Ac 4366 BET 38 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1933 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 1933 BY VYNNE BORLAND, M.b., Ch.b. B.Sc., d.p.h. Medical Officer of Health and Administrative Tuberculosa 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, 1933-34 as on 31st December, 1933. Meetings held at the Town Hall at 6 p.m. on the first Wednesday. *Councillor R. E. Pearson, J.P., L.C.C., Chairman. *Councillor H. T. Clark, Vice-Chairman. *Councillor C. Bennett. * „ Marshall Jones. „ Rev. R. C. Jones, B.A ,, E. T. Malindine. „ A. C. Rawles, M.C. * „ Mrs. K. E. Rawles, M.B.E. *Councillor 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 Miss L. D. Benoly, J.P.). Committee: Baths Electricity Finance Housing Law and General Purposes Libraries Staff Street Trading Valuation Works and Stores Chairman: Councillor Mrs. K. E. Rawles, M.B.E. „ A. C. Rawles, M.C. „ L. Haltrecht. „ M. Jones. „ J. R. Davy, J.P. „ Mrs. A. E. Davy. „ M. R. Seymour. „ T. Brooks, J.P. Alderman G. Edmonds, J.P. Councillor 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 R. E. Pearson, J.P., L.C.C., H. T. Clark and Rev. S. L. Sarel, M.A. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT, as on 31st December, 1933. 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 I Food *J. O. G. Weeks J 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. *§S. R. B. Slater. District Sanitary Inspectors. Maternity and Child Welfare : Miss Kathleen M. Horton, m.r.c.s., l.r.c.p., d.p.h., Assistant Medical Officer. †‡Miss G. I. Le Geyt, Superintendent Health Visitor. †‡Miss E. M. Patrick, Assistant Supt. Health Visitor. †Mrs. F. M. Barden. †Miss V. D. Cornish. †‡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. Miss D. M. Hare, Temporary Clerk. tCertificated Nurse. ‡Certified Midwife. dHealth Visitors' Diploma. Employees: Maternity & Child Welfare Centre: 1 Storekeeper, 1 Caretaker, 3 Cleaners (part-time). *Certificated Sanitary Inspector. Certified Meat, etc. Inspector. Disinfection : 1 Leading Disinfector, 3 Disinfectors Combined Drainage: 1 Drain-layer, 3 Labourers. Personal Cleansing Station: 1 Woman Attendant (part-time). 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. Tuberculosis †‡dMrs. J. Callow. Health Visitors 2 Messengers, one Of whom acts as Temporary Mortuary Keeper. 5 Unestablished Part Time Officers. Maternity and Child Welfare Centres. Medical Officers. Miss H. M. M. Mackay, M.D., B.S., M.R.C.S., F.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.B., B.S., M.R.C.S., L.R.C.P., 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. Parkes. F.I.C., F.C.S., Public Analyst. Vaccination Officers: H. J. Hardwick (North East). Miss M. Peters (South West). Staff changes during 1933. Miss E. Packman who had acted as general assistant at the Welfare Centre for some years, retired toward the end of the year, and the place was filled by the appointment of Miss D. M. Hare, as Temporary Woman Clerk. † Died in 1934. 6 Public Health Department, Town Hall, Bethnal Green, E.2. 23rd April, 1934. 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 12.5 per thousand of the population. The Infant Mortality Rate for the year shows a reduction, being 66.3 per thousand births as against 69.1 for 1932. The comparative rates for ten years are given on page 28. These figures give no grounds for either optimism or pessimism but rather indicate that we should be unrelaxing in our efforts. It is so easy to be satisfied with results. We may be "looking through rosecoloured glasses" when suddenly we are awakened out of our complacence. Such an experience may be realised when the results of the 1934 measles epidemic have been analysed. The Maternal Mortality Rate was 1.3 per 1000 births. I should like to draw attention to the continued toll of deaths resulting from street accidents, full particulars and discussion of which are given on page 31. There was an increase in notifications of Diphtheria from 355 cases in the previous year to 488 in 1933 while cases of Scarlet Fever increased from 590 cases to 786. The increased incidence in both diseases was general in London. There were 11 cases of Smallpox as against 25 in 1932. The annual report of the Public Analyst shows a slight decrease in the number of adulterated samples although the total number of samples examined was slightly more than in 1932. I am glad to have this opportunity of expressing my gratitude to the members of the Health Committee for their encouraging help and courtesies. My thanks are also extended to my colleagues in other departments for their many kindnesses and willing cooperation. It is also my duty and pleasure to record my indebtedness to the office staff, to all those embraced under the heading of sanitary inspection, to the medical and health visiting staff, including Tuberculosis, and all workers under the Maternity and Child Welfare scheme for their efficient service, co-operation and loyalty which are cardinal factors in the promotion and maintenance of smooth administration. 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 1¾ miles from west to east and about one mile from north to south, and 760 acres in area. It is bounded by Shoreditch and Hackney on the north, Stepney on the south and Poplar on the east. Where the original soil exists it is of gravel and sand formation. The surface is generally flat, varying from 36 to 54 feet above sea level. The principal industries carried on in the district are the making of boots, shoes and clothing, cabinet making and other branches of the furnishing trade. The main lines of the Great Eastern section of the L.N.E.R. pass through the Borough. There are also three railway stations in the Borough, and several others in close proximity, while various tram and motor bus routes traverse the main roads in the Borough. There is a considerable daily inflow and outflow of workers, with the larger stream outward to workplaces in other parts of London. The tendency is for the Borough to be increasingly used for industrial and commercial purposes and the resident population is very congested. At the 1931 census there were 18,156 structurally separate dwellings in the Borough, and 27,978 families or separate occupiers lived therein. There is an excellent open space to the east of the Borough in the shape of Victoria Park, and there are a few small open spaces elsewhere in the Borough. The rateable value of the Borough on the 31st December, 1933, was £520,248, and the product of a 1d. rate is estimated at £2,030. SOCIAL WELFARE. The close association of the public health with the economic circumstances of the people makes it desirable 8 to note the chief facts concerning the social welfare of the residents in the Borough. The outstanding social fact continues to be widespread unemployment, with a further substantial percentage of the population on short time or earning a very precarious livelihood. A large section of the population has been subsisting for some years on the limited resources of Unemployment Benefit, Public Assistance and the charitable help of relatives and friends. Recent enquiries concerning nutrition go to show that the amount of assistance they receive is inadequate to maintain the families of the unemployed or low-wage workers in a proper state of health. Every one who has studied the effects on health of the deprivations arising from the Great War and during previous industrial depressions cannot but be alarmed as to the probable results of the present low standard of living. These effects, as past experience shows, do not fully show themselves immediately but express themselves in a generally lowered resistance to disease for several years later. The administration of public assistance is 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 large number of persons receiving public assistance (apart from those obtaining medical relief only) which was 5,504 at the end of 1933. 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 24th June. 1933. Bethnal Green Hospital 6 … … … … … … … 6 Waterloo House 11 177 … … 305 50 12 555 Leytonstone Childrens Homes … … … … … 163 4 167 17 177 ... … 305 50 163 16 728 Week ended 23rd December, 1933. Bethnal Green Hospital … … … … … … … … … Waterloo House 16 179 … … 338 49 1 1 584 Leytonstone Children's Homes … … 4 … … … 134 7 145 1C 179 4 … 338 49 135 8 729 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 previous Column Week ending 24th June, 1933 1558 1853 2597 6008 2288 576 341 2 Week ending 23rd December, 1933 1419 1767 2318 5504 2170 449 245 1 10 It should be explained that so far as the foregoing figures for Bethnal Green Hospital are concerned these only relate to persons in receipt of "public assistance" and do not include the patients treated there as a general hospital. The complete figures for Bethnal Green Hospital are given later. I am informed by the Education Officer that the average number of necessitous school children provided with meals of some kind during the year was 808 (milk), 163 (cod liver oil) and 74 (dinners). This assistance which is only granted while the schools are open, shows some increase on the previous year, but is surprisingly small in view of the widespread poverty in the Borough. 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 1932-33, the cost of the Public Health service was £26,179, or 5s. Od. per head of the population, equivalent to a rate of 1s. 1d. in the £. These figures differ from those in earlier 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. The 11 Borough Council is the Maternity and Child Welfare authority, but at 4 or 5 years of age the children come under the jurisdiction of the L.C.C. as the School Medical authority. When young persons leave school and enter industry, they come under the health supervision of the Factory Inspector and the Insurance Panel Doctor. Apart from the London County Council and the Borough Council, 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 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 37 general medical practitioners with consulting rooms in the Borough. The friendly relations with local practitioners reported in previous years continue. 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. The Association reports increasing difficulty in raising funds. Nursing visits last year were 5,000 more than in 1932, and another nurse is needed. Address: 80, Nichols Square, E.2. Telephone: BIS. 5287. An account of the work of the Association on behalf of the Council will be found in the Maternity and Child Welfare Section of this report. HOSPITALS. Public. London County Council: Bethnal Green Hospital, Cambridge Road. 12 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 5,539 Operations performed 1,070 (including 691 under general anaesthesia and 223 abdominal sections.) Out-patients (4,558) Attendances 13,980 Some idea of the wide range of medical work carried out in the hospital may be gathered from the following figures about some of the special departments:— Massage: Patients treated 6,801; Treatments given:— Massage 4,513 Electrical 2,381 Light 766 Remedial exercises 3,076 X-ray : In-patients X-rayed 1,494 ; Out-patients 778. In addition, there are departments for pathological, bacteriological and bio-chemical examinations, and for venereal disease. 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 27,461 126,237 2,142 ... Mildway Mission Hospital, Austin Street 56 16,790 55,294 973 ... City of London Hospital for Diseases of the Heart and Lungs, Victoria Park 188 11,390 43,815 1,292 44 The Queen's Hospital also has 44 beds at a country branch, the Little Folks' Home, Bexhill, 13 In addition to its importance as a consultative centre, both in respect of Tuberculosis and Heart conditions, the City of London Hospital carries on a great deal of research work. The London Hospital, Whitechapel Road, although situated outside the Borough, is also largely used by residents. DISPENSARIES, &c. The following Dispensaries exist in the Borough, and I have been furnished with the following statistics concerning last year's work. No. of Out-Patients Out-Patients' Attendances. Visits to Patients Homes. *Queen Adelaide's Dispensary, Pollard Row 2,138 5,116 540 Medical Mission, St. James-the-Less, St. James's Road 1,364 6,800 410 †Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 3,481 20,489 4,473 *There were also 501 patients who attended the Dental Department of this Dispensary. †here were also attendances as follows:—Dental Department, 781; Eye Department, 442; Massage and Sunlight, 365; Chiropody Clinic, 527. 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 Frederick Menzies, School 14 Medical Officer, L.C.C., I have been furnished with the following information concerning local arrangements for the medical treatment of school children. "The only school treatment centre in 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 445 children were treated. Spectacles were prescribed in 300 cases and in 221 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 2,411 children were inspected in the schools and 1,925 or 79.8 per cent were found to require treatment. The number of children treated at the centre was 1,361 and 2,818 attendances were made. "In the minor ailments department the doctor attends on two sessions a week, and two nurses are in attendance daily. During 1933, the number of children treated was 2,220, and 28,761 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. I have been furnished with the following information concerning the work of the day nurseries:— Somerford Street. Bishops Road. Accommodation 30 50 Total attendances 5,097 9,518 Fee per attendance 8d. l0d. Certain of the children attending the Somerford Street Day Nursery also attend the Council's Welfare Centre every week for light treatment and 15 of them were sent away to the country for a fortnight's holiday in August. 15 INVALID CHILDREN'S AID ASSOCIATION, BETHNAL GREEN BRANCH. The Bethnal Green Branch of the Invalid Children's Aid Association, which has offices at 36, Barnet Grove, has furnished the following report of its activities:—Its objects are:—To visit delicate and crippled children in Bethnal Green; to aid their parents to procure competent medical advice; and to act upon it; to obtain admission for the children to suitable Hospitals and Nursing or Convalescent Homes ; to supply surgical appliances and to supervise their use. Parents contribute towards the cost of treatment where possible. During 1933, 260 new cases were referred to the Branch, in addition to 86 children already known to it and requiring further help. Of these 346 children, 50 were suffering from rheumatic or heart affections, and 49 from bronchitis, pneumonia and other non-tuberculous diseases of the lungs; while 71 were generally "run down" or anaemic. Children are sent to the Association by public and voluntary bodies as well as by private persons, but the majority come either from Hospitals and private practitioners, or from L.C.C. School authorities—the figures from these two sources being respectively 162 and 82. In the course of 1933, the Branch sent in all 166 children to 47 convalescent and nursing Homes for an average period of 9 1/7 weeks each; 37 surgical appliances were provided, and countless visits paid to children at home. The Branch aims at working as closely as possible with all existing organisations both municipal and charitable, and undertakes much work on behalf of the L.C.C. In particular the Committee desire to record their appreciation of the sympathy and practical support of the Public Health Department of the Bethnal Green Borough Council. ORPHANS. There is a branch of the National Children's Home and Orphanage situated in Bonner Road. 16 MATERNITY. Public. The Borough Council has two Maternity Clinics, one at Cornwall Road, and one at St. Matthew's Institute, Hereford Street, at which a variety of work for maternal welfare is carried on. The Council also employs a midwife, who resides in the borough. (For further particulars see the section of this report dealing with Maternity and Child Welfare). London County Council: There are 18 beds in the Maternity ward in Bethnal Green Hospital, and 3 midwives are employed. Dr. W. P. Greenwood informs me that 298 maternity cases (including 11 stillbirths) were dealt with in the year. An ante-natal clinic is held weekly for women intending to enter the hospital for confinement and 271 women made 1,106 attendances at the Clinic, 48 of the mothers were also seen at the post-natal clinic, making 61 attendances thereat. Other. There are 2 private midwives living and practising in the borough while about 6 others who reside outside also occasionally 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 47 7 * Mothers Hospital, Clapton 24 96 161 Jewish Maternity Hospital, Stepney 37 5 * London Hospital, Whitechapel 215 274 2,571 *Figures not furnished. 17 The Royal London Maternity Charity granted 162 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 89 medical practitioners are on the medical panel for the Borough, 37 of whom have consulting rooms in the Borough. 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 "0" 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:—HOP 0262. 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 18 of Health, London Ambulance Service, Victoria Embankment, E.C.4. Except in the case of ambulances called for accidents, the following particulars are generally required in connection with applications for vehicles-- (a) Name, sex and age of patient and the address from which to be removed. (b) Certified disease. (c) Full address of the destination when it is other than one of the Council's hospitals or institutions. (d) Date and time of removal. (e) In appropriate cases the name and address of the person who accepts responsibility for payment of the charges. General Notes. Ambulances are equipped with stretcher, carrying chair, 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. 19 Ambulance Stations. The following are the nearest stations which are open always:— Name of Station. Address. Bloomsbury 15, Herbrand Street, Tavistock Square, W.C.I. HOP 0262. 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.l. TUBERCULOSIS DISPENSARY. This is situated at the City of London Hospital for Diseases of the Heart and Lungs, Victoria Park, and its work is fully discussed in the Tuberculosis Section of this report. VENEREAL DISEASE. This is dealt with by the L.C.C. The nearest treatment centres are at the Whitechapel Clinic, Turner Street, adjoining the London Hospital, Whitechapel Road, and the Metropolitan Hospital, Kingsland Road. PERSONAL CLEANSING STATIONS. For Adults and Children under School Age. The Council has established a Personal Cleansing Station at the Depot, Digby Street. A report on its work is given later. For School Children. Sir Frederick 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. 20 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 5,367 attendances were made for vermin and 614 for scabies or impetigo. REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. The Town Clerk is the Superintendent Registrar for the Borough. The District Registrars of Births and Deaths are:— For N.E. Bethnal Green:— H. J. Hardwick, 106, Bishops Road. For S. W. Bethnal Green:— Miss M. Peters, 347, Bethnal Green Road. Office hours:— Mon.-Fri. 10 a.m.-l p.m. Sat. 10 a.m.-12 noon. Mon. and Fri. 3-5 p.m. 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. Mr. P. Ivess, the Vaccination Officer transferred to the Council from the service of the old Board of Guardians, died on the 7th February, 1933. The Public Health Committee appointed Mr. J. H. Lloyd, as Acting Vaccination Officer, with the assistance of Mr. F. G. Thomas, until the 14th August, 1933, when the duties were taken over by the District Registrars, each of whom has been appointed by the Council as Vaccination Officer in his (and her) district. 21 HEALTH EDUCATION. Two series of lectures, each illustrated by cinematograph films, were organised by the British Social Hygiene Council and were given in the Lecture Hall of the Public Library, during the year, as follows: In January, an afternoon lecture to women, followed by a mixed meeting in the evening, were followed by talks on 3 successive Tuesday evenings to young women, and on 3 successive Wednesday evenings to young men. The then Chairman (Councillor Miss L. D. Benoly, J.P.) of the Public Health Committee took the chair at some of these meetings. At the end of the year, 3 more lectures were given as follows: 10th October by Dr. I. Feldman (for men). Chairman : His Worship the Mayor (Councillor C. Bennett, J.P.) 14th November by Dr. Rose Turner (for women). Chairman : Her Worship the Mayor (Councillor Miss L. D. Benoly, J.P.) 12th December by Mr. H. V. Wilkins. Chairman : Councillor R. E. Pearson, J.P., L.C.C. Chairman of the Public Health Committee. The lectures were well attended and much appreciated, as evidenced by the intelligent questions asked. The Public Health Committee took a stand at the Exhibition of Industries, organised by the Bethnal Green Chamber of Commerce, which was held in the York Hall, Old Ford Road, from the 25th October to 1st November. Various aspects of the work of the Public Health Department were illustrated, and the stand evoked a good deal of public interest, 22 VITAL STATISTICS. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. BIRTHS. Males Females TOTAL Birth Rate Legitimate 758 Illegitimate 19 692 25 1,494 14.3 DEATHS. Males Females TOTAL Death Rate 694 612 1,306 12.5 MATERNAL MORTALITY. Number of women dying in, or in consequence of, childbirth:— Rate per 1,000 total (live & still) births. From Sepsis 2 1.3 From other puerperal causes — — INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births:— Legitimate 64.1 Illegitimate 136.3 Deaths from Measles (all ages) 6 „ „ Whooping Cough (all ages) 11 „ ,, Diarrhœa (under two years of age) 31 23 VITAL STATISTICS of Bethnal Green During 1933 and Previous 5 Years. Year Population Estimated to Middle of Each Year Births Total Deaths Registered in the Borough Transferable Deaths Net Deaths of Persons Resident in the Borough Uncorrected Number Net Of Nonresidents registered in the Borough Of Residents not registered in the Borough At all Ages Under 1 year of Age Number Birth Rate Number Death rate Number Rate per 1,000 births or infantile mortality 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 1,510 136 133 64.4 1930 Not available 1,374 1,955 17.7* 1,197 243 267 1,223 11.1* 118 60.3 1931 109,200 1,289 1,836 16.8 1,423 331 275 1,367 12.5 161 87.7 1932 106,300 1,139 1,635 154 1,334 335 292 1,291 12.0 113 69.1 1933 104,200 1,037 1,494 14.3 1,353 325 278 1,306 12.5 99 66.3 * Calculated on estimated population in 1929. 24 POPULATION. The Vital Statistics in this report have been calculated on the estimated resident population of the Borough at the middle of the year 1933 of 104,200. MARRIAGES. The number of marriages registered in Bethnal Green during 1933 was 806. This is equal to a rate of 15.5 persons marrying per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1933 was 1,034, and in addition 460 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 1,494 births (777 males, 717 females). The birth-rate for 1933 was, therefore, 14.3 births per 1,000 population, the lowest ever recorded in the Borough. The provisional birth-rate for London is given as 13.2 and for England and Wales as 14.4. ILLEGITIMACY. Of the 1,494 births credited to this Borough, 44 were illegitimate, being 19 males and 25 females, and being 2.9 per cent of the total number of births. STILLBIRTHS. Thirty-eight stillbirths were registered as belonging to the Borough, being a proportion of 2.5 per cent of all births alive or dead. DEATHS. The number of deaths during the year belonging 26 to the Borough, was 1,306. This figure gives an annual death rate of 12.5 per 1,000 population, which compares with 12.2 for the County of London and 12.3 for England and Wales as a whole. Measles, Cancer and Heart disease all show decreases, but there is a marked increase in the deaths from Influenza, Pneumonia and other respiratory diseases. 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 are given in the accompanying table. 26 Causes of death at different periods of life in the Metropolitan Borough of Bethnal Green, 1933. 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 694 62 13 16 28 27 29 44 91 125 150 109 F 612 37 9 14 22 37 18 33 68 89 141 144 1. Typhoid and Paratyphoid M ... ... ... ... ... ... ... ... ... ... ... ... Fevers F ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles M 5 2 2 1 ... ... ... ... ... ... ... ... F 1 ... 1 ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... F 3 ... 1 ... 2 ... ... ... ... ... ... ... 4. Whooping Cough M 6 1 3 2 ... ... ... ... ... ... ... ... F 5 2 ... 3 ... ... ... ... ... ... ... ... 5. Diphtheria M 4 ... ... ... 4 ... ... ... ... ... ... ... F 5 ... ... 3 2 ... ... ... ... ... ... ... 6. Influenza M 35 ... ... 1 2 ... 3 6 8 8 8 ... F 39 ... ... ... ... 2 ... ... 7 7 12 11 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-Spinal Fever M 6 ... ... 2 1 ... 2 ... 1 ... ... ... F 4 ... ... 1 1 1 ... 1 ... ... ... ... 9. Tuberculosis of respiratory M 50 ... ... ... 1 5 8 10 13 10 3 ... system F 24 ... ... ... 1 9 4 4 2 1 2 1 10. Other Tuberculous Diseases M 5 ... 1 1 ... 1 2 ... ... ... ... 1 f 9 1 ... ... 1 4 ... 1 1 ... 1 ... 11. Syphilis M 3 1 ... ... ... 1 ... ... ... ... 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... 12. General Paralysis of the M 2 ... ... ... ... ... ... 1 ... ... ... ... Insane, tabes dorsalis F 2 ... ... ... ... ... ... 1 1 1 ... ... 13. Cancer, malignant disease M 78 ... ... ... 1 ... 1 4 10 24 28 10 f 66 ... ... ... ... ... 2 6 ... l8 17 12 14. Diabetes M 8 ... ... ... 1 ... ... ... 2 4 17 12 F 14 ... ... ... ... ... ... ... 4 2 7 1 15. Cerebral Hæmorrhage, etc. M 19 ... ... ... ... ... ... 2 3 5 9 f 19 ... ... ... ... ... 1 ... 3 7 5 2 16. Heart Disease M 172 ... ... ... 2 2 3 5 17 30 65 48 f 160 ... ... 1 2 7 5 6 16 23 50 I 50 17. Aneurysm M 3 ... ... ... ... ... ... 1 1 1 ... ... F 2 ... ... ... ... ... ... ... ... 1 1 ... 18. Other Circulatory Diseases M 14 ... ... ... ... ... ... 2 ... 4 3 5 F 18 ... ... ... ... ... ... ... 2 2 9 5 19. Bronchitis M 22 1 ... ... ... ... ... 2 3 3 4 9 F 17 2 ... 1 ... ... 1 2 2 2 7 20. Pneumonia (all forms) M 65 12 5 4 3 6 1 6 8 10 5 5 F 61 10 4 4 4 1 3 3 7 6 10 9 21. Other respiratory diseases M 22 ... ... ... ... ... ... 1 ... 3 8 10 F 58 ... ... ... ... 1 ... ... 1 4 16 36 22. Peptic Ulcer M 7 ... ... ... ... ... 1 2 2 1 1 ... f ... ... ... ... ... ... ... ... ... ... ... ... 23. Diarrhœa, etc. M 19 18 ... ... ... ... ... ... ... 1 ... ... F 14 11 2 ... ... ... ... ... 1 ... ... ... 24. Appendicitis M 6 ... 1 1 2 ... ... ... ... 1 1 ... F 5 ... ... ... ... 2 ... 1 1 1 ... ... 25. Cirrhosis of Liver M 3 ... ... ... ... ... ... ... ... 2 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... 26. Other Diseases of Liver, etc. M ... ... ... ... ... ... ... ... ... ... ... ... F 2 ••• ... ... ... ... ... ... ... i ... 1 27. Other Digestive Diseases M 13 2 ... 1 ... ... ... ... 2 1 3 3 F 10 ... ... 1 ... ... ... 2 2 2 2 1 28. Acute and Chronic Nephritis M 18 ... ... 1 1 1 ... 1 6 6 1 1 F 10 ... ... ... ... l ... 1 1 3 2 2 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... 1 ... 1 ... ... ... ... 30 Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malforma- M 22 21 ... ... 1 ... ... ... ... ... ... ... tions, etc. F 9 9 ... ... ... ... ... ... ... ... ... ... 32. Senility MN 1 ... ... ... ... ... ... ... ... ... 1 ... F 2 ... ... ... ... ... ... ... ... ... ... ... 33. Suicide M 14 ... ... ... ... ... 3 ... 4 6 ... 1 F 5 ... ... ... ... l ... 1 1 1 1 ... 34. Other Violence M 23 1 ... 1 4 6 3 1 2 1 4 ... F 12 1 ... 1 2 2 ... ... ... 2 2 2 35. Other Defined Diseases M 49 3 1 1 5 5 2 2 10 5 8 7 F 34 1 1 ... 6 5 3 3 5 6 2 2 36. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... Totals 1306 99 22 30 50 64 47 77 159 214 291 253 27 28 MATERNAL MORTALITY. Systematic inquiry continues to be made into every maternal death belonging to the Borough. Two cases were investigated :— (1) Septic Abortion (2) Purulent Metritis (following recent delivery) Peritonitis and Septicaemia The maternal death rate was therefore 1.3 per 1,000 births. There was a third case in which childbirth was complicated by another condition (Fibrosis of the Uterus), but this has not been counted as a case of maternal mortality. None of the mothers concerned attended the Council's Maternity Clinic, but 2 of them are known to have received ante-natal care. INFANTILE MORTALITY. Ninety-nine 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 66.3 per 1,000 births. The infant death rate for London was 59 and for England and Wales as a whole 64. Comparison with previous years is as follows :— 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 1932 69.1 29 The causes of death among infants are shown in the following table. Infantile Mortality in Bethnal Green in 1933 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 ... ... ... ... ... ... ... ... 2 2 1.3 Whooping Cough ... ... ... ... ... ... ... 3 ... 3 2 .0 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 0.7 Tuberculosis ... ... ... ... ... ... ... ... 1 1 0-7 Bronchitis ... ... ... ... ... ... 1 2 ... 3 2.0 Pneumonia (all forms) ... ... ... ... ... 3 10 6 2 22 14.7 Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... Diarrhœa and Enteritis ... ... ... ... ... 10 9 8 2 29 19-4 Other Digestive Diseases ... ... ... ... ... 1 ... 1 2 1.3 Syphilis ... ... ... ... ... ... 1 ... ... 1 0.7 Rickets ... ... ... ... ... ... ... ... 1 1 0.7 Congenital Malformations 1 ... ... ... 2 1 ... ... 3 2.0 Congenital Debility 1 ... ... ... 1 ... ... ... ... 1 0.7 Premature Birth 8 3 2 ... 13 2 ... ... ... 15 10.0 Injury at Birth 2 1 ... ... 3 ... ... ... ... 3 2.0 Other early infancy diseases 5 ... ... 5 3 ... ... ... 8 5.4 Other Causes 1 1 ... ... 2 ... 2 ... ... 4 2.7 Totals 19 6 2 ... 27 19 25 19 9 99 66.3 Net Births in the year Legitimate 1450 Net Deaths in the year Legitimate infants 93 illegitimate 44 illegitimate infants 6 Suffocation (2), Convulsions, Impetigo, (1 each). 30 CANCER, Cancer was responsible for 144 deaths or 11 per cent. of the total deaths in the Borough. The local distribution of the disease in these deaths was as follows :— M. F. Total. Buccal cavity, pharynx 10 2 12 Digestive organs and peritoneum 41 33 74 (Esophagus (6-1) Stomach (17-10) Intestines (5-10) Rectum (5-5) Others (8-7) Respiratory organs 20 5 25 Uterus — 7 7 Other female genital organs — 2 2 Breast — 13 13 Male genito - urinary organs 5 — 5 Skin — — — Other or unspecified organs 2 4 6 78 66 144 DEATHS FROM MOTOR TRAFFIC. I continue to draw attention to the increasing mortality from motor traffic accidents in the streets. The following cases occurred in 1933 : 31 Pedestrians (14) Others (3)- M 2 Knocked down by motor lorry. M 16 Knocked off bicycle by motor F 3 Knocked down by motor car. car. M 7 Run over by motor coach. M 19 Collision with motor lorry M 7 Knocked down by motor lorry. while riding motor cycle. F 15 Run over by motor lorry. M 22 Fell under motor bus while M 20 Collision with motor van. riding pedal cycle. M 27 Collision between motor lorry and van. M 37 Knocked down by motor lorry. M 50 Struck by motor car. F 63 Knocked down by motor car. F 66 Knocked down by motor lorry. F 68 Knocked down by motor lorry. M 69 Knocked down by motor car. M 72 Knocked down by motor lorry. It will be seen that despite the new transport regulations, the rapid rate at which large and heavymotor vehicles rush through the roads in the Borough still exacts a toll among the children and the aged. These facts reveal a real problem of public health and safety which has not hitherto been tackled in a sufficiently practical manner. There are certain types of people who will always be with us. I speak of the careless, the dreamer, the chance taker, children and aged persons. But even so, there ought to be regulations which, while not guaranteeing immunity from accidents, would certainly provide a greater degree of safety not only to the classes mentioned but also to the average pedestrian and the motorist as well. The compulsory stoppage of all vehicles within a distance of not less than ten feet from a tram-car taking on or discharging passengers is only one of many precautions that would have a salutary effect. We have no records of non-fatal accidents but I am convinced that the victims in some of these cases have their resistance lowered and consequently become more liable to contract disease. PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 7 bodies were received at the 32 Mortuary, i.e. :— On Coroner's order — From the Police — At the request of relatives 7 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. 33 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, at which a consultant attends weekly for the diagnosis and treatment of children requiring special observation. (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 34 conducts confinements in the district; also (x) Provides a panel of Obstetrical Consultants whose services are available to local doctors in any difficult or abnormal confinement; (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. The public service is accustomed to grumbles from those whose vested interests or prejudices it disturbs. It is, therefore, all the more gratifying to receive appreciation and praise. A mother writes : " I feel that I must write this letter in appreciation of the wonderful attention given to me during the period of my confinement. I think the Welfare Scheme of providing midwife and home help, a boon to poor people." In the interests of the modesty of the staff, I refrain from quoting further laudatory personal remarks by this mother. Suffice it to show that there is a human side to our work. NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 1,034 live births were registered in the Borough ; and 1,002 live births were notified to the Medical Officer of Health. There were also 41 stillbirths notified. Of the 1,043 living and stillbirths notified, 27 were found to relate to other districts and were duly transferred, 764 were notified by midwives, 35 164 by maternity assistants of the London Hospital, 70 by medical practioners, and 18 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 479 live babies and 18 stillbirths being received in this way. The nett total of notified live births belonging to the borough was thus 1,472. 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) 1,461 11,128 Children (1—2 years) 3 9 4,008 „ (2—3 years) 2 4,168 13,432 „ (3—4 years) 3 3,142 „ (4—5 years) 1 2,114 Mothers (Ante-Natal) 1,032 485 „ (Post-Natal) 217 140 Stillbirths 26 23 Visits. Re-visits. Infant Deaths 43 5 Maternal Deaths 2 — Puerperal Fever (11) and Pyrexia (60) 19 52 Ophthalmia Neonatorum 9 25 Acute Poliomyelitis — 1 Other Notifiable Diseases — 4 Diarrhoea and Enteritis — 1 Measles (451), and German Measles (238) 337 352 Whooping Cough 152 266 Other Non-Notifiable Diseases 17 42 Milk Grants 39 42 Convalescent Treatment 14 1 Other matters 155 139 Total Visits 3,532 26,138 Grand Total 29,670 36 In addition, 168 visits and 1,656 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 302 Children's Clinics 1,115 Dental Clinic 120 Light Clinic 191 Mothers' Clinic 21 Other Clinics 416 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 records being transferred to the Divisional Medical Officer as the children either enter school or attain the age of 5. I am glad to note that the fall in the number of outdoor visits has been arrested. It is, however, still unsatisfactory that the staff available does not permit of more than an annual visit to the 3 and 4 year olds, among whom more intensive work is so necessary. MATERNITY AND CHILD WELFARE CENTRES. At the Council's principal Centre in Cornwall Road, there are 2 morning sessions and 5 afternoon sessions for infant consultations and 2 sessions in connection with the Maternity Clinic each week. 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 37 on Monday and Thursday afternoons, and an AnteNatal Clinic on Thursday mornings. The following ratios may be of interest:— Ante-Natal Children's Clinics Clinics Acreage per Centre 380 380 Population per Centre 53,150 53,150 Percentage of new expectant mothers or babies under 1, attending Centres respectively, to total net births 33 69.7 CHILDREN'S CLINICS. The statistics of attendances at the Centres during 1933, and in previous years are as follows :— 1933 Cornwall Hereford Road Street Babies (0—1): First attendances 716 340 Subsequent „ 6,732 2,949 Children (1—5): First „ 95 49 Subsequent „ 4,364 2,121 Toddlers Clinic attendances 266 — Total „ 12,173 5,459 Cornwall Hereford Road Street Sessions per week 6 2 Doctors' attendances per week 9 3 1933*. 1932*. 1931. 1930. 1929. 1928. Total Attendances of Children 17,632 18,668 19,100 19,843 18,481 19,373 New Cases 1,466 1,510 1,400 1,497 1,452 1,536 (Children) Medical Consultations— Children 9,969 10,462 12,062 11,982 11,800 12,552 *Including Toddlers Inspections. Statistics with regard to the attendances at the Maternity Clinic are given in detail later, 38 CORNWALL ROAD INFANT CONSULTATIONS. Dr. K. M. Horton reports : Infant Consultations have been held 5 times weekly at this Centre. The two morning clinics available at the same time as the two Milk Grants sessions, continue to be small in number, but the afternoon clinics have been well attended. Health Talks have been given at intervals and the exhibition of model clothing has been on view. The waiting time has been reduced to the minimum as it is realised how urgent it is for our mothers to get home as quickly as possible. Progress has been made in the attempt to reduce overclothing, the exceptional hot sunny summer being a valuable ally. Mothers seem to understand the problem of underfeeding but the danger of overfeeding is still not appreciated by many. As last year, the importance of teaching and of child management is to my mind the most outstanding fact to be noticed. The child who refuses to eat or sleep, the constipated child, the child who refuses to let his mother feed the new baby without interference, the child with enuresis, in fact the Worried child, is with us in large numbers. The most careful physical examination shows no defect and in the majority of cases the mother, though a careful mother, is also over-anxious. These are the children who cannot go to a convalescent home because they will be separated from the parent. These are the children with the active, sensitive minds who, properly managed, may go further than most in after life, but who will inevitably fall below standard unless they are. Such children need the care and attention that only small clinics can give and the frequent attendances at them that are difficult for our mothers to make. Friendly co-operation between the neighbouring hospitals and the clinics continues and the growing custom of sending written records of the feeding in hospital enables us to ensure that continuity that is so vital in successful artificial feeding of infants. Many hospitals now have their own Infant Welfare clinics at which attendances are made up to two months of age. It may be that the normal healthy baby thus fails to attend at one of our clinics, and while this will account for variation in our numbers we are content, for the baby has received the necessary advice and supervision elsewhere. It is interesting to record that we have had a steady number of students at the clinics from the College of Nursing and the London Hospital. They seem keenly interested and it is hoped that they will continue, not only for the profit to themselves but for the stimulus that they provide for our permanent staff. 39 HEREFORD STREET INFANT CONSULTATIONS. This year has seen the establishment of the two afternoon sessions held weekly at this Centre. The majority of the mothers have now formed the habit of attending at this branch centre and attendances have been steady. As last year, a large number of children have been transferred to Cornwall Road temporarily in order to attend the Sunlight, Inhalation or Breast-feeding Clinics or for Massage. Our figures for this clinic are therefore definitely less than they would be if no need arose for their transference. It is satisfactory to note how gladly the mothers cooperate with suggested treatment from this Centre. On the whole they seem to be in even more difficult circumstances than in other parts of the Borough and so their efforts are particularly worthy of mention. The children themselves show no marked physical difference from those attending Cornwall Road but they are perhaps more self-reliant, go to school earlier and show less evidence of nervous tension. It seems to be true that once a family attends it continues to do so, but in many cases mothers who work morning and evening (as many do in this area) have little time to spare for attendances at a centre. During the year a wireless set was installed by the kindness of Wired Wireless, Ltd. We have been visited by Health Visitor students who are trained nurses doing their practical work before their examination. It is pleasant to record our thanks to the Rector of St. Matthew's and his staff for their continued helpful co-operation in the arrangements of the rooms in use, and to those Councillors who have been interested in our work here. TODDLERS' CLINIC. At weekly intervals throughout the year children between the ages of 2 and 5 years have been inspected. Letters of invitation have been sent out inviting mothers to bring their children for a general medical examination once a year. The response has not been good but the average attendance is rather better than last year, 6.5 as against 5.4. Nearly twice the number of children Showing signs of rickets were found, many of them slight but definite cases, and enlarged glands of neck and enlarged tonsils occurred in approximately the same proportion as last year. It is encouraging to find that many fewer children were found going late to bed, as a special effort had been made this year to ensure adequate sleep for children attending the Centres. 40 It is noticeable that there is a big increase in the number of children included under the heading Nervous Tension. This includes a variety of conditions : refusal to eat or sleep, refusal of medicines, unruly behaviour at home, night terrors, etc. There is no sign of physical abnormality but the condition is a very concrete one to the mother and a real obstacle to the child. Enuresis added to this group would make an even bigger total of nervous manifestations due to defects in management and would in fact form the biggest group of conditions requiring treatment discovered in the clinic. Treatment consists in good management of these children through the re-education of both mother and child. It is interesting to compare this group of children with the group of Worried Mothers attending the Breast Feeding clinic whose milk failed, as far as can be said, entirely owing to their mental condition. This problem needs all the care and thought that has been devoted to the physically unfit mother and child, more particularly since they are apparently increasing in number. An attempt has been made to estimate the physical condition of the children examined by comparing the average weight and height with a known standard in the various age groups. This can only be a rough estimate and the results are as follows :— Age Standard Average Standard Average Weight Weight Height Height 2 years 28—29 lbs. 29 lbs. 1 oz. 2 ft. 7.9 in. 2 ft. 10 in. 3 „ 33—34 „ 31 „ 0 „ 2 „ 10-11 „ 3 „ 0 „ 4 „ 37—38 „ 32 „ 10 „ 3 „ 1-3 „ 3 „ 1 „ It will be noted that up to the age of 2 years the average weight is satisfactory, though the height is not, but the height in the 3-year group is nearly up to standard. Weight in the 3 and 4 year old groups is below standard. It is interesting to remember the reiteration of Sir George Newman on the unsatisfactory state of health of the Pre-School child and the figures may perhaps indicate the importance of continued care for the toddler until school age is reached, not only by inspection at such a clinic as this, but by educating the mothers who are often nursing a younger baby at this stage, and by the increased use of Day Nurseries and Nursery Schools. Records :— Children inspected 267 Requiring treatment 187 Sessions held 41 Average attendance 6.5 41 Conditions found on examination : Defects in Development Late in talking 17 „ „ teething 5 Mongol 1 Congenital Inguinal Hernia 1 Cleft palate 1 Blocked lacrymal duct 1 Squint 3 Deafness 1 Stutter 1 Defects in Nutrition Early rickets 12 Knock-knee 55 Dental caries 52 Nutritional anaemia 1 Defects in Management Nervous Tension 57 Enuresis 25 Late to Bed 18 Insufficient Fresh Air 13 Results of Infection Enlarged Tonsils 67 ,, Glands of Neck 40 Bronchitis 8 Endocarditis 5 Discharging Eyes 6 „ Ears 4 Recurrent Sore Throat 4 Threadworms 4 Recurrent Styes 3 Adenoids 2 Stomatitis 1 Impetigo 6 Urticaria 4 Infantile Eczema 1 MATERNITY CLINIC (CORNWALL ROAD). This is open every Wednesday and Thursday morning. Particulars of attendances : Total. Expectant Mothers—First visits 388 1,444 „ „ —Subsequent visits 756 Mothers recently confined—First visits 209 „ ,, „ —Subsequent visits 145 Total Attendances 1,498 42 The number of sessions was 103, and the average attendance per session was 14.5, as compared with 11.2 the previous year. 122 of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement, and some of them were sent away to a convalescent home. The 388 women who attended for the first time may be grouped as follows :— Gravid:—Primiparae 41 —Multiparae 327 368 Not pregnant 19 Sterile 1 388 In the case of the 368 gravid women, the following were the periods of gestation :— 3 were in the 1st month 24 „ „ „ 2nd „ 40 „ „ „ 3rd „ 46 „ „ „ 4th „ 78 „ ,, ,, 5th ,, 86 „ „ „ 6th „ 59 „ „ „ 7th „ 32 „ „ „ 8th „ nil ,, ,, ,, 9th ,, An analysis of these cases shows :— Full-term confinements. 245 Premature births 6 Miscarriages (7) ; Stillbirths (5) 12 Pregnancy terminated 1 Not yet confined 96 Left Borough (results unknown) 8 The known confinements took place :— 194 at home, and 62 in institutions. 43 The results of the 94 cases brought forward from 1932 were as follows :— Full-time confinements 81 Premature births — Miscarriages (3); Stillbirths (-) 3 Pregnancy terminated at Hospital 1 Found to be not pregnant 4 Left district (result unknown) 5 Of the 81 for whom we have information, in 60 cases the confinement took place at home, and in 21 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 for the year 1933. I am glad to report an increase in the attendance at the Clinic of Ante-Natal cases, and especially of Post-Natal cases, and in each case the increase applies to both first and subsequent attendances. There were two Caesarean births,and in one case the patient had already undergone two previous operations for Caesarean section. There were no deaths amongst the mothers attending the Clinic. 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 multigravida, In two cases there was a history of ante-partum haemorrhage, in two cases there was a history of a fall during pregnancy, and in one case there was a history of a large child, and a long though spontaneous labour. With regard to premature confinements, all occurred in multigravida. In one case there was a history of ante-partum haemorrhage, and in every case the pregnancy rapidly supervened after the birth of the last child, the intervals between the two confinements being respectively 9 months, 11 months, two at intervals of 15 months, and the longest interval being 21 months. Two cases of early pregnancy were terminated in hospital. In both cases the patients were 6 gravida, and in one case the patient was suffering from heart disease, and in the other case from kidney disease. In each case the patient made a, successful recovery. 44 The Borough Midwife continues to attend the Clinic when possible, and on a number of occasions the local midwives have attended the Clinic, and several patients have been referred to the Clinic by doctors with a request for a report on the case. 21 st March, 1934. R. C. Townshend. MATERNITY CLINIC, HEREFORD STREET. Dr. Horton reports : This Clinic, held on Thursday morning of each week, has completed another satisfactory year. The average attendance shows a small increase. Friendly co-operation with doctors in practice in the Borough, with the Borough Midwife and with the neighbouring hospitals has continued. Miss Basden, M.S., F.R.C.S., has kindly given us consultant's opinion as occasion has required. It is interesting to note that many more mothers are now delivered in maternity homes and hospitals than in their own homes. As these institutions run their own maternity clinics for mothers intending to enter them for their confinements, a steady number of mothers leave Hereford Street at about the 7th month of pregnancy to attend these clinics. It is satisfactory that the mothers appreciate and make use of the excellent facilities available for their welfare in these institutions. It is still difficult to persuade mothers to attend for dental treatment but more have attended this year than last. Postnatal attendances have been satisfactory but in many cases attendance at hospital after delivery in hospital has taken the place of a post-natal attendance at the clinic. The one premature child weighed 6 lbs. at birth and has made satisfactory progress since. The mother of the stillborn child did not attend the clinic after the 26th week of pregnancy. The child was full-term and was delivered in hospital. The mother was at work throughout her pregnancy as the father was out of work. The one miscarriage occurred in a young woman who had been pregnant six times. Three children are living and she had had a stillborn child and a miscarriage previously. This time she miscarried at the 14th week, being referred to hospital on her second attendance at the clinic. She has made a satisfactory recovery. Record of attendances and analysis of cases :— Expectant Mothers First attendances 124 Subsequent attendances 359 483 45 Mothers recently confined 93 Subsequent attendances 127 220 Sessions held 52 Average attendance per session 13.5 Analysis of 1933 cases First attendance—Primiparae 7 „ „ Multiparae 102 Not pregnant 15 Periods of gestation :— In the 1st month 5 „ „ 2nd „ 7 „ „ 3rd 15 ,, ,, 4th „ 23 „ „ 5th „ 14 ,, ,, 6th „ 20 „ „ 7th „ 16 8th „ 9 „ „ 9th „ None Full-term confinements 68 Not yet confined 34 Removed from district 4 Premature child 1 Miscarriage 1 Stillbirth 1 Known confinements at home 37 „ „ in institutions 31 Cases brought forward from 1932 :— Full-term 29 Premature Nil Not pregnant 4 BREAST FEEDING CLINIC. (CORNWALL ROAD CENTRE). Dr. Horton reports : This Clinic was established a year ago for cases in which there was evidence that the likelihood of maintaining breast feeding was uncertain or even extremely doubtful. Such mothers need the skill and supervision in favourable surroundings that a small clinic can give them. The average attendance was 16.2, this number being about the maximum at which good work can be done under our present circumstances to 46 maintain the necessary standard of individual attention. Every mother and child is a distinct and individual problem needing patient personal observation and treatment. It is well known that one morning's test feed is not an accurate method of estimating the efficiency of the breast milk supply. It is better to keep the mother and child at the Centre for a whole day and by taking the average of several feeds, reach a more satisfactory conclusion. A second objection to the one clinic weekly is that too long an interval elapses between each, during which time bottle feeding may be substituted by the mother. It is hoped that an afternoon session held halfway through the week may help to overcome both of these difficulties. The number of mothers who refuse to breast feed is rather higher than last year, indicating the urgent necessity for continued and widespread teaching as to the importance and the many mutual advantages of breast feeding. It may be that the very success of artificially fed infants militates against breast feeding in the minds of some of these mothers. No outstanding factor of pressure of financial circumstances, poor physical condition either of child or mother can be found in this group, but it is noteworthy that many of these mothers had never breast fed any child, although as far as we can tell the milk supply was adequate in every case. A mental attitude, either lack of self-confidence or a fixed idea as to its impossibility seems a possible explanation. It is among such mothers that increased careful work may produce results which are worth while. Breast milk failed in about the same number of mothers as last year, and it is interesting to note that neither poor physical condition nor unsatisfactory home conditions was the primary cause. The Worried mother heads the list and if the badly managed infants be added to this number, it will be seen that over half the cases of failure of breast milk in our series are due to a mental attitude rather than a physical defect. To attempt to assess the true value of the work done in this clinic, records have been kept of all infants at the sixmonthly visit by the Health Visitors. It is sad to record that the number of our breast-fed babies was down by 20 per cent. and the infants weaned were four times the number that they were on discharge from the clinic. It should be remembered that every case attending this clinic is one in which the continuance of breast feeding was very doubtful at their first attendance, so the results are not quite as discouraging as they appear. They are, however, indications of the need for continued and increased effort to improve them. 47 Attendance records:— New cases 263 Carried forward from 1932 32 Subsequent attendances 534 Total attendances 829 Doctors' consultations 207 Number of sessions 51 Average attendance per session 16.2 Results on discharge from the clinic :— Breast fed 125 ,, ,, with complementary feed 120 Weaned 20 Removals from district 8 Died 7 Carried forward to 1934 15 Total 295 Results shown by visiting home at 6 months :— Breast fed 100 ,, ,, with complementary feed 78 Weaned 87 Reasons for weaning in 87 cases :— Mother refused to breast feed 36 Breast milk failed 33 Mother at work 6 pregnant 1 Twins 3 Illness of mother 4 baby 4 Failure of breast milk was due to :— Worry of mother 12 Debility of mother 7 Home conditions 7 Badly managed infant 5 Illness of baby 2 Babies died Found dead in cot 2 Whooping Cough 1 Pneumonia 1 Marasmus 1 Gastro-Enteritis 2 48 MOTHERS' CLINIC, 1933. This Clinic, which was established in October, 1931, to give Contraceptive advice to married women within the terms of the Memorandum issued by the Ministry of Health, has been held on two consecutive Thursdays in alternate months. Every effort has been made to keep this Clinic distinct from the other work of the Centre, all stores and apparatus and all records being kept separately ; also at the time at which it is held there is no other clinic on the ground floor. On their first attendance each Mother receives a complete physical examination, and gynaecological examination, and in suitable cases contraceptive instruction. Each subsequent week they must demonstrate their ability to practise the advice given before they are allowed to leave the Clinic. They report at intervals afterwards to ensure that as far as is possible their technique and their apparatus are satisfactory, and that each Mother herself is perfectly fit and able to continue. From these remarks it will be realised that each two consecutive weeks, in fact, constitute ONE SESSION. Attendances have been as follows :— January 10 March 23 May 18 July 30 August (end of) 13 (M.O. away in September) November 38 Total 132 Average Attendance 22 Analysis of cases attending :— First Attendances : Contraceptive advice given 39 „ „ postponed 5 Referred to Burdett Road Clinic 17 Total 61 Subsequent Attendances 71 Total Attendances 132 49 Clinical Analysis of Cases given Contraceptive Advice :— Tuberculosis (all under hospital supervision) 12 Myocarditis 8 Nephritis 5 Neurasthenia (all under hospital or clinic) 4 Epilepsy 3 Hyperthyroidism 3 Contracted Pelvis 3 Recurrent adherent Placenta 1 39 Mothers have been referred by :— Medical Officers, Welfare Centres 43 Health Visitors 12 Local Hospitals 4 L.C.C. Worker 1 Mother herself 1 Total 61 Analysis of Cases referred to Burdett Road Clinic :— Debility and Anaemia 6 Asthma and Bronchitis 2 Neurasthenia 2 (under no clinic) Mothers who asked for contraceptive advice ... 7 Total 17 All these Mothers had been pregnant at least three times:— 1 pregnancies 12 1 „ 11 3 „ 10 Incidence of Pregnancy :— Failure of technique 1 (Hysterectomy later in Bethnal Green Hospital) By own wish and at own risk 1 Total 2 It is interesting to note that every one of these Mothers attends the Infant Welfare and other Clinics regularly with her children. Dr. Horton reports :— In my opinion the inference from this Report is clear. 50 To avoid keeping Mothers waiting and to avoid the present extended hours on duty of all the Staff concerned, more Sessions and more appropriate equipment are essential. Should the attendances increase in the next year when the Clinic will be more widely known and recommended, a Session each month (two consecutive weeks) is clearly indicated if careful work is to be successfully carried on.* Mention must be made of the willing co-operation and enthusiasm of the Health Visitors who staff this Clinic, and the Domestic Staff for their help in arranging the rooms suitably, and keeping the Toddlers happy while the Mothers attend the Clinic. K. M. Horton. *This suggestion was adopted by the Committee as from the beginning of 1934. HEALTH TALKS. Dr. Horton reports : An effort has been made this year to make these Talks of practical value to the mothers. In many cases the Talks have been accompanied by demonstrations to impress the subject more clearly on the minds of the audience. Five main groups of subject have been presented. Each group represents one of the management problems which every mother must solve for herself in order to bring up a happy, healthy child. We have been assisted in our work by senior student Health Visitors who have given nearly half of these Talks. Informal teaching goes on at the stall for clothing on view at the Centre at which the Borough Midwife is on duty as often as possible. A life size baby doll has been lent to us and so it is now possible to demonstrate the correct type of infant clothes on a model. A smaller doll is in use for the same purpose at the Hereford Street Centre. Classification of Talks :— I—Clothes for Infants and Children. Choice of material, Patterns of garments, Washing and care of clothes. II—Food for Infants and Children. Breast feeding, Shopping, Artificial feeding, Storage, Over-feeding, Cookery. Vitamins, 51 III—The Management of the Well Child. Planning the night, sleep, cot, Planning the day, meals, the bath, care of teeth, nose drill, Formation of good habits. IV—The Management of the Ill Child. Thrush, Chilblains, Teething, Measles, Colds, Whooping Cough. Rashes, V—The Management of the Mother. During Pregnancy, Before and After Delivery. BOROUGH MIDWIFERY SERVICE. The Borough Midwife had 31 bookings carried forward from 1932. During 1933, 131 bookings were received, and 22 cases remained on the books at the end of the year. The following figures show the work of the Borough Midwife during the year : Bookings carried forward 31 „ received in 1933 131 162 Cases delivered by— Borough Midwife 75 Deputy 54 - 129 (of these 12 were primiparae, and 117 multiparae). Cases removed in labour to hospital by Borough Midwife 3 Cases sent to hospital by Medical Officer, Maternity Clinic 2 Cases entering hospital on own account 4 Withdrawn: Transferred to another midwife 1 Removed from Borough 1 Cases on books at end of year 22 162 52 The Borough Midwife and her deputy paid 1,393 visits in connection with her practice. She also conducts a regular weekly session for ante-natal care of her patients. It is gratifying to record that 33 of the mothers delivered by the Borough Midwife during the year had been previously attended by her, 22 on one previous occasion, 6 of them on two previous occasions, 3 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. No consultation took place during the year. HOME HELPS. At the end of the year, there were 12 Home Helps on the panel, while 6 other women are occasionally employed as relief helps. During the year, there were 206 applications for Home Helps, as compared with 250 in 1932, 275 in 1931, 165 in 1930, and 65 in 1929. In 76 cases the mother paid a contribution for the services rendered. MATERNITY OUTFITS. Outfits were issued as follows:—Free, 162; Halfprice, 37; Full price, 35. Total, 234. 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 53 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. Grants of this kind were made to 7,990 families (compared with 7,999 in 1932), the grants being in respect of 9,711 individuals. There were 2 sessions a week, and 22,523 attendances at the Welfare Centre in connection with Milk Grants. During the year the following quantities of milk were issued to necessitous mothers:— Grade A (Tuberculin Tested) Milk 9,985 galls. Dried Milk 30,849 pkts. Condensed Milk 2 tins. together with medicines, etc. The approximate cost of milk given in this way was £3,594. 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 a little above cost price. The amount sold during the year was as follows :— Dried Milk 5,543 pkts. Condensed Milk 1 tin. 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., F.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:— 54 Special Clinic for Delicate Children. Report for 1933. The sunny summer of 1933 undoubtedly effected an improvement in the appearance of the children, and it seems legitimate to suppose also in their general health. Mothers, getting accustomed to the long continuance of good weather, in many cases reduced the children's clothing to a minimum during the heat of the day, with marked benefit to their health. It was usual to see young children at the clinic wearing a bathing dress only, which incidentally by reducing their laundry work was a boon to the mothers also. During the past year the majority of children sent to the clinic by other medical officers have been toddlers, with only a small proportion of young infants. Whether this is an indication of the relatively better health of infants, it is not possible to say—but this would seem the probable deduction. Also the wide use of dried milk, together with the appropriate measure supplied by the makers, makes for accuracy in carrying out the doctor's directions as regards feeding, thus diminishing the number of babies suffering from serious underfeeding. The number of children who have attended is set out below:— No. of Sessions 48 New Cases 34} Total Subsequent attendances 251} attendance 285 Consultations 284} H. M. M. Mackay, M.D. 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 12 were Gas Sessions. Total. Children. Mothers. New cases 175 92 83 Subsequent attendances, including cases brought forward from 1932 323 87 236 Total 498 179 319 55 Total Children Mothers Average attendance 11 Gas administrations 84 29 55 192 Temp, teeth. Extractions 428{ 42 53 236 Perm, teeth. 39 Temp, teeth. Fillings 50{19 8 11 Perm, teeth. Dressings 4 2 2 Silver Nitrate 12 12 — Scaling and polishing 27 6 21 2 One plate Dentures 34{ 16 Two plates }— 18 Expectant mothers treated — 21 Cases referred to London Hospital — 11 Patients recommended by Centre Doctors 30 34 „ H.V. 45 39 Children attending for routine inspection 22 — Children brought by mothers own accord 4 — The attendance has been maintained as last year. A larger number of mothers attended this year as new cases, many of whom had badly neglected mouths requiring prolonged treatment. It is an encouraging sign that an increasing number of these mothers each year now consent to have dental treatment, this of course increases the amount of denture work, which now occupies a large part of the sessions. More attention has been given to children of the younger age group, 1½—3½ years, and mothers attending for treatment themselves are urged to bring their toddlers for inspection and any necessary treatment, as it is found in numbers of cases that dental caries has commenced before all the milk teeth have erupted. Janet H. M. Sutherland, Dental Surgeon Mr. Bate furnishes me with the following statistics and comments:— Sessions held, 47, of which 13 were Gas Sessions. Children attending routine inspections, 205, of whom 105 were found to require treatment. 87 of these children were treated, the remaining 18 failing to re-attend for treatment. Children referred by Medical Officers and Health Visitors. 51 all requiring treatment and making 201 subsequent attendances. Teeth extracted Children or stopped Treatment under gas 122 432 Treatment under ethyl chloride spray 6 6 56 Teeth extracted Children or stopped Stoppings 38 69 Removal of stain by polishing 10 — Silver nitrate 12 — Cases referred to London Hospital for urgent treatment 4 — The number of attendances at the Toddlers' Dental Clinic during 1933 has not altered perceptibly from 1932, but the condition of the mouths examined indicated a marked improvement generally. A greater number of parents are bringing their children up for regular inspection, at intervals of from three to six months, after their first attendance. It is this regular inspection that is so important to eliminate disorders of the teeth and gums before they do any extensive damage. It is particularly noticeable how quickly dental decay and gum disorders develop in these young children, even in three months after previous treatment. I am pleased to find that the tooth brush is being used more extensively and regularly by these children, and the ones we have at the centre which are specially designed for young children are ideal for the purpose, and have been appreciated by many parents, who had experienced difficulty in obtaining a suitable one. F. Reginald Bate, L.D.S., R.C.S. (Eng.), Dental Surgeon. Dr. D. I. Mart acts as anaesthetist for both Miss Sutherland and Mr. Bate. ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the arrangements with the Queen's Hospital, 12 young children had operations for enlarged tonsils as in-patients upon the recommendation of the Medical Officers of the Welfare Centres. ARTIFICIAL SUNLIGHT CLINIC. I append the report of Dr. Horton, who conducts the Light Clinic:— We have been fortunate to have had a third mercuryvapour lamp, of the Jesionek type, installed during the year 57 and the Clinic has been equipped with curtains to allow the simultaneous treatment of adults and children. Despite these additions, our total attendance and our average are rather lower than last year, 423 new cases attending this year as against 453 in 1932. It seems reasonable to suggest that the unusually hot sunny summer of 1933 accounts for this fact, the abundance of natural sunlight making the use of artificial sunlight unnecessary during that period. Re-attendances have been satisfactory, as it may be seen from our total of lapsed cases, those who failed to complete their course of treatment, is directly proportional to our total new cases and shows a corresponding decrease on the total lapsed cases of last year. Our results with mothers are not satisfactory, for while in most cases it is easy to persuade a mother to attend a clinic at which her child will benefit, it is extremely difficult to get her to do it for her own sake, the inevitable dislocation of household arrangements being too big a price to pay. Rickets again forms the largest group of cases treated, while malnutrition and anaemia are second and third on the list. Most groups are divided into sub-groups to include conditions subsidiary to the main one. It is interesting to note the progress that Mongol children have made. There can be little doubt as to the popularity of this clinic or of the useful work it does. Repeated requests for further courses of treatment are made by mothers and frequently a mother has come for the first time to the Centre because she has seen how well someone else's child has progressed after sunlight treatment. Records:— Children First attendances 423 Subsequent attendances 6,309 Mothers First attendances 10 Subsequent attendances 87 Total treatments 6,829 No. of sessions 150 Average per session 45.5 Cases also having Inhalation Treatment 65 „ „ „ Massage 12 Analysis of Cases :— No Cases Improved Lapsed Removed change Mothers Debility after Influenza 2 — 2 — — Failing Breast Milk ... 4 1 3 — — Debility after antepartum haemorrhage 1 1 — — — „ ,.Confinement 2 1 1 — — Anaemia 2 1 1 — — 58 Im- Re- No Children Cases proved Lapsed moved change Malnutrition 66 25 26 3 12 Anaemia 6 — 2 4 — Nervous Tension 3 2 1 — — Bronchitis 2 2 — — — Otorrhoea 1 1 — — — Anaemia 61 26 28 — 7 Malnutrition 22 9 8 2 2 Rickets 3 1 2 — — Recurrent Colds 7 4 1 — 2 Otorrhoea 1 1 — — — Nervous Tension 7 5 2 — — Rickets 114 49 46 5 14 Malnutrition 3 — 3 — — Persistent loss of weight 7 6 — 1 — Recurrent colds 5 3 — 1 1 Delayed Development 35 20 7 — 5 Congenital Dislocation of Hip 1 — — 1 — Mongols 4 3 1 — — Nervous Tension 1 — — 1 — Wasting of Left Leg 1 1 — — — Debility after Whooping Cough 15 10 5 — — Influenza 22 19 3 — — Pneumonia 8 1 7 — — Glands of Neck 1 1 — — — Removal of Tonsils 1 1 — — — Otorrhoea 1 — — — 1 Enteritis 2 2 — — — Bronchitis 10 4 4 1 1 Quinsy 1 — 1 — — Diphtheria 2 — 2 — — Scarlet Fever 1 — — — 1 Skin Conditions Urticaria 8 6 2 — — Impetigo 2 — 2 — — Recurrent Styes 3 1 2 — — INHALATION. We continue to derive useful service from the Spiess-Drager Inhaler, presented to the Council in 1930. Dr. Horton reports :— Catarrhal conditions of the upper respiratory tract have been treated in this Clinic throughout the year. Pine and 59 Cajuput Oil in equal parts have been found to be the most generally useful inhalant, though Pine Oil alone and in combination with Campheugene have been used. Re-attendances have been satisfactory in most cases and though failure in this respect accounts for a number of cases recorded under the "No change" heading, those children who have had a regular course of treatment show definite improvement if not actual cure. The number of mothers shows an increase this year and the treatment has been popular. The total number of treatments given is less than last year. The unusually good summer probably accounts for the decrease. Records:— Carried forward from 1932 18 New cases in 1933—Children 131 Subsequent treatments 1,436 New cases—Mothers 12 Subsequent treatments 79 Total treatments given in 1933 1,676 Cases carried forward to 1934 34 No. of sessions held in 1933 150 Average attendance per session 11.3 Im- No Re- Analysis of Cases :— Cases Cured proved change moved Bronchitis 45 14 10 16 5 Tracheitis 3 2 — 1 — Fibroid Lung 1 — 1 — — Asthma 2 — 1 1 — Catarrh after Whooping Cough 15 7 4 4 — „ „ Influenza 12 4 4 4 — „ „ Pneumonia 7 12 4 — Recurrent Colds 24 9 11 4 — ORTHOPEDIC TREATMENT. Children seen at any clinic in need of Orthopaedic treatment are referred by the Council's arrangement to the Orthopaedic Surgeons at the Queen's Hospital for Children. There are two days a week on which cases can be seen and so very little delay occurs in beginning treatment, splints and appliances being ordered by the Queen's Hospital, while Massage, Exercises or Light treatment is given at the Welfare Centre. A satisfactory scheme for ensuring regular re-attendance at 60 hospital is established and these on the whole have been good. It will be noticed that 14 parents refused to allow their children to be treated by the surgeon in spite of advice and explanation. It may be that fear that their children should be classed as "cripples" influences some of them. Others seemed quite unable to grasp the importance of immediate treatment. This is sad, as such treatment is one definite way of materially improving the physical fitness of the pre-school child. Education of the parents seems the solution not only of the mothers but the fathers also. Records:— Children carried forward from 1932 15 New children attending in 1933 51 Total No. of children attending hospital 66 Children discharged cured 4 „ still under treatment and carried forward to 1934 33 Children transferred to other hospitals 4 „ at school under L.C.C 2 „ removed from district 9 Parents refused treatment 14 66 Analysis of Cases :— Genu Valgum 27 „ Varum 7 „ Valgum with Flat Foot 20 „ Varum „ „ „ 7 Amyotonia Congenita 1 Congenital Dislocation of Hip 1 Cranial Asymetry 1 Talipes 1 Trigger Thumb 1 MASSAGE. Miss Lawson has continued her work as masseuse at the Cornwall Road Centre, where she attends for 6 sessions per week. 61 The year has been a busy one as full advantage has been taken of the facilities for Massage at the Centre. Children have been referred from hospitals and from doctors in practice, as well as by the Medical Officers at the Infant Consultations. Many children receive massage at the same time at which they attend for sunlight treatment. The number of mothers treated for failing breast milk is down this year. It is hoped that this number may increase if a session can be arranged at which massage and test feeding run concurrently to avoid the extra attendance at the Centre which is unwise in these cases. Rickets in its various manifestations forms the largest group of cases but the analysis shows that the work has been of a representative character. It is satisfactory to know that many cases of threatened deformity have responded well to the combination of massage with sunlight treatment, thus avoiding subsequent attendance at an orthopaedic clinic. Records:— Cases carried forward from 1932 40 New cases treated in 1933 106 Subsequent attendances in 1933 1,741 Total treatments 1,893 Discharged 129 Carried forward to 1934 23 Analysis of Cases:— Rickets 31 Genu Valgum 19 „ Varum 6 Curved Tibia 41 Flat Foot 10 Talipes 5 Poor Muscular Development 13 „ Chest „ 4 Torticollis 9 Constipation 7 Amyotonia Congenita 1 Anterior Poliomyelitis 1 Erb's Paralysis 1 Spastic Monoplegia 1 Fracture of Thigh 1 Failing Breast Milk 2 62 CONVALESCENT TREATMENT. During the year 14 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, and 18 mothers to the "George Whitlaw" Convalescent Cottage, Amerden, near Taplow. Thirty two mothers were thus sent away for two weeks. With regard to children, the arrangement made with the Hertfordshire County Council in 1922 was continued, and 52 children were sent to that Council's Home at St. Leonard's-on-Sea, Sussex, 1 for two weeks, 1 for three weeks, 44 for the normal period of four weeks, 1 for six weeks, 2 for seven weeks, 2 for eight weeks, and 1 for eleven weeks. Contributions towards the cost of convalescence were made in 38 cases out of the 84 sent away. Dr. Horton reports:— 52 children were sent to the sea for convalescence this year. This number is by no means the total number of children seen in the clinics who require this valuable treatment but it is difficult to make greater use of the available facilities. Two conditions must be fulfilled before any medical officer can begin the necessary arrangements. The child must have been vaccinated and the mother must be willing to let the child go. In many cases one or other is lacking and so the child misses the chance of a month at the sea. Many children who need it urgently are unable to be given it. The gain in weight and health of the child who comes back and the delighted faces of their mothers may be the best advertisement for the value of this treatment in the next year. Records:— Children recommended 59 „ sent to convalescent home 52 Lapsed 7 At school 2 Removed 2 Parents refused 3 63 Analysis of Cases:— Anaemia and Malnutrition 18 Anaemia 17 Poor weight and undernourished 7 Debility after Scarlet Fever 2 „ „ Diphtheria 1 „ „ Chicken Pox 1 „ „ Pneumonia 2 „ „ Whooping Cough 3 „ „ Otitis Media 1 HOSPITAL TREATMENT FOR MALNUTRITION. We have no formal arrangement for prolonged observation and in-patient treatment for children suffering from dietetic mismanagement and malnutrition. Such cases as cannot be dealt with through the Council's Special Clinic for Delicate Children are referred to the Queen's Hospital or one of the General Hospitals. NURSING ASSISTANCE. A scheme of home nursing has been in operation for some years by arrangement with a voluntary organisation,the Shoreditch and Bethnal Green Nursing Association. During the year 227 children under the age of 5 were nursed, a total of 2,577 visits being made. 32 mothers received 407 visits for nursing in connection with conditions incidental to child-bearing. 64 Nursing Assistance, 1933. Disease Children UNDER FIVE years Mothers Others Total Visits Cases Visits Cases Visits Cases Visits Ophthalmia Neonatorum ... ... ... ... ... ... ... Discharging Eyes 46 632 ... ... ... ... 632 Measles 1 2 ... ... ... ... 2 Whooping Cough 2 31 ... ... ... ... 31 Diarrhœa ... ... ... ... ... ... ••• Puerperal Fever and Pyrexia ... ... 1 8 ... ... 8 Other pre-natal and postnatal conditions ... ... 31 399 ... ... 399 Otorrhœa, Abscess of Ear 8 221 ... ... ... ... 221 Tonsils and Adenoids 42 123 ... ... ... ... 123 Influenza ... ... ... ... 24 224 224 Bronchitis 2 47 ... ... ... ... 47 Pneumonia 7 151 ... ... 22 257 408 Tuberculosis ... ... ... ... ... ... ... Intestinal Conditions 6 17 ... ... ... ... 17 Threadworms 54 632 ... ... ... ... 632 Discharging Umbilicus 32 456 ... ... ... ... 456 Impetigo and Eczema 3 15 ... ... ... ... 15 Circumcision 3 43 ... ... ... ... 43 Septic arm, leg, etc. 5 30 ... ... ... ... 30 Miscellaneous 16 177 ... ... 1 19 196 Totals 227 2577 32 407 47 500 3484 12 cases were in hand at the beginning of the year. 6 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 : one in Bethnal Green Hospital, and the other in the London Hospital. There was no death from the disease. Eighteen cases were notified as Puerperal Pyrexia. The patients were treated at the following Hospitals:— London (5), North Western (4), Bethnal Green (3), Mothers' (2), City of London Maternity (3), and East End Maternity Hospital (1). 65 OPHTHALMIA NEONATORUM, &c. Nine notifications of Ophthalmia Neonatorum were received during the year. Five of the patients were treated at home and four received hospital treatment, the hospitals concerned being: St. Margaret's, Moorfields, City Road Maternity and Bethnal Green General. The Health Visitors paid 55 visits to cases. Two cases were still under treatment at the end of the year. All the other cases cleared up without any impairment of vision being reported. Twenty-seven reports were also received from Medical Officers of the London County Council concerning new born babies suffering from inflammation of the eyes, 2 of these cases being subsequently notified as Ophthalmia Neonatorum. These cases were also visited by the Health Visitors. The district nurses treated 46 cases of discharging eyes in young infants, paying 632 visits for the purpose. CHILDREN ACT, 1908 (Part I). CHILDREN & YOUNG PERSONS ACT, 1932 (Part V) Under the Transfer of Powers (London) Order, 1933, the duties of the London County Council under the above-mentioned Acts were transferred to the Metropolitan Borough Councils. At the end of the year, there were 11 foster mothers and 14 foster children on the register in the Borough. The children are visited regularly by the Health Visitors. 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 half the children inspected are found to require medical treatment. 66 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 19.9 per cent. of Bethnal Green children are well clothed and shod compared with 54.5 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. Last year, in another part of this report, I had occasion to comment, with satisfaction, on the strenuous efforts of the residents in the borough to eradicate insect vermin. I am, therefore, extremely gratified to note that this year Bethnal Green has achieved the record, wonderful considering its housing conditions, of having a higher standard of cleanliness of head and body among school children than the average for London as a whole. The medical inspection 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 has been in operation since the beginning of 1932 is a small contribution to the solution of the problem, but much more requires to be done. 67 Routine Medical Inspection of Elementary School Children in Bethnal Green in 1933. Age Groups Number Examined clothing and boots nutrition cleanliness of head cleanliness of body teeth vision Good Fair Poor Good Average Below normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed 4 or more decayed 6/6 in both eyes 6/9 in either or both eyes 6/12 or worse in either or both eyes entrants Boys 1023 219 802 2 75 907 41 — 1018 5 — 1012 11 — 583 343 97 — — — Girls 933 186 741 6 69 838 26 — 922 9 2 925 7 1 539 313 81 — — — Age 8— Boys 849 187 656 6 30 754 65 — 836 13 — 840 9 — 606 213 30 373 304 160 Girls 807 193 610 4 65 703 39 — 784 22 1 799 8 — 547 225 35 398 285 120 Age 12— Boys 692 110 578 4 75 569 48 — 690 2 — 686 5 1 526 155 11 327 212 152 Girls 920 117 799 4 106 774 39 1 908 11 1 917 3 — 668 243 9 484 240 193 Age 14— Boys 851 172 674 5 155 672 24 — 847 4 — 845 6 — 635 208 8 455 222 162 Girls 1059 233 825 1 162 871 26 — 1045 12 2 1083 5 1 758 293 8 595 235 227 Total 7134 1417 5685 32 737 6088 308 1 7050 78 6 7077 54 3 4862 1993 279 2632 1498 1014 Percentage 19.9 79.7 0.4 10.3 85.4 4.3 — 98.8 1.1 0.1 99.2 0.8 0.0 68.2 27.9 3.9 51.2 29.1 19.7 London 54.5 44.8 0.7 20.8 74.9 4.3 — 96.4 3.2 0.4 98.2 1.7 0.1 69.4 26.0 4.6 63.2 20.3 16.5 68 Examination of Elementary School Children in Bethnal Green, 1933. BOYS GIRLS Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number examined 1023 849 692 851 933 807 920 1059 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 18 8 23 6 10 8 7 5 8 4 10 2 12 10 4 3 Skin disease 10 8 17 13 6 4 2 2 12 9 2 2 9 7 9 7 Defective teeth — 386 — 207 — 159 — 216 — 339 — 221 — 247 — 301 Enlarged tonsils 175 35 91 26 48 10 11 7 176 55 83 28 55 13 46 23 Adenoids 9 6 4 — — — 1 1 11 6 3 1 2 1 1 1 Enlarged tonsils and adenoids 25 16 5 3 2 2 1 1 13 10 12 8 3 1 1 1 Other nose and throat defects 9 3 8 5 4 3 2 2 10 4 5 5 7 6 3 3 Enlarged glands 12 1 7 2 2 — 1 — 12 2 6 — 1 — 2 2 Eye disease 38 27 17 7 6 5 3 3 34 17 19 10 13 8 10 5 Vision defect — — — 103 — 105 — 110 — — — 64 — 131 — 150 Otorrhoea 15 12 5 5 5 3 5 4 12 9 — — 7 6 3 3 Other ear disease 5 4 3 3 3 3 3 3 3 1 3 3 3 3 2 1 Defective hearing 4 2 — — 4 4 7 5 1 1 2 1 5 2 — — Speech defects 3 — 3 2 3 — 3 3 2 — 3 1 — — 1 — Heart defects 6 — 14 — 13 1 5 — 10 — 11 — 20 — 14 1 Anaemia 2 — 7 — 1 — — — — — 5 — 4 — 6 4 Lung defects 55 13 38 10 17 3 7 3 41 9 15 2 9 3 6 3 Nervous defects 3 1 3 — 3 — 1 1 1 — 4 — 7 1 4 — Phthisis — — — — — — — — — — — — — — — — Other t.b. disease — — — — — — — — — — — — — — — — Rickets 4 1 2 — — — — — 3 1 — — — — — — Spinal deformities 2 1 2 2 1 — 1 1 — — 2 1 2 2 3 3 Other deformities 12 4 4 1 7 5 4 2 9 2 4 — 13 5 9 8 Other defects 26 18 28 15 21 15 11 8 19 14 22 16 36 18 20 16 Number of children noted for treatment 468 339 260 329 421 315 381 453 *Defects however slight are included under "cases"; those severe enough to require treatment are shown under* 69 THE CONTROL OF DISEASE. During the year, the number of cases of practically every infectious disease showed a substantial increase, except Smallpox, Enteric Fever and Ophthalmia Neonatorum. Scarlet Fever jumped from 590 to 786 and Diphtheria from 355 to 488. The total number of cases of all diseases (including Tuberculosis) rose from 1,460 to 1,813. With the limited resources for research at my disposal, I cannot assign specific reasons for this substantial increase in sickness. It may be due to the coincidence of the periodical crests of several of the diseases or it may be the result of the generally lowered resistance of the population owing to the prevalent social conditions. The accompanying table shows the number of cases of each disease, the age composition of the patients and the numbers removed to hospital. 70 Cases of Notifiable Diseases Notified during 1933. 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 11 11 ... 1 ... ... 1 1 2 1 2 2 1 ... 11 Enteric Fever 4 4 ... ... ... ... ... ... ... 1 2 1 ... ... 3 Diphtheria (inc. Memb. Croup) 488 488 8 13 43 53 49 183 70 20 17 29 3 ... 486 Scarlet Fever 782 786 5 29 50 69 96 291 149 40 25 31 1 ... 769 Puerperal Fever 2 2 ... ... ... ... ... ... ... ... 1 1 ... ... 2 Puerperal Pyrexia 18 18 ... ... ... ... ... ... ... 2 6 10 ... ... 18 Ophthalmia Neonatorum ... 9 9 ... ... ... ... ... ... ... ... ... ... ... 4 Erysipelas 99 99 3 2 ... 1 ... 2 4 8 10 26 32 11 65 Cerebro-spinal Fever ... 20 2 1 2 ... 1 1 2 ... 5 5 1 ... 20 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia ... 139 5 5 2 6 5 13 9 11 10 35 27 11 100 Acute Influenzal Pneumonia ... 82 ... ... 2 ... ... 7 1 5 7 20 30 10 43 Dysentery ... 2 ... ... ... ... ... 1 ... ... ... 1 ... ... ... Malaria ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever, Cholera, Plague, Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Hydrophobia, Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... 109 ... ... ... ... 1 2 1 17 20 37 28 3 • Other forms of Tuberculosis ... 43 1 1 ... ... 2 14 7 5 3 9 1 ... • Total 1813 33 52 99 129 155 515 245 110 108 208 124 35 1521 * See particulars as to Sanatorium Treatment in Tuberculosis section. † The Registrar-General's figures are for notifications received during the 52 weeks ended 30th December, 1933, and include several non-residents. The Council's figures are for cases notified during the calendar year, and exclude non-residents. 71 Diphtheria. There were 488 cases of diphtheria notified during the year. The age grouping of the cases is given in the accompanying table. All but 2 of the cases were removed to an isolation hospital. 9 deaths from this disease occurred during the year, equivalent to a case mortality of 1.8 per cent., or general death rate of 0.08 per 1,000 of the population. These figures seem to show that although the disease was more prevalent than in 1932, the infection was less virulent. From information received from the hospital it would appear that in 82 cases (or 16.8 per cent, of the total) the diagnosis of Diphtheria was not confirmed. There were 6 "return" cases. Anti-diphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 60,000 units were supplied during the year. Scarlet Fever. There were 786 cases of scarlet fever notified during the year, 769 of the patients being removed to an isolation hospital. 9 deaths were certified as due to scarlet fever during the year, equal to a case mortality of 1.1 per cent., and a death rate of 0.08 per 1,000 population. These mortality rates are twice as high as in 1932, and suggest either that this disease is not so mild as in recent years or that the child population is less fit to throw off the infection. From information received from the hospitals, it would appear that in 51 cases (or 6.5 per cent, of the total) the diagnosis was not confirmed. There were 19 "return" cases. Mild Smallpox. 11 cases of mild Smallpox occurred in the Borough during the year. 72 Enteric Fever. Four 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, etc., on behalf of the London County Council. Attention should be drawn to the comparatively large number of cases of Cerebro Spinal Fever notified this year. There was 6 bacteriological confirmation of the great majority of the 20 cases. There were 10 deaths from this disease. Consultations with Medical Practioners. 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. 78 VACCINATION. The following is the latest available return prepared by the Vaccination Officers for the Borough, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1932, inclusive. Registration SubDistricts comprised in each Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1932. Number of these Births duly entered by 31st Jan., 1934. No. of Births which on 31st Jan.. 1934, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1934, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1933. No. of Declarations of Conscienous Objection actually received by Vaccination Officer during the Calendar Year 1933. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Declaration 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 741 115 — — 379 34 — 2 30 181 251 428 South West 401 52 — — 222 7* — — 20 100 172 204 TOTAL 1,142 167 — — 601 41 — 2 50 281 423 632 Children vaccinated after declaration of conscientious objection: N.E., 7; S.W., nil. Vaccination certificates for 1933 sent to other Vaccination Officers: N.E., 32; S.W., 18. *plus 5 cases in which statutory declarations were made and children subsequently died unvaccinated. 74 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 149 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations. In addition 3 posthumous notifications were received making a total of 152 certificates. Information was also received from the Register-General or from the Local Registrars of the deaths of 17 persons who had died from Tuberculosis but who had not been notified under the Regulations. During the year 25 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, 1933, was 1,330. The details are given in the table on page 77. During the year there were registered 74 deaths from Pulmonary Tuberculosis, and 14 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 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 1932 99 11 110 The notifications received during the year will be seen from the following tables:— 75 Public Health (Tuberculosis) Regulations, 1930. PART i.—SUMMARY OF NOTIFICATIONS (during the period from the 2nd January, 1933, to the 30th December, 1933, in the area of the Metropolitan Borough of Bethnal Green. AGE PERIODS Formal Notifications Number of Primary Notifications of new cases of tuberculosis Total Notifications 0— l— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total (all ages) Pulmonary Males ... ... 1 ... 10 8 11 10 11 8 3 62 92 ,, Females ... l 1 1 7 12 8 8 5 3 ... 46 55 Non-Pulmonary Males ... 3 8 3 1 ... 3 1 1 ... ... 20 22 ,, ,, Females 1 ... 6 3 4 2 2 3 ... ... ... 21 25 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 ... ... ... ... ... 2 7 4 4 3 ... 20 ,, Females ... 1 ... ... 1 3 3 ... ... 1 3 12 Non-Pulmonary Males ... 1 ... 1 1 1 2 ... ... ... ... 6 „ ,, Females ... ... ... 1 2 1 1 ... 2 ... ... 7 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 Death Returns from local Registrars 7 4 transferable deaths from Registrar General 4 2 Posthumous notifications 1 2 "Transfers" from other areas (other than transferable deaths) 20 5 Other Sources if any (specify) ... ... PART III.—NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1933, on the Registers of Notifications kept by the Medical Officer of Health of the County Borough, or Metropolitan Borough Pulmonary Non-Pulmonary Total cases Male's Fem'ls Total Males Fem'ls Total 487 382 869 256 205 461 1330 Number of cases removed from the Register(s) during the year by reason inter alia of:—1 Withdrawal of notification ... 1 1 ... 1 1 2 2 Recovery from the disease 1 1 2 2 1 3 6 3 Death 58 35 93 7 8 15 108 4 Patients removed from Borough 29 22 51 13 4 17 68 5 Lost trace 12 7 19 2 1 3 22 Total 100 66 166 24 15 39 205 76 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 17 deaths certified from Tuberculosis in which the deceased person had not previously been notified. This represents 20 per cent, of the deaths from Tuberculosis during the year. Enquiry of the certifying practitioner in each case elicited the following explanations:— Assumed previously notified 6 Due to oversight or pressure of work 5 Diagnosis only reached at or immediately before death 3 Certified by Coroner 1 No reply 2 Late notification, probably due to delay in seeking medical treatment, is shown by the following figures:— Notified practically at time of death 8 „ within 1 month ,, „ 8 „ „ 3 months „ „ 4 „ „ 6 months „ „ 6 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. 77 Tuberculosis Register. Pulmonary Non-Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/32 504 385 254 192 1335 Number of new cases notified under the Public Health (Tuberculosis) Regulations, 1930, during the year 63 46 21 22 152 Transferred from non-pulmonary 1 ... ... ... 1 Other cases added to the Tuberculosis Register during year 19 17 6 6 48 587 448 281 220 1536 Number of cases removed from Tuberculosis Register during year. (For details see separate statement) 100 66 24 15 205 Transferred to pulmonary ... ... 1 ... 1 Cases remaining on Tuberculosis Register 31/12/33 487 382 256 205 1330 WORK OF TUBERCULOSIS HEALTH VISITORS. The two Tuberculosis Health Visitors paid 4,309 visits of enquiry and advice with regard to the welfare of tuberculous patients in the Borough. In addition they made 454 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 78 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 22 sputum flasks were distributed to patients. Twelve sputum tins, with 1,450 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 155 patients were recommended for Sanatorium or Hospital treatment and 148 of them were sent away to institutions. In addition, owing to altered administrative arrangements made by the L.C.C., 41 patients formerly treated as Public Assistance cases in General Hospitals, were transferred to the Municipal Tuberculosis Scheme. Fourteen children were recommended for admission to an open-air school, and thirteen were accepted. GRANTS OF EXTRA NOURISHMENT. During the year 398 grants of Grade A (Tuberculin Tested) milk and new laid eggs were made to 147 79 necessitous tuberculous patients at an estimated cost of £250. 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 Annual Return to the Ministry of Health appears in the appendix to this report on pages 117 and 125. I should like to draw attention to Dr. Howell's very thoughtful remarks concerning the importance and difficulties of X-ray assistance in the diagnosis of Tuberculosis and also with regard to the diagnosis and treatment of children suffering or suspected to be suffering from Tuberculosis. 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 1933, 3 dispensary patients received dental treatment at the City of London Hospital for Diseases of the Heart and Lungs, and made 4 attendances therefor. Two patients were also assisted in the provision of artificial dentures, 80 FINSEN LIGHT TREATMENT FOR LUPUS. PNEUMOTHORAX REFILLS. Since 1921, the Council has paid for the Finsen Light treatment of cases of Lupus at the London Hospital. During the year 6 patients were so treated, making 585 attendances for treatment. Two patients also made 384 attendances for arc light treatment of Lupus at the same hospital. General Light Treatment was provided at the City of London Hospital for Diseases of the Heart and Lungs for 1 patient who made 48 attendances. Under the Council's arrangements for the provision of pneumothorax refills, 2 patients had 24 refills at the Brompton Hospital and 16 patients received this form of treatment at the City of London Hospital, having 189 refills between them, and 3 patients had 39 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 345 cases of Measles came to my knowledge from the following sources:— Schools 193 L.C.C. Ambulance Service 130 Other Hospitals 2 Medical Practitioners 4 Health Visitors 12 Sanitary Inspectors 4 All cases were visited, either by a Health Visitor or the District Sanitary Inspector, according to the age of the patient, 81 122 patients were removed to L.C.C. Special Hospitals, and in one case nursing assistance was provided by the Council. After various corrections of diagnosis and sifting of "suspected" cases, there would appear to have been a nett total of at least 311 actual cases. Information as to cases not already known to them 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 6 deaths from measles during the year. German Measles. 410 cases of German Measles were also reported, 85 of them being removed to hospital. Correction of diagnosis and sifting of "suspected" cases, makes the nett total of actual cases about 405. Whooping Cough. 144 cases of Whooping Cough among children under 5 years came to my knowledge; through reports from the L.C.C. (86), Health Visitors (54), Schools (1), and other sources (3), and these children were visited by the Health Visitors. 89 children were removed to an Isolation Hospital and 81 recovered. 11 deaths from this disease were recorded during the year. Miscellaneous Investigations. 383 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 82 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. DISINFECTION SERVICE. During the year, 2,064 rooms and 29,873 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 1,473 8,920 Scabies 61 1,450 Verminous condition 517 2,873 Other conditions 13 395 Hospital bedding — 11,700 2,064 25,338 There were also 4,535 articles disinfected in the Formalin Chamber. No. of articles destroyed by request, 346. 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. 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 83 of their rooms. The sprayers were lent on 467 occasions during the year, as compared with 208 in 1932. Verminous Conditions. Forty-five children (in 35 families) were reported from the L.C.C. Cleansing Station as being infested with vermin, 29 of the families being cases of head lice only. In every case advice as to the treatment of the clothing and bedding was given and disinfestation by steam was offered. In 12 cases disinfection of some kind was accepted. These reports have shown steady improvement for many years. Considering the conditions under which a large proportion of the children live, it is remarkable that only 2 cases of fleas and 4 cases of body lice were reported last year, and speaks well for the care taken by mothers to keep their children clean despite adverse circumstances. Rooms were disinfested of vermin in 517 cases. Scabies or Itch. Ninety-four children suffering from this disease were visited after being excluded from the Elementary Schools. In 82 instances disinfestation of the clothing and bedding was accepted. In addition, 26 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 4 of these cases the bedding was disinfected. 61 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 84 men. During the year 172 men and 12 women had 191 baths and their clothing was disinfected for vermin, and 24 men, 12 women and 3 young children had treatment with sulphur ointment, in addition to baths and disinfection, on a total of 67 occasions, for Scabies. DISTRIBUTION OF DISINFECTANTS. During the year 6,361 pints of partially diluted disinfecting 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 1,267 Diphtheria bacilli present in 176 Sputum—specimens submitted for examination 129 Tubercle bacilli present in 10 Blood-serum—specimens examined for Widal reaction (negative) 2 Faeces—specimen submitted 2 Dysentery organisms present in 1 One specimen of bath water was examined and proved to be entirely satisfactory. Other bacteriological examinations in connection with food are reported on elsewhere. 85 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928, SECTION 28. Care of Aged and Infirm Persons. During the year, it was not found necessary to apply for a magistrate's order for the removal to hospital of any aged and infirm person found to be living under insanitary conditions and not receiving proper care and attention. FOOD POISONING. Food Poisoning became notifiable throughout London, under Section 7 of the London County Council (General Powers) Act, 1932, on the 12th July, 1932. During 1933, 34 cases were notified. Of these cases, 16 were attributed to eating fish (including tinned fish), 13 to meat (including tinned meat), and 5 to other foods. Four members of one family had partaken of tinned herrings, but it was not possible to obtain a sample for analysis. In another family, 3 cases were alleged to be due to eating beef sausages. Two cases due to drinking lemonade were investigated, the illness being attributed to contamination of the bottle stoppers by paraffin. Chocolates which had been attacked by grubs were the cause of two further cases. 86 PROTECTION OF FOOD SUPPLY. The work of the Local Health Authority with a view to the protection of the food supply takes three forms: (i) Supervision of premises where food is 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 foodstuff's now in common use. We had the disquieting experience this year of having two summonses decided against the Council. In one case it was held that as there was no specified quantity of talc in the B.P. description of Aspirin tablets, the Council could not prove excess. The other case was dismissed on a technical point arising from the form of the analyst's certificate, although the offence was clear. We continue to experience difficulty in protecting the people of the borough against adulteration and misdescription owing to the absence of official standards for many common articles of food. It is understood that this matter is under consideration by the Ministry of Health, and it is to be hoped that definite recommendations and decisions will be made ere long. 87 FOOD AND DRUGS ACTS. Seven hundred and thirty-eight samples were taken; 681 of these proved to be "genuine" and 57 or 7.7 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 354 334 20 1 1 ... 355 Butter 99 95 4 18 17 1 117 Margarine 12 12 ... ... ... ... 12 Sterilised Milk 1 1 ... ... ... ... 1 Condensed Milk ... ... ... 4 4 ... 4 Cream 6 6 ... 4 4 ... 10 Lard 1 1 ... 1 1 ... 2 Dripping 1 1 ... 1 1 ... 2 Orange Wine 1 1 ... ... ... ... 1 Ginger Wine ... ... ... 1 ... ... 1 Whisky 5 5 ... 8 8 ... 13 Gin 4 4 ... 1 1 ... 5 Parrish's Food 7 2 ... 3 2 ... 10 Liquid Paraffin ... ... ... 2 2 ... 2 Camphorated Oil 1 1 ... ... ... ... 1 Malt Extract and Cod Liver Oil ... ... ... 1 1 ... 1 Olive Oil 1 1 ... ... ... ... 1 Ammon. Tinc. Quinine ... ... ... 3 3 ... 3 Lysol ... ... ... 3 3 ... 3 Bismuth Tablets ... ... ... 2 2 ... 2 Aspirin Tablets 7 6 1 ... ... ... 7 Egg Squares 1 1 ... ... ... 1 Table Jelly 3 2 1 15 14 ... 18 Dessicated Soup 1 1 ... 1 1 ... 2 Pepper 2 2 ... ... ... ... 2 Mustard 1 1 ... ... ... ... 1 Mixed Peel 1 1 ... 6 5 ... 7 Ground Ginger ... ... ... 3 3 ... 3 Ground Cinnamon ... ... ... 3 3 ... 3 Sultanas ... ... ... 5 5 ... 5 Mincemeat ... 1 ... 2 2 ... 3 Sweets 6 6 ... 3 2 ... 9 Bread ... ... ... 14 14 ... 14 Self-raising Flour ... ... ... 3 3 ... 3 Flour ... ... ... 5 5 ... 6 Pearl Barley 2 2 ... ... ... ... 2 Jam 33 28 5 2 2 ... 35 88 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 41 36 5 2 1 1 43 Malt Vinegar 5 4 1 ... ... ... 5 Sauce 1 1 ... ... ... ... 1 Minced Meat 2 ... 2 9 5 4 11 Sausages 2 1 1 1 1 ... ... Fish Paste 1 1 ... ... ... ... 1 Suet, Shredded I 1 ... ... ... ... 1 Cream Ice 1 1 ... ... ... ... 1 Ice Cream ... ... ... 3 3 ... ... Fruit in Syrup 1 1 ... ... ... ... 1 Dried Fruits 1 1 ... ... ... ... 1 Frying Oil 1 1 ... ... ... ... l Totals 608 562 46 130 119 11 738 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 1933, 738 samples were examined under the Food and Drugs (Adulteration) Act. Ten of these samples were submitted by neighbouring Authorities, the remainder by the Inspectors. No samples under the Act were submitted by the Public. One hundred and thirty of the Inspectors' samples were purchased informally. Fifty-seven samples were found to be adulterated, 46 formal and 11 informal. In addition 60 other samples were reported as of doubtful purity or inferior quality. The adulteration was at the rate of 7.7 per cent., as compared with 2.7 per cent. for the whole of London and 5.1 per cent. for the whole of England and Wales in 1932. The adulteration in the Borough for the past ten years was as follows:— 89 Year No. of samples examined Percentage of adulteration 1933 738 7.7 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 Average 737 6.9 The amount of adulteration, although fairly constant, over the past few years, still remains higher than that of other Boroughs of similar character. The number of samples examined was at the rate of 6.9 per 1,000 of the population, as compared with 10.0 per 1,000 for the whole of London and 3.4 per 1,000 for the whole of England and Wales in 1932. 355 samples of milk were examined during the year of which 20 samples, or 5.6 per cent. were found to be adulterated and 51 samples were reported as of inferior quality or doubtful purity. The milk adulteration for the past 10 years was as follows: Year No. of milks examined Percentage of adulteration 1933 355 5.6 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 Average 317 5.1 Condensed Milks. Nine samples of condensed milk were examined, all of which were satisfactory. 90 Preservatives. There were eleven contraventions of the Preservatives Regulations. Other samples examined during the year were:— 13 Rag Flocks, 4 of which were unsatisfactory. 1 Soap. 1 Lemonade. All for the Public Health Department. Albert E. Parkes, f.i.c. FOOD AND DRUGS. Legal Proceedings, 1933. Particulars of the legal proceedings taken during the year in respect of foods and drugs, will be found in the appendix, p. 113. SAMPLES TAKEN INFORMALLY. One hundred and thirty samples were taken informally during the year, 11 of which were found to be adulterated as follows:— Article No. of Sample Offence Vinegar 57 25% deficient in acid Clear Mints 110 165 parts per million SO2 Parrish's Food 300 40% deficient in Phosphate of Lime Minced Beef 325 32 parts per million SO2 do. 327 2145 do. do. 328 1275 do. do. 329 297 do. Butter 390 18% water Table Jelly 508 47 parts per million excess SO2 Chopped Peel 662 165 parts per million SO2 Wine 666 Ginger Cordial The genuine samples are indicated in the table on pages 87 and 88, 91 PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 to 1927. 4 formal and 7 informal samples taken under these Regulations were found to contain preservatives, to wit, sulphur dioxide, in parts per million, as follow : Minced Meat 32 „ 297 „ 551 „ 1275 „ 2145 „ 2500 Sausages 70 Table Jelly 40 „ 47 Sweets (Clear Mints) 165 Chopped Peel 165 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Four informal samples of condensed milk were taken, and were found to comply with the Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. No samples of dried milk were taken during the year. BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year 18 bacteriological examinations of milk, 15 of other food and 1 of water were made as follows:— Ordinary Milk, 2; Grade A (Tuberculin Tested) Milk, 3; Grade A, 1; Pasteurised Milk, 12; Tinned Pilchards, Ice Cream, Milk Powder, Cornflour, Meat Extract, 1 each; Butter, 10; Water, 1. 92 B. Coli were found in 4 samples of Pasteurised Milk, 1 each of Grade A (T.T.) and Grade A, 2 in ordinary milk, 1 Ice Cream and all 10 samples of Butter. FOOD PREMISES. Milkshops and Dairies. 86* applications for registration were considered during 1933, 11 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 1932 290 Deduct number of purveyors removed from register during the year 13 Add number of new purveyors added to register by resolution of the Public Health Committee during the year 39 Number of purveyors of milk on register at end of 1933 316 During the year 959 inspections of milkshops were made by the Inspectors, and 74 notices were served under the Public Health (London) Act, 1891. Legal proceedings were not found to be necessary in respect of milk premises. 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 £1 in fine and £2 2s. Od. in costs, in each case. One person was fined 20s. with 10s. costs for not having his milk receptacle properly inscribed with his *This includes changes of occupier in premises previously on the register. 93 name and address and another was fined 20s. for failing to observe due precautions to prevent milk being contaminated. Milk (Special Designations) Order, 1923. 15 dairymen were licensed to sell "Grade A (Tuberculin Tested)" Milk, 3 for the sale of "Certified" Milk, and 3 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, Islington and Rugby were also granted during the year. Two summonses were taken out and were successful in respect of offences under the regulations: selling "Grade A" Milk not up to standard, selling "Grade A (T.T.)" Milk without a licence. A third summons for selling the same grade not in accordance with licence, was withdrawn. Cowhouses. There were at the end of 1933 8 licensed cowhouses in the Borough. 49 inspections were made during the year. No notices were served. During the year, by the operation of the Transfer of Powers (London) Order, the licensing of Cowsheds was transferred to the Borough Council. The following premises were duly licensed:- 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, Gibralter Walk—(18 cows). 55, Kerbela Street—Shed No. 1—(18 cows). Shed No. 2—(2 cows). 94 2, Lisbon Street—(19 cows). 64, Squirries Street—(14 cows). 38, Three Colts Lane—(23 cows). I am glad to report the discontinuance of one more of the cowhouses hitherto existing in the Borough. Ice Cream Premises. There were 171 ice cream premises registered at the end of the year, and 372 visits were paid to them by the district inspectors: 26 notices were served. Fried Fish and Fish-Curing Premises. At the end of 1933 there were 44 fried fish vendors' premises in the Borough, at 3 of which curing was also carried on. There were 18 fish curers' premises, including these two. Two hundred and forty-three visits were made by the Food Inspectors to these premises, and 7 notices were served for insanitary conditions. Workshop Bakehouses. There are, in Bethnal Green, 36 workshop bakehouses, 10 of which are underground: 111 visits were made to them during the year, resulting in the serving of 8 sanitary notices. Factory Bakehouses. There are also 27 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 twelve inspections were made during the year, and 8 notices were served. 95 Other Premises used for the Preparation or Sale of Food. There were 201 such premises on the register, the majority being restaurant-kitchens or butchers' shops. 684 inspections were made during the year, and arising out of such inspections 68 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. The licensing is now in the hands of the Borough Council. 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:— Lambs 120 Pigs 38 Total 158 These figures are less than half the number of animals slaughtered in the previous year. No carcases or offal were condemned. Slaughterers of Poultry. There are 8 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough: 174 visits were paid to them during the year. There 96 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. No seizures took place. On 11 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 — — 91½ Fruit — 17 82 also Eggs (383), Tinned Tomatoes (30 tins). FOOD POISONING. During the year 34 cases of suspected food poisoning were investigated. 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, 1932. Imported meat and eggs are required to be labelled as such. 97 GENERAL SANITARY ADMINISTRATION. Every year I endeavour to find some new analogy for the work of the Sanitary Inspectors, in order to draw attention to its importance and significance to the health of the Borough. The prosaic figures about dirty rooms cleansed and defective roofs made sound do not seem very interesting in themselves, but in actual fact they represent the perpetual struggle of the sanitary inspector against the deterioration of the sanitary environment of the people. As I have frequently remarked, the real problem is that part of the housing in the Borough is old and worn out and from a public point of view is not worth the expense of repair, while another and still larger part, although structurally still comparatively sound, is of a type seriously below modern standards of ventilation, fighting and amenity and too closely congested. It is mostly houses of these two types which the sanitary inspectors have to keep from getting worse. I can only liken their task to that of Sisyphus, who in Greek mythology was doomed to push a heavy stone up a hill, the stone invariably rolling down again when it reached the top. I do not know whether any of these old houses actually reach the top of the hill of good sanitation. Certain it is that many of them are forever slipping down. 98 SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding, for the 52 weeks ended 30th december, 1933. Nature of Visit Totals Infectious Diseases (notifiable) 1713 Infectious Diseases (non-notifiable) 977 Food Poisoning 1 Complaints 4867 House to House Inspections 967 Milkshops (825) and Cowsheds (51) Inspections 876 Other Food Premises Inspections (Meat 26, Poultry 150, Others 1406) 1582 Factory (927) and Workshop (1912) Inspections 2839 Outworkers' Homes Inspections 941 Tenement House Inspections 306 Drainage Inspections 3239 Smoke Nuisances—Premises under observation 67 Other Inspections or Special Work 7070 Re-Inspections 20720 Total Visits for the Year 46165 Unsound Food Seizures (0) or Surrenders (12) 12 Samples of Food, etc., taken 739 Samples of Rag Flock taken 13 Laying Rat Baits 1149 Police Court Attendances 58 Premises where Nuisances abated 6218 Premises where Matters Outstanding 766 The following sanitary defects were discovered during the year:— Dirty rooms 6,417 Defective drains and choked w.c.'s 944 Defective and dirty w.c.'s 2,345 Defective water supply 531 Defective paving 704 Defective gutters and rainwater pipes 662 Defective roofs 1,419 Dampness 717 Defective dustbins. 1,372 Smoke nuisances 8 Other defects 9,526 Total 24,645 99 The work of the outdoor staff is reflected in the volume of clerical work associated with sanitary administration. During the year 5,558 Preliminary Notices were served requiring the remedying of Nuisances. 2,793 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 669 premises with nuisances outstanding. During the year, nuisances at 6,218 premises were abated and 766 premises with nuisances outstanding were carried forward to 1934. COMMON LODGING HOUSES. Under the operation of the Transfer of Powers (London) Order, 1933, the licensing of Common Lodging Houses came under the jurisdiction of the Borough Council. There are 5 such premises in the Borough, and the inspectors paid 44 visits to them. One sanitary notice was served. 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; 929 visits of inspection were made to these houses, and arising out of such visits 287 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 100 number of the houses coming under these by-laws have so far been formally registered. RENT AND MORTGAGE INTEREST RESTRICTIONS (AMENDMENT) ACT, 1933. During the year one application for a certificate as to the state of repair of a house was received. WATER SUPPLY TO NEW HOUSES. During the year 75 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 67 formal observations of smoke shafts were made and 3 intimation and 1 statutory notices were served. NOISE. I regret to report no progress in dealing with preventable noise, now generally recognised as conducive to ill health. Complaints continue to be received about this evil. Apart from unnecessarily loud street noises, industrial processes are frequently carried on regardless of the hearing and nerves of the workpeople and residents in the vicinity. When, as sometimes happens, work is carried on at rush periods late into the night, children and adults, who have to rise early, and who are compelled by the housing shortage to five in the neighbourhood, are deprived of proper sleep. They naturally apply to the Public Health Department for assistance, and quite rightly, cannot understand our apparent helplessness or how the law can be so stupid as not to recognise as a " nuisance " something which is at least as bad as a bad smell in its effect upon health. 101 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, 171 tins of treated biscuits and 7 bottles of Squill being issued in this way, while 411 tins of biscuits were used as baits in the sewers in the quarterly campaigns described later. It is clear that spasmodic efforts to deal with the rat nuisance are futile. With this in mind, arrangements were made during the year to carry out planned measures for rat destruction for one week every three months and this scheme was also adopted by the four neighbouring boroughs. Particular attention was devoted to the sewers at the boundaries, so as to ensure that anti-rat measures within one borough should not result in a mere transfer of the nuisance to another area. Accordingly, in co-operation with the Medical Officers of Health and Borough Engineers of Hackney, Poplar, Shoreditch and Stepney, the systematic laying of rat poison at selected points was carried out in February, May, July and November. Other methods adopted included the use of a specially designed galvanised iron sewer rat trap in the shape of a large dustbin. Owing to the probable percolation of the sulphur gas into the sewers of the London County Council, the use of the Clayton Disinfecting apparatus in the Borough Council sewers has been discontinued. So far as it is possible to estimate the result in figures, the following statistics concerning Bethnal Green illustrate it: Baits laid (in 1,104 manholes) 15,253 Baits taken 12,421 Percentage of baits taken 82 For the whole of the 5 boroughs, it would appear that about 64,000 baits were laid, and approximately 102 40,000 were taken. While it cannot be asserted that each of the baits taken represents a rat killed it is reasonable to assume that this happens in a high proportion of cases. Enquiry of the London County Council elicited that the number of rats' bodies observed at the Northern Outfall Works rose from 35,242 in 1932 to 45,181 in 1933, but these figures are affected by so many incalculable factors that it would be unreliable to assume that the East London anti-rat campaign was responsible for this increase. 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. 13 formal samples of rag-flock were taken during the year, and in 4 cases the amount of chlorine present was found to be slightly in excess of the limit fixed by the Regulations. Proceedings were taken in 3 instances, costs amounting to £10 10s. Od. being awarded against the defendants. RAG AND BONE DEALERS. Thirteen persons or firms are known to be carrying 103 on this business in the Borough. During the year 14 visits of inspection were made, and 1 sanitary notice was served. No proceedings were necessary in respect of contravention of the by-laws during the year. HAIRDRESSERS. 95 hairdressers' premises were on the register, 153 visits were made to them, and 15 Notices were served. COMBINED DRAINAGE SYSTEMS. The reconstruction and maintenance of such combinations of drains of houses and premises as are found to be sewers by law defined and are not under highways is carried out by the Public Health Department. The staff engaged on this work consists of a drainlayer and four labourers, with additional help as required. During the year 4 systems were reconstructed, taking 8 houses. At the end of the year there were 629 such combined drainage systems, taking 3,191 houses. DRAINAGE WORK. Legal proceedings were taken in one instance during the year in respect of offences in connection with drainage work. Costs amounting to £2 2s. 0d. and a fine of 10/- were awarded to the Council. 104 HOUSING. GENERAL. Very little happened during 1933 to alter the somewhat pessimistic estimate of the housing situation in the borough, which I gave in last year's report. The facts speak for themselves. With 142 persons per acre and 1.35 persons per room, Bethnal Green ranks as the third worst borough in London. It is difficult to measure with equal precision the condition and suitability of the housing in the borough, but that a large part of it is old, worn out or unsuitable, or all three, is unquestionable. A considerable portion of the borough has been included in represented insanitary areas. Small portions of some of these areas have come under review during the past few years, but the great bulk of them remains to be dealt with. OVERCROWDING. On the census standard of 2 persons per room, 23.6 per cent. of the population of the borough was overcrowded in 1931. But this figure, like most averages, obscures some very disagreeable extremes, and in any case, it does not profess to lay down that as many as 2 persons per room is consistent with good hygiene or decency. The census actually recorded 105 families of from 6 to 10 persons, living in 1 room, to say nothing of 130 families of 5 persons, 284 families of 4 persons and 579 families of 3 persons also living in 1 room tenements. Such disgraceful figures might be multiplied by examining some of those for the "larger" tenements of 2 or more rooms, for example, the 2 families of 13 persons each occupying 2 rooms. Eighteen particularly bad cases of overcrowding were reported to the Public Health Committee during the year, but these of course are only those of which we have been forced to take cognizance. The additional and better accommodation provided by the Borough Council and L.C.C. has done a little to 105 ameliorate this state of affairs, but it is hopeless to attempt to solve the problem merely by providing accommodation. Unless the accommodation is within the means of the overcrowded families, it is useless to them. Nor is there much substance in the argument which has been used, that the provision of this new accommodation leads to a " shifting up " of families, whereby the tenements vacated by families going to municipal houses are occupied by overcrowded families from still inferior tenements. The fact is, that the demand for accommodation, both residential and industrial, in and around the central districts of London is so great, and the rental level accordingly so high (apart from letting restrictions), that the tenements set free by families entering municipal estates are in practice rarely available to the poor overcrowded families in slum property. RENT AND NUTRITION. Another aspect of the same matter is seen in the danger of families with limited income taking housing accommodation, the rents or incidental expenses of which are beyond their means, except at the expense of nutrition. Much valuable research during the past few years has shown that serious malnutrition may be an unexpected but wholly evil result of well meant efforts for improved housing. Various schemes have been devised to solve this problem, notably the plan of rebates for children, and the Leeds scheme of differential rents according to income. UNDERGROUND ROOMS. Attention is periodically called to the use of underground rooms for sleeping purposes, but beyond the endeavour to prevent the separate letting of such rooms when vacated, it has not been deemed practicable to deal with the matter, owing to the shortage of accommodation within the means of the people. 106 INSANITARY AREAS : Slum Clearance and Improvement Schemes. Although the greater part of the notorious Brady Street area (originally represented to the L.C.C. in 1904, and re-represented in 1912 by the then M.O.H.) has since been dealt with, there even yet remain two small portions of exceeding bad property awaiting attention. Work on the Teale Street area, which the L.C.C. decided to deal with in 1928, is now (1934) in hand. 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 L.C.C. in 1920, has since been re-represented in two separate parts (1934). During the year, at the request of the L.C.C., a list was prepared of 11 small insanitary areas which were suitable for demolition, but owing to their size were unsuitable for housing sites, and with which the Borough Council proposed to deal systematically as Clearance Areas over a period of 5 years. The areas in question contain 76 houses and a population of 361. This plan is based upon the assumption that the L.C.C. will deal with larger areas, and thereby provide surplus accommodation for the persons displaced from these smaller Clearance Areas. OTHER HOUSING SCHEMES. During the year, the Borough Council completed the Claredale Estate (73 tenements). HOUSING STATISTICS FOR 1933. Number of Houses erected during the year—73 tenements. 1. Inspection or Dwelling Houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,770 (b) Number of Inspections made for the purpose 20,130 107 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 967 (b) Number of Inspections made for the purpose of the regulations 967 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (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 ren- dered fit after service of formal notices :— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices Notices served : were served requiring de- Intimations, 5,558 fects to be remedied Statutory Notices 2,793 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 6,218 (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 4 108 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 (D) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (E) Proceedings under Section 3 of the Housing Act, 1925 :— (1) Number of dwelling-houses in respect of which notices became operative requiring repairs Nil (2) Number of dwelling - houses which were rendered fit after service of formal notices :— (а) By owners Nil (б) 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 (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 109 FACTORIES, WORKSHOPS, OUTWORKERS, &c. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 1739 274 ... Workshops (Including Workshop Laundries) 2693 507 2 Workplaces (Other than Outworkers' Premises) 108 31 ... Total 4540 812 2 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts:— Want of cleanliness 212 197 7 ... Want of ventilation 4 2 2 ... Overcrowding 1 ... 1 ... Want of drainage of floors ... ... ... ... Other Nuisances 481 492 ... 2 Sanitary accommodation— insufficient 3 3 ... ... unsuitable or defective 620 581 ... ... not separate for sexes 9 9 ... ... Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to out work). ... ... ... ... Total 1330 1284 10 2 110 Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number Workshops 1186 Workshop Bakehouses 36 Total Number of Workshops on Register 1222 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) 27 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 20 Reports (of action taken) sent to H. M. Inspector. 20 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 10 Home Workers. Of the 2,436 workmen and contractors whose names appeared on the lists received, 1,708 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. ll1 The number of visits paid to Home Workers' dwellings was 1,561. The number of premises found to be in an insanitary condition was 219, or 39.6 per cent. of the 553 premises inspected. Notices were served in 262 cases, while 31 other premises were under notice arising from other visits, and a verbal intimation was given in 12 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. 112 HOME WORK. Nature of Work OUTWORKERS' LISTS, SECTION 107 * Outworkers in unwholesome premises, Section 108 Outwork in infected premises, Sections 109,110 Lists received from Employers Addresses of Outworkers Notices served on Occupiers as to keeping or sending lists Prosecutions Instances Notices served Prosecutions Instances Orders made (s. 110) Prosecutions (s. 109, 110) Sending twice in the year Sending once in the year Failing to keep or permit inspection of lists Failing to send lists Lists Outworkers Lists Outworkers Received from other Councils Forwarded to other Councils Contractors Workmen Contractors Workmen Wearing Apparel- Making, etc. 64 86 199 2 13 12 894 184 67 ... ... 59 71 ... 2 ... ... Boots and Shoes 26 35 203 4 2 16 125 161 25 ... ... 38 43 ... ... ... ... Curtains, Furniture hangings and Trimmings 4 18 18 ... ... ... 15 13 4 ... ... 8 8 ... ... ... ... Fur-pulling and feathers ... ... ... ... ... ... 8 ... ... ... ... 1 2 ... ... ... ... Umbrellas, etc. 4 ... 11 ... ... ... 26 2 2 ... ... 11 11 ... ... ... ... Artificial Flowers ... ... ... ... ... ... 4 ... ... ... ... 3 2 ... ... ... ... Paper, etc., Boxes, Paper Bags 16 ... 149 2 ... 7 112 36 17 ... ... 59 76 ... ... ... ... Brush-making 8 ... 237 ... ... ... 21 198 3 ... ... 14 14 ... ... ... ... Draught Board Making 2 ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, etc. 2 ... 39 ... ... ... 4 29 2 ... ... 7 10 ... ... ... ... Textile Weaving 2 ... 14 ... ... ... ... ... 2 ... ... 1 1 ... ... ... ... Toys 2 ... 163 ... ... ... 3 105 2 ... ... 18 24 ... ... ... ... Total 130 139 1035 8 15 35 1212 728 126 ... ... 219 262 2 * The figures in these columns relate to outworkers' premises at which nuisances were found and dealt with under Public Health (London) Act. 113 APPENDIX I. LEGAL PROCEEDINGS. During the year, 39 summonses were heard in respect of nuisances, with the following results :— Withdrawn on payment of costs amounting to :— Nil 1 £1 1 0 25 £1 11 6 7 £2 2 0 1 Nuisance Orders obtained with costs amounting to :— £1 1 0 2 £2 2 0 2 Fine £1. Costs £1 1 0 1 It was also found necessary in 2 cases to obtain a Distress Warrant for the recovery of costs. Other legal proceedings are summarised in the following list. Legal Proceedings, 1933. Sample Date Offence Result 613 (1932) 3.1.33 Food and Drugs (Adulteration) Act. Selling milk containing 10.5% added water Fined £2 Costs £3 3s. 0d. 665 (1932) 12.1.33 Selling Vinegar 9% deficient in acetic acid No fine Costs £2 2s. 0d. 14 23.2.33 Selling Vinegar 25% deficient in acetic acid Dismissed on payment of £3 3s. 0d. costs 49 7.3.33 Selling milk containing 10.5% added water No fine Costs £4 4s. 0d. 91 28.3.33 Selling milk 3% deficient in fat Withdrawn (warranty defence) Costs £2 2s. 0d. 75 30.3.33 Selling Raspberry Jam containing 90% foreign fruit jam Fine 2/- Costs £3 3s. 0d. 114 Legal Proceedings—contd. Sample Date Offence Result Food and Drugs (Adulteration) Act 117 6.4.33 Selling Strawberry Jam 24.4% deficient in fruit Fine £1 Costs £3 3s. 0d. 170 27.4.33 Delivering milk in pursuance of contract 3.3% deficient in fat Withdrawn (warranty defence) Costs £3 3s. 0d. 166 27.4.33 Selling aspirin tablets containing 3% excess of silicious matter Dismissed with £2 2s. 0d. costs against Council 191 2.5.33 Selling Vinegar 15% deficient in acetic acid Fine £1 Costs £2 2s. 0d. 158 2.5.33 Selling Vinegar 11% deficient in acetic acid No fine Costs £1 1s. 0d. 176 11.5.33 Selling milk 16.6% deficient in fat Fined £2 No costs 219 6.6.33 Selling milk 5% deficient in fat Withdrawn Costs £2 2s. 0d. 249 13.6.33 Selling milk containing 4.7% added water No fine Costs £3 3s. 0d. 321 18.7.33 Selling Parrish's Food 35% deficient in tricalcium phosphate Dismissed with £5 5s. 0d. costs against Council 364 1.8.33 Selling Milk 23% deficient in fat Fined £1 Costs £3 3s. 0d. Public Health (Preservatives in Food) Regulations. 370 5.9.33 Selling Minced Meat containing S02 an added preservative Fine £5 Costs £5 Food and Drugs Adulteration) Act. 383 5.9.33 Selling Parrish's Food 24% deficient in ferrous phosphate and 54% deficient in tricalcium phosphate Withdrawn Costs £3 3s. 0d. 363 12.9.33 Selling Parrish's Food 24% deficient in ferrous phosphate Dismissed (warranty defence) No costs 362 19.9.33 Selling Parrish's Food 23% deficient in tricalcium phosphate No fine Costs £5 5s. 0d. 424 22.9.33 Selling Parrish's Food 49% deficient in ferrous phosphate and 36% deficient in tricalcium phosphate Fine £2 Costs £5 5s. 0d. 476 12.10.33 Selling Milk 5% deficient in fat Withdrawn (defendant dead) 712 30.1.34 Selling Butter containing 1.6% excess of water Adjourned sine die 115 Legal Proceedings—contd. Sample Date Offence Result Food and Drugs (Adulteration) Act 709 31.1.34 Selling Milk containing 4.7% added water Dismissed unable to prove ownership Public Health (Preservatives in Food) Regulations. 750 29.8.33 Selling Minced Meat containing S02 an added preservative Fine £5 Costs £10 10s. Od. 518 9.11.33 Selling Table Jelly containing excess of preservative No fine Costs £2 2s. Od. 116 Legal Proceedings—contd. Date Offence Inspector Result Milk and Dairies Order, 1926. 28.3.33 Filling bottle with milk otherwise than on registered premises Weeks Fine £1 Costs £2 2s. 0d. 11.5.33 Not using all practicable precautions to prevent milk being contaminated Weeks Fine £1 No costs 24.10.33 Filling bottle with milk other than on registered premises Weeks Fine £1 Costs £2 2s. 0d. Milk and Dairies (Consolidation) Act, 1915. 28.7.33 Selling milk from receptacle not conspicuously inscribed with name and address Weeks Fine £1 Costs 10/- Milk (Special Designations) Order 1.8.33 Selling milk purporting to be " Grade A " milk not of standard laid down Weeks Fine £1 No costs 31.10.33 Selling " Grade A " (T.T.) milk without a license Weeks No fine Costs £2 2s. 0d. 31.10.33 Selling " Grade A " (T.T.) milk not in accordance with a license Weeks Withdrawn Public Health (Meat) Reaulations, 1924 30.6.33 Failing to have name and address inscribed on stall Henley Summons not served owing to wrong address given by defendant 30.6.33 Failing to have meat exposed for sale suitably covered over Henley do. Rata Flock Act. 24.5.33 Having in possession rag flock containing 20 parts excess of chlorine Jenkins Withdrawn Costs £3 3s. 0d. 24.5.33 Having in pssession rag flock containing 30 parts excess of chlorine Jenkins Withdrawn Costs £3 3s. 0d. 24.5.33 Having in possession rag flock containing 170 parts excess of chlorine Jenkins Withdrawn Costs £4 4s. 0d. 5.10.33 Metropolis Management Act. Failing to give notice of drainage work Billings Fine 10/Costs £2 2s. 0d. 117 APPENDIX II. TUBERCULOSIS DISPENSARY. REPORT FOR THE YEAR 1933. By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., Lond., Clinical Tuberculosis Officer. For the seventh year in succession there has been no change in the personnel of the Dispensary. I have to report, however, that I was off duty for four months during the year, owing to illness, and I would Like to take this opportunity of thanking the Committee for their sympathetic consideration during this period. Dr. Dowling assumed charge of the department, and I am grateful to him for the able and conscientious manner in which he carried on during my absence. He was able to do this the more readily and without any undue anxiety, as he was acquainted with every case. Our usual practice of consulting one another on most cases and discussing any special features and points of difficulty enables either Tuberculosis Officer, in an emergency, to take over entire charge of the department without the patients suffering in any way. No radical alteration in the routine of the department has been introduced during the year and the sessions have remained the same. Patients are 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 poasible, for school children, and the evening sessions for those who are at work during the day, but these reservations are not strictly adhered to if it is found inconvenient for any particular patient to attend during one of the morning sessions. Patients may attend during any part of the session, and are seen strictly in order of their arrival at the Hospital, irrespective of whether they are new or old cases. This arrangement reduces the period of waiting to a minimum. We continue to take advantage of our close association with the hospital in referring difficult cases for special opinions to the Physicians and Surgeons or to one of its special departments. We appreciate especially the facilities for personal interviews with the hospital staff, which enable us not only to discuss individual cases but to keep in touch with other opinions generally and to see other work. The number of cases referred to the X-Ray Department again shows an increase. This is only to be expected, as frequent improvements in technique have added considerably to the value of X-rays, not only in the detection of early tuberculosis, but in other directions also. Early infiltration of the lung may often be demonstrated by X-rays before the appearance of any physical signs, so that we cannot neglect to take an X-ray picture of any case whose symptoms suggest possible tuberculosis. It must not be forgotten, however, that occasionally a patient may have definite physical signs of disease with a positive sputum while the X-ray picture may fail to show any evidence of tuberculosis. The present tendency, therefore, to minimise the importance of routine physical examination and rely entirely on X-rays should be resisted, as the neglect of either method will result in failure to detect tuberculosis in certain cases and in erroneous diagnosis in others. 118 The errors of the Clinician are widely broadcast, but he is not alone in his fallibility : the Radiologist must take his due share although not receiving the same publicity. Like the Physician he is beset with numerous pitfalls. Shadows on the X-ray film caused by diseases other than tuberculosis, yet simulating it, are frequent, and it is not yet fully recognised that the correct interpretation of an X-ray film is often extremely difficult. Radiology of the chest is a special branch requiring years of experience, and while the opinion of the Radiologist who has made a special study of this is of inestimable value, that of his colleague with little or no experience in this particular branch may not only be useless but misleading. The use of X-rays is not limited to the diagnosis of early tuberculosis, but is of the greatest value in the differential diagnosis of tuberculosis, bronchiectasis, cancer of the lung, etc. X-rays will also show the extent of the disease, and often enable us to form an opinion of its activity—invaluable information in deciding the appropriate form of treatment. They will, further, help us to estimate more correctly the results of treatment, and are an indispensable guide in treatment by Artificial Pneumothorax. We are grateful to the Hospital for providing immediate admission for a number of urgent cases, and to the Staff for facilities in following up our cases while in the wards. This arrangement adds considerable interest to our work, as it enables us to keep in touch with all the latest methods of treatment and diagnosis. The local charitable organisations continue to give us their valuable support, and we are specially indebted to the Invalid Children's Aid Association for sending a large number of our debilitated children to convalescent homes in the country or at the seaside. Both Tuberculosis Officers are members of the local committees of this Association. The Charity Organisation Society has provided dentures, surgical instruments, clothing, etc., when necessary, while the United Services Fund has helped the families of ex-service men. The children attending Stormont House open-air school have made good progress during the year. It has previously been the practice of the London County Council to allow only notified cases of tuberculosis in this class of school, but recently it has been decided to admit in addition " suspect " cases of tuberculosis. This innovation would, at first sight, appear to be undesirable, and I was not very hopeful that the parents of suspect cases would readily agree to their children working in such close association with definite cases of tuberculosis. I was, however, able to assure these parents that no actively infectious case was allowed to remain at the school and there has been little difficulty in obtaining their consent. The school is full, and there is a large number awaiting admission, but as preference is given to notified cases, it is to be hoped that the increased waiting list will not materially delay the entry of the definitely tuberculous child. There are 90 children on the roll, with an average attendance of 74. With two or three exceptions all the children come from the neighbouring boroughs of Bethnal Green. Hackney and Stoke Newington, and are recommended for admission either by Dr. Hamilton of the Metropolitan Hospital Dispensary or by myself, and as Dr. Hamilton is a member of the Committee of Management, we frequently meet at the school and consult one another on the progress of the children. Both pulmonary and non-pulmonary cases of either sex are eligible for admission, and the ages range from six to sixteen years. The classes are held in special open-air shelters which have recently been renovated and brought up to date. Records of temperature, weight, etc., are kept by the nurse, and I visit the school weekly, making frequent examinations, and directly supervising the exercise and rest of each child. Hot milk during the morning and an excellent dinner mid-day are provided at a nominal charge, but no payment is exacted in necessitous cases. It is the aim of the London County Council that all children attending open-air schools should receive a summer holiday. Accordingly, 57 of the 119 children, who would not otherwise have had a holiday, were sent to Broadstairs for two weeks during the summer for the usual annual school journey. Under this scheme, the children, who are accompanied by their teachers, continue with their lessons, but as these largely take the form of nature study, practically all their time is spent in the open air. While it would be difficult to demonstrate any immediate and tangible evidence of benefit, such as marked increase in weight or improvement in the physical signs of disease, I am satisfied that school journeys have a beneficial influence on the general health of the children. In addition to the school journey, four children received a school holiday at Margate, while three boys, whose general health was not satisfactory, were sent to the Victoria Home, Broadstairs, for three months. During the year 13 children were transferred to elementary schools, treatment in an open-air school being considered no longer necessary, while 10 children were discharged as fit for work and placed in employment by the School Care Committee. In addition to open-air schools for tuberculous children there are, throughout London, a number of other open-air schools for non-tuberculous delicate children. Both classes of schools, I am certain, play a very useful part in the treatment and prevention of tuberculosis. Among other essentials these schools ensure :— 1. A healthy environment with abundance of fresh air for the greater part of the day. 2. Greater freedom from the risk of infection or re-infection. As many of the children come from infected homes there is considerably less exposure to prolonged and massive doses of infection. The risk of bovine infection is obviated by sterilisation of the school milk supply. 3. A higher standard of cleanliness than it is possible to maintain in the ordinary elementary school. Bathing facilities are available at Stormont House for those needing them, dental hygiene is supervised and cleanliness of the heads of children rigidly enforced. 4. A hygienic mode of living is instilled into the child, which it carries into the home and probably never quite loses for the remainder of its life. 5. More immediate means for the treatment of diseases other than tuberculosis, and the prevention of the spread of infectious diseases. With weekly observation and frequent routine examination it is often possible for the Medical Officer to detect disease in its incipient stage and to ensure immediate treatment. Likewise the daily attendance of the nurse, who takes the temperature of the children morning and evening and reports as to the presence or otherwise of a rash or sore throat in any child with a rise in temperature, has frequently resulted in the immediate exclusion of an early case of infectious disease. Naturally, we have had, at Stormont House, isolated cases of measles, diphtheria, and scarlet fever contracted elsewhere, but thanks to the vigilance of the nurse there has not been a single incidence of the spread of the infection to other children in the school since it was opened 15 years ago. The scheme introduced by the London County Council in 1922, which aimed at closer working arrangements between the school medical service and the Dispensary and a reduction in the number of children attending the Tuberculosis Dispensary, is still being carried out. All healthy contacts and those who after a period of observation at the Dispensary show no definite evidence of tuberculosis, together with other children whose health is not entirely satisfactory, are transferred to the school medical department. The Tuberculosis Officer sends a report on each case to the School Medical Officer, who provides special observation for such cases, arranging periodic examinations and the keeping of accurate records of weight, etc. Should the School Medical Officer later suspect tuberculosis in any of these children they are immediately referred back to the Dispensary for further investigation. 120 The scheme is working smoothly, and the School Medical Officer and Tuberculosis Officer arrange consultations when necessary. The arrangements for institutional treatment have again shown steady improvement. The period of waiting is less, and no patient has been refused treatment suitable to his case. The advanced case is no longer the problem it formerly was, as a large number of beds in the London County Council general hospitals is now available for this class of patient. There is still some difficulty in persuading patients to enter these institutions, but it would appear that the prejudice to these hospitals is becoming less acute. Moreover, as patients are now frequently offered a choice of hospital, it is often found that a patient who refuses to enter his local hospital will not hesitate to accept the offer of a vacancy in a hospital more remote from his home. This increased tendency on the part of the advanced case to enter hospital should, I feel certain, have a definite influence in the prevention of the spread of infection. I still continue to act as Consultant to the Bethnal Green Hospital and visit the Hospital regularly every fortnight, or more frequently, if required. The London County Council has recently had under consideration the whole question of the management of the tuberculosis wards of their general hospitals, and I am pleased to report that the appointment of tuberculosis officers as consultants has been confirmed. I think these appointments desirable, as it enables us to keep in touch with our patients, and the mere fact that we can assure a patient that we will continue to visit him in the hospital often enables us to persuade him to enter when otherwise he would not consent. I would like to take this opportunity of thanking the medical staff of Bethnal Green Hospital for their unfailing courtesy and willing co-operation. The results of sanatorium treatment have shown considerable improvement in recent years. The factors contributing to this improvement are many, but probably the more important are earlier diagnosis with the aid of X-rays, the less virulent nature of the disease with an increased individual resistance, and recent advances in treatment, such as the use of Artificial Pneumothorax and Sanocrysin, although perhaps it is a little too early to give any decided opinion on the latter form of treatment. But the patient on leaving sanatorium has only won half the battle, and it is to be regretted that a fight so well begun should so frequently end in disaster. While it is true no panacea has been discovered, it cannot be denied that medical science has at least done something, only to be thwarted at the critical moment by economic conditions, as it is only too true that relapses occur in proportion to the standard of living of the patient's family. What is the prospect of even the most hopeful case with the disease quiescent on his discharge from sanatorium ? He has probably lost his job, and the mental distress occasioned by his hopeless task of finding employment and his inability to provide for himself and family is only too soon reflected in his general health. Under such conditions it is not surprising that relapses are frequent. The majority of ex-sanatorium patients are capable of doing remunerative work under suitable conditions, but they cannot be expected to compete in the open market with the able-bodied. The policy of helping a man to regain his health and working capacity, when the former will probably relapse and there is no opportunity of taking advantage of the latter, would not appear to be a very sound one, either from humanitarian reasons or from an economic aspect. The burden of the tuberculous patient on leaving sanatorium is usually more than he can bear unaided, and as the trouble at this stage is mainly economical, none but the State can render efficient treatment, and the care of the tuberculous, to be efficient, should be continuous and permanent. I offer no excuse for again urging the necessity for the provision of workshops subsidised by the State, where patients could work at suitable occupations under direct medical supervision and obtain a living wage, and emphasizing the fact that the cost to the State could not possibly be greater than their continuous maintenance in total unemployment. An extension 121 of the village settlement might be considered as an. alternative scheme, but a large number of patients are temperamentally unsuited for this life. The Tuberculosis Care Committee succeed in finding employment for a certain number of our patients, but more frequently all their endeavours result in failure. The Handicrafts Class, organised by the Hackney and Stoke Newington Care Committee, makes no pretence of enabling patients to earn a living, but it provides an interest to occupy their minds and helps to save them from brooding over their condition. The crafts taught are varied and useful and include leather, bead, basket and pewter work and the making of gloves and artificial flowers. The class is run on voluntary lines, since the Ministry of Health does not sanction the use of public funds for this purpose, but as the Care Committee have no funds at their disposal, some difficulty is experienced in raising the necessary money to carry on. Unless further support is forthcoming, it is feared the class may have to close down—a step that would be regretted both by the Committee and the patients, who are keenly interested in the work. The scheme for the supply of extra nourishment in necessitous cases, adopted by the Boroughs in 1921, has been slightly modified during the year. The Public Assistance Committee now undertakes the responsibility for the provision of extra diet in those cases of tuberculosis already in receipt of relief, leaving the Boroughs to provide for those cases who do not come under the care of the former body. This arrangement should prove more satisfactory, as it will release a certain amount of Borough funds previously expended on those in receipt of relief and so enable us to extend the grant, and should also prevent any overlapping. Formerly the borough expenditure sanctioned by the Ministry of Health was not permitted to exceed £2 per 1,000 of the population, but since the introduction of the Block Grant local authorities are allowed a greater latitude in this direction. The additional diet given takes the form of milk and eggs, and is particularly helpful to patients leaving sanatorium who are unable to provide suitable nourishment for themselves pending their return to work. The local authorities' expenditure on special forms of treatment, such as Finsen Light for Lupus and refills in Artificial Pneumothorax, tends to increase yearly. Finsen Light treatment of Lupus is on the whole very satisfactory and effects a cure in a large majority of the cases. But facial Lupus appears to be peculiarly resistant to treatment, and relapses are common. A few cases of the latter have now been under treatment for years, and while we realise the expense involved, we have no alternative but to persist with Finsen Light, as no other form of treatment offers anything like the same chance of ultimate cure. The main cause of the growth of expenditure, however, is the increase in the number of Artificial Pneumothorax cases, but in view of the encouraging results of this form of treatment the expense, in my opinion, is completely justified. Recently local authorities have also been asked to accept financial res ponsibility for another special form of treatment, namely, that of Sanocrysin or gold. In many quarters it is felt that this form of treatment has not yet passed the experimental stage, and that public authorities should not assume responsibility for it until its success is more generally accepted. I submit at the end of this report a statistical summary of the work of the Department for the year. Apart from a slight fall in the number of new cases and the total number of attendances in both Boroughs, the tables presented show no striking variation as compared with those of recent years. Under the circumstances I, therefore, do not propose to enter into any detailed examination of the figures. 122 In conclusion I would like to thank the Medical Officers of Health, the Hospital Physicians and Surgeons, the Resident Medical Officer, and the Hospital Secretary for their valuable help and advice, and the Dispensary Staff for their efficient work and loyal support. H. TYLFORD HOWELL. 14th March, 1934. It is with very deep regret that I have to report the death from Pneumonia on 24.1.34 of Dr. W. J. Dowling, the Assistant Tuberculosis Officer. Dr. Dowling was an able physician and a most agreeable and loyal colleague, very popular with his patients by reason of his unfailing courtesy, his bright and cheery manner, and his ready sympathy. His services to the department were unstinting, and his loss will be keenly felt. H.T.H. 123 STATISTICAL TABLES. BOROUGH OF BETHNAL GREEN. STATISTICAL TABLES. BOROUGH OF BETHNAL GREEN. The Totals of New Cases. Males 337 Females 366 693 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 198 28 Local Practitioners 175 33 Contact cases (per M.O.H.) 225 3 London County Council 15 2 Victoria Park Hospital 17 17 Other sources 49 34 Transferred from other Areas 14 13 3. The Diagnosis of the New Cases. Diagnosis. Adults. Children under 15. Total. Males. Females. Males. Females. Pulmonary Tuberculosis 62 34 1 1 98 Non-pulmonary Tuberculosis 5 7 11 9 32 Non-tuberculous 135 184 105 110 634 Doubtful 13 9 5 2 29 Total 215 234 122 122 693 124 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 3 Non-pulmonary Tuberculosis — Non-tuberculous 217 Doubtful 5 Total 225 5. Sputum Examinations. Tubercle Bacilli present 69 Tubercle Bacilli absent 438 Total 507 6. Other Figures. Total number of attendances 4,135 Systematic examinations at the Dispensary 1,804 Number of patients sent to hospital or sanatorium by the L.C.C. 50 Number of letters written l,320 Number of visits to patients at their homes 90 Number of attendances at:— X-Ray Department 227 Dental Department 7 Sunlight 48 Other Departments 33 125 TUBERCULOSIS SCHEME OF THE BETHNAL GREEN METROPOLITAN BOROUGH COUNCIL. (a) Return showing the work of the Dispensary for the year 1933. Diagnosis. Pulmonary Nonpulmonary Total Grand Total Adults Children Adults Children Adults Children A. —New cases examined during the year (excluding contacts): (a) Definitely tuberculous M. F. M F. M. F. M. F. M. F. M F 49 32 1 1 5 6 11 9 54 38 12 10 114 *(b) Diagnosis not completed ... ... ... ... ... ... ... ... 11 7 4 2 24 (c) Non-tuberculous ... ... ... ... ... ... ... ... 98 118 49 52 317 B. —Contacts examined during the year:— (a) Definitely tuberculous 2 1 ... ... ... ... ... ... 2 1 ... ... 3 *(b) Diagnosis not completed ... ... ... ... ... ... ... ... 2 2 1 ... 5 (c) Non-tuberculous ... ... ... ... ... ... ... ... 37 66 56 58 217 C. —Cases written off the Dispensary Register as (a) Recovered 1 1 ... ... ... ... 3 3 1 1 3 3 8 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous ... ... ... ... ... ... ... ... 136 184 105 110 535 D. —Number of Cases on Dispensary Register on Dec. 31st (a) Definitely Tuberculous 280 184 14 17 47 35 94 73 327 219 108 90 744 (b) Diagnosis not completed ... ... ... ... ... ... ... ... 6 3 4 2 15 1. Number of cases on Dispen- sary Register on January 1st 733 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 18 3. Number of cases transferred toother areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 81 4. Cases written off during the year as Dead (all causes) 48 5. Number of attendances at the Dispensary (including contacts) 4133 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 200 7. Number of consultations with Medical Practitioners :— (a) Personal 25 (b) Other 285 8. Number of visits by Tuber- culosis Officers to homes (including personal consultations) 90 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2657 10. Number of :— (a) Specimens of sputum, &c., examined 507 (b) X-ray examinations made in connection with Dispensary work 227 11. Number of ''Recovered" cases restored to Dispensary Register, and included in A(«) and A(6) above 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 270 * i.e. Remaining undiagnosed on 31st December. 26th February, 1934. H. T. Howell, Clinical Tuberculosis Officer. 126 127 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 1933 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 Prev. to 1926 1926 1927 1928 1929 1930 1931 1932 1933 Class T.B. minus Class T.B. plus Class T.B. minus Class T. B. plus Class T.B. minus ClaasT B. plus Class T.B. minus Class T. B. plus Class T.B. minus Class T.B- plus Class T.B. minus Class T.B plus Class T.B- minus Class T.B. plus Class T.B. minus Class T B. plus Class T.B. minus Class T B- plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 1 Group 2 I 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) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December Disease Arrested Adults M. 6 3 3 1 2 F. 2 1 Children 2 1 Disease not Arrested Adults M. 33 13 12 4 29 1 2 2 4 1 1 5 1 7 4 2 1 2 5 6 3 5 3 11 6 5 6 4 15 6 2 6 2 10 6 3 15 7 25 18 4 8 9 21 F. 20 4 6 3 13 1 1 1 1 1 1 2 3 3 3 2 8 6 1 4 1 6 4 3 1 4 4 2 5 1 8 7 5 6 4 15 19 4 8 12 Children 8 1 1 1 3 1 1 1 1 1 1 2 1 1 2 Condition not ascertained during the year 14 7 8 4 19 2 1 1 1 3 2 2 2 5 3 2 1 6 6 1 3 2 6 5 3 3 4 10 5 2 6 1 9 7 4 5 3 12 Total on Dispensary Register at 31st December 83 24 29 12 65 8 3 3 2 8 7 2 7 2 11 14 8 6 5 19 18 6 12 6 24 17 11 10 8 29 17 7 17 4 28 22 13 26 14 53 39 8 16 9 33 (b) Not now on Dispensary Register and Reasons for removal therefrom Discharged as Recovered Adults M 1 1 F. 2 1 Children 2 Lost Sight of or otherwise Removed from Dispensary Register 22 12 9 8 29 6 6 4 2 12 6 7 1 1 15 7 3 4 3 10 10 2 4 8 14 9 5 7 1 13 8 7 9 2 18 4 3 3 3 9 1 1 1 Dead Adults M. 11 5 14 8 27 6 6 14 16 36 3 2 6 11 19 6 1 14 18 33 2 1 8 15 24 9 1 3 28 32 5 7 14 21 2 1 2 4 7 3 4 5 9 F. 3 6 8 7 21 3 4 7 17 28 7 4 9 6 19 3 3 6 9 18 5 5 9 14 3 5 13 18 3 6 9 3 1 4 5 1 1 Children 1 1 1 1 1 1 2 1 1 2 Total Written off Dispensary Register 41 23 31 23 77 17 16 25 36 77 17 13 22 18 53 17 7 25 31 63 17 3 17 32 52 21 6 16 43 65 12 7 19 22 48 9 4 6 11 21 4 1 4 6 11 Grand Totals 124 47 60 35 142 25 19 28 38 85 24 15 29 20 64 31 15 31 36 82 35 9 29 38 76 38 17 26 51 94 30 14 36 26 76 31 17 32 25 74 43 9 20 15 44 128 129 (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 1933 of all Patients remaining on the Register. Conditional the time of the last record made during the year to which the Return relates Prev. to 1926 1926 1927 1928 1929 1930 1931 1932 1933 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December Disease Arrested Adults M. 1 1 2 1 1 1 1 F. 1 1 1 1 1 1 1 1 Children 5 3 8 1 1 2 1 1 1 1 1 1 1 1 2 1 1 2 Disease not Arrested Adults M. 6 1 2 9 1 1 1 3 1 1 2 1 1 1 3 1 1 1 1 1 3 1 1 3 1 2 1 7 1 1 2 1 5 F. 2 1 2 5 1 1 2 1 1 1 1 2 1 1 2 1 1 1 3 1 1 2 1 2 1 1 5 Children 8 1 2 20 31 1 1 4 6 1 1 2 2 2 4 1 3 4 5 1 6 12 5 2 2 6 15 5 2 6 13 5 2 13 20 Condition not ascertained during the year 6 1 12 19 1 6 7 2 1 3 2 1 2 5 1 1 2 4 2 1 4 7 2 1 1 4 8 3 1 4 8 Total on Dispensary Register at 31st December 29 2 5 39 75 6 1 2 12 21 5 2 2 9 6 3 7 16 4 3 6 13 9 2 1 13 25 11 4 4 11 30 11 4 3 12 30 7 5 3 15 30 Transferred to Pulmonary 1 2 3 1 1 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom Discharged as Recovered Adults M 1 1 1 3 F. 1 1 2 Children 5 3 8 1 1 1 1 1 3 1 1 Lost sight of. or otherwise Removed from Dispensary Register 6 1 6 21 34 5 2 2 9 3 1 1 2 7 2 1 6 9 3 3 6 2 1 3 6 1 1 5 7 1 1 Dead Adults M. 1 1 1 1 F. 1 1 1 1 2 1 1 Children 1 1 2 1 1 Total written off Dispensary Register l5 5 8 23 51 7 1 2 3 13 4 1 2 3 10 2 1 6 9 4 3 7 2 2 3 7 1 1 5 7 1 1 1 1 Grand Totals of (a) and (b) excluding those transferred to Pulmonary) 44 7 13 62 126 13 2 4 15 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 12 31 8 5 3 15 31 130 INDEX. PAGE Aged and Infirm Persons 85 Ambulances 17 Bacteriological Examinations (medical) 84 do. do. (food) 91 Bakehouses 94 Bedsteads, Bedding and Clothing (Tuberculosis) 78 Births 22, 24 Breast Feeding Clinic 45 Cancer 30 Chicken Pox 81 Cleansing Stations : Personal 19, 83 Clinics 13, 36 Combined Drainage Systems 103 Common Lodging Houses 99 Condensed Milk Regulations 91 Convalescent Treatment 62 Cowhouses 94 Day Nurseries 14 Deaths 22, 24 „ from Motor Traffic 30 Delicate Children: Clinic for 53 Dental Clinic (M. & C.W.) 54 Dental Treatment of Tuberculosis Patients 79 Diabetes 81 Diphtheria 71 DISEASE, CONTROL OF 69 Disinfectants : Distribution of 84 Disinfection 82 Dispensaries 13,19, 79 Drainage Work 103 Dried Milk, &c. 53 Dried Milk Regulations 91 Enlarged Tonsils, Adenoids and Mastoid Disease 56 Enteric Fever 72 Expenditure on Public Health Work 9 Extra Nourishment 78 Factories and Workshops 109 Finsen Light Treatment 80 Fish Curing and Fried Fish 94 FOOD 86 Food Premises 92 ,, Poisoning 85, 96 Food and Drugs Acts 87 Foster Children 65 Fried Fish and Fish Curing 94 General Description of District 7 GENERAL SANITARY ADMINISTRATION 97 German Measles 81 131 PAGE Hairdressers 103 Health Education Lectures 21 HEALTH SERVICES 10 Health Visitors 35 do. do. Tuberculosis 77 Home Helps 52 Home Workers 110 Hospitals 11 HOUSING 104 ,, Schemes 106 Ice Cream 94 Illegitimacy 24 Imported Food 96 Infant Consultations 38 Infantile Mortality 22,28 INFECTIOUS DISEASE 69 Inhalation Therapy 58 Insanitary Areas 106 Insurance Acts, National Health 17 INTRODUCTION DISEASE 6 Invalid Children's Aid Association 15 Joint Dispensary Committee (Tuberculosis) 79 LEGAL PROCEEDINGS 113 Light Treatment 56 Malnutrition : Hospital treatment for 63 Marriages 24 Massage 60 Maternal Mortality 22,28 MATERNITY AND CHILD WELFARE 33 Maternity Clinic 41 Maternity Institutions 16 Maternity Outfits 52 Measles 80 Meat Regulations 95 Medical Inspection (school children) 65 Medical Practitioners 11 „ ,, Consultations with 72 Midwifery: Borough Midwifery Service 51 Midwives 16 Milk 89 Milk for necessitous mothers and children 52 Milkshops and Dairies 92 Milk (Special Designations) Order 93 Mortuary 31 Mothers' Clinic 48 Motor Traffic Accidents 30 Noise 100 Notification of Births 34 Nurseries, Day 14 Nurses and Nursing Assistance 11,63 Nutrition, Rent and 105 Obstetrical Consultants 52 Offensive Matter 102 do. Trades 102 132 page Open-Air Sleeping Shelter 78 Ophthalmia Neonatorum 65 Orphans 15 Orthopaedic Treatment 59 Outworkers 110 Overcrowding 104 Personal Cleansing Stations 19, 83 Pneumo-thorax Refills 80 Population 24 Poultry Slaughterers 95 Public Assistance 8 PUBLIC HEALTH COMMITTEE 3 Public Health Expenditure 9 Puerperal Fever and Puerperal Pyrexia 64 Rag and Bone Dealers 102 Rag Flock Act 102 Rats and Mice 101 Registration of Births, Deaths and Marriages 20 Rent Restrictions Acts 100 Sanatorium Treatment 98 Scabies (Itch) 83 Scarlet Fever 71 School Children : Medical Inspection 13,65 School Meals 10 Shelter for Contacts 84 do. Open-Air Sleeping 78 Slaughterhouses 95 Smallpox 71 Smoke Nuisance 100 Social Welfare 7 Special Clinic for Delicate Children 53 Sputum Outfits 78 STAFF 4 Stillbirths 24 Street Accidents 30 Talks to Mothers 50 Tenement Houses 99 Toddlers' Clinic 39 Tonsils, Adenoids and Mastoid Disease 56 TUBERCULOSIS 74 Tuberculosis Dispensary 79 „ Officer, Report of 117 Underground Rooms 105 Unsound Food 96 Vaccination 20 Vaccination Returns 73 Venereal Disease 19 Verminous Conditions 83 VITAL STATISTICS 22 Water Supply 100 Welfare Centres 36 Whooping Cough 81 Workshops and Factories 109 "V