ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY G. CLARK TROTTER, M.D., D.P.H , F.R.S.E. President, Incorporated Sanitary Association of Scotland. Fellow of the Royal Society of Medicine, &c., &c. Medical Officer of Health 1920 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health and Housing Committee. Major. Alderman W. H. GREEN, J.P. Chairman. Councillor Mrs. 13. M. DRAPPER, J.P. Vice=Chairman. Councillor J. TIFFEN. Councillor Mrs. M. Charlton. Councillor A. G. Howard. Councillor Miss A. M. Jacob. Alderman E. J. Knight. Councillor Rev. J. Mahoney. Councillor W. F. Marchant. Councillor G. Tarns. Councillor Mrs. L. White. Councillor E. C. Wood. Maternity and Child Welfare Committee Consists of the Members of the Public Health Committee and the following co-opted Members:— Mrs. G. Green, Mayoress. Mrs. Monk. Mrs. Tiffen. Sister Constance Welch, Staff of the Public Health Department. Medical Officer of Health G. Clark Trotter, m,d., d.p.h., f.r.s.e. Assistant Medical Officer of Health Nicholas M. Donnelly, m.b., d.p.h. (Tuberculosis Officer). Ronald Hunter, m.r.c.s., l.r.c.p., d.p.h. (Maternity and Child Welfare Officer.) Public Analyst. Henry G. Harrison, m.a. (Cantab), f.i.c. Sanitary Enspector's. Thomas Turner. John V. Snowdon. Robert D. J. Simpson. Arthur G. Kemp. *Alfred Priest. Frederick Hewett. Philip Shelley. Harry Allam. Albert E. Yates. *Retired June, 1920. Health Visitors. Miss A. S. Baird Miss H. F. G. Piper Miss E. Clubbe Miss W. C. Smart. Miss E. Holland Miss E. T. Stowell Chief Clerk. Charles A. Chapman. Clerk. Henry J. L. Smith F. Giles (temporary). Municipal Dispensary for the Prebention of Consumption, 78 Amersham Vale, New Cross, S.E. Nurse—Miss Porteous. Attendant—G. Abbott. Coroner's Court and Mortuary. Attendant—G. W. }. Wagner. Disinfecting Station. C. F. Dowsett (Chief Disinfector). T. Lyons F. Smith J. Lloyd Cleansing station. Bath Attendant—Mrs. Wagner. School Nurse—Miss Wyatt. Metropolitan Borough of Deptford Public Health Department, Town Hall New Cross Road, S.E. 14. December, 1921. To the the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Ladies and Gentlemen, I have the honour to submit the Annual Report on the Health of the Borough for the year 1920. Included are the statistical tables as prescribed by the Ministry of Health. The Report has been shortened by avoiding repetition of matters which have been fully dealt with in the reports of my predecessor. The estimated population for the middle of the year 1920 was : for the civil population, 1 15,636; and the total population 115,772. The birth-rate for the year was 28.3 per 1,000, which is 7.8 more than that for the previous year, and 1.8 more than for the whole of London. The deaths during the year were 1,408 being 61 less than in the previous year. The death-rate was 12.2 (the lowest recorded) compared with 13.0 per 1,000 for the previous year. The year 1920 furnished a record in having the lowest infantile mortality, the rate being 79 per 1,000 births, as compared with 85 in 1919, which year was also, at that time, the lowest. As regards infectious diseases, there were during the year 723 cases of Scarlet Fever fairly generally distributed throughout the Borough, but the East, North and North-West Wards were more affected than the others. Out of all these Scarlet Fever cases there were but two deaths. Cases of Diphtheria numbered 315, with 21 deaths, the cases being mostly in the North-West and North Wards. 5 I had the opportunity before taking up my duties as your Medical Officer of Health of going over the districts with the Sanitary Inspectors, and also had, before my arrival, read as far as possible the previous Annual Reports. I was therefore able to start right away on the matters which required most attention. The house inspection in the borough, which is detailed within this report, was very thoroughly gone into. The Child Welfare work, owing to the loss of our Assistant Medical Officer, also called for considerable supervision. Diarrhoea in children of two years and under was make notifiable on the 1st August. In November, the premises now occupied as a Maternity Home were inspected by your Committee, and the formal approval of the Ministry was received in December. The Tuberculosis work had to be organised also as had been the case with the Child Welfare work, as Dr. Macdonald resigned in June. I deal with these staff matters in the report. Looking back upon my work in the Borough I feel very grateful for the assistance and encouragement I received from the Council and the help given me by my staff in the difficult circumstances of a time when so many changes were taking place. The progress which was made and continued into the next year— I had no thought at the time, I would not personally review in another report, and can only express my indebtedness for the great interest the Public Health and Maternity and Child Welfare Committees showed, and the stimulus they gave to the work of my department. I am, Your obedient Servant, G. Clark Trotter, Medical Officer of Health. 6 Summary of Vital and Mortality Statistics for 1920. 1920. 1919. Area 1,563 acres 1,563 acres Population— Census 1901 110,398 110,398 Census 1911 109,496 109,496 Estimated to middle of 1920 115,636 111,205 Number of inhabited houses 16,855 16,855 Average number of persons per house 6.9 6.5 Density 74 per acre 71 jper acre Length of Public Streets 53 miles approx. 53 miles approx. Rateable Value £644,159 £621,248 1d. Rate produces (approximately) £2,504 £2,490 Cost of administration of Public Health Department £2,984 £2,617 Marriages 1,045 1,004 Marriage Rate 9.0 8.7 Births 3,276 2,426 Birth Rate 28.3 20.5 Birth Rate, average for the previous 10 years 24.7 25.4 Deaths 1,408 1,469 Death Rate 12.2 13.0 Death Rate, average for the previous 10 years 15.3 15.3 Infantile Mortality 79 per 1,000 85 per 1,000 births births Infantile Mortality, average for 107 per 1,000 109 per 1,000 the previous 10 years births births Zymotic Death Rate 0.8 0.7 Area and Population. Births and Deaths. 8 Acres. 1563 Estimated Civil Population. 115,636 The total population for Deptford has been estimated by the Registrar-General as 115,772. The civil population has been estimated as 115,636. For the purpose of this Report the total population (115,772) has been used in calculating the Birth and Marriage Rate as it includes all the elements of the population contributing to these rates. It consists therefore of all the non-civilians enlisted from this district whether serving at home or abroad. For the Death Rate the estimate of the civil population (115,636) has been adopted as it excludes all the men who have joined the services from this Borough. The estimated civil population for each of the various wards was as follows:— East 22,373 South 12,824 North 25,206 South-East 13,011 North-West 24,797 South-West 17,425 As the Borough has an area of 1,563 acres, the density of the population on this estimate is 74 per acre approximately. The following table shows the total number of dwelling houses and the number inhabited and uninhabited in 1901, 1911, and 1920 respectively:— Year. HOUSES. Inhabited. Uninhabited. Total. 1901 15,823 516 16,339 1911 16,102 491 16,593 1920 16,855 43 16,898 Taking the number of inhabited houses in 1920 to be 16,855 as set forth in the above table, and calculating the population to be 115,636, then the average number of persons per house would be 6.9, 9 Births. Number of births 3726 Average number of births for previous 10 years 2780 Average birth.rate for previous 10 years 24.7 Birth.rate of Deptford per 1000, for 1920 28.3 England and Wales 25.4 96 Great Towns 26.2 148 Smaller Towns 24.9 London 26.5 The total number of births registered in the Borough in 1920 was 3276, as compared with 2426 in 1919. Of these, 1701 were boys and 1575 were girls. This is 496 above the average for the past 10 years and 850 above the figure for 1919. The birth.rate for the Borough was equivalent to an annual rate of 28.3 per 1000 of the population, as compared with 20'5 for 1919, 18.3 for 1918, and 20.1 for 1917. The birth.rate for London was 26.5 per 1000, compared with 18.3 for 1919. The following table gives the number of births and deaths of children under one year of age which have occurred during the past ten years, with the respective rates:— Year. Estimated population. Births. Deaths under one year. No. Rate per 1000. No. Mortality per 1000 births. 1910 119,642 2959 24.7 366 123 1911 109,475 3001 27.4 428 143 1912 109,377 2896 26.5 258 89 1913 109,280 3106 28.0 350 113 1914 109,182 3121 28.6 309 99 1915 110,299 2955 26.8 391 132 1916 110,299 2918 26.5 258 88 1917 115,403 2329 20.1 239 102 1918 114,328 2093 18.3 205 97 1919 115,843 2426 20.5 207 85 Average for 10 years 112,313 2780 24.7 301 107 1920 115,772 3276 28.3 259 79 10 Illegitimate Births. The illegitimate births number 84 or 2.6 per cent. of the total births. These births occurred in the several wards as follows East 19 South 8 North 10 South-East 8 North-West 27 South-West 12 84 Marriages. There were 1,045 marriages in the Borough during the year, as compared with 1,004 in the previous year. The marriage rate for 1920 was equal to 9.0 per 1,000 of the estimated population and has not been exceeded in any year for the past ten years. The rate for 1919 was 8.7 per 1,000. The marriages were celebrated in the following places:— 660 in Churches of England. 99 in other places of worship. 286 in the Superintendent Registrar's Office. 1,045 Total Deaths. Number of deaths for 1920 1,408 Average number of deaths for previous ten years 1,675 Average death.rate for previous ten years 15.3 Death.rate per 1,000 for Deptford for 1920 12.2 „ „ England and Wales 12.4 „ „ 96 Large Towns 12.5 „ „ 148 Smaller Towns 11.3 „ „ County of London 12.4 The number of deaths registered within the Metropolitan Borough of Deptford from all causes during 1920 was 1,003, equal to a death. rate of 8.7 as compared with 1,051 deaths, and a death.rate of 10.1 during the previous year. The total number of deaths belonging to Deptford is obtained by deducting the number of deaths of non. parishioners registered in the Borough, viz., 207, of which number 186 occurred in the Metropolitan Asylums Board's South Eastern Hospital making 796 deaths actually belonging to Deptford. this number we must add 612 deaths of parishioners which occurred in public institutions outside the Borough, making a total of 1,408, of which 748 were males and 660 females, and upon these figures the statistics are based. 11 The death-rate for the Borough was equal to an annual rate of 12.2 per 1,000 of the population, as compared with 13.0 for 1919, 17.9 for 1918, and 16.0 for 1917. The subjoined table shows the number of deaths which have • occurred during the past ten years, with the respective rates. Year. Estimated Population. Deaths. No. Rate per 1000. 1910 119,642 1671 13.9 1911 109,475 1728 15.8 1912 109,377 1442 13.2 1913 109,280 1727 15.5 1914 109,182 1598 14.6 1915 110,299 1962 17.8 1916 110,299 1666 15.1 1917 *103,527 1663 16.0 1918 *102,036 1827 17.9 1919 *111,205 1469 13. 0 Average for 10 years 109,432 1675 15.3 1920 *115,636 1408 12.2 * Civil population. The following table gives the number of deaths belonging to each Ward, and the death rates for each Ward. Ward. Deaths. • Death Rate per 1,000. Males. Females. Children under 1 year. Total. East Ward 165 157 75 322 14.4 North Ward 154 134 50 288 11.4 North-West Ward 141 100 61 241 9.7 South Ward 74 100 17 174 13.6 South-East Ward 1.15 79 27 194 14.9 South-West Ward 99 90 29 189 10.8 Deaths of residents occurring in outlying public institutions are allocated to their respective Wards, according to the addresses of the deceased as received from the Registrar-General's Department. 12 The proportion which the mortality at various ages bears to the total number of deaths during 1919 and 1920 is as follows:— 1919. 1920. Under 1 year 19.3 per cent. 18.4 per cent. deaths. 1 to 2 years 5.4 2.7 2 to 5 „ 4.8 3.5 5 to 15 „ 4.0 4.3 15 to 25 „ 4.0 5.0 25 to 45 „ 13.0 13.2 45 to 65 „ 21.0 24.2 65 years and upwards 28.5 28.7 Infantile Mortality. Total deaths of Infants under one year, 259. 1920. Average for previous 10 years. Deptford Infantile death rate per 1000 births 79 107 England and Wales 80 96 Large Towns 85 148 Smaller Towns 80 County of London 75 Of the 1408 deaths recorded during the year 259 were of infants under one year of age. During the past ten years the infantile death.rate has lallen from 143 to 79 per 1000 births registered. In a previous table is given the infantile mortality per 1000 births for the past ten years. Deaths of Illegitimate Infants. Of the 259 infants who died before attaining the age of one year, 18 or 6.9 per cent. were illegitimate, the mortality amongst them being in the proportion of 214 deaths per 1000 against 76 per 1000 among children born in wedlock. The mortality amongst infants in the various Wards is shown in the following table:— Ward. Births Registered, Deaths under 1 year of age. Infantile mortality per 1000 Births. East 757 75 99 North 770 50 65 North-West 729 61 84 South 304 17 56 South-East 312 27 87 South-West 404 29 72 13 Comparative table of infantile deaths from Diarrhoea and Enteritis. RATE PER 1000 BIRTHS. Diarrhoea and Enteritis under two years. Total deaths under one year. England and Wales 8.3 80 96 Great Towns 10.4 85 148 Smaller Towns 7.8 80 London 9.5 75 Deptford 11.9 79 TABLE SHEWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1920 Births 3276 Deaths—including those in outlying Public Institutions 1408 Excess of Births over Deaths 1868 The following is a list of the principal causes of the 259 infantile deaths in the Borough during 1920, viz.:— Measles 3 Whooping Cough 7 Tuberculosis 4 Meningitis 3 Influenza 1 Bronchitis and Pneumonia 64 Diarrhœal Diseases 37 Enteritis and Diseases of Digestive System Congenital Malformation, Atelectasis, Premature Birth, Debility and Marasmus 98 Other causes 42 259 Maternity and Child Welfare Work. The infant welfare work in the Borough has steadily increased. Dr. Scarisbrick terminated his duties as Assistant Medical Officer on the 1st May, and during the summer under my supervision the work was carried on by Dr. Winifred Buckley and Dr. Annette G. T. Anderson, who took the afternoon clinics, Dr. Buckley also taking the morning ante-natal clinic. While this arrangement worked fairly satisfactorily the Committee considered the increasing work called for 14 a whole-time Assistant, and Dr. Ronald Hunter commenced his duties on the 1st October. Dr. J. H. Rees, who had acted at the TubercuDispensary also acted during a portion of August ond September, pending Dr. Hunter taking up his duties. By Order of the Council after obtaining the necessary confirmation, diarrhoea in children of two years and under was made a notifiable disease, and came into force on the 1st August. It was found upon investigation that the work of the Albany Institute Clinic, which had in the early days of its establishment served mostly Deptford infants, had now comparatively few infants from the Borough, its clientele being drawn mainly from Greenwich. No doubt the opening of our municipal clinics, being nearer, had in large part attracted the mothers. The few still attending the Albany Clinic passed our own clinics on the way, and the Committee were of opinion that the time of the Council's Health Visitor who attended the Albany Clinic could be more usefully employed elsewhere. The severance of the Albany Institute as an affiliated clinic was decided upon not without regret, as undoubtedly it had in the past well served Deptford when the municipal clinics were only being thought of. The disassociation on the ground that the clinic was essentially a Greenwich one did not affect the grant which the Council still continued to make in respect of the four Deptford cots at the Babies' Home connected with the Albany Institute, to which cases continued to be sent, and in this way Deptford is still associated with the Institute which had done so much good work in the past. HEALTH WEEK. Health Week was held from the 2nd to the 8th May. On Thursday. 6th May, a meeting for mothers was held in Zion Chapel, New Cross Road, and on Saturday, the 8th, a mass meeting in Deptford Park. VOLUNTARY WORKERS. The Borough has been fortunate in the great interest which has taken in its Infant Welfare Work. With the large numbers attending the clinics and the many other duties which devolve upon the Health Visitors, it is no exaggeration to say that, but for the help of the ladies who assist voluntarily, the clinics would have been severely handicapped. These ladies who week after week carry on with a true missionary spirit this work, do so I am sure at considerable self-sacrifice. Not only does the undertaking of this work tie them down to regular 15 attendance (otherwise they would be of little use) but the distances of the clinics, such as Erlam Road and Gosterwood Street, involve loss of time and considerable walking. It is work which I think does not always receive the grateful recognition it deserves, as it is from its nature carried on so quietly and unobtrusively, and yet is essentially work of the utmost importance, and which has far-reaching results. The following table gives the number of cases in which free and assisted milk was supplied to mothers up to the end of the year:— Applications considered by Milk Sub-Committee, Total, 1,559, dealt with as follows :— Granted free 695 „ at half-price 458 „ at three-quarter price 113 Refused or adjourned for further enquiry 293 Cost of milk, year ended 31st March, 1921, including dried milk:— £ s. d. 3,513 7 11 Receipts 2,303 18 2 Net Cost £1,209 9 9 16 GOSTERWOOD MALL CLINIC. 1920. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 17 6 8 218 249 133 February 4 25 11 2 11 49 287 336 142 March 5 17 1 2 8 28 420 448 191 April 3 19 3 6 2 30 191 221 58 May 4 29 4 4 8 45 334 379 155 J une 4 28 6 6 4 44 369 413 165 July 4 19 1 1 2 23 343 386 144 August 4 23 2 8 6 39 382 421 167 September 4 19 4 1 5 29 370 399 134 October 4 20 2 2 7 31 405 436 165 November 5 19 2 5 3 29 403 432 176 December 3 6 2 5 2 15 167 182 88 Total 48 241 44 42 66 393 3889 4282 1718 HALES STREET CLINIC. 1920 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 29 7 6 2 42 197 239 88 February 4 29 2 4 3 35 233 268 72 March 4 16 1 8 2 25 217 242 72 April 5 17 4 3 4 24 176 200 64 May 4 14 1 2 1 17 174 191 61 June 4 13 1 3 1 17 162 179 40 July 5 22 .. 4 4 26 197 223 57 August 4 14 2 4 .. 20 217 237 61 September 5 15 .. 1 1 16 221 237 63 October 4 19 .. 3 2 22 368 380 39 November 4 18 1 3 3 22 233 305 78 December 4 7 .. 1 1 8 346 354 77 Total 52 213 19 42 24 274 2798 3072 822 17 NAPIER STREET CLINIC. 1920. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 23 2 5 17 47 216 263 130 February 4 23 2 2 13 40 309 349 156 March 5 11 1 2 7 21 354 375 160 April 3 15 4 5 4 28 177 205 106 May 3 11 3 5 3 22 223 245 112 June 5 19 4 3 7 83 379 412 196 July 4 15 4 4 1 24 248 272 151 August 4 19 2 4 6 31 314 345 156 September 4 16 3 5 6 29 298 327 161 October 4 21 3 6 6 36 377 413 200 November 5 16 • • 5 3 24 430 454 194 December 3 4 1 1 .. 6 172 178 80 Total 48 193 29 47 72 341 3497 3838 1802 GOLSMITHS' COLLEGE CLINIC. 1920 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5. January 5 23 1 9 6 39 398 437 113 February 4 25 4 7 2 38 350 388 152 March 4 14 1 4 7 26 334 360 130 April 4 18 5 3 6 32 358 390 138 May 3 14 2 3 3 22 264 286 104 June 4 30 5 7 3 45 321 366 116 July 5 21 5 8 4 38 452 490 181 August 4 14 3 11 2 30 428 458 155 September 5 25 4 6 4 39 588 627 194 October 4 17 .. .. 3 24 515 539 171 November 4 14 .. 4 3 21 423 444 161 December 3 5 1 8 1 15 306 321 136 Total 49 220 31 74 44 369 4737 5106 1751 18 BESSON STREET CLINIC. 1920. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5. January 4 18 2 12 11 43 281 324 168 February 2 8 4 5 4 21 112 133 71 March 4 18 3 6 2 29 312 341 177 April 4 21 7 4 3 35 312 347 160 May 4 17 3 2 4 26 323 349 133 June 5 19 4 10 4 37 459 496 207 July 4 11 4 3 6 24 316 340 130 August 4 18 4 5 .. 27 348 375 169 September 4 14 3 4 4 25 401 426 187 October 5 12 1 5 5 25 551 576 220 November 4 8 .. 11 3 22 364 386 154 December 4 9 .. 3 1 13 323 336 158 Total 48 173 39 70 47 329 4103 4430 1907 ERLAM ROAD CLINIC. 1920 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5 January 4 15 1 2 9 27 122 150 107 February 4 18 5 3 5 31 183 214 101 March 4 20 1 3 7 31 228 259 146 April 4 9 4 .. 3 16 203 219 98 May 4 11 4 1 3 19 203 222 102 June 5 15 1 2 4 22 230 253 143 July 4 12 1 3 3 19 176 196 93 August 4 14 2 1 4 21 198 220 119 September 5 10 1 1 3 15 264 279 110 October 4 11 1 2 .. 14 250 264 113 November 4 3 .. 2 .. 5 199 205 94 December 4 10 1 .. .. 11 160 171 83 Total 50 148 22 20 41 231 2416 2652 1309 19 NOTIFICATION OF BIRTHS ACT. The number of births notified under the Act was 3237, notifications being received as follows:—665 from doctors; 1,577 from midwives; 928 from parents: 133 from other persons. 117 parents were warned in respect of their delay in complying with the Act. The distribution or visits in the different wards was as follows :— Ward E. N. N.W. S. S.E. S.W. Total. Miss Baird Visits 1016 .. .. .. .. .. 1016 Revisits 1848 .. .. .. .. .. 1846 Total 2864 •• .. .. .. .. 2864 Miss Clubbe Visits .. .. .. .. .. 825 825 Revisits .. .. .. .. .. 1567 1567 Total .. .. .. .. .. 2392 2392 Miss Holland Visits .. .. .. 418 564 .. 982 Revists .. .. .. 605 1367 .. 1972 Total .. .. .. 1023 1931 .. 2954 Miss Piper Visits .. 1370 .. .. .. .. 1370 Revisits .. 1972 .. .. .. .. 1972 Total .. 3312 .. .. .. .. 3342 Miss Smart Visits 855 .. .. .. .. .. 855 Revisits 1284 .. .. .. .. .. 1284 Total 2139 .. .. .. .. .. 2139 Miss Stowell Visits .. .. 1383 .. .. .. 1383 Revisits .. .. 2283 .. .. .. 2283 Total .. .. 3666 .. .. .. 3666 Total Visits 1871 1370 1383 418 564 825 6431 Revisits 3132 1972 2283 60S 1367 1567 10956 Total 5003 3342 3666 1023 1931 2392 17357 20 SUMMARY OF WORK OF HEALTH VISITORS. The work done by the health visitors is summarised in the following Table:— 1st visits Re-visits Total Births 3049 9878 12927 Still Births 81 124 205 Infant Deaths 235 2 237 Expectant Mothers 268 454 722 Puerperal Fever 15 13 28 Ophthalmia Neonatorum 20 84 110 Measles 350 150 506 Pneumonia 1 — 1 Diarrhoea 129 133 262 Verminous Children 33 25 58 Scabies 89 31 120 Miscellaneous 1011 9 1020 Unsuccessful visits 1138 23 1161 Totals 5,431 10,926 17,357 Feeding. Of the 3,049 births visited (at first visit)— 2,711 Breast Fed. 159 Mixed Feeding. 179 Hand Fed. Births Notified, Year 1920. Ward. Births Notified, Alive. Dead. By whom Notified. Total. Male, Female. Parent. Doctor. Midwife Other Person. East 747 408 339 730 17 79 113 540 15 North 774 411 363 743 31 164 227 366 17 North-west 694 320 374 681 13 215 112 304 63 South 295 160 135 289 6 164 47 66 18 South-east 310 181 129 303 7 114 64 120 12 South-west 417 218 199 407 10 192 102 115 8 3237 1698 1539 3153 84 928 665 1511 133 21 Table No. 1. METROPOLITAN BOROUGH OF DEPTFORD. VITAL STATISTICS OF WHOLE DISTRICT DURING 1920 AND PREVIOUS YEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Under 1 year of Age. At all Ages. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1914 109,182 3,071 3,121 28.6 1,145 10.5 163 616 309 99 1,598 14.6 1915 110,299 2,891 2,955 26.8 1,406 12.7 144 700 391 132 1,962 17.8 1916 110,299 2,838 2,918 26.5 1,126 10.2 135 675 258 88 1,666 15.1 1917 103,527 2,262 2,329 20.4 1,091 10.5 161 733 239 102 1,663 16.0 1918 102,036* 2,085 2,093 18.3 1,361 13.3 230 696 205 97 1,827 17.9 1919 111,205* 23,96 2,426 20.5 1,051 95 202 620 207 85 1,469 13.0 1920 115,636* 3,191 3,276 28.3 1,003 10.1 207 612 259 79 1,408 12.2 Area of District in acres (land and inland 1,563. water). *Civil population. Total population at all ages 109,496. At census Total families or separate occupiers, 25,040. 1911. 22 Table No. 2. METROPOLITAN BOROUGH OF DEPTFORD Causes of, and Ages at Death during the Year 1920. CAUSES OF DEATH. Nett Deaths at the subjoined Ages of "Residents ' whether occurring within or without the District. All Ages. 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 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 All causes Certified Enteric Fever 1 .. .. .. .. .. 1 .. .. Small Pox • • .. .. .. .. .. .. .. .. Measles 19 3 10 5 1 .. .. .. .. Scarlet Fever 2 .. . . .. 2 .. .. .. .. Whooping Cough 16 7 4 4 1 .. .. .. .. Diphtheria and Croup 21 . . .. 13 8 .. .. .. .. Influenza 16 1 • • 1 1 2 5 4 2 Erysipelas 2 .. .. .. .. .. .. 2 .. Phthisis (Pulmonary Tuberculosis) 128 1 .. .. 6 29 53 37 2 Tuberculous Meningitis 11 3 2 1 3 1 .. 1 .. Other Tuberculous Diseases 18 .. 1 1 7 3 2 2 2 Cancer, malignant disease 116 .. . . .. .. 1 10 64 41 Rheumatic Fever 19 .. .. .. 8 2 4 5 .. Meningitis 8 3 • • 4 .. • • • • 1 .. Organic Heart Disease 107 1 .. .. 3 2 17 41 43 Bronchitis 134 24 3 3 2 1 6 35 60 Pneumonia (all forms) 124 37 12 10 1 4 15 31 14 Other diseases of Respiratory Organs 25 3 1 2 .. 1 4 7 7 Diarrhoea and Enteritis 44 37 2 .. .. .. • • 3 2 Appendicitis and Typhlitis 6 .. .. 1 1 1 3 .. .. Cirrhosis of Liver 3 .. .. • • .. .. .. 2 1 Alcoholism 1 .. .. .. .. • • 1 .. .. Nephritis & Bright's Disease 24 .. .. • • 2 1 7 9 5 Puerperal Fever 11 .. .. .. .. 1 8 2 .. Other accidents and diseases of Pregnancy and Parturition 1 .. .. .. .. .. 1 .. .. Congenital Debility and Malformation, including Premature Birth 102 98 3 1 .. .. .. .. .. Violent Deaths (excluding Suicides) 45 5 1 .. 6 11 3 12 7 Suicides 14 . . . . .. .. 1 5 6 2 Other defined diseases 389 36 .. 3 8 9 41 77 215 Diseases ill-defined or unknown 1 .. .. .. .. .. •• .. 1 1408 259 39 49 60 70 186 341 | 404 23 Table No. 3. METROPOLITAN BOROUGH OF DEPTFORD. Infantile Mortality, 1920. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. All Causes Certified Uncertified .. .. .. .. •• .. •• .. .. .. Small Pox • • .. .. .. . . . . . . .. .. .. Chicken Pox .. .. .. .. . . . . .. .. .. .. Measles .. .. .. .. . . .. . . 2 1 3 Scarlet Fever .. .. .. .. .. . . .. .. .. .. Whooping Cough .. .. .. .. .. .. 3 3 1 7 Diphtheria and Croup .. .. .. .. .. .. .. . . . . .. Erysipelas .. .. .. .. .. .. .. .. . . . . Tuberculous Meningitis .. .. .. .. .. .. 2 1 .. 3 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. 2 .. 1 .. 3 Convulsions 3 2 .. .. 5 3 .. 1 1 10 Laryngitis .. .. .. .. .. .. .. .. . . .. Bronchitis 2 1 2 1 6 10 7 1 .. 24 Pneumonia (all forms) .. .. .. 2 .. 9 14 7 5 37 Diarrhœa .. .. 1 . . 1 5 2 1 1 10 Enteritis .. 1 .. 2 3 11 9 1 4 28 Gastritis .. .. .. .. .. 2 1 .. .. 3 Syphilis .. .. .. .. . . 2 .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. . . .. .. .. Injury at Birth 5 1 .. .. 6 .. .. . . .. 6 Atelectasis 4 .. .. .. 4 1 .. • • .. 5 Congenital Malformations 3 l .. 1 5 2 1 .. 1 9 Premature Birth 37 4 3 1 45 6 4 .. .. 55 Atrophy, Debility, and Marasmus 7 3 1 1 12 16 5 1 .. 34 Other Causes 4 1 2 1 8 5 3 1 2 19 65 14 9 9 97 74 51 20 17 259 Nett Births—Legitimate, 3192; Illegitimate, 84. Nett Deaths—Legitimate infants, 241; Illegitimate infants, 18. 24 Table No. 4. METROPOLITAN BOROUGH OF DEPTFORD. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1920. Notifiable Disease Number of cases notified. Total cases notified in each Ward. Total Cases Removed to Hospital. At all Ages At Ages—Years East Ward North Ward North-West Ward South Ward South-East Ward South-West Ward Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera • • .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 315 5 79 180 32 17 2 .. 48 65 65 33 47 57 296 Erysipelas 32 2 2 8 11 30 20 9 37 16 9 2 8 10 .. Scarlet fever 723 7 174 467 56 18 1 .. 118 210 175 52 88 80 701 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 11 .. 1 3 4 3 .. .. 1 2 4 1 3 .. 9 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 18 .. .. .. 6 12 .. .. 7 4 2 2 2 1 17 Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 250 .. 3 40 55 94 55 3 84 68 43 8 29 18 110 Other forms of Tuberculosis 68 7 12 26 10 9 4 .. 21 15 18 4 6 4 5 Ophthalmia Neonatorum 26 26 .. .. .. .. .. .. 12 7 3 .. .. 4 8 Anthrax 1 .. .. . . . . 1 .. .. .. .. 1 .. .. .. .. Infantile Enteritis 162 96 66 .. . . . . . . .. 104 30 6 2 12 8 .. Acute Pneumonia 82 6 19 12 9 21 13 2 30 9 27 4 8 4 .. Malaria 23 .. .. .. 6 15 2 .. 9 5 6 .. 1 2 .. Dysentery 2 .. .. .. 2 .. .. .. .. .. 2 .. .. .. .. Enceph. Lethargica 2 • • .. .. • • 1 1 .. 1 .. .. 1 • • • • 2 Totals 1765 149 356 746 181 221 98 14 472 431 361 109 204 188 1148 Infectious and other Diseases. 26 INFECTIOUS AND OTHER DISEASES. The list of notifiable infectious diseases has been extended and now includes the following diseases, viz.:—Scarlet Fever, Diphtheria, Erysipelas, Enteric Fever, Puerperal Fever, Cerebro-Spinal Fever, Pulmonary Tuberculosis, other Tuberculous Diseases, Smallpox, Ophthalmia Neonatorum, Poliomyelitis, Anthrax, Primary Pneumonia, Influenzal Pneumonia, Malaria, Dysentery, Trench Fever, Encephalitis lethargica Polio-Encephalitis and Diarrhoea in children of two years of age and under. Notifiable Infectious Diseases. Under the provisions of Public Health (London) Act, 1881, and the Tuberculosis Regulations, 1,765 notifications of cases of infectious diseases were received, as compared with 3,087 in 1919. This decrease is entirely due to the fact that by Order of the Ministry of Health, Measles is no longer a notifiable disease. Deaths from Epidemic Diseases. To the seven principal epidemic diseases (Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever, Diarrhoeal Diseases) 98 deaths were ascribed, and the death-rate from them was 0.8 per 1,000 of the estimated civilian population, as against 0.7 per 1,000 in the preceding year. A summary of the deaths from epidemic diseases will be found in Table 2, and a list of the cases notified in Table 4. Bacteriological Examinations made at the Seamen's Hospital. Material. Total Specimens examined. Number positive. Number negative. Swabs for Diphtheria 469 97 372 Sputa for Tuberculosis 22 3 19 Blood for Enteric Fever 13 2 11 Blood for Wasermann reaction 1 — 1 Films for Gonococcus 4 — 4 Total 509 102 407 In addition to the above, 578 specimens of sputa were examined at the Council's Tuberculosis Dispensary. 27 Small-Pox. It is satisfactory to note that no case of Small-pox was notified during the year. No deaths have occurred from this complaint in the Borough since 1902, in which year there were 30 deaths out of a total of 139 cases; in the next year only two cases were notified with no deaths. In 1918 one case was notified which ended in recovery. Scarlet Fever. 1920 Average of previous 10 years. Number of cases 723 415 „ deaths 2 9 Death rate per 1,000 in Deptford 0.02 0.07 747 notifications were received during the year 1920, relating to 723 cases. Of these, 12 cases were errors in diagnosis and cases which occurred in hospital, thus reducing the net number of cases to 711. The number of cases for 1920 was in excess of that in the previous year. The deaths were 2, compared with 9, 3 and 6 in the 3 preceding years. The death-rate was 0.02per 1,000, and for the three preceding years 0.02, 0.03 and 0.05 respectively. The rate of mortality for England and Wales was 0.04, for the 96 great towns 0.04, for the 148 smaller towns 0.03, for the County of London 0.05 per 1,000. Seven hundred and one of these cases were removed to hospital, and previous records show that the percentage of deaths is much lower if the patient is treated in hospital than if nursed at home. Diphtheria. 1920 Average for previous 10 years. Number of Cases 315 219 Number of Deaths 21 18 Death-rate per 1,000 0.18 0.16 The total number of notifications received was 321, relating to 315 cases. Of the number notified, 11 were errors of diagnosis, reducing the number of cases to 304 compared with 261, 240 and 195 for the previous three years. 28 Twenty-one deaths were registered during the year. The rate of mortality was 0.18 per 1,000. The death-rate for England and Wales was 0.15, for the 96 great towns 0.16, for the 148 smaller towns 0.14, and for the County of London 0.22. The disease was most prevalent in the latter part of the year. The cases were distributed in the various wards as follows:— East 48, North 65, North-West 65, South 33, South-East 47, and South-West 57. Two hundred and ninety-six cases were removed to hospital. Enteric Fever. 1920 Average of previous 10 years Number of Cases 11 15 Number of Deaths 1 4 Death-rate per 1,000 0.01 0.03 During the past year we had 11 cases notified, as compared with 8 cases in 1919. One death was attributed to that disease during the year. The death-rate for Deptford was 0.01 per 1,000. The case mortality for 1920 was 9 per cent., compared with 25 per cent, last year. The rate of mortality for England and Wales was 0.01, for the 96 great towns 0.01, for the 148 smaller towns 0.02, and for the County of London 0.01. The cases were distributed in the different wards as follows:— East 1, North 2, North-West 4, South-East 3 and South 1. Bacteriological examinations were made of 13 specimens of blood, of which 2 were found to be positive and 11 negative. Erysipelas. 1920 Average of previous 10 years. Number of Cases 82 145 Number of Deaths 2 - Eighty-two cases of Erysipelas have been notified during 1920. I here were two deaths registered from the disease. 29 Puerperal Fever. 1920 Average for previous 10 years. Number of Cases 18 4 Number of Deaths 11 - Eighteen cases of puerperal fever were notified, compared with 9, 5 and 3 for the three years preceding. The case mortality was 61 per cent. compared with 33.3 per cent. for 1919 and 90 per cent. for 1918. Should a case of Puerperal Fever be notified it is carefully enquired into by the Medical Officer of Health and the Health Visitor. Disinfection is carried out, and every effort made to prevent further cases. In addition to the above the following section of the rules of the Central Midwives' Board was rigorously enforced:— "Whenever a midwife has been in attendance upon a patient suffering from puerperal fever or from any other illness supposed to be infectious, she must disinfect herself and all her instruments and other appliances, to the satisfaction of the local Sanitary Authority, and must have her clothing thoroughly disinfected before going to another labour. Unless otherwise directed by the supervising authority, all washable clothing should be boiled, and other clothing should be sent to be stoved (by the local Sanitary Authority), and then exposed freely to the open air for several days." Ophthalmia Neonatorum. Twenty-six cases were notified during the year, and were visited by the Health Visitors. Twelve of the cases were in the East Ward, seven in the North Ward, three in the North-West Ward and four in the South-West Ward. Epidemic Cerebro-Spinal Meningitis, Acute Polio-Myelitis or Polio-Encephalitis. No cases of these diseases were notified in the borough, but we have received notifications from the County Council of cases occurring in other Metropolitan Boroughs. Plague. No case of plague occurred during the year. 30 Chicken Pox. This disease was not notifiable in 1920 and there were no deaths, although a fair number of cases occurred amongst school children. Glanders. No case of the above disease was notified during the year. Anthrax. One case of Anthrax was notified in the person of a man, aged 39 years, resident in this Borough and employed by a firm of hide and skin dressers in the Borough of Bermondsey. The pustule developed on the neck. The patient received prompt treatment at Guy's Hospital and recovered. Continued and Typhus Fever. No case of Continued Fever was notified during the year. We have had no case of Typhus Fever since 1903, when we had one case, and in 1901 we had eight cases. Diarrhœa and Enteritis. 1920 Average of previous 10 years. Number of Cases notified 162 — Number of Deaths 44 73 Death-rate per 1,000 (all ages) 0.38 0.48 Death-rate per 1,000 (under two years of age) 0.34 0.45 Death-rate in 1911 per 1,000 was 1.72. These diseases were the cause of 44 deaths during 1920. Of this number 37 were of children under one year of age, 39 of the 44 being under two years of age. The death rate was 0.38 per 1,000 at all ages, and 0.34 for infants under two years of age. The cases of this disease occurred among the inhabitants of the various Wards as follows:— East 104. North 30 North-West 6. South 2. South-East 12. South-West 8. 31 Measles. 1920. Average for previous 10 years. Number of Deaths 19 49 Death rate per 1,000, Deptford 0.16 0.42 The number of cases of Measles dealt with during the year was 356, as compared with 1,439 for the previous year with 19 deaths. The cases occured among the inhabitants of the various wards as follows :— East 87 North 72 North-West 78 South 43 South-East 49 South-West 27 The rate of mortality for England and Wales was 0.19, for the 96 great towns 0.22, for the 148 smaller towns 0.19, and for the Metropolis as a whole 0.22. Whooping Cough. 1920 Average for previous 10 years. Number of Deaths 16 34 Death-rate per 1,000, Deptford 0.14 0.30 This disease was the cause of 16 deaths, compared with 1, 30 and 24 for the three preceding years. The death-rate per 1,000 persons living was 0.14 as compared with 0.11 for England and Wales, 0.14 for the 96 great towns, 0.10 for the 148 smaller towns and 0.l7 for the County of London. Leprosy. There were no known cases of Leprosy in the borough during the year. Pulmonary Tuberculosis. Number of cases notified in 1920 250 Number of deaths 128 Death-rate per 1,000, Deptford 1.1 Phthisis was the cause of 128 deaths during 1920, compared with 133 for 1919. The death-rate was l.l per 1,000 persons, compared with 1.2 and 1.6 for the two preceding years. 32 The following table gives the number of cases notified in each ward:— East 84 South 8 North 68 South-east 29 North-west 43 South-west 18 Whole Borough 250 AGES AT WHICH DEATH OCCURRED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. 1 — 6 29 53 37 2 1 28 General Tuberculosis. Twenty-nine deaths were recorded as being due to these diseases. Eleven deaths were classified as tuberculous meningitis and 18 as other tuberculous diseases. Sixty-eight cases were notified, their distribution being shown in the following table:— EastWard 21 North Ward 15 North-West Ward 18 South Ward 4 South-East Ward 6 South-West Ward 4 The following gives the ages at which death occurred:— Cause. Under 1 1 to 2 2 5 to 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Tubercular Meningitis 3 2 1 3 1 ~~ 1 - Other Tubercular) Diseases - 1 1 7 3 2 2 2 Disinfection was carried out as in previous years when patients left their homes to enter sanatoria, Poor Law Institutions, etc., and in the case of death. 33 Tuberculosis Control. On the 22nd January the Borough Council approved of the establishment of a Home of Rest for advanced cases of pulmonary tuberculosis, jointly with neighbouring boroughs. The scheme, however, was finally abandoned in view of the fact that the central authorities were making provision vitally affecting the future administration of the control and treatment of tuberculosis in London. Dr. Murdoch Macdonald resigned his post of Tuberculosis Officer in June, 1920, and from the 19th July I had the temporary assistance of Dr. J. R. Rees, pending the present Tuberculosis Officer, Dr. Donnelly taking up his duties, which he did on August 23rd. Dr. Donnelly has prepared a summary of the tuberculosis work which is appended. In reference to his remarks regarding the home conditions, both the suggestions regarding the obtaining of extra accommodation—grant in aid of an extra room—and in certain cases the giving of a bed on loan—I have had experience of. The extra accommodation subsidised did not find favour many years ago with the Local Government Board owing to difficulties of financial control, but I have seen the same system applied by a Society. The loaning of beds is more feasible, but in all these matters the difficulty in London is multiple control. The patient comes under the dispensary or not, and is under another authority for indoor institutional treatment, while the home attention of the insured devolves upon the panel doctor. These conditions do not make for simplification. An authority which controls all tuberculosis work, including treatment, can in suitable cases easily lend beds. Advanced cases are best dealt with in a home such as was considered as I have before mentioned. The work of the After Care Committee in Deptford has been so well carried out that it seems but a just reward that it receive all the supplementary assistance possible. Tuberculosis Dispensary. Dr. Donnelly reports as follows :— In June of this year, Dr. Macdonald, who was Tuberculosis Officer of the Borough for six years, resigned, and a locum tenens carried on the work until the present Tuberculosis Officer took up his duties at the end of August. This report must consequently suffer from the loss of Dr. Macdonald's many year's experience of the patients and their conditions of life and from the interruption necessitated by the change over. 34 During 1920, new cases to the number of 689 were examined at the Dispensary. This includes 251 contacts and also 61 ex-service men who were referred to the Dispensary by the Ministry of Pensions. Of the total number examined 190 were insured persons. The number of attendances recorded by all patients was 6,615, being 816 more than last year. Of the new cases 199 were found to be suffering from pulmonary tuberculosis and 38 from non-pulmonary tuberculosis: 127 were doubtful and kept under observation and the remainder were discharged as non-tuberculous. Death—Notification Interval. in amplification or the statement made last year with reference to this point, an examination of 157 deaths belonging to the Borough attributed to tuberculosis in the death returns reveals the following information:— Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Cases not notified 26 18 Cases notified at death 15 5 Cases notified one month before death 8 3 Cases notified three months before death 19 2 Cases notified six months before death 6 - Cases notified more than six months before death 54 1 Of the cases not notified, more than half were deaths occurring in Institutions. Whatever the condition of the patient on admission, a diagnosis of tuberculosis must have been arrived at before death and ought to have been notified. It must be borne in mind that notification is the only means of bringing the disease to the knowledge of the Public Health Department, and that the earlier the notification the more valuable the information. During the year 318 cases (250 pulmonary and 68 non-pulmonary) were notified. The distribution of the cases is shewn below :— WARD DISTRIBUTION. E. N. N.W. S. S.E. S.W. Total. Pulmonary Tuberculosis 84 68 43 8 29 18 250 Non-Pulmonary Tuberculosis 21 15 18 4 6 4 68 105 83 61 12 35 22 318 35 This gives an incidence figure per year (pulmonary tuberculosis) of 2.7 per 1,000 on an estimated population of 115,636. With regard to the patients attending the dispensary the same procedure and the same methods of treatment were carried out as have been indicated in previous reports. It was found as the result of the continued growth in the number of attendances at the Dispensary, that on some days as many as 70 or more attendances were registered. With such numbers, sufficient attention and examinations as frequently as desirable could not be given in each case, and it was therefore decided that the number of sessions should be increased and the following time-table was adopted in November:— Monday and Thursday 9.30 to 11 a.m. Men. Tuesday Evening 6.30 „ 7.30 p.m. Men at work. Tuesday and Friday 9.30 „ 11a.m. Women. Friday Evening 6.30 „ 7.30 p.m. Women at work. Monday 2.0 „ 3.0 p.m. Children NOT at School. Saturday 9.30 „ 11.0 a.m. Children attending School. This it will be seen gives separate times for men and women, another evening session and a Saturday morning session for school children, so that schooling is interfered with as little as possible. Notice of this change was given to the medical profession, and the opportunity was taken of drawing their attention to the great importance of the examination of "contacts," to secure their co-operation in this respect. The return of work shows also a continued increase in the clerical and bacteriological work which has been carried out very willingly by the clerk-dispenser. The suggested joint home for Deptford, Greenwich and Lewisham, referred to by Dr. Macdonald in his last report has not been established, so that for the majority of advanced cases the Deptford and Greenwich Hospital is the only available institution affording the necessary treatment. Very many patients will not go there as long as they can struggle along in their own homes where they remain centres of 36 infection. It is just in their last days that owing to the continued attention they need from the other members of the family, and to weakness, preventing their taking proper precautions, they are most liable to infect, especially under the home conditions in which so many of our people live. The investigation of the sleeping arrangements of another 300 patients showed that only 105 slept in a separate room, 121 slept with another person in the room, nearly always in the same bed. The remainder had two or more persons also in the room, and in only a few of these had the patient a separate bed. Not only is infection spread in this way, but where patients have had good sanatorium treatment the good results obtained are not likely to be maintained under such conditions. Experience of the work of the whole-time nurse shows that adequate visiting and re-visiting, following up of "contacts" and "observation" and "supervision" cases cannot be done by one nurse, who has the work to do in addition to attendances at Dispensary during the hours patients are seen. It is intended to ask the Council's sanction for the temporary appointment of a part-time nurse and to make subsequent recommendations on the result of this measure if adopted. The Care Committee's work is rendered difficult by post war conditions, lack of funds and voluntary visiting, which latter is still carried out almost entirely by the Hon. Secretary. It would be of great advantage for prevention and treatment if a fund could be created whereby help could be given in the way of clothing, money to assist payment of cost of better accommodation, such as another house, room or bed, and rest periods or holidays for patients (or for non-tubercular contacts who are in poor health and liable to be easily infected, or for boarding children of tuberculous parents away from their homes with healthy foster parents in good circumstances). During the year 111 patients were admitted to sanatoria. Four notifications on Form C of cases admitted to Poor Law Institutions were received, though the actual number of such admissions was much in excess of this. The discrepancy arises owing to the fact that many cases which should properly have been notified on Form C were notified on Form A, probably under the impression that they were primary notifications. Full details as to the work of the dispensary will be found in the tables appended. 37 Metropolitan Borough of Deptford, Return as to Work carried out in connection with the Deptford Dispensary for the period from 1st January, 1920, to 31st December, 1920. Insured. Uninsured. Males. Females. Children under 16. Adults. Males. Females 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 129 51 353 43 113 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 76 23 65 9 26 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 6 1 27 - 4 (d) Number included under 1 (a) who were found to be non-tuberculous 32 15 204 22 52 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 15 12 57 12 31 Insured. Uninsured. 2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) ) 2985 3630 (b) Number of the above attendances at which systematical physical examinations and records were made 748 984 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions 54 30 4. Number of visits to patients at their own homes by the Dispensary nurses in connection with the supervision of home conditions and "following up " 913 994 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 16 39 6. Number of consultations with the— (a) Medical Adviser of the Insurance Committee - - (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated - - (c) Practitioners at the homes of patients 62 20 7. Number of written reports concerning individual patients made to— (a) Public authorities 695 248 (b) Practitioners 52 15 8. Number of specimens of sputum examined 378 200 38 METROPOLITAN BOROUGH OF DEPTFORD. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 4th January, 1920 to 1st January, 1921. Notifications on Form A Notifications on Form B. Number of Notifications on Form C. Age Periods. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Cases admitted to 0-] 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications. Poor Law Institutions. Sanatoria. Under 5 5-10 10-15 Total Primary Notifications, Pulmonary— Males ... 1 12 7 9 12 29 23 31 8 3 135 167 1 1 ... 2 2 ... 63 Females ... ... 6 12 14 20 25 17 8 8 ... 110 137 1 1 1 3 4 3 44 Non-Pulmonary Males 1 7 9 9 7 1 4 1 ... 2 ... 41 46 ... ... 2 2 3 1 2 Females 6 4 4 1 1 1 3 1 1 1 ... 23 25 1 ... 1 2 3 ... 2 * Re-notifications. 39 Pneumonia. There were 82 cases of Pneumonia notified as being associated with Influenza. 30 cases from the East-Ward, 9 from the North, 27 from the North-West, 4 from the South, 8 from the South-East, and 4 from the South-West,; 25 of the cases were under 5 years of age. The deaths from Pneumonia of all forms numbered 124, of these 37 were under one year of age, 22 under 5 years, and 14 were 65 years and upwards. Bronchitis. There were 134 deaths from Bronchitis which was most severe in the East and North Wards. Influenza. There were 16 deaths from this disease, 11 of them being adults over 25 years of age. Disinfecting Work—Shelter. The Public Health (London) Act, 1891, Section 60, Sub-Section 4, imposes on the Sanitary Authority the duty of making provision for the temporary housing of persons who are compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the Sanitary Authority. The accommodation provided consists of a detached building containing two separate and distinct tenements, each consisting of two bedrooms, kitchen, larder, bathroom, and w.c. The shelter was not used during the year. The disinfection of infected clothing and bedding has been carried out at the Disinfecting Station, Watson Street. 40 Table SHOWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1920. Date 1920 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses. Sheets. Blankets. Odd articles Articles destroyed. January 149 165 85 162 72 22 68 106 110 February 90 92 60 138 40 25 44 87 148 March 115 122 68 161 55 46 76 109 449 1 bed, 2 palliasses, 2 pillows, 1 bolster, 55 odd articles April 102 118 56 117 42 20 46 85 113 15 odd articles May 111 131 49 121 38 21 43 60 69 2 mattresses, 1 blanket, 3 3 odd articles June 113 122 52 103 31 20 80 32 61 2 beds, 2 palliasses July 93 101 31 98 35 20 50 48 178 1 bed August 70 79 38 77 28 12 36 43 52 September 133 139 81 160 68 30 70 59 85 1 mattress, 1 pillow October 166 175 96 183 71 35 77 110 133 2 beds, 1 mattress, 1 bolster, 2 odd articles November 167 169 94 228 77 48 80 145 215 2 beds, 1 mattress, 3 pillows December 182 202 125 265 102 38 134 214 278 Total 1491 1615 835 1813 659 337 804 1098 1891 Table SHOWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES. 1920 Date Scarlet Fever. Diphtheria. Erysipelas. Puerperal Fever, Pulmonary Tuberculosis. Measles. Enteric Fever. Cancer. Scabies. Anthrax. Influenza. Pneumonia. Senile Decay. Whooping Cough. January 71 32 .. 2 11 44 .. 3 .. 1 .. .. .. .. February 57 20 1 2 4 1 2 .. .. 1 2 .. .. March 52 27 2 14 5 2 3 9 .. 1 1 .. .. April 38 25 1 .. 38 3 .. 4 .. 3 2 .. .. May 36 20 .. 2 31 9 .. 2 4 .. .. 4 .. .. June 27 24 .. .. 30 1 .. 3 7 .. .. 3 1 .. July 22 29 . . .. 27 1 2 2 8 .. .. .. .. 1 August 26 16 .. .. 25 .. .. .. 1 .. .. 2 .. .. September 69 29 .. 4 31 .. .. 2 1 .. .. 2 .. .. October 95 31 .. 2 28 .. .. 1 .. .. .. .. .. .. November 100 33 1 3 24 .. .. 6 1 .. .. 1 .. .. December 145 19 1 .. 29 1 .. 1 .. .. .. 1 1 .. Total 938 305 6 15 292 65 4 25 35 1 5 18 2 1 41 Special Cases. Jan. 26th—Abinger Road. Cancer. 1 bed, 2 pillows, 2 bolsters—disinfected. Feb. 6th—St. Donatt's Road. Cancer. 1 bed, 3 pillows, 1 bolster, 1 mattress, 1 sheet—disinfected. Mar. 17th—St. Donatt's Road. Cancer. 9 mattresses, 4 pillows, 1 bolster, 2 blankets, 3 odd articles—disinfected. 17th—Brockley Road. Cancer. 1 mattress, 2 pillows, 1 bolster, 2 odd articles—disinfected. June 5th—Blockhouse Street. Cancer. 1 bed, 1 mattress, 2 pillows—disinfected. July 14th—Evelyn Street. Cancer. 1 bed, 5 pillows, 1 bolster, 1 blanket— disinfected. 30th—Waller Road. Cancer. 1 bed, 2 pillows, 1 bolster, 1 mattress, ] sheet, 1 odd article—disinfected. Sept. 22nd—Endwell Road. Cancer. 1 bed, 1 mattress, 2 pillows, 3 bolsters, 2 blankets, 3 odd articles—disinfected. Oct. 6th—Ludwick Road. Cancer. 1 bed, 1 bolster—destroyed. Nov. 4th—Kitto Road. Cancer. 1 bed, 4 pillows, 1 bolster, 2 odd articlesdisinfected. 11th—Harcourt Road. Cancer. 1 bed—disinfected ,, 23rd—Douglas Street. Cancer. 1 bed, 4 pillows, 1 bolster, 1 sheet, 2 blankets, 10 odd articles—disinfected. Dec. 20th—Seymour Street. Cancer. 1 bed—disinfected. verminous premises. Seventy-five premises consisting of 112 rooms were fumigated during the year. books. Two hundred and eighty-four Library books were disinfected during the year. cleansing station. One thousand seven hundred and seventy two articles of clothing were disinfected during the year. Total number of Premises disinfected 1491 ,, ,, Rooms ,, 1615 ,, ,, Beds ,, 835 ,, ,, Pillows ,, 1803 ,, ,, Bolsters ,, 659 ,, ,, Mattresses ,, 337 ,, ,, Sheets ,, 804 ,, ,, Blankets ,, 1098 ,, ,, Odd Articles ,, 1891 Total articles 7427 Total number of Beds destroyed 9 ,, ,, Mattresses ,, 5 Palliasses ,, 4 ,, ,, Bolsters ,, 2 Pillows ,, 6 ,, ,, Odd Articles,, 77 Total 103 N.B.—The above Articles were destroyed at the request of the owners 42 1,457 children received baths and had their clothing disinfected. In 654 instances this process was required to be repeated a second time within a month, and in 544 instances a third bath and disinfection was required. Thus, 2,655 baths in all were given. The number of rooms disinfected by the Council's staff during the year was 1,615. Disinfecting fluid is supplied gratis in cases of infectious disease where required. For the removal of infected bedding, etc., and its return after disinfection an adequate staff is maintained. There are two vans employed, one used for collecting infected materials, and the other a pure van for returning them after disinfection is completed. One man is employed for collection, and another for returning the sterilised materials. Cleansing and disinfection of 1,615 rooms in 1,491 houses in which infectious diseases, etc., have occurred, have been carried out under the direction of your Medical Officer of Health. The infected rooms have been fumigated, and when necessary the walls of the disinfected portion of the house have been stripped and the ceilings cleansed. Mortuary Report for the year ending 31st December, 1919. Bodies Received, etc. Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Unknown. Deposited to await burial only. Infectious. Remarks. 132 79 53 130 74 17 1 2 1 1 deposit 1 inquest See below Six bodies were left on deposit after inquests to await burial, two bodies were detained after inquests to await burial (advanced decomposition), one body detained to await burial after inquest (infectious— scarlet fever), one body received into Mortuary (infectious—scarlet fever), by order of the Public Health Authority; two bodies were in a very verminous and neglected condition on arrival at Mortuary. Boroughs of which deceased persons were residents. Deptford 60 Forest Hill 1 Rotherhithe 2 Camberwell 2 Greenwich 22 Bradford (Yorks) 1 Lewisham 18 Sheerness 1 Bermondsey 6 Chislehurst 1 Woolwich 3 Poplar 2 Plumstead 4 Peckham . 1 Westminster 1 Bethnal Green 1 Sydenham 2 Forest Gate 1 Belvedere 2 Liverpool 1 Total 132 General Sanitary Administration. 44 Work of Sanitary Inspectors. The work performed by the District Inspectors represents, as usual, a very large number of inspections. The total inspections and visits to premises numbered 26,346. The figures stated above related to 5,943 houses in which sanitary improvements of one kind and another were effected, as shown in the following table. The premises visited included stable yards, manure depots, vacant land, passages, public urinals, urinals attached to public houses, etc. 2,036 house-to-house inspections were made. 45 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1920. Table No. 1. Number of District. 1 2 3 4 5 6 7 8 Totals Complaints Received 16 28 52 53 71 52 79 36 387 Total Premises Inspected 891 352 839 995 829 820 825 392 5943 Re-Inspections, Calls, Service of Notices, &c.,&c. 3033 1191 2755 3197 2899 3298 2565 1465 20403 Inspections under notice from Contractors, per Bye-Laws 33 16 9 20 25 13 35 1 157 Number of Cases in which Proceedings have been taken 2 1 3 6 " Intimations " Serve 487 123 462 593 570 605 551 312 3703 " Statutory Notices" Served 68 ... 17 9 91 61 18 4 268 Houses closed by Magistrate's Order • . . . . . . .. . . . • .. . .. ... ,, ,, voluntarily ... ... ... ... ... ... ... ... Water Closets— Old Closets abolished ... . • • 1 . • • . . . ... 1 New Closets provided ... ... 1 1 » • . • • • 4 . .. 6 ,, ,, ,, in Workshops . • • • •. . . . • • • . .. M| Basin and Trap provided 28 8 7 26 35 41 48 22 215 Water Supply provided 22 . . . 7 9 5 43 Water Supply Apparatus provided 60 2 10 27 49 33 1 ... 182 Limewashed 30 3 5 5 22 51 38 46 200 Walls Repaired 25 . . . 4 13 12 48 40 21 163 Floors Repaired 10 • . . 4 4 3 6 2 5 34 Doors provided or repaired and fastening provided 2 13 3 19 7 7 11 62 Ventilated ... • • • 1 • •• . . . 6 1 2 10 Seats provided or repaired 15 2 3 3 11 9 4 48 Basins Cleansed • • • . • . 2 1 2 9 4 . . . 18 Miscellaneous Repairs ... ••• ... 6 ... ... ... 6 Drains— Drains Re-constructed ... , , 8 17 9 24 2 5 55 Surface Drains provided • • • ... . . • . • . . . . 2 • . ■ . . . 2 Cleansed and Amended 42 28 48 20 44 70 33 19 304 Gully Traps fixed 9 13 •.. • 22 11 37 17 109 New Soil Pipes and Vent Pipes fixed 10 4 5 2 12 21 27 81 Chambers built and Interceptors provided ... 2 3 5 18 2 1 31 Interceptors only fixed ... ... ... 1 1 3 ... 5 Ventilated 10 ... 4 17 12 -.. . . . 43 Provided to Stables • • • • • • ... . . • . •. . • • ... Clearing Eyes • • • • • • 4 5 9 ... 18 Miscellaneous Repairs ... ... ... 4 16 ... 20 Sinks, Bath& Lavatory Wastes, and Rain Water Pipes- Disconnected from drains, trapped and ventilated ... 5 8 40 33 39 ... 26 151 46 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1920—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 8 Totals Cesspools— Abolished ... . .. ... ... . . . . • • •.. ... Dustbins- Provided 75 99 140 139 217 180 235 138 1223 Repaired ... ... *v ... 5 ... . . • ... 5 Yards- Paved ... • . . 7 ... 14 57 78 Surface Repaired 35 1 21 10 31 59 ... 38 195 Urinals— Cleansed and Tarred . • • ... ... 1 2 2 ... 5 Doors provided or repaired ... ... ... ... . . • ... ... .... • . . Scullery &Wash-house— Floors paved or repaired 10 ... 15 16 32 9 ... 11 93 Coppers repaired • • • ... ... • • • ... • • • ... ... Forecourts— Paved ... . . • 2 3 5 1 2 13 Surface Repaired ... 1 ... ... 8 1 ... 11 21 Gutters and Rain Water Pipes Provided and Repaired 56 20 47 72 132 155 98 83 663 Water Supply— Store Cisterns provided • .. ... ... ... >. ,, Covers provided • .< ... 5 5 .. i, Cleansed >> ,, abolished • . . ... "i i 5 Supply Reinstated ... .*. . 6 "i 2 1 3 13 Fittings Repaired 23 15 19 47 38 73 12 227 New Houses Inspected for Certificates before Occupation Mt Potable Water provided from Service ... • * • ... Cleansing and Repairs— Houses Cleansed and Limewashed Houses repaired and Ventilation improved 205 25 259 327 239 340 322 145 1862 200 31 50 95 175 220 174 160 1105 House roofs repaired 55 18 72 84 179 110 104 ... 622 Miscellaneous Repairs 18 ... 122 205 136 401 Dampness abated ... ... ... 29 ... 47 44 ... 120 Rat nuisances abated ... ... ... 9 ... ... ... ... 9 Dung Receptacles- Abolished ... ... ... ... ... ... ... ... Repaired ... ... ... ... ... ... ... ... Provided 6 ... ••• 2 ... ... ... 8 47 ANNUAL REPORT OF SANITARY INSPECTORS t « ~ J ' S.J FOR THE YEAR 1920—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 8 Totals. • Underground Rooms— Used as dwellings abolished Overcrowding- Cases Abated 4 1 1 4 10 Accumulations Removed 6 6, 10 5 9 3 39 Animals- Ceased keeping as a Nuisance ... • • • 3 2 3 4 1 13 Smoke Nuisances- Cases Abated 5 ... ... ... ... 1 ... • • 6 Observations 5 ... ... ... ... 9 ... 14 District No. 1.—Inspector Simpson. District No. 2.—Inspector Priest to June, 1920. District No 3.—Inspector Shelley. District No. 4.—Inspector Snowdon. District No. 5.—Inspector Kemp. District No. 6.—Inspector Hewett. District No. 7.—Inspector Ai.lam. District No. 8.—Inspector Yates from July, 1920. HOUSING. Dilapidated Areas. A thorough inspection was made of the East Ward. For convenience these were classified as follows :— Frankham Area.—Consisting of Church Street, Hales Street, Stanhope Street, Frankham Street, Giffen Street and Bevil Street, involving 229 deficient houses. 48 Addey Area.—Comprising Church Street, Norval Street, Addey Street, Hosier Street and Creek Street, involving 179 deficient houses. Bronze Area.—Comprising Knott Street, Alfred Place, Alvar Street, Benmore Street, Dugall Street, Hamer Place, Bronze Street, Church Street, Crossfield Lane, Mary Ann Buildings, Copperas Square, involving 286 deficient houses. Speedwell — Baildon Area. — Comprising Baildon Street, Speedwell Street, Batches Cottages, Providence Place, Wybourn Cottages, Cockle's Cottages and Sun Cottages, involving 117 deficient houses. Dr. Bryce, from the Ministry of Health, paid an informal visit, and visited the district. A representation was made by me in accordance with Section 4 of the Housing of the Working Classes Act, 1890, as amended by the Housing and Town Planning Act, 1909 (Section 22). Provision of Houses. Tenders for erection of first 55 houses on the Arica Road site were accepted 9th March, 1920 (Edwards Construction Co.) and building commenced in April. On April 16th, Dr. Addison performed the opening ceremony and cut the first sod. Remaining 191 dwellings are being built by H.M. Office of Works. Complete scheme will give Houses A Type (non-parlour) 61 „ B ,, (parlour) 167 Flats (2 bedrooms) 6 „ (3 „ ) 12 246 dwellings First two houses completed in December, 1920 and opened by the Mayor. Garden City Scheme. In the early part of 1920, a Garden City Scheme was mooted, and a Conference of representatives from Bermondsey, Lewisham and Deptford was held and approved of a scheme for the development of a garden city at Bromley at an estimated capital cost of £4,995,000. Later, Lewisham decided not to participate, and Bermondsey and Deptford carry on and form a joint committee. 49 The London Council subsequently took action to compulsorily acquire the site in question for their housing scheme, and the Borough Councils dropped out: however, as a result of deputations to the Council, it was agreed that at least 700 houses, when built, should be allocated to Deptford applicants. vacant land in brookmill road and harton street. Proposals to build on these sites were abandoned owing to adverse decisions of the Ministry of Health and the London Housing Board. UNSOUND FOOD. The following quantities of food were, upon examination by the Officers of the Department, found to be unsound, unwholesome and unfit for human consumption:— Beef 173 lbs. Pears 1 box Bacon 330½ ,, Sausage 70 lb3. Hams 28 hams and 29 „ Apples 20 ,, Herrings 3 brls. and 8 boxes Cod fish 23i „ Kippers 24 ,, Butter 5I¾ ,, Haddock 3 ,, Cheese 30 ,, Tomatoes 61 ,, Rabbits 96 and 743 ,, Dates 7 ,, Condensed Milk 260 tins Flour 2 bags Varioustinnedfoods 15 ,, Lamb 2 carcases Margarine 15 lbs. Sheep 2 „ Corned Beef 6 „ Liver 30 lbs. Periwinkles 4 bags These were all voluntarily surrendered. The conditions imposed by the Ministry of Food and the establishment of fixed prices removed th3 temptation to which some traders are exposed, of endeavouring to sell unsound food. Part of the butter was returned under precautions to the wholesalers. The remainder of the foods was destroyed. SALE OF FOOD AND DRUGS ACTS. During the year the Sanitary Inspectors collected 586 samples under the above Acts, and submitted them to the Public Analyst for analysis, of these six were samples taken informally. Of the number submitted 15 or 2'5 per cent, were reported as adulterated. This percentage is the lowest recorded in Deptford. 50 Samples taken during 1920. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Almonds, Ground 4 4 .... Arrowroot 3 3 .. liaking Powder 7 7 .. Corned Beef 2 2 .. Butter 39 39 .. Cheese 1 1 .. Cocoa 1g 16 .. Coffee 2 2 .. Preserved Cream 1 1 .. Custard Powder 5 5 .. . Dripping 5 5 . . Fish Paste 1 1 .. Ground Ginger 2 2 .. Honey 2 2 .. Table Jelly 2 2 .. Lard 16 16 .. Margarine 6 6 .. Potted Meat 1 1 .. Milk 342 352 2.8 Separated Milk 32 32 . . Mustard 23 23 • . Pepper 28 28 , # Ground Rice 1 1 , , Sausage 8 12 333 Sulphur Lozenges 1 1 . . Cream of Tartar 3 3 . . Vinegar 27 1 28 36 Total formal samples 580 15 595 2.52 Informal Samples— Butter.. 1 . . 1 , . Jam 1 1 Dried Milk 3 . . 5 Milk Food 1 1 Grand Total 58g 15 601 | 2 59 51 Proceedings Taken with regard to Samples Purchased during the year. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 25 t Milk 3 per cent, abstraction of fat — Dismissed. Warranty proved. G4 t 1 1 5 1 0 0 1 1 0 39 a 1 » 10 „ 2 0 0 2 2 0 98 S I > 15 per cent, added water 3 3 0 2 2 0 11 a 1 I 1 — — Vendor cautioned. 15 H I 1 1 per cent, abstraction of fat - — Vendor cautioned. 14 K » > 2 per cent, added water and traces of colouring matter - — Vendor cautioned. 28 K > 1 1 per cent, abstraction of fat - — Vendor cautioned. 7 p I ) 11 „ „ „ - Proceedings not - taken owing to bottle containing 3rd portion of sample bursting. 61 t 1 I 1 ,, „ i. •• - — Vendor cautioned. 12 o Breakfast Sausage Boric acid 12 grains per lb... - — Vendor cautioned. 57 T Pork Sausage Boric acid 2'45 grains per lb. - — Vendor cautioned. 60 T Beef Boric acid 3 99 grains per lb. - — Vendor cautioned. 80 T Boric acid 1 57 grains per lb. - — Vendor cautioned. 40 K Vinegar .. 3 per cent, excessive water .. - — Vendor cautioned. summary. £ s. d. Fines .. .. .. .. 0 3 0 Costs .. .. .. .. 5 5 0 11 8 0 52 Prosecutions under Public Health Act and By-Laws. Premises. Offence. Result of Proceedings. 104 New Cross Road Non-compliance Fined £1 and £1 Is. costs with order (necessary works subsequently carried out) 4 Reginald Place do. Fined £5 and £1 2s. costs and order for work to be carried out within 14 days. 20 Reginald Place do. Fined £6 and £-2 2s. costs and order for work to be carried out within 21 days. G7 Watergate Street do. Order for work to be carried out within 21 days. Costs 12. 6d. 73 Watergate Street do. ' Order for work to be carried out within 21 days. Costs 12s. 6<1. 77 Watergate Street do. Order for work to be carried out within 21 days. Costs 12s. 6d. Infectious Disease. A medical practitioner was fined 10s. and £?> 3s. costs for failing to " notify forthwith " a case of infectious disease. Factory and Workshops Act. 54 At the request of the Public Health Committee, Miss Smart inspected the sanitary accommodation at factories and workshops where females were employed. 123 such inspections were made and various defects reported and referred to the Factory and Workshops Inspector for attention. 55 Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDING DURING 1920. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1919 Added 1920 Removed 1920 On register at end of 1920 • Milk premises 2-29 19 59 189 293 3 Cowsheds • • Slaughter-houses 2 * • • 2 55 • • Other offensive trade premises Ice cream premises .. 2 130 2 3 2 129 16 114 7 • * Registered houses let in lodgings 289 289 578 Table. METROPOLITAN BOROUGH OF DEPTFORD. PUBLIC HEALTH DEPARTMENT. TABULATION OF REPORT AS REQUIRED BY S. 131 OF THE FACTORY AND WORKSHOP ACT, 1901. INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES, during 1920. CLASS OF WORK. Number of Places Number of Inspections. Number of Number of Prosecutions. On Register at end of 1919 Added 1920. Removed 1920. On Register at end of 1920. Written Intimations. Notices. Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories - Factory Laundries 4 4 22 2 Factory Bakehouses 11 11 26 46 1 Other Factories 134 10 2 142 265 142 4 Worksh ops- Workshop Laundries 5 5 17 5 WorkshopBakehouses 45 45 48 205 4 Other Workshops 176 5 54 127 190 77 3 Workplace s- Places where Food is prepared for Sale 118 5 6 117 220 282 7 1 Workplaces other than the above 62 1 7 56 60 9 2 Home-workers' Premises 526 68 95 499 503 202 Total I 1081 89 164 1006 1351 1 1 970 21 1 56 Table. • i' METROPOLITAN BOROUGH OF DEPTFORD. This Table is by request of the Secretary of State. Annual Report oj Medical Officer of Health for the year 1920, On the Administration of the Factory and Workshop Act, 1901 in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. • 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 190 5 Workshops (including Workshop Laundries) 287 7 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 251 10 Total 768 22 2.—DEFECTS FOUND. PARTICULARS. Number of Defects. Number of Prosecutions Found. Remedied. Referred to HM. Inspector. Nuisances under the Public Health Acts. Want of Cleanliness 243 233 Want of Ventilation 3 3 Overcrowding Want of Drainage of Floors Other Nuisances 101 98 Sanitary Accommodation Insufficient 7 3 Unsuitable or defective ' Not Separate for Sexes 69 66 Offences under the Factory and Worhshop Act. Illegal Occupation of Underground Bakehouse (sec. 101) Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) Other Offences (excluding oftences relating to outwork which are included in Part 3 of this Report) Total 423 403 Or -a Table—continued 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108 OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year. Once in the year. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Lists. Outworkers. Lists. Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Contactors. Workmen. Con- 1 ractorsJ Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 6 Wearing apparel— Making, etc. 49 204 4 10 60 Boxmaking 1 15 1 Total 49 264 5 25 61 58 Table—continued. 4.—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 45 Dressmaking 28 Laundries 5 Millinery 13 Shirtmaking 1 Tailoring 12 Wheelwrights (Smiths, &c ) 14 Others 59 Total number of Workshops on Register 177 5.—OTHER MATTERS. Class. Number. Matters notified to H.M Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 9 Reports (of action taken) sent to H.M. Inspector 6 Other 5 Underground Bakehouses (s. 101): — Certificates granted during the year — In use at the end of the year 16 59 CANAL BOATS ACTS. The following is the report of Inspector Turner, the SanitaryInspector to whom is assigned the performance of the duties under the above Acts. I have the honour to present my Report under the Canal Boats Acts for the year ended 31st December, 1920, as follows:— For the purposes of inspection during the year, visits were made on the following dates, viz.:— February 11th and 19th, April 29th, May 25th, June 24th, July 3rd, 9th and 22nd, August 30th, October 11th and 26th, and November 22nd. Number of visits ... ... 12 Number of boats inspected ... 0 No boats were found for inspection on the above dates, there being very little traffic on the canal during the year. The arrangements for inspection are :— Periodical inspection by Sanitary Inspector, duly appointed under the Canal Boats Acts jointly with the duties as Inspector of Workshops, Dairies, Milkshops, &c. Name and address of Inspector:—Thomas Turner, 161 St. Asaph Road, Brockley, S.E. 4. Remuneration of Inspector, £2 per annum, part of salary as Sanitary Inspector apportioned to these duties. INDEX. Page Page Vital Statistics— Sanitary Work— Summary of 6 Housing . 47-49 Population 8 Coroner's Court & Mortuary 42 Births . 9 Summary of Male Inspectors' Work 45 Marriages 10 Legal Proceedings 52 Deaths 10 in Wards 11 Food Supply— Causes and ages of 22 Unsound Food 49 „ from Zymotic Diseases 26 sale of food and drugs „ Tuberculous Diseases 31 Acts 49-51 ,, of Infants .. .. 12 Ministry of Health Tables 21-24 Factories and Workshops- Home Office Tables .. 55-58 , , Maternity and Child Wel = Infectious Diseases— fare 13-20 Deaths from 26 Cases notified 26-32 Tuberculosis Dispensary— ,, , „ Report of Tuberculosis Puerperal Fever 29 Officer 33-38 Scarlet Fever 27 Tuberculosis 31 Canal Boats- Disinfecting 39 Report of Inspector 59