C.1. AC4366 M. BET 42 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1937 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.1 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1937 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, 1937-38 as on 31st December, 1937 Meetings held at the Town Hall at 7 p.m. on the first Wednesday. *Councillor Mrs. M. S. Bridger, J.P., Chairman. *Councillor Mrs. A. Hillman, Vice-Chairman. Alderman C. Hoskins. * „ Mrs. A. O'Brien. „ E. A. Wormald. Councillor C. S. Bussin. * „ Mrs. R. Elsbury. Councillor J. J. Lecount. „ Rev. J. Ough.M.A. * ,, Mrs. E. Peaston. „ Mrs. R. Rockfelt. * „ Mrs. B. L. Tate. *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 P. J. Bridger, J.P.). Committee : Chairman : Baths Councillor A. E. McAuliffe. Electricity ,, H. P. Wilson, J.P. Finance ,, J. C. Edwards. Housing ,, H. Hooke. Law and General Purposes „ H. E. Tate, J.P. Libraries „ A. E. Turpin. Staff „ H. J. Stubbs. Street Trading ,, Mrs. B. L. Tate. Valuation ,, J. E. A. King, L.C.C. Works and Stores ,, A. W. Hastings. 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: Councillor Mrs. M. S. Bridger, J.P., Alderman C. Hoskins and Councillor Mrs. B. L. Tate, 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT, as on 31st December, 1937 Vynne Borland, M.B., Ch.B., B.Sc., D.P.H., Medical Officer of Health. Maternity and Child Welfare: Miss A. Mary Purce, M.B., B.Ch., B.A.O. Assistant Medical Officer. †‡Miss G. I. Le Geyt, Superintendent Health Visitor. †‡Miss E. M. Patrick, Assistant Supt. Health Visitor. †Mrs. F. M. Barden †Miss V. D. Cornish *†‡dMiss D. L. Fraquet †‡Miss C. E. Love †‡dMiss A. A. Page †‡dMiss M. Playle †‡Mrs. A. G. Price †Mrs. A. W. Rosling †‡dMiss L. F. Wright} Health Visitors. Miss M. V. Hazell, Clerk Dispenser. Miss D. M. Hare, Clerk. †Certificated Nurse. ‡Certified Midwife. dHealth Visitors' Diploma. Maternity & Child Welfare Centre: 1 Storekeeper, 1 Caretaker, 3 Cleaners (part time). General Administration: *J. Henry Lloyd, f.s.s., A dministrative A ssistant and Chief Clerk F. G. Thomas *R. W. Slyfield L. A Taylor S. P. Hansen R. F. Marshall J. E. Pestell J P. Mackenzie} Clerks. S. A. Edmonds, Junior Clerk. Tuberculosis: †‡dtMrs. J. Callow †tMiss M. L. Grant} Tuberculosis Visitors. tTuberculosis Certificate. Employees: 2 Attendants, one of whom acts as Temporary Mortuary Keeper. Sanitary Inspection: *W. Billings Senior Sanitary Inspector. *J. O. G. Weeks *§G. E. Gould} Food Inspectors. *E. J. Jenkins, Workshops Inspector. *§F. C. Sharpe, Housing Inspector. *G. I. Brighting *G. S. Freeman *§W. H. Heron *J. H. Hewitt *§S. R. B. Slater Inspectors. *E. F. Swash} District Sanitary Inspectors. *Certificated Sanitary Inspector. §Certified Meat, etc. Inspector. Disinfection: 1 Leading Disinfector, 3 Disinfectors. Combined Drainage: 1 Drain-layer, 3 Labourers. Personal Cleansing Station: 1 Woman Attendant (part-time). 5 Unestablished Part Time Officers 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 : Mrs. E. M. Johnson, L.D.S. (R.C.S.). F. R. Bate, L.D.S. (R.C.S.). Masseuse : Miss Y. Lawson, C.S.M.M.G. Clinical Tuberculosis Officers: (appointed by the Governors of the London Chest Hospital) : Senior, H. Tylford Howell, M.R.C.S., L.R.C.P. (Ldn.). Junior, A. F. W. Anglin, M.D. 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 the Year. Dr. A. M. Puree took up her duties as Medical Officer for Maternity and Child Welfare, on the 1st January, 1937. Miss E. E. Taylor resigned her appointment as Borough Midwife, the resignation taking effect on the 31st July. Having regard to the position created by the Midwives Act, 1936, and the L.C.C. service established thereunder, the council decided not to fill the vacant post. 6 Public Health Department, Temporary Offices, 15, Old Ford Road, Bethnal Green, E.2. 3rd May, 1938. 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 1937. The general death rate at all ages from all causes was 12.5 per thousand of the population. When corrected by the comparability factor of the Registrar General (1.13) the rate becomes 14.1 which is 0.2 below that of the previous year. In my report for 1935, I foreshadowed an increase in the Infant Mortality rate in 1936, chiefly on account of the expected measles epidemic with its attendant complications and lowering of resistance to other diseases. Unfortunately the prognostication was correct and the rate was 98. The efforts of the Council in the furtherance of the health of the people arc not spasmodic but. are a steady and unremitting activity in the use of all its powers. It is very gratifying, therefore, to report that for the year 1937 the Infant Mortality rate was the low figure of 54 per thousand births. The rate for London was 60, while for England and Wales as a whole it was 58. The number of mothers dying in child birth was the same as for the previous year, namely 3. Owing, however, to the decreased number of births the Maternal Mortality rate shows a slight increase, i.e., 2.3 as against 2.1 per thousand births. The rate for England and Wales was 3.11. 7 The incidence of infectious disease in 1937 showed very little change from 1936. There was one case less of Diphtheria, there being 222 cases, while the number of Scarlet fever cases notified during the year was 307 compared with 332 in the previous year. I desire to draw the attention of the members of the Council to the special report in the appendix on food expenditure compiled by Mr. Lloyd and myself. I have pleasure in expressing my gratitude to the members of the Public Health Committee for their unfailing courtesy and their earnest and sympathetic consideration of all matters relating to the public health. I also take the opportunity of thanking my colleagues in other departments for their ready and willing co-operation and also the members of the staff for their efficient and loyal service. 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 If miles from west to east and about one mile from north to south, and 760 acres in area. It is bounded by Shoreditch and Hackney on the north, Stepney on the south and Poplar on the east. Where the original soil exists it is of gravel and sand formation. The surface is generally flat, varying from 36 to 54 feet above sea level. The principal industries carried on in the district are the making of boots, shoes and clothing, cabinet making and other branches of the furnishing trade. The main lines of the Great Eastern section of the L.N.E.R. pass through the Borough. There are also three railway stations in the Borough, and several others in close proximity, while various tram and motor bus routes traverse the main roads in the Borough. There is a considerable daily inflow and outflow of workers, with the larger stream outward to workplaces in other parts of London. The tendency is for the Borough to be increasingly used for industrial and commercial purposes and the resident population is very congested. At the 1931 census there were 18,156 structurally separate dwellings in the Borough, and 27,978 families or separate occupiers lived therein. There is an excellent open space to the east of the Borough in the shape of Victoria Park, and there are a few small open spaces elsewhere in the Borough. The rateable value of the Borough on the 31st December, 1937, was £526,589, and the product of a Id. rate is estimated at £2,030. 9 SOCIAL WELFARE. There has been very little change in the social circumstances of the residents in the Borough during the year. Unemployment, short time and low wages characterise the economic position of a large section of the population and this is naturally reflected in a rather low standard of life. 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 cncerning public assistance granted during the year: Number of Persons Resident in Betiinal Green in Receipt of Out-Relief Week Ending Men Women Children under 16 Total Persons Total Cases 2. 1. 37 1,132 1,565 1,219 3,916 1,985 26. 6. 37 930 1,385 843 3,158 1,757 25. 12. 37 887 1,335 714 2,936 1,708 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 2,936 at the end of the year. 10 I am informed by the Education Officer that the average number of necessitous school children provided with free meals of some kind at public elementary schools in the Borough during the year was 1,036 (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 1936-37, the cost of the Public Health service was £25,603, or 5s. 5d. per head of the population, equivalent to a rate of 1. 0½d. 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 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 11 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 25 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 5 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. No. of admissions 5,786 Operations performed 1,286 (including 1,073 under general anaesthesia, 34 under spinal anaesthesia, 35 hernia operations, and 219 abdominal sections). Out-patients (7,841) Attendances 48,763 Some idea of the work carried out in the hospital may be gathered from the following figures about a few of the special departments :— Dental: No. of patients 341. Attendances 695. No. of extractions 262. Dentures: full upper and lower 5, repairs 3. Massage: Patients treated 892; Treatments given 23,320. X-ray: In-patients X-rayed 2,824; Out-patients 2,454. In addition, there are departments for pathological, bacteriological and bio-chemical examinations, and for venereal disease. 5,400 pathological and bacteriological examinations were made in the laboratory during the year. Attention has been drawn in previous reports to the wide range of services provided at this hospital and the high standard of medical treatment it maintains. The statistics concerning the out-patients department indicate that it is increasingly appreciated by local residents, this being particularly marked since the hospital was transferred from the poor law to the public health service. Whereas in 1930 the out-patients were 1,065 and their attendances 7,516, in 1937 the figures were 7,841 and 48,763 respectively. (Information as to the Midwifery work of the hospital is given in a later paragraph in this report). 13 Other. The Officers of the other 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 151 23,721 106,006 1,922 20.06 Mildmay Mission Hospital, Austin Street 58 16,085 51,914 949 17.35 London Chest Hospital Bonner Road 190 13,788 41,701 1,343 42.9 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 London Chest 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' Medical Visits to Out-Patients. Attendances. Patients' Homes. * Queen Adelaide's Dispensary, Pollard Row 1,313 3,879 485 §Medical Mission, St. James-the-Less, St. James's Road 276 4,179 315 †Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 2,914 22,700 4,617 (new 1,173) *There is also a Dental Department attached to this Dispensary and 197 patients received treatment thereat. †There were also attendances as follows:- Dental Department, 1,011; Eye Department 279; Massage and Sunlight 324; Chiropody Clinic 470. §In addition, there were 121 attendances for dental treatment. 14 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. 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: Ailment New Cases Attendances Minor Ailments 1,853 19,320 Eyes 465* — Teeth 1,576 2,875 *Spectacles were prescribed in 255 eases and obtained in 246 cases. DENTAL INSPECTION. 4,765 children were inspected by dentists and 3,846 found to require treatment. Further particulars as to the medical inspection of Bethnal Green School children will be found on page 55. 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 6,119 Average attendance 27.0 Twelve children were sent away to a Holiday Home for 3 weeks, while 13 others were sent away for convalescence for various periods. 15 INVALID CHILDREN'S AID ASSOCIATION, BETHNAL GREEN BRANCH. The Bethnal Green Branch of the Invalid Children's Aid Association, which has offices at 36, Barnet Grove, has furnished the following report of its activities:— In 1937 this branch of our Association continued its work for the invalid and crippled children living in Bethnal Green. Such children, with hundreds of whom we are in constant touch, are referred to us by doctors, hospitals, school care committees and other societies in the district, and during the past year our help was asked for 234 new cases, besides 100 applications on behalf of children already known to us. Of these new cases brought to our notice, 21 were crippled, 16 were suffering from rheumatism and heart trouble, 47 from pneumonia and bronchitis or other chest troubles, 9 from infected or enlarged glands, 49 were anaemic or debilitated, and 21 were suffering from serious malnutrition. In all, 136 children were sent away during the year for varying periods of convalescence, for an average stay of over seven weeks; 40 were supplied with surgical instruments, and 26 with other forms of help; while regular visiting and supervision was undertaken of a great many more, at the request of hospitals, dispensaries, and L.C.C. After-Care clinics. As in previous years, the Public Health Department of the Borough Council has helped us with the cost of convalescence or instruments ordered for children under 5, and have now extended their help to include the provision of spectacles. We should like to record once more our thanks for their co-operation. MATERNITY. Public. The Borough Council has two Maternity Clinics, one at Cornwall Road, and one at St. Matthew's Institute, Heretord Street, at which a variety of work for maternal welfare is carried on. (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 583 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 672 women made 3,920 attendances at the Clinic, 228 of the mothers were also seen at the post-natal clinic, making 280 attendances thereat. Other. Up to the end of the year, there were 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, are also largely used by residents of the Borough, as shown by the following figures furnished by them:— In At Ante-Natal Hospital Home Clinic City of London Maternity Hospital, Attendances City Road 35 3 225* Mothers' Hospital, Clapton 13 73 153† East End Maternity Hospital 41 — ‡ Jewish Maternity Hospital, Stepney 43 3 176° London Hospital, Whitechapel 196 185 2,537 ‡24 patients attended, but number of attendances not known. †Relating to 25 mothers attending: in addition there were 404 attendances at the S.A. Ante-Natal Clinic at Nichols Square. *Relating to 45 mothers attending. °PrimiparEe also advised to attend weekly sewing class, urine test and ante-natal care lecture. The Royal London Maternity Charity granted 68 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 22 insurance medical practitioners practice in the Borough, 14 of them residing in the Borough and 5 employing assistants. 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.I. 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, Countv Hall, S.E.I. 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.I. Eastern Brooksby Walk, E.9. Hackney Paragon Road, Mare Street, Hackney, E.9. Highbury Calabria Road, Highbury, N.5. Poplar 7, Woolmore Street, E.14. Shoreditch 5, Montclare Street, E.l.} WAT 3311 TUBERCULOSIS DISPENSARY. This is situated at the London Chest Hospital, 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 CleansingStation 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 3,831 attendances were made for vermin and 1,287 for scabies or impetigo. REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. The Town Clerk is the Superintendent Registrar for the Borough. The District Registrars of Births and Deaths are :— For N.E. Bethnal Green:— H. J. Hardwick, 106, Bishops Road. Office Hours:— Mon.-Fri. 10 a.m.-l p.m. Sat. 10 a.m.-12 noon. Mon. and Fri. 3-5 p.m. For S. W. Bethnal Green:— Miss M. Peters, 347, Bethnal Green Road. Office hours 10.30 a.m.-l p.m. daily. VACCINATION. The Public Vaccinators are:— For N.E. Bethnal Green:— Dr. E. F. Fernando, 83, Roman Road. For S. W. Bethnal Green:— Dr. J. G. L'Etang, 386, Bethnal Green Road. 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 In March, a series of three talks to young women were given in the lecture hall of the Public Library, by speakers On behalf of the British Social Hygiene Council. Councillors Mrs. Bridger, Mrs. Rockfelt and Mrs. Tate took the chair at these meetings. A further lecture to a mixed audience was given on the 23rd March by Dr. R. Forgan, Councillor H. E. Tate, J.P., being in the chair. 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. During the year, arrangements were made with the Central Council for Health Education for the supply of one of the Empire Marketing Board poster frames (which was fixed at the side of the Town Hall) and a monthly set of posters to display on it. NATIONAL CAMPAIGN TO ENCOURAGE WIDER USE OF HEALTH SERVICES. The department also took part in the national campaign organised by the Central Council for Health Education to encourage the wider use of the local health services, which commenced in October. Posters, cards and folders which were supplied by the Central Council were distributed through the Borough Council's various contacts with the public and through the churches, schools and other social agencies in the Borough. In addition, a special leaflet directory of local health services was prepared for distribution through the post offices, etc. 22 VITAL STATISTICS LIVE BIRTHS. Males Females TOTAL Birth Rate Legitimate 635 583 1,258 13.3 Illegitimate 15 25 TOTAL Rate per 1,000 total (live and still) births. STILLBIRTHS 37 28.6 DEATHS. Males Females TOTAL Death Rate M.O.H. 629 560 1,189 12.5 R.G. 627 560 1,187 When corrected by the Comparability Factor of the Registrar-General (1.13), the Death Rate becomes 14.1. MATERNAL MORTALITY. Number of women dying in, or in consequence of, childbirth:— Rate per 1,000 total (live and still) births. From Sepsis 2 1.53 From other puerperal causes 1 0.77 INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births:— Legitimate 49 54 Illegitimate 200 Deaths from Cancer (all ages) 165/6 ,, ,, Measles (all ages) 1 „ „ Whooping Cough (all ages) 10 „ ,, Diarrhoea (under two years of age 12 23 VITAL STATISTICS of Bethnal Green During 1937 and Previous 5 Years Year Population Estimated to Middle of Each Year Births Total Deaths Registered in the Borough Transferable Deaths Net Deaths of Persons Resident in the Borough Uncorrected Number Net Of Nonresidents registered in the Borough Of Residents not registered in the Borough At all ages Under 1 year of Age Number Birth Rate Number Death Rate Number Rate per 1.000 births or infantile mortality 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 1,129 831 229 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 1937 94,560 1,025 1,258 13.3 1,154 329 364 1,189 12.5 68 54 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 1937 of 94,560. MARRIAGES. The number of marriages registered in Bethnal Green during 1937 was 857. This is equal to a rate of 18.1 persons marrying per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1937 was 1,025, and in addition 233 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 1,258 births (650 males, 608 females). The birth-rate was, therefore, 13.3 births per 1,000 population, the lowest ever recorded in the Borough. The provisional birth-rate for London is given as 13.3 and for England and Wales as 14.9. ILLEGITIMACY. Of the births credited to this Borough, 40 were illegitimate, being 15 males and 25 females, and being 3.2 per cent. of the total number of births. STILLBIRTHS. Thirty-seven stillbirths were registered as belonging to the Borough, being a proportion of 2.9 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 1,189, but the Registrar General gives the figure as 1,187. Whichever figure be correct, it gives an annual crude death rate of 12.5 per 1,000 population which when multiplied by the Registrar-General's Comparability Factor is corrected to 14.1 and may be compared with 12.4 (similarly corrected) for the County of London and 12.4 for England and Wales as a whole. 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, 1937 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 627 41 9 4 7 25 24 37 78 131 140 131 F 560 27 5 5 7 15 17 36 48 91 150 159 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles M 1 ... ... 1 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough M 4 3 1 ... ... ... ... ... ... ... ... ... F 6 3 2 1 ... .... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... F 4 ... 1 1 2 ... ... ... ... ... ... ... 6. Influenza M 14 ... ... ... ... 2 ... 3 ... 6 3 ... F 19 ... 1 ... ... 1 1 1 ... 7 4 4 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... 1 ... ... ... ... ... 8. Cerebro-Spinal Fever M 1 ... ... 1 ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 9. Tuberculosis of respiratory system M 49 ... ... ... ... 4 10 9 12 7 5 2 F 24 ... ... ... ... 5 5 4 6 4 ... ... 10. Other Tuberculous Diseases M 4 ... 1 1 ... F 3 ... ... ... ... ... 1 ... ... ... 1 ... 11. Syphilis M 3 ... ... ... ... ... ... 1 1 1 ... ... F 1 ... ... ... ... ... ... ... ... ... ... 1 12. General Paralysis of the Insane, tabes dorsalis M 2 ... ... ... ... ... ... ... ... 1 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer, malignant disease M 92 ... .... ... ... 1 1 6 18 27 21 18 F 74 ... ... ... ... ... 2 3 13 23 22 11 14. Diabetes M 6 ... ... ... ... ... ... ... ... 2 2 2 F 14 ... ... ... ... 1 .... 1 ... 3 7 15. Cerebral Haemorrhage, etc. M 15 ... ... ... ... ... ... ... 2 1 5 7 F 20 ... ... ... ... ... ... 4 1 2 8 5 16. Heart Disease M 187 ... ... ... ... 5 3 4 10 39 64 62 F 194 1 ... 1 2 3 3 5 6 27 57 89 17. Aneurysm . M 1 ... ... ... ... ... 1 ... ... ... ... ... F 6 ... ... ... ... 3 ... ... 3 2 ... 1 18. Other Circulatory Diseases M 16 ... ... ... ... .... ... 1 1 5 6 3 F 19 ... ... ... ... .... ... 2 2 1 7 7 19. Bronchitis M 25 1 ... ... ... ... ... 2 3 7 3 9 F 22 1 ... ... ... ... ... ... 1 3 8 9 20. Pneumonia (all forms) M 59 12 3 2 1 1 ... 3 14 10 8 5 F 36 7 1 ... 1 ... 1 1 3 3 11 8 21. Other respiratory Diseases M 5 ... ... ... 1 ... ... ... 2 1 ... 1 F 4 ... ... ... ... ... ... ... 2 2 ... ... 22. Peptic Ulcer M 7 ... ... ... ... ... 2 ... 3 2 ... ... F 3 ... ... ... ... ... ... 1 ... 1 ... 1 23. Diarrhoea, etc M 9 9 .... ... ... ... ... .... ... ... ... ... F 6 3 ... ... 1 ... .... 1 ... ... ... 1 24. Appendicitis M 4 ... .... ... 1 ... ... ... 1 ... 2 ... F ... ... ... ... ... ... ... ... ... ... ... ... 25. Cirrhosis of Liver M ... ... .... .... .... ... ... ... ... .... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 26. Other Diseases of Liver, etc M 1 ... ... ... ... ... ... .... ... 1 ... ... F 2 ... ... ... .... ... ... ... .... ... 2 ... 27. Other Digestive Diseases M 5 ... ... ... .... .... 1 1 .... 1 ... 2 F 7 ... ... ... ... ... 2 2 1 1 1 28. Acute and Chronic Nephritis M 20 ... ... ... ... 3 1 2 6 4 1 3 F 22 ... .... ... ... 1 ... 1 1 5 7 7 29. Puerperal Sepsis F 2 ... .... ... ... ... 1 l ... ... ... ... 30. Other Puerperal Causes F 1 ... .... ... ... 1 ... .... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformations, ctc M 15 15 ... ... .... ... ... .... ... ... ... ... F 11 10 .... ... ... 1 ... ... ... ... ... ... 32. Senility M ... ... ... .... ... ... ... ... ... ... ... ... F 4 ... .... ... ... ... ... ... ... ... ... 4 33. Suicide M 8 ... ... ... ... 2 1 1 1 3 ... ... F 3 ... ... ... ... ... ... ... 2 1 ... ... 34. Other Violence M 23 ... 1 ... 3 4 2 1 1 3 2 6 F 7 1 ... ... .... ... ... 1 1 ... 4 35. Other Defined Diseases M 51 1 3 ... ... 3 2 3 3 9 17 10 F 44 1 ... 1 1 2 2 9 4 5 14 5 36. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... .... ... ... .... ... ... Totals 1187 68 14 9 14 40 41 73 126 222 290 290 28 MATERNAL MORTALITY. During the year, the following deaths were noted : 1. Peritonitis and gangrene of uterus following labour. 2. Toxaemia resulting from puerperal eclampsia. 3. General peritonitis, ovarian abscess and peral sepsis. In addition, two other women died, one from heart disease and arterio sclerosis accelerated by incomplete abortion and another from chorion epithelioma (a form of cancer) and hydatidiform mole. Only the first three cases have been counted as Maternal Mortality for statistical purposes, giving a rate of 2.3 per 1,000 total births (live and still). In England and Wales the rate was 3.11 per 1,000 births. INFANTILE MORTALITY. Sixty 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 54 per 1,000 births. The infant death rate for London was 60 and for England and Wales as a whole 58. Comparison with previous years is as follows :— 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 1936 98.0 29 Our refusual to take the disappointing high infant death rate in 1936 as any evidence of failure has been justified by last year's return to more satisfactory figures for the Borough. The number of deaths is in fact little more than half that for the preceding year and is quite simply accounted for by the absence of the exceptional adverse factors to which I referred in my last annual report. 30 The causes of death among infants are shown in the following table. Infantile Mortality in Bethnal Green in 1937 Causes of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 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 ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 4 1 6 4.8 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... Tuberculosis ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 ... 1 ... ... 2 1.6 Pneumonia (all forms) ... ... ... ... ... 3 4 9 3 19 15.1 Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... Diarrhœa and Enteritis . ... ... ... ... ... 3 6 2 1 12 9.5 Other Digestive Diseases ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 2 ... ... 3 2 ... ... ... 5 4.0 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... Premature Birth 14 ... 1 ... 15 1 ... ... 1 17 13.5 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 0.8 Other early infancy diseases 4 ... ... ... 4 ... ... ... ... 4 3.2 †Other Causes ... ... ... ... ... ... ... ... 2 2 1.6 Totals 20 2 1 1 24 9 12 15 8 68 54.1 Net Births in legitimate 1218 the year illegitimate 40 Net Deaths in legitimate infants 60 the year illegitimate infants 8 † Pericarditis and Otitis media (1 each). 31 CANCER. Cancer was responsible for 165 deaths or 14 per cent. of the total deaths in the Borough. The local distribution of the disease in these deaths was as follows :— M. F. Total Buccal cavity, pharynx 6 2 8 Digestive organs and peritoneum 53 27 80 (Esophagus (4-1) Stomach (29-9) Intestines (9-7) Rectum (7-5) Others (4-5) Respiratory organs. 20 5 25 Uterus — 10 10 Other Female genital organs — 3 3 Breast — 21 21 Male genito - urinary organs 9 — 9 Skin 1 1 2 Other or unspecified organs 2 5 7 91† 74 165† † The Registrar General returns 92 and 160 respectively, but I am not acquainted with the particulars of the additional ease. DEATHS FROM MOTOR TRAFFIC. Street accidents continue to cause unnecessary deaths among residents. During the year 11 pedestrians, 2 motor cyclists and 3 motor drivers were killed in this way, involving 10 vans or lorries, 3 private cars, 2 motor cycles, 1 tram and 1 bus. Observation suggests that most of these accidents are due to excessive speed. 32 PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 5 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. 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. Co-operation with the maternity hospitals serving the Borough continues. 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, 1,025 live births were registered in the Borough ; and 1,046 live births were notified to the Medical Officer of Health. There were also 28 stillbirths notified. Of the 1,074 living and stillbirths notified, 202 were found to relate to other districts and were duly transferred, 710 were notified by midwives, 113 by maternity assistants of the London Hospital, 31 by medical practitioners, and 18 by parents and others. Through the courtesy of neighbouring Medical Officers of Health I also received copies of notifications of births of Betlmal Green babies which took place outside the Borough, information as to 439 live babies and 14 stillbirths being received in this way. . The net total of notified live births belonging to the Borough was 1,290. 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 :— V isits Re-visits Babies (under 1 year) 1,300 10,071 Children (1—2 years) 3 4,823 „ (2—3 years) 2 8 4,001 13,874 „ (3—4 years) 1 3,224 „ (4—5 years) 2 1,826 Mothers (Ante-Natal) 755 530 „ (Post-Natal) 77 176 Stillbirths 28 17 Infant Deaths 27 9 Maternal Deaths — 1 Puerperal Fever (31) and Pyrexia ( 14) 25 50 Ophthalmia Neonatorum 11 33 Acute Poliomyelitis — 4 Other Notifiable Diseases — 1 Diarrhoea and Enteritis — — Measles (430), and German Measles (45) 191 284 Whooping Cough 298 562 Other Non-Notifiable Diseases 16 26 Milk Grants — — Convalescent Treatment 3 — Other matters 611 270 Total Visits 3,350 25,908 Grand Total 2 9,258 In addition, 76 visits and 2,102 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 120 Children's Clinics 1,286 Dental Clinic 169 Light Clinic 262 Mothers' Clinic 93 Other Clinics 333 Total 2,263 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 a substantial falling off compared with last year, partly due to the welcome reduction in the number of cases of measles, but mainly due to illness among the staff. 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. 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 47,280 47,280 Percentage of expectant mothers, or babies under 1, attending Centres respectively, to total net births 29.6 72.7 MATERNITY CLINIC (CORNWALL ROAD). This is open every Wednesday and Thursday morning. Particulars of attendances : Total Expectant Mothers—First visits 265 1,000 ,, —Subsequent visits 735 Mothers recently confined—First visits 138 180 „ ,, ,, —Subsequent visits 42 Total Attendances 1,180 The number of sessions was 102, and the average attendance per session was 11.5, as compared with 12.7 and 14.8 the previous two years. 76 of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement. The 263 women who attended for the first time may be grouped as follows :— Gravid Primiparæ 20 —Multiparæ 213 233 Not pregnant 30 37 In the case of the 233 gravid women, the following were the periods of gestation :— 21 were in the 2nd month 20 „ „ „ 3rd „ 34 ,, ,, ,, 4th ,, 33 ,, ,, ,, 5th ,, 44 ,, ,, ,, 6th ,, 55 ,, ,, ,, 7th ,, 21 ,, ,, ,, 8th ,, 5 ,, ,, ,, 9th ,, An analysis of these cases shows :— Full-term confinements 148 Premature births 7 Miscarriages (4) ; Stillbirths (2) 6 Not yet confined 73 Left Borough (results unknown) 3 The known confinements took place :— 104 at home, and 44 in institutions. The results of the cases brought forward from 1936 were as follows :— Full-time confinements 54 Premature Birth 1 Stillbirth 1 Left district (result unknown) 1 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 1937. I am glad to report that there has not been a single death among the mothers attending the Clinic during the year. There has been a slight decrease in the number of expectant mothers owing to the increasing desire of the mothers to be confined in hospital. I much regret the marked decrease in the attendance of the mothers recently confined and would appreciate more co-operation in encouraging these mothers to attend, although I am aware of the difficulties these mothers experience in arranging their domestic affairs to enable them to attend. With regard to the Miscarriages, 3 cases were treated in hospital, and the remaining case by her own doctor. 38 In 3 cases, the patients were multigravida, and the fourth, a primipara aged 18 years. In one ease the miscarriage was brought on by fright, and in the remaining cases there was no apparent cause. With regard to the two stillbirths, one case was due to placenta prævia, and the other case due to chronic nephritis, and both confinements occurred in hospital. With regard to the premature confinements, two cases occurred in primigravidæ, one case being due to a twin pregnancy in a woman suffering from heart disease, and the other case being due to anaemia. Five cases occurred in multigravidæ, one case being due to a fall, one to ante partum hæmorrhage, and the other cases being due to anaemia and poor general condition. Finally I should like to record my thanks to the staff of the Department for their unfailing help and efficient work during the past year. Ruth C. Townshend. MATERNITY CLINIC, HEREFORD STREET. This clinic is held once weekly on Thursday mornings and both ante-natal and post-natal cases are seen. RECORDS :— Expectant Mothers : First attendances 93 Subsequent attendances 245 Mothers recently confined : First attendances 61 Subsequent attendances 48 Total attendances 447 Number of sessions held 52 Average attendance per session 8.6 Mothers attending both before and after confinement 26 Primiparæ 6 Multiparæ 76 Not pregnant 11 93 Periods of Gestation:- In the 1st month Nil ,, 2nd 17 ,, 3rd „ 7 ,, 4th ,, 11 ,, 5th ,, 13 ,, 6th „ 15 39 In the 7th month 11 8th „ 5 9th Nil Full-term confinements 44 Not yet confined 31 Removed from district 3 Premature birth 1 Miscarriage 2 Stillbirth 1 Known confinements at home 29 ,, ,, in institutions 17 Cases brought forward from 1936:— Full-term confinements 23 Not pregnant 3 Miscarriage Nil, Stillbirth 1 1 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 week. Every mother receives a complete physical and gynaecological examination at her first attendance, when it is decided whether she is eligible for advice at the clinic. Total attendances during year 452 No. of sessions 50 Average attendance per session 9.0 Analysis of cases attending:— First Attendances : Contraceptive advice given 37 Referred to Burdett Road Clinic 1 Referred to Hospital 1 Total new cases 39 Subsequent Attendances 413 Total Attendances 452 40 Mothers have been referred to the Clinic by:- Medical Officers at Welfare Centres 23 Health Visitors 10 Hospital or other Doctors 1 Old Patients 5 Clinical Analysis of Cases given Contraceptive Advice: Anaemia 3 Anaemia and Malnutrition 9 Anaemia with other conditions (heart etc.) 2 Rheumatic conditions 2 Heart Disease and Chorea 1 Nephritis 1 Epilepsy 1 Hyperthyroidism 1 Neurasthenia 5 Emaciation or Bronchitis 1 Scoliosis 1 Contracted Pelvis 1 Tuberculosis contact 3 Chronic Bronchitis 3 Asthma 1 General Debility 2 Total 37 BOROUGH MIDWIFERY SERVICE. The Borough Midwife had 12 bookings carried forward from 1936. The following figures show her work during the year :— Bookings carried forward 12 „ received in 1937 42 54 Cases delivered by— Borough Midwife 21 Deputy 25 Confined in Hospital 6 Cancelled 2 54 (of the 52 known confinements 5 were primiparæ, and 48 multiparæ). 41 The Borough Midwife and her deputy paid 624 visits in connection with her practice. As reported elsewhere, she resigned during the year and in view of the impending establishment of a home midwifery service by the L.C.C., the remaining cases were attended by Nurse Cumberlidge, the deputy midwife, and the appointment was not filled. 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. No 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 190 cases. In 61 cases the mother paid a contribution for the services rendered. There were extensions of the Home Helps' Services beyond the usual 2 weeks in 41 cases. MATERNITY OUTFITS. Outfits were issued as follows :—Free, 145; Sold, 70. Total, 215. 42 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 1937, and in previous years are as follows :— Cornwall Road Hereford Street Total Babies (0—1): First attendances 640 298 938 Subsequent ,, 6,328 2,554 8,882 Children (1—5): First „ 136 56 192 Subsequent „ 5,269 1,860 7,129 Toddlers Clinic attendances 151 — 151 Total „ 12,524 4,768 17,292 The figures show a welcome increase in the number of older children attending the centres, the total attendances rising from 6,626 in 1936 to 7,472 in 1937. The numbers of consultations on children seen by the doctors were as follows :— Cornwall Road Hereford Street Total Babies (0—1) 3,605 1,640 5,245 Children (1—5) 3,466 1,383 4,849 Total 7,071 3,023 10,094 1936*. 1935*. 1934*. 1933*. 1932*. 1931. Total Attendances 16,479 16,612 16,195 17,632 18,668 19,100 New Cases 1,100 1,172 1,528 1,466 1,510 1,400 Medical Consultations 9,603 9,328 9,025 9,969 10,462 12,062 *Including Toddlers' Inspections. 43 TODDLERS' CLINIC. The special session for toddlers which was discontinued in 1936 has not been recommenced but a new system of invitation by reply card has been adopted, mothers being given special appointments at one of the morning infant consultations. This has worked as well as the earlier system. Statistics relating to the children examined in this way are as follow :— Children inspected : Boys Girls Total At 2 yrs 34 37 71 ,, 3 ,, 24 26 50 ,, 4 ,, 15 15 30 151 Children requiring treatment or advice 51 Sessions held 47 Average attendance 3.2 Conditions found on examination : Defects of Development: Late Teething 1 ,, Walking 5 „ Talking 1 Internal Strabismus 2 Tonsils enlarged (seriously) 5 Tonsils enlarged (slightly) 13 Adenoids — Mouth-breathers 1 Cleft palate 1 Prolapse rectum 1 Undescended testicle 1 Defects of Nutrition : Markedly below weight Muscular tone poor 46 ,, fair 35 Genu Valgum 7 „ Varum 1 ,, ,, and flat feet 1 Pes-planus 2 Talipes 1 Dental Caries 29 Nutrition fair 48 „ poor 51 44 Results of Infection : Adenitis, Cervical 9 Otorrhœa 2 Nasal Catarrh 7 Deaf 1 Eyes : Conjunctivitis 1 Skin : Urticaria 8 Impetigo 3 Threadworms : 1 Chest : Cardiac Murmurs 2 Narrow Chest 3 Bronchial 3 Management : Enuresis 2 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 45 new cases were referred to Dr. Mackay and there were 238 consultations in all. DENTAL CLINIC. Three sessions per week are held in connection with the Dental Clinic, one (mainly for expectant mothers) conducted by Mrs. E. M. Johnson, L.D.S. (R.C.S.) and two by Mr. F. Reginald Bate, L.D.S. (R.C.S.). 45 Mrs. Johnson reports on the work during the year as follows :— Sessions held 49 of which 10 were Gas Sessions Total Mothers Children New Cases 85 81 4 Subsequent attendances, including cases brought forward from 1936 398 391 7 Total 483 472 11 Total Mothers Children Average attendance 9.7 Gas administrations 77 72 5 Local anaesthetic 16 16 — 519 Gas Extractions 553. 541 12 22 Local anaes. Fillings 10 10 — Gum treatment 8 8 — Sealing and polishing 14 14 — Dentures 81 9 one plate 36 Two plates 45 — Expectant mothers treated .... 32 — Cases referred to Hospital 7 Patients recommended by Centre Doctors 50 3 „ H.V 29 — „ „ „ Others 6 1 During the year 1937, the number of patients attending the clinic, which is held once a week, shewed an increase on the previous year of 55 attendances. The number of anaesthetic administrations (gas and local) was slightly less but the number of teeth extracted increased in actual number—thus giving a higher ratio of teeth extracted per each administration. This suggests that patients allow their mouths to become so septic that, on taking into account their general condition, the sole treatment possible for the majority is complete extraction. Further evidence of this fact is shown in the decrease of conservative work, scaling and parodontal treatment. The amount of prosthetic work done during the year nearly doubled that of the previous year necessitating for the first time the clinic being open during August. It is very regrettable that in so many cases complete extraction of the teeth is the only treatment possible. This is largely due to the fact that patients do not attend the clinic at a time sufficiently early to allow of conservative treatment, 46 but wait until their mouths are so septic that extraction is the only treatment practicable. More instruction in oral hygiene should benefit them and encourage them to improve the condition of their mouths and thereby their general health. Elsa M. Johnson, L.D.S. Eng. Mr. Bate furnishes me with the following statistics:— Sessions held, 92, of which 16 were Gas Sessions. Children attending routine inspections, 42, of whom 30 were found to require treatment. Children referred by Medical Officers and Health Visitors 154, 137 of them requiring treatment and making 311 subsequent attendances. Teeth extracted Children or stopped Treatment under gas 152 488 Treatment under ethyl chloride spray 28 38 Stoppings 99 158 Removal of stain by polishing. 21 — Silver Nitrate 67 teeth — Gum treatment 3 - — During the year there was a marked decrease in the number of routine cases that attended the Centre, although a large number of notices were sent out, but the number of cases, recommended by the Centre, doctors, and Health Visitors, which attended showed an increase over the year 1936, and the subsequent attendances were about the same, so that although there appears to have been a lesser number of Toddlers inspected, the actual number of treatments completed averages about the same as for the previous year. F. Reginald Bate, L.D.S., R.C.S., (Eng.), Dental Surgeon. 47 ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the arrangements with the Queen's Hospital, 7 young children had operations for enlarged tonsils as in-patients upon the recommendation of the Medical Officers of the Welfare Centres. LIGHT CLINIC. No. of Sessions 144 Average attendance 33.0 Treatments :— Children : First attendances 267 Subsequent attendances 4,587 Mothers : First attendances — Subsequent attendances — Total 4,854 Cases carried forward from 1936 34 Cases carried forward to 1938 35 Analysis of Cases :— No. of cases Marked Improvement Improved Lapsed Removed from Borough Also Massage having Inhalation Mothers: Nil Children : Malnutrition 39 7 16 13 2 7 3 Anaemia 25 5 11 8 — — — Bronchitis 49 10 23 12 2 1 25 Catarrh 17 4 5 5 2 — — Loss of Appetite 8 — 6 2 — — — Collapsed Lung 1 — 1 — — 1 1 Otitis Media 1 — — 1 — — — Rickets 63 15 21 23 1 25 3 Delayed development 34 5 13 12 1 12 2 Nervous Tension 3 — 2 1 — 1 — Amyotonia 1 — 1 — — — — Debility after Measles 3 1 2 1 Influenza .... 5 — 1 4 — — — Whooping Cough 10 2 4 3 — 2 2 Bronchitis 2 1 1 — — — — Tonsillitis 1 1 — — — — 1 Pneumonia 2 — 2 — — — 2 Skin Septic Urticaria .... 1 - - 1 - - Chilblains 1 —. - 1 — — —» 48 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. Three sessions are held each week and the treatment is sometimes given in addition to a course of Artificial Sunlight. Rccords :— No. of sessions held 144 Average attendance per session 8.9 Cases carried forward from 1936 4 Children : New cases 100 Subsequent treatments 1,193 Mothers : New cases — Subsequent treatments — Total treatments 1,293 Cases carried forward to 1938 7 Clinical Analysis:— Cases Cured Improved Lapsed Bronchitis 68 6 36 26 Nasal Catarrh 27* 3 12 11 Mouth Breather 1 — 1 Collapse of Lung following Broncho Pneumonia 1 — 1 *1 case removed. 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. 49 58 children attended the hospital this year. Two were admitted for in-patient treatment and the rest attended as out-patients, while in 29 cases appliances were provided by the Council. Records of attendances, results and clinical analysis follow :— Cases carried forward from 1936 34 New cases attending in 1937 58 Total number referred to Hospital 92 Results :— Discharged cured 8 Under treatment and carried forward 61 Transferred to other hospitals or depts. 2 At school under the care of the L.C.C. 6 Removals from district 5 Parents refused further treatment 5 Lapsed attendances 5 Total 92 Analysis of cases :— Genu Valgum 21 „ Varum 21 ,, Valgum with Pes planus 16 „ Varum „ 12 Flat Foot 12 Postural Kyphosis 1 Talipes 3 Eversion of feet 2 Inversion of right foot 1 Intoeing 1 Misplacement of toe nails 1 No treatment necessary 1 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 50 Orthopaedic Surgeons at the Queen's Hospital in connection with the Borough Council's Orthopaedic scheme. RECORDS:— Cases carried forward from 1936 16 New cases treated in 1937 112 Subsequent attendances 2,049 Total treatments 2,161 Discharged, treatment completed 100 Carried forward to 1938 28 Average attendance per session 7.5 Analysis of Cases :— Children : Rickets 20 Curved Tibiae 16 Genu Valgum (knock knee) 5 ,, Varum (bow legs) 9 Pes Planus (flat foot) 20 Talipes 3 Torticollis Faulty Chest Development. 4 Amyotonia 30 Erb's Paralysis 2 Anterior Poliomyelitis 2 Congenital Deformity of Arm 1 Defective Posture 1 Collapsed Lung after Pneumonia 1 Constipation 1 Myotonia following Illness 3 Mothers :— Failing Rreast Milk — Amyotonia after confinement — CONVALESCENT TREATMENT. During the year 20 mothers were sent to various convalescent homes, usually for a period of two weeks, after confinement. The number of children sent away to various convalescent homes totalled 143 against the corresponding figure for 1936 of 77. The three cots engaged 51 with the Association for Maternity and Child Welfare were kept full practically the whole year and in addition several other homes were used. There were many cases of extended treatment beyond the usual four weeks because of acute debility in the first place, illnesses contracted at the home, and contact with others suffering from an infectious disease. At the end of the year there were 18 children away because homes were in quarantine for different reasons ; and ten others for illnesses and debility. 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 at the end of which the mother has to re-apply. During the year 9,569 grants were made arising out of 6,972 family applications and re-applications. The grants were made up as follows : Expectant mothers 684 Nursing mothers 1,102 Children under 3 6,240 Children 3-5 1,543 52 There were 2 sessions a week, and 21,715 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 8,263 galls. Dried Milk 32,836 pkts. together with medicines, etc. The approximate cost of milk given in this way was £3,205. Although the number of grants has not increased very much, there have been changes in the grants ; increased quantities being allowed and liquid milk being used instead of dried milk in many cases. 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 £280. The substantial reduction in this amount is due to the transfer of many families to the care of the Unemployment Assistance Board. The Scheme involves a great deal of clerical labour which might well be reduced if the L.C.C. would allow us to 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 8,806 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. 53 The following table shows the cases dealt with during the year:— Nursing Assistance. Disease Children under five years Mothers Others Total Visits Cases Visits Cases Visits Cases Visits Ophthalmia Neonatorum 2 36 ... ... ... ... 36 Discharging Eyes 37 500 ... ... ... ... 500 Other Eye Conditions 4 26 ... ... ... ... 26 MeasIes ... ... .... ... 2 14 14 Whooping Cough 1 34 ... ... ... ... 34 Diarrhoea ... ... .... ... ... ... ... Pre-natal Conditions ... ... 6 64 ... ... 64 Puerperal Fever and Pyrexia ... ... ... ... ... ... ... Other post-natal conditions ... ... 32 469 ... ... 469 Otorrhœa, other Ear diseases 17 366 ... ... ... ... 366 Tonsils and Adenoids 28 92 ... ... ... ... 92 Tonsillitis ... ... ... ... ... ... ... Influenza ... ... .... ... 19 177 177 Bronchitis 10 103 ... ... ... ... 103 Pneumonia 17 227 ... ... 29 189 416 Tuberculosis ... ... ... ... 1 5 5 Intestinal Conditions 3 27 ... ... ... ... 27 Worms 29 297 ... ... ... ... 297 Discharging Umbilicus 12 173 ... ... ... ... 173 Impetigo, skin eruption ... ... ... ... ... ... ... 4 71 ... ... ... ... 71 Constipation 5 17 ... ... ... ... 17 Miscellaneous 8 108 ... ... ... ... 108 Totals 177 |2,077 38 533 51 385 2,975 6 cases were in hand at the beginning of the year. 11 cases were in hand at the end of the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Six cases of Puerperal Fever were reported during the year. Four patients were treated in the North—Western Hospital and the others in the London and Mile End Hospitals. Two of the patients died. 54 Sixteen cases were notified as Puerperal Pyrexia, and were treated at the following Hospitals :— Bethnal Green (8), Mothers' (1), London (4), Northwestern (1). The remaining 2 cases were treated at home by a doctor connected with the Salvation Army Midwifery Service. OPHTHALMIA NEONATORUM, &c. Fourteen notifications of Ophthalmia Neonatorum were received during the year. Six of the patients were treated at home, 3 received treatment at St. Margaret's Hospital, 5 at the Bethnal Green Hospital. The Health Visitors paid 68 visits to cases. Eleven of the cases cleared up without any impairment of vision being reported : one child died, another was still under treatment at the end of the year, while in the remaining case, the first for many years, the child is believed to have become blind. 16 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 36 cases of discharging eyes in young infants, paying 493 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 15 foster mothers and 18 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 : 55 Routine Medical Inspection of Elementary School Children in Bethnal Green in 1937 Age Groups Number Examined CLOTHING AND BOOTS NUTRITION CLEANLINESS OF HEAD CLEANLINESS OF BODY TEETH VISION Good Fair Poor Good Average Below normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed 4 or more decayed 6/6 in both eyes 6/9 in either or both eyes 6/12 or worse in either or both eyes ENTRANTS Boys 735 44 691 - 83 570 80 2 727 7 1 726 9 — 422 262 51 — - - Girls 675 44 630 1 87 502 81 5 661 13 1 661 14 — 354 289 32 — — — Age 7— Boys 688 35 651 2 54 528 106 — 686 1 1 688 — — 491 184 13 378 192 116 Girls 672 37 633 2 75 182 113 2 669 1 2 670 2 — 464 192 16 356 211 100 Age 11— Boys 645 30 614 1 47 502 96 — 644 1 — 642 1 2 508 132 5 396 148 100 Girls 757 16 739 2 72 577 107 1 751 6 — 755 2 — 572 181 4 475 155 125 Age 14— Boys 698 16 682 — 76 582 40 — 696 2 — 696 2 — 518 175 5 478 115 103 Girls 861 80 780 1 187 616 58 — 848 12 1 860 1 — 618 236 7 520 190 149 Total 5731 302 5420 9 681 4359 618 10 5682 43 6 5698 31 2 3947 1651 133 2603 1011 693 Percentage 5.3 94.5 0.2 11.9 76.0 12.1 99.1 0.8 0.1 99.4 0.6 0.0 68.9 28.8 2.3 60.4 23.5 16.1 London 55.6 44.1 0.3 16.5 77.4 6.1 97.6 2.1 0.3 99.1 0.9 0.0 70.2 26.3 3.5 67.6 19.0 13.4 56 Examination of Elementary School Children in Bethnal Green 1937 BOYS GIRLS Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number examined 735 688 645 698 675 672 757 861 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 24 20 22 16 12 9 3 3 25 22 22 17 8 7 5 3 Skin disease 16 11 10 6 6 4 4 3 8 7 15 10 9 7 16 12 Defective teeth — 288 — 183 — 133 — 179 — 298 — 190 - 177 — 241 Enlarged tonsils 166 60 69 20 40 10 16 5 147 54 78 37 44 14 15 4 Adenoids 3 3 4 1 1 1 — — 2 2 5 4 1 1 — — Enlarged tonsils and adenoids 19 18 6 5 — — — — 14 12 8 7 — — — — Other nose and throat defects 28 4 18 3 17 4 — — 22 4 20 6 25 1 30 4 Enlarged glands 9 2 12 3 4 — 2 — 11 — 7 1 2 — 1 — Eye disease 23 14 13 3 12 8 9 5 30 15 19 8 18 8 10 7 Vision defect — — — 56 — 67 — 73 — — — 61 — 69 — 93 Otorrhœa 6 4 5 4 6 4 9 7 5 5 3 3 3 1 4 4 Other ear disease 2 1 — 3 3 2 — 2 1 — — 2 - 1 1 Defective hearing 1 1 2 — 2 1 2 — 1 — 3 1 1 — 2 1 Speech defects 7 — 2 — 4 1 2 — 1 — 1 1 2 — — — Heart defects 13 1 8 1 7 — 3 — 7 1 10 2 8 — 9 1 Anaemia 3 2 8 6 7 2 1 1 — — 9 5 6 2 3 — Lung defects 31 12 21 9 13 1 8 4 22 11 21 9 7 1 — — Nervous defects 5 1 2 — 4 2 — — 3 — 3 — 6 3 — — Phthisis — — — — — — — — — — — — — — — — Other T.B. disease — — — — — — — — — — — — — — — — Rickets 7 5 — — — — 1 1 1 — 1 — 2 1 — — Spinal deformities — — — — 5 1 1 1 — — — — 2 2 4 3 Other deformities 7 4 7 4 1 1 5 2 3 2 3 1 9 2 16 8 Other defects 30 24 11 4 13 5 7 4 25 20 27 20 29 18 21 6 Number of children noted for treatment 365 271 226 259 361 300 263 344 *Defects however slight are included under " cases " ; those severe enough to require treatment are shown under * 57 The deterioration in nutrition upon which I remarked last year still continues. Children marked " below normal " who were 4.3, 8.9 and 11.3 per cent, in 1934, 1935 and 1936 respectively were 12.1 per cent, in 1937, double the average percentage for London. In dental and visual conditions, Bethnal Green children do not differ materially from those in the rest of London, although the very big proportion of toddlers who require dental treatment upon entrance to school is extremely unsatisfactory. On the other hand, Bethnal Green mothers retain their high standard of personal cleanliness of the children. The paradox continues that in a borough noted as a centre of the boot and shoe and clothing trades only 5.3% of the children are well clothed and shod, compared with 55.6% in London as a whole. 58 CONTROL OF DISEASE There was no marked change in the incidence of infectious disease in 1937 as compared with 1936. A slight reduction in the number of cases of Scarlet fever, Enteric fever and Erysipelas was offset by some increase in Pneumonia, Dysentery and the Puerperal infections. Among the non-notifiable diseases, the fall in measles cases was counter-balanced by an unfortunate rise in the number of cases of whooping cough. Diphtheria. There were 222 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 at least 39 cases (or 13.1 per cent, of the total) the diagnosis of Diphtheria was not confirmed. 22 cases developed in hospital 7 of these being hospital staff, while there were 9 " 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; 32,000 units were supplied during the year. 59 Scarlet Fever. There were 307 cases of scarlet fever notified during the year, 297 of the patients being removed to an isolation hospital. No deaths were certified as due to scarlet fever during the year. From information received from the hospitals, it would appear that in at least 20 cases (or 6.5 per cent, of the total) the diagnosis was not confirmed. 8 cases seem to have been developed in hospital, 5 being members of the hospital staff, while there were 10 " second cases." Enteric Fever. Three 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. 1 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. 60 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 ana 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 4 3 ... ... ... 1 ... ... ... 1 ... 1 ... ... 3 Diphtheria (inc. MembCroup) 225 222 7 13 10 24 24 77 27 11 12 16 1 ... 222 Scarlet Fever 305 307 2 12 31 34 37 111 46 14 10 9 1 ... 297 Puerperal Fever 6 6 ... ... ... ... ... ... ... ... 1 5 ... ... 6 Puerperal Pyrexia 16 16 ... ... ... ... ... ... ... 2 4 10 ... ... 14 Ophthalmia Neonatorum ... 14 14 ... ... ... ... ... ... ... ... ... ... ... 8 Erysipelas 72 73 2 ... ... 1 1 2 5 6 6 17 24 9 55 Cerebro-spinal Fever ... 6 ... 1 1 ... 1 2 ... ... ... 1 ... ... 6 Acute Poliomyelitis ... 4 ... ... 1 ... 1 2 ... ... ... ... ... ... 4 Actute Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-enceohal- itis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia 100 72 5 3 2 2 ... 12 3 4 2 19 14 6 48 Acute Influenzal Pneumonia 29 ... ... 1 ... ... ... ... 3 ... 10 8 7 9 Dysentery ..... 52 4 6 7 10 3 11 1 3 1 4 1 1 48 Malaria .... .... .... .... .... .... ..... .... .... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever, Cholera, Plague, Relapsing Fever .... .... .... .... .... ... ... ... ... ... ... ... ... ... ... Anthrax, Hydrophobia, Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... 109 ... ... ... ... 1 3 4 9 15 43 27 7 * Other forms of Tuberculosis ... 24 ... 1 ... 1 1 2 6 3 1 4 4 1 * Total ... 937 34 36 53 73 69 222 92 56 52 189 80 31 720 ♦Sec particulars as to Sanatorium Treatment in Tuberculosis section †The Registrar General's figures are for notifications received during the 52 weeks ended 1st January, 1938, and include several non-residents. The Council's figures are for cases notified during the calendar year, and exclude non-residents and duplicate notifications 61 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, 1936, inclusive Registration SubDistricts comprised in each Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec. 1936 Number of these Births duly entered by 31st Jan., 1938 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., 1938, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1937 No of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1937 Successfully Vaccinated Insusceptible of Vaccination Had Smallpox Declaration of conscientious objection received Died Un vaccinated Postponement by Medical Certificate Removal to Districts, V.O. of which apprised Removal to places unknown and cases not found North East 836 120 1 - 513 53 4 64 43 38 164 521 South West 233 29 — - 167 6 — 2 5 24 111 161 TOTAL 1069 149 1 — 680 59 4 66 48 62 275 682 Children vaccinated after declaration of conscientious objection : nil. Vaccination certificates for 1937 sent to other Vaccination Officers : 85 62 TUBERCULOSIS. Particulars of the notification certificates received during the year are set out in the tables appended hereto, from which it will be seen that 130 new cases were notified in addition to 3 notifications which were posthumous. Information was also received from the RegistrarGeneral or from the Local Registrars of the deaths of 7 persons who had died from Tuberculosis but who had not been notified under the Regulations. During the year 28 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, 1937, was 1,166. The details are given in the table on pages 63 and 64. During the year according to the Registrar General's return, there were registered 73 deaths from Pulmonary Tuberculosis, and 7 deaths from other tuberculous diseases. The number of deaths from Tuberculosis of all kinds during the past few years is as follows:— Pulmonary Non-Pulmonary Total 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 1936 65 16 81 63 Source of Information No. of cases Pulmonary NonPulmonary Death Returns from local Registrars 4 3 transferable deaths from Registrar General ... ,... Posthumous notifications 3 .... "Transfers" from other areas (other than transferable deaths) 21 7 Other Sources if any (specify) ... .... Public Health (Tuberculosis) Regulations, 1930 PART I .—SUMMARY OF NOTIFICATIONS during the period from the 1st January, 1937, to the 31st December, 1937, in the area of the Metropolitan Borough of Bethnal Green. Formal Notifications Number of Primary Notifications of new cases of tuberculosis Total Notifications AGE PERIODS 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— total (all ages Pulmonary Males ... 1 1 1 6 5 12 8 8 9 6 57 70 „ Females ... ... 2 3 3 10 14 9 4 4 ... 49 55 Non-Pulmonary Males ... 2 1 4 2 ... 1 ... 1 ... 1 12 13 „ Females ... 1 1 2 1 1 2 1 2 1 ... 12 13 PART II.-—SUPPLEMENTAL RETURN. —New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. AGE PERIODS 0— 1— 5— 10— 15— 20— 25- 35— 45— 55— 65— Total Pulmonary Males ... 1 1 ... 1 2 3 4 4 3 3 22 „ Females ... ... ... ... 1 1 3 1 ... ... ... 6 Non-Pulmonary Males ... 3 1 ... 3 ... ... ... ... 1 ... 8 „ Females ... ... ... ... 1 ... ... ... ... ... 1 2 The source or sources from which information as to the above-mentioned eases was obtained, is stated below: PART III. —NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1937, 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 435 360 795 210 161 371 1,166 Number of cases removed from the Register(s) during the year by reason of:- 1 Withdrawal of notification ... 4 4 ... ... ... 4 2 Recovery from the disease 1 3 4 4 9 13 17 3 Death 57 27 84 5 6 11 95 4 Otherwise 37 30 67 17 8 25 92 Total 95 64 159 20 23 49 208 64 Tuberculosis Register. Pulmonary Non-Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/36 440 366 216 109 1200 Number of new cases notified under the Public Health (Tuberculosis) Regulations, 1930, during the year 60 49 12 12 133 Transferred from non-pulmonary .... .... .... .... .... Other cases added to the Tuberculosis Register during year 21 9 8 3 41 530 424 236 184 1374 Number of cases removed from Tuberculosis Register during year. (For details see separate statement) 95 64 26 23 208 Transferred to pulmonary .... .... .... .... .... Cases remaining on Tuberculosis Register 31/12/37 435 360 210 161 1166 There were 7 deaths certified from Tuberculosis in which the deceased person had not previously been notified. This represents 8.7 per cent, of the deaths from Tuberculosis during the year. Enquiry elicited the following explanations :— Diagnosis only reached after p.m 2 Certified by Coroner 3 Assumed already notified 1 Notified in another district 1 Late notification, probably due to delay in seeking medical treatment, is shown by the following figures :— Notified practically at time of death 6 ,, within 1 month „ 7 ,, ,, 3 months ,, 9 ,, ,, 6 months „ 2 65 TUBERCULOSIS DISPENSARY. The Tuberculosis Dispensary for the Borough is provided under agreement by the London Chest Hospital 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 109. I would direct particular attention to Dr. Howell's remarks on page 110 on the social aspect of Tuberculosis. Having regard to his very considererable experience in dealing with Tuberculosis, his comments and recommendations are entitled to serious consideration. Most of his proposals are matters for the London County Council and it is to be hoped that action on these lines will be taken by that body in the early future. WORK OF TUBERCULOSIS VISITORS. The two Tuberculosis Visitors paid 4,453 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 66 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. 66 SUPPLY OF SPUTUM OUTFITS. During the year 21 sputum flasks were distributed to patients. 11 sputum tins, with 291 cardboard refills were distributed to patients for use indoors. OPEN-AIR SLEEPING SHELTER. The Council's Open-Air Sleeping Shelter was not used during part ot the year. Unfortunately, owing to the limited space available in the yards and gardens attached to the houses in the Borough, very little 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. Some assistance has also been rendered to patients in getting necessary clothing for use while in sanatoria. SANATORIUM TREATMENT. During the year 137 patients were recommended for Sanatorium or Hospital treatment and 6 were recommended for admission to hospital for " observation for diagnosis " ; 135 of the former and all the latter were sent away to institutions. In addition, 104 patients received treatment for Tuberculosis in the general hospitals of the L.C.C. Eleven children were recommended for admission to an open-air school, 10 being accepted. 67 GRANTS OF EXTRA NOURISHMENT. 435 grants of Tuberculin Tested milk and new laid eggs were made to 126 necessitous tuberculous patients at an estimated cost of £282. DENTAL TREATMENT FOR TUBERCULOUS PATIENTS. Seven dispensary patients received dental treatment at the London Chest Hospital, making 10 attendances therefor. One patient was also assisted in the provision of artificial dentures. FINSEN AND ARC LIGHT TREATMENT. Since 1921, the Council has paid for the Finsen Light treatment of cases of Lupus at the London Hospital. During the year 7 patients were so treated, making 388 attendances for treatment. Three of these patients also made 175 attendances for arc light treatment of Lupus at the same hospital. PNEUMOTHORAX REFILLS. The arrangements for carrying out artificial Pneumothorax are now in the hands of the Tuberculosis officers. 25 patients received this treatment having 279 refills during the year, as compared with 30 patients and 305 refills in 1936. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was taken under these regulations during the year. 68 NON-NOTIFIABLE DISEASES. Measles. During the year 254 cases of Measles came to my knowledge from the following sources : — Schools 125 L.C.C. Ambulance Service 96 Other Hospitals 2 Health Visitors 26 Sanitary Inspectors 5 All cases were visited, either by a Health Visitor or the District Sanitary Inspector, according to the age of the patient. 93 patients were removed to L.C.C. Special Hospitals, and in 2 cases, nursing assistance was provided by the Council, 14 nursing visits being paid. After various corrections of diagnosis and sifting of " suspected " cases, there would appear to have been a net total of 233 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 was one death from measles during the year. German Measles. 118 cases of German Measles were also reported, 54 of them being removed to hospital. Whooping Cough. 410 cases of Whooping Cough came to my knowledge ; through reports from the L.C.C. (109), Health Visitors (80), Sanitary Inspectors (9), Schools (199), 69 Hospitals (10), doctors (2), and parents (1), and these children were visited by the Health Visitors and the Sanitary Inspectors. 8 cases proved not to be Whooping Cough leaving a net total of 402. 117 children were removed to an Isolation Hospital, and 34 nursing visits were paid to two cases at home. 10 deaths from this disease were recorded during the year. Miscellaneous Investigations. 444 cases of Chickenpox were reported and these were visited by the Sanitary Inspectors. A numberof 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 Betlinal Green patient at the University College Hospital. This was continued throughout the year until the death of the patient in November. 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 1,221 Diphtheria bacilli present in 57 Sputum—specimens submitted for examination 71 Tubercle bacilli present in 11 Four throat swabs were examined by another laboratory with a positive result in 2 cases, and 2 specimens of sputum, 1 positive and 1 negative. Other bacteriological examinations in connection with food are reported on elsewhere. 70 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 1,934 pints of partially diluted disinfecting fluid were distributed to applicants at the Town Hall. This practice was discontinued at the end of June. DISINFECTION SERVICE. During the year, 1,815 rooms and 32,650-articles were disinfected for various reasons. Two Morris motor vans are used for conveying articles for routine disinfection, and an additional steel body motor-van of the Dennis type is available for special disinfestation purposes. The table appended gives details of the rooms, bedding and clothing disinfected. Articles of Clothing, etc., No. of Rooms Disinfected by Disinfected Steam Formalin Infectious disease 165 6,734 778 Scabies 20 7,307 3 Verminous condition 1,630 5,329 11 Other conditions — 85 5 Hospital bedding — 11,920 478 1,815 31,375 1,275 Number of articles destroyed by request, 555. 71 At the beginning of the year, the routine disinfection of rooms after infectious disease was discontinued in the South, West and North wards. In July, it was also abandoned in the remaining (East) ward and the week-end attendance of one of the disinfectors was discontinued at the same time. Room disinfection will in future only be carried out in cases of Tuberculosis, Typhoid fever, Smallpox, and other special circumstances. The increase in the amount of disinfection, notwithstanding the above mentioned change, is due to greater activity in dealing with verminous conditions. The articles destroyed included a large quantity of old and verminous furniture weighing in all over 18 tons. Disinfestation. Disinfestation of bugs was effected in the following houses : 1937 1936 L.C.C. and Borough Council tenements 21 6 Other houses 487 380 In addition 8 houses on Clearance Areas were dealt with, as well as a large quantity of infested furniture at various houses. Disinfestation was also carried out in a number of other cases, such as ants, fleas and beetles. The furniture of 90 families removing to Borough Council tenements was disinfested by hydrocyanic acid gas by contractors in course of transit from their previous homes, the bedding being treated by steam at the Council's Disinfecting Station at the same time. As in the previous year, sulphur, Vermicine and Slatford were used for room disinfestation according to the circumstances of the case. Heavy naphtha was also used in some instances as well as for the disinfestation of furniture. Apart from the 72 hydrocyanic gas treatment of furniture, all the disinfestation work is carried out by the Council's employees. The increased volume of this work represents a substantial addition to the comfort and amenity of the residents in the borough. While it is recognised that in the older houses, the structural condition prevents a thorough destruction of the bugs, fumigation plus the active co-operation of the tenants can do a great deal to keep them under, and steps are now being taken systematically to prevent the Council's new tenements becoming infested. It is to be regretted that the L.C.C. has not yet taken similar steps with regard to its new tenements. 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 disinfestation of their rooms. The sprayers were lent on 293 occasions during the year, as compared with 408 in 1936. Verminous Conditions. The children in 4 families were reported from the L.C.C. Cleansing Station as being infested with vermin of some kind. In every case advice as to the treatment of the clothing and bedding was given and disinfestation by steam was offered and in 3 cases was accepted. Rooms were disinfested of vermin in 1,630 cases, as compared with 902 in 1936. Scabies or Itch. 229 children suffering from this disease were excluded from the Elementary Schools. In addition, 23 cases of Scabies were reported by the London Hospital, 18 by Bethnal Green Hospital, 16 by other hospitals and 11 by private doctors. In all but 37 of these cases the bedding and clothing were disinfected, 20 rooms were also fumigated after 73 Scabies. The figures represent a considerable increase in Scabies, the incidence of which had been low for some years previously. 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 baths are available for women every afternoon from Monday to Friday. During the year 57 men. 13 women and 14 children had 88 baths and their clothing was disinfected for vermin, and 133 men, 145 women and 36 young children had treatment, in addition to baths and disinfection, on a total of 526 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 155 396 Vermin 5 5 Cleansing1 1 These figures are included in the foregoing figures of total work done at the Station. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928, SECTION 28. Care of Aged and Infirm Persons. During the year, no action was found necessary under this section. FOOD POISONING. Food Poisoning has been notifiable throughout London since 1932. During the past year, 29 cases were notified. Of these cases, 11 were attributed to eating fish of various kinds, including shell fish and tinned, and 15 to meat and 1 to tinned tomatoes, 1 to ice cream, 1 to infection by organisms of the Salmonella group, the food in question not beingtraced. 74 PROTECTION OF FOOD SUPPLY The work of the Local Health Authority with a view to the protection of the food supply takes three forms : (1) Supervision of premises where food is prepared or sold, to ensure cleanliness ; (ii) Examining food as to its soundness ; and (iii) Sampling food to ascertain its composition and quality. The whole sanitary inspecting staff co-operate in exercising general supervision over the cleanly conduct of the food trades. 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 torms. It is to be hoped that when the new Food and Drugs Bill is passed into law it will be speedily followed by Government standards of composition of the principal foods for the protection of the public. FOOD AND DRUGS ACTS. Seven hundred and thirty-five samples were taken ; 702 of these proved to be " genuine " and 33 or 4.5 per cent, adulterated. 75 The details are given in the following table:— SUMMARY OF ANALYST'S REPORTS. Article Samples taken formally Samples taken informally No. taken Genuine Adulterated No. taken Genuine Adulterated Total number of samples taken Milk 357 345 12 8 8 .... 365 Sterilised Milk 1 1 .... .... .... 1 Butter 96 91 5 7 6 1 103 Margarine 7 7 .... .... .... 7 Condensed Milk 2 2 .... 3 3 .... 5 Cream 3 3 .... 1 1 .... 4 Cream Cheese 1 1 .... .... .... 1 Cheese 2 2 .... 3 2 1 5 Dripping 2 1 1 .... .... 2 Cordials 5 4 1 3 3 .... 8 Gin 3 3 .... .... .... .... 3 Whisky 5 4 1 .... .... .... 5 Fruit Flavoured Syrups 2 2 .... 1 1 .... 3 Aspirin Tablets 3 3 .... 1 1 .... 4 Other Drugs 3 3 .... 1 1 .... 4 Jelly 5 5 .... .... .... .... 5 White Pepper .... .... .... 1 1 .... 1 Pepper 3 3 .... .... .... .... 3 Sugar .... .... .... 1 1 .... 1 Cake .... .... .... 9 8 1 9 Sweets 10 9 .... 3 3 .... 13 Vermicelli 1 1 .... .... .... .... 1 Flour .... .... .... 18 18 .... 18 Jam 28 26 .... .... .... .... 28 Honey 3 3 .... .... .... .... 3 Lemon Curd 1 1 .... .... .... .... 1 Vinegar 67 66 .... .... .... .... 67 Malt Vinegar 4 4 .... 1 1 .... 5 Bacon .... .... .... 5 5 .... 5 Minced Meat 1 1 .... 7 6 1 8 Sausages 5 1 .... 6 5 1 11 Dried Fruits 2 2 .... 7 7 .... 9 Candied Peel 1 1 .... 9 9 .... 10 Smoked Fish ... .... .... 13 13 .... 13 Fish Paste 1 1 .... .... .... .... 1 Other Foods 2 2 .... 1 1 .... 3 Totals 626 598 28 109 104 5 735 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 1937, 735 samples were examined under the Food and Drugs (Adulteration) Act. All samples were 76 submitted by the Inspectors. No samples were submitted by the public under the Act. One hundred and nine of these samples were purchased informally. Thirty-three samples were found to be adulterated, 28 formal and 5 informal. The adulteration was at the rate of 4.49 per cent., as compared with 3.38 per cent, for the whole of London and 5.3 per cent, for the whole of England and Wales in 1936. The rate of adulteration in the Borough for the past ten years was as follows :— Year No. of Samples examined Percentage of adulteration 1937 735 4.5 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 Average 732 6.8 The number of samples examined was at the rate of 7.59 per 1,000 of the population as compared with 9.92 per 1,000 for the whole of London and 3.6 per 1,000 for the whole of England and Wales in 1936. Three hundred and sixty-five samples of milk were examined, 12 of which, or 3.29 per cent., were reported as adulterated. The milk adulteration in the Borough for the past ten years was as follows Year No. of Samples examined Percentage of adulteration 1937 365 3.3 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 Average 343 5.1 77 The average milk adulteration for the whole of London was at the rate of 2.45 per cent., and for the whole of England and Wales 7.1 per cent.in 1936. Condensed Milks. Five samples of condensed milk were examined, all of which were satisfactory. Preservatives. There were eight contraventions of the Preservatives Regulations. 5 samples of unlabelled sausages, containing sulphur dioxide. 1 minced meat, containing sulphur dioxide. 1 ginger wine, containing excess of benzoic acid. 1 sweets, containing excess of sulphur dioxide. Other samples examined during the year, all for the Public Health Department, were :— 27 Rag Flocks, 4 of which were unsatisfactory. 3 samples of filth. 1 cigarette. 6 disinfectant fluids and 1 vermin killer under the Poisons and Pharmacy Act. 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.106. SAMPLES TAKEN INFORMALLY 109 samples were taken informally during the year, 5 of which were found to be adulterated as follows:— Article No. of Sample Offence Gruyere Cheese 35 Contained formaldehyde 20 parts per million Minced Meat 440 Contained sulphur dioxide, 121 parts per million Sausage 532 Contained sulphur dioxide, 43 parts per million Butter 524 16.3 per cent.water Chocolate Roll 705 No cocoa present 78 PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. No samples of dried milk were taken during the year. BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year, 34 bacteriological examinations, including 17 of milk, were made as follows :— Pasteurised Milk, 13 ; Tuberculin Tested Milk, 2 ; Ordinary Milk, 2 ; Tinned Herrings, 1 ; Tinned Sardines, 1 ; Tinned Salmon, 1 ; Salmon and Shrimp Paste, 1 ; Ice Cream, 1 ; Ice Mix, 1 ; Filth, 6 ; Miniature Cigarettes, 1 ; Victoria Park Lido Water, 1 ; Public Baths Water, 1 ; Rat, 1 ; Swimming Bath Water, 1 ; B. Coli was found in 1 sample of " Tuberculin Tested " Milk and in 2 samples of ordinary milk. THE FAT CONTENT IN MILK. For the past two years I have reported the results of investigations made in this department into the percentage of fat found in Bethnal Green milk samples, especially from the point of view of its low level compared with agricultural experience and its falling off as compared with earlier years. There was no great change in 1937 compared with 1935 and 1936, and the figures are still very unsatisfactory, calling for some explanation by the milk trade. From the evidence furnished in my last report, it is clear that milk consumers are entitled to expect an average fat percentage of 3.6 or 3.7. Bethnal 70 Green consumers, however, only get about 3.35. As I pointed out in 1935, unless the cows supplying Bethnal Green milk have changed their habits, some of the cream is being intercepted between cow and consumer. Apart from the ethics of this procedure, the matter has an important public health aspect. Milk with less than the normal amount of fat is so much the poorer as an all round food. It is also very serious that samples taken in course of delivery to local hospitals are found to be similarly defective, the fat percentage in one case being as low as 3.15. It should be added that, undesirable as may be the supply of milk so poor in quality, it is perfectly legal owing to the deplorably low standard laid down in the Milk Regulations of 1901 which still govern the matter. As the Government is now concerned with the passing of a new Food and Drugs Bill, it is to be hoped that the opportunity will be taken to lay down in one of the orders under the Bill when it is passed into law a revised and more satisfactory composition for milk. BETHNAL GREEN NUTRITION. Although it is not solely a matter of food supply, the state of nutrition of any community is more closely bound up with the nature, quality and quantity of its food than any other factor. It is also true to say of the modern town population that the nature, quality and quantity of the food consumed is mainly dependent upon incomes. During the past few years there has been much discussion on these and allied problems. With a view to gleaning a few of the more salient facts about the food supply of a cross section of Bethnal Green residents, an enquiry was carried out with the help of the Health Visitors in May 1937, among certain families. The results of this enquiry have been embodied in a report which appears as an appendix to this report. Here it may be stated , that the investigation broadly confirmed the views (1) that the food of the 80 poor is very deficient in some of the essentials of a sound dietary ; (2) that this is due primarily to their poverty and not their ignorance ; (3) that as income rises, families are not only able but do, in fact, provide themselves with a more adequate dietary. The results of this investigation have been communicated to Sir John Orr, the international expert in problems of nutrition, and it is specially gratifying to report that Bethnal Green has been selected as one of the areas in which an extended scheme of nutrition research under his general direction is to be carried out in 1938. I hope to be able to report some of the results of this work next year. FOOD PREMISES. Milkshops and Dairies. 43* applications for registration were considered. The figures in regard to registration of Milkshops are set out below :— Number of purveyors of milk on register at end of 1936 354 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 .... 43 Number of purveyors of milk on register at end of 1937 367 During the year 807 inspections of milkshops were made by the Inspectors, and 112 notices were served under the Public Health (London) Act. Legal proceedings were taken in respect of the dirty condition of a milkshop and the name of the purveyor was subsequently removed from the register. * This includes changes of occupier in premises previously on the register. 81 Manufacture of Cheese. One premises was registered for the manufacture of cheese. Six inspections were made during the year. MILK (SPECIAL DESIGNATIONS) ORDER. Nine Dairymen were licensed to sell " Pasteurised " Milk, 10 " Tuberculin Tested " Milk and 1 " Accredited " Milk. Twelve Supplementary licenses to sell milk in the Borough were granted during the year ; 8 to sell " Pasteurised " Milk from premises in Stepney, Hackney, Kensington, Poplar and Finsbury and 4 to sell " Tuberculin Tested " Milk from premises in Stepney, Hackney and Poplar. 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. Cowhouses. There were at the end of the year, 7 licensed cowhouses in the Borough. 60 inspections were made during the year. No notices were served. The following premises are duly licensed :— 63, Bishop's Way—Shed No. 1—(8 cows). Shed No. 2—(6 cows). 23, Ezra Street—(6 cows). 38, Fellbrigg Street—(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). 38, Three Colts Lane—(23 cows). 82 Ice Cream Premises. There were 179 ice cream premises registered at the end of the year, and 331 visits were paid to them by the district inspectors : 41 notices were served. Fried Fish and Fish-Curing Premises. At the end of 1937 there were 32 fried fish vendors' premises in the Borough. There were 21 fish curers' premises. 307 visits were made by the Food Inspectors to these premises, and 21 notices were served for insanitary conditions. Workshop Bakehouses. There are, in Bethnal Green, 32 workshop bakehouses, 9 of which are underground : 168 visits were made to them during the year, resulting in the serving of 21 sanitary notices. Factory Bakehouses. There are also 33 factory bakehouses, 10 of which are underground. In nearly every case the mechanism used, which causes the bakehouse to be a factory, is a dough mixer. Generally speaking, the factory bakehouses are kept clean and in a sanitary condition. 164 inspections were made during the year, and 24 notices were served. Other Premises used for the Preparation or Sale of Food. There were 234 such premises on the register, the majority being restaurant-kitchens or butchers' shops. 972 inspections were made during the year, and arising out of such inspections 64 notices to remedy faults or insanitary conditions were issued. 83 Slaughterhouses. There are two licensed slaughterhouses in the Borough, situated at :— 294, Bethnal Green Road. 354, Bethnal Green Road. 11 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 .... .... .... 8 Pigs 22 No carcases or offal were condemned. Slaughter of Animals Act, 1933. Two slaughtermen have been licensed under this Act. Slaughterers of Poultry. There are 8 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough : 271 visits were paid to them during the year, no notices being 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. 84 On 20 occasions during the year, unsound food comprising the following articles was surrendered by the owners, examined and destroyed as trade refuse:— Description of Article. Weight. Tons. cwt. Lb. Fish - 4 14 Fruit - 4 34 Canned Foods 1 3 — Meat — - 35½ Vegetables — - 50 Rabbits — - 56 Desiccated Cocoanut 3 5 — and 118 tins of salmon, sardines and herrings. FOOD POISONING. During the year 29 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. 85 SANITATION AND HOUSING The following figures give an outline of the work of the sanitary inspectors during the year. SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for the 52 weeks ended 1st january, 1938. Nature of Visit Totals Infectious Diseases (notifiable) 793 Infectious Diseases (non-notifiable) 939 Food Poisoning 29 Complaints 4,752 House to House Inspections 576 Housing Inspections 1,174 Milkshops (540) and Cowsheds (41) Inspections 581 Other Food Premises Inspections (Slaughterhouses 11, Poultry 270, Others 1,364) 1,645 Factory (1,137) and Workshop (1,664) Inspections 2,801 Outworkers' Homes Inspections 834 Common Lodging House Inspections 20 Tenement House Inspections 328 Tenement House Staircase Lighting Inspections 154 Shops Act Inspections 316 Drainage Inspections 3,975 Other Inspections or Special Work 5,106 Re-Inspections 20,617 Total visits for the Year 44,640 Unsound Food Seizures (2) or Surrenders (17) 19 Samples of Food, etc., taken 735 Samples of Rag Flock taken 27 Other Samples (Poisons, etc.) taken 4 Police Court Attendances 47 Premises where Nuisances abated 5,900 Premises where Matters Outstanding 804 Time Engaged at New Buildings (Hours) 207 80 The following sanitary defects were discovered during the year:— Dirty rooms 6,489 Defective drains and choked w.c.'s 528 Defective and dirty w.c.'s 1,610 Defective water supply 149 Defective paving 624 Defective gutters and rainwater pipes 871 Defective roofs 1,959 Dampness 1,235 Defective dustbins 1,112 Smoke nuisances 29 Overcrowding 21 Other defects 9,184 Total 23,811 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, 5,611 Preliminary Notices and 2,429 Nuisance 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 962 premises with nuisances outstanding. During the year, nuisances at 5,900 premises were abated and 804 premises with nuisances outstanding were carried forward to 1938. COMMON LODGING HOUSES. There are 4 such premises in the Borough, and the Inspectors paid 34 visits to them. Four sanitary notices were served. 87 TENEMENT HOUSES. The number of houses on the register as being let in lodgings or occupied by members of more than one family was 270 ; 1,473 visits of inspection were made to these houses, and arising out of such visits 463 notices were served. RENT AND MORTGAGE INTEREST RESTRICTIONS (AMENDMENT) ACT, 1933. During the year one application for a certificate as to the state of repair of a house was received, and granted. WATER SUPPLY TO NEW HOUSES. During the year 382 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 29 formal observations of smoke shafts were made, and 1 intimation notice was served. These occasions only related to industrial premises. The Council has no special powers with regard to the most prolific cause of atmospheric impurity—the ordinary domestic chimney. NOISE. I welcome the provision contained in the L.C.C. (General Powers) Act, 1937, to deal in some small measure with the serious nuisance of noise. 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 88 supply of rat poison, 53 tins and 23 packets of treated biscuits and 8 bottles of Squill being issued in this way. 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 300 manholes) 17,304 Baits missing15,866 Percentage of baits missing 92 Other methods of destruction carried out on an experimental scale have been as follows :— Rats killed Breakback traps 227 Dustbin traps 236 Cage traps 42 In the absence of scientific methods applied on a large scale, it may be doubted whether our present efforts very materially affect the rat population. 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. 4 inspections were made at these premises, and 1 sanitary notice was served. Poultry slaughtering, an offensive trade also, is dealt with elsewhere in this report. 89 RAG-FLOCK ACT, 1911. 27 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. RAG AND BONE DEALERS. 18 persons or firms are known to be carrying on this business in the Borough. During the year 32 visits of inspection were made, and 9 sanitary notices were served. HAIRDRESSERS. 98 hairdressers' premises were on the register, 220 visits were made to them, and 19 Notices were served. SHOP ACTS, 1934. Certificates of exemption from the requirements of this act with regard to the provision of sanitary conveniences have been issued on grounds of restricted accommodation or other special circumstances in the following cases : 1936, 34 ; 1937, 188. 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 3 houses. At the end of the year there were 637 such combined drainage systems, taking 3,238 houses. DRAINAGE WORK. No legal proceedings were taken during the year in respect of offences in connection with drainage work. 90 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 1937:- Area Houses Pop. Action taken by Borough Council Action taken by London County Council Abingdon St. (now Herald St.) 90 467 - Represented Ada Place & Pritchards Road - - - New housing in course of completion Anns Place 4 8 Represented and declared Clearance Area. Confirmed by Ministry of Health - Burnham Square — — Confirm Compulsory Purchase orders. Revised redevelopment scheme adopted providing for 80 flats containing 272 rooms. — Busby Sq. 16 79 Declared to be Clearance Area not suitable for redevelopment for housing purposes. Ministry of Health confirm Clearance Order - Coopers Gardens 91 424 - Represented and declared Clearance Areas. Ministry of Health enquiry held; confirmed with exception of certain premises Coventry St. (now Covtry Rd.) 11 - - Represented Clearance and Compulsory Purchase Orders confirmed by Ministry of Health. Darling Row 147 989 - Delta Street — — Redevelopment scheme to provide 35 tenements completed — Digby Street — — Second block of tenements (55) erected and occupied. — 91 Area Houses Pop. Action taken by Borough Council Action taken by London County Council Dinmont Estate — — — New housing in course of completion Edward Place 5 22 Represented and declared Clearance Areas; confirmed by Ministry of Health — † Emraa St. 95 585 - Represented and declared Clearance Areas. Compulsory Purchase Orders made. Ministry of Health enquiry held James St. (6 areas) 76* 411 " Areas 1, 3 & 4 and additional lands to be transferred to Borough Council for redevelopment. Clearance Orders confirmed by Ministry of Health Lansdell Place 79 432 - Represented. Clearance and Compulsory Purchase Orders made, cleared site proposed to be transferred to Borough Council for development Martha Ct. — — All premises demolished except 2 derelict houses — † Minerva St. 295 1,304 - Represented and declared Clearance Areas, Compulsory Purchase Orders made. Ministry enquiry held 92 Area Houses Pop. Action taken by Borough Council Action taken by London County Council Pedley St. 86 353 — Ministry of Health Local enquiry held Pott Street — — — 3 Blocks (110 tenements) completed Punderson Gardens 227 1,245 — Represented and declared Clearance Areas Tent St. 81 505 — Represented and declared Clearance Areas Violet St. 4 9 Represented and declared Clearance Areas, confirmed by Ministry of Health — †Vyner St. 128 572 - Represented and declared Clearance Areas, Compulsory Purchase Orders made. Ministry of Health enquiry held Waterloo House (Wellington Estate) — — — Four Blocks completed (152 tenements) * Including 4 in Stepney †Forming part of Redevelopment Area No. 1 Public Utility Society—— Scheme Nags Head Further block (38 tenements) Fields completed 93 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 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) 25 (Haig House) 4 71 (Dinmont House) 245 1937 35 (Delta) 152 (Wellington) 110 (Pott Street) 38 (Sturdee) 6 (Ayshford) 341 94 HOUSING ACTS 1935 AND 1936—OVERCROWDING. Little further can be stated as to the extent of overcrowding in the Borough as revealed by the Survey taken under the provisions of the Housing Act, 1935, except to report upon the present statistical position, as known to your officers. Whilst it may be assumed that there is a fair degree of accuracy in arriving at the number of cases that have been abated during the year, it is not possible to say whether the additions made during the year represent all the new eases that are occurring. At the end of 1936, there were 3,610 cases on the register. During 1937, 179 cases were added (102 of these being "review cases," i.e., families becoming overcrowded by reason of children attaining the age of 1 or 10 years and therefore being subject to a different classification) making a total of 3,789 cases to be dealt with. By the end of the year this total had shrunk to 3,005, the total of 784 removed from the register being composed as follows:— Families Equivalent adults Rehoused by L.C.C. (including 45 in connection with Clearance Areas) 145 779 Rehoused by Borough Council (including 8 in connection with Clearance Areas) 28 149 Rehoused by Housing Associations 6 38½ Rehoused by others 10 44½ Removed—mostly without trace 484 2,275 Alterations in families (by deaths, marriages, arrangements for members of families to sleep out, taking over extra rooms, etc.) 111 598½ 784 3,884½ 95 The 3,005 families remaining on the register at the end of 1937 comprised 15.715| equivalent adults. The system of certification on the part of the Borough Council which gives preferential consideration to applicants to the London County Council for housing accommodation who are living under overcrowded conditions continues to operate. During the year 294 cases have been so certified. These, added to the balance of 1936 cases outstanding at the end of that year, made a total of 647 cases to be dealt with. During 1937, 100 cases have been accommodated and in 135 instances information has been received from the L.C.C. that the application has been cancelled for various reasons (frequently applicants have not bothered to view the accommodation offered). This leaves a total of 412 cases remaining to be dealt with at the end of 1937. Rather more than half of this total were certified in 1936—the long delay in dealing with these in many instances may be put down to the size of fiat or house needed, four and five-roomed accommodation still being very scarce. In addition to cases certified for preferential consideration on the ground of overcrowding, 77 other cases were certified for preferential consideration in the main on health grounds, but the L.C.C. have found it possible to deal with but few of these. The system of notifying the owner or other responsible person of the provisions of the Act in relation to overcrowding has been continued as regards all known cases of premises being vacated. Some 200 letters have been written in this connection. At a suitable interval after the vacation of premises a return visit has been made by the District Sanitary Inspector to ascertain the new user of such premises, 96 and in 7 instances fresh overcrowding has been discovered. Pending- the fixing of " the appointed day " for this Borough we are of course unable to deal with such occurrences. For comparison, the following table, similar to that published in my report for 1936, is given in respect of the overcrowding remaining in the Borough at the end of 1937:— Degree of overcrowding (expressed in X times the legal standard) Rooms required Total families 2 3 4 5 6 7 Over 3 2 4 14 12 — — 32 ,, 2 76 170 202 52 6 1 507 From 1½ to 2 69 490 389 68 12 1 1,029 „ 1 to 1½ 106 660 466 171 18 1 1,422 Segregation 15 — — — — — 15 Totals 268 1324 1071 303 36 3 3,005 97 GENERAL. The foregoing facts indicate that substantial progress is being made both in the reduction of overcrowding, in the demolition of insanitary areas and in the provision of new housing. We are apt in the day to day absorption in the details of this complicated problem, especially when hard and urgent cases compel our attention, to lose sight of the larger issues, and that long term view which is essential to a sound policy. It is worth while therefore taking stock not only of the actual situation but also of the probable trend of events and the situation which will exist in 5 or 10 years' time. Two aspects in particular appeal to me : (1) The respective spheres of the Borough Council and the L.C.C. (2) The standard of the new housing. With regard to the first, it is surely a truism to say that nowhere in London or even in Greater London can the local aspect of the housing problem be separated from the problem of the whole aggregate of London. There are no self-contained communities : all are linked in the tangled factors that affect housing such as place of work, means of transit, relative standard of living, etc. This applies with special force to the congested districts in East London where nearly two centuries of unplanned and uncontrolled development and a large poor population have created a housing problem of great magnitude and particular complexity. In the face of such circumstances it is obvious that the local borough council can only touch the fringe of the problem. The new housing required can only be economically and effectively provided on a big long term programme and it is most needed in those boroughs which would be the least fitted by their 98 low rateable value to bear the burden of such provision. Fortunately, the recently adopted " Redevelopment Area " procedure gives hope of quicker and thorough treatment of the whole problem of replanning London housing and adjusting its relationship with industry, commerce and transport. This procedure applied with vigour by the L.C.C. should bring about large scale improvements during the next 5 to 10 years. As will have been noted from the figures on pages 90-93, the L.C.C. rehousing programme is now making accelerated progress. If it be taken for granted that a large resident population must be housed in Central London (a conclusion which is, however, strongly contested by many town planning experts) it is desirable that such housing should be of a sufficiently high standard to provide some compensation for the loss of privacy and amenity in the separate house and garden which is still generally regarded as the ideal family residence. I must confess that I am rather doubtful whether this standard is being attained. To a large extent, such matters as height of buildings, closeness of blocks, size of rooms and character of fitments arc controlled by economic considerations. There are, however, other features of the tenement building which deserve attention, even if they may involve a slightly increased expenditure, such as the provision of lifts, hot water supply, modern scientific methods of refuse disposal, and gardens and other means of recreation for young children. In previous reports I have pointed out the serious hardship which bears on families on the upper floors of tenement buildings, in climbing to and from their flats for every occasion of shopping, work, school, exercise, etc. With regard to the disposal of refuse, there is available an up-to-date 99 scientific and hygienic system, known as the " Garchey " system, beside which all our present methods appear wasteful, unhygienic and inefficient. It is a further advantage of this system that the heat used in it can be utilised to provide a common hot water supply. This of course can be supplied in a much cheaper way than by individual housewives using separate means of heating, apart from the convenience and health value of its being continually " on tap." Having regard to the fact that such large sums of public money are being invested in housing it seems to me very important to secure that there shall be an adequate return in following years not only in the maintained value of the buildings owing to their up-to-date character but also in the form of the added health and comfort of those who live in them. HOUSING STATISTICS FOR 1936. Number of Houses erected during the year—379 tenements and 3 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) 6,669 (b) Number of inspections made for the purpose 6,609 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 576 (b) Number of Inspections made for the purpose of the regulations 576 100 (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 9, 10 and 16 of the Housing Act, 1936 :— (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, 5,611 fects to be remedied 'Nuisance Notices 2,429 (2) Number of dwelling-houses in which defects were remedied :— (a) By owners 5,900 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made One 101 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (D) Proceedings under Section 12 of the Housing Act, 1936 :— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made One (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, 1936. Part iv—Overcrowding. (a) (i) No. of dwellings overcrowded at end of year 3,005 (ii) No. of families dwelling therein 3,005 (iii) No. of persons dwelling therein 15,715 (b) No. of new cases of overcrowding reported during year 179 (c) (i) No. of cases of overcrowding relieved during year 784 (ii) No. of persons concerned in such cases 3,884 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after local authority has taken steps for abatement of overcrowding 7 (e) Any other particulars with respect to crowding conditions upon which the M.O.H. may consider it desirable to report — 102 FACTORIES, WORKSHOPS, OUTWORKERS, &c. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices 1 Prosecutions Factories (Including Factory Laundries) 2,404 412 Workshops (Including Workshop Laundries) 2.161 339 Workplaces (Other than Outworkers' Premises) 202 35 Totals 4,767 786 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 A cts :— Want of cleanliness 431 411 6 ... Want of ventilation 7 4 ... Overcrowding ... ... ... ... Want of drainage of floors ... Other Nuisances 447 393 8 ... Sanitary accommodation— ... ... ... ... insufficient 4 4 ... ... unsuitable or defective 326 260 ... ... not separate for sexes 1 1 ... ... Offences under the Factories and Workshop A cts :— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to out work) ... ... ... ... Totals 1,216 1,073 14 ... 103 Registered Workshops. Workshops on the Register (s. 131) at the end of the year Number Workshops 923 Workshop Bakehouses 32 Total Number of Workshops on Register 955 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 Notified by H.M. Inspector 14 Health Acts, but not under the Factory and Workshops Acts (s. 5, 1901). Reports (of action taken) sent to H.M. Inspector 14 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 19 HOME WORKERS. Of the 2,167 names of workmen and contractors which appeared on the lists received, 1,625 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. 104 The number of visits paid to Home Workers' dwellings was 938. The number of premises found to be in an insanitary condition Avas 142, or 30.3 per cent, of the 468 premises inspected. Notices were served in 198 cases, while 50 other premises were under notice arising from other visits, and a verbal intimation was given in 20 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 Glasgow, Newcastle, Hoddesdon, Croydon and Epsom, and local firms have sent in lists containing outworkers resident in Harrow, Dagenham, Hornchurch, Rochford, Southend-on-Sea and Welling. 105 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. 32 137 208 2 5 819 197 54 ... ... 47 67 ... ... ... ... Boots and Shoes 8 31 70 2 2 2 89 68 12 ... ... 14 25 ... ... ... ... Curtains, Furniture hangings and Trimmings 2 58 3 2 ... 14 15 43 6 ... ... 3 3 ... ... ... ... Fur-pulling and feathers ... ... ... ... ... 13 ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. 2 ... 13 ... ... ... 19 1 4 ... ... 7 7 ... ... ... ... Artificial Flowers ... ... ... ... ... 21 ... ... ... ... 5 6 ... ... ... ... Paper, etc.,Boxes, Paper Bags 11 3 172 1 ... 8 94 59 16 ... ... 37 50 ... ... ... ... Brush-making 8 ... 88 1 ... 1 8 54 2 ... ... 7 9 ... ... ... ... Draught Board Making 1 ... 2 ... ... ... ... 2 ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, etc. Textile Weaving 1 ... 10 ... ... ... 18 ... 2 ... ... 15 1 19 2 ... ... ... ... Toys 1 ... 158 ... ... ... 26 99 2 ... ... 6 10 ... ... ... ... Totals ... 61 229 724 8 2 30 1,182 521 100 ... ... 142 198 ... ... ... ... *lhe figures in these columns relate to outworkers premises at which nuisances were found and dealt with under Public Health (London) Act. 106 APPENDIX I. LEGAL PROCEEDINGS During the year, 32 summonses were heard in respect of nuisances, with the following results :— Withdrawn on payment of costs amounting to : — £110 23 £15 0 1 £1 11 6 8 Other legal proceedings are summarised in the following list :— Legal Proceedings, 1937. No. of Sample in Food cases Date Offence or Occasion Result — 5th Jan. Public Health (London) Act Allowing tilth to accumulate in passageway to bakehouse and stairs to basement Fine £1 Costs £5 — 5th Jan. Factory and Workshop Act Allowing Bakehouse to be in state unlit for use Fine £2 Costs £5 383 (1936) 19th Jan. Food and Drugs Act, &c. Selling cheese containing preservative (formaldehyde) Dismissed, Warranty defcnee 526 (1936) 50 5th Feb. Food and Drugs A dulleration A a Selling vinegar 10% deficient in acetic acid Costs £5 5s. Od. 4th Murcli Selling milk which contained 4.7% added water Costs £7 7s. Od. — 16th April Public Health (London) Act Exposing for sale tins of unsound food Fine £10 Costs £10 10s. Od. — 16th April Milk and Dairies Order Dirty condition of milkshop Same defendant as preceding case : summons not proceeded with 107 No. of Sample in Food cases Date Offence or Occasion Result — 6th May Public Health (London) Act Allowing filth to accumulate at Bakehouse Fine 5s. Od. Costs £5 5s. Od. — 6th May Factory and Workshop Act Unfit condition of Bakehouse Fine 5s. Od. Costs £5 5s. Od. 228 15th June Food and Drugs A dulteration A ct Selling alto mints which contained 212 parts per 1,000,000 of sulphur dioxide in excess of amount permitted (retailer) Dismissed on conviction of manufacturer do. do. Selling alto mints which contained 212 parts per 1,000,000 of sulphur dioxide in excess of amount permitted (wholesaler) Dismissed on conviction of manufacturer do. do. Selling alto mints which contained 212 parts per 1,000,000 of sulphur dioxide in excess of amount permitted (manufacturer) Fine £25 Costs £15 but this decision was reversed upon appeal — 24th June Public Health (London) A ct Having possession of rag Hock containing chlorine 70 parts in excess of maximum permitted Costs £7 7s. Od. """"" 28th June Having possession of rag Hock containing chlorine 12 parts in excess of maximum permitted Withdrawn Costs £3 3s. Od. 28th June Having possession of rag flock containing chlorine 15 parts per 100,000 in excess of maximum permitted Withdrawn Costs £3 3s. Od. 264 29th June Food and Drugs Adulteration Act Selling milk 10% deficient in fat (retailer) Withdrawn (see next case) 298 29th June Delivering milk in pursuance of contract of sale 6.6% deficient in fat (wholesaler) Withdrawn Costs £8 8s. Od. — 27th July Public Health (London) Act Allowing refuse to accumulate in shop Fine £1 Costs £2 2s. Od. — 10th Aug. Public Health (Meal) Regulations, 1924 Causing refuse to accumulate in shop Fine £2 Costs £2 2s. Od. 108 No. of Sample in Food cases Date Offence or Occasion Result 370 10th Aug. Food and Drugs Adulteration Act Selling raspberry jam containing 75% apple jam Dismissed, Costs 10s. 6d. — 6th Oct. Public Health (London) Act Depositing unsound food for sale Fine £5 Costs £3 3s. Od. — 26th Oct. Distributing toys in exchange for rags, contrary to bye-laws Fine 5s. each (2 persons) 491 3rd Nov. Food and Drugs Adulteration Act Selling vinegar 10% deficient in acetic acid Costs £1 Is. Od. — 28th Dcc. Public Health (London) Act Distributing toys in exchange for rags, contrary to bye-laws Costs 2s. Od. 109 APPENDIX II. TUBERCULOSIS DISPENSARY at the LONDON CHEST HOSPITAL REPORT FOR THE YEAR 1937 By H. Tylford Howell, M.R.C.S., L.R.C.P., Clinical Tuberculosis Officer. Before presenting a detailed statement of the work of the Dispensary for the year, I have to report a change in the personnel of the department. Dr. F. Temple Clive, the assistant Tuberculosis Officer, tendered his resignation in June on obtaining the appointment of Medical Superintendent at the National Sanatorium, Benenden. Dr. Clive was an able physician, popular with his patients by reason of his unfailing courtesy, his ready sympathy, and his bright and cheerful manner. His loss will be keenly felt. Dr. A. F. W. Anglin, Assistant Medical Officer attheColindale Hospital, was appointed to fill the vacant post and took up his duties in September. I reported last year that as a result of the Tuberculosis Officers taking on the work of " refills " in Pneumothorax cases, it was found necessary to add three sessions for this purpose. The hours are as follows :— Monday, Wednesday, Thursday, Friday and Saturday from 10 to 12 o'clock, and Thursday evenings from 7.30 to 9 o'clock. In addition to the above, three sessions are reserved for Artificial Pneumothorax refills Thursday at 12 o'clock and at 2 o'clock, and Saturday at 12.30. The accommodation of the department is still adequate in every respect. The two consulting rooms, each with two dressing rooms and a dark room for throat examinations attached, are light and airy. In addition there are rooms for Artificial Pneumothorax refills, waiting rooms, a laboratory, and offices for the Tuberculosis Officers and clerk. We continue to take every advantage of the unique facilities offered us for specialist opinion in the various departments of the Hospital. The opinion of the Physicians, Surgeons, Laryngologists, Radiologists, Pathologist and Dentist is always readily 110 obtainable, and we are particularly grateful to the Larvngologists and Radiologists for the ready response to our numerous requests for consultation. 1,171 cases were referred for X-ray examination. Previously our use of X-rays was limited, but it is now recognised that no Dispensary can successfully fulfil its function under such a restriction. Not only are X-rays indispensable in diagnosis, but they also tell us the extent and progress of the disease, and consequently are invaluable in deciding the correct form of treatment. Treatment by Artificial Pneumothorax without X-rays would be impossible. They are an essential guide in the choice of suitable cases for this form of treatment, and later, in ascertaining the degree of collapse of the lung and the necessity or otherwise of a refill. Moreover they enable us to keep a constant check on the sound lung—a matter of great importance. In this connection I am pleased to report that a new X-ray screening apparatus is being installed for the sole use of the Out-patient department. This will greatly facilitate our work in the Artificial Pneumothorax Clinics. The arrangements for Artificial Pneumothorax refills are working smoothly, and the times of the sessions appear to be convenient and adequate. The attendances at these clinics number 988 for the year, and the refills 702. I am convinced that this form of treatment affords the quickest means of a return to working capacity, reduces the possibility of a relapse, and offers a greater hope of ultimate recovery. Especially is this the case with the class of patient attending the Dispensary. Tuberculosis is very largely a disease of the poor. A patient in comfortable circumstances, who can stay in a sanatorium, if necessary, for a year or more, knowing that his family will not suffer want and with no financial worries to retard his progress, has a good chance of obtaining a cure and retaining his health on discharge. The prospects of the average working class man with whom we come into contact at the Dispensary are distinctly less favourable. He and his family have probably been in straitened circumstances for some time, possibly with insufficient and unsuitable diet. In his debilitated condition his resistance must necessarily suffer. He, too, may go to a sanatorium, but with a family dependent upon his earnings he is never free from worry, makes unsatisfactory progress, and leaves before a cure is effected. After discharge, if he has not already lost his employment, he returns to work, while still unfit. Ill Under such conditions, relapse is only too common, and the sanatorium is given the blame. There is nothing wrong with the sanatorium—it has done and still is doing its share of the work satisfactorily. In my opinion the present tuberculosis scheme fails in two important particulars—firstly, the failure to provide a sufficiently long course of sanatorium treatment, and secondly, the lack of provision for the placing of ex-sanatorium patients in suitable employment. The problem is an economic one and should be a matter for the State. In view of its importance, I make no apology for again urging improvement in the tuberculosis scheme on the following lines : 1. A greater measure of financial support for the families of tuberculosis patients while in sanatorium. The consequent freedom from worry would enable them to secure a fuller benefit from their treatment and also permit them to stay in sanatorium until this is completed. 2. Extension of Village Settlements on the lines of Papworth and Preston Hall. At these institutions a patient is first treated for his disease, and when his condition has sufficiently improved he is trained in some suitable trade. Later, permanent employment is found for him, while he lives under ideal conditions in a model hostel or cottage, under constant medical supervision. 3. Provision of Municipal workshops. Here again patients would work under strict medical supervision but would continue to live at home. The class of work and the hours of employment would in each case be governed by the patient's physical capacity, and a man should receive a minimum living wage, irrespective of his earning capacity. 4. The employment of ex-sanatorium patients in tuberculosis institutions. At first sight it would appear that such an experiment would be too expensive and risky, but this is not the experience of Maltings Farm Sanatorium at Colchester and the Berkshire and Buckinghamshire sanatorium at Peppard Common, which have employed ex-patients for some years. Dr. Esther Car ling of the latter santorium, after twenty-three years experience of this experiment is full of enthusiasm, and writes :— " There has been no reason to complain of the services rendered by the tuberculous. Steady work for thirty years in one case, for twenty-three years in another, for thirteen and seven in two other instances, are records of people on our nursing staff to-day. There have been occasional periods of sickness, but the Committee's scale of sick leave has usually covered the case and there have been few instances of special consideration." 112 It would take time and money to develop these schemes on such a scale as to absorb all the tuberculous, but surely it is more rational to utilise a man's earning power, even though impaired, than keep him in total unemployment. Under the present scheme much expense is incurred in restoring a man's health and working capacity, only to leave him stranded. Would it not be more humane to complete the task and find him work ? With his subnormal health he cannot compete in the open market, and experience shows that we cannot look to the private employer to give preference to the tuberculous, for he not only has to consider whether he can afford to employ sub-standard labour, but must also pay regard to the feelings of his other employees, who may object to working in close daily contact with a consumptive. The Handicraft Class, run by the Hackney and Stoke Newington Care Committee, makes no pretence of enabling patients to earn a living, but rather to provide an interest to occupy their minds and save them from brooding over their condition. It does, however, provide a little in the way of pocket money, as all articles made by the patients are sold, and after deducting the cost of materials and a small percentage for expenses, the surplus is paid over to the worker. The crafts taught are varied and useful, and include leather, bead, basket, pewter work, and the making of gloves and artificial flowers. The Class is in a sound financial position, thanks to the assistance of 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. Our main difficulty at present is the sale of the goods, and we appeal again for further local support in this direction. W e are indebted to the Mayor and the Hackney Borough Council for permission to hold a Sale at their Health Exhibition, held in the Town Hall in September last. This exhibition, which proved to be most instructive and interesting, attracted a large number of people, and we are grateful for such an opportunity to display our goods to the public. The local charitable organisations have again given us valuable help, and we are specially indebted to the Bethnal Green and Hackney branches of the Invalid Children's Aid Association, for sending a large number of our debilitated children to Convalescent Homes in the country or at the seaside. The Charity Organisation Society has assisted in the supply of instruments, dentures, clothing, etc., and the National Association for the Prevention of Tuberculosis, the Royal Naval Benevolent Trust, Jewish Hoard of Guardians, Soldiers, Sailors and Airmen's Families Association, Soldiers and Sailors Help Society, British Legion and United Services Fund Benevolent Committees, and the British Red Cross Society, have given financial assistance in necessitous cases. 113 Thirty-seven of our children were recommended for admission to an open-air school during the year. It is the aim of these schools to restore children to normal health and to inculcate in them habits of personal cleanliness and health, at the same time giving each child an education which is not beyond its physical capacity. I cannot speak with authority of results on the educational side, but judging by the number of children who succeed in gaining scholarships to secondary schools, 1 should think they are in every way satisfactory. On the medical side, I am convinced that open-air schools not only succeed in their function of restoring a child's health, but also in instilling in him hygienic habits which he carries into the home and probably never quite loses for the remainder of his life. The return to health is moreover accompanied by a remarkable improvement in the mental outlook of the children. This is largely due to the fact that being backward educationally by reason of enforced absence from school through illness, they are, at the ordinary elementary school, too often at the bottom of their class, with the result that a sensitive child often develops a sense of inferiority and an intense dislike of school. On entering an open-air school, they meet others in the same backward state as themselves; less attention is therefore drawn to them in this respect, with the result that they soon lose their haunted and worried appearance, and become happy and contented again. Stormont House School, situated on Hackney Downs, admits pulmonary, non-pulmonary and suspected cases of tuberculosis, and the ages range from 6 to 16 years. There are 88 on the roll, and with two or three exceptions, all the children come from the neighbouring Boroughs of Bethnal Green, Hackney and Stoke Newington. All Classes are held in the open air. Becords of weight, temperature, etc., are kept by the Dispensary nurse, who attends the school daily. I visit the school weekly, making frequent examinations, and directly supervising the exercise and rest of each child. A drink of milk, morning and afternoon, and an excellent dinner are provided at a nominal charge, but no payment is exacted in necessitous cases. During the year 5 children were transferred to an elementary school, treatment in an open-air school being considered no longer necessary, while 8 children were discharged as fit for work and placed in employment by the School Care Committee. In accordance with the London County Council regulation that all children attending an open-air school shall receive a summer holiday, 53 boys and '26 girls, who would not otherwise have gone away, were sent on a school journey to Bustington for two weeks, The children, who are accompanied by their teachers and nurses, continue with their lessons but as these largely take the form of 114 nature study, practically all their time is spent in the open-air. It is difficult to demonstrate any immediate and tangible evidence of benefit, such as marked increase in weight or improvement in the physical signs of disease, but there is little doubt that these journeys have a beneficial influence on the general health of the children. While there is little difficulty in arranging convalescence or a short holiday for children, either through the London County Council or one of the charitable organisations, it is rarely possible to do this for the adult, whatever his trouble. A patient with debility or symptoms slightly suggestive of tuberculosis, or the quiescent case of tuberculosis, is not suitable for sanatorium, but on the other hand a short holiday may be necessary to build him up for the winter. If he cannot afford to pay for one himself, he has to do without and run the risk of a further breakdown in health. Concerning the question of holidays generally, I would like to add a word of warning on the dangers of sunbathing. Indiscriminate sunbathing may be harmful even to a healthy person, but to the tuberculous it is a positive danger. In spite of repeated warnings on our part that patients suffering from pulmonary tuberculosis should never sunbathe, we find it difficult to control this craze. Only too frequently do we see a young adult, recently returned from a holiday at the seaside, proudly displaying his tan or his blisters, as the case may be, with signs of active tuberculosis, due to the lighting up of an old latent focus, or still more frequently with marked extension of the disease. Sunbathing may be beneficial in certain cases of surgical tuberculosis, but even then should only be carried out under strict medical supervision. We are indebted to the School Medical Service for their cooperation in carrying out the scheme for the supervision of contacts. To prevent over-crowding of the Tuberculosis Dispensaries, all healthy contacts, and those who, after a period of observation at the Dispensary, show no evidence of tuberculosis, are referred to the School Medical Service. A report on each child is sent to the School Medical Officer, who keeps the case under special observation, arranging for periodic examinations and the keeping of accurate records of weight, etc. Should the School Medical Officer later suspect tuberculosis in any of these children, they are referred back to the Dispensary for further investigation. I continue to act as Tuberculosis Consultant to the Bethnal Green Hospital. I reported last year that in view of the increase of work I contemplated visiting the Hospital weekly, instead of fortnightly as hitherto. This arrangement, which is now being carried out, I find much more satisfactory. The routine round 115 is not rushed, and I can devote more time to individual patients, to the selection of patients suitable for Artificial Pneumothorax treatment, the supervision of treatment, and the examination of suspected cases in other wards of the Hospital. Bethnal Green and Hackney Hospitals admit most of our advanced patients, and until recently we have always been able to secure immediate admission for an urgent case. During the last year, however, we have frequently experienced difficulty in this direction. This is due to the shortage of beds for advanced patients, and unless the matter is tackled soon, the position may become really serious. The Borough Councils as before, supply milk and eggs to tuberculosis patients not in receipt of relief and whose financial circumstances warrant it, while the Public Assistance Committee gives a grant for this purpose to those under their care. Previously Public Assistance Committees were rather frugal in their recommendations, but recently there has been a change in the attitude of the London County Council in this matter. They now wish to ensure that, where necessary, every tuberculosis patient should receive extra nourishment. Since all recommendations for the grant must be approved by the Tuberculosis Officer, the attendance of the patient at the Dispensary at regular intervals is ensured which is of material assistance to us in the supervision of these cases. I submit at the end of the report a statistical summary of the work 01 the department for the year. The figures usually show little variation from year to year, but during 1937 it will be noted that there has been an increase of 194 in the total number of new cases, due to the rise in the contact figures for Bethnal Green. I would point out that the tables showing the results of the contact examinations do not give a true indication of the percentage of positive contacts, as the Ministry of Health has laid down that only those who attend the department as the result of the tuberculosis scheme are to be included in the returns. Those who are sent by doctors and who attend voluntarily are not to be entered as contacts, notwithstanding the fact that they may at the moment be living with an infectious case of tuberculosis. 428 cases were referred for opinion of the Tuberculosis Officer by the general practitioners. Here again I would point out that this figure only partially represents the number of cases sent by doctors during the year, as only those who had not previously attended the department are recorded. Our relations with the local practitioners are still of the most cordial nature, with an entire absence of petty annoyances and misunderstandings, and I think we may infer from the use they make of the department that they find it of value for the purpose of consultation. 116 The total number of attendances and the systematic examinations number 7,046* and 3,297 respectively. We consider frequent examination of the highest importance and essential in determining the progress of a patient, his fitness for work, or the necessity for alteration of treatment. It will be seen by comparing the above figures, that we average one examination for just over two attendances. The attendances at the Artificial Pneumothorax clinic number 988, compared with 775 for the previous year. In comparing these totals, however, it should be remembered that as we did not take over the work of " refills " until April, 1936, last year's figures covered a period of nine months only. 171 of our patients were admitted to Sanatorium or Hospital under the tuberculosis scheme. This figures does not include cases admitted to the London County Council General Hospitals. No one in the early stage of the disease or offering a reasonable hope of such improvement as will enable him to return to work, is refused sanatorium treatment, and the waiting period is usually reasonable. In conclusion I would like to thank the Medical Officers of Health, the Hospital Physicians and Surgeons, the Resident Mcdieal Officer and the Hospital Secretary for their kindly help and advice, and the Dispensary Staff for their efficient work and loyal support. II. TYLFORD HOWELL. 25th March, 1938. *These and other figures include Hackney patients attending the Dispensary. 117 BOROUGH OF BETHNAL GREEN 1. The Totals of New Cases Males 413 Females 399 Total 812 2. The Sources of the New Cases Total Tuberculous Medical Officer of Health 172 23 Local Practitioners 140 20 Contact Cases (per M.O.H.I 357 5 London County Council 3 1 London Chest Hospital 7 7 Other Sources 82 58 Transferred from other Areas 25 25 3. The Diagnosis of the New Cases Diagnosis Adults Children under 15 Total Males Females Males Females Pulmonary Tuberculosis 01 52 3 2 121 Non-pulmonary Tuberculosis 4 10 8 2 24 Non-tuberculous 107 208 154 117 040 Doubtful 9 6 4 2 21 Total 244 270 109 123 812 4. Thf. Diagnosis of Contact Cases Pulmonary Tuberculosis 5 Non-pulmonary Tuberculosis — Non-tuberculous 347 Doubtful 5 Total 357 5. Sputum Examinations Tubercle Bacilli present 61 Tubercle Bacilli absent 207 Total 328 6. Other Figures Total number of attendances 3,701 Systematic examinations 1,890 Number of patients sent to hospital or sanatorium by the L.C.C. 80 Number of letters written 1,010 Number of visits to patients at their homes 144 Number of attendances at:— X-ray Department 525 Dental Department 9 Artificial Pneumothorax Clinic 416 Other Departments 41 118 APPENDIX III. REPORT OF THE RESULTS OF AN ENQUIRY INTO THE FOOD EXPENDITURE OF CERTAIN BETHNAL GREEN FAMILIES. (Being a preliminary to a special nutrition investigation under the direction of Sir John Boyd Orr.) In May 1937, an enquiry was instituted into the amount of money actually expended upon various foodstuffs by certain families resident in the Borough who were known to be in poor economic circumstances. The families in question were those in which the mother and/or some young child was receiving a grant of milk under the Borough Council's Maternity and Child Welfare scheme and were therefore families in which the father was either unemployed or earning low wages. A form of enquiry was drawn up with a view to eliciting the amount spent on the principal items of food grouped according to their nature. At the same time, with a view to obtaining information as to items which might affect the money available for food, the enquiry was extended to cover the principal items of domestic expenditure apart from food. As particulars of the family income were already available on the Milk Grant records there was no need for special enquiry on this point. The forms were distributed to the mothers with an explanatory letter from the Medical Officer of Health by the Health Visitors who also assisted the mothers in filling up the required figures. The original intention was to obtain returns for four successive weeks from each family so that any abnormal expenditure in one week might be counter-balanced or any variation in quantity or choice of foodstuffs might be noted. While adequate four week returns were obtained in a few cases, in the majority of instances the four weeks were largely a "wooden" repetition of one another indicating that some attempt had been made to strike an average or else the return consisted of a single week's figures or a statement either that the mother was unwilling to fill up further forms or that "every week was much the same." At the outset it was hoped to obtain particulars in respect of about 500 families. Unfortunately, for various reasons, only 223 adequate returns were obtained. These returns have now been classified and analysed. The forms were first grouped according to the net income per head of the family after deducting rent. The sex and age composition of the family was calculated according to a food cost scale based on various scales of coefficients for food requirements on a man-unit basis. The actual 110 expenditure on eac-h item of food has been summed up for each income group and the family co-efficients applied to it to show the average expenditure per man-unit in that group. The number of families falling within the several income ranges is shown in the tables*. An important difficulty in dealing with many of the returns was the discrepancy between the total expenditure shown and the understood family income. In some cases, this, is no doubt, explainable either by a slight exaggeration of the actual amount spent or by mistakes of calculation, but in a much larger number of cases the explanation is to be found in borrowing and pawning. Special enquiry was made in these cases of discrepancy and a number of the mothers voluntarily called at the Public Health Department offices to furnish information. Having regard to the limited numbers and the inevitably defective character of some of the returns from the point of view of precise or reliable statements, the data presented must be regarded as indicative of the position rather than as finally conclusive in the scientific sense. Nevertheless, to those closely acquainted with the people of the district, the facts brought out undoubtedly closely express the truth about the food supply of a large portion of the population, i.e., those families whose net income after paying rent is less than 10/- per head. The broad results of the enquiry are shown in the summary which appears as Table A. As will be seen, with the notable exception of bread, bought for its relative cheapness, the figures reveal an almost regular increase in the amount spent on the various foods in proportion to the increase in income. This is especially marked in the first class protein foods such as meat and cheese and also in the vegetable and fruit group. It demonstrates the truth of the statements in the report on "Workers Nutrition and Social Policy," issued by the International Labour Office in 1936: "When purchasing power is provided for the workers through employment and adequate wages, the workers themselves tend to select the better and more nutritive foodstuffs and are more amenable to the influence of education" — "Worker's families with low incomes evidently find the protective foods too expensive and cannot afford them. The question of income is thus at the root of the nutrition problem." ♦The 223 families included 1196 persons and ranged in size from 2 to 13 persons, the average size being 5.3 persons. The average weekly expenditure was £2 6s. 4id. 120 A vital feature of the enquiry is the comparison of the actual expenditure with the minimum expenditure embodied in the British Medical Association's report on " Nutrition " issued in 1933. The following figures will give this comparison at a glance. Bethnal Green families on milk grants—net income per head after deducting rent Food expenditure, per man-unit Compared with B.M.A. minimum per man-unit (1933 figures, 5/10J adjusted to July, 1937, food prices. 7/1)* Under 5/— 4/11 — 2/2 5/— to 6/3 5/8 — 1/5 6/3 to 7/6 6/1 — 1/– 7/6 to 10/- 6/4 — –/9 10/-and over 7/3 — –/2 Every group except the last is seen to be under the British Medical Association's scale. These figures are strikingly represented in a graph which Mr. Lloyd has drawn on the basis of this comparison. Taking the comparison of the results of the enquiry with the British Medical Association's minimum scale a little more into detail, there will be seen from Table B rather more clearly those respects in which the dietary of the Bethnal Green families differ from that recognised by the British Medical Association. There are serious deficiencies in the protein, carbohydrate and fresh food groups while in no group is there any substantial countervailing increase over the British Medical Association's standard. Not only is the expenditure on meat, bacon and cheese much lower, but other sources of protein and fat such as milk| and butter are also very low. The fat allowance is only maintained through the substitution of margarine for butter. In the vegetables and fruit group, while comparison with individual items is difficult owing to variation in classification, it is clear that the poorer Bethnal Green families are gravely below the British Medical Association's minimum. Table B is based on the average of all the income groups coming within the scope of the enquiry and therefore does not show the full extent of the comparison with the British Medical Association's standard of the very lowest income group. Table A and the comments thereon have already sufficiently emphasised the point that the size of the family income per head determines the adequacy of the principal constituents of a sound dietary. | See note on p. 121. 121 It may, however, be added as a most striking illustration of this that compared with the British Medical Association's allowance of approximately 1/4 per man-unit for vegetables and fruit the amounts expended by the families in the enquiry, grouping them according to income, were as follows :— Under 5/- 5/-to 6/8 6/3 to 7/6 7/6 to 10/- 10/- and over 8d. 9d. 10±d. lid. 1/l½d. No group, even the highest, could afford the British Medical Association's standard, while the lowest had half that amount. Table C supplements Tables A and B, and illustrates in a different way the deprivations which follow a low income. This table is based not on the actual expenditure per head but on the number of families affected by a particular shortage. The outstanding fact is the low consumption of valuable foods like liquid milkf, butter, eggs and fruit. That nearly one third of these families should be deprived of such essentials to a sound dietary is a profound indictment of present standards of working class living. It is also regrettable that wholemeal bread appears to be rarely eaten. With regard to beer and wines and spirits it is doubtful whether the figures given are a true reflex of the facts. While, however, they may be an under-estimate of the actual expenditure, the candour with which other expenditure has been recorded (e.g. tobacco, pocket money, etc.) makes it reasonable to conclude that the amount spent on alcoholic liquor in families in these categories is relatively small and substantially less than is frequently supposed by critics of working class life. Table D contains information as to the economic classification of the families concerned in the enquiry. It brings out the surprising fact that in as many as 45 per cent, of the families the father was in employment indicating the exceedingly low level of the wages paid in and around the borough. The supplemental information with regard to rent and other domestic expenditure forms the subject of a separate report. It is appreciated that owing to the limitations of the material available in this enquiry no precise significance can be claimed for the figures actually obtained. On the other hand, the standards of comparison employed have been deliberately chosen on a low level in order to avoid any criticism that a higher standard applied to restricted data might have evoked. The British fTo some extent, the actual shortage of milk was made up by the Borough Council grant which amounted to an average of 2/10 per family. This, however, is specially allocated to the expectant or nursing mother or young children in the family and cannot be regarded as generally available for the other members. The milk grant is of course made precisely because the family income is insufficient to enable the family themselves to provide the milk needed. 122 Medical Association's Nutrition scales were explicitly published as minima and not as desirable standards. When comparison is made with the optimum, i.e., more adequate standard laid down ill Sir John Orr's report on " Food, Health and Income " the deficiency in the food supply of the poorer Bethnal Green families appears in even greater seriousness. The full extent of the comparison of the Bethnal Green figures with those of a "diet adequate for full health" in Sir John Orr's report on "Food, Health and Income" will be seen in the accompanying table : Bethnal Green enquiry, per head* d. Sir J. Orr's "Diet adequate for full health," per head* d. Meat (including bacon and ham) 12.2 31.8 Fish 2.2 5.8 Cheese 1.0 2.0 Bread, flour, cakes 10.1 13.8 Sugar 2.2 2.8 Jam, syrup, etc .9 1.9 Butter and Cream .9 6.8 Margarine 2.2 0.8 Dripping, lard, suet .7 2.2 Milk, fresh 2.4 10.2 Milk, condensed, dried 1.5 1.0 Eggs 1.4 4.0 Vegetables 5.5 8.2 Fruit 1.2 9.5 Tea 2.8 4.6 Miscellaneous 2.7 14.6 49.9 = 4/2 120.0 = 10/- ♦The food expenditure figures in Sir John Orr's report have been calculated per head. In this table, the Bethnal Green figures have been re-calculated on this basis for purpose of comparison. The serious inadequacy of the Bethnal Green diet is seen in every item, but is specially glaring in precisely those "fresh" foods (such as butter, milk and fruit) which modern scientific investigation has shown to be so important for sound nutrition and growth. Even in the carbohydrate foods, to which the poor resort because of their cheapness as a substitute for the dearer protein and protective foodstuffs, the poorer Bethnal Green families do not get a sufficiency for a good standard of health. 128 It is interesting to observe that the Bethnal Green figures correspond fairly closely to the lowest income group in Sir John Orr's report, i.e., those families with a gross income per head below 10/-. The results of the enquiry are therefore submitted as rough approximations to the truth. They are an important indication of the low standard of nutrition at present existing in a section of the population of the Borough. What proportion of Bethnal Green residents may be living at this level cannot be stated but there is little doubt that it is a substantial number. Further investigation of the facts on more scientific lines than were practicable on this occasion is very much to be desired. Vynne Borland, Medical Officer of Health. J. Henry Lloyd, Administrative Assistant and Chief Clerk. Public Health Department, 15, Old Ford Boad, Bethnal Green, E.2. 31 si December, 1937. 124 table a EXPENDITURE IN PENCE PER MAN-UNIT Under 5/- 5/- to 6/3 6/3 to 7/6 7/6 to 10/- Over 10/- Summary d. d. d. d. d. d. Meat 11.8 14.1 15.6 16.2 20.4 14.2 Bacon 1.9 2.3 2.5 2.8 2.5 2.3 Fish 2.4 2.7 3. 4.5 3.5 3. Poultry .2 ..3 .3 .7 — .3 Tinned meat or fish .5 ..5 .4 .9 .4 .5 Cheese 1.2 17.4 1.3 21.2 1.7 23.5 1.5 26.6 2. 28.8 1.4 21.7 Bread, white 12.0 11.8 11.4 10.3 11.1 11.7 Bread, wholemeal .2 .1 .7 .3 .9 .3 Flour .8 1.1 1.2 1.4 1.8 1.1 Cakes .7 1. 1.2 .7 .5 .9 Oatmeal, rice, etc. .8 1. 1.2 1.5 1.5 1.1 Sugar 2.8 3.1 3. 3. 3.5 3. Jam, marmalade, syrup 1. 18.9 1.2 19.3 1.4 20.1 1.4 18.6 1.5 20.8 1.2 19.3 Butter 1. 1. 1. 1. 2.1 1. Margarine 3.1 3.1 3.1 3.1 3.5 3.1 Dripping .4 .5 .7 .7 .8 .6 I.ard and suet .3 .4 .6 .5 .8 .4 Cream... .1 4.9 .1 5.1 .1 5.5 .1 5.4 .2 7.4 .1 5.2 Milk, fresh 2.3 3.9 3. 3.6 3.5 3.2 Milk, dried or condensed 1.8 4.1 1.8 5.7 2.6 5.6 2.2 5.8 4.2 7.7 2.1 5.3 Eggs 1.2 1.2 2.1 2.1 2.5 2.5 2.2 2.2 1.8 1.8 1.9 1.9 Vegetables 6.8 7.1 8.1 8.3 10.8 7.5 Fruit . .9 1.7 1.9 2.2 1.6 1.8 Tinned vegetables or fruit .2 7.9 .2 9. .3 10.3 .5 11. 1.2 13.6 .3 9.6 Tea 3.5 3.9 3.9 4.2 5. 3.8 Coffee — .2 .1 .1 .3 .1 Cocoa .6 .6 .8 .8 1.1 .7 Beer .4 .1 .1 .4 — .2 Wine or spirits — — — — — — Mineral waters .1 4.7 .1 4.9 .1 5. .1 5.6 .1 6.5 .1 4.9 Condiments .3 .3 .6 .6 .5 .5 .6 .6 .9 .9 .5 .5 Total food expenditure 59.4 67.9 73. 75.8 87.5 68.4 Bent 34.8 32.6 35.7 38.1 41.4 34.9 Other Expenses 32. 66.8 38.8 71.4 46.1 88.8 49.9 88. 57. 98.4 40.9 75.8 Total ... 126.2 139.3 154.8 163.8 185.9 144.2 Approximate total expenditure ... 10/6 11/7 12/11 13/8 15/6 12/- 125 TABLE B COMPARISON OF EXPENDITURE ON PARTICULAR FOODS BETWEEN CERTAIN BETHNAL GREEN FAMILIES AND THE BRITISH MEDICAL ASSOCIA TION'S (REVISED) MINIMUM B.M.A. revised minimum B.G. enquiry Average expen. d. d. Meat 16.9 14.2 Bacon 3.6 2.3 Fish 1.8 3. Poultry — .3 Tinned meat or fish — .5 Cheese 3.9 26.2 1.4 21.7 Bread, white and w'meal 15. 12. Flour —. 1.1 Cakes — .9 Oatmeal, rice, etc. 3.6 1.1 Sugar 2.7 3. 19.3 Jam, marmalade, syrup 6.2 27.5 1.2 Butter 3. 1. Margarine — 3.1 Dripping — .6 Lard and Suet 2.1 .4 Cream — 5.1 .1 5.2 Milk, fresh 6. 3.2 Milk, dried or condensed — 6. 2.1 5.3 Eggs 1.2 1.2 1.9 1.9 Vegetables 7.8 7.5 Fruit 8.1 1.8 Tinned fruit or vegetables — 15.9 .3 9.6 Tea 3.6 3.8 Coffee — .1 Cocoa — .7 Beer — .2 Wine or spirits — — 4.9 Mineral waters — 3.6 .1 Condiments — .5 .5 Total 85.5 68.4 Approximately 7/1 5/8 126 TABLE c TABLE ILLUSTRATING DEPRIVATION OR RARE USE OF CERTAIN FOODS Under 5/- 5/-to 6/3 6/3 to 7/6 7/6 to 10/- Over 10/- Total % of total families Families whose Budgets showed : No Butter 36 54 35 23 3 151 67.7 No Eggs 24 26 13 10 2 75 33.6 No Liquid Milk 23 17 17 10 3 70 31.4 No Fruit 20 22 10 6 3 67 30 No Condiments 28 24 20 17 2 91 40.8 Some Wholemeal Bread 2 4 5 4 1 16 7.2 Some Cream 3 4 6 4 1 18 8.1 Some Beer 4 2 1 4 — 11 4.9 Some Wines or Spirits — — — — — — — Some Mineral Waters — 3 4 5 * 1 13 5.8 Total families 40 75 53 38 8 223 127 TABLE D ECONOMIC CIRCUMSTANCES OF FAMILIES IN ENQUIRY Principal Source of Income* Under 5/- 5/-to 6/3 6/3 to 7/6 7/6 to 10/- Over 10/- Total %of total families Earnings from Employment 11 27 30 29 4 101 45.3 Receiving : Unemployment Benefit 19 20 10 5 — 54 24.2 Unemployment Assistance 9 13 8 — — 30 13.4 Public Assistance 8 12 4 4 2 30 13.5 Widows' Pensions, etc 2 3 1 — 2 8 3.6 Families with Children earning 9 12 9 7 2 39 17.5 Total Number of Families 49 75 53 38 8 223 *Where the family income is made up from two or more sources, the principal source has been taken 128 SUPPLEMENTARY REPORT WITH REGARD TO WEEKLY EXPENDITURE OF CERTAIN BETHNAL GREEN FAMILIES UPON RENT AND OTHER DOMESTIC ITEMS. A study of the expenditure of the families included in the enquiry upon rent and other items apart from food sheds a further light on the difficulties in which they live and affords a little explanation in some instances of why the amount spent on food is so low. Figures with regard to rent are available in respect of 222 families and although for their full appreciation they need detailed study in relation to the size and income of the family the following are the salient facts. The average rent for all the families is 11/4 and 35 per cent, of all the rents fall into the same group, 10/to 12/6. This, however, rather obscures the fact that there is a very wide and arbitrary variation in the actual rent paid which ranges from 6/— to 26/10. The anomaly is emphasised when it is explained that the first rent is paid by a family with a gross income per head of 15/- while the second is paid by a nine member family with a gross income of 5/9 per head, and notwithstanding their high rent they are overcrowded while the net income per head available for food, etc., is thereby reduced to 2/9. To attempt a comprehensive correlation of income, rental and size of family would have involved more labour than is available for the task but close examination of the attached table will reveal the practical dilemma which faces poor families. To pay the rent for adequate accommodation for any family in excess of 4 or 5 persons, especially a decontrolled tenement, they must go short in the allowance for food, etc. On the other hand, if they restrict their rent in the endeavour to maintain a decent standard of food supply, they most probably become overcrowded. The facts as to overcrowding in this table are not complete as only a small proportion of the cases were examined from this point of view. The rent figures also demonstrate the excessive proportion of working-class income which is swallowed up in this way. The average for these families would appear to be about a quarter but for some of them it is nearly 30 to 40 per cent., and with the 129 usual irony of circumstances it is most frequently the families with the larger families and lower income per head who carry the heavier burden. Incidental to the economic enquiry, the size of the families in the various income groups has been ascertained and the following figures reveal the extraordinary inversion of the ratio of income to the size of family. Gross income per head Under 5/- 5/-to 6/3 6/3 to 7/6 7/6 to 10/- Over 10/Average size * 7.6 6.3 5.1 4.4 of family. *There was only one family in this group with 11 members but this of course cannot be taken as representative. The profound effect of size of family and rental upon the amount available for food per head is insufficiently appreciated. Two sample families may be taken to illustrate this : one with the low income of 30/- but only three members and 7/11 rent, while another with an income of 65/- had 9 members and a rent of 19/9. A little calculation will shown that despite the smallness of the gross income in the first case there was actually available 7/4 per head for food, etc., as against only 5/- per head in the (superficially) better off family. 130 RENTS Table showing families of varying sizes grouped according to gross income per head, showing average rent paid in each group. Size of family I Under 5/- II 5/- to 6/3 III 6/3 to 7/6 IV 7/6 to 10/- V 10/- and over 2 — — — 1 10/6 2 7/3 3 — — 1 17- 15 9/6 22 9/11 4 — — 2 7/10 32 11/7 15 12/1 5 — 1 6/4 16 9/8 21 10/11 9 12/3 6 — 2 11/10 18 11/- 8 10/10 4 14/7 7 — 3 12/2 5 13/10 7 10/7 — 8 — 4 12/9 5 11/6 4 14/- 2 18/2 9 — 3 15/6 3 15/6 1 8/6 3 19/6 10 — 1 10/2 3 12/- 2 17/7 — 11 1 18/8 — — 3 14/1 1 13/11 12 — — — 1 22/- — 13 1 12/6 Total families Average rent 1 18/8 14 12/5 54 11/1 95 11/4 58 11/11 Average size of family 11 7.6 6.3 5.1 4.4 Approx. average family income 44/- 42/3 43/- 44/6 50/11 Approx. % rent to come 42.4 29.4 27.5 25.4 23.4 Calculated from above averages Do. 26.4 30.1 20.0 28.1 Calculated from 10 random samples in each lincome gr oup 131 INDEX page Aged and Infirm Persons 73 Ambulances 17 Bacteriological Examinations (medical) 69 do. do. (food) 78 Bakehouses 82 Bedsteads, Bedding and Clothing (Tuberculosis) 66 Birth Control 39 Births 22,24 Cancer 31 Chemical Examinations (food) 74 Chicken Pox 69 Cleansing Stations : Personal 19,73 Clinics 14,42 Combined Drainage Systems 89 Common Lodging Houses 86 Condensed Milk Regulations 77 Convalescent Treatment 50 Cowhouses 81 Day Nurseries 14 Deaths 22,25 Delicate Children : Clinic for 44 Dental Clinic (M. & C.W.) 44 Dental Treatment of Tuberculous Patients 67 Diabetes 69 Diphtheria 58 DISEASE, CONTROL OF 58,84 Disinfectants: Distribution of 70 Disinfection 70 Disinfestation 71 Dispensaries 13 Drainage Work 89 Dried Milk, &c. 52 Dried Milk Regulations 78 Enlarged Tonsils, Adenoids and Mastoid Disease 47 Enteric Fever 59 Expenditure on Public Health Work 10 Extra Nourishment (M.C.W.) 51 do. (Tuberculosis) 67 Factories and Workshops 102 Fat Content in Milk 78 Finsen Light Treatment 67 Fish Curing and Fried Fish 82 FOOD 74,84 Food Expenditure Enquiry 118 Food Premises 80 do. Poisoning 73, 84 Food and Drugs Acts 74 Foster Children 54 132 page Fried Fish and Fish Curing 82 General Description of District 8 German Measles 68 Hairdressers 89 Health Education 20 HEALTH SERVICES 10 do. do. National Campaign to encourage wider use of 21 Health Visitors 34 do. do. Tuberculosis 65 Home Helps 41 Home Workers 103 Hospitals 12 HOUSING 90,97 IceCream 82 Illegitimacy 24 Infant Consultations 42 Infantile Mortality 22, 28 INFECTIOUS DISEASE 58 Inhalation Therapy 48 Insanitary Areas 90 Insurance Acts. National Health 17 INTRODUCTION 0 Invalid Children's Aid Association 15 LEGAL PROCEEDINGS 77, 106 Light Treatment (M.C.W.) 47 do. (Tuberculosis) 67 Malnutrition 51 Marriages 24 Massage 49 Maternal Mortality 22,28 MATERNITY AND CHILD WELFARE 33 Maternity Clinics 15,36 Maternity Institutions 16 Maternity Outfits 41 Measles 68 Meat Regulations 83 Medical Inspection (school children) 14, 54 Medical Practitioners 11 do. do. Consultations with 59 Midwifery: Borough Midwifery Service 40 Milk 76,78 Milk for necessitous mothers and children 51 Milk in Schools 10, 81 Milkshops and Dairies 80 Milk (Special Designations) Order 81 Mortuary 32 Mothers' Clinic 39 Motor Traffic Accidents 31 Noise 87 Notification of Births 33 Nurses and Nursing Assistance 11,52 Nutrition 79 Obstetrical Consultants 41 Offensive Matter 88 do. Trades 88 Open-Air Sleeping Shelter 66 Ophthalmia Neonatorum 54 Orthopcedic Treatment 48 Outworkers 103 133 Page Overcrowding 94 Personal Cleansing Stations 19,73 Pharmacy and Poisons Act 84 Pneumothorax Refills 67 Population 24 Poultry Slaughterers 83 Public Assistance 9, 10 PUBLIC HEALTH COMMITTEE 3 Public Health Expenditure 10 Puerperal Fever and Puerperal Pyrexia 53 Rag and Bone Dealers 89 Rag Flock Act 89 Rats and Mice 87 Registration of Births, Deaths and Marriages 20 Rent Restrictions Acts 87 Sanatorium Treatment 66 Sanitary Inspectors, work of 85 Sanitation and Housing 85 Scabies (Itch) 72 Scarlet Fever 59 School Children : Medical Inspection and Treatment 14, 54 School Meals 10 School Milk Scheme 10, 81 Shelter for Contacts 70 do. Open-Air Sleeping 66 Shop Acts 89 Slaughterhouses 83 Slaughtermen 83 Smoke Nuisance 87 Social Welfare 9 Special Clinic for Delicate Children 44 Spraying Machines 72 Sputum Outfits 66 STAFF 4, 5 Stillbirths 22,24 Street Accidents 31 Tenement Houses 87 Toddlers' Clinic 43 Tonsils, Adenoids and Mastoid Disease 47 TUBERCULOSIS 62 Tuberculosis Care Committee 65 Tuberculosis Dispensary 19,65 do. Officer Report of 109 do. Visitors 65 Unsound Food 83 Vaccination 20 Vaccination Returns 61 Venereal Disease 19 Verminous Conditions 72 VITAL STATISTICS 22 Water Supply 87 Welfare Centres 35 Whooping Cough 68 Workshops and Factories 102