C.I. Ac 43 66 BET 37 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1932 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. THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1932 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, 1932-33 as on 31st December, 1932. Meetings held at the Town Hall at 6 p.m. on the first Wednesday. *Councillor Miss L. D. Benoly, J.P., Chairman. *Councillor Rev. R. C. Jones, B.A., Vice-Chairman. Councillor G. Bayley, J.P. „ S. Brown. * „ H. T. Clark. ,, j. H. Fletcher. * „ Marshall Jones. ,, E. T. Malindine. Councillor A. C. Rawles, M.C. * „ Mrs. K. E. Rawles, M.B.E. * „ Rev. Preb. S. L. Sarel, M.A. * „ A. J. Sharman. H. E. Tate, J.P. *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 C. Bennett, J.P.). Committee: Chairman: Baths Councillor Mrs. K. E. Rawles, M.B.E. Electricity „ A. C. Rawles, M.C. Finance Alderman W. Rawles, J.P. Housing Councillor M. Jones. Law and General Purposes „ J. R. Davy. Libraries „ Rev. Preb. S. L. Sarel, M.A. Staff „ R. E. Pearson, J.P., L.C.C. Street Trading „ T. Brooks, J.P. Valuation „ J. Harris. Works and Stores „ W. H. Jones. 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 Miss L. D. Benoly, J.P., Rev. R. C. Jones and Rev. S. L. Sarel, 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT, as on 31st December, 1932. Vynne Borland, M.B., Ch.B., B.Sc., D.P.H., Medical Officer of Health. Sanitary Inspection: *§Evan Richards Chief Sanitary Inspector. *§A. S. Henley *J. O. G. Weeks Food Inspectors. *W. Billings, Housing Inspector. *E. J. Jenkins, Workshops Inspector. *G. I. Brighting. *§G. E. Gould. *§W. H. Heron. *J. H. Hewitt. *§F. C. Sharpe. *SS. R. B. Slater. District Sanitary Inspectors. *Certificated Sanitary Inspector. § Certified Meat, etc. Inspector. Disinfection: 1 Leading Disinfecfcor, 3 Disinfectors. Combined Drainage : 1 Drain-layer, 3 Labourers. Personal Cleansing Station: 1 Woman Attendant (part-time). 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 Suit. Health Visitor. †Mrs. F. M. Barden. †Miss V. D. Cornish. *†‡dMiss D. L. Fraquet. †‡Miss C. E. Love. *†‡dMiss A. A. Page. †‡dMiss M. Playle. †Mrs. A. W. Rosling. †‡dMiss L. F. Wright. Health Visitors. †‡Miss E. E. Taylor, Borough Midwife Miss M. V. Hazell, Clerk Dispenser. †Certificated Nurse. ‡Certified Midwife. d Health Visitors' Diploma. Maternity & Child Welfare Centre: 1 Storekeeper, 1 Attendant, 1 Caretaker, 3 Cleaners (pairt-time). General Administration: *J. Henry Lloyd, f.s.s., Chief Clerk. F. G. Thomas. *R. W. Slyfield. L. A. Taylor. S. P. Hansen. G. S. Freeman. R. F. Marshall. J. E. Pestell. Clerks. J. P. Mackenzie, Junior Clerk. Tuberculosis: †‡Miss E. S. Crisp. †‡dMrs. J. Callow. T uberculosis Health Visitors. Employees: 2 Messengers, one of whom acts as Temporary Mortuary Keeper. 6 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. Dental 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. Parses, F.I.C., F.C.S., Public Analyst. †P. Ivess, Vaccination Officer. Staff changes during 1931. Miss L. E. Gavin resigned her appointment as ClerkDispenser. Her successor, Miss M. V. Hazell, took up her duties on the 15th February, 1932. †Mr. p. Ivess died on the 7th February, 1933. 6 Public Health Department Town Hall, Bethnal Green, E.2. 10th April, 1933. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, I have the honour to submit my annual report relative to the Public Health work of the Metropolitan Borough of Bethnal Green. The general death rate at all ages from all causes was 1.20 per thousand of the population. The Infant Mortality Rate for the year was 69.1 per thousand births which shews a gratifying reduction from the high figure of 87.7 in 1931. The rate for London was 66. The comparative rates for ten years are given on page 28. The Maternal Mortality Rate was 1.2 per 1,000 births. Although street accidents still exact a heavy toll there was a reduction in this number of deaths from this cause in 1931. The number of cases of Diphtheria notified was 355 against 320 in the previous year. Scarlet Fever notifications also increased from 432 cases in 1931 to 590 cases in 1932. There was a reduction in the number of cases of Mild Small Pox from 146 to 25. The Public Analyst's report shews a slight increase in the number of adulterated samples, thus demonstrating the need for eternal vigilance. I desire to thank the Chairman and members of the Public Health Committee for their help and courtesy throughout the year. Thanks and appreciation are also due to my colleagues in other departments for their co-operation and many courtesies. I have also to place on record the assistance and co-operation extended to me by Dr. Horton, Mr. Richards, Mr. Lloyd and the other members of the Public Health staff. I am, Ladies and Gentlemen, Your obedient servant, Vynne Borland. 7 GENERAL DESCRIPTION. Bethnal Green is a roughly rectangular shaped district in East London, about If 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, 1932, was £521,380, 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 a which have taken place in the borough during the past year. As in 1931, the outstanding social fact in the Borough was widespread unemployment, fluctuating during the last quarter of the year between 19.2 and 201 per cent of the insured adult males. A further substantial percentage was on short time and earning a very precarious livelihood. While unemployment insurance benefit and public assistance go some way to mitigate the worst results of this long continued acute poverty of a large section of the population, I am increasingly anxious concerning its eventual effect upon the health standards of the Borough. It will be remembered that the actual results of the physical deterioration of the peoples of Central Europe in consequence of the blockade during the Great War did not fully manifest itself until after the War. Similarly it may be that we shall not be able to estimate the true reflex of the present deprivations for some years and not alone in possibly raised morbidity and mortality rates but in the set back to the rising standard of health which was fairly definitely indicated before the present industrial depression. 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. The grave state of unemployment and poverty in the Borough is indicated by the increasing number of persons receiving public assistance (apart from those obtaining medical relief only) which was 4,016 at the end of 1930, 4,764 at the end of 1931, and 5,764 at the end of 1932. 9 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 25th June. 1932. Bethnal Green Hospital 7 5 ... ... ... ... ... ... 12 Waterloo House ... 167 177 1 ... 184 60 2 8 599 Leytonstone Children's Homes ... 2 1 ... 173 11 187 174 182 3 1 184 60 175 19 798 Week ended 24th December, 1932. Bethnal Green Hospital 7 4 ... ... ... ... 11 Waterloo House... 12 192 1 ... 294 43 ... 8 550 Leytonstone Children's Homes ... ... 1 ... ... ... 159 6 166 19 196 2 ... 294 43 159 14 727 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 25th June, 1932 1485 1824 2467 5776 2227 628 264 203 Week ending 24th December, 1932 1508 1845 2511 5764 2253 581 269 229 10 I am informed by the Education Officer that the average number of necessitous school children provided with meals of some kind (i.e., dinners, milk or cod liver oil) during the year was 740. Of this number 586 consisted of milk, 122 of cod liver oil and 70 of dinners. This assistance is only granted while the schools are open. Economic enquiries made in connection with applications for various Maternity and Child Welfare services indicate that a very large portion of the population is living at an extremely low level. PUBLIC HEALTH EXPENDITURE. During the financial year 1931-32, the cost of the Public Health service was £27,698, or 5s. 8d. per head of the population, equivalent to a rate of 1s. 1½d. 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 Committee and by general medical practitioners, midwives, nurses, voluntary hospitals and a host of charitable societies. The Medical Officer of Health is 11 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 38 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: Bis. 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 5,563 Operations performed 906 (including; 683 under general anaesthesia and 170 abdominal sections.) Out-patients' (4,482) Attendances 18,259 12 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 27,114 136,564 2,149 ... Mildmay Mission Hospital, Austin Street 56 17,764 53,216 1,111 15 City of London Hospital for Diseases of the Heart and Lungs, Victoria Park 188 11,639 43,070 1,211 46 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 Old-Patients. Out-Patients' Attendances. Visits to Patients' Homes *Queen Adelaide s Dispensary, Pollard Row 2,505 5,703 558 Medical Mission, St. James-tbe-Less, St. James' Road 1,367 7,129 305_ †Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 3,204 15,607 4,177 *There were also 562 patients who attended the Dental Department of this Dispensary. †There were also attendances as follows:—Dental Department, 637; Eye Department, 456; Massage and Sunlight, 467. 13 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, 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 school treatment centre in the Borough 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 on one session a week and during the year 475 children were treated. Spectacles were prescribed in 277 cases and in 230 cases spectacles were obtained. "The dentist visits the centre on eleven sessions a fortnight, and the schools on one session a fortnight, to inspect the children's mouths. During the year 2,241 children were inspected in the schools and 1,847 or 82.4 per cent, were found to require treatment. The percentage for the preceding years were 71.9 and 60.3. The number of children treated at the centre was 1,384 and 2,872 attendances were made. " In the minor ailments department the doctor attends on five sessions a fortnight, and a nurse is daily in attendance. During 1932, the number of children treated was 2,037, and 27,398 attendances were made." DAY NURSERIES. There are two Day Nurseries in the Borough, both belonging to voluntary societies:— (i) Bethnal Green Day Nursery, Somerford Street. (ii) Pro Patria Day Nursery, Bishops Road. 11 I have been furnished with the following information concerning the work of the day nurseries:— Somerford Street. Bishops Road. Accommodation 30 50 Total attendances 5,094 8,984 The Secretary of the Pro Patria Day Nursery reports that the attendances are lower due partly to the epidemics in the spring and the shortage of work in the autumn. She also states "We have found during the last few months so much poverty among the parents of the children that is most distressing. Up to the present time we have had no difficulty in getting in the payments, l0d. a day for one child, but now in some cases the charge has been lowered to meet the hardest ones." Similar remarks apply to the Somerford Street Nursery. 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 15 the Maternity ward in Bethnal Green Hospital. Dr. W. P. Greenwood informs me that 273 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 235 women made 864 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. The maternity services connected with the London Hospital, City of London Maternity Hospital, Salvation Army Midwives, Maternity Home, 24, Underwood Street, E.l, Maternity Hospital, 384-396, Commercial Road, E.l, 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 Hospital At Home Ante-Natal Attend'nces City of London Maternity Hospital, City Road 59 4 * Mothers' Hospital, Clapton 21 128 635 Jewish Maternity Hospital, Stepney 49 6 147 London Hospital, Whitechapel 242 287 2,582 *Figures not furnished. The Royal London Maternity Charity granted 112 free midwives' letters to Bethnal Green mothers during the year. MEDICAL TREATMENT OF PERSONS INSURED UNDER THE NATIONAL (HEALTH) INSURANCE ACTS. Arrangements are made by the London Insurance Committee. I understand that 90 medical practitioners are on the medical panel for the Borough, 38 of whom have consulting rooms in the Borough. 16 AMBULANCES. As a full account of the L.C.C. ambulance arrangements was given in the Annual Report for 1930, the following synopsis may suffice: 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 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— (а) 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. 17 (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. Ambulances are equipped with stretcher, carryingchair, blankets and pillow. A male attendant accompanies the driver, if required to assist with stretcher or chair. 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. General Notes. Ambulance Stations. The following are the nearest stations which aro 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, Hackney, E.9. Highbury Calabria Road, Highbury, N.5. Poplar 7, Woolmore Street, E.14. Shoreditch 5, Montclare Street, E.1. City 7200. 18 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, Ivingsland Road. PERSONAL CLEANSING STATIONS. For Adults and Children under School Age. The Council has established a Personal Cleansing Station at the Depôt, Digby Street. A report on its work is given later. For School Children. Sir F. N. Kay Menzies, School Medical Officer, L.C.C., has kindly furnished me with the following information concerning the work carried out at the Bathing Centre, 5a, Russia Lane. Children resident in the Borough and attending L.C.C. schools found to require treatment for scabies, impetigo or personal hygiene receive the necessary treatment under the approved scheme at the Cleansing Station, situated in Russia Lane. During the year 5,544 baths were given and 630 children received treatment for scabies or impetigo. REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. The Town Clerk is the Superintendent Registrar for the Borough. 19 The District Registrars of Births and Deaths are: — For N.E. Bethnal Green : — H. J. Hardwick, 106, Bishops Road. Office hours: — Mon.-Fri. 10 a.m.-l p.m. Sat. 10 a.m.-12 noon. Mon. and Fri. 3-5 p.m. For S.W. Bethnal Green :— Miss M. Peters, 347, Bethnal Green Road. Office hours: — 10.30 a.m.-l p.m. daily. VACCINATION. The Public Vaccinators are :— For N.E. Bethnal Green :— Dr. J. Duffin, 38, Bishops Road. For S.W. Bethnal Green : — Dr. J. G. L'Etang, 386, Bethnal Green Road. The Vaccination Officer during 1932 was Mr. P. Ivess, who, unfortunately, died on the 7th February, 1933. His successor has not yet been appointed. CERTIFYING SURGEON: FACTORIES AND WORKSHOPS. The local Certifying Surgeon under the Factory and Workshops Act is:— Dr. J. Bate. 1, Old Ford Road. HEALTH EDUCATION. Two lectures, each illustrated by cinematograph films, were given in the Lecture Hall, of the Publio Library, at the beginning of the year, as follows : 4th Feb.—Dr. T. W. Hill on " Cleanliness." (Health and Cleanliness Council.) 3rd March.—Mr. F. V. Maguire, l.d.s., on " Teeth. How they come and Why they go." (Dental Board of the United Kingdom.) 20 Councillor C. Bennett, Chairman of the Publio Health Committee, took the chair on each occasion. The lectures, while not largely attended, were much appreciated by those who were present, and the second one gave useful publicity for the Council's dental work for expectant and nursing mothers and young children. 21 VITAL STATISTICS. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. BIRTHS. Males Females TOTAL Birth Rate Legitimate 835 737 1,635 15.4 Illegitimate 36 27 DEATHS. Males Females TOTAL Death Rate 704 587 1,291 12.0 MATERNAL MORTALITY. Number of Women dying in, or in consequence of, childbirth: — Rate per 1,000 total (live & still) births. From Sepsis 1 0.6 From other puerperal causes 1 0.6 INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births :— Legitimate 65.5 Illegitimate 158.7 Deaths from Measles (all ages) 43 „ „ Whooping Cough (all ages) 10 „ „ Diarrhœa (under two years of age) 25 22 POPULATION. The Vital Statistics in this report have been calculated on the estimated resident population of the Borough at the middle of the year 1932 of 106,300. CENSUS, 1931. Since the last Annual Report, the complete figures for the Census of 1931 have been published and the more important tables are reprinted in this report. The population fell by 8.5 per cent between 1911 and 1921. Between 1921 and 1931 it fell by a further 7.7 percent, a loss of 16 2 per cent by migration being offset by a nett addition of 8.5 per cent excess of births over deaths. The average age was found to be 29.5 for males, and 30.7 for females, compared with 32 and 33.9 respectively, for the County of London. The average size of the family was 3.79 compared with 3.46 for London as a whole. Statistics with regard to the density of the population, occupation of dwellings, overcrowding, etc., are given in the Housing Section of this report. The age and sex composition and marital condition of the population will be seen in the following table : 23 Age last Birthday Persons Males Females Total Single Married Widowed Divorced Total Single Married Widowed Divorced All Ages 108,194 52,278 29,746 20,485 2,003 44 55,916 29,883 20,742 5,225 66 0— 4 8,951 4,524 4,524 - 4,427 4,427 _ - - 5— 9 10,198 5,124 5,124 — — 5,074 5,074 - 10—14 9,671 4,861 4,861 — — 4,810 4,810 15—19 11,557 5,625 5,605 20 5,932 5,852 80 20—24 11,375 5,583 4.792 785 6 — 5,792 4,475 1,309 7 1 25—29 9,108 4,459 2,140 2,293 21 5 4,649 2,007 2,607 27 8 30—34 7,649 3,599 804 2,758 29 8 4,050 980 2,967 90 13 35-39 6,355 2,893 351 2,478 58 6 3,462 578 2,730 147 7 40—44 6,373 2,925 314 2,537 67 7 3,448 458 2,675 306 9 45—49 6,243 2,909 295 2,494 116 4 3,334 335 2,472 520 7 50—54 5,782 2,809 299 2,320 187 3 2,973 259 2,174 536 4 55—59 4,790 2,371 204 1,925 239 3 2,419 202 1,562 652 3 60—64 3,788 1,792 181 1,309 301 1 1,996 151 1,113 723 9 65—69 2,721 1,264 118 807 335 4 1,457 116 574 766 1 70—74 1,921 879 86 481 310 2 1,042 84 314 643 1 75—79 1,106 439 29 198 212 - 667 48 128 489 3 80—84 438 163 15 63 84 1 275 20 30 224 1 85—89 138 47 3 14 30 91 6 6 79 90—94 28 12 1 3 8 16 1 1 14 - 95 and over 2 - — — — 2 — — 2 — 24 MARRIAGES. The number of marriages registered in Bethnal Green during 1932 was 780. This is equal to a rate of 14'7 persons marrying per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1932 was 1,141, and in addition 494 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 1,635 births (871 males, 764 females). The birth-rate for 1932 was, therefore, 15• 4 births per 1,000 population, the lowest ever recorded in the Borough. The provisional birth-rate for London is given as 14'2 and for England and AVales as 15-3. ILLEGITIMACY. Of the 1,635 births credited to this Borough, 63 were illegitimate, being 36 males and 27 females, and being 3-8 percent of the total number of births. The latter figure represents a surprising and regrettable change for the worse after being stationary for many years at the comparatively low level of 2 2 per 1,000. STILLBIRTHS. Fifty-two 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 during the year belonging to the Borough, according to the Registrar General's 25 annual return was 1,291. This figure gives an annual death rate of 12.0 per 1,000 population, which compares with 12.3 for the County of London and 12.0 for England and Wales as a whole. Measles, Cancer and Heart disease all show increases, but there is a marked fall in the deaths from Pneumonia and Diarrhœa. 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. The causes of death among the population of Bethnal Green as classified by the Registrar-General, are given in the accompanying table. 26 27 causes of death at different periods of life in the Metropolitan Borough of Bethnal Green, 1932. 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 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 and upwards All causes M 703 69 20 17 21 26 36 35 86 142 143 108 f 588 44 26 13 13 36 25 26 73 79 105 148 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 2. Measles M 20 4 10 5 1 ... ... ... ... ... ... ... F 23 6 13 4 ... ... ... ... ... ... ... ... 3. Scarlet Fever M 1 ... ... ... 1 ... ... ... ... ... ... ... F 2 ... ... ... 1 1 ... ... ... ... ... ... 4. Whooping Cough M 4 2 1 1 ... ... ... ... ... ... ... ... f 6 2 4 ... ... ... ... ... ... ... ... ... 5. Diphtheria M 6 ... ... 4 2 ... ... ... ... ... ... ... F 11 1 1 5 3 ... ... ... 1 ... ... ... 6. Influenza M 7 ... ... ... 1 1 ... ... 1 1 ... 3 F 7 ... ... ... ... ... ... 1 ... 1 1 4 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-Spinal Fever M 2 ... ... ... ... 1 ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system m 61 1 1 ... 1 8 13 9 12 11 5 ... F 38 1 ... 2 1 12 5 3 8 3 3 ... 10. Other Tuberculous Diseases m 5 1 ... ... 1 2 ... ... ... ... ... 1 F 6 ... ... 1 2 1 ... ... ... 1 1 ... 11. Syphilis M 4 ... ... ... ... ... ... 1 3 ... ... ... f 2 ... ... ... ... ... ... ... 1 ... 1 ... 12. General Paralysis of the Insane, tabes dorsalis m 1 ... ... ... ... ... ... ... 1 ... ... ... f 2 ... ... ... ... ... ... ... 1 1 ... ... 13. Cancer, malignant disease m 92 ... 1 ... ... 2 1 4 14 37 24 9 F 70 ... ... ... ... ... 3 7 14 22 15 9 14. Diabetes m 7 ... ... ... ... ... ... ... 1 4 1 1 f 9 ... ... ... ... ... ... ... 1 4 2 2 15. Cerebral Hæmorrhage, etc. M 13 ... ... ... ... ... ... ... 2 2 5 4 F 17 ... ... ... ... ... ... 1 1 5 7 3 16. Heart Disease M 210 ... ... ... ... 5 2 5 17 44 70 67 F 182 ... ... ... 1 7 9 6 24 20 45 70 17. Aneurysm m 7 ... ... ... ... ... ... 2 1 1 2 1 f 2 ... ... ... ... ... ... ... ... 1 1 ... 18. Other Circulatory Diseases m 11 ... ... 1 ... ... ... ... 1 4 2 3 F 10 ... ... ... ... ... ... ... ... 2 1 7 19. Bronchitis M 21 4 ... ... ... ... ... 2 5 2 7 1 F 21 1 ... ... ... 2 ... ... ... 4 1 13 20. Pneumonia (all forms) M 51 6 4 2 2 2 2 3 9 9 8 4 F 42 8 3 1 3 1 2 1 3 1 8 11 21. Other respiratory diseases M 12 3 ... ... ... ... ... 2 ... 2 3 2 F 24 1 ... ... ... ... 2 ... ... 1 8 12 22. Peptic Ulcer M 6 ... ... ... ... ... ... ... 4 2 ... ... F 3 ... ... ... ... 1 ... ... 2 ... ... ... 23. Diarrhœa, etc. M 18 17 1 ... ... ... ... ... ... ... ... ... F 8 5 2 ... ... ... ... ... ... 1 ... ... 24. Appendicitis M 7 ... ... ... 2 1 1 ... 1 1 1 ... f 2 ... 1 ... ... ... ... ... 1 ... ... ... 25. Cirrhosis of Liver M 1 ... ... ... ... ... ... ... ... ... 1 ... F 2 ... ... ... ... ... ... ... 2 ... ... ... 26. Other Diseases of Liver, etc. M 1 ... ... ... ... ... ... ... ... ... ... 1 F 1 ••• ... ... ... ... ... ... 1 ... ... ... 27. Other Digestive Diseases M 8 1 ... ... ... ... .... ... 1 3 1 ... F 9 ... ... ... ... 2 1 1 ... 1 2 2 28. Acute and Chronic Nephritis m 16 ... ... ... ... ... ... ... 2 5 5 4 F 19 ... ... ... ... 2 1 1 4 5 4 2 29. Puerperal Sepsis ... ... • •• ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 31. Congenital Debility, Premature Birth, Malformations, etc. M 23 23 ... ... ... ... ... ... ... ... ... ... F 19 18 ... ... 1 ... ... ... ... ... ... ... 32. Senility M ... ... ... ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... ... ... ... ... ... ... 4 33. Suicide M 11 ... ... ... ... ... 2 2 4 3 ... ... F 5 ... ... ... ... 1 ... 2 1 1 ... ... 34. Other Violence m 26 1 ... 4 6 1 5 ... 4 5 ... ... F 6 1 1 ... ... ... ... ... 1 1 ... 2 35. Other Defined Diseases M 51 6 2 ... 4 3 8 4 3 6 8 7 F 31 ... 1 ... 1 6 1 2 5 4 5 6 36. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... ... ... ... 1 Totals 1291 113 46 30 34 62 61 61 159 221 248 256 28 MATERNAL MORTALITY. Systematic inquiry continues to be made into every maternal death belonging to the Borough. The cases investigated were : — (a) Puerperal Septicaemia 1 (b) Rupture of Uterus 1 The maternal death rate was therefore 1.2 per 1,000 births. There were also two other cases in which childbirth was complicated by other conditions (Mitral Stenosis, Rheumatic Endocarditis), but these are not counted as cases of maternal mortality. None of the mothers concerned attended the Council's Maternity Clinic, and only 2 of them are known to have received any systematic ante-natal care. INFANTILE MORTALITY. One hundred and thirteen 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 69.1 per 1,000 births. The infant death rate for London was 66 and for England and Wales as a whole 65. Comparison with previous years is as follows:— 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 1931 87.7 29 The causes of death among infants are shown in the following table. Infantile Mortality in Bethnal Green in 1932 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 ... ... ... ... ... 1 1 2 6 10 6.1 Whooping Cough ... ... ... ... ... ... 1 2 1 4 2.4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 0.6 Erysipelas ... ... ... ... ... ... ... ... ... ... ... Tuberculosis ... ... ... ... ... ... 1 1 1 3 1.8 Meningitis Meningococcal ... ... ... ... ... ... ... ... ... ... ... Meningitis (purulent) ... ... ... ... ... ... ... ... ... ... ... Septicaemia ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 3 2 ... 5 3.1 Pneumonia (all forms) ... ... 1 ... 1 4 2 3 4 14 8.6 Other Respiratory Diseases ... ... ... ... ... 1 2 ... 1 4 2.4 Diarrhœa and Enteritis ... ... ... ... 1 6 7 6 1 21 12.9 Other Digestive Diseases ... ... ... ... ... ... ... ... 1 1 0.6 Syphilis ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... 1 ... ... 1 0.6 Congenital Malformations 2 ... ... ... 2 4 l ... 1 8 4.9 Congenital Debility ... ... ... ... ... 1 2 ... ... 3 1.8 Premature Birth 17 1 ... ... 18 1 ... ... ... 19 11.6 Injury at Birth 4 ... ... ... 4 ... 1 ... ... 5 3.1 Atelectasis 6 ... ... ... 6 1 ... ... ... 7 4.3 Want of attention at Birth 2 ... ... ... 2 ... ... ... ... 2 1.2 Otitis Media ... ... ... ... ... 1 1 1 ... 3 1.8 Other Causes ... ... ... ... ... ... 1 1 ... 2 1.2 Totals 31 1 1 1 34 20 24 18 17 113 69.1 Net Births in the year {legitimate 1572 Net Deaths in{ the year{ legitimate infants 103 {illegitimate 63 illegitimate infants 10 Cellulitis, Nephritis, (1 each). 30 CANCER. Cancer was responsible for 163 deaths or 12.6 per cent of the total deaths in the Borough. This is a substantial increase over 1931, when there were 129 deaths or 9 per cent of the total. The local distribution of the disease in these deaths was as follows : — M. F. Total. Buccal cavity, pharynx 11 2 13 Digestive organs and peritoneum 53 29 82 (Esophagus (4-0) Stomach (27-12) Intestines (4-9) Rectum (11-5) Others (7-3) Respiratory organs 10 2 12 Uterus — 10 10 Other female genital organs — 3 3 Breast — 21 21 Male genito - urinary organs 13 — 13 Skin — — — Other or unspecified organs 6 3 9 93 70 163 The fact that Cancer causes one-eighth of the mortality in the Borough (which is not very dissimilar in this respect from the rest of the country) should compel greater attention to this terrible disease. 31 DEATHS FROM MOTOR TRAFFIC. In previous years I have drawn attention to the increasing mortality from motor traffic accidents in the streets. It will be seen from the following list of cases in 1932 that there is a reduction in the deaths from this cause : Pedestrians (9) M 4 Run over by taxicab. M 5 Run over by motor lorry. M 5 Knocked down by motor lorry. M 6 Knocked down by motor car. M 7 Knocked down and run over by motor lorry. M 7 Knocked down by motor van. M 46 Knocked down by motor bus M 56 Knocked down by motor coach. M 61 Run over by motor car. Others (6). M 23 (motor cyclist). Collision between motor cycle and motor bus M 25 (cyclist). Knocked down by motor car. M 25 Motor cycle, collision with motor bus. M 26 Ditto. M 34 (cyclist). Rode his cycle into motor car. F 52 (passenger). Collision of two motor cars. Some improvement has no doubt resulted from the new transport regulations, but the rapid rate at which large and heavy motor vehicles rush through the roads in the Borough still exacts a toll among the children. Only 1 death was recorded as resulting from railway transport, a man of 49 who fell from a train. 32 VITAL STATISTICS of Bethnal Green During 1932 and Previous 5 Years. Year Population Estimated to Middle of Each Year Births Transferable Deaths Net Deaths of Persons Resident in the Borough Uncorrected Number Net Total Deaths Registered in the Borough 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 infatttile mortality 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 1,367 125 161 87.7 1932 106,300 1,139 1,635 15.4 1,334 335 292 1,291 12.0 113 69.1 " Calculated on estimated population in 1929. 33 PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 19 bodies were received at the Mortuary, i.e.: — On Coroner's order 13 From the Police 1 At the request of relatives 5 Exact particulars are only available as to the body on which a coroner's inquest was held, where the cause of death was drowning. On 14 bodies post-mortem examinations were made. The reduction in the number of bodies deposited at the mortuary is due to the altered practice of the Coroner who now conducts 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. 34 MATERNITY & CHILD WELFARE. The following cursory outline gives some idea of the variety and extent of the Maternity and Child Welfare 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, also Inhalation. (v) Dental inspection and treatment, including provision of dentures. (vi) Orthopaedic treatment, including provision of in-patient treatment for children requiring it, is provided through the agency of the Queen's Hospital. (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 35 (x) Provides a panel of Obstetrical Consultants whose services are available to local doctors in any difficult or abnormal confinement. (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. It is not the practice of local authorities to advertise their social services in the manner of commercial undertakings. If it were, there is an abundance of good material for such publicity. Not the least gratifying feature of the Council's public health work is the growing appreciation and co-operation it elicits from the residents in the Borough. It is a frequent experience in connection with invitations to parents to send their children for dental examination to receive such communications as the following : — "May I express appreciation of the interest taken by the Council for the health and welfare of the children of the Borough." NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 1,143 live births were registered in the Borough; and 1,103 births were notified to the Medical Officer of Health. There were also 35 36 stillbirths notified. Of the 1,138 living and stillbirths notified, 819 were notified by midwives, 192 by maternity assistants of the London Hospital, 90 by medical practitioners, and 37 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 520 live babies and 19 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) 1,595 10,750 Children (1—2 years) 10 20 4,013 11,962 „ (2—3 years) 4 3,170 „ (3—4 years) 2 2,481 „ (4—5 years) 4. 2,298 Mothers (Ante-Natal) 895 413 ,, (Post-Natal) 61 37 Stillbirths 47 27 Visits. Re-visits. Infant Deaths 56 18 Maternal Deaths 2 2 Puerperal Fever (11) and Pyrexia (39) 17 33 Ophthalmia Neonatorum 18 55 Acute Poliomyelitis 2 4 Other Notifiable Diseases 4 10 Diarrhoea and Enteritis 2 1 Measles (2,441), and German Measles (5) 1,109 1,337 Whooping Cough 80 174 Other Non-Notifiable Diseases 29 88 Milk Grants 14 410 Convalescent Treatment 11 7 Other matters 143 203 Total Visits... 4,105 25,531 Grand Total 29,636 37 In addition, 156 visits and 1,826 re-visits were rendered futile owing to the absence of the mother or the occasion being inconvenient for an interview. The indoor (clinic) work of the Health Visitors is shown in the following figures: — Sessions attended. Maternity Clinics 321 Children's Clinics 1,170 Dental Clinic 118 Light Clinic 194 Mothers' Clinic 5 Other Clinics 394 The Council's Health Visitors assist 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 either enter school or attain the age of 5. I have to draw attention to the continued reduction in the number of outdoor visits paid by the Health Visitors. These have fallen from 34,120 in 1930 to 31,065 in 1931, and 29,636 in 1932. The fall in 1932 is more serious than it appears, because the above figure includes 2,184 extra visits which were necessitated in this year owing to the outbreak of Measles, thus obscuring the fact that the ordinary visits to babies and children—the chief work of the Health Visitorshad fallen by 3,074. The fall in the birth rate may be discounted as an important factor in explaining this because a comparison of the visit figures with those of the child population of the Borough will show that the visitation is quite inadequate. This is particularly marked in the toddler age group. The chief explanation is undoubtedly that the services of the Health Visitors have been increasingly taken up with additional sessions at the Welfare Centres and their outdoor work has 38 necessarily been curtailed. It may be that the only satisfactory remedy is to increase the health visiting staff. MATERNITY AND CHILD WELFARE CENTRES. At the Council's principal Centre in Cornwall Road, there were 101 morning sessions and 154 afternoon sessions for infant consultations and 113 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. The auxiliary Centre at St. Matthew's Institute, Hereford Street, is used for Infant Consultation Sessions on Monday and Thursday afternoons, and an AnteNatal Clinic on Thursday mornings. There were 101 Infant Consultation Sessions and 52 Ante-Natal Sessions. The following ratios may be of interest:— Ante-Natal Clinics Children's Clinics Acreage per Centre 380 380 Population per Centre 53,150 53,150 Ratio of new expectant mothers or babies under 1 attending Centres respectively, to total net births 44.3 67.2 CHILDREN'S CLINICS. The statistics of attendances at the Centres during 1932, and in previous years are as follows :— 1932 Cornwall Road Hereford Street Babies (0—1): First attendances 779 348 Subsequent ,, 7,609 2,955 Children (1—5): First 110 60 Subsequent 4,733 1,846 Total „ 13,459 5,209 39 1932 Cornwall Road ord Street Sessions per week 6 2 Average attendance per Session 52.7 51.9 Doctors' attendances per week 9 3 Medical Consultations: Babies 4,173 1,966 Children 2,856 1,239 1932. 1931. 1930. 1929. 1928. Total Attendances of Children 18,668 19,100 19,843 18,481 19,373 New Cases (Children) 1,510 1,400 1,497 1,452 1,536 New Cases (Mothers) 724 740 716 761 759 Medical Consultations— Children 10,462 12,062 11,982 11,800 12,552 Mothers 1,956 1,906 1,702 1,688 1,726 Statistics with regard to the attendances at the Maternity Clinic are given in detail later. 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. Dr. Horton reports as follows :— Cornwall Road Infant Consultations. Five sessions each week are devoted to Infant Consultations, three in the afternoon and two in the morning. The morning clinics are new and are intended to save mothers an additional journey to the centre and serve those families receiving Milk Grants, the sessions for which are 40 held at the same time, but they are also available for all children, including those from Hereford Street who attend Cornwall Road for Sunlight Treatment, Inhalation, Massage or the Breast Feeding Clinic. Attendances have not been big, but a certain number of mothers are glad of the opportunity to save time. The urgent need to be at home for school children and husbands at dinner time prevents many from attending a morning clinic, as well as a Milk session or for some form of treatment. The Wednesday afternoon clinic which began the year as a small one owing to the transference of a big group of mothers to Hereford Street, has increased in numbers though the attendances are not so large as on Tuesday and Friday when the clinics are old established. A stall on which model infant clothing is shown and where either garments or materials may be bought by the mothers has been open during the afternoon sessions. Few Health Talks have been given, the staff finding it increasingly difficult to fit these into the busy routine work. Those that have been given have been good and much appreciated. From the point of view of a medical officer the outstanding need seems to be to tackle the problem of child management. Apart from conditions due to lack of good general diet and to insufficient fresh air, these mismanaged children form a big group attending the clinics. It is encouraging to 9ee the ready response made by the young mother to the advice of the centre staff, but a large amount of work remains to be done to ensure rational treatment of the young child. Good response has been made to the Council's Orthopaedic scheme and to the arrangements made for treatment for Enlarged Tonsils and Adenoids. Increasingly mothers ask for Dental treatment for their children, but still relatively few mothers are willing to part with their children for Convalescence. An attempt has been made to reduce the number of bottles of medicine given at the clinics, and to teach that good health means a good life. It is encouraging to find an occasional mother who says "No medicine, thank you, doctor." Infant Consultations, Hereford Street. This has been the first whole year of the clinic's existence and it has been spent in establishing it as a separate unit from the Cornwall Road Centre. Change is accepted slowly by our mothers, and as many of them had previously attended Cornwall Road with their children, 41 they have had to form the habit of attending the branch oentre. Routine consultations have been held on Mondays and Thursdays, having respectively two and one Medical Officer in attendance. Attendances have been satisfactory when it is remembered that at any branch centre a steady number of children must be referred to the main oentre for various purposes and varying lengths of time. One hundred and eighteen children from Hereford Street attended for Sunlight treatment at Cornwall Road, while ninety-six mothers and infants were referred to the Breast Feeding Clinic; also the majority of children receiving Milk grants, and all children receiving Massage or Inhalation treatment attend Cornwall Road. In fact the very success of these other clinics implies a continuous withdrawal of a number of children from Hereford Street. The organisation of the work has been satisfactory and an acknowledgment must be made to the staff for their help and co-operation in ensuring the comfort of the mothers while at the centre and eliminating waiting and delay. Thirty talks were given by the Superintendent Health Visitor at the Monday clinic. These have been appreciated and commented on by individual mothers. Model garments for infants have been on view at each session, and although for obvious reasons the sales have been small, the mothers have been interested and encouraged to make similar clothes for their own children. Our thanks are due to the clergy of St. Matthew's for their assistance in arranging the club room most conveniently for the clinic and to those Councillors who have visited us for their interest in the work. TODDLERS' CLINIC. The Toddlers' Clinic has been held at the Cornwall Road Centre on Monday morning in each week and has completed its first year of its existence. Letters of invitation to attend have been sent to each district in weekly rotation. The Superintendent Health Visitor and the Health Visitor in charge of the district being on duty at the clinic. Attendances have been small, but judging by the frequency with which replies are received explaining inability to attend, the invitations are appreciated by the parents. The results of examination show that more than half of the children required treatment of some kind. The biggest groups were Dental Caries and Rickets. Sixty children had 42 enlarged tonsils, but only twenty-five required treatment, the remaining thirty-five children being quite untroubled by them. The problem of child management frequently recurred, thirty-three children being found who had insufficient sleep, sixteen children had insufficient fresh air and exercise while a similar number had symptoms of marked nervous tension. These mismanaged children not only come from crowded homes with overburdened mothers where the problem is difficult to solve, but also from good homes with over-anxious mothers. The height and nutrition of the majority of the children was satisfactory and their resistance to serious illness, judged by their previous history, apparently good. Records are as follows:— Sessions 40 Children inspected 213; Children treated 155 Total 368. Average attendance per session 9.2 Conditions found on examination. Development Late in Teething 9 „ „ Talking 10 Nutrition Dental caries 57 Rickets 34 Infection Enlarged glands of neck 32 „ tonsils 60 Discharging ears 7 Management Laite to bed 33 Insufficient fresh air 16 Nervous tension 16 MATERNITY CLINIC (CORNWALL ROAD). This is open every Wednesday and Thursday, morning, and during 1932 the special post-natal session on Monday after being altered from weekly to monthly was finally discontinued owing to the falling off in attendance Particulars of attendances: Expectant Mothers—First visits 372 ,, „ —Subsequent visits 703 Mothers recently confined—First visits 139 ,, ,, „ —Subsequent visits 59 Total. 1,075 198 43 The number of sessions was 113, and the average attendance per session was 11 2. 41 of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement, and 15 mothers were sent away to a convalescent home. The 372 women who attended for the first time may be grouped as follows:— Gravid:—Primipara 45 —Multipara 307 352 Not pregnant 20 372 In the case of the 352 gravid women, the following were the periods of gestation:— 3 were in the 1st month 39 „ „ „ 2nd „ 27 „ „ „ 3rd „ 52 „ „ „ 4th „ 50 „ „ „ 5th „ 84 „ „ „ 6th „ 70 „ „ „ 7th „ 27 „ „ „ 8th „ nil „ „ „ 9th „ An analysis of these cases shows:— Full-term confinements 233 Premature births 4 Miscarriages (6); Stillbirths (5) 11 Not yet confined 94 Left Borough (results unknown) 6 Transferred to Hereford St. Clinic 4 The known confinements took place:— 192 at home, and 56 in institutions. Wasserman reaction for syphilis Nil 44 The results of the 91 cases brought forward from 1931 were as follows:— Full-time confinements 87 Premature births — Miscarriages(l); Stillbirths(l) 2 Left district (result unknown) 1 • Found to be not pregnant 1 Of the 88 for whom we have information, in 69 cases the confinement took place at home, and in 19 cases in an institution. Dr. R. C. Townshend reports on the work of the Maternity Clinic, as follows:— Report on the Cornwall Road Ante-Natal Clinic during the year 1932. Although there was a decrease in the numbers, the actual results of the cases are good. There was one Caesarean, two instrumental cases and no deaths amongst the mothers attending the Clinic. Two factors have contributed to the decrease in attendances, namely the fall in birth rate, and the additional Ante-Natal Clinic in Hereford Street, which was open throughout the year. Assuming that the attendance of patients from the districts which are now under the Hereford Street Clinic was only 2 par week, this would account for a decrease of 104 new antenatal cases in the year. With regard to the miscarriages, all 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 still-births, all occurred in multipara, in two cases the confinement was 28 weeks premature, and in one case 36 weeks premature. In one case delivery occurred before the arrival of the midwife, and in one case the child was abnormally large and delivery instrumental. With regard to the premature confinements, all occurred in multipara, and in every case the delivery took place in hospital. One case was due to an induction of labour at the eighth month on account of heart disease, with the result that both motheT and child lived. In one case the patient was a multip. 14, aged 39. The Borough Midwife continues to attend the Clinic when possible and report on her cases, and the local midwives have also visited the clinic occasionally for a 45 sultation about their cases. In addition, the midwife is always provided with a written report on every case, which is afterwards returned to me with a report on the confinement. I also receive other reports from health visitors on cases which they visit. It will thus be seen that there is a very close co-operation between the clinic and the midwives, and that all patients visiting the clinic are followed up as far as it is possible. R. C. Townshend. 15th March, 1933. MATERNITY CLINIC, HEREFORD STREET. The new Ante-Natal Clinic at the Hereford Street Centre which was opened in September, 1931, has now become well established in the district. Dr. Horton reports on the year's working as follows :— Hereford Street Ante-Natal Clinic. The average attendance for the year has been satisfactory. Re-appointments have been well kept and many new cases have been recommended to the clinic by mothers already attending it. The frequent visits of the Borough Midwife and the midwives practising in the district have been valuable and the interest of doctors in practice in the Borough "has made for pleasant co-operation in the care of the mothers. Miss Basden, M.S., F.R.C.S., of the Mildmay Hospital has kindly given expert opinion on any case requiring a Consultant's advice. The one miscarriage occurred in an anaemic undernourished woman with six children. She made a normal recovery in hospital. The four mothers of premature children were women with poor home conditions and a history of illness. Two of them had had premature children previously. They all attended the clinic late in pregnancy. The importance of post-natal care is apparently increasingly realised, the majority of mothers attending for examination after delivery. 'It is still difficult to persuade mothers to attend the Dental Clinic, but the minority who have had courage to do so have been surprised to find how painless efficient dentistry can be to-day. My thanks are due to the nursing staff on duty at 46 this clinic. Their help with the additional services of Home Helps and Maternity Outfits, and the friendly but efficient atmosphere they have created have been very valuable assets. Records are as follows:— Expectant mothers First attendances 115 Subsequent „ 374 Total „ 489 Mothers recently confined First attendances 86 Subsequent ,, 115 Total „ 201 Sessions held 52 Average attendance per session 13.2 Analysis of 1932 cases:— First attendances—Primiparse 13 Multiparæ 92 Not pregnant 10 115 Periods of Gestation:— In 1st month 1 „ 2nd „ 11 „ 3rd „ 14 „ 4th „ 20 „ 5th „ 16 „ 6th „ 16 „ 7th „ 19 „ 8th 8 „ 9th „ Nil. Full term confinements 68 Not yet confined 33 Removed from district 4 Premature birth 3 Miscarriage 1 Stillbirths Nil. Known confinements:— At home 51 ,, institutions 21 — 72 47 Cases brought forward 1931:— Full term confinements 15 Premature birth 1 Not pregnant 1 – 17 MOTHERS' CLINIC. A clinic to provide contraceptive advice for married women within the terms of the Memorandum of the Ministry of Health was opened at Cornwall Road in October. The clinic is to be held in two consecutive weeks every two months, on Thursday afternoons. At this time there is no Maternity or Child Welfare session held at the centre. Mothers may be recommended by doctors at the clinics or from hospitals in the neighbourhood. Two members of the Health Visiting staff received a course of training in the management of such a clinic at Burdett Road. Our thanks are due to the Secretary and the Medical Officer at Burdett Road for their courtesy and interest. The October session was in the nature of an experiment and was not followed by a second session. Two mothers attended. Arrangements seemed satisfactory and at the November clinic five mothers attended. Of the total four only were eligible for treatment at the clinic. We look forward to next year's work. Record of Cases. Advice and contraceptive given 4 Referred to Burdett Road Clinic 2 No treatment or advice 1 Analysis of Cases. Rheumatic Carditis 4 Neurasthenia 2 1 under Maudsley Hospital 1 „ Maida Vale „ No abnormality found 1 — 7 Record of Attendances. October 2 November b BREAST FEEDING CLINIC. The Breast Feeding Clinic was begun to try to maintain breast feeding in cases where there were definite signs of its being given up. The reasons are many, but fall into three 48 big groups: (1) Difficulty of circumstance—the mother being compelled to work or her home conditions being such that she has inadequate time to spend on her child; (2) The mother herself being undernourished physically or overstrained menrtally or unskilled in the technique and management of her child; (3) The child, varying from the feeble baby who sucks poorly to the vigorous infant who gulps his feed in a hurry. A quiet room is used and every mother is made as comfortable as possible. Test feeds are given and any child not receiving an adequate feed is seen by the doctor. Each feed is carefully supervised by the nursing staff in charge, and practical advice as to the management of each individual child is given. In certain cases appointments for afternoon test feeds are given, and every effort made to overcome each particular difficulty. Records are kept and the mothers encouraged to be interested in them. Such work is not possible in a busy routine Infant Clinic, and not the least of our difficulties is to overcome outside influences against breast feeding. Numbers show nearly 50 per cent, of complete successes and about 20 per cent, of oartial success. The records are as follows:— New cases 300 Subsequent attendances 565 Total attendances 865 Average attendance per session 16.7 Doctors' Consultations 144 Health Visitors ,, 721 Results of cases attending: — Breast fed entirely 146 Breast fed with supplementary feed 64 Weaned 71 Removals 19 300 Reasons for Weaning: — Breast milk failed 32 Mothers refused to breast feed 25 Mothers working 4 „ pregnant 3 „ illness 3 ,, with twins 2 Baby with Whooping Cough 1 Mongol 1 71 49 HEALTH TALKS AT WELFARE CENTRES. One hundred and twenty five Health talks to mothers have been given during the year by the Health Visitors. It has been found easier to use the waiting time at the Antenatal Clinic for this purpose than at the Infant Consultations, as the mothers usually have no children with them at these clinics and as no weighing has to be done. Both, factors are against the quiet atmosphere necessary for the speaker to be heard and understood by the audience. The subjects of the talk? have been varied, but may be grouped under four headings:— 1. The Auxiliary Services, i.e., Home Helps, Maternity Outfits, etc. 2. Food Values, including cookery, planning the family budget, menus, etc. 3. Labour Saving Methods, care of the child, the making of garments, arrangements in the home, etc. 4. Safety First, dustbins, fireguards, cots, reins for toddlers, treatment of minor ailments, etc. The talks have been appreciated by many of the mothers, who make comments and criticise them with interest both at the time and subsequently. BOROUGH MIDWIFERY SERVICE. The Borough Midwife had 28 bookings carried forward from 1931. During 1932, 131 bookings were received, of which 9 were subsequently cancelled, 8 for confinement in hospital and 1 because of removal from the Borough. During the year 121 mothers were attended, 90 by the Borough Midwife (5 of whom she found it necessary to take to hospital while in labour), and 31 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. In 3 cases a doctor was engaged by the patient as well as the Borough Midwife. Of the mothers delivered, 6 were primiparae and 110 multiparse. There were 31 expectant mothers on the books at the end of the year. The Borough Midwife or her deputy paid 1,260 visits in connection with her practice and 25 other 50 visits. She also conducts a regular weekly session for ante-natal care of her patients. It is gratifying to record that 42 of the mothers delivered by the Borough Midwife during the year had been previously attended by her, 27 on one previous occasion, 6 of them on two previous occasions, 7 on three occasions, and 2 on four occasions. OBSTETRICAL CONSULTANTS. The Council has a panel of five Obstetric Consultants, who may be called in by any general practitioner in any midwifery case which presents difficulty or abnormality. One consultation took place during the year. HOME HELPS. At the end of the year, there were 12 Home Helps on the panel, while 5 other women were also occasionally employed as relief helps. During the year, there were 250 engagements of Home Helps, as compared with 275 in 1931, 165 in 1930, and 65 in 1929. In 145 cases the mother paid a contribution for the services rendered. MATERNITY OUTFITS. Outfits were issued as follows:—Free, 152; Halfprice, 35; Cost price, 34. Total, 221. 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:— 61 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 9fin. 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 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. 7,999 families were assisted in this way compared with 8,793 in 1931, a total of 10,132 individual grants being made in this way. There were 100 sessions for dealing with applications for milk grants, and parents made 22,564 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 15,894 galls. Dried Milk 24,980 pkts. Condensed Milk 29 tins. together with medicines, etc. The approximate cost of milk given in this way was £3,955. 52 SUPPLY OF DRIED MILKS, Etc. Apart from the milk issued free or at half-price, dried milk of various brands, labelled specially to the Council's directions to avoid the use of trade names, is sold to the mothers practically at cost price. The amount sold during the year fell considerably and was as follows :— Dried Milk 5,221 pkts. Condensed Milk 8 tins. HYGIENIC CLOTHING. The Welfare Centres continue their useful service of 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. 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 1932,. In the past year the children sent to this clinic have appeared to be of much the same type as in previous years, but I think there is no doubt from the appearance of the mothers that maintenance of the condition of the children 53 has often been achieved at the expense of the diet and' health of the mother, and that there is a definite falling off in the health of the latter. If this be so, then this retrogression is likely before long to affect the children too. Professor Davidson and his co-workers in Aberdeen, have shown that approximately 50 per cent, of the working-class women whom they examined were suffering from anaemia, which was primarily nutritional in origin, and could be cured by giving iron, and that with the industrial depression the dietary of the poorer classes of the community has become definitely worse. Bearing in mind how the welfare of the whole family is usually dependent on the mother, it seems important that the maternity and child welfare service should concentrate on this problem in the interests of both mother and child. The Aberdeen investigators suggest that " a glass of milk . . . and a pennyworth of iron and ammonium citrate daily without ai\y additional change in the diet of pregnant women of the poorest classes would produce remarkably beneficial results to mother and infant." But this leaves out of count the ill-fed mother of a growing family. If the health of the mothers is not improved, it seems certain that the proportion of physically, subnormal and nervous children in the population is bound to increase. The attendances at the clinic were as follows:— No. of sessions 48 New cases 51 Subsequent attendances 348 Total attendances 399 The figures for the past year are:— New Cases 52 Total attendance 408 Subsequent attendances 356 Consultations 401 H. M. M. MACKAY, M.D. LIGHT CLINIC. I append the report of Dr. K. M. Horton, who conducts the Light Clinic:— Artificial Sunlight Clinic. This year's work has been encouraging; 469 new cases were referred for treatment, as against 272 in last year. At all three sessions both lamps have been used to capacity 54 and despite giving special appointments to the mothers and good team work by the staff, the clinic has been crowded. Re-attendances have been good and results satisfactory. Fifty per cent, of the lapsed cases ceased to attend because of school attendance or sickness of the child or owing to sickness or pregnancy of the mother. In very few instances only is the lapse due to indifference on the mother's part. Children have been referred to the clinic by doctors in practice and by hospitals in the district and we have been glad to co-operate with them. In 94 instances the treatment was combined with Inhalations and suitable cases are given Massage on the same morning of attendance. An analysis of cases follows:—In most cases each group is divided into sub-groups to include some condition subsidiary to the main one. It has been interesting to see the good response made by the highly-strung children and to observe how rapidly teeth are cut, or standing or walking achieved where these developments are delayed. Mothers frequently ask for a second course of treatment for their children. In view of the many and varied calls on a Bethnal Green mother's time this fact is encouraging for the future. We look forward to the increased facilities that the installation of a third lamp will give us. My thanks are due to the Nursing staff in charge of this clinic whose enthusiastic co-operation is largely responsible for the increased work in the past year. Records are as follows:— No. of sessions 154 Total treatments given 7,497 Average attendance per session 48.7 Cases treated: Children: First attendances 453 Subsequent „ 6,887 Mothers: First attendances 16 Subsequent „ 138 Analysis of Cases. Diagnosis Cases Improved Lapsed Removed No change Anaemia 88 37 22 8 2 Undernourished 15 Rickety 8 Otorrhœa 6 Nervous Tension 9 Malnutrition 62 31 22 7 l Anaemia 6 Rickety 6 *Chronic Cough 6 Nervous Tension 3 56 Diagnosis Cases Improved Lapsed Removed No change Delayed Development 29 12 n 6 — Debility after 104 44 46 9 4 Whooping Cough 18 Measles 17 *Bronchitis 15 Broncho Pneumoni a 12 with Cervical Adenitis 6 ,, Nervous Tension 6 Rickets 123 83 58 13 1 *Coughs and Colds 29 Anaemia 6 Nervous Tension 5 *Bronchitis 48 26 18 4 1 Skin Eruptions 10 4 6 — — Styes Impetigo Urticaria Eczema Debility after Confinement 7 4 3 — — Failing Breast Milk 10 7 2 — 1 *Also received Inhalation treatment. DENTAL CLINIC. Two sessions per week are held in connection with, the Dental Clinic, one conducted by Miss J. H. M. Sutherland, L.D.S.(R.C.S.) and the other by Mr. F. Reginald Bate, L.D.S.(R.C.S.). Miss Sutherland reports on her work during the year as follows:— Sessions held 46 of which 14 were Gas Sessions and 7 partly devoted to routine inspections of children of 3 and 4 years of age. Total. Children. Mothers. Brought forward from 1931 38 18 20 New cases 151 84 67 Routine Inspection 22 22 — Subsequent attendances 337 115 222 Total 510 Average attendance 11 Gas administrations 124 48 76 Extractions 641 254 Temp. teeth. 76 53 387 Perm. teeth. 68 Total. Children. Mothers Fillings 70 40 Temp, teeth. 20 14 30 Perm, teeth. Dressings 13 2 11 Silver Nitrate 27 26 1 Scaling and polishing 10 3 7 Dentures 32 2 One plate — 17 15 Two dates Expectant mothers treated — 23 Cases referred to London Hospital — 4 „ „ „ Mildmay 2 — Patients recommended by Centre Doctors 35 48 H.V 44 19 Forty-six sessions were held during the year, fourteen of which were gas sessions and seven were partly used for routine inspection cases. The average attendance was maintained much as last year. An increased attendance of expectant mothers is again noted and there is a greater willingness to receive treatment. The number of mothers fitted with artificial dentures has also increased. This section of the dental work occupies a considerable part of each session and time that was spent last year on routine inspections has now been given to these mothers (as the afternoon sessions deal mainly with inspections). It is hoped that the mothers who have received dental treatment themselves will be encouraged to bring their children, especially those under two years of age, for prophylactic and conservative treatment, as it has been found that caries often starts even before the temporary teeth are fully erupted. Instruction in the correct method of brushing the teeth is given, and emphasis is laid on the necessity of teaching children to chew their food. Janet H. M. Sutherland, Dental Surgeon. Mr. Bate furnishes me with the following statistics and comments :— Sessions held, 48, of which 14 were Gas Sessions. Children attending routine inspections, 203, of whom 121 were found to require treatment. 103 of these children were treated, the remaining 18 failine to re-attend for treatment. Children referred by Medical Officers and Health Visitors, &0 all requiring treatment and making 198 subsequent attendances, 57  Children. Teeth extracted or stopped. Treatment under gas 130 425 Treatment under ethyl chloride spray 11 12 Stoppings 50 86 Removal of stain by polishing 5 — Silver nitrate 16 — Cases referred to L.C.C. 2 — Refused treatment Nil. — The number of inspections for 1932 has worked out a little under that of the previous year. There has been a less number of extractions performed, although there was a slight increase in the number of gas cases that attended. There is also a definite increase in the number of conservative treatments (fillings, etc.) given, which indicates that the parents are realising that it is important to preserve the deciduous teeth as long as possible. Speaking generally, the mouths inspected were in a better condition than the previous year and a lesser number failed to return for treatment. 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. During the year, the Orthopaedic scheme, arranged with the Royal National Orthopaedic Hospital, was terminated. A new scheme, arranged with the Queen's Hospital, came into operation on the 1st October. Under the revised arrangements any Medical Officer at the Welfare Centres who finds a child requiring orthopaedic treatment refers the child to one or other of the two Orthopaedic Surgeons who attend weekly at the Queen's Hospital. If in-patient treatment or any appliance is recommended, it is provided by the Council, subject to possible contribution by the parents under the Council's income scale. The new scheme has led to much greater promptitude in dealing with cases and to fuller information being available concerning treatment, 58 During the first nine months 8 sessions were held at the Orthopaedic Clinic by the Surgeon from the Royal National Orthopaedic Hospital, at which there were 130 attendances, 34 being of new cases and 96 old cases. The Orthopaedic sister attended 32 times, and 133 attendances were made at her sessions. During the last quarter, 15 children were referred to the Queen's Hospital. MASSAGE. Miss Lawson has continued her work as Masseuse to the Council's Welfare Centres. In the early part of the year she treated 42 children under the supervision of the visiting Orthopaedic Surgeon, and in the latter half 19 children who were referred to the Orthopaedic Department of the Queen's Hospital. Children have been sent to the Centre for massage from the London, Queen's and Bethnal Green Hospitals. Cases carried forward from 1931 31 New cases in 1932 116 An analysis of the records follows:— Rickets 40 Curved Tibiæ 34 Genu Valgum 16 „ Varum 2 Torticollis 13 General Debility 8 Flat Foot 7 Talipes 5 Poor Chest Development 3 Congenital Deformity of Toes 2 Injury to Elbow 1 Fractured Femur 1 Kyphosis 1 Spastic Monoplegia 1 Anterior Poliomyelitis 1 Amyotonia Congenita 1 Constipation 3 Failing Breast Milk 8 147 59 INHALATION CLINIC. The attendances at this clinic for the treatment of catarrhal conditions of the respiratory tract have been satisfactory. Early in the year a second inhaling mask was attached to the Spiess-Drager Inhaler, enabling two treatments to be given simultaneously. Campheugene, Cajuput and Pine Oils in all three combinations have been used for fixed periods, better results being obtained by the combination of Cajuput and Pine Oils than either of the others. There were 159 sessions during the year and the following attendances were made:— Children: First 144 Subsequent 1,623 Mothers: First 2 Subsequent 13 Cases carried forward from 1931 17 New cases in 1932 149 Analysis of the cases is as follows:— Diagnosis Cases Cured Improved No Change Bronchitis 58 11 24 23 Tracheitis 23 9 8 6 Recurrent Colds 17 8 6 3 Catarrh after Whooping Cough 5 2 2 1 Bronchial Catarrh 3 2 1 — Asthma 1 — 1 — Laryngitis 1 1 — — Aphonia 1 — — 1 Fibroid Lung 2 — — 2 For various reasons 37 children could not attend often enough for a definite result to be obtained from the treatment. Eighteen cases are carried forward to 1933. ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the arrangements with the Queen's Hospital, 14 young children had operations for enlarged tonsils as in-patients upon the recommendation of the Medical Officers of the Welfare Centres, 60 CONVALESCENT TREATMENT. During the year 10 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, and 8 mothers to the "George Whitlaw" Convalescent Cottage, Amerden, near Taplow. Eighteen mothers were sent away for two weeks. In 7 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 60 children were sent to that Council's Home at St. Leonard's-on-Sea, Sussex, 1 for one week, 1 for two weeks, 48 for the normal period of four weeks, 5 for five weeks, 4 for six weeks, and 1 for eight weeks. One child was also sent to the John Madocks' Babies' Home at Basing for two weeks. In 14 cases the parents contributed to the cost of the convalescence. Evidence continues to come in concerning the beneficial results of the convalescent treatment provided by the Council for mothers after confinement and for young children. 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 fox Delicate Children are referred to the Queen's Hospital or one of the General Hospitals. NURSING ASSISTANCE. A scheme of home nursing has been in operation for some years by arrangement with a 61 voluntary organisation, the Shoreditch and Bethnal Green Nursing Association. During the year 312 children under the age of 5 were nursed, a total of 3,235 visits being made. 34 mothers received 396 visits for nursing in connection with conditions incidental to child-bearing. Nursing Assistance, 1932. Disease Children UNDER FIVE years Mothers Others Total Visits Cases Visits Cases Visits Cases Visits Ophthalmia Neonatorum 1 11 ... ... ... ... 11 Discharging Eyes 59 797 ... ... ... ... 797 Measles 14 184 ... ... 1 5 189 Whooping Cough ... 2 ••• ... ... ... 2 Diarrheœa ... ... ... ... ... ... ... Puerperal Fever and Pyrexia ... ... 1 5 ... ... 5 Other pre-natal and postnatal conditions ... ... 33 391 ... ... 391 Otorrhoea. Abscess of Ear 33 546 ... ... ... ... 546 Tonsils and Adenoids 59 226 ... ... ... ... 226 Influenza 1 2 ... ... 10 103 105 Bronchitis 6 47 ... ... ... ... 47 Pneumonia 10 166 ... ... 14 223 389 Tuberculosis 3 23 ... ... ... ... 23 Intestinal Conditions 4 17 ... ... ... ... 17 Threadworms 55 464 ... ... ... ... 464 Septic Umbilicus 32 328 ... ... ... 328 Impetigo and Eczema 5 128 ... ... ... ... 128 Circumcision 4 30 ... ... ... ... 30 Septic arm, leg. etc. 17 154 ... ... ... ... 154 Miscellaneous 9 110 ... .... 1 7 117 Totals 312 3235 34 396 26 338 3969 11 cases were in hand at the beginning of the year. 5 cases were in hand at the end of the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of Puerperal Fever were reported during the year. The patients were treated : 1 in Bethnal 62 Green Hospital, and the other in the East London Maternity Hospital. There was 1 death from the disease. Fifteen cases were notified as Puerperal Pyrexia. One patient was treated at home. The other patients were treated at the following Hospitals:—London (6), North Western (2), and Bethnal Green, Mothers', City of London Maternity, Jewish Maternity, St. Peter's and Charing Cross (1 each). OPHTHALMIA NEONATORUM. 19 notifications of Ophthalmia Neonatorum were received during the year. 5 cases were removed to and treated in the St. Margaret's Hospital, 1 to the Bethnal Green Hospital, while 6 other cases were treated as out-patients at the London and Moorfield's Hospitals. The remaining cases were treated at home. The Health Visitors paid 73 visits to cases. Every case cleared up without any impairment of vision being reported. 34 reports were also received from Medical Officers of the London County Council concerning new born babies suffering from inflammation of the eyes, 1 of these cases being subsequently notified as Ophthalmia Neonatorum. These cases were also visited by the Health Visitors. The district nurses treated 59 cases of discharging eyes in young infants, paying 797 visits for the purpose. 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. 63 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 to economic causes, which is certainly responsible for the fact that only 20.9 per cent, of Bethnal Green children are well clothed and shod compared with 58.2 per cent. throughout London. The irony of this situation 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 cleanliness 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 present facilities for the supervision of "the toddler'' and closer relations between the Maternity and Child Welfare and School Medical Services. The routine medical inspection of toddlers by Dr. Horton, the full-time Medical Officer, which Avas 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. 64 Routine Medical Inspection of Elementary School Children in Bethnal Green in 1932. 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 decyaed j 6; 6 in both eyes 6/9 in either or both eyes 6/12 or worse in either or both eyes entrants Boys 951 248 695 8 96 797 57 1 914 35 2 918 30 3 511 324 116 — — — Girls 1074 257 807 10 113 904 57 — 1025 43 6 1037 35 2 587 355 132 — — — Age 8— Boys 805 146 657 2 59 680 66 790 15 — 778 25 2 504 262 39 340 336 108 Girls 834 141 691 2 77 695 62 — 809 21 4 799 32 3 503 299 32 325 358 150 Age 12— Boys 981 145 835 1 91 823 67 — 968 12 1 963 18 — 657 305 19 501 266 208 Girls 1-234 308 924 2 133 1050 51 — 1172 59 3 1190 42 2 861 358 15 558 364 311 Age 14— Boys 594 108 485 1 104 471 19 — 577 17 — 568 26 — 378 212 4 298 176 120 Girls 772 158 612 2 95 643 34 — 741 29 2 742 30 — 529 230 13 365 200 206 Total 7245 1511 5706 28 768 6063 413 1 6996 231 18 6995 238 12 4530 2345 370 2387 1700 *1103 Percentage 20.9 78.7 0.4 10.6 83.7 5.7 — 96.6 3 .2 0.2 96.5 3.3 0.2 62.5 32.4 51 46.0 328 21.2 London 58.2 41.1 0.7 21.1 74.3 4.6 — 96 .0 3. 6 0.4 97.5 2.4 0.1 68.7 26.3 50 61.7 21.3 17. 0 65 Examination of Elementary School Children in Bethnal Green, 1932. BOYS GIRLS Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number examined 951 805 981 594 1074 834 1234 772 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 15 8 14 7 17 6 1 1 21 9 11 3 13 3 4 2 Skin disease 22 13 9 8 13 8 3 2 24 14 8 4 8 6 8 8 Defective teeth — 381 — 265 — 311 — 204 — 439 — 296 — 356 — 238 Enlarged tonsils 214 66 70 23 107 44 36 23 225 72 104 38 120 40 45 31 Adenoids 19 11 10 8 3 3 4 4 13 5 12 7 7 6 2 2 Enlarged tonsils and adenoids 23 15 7 6 3 2 — — 24 21 12 12 4 4 1 1 Other nose and throat defects 10 2 13 7 8 5 3 2 15 4 5 1 33 7 2 1 Enlarged glands 15 — 5 1 10 1 3 — 21 — 3 — 6 2 7 — Eye disease 53 34 12 8 10 7 8 3 39 26 17 9 12 11 10 8 Vision defect — — — 52 — 163 — 81 — — — 85 — 188 — 129 Otorrhoea 11 8 7 5 5 3 7 6 14 9 11 8 4 3 6 5 Other ear disease 1 1 7 6 9 6 6 6 3 3 5 4 3 2 6 6 Defective hearing 4 1 2 2 5 4 3 1 1 — 3 1 1 — 2 — Speech defects 2 — 5 1 5 4 2 1 3 — 1 — 2 — 2 1 Heart defects 7 — 9 — 16 — 7 1 8 1 13 2 19 2 19 3 Anaemia 8 2 8 5 8 1 4 1 11 4 13 5 8 2 5 1 Lung defects 93 22 41 18 21 5 7 4 83 21 34 9 26 9 15 6 Nervous defects 3 2 6 — — — — — 4 — 3 — 3 — 4 — Phthisis — — — — — — — — 1 — 1 — — — — Other T.B. disease — — — — — — — — — — — — — — — — Rickets 28 3 4 — 4 1 — — 20 1 2 3 2 — Spinal deformities 1 — 3 3 2 1 2 2 1 — 2 2 9 5 9 5 Other deformities 11 3 6 1 10 7 11 7 10 2 6 2 17 7 6 4 Other defects 30 16 9 6 23 16 4 — 24 12 24 14 23 11 10 6 Number of children noted for treatment 490 369 489 295 543 416 562 373 'Defects however slight are included under " cases "; those severe enough to require treatment are shown under * 66 THE CONTROL OF DISEASE. It is satisfactory to report that the epidemic of Smallpox has subsided, a few sporadic cases only being notified during the year. The number of cases of Diphtheria notified, although slightly in excess of the number notified in 1931, is below the average for the past five years. Scarlet Fever was prevalent, the number of cases notified being 158 in excess of the previous year. This is no doubt attributable to the quinquennial incidence of this disease. We have the curious anomaly of the organised public health service concentrating its excellent resources on diseases like Scarlet Fever, while Rheumatism—a non-notifiable disease—with its great potentiality for serious crippling is practically outside its ken. The limited scope of the local health service is of course specially marked in the London Boroughs where the local health authority has no responsibility for the school medical service. 67 Cases of Notifiable Diseases Notified during 1932. Disease Number of Cases Notified / Removed to Hospital 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 Smallpox 24 25 ... ... ... 1 ... 2 7 4 3 4 4 ... 25 Enteric Fever 6 5 ... ... ... ... 1 ... ... 1 2 1 ... ... 5 Diphtheria (inc. Memb. Croup) 354 355 5 21 33 40 37 139 44 15 9 9 2 1 351 Scarlet Fever 591 590 4 37 45 52 63 264 75 24 16 9 1 ... 575 Puerperal Fever 2 2 ... ... ... ... ... ... ... ... ... 2 ... ... 2 Puerperal Pyrexia 15 15 ... ... ... ... ... ... ... ... 4 11 ... ... 14 Ophthalmia Neonatorum ... 19 19 ... ... ... ... ... ... ... ... ... ... 6 Erysipelas 96 96 4 1 2 2 ... 1 4 6 5 28 34 8 47 Cerebro spinal Fever ••• 6 ... 1 1 ... ... ... 2 1 1 ... ... 6 Acute Poliomyelitis ... 3 ... 2 ... 1 ... ... ... ... ... ... ... ... 3 Acute Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia ... 131 3 7 4 7 4 21 12 8 12 26 21 6 74 Acute Influenzal Pneumonia ... 28 ... ... ... ... ... 2 2 1 4 10 8 1 10 Dysentery ••• ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... 1 ... ... ... ... ... ... ... 1 ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever, Cholera, Plague, Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Hydrophobia, Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... 145 ... ... 1 1 ... 4 4 25 22 49 32 7 * Other forms of Tuberculosis ... 39 2 ... 2 ... 2 8 3 6 6 7 2 1 * Total 1460 37 69 88 104 108 441 151 92 84 158 104 24 1118 * See particulars as to Sanatorium Treatment in Tuberculosis section. †The Registrar-General's figures are for notifications received during the 52 weeks ended 31st December, 1932, and include several non-residents. The Council's figures are for cases occurring during the calendar year, and exclude non-residents. 68 Diphtheria. There were 355 cases of diphtheria notified during the year. The age grouping of the cases is given in the accompanying table. All but 4 of the cases were removed to an isolation hospital. Seventeen deaths from this disease occurred during the year, equivalent to a case mortality of 4-8 per cent., or general death rate of 016 per 1,000 of the population. The figures represent a set-back in the Borough's experience of a falling mortality from diphtheria, the average case mortality being 26 and death rate being 0.1 during the previous 5 years. Anti - diphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 104,000 units were supplied during the year. Scarlet Fever. There were 590 cases of scarlet fever notified during the year, 575 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. Three deaths were returned by the RegistrarGeneral as due to scarlet fever during the year, equal to a case mortality of 0.5 per cent., and a death rate of 0.03 per 1,000 population. Mild Smallpox. Twenty-five cases of mild Smallpox occurred in the Borough during the year. The present outbreak of Smallpox began in March, 1929, and there were 263 cases that year, 69 During 1930 the disease was at its height in the Borough, there being 948 cases, and then dropped to 146 cases in 1931, and it seems likely that sporadic cases will occur throughout London for some time. The elaborate precautions which were originally adopted with a view to preventing the spread of infection have been somewhat modified in view of the comparatively innocuous character of the disease. Enteric Fever. Five cases were notified and removed to hospital. 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 Cerebro Spinal Fever and Poliomyelitis, 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, and Home Nursing will be found in the section relating to Maternity and Child Welfare. 70 VACCINATION. The following is the latest available return prepared by Mr. J. H. Lloyd, Acting Vaccination Officer for the Borough, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1931, inclusive. Registration SubDistricts comprised in the Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1931. Number of these Births duly entered by 31st Jan., 1933. No. of Births which on 31st Jan.. 1933, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1933, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1932. No. of Declarations of Conscien ous Objection actually received by Vaccination Officer during the Calendar Year 1932. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Declarati n of conscientious objection received. Died, Unvaccinated. Postponement by Medical Certificate Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. North East 837 83 — 474 56 2 8 15 199 299 385 South West 444 54 — — 204 16 1 3 6 160 220 230 TOTAL 1,281 137 — — .678 72 3 11 21 359 519 615 71 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the notification certificates received during the year are set out in the tables appended hereto, from which it will be seen that 174 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations. In addition 10 posthumous notifications were received making a total of 184 certificates. Information was also received from the Registrar-General or from the Local Registrars of the deaths of 16 persons who had died from Tuberculosis but who had not been notified under the Regulations. During the year 18 persons who had been notified in other Boroughs to be suffering from Tuberculosis took up their residence in this Borough. The number of patients remaining on the Tuberculosis Register at the 31st December, 1932, was 1,335 The details are given in the table on page 74. During the year the Registrar-General reported 99 deaths from Pulmonary Tuberculosis, and 11 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 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 The notifications received during the year will be seen from the following tables : — 72 Public Health (Tuberculosis) Regulations, 1930. PART I.—SUMMARY OF NOTIFICATIONS during the period from the 3rd January, 1932, to the 31st December, 1932, in the area of the Metropolitan Borough of Bethnal Green. AGE PERIODS Formal Notifications Number of Primary Notifications of new cases of tuberculosis total (all ages) Total Notifications 0— 1— 5— 10— 15— 20— 25- 35 — 45— 55— 65— Pulmonary Males ... ... 4 3 9 13 8 15 15 6 1 74 93 Females ... 1 ... 1 16 9 18 7 5 4 4 65 88 Non-Pulmonary Males ... 1 5 2 5 3 5 1 1 1 ... 24 27 ,, ,, Females 1 2 1 1 1 3 1 ... ... ... 1 11 14 part II.—SUPPLEMENTAL RETURN —New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above mentioned period, otherwise than by formal notification. AGE PERIODS 0— 1— 5— 10- 15— 20— 25— 35— 45- 55— 65— Total Pulmonary Males 1 1 ... ... ... 5 5 ... 4 2 1 19 ,, Females 1 1 1 ... 1 1 1 ... 1 1 1 9 Non-Pulmonary Males 1 ... 3 1 ... ... 1 ... ... ... ... 6 „ ,, Females ... 3 1 2 1 ... 1 ... ... 1 1 10 The source or sources from which information as to the above-mentioned cases was obtained, is stated below: Source of Information No. of cases Pulmonary NonPulmonary from local Registrars 6 4 Death Returns transferable deaths from Registrar General 5 1 Posthumous notifications 6 4 "Transfers" from other areas (other than transferable deaths) 11 7 Other Sources if any (specify) ... ... PART III.—NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1932, on the Registers of Notifications kept by the Medical Officer of Health of the County Borough, or Metropolitan Borough Pulmonary Non-Pulmonary Total cases 1335 Males 504 Fem'ls 385 Total 889 Males 254 Fem'ls 192 Total 446 Number of cases removed from the Register(s) during the year by reason inter aliaol:—1 Withdrawal of notification 3 ... 3 ... 2 2 5 2Recovery from the disease 3 1 4 2 1 3 7 3 Death 65 44 109 4 8 12 121 4 Patients removed from Borough ... ... ... ... ... 104 6 Lost trace ... ... ... ... ... ... 76 Total ... ... ... ... ... ... 313 73 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 16 deaths certified from Tuberculosis in which the deceased person had not previously been notified. This represents 14.5 per cent, of the deaths from Tuberculosis during the year. Enquiry of the certifying practitioner in each case elicited the following explanations:— Due to oversight or pressure of work 1 Diagnosis only reached at or immediately before death 10 Certified by Coroner 2 No reply 3 Late notification, probably due to delay in seeking medical treatment, is shown by the following figures:— Notified practically at time of death 12 „ within 1 month „ „ 7 „ „ 3 months „ „ 8 „ „ 6 months „ ,, 10 The chief difficulty about delay or failure in the notification of Tuberculosis lies in the nature of the disease and the poverty of the residents in the borough. A man may suspect that he is suffering but dare not admit the fact for fear of losing his employment. Consequently he does not call in a doctor until 'his physical weakness compels him to give in. Until some adequate provision is made for the tuberculous as a disabled man, I am afraid this state of things is likely to continue. 74 Tuberculosis Register. Pulmonary Non-Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/31 572 394 259 201 1426 Number of new cases notified under the Public Health (Tuberculosis) Regulations, 1930, during the year 78 67 26 13 184 Transferred from non-pulmonary 2 1 ... ... 3 Other cases added to the Tuberculosis Register during year 17 7 6 8 38 669 469 291 222 1651 Number of cases removed from Tuberculosis Register during year. (For details see separate statement) 165 84 35 29 313 Transferred to pulmonary ... ... 2 1 3 Cases remaining on Tuberculosis Register 31/12/32 504 385 254 192 1335 WORK OF TUBERCULOSIS HEALTH VISITORS. The two Tuberculosis Health Visitors paid 4,359 visits of enquiry and advice with regard to the welfare of tuberculous patients in the Borough. In addition they made 574 futile calls owing to patients being out. 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 Committee has functioned during the year as the local 75 Tuberculosis Care Committee, dealing with such matters as grants of extra nourishment, assessments for sanatorium treatment on behalf of the London County Council, special treatment, etc. SUPPLY OF SPUTUM OUTFITS. During the year 23 sputum flasks were distributed to patients. Thirty sputum tins, with 1,659 cardboard refills were distributed to patients for use indoors. OPEN-AIR SLEEPING SHELTER. The Council's Open-Air Sleeping Shelter was in use during the early 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. 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 for Sanatorium or Hospital treatment. One hundred and thirty-one of them were sent away to institutions, arrangements being made in one case for the patient's treatment in Switzerland. 76 ihe position with regard to the remaining 21 cases may be summarized as under:— Offered treatment in a General Hospital 16 (9 accepted). Offered a vacancy in the Jewish Home for Incurables 1 (Declined). Recommended for the Spero Leather Factory 1 (Not eligible). Recommended for Burrow Hill Colony 1 ( do. ) Recommended for Preston Hall or Papworth Village Settlement 1 ( do. ) Offered vacancy in a Sanatorium 1 (Declined). Nine children were recommended for admission to an open-air school. Seven were admitted to Stormont House, Hackney, one to Geere House, and in the remaining case the family removed from the borough while the case was under consideration. GRANTS OF EXTRA NOURISHMENT. During the year 382 grants of Grade A (Tuberculin Tested) milk and new laid eggs were made to 136 necessitous tuberculous patients at an estimated cost of £285. Thirty 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 128. I should like to draw attention to Dr. Howell's remarks concerning the treatment of advanced cases and the close connection between bad housing conditions and Tuberculosis. I also endorse his opinion as to the great value to the Tuberculosis service of the 77 ment by which he has, acted as Hon. Consultant at the Bethnal Green Hospital. 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 representatives of Bethnal Green and three of Hackney), has met regularly during the year. DENTAL TREATMENT FOR TUBERCULOSIS PATIENTS. During 1932, 8 dispensary patients received dental treatment at the City of London Hospital for Diseases of the Heart and Lungs, and made 13 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 4 patients were so treated, making 364 attendances for treatment. Two patients also made 238 attendances for arc light treatment of Lupus at the same hospital. General Light Treatment was provided for 3 patients on 65 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 106 refills at the 78 Brompton Hospital and 16 patients l'eceived this form of treatment at the City of London Hospital, having 148 refills between them, and 1 patient had 8 refills at Colindale Hospital. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was taken under these regulations during the year. NON-NOTIFIABLE DISEASES. Measles. During the year 1,606 cases of Measles came to my knowledge from the following sources:— Schools 987 L.C.C. Special Hospitals 445 Other Hospitals 9 Medical Practitioners 15 Health Visitors 89 Sanitary Inspectors 26 Others 35 1,606 All cases were visited, either by a Health visitor or the District Sanitary Inspector, according to the age of the patient. Four hundred and sixty-five patients were removed to L.C.C. Special Hospitals, and in 15 cases nursing assistance was provided by the Council. Forty-five cases proved to be not measles, one case being diagnosed in hospital as Scarlet Fever. One hundred and twenty-eight cases of "suspected measles" were reported through the school organisation, but only 43 proved to be measles. 79 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. There were 43 deaths from measles during the year. German Measles. Twenty-five cases of German Measles were also reported, 3 of them being removed to hospital. Whooping Cough. Seventy - six cases of Whooping Cough among children under 5 years came to my knowledge; through reports from the L.C.C. (47), Health Visitors (24), Schools (4), and other sources (1), and these children were visited by the Health Visitors. Fifty-four children were removed to an Isolation Hospital and 47 recovered. Ten deaths from this disease were recorded during the year. Miscellaneous Investigations. 464 cases of Chickenpox were reported and visited by the Sanitary Inspectors. A number of other children were also 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 continued throughout the year and the patient has shown some improvement under treatment. 80 DISINFECTION SERVICE. During the year, 1,500 rooms and 28,345 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. The table appended gives full details of the rooms, bedding and clothing disinfected. No. of Rooms Disinfected Articles of Clothing, etc. Infectious disease 1,081 6,327 Scabies 61 2,635 Verminous condition 338 3,308 Other conditions 20 498 Hospital bedding — 11,970 1,500 24,738 There were also 3,607 articles disinfected in the Formalin Chamber. No. of articles destroyed by request, 89. 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 VERMIN. In view of the slur often cast upon residents in the East end concerning their alleged dirty and verminous conditions, I think it only right to report as to the facts. There can be no doubt that, considering the congested state of the housing of the Borough, and the frequency with which these closely packed houses are also overcrowded with tenants, some dirt and vermin are 81 inevitable, notwithstanding the efforts of the people. The remarkable thing is not that dirt and vermin should exist but that they are steadily being reduced. Compared with conditions before the War or even 10 years ago, there is abundant testimony as to the improvement effected. The figures of the School Medical Service showing 95 per cent. of Bethnal Green children to be clean of both head and body, compared with 95 per cent. and 97 per cent. respectively for the whole of London, are a striking tribute to the zeal of Bethnal Green mothers in maintaining a good standard for their children against great odds. Of recent years, the Council has offered active assistance to residents in their war against vermin by means of the personal cleansing station, disinfestation of rooms, clothing and bedding, and by the loan of spraying machines with a suitable insecticide. These facilities, but more particularly the latter, have been freely used. During the year, the Housing Committee had under consideration the question of verminous conditions arising in the Council's new tenements, on the Hadrian Estate. At the request of that Committee I reported on the matter and a copy of my report is appended. The measures recommended have since been put into operation. Metropolitan Borough of Bethnal Green. Bug Infestation of Houses on Council's New Estate. To the Chairman and Members of the Housing Committee. Ladies and Gentlemen, I have the honour of submitting for your consideration the following report relative to the infestation by bugs of houses on the new estates of the Council. 82 Before formulating any means that may prevent the invasion of bug's into new houses it is necessary to take into consideration every possible source of infestation. In the following enumeration of possible sources I have endeavoured to arrange them in their order of possibility or probability. 1. Infested furniture, pictures, bedding, clothing, etc., imported direct from an infested house. 2. The introduction of infested second-hand articles. • 3. Clean articles as enumerated in 1 becoming infested by removing them in an infested furniture van. 4. Infestation from adjacent infested houses. 5. Infestation from the sites of old infested houses. 6. Using in construction of new buildings infested material from old demolished houses. 1. One might be pardoned for remarking at first thought that there is no excuse for placing this source first on the list or that it should not be on the list at all. If the house which is being vacated is disinfected and all the various articles therein disinfected, why should it be possible for the new house to become infested? The success or failure of disinfection and disinfestation depends on the intensity of the procedure. This must be thorough enough —to use a war-time expression—to provide a "direct hit" which is necessary for extermination. The method at present carried out by the Public Health Department is as follows: — (a) Communications from the Town Clerk giving present addresses of intending occupiers of new houses. (b) Visit by sanitary inspector who makes a thorough examination for evidence of infestation. If there is no such evidence a "clean bill" is given. If there is evidence disinfection of premsies is carried out by fumigation with sulphur and the tenants given solution D to spray on articles. Any articles that will not be damaged or destroyed by steam disinfection are submitted to that process. Sometimes bedding has been destroyed at the request of the tenants. This procedure may be successful in exterminating the present generation, but some crevice or crack containing eggs may easily be overlooked and accordingly the new house becomes infested. Suggestions for a more efficient procedure are given later. 2. There is always a danger of infestation from second-hand articles. Permission to destroy infested articles 83 may be given, but if people replace them with second-hand articles without efficient examination and disinfection, if neoessary, the trouble begins again. 3. The possibility of an infested removal covered van must not be overlooked. It is quite feasible that an occasional bug or one or two eggs may be left in the van after the removal of infested articles and thus contaminating perfectly clean ones. 4. If new houses are built abutting on or adjacent to old infested house's there is a possibility of migration unless precautions are taken. Bugs walk rapidly and are capable of migrating from one house to another, passing along walls, pipes and gutters. It is a fact that one infested house at the end of a terrace may ultimately be responsible for the infestation of every house in the terrace. But wherever the new houses on the Hadrian Estate have been built against old houses there is a new wall 18 inches thick up the first two storeys and then 14 inches thick up to the top. There is also the old party wall and between that and the new wall a layer of concrete averaging 3 inches in thickness. These facts would certainly rule out the possibility of number 4 being in any way responsible. 5. Neither do I think it possible to have direct infestation from the sites of the old demolished houses. The houses are built on a layer six inches thick, composed of new material and spade finished. No insects would survive this treatment. If it were possible, as has been tentatively suggested in Mr. Hilder's report, I feel sure that the infestation would be more generalised and not simply occur in isolated flats here and there. 6. I understand that the only material from demolished houses which has been used for rebuilding was a very little rubble which was crushed in a mortar mill. This mill crushes the rubble down to pieces less than the size of a pea. It is afterwards mixed with lime. After running the gauntlet of this process, I cannot conceive the possibility of the survival of either bugs or their eggs if any were present. There are one or two minor factors which should not be overlooked. The first is the very remote possibility of workmen carrying in the bugs or their eggs on their clothes. They may also be introduced with luggage, boxes and packages that have been left standing in some place infested by bugs. There is also the possibility of children carrying into the home old infested wood, intended for firewood,. 84 which they have pilfered when no one in charge was around. After analysing the various possibilities as outlined, I can only arrive at the conclusion that the infestation of certain flats on the Hadrian Estate occurred by direct importation by the tenants. Life History. The bug problem is beset with difficulties and to fully appreciate these one must have some knowledge of the life history of the insect. The bug is generally not in evidence during the day, but lurks unseen in crevices, cracks, bedsteads, back of pictures and other places where it is not likely to be disturbed. At night it is hungry and becomes active in its search for food, often travelling some distance. To borrow another war-time phrase, it makes sorties and then returns to its entrenched position. Its normal food is human blood, but it has been known to suck the blood of higher animals. Since opportunities for feeding may be rare, the insect prepares for long fasting by engorging itself when it has a chance. The adult bug can exist for incredible periods without sustenance. Specimens have been kept for over a year without apparent injury. They can also persist throughout the winter, even though exposed to a considerable degree of cold. Although nothing very definite appears to be known about the life period of the male, the mature female probably lives on an average 6—8 months. The white oval eggs are deposited in batches of 6 to 50 in cracks and crevioes, etc., and at first are covered with a sticky substance which causes them to adhere to the surface on which they are laid. The female bug is very prolific if circumstances are favourable and during its lifetime lays about 200 eggs. A full meal, if available, is taken before ovipositing, but if food is lacking or the winter temperature low, domestic affairs are at a low ebb. The young bugs, which somewhat resemble their parents, hatch out in about 7—10 days. Before they reach maturity they moult five times in a period of 7—11 weeks, but under perfectly normal conditions this process may last 6 months or even a year. The young bug generally partakes a meal before each moult. Preventive Measures. 1. Public Health Department to be notified of addresses of intending tenants three weeks before taking up residence in new house. 85 2. Weekly inspection by sanitary inspector for three consecutive weeks. 3. If after three inspections no infestation is found no further steps to be taken. 4. If there is infestation, disinfection shall be carried out weekly for three consecutive weeks by the disinfecting staff. This will necessitate the tenants leaving the house for two hours on each occasion. In addition the householders will be given a cream composed of mercurial ointment and turpentine to smear in joints of bedsteads and visible cracks or crevices in all articles. They will also receive solution D to spray all articles during the last week. Two additional disinfections are advocated in order to kill off young bugs which have hatohed out of eggs which have survived. It should be understood that even by carrying out this very full procedure complete disinfestation cannot be guaranteed when the people remove to their new home. Some bugs behind skirting boards, etc., may have survived the bombardment and also others may immigrate from a neighbouring house before all articles are removed. There may also be some hidden beneath the paper on the back of pictures which the tenant does not wish to destroy. If a scheme as outlined is adopted the Council can be satisfied that they have done everything they could do. At the same time tenants entering new flats from infested houses should be informed of the possibility of their taking in one or two bugs or their eggs and impressed with the need of co-operation with the Council by continuing to keep a watchful eye for any sign of re-infestation. Only by the tenants diligently carrying out this advice and taking every precaution against spread will they be ensured of freedom from infestation. Your obedient servant, V. Borland. 21th October, 1932. Spraying Machines. 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 86 of their rooms. The sprayers were lent on 208 occasions during the year, as compared with 240 last year, and 522 in 1930. Verminous Conditions. Sixty-six children 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 23 cases disinfection of some kind was accepted. Rooms were disinfested of vermin in 338 cases. Scabies or Itch. Eighty-seven children suffering from this disease were visited after being excluded from the Elementary Schools. In 72 instances disinfestation of the clothing and bedding was accepted. In addition, 14 cases of Scabies were reported by the London Hospital, one by the Mildmay Mission Hospital, and one by a private doctor ; and in all but 3 of these cases the bedding was disinfected. Sixty-one 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. 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 308 baths and their clothing was disinfected for vermin, and 93 men, 56 women and 8 young children had treatment with sulphur ointment, in addition to baths and disinfection, on a total of 216 occasions, for Scabies. 87 DISTRIBUTION OF DISINFECTANTS. During the year 6,713 pints of partially diluted disinfected fluid were distributed to applicants at the Town Hall. 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 not used during the year. 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 examination 1045 Diphtheria bacilli present in 125 Sputum—specimens submitted for examination 138 Tubercle bacilli present in 15 Blood-serum—specimens examined for Widal reaction (both negative) 2 Specimens examined for Wassermann test (both negative) 2 Other bacteriological examinations in connection with food are reported on elsewhere. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928, SECTION 28. Care of Aged and Infirm Persons. During the year, a magistrate's order was obtained on one occasion for the removal to hospital of an aged and infirm person found to be living under insanitary conditions and not receiving proper care and attention. 88 FOOD POISONING. During the year, Food Poisoning became notifiable throughout London, under Section 7 of the London County Council (General Powers) Act, 1932, which came into operation on the 12th July. Up to the end of the year 41 cases had been notified. Fourteen of these occurred in one batch in September, particulars of which are given below. Of the remaining cases I5 were attributed to fish of some kind, 7 to meat of some kind, and 5 to miscellaneous foods, singly and in combination. It is perhaps too early to speak definitely about the value of the notification of food poisoning, but the experience so far gained is not impressive of its usefulness. There are great difficulties in distinguishing Food Poisoning from the numerous other ailments of the alimentary canal, to say nothing of the difficulty of isolating the particular article of food,, even when the case has been definitely diagnosed as Food Poisoning. This means, I am afraid, that much of our time may be spent on enquiries into cases of digestive upset, which may be useful in pointing the moral of more judicious eating habits to the patient, but is hardly relevant to Food Poisoning in the medical sense. On the other hand, the notification may bring to light in a prompter and more certain manner than heretofore some case of genuine Food Poisoning, possibly affecting a number of people, and may thus facilitate early and effective action to deal with the matter. INVESTIGATION OF AN OUTBREAK OF FOOD POISONING. On the 2nd and 5th September, 1932, notifications of suspected food poisoning occurring in 14 people were received from a medical practitioner. Three of these were in one family, five in another, one in another, one in another, four in another. Three more sufferers were found in the last family, making a total of 17 cases in 89 Bethnal Green. All were found to be suffering from varying degrees of gastro-enteritis. Enquiries elicited from the information that all had attended a wedding party at premises in Stepney lasting from 2 p.m. on the 30th August until 2 a.m. on the 31st August. The food offered between those hours consisted of small sandwiches of egg, salmon and cress with coffee about 3.45 p.m.; at 4 p.m. lunch, comprising soup, bulicni (said to consist of lights and liver chopped up and bound with paste), giblet .pie, chicken and baked potatoes, green salad and mayonnaise. At 8 p.m., the menu for dinner was cocktail, salted almonds, grape fruit, hoi's d'oeuvres varies, egg mayonaisse, Scotch salmon with sauce hollandaise and cucumber salad, vermicelli soup and fillets, tomato soup, roast veal with mushroom sauce and mixed vegetables, French salad, lemon ice, roast chicken with French potatoes and green peas, cucumber and olives, ice pudding, wine jellies, compote of fruit, dessert, black coffee. Drinks, whisky, cherry brandy, kummel, home-made wines. Endeavours were made to obtain any food that might have been left over either at the Stepney premises or at the establishment in Hackney where the food came from, but everything remaining had been thrown out as waste. Investigation seemed to point out that illness occurred in only those who had eaten the chopped liver or giblet pie at 4 o'clock. The chopped liver was, in all probability to blame as one patient stated she thought it was "off." No vomited material could be obtained, but faeces from one patient were sent for clinical examination, the result of which was as follows:—"The specimen is light in colour and of semi-fluid consistency. In addition to traces of the usual faecal debris it shows a definitp excess of mucus together with rather more than a trace of pus, an occasional blood disc, and some columnar cells from the intestinal mucosa. The stained preparations show coliform bacilli, anaerobes, and micrococci. The cultures contain B. coli, intestinal streptococci, and a non-lactose fermenting bacillus having the cultural 90 characters of Morgan's No. 1 bacillus. This last is apparently the peccant organism." These facts were communicated to the Medical Officer of Health for the London County Council, also to the Medical Officers of Health for Stepney, Hackney, Tottenham and Leyton (where there were four cases), the latter three also being furnished with the names of passible cases in their district. 91 PROTECTION OF FOOD SUPPLY. The work of the Local Health Authority with a view to the protection of the food supply takes threo forms: (i) Supervision of premises where food is prepared 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 cleanliness, 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. 92 FOOD AND DRUGS ACTS. Seven hundred and eighteen samples were taken; 661 of these proved to be "genuine'' and 57 or 7.9 per cent. adulterated. The details are given in the following table:— SUMMARY OF ANALYST'S REPORTS. Article Samples taken formally Samples taken informally Total number of samples taken No. taken Genuine Adulterated No. taken Genuine Adulterated Milk 327 306 21 5 5 ... 332 Butter 96 96 ... 9 9 ... 105 Margarine 14 14 ... 1 1 ... 15 Sterilised Milk 2 2 ... ... ... ... 2 Condensed Milk 4 4 ... 5 5 ... 9 Cream 7 7 ... 2 2 ... 9 Cheese ... ... ... 1 1 ... 1 Lemonade ... ... ... 1 1 ... 1 Lemon Squash ... ... ... 3 3 ... 3 Ginger Wine 1 1 ... 1 1 ... 2 Cordials ... ... ... 3 3 ... 3 Whisky 4 2 2 1 1 ... 5 Gin 4 4 ... ... ... ... 4 Tincture of Iodine 1 1 ... ... ... 1 Seidlitz Powder ... ... 1 1 ... 1 Dill Water ... ... ... 1 1 2 Aspirin Tablets 6 4 2 ... ... ... 6 Jelly Squares ... ... ... 1 1 ... 1 Table Jelly 1 1 ... ... ... 1 Baking Powder ... ... ... 1 1 ... 1 Pepper l l ... ... ... ... 1 Mustard l l ... 3 ... 4 Mixed Spice l l ... 1 1 ... 2 Ground Ginger 6 6 ... 1 ... 1 7 Ground Cinnamon l 1 ... 6 6 ... 7 Sugar ... ... ... 8 8 ... 8 Mincemeat l 1 ... 6 6 ... 7 Sweets 7 6 1 1 1 ... 8 Bread ... ... ... 8 8 ... 8 Bread and Butter 1 1 ... ... ... ... 1 Flour ... ... ... 8 8 ... 8 Rice ... ... ... 1 1 ... 1 Pearl Barley 3 3 ... 1 1 ... 4 Jam 41 35 6 10 8 2 51 Lemon Curd 1 1 ... ... ... ... 1 93 SUMMARY OF ANALYST'S REPORTS—continued. Article Samples taken formally Samples taken informally Total number of Samples taken No. taken Genuine Adulterated No. taken Genuine Adulterated Vinegar 49 46 3 1 1 ... 50 Malt Vinegar 2 2 ... 3 3 ... 5 Sauce 1 1 ... 1 1 ... 2 Minced Meat 9 2 7 9 2 7 18 Sausages ... ... ... 5 5 ... 5 Meat 1 ... 1 3 ... 3 4 Suet ... ... 1 1 ... 1 Chicken and Ham Roll 1 1 ... ... ... ... 1 Brawn 1 1 ... ... ... ... 1 Tinned Peas 1 1 ... ... ... ... 1 Dried Fruits ... ... ... 5 5 ... 5 Tea ... ... ... 1 1 ... 1 Cocoa ... ... ... 2 2 ... 2 Totals 596 553 43 122 108 14 718 The Public Analyst has furnished me with the following report on his work during the year :— Annual Report of the Public Analyst. During the year 1932, a total of 718 samples were examined under the Food and Drugs (Adulteration) Act. Seven of these samples were taken by neighbouring Authorities, the remainder by the Inspectors. No samples under the Act were submitted by the public. Included in this number are 122 samples purchased informally. Fifty-seven samples were found to be adulterated. In addition 62 other samples were of inferior quality, or doubtful purity. The adulteration was at the rate of 7.9 per cent. of the samples examined. The average rate of adulteration for the London Boroughs in 1931 was 2.9 per cent., and for the whole of England and Wales, 4.6 per cent. The adulteration in the Borough for the past 10 years was as follows :— 94  No. of samples examined Percentage of adulteration 1932 718 7.9 1931 749 7.1 1930 737 6.5 1929 750 8.0 1928 731 9.3 1927 728 9.2 1926 721 3.3 1925 745 3.9 1924 754 6.1 1923 736 5.6 Average 737 6.7 The number of samples examined was at the rate of 6.65 per 1000 of the population, as compared with 9.97 per 1000 for the London Boroughs in 1931, and 3.41 per 1000 for the whole of England and Wales. The number of samples of milk examined was 332, of which 21 samples, or 6:4 per cent. were found to be adulterated. The figures for the past ten years are as follows: — Year No. of milks examined Percentage of adulteration 1932 332 6.4 1931 303 3.0 1930 296 6.8 1929 287 5.2 1928 306 8.2 1927 275 5.4 1926 340 2.9 1925 355 4.8 1924 323 2.8 1923 350 7.4 Average 317 5.3 Condensed Milks. Nine samples of condensed milk were examined and found to be satisfactory. Preservatives. There were 21 contraventions of the Preservatives Regulations. 96 Other samples examined during the year were: — Nineteen Rag Flocks, one of which was unsatisfactory, and one Medicine. Albert E. Parkes, f.i.c. FOOD AND DRUGS. Legal Proceedings, 1932. Sample No, Food and Drugs (Adulteration) Act- 23.2.32 32 Delivering Milk, in pursuance of a contract, 6:6°/o deficient in fat £5 5s. 0d. Costs 15.3.32 71 Selling Strawberry Jam containing 10o/o Apple Pulp £2 2s. 0d. Costs 15.3.32 68 Selling Raspberry Jam containing 50°/o Apple Pulp, and small quantity of gingelley seeds £2 2s. 0d. Costs 5.4.32 119 Selling Milk 6.6°/o deficient in fat £2 2s. 0d. Costs 19.4.32 131 Selling Aspirin Tablets containing foreign ingredient to extent of 68.5o/o £1 10s. 0d. Fine £3 10s. 0d. Costa 21.4.32 134 Selling Milk 20°/o deficient in fat £1 3s. 0d. Costs 10.5.3 172 Selling Milk 36.6°/o deficient in fat £5 0s. 0d. Fine £3 3s. 0d. Costs Public Health (Preservatives in Food) Regulations. 3.5.32 153 Selling Strawberry Jam containing 20 parts per million excess of preservative £10 10s.0d. Costs Food and Drugs (Adulteration) Act. 31.5 32 24S Delivering Milk, in pursuance of a contract, 20o/o deficient in fat £5 0s. 0d. Fine £5 5s. 0d. Costs 76.32 225 Selling Raspberry Jam containing 75o/o foreign fruit £3 3s. 0d. Costs 28.6.32 273 Selling Aspirin Tablets 20o/o deficient in aspirin £2 2s. 0d. Costs 25.732 344 Selling Minced Beef containing ingredient injurious to health, to wit, Sulphur Dioxide £3 3s. 0d. Costs 26.7.32 348 Do. do. do. £3 3s. 0d. Costs 26.7.32 347 Do. do. do. £3 3s. 0d. Costs 27.7.32 351 Do. do. do. £3 3s. 0d. Costs 27.7.32 352 Do. do. do. £3 3s. 0d. Costs 28.7 32 346 Do. do. do. £4 4s. 0d. Costs 28.7.32 358 Selling Milk 6.60/0 deficient in fat £2 2s. 0d. Costa 96 FOOD AND DRUGS—Contd. Legal Proceedings, 1932. Sample No. Food and Drugs (Adulteration) Act. 13.9.32 395 Selling Minced Beef containing ingredient injurious to health, to wit, Sulphur Dioxide £2 0s. 0d. Fine £3 3s. 0d. Costs 4.10.32 436 Selling Raspberry Jam containing 33o/o Gooseberry Jam £1 0s. 0d. Fine £3 3s. 0d. Costs 18.10 32 301 Delivering Milk containing 2.3o/o added water £4 4s. 0d. Costs 18.10.32 316 Selling Milk containing 2.3o/o added water Dismissed: — Warranty proved against Wholesaler 1.11.32 469 Selling Milk l0 o/o deficient in fat £3 3s. 0d. Costs 8.11.32 481 Selling Vinegar 10 o/o deficient in acetic acid 5s. Fine: £2 2s. 0d. Costs Public Health (Preservatives in Food) Regulations. 22.12.32 592 Selling "Icy Mints" containing 116 parts per million Sulphur Dioxide in excess of permissible amount Dismissed: — Case against Wholesaler proved 22.12.32 592 Selling (to retailer above) "Icy Mints" containing 116 parts per million Sulphur Dioxide in excess of permissible amount £5 5s. 0d. Costs SAMPLES TAKEN INFORMALLY. One hundred and twenty-two samples were taken informally during the year, fourteen of which were found to be adulterated as follows :— Article No. of Sample Offence Ground Ginger 59 Contained 5432 parts SO2 per million Raspberry Jam 60 „ 20°/o foreign fruit jam Red Plum Jam 159 „ 10°/o do. Dill Water 257 Consisted of Hydrogen Peroxide Minced Meat 284 Contained 1200 parts SO2 per million Do. 285 „ 3000 do. Do. 286 „ 30 do. Do. 287 „ 1500 do. Do. 288 „ 1900 do. 97 Article No. of Sample Offence Minced Meat 290 Contained 40 parts SO2 per million Do. 291 2000 do. Minced Beef 364 54 do. Do. 365 52 do. Do. 366 »> 54 do. The genuine samples are indicated in the table on pages 92 and 93. PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 to 1927. Ten formal and 11 informal samples taken under these Regulations were found to contain preservatives, to wit, sulphur dioxide, in parts per million, as follow: Minced Meat ,, ,, ,, ,, ,, ,, ,, ,, ,, ,, ,, ,, ,, 20 30 40 100 570 750 950 1200 1250 1300 1500 1900 2000 3000 Minced Beef Ground Ginger Sweets (Icy Mints) Strawberry Jam 52 54 54 525 5432 340 60 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Pour formal samples and five informal samples of condensed milk were taken under these Regulations. All the samples were found to comply with the Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. No samples of dried milk were taken during the year. 98 BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year 17 bacteriological examinations of milk, 4 of other food and 2 of other materials were made as follows:— Ordinary Milk, 2; Grade A (Tuberculin Tested) Milk, 3; Pasteurised Milk, 12; Toast, Butter, Margarine, Cream Cheese, 1 each; Scrapings from milk churn lids, 1; Vomited material, 1. B. Coli were found in 6 samples of Pasteurised Milk and in the samples of Cream Cheese and scrapings from milk churn lids. FOOD PREMISES. Milkshops and Dairies. Fifty-three* applications for registration were considered during 1932, seven of them referring to a round only. The figures in regard to registration of Milkshops are set out below:— Number of purveyors of milk on register at end of 1931 268 Deduct number of purveyors removed from register during the year 12 Add number of new purveyors added to register by resolution of the Public Health Committee during the year 34 Number of purveyors of milk on register at end of 1932 290 During the year 828 inspections of milkshops were *This includes changes of occupier in premise previously on the register. 99 made by the Inspectors, and 57 notices were served under the Public Health (London) Act, 1891. Legal proceedings were found to be necessary in respect of milk premises in one case. Some careless or unscrupulous milk traders are 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. Two milk vendors were summoned for the offence, being ordered by the magistrate to pay an aggregate of 10s. in fines and costs. One person was fined 20s. for carrying on the trade of milk vendor without being registered and another was fined 20s. with £7 7s. costs for failing to observe due cleanliness in the manufacture of cream cheese. Milk (Special Designations) Order, 1923. Fourteen dairymen were licensed to sell "Grade A (Tuberculin Tested)" Milk, 2 for the sale of "Certified" Milk, and 4 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 1932 9 licensed cowhouses in the Borough. 39 inspections were made during the year. No notices were served. The premises are as follows:— 100 63, Bishop's Road.—Shed No. 1—(8 cows). Shed No. 2—(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). 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). I am glad to report the discontinuance of two of the cowhouses hitherto existing in the Borough. BACTERIOLOGICAL PURITY OF MILK. The Council may be interested in the following summary of a paper I submitted at a joint meeting of the Society of Medical Officers of Health (Metropolitan Branch) and the Society of Chemical Industry (Food Section), on " The Bacteriological Standards of Milk." The present evidence concerning the production of milk leads to the conclusion that a certain bacteriological content is inevitable and normal. This has led to the Milk (Special Designations) Orders, 1922 and 1923, laying down definite standards for certain specified grades, with the object of bringing the bacteriological content under control. It is clear, however, from statistics published by London Medical Officers of Health that these standards are not very satisfactorily observed. In 1931, over 10 per cent, of the samples taken were unsatisfactory, the worst grade in this respect being Pasteurised Milk. The amount of sampling done and the results obtained vary to an extraordinary extent from borough to borough. Among those boroughs which carry out a fair amount of sampling, the percentage of samples contravening the standards range from 3.3 to 44.4. The most frequently tested grades are Grade A (Tuberculin Tested) and Pasteurised, and the percentage of unsatisfactory samples varies from 3.3 to 36.5 in the case of the former and from 9.0 to 46.6 in the case of the latter grade,. (In Bethnal Green, the average percentage 101 Unsatisfactory is 7.8 for all grades, 3.3 for Grade A (Tuberculin Tested) and 9.0 for Pasteurised). Successful legal proceedings for offences under the Milk (Special Designations) Orders have been taken in only one borough. There are technical difficulties in getting thoroughly representative samples and a uniform bacteriological examination, which are partly responsible for the limited amount of sampling and of action to enforce the standards laid down in the Orders. Opinion is pretty general that the present classification of graded milk is unsatisfactory, in particular that there are too many grades and they are badly named. It is also felt that the bacteriological standards set out in the Orders ought to be raised. There is, for instance, no requirement that B. Coli should be absent from Pasteurised Milk, while up to 200,000 bacteria are permitted in the case of Grade A (Tuberculin Tested) milk which might reasonably be reduced to 100,000. The Society of Medical Officers of Health is of opinion that the special grades of milk should be reduced to two, those now known as Grade A (Tuberculin Tested) and Pasteurised. PASTEURISATION. Within recent years, there has been much discussion as to the merits and demerits of Pasteurised Milk. Results of feeding animals on Pasteurised Milk have been advanced from time to time to show that it is less growth -promoting than raw milk, but the evidence available shows that these animals require rather more mineral salts than the calf. Pasteurisation naturally diminishes the vitamin C Content, but this is unimportant since even when infants are fed on raw milk the vitamin C content is practically always supplemented. I do not think there are any human experiments which demonstrate that Pasteurised Milk is inferior to raw milk in nutritive value. On the other hand years of clinical experience demonstrate that infants and young children have been fed on heated milk with no detectable deterioration in their nutritive condition. Raw cows' milk is originally intended for the calf and it is possible that the slight changes occurring when it is pasteurised 102 render the milk less unsuitable for the young of another species. Ice Cream Premises. There were 159 ice cream premises registered at the end of the year, and 297 visits were paid to them by the district inspectors : 30 notices were served. Fried Fish and Fish-Curing Premises. At the end of 1932 there were 43 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 fifty-eight visits were made by the Food Inspectors to these premises, and 14 notices were served for insanitary conditions. Workshop Bakehouses. There are, in Bethnal Green, 37 workshop bakehouses, 10 of which are underground: 118 visits were made to them during the year, resulting in the serving of 3 sanitary notices. Factory Bakehouses. There are, in Bethnal Green, 26 factory bakehouses, 9 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. One hundred and seven inspections were made during the year, and 4 notices were served. Other Premises used for the Preparation or Sale of Food. There were 196 such premises on the register, the majority being restaurant-kitchens or butchers' shops. 163 Six hundred and nine inspections were made during the year, and arising out of such inspections 40 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 138 Lambs 185 Pigs 34 Total 357 These figures show an increase in the number of animals slaughtered compared with the previous year. The Meat Inspector attributes the fact that no bullocks were slaughtered to their continued high price and the decline in trade. No carcases or offal were condemned, the whole of the animals being in first class condition, with the exception of one sheep found dead in the lair at one slaughterhouse. This was removed for destruction by an extractor of fats. Slaughterers of Poultry. There are 8 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough: 104 129 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 slaughterhouses and other premises where food is prepared or sold, the Food Inspectors keep stalls and market places under regular supervision, particularly during the weekend. The District Sanitary Inspectors also keep general observation in the course of their duties. Two seizures took place, consisting of 24 lb. of tomatoes and 7½ lb. of apples and pears, the traders in question being summoned and fined £3 with £4 4s. Od. costs, and £5 with £5 5s. Od. costs, respectively. On 20 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 - 2 44 Meat - 2 47 Fruit - 1 40 Vegatables - — 38 Turkeys - 10 56 Cheese - 6 70 also Eggs (1,800), Tinned Fish (102 tins), Winkles (1 bag), Whelks (2 bags). FOOD POISONING. During the year 41 cases of suspected food poisoning were investigated. 105 Food poisoning or suspected food poisoning was made a notifiable condition under Section 7 of the London County Council (General Powers) Act, 1932. There are, of course, innumerable occasions on which illness may possibly be due to the eating of some kind of food, and it is difficult to determine either the precise food in question or whether the illness had been caused by the immoderate quantity taken, the injudicious mixing of incompatible articles or the actual bad condition of the food, quite apart from the question of whether the patient is suffering from a toxic condition. There are also of course, cases where persons have an idiosyncrasy against certain foods, i.e., even small quantities may set up gastric, intestinal or constitutional symptoms. The Section specifies actual or suspected food poisoning as the notifiable condition, and it must depend for its usefulness upon the extent to which doctors confine its operation to definite cases of poisoning, with substantial suspicion of contaminated food as the cause of the illness. The subject is dealt with more fully in the preceding section dealing with the Control of Disease. SALE OF FOOD ORDER, 1921. Part iii of this Order was continued in force during the year under the Expiring Laws Continuance Act, 1931. Imported meat and eggs are required to be labelled as such. 106 GENERAL SANITARY ADMINISTRATION. This section of my report is mainly concerned with the work of the Sanitary Inspectors, under the capable leadership of Mr. Evan Richards. It is sometimes imagined that the problems of sanitation have been solved and that the task of the present day sanitary inspector is a relatively light one. This is very far from the truth. The sanitary inspector is primarily concerned with the maintenance of a hygienic domestic environment for the community, which depends upon such things as a satisfactory water supply, the prompt and efficient removal of refuse of all kinds, a clean, dry, well lighted, well-ventilated house. When it is remembered that a large number of the houses in the Borough did not come up to the latter standard, even when they were built, and that they are now old, and when it is further realised that casual employment and low wages in many cases mean frequently changing tenants with little interest in their temporary abode and consequently little care for its structure or sanitary equipment, it is not surprising that "nuisances" and "sanitary defects" abound. Much of the work is indeed like the process of patching up an outworn, old-fashioned garment, requiring infinite skill and patience to achieve a tolerable repair, and much of it is wasted labour. It used to be said that the Infant Death Rate was a sensitive index to the sanitary administration of a district, and there is much truth in the statement, although it requires qualification. I would build on it the analogous statement that the activity of the sanitary inspectors is a measure of the sanitary conscience of a district. Judged by this standard, Bethnal Green has a very live " sanitary conscience." It is specialty important in these difficult times that this work should not be relaxed, but if anything increased. Any diminution in the systematic house to house inspection of the district, in the enforcement of Sanitary Notices, or in the many day to day activities of the Sanitary Staff, 107 must sooner or later weaken the defences against ill health and undo the work of the past generation in building up good sanitation. SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding, for the 52 weeks ended 31st december, 1932. Nature of Visit Totals Infectious Diseases (notifiable) 1256 Infectious Diseases (non-notifiable) 1093 Food Poisoning 7 Complaints 5053 House to House Inspections 933 Milkshops (672) and Cowsheds (40) Inspections 712 Other Food Premises Inspections (Meat 7, Poultry 136, Others 1297) 1440 Factory (762) and Workshop (1819) Inspections 2581 Outworkers' Homes Inspections 926 Tenement House Inspections 322 New Buildings Inspections 4 Drainage Inspections 3889 Smoke Nuisances—Premises under observation 25 Other Inspections or Special Work 5715 Re-Inspections 22120 Total Visits for the Year 46076 Unsound Food Seizures (2) or Surrenders (16) 18 Samples of Food, etc., taken 707 Samples of Rag Flock taken 19 Police Court Attendances 88 Premises where Nuisances abated 5217 Premises where Matters Outstanding 669 The following sanitary defects were discovered during the year :— Dirty rooms 7,488 Defective drains and choked w.c.'s 1,073 Defective and dirty w.c.'s ... 2,534 Defective water supply 686 Defective paving 903 Defective gutters and rainwater pipes 843 Defective roofs 2,091 Dampness 862 Defective dustbins ... 1,290 Smoke nuisances 24 Other defects 10,592 Total ... 28,386 108 The work of the outdoor staff is reflected in the volume of clerical work associated with sanitary administration. During the year 6,030 Preliminary Notices were served requiring the remedying of Nuisances. 3,353 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 519 premises with nuisances outstanding. During the year, nuisances at 5,217 premises were abated and 669' premises with nuisances outstanding were carried forward to 1933. 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 ; 922 visits of inspection were made to these houses, and arising out of such visits 269 notices were served. 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 certificates as to the state of repair of a house were received. 109 WATER SUPPLY TO NEW HOUSES. During the year 98 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 25 formal observations of smoke shafts were made and 4 intimation and 2 statutory notices were served. NOISE. I regret to report no progress in dealing with preventable noise, now generally recognised as conducive to ill health. During the year, complaint was made on two occasions by the residents in a street in the Borough of excessive noise from a factory, particularly at night. Representations made led to some improvement. It is obvious that there is need for further legislation extending the public health expression " nuisance" to cover loud and persistent noises in proximity to dwelling houses. 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, 286 tins of treated biscuits and 4 bottles of Squill being issued in this way. 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. Of 2,100 baits laid during this week, i,678 were found to have disappeared. 110 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. 13 inspections were made at these premises. Poultry slaughtering, an offensive trade also, is dealt with elsewhere in this report. RAG-FLOCK ACT, 1911. Nineteen formal samples of rag-flock were taken during the year, and in 1 case the amount of chlorine present was found to be slightly in excess of the limit fixed by the Regulations. RAG AND BONE DEALERS. Fourteen persons or firms are known to be carrying on this business in the Borough. During the year 18 visits of inspection were made, and 2 sanitary notices were served. No proceedings were necessary in respect of contravention of the by-laws during the year. HAIRDRESSERS. Eighty - four hairdressers' premises were on the register, 150 visits were made to them, and 18 Notices were served. COMBINED DRAINAGE SYSTEMS. The reconstruction and maintenance of such combinations of drains of houses and premises as are found 111 to be sewers by law defined and are not under highways is carried out by the Public Health Department. The staff engaged on this work consists of a drainlayer and four labourers, with additional help as required. During the year 13 systems were reconstructed, taking 79 houses. At the end of the year there were 625 such combined drainage systems, taking 3,183 houses. DRAINAGE WORK. Legal proceedings were taken in 3 instances during the year in respect of offences in connection with drainage work. Costs amounting to £2 2s. Od. and a fine of £1 were awarded to the Council in respect of 1 case, and the other two cases were adjourned sine die. 112 HOUSING. The Census of 1931 revealed the fact that Bethnal Green ranks as the third worst Borough in London in regard to density of population per acre and per room, and also for overcrowding. 23:6 per cent, of the population in the Borough was over-crowded on the basis of more than 2 persons per room. At the previous Census in 1921, the percentage was 27 8. In other words, during a decennium in which there has been more talk about Housing than ever before, there was a reduction of only 12 per cent, in the overcrowded population of the Borough. At the same rate of progress, it will be another 80 years before overcrowding is abolished. In order to appreciate the full significance of this conclusion, it should be remembered that the standard of overcrowding adopted is a low standard which no person with a moderate sense of decency would accept. Moreover, overcrowding is only one phase of the Housing problem. Were the community to adopt a more reasonable standard of accommodation, paying regard to difference of sex and age and to the desirability of separate rooms for sleeping and living, it is obvious that the actual degree of overcrowding would be seen to be enormously greater than that recorded above and the rate of progress in dealing with it would be realised as even slower than the snail's pace which I have calculated. The following further figures from the 1931 Census illustrate several serious aspects of the matter. The relative densities of the population per acre and per room in each Ward of the Borough and in the Borough as a whole, and the County of London, are shown in the following table :— 113 Ward or Persons Population StructuralRooms District Persons Families in PrivateI Families ly separate dwellings Occupied sons per room East 38,726 109-4 9,973 36,753 5,855 28,883 1'27 North 18,142 160 5 4,839 17,840 3,054 13,387 1 33 South 28,476 178 0 7,256 28,390 5,106 20,056 1 42 West 22,850 171 8 5,848 22,717 4,141 16,140 1 41 Green 108 •194 142.4 27,916916 105,700 18,156 78,466 1.35 London 4,397,003 58 7 1,190,030 4,122,639 730,628 4,198,292 0 98 The occupation of dwellings of various sizes and by families of different sizes is shown in the following tables :— 114 Structurally Separate Dwellings of Number of Rooms 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6-8 Rooms 9 or more Rooms All Sizes Total Occupied Vacant Furnished Others Dwellings occupied by one private family 420 2,717 3,270 2,461 981 907 49 10,805 36,592 36,388 70 134 Dwellings occupied by two private families 5 51 220 1,053 1,133 2,831 56 5,349 28,874 28,755 64 55 Dwellings occupied by three or more private families. — — 17 147 284 1,247 307 2,002 13,356 13,323 16 17 Total dwellings occupied 425 2,768 3,507 3,661 2,398 4,985 412 18,156 78,822 78,466 150 206 Dwellings wholly vacant furnished 0 11 11 7 — 3 1 42 124 — 124 — others 1 14 27 24 10 10 1 87 336 — — 336 Total dwellings occupied and vacant 435 2,793 3,545 3,692 2,408 4,998 414 18,285 79,282 78,466 274 542 Number of private families therein 430 2,819 3,761 5,013 4.119 10,503 1,271 27,916 — — - - Miscellaneous habitations and institutions housing non-private families 44 115 Number of Persons in family- Number of Private Families occupying the following Number of Rooms. Total Private Families Population in Private Families. Rooms Occupied. Density of Occupation. Average Number of Persons per Room. Population at following densities of occupation (Persons per Room). 1 2 3 4 5 6-7 8-9 10 or more. over 3. 3 and over 2. 2 and over 1½ 1½ and over 1. l 1,985 808 288 73 10 11 2 1 3,178 3,178 4,902 0 .65 2 929 2,461 1,595 440 84 52 8 3 5,572 11,144 13,237 0.84 — — 1,858 — a 579 2,199 1,921 810 185 98 10 3 5,805 17,415 15,625 1.11 — 1,737 — 6,597 4 284 1,393 1,620 956 288 152 14 5 4,712 18,848 14,298 1.32 - - 5,572 6,480 5 790 1,084 753 325 154 12 2 16,250 10,654 1.53 1,136 3,950 5,420 3,765 6 61 418 720 643 226 157 11 3 2,239 13,434 7,845 1.71 366 2,508 4,320 5,214 7 24 241 441 415 187 109 17 6 1,440 10,080 5,299 1.90 1,855 8 11 130 258 272 101 72 3 1 848 6,784 3,113 2.18 576 9 7 56 123 158 76 39 2 2 463 4,167 1,786 2.33 567 2,9"29 684 369 10 2 26 52 82 45 19 2 2 230 2,300 913 2.52 800 820 640 20 11 — 9 28 30 17 17 2 1 104 1,144 439 2.61 407 517 187 22 12 — 1 10 14 8 7 1 1 42 504 198 2.55 13 — 2 4 9 2 2 — — 19 247 74 3.34 195 — — 14 — — 1 4 3 — — — 8 112 34 3.30 70 42 — — 15 and over — — — — 3 3 — — 6 93 33 2.82 16 77 — — 2 Persons and over 2,027 7,7?6 7,857 4,586 1,550 881 82 29 24,738 102,522 73,548 1.39 7,322 17,647 24,654 25,050 Total Private Families 4,012 8,534 8,145 4,659 1,560 892 84 30 27,916 — - - - - — - Population in Private Families 8,071 27,985 32,733 22,824 8,514 4,953 445 175 — 105,700 — 135 7,322 17,647 24,654 25,050 Rooms occupied 4,012 17,068 24,435 18,636 7,800 5,462 690 347 — — 78,450 — — — — — 14.4 30 .5 29.2 16.7 5. 6 3 .2 0 .3 0. 1 100.0 1931. Percentage of Families living in various units of occupation. 15.7 29.0 28.1 17 .3 6.0 3.4 0.4 0.1 100.0 1921. ” ” ” ” 116 OVERCROWDING. Considering the matter in more practical detail, I have to report a continuance of the unsatisfactory conditions which have prevailed for some years in attempting to deal with overcrowding as a "nuisance" under the Public Health Acts. The plain fact is that the majority of the overcrowded families are too poor to pay for the accommodation they require, even if it were available, at prevailing rentals. Unless, therefore, either their economic position is substantially improved, or, what amounts to the same thing from a housing point of view, housing accommodation is provided by the State at a substantially reduced rental, overcrowding cannot be abolished. Recognising these facts only the more outrageous cases are taken up for "official action." Fifteen such cases were reported to the Public Health Committee during the year, but I am afraid that in the great majority of the cases no useful action was found possible. RENT AND NUTRITION. Attention has been directed in "The Lancet" and other medical journals to the close connection between the relatively high rentals required from working class tenants and their lowered standard of nutrition resulting from their diminished incomes. The facts are somewhat obscured by " average" figures which do not reveal the great variations which exist. Control has, of course, had the effect of keeping the general level of rent lower than it would otherwise have been, but the unfortunate tenant of the decontrolled tenement finds little consolation in this average for his own high rent. Moreover, rent is a fixed standing charge, while the income from which food, etc., have to be provided, is a fluctuating and frequently diminishing amount. I mention this matter to show that not only is Housing intimately bound up with the Public Health, from the point of view of the physical environment, 117 but there is the further consideration that where the present charge for housing is excessive, compared with income, the amount available for food is reduced and thus the danger of ill health is accentuated. Various schemes have been designed to mitigate this danger, the most notable being one to allow a rebate from the rent according to the number of children in the family. While this may be quite practicable in public housing schemes, it does not seem likely to be applied to housing owned by private individuals or commercial concerns. UNDERGROUND SLEEPING ROOMS. Attention has been drawn to several cases in which underground rooms have been used for sleeping purposes, but while endeavour has been made to prevent the separate reletting of such rooms when vacated, it has not appeared advisable to take any further action in view of the housing shortage. 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. During the year, the Borough Council completed a housing scheme known as the Hadrian Estate, which 118 contains 83 tenements; and a smaller scheme consisting of 73 tenements in Temple Street, Claremont Street and Teesdale Street, to be known as the Claredal© Estate was in course of completion. HOUSING STATISTICS FOR 1932. Number of Houses erected during the year—98 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) 9,268 (b) Number of Inspections made for the purpose 20,328 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 933 (5) Number of Inspections made for the purpose 933 (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 subhead) 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 servioe of formal notices :— (a) By owners Nil (b) By Local Authority in default of owners Nil 119 (B) Proceedings under Public Health Acts : — (1) Number of dwelling-houses] in respect of which notices Notices served were served requiring de- Intimations, 6,030 facts to be remedied Statutory Notices, 3,353 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 5,217 (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 ground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or ground 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 became operative 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 declaration by owners of intention to close Nil 120 (F) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders became operative 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 became operative Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 121 FACTORIES, WORKSHOPS, OUTWORKERS, &c. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 1707 187 2 Workshops (Including Workshop Laundries) 2849 579 ... Workplaces (Other than Outworkers' Premises) 159 51 ... Total 4715 817 2 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 234 236 ... ... Want of ventilation 3 3 ... ... Overcrowding 1 1 ... ... Want of drainage of floors Other Nuisances 610 630 ... ... Sanitary accommodation— insufficient 6 6 ... ... unsuitable or defective 572 588 ... 2 not separate for sexes 3 3 ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to out work). ... ... ... ... Total 1429 1467 ... 2 12 Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number Workshops 1270 Workshop Bakehouses 37 Total Number of Workshops on Register 1307 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) 35 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 32 Reports (of action taken) sent to H. M. Inspector. 32 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 19 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 123 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 945 Upholsterers 47 French Polishers 154 Metal Workers 69 Blacksmiths, Vehicle Builders and Garages 35 Basket Makers and Coopers 15 Box and Case Makers 34 Printing, Stationery and Bookbinding 27 Tailors 196 Dressmakers 140 Waterproof Makers 4 Furriers 20 Boot and Shoe Makers 70 Other Clothing Trades 49 Sawmills "44 Other Trades, including Chemists, Glassworkers, Brushmakers, etc. 157 Total 2,006 Home Workers. Of the 2,425 workmen and contractors whose names appeared on the lists received, 1,677 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. The number of visits paid to Home Workers' dwellings was 926. The number of premises found to be in an insanitary condition was 187, or 35.6 per cent. of the 525 premises inspected. Notices were served in 243 cases, while 35 other premises were under notice arising from other visits, and a verbal intimation was given in 11 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. 124 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 Outworkers Outworkers Received from other Councils Forwarded to other Councils Lists Contractors Workmen Lists Contractors Workmen Wearing Apparel— Making, etc 62 128 206 7 ... 41 966 217 59 ... ... 53 70 ... 6 ... ... Boots and Shoes 24 71 270 ... ... ... 173 194 25 ... ... 55 68 ... 1 ... ... Curtains, Furniture hangings and Trimmings ... ... ... 2 13 1 21 4 4 ... ... 4 7 ... ... ... ... Fur-pulling and feathers ... ... ... ... ... ... 6 ... ... ... ... 1 2 ... ... ... ... Umbrellas, etc ... ... ... 2 ... 4 32 3 5 ... ... 8 8 ... ... ... ... Artificial Flowers ... ... ... ... ... ... 16 ... ... ... ... 2 2 ... ... ... ... Paper, etc., Boxes, Paper Bags 18 ... 163 2 ... 2 91 36 19 ... ... 41 51 ... ... ... ... Brush-making 8 ... 231 ... ... ... 23 190 2 ... ... 9 15 ... 2 ... ... Draught Board Making 2 ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, etc. ... ... ... 1 ... 13 2 8 2 ... ... 4 6 ... ... ... ... Textile Weaving 2 ... 18 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Toys 2 ... 139 ... ... ... 5 96 2 ... ... 10 14 ... ... ... ... Total 118 199 1029 14 13 61 1335 748 121 ... ... 187 243 ... 9 ... ... * The figures in these columns relate to outworkers' premises at which nuisances were found and dealt with under Public Health (London) Act. 120 APPENDIX I. LEGAL PROCEEDINGS. (In addition to the prosecutions for offences under the Food and Drugs Acts reported on pages 95-96.) In 15 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. 15 £1 1 0 In 4 other cases Nuisance Orders were obtained with orders as to costs of £3 3s. Od. in one instance, and £2 2s. Od. in each of the other three. It was also found necessary in 1 case to obtain a Distress Warrant for the recovery of costs. Other legal proceedings are summarised in the following list. 126 127 SUMMARY OF LEGAL PROCEEDINGS. (Other than Food and Drugs Acts cases, for which see pages 95—96). Date of Hearing. Offence. Officer. Result. 26th Jan., 1932 Public Health (London) Act. Illegal occupation of cellar for sleeping purposes Slater Fined 20s. or 5 days' imprisonment, to he suspended for 14 days 18th Feb., 1932 L.C.C. (General Powers) Act, 1928. Application for order for removal of Mrs. C.B. to Bethnal Green Hospital Borland Order made for 3 months 23rd Feb., 1932 Milk and Dairies Order, 1926. Filling bottle with milk other than on registered premises Weeks Adjourned—line die. 28th April, 1932 Filling bottle with milk other than on registered premises ,, Fined 10s. 3rd May, 1932 Carrying on trade of purveyor of milk without being registered ,, Fined 20s. 28th June, 1932 L.C.C. (General Powers) Act, 1908. Failure to observe cleanliness to utensils used in manufacture of cream cheese Richards Fined 20s.; Costs £7 7s. 0d. Public Health (London) Act. 11th Aug., 1932 Failing to give notice of fitting W.C. pan and trap at 37, Teesdale Street Jenkins Fined 10s.; Costs £1 1s. 0d. 11th Aug., 1932 Repairing W.C. in manner contrary to law at 37, Teesdale Street ,, Do. do. 27th Oct., 1932 Depositing and exposing for sale unsound apples and pears Billings Fined £5 ; Costs £5 5s. 0d. 27th Oct., 1932 Constructing sink waste pipe in improper manner at 139, Bethnal Green Road Heron Adjourned—sine die. 27th Oct., 1932 Constructing sink waste pipe without due notice at 139, Bethnal Green Road ,, Do. do. 27th Oct., 1932 Constructing sink waste pipe in improper manner at 139, Bethnal Green Road ,, Do. do. 27th Oct., 1932 Constructing sink waste pipe without due notice at 139, Bethnal Green Road ,, Do. do. 7th Nov., 1932 Exposing for sale unsound tomatoes Henley Fined £3 ; Costs £4 4s. 0d. 128 APPENDIX II. TUBERCULOSIS DISPENSARY. REPORT FOR THE YEAR 1932. By H. Tylford Howell, M.R.C.S., Eng., L.E.C.P., Lond., Clinical Tuberculosis Officer. In order to present a coherent statement of the work of the Dispensary during any year, it is necessary to recapitulate briefly details of routine given in previous reports. For the sixth year in succession there has, fortunately, been no change in the personnel of the department. The sessions have remained unaltered, 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 9 o'clock. Saturday mornings are reserved as far as possible for school children, and the evening sessions are intended for those patients who are at work during the day. In view of recent critical remarks in the press with reference to the lengthy periods of waiting in the out-patient department of some hospitals, I would like to point out that, owing to the ample dressing-room accommodation available, the majority of our patients are seen within a quarter of an hour of their arrival, and seldom—unless during an unforeseen rush of work—are they called on to wait for half an hour. The practice of the two medical officers consulting one another on most new cases and afterwards discussing the appropriate form of treatment or points of special difficulty, is being continued. Facilities for further consultations are also available in the various departments of the Hospital. The opinion of a Physician, Surgeon, Laryngologist, Radiologist, Pathologist or Dentist can be immediately obtained, and a case thoroughly investigated without loss of time. We specially appreciate the facilities for consultations with the Hospital Staff, as they not only enable us to discuss individual cases, but afford opportunities for keeping in touch with other opinions generally, and of witnessing new methods of treatment and diagnosis and estimating their value. 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 these cases in the wards. The number of cases referred to the X-ray Department tends to increase as the value of X-rays in diagnosis increases. Radiology is making rapid strides, and recent improvements in technique, together with greater experience in the interpretation of the films, has rendered it our most valuable aid in diagnosis. The question of expense must of necessity always receive due consideration, but the detection of tuberculosis in its early stage is so essential to successful treatment that I hope we shall not be called upon to limit the use of X-rays on that score. 129 We have always experienced difficulty in impressing patients with the desirability of the extraction of septic teeth, and the number of cases referred to the Dental Department of the Hospital is, as usual, small. It must be noted, however, that a certain number of patients receive dental treatment during their stay in hospital, while all children are referred to the School Clinic. The arrangements for the supply of dentures for our patients are in the hands of the Hospital Almoner, who has kindly volunteered to undertake this duty for us. The various charitable organisations in the district continue to help us in many ways. The Hackney and Bethnal Green branches of the Invalid Children's Aid Association have been most helpful in arranging convalescent treatment for our debilitated children, at the seaside or in the country. Both Tuberculosis Officers are members of the local Committees of this Association. The Charity Organisation Society and the United Services Fund have assisted in the supply of surgical instruments, dentures, clothing, etc., and have provided accommodation for many of our children while the mothers are receiving sanatorium treatment. Financial assistance is also given in certain cases. One hundred and sixteen cases were admitted to hospital or sanatorium through the London County Council during the year. This figure does not include the admissions to the London County Council general hospitals. The increased accommodation at the disposal of the Council is reflected in the shorter waiting period and in the increased facility with which we are able to obtain institutional treatment for our patients, but the period of stay at a sanatorium is still too short to effect a cure in the majority of cases. This is especially to be regretted, as tuberculosis in the early stage may now definitely be regarded as a curable disease. Within recent years the whole aspect of the disease may be said to have changed. The acute and rapidly fatal form of Pulmonary Tuberculosis is now comparatively rare, and the term " galloping consumption," once so common, is now rarely heard. Formerly I used to consider the outlook even of the early ease as decidedly gloomy, but now, with suitable and adequate treatment, the prospeet is much brighter, and the probability of a cure much less remote. This more hopeful outlook is not entirely explained by the less virulent nature of the disease, but is also in some measure due to an increased individual resistance to tuberculosis. The problem of the advanced case, although not yet solved, is not so acute as formerly, as there is less difficulty in persuading patients to enter one of the Council's general hospitals than when these Institutions were under the control of the Guardians. The isolation of the advanced case is of such importance in the prevention of the spread of tuberculosis that no effort should be spared to ensure its being effectively carried out. As there now appears to be ample accommodation available, I would again urge the necessity of making the hospitals more attractive to the tuberculous patient. In my opinion the question would be largely solved if certain of the Council's general hospitals were wholly or mainly set aside for tuberculous patients, and a relatively greater number of these patients were later transferred to sanatorium. Such hospitals would in time acquire the status of special hospitals, and in consequence would, I am convinced, attract a larger number of patients. As pointed out in last year's report, the argument that treatment in the Council's general hospitals is satisfactory and adequate is of little avail if patients continue to regard them as general hospitals, and refuse to enter because they feel that in such institutions no special care or knowledge is available to them. Having persuaded an advanced case to enter hospital, every effort should be made to make him happy and contented, so as to induce him to stay 130 as long as possible. Perhaps more could be done in this direction if there were fewer restrictions. The hopeless case, tired of being confined to bed, might, even if he has a slight rise in temperature, be allowed to sit up for a little if he feels so inclined. Permission to smoke might be more freely given. Wireless entertainments should be available in all wards; the dietary also might with advantage be made more attractive. It may be argued that it is inadvisable to give privileged treatment to tuberculous patients, but it must be remembered that theirs is unexceptional case requiring exceptional treatment, and it is to the public good, apart from any consideration for the patient, that his sojourn in hospital should be a prolonged one. The dissemination of infection, however, should not be attributed solely to the advanced case. The moderately advanced, or even the early case who goes about his daily work, is a source of danger if he has not been properly educated in the necessary precautions against the spread of disease, and his home conditions are generally such as to make this difficult in practice. Accordingly efforts to prevent the risk of infection should be conducted along two main lines—the education of the individual and the improvement of environment. The consumptive patient is given personal advice by the Tuberculosis Officers and the visiting nurses both at the Dispensary and in his home. In detailing the precautions necessary to avoid the spread of infection, special attention is paid to the disposal of the sputum, and the danger of indiscriminate spitting explained. A short stay at a sanatorium, however, is of more value in the education of the patient than personal talks at the Dispensary. One rarely finds an ex-patient of one of these institutions, whatever may be his conduct in public, who would be guilty of spitting indiscriminately about his home. Sputum flasks are supplied free of charge by the Borough Authorities, but patients, for fear of being shunned by their fellows, are shy in their use. The children of an infectious case may be boarded out in the country, but the scheme has not been successful, as it is difficult to persuade parents to surrender them to a home they have never seen and which, naturally, they are discouraged from visiting. Hygienic improvements in the condition of the home are attempted, and the family advised as to the best arrangement of the available sleeping accommodation. Where necessary, bed and bedding may be provided free of charge. Unfortunately there remain a certain number of homes so over-crowded that any re-arrangement is impossible, and advice of little or no avail. Only the provision of a new home will meet such cases. Where the financial circumstances of the family permit, removal is advised, and the London County Council and the Borough Council usually give preferential consideration to the application of such cases for the houses and flats at their disposal. The lot of those who cannot afford to move is in some cases truly tragic. Local authorities have the power to provide homes for these people, and in some instances have undertaken this responsibility. The Sheffield Council have already adopted a scheme for the re-housing of the families of infectious cases of tuberculosis. The ordinary Council houses allotted for this purpose are subject to the special supervision of the Health Committee, and, where necessary, a portion of the rent is remitted. The expense of the scheme is surprisingly small—less than £10 per annum on each home, surely a negligible amount for such a measure of public protection and such an obvious benefit to the family. The difficulty of obtaining employment for the tuberculous is as acute as ever. The Care Committee are successful in placing a certain number of our patients, but their power is limited, and they are handicapped by lack of funds. The time perhaps is not opportune to embark on any 131 new schemes of employment for the tuberculous when there are so many able-bodied men and women seeking work, but I cannot let any opportunity pass of emphasising the importance of the question. The success of the Spero Leather Factory, where some of our patients have been in continuous employment for several years, suggests that local workshops run on similar lines might later provide a solution of the problem. The scheme for the provision of extra nourishment, adopted by the Boroughs in 1921, still operates. As pointed out in last year's report it had previously been our practice to recommend two pints of milk and one egg daily, but during the year it was decided that the supply of milk should be reduced to one pint. This has enabled us to extend the grant without increase of expenditure, and is greatly appreciated by the satients thus benefited. The grant as laid down by the Ministry of tealth, is, as far as possible, limited to patients about to enter or those leaving sanatorium, and there is little doubt it is of especial value to these latter, who are often unable to provide suitable nourishment for themselves pending their return to work. I continue to act as Consultant to the Bethnal Green Hospital. I have now visited the hospital regularly for ten years in succession, and find the work both interesting and useful. It enables me to keep in touch with patients whom I would otherwise lose sight of for prolonged periods. I examine all cases of suspected tuberculosis, helping to secure early diagnosis in some instances, and to prevent erroneous notification in others, thus avoiding the unnecessary examination of "false" contacts. I am grateful for the unfailing courtesy and co-operation of the Medical Staff, who readily adopt any suggestions I care to make. I feel that the free access accorded to the Tuberculosis Officer to visit patients at the local general hospitals serves a very necessary and useful purpose, and it is hoped that the London County Council will not lose sight of this fact should any re-arrangement of the visiting staff be contemplated. The children attending Stormont House open-air school have made satisfactory progress during the year. The school, which is always full, accommodates 90 children, which is sufficient for the three Boroughs it mainly serves—namely Hackney, Bethnal Green and Stoke Newington,— as the waiting list is never a long one. Both pulmonary and nonpulmonary cases of tuberculosis of either sex are eligible for admission, the ages ranging from 6 to 16 years. The classes are held in special open-air shelters in the grounds of the school, while ample accommodation is available in the permanent building in bad weather. The Dispensary Nurse visits the school daily, and keeps a record of the temperature and weight of each child. The Tuberculosis Officer visits weekly, making periodic examinations of the children, and supervising the exercise and rest of each case. Hot mid-day meals are provided at a nominal charge, but in necessitous cases no payment is exacted. Two school journeys were undertaken during the summer, one for 25 boys at Seasalter, and another for 24 girls at Bognor, each for a period of two weeks. Under the scheme the children, who are accompanied by their teachers, have still to continue their lessons, but as these largely take the form of nature study, practically all their time is spent in the open air, so that the maximum benefit from a stay at the seaside is assured. During the year five children were discharged as fit for work, and thirteen had so improved as to permit of their transfer to an ordinary elementary school. All the scholars leaving school were placed in employment by the School After-care Committee, and, contrary to what one would expect, it is satisfactory to know that attendance at an open-air school for tuberculous children does not seem to prejudice a child's chances of obtaining work. 132 The School Medical Officer and the Tuberculosis Officer continue to work in close co-operation in the supervision of "contacts" and delicate children. A report on all contacts and " unsatisfactory " children whom the Tuberculosis Officer encounters in his work is forwarded to the School Medical Officer. These children are examined and weighed at regular intervals by the school medical authorities, and should a case fail to make satisfactory progress, or later reveal any suspicious symptom, it is referred back to the Dispensary for a further opinion. The scheme ensures a more systematic supervision than would otherwise be possible, and probably prevents a breakdown in certain cases by the timely provision of treatment, frequently in the form of a period of convalescence at the seaside or in the country. The Boroughs continue to undertake financial responsibility for special forms of treatment, such as Finsen Light for Lupus, and refills in Artificial Pneumothorax cases on their return from sanatorium. The Finsen Light Treatment of Lupus is on the whole very satisfactory. All cases show marked improvement, and a cure is hoped for in the majority. The number of Artificial Pneumothorax cases increases yearly, and an added expenditure in this direction may be expected, but the results are encouraging, and the expenditure in my opinion is justified. I submit at the end of the report a statistical summary of the work of the department for the year. The figures show no striking variation and call for no special comment. 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. 15th March, 1933. 133 STATISTICAL TABLES. BOROUGH OF BETHNAL GREEN. 1. The Totals of New Cases. Males 352 Females 394 746 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 223 28 Local Practitioners 168 38 Contact cases (per M.O.H.) 261 — War Pensions Committee 1 6 London County Council 13 2 Victoria Park Hospital 20 20 Other sources 48 34 Transferred from other Areas 12 9 3. The Diagnosis of the New Cases. Diagnosis. Adults. Children under 15. Total. Males. Females. Males. Females. Pulmonary Tuberculosis 54 46 2 1 103 Non-pulmonary Tuberculosis 10 3 16 5 34 Non-tuberculous 146 190 119 140 595 Doubtful 4 5 1 4 14 Total 214 244 138 150 746 131 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 4 Non-pulmonary Tuberculosis 2 Non-tuberculous 250 Doubtful 5 Total 261 5. Sputum Examinations. Tubercle Bacilli present 105 Tubercle Bacilli absent 508 Total 613 6. Other Figures. Total number of attendances 4,522 Systematic examinations at the Dispensary 2,205 Number of patients sent to hospital or sanatorium by the L.C.C. 53 Number of letters written 1,380 Number of visits to patients at their homes 133 Number of attendances at:— X-Ray Department 203 Dental Department 12 Sunlight 65 Other Departments 36 135 TUBERCULOSIS SCHEME OF THE BETHNAL GREEN METROPOLITAN BOROUGH COUNCIL, (a) Return showing the work of the Dispensary for the year 1932. 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 46 43 2 1 9 3 13 5 55 46 15 6 122 *(b Diagnosis not completed ... ... ... ... ... ... ... ... 3 3 1 2 9 (c) Non-tuberculous ... ... ... ... ... ... ... ... 100 111 58 76 345 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 2 ... ... 1 ... 1 ... 3 0 1 ... 6 *(6) Diagnosis not completed ... ... ... ... ... ... ... ... 1 2 ... 2 5 (c) Non-tuberculous ... ... ... ... ... ... ... ... 46 79 61 64 250 C.—Cases written off the Dispensary Register as (a) Recovered ... 1 ... ... 2 1 3 1 2 2 3 1 8 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous ... ... ... ... ... ... ... ... ... 149 193 119 140 601 D.—Number of Cases on Dispensary Register on Dec. 31st: (а) Definitely Tuberculous (б) Diagnosis not completed 276 181 15 19 48 33 85 71 324 2 214 2 100 1 90 728 5 1. Number of cases on sary Register on January 1st 744 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 14 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 86 4. Cases written off during the year as Dead (all causes) 67 5. Number of attendances at the Dispensary (including contacts) 4522 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 170 7. Number of consultations with Medical Practitioners:— (a) Personal 30 (b) Other 300 8. Number of visits by culosis Officers to homes (including personal consultations) 133 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3010 10. Number of :— (а) Specimens of sputum, &c., examined 613 (б) X-ray examinations made in connection with Dispensary work 203 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 266 * i .e. Remaining undiagnosed on 31st December. 21st February, 1933. H. T. Howell, Clinical Tuberculosis Officer. 186 137 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 1932 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 1932 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus j 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) Group 1 Group 2 Group 3 Total (Class P.B. Plus) (a) Remaining on Dispensary Register on 31st December Disease Arrested Adults M. 3 1 1 1 1 F. 0 Children 2 Disease not Arrested Adults M. 32 16 18 4 38 2 3 2 5 1 1 6 1 7 5 2 1 2 5 6 4 5 5 14 10 6 )1 5 22 8 3 10 4 17 13 6 15 10 31 F. 29 4 7 3 14 1 1 1 2 1 3 5 4 3 2 9 7 1 5 2 8 7 4 1 1 6 5 3 8 3 14 16 7 8 8 23 Children 8 1 1 2 3 3 1 1 1 2 1 1 2 2 2 Condition not ascertained during the year 19 9 9 4 22 4 1 1 3 3 3 4 2 2 1 5 8 2 2 5 2 2 2 6 2 1 2 1 4 Total on Dispensary Register at 31st December 93 29 35 12 76 12 3 3 1 7 7 3 8 2 13 17 8 6 5 19 21 6 12 7 25 24 12 14 8 34 20 8 20 8 36 31 15 23 18 56 (b) Not now on Dispensary Register and Reasons for removal therefrom Discharged as Recovered Adults M 1 F. 2 Children 1 Lost Sight of or otherwise Removed from Dispensary Register 17 8 5 8 21 5 7 4 3 14 6 6 6 1 13 7 3 3 3 9 8 2 5 7 14 4 4 2 1 7 6 6 7 13 3 1 1 2 I Dead | Adults M. 9 5 13 8 26 4 5 14 16 35 3 2 6 11 19 6 1 13 18 32 2 6 15 21 8 1 2 28 31 5 3 12 15 2 1 3 4 F. 1 5 6 7 18 3 4 7 17 28 7 4 9 6 19 2 3 6 8 17 5 5 9 14 3 5 13 18 2 6 8 2 1 1 Children 1 1 1 1 1 1 2 1 1 2 Total Written off Dispensary Register 31 18 24 23 65 13 16 25 37 78 17 12 21 18 51 15 7 23 30 60 15 2 16 31 49 15 5 10 43 58 11 6 12 18 36 7 1 1 5 7 Grand Totals... 124 47 59 35 141 25 19 28 38 85 24 15 29 20 64 32 15 29 35 79 36 8 28 38 74 39 17 24 51 92 31 14 32 26 72 38 16 24 23 63 138 139 (b) NON-PULMONARY TUBERCULOSIS.—Supplementary Annual Return showing in Dispensary Register; and (b) the reasons for the removal of all cases written off summary form (a) the condition at the end of 193'2 of all Patients remaining on 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 1932 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December Disease Arrested Adults- M. 1 1 1 1 1 1 F. 1 1 1 1 1 1 1 1 Children 5 1 3 9 1 1 1 1 1 1 Disease not Arrested Adults- M. 6 1 3 10 1 1 1 3 1 1 o 1 1 2 1 2 3 i 1 1 3 1 1 4 1 3 1 9 F. 3 1 3 7 1 1 2 1 1 1 1 2 1 1 1 1 I 1 2 4 1 2 3 Children 9 1 2 21 33 1 1 5 7 2 1 1 4 2 5 7 5 5 5 1 9 15 4 1 1 10 16 7 2 10 19 Condition not ascerta during the year ned 8 1 3 10 22 2 1 5 8 2 1 1 4 2 1 2 1 6 2 1 3 3 1 2 6 4 2 1 2 9 Total on Dispensary gister at 31st Decerr Re- ber 32 4 7 40 83 7 1 2 12 22 7 3 2 12 6 1 4 7 18 5 3 6 14 9 3 1 13 26 11 4 4 12 31 11 4 3 13 31 Transferred to Pulmon ary 1 2 3 1 1 1 1 (b) Not now on Dispensary Register and reasons for removal there from Discharged as Recovered Adults- M 1 1 1 3 F. 1 1 2 Children 3 2 5 1 1 1 1 1 1 Lost sight of, Removed from Register or otherwise Dispensary 5 4 20 29 4 1 3 8 2 1 1 2 6 1 6 7 2 3 5 2 1 3 6 1 1 4 6 Dead Adults M. 1 1 1 1 F. 1 1 1 1 2 Children 1 1 2 1 1 Total written off Dispensary Register 12 3 6 22 43 6 1 1 4 12 2 1 1 3 7 1 6 7 3 3 6 2 1 3 6 1 1 4 6 1 1 Grand Totals of (a) and (b) excluding those transferred to Pulmonary) 44 7 13 62 126 13 2 3 16 34 9 1 4 5 19 6 2 4 13 25 8 3 9 20 11 4 1 16 32 12 5 4 16 37 11 5 3 13 32 140 INDEX. page Aged and Infirm Persons 87 Ambulances 16 Bacteriological Examinations (medical) 87 do. do. (food) 98 Bakehouses io2 Bedsteads, Bedding and Clothing (Tuberculosis) 75 Births.21,24,35 Breast Feeding Clinic 47 Bug Infestation 81 Cancerr 30 Census, 1931 22 Certifying Surgeon: Factories and Workshops 19 Chicken Pox 79 Cleansing Stations: Personal 18 Clinics 13,34,38 Clothing, Hygienic 52 Combined Drainage Systems 110 Condensed Milk Regulations 97 Convalescent Treatment 60 Cowhouses 99 Day Nurseries 13 Deaths 21,24 ,, from Motor Traffic 31 Delicate Children: Clinic for 52 Dental Clinic (M. & C.W.) 55 Dental Treatment of Tuberculous Patients 77 Diabetes 79 Diphtheria 68 DISEASE, CONTROL OF 66 Disinfectants: Distribution of 87 Disinfection 80 Dispensaries 12, 76 Drainage Work 110 Dried Milk, &c. 52 Dried Milk Regulations 97 Enlarged Tonsils, Adenoids and Mastoid Disease 59 Enteric Fever 69 Expenditure on Public Health Work 10 Extra Nourishment 76 Factories and Workshops 121 do. do. Certifying Surgeon 19 Finsen Light Treatment 77 Fish Curing and Fried Fish 102 FOOD 91 Food Premises 98, 102 ,, Poisoning 88, 104 Food and Drugs Acts 92 Fried Fish and Fish Curing 102 General Description of District 7 GENERAL SANITARY ADMINISTRATION 106 German Measles 79 Hairdressers 110 Health Education Lectures 19, 49 141 PAGE HEALTH SERVICES 10, 34 ,66 Health Visitors 36 do. do. Tuberculosis Home Helps 50 Home Workers 123 Hospitals HOUSING 112 ,, Schemes Hygienic Clothing 22 Ice Cream 102 Illegitimacy 24 Imported Food 105 Infant Consultations 39 Infantile Mortality 21,28 INFECTIOUS DISEASE 66 Inhalation Therapy 59 Insanitary Areas 117 Insect Pests 80 Insurance Acts, National Health 15 INTRODUCTION 6 Joint Dispensary Committee (Tuberculosis) 77 Labelling of Food 106 Lectures, Health Education 19 LEGAL PROCEEDINGS: Food 95 Other 125 Light Treatment 53 Malnutrition: Hospital treatment for 60 Marriages 24 Massage 58 Maternal Mortality 21, 28 MATERNITY AND CHILD WELFARE 34 Maternity Clinic 42, 45 Maternity Institutions 14 Maternity Outfits 50 Measles 78 Meat Regulations 103 Medical Inspection (school children) 62 Medical Practitioners 11 ,, ,, Consultations with 69 Midwifery: Borough Midwifery Service 49 Midwives 15 Milk 98 Milk for necessitous mothers and children 51 Milkshops and Dairies 98 Milk (Special Designations) Order 99, 100 Mortuary 33 Mothers' Clinic 47 Motor Traffic Accidents 31 Noise 109 Notification of Births 35 Nurseries, Day Nurses and Nursing Assistance 11, 60 Nutrition, Rent and 116 Obstetrical Consultants 50 Offensive Matter 110 do. Trades 108, 110 143 page Open-Air Sleeping Shelter 75 Ophthalmia Neonatorum 62 Orphans 14 Orthopaedic Treatment 57 Outworkers 123 Overcrowding 116 Pasteurisation of Milk 101 Personal Cleansing Stations 18, 86 Pneumo-Thorax Refills 77 Population 2 2 Poultry Slaughterers 103 Public Assistance 9 PUBLIC HEALTH COMMITTEE 3 Public Health Expenditure 10 Puerperal Fever and Puerperal Pyrexia 61 Rag and Bone Dealers 110 Rag Flock Act 110 Rats and Mice 109 Registration of Births, Deaths and Marriages 18 Rent Restrictions Acts 108, 116 Sanatorium Treatment 75 Sanitary Inspectors, work of 107 Scabies (Itch) 86 Scarlet Fever 68 School children: Medical Inspection 62 School Meals 10 Shelter for Contacts 87 do. Open-Air Sleeping 75 Slaughterhouses 103 Smallpox 68 Smoke Nuisance 109 Social Welfare 7 Special Clinic for Delicate Children 52 Sputum Outfits 75 STAFF 4 Stillbirths 24 Street Accidents 31 Talks to Mothers 49 Tenement Houses 108 Toddlers' Clinic 41 Tonsils, Adenoids and Mastoid Disease 59 TUBERCULOSIS 71,128 Tuberculosis Dispensary 18. 76 „ Officer, Report of 128 Underground Rooms Unsound Food 104 Vaccination Vaccination Returns Venereal Disease Verminous Conditions 86 VITAL STATISTICS 21, 32 Water Supply 100 Welfare Centres 38 Whooping Cough 79 Workshops and Factories 121