C.I AC 4366 BET 36 the Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1931 BY VYNNE BORLAND, M.B.. Gh-B., B.Sc.. D.P.H. Medical Officer of Health and Administrative Tuberculosis and Maternity and Child Welfare Officer for the Metropolitan Borough of Bethnal Green. LONDON: Printed by Freame, Manning & Co., Ltd., 12a. Lee High Road, Lewisham, S.E.13. THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1931 BY VYNNE BORLAND, m.b.. Ch b., B.Sc.. d.p.h. Medical Officer of Health and Administrative Tuberculosis and Maternity and Child Welfare Officer for the Metropolitan Borough of Bethnal Green. LONDON: Printed by Freame, Manning & Co., Ltd., 12a, Lee High Road, Lewisham, S.E.13. Metropolitan Borough of Bethnal Green PUBLIC HEALTH COMMITTEE, 1931-32 as on 31st December, 1931. Meetings held at the Town Hall at 6 p.m. on the first Wednesday. *Councillor C. Bennett, Chairman. *Councillor Rev. R. C. Jones, B.A., Vice-Chairman. *Councillor Miss L. D. Benoly, *Councillor Mrs.K.E.Rawles, J.P. M.B.E. „ W. C. Chandler, * „ Rev. Preb. J.P. S. L. Sarel, M.A. * ,, H. T. Clark. * ,, A. J. Sharman. „ L. Haltrecht. „ A. G. Thoms. „ E. T. Malindine. (One vacancy). *Member of Public Health Sub-Committee. Ex-Officio Members of the Public Health Committee: (The Mayor and Chairmen of other Standing Committees of the Council.) His Worship the Mayor (Councillor T. Brooks, J.P.). Committee: Chairman: Baths Councillor G. Bayley, J.P. Electricity „ L. Haltrecht. Finance „ J. R. Davy. Law and General Purposes „ M. R. Seymour, A.C.A. Libraries „ Rev. Preb. S. L. Sarel, M.A. Housing ,, Mrs. K. E. Rawles, M.B.E. Staff „ R. E. Pearson, J.P., L.C.C. Street Trading Alderman G. Edmonds, J.P. Valuation Councillor J. Harris. Works and Stores Alderman W. Rawles, J.P. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. Council Representatives on Joint (Tuberculosis) Dispensary Committee : Councillors C. Bennett, Rev. R. C.Jones and Rev. S. L. Sarel. STAFF OF THE PUBLIC HEALTH DEPARTMENT, as on 31st December, 1931. Vynne Borland, M.B., Ch.B., B.Sc., D.P.H., Medical Officer of Health. Maternity and Child Welfare: Miss Kathleen M. Horton, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer. †‡Miss G. I. Le Geyt, Superintendent Health Visitor. †‡Miss E. M. Patrick, Assistant Supt. Health Visitor. †Mrs. F. M. Barden. †Miss V. D. Cornish. *†‡Miss D. L. Fraquet. †‡Miss C. E. Love. Health †‡Miss A. A. Page. Visitors. †‡Miss M. Playle. †Mrs. A. W. Rosling. †‡Miss L. F. Wright. †‡Miss E. E. Taylor, Borough Midwife r Miss L. F. Gavin, Ph.C., Clerk Dispenser. †Certificated Nurse. ‡Certified Midwife. d Health Visitors' Diploma. Maternity & Child Welfare Centre: 1 Storekeeper, 1 Attendant, 1 Caretaker, 2 Cleaners (part-time). General Administration: *J. Henry Lloyd, f.s.s., Chief Clerk. F. G. Thomas. *R. W. Slyfield. L. A. Taylor. S. P. Hansen. Clerks. *F. C. Sharpe. G. S. Freeman. 1 J. E. Pestell. ) J. P. Mackenzie, Junior Clerk. R. F. Marshall, Temporary Clerk. Tuberculosis: †‡Miss E. S. Crisp. Tuberculosis †‡dMrs. J. Callow. Health Visitors. r Since retired from service. Employees: 2 Messengers, 1 Mortuary Keeper. Sanitary Inspection: *§Evan Richards Chief Sanitary Inspector. *§A. S. Henley 1 Food *J. O. G. Weeks j Inspectors. *W. Billings, Housing Inspector. *E. J. Jenkins, Workshops Inspector. *r F. T. Bare. *G. I. Brighting. *§G. E. Gould. Dstrict *$W. H. Heron. Sanitary *J. H. Hewitt. Inspectors. *§S. R. B. Slater. *Certificated Sanitary Inspector. §Certified Meat, etc. Inspector. Disinfection : 1 Leading Disinfector, 3 Disinfectors. Combined Drainage: 1 Drain-layer, 3 Labourers. Personal Cleansing Station: 1 Woman Attendant (part-time). 5 Unestablished Part Time Officers. Maternity and Child Welfare Centres. Medical Officers. Miss H. M. M. Mackay, M.D., B.S., M.R.C.S., M.R.C.P. Miss D. I. Mart, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Mrs. D. E. Mason, M.R.C.S., L.R.C.P. Miss R. C. Townshend, M.R.C.S., L.R.C.P., M.B., B.S., D.P.H. Irthofcpdic Surgeon-. H. J. Seddon, F.R.C.S., L.R.C.P., M.B., B.S. Cental Surgeons: Miss J. H. M. Sutherland, L.D.S. (R.C.S.). F. R. Bate, L.D.S. (R.C.S.). Masseuse : Miss Y. Lawson, C.S.M.M.G. Clinical Tuberculosis Officers: (appointed by the Governors of the City of London Hospital for Diseases of the Heart and Lungs): Senior, H. Tylford Howell, M.R.C.S., L.R.C.P., London. Junior, W. J. Dowling, B.A., M.D. A. E. Parkes, F.I.C., F.C.S., Public Analyst. P. Ivess, Vaccination Officer. Staff changes during 1931. Dr. Kathleen M. Horton, was appointed to the new full time post of Assistant Medical Officer for Maternity and Child Welfare and took up her duties on the 23rd November, 1931. Mr. R. G. Parker, resigned his appointment as Junior Clerk and left on the 7th November. His successor, Mr. J. P. Mackenzie, took up his appointment on 28th December, 1931. Mr. F. T. Bare, Sanitary Inspector, retired on superannuation at the end of the year, after 30 years service. Mr. F. C. Sharpe, a member of the clerical staff who has recently acted as temporary Sanitary Inspector, has been appointed to the vacancy on probation for 6 months. Mr. J. Ward, retired from the position of Leading Disinfector during the year after having been 37 years in the Council's service. 6 Public Health Department, Town Hall, Bethnal Green, E.2. 11th April, 1932. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, I have the honour to submit herewith my third Annual Report relative to the health of the Metropolitan Borough of Bethnal Green. The general death rate at all ages from all causes was 12.5, which shews a slight increase over the average for the previous four or five years. The Infant Mortality Rate for the year was 88 per 1,000 births, to approximate which we have to refer back to 1922, when it was 90.2. Unemployment, straightened economic circumstances with correspondingly lessened provision of the necessities of life, overcrowding, and attempts to procure abortion are interlinked factors which must indubitably have had an adverse contributory influence on the successful rearing of children. The reflex is seen in 47 deaths from diarrhoea and 55 from congenital debility and premature birth, which amount to almost 70% of the total of 161. The Maternity and Child Welfare Centre at Thornton Hall was discontinued in September, and simultaneously an improved centre was opened at St. Matthew's Hall, Hereford Street. Two additional sessions are held, one for infant consultations and the other for expectant and nursing mothers. Correlated with this, in November, the Council appointed a full-time Assistant Medical Officer, Dr. K. M. Horton, to undertake the extra sessions and to replace certain part-time medical officers holding consultations at the Cornwall Road Centre. There was a general decline in notifiable diseases except in the case of Pneumonia, which contributed materially to the Death Rate with 159 deaths out of a total of 1,368. The number of cases of Small-pox was considerably less, there being 146 cases against 948 in 1930. The Public Analyst's report shews a slight percentage increase in the total number of adulterations found, but the adulteration of milk reached the low figure of 3%, which is the lowest figure recorded during the past seven years, 7 I am pleased to have this opportunity to again place on record my thanks to the members of the Council and in particular the Chairman. and members of the Public Health Committee for their courtesy and support throughout the year. I have also to tender my thanks to Mr. Richards, Mr. Lloyd and the staff of the Public Health Department for their valuable support during the year. My thanks and appreciation are also extended to my colleagues in other departments for their many courtesies and co-operation. I am, Ladies and Gentlemen, Your obedient servant, Vynne Borland. 8 GENERAL DESCRIPTION. Bethnal Green is a roughly rectangular shaped district in East London, about 1¾ miles from west to east and about one mile from north to south, and 760 acres in area. It is bounded by Shoreditch and Hackney on the north, Stepney on the south and Poplar on the east. Where the original soil exists it is of gravel and sand formation. The surface is generally flat, varying from 36 to 54 feet above sea level. The principal industries carried on in the district are the making of boots, shoes and clothing, cabinet making and other branches of the furnishing trade. The main lines of the Great Eastern section of the; L.N.E.R. pass through the Borough. There are also three railway stations in the borough, and several others in close proximity, while various tram and motor bus routes traverse the main roads in the Borough. There is a considerable daily inflow and outflow of workers, with the larger stream outward to workplaces in other parts of London. The tendency is for the borough to be increasingly used for industrial and commercial purposes and the resident population is very congested. At the 1931 census there were 18,156 structurally separate dwellings in the borough, and 27,978 families or separate occupiers lived therein. There is an excellent open space to the east of the borough in the shape of Victoria Park, and there are a few small open spaces elsewhere in the borough. The rateable value of the borough on the 31st December, 1931, was £522,483, and the product of a Id. rate is estimated at £2,040. SOCIAL WELFARE. Public Health and Social Welfare are closely bound up together. Some information has therefore been sought by which to measure the social changes 9 which have taken place in the borough during the past year. The outstanding fact is widespread unemployment, which, while fluctuating slightly during the year again stood on the 16th November, 1931, at the similarly high level of the previous year (14.7 per cent among the total insured population and 22.4 per cent among the men.) An unknown but substantial further percentage of the workers in the Borough are on short time. The reduced earnings in these latter families taken together with the fact-that one - fifth of the natural breadwinners are out of work and their dependents living on the meagre allowances provided by unemployment insurance or public assistance, make it not prising that the health records for the year should show a serious deterioration. The administration of public assistance is now in the hands of the London County Council. I have been furnished, by the courtesy of the local Public Assistance Officer, with the following figures concerning public assistance granted during the year. It is gratifying to note that there are now few children in Bethnal Green Hospital and Waterloo House, those needing the care of the L.C.C. being transferred to the Leytonstone Children's Home. It will be noted that at the end of the year the number of persons receiving public assistance (apart from those obtaining medical relief only) had increased from 4,016 to 4,764, and the number of persons receiving medical relief only from 64 to 165. LONDON COUNTY COUNCIL. PUBLIC ASSISTANCE DEPARTMENT— AREA II. Persons Afforded Institutional Relief (in Bethnal Green Institutions) other than Casuals. SICK CASES. OTHER CASES TOTAL Men Women Children 3-16 Children under 3 Men Women Children 3-16 Children under 3 Week ended 27th June, 1931. Bethnal Green Hospital 69 38 6 6 ... ... ... ... 119 Waterloo House 128 150 ... .... 196 72 1 3 550 Leytonstone Children's Homes ... ... 10 ... ... ... 173 20 203 197 188 16 6 196 72 174 23 872 Week ended 26th December, 1931. Bethnal Green Hospital 11 12 1 ... ... ... ... ... 24 Waterloo House 149 176 ... ... 199 61 1 9 595 Leytonstone Children's Homes ... ... 17 ... ... ... 172 10 199 160 188 18 ... 199 61 173 19 818 Number of Persons Afforded Relief other than Institutional Relief. Numbers excluding Casuals and persons in receipt of Medical Relief only. Persons in receipt of Medical Relief only Men Women Children under 16 Total Persons Total Cases Ablebodied men Men set to work or training included in Column Week ending 27th June, 1931 1118 1534 1698 4350 1891 313 172 126 Week ending 26th December, 1931 1232 1623 1909 4764 2010 421 202 165 10 11 I am informed by the Education Officer that the average number of necessitous school children provided with meals (i.e., dinners, milk and cod liver oil) during the year was 675. Of this number 537 consisted of milk, 110 of cod liver oil and 44 of dinners. This assistance is only granted while the schools are open. In the Annual Report for 1928 it was stated that Welfare Centre inquiries tended to show that the majority of families were below the "living wage" level of £4 per week for a family of 5. I am afraid that the general level of wages is much lower now than it was then. PUBLIC HEALTH EXPENDITURE. The economy of the expenditure on the public health services will be seen from a comparison of its relatively small cost with the striking results in healthier and longer lives which are recorded elsewhere in this and previous reports. During the financial year 1930- 31,. the cost of these services was £25,824, or 4s. 8½,d. per head of the population, equivalent to a rate of 1/0½ in the £. These figures differ from those in previous years owing to the fact that there is now no specific Government Grant for Public Health work, which in 1929-30 amounted to £6,262. The present block grant is not earmarked to any particular service. THE HEALTH SERVICES IN THE BOROUGH. The Borough Council is recognised by statute as the local health authority, but many important health services are still outside its jurisdiction and indeed health functions are exercised by an extraordinary diversity of agencies. The number of these agencies has been somewhat reduced by recent legislation, but there seems much need for further simplification. Apart from the London County Council and the Borough Council, whose functions overlap at some points, health functions are also exercised by the London Insurance 12 Committee and by general medical practitioners, midwives, nurses, voluntary hospitals and a host of charitable societies. The Medical Officer of Health is dependent upon the courtesy of these agencies for any information as to their activities. A brief list of them is appended: — GENERAL MEDICAL PRACTITIONERS. There are 35 general medical practitioners with consulting rooms in the Borough. The friendly relations with local practitioners reported in previous years continues. NURSES. The Shoreditch and Bethnal Green District Nursing Association has its headquarters just outside the Borough, but undertakes a great deal of nursing in the Borough, which occupies the services of approximately 4 full-time nurses. Address: 80, Nichols Square, E.2. Telephone: Bish. 5287. An account of the Council's arrangements with the Association for nursing services will be found in the Maternity and Child Welfare Section of this report. HOSPITALS. Public. London County Council: Bethnal Green Hospital, Cambridge Road. The County Medical Officer has kindly permitted Dr. W. P. Greenwood, the Medical Superintendent, to furnish me with the following statistics concerning the work of the Bethnal Green Hospital for the year. Information as to the Midwifery work of the hospital is given in a later paragraph in this report. No. of Admissions 6,607 Operations performed under general anaesthetic 1,786 Out-patients' (1,598) Attendances 11,835 13 Other. The Officers of the hospitals have furnished me with the following statistics concerning their work last year— Beds No. of new Outpatients Outpatients Attendances No. of Inpatients Average duration Inpatient treatment (days) Queen's Hospital for Children, Hackney Road 160 29,525 142,002 1,955 23 Mildmay Mission Hospital, Austin Street 56 15,386 49,930 982 17 City of London Hospital for Diseases of the Heart and Lungs, Victoria Park 186 10,326 42,907 1,048 52 The Queen's Hospital also has 44 beds at a country branch, the Little Folks' Home, Bexhill. In addition to its importance as a consultative centre, both in respect of Tuberculosis and Heart conditions, the City of London Hospital carries on a great deal of research work. The London Hospital, Whitechapel Road, although situated outside the Borough, is also largely used by residents. DISPENSARIES, &c. The following Dispensaries exist in the Borough, and I have been furnished with the following statistics concerning last year's work. No. of Out-Patients. Out-Patients' Attendances. Visits to Patients' Homes *Queen Adelaide's Dispensary, Pollard Row 2,201 5,823 541 Medical Mission, St. James-the-Less, St. James' Road 1,461 6,102 160 Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 2,793 17,162 3,016 *There were also 644 patients who attended the Dental Department of this Dispensary. 14 CLINICS. For Children Under Five. The Council has a Welfare Centre in Cornwall Road (also a Branch Centre at St. Matthew's Institute, Hereford Street) at which a variety of work, including Infant Consultations, Orthopaedic Clinic, Dental Clinic, Light Clinic, etc., is carried on. This work is commented on in the Maternity and Child Welfare Section of this Report. For School Children. These are conducted by the London County Council. By the courtesy of Sir. F.N. Kay Menzies, School Medical Officer, L.C.C., I have been furnished with the following information concerning local arrangements for the medical treatment of school children. The only school treatment centre in Bethnal Green is situated at the St. James-the-Less Dispensary, St. James's Road, Bethnal Green. At this centre special departments are arranged for the treatment of eye (refraction) cases, dental cases and for children suffering from minor ailments. " The ophthalmic surgeon attends the centre one session a week and during the year 1931 418 children were treated. Spectacles were prescribed in 280 cases and in 238 cases spectacles were obtained. The dentist visits the centre on eleven sessions a fortnight, and the schools on one session a fortnight for inspection. During the year 2,090 children were inspected in the schools and 1,502 or 71.9 per cent, were found to require treatment. The percentage for the preceding year was 60.3. 1,473 children were treated at the Centre and 2,859 attendances were made. In the minor ailments department the doctor attends on five sessions a fortnight, and a nurse is daily in attendance. During 1931, the number of children treated was 1,785, and 26,549 attendances were made. DAY NURSERIES. There are two Day Nurseries in the Borough, both belonging to voluntary committees :— (i) Bethnal Green Day Nursery, Somerford Street. (ii) Pro Patria Day Nursery, Bishops Road. 15 I have been furnished with the following information concerning the work of the day nurseries:— Somerford Street. Bishops Road. Accommodation 28 50 Average number of children attending 27 43 Total Attendances 5,846 10,968 Certain of the children attending the Somerford Street Day Nursery also attend the Council's Welfare Centre every week for light treatment and some are sent away to country homes during the summer. ORPHANS. There is a branch of the National Children's Home and Orphanage situated in Bonner Road. MATERNITY. Public. The Borough Council has two Maternity Clinics, one at Cornwall Road, and one at St. Matthew's Institute, Hereford Street, at which a variety of work for maternal welfare is carried on. The Council also employs a midwife, who resides in the borough. (For further particulars see the section of this report dealing with Maternity and Child Welfare). London County Council: There are 18 beds in the Maternity ward in Bethnal Green Hospital. Dr. W. P. Greenwood informs me that 247 maternity cases were dealt with in the year. An ante-natal clinic is held weekly for women intending to enter the hospital for confinement and 226 women made 542 attendances at the Clinic. Other. There are 2 private midwives living and practising in the borough while about 6 others who reside outside also frequently practice in the borough. 16 The maternity services connected with the London Hospital, City of London Maternity Hospital, Salvation Army Midwives, Maternity Home, 24, Underwood Street, E.1, Maternity Hospital, 384-396, Commercial Road, E.1, and Royal London Maternity Charity, although these Institutions are situated or directed from outside the Borough, are also largely used by residents of the Borough. Through the courtesy of the respective Secretaries, I have been informed that Bethnal Green mothers were confined as follows:— In At Ante-Natal Hospital Home Attend'nces City of London Maternity Hospital, City Road 53 3 224 Mothers Hospital, Clapton 25 143 155 Jewish Maternity Hospital, Stepney 54 11 * London Hospital, Whitechapel 274 366 * *figures not available. MEDICAL TREATMENT OF PERSONS INSURED UNDER THE NATIONAL (HEALTH) INSURANCE ACTS. Arrangements are made by the London Insurance Committee. I understand that 91 medical practitioners are on the medical panel for the Borough, 34 of whom have consulting rooms in the Borough. AMBULANCES. As a full account of the L.C.C. ambulance arrangements was given in last year's Annual Report I do not deem it necessary to repeat the information. How to Obtain an Ambulance or Ambulance Omnibus. The vehicles are available at any hour of the day or night including Sundays and public holidays. To call an ambulance by telephone, in cases of accident or sudden illness in the street, place the telephone receiver to the ear (and dial "O" if 17 connected to an automatic exchange). When the operator answers, ask for "ambulance" and wait for the reply "ambulance"; then give particulars. In cases other than accident, etc., the following telephone number should be used:—city 7200. This number is connected to the central call office for ambulances which is open continuously and is located at the London County Council, Victoria Embankment Offices, E.C.4. Applications for vehicles may also be made by letter, telegraph, or personal call at the central call office or any of the ambulance stations. Letters should be addressed to the Medical Officer of Health, London Ambulance Service, Victoria Embankment, E.C.4. Except in the case of ambulances called for accidents, the following particulars are generally required in connection with applications for vehicles— (a) Name, sex and age of patient and the address from which to be removed. (b) Certified disease. (c) Full address of the destination when it is other than one of the Council's hospitals or institutions. (d) Date and time of removal. (e) In appropriate cases the name and address of the person who accepts responsibility for payment of the charges. General Notes. Ambulances are equipped with stretcher, carryingchair, blankets and pillow. A male attendant accompanies the driver, if required to assist with stretcher or chair. 18 Ambulance omnibuses are equipped for recumbent or sitting cases as required. In cases of private hire the amounts fixed in advance must be paid to the driver before the patient enters the ambulance. The driver will give an official receipt for all sums received. Only light hand luggage can be carried in the vehicles. Infants in arms are not considered as additional passengers. Associations, authorities and others requiring repeated services may enter into special arrangements with the Council as regards payment. Ambulance Stations. The following are the nearest stations which are open always:— Name of Station. Address. Bloomsbury 15, Herbrand Street, Tavistock Square, W.C.1. Eastern Brooksby Walk, E.9. Hackney Paragon Road, Mare Street, City 7200. Hackney, E.9. Highbury Calabria Road, Highbury, N.5. Poplar 7, Woolmore Street, E.14. Shoreditch 5, Montclare Street, E.1. , TUBERCULOSIS DISPENSARY. This is situated at the City of London Hospital for Diseases of the Heart and Lungs, Victoria Park, and its work is fully discussed in the Tuberculosis Section of this report. VENEREAL DISEASE. This is dealt with by the L.C.C. The nearest treatment centres are at the Whitechapel Clinic, Turner Street, adjoining the London Hospital, Whitechapel Road, and the Metropolitan Hospital, Kingsland Road. 19 PERSONAL CLEANSING STATIONS. For Adults. The Council has established a Personal Cleansing Station at the Depot, Dig by Street. For School Children. Sir F. N. Kay Menzies, School Medical Officer, L.C.C., has kindly furnished me with the following figures concerning the work carried out at the Bathing Centre, 5a, Russia Lane: — Verminous conditions. Scabies. Impetigo. No. of children. 5,026 72 81 No. of baths 5,991 91 484 REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. The Town Clerk is the Superintendent Registrar for the Borough. The District Registrars of Births and Deaths are:— For N.E. Bethnal Green:— For S.W. Bethnal Green: — H. J. Hardwick, Miss M. Peters, 106, Bishops Road. 347, Bethnal Green Road. Office hours:— Office hours :— Mon.-Fri. 10 a.m.-l p.m. 10.30 a.m.-1 p.m. daily. Sat. 10 a.m.-12 noon. Mon.-Fri. 3-5 p.m. VACCINATION. The Public Vaccinators are : — For N.E. Bethnal Green:— For S.W. Bethnal Green:— Dr. G. Murray Heiron. Dr. J. G. L'Etang, 130, Roman Road. 386, Bethnal Green Road. The Vaccination Officer is Mr. P. Ivess, who is now on the staff of the Public Health Department, Town Hall. 20 CERTIFYING SURGEON: FACTORIES AND WORKSHOPS. The local Certifying Surgeon under the Factory and Workshops Act is:— Dr. J. Bate, 1, Old Ford Road. 21 VITAL STATISTICS. The Vital Statistics for the Borough for 1931 are unsatisfactory. The Death Kate is higher than the average for recent years. Deaths among infants were at the high rate of 88 per 1,000 births, to approximate which we have to go back to 1922. Such an unhappy retrogression must compel us to give serious consideration to the possible causes and provides a necessary reminder that the price of Health like that of Liberty, is eternal vigilance. There can be no doubt that an important factor in this increased mortality is the lowered standard of living which has inevitably followed the prolonged unemployment and reduced income of the residents in the Borough. Study of Tuberculosis and of general mortality rates has revealed the correlation which exists between a rising standard of living and a falling death rate and it is only reasonable to assume that the converse also holds good. The only relatively satisfactory figure is that of the Birth Rate which has fallen to 16·8. Having regard to the economic situation and the overcrowding which exists in the Borough, there is still great need for birth control, if the children born are to receive anything like a fair chance in life. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. BIRTHS. Males Females TOTAL Birth Rate Legitimate 933 849 1,836 16·8 Illegitimate 26 28 DEATHS. Males Females TOTAL Death Rate 734 634 1,368 12·5 22 MATERNAL MORTALITY. Number of Women dying in, or in consequence of, childbirth:— From Sepsis 4 From other causes 6 INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births :— Legitimate 85.8 Illegitimate 148.1 Deaths from Measles (all ages) 5 „ „ Whooping Cough (all ages) 10 „ ,, Diarrhoea (under two years of age) 50 POPULATION. The Vital Statistics in this report have been calculated on the estimated resident population of the Borough at the middle of the year 1931 of 109,200. CENSUS, 1931. The full results of the Census taken in 1931, are not yet published at the time of preparing this report, but I have obtained from the Registrar General in advance of publication such figures as are available. The following table gives the figures for the four wards of the Borough:— Males Females Total persons Structurally separate dwellings Total families (separate occupiers) North 8,871 9,271 18,142 3,054 4,849 East 18,716 20,010 38,726 5,855 10,002 South 13,762 14,714 28,476 5,106 7,263 West 10,929 11,921 22,850 4,141 5,864 52,278 55,916 108,194 18,156 27,978 23 Since the Census of 1921, the population has fallen by 7-7 per cent, the reductions in the wards being:, North 8.4 per cent, East 4.9 per cent, South 9 per cent, West 10 per cent. The reduction of the population has of course slightly reduced the density per acre, although this still remains very high:— Persons per acre North 158 East 109* South 180 West 174 Borough 142 *If the park land be deducted, the density in the East Ward is 151 per acre. MARRIAGES. The number of marriages registered in Bethnal Green during 1931 was 599. This is equal to a rate of 11 persons marrying per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1931 was 1,289, and in addition 547 occurred outside the Borough to Bethnal Green residents in excess of those occurring in Bethnal Green to residents of other localities, making a total of 1,836 births (959 males, 877 females). The birth-rate for 1931 was, therefore, 16.8 births per 1,000 population, the lowest ever recorded in t'he Borough. The provisional birth-rate for London is given as 15.0, and for England and Wales as 15.8. ILLEGITIMACY. Of the 1,836 births credited to this Borough, 40 were illegitimate, being 21 males and 19 females, and being 2 2 per cent, of the total number of births. 24 CAUSES OF DEATH at different periods of life in the Metropolitan Borough of Bethnal Green, 1931, Cause of Death. All Ages Number of Deaths of residents at various ages, whether occurring within or without the Borough Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 1 years 35 and under 45 years 45 and under 55 years 55 and under 6.'. years 65 and under 75 years 75 and upwards All causes M 734 97 13 13 20 1 36 35 44 83 130 144 119 F 634 64 15 13 27 1 30 35 37 68 64 132 149 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 2. Measles M 4 3 ... 1 ... ... ... ... ... ... ... ... F 1 ... 1 ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... ... ... 4. Whooping Cough M 6 3 3 ... ... ... ... ... ... ... ... ... F 4 2 ... 2 ... ... ... ... ... ... ... ... 5. Diphtheria M 3 ... ... 3 ... ... ... ... ... ... ... ... F 4 ... 3 1 ... ... ... ... ... ... ... ... 6. Influenza M 8 ... ... ... ... ... 1 ... 3 1 2 1 F 10 1 ... ... ... ... 1 ... 2 1 ... 5 7. Encephalitis Lethargica M 1 ... ... ... ... 1 ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-Spinal Fever M 4 1 1 ... 1 1 ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system M 72 ... ... 1 ... 8 16 20 18 7 2 ... F 47 ... ... 2 2 16 11 7 9 ... ... ... 10. Other Tuberculous Diseases M 4 ... ... 2 2 ... ... ... ... ... ... ... F 9 ... ... 2 2 1 1 l 2 ... ... ... 11. Syphilis M 2 ... ... ... ... ... ... ... 1 1 ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 12. General Paralysis of the Insane, tabes dorsalis M 3 ... ... ... ... ... ... ... 2 ... 1 ... F 1 ... ... ... ... ... ... l ... ... ... ... 13. Cancer, malignant disease M 64 ... ... ... ... 1 1 l 10 22 18 11 F 65 ... ... ... ... ... 1 3 8 14 25 14 14. Diabetes M 6 ... ... ... ... ... ... ... ... 1 4 1 F 11 ... ... ... ... ... 2 ... 1 4 2 2 15. Cerebral Haemorrhage, etc. M 27 ... ... ... ... ... ... ... 3 7 12 5 F 20 ... ... ... ... ... ... 2 3 4 5 6 16. Heart Disease M 188 ... ... ... 2 2 1 5 21 38 48 71 F 160 ... ... ... 2 3 4 6 15 15 52 63 17. Aneurysm M 5 ... ... ... ... ... ... ... 1 1 3 ... F 1 ... ... ... ... ... ... ... ... ... ... 1 18. Other Circulatory Diseases M 11 ... ... ... ... ... ... ... ... 1 8 2 p 12 ... ... ... ... ... ... 1 1 1 6 3 19. Bronchitis M 28 3 ... ... ... 1 1 1 4 8 3 7 T7 35 4 ... ... ... ... ... 1 3 ... 12 15 20. Pneumonia (all forms) r M 84 19 7 ... 5 3 4 8 11 10 10 7 p 75 10 7 4 2 3 1 2 6 8 15 17 21. Other respiratory diseases M 7 ... ... ... ... 1 ... 1 1 1 3 ... F 8 ... ... 1 ... ... ... 1 2 2 1 1 22. Peptic Ulcer M 10 ... ... ... ... ... 1 1 3 3 2 ... F 1 ... ... ... ... ... ... ... ... 1 ... ... 23. Diarrhoea, etc. M 30 29 1 ... ... ... ... ... ... ... ... ... F 20 18 2 ... ... ... ... ... ... ... ... ... 24. Appendicitis M 4 ... ... ... ... ... 1 1 ... 1 1 ... F ... ... ... ... ... ... ... ... ... ... ... ...... 25. Cirrhosis of Liver M 2 ... ... ... ... ... ... ... ... 1 1 ... F 1 ... ... ... ... ... ... ... ... ... ... 1 26. Other Diseases of Liver, etc. M 2 ... ... ... ... ... ... ... 1 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 27. Other Digestive Diseases M ... 2 1 2 ... 1 ... ... ... 2 ... ... F 8 1 ... ... 2 ... ... 1 1 ... 1 2 28. Acute and Chronic Nephritis M 10 ... ... ... ... 1 ... 1 1 4 1 2 F 21 ... ... ... ... 1 2 3 3 4 4 4 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... ... 3 1 ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... ... ... F 6 ... ... ... ... 2 3 ... 1 ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. M 30 ... 29 ... ... ... 1 ... ... ... ... ... ... F 28 26 ... 1 1 ... ... ... ... ... ... ... 32. Senility M 3 ... ... ... ... ... ... ... ... ... 1 2 F 8 ... ... ... ... ... ... ... ... ... 1 7 33. Suicide M 12 ... ... ... ... 1 1 1 ... 6 1 2 F 7 ... ... ... ... 1 1 ... 2 3 ... ... 34. Other Violence M 38 ... ... 3 8 7 5 1 1 2 7 4 F 11 ... 1 ... 3 ... ... ... ... ... 4 3 35. Other Defined Diseases M 58 8 ... 1 2 7 3 3 2 12 16 4 F 52 2 1 ... 11 3 5 6 8 7 4 5 36. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Totals ... 1368 161 28 26 47 66 70 81 151 194 276 268 25 26 STILLBIRTHS. Fifty-six stillbirths were registered as belonging to the Borough, being a proportion of 3 per cent. of all births, alive or dead. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 1,423. Of these, 331 were of persons whose residence was not in Bethnal Green, dying in Bethnal Green Institutions or other places in the Borough. There were also reported to me 275 deaths of Bethnal Green persons who died in institutions in other parts of London or in other parts of England and Wales. The foregoing figures give the net number of deaths for Bethnal Green as 1,367, which is slightly discrepant from the figure of 1,368 given by the RegistrarGeneral, but does not affect the annual death-rate of 12.5 per 1,000 of population. This death-rate compares with 12.4 for the County of London and 12.3 for England and Wales as a whole. Tuberculosis, Heart disease, Pneumonia, Diarrhoea, Premature Birth and Suicide all show increases. Measles was the only disease with a marked decrease and this is explainable by the biennial incidence of the disease. Infantile mortality and the mortality from cancer, street accidents and from tuberculosis and other infectious diseases are subjects of comment in other parts of this report. 27 The causes of death among the population of Bethnal Green as classified by the Registrar-General, are given in the accompanying table. MATERNAL MORTALITY. During the year systematic inquiry has been made into every maternal death belonging to the Borough. The cases investigated fall into the following groups: — (a) Septicaemia following abortion 2 (b) Other cases of Septicæmia 2 (c) Other causes of death directly connected with childbirth 6 There were also two other cases in which childbirth was complicated by other conditions (Pneumonia, Endorcarditis) but these are not counted as cases of maternal mortality. The foregoing figures represent a relapse in the Borough's record with regard to maternal mortality which, on the whole, has compared favourably with that of other districts in recent years. Abortion again appears as a cause, and it is no doubt more prevalent than these figures would suggest. None of the mothers concerned attended the Council's Maternity Clinic, and only 5 of them are known to have received any ante-natal care. One of the medical reports contains the significant comment: " I think that skilled ante-natal supervision at a Clinic would have disclosed the disproportion and it could then have been dealt with at election." Another says: "If the patient had had ante-natal treatment case could have been dealt with by Cæsarean section." It is not only necessary, however, to obtain advice but also to act on it. A doctor reports: "I advised induction: this 28 was refused, and I advised it again and it was again refused." This woman lost her life. INFANTILE MORTALITY. One hundred and sixty - one deaths of Bethnal Green infants under one year of age are reported by the Registrar-General as having taken place during the year. This is equal to a rate of infantile mortality of 87.7 per 1,000 births. The infant death rate for London was 65 and for England and Wales as a whole 66. Comparison with previous years is as follows: — 1916 106.0 1917 112.0 1918 129.0 1919 85.0 1920 95.0 1921 98.2 1922 90.2 1923 68.7 1924 78.0 1925 80.6 1926 71.1 1927 57.7 1928 73.9 1929 64.4 1930 60.3 The causes of death among infants are shown in the following table. The increased mortality was chiefly due to Diarrhoea and Premature Birth. 29 Infantile Mortality in Bethnal Green in 1931* Causes of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 3 months & under 6 months 6 months & under 9 Months 9 months & under 12 months Total Deaths under 1 year Rate per 1,000 Births Measles ... ... ... ... ... ... ... i 2 3 1.6 Whooping Cough ... ... ... ... ... ... 3 i 1 5 2.7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 2 1 ... 3 1.6 Tuberculosis ... ... ... ... ... ... ... ... ... ... ... Meningitis Meningococcal ... ... ... ... ... ... 1 ... ... 1 0.5 Meningitis (purulent) 1 ... ... ... ... ... 1 ... ... 2 1.1 Septicaemia ... ... ... 1 1 ... ... 1 ... 2 1.1 Bronchitis ... ... ... ... ... 1 5 ... ... 6 3.2 Pneumonia (all forms) 1 ... ... 2 3 4 10 3 5 25 13.6 Diarrhoea and Enteritis ... ... 1 ... l 12 18 13 7 51 27.8 Syphilis ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations i ... ... ... I 2 ... ... ... 3 1.6 Congenital Debility i ... 1 ... 2 3 1 1 ... 7 3.8 Premature Birth 32 1 ... ... 33 4 1 ... 1 39 21.2 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 0.5 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 2.2 Icterus Neonatorum ... ... ... ... ... 1 ... ... ... 1 0.5 Violence ... ... ... ... ... ... ... ... ... ... ... †Other Causes ... ... ... ... ... 3 1 3 1 8 4.4 Totals 41 1 2 3 47 32 41 24 17 161 87.7 Net Births in (legitimate 1782 Net Deaths in legitimate infants 153 the year (illegitimate 54 the year illegitimate infants 8 'These figures differ slightly from those of the Registrar-General probably due to altered classification arising from further information. †Appendicitis, Arthritis, Cellulitis, Influenza, Intussusception, Ketosis, Nephritis, Osteomyelitis (1 each). 30 CANCER. Cancer was responsible for 129 deaths or 9 per cent. of the total deaths in the Borough. The local distribution of the disease in these deaths was as follows:— M. F. Total. Buccal cavity, pharynx 6 1 7 Digestive organs and peritoneum 38 33 71 (Esophagus (9-1) Stomach (12-9) Intestines (8-11) Rectum (4-3) Others (5-9) Respiratory organs 12 2 14 Uterus — 4 4 Other female genital organs — 3 3 Breast — 12 12 Male genito - urinary organs 4 — 4 Skin 1 3 4 Other or unspecified organs 3 5 8 64 63 127* *Two other deaths were found by the Registrar-General, upon enquiry, to be due to cancer, but I am not acquainted with the localisation of the disease in these cases. The fact that Cancer causes nearly one-tenth of the mortality in the Borough (which is not dissimilar in this respect from the rest of the country) should compel greater attention to this terrible disease. DEATHS FROM MOTOR TRAFFIC. Last year I drew attention to the steadily increasing 31 mortality from motor traffic accidents in the streets. With a view to focussing some public attention on this subject I append brief particulars of the deaths in this category during 1931: — Pedestrians (17). Others (6). M 4 Knocked down by motor car. M 16 Fall from van. M 4 Knocked down by motor van. M 22 Run over by motor lorry while M 5 Knocked down by motor cycle. cycling. M 6 Run over by motor van. M 22 Thrown from motor cycle. F 7 Knocked down by motor lorry. M 24 Collision with steam waggon M 8 Run over by motor lorry. while motor cycling. F 8 Run over by motor lorry. M 34 Thrown from motor van in M 8 Run over by motor lorry. collision with motor coach. M 11 Knocked down by motor van. M 65 Fall from skidding 'bus. M 12 Knocked down by motor ambulance. M 20 Crushed between motor bus and tree. M 26 Knocked down and run over by motor lorry. M 56 Run over by motor lorry. M 73 Knocked down by motor coach. F 75 Knocked down by motor car. F 78 Knocked down by motor van. M 79 Knocked down by motor 'bus. 32 VITAL STATISTICS of Bethnax Green During 1931 and Previous 5 Years. Year Population Estimated to Middle of Each Year Births Total Deaths Registered in the Borough Transferable Deaths Net Deaths Resident in of Persons the Borough Uncorrected Number Net Of Nonresidents registered in the Borough Of Residents not registered in the Borough At all Ages Under 1 year of Age Number Birth Rate Number Death rate Number Rate per 1,000 births or infantile mortality 1926 119,600 1,993 2,501 20.9 1,363 271 301 1,393 11.6 178 71.1 1927 117,900 1,782 2,353 19.9 1,303 264 293 1,339 11.3 136 57.7 1928 112,200 1,570 2,137 19.0 1,323 268 262 1,317 11.7 158 73.9 1929 110,500 1,491 2,064 18.6 1,529 270 251 1,510 13.6 133 64.4 1930 Not available 1,371 1,955 17.7* 1,197 243 267 1,223 11.1* 118 60.3 1931 109,200 1,289 1,836 16.8 1,423 331 275 1,367 12.5 161 87 .7 * Calculated on estimated population in 1929. 33 PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 80 bodies were received at the Mortuary, i.e.: — On Coroner's order 64 From the Police 6 At the request of relatives 10 Exact particulars are only available as to the 8 bodies on which coroner's inquests were held. On 5 of these bodies post-mortem examinations were made. There were also 62 post-mortem examinations made in eases in which there was no inquest. The reduction in the number of bodies deposited at the mortuary is due to the altered practice of the Coroner who now conducts most of the inquests in Bethnal Green cases at Courts in adjoining boroughs and the bodies in such cases are of course deposited in the mortuaries attached to these Courts. Mortuary Statistics. Places from which bodies were brought to the Mortuary in connection with Inquests. Removed by the Police from streets, etc. 4 „ „ Bethnal Green Hospital 1 „ „ Private houses, etc. 3 Total 8 Inquest cases classified according to age:— Number under 1 year — ,, over 1 year and under 5 years — „ „ 5 years „ „ 15 „ 3 „ „ 15 „ „ ,, 25 ,, — „ „ 25 „ „ ,, 45 ,, 2 „ „ 45 ,, „ ,, 65 ,, 3 „ „ 65 ,, ,, ,, 75 ,, — „ „75 „ — Total 8 In all the 62 cases in which a post-mortem examination was made but no inquest was held, the deaths were due to "Natural Causes." The bodies came from private houses in every case except one, which was brought in by the police. The ages in these cases were as follow : — Under 1 year 3 Over 1 year and under 5 years 2 „ 5 „ „ 15 4 „ 15 „ „ 25 2 „ 25 „ „ 45 5 „ 45 „ „ 65 17 „ 65 „ „ 75 11 „75 18 62 34 Causes of death in inquest cases: — Natural causes — Accidental: falls 1; run over by motor car 1; drowning 1 3 Open Verdict (drowning) 1 Suicide: drowning 1; gas poisoning 1; other poisoning 2 4 Total 8 35 MATERNITY & CHILD WELFARE. The unfortunate relapse in the health records of the Borough with regard to maternal and infant mortality, naturally leads one to look afresh at our arrangements for maternity and child welfare to see whether they are adequate and efficient or whether there is some weakness or omission which we have overlooked. In the main, I think it probable that the increased mortality is due to general social causes, unemployment and low wages resulting in a reduced family income available for necessary nourishment, clothing and shelter. Only to a very small extent can the Maternity and Child Welfare authority deal directly with this state of things. Grants of milk to necessitous mothers and children have substantially increased during the year, but such assistance only goes a very small way to remedy the lowered vitality which follows prolonged poverty. The lack of any effective co-ordination between the various (public and private) agencies for maternal and child welfare is an unfortunate weakness in the present situation. During the year the Council endeavoured to obtain some small measure of co-operation with the various maternity hospitals in which Bethnal Green mothers are confined, in order to secure that the mothers had better facilities for ante-natal care, but the effort was not successful. The midwifery facilities in and about the district are in a general way excellent, but owing to the lack of a pre-arranged plan and a common standard of ante-natal care it is probable that many mothers do not in fact obtain adequate ante-natal care. A most important step forward in the Councils Maternity and Child Welfare scheme was the appointment, towards the end of the year, of a full time Medical Officer for this work, replacing several temporary part-time officers. Another improvement has been the hiring of rooms for a Welfare Centre at St. Matthew's Institute, Hereford Street, in place of the 36 very unsatisfactory centre at Thornton Hall. The number of sessions has also been increased. The following cursory outline gives some idea of the variety and extent of the work undertaken by the Council: — (i) Mothers and children are visited in their homes by a staff of 10 Health Visitors. (ii) Mothers are also given advice with regard to their own and their children's health by a staff of one full-time and several part-time lady, doctors at the Welfare Centres. The Council's principal Maternity and Child Welfare Centre (Cornwall Road) is a well-equipped building at which the usual clinics for general advice with regard to maternal and child welfare are held. A branch centre is also conducted on hired premises at St. Matthew's Institute, Hereford Street, where weekly Infant consultations and an ante-natal clinic are held. In addition, the following special branches of work are undertaken at or from Cornwall Road Centre. (iii) Special Clinic for delicate children. (iv) Light treatment. (v) Dental inspection and treatment, including provision of dentures. (vi) Orthopaedic Clinic, including provision of inpatient treatment for children requiring it. (vii) Massage. (viii) Grants of milk are made to necessitous expectant and nursing mothers and young children. (ix) The Council employs a trained midwife, who conducts confinements in the district ; also (x) Provides a panel of Obstetrical Consultants whose services are available to local doctors in any difficult or abnormal confinement. 37 (xi) Provides the services of Home Helps to relieve women of domestic work during confinement ; and (xii) Supplies a sterile maternity outfit. (xiii) Mothers recovering from confinement, also ailing children, are sent away for convalescent treatment. (xiv) In-patient operative treatment is provided for children with enlarged tonsils, etc. (xv) Nursing assistance in a variety of illnesses is provided through the agency of the District Nursing Association. If the Council's welfare work were a commercial undertaking, its merits would doubtless be proclaimed by posters and newspaper headlines. Municipal enterprise is more modest but none the less appreciates such testimonials as the following: — " I am writing to you thanking you very much indeed for the lady which you sent to me for assistance while my wife was in hospital. I am sure that the lady is worthy of all the appreciation which I can give to her for the way that she did her work and cleaned in every way. The lady is worth all that we can wish for her, as she was very good and kind to all the children and everything done to the very best, and I thank you very much for sending her along to me and the family." " I wish to write and thank you for the excellent services of the Borough Council's Home Help during my cnfinement." Another pleasant indication of the simple human feeling which animates this work is the fact that mothers frequently make gifts to the Centre for issue to others less fortunate of children's clothing, perambulators, etc., for which they no longer have use. NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 1,299 live births were registered in the Borough; and 1,275 births were notified to 38 the Medical Officer of Health. There were also 32 stillbirths notified. Of the 1,307 living and stillbirths notified, 940 were notified by midwives, 208 by maternity assistants of the London Hospital, 119 by medical practitioners, and 40 by parents and others. Through the courtesy of neighbouring Medical Officers of Health I also received copies of notifications of births of. Bethnal Green babies which took place outside the Borough, information as to 561 live babies and 24 stillbirths being received in this way. WORK OF HEALTH VISITORS. The following table gives some account of the outdoor work of the Health Visitors so far as this can be expressed in statistics:— Visits. Re-visits. Babies (under 1 year) 1.871 12,165 Children (1—2 years) 2 12 4,587 13,353 „ (2—3 years) 5 3,856 „ (3—4 years) 3 2,824 „ (4—5 years) 2 2,086 Mothers (Ante-natal) 919 361 „ (Post-natal) 43 46 Stillbirths 54 50 Visits. Re-visits. Infant Deaths 98 9 Maternal Deaths 4 1 Puerperal Fever (25) and Pyrexia (44) 23 46 Ophthalmia Neonatorum 23 91 Acute Poliomyelitis — — Other Notifiable Diseases 2 — Diarrhoea and Enteritis 1 — Measles (259), and German Measles (3) 124 138 Whooping Cough 120 199 Other Non-notifiable Diseases 28 94 Milk Grants 28 889 Convalescent Treatment 12 7 Other matters 70 184 Total Visits 3,432 27,633 Grand Total 31,065 39 In addition, 97 visits and 2,270 re-visits were rendered futile owing to the absence of the mother or the occasion being inconvenient for an interview. The reduction in the number of outdoor visits as compared with last year's 34,120 is chiefly attributable to the increase in the number of indoor clinic engagements. If the outdoor work is to be maintained it will be necessary at an early date to consider some increase in the staff. The indoor (clinic) work of the Health Visitors is shown in the following figures:— Sessions attended. Maternity Clinics 329 Children's Clinics 1,230 Dental Clinic 108 Light Clinic 216 Other Clinics 166 The Council is able, through the Health Visitors, to render considerable assistance to the London Hospital Maternity Charity by reporting on the home conditions and preparations of expectant mothers who have booked with that hospital for midwifery services. Liaison also exists with the L.C.C. School Medical Service, our child welfare record cards being transferred to the Divisional Medical Officer as the children attain the age of 5. MATERNITY AND CHILD WELFARE CENTRES. At the Council's principal Centre in Cornwall Road, there were 166 sessions for infant consultations and 146 sessions in connection with the Maternity Clinic. Other work carried on at the Centre in connection with the Special Clinic for Delicate Children, massage, milk grants, etc., will be found reported on under these separate headings. 40 The auxiliary Centre at Thornton Hall, Mount Street, was in use on Monday afternoons up to the 14th September, when the work was transferred to St. Matthew's Institute, Hereford Street. Infant Consultation Sessions being held on Thursday afternoons as well as Mondays and an Ante-Natal Clinic on Thursday mornings. There were 35 Infant Consultation Sessions at Thornton Hall and 29 at Hereford Street. CHILDREN'S CLINICS. The statistics of attendances at the Centres during 1931 and in previous years are as follows: 1931 Cornwall Road. Thornton Hall. Hereford Street. Babies (0—1): First attendances 1,006 120 110 Subsequent ,, 9,395 1,068 867 Children (1—5): First „ 113 28 23 Subsequent ,, 4,999 699 672 Total „ 15,513 1,915 1,672 Cornwall Road. Thornton Hall. Hereford Street. Sessions per week 3 — 2 Average attendance per Session 93.5 54.7 57.6 Doctors' attendances per week 6 — 3 Medical Consultations: Babies 5,988 896 653 Children 3,419 568 534 The following ratios may be of interest:— Ante-Natal Clinics Children's Clinics Acreage per Centre 380 380 Population per Centre 54,600 54,600 Medical Sessions per 100 births 8.5 31.1 Ratio of new expectant mothers or babies under 1, attending Centres respectively, to total net births 24.l% 65.3% 41 The number of children under 1 attending for the first time is 65.3 per cent. of the number of live births recorded during the year. 1931. 1930. 1929. 1928. 1927. Total Attendances of Children 19,100 19,843 18,481 19,373 18,223 New Cases 1,400 1,497 1,452 1,536 1,553 (Children) New Cases 740 710 761 759 600 (Mothers) Medical Consultations- Children 12,062 11,982 11,800 12,552 12,283 Mothers 1,906 1,702 1,688 1,726 1,390 Statistics with regard to the attendances at the Maternity Clinic are given in detail later. TALKS TO MOTHERS. The educational work of the Centres is frequently intensified by informal talks to groups of mothers by members of the Health Visiting Staff. During the year 47 such talks were given, the majority of them in connection with the Maternity Clinic. The subjects of talks were, of course, mainly such things as Infant feeding, clothing and exercise, practical home preparations for confinement, importance of dental care, etc., but other useful talks were given on such topics as "Babies and Hot Sunshine," "Warding off Bronchitis," " Work of Kidneys during Pregnancy," etc. LITERATURE. We have not added to our stock of literature during the year, but the standing leaflets on Maternal and Child Welfare and the booklet " To Fathers and Mothers " are in regular use. INFANT CONSULTATIONS. The work of Infant Consultations has continued 42 on the same lines as heretofore, that is, the individual inst ruction of the mother by the doctor or health visitor. A few observations by two of the Medical Officers will be of interest I think the chief difficulty this year has been with children over one year. It is easier so long as a baby is breast fed or bottle fed, but when it begins to be dependent on other foods the difficulty arises of providing enough variety on a very limited income. I emphasize variety because it is important both for ensuring that no essentials are omitted from the diet and also because children, like adults, eat better if their food is attractive and not monotonous. Next to the food difficulty is the overcrowding in so many homes. This again is a potent cause of lack of sleep in children. It is discouraging to see toddlers return from a month's convalescence looking bonny and having gained weight well and then to watch them lose ground again gradually. This must happen to a certain extent as it is the children whose home conditions are worst who most need and who are most sent for convalescence. Lack of outdoor life is another difficulty. One cannot expect a mother to take out her two or three or more young children if she lives on the third or fourth floor. Every time she goes out with them she may have a pram. to carry up and down as well as one or two children. Sometimes one is surprised to find that even if there is a garden it is not used for a baby as much as it might be. Bronchitis is still fairly prevalent. I have found on the whole that good results are obtained from inhalation therapy, especially in children with frequent or semichronic respiratory trouble. (Signed) D. E. Mason. It is very gratifying to note how the attitude of the parents is changing towards dental treatment. At first they would not believe that it was necessary to treat first teeth if decayed; now I am often asked to examine a child's milk teeth "to see if anything needs attention." (Signed) D. I. Mart. MATERNITY CLINIC (CORNWALL ROAD). This is open every Wednesday and Thursday morning, and during 1931 the former monthly special 43 post-natal session on Monday was made a weekly session. Particulars of attendances: Total. Expectant Mothers—First visits 526 1,405 ,, „ —Subsequent visits 879 Mothers recently confined—First visits 267 411 ,, „ ,, —Subsequent visits 144 The number of sessions was 146, and the average attendance per session was 12.6. 129 of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement, and 19 mothers were sent away to a convalescent home. The 526 women who attended for the first time may be grouped as follows : — Gravid:—Primiparæ 75 -Multipara 415 490 Sterile 1 Not pregnant 35 526 In the case of the 490 gravid women, the following were the periods of gestation :— 2 were in the 1st month 11 ,, ,, ,, 2nd ,, 43 ,, ,, ,, 3rd ,, 54 ,, ,, ,, 4th ,, 84 „ „ „ 5th „ 129 ,, „ „ 6th „ 114 „ „ „ 7th ,, 40 ,, ,, ,, 8th ,, 2 ,, „ „ 9th „ while 11 who were not examined upon their first attendance have not been allocated. 44 An analysis of these cases shows :— Full-term confinements 357 Premature births 9 Miscarriages(12); Stillbirths(4) 16 Not yet confined 91 Left Borough (results unknown) 8 Transferred to Hereford St. Clinic 9 The known confinements took place :— 305 at home, and 77 in institutions. Washerman reaction for syphilis ... Nil The results of the 132 cases brought forward from 1930 were as follows: — Full-time confinements 123 Premature births 4 Miscarriages (2); Stillbirths (2) 4 Left district (result unknown) 1 Of the 131 for whom we have information, in 79 cases the confinement took place at home, and in 52 cases in an institution. Dr. R. C. Townshend reports on the work of the Maternity Clinic, as follows : — Report on the Ante-Natal Clinic during the year 1931. I have to report that there have been no maternal deaths amongst the mothers attending the Ante-Natal Clinic. I have to report a decrease in the average attendance per session, although the number of new cases of expectant mothers was practically the same as in the preceding year. I think the decrease is due to the following factors: — 1. The institution of a weekly instead of a monthly Post-natal session. 2. The formation of a weekly Post-natal Clinic by the London Hospital. 3. The formation of the new Ante-natal Clinic in Hereford Street. 45 With regard to the miscarriages, one case occurred in a primipara who had suffered from smallpox in early pregnancy, the remaining cases occurred in multipara, and with one exception were treated by their own doctor or admitted to hospital, and in every case the patient recovered. With regard to the stillbirths, two cases occurred in primipara and were apparently due to abnormally long labours, and in each case the patient failed to attend The Ante-natal Clinic after months' pregnancy. In the remaining four cases, the patients were multipara, and in one of these there was a history of an abnormal presentation, and in each case it is again noteworthy to remark that the patients failed to keep their appointments at the Clinic during the later months of pregnancy. With regard to the premature confinements, in Three cases there was a twin pregnancy, in four cases there was a history of ante-partum haemorrhage, and in one case there was a history of an attack of smallpox about the sixth month of pregnancy. The Borough Midwife has attended the Clinics when possible, and reported on her cases, and the local midwives send cases regularly to the Clinic and have reports on their patients posted to them under the Council's scheme. The Post-natal Clinic was held once a week. The majority of cases were suffering from post-natal debility, and in addition there were several cases of uterine misplacements, and a certain number of patients who were referred to special hospitals for further treatment. The attendances of post-natal mothers has been disappointing, owing, I think, to the fact that in a large number of cases the mothers have to attend at the Infant Welfare or Light Clinics where they are able to obtain tonics for themselves, and they are unable to spare the time to attend an additional clinic. In cpnclusion, I should like to express my thanks to the staff of the Department for their excellent work and unfailing help. Ruth C. Townshend. March, 24th, 1932. MATERNITY CLINIC, HEREFORD STREET. The new Ante-Natal Clinic at the Hereford Street Centre was opened in September, 1931. Nine mothers belonging to the districts allotted to this Centre were 46 transferred from Cornwall Road to form a nucleus for the new clinic. Thirteen sessions have since been held, at which 30 expectant mothers attended for the first time and made 41 subsequent attendances. Dr. K. M. Horton reports as follows: The figures for three months' work suggest that the installation of this Clinic supplies a very definite need in this area of Bethnal Green. We look forward to a substantial increase of attendances in the next year. An analysis for cases attending the Centre is as follows:— Expectant Mothers—First attendances 30 Subsequent „ 41 Transferred from Cornwall Road 9 Mothers recently confined— First attendances 16 Subsequent „ 3 The number of sessions was 13 and the average attendance per session was 5.6. The 30 women who attended for the first time may be grouped as follows:— Gravid—Primiparæ2 —Multiparæ 26 Not pregnant 2 In the cases of the 28 gravid women, the following were the periods of gestation: — In the 1st month — „ „ 2nd „ 1 „ „ 3rd ,, 2 ,, ,, 4th ,, 1 ,, „ 5th ,, 3 „ „ 6th „ 7 „ „ 7th „ 9 „ „ 8th „ 2 „ „ 9th „ — 47 while 3 who had not been examined upon their first attendance have not been allocated. An analysis of these cases shows: — Full term confinements 10 Not yet confined 17 Left borough (result unknown) 1 The known confinements took place: — At home 8 In institutions 2 BOROUGH MIDWIFERY SERVICE. The Borough Midwife had 29 bookings carried forward from 1930. During 1931 168 bookings were received, of which 9 were subsequently cancelled. During the year 170 mothers were attended, 120 by the Borough Midwife and 50 by a private midwife acting as her deputy. These figures include 2 unbooked cases in which the Borough Midwife attended in emergency and which were removed to hospital. Five booked cases were also removed to hospital while in labour. In three cases a doctor was engaged by, the patient as well as the Borough Midwife. Of the mothers delivered, 18 were primiparæ and 152 multiparæ. There were 28 expectant mothers on the books at the end of the year. The Borough Midwife or her deputy paid 1,887 visits in connection with her practice and 31 other visits. She also conducts a regular weekly session for ante-natal care of her patients. It is gratifying to record that 54 of the mother's delivered by the Borough Midwife during the year had been previously attended by her, 40 on one previous occasion, 13 of them on two previous occasions, and 1 on four occasions. OBSTETRICAL CONSULTANTS. The Council has a panel of five Obstetric 48 Consultants, who may be called in by any general practitioner in any midwifery case which presents difficulty or abnormality. Two consultations took place during the year. HOME HELPS. At the end of the year, there were 11 Home Helps on the panel, while 7 other women were also occasionally employed as relief helps. During the year, there were 275 engagements of Home Helps, as compared with 165 in 1930 and 65 in 1929. In 134 cases the mother paid a contribution for the services rendered. MATERNITY OUTFITS. Outfits were issued as follows:—Free, 111; Halfprice, 34; Cost price, 38. Total, 183. This service is now available to mothers attended from Hospitals. In view of the numerous enquiries as to the contents of the Council's Outfit, a list is here given: — Maternity Outfit-. Contents. 3 Accouchement Squares (cotton and wool) 18in. by 18in. 6 Large Perineal Pads (wrapped in 3). 6 Small Perineal Pads. 1 Sterilized Binder. 1 Packet (8 ounces) White Absorbent Wool. 1 sheet Tissue, 15in. by 9½in. 2 sheets Tarred Paper, 30in. by 36in. 6 Plain Lint Cord Dressings (3in. square cut out keyhole) 3 12in. Linen Thread Ligatures. 1 Tube or Pot (loz.) Vaseline. 1 ounce Boric, Starch and Zinc Powder in tin. 1 Tablet Curd Soap. 1 dozen Sheathed Safety Pins (assorted). PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. The prevalence of unemployment and low wages among the residents in the Borough, to which reference 48 has been made elsewhere, has led to increased privation among the mothers and children. So far as necessitous expectant and nursing mothers and young children under 5 are concerned, the Council is able to render some slight assistance by way of grants of milk. 8,793 families were assisted in this way compared with 6,087 in 1930. There were 101 sessions for dealing with applications for milk grants, and parents made 19,741 attendances at the Welfare Centre in connection with this subject. During the year the following quantities of milk were issued to necessitous mothers:— Grade A (Tuberculin Tested) Milk 13,359 galls. Dried Milk 21,149 pkts. Condensed Milk 281 tins. together with medicines, etc. The approximate cost of milk given in this way was £3,473. SUPPLY OF DRIED MILKS, Etc. In connection with the work of the Council's Centres dried milk of various brands, labelled specially to the Council's directions to avoid the use of trade names, were sold to the mothers:— Dried Milk 8,723 pkts. Condensed Milk 6 tins. HYGIENIC CLOTHING. The Welfare Centres continue their useful service of1 helping mothers to obtain more hygienic clothing for their children. Garments recommended by the Central Council for Child Welfare are exhibited at the Centre and are eagerly copied by mothers and there is no doubt that the Council's educational work in this respect is doing much to raise the standard in young children's clothing. 50 SPECIAL CLINIC FOR DELICATE CHILDREN. Since 1925, a Special Consultation Clinic for Delicate Children has been in operation at the Centre, conducted by Dr. Helen M. M. Mackay, M.D.; M.R.C.P. Medical Officers at the Infant Consultations observing children whose conditions require special investigation, or on whom they desire a second opinion, refer such children to the Special Clinic. Dr. Mackay reports on the work of the year as follows : — Special Clinic for Delicate Children. Report for 1931. The following reflections have been suggested by the work of the Clinic during 1931. The family income as stated by the mothers of many children attending this Clinic was often so low that one marvelled how they were able to carry on at all. It is often said in such circum— stances, where poverty is at the root of ill.health, that medical advice is all but wasted1, but time and again this is disproved since, for example, by providing the mother with a belter knowledge of dietetic needs she is helped to expend her money better, and by adVice on the management of her children she is enabled to make better use of the possibilities open to her. Nevertheless, the doctor.s com— parative helplessness in the face of extreme poverty, without the aid of the various social agencies that are ready to co— operate, is obvious. Thus it is difficult to over.estimate the value of the borough milk grants to children in im— poverished families. In the long run it probably proves an economy for the State by avoiding more expensive treatment later. The Invalid Kitchen in the Borough has given valu— able assistance, particularly perhaps in some cases where the mother, in order to provide for her family, was cutting her own food so low as to render herself incapable of coping with the management of her children. The Invalid Children.s Aid Association and the United. Services Fund have helped in other cases. In a Hospital the medical staff are accus— tomed to rely on the Lady Almoner as a skilled liaison officer trained in social work who is able to co.ordinate this side of the work, and I believe such help would be of great value at the Borough Welfare Cenbre. Apart from poverty, an outstanding cause of ill.health 51 among young children attending the Clinic is insufficient sleep. Not infrequently this is due to the parents inability to go out together without dragging the children with them —and perhaps every Saturday and Sunday the children.s bed.time may be. from 9 to 11 p.m. One wonders whether some scheme could not be devised whereby a school hall, and playground might be set aside, perhaps on Saturday and Sunday afternoons, for young children in order to free the parents for a few hours. It seems very probable that vol— untary helpers might be obtainable to assist in looking after the children, and undler such ciroumstaraces expenses need not be large. In the past year the proportion of infants referred to the Clinic, as compared with the number of toddllers, has been smaller than in many previous years. As in the past, the majority of the patients have been children making poor progress or those suffering from recurrent bacterial infections. The Health Visitors ready help and co.operation constantly enable patients. difficulties to be dealt with suc— cessfully, and mothers appear to be more ready to profit from their help year by year. The figures for the past year are : — New Cases 119 ) Total Subsequent attendances 469 I attendance 588 Consultations 562 H. M. M. Mackay. PROPHYLACTIC LIGHT CLINIC. I append the report of Dr. K. M. Horton, who 3onducts the Prophylactic Light Clinic: — Both Ultra.violet ray lamps have been in constant use during the year, treatment being given under the super— vision of Dr. Mart until November. Three sessions are held weekly and nearly three hundred patients attended the Clinic, referred from the Ante.natal and Child Welfare Clinics, from Dr. Mackay.s Clinic and from the Bethnal Green Day Nursery, Somerford Street. An analysis of cases is given below. Rickets was again the largest group, being followed by General Debility and Recurrent Bronchitis, this third group usually receiving Inhalation treatment at the same time. Ultra.violet ray therapy seems particularly useful to another considerable group of patients, those children who are recently recovered 52 from some acute illness and whose parents are not willing to send them away to a Convalescent Home, and those mothers who suffer from marked debility after confinement but whose home circumstances prevent convalescence. The co.operation of doctors in private practice and of the neighbouring hospitals has continued, and we have been glad to treat the cases referred to us by them. Analysis of Cases. Rickets 86 Debility 39 Debility after Bronchitis 3 ,, ,, Broncho.pneumonia 9 ,, „ Diphtheria 1 „ ,, Measles 4 ,, ,, Whooping Cough 4 „ „ Tonsillitis 2 ,, with Otitis Media 3 Recurrent Bronchitis 29 Catarrhal Children 12 Anaemia 6 Marasmus 12 Malnutrition 5 Backward Development 10 Failure to Gain Weight 16 Delayed Dentition 15 Septic Sores and Boils 6 Enlarged Cervical Glands 2 Chilblains 1 Night Terrors 4 Rheumatism 3 272 K. M. Horton. LIGHT TREATMENT. The following statistics give some idea of the light treatments given to mothers and children during 1931: — Consultations with Medical Officer:—1,247. Treatments:— Children 3,158 Expectant Mothers 11 Nursing Mothers 134 53 DENTAL CLINIC. The Dental Clinic established in September, 1925, commenced weekly sessions (instead of fortnightly), from the beginning of the year. Miss J. H. M. Sutherland, L.D.S. (R.C.S), reports on her work during the year as follows:— Sessions held 45 of which 14 were Gas Sessions and 9 partly devoted to routine inspections of children of 3 and 4 years of age. Total. Children. Mothers. Brought forward from 1930 27 15 12 New cases 152 95 57 Subsequent attendances 316 156 160 Routine Inspection 71 71 — Total 539 Average attendance 12 Gas administrations 131 78 53 342 Temp, teeth. Extractions 584. 100 46 242 Perm. teeth. 130 Temp, teeth. Fillings 164. 49 8 34 Perm, teeth. Dressings 16 5 11 Silver Nitrate 47 47 — Scaling and polishing 17 5 12 Dentures 27 { 12 Two plates } — 15 Expectant mothers treated — 18 Cases referred to London Hospital 3 „ „ „ Mildmay „ 1 Patients recommended by Centre Doctors 37 31 H.V 19 18 „ ., „ Local Dentist 1 — Forty.five sessions were held during the year, 14 of which were Gas sessions, and 9 partly devoted to routine inspection of children of three and four years of age. The new cases numbered 223, of whom 71 were children who attended the routine inspections following a letter from the M.O.H. The average attendance has been maintained throughout the year. An increased attendance of expectant mothers has been noted (many of whom required extensive treatment). This is a most encouraging fact, for the dental health of the expectant and nursing mother plays a large part in the genera] and dental health of the child. Fifteen mothers were fitted with dentures. Old cases are returning in larger numbers for further treatment, and mothers are constantly 64 urged to bring their young children at the first signs of any dental defect, when conservative treatment can be carried out successfully. Many children under two years of age have been treated and advised to return periodically for examination. At the routine inspections, 71 children attended for examination, and 62 were found to require treatment ;und 37 were treated at the Centre. Janet H. M. Sutherland. The routine inspection of toddlers, which was com— menced in 1930, was extended in 1931 by the engage— ment of a second dental surgeon attending an additional weekly session. Owing to the inevitable over.lapping of the Borough Council and the County Council in dealing with the children of 3 and 4, which results from the present division of functions, it has been difficult to organise the inspections satisfactorily. A further obstacle has been the prevalent fallacy that . the milk teeth . do not matter. Notwithstanding these difficulties, some improvement in the attendance of the children has been effected and there is evidence of a much readier appreciation by parents of the value of early dental inspection and treatment. The proposed adoption by the L.C.C. of improved methods of notifying the Borough Councils of children newly admitted to school will somewhat facilitate the keeping of our records. Mr. F. Reginald Bate, L.D.S. (R.C.S.), who has undertaken the second weekly dental session commenced on the 16th April, 1931, furnishes me with the following statistics and comments: — Sessions held, 32, of which 11 were Gas Sessions. Children attending routine inspections, 208, of whom 148 were found to require treatment. 114 of these children were treated, the remaining 34 failing to re.attend for treatment. Children referred by Medical Officers and Health Visitors, 49, all requiring treatment and making 162 subsequent attendances. 66 Teeth extracted Children. or stopped. Treatment under gas 125 435 Treatment under ethyl chloride spray 20 25 Stoppings 30 46 Removal of stain by polishing 5 — Silver nitrate 4 — Cases referred to L.C.C. 1 — Refused treatment 1 — Reviewing the cases as a whole, it was noticed that, with one or two exceptions, the condition of the mouths and teeth examined were either in good order, or else very bad, which accounts for the comparatively large number of ex— tractions. There was also quite a definite prejudice towards treatment of a conservative nature on the part of the parents, but this is now being overcome in a good many instances, after pointing out the importance of keeping the deciduous teeth, if possible, until such time as they are shed naturally. It is hoped that during the year 1932 there will be an increase in the number of fillings done, and a decrease in the number of extractions. F. Reginald Bate, L.D.S., R.C.S., Dental Surgeon. Dr. D. I. Mart acts as anaesthetist for both Miss Sutherland and Mr. Bate. ORTHOPAEDIC TREATMENT. The Orthopaedic Clinic has now completed its fourth year. The Orthopaedic Surgeon attends the Clinic once a month, while an Orthopaedic Sister attends once a week to carry out any prescribed treatment. Children found to require instruments or in.patient treatment are provided for accordingly. During the year 1931, 13 sessions were held at the Orthopaedic Clinic by the Surgeon, at which there were 345 attendances, 115 being of new cases and 230 old cases. The Orthopaedic sister attended 37 times, and 216 attendances were made at her sessions. 66 Copy of Report concerning Orthopaedic Cases treated during 1931. Record of Cases carried over from 1930. Total Number. *Number still attending Clinic 11 „ lapsed 26 Unable to attend 6 43 ♦Including 1 recommended for in.patient treatment at Royal National Orthopaedic Hospital. Record of New Cases in 1931. Number attending 56 13 cured „ discharged 4 unable to attend 18 1 sent to Infant Welfare Treatment stopped 4 Recommended for in.patient treatment at Royal National Orthopaedic Hospital 4 Transferred to other Hospitals 3 Left District 4 Lapsed 27 115 Record of Cases treated during 1931, including 115 new cases. Erbs Paralysis 1 Torticollis 6 Curved Tibia (Rachitic) 82 Genu Valgum 42 *Talipes Equino Varus 7 Flat Feet 14 A.P.M. 1 Genu Recurvation 1 Spastic Monoplegia 1 Scoliosis 2 General Debility 1 158 ♦Including 1 Spastic E. V. with Spina bifida. Dr. H. J. Seddon.s comments are as follows: — A large number of cases of bowing of the tibiae and knock.knee have been seen in the Clinic during the past year. They have responded to treatment in a most gratifying way. The conditions were diagnosed early and in most 57 cases the application of splinits resulted iin correction of the deformity. Relatively few cases have had to be admitted for operative correction. Occasionally some difficulty is experienced in persuading parents of the need of continual splintage, but there has been a noticeable improvement in their co.operation during the year. IN.PATIENT TREATMENT. Dr. Seddon also furnishes the following notes concerning the children who received in.patient treatment during the year, 1931: — E.S., aged 2, was admitted on July 22nd, 1931, with severe rickets. Both tibiae were bowed and required osteoclasis, which was performed on August 10th. She was discharged on October 5th with perfectly straight legs. A.D., aged 3, was admitted on January 13th, 1931, with an equino cavo varus deformity of the left foot following Infantile Paralysis. On January 29th a Steindler operation was performed, and on May 5th and June 6th further manipulations were performed which gave the child an almost normal foot. There was considerable recovery in the paralysed muscles, and he was discharged walking well on August 10th. C.H., aged 3½, was admitted on January 8th, 1931, with knock.knees following rickets. On February 12th a bilateral supracondylar osteotomy was performed. He was discharged on May 2nd with straight legs. L.C., aged 3, was admitted on July 13th, 1931, with severe rickets. She improved rapidly under anti.rachitic treatment and it was not necessary to perform any operation on the tibiae. Such bowing as was present on admission improved spontaneously. She was discharged on October 24th. R.S., aged 1 year 11 months, was admitted on July 29th, 1931, with rickets. As active disease had almost subsided on August 14th, it was possible to do an osteoclasis for bowing of the tibiae. He was discharged walking well on October 24th. MASSAGE. Massage is given by a trained Masseuse under the 58 general supervision of the Orthopaedic Surgeon. During the year there were 281 sessions for massage; 84 new cases were treated, and there were 1,323 treatments. The new patients treated by Miss Laxvson included 38 children awaiting the attendance of the Orthopaedic Surgeon at the next session, 29 other children referred by the Medical Officers for poor muscular develop— ment, etc., and 17 mothers referred for breast massage, etc. INHALATION THERAPY. The Spiess.Drager inhaling apparatus installed last year has been increasingly used this year. Pine oil and Cajuput Oil separately and in combination were used as Inhalants, mixed with oxygen under pressure. An attempt to extend the treatment to mothers as well as children was made, but so far not many have availed themselves of this opportunity. It is felt that the number will increase as the success that is met with in this treatment becomes more generally known. Sixteen children were still under treatment at the end of 1929 and were carried forward. 141 Sessions were held during the year, and there were: — 84 First attendances by Children. 564 Subsequent attendances. 3 First attendances by Mothers. 24 Subsequent attendances. Bronchitis, Asthma and Catarrhal conditions of the upper air passages have been successfully treated. Only one case was discharged without relief, the majority making definite improvement in varying lengths of time. The treatment is simple and pleasant and so is easily given to quite young children and it is usually enjoyed by both children and mothers. 59 The results of the treatment were as follow: — Discharged cured 19 „ improved 26 No change 11 Ceased to attend 29 Removed from district 1 86 Carried forward to 1932 17 103 ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the arrangements with the Queen.s Hospital, 10 young children had operations for onlarged tonsils as in.patients upon the recommendation of the Medical Officers of the Welfare Centres. The Council.s scheme is a much needed improvement on the common practice of discharging children immediately after the operation, which is not only distressing to patient, parents and public, but fraught with considerable danger to the patient especially in transit through our busy and dusty streets. Owing to the increased accommodation at the Queen.s Hospital there is now much less delay in arranging vacancies. CONVALESCENT TREATMENT. During the year 18 mothers were sent to the London Mothers. Convalescent Home, Sunningdale, Berkshire, and 2 mothers to the . George Whitlaw. Convalescent Cottage, Amerden, near Taplow. Twenty mothers were sent away for two weeks. In 8 of the cases the husband contributed to the cost of the convalescence. With regard to children, the arrangement made with the Hertfordshire County Council in 1922 was continued, and 74 children were sent to that Council.s Home at St. Leonard.s.on.Sea, Sussex, 4 for one week, 3 for two weeks, 2 for three weeks, 49 for the normal 61 period of four weeks, 7 for six weeks, 1 for seven weeks, 6 for eight weeks and 2 for nine weeks. 5 children were also sent to the John Madocks. Babies. Home at Basing for periods varying from 6 to 13 weeks. In 26 eases the parents contributed to the cost of the convalescence. The provision of convalescent treatment is among the most valuable branches of our work. The physical and mental benefits of a holiday in the country or seaside under sympathetic medical and nursing care only require stating to be realised, especially to those acquainted with the housing conditions in Bethnal Green. Astonishing records of progress have been noted among weakly children, for the first time provided with adequate food and sleep and ample room for healthy open.air exercise. We are fortunate indeed in the homes to which we send our mothers and children and spontaneous letters of appreciation are frequently received from mothers concerning the treatment they or their children have received. HOSPITAL TREATMENT FOR MALNUTRITION. We have no formal arrangement for prolonged observation and in.patient treatment for children suffering from dietetic mismanagement and malnutrition. Such cases as cannot be dealt with through the Council.s Special Clinic for Delicate Children are referred to the Queen.s Hospital or one of the othler General Hospitals. NURSING ASSISTANCE. A scheme of home nursing has been in operation for some years by arrangement with a voluntary organisation, the Shoreditch and Bethnal Green Nursing Association. During the year 273 children under the age of 5 were nursed, a total of 2,896 visits being made. Thirty.eight mothers received 297 visits for nursing in connection with conditions incidental to child. bearing. 61 Nursing Assistance, 1931. Disease Children UNDER FIVE years Mothers Others Total Visits Cases Visits Cases Visits Case* Visits ... Ophthalmia Neonatorum ... ... ... ... ... ... ... Discharging Eyes 69 1114 ... ... ... ... 1114 Measles 2 10 ... ... ... ... 10 Whooping Cough ... ... ... ... ... ... ... Diarrhoea ... ... ... ... ... ... ... Puerperal Fever and Py— rexia ... ... ... ... ... ... ... Other pre.natal and post— natal conditions ... ... 37 281 ... ... 281 Otorrhoea, Abscess of Ear 20 384 ... ... ... 384 Tonsils and Adenoids 58 189 ... ... ... ... 189 Influenza ... ... ... ... 19 78 78 Bronchitis 3 25 ... ... 2 6 31 Pneumonia 20 228 ... ... 19 110 338 Tuberculosis 4 48 ... ... ... ... 48 Intestinal Conditions 10 45 ... ... ... ... 45 Threadworms 53 456 ... ... ... ... 456 Septic Umbilicus 6 58 ... ... ... ... 58 Impetigo and Eczema 1 191 ... ... ... 191 Circumcision 5 33 ... ... ... ... 33 Pemphigus 2 12 ... ... ... ... 12 Septic arm, leg, etc. 2 is ... ... ... ... 18 Miscellaneous 12 85 1 16 1 6 107 Totals 273 2896 38 297 41 200 3393 11 cases were in hand at the beginning of the year. 11 cases were in hand at the end of the year. A total of 3,393 visits was paid to 352 cases at a cost of £226 4s. Od. PUERPERAL FEVER AND PUERPERAL PYREXIA. Eight cases of Puerperal Fever were reported during the year. One of the patients was also suffering from Smallpox and was treated in the Joyce Green Hospital, 2 in Bethnal Green Hospital, and the remaining 5 cases in the London Hospital. There were 3 deaths from the disease. Fifteen cases were notified as Puerperal Pyrexia. Two of the patients were treated at home; the others at the following Hospitals:—London (3), Mothers. (3), 62 City of London (2), Bethnal Green, North Western, South Western, St. Peter.s and Underwood Street one each. OPHTHALMIA NEONATORUM. 23 notifications of Ophthalmia Neonatorum were received during the year, 6 of these notifications coming. from public medical officers of the London County Council, 7 from hospital doctors and 10 from private medical practitioners. One case Avas removed to and treated in the St. Margaret.s Hospital, 2 to the Bethnal Green Hospital, while 6 other cases were treated at the London Hospital. The remaining cases were treated at home. Very special attention is given to this serious ailment. Every case is very carefully watched by the Health Visitor until the condition clears up, and her reports are most thoroughly scrutinized, the object being the prevention of any risk of blindness resulting. The Health Visitors paid 114 visits to cases. Every, case cleared up without any impairment of vision being reported. 47 reports were also received from Medical Officers of the London County Council concerning new born babies suffering from inflammation of the eyes, 4 of these cases being subsequently notified as Ophthalmia Neonatorum. These cases were also visited by the Health Visitors. The district nurses treated 69 cases of discharging eyes in young infants, paying 1,114 visits for the purpose. MATERNITY AND CHILD WELFARE DEVELOPMENTS. Children under School Age. In 1930 I submitted a special report to the Public Health Committee arising out of the joint circular of the Ministry of Health and the President of the Board of Education on the subject of the serious defects found 63 in young children upon their entrance to school. The recommendations in this report were: — 1. Additional Welfare Centres. 2a. Extension of the scope of the Special Clinic for Delicate Children to cover the treatment of squint, rheumatism and rickets. 2b. Provision of hospital beds for children suffering from malnutrition, etc. 3. Dental Inspection of toddlers and increased Dental Sessions. 4. Establishment of a Day Nursery. The present position with regard to these recommendations is as follows: — 1. No additional Centre has been provided, but the old Centre at Thornton Hall, Mount Street, has been replaced by a more suitable one at St. Matthew.s Institute, Hereford Street, where more Sessions are being held. 2. There has been no development under these headings. 3. This has been carried out. 4. No action has been taken. MEDICAL INSPECTION OF SCHOOL CHILDREN. The County School Medical Officer has kindly furnished me with the following statistics with regard to the medical inspection of the school children in the Borough. It will be seen that more than half the children inspected are found to require medical treatment. In nutrition and in soundness of teeth and vision, Bethnal Green children are under the average for London, There can be no doubt this is mainly due 61 to economic causes, which is certainly responsible for the fact that only 22.5 per cent, of Bethnal Green children are well clothed and shod compared with 60.8 per cent, throughout London. The irony of this situ. ation is that the clothing and boot and shoe trades are two important local industries in which there is much unemployment. It is encouraging to note that in clean. liness Bethnal Green does not differ materially from the general London average. These figures as a whole, however, are a plain demonstration that there is a lack of adequate medical care of young children in the years immediately preceding their attendance at school. To remedy this requires some extension of the pre. sent facilities for the supervision of . the toddler . and closer relations between the Maternity and Child Wel. fare and School Medical Services. The routine medical inspection of toddlers by the new full.time Medical Officer, which has been instituted from the beginning of 1932 is a small contribution to the solution of the problem, but increased staff and premises are required for it to be tackled thoroughly. Routine Medical Inspection of Elementary School Children in Bethnal Green in 1931. Age Groups Number Examined CLOTHING AND BOOTS NUTRITION CLEANLINESS OF HEAD CLEANLINESS OF BODY TEETH VISION Good Fair Poor Good Average Below normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed 4 or more decayed . 6,6 in both eyes 6/9 in either or both eyes 6/12 or worse in either or both eyes ENTRANTS Boys 1C90 313 772 5 198 836 56 — 1036 53 I 1028 57 5 556 417 117 — — — Girls 1207 338 858 11 167 1008 32 — 1157 40 10 1155 45 7 605 460 142 — — — Age 8— Boys 976 202 773 1 54 846 76 — 935 39 2 913 60 3 532 392 52 374 443 155 Girls 977 209 764 4 103 822 52 — 907 65 5 897 75 5 550 375 52 327 459 189 Age 12— Boys 773 95 676 2 99 636 38 — 748 25 — 738 33 2 477 278 18 325 285 163 Girls 960 236 724 — 105 830 25 — 903 56 1 932 28 — 644 304 12 422 322 215 Age 14— Boys 616 91 524 1 58 532 26 — 598 18 — 598 17 1 401 205 10 302 177 136 Girls 712 163 549 — 81 621 10 — 688 19 5 690 20 2 480 220 12 304 237 168 Total 7311 1647 5640 24 865 6131 315 — 6972 315 24 6951 335 25 4245 2651 415 2054 1923 1026 Percentage London 22.5 77.2 0 3 11.8 839 4.3 — 95.4 4.3 03 95.1 4.6 0.3 58.1 36.2 57 411 38.4 20.5 60.8 38.5 0.7 206 749 4.5 — 95 5 4.0 0.5 973 2 6 o.i 662 27.4 6.4 58.5 23 5 18 0 65 Examination of Elementary School Children in Bethnal Green, 1931. BOYS GIRLS Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number examined 1090 976 773 616 1207 977 960 712 Cases * Cases * Cases • Cases * Cases * Cases # Cases * Cases . Malnutrition 4 2 10 3 2 1 2 1 2 8 5 1 2 — — — Skin disease 14 3 10 8 7 7 2 2 23 12 10 8 5 4 5 3 Defective teeth ... — 466 — 363 — 274 — 209 — 508 — 356 — 293 225 Enlarged tonsils... 278 118 108 38 63 22 47 32 275 106 132 52 113 51 63 47 Adenoids 38 21 21 15 2 1 3 3 28 12 21 14 6 3 3 3 Enlarged tonsils and adenoids 30 20 10 9 7 6 i 1 36 24 10 10 4 4 3 3 Other nose and throat defects 11 2 10 1 5 5 4 2 11 5 8 3 4 3 4 3 Enlarged glands... 33 2 10 1 11 — 9 1 25 — 15 — 10 2 1 — Eye disease 41 28 29 20 11 9 11 9 52 29 22 17 16 14 6 3 Vision defect — — — 101 — 116 — 84 — — — 133 — 150 99. Otorrhoea n 11 14 5 5 4 2 1 22 12 8 6 8 5 4 4 Other ear disease 7 4 3 3 4 4 7 7 8 4 5 4 2 2 14 14 Defective hearing — — 5 5 3 2 2 2 3 2 2 1 2 1 2 2 Speech defects 4 — 5 2 3 2 — — 1 — I 1 — — 1 1 Heart defects 12 1 13 1 11 1 12 3 14 1 18 1 19 1 16 — Anaemia 11 4 7 3 3 1 9 — 5 — 20 3 16 2 5 2 Lung defects 96 25 41 19 17 6 9 3 121 38 53 22 14 5 6 2 Nervous defects 1 — 6 2 3 2 2 — 8 2 9 4 5 1 3 2 Phthisis — — — — 1 — — — 1 1 — — — Other t.b. disease — — 1 1 Rickets 28 3 8 — 4 — — 13 1 15 3 — Spinal deformities — — — — 3 1 — — — 1 6 2 3 3 Other deformities 11 2 9 7 14 7 4 1 11 5 13 1 17 4 14 11 Other defects 15 6 33 19 23 14 15 10 27 22 25 14 26 15 13 13 Number of children noted for treat— ment 577 501 397 292 641 513 459 359 66 .Defects however slight are included under . cases . ; those severe enough to require treatment are shown under * 67 THE CONTROL OF DISEASE. It is satisfactory to report that the epidemic of Smallpox which occupied so much of our time and energy in 1929 and 1930, subsided in 1931, although sporadic cases still occur. At the same time, prac— tically all the other important notifiable diseases have also fallen considerably in their incidence. A notable exception to this was Pneumonia, which was not only prevalent but contributed to the rise in the Death Rate, which is recorded elsewhere in this report. I do not propose to repeat the considerations advanced in my report last year that the Medical Officer of Health should be furnished with more information about the illness which is occurring in his district and with greater powers to prevent and deal with it. We have the curious anomaly of the organised public health service concentrating its excellent resources on diseases like Scarlet Fever and Diphtheria, while Rheumatism—a non.notifiable disease—with its great potentiality for serious crippling is practically outside its ken. This anomaly is of course specially marked in the London Boroughs where the local health authority has no responsibility for the school medical service. Cases of Notifiable Diseases Notified during 1931. Disease Number of Cases Notified Reported _ by RegistrarGeneral. Total Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Removed to Hospital Smallpox 144 146 1 ... 2 2 3 28 25 21 14 27 19 4 144 Enteric Fever 3 8 ... 1 1 ... ... ... ... ... ... 1 ... ... 3 Diphtheria (inc. Memb. Croup) 322 320 7 22 25 31 32 130 36 16 8 10 1 2 320 Scarlet Fever 428 432 1 24 35 42 36 163 76 27 12 15 ... 1 428 Puerperal Fever 7 8 ... ... ... ... ... ... ... ... 2 6 ... ... 8 Puerperal Pyrexia 15 15 ... ... ... ... ... ... ... 1 2 12 ... ... 13 Ophthalmia Neonatorum ... 23 23 ... ... ... ... ... ... ... ... ... ... 3 Erysipelas 97 99 5 3 ... 1 3 8 8 5 9 22 21 14 46 Cerebro-spinal Fever ... ... 6 2 ... 1 ... ... 2 ... ... 1 ... ... 6 Acute Poliomyelitis ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 Acute Encephalitis Lethargica ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia ... 155 8 11 13 6 7 16 8 13 9 28 27 9 81 Acute Influenzal Pneumonia ... 29 ... 2 1 2 ... 1 ... 5 ... 6 9 3 8 Dysentery ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Malaria ... 3 ... ... ... ... ... ... ... ... ... 2 1 ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever, Cholera, Plague, Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Hydrophobia, Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... 214 12 8 10 22 29 108 17 5 2 1 ... ... 25 Pulmonary Tuberculosis ... 126 ... ... ... 1 5 2 18 19 48 30 3 * Other forms of Tuberculosis ... 45 ... 2 3 1 3 12 8 4 2 8 2 ... * Total ... 1627 59 73 91 107 114 474 180 115 81 186 111 36 1087 89 * See particulars as to Sanatorium Treatment in Tuberculosis section. † The Registrar-General's figures are for notifications received during the 52 weeks ended 2nd January, 1932. The Council's figures are for cases occurring during the calendar year. 69 Diphtheria. There were 320 cases of diphtheria notified during the year. The age grouping of the cases is given in the accompanying table. All the cases were removed to an isolation hospital. Seven deaths from this disease occurred during the year, equivalent to a case mortality of 2.2 per cent., or general death rate of 0.06 per 1,000 of the population. There has been much discussion in recent years concerning artificial means of securing immunity from Diphtheria. Although the question has been mooted, no proposal for the use of these means in the Borough has yet been adopted. As will have been seen from the figures in my last report, the mortality from Diphtheria has shown a decided fall during the last 10 years. I understand that the Schick test and immunisation1 treatment have been employed at the Queen.s Hospital recently as a means of checking outbreaks of Diphtheria in the Hospital. Anti . diphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 36,000 units were supplied during the year. Scarlet Fever. There were 432 cases of scarlet fever notified during the year, 428 of the patients being removed to an isolation hospital. The disease is still of a mild character. I understand that the Dick test has been used in the Queen.s Hospital for the purpose of diagnosis and serum for immunisation or therapeutic purposes, in order to prevent the spread of scarlet fever in the hospital. One death was returned by the Registrar.General as due to scarlet fever during the year, equal to a case 70 mortality of 0 2 per cent., and a death rate of 0 01 per 1,000 population. Smallpox. One hundred and forty.six cases of Smallpox occurred in the Borough during the year, while many cases occurred in other London Boroughs with contacts in Bethnal Green. The present outbreak of Smallpox began in March, 1929, and there were 263 cases that year. During 1930 the disease was at its height in the Borough, there being 948 cases. The character of the disease has remained unchanged, i.e., extremely mild. There was 1 death in 1929, 2 in 1930, but none in 1931. Enteric Fever. Three cases were notified and removed to hospital but one was eventually discharged .no obvious disease.. Chicken Pox. This disease ceased to be notifiable during the year. Other Notifiable Diseases. Particulars of the number of notifications of various diseases and the age grouping of the patients will be found in the accompanying table. In addition to the usual routine enquiries and protective measures, special enquiries have been made in a number of cases of Encephalitis Lethargica, etc., on behalf of the London County Council. Consultations with Medical Practitioners. I was called in consultation by medical practitioners with a view to discussing the diagnosis in a number of doubtful cases. Statistics and notes with regard to Puerperal Fever, Ophthalmia Neonatorum, Infantile Diarrhoea, and Home Nursing will be found in the section relating to Maternity and Child Welfare, SMALL-POX 1931. (CALENDAR YEAR.) 0—1 1—2 2—3 3—4 4—5 5—10 10—15 15 2020 -25 25—45 45—65 65- Total Vaccinated: In infancy ... ... ... ... ... ... 2 ... 1 4 13 2 22 Subsequently ... ... ... ... ... ... ... ... ... ... ... Unvaccinated 1 ... 2 2 3 28 23 20 16 20 7 2 124 Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 3 28 25 20 17 24 20 4 146 71 VACCINATION. The following is the latest available return by Mr. P. Ivess, Vaccination Officer of the North East and South West Sub.Districts of the Bethnal Green Registration District, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1930, inclusive. Registration Sub. Districts comprised in the Vaccination Officer.s District. No. of Births from 1st Jan. to 31st Dec., 1930. Number of these Births duly entered by 31st Jan., 1932. No. of Births which on 31st Jan.. 1932, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1932, not accounted for Total No. ot Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1931. No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1931. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Declarations of conscientious objection received. Died Unvacci. nated. Postponement by Medical Certificate Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. North East 858 88 1 Nil 549 26 20 8 15 151 233 388 South West 516 71 Nil Nil 279 14 18 1 11 122 245 257 TOTAL ... 1,374 159 1 Nil 828 40 38 9 26 273 478 645 72 78 NON.NOTIFIABLE DISEASES. Measles. During the year 177 cases of Measles came to my knowledge from the following sources: — Schools 71 L.C.C Special Hospitals 81 Other Hospitals 6 Medical Practitioners 7 Health Visitors 10 Others 2 177 Ten cases of German Measles were also reported. All cases were visited, either by a Health Visitor or the District Sanitary Inspector, according to the age of the patient. Eighty . five patients were removed to L.C.C. Special Hospitals, and in two cases nursing assistance was provided by the Council. Seven cases proved to be not measles. Twenty.nine cases of . suspected measles. were reported through the school organisation, but only 1 proved to be measles. Information as to primary cases under school age is passed on to the L.C.C., to enable that authority to check the spread of infection in the schools and similar information is sent to Sunday Schools. Whooping Cough. One hundred and twelve cases of Whooping Cough came to my knowledge; through reports from the L.C.C. (77), Health Visitors (25), Schools (4), and other sources (6), and these children (all under 5) 74 were visited by the Health Visitors. 83 children were removed to an Isolation Hospital and 76 recovered. 9 deaths from this disease were recorded during the year. Miscellaneous Investigations. A number of children were visited by the Inspectors for illnesses reported by the Head Teachers, and suggestive of one of the notifiable diseases. Diabetes. Arising out of an application from the University College Hospital on behalf of a poor Bethnal Green patient, the Council sought and obtained the sanction of the Ministry of Health to pay for the provision of insulin for such patient. This was done throughout the year and the patient has shown some improvement under treatment. No other application has been received. Health Education Lectures on Venereal Disease. Two lectures given in the Public Library Lecture Hall on the subject of the Dangers of Venereal Disease were arranged by the British Social Hygienic Council, on behalf of the Borough Council, during the Autumn, one being for men and the other for women. Councillor C. Bennett took the chair at the first and Councillor Miss L. D. Benoly at the second. The lectures, which were illustrated by cinematograph films, were well attended. DISINFECTION SERVICE. During the year, 1,498 rooms and 31,084 articles were disinfected for various reasons, liquid Formalin in the form of a spray being used for the purpose of disinfecting rooms. Two Morris motor vans are used for conveying articles for disinfection. 75 The table appended gives full details of the rooms, bedding and clothing disinfected. No. of Rooms Articles of Disinfected Clothing, etc. Infectious disease 1,186 11,018 Scabies 59 4,107 Verminous conditions 200 2,889 Other conditions 53 805 Hospital bedding 11,339 1,498 30,158 There were also 926 articles disinfected in the Formalin Chamber. No. of articles destroyed by request, 238. Arrangements are now in operation for any necessary disinfection to be carried out during the week.end, one disinfector standing by for duty on Saturday afternoon and Sunday morning. INSECT PESTS. A small stock of spraying machines is kept for issue on loan, with a quantity of insecticide, to residents desirous of following up and completing the disinfection of their rooms. The sprayers were lent on 240 occasions during the year, as compared with 522 last year, and 428 in 1929. Verminous Conditions. One hundred and two children in 68 families were reported from the L.C.C. Cleansing Station as being infested with vermin. In every case advice as to the treatment of the clothing and bedding was given and disinfestation by steam was offered. In 22 cases disinfection of some kind was accepted. Rooms were disinfested of vermin in 200 cases. 76 Scabies or Itch. Forty.six children suffering from this disease were visited after being excluded from the Elementary Schools. In 31 instances disinfestation of the clothing and bedding was accepted. In addition, 18 cases of Scabies were reported by the London Hospital and one by the London Jewish Hospital; and in all but 2 of these cases the bedding was disinfected. Fifty.nine rooms were also fumigated after Scabies. Personal Cleansing Station. The Personal Cleansing Station is becoming better known to the public as part of the Council.s considered scheme for the destruction of insect pests, although it has been little used by women. It should be emphasised by all whom it may concern that use of the Council.s Cleansing Baths for this purpose is not attended by any indignity. The whole procedure is simply one of personal hygiene and those who are so unfortunate as to get into a verminous condition or to be afflicted with Scabies, should take prompt advantage of the facilities available to them to get rid of their trouble. Considering the deplorable housing conditions in the Borough it is remarkable what a brave fight against vermin and dirt is waged by the housewives. The baths are available for women on Wednesdays, when a woman attendant is engaged, the other days being allocated to men. During the year men had 289 baths and a woman had 1 bath and their clothing was disinfected for vermin, and 107 men, 24 women and 8 young children had treatment with sulphur ointment, in addition to baths and disinfection, on a total of 352 occasions for Scabies. DISTRIBUTION OF DISINFECTANTS. During the year 6,099 pints of partially diluted disinfectant fluid were distributed to applicants at the Town Hall. 77 SHELTER FOR CONTACTS. (3, St. James Road). These premises, consisting of a nine.room house, are occupied by a caretaker and are available, as required by statute, for the accommodation of contacts of infectious disease during the disinfection of premises. The shelter was used on two occasions, one arising from smallpox (1 child), and one from scabies (family of 4). BACTERIOLOGICAL EXAMINATIONS. The Council.s bacteriological work is carried out by the Clinical Research Association. The following specimens were examined during the year: — Throat and Nasal Swabs—submitted for examin— ation 909 Diphtheria bacilli present in 99 Sputum—specimens submitted for examination 176 Tubercle bacilli present in 20 Blood.serum—specimens examined 1 Widal reaction positive in 1 One eye swab was also examined. Other bacteriological examinations in connection with food are reported on elsewhere. LONDON COUNTY COUNCIL (GENEEAL POWERS) ACT, 1928, SECTION 28. Care of Aged and Infirm Persons. During the year, a magistrate.s order was obtained on three occasions for the removal to hospital of aged and infirm persons found to be living under insani— tary conditions and not receiving proper care and attention. In several other instances brought to my notice, the person concerned voluntarily agreed to enter hospital without the necessity for adopting the formal procedure referred to above. 74 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and parti— culars of the number of notification certificates received during the year are set out in the tables appended hereto, from which it will be seen that 171 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations. In addition, there were 33 cases which came to my knowledge other than by notification, 18 of these being after death, making a total of 204 cases. The number of patients remaining on the Tuber— culosis Register at the 31st December, 1931, was 1,426. The details are given in the table on page 81. During the year the Registrar.General reported 119 deaths from Pulmonary Tuberculosis, and 13 deaths from other tuberculous diseases. The number of deaths from Tuberculosis of all kinds during the past few years is as follows:— Pulmonary Non.Pulmonary Total 1919 185 31 216 1920 173 24 197 1921 158 26 184 1922 194 25 219 1923 164 19 183 1924 134 18 152 1925 121 21 142 1926 121 20 141 1927 115 17 132 1928 105 18 123 1929 109 10 119 1930 96 12 108 1931 119 13 132 79 The notifications received during the year will be seen from the following tables Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Form A received during the year 1931. Age of Patient Tuberculosis of the Lungs Other Tuberculosis Male Female Total Male Female Total Primary Notifications. 0—1 year ... ... ... ... ... ... 1—5 years. ... 1 1 7 2 9 5—10 „ 3 2 5 8 4 12 10—15 „ 1 1 •2 2 6 8 16—20 8 10 18 2 2 4 20—25 „ 10 9 19 2 2 25—35 „ 13 12 25 4 3 7 35. 45 „ 18 5 23 1 ... 1 45—55 „ 18 7 25 1 1 55—65 ,, 3 2 5 1 ... 1 65 years and over 2 1 3 ... ... ... Total ... 76 50 126 25 20 45 Cases re.notified 40 27 67 6 6 11 Total Notifications on Form a 116 77 193 31 25 56 80 Patients added to the Register otherwise than by notification. Pulmonary Non.Pulmonary 0—1 years — — 1.5 1 7 5—10 — 2 10—15 — 1 15.20 1 — 20—25 4 — 25—35 8 1 35—45 2 — 45—55 2 2 55—65 2 — 65 years and over — — 20 13 — — Notification is fairly satisfactory on the whole, but delay is sometimes experienced in the receipt of notifications of admissions to and discharges from sanatoria. There were 18 deaths certified from Tuberculosis in which the deceased person had not previously been notified. Enquiry of the certifying practitioner in each case elicited the following explanations: — Due to oversight or pressure of work 1 Previous notification assumed or alleged 1 Diagnosis only reached at or immediately before death 13 Certified by Coroner 1 No reply 2 Ten of these cases were Tuberculous Meningitis. Late notification, probably due to delay in seeking medical treatment, is shown by the following figures: — Notified practically at time of death 8 ,, within 1 month „ " 6 „ „ 3 months „ „ 12 „ „ 6 months „ „ 15 81 No. of Notifications on Forms C. & D. Poor Law Institutions Sanatoria C D C D Pulmonary Tuberculosis— Male 54 34 79 63 Female 14 11 49 33 Non.Pulmonary Tuberculosis— Male ... ... ... 19 4 Female ... ... 19 4 C—upon admission D—upon Discharge Public Health (Tuberculosis) Regulations, 1924. Pulmonary Non.Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/30 ... 576 402 245 187 1410 Number of cases notified under the Public Health (Tuberculosis) Regulations, 1912, during the year 1931 76 50 25 20 171 Transferred from non.pulmonary 1 ... ... ... 1 Other cases added to theTuber. culosis register during year 9 11 5 8 33 662 463 275 215 1615 Number of cases removed from Tuberculosis Register during year. (For details see separate statement) ... 90 69 15 14 188 Transferred to pulmonary ... ... ... 1 ... 1 Cases remaining on Tuber. culosis Register 31/12/31 ... 572 394 259 201 1426 Details of Cases removed from Tuberculosis Register during the Year 1931. Deaths 144 Patients removed from Borough 42 Cases removed from Register as " Cured" 2 Total 188 82 WORK OF TUBERCULOSIS HEALTH VISITORS. The two Tuberculosis Health Visitors paid 4,951 visits of enquiry and advice with regard to the welfare of tuberculous patients in the Borough. In the course of their work they endeavour to persuade patients to adopt such hygienic manner of life as is practicable by separate sleeping accommodation, safe collection and disposal of sputum, etc. They also make economic enquiries on behalf of the L.C.C. in connection with sanatorium treatment, etc. TUBERCULOSIS SUB.COMMITTEE. The Sub.Committee of the Public Health Com— mittee has functioned during the year as the local Tuberculosis Care Committee, dealing with such matters as grants of extra nourishment, assessments for sana— torium treatment on behalf of the London County: Council, special treatment, etc. SUPPLY OF SPUTUM OUTFITS. During the year 15 sputum flasks were distributed to patients. Eighteen sputum tins, with 2,143 card— board refills, were distributed to patients for use indoors. OPEN.AIR SLEEPING SHELTER. The Council.s Open.Air Sleeping Shelter was in use during the latte? part of the year. Unfortunately, owing to the limited space available in the yards and gardens attached to the houses in the Borough, very little extension of use can be made of this valuable adjunct to treatment. PROVISION OF BEDSTEADS AND BEDDING, AND CLOTHING. The bedsteads and bedding which are available for loan to necessitous patients to enable them to sleep alone were frequently used during the year. 83 Some assistance has also been rendered to patients in getting necessary clothing for use while in sanatoria. SANATORIUM TREATMENT. During the year 152 patients were recommended to the London County Council for Sanatorium Treat— ment, and 135 of them were sent away for such treat— ment. Of the remaining 17 cases, 13 patients were offered beds in one of the L.C.C. General Hospitals and in 9 instances this offer was accepted; in 1 case a sanatorium vacancy was declined; 1 patient removed to another borough while his case was under consideration; and in the remaining 2 cases the L.C.C. were unable to provide sanatorium treatment, no reason being given for non. acceptance. One patient was sent to Papworth but did not remain. Eight children were recommended and admitted to the open.air school at Stormont House, Hackney. GRANTS OF EXTRA NOURISHMENT. During the year 305 grants of Grade A (Tuberculin Tested) milk and new laid eggs were made to 113 necessitous tuberculous patients at an estimated cost of £325. 35 patients were receiving nourishment at the end of the year. Now that the detailed restriction of the Ministry of Health has been removed by the Local Government Act, slightly more has been spent on this very necessary adjunct to medical treatment. TUBERCULOSIS DISPENSARY. A full report on the work of the Dispensary, by Dr. H. T. Howell, the Clinical Tuberculosis Officer, together with a copy of the new Annual Return to the Ministry of Health appears in the appendix to this report on page 123, 84 JOINT DISPENSARY COMMITTEE. The Joint Dispensary Committee (which was set up under the agreement between the Borough Council and the Governors of the City of London Hospital for Diseases of the Heart and Lungs, and consists of four representatives of the Hospital Governors, three repre— sentatives of Bethnal Green and three of Hackney), has met regularly during the year. DENTAL TREATMENT FOR TUBERCULOSIS PATIENTS. During 1931, 3 dispensary patients received dental treatment at the City of London Hospital for Diseases of the Heart and Lungs, and made three attendances therefor. Four patients were also assisted in the provision of artificial dentures. FINSEN LIGHT TREATMENT FOR LUPUS. PNEUMOTHORAX REFILLS. Since 1921, the Council has paid for the Finsen Light treatment of cases of Lupus at the London Hospital. During the year 6 patients were so treated, making 91 attentances for treatment. Four patients also made 249 attendances for arc light treatment of Lupus at the same hospital. General Light Treatment was provided for three patients on 35 occasions at the City of London Hospital for Diseases of the Heart and Lungs. Under the Council.s arrangements for the provision of pneumothorax refills, 4 patients had 68 refills at the Brompton Hospital and 11 patients received this form of treatment at the City of London Hospital, having 82 refills between them. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was taken under these regulations during the year. 85 PROTECTION OF FOOD SUPPLY. The work of the Local Health Authority with a view to the protection of the food supply takes three forms: (i) Supervision of premises where food is pre— pared or sold, to ensure cleanliness; (ii) Examining food as to its soundness; and (iii) Sampling food to ascertain its composition and quality. The whole sanitary inspecting staff co.operate in exercising general supervision over the cleanly conduct of the food trades. The conditions under which food is sold in the street or from shops with open fronts still gives room for much dissatisfaction. Unsound food is much less frequently found than in former years and in this as in the matter of cleanli— ness, food traders and the public are rightly recognising the need for higher standards. The figures which follow illustrate the problems which arise in testing the quality and nature of the great variety of foodstuffs now in common use. We still lack official standards for many important foods. 86 FOOD AND DRUGS ACTS. Seven hundred and forty.nine samples were taken; 695 of these proved to be "genuine" and 53 or 7.l per cent, adulterated. The details are given in the following table:— SUMMARY OF ANALYST.S REPORTS. Samples taken formally Samples taken informally Article No. taken Genuine Adulterated No. taken Genuine Adulterated Total number of samples taken Milk 302 293 9 I I ... 303 Butter 97 94 3 24 23 1 121 Margarine 18 15 3 1 1 ... 19 Sterilised Milk 1 1 ... ... ... ... 1 Condensed Milk 2 2 ... 3 3 ... 5 Cream 8 8 ... 1 1 ... 9 Tinned Cream ... ... 1 1 ... 1 Lard 2 2 ... 2 2 ... 4 Lemon Squash ... ... 1 1 ... 1 Ginger Wine ... ... 1 ... i 1 Cordials ... 1 ... 12 io 2 13 Whisky ... 3 ... ... ... ... 5 Rum ... ... ... 4 2 2 4 Tincture of Quinine ... ... 4 4 ... 4 Castor Oil 5 ... ... 2 2 ... 2 Camphorated Oil ... 1 ... ... ... ... 1 Pills ... ... ... 1 1 ... 1 Mercury Ointment... ... ... ... 1 1 ... 1 Cod Liver Oil and Malt ... 1 1 ... 4 4 ... 5 Gentian Root ... ... ... 2 1 1 2 Spirits of Nitrous Ether ... ... ... ... 1 1 ... 1 Aspirin Tablets ... 1 ... ... ... ... 1 Pepper ... 1 ... 1 1 ... 2 Mustard 2 ... ... 1 1 ... 1 Mixed Spice ... ... ... 3 3 ... 3 Ground Ginger ... ... 2 6 5 1 8 Stem Ginger 1 ... ... 1 1 ... 1 Sultanas ... ... ... 7 7 ... 7 Mincemeat 1 1 ... 4 4 ... 5 Sponge Cake ... ... ... 7 7 ... 7 Sweets 1 1 ... 7 7 ... 8 Bread ... ... ... 8 8 ... 8 Flour .. ... ... ... 9 9 ... 9 Rice 2 2 ... ... ... 2 Pearl Barley 13 13 ... 2 2 ... 15 Ground Rice ... ... 2 2 ... 2 Jam 52 47 5 3 3 ... 55 67 SUMMARY OF ANALYST.S REPORTS—continued. Article Samples taken formally Samples taken informally I No. taken Genuine Adulterated 1 No. taken Genuine Adulterated Total number of Samples taken Vinegar 54 47 7 3 1 2 57 Malt Vinegar 6 6 .... .... ... .... 6 Frying Oil .... .... .... 8 "s .... 8 Fried Fish and Potatoes ... .... • •• .... 4 4 .... 4 Minced Meat .... .... 3 3 3 Sausages 2 1 .... 0 1 1 4 Meat Paste .... .... .... 2 2 .... 2 Fish Paste .... .... .... 1 1 .... 1 Tinned Fruit .... .... .... 1 1 .... 1 Golden Syrup 1 1 .... ... .... 1 Honey 1 1 .... .... 1 Drippiig 1 1 .... 6 5 1 7 Tinned Peas 3 3 .... .... .... 3 Dried Peas 1 1 .... .... .... 1 Dried Herbs 3 1 2 6 "2 4 9 Tea .... .... .... 2 2 .... 2 Cocoa 1 1 .... .... ... .... 1 Totals 584 550 34 165 146 19 749 The Public Analyst has furnished me with the following report on his work during the year :— During the year 1931, a total of 749 samples were ex— amined under the Food and Drags (Adulteration) Act. Two of these samples were taken by a neighbouring Authority; the remainder were submitted by the Inspectors. No samples were submitted by the Public. One hundred and sixty.eight samples were purchased informally. Fifty.three samples were found to be adulterated; in addition forty.eight other samples were of inferior quality or doubtful purity. The adulteration was at the rate of 7.1 per cent. The average rate of adulteration for the London Boroughs in 1930 was 2.9 per cent., and for the whole of England and Wales, 4.8 per cent. 88 The adulteration in the Borough for the previous eight years was as follows : — Year No. of samples Examined Percentage of adulteration 1930 737 6.5 1929 750 8.0 1928 731 9.3 1927 72 8 9.2 1926 721 3.3 1925 745 3.9 1924 754 61 1923 736 5.6 Average 73 8 6.5 The number of samples examined was at the rate of 6.9 per 1,000 of the population, as compared with 9.1 per 1,000 for the London Boroughs and 3.6 for the whole of England and Wales. Three hundred and three samples of milk were examined of which 9 samples, or 3.0 per cent, were found to be adulterated. This is the lowest rate of adulteration for milk recorded in the Borough for the past seven years. I he figures for the previous six years are as follows: — Year No. of milks Examined Percentage adulterated 1930 296 6.8 1929 281 5.2 1928 306 8.2 1927 275 5.4 1926 340 2.9 1925 355 4.8 Average 310 5.5 Condensed, Milk. Five samples of condensed milk were examined. They were all satisfactory. 89 Preservatives. There were 11 contraventions of the Preservatives Regulations. Other samples examined during the yeair were : — Twenty.five samples of Rag Flock, 5 of which were not up to standard quality of cleanliness. One Well Water, one Bath Water and one Creosote Oil. Albert E. Parkes. f.i.c. FOOD. AJNTI) DEUGS. Legal Proceedings, 1931. Sample No, Food and Drugs (Adulteration) Act. 12.1.31 636 Selling Raspberry Jam containing other fruit jam than Raspberry to extent of 75°/o Fine £5 : Costs £2 2s. Od. 13.2.31 637 Selling Vinegar 42«/o deficient in acetic acid Fine £8 : Costs £5 5s. Od. 6.2.31 635 Selling Butter containing 5 1°/o excess of water Adjourned sine die. 6.2.31 657 Selling Butter containing 3°/o excess of water Do. 6.2.31 — Consigning Butter containing more than 16% water to A.S. Dismissed on legal point. 62.31 - Consigning Butter containing more than 16«/o water to A.M. Do. 9.2.31 666 Selling Milk containing 15°/o added water Fine £2 : Costs £8 8s. Od. 9.2.31 689 Selling Milk containing 17°/o added water Fine £20 : Costs £7 7s. Od. 2 3.31 8 Selling Vinegar 7J°/o deficient in acetic acid No Fine : Costs £1 3s. Od. 30.331 18 Selling Strawberry Jam 64»/o deficient in strawberries Dismissed : Warranty proved as against Wholesaler. 23.3.31 78 Delivering Milk, in pursuance of contract, 30«/o deficient in fat Public Health (Preservatives, etc., in Food) Regulations No Fine : Costs £3 3s. Od. 7.5.31 89 Selling Strawberry Jam containing 50 parts per million excess of SO! Food and Drugs (Adulteration) Act. Dismissed : Warranty proved. 2.4.31 113 Selling Vinegar 7 \r>o/0 deficient in acetic acid Public Health (Preservatives, etc., in Food) Regulations Fine 5/. : Costs £1 3s. Od. 7.5 31 — Selling Strawberry Jam containing 50 parts per million excess of SO2 Adjourned sine die. 90 FOOD AND DRUGS—Contd. Legal Proceedings, 1931. Sample No. Food and Drugs (Adulteration) Act. 4.6.31 171 Selling Strawberry Jam containing 75«/o other fruit jam Food and Drugs (Adulteration) Act. Fine 18/. : Costs £2 2s. Od. 4.5.31 173 Selling Milk containing 4 .5o/o added water No Fine : Costs £4 4s. Od. 1.6.31 193 Selling Milk 26°/o deficient in fat Fine £2 : 30.6.31 284 Selling Thyme containing 4.5»/o excess of Sand Public Hea.th (Preservatives, etc., in Food) Regulations Costs £1 Is. Od. Costs 2/.. 6.7.31 281 Selling Ground Ginger containing added preservative to wit SO2 Withdrawn. 6.7.31 283 Do. do. Food and Drugs (Adulteration) Act. No Fine : Costs £5 5s. Od. (Wholesalers). 6.7.31 329 Selling Vinegar 20°/o deficient in acetic acid Fine £1 : No Costs. 31.8.31 415 Selling Milk 6.6«/o deficient in fat Fine £1 : No Costs. 3.11.31 537 ■Selling Vinegar 12 .50/0 deficient in acetic acid Public Health (Preservatives, etc., in Food) Regulations Fine £5 : Costs £3 3s. Od. 16.11.31 575 Selling Sausages, unlabelled, containing preservative in form of SO2 No Fine : Costs £1 3s. Od. SAMPLES TAKEN INFORMALLY. One hundred and sixty-five samples were taken informally during the year, nineteen of which were found to be adulterated, as follows: — Article No. of Sample Offence Ginger Wine 69 Contained 0:4 grs. per pint Zinc. Dripping 111 ,, 3 'O% free fatty acids. Vinegar 129 20% deficient in acetic acid. Mixed Herbs 250 Contained 3.8% Sand. Thyme 257 ,,7.2% „ Veal Stuffing 259 ,, 7.8%„ „ Parsley 263 »» 3-5% ,, 91 Article. No. of Sample. Offence Ground Ginger 265 Contained 320 parts per million Sulphur Dioxide. Vinegar 328 20«/o deficient in acetic acid. Butter 339 Contained 16.5»/o water. Lemon Crush Cordial 389 „ 680 parts per million Benzoic Acid. Sausages 570 „ 192 parts per million Sulphur Dioxide. Minced Meat 732 .1 160 „ „ ft Do. 737 a 160 tl a a Do. 741 a 30 „ ,, ,1 Rum 747 37° under proof. Do. 769 37° a a Ginger Wine 774 Contained l/3rd grs. per pint Zinc. Gentian Root 768 Consisted of Ground Ginger. The genuine samples are indicated in the table on pages 86 and 87. PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 to 1927. One formal and 6 informal samples taken under these Regulations were found to contain preservatives, as follow:— Minced Meat ... 160 160 30 parts per million of sulphur dioxidt Sausages 1101 1921 Ground Ginger ... 320/ Lemon Crush Cordial 680 parts per million of benzoic acid PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Two formal samples and three informal samples of condensed milk were taken under these Regulations. All the samples were found to comply with the Regula— tions. 92 PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. No samples of dried milk were taken during the year. BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year 17 bacteriological examinations of milk, 1 of other food and 1 of water were made as follows:— Ordinary Milk, 4; Grade A Milk, 2; Grade A (Tuberculin Tested) Milk, 3; Pasteurised Milk, 8; Cream, 1; Well Water, 1. B. Coli were found in 2 samples of ordinary milk, in 3 samples of Pasteurised Milk and in the sample of well water. FOOD PREMISES. Milkshops and Dairies. Forty.five* applications for registration were considered during 1931, four of them referring to a round only. ♦This includes changes of occupier in premises previously on the register. 93 The figures in regard to registration of Milkshopa are set out below:— Number of purveyors of milk on register at end of 1930 260 Deduct number of purveyors removed from register during 1931 37 Add number of new purveyors added to register by resolution of the Public Health Committee during 1931 ... 45 Number of purveyors of milk on register at end of 1931 268 During the year 734 inspections of milkshops were made by the Inspectors, and 61 notices were served under the Public Health (London) Act, 1891. No legal proceedings were found to be necessary. A large number of the premises registered for th( sale of milk are small general shops where the shopkeeper, with the best of intentions, inevitably has difficulty in adequately protecting the milk from contamination. The recent practice of pasteurising oi sterilising milk and supplying it in sealed bottles partly meets this difficulty, but there is still a large quantity of loose milk distributed in shops of the type referred to. The public undoubtedly prefers the more cleanly method of delivering milk in sealed bottles. This depends for its advantages on the cleansing and filling of the bottles in suitable premises and under conditions which preclude contamination of the milk. Some careless or unscrupulous milk traders are, however, occasionally found filling bottles in the street and perhaps sealing them with discs taken from their pocket —a practice both contrary to the Milk and Dairies Order and to the principles of hygiene. Three milk vendors were summoned for the offence, being ordered by the magistrate to pay an aggregate of £4 19s. Od. in fines and costs. 94 Milk (Special Designations) Order, 1923. Eight dairymen were licensed to sell " Grade A (Tuberculin Tested)" Milk, 1 for the sale of " Grade A " Milk, and 2 for the sale of " Pasteurised " Milk, while supplementary licences to sell " Certified " milk in the Borough from premises in Stepney and Hackney and others to sell " Grade A (Tuberculin Tested)," "Grade A" and "Pasteurised" milk in the Borough from premises in Poplar, Shoreditch, Hackney, Stepney and Islington were also granted during the year. The samples of graded milks taken during the year were found to be in conformity with the Order. Cowhouses. There were at the end of 1931, eleven licensed cowhouses in the Borough. Forty-six inspections were made during the year. No notices were served. The premises are as follows: — 63, Bishop.s Road.—Shed No. 1—(8 cows). Shed No. 2—(6 cows). 42, Cheshire Street—(6 cows). 23, Ezra Street—(6 cows). 38, Fellbrigg Street—Shed No. 1—(8 cows). Shed No. 2—(8 cows). 104, Gibraltar Walk—(18 cows). 34b, Green Street—(45 cows). 1, Hamilton Road—(14 cows). 55, Kerbela Street-—Shed No. 1—(18 cows). Shed No. 2—(2 cows). 2, Lisbon Street—(19 cows). 64, Squirries Street—(14 cows). 38, Three Colts Lane—(23 cows). A copy of the Milk and Dairies Order, 1926, was furnished to each cowkeeper in the Borough, and his attention was drawn to the requirements of the Order at the time it came into operation. Renewed representations were made during the year to the London County Council, as the licensing authority for cow— houses, concerning the unsatisfactory charaoter of 96 certain of these premises, which are of such old con— struction and so situated as to be difficult of alteration to comply with modern standards. It is to be hoped that some action will be taken in the matter during1 1932, as a continuance of the present situation cannot be justified from a public health point of view. Ice Cream Premises. There were 161 ice cream premises registered at the end of the year, and 275 visits were paid to them by the district inspectors: 21 notices were served. Fried Fish and Fish.Curing Premises. At the end of 1931 there were 47 fried fish vendors. premises in the Borough, at two of which curing was also carried on. There were 19 fish curers. premises, including these two. Two hundred and sixty.six visits were made by the Food Inspectors to these premises, and 5 notices were served for insanitary conditions. Workshop Bakehouses. There are, in Bethnal Green, 40 workshop bakehouses, 11 of which are underground: 109 visits were made to them during the year, resulting in the serving of 12 sanitary notices. Factory Bakehouses. There are, in Bethnal Green, 27 factory bakehouses, 10 of which are underground. In nearly every case the mechanism used, which causes the bakehouse to be a factory, is a dough mixer. Generally speaking, the factory bakehouses are kept clean and in a sanitary condition. 102 inspections were made during the year, and two notices were served. Wholesale Dealers in Margarine. The following premises are registered as being occupied by wholesale dealers in margarine: — 136, 352, 374 and 420, Bethnal Green Road, 153 96 and 200, Brick Lane, 231, Cambridge Road, 19, 182, 199, 209, 211, Green Street, 282, 324a and 489, Hackney Road and 43a, Old Ford Road. Other Premises used for the Preparation or Sale of Food. There were 192 such premises on the register, the majority being restaurant.kitchens or butchers. shops. 622 inspections were made during the year, and arising out of such inspections 37 notices to remedy faults or insanitary conditions were issued. Slaughterhouses . There are two licensed slaughterhouses in the Borough, situated at: — 294, Bethnal Green Road. 354, Bethnal Green Road. Visits were made to slaughterhouses by the Food Inspector twice weekly during the year. Public Health (Meat) Regulations, 1924. During the year regular visits were made to the slaughterhouses for the purpose of inspecting animals before slaughter and their carcases and offal after slaughter. The number of animals killed was as follows : — Sheep 247 Lambs 90 Pigs 18 Total 265 Still fewer animals were slaughtered than in the previous year. The Meat Inspector attributes this to the continued high prices of live cattle and the diminished purchasing power of the people. Where a silverside was formerly cut into two or three pieces it is now cut into seven or eight pieces. The quality of the sheep, lambs 97 and pigs remains at the same high standard as before, as evidenced by the small amount of offal condemned. No carcases were condemned. The condemned offal was:— 1 Sheep.s Liver Cyst. 1 Pig.s Head Tubercular. Slaughterers of Poultry. There are 8 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough: 104 visits were paid to them during the year. There are also premises on which poultry is kept prior to slaughter, and to which the by.laws would apply. Premises on which slaughtering of poultry is carried on: — 147, 151, 159 and 267, Brick Lane, 107, Bethnal Green Road, 80, Virginia Road, 71, Church Street and 36, Hare Street. UNSOUND FOOD. In addition to the special inspections of slaughter— houses and other premises where food is prepared or sold, the Food Inspectors keep stalls and market places under regular supervision, particularly during the week— end. Te District Sanitary Inspectors also keep general observation in the course of their duties. One seizure took place, consisting of 5 lb. of sausages, the trader in question being summoned and fined £10 with £5 5s. Od. costs on one summons, and £15 with £5 5s. Od. on another summons. On 30 occasions during the year, unsound food, comprising the following articles was surrendered by the owners and destroyed as trade refuse: — Description of Article. Weight. Tons. Cwts. lb. Fish 1 7 47 Meat — 1 85 Fruit 1 15 1 Vegetables 1 14 48 98 Also Dried Figs, 1 ton. Tinned fish, 95 tins. Cakes, 106 lb. Fish and Meat Paste, 180 tins. FOOD POISONING. During the year 11 cases of suspected food poisoning, all children, were investigated. In one fatal case, post.mortem examination disposed of the suggestion and in another no definite evidence was obtained. The other 9 cases were associated with Olga Street School, one proving fatal, and children from Poplar were also concerned. In co.operation with the Medical Officer of Health of that Borough, investigation was made into the illness, which resembled food poisoning, and after the elimination of other possible factors, contamination of milk was considered, also sweets called " jelly beans." Chemical and bacteriological examination of the milk showed it to be of poor quality with a high bacterial content. The " jeliy beans" gave no result. Upon further inquiry, it was found that the milk dealer in the adjoining borough responsible for the supply, pasteurised his milk by the flash point method. I under— stand from the Medical Officer of Health that this dairy— man has now installed a more up.to.date pasteurising plant. SALE OF FOOD ORDER, 1921. Part iii of this Order was continued in force during the year under the Expiring Laws Continuance Act, 1929. Imported meat and eggs are required to be labelled as such. Legal proceedings were taken for one contravention of the Order during the year. MILK, BUTTER AND MARGARINE. With a view to ascertaining the consumption of Margarine in a working.class district, I enquired of about 270 shopkeepers (mostly milkshops, provision dealers and general shops) in Bethnal Green as to their sales of Margarine in 1931. Practically all replied. 99 The total sales thus rendered was 909,167 lb., or 8.3 lb. per head of the population. For purposes of comparison and general interest, 1 obtained at the same time particulars of the sales of milk and butter. The replies gave totals of 4,425,252 quarts of milk and 683,696 lb. of butter, equivalent to 40.5 quarts and 6.26 lb. per head respectively. The full significance of these figures is only seen when we express them in terms of a family of 5 persons pex week wjhen the amounts are 7¾ pints of milk, 06 lb. margarine and 0.8 lb. of butter. Even lumping ther butter and margarine together it only amounts to 1.4 lb. per week. More striking still is the comparison of these figures for Bethnal Green with those for the country as a whole. Estimated consumption per head Great Bethnal per annum. Britain Green Milk 22.6galls. 10.1 galls. Butter 21. 5 lb. 6.26 lb. Margarine 131b. 8.31b. The average resident in Bethnal Green gets less than half the national ration of milk, less than a third of buttter and only a little more than half of margarine. Margarine is of course very valuable as a cheaper fat than butter and equally wholesome, but unless vitamins are specially added it is not really a substitute for butter. Having regard to the relatively high cost of the other vitamin.containing foods like greengrocery and fruit, butter is an essential article of working.class diet and the low consumption of this valuable food is a disquieting feature of this inquiry. The consumption of milk is also seriously low, compared with the requirements of the child population. I have to express my great appreciation of the courtesy and public spirit of the shopkeepers who so readily and thoroughly complied with my request for information. 100 GENERAL SANITARY ADMINISTRATION. The gradual emergence of new branches of Public Health activity does not in any way lessen the vital importance of the original task—to provide a sanitary environment for the people. This work is specially difficult in a congested borough like Bethnal Green, where the greater part of the housing is seriously below modern standards, badly designed, dark, lacking in proper lighting and ventilation, and much of it worn out In structure. To deal with this situation by way of Notices to remedy particular " sanitary defects " is nothing more than continually giving " first aid " to a patient who has long needed the surgeon's knife. Unfortunately owing to illness among the staff, the figures for 1931 show some falling off compared with previous years. SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for the 53 weeks ended 2nd January, 1932. Nature of Visit Totals Infectious Diseases (notifiable) 1403 Infectious Diseases (non-notifiable) 733 Complaints 4814 House to House Inspections 1108 Milkshops (621) and Cowsheds (39) Inspections 660 Other Food Premises Inspections (Meat 18, Poultry 99, Others 1324) 1441 Factory (645) and Workshop (1988) Inspections 2633 Outworkers' Homes Inspections 1151 Tenement House Inspections 418 New Buildings Inspections 117 Drainage Inspections 3029 Smoke Nuisances—Premises under observation 22 Other Inspections or Special Work 6044 Re-Inspections 23266 Total Visits for the Year 46839 Unsound Food Seizures (2) or Surrenders (26) 28 Samples of Food, etc., taken 752 Samples of Rag Flock taken 20 Police Court Attendances 88 Premises where Nuisances abated 6803 Premises where Matters Outstanding 519 101 The following sanitary defects were discovered during the year:— Dirty rooms 6,905 Defective drains and choked w.c.'s 1,076 Defective and dirty w.c.'s 2,316 Defective water supply 793 Defective paving 690 Defective gutters and rainwater pipes 749 Defective roofs 1,521 Dampness 713 Defective dustbins 1,457 Smoke nuisances 12 Other defects 8,937 Total 25,169 The work of the outdoor staff is reflected in the volume of clerical work associated with sanitary administration. During the year 5,793 Preliminary Notices were served requiring the remedying of Nuisances. 3,231 Statutory Notices were served. The legal proceedings which were necessary to enforce the Notices served are reported on in the appendix to this report. At the beginning of the year there were 965 premises with nuisances outstanding. During the year, nuisances at 6,803 premises were abated and 519 premises with nuisances outstanding were carried forward to 1932. TENEMENT HOUSES. The number of houses on the register as being let in lodgings or occupied by members of more than one family was 170; 808 visits of inspection were made to these houses, and arising out of such visiits 276 notices were served. 102 Comprehensive by-laws with regard to tenement houses were made in 1925, although many important clauses do not operate until six months after the Rent Restrictions Acts have ceased to be in force. During 1931, the L.C.C. made amending by-laws, whereby certain of these clauses come into operation upon any tenement houses becoming decontrolled. Only a small number of the houses coming under these by-laws have so far been formally registered. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920 & 1923. During the year no applications for certificated as to the state of repair of a house were received. CUSTOMS AND INLAND REVENUE ACTS. Provision was contained in the Customs and Inland Revenue Act, 1890, amended in 1891 and 1903, for the exemption from inhabited house duty of dwellings below 7s. 6d. in weekly rent, certified by the Medical Officer of Health to be so constructed as to provide suitable accommodation for the families occupying them. Owing to the lapse of time and altered levels of rentals, little use is now made of this provision and no application for a certificate was received during the year. WATER SUPPLY TO NEW HOUSES. During the year 33 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 22 formal observations of smoke shafts were made and 1 statutory notice was served. NOISE. I regret to report no progress in dealing with preventable noise, now generally recognised as conducive to ill health. Complaints are frequently made by residents of loud and persistent noises at all hours of the day and sometimes at night, with consequent loss of sleep and injury to nerves. In the absence of definite 103 lation extending the public health expression "nuisance" to cover such evils it is difficult to take any useful action. RATS AND MICE (DESTRUCTION) ACT, 1919. No formal notices were served under the Act during the year. A number of complaints as to rat infestation have been investigated and dealt with and occupiers of premises have been advised in the matter. Poor occupiers have been assisted by the supply of rat poison, 138 tins of treated biscuits axid 31 bottles of Squill being issued in this way. In some portions of the district, more particularly in the neighbourhood of railway arches and similar convenient. breeding places, there is considerable nuisance from rats. In the circumstances, a special anti-rat campaign was organised by poster and circular, in addition to the national campaign in November. During "Rat Week" the Clayton Disinfecting apparatus, jointly owned by the Works and the Public Health Committees, was brought into use, and the sewers in certain streets were thoroughly cleared of rats. OFFENSIVE MATTER. During the summer months, the inspectors keep special observation to see that offensive matter is not conveyed through the streets during hours prohibited by the by-laws. Legal proceedings were not necessary in any instance during the year. OFFENSIVE TRADES. During the year, one offensive trade, that of a Fur-skin Dresser, was carried on at 74, Florida Street. 3 inspections were madcj at these premises. Poultry slaughtering, an offensive trade also, is dealt with elsewhere in this report. RAG-FLOCK ACT, 1911. Twenty-five formal samples of rag-flock were taken during the year, and in 2 cases the amount of chlorine 104 present was found to be in excess of the limit fixed by the Regulations. Prosecution took place, and the defendants were fined 10s. and £2 2s. Od. costs in on© case and in the other fined £3 0s. Od. and £2 2s. Od. costs. RAG AND BONE DEALERS. Thirteen persons or firms are known to be carryingon this business in the Borough. During the year 20 visits of inspection were made, and one sanitary notice was served. No proceedings were necessary in respect of contravention of the by-laws during the year. HAIRDRESSERS. Seventy-seven hairdressers' premises were on the register, 94 visits were made to them, and 20 Notices were served. COMBINED DRAINAGE SYSTEMS. The reconstruction and maintenance of such combinations of drains of houses and premises as are found to be sewers by law defined and are not under highways is carried out by the Public Health Department. The records concerning these drainage systems have been checked during the year and excluding those which have gone out of existence through demolition of premises there were at the end of the year 612 combined drainage systems, taking 3,104 houses. The staff engaged on this work consists of a drainlayer and three labourers, with additional help as required. During the year 12 systems were reconstructed taking 46 houses. DRAINAGE WORK. Legal proceedings were taken in 4 instances during the year in respect of offences in connection with drainage work. Costs amounting to 23s. were awarded to the Council in respect of 3 cases and £2 2s. Od. in the other case. 105 HOUSING. The 1901 Census revealed the fact that 30 per cent, of the population in the Borough was overcrowded on the low basis of more than 2 persons per room. The 1921 Census showed that the percentage of overcrowding on the same basis was 27 per cent. In 20 years, in spite of much discussion about Housing, only 10 per cent, of the overcrowded population had been dealt with. It is unfortunate that the full results of the 1931 Census are not available at the time this report is being prepared and do not seem likely to be published before the report must be issued. I am not, therefore, able to say what has been the precise change in the position since 1921. Such Census figures as have been obtained, however, give no grounds for optimism. While the population has fallen by 7.7 per cent, the number of separate dwellings has also slightly fallen, while the number of families (i.e. separate occupiers of dwellings) has actually increased. The apparent inconsistency of a reduction in population and increase in families is no doubt explained by the changing age composition of the population arising from the reduced birth rate. OVERCROWDING. I have to report the same unsatisfactory position with regard to overcrowding as in 1930. Low as are the official standards of overcrowding, it is well known that hundreds of families are living considerably below them. As it is also known that the great majority of these families are too. poor to pay the I'ent for the accommodation they really require, even if it were available, we are compelled to close our eyes to the continued breach of the law. Occasionally attention is drawn officially to a case more terrible than usual in its defiance of decency and health and then "action" of some kind is attempted. Twenty-four such cases were reported to 106 the Public Health Committee during the year. In a few cases, where there has been apathetic acceptance of bad housing conditions in spite of several grown-up children earning wages, pressure has led to other and better accommodation being obtained. In the majority of cases, however, the poverty of the family being the real cause of their insufficient accommodation it has been impossible to remedy the overcrowding. An examination of the reports on these cases provides an incidental but important sidelight upon the need for a more general knowledge and practice of birth control. One or two rooms, originally barely sufficient for man and wife and perhaps one child, are overcrowded worse and worse as other children are brought into the family. At the same time, a vicious circle of cause and effect results from the promiscuity and deterioration inseparable from overcrowding. Prudential considerations and the facilities for practising them are naturally at a minimum in such circumstances. INSANITARY AREAS. Slum Clearance and Improvement Schemes. Under this heading, there is little to record. The Brady Street area (originally represented to the London County Council by the then Borough Medical Officer of Health, in 1904 and re-represented in 1912), is still awaiting completion. The Teale Street area which the London County Council decided to deal with in 1928 is still awaiting the actual execution of the work and the same applies to the Digby Street area which was represented to the Borough Council in 1929, after having formed part of the Green Street area referred to the London County Council in 1920. OTHER HOUSING SCHEMES. On the other hand, the Borough Council having obtained a suitable site off the Hackney Road in 1931 107 are now completing a housing scheme known as the Hadrian Estate, which will contain 83 tenements as well as a smaller scheme consisting of 73 tenements in Temple Street, Claremont Street and Teesdale Street, to be known as the Claredale Estate. HOUSING STATISTICS FOR 1931. No. of Houses erected during the year-38 tenements. 1. Inspection of Dwelling-houses during the year: — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,627 (b) Number of inspections made for the purpose 22,404 (2) (a) Number of dwelling-hoases (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 19l25 1,108 (b) Number of inspections made for the purpose 1,108 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding siub-head) found not to be in all respects reasonably fit for human habitation Nil. 2. 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 Nil. 3. Action under Statutory Powers during the year: — (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners Nil. (b) By local authority in default of owners Nil. 108 (b) Proceedings under Public Health Acts: — (1) Number of dwelling-houses Notices served: in respect of which notices Intimations, 5,793 were served requiring de) Statutory Notices, 3,231. fects to be remedied (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 6,803 (b) By local authority in default of owners Nil. (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. (d) Proceedings under Section 20 of the Housing Act, 1930: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (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. (e) Proceedings under Section 3 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners Nil. (b) By local authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close ... Nil. 109 (f) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which Closing Orders were made Nil. (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 110 FACTORIES, WORKSHOPS, OUTWORKERS, &c. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 1159 208 ... Workshops (Including Workshop Laundries) 3366 674 3 Workplaces (Other than Outworkers' Premises) 147 46 ... Total 4672 928 3 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisdnces under the Public Health Acts:— Want of cleanliness 306 280 ... ... Want of Ventilation 2 2 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other Nuisances 603 642 ... 2 Sanitary accommodation— insufficient 10 10 ... ... unsuitable or defective 570 565 ... 1 not separate for sexes 6 6 ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to out work). ... ... ... ... Total 1497 1505 ... 3 1ll Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number Workshops 1434 Workshop Bakehouses 40 Total Number of Workshops on Register 1474 Other Matters. Class Number Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 26 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Acts (s. 5, 1901). Notified by H.M. Inspector 22 Reports (of action taken) sent to H. M. Inspector. 22 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 21 FACTORIES AND WORKSHOPS. The trades carried on in the Borough are very varied as will be seen from the following classified list of the factories and workshops on the register. The number of workplaces does not, of course, indicate the relative economic importance of the various groups, as 112 the great majority of the workshops in the furnishing trade, for example, are small while several firms in the boot and shoe trade are in a very large way of business. Cabinet and Furniture Makers 913 Upholsterers 52 French Polishers 152 Metal Workers 58 Blacksmiths, Vehicle Builders and Garages 36 Basket Makers and Coopers 15 Box and Case Makers 37 Printing, Stationery and Bookbinding 23 Tailors 231 Dressmakers 97 Waterproof Makers 3 Furriers 22 Boot and Shoe Makers 73 Other Clothing Trades 45 Sawmills 43 Other Trades, including Chemists, Glassworkers, Brushmakers, etc. 192 Total 1,992 Home Workers. Of the 2,994 workmen and contractors whose names appeared on the lists received, 2,112 resided within the Borough. The latter figure is approximately double the number of individual workers, as in the majority of cases the same people are notified in February and in August. M The number of visits paid to Home Workers' dwellings was 1,498. The number of premises found to be in an insanitary condition was 196, or 34 per" cent, of the 573 premises inspected. Notices were served in 136 cases, while 38 other premises were under notice arising from other visits, and a verbal intimation was given in 22 further cases. Difficulty is still experienced in getting some employers promptly and accurately to send in copies of their list of outworkers, but no legal proceedings were taken in the matter during the year. 113 HOME WORK. Nature of Work OUTWORKERS' LISTS, SECTION 107 * Outworkers in unwholesome premises,Section 108 Outwork in infected premises, Sections 109,110 Lists received from Employers Addresses of Outworkers Notices served on Occupiers as to keeping or sending lists Prosecutions Instances Notices served Prosecutions Instances Orders made (s. 110) Prosecutions (s. 109, 110) Sending twice in the year Sending once in the year Failing to keep or permit inspection of lists Failing to send lists Lists Outworkers Lists Outworkers Received from other Councils Forwarded to other Councils Contractors Workmen Contractors Workmen . Wearing Apparel— Making, etc. 77 62 150 1 ... 3 1052 271 70 ... ... 61 70 1 1 ... ... Boots and Shoes 37 23 149 ... ... ... 188 236 26 ... ... 54 76 ... ... ... ... Curtains, Furniture hangings and Trimmings 4 14 2 ... ... ... 23 8 9 ... ... 5 9 ... ... ... ... Fur-pulling and feathers ... ... 2 ... ... ... 7 ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. 4 ... 13 1 ... ... 41 18 4 ... ... 11 18 ... ... ... ... Artificial Flowers ... ... ... ... ... ... 7 ... 2 ... ... 1 1 ... ... ... ... Paper, etc., Boxes, Paper Bags 24 ... 139 1 ... 1 121 51 20 ... ... 42 57 ... ... ... ... Brush-making 8 ... 42 ... ... ... 17 208 4 ... ... 17 24 ... ... ... ... Draught Board Making 2 ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, etc. ... ... ... 1 ... 4 9 11 2 ... ... ... ... ... ... ... ... Textile Weaving 2 ... 20 ... ... ... ... ... 2 ... ... 2 2 ... ... ... ... Toys 2 ... 20 ... ... ... 1 69 2 ... ... 3 3 ... ... ... ... Total 160 99 539 4 ... 8 1466 872 143 ... ... 196 260 1 1 ... ... *The figures in these columns relate to outworkers' premises at which nuisances were found and dealt with under Public Health (London) Act. 114 APPENDIX I. LEGAL PROCEEDINGS. (In addition to the prosecutions for offences under the Food and Drugs Acts reported on pages 89-90). In 46 cases summonses for non-compliance with Statutory Notices served under the Public Health (London) Act, requiring the abatement of nuisances were withdrawn, upon the specified works being done and costs being paid to the Council, as follows:— Cases. Costs in each Case. 3 £0 10 6 . 41 £110 1 £2 2 0 1 Nil. In 17 other cases Nuisance Orders were obtained with orders as to costs as shown in the following list. It was also found necessary in 2 cases to obtain Distress Warrants for the recovery of costs. 115 SUMMARY OF LEGAL PROCEEDINGS. (Other than Food and Drugs Acts cases, for which see pp. 89-90). Date of Hearing. Offence. Officer Result 1931 1st January Public Health (London) Non-compliance with notice re nuisance at 6. Fleet Street Hill Bare Nuisance Order (14 days). Costs £2 2s. 3rd February Public Health (London) Act. Failing to give notice of intention to fit w.c. pan and trap at 29. 31 and 33, Burnside street (3 summonses) Billings No Fine. Costs £1 3s. in respect of each summons. 2nd April Public Health (London) Act. Non-compliance with notices re nuisances at 24 and 42, Selby Street (2) Billings Nuisance Order. Costs £2 2s. in each case. 26th February Public Health (London) Act. Non-compliance with notice re overcrowding at 93, Guinness Buildings Slater Nuisance Order (21 days). Costs 10s. 6d. 2nd March Milk and Dairies Order, 1926. Filling bottle with milk otherwise than on registered premises Weeks Fine 10s. No costs. 12th March Public Health (London) Act. Non-compliance with notice re nuisances at 30, 32, 34 and 40, Selby Street (4) Billings Nuisance Order (28 days) and Costs £2 2s. in each case. 19th March Public Health (London) Act. Non-compliance with notice re overcrowding at 5, Hare street Bare Nuisance Order (21 Days). No costs. 116 117 SUMMARY OF LEGAL PROCEEDINGS —continued. (Other than Food and Drugs Acts cases, for which see pp. 89-90) Date of Hearing. Offence. Officer. Result 1931. 23rd March L.C.C. (General Powers) Act, 1928. Application for order for removal of H. W. to Bethnal Green Hospital L.C.C. (General Powers) Act, 1928. Borland Adjourned sine die. 16th March Application for order for removal of M. T. to Bethnal Green Hospital Milk and Dairies Order, 1926. Borland Order made (3 months). 2nd April Filling bottle with milk otherwise than on registered premises Public Health (London ) Act. Weeks Fine 5s. Costs £1 3s. 28th May Non-compliance re overcrowding at 52, Old Ford Road Milk and Dairies Order, 1926. Brighting Nuisance Order (21 days). 1st June Filling a bottle with milk other than on registered premises Public Health (London) Art. Billings Fine £2. Costs £1. 1s. 28th May Non-compliance with magistrate's order to abate overcrowding Rag Flock Act, 1911. Bare Fined £1. Went to prison; released on paying 8s. l0d. after serving 6 days. 4th June Being in possession Rag Flock containing 254 parts per 100,000 excess of chlorine Jenkins Fined 10s. Costs £2 2s. 4th June Being in possession Rag Flock containing 15 parts per 100,000 excess of chlorine Public Health (Meat) Regulations, 1924. „ Fined £3. Costs £2 2s. 1st June Failing to take steps to guard against contamination of meat exposed for sale Henley Fine £2. 4th June Metropolis Management Act. Failing to give notice of intention to execute drainage works Public Health (London) Act Jenkins Costs £2 2s. 22nd June Non-compliance with notice re nuisances at 21, 23 and 25, Busby Street, and 30 and 32, Granby Street (5) Public Health (Meat) Regulations, 1924. Bare Nuisance Order and Costs £1 1s. in each case. 29th June Failing to screen meat stall Henley Fined £1 or 5 days 29th June Failing to have meat stall inscribed with name and address Sale of Food Order, 1921. „ Costs 2s. 29th June Exposing for sale meat which was not labelled "imported," etc. „ Withdrawn. 6th August Public Health (London) Act. Non-compliance with notice re nuisance at 379, Cambridge Road (workshop) Public Health (London) Act. Jenkins Nuisance Order. Costs £3 3s. 3rd September Illegal occupation of cellar for sleeping purposes Slater Adjourned sine die. 9th November Depositing for sale 21b. unsound sausages Weeks Fine £10. Costs £5 5s. 9th November Selling 31b. unsound sausages „ Fine £15. Costs £5 5s. 12th November Non-compliance with notice re nuisance at 6, Clarkson Street L.C.C. (General Powers) Act, 1928. Heron Nuisance Order (14 days) and Costs £2 2s. 11th December Application for order to remove E. L. to Bethnal Green Hospital Borland Order made (3 months). 118 TUBERCULOSIS SCHEME OF THE BETHNAL GREEN METROPOLITAN BOROUGH COUNCIL. (a) PULMONARY TUBERCULOSIS.-Supplementary Annual Return showing in written off the Register. The Table is arranged according to the years in summary form (a) the condition at the end of 931 of all Patients remaining on which the patients were first entered on the Dispensary Register as definite the Dispensary Register; and (b) the reasons for the removal of all cases cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 1930 1931 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class | T.B. Plus) (a) Remaining on Dispensary Register on 31st December Disease Arrested Adults M. 3 3 3 6 1 F. 1 2 Children 1 Disease not Arrested Adults M. 40 19 23 8 50 3 2 5 1 8 1 1 6 1 8 6 3 4 2 9 10 3 6 6 15 14 6 7 8 21 26 4 11 9 24 F. 29 4 8 4 16 2 1 1 1 2 2 1 5 5 5 4 1 10 9 1 5 3 9 8 5 3 3 11 12 6 11 8 25 Children 11 2 3 2 1 1 2 3 1 1 Condition not ascertained during the year 11 5 4 3 12 2 1 2 1 4 2 2 1 3 5 2 1 2 5 5 2 5 2 9 6 4 5 3 12 Total on Dispensary Register at 31st December 96 31 38 15 84 12 3 7 3 13 7 3 10 3 16 18 10 9 5 24 24 7 16 11 34 30 15 15 14 44 41 11 22 17 50 (b) Not now on Dispensary Register and Reasons for removal therefrom Discharged as Recovered (27 Unclassified) Adults M 1 F. 1 Children 1 Lost Sight of or otherwise Removed from Dispensary Register (402 Unclassified) 13 7 5 6 18 5 7 3 3 13 6 6 5 1 12 7 1 2 3 6 5 1 2 6 9 3 2 2 1 5 1 1 Dead (730 Unclassified) Adults M. 8 4 11 6 21 4 5 11 14 30 3 2 6 10 18 5 1 11 18 30 2 5 13 18 6 1 24 25 1 2 5 7 F. 1 5 5 7 17 3 4 7 17 28 7 4 7 6 17 2 3 6 8 17 5 5 8 13 2 2 11 13 1 1 Children 1 1 1 1 1 1 2 1 1 Total Written off Dispensary Register 25 16 21 19 56 13 16 21 35 72 17 12 18 17 47 14 5 20 30 55 12 1 12 27 40 11 2 6 36 44 1 1 2 6 9 Grand Totals 121 47 59 34 140 25 19 28 38 85 24 15 28 20 63 32 15 29 35 79 36 8 28 38 74 41 17 21 50 88 42 12 24 23 59 119 120 (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in Dispensary Register; and (b) the reasons for the removal of all cases summary form (a) the condition at the end of 1931 of all Patients remaining on the written off the Register. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 1929 1930 1931 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December Disease Arrested Adults M. 1 1 F. 2 2 1 1 Children 3 3 3 9 1 1 1 1 1 1 Disease not Arrested Adults M. 9 3 4 16 2 1 2 5 1 1 2 2 1 1 4 1 1 2 1 1 1 3 2 1 3 F. 3 1 3 7 1 1 2 4 2 1 3 1 1 1 3 2 1 3 1 1 2 1 2 2 5 Children 11 1 2 28 42 1 1 5 7 2 1 1 4 1 1 1 5 8 2 4 6 8 1 10 19 9 3 2 16 30 Condition not ascertained during the year 9 1 2 8 20 2 3 5 2 1 1 4 2 1 3 6 2 1 1 4 2 1 4 7 Total on Dispensary Register at 31st December 37 6 8 46 97 7 1 2 12 22 7 3 3 13 7 2 4 10 23 7 3 6 16 11 3 1 16 31 12 5 4 17 38 Transferred to Pulmonary 1 1 2 (b) Not now on Dispensary Register and reasons for removal therefrom Discharged as Recovered (39 Unclassified) Adults M 1 1 F. 1 1 Children 3 1 1 (122Unclassified) Lost sight of, or otherwise Removed from Dispensary Register 2 3 16 21 4 1 2 7 1 1 1 2 5 3 3 1 3 4 1 1 Dead (12 Unclassified) Adults M. 1 1 F. 1 1 1 1 2 Children 1 1 1 1 Total written off Dispensary Register 7 1 5 16 29 6 1 1 3 11 1 1 1 2 5 3 3 1 3 4 1 1 Grand Totals of (a) and (b) excluding those transferred to Pulmonary) 44 7 13 62 126 13 2 3 15 33 8 1 4 5 18 7 2 4 13 26 8 3 9 20 11 4 1 16 32 12 5 4 17 38 121 122 TUBERCULOSIS SCHEME OF THE BETHNAL GREEN METROPOLITAN BOROUGH COUNCIL. Return showing the work of the Dispensary during the year 1931. Diagnosis. Pulmonary Nonpulmonary Total Grand Total Adults Children Adults Children Adults Children A.—New cases examined during the year (excluding contacts): M. F. M F. M. F. M. F. M. F. M. F. (a) Definitely tuberculous 56 37 3 1 3 5 13 16 59 42 16 17 134 *(b) Diagnosis not completed ... ... ... ... ... ... ... ... 10 4 3 1 18 (c) Non-tuberculous ... ... ... ... ... ... ... ... 118 144 69 56 387 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 1 ... ... ... ... ... ... 2 1 ... ... 3 *(b) Diagnosis not completed ... ... ... ... ... ... ... ... ... 1 1 1 3 (c) Non-tuberculous ... ... ... ... ... ... ... ... 30 73 65 76 244 C.—Cases written off the Dispensary Register as (a) Recovered ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous ... ... ... ... ... ... ... ... 150 218 136 132 636 D.—Number of Cases on Dispensary Register on Dec. 31st: (a) Definitely Tuberculous 287 174 15 17 44 36 87 73 331 210 102 90 733 (b) Diagnosis not completed ... ... ... ... ... ... ... ... 5 3 2 1 11 1. Number of cases on Dispen8. Number of visits by sary Register on January 1st 701 701 culosis Officers to homes 2. Number of cases transferred (including personal from other areas and cases sulfations) 146 returned after discharge der Head 3 in previous years 18 9. Number of Visits by Nurses or 3. Number of cases transferred .Health Visitors to Homes toother areas, cases not for Dispensary purposes 3094 desiring further assistance 10. Number of:— under the scheme, and cases {a) Specimens of sputum, &c„ lost sight of 42 examined 610 4. Cases written off duung the year as Dead (all causes) 86 (b) X-ray examinations made 5. Number of attendances at the in connection with Dispensary (including consary work 187 tacts 4653 11. Number of ''Recovered" 6. Number of Insured Persons cases restored to Dispensary under Domiciliary TreatRegister, and included in ment on the 31st December 184 A(a) and A(6) above 7. Number of consultations with Medical Practitioners :— Number of " T.B. plus " cases (а) Personal 40 on Dispensary Register on (б) Other 370 December 31st 265 * i.e., Remaining undiagnosed on 31st December. 26th February, 1931. H. T. Howell, Clinical Tuberculosis Officer. 123 APPENDIX II. TUBERCULOSIS DISPENSARY. REPORT FOR THE YEAR 1931. By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., Lond., Clinical Tuberculosis Officer. For the fourth year in succession 1 am pleased to report 'there has been no change in the personnel of the Dispensary. The sessions have remained the same, patients being seen on Monday, Wednesday, Thursday, Friday and Saturday mornings from 10 to 12 o'clock; Wednesday evenings from 5.30 to 7; and on Thursday evenings from 7.30 to (J o'clock. Saturday morning is reserved for school children and their mothers, and the evening sessions for patients who are at work during the day, and for those who find it inconvenient to attend one of the morning sessions. Patients may attend during any part of a session, an arrangement which reduces the period of waiting to a minimum. In a large number of dispensaries separate sessions are held for the different sexes. We have never ftound this to be necessary, as the accommodation of the department is in every way adequate to obviate the necessity for such an arrangement. The ample dressing-room facilities enable the Tuberculosis Officer to -examine patients in the order of their arrival at the Hospital irrespective of sex, and privacy is ensured, since the dressing-rooms are not used by more than one patient at a time, unless they are members of the same family. The consulting-rooms, waiting-rooms, laboratory, and offices for the Tuberculosis Officers and Clerk are also in every way satisfactory. The structural alterations reported last year have proved advantageous, enabling patients to leave the department from the dressing-rooms direct instead of passing through the consulting-rooms as previously. The Tuberculosis Officers continue to utilise to an increasing degree the opportunities for consultation with the various departments of the Hospital. These enable us to investigate all cases with little loss of time, for, when necessary, the opinion of a Physician, Surgeon, I.aryngologist, Radiologist, Pathologist or Dentist is immediately available. It is thus possible to make a thorough investigation of a case, including sputum and X-ray examinations, within a period of 24 hours. The value of personal consultation with the specialist concerned and of our close clinical contact with the Hospital StalT — which afford constant opportunities for discussing the merits of new methods of treatment and diagnosis—cannot be over-estimated. We are grateful to the Hospital for providing immediate admission in cases of emergency, and to the Staff for their courtesy in giving us every facility for following up our cases while in the wards. The number of patients referred to the Radiologist tends to increase yearly, for recent advances in technique and greater experience in the 124 pretation of the films have made X-rays our most valuable aid in the detection of early tuberculosis. It is not, however, generally recognised that the value of radiology mainly lies in the correct interpretation of the lillms, and that this requires considerable experience. The practice of referring cases direct to Radiologists with little experience of chest radiology is to be regretted, since it frequently results in the notification of cases as tubercular when there is no real justification for such a course. It is now exceptional, at least in this district, for a general practitioner erroneously to notify a case as suflering from tuberculosis on clinical evidence alone. The certainty of the error in diagnosis being detected later on by means of X-rays has imbued the clinician with a healthy dread of hasty diagnosis. The various charitable organisations in the district continue to assist us in many ways. The Hackney branch of the Invalid Children's Aid Association, of which both Tuberculosis Officers are members, has been particularly helpful, and has sent quite a number of debilitated children to convalescent homes at the seaside or in the country. In the past the work of this association in Bethnal Green was carried out from Headquarters, but during the year a local branch, run by a Committee with local interests, has been formed. 1 was invited to join this committee, and was pleased to accept the invitation. An energetic Secretary has been appointed, and we have already had refcison to be grateful to the Committee for undertaking convalescent treatment of many of our children. The Charity Organisation Society has provided dentures, surgical instruments and clothing, and has frequently found accommodation for the children of mothers receiving sanatorium treatment. The United Services Fund also provides accommodation for the children of ex-service men, and gives financial assistance to the families of those who are unable to work. The children attending Stormont House Open-air school on Hackney Downs continue to make good progress. That open-air schools are doing valuable work cannot be doubted. Among other things they ensure (1) fresh air and sunlight for the children during school hours ; (2) supervision of exercise and rest ; (3) proper and suificient diet (hot midday meals and milk being provided at a nominal fee with no charge in necessitous cases i; (4) medical treatment ; (5) individual attention both educationally and medically which is not possible in larger schools, and (6) an hygienic way of life, with an equal zeal. In schools of this nature, where of necessity the educational and! medical work are very closely associated, there is always the danger of iricticn from a clashing of interests, with a resulting loss of efficiency on one or both sides of the work, unless there is perfect understanding and mutual goodwill between the Medical Officer and the Head Teacher. We are fortunate at Stormont House in having a Head Teacher whose first consideration is the welfare of the children, and who welcomes and carries out any suggestion for their benefit, be it educational or medical in aspect, Tlie work of the school is closely associated with that of the twc* neighbouring Dispensaries. Dr. Hamilton, the Tuberculosis Officer for the Boroughs of Hackney and Stoke Newington, is a member of the Committee, and I am Medical Officer of the school, visiting it weekly, while the Dispensary Nurse is part time school nurse and visits the school daily. During the year 12 children were discharged as fit for work, while 7 others had so improved as to enable me to recommend their transfer to an ordinary elementary school. The placing of the children in work on leaving school is in the hands of the school after-care committee, and contrary to what one would expect, 126 there is little difficulty in finding more or less suitable employment. The fact that they have attended an open-air school for tuberculosis children does not seem to handicap them in this respect, and it apparently leaves no stigma. Old scholars are not forgotten and left to their own devices.; the Care Committee still continues to keep a friendly eye on them, while they are encouraged to attend the Dispensary at regular intervals for the purpose of supervision. Institutional treatment has, on the whole, been a little easier to obtain during the year. Fewer cases have been refused admission, but the period of waiting is still longer tlian is desirable, and in certain cases may be detrimental to successful treatment. The period of stay at a Sanatorium is in most cases much too short for cure of the disease, and this aspect of the subject, in my opinion, needs urgent consideration. The problem of the advanced case is not yet solved. There is still considerable difficulty in persuading the advanced patient to enter the Council's general hospitals, although this difficulty is perhaps less acute than when these institutions were under the control of the Guardians, for patients are more hopeful that they may later be transferred to one of the Council's sanatoria. In view of the fact that there now appears to be ample accommodation for this class of case in the general hospital's, it seems a pity that something cannot be done to induce patients to enter them. The argument that treatment at these institutions is satisfactory and adequate is of little avail if patients continue to regard them as General Hospitals, and feel that no special knowledge or care is available for them. I am of the opinion that this difficulty could be solved if a few of the Council's general hospitals were wholly or partly set aside for such cases, and a relatively greater proportion of the patients of such institutions were later transferred to sanatoria. These hospitals would acquire the status of special hospitals, and in consequence would, 1 am convinced, attract a larger number of patients. The isolation of the advanced case is of such importance in the prevention of the spread of tuberculosis that it is worthy of every consideration, for there is little doubt that the recent remarkable decline in the death rate from tuberculosis is due in no small measure to segregation. It may be argued that the complete isolation of the tuberculous would result in loss of immunity to this disease. The method of obtaining immunity by direct contact with the advanced infectious case- is, however, not only crude but dangerous, since neither the dose nor the virulence of the infection can be regulated so as to guarantee that there will be no damage to health in the process. The result of sanatorium treatment, as far as it goes, has on the whole been satisfactory, but as previously mentioned, in only a few cases has the stay in an institution been sufficiently prolonged to jensure a cure. A stage of arrest or quiescence has been attained in quite a number oli cases, but this carries no guarantee of a permanent cure later. Frequently the most critical period of a man's treatment is that immediately following his discharge from sanatorium. The ideal conditions that prevailed in the institution only tend to exaggerate the jutter inadequacy of those that await the average patient on iiis discharge. In an overcrowded home fresh air is almost unobtainable, food often lacking—if not in quantity then in quality—and proper rest impossible. Moreover the patient has frequently lost his employment, and fails to find other suitable work ; hence it is not to be wondered at that relapses are common. In view of the crowded nature of the homes and the present high level of 126 unemployment there is little that we can do. We endeavour, however, in various ways to ameliorate the lot of patients after discharge:— 1—A constant lookout is kept on the patient for any reactivity of the disease, and if necessary a further period of sanatorium treatment is recommended. 2—A new house is sometimes obtained either through the Borough or the London County Council, under a scheme of preferential treatment for tuberculous cases. 3—Bed and bedding are supplied in certain casts where the financial circumstances of the patient will not permit of their purchase. 4—The children of infectious cases may be boarded out in suitable homes, but advantage of this facility is only too frequently refused by parents. 5—A grant of extra diet in the form of milk and eggs is given by both Boroughs on the recommendation of the Tuberculosis Officer. The total expenditure sanctioned by the Ministry is limited to £2 per 1,000 of the population. Formerly it had been our practice to recommend that patients receive two pints of milk and one egg daily, but after consultation with the Medical Officers of Health it was decided, in order to extend the benefit to a larger number of patients, that the supply of milk be reduced to one pint. Under the change from the percentage to the Block Grant in the Local Government Act of 1929, a larger Exchequer grant may be expected in the poorer districts, and a greater latitude in matters of expenditure allowed to local authorities, so it is hoped that advantage may be taken of this to increase the allowance for the provision of extra nourishment. 6—We endeavour through the Tuberculosis Care Committee to find employment for those who are out of work, but the present state of the labour market often makes this impossible. The Committee, however, have frequently been successful in placing patients, notably in the case of women, situations being found for them in sanatoria as Nurses, sewing maids and ward maids. 7—For those who are unable to find employment we have in Hackney a Handicraft Class, where patients are taught basket-making, glove-making, artificial flower-making, and leather, bead, and pewter work. While these classes do not attempt to enable patients to earn a livelihood, they succeed in giving them a little pocket money, and what is perhaps more important, they give patients an interest to occupy their minds and save them from brooding over their condition. The articles made are sold, and after deducting a small percentage for class funds the surplus is paid over to the worker. Orders may also be taken by individual patients, who may sell what they make under these conditions. The Boroughs continue to undertake financial responsibility for cases requiring spccial treatment, such as Finsen Light for Lupus, and refills in Artificial Pneumothorax cases on their return from sanatorium. The results in both these forms of treatment are very satisfactory, and the increasing expenditure incurred is, in my opinion, justified. All patients undergoing these forms of treatment are periodically examined by the Tuberculosis Officer, and reports submitted to the Medical Officers of Health as to their progress. I submit at the end of this report a statistical summary of the work of the department for the year. From a comparison with the corresponding figures for 1930 it will be seen that the chief feature of an all round increase in the figures is the rise in the total number of attendances by nearly 3,000. In conclusion I would like to thank the Medical Officers of Health, the Hospital Physicians and Surgeons, the Resident Medical Officer, and the Hospital Secretary for their valuable help and advice, and the Dispensary Staff for their efficient work and loyal support. H. TYLFORD HOWELL. 14th March, 1932. 127 STATISTICAL TABLES. BOROUGH OF BETHNAL GREEN. 1. The Totals of New Cases. Males 376 Females 424 800 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 216 35 Local Practitioners 225 44 Contact cases (per M.O.H.) 250 3 War Pensions Committee - - London County Council 30 7 Victoria Park Hospital 15 12 Other sources 48 36 Transferred from other Areas 16 11 3. The Diagnosis of the New Cases. Diagnosis. Adults. Children under 15. Total. Males. Females. Males. Females. Pulmonary Tuberculosis 60 44 3 1 108 Non-pulmonary Tuberculosis 4 6 13 17 40 Non-tuberculous 148 217 134 132 631 Doubtful 10 5 4 2 21 Total 222 272 154 152 800 128 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 3 Non-pulmonary Tuberculosis - Non-tuberculous 244 Doubtful 3 Total 250 5. Sputum Examinations. Tubercle Bacilli present 94 Tubercle Bacilli absent 516 Total 610 6. Other Figures. Total number of attendances 4,653 Systematic examinations at the Dispensary 2,374 Number of patients sent to hospital or sanatorium by the L.C.C. 57 Number of letters writtJn 1,349 Number of visits to patients at their homes 146 Number of attendances at:— X-Ray Department 187 Dental Department 3 Sunlight 100 Other Departments 54 129 INDEX. PAGE Aged and Infirm Persons 77 Ambulances 16 Bacteriological Examinations (medical) 77 do. do. (food) 92 Bakehouses 95 Bedsteads, Bedding and Clothing (Tuberculosis) 82 Births 21, 23 Butter 98 Cancer 30 Census, 1931 22 Certifying Surgeon: Factories and Workshops 20 Chicken Pox 70 Children under School Age 62 Cleansing Stations: Personal 18,76 Clinics 14 Clothing, Hygienic 49 Combined Drainage Systems 104 Condensed Milk Regulations 91 Convalescent Treatment 59 Cowhouses 94 Customs & Inland Revenue Acts 102 Day Nurseries 14 Deaths 6, 21, 24, 26 ,, from Motor Traffic 30 Delicate Children: Clinic for 50 Dental Clinic (M. & C.V.V.) 63 Dental Treatment of Tuberculous Patients 84 Diabetes 74 Diphtheria 69 DISEASE, CONTROL OF 67, 84 Disinfectants: Distribution of 76 Disinfection 74 Dispensaries 13 Drainage Work 104 Dried Milk, &c. 49 Dried Milk Regulations 92 Enlarged Tonsils, Adenoids and Mastoid Disease 59 Enteric Fever 70 Expenditure on Public Health Work 11 Extra Nourishment 83 Factories and Workshops 110 do. do. Certifying Surgeon 20 Finsen Light Treatment 84 Fish Curing and Fried Fish 95 FOOD 85, 99 Food Premises 92, 97 ,, Poisoning 98 Food and Drugs Acts 86 Fried Fish and Fish Curing 95 General Description of District 8 130 PAGE GENERAL SANITARY ADMINISTRATION 100, 104 Hairdressers 104 HEALTH SERVICES 11 Health Visitors 38 do. do. Tuberculosis 82 Home Helps 48 Home Workers 112 Hospitals 12 HOUSING 105, 109 Hygienic Clothing 49 Ice Cream 95 Illegitimacy 23 Infant Consultations 41 Infantile Mortality 6, 22, 28 INFECTIOUS DISEASE 67 84 Inhalation Therapy 58 Insanitary Areas 106 Insect Pests 75 Insurance Acts, National Health 16 INTRODUCTION 6 Joint Dispensary Committee (Tuberculosis) 84 Leaflets 41 Lectures, Health, Education 74 LEGAL PROCEEDINGS: Food 89 Other 114 Light Treatment 51,52 Malnutrition: Hospital treatment for 66 Margarine 98 Marriages 23 Massage 57 Maternal Mortality 22, 27 MATERNITY AND CHILD WELFARE 35,39,63 Maternity Clinic 42, 45 Maternity Institutions 15 Maternity Outfits 48 Measles 73 Meat Regulations 96 Medical Inspection (school children) 63 Medical Practitioners Midwifery: Borough Midwifery Service 47 Midwives 15 Milk 98 Milk for necessitous mothers and children 48 Milkshops and Dairies 92 Milk (Special Designations) Order 94 Mortuary 33 Motor Traffic Accidents 30 Noise 102 Notification of Births 37 Nurseries, Day Nurses and Nursing Assistance Obstetrical Consultants 47 Offensive Matter 108 do. Trades 103 131 page Open-Air Sleeping Shelter 82 Ophthalmia Neonatorum 62 Orphans Orthopaedic Treatment 55, 57 Outworkers Overcrowding 105 Personal Cleansing Stations 18, 76 Pneumo-Thorax Refills 84 Population Poultry Slaughterers 97 PUBLIC HEALTH COMMITTEE 3 Public Health Expenditure 11 Puerperal Fever and Puerperal Pyrexia 61 Rag and Bone Dealers 104 Rag Flock Act 103 Rats and Mice 102 Registration of Births, Deaths and Marriages 19 Rent Restrictions Acts 102 Sanatorium Treatment 83 Sanitary Inspectors, work of 100 Scabies (Itch) 76 Scarlet Fever 60 Shelter for Contacts 77 do. Open-Air Sleeping 82 Slaughterhouses 96 Smallppx 70 Smoke Nuisance 102 Social Welfare 8 Special Clinic for Delicate Children 50 Sputum Outfits 82 STAFF 4 Stillbirths 26 Street Accidents 30 Talks to Mothers 41 Tenement Houses 101 Tonsils, Adenoids and Mastoid Disease 59 TUBERCULOSIS 79, 84, 118, 126 Tuberculosis Dispensary 18, 83, 84 „ Officer, Report of 123 Unsound Food 97 Vaccination 19 Vaccination Returns 72 Venereal Disease 18 Verminous Conditions. 75 VITAL STATISTICS 21,34 Water Supply 102 Welfare Centres 39 Whooping Cough 73