THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1938 BY VYNNE BORLAND, m.b., ch.b., b.s<?., d.p.ii. 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 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1938 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: Prmted by Tee & Whiten and j. Mead, Ltd., 21 City Road, e.c.i Metropolitan Borough of Bethnal Green PUBLIC HEALTH COMMITTEE, 1938-39 as on 31st December, 1938 Meetings held at the Town Hall at 7 p.m. on the first Wednesday. *Councillor Mrs. A. Hillman, Chairman. *Councillor Mrs. R. Rockfelt, Vice-Chairman. Alderman J. Hewer, Councillor J. J. Lecount. „ C. Hoskins. * „ Mrs. E. Peaston. * „ Mrs. A. O'Brien. * „ Mrs. B. L. Tate. *Councillor Mrs. M. S. Bridger, J.P. „ A. E. Turpin. * „ Mrs. R. Elsbury. „ J. C. Edwards. *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 „ M. Finegold. Finance „ J. C. Edwards. Housing „ Rev. J. Ough, M.A. Law and General Purposes ,, S. Elsbury. Libraries „ A. E. Turpin. Staff „ Mrs. M. S. Bridger, J.P. Street Trading ,, Mrs. R. Elsbury. Valuation „ H. P. Wilson, J.P. Works and Stores ,, L. E. Holt. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. Council Representatives on Joint (Tuberculosis) Dispensary Committee : Councillors Mrs. A. Hillman, Mrs. R. Rockfelt. and Mrs. B. L. Tate. STAFF OF THE PUBLIC HEALTH DEPARTMENT, as on 31st December, 1938 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 †‡dMrs. 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., Administrative Assistant 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} L. Harley } Junioor Clerks. Tuberculosis : †‡dMrs. J. Callow } Tuberculosis †Miss M. L. Grant } Visitors. Tuberculosis Certificate. Employees: General: 2 Attendants, one of whom acts as Temporary Mortuary Keeper. Sanitary Inspection: *W. Billings Senior Sanitary Inspector. *J. O. G. Weeks *§G. E. Gould rood Inspectors. *E. J. Jenkins, Workshops Inspector. *§F. C. Sharpe, Housing Inspector. *G. I. Bnghting *G. S. Freeman *§W. H. Heron *J. H. Hewitt *§S. R. B. Slater *E. F. Swash District Sanitary Inspectors. •Certificated Sanitary Inspector. §Certified Meat, etc. inspector. Disinfection: 1 Leading Disinfector, 3 Disinfectors. Drainage: 5 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.IL Dental Surgeons : Mrs. E. M. Johnson, L.D.S. (R.C.S.). F. R. Bate, L.D.S. (R.C.S.). Dental Anaesthetist: Miss A. R. Kerridge, M.R.C.S., L.R.C.P.. D.A. 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. The retirement of Mr. C. Batstone, drainlayer, is referred to on p. 86. 6 Public Health Department, Temporary Offices, 15, Old Ford Road, Bethnal Green, E.2. 30th May, 1939. 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 1938. The general death rate at all ages from all causes was 11.3 per thousand of the population. When corrected by the comparability factor of the Registrar General (1.13) the rate becomes 12.8 which is 1.3 below that of the previous year. There were 78 deaths of infants under one year which gives an Infant Mortality rate of 59 per 1000 births compared with 54 in the previous year. The rate for London was 57. This increase is more than accounted for by the deaths due to Diarrhoæ and Enteritis which were responsible for a rate of 21.3 per thousand against 9.5 in the previous year. It is quite possible that some of the cases might have been saved if medical advice had been sought earlier. It is unfortunate that in many cases of illness at all ages the doctor is not called in until the disease has become well advanced and so lessens the chances of recovery. No doubt economic circumstances are important factors in the delay. The number of mothers dying in child birth was 2 which gives a Maternal Mortality rate of 1.4 per thousand births. The rate for England and Wales was 3.1. 7 There was a slight increase in the incidence of Diphtheria, and Scarlet Fever during the year there being 235 cases of the former and 348 cases of the latter compared with 222 and 307 cases respectively in the previous year. Duties in connection with Air Raid Precautions have cost much additional work on the Department and it is a pleasure to report that the members of the staff have very willingly responded to the increased pressure arising therefrom. I am pleased to have this opportunity of recording my appreciation and thanks to the members of the Public Health Committee for their unfailing courtesy and sympathetic consideration of the many matters relating to the public health, I desire at the same time to thank my colleagues in other departments for their ungrudging cooperation and also the members of the staff for their loyal and efficient 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 1¾ miles from west to east and about one mile from north to south, and 760 acres in area. It is bounded by Shoreditch and Hackney on the north, Stepney on the south and Poplar on the east. Where the original soil exists it is of gravel and sand formation. The surface is generally flat, varying from 36 to 54 feet above sea level. The principal industries carried on in the district are the making of boots, shoes and clothing, cabinet making and other branches of the furnishing trade. The main lines of the Great Eastern section of the L.N.E.R. pass through the Borough. There are also three railway stations in the Borough, and several others in close proximity, while various tram and motor bus routes traverse the main roads in the Borough. There is a considerable daily inflow and outflow of workers, with the larger stream outward to workplaces in other parts of London. The tendency is for the Borough to be increasingly used for industrial and commercial purposes and the resident population is very congested. At the 1931 census there were 18,156 structurally separate dwellings in the Borough, and 27,978 families or separate occupiers lived therein. There is an excellent open space to the east of the Borough in the shape of Victoria Park, and there are a few small open spaces elsewhere in the Borough. The rateable value of the Borough on the 31st December, 1938, was £520,393, and the product of a Id. rate is estimated at £1,995. 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 concerning public assistance granted during the year : Number op Persons Resident in Bethnal Green in Receipt of Out-Relief Week Ending Men Women Children under 16 Total Persons Total Cases 1. 1. 38 880 1,335 716 2,931 1,702 25. 6. 38 847 1,304 652 2,803 1,673 31. 12. 38 811 1,297 572 2,680 1,649 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 2,680 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 1,142 (milk), and 59 (dinners). 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 1937-38, the cost of the Public Health service was £28,089, or 6s. 0½d. per head of the population, equivalent to a rate of Is. 2d. 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 Surgeon 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 27 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 6,790 Operations performed 1,387 (including 932 under general anaesthesia, 28 under spinal anaesthesia, 71 hernia operations, and 242 abdominal sections). Out-patients (9,175) Attendances 52,933 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 568. Attendances 1,119. No. of extractions 1,658. Dentures : full upper and lower 62, repairs 4. Massage: Patients treated 907 ; Treatments given 24,127. X-ray : In-patients X-rayed 3,256; Out-patients 2,683. In addition, there are departments for pathological, bacteriological and bio-chemical examinations, and for venereal disease. 6,869 pathological and bacteriological examinations were made in the laboratory during the year. (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 23,034 110,610 2,116 21.59 Mildmay Mission Hospital,' Austin Street 58 15,033 53,537 1,043 15.78 London Chest Hospital Bonner Road 190 14,781 42,967 1,331 42.5 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 991 3,196 403 §Medical Mission, St. James-the-Less, St. James's Road 247 4,370 240 †Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 2,829 22,722 4146, (new 1,108) *There is also a Dental Department attached to this Dispensary and 206 patients received treatment thereat. §In addition, there were 159 attendances for dental treatment, and 220 attendances at the Eye and Ear Clinic. †There were also attendances as follows :—Dental Department, 1,012 ; Eye Department 183 ; Massage and Sunlight 324; Chiropody Clinic 597. 14 CLINICS. For Children Under Five. The Council has a Welfare Centre in Cornwall Avenue (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 1,868 18,253 Eyes 458* — Teeth 1,266 2,687 *Spectacles were prescribed in 247 cases and obtained in 185 cases. DENTAL INSPECTION. 2.119 children were inspected by dentists and 1,667 found to require treatment. Further particulars as to the medical inspection of Bethnal Green School children will be found on page 53. DAY NURSERIES. There is only one Day Nursery in the Borough, the Bethnal Green Day Nursery, Somerford Street, which belongs to a voluntary society. I have been furnished with the following information concerning its work. Accommodation 30 Total attendances 5,952 Average attendance 27.0 Fifteen children were sent away to a Holiday Home for 3 weeks, while 3 cots at convalescent homes in the country have been continously used for suitable cases. A medical officer attends the nursery every fortnight. The nursery escaped any infectious illness during the year. 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 :— During 1938, this Branch of our Association has been brought into touch with 293 more invalid or crippled children of the district. in addition to 108 applications for help for children already known to us. The children are referred to us, in the first place, by doctors and Hospitals and also by the School Care Committees in Bethnal Green. Sometimes, we are notaskedto do more than keep in touch with the child, to visit regularly and ensure attendance at Hospital; but frequently we are called upon to arrange periods of convalescence or to supply surgical instruments. Our figures for 1938 are found to be somewhat higher than previously. 155 children have been sent away for convalescence, averaging over six weeks' stay. We supplied surgical insturments for 35 more, and others were helped with clothes and other necessaries. A very large part of our work consists of regular visiting and supervision on behalf of the L.C.C. After Care Clinics and Hospitals. Among the new cases referred to us this year, 37 were crippled,. 37 were suffering from rheumatism and heart trouble, 35 from pneumonia and bronchitis or other chest troubles, 7 from infected or enlarged glands, and 21 were suffering from serious malnutrition. A large number of the children (62) were diagnosed as anaemic or debilitated ; the increase in this number coincidcd with a period of slackness in trade, many of the parents being unemployed or on " short time," and the prevalence of " general debility " and unspecified illness can only be regarded as the result of persistent poverty. We have been grateful to the Public Health Department of the Borough Council for their help with the cost of convalescence for children under school age, and towards the provision of instruments for such children. We appreciate, too, their efforts to rehouse some of the most overcrowded families, which has become an urgent need. 16 MATERNITY. Public. The Borough Council has two Maternity Clinics, one at Cornwall Avenue, and one at St. Matthew's Institute, Hereford 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). 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 696 live births were dealt with in the year. An ante-natal clinic is held weekly for women intending to enter the hospital for confinement and 741 women made 4,644 attendances at the Clinic, 430 of the mothers were also seen at the post-natal clinic, making 430 attendances thereat. Other. The Midwifery service has undergone a profound change as a result of the Mid wives Act, 1936. The L.C.C. home midwifery service has enrolled a great many of the former private midwives and has also largely co-ordinated the various voluntary midwifery services. Thore is still however one private midwife practising in the borough. The L.C.C. midwives attended 74 births in the borough during the year. 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 bv residents of the Borough, as shown by the following figures furnished by them :— 17 In Hospital At Home Ante-Natal Clinic Attendances City of London Maternity Hospital City Road 40 - 174 Mothers' Hospital, Clapton 41 57 193† East End Maternity Hospital 15 17 162 Jewish Maternity Hospital, Stepney 31 - 142 London Hospital, Whitechapel . 219 154 2,383 †Relating to 29 mothers attending: in addition there were 336 attendances at the S.A. Ante-Natal Clinic at Nichols Square. The Royal London Maternity Charity granted 66 free midwives' letters to Bethnal Green mothers during the year. MEDICAL TREATMENT OF PERSONS INSURED UNDER THE NATIONAL (HEALTH) INSURANCE ACTS. Arrangements are made by the London Insurance Committee. I understand that 23 insurance medical practitioners practice in the Borough, 15 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.1. 18 Applications for vehicles may also be made by letter, telegraph, or personal call at the central call office or any of the ambulance stations. Letters should be addressed to the Medical Officer of Health, London Ambulance Service, County Hall, S.E.1. Except in the cese 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. 19 Associations, authorities and others requiring repeated services may enter into special arrangements with the Council as regards payment. Ambulance Stations. The following are the nearest stations which are open always :— Name of Station. Address Bloomsbury 15, Herbrand Street, Tavistock" Square, W.C.1. Eastern Brooksby Walk, E.9. Hackney Paragon Road, Mare Street, WAT 3311 Hackney, E.9. Highbury Calabria Road, Highbury, N.5. Poplar 7, Woolmore Street, E.14. Shoreditch 5, Montclare Street, E.l. TUBERCULOSIS DISPENSARY. This is situated at the 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 Cleansing Station at the Depot, Digby Street. A report on its work is given later. For School Children. Sir Frederick Menzies, School Medical Officer, L.C.C., has kindly furnished me with the following information concerning the work carried out at the Bathing centre, 5a, Russia Lane : Children resident in the Borough and attending L.C.C. schools found to require treatment for scabies, 20 impetigo or personal hygiene receive the necessary treatment under the approved scheme at the Cleansing Station, situated in Russia Lane. During the year 4,057 attendances were made for vermin and 2,064 for scabies or impetigo. REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. The Town Clerk is the Superintendent Registrar for the Borough. The District Registrars of Births and Deaths are :— For N.E. Bethnal Green:— For S. W. Bethnal Green:— H. J. Hardwick, Miss M. Peters, 106, Bishops Way. 347, Bethnal Green Road. Office Hours :— Office hours :— Mon.-Fri. 10 a.m.-l p.m. 10.30 a.m.-l p.m. daily. Sat. 10 a.m.-l2 noon. Mon. and Fri. 3-5 p.m. VACCINATION. The Public Vaccinators were :— For N.E. Bethnal Green:— For S. W. Bethnal Green:— Dr. E. F. Fernando, Dr. J. G. L'Etang, 83, Roman Road. 386, Bethnal Green 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 February and March, a series of three talks and film displays to women, men and a mixed audience of parents respectively, were given in the lecture hall of the Public Library, by speakers on behalf of the British Social Hygiene Council. Councillors Mrs. Bridger, and Turpin took the chair at these meetings. There was a fairly good attendance at the first two, but the third meeting was very poorly attended. 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. Other health education activities include the exhibition of a monthly set of posters on one of the large E.M.B. poster frames at the side of the Town Hall, and the distribution through the Welfare Centres, etc. of the monthly magazine " Better Health." NATIONAL CAMPAIGN TO ENCOURAGE WIDER USE OF HEALTH SERVICES. The department continued its part in the national campaign organised by the Central Council for Health Education to encourage the wider use of the local health services, which terminated in April. 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 issued for distribution through the post offices, etc. 22 VITAL STATISTICS LIVE BIRTHS. Males Females TOTAL Birth Rate Legitimate 671 600 1,316 14.2 Illegitimate 24 21 TOTAL Rate per 1,000 total (live and still) births. STILLBIRTHS 43 31.6 DEATHS. Males Females TOTAL Death Rate 543 509 1,052 11.3 When corrected by the Comparability Factor of the Registrar-General (1.13), the Death Rate becomes 12.8. MATERNAL MORTALITY. Number of women dying in, or in consequence of, childbirth :— Rate per 1,000 total (live and still) births. From Sepsis 1 0.7 From other puerperal causes 1 0.7 INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births :— Legitimate 54 Illegitimate 200 59.3 Deaths from Cancer (all ages) 158 ,, ,, Measles (all ages) 6 „ ,, Whooping Cough (all ages) 2 „ „ Diarrhoea (under two years of age) 29 23 VITAL STATISTICS of Bethnal Green During 1938 and Previous 5 Years Year Births Transferable Deaths Net Deaths of Persons Resident in the Borough Population Estimated to Middle of Each Year Net Total Deaths Registered in the Borough Of Nonresidents registered in the Borough Of Residents not registered in the Borough At all ages Under 1 year of Age Uncorrected Number Number Birth Rate Number Death Rate Number Rate per 1,000 births or infartile mortality 1933 104,200 1,037 1,494 14.3 1,353 325 278 1,306 12.5 99 66.3 1934 102,060 995 1,400 14.3 1,272 352 287 1,207 11.8 106 72.6 1935 99,910 996 1 ,438 14.4 1,129 331 229 1,027 10.3 74 51 1936 90,900 1,071 1,312 13 5 1,343 318 432 1,229 12.7 128 98 1937 94,360 1,025 1,258 13.3 ] ,154 329 364 1,189 12.5 68 54 1938 92,910 1,106 1,316 14.2 1,063 341 330 1,052 11.3 78 59 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 1938 of 92,910. MARRIAGES. The number of marriages registered in Bethnal Green during 1938 was 808. This is equal to a rate of 17.4 Persons marrying Per 1,000 of the Population. BIRTHS. The number of births registered in the Borough during 1938 was 1,106, and in addition 210 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 1,316 births (695 males 621 females). The birth-rate was, therefore, 14.2 births Per 1,000 Population. The Provisional birth-rate for London is given as 13.4 and for England and Wales as 15.1. ILLEGITIMACY. OP the births credited to this Borough, 45 were illegitimate, being 24 males and 21 females, and being 3.4 Per cent. of the total number of births. STILLBIRTHS. Forty-three stillbirths were registered as belonging to the Borough, being a Proportion oP 3.2 Per cent. of all births alive or dead. 25 DEATHS. The number of deaths during the year belonging to the Borough was 1,052. This gives an annual crude death rate of 11.3 Per 1,000 Population which when multiplied by the Registrar-General's Comparability Factor (1.13) is corrected to 12.8 and may be compared with 11.4 (similarly corrected) for the County of London and 11.6 for England and Wales as a whole. Infantile mortality and the deaths from cancer, 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 OP DEATH at different periods of life in the Metropolitan Borough of Bethnal Green, 1938 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 543 45 7 5 9 13 17 33 61 111 128 114 P 509 33 6 4 7 17 16 36 45 90 107 148 1. Typhoid and Paratyphoid Pevers M .... .... .... .... .... .... .... .... .... .... .... .... P .... .... .... .... .... .... .... .... .... .... .... .... 2. Measles M 4 1 1 2 .... .... .... .... .... .... .... .... P 2 1 1 .... .... .... .... .... .... .... .... .... 3. Scarlet Pever M .... .... .... .... .... .... .... .... .... .... .... .... P 2 .... .... .... 1 .... .... .... 1 .... .... .... 4. Whooping Cough M .... .... .... .... .... .... .... .... .... .... .... .... P 2 .... 2 .... .... .... .... .... .... .... .... .... 5. Diphtheria M 3 .... .... 1 2 .... .... .... .... .... .... .... P 2 .... .... 2 .... .... .... .... .... .... .... .... 6. InPluenza M 2 .... .... .... .... .... .... .... .... 2 .... .... P 1 .... .... .... .... .... .... .... .... .... .... 1 7. Encephalitis Lethargica M .... .... .... .... .... .... .... .... .... .... .... .... P .... .... .... .... .... .... .... .... .... .... .... .... 8. Cerebro-Spinal Pever M 1 .... 1 .... .... .... .... .... .... .... .... .... P .... .... .... .... .... .... .... .... .... .... .... .... 9. Tuberculosis oP respiratory system M 46 .... .... 1 .... 3 5 10 14 9 4 .... P 22 1 .... .... .... 8 4 3 4 1 .... 1 10. Other Tuberculous Diseases M 6 1 .... .... 2 1 .... .... .... 2 .... .... P 6 .... 1 .... 1 2 .... 1 1 .... .... .... 11. Syphilis M 2 1 .... .... .... .... 1 .... .... .... .... .... P 3 1 .... .... .... .... 1 .... 1 .... .... .... 12. General Paralysis oP the Insane, tabes dorsalis M .... .... .... .... .... .... .... .... .... .... .... .... P 1 .... .... .... .... .... .... 1 .... .... .... .... 13. Cancer, malignant disease M 85 .... .... .... .... 2 2 8 10 20 31 12 P 73 .... .... .... .... 1 4 10 9 26 12 11 14. Diabetes M 3 .... .... .... .... .... .... .... 3 .... .... .... P 13 .... .... .... .... .... .... 1 1 4 5 2 15. Cerebral Hæmorrhage, etc. M 11 .... .... .... .... .... .... .... 2 .... 2 7 P 18 .... .... .... .... .... 1 .... 1 4 5 7 16. Heart Disease M 160 .... .... .... 1 .... 1 1 7 35 50 65 P 176 .... .... .... 2 4 3 6 10 21 47 83 17. Aneurysm M 5 .... .... .... 1 .... .... .... 1 2 1 .... P 2 .... .... .... .... .... .... .... 1 1 .... .... 18. Other Circulatory Diseases M 17 .... .... .... .... .... .... .... 1 3 9 4 P 28 .... .... .... .... .... .... .... 4 10 4 10 19. Bronchitis M 14 .... .... .... .... .... .... 1 8 4 5 1 P 9 1 .... .... .... .... .... .... 1 1 4 2 20. Pneumonia (all Porms) M 49 6 3 .... .... 1 .... 2 5 15 12 5 P 29 7 2 1 .... .... .... 1 3 4 6 5 21. Other respiratory Diseases M 2 .... .... .... .... 1 .... .... 1 .... .... .... P 6 .... .... .... 1 .... 2 .... .... 1 i 1 22. Peptic Ulcer M 12 .... .... .... .... .... 1 2 1 5 2 1 P 4 .... .... .... .... .... .... .... 1 .... 1 2 28. Diarrhœa, etc M 20 18 1 .... .... .... .... .... .... 1 .... .... P 11 10 .... .... .... 1 .... .... .... .... .... .... 24. Appendicitis M 4 .... .... .... .... 1 1 .... 1 .... 1 .... P 5 .... .... .... 1 .... 1 1 .... 2 .... .... 25. Cirrhosis oP Liver M .... .... .... .... .... .... .... .... .... .... .... .... P .... .... .... .... .... .... .... .... .... .... .... .... 26. Other Diseases oP Liver, etc M .... .... .... .... .... .... .... .... .... .... .... .... P 4 .... .... .... .... 1 .... .... .... 1 1 1 27. Other Digestive Diseases M 13 2 1 1 .... 1 1 1 .... 2 1 3 P 12 1 .... .... .... .... .... 1 1 1 4 4 28. Acute and Chronic Nephritis M 13 .... .... .... .... 1 .... 4 2 3 .... 3 P 15 .... .... .... .... .... .... 1 .... 3 7 4 29. Puerperal Sepsis P 1 .... .... .... .... .... .... 1 .... .... .... .... 30. Other Puerperal Causes P 1 .... .... .... .... .... .... 1 .... .... .... .... 31. Congenital Debility, Premature Birth, MalPormations, etc M 14 14 .... .... .... .... .... .... .... .... .... .... P 9 9 .... .... .... .... .... .... .... .... .... .... 82. Senility M 5 .... .... .... .... .... .... .... .... .... 1 4 P 5 .... .... .... .... .... .... .... .... .... .... 5 33. Suicide M 9 .... .... .... .... .... 1 .... 2 3 2 1 P 4 .... .... .... .... .... .... 1 1 1 1 .... 84. Other Violence M 15 .... .... .... 1 .... .... 3 4 2 2 3 P 14 1 .... .... .... .... .... .... .... 3 4 6 35. Other DePined Diseases M 28 2 .... .... 2 2 4 1 4 3 5 5 P 29 1 .... 1 1 .... .... 7 5 6 5 3 86. Causes ill-dePined or unknown M .... .... .... .... .... .... .... .... .... .... .... .... P .... .... .... .... .... .... .... .... .... .... .... .... Totals 1052 78 13 9 16 30 33 69 106 201 235 262 28 MATERNAL MORTALITY. During the year, the following deaths were noted: 1. Septicaemia following septic abortion. 2. Uterine haemorrhage, retention of placenta. These cases give a Maternal Mortality rate of 1.4 per 1,000 total births (live and still). In England and Wales the rate was 3.1 per 1,000 births. INFANTILE MORTALITY. Seventy 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 59 per 1,000 births. The infant death rate for London was 57 and for England and Wales as a whole 53. 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 1937 54.0 29 The causes of death among infants are shown in the following table. Infantile Mortality in Bethnal Green in 1938 Causes of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 3 months & under 6 months 6 months & under 9 months 9 months & under 12 months Total Deaths under 1 year Rate per 1,000 Births Measles .... .... .... .... .... .... .... .... 2 2 1.5 Whooping Cough .... .... .... .... .... .... .... .... .... .... .... Scarlet Fever .... .... .... .... .... .... .... .... .... .... .... Diphtheria and Croup .... .... .... .... .... .... .... .... .... .... .... Tuberculosis .... .... .... .... .... .... .... 1 1 2 1.5 Bronchitis .... .... .... .... .... 1 .... .... .... 1 0.8 Pneumonia (all forms) .... .... .... .... .... 2 5 4 1 12 9.1 Other Respiratory Diseases .... .... .... .... .... .... .... .... .... .... .... Diarrhoea and Enteritis .... .... .... .... .... 2 13 10 3 28 21.3 Other Digestive Diseases .... .... .... .... .... .... 1 1 1 3 2.3 Syphilis .... .... .... .... .... 1 .... 1 .... 2 1.5 Rickets .... .... .... .... .... .... .... .... .... .... .... Congenital Malformations 2 .... .... .... 2 .... 1 .... .... 3 2.3 Congenital Debility .... .... .... .... .... .... .... .... 1 1 0.8 Premature Birth 14 .... .... .... 14 1 .... .... .... 15 11.3 Injury at Birth 1 .... .... .... 1 .... .... .... .... 1 0.8 Other early infancy diseases 4 .... .... .... 4 .... .... .... .... 4 3.0 †Other Causes .... .... 1 .... 1 1 2 .... .... 4 3.0 Totals 21 .... 1 .... 22 8 22 17 9 78 59.3 Net Births in the year legitimate 1271 Net Deaths in the year legitimate infants 69 illegitimate 45 illegitimate infants 9 Asphyxia, Otitis media, Pyelitis, Infantile Eczema (1 each). 30 CANCER. Cancer was responsible for 158 deaths or 15 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 3 — 3 Digestive organs and peritoneum (Esophagus (9-0) Stomach (20-13) Intestines (11-9) Rectum (8-8) Others (5-9) 53 39 92 Respiratory organs 20 2 22 Uterus — 4 4 Other Female genital organs — 7 7 Breast — 13 13 Male genito-urinary organs 7 — 7 Skin 1 2 3 Other or unspecified organs 1 6 7 85 73 158 31 PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year one body was 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. 32 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. In addition, during the year closer relationship between the council's maternity clinics and the L.C.C. hospital midwifery service was promoted by the association of Drs. Purce and Townshend with Bethnal Green, Hackney and Mile End Hospitals in an honorary capacity. This arrangement while it imposes noobligations on the medical officers facilitates their consultation with the hospital staffs with regard to any mother who has attended the Clinic and is subsequently admitted to hospital for confinement. Co-ordination in ante-natal care has also been promoted by the new Home midwifery service established by the L.C.C. under the Midwives Act 1936. NOTIFICATION OF BIRTHS. During the year, 1,115 live births and 39 still births were registered in the Borough; and 1,110 live births were notified to the Medical Officer of Health. There were also 37 stillbirths notified. Of the 1,147 living and stillbirths notified, 272 were found to relate to other districts and were duly transferred, 773 were notified by midwives, 78 by maternity assistants of the London Hospital, 16 by medical practitioners, and 8 by parents and others. 33 Through the courtesy of neighbouring Medical Officers of Health I also received copies of notifications of births of Bethnal Green babies which took place outside the Borough, information as to 475 live babies and 13 stillbirths being received in this way. The net total of notified live births belonging to the Borough was 1,322. WORK OF HEALTH VISITORS. The following table gives some account of the outdoor work of the Health Visitors so far as this can be expressed in statistics:— Visits Re-visits Babies (under 1 year) 1,337 11,827 Children (1—2 years) 3 6 4,930 14,265 „ (2—3 years) 2 4,182 „ (3—4 years) — 3,044 „ (4—5 years) 1 2,109. Mothers (Ante-Natal) 945 597 „ (Post-Natal) 72 141 Stillbirths 36 20 Infant Deaths 28 5 Maternal Deaths 1 — Puerperal Fever (13) and Pyrexia (44) 21 36 Ophthalmia Neonatorum 11 32 Acute Poliomyelitis — 7 Other Notifiable Diseases 3 2 Diarrhœa and Enteritis 2 5 Measles (1,690), and German Measles (17) 708 999 Whooping Cough 165 346 Other Non-Notifiable Diseases 14 43 Milk Grants 1 — Convalescent Treatment 1 — Other matters 161 200 Total Visits 3,512 28,525 Grand Total 32,037 In addition, 64 visits and 2,346 re-visits were rendered futile owing to the absence of the mother or the occasion being inconvenient for an interview. 34 The indoor (clinic) work of the Health Visitors is shown in the following figures:— Sessions attended Maternity Clinics 115 Children's Clinics 1,322 Dental Clinic 154 Light Clinic 188 Mothers' Clinic 104 Other Clinics 264 Total 2,147 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. MATERNITY AND CHILD WELFARE CENTRES. At the Council's principal Centre in Cornwall Avenue, 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 Delicatc Children, light and inhalation therapy, massage, milk grants, etc., will be found reported on under these separate headings. 35 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. MATERNITY CLINIC (CORNWALL AVENUE). This is open every Wednesday and Thursday morning. Particulars of attendances : Total  Expectant Mothers—First visits 230 965 ,, —Subsequent visits 735 Mothers recently confined—First visits 157 250 „ „ ,, —Subsequent visits 93 Total Attendances 1,215 The number of sessions was 103, and the average attendance per session was 11.8, as compared with 11.5 and 12.7 the previous two years. 77 of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement. The following ratios may be of interest:— Ante-Natal Children's  Clinics Clinics Acreage per Centre 380 380 Population per Centre 46,455 46,455 Percentage of expectant mothers, or babies under 1, attending Centres respectively, to total net births 26.3 80.9 The 230 women who attended for the first time may be grouped as follows:— Gravid:—Primiparae 19 —Multipara? 200 219 Not pregnant 11 36 In the case of the 219 gravid women, the following were the periods of gestation:— 15 were in the 2nd month 20 „ „ „ 3rd ,, 35 „ „ „ 4th „ 32 „ „ „ 5th „ 51 ,, ,, ,, 6th ,, 33 „ „ „ 7th „ 25 „ „ „ 8th 8 „ ,, ,, 9th ,, An analysis of these cases shows:— Full-term confinements 150 Premature births 6 Miscarriages (5) ; Stillbirths (6) 11 Pregnancy terminated 1 Not yet confined 45 Left Borough (results unknown) 7 The known confinements took place:— 101 at home, and 52 in institutions. The results of the cases brought forward from 1937 were as follows:— Full-time confinements 69 Premature Birth 2 Stillbirth 1 Not pregnant 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 Avenue Ante-Natal Clinic for the year 1938. I am glad again to be able to report that there has not been a single death among the mothers attending the Clinic during the year, and also to record that there has been an increase in the attendance of mothers recently confined. With regard to the miscarriages, two patients were treated in hospital, and two by their own doctor. All the patients were multigravidæ, and no definite cause was assigned, though it may be noted that in four cases the patients were suffering from anaemia. 37 With regard to the still-births, in five cases the confinements occurred in hospital, and in the remaining case the patient was a 10-gravidæ who had been repeatedly urged to go into hospital for her confinement on account of her marked anæmia and cardiac dilatation, but declined to do so, with the result that she was confined at home after a very long labour, terminating in a still-birth. With regard to the premature confinements in every case the patient was a multipara, and in five cases the confinement took place in hospital. I should like to add that on the whole the general health of the mothers appears satisfactory, apart from the fact that most of them require dental treatment, and although they are invariably urged to attend the dental clinic, it is a matter of regret that so few of them avail themselves of the opportunity. Ruth C. Townsiiend. February 8th. 1939. 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 86 Subsequent attendances 207 Mothers recently confined : First attendances 50 Subsequent attendances 35 Total attendances 378 Number of sessions held 52 Average attendance per session 7.2 Mothers attending both before and after confinement 28 Primiparse 4 Multiparas 74 Not pregnant 8 86 Periods of Gestation:— In the 1st month Nil „ 2nd 16 „ 3rd „ 10 ,, 4th „ 9 , i 5th ,, 6 „ 6th 13 38 In the 7th month 20 „ 8th „ 4 ,, 9th Nil Full-term confinements 41 Not yet confined 31 Removed from district 4 Premature birth — Miscarriage 1 Stillbirth 1 Known confinements at home 26 „ „ in institutions 15 Cases brought forward from 1937 :— Full-term confinements 27 Not pregnant 2 Miscarriage Nil, Stillbirth 1 1 Removed 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. No. of sessions 53 Average attendance per session 7.7 Analysis of cases attending :— First Attendances : Contraceptive advice given 36 Referred to Burdett Road Clinic 1 Referred to Hospital 5 Total new cases 42 Subsequent Attendances 367 Total Attendances 409 39 Mothers have been referred to the Clinic by:— Medical Officers at Welfare Centres 16 Health Visitors 13 Hospital or other Doctors 6 Old Patients 7 Clinical Analysis of Cases given Contraceptive Advice: Anæmia 13 Anaemia and Malnutrition 1 Rheumatic conditions 1 Heart Disease 2 Nephritis 2 Pyelitis 1 Thyrotoxicosis 1 Neurasthenia 4 Dyspnoea 1 Old Poliomyelitis 1 Tuberculosis contact 1 Hyperpiesis 2 Asthma 2 General Debility 3 Habitual Abortion 1 Total 36 OBSTETRICAL CONSULTANTS. The Council has a panel of 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 10 Home Helps on the panel, with 14 other women actingoccasionally as relief helps. During the year, Home Helps were arranged for in 186 cases. In 69 cases the mother paid a contribution for the services rendered. There were extensions of the Home Helps' Services beyond the usual 2 weeks in 47 cases. MATERNITY OUTFITS. Outfits were issued as follows:—Free, 106; Sold, 71. Total, 177. 40 CHILD WELFARE CLINICS. Cornwall Avenue Hereford Street  Sessions per week 5 2 Doctors' attendances per week 8 3 The statistics of attendances at the Centres during 1938, and in previous years are as follows:— Cornwall Avenue Hereford Street Total  Babies (0—1): First attendances 758 309 1,067 Subsequent „ 7,127 3,128 10,255 Children (1—5): First „ 153 61 214 Subsequent „ 5,532 2,370 7,902 Toddlers Clinic attendances 68 — 68 Total „ 13,638 5,868 19,506 The figures show a continued increase in the number of older children attending the centres, the total attendances rising from 6,626 in 1936 to 7,472 in 1937 and 8,182 in 1938. The numbers of consultations on children seen by the doctors were as follows:— Cornwall Avenue Hereford Street Total  Babies (0—1) 3,961 1,847 5,808 Children (1—5) 3,670 1,526 5,196 Total 7,631 3,373 11,004 1937*. 1936*. 1935*. 1934*. 1933*. 1932*. Total Attendances 17,292 16,479 16,612 16,195 17,632 18,668 New Cases 1,130 1,100 1,172 1,528 1,466 1,510 Medical Consultations 10,094 9,603 9,328 9,025 9,969 10,462 *Including Toddlers' Inspections. 41 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 38 new cases were referred to Dr. Mackay and there were 255 consultations in all. DENTAL CLINIC. Three sessions per week are held in connection with the Dental Clinic, conducted by Mrs. E. M. Johnson, L.D.S. (R.C.S.) and by Mr. F. Reginald Bate, L.D.S. (R.C.S.). Mrs. Johnson reports on the work during the year as follows:— Sessions held Total 46 of which 10 were Gas Sessions Mothers Children New Cases 113 107 6 Subsequent attendances, including cases brought forward from 1937 409 407 2 Total 522 514 8 Total Mothers Children  Average attendance 11.3 Gas administrations 98 96 2 Local anaesthetic 19 602 Gas 18 1 Extractions 633 31 Local anaes. 625 8 Fillings 33 33 — Gum treatment 8 8 — Scaling and polishing 22 22 — Dentures 64 6 One plate 29 Two plates — — Expectant mothers treated 37 — Cases referred to Hospital 0 — Patients recommended by Centre Doctors 49 2 „ „ „ H.V. 50 2 „ „ „ Others 8 — 4,2 This year, the number of patients attending the clinic, and the actual amount of work done for them has again increased. There were 39 more attendances than in the previous year, showing an average attendance per session of 11.3 as against 9.7 last year. The amount of work done has been correspondingly more, particularly in the number of extractions, fittings, scalings and parodontal treatments. It is pleasing to see the increase in these latter types of treatment, as it is often difficult to get patients to accept them. Owing to this increase in the work, in future two sessions a week will be held for Mothers. Although the number of patients coming to the Clinic has increased, it is a pity that most of them still do not attend early enough, and thus obviate the necessity of complete extractions as the only course of treatment open to them. Elsa M. Johnson, L.D.S. Eng. Mr. Bate furnishes me with the following statistics:— Sessions held, 92, of which 13 were Gas Sessions. Children attending routine inspections, 18, of whom 11 were found to reauire treatment. Children referred by Medical Officers and Health Visitors 194, 175 of them requiring treatment and making 323 subsequent attendances. Teeth extracted Children or stopped  Treatment under gas 153 558 Treatment under ethyl chloride spray 31 39 Stoppings 120 179 Removal of stain by polishing 38 — Silver Nitrate 112 teeth — Gum treatment 9 — In addition, 9 mothers were treated by syringing of sockets after extractions. The year 1938 has shown a definite increase in the number of children inspected, although the number of Routine Cases that attended was extremely poor, showing a still further decrease on the previous year, but l am pleased to say that the cases sent along by the Centre Doctors and Health Visitors maintained a very fair average. 43 The year shows a record in the number of fillings and other prophylactic treatment completed, which is very encouraging and it is to be hoped that good attendances will continue throughout the coming year. F. Reginald Bate, L.D.S., R.C.S., (Eng.), Dental Surgeon. Dr. A. R. Kerridge was appointed as Ana;sthetist during the year. DENTAL CARE OF TODDLERS I must express my disappointment at our failure hitherto to secure the co-operation of the parents of young children in the proper care of their teeth. Considerable thought and effort has been devoted to suitable publicity schemes to intensify the educational efforts of the doctors and health visitors, but the response hitherto has been very small. At present the Dental Clinic is working considerably under capacity so far as young children are concerned, yet it is well known that the condition of the teeth of the majority of these children at 3 and 4 is very unsatisfactory. Bethnal Green parents show in other matters such a high standard of care for their children that their ignorance or indifference with regard to dental health is both surprising and disconcerting. The Clinic at the Welfare Centre is well equipped and well staffed and it seems a thousand pities that these facilities are not used more fully by those for whom they were intended. ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the arrangements with the Queen's Hospital, 11 young children had operations for enlarged tonsils as in-patients upon the recommendation of the Medical Officers of the Welfare Centres. 44 LIGHT CLINIC. No. of Sessions 150 Average attendance 17.3 Treatments :— Children First attendances 127 Subsequent attendances 2,465 Mothers : First attendances 2 Subsequent attendances 40 Total 2,634 Cases carried forward from 1937 35 Cases carried forward to 1939 26 Analysis of Cases :— No. of cases Improved Lapsed Removed from Borough Also Massage "aving Inhalation  Mothers: Anaemia 2 1 — — — — Children: Malnutrition 17 8 9 — — 2 Anaemia 21 12 9 — 5 — Bronchitis 19 11 9 1 1 8 Catarrh 12 6 6 — — 1 Loss of Appetite 3 2 1 — — — Rickets 42 18 — — 21 4 Nervous Tension 4 3 1 — — 1 Debility after Measles 7 4 3 — — — Scarlet Fever 1 1 — — — — Whooping Cough 2 1 1 — — — Rheumatism 1 — 1 — — — Tonsillitis 2 1 1 — — — Pneumonia 2 2 — — — — Mastoid 1 — 1 — — — Skin Impetigo 1 — 1 — — — Chilblains 1 1 — — — — 45 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. Records:— No. of sessions held 110 Average attendance per session 3.6 Cases carried forward from 1937 7 Children : New cases 37 Subsequent treatments 364 Mothers : New cases — Subsequent treatments — Total treatments 401 Cases carried forward to 1939 3 Clinical Analysis:— Cases Cured Improved Lapsed  Bronchitis 14 — 6 8 Nasal Catarrh 19 — 15 4 Nasal Catarrh and Bronchitis 8 — 4 4 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. 46 One child was admitted for in-patient treatment and the rest attended as out-patients, while in 72 cases appliances were provided by the Council. Records of attendances, results and clinical analysis follow:— Cases carried forward from 1937 61 New cases attending in 1938 72 Total number referred to Hospital 133 Discharged cured 14 Under treatment and carried forward 80 Transferred to other hospitals or depts 3 At school under the care of the L.C.C. 15 Removals from district 8 Parents refused further treatment 11 Lapsed attendances or dead 2 Total 133 Analysis of cases :— Genu Valgum 15 „ Varum 4 „ Valgum with Pes planus 8 „ Varum „ — Flat Foot 7 Postural Kyphosis — Talipes 3 Eversion of feet 1 Inversion of right foot — Intoeing 1 Miscellaneous defects 6 Bowed Tibiae 15 „ „ with Pes planus 11 Curved Tibiae, valgus feet and ankles 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 47 Orthopaedic Surgeons at the Queen's Hospital in connection with the Borough Council's Orthopaedic scheme. RECORDS:— Cases carried forward from 1937 28 New cases 108 Subsequent attendances 1,430 Total treatments 1,538 Analysis of 136 treated Cases:— Children : Rickets 16 Curved Tibife 11 Genu Valgum (knock knee) 4 „ Varum (bow legs) 5 Pes Planus (flat foot) 16 Talipes 1 Torticollis 18 Faulty Chest Development 25 General Muscular Debility 31 Scoliosis 1 Little's Disease 1 Injury to Thigh 1 Defective Posture 1 Collapsed Lung 1 Debility following Illness 4 CONVALESCENT TREATMENT. During the year, there was an increase in the number of recommendations for convalescent treatment for nursing mothers and children. Mothers: The bed reserved at the Zachary Merton Convalescent Home, Rustington, was kept occupied during the nine months of its availability, and the London Mothers Convalescent Home, Sunningdale, also provided vacancies. Seventeen mothers went to Rustington and fifteen to Sunningdale, total 32 compared with 20 during 1937. 48 Children: Two beds were reserved at the John Madock's Home, Basing (now closed), one at the Noel Home, Letchworth, and two at "Hurstleigh," Tunbridge Wells (now closed). All beds were kept occupied and these and other homes provided vacancies as mentioned below:— John Madock's Home, Basing 16 Noel Home, Letchworth 13 " Hurstleigh," Tunbridge Wells 9 The Priory, Ascot 50 Little Folks' Home, Bexhill 15 Lennox Home, Southbourne 18 St. Martin's Home, Wokingham 56 St. Andrew's Hospital, Folkestone 2 John Horniman Home, Worthing 5 Children's Home, Clewer 8 These admissions total 192 as compared with 143 for 1937. The usual period for convalescence for children was four weeks, but in some special cases this was extended to as much as ten weeks. 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. 49 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 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 12,736 grants were made arising out of 8,793 familv applications and re-applications. The grants were made up as follows: Expectant mothers 978 Nursing mothers 1,595 Children under 3 7,829 Children 3-5 2,334 There were 2 sessions a week, and 25,956 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 16,527 galls. Dried Milk 45,720 lbs. together with medicines, etc. The approximate cost of milk given in this way was £4,829. 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. 50 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 £.383. 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 11,056 lbs. 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. 51 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 4 36 .... .... .... .... 36 Discharging Eyes 42 381 .... .... .... .... 381 Other Eye Conditions 4 79 .... .... .... .... 79 Measles 21 188 .... .... 5 87 275 Whooping Cough 5 86 .... .... .... .... 86 Diarrhœa .... .... .... .... .... .... .... Pre-natal Conditions .... .... 2 24 .... .... 24 Puerperal Fever and Pyrexia .... .... .... .... .... .... .... Other post-natal conditions .... .... 19 239 .... .... 239 Otorrhœa, other Ear diseases 24 200 .... .... .... .... 200 Tonsils and Adenoids 36 199 .... .... .... .... 199 Tonsillitis .... .... .... .... .... .... .... Influenza .... .... .... .... 4 23 23 Bronchitis 11 86 .... .... .... .... 86 Pneumonia 14 202 .... .... 19 445 647 Tuberculosis .... .... .... .... 1 5 5 Intestinal Conditions 5 25 .... .... 1 2 27 Worms 18 121 .... .... .... .... 121 Discharging Umbilicus 11 78 .... .... .... .... 78 Impetigo, skin erup- .... .... .... .... .... .... .... tion 8 115 .... .... .... .... 115 Miscellaneous 19 243 .... .... 2 22 265 Totals 222 2,039 21 263 32 579 2,881 11 cases were in hand at the beginning of the year. 3 cases were in hand at the end of the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of Puerperal Fever were reported during the year. One patient was treated in the Hackney Hospital and the other at home. 52 Eighteen cases were notified as Puerperal Pyrexia, and were treated at the following Hospitals :— Bethnal Green (7), London (4), St. Peters (2) The remaining 5 cases were treated at home. OPHTHALMIA NEONATORUM, &c. Fifteen notifications of Ophthalmia Neonatorum were received during the year. Five of the patients were treated at home, 1 received treatment at St. Margaret's Hospital, 9 at the Bethnal Green Hospital. The Health Visitors paid 54 visits to cases. Fourteen of the cases cleared up without any impairment of vision being reported : one child died. 19 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 42 cases of discharging eyes in young infants, paying 381 visits for the purpose. CHILD LIFE PROTECTION. Under the Transfer of Powers (London) Order, 1933, the duties of the London County Council under the Children Acts were transferred to the Metropolitan Borough Councils. At the end of the year, there were 11 foster mothers and 16 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 : 53 Routine Medical Inspection of Elementary School Children in Bethnal Green in 1938 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 739 54 684 1 111 538 87 3 737 2 — 737 2 — 449 247 43 — — — Girls 692 31 660 1 92 520 70 4 682 9 1 687 5 — 421 245 26 — — — Age 7— 652 40 608 4 46 458 144 4 649 2 1 649 3 — 466 174 12 381 187 84 Girls 604 47 556 1 62 435 105 2 599 3 2 602 2 — 420 179 5 348 177 78 Age 11— Boys 647 124 519 4 69 507 71 — 644 3 — 642 5 — 511 132 4 412 147 88 Girls 672 14 656 2 75 503 83 1 666 4 2 666 3 3 517 149 6 435 128 108 Age 14— Boys 600 21 578 1 70 465 65 598 1 — 594 5 1 433 162 5 419 83 98 Gills 816 63 753 — 221 544 50 1 805 11 — 815 1 — 595 215 6 533 158 124 Total 5422 394 5014 14 746 3970 691 15 5380 35 7 5392 26 4 3812 1503 107 2528 880 580 Percentage 7.3 92.5 0.2 13.8 73.2 13.0 99.3 0 6 0.1 99.4 0.5 0.1 70.3 27.7 2.0 63.4 22.1 14.5 London 54.6 45.1 0.3 16.2 77.2 6.6 97.7 2.0 0.3 98.7 1.2 0.1 70.2 20.3 3.5 67.8 19.0 13.2 54 Examination of Elementary School Children in Bethnal Green 1938 BOYS GIRLS Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number examined 739 652 647 600 692 604 672 816 Cases * Cases * Cases * Cases * Cases • Cases * Cases * Cases * Malnutrition 42 23 21 14 12 7 1 1 36 28 17 13 13 10 4 4 Skin disease 16 11 11 9 9 7 13 8 6 4 11 10 15 14 21 11 Defective teeth — 287 — 167 — 131 — 166 — 260 — 173 — 150 — 220 Enlarged tonsils 105 46 48 24 15 5 16 9 110 39 54 21 33 11 21 12 Adenoids 3 1 2 2 2 — — — 1 1 2 2 — — — — Enlarged tonsils and adenoids 10 6 6 5 — — 1 1 6 6 7 6 1 1 — — Other nose and throat defects 18 8 22 5 11 2 2 2 7 2 14 2 15 2 20 — Enlarged glands 15 1 3 — 4 — 2 — 11 3 13 1 7 1 2 — Eye disease 27 17 10 5 5 3 5 3 26 16 13 6 9 6 3 2 Vision defect — — — 47 — 55 — 45 — — — 55 — 71 — 82 Otorrhœa 4 2 2 2 9 7 3 2 5 5 2 2 8 3 2 2 Other ear disease — — 4 8 3 3 — — 2 2 3 2 — — 1 — Defective hearing — — — — 1 — 1 1 — — — — 2 —- 1 — Speech defects — — 5 1 1 1 — — 1 — 1 — — — — — Heart defects 3 — 6 — 6 — 3 — 9 — 6 — 8 2 9 — Anaemia 6 6 8 6 5 3 4 4 7 7 5 2 1 — 5 4 Lung defects 33 15 15 5 1 — 5 1 33 15 15 3 3 — 5 1 Nervous defects 2 1 4 1 2 — 5 1 5 2 2 1 1 — — — Phthisis — — — — 1 1 — — — — 1 1 — — — — Other T.B. disease — — — — — — — — — — — — — — — — Rickets 4 2 3 — 1 — — — 1 — 1 — 1 — 1 — Spinal deformities — — 2 1 1 1 1 1 — — 1 — 1 — 7 3 Other deformities 4 — 4 — 5 1 — — 5 2 2 — 9 — 12 10 Other defects 27 20 19 14 17 10 9 6 27 22 30 22 28 15 8 5 Number of children noted for ment 441 311 237 251 414 322 286 356 ♦Defects however slight are included under "cases"; those severe enough to require treatment are shown under * 55 CONTROL OF DISEASE The only marked change in the incidence of infectious disease in 1938 as compared with 1937, was the great increase in the number of measles cases though there was fortunately some reduction in whooping cough. Diphtheria. The were 235 cases of diphtheria notifiedd uring the year. The age grouping of the cases is given in the accompanying table. All the cases were removed to an isolation hospital. 5 deaths from this disease occurred during the year, equivalent to a case mortality of 2.1 per cent., or general death rate of 0.05 per 1,000 of the population. From information received from the hospitals it would appear that in at least 41 cases (or 17.4 per cent. of the total) the diagnosis of Diphtheria was not confirmed. 15 cases developed in hospital 5 of these being hospital staff, while there were 15 "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; 12,000 units were supplied during the year. Scarlet Fever. There were 348 cases of scarlet fever notified during the year, 316 of the patients being removed to an isolation hospital. Two deaths were certified as due to scarlet fever during the year. From information received from the hospitals, it would appear that in at least 19 cases (or 5.5 per cent. of the total) the diagnosis was not confirmed. 6 cases seem to have been developed in hospital, 2 being members of the hospital staff, while there were 16 " second cases." 56 Enteric Fever. Two cases were notified. Other Notifiable Diseases. Particulars of the number of notifications of various diseases and the age grouping of the patients will be found in the accompanying table. Consultations with Medical Practitioners. I was called in consultation by medical practitioners with a view to discussing the diagnosis in a number of doubtful cases. Statistics and notes with regard to Puerperal Fever, Ophthalmia Neonatorum, and Home Nursing will be found in the section relating to Maternity and Child Welfare. Cases of Notifiable Diseases Notified during the Year Disease Number of Cases Notified Removed to Hospital Reported †boy RegistrarGeneral Total Under 1 year 1 and under 2 years 2 and under 3 years ana under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Smallpox .... .... .... .... .... .... .... .... .... .... .... .... .... .... Enteric Fever 2 2 .... .... .... .... .... .... .... .... .... 2 .... .... 2 Diphtheria (inc. Memb. Croup) 237 235 4 13 13 24 18 104 84 12 5 8 .... .... 235 Scarlet Fever 347 348 1 19 22 34 41 151 45 10 7 14 4 .... 316 Puerperal Fever 2 2 .... .... .... .... .... .... .... .... .... 2 .... .... 1 Puerperal Pyrexia 18 18 .... .... .... .... .... .... .... 1 5 12 .... .... 13 Ophthalmia Neonatorum .... 15 15 .... .... .... .... .... .... .... .... .... .... .... 10 Erysipelas 74 73 1 2 .... 1 .... 2 7 1 7 21 25 6 52 Cerebro-spinal Fever .... 3 .... 2 .... .... .... 1 .... .... .... .... .... .... 3 Acute Poliomyelitis .... 2 .... 2 .... .... .... .... .... .... .... .... .... .... 2 Acute Encephalitis Lethargica .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Acute Polio-encephalitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Acute Primary Pneumonia 131 .... 122 7 8 9 3 6 20 8 7 3 25 20 6 53 Acute Influenzal Pneumonia 8 .... .... .... .... .... .... .... 1 1 2 2 2 1 Dysentery .... 23 1 3 4 1 2 4 1 .... .... 2 3 2 21 Malaria .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Continued Fever .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Typhus Fever, Cholera, Plague, Relapsing Fever .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Anthrax, Hydrophobia, Glanders .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... ‡Measles .... 7 1 3 1 .... .... 1 .... .... 1 .... .... .... 2 ‡Whooping Cough 44 12 3 5 6 7 10 .... .... .... .... 1 .... 7 Pulmonary Tuberculosis .... 113 1 .... 2 .... .... 1 1 14 13 39 39 3 * Other forms of Tuberculosis .... 16 .... 2 .... .... 1 3 3 4 1 2 .... .... * Total 1031 43 57 56 69 75 297 99 50 43 129 94 19 718 *See particulars as to Sanatorium Treatment in Tuberculosis section †The Registrar General's figures are for notifications received during the 52 weeks ended 31st December, 1938, and include non-residents. The Council's figures are for cases notified during the calendar year, and exclude non-residents and duplicate notifications. ‡Notifiable from 1st October, 1938. 58 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, 1937, inclusive Registration SubDistricts comprised in each Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec. 1937 Number of these Births duly entered by 31st Jan., 1939 No. of Births which on 31st Jan., 1938, remained unentered in the Vaccination Register on account of No. of these births remaining on 31st Jan., 1939, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1938 No of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1938 Successfully Vaccinated Insusceptible of Vaccination Had Smallpox Declaration of conscientious objection received Died Unvaccinated Postponement by Medical Certificate Removal to Districts, V.O. of which apprised Removal to places unknown and cases not found North East 811 82 — — 515 36 7 71 30 70 153 549 South West 216 22 — — 157 6 — 1 2 28 122 145 TOTAL 1027 104 — — 672 42 7 72 32 98 275 694 Children vaccinated after declaration of conscientious objection: nil. Vaccination certificates for 1938 sent to other Vaccination Officers : 118 59 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 126 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 14 persons who had died from Tuberculosis but who had not been notified under the Regulations. During the year 25 persons who had been notified in other Boroughs to be suffering from Tuberculosis took up their residence in this Borough. The number of patients remaining on the Tuberculosis Register at the 31st December, 1938, was 1,132. The details are given in the table on pages 60 and 61. During the year according to the Registrar General's return, there were registered 68 deaths from Pulmonary Tuberculosis, and 12 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 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 1937 73 7 80 Oi O Public Health (Tuberculosis) Regulations, 1930 PART i.—SUMMARY OF NOTIFICATIONS during the period from the 1st January, 1938, to the 31st December, 1938, in the area of the Metropolitan Borough of Bethnal Green. AGE PERIODS Formal Notifications Number of Primary Notifications of new cases of tuberculosis Total Notifications 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— total (all ages) Pulmonary Males .... 1 1 1 5 4 16 8 23 12 1 72 80 „ Females 1 .... .... .... 9 9 11 4 3 1 2 40 47 Non-Pulmonary Males .... .... 2 2 1 .... 1 .... .... .... .... 6 6 Females .... 1 1 1 3 1 .... 1 .... .... .... 8 10 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 4 1 4 4 .... 15 ,, Females .... .... 2 .... .... 3 4 4 1 1 .... .... 15 Non-Pulmonary Males .... 1 2 .... 2 .... 1 .... .... 1 .... 7 ,, Females .... .... 2 .... 1 .... .... 1 .... 1 .... .... 5 The source or sources from which information as to the above-mentioned cases was obtained, is stated below : Source of Information No. of cases Pulmonary NonPulmonary Death Returns from local Registrars 6 4 transferable deaths from Registrar General 3 1 Posthumous notifications 1 2 " Transfers " from other areas (other than transferable deaths) 20 5 Other Sources if any (specify) .... .... PART III.—NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1938, 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 434 344 778 196 158 354 1,132 Number of cases removed from the Register(s) during the year by reason of :— 1 Withdrawal of notification 2 2 4 .... 1 1 5 2 Recovery from the disease 5 4 9 7 2 9 18 3 Death 54 27 81 5 5 10 91 4 Otherwise 28 39 67 15 8 23 90 Total 89 72 161 27 16 43 204 61 Tuberculosis Register. Pulmonary Non-Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/37 435 360 210 361 1166 Number of new cases notified under the Public Health (Tuberculosis) Regulations, 3930, during the year 73 40 6 10 129 Transferred from non-pulmonary .... .... .... .... .... Other cases added to the Tuberculosis Register during year 15 16 7 3 41 523 416 223 174 1336 Number of cases removed from Tuberculosis Register during year. (For details see separate statement) 89 72 27 16 204 Transferred to pulmonary Cases remaining on Tuberculosis Register 33/12/88 434 344 196 158 1132 There were 14 deaths certified from Tuberculosis in which the deceased person had not previously been notified. This represents 17.5 percent. of the deaths from Tuberculosis during the year. Enquiry elicited the following explanations :— Diagnosis only reached after p.m. 6 Certified by Coroner 2 Diagnosed shortly before death 5 No reply to enquiries 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 „ 11 „ „ 3 months „ 4 „ „ 6 months „ 8 62 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 its work by Dr. H. T. Howell, the Clinical Tuberculosis Officer, appears on page 105. Dr. Howell makes some striking observations and suggestions concerning the difficulties in securing earlier diagnosis of Tuberculosis and his report also contains some interesting figures with regard to the local Tuberculosis notification and mortality rates. WORK OF TUBERCULOSIS VISITORS. The two Tuberculosis Visitors paid 5,021 visits of enquiry and advice with regard to the welfare of tuberculous patients in the Borough. In addition they made 216 futile calls owing to patients being out. Having regard to the character of the district and the poverty of so many of the patients, their task is a difficult one but they are able to carry out useful educational work with regard to preventive measures and no doubt their visits have a beneficial psychological result in encouraging patients. TUBERCULOSIS CARE COMMITTEE. The Sub-Committee of the Public Health Committee has functioned during the year as the local Tuberculosis Care Committee, dealing with such matters as grants of extra nourishment, provision of special treatment, etc. SUPPLY OF SPUTUM OUTFITS. During the year 34 sputum flasks were distributed to patients. 17 sputum tins, with 598 cardboard refills were distributed to patients for use indoors. 63 OPEN-AIR SLEEPING SHELTER. The Council's Open-Air Sleeping Shelter was not used during 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 123 patients were recommended for Sanatorium or Hospital treatment and 7 were recommended for admission to hospital for "observation for diagnosis"; 121 of the former and all the latter were sent away to institutions. In addition, 134 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, all being accepted. GRANTS OF EXTRA NOURISHMENT. 367 grants of Tuberculin Tested milk and new laid eggs were made to 120 necessitous tuberculous patients at an estimated cost of £252. 64 DENTAL TREATMENT FOR TUBERCULOUS PATIENTS. Three dispensary patients received dental treatment at the London Chest Hospital, making 4 attendances therefor. Seven patients were 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 6 patients were so treated, making 359 attendances for treatment. Three patients also made 305 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. 31 patients received this treatment having 326 refills during the year, as compared with 25 patients and 279 refills in 1937. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was taken under these regulations during the year. 65 OTHER DISEASES. Measles. During the year 1143 cases of Measles came to my knowledge from the following sources :— By formal notification by medical practitioners 61 Schools 652 L.C.C. Ambulance Service 272 Other Hospitals 43 Health Visitors 85 Sanitary Inspectors 23 Parents 7 All cases except one were visited, either by a Health Visitor or the District Sanitary Inspector, according to the age of the patient. 329 patients were removed to L.C.C. Special Hospitals, and in 26 cases, nursing assistance was provided by the Council, 275 nursing visits being paid. After various corrections of diagnosis and sifting of "suspected" cases, there would appear to have been a net total of 1077 actual cases. Information as to cases not already known to them is passed on to the L.C.C., to enable that authority to check the spread of infection in the schools and similar information is sent to Sunday Schools. There were six deaths from measles during the year. German Measles. 39 cases of German Measles were also reported, 5 of them proving to be not German Measles. 17 of them were removed to hospital. 66 Whooping Cough. 250 cases of Whooping Cough came to my knowledge; 32 by formal notification by medical practitioners and through reports from the L.C.C. hospital service (54), Health Visitors (34), Schools (112), and others (18), and these children were visited by the Health Visitors and the Sanitary Inspectors. 6 cases proved not to be Whooping Cough leaving a net total of 244. 60 children were removed to an Isolation Hospital, 86 nursing visits were paid to five cases at home. Two deaths from this disease were recorded during the year. Miscellaneous Investigations. 460 cases of Chickenpox were reported and these were visited by the Sanitary Inspectors. A number of other children were also visited by the Inspectors for illnesses reported by the Head Teachers, and suggestive of one of the notifiable diseases. 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—examined 1,164 Diphtheria bacilli present in 64 Sputum—specimens examined 62 Tubercle bacilli present in 4 Blood—specimens examined 2 Typhoid Bacilli present in 0 Faeces—specimens examined 6 Typhoid bacilli present in 0 One throat swab was examined by another laboratory with a positive result. Other bacteriological examinations in connection with food are reported on elsewhere. 67 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. DISINFECTION SERVICE. During the year, 1,670 rooms and 37,963 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. No. of Rooms Disinfected Articles of Clothing, etc., Disinfected by Steam Formalin Infectious disease 99 6,632 747 Scabies 14 11,231 1 Verminous condition 1,548 3,286 80 Other conditions 9 119 3 Hospital bedding — 13,304 560 1,670 36,572 1,391 Number of articles destroyed by request, 219. Quantity of furniture, bedsteads, etc. destroyed by request, 10 tons 1 cwt. 2 qrs. As reported last year, the routine disinfection of rooms has been discontinued except for certain diseases like Tuberculosis or other special circumstances. On the other hand, the work of the staff in the disinfestation of rooms, furniture and bedding has greatly increased. 68 Disinfestation. Disinfestation of bugs was effected in the following houses : 1938 1937 1936 L.C.C. and Borough Council tenements 18 21 6 Other houses 429 487 380 Advantage was taken to destroy, by request, a large quantity of old infested furniture from the houses in question. Disinfestation was also carried out in a number of other cases, such as ants, slugs, silverfish, woodworms, fleas and beetles. The furniture of 43 families removing to Borough Council tenements was disinfested by hydrocyanic acid gas by contractors in course of transit from the previous homes, the bedding being treated by steam at the Council's Disinfecting Station at the same time. Sulphur, Vermicine, Slatford and Ris powder 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 hydrocyanic gas treatment of furniture, all the disinfestation work is carried out by the Council's employees. 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 206 occasions during the year, as compared with 293 in 1937. Verminous Conditions. The children in 2 families were reported from the L.C.C. Cleansing Station as being infested with vermin of some kind. Advice as to the 69 treatment of the clothing and bedding was given and disinfestation by steam was offered and accepted in one case. Rooms were disinfested of vermin in 1,548 cases, as compared with 1,630 in 1937 and 902 in 1936. Scabies or Itch. 370 children suffering from this disease were excluded from the Elementary Schools. In addition, 35 cases of Scabies were reported by the London Hospital, 1 by Bethnal Green Hospital, and 4 by private doctors. In all but 44 of these cases the bedding and clothing were disinfected; 14 rooms were also fumigated after Scabies. The figures indicate that the increase in Scabies, which was noted last year, still continues, and is reflected in the following figures concerning adults. The prevalence seems to be general in the East London Boroughs. 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 33 men, 15 women and 8 children had 58 baths and their clothing was disinfected for vermin, and 175 men, 197 women and 90 young children had treatment, in addition to baths and disinfection, on a total of 816 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 273 531 Vermin 7 7 These figures are included in the foregoing figures of total work done at the Station. 70 PUBLIC HEALTH (LONDON) ACT, 1936, SECTION 224. Care of Aged and Infirm Persons. During the year, action was found necessary in two cases under this section. FOOD POISONING. Food Poisoning has been notifiable throughout London since 1932. During the past year, 28 cases were notified. Of these cases, 10 were attributed to eating fish of various kinds, including shell fish and tinned, and 10 to meat and 1 to tinned tomatoes, 1 to ice cream, 1 to watercress, 1 to pickled onions and 3 to chicken roll. In one case the food was not traced. 71 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 forms. FOOD AND DRUGS ACTS. Seven hundred and twenty-three samples were taken; 689 of these proved to be "genuine" and 34 or 4.7 per cent. adulterated. 72 The details are given in the following table :— SUMMARY OF ANALYST'S REPORTS. Article Samples taken formally Samples taken informally Total number of samples taken No. taken Genuine Adulterated No. taken Genuine Adulterated Milk 350 347 9 3 2 1 359 Sterilised Milk .... .... .... 1 1 .... 1 Butter 98 97 1 4 4 .... 102 Margarine 4 4 .... .... .... .... 4 Cream 5 5 .... .... .... .... 5 Canned Cream 1 1 .... .... .... .... 1 Cheese 3 3 .... .... .... .... 3 Lard 3 3 .... 1 1 .... 4 Dripping 5 5 .... .... .... .... 5 Fat Mixture 1 .... 1 .... .... .... 1 Cooking Fat 1 1 .... .... .... .... 1 Mustard 2 2 .... 2 2 .... 4 Vinegar 44 43 1 1 .... 1 45 Malt Vinegar 1 1 .... .... .... .... 1 Tomato Sauce 1 ] .... .... .... .... 1 Horse Radish Sauce 1 1 .... 1 1 .... 2 Ground Ginger .... .... .... 1 1 .... 1 Pearl Barley .... .... .... 4 4 .... 4 Jam 34 34 .... 5 4 1 39 Honey 2 2 .... .... .... .... 2 Apricot Curd Table Jelly 1 1 .... .... .... .... 1 4 1 3 4 4 .... 8 Chocolate Roll 11 3 8 8 5 3 19 Ice Cream .... .... .... 1 1 .... 1 Minced Meat 1 1 .... 11 11 .... 12 Sweets 6 6 .... 2 2 .... 8 Dried Fruits 1 1 .... 9 9 .... 10 Preserved Fruits .... .... .... 2 2 .... 2 Preserved Peel 1 1 .... 1 1 .... 2 Lemon Curd 1 1 .... .... .... .... 1 Lemon Squash 1 1 .... .... .... .... 1 Ginger Wine 3 3 .... .... .... .... 8 Cordials .... .... .... 10 10 .... 10 Bread .... .... .... 4 4 .... 4 Flour .... .... .... 4 4 .... 4 Potato Meal 1 1 .... .... .... .... 1 Baked Beans .... .... .... 1 1 .... 1 Ground Almonds .... .... .... 1 1 .... 1 Gin 2 2 .... .... .... .... 2 Whisky 6 6 .... 1 1 .... 7 Tea .... .... .... 2 2 .... 2 Cooked Meat 1 1 .... .... .... .... 1 Sausages 2 .... 2 .... .... .... 2 Filleted Herring .... .... .... 1 1 .... 1 Canned Fish 1 1 .... 12 12 .... 13 Pickled Fish .... .... .... 2 2 .... 2 Aspirin Tablets 5 4 1 1 1 .... 6 Olive Oil 2 1 l .... .... .... 2 Sulphur Ointment 1 1 .... .... .... .... 1 Chillie Paste .... .... .... 1 1 .... 1 Other Drugs .... .... .... 9 8 1 0 Totals 613 580 27 110 103 7 723 73 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 1938, 723 samples were examined under the Food and Drugs (Adulteration) Act, all of which were submitted by the Inspectors. No samples were submitted by the Public under the Act. One hundred and ten of these samples were purchased informally. Thirty-four samples were found to be adulterated, twenty-seven formal and seven informal. The adulteration was at the rate of 4.7 per cent. as compared with 3.46 per cent. for the whole of London and 5.5 per cent. for the whole of England and Wales in 1937. The number of samples examined was at the rate of 7.64 per 1,000 of the estimated population as compared with 9.91 per 1,000 for the whole of London and 3.79 per 1,000 for the whole of England and Wales in 1937. Three hundred and fifty-nine samples of milk were examined of which ten samples or 2.8 per cent. were reported as adulterated, as compared with 3.26 per cent. for the whole of London and 7.4 per cent. for the whole of England and Wales in 1937. The rate of adulteration in the Borough for the past 10 years was as follows:— Year No. of Samples examined Percentage of adulteration 1938 723 4.7 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 Average 731 6.3 The milk adulteration in the Borough for the past 10 years was as follows:— 74 Year No. of Samples examined Percentage of adulteration 1938 359 2.8 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 Average 350 4.6 Condensed Milks No condensed milks were examined during the year. Preservatives There were five contraventions of the Preservatives Regulations :— 3 Table Jellies which contained Benzoic acid preservative. 2 Fresh Sausages which contained sulphur dioxide preservative. Chocolate Rolls Nineteen samples of Chocolate Rolls were examined and in 11 cases it was found that cocoa was absent or deficient. Several prosecutions resulted and later samples were found to be satisfactory. Other samples examined during the year, all for the Pulic Health Department were :— 23 Rag Flocks, 2 of which failed to reach the necessary standard of cleanliness and 2 samples of Feathers, both of which were unsatisfactory. Albert E. Parkes. 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. 102. 75 SAMPLES TAKEN INFORMALLY 110 samples were taken informally during the year, 7 of which were found to be adulterated as follows:— Article No. of Sample Offence Milk 184 10 per cent. deficient in fat Chocolate Roll 186 189 326 No cocoa present Malt Vinegar 342 61.5 per cent. deficient in acid Blackcurrant Jam 428 6 per cent deficient in fruit Bismuth Tablets 690 85 per cent. deficient in bismuth SPECIAL EXAMINATIONS OF FOOD, Etc. During the year, 20 bacteriological or special chemical examinations were made as follows: Pasteurised Milk 7 Tuberculin Tested Milk 1 Ordinary Milk 1 Raspberry Jam 1 Baked Beans 1 Ice Cream 1 Water boiled in aluminium kettle 1 Water from tap 5 Victoria Park Lido Water 1 Public Swimming Bath Water 1 None of the examinations gave any results calling for public health action. BETHNAL GREEN NUTRITION. At the time of compiling this report, the nutrition survey carried out in Bethnal Green by the Rowett Institute, under the general direction of Sir John Orr, during 1938-39 had not been completed. I hope that some account of this survey and its conclusions may be available for my report next year. 76 FOOD PREMISES. Milkshops and Dairies. 38* 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 1937 367 Deduct number of purveyors removed from register during the year 50 Add number of new purveyors added to register by resolution of the Public Health Committee during the year 38 Number of purveyors of milk on register at end of 1938 355 During the year 757 inspections of milkshops were made by the Inspectors, and 102 notices were served under the Public Health (London) Act. I have to draw attention to the abnormally large number of milk shops which have been registered in the Borough. The above mentioned figure (355) represents a milkshop to every 267 residents in the Borough. A high ratio seems to be general in East London. In the neighbouring boroughs of Hackney, Poplar, Shoreditch and Stepney, the average is one milkshop per 341 residents, but in the four West End boroughs it is only 1 per 614. Notwithstanding the substantial fall in the population, the number of milkshops in Bethnal Green has increased from 245 in 1925, 260 in 1930 to 326, 354, 367 and 355 in the last four years. It is true that a great many of these so called milkshops are really "general" shops where milk is only sold in bottles, but the existence of such a considerable number of milk traders leads to undue competition, and temptation to adulteration. When * This includes changes of occupier in premises previously on the register. 77 there are so many small distributing agencies it increases the difficulty of exercising adequate supervision over the trade. The law with regard to the registration of milkshops makes it difficult to refuse or revoke registration except for very serious conditions but nevertheless I am of opinion that it is desirable in the public interest that the number of milk traders should be reduced and that registration should be restricted to persons and premises of whose suitability for the business there is no doubt. I intend to carry out an investigation with a view to ascertaining whether the great increase in the number of milk sellers has been reflected in an increase in the per capita consumption of milk and will report the results in my next annual report. MILK (SPECIAL DESIGNATIONS) ORDER. Seven Dairymen were licensed to sell "Pasteurised" Milk and nine "Tuberculin Tested" Milk. Thirteen Supplementary licenses to sell milk in the Borough were granted during the year; 9 to sell "Pasteurised" Milk from premises in Stepney, Hackney, Poplar, Finsbury and the Rural District of Oswestry 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. 78 Cowhouses. There were at the end of the year, 5 licensed cowhouses in the Borough. 32 inspections were made during the year. 2 notices were served. The following premises are duly licensed:— 23, Ezra Street—(6 cows). 38, Fellbrigg Street—(8 cows), [closed in 1939] 104, Gibraltar Walk—(18 cows). 55, Kerbela Street—Shed No. 1—(18 cows). Shed No. 2—(2 cows). 38, Three Colts Lane—(23 cows). Manufacture of Cheese. One premises was registered for the manufacture of cheese. Two inspections were made during the year. Ice Cream Premises. There were 181 ice cream premises registered at the end of the year, and 395 visits were paid to them by the district inspectors: 33 notices were served. Fried Fish and Fish-Curing Premises. At the end of 1938 there were 32 fried fish vendors' premises in the Borough. There were 18 fish curers' premises. 258 visits were made by the Food Inspectors to these premises, and 21 notices were served for insanitary conditions. Bakehouses. There are, in Bethnal Green, 58 bakehouses including 29 where power is employed, and 16 of them are underground. 293 inspections were made during the year, and 26 notices were served. 79 Other Premises used for the Preparation or Sale of Food. There were 216 such premises on the register, the majority being restaurant-kitchens or butchers' shops. 1033 inspections were made during the year, and arising out of such inspections 64 notices to remedy faults or insanitary conditions were issued. Slaughterhouses. There are two licensed slaughterhouses in the Borough, situated at:— 294, Bethnal Green Road. 354, Bethnal Green Road. 15 visits were made to them by one of the Food Inspectors. Public Health (Meat) Regulations, 1924. The number of animals killed at the slaughterhouses was as follows:— Lambs 40 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: 269 visits were paid to them during the year, 2 notices were served for insanitary conditions. 80 UNSOUND FOOD. In addition to the special inspections of slaughterhouses and other premises where food is prepared or sold, the Food Inspectors keep stalls and market places under regular supervision, particularly during the week-end. The District Sanitary Inspectors also keep general observation in the course of their duties. On 27 occasions during the year, unsound food was examined and destroyed as trade refuse comprising the following articles:— Description of Article. Weight. Tons. Cwt. Lb. Fish — 4 42 Fruit 2 1 74 Meat — 1 90¾ Vegetables — — 98 Rabbits — 1 66 Turkeys — — 59 Lemon Curd — — 16 also 60 eggs and 1 bushel of winkles. Most of this food was surrendered by the owners but in 4 cases the food was seized by the inspector: 30 eggs, 30 eggs, 39f lbs. meat and faggots, 20 lbs. blackcurrants. A noteworthy case of unsound food was dealt with during the year in which, for the first time, the new penalty under the Public Health (London) Act, 1936, of the public exhibition at the defendant's premises of a notice of his conviction, was put into operation. The circumstances in this case were such as amply to justify severe measures. Not only had the tradesman in question been convicted on 2 occasions of having substantial quantities of 81 unsound food deposited and exposed for sale but he was also found guilty of allowing refuse to accumulate in his shop and the council had found it necessary in the interests of public health, to remove his name from the register of purveyors of milk. FOOD POISONING. During the year 28 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, 30 persons have been placed on the Council's list in respect of 29 premises as authorised, subject to the provisions of the Act and regulations, to sell poisons specified in Part II of the Poisons List. 82 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 31st December, 1938. Nature of Visit Totals Infectious Diseases (notifiable) 872 Infectious Diseases (non-notifiable) 1,466 Food Poisoning 1 Complaints 4,654 House to House Inspections 706 Housing Inspections 1,511 Milkshops (£42) and Cowsheds (19) Inspections 561 Other Food Premises Inspections (Slaughterhouses 4, Poultry 262, Others 1,526) 1,792 Factory (power 1,480, non-power 845) Inspections 2,325 Outworkers' Homes Inspections 458 Common Lodging House Inspections 19 Tenement House Inspections 316 Tenement House Staircase Lighting Inspections — Shops Act Inspections 313 Drainage Inspections 3,830 Other Inspections or Special Work 5,116 Re-Inspections 18,633 Total visits for the Year 42,573 Unsound Food Seizures (4) or Surrenders (23) 27 Samples of Food, etc., taken 724 Samples of Rag Flock taken 23 Other Samples (Poisons, etc.) taken 4 Police Court Attendances 54 Premises where Nuisances abated 5,311 Premises where Matters Outstanding 909 Time Engaged at New Buildings (Hours) 163 83 The following sanitary defects were discovered during the year:— Dirty rooms 6,485 Defective drains and choked w.c.'s 501 Defective and dirty w.c.'s 1,554 Defective water supply 351 Defective paving 467 Defective gutters and rainwater pipes 584 Defective roofs 1,630 Dampness 849 Defective dustbins 1,043 Smoke nuisances 28 Other defects 10,755 Total 24,247 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, 5,462 Preliminary Notices and 2,437 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 804 premises with nuisances outstanding. During the year, nuisances at 5,311 premises were abated and 909 premises with nuisances outstanding were carried forward to 1939. COMMON LODGING HOUSES. There are 4 such premises in the Borough, and the Inspectors paid 50 visits to them. Three sanitary notices were served. 84 TENEMENT HOUSES. The number of houses on the register as being let in lodgings or occupied by members of more than one family was 268; 1,603 visits of inspection were made to these houses, and arising out of such visits 560 notices were served. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920-1938. During the year two applications for a certificate as to the state of repair of a house were granted. WATER SUPPLY TO NEW HOUSES. During the year 195 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 2 formal observations of smoke shafts were made. 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. RATS AND MICE (DESTRUCTION) ACT, 1919. No formal notices were served under the Act during the year. A number of complaints as to rat infestation have been investigated and dealt with and occupiers of premises have been advised in the matter. Poor occupiers have been assisted by the supply of rat poison, 159 packets of treated biscuits being issued in this way. The systematic measures for rat destruction for one week every three months continued during the 85 year, and the following statistics illustrate the measurable results: Baits laid (in 300 manholes) 17,256 Baits missing 15,842 Percentage of baits missing 91.2 Other methods of destruction carried out on an experimental scale have been as follows:— Rats killed Breakback traps 42 Dustbin traps 195 Cage traps 202 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. 17 inspections were made at these premises. No sanitary notice was served. Poultry slaughtering, also an offensive trade, is dealt with elsewhere in this report. RAG-FLOCK ACT, 1911. 23 formal samples of rag-flock were taken during the year, and in 2 cases the amount of chlorine present was found to be in excess of the limit fixed by the Regulations. 2 informal samples of feathers were also taken. 86 RAG AND BONE DEALERS. 17 persons or firms are known to be carrying on this business in the Borough. During the year 40 visits of inspection were made, and 6 sanitary notices were served. HAIRDRESSERS. 111 hairdressers' premises were on the register, 276 visits were made to them, and 63 Notices were served. SHOP ACTS, 1934. 26 Certificates of exemption from the requirements of this act with regard to the provision of sanitary conveniences were issued on grounds of restricted accommodation or other special circumstances. COMBINED DRAINAGE. The reconstruction of such combinations of drains of houses and premises as are found to be sewers by law defined and are not under highways was during the year transferred to the department of the Borough Engineer and Surveyor. Mr. C. W. Batstone, the drainlayer formerly in charge of this work, retired after a long period of loyal and efficient service. The remainder of the drainage staff plus an additional labourer are now engaged in the flushing of combined drains, drain testing and rat destruction. DRAINAGE WORK. No legal proceedings were taken during the year in respect of offences in connection with drainage work. 87 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 1938:— Area Houses Pop. Action taken by Borough Council Action taken by London County Council Ada Place & Pritchards Road — — — New housing completed Anns Place — — Awaiting demolition — Burnham Square — — New housing (80 flats containing 272 rooms) in course of erection — Busby Sq. — — Awaiting demolition — ‡ Coopers Gardens (5 areas) 91 424 — Awaiting demolition Coventry Road 11 59 — Represented and declared Clearance Areas. Darling Row (2 areas) - - - Partially cleared; other properties awaiting demolition Digby Street — — Extension for further 18 tenements approved — Dinmont Estate — — — New housing in course of completion Edward Place — — Awaiting demolition — 88 Area Houses Pop. Action taken by Borough Council Action taken by London County Council †Emma St. — — — Compulsory Purchase Orders confirmed by Ministry of Health Herald St. (4 areas) - - - Clearance and Compulsory Purchase Orders made; confirmed by Ministry of Health ‡Hereford St. (9 areas) — — - Represented James St. (6 areas) - - - Compulsory Purchase Orders confirmed by Ministry of Health Lansdell Place (4 areas) 79 432 — Compulsory Purchase Orders confirmed by Ministry of Health Martha Ct. — — All premises now demolished except 1 derelict house — ‡ Menotti St. (3 areas) — — — Represented †Minerva St. (4 areas) - - - Compulsory Purchase Orders confirmed by Ministry of Health. Demolition in progress ‡ Newling St. (14 areas) — — — Represented Pedley St. (2 areas) - — — Awaiting clearance 89 Area Houses Pop. Action taken by Borough Council Action taken by London County Council Punderson Gardens (4 areas) — — — Compulsory Purchase Orders made. Ministry of Health enquiry held ‡Squirries St. (5 areas) 311 1,706 — Represented Tent St. 81 505 — Erection of new dwellings in progress ‡Turin St. (3 areas) 465 2,499 - Represented. Declared to be Clearance Area and Compulsory Purchase Orders made Violet St. 4 9 Awaiting demolition — † Vyner St. (9 areas) 128 572 - Compulsory Purchase Orders confirmed by Ministry of Health Waterloo House (Wellington Estate) — — - Tender accepted for further blocks of new dwellings and erection in progress †Forming part of Redevelopment Area No. 1 ‡Forming part of Redevelopment Area No. 2 Public Utility Society— Scheme Nags Head Ministry of Health confirm Clearance Fields Order No. 1 Area 90 The substantial amount of new housing construction in the Borough 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 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 (Holly bush House) 71 (Dinmont House) 25 (Haig House) 4 245 1937 35 (Delta) 152 (Wellington) 110 (Pott Street) 38 (Sturdee) 6 (Ayshford) 341 1938 - 60 (Cheverill House) 53 (Ada House) 24 (Pritchards House) 27 (Horatio House) 24 (Burwell House) 188 HOUSING ACTS 1935 and 1936—OVERCROWDING. During the year, substantial progress was made both in remedying the overcrowding already 91 recorded in the Borough and in making provision under the Housing Act 1936, for the systematic legal discouragement if not prevention of further overcrowding. ABATEMENT OF OVERCROWDING During the task of measuring up of all rooms in the Borough which would be subject to the provisions of the Housing Act 1936 on the appointed day, the opportunity was taken to revise the register of overcrowded families. The following statistics are therefore as reliable as is possible in the absence of any machinery for recording the migration of the population from day to day. At the end of 1937 there were 3,005 cases on the register. During 1938, 889 cases were added (713 of these were discovered during the course of the measuring of rooms) making a total of 3,894 cases to be dealt with. By the end of the year this total had shrunk to 2,448, the total of 1,446 removed from the register being composed as follows:— Equivalent Families adults Rehoused by L.C.C. (including 63 in connection with Clearance areas) 215 1,105 Rehoused by Borough Council 2 12½ Rehoused by Housing Association 1 6½ Removed—mostly without trace 371 1,660½ Alterations in families (by deaths, marriages, arrangements for members of families to sleep out, taking over extra rooms, etc.) 857 5,518 1,446 8,302½ The 2,448 families remaining on the register at the end of 1938 comprised 12,762 equivalent adults. The system of certification on the part of the Borough Council which gives preferential consideration to applicants to the London County Council 92 for housing accommodation who are living under overcrowded conditions continues to operate. During the year 456 cases have been so certified. These, added to the balance of cases outstanding at the end of 1937 made a total of 868 cases to be dealt with. During 1938, 158 cases have been accommodated and in 190 other instances information has been received from the L.C.C. that the application has been cancelled for various reasons (arrears of rent on existing tenancies, no replies to letters addressed to applicants, not bothering to view accommodation offered, are typical reasons). This leaves a total of 520 cases remaining to be dealt with at the end of 1938. In view of the fact that some 130 of these cases were certified in 1936 the question of some speeding up in dealing with these arrears has recently been taken up with the L.C.C. Doubtless in some instances the delay is due to the special size of the flat or house needed but in others it is due to the reluctance of the applicant to leave the district. Some of the reasons given for refusing offers made seem to be far from reasonable. In addition to cases certified for preferential consideration on the grounds of overcrowding, 104 other cases were certified for preferential consideration in the main on health grounds, but the L.C.C. have only found it possible to deal with 10 of these and similar applications made in preceding years. The total of cases outstanding which have been certified under this category is now 205. 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 250 letters have been written in this connection. 93 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 and in five instances fresh overcrowding has been discovered. All these cases were discovered prior to "the appointed day" (1st October, 1938). It will of course be possible to take action as regards any similar discoveries in the future. For comparison, the following table, similar to that published in my Annual Reports for the past two years is given in respect of the overcrowding remaining in the Borough at the end of 1938:— Degree of overcrowding (expressed in X times the legal standard) Rooms required Total families 2 3 4 5 6 7 Over 3 6 – 3 4 – – 13 „ 2 36 32 121 17 2 – 208 From 1½ to 2 50 257 128 68 5 – 514 „ 1 to 1½ 128 792 637 144 5 2 1,708 Segregation 5 – – – – – 5 Totals 231 1081 889 233 12 2 2,448 PREVENTION OF OVERCROWDING measurement of rooms The appointed day in respect of the Borough was fixed for the 1st October. 1938, on which date certain provisions of the Housing Act 1936 came into force. These related to overcrowding becoming an offence, and to the necessity for a statement, amongst other things, of the permitted number of persons in respect of any dwelling being entered in the rent book relating to such premises. It was therefore necessary previously to complete the measuring up of all rooms occupied in the Borough for dwelling purposes. 94 Some 22,000 had been measured in connection with the Housing survey of 1935, but a further 50,000 remained to be dealt with. A temporary staff of 16 men (2 employed as clerks, the remainder as measurers) was engaged for the work under the supervision of Mr. F. G. Thomas and were so employed for a period of approximately six months. From the information so obtained, some 18,000 certificates were prepared and despatched to owners, and duplicates furnished to all responsible tenants. Accompanying each of these certificates was a pamphlet which had been prepared, relating to the prevention and abatement of overcrowding and the rights and duties of owners and tenants under the Housing Act 1936 with regard to overcrowding. As reported above, the visits of the measurers also enabled information to be obtained with regard to the previously recorded cases of overcrowding. The whole task was completed with great efficiency and some weeks within the estimated time and reflected great credit both on Mr. Thomas who organised it and on the local men who carried it out. The work of verifying that the appropriate entries are made in rent books, and that the provisions of the Act as regards overcrowding are observed will of course devolve on the Sanitary Inspectors, but a good deal of fresh office work has been created in the preparation of new certificates necessitated by the constant changes in ownership of property and the ever varying occupations of rooms in premises which are sublet to several tenants. 95 HOUSING STATISTICS FOR 1938. Number of Houses erected during the year—188 tenements and 7 houses. 1. Inspection of Dwelling Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,699 (b) Number of inspections made for the purpose 7,699 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 706 (b) Number of Inspections made for the purpose of the regulations 706 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation — 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 — 96 (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices Notices served: were served requiring de- Intimations, 5,642 fects to be remedied Nuisance Notices 2,437 (2) Number of dwelling-houses in which defects were remedied:— (a)By owners 5,311 (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 1 (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 under- ground rooms in respect of which Closing Orders were made 3 (2) Number of separate tenements or under- 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 2,448 (ii) No. of families dwelling therein 2,448 (iii) No. of persons dwelling therein 12,762 (b) No. of new cases of overcrowding reported during year 889 (c) (i) No. of cases of overcrowding relieved during year 1,446 (ii) No. of persons concerned in such cases 8,302 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after local authority has taken steps for abatement of overcrowding 5 (e) Any other particulars with respect to crowding conditions upon which the M.O.H. may consider it desirable to report. — 97 FACTORIES, OUTWORKERS, &c. Inspection of Factories, &c. Premises Number of Inspections Written Notices Prosecutions Factories (with mechanical power) 1,935 320 .... Factories (without mechanical power) 1,853 289 .... Other Premises under the Act (including works of Building and engineering construction but not outworkers premises) 192 37 .... Totals 3,980 646 .... Defects found:— Particulars Number of Defects Found Remedied Referred to H.M. Inspector Number of Prosecutions Nuisances under the Public Health Acts:— Want of cleanliness 111 118 5 ... Overcrowding 1 1 ... ... Unreasonable temperature ... ... ... ... Inadequate ventilation 2 3 ... ... Ineffective drainage of floors 1 2 ... ... Sanitarv conveniences— insufficient 7 6 ... ... unsuitable or defective 567 580 ... ... not separate for sexes 3 1 ... ... Other Offences (excluding offences relating to Home Work or offences under Third schedule of Factories Act, 1937) 311 312 6 ... Totals 1,003 1,023 11 ... 98 Registered Factories. On the Register at the end of the year Number Factories 1,717 Bakehouses 58 Total 1,775 Other Matters. Class Number Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 114, 128) 14 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Acts (s. 9). Notified by H.M. Inspector 7 Reports (of action taken) sent to H.M. Inspector 7 Basement Bakehouses (s. 54) in use at the end of the year 16 OFFICE HYGIENE. Special attention has been directed in recent years to the need for a prescribed minimum of hygiene in offices similar to that which is enforced in factories and other workplaces. It is obvious that the clerk needs the protection of the law with regard to such working conditions as heating, ventilation, lighting, underground workrooms, overcrowding and sanitary accommodation, equally as much as other workers. 99 Some progress in this direction has been made in the provinces owing to the specific inclusion of "offices" in the expression "workplace" in the Public Health Act, 1936. Unfortunately, the position in London is not so clear. The provincial Public Health Act has probably not been in operation quite long enough to judge whether it is adequate to deal with offices but it is clearly unsatisfactory that in London, where such a large number of offices exist, the law should lag behind that in the rest of the country. During the year, the workshops Inspector visited and inspected 69 offices attached to factories, etc., and made 97 inspections in all to such offices. HOME WORKERS. Of the 1,867 names of workmen and contractors which appeared on the lists received, 1,417 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. They represent a substantial falling off compared with previous years, but how far this is due to changes in the organisation of the trades concerned or to commercial depression I do not know. The number of visits paid to Home Workers' dwellings was 657. The number of premises found to be in an insanitary condition was 104, or 30.7 per cent. of the 338 premises inspected. Notices were served in 125 cases, while 23 other premises were under notice arising from other visits, and a verbal intimation was given in 17 further cases. 100 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 Cardiff, Enfield, Epsom, Kingston and Richmond and local firms have sent in lists containing outworkers resident in Ashford, Canvey Island, DagenhamHornchurch, Rochford and Southend-on-Sea. 101 HOME WORK Nature of Work OUTWORKERS' LISTS, SECTION 110 * Outworkers in unwholesome premises, Section 111 Lists received from Employers Addresses of Outworkers Notices served on Occupiers as to keeping or sending lists Prosecutions Instances Notices served Prosecutions 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, ete. 33 127 225 2 1 3 818 237 63 ... ... 34 42 ... Boots and Shoes 9 22 87 ... ... ... 83 84 14 ... ... 5 7 ... Curtains, Furniture hangings and Trimmings 4 43 19 ... ... ... 6 33 8 ... ... 3 4 ... Fur-pulling and feathers ... ... ... ... ... ... 17 ... ... ... ... 1 1 ... Umbrellas, etc. 2 ... 14 ... ... ... 12 5 4 ... ... 4 5 ... Artificial Flowers ... ... ... ... ... ... 28 ... ... ... ... 5 5 ... Paper, etc.,Boxes, Paper Bags 10 ... 141 2 ... 6 82 53 20 ... ... 27 44 ... Brush-making 3 ... 14 ... ... ... 22 5 4 ... ... 2 4 ... Draught Board Making 1 ... 2 ... ... ... ... ... 2 ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, etc. ... ... ... ... ... ... 17 ... ... ... ... 4 5 ... Textile Weaving 1 ... 10 ... ... ... ... ... 2 ... ... ... ... ... Toys 1 ... 62 ... ... ... 6 33 2 ... ... 3 8 ... Totals 64 192 574 4 1 9 1,091 450 119 ... ... 88 125 ... "The figures in these columns relate to outworkers' premises at which nuisances were found and dealt with under Public Health (London) Act. 102 APPENDIX I. LEGAL PROCEEDINGS During the year, 31 summonses were heard in respect of nuisances, with the following results Withdrawn on payment of costs amounting to:— £1 5 0 11 £1 11 6 16 Nuisance orders were made and costs obtained in the following cases £2 2 0 2 £3 3 0 2 Other legal proceedings are summarised in the following list:— No. of Sample in Food Cases Date Offence or Occasion Result 686 25th Jan. Food and Drugs Act No fine Costs £5 5s. 0d. Selling whisky containing 3.5% added water 25 10th Feb. Selling milk 13.3% deficient in fat No fine Costs £4 4s. 0d. — 16th Feb. Pubhc Health (London) A ct Fine £1 Costs £3 3s. 0d. Non compliance with notice requiring provision of dustbin — 21st Feb. Depositing and exposing for sale 30 unsound eggs Fine £15, Costs £10 10s. 0d. Notice of Conviction and previous conviction to be affixed to premises for 21 days 9 22nd Feb. Food and Drugs Act Selling Chocolate Roll which was devoid of cocoa or chocolate No fine Costs £3 3s. 0d. 40 15th Mar. Selling chocolate roll which was devoid of cocoa or chocolate Fine £2 Costs £5 5s. 0d. 72 22nd Mar. Selling chocolate roll which was devoid of cocoa or chocolate Fine £5 Costs £5 5s. 0d. 79 30th Mar. Selling chocolate roll which was devoid of cocoa or chocolate Fine £5 5s. 0d. Costs £5 5s. 0d. 76 29th Mar. Selling milk which was 3.3% deficient in fat No fine Costs £2 2s. 0d. 95 29th Mar. Selling milk which was 3.3% deficient in fat No fine Costs £5 5s. 0d. 103 No. of Sample in Food cases Date Offence or Occasion Result 117 12th Apl. Selling chocolate roll which did not contain any cocoa or chocolate matter Fine £5 0s. 0d. Costs £5 5s. 0d. 107 13th Apl. Selling chocolate roll which did not contain any cocoa or chocolate matter No fine Costs 2s. 0d. 132 26th Apl. Selling chocolate roll which did not contain any cocoa or chocolate matter Fine £15 0s. 0d. Costs £5 5s. 0d. 143 27th Apl. Selling milk which contained 3.5% added water No fine Costs £4 4s. 0d. 170 10th May Selling chocolate roll which did not contain any cocoa or chocolate matter Fine £5 0s. 0d. Costs £5 0s. 0d. — 28th June Byelaws under P.H. (London) Act Fine 5s. 0d. Exchanging toys for rags and bones — 28th June Exchanging toys for rags and bones Fine 5s. 0d. 344 17th Aug. Food and Drugs Act Fine £5 0s. 0d. Costs £5 5s. 0d. Selling malt vinegar 75% deficient in acetic acid 422 20th Sept. Selling milk deficient in fat to extent of 20% No fine Costs £3 3s. 0d. 443 27th Sept. Delivering in pursuance of contract of sale milk found to be 6.6% deficient in fat No fine Costs £6 6s. 0d. — 4th Oct. Public Health (London) Act Fine £2 0s. 0d. Costs £3 0s. 0d. Depositing for sale 20 lb. of unsound Blackcurrants — 11th Oct. Having deposited for sale about 39¾ lbs. of unsound meat Dismissed 11th Oct. Failing to observe due cleanliness in part of building in which food for human consumption was deposited (21.6.38) Fine £2 0s. 0d. Costs £5 5s. 0d. 11th Oct. Failing to observe due cleanliness in part of building in which food for human consumption was deposited (28.6.38) Dismissed Costs 2s. 0d. 24th Oct. Application for order for removal of aged and infirm person Removal order granted 482 1st Nov. Food and Drugs Act Selling table jelly containing benzoic acid, an added preservative Dismissed Costs 2s. 0d. 485 1st Nov. Exposing for sale by retail unlabelled parcel of margarine No fine Costs £3 3s. 0d. 104 No. of Sample in Food cases Date Offence or Occasion Result 513 8th Nov. Selling table jelly containing benzoic acid Fine £10 0s. 0d. Costs £10 0s. 0d. — 21st Nov. P.H. (London) Act Application for order for removal of aged and infirm person Removal order granted 548 6th Dec. Food and Drugs Act Withdrawn Costs £2 2s. 0d. Selling olive oil which contained 25% of vegetable oil other than pure olive oil 567 7th Dec. Selling aspirin tablets which were 5% deficient in aspirin No fine Costs £1 1s. 0d. 605 20th Dec. Selling milk which contained 2.3% added water No fine Costs £4 4s. 0d. 105 APPENDIX II. TUBERCULOSIS DISPENSARY at the LONDON CHEST HOSPITAL REPORT FOR THE YEAR 1938 By H. Tylford Howell, M.R.C.S., L.R.C.P:, Clinical Tuberculosis Officer. No change in the personnel of the department has occurred during the year. The sessions, which have remained unaltered, are as follows:— Monday, Wednesday, Thursday, Friday and Saturday mornings from 10 to 12 o'clock, and Thursday evenings from 7.30 to 9 o'clock. In addition to the above, three sessions are reserved for Artificial Pneumothorax refills:— Thursday at 12 and 2 o'clock, and Saturday at 12.30. Saturday mornings are reserved as far as possible for school children, and Thursday evenings for those patients who are at work during the day. The accommodation of the department is on adequate lines, comprising, as it does, two large and airy consulting rooms, with two dressing rooms and a dark room for throat examination attached to each. In addition there are waiting rooms, offices for Tuberculosis Officers and Clerk, a laboratory, and rooms for Artificial Pneumothorax refills. I intimated in last year's report that it was intended to install a new X-ray screening apparatus for the sole use of the Outpatient department. This has now been in use for nearly a year and has proved a great convenience to us in our refill clinic. Previously we had to screen our cases in the main X-ray department of the Hospital, an arrangement that occasionally involved some delay in favour of more urgent cases. There is now no waiting, and the saving of time both to the patients and the Tuberculosis Officer is appreciated. A happy and close working arrangement with the Hospital offers us unique facilities for specialist opinion in the various departments of the Hospital. Personal interviews with the various members of the Staff are of daily occurrence, and we are grateful to the Physicians and Surgeons, Laryngologists, Radiologists, Pathologists and Dentist, who have so willingly given us the benefit of their opinions and advice. 1,208 cases were referred to the X-ray department alone, an increase of 37 over the previous year. It is now our practice to X-ray all patients whose symptoms or general condition are in any way suggestive of tuberculosis, even in the absence of physical 106 signs of disease. In consequence of the advance in radiological technique and our experience in the interpretation of X-ray films, it is now possible in nearly all cases to detect tuberculosis in its early stage. In spite of this, out of 232 new cases notified as tuberculous during the year, only 92 had early disease, the remainder being in an advanced or moderately advanced stage. These figures are rather disquieting and in my opinion are due to two main causes: (1) The insidious nature of the onset of tuberculosis in the majority of cases, and (2) the reluctance of the average man to seek medical advice until his condition is such that he can no longer carry on with his work. Frequently we meet cases presenting none of the symptoms usually associated with tuberculosis, such as cough, sputum, loss of appetite and weight, etc., yet which, on examination reveal extensive disease. How to secure earlier diagnosis is still one of our main outstanding problems. I think it would be reasonable to state that the Tuberculosis Dispensaries can guarantee early diagnosis, if the cases present themselves for examination in time. The problem, therefore, is really one of securing earlier attendance of patients. There is an all too frequent tendency to lay the onus for the delay on the general practitioner, but in my opinion this is quite unjustified, and I am convinced that he is playing his part satisfactorily. Our relations with the general practitioner are so cordial that he does not hestitate to send a doubtful case to the Dispensary for a further opinion, and it is no fault of his if the patient does not seek his advice until the disease is well advanced. We can seek out the contacts, but our difficulty lies in getting into touch with cases other than contacts, who delay seeking advice for the simple reason that they do not feel ill. As I have previously pointed out, the only solution appears to be the periodic X-ray examination of the whole population. Colossal as this task would be, it has, I believe, been attempted in some countries. Since, however, tuberculosis is largely a disease of adolescence and young adult life, an attempt in the first place might be made to supervise the age period 15-25, as is already being done in the case of children up to the age of 14 by the Infant Welfare Service and the School Medical Service. This, I feel certain, would bring to light many cases of tuberculosis at a stage which would offer a better hope of cure, and help materially to reduce the already falling death rate. Some figures, provided through the courtesy of the Medical Officers of Health, showing the decline in the incidence and death rate of tuberculosis during recent years, may be of interest, and I have accordingly drawn up tables giving the actual number of notifications and deaths in each Borough during the last 20 years. The graphs, showing the notification and death rate per 1,000 of the population, present the information in another form, and are of course corrected for any change in the population. 107 Both Hackney and Bethnal Green inaugurated their Dispensary schemes during the War, but I have purposely omitted this period as the figures during this abnormal time are hardly comparable. It will be seen that during the last 20 years the death rate in both Boroughs has fallen to less than half. No less satisfactory is the decline in the number of persons that contract tuberculosis as shown in the number of notifications. It has been stated that this decline in the tuberculosis mortality rate is only a natural wave in an epidemic curve, and has no relation to the Tuberculosis campaign. Are we to believe that all recent attempts to provide better housing and improved economic conditions have been futile, and that Open-air schools, the boarding-out of children from infected homes, the segregation of the advanced case, and the teaching of the infectious case how to prevent the spread of infection, are useless ? Can one dispute the fact that the onset of poverty in any area is always panied by an increase in the incidence of tuberculosis ? Perhaps the most convincing results of any anti-tuberculosis measure have been obtained by the provision of cleaner milk. Nonpulmonary tuberculosis, mainly a disease of glands, bones and joints, and abdominal organs, is in children largely due to bovine tuberculosis, contracted through infected milk. There is no doubt that the remarkable fall in this type of disease is largely, if not entirely, due to improved milk supply. BETHNAL GREEN Year Population NOTIFICATIONS DEATHS Pulmonary Nonpulmon ary Total Pulmonary Nonpulmon ary Total 1919 110,085 254 65 319 185 31 216 1920 116,600 270 65 335 178 24 197 1921 118,300 244 48 292 158 26 184 1922 118,400 252 48 300 194 25 219 1923 118,700 263 60 323 164 19 183 1924 119,200 202 52 254 134 18 152 1925 119,800 189 54 243 121 21 142 1926 119,600 154 57 211 121 20 141 1927 117,900 151 39 190 115 17 132 1928 112,200 177 43 220 105 18 123 1929 110,500 149 38 187 109 10 119 1930 110,500 153 45 198 96 12 108 1931 109,200 126 45 171 119 13 132 1932 106,300 145 39 184 99 11 110 1933 104,200 109 43 152 74 14 88 1934 102,060 127 28 155 74 7 81 1935 99,910 115 26 141 59 4 63 1986 96,900 111 29 140 65 16 81 1937 94,560 109 24 133 73 7 80 1938 94,560* 113* 16* 129* 66* 12* 78* *Approximate 108 161 cases were admitted to sanatorium or hospital, other than general hospital, during the year. No case offering a reasonable hope of cure, or such improvement as will enable the patient to return to work, is refused admission. The results of treatment are, on the whole, satisfactory, and a stage of arrest or quiescence has been acquired in a quite a number of cases, but the stay in sanatorium is too short in most instances to effect a cure. To obtain this it is essential that a more prolonged course of treatment be provided, and the number of beds available for this purpose, increased. It has been stated that the introduction of surgical methods in the treatment of pulmonary tuberculosis has increased the length of stay in hospital or sanatorium in those cases undergoing such forms of treatment, and accordingly, reduced the accommodation available for other cases. While the former statement is undoubtedly true, the effect on the accommodation must necessarily be very slight, as only a small proportion of cases of pulmonary tuberculosis are suitable for Artificial Pneumothorax. Bethnal Green and Hackney Hospitals admit most of our advanced patients. I pointed out last year that we had occasionally experienced difficulty in securing admission in an urgent case. The shortage of beds still exists and it is to be hoped that the matter will receive attention before the position becomes more serious. In my capacity of tuberculosis consultant, I am able to follow up our cases admitted to Bethnal Green Hospital I visit the Hospital weekly and make a routine round of the tuberculosis wards, supervising treatment generally and selecting cases for Artificial Pneumothorax, and other special forms of treatment. I also examine suspected cases of tuberculosis in other wards, thus helping to secure earlier diagnosis. I would like to take this opportunity of again thanking the medical Staff of the Hospital for their unfailing courtesy and willing co-operation. Thirty-eight of our children were admitted to Stormont House Open-air School during the year. The school, most favourably situated on Hackney Downs, has accommodation for 90 scholars, both boys and girls being admitted. With one or two exceptions all the children come from the Boroughs of Bethnal Green, Hackney, and Stoke Newington, and are patients of the Tuberculosis Dispensaries of the Metropolitan and London Chest Hospitals. The classes are held in open-air shelters and the children are kept under strict medical supervision, records of weight and temperature being kept by the school nurse, while the Medical Officer makes frequent examination of the scholars, and supervises 109 the rest and exercise of each child. Hot milk in the morning and afternoon and an excellent mid-day meal are provided. Breakfast may also be supplied to any child who has not had a satisfactory meal before leaving home. In accordance with the instructions of the London County Council that all scholars attending open-air school should receive an annual holiday, 51 boys and 27 girls were sent to the seaside for a period of two weeks during the summer. Should any children not make satisfactory progress, longer periods of convalescence, varying from three to six months, are provided. All the children attending Stormont House made satisfactory progress during the year and 12 were discharged as fit for work, while 7 had so improved as to permit of their transfer to an ordinary elementary school. The School Medical Officer and the Tuberculosis Officers continue to work in close co-operation in the supervision of contacts. 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, and a report is each child is forwarded to the School Medical Officer. These children are examined and weighed at regular intervals and should a child fail to make satisfactory progress or later reveal any symptoms suggestive of tuberculosis, he is referred back to the Dispensary for a further opinion. The scheme ensures a more systematic supervision than would otherwise be possible, and probably prevents a breakdown in certain cases by the timely provision of treatment, frequently in the form of a period of convalescence at the seaside or in the country. We are indebted to the local charitable organisations for their valuable help during the year. The Hackney and Bethnal Green branches of the Invalid Children's Aid Association, have provided convalescence for our debilitated children. 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 Board 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 Bed Cross Society, have given financial assistance in necessitous cases. Under an arrangement with the London County Council, the Invalid Children's Aid Association is also responsible for the boarding-out of children from tuberculous households. The object of this scheme is two fold; in the first place, to remove children from the danger of infection by another member of the 110 family, and secondly, to enable a parent to enter sanatorium. A mother naturally hesitates to accept the offer of sanatorium treatment until she has made suitable provisions for her children. In certain cases she is able to do this by placing them with relatives or friends, but in other instances no adequate arrangements can be made for their proper care and attention during her absence, and were it not for the boarding-out scheme the mother would be compelled to refuse institutional treatment. The majority of the children are boarded-out with registered foster mothers, but delicate children and babies who require a certain medical supervision are placed in nursing homes in the country or at the seaside. Where the household is badly infected, children may be boarded-out for considerable periods, sometimes extending to years. Parents are not required to make any contribution towards a child's maintenance but may do so if they wish. The scheme has now been in existence since 1925, and is a praiseworthy attempt to solve a very difficult problem. Although more mothers are now persuaded to allow their children to be boarded-out than formerly, it surprises me that still so many refuse. This is partly due to parent's reluctance to surrender a child to a home they have never seen and which, for obvious reasons, they are discouraged from visiting, but not entirely so, as difficulty is frequently experienced in obtaining sanction for admission to a convalescent home. The Handicraft Class, organised by the Hackney and Stoke Newington Tuberculosis Care Committee, continues its useful work. The main object of the Class is to provide patients with an interest to occupy their minds and keep them from brooding over their condition. Among the crafts taught are basket work, artificial flower making, glove making, leather, bead and pewter work, and as any profits on the sale of the articles are paid over to the patients, it enables them to earn a little pocket money. The Class is deservedly popular and well attended, and thanks to the assistance of the Alexandra Rose Day Fund, the Inner Wheel of the Rotary Club and other local bodies, and the support and interest of the Mayors of Hackney and Stoke Newington, is in a sound financial position. As hitherto, our main difficulty lies in the sale of the goods, and further local support in this direction would be appreciated by the Committee. We are indebted to the Mayor and Borough Council of Stoke Newington for permission to hold an Exhibition and Sale at the Mayor's Gallery, last October. We are also grateful to Mrs. Jefferies for kindly opening the Exhibition, and to the Mayor of Stoke Newington for taking the Chair. The public authorities continue to supply extra nourishment to necessitous cases of tuberculosis, the Public Assistance Committee 111 to those in receipt of relief, the Unemployment Assistance Board to those receiving unemployment assistance, while the Borough Councils provide for patients who do not come under the care of these two bodies. The grant in each case is supplied only on the certificate of the Tuberculosis Officer that extra diet is necessary for the proper treatment of the patient. I have always held that efficient nourishment is the first essential in the treatment of tuberculosis, and I feel that any expenditure in this direction is fully justified. The authorities concerned treat our recommendations with every consideration and refuse a grant only in those cases which on investigation are found not to be justified on financial grounds. The schemes are now working smoothly and there appears to be no overlapping. Both the London County Council and the Borough in their re-housing schemes give preferential consideration to the tuberculous, on the recommendation of the Tuberculosis Officer that improved accommodation is desirable in the interests of the patient and for the prevention of the spread of the disease to his family. A large number of blocks of fiats have been recently completed locally and an increasing number of our patients are being re-housed. I submit, at the end of this report, a statistical summary of the work of the department for the year. The tables presented show no striking variation from those of recent years and call for no special comment. In conclusion, I would like to thank the Medical Officers of Health, the Hospital Physicians and Surgeons, the Besident Medical Officer, and the Hospital Secretary for their kindly help and advice, and the Dispensary Staff for their efficient work and loyal support. H. TYLFORD HOWELL. 6th March, 1939. 112 STATISTICAL TABLES. BOROUGH OF BETHNAL GREEN 1. The Totals of New Cases Males 387 Females 350 Total 743 2. The Sources of the New Cases Total Tuberculous Medical Officer of Health 253 27 Local Practitioners 162 25 Contact Cases (per M.O.H.) 234 8 London County Council .... .... London Chest Hospital 12 12 Other Sources 66 48 Transferred from other Areas 16 16 3. The Diagnosis of the New Cases Diagnosis Adults Children under 15 Total Males Females Males Females Pulmonary Tuberculosis 63 45 4 2 119 Non-pulmonary Tuberculosis 7 4 4 2 17 Non-tuberculous 169 201 125 96 591 Doubtful 8 3 2 3 16 Total 252 253 135 103 743 4. The Diagnosis of Contact Cases Pulmonary Tuberculosis 8 Non-pulmonary Tuberculosis .... Non-tuberculous 221 Doubtful 5 Total 234 5. Sputum Examinations Tubercle Bacilli present 50 Tubercle Bacilli absent 306 Total 356 6. Other Figures Total number of attendances 3,488 Systematic examinations 1,928 Number of patients sent to hospital or sanatorium by the L.C.C. 68 Number of letters written 1,743 Number of visits to patients at their homes 136 Number of attendances at:— X-ray Department 562 Dental Department 3 Artificial Pneumothorax Clinic 394 Other Departments 48 113 INDEX page Aged and Infirm Persons 70 Ambulances 17 Bacteriological Examinations (medical) 66 do. do. (food) 75 Bakehouses 78 Bedsteads, Bedding and Clothing (Tuberculosis) 63 Birth Control 38 Births 22, 24, 32 Cancer 30 Chicken Pox 66 Clearance Areas 87 Clinics 14, 34 Combined Drainage Systems 86 Common Lodging Houses 83 Convalescent Treatment47 Cowhouses 78 Day Nurseries 14 Deaths 22, 25 Delicate Children: Clinic for 41 Dental Clinic (M. & C.W.) 41 Dental Treatment of Tuberculous Patients 64 Diphtheria 55 DISEASE, CONTROL OF 55 Disinfection 67 Disinfestation 68 Dispensaries 13 Drainage Work 86 Dried Milk, &c 50 Enlarged Tonsils, Adenoids and Mastoid Disease 43 Enteric Fever 55 Expenditure on Public Health Work 10 Extra Nourishment (M.C.W.) 50 do. (Tuberculosis) 63 Factories and Workshops 97 Finsen Light Treatment 64 Fish Curing and Fried Fish 78 FOOD 71 Food Premises 76 do. Poisoning 70,81 Food and Drugs Acts 71 Foster Children 52 Fried Fish and Fish Curing 78 General Description of District 8 German Measles 65 Hairdressers 86 Health Education 20 41 114 page HEALTH SERVICES 10 do. do. National Campaign to encourage wider use of 21 Health Visitors 33 do. do. Tuberculosis 62 Home Helps 39 Home Workers 99 Hospitals 12 HOUSING 87 Ice Cream 78 Illegitimacy 24 Infant Consultations 40 Infantile Mortality 22, 28 INFECTIOUS DISEASE 55 Inhalation Therapy 45 Insanitary Areas 87 Insurance Acts. National Health 17 INTRODUCTION 6 Invalid Children's Aid Association 15 LEGAL PROCEEDINGS 102 Light Treatment (M.C.W.) 44 do. (Tuberculosis) 64 Malnutrition 48, 54 Marriages 24 Massage 46 Maternal Mortality 22, 28 MATERNITY AND CHILD WELFARE 32 Maternity Clinics 16, 17,35,37 Maternity Institutions 16 Maternity Outfits 39 Measles 65 Meat Regulations 79 Medical Inspection (school children) 52 Medical Practitioners 11 do. do. Consultations with 55 Milk for necessitous mothers and children 49 Milk in Schools 10, 77 Milkshops and Dairies 76 Milk (Special Designations) Order 77 Mortuary 31 Mothers' Clinic 38 Notification of Births 32 Nurses and Nursing Assistance 11,50 Nutrition 48,53, 75 Obstetrical Consultants 39 Offensive Matter 85 do. Trades 85 Open-Air Sleeping Shelter 63 Ophthalmia Neonatorum 52 Orthopaedic Treatment 45 Outworkers 99 Overcrowding 90 Personal Cleansing Stations 19, 69 Pharmacy and Poisons Act 81 Pneumothorax Refills 64 Population 24 Poultry Slaughterers 79 Public Assistance 9 PUBLIC HEALTH COMMITTEE 3 Public Health Expenditure 10 123 115 Page Puerperal Fever and Puerperal Pyrexia 51 Rag and Bone Dealers 86 Rag Flock Act 85 Rats and Mice 84 Registration of Births, Deaths and Marriages 20 Rent Restrictions Acts 84 Sanatorium Treatment 63 Sanitary Inspectors, work of 82 Sanitation and Housing 82 Scabies (Itch) 69 Scarlet Fever 55 School Children: Medical Inspection and Treatment 14, 52 School Meals 10 . School Milk Scheme 10, 77 Shelter for Contacts 67 do. Open-Air Sleeping 63 Shop Acts 87 Slaughterhouses 79 Slaughtermen 79 Smoke Nuisance 84 Social Welfare 9 Special Clinic for Delicate Children 41 Spraying Machines 68 Sputum Outfits 62 STAFF 4 Stillbirths 22, 24 Tenement Houses 84 Tonsils, Adenoids and Mastoid Disease 43 TUBERCULOSIS 59 Tuberculosis Care Committee 62 Tuberculosis Dispensary 19, 62 do. Officer Report of 105 do. Visitors 62 Unsound Food 80 Vaccination 20 Vaccination Returns 58 Venereal Disease 19 Verminous Conditions 68 VITAL STATISTICS 22 Water Supply 84 Welfare Centres 34 Whooping Cough 66 Workshops and Factories 97