M. AC 4366 BET 41 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1936 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 Tee & Whiten an<l J. Mead, Ltd., 21 City Road, E.C.I THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1936 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 Tee & Whiten and J. Mead, Ltd., 21 City Road, E.C.I Metropolitan Borough of Bethnal Green PUBLIC HEALTH COMMITTEE, 1936-37 as on 31st December, 1936 Meetings held at the Town Hall at 7 p.m. on the first Wednesday. *Councillor Mrs. B. L. Tate, Chairman. *Councillor E. F. Berry, Vice-Chairman. *Councillor Mrs. M. S. Bridger. *Councillor Mrs. E. Peaston. „ A. G. Clark. * „ Mrs. R. Rockfelt. „ J. C. Edwards. * „ Mrs. M. Simmonds. * „ Mrs. A. Hillman. „ A. E. Turpin. „ W. C. Johns. „ E. A. Wormald. *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 H. P. Wilson, J.P.). Committee: Chairman: Baths Councillor W. C. Johns. Electricity „ E. Schleich. Finance „ E. A. Wormald. Housing ,, H. Hooke. Law and General Purposes „ H. E. Tate, J.P. Libraries „ J. C. Edwards. Staff „ W. G. Webster. Street Trading Ald. E. Balme. Valuation Councillor H. J. Stubbs. Works and Stores „ P. J. Bridger. 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 Mrs. M. S. Bridger, Mrs. B. L. Tate, and W. J. Webster. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT, as on 31st December, 1936. Vynne Borland, M.B., Ch.B., B.Sc., D.P.H., Medical Officer of Health. Sanitary Inspection: Maternity and Child Welfare: General Administration: *W. Billings vcancy *J. Henry Lloyd, f.s.s., Chief Clerk. Senior Sanitary Inspector. Assistant Medical Officer F.G. Thomas *J. O. G. Weeks Food †‡Miss G. I. Le Geyt, *R.W. Slyfield *§G. E. Gould Inspectors. Superintendent Health Visitor L.A. Taylor *E. J. Jenkins, Workshops Inspector. †‡Miss E. M. Patrick, S.P.Hansen Clerks. *§F. C. Sharpe, Housing Inspector. Assistant Supt. Health Visitor. R.F.Marshall '*G. I. Brighting †‡Mrs. F M. Barden J. E. Pestell *G. S. Freeman Districtsanitry inspector †‡Miss V. D. Cornish J.P Mackenzie *§W. H. Heron †‡Miss A. G. Dyer Health S. A. Edmonds. Junior Clerk §S. B. B. Slater †‡Miss C. E. Love visitor *E. F. Swash †‡Miss A. A. Page Visitors. †‡Miss M. Playle †‡Mrs. A. W. Rosling †‡Miss L. F. Wright *Certificated Sanitary Inspector. †‡Miss E. E. Taylor, Borough Midwife. Tuberculosis: §Certified Meat, etc. Inspector. Miss M. . Hazcll, Clerk Dispenser. †‡dtMrs. J. Callow Tuberculosis Miss D. M. Hare, Clerk. †tMiss. M. L. Grant Visitors. † Certificated Nurse. Disinfection '†Certified Midwife. tTuberculosis Certificate. dHealth Visitors' Diploma. 1 Leading Disintector, 3 Disinfectors. Combined Drainage: Employees: 1 Drain-layer, 3 Labourers. Maternity §Child Welfare Centre: Personal Cleansing Station: 1 Storekeeper, 1 Caretaker, 2 Attendants, one of whom acts as 1 Woman Attendant (part-time). 3 Cleaners (part time). Temporary Mortuary Keeper. 5 Unestablished Part Time Officers at 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 M. Barnby, L.D.S. (B.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. (Ldn.). Junior, F. Temple Clive, M.R.C.S., L.R.C.P. (Ldn.). Public Analyst: A. E. Parkes, F.I.C., F.C.S. Vaccination Officers : H. J. Hardwick (North East). Miss M. Peters (South West). Staff Changes During 1935. As mentioned in the prefatory letter in last year's Annual Report, Mr. Evan Richards, Chief Sanitary Inspector, died on the 12th May, 1936. Mr. W. Billings was subsequently appointed Senior Sanitary Inspector, Mr. F. C. Sharpe was transferred to Housing and other special duties and his place as District Sanitary Inspector was taken by Mr. G. S. Freeman. Mr. Freeman's position in the office was taken by Mr. J. P. Mackenzie and Mr. S. A. Edmonds was appointed to the vacancy thereby created as Junior Clerk. Dr. K. M. Horton resigned her appointment as full time M.O., for M. & C.W., the resignation taking effect on the 31st October, 1936. Dr. A. M. Purce was appointed to the vacant post at the end of the year and took up her duties on the 1st January, 1937. 6 Public Health Department, Town Hall, Bethnal Green, E.2. 24th May, 1937. 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 for the year 1936. The general death rate at all ages from all causes was 12.7 per thousand of the population. When corrected by the comparability factor of the Registrar General (1.13) the rate becomes 14.3, which is 2.9 higher than the previous year. My comments on this increase will be found under the heading on Vital Statistics. I gave warning last year, when the rate was the lowest on record, to be prepared for a set back this year in the Infant Mortality Rate, as 1935 fortunately fell between the biennial epidemic of measles. Whereas in that year there were no deaths from measles, 4 deaths from whooping cough and 16 from diarrhcea, in 1936 there were 17 deaths from measles, 13 from whooping cough, and 39 from diarrhcea. Mainly on account of these deaths the Infant Mortality Rate is 98 per thousand births. Further comment is made later. The Maternal Mortality Rate was 2.1 which is accounted for by there being 3 deaths as against 2 in the previous year. 7 I have to record for the third year in succession a reduction in the number of cases of Diphtheria and Scarlet Fever, there being 223 cases of Diphtheria and 332 cases of Scarlet Fever compared with 330 and 414 respectively in the previous year. I am pleased to place on record my appreciation to the members of the Public Health Committee for their many courtesies, and their earnest and sympathetic consideration of all problems relating to the public health. My thanks are also due to my colleagues in other departments for their help and co-operation on many matters and to the public health staff throughout for their loyal and efficient support. I am, Ladies and Gentlemen, Your obedient Servant, Vynne Borland. 8 GENERAL DESCRIPTION Bethnal Green is a roughly rectangular shaped district in East London, about 1¾ miles from west to east and about one mile from north to south, and 760 acres in area. It is bounded by Shoreditch and Hackney on the north, Stepney on the south and Poplar on the east. Where the original soil exists it is of gravel and sand formation. The surface is generally flat, varying from 36 to 54 feet above sea level. The principal industries carried on in the district are the making of boots, shoes and clothing, cabinet making and other branches of the furnishing trade. The main lines of the Great Eastern section of the L.N.E.R. pass through the Borough. There are also three railway stations in the Borough, and several others in close proximity, while various tram and motor bus routes traverse the main roads in the Borough. There is a considerable daily inflow and outflow of workers, with the larger stream outward to workplaces in other parts of London. The tendency is for the Borough to be increasingly used for industrial and commercial purposes and the resident population is very congested. At the 1931 census there were 18,156 structurally separate dwellings in the Borough, and 27,978 families or separate occupiers lived therein. There is an excellent open space to the east of the Borough in the shape of Victoria Park, and there are a few small open spaces elsewhere in the Borough. The rateable value of the Borough on the 31st December, 1936, was £528,311, and the product of a Id. rate is estimated at £2,020. SOCIAL WELFARE. The close connection between the economic position of the people and their standard of health makes it necessary to collate some of the outstanding facts about the social welfare of the residents in the Borough. Large numbers of them are still unemployed and a still larger number either working short time or in employment of very irregular and 9 unreliable duration. Those who are so fortunate as to have employment of comparative regularity are frequently paid low wages. In considering the figures as to public assistance it should be borne in mind that these only relate to cases in which assistance has actually been invoked. There are doubtless thousands of individuals who struggle on in economic difficulties either through technical ineligibility for such assistance or disinclination to seek it. The foregoing circumstances naturally lead to a low standard of life, where nutrition, clothing and housing fall below the levels desirable for a healthy life. While public measures of one kind and another have done a great deal to prevent gross deterioration, such as existed before the war, it must be recognised that they are inadequate to ensure that the families concerned (who constitute a substantial section of the community) can get enough of the right types of food, clothing and housing to maintain the much higher standard of life which may reasonably be expected by every member of the community to-day. Public attention has been recently directed to the nutrition branch of this problem, which is all to the good, but I think it necessary to emphasise that while food may be the first essential for a healthy life, it is by no means the only one. We have also to consider whether families have the means to provide themselves with such clothing and shelter as they need for the protection and sound development of their bodies. 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. Although there has been some improvement during the year, the large amount of unemployment and poverty in the Borough is indicated by the considerable number of persons receiving public assistance, which was 3,787 at the end of 1936. 10 LONDON COUNTY COUNCIL PUBLIC ASSISTANCE DEPARTMENT—AREA II. Number of Persons in Receipt of Out-Relief Week Ending Men Women Children under 16 Total Persons Total Cases 4. 1. 36 1,400 1,845 1,861 5,106 2,316 27. 6. 36 1,252 1,677 1,465 4,394 2,133 26. 12. 36 1,099 1,535 1,153 3,787 1,958 I am informed by the Education Officer that the average number of necessitous school children provided with meals of some kind at public elementary schools in the Borough during the year was 1003 (milk), and 45 (dinners). This number of children is surprisingly small in view of the widespread poverty in the Borough. The number of children obtaining cheap milk under the scheme of the Milk Marketing Board is not known. Economic enquiries made in connection with applications for various Maternity and Child Welfare services continue to indicate that a very large portion of the population is living at a low level. PUBLIC HEALTH EXPENDITURE. During the financial year 1935-36, the cost of the Public Health service was £25,959, or 5s. 4d. per head of the population, equivalent to a rate of 1s. 1d. in the £. 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 11 indeed health functions are exercised by an extraordinary diversity of agencies. The number of these agencies has been somewhat reduced by the legislation of recent years, but there seems much need for further simplification. The Borough Council is the Maternity and Child Welfare authority, but between 3 and 5 years of age most 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. Brief notes about some of them follow. GENERAL MEDICAL PRACTITIONERS. There are 36 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. 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. 12 HOSPITALS. Public. London County Council: Bethnal Green Hospital, Cambridge Road. I am indebted to Dr. W. P. Greenwood, the Medical Superintendent, for the following statistics concerning the work of the Bethnal Green Hospital for the year. (Information as to the Midwifery work of the hospital is given in a later paragraph in this report). No. of admissions 6,203 Operations performed 1,480 (including 716 under general anaesthesia and 215 abdominal sections). Out-patients (5,776) Attendances 38,253 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:— Dental: No. of patients 339. Attendances 770. No. of extractions 235. Dentures: full upper and lower 13, partial 1. Massage: Patients treated 811; Treatments given 22,897. X-ray: In-patients X-rayed 2,747; Out-patients 1,979. 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 25,180 106,346 2,171 Mildmay Mission Hospital, Austin Street 56 15,723 52,496 939 17·35 City of London Hospital for Diseases of the Heart and Lungs, Victoria Park 188 13,373 44,102 1,273 44·8 13 The Queen's Hospital also has 44 beds at a country branch, the Little Folks' Home, Bexhill. In addition to its importance as a consultative centre, both in respect of Tuberculosis and Heart conditions, the City of London Hospital carries on a great deal of research work. The London Hospital, Whitechapel Road, although situated outside the Borough, is also largely used by residents. DISPENSARIES, &c. The following Dispensaries exist in the Borough, and I have been furnished with the following statistics concerning last year's work. No. of Out-Patients. Out-Patients' Attendances. Visits to Patients' Homes. *Queen Adelaide's Dispensary Pollard Row 1,405 4,022 550 §Medical Mission, St. James-the-Less, St. James's Road 327 4,071 298 †Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 3,085 22,214 4,643 *There is also a Dental Department attached to this Dispensary. †There were also attendances as follows:—Dental Department, 1,103; Eye Department 359; Massage and Sunlight 109; Chiropody Clinic 211. §In addition, 115 patients had dental extractions. CLINICS. For Children Under Five. The Council has a Welfare Centre in Cornwall Road (as well as 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 discussed in the Maternity and Child Welfare Section of this Report. For School Children. These are under the control of the London County Council. 14 By the courtesy of Sir Frederick Menzies, School Medical Officer, L.C.C., I have been furnished with the following information concerning local arrangements for the medical treatment of school children. "The Bethnal Green school treatment centre is situated at the St. James-the-Less Dispensary, St. James's Boad, 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 384 children were treated. Spectacles were prescribed in 275 cases and in 241 cases spectacles were obtained. "The dentist visits the centre on twenty-one sessions a month, and the schools in the neighbourhood on one session a fortnight to inspect the children's mouths. During the year 3,845 children were inspected in the schools and 2,744 or 71 per cent. were found to require treatment. The number of children treated at the centre was 1,608 and 3,139 attendances were made. "In the minor ailments department the doctor attends on two sessions a week, and two nurses are in attendance daily. During 1936, the number of children treated was 1,854, and 23,225 attendances were made." DAY NURSERIES. There is now only one Day Nursery in the Borough, the Bethnal Green Day Nursery, Somerford Street, which belongs to a voluntary society. I have been furnished with the following information concerning its work. Accommodation 30 Total attendances 5,617 Average attendance 25.5 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:— "In the past year this Branch of the Association has been in touch with many delicate and crippled 15 children living in Bethnal Green, who have been referred to us for convalescence, for visiting and advice, for help in obtaining surgical instruments or other necessary treatment. In all, 277 new cases were referred to us this year, and apart from these we have helped and visited 148 children already known to us. 149 of these were sent away for convalescence for an average stay of seven weeks. Many more were visited and kept under observation at the request of doctors, hospitals and dispensaries of the district, and 53 were helped to obtain surgical instruments. "It may be of interest to know that among these children were 28 suffering from rheumatism and heart trouble, 64 with pneumonia, bronchitis, or other chest affections, and 61 who were anaemic or debilitated. The measles epidemic resulted in about 20 children being sent to us, usually for convalescent treatment, which proved necessary after an attack of measles or the complications accompanying it. Many of these were referred by the Public Health Department. "Much of our work is done for the London County Council, and in all of it we co-operate closely with the Council and the Borough Council, whose help and support is of much value, and is sincerely appreciated". 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). 16 London County Council: There are 30 maternity beds in the Bethnal Green Hospital, and 6 midwives are employed. Dr. W. P. Greenwood informs me that 573 maternity cases were dealt with in the year. An ante-natal clinic is held weekly for women intending to enter the hospital for confinement and 557 women made 3,343 attendances at the Clinic, 284 of the mothers were also seen at the post-natal clinic, making 406 attendances thereat. Other. There are 2 private midwives living and practising in the borough while several others who reside outside also occasionally practise 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 At Ante-Natal Hospital Home Clinic City of London Maternity Hospital, Attendances City Road 29 4 194‡ Mothers' Hospital, Clapton 19 60 148† East End Maternity Hospital 39 — * Jewish Maternity Hospital, Stepney 41 4§ 175° London Hospital, Whitechapel 210 187 2,145 *Practically all mothers attend Council's Maternity Clinic. †Relating to 21 mothers attending: in addition there were 310 attendances at the S.A. Ante-Natal Clinic at Nichols Square. ‡Relating to 35 mothers attending. §In addition to attendances at Ante-Natal Clinics, these patients were visited at home by midwife (13 ante-natal visits). °Primiparse also attend weekly sewing class, urine test and antenatal care lecture. The Royal London Maternity Charity granted 94 free midwives' letters to Bethnal Green mothers during the year, 17 MEDICAL TREATMENT OF PERSONS INSURED UNDER THE NATIONAL (HEALTH) INSURANCE ACTS. Arrangements are made by the London Insurance Committee. I understand that 68 medical practitioners are on the panel for the Borough, 29 of them having surgeries in the Borough. AMBULANCES. The following synopsis of the L.C.C. ambulance arrangements is given: 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 case of accident or sudden illness in the street, place the telephone receiver to the ear (and dial "O" if connected to an automatic exchange). When the operator answers, ask for "ambulance" and wait for the reply " ambulance "; then give particulars. In cases other than accident, etc., the following telephone number should be used:—WATerloo 3311. This number is connected to the central call office for ambulances which is open continuously and is located at the London County Council, County Hall, S.E.1. Applications for vehicles may also be made by letter, telegraph, or personal call at the central call office or any of the ambulance stations. Letters should be addressed to the Medical Officer of Health, London Ambulance Service, County Hall, S.E.1. 18 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.1. WAT 3311 Eastern Brooksby Walk, E.9. Hackney Paragon Road, Mare Street, Hackney, E.9. Highbury Calabria Road, Highbury, N.5. Poplar 7, Woolmore Street, E.l4. Shoreditch 5, Montclare Street, E.1. TUBERCULOSIS DISPENSARY. This is situated at the City of London Hospital for Diseases of the Heart and Lungs, Victoria Park, and its work is fully discussed in the Tuberculosis Section of this report. VENEREAL DISEASE. This is dealt with by the L.C.C. The nearest treatment centres are at the Whitechapel Clinic, Turner Street, adjoining the London Hospital, Whitechapel Road, and the Metropolitan Hospital, Kingsland Road. 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: Children resident in the Borough and attending L.C.C. schools found to require treatment for scabies, 20 impetigo or personal hygiene receive the necessary treatment under the approved scheme at the Cleansing Station, situated in Russia Lane. During the year 4,691 attendances were made for vermin and 951 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:— For S.W. Bethnal Green:— H. J. Hardwick, Miss M. Peters, 106, Bishops Road. 347, Bethnal Green Road. Office Hours:— Office hours:— Mon.-Fri. 10 a.m.-l p.m. 10.30 a.m.-l p.m. daily. Sat. 10 a.m.-12 noon. Mon. and Fri. 3-5 p.m. VACCINATION. The Public Vaccinators are:— For N.E. Bethnal Green:— For S.W. Bethnal Green:— Dr. E. F. Fernando, Dr. J. G. L'Etang, 83, Roman Road. 386, Bethnal Green Boad. Each Registrar of Births and Deaths acts as Vaccination Officer in his (or her) district. HEALTH EDUCATION. The usual daily educational work of the Welfare Centre by Doctors and Health Visitors, and also of the Sanitary Inspectors was carried on during the year. Leaflets on a variety of subjects supplemented the spoken word. 21 The remaining two lectures and film displays of the 1935-36 series were held on the 29th January and 4th February, the first being for men (chairman, Councillor A. G. Turpin, lecturer Dr. R. Forgan) and the second for women (chairman, Councillor Mrs. M. S. Bridger, lecturer, Dr. Rose Turner). Both meetings were well attended and as usual the questions showed an intelligent appreciation of the subjects dealt with. The Public Health Committee has continued the arrangement with the Public Libraries Committee to take advertisement space on the book marks published by the latter. This space is used to give publicity to various aspects of maternity and child welfare and other public health services. 22 VITAL STATISTICS EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. LIVE BIRTHS. Males Females TOTAL Birth Rate Legitimate 614 655 1,312 13.5 Illegitimate 21 22 TOTAL Rate per 1,000 total (live and still) births. STILLBIRTHS 55 40.2 DEATHS. Males Females TOTAL Death Rate M.O.H. 642 587 1,229 12.7 R.G. 645 587 1,232 When corrected by the Comparability Factor of the Registrar-General (1.13), the Death Rate becomes 14.3. MATERNAL MORTALITY. Number of women dying in, or in consequence of, childbirth:— Rate per 1,000 total (live and still) births. From Sepsis 2 1.4 From other puerperal causes 1 0.7 INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births:— Legitimate 97 98 Illegitimate 139 Deaths from Cancer (all ages) 175 „ „ Measles (all ages) 17 „ „ Whooping Cough (all ages) 13 „ „ Diarrhœa (under two years of age) 39 23 VITAL STATISTICS of Bethnal Green During 1936 and Previous 5 Years Year Population Estimated to Middle of Each Year Births Transferable Deaths Net Deaths of Persons Resident in the Borough Uncorrected Number Net Total Deaths Registered in the Borough Of Nonresidents registered in the Borough Of Residents not registered in the Borough At all ages Under 1 year of Age Number Birth Rate Number Death Rate Number Rate per 1,000 births or infantile mortality 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 15.4 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 1934 102,060 995 1,460 14.3 1,272 352 287 1,207 11.8 106 72.6 1935 99,910 996 1,438 14.4 1,129 331 229 1,027 10.3 74 51 1936 96,900 1,071 1,312 13.5 1,343 318 432 1,229 12.7 128 98 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 1936 of 96,900. MARRIAGES. The number of marriages registered in Bethnal Green during 1936 was 797. This is equal to a rate of 16.4 persons marrying per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1936 was 1,071, and in addition 241 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 1,312 births (635 males, 677 females). The birth-rate for 1936 was, therefore, 13.5 births per 1,000 population, the lowest ever recorded in the Borough. The provisional birth-rate for London is given as 13.6 and for England and Wales as 14.8. ILLEGITIMACY. Of the births credited to this Borough, 43 were illegitimate, being 21 males and 22 females, and being 3.3 per cent. of the total number of births. STILLBIRTHS. Fifty-five stillbirths were registered as belonging to the Borough, being a proportion of 4.0 per cent. of all births alive or dead. 25 DEATHS. The number of deaths during the year belonging to the Borough according to local records was 1,229, but the Registrar General gives the figure as 1,232. Whichever figure be correct, it gives an annual crude death rate of 12.7 per 1,000 population which when multiplied by the Registrar-General's Comparability Factor is corrected to 14.3 and may be compared with 12.5 for the County of London and 12.1 for England and Wales as a whole. I pointed out last year that the very favourable climatic conditions and low death rate experienced during 1935 were exceptional and that it would be too optimistic to expect a similar result in the following year. My caution has been justified in the event. 1936 was emphatically not a good year for weather and was characterised by epidemics of influenza, measles and whooping cough with their sequelae in bronchitis and pneumonia as well as by substantial increases in the deaths from the main causes like heart disease, cancer, tuberculosis, etc. which were below their usual level in the previous year. Infantile mortality and the deaths from cancer, street accidents and from tuberculosis and other infectious diseases are subjects of comment in other parts of this report. The causes of death among the population of Bethnal Green as returned by the Registrar General are given in the accompanying table. 26 27 CAUSES OF DEATH at different periods of life in the Metropolitan Borough of Bethnal Green, 1936 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 645 71 14 7 6 23 22 26 70 129 158 119 F 587 58 9 11 11 10 21 35 57 79 150 146 1. Typhoid and Paratyphoid Fevers M 1 ... ... ... ... ... ... ... ... 1 ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 2. Measles M 9 2 4 3 ... ... ... ... ... ... ... ... F 8 3 4 1 ... ... ... ... ... ... ... ... 3. Scarlet Fever M 1 ... ... ... ... ... 1 ... ... ... ... ... F 1 ... ... ... ... ... ... ... ... 1 ... ... 4. Whooping Cough M 5 4 1 ... ... ... ... ... ... ... ... ... F 8 3 2 2 1 ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... F 4 ... ... 1 3 ... ... ... ... ... ... ... 6. Influenza M 8 ... ... ... ... 2 1 1 1 1 1 1 F 5 ... ... ... ... 1 ... 1 ... 2 ... 1 7. Encephalitis Lethargica M 1 ... ... ... ... ... ... 1 ... ... ... ... F 1 ... ... ... ... ... 1 ... ... ... ... ... 8. Cerebro-Spinal Fever M 5 ... 2 3 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system M 44 ... ... ... ... 5 7 3 10 16 3 ... F 21 ... ... 1 ... 3 4 4 6 1 2 ... 10. Other Tuberculous Diseases M 11 1 1 1 1 4 1 1 ... 1 ... ... F 5 1 ... ... ... 1 ... ... ... 3 ... ... 11. Syphilis M 3 ... ... ... ... ... ... 2 1 ... ... ... F 2 ... ... ... ... ... ... ... 1 1 ... ... 12. General Paralysis of the Insane, tabes dorsalis M 1 ... ... ... ... ... ... ... ... ... 1 ... F 2 ... ... ... ... ... ... ... 2 ... ... ... 13. Cancer, malignant disease M 99 ... ... ... ... ... 1 1 15 31 36 15 F 76 ... ... 1 ... ... 4 6 15 17 17 16 14. Diabetes M 4 ... ... ... ... ... ... ... 1 1 1 1 F 15 ... ... ... ... ... ... ... 2 4 5 4 15. Cerebral Hæmorrhage, etc. M 13 ... ... ... ... ... ... 1 3 1 5 3 F 29 ... ... ... ... ... ... ... 3 3 16 7 16. Heart Disease M 184 ... ... ... ... 1 4 4 13 27 73 62 F 196 ... ... ... ... 2 7 8 7 22 70 80 17. Aneurysm M 3 ... ... ... ... ... ... 1 ... 2 ... ... ... 1 ... 1 F 2 ... ... ... ... ... ... ... ... ... ... 2 ... 7 5 18. Other Circulatory Diseases M ... ... ... ... ... 14 5 5 1 3 F 14 ... ... ... ... ... ... ... 4 8 5 4 19. Bronchitis M 23 1 ... ... ... 1 ... ... 25 5 1 ... ... ... ... ... 1 2 10 6 F 2 1 ... 2 7 20. Pneumonia (all forms) M 50 21 3 ... 1 6 7 6 10 2 3 6 F 36 ... 2 2 ... 3 2 3 2 1 21. Other respiratory Diseases M 7 ... ... ... ... ... 1 ... ... 1 ... F 1 ... ... ... ... ... ... ... ... ... 22. Peptic Ulcer M 6 ... ... ... ... ... ... 2 1 2 1 ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 23. Diarrhœa, etc. M 24 22 2 ... ... ... ... ... ... ... ... ... F 16 16 ... ... ... ... ... ... ... ... ... ... 24. Appendicitis M 1 ... ... ... ... ... ... ... ... ... ... 1 F 3 ... ... ... ... ... ... 1 ... 1 1 ... 25. Cirrhosis of Liver M 1 ... ... ... ... ... ... ... ... 1 ... ... F 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 2 26. Other Diseases of Liver, etc. M 4 ... ... ... ... ... ... ... 2 F 2 ... ... ... ... ... ... ... ... ... ... 1 1 2 2 2 1 27. Other Digestive Diseases M 11 1 ... ... ... 1 1 1 3 3 3 1 F 12 ... ... ... ... ... 2 1 4 7 6 28. Acute and Chronic Nephritis M 20 ... ... ... ... ... ... 4 5 ... 1 2 F 12 ... ... ... ... ... ... 29. Puerperal Sepsis F 2 ... ... ... ... 1 ... 1 ... ... ... ... 30. Other Puerperal Causes F 1 ... ... ... ... ... 1 ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformations, etc. M 16 16 ... ... ... ... ... ... ... ... ... ... F 18 18 ... ... ... ... ... ... ... ... ... ... 32. Senility M 6 ... ... ... ... ... ... ... ... ... 2 4 5 F 5 ... ... ... ... ... ... ... ... ... ... 5 ... 3 33. Suicide M 11 ... ... ... ... 1 ... 2 ... ... ... ... ... ... 3 2 1 ... F 6 ... ... 1 ... 34. Other Violence M 10 ... ... ... 3 1 1 1 1 2 ... ... ... 3 ... ... 2 1 2 1 7 f 16 1 6 2 2 9 14 5 6 35. Other Defined Diseases M 49 3 1 ... 1 9 6 5 6 5 f 40 2 ... 2 4 ... 36. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Totals ... 1232 129 23 18 17 33 43 61 127 208 308 265 28 MATERNAL MORTALITY. During the year, the following deaths were noted: 1. Toxœmia during pregnancy following las and nephritis. 2. Pyaemia following abortion. 3. Mammary abscess and pulmonary embolism. 4. Myocarditis accelerated by obstetric shock and anaemia. Only the first three cases have been counted as Maternal Mortality for statistical purposes, giving a rate of 2.1 per 1,000 total births (live and still). In England and Wales the rate was 3.81 per 1,000 births. INFANTILE MORTALITY. One hundred and twenty-eight deaths of Bethnal Green infants under one year of age are recorded as having taken place during the year. This is equal to a rate of infantile mortality of 98 per 1,000 births. The infant death rate for London was 66 and for England and Wales as a whole 59. Comparison with previous years is as follows:— 1926 71.1 1927 57.7 1928 73.9 1929 64.4 1930 60.3 1931 87.7 1932 69.1 1933 66.3 1934 72.6 1935 51.0 29 Coming after the record low rate for 1935, the rate for 1936 is very disappointing. The increase is almost wholly accounted for by four diseases. The biennial epidemic of measles occurred during the year, accompanied by many cases of whooping cough, accounting between them for a death rate of 9 per 1,000. Pneumonia was responsible for a similar increase, while diarrhœa deaths gave an increased death rate as high as 18.3 per 1,000. As will be remembered, the year was characterised by a deficit of sunshine, and the autumn and winter were one prolonged period of gloomy rainy weather, with a loss of opportunity for outdoor recreation. 30 The causes of death among infants are shown in the following table. Infantile Mortality in Bethnal Green in 1936 Causes of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 3 months & under 6 months 6 months & under 9 months 9 months & under 12 months Total Deaths under 1 year Rate per 1,000 Births Measles ... ... ... ... ... ... 1 2 2 5 ... Whooping Cough ... ... ... ... ... 1 3 1 2 7 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... Tuberculosis ... ... ... ... ... ... ... 1 1 2 ... Bronchitis ... ... 2 ... 2 ... 3 2 ... 7 ... Pneumonia (all forms) 1 1 2 ... 4 2 11 8 5 30 ... Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... Diarrhœa and Enteritis ... ... ... 1 1 13 11 6 6 37 ... Other Digestive Diseases ... ... ... ... ... ... ... ... 1 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 ... ... ... 1 2 1 ... ... 4 ... Congenital Debility ... 1 ... ... 1 ... ... ... ... 1 ... Premature Birth 18 1 1 ... 20 1 ... ... ... 21 ... Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 ... Other early infancy diseases 4 2 ... ... 6 ... ... ... ... 6 ... †Other Causes ... ... ... ... ... ... 3 1 1 5 ... Totals 26 5 5 1 37 19 33 21 18 128 ... Net Births in the year legitimate 1269 illegitimate 43 Net Deaths in the year legitimate infants 122 illegitimate infants 6 † Meningitis (2), Otitis-media, Erysipelas and osteomyelitis (1 each). 31 CANCER. Cancer was responsible for 175 deaths or 14.0 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 5 2 7 Digestive organs and peritoneum 53 35 88 (Esophagus (2-0) Stomach (23-13) Intestines (5-9) Rectum (15-7) Others (8-6) Respiratory organs 21 3 24 Uterus — 8 8 Other Female genital organs — 2 2 Breast — 14 14 Male genito - urinary organs 13 — 13 Skin 1 1 2 Other or unspecified organs 6 11 17 99 76 175 DEATHS FROM MOTOR TRAFFIC. After some years of reduced mortality among local residents from motor traffic accidents in the streets, there was a serious lapse in 1936 when the following 17 deaths occurred: M 7 Knocked down and ran over by motor lorry. M 14 Fell under motor bus. M 14 Collision with motor bus while cycling. 32 M 19 Pedal cycle swerved causing his head to strike telegraph post. M 27 Rode pedal cycle into stationary coffee stall. M 45 Fell from pedal cycle under motor lorry. M 55 Knocked down by tram. F 5 Run over by motor coach. F 6 Knocked down by motor car. F 10 Knocked down by motor van. F 36 Thrown out of overturned motor van. F 39 Knocked down by private motor car. F 52 Knocked down by motor van. F 61 Knocked down by motor. F 71 Knocked down by commercial van. F 78 Run over by motor bus. F 86 Knocked down bv private motor car. PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year no bodies were received at the Mortuary. The limited use of the mortuary during recent years is due to the fact that the District Coroner 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 AND CHILD WELFARE There were no changes of great importance in the Maternity and Child Welfare service during the year apart from the resignation of Dr. K. M. Horton at the end of October. We are still anxiously awaiting the allocation of a site for a Welfare Centre and Day Nursery in the Re-development Area to serve the North Ward. It seems probable that a satisfactory scheme for this purpose will be framed during 1937. Co-operation with the maternity hospitals serving the Borough continues and it will be noted that one of them has fully accepted the Council's offer to undertake the ante-natal care of its patients. In the case of Bethnal Green and London Hospitals we have now what amounts to a virtual scheme of notification of pregnancy so that preparations for the confinement can be supervised by the Health Visitors from an early stage. NOTIFICATION OF BIRTHS. During the year, 1,083 live births were registered in the Borough ; and 1,060 live births were notified to the Medical Officer of Health. There were also 51 stillbirths notified. Of the 1,111 living and stillbirths notified, 224 were found to relate to other districts and were duly transferred, 736 were notified by midwives, 105 by maternity assistants of the London Hospital, 38 by medical practitioners, and 8 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 472 live babies and 15 stillbirths being received in this way. The net total of notified live births belonging to the Borough was 1,321. 34 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) 1,341 11,855 Children (1—2 years) 5 10 4,454 13,478 „ (2—3 years) 1 3,984 ,, (3—4 years) 3 2,841 „ (4—5 years) 1 2,199 Mothers (Ante-Natal) 672 623 „ (Post-Natal) 101 535 Stillbirths 34 37 Infant Deaths 51 10 Maternal Deaths - - Puerperal Fever (9) and Pyrexia (28) 9 28 Ophthalmia Neonatorum 5 15 Acute Poliomyelitis 1 3 Other Notifiable Diseases 5 4 Diarrhœa and Enteritis 3 2 Measles (2,586), and German Measles (3) 1,089 1,500 Whooping Cough 189 484 Other Non-Notifiable Diseases 22 39 Milk Grants 1 1 Convalescent Treatment 4 2 Other matters 53 225 Total Visits 3,590 28,841 Grand Total 32,431 In addition, 120 visits and 2,157 re-visits were rendered futile owing to the absence of the mother or the occasion being inconvenient for an interview. 35 The indoor (clinic) work of the Health Visitors is shown in the following figures:— Sessions attended Maternity Clinics 149 Children's Clinics 1,256 Dental Clinic 170 Light Clinic 282 Mothers' Clinic 73 Other Clinics 378 Total 2,308 The Council's Health Visitors assist the midwifery department of the London and other Hospitals by reporting on the home conditions and preparations of expectant mothers who have booked with these hospitals 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. The total number of outdoor visits shows little change from last year but owing to the prevalence of measles there was some falling off in the visits to expectant mothers and children over one year of age. MATERNITY AND CHILD WELFARE CENTRES. At the Council's principal Centre in Cornwall Road, there are 2 morning sessions and 3 afternoon sessions for infant consultations, and 2 sessions in connection with the Maternity Clinic each week. The special session for toddlers was temporarily suspended at the end of the year pending the consideration of other means for dealing with this branch of the work. Other work carried on at the Centre in connection with the Special Clinic for Delicate Children, light and inhalation therapy, massage, milk grants, etc., will be found reported on under these separate headings. 36 The auxiliary centre at St. Matthew's Institute, Hereford Street, is used for Infant Consultation Sessions on Monday and Thursday afternoons, and an Ante-Natal Clinic on Thursday mornings. The following ratios may be of interest:— Ante-Natal Clinics Children's Clinics Acreage per Centre 380 380 Population per Centre 48,450 48,450 Percentage of new expectant mothers, or babies under 1, attending Centres respectively, to total net births 27.3 73.6 MATERNITY CLINIC (CORNWALL ROAD). This is open every Wednesday and Thursday morning. Particulars of attendances: Total Expectant Mothers—First visits 272 1,050 ,, —Subsequent visits 778 Mothers recently confined—First visits 188 283 „ ,, ,, —Subsequent visits 95 Total Attendances 1,333 The number of sessions was 105, and the average attendance per session was 12.7, as compared with 14.8 and 12.2 the previous two years. 80 of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement. The 272 women who attended for the first time may be grouped as follows:— Gravid:—Primiparæ 33 —Multiparæ 221 254 Not pregnant 18 37 In the case of the 254 gravid women, the following were the periods of gestation:— 1 was in the 1st month 16 were in the 2nd „ 22 „ „ „ 3rd ,, 28 „ ,, ,, 4th ,, 33 ,, ,, ,,5th ,, 54 „ „ „ 6th ,, 51 „ „ „ 7th 43 „ „ „ 8th „ 6 ,, ,, ,,, 9th ,, An analysis of these cases shows:— Full-term confinements 169 Premature births 6 Miscarriages (5); Stillbirths (5) 10 Maternal death (heart failure) 1 Not yet confined 56 Left Borough (results unknown) 12 The known confinements took place:— 112 at home, and 57 in institutions. The results of the 62 cases brought forward from 1934 were as follows:— Full-time confinements 58 Miscarriage 1 Left district (result unknown) 3 Dr. R. C. Townshend reports on the work of the Maternity Clinic, as follows:— Report to the Medical Officer of Health on the Cornwall Road Ante-Natal Clinic for the year 1936. There has been a slight decrease in the number of attendances of expectant mothers, which in my opinion is due to the increasing number of mothers who are confined in hospitals or institutions and consequently attend the corresponding ante-natal clinic. I am glad to report an increase in the number of mothers recently confined. I regret to report there was one maternal death due to heart failure. The patient attended the clinic on one occasion only at the tenth week of pregnancy and then booked 38 with an institution for her confinement, and remained under their supervision throughout her pregnancy. With regard to the miscarriages, in three cases the patients were multigravidæ and attended the clinic suffering from threatened miscarriages and were immediately referred to hospital. In one case, the patient was a 12gravida and had a six weeks miscarriage following a fall, and in the remaining case the patient was a primipara of 81, suffering from anaemia. With regard to the stillbirths, in every case labour was premature, and in three cases there was a history of antepartum haemorrhage, one case being due to placentaprævia. With regard to the premature confinements, in two of these cases, the cause was ante-partum haemorrhage, and in one case hydramnios. Ruth C. Townsiiend. MATERNITY CLINIC, HEREFORD STREET. This clinic is held once weekly on Thursday mornings and both ante-natal and post-natal cases are seen. The figures show a substantial reduction on those for 1935. This no doubt mainly reflects the fall in the number of births. RECORDS:— Expectant Mothers: First attendances 90 Subsequent attendances 274 Mothers recently confined: First attendances 65 Subsequent attendances 62 Total attendances 491 Number of sessions held 53 Average attendance per session 9.2 Mothers attending both before and after confinement 18 Primiparæ 2 Multiparæ 73 Not pregnant 15 90 Periods of Gestation:— In the 1st month 1 ,, 2nd ,, 10 ,, 3rd ,, 11 ,, 4th ,, 14 ,, 5th ,, 9 » 6th ,, 11 39 In the 7th month 12 „ 8th „ 7 ,, 9th „ Nil Full-term confinements 40 Not yet confined 27 Removed from district 6 Pregnancy terminated 1 Miscarriage 1 Stillbirths 1 Known confinements at home 25 „ „ in institutions 15 Cases brought forward form 1935:- Full-term confinements 25 Removed from district 1 Miscarriage 1, Stillbirth 1 2 MOTHERS' CLINIC. This clinic, established to give birth control advice to married women within the terms of the memoranda of the Ministry of Health, is held every month. The average attendance continues to increase and weekly sessions have now been found necessary. Every mother receives a complete physical and gynæcological examination at her first attendance, when it is decided whether she is eligible for advice at the clinic. Total attendances during year 411 Average attendance per session 34.3 Analysis of cases attending:— First Attendances: Contraceptive advice given 60 Referred to Burdett Road Clinic 1 Total new cases 61 Subsequent Attendances 350 Total Attendances 411 Mothers have been referred, to the Clinic by:— Medical Officers at Welfare Centres 38 Health Visitors 14 Hospital Doctors 3 Old Patients 11 40 Clinical Analysis of Cases given Contraceptive Advice: Anæmia 14 Anæmia and Malnutrition 7 Anæmia with other conditions (heart etc.) 4 Rheumatic conditions 7 Heart Disease 1 Nephritis 1 Epilepsy 2 Hyperthyroidism 1 Pulmonary Tuberculosis 3 Neurasthenia 16 „ and Malnutrition 1 Recurrent miscarriage 1 Amputation of Breast 1 Psychosis 1 Total 60 Cases Referred to Burden Road Clinic:— No abnormal condition discovered 1 Incidence of Pregnancy in 1936:— Failure of technique 5 By own wish and at own risk 4 One death occurred after sterilisation followed by embolism. BOROUGH MIDWIFERY SERVICE. The Borough Midwife had 21 bookings carried forward from 1935. The following figures show the work of the Borough Midwife during the year:— Bookings carried forward 21 ,, received in 1936 81 102 Cases delivered by— Borough Midwife 45 Deputy 30 Doctor 3 78 (of these 17 were primiparæ, and 71 multiparæ). 41 Cases sent to hospital during pregnancy 1 Cases removed in labour to hospital by Borough Midwife 3 Cases entering hospital on own account 2 Removed from Borough 2 Other cancellations 4 Cases on books at end of year 12 102 The Borough Midwife and her deputy paid 940 visits in connection with her practice. She also conducts a regular weekly session for ante-natal care of her patients. OBSTETRICAL CONSULTANTS. The Council has a panel of three Obstetric Consultants, who may be called in by any general practitioner in any midwifery case which presents difficulty or abnormality. One consultation took place during the year. HOME HELPS. At the end of the year, there were 12 Home Helps on the panel, with 6 other women acting occasionally as relief helps. During the year, Home Helps were arranged for in 172 cases. In 61 cases the mother paid a contribution for the services rendered. This service, despite its difficulties and the falling birth rate, steadily maintains its usefulness. Of the 184 applications made during the year, some 27 were not proceeded with for various reasons such as non-payment of contribution, removal from district, admission to hospitals, or relative being found available for help at confinement. 42 Miss Le Geyt reports: "A feature of the work in 1936 has been the need for extending, on medical grounds, the Home Help's service beyond the allotted two weeks. This has been greatly appreciated by the invalid and the household in all the 50 cases supplied with extensions of the service. Emergency applications for Home Helps were arranged in response to requests from the Lady Almoners of nearby hospitals at the time of discharge of patients after confinement, and also on the recommendation of the Medical Officers of the Maternity Clinics." MATERNITY OUTFITS. Outfits were issued as follows:—Free, 133; Sold, 71. Total, 204. CHILD WELFARE CLINICS. Cornwall Road Hereford Street Sessions per week 5 2 Doctors' attendances per week 8 3 The statistics of attendances at the Centres during 1936, and in previous years are as follows:— Cornwall Road Hereford Street Total Babies (0—1): First attendances 680 292 972 Subsequent „ 6,283 2,598 8,881 Children (1—5): First ,, 86 42 128 Subsequent „ 4,723 1,629 6,352 Toddlers Clinic attendances 146 - 146 Total „ 11,918 4,561 16,479 43 The numbers of consultations on children seen by the doctors were as follows:— Cornwall Hereford Road Street Total Babies (0—1) 3,679 1,728 5,402 Children (1—5) 3,021 1,180 4,201 Total 6,700 2,903 9,603 1935*. 1934*. 1933*. 1932*. 1931. 1930. Total Attendances 16,612 16,195 17,632 18,668 19,100 19,843 New Cases 1,172 1,528 1,466 1,510 1,400 1,497 Medical Consultations 9,328 9,025 9,969 10,462 12,062 11,982 *Including Toddlers Inspections. INFANT CONSULTATIONS. I append some extracts from reports of the Medical Officers on their work at the Centres during the year: "It seems to me that mastitis, generally followed by breast abscess, is becoming more common than it used to be. Frequently now we have cases that have to be w.eaned on account of this. It is most disappointing because usually I think the mothers with most milk tend to have mastitis. Besides the loss to the baby of breast milk, this is a most painful illness and may mean weeks of disablement with a tendency to recurrence in a future pregnancy. It usually happens from two to three weeks after delivery. " I have found the Breast Feeding Clinic of great value, not only as a means of discovering the quantity of milk secreted but also for the encouragement and advice which is given by the Health Visitors in charge. Often a mother is surprised to find that her baby cries because he is overfed rather than underfed. This can only be demonstrated to her by one or more test feeds. Often too the young woman with her first baby is given confidence and encouragement to continue breast-feedings when she finds from a test feed that she has more milk than she thought she had. "I feel more than ever the need of outdoor life for babies and young children. If only there could be provision for outdoor play centres. I hope in the new housing schemes this has not been forgotten." D. E. Mason. "When acting as locum tenens for the medical officer at the Bethnal Green Maternity and Child Welfare Centres, I am always impressed by the 'welfare mindedness' of the 44 mothers who attend there. With, indeed, few exceptions, they come with the firm conviction that whatever help and advice they require in connection with the health and management of their children will be forthcoming at the 'welfare' "The general condition of the children attending the centres regularly is, on the whole, good. There are comparatively few cases of rickets severe enough to be referred to the Orthopaedic Hospital and the minor cases for the most part respond well to the massage and ultra-violet light therapy available at the centre. Cases of bronchitis associated with dentition benefit considerably from treatment at the Inhalation Clinic. " I should have liked to see a greater number of children between the age of two and school age. The advent of another child invariably distracts the attention of the mother from the elder child for whom regular attendance at the centres would do much. "The nutrition of the children in general is as good as one can expect under present economic conditions. Again it is the toddler who shows most the ill effects of insufficient suitable nourishment. "The milk grant to necessitous cases, comparatively generous as it is, shows satisfactory returns in the improved condition of the recipient, yet the line which must be drawn between those eligible and those ineligible may be rigid enough to cause some heart burning. The way of the wife of the small wage earner is hard, when the difference between unemployment benefit and earned wages is small. The expenses incidental to the man's work, fares, etc., may leave less money available for the family nourishment than there was when he was in receipt of unemployment benefit, with consequent deterioration in the condition of the children concerned. "Thursdays during November and December of 1936 were notable for inclement weather and it says much for the expectant mothers attending the Hereford Street Maternity Clinic that they so largely kept the appointments made for them. It is satisfactory that they are so sure of deriving sufficient benefit from their attendance as to make the effort of getting there worth while, thus making possible the supervision which is necessary for their well-being and safety." a. r. pilkington. TODDLERS' CLINIC. In view of the change of Medical Officers and the continued low attendance of children the special weekly Toddlers' session was discontinued in November. As will be seen from the following figures, during the nine months the Clinic 45 was running only 127 children attended, the average attendance being just over four children per session. These small figures make it difficult to draw any reliable conclusions from the conditions found. It is, however, probably significant that such a high proportion of the children were found to require treatment of some kind. While some children may have been taken to the Clinic because they presented obvious signs of disease, it may reasonably be assumed that the majority of the mothers to respond to the invitation were of the careful kind whose children were, if anything, slightly above the average. Children inspected : Boys Girls Total At 2 yrs. 49 38 87 ,, 3 ,, 11 18 29 „ 4 „ 7 4 11 127 Subsequent attendances 17 Total attendances 144 Children requiring treatment or advice 122 Sessions held 33 Average attendance 4.4 Conditions found on examination: Defects of Development: Late Teething 22 „ Walking 10 „ Talking 8 Congenital Inguinal Hernia 1 Internal Strabismus 2 Tonsils enlarged (seriously) 30 Tonsils enlarged (slightly) 25 Adenoids 4 Mouth-breathers 3 Defects of Nutrition: Markedly below weight 5 Muscular tone poor 8 ,, ,, fair 50 Genu Valgum 12 „ Varum 4 Pesplanus 1 Dental Caries 14 Nutrition fair 78 46 Results of Infection : Adenitis, Cervical 25 Ear-Nose-Throat Otorrhœa 6 Nasal Catarrh 2 Results of Infection : Eyes Conjunctivitis 1 Recurrent Styes 1 Skin 8 Urticaria 5 Impetigo arts on head and face 1 Thyroglossal cyst 1 Chest Cardiac Murmurs 4 Fibroid Lung 2 Poor Air Entry 6 Management: Nervous tension 35 Night terrors 22 Enuresis 4 THE CARE OF THE TODDLER. One of the major problems of Maternity and Child Welfare is to secure the adequate medical supervision of the Toddler. Apart from such evidence as may be deduced from the foregoing figures and corresponding figures in the reports for the last few years, it is clear from other indications that the health of the young child between two and five is satisfactory. From the London County Council statistics relating to the medical inspection of Bethnal Green school entrants it appears that 52 per cent of the boys and 50 per cent, of the girls presented defects requiring treatment, these figures being actually worse than those for 1935, which were 44 per cent, in both groups. This can only be described as a serious state of affairs. The Borough Council has done everything in its power to provide adequately staffed and equipped Welfare Centres. They are well advertised and mothers are encouraged to make full use of them. The attendance figures show that there is a good response from expectant mothers and that infants in arms are well catered for. With children from two to five it is otherwise. During the year, only 423 individual children over one year of age attended the Welfare Centres (including the Toddlers' Clinic). As a large number of these were children 47 between one and two, the proportion of the children between two and five in the Borough who attend the Welfare Centres is obviously very small indeed. It is clear therefore that far more vigorous measures are necessary if we are to ensure that toddlers receive the medical supervision they need. More nursery schools would be a valuable contribution to this end. At present there is only one in the Borough. So far as the Borough Council is concerned, it has three means at its disposal:— 1. Home visits by the Health Visitors; 2. Medical supervision at the Welfare Centres; 3. Day nurseries. A substantial amount of useful work is being done under the first heading, as will be seen from the figures on previous pages. With regard to the third means, the Council is at present held up in its desire to provide a much needed Day Nursery in the North Ward by the pending Redevelopment of this part of the Borough. The most difficult problem is how to get the Toddler to the Welfare Centre which up to the present we have not been able to solve. For the moment, as an alternative plan to the special Toddlers session on Monday morning (an admittedly difficult time for most mothers), a special letter card has been devised to be issued to mothers about the time of their children's birthdays. This card urges the advisability of a general health overhaul at one of the Infant Consultation Sessions, thereby giving the mother a more convenient time and the opportunity of bringing other young children at the same time to save journeys. In addition to this, we are endeavouring to attract the mothers of children who have suffered from measles or whooping cough to bring up their children for medical examination and any possible benefit which may be derived from inhalation or light treatment for the clearing up of any after effects of their illness. I cannot help feeling that the problem is complicated by the fact that two distinct authorities are concerned in it and that there is no co-ordinated plan between them to deal with it. Although the school entrance age is nominally five, in actual practice in East London a large number, if not the majority, of children commence attending at three. Owing to illness or other reason, a certain number are taken off and on the school registers during these two years, which adds to the difficulty of making clear provision for the public oversight of this age period. The reasons leading to this large school entrance before the compulsory age are probably mainly social and they no doubt arise from the same domestic stresses which render regular attendance at the Welfare 48 Centres difficult for the mothers. It may well be doubted, however, whether the ordinary public elementary school is the most suitable provision for the toddler, nor are the school medical treatment facilities quite appropriate for very young children. The solution seems to lie in the pooling of the resources of the Maternity and Child Welfare and Education Authorities in a joint scheme. The features of such a scheme I think should be:— (a) A Welfare Centre in each ward of the Borough, sufficiently near to every home to make attendance easy. (The Borough Council has already adopted this principle, has centres in two wards, and is only waiting for sites to be available for such centres in the other two wards.) (b) The provision at each centre of facilities not only for medical inspection and therapeutic measures such as light treatment, inhalation, massage, and dental treatment, but also for minor ailments and facilities for obtaining tonsils and adenoids and orthopaedic treatment. Children attending would be eligible for milk grants, medicines and convalescent treatment. Any of these forms of treatment could of course be provided for school children over five if desired and arranged for, thus providing a school clinic in each ward of the Borough. (c) The establishment of one or more nursery schools in each ward in addition to such day nurseries as may be considered necessary. (There is at present one nursery school in the West Ward and a day nursery in the South Ward, while a second day nursery is proposed by the Borough Council in the North Ward. These might very well be considered in relation to, although they should not be restricted to, the Housing Schemes which are now under consideration.) (d) The medical inspection and treatment of all children under five to be delegated to the Borough Council, the County Council paying such contribution in respect of those attending school as may be reasonable in the circumstances. The foregoing plan would be in addition to the home visiting of the Health Visitors. With this unified effort and these facilities available, I think we might reasonably hope to bring practically all young children under systematic medical supervision and be able to prevent the onset of the health defects which characterise half the school entrants and render partly nugatory the work devoted to infancy. 49 SPECIAL CLINIC FOR DELICATE CHILDREN. Since 1925, a Special Consultation Clinic for Delicate Children has been in operation at the Centre, conducted by Miss 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. During the year 29 new cases were referred to Dr. Mackay and there were 166 consultations in all. DENTAL CLINIC. Three sessions per week are held in connection with the Dental Clinic, one (mainly for expectant mothers) conducted by Miss M. Barnby, L.D.S. (R.C.S.) and two by Mr. F. Reginald Bate, L.D.S. (R.C.S.). Miss Barnby reports on her work during the year as follows Sessions held 47 of which 13 were Gas Sessions T otal. Mothers. Children. New Cases 100 88 18 Subsequent attendances, including cases brought forward from 1935 322 306 16 Total 428 394 34 Total Mothers Children Average attendance 9 Gas administrations 78 77 1 Local anæsthetic 23 23 - Extractions 512 473 Gas ... ... ... 509 3 39 Local anaes. Fillings 25 25 - Gum treatment 41 41 - Scaling and polishing 28 27 1 Dentures 46 4 One plate 21 Two plates 25 - Expectant mothers treated 28 - Cases referred to Hospital 12 - Patients recommended by Centre Doctors 40 1 „ „ „ H.V. 39 9 ,, „ „ Others 9 8 50 This clinic is held once a week. During 1936 there was an increase in the number of mothers availing themselves of dental treatment; but unfortunately when the majority of them attended their mouths were in such an appallingly septic condition that total extraction was the only possible treatment to put their mouths into a healthy condition. As a result of this sepsis, the number of extracted teeth has increased from 177 to 512. The number of general anaesthetics has been nearly doubled, and local anaesthetics are more than double those administered in 1936. The marked tendency to dental caries during pregnancy is well known, but instead of taking extra care of their teeth during this period a large proportion of patients allow their teeth to decay until they have pain, and extraction is the only remedy. Also there was very little co-operation on the part of mothers in regard to conservative treatment. The denture work shows a definite increase, and the list of patients requiring dentures is growing rapidly and more time may be needed to cope with this work. Instruction is given in oral hygiene wherever improvement is possible. Mothers are encouraged to bring their children for regular inspection, even if no treatment is required. Muriel Barnby, L.D.S., Dental Surgeon. Mr. Bate furnishes me with the following statistics :— Sessions held, 98, of which 18 were Gas Sessions. Children attending routine inspections, 66, of whom 44 were found to require treatment 38 of these children were treated, the remaining 6 being under treatment at the end of the year. Children referred by Medical Officers and Health Visitors 136, 112 of them requiring treatment and making 313 subsequent attendances. In view of the continued disappointing response to the circular to parents inviting them to bring their children for dental inspection, a new combined propaganda card and prepaid reply card has been devised whereby parents can apply for a special appointment with the Dental Surgeon. These cards are sent out to a number of parents of toddlers every week, as well as being issued through the Public Libraries. The new method has not so far been any more successful than the old, only 70 cards being returned during the year, and it will probably be necessary to take more energetic measures to arouse parents to a sense of the urgent need for greater care of the teeth of toddlers. 51 Teeth extracted Children or stopped Treatment under gas 164 477 Treatment under ethyl chloride spray 33 41 Stoppings 89 162 Removal of stain by polishing 18 — Silver Nitrate 103 teeth — Gum treatment 3 Grinding smooth, chipped teeth 12 — Of the Routine Inspections for 1936, two-thirds of the total examined required treatment, which represents a much greater proportion than that of the previous year. The number of non-routine cases, and the subsequent attendances, together with the treatments completed, shows an increase on the previous year. F. Reginald Bate, L.D.S., R.C.S., (Eng.), Dental Surgeon. Dr. D. I. Mart acts as anaesthetist for both Miss Barnby and Mr. Bate. ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the arrangements with the Queen's Hospital, 16 young children had operations for enlarged tonsils as in-patients upon the recommendation of the Medical Officers of the Welfare Centres. LIGHT CLINIC. Difficult as it may be to demonstrate the tangible benefits of artificial light treatment by itself, there can be little doubt that taken in conjunction with other forms of treatment the general result is beneficial. Whether "the little extra" is physical or psychological it is certainly there. The Light Clinic is of special value in such a year as that under report when there were considerable periods with little or no bright sunshine. It will be seen from the 52 following figures that, apart from the general medical supervision given to all children attending the Welfare Centres, supplementary treatment such as massage and inhalation was given in a number of cases. No. of Sessions 149 Average attendance 36.0 Treatments :— Children : First attendances 343 Subsequent attendances 5,259 Mothers : First attendances Subsequent attendances — Total 5,602 Cases carried forward from 1935 59 Cases carried forward to 1937 34 Analysis of Cases :— No. of cases Marked Improvement Improved Lapsed Removec from Borough Also Massage having Inhalation Mothers : Nil Children : Malnutrition 44 12 15 15 1 1 7 Anaemia 12 — 7 5 — — — Delayed development 1 — 1 — — — — Nervous Tension 2 — 1 1 — — — Ansemia 31 4 12 14 1 — 4 Malnutrition 5 1 3 1 — — 2 Amyotonia 1 — — 1 — — — Cervical Adenitis 2 2 — — — — 1 Recurrent Colds 4 1 1 2 — — 1 Delayed development 8 1 4 — — 1 1 Rickets 77 11 32 32 2 21 8 Delayed development 72 11 33 27 1 9 10 Nervous Tension 19 5 10 4 — - 6 Debility after Measles 50 17 13 20 5 10 Influenza 1 1 — — — - — Whooping Cough 10 4 2 3 1 - 3 Rronchitis 10 2 5 2 1 - 6 Dysentery 1 — — 1 — - — Scarlet Fever 1 1 — — — - — Tonsillitis 3 — 1 2 — - 1 Adenitis 2 — 1 1 — - — Pneumonia 6 1 2 3 — - 2 Chicken Pox 1 — 1 — — - 1 Mumps 2 — 1 1 — - — Skin Recurrent Styes 1 - - 1 - - 1 Chilblains 1 1 - - - - - Congenital Heart Disease 1 — 1 — — - 1 Asthma 1 1 — - - — - 53 INHALATION CLINIC. This Clinic has continued to give treatment for catarrhal conditions of the upper respiratory tract by the inhalation of volatile oils atomised by the passage of a current of oxygen. During the year by the courtesy of the Inhaling Drug and Apparatus Co., the original Spiess-Drager Inhaling Apparatus has been replaced by the improved Collison type. Pine oil and Cajuput oil in equal parts have been used throughout the year. Three sessions are held each week and the treatment is sometimes given in addition to a course of Artificial Sunlight. It is effective and pleasant and can be a useful aid to the work in the infant consultations. Records :— Cases carried forward from 1935 9 New cases in 1936 : Children 109 Subsequent treatments 1,115 New cases in 1936 : Mothers 8 Subsequent treatments 55 Total treatments—1936 1,287 Cases carried forward to 1937 4 No. of sessions held in 1936 149 Average attendance per session 8.8 Clinical Analysis :— Cases Cured Improved Lapsed Bronchitis 36* 8 14 13 Tracheitis 2 1 1 — Fibroid Lung 1 — 1 — Asthma 1 — 1 — Emphysema 1 1 — — Tonsillitis 1 — — 1 Catarrh after Influenza 1 — 1 — ,, „ Whooping Cough 8 3 3 2 „ „ Measles 6 2 2 2 ,, ,, Pneumonia 4 1 1 2 „ with Rickets 4 2 1 1 ,, with Teething 28 10 10 8 Nasal Catarrh 15 3 8 4 Coughs and Colds 13 2 8 3 *1 case no change. 54 ORTHOPÆDIC SCHEME. Children found by the medical officers at the infant consultations or Toddlers' Clinic to be in need of Orthopaedic treatment can be referred to the Queen's Hospital for Children for opinion and treatment by the Orthopaedic Surgeon. Massage and Light treatment are arranged at the Centre. 64 children attended the hospital this year. One was admitted for in-patient treatment and the rest attended as out-patients, while in 32 cases appliances were provided by the Council. One child was discharged cured and seven have completed their treatment and attend for observation only. Records of attendances, results and clinical analysis follow :— Records :— Cases carried forward from 1935 32 Treatment completed (1935) but still under observation 3 New cases attending in 1936 29 Total number referred to Hospital 64 Results :— 1 Discharged cured 1 Treatment completed but still under observation 4 Under treatment and carried forward 30 Transferred to other hospitals or depts 3 At school under the care of the L.C.C. 10 Removals from district 7 Parents refused further treatment 5 Lapsed attendances 4 Total 64 Analysis of cases :— Genu Valgum 20 „ Varum 12 „ Valgum with Pes planus 16 „ Varum „ 10 Congenital Dislocation of Hip 1 Flat Foot 2 Rickets 1 Postural Kyphosis 1 Inability to walk (1 year 9 months) 1 55 MASSAGE. Cases are referred for Massage directly from the Medical Officers of the Clinics, by outside hospitals in cases where it is easier for the mother to attend the Welfare Centre than the hospital, or by the Orthopaedic Surgeons at the Queen's Hospital in connection with the Borough Council's Orthopaedic scheme. RECORDS:— Cases carried forward from 1935 23 New cases treated in 1936 150 Subsequent attendances 1,739 Total treatments 1,889 Discharged, treatment completed 157 Carried forward to 1937 16 Analysis of Cases :— Children : Rickets 17 Curved Tibiæ 23 Genu Valgum (knock knee) 9 ,, Varum (bow legs) 9 Pes Planus (flat foot) 13 Talipes 1 Pigeon Toes 3 Torticollis 13 Chest deformity 5 Amyotonia 36 Erb's Paralysis 1 Anterior Poliomyelitis 2 Pseudo hypertrophic muscular dystrophy 1 Delayed development (general) 16 Kyphosis 2 Constipation 19 Mothers :— Failing Breast Milk 2 Amyotonia after confinement 1 CONVALESCENT TREATMENT. During the year 12 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, 9 mothers to the "George Whitlaw" Convalescent Cottage, Amerden, near Taplow, and one to the Mayfield Convalescent Home in Sussex. 56 This last named is a new home recently opened by the Association of Maternity and Child Welfare Centres. With regard to children, 42 were sent to the Hertfordshire County Council's Home at St. Leonard's-on-Sea, Sussex, for periods varying from 2 to 4 weeks. We have also an arrangement with the Association of Maternity and Child Welfare Centres for the reservation of 3 cots to be used interchangeably at the John Madocks Babies Home, Basing, and the Noel Home, Letchworth. Under this arrangement 20 children were sent to the Noel Home, for periods of 2 to 12 weeks, and 15 children to the John Madocks Home, for periods of 4 to 15 weeks respectively. In addition, one specially delicate child was placed in the care of a lady near Pershore for 8 Aveeks after extended treatment at Basing. HOSPITAL TREATMENT FOR MALNUTRITION. We have no formal arrangement for prolonged observation and in-patient treatment for children suffering from dietetic mismanagement and malnutrition. The Council has, however, occasionally paid for the treatment of Bethnal Green children in the St. Thomas's Babies Hostel. 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, makes it specially necessary to care for the nutrition of mothers and children, expectant and nursing mothers and young children under 5. The Council's grants of milk to necessitous expectant and nursing mothers and young children under five years are made for a period of 4 weeks 57 at the end of which the mother has to re-apply. During the year 9,422 grants were made arising out of 7,147 family applications and re-applications. The grants were made up as follows : Expectant mothers 514 Nursing mothers 1,565 Children under 3 5,994 Children 3-5 1,349 There were 2 sessions a week, and 23,746 attendances at the Welfare Centre in connection with Milk Grants. During the year the following quantities of milk were issued to necessitous mothers:— Tuberculin Tested Milk 3,692 galls. Dried Milk 36,259 pkts. together with medicines, etc. The approximate cost of milk given in this way was £2,900. The arrangement with the L.C.C. whereby that authority pays for the milk supplied to mothers and children who are on Public Assistance, was continued during the year, the refund amounting to £548. The scheme involves a great deal of clerical labour which might well be reduced if the L.C.C. could adopt a simpler method of accounting in the matter. 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 8,354 pkts. 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. 58 During the year 266 children under the age of 5 were nursed, a total of 3,376 visits being made. 33 mothers received 484 visits for nursing in connection with conditions incidental to child-bearing. Nursing Assistance. Disease Children under five years Mothers Others Total Visits Cases Visits Cases Visits Cases Visits OphthalmiaNeonatorum 4 47 ... ... ... ... 47 Discharging Eyes 43 651 ... ... ... ... 651 Other Eye Conditions 5 179 ... ... ... ... 179 Measles 41 554 ... ... 11 147 701 Whooping Cough 3 35 ... ... 1 25 60 Diarrhoea ... ... ... ... ... ... ... Pre-natal Conditions ... ... 3 46 ... ... 46 Puerperal Fever and Pyrexia ... ... ... ... ... ... ... Other post-natal conditions ... ... 30 438 ... ... 438 Otorrhoea, other Ear diseases 16 362 ... ... ... ... 362 Tonsils and Adenoids 31 134 ... ... ... ... 134 Tonsillitis 2 56 ... ... ... ... 56 Influenza 1 16 ... ... 1 10 26 Bronchitis 3 60 ... ... ... ... 60 Pneumonia 16 254 ... ... 11 187 441 Tuberculosis .... ... ... ... ... ... ... ... Intestinal Conditions 9 55 ... ... 1 7 62 Threadworms 34 232 ... ... ... ... 232 Discharging Umbilicus 29 326 ... ... ... .... 326 Impetigo 3 37 ... ... ... ... 37 Phimosis 2 16 ... ... ... ... 16 Scald 3 61 ... ... ... ... 61 Scalp Sores 2 15 ... ... ... ... 15 Rash 3 75 ... ... ... ... 75 Miscellaneous 16 211 ... ... ... ... 211 Totals 206 3,376 33 484 25 376 4,236 9 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. One patient was treated in the Mildmay Mission Hospital and the other in Bethnal Green Hospital. 59 Nine cases were notified as Puerperal Pyrexia, and were treated at the following Hospitals : Bethnal Green (2), Mothers' (1), London Jewish (1), Mile End (1), St. Leonard's (1). The remaining 3 cases were treated at home by private medical practitioners. OPHTHALMIA NEONATORUM, &c. Ten notifications of Ophthalmia Neonatorum were received during the year. Four of the patients were treated at home, 2 received treatment at St. Margaret's Hospital, 2 at the Bethnal Green Hospital, 1 at Queen's Hospital and 1 at the London Hospital. The Health Visitors paid 20 visits to cases. Nine of the cases cleared up without any impairment of vision being reported : the other child was still under treatment at the end of the year. 32 reports were also received from Medical Officers of the London County Council concerning newborn babies suffering from inflammation of the eyes. These cases were also visited by the Health Visitors. The district nurses treated 43 cases of discharging eyes in young infants, paying 651 visits for the purpose. CHILD LIFE PROTECTION. Under the Transfer of Powers (London) Order, 1933, the duties of the London County Council under the Children Acts were transferred to the Metropolitan Borough Councils. At the end of the year, there were 11 foster mothers and 15 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 : 60 Routine Medical Inspection of Elementary School Children in Bethnal Green in 1936 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 Pedicull Clean Dirty Pediculi All sound Loss 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 754 44 707 3 98 543 113 748 6 - 751 3 423 293 38 — — - Girls 700 44 656 — 103 511 82 4 692 8 - 697 3 - 380 281 29 — — — Age 7— Boys 626 38 588 — 54 460 112 — 622 4 — 625 1 — 443 177 6 317 213 89 Girls 646 46 600 — 61 490 94 1 641 4 1 646 — — 439 200 7 304 230 108 Age 11— Boys 736 25 710 1 62 577 96 1 731 5 — 729 7 — 567 164 5 442 163 128 Girls 717 25 689 3 108 531 75 3 703 13 1 712 5 — 542 174 1 432 170 115 Age 14— Boys 694 15 678 1 112 545 36 1 691 2 1 690 2 2 539 152 3 457 118 118 Girls 906 43 863 - 167 704 35 — 895 10 1 899 7 - 634 2f,7 5 550 177 174 Total 5779 280 5491 8 765 4361 643 10 5723 52 4 5749 28 2 3977 1708 94 2502 1071 782 Percentage 4.8 95.1 0.1 13.2 75.5 11.3 99.0 0.9 0.1 99.5 0.5 0.0 68.8 29.6 1.6 58.1 24.9 17.0 London 56.4 43.2 0.4 16.6 77.4 6.0 97.5 2.2 0.3 99.2 0.7 0.1 70.5 26.1 3.4 66.2 19.3 14.5 61 Examination of Elementary School Children in Bethnal Green 1936 boys GIRLS Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number examined 754 626 736 694 700 646 717 906 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 38 38 20 15 6 5 13 12 28 24 15 13 8 7 10 10 Skin disease 12 10 9 7 7 6 9 G 11 6 9 9 6 5 12 8 Defective teeth — 311 — 152 — 162 — 153 — 295 — 186 156 271 Enlarged tonsils 150 64 51 17 26 9 5 3 116 44 79 31 38 11 15 5 Adenoids 5 4 2 2 — — — — 4 3 3 3 1 1 Enlarged tonsils and adenoids 16 10 1 1 2 2 — — 8 6 17 12 4 Other nose and throat defects 17 3 17 1 17 3 1 — 17 7 12 7 14 1 13 1 Enlarged glands 21 — 12 — 13 — 2 — 16 — 12 3 8 — 3 Eye disease 27 15 14 8 11 7 5 2 30 19 14 8 13 8 6 2 Vision defect — — — 55 — 85 — 84 — — — 68 80 127 Otorrhoea 4 2 1 1 6 6 6 5 4 3 7 4 1 1 4 3 Other ear disease 2 2 1 1 — — 3 2 — _ 1 1 - Defective hearing 3 2 1 1 2 1 1 1 — 2 1 2 1 2 2 Speech defects 4 2 2 — 3 — 3 1 4 — 1 1 — 1 1 Heart defects 6 — 4 — 5 — 5 — 15 1 13 — 10 1 8 Anaemia 1 — 3 1 4 1 2 — 3 1 1 1 Lung defects 42 12 17 2 15 4 6 2 43 19 16 2 15 1 2 Nervous defects — — 2 1 7 4 — — 5 2 1 3 1 2 Phthisis - - - - - - - - - - 1 1 1 1 Other T.B. disease — — — — - Rickets 3 1 2 2 2 2 1 - Spinal deformities 1 — — — 2 1 1 1 — 11 4 3 2 Other deformities 3 1 5 2 8 3 1 — 5 4 2 2 10 15 8 Other defects 26 23 16 7 30 24 12 6 27 22 15 10 18 9 13 4 Number of children noted for treatment 392 229 264 240 351 281 246 380 Defects however slight are included under " cases " ; those severe enough to require treatment are shown under * 62 One does not expect big changes in these figures from one year to another, but there are some differences which although small in extent are rather significant. In nutrition, for example, those marked "below normal" have increased to 11.3% from 8.9% in 1935 and 4.3% in 1934. In dentition and vision there seems to be some slight improvement but Bethnal Green children are below the London average. Once again I draw attention to the paradoxical situation that in a borough where the clothing and boot and shoe trades are noteworthy, only 4.8% of the residents' children are well clothed and shod ; which represents a further reduction on the figures for 1934 and 1935, which were 12.3% and 5.7% respectively. On the other hand, the high standard of personal cleanliness of the children, on which I have commented in previous years, is well maintained, 99.5% being clean of body and 99.0% clean of head. 63 CONTROL OF DISEASE For the third year in succession, the figures for practically every notifiable infectious disease show a further reduction. The total for all diseases in 1933 was 1,813, in 1934 it was 1,236, in 1935, 1,083, and in 1936, 935. Just as it was difficult to account for the abnormally high figures for 1933, so it is not easy to explain why those for last year should be low. This is especially the case, having regard to the bad weather conditions during the latter part of the year in contradistinction to the brilliant summer of 1935. The year was also less satisfactory with regard to the non-notifiable diseases owing to the occurrence of the biennial epidemic of measles and a large number of cases of whooping cough. Diphtheria. There were 223 cases of diphtheria notified during the year. The age grouping of the cases is given in the accompanying table. All the cases were removed to an isolation hospital. 4 deaths from this disease occurred during the year, equivalent to a case mortality of 1.8 per cent., or general death rate of 0.04 per 1,000 of the population. From information received from the hospitals it would appear that in 37 cases (or 12.1 per cent. of the total) the diagnosis of Diphtheria was not confirmed. 26 cases developed in hospital 5 of these being hospital staff, while there were 10 "second cases" in families in which a case had recently occurred. Anti-diphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 8,000 units were supplied during the year. 64 Scarlet Fever. There were 332 cases of scarlet fever notified during the year, 321 of the patients being removed to an isolation hospital. Two deaths were certified as due to scarlet fever during the year, equal to a case mortality of 0.6 per cent., and a death rate of 0.02 per 1,000 population. From information received from the hospitals, it would appear that in 12 cases (or 3.6 per cent. of the total) the diagnosis was not confirmed. 12 cases seem to have been developed in hospital, 5 being members of the hospital staff, while there were 21 " second cases." Enteric Fever. Nine cases were notified. 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. Consultations with Medical Practitioners. I was called in consultation by medical practitioners with a view to discussing the diagnosis in a number of doubtful cases. Statistics and notes with regard to Puerperal Fever, Ophthalmia Neonatorum, and Home Nursing will be found in the section relating to Maternity and Child Welfare. 65 Cases of Notifiable Diseases Notified during the Year 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 10 9 ... ... 1 ... 1 2 ... ... 1 2 2 ... 9 Diphtheria (inc. Memb. Croup) 222 223 5 15 20 20 24 86 26 8 8 11 .... ... 223 Scarlet Fever 335 332 1 26 33 44 31 107 53 16 13 8 ... ... 321 Puerperal Fever 2 2 ... ... ... ... ... ... ... ... 1 1 ... ... 2 Puerperal Pyrexia 9 9 ... ... ... ... ... ... ... ... 4 5 ... ... 8 Ophthalmia Neonatorum ... 10 10 ... ... ... ... ... ... ... ... ... ... ... 6 Erysipelas 96 90 1 ... 1 ... ... 4 3 3 5 22 28 23 58 Cerebro-spinal Fever ... 6 1 1 3 ... ... ... 1 ... ... ... ... ... 6 Acute Poliomyelitis ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Acute Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia 87 66 4 7 5 3 1 4 3 7 7 13 8 4 51 Acute Influenza] Pneumonia ... 14 ... ... ... ... ... 1 ... 1 8 4 4 1 8 Dysentery ... 32 1 5 5 4 3 2 1 5 2 2 2 ... 31 Malaria ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever, Cholera, Plague, Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Hydrophobia Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... 111 ... 1 ... ... ... 1 2 12 18 38 29 9 * Other forms of Tuberculosis ... 29 1 2 2 1 1 7 5 1 ... 5 3 1 * Total . 935 24 57 70 73 62 214 94 54 62 111 76 38 725 *See particulars as to Sanatorium Treatment in Tuberculosis section. The Registrar General's figures are for notifications received during the 53 weeks end£d 2nd January, 1937, and include several non-residents. The Council's figures are for cases notified during the calendar year, and exclude non-residents and duplicate notifications. 66 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, 1935, inclusive Registration SubDistricts comprised in each Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec. 1935 Number of these Births duly entered by 31st Jan., 1937 No. of Births which on 31st. Jan., 1937, remained unentered in the Vaccination Register on account of No. of these births remaining on 31st Jan., 1937, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1936 No of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1936 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 716 76 479 35 36 33 57 138 517 South West 280 34 — 211 6* — 1 5 23 154 179 TOTAL 996 110 — — 690 41* 37 38 80 292 696 Children vaccinated after declaration of conscientious objection : N.E., nil ; S.W., nil. Vaccination certificates for 1936 sent to other Vaccination Officers : N.E., 25 ; S.W., 75 * Plus 7 cases in which statutory declarations were made and children subsequently died unvaccinated. 67 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 140 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations, 3 of the notifications being posthumous. Information was also received from the RegistrarGeneral or from the Local Registrars of the deaths of 8 persons who had died from Tuberculosis but who had not been notified under the Regulations. During the year 19 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, 1936, was 1,200. The details are given in the table on pages 68 and 69. During the year there were registered 65 deaths from Pulmonary Tuberculosis, and 16 deaths from other tuberculous diseases. The number of deaths from Tuberculosis of all kinds during the past few years is as follows :— Pulmonary Non-Pulmonarv Total 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 1933 74 14 88 1934 74 7 81 1935 59 4 63 Public Health (Tuberculosis) Regulations, 1930 PART 1.—SUMMARY OF NOTIFICATIONS during the period from the 1st January, 1936, to the 31st Dece area of the Metropolitan Borough of Bethnal Green. mber, 1936, in the AGE PERIODS Formal Notifications Number of Primary Notifications of new cases of tuberculosis Total Notifications 0— 1- 5- 10— I 15— 20— 25— 35— 45— 55— 65— total (all ages) Pulmonary Males 2 1 2 5 9 7 14 10 10 7 67 88 „ Females 7 9 10 7 1 8 1 43 55 Non-Pulmonary Males 5 6 2 4 2 1 20 20 „ Females 1 .... 1 3 1 .... 1 1 ... 7 11 1'ART 11.—SUPPLEMENTAL RETURN.—New Cases of Ti during the above-mentioned perio ibercul d, othl :>sis coming to the knowledge of the mwiSF. than by formal notification. Medica 1 Officer of Health AGE PERIODS 0- 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total Pulmonary Males 1 1 1 3 1 4 1 12 „ Females .... 2 4 2 1 1 10 Non-Pulmonary Males 1 1 1 1 1 5 „ Females 1 1 1 3 The source or sources from which information as to the above-mentioned cases was obtained, is stated below : Source of Information No. of eases Pulmonary NonPulmonary Death Returns from local Registrars 5 transferable deaths from Registrar General 2 1 Posthumous notifications 1 2 " Transfers " from other areas (other than transferable deaths) 14 5 Other Sources if any (specify) PART III.—NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1936, on the Register of Notifications kept by the Medical Officer of Health of the Metropolitan Borough Pulmonary Non-Pulmonary Total cases Males Fem'ls Total Males Fem'ls Total 449 :!<;« 815 216 169 385 1,200 Number of cases removed from the Register(s) during the year by reason of:— 1 Withdrawal of notification 3 2 5 3 1 4 9 2 Recovery from the disease 16 14 30 17 9 26 56 3 Death 56 28 84 5 3 8 92 4 Patients removed from Borough 30 23 53 9 13 22 75 5 Lost trace 4 3 7 2 3 5 12 Total 169 70 179 36 29 65 244 68 69 With regard to notification, I think it is necessary to say that considerable difficulty is created by the failure of medical officers of residential institutions to forward notifications promptly and correctly in accordance with the regulations. During 1936, no fewer than 93 or 24 per cent, were received later than the time specified in the regulations. In 38 cases a notification was actually not received at all, while on the other hand 15 notifications were sent in unnecessarily. It may be that the medical officers concerned are not provided with sufficient clerical assistance. It should, however, be pointed out that these notifications are no mere formality but are the basis on which action depends with regard to disinfection, the after care of patients, etc. Tuberculosis Register. Pulmonary Non-Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/35 477 378 227 186 1268 Number of new cases notified under the Public Health (Tuberculosis) Regulations, 1930, during the year 68 43 21 8 140 Transferred from non-pulmonary Other cases added to the Tuberculosis Register during year 13 15 4 4 36 558 436 252 198 1444 Number of cases removed from Tuberculosis Register during year. (For details see separate statement) 109 70 36 29 244 Transferred to pulmonary Cases remaining on Tuberculosis Register 31/12/30 449 366 216 169 1200 70 There were 8 deaths certified from Tuberculosis in which the deceased person had not previously been notified. This represents 9.9 per cent, of the deaths from Tuberculosis during the year. Enquiry of the certifying practitioner elicited the following explanations :— Diagnosis only reached after p.m. 3 Certified by Coroner 2 Oversight 1 Assumed already notified 2 Late notification, probably due to delay in seeking medical treatment, is shown by the following figures :— Notified practically at time of death 7 ,, within 1 month ,, 6 ,, ,, 3 months ,, 9 „ ,, 6 months „ .... 9 TUBERCULOSIS DISPENSARY. The Tuberculosis Dispensary for the Borough is provided under agreement by the City of London Hospital for Diseases of the Heart and Lungs and is shared with the Hackney Borough Council. A full report on the work of the Dispensary, by Dr. H. T. Howell, the Clinical Tuberculosis Officer, appears in the appendix to this report on page 122. This position, adopted for convenience, by no means indicates the relative importance of Dr. Howell's report, and I strongly recommend its perusal as a valuable contribution to our better understanding of the problems of Tuberculosis. 71 WORK OF TUBERCULOSIS VISITORS. The two Tuberculosis Visitors paid 4,626 visits of enquiry and advice with regard to the welfare of tuberculous patients in the Borough. The reduced number of visits was owing to the illness of one of the visitors. In addition they made 186 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 CARE COMMITTEE. The Sub-Committee of the Public Health Committee has functioned during the year as the local Tuberculosis Care Committee, dealing with such matters as grants of extra nourishment, provision of special treatment, etc. SUPPLY OF SPUTUM OUTFITS. During the year 14 sputum flasks were distributed to patients. 11 sputum tins, with 476 cardboard refills were distributed to patients for use indoors. OPEN-AIR SLEEPING SHELTER. The Council's Open-Air Sleeping Shelter was in use during 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, 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. 72 Some assistance has also been rendered to patients in getting necessary clothing for use while in sanatoria. SANATORIUM TREATMENT. During the year 116 patients were recommended for Sanatorium or Hospital treatment and 7 were recommended for admission to hospital for " observation for diagnosis " ; 111 of the former and all the latter were sent away to institutions. In addition, 88 patients received treatment for Tuberculosis in the general hospitals of the L.C.C. Thirteen children were recommended for admission to an open-air school, all being accepted. GRANTS OF EXTRA NOURISHMENT. 355 grants of Tuberculin Tested milk and new laid eggs were made to 111 necessitous tuberculous patients at an estimated cost of £222. DENTAL TREATMENT FOR TUBERCULOUS PATIENTS. Five dispensary patients received dental treatment at the City of London Hospital for Diseases of the Heart and Lungs, making 9 attendances therefor. One patient was also assisted in the provision of artificial dentures. FINSEN AND ARC LIGHT TREATMENT. PNEUMOTHORAX REFILLS. Since 1921, the Council has paid for the Finsen Light treatment of cases of Lupus at the London Hospital. During the year 5 patients were so treated, making 278 attendances for treatment. 4 patients also made 548 attendances for arc light treatment of Lupus at the same hospital. 73 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was taken under these regulations during the year. NON-NOTIFIABLE DISEASES. Measles. During the year 1,449 cases of Measles came to my knowledge from the following sources :— Schools 740 L.C.C. Ambulance Service 485 Other Hospitals 9 Medical Practitioners 64 Health Visitors 118 Sanitary Inspectors 25 Parents, etc. 8 All cases were visited, either by a Health Visitor or the District Sanitary Inspector, according to the age of the patient. 509 patients were removed to L.C.C. Special Hospitals, and in 51 cases, nursing assistance was provided by the Council, 509 nursing visits being paid. After various corrections of diagnosis and sifting of "suspected" cases, there would appear to have been a net total of 1,390 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 17 deaths from measles during the year. 74 German Measles. 16 cases of German Measles were also reported, 8 of them being removed to hospital. Whooping Cough. 305 cases of Whooping Cough came to my knowledge ; through reports from the L.C.C. (79), Health Visitors (56), Sanitary Inspectors (6), Schools (155), Hospitals (5), doctors (2), and parents (2), and these children were visited by the Health Visitors and the Sanitary Inspectors. 13 cases proved not to be Whooping Cough leaving a net total of 292. 93 children were removed to an Isolation Hospital, and 93 nursing visits were paid to two cases at home. 13 deaths from this disease were recorded during the year. Miscellaneous Investigations. 294 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. The Council has for some years paid for the Insulin required in the treatment of a Bethnal Green patient at the University College Hospital. This was continued throughout the year and the patient has shown some improvement under treatment. 75 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 1,052 Diphtheria bacilli present in 65 Sputum—specimens submitted for examination 110 Tubercle bacilli present in 11 Blood—specimen submitted 1 Paratyphoid B—agglutination 1 One throat swab was examined by another laboratory with a positive result. Other bacteriological examinations in connection with food are reported on elsewhere. SHELTER FOR CONTACTS. (3, St. James Road). These premises consisting of a nine-room house, are occupied by a caretaker and are available, as required by statute, for the accommodation of contacts of infectious disease during the disinfection of premises. The shelter was used during the year. DISTRIBUTION OF DISINFECTANTS. During the year 4,500 pints of partially diluted disinfecting fluid were distributed to applicants at the Town Hall. DISINFECTION SERVICE. During the year, 1,571 rooms and 29,692 articles were disinfected for various reasons. Two Morris motor vans are used for conveying articles for routine disinfection, but an additional motor-van of the Dennis type was purchased during the year for special disinfestation purposes. The new 76 van has a large steel body and is otherwise equipped for the conveyance and disinfestation by hydrocyanic acid gas of furniture. The table appended gives details of the rooms, bedding and clothing disinfected. No. of Rooms Disinfected Articles of Clothing, etc., Disinfected by Steam Formalin Infectious disease 643 5,449 1,304 Scabies 23 6,218 — Verminous condition 902 4,032 93 Other conditions 3 23 61 Hospital bedding — 12,445 67 1,571 28,167 1,525 Number of articles destroyed by request, 1,409. The increase in the amount of disinfection, notwithstanding the reduction of infectious disease, is due to greater activity in dealing with verminous conditions and with cases of scabies. In addition, 6 cwt. of rags were disinfected for a commercial firm. 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 of their rooms. The sprayers were lent on 408 occasions during the year, as compared with 468 in 1935. Verminous Conditions. 37 children (in 19 families) were reported from the L.C.C. Cleansing Station as being infested 77 with vermin, 8 of the families being eases 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 13 cases disinfection of some kind was accepted. Rooms were disinfested of vermin in 902 cases. Scabies or Itch. 103 children suffering from this disease were excluded from the Elementary Schools. In addition, 35 cases of Scabies were reported by the London Hospital, one each by the Queen's, Bethnal Green, Mile End and East London Hospitals. In all but 20 of these cases the bedding and clothing were disinfected. 23 rooms were also fumigated after Scabies. Personal Cleansing Station. The Personal Cleansing Station continues to serve a useful purpose as part of the Council's scheme for the destruction of insect pests. The hours of attendance have been re-arranged so that the baths may be available for women every afternoon from Monday to Friday. During the year 61 men, 18 women and 4 children had 85 baths and their clothing was disinfected for vermin, and 89 men, 152 women and 25 young children had treatment, in addition to baths and disinfection, on a total of 576 occasions, for Scabies. By arrangement with the Shoreditch and Stepney Borough Councils, residents in those boroughs have been dealt with at the Personal Cleansing Station during the year as follows :— Persons Baths Scabies 166 456 Vermin 1 1 These figures are included in the foregoing figures of total work done at the Station. 78 VERMIN IN RELATION TO HOUSING. Re-inspection of the new tenements on the Butler Estate one year after the entry of the new tenants showed that the disinfestation of their furniture prior to occupation had been successful. In only 4 cases were traces of vermin seen and they were slight. Similar steps have been taken with the furniture of the new tenants on the Digby Estate opened during 1936. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928, SECTION 28. Cake of Aged and Infirm Persons. During the year, it was found necessary in two cases to apply for a magistrate's order for the removal to hospital of aged and infirm persons found to be living under insanitary conditions and not receiving proper care and attention. FOOD POISONING. Food Poisoning has been notifiable throughout London since 1932. During the past year, 15 cases were notified. Of these cases, 9 were attributed to eating fish of various kinds, including shell fish and tinned, and 4 to meat and 1 to egg and 1 to infection by organisms of the Salmonella group. 79 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 conduet of the food trades. 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. On the other hand, the conditions under which food is sold in the street or from shops with open fronts are still unsatisfactory, while the sophistication of food although checked in some ways still continues in new and subtler forms. CLEANLINESS IN THE FOOD TRADES. The by-laws prepared by the L.C.C. under Section 6 of the London County Council (General Powers) Act, 1932, to promote sanitary and cleanly conditions in the manufacture, etc. of any article intended for the food of man have now been issued. The Street Trading Committee continues its endeavours to prevent the contamination of food sold in the streets. Little more can be done until the law is considerably extended and strengthened in its control of the food trades. FOOD AND DRUGS ACTS. Seven hundred and twenty-four samples were taken ; 705 of these proved to be " genuine " and 19 or 2.6 per cent. adulterated. 80 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 380 373 7 15 15 .... 395 Butter 94 94 .... 3 3 .... 97 Margarine 4 4 .... .... .... .... 4 Condensed Milk 1 1 .... 1 1 .... 2 Dried Milk 3 3 .... .... .... ...." 3 Cream 7 7 .... 1 .... .... 8 Cream Cheese 1 .... 1 .... .... .... 1 Cheese 1 .... 1 1 .... 1 2 Lard 1 1 .... .... .... ... 1 Dripping 2 2 .... .... .... .... 2 Cordials .... .... .... 7 7 .... 7 Wines 1 1 .... .... .... .... 1 Whisky 8 8 .... .... .... .... 8 Sulphur Ointment 1 1 .... 1 .... 1 2 Aspirin Tablets 5 5 .... 3 3 .... 8 Other Drugs .... .... .... 7 7 .... 7 Jelly 6 6 .... 2 2 .... 8 Jelly Crystals .... .... .... 4 4 .... 4 Mustard .... .... .... 5 5 .... 5 Pepper .... .... .... 1 1 .... 1 Sugar 4 4 .... .... .... .... 4 Ground Ginger 2 2 .... .... .... .... 2 Mincemeat 1 1 .... .... .... .... 1 Sweets 3 3 .... .... .... .... 3 Bread .... .... .... 5 5 .... 5 Flour .... .... .... 5 5 .... 5 Jam 23 22 1 3 2 1 26 Honey 2 2 .... .... .... .... 2 Lemon Cheese 1 1 .... .... .... .... 1 Vinegar 59 53 6 2 2 .... 61 Malt Vinegar 2 2 .... .... .... .... 2 Shredded Suet 1 1 .... .... .... .... 1 Minced Meat .... .... .... 9 9 .... 9 Sausages .... .... .... 1 1 .... 1 Tea .... .... .... 1 1 .... 1 Dried Fruits 3 3 .... 4 4 .... 7 Sultanas .... .... .... 1 1 .... 1 Ground Almonds 6 6 .... .... .... .... 6 Arrowroot .... .... .... 4 4 .... 4 Candied Peel .... .... .... 6 6 .... 6 Sardines .... .... .... 3 3 .... 3 Silds 1 1 .... 1 1 .... 2 Fish Paste 2 2 .... .... .... .... 2 Barlova .... .... .... 1 1 .... 1 Dried Herbs 2 2 .... .... .... .... 2 Totals 627 611 16 97 94 3 724 81 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, 1936, 724 samples were examined under the Food and Drugs (Adulteration) Act. All samples were submitted by the Inspectors. No sample under the Act was submitted by the Public. Ninety-seven of the samples were purchased informally. Nineteen samples were found to be adulterated, 16 formal and 3 informal. In addition 62 other samples were of inferior quality or doubtful purity. The adulteration was at the rate of 2.6 per cent. as compared with 4.1 per cent. for the whole of London, and 5.5 per cent. for the whole of England and Wales in 1935. The rate of adulteration in the Borough for the past ten years was as follows :— Year No. of Samples examined Percentage of adulteration 1936 724 2.6 1935 704 8.2 1934 735 6.1 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 Average 731 7.3 The adulteration is the lowest recorded for several years. The number of samples examined was at the rate of 7.2 per 1,000 of the population, as compared with 9.9 per 1,000 for the whole of London and 3.6 per 1,000 for the whole of England and Wales, in 1935. Three hundred and ninety-three samples of milk were examined during the year, of which seven samples or 1.8 per cent. were found to be adulterated and fifty-four other samples were of doubtful purity or inferior quality. 82 The milk adulteration in the Borough for the past ten years was as follows :— Year No. of Samples examined Percentage of adulteration 1936 393 1.8 1935 390 5.1 1934 407 5.7 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 Average 335 5.8 Condensed Milks. Two samples of condensed milk were examined and found to be satisfactory. Preservatives. There were four contraventions of the Preservatives Regulations. These consisted of:— 2 Raspberry Jams. Both contained excess of sulphur dioxide. 2 Gruyere Cheeses. Both contained formaldehyde. Other samples examined during the year were :— 22 Rag Flocks, 4 of which were unsatisfactory. 4 samples under the Pharmacy and Poisons Act, 2 of which were unsatisfactory. all for the Public Health Department. Albert E. Parkes, F.I.C. Public Analyst. FOOD AND DRUGS. Legal Proceedings. Particulars of the legal proceedings taken during the year in respect of foods and drugs, will be found in the appendix, p. 119. SAMPLES TAKEN INFORMALLY. Ninety-seven samples were taken informally during the year, 3 of which were found to be adulterated as follows ;— 83 Article No. of Sample Offence Raspberry Jam 104 57 parts per million Sulphur Dioxide Gruyere Cheese 374 50 „ „ Formaldehyde Sulphur Ointment 570 10% deficient in sulphur The genuine samples are indicated in the table on page 80. PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 to 1927. Two formal and 2 informal samples taken under these regulations were found to contain preservatives, in parts per million, as follow : Jam 57 (Sulphur Dioxide) Gruyere Cheese 50 (Formaldehyde) „ 50 „ „ 50 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. One formal and 1 informal sample of condensed milk were taken, and were found to comply with the Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. Three samples of dried milk were taken during the year, all genuine. 84 THE FAT CONTENT IN MILK. Last year I reported the results of a statistical investigation made by Mr. J. H. Lloyd as to the fat percentage in samples of Bethnal Green milk in 1925 and 1935 respectively, the facts revealing an extraordinary fall in the fat content in that period. Mr. Lloyd has continued this study in respect of the 1936 samples and as the figures seem to point to a continuous process in the lowering of the fat standard of the milk sold in the borough I think public attention should be directed to the facts. For purposes of comparison, the new figures are shown below with those relating to 1925 and 1935 : 1925 1935 1936 March quarter 3.43 3.40 3.30 June „ 3.45 3.26 3.21 Sept. „ 3.46 3.38 3.30 Dec. „ 3.79 3.40 3.44 Year 3.56 3.36 3.31 Subsequently to the publication of last year's Annual Report, I sought information from the Medical Officers of Health of neighbouring boroughs as to whether they had observed any fall in the fat content of milk during the same period. Full comparative data was only available for Stepney, where the average fat percentage in 1925 was 3.64* and in 1935 3.59. This reduction is very slight but it is a surprising thing that the fat percentage for milk sold in two adjoining boroughs in the same year should be 3.36 in one and 3.59 in the other. For 1935, the average fat percentage in Hackney was 3.42, Shoreditch 3.4 and in Poplar 3.4-3.6 for large firms and 3.46-3.47 for small local retailers. An interesting report on " The Composition of Milk " by the County Analyst for Lancashire makes it evident that these low fat percentages are exceptional. In other London boroughs and in provincial towns, fat percentages about 3.6 and 3.7 are common, as one might expect from the generally recognised average which this analyst gives as 3.75. Kensington, for example, for which very full information is available, shows a fairly consistent standard from 3.63 in 1925 and 3.64 in 1935. ♦Based on all samples taken, genuine or adulterated. 85 The Bethnal Green figures for 1935 are not large enough to warrant any exhaustive analysis but the following extracts from Mr. Lloyd's calculations may be of interest: Average fat Percentage Samples taken in shops 3.36 „ „ street 3.29 ,, ,, course of delivery *3.25 ,, ,, from dairymen who are also cow- keepers 3.35 „ ,, large dealers 3.28 „ ,, „ retailers from outside the borough 3.28 *It may be noted that 42 of the samples taken on delivery were at hospitals and schools, intended for invalids and children and presumably supplied under contract, yielding an average fat percentage of 3.24. The questions raised by these figures may be summed up in the following main points : (1) Is the concentration of the milk trade into the hands of a few large wholesale firms and its systematic processing, while undoubtedly productive of some good in raising the bacterial purity of the milk, accompanied by any lowering of the chemical standard (as measured by the fat content) ? (2) Whether the low fat standard laid down in the Sale of Milk Regulations, 1901, offers a temptation in the wholesale processing of milk to skim off some of the surplus fat above this standard ? A well known feature of the London milk trade during recent years has been the sale of so-called " Utility " or " Economy " Cream which appears to be a mixture of milk and cream. It may legitimately be suspected that the cream which is so used may be derived from the surplus milk fat referred to above. If this be so, the procedure while probably very profitable for the milk trade makes it doubtful whether the consumer who imagines that he is getting milk " as delivered by the cow " with all its natural fat is receiving " a square deal." Moreover, although this enquiry has been confined to the fat content because the required information was more readily available, it is very probable that the nonfatty solids in milk have undergone a similar reduction and that the question involved is really a general deterioration in the quality of the milk sold to the consumer. 86 This unsatisfactory state of affairs mainly arises from the low standard of 3.0 fat percentage laid down by the Sale of Milk Regulations, 1901. It is of course recognised that, in practice, the fat percentage in milk as delivered by the cow varies between wide limits and that it will occasionally be as low as 3 per cent. or even lower. Possibly it was equitable, when the milk trade was mainly in the hands of small producers and traders unable to mix a large quantity of milk from different herds to maintain a good average, that such a low level should be permitted without constituting an offence. Now, however, that the trade is organised on such a large scale that it should be readily possible to maintain the milk supply at its natural average level of about 3.6 per cent. of fat, there seems no reason why the limit should not be raised accordingly for the protection of the public. While changed processes in the milk trade may be part of the reason for the unsatisfactory composition of the milk supplied in the borough it cannot be the whole explanation. These changes apply to the whole of London, but as will have been seen from the figures given above, Bethnal Green milk appears to be not only poorer than in the past but much poorer than that of other London boroughs at present. The reasons for this are obscure, but may have some connection with the character of the local milk trade. It will have been noticed that the figures given, although too small to establish any conclusion, suggest that the shop samples are on the whole better than the street samples and although the cowkeeper-dairymen samples were slightly under the average in 1925 and 1935 they have kept a more consistent level than the others and were in 1936 above the general level. This somewhat points to the street trade as requiring special consideration. The outstanding features of the local milk trade may be summed up as follows : (a) the large number of persons registered for the sale of milk, which number is actually increasing; (b) the acute competition between them for"trade; (c) the difficulty in controlling the operations of itinerant vendors who trade in several boroughs. In 1925 there were 245 persons registered for the sale of milk in the borough or 2.04 per 1,000 of the population. By 1935 this had increased to 326 persons or 3.26 per 1,000. In other words while in 1925 there was a milk business to every 500 residents, in 1935 there was one to every 300. While it is true that a large number of the additional persons on the register only sell a small quantity of bottled milk, nevertheless the fact that they find it necessary to take on 87 this business and obtain registration is an indication of the keen competition among local traders. Of the 354 persons at present on the register 81 are traders from outside the borough while another 11 are itinerant vendors who have no shop but merely store their vehicles in the borough. There are of course constant changes amongst these traders and despite frequent interchange of information with neighbouring boroughs they are in practice difficult to keep under adequate supervision. Having given the matter careful consideration, I do not think that there is very much that the Council itself can do with regard to the improvement of the milk supplied in the borough. It would undoubtedly be an advantage if the number of milk retailers were substantially reduced and that only responsible persons with really suitable premises were allowed to be registered. Unfortunately the weak state of the law does not help the Council very much to achieve this. The number of samples of milk now taken is well up to the average in London but might possibly be increased to advantage. The fundamental remedy is, however, for the Government to raise the standard laid down in the Sale of Milk Regulations, 1901, so as to compel the producers and distributors to organise their business in such a manner as to ensure that the consumer gets milk of good average quality as delivered by the cow. 88 BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year 17 bacteriological examinations of milk, 1 of ice cream and 2 of water were made as follows :— Ordinary Milk, 5 ; Tuberculin Tested Milk, 1 ; Pasteurised Milk, 10 ; Sterilised Milk, 1 ; Ice Cream, 1 ; Swimming Bath Water, 2. B. Coli was found in four samples of Pasteurised Milk, and 1 of ordinary milk. FOOD PREMISES. Milkshops and Dairies. 58* applications for registration were considered, 2 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 1935 326 Deduct number of purveyors removed from register during the year 30 Add number of new purveyors added to register by resolution of the Public Health Committee during the year 58 Number of purveyors of milk on register at end of 1936 354 During the year 628 inspections of milkshops were made by the Inspectors, and 44 notices were served under the Public Health (London) Act. Legal proceedings were not found to be necessary in respect of milk premises. * This includes changes of occupier in premises previously on the register. 81 A summons against a milk seller for selling milk from a vehicle and receptacle not properly inscribed with his name and address resulted in the vendor being ordered to pay £l 3s. 0d. costs. 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 costs amounting to 2s. and £l 3s. 0d. respectively. Milk (Special Designations) Order. 11 Dairymen were licensed to sell " Grade A (Tuberculin Tested) " Milk, 1 for the sale of " Certified " Milk, 2 for the sale of " Grade A" Milk and 10 for the sale of " Pasteurised " Milk, while supplementary licenses to sell " Certified " Milk in the Borough from premises in Hackney and Stepney and others to sell " Grade A (Tuberculin Tested)," " Grade A " and " Pasteurised " Milk in the Borough from premises in Hackney, Finsbury, Stepney, Poplar and Kensington were also granted during the year. During the year, the revised order came into operation, reducing the number of recognised grades and laying down a simplified bacteriological standard for these milks. School Milk Scheme. The scheme for the provision to school children at a reduced price of one-third of a pint of milk each school day was continued during the year. Pasteurised milk is being supplied to the schools in the borough and the supply is tested from time to time as to its composition and bacterial standard. 90 Cowhouses. There were at the end of the year, 8 licensed cowhouses in the Borough. 40 inspections were made during the year. One notice was served. The following premises are 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, Gibraltar Walk—(18 cows). 55, Kerbela Street—Shed No. 1—(18 cows). Shed No. 2—(2 cows). 2, Lisbon Street—(19 cows). 64, Squirries Street—(14 cows). 38, Three Colts Lane—(23 cows). Ice Cream Premises. There were 180 ice cream premises registered at the end of the year, and 305 visits were paid to them by the district inspectors : 13 notices were served. Fried Fish and Fish-Curing Premises. At the end of 1936 there were 31 fried fish vendors' premises in the Borough. There were 19 fish curers' premises. 258 visits were made by the Food Inspectors to these premises, and 17 notices were served for insanitary conditions. Workshop Bakehouses. There are, in Bethnal Green, 31 workshop bakehouses, 9 of which are underground : 98 visits were made to them during the year, resulting in the serving of 5 sanitary notices. In one instance the dirty conditions found necessitated the issuing of two summonses, the defendant being fined £1 and £2, with £5 costs on each summons. 91 Factory Bakehouses. There are also 33 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. 122 inspections were made during the year, and 13 notices were served. Other Premises used for the Preparation or Sale of Food. There were 220 such premises on the register, the majority being restaurant-kitchens or butchers' shops. 858 inspections were made during the year, and arising out of such inspections 83 notices to remedy faults or insanitary conditions were issued. In one instance, legal proceedings were found necessary, the defendant being ordered to pay £3 3s. 0d. costs. Slaughterhouses. There are two licensed slaughterhouses in the Borough, situated at :— 294, Bethnal Green Road. 354, Bethnal Green Road. 16 visits were made to slaughterhouses by the Food Inspector. Public Health (Meat) Regulations, 1924. The number of animals killed at the slaughterhouses was as follows :— Lambs 13 No carcases or offal were condemned. Slaughter of Animals Act, 1933. Two slaughtermen have been licensed under this Act. 92 Slaughterers of Poultry. There are 9 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough : 269 visits were paid to them during the year, and 5 notices were served for insanitary conditions. 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 week-end. The District Sanitary Inspectors also keep general observation in the course of their duties. On 16 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. Cwt. Lb. Fish — 3 72 Meat — 2 62½ Rabbits — 1 103 Vegetables — 8 64 Fruit 3 18 82 also 1 box of kippers and ½ sack mussels. FOOD POISONING. During the year 15 cases of suspected food poisoning were investigated. The subject is dealt with more fully in the preceding section dealing with the control of Disease. PHARMACY AND POISONS ACT, 1933. Under this Act, 32 persons have been placed on the Council's list in respect of 34 premises as authorised, subject to the provisions of the Act and regulations, to sell poisons specified in Part II of the Poisons List. 93 SANITATION AND HOUSING The following figures give a bare outline of the work of the sanitary inspectors during the year. The measles epidemic added substantially to the visits of the inspectors during the year but nevertheless the normal work was well maintained. SANITARY SUPERVISION OF THE BOROUGH A Summary of Inspections and Visits, with Matters Outstanding, for the 53 weeks ended 2nd january, 1937. Nature of Visit Totals Infectious Diseases (notifiable) 861 Infectious Diseases (non-notifiable) 1,261 Complaints 4,864 House to House Inspections 733 Milkshops (535) and Cowsheds (40) Inspections 575 Other Food Premises Inspections (Slaughterhouses 8, Poultry 269, Others 1375) 1,652 Factory (903) and Workshops (1,628) Inspections 2.531 Outworkers' Homes Inspections 717 Common Lodging House Inspections 21 Tenement House Inspections 264 Drainage Inspections 3,866 Smoke Observations 19 Other Inspections or Special Work 8,195 Re-Inspections 21,052 Total visits for the Year 46,611 Unsound Food Seizures (0) or Surrenders (16) 16 Samples of Food, etc., taken 713 Samples of Rag Flock taken 22 Police Court Attendances 67 Premises where Nuisances abated 5,759 Premises where Matters Outstanding 962 94 The following sanitary defects were discovered during the year :— Dirty rooms 5,946 Defective drains and choked w.c.'s 688 Defective and dirty w.c.'s 1,908 Defective water supply 307 Defective paving 766 Defective gutters and rainwater pipes 860 Defective roofs 2,072 Dampness 1,273 Defective dustbins 1,026 Smoke nuisances 24 Overcrowding 19 Other defects 10,718 Total 25,607 The work of the outdoor staff is reflected in the volume of clerical work associated with sanitary administration. During the year in addition to recording the above mentioned nuisances and defects, 5,652 Preliminary Notices and 2,555 Statutory Notices requiring the remedying of Nuisances were written and 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 989 premises with nuisances outstanding. During the year, nuisances at 5,759 premises were abated and 962 premises with nuisances outstanding were carried forward to 1937. COMMON LODGING HOUSES. There are 4 such premises in the Borough, and the Inspectors paid 17 visits to them. Two sanitary notices were served. 95 TENEMENT HOUSES. The number of houses on the register as being let in lodgings or occupied by members of more than one family was 276 ; 1,235 visits of inspection were made to these houses, and arising out of such visits 369 notices were served. Comprehensive by-laws with regard to tenement houses were made in 1925, although many important clauses do not fully 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. Steps are now being taken to bring on to the register the numerous premises in the Borough which come under the by-laws. A commencement has been made with those houses where a non-resident owner has let the whole of the tenement separately. RENT AND MORTGAGE INTEREST RESTRICTIONS (AMENDMENT) ACT, 1933. During the year 3 applications for a certificate as to the state of repair of a house were received, and granted. WATER SUPPLY TO NEW HOUSES. During the year 245 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 24 formal observations of smoke shafts were made and 1 intimation and 1 statutory notice were served. As pointed out last year, the Council's powers, being limited to the grosser nuisances created by factories, are useless for dealing with the most serious cause of atmospheric pollution—the ordinary domestic chimney. It is to be hoped that the growing popularity of electricity will gradually oust the burning of crude coal in the Borough and thus enable the residents to breathe somewhat purer air. 96 NOISE. I welcome the intention of the London County Council to promote legislation to deal in some small measure with the serious nuisance of noise. The close proximity of much of the housing accommodation in the Borough to factories and other noise producing agencies makes it urgently necessary that there should be some public control of a nuisance liable to cause injury to health. 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, 101 tins of treated biscuits and one bottle of Squill being issued in this way, while 432 tins of biscuits were used as baits in the sewers in the quarterly campaigns described later. The systematic measures for rat destruction for one week every three months continued during the year, and the following statistics illustrate the measurable results : Baits laid (in 298 manholes) 17,292 Baits missing 16,132 Percentage of baits missing 93 Other methods of destruction carried out on an experimental scale have been as follows :— Rats killed Breakback traps 240 Dustbin traps 212 Cage traps 38 In the absence of more energetic action by landlords and the occupiers of business premises and the application of scientific methods on a large scale, it may be doubted whether our present efforts very materially affect the rat population. 97 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 during the year. OFFENSIVE TRADES. During the year, one offensive trade, that of a Fur-skin Dresser, was carried on at 74, Florida Street. 28 inspections were made at these premises, and 4 sanitary notices were served. Poultry slaughtering, an offensive trade also, is dealt with elsewhere in this report. RAG-FLOCK ACT, 1911. 22 formal samples of rag-flock were taken during the year, and in 4 cases the amount of chlorine present was found to be in excess of the limit fixed by the Regulations. Proceedings were taken in all 4 cases, but the summonses were withdrawn upon payment of costs amounting to £16 16s. 0d. RAG AND BONE DEALERS. 17 persons or firms are known to be carrying on this business in the Borough. During the year 23 visits of inspection were made, and 3 sanitary notices were served. HAIRDRESSERS. 98 hairdressers' premises were on the register, 182 visits were made to them, and 24 Notices were served. 98 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 1 system was reconstructed, taking 4 houses. At the end of the year there were 636 such combined drainage systems, taking 3,235 houses. DRAINAGE WORK. No legal proceedings were taken during the year in respect of offences in connection with drainage work. 99 HOUSING Clearance Areas and Rehousing. In continuation of the record of progress of housing schemes given in last, year's report, I furnish the following summary of action taken in 1936 :— Area Houses Pop. Action taken by Borough Council Action taken by London County Council Digby Street — — Second block of tenements (55) erected and occupied. - Martha Ct. - - All premises vacated and awaiting demolition. - Lansdell Place 58 299 Represented 28.10.36 - Delta Street - - Redevelopment scheme in hand to provide 35 tenements (accommodation for approximately 200 persons). - Burnham Square - - Revised clearance orders made. Redevelopment scheme in hand to provide 65 tenements (accommodation for approximately 340 persons). Majority of houses vacated. Ministry of Health Enquiry held. - Busby Sq. 16 79 Declared to be Clearance Area not suitable for redevelopment for housing purposes. Ministry of Health Enquiry held. - Voss Street - - Area cleared. - Ada Place & Pritchards Road - - Tenders accepted for erection of blocks 1 and 2 (87 tenements). Block 1 in course of erection. Darling Row 147 989 Represented and Clearance and Compulsory Purchase Orders made. Dinmont Estate - - Blocks 1, 2 & 3 completed. Tender accepted for Block 4 (60 tenements) now in course of erection. 100 Area Houses Pop. Action taken by Borough Council Action taken by London County Council James St. (6 areas) 76* 411 - Represented & to be cleared. Areas 1, 3 & 4 and additional lands to be transferred to Borough Council for redevelopment. Hollybush Gardens — — - Block of 90 tenements completed and occupied. Pott Street - - - Tender accepted for erection of Blocks 1, 2 & 3 (104 tenements). Blocks 1 and 2 in course of erection. Pedley St. 86 353 - Declared Clearance Area in 1935. Ministry of Health Local Enquiry held 30.11.36. Waterloo House (Wellington Estate) - - - Tender accepted for erection of Blocks 1 (part) and 2 (152 tenements). Four Blocks in course of erection. Public Utility Society- Scheme Nags Head Clearance Orders made in re- Fields spect of 31 houses. One block of 25 flats completed, and further block in course of erection. *Including 4 in Stepney 101 The increased tempo of new housing construction can be seen from the following comparative table for the past 10 years:— NEW TENEMENTS. Completed in Borough Council Provided by London County Council Public Utility Society * Other Total 1927 32 (Cambridge Heath) — — 2 34 1928 - 45 (Codrington House) - - 45 1929 16 (Weaver House) 22 (Harvey House) 15 (Queen Margaret's flats) - 53 1930 - 28 (Blackwood House) - - 28 1931 - 37 (Rutherford House) - 1 38 1932 83 (Hadrian) 8 (Tyler House) - 7 98 1933 73 (Claredale) - - - 73 1934 - 59 (Besford House) 15 (Ropley Street) 11 85 1935 40 (Butler) 59 (Gillman House) 27 (Maude House) 40 (Mulberry House) 166 1936 55 (Digby) 90 (Hollybush House) 71 (Dinmont House) 25 (Haig House) 4 245 It should be borne in mind that this new building follows the clearing away of equally large numbers of old, worn out, dark and unsavoury dwelling houses and insanitary areas. Even these facts do not fully reveal the profound change which is taking place in the housing situation of the Borough. At the beginning of 1937, the Borough Council and London County Council between them had preparations in hand for no fewer than 503 further tenements in the Borough, apart from the provision 102 for Bethnal Green residents outside the Borough and from other schemes in the Borough which had not then matured. Furthermore, the large Redevelopment Area in the North and East wards has yet to be carried out. REDEVELOPMENT AREA. In view of the special importance in the future replanning and rehousing of the Borough, I append some extracts from the joint report of the Housing, Public Health, Town Planning and Highways Committees of the London County Council with regard to this matter. (i) Housing Conditions in the East End of London Housing conditions in a large part of the East End of London, particularly in the Metropolitan Boroughs of Stepney, Bethnal Green and Shoreditch, have for many years been regarded with the gravest concern. Past efforts at reconstruction have been confined to the worst of the unhealthy areas and, owing to the lack of suitable rehousing accommodation, progress has been slow. For the rest, reliance has been placed on improved public health administration, which, while affording a large measure of amelioration, is powerless against the evils of cramped planning, bad internal arrangement of houses, structural decay and major sanitary defects. Up to the present it has been possible to do little more than touch the fringe of the problem, which now becomes increasingly important and urgent owing to the demand for an improvement in the general standard of housing accommodation, the inauguration of the campaign against slums, and overcrowding, and the application of the principles of town planning to built-up areas. In the heart of the East End the development, in the main, is more than 100 years old, and in some parts considerably older. The practical difficulties of dealing with the problem in this district are vastly increased by the sporadic introduction of industry and commerce into what were originally residential areas. The houses which are unfit for human habitation constitute a considerable percentage of the whole. Many are in clearly-defined areas of sufficient extent to form sites for the erection of block dwellings, but the remainder are in small groups scattered in large numbers over an extensive area. The larger aggregations of unfit houses can 103 suitably be dealt with under Part T of the Housing Act, 1930, by acquisition, clearance and reconstruction. The smaller groups do not afford sites of sufficient size for the erection of block dwellings and would by the normal procedure of the 1930 Act be dealt with by clearance orders. The sites would be left with the owners, who in many instances would not be in a position to redevelop them to advantage ; and such piecemeal treatment would perpetuate the bad planning of the district, which is the fundamental obstacle in the way of an effective and permanent remedy of the existing evils. The only satisfactory alternative would be a general redevelopment of the whole district on modern lines, involving the closing of some of the streets, the widening and improvement of others, the provision of open spaces and the re-arrangement of housing, industrial and commercial user. (ii) Redevelopment Areas Any large scale project of this nature would be impracticable under the limited powers of the 1930 Act, and special legislation would have been necessary, but the Housing Act, 1935, provides in the general law an entirely new procedure for dealing with extensive areas which it is expedient to redevelop as a whole. By section 13 of the Act it is the duty of a local authority to declare as a redevelopment area any area in its district with regard to which it is satisfied as a result of an inspection that the following conditions exist:—(a) that the area contains 50 or more working class houses ; (b) that at least one-third of the working-class houses in the area are overcrowded, or unfit for human habitation and not capable at reasonable expense of being rendered so fit, or so arranged as to be congested ; (c) that the industrial and social conditions of the local authority's district are such that the area should be used to a substantial extent for rehousing ; and (d) that it is expedient in connection with the provision of housing accommodation that the area should be redeveloped as a whole. (iii) Proposed Redevelopment Area in Bethnal Green Since the passing of the 1935 Act, the Housing and Public Health Committee have given close attention to the question of applying the redevelopment provisions of the Act to the part of East London to which earlier reference has been made. Any project of this nature could not possibly be contemplated in one step or within any specified number of years. The utilisation of 20½ acres of Hackney Marsh for housing purposes makes it possible, however, for consideration to be given to a definite 104 scheme of redevelopment, and it is considered that a commencement should be made with an area of about 46 acres in the northern part of Bethnal Green. This area has been selected for the following reasons, apart from conditions necessary for compliance with the Act:—(1) The dwellings to be erected on the 20½ acres of Hackney Marsh can be utilised for rehousing persons displaced from clearance and other areas in Hackney and other neighbouring boroughs, the sites of which can, in turn, be utilised for rehousing persons displaced from the proposed redevelopment area ; (2) the new dwellings to be erected on the proposed redevelopment area could be utilised for rehousing in connection with further redevelopment areas or clearance areas in more congested districts to the south ; (3) the redevelopment of the area now in question could be considered either as part of a larger redevelopment scheme or as a complete scheme in itself without committing the Council to an extension on similar lines. The area, which is intersected from north to south by Cambridge Road and from east to west by Hackney Road and Bishop's Road, lies between the Regent's Canal on the north and Old Bethnal Green Road on the south. With the exception of the gas containers belonging to the Gas Light and Coke Company adjoining the canal, the area comprises all the property on the north side of Hackney Road and Bishop's Road between the Council's Dinmont estate (Teale Street area) on the west, and Wellington estate (Waterloo House site) in Bishop's Road on the east. On the south side of Hackney Road and Bishop's Road, the area is bounded on the east by Russia Lane and on the west by Temple Street, the southern boundary being the Council's Bethnal Green hospital and Old Bethnal Green Road. The portion of the area north of Hackney Road and Bishop's Road is composed of a heterogeneous collection of dwelling houses, commercial properties and industry, whilst the portion of the area south of Hackney Road consists, in the main, of a large block of old residential property with some infiltration of industry. The remaining portion of the area south of Bishop's Road mainly comprises a block of residential property which, except for a number of unfit houses, is generally of a somewhat better character than the remainder of the residential property in the area. It may be possible for a number of the better conditioned houses in this part of the area to be acquired and utilised temporarily as rehousing accommodation in connection with the Council's clearance operations and the abatement of overcrowding. The whole area is a typical example of the results of the uncontrolled 105 development of London in the past. When the operations now envisaged are completed, the area will form an integral part of an area of over 60 acres, including the Council's existing housing development and Bethnal Green Hospital, redeveloped on modern housing and town planning principles. The undermentioned properties are included in the area :— Houses—Working class 693 Houses with shops on ground floor—Working class 134 Premises, partly industrial or commercial and partly occupied by persons of the working classes 22 Peabody Buildings—Eight blocks of dwellings—Working class 183 Premises occupied by persons not of the working classes 11 Licensed premises 12 Commercial premises (non-residential) 54 Factories and general industrial premises (non-residential) 59 Mowlem Street School 1 Roman Catholic Lithuanian Church 1 Vacant houses (including 4 shops with living accommodation over them) 15 Vacant industrial and commercial properties 11 Derelict properties 14 Total 1,210 A portion of the London and North Eastern Railway runs through the area on a viaduct and Cambridge Heath station and various ancillary railway properties are situated in the area. Of the working-class dwelling houses in the area, 503 (47.4 per cent.) are unfit for human habitation and not capable at reasonable expense of being rendered so fit (section 13 (l) of the Housing Act, 1935). There are also two contiguous blocks of tenement dwellings comprising 56 houses which are not unfit but which are badly congested and overshadowed at the rear. In addition to overcrowding in houses which are unfit for human habitation or congested, 24 other houses which are not unfit or congested are overcrowded on the standard laid down in the Act. 106 It will be seen, therefore, that out of 1,061 working-class houses in the area, 583 are overcrowded, or unfit for human habitation and not capable at reasonable expense of being rendered so fit, or are badly congested. This represents 55 per cent. of the working-class dwellings in the area compared with the statutory condition of at least one-third. The total population of the area is 5,471, of whom 5,382 are persons of the working classes (including 511 persons in Peabody buildings), and 89 are persons other than workingclass. It is estimated that the redevelopment of the area will involve the displacement and rehousing of 4,700 persons of the working classes. (iv) The Redevelopment of the Area Having regard to the close connection between the treatment of a redevelopment area and town planning, it is necessary to bear in mind from the commencement the correlation of the development entailed by the provision of adequate housing accommodation with the provisions of wider planning schemes for the district. The Minister of Health, as already mentioned, emphasises this aspect of the question in his memorandum on the redevelopment provisions of the Act, in which he states that, once a local authority has decided that the conditions in a particular part of its district are such that it becomes the duty of the authority to declare a redevelopment area, the actual limits of that area will depend almost as much on planning considerations as on those of housing and finance. While the initial stage of the procedure under the Act is merely the declaration of the area and the publication of the Council's resolution, we think it desirable that some indication should now be given of the proposals which we have in mind for the redevelopment of the area and the probable extent of the financial commitments involved. We contemplate the removal of many of the factories and workshops into a portion of the area to be set apart from the residential district for that purpose ; the erection by the Council of blocks of flats ; the widening of Cambridge Road, Old Bethnal Green Road, Pritchard's Road, Hackney Road and Bishop's Road ; and the erection of shops and commercial premises where required on the frontages of certain of these roads. After the area has been declared to be a redevelopment area, there is nothing to prevent the Council from dealing with unfit houses in the area under the Housing Act, 1930 ; and the Housing and Public Health Committee propose to consider shortly as to declaring portions of the area to be 107 clearance areas under that Act. The compensation for such property, as well as for the acquisition under the 1935 Act of houses unfit for human habitation and not capable at reasonable expense of being rendered so fit, will be assessed on the basis applicable to unfit houses purchased under Part I of the 1930 Act, viz., site value. The compensation payable in respect of other property in a redevelopment area is assessed in accordance with the provisions of the Acquisition of Lands (Assessment of Compensation) Act, 1919, viz., market value, subject, however, to deductions if the rental value of the premises is enhanced by reason of their being used for illegal purposes, or being overcrowded, or if the premises are in a defective state of sanitation or are not in reasonably good repair. The new accommodation provided to rehouse persons displaced from unfit houses in a redevelopment area and from any other houses in the area that may be acquired under the Housing Act, 1930, will rank for subsidy under that Act. Accommodation provided for rehousing persons displaced from other houses in a redevelopment area will rank for subsidy under the 1935 Act. The subsidy under the 1935 Act takes the form of an annual contribution for 40 years from the State in respect of each dwelling, the amount being related to the cost per acre of the site, as developed, in accordance with a graduated scale set out in the Third Schedule to the Act. Apart from the subsidies in respect of the provision of new housing accommodation, no State grant is payable under the Housing Acts towards the expenditure involved in dealing with a redevelopment area, although grants might be payable in respect of specific services under other Acts, e.g., Ministry of Transport grants for major road improvements. 108 HOUSING ACT 1935—OVERCROWDING SURVEY. The Overcrowding Survey which was undertaken under the provisions of the Housing Act 1935 Avas completed during the early part of the year. A brief report on the statistics obtained was submitted to the Borough Council, and a fuller summary of the information to the London County Council. Too much reliance should not be placed on the accuracy of the figures obtained, as it has since become obvious that in many instances misleading statements were made to the enumerators both as to the numbers in family and as to the number of rooms occupied. It is difficult to suggest what induces people to make these false statements unless it be fear of penal action on the part of the authorities when overcrowding is discovered, or a desire to be left alone in the old home surroundings, however overcrowded or unsuitable they may be. The returns obtained by the enumerators showed that there were 26,093 families resident in the Borough to whom the Survey referred. Of these, 3,875 families were living in overcrowded conditions and 19 in circumstances where the segregation of the sexes as provided by the Act was not possible—a total of 3,894 cases to be dealt with. In addition, during the two years following the Survey a further total of249 cases would become overcrowded by reason of children attaining the age of 1 or 10 years and therefore subject to a different classification. 147 of these cases had been added to the register by the end of 1936. 30 other cases were discovered subsequent to the Survey, which brought the known total of" overcrowded cases to 4,071. By the end of the year, this figure had been reduced by 461 to 3,610. The following is a summary 100 of the composition of the relieved cases, together with the number of equivalent adults involved:— Families Equivalent adults Rehoused by London County Council : (49 in connection with Clearance Areas) 170 821 Rehoused by Borough Council: (13 in connection with Clearance Areas) 19 107 Rehoused by Housing Association 6 40 Rehoused by others 19 97 Moved without trace 225 1,068 Alterations in families (by deaths, marriages—arrangements for members of family to sleep out, etc.) 22 120 Total 461 2,253 The 3,610 families remaining on the register at the end of 1936 comprised 18,714 equivalent adults. In connection with the relief of overcrowding, the London County Council has devised a system of certification on the part of the Borough Council which gives preferential consideration to an applicant for housing accommodation who is living under overcrowded conditions. From the inception of the scheme at the end of April, 1936, 456 cases were so certified. Notification was received from the London County Council in respect of 30 cases that the applications had been cancelled for various reasons, and that 73 cases had been accommodated. The appointed day when overcrowding becomes an offence and the machinery for dealing with it comes into force, has not yet been fixed for this Borough. It is not therefore possible to deal with 110 cases of dwellings becoming again overcrowded following vacation by overcrowded families, except informally. In all known cases of premises becoming vacated, whether by overcrowded families or not, the owner or other responsible person is informed of the provisions of the Act, and advised as to the need for care in the re-letting of such premises. Despite these measures, 4 cases of premises having again become occupied in overcrowded conditions following vacation by an overcrowded family were discovered in the course of enquiries regarding applications for housing accommodation. I am afraid that this unsatisfactory state of affairs will continue until the appointed day is fixed for the Borough. The following table gives some idea of the magnitude of dealing with the problem of overcrowding remaining in the Borough at the end of 1936:— Degree of overcrowding (expressed in X times the legal standard) Rooms required Total families 2 3 4 5 6 7 Over 3 2 8 17 15 — — 42 „ 2 94 210 254 58 6 1 623 From 1½ to 2 95 615 461 70 15 1 1,257 „ 1 to 1½ 144 770 536 199 22 1 1,672 Segregation 16 - - - - - 16 Total 351 1603 1268 342 43 3 3,610 111 GENERAL. Notwithstanding the size of the problem presented in the foregoing figures, I think the housing situation of the Borough is now more hopeful than it has been for many years. No one can expect such a longstanding and widespread evil to be abolished suddenly by a wave of the hand. The great step forward is that the actual cases of overcrowding are now recorded and systematic efforts are being made to deal with them. The progress, at present inevitably slow, will increase as the London County Council housing schemes get under way. With regard to the other and perhaps more important aspect of Housing-Slum Clearance —the facts and figures already given show what substantial progress is being made. The completion of the Hackney Marshes Scheme will provide a much needed pool of accommodation to enable clearance schemes to be carried out in the Borough on a larger scale and at a greater speed. If, as I hope, it should prove possible to apply the redevelopment procedure to other large areas in the Borough we may reasonably expect a dramatic transformation in its appearance within the next 5 or 6 years. Residents who have been compelled to endure overcrowding and unhealthy living conditions in old houses, too closely packed together in narrow streets, ill lit, ill ventilated and inconvenient, may find it difficult to realise that a totally different kind of planning and construction of Bethnal Green housing on modern lines is not only possible but probable. It is, however, important that some sense of the significance of present changes should be conveyed to the people in order to elicit their intelligent and friendly co-operation. All housing schemes involve a great deal of disturbance of accustomed routine in domestic life. People who have lived for many 112 years in a particular house or district sometimes unthinkingly resent the necessity of change even although it may mean better health for themselves and their families. In the vast task of replanning and rebuilding the insanitary areas in East London and in finding more adequate accommodation for the overcrowded, the local authorities concerned can be greatly helped by the willingness of the residents to co-operate in the plans made for their welfare. With the broader view of the replanning of the housing accommodation in the Borough which is now being adopted, I hope that further consideration will be given to the relative merits of houses and block dwellings. In so far as the latter are deemed to be necessary because of the large amount of accommodation needed in the limited area of Central and East London, it is most desirable that they should make better provision for family life than is frequently the case with such buildings. The location of young children and invalids on the upper floors of large tenement buildings places a heavy burden on the mothers, which might be greatly alleviated by the provision of lifts. Day Nurseries, and adequate gardens and playgrounds should also be regarded as necessary features of every tenement building scheme. HOUSING STATISTICS FOR 1936. Number of Houses erected during the year—241 tenements and 4 houses. 1. Inspection of Dwelling Houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,984 (b) Number of inspections made for the purpose 21 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 733 (b) Number of Inspections made for the purpose of the regulations 733 113 (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) 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 — 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 — 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 .... — (2) Number of dwelling-houses which were dered fit after service of formal notices :— (a) By owners — (b) By Local Authority in default of owners — (B) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices Notices served : were served requiring de- Intimations, 5,652 fects to be remedied Statutory Notices 2,555 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 5,759 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil 114 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (D) Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1935—Overcrowding. (a) (i) No. of dwellings overcrowded at end of year 3,610 (ii) No. of families dwelling therein 3,610 (iii) No. of persons dwelling therein 18,714 (b) No. of new cases of overcrowding reported during year 177 (c) (i) No. of cases of overcrowding relieved during year 461 (ii) No. of persons concerned in such cases 2,253 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after local authority has taken steps for abatement of overcrowding 4 (e) Any other particulars with respect to crowding conditions upon which the M.O.H. may consider it desirable to report - 115 FACTORIES, WORKSHOPS, OUTWORKERS, &c. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 2,005 197 .... Workshops (Including Workshop Laundries) 2,249 365 .... Workplaces (Other than Outworkers' Premises) 118 28 .... Total 4,372 590 .... 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 174 170 9 .... Want of ventilation 2 1 1 .... Overcrowding .... .... .... .... Want of drainage of floors .... 1 .... .... Other Nuisances 409 399 1 .... Sanitary accommodation— .... .... .... .... insufficient 9 10 .... .... unsuitable or defective 573 558 .... .... not separate for sexes 1 1 .... .... Offences under the Factories and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) .... .... .... .... Other offences (Excluding offences relating to out work). .... .... .... .... Total 1,168 1,140 11 .... 116 Registered Workshops. Workshops on the Register (s. 131) at the end of the year Number Workshops 998 Workshop Bakehouses 31 Total Number of Workshops on Register 1,029 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) 22 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 21 Reports (of action taken) sent to H.M. Inspector. 21 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 19 HOME WORKERS. Of the 2,004 names of workmen and contractors which appeared on the lists received, 1,574 were given as residing within the Borough. These figures are approximately double the number of individual workers, as in the majority of cases the same people are notified in February and in August. 117 The number of visits paid to Home Workers' dwellings was 849. The number of premises found to be in an insanitary condition was 107, or 24.1 per cent. of the 445 premises inspected. Notices were served in 144 cases, while 31 other premises were under notice arising from other visits, and a verbal intimation was given in 16 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. It may be of interest to mention that some of the homeworkers resident in Bethnal Green are employed by firms whose place of business is as far away as Croydon and Epsom, and local firms have sent in lists containing outworkers resident in Bexley, Hornchurch, Laindon, Rochford, Romford, Southendon-Sea and Welling. 118 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. 29 64 187 4 6 16 876 146 44 .... .... 35 47 .... .... .... .... Boots and Shoes 9 9 86 1 .... 13 99 74 14 .... .... 15 19 .... .... .... .... Curtains, Furniture hangings and Trimmings 2 54 4 .... .... .... 8 31 6 .... .... 7 10 .... .... .... .... Fur-pulling and feathers .... .... .... .... .... .... 10 .... .... .... .... .... .... .... .... Umbrellas, etc. 2 .... 16 .... .... .... 17 2 4 .... .... 5 8 .... .... .... .... Artificial Flowers .... .... .... .... .... .... 19 .... .... .... .... 1 1 .... .... .... .... Paper, etc.,Boxes, Paper Bags 9 1 146 1 .... 7 96 44 15 .... .... 26 37 .... .... .... .... Brush-making 3 .... 79 .... .... .... 11 58 2 .... .... 5 5 .... .... .... .... Draught Board Making 1 .... 2 .... .... .... .... .... 2 .... .... .... .... .... .... .... .... Cosaques, Christmas Crackers, Christmas Stockings, etc. .... .... .... .... .... .... 5 .... .... .... .... 3 5 .... .... .... .... Textile Weaving 1 .... 8 .... .... .... .... .... 2 .... .... .... .... .... .... .... .... Toys 1 .... 125 .... .... .... 15 71 2 .... .... 10 12 .... .... .... Total 57 128 653 6 6 36 1,156 426 91 .... .... 107 144 .... .... .... .... *The figures in these columns relate to outworkers' premises at which nuisances were found and dealt with under Public Health (London) Act. 119 APPENDIX I. LEGAL PROCEEDINGS During the year, 26 summonses were heard in respect of nuisances, with the following results :— Withdrawn on payment of costs amounting to :— £1 1 0 15 £2 2 0 2 £5 5 0 2 while in one case the summons was withdrawn without costs owing to the death of the defendant. Nuisance Orders obtained with costs amounting to :— £5 5 0 1 £3 0 0 2 £2 2 0 3 Other legal proceedings are summarised in the following list:— Legal Proceedings, 1936. No. of Sample in Food cases Date Offence or Occasion Result Milk and Dairies Order, 1926 — 8th Jan. Filling bottle with milk other than on registered premises No fine Costs 2/- Food and Drugs Adulteration Act, 1928 615 do. Selling milk which contained 3.5% added water No fine Costs £4 4s. 0d. 621 15th Jan. Selling Mercury ointment which was 64% deficient in mercury Fine £2 Costs £3 3s. 0d. 623 20th Jan. Selling Mercury ointment which was 65% deficient in mercury Fine £5 Costs £5 0s. 0d. 626 20th Jan. Selling Mercury ointment which was 65% deficient in mercury Fine £5 Costs £2 0s. 0d. 622 22nd Jan. Selling Mercury Ointment which was entirely deficient in mercury In this case an appeal was entered by the defendant, which was heard on the 17th April and allowed with costs against the Council Fine £5 Costs £2 0s. 0d. 120 No. of Sample in Food cases Date Offence or Occasion Result Food and Drugs Adulteration Act, 1928 674 29th Jan. Selling milk which was 13.3% deficient in fat Fine £5 0s. 0d. Costs £3 0s. 0d. 652 5th Feb. Selling grape fruit squash containing 15 parts per million of sulphur dioxide in excess of amount permitted No fine Costs £3 3s. 0d. Public Health (London) Act - 6th Feb. Exposing for sale two loaves of bread unwholesome and unfit for food No fine Costs £3 3s. 0d. Food and Drugs Adulteration Act, 1928 616 19th Feb. Selling milk which contained 3.5% added water No fine Costs £4 4s. 0d. 13 19th Feb. Selling milk which was 5% deficient in fat No fine Costs £2 2s. 0d. Milk and Dairies (Consolidation) Act, 1915 - 14th April Selling milk from a receptacle not having name and address inscribed thereon No fine Costs £1 3s. 0d. Public Health (Preservatives, etc., in Food) Regulations 112 21st April Selling raspberry jam containing 10 parts per million of sulphur dioxide in excess of amount permitted Withdrawn Costs £3 3s. 0d. Food and Drugs Adulteration Act, 1928 619 7th April Selling Mercury ointment which was 31% deficient in mercury No fine Costs £7 7s. 0d. Milk and Dairies Order, 1926 - 12th May Filling bottle with milk otherwise than on registered premises No fine Costs £1 3s. 0d. L.C.C. (General Powers) Act, 1928 - 14th May Application to remove an aged and infirm person to Bethnal Green Hospital Order made Food and Drugs Adulteration Act, 1928 192 19th May Selling vinegar which was 15% deficient in acetic acid Dismissed Warranty proved Rag Flock Act, 1911 - 2nd July Possessing rag flock containing 20 parts of chlorine in excess of permitted limit Withdrawn on payment of £5 5s. 0d. Costs 121 No. of Sample in Food cases Date Offence or Occasion Result Rag Flock Act, 1911 - 2nd July Possessing rag flock containing 23 parts of chlorine in excess of permitted limit Withdrawn on payment of £5 5s. 0d. costs - 2nd July Possessing rag flock containing 170 parts of chlorine in excess of permitted limit Withdrawn on payment of £3 3s. 0d. costs - 2nd Jnly Possessing rag flock containing 73 parts of chlorine in excess of permitted limit Withdrawn on payment of £3 3s. 0d. costs Public Health (Meat) Regulations, 1924 — 18th July Failing to cause rubbish to be placed in properly covered receptacles No fine Costs £3 3s. 0d. — 18th July Failing to observe due cleanliness Withdrawn Food and Drugs Adulteration Act, 1928 388 21st July Selling vinegar 5% deficient in acetic acid Dismissed Warranty proved Public Health (London) Act, 1936 — 15th Oct. Application to remove aged and infirm person Order made - 18th Dec. Non compliance with abatement order in respect of nuisance Fine £25 0s. 0d. Costs £10 10s. 0d. 122 APPENDIX II. TUBERCULOSIS DISPENSARY REPORT FOR THE YEAR 1936 By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., Lond., Clinical Tuberculosis Officer. Before presenting the statement of the work of the Dispensary, I have to report a change in the personnel of the department. Mrs. Darnell, who had acted as Clerk since 1919, resigned her appointment during the year. She was most efficient and capable and always took the keenest interest in her work. We much regretted her decision to retire. Apart from the usual clerical duties, the Dispensary Clerk is responsible for the keeping of the intricate records required by the Ministry of Health. The question of filling the post satisfactorily is, in consequence, not an easy one ; so we are fortunate in securing the services of Miss Wright, who has had five years previous experience in this class of work at the Fulham Dispensary. Miss Wright took up her duties on July 1st and has already proved herself a competent clerk. As a result of the Tuberculosis Officers taking on the work of " refills " in Pneumothorax cases in April, it was found necessary to make a slight alteration in the sessions. The hours at present are as follows :— Monday, Wednesday, Thursday, Friday and Saturday mornings from 10 to 12 o'clock, and Thursday evenings from 7.30 to 9 o'clock. Saturday mornings are reserved as far as possible for school children, and Thursday evenings for those patients who are at work during the day. In addition to the above, three sessions for Artificial Pneumothorax refills have been added ; Thursday morning at 12 o'clock, Thursday afternoon at 2 o'clock, and Saturday morning at 12.30. These arrangements are working quite satisfactorily. The Artificial Pneumothorax Clinics have given us an added interest in our work, though necessarily adding considerably to our duties. Since April there have been 775 attendances, with 629 " refills," at these clinics. These figures do not perhaps convey the amount of time and work given to these cases. I would point out that before deciding whether to give a patient a refill or not, it is essential at each attendance to make a thorough clinical examination, and in addition, in the majority of 123 cases, to inspect the lungs under the X-ray screen. This is necessary not only to ascertain the degree of collapse of the affected lung, but what is of equal importance, to enable us to keep a constant check on the sound lung. It is very probable that the number of refills will tend to increase, as the more I see of Collapse Therapy, the more I am convinced that it offers the best chance of recovery to patients with acute disease, limited to one lung. Especially is this the case in the class of patient attending the Dispensary. While freely acknowledging the great benefit to patients of a course of routine sanatorium treatment, we cannot ignore the fact that relapses are common. This is not surprising when we contrast the life of a patient at a sanatorium, with its abundant supply of good food and fresh air, and the life he may have to face on his discharge. The home is probably overcrowded, and the economic conditions of his family often compel him to commence work before he is really capable of this. It is in these cases that Collapse Therapy has proved to be of such value in that the risk of breakdown is considerably reduced. In the inauguration of the Artificial Pneumothorax Clinic and the subsequent routine work of the new department, I am most indebted to Dr. Temple Clive, whose previous experience in this class of work has been such an invaluable help. The number of patients X-rayed shows an increase of 252 over the figures of last year. If we are to detect tuberculosis in its earliest stage, we cannot afford to neglect taking an X-ray picture of any patient with symptoms even remotely suggesting tuberculosis, whether we are able to find any evidence of disease on clinical examination of the chest or not. In this connection I would point out that it is now our practice to X-ray all patients referred to the Department by local doctors. If the symptoms or the general condition of a patient are sufficiently suggestive to the family doctor, who should, from his previous knowledge of the case, be in the best position to judge, I think it rather presumptuous on our part to refuse an X-ray examination even in the absence of clinical signs of disease. Owing to the advance in recent years of X-ray technique and consequently our ability to detect tuberculosis in its early stage, it is disconcerting that such a large proportion of our cases are in an advanced state when first diagnosed. Out of 167 new cases notified as tuberculous during the year, 78, or less than half, had early disease, while 37 were in an advanced state and 52 were moderately advanced. This regrettable state of affairs is, in my opinion, almost entirely due to the insidious nature of the onset of tuberculosis in the 124 large proportion of cases, and in a lesser degree to the reluctance of the average man to seek medical advice until he is so ill that he can no longer carry on with his work. Frequently we meet cases with no cough, no loss of weight, no loss of appetite or any of the other symptoms that we usually associate with tuberculosis, yet on examination reveal wellmarked disease. Lucky is the man whose onset of disease is accompanied by a haemorrhage. He may be alarmed at the time, but he is almost certain to seek medical advice, when there is a very good chance of his obtaining a cure. How to secure earlier diagnosis is one of our greatest outstanding problems. I am satisfied that the general practitioner is playing his part, as he does not hesitate to send doubtful cases to the Dispensary for a further opinion, and it is no fault of his that a patient does not seek his advice until the disease is well advanced. In the case of contacts a fair percentage present themselves for examination at the Dispensary, while others are sought out at their homes. In cases other than contacts, patients delay seeking advice for the simple reason that they often do not feel ill. We cannot search for these ourselves, unless we undertake the stupendous task of periodic examination of the whole population. Tuberculosis is, however, largely a disease of adolescence, and probably an effective medical supervision of this age period, which has not showed a decline in the mortality rate to the same extent as other age groups, would bring to light cases of tuberculosis in an earlier stage than would otherwise be possible. As I have previously pointed out, this age period is neglected by the State, and I was pleased to note that attention was drawn to this fact at the last annual meeting of the National Association for the Prevention of Tuberculosis. The Infant Welfare Centres and School Medical Service between them undertake the care of children up to the age of 14. At this most critical period of their lives, growing boys and girls go out into the world, often into unsuitable and unhealthy occupations with no supervision of any kind. The rush and competition of modern life demand their toll and should this lead to the onset of tuberculosis, the natural independence of youth deters them from seeking advice until the disease is well established. We must not be discouraged, however, by the gloomy outlook I have presented, of what is, after all, only one of the many aspects of the question, but rather take heart when we review the results of the anti-tuberculosis scheme as a whole. A few figures showing the decline in the mortality from tuberculosis in recent years should prove a pleasant antidote. Perhaps I cannot do better than quote from the speech of the Minister of Health in July last to the National Association for the Prevention of Tuberculosis :— " In 1898, the year the Association was founded, 41,335 persons died from pulmonary, and 12,447 from other forms of 125 tuberculosis, making a total of 53,782. In 1935, although the population had increased by a third in the interval, the number of deaths had fallen to 24,603 from pulmonary, and 4,598 from non-pulmonary tuberculosis—or less than 30,000 in all. Looking at these figures in another way, the standardised death-rate from tuberculosis per million has fallen from 1,915 to 687 in less than forty years. Even in the past twenty-five years the annual deaths from pulmonary tuberculosis have come down by over a third, and from non-pulmonary by not far short of three-quarters." Surely there are justifiable grounds for encouragement here. In the supervision of children under the age of fourteen we work in close co-operation with other health services. The Maternity and Child Welfare Centres of the Borough Councils consult us, both in the case of mothers and infants, whom they may suspect of having tuberculosis. We, on the other hand, refer all cases of pregnancy to the Centres where, while still attending the Dispensary at regular intervals, they are kept under observation during the child bearing period, and suitable arrangements are made for the confinement. A satisfactory arrangement with the School Medical Service has been in operation since 1922. All healthy contacts and those who, after a period of observation at the Dispensary, show no evidence of tuberculosis, together with other children whose health is not entirely satisfactory, are transferred to the School Medical Department. The Tuberculosis Officer forwards a report on each child to the School Medical Officer, who provides special observation for such cases, arranges frequent periodic examinations and the keeping of accurate records of weight, etc. Should the School Medical Officer later suspect tuberculosis in any of those children they are immediately referred back to the Dispensary for further investigation. The scheme is working smoothly. In addition to our co-operation with the Borough Health Services, which are mainly concerned with the care of children, our works brings us into close contact with the Public Assistance Committee and the General Hospitals of the London County Council. I have acted as Consultant to the Bethnal Green Hospital for the last 14 years. The Hospital admits most of our advanced cases, with occasionally, patients requiring urgent Artificial Pneumothorax treatment. On the fortnightly visits I am able to follow up these cases, of whom we would otherwise lose sight for prolonged periods. I make a routine round of the tuberculosis wards, supervising treatment generally, selecting cases for Artificial Pneumothorax, and other special forms of treatment. I also examine suspected cases of tuberculosis in other wards of the Hospital, thus helping to secure earlier diagnosis.+ 126 The work of visiting the various wards of the Hospital and the supervision of the Artificial Pneumothorax cases has so increased that I find there is insufficient time for the routine round. To meet this difficulty I have decided in future to visit the Hospital weekly instead of fortnightly as previously, as I regard the work, apart from its interest, as one of our most important functions. I should like to take this opportunity of recording my gratitude to the Medical Staff for their unfailing courtesy and ready cooperation. In addition to the association with the various public services, we also work in close and friendly contact with the local charitable organisations. The Bethnal Green and Hackney Branches of the Invalid Children's Aid Association, of which Committees both Tuberculosis Officers are members, in particular, have been most helpful and have sent a considerable number of our debilitated children to convalescent homes, either at the seaside or in the country. The Charity Organisation Society has assisted in the supply of surgical instruments, dentures, clothing, etc., and the Jewish Board of Guardians, Soldiers and Sailors Help Association, and Soldiers, Sailors and Airmens Families Association have given financial assistance in necessitous cases. The children attending Stormont House School have, without exception, made satisfactory progress during the year. The School, which is admirably situated on Hackney Downs, has accommodation for 90 scholars. With one or two exceptions all the children are patients of the Tuberculosis Dispensaries at the Metropolitan and Victoria Park Hospitals, admission being restricted to notified or "suspect" cases of tuberculosis. The Classes are held in special open-air shelters, but ample indoor accommodation is available in bad weather. The children are kept under strict medical supervision, records of weight and temperature being kept by the nurse, who visits the school daily, while the Medical Officer makes frequent examinations of the children, and supervises the exercise and rest of each child. Hot milk during the morning and afternoon, together with an excellent mid-day meal are provided. Breakfast may also be supplied to any child who has not had a satisfactory meal before leaving home. During the year 18 children were discharged as fit for work and 9 transferred to ordinary elementary schools, as further stay in an open-air school was considered no longer necessary. All the scholars leaving school were placed in suitable employment by the School Care Committee. Satisfactory as the immediate result of treatment at an openair school is, it is encouraging to learn that the after history of these children is equally convincing. A breakdown later is a very 127 rare occurrence. At a re-union held at the School in December at which 57 old scholars attended, all appeared to be in excellent health, and only one lad was out of employment, and he only temporarily. In accordance with the rule of the London County Council that all children attending their Open-air Schools should receive an annual holiday, 20 scholars from Stormont House were sent to Tankerton, Kent, and 54 to Rustington for a period of two weeks during the summer. For the children who are not making satisfactory progress, longer periods of convalescence are readily provided by the Council. Under this arrangement several of the children were sent to Broadstairs during the year for periods varying from three to six months. In a school of this nature where the children are sub-normal in health, the education of the particular child must always be guided by his medical condition. It is therefore essential if there is to be no loss of efficiency either on the educational or medical side, that there should be close co-operation and natural good will between the Head Teacher and the Medical Officer. We are fortunate at Stormont House, as Mr. Bowling, the Head Teacher, is keenly interested in the medical welfare of the children, and freely adopts any suggestion I care to make. The Handicraft Class run by the Hackney and Stoke Newington Care Committee, continues its useful work in providing an interest to patients to occupy their minds and keep them from brooding over their condition. Incidentally it also provides a little pocketmoney, as all articles made by patients are sold, and after deducting the cost of materials and a small percentage for expenses, the surplus is paid over to the worker. Patients are taught basketmaking, artificial flower-making, glove-making, leather, bead and pewter work or any other craft a patient may particularly desire. The Class is now in a sound financial position thanks to the assistance of the National Association for the Prevention of Tuberculosis, the Alexandra Rose Day Fund, the Inner Wheel of the Hackney Rotary Club and other local bodies, and the support of the Mayors of Hackney and Stoke Newington. A Sale of Work was held in October at the Town Hall, Hackney, kindly lent for the purpose by the Mayor and Corporation, and it is hoped to hold a further Sale during the coming year. It is hoped that the Mayors of Hackney and Stoke Newington will attend the Sale. The London County Council and the Boroughs in their rehousing schemes give preferential consideration to the tuberculous and a number of patients have been rehoused during the year. 128 The number of families with one or more tuberculous members in urgent need of better accommodation, is, however, still considerable, and speeding up of the re-building schemes appears to be neccessary. Desirable as fresh air and suitable accommodation may be, these are of little avail in the absence of an adequate diet, which is, in my opinion, the first essential in a patient's fight against tuberculosis. The Public Authorities, recognising the importance of diet in treatment, give grants for extra nourishment to tuberculous patients where financial circumstances warrant it. The Borough Councils supply milk and eggs to those patients who are not in receipt of Relief while the Public Assistance Committee give a grant for this purpose to those under their care. This arrangement has obviated the possibility of overlapping and has released funds formerly expended by the Boroughs on those in receipt of Relief, and so enabled us to extend the grant. Formerly the Public Assistance Committee turned down quite a number of our recommendations without informing us of their action, but since the Borough Medical Officers of Health kindly took the matter up for us with the London County Council, the position has improved, and the number now refused a grant is relatively small and probably justified on financial grounds. Moreover we are now informed of the reasons for refusal. During the year 133 cases were admitted to Sanatorium or to Hospitals other than the London County Council general hospitals. We are fortunate in London as far as institutional treatment is concerned, as the London County Council now have adequate accommodation for all classes of cases, including those with advanced disease. No case offering a prospect of cure, or a reasonable hope of such improvement as will enable the patient to resume work, is refused the chance of sanatorium treatment. Moreover the waiting list has now been considerably reduced. The old problem of the advanced case has also, to a large extent, been solved, as we are experiencing much less difficulty than formerly in persuading patients to enter the Council's General Hospitals. Of the many reasons contributing to this, I would mention the improved status of the Hospitals under the London County Council, the more energetic and efficient treatment now available, the knowledge that the Tuberculosis Officer will continue to supervise their treatment, and the latitude allowed a patient in his choice of a Hospital. 129 In spite of the increased willingness of advanced patients to enter hospital there will always remain a certain number who wish to spend their last days with their family at home. While one cannot but sympathise with this attitude, from a Public Health standpoint it is to be regretted, as an advanced case of tuberculosis is a virulent source of infection and a menace to those in close contact with him. Nothing short of compulsory removal will usually avail, but only exceptional circumstances could justify such harsh measures. I submit at the end of the report a statistical summary of the work of the department for the year. 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. 12th March, 1937. 130 BOROUGH OF BETHNAL GREEN 1. The Totals of New Cases. Males 315 Females 302 Total 617 2. The Sources of the New Cases. Total Tuberculous Medical Officer of Health 185 14 Local Practitioners 189 25 Contact Cases (per M.O.H.) 136 1 London County Council 1 — Victoria Park Hospital 10 10 Other Sources 79 64 Transferred from other Areas 17 16 3. The Diagnosis of the New Cases Diagnosis Adults Children under 15 Total Males Females Males Females Pulmonary Tuberculosis 58 39 5 1 103 Non-pulmonary Tuberculosis 4 4 13 6 27 Non-tuberculous 131 170 88 76 465 Doubtful 7 5 6 4 22 Total 200 218 112 87 617 4. The. Diagnosis of Contact Cases Pulmonary Tuberculosis 1 Non-pulmonary Tuberculosis — Non-tubcrculous 132 Doubtful 3 Total 136 5. Sputum Examinations Tubercle Bacilli present 18 Tubercle Bacilli absent 268 Total 349 6. Other Figures Total number of attendances 4,186 Systematic examinations at the Dispensary 1,789 Number of patients sent to hospital or sanatorium by the L.C.C. 66 Number of letters written 1,469 Number of visits to patients at their homes 140 Number of attendances at:— X-ray Department 501 Dental Department 10 Artificial Pneumothorax Clinic 250 Other Departments 48 131 INDEX PAGE Aged and Infirm Persons 78 Ambulances 17 Bacteriological Examinations (medical) 75 do. do. (food) 88 Bakehouses 90 Bedsteads, Bedding and Clothing (Tuberculosis) 71 Birth Control 39 Births 22, 24 Cancer 31 Chicken Pox 74 Cleansing Stations: Personal 19, 77 Clinics 13, 42 Combined Drainage Systems 98 Common Lodging Houses 94 Condensed Milk Regulations 83 Convalescent Treatment 55 Cowhouses 90 Day Nurseries 14 Deaths 22, 25 Delicate Children: Clinic for 49 Dental Clinic (M. & C.W.) 49 Dental Treatment of Tuberculosis Patients 72 Diabetes 74 Diphtheria 63 DISEASE, CONTROL. OF 63, 92 Disinfectants: Distribution of 75 Disinfection 75 Dispensaries 13 Drainage Work 98 Dried Milk, &c. 57 Dried Milk Regulations 83 Enlarged Tonsils, Adenoids and Mastoid Disease 51 Enteric Fever 64 Expenditure on Public Health Work 10 Extra Nourishment (M.C.W.) 56 do. (Tuberculosis) 72 Factories and Workshops 115 Finsen Light Treatment 72 Fish Curing and Fried Fish 90 FOOD 79, 92 Food Premises 88 „ Poisoning 78, 92 Food and Drugs Acts 79 Foster Children 59 Fried Fish and Fish Curing 90 General Description of District 8 German Measles 74 Hairdressers 97 132 PAGE Health Education 20 HEALTH SERVICES 10 Health Visitors 34 do. do. Tuberculosis 71 Home Helps 41 Home Workers 116 Hospitals 12 HOUSING 93, 99 Ice Cream 90 Illegitimacy 24 Infant Consultations 43 Infantile Mortality 22, 28 INFECTIOUS DISEASE 63 Inhalation Therapy 53 Insanitary Areas 99 Insurance Acts. National Health 17 INTRODUCTION 6 Invalid Children's Aid Association 14 LEGAL PROCEEDINGS 119 Light Treatment (M.C.W.) 51 do. (Tuberculosis) 72 Malnutrition 56 Marriages 24 Massage 55 Maternal Mortality 22, 28 MATERNITY AND CHILD WELFARE 33, 59 Maternity Clinics 15, 36 Maternity Institutions 16 Maternity Outfits 42 Measles 73 Meat Regulations 91 Medical Inspection (school children) 59 Medical Practitioners 11 „ „ Consultations with 64 Midwifery: Borough Midwifery Service 40 Milk 82, 84 Milk for necessitous mothers and children 56 Milk in Schools 89 Milkshops and Dairies 88 Milk (Special Designations) Order 89 Mortuary 32 Mothers' Clinic 39 Motor Traffic Accidents 31 Noise 96 Notifications of Births 33 Nurses and Nursing Assistance 11, 57 Obstetrical Consultants 41 Offensive Matter 97 do. Trades 97 Open-Air Sleeping Shelter 71 Ophthalmia Neonatorum 59 Orthopaedic Treatment 54 Outworkers 116 Overcrowding 108 Personal Cleansing Stations 19, 77 Pharmacy and Poisons Act 92 Pneumothorax Refills 72 Population 24 Poultry Slaughterers 92 133 PAGE Public Assistance 9, 10 PUBLIC HEALTH COMMITTEE 3 Public Health Expenditure 10 Puerperal Fever and Puerperal Pyrexia 58 Rag and Bone Dealers 97 Rag Flock Act 97 Rats and Mice 96 Registration of Births, Deaths and Marriages 20 Rent Restrictions Acts 95 Sanatorium Treatment 72 Sanitary Inspectors, work of 93 Sanitation and Housing 93 Scabies (Itch) 77 Scarlet Fever 64 School Children: Medical Inspection and Treatment 13, 59 School Meals 10 School Milk Scheme 10, 89 Shelter for Contacts 75 do. Open-Air Sleeping 71 Slaughterhouses 91, 92 Smoke Nuisance 95 Social Welfare 8 Special Clinic for Delicate Children 49 Sputum Outfits 71 STAFF 4, 5 Stillbirths 22, 24 Street Accidents 31 Tenement Houses 95 Toddlers' Clinic 44 Tonsils, Adenoids and Mastoid Disease 51 TUBERCULOSIS 67 Tuberculosis Dispensary 19, 70 „ Officer Report of 122 „ Visitors 71 Unsound Food 92 Vaccination 20 Vaccination Returns 66 Venerea] Disease 19 Verminous Conditions 76, 78 VITAL STATISTICS 22 Water Supply 95 Welfare Centres 35 Whooping Cough 74 Workshops and Factories 115