DEPT 17 ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY CHARLES S. THOMSON, M.D., D.P.H., B.Hy. O.M.M. (Greece). Medical Officer of Health 1921 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. DEPT 17 The Municipal Maternity Home. Public Health Committee. Mayor. Alderman W. H. GREEN, J.P. Chairman. Councillor Rev. J. MAHONEY. Vice=Chairman. Councillor A. G. HOWARD. Councillor Mrs. M. Charlton. Councillor Mrs. B. M. Drapper, J.P. Councillor Miss A. M. Jacob. Alderman E. J. Knight. Councillor W. F. Marchant, O.B.E., L.C.C. Councillor J. P. Searle. Councillor J. Tiffen. Councillor Mrs. L. E. White. Councillor E. C. Wood. Maternity and Child Welfare Committee Chairman. Councillor Mrs. B. M. Drapper, J.p. Vice-Chairman. Mrs. G. Tiffen. Consists of the Members of the Public Health Committee and the following co-opted Members:— Mrs. G. E. Green, Mayoress. Mrs. L. H. Monk. Mrs. G. Tiffen. Sister Constance Welch. Staff of the Public Health Department. Medical Officer of Health. Charles S. Thomson, m.d., d.p.h., b.hy. Assistant Medical Officers of Health. Nicholas M. Donnelly, m.b., d.p.h. (Tuberculosis Officer). Gladys Ward, m.d., d.p.h. (Maternity and Child Welfare Officer.) Public Analyst. Henry G. Harrison, m.a. (Cantab), f.i.c. Sanitary Inspectors. Robert D. J. Simpson Frederick Hewett. Philip Shelley Harry Allam. John V. Snowdon. Albert E. Yates. Arthur G. Kemp. William F. Mayo. 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. Clerks. Henry J. L. Smith F. Giles. Municipal Dispensary for the Prebention of Consumption, 78 Amersham Vale, New Cross, S.E. Nurse—Miss Porteous. Attendant—G. Abbott. Municipal Maternity Home. 52 Wickham Road. Medical Officer— Gladys Ward, m.d., d.p.h. Matron—Miss Kate Smith. Nurses—Miss E. Cross, Miss G. Treloar, Miss E. M. Lee, Miss E. C. Macaulay. Coroner's Court and Mortuary. Attendant—G. W. J. 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. July, 1922. To His Worship the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Ladies and Gentlemen, I have the honour to present to you the Annual Report on the Health of the Borough for the calendar year 1921. As I entered upon my duties as Medical Officer of Health late in November, I have not attempted to prepare a comprehensive report, though the usual full statistical returns will be found embodied herein. In the next Annual Health Report I shall endeavour to make a full statement embracing the different phases of the activities of your Health Department. The rate of infant mortality for the year 1921 is again satisfactory; though statistically greater than that for the year 1920, the actual number of infants' deaths was less. The apparent increase was due to the heavy fall in the birth-rate for 1921 as compared with 1920. With our present staff of Health Visitors and also voluntary workers, your Council may confidently look forward to an untiring battle waged against those factors which take their toll of infant life. Whilst paying such attention as we can in these times to housing and respiratory diseases, it is upon the mother that we concentrate our attention chiefly. If we continue to teach our mothers wisely and patiently, our infant death-rate will continue to shrink. During 1921, Dr. Gladys Ward threw herself with enthusiasm into her work, and I am certain that many little lives owed their security of tenure to her skill and tenacity of purpose. The opening of the Municipal Maternity Home in Wickham Road was only to be expected from a Council which takes a serious view of its duty to expectant women, and children. 6 Throughout the country, the reduction in the infant mortality rate which we have witnessed in recent years has not been accompanied by a lowering of the maternal mortality rate. Many of these maternal deaths could have been averted if only the confinements had taken place under conditions admitting of the best possible surgical asepsis. If we are to have overcrowding throughout the country for some years, how can we expect puerperal infection to be diminished? The only sure and safe shield for the lying-in mother is a well-equipped and wellofficered maternity home. As Dr. Janet A. Campbell says: "The mother going into the home should experience a sense of relief and should instinctively feel assured of a successful issue." We, then, in the year of grace 1921, have placed a beautiful maternity home at the disposal of our women folk during the greatest period of their lives. There is no need to boom the home, as each successive mother, restored to the bosom of her own family and district, is a missionary who preaches the gospel of our municipal obstetrical successes. The heavy fall in the national birth-rate, whether a good or a bad thing for the country, only serves to bring home to every student of such matters the great need for safeguarding the welfare of every mother and child. Another noteworthy point is the steady increase in the number of pregnant women who are attending the Ante-natal Centre in Napier Street. I doubt very much the wisdom of a Maternity and Child Welfare Medical Officer endeavouring to examine more than twelve women in a session; the numbers now flocking to the Centre to be examined by Dr. Hill make it imperative that an additional session be arranged for. Our mother and baby department is waxing strong, and with developments in the air, your Maternity and Child Welfare Committee might well smile when plaintive voices are heard asking how comes it that London has an infantile mortality rate second to none. A successful year's work at the Tuberculosis Dispensary falls to be recorded. Dr. Donnelly has kept in touch alike with the patients and the medical men who send them. Consultations in the homes of patients have been held with family doctors, and I can testify that no stone has been left unturned to advance the interests of the affected families. Mrs. Monk has been a pillar to every affected household and in spite of many benevolent responsibilities eating up her time, she has 7 none the less been able to train up a strong band of After-Care visitors. There is room still for more work at the Dispensary, and this will be forthcoming, I believe, once the medical men in practice notify their cases as required by the Tuberculosis Regulations. Medical officers hesitate to draw their Council's attention to this general failure of medical men to notify cases of Tuberculosis, partly because of the happy relations which subsist between the Medical Officer of Health and his brethren in practice. There are reasons which practitioners advance for their omissions, but the law of the land is clear on the point, and their failure in notifying is just as serious a matter as the concealment of the facts—for the sake of peace—by any Medical Officer of Health. A statement of the work for the year is embodied herein, thanks to Dr. Donnelly. There is one machine which I am studying for the moment and which is peculiar to London; I refer to the vast network of ameliorative agencies, which covers the whole Metropolis. A mere glimpse at these gladdens the heart. How is it possible for a man to be other than an optimist when he tries to understand this massed band of help? It is a course of study in itself, and no public worker is fully equipped unless and until he is au fait with the hospitals, the Guardians, the Red Cross, War Pensions Comnittees, Invalid Childrens' Aid Association, Charity Organisation Society, Cripples' Guild, etc. These are channels through which many pass yearly to a happier dawn and a fuller life. Here in Deptford, then, is a man's work to do. With the support of a loyal and willing staff of workers, and the encouragement and guidance of an earnest Council, let us see whether we can bring more sunshine into the lives of others. Your obedient Servant, Charles S. Thomson, Medical Officer of Health. 8 Summary of Vital and Mortality Statistics for 1921. 1921. 1920. Area 1,563 acres 1,563 acres Population— Census 1911 109,496 109,496 Census 1921 112,500 112,500 Estimated to middle of 1921 113,500 115,636 Number of inhabited houses 16,966 16,855 Average number of persons per house 6.1 6.9 Density 73 per acre 74 per acre Length of Public Streets 53 miles approx. 53 miles approx.. Rateable Value £654,526 £644,159 1d. Rate produces (approximately) £2,522 £2,504 Cost of administration of Public Health Department £4,313 £2,984 Marriages 884 1,045 Marriage Rate 7.8 9.0 Births 2,667 3,276 Birth Rate 23.5 28.3 Birth Rate, average for the last 10 years 25.1 24.7 Deaths 1,382 1,408 Death Rate 12.2 12.2 Death Rate, average for the last 10 years 15.1 15.3 Infantile Mortality 88 per 1,000 births 79 per 1,000 births Infantile Mortality, average for the last 10 years 103 per 1,000 births 107 per 1,000 births Zymotic Death Rate 0.8 0.8 . Area and Population. Births and Deaths. 10 Area and Population. Acres. Estimated Population. 1563 113,500 The Census of 1921, originally planned for the 24th April, was unavoidably postponed until the 19th June. Unfortunately, while the latter date avoided the recognised period of industrial holidays, it is now clear that, owing to the abnormally fine weather, some holiday movement was already then in progress. This of course affected the Census Returns, as far as local population figures are concerned, and it has been therefore deemed necessary to make an adjustment by measuring the extent of the non-resident population in the more popular holiday areas and by effecting its redistribution throughout the country. The population of Deptford to the middle of 1921 has been estimated by the Registrar-General as 113,500. The population for each of the various wards, based on this estimate, was as follows:— East 21,960 South 12,587 North 24,741 South-East 12,770 North-West 24,339 South-West 17,103 As the Borough has an area of 1,563 acres, the density of the population on this estimate is 73 persons per acre approximately. Births. Births. Birth rate. 2,667 23.5 The total number of births registered in the Borough was 2,549, and of these 47 were transferred to other districts as the permanent addresses of the parents were outside this Borough. 165 Births occurring outside the Borough, in maternity hospitals, etc., were similarly transferred to this district, making a total of 2,667 births in all belonging to Deptford. Of these, 1,385 were males and 1,282 were females. The birth-rate was 23.5 per 1,000 of the estimated population, as compared with 28.3 for the previous year. The birth-rate for England and Wales for 1921 was 22.4 for the 96 Great Towns 23.3, for the 148 Smaller Towns, 22.7, and for the County of London 22.3. The Municipal Maternity Home. A Corner of the Garden. The Municipal Maternity Home. The Labour Ward. 11 The following table shows the number of births, birth-rates, the deaths of children under one year of age, and the infantile mortality for the past ten years:— Year. Estimated population. Births. Deaths under one year. No. Rate per 1000. No. Mortality per 1000 births. 1911 109,475 3001 27.4 428 143 1912 1913 109,377 109,280 2896 3106 26.5 28.0 258 350 89 113 1914 109,182 3121 28.6 309 99 1915 110,299 2955 26.8 391 132 1916 110,299 3918 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 1920 115,772 3276 28.3 259 79 Average for 10 years 111,926 2812 25.1 290 103 1921 113,500 2667 23.5 234 88 Illegitimate Births. The illegitimate births numbered 68 or 2.5 per cent. of the total births. These occurred in the several wards as follows:— East 20 South 7 North 18 South-East 5 North-West 12 South-West 6 Marriages. Marriages. 884 Marriage Kate 7.8 There were 884 marriages in the Borough during 1921, as compared with 1,045 in the previous year. The marriage rate was equal to 7.8 per 1,000 of the population as compared with 9.0 for the year 1920. The marriages were celebrated in the following places:— 575 in Churches of England. 98 in other places of worship. 211 in the Superintendent Registrar's Office. 884 Total 12 Deaths. Deaths. 1,382 Death Kate. 12.2 The deaths registered in Deptford numbered 932 equalling a deathrate of 8.2, as compared with 1,003 and a death-rate of 8.7 for the preceding year. Of this number, 213 were non-parishioners. 663 deaths of Deptford residents occurred outside the Borough in public institutions, etc., making a total of 1,382 deaths belonging to this Borough. Of these 695 were males and 687 females. The death-rate was 12.2, compared with a similar rate for the preceding year. The death-rate for England and Wales was 12.1, for the 96 Great Towns 12.3, for the 148 Smaller Towns 11.3, and for the County of London 12.4. The following 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. 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 1920 *115,636 1408 12.2 Average for 10 years 109,032 1649 15.1 1921 113,500 1382 12.2 * Civil population. 13 The following table gives the number of deaths belonging to each Ward, and the respective death rates. Deaths of residents occurring outside the Borough are allocated to their respective Wards:— Ward. Deaths. Death Rate per 1,000 Males. Females. Children under 1 year. Total. East Ward 169 167 81 336 15.3 North Ward 140 146 51 286 11.6 North-West Ward 130 112 50 242 9.9 South Ward 58 72 12 130 10.3 South-East Ward 100 81 12 181 14.2 South-West Ward 98 109 28 207 12.1 The proportion which the mortality at various ages bears to the total number of deaths during 1921 and the previous year is as follows:— 1920. 1921. Under 1 year 18.4 per cent. 16.9 per cent. deaths. 1 to 2 years 2.7 3.1 ,, ,, 2 to 5 „ 3.5 3.0 ,, ,, 5 to 15 „ 4.3 3.4 ,, ,, 15 to 25 „ 5.0 5.4 ,, ,, 25 to 45 „ 13.2 11.9 ,, ,, 45 to 65 „ 24.2 24.2 ,, ,, 65 years and upwards 28.7 32.1 ,, ,, Infantile Mortality. Infant Deaths. 234 Infantile Mortality. 88 234 Infants died before attaining the age of one year, i.e., 88 per 1,000 of the births registered. Of the above number, 18 or 7.7 per cent. were illegitimate, the mortality amongst them being in the proportion of 265 per 1,000. 14 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 602 81 135 North 607 51 84 North-West 549 50 91 South South-East 301 282 12 12 40 43 South-West 326 28 86 Comparative table of infantile deaths from Diarrhœa and Enteritis. RATE PER 1000 BIRTHS. Diarrhœa and Enteritis under two years. Total deaths under one year. England and Wales 15.5 83 96 Great Towns 19.3 87 148 Smaller Towns 15.6 84 County of London 21.3 80 Deptford 20.6 88 TABLE SHEWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1921 Births 2667 Deaths 1382 Excess of Births over Deaths 1285 15 NAPIER STREET CLINIC. 1921. 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 14 2 4 4 24 305 329 161 February 4 16 6 1 4 27 293 320 139 March 3 22 1 3 6 32 300 332 148 April 4 13 2 5 7 27 246 273 137 May 4 19 1 2 3 25 231 256 120 June 4 13 2 6 6 27 244 271 126 July 4 11 1 3 3 18 272 290 117 August 4 20 .. 4 4 28 233 261 131 September 3 9 1 2 2 14 150 164 80 October 5 15 2 2 1 20 195 215 102 November 4 18 3 1 1 23 196 219 137 December 3 11 .. .. 2 13 129 142 76 Total 47 181 21 33 43 278 2794 3072 1474 ERLAM ROAD CLINIC. 1921 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 9 .. 1 5 15 201 216 95 February 4 16 •• 1 3 20 207 227 94 March 4 7 1 1 2 11 233 244 90 April 4 14 .. 5 5 24 223 247 105 May 4 14 3 1 1 19 211 230 91 June 5 13 .. 1 6 20 313 333 119 July 4 12 •• 4 1 17 253 270 117 August 5 18 2 1 2 23 336 359 148 September 3 4 2 2 1 9 207 216 79 October 4 10 .. 1 5 16 272 288 111 November 5 4 .. .. 3 7 206 213 102 December 3 7 .. 1 •• 8 136 144 81 Total 49 128 8 19 34 189 2798 2987 1232 16 GOSTERWOOD STREET CLINIC. 1921. 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 24 2 10 4 40 439 479 212 February 4 20 4 3 3 30 381 411 151 March 3 6 1 4 3 14 249 263 96 April 4 18 3 2 7 30 351 381 137 May 4 21 1 4 4 30 336 366 123 June 4 25 2 5 8 40 376 416 133 July 4 19 2 1 4 26 417 443 149 August 4 18 5 8 3 34 452 486 163 September 3 3 1 2 7 13 288 301 97 October 5 29 2 5 8 44 521 565 171 November 4 13 2 2 3 20 266 286 110 December 3 9 2 3 1 15 231 246 93 Total 47 205 27 49 55 336 4307 4643 1635 HALES STREET CLINIC. 1921 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 2 2 3 22 290 312 85 February 4 14 2 2 3 21 239 260 64 March 4 14 .. 2 11 27 262 289 76 April 4 18 .. 1 5 24 263 287 76 May 5 10 1 3 1 15 236 251 65 June 5 14 1 3 4 22 314 336 90 July 4 14 .. 1 5 20 245 265 73 August 4 9 1 2 •• 12 216 228 64 September 5 13 2 3 3 21 323 344 86 October 4 20 1 3 8 32 270 302 93 November 4 9 .. .. 4 13 208 221 64 December 4 9 .. •• 4 13 209 222 67 Total 51 159 10 22 51 242 3075 3317 903 17 GOLSMITHS' COLLEGE CLINIC. 1921 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 19 3 1 1 24 439 463 159 February 4 16 1 8 7 32 470 502 146 March 4 11 4 1 5 21 488 509 146 April 4 18 6 4 .. 28 439 467 146 May 4 10 4 5 2 21 353 374 113 June 5 23 3 7 2 35 456 491 154 July 4 20 3 2 5 30 359 389 136 August 4 18 2 4 5 29 402 431 155 September 4 13 5 4 5 27 441 468 148 October 4 20 3 2 7 32 430 462 152 November 4 10 1 4 3 18 400 418 158 December .. 4 12 .. 5 .. 17 264 281 127 Total 49 190 35 47 42 314 4941 5255 1740 BESSON STREET CLINIC. 1921. 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 11 3 8 39 352 391 187 February 4 6 2 1 4 13 397 410 112 March 3 6 .. 1 2 9 254 263 97 April 5 17 1 10 .. 28 426 454 160 May 4 4 1 3 3 11 311 322 108 June 4 13 1 5 1 20 317 337 113 July 5 20 4 2 8 34 444 478 180 August 4 9 2 5 7 23 328 351 124 September 4 15 2 1 5 23 370 393 131 October 4 11 3 4 1 19 406 425 158 November 4 9 .. 4 1 14 288 302 110 December 4 6 .. 2 1 9 267 276 121 Total 49 133 27 41 41 242 4160 4402 1601 18 Summary of Visits paid by Health Visitors. Ward E. N. N.W. S. S.E. S.W. Total. Miss Baird Visits 687 .. .. .. .. .. 687 Revisits 2459 .. .. .. .. .. 2459 Total 3146 .. .. .. .. .. 3146 Miss Clubbe Visits .. .. .. .. .. 621 621 Revisits .. •• .. .. .. 2461 2461 Total .. .. .. .. .. 3082 3082 Miss Holland Visits .. .. .. 324 445 .. 769 Revists .. .. .. 754 1360 .. 2114 Total .. .. .. 1078 1805 .. 2883 Miss Piper Visits .. 754 .. .. .. .. 754 Revisits .. 2488 .. .. .. .. 2488 Total .. 3242 .. .. .. .. 3242 Miss Smart ,. Visits 684 .. .. .. .. .. 684 Revisits 1967 .. .. .. .. .. 1967 Total 2651 .. .. .. .. .. 2651 Miss Stowell Visits .. .. 882 .. .. .. 882 Revisits .. .. 2681 .. .. .. 2681 Total .. .. 3563 .. •• .. 3563 Total Visits 1371 754 882 324 445 621 4397 Revisits 4426 2488 2681 754 1360 2461 14170 Total 5797 3242 3563 1078 1805 3082 18567 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 2440 12491 14931 Still Births 47 3 50 Infant Deaths 201 1 202 Expectant Mothers 242 413 655 Ophthalmia Neonatorum 17 24 41 Measles 54 16 70 Infantile Diarrhœa 106 89 195 Scabies in children 11 3 14 Verminous Children 11 5 16 Puerperal Fever 11 4 15 Tuberculosis 18 5 23 Pneumonia 12 23 35 Miscellaneous 782 47 829 Unsuccessful visits 445 1046 1491 Totals 4,397 14,170 18,567 The Municipal Maternity Home. A Ward. Nurse and Baby. 19 Births Notified, Year 1921. Ward. Births Notified. Alive. Dead. By whom Notified. Total. Male. Female. Parent. Doctor. Midwife Other Person..  East 569 291 278 562 7 54 89 415 11 North 584 283 301 573 11 110 180 286 8 North-west 539 283 256 532 7 154 119 250 16 South 304 157 147 296 8 126 60 93 25 South-east 277 142 135 270 7 99 72 92 14 South-west 321 180 141 315 6 145 53 114 9 2594 1336 1258 2548 46 688 573 1250 83 Milk supplied to Necessitous Mothers and Children. During the year 3,576 applications were received and were dealt with as follows:— Granted free 3125 ,, at half-price 236 „ at three-quarter price 19 Refused 102 Referred to Guardians 94 3,576 Maternity Home. Particulars of cases admitted during the year 1921:— Cases admitted, 35. Average stay, Two weeks. Cases delivered by midwives, 34. ,, ,, ,, doctors, 1. Cases in which medical advice sought, 1. (a) Ante-natal, Nil. (b) During labour, 1 (Uterine Inertia). (c) After labour, Nil. (d) For infant, Nil. Cases notified as puerperal sep??? Nil. Temperature rose above 100??? for 24 hours with rise in pulse, 1—Influenza. Notified as Ophthalmia Neonatorum, 1. (Recovered, no permanent impairment of vision.) Inflammation (eyes), One. Not entirely breast-fed, One. Maternal deaths, Nil. Fœtal deaths, 1 stillborn. 20 Table No. 1. METROPOLITAN BOROUGH OF DEPTFORD. VITAL STATISTICS OF WHOLE DISTRICT DURING 1921 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 2,396 2,426 20.5 1,051 9.5 202 620 207 85 1,469 13.0 1920 115,636 3,191 3,276 28.3 1,003 8.7 207 612 259 79 1,408 12.2 1921 113,500 2,549 2,667 23.5 932 8.2 213 663 234 88 1,382 12.2 Area of District in acres (land and inland water). 1,563. Total population at all ages 112,500. Total families or separate occupiers, 25,040. At census 1921 ,, ,, 1911 21 Table No. 2. METROPOLITAN BOROUGH OF DEPTFORD Causes of, and Ages at Death during the Year 1921. 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 Certified causes 1382 234 43 41 47 74 165 334 444 Enteric Fever 2 .. .. .. .. 1 1 .. .. Small Pox .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 13 1 3 3 5 .. 1 .. .. Whooping Cough 14 7 3 4 .. .. .. .. .. Diphtheria and Croup 13 .. 2 3 7 1 .. .. .. Influenza 25 .. .. 1 2 3 3 6 10 Meningococcal meningitis 3 2 1 .. .. .. .. .. .. Tuberculosis of respiratory system 121 .. 1 1 1 32 44 38 4 Other Tuberculous Diseases 31 5 2 6 9 4 2 3 .. Cancer, malignant disease 145 .. .. .. .. . . 18 67 60 Rheumatic Fever 3 .. .. .. .. .. 1 1 1 Diabetes 7 .. .. .. .. 2 1 3 1 Cerebral Haemorrhage, &c. 63 .. .. .. .. .. 3 21 39 Heart Disease 145 .. .. .. 1 10 10 54 70 Arterio-sclerosis 13 .. .. .. .. .. .. 5 8 Bronchitis 127 15 3 1 1 .. 3 25 79 Pneumonia (all forms) 119 34 12 6 2 3 16 26 20 Other Respiratory Diseases 14 2 1 1 .. 1 3 3 3 Ulcer of Stomach or Duodenum 9 .. .. .. .. .. 3 6 .. Diarrhœa, &c. 65 49 6 1 .. .. 2 1 6 Appendicitis and Typhlitis 17 .. .. 2 9 1 1 3 1 Cirrhosis of Liver 1 .. .. .. .. .. .. .. 1 Acute and chronic Nephritis 23 .. .. 2 .. .. 6 7 8 Puerperal Sepsis 4 .. .. .. .. .. 4 .. .. Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. .. 4 .. .. Congenital Debility anc Malformation, including Premature Birth 84 84 .. .. .. .. .. .. .. Suicides 5 .. .. .. .. .. 3 2 .. Other death from violence 37 3 2 3 2 4 8 7 8 Other defined diseases 274 32 6 7 8 12 28 56 125 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. 1382 234 43 41 47 74 165 334 444 22 Table No. 3. METROPOLITAN BOROUGH OF DEPTFORD. Infantile Mortality, 1921. 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 1months. Total Deaths under 1 year.  All Certified Causes Uncertified 50 15 8 6 79 43 47 29 36 234 Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. 1 .. .. .. 1 Whooping Cough .. .. .. .. .. 3 .. 2 2 7 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 1 .. .. 1 Abdominal Tuberculosis Other Tuberculous .. .. .. .. .. 1 2 1 .. 4 Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. 1 1 2 Convulsions 3 .. 1 .. 4 1 2 2 2 11 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 1 1 3 7 2 3 2 17 Pneumonia (all forms) .. .. .. .. .. 5 7 7 15 34 Diarrhœa .. .. .. .. .. .. 9 1 1 11 Enteritis .. .. 1 1 2 7 9 8 12 38 Gastritis .. .. 1 .. 1 .. 1 1 .. 3 Syphilis .. .. .. .. .. 3 .. .. .. 3 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying 2 .. .. .. 2 .. .. .. .. 2 Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis 7 .. .. .. 7 .. 1 .. .. 8 Congenital Malformations .. .. .. .. .. 2 1 .. .. 3 Premature Birth 31 7 3 3 44 5 .. .. .. 49 Atrophy, Debility, and Marasmus 6 7 1 1 15 7 10 .. .. 32 Other Causes 1 .. .. •• 1 1 2 3 1 8 50 15 8 6 79 43 47 29 36 234 Nett Births—Legitimate, 2599; Illegitimate, 68. Nett Deaths—Legitimate infants, 216; Illegitimate infants, 18. 23 Table No. 4. METROPOLITAN BOROUGH OF DEPTFORD. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1921. Notifiable Disease At all Ages Number of cases notified. Total cases notified in each Ward. Total Cases Removed to Hospital.  At Ages—Years East Ward North Ward North-West Ward South Ward South-East Ward South-West Ward Under 1 1 to 5 5to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 363 5 97 184 43 30 4 .. 67 83 98 26 35 54 357 Erysipelas 58 .. 4 6 4 20 18 6 19 23 9 1 5 1 .. Scarlet fever 951 18 237 564 94 37 1 .. 166 254 264 63 80 124 876 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 9 .. .. 2 5 2 .. .. 3 4 2 .. .. .. 8 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 11 .. .. .. 2 8 1 .. 4 4 1 1 1 .. 11 Cerebro-Spinal Meningitis 3 2 .. 1 .. .. .. .. 1 .. .. .. .. 2 2 Poliomyelitis 4 .. .. 3 1 .. .. .. .. .. .. .. 1 3 4 Pulmonary Tuberculosis 225 .. 2 32 57 77 51 6 79 62 40 5 25 14 189 Other forms of Tuberculosis 66 3 15 25 10 10 2 1 22 18 13 1 5 7 20 Ophthalmia Neonatorum 19 19 .. .. .. .. .. .. 5 2 4 3 2 3 6 Anthrax .. .. .. .. . . .. .. .. .. .. .. .. .. .. .. Infantile Enteritis 109 65 44 .. .. .. .. .. 26 54 17 2 6 4 .. Acute Pneumonia 47 6 5 9 6 13 8 .. 25 5 8 4 1 4 .. Malaria 7 .. .. .. 2 4 1 .. 2 2 .. 1 .. 2 .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. . . .. .. Enceph. Lethargica 1 .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 Totals 1873 118 404 826 224 202 86 13 419 511 456 108 161 218 1474 Infectious and other Diseases. 26 INFECTIOUS AND OTHER DISEASES. Under the provisions of the Public Health (London) Act, 1891, and the Tuberculosis Regulations, 1873 cases of infectious diseases were notified, as compared with 1,764 in 1920. This increase was due due to an increased autumnal prevalence of scarlet fever and diphtheria. In Table 4 (post) will be found a list of cases notified and their distribution in the several Wards. To the seven principal epidemic diseases, viz.:—Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever and Infantile Diarrhœa, 98 deaths were ascribed, and the death-rate was 0.86 per 1,000 as against 0.74 in the preceding year. An annexed table indicates the number of deaths and the death-rates from these diseases during the past ten years. Bacteriological Examinations made at the Seamen's Hospital. Material. Total specimens examined Number Positive. Number Negative.  Swabs for Diphtheria 568 87 481 Sputa for Tuberculosis 52 8 44 Blood for Enteric Fever 5 2 3 Samples from Ice Cream Shop (for Enteric Fever), comprising 1, Dust from room; 2, Cream; 3, Ice; 4, Copper contents; 5, Pan scrapings; and 6, Fasces 6 — 6 Films for Gonococcus 4 — 4 Blood for Wassermann Reaction 22 2 20 Totals 657 99 558 In addition to the above, 859 specimens of sputa were examined at the Council's Tuberculosis Dispensary. 27 Deaths and Death Rates from Principal Infectious Diseases. Year Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Diarrhcea and Enteritis (under 2 years) Total No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate  1911 2 0.02 — — 67 0.61 7 0.06 35 0.32 15 0.14 172 1.57 298 2.72 1912 2 0.02 — — 28 0.26 6 0.05 24 0.22 11 0.10 28 0.26 99 0.91 1913 2 0.02 — — 50 0.45 3 0.03 43 0.39 20 0.18 90 0.81 208 1.87 1914 3 0.03 — — 50 0.46 9 0.08 9 0.08 25 0.23 88 0.81 184 1.69 1915 5 0.05 — — 49 0.44 9 0.08 61 0.55 10 0.09 94 0.85 228 2.07 1916 1 0.01 — — 32 0.29 5 0.05 14 0.13 13 0.12 49 0.44 114 1.03 1917 — — — — 30 0.29 2 0.02 20 0.19 22 0.21 56 0.54 130 1.25 1918 2 0.02 — — 19 0.19 3 0.03 50 0.49 12 0.12 20 0.19 106 1.04 1919 2 0.01 — — 21 0.18 9 0.08 1 0.01 16 0.14 33 0.33 82 0.74 1920 1 0.01 — — 19 0.16 2 0.02 16 0.14 21 0.18 39 0.34 98 0.85 Average for 10 years 2 0.02 — — 36 0.33 5 0.05 27 0.25 16 0.15 67 0.61 155 1.42 1921 2 0.02 — — 1 0.01 13 0.11 14 0.12 13 0.11 55 0.48 98 0.86 28 Small-Pox. No cases of Small-Pox were notified during the year. Scarlet Fever. 951 persons were notified as suffering from this disease during the year under report as compared with a total of 747 for the previous year. Included in this total are 17 nurses on the staff of the South-Eastern Hospital, and also 10 patients who, after removal to hospital, were certified to be not suffering from the disease in question. There were 13 deaths as compared with 2, 9 and 3 in the three preceding years. Diphtheria. The total number of patients certified to be suffering from Diphtheria was 363 as compared with a total of 315 for the previous year. Of this number 19 were errors of diagnosis, and 22 were nurses on the staff of the South-Eastern Hospital. There were 13 deaths as compared with 21,16 and 12 for the three preceding years. Enteric Fever. Nine cases of Enteric Fever were notified, as compared with 11 in the previous year, One case was certified, after removal to hospital, to be not suffering from this disease, but from acute lobar pneumonia. There were two deaths. Acute Primary Pneumonia and Acute Influenzal Pneumonia. These diseases are compulsorily notifiable under the Public Health (Pneumonia, Malaria, Dysentery, etc., Regulations), 1918. 47 cases were notified during the year. Puerperal Fever. Eleven cases of Puerperal Fever were notified as compared with 18 in the previous year. There were 4 deaths. Ophthalmia Neonatorum. Nineteen cases were notified during the year. These were visited by the Health Visitors, and, where necessary, by a Ranyard Nurse, in accordance with the Council's scheme for the provision of nursing assistance. Six cases were admitted to hospitals. 29 From subsequent enquiries it has been ascertained that 15 patients recovered with no apparent impairment of vision. Three patients died from other causes (pneumonia, influenza and enteritis), and at the time of writing one patient is still attending St. Margaret's Hospital with ulcer of the right eye. Measles. Measles is not a notifiable disease, but during the year, 54 cases were brought to the notice of the Public Health Department, either by the Head Teachers of schools or by the parents. These were visited by your Health Visitors and arrangements were made by the Ranyard Nurses' Association for daily visits of a nurse to such cases as your Medical Officer of Health deemed advisable. Diarrhœa and Enteritis. Infantile Diarrhoea occurring in children two years of age and under is notifiable in this Borough by Order of the Council dated 27th July, 1920. During the year 1921, 109 such cases were notified. Diarrhoea and Enteritis caused 65 deaths during the year, and of this number, 55 were children under two years of age. In Table 4 (post) will be seen the distribution of the cases in the various wards of the Borough. Cerebro-Spinal Meningitis. Three patients were notified as suffering from this disease during the year. There were two deaths. Acute Polio-Myelitis. Four cases of this disease were notified. Three deaths occurred. Encephalitis Lethargica. One case of this disease was notified. Malaria. Seven cases of Malaria were notified in the persons of ex-service men who had contracted the disease in the East. TUBERCULOSIS DISPENSARY. Dr. Donnelly reports as follows:- During the year 1921, the total attendances at the Dispensary were 5,053, as compared with 6,615 for 1920. 30 The decreased number is largely due the fact that it was endeavoured to limit treatment at the Dispensary to those requiring special treatment such as Tubercnlin, aspirations, etc., and to those who could not obtain other adequate medical attendance elsewhere, so that where insured patients could obtain suitable treatment from their own panel practitioners, they were put on domiciliary treatment. It was also endeavoured in doubtful cases to limit to two months the period of observation at the Dispensary before a definite diagnosis was arrived at. The increased number of sessions started at the end of 1920 have aided in this by allowing more frequent and detailed examinations. Special appointments are made for the occasional individual who cannot attend during dispensary hours. Of those attending, 709 were new cases, 231 being insured. This number includes 156 contacts. This is not a satisfactory number of contacts, but from personal experience of visiting at the houses of patients, I am aware of the difficulty of persuading parents to bring contact children for examination or of persuading themselves or other adult contacts to be examined. It has been suggested that while excessive interference with the liberty of the subject is to be deprecated, this matter is so important that it seems quite permissible to insist that after a death from tuberculosis, or after a notification, the head of the household should furnish the Medical Officer of Health with a certificate stating that all the contacts have been seen by a qualified medical man and undergone a proper examination, and detailing the results thereof. Such certificate would of course be provided free at the Dispensary, and in this way the majority of contacts in any area would come within the purview of the Tuberculosis Officer. In last year's report was mentioned the intention of asking the Council's sanction for the appointment of a part-time nurse to assist in the work. This sanction was obtained and the services of a part-time nurse were secured in March for four mornings a week at the Dispensary, thus giving the whole-time nurse considerably more time for visiting work. The result is seen in the increased number of visits. Visiting at the homes of all notified cases has for some time been carried out by the Dispensary whole-time nurse. Formerly a lot of this visiting was done by the Health Visitors on the staff of the Public Health Department. If this procedure were again adopted it would give the Dispensary nurse further opportunity for the necessary visiting and re-visiting at the homes of dispensary cases 31 Of the new cases, 149 were found to be suffering from Pulmonary Tuberculosis, and 20 from Non-pulmonary Tuberculosis, 167 were doubtful and kept under observation, or did not return for completion of diagnosis. The remainder was discharged as non-tubercular. To secure the co-operation of the general practitioners, the procedure suggested by the Ministry of Health has been adopted, and on receipt of a notification a letter is sent to the practitioner asking, (1) Is the case insured? (2) Does he desire to consult with the Tuberculosis Officer as to the form of treatment most suitable to the circumstances of the case? If the practitioner then sends the case to the Dispensary, or asks the Tuberculosis Officer to see the case at home with him, satisfactory arrangements can generally be made as to treatment, and the examination of contacts either by the Tuberculosis Officer or the practitioner. When the practitioner states that he does not desire to consult the Tuberculosis Officer, the latter cannot interfere, and it is more difficult to get satisfactory information as to contacts. Some steps were taken to reach a solution of the difficulty by approaching practitioners, but no definite result has been reached so far. The Health Ministry have laid down that when a practitioner first notifies a case as needing treatment (?exact wording of Ministry's circular) he is to send a report to the Regional Medical Officer of the district and the latter is to forward it to the Tuberculosis Officer. This arrangement has not so far been carried out thoroughly, only one report having been received from the Regional Medical Officer. The practitioner is subsequently to furnish three monthly reports on cases on domiciliary treatment to the Tuberculosis Officer when a case seen at the Dispensary is put down for such treatment a report is sent to the general practitioner on the patient's condition, and he is requested to send a report in three months to the Tuberculosis Officer on Form G.P. 17. The practitioner then can make recommendations re subsequent treatment or ask to have the case seen again at the dispensary. Should the practitioner not furnish these reports after reminder from the Tuberculosis Officer, the Regional Medical Officer is to be so informed. Co-operation between the School Medical Service and the Dispensary is maintained, and when an opinion is directly asked for as to a child's condition, or his fitness to attend school, it is given by the 32 Tuberculosis Officer. When a case is simply referred to the Dispensary and the child's condition remains unsatisfactory though not definitely tubercular, after a period of observation of one or two months, Form M.O.T.T. is sent with short notes if observation at school is desirable, and recommendations made re malt and oil or milk at school and sending child to Dispensary at a later date, or the child may be recommended for open air school or to one of the charitable organisations for convalescent treatment. An endeavour is being made to facilitate the work of the Care Committee by securing more voluntary workers, thus leaving the Secretary more at liberty for that part of the work requiring her special experience. Many cases needing help remain unaided as there is no fund to draw upon. As regards obtaining employment for cases fit for light work, a special committee of the Labour Exchange was formed and several cases were referred to it, but results in the present unemployment crisis have been disappointing. As regards advanced cases the institutional accommodation for these remains very deficient, but it is hoped that this will shortly be overcome by the London County Council providing a hospital for such in South London. There has been a further increase in the number of specimens of Sputum examined at the Dispensary, both for Dispensary cases and general practitioners, viz., 859 as compared with 578 in 1920. The preparation of these specimens is carried out by the Dispenser, and with the increased clerical duties has added considerably to her work. Details were given in the last two Annual Reports regarding the sleeping accommodation of 600 patients, showing that about onethird of the number only have separate bedrooms. Of the other two-thirds, not only were there one or two others in the rooms, but very few of the patients had separate beds. Such conditions brought about by the shortage or proper housing accommodation tends to nullify the benefit of treatment and attempts at prevention. Death—Notification Interval. An examination of deaths belonging to the Borough attributed to tuberculosis in the death returns reveals the following information :— 33  Pulmonary Tuberculosis. ulmonary Tuberculosis. Cases not notified 27 16 Cases notified at death 10 6 Cases notified one month before death 9 4 Cases notified three months before death 18 — Cases notified six months before death 13 — Cases notified more than six months before death 44 5 Of the cases not notified, almost all 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 291 notifications (225 pulmonary and 66 nonpulmonary) were received. The distribution of the cases is shewn below:— WARD DISTRIBUTION. E. N. N.W. S. S.E. S.W. Total  Pulmonary Tuberculosis 79 62 40 5 25 14 225 Non-Pulmonary Tuberculosis 22 18 13 1 5 7 66 101 80 53 6 30 21 291 This gives an incidence figure of 2.6 per 1,000 of the estimated population. 34 Metropolitan Borough of Deptford. Return as to Work carried out in connection with the Deptford Dispensary for the period from 1st January, 1921 to 31st December, 1921. 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 172 59 268 50 160 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 68 27 7 17 30 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 3 3 8 — 6 (d) Number included under 1 (a) who were found to be non-tuberculous 65 21 189 16 82 (e) Number included in 1 (a) in whom the diagnosis was found to be doubtful 36 8 64 17 42 Insured Uninsured  2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) ) 2171 2882 (b) Number of the above attendances at which systematical physical examinations and records were made 820 1109 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions 125 156 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" 1163 1838 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the hospital to which the Dispensary is affiliated — 2 6. Number of consultations with— (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 3 _ 7. Number of written reports concerning individual patient made to— (a) Public authorities 515 226 (b) Practitioners 90 24 8. Number of specimens of sputum examined 571 288 35 METROPOLITAN BOROUGH OF DEPTFORD. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 2nd January, 1921 to 31st December, 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 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. Sana toria.  U nder 5 5-10 10-15 Total Primary Notifications, Pulmonary— Males ... ... 17 4 7 18 23 14 20 12 6 121 141 ... 1 1 2 2 11 96 Females . . . 2 6 3 6 26 26 14 14 5 ... 102 126 ... ... ... ... 1 12 70 Non-Pulmonary Males 1 9 10 1 2 2 2 2 1 ... ... 30 31 ... 1 ... 1 1 ... 11 Females 2 6 8 4 4 2 5 1 ... 1 1 34 38 ... 1 ... 1 4 ... 9 36 The 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. Disinfection. The disinfection of infected clothing and bedding has been carried out at the Disinfecting Station, Watson Street, by means of two machines of the Washington-Lyons pattern with independent boilers. The number of rooms disinfected by the Council's staff during the year was 1,848. Disinfecting fluid is supplied gratis where required in cases of infectious disease. When necessary, the walls of the disinfected portion of the house have been stripped and the ceilings cleansed. Table SHOWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1921. Date 1921 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses. Sheets. Blankets. Odd articles Articles destroyed.  January 144 150 90 202 65 52 88 179 190 February 111 115 59 158 51 38 90 126 183 March 110 112 52 152 52 36 60 93 120 April 128 142 87 161 58 22 57 94 139 May 131 156 76 152 46 29 72 89 150 1 bed, 2 pillows, 3 odd articles. June 132 152 72 157 58 32 80 85 101 1 mattress July 138 170 81 145 60 25 80 75 137 2 beds August 116 137 77 138 53 21 70 51 125 1 mattress, 4 odd articles September 117 132 70 150 43 22 77 76 180 2 beds, 3 mattresses, 2 palliasses, 1 bolster, 6 pillows October 162 186 98 195 76 39 126 154 316 2 palliasses November 168 183 101 215 69 37 139 193 372 3 beds, 2 mattresses, 1 bolster, 1 pillow, 7 odd articles December 194 214 114 280 100 66 132 246 404 Total 1651 1848 977 2105 731 419 1071 1461 2417 37 Table SHOWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES. 1921 Date Scarlet Fever. Diphtheria. Erysipelas. Puerperal Fever. Pulmonary Tuberculosis. Measles. Enteric Fever. Cancer. Scabies. Cerebro-Spinal Fever. Pneumonia. Influenza. Senile Decay. Miscellaneous.  January 86 40 .. 2 19 .. .. .. .. .. .. .. .. .. February 52 34 1 5 11 1 .. 2 1 2 1 .... .. .. March 60 27 .. .. 16 .. .. 1 2 1 .. .. .. .. April 54 31 1 1 32 .. .. 1 .. 1 5 .. .. 1 May 69 25 .. I 20 .. 1 6 2 .. .. 1 .. .. June 71 23 .. .. 32 .. 1 .. .. .. .. .. .. .. July 87 22 .. .. 27 1 .. 2 .. .. 1 1 .. .. August 68 13 .. .. 19 .. 6 3 .. .. .. .. 1 .. September 70 17 .. I 15 1 .. 6 .. .. .. .. .. 2 October 115 20 1 l 26 .. 1 5 1 .. .. .. .. .. November 122 22 .. .. 23 4 .. 2 .. .. .. .. .. .. December 143 28 .. .. 21 1 1 3 .. .. 2 1 .. 11 Total 997 302 3 11 261 8 10 31 6 4 9 3 1 14 verminous premises. 121 premises consisting of 188 rooms were fumigated during the year. books. 267 Library books were fumigated during the year. cleansing station. 2,541 articles of clothing, etc., were disinfected during the year. MIDWIVES ACT. Disinfection of wearing apparel, etc., was carried out in one case. Total number of Premises disinfected 1651 ,, ,, Rooms „ 1848 ,, ,, Beds ,, 977 ,, ,, Pillows „ 2105 ,, ,, Bolsters ,, 731 ,, ,, Mattresses „ 419 ,, ,, Sheets ,, 1071 ,, ,, Blankets ,, 1461 ,, ,, Odd Articles „ 2417 Total articles 9181 Total number of Beds destroyed 8 ,, ,, Mattresses ,, 7 ,, ,, Palliasses „ 4 ,, ,, Pillows „ 9 ,, ,, Bolsters ,, 2 ,, ,, Blankets ,, 2 ,, ,, Odd Articles ,, 19 Total 51 N.B.—The above Articles were destroyed at the request of the owners 38 Special Cases. Feb. 16th—Friendly Street. Cancer. 1 bed, 2 pillows—disinfected. Mar. 19th — Harefield Road. Cancer. 1 bed, 4 pillows, 1 bolster—disinfected. April 9th—Alloa Road. Cancer. 1 bed, 4 pillows, 1 bolster—disinfected. May 6th—Camplin Street Cancer. 1 bed, 5 pillows, 2 bolsters, 3 sheets, 2 blankets, 10 odd articles—disinfected. ,, 11th—Rollins Street. Cancer. 1 bed, 1 odd article—disinfected. ,, 21st—Prince Street. Cancer. 1 bed, 4 pillows, 1 bolster, 2 sheets, 2 blankets, 7 odd articles—disinfected. ,, 28th—Waller Road. Cancer. 1 bed, 2 pillows, 1 bolster, 1 odd article— disinfected. July 12th—Kitto Road. Cancer. 1 mattress, 3 Pillows, 1 bolster—disinfected. August 4th—Drakefell Road. Cancer. 1 bed, 1 bolster, 2 blankets—disinfected. ,, 23rd—Render Street. Cancer. 1 bed, 2 pillows, 1 bolster, 2 mattresses. 9 odd articles—disinfected. ,, 30th—Reginald Road—Cancer 1 bed, 1 bolster—disinfected. ,, 31st—Hatcham Park Road. Cancer. 1 bed, 5 pillows, 1 bolster, 1 mattress—disinfected. Sept. 3rd—Lewisham High Road. Cancer. 5 pillows, 1 bolster, 1 mattress, 2 blankets, 31 odd articles —disinfected. 27th—Napier Street. Cancer. 2 mattresses, 2 palliasses, i pillows— destroyed. ,, 28th—Scawen Road Cancer. ] mattress, 2 pillows, 1 bolster, 1 sheet, 1 blanket, 4 odd articles—disinfected. Oct. 5th- Woodpecker Road. Cancer. 1 bed—disinfected. ,, 8th—Barlborough Street. Cancer. 1 bed—disinfected. ,, 14th—Hunsden Road. Cancer. 1 bed, 4 pillows, 1 bolster, 2 blankets, 2 odd articles—disinfected. 2 palliasses—destroyed. Nov. 17th—Shardeloes Road. Cancer. 1 bed, 1 mattress, 2 pillows, 1 odd article—disinfected. , ,, 17th—Wickham Road. Cancer 1 bed, 3 pillows, 1 bolster, 1 sheet, 1 blanket, C odd articles—disinfected. Dec. 9th—Hunsden Road. Cancer. 1 bed, 4 pillows, 1 bolster, 1 sheet, 2 blankets, 3 odd articles—disinfected. ,, 31st—High Street. Cancer. 1 bed, 2 pillows, 1 bolster, 3 blankets, 4 odd articles— disinfected. Mortuary Report for the year ending 31st December, 1921. Bodies Received, etc. Total. Male. Female. Inquests. Postmortems Under 1 year of age. Unknown. Deposited to await burial only. Infectious.  86 54 32 82 45 19 3 3 1 Six bodies were detained after inquests to await burial (advanced decomposition). Four bodies were left on deposit after inquests, to await burial. One body (infectious) was deposited to await burial. Three bodies of infants (unknown) were received, one of which was buried by order of the Coroner as a fœtus, no inquest being held. Boroughs of which deceased persons were residents. Deptford 54 Sydenham 1 Greenwich 10 Bermondsey 10 Lewisham 5 Plymouth 1 Camberwell 2 Poplar 1 Plumstead 1 Stepney 1 General Sanitary Administration. Work of Sanitary Inspectors. During the year the District Sanitary Inspectors made 26,351 visits in all to 5,768 premises. 1,412 systematic house-to-house inspections were made. Numerous sanitary improvements and repairs were effected, as shown in the following table:— 41 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1921. Table No. 1. Number of District. 1 2 3 4 5 6 7 Totals  Complaints Received 14 72 54 38 70 58 20 326 House-to-house Inspections 291 354 290 290 9 59 119 1412 Total Premises Inspected 798 842 908 826 830 931 633 5768 Re-Inspections, Calls, Service of Notices, &c., &c. 3053 2869 3045 3262 3037 3371 1946 20583 Inspections under notice from Contractors, per Bye-Laws 16 ... 33 28 48 23 20 168 Number of Cases in which Proceedings have been taken ... ... ... 1 ... 4 ... 5 "Intimations" Served 539 444 573 516 438 548 421 3479 "Statutory Notices" Served 26 27 68 13 11 6 4 155 Notices served under Section 28 Housing, Town Planning, &c., 1919 23 14 27 44 9 20 4 141 Number of houses in which work was carried out by Sanitary Authority in default of owner 3 3 1 ... ... ... ... 7 Number of houses upon which closing orders became operative 1 ... ... ... • ...• ... ... 1 Water Closets- Old Closets abolished 3 ... ... ... 1 ... ... 4 New Closets provided 3 2 ... ... 1 ... ... 6 ,, „ ,, in Workshops ... ... ... ... ... .. ... Basin and Trap provided 58 19 66 52 70 49 15 329 Water Supply provided 6 11 ... ... 1 ... ... 18 Water Supply Apparatus provided 94 9 58 ... 2 ... 43 206 Limewashed 63 ... 38 38 22 54 41 256 Walls Repaired 21 ... 34 33 17 ... 24 129 Floors Repaired 24 3 6 1 10 ... 3 47 Doors provided or repaired 14 2 20 2 5 3 6 52 Ventilated ... ... ... ... ... 3 ... 3 Seats provided or repaired 38 .. 5 4 1 5 4 57 Basins Cleansed ... 14 ... 2 3 .. 17 36 Roofs repaired 44 ... ... 22 ... ... ... 56 Drains— Drains Re-constructed 17 7 31 31 18 25 5 134 Surface Drains provided ... 5 ... ... ... .. ... 5 Cleansed and Amended 31 33 67 49 65 81 47 373 Gully Traps fixed 39 ... 47 35 17 ... 3 141 Soil Pipes and Vent Pipes fixed or repaired 25 3 22 21 43 10 4 128 Chambers built and Interceptors provided 7 2 11 21 1 ... ... 42 Interceptors only fixed ... ... ... 1 .. ... ... 1 Ventilated (fresh-air inlets provided, &c.) 12 ... 9 26 1 3 ... 51 Covers provided to chambers ... ... ... 2 ... ... ... 2 Clearing Eyes ... ... 17 6 1 1 1 26 42 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1921—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals Sinks, Bath & Lavatory Wastes, and Rain Water Pipes- Disconnected from drains, trapped and ventilated 21 15 33 5 45 89 41 249 Cesspools— Abolished ... ... ... ... ... ... ... ... Dustbins— Provided 132 97 136 136 149 125 115 890 Repaired 2 ... 2 ... ... ... ... 4 Yards- Paved ... 17 3 6 38 ... 8 72 Surface Repaired 150 9 37 64 1 62 75 398 Urinals— Cleansed or Repaired ... ... 4 ... ... ... ... 4 Scullery &Wash-house— Floors paved or repaired 28 2 40 10 9 6 18 113 Forecourts— Paved 8 ... 2 ... 1 ... ... 11 Surface Repaired ... ... 9 11 1 10 4 35 Gutters and Rain Water Pipes Provided and Repaired 129 36 93 88 71 130 81 628 Water Supply— Store Cisterns provided ... ... ... ... ••• ... ... ... „ ,, Covers provided ... ... 1 3 ... • •• ... 4 ,, ,, Cleansed ... ... ... 1 ... 2 ... 3 „ ,, abolished ... ... ... 2 ... ... ... 2 Supply Reinstated 4 ... 7 3 9 ... 1 24 Fittings Repaired 29 ... 63 66 56 45 19 278 New Houses Inspected for Certificates before Occupation 1 ... 1 ... ... ... ... 2 Potable Water provided from Service ... ... ... ... ... ... ... ... Cleansing and Repairs— Houses Cleansed and Limewashed 345 159 277 312 240 205 307 1845 Houses repaired and Ventilation improved 274 46 353 204 150 188 276 1491 House roofs repaired 105 59 150 79 80 88 70 631 Dampness abated 86 ... ... 51 ... ... ... 137 Dung Receptacles— Abolished ... ... ... 3 ... ... ... 3 Provided ... ... 2 3 ... ... 1 6 43 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1921 —continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals. New Sinks fixed ... ... ... 7 ... ... ... 7 Sink waste pipes repaired ... ... ... 39 ... ... ... 39 Overcrowding- Cases Abated 2 ... ... ... ... ... 1 3 Accumulations Removed 2 7 12 ... 4 8 6 39 Animals- Ceased keeping as a Nuisance ... ... ... ... 2 3 3 8 5moke Nuisances- Cases Abated 1 ... ... 3 ... 1 2 7 Observations 5 ... ... 8 ... 3 9 25 Rooms occupied in such a manner as to be a nuisance 4 ... ... ... ... ... ... 4 District No. 1.—Inspector Simpson. District No 2.—Inspector Shelley. District No. 3.—Inspector Kemp. District No. 4.—Inspector Hewett. District No. 5.—Inspector Allam. District No. 6.—Inspector Yates. District No. 7.—Inspector Mayo. 44 HOUSE-TO-HOUSE INSPECTIONS. House-to-house inspections were made in the following streets during the year:— Street. Total Houses inspected. Number in which defects were found. Number in which no defects were found. Addey Street 32 31 l Albury Street 5 5 — Alpine Road 35 30 5 Alverton Street 30 19 11 Avonley Road 13 9 4 Baildon Street 37 37 — Berthon Street 12 12 — Bestwood Street 7 7 — Camplin Street 30 12 18 Canterbury Road 56 49 7 Childers Street 32 22 10 Chipley Street 5 5 — Church Street 34 34 — Cornbury Road 20 20 — Croft Street 22 17 5 Douglas Street 69 31 38 Edale Road 27 25 2 Edward Street 38 33 5 Faulkner Street 35 33 2 Frankham Street 16 16 — Giffin Street 22 21 1 Gosterwood Street 114 85 29 Glenville Grove 26 8 18 Hamilton Street 58 55 3 Harts Lane 3 3 — Heston Street 1 1 — Hyde Street 71 68 3 kender Grove 4 3 1 Render Street 119 100 19 Render Place 8 3 5 Kerry Road 53 14 39 knoyle Street 27 27 — Lubbock Street 22 20 2 Mary Ann Buildings 3 3 — Napier Street 20 13 7 Norfolk House 8 3 5 Railway Grove 34 19 15 Reaston Street 56 45 11 Rolt Street 82 54 28 Stanley Street 25 12 13 Warwick Street 90 30 60 White Post Lane 1 1 — Windmill Lane 10 7 3 Totals 1412 1042 370 45 UNSOUND FOOD. On November 9th, Inspector Shelley, acting on information received from a neighbouring borough, visited a yard in this borough and found deposited there in a cart, 516 tins of potted crayfish, 476 jars of potted meat and 32 tins of condensed milk, which were unsound and unfit for the food of man. The articles were accordingly seized, condemned by a Justice, and destroyed. Legal proceedings were not instituted as it was found impossible to prove that the articles in question were intended for human consumption. During the year, the following quantities of food were bronght to the notice of this Department, voluntarily by the owners, found to be unsound, and destroyed:— Apples 2 boxes Bacon 10 sides and l½ cwt. Cherries 2 baskets Chestnuts 56 lbs. Codfish 2 boxes Condensed Milk 88 tins Crabs 20 Dates 38 boxes Dog fish 1 trunk Fish fillets 4 boxes Grapes 40 lbs. Haddock 6 stone, 3 boxes, 1 trunk Herrings 2 barrels and 1 box Herrings (tinned) 1 tin Kippers 53 boxes Pears (tinned) 280 „ Plaice 29½ stone Potatoes 3½ sacks Rabbits 140 Sardines 1 tin Skate 9 stone and 2 boxes Soles 1 box and 1 trunk Tomatoes (tinned) 2 tins Tomatoes 74 lbs. Whelks 2 bushels SALE OF FOOD AND DRUGS ACTS. 600 samples were purchased and submitted to the Public Analyst for analysis. Of this number, 35 or 5.8% were adulterated. In 18 instances legal proceedings were taken, and fines and costs amounting to £41 18s. were inflicted. 46 Samples taken during 1921. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Halting Powder 1 .. 1 .. Brawn 2 .. 2 .. Butter 50 2 52 3.8 Ground Cinnamon 4 .. 4 .. Cocoa 11 .. 11 .. Coffee 2 .. 2 .. Preserved Cream 1 .. 1 .. Custard Powder 1 .. 1 .. Dripping 4 .. 4 .. Flour 1 .. 1 .. Ground Ginger 2 .. 2 .. Lard 14 1 15 6 7 Margarine 4 .. 4 .. Milk 367 26 393 6.6 Separated Milk 12 1 13 7.7 Skim Milk 1 1 2 50.0 Mustard 18 .. 18 .. Pepper 18 .. 18 .. Meat Paste 1 .. 1 .. Salmon and Shrimp Paste 2 1 3 33.3 Fish Paste — 1 1 100.0 Pork Sausage 1 .. 1 .. Beef Sausage 1 .. 1 .. Sausage 3 .. 3 .. Vinegar 36 1 37 2.7 Malt Vinegar 4 •• 4 .. Informal Samples— Milk 1 l 2 50.0 Flour 1 .. 1 .. Dried Milk 1 .. 1 .. Fish Paste 1 .. 1 .. Totals 565 35 600 5.8 47 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. 5 a Milk 5 per cent. abstraction of fat 2 0 0 1 1 0 7 a „ 1 per cent. added Water — — Vendor cautioned. 2 h „ 1 per cent. abstraction of fat — — Vendor cautioned 5 h „ 1 „ „ — — Vendor cautioned. 14 h „ 1 per cent. added water — — Vendor cautioned. 17 h „ 1 „ „ — — Vendor cautioned. 13 k „ 13 per cent. abstraction of fat — — Dismissed. Warranty proved 9 a Skim Milk 9 per cent. added water — 1 1 0 Dismissed on payment of costs 4 T Butter 9.6 per cent. excess of water — — Dismissed. Warranty proved 40 H Milk 14 per cent. added water 1 0 0 1 1 0 41 H „ 13 ,, „ — — Dismissed. 39 o „ Traces of colouring matter — — Vendor cautioned 45 O „ 3 per cent. abstraction of fat — — Vendor cautioned. 49 O „ 8 per cent. abstraction of fat and 12 percent. added water 4 4 0 1 1 0 50 O „ 7 per cent. abstraction of fat and 6 per cent. added water 4 4 0 1 1 0 52 0 „ 4 per cent. abstraction of fat and 3 percent. added water 4 4 0 1 1 0 53 O „ 9 per cent. abstraction of fat and 12 percent. added water 4 4 0 1 1 0 30 s „ 19 per cent. abstraction of fat and 8 per cent. added water 0 1 0 2 2 0 40 SY „ 6 per cent. abstraction of fat — — Dismissed on conviction of wholesale firm, samples 4953 O 41 SY „ Traces of colouring matter — — Vendor cautioned. 42 SY „ 14 percent. abstraction of fat — — Dismissed on conviction of wholesale firm, samples 4953 O 30 H Separated Milk 8 percent. added water 1 0 0 1 1 0 33 a Salmon and Shrimp Paste Boric acid 12 2 grains per lb. — — Vendor cautioned. 13 a Milk 2 per cent. added water — — Informal sample 61 S „ 4 per cent. abstraction of fat 0 1 0 2 2 0 20 T „ 2 „ „ „ — — Vendor cautioned. 22 t „ 1 „ „ „ — — Vendor cautioned. 23 T „ 5 „ „ „ — — Summons withdrawn on Solicitor's advice 64 T Butter 0.7 per cent. excess of water — — Vendor cautioned 35 T Fish Paste Boric acid 4 0 grains per lb. — — Vender cautioned 76 S Lard 2.1 per cent. excess of water — — V#ndor cautioned 92 O Milk 6 per cent. abstraction of fat — — Snmmons dismissed. Warranty proved 83 SY „ Traces of colouring matter — — Vendor cautioned 34 T „ 18 per cent. added water 4 4 0 1 1 0 71 S Vinegar 12 per cent. excessive water 2 2 0 1 1 0 SUMMARY. £. s. d. Fines 27 4 0 Costs 14 14 0 41 18 0 48 Legal Proceedings taken under Public Health Act and By-Laws. Premises. Offence. Fine. Costs. Remarks. £ s. d. £ s. d. 2, 4, 6, 8 and 12 Kenwood Avenue Premises without dustbins 5 0 0 5 5 0 5 summonses 2, 4, 6, 8 and 20 Reginald Place Do. do. 5 5 0 2 12 6 5 summonses 47 Windmill Lane Do. do. 0 10 6 0 10 6 161 Grove Street Fixing w.c. pan without noticc - 0 10 0 Dismissed on payment of costs 40 Sandbourne Road Drains in such a state as to be a nuisance 1 0 0 1 1 0 And Order for necessary work to be carried out within 28 days 42 Sandbourne Road Do. do. 1 0 0 1 1 0 Do. 44 Sandbourne Road Do. do. 1 0 0 1 1 0 Do. 70 Gellatly Road Fixing w.c. pan and trap without notice 1 0 0 1 1 0 Do. 1 Martha Place Improperly repairing drains without notice 2 2 0 1 1 0 Do. SUMMARY £ s. d Fines 16 17 6 Costs 14 3 0 £31 0 6 HOUSING. In December, 1920, the first two houses of the Council's Housing Estate. Arica Road, were completed, and were opened by His Worship the Mayor. During the year 1921, 109 houses were completed, making a total of 111 occupied or ready for occupation at the end of the year under report. Of these, 74 are in Deptford and 37 in Lewisham Borough, and comprise the following types:— Deptford Borough— concrete construction. Type A (non-parlour) Arica Road 19 houses Type B (parlour) Revelon Road 28 „ Type B „ Brockill Cresent 8 „ brick construction. Type B (parlour) Brockill Crescent 19 „ Total in Deptford 74 „ Lewisham Borough— brick construction. Type A (non-parlour) Brockill Crescent 4 houses Type B (parlour) Do. 33 „ Total in Lewisham 37 „ Factory and Workshops Act. 50 Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDING DURING 1921. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1920 Added 1921 Removed 1921 On register at end of 1921 Milk premises 179 33 76 136 439 15 .. Cowsheds .. .. .. .. .. .. .. Slaughter-houses 2 .. .. 2 24 .. .. Other offensive trade premises 2 .. .. 2 15 .. .. Ice cream premises 120 10 52 78 225 27 .. Fried fish, etc, shops 29 5 1 43 174 19 .. Restaurants 52 3 2 53 85 21 .. Other food premises 15 1 .. 16 49 20 .. 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 1921. CLASS OF WORK. Number of Places Number of Inspections. Number of Notices. Number of Prose cutions. On Register at end of 1920 Added 1921. Removed 1921. On Register at end of 1921. Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories Factory Laundries 4 4 17 5 Factory Bakehouses 11 3 14 29 57 1 Other Factories 142 39 10 171 505 241 6 Workshops Workshop Laundries 5 5 18 9 1 Workshops Bakehouses 45 45 90 198 2 Other Workshops 127 17 45 99 185 159 5 Workplaces Places where Food is prepared for Sale 117 6 2 121 228 314 25 Workplaces other than the above 56 5 5 56 76 72 Home-workers' Premises 499 65 275 289 299 383 22 Total 1006 135 337 804 1447 1438 62 51 Table. METROPOLITAN BOROUGH OF DEPTFORD. This Table is by request of the Secretary of State. Annual Report of Medical Officer of Health for the year 1921. On the Administrationof 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) 303 7 Workshops (including Workshop Laundries) 366 8 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 386 25 Total 1055 40 2 —DEFECTS FOUND. PARTICULARS Number of Defects. Number of Prosecutions Found. Remedied. Referred to H M. Inspector. Nuisances under the Public Health Acts. Want of Cleanliness 34 34 Want of Ventilation Overcrowding 1 1 Want of Drainage of Floors 1 1 Other Nuisances 29 29 Sanitary Accommodation Insufficient 7 5 Unsuitable or defective 75 75 Not Separate for Sexes Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bake house (sec. 101) Breach of Special Sanitary Requirements for Bakehouses (ss 97 to 100) Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 147 145 52 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. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109,110) Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Work- men. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— Making, etc. 94 12 269 17 21 56 6 Fur-pulling 1 1 Umbrella making 1 1 Artificial flower making 1 1 Tent making 1 1 Tennis ball making 3 3 Paper bag making 7 7 Total 108 12 277 17 21 56 6 53 Table—continued. 4 —REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 45 Dressmaking 17 Laundries 5 Millinery 14 Shirtmaking 1 Tailoring 13 Wheelwrights (Smiths, &c ) 12 70 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) 10 Action taken in matters referred by H.M. Inspectoras remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 16 54 CANAL BOATS ACTS. Under Sec. 3 of the Canal Boats Act, 1884, this Council is required to submit a report each year to the Ministry of Health on the execution of the above Acts and the steps taken to enforce compliance with the provisions thereof. The following report by Inspector Hewett, to whom is assigned the duties of Canal Boats Inspector, has been forwarded to the Ministry:— Sir, I beg to report for the year ending December 31st, 1921, that for the purpose of Canal Boats inspection, I made eleven visits on the following dates, viz.:— March 31st, April 5tb, May 2nd and 23rd, June 20th, July 14th and 16th, September 15th, October 7th, November 30th and December 12th. Only one boat "Witham," registered No. 351 at Brentwood, was inspected and found to be satisfactory. No children of school age were on board. The arrangements made for the inspection of Canal Boats are:—Periodical inspection by Sanitary Inspector duly appointed under the Canal Boats Acts, jointly with other duties as District Inspector. Yours obediently, (Signed) F. Hewett. INDEX. Page Vital Statistics- Summary of 7 Population 10 Births 10 Marriages 11 Deaths 12 ,, in Wards 13 ,, Causes and ages of 21 ,, from Zymotic Diseases 26-27 ,, Tuberculous Diseases 33 „ of Infants 13 Ministry of Health Tables 20-23 Infectious Diseases— Deaths from 26-27 Cases notified 26-35 Puerperal Fever 28 Scarlet Fever 28 Tuberculosis 29-35 Disinfecting 36 Page Sanitary Work- Housing 48 Coroner's Court & Mortuary 38 Summary of Sanitary Inspectors' Work 41 Legal Proceedings 47, 48 House-to-house Inspections 44 Food Supply— Unsound Food 45 Sale of Food and Drugs Acts 45-47 Factories and Workshops— Home Office Tables 50-53 Maternity and Child Welfare- Infant Welfare Clinics 15-17 Work of Health Visitors 18 Tuberculosis Dispensary— Report of Tuberculosis Officer 29-35 Canal Boats— Report of Inspector 54