome with Cinemotors—the supply of electricity. The body has been enamelled in bright colours—red and yellow— and lettered on the sides "Bermondsey Borough Council Health Propaganda Cinemotor," and on the hood over the driver's cab "Here comes Good Health." The two photographs are published by the kind permission of "Transport Efficiency." IX.—SANITARY ADMINISTRATION. HOUSING. During the year 1936, eleven new areas were represented to the Council, comprising in all 237 dwelling houses and 14 dwelling houses and shops. The following are the areas represented:— Area in sq. ft. (approx.) No. of Dwelling Houses No. of Dwelling houses and Shops Date Title of Clearance Area Elephant Lane, No. 1 4/2/36 62,046 45 4 - Elephant Lane, No. 2 4/2/36 2,485 2 26 1 Cathay Street, No. 1 4/2/36 28,461 Cathay Street, No. 2 4/2/36 7,428 8 2 Cathay Street, No. 3 4/2/36 2,120 2 - Maze Pond, No. 1 2/6/36 11,829 13 - 41 1 Maze Pond, No. 2 2/6/36 21,664 1/12/36 40,466 46 4 Sard's Rents, No. 1 Sard's Rents, No. 2 1/12/36 8,499 13 2 Sard's Rents, No. 3 1/12/36 2,342 4 - - 1/12/36 Sard's Rents, No. 4 20,909 37 The Kipling Street area which was originally represented in November, 1935, was re-represented in April, 1936. The following areas have been declared by the Council, and the particulars of these are shewn hereunder: — Title of Clearance Area Area in sq.ft. (Approx.) No. of dwelling houses Population Families Persons Date declared by Council Kipling Street and lands adjoining 58,144 118 176 656 28/4/36 Elephant Lane No. 1 and lands adjoining 52,730 49 101 360 28/4/36 Elephant Lane No. 2 and lands adjoining 3,602 2 7 23 28/4/36 Cathay Street No. 1 and lands adjoining 29,321 27 46 176 23/6/36 Cathay Street No. 2 and lands adjoining 19,248 11 17 78 23/6/36 Cathay Street No. 3 2,120 2 4 10 23/6/36 Sards Rents No. 1 and lands adjoining 59,298 52 78 294 15/12/36 Sards Rents No. 2 8,499 15 20 82 15/12/36 Sards Rents No. 3 2,342 4 4 16 15/12/36 Sards Rents No. 4 and lands adjoining 30,260 37 41 157 15/12/36 The clearing of these areas will necessitate the demolition of 317 houses, and the rehousing of 494 families, consisting of 1,852 persons. The housing activities of the Council have been continued as in previous years, and 457 flats, 5 cottages and 6 shops were erected during 1936. Particulars of these are given hereunder:— Position Number of dwellings No. of families accommodated Rotherhithe Street 5 cottages 5 families Rotherhithe Street 3 flats and 1 shop 3 „ West Lane 4 flats 4 „ Bryan House 18 flats and 1 shop 18 „ Cherry Garden House 17 flats and 1 shop 17 „ Purbrook Estate 34 flats 34 „ Southwark Park Estate 30 30 Whites Grounds Estate 30 30 „ Cherry Garden Street 138 „ 38 „ Elim Estate 45 „ 45 „ Meakin Estate 34 „ 34 „ Redriff Estate 51 flats and 1 shop 51 „ Irwell Estate 24 fiats and 1 shop 24 „ Creasy Estate 21 „ 21 „ Adams Gardens Estate 47 flats and 1 shop 47 „ Renforth Street 28 „ 28 „ Tyers Estate 27 „ 27 „ Dhonau Estate 6 „ 16 „ At the end of the year the following dwellings were in course of erection by the Council:— Position Number of flats and shops 50 flats Elim Estate Redriff Estate, Block 6 60 „ Southwark Park Estate, Blocks 1 and 2 38 „ Adams Gardens Estate, Blocks 1 and 3 56 „ Trinity Road Site 39 „ Tyers Estate, Block 1 17 „ Dhonau Estate, Block 2 26 „ Arnolds Place, Block 1 31 „ and 1 shop Whites Grounds Estate, Block 5 20 „ Horney Lane, Blocks 1, 2 and 3 40 „ Meakin Estate, Block 1 11 „ Leroy Street, Block 2 16 „ 64 „ Aylton Street Site, Block 2 The London County Council have also erected in the Borough 287 flats, and these are situated in the Tabard Gardens and Dickens Estates. Private enterprise has been responsible for the erection of 8 houses and flats. Altogether, therefore, 749 flats and houses were erected in Bermondsey during the year referred to in this report. The houses demolished on insanitary areas number 367, and 26 houses have been demolished following the service of Demolition Orders and by other measures. HOUSING ACT, 1935—OVERCROWDING. The following was the position at the end of 1936 with relation to overcrowding:— ( a ) (i) Number of dwellings overcrowded at the end of the year 2,889 (ii) Number of families dwelling therein 2,889 (iii) Number of persons dwelling therein 15,706 (b) Number of new cases of overcrowding re- reported during the year 36 (c) (i) Number of cases of overcrowding relieved during the year 300 (ii) Number of persons concerned in such cases 1,492 (d) One case in which a dwelling house became overcrowded a second time after the Council had once already taken steps to abate overcrowding came to my notice during 1936. Intimation Notices were served on the tenants and subtenants under the Public Health (London) Act, 1891. (e) Four cases were referred to me in which dwelling houses became re-overcrowded after families had removed by private arrangement. Two of these families were rehoused by the Borough Council, after Notices had been served under the Public Health (London) Act, 1891, and action in regard to the remaining two families is still under consideration. Fifty-four cases of overcrowding in London County Council dwellings in Bermondsey have been abated and 4 cases in Borough Council dwellings, the number of persons dwelling therein in the first case being 253, and in the latter case 18; 109 cases have been relieved in connection with clearance operations, the equivalent persons in these cases totalling 577; these cases are included in C (i) and (ii) above. ERADICATION OF BED BUGS. For the past three years a concerted attack has been made in this borough against the bed bug, and the following table shows the action taken in this direction during the year 1936: — Infested Disinfested Council flats or houses 234 234 Council houses on Insanitary Areas during decanting 429 429 London County Council Removals 25 25 Houses disinfested prior to demolition 285 Other houses or flats 454 454 The disinfestation of houses is accomplished by means of gas, Sulphur dioxide or C.A.P. being used for the purpose. The Disinfecting Station is modern and well equipped, and the work is performed by the staff of the Council. The room or house is sealed up in the usual way before being filled with gas, and all bedding is brought into the Disinfecting Station where it is treated with steam at high pressure. In the case of removals from Council's flats or from insanitary areas, it is the usual practice to return the bedding and other effects to the new flat. INSPECTIONS. PROCEEDINGS, ETC. Hereunder will be found particulars of Inspections, Proceedings, etc., for the year 1936:— Inspection of Dwelling Houses during the Year:- (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,911 (b) Number of Inspections made for the purpose 41,554 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,912 (b) Number of Inspections made for the purpose 3,912 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 277 (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 958 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 2,967 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 958 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 741 (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 4,632 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 1,665 (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 18 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 18 (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 3 (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 19,402 Number of houses occupied by the working classes 19,358 REGISTERED PREMISES— Number on Register at end of 1936 Number of Inspections Number of Prosecutions Premises Common Lodging Houses 3 65 - 3 Seamen's Lodging Houses 18 - 264 Milkshops 647 - Houses let in lodgings 4,168 - 1,191 Ice Cream Premises 141 340 - Offensive Trades (including Poultry Slaughter-houses) 13 121 - SMOKE NUISANCES— Number of observations 127 Number of notices 22 Number of complaints 8 Number of summonses 2 WATER SUPPLY TO TENEMENT HOUSES- Premises supplied 25 Prosecutions Nil SALE OF FOOD Number of premises used other than ice-cream premises, milk shops and cowsheds 659 Number of inspections 2,465 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 — No notices were served under this Act. 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, inhabitated by more than one family. Water supply has been installed on one of the storeys of 25 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:- For securing the cleanliness of tanks, cisterns, etc. 1 Number of prosecutions under the Milk and Dairies (Consolidation) Act, 1915 3 WORK OF DISTRICT INSPECTORS, 1936. 12 13 14 15 16 17 18 19 20 21 22 23 1 3 4 5 6 7 8 9 10 11 2 House-to-House Special Inspections Complaints Infectious Diseases Factories & Workshops Specially Inspected Offensive Trades Outworkers' Bi-Annual Inspection Underground Conveniences Other Calls and Visits Chimneys watched Bakehouses Butchers Food Stores Fruiterers and Greengrocers Ice Cream Restaurants and Eating Houses Destruction of Food Various TOTALS Common and Seamens Lodging Houses Fishmongers, Friers and Curers Drains Tested Visits Ints. Markets District No. 1 562 1733 361 93 - - 21 - 10 2165 8 30 29 55 22 61 21 42 40 70 - - 5323 588 „ No. 2 492 1196 397 58 - - 31 - 17 3523 2 16 - 72 15 51 34 20 75 21 1 6021 740 - „ No. 3 582 1873 565 142 - - 13 - 6 3164 13 27 5 145 81 33 40 39 65 42 3 - 6838 847 1145 201 140 - - 22 - 43 2566 - 20 - 28 10 12 10 15 96 14 2 - 4748 „ No. 4 424 606 380 1012 349 80 - - 25 - 38 2696 17 23 2 45 21 28 5 - 4820 638 „ No. 5 9 5 73 12 „ No. 6 354 928 583 109 - 1 34 - 25 3764 1 26 8 18 14 101 17 19 75 16 1 - 6094 784 „ No. 7 552 1010 287 153 6 - 44 - 27 3097 59 14 - 48 14 78 24 28 61 25 5 - 5532 791 566 1171 73 4 - 43 - 155 18 38 39 58 5 22 6 255 27 7 - 5513 No. 8 408 2600 18 649 3912 10068 3151 848 10 1 233 - 321 23575 118 194 469 170 379 157 209 740 227 24 - 44889 5643 Total 83 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. HOMEWORK. NATURE OF WORK (1) Outworkers' Lists, Seetion 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) Instances (14) Notices served (15) Prosecutions (16) Lists (2) Outworkers Failing to keep lists (9) Falling to send lists (10) Resident in Bermondsey Resident in other Districts (5) Contractors (6) Workmen (7) Contractors (3) Workmen (4) Wearing Apparel:— (1) Making, etc. 16 - 24 45 2 32 9 - - 12 12 - - - 2 - - - - (2) Cleansing and washing - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - Umbrellas, etc. 1 - - - - - 1 - - - 1 - - - - Sacks 4 - 9 3 - - 2 - - 1 1 - - - - 3 3 - - - - Paper, etc., Boxes, Paper Bags 1 - 11 1 - 5 1 — - Brush making - - - - - - - - - - - - - - - Combs, etc. - - - - - - - - - - - - - - - Leather Goods 2 - 2 8 - - 1 - - - - - - - - Surgical Instruments 2 - - 2 - - 1 - - - - - - - - Coathangers 1 - 14 10 - 3 1 - - - - - - - - Carding of buttons, etc - - - - 6 - - - 1 1 - - - - - Onion Peeling - - - - - 5 - - - - - - - - - Games and Toys - - - - - 1 - - - - - - - - - Total 27 - 60 69 2 52 15 - - 17 17 - 2 - - FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK INSPECTION. Number of Premises Written Notices Inspections Prosecutions Factories (including Factory Laundries) 1,621 60 - Workshops (including Workshop Laundries) 662 65 - Workplaces (other than Out workers' Premises) 6,011 12 - Total 8,294 137 - DEFECTS FOUND, Number of Defects Found Remedied Referral to H.M. Inspector Number of Prosecutions Particulars 18 18 Nuisances under the Public Health Acts— Want of Cleanliness - - - Want of Ventilation - - - - Overcrowding - 2 - 2 Want of Drainage of Floors 2 - - Other Nuisances 37 37 - - 11 Sanitary Accommodation— Insufficient - 11 - - 67 67 Unsuitable or Defective - Not separate for Sexes 2 2 1 - Offences under the Factory and Workshop Act— Illegal Occupation of Underground Bakehouse (s. 101) - - - - Breach of Special Sanitary Requirements for Bake-houses (ss 97 to 100) - 56 56 - Other Offences - - - - - Total 193 193 1 OTHER MATTERS Number Class. - 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) 3 3 2 Other Underground Bakehouses (s. 101):- - Certificates granted during 1936 In use at end of 1936 17 Workshop Bakehouses 16 Workshops on the Register (s. 131) at the end of 1936 405 Total Number of Workshops on Register 421 No OF BAKEHOUSES IN THE BOROUGH. In Use Not in Use Underground Above ground Above ground Underground 17 5 2 35 36 of these are Factory Bakehouses. HOUSE, TRADE AND MARKET REFUSE. The following table shows the amount of house, trade and market refuse disposed of during 1936: — Disposal Loads tons cwts. q rs . 16,965 21,191 House Refuse to Barge 12 1 Trade Refuse „ Barge 2,874 2,033 15 2 Street Markets Refuse to Barge 2,307 2,202 14 - Totals 3 25,428 1 22,146 OFFENSIVE TRADES. The offensive trades on the Register are as follows: Fellmongers 3 Fatmelters 2 Glue and size makers 3 Dresser of Fur Skins 5 MORTUARY. As mentioned in my last Annual Report the London County Council now acts as agent for the Borough Council in the matter of mortuary accommodation, and receives into the mortuary at St. Olave's Hospital those bodies, for which it is the duty of the Borough Council to provide. A fee of one guinea per body is paid by the Borough Council for this service. Number of infectious bodies removed 1 Total number of bodies removed 17 STREET MARKETS. The market scheme continues to work smoothly and satisfactorily. Number of Licences in operation 563 Income £3, 166 6s. 9d. There have been 6 prosecutions during the year. DRAINAGE WORK. Hereunder will be found particulars of drainage work, &c., carried out by the Drainage Inspector during 1936: — Drains Tested 711 Intimation Notices served Visits to Underground Conveniences 521 Other Visits 3,845 WORK OF THE FACTORIES AND SHOPS INSPECTOR. Shops. Visits 1,662 Notices served under Shops Act, 1934 86 Notices served under Public Health (London) Act, 1891 48 Factories. Visits 722 Notices served 60 Workshops. Visits 662 Notices served 65 Visits to Offensive Trade premises 120 Various Visits 447 Chimneys watched 9 X—FOOD CONTROL. UNSOUND FOOD. The general inspection of food in shops and on stalls forms part of the duty of the District Sanitary Inspectors and of the Market Inspector. 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 tons cwts. qrs. lbs. Weight Confectionery - - - 3 Fresh Fish - 3 2 24 Shell Fish — 1 0 18 Smoked Fish - 2 0 0 Fresh Fruit 1 12 3 2 Canned Goods - - - 27 Meat — — 3 18 Poultry - - 2 4 Vegetables - 12 1 0 Rabbits - 2 2 1 Total 2 16 0 13 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925,1933. One hundred and seven samples have been taken during the year by the Wharves Inspectors. Of this number 4 samples were submitted to bacteriological examination, 1 to chemical examination, 7 to ascertain the composition, 2 to ascertain cause of stain, 4 to ascertain whether contaminated by river water, 4 to ascertain composition of black mineral matter, 1 to ascertain composition of red particles, 26 for the presence of preservative, 4 for the presence of preservative and metals, and the remainder for the presence of metals. In addition, 7 samples have been taken by officers for special purposes. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933. No. of samples Articles Examined Examination Result Action Negative Almonds, Shelled 1 For presence of lead Released Sulphur Dioxide, 580 parts per million Apple Pectin For preservative 1 No action Tin .24 grains per lb. Apples, canned 1 For presence of metals No action Satisfactory Asparagus 1 Bacteriological Released Green colour due to to copper Bacon Rind To ascertain cause of stain 2 Bacon trimmed Not contaminated Brine 1 To ascertain whether contaminated by river water Released Unsatisfactory Brine Chemical 1 Destroyed Unsatisfactory Brine 1 Bacteriological Importer warned and Dutch authorities notified Unsatisfactory Brine 1 Bacteriological Destroyed Tin 2 grains per lb. Brisling For presence of metals 1 Destroyed Butter 1 To ascertain composition Genuine butter Released Negative Butter, French 13 For presence of Boric Acid Released Not contaminated Cauliflower in Brine 3 To ascertain whether contaminated by river water Released No metallic contamination Crab, Korean 1 For presence of metals No action Copper 18 parts per million Cherries, drained 1 For presence of copper No action PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued Articles examined No. of Samples Examination Result Action For presence of copper No action Copper 20 parts per million Cherries, drained 2 „ „ „ „ „ Copper 23 parts per million 1 „ „ „ „ 2 Copper 25 parts per million „ „ „ Copper 26 parts per million Importer warned 1 „ „ „ „ Copper 30 parts per million „ „ „ 1 „ „ Copper 30 parts per million Re-exported „ „ 1 „ „ „ „ „ 3 Copper 40 parts per million For preservative Egg Albumen Negative Released 1 Egg Yolk Boric Acid 1.5% Boric Acid 1.65% For presence of Boric Acid Released for leather dressing 2 Egg Yolk Negative No action 1 For preservative Released for paste and linoleum making Flour To ascertain composition of black mineral matter 4 Sulphides of iron and lead Tin .53 grains per lb. Herring Roes, soft For presence of metals No action 1 Herrings in Marinade Satisfactory No action 1 „ „ To ascertain composition Genuine Lard, Lithuanian 1 „ „ Lard, Polish „ „ „ 5 Tin .36 and .66 grains per lb. „ Oranges, Manderin 2 For presence of metals Orange Juice, natural Released For preservative Sulphur Dioxide, 250 parts per million 1 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. Articles Examined No. of Samples Examination Result Action Pineapple, canned 1 For presence of metals Lead 10 parts per million Tin .39 grains per lb. Released „ „ Lead 2 parts per million Tin .22 grains per lb. „ „ „ „ „ 1 Lead 4 parts per million Tin .33 grains per lb. „ „ „ 1 Tin .27 grains per lb. „ „ „ „ „ 1 „ Tin .29 grains per lb. „ „ „ „ „ „ „ Tin .57 grains per lb. 1 „ „ Satisfactory Sulphur Dioxide, 1,175 parts per million For preservative 1 No action Plum Pulp 2 Satisfactory Sulphur Dioxide, 870 and 1,537 parts per million „ „ Raspberry Pulp Released Satisfactory Sulphur Dioxide, 1,500 and 1,800 parts per million For preservative 2 No action Red Currant Pulp 1 Released for dog biscuits To ascertain composition of red marks on sack Red marks consisted largely of iron, which had also filtered through to the flour Rye Flour and Sack 1 Destroyed For presence of metals Unsatisfactory Tin 1.8 grains per lb. Salmon No action 1 For presence of metals and preservative Salmon Spread Tin .2 grains per lb. No preservative For preservative „ Sea Salmon 1 Satisfactory For presence of metals Sardines 3 Released „ 1 No. of Samples Examination Result Articles Examined Action For presence of metals 2 Tin .04 grains per lb. in each Sardines, Portugese No action 1 Lead 10 parts per million Tin .49 grains per lb. „ „ „ „ 1 „ „ Lead 6 parts per million Tin .62 grains per lb. „ „ „ 1 „ „ „ „ „ Lead 6 parts per million Tin .12 grains per lb. „ „ 1 Lead 4 parts per million Tin .21 grains per lb. „ „ „ 1 „ „ „ „ „ 1 „ „ Lead 8 parts per million Tin .16 grains per lb. Lead 8 parts per million Tin .19 grains per lb. „ „ „ Stopped Re-exported Released No action Destroyed 1 „ „ „ „ Lead 26 parts per million Tin .45 grains per lb. 1 „ „ Lead 14 parts per million Tin .25 grains per lb. „ „ 2 No preservative Tin .08 and .52 grains per lb. No preservative Unsatisfactory Sausages, Frankfurter For presence of metals and preservative 1 Sausages, Salami For preservative 1 Bacteriological „ „ PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. Articles Examined No. of Samples 1 Result Action Examination No preservative Tin .08 grains per per lb. No action Sild, Norwegian For presence of metals and preservative 1 No action Sprats in Oil, Latvia For presence of metals Satisfactory Tin .66 grains per lb. Tin .6 grains per lb. Copper 35 parts per million 1 Released M.O.H. for Dundee notified Tomato Extract For presence of metals „ „ 1 Released M.O.H. for City of London notified „ „ Tin .12 grains per lb. Lead 2 parts per million Copper 35 parts per million Re-exported 1 Tomato Paste „ „ Copper 40 parts per milion Tin 1.65 grains per lb. „ 1 Copper 40 parts per million Tin 2.3 grains per lb. „ „ „ „ „ 1 Copper 40 parts per million Tin 2 grains per lb. „ „ „ „ 1 „ Copper 40 parts per million Tin 1.9 grains per lb. „ „ „ „ 1 „ „ „ „ „ 1 „ „ „ „ „ Copper 50 parts per million Tin 1.6 grains per lb. Copper 40 parts per million Tin 1.98 grains per lb. No action 1 Copper 20 parts per million Tin .56 grains per lb. „ „ „ „ PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. Articles Examined No. of Samples Examination Result Action taken Tomato Puree For presence of metals Copper 10 parts per milion Tin 1.47 grains per lb. 1 Released „ „ „ 1 „ „ „ Copper 10 parts per million Tin .56 grains per lb. „ „ „ „ 1 Copper 25 parts per million Tin 1.51 grains per lb. „ Tomatoes, Peeled Plum Tin .1 grains per lb. „ „ 1 No action Samples Examinod for Special Purposes. Fish Paste Bacteriological 1 Satisfactory No action Swimming Bath Water 2 Bacteriological and Chemical Satisfactory „ To ascertain whether injurious to the men handling Bleached Earth 1 Kaolin; and harmless Referred to the Home Office Grit and Ash from Factory Chimney Smoke nuisance 3 Satisfactory Subsequent Prosecution WORK OF THE WHARF AND FOOD INSPECTORS, 1936. 12 1 4 5 6 7 8 9 10 11 3 2 Food Factories Fish Curers Food Stores Milksellers Pharmacy & Poisons Nuisances Found Intimations Served Various Ice Cream Premises Number of Samples taken Food and Drugs Imported Food Regulations Milk (Special Designation) Order Samples of Milk for presence of Tubercle Bacilli Grit Deposit (Bacteriological Examination) Ice Cream (Bacteriological Examination) Samples of Milk for presence of Bacillus Abortus Jam Butter and Margarine Swimming Bath Water (Bacteriological Examination) Other Food Wharves and Depots Destruction of Food - 24 98 - 363 1844 - - 222 - - 14 - - 25 - - - - - - 17 - 32 - 162 1823 - - 234 4 3 16 - - 23 - - - - - - 130 2 459 37 1351 - - 240 14 9 138 - - 59 - - - 124 - - - - 6 - - 143 647 551 1 3 - 451 131 1502 - 195 9 3 109 4 2 164 551 107 195 9 109 3 4 813 697 619 1502 2 MILK PREMISES. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Thirty-one milksellers were registered under the above Act during 1936, and fifty-seven names were removed from the Register, making a total of 264 milksellers on the Register at the end of the year under report. MILK (SPECIAL DESIGNATIONS) ORDERS, 1923, 1936. During the year under report the following licences were granted:— Dealers' Licences: To bottle and sell Grade "A" (Tuberculin Tested) Milk 7 To sell Grade "A" (Tuberculin Tested) Milk 21 To sell Grade "A" Pasteurised Milk 1 To sell Pasteurised Milk 22 To sell Tuberculin Tested Milk 1 Pasteuriser's Licence: To sell milk as Pasteurised 1 Supplementary Licences: To sell Certified Milk 4 To sell Grade "A" Pasteurised Milk 3 To sell Grade "A" (Tuberculin Tested) Milk 7 To sell Pasteurised Milk 11 To sell Tuberculin Tested Milk 1 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 are made for the sampling of milk supplied to all schools in the borough. Samples are taken for both bacteriological and chemical analysis, and so far a good standard has been maintained. Samples have been taken from 32 schools, and a total of 707 samples have been examined, as follows:— For Chemical (i.e., Fat and non-Fatty Solids) Examination. Liquid Milk undesignated 307 Liquid Milk undesignated (informal) 3 Grade "A" Tuberculin Tested Milk 6 Pasteurised Milk 49 Pasteurised Milk (informal) 46 MILK SAMPLING—continued Sterilized Milk 59 Condensed Milk (informal) 27 Evaporated Milk (informal) 3 Dried Milk (informal) 4 504 For Bacteriological Examination. Tuberculin Tested (Pasteurised) Milk 5 Grade "A" Tuberculin Tested Milk 54 Grade "A" Pasteurised Milk 4 Pasteurised Milk (from schools) 45 Pasteurised Milk (other than from schools) 34 Tuberculin Tested (Certified) Milk 1 Tuberculin Tested Milk 51 For tubercle bacilli 9 For brucella abortus 4 Pasteurised Milk (Phosphataze Test) 1 208 ICE CREAM. One hundred and eighteen samples of ice cream have been examined with the following results: — 1. Bacterial Count. Up to 100 per 1 c.c. 4 Over 100 to 500 per 1 c.c. 5 Over 500 to 1,000 per 1 c.c. 3 Over 1,000 to 5,000 per 1 c.c. 11 Over 5,000 to 10,000 per 1 c.c 7 Over 10,000 to 50,000 per 1 c.c. 42 Over 50,000 to 100,000 per 1 c.c. 6 Over 100,000 to 200,000 per 1 c.c 11 Over 200,000 to 400,000 per 1 c.c. 4 Over 400,000 to 600,000 per 1 c.c. 3 Over 600,000 to 800,000 per 1 c.c. 2 Over 800,000 to 1,000,000 per 1 c.c. 1 Over 2,000,000 9 Spoilt culture—overgrown 1 2. Presence of B. Coli. B. Coli present in 1 c.c. 1/10th c.c. and 1 100 th c.c. 40 B. Coli present in 1 c.c. and 1/10th c.c. 21 B. Coli present in 1 c.c. 16 B. Coli absent in tests ranging from 1 c. c. to 1/lOOth c.c. 32 3. Chemical Analysis. Fat 3.10 per cent. 1 Fat 3.20 per cent. 1 Fat 3.85 per cent. 1 Fat 3.95 per cent. 1 Fat 11.90 per cent. 1 Fat 12.40 per cent. 1 Fat 15.70 per cent. 1 Fat 16.70 per cent. 1 Fat 16.76 per cent. 1 PHARMACY AND POISONS ACT, 1933. Parts II and III of this Act, which considerably revise the law relating to the sale, supply, storage and transport of poisons, together with the Rules made by the Home Office under section 23, came into full effect on the 1st May, 1936. The existing legislation was thereby repealed. Section 25 (5) requires the local authority to take steps to secure compliance by persons not being authorised sellers of poisons with the requirements of the Act and the Rules relating to poisons in Part II of the Poisons List. Mr. H. E. Butcher, Food and Drugs Inspector, was appointed inspector under the Act. The number of premises listed for the year was fifty-seven, and the number of persons removed from the list two. Two samples were submitted for analysis by the Public Analyst. All those who might possibly be sellers of poisons were warned by circular letter against infringement of the new requirements, and such shops as general shops, accumulator chargers, garages, and hairdressers, as well as street markets and street vendors, were kept under observation by the inspector. There was one prosecution during the year, that of a hairdresser against whom proceedings were taken for selling a hair dye containing a dangerous poison without being a listed seller of poisons. The defendant had received two letters warning him against the sale of preparations containing poisons; he was fined £2 and ordered to pay £3 3s. 0d. costs. FOOD AND DRUGS. Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated Percentages of Articles Adulterated Ale, 1 1 - - Ale, Brown (informal) 1 1 - - Ale (informal) 1 1 1 - - - Apricots, dried (informal) 1 - Aspirin Tablets 3 3 - Aspirin Powder (informal) 1 - - 1 - Almonds, ground - 11 11 Arrowroot - 2 2 - - Baking Powder 1 - - 1 1 1 Bananacreme - - Barley, pearl 7 7 - - Barley, pot 1 - 1 - - Beer, bitter 1 1 - Bicarbonate of Soda 4 4 - - Borax, pure 3 - 3 - Bread Crumbs (informal) 1 1 - - Brawn 12 12 - Brawn, veal - 8 8 - - Brawn, pork 5 5 - - Brawn (informal) 1 - 1 - Buns, real cream (informal) 1 - - 1 Butter 74 74 - - 1 Calamine Lotion, Colloidal - - 1 Camphor, spirit of 1 1 - - Capers, French (informal) 1 - 1 - Caraway Seeds (informal) 1 1 - - 1 Cascara Sagrada, fluid, extract of 1 - - Candied Peel, mixed 1 1 - - Candied Peel, mixed (informal) 2 2 - - Cherry Ciderette 1 1 - Cherries, Glace (informal) - 1 1 - - Chicken and Ham Roll 1 1 - - Cheese 11 11 - - Cheese, Dutch 1 1 - Cheese, in foil - 6 6 - - Cheese, Cheddar, in foil 7 7 - - Cider 2 2 - - Cod fillets (informal) 2 2 - - Cocoa 12 12 - 7 - Cocoanut, desiccated 7 - 4 - - Coffee 4 - Coffee, Arabian 1 - 1 - Coffee and Chicory Extract 7 7 - 1 - Coffee and Chicory 1 - Colouring, lemon yellow (informal) - - 1 1 - 3 Cornflour 3 - 1 - Cordial, peppermint flavour 1 - - Cordial, non-alcoholic 1 1 - - Crab, tinned (informal) 2 2 - - Cream, fresh 6 6 - - Cream, coffee 1 1 - - Cream, fresh (informal) - 1 1 - FOOD AND DRUGS—continued. Total Samples Taken Number Genuine Number Adulterated Percentages of Articles Adulterated Articles submitted for Analysis Cream, tinned 2 2 - - Cream, tinned (informal) 15 15 - - Cream Horns, real cream 1 1 - - Cream Soda 1 1 - - Curry Powder 2 2 - - Custard Powder 1 1 - - 1 1 - - Delitalade Doughnuts, real cream 1 1 - - Dripping 53 53 - - 2 2 - - Egg Substitute Powder Epsom Salts 1 1 - - Easton's Syrup 1 1 - - Eucalyptus, oil of 2 2 - - 2 2 - - Figs, syrup of Figs, dried (informal) 1 1 - - Flour 3 3 - - Flour, self-raising 29 29 - - Flour, bun 1 1 - - Flour, pea 1 1 - - Flour, cake 1 1 - - Fruit Syrup, grapefruit 1 1 - - Fruit Juice 1 1 - - Fruit Pectin, compound 1 1 - - 1 Fruit Syrup (informal) 1 - - 2 2 - - Ginger Beer Ginger Wine Essence 1 1 - - Ginger, ground 6 6 - - Gingerade, blackcurrant 1 1 - - - - 1 1 Ginger, ground (informal) Gelatine (informal) 2 2 - - Glycerine 1 1 - - Glycerine, Lemon and Honey, Balsam (informal) 1 1 - - Grape Fruit Squash 5 5 - - - - - - 1 1 Halibut Oil Hexagons Ham Pâté 1 1 - Herbs, mixed, dried 1 1 - Honey 1 1 - - 2 2 - - Hydrogen Peroxide Ice Cream (informal) 9 9 - - Iodine, tincture of 4 4 - - Iodine, solution of 1 1 - - 1 - Jelly, calves feet (informal) 1 - Jelly, blackcurrant 4 4 - - Jelly, port wine 1 1 - - Jelly, greengage 1 1 - - Jelly, strawberry 1 1 - - FOOD AND DRUGS—continued Total Samples Taken Number Genuine Number Adulterated Percentages of Article Adulterated Articles submitted for Analysis Jelly, raspberry 3 3 - - Jelly, mint sauce 2 2 - - Jelly, orange (informal) 1 1 - - Jelly, wild bramble 1 1 - - Jelly, plum 1 1 - - Jam, apricot 3 3 - - Jam, blackcurrant 3 3 - - Jam, plum 2 2 - - Jam, greengage 1 1 - - Jam, raspberry 4 4 - - Jam, strawberry 1 1 - - Jam, mixed fruit 1 1 - - Jam, peach, tinned 1 1 - - Jam, red plum 1 1 - - Jam, plum, stoneless 2 2 - - Jam, blackberry and apple 1 1 - - Jam, red plum, stoneless (informal) 1 1 - - Jam, green gooseberry 1 1 - - Junket Crystals 1 1 - - 1 1 - - Ketchup (informal) 2 2 - - Lemonade Lemon Squash Powder 1 1 - - Lemonade Powder and crystals 12 12 - - Lentils 3 3 - - Lemon Cheese (informal) 1 1 - - Lard 33 1 2.94 34 Lemonade 5 5 - - Lime Juice, cordial 1 1 - - 1 1 - - Malt, extract of, with Halibut Liver Oil Malt, extract of, with Cod Liver Oil 1 1 - - Magnesia, citrate of 1 1 - - Marmalade 2 2 - - Marmalade, ginger (informal) 1 1 - - Marmalade, honey 1 1 - - Margarine 47 47 - - Milket, orange 1 1 - - Mussels in Vinegar (informal) 1 1 - - Milk 307 298 9 2.93 Milk (informal) 3 2 1 33.33 Milk, Sterilised 59 56 3 5.09 Milk, Evaporated (informal) 3 3 - - Milk, Condensed (informal) 27 27 - - Milk, Dried (informal) 4 4 - - Milk (Grade "A" (T.T.) 6 6 - - Milk, Pasteurised 49 49 - - Milk, Pasteurised (informal) 46 46 - - Milk Gums 1 1 - - Milk Food (informal) 1 1 - - Mint, dried 10 8 2 20.00 Mint, dried (informal) 1 - 1 100.00 Mustard 12 12 1 100.00 Mint Bricks 1 1 - - FOOD AND DRUGS—continued Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated Percentage of Articles Adulterated Mint, in Malt Vinegar (informal) 1 1 - - Mustard (informal) 1 1 - - Mints, Clear 5 4 1 20.00 Mincemeat 2 2 - - 3 2 1 33.33 Nitre, Sweet Spirit of 1 1 - Oats, Breakfast - Oatmeal 1 1 - - Oil, Castor (informal) 1 1 - - Oil, Cod Liver 2 2 - - Oil, Cod Liver with Malt Extract 1 1 - - Oil, Olive 2 2 - - Oil, Camphorated 2 2 - - Oil, Olive (informal) 2 2 - - Oil, Cod Liver, Cream Emulsion 1 1 - - Ointment, sulphur 2 2 - - Ointment, basilicon 1 1 - - Ointment, zinc 5 5 - - Ointment, zinc and castor oil 1 1 - - Ointment, iodine (informal) 1 1 - - Orange Quinine Tonic Powder 1 1 - - 1 1 - - Peas, split Pepper 17 17 - - Pepper (informal) 1 1 - - Pepper, compound (informal) 1 - - 1 Porter 1 1 - - Prunes, dried (informal) 1 1 - - Paste, fish 7 7 - - Paste, salmon and shrimp 7 7 - - Paste, crab 1 1 - - Paste, turkey and tongue (informal) 1 1 - - Pickle 4 4 - - Pickle (informal) 1 1 - - Prawns in Jar 2 2 - - 2 2 - - Pudding, black 1 1 - - Quinine, Ammoniated Tincture of Quinine, Bisulphated Tablets 1 1 - - 1 1 - - Roll, veal, ham and egg Roll, galantine 1 1 - - Rice 12 12 - - Rice, flaked 6 6 - - Rice, ground 3 3 - - Raisins, seedless (informal) 2 2 - - Role Mops (Bismark Herrings) 1 1 - - Raisins, stoned 1 1 - - 2 2 - - Sardines, in tin (informal) Sausages, beef 34 34 - - Sausages, breakfast 17 17 - - Sausages, cardigan 1 1 - - Sausages, chipolata 14 11 3 21.43 Sausages, Cambridge 2 2 - - Sausages, liver 2 2 - - Sausages, luncheon 2 2 - - FOOD AND DRUGS —continued Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated Percentages of Articles Adulterated 1 1 - - Sausages, Lincolnshire Sausages, pork 30 27 3 10.00 Sausages, Devonshire 2 2 - - Sausages, undesignated 1 1 - - Sausages, Hereford 1 1 - - Sausages, Parisien 1 1 - - Sauce 9 9 - - Sauce (informal) 1 1 - - Sauce, chop 1 1 - - Sauce, mint 1 1 - - Sauce, mint (informal) 1 1 - - Sauce, tomato 4 4 - - Sauce, Worcestershire 1 1 - - Sauce, Yorkshire 1 1 - - Shortening 3 3 - - Soda Water 2 2 - - Sild, Norwegian (informal) 2 2 - - Sherry 3 3 - - Squash, lemon 4 4 - - Sherbet 3 3 - - Sherbet Dabs 1 1 - - Squash 1 1 - - Stout, materials for making 1 1 - - Stuffing, sage onion and egg 1 1 - - Suet, shredded 35 32 3 8.57 Suet, shredded (informal) 1 1 - - Stout 1 1 - Stout (informal) 1 1 - Sugar 6 6 - - Sugar, glucose barley 1 1 - - - - Sugar, raw cane 1 1 - Sultanas 2 2 - - - Sultanas (informal) 1 1 - - Syrup, cherry cough 1 1 - - Syrup, golden (informal) 1 1 - - 1 1 - - Tablets, compound quinine Tapioca 2 2 - - Tapioca, flaked 1 1 - - Tea 14 14 - - Thyme 1 1 - - Tonic, cinnamon and quinine 1 1 - - Tonic, quinine (mineral) 1 1 - - Tonic, fruit, non-alcoholic (informal) 1 1 - - 1 - - Veal, Ham and Tongue Roll, tinned (informal) 1 Vinegar 54 53 1.85 1 Vinegar, malt 21 19 2 9.52 Vinegar, table (informal) 3 3 - - Vinegar, raspberry 1 1 - - Whisky 1 1 - - Wine, black-currant, non-alcoholic 2 2 - - Wine, ginger, non-alcoholic 1 1 - - Wine, cherry ginger, essence 1 1 - - Wine, orange quinine 2 2 - - Wine, port 1 1 - - 1,502 1,471 31 2.064 Total PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1936. Sample Adulteration or Infringement Remarks Milk Sale of milk deficient in milk fat 23.3 per cent. Dismissed under Probation of Offenders' Act, 1907, on payment of Costs, £1 1s. Pork Sausages Wilful neglect to label sausages containing preservative Fine £1 Costs £2 2s. Chipolata Sausages Wilful neglect to label sausages containing preservative Withdrawn Milk Selling milk containing added water to the extent of 6.3 per cent. Dismissed under Probation of Offenders' Act, 1907, on payment of Costs—£2 2s. Chipolata Sausages Selling sausages containing preservative without causing same to be labelled to that effect Dismissed under Probation of Offenders' Act, 1907, on payment of Costs—£3 3s. Pork Sausages Ditto Fine £2 Costs £5 5s. Vinegar Selling vinegar deficient in Acetic Acid to the extent of 15.0 per cent. Dismissed under Probation of Offenders' Act, 1907, on payment of Costs—£2 2s. Sweet Spirit of Nitre Selling Sweet Spirit of Nitre deficient in Ethyl Nitrite to the extent of 40.8 per cent. Dismissed under Probation of Offenders' Act, 1907, on payment of Costs—£s 5s. Milk Dismissed. Dealt with in conjunction with cases Nos. 122a and 122b Sailing milk containing added water to the extent of 4.4% Milk Selling milk containing added water to the extent of 1.4% Fine £5 Costs—£4 4s. Milk Selling milk deficient in milk fat to the extent of 5.0% Fine £5 Costs—£4 4s. Shredded Suet Selling shredded suet deficient in fat to the extent of 20.8% Fine £1 Costs £2 2s. PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1936. Sample Adulteration or Infringement Remarks No. 133 Dried Mint Selling Dried Mint to the prejudice of the purchaser Dismissed with a caution under Probation of Offenders' Act, 1907, on payment of cost, £1 1s. Sterilized Milk Selling sterilized milk containing added water to the extent of 4.9% Fine £5 Costs £8 8s. 137a ,, ,, Selling sterilized milk containing added water to the extent of 3.0% Dismissed under Probation of Offenders' Act, 1907, on payment of costs, 10/6 138 ,, ,, Dismissed under Probation of Offenders' Act, 1907, on payment of costs, £2 2s. 141 Selling sterilized milk containing added water to the extent of 5.6% 142 Shredded Suet Selling shredded suet deficient in fat to the extent of 5.2% Dismissed upon proof of warranty 143 Hair Dye Selling poison without being authorised Fine £2 Costs £3 3s. OTHER PROSECUTIONS. Milk and Dairies (Consolidation) Act, 1915. Section 6. 119a Selling milk from barrow without having name and address of vendor conspicuously inscribed thereon Fine £1 Costs £2 2s. ,, ,, Fine £2 119b Fine £2 Costs £1 1s. 137b Carrying on trade of Dairyman without being registered Milk and Dairies (Amendment) Act, 1922. 140 Using designation for sale or advertisement of milk without being licensed Dismissed with a caution under Probation of Offenders' Act, 1907, on payment of costs, £3 3s. London County Council (General Powers) Act, 1932. 130 Use of unregistered premises for manufacture of ice cream Dismissed under Probation of Offenders' Act, 1907, on payment of costs, 10/- SUMMARY. £ s. d. Fines 26 0 0 Costs 53 10 6 £79 10 6 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933. Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Quantity Weight Weight MEAT. Beef. tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs Dried - - I 2 bags I 2 - - - - - - - - - - - - - Corned - I - 42 cases and 188 tins 1 14 1 4 - - - - - - - - - Tinned Veal 1 135 cases and 36 tins - - - - 418 tins 2 3 12 2 10 19 - - - - - - - Casings - 2 casks - 6 - - - - - - - - - - - - - - - - 45 sides 13 gammons 1 case 1 back 5 - - - 66 bales 6 - - Pork. Bacon 12 5 3 10 - - - - - - - Tinned Brawn 2 tins - - - 12 - - - - - - - - - - - - - - - - Tinned Hams 25 cases and 407 tins 3 3 1 11 7 cases and 15 tins 2 2 12 - 26 cases 1 2 2 - - - - - - 24 - 17 - - - 1 - 12 hams Smoked Hams Various 3 3 - - - - - - - 17 cases and 17 tins - 11 3 14 - - - - - - - Canned Pork - - - - - - - - - - 1 carcase, 2 sides, 1 hindquarter - 2 23 - - - - Fresh Pork 4 - - - - - - - - - Fresh Tongues - - 6 tongues - 27 - - - - - - - - - - - - - - - Canned Tongues - - - - - 260 tins - 13 1 5 - - - - - — - - - - 1 cask - 1 2 Tongues in Brine - - - - - 4 tongues - — - 24 - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933.-continued Quantity Unsound Disposed of for Purposes other than Human Food Removed for Sorting under S.A. Exported Articles Destroyed Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons lbs tons cwt qr lbs tons cwt qr lbs tons lbs CWt qr cwt qr Mutton. 1 carcase - 1 17 - - - - - - - - - - - - - - - - Rabbits - - 24 cases and - 18 1 9 6 cases - 3 - - - - - - - - - - Various. Kidneys - 3 rabbits 22 tins - - - - - 3 - - - - - - - - - - - - 14 16 1 24 Canned Meat Various 47 cases 1 4 2 22 - - - - - - - - - - - - - - 4 cases and - 1 3 26 - - Tinned Sausages - - - - - - - - - - 2 tins 4 cases - - - - - Salami Sausages 2 - 3 - - - - - - - - - - DAIRY PRODUCE. Butter Various - - - - - 250 boxes 1 2 6 5 - - - - - - - - - Cheese - - Various - 18 2 1 - - - - - - - - - - - - - Eggs - - - 2,853 tins 119 2 1 - - - - - - - - - - - - - Egg Yolk 7 casks - 14 - 37 tins - 4 2 14 - - 85 casks 8 - - - - - - - Margarine 18 boxes - 9 - - - - - - - - - - - - - - - - - Milk - - - - - 1 case and 1,123 tins - 11 2 18 - - - - - - - - - - FRUIT. Fresh. Apples - - 5 bags - - - - - 4 - - - - - - - - - - - Grenades - - 41 cases 1 - - - - - - - - - - - - - - - - Lemons - - 67 cases 1 13 2 535 cases 20 - - - - - — - - - - - - Melons - - 66 cases 3 - - - 3 - - - - - - - - - - - - Mixed - - 4,349 cases 200 - - - - - - - - - - - - - - - - Oranges - - - - - 8,499 boxes 439 11 2 - 706 boxes 27 16 - - - - - - - Pears - - 1,323 cases 28 4 2 - - - - - - - - - - - - - - Raspberries - 5 tubs - 1 3 3 - - - - - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933 -continued Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Articles Quantity Weight Quantity Weight Quantity Weight lbs. tons lbs tons Canned and Juice. tons cwt qr cwt qr cwt qr lbs 3 cases and 24 tins Apricots - - - - - - 2 - - - - - - - Apricot Pulp - 1 cask, 9 cases, 247 tins 2 19 3 18 - - - - - - - - - Blackcurrants - - 22 cases - 18 - - - - - - - - - - Blackcurrant Pulp - - - 8 cases and 3 tins - 6 - - - - - - - - - - - Grapefruit - - 2,331 cases 49 18 1 - - - - - - - - Grapefruit Juice - - - 164 casks 23 12 - - - - - - - - - Grapefruit Canned - - - 20 cases and 4 tins 8 2 6 - - - - - - - - - - - - Grapes Preserved 2 tins 1 - - - - - - - - - Greengage pulp - - - 2 casks and 15 cases 1 5 - - - - - - - - - - - Raspberry Pulp - 10 casks 2 10 - - - - - - - - - Lemon Peel - - - 10 barrels 3 15 2 - - - - - - - - - - 14 cases and 57 tins Oranges Canned 5 0 17 - - - - - - - - - - - - - Orange Juice - - 375 casks 49 8 - - - - - - 10 barrels 3 15 2 2 - - - Orange Peel - - - - - - - Orange Pulp - - - 3 tins - 1 2 - - - - - - - - Peaches Canned - 7 cases - 3 - - - - - - - - - - - Pears Canned - - - 6 cases - 3 24 - - - - - - - - Pineapple Canned - - 73 cases and 61 tins 2 7 3 12 - - - - - - - - Preserves - - 1 case - 1 - - - - - - - - - - Strawberries Preserved - - - 1 cask - 3 - - - - - - - - - - - 115 cases and 62 tins 3 10 23 Tomatoes Canned - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933-continued Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Articles Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs. tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs Tomato Puree 24 cases and 33 tins - 1 3 - 25 - - - 19 cases - 9 2 - - - - - - - - Tomato Paste - - 79 coses and 7 tins 4 - - 268 cases 13 - - - - - - - - - - - - Various Canned - - Various 12 11 2 8 - - - - - - - - - - - - - Mixed Pulp 3 casks - - - - - - 15 - - - - - - - - - - - - Dried. Currants - - 19 bags 1 18 - - - - - - - - - - - - - - - Various - - Various 2 13 - - - - - - - - - - - - - - - Prunes - - 5 cases 2 13 - - - - - - - - - - - - - - - Sultanas 62 boxes - 13 3 10 Various 5 1 17 - - - - - - - - - - - CEREALS, etc. Butter Beans 2 - - Various 26 - - - - - - - - - - - - - - - Flour 2,406 sacks 150 7 2 - - - - - - - - - - - - - - - - Rice Various 1027 11 3 Various 2 17 16 - - - - - - - - - - - - Rice Ground Various 15 - - - - - - - - - - - - - - - - - - Rice Sweepings Various - 4 1 - - - - - - - - - - - - - - - Tea 1077 bags 53 17 - - - - Various 69 5 2 - - - - - - - - - Wheat Various 246 13 1 - - - - - - - - - - - - - - - - Macaroni 214 boxes 2 13 2 - - - - - - - - - - - - - - - - POULTRY. I Chickens - - 80 cases 3 chickens 1 4 - 69 cases 1 - - - - - - - - - - - - Turkeys - 13 birds - 1 1 6 - - - - - - - - - - - - - - - - - - Partridges - - - 36 cases 1 11 - - - - - - - - - - VEGETABLES. Cauliflower Various 2 4 2 - - - - - - - - - - - - - - - - Endives - - - 3 - - - - - - 21 crates and 2 bags - - - - - - - - - Gherkins - 10 casks - 3 casks - 1 2 - 5 - - - - - - - - - - - 1 case - - - Mushrooms Dried - - 1 2 - 4 - - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933— continued Quantity Unsound Articles Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Exported Quantity Weight Quantity Weight Quantity Weight Quantity Weight tons cwt qr lbs 1 tons cwt qr lbs tons cwt qr lbs tons cwt qr lbs Onions - - 30 bags 1 - - - - - - - - - - - - - - - - Potatoes 4 bags and 1 basket - 1 - - - - - - - - - - - - - - - - - 4 Red Cabbage 18 88 bags 8 - 38 bags 1 - - - - - - - - - - - - - - 10 tins 1 2 20 - - - Sauerkraut - - - - - - - - - - - - Carrots - Various 3 - - - - - - - - - - - - - - - - - FISH. Anchovies 14 casks and 2 tins 3 10 1 14 - - - - - - - - - - - - - - - Crab Dressed - 1528 cases 7 2 - - - - - - - - - - - - - - - - Dry Fish Various - - - - 2 - - - - - - - - - - - - - Pike - - - 8 cases 8 - - - - - - - - - - - - - - - Herring Roes Canned - - 4 6 cases 2 - - - - - - - - - - - - - - - Salmon - 37 tins 9 - - - 1 - - - - - - - - 2 - - - Sardines. 80 cases - Various - 5 3 2 - - 2 - - - - - - - - - - Samolax - 15 cases 7 2 - - - - - - - - - - - - - - - - NUTS. I Cocoanuts - Various 3 11 - - - - - - - - - - - - - - - - Groundnuts 1309 bags 48 3 - - 16 bags 1 2 2 9 - - - - - - - - - - - Walnuts Shelled - 1 case - 1 27 - - - - - - - - - - - - - - - Walnuts in Brine - - 2 5 casks 10 - - - - - - - - - - - - - - - VARIOUS. I Canned Goods Various 91 13 2 1 - - - - - - - - - - - - - - - Chicken and Ham Rolls - - 11 tins - 11 - - - - - - - - - - - - - - - - Tallow 35 casks 11 5 - - - - - - - - - - - - - - - - Lard Oil 200 barrels 5 - - - - - - - - - - - - - - - - - - - - - Cocoa Waste - 1 sack 5 - - - - - - - - - - - - - - 1092 2 1 20 Total 19 61 1587 12 3 12 3 101 12 - - XI.—HEALTH SERVICES. MATERNITY AND CHILD WELFARE CENTRES. Public Health Centre, Grange Road. Monday, 2.0 p.m.-4.0 p.m. Wednesday, 9.45 a.m.-12 noon Thursday, 2.0 p.m.-4.0 p.m. Ante-natal Clinic Tuesday, 2.0 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 Clinic Thursday, 4.30 p.m.-7.30 p.m. Bermondsey Gospel Mission, 1-3, Jamaica Road. Monday, 2.0 p.m.-4.0 p.m. Friday, 2.0 p.m.-4.0 p.m. Manor Chapel, Roseberry Street. Monday, 2.0 p.m.-4.0 p.m. Bryan House, Rotherhithe Street. Thursday, 2.0 p.m.-4.0 p.m. Princess Club, Jamaica Road. Tuesday, 2.0 p.m.-4.0 p.m. Thursday, 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 Class Wednesday, 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. Central Hall, Bermondsey Street. Tuesday, Wednesday, Thursday and Friday, 2.0 p.m.-4.0 p.m. 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, 9.30 a.m.-12 noon. Tuesday, 1.30 p.m.-4.0 p.m. Wednesday, 9.30 a.m.-12 noon. Friday, 9.30 a.m.-12 noon SPECIAL CLINICS FOR WOMEN. Public Health Centre, Grange Road. Wednesday 4.30 p.m.-6.30 p.m. 98, Rotherhithe New Road. Thursday 2.0 p.m.-4.0 p.m. PUERPERAL FEVER-CONSULTANTS. Mr. A. J. McNair, F.R.C.S., 9 Devonshire Place, W.l. (Telephone: Welbeck 6241.) Mr. G. F.Gibberd, F.R.C.S., 14 St. Thomas's Street, S.E.I. (Telephone: Hop 1010); and 20 Harley Street, W.l. (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. Public Health Centre, Grange Road. Monday to Thursday (inclusive), 10.0 a.m.-7.30 p.m, Friday 10.0 a.m.-5 p.m. 98 Rotherhithe New Road. Monday, Thursday and Friday, 2.0 p.m.-5.0 p.m. Tuesday 2.0 p.m.-7.30 p.m. Wednesday, 10 a.m.-7.30 p.m. From 5.0 p.m. to 7.30 p.m. the Centres are open only for patients who cannot attend during the day. TUBERCULOSIS DISPENSARY, Public Health Centre, Grange Road. Patients are seen by appointment only. Evening sessions are held for patients at work. LIGHT TREATMENT CENTRE, The Solarium, Public Health Centre, Grange Road. Monday to Thursday (inclusive), 9.30 a.m.-5.30 p.m. Friday, 9.30 a.m.-1 p.m. Monday and Thursday, 6.0 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 CLINICS. Public Health Centre, Grange Road. Monday at 9.30 a.m. 98 Rotherhithe New Road. Friday at 9.50 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 a.m.-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), 10.30 a.m.- 1.0 p.m. and 3.0 p.m.-6.0 p.m. Saturday, 9.30 a.m.-12 noon. 163 Abbeyfield Road. Dental Monday, 9.30 a.m.-12 noon. Tuesday, 1.30 p.m,-4.0 p.m. Wednesday, 9.30 a.m-4.0 p.m. Thursday and Friday, 9.30 a.m.-12 noon. Trinity School Treatment Centre, Redriff Lane. Minor Ailments Monday to Friday, 12 noon-1 p.m. INVALID CHILDREN'S AID ASSOCIATION (Bermondsey Branch) Municipal Offices, Spa Road. Office hours Monday to Friday (inclusive), 9.30a.m.-5.30 p.m. Saturday, 9.30 a.m.-12.30 p.m. Tuesday, 5.30 p.m.-7.30 p.m. (by appointment only). NURSING ASSOCIATIONS. St. Olave's District Nursing Association, 13 Cherry Garden Street. Rotherhithe Queen's District Nursing Association, 149 Lower Road. FOOT CLINICS. Public Health Centre, Grange 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. White's Grounds Estate. Monday, 2.0 p.m. to 5.0 p.m. 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. Bryan House, Rotherhithe Street. Tuesday, 2.0 p.m. to 5.0 p.m. Patients are seen by appointment only. Appointments can be 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. W. B. Pemberton, 50 Grange Road. 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—Waterloo 3311 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—Waterloo 3311. 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, Street, Greenwich, S.E.10