AC 4378 M. BER 50 Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1937 BY D. M. CONNAN, M.D., D.P.H., Medical Officer of Health. BER 50 Borough of Bermondsey. REPORT ON THE SANITARY CONDITION OF THE BOROUGH OF BERMONDSEY For the Year 1937 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— Area 8 Dwellings 8 Rateable Value 8 Population 8 Births 8 Deaths 9 Marriages 9 Infantile Mortality Rates 10 Deaths from Tuberculosis 10 Vital Statistics of District 11 Causes of Deaths 14 Deaths from Zymotic Diseases 16 Infantile Mortality, Causes of Deaths 17 INFECTIOUS DISEASES— Diseases Notifiable 18 Diphtheria 19 Scarlet Fever 23 Enteric Fever 23 Dysentery 24 Small-Pox 24 Ophthalmia Neonatorum 24 Puerperal Fever and Pyrexia 25 Acute Primary and Acute Influenzal Pneumonia 25 Whooping Cough 25 Measles 26 Disinfection 26 Cleansing Station 27 Shelter 28 Bacteriological Laboratory 28 Food Poisoning 29 Insulin for Diabetic Patients 29 Nursing 30 Cases Notified in 1937 31 Cases Notified for last ten years 32 TUBERCULOSIS— New Cases and Deaths 33 Period between Notifications and Deaths 33 Nursing and Extra Nourishment 34 Shelters 34 Lady Almoner 35 Work of the Tuberculosis Dispensary 36 Summary of Notifications 37 Cases on the Register 38 PAGE LIGHT TREATMENT, ELECTRO-THERAPY AND MASSAGE— Work done in the Solarium 39 Leysin Patients 47 MATERNITY AND CHILD WELFARE— Fairby Grange Convalescent Home 55 Midwifery Service 56 Obstetric and Puerperal Fever Consultants 57 Infant Life Protection 57 Maternal Mortality 57 Work of the Health Visitors 58 Attendances at Centres 59 Extracts from Vital Statistics, 1937 60 DENTAL TREATMENT— Particulars of Treatment and Work for 1937 66 Particulars of Children Treated 65 CONSULTATION AND OTHER CLINICS- X-ray Department 67 Post-Infectious Disease Clinic 69 Post-Natal and Special Clinics for Women 71 Children's Clinic 73 Foot Clinic 74 PROPAGANDA 75 SANITARY ADMINISTRATION- Housing 83 Housing Act, 1936—Overcrowding 85 Eradication of Bed Bugs 86 Inspections and Proceedings 88 Work of the District Inspectors 91 Factories and Workshops—Homework 92 Factories and Workshops—Inspections 93 Bakehouses 94 House, Trade and Market Refuse 94 Offensive Trades 94 Mortuary 95 Street Markets 95 Drainage Work 95 Work of Factories and Shops Inspector 95 FOOD CONTROL— Imported Food Regulations—Samples taken 101 Unsound Food—Shops and Stalls 108 Work of the Wharves and Food Inspectors 109 Milk Premises 110 Milk Licences 110 Milk Sampling 110 Ice Cream 111 Halibut Liver Oil 144 Pharmacy and Poisons Act, 1933 114 Food and Drugs—Samples Taken 115 Food and Drugs—Prosecutions 121 Unsound Food—Wharves, etc. 122 HEALTH SERVICES 127 PUBLIC HEALTH DEPARTMENT. PUBLIC HEALTH COMMITTEE, 1937. Chairman Councillor S. R. WEIGHTMAN 1936-37 „ „ E. J. GIBSON 1937-38 Vice-Chairman „ C. J. LEE 1936-37 „ „ S. R. WEIGHTMAN 1937-38 Alderman G. R. Balleine Councillor R. E. Goodwin „ Mrs. L. M. Brown „ Miss K. Groves „ A. E. Hatcher „ Mrs. A. M. Hatcher „ A. V. Parker „ Mrs. F. Humphreys Councillor Mrs. S. C. Amos „ A. V. Kidd „ H. A. Beal „ Mrs. R. E. Laker „ R.A.W. Butchers „ F. W. Love „ W. T. Cockett „ W. S. McKay „ Mrs. E. V. Coyle „ Miss E. M. Nix „ J. A. W. Douglas „ G. H. Stean „ F.J.W.Fielder „ A. E. Winch „ Mrs. L. A. Glasson „ J. A. Wright Ex-officio: Councillor E. J. GIBSON, J.P., Mayor of Bermondsey, 1936-37 Councillor A. M. DOWNING, J.P., Mayor of Bermondsey, 1937-38 MATERNITY AND CHILD WELFARE COMMITTEE, 1937 Chairman Councillor Mrs. E. V. COYLE 1936-37 „ Councillor Mrs. D. A. GREEN, 1937-38 Vice-Chairman Councillor Mrs. F. A. POWELL 1936-37 „ Alderman Mrs. L. JONES 1937-38 Alderman Mrs. L. M. Brown Councillor Mrs. R. E. Laker „ Miss M. I. Henrich „ G. Loveland Councillor D. Bradley „ Mrs. M. F. Lowery „ Miss I. Condon „ Mrs. W. L. Miller „ Mrs. M. Cushing „ Miss E. M. Nix „ Mrs. A. M. Fortescue „ Mrs. A. E. Pitt „ E. J. Gibson „ Mrs. J. V. Snowdon „ Mrs. L. A. Glasson „ S. R. Weightman „ Mrs. A. M. Hatcher „ J. A. Wright Co-opted Members: Mrs. E. R. Balman Miss J. Langley Mrs. E. B. Childs Mrs. H. Richardson Mrs. A. E. Gledhill Rev. W. Spencer Miss E. M. Haslam Mrs. E. C. Starr Ex-officio : Councillor E. J. GIBSON, J.P., Mayor of Bermondsey, 1936-37 Councillor A. M. DOWNING, J.P., Mayor of Bermondsey, 1937-38 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. (Died 13th Nov. 1937) 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. (Resigned June 1937) J. Marshall, M.B., Ch.B. (Commenced June 1937) 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. Nurse in Charge—Mrs. Dorothy Cottier. Solarium Nurses—Estelle Jagôt, Muriel Coleby, Joyce Hopkins, Gladys Warry, and Martha Saunders MATERNITY AND CHILD WELFARE. Assistant Medical Officers for Maternity and Child Welfare— Ruth W. Plimsoll, M.B.,B.S., D.P.H.; Florence L. Telfer, M.D., D.M.R.E. Health Visitors. Rosa Bache Elizabeth Lawrence Avis Baird Kathleen Parry Sarah Bowles Gwendolen Riches Lucy Brown Edith Riley Amy Carlton Florence Robson Marie Helden Florence Wadds Isabel White FAIRBY GRANGE CONVALESCENT HOME. Matron—Florence Child Sister—Ann O'Meara POST NATAL AND SPECIAL CLINICS FOR WOMEN Consultant Gynæcologist—Glady Dodds, M.D., D.P.H., M.C.O.G., F.R.C.S. (Eng.) CHILDREN'S CLIINIC Medical Officer —Ursula Shelley, M.D., M.R.C.P. (Lond.) RHEUMATISM CLINIC. Medical Officer —Ursula Shelley, M.D., M.R.C.P. (Lond) 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.R.I.P.H.H. CLERICAL STAFF. A. I. Fair, Chief Clerk J. A. Blake, General Clerk F. W. Smith, Second Clerk J. F. M. Brooker, General Clerk C. W. Whye, General Clerk J. W. J. Saward, General Clerk A. Manning, General Clerk Alice Jones, General Clerk F. R. Parker, General Clerk F. Cornwell, Junior Clerk C. F. Yaxley, General Clerk H. D. White, Junior Clerk Rose Dutch, Clerk and Dispenser F. H. Mummery, Junior Clerk J. L. Springett, Junior Clerk H. J. Smith, General Clerk Joyce Field, Junior Clerk C. H. Harris, General Clerk S. R. Weightman, Junior Clerk DISINFECTING AND CLEANSING STATION : A. C. Davidson, Foreman in Charge. PUBLIC HEALTH DEPARTMENT. MUNICIPAL OFFICES, SPA ROAD, S.E.16. Borough of Bermondsey. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. To the Mayor, Aldermen and Councillors of the Borough of Bermondsey. Sir, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1937. I desire, as in previous years, to express thanks to the chairmen and members of committees, and to say that the harmonious relations between the controlling committees and the officers of the department have contributed greatly to the efficiency of the department and the happiness and welfare of the staff. In particular I wish to express my personal thanks to all the chairmen who have been in office during the year. The effective working of an active department depends in a very large measure on the interest and advice contributed by the latter outside the committee-room, and these have been accorded to the fullest extent during the year. This year has been one of unusual pressure upon the staff, and bearing in mind the very low rates of incidence of the infectious diseases, this fact is rather difficult to explain. I think there can be very few Public Health Departments in the country with a more efficient and hardworking staff than our own, and I am grateful for the opportunity of expressing my appreciation of their work in this manner to the Council. I am, Sir, Ladies and Gentlemen, Your obedient Servant, D. M. CONNAN. I.—VITAL STATISTICS. GENERAL. The area of the borough (exclusive of area covered by water) is 1,336 acres. The number of inhabited houses at the end of 1937 according to the Rate Books was 19,483. The rateable value of the borough on the 31st December, 1937 was £872,611, the product of a penny rate being £3,445. POPULATION. Estimate of Registrar General Census 1921 1931 to 30th June, 1936 to 30th June, 1937 119,452 100,400 111,542 98,790 BIRTHS. The total number of births belonging to the borough registered during 1937 was 1421, consisting of 747 males and 674 females. The number for 1936 was 1,545. The birth rate for 1937 was 14.4 per 1,000 persons living, compared with 15.4 for 1936. DEATHS. The total number of deaths belonging to the borough registered during 1937 was 1,212, consisting of 650 males and 562 females. The number for 1936 was 1,289. The death rate for 1937 was 12.3 per 1,000 persons living, compared with 12.8 for 1936. MARRIAGES. The total number of marriages in the borough in 1937 was 1,090, being 120 above the number for 1936, and 82 above the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. This makes a marriage rate of 22.07 per 1,000 of the population, compared with a marriage rate last year of 19.32. Year No. Rate 1,021 1927 16.88 1928 1,055 18.32 1929 994 17.47 1930 17.94 1,021 1931 1,001 17.81 1932 936 17.00 1933 1,007 18.77 1934 1,050 19.91 1935 1,027 20.00 1936 970 19.32 1,008 Average for years 1927-1936 18.34 1937 1,090 22.07 INFANTILE MORTALITY. Year Whole Borough London No. of Deaths Rate per 1,000 Births No. of Deaths Rate per 1,000 Births 67 4,357 59 1927 149 85 4,879 67 1928 178 160 71 4,995 71 1929 1930 130 63 4,109 59 57 1931 112 4,270 65 56 4,143 67 1932 103 92 61 3,377 60 1933 67 100 64 3,832 1934 69 1935 103 3,229 58 92 60 3,691 66 1936 64 Average for years 1927-1936 4,088 65 122 59 * 84 * 1937 TUBERCULOSIS OF THE RESPIRATORY SYSTEM. In the following Table will be found particulars of deaths from Tuberculosis of the Respiratory System since the year 1927. Sub-District Bermondsey Rotherhithe St. Olave Whole Borough London Year No. No. No. Rate No. No. Rate 42 1927 87 15 144 1.19 4140 0.91 1.24 1928 43 143 3985 0.89 88 12 1929 1.03 0.96 31 8 117 4230 78 36 15 132 1.16 3826 0.87 1930 81 0.90 1931 81 30 5 116 3907 1.03 71 1.05 1932 34 11 116 3564 0.82 23 8 0.92 0.82 1933 68 99 3530 22 90 0.86 3227 0.76 1934 64 4 1935 23 0.95 70 5 98 2847 0.68 1936 51 6 22 79 0.79 2848 0.69 31 9 Averages for years 1927-1936 1134 1.02 0.83 74 3610 63 * 1937 * 2 87 0.89 22 *These figures are furnished by the Medical Officer of Health, London County Council, and were not available at the time of going to press—26th May, 1938. INFANTILE MORTALITY RATE FOR 25 YEARS. VITAL STATISTICS OF WHOLE DISTRICT DURING 1937 AND PREVIOUS YEARS. Total Deaths registered in the District Deaths of Non- Residents registerd 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 Year 1 Total Deaths in Public Institutions in the District 9 Population estimated to Middle of each Year 2 Births No. 3 Rate 4 Under 1 Year of Age At all Ages No. 12 Rate 13 No. 5 Rate per 1,000 Births registered 6 Rate 8 No. 7 1927 121,000 2,233 18.5 119 53 1,236 10.2 616 22 352 1,566 12.9 1928 115,200 2,080 18.1 143 69 1,230 10.7 671 39 329 1,520 13.2 127 1,304 11.4 696 378 1929 113,800 2,252 19.8 56 32 1,650 14.5 1930 113,800 2,059 18.1 90 44 1,169 10.3 686 46 365 1,488 13.1 1931 112,400 1,958 17.4 91 46 1,169 10.4 596 1,408 12.5 92 331 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 1935 102,700 1,487 14.5 99 67 1,142 11.1 756 255 314 1,201 11.7 1936 100,400 1,545 15.4 76 49 1,136 11.3 723 175 328 1,289 12.8 Averages for years 1927-1936 110,176 16.7 97 10.9 129 1,409 12.8 1,197 1,851 52 694 341 1937 98,790 1,421 14.4 61 43 1,148 11.6 741 245 309 1,212 12.3 (12) OTHER INSTITUTIONS, Etc., Etc. III. Other Institutions, etc., the Deaths in which have been distributed among the several localities in the District 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. No. of Deaths No. of Deaths No. of Deaths St. Olave's Hospital Ladywell Institution Acton Hospital, Acton 1 234 42 Albany Hospital, Deptford 1 All Saints' Hospital, Southwark 2 Ambulances on way to Hospital 16 Bermondsey Medical Mission Hospital Bexley Mental Hospital, Bexley 7 Brompton Hospital 1 1 Brook Hospital, Shooters Hill 1 Caterham Hospital, Caterham 1 Colindale Hospital, Hendon 1 Deaths in River Thames, Surrey Commercial Docks, Wharves, etc. Cottage Hospital, Hendon 1 County Hospital, Farnborough 1 Darenth Park, Darenth 1 Douglas House, Bournemouth 1 Downs Hospital for Children, Sutton 1 6 Evelina Hospital 4 Friern Hospital, Friern Barnet 1 Fulham Hospital 1 Railway 1 Grove Park Hospital 2 Guy's Hospital 52 Hackney Hospital 1 Private Houses 3 Horton Hospital, Epsom 4 Hospital, The, Coulsdon 3 Hostel of God, Clapham Common 1 Total 245 Hundred Acres, Banstead 5 Infants' Hospital, Westminster 1 Kings College Hospital 3 Ladywell Institution 42 Lambeth Hospital 8 Leavesden Hospital, Watford 1 Lewisham Hospital 10 London Hospital 1 Lying-in Hospital, York Road 1 Margate General Hospital, Margate 1 Miller Hospital 2 Newington Institution, Southwark 4 Nursing Home, Bolingbroke Grove, Battersea 1 Park Hospital, Hither Green 9 Pea-pickers Encampment, Offham 1 Poplar Hospital 1 Princess Elizabeth of York Hospital, Shadwell 3 Private Houses 10 Queen Mary's Hospital for Children, Carshalton 3 Queen Mary's Hospital, Chislehurst 1 Railway at Mitcham 1 (13) OTHER INSTITUTIONS, Etc., Etc.—continued Institutions, etc., within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, etc., the Deaths in which have been distributed among the several localities in the District. No. of Deaths St. Alfege's Hospital, Greenwich 17 St. Alfege's Institution, Greenwich 11 St. Bartholomew's Hospital 1 St. Benedict's Hospital, Wandsworth 1 St. Clement's Hospital, Poplar 1 St. Ebbas Hospital, Epsom 1 St. Francis Hospital, Camberwell 4 St. George-in-the-East Hospital, Stepney 5 St. Gile's Hospital, Camberwell 4 St. James' Hospital, Balham 1 St. John's Hospital, Battersea 3 St. Joseph's Hospice, Hackney 2 St. Luke's Hospital, Paddington 1 St. Mary Abbot's Hospital, Kensington 1 St. Nicholas Hospital, Woolwich 1 St. Peter's Hospital, Stepney 2 St. Peter's Hospital, Westminster 1 St. Thomas's Hospital 5 Seaman's Hospital, Greenwich 1 South-Eastern Hospital, New Cross 9 South-Western Hospital, Stockwell 3 Street 2 Tooting Bee Hospital 15 University College Hospital 1 West Kent General Hospital, Maidstone 1 Workplaces 1 Total 309 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1937. Causes of Death Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 65 and up wards 25 and under 45 45 and under 65 84 12 99 All Certified 1212 6 27 48 340 596 Causes Uncertified - - - - - - - - - - - Typhoid and Paratyphoid Fever - - - - - - - Measles - - - - - - - - - (14) - - Scarlet Fever - - - - - - - Whooping Cought 7 5 1 1 - - - - - Diphtheria 5 3 2 - - - - - - Influenza 39 - - - 1 1 2 16 19 Encephalitis Lethargica 1 - - - - 1 - - - Cerebro-spinal Fever 4 2 1 1 - - - - - Tuberculosis of Respiratory System 87 - - 1 20 27 30 9 - Other Tuberculous Diseases 5 - 1 3 - 1 1 - - Syphilis 10 1 - - - 3 3 3 - General Paralysis of the Insane, tabes dorsalis - 2 - 1 1 - - - - Cancer, Malignant Disease 154 - - 1 11 65 77 - - Diabetes 7 - - 1 3 3 - - - Cerebral Hæmorrhage, etc. 96 1 1 - 1 28 65 - - Heart Disease 262 - 1 3 16 59 183 - - Aneurysm 3 - 3 - - - - - - Other Circulatory Diseases 23 - - - 1 17 5 - - Bronchitis 92 4 - - - 1 24 63 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1937—continued Causes of Death Deaths at the subjoined ages of " Residents " whether occurring in or beyond the district. All Ages 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and up wards Under 1 Pneumonia (all forms) 105 17 3 5 5 2 29 44 - Other Respiratory Diseases 17 - - 1 1 8 7 - - Peptic Ulcer 17 3 9 5 - - - - - Diarrhœa, etc. 24 21 2 1 (15) - - - - - Appendicitis 3 1 2 - - - - - - Cirrhosis of Liver 4 1 5 - - - - - - Other Diseases of Liver, etc, 3 - 2 - - - - - - Other Digestive Diseases 17 1 5 11 - - - - - Acute and Chronic Nephritis 72 5 7 16 44 - - - - Puerperal Sepsis - - - - - - - - - Other Puerperal Causes 1 1 - - - - - - - Congenital Debility, Premature Birth, Malformations, etc, - 27 27 - - - - - - Senility 14 1 13 - - - - - - Suicide 11 - - 1 1 3 4 2 - 16 Other Violence 50 3 1 6 4 6 14 - Other Defined Causes 49 3 12 6 8 12 8 - - Causes ill-defined or unknown - - - - - - - - - 1212 84 6 12 27 48 99 340 596 DEATHS FROM ZYMOTIC DISEASES, 1937. Year All Causes Principal Zymotic Diseases Smallpox Measles Scarlet Fever Diphtheria Whooping Cough Enteric Fever Diarrhœa No. No. Rate Rate No. Rate No. Rate No. No. Rate No. Rate No. Rate No. Rate Rate 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 101 .89 - 61 7 .06 8 6 .05 2 .02 17 .15 13.1 .54 .07 - 1931 1408 12.5 24 .21 - - 3 .03 1 .01 6 .05 5 .04 - - 9 .08 1932 1326 12.0 67 .61 1 .01 25 .23 - 11 .10 16 .15 - - 14 .13 - 1933 1340 12.5 .42 - 9 4 .04 13 .12 5 .05 - - 14 .13 45 - .08 1934 1304 12.4 87 .83 - - 38 .36 1 .01 10 .10 10 .10 - - 28 .26 1935 1201 11.7 54 .53 - - 4 .04 10 .10 5 .05 - - 35 .34 - - 1936 1289 12.8 56 .56 - - 20 .20 - 8 .08 5 .05 4 .04 19 .19 - Average for years 1927-1936 1409 68 - 25 10 .09 12 .11 1 18 .22 - .01 .17 12.8 .61 2 .02 1212 12.3 36 - - - - - - .05 7 - 24 INFANTILE MORTALITY. Deaths from Stated Causes at Various Ages under One Year of Age, 1937. 1—2 weeks Total under 1 month 1—3 months 9—12 months Cause of Death Under 1 week 6—9 months Total under 1 year 2—3 weeks 3—6 months 3—4 weeks - - - - - - Measles - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - 1 2 1 1 5 - Diphtheria - - - - - - - - - - Influenza - - - - - - - - - - Cerebro-spinal Meningitis - - - - 2 - 2 - - - Tuberculous Meningitis - - - - - - - - - - Other forms of Meningitis - - - - - 1 - 1 - - Tuberculosis of Respiratory System - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Syphilis - - - 1 1 - - - - - Bronchitis - - 2 1 1 4 - - - - Pneumonia (all forms) - - 5 8 1 3 17 - - - Other Respiratory Diseases - - - - - - - - - - Diarrhoea and Enteritis 1 1 - 2 5 7 3 4 21 - Congenital Debility and Malformation, Premature Birth - 14 18 1 13 1 2 1 - - Injury at Birth - 4 - - 4 4 - - - - Other Causes 4 1 1 6 1 3 - 1 11 - Totals 21 2 2 1 26 14 24 10 10 84 II—INFECTIOUS DISEASES, ETC. The following diseases are notifiable :- Anthrax Acute Poliomyelitis Acute Influenzal Pneumonia Cerebro Spinal Meningitis Diphtheria Enteric Fever and Typhoid Fever Glanders Malaria Membranous Croup Plague Puerperal Fever Relapsing Fever Small-pox Tuberculosis —all forms Acute Polioencephalitis Acute Primary Pneumonia Cholera Continued Fever Dysentery Encephalitis Lethargica Erysipelas Hydrophobia in Man *Measles Ophthalmia Neonatorum Puerperal Pyrexia Scarlet Fever and Scarlatina Typhus *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 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 exceptions 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. DIPHTHERIA. The number of cases of diphtheria notified during the year was 167 ; this is the lowest figure recorded in the borough for 32 years. Of these patients, in 30 cases the diagnosis of diphtheria was not confirmed, so that the actual number of cases of diphtheria which occurred in the borough last year was 137. When it is remembered that last year's net figure of 180 was the lowest recorded since 1910, I feel sure that the Council will receive the present low record with pleasure. I do not think that it would be either wise or fair to attribute this reduction to any particular cause, but at the same time the vigilance of the general practitioners and the work of the Schick Clinics must have played a part in securing this reduction. As an illustration both of the value of Schick immunisation, and of the excellent work of the general practitioners and of the co-operation between this Department, the private doctor and the London County Council as the infectious hospitals authority, I wish to record the following notes. A child was notified to me as suffering from diphtheria on 28th August and removed to hospital at once. She had been Schick tested in this Department in May of the previous year (1936), and being found to be susceptible to diphtheria, immunising injections were given. These injections were not successful in protecting her, and a further series of injections were given in September 1936. When tested after the second series of injections, the Schick test gave a negative result, indicating that the second series of injections had been successful in conferring protection against diphtheria. In spite of this apparent protection the child was attacked by diphtheria about a year later, and was removed to hospital as I have already stated. I was naturally disappointed at this apparent failure, and wrote to Dr. Ronaldson, the Medical Superintendent of the Fever Hospital to which she had been admitted, stating the facts and asking for his guidance. From his report it appears that, although the protective treatment which we had given her here failed of its immediate object in preventing an attack of the disease, it may quite well have been the decisive factor which tipped the balance against death. The dose of antitoxin administered to this child in hospital, 432,000 units, is five or six times the maximum dose administered in an ordinary case of diphtheria, and is described as " massive ". by Dr. Ronaldson. In his report Dr. Ronaldson also gives the history of another Bermondsey patient which is particularly interesting as showing the vital part which the family doctor played in the treatment of the patient. I append the report and wish to express my very great appreciation of his courtesy and my admiration for his skill and courage. Dr. Ronaldson's Report : " A girl aged 7 years 8 months was admitted on 28th August, 1937, certified as diphtheria. Her previous history showed that she had received three immunising injections on 4th May, 1936, but as she was still found to be susceptible the injections were repeated on 7th September, 1936. After the second series of injections a Schick test showed apparent immunity. " Her attack of diphtheria was of an unusually virulent nature and the diagnosis was confirmed by cultures both before and after admission to hospital. When examined in hospital the membrane was seen to cover the tonsils, palate and posterior pharyngeal wall; the glands of the neck were greatly enlarged and patient had the " poisoned look " which signifies a severe attack. Diphtheria antitoxin was given in massive doses (432,000 units) by intravenous drip apparatus and by intramuscular injection ; also glucose and daily injections of cortin (suprarenal Cortex extract). Precocious (early) paralyses of 6th nerve (eye muscles) and palate occurred in the first week of disease —a rare happening and a further indication of an unusually virulent form of diphtheria. These paralyses only lasted for a few days and none of the later and more usual forms of paralysis appeared. Convalescence was slow but uneventful and recovery was complete. "It is exceptional for Schick negative subjects to develop any form of diphtheria, but an unusually virulent type of germ, may in rare instances, attack a person who is immune to the ordinary varieties of the disease. Even when this does happen our experience shows that those whose negative Schick test indicates the power to resist infection only suffer from a mild attack. The case described above is therefore most exceptional, but it illustrates the fact that even if an immunised subject should develop a grave infection there is still the possibility that the patient may have sufficient resistance to turn the scale in his or her favour. " My view of this case is not that it was one of the rare failures of diphtheria prevention, but rather that it was an example of a patient whose natural susceptibility to diphtheria could not be completely overcome even after two immunising courses. That the injections stood her in good stead is suggested by the outcome of the case. This view is supported by our experience of another Bermondsey patient whos is now in hospital. " This paticular patient was never Schick tested, but a parent was a tuberculosis subject and her family doctor thought it would be a good thing for her to avoid any infectious diseases which might weaken her resistance and predispose to the parents' infection. He therefore gave her a series of immunising injections against various infections, of which diphtheria was one. Though she could not be regarded as a fully immunised case her later medical history was interesting as, like the first case, she contracted diphtheria in a particularly severe form ; not knowing anything about the history of the immunising injections, we were somewhat puzzled by the fact that the throat condition cleared up so rapidly after antitoxin, but when the doctor gave us this information the explanation was obvious. The inference from these cases is that preventive injections against diphtheria are always of value, and that in the very rare instances in which they do not confer complete protection they may still prove beneficial. With the increase in the number of immunised cases we must expect to meet with exceptions now and again and recent Toronto work suggests that like some other preventive measures (e.g. Typhoid) the immunity may become lessened after about five years. Personally, I think that propaganda for prophylaxis should take note of these points so that the occasional exceptions will not tend to discredit a very valuable measure." In my last Annual Report I emphasised the importance of speed in the diagnosis and treatment of this disease. Once more I would reiterate this advice and draw attention to the fact that not only is antitoxin supplied free for any patient in the borough, but that any and every scientific aid to the diagnosis and treatment of this disease is at the hand of the family doctor on the same terms if he will only ask for it. Speed, I almost said, speed only, is required of him. During the year there were unfortunately five deaths from diphtheria, all of children under the age of seven. Three of these patients died from heart failure, one from toxaemia and one from other complications. In one case tracheotomy was performed. Of these five patients the diagnosis was made in one case four days after the onset of the disease, in one case the diagnosis was made three days after onset, in two cases the diagnosis was made two days after onset, and in one case the diagnosis was made at once. In every case the patient was removed to hospital immediately. NOTIFIED CASES OF DIPHTHERIA FOR 25 YEARS. NOTIFIED CASES OF SCARLET FEVER FOR 25 YEARS. The appended table shows the number of attendances at the two Schick Clinics during the year. Clinic No. of Sessions No. of new patients Total Attendances Public Health Centre, Grange Road 98 Rotherhithe New Road 59 158 907 46 492 69 1,399 105 Totals 227 SCARLET FEVER. The number of cases of scarlet fever notified during the year was 167, by a coincidence exactly the same as the number of cases of diphtheria. This is the lowest number ever recorded in the borough, and is less by nearly 100 cases than the corresponding figure for last year. Twenty-four cases were returned as " not suffering " from Scarlet Fever, so that the total number of genuine cases of scarlet fever during the year was 143, a remarkable record when the size and type of the borough is taken into consideration. I am happy to be able to report that there were no deaths from this disease. ENTERIC FEVER. Five cases of enteric fever were notified in this borough during the year. Subsequent investigation in hospital showed that the diagnosis was inaccurate in three of these cases, so that actually there were only two genuine cases of this disease. These two cases occurred in the same family, the first one occurring at the end of June. In spite of the most painstaking investigation on the part of the Inspector, the source of the infection could not be traced, though there was no question at all about the accuracy of the diagnosis. This patient was in hospital for eleven weeks, and was only discharged after four successive bacteriological examinations had each given negative results. Twenty-five days after the patient had returned home a second member of the family was taken ill and was later removed to hospital and notified as suffering from enteric fever. There seems to me no doubt that the second patient was infected from the first one, although care was taken to make certain that the first patient was free from infection, so far as this could be ascertained by bacteriological means, before discharge from hospital. Fortunately no further cases followed these two, and although at one time another inmate of the house was suspected as being a carrier, neither bacteriological nor clinical evidence supported this suspicion. Both patients made a good recovery and have remained free from infection. DYSENTERY. A minor epidemic of dysentery occurred during the last quarter of the year, 43 cases being notified to me. Many of these cases occurred in infants or very young children, eleven were removed to hospital, and in one of the latter patients the diagnosis of dysentery was not confirmed. Home nursing was provided in one case, and there were no deaths from this disease. In several of these cases the diagnosis was definitely pinned down to the Sonne bacillus. SMALL-POX. There were no cases of small-pox and no revaccinations were made under the Public Health (Small-pox Prevention) Regulations 1917. OPHTHALMIA NEONATORUM. There was only one case of ophthalmia neonatorum notified this year as compared with six cases last year. Unfortunately, in spite of treatment in hospital, this infant's vision was slightly impaired. The child is, however, still under treatment, and there is a good prospect of improvement. Cases Total Blindness Notified Treated Vision Un- Impaired Vision Impaired Deaths At home In Hospital 1 - - 1 - - 1 PUERPERAL FEVER AND PUERPERAL PYREXIA. Only one case of puerperal fever was notified during the year, but there were thirteen cases of puerperal pyrexia. Eleven of these patients were treated in hospital and all made a complete recovery. The Council provides the services of a consultant obstetric surgeon or gynaecologist, and of a nurse where this is requested by the practitioner, and in addition all forms of bacteriological examination are also undertaken free of charge. Facilities No. of Cases Second Opinions Nil Nursing provided Nil Bacteriological examinations Nil Admitted to Hospital 11 ACUTE PRIMARY AND ACUTE INFLUENZAL PNEUMONIA. One hundred and seventy cases of acute primary and acute influenzal pneumonia were notified during the year ; of these 30 cases were of the influenzal variety. Home nursing was provided by the Council in 39 cases and 31 patients were sent to hospital. WHOOPING COUGH. During the year the total number of cases of whooping cough brought to my notice was 471. Of this number 275 cases were notified to me under the Whooping Cough and Measles Regulations which came into force on the 1st October, 1936, and 196 cases were reported to me as the result of investigations made by the Health Visitors ; 111 patients were removed to hospital for treatment, and amongst these the diagnosis was not confirmed in two cases ; nursing was provided for 10 cases at home. Unfortunately seven deaths were recorded, six of which occurred in hospital and one at home. All of the deaths occurred in young children, five were under one year old, one was under two and one was three years old. In every case except one, death was due to broncho pneumonia complicating the whooping cough. In the seventh case gastro enteritis occurred as a complication in a very sickly infant of four months. MEASLES. The number of cases of this disease notified under the regulations was 85 and a further 65 cases were reported to me from various sources, making a total of 150 cases of measles during the year. In seven cases the diagnosis of measles was subsequently found to be inaccurate, so that the net figure for the year was 143. Fifty-four patients were removed to hospital for treatment and home nursing was provided in 6 cases. There were no deaths. DISINFECTION. The figures showing the work done in the disinfecting station are set out below. For many years it has been the custom in this borough to insist on the disinfection of premises and articles exposed to infection in all cases of notifiable infectious disease, regard being had as far as possible to the convenience of the householder. Rooms are sealed for disinfection and beds, bedding, clothes and other articles are brought into the station for treatment. Pillows (cases) 1,746 Beds 673 Quilts 1,203 Blankets 2,445 Bolsters 589 Sheets 1,672 Furniture 3,068 „ (cases) 293 Books 106 Miscellaneous 5,538 Cushions 195 Verminous Clothing 1,855 „ Bedding 15,870 Mattresses 18 Scabies, Clothing 15,673 Overlays 740 Pillows 1,820 25,012 new tabs were used to replace those taken off mattresses, palliasses, and cushions before disinfection. Number of rooms disinfected 2,659 Number of mattresses and other articles destroyed 1,931 Furniture, Floorcloth, etc. destroyed 98 Loads CLEANSING STATION. The cleansing station was opened in October, 1931, and the table subjoined sets out the number of patients treated since that date:— 1932 1933 1934 1935 1936 1937 Verminous: Adult Females 4 9 10 3 6 17 Adult Males 82 82 85 124 112 114 Children 2882 1772 3404 3566 3214 3383 27 Scabies: Adult Females 32 ;■ 59 70 106 31 Adult Males 15 24 20 35 38 69 148 Children, Females 177 217 191 228 219 Children, Males 186 103 131 160 172 212 It is a somewhat perturbing fact that there has been a steady, if only slight, increase in each category every year. Men are more prone to be infested by vermin than are women, and this I have always associated with the fact that in our borough at any rate, men make much more use of the common lodging houses than do women. For this reason we endeavour to make the existence of the station known in the common lodging houses, and keep the latter under careful observation. On the other hand women appear to suffer from scabies more frequently than men, and we do not get many cases of scabies from the common lodging houses. It almost appears as if the reservoir of scabies was among the children, and that mothers are more often infected than fathers. Each adult patient appears to be cleared of the trouble after an average of two treatments, while in the case of children the average number of treatments per child is about four. This difference may be due to the fact that children scratch themselves more unrestrainedly than adults and so the infection extends more widely and even more deeply than in the case of adults ; staphylococcal infection of the skin as a result of scratching is also more frequent in children. An alternative explanation may, however, be the possibility that adults, who are much more difficult to control than children, are not entirely cleared of the disease and remain for some time as a source of infection in the house, and this almost certainly is the case in some instances. In every case reported to the Department the home is inspected by the District Sanitary Inspector. Disinfection of the bedding and clothing is performed in the station, and contacts are inspected and required to attend for treatment if found to be suffering from scabies. If necessary rooms are disinfected and notices served under the Public Health Act, and in some instances the family is given temporary accommodation in the shelter. 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 37, 1 for diphtheria and 36 for verminous conditions, the total number of persons accommodated being 187. BACTERIOLOGICAL LABORATORY. To a large extent the work of the bacteriological laboratory consists in the examination of sputa for the tubercule bacillus and of throat swabs for K.L.B., and only about eight per cent, of the total number of investigations made were for other purposes. One or two of the practitioners in the borough do make considerable use of the facilities provided by the Council, but generally speaking this source of assistance is rather neglected. 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 (29) request, and it will be seen from the accompanying table that the number of these " various " investigations shows a slight decrease this year. Examined for Total Examinations Results of Examination Positive Negative 1936 1937 1936 1937 1936 1937 Diphtheria (specimens taken by Medical Officer of Health) 353 25 19 271 290 328 Ditto (taken by general practitioners) 63 1181 1194 1246 65 1131 Diphtheria (total specimens taken) 1547 1536 88 84 1459 1452 Phthisis 1280 1458 196 188 1084 1270 Various 263 258 34 41 229 217 Total specimens taken 3090 3252 318 313 2772 2939 FOOD POISONING. Seventeen cases of Food Poisoning were notified to me during the year under The Public Health (London) Act, 1936, Section 182. 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 patients have been supplied during the year as compared with twenty-seven patients in 1936. 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 Diarrhœa, 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. St. Olave's District Nursing Association Rotherhithe Queen's Nursing Association Totals whole Borough Disease Cases Visits Cases Visits Cases Visits 39 831 26 597 13 234 Pneumonia 12 190 Broncho pneumonia 12 190 - - 508 8 38 609 Bronchitis 30 101 746 17 291 65 1,037 Influenza 48 106 Measles 5 1 15 6 121 2 43 10 243 Whooping Cough 8 200 Tuberculosis:— (a) Respiratory System 49 1,319 71 3,772 2,453 22 3 9 572 (b) Other Forms 6 313 259 1 18 1 18 - Puerperal Pyrexia - - - - Puerperal Fever - - - 181 44 Pregnancy and Labour 39 626 6 807 Diseases of the Digestive System 242 26 167 10 75 36 7 Infantile Diarrhoea (under 2 years) 1 6 2 13 1 14 274 70 19 344 Discharging Ears 5 5 39 3 34 8 73 Discharging Eyes Post-operative cases:— 61 21 19 82 (a) Tonsils & Adenoids 14 5 (b) Other cases Other diseases 1 7 1 7 - 496 - 33 6 112 39 608 9,569 317 6,801 419 102 2,768 Totals CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1937. NOTIFIABLE DISEASE NUMBER OF CASES NOTIFIED BERMONDSEY ROTHERHITHE ST OLAVE Total Cases removed to Hospital 1 2 4 5 6 Total 2 Total St. John St. Olave Total At all Ages At Ages—Year 3 1 3 St. Thomas 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 & upwards - - 34 4 Diphtheria (including Membranous Croup) 120 - 2 43 - 7 9 167 4 75 26 8 7 32 18 5 12 19 18 13 38 4 3 167 - Erysipelas 28 3 - 2 2 1 5 7 4 4 6 2 2 2 2 14 4 6 10 2 2 4 17 - - - - Scarlet Fever 167 3 64 64 23 7 - 5 1 - - - 14 32 11 17 15 16 105 27 14 8 49 9 3 1 13 156 1 Cerebro-Spinal Meningitis - - 4 8 1 4 3 1 1 1 1 1 1 1 10 - - - 2 10 - - - - - - - Ophthalmia Neonatorum - - - - - 1 1 - - 1 - 1 1 - - - - - - - - - - - - - - - Enteric Fever 5 - - 1 1 1 - 1 1 - - 2 2 1 2 3 - - - 5 - - - - - - - - Puerperal Fever 1 - - 1 - - 1 1 - - - - 1 - - - - - - - - - - - - - - - Puerpera l Pyrexia 13 - 3 8 2 - - 1 2 1 4 2 10 1 1 2 1 1 10 - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 43 2 14 7 3 6 2 4 4 1 5 2 1 2 1 11 2 25 4 31 1 1 - - - - - 11 Anthrax 1 - - - - - 1 - 1 1 - - - - 1 - - - - - - - - - - - - - Acute Poliomyelitis 1 - 1 - - - - 1 1 - 1 - - - - - - - - - - - - - - - - - Pneumonia (Acute Primary and Acute Influenzal) 38 17 13 13 102 25 58 5 10 170 13 21 10 6 15 10 11 16 25 20 13 20 11 12 21 3 2 31 Whooping Cough (under 5) - - - 26 160 33 223 82 33 275 52 - - 23 37 42 11 21 21 28 20 10 3 75 - - - - Measles (under 5) 85 15 70 - - 17 5 6 3 15 3 49 21 6 3 30 - 4 2 6 33 - - - - - - - Tuberculosis— Respiratory System 147 - 3 1 1 21 24 31 18 19 22 7 12 17 18 19 18 13 97 16 18 10 44 4 2 6 - - Other forms of Tuberculosis - 3 1 4 21 4 9 1 1 - 2 6 2 6 2 8 1 4 2 7 2 2 2 31 - 3 - - CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEARS 1928-1937. Notifiable Disease. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 16 7 - - - Small Pox 1 46 47 3 21 Diphtheria (including Membranous Croup) 603 463 462 263 263 386 372 273 207 167 Erysipelas 43 45 41 49 49 68 73 53 39 28 Scarlet Fever 493 584 507 310 446 640 597 367 266 167 Cerebro-Spinal Meningitis 2 4 5 9 9 4 2 2 4 10 Acute Polio-Myelitis and Acute Polio- Encephalitis 2 2 1 1 3 1 - 1 - - Ophthalmia Neonatorum 8 11 13 14 10 7 6 5 6 1 Anthrax 2 1 1 - - - 1 - 1 - Enteric Fever 2 2 5 1 2 2 2 3 15 5 (32) Puerperal Fever 7 12 14 13 8 6 2 3 6 1 20 13 Puerperal Pyrexia 20 19 37 27 24 19 9 13 Encephalitis Lethargica 4 1 4 1 2 - 2 2 - - Dysentery - - - 1 3 1 43 - - - Malaria - 2 - - - - - - - - Malaria (induced) 1 - - - - - - - - - Pneumonia (Acute Primary and Acute Influenzal) 167 102 53 110 119 136 121 113 125 170 Whooping Cough (under 5) - - - - 103 275 - - - - Measles (under 5) - - - 7 85 - - - - - Tuberculosis :— Respiratory System 194 177 184 208 175 182 141 129 142 147 Other forms of Tuberculosis 54 40 46 40 35 34 32 34 34 31 (33) 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, 1937—NEW CASES AND DEATHS. AGE—PERIODS NEW CASES DEATHS Pulmonary Non Pulmonary Pulmonary Non- Pulmonary F. M. M. M. F. M. F. F. 0 - - - - - - - - 1 3 1 2 - 1 - - - 2 3 3 1 - - 5 2 1 10 2 2 2 - 1 1 - - 12 2 4 15 11 2 6 - - 20 - 13 14 2 6 6 - - 25 24 13 3 7 9 6 - - 35 1 - 13 9 8 4 - - 45 20 12 1 1 - 1 3 4 55 - 11 3 19 4 - - - 65 and upwards 1 6 2 5 3 - - - 113 19 55 32 2 3 56 18 TABLE II. TUBERCULOSIS, 1937—PERIOD BETWEEN NOTIFICATION AND DEATH. Period Between Notification and Death Respiratory System Other Forms Males Females Total Percentage of Total Deaths Males Total Percentage of Total Deaths Females Not notified 2 1 3 3.45 1 1 2 40.00 0-1 month 15 4 19 21.84 1 2 3 60.00 1-3 months 7 1 8 9.19 - - - - 3-6 months 3 - - 3 6 6.90 - - 3 1 4 4.60 6-12 months - - - - 1-2 years 6 5 11 12.64 - - - - 2-5 years 11 14 25 28.74 - - - - Over 5 years 8 3 12.64 - 11 - - - Totals 55 32 2 100.00 87 100.00 3 5 NURSING AND EXTRA NOURISHMENT. The aid of the District Nursing Associations has been enlisted in 80 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 1937 the number of visits paid by the district nurses to patients suffering from tuberculosis was 4,344. 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 127 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 14 shelters at present in use, 3 having been erected during the year and 2 dismantled owing to the death or removal of the patient. In addition to the supply of shelters, beds and bedding are supplied on loan for the use of patients at home where suitable use can be made of them. By this means we are often enabled to arrange for a patient to sleep alone and so lessen the risk of infection. Twenty-eight beds are in use at present. LADY ALMONER There is no call for any special comment on the work of the Lady Almoner this year She undertakes a variety of duties which are concerned mainly with the after-care of patients, visiting the homes, and co-ordinating as far as possible the different sources from which it is possible to derive help for patients. She also acts as Child Protection Visitor under Part XIII of The Public Health (London) Act, 1936. In the course of her work she has interviewed several hundred patients and paid a total of 778 visits. RETURN SHOWING THE WORK OF THE DISPENSARY DURING THE YEAR 1937. Diagnosis Pulmonary Non-pulmonary Total Grand Total Adults Children Adults Adults Children Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts) : — -I 1 1 "' (a) Definitely tuberculous 62 34 1 5 7 2 2 67 41 3 4 2 (b) Diagnosis not completed - - - - 5 - - 4 - - - - (c) Non-tuberculous - - - 184 196 43 25 572 - - - - - B.—Contacts examined during the year: — r 11 (a) Definitely tuberculous 5 11 - - - - 5 11 - - - - (b) Diagnosis not completed - - - - - - - - - - - - 492 (c) Non-tuberculous - - - - 94 130 114 138 - - - - C —Cases written off the Dispensary Register as O u rr K 1 ft (a) Recovered 4 8 8 7 - 5 10 6 4 13 18 13 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - 285 329 166 - - 987 159 (36) I 611U i D. —Number of Cases on Dispensary Register on December 31st:— 222 40 37 49 (a) Definitely tuberculous 298 3 4 56 39 96 332 271 76 784 (b) Diagnosis not completed - - - - - - - 5 4 - - - 1. Number of cases on Dispensary Register on January 1st 817 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 914 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 *2,832 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 49 10. Number of:— (a) Specimens of sputum, etc., examined 1,109 4. Cases written off during the year as Dead (all causes) 77 (6) X-ray examinations made in connection with Dispensary work 1,123 5. Number of attendances at the Dispensary (including Contacts) 4,143 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above - 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 105 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 329 7. Number of consultations with medical practitioners:— (a) Personal 100 (6) Other 253 * In addition to these visits 645 visits were made by the Lady Almoner and 196 visits by the School Nurse. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from the 1st January, 1937, to the 31st December, 1937. Formal notifications Age Periods Number of primary notifications of new cases of Tuberculosis Total Notifications 55 to 65 65 and upwards Total (all ages) 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 Pulmonary, Males - 1 19 18 113 3 12 12 10 19 5 99 - - 12 - 2 48 54 „ Females 1 9 12 8 4 - - 1 3 1 4 2 - - - 15 16 Non-Pulmonary Males 2 2 - „ Females 1 1 2 - 6 - 1 18 3 1 1 16 - New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the abovementioned period, otherwise than by formal notification. 45 to 55 55 to 65 65 and upwards Age Periods 0 to 1 10 to 15 20 to 25 Total 1 to 5 5 to 10 15 to 20 25 to 35 35 to 45 - - 1 5 1 1 - 14 Pulmonary Males 2 1 3 - „ Females - 1 - 2 1 - 8 2 1 1 - - Non-Pulmonary Males - - - 1 - 1 1 - - 3 - - - - - - - - „ Females 1 1 1 3 - - (38) Returns rendered under the PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 1st QUARTER, 1937. Respiratory System Other Forms M. F. M. F. Number of Cases on Register at commencement of Quarter 385 292 117 123 31 12 3 6 Number of Cases notified during Quarter Inward Transfers, Un-notified Deaths, etc. 2 3 2 1 Number of Cases removed from the Register 29 23 6 8 Number of Cases remaining on the Register at end of Quarter 389 284 116 122 2nd QUARTER, 1937. Respiratory System Other Forms F. M. M. F. Number of Cases on Register at commencement of Quarter 389 284 116 122 Number of Cases notified during Quarter 24 18 1 3 Inward Transfers, Un-notified Deaths, etc. 3 1 1 - Number of Cases removed from the Register 16 15 2 6 Number of Cases remaining on the Register at end of Quarter 400 119 288 116 3rd QUARTER, 1937. Respiratory System Other Forms M. F. ; M - F. Number of Cases on Register at commencement of Quarter 400 288 116 119 Number of Cases notified during Quarter 26 9 8 4 Inward Transfers, Un-notified Deaths, etc. 4 3 2 Number of Cases removed from the Register 18 7 19 5 Number of Cases remaining on the Register at end of Quarter 411 282 115 120 4th QUARTER, 1937. Respiratory System Other Forms M. F. M. F. 115 411 120 Number of Cases on Register at commencement of Quarter 282 Number of Cases notified during Quarter 18 9 5 3 5 1 Inward Transfers, Un-notified Deaths, etc. - - Number of Cases removed from the Register 27 14 10 6 Number of Cases remaining on the Register at end of Quarter 117 407 278 110 IV. LIGHT TREATMENT, ELECTROTHERAPY AND MASSAGE. My Annual Report for 1936 contained a brief description, together with a photograph and plans, of the Public Health Centre in Grange Road. Included in this account there was a description of the first floor or Solarium in which light treatment, electro-therapy and massage are administered. A tabular statement of the work done in the Solarium during the year is set out below :— Total Number of Attendances 51,125 Number of Individual Patients 1,666 Number of Treatments 82,143 Massage 5,902 Medical Electricity 755 Diathermy 3,740 Physical Exercises 2,931 Radiant Heat 13,409 Light 51,125 Ultra Violet Local 4,117 Mechanical Vibratory Massage 21 Q-Ray Pad 143 Number of Medical Examinations 3,723 Number of New Cases 1,355 Owing to the provision of additional forms of physical treatment it is hardly possible to compare this table with the tables set out in previous Annual Reports. The increase in the work during 1937 was however so great, that towards the end of the year it became necessary to report the circumstances to the Public Health Committee, and the substance of the report which was submitted to the Committee is here set out. "The Public Health Centre has now been open to the public for a full year, and during the course of that year I have on several occasions drawn the attention of the Committee to the great increase in the amount of work which has fallen upon the Solarium staff. The Borough Council began to provide light treatment in 1924 and for this purpose the waiting room of the old Tuberculosis Dispensary was utilised. The number of patients increased so rapidly that this accommodation became insufficient, and in 1926 a temporary corrugated iron structure was erected behind the Dispensary. In this building patients were treated until the Public Health Centre was opened in November 1936, and the number of treatments given annually averaged 26,000. "It was anticipated that the amount of work which would be done in the new building would greatly exceed that which had previously been done, and that the maximum attendance would not exceed 50,000. Provision was made for expansion on this scale. Such expansion was anticipated for several reasons: — (1) Even in the old premises a certain number of patients had to be put on the waiting list. (2) Provision was made in the new Centre for giving certain valuable forms of treatment which it had not been possible to give in the old premises. These new forms of treatment included Diathermy, Medical Electricity, Medical Exercises and Massage. (3) Possibly a further reason for the increase is the fact that there is no other institution in the borough at which patients can obtain such treatment. "Whatever be the real reasons there has certainly been a very large increase in the work of this department, an increase which has considerably exceeded our anticipations. "The total number of treatments given during 1937 was 82,143. A considerable number of patients have more than one form of treatment at one attendance, for instance it is the practice in many cases to give radiant heat treatment before ultra violet radiation or Medical Electricity or Diathermy. It thus comes about that while the number of treatments in 1937 was 82,143, the number of attendances was 51,125. "For comparison with other years the figure to be taken is that of the total number of treatments, namely 82,143, since in previous years the other forms of treatment were not available. "There are two points to which the special attention of the Committee ought to be drawn:— (1) In the case of Massage, Medical Electricity and Diathermy and to a more limited extent also in the case of Medical Exercises, members of the Committee should understand that the treatment given is individual. That is to say that a patient receiving any one of these forms of treatment requires the whole attention of a nurse or of a doctor during the whole time of the treatment, usually about twenty minutes. This, of course, has to be compared with Radiant Heat or Ultra Violet Light treatment in which the treatment can often be administered to a group of patients simultaneously, and in which such a group—except children can safely be left from time to time by the nurse, and consequently does not require her full attention. (2) The second point to which I wish specially to draw attention is that almost all the diseases for which treatment is given in the Solarium are chronic diseases. Such diseases require prolonged treatment and consequently most Solarium patients are in attendance two or three times a week for several weeks. The average duration of treatment is about twelve weeks. "In order to make the very best use of the excellent equipment which has been provided by the Council, and in order to prevent congestion, certain rules have been formulated for the working of the Solarium. "The rule of the Council is that only persons living in the borough may receive treatment at the Solarium, and the very rare exceptions to this rule have been reported to the Committee. Every patient attending is required to be recommended by a doctor, usually his or her own doctor, occasionally a doctor from a neighbouring institution, a school doctor or one of our own Medical Officers. All patients are seen by one of our own doctors in the Solarium at their first visit, and they are then examined at intervals during the course of treatment, notes being made on each case. The total number of examinations during the year was 3,723, and the doctors have explicit instructions to discharge patients as soon as, in their opinion, the patient is cured, or the maximum improvement to be expected has been achieved. All patients come by appointment. "In spite of these precautions the amount of work which has been done during 1937 has exceeded the capacity of the building, the equipment and the staff, and I wish to make certain recommendations under each of these headings:— "Building—As I have already pointed out, in modern practice many patients are given Radiant Heat before receiving other forms of treatment. This often means, especially on the female side of the Solarium, that congestion occurs in the treatment cubicles. If such treatment could be given to groups of patients in a room instead of to individuals in cubicles this difficulty would, to a large extent, be solved. I suggest that the room which is at present used by the nurses as a common room would suit admirably for this purpose. In anticipation of such a possible use in the future, this room was wired for the purpose when the building was being erected, so that no new wiring would be necessary. "If the Committee adopts this suggestion it will be necessary to provide another nurses' room, and this could be done on the north side of the Solarium floor. The situation of the suggested new room, though not quite so convenient for the nurses, does not offer any real obstacle, and having considered the whole layout of the floor very carefully, both with Mr. Bush and the Council's Architect, I am of opinion that this is the best solution. "A second suggestion in connection with the building is that permanent screens, to match the remainder of the furnishings, should be erected to enclose the two Schnee Cell machines. "Equipment—The installation of a room for the administration of collective Radiant Heat treatment would require the provision of four additional Radiant Heat lamps. In addition two more Radiant Heat lamps are required for the male section. "Staff—The staff of the Solarium maybe divided into two classes, medical and nursing staff. "Nursing Staff — The nursing staff consists of the following members:— Name Service Mrs. Cottier 15¾ years Miss Jagot 6¼ Miss Coleby 2¾ „ Miss Hopkins 1¼ „ Miss Warry 1¼ " Miss Saunders 7 months Miss O'Farrell 7 „ Miss J. White 3 „ "The first six nurses are members of the permanent staff, and of these, three are employed for part of their time in giving massage. Miss O'Farrell is not on the permanent staff, but she is employed as a whole-time masseuse. Miss J. White has been employed temporarily on the instruction of the late Chairman of the Committee, which instruction was approved by the full Committee on December 7th last. Miss Saunders has recently sent in her resignation to take effect at the end of February next. In spite of the additional temporary help which has been provided by the Committee, there is no doubt that the present staff has been working under far too high a pressure, and is insufficient for the work which it is called upon to do. "The number of patients received for treatment must, therefore, be limited artificially or alternatively the staff must be increased. "I feel I must also draw the attention of the Committee to another point in connection with the nursing staff. For several years in the temporary premises the staff consisted of two nurses, Mrs. Cottier and Miss Jagot. There has been a vast expansion in the work and a consequent increase in the staff. While lam happy to be able to say that each individual member of the staff has worked excellently and fully justified her selection by the Council, I must take the rather unusual course of drawing special attention to the work of Mrs. Cottier. Ido not think it is an exaggeration to say that the great success of this work has been in large measure due to her organising ability coupled with her own capacity for hard work, and the tact and amiability which enables her to extract almost the last ounce from those who work under her. I think that her position in charge of the Solarium should now be definitely recognised by the Council, and that her office should be given a definite designation and carry a salary commensurate with the responsibility. "Medical Staff — In 1924 light treatment was first begun in the borough, largely owing to the enthusiasm of my predecessor, Dr. King Brown. As the work was in the nature of an experiment and did not at that time justify the appointment of a special Medical Officer, the examination of patients and the medical supervision was undertaken almost wholly by myself as Assistant Medical Officer of Health. Since that time no special appointment has ever been made in spite of the tremendous increase of work, and such increase has been met by arranging for other Assistant Medical Officers to give help for one or two sessions every week in the Solarium. At the present moment Dr. Telfer, who has a specialist qualification in Electrical and Physical Therapy as well as in Radiology, is in medical charge of the Solarium. The remarks which I have made concerning Mrs. Cottier apply with equal force to Dr. Telfer, and with mutual help they have welded together and controlled a team which I am sure is unequalled anywhere. Certain other medical members of the staff at present give help in the work of the Solarium, namely, Dr. Plimsoll, Dr. Marshall, and Dr. Grantley Smith, the Municipal Dental Surgeon, who has done this work voluntarily solely out of his interest in the work of the Department. Owing to the increase of work in the dental department, upon which I have already submitted a report to the Maternity and Child Welfare Committee, it may no longer be possible for either Dr. Grantley Smith or Dr. Plimsoll —who administers dental anaesthetics —to take part in the work of the Solarium. This will leave two doctors only, both of whom give only part of their time to Solarium work, namely Dr. Telfer and Dr. Marshall, and this number will be insufficient to cope with the work especially when the Committee remember that certain forms of electrical treatment, for instance surgical or pelvic diathermy and medical electricity, can only be administered under the direct control of a doctor. With these considerations in mind I, therefore, suggest that Dr. Telfer be definitely designated as Medical Officer in charge of the clinical work of the Solarium and that a suitable increased maximum salary be awarded for this office; that Dr. Marshall continue to be employed for part of his time in the Solarium, and that a part-time Medical Officer with experience in this work be also employed for at least three sessions per week at a guinea-and-a-half for each session." After full consideration by the Committee on the 4th January, 1938, these suggestions were adopted. Considerable care has been taken to see that patients are not allowed to continue treatment for unduly long periods, and patients are discharged as soon as they have received the maximum benefit likely to be derived from treatment. The majority of the diseases for which patients are sent to the Solarium are, however chronic in nature and in many cases of old-standing; notwithstanding this fact however the average length of time for which a patient attends the Solarium is about twelve weeks. Many of the patients, particularly those suffering from the various manifestations of rheumatism and of arthritis, belong to that large class to be found in every industrial community for the treatment of whom little or no provision has ever been made. It is not contended that such patients are cured by a course of treatment, but that they derive very much benefit from such a course is in my opinion an undoubted fact. Many of the cases which are of recent origin are discharged after a few months of treatment free from pain and with full movement in the joint. Some remain well and others return from time to time for a further course of treatment. The long-standing cases are more obstinate; even in these cases pain is usually much relieved although the range of joint movement remains much the same. This type of case is usually treated by general ultra violet light together with focal infra red radiation, diathermy and massage. Included in this class are some of those hospital derelicts who have suffered prolonged periods of disablement following injury or accident. Persistent treatment in some of these cases has effected remarkable results. The largest single class amongst the child patients includes those variously labelled debility, malnutrition or anaemia. Light treatment will not take the place of a defective diet, neither will it counteract the evil effects of overcrowding or of bad housing conditions. It does, however, act as a very valuable tonic in these cases, and when combined with remedial exercises under the direction of a nurse, the beneficial effect of such a course of treatment is apparent. A large number of children suffering from bronchitis, sometimes following an attack of measles or of whooping cough, have been sent to the Solarium for treatment. These children are usually under five and many of them are less than two years old. The bronchitis oftens begins when the child is a few months old and recurs frequently especially during teething. These children are given general ultra violet light daily for a month, and the number of treatments is continued or reduced according to the results obtained. The period of treatment is usually from two to four months. In a large proportion of these cases the attacks have ceased completely after six to eight weeks treatment, and in the remaining cases the severity and frequency of the attacks have been much reduced. Amongst the children there have been also quite a number of cases of more or less manifest rickets, and included with these should be mentioned also children suffering from scoliosis, postural defects, genu valgum and genu varum. The administration of light treatment combined with physical exercises and massage has been of great assistance in all these cases. LEYSIN PATIENTS. In the following table will be found a complete list of patients who have been sent to Leysin by the Borough Council. Initials of Patient Age Sex Localisation of Disease Period previously under Medical Treatment prior to going to Leysin Date returned from Leysin Result Date sent ot Leysin 12 M. 5 years 5/7/27 Well and at work Left Foot 28/7/24 S.B. I.R. 10 F. Glands of Neck 5 „ 28/7/24 6/10/25 Removed from District M.S. 15 F. 6 „ 28/7/24 6/10/25 Well. Now married Right Knee Well. Now married A.L. 19 F. Glands of Neck 2 „ 1/10/24 6/10/25 C.P. 37 F. Forearm and Peritoneum 1/10/24 6/10/25 Well and at work 2 „ M.B. 28 F. Glands of Neck 15 „ 26/10/25 22/2/27 „ „ E.C. 26/10/25 16 F. Right Knee 5 „ 8/7/27 „ „ H.C. 10 M. Glands of Neck 2 „ 26/10/25 22/2/27 „ „ A.H. 21 F. Left Hip 9 „ 17/5/26 29/6/28 „ „ (47) 23 F. Spine and Right Hip 18 „ 17/5/26 17/9/27 E.W. „ „ G.B. 20 F. Left Ankle 2 „ 9/2/27 28/4/29 Removed from District 19 M. Abscess of Ribs 2 „ 1/2/27 8/5/28 L.T. „ „ C.P. 24 M. Spine 7 „ 5/2/27 8/5/28 Keeping well Removed from District A. R. 26 F. Glands of Neck 3 „ 5/2/27 8/6/29 E.G. M. Lupus of Nose 4 „ 20/6/28 8/6/29 Well and at work 16 C.P. 26 Tuberculide of Skin 1 „ 20/6/28 8/6/29 M. „ „ H.S. 18 M. Right Hip 3 „ 20/6/28 26/9/30 „ „ 23 Right Hip 8 „ 31/5/29 5/8/32 I.S. F. „ „ 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 18 M. Left Knee 1 year 15/4/30 1/2/33 E.W. „ „ Dead (Tuberculous Meningitis) G.L. 15 M. Spine 10 months 13/10/30 - V.B. 16 F. Lupus of Nose 1 year 6/2/31 6/5/32 Well and at work 34 Spine 4 years 13/10/30 Dead (Cerebro-spinal Meningitis) D.R. M. - J.O.B 17 M. Right Knee 7 months 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 26/3/37 Seen recently —keeping well H.H. 20 F. Glands of Neck 1 year 17/5/30 26/3/37 Well and at work 21/7/36 Still at Leysin J.H. 10 F. Glands of Neck 3 months - - M.D. 25 F. Spine and Left Elbow 6 years 17/2/37 Still at Leysin V.—MATERNITY AND CHILD WELFARE. During the course of the year the Maternity and Child Welfare Scheme has been in operation without serious modification, although there have been various changes to some of which I wish to draw attention. The work of the Health Visitors has been increased during the last year or two by the addition of the visiting of tuberculosis patients and of children suffering from measles and whooping cough. They have also been required to pay many visits in connection with the scheme for the following up of children who have been notified as suffering from infectious disease. On account of this additional work and in order to avoid the necessity of employing a locum tenens Health Visitor during the annual holiday period, the Council appointed in April one additional Health Visitor. A number of special foods such as Virol, Cod Liver Oil and Malt, Oil Emulsion and Roboleine are purchased by the Council and sold to the mothers at cost-price at the infant welfare centres. Even at cost-price some of the products are too expensive for the poorer mothers who refrain from purchasing foods which have been prescribed by the doctor. Halibut Liver Oil for example is very expensive for Bermondsey mothers and the tendency has been either to ignore the doctor's instructions or to purchase a cheap and usually inferior oil with a vitamin value correspondingly low. I suggested to the Committee that these products should be regarded as foods, and that they should be supplied to mothers and children under exactly the same scheme as that under which milk is supplied and using the same income scale. The Committee has not yet, however, arrived at a decision on this matter. In May, Circular 1622 of the Ministry of Health, was under discussion, and the following report was submitted to the Committee:— "This Circular of the Ministry of Health relates to Maternal Mortality, upon which subject a report has recently been presented to Parliament. The Maternity and Child Welfare Committee has taken a keen interest in this subject, and most of the members are familiar with the problem, and I think also with the means which have been suggested at various times for the improvement in our own Service. The Circular draws attention to the more important recommendations contained in the Parliamentary Report. "1. The Importance of Team Work. "Under this heading it is stated that the Local Authority, i.e., the Borough Council, is the best agency to secure combined effort and harmonious inter-working between the Health Visitors, midwives, general practitioners, Medical Officers of Clinics and hospital staffs. This is undoubtedly correct, and it makes the attitude of the Minister with regard to the new Midwives Act somewhat puzzling. In this connection I should point out that all the midwives practising in the borough are in close touch with the Health Visitors and lady doctors, and it is the usual practice for midwives to attend the Ante-Natal Clinics with their patients. In addition, most of the midwives are in constant touch with the office staff, and are kept well informed with regard to the Borough Council Maternity and Child Welfare Scheme, and are, from time to time, acquainted with any changes which are made in that scheme by the Council. So far as general practitioners are concerned I would like to inform the Committee that I have already arranged a meeting at the Public Health Centre, Grange Road, to which I have invited all the medical men practising in the borough, for the purpose of explaining to them the aims of the Borough Council, and of eliciting their help. "2. Consultant Services. " The Circular stresses the need of providing the services of Obstetric Consultants. The Borough Council has provided these services for several years, and each practitioner is reminded of these and other services from time to time in the booklet which is issued by the department to doctors, a copy of which is available for members of the Committee to see. "3. Emergency Help. "The Circular suggests that an emergency unit, consisting of a consultant obstetrician and a nurse with all necessary equipment, should be available for attendance at short notice at the home of any patient. I do not think that this service is likely be greatly used in this borough because of the close proximity of the two hospitals, Guy's and St. Olave's. At the same time it is, in my opinion, an excellent suggestion, even if it were the means of saving only a single life. I think it should be possible to arrive at an arrangement with the authorities at Guy's Hospital or with the London County Council at St. Olave's or with both bodies, so that such a unit should always be available, and I suggest that the Committee consider this possibility. "4. Maternal Accommodation. "This is provided both at Guy's and at St. Olave's Hospitals and the borough is well off in this respect. The Circular suggests that in-patient accommodation should be available for Ante-Natal cases, and as this has already been provided, and is quite frequently used, I have no comment to make. "5. Ante-Natal Services. "So far as I am able to judge our Ante-Natal services are adequate and work in close touch both with general practitioners and midwives. In addition the Council employs an expert obstetrician and gynaecologist who attends for two sessions a week, to whom suitable difficult cases can be and are referred. "6. Post-Natal Services. "Under this heading it is suggested that arrangements should be made for holding post-natal sessions at every Ante-Natal Clinic, and the Circular goes on to say that 'no effort should be spared to persuade the women who attend at the Ante-Natal Clinic to return after confinement for medical examination.' It is also suggested that minor ailments associated with or following confinement might be treated and advice on contraception given where such is indicated. So far as we are concerned in this borough such facilities are available for every mother, and it has been the habit in the past to arrange for every mother to be examined where this has been suggested by the mother or appears to be necessary to the doctor. If the Committee so desire I can arrange for every mother to be invited to attend for examination after confinement on the same day as the Ante-Natal patients are seen, and I think that an instruction to this effect might be quite reasonably given to the lady doctors. "7. Adequate Supply of Milk. "The Committee has already given instructions for a report to be submitted on the scales of income which are at present in force. It was the desire of the Committee that our present scales should be comparable with that suggested by the London County Council for the new Midwifery Act. Unfortunately sufficient time has not elapsed since that instruction was given to enable us to compare the two scales, but I hope to have the information available for the next Committee. "8. Home Helps. "The Circular suggests that Home Helps should be tried in this borough. This suggestion has never been given a real trial in the borough, chiefly because there are so many inherent difficulties. I have made enquiries from time to time, and find that we are occasionally asked for such help, and I think that the Committee might consider forming a suitable panel of Home Helps. "9. Dental Treatment. "This Council maintains two excellent Dental Centres, and I feel sure that the scheme at present in force meets with the approval of the Ministry. Should the Committee later decide to revise the Income Scale for the supply of milk, I would suggest that the revised scale should also apply to dental treatment. "I suggest the following points for the consideration of the Committee:— 1. That one or more general practitioners be co-opted on the Maternity and Child Welfare Committee. 2. That the Medical Officer of Health be authorised to approach the authorities of Guy's Hospital and the London County Council, if necessary, with a view to the maintenance of an emergency unit; a report to be submitted as soon as possible on the subject. 3. That all post-natal patients be invited to attend by appointment at Ante-Natal Clinics. 4. That a panel of Home Helps be set up and kept in the department. 5. That the Milk Scale be revised, and that the Medical Officer of Health be authorised, when the scale is revised, to provide meals for mothers, in such cases as are suitable, by arrangement with the authorities of the Princess Club and of the Central Hall." With regard to the suggestions which were made to the Committee in that report I may observe that the first suggestion, that one or more general practitioners be co-opted on the Maternity and Child Welfare Committee, is still under consideration. An agreement has already been made with the London County Council for the provision of an emergency unit in midwifery cases, and so far as post-natal patients are concerned it is pointed out that it has been the practice in this borough to make appointments for post-natal patients to be seen on the same days, and by the same doctors as ante-natal patients. The question of holding separate post-natal clinics is still under consideration. The other two suggestions which relate to Home Helps and the revision of the Scales of Income in connection with the Maternity and Child Welfare Scheme were the subject of a further report which was submitted to the Committee in June. One income scale was finally agreed upon which should apply in future to applications for Midwifery Service, Milk, Dental Treatment (Maternity and Child Welfare cases), Home Helps and for admission to Fairby Grange Convalescent Home, and the Council at the same time decided to set up a panel of Home Helps. In my last Annual Report I made reference to the experimental establishment of two sub-centres in the borough, and the following report submitted to the Committee in May and later adopted by the Council indicates that the experiment proved a failure:— "I was instructed by the Committee to report at this meeting upon the Sub-Centres. The two Sub-Centres have now been in operation for more than twelve months. The Centre at Bryan House differs from that at Whites Grounds in that at Bryan House an Infant Welfare Centre is held once a week on Thursday afternoons. The figures for this Centre are set out below for the two years 1935 and 1936. "Bryan House Infant Clinic No. of Sessions New Cases Total Attendances Seen by Doctor under 1 yrs. 1—5 yrs. under 1 yr. 1-5 yrs. 1935 39 554 51 944 2 540 1936 710 844 52 41 26 1043 "From this table it will be seen that the total attendances have increased by nearly 500 with proportionate increases in the other columns, and it appears that the Infant Clinic has been considerably benefitted by the change of premises. "Toddlers' Play Centres. "The play centres were intended to receive children between the ages of one and five for short periods, so that a mother might be free to do shopping and other similar works of necessity. The response in this case has been disappointing. The number of children attending varies greatly, sometimes being very few— occasionally reaching the maximum of 12, but it is noticeable that these children are drawn from a very restricted number of families, so that the same children repeatedly come to the play centres, and sometimes several children from one family attend. "Health Visitors' Consultations. "It was also intended that these sub-centres should act as a local centre conveniently near to the home, at which mothers could readily consult the Health Visitor. The number of such consultations has been very small, and although the Health Visitor attends every morning there are frequently no consulta- tions. This seems to suggest that the attendance at the weekly Infant Welfare Centre combined with the home visits of the Health Visitor are quite sufficient to meet the needs in most cases. "Complaints to Sanitary Inspectors. "The same remarks apply in the case of the Sanitary Inspectors. It was the original intention that the District Sanitary Inspector should call each morning so that he might be able to deal promptly with any complaint brought to his notice, but the complaints have been so few that this arrangement has been discontinued. "Foot Clinic Sessions. "One Foot Clinic Session a week has been held at each Centre, and the Session has been fairly well attended. The average attendance at these centres has, however, been decidedly lower than at the two main Foot Clinics, and this involves a considerable waste of time and energy on the part of the chiropodists, who are already working at full pressure. This is a matter of course for the Public Health Committee, but it is reported to the Maternity and Child Welfare Committee as being involved in the general question of the Sub-Centres. "On the whole the response to this experiment has been disappointing. I am regretfully forced to the conclusion that the Committee should consider discontinuing these Centres. It will be necessary to continue the Infant Welfare Centre at Bryan House until such time as other suitable premises can be obtained. I understand, however, that premisesto be erected by the Housing Department will be available in the course of a few months time, so that it would not be necessary to return to the church premises formerly occupied by the Centre if Bryan House Sub-Centre were to be closed." In June a letter was received from the Reverend Dr. J. Scott Lidgett suggesting that the time had perhaps arrived when the Borough Council should assume full responsibility for the Alice Barlow House Welfare Centre. This was the first centre established in the borough and one of the first to be founded in London. The work at this centre, conducted as a voluntary organisation under the control of Dr. Scott Lidgett ever since its foundation has been of a very high character, and the most amicable and intimate co-operation has always existed between that voluntary body and the Public Health Department of the borough. The Council agreed with Dr. Scott Lidgett's proposal and arrangements were made for the centre to become a municipal centre as from the 1st October, 1937, Miss Parry, the Health Visitor being transferred to the permanent staff of this Department. At the very end of the year similar applications were also received from the Reverend Walter Spencer and the Reverend Humphrey Richardson with regard to the centres held at the Central Hall and St. George's Hall respectively. These applications are still under consideration. FAIRBY GRANGE CONVALESCENT HOME. The total number of patients received into the home during the year, including mothers, babies, and toddlers, was 444, a slight increase on the figures for 1936. Number of women admitted 215 Number of babies admitted 85 Number of toddlers admitted 144 The figure naturally remains more or less stationary from year to year, and it is of course only during the summer months that there is any pressure on our accommodation, though there are usually quite a number of applications for admission in the winter. In the autumn Dr. Priestley resigned from the position of Medical Officer, and on September 28th Dr. A. L. George was appointed to succeed him. During the year the fire appliances at the home have been overhauled, and the provision of means of protection against fire is now modern and adequate. MIDWIFERY SERVICE. Out of a total of 1,488 births, 630 occurred at home and 858 took place in hospitals. For several years there has been an increasing tendency for mothers to go into hospitals for their confinements, a tendency which I think ought to be encouraged at the present time in this borough. Of the 630 domiciliary births, the proportion shewn from each source, which were booked under our midwifery scheme is shown in the following table:- Notified by Number Number booked under Council's Scheme 88 Guy's Hospital Externs 230 Midwives 360 197 38 - Doctors Parents 2 - Totals 630 285 The figure of 285 compares with 272 patients similarly booked in 1936. In 149 of these cases the full fee of the midwife was paid by the Council and a proportion of the fee was paid in 128 other cases; the remaining 8 cases were assessed to pay the full fee. At the time of writing the London County Council Scheme under the new Midwives' Act has only just come into force and it is not yet possible to say in what way, or to what extent, our own scheme will be affected. The London County Council Scheme is so very similar in its main features to our own, which has now been in operation since the end of 1929, that the advantages of this additional scheme in this borough are not at present very obvious, though they may become more apparent as time goes on. The two London County Council midwives appointed for this district have begun attending ante-natal clinics and have already been welcomed by the staff. OBSTETRIC AND PUERPERAL FEVER CONSULTANTS. The names of the gentlemen who have agreed to act in this capacity will be found on pages 128 and 129. The number of consultations during the year was as follows:— Obstetric Consultations Nil Puerperal Fever Consultations Nil 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 12 fostermothers with 13 children and 93 visits were paid by the visitor. MATERNITY MORTALITY. The death of one patient only can be included in this category this year and 1 am somewhat doubtful whether even this case is rightly so included. This patient died as the result of an abortion, having had nine previous pregnancies, seven children being alive at present; the first pregnancy occurred at the age of 17. There is a distinct possibility that abortion in this case may have been due to the taking of drugs, and although no definite evidence was obtained I am convinced that drugs for this purpose are sold in the borough. HEALTH VISITORS. The following table shows the work done by the Municipal and Voluntary Centres and Health Visitors during 1937 :- District Births Notified Visits to Infants and Children Visits to Expectant Mothers Visits to cases of Infectious Disease Attendances at Centres & Clinics Health Talks Unclassified or Special Visits Puerperal Pyrexia & Fever Ophthalmia Neonatorum Whooping Cough Tuberculosis Post-Infectious Disease First Visits Re-visits Measles Under 1 year 1-5 years Revisits Primary Visits Miss Robson 69 75 680 1249 58 115 3 - 3 38 179 59 34 316 - Central Hall 100 96 672 1149 38 88 2 - 11 47 113 91 83 192 - Miss Bowles 52 45 524 1059 39 99 - 2 15 167 61 24 300 2 - Miss Lawrence 56 438 635 31 58 - - 20 37 164 239 206 - 65 306 St. George's Hall 72 90 725 1065 41 127 - - 1 16 257 49 543 178 40 Miss Riches 72 71 458 953 46 80 1 7 21 174 124 91 266 - - 94 Miss Brown 93 116 538 858 61 129 2 1 30 35 263 191 296 - Miss Riley 142 133 1033 631 60 99 1 4 44 167 68 80 265 - - Miss Helden 96 96 826 944 49 116 1 9 47 360 200 95 273 1 - Miss Parry 107 78 617 849 57 174 - 2 28 38 246 84 139 192 34 Miss Carlton 92 89 792 1010 48 114 - 2 2 33 130 64 155 308 10 Miss White 66 75 617 1313 71 161 1 1 5 63 137 132 104 277 - Miss Wadds 161 164 866 831 57 108 6 - 24 64 146 131 53 293 - Miss Bache 109 99 634 782 65 115 2 - 5 15 102 101 61 245 - Salomon's Centre 96 123 650 2824 424 354 - - 21 30 7 15 354 - - Miss Baird 12 22 247 281 14 40 - - 21 17 78 48 305 103 - Totals 1410 1428 10317 16433 1159 1977 18 7 193 560 2832 1470 2212 4064 87 ATTENDANCES AT MATERNITY AND CHILD WELFARE CENTRES. The following table shows attendances at Maternity and Child Welfare Centres during 1937 :— Name of Centre Children's Consultations Ante-natal Clinic Sewing Class Gynaecological Clinic No. of Sessions New Cases Total Attendances No. seen by Doctor Total Attendances No. of Sessions New Cases Post- Natal Cases No. of Sessions New Cases Total Attendances No. of Attend ancea No. of Session Under 1 year 1-5 years Under 1 year 1-5 years 148 239 57 4,722 3,164 3,680 46 144 - - 49 159 398 Public Health Centre, Grange Road 22 657 98 Rotherhithe New Road 151 198 24 4,114 2,401 2,929 49 131 63 694 - - 48 114 261 Bryan House 51 52 22 - - - - 44 294 - - 873 781 1,150 - Bermondsey Gospel Mission 95 83 20 1,533 1,438 - - - - - - - - 1,997 - Roseberry Street 47 38 3 760 822 822 - - - - - - - - - Salomon's Centre 81 10 2,320 1,167 1,384 204 273 - - - - 150 557 3,297 - Princess Club 148 138 25 2,587 2,041 3,107 46 16 332 45 781 - - 70 - Fulford Street 100 121 9 2,069 1,118 1,983 51 116 47 548 - - - - - St. George's Hall 66 12 989 968 1,224 - - - - 45 - - 62 821 - Central Hall 224 5,123 8,188 7,605 - - - 26 401 - - 243 50 - - Totals 1,180 1,255 238 25,090 22,088 25,881 391 1,018 421 5,528 160 2,297 97 273 659 EXTRACTS FROM VITAL STATISTICS, 1937. Births. Registered— Total Males Females Live Births Legitimate 1,389 732 657 Illegitimate 32 15 17 Birth Rate per 1,000 of the estimated resident population 14.4 Total Males Females Stillbirths 45 27 18 Rate per 1,000 total (live and still) births 31 Notified within 36 hours of birth— (1) Live Births, 1,449. (2) Stillbirths, 39. (3) Total, 1,488. (1) By Midwives, 1,218*. (2) By Parents and Doctors, 270 * Including 858 births delivered by midwives in Hospitals. Total. Males. Females Deaths 1,212 650 562 Death Rate per 1,000 of the estimated resident population .. 12.3 Maternal Deaths. Deaths from puerperal causes:— Rate per 1,000 total (live and still) births. Deaths. Puerperal Sepsis - - Other puerperal causes 1 0.68 Total 1 0.68 Death Rate of Infants under 1 year of age. All Infants per 1,000 live births 59 Legitimate infants per 1,000 legitimate live births 56 Illegitimate infants per 1,000 illegitimate live births 187 Health visitors. Visits paid by Health Visitors during the year:— To Expectant Mothers (1) First Visits, 1,159. (2) Total Visits, 1,977 To Infants under 1 (1) First Visits, 1,428. (2) Total Visits, 10,317 To Children, 1—5 Total Visits, 16,433 Convalescent Homes for Children under 5. Number of Beds, 16. Number of Children under 5 received during the year, 229. Day Nurseries. Number of day nurseries 2 (both voluntary). Number of places for children under 5 in the nurseries:— Summer months 60. Winter months 56. Total number of attendances of children at these nurseries during the year:— 8,856. Deaths from Cancer (all ages) 154 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) 7 Deaths from Diarrhoea (under 2 years of age) 23 VI. DENTAL TREATMENT. The attached tables summarise the work which has been done at the two dental centres during the year. One or two interesting cases of orthodontic work in schoolchildren have occurred in which it has been possible with the aid of the new apparatus to save teeth which formerly would have been extracted. The pressure of work at the Bermondsey centre has increased so much that at the end of the year the following report was submitted to the Committee:— "For the past six years there has been an increasing pressure of work on the staff of the dental centres. This is due to an appreciation of and to an increase in the demand for those services. This demand has been greatly increased by the opening of the new Public Health Centre. In Bermondsey, much more so than at the Rotherhithe centre, there is a continual demand for the immediate relief of pain by patients who come without appointment, particularly at the evening sessions, and these patients, of necessity, require attention. The evening sessions can be fully occupied with the routine appointment work, but allowance of time has to be made for non-appointment patients, and this causes unduly large spaces between appointments. Even when allowance is made for the casual patients it is a very common experience to find these patients attending in such numbers as to cause dislocation of the evening's work. "A considerable period of waiting is thus caused and in the past we have used every endeavour to avoid this delay. It is found that there is insufficient time at the operator's disposal for him to do his work in a proper manner for each individual patient, and such fatigue on the part of the Dental Surgeon is caused as constitutes a definite danger to the patients. "When the Bermondsey Centre was at 110 Grange Road, it was open to patients for fifteen sessions a week, including five evening sessions of which Dr. Grantley Smith did two and Mr. Shapland three. Mr. Shapland also did two evening sessions at the Rotherhithe centre, making five evening sessions which he did during the week, permanently. At that time seven sessions were held at the Rotherhithe centre including the two evening ones, but the work increased there, and a session (Friday evening) was taken from Bermondsey and handed over to Rotherhithe. The position as it exists now is that there are fourteen sessions including four evenings at the Bermondsey centre, and eight sessions including two evenings at the Rotherhithe centre. "These evening sessions are absolutely essential to deal with the treatment of people who are at work in the day time. The full-time Dental Surgeon works for eleven sessions per week, and in my opinion the maximum number of evening sessions per week which a whole-time Dental Officer should be called upon to do permanently is two. A review of the appended table showing figures of patients treated, and number of attendances at the centres, indicates how the work has increased. In view of these facts I desire to make the following suggestions The number of sessions at the Rotherhithe centre should be increased from eight to eleven sessions including two evening sessions thus constituting full time work for one Dental Surgeon and Nurse. This will reduce the sessions at the Bermondsey centre from fourteen to eleven, with only two evenings, and will take Mr. Shapland away from two evening and one morning sessions, which he at present does at the Bermondsey centre. To cope adequately with the evening work at Bermondsey it is considered essential that two Dental Surgeons should be on duty for each of the first four evening sessions of the week, and also that the Friday evening sessions should be re-opened with one Dental Surgeon in attendance. If this suggestion is adopted, additional help will be required for seven evening sessions and one morning session. This makes a total of eight additional sessions required, seven for the evening and one for the day. The appointment of a whole-time Dental Surgeon would mean that he would have to work three evenings, and that Dr. Grantley-Smith and Mr. Shapland would have to work an additional evening constituting three evenings each. "Instead of this it is suggested to the Committee that two part-time Dental Surgeons be appointed, each doing four sessions per week. In the past Dr. Grantley Smith has always worked a session at the Rotherhithe centre, but with the pressure of work at Bermondsey in the New Centre he has had to discontinue this arrangement. He is, however, anxious to resume this work. "It is important that Mr. Shapland should be able to refer Rotherhithe patients to Bermondsey for X-ray and other purposes, and be at the Public Health Centre to attend to them. Two whole time Dental Nurses are at present employed, and I am of the opinion that one additional whole-time nurse is required. There are four reasons for making the recommendation. 1. — Particularly at the Public Health Centre the pressure of work at certain sessions is too much for the present staff. 2.— If the Committee approves of the appointment of additional part-time Dental Surgeons, the appointment of an additional nurse will become imperative. 3.- There is no provision at the present time for the displacement of either of the two permanent Dental Nurses in case of sickness or holiday. 4.- The help of an additional nurse at gas sessions at both Centres is essential. I therefore recommend: 1. — That the Rotherhithe centre be open for full-time service of eleven sessions per week including two evening sessions. 2.— That two Dental Surgeons be employed at the Public Health Centre on the evenings of Monday, Tuesday, Wednesday, and Thursday, and that the Friday evening session be re-opened with one Dental Surgeon on duty. 3.— That two additional part-time Dental Surgeons be employed for four sessions each week. 4. —That an additional whole-time Dental Nurse be employed. (64) ATTENDANCES AT DENTAL CENTRES. Year Centre Number of patients treated Number of visits necessary Number of sessions per week Remarks 1921 Rotherhithe 579 2183 11 Staff: 1 dentist, 1 nurse, 1 mechanic 1922 Rotherhithe 1086 3872 11 1923 1482 4130 11 Staff : 1 dentist, 1 nurse, 2 mechanics Rotherhithe 1924 Bermondsey 4400 11 Centre removed to Grange Road 1544 1925 Bermondsey 5043 11 1976 1926 Bermondsey 2263 5307 11 Bermondsey 3079 18 Staff: 2 dentists, 2 Nurses, 3 mechanics. 1 dentist and 1 nurse doing 7 sessions. 11 sessions at Bermondsey, 7 at Rotherhithe 1927 6249 Rotherhithe Bermondsey 8777 18 1928 3874 Rotherhithe 1929 4738 9538 20 Bermondsey Mr. Shapland's and Mrs. Hodgson's sessions increased by 2. 13 sessions at Bermondsey Bermondsey 1930 Bermondsey 5820 12676 22 Mr. Shapland and Mrs. Hodgson made full-time. 15 sessions at Bermondsey Rotherhithe 1931 Bermondsey 6357 12571 22 Rotherhithe 1932 Bermondsey 7290 12477 22 Rotherhithe 1933 Bermondsey 6980 12740 22 14 sessions at Bermondsey, 8 at Rotherhithe Rotherhithe 1934 Bermondsey 7598 13778 22 Ditto Rotherhithe 1935 Bermondsey 7634 14685 22 Ditto Rotherhithe 1936 Bermondsey 6749 13405 22 Ditto Rotherhithe 1937 Bermondsey 8425 15077 22 Ditto Rotherhithe After prolonged consideration of the report the Council decided to adopt the suggestions contained in the report, and put them into force at the beginning of the next financial year, i.e., Ist April, 1938. (65) DENTAL TREATMENT CARRIED OUT DURING 1937 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 773 857 2764 694 227 155 24 195 90 2042 Women 1262 1382 2307 1155 137 267 32 170 117 2563 Men 1936 2998 3760 2041 276 260 148 3698 77 46 Tuberculosis Cases 26 21 12 21 4 5 2 27 91 99 Children (Table I.) 2417 379 455 2 - - 1843 817 831 638 Totals 4815 11339 1174 108 630 357 6094 4290 1091 10245 98, ROTHERHITHE NEW ROAD Maternity Cases 526 281 38 23 128 21 1326 531 1947 371 728 19 62 Women 339 435 400 84 109 33 913 Men 6 6 1 1 - - 1 2 23 - Tuberculosis Cases 558 648 993 484 72 51 83 29 1045 13 Children (Table I.) 718 716 1926 96 524 289 5 - - 1525 Totals 2212 2331 5595 1352 487 61 961 275 83 4832 Totals both Centres 7027 8425 16934 5642 2052 1661 169 905 440 15077 (66) TREATMENT OF CHILDREN DURING 1937 Number of Attendances for Orthodontics Anæsthetics Total Number of Attendances Number of Extractions CENTRE Age Group Number Examined Number of Scalings Number of Fillings Number Treated Local General 1208 PUBLIC HEALTH CENTRE, GRANGE ROAD. Under 5 years 264 247 244 20| 16 527 - - Over 5 years 1209 553 584 363 394 435 2 99 1316 817 2417 638 1843 Totals 831 379 455 2 99 98, ROTHERHITHE NEW ROAD. 186 249 169 - Under 5 years 776 2 17 364 - 355 1161 5 272 Over 5 years 532 467 1150 94 34 Totals 718 716 1926 96 524 289 5 34 1525 1535 1547 Totals both Centres 4343 1162 133 475 744 7 3368 VII.—CONSULTATION AND OTHER CLINICS. X-RAY DEPARTMENT. The year 1937 has seen the first full year's working of this department. The total number of X-ray films taken during the year was 1,755. A separate appointment has been made for each patient, and this system, which the Council is aware functions in all the municipal clinics, is of a very great advantage to the patients since it entirely eliminates the long period of waiting which commonly distinguishes out-patient institutions. Every patient has been recommended for X-ray examination by a medical practitioner. Many of them have been sent up by our own medical officers from the Tuberculosis Clinic; a small number of patients have come from the medical officers of the Infant Welfare and Ante-Natal Centres and a few have been sent from the Children's Clinic by Dr. Shelley. Nearly a fifth of the total number of patients have been sent by general practitioners working in the borough. This is a very encouraging feature of the work, and it is even more satisfactory to be able to record that in quite an appreciable proportion of the cases general practitioners have accompanied their own patients in order to see the screening and films for themselves. In this way, while we have been of undoubted assistance to the doctors, they have also themselves come into closer contact with the medical officers of the department. We have done everything in our power to encourage doctors in this practice, since it is not only a distinct advantage both to doctor and to patient, but it also helps to foster that intimate and harmonious relation which ought to exist between the general practitioner and the Public Health Department. A large number of patients have naturally been sent from the Tuberculosis Clinic, and in general it may be said that an endeavour is made to secure that every patient attending that clinic is submitted to X-ray examination at least once. The fact that the X-ray Department is under municipal control and situated in the same building as the Tuberculosis Clinic has been of great advantage to the Tuberculosis Officers. Not only is there thus economy of time, but examinations are much more easily arranged so as to give the maximum amount of consideration to the convenience of the patient. In the case of patients sent from the Tuberculosis Clinic it is the practice to screen every patient in addition to taking a film, and the sessions are so arranged as to enable both Tuberculosis Officers to be present and see the screening of their own patients. The readiness with which patients can be X-rayed is also of particular advantage in connection with the artificial pneumothorax treatment which is carried out at the Tuberculosis Clinic. Altogether during the year 1,228 screen examinations were made. Most of the patients who were sent for X-ray examination from the Infant Welfare Centres were referred on account of postural defect, suspected rickets or injury. Some children under five are included in the numbers sent from the Tuberculosis Clinic since these children were first of all sent to the Tuberculosis Officer for an opinion before being X-rayed. A few children were sent for X-ray examination of the heart, and in one or two cases where twins were suspected at the Ante-Nata Clinic these patients were X-rayed in order to decide the question definitely. The patients which were sent by general practitioners were the subjects of a variety of different diseases including injuries in which fracture or dislocation was suspected, chest cases, a few kidney cases, one or two in which neoplasm was diagnosed, and a considerable number in which gastric or duodenal ulcer or some other pathological condition in the abdomen was suspected. In most of the latter instances the investigation included examination by means of a barium meal, the patient attending on three or four successive occasions and being the subject of several films. In a few instances barium enemata have been administered. The total number of individual patients who have been examined is 1,026. I am pleased also to report that the layout of this department, which to a certain extent was experimental, has been found in practice to work most satisfactorily. POST-INFECTIOUS DISEASE CLINIC. In my last Annual Report reference was made to a scheme which had then just begun for the examination of children who had suffered from an attack of infectious disease. The scheme has now been in operation for a full year, and it is of interest to scrutinise the results of the year's work. During the year all cases of scarlet fever, diphtheria, acute primary and acute influenzal pneumonia, measles and whooping cough occurring in children of and below school age have been dealt with under this scheme. Three months after the date of notification the health visitor has visited the home of the patient. If the child appeared to have recovered completely from the illness, no further action was taken. If on the other hand, the child had not completely recovered, and was not under the supervision of a general practitioner or attending hospital, then the health visitor has made arrangements, with the consent of the parents, for the child to be examined either at the Post-Infectious Disease Clinic held at the Public Health Centre or at an Infant Welfare Clinic if the child was under five. The period of three months, which is only approximate, is allowed to elapse so that any 'complications' following the attack may be distinguished from the ill-effects of the actual disease itself. The total number of cases referred to the health visitors was 1,120 and altogether 1,470 visits were paid to the homes of these patients. Action Taken Scarlet Fever Diphtheria Whooping Cough Totals Measles Acute Influenzal Pneumonia Acute Primary Pneumonia Number of cases referred to the Health Visitors 655 86 156 64 1,120 155 4 Number of primary examinations at Post-Infectious Disease Clinic 39 31 11 148 64 3 - Number of re-examinations at Post-Infectious Disease Clinic 1 - 111 27 18 - 65 Number of examinations at Infant Welfare Clinics 20 8 59 - 91 4 - Number of patients found to be suffering from defects 29 86 - 23 158 19 1 Percentage defective of total number of cases referred to the Health Visitors 26.7 18.7 1.5 12.1 14.2 13.1 - The accompanying tables show the number of patients who were considered by the health visitor to require examination together with the proportion of these patients who were found when examined to be suffering from some recognisable defect. There were, however, some patients who, when visited, were found to be already under the supervision of the family doctor or attending a hospital. These presumably were also suffering from some sequel to the infectious fever. The number of these patients is small, and although they have not been examined at the clinic it must be borne in mind that the proportion of defects shown in the table is somewhat smaller than it would have been had these patients also been included. In the following table the defects discovered by examination at the clinic have been roughly classified; many patients were found to be suffering from more than one defect; quite a number of patients, were on the other hand, found to be healthy. In every case where a defect was found appropriate treatment was arranged; healthy children were discharged. Result of Examination Infectious Disease after which examined. Measles Whooping Cough Acute Primary Pneumonia Diphtheria Scarlet Fever 15 Number of patients found to be suffering from: Malnutrition 29 - 13 14 9 Bronchitis 2 - 24 - Heart Affection 1 2 - 2 4 Tonsils, enlarged or septic 8 - 12 37 6 - 2 Discharge of Ear 1 3 1 1 2 - - Discharge of Eye - - - 1 - 2 Discharge of Nose - 1 Albuminuria 1 - 2 Three patients were diagnosed as "mismanagement" and referred to the Child Guidance Clinic. In four cases, all following whooping cough, pulmonary tuberculosis was suspected and the patients were sent for observation to the Tuberculosis Clinic; four patients were also found to be suffering from asthma either caused by or aggravated by whooping cough. Signs of rickets were found in two children, one following scarlet fever and one following whooping cough, and rheumatism followed the infectious disease in one case after diphtheria and in a second case after scarlet fever. There were two cases of muscular weakness following diphtheria and one child developed an umbilical hernia as a result of whooping cough. It has already been mentioned that this year has been remarkable for the occurrence of the lowest number of cases of scarlet fever ever recorded in the borough, ana as the number of cases of diphtheria and measles was also very low the total number of cases seen at this clinic is likely to increase next year. Judging from the results of this year's work it appears that great care is taken that no child is discharged from a London County Council fever hospital until it is reasonably fit to return home. On the other hand I feel sure that the Council appreciating the value of the work which has been done in this clinic will approve of its continuation. POST-NATAL AND SPECIAL CLINICS FOR WOMEN. The total number of attendances during the year was 659. of this number 276 were new patients attending for the first time. Dr. Dodds points out that may of the patients attending these clinics are more or less resigned to the symptoms as being part of the penalty of that time of life in women; they are mostly unaware that any relief, even from minor discomfort, is possible The clinics fulfil a useful purpose in many ways, but especially in the following conditions:— (1) The treatment of menstrual irregularities. Several of the patients in this group had severe menorrhagia, which they considered to be a minor discomfort and a phenomenon to be expected at the menopause. Treatment was possible in these cases before they became debilitated and anaemic. (2) The treatment of cervicitis at the clinic removes a common predisposing cause to carcinoma of the cervix. (3) The treatment of minor disabilities at the menopause helps a group of patients who are apt to consider that these disabilities have to be endured at this time. The complaints from which the patients suffered may be summarised in the following way:- Menstrual Irregularities. Fifty-six patients reported at the clinic on this account. Sixteen were found to be pregnant. Three patients had carcinoma of the uterus. The remainder had either fibroids, ovarian cysts or hormonal disturbances. They were either treated at the clinic or transferred to hospital. Displacement of the Uterus. Thirty-four patients with this complaint reported and were either treated at the clinic or transferred to hospital for operation. Inflammation of the Uterus and Appendages. Twenty-four patients came under observation for this reason. The majority had cervicitis, which was treated at the clinic. Three patients were transferred to hospital for further investigation and treatment. Disorders of Menstruation. Nine patients were referred to the clinic for investigation of sterility and two patients for investigation of dysmenorrhoea. Minor Disabilities of the Menopause. Sixteen patients received treatment at the clinic for these disorders. Backache. Nine patients had this symptom and were either treated at the clinic or transferred to the Solarium or to hospital. Hyperpiesia. Twelve patients with this sign were kept under observation. Breasts. Five patients came complaining of pain in the breasts. Four had chronic mastitis, and one had a simple cyst in the breast. Rheumatism. A large number of patients complained of pains in joints and muscles. They were either treated at the clinic or transferred to the Dental Clinic or to the Solarium, or to a Rheumatism Clinic. Intestines. Twenty-one patients had symptoms referable to the intestines. These patients were either transferred to hospital or recommended to attend their own doctor for treatment. Miscellaneous. The remainder of the patients suffered from a variety of conditions such as diabetes, heart disease, varicose veins, anaemia, debility, obesity, etc. The majority were transferred to their own doctor or to hospitals for treatment. CHILDREN'S CLINIC. During the year there have been 47 sessions of the Children's Clinic. Dr. Shelley is the visiting physician who attends at this clinic which is operated in conjunction with the Post-Infectious Disease Clinic, a reference to which is made in another part of this report. At this clinic, in addition to those children who are sent to her under the Post-Infectious Disease Scheme, Dr. Shelley also sees children who are referred to her for diagnosis and advice from any of the other municipal clinics in the borough or from general practitioners. Ninety-seven children have been sent to her during the year, practically all of whom have come from Infant Welfare Centres. All of these patients are seen by appointment, and in most of these cases there has been an element of doubt in the diagnosis or for some other reason the doctor at the Infant Welfare Clinic has desired a second opinion. In every case a diagnosis is made as soon as possible, and a report is sent to the doctor from whom the case originated. Where further investigation or treatment is necessary, this is usually arranged by Dr. Shelley. In five cases no diagnosable condition was discovered, and a report to that effect was sent to the doctor. Congenital heart defect was noted in five cases and seven patients were found to be suffering from manifestations of rheumatism, the heart having been already involved in one or two of these latter patients. Two cases of rickets were noted, and in two patients, referred for "fits," one patient appeared to be suffering from petit mal, and one from the result of a previous injury. In one infant a congenital dislocation of the hip was diagnosed, and treatment arranged at an orthopaedic department. A considerable number of patients were seen in whom definite postural defects, in some cases amounting to deformity, were defined, and one or two cases of muscular paralysis were discovered. Four children were found to have chronic bronchitis, and five were suspected of tuberculosis. In one case glandular fever was diagnosed. A considerable number of children were found to be suffering from nasopharyngeal catarrh and from enlarged tonsils and adenoids, and about 16 per cent. were undernourished. FOOT CLINIC. Three whole-time chiropodists, two ladies and a gentleman are employed in the two clinics and during most of the year two part-time chiropodists have also been employed. Even with this additional help patients have to wait considerable periods for an appointment. Details of the attendances at the foot clinics are given in the following table:— Clinic Men Women Total Bermondsey 2,280 5,856 8,136 Rotherhithe 5,587 1,563 4,024 3,843 Totals 9,880 13,723 The total number of patients treated during the year is 13,723. Each of these patients comes by appointment and no patient is treated who should properly be under the care of a doctor, nor is any patient allowed to attend more frequently than is necessary for proper treatment. In spite of this organisation it appears to me that the chiropodists are overworked, and in view of the fact that the total number of treatments this year shows an increase of 1,000 over last year's figures, I think it will be necessary before long to appoint one of the part-time assistants as a whole-time chiropodist. The popularity of these clinics is astonishing and the pressure under which the chiropodists' work is rendered less obvious than it would otherwise be by reason of the machine like operation of the appointment system. In one or two cases Miss Cook has visited old and crippled patients at home in order to give treatment which otherwise could not have been obtained, but these cases have been very few in number. VIII. —PROPAGANDA. During the year 1937 lectures and demonstrations in every instance illustrated by lantern and cinema films were given:— Lectures. Audiences. Schools 72 12,607 Clubs and other Institutions 28 737 Open-air with Cinema Van 71 29,120 171 42,464 The following is a complete list of films at present in use by the Department:— Title Synopsis Sizes 35mm and 16 mm Where there's Life there's 'Ope The skin, and why it should be kept clean Production of Tuberculin Tested Milk A demonstration of the care taken to ensure a clean milk supply „ The Story of our Food Supply How the public are protected against unsound and adulterated food „ „ Health and Clothing The value of wool next the skin, and the advantages of modern dress. Suitable mainly for women and girls Preparation of Dried Milk The processes from cow to carton 35 mm Shirley Schools Shows how children can be "brought up" and trained, even in an institution 35 mm and 16 mm Maternity and Child Welfare „ A demonstration of washing, dressing and feeding a baby and toddler with introduction of interest to expectant mothers 'Oppin Hop-picking in Kent. Conditions are shewn to be very primitive and only the fittest should go „ Title Synopsis Sizes 35 mm and 16 mm An attempt to explain the "germ theory" in a simple manner Germs A wander around the Borough to see what the Council does for public welfare „ Some Activities of the Bermondsey Borough Council „ This includes a drill display by an orphanage school Children's Exercises „ Of great interest to most people and deals with the subject optimistically Consumption (Tuberculosis of the Lungs) The necessity and value of artificial as well as natural sunlight „ Sunlight is Life A diagrammatic film of the digestive organs, shewing what happens in constipation „ Inside Out 35 mm An easily understood explanation of teeth and their troubles Teeth „ A fairy story about teeth. Very suitable for young children Ivory Castles 35 mm and 16 mm Emphasises the danger of a filthy pest The Fly 35 mm Microscopical views of these are shewn The Flea, Bug, and Louse Ministry of Agriculture film 35 mm and 16 mm The Rat Menace On being too fat Too many Pounds 35 mm 16 mm Uses of body framework, growth, repair and in action Body Framework Growth, pores, sweat and oil glands 16 mm The Skin Structure, action and development by proper exercise 16 mm Muscles 16 mm Moving blood under the microscope, and action of the heart, arteries and lungs Circulation 16 mm The mechanics of breathing and the structure of air passages Breathing 16 mm Digestion The complete process through the digestive tract Title Synopsis Sizes Compares good and bad positioning and gives methods of correction 16 mm Posture 16 mm The Feet Structure and Care 16 mm Shews good and bad teeth and necessary Care Care of the Teeth 16 mm On the danger of Diphtheria The Empty Bed A tour of the Open Spaces in Bermondsey and the gardens of Fairby Grange Convalescent Home 16 mm The Beauty of Flowers (in colour) 16 mm Demonstration of how to become fit by the members of the Arsenal Football Club Alive and Kicking 16 mm Seeing is Believing Structure of the Eye—its uses and how to take care of it At the beginning of the Winter Session a member of the staff visits each school in the borough and invites the Head Teacher to select any of the above subjects for an illustrated lecture, and a suitable date is then arranged. Frequently requests are received for a series of six lectures to be given in one school, spread over the winter months, but owing to the number of schools to be served this is usually impossible. Every lecture, without exception, is given by a medical member of the staff, each doctor being allocated the same day weekly for this purpose. Seventy-two were given during the year. Illustrated lectures in schools have always been something of a problem owing to the lack of dark blinds, and the absence of electricity from many schools. It is true that these difficulties are to a large extent overcome by taking a good supply of dark blankets, and a number of batteries for the supply of electricity. Nevertheless the fitting up takes a considerable time, and at the best the result is not as good as in a hall properly equipped for the purpose; on each occasion also we have to take a number of pails for water and sand and properly illuminated "Exit" notices in order to comply with the regulations of the London County Council Fire Brigade. The Central Library in Spa Road has a hall on the ground floor specially constructed for the showing of films, and each Head Teacher is offered the free use of the hall for the purpose of school lectures. It is pleasing to note that an increasing number are accepting this invitation, and these particular lectures are given with greater comfort for the children and a minimum amount of worry for our staff. As with schools, so with all other lectures and demonstrations. The persons applying for the lecture, are allowed to choose their own subject and as a matter of interest the following table has been prepared showing the selections made during the year. Summary of Films used 1937. Schools Other Indoor Outdoor Total 10 Activities of the Bermondsey Borough Council 6 7 23 0 1 2 3 Sunlight is Life 8 5 1 Circulation 2 3 0 Production of Tuberculin Tested Milk 6 9 3 1 7 Digestion 3 12 1 22 The Story of Our Food Supply 9 0 2 2 4 Breathing 0 6 The Skin 4 2 1 4 5 Posture 0 0 4 Muscles 2 6 0 3 Health and Clothing 3 0 0 The Feet 2 3 5 0 6 12 Body Framework 6 0 2 The Fly 2 4 0 4 6 2 Leysin 1 0 1 Too Many Pounds 0 8 3 2 Germs 3 Schools Other Indoor Outdoor Total 2 2 6 10 Beauty of Flowers Children's Exercises 2 0 10 12 Public Health Service 0 4 4 8 9 21 Cleanliness 0 12 Alive and Kicking 1 0 1 0 1 'Oppin 0 8 9 The Rat Menace 1 3 0 2 Teeth 1 0 2 3 0 The Empty Bed 0 4 4 Health and Clothing 0 0 8 8 1 Borrowed Films 4 0 5 77 33 106 216 It will be noticed that at 171 lectures 216 films were shewn This is accounted for by the fact that frequently two or more are shewn at one meeting. In addition to the usual work normally carried out by the Propaganda Staff some 62 demonstrations to over a thousand visitors were given in the new Public Health Centre during the past year. On the instructions of the Public Health Committee Friday afternoons and evenings are allocated for this purpose. Each demonstration lasts about one hour and is given to a party not exceeding 30 persons, by a Medical Officer or a senior member of the staff. The visitors are taken over the Clinic and the work of each section very fully explained. Many doctors, health visitors and nurses have been included as well as large numbers of the general public. Numerous parties from other parts of the country have paid visits, and a number of Public Health officials from almost all over the world have been entertained. Quite recently a number of Head Teachers have requested permission for senior school children to be conducted over the Centre. In each case the party has been received by the Medical Officer of Health, and personally shown through the building by him. These visits provide further opportunities for lectures and talks on hygiene and in my opinion are really valuable. There are three waiting rooms in the Centre and each has been equipped with a "Propaganda Table." These have been specially constructed to take thirty-six lantern slides, 6½in. by 4¾in. The slides rest on the top of the table under a sheet of glass, and arranged under the slides are ten tubular lamps for illumination. Each Monday morning a complete change is made and another series is on view for the week. Almost every patient who has to wait at all, spends part of the time at the table. In October the Prime Minister opened a great National Health Campaign, the slogan of which was "Use Your Health Services." Bermondsey, in common with all other Local Authorities, proceeded to advertise its Health Services even more extensively than before in an endeavour to make them better known. It will be seen from other sections of the Annual Report that already in this borough 100 per cent, of expectant mothers attend antenatal centres, 86 per cent, of the mothers and infants eligible to attend made nearly 56,000 visits to the Infant Welfare Centres, and 82,000 treatments were given in the Solarium. It seems almost impossible for the Health Services to become more widely known in the borough than they already are, but every suggetsion made to this end has received consideration. During the year two new films were written, photographed and produced by the Council's staff. The first entitled "Alive and Kicking," was taken at the headquarters of the Arsenal Football Club at Highbury by the kind permission of the Manager, Mr. George Allison. The main portion of the film shows the men in training, and is most useful and instructive for lectures on "Keeping Fit." It is extremely popular with audiences of school boys and young men, especially so as the lecturer, a doctor on the staff of the Department —Dr. James Marshall —is an ex-Arsenal player. ILLUMINATED PROPAGANDA TABLE The second film is entitled "Seeing is Believing," and is concerned with the structure of the eye—its use and how to take care of it. Opportunity has been taken of "shooting" new and up-todate sections of existing films. This applies particularly to the film entitled "Activities of the Bermondsey Borough Council," which as will be seen from the table previously mentioned, was shown twenty-three times during the year. We are now so arranging the film that each department concerned will have a section dealing with its own work which can be shown separately when required, while at the same time all the sections can be shewn together so as to make a complete film of the work of a Borough Council. Owing to the large number of applications which we have received for two separate lectures to be given at the same hour it became necessary to purchase a second projector. As there are now some good 16 mm. sound projectors on the market it was decided to purchase one of these, especially as there are a number of sound films on hygiene also available for hiring. Both silent and sound films can be shewn, and the apparatus itself is a distinct advance on the one purchased several years ago. We are still looking forward to the time when an equipment at a reasonable cost can be purchased for producing our own "Sound on Film" pictures. For some considerable time difficulties have arisen by reason of the number of applications received for borrowing our films. During the past year such requests have been more numerous than ever. This is probably due to the amount of advertisement which they have had, and whilst we endeavour to accommodate other authorities as far as possible, the films are so frequently in use in fulfilling our own engagements that we are constantly under the necessity of refusing to loan them. I make the suggestion that this difficulty might be overcome by some central authority, either voluntary, municipal or commercial, providing a library of all Public Health and Hygiene films as are of sufficient merit to warrant inclusion. It would not be reasonable for a local authority such as Bermondsey to have copies made for hiring purposes. We have always made a practice of allowing copies of our films to be made, and on request are prepared to lend the negatives to a recognised firm of film printers for this purpose. When the negotiations for the loan from us of the negative have been completed, the purchaser deals directly with the firm for payment of the copy. We charge neither royalty nor any other fee for the service. During the past year copies of some films have gone to South Africa and New Zealand, and enquiries have also been received from the United States of America. Two elections were held during 1937, that of the London County Council in March and the Borough Council in November. On each occasion advantage was taken of the opportunity to show hygiene films to the crowd waiting outside the Town Hall. A screen was fitted in front of the houses opposite and the films were shewn by a projector through one of the Town Hall windows. On many occasions attempts have been made to assess the value of educational work of the kind in which we are engaged, and although it is difficult to produce a convincing reply to critics, there are now very few people who do not admit that such work has an important part to play in the sphere of Public Health. In a very definite sense this work is specialised and calls for great originality and keen interest. The Council owes a debt of gratitude to the many members of the department who assist in the work, since many of the lectures are given at night after office hours. In addition to the Medical Officers and Dental Surgeons, several of the Sanitary Inspectors and Health Visitors have given lectures during the year, some of whom have developed latent powers of public speaking which have been of very great value to the department. To each of these members of the staff and to Mr. Bush, who is in charge of this section, I tender my thanks. OPEN AIR PROPAGANDA CINEMOTOR-A TYPICAL YOUNG AUDIENCE IX.—SANITARY ADMINISTRATION. HOUSING. During the year 1937, five new areas were represented to the Council, comprising in all 281 dwelling houses, and 15 dwelling houses and shops. The following are the areas represented:— Title of Clearance Area Date Area in sq. ft. (Approx.) No. of Dwelling houses No. of Dwelling houses and shops 11/5/37 Cottage Row 29,933 1 34 6/7/37 Ainsty Street 136,026 146 5 Wilds Rents 6/7/37 5,162 4 1 7/12/37 Freda Street, No. 1 96,296 93 6 Freda Street, No. 2 7/12/37 9,777 4 2 The following areas were 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 Date declared by Council Families Persons Maze Pond, No. 1 52 152 11,829 13 26/1/37 Queen's Place and lands adjoining 43 10,028 12 10 27/4/37 Ainsty Street and lands adjoining 746 208 145,493 161 28/9/37 32 5,162 Wilds Rents 5 10 28/9/37 Cottage Row and lands adjoining 226 39,933 38 57 28/9/37 The clearing of these areas will necessitate the demolition of 229 houses, and the rehousing of 337 families, consisting of 1,199 persons. The housing activities of the Council have been continued as in the past, and 448 flats and 3 shops were erected during 1937. Particulars of these are given hereunder:— Position No. of Dwellings No. of families accommodated 38 38 Dhonau Estate Tyers Estate 28 28 50 Elim Estate 50 Southwark Park Estate 38 38 Swan Mead 16 16 Whites Grounds Estate 20 20 Horney Lane 40 40 Arnold Estate 31 and 1 shop 31 Adams Gardens Estate 40 40 47 Aylton Estate 47 Decima Street 12 12 2 and 2 shops Kirby Estate 2 Neckinger Estate 14 14 5 5 Lynton Estate Holyoake House 38 38 Redriff Estate 29 29 At the end of the year 1937, the following dwellings were in course of erection by the Council: — Position Redriff Estate, Block 6 Redriff Estate, Block 8 Adams Gardens, Block 1 Adams Gardens, Block 3 Tyers Estate, Block 2 Dhonau Estate, Block 1 Arnold Estate, Block 9 Arnold Estate, Block 10 Arnold Estate, Block 3 Arnold Estate, Block 5 Arnold Estate, Block 11 Alice Street, Block 4 Trinity Road Site Aylton, Risdon and Renforth Street, Block 2 Prospect Street, Block 1 Neckinger Mills Site, Block 1 Neckinger Mills Site, Block 2 Lynton Mews Site, Block 1 Lynton Mews Site, Block 4 Balaclava Road Site 684/688 Rotherhithe Street Rowley Buildings Site Number of flats and shops 31 flats 11 flats 12 flats 6 flats 1 flat 16 flats 16 flats 14 flats 15 flats 20 flats 19 flats 82 flats, 1 shop and 1 dairy 1 flat 17 flats 73 flats and 5 shops 100 flats 51 flats 15 flats 3 flats 22 flats 15 flats 13 flats and 4 shops The London County Council have also erected in the Borough 63 flats on the Tabard Gardens Estate, and one house in Aylwin School. Private enterprise has been responsible for the erection of 8 flats. Altogether, therefore, 520 flats and houses were erected in Bermondsey during the year. The houses demolished on insanitary areas number 302, and 14 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 1937 with relation to overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 2,573 (ii) Number of families dwelling therein 2,573 (iii) Number of persons dwelling therein 13,926 (b) Number of new cases of overcrowding rereported during the year 133 (c) (i) Number of cases of overcrowding relieved during the year 449 (ii) Number of persons concerned in such cases 2,569 (d) Two cases in which dwelling houses became overcrowded a second time after the Council had taken steps already to abate overcrowding came to my notice during 1937. Notices under the Public Health (London) Act, 1936, were served in connection with these cases, and one family was rehoused by the Borough Council and the other family removed privately. A Summons was also taken out against the owner in the first mentioned case, and he was fined £2, and ordered to pay £1 1s. costs. (e) Two cases also came to my notice where the occupiers had refused to accept accommodation offered to them by the London County Council. Notices were served upon them under the Public Health (London) Act, 1936, and owing to the pressure brought to bear the accommodation next offered was accepted, and the overcrowding abated. Eight other cases of overcrowding were reported in which I considered it necessary to take action, and the overcrowding was abated in each case, two of the families being rehoused by the Borough Council. A Summons was taken out in one case. Twenty-seven cases of overcrowding in London County Council dwellings in Bermondsey have been abated, and twenty-eight cases in Borough Council dwellings, the number of persons dwelling therein in the first case being 140, and in the latter case 144; 119 cases have been relieved in connection with clearance operations, the equivalent persons in these cases totalling 643; these cases are included in c (i) and (ii) above. ERADICATION OF BED BUGS. In order to assist in the battle against the bed bug it has been our custom now for some years to disinfect all houses which have been emptied for demolition. The premises occupied by families who have been accepted as tenants in any of the Borough Council Estates are inspected, and the Sanitary Inspector arranges for the disinfestation both of the house and the furniture, where his inspection shows evidence of vermin. The following table shows the fumigations carried out during 1937: — Infested Disinfested 244 244 Council flats or houses Council houses on Insanitary Areas during decanting 353 353 London County Council Removals 11 11 Houses disinfested prior to demolition 209 - 274 274 Other houses or flats In May 1934 this Council acquired the right to use a proprietary method of disinfestation known as Cimex-Azet Phume. This method was simple in application and required no expensive apparatus, and though the lethal agent used was poisonous to human beings, after quite an extensive personal experience of its properties, I regarded it as being safe for general use in our Borough. My attention has, however, been drawn to the fact that in certain continental countries the same re-agent has been used, and that its use is not by any means free from danger to human beings. A report was made in this sense to the Public Health Committee, with a certain degree of reluctance, and the use of this method has been discontinued. Since July 1934, this re-agent has been used in 584 cases with a very small proportion of failures, and without a single complaint of ill effects following its use, either from tenants or from operators. We have carefully considered the question of using Hydrocyanic Acid Gas, having also had the expert advice of Mr. McKenny Hughes on the matter, and it appears to be quite clear that this gas could not be used with safety in this Borough. The use of this gas for the disinfestation of furniture in specially constructed vans was also considered, but it was decided that even this could not be done with safety in our present station owing to the congestion and lack of space in the depot. At present we are, therefore, thrown back upon Sulphur Dioxide and the use of the blow lamp, but we are experimenting with other re-agents, and in particular Heavy Naphtha, guided by the advice of Mr McKenny Hughes and Mr. Ashmore, and the experience of the Medical Officers of Health of Liverpool and Woolwich. In every case where vermin are discovered the Inspector is required, as part of his duty, to explain to the householder the need for keeping the house free from vermin, and the methods by which the tenant himself can assist in this matter. The Public Health Department possesses a series of lantern slides and a film on this subject, and lectures and talks are frequently given, expecially during the summer months. INSPECTIONS. PROCEEDINGS, ETC. Hereunder will be found particulars of Inspections, Proceedings, etc., for the year 1937:— Inspection of Dwelling Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,244 (b) Number of Inspections made for the purpose 39,830 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,354 (b) Number of Inspections made for the purpose 3,354 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 310 (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 1,175 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 2,494 Action under Statutory Powers during the Year:- (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1,175 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 1,152 (i) 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 4,305 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,811 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which Demolition Orders were made 9 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 9 (D) Proceedings under section 12 of the Housing Act, 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 41 (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 19,606 Number of houses occupied by the working classes 19,462 REGISTERED PREMISES — Premises Number on Register at end of 1937 Number of Inspections Number of Prosecutions Common Lodging Houses 3 45 - Seamen's Lodging Houses 3 8 - Milkshops 260 674 - Houses let in lodgings 1,102 3,256 - 148 Ice Cream Premises 379 - 14 373 Offensive Trades (including Poultry Slaughter-houses) - SMOKE NUISANCES— Number of observations 69 Number of notices 4 Number of complaints 6 Number of summonses Nil 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 cowshed 632 Number of inspections 2,008 RAG FLOCK ACT, 1911 AND PUBLIC HEALTH (LONDON) ACT, 1936:— 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— Every inhabited 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, and in one instance the attention of the appropriate authority was drawn to defects discovered by inspection. WORK OF DISTRICT INSPECTORS, 1937. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 House-to-House Special Inspections Complaints Infectious Diseases Factories & Workshops Specially Inspected Offensive Trades Outworkers' Bi-Annual Inspection Underground Conveniences Drains Tested Other Calls and Visits Chimneys watched Bakehouses Common and Seamens Lodging Houses Butchers Fishmongers, Friers and Curers Food Stores Fruiterers and Greengrocers Ice Cream Markets Restaurants and Eating Houses Destruction of Food Various TOTALS Visits Ints. District No. 1 384 1064 340 93 - - 20 - 3 2238 8 13 13 1 5 3 - 12 55 1 - - 4253 424 65 427 881 446 62 - 28 - 35 3637 13 35 15 53 33 17 1 - 5771 712 „ No. 2 - - 23 - 1487 562 145 - 5 - 7 38 40 66 7133 „ No.3 551 - 18 4008 20 19 77 25 46 19 - - 805 57 4634 „ No. 4 456 807 171 92 - 26 - 32 2893 19 11 7 19 5 21 16 2 - 772 - - - „ No. 5 378 826 362 56 21 - 33 2846 11 23 2 23 5 16 1 82 4 3 - 4713 679 - 21 - „ No. 6 602 530 75 36 3765 10 15 14 91 1 5647 319 - - 36 8 4 49 29 39 23 1 731 - 41 „ No. 7 565 1010 307 142 - 43 - 3456 4 14 35 4 78 28 31 64 25 - 5847 804 - - - „ No. 8 274 814 381 32 13 2252 39 23 41 5 2 39 530 4 - 4624 514 126 - 8 29 12 - - Total 7491 3099 211 211 61 155 53 93 272 226 42622 5441 3354 791 - 25095 227 144 1010 117 11 - - - FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. HOMEWORK. NATURE OF WORK (1) Outworkers' Lists, Section 107 Outwork in Unwholesome Premises Section, 108 Outwork in Infected Premises (Sections 109, 110) Lists received from Employers Outworkers resident in Bermondsey received from other Districts Notices served on Occupiers as to keeping or sending lists (8) Prosecutions Instances (11) Notices served (12) Prosecutions (13) Instances (14) Notices served (15) Prosecutions (16) Lists (2) Outworkers Failing to keep lists (9) Failing to send lists (10) Resident in other Districts (5) Resident in Bermondsey Contractors (6) Contractors (3) Workmen (4) Workmen (7) Wearing Apparel:— 1 f\ 8 41 - 8 - (1) Making, etc. 16 27 56 1 10 - - - - (92) - - - - - (2) Cleansing and washing - - - - - - - - - - - - - - - - - - - - Fur pulling - - - - - - - 2 - - - - - - Umbrellas, etc. - - - - - - - 1 - 1 - - - Sacks 5 4 1 - - 4 - - - 3 3 - 1 2 10 1 9 2 - - - - Paper, etc., Boxes, Paper Bags - - 2 - - - - - - - - - Brush making - - - - - - - - - - - - Combs, etc. - - - - - - - - - 1 1 - - 6 2 7 3 3 - - - Leather Goods - - - - 2 - - - - - - - Surgical Instruments 2 - - - - 5 1 3 2 - 5 - - Coathangers 2 - 22 18 - - - 7 - - - 1 1 - - - Carding of buttons, etc. - - - - - - - 2 - - 2 - - 2 - - - Onion Peeling - - - - - - - - - - Games and Toys - - - - - - - - - - - - Artificial Flowers 2 - - - - - - - - - - - Total 33 65 85 71 21 - - 21 21 - 2 - 1 (93) FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK INSPECTION. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 2,361 72 - Workshops (including Workshop Laundries) 562 74 - Workplaces (other than Out workers' Premises) 6,468 15 - Total 161 9,391 - DEFECTS FOUND Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 17 - 17 - Want of Ventilation 1 1 - - Overcrowding - - - - Want of Drainage of Floors - - - - Other Nuisances - 49 49 - Sanitary Accommodation— *±iJ Insufficient 7 - 7 - Unsuitable or Defective 86 86 - - Not separate for Sexes 1 1 - - Offences under the Factory and Workshop Act— 1 I Illegal Occupation of Underground Bakehouse (s. 101) - - - - Breach of Special Sanitary Requirements for Bake-houses (ss. 97 to 100) - - 22 22 - Other Offences - - - Total 183 183 - - (94) OTHER MATTERS. Number Class. Matters notified to H.M. Inspectors of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) - Notified by H.M. Inspectors Action taken in matters re ferred by H.M. Inspectors as remediable under the Publics Health Acts, but not under the Factories Act (s. 7) 4 4 Reports (of action taken sent to H.M. Inspectors) 1 Other Underground Bakehouses (s. 101) Certificates granted during 1937 - In use at end of 1937 14 Workshop Bakehouses 12 384 Workshops on the Register (s. 131) at the end of 1937 396 Total Number of Workshops on Register No OF BAKEHOUSES IN THE BOROUGH. Not in Use In Use Underground Above ground Above ground Underground 14 35 3 5 37 of these are Factory Bakehouses HOUSE, TRADE AND MARKET REFUSE. The following table shows the amount of house, trade and market refuse disposed of during 1937 :— Disposal Loads tons cwts. qrs. House Refuse to Barge Trade Refuse „ Barge Street Markets Refuse to Barge 17,244 3,065 2,449 8 11 14 21,466 2,200 2,364 3 1 2 22,758 14 2 Totals 26,031 OFFENSIVE TRADES. The offensive trades on the Register are as follows: Fellmongers 3 Fatmelters 1 Glue and size makers 3 Dresser of Fur Skins 7 MORTUARY. The Public Health (London) Act, 1936, Section 234, requires the Borough Council to provide a proper place for the reception of dead bodies before interment. The London County Council acts as agent for the Borough Council in this matter 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 Nil Total number of bodies removed 15 STREET MARKETS. The market scheme continues to work smoothly and satisfactorily. Number of Licences in operation 449 Income £2,958 16s. 3d. DRAINAGE WORK. Hereunder will be found particulars of drainage work, &c., carried out by the Drainage Inspector during 1937 : — Drains Tested 623 Visits to Underground Conveniences 388 Other Visits 3,317 WORK OF THE FACTORIES AND SHOPS INSPECTOR. Shops. Visits 1,019 Notices served under Shops Act, 1934 14 Notices served under Public Health (London) Act 1936 38 Factories. Visits 1,122 Notices served 64 Workshops. Visits 562 Notices served 66 Visits to Offensive Trade premises 373 Various Visits .. 409 Chimneys watched 8 There have been 2 prosecutions during the year. X.—FOOD CONTROL. It will be observed that out of 108 samples taken by the Wharves Inspectors during the year, in 77 cases the investigation has been concerned with the possibility of metallic contamination. This subject has received the most careful attention of the officers of this department who have, on a great many occasions, interviewed the owners of suspected goods for the purpose of discussing the treatment to be accorded to the particular goods in which they had an interest. Copper, lead, tin, zinc and iron are the contaminating metals which have been found in samples this year. So far as iron is concerned, there was only one instance in which this metal was found and in this case contamination of a parcel of muscatels occurred as a result of careless stowing of cargo. The standard aimed at in this department is the total exclusion of all metallic contamination from foodstuffs. This is, of course, the highest possible standard and may be in some instances unattainable. If it is argued by the merchant that the standard is unobtainable in his particular product, the onus is on him to support his view with the most impressive arguments at his command and to convince the Medical Officer of Health that his goods are free from harmful and unnecessary metallic content. The position thus taken by the Public Health Department explains why it is necessary so often to meet the owners of goods who may be faced with considerable financial loss should the goods be condemned. It is frequently contended that the presence of metals in small quantities in food is not harmful. It must be remembered, however, that if metallic contamination be permitted in one variety of food it may occur in many others and, consequently, the consumer may be the subject of repeated small doses of metallic poison from a variety of different articles of diet. Of the metals mentioned, lead, copper and tin are the most dangerous. Of zinc, it is not possible to say much more than that it ought to be excluded from foodstuffs on the general principle that all unnecessary contamination should be avoided. Presumably, it obtains access during the process of manufacture. Lead is a cumulative poison and is, on this account, the more dangerous; moreover, the signs and symptons of lead poisoning are well known and there is little difficulty in convincing owners and others that its presence in foodstuffs, even in small quantities, is extremely undesirable. Most of the samples in which lead has been found this year have been samples of sardines or sild in tins, where it has been suggested that the lead has gained admittance through the solder used for sealing the tins. In some instances, there has been double contamination by both lead and tin. Lead has also been found in several colouring powders used for different purposes. In the summary of samples forming part of this report, the words "No Action " are frequently to be found in the last column. This phrase simply refers to the actual parcel from which the sample was drawn and must not be taken to mean that the contamination thus discovered was ignored. The attention of every importer has immediately been drawn to contamination whereve it has been discovered and, in many instances, there has been communication between this department and the foreign manufacturer. Most of the cases of contamination by copper have occurred in connection with tomatoes and cherries. Importers have advanced one or all of four different arguments to explain or excuse the presence of copper in their products. Inevitably the first excuse is that copper is not harmful and we are asked to advance proofs that it is so. In my opinion, it is both harmful and unnecessary, and, therefore, to be excluded or reduced to the minimum possible quantity in all foodstuffs. Secondly, copper is frequently stated to be present in the natural product, growing tomatoes for instance, before these have been subjected to any process whatsoever. This may be true, but the amount of copper so present is extremely small. A third argument is that spraying solutions and dusting powders containing copper are used by the fruit growers to prevent the growth of parasites on the plants or trees, and that copper so deposited on the flowers or immature fruit may become incor- porated in the full grown fruit. Lastly, it has been admitted by a number of firms that the copper may obtain access to the product from the processing vessels which are themselves often made of that metal. So far as tin is concerned, this metal is derived from the containers in which the food is packed and its presence may be an indication that the product is old and has been kept in stock for a long time., It has often been suggested by importers that standards of permissible limits for metals should be fixed. While this procedure would no doubt have its advantages, it has the disadvantage that the permissible limit, beyond which it would presumably be an offence to contaminate food, would immediately become the permanent standard to which producers would endeavour to conform. I am of the opinion that it is best to adhere to the general principle that all metallic contamination is dangerous and that every possible means must be taken to avoid such contamination. Apart from metallic contamination there have arisen during the year three other matters of interest to which I wish to draw attention. It has been found on a number of occasions that the very fine leavings from broken biscuits and wafers were being sold very cheaply to children from certain shops in the borough, under the name of "gold dust". A very considerable amount of foreign matter was found in this biscuit dust and, as it was obviously quite easy to include sweepings in the dust, the view was taken that the sale of the product should be prevented if possible. The tradesmen concerned were, therefore, informed that the practice of selling this dust was a most undesirable one and agreed without further argument to cease selling the product. Towards the end of the year a quantity (56 lbs.) of dark raw sugar deposited in a warehouse, was seized. This sugar, unrefined and dark brown, almost black in colour, is popularly known as "foot sugar" and although mostly used in trade processes is sold in appreciable quantities at Christmas time for the purpose of making Christmas puddings. Solutions of a number of samples of sugar from this warehouse were tested and the filter pads were in several cases almost black in colour and exhibited appreciable quantities of grit and dirt. The smell was offensive and the sugar was consequently seized and taken before a magistrate who subsequently condemned it and ordered its destruction. The Public Analyst certified the presence of 1.35% of coarse insoluble matter, mostly sand, and the bacteriological report showed it to contain B. Welchii in 0.1 gm., streptococci in 0.1 gm., and coliform bacilli in 1 gm.; a total count of 400 organisms in 1 gm. Arising out of this seizure there followed a prosecution on the 1st and 15th February, 1938, at Tower Bridge Police Court. Professor John Eyre gave evidence on behalf of the Council, supporting the views of the Public Analyst and the Bacteriologist. The defendants were represented by counsel but the magistrate found that the sugar was unfit for food and a fine of £20 was imposed, costs of £52.10.0 being awarded to the Council. The third matter to which I wish to draw attention concerns canned apples. A consignment consisting of 3,000 cartons, each carton containing six ten pound tins of canned apples, was landed in May, 1937. When examined these goods appeared to be sound. Owing to fluctuations in the market price, or for some other reason, these goods were not immediately sold and in October it appeared that the contents of some of the tins were fermenting. The owner arranged for the whole of the consignment to be sorted and 613 cartons of blown tins were placed under stop. The owner however would not accept the contention that the contents of these tins were unsound merely because external examination showed that the containers were blown. He argued that the contents were quite wholesome and stated that he could easily dispose of them to restaurants. He opened several blown tins in my presence and I agreed with him that so far as it was possible to tell by looking at the contents and by smelling and tasting them, the apples appeared to be wholesome. It was suggested that the apples might be used for making jam and as we have more than one firm of jam manufacturers in the borough of high reputation, an offer was made to the owner to secure the opinion of one of these firms as to the suitability of these apples for this purpose. The contention behind this suggestion was that in the process of boiling the fruit to make jam, the products of decomposition would be boiled away and that no harm could result if the apples were released for this purpose. It is significant that this offer was refused by the owner of the apples. I was then requested by the owner to submit samples to the Public Analyst for his opinion. This I refused, on the ground that a "blown" tin is in my opinion a bad tin, and that a chemical analysis would neither fortify that opinion if favourable to me, nor modify my view if favourable to him. Under these circumstances the owner submitted samples to his own analyst, and I instructed the Inspector to seize the whole consignment of 613 cartons and take it before a magistrate. The report from the analyst to the owner is in the following terms:— "We have carefully examined the specimens of canned apples which you handed to us on the Ist November. One of the tins appeared to be quite normal, but the other was "blown". The object of our investigation was to discover the cause and significance of this state. Taking the blown tin, we collected the excess of gas, which amounted to 37ml. and this upon analysis was found to consist of nearly pure hydrogen. There was no carbon dioxide. The fruit itself appeared to be in sound condition; there was no evidence of mouldiness or decomposition of any kind. Chemical tests showed the presence of free iron (as distinct from the iron which is naturally combined in fruit) and the condition of the tin plate showed that it had been considerably etched by the acid of the fruit. The determination of the tin present in the fruit showed 0.6 grain per lb., which is not excessive. The reason for this comparatively low figure is doubtless to be found in the large weight of fruit as compared with the tin plate surface. Bacteriological tests were made on the fruit but cultures upon various media for the separation both of bacteria and moulds failed to produce any growth at all. We are, therefore, of opinion that the defective cans are "hydrogen swells"; they are not blown by reason of any bacterial contamination. The sound tin has also been examined. No gas was found in it and the can was much less etched. The fruit contained in it, which showed only a faint reaction for iron was in quite good condition. We are, therefore, of opinion that all the fruit is fit for consumption inasmuch as there is no bacterial spoilage, but that the 'blown' tins are in a somewhat unsatisfactory condition from the commercial point of view as the presence of traces of iron are likely to produce discolourations in use and so be the subject of complaints." The term "hydrogen swell" used in this report is a popular one at the moment, but in my opinion it merely serves to cloud the issue and "darken counsel." The magistrate having satisfied himself by personal inspection -and it may be mentioned that two stipendiary magistrates inspected the tins—that the goods were unsound, condemned them as being unfit for food and ordered their destruction. An expert sent by the London Chamber of Commerce on behalf of the owner also examined 40 cartons containing 240 tins and stated that he was satisfied. The goods were subsequently destroyed. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS 1925,1933. One hundred and eight samples have been taken during the year by the Wharves Inspectors. Of this number 8 samples were submitted to ascertain the composition, 3 to ascertain the composition and for the presence of preservative, 3 for the presence of formalin, 20 for the presence of preservative, 8 for the presence of preservative and metals, 3 for special purposes, and the remainder for the presence of metals. In addition, one sample of dark raw sugar was taken for bacteriological examination. (102) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933. No.of Sampies Result Action Article Examined Purpose of Examination Bacon, Canadian 1 Negative For presence of formalin No Action 1 Formaldehyde 5 parts per million No action Formaldehyde is present in wood smoke and may be in Smoked Bacon to extent of 30 parts per million Bacon, Canadian, Smoked „ „ Hydrocyanic Acid present to extent of about .016% 1 Brine, containing pickled gherkins To ascertain cause of unusual odour Destroyed 1 Butter, Austrian Genuine Butter Free from Boric Acid To ascertain composition and for presence of Boric Acid No Action 3 Butter, French Free from Boric Acid No action For presence of Boric Acid Copper 10 parts per million Cherries, Drained 2 No action For presence of Copper do. 2 Copper 14 parts per million No action „ „ do. 1 Copper 15 parts per million No action „ „ Cherries, Drained, English 1 Copper 15 parts per million No action „ „ 1 Copper 16 parts per million Cherries, drained No action „ „ 1 do. Copper 20 parts per million No action „ „ 1 Cherries, Glace Copper 20 parts per million Released with warning Importer communicated with Canadian packers „ „ Copper 24 parts per million Cherries, Drained 1 No action „ „ 1 Cherries, Glace Copper 20 parts per million „ „ „ (103) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.— continued No. of Samples Purpose of Examination Result Articles examined Action Cherries, Drained, French 1 For presence of Copper Copper 24 parts per million Released. Importer warned 1 „ „ Copper 26 parts per million Cherries, Drained To be re-exported 1 Copper 30 parts per million „ „ Released. Warning letter to importer. Letter from French manufacturer stating that his plant was to be overhauled „ „ „ „ Copper 40 parts per million Cherries, Drained, Belgian 1 Re-exported to Antwerp under written guarantee For metallic contamination Lead 25 parts per million Colour for Rusks, Pink 1 Supply withdrawn from use „ „ Colouring Powder, Red 1 Lead not exceeding 5 parts per million No action 1 „ „ Lead 12 parts per million Colouring Powder, Red, for Sausages Merchant warned Lead 5 parts per million „ „ 1 No action „ „ 1 Colouring Powder, Yellow Lead practically nil „ „ „ 1 For metallic contamination Lead nil. Tin .04 grains per lb. Crab, Dressed, Norwegian „ For metallic contamination or preservative Tin .6 grains per lb. Free from Boric Acid and Sulphur Dioxide 1 „ „ „ 1 Negative Egg Yolk, Frozen English For presence of Boric Acid „ 1 For presence of preservative „ Egg, Yolk „ 1 „ Egg Yolk, Roumanian „ „ „ Unscreened flour contained particles. Screened flour contained no particles To ascertain whether metal turnings found on outside of bags of flour had filtered through Flour 2 Whole consignment used for starching yarns, etc., under supervision of M.O.H. for Dundee (104) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. No. of Samples Purpose of Examination Action Result Articles Examined Metal, off flour bags 1 To ascertain composition An alloy of Magnesium, Aluminium and Zinc No action Fruit, Pectin, Polish 1 For presence of preservative Negative 1 Gaffelbidder „ „ „ „ Gaffelbidder, Baby 1 „ „ „ „ 1 Gloss, for cake and Pastry To ascertain composition and for presence of preservative Preservative absent. Probably dried white of egg „ 1 Goose Liver, Nat- Hungarian For metallic contamination or preservative Preservative absent. Liver surrounded by fat. No metallic contamination „ 1 Honey To ascertain composition and for presence of preservative Genuine Honey. Preservative absent „ 2 Lard, Chinese To ascertain composition Genuine Lard „ Lard, Polish 1 „ „ „ „ Lard, Swedish 1 „ „ „ „ Lemon Juice 1 For presence of preservative Sulphur Dioxide 275 parts per million „ „ „ 1 Sulphur Dioxide 395 parts per million „ „ Letter to Copenhagen Ministry of Agriculture Liver Paste, tinned Zinc 25 parts per million. Tin and Lead absent 1 For metallic contamination For presence of preservative Makrel Fillet No action Negative 1 Mill Stone Dressings Lead 12 parts per million Taken in conjunction with Turmeric For metallic contamination 1 To ascertain composition of red powder Muscatels Red powder consisted of an Oxide of Iron Muscatels sorted. Those with the powder attached destroyed 1 (105) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. No. of Samples Purpose of Examination Action Articles Examined Result Mustard 2 For presence of preservative Negative No action Mustard, German „ 1 For presence of preservative or metallic contamination „ Preservative absent. Tin .29 grains per lb. Lead 2 parts per milion Meat Conserves 1 „ „ Oil, Vegetable „ Oil of vegetable origin 1 To ascertain composition Onion Powder Lead absent. Copper 20 parts per million For metallic contamination Released. Importer warned 1 Oysters, tinned New Zealand For presence of preservative or metallic contamination Preservative absent. Tin .47 grains per lb. Lead not exceeding 2 parts per million. Copper not exceeding 6 parts per million No action 1 Oysters, tinned U.S.A. 1 Preservative absent. Tin .15 grains per lb. „ „ „ Paté de Foie Gras Preservative absent A trace of Zinc 1 „ „ „ Pea Flour Negative „ 1 For presence of formalin „ „ Prawns, canned 2 For presence of preservative Sulphur Dioxide 874 parts per million Pulp, Gooseberry No action. Limit 1,500 parts per million 1 „ „ Pulp, Strawberry Sulphur Dioxide, 1,465 parts per million No action. Limit 2,000 parts per million 1 „ „ Salmon, Japanese No action Negative 1 For presence of preservative or metallic contamination Salmon, Smoked Sea „ „ For presence of preservative 1 (106) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. No. of Samples Purpose of Examination Result Action Articles Examined For metallic contamination Lead 2 parts per million No action Sardines, French Moroccan 1 „ „ „ 3 Lead not exceeding 2 parts per million „ „ Warning letter to Importer. Casablanca Export Controller investigating „ „ 1 Lead 4 parts per million. Tin .08 grains per lb. „ „ „ „ 1 Lead 8 parts per million. Tin .04 grains per lb. „ „ „ „ Lead 8 parts per million 1 „ „ „ „ Sardines, Portugese, Boneless No action 1 Lead 2 parts per million. Traces of tin „ „ „ 1 Lead 4 parts per million. Traces of tin „ „ „ „ „ Sardines, Portugese 3 Negative „ „ „ 3 Lead not exceeding 2 parts per million „ „ „ „ „ „ „ 5 Lead 2 parts per million „ „ „ „ „ Lead 3 parts per million. Traces of tin 1 „ „ „ „ „ Lead 4 parts per million. Traces of tin 1 „ „ „ „ „ Lead 6 parts per million. Traces of tin 1 „ „ „ 1 Lead 6 parts per million „ „ „ „ Warning letter to Importer who communicated with Portugese authorities 1 „ „ Lead 12 parts per million Sealax, Smoked For presence of preservative 1 Negative No action Shrimps, Peeled, in Glass For metallic contamination 1 „ „ (107) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925, 1933.—continued. Articles Examined No. of Samples Purpose of Examination Result Action taken Sild, Norwegian 1 For metallic contamination Tin 0.55 grains per lb. Whole parcel re-exported to to Norway under written guarantee Tin 0.88 grains per lb. 1 „ „ „ „ 1 Tin 1.1 grains per lb. „ „ „ „ 1 Tin 2.21 grains per lb. „ „ „ „ „ „ 1 Tin 3.15 grains per lb. „ „ Tin 3.23 grains per lb. 1 „ „ „ „ 1 Lead 4 parts per million Warning letter to Importer who informed Norwegian Parker „ „ „ „ Negative Sugar 1 No action „ „ Tomato Paste 1 Tin 0.07 grains per 1b. Copper 14 parts per million „ „ „ „ „ 1 Tin 0.39 grains per lb. Copper 18 parts per million „ „ „ Tomato Powder 1 Lead 8 parts per million. Copper 120 parts per million Stopped for destruction „ „ Tomato Puree 1 Copper 25 parts per million. Practically free of tin Warning letter to Importer „ „ Turmeric For presence of Lead 1 Uncoated negative. Coated 3.5 parts per million. Scrapings 30 parts per million. Scrapings consisted largely of Silica, Iron, Aluminia, Magnesia and Lime „ „ 1 To ascertain composition of coating Coating consisted of Turmeric Samples Examined for Special Purposes. Dark Raw Sugar 1 Bacteriological Unsatisfactory Subsequent prosecution UNSOUND FOOD. The general inspection of food in shops and on stalls forms part of the duty of the District Sanitary Inspectors. Food, in the quantities stated, came under the notice of the Inspectors during the year, and being found unfit for human consumption was destroyed. Weight Description of Food tons cwts. qrs. lbs. - 2 14 1 Fresh Fish 1 - 2 Shell Fish - - 4 1 Dried Fruit 9 - 10 Lettuce 1 1 1 Milk, Condensed - 19 - 9 - Milk, Sterilized (seven pint bottles) - - 6 1 Poultry - - - - - 20 Rabbits - - Sugar - 7 - 2 Tomatoes 1 12 Total - 0 22 12 WORK OF THE WHARF AND FOOD INSPECTORS, 1937. 1 4 5 6 7 9 10 11 2 3 12 8 Ice Cream Premises Food Stores Food Wharves and Depots Milksellers Pharmacy & Poisons Destruction of Food Nuisances Found Intimations Served Visits Number of Samples taken Food Factories Fish Curers Milk (Special Designation) Order Samples of Milk for presence of Tubercle Bacilli Ice Cream (Bacteriological Examination) Samples of Milk for presence of Bacillus Abortus Raw Sugar (Bacteriological Examination) I Food and Drugs Imported Food Regulations Jam Other Butter and Margarine - 25 117 - 348 1939 - - 225 4 - - 18 - - - - - 22 - 23 1 10 176 1917 - - - - - 29 - - - - 25 253 3 16 - 122 5 530 38 92 1498 - - 345 28 21 129 - - 61 - - - - - - 18 - - 345 153 674 508 13 10 153 1509 201 8 145 1 1 273 4 - 49 672 48 961 5507 674 508 824 48 31 153 1509 108 201 8 145 4 440 1 145 MILK PREMISES. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Thirty-three milk sellers were registered under the above Act during 1937, and thirty-seven were removed from the Register, making a total of 260 milk sellers on the Register at the end of the year under report. MILK (SPECIAL DESIGNATIONS) ORDER, 1936. During the year under report the following licences were granted:— Dealers' Licences. To bottle and sell Tuberculin Tested Milk 5 To sell Tuberculin Tested Milk 25 To sell Pasteurised Milk 28 Supplementary Licences. To sell Accredited Milk 1 To sell Pasteurised Milk 14 To sell Tuberculin Tested Milk 9 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 35 schools, and a total of 702 samples have been examined, as follows: — For Chemical (i.e., Fat and non-Fatty Solids) Examination. Liquid Milk, undesignated 250 Liquid Milk, undesignated (informal) 8 Sterilized Milk 95 Tuberculin Tested Milk 1 Tuberculin Tested Milk (informal) 1 Pasteurised Milk 47 Pasteurised Milk (informal) 54 Chocolate Milk tinned (informal) 1 Condensed Milk (informal) 30 Dried Milk (informal) 3 490 (110) For Bacteriological Examination. Milk, undesignated 4 4 Tuberculin Tested Milk 91 Tuberculin Tested (Pasteurised) Milk 5 Tuberculin Tested (Certified) Milk 1 Pasteurised Milk (from schools) 53 Pasteurised Milk (other than from schools) 47 For tubercle bacilli 6 For brucella abortus 4 For bacteria of typhoid group 1 212 ICE CREAM. One hundred and fifty-eight samples of ice cream have been examined with the following results:— 1. Bacterial Count. Up to 100 per 1 c.c. 3 Over 100 to 500 per 1 c.c. 11 Over 500 to 1,000 per 1 c.c. 2 Over 1,000 to 5,000 per 1 c.c. 20 Over 5,000 to 10,000 per 1 c.c. 15 Over 10,000 to 50,000 per 1 c.c. 30 Over 50,000 to 100,000 per 1 c.c. 24 Over 100,000 to 200,000 per 1 c.c. 0 Over 200,000 to 400,000 per 1 c.c 6 Over 400,000 to 600,000 per 1 c.c. 4 Over 600,000 to 1,000,000 per 1 c.c. 1 Over 1,000,000 to 2,000,000 per 1 c.c. 2 Over 2,000,000 7 Impossible to count 9 Spoilt culture—overgrown 1 145 111 2. Presence of B. Coli. B. Coli present in 1 c.c., 1/10th c.c., and 1 /100th c.c. 47 B. Coli present in 1 c.c., and 1/10th c.c. 22 B. Coli present in 1 c.c. 21 B. Coli absent in 1 c.c., 1/10th c.c., and 1/100th c.c. 55 145 3. Chemical Analysis. Fat 1.85 per cent. 1 Fat 2.25 per cent. 1 Fat 3.00 per cent. 1 Fat 3.25 per cent. 1 Fat 4.95 per cent. 1 Fat 9.30 per cent. 1 Fat 10.45 per cent. 1 Fat 12.55 per cent. 1 Fat 13.45 per cent. 1 Fat 14.35 per cent. 1 Fat 15.35 per cent. 1 Cream Ice. Two samples were taken for chemical analysis with the following results:— Fat 3.70 per cent. 1 Fat 8.40 per cent. 1 2 The chemical analyses emphasise the fact, already well known, that ice creams vary enormously in food value; 1.85 per cent. of fat in the sample of poorest quality compares with 15.35 per cent, of fat in that of best quality. The bacteriological examinations show that about 30 per cent, of the samples had a high bacterial count and some of the samples were shockingly contaminated. This question has received the earnest attention of the Food and Drugs Inspector and of the District Inspectors for the last three or four years. In the case of each application for registration, the premises have been inspected and re-inspection of premises has been carried out frequently, especially during the summer time. A considerable number of applications for registration have been refused, and many applicants have been interviewed by the Committee. One of the difficulties of the present position is that premises only are registerable and the personal habits and standard of education of many of the applicants, mostly of foreign origin, are such that it would be impossible to expect them to manufacture a clean ice-cream even in ideal premises. Under the circumstances, it would seem reasonable that in future legislation the registration of all makers and vendors of ice-cream should be imposed, in addition to the registration of premises. In my opinion, it would be reasonable to prohibit the sale of "loose" ice-cream in the street, and to require that all ice-cream so sold should be pre-wrapped. It would also be an advantage if the name and address of the manufacturer were required to be printed on the wrapper, cup or packet, together with the date of manufacture. This latter precaution might be of some assistance in preventing the sale of ice-cream which had been thawed and re-frozen, a practice which seems to be fairly common in this borough. So far as the premises in which ice-cream is manufactured are concerned, I would suggest that —except in the case of dairies— these should be required to be used exclusively for the making of ice cream, and that no other produce should be either made or sold on such premises; that water used for the manufacture of the ice-cream and for the cleansing of vessels must come from the rising main ; and that applicants for the registration of premises be required to give one month's notice of their desire for registration. Much trouble has arisen in this borough on account of the fact that many applicants for registration purchase expensive apparatus and rent premises before making the application. If registration is refused on the grounds that the premises are unsuitable, the applicant then makes a plea to the Committee that he has spent much money on apparatus, and will be involved in considerable loss if he is refused registration. The question of fixing legal standards, both bacteriological and chemical, for ice-cream is, I believe, under consideration. As standards of this nature have already been applied to milk, there seems to be no valid reason why similar standards should not be devised for ice-cream. HALIBUT LIVER OIL. A point of some considerable importance arose during this year in connection with Halibut Liver Oil. This oil has been very widely advertised in the Press, especially as being of great importance in infant feeding. For some years it has been supplied at our Infant Welfare Centres, the mothers purchasing it at cost price from those Centres. Even when sold at cost price Halibut Liver Oil is often too expensive for our mothers to purchase, and the fact that its administration to babies is in quantities of a drop or two at a time and that only a small quantity—5 c.c.s. about 70 —75 drops —is obtained for 1/3 makes it appear even more expensive than is actually the case. Hitherto, we have always obtained this oil from the firm which, I believe, was responsible for introducing its use to this country, their product having a guaranteed standard of vitamin content. Other things being equal, it is a rule of this Council to accept the lowest price tendered, and towards the end of the year I received an offer of Halibut Liver Oil in 5 c.c. bottles at 9d. per bottle. Under the circumstances it appeared wise to consider this second offer and a small sample was purchased and examined. This oil was found to have rather less than a quarter of the guaranteed vitamin content of the oil previously used and, in all probability, consisted of a mixture of fish oils. Actually, therefore, although sold at a lower price, it was in fact a more expensive and certainly a much less efficacious product than that previously in use. I believe the oil in question was a foreign product and attention is drawn to this experience since it appears that more than one of these imitation oils are on the market at the present time. PHARMACY AND POISONS ACT, 1933. Sixty-four premises were entered on the Council's List for the year under report; ten premises were subsequently removed from the List. As a result of informal samples being purchased, it was found that fifteen contraventions of the Act occurred, poisons being sold wrongly by both listed and unlisted vendors. Warning letters were sent in each case. (115) FOOD AND DRUGS. Total Samples Taken Number Adulterated Percentages of Articles Adulterated Number Genuine Articles submitted for Analysis - Ale - 2 2 Almonds, essence of (informal) 1 1 - - 8 Almonds, ground 8 - - Aniseed, balsam of (informal) 1 1 - - Apricots, dried 2 2 - - Arrowroot 1 1 - - Aspirin Tablets 3 3 - - Aspirin Tablets (informal) 1 1 - - 1 Balsam, Friars (informal) 1 - - Barley Sugar Cubes 1 1 - - Barley, pearl 7 7 - - 1 Barley, Pot 1 - - 1 Barley, Patent 1 - - Beef, Fluid 1 1 - - Beer 1 1 - - 2 Bicarbonate of Soda 2 - - 1 Blancmange Powder 1 - - 1 Boracic Acid Crystal 1 - - Boracic Powder (Informal) 1 1 3 - - Borax, Pure 3 - - Brawn 10 10 - - Brawn, Beef 1 1 - - Brawn, Pork 5 5 - - 3 3 Brawn, Veal - 68 - Butter 68 - - Butter (Informal) 1 1 - - 1 Cakes, Sponge 1 - - Candied Peel, Mixed (Informal) 1 1 - - Capers, French (Informal) 2 2 - - Catarrh Syrup Compound 1 1 - - Cheese 12 12 - - Cheese, Cheddar in Foil 1 1 - - 4 Cheese, in Foil 4 - - Cheese, and Tomato Spread (Informal) 1 1 - - 1 Cheese Spread, Pineapple Flavour 1 - - Cherries, Glace 1 1 - - Cherries, Glace (Informal) 1 1 - - 1 Chutney (Informal) 1 - - Chutnee 1 1 - - 1 Cider 1 - - Cider (Informal) 1 1 - - Citron (Informal) 1 1 - - Cocoa 4 4 - - 3 3 Cocoa (Informal) - - 5 5 Cocoanut, Desiccated - - Coffee, Pure 1 1 - - Coffee, Pure (Informal) 2 2 - - Coffee, French 1 1 - - Coffee, French (Informal) 1 1 - - Coffee, Dandelion 1 1 - - Coffee and Chicory 3 3 - - Coffee and Chicory Extract 6 6 Cold and Influenza Mixture - - 1 1 - - (116) FOOD AND DRUGB—continued. Total Samples Taken Number Genuine Number Adulterated Articles submitted for Analysis Conserve, Grapefruit 2 2 - Cordial 1 1 - 1 Cordial, Strawberry Flavour 1 - 1 Cordial, Raspberry 1 - 5 5 Cream, Fresh - Cream, Fresh (Informal) 1 1 - 2 2 Cream, Coffee - Cream, Tinned (Informal) 22 22 - 1 1 Cream, Salad (Informal) - 1 Cream Ice 1 - Cream Ice (Informal) 1 1 - 1 Currants (Informal) 1 - Curry Powder 5 5 - Curry Powder (Informal) 1 1 - Custard Powder 1 1 - Custard Powder (Informal) 2 2 - Cornflour 1 1 - Dripping 43 43 - 1 Dripping (Informal) 1 - Epsom Salts 2 2 - 1 Eucalyptus, Oil of 1 - Eucalyptus, Oil of (Informal) 1 1 - Figs, Dried (Informal) 1 1 - 1 Flour, Bun 1 - Flour, Bun (Informal) 1 1 - Flour, Pea 1 1 - Flour, Self-Raising 13 13 - Flour, Self-Raising (Informal) 1 1 - Food Beverage (Informal) 1 1 - Fruit Cough Cure 1 1 - Fruit, Mixed Dried (Informal) 2 2 - Fruit Pectin 1 1 - Gelatine (Informal) 2 2 - Gin 2 2 - Ginger Beer 1 1 - Ginger, Ground 2 2 - Ginger, Ground (Informal) 1 1 - Ginger, Preserved 2 2 - Glucose 1 1 - Grape Fruit Squash 4 4 - 1 Gravy Browning (Informal) 1 - Gravy Powder (Informal) 1 1 - Gravy Thick 1 1 - Ham Pate 1 1 - 3 Honey 3 - Honey (Informal) 12 12 - 1 Horseradish Cream 1 - Horseradish Cream (Informal) 2 2 - Hydrogen Peroxide 3 3 - (117) FOOD AND DRUGS—continued Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated Percentages of Article Adulterated Ice Cream (Informal) 11 11 - - Iodine, Tincture of 1 1 - - Iodine, Paint (Informal) 4 4 - - Iodine Lotion (Informal) 1 1 - - Iodine, Spirit of (Informal) 1 1 - - 2 2 - - Jam, Apple and Strawberry Jam, Apricot 3 3 - - Jam, Black Currant 8 8 - - 2 Jam, Bramble Seedless 2 - - Jam, Damson 2 2 - - Jam, Greengage 1 1 - - Jam, Mixed Fruit (Informal) 1 1 - - - Jam, Plum 5 5 - Jam, Plum, Red (Informal) 1 - 1 - 1 - Jam, Stoneless Plum 1 - 19 10.53% Jam, Raspberry 17 2 Jam, Raspberry (Informal) 1 1 - - - Jam, Raspberry and Gooseberry 1 1 - Jam, Strawberry 6 6 - - Jelly, Blackcurrant 2 - - 2 Jelly, Lemon - 3 3 - Jelly, Lime (Informal) 1 1 - - Jelly, Pineapple 1 1 - - Jelly, Raspberry 4 4 - - Jelly, Strawberry 2 2 - - 3 - - Ketchup 3 1 Ketchup, Tomato (Informal) 1 - - 31 2 Lard 6.06% 33 Lard (Informal) 3 3 - - Lemon Barley Crystals 2 2 - - 1 Lemon Barley Powder (Informal) 1 - - Lemon Curd 1 1 - - Lemon Curd (Informal) 1 - 1 - 2 - Lemon Powder and Tablets 2 - Lemon Squash 2 2 - - 1 - Lemon Squash Powder 1 - Lemonade 1 1 - - Lemonade Powder and Crystals 6 6 - - Lentils 2 - 2 - Liniment, Mustard (Informal) 1 I - - Liniment, Vapour 1 1 - - Liquorice Bundles 1 1 - - Lotion, Eye, Cocain, and Boracic 1 1 - 1 - 1 1 Lozenges, Brompton - - - - Magnesia, Citrate of 2 2 Margarine 23 23 - - Margarine (Informal) 1 1 - - Marmalade, Lime 1 1 - - Marmalade, Ginger 1 1 - - Medicinal Liquid Paraffin 3 3 - - Milk 8 250 242 3.2% Milk (Informal) 8 8 - - (118) FOOD AND DRUGS—continued Articles submitted for Analysis Total Samples Taken Number Genuine Number Adulterated Percentage of Articles Adulterated 1 - Milk, Chocolate, Tinned (Informal) 1 - Milk, Condensed (Informal) 30 30 - - Milk, Dried 3 3 - - Milk, Pasteurised 47 46 1 2.13% 54 Milk, Pasteurised (Informal) 54 - - Milk, Sterilized 95 93 2 2.11% Milk, Tuberculin Tested 1 1 - - Milk, Tuberculin Tested (Informal) 1 1 - - Milk Jelly Crystals 1 1 - - Milk Pudding Powder (Informal) 1 1 - - Mincemeat (Informal) 1 1 - - Mineral Water, Cream Soda 1 1 - - Mineral Water 4 4 - - Mineral Water (Informal) 1 1 - - Mint, Dried 8 8 - - Mint, Dried (Informal) 2 2 10 - - 10 Mints, Clear - - 1 Mints, Clear (Informal) 1 - - Mustard 8 8 - - Mustard (Informal) 2 2 - - 2 Mustard, Compound 2 - - 1 1 Mustard, German - - 2 Mustard, Prepared 2 - - Mustard Prepared (Informal) 1 1 - - Oatmeal 1 1 - - Oats, Flaked 1 1 - - Oil, Cod Liver and Malt Extract 2 2 - - Oil, Cod Liver Emulsion and Hypophosphites 1 1 - - 1 Oil, Halibut Liver and Orange Juice 1 - - Oil, Lucca 1 1 - - 1 Oil, Cotton Seed 1 - - 1 Oil, Whale 1 - - 2 2 Oil, Camphorated (Informal) - - 3 Oil, Castor (Informal) 3 - - Oil, Camphorated Amber and Eucalyptus (Informal) 1 1 - - 1 1 Oil, Cod Liver (Informal) - - Oil, Nut (Informal) 1 1 - - Oil, Olive 4 4 - - Oil, Halibut Liver and Malt Extract 1 1 - - 1 Oil, Halibut Liver (Informal) 1 - - Ointment, Basilicon 1 1 - - 3 Ointment, Sulphur 3 - - 1 1 Ointment, Wintergreen - 4 - Ointment, Zinc 4 - - Orange Squash 1 1 - - 3 3 Paste, Bloater (Informal) - - 3 Paste, Chicken, and Ham (Informal) 3 2 - - Paste, Crab (Informal) 2 - - Paste, Fish 4 4 - - Paste, Salmon, and Anchovy (Informal) 1 1 5 - - Paste, Salmon and Shrimp 5 - - (119) FOOD AND DRUGS —continued Total Samples Taken Percentages of Articles Adulterated Articles submitted for Analysis Number Genuine Number Adulterated Paste, Salmon and Shrimp (Informal) 1 1 - - 1 1 Paste, Tomato, Tinned (Informal) - - Parrish's Chemical Food 4 4 - - Pastilles, Halibut Liver Oil 1 1 - - Pepper 15 15 - - Pepper (Informal) 9 9 - - Pepper, Compound (Informal) 1 1 - - Peppermint, Concentrated (Informal) 1 1 - - Peas, Tinned (Informal) 1 1 - - 3 Pickle, Sweet 3 - - Pickle, Mixed 2 2 - - Pickle, Mustard 3 3 - - Pickle (Informal) 2 2 - - Pickled Red Cabbage 1 1 - - Pineapple, Tinned (Informal) 1 1 - - 3 3 Prunes - - Pudding, Black 4 4 - - Raisins 2 2 - - Rice 8 8 - - 2 Rice, Flaked 2 - - Salad Cream 1 1 - - Salad Cream (Informal) 1 1 - - 1 Salmon, Tinned (Informal) 1 - - Salts, Epsom 1 1 - - Salts, Glauber 1 1 - - 7 Sauce 7 - - Sauce (Informal) 4 4 - - 3 Sauce, Chop 3 - - Sauce, Fruit (Informal) 1 1 - - Sauce, Horseradish 1 1 - - Sauce, Mint 4 4 - - Sauce, Mustard (Informal) 1 1 - - Sauce, Tomato 2 2 - - 3 Sauce, Tomato (Informal) 3 - - Sauce, Worcestershire 3 3 - - Sausages, Beef 33 33 - - Sausages, Breakfast 8 8 - - Sausages, Cambridge 3 3 - - Sausages, Chipolata 19 17 2 10.53% Sausages, Garlic (Informal) 1 1 - - 5 5 Sausages, Liver - - Sausages, Luncheon 3 3 - - Sausages, Oxford 2 2 - - Sausages, Pork 24 24 - - 1 1 Sausages, Suffolk - - Saveloys 1 1 - - Seasoning (Informal) 1 1 - - 1 Semolina 1 - - Sherbet Powder 2 2 - - Shortening 2 2 - - Soda Water 1 1 - - Soup, Oxtail (Informal) 1 1 - - Spice, Mixed (Informal) 1 1 - - (120) FOOD AND DRUGS —Continued Total Samples Taken Number Genuine Number Adulterated Percentage of Articles Adulterated Articles submitted for Analysis Sponge Fingers - 1 1 - 1 Stuffing, Egg and Thyme 1 - - Stuffing, Sage and Onion (Informal) 1 1 - - Strawberries in Syrup 1 1 - - Suet, Shredded 34 34 - - Suet, Shredded (Informal) 1 1 - - Sugar 5 5 - - 2 Sugar, Barbados (Informal) 2 - - Sugar, Dark Raw 1 1 - - Sugar, Foot (Informal) 2 2 - - Sugar, Icing 1 1 - - 1 1 Sulphur and Treacle - - Surgical Spirit 1 1 - - Syrup, Blackcurrant (Informal) 1 1 - - 1 Syrup, Cane 1 - - 3 Syrup, Golden (Informal) 3 - - Syrup, Orange (Informal) 1 1 - - 1 Tablets, Ammoniated Quinine 1 - - Tablets, Bismuthated Magnesia (Informal) 1 1 - - 1 1 - Tablets, Bisurated Magnesia - Tablets, Candy Lax 1 1 - - Tablets, Cherry Ciderette (Informal) 1 1 - - Tablets, Epsom Salts 1 1 - - Tablets, Lime 1 1 - - 1 Tablets, Linseed, Liquorice and Chlorodyne - 1 - 3 Tapioca 3 - - Tapioca, Flaked 2 2 - - Tea 11 11 - - Tea, China 1 1 - - Tea, Herb 1 1 - - Tinned Red Salmon (Informal) 1 1 - - Tomato Soup 1 1 - - Tonic, Orange Quinine 2 2 - - Tonic, Phosphorised Quinine and Iron 1 1 - - Treacle, Black (Informal) 1 - 1 - Vegetable Extract (Informal) 1 - 1 - Vermouth, British 1 1 - - 6.25% Vinegar 48 45 3 Vinegar (Informal) 3 2 1 33.33% 27 27 Vinegar, Malt - - - Vinegar, Malt (Informal) 1 1 - 1 Vinegar, Spirit (Informal) 1 - - Vinegar, Table 2 1 1 50.00% Wafer and Biscuit Dust (Informal) 1 1 - - Walnuts, Pickled (Informal) 1 1 - - Whisky 1 1 - - Wine, Blackcurrant Flavour (Informal) 1 1 - - 1 Wine, Cherry 1 - - Wine, Cherry Flavour, Non-Alcoholic 1 1 - - Wine, Ginger 1 1 - - 2 Wine, Ginger, Essence 2 - - 4 Wine, Port 4 - - Wine, Raisin Flavour Non-Alcoholic 1 1 - - 1,509 1,487 22 1.46% Total (121) PROSECUTIONS IN CONNECTION WITH SAMPLES TAKEN DURING 1937. No. Sample Adulteration or Infringement Remarks 158 Milk Selling Milk containing added water to the extent of 1.4 per cent. Fine £1 Costs £2 2s. 159 Raspberry Jam Selling Raspberry Jam containing 18 per cent. Raspberry Fruit and 12 per cent. Apple Fruit Dismissed. Warranty proved. See Prosecution No. 167 Lard 160 Selling Lard to the prejudice of the purchaser Withdrawn. Conflict of Analysts' Certificates Milk 161a Selling Milk containing 1.2 per cent. of added water Dismissed under Probation of Offenders' Act, 1907, on payment of Costs £7 7s. „ 161b Selling Milk containing 0.5 per cent. of added water Chipolata Sausages 162a Selling Chipolata Sausages to the prejudice of the purchaser Withdrawn. Taken in conjunction with 162b „ „ Selling sausages containing preservative without causing same to be labelled to that effect 162b Dismissed under Probation of Offenders' Act, 1907, on pay ment of Costs £2 Milk Selling Milk containing 2.0 per cent, of added water 163 Dismissed under Probation of Offenders' Act, 1907, on payment of Costs £3 3s. Vinegar 164 Selling vinegar deficient in Acetic Acid to the extent of 28.0 per cent. Fine 1/- Costs £2 2s. Raspberry Jam Wilfully giving label with Raspberry Jam which falsely described same 167 Fine £5 Costs £5 5s. Vinegar Selling vinegar deficient in Acetic Acid to the extent of 19.0 per cent. 173 Dismissed under Probation of Offenders' Act, 1907, on payment of Costs £2 2s. Dark Raw Sugar Depositing for sale dark raw sugar which was unsound, unwholesome or unfit for food 179 Fine £20 Costs £52 10s. SUMMARY. £ s. d. Fines 26 1 0 Costs 76 11 0 Total £102 12 0 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933. Quantity Unsound Articles Disposed of for Purposes other than Human Food Removed for Sorting under S.A. Exported Destroyed Quantity Weight Quantity Weight Weight Quantity Weight Quantity MEAT. lbs cwt qr lbs lbs tons cwt qr tons tons cwt cwt lbs qr tons qr Beef Various 3 2 15 - - - - - - - - - - - - - - - Brisket 6 tins 1 12 - - - - - - - - - - - - - - - - - - Corned 1,683 tins 3 11 9 - - - - - - - - - - - - - - - Various 1 10 9,101 tins 3 4 - Tinned Veal 0 - - - - - - - - - - - - Casings 328 bungs - - - - - - - - - - - - - - - - - - - 1 cap end 4 middles (122) 85 runners 4 2 24 tierces - - - 6 - - - - - - - Calves Legs 164 cases 19 13 tins 2 22 4 - - - - - - - - - - - - - - Pork. 8 sides Bacon Various 1 6 3 58 bales 1 10 4 - - - - - - - - - - 15 Various 3 13 - Ham - - - - - - - - - - - - - - - - 6 - Tinned Ham Various 6 7 0 Various 19 13 - - - - - - - - - - - Ham Roll Various 2 16 Various 5 3 2 - - - - - - - - - - - - - Fresh Pork Various 12 2 26 Various 6 7 3 - - - - - - - - - - - - Jellied Pork 3 2 - - 58 tins - - - - - - - - - - - - - - - Pressed Pork - 15 tins 3 16 - - - - - - - - - - - - - - - - 35 tins - Pork Loins 1 3 14 - - - - - - - - - - - - - - - Pork Shoulders - 149 tins 12 8 - - - - - - - - - - - - - - - - Tongues - 560 tins 2 5 2 20 - - - - - - - - - - - - - - Mutton 3 carcases 3 25 - - - - - - - - - - - - - - - - - Lamb Various 6 1 7 - - - - - - - - - - - - - - - - Lamb, canned 1 tin 6 - - - - - - - - - - - - - - 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 Quantity Weight Quantity Weight Quantity Weight Weight tons cwt qr lbs tone cwt qr lbs tons cwt qr lbs tons lbs cwt qr RABBITS 55 cases 2 5 - - - - - - - - - - - - - - - - - VARIOUS. Meat Cubes Various 10 2 10 - 11 - - - - - - - - - - - - - - Sausages 29 tins 2 cases 2 1 2 26 - - - - - - - - - - - - - - DAIRY PRODUCE. Butter 36 - 1,584 boxes - - - - - - - - - - - - - - - - - Cheese Various 2 3 1 11 - - - - - - - - - - - - - - - Eggs 3,024 tins 124 13 3 23 - - - - - - - - - - - - - - - - - Egg Yolk 2 casks 4 - - - - - - - - - - - - - - - - - - - Lard Various 1 10 casks 2 - - - - - - - - - - - - - Milk, Canned 15 cases and 1,737 tins 1 5 18 - 87 oases 1 10 - - - - - - - - - - - - - 3 tins and 6 bags Milk Powder 4 3 - - - - - - - - - - - - - - - - FRUIT. Fresh. 255 cases - Apples 5 10 - - - - - - - - - - - - - - - - Cherries 1 cask 1 - 2 cases 10 - - - - - - - - - - - - - - - Citrons 18 casks 4 19 2 - - - - - - - - - - - - - - - - 20 Dates 8 boxes 2 1 - - - - - - - - - - - - - - - - Figs 20 bags 4 - - - - - - - - - - - - - - - - - - Grape Fruit Various 112 18 17 18 barrels 2 11 3 - - - - - - - - - - - - 22 cases and 69 blls. - Grapes 1 15 - - - - - - - - - - - - - - - - 1 1,619 cases Oranges - Various 862 8 1 51 16 3 - - - - - - - - - - Tomatoes 101 boxes 12 - - - - - - - - - - - - - - - - - - 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 cwt qr lbs. tons Canned and Juice. tons cwt qr lbs cwt qr lbs tons Apples 3,689 tins - 5 10 - - - - - - - - - - - Apricot Pulp 125 cases and 286 tins 6 14 1 - - - - - - - - - - - Blackcurrant Pulp 1 cask, 29 cases and 5 tins 1 13 3 26 - - - - - - - - - - Blackcurrants 1 3 28 cases and 18 tins - - - - - - - - - - - - Fruit Salad 24 tins 24 - - - - - - - - - - - - - Grapefruit Juice 2 cases and 32 casks 5 17 3 9 - - - - - - - - - - Grapes 21 cases 13 - - - - - - - - - - - - - Lemon Juice 1 ½-pipe, 5 carboys and 12 casks 4 19 3 8 - - - - - - - - - - Oranges 2 cases and 27 tins 2 3 - - - - - - - - - - - - Orange Juice 31 casks 3 4 - - - - - - - - - - - Orange Pulp 223 cases 11 11 1 - - - - - - - - 17 - - - Peaches 35 cases and 162 tins 1 22 - - - - - - - - - - - Pineapple 161 cases and 6,752 tins 9 8 17 - - - - - - - - - - - Pears 13 cases 18 tins 3 2 - - - - - - - - - - - - Strawberry Pulp 1 3 7 1 cask, 3 cases and 11 tins 6 - - - - - - - - - - Tomato Puree 5 2 4 - - Various - - - - - - - - - PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 & 1933-continued Articles Quantity Unsound Disposed of for Purposes other than Human Food Destroyed Removed for Sorting under S.A. Quantity Weight Quantity Weight Quantity Weight DRIED. qr lbs lbs tons cwt qr lbs. tons cwt tons cwt qr Muscatels Various 1 8 - - - - - - - - - - - - Prunes 24 boxes 5 1 12 - - - - - - - - - - - CEREALS. Beans, Soya Various 20 - - - - - - - - - - - - - Beans, Butter Various 1 14 3 - - - - - - - - - - - Corn Flakes Various 11 - - - - - - - - - - - - - Flour 640 bags 40 528 bags 35 10 - - - - - - - - - - Rice - Various 10 7 1 5 bags 5 - - - - - - - - Wheat Various 625 16 2 21 - - - - - - - - - - POULTRY. Chicken 92 cases and 2 carcases 1 17 9 439 cases 3 14 15 - - - - - - - Chicken Breast 139 tins 2 2 1 - - - - - - - - - - - Ducks 58 cases 17 - - - - - - - - - - - - - Partridges 3 46 cases 5 - - - - - - - - - - - - Pigeons 20 Boxes 2 - - - - - - - - - - - - - Turkey Meat 5 tins 2 - - - - - - - - - - - - - VEGETABLES. Asparagus 1,895 tins 16 3 19 - - - - - - - - - - - 100 baskets and 75 crates 2 2 Beans, Runner - - - - - - - - - - - - Beetroot 1 bag 1 - - - - - - - - - - - - - Cabbage, Red 49 bags 1 19 - - - - - - - - - - - - Carrots 140 packgs. 1 17 2 - - - - - - - - - - - Gherkins 1 2 16 tins - - - - - - - - - - - - Lettuce 40 crates 8 - - - - - - - - - - - - - 410 bags 19 3 Onions - - - - - - - - - - - - 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 lbs tons cwt qr lbs tons lbs tons cwt qr lbs qr cwt qr Peas 126 tins 1 1 26 - - - - - - - - - - - - - - - - 1 box and 134 bags 10 12 4 Potatoes - - - - - - - - - - - - - - - - Sauerkraut 1 tin 11 - - - - - - - - - - - - - - - - - - FISH. 1 12 Anchovies 1 tin - - - - - - - - - - - - - - - - - 18 tins 1 2 - - - - - - Caviare - - - - - - - - - - - Crab Spread Various - - - - 6 - - - - - - - - - - - - - - 525 tins 2 1 Lobster - - - - - - - - - - - 17 tins 15 - - - - - - Pilchards - - - - - - - - - - 6 tins 9 - - - Prawns - - - - - - - - - - - - - - - 5 cases and 105 tins 4 3 20 - - - - - - - - - - Salmon - - - - - - Sardines 14 tins 2 3 - - - - - - - - - - - - - - - - - NUTS. Almonds, Shelled 23 bags and 2 boxes 9 10 - - - - - - - - - - - - - - - - - Cocoanut, desiccated Various 2 - - - - - - - - - - - - - - - - - - 15 bags 15 Ground Nuts - - - - - - - - - - - - - - - - - - - 1 ease and 16 bags 8 1 27 - - - - - Walnuts - - - - - - - - - - VARIOUS. Confectionery 14 cases 1 1 1 - - - - - - - - - - - - - - - - Various 26 - - - Cocoa Powder - - - - - - - - - - - - - - - Various 92 Cocoa Waste - - - - - - - - - - - - - - - - - - Conserves Various 1 18 2 - - - - - - - - - - - - - - - - Various 6 - - - - Glucose - - - - - - - - - - - - - - 1 tin and 108 bottles 1 Preserved Food - - - - - - - - - - - - - - - - - - Tallow 3 casks 1 - - - - - - - - - - - - - - - - - - 3 bags 3 198 bags 9 18 - - Sugar 10 bags 15 - - - - - - - - - - - Various 17 3 21 Canned Goods Various 14 6 96 - - - - - - - - - - - - - 732 1 2 14 - 1482 - 146 - 5 14 3 15 8 26 14 2 15 Total - XI.—HEALTH SERVICES. MATERNITY AND CHILD WELFARE CENTRES. Public Health Centre, Grange Road. Monday, 2.0 p.m.-4.30 p.m. Wednesday, 9.45 a.m.-12 noon Thursday, 2.0 p.m.-4.30 p.m. Ante-natal Clinic Tuesday, 2.0 p.m.-4.30 p.m. 98 Rotherhithe New Road. Tuesday, 9.45 a.m.-12 noon Wednesday, 2.0 p.m.-4.30 p.m. Friday, 2.0 p.m.-4.30 p.m. Ante-natal Clinic Tuesday 2.0 p.m.-4.30 p.m. Bermondsey Gospel Mission, 1-3, Jamaica Road. Monday, 2.0 p.m.-4.30 p.m. Friday, 2.0 p.m.-4.30 p.m, Manor Chapel, Roseberry Street. Monday, 2.0 p.m.-4.30 p.m. Bryan House, Rotherhithe Street. Thursday, 1.30 p.m.-4.30 p.m. Sewing Class Wednesday, 2.0 p.m.-4.30 p.m. Princess Club, Jamaica Road. Monday, 2.0 p.m.-4.30 p.m. Tuesday, 2.0 p.m.-4.30 p.m. Wednesday, 2.0 a.m.-4.30 p.m. Friday, 2.0 p.m.-4.30 p.m. Ante-natal Clinic Thursday, 2.0 p.m.-4.0 p.m. Sewing Class Wednesday, 2.0 p.m.-4.30 p.m. Alice Barlow House, Fulford Street. Thursday, 2.0 p.m.-4.30 p.m. Friday, 2.0 p.m.-4.30 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.-4.30 p.m. St. George's Hall, Old Kent Road. Tuesday 2.0 p.m.-4.30 p.m. Sewing Class Thursday, 2.0 p.m.-4.30 p.m. Toddlers Clinic First Wednesday in each month 2.0 p.m.-4.30 p.m. Salomons Centre, Newcomen Street, Monday 10.0 a.m.-12 noon and 2.0 p.m.-4.30 p.m. Thursday 2.0 p.m.-4.30 p.m Ante-natal Clinics:— Monday, 9.30 a.m.-12 noon. Tuesday, 1.30 p.m.-4.30 p.m. Wednesday, 9.30 a.m.-12 noon. Friday, 9.30 a.m.-12 noon POST-NATAL AND SPECIAL CLINICS FOR WOMEN. Public Health Centre, Grange Road. Wednesday 4.30 p.m.-6.30 p.m. 98, Rotherhithe New Road. Monday 4.30 p.m.-6.30 p.m. CHILDREN'S CLINIC. Public Health Centre, Grange Road. Wednesday 2.0 p.m.-4.30 p.m. POST-INFECTIOUS DISEASE CLINIC. Public Health Centre, Grange Road. Wednesday 2.0 p.m.-4.30 p.m RHEUMATISM CLINIC. Public Health Centre, Grange Road. Tuesday 2.0 p.m.-4.30 p.m. Evening Clinic once a month. PUERPERAL FEVER—CONSULTANTS. Mr. A. J. McNair, F.R.C.S., 9 Devonshire Place, W.1. (Telephone: Welbeck 6241.) Mr. G. F. Gibberd, F.R.C.S., 14 St. Thomas's Street, S.E.1. (Telephone: Hop 1010); and 20 Harley Street, W.1. (Telephone: Langham 4032.) Applications for the services of a Consultant should be made to the Medical Officer of Health. OBSTETRIC CONSULTANTS. Mr. A. J. McNair, F.R.C.S., and Mr. G.F. Gibberd, F.R.C.S., as above. Applications for the services of a Consultant should be made to the Medical Officer of Health. DAY NURSERIES. Newcomen Day Nursery, 66-67 Snowsfields. Monday to Friday (inclusive), 7.0 a.m.-7.0 p.m. Saturday, 7.0 a.m.-1.0 p.m. "Alice Barlow" Social Welfare Centre, 14 Fulford Street. Monday to Friday (inclusive), 7.30 a.m.-6.30 p.m. Saturday, 7.30 a.m.-12.30 p.m. FAIRBY GRANGE CONVALESCENT HOME, Hartley, near Longfield, Kent. For mothers and children under 5 only. Application Forms and full pilars can be obtained a, any of the Maternity and Child Welfare Centres. DENTAL TREATMENT CENTRES. Public Health Centre, Grange Road. Monday to Friday (inclusive), 10.0 a.m.-7.30 p.m. 98 Rotherhithe New Road. Monday, Thursday and Friday, 10.0 a.m.-5.0 p.m. Tuesday 2.0p.m-7.30p.m. Wednesday, 10a.m.-7.30p.m. From 5.0 p.m. to 7.30 p.m. the Centres are open 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 and Thursday 9.30 a.m.-8.0 p.m. Tuesday and Wednesday 930 a.m.-5.30 p.m. Friday 9.30 a.m.-1.0 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 10.0 a.m. 98 Rotherhithe New Road. Friday at 11.0 a.m. DIPHTHERIA "CONTACTS" CLINIC, Municipal Offices, Spa Road. Monday and Thursday at 9.30 a.m. For school-children only. DIPHTHERIA "CARRIER" CLINIC, Guy's Hospital. Wednesday at 2.30 p.m. For school-children only by appointment. L.C.C. SCHOOL TREATMENT CENTRES. Bermondsey School Treatment Centre, Bermondsey Settlement, Farncombe Street. Minor Ailments Monday to Friday (inclusive), 10.30 a.m.- 1.0 p.m. and 3.0 p.m.-6.0 p.m. Saturday, 9.30 a.m.-12 noon. Dental Monday to Friday (inclusive), 9.0 a.m.- 4.30 p.m. (Monday afternoons and alternate Thursday afternoons excepted.) Ear, Nose and Throat Alternate Wednesdays, 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, 9.30a.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 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, Church Street, Greenwich, S.E.10