A. Hendry. Photo. New Cross. Fred Hart. Breast Fed, 8½ months. Weight 23 lbs. 2 ozs. DEPT 16 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. 1923 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14 68619 Public Health Committee. Major. Councillor G. TAMS, J.P. Chairman. Councillor E. C. WOOD. Vice=Chairman. Alderman W. H. GREEN, J.P. Alderman Mrs. G. E. Green Councillor Mrs. A. A. Cheason Councillor Mrs. B. M. Drapper, J.P. Councillor A. G. Howard Councillor Rev. J. Mahoney Councillor W. F. Marchant, O.B.E., L.C.C. Councillor Mrs. G. Tiffen Councillor Miss K. P. Warcup Councillor Mrs. L. E. White , Maternity and Child Welfare Committee Chairman. Councillor Mrs. B. M. Drapper, J.P. Vice-Chairman. Alderman Mrs. G. E. Green Consists of the Members of the Public Health Committee, as above. Staff of the Public Health Department. /Medical Officer of Health and Administrative Tuberculosis Officer. Charles. S. Thomson, m.d., ch. b. (University of Glasgow), d.p.h. (Durham), o.m.m. (Greece.) Assistant Medical Officer of Health and Tuberculosis Officer. J. A. Harbison, m.d., d.p.h. Second Assistant Medical Officer of Health and Maternity and Child Welfare Medical Officer. S. Eleanor Hill, m.d., b.s. Public Analyst. Henry G. Harrison, m.a. (Cantab ), f.i.c. Chief Clerk. Charles A. Chapman, Cert, s.i.e.b. (Lond.) Clerks. A. G. W. Pettitt, H. E. Green, G. A. Langley. Sanitary Inspectors Robert D. J. Simpson, Cert. Royal Sanitary Institute. Phillip Shelley, ,, ,, ,, „ „ ,, „ ,, (Meat and other Foods). John V. Snowdon, ,, ,, ,, ,, ,, ,, ,, ,, (Meat and other Foods). Arthur G. Kemp, ,, „ ,, ,, ,, s.i.e.b. (London). ,, Royal Sanitary „ (Meat and other Foods). Frederick Hewett, ,, s.i.e.b. (London). „ Royal Sanitary ,, (Meat and other Foods). Harry Allam, „ ,, ,, ,, ,, s i e.b. (London). ., Royal Sanitary ,, (Meat and other Foods). Albert E. Yates, ,, s.i.e.b. (London). s.i.e.b. (London) (Meat and other Foods). William F. Mayo, ,, s.i.e.b. (London) Health Visitors. Miss E. Clubbe, Certs. General Training; c m.b. and Health Visitor (r.s.i.) „ E. Holland ,, ,, ,, c.m.b. and Health Visitor (r.s.i.) San. Inst, (r.s.i.) „ H. F. G. Piper ,, „ ,, c.m.b. and Health Visitor (r.s.i.) ,, E. T. Stowell ,, ,, ,, c.m.b. and Health Visitor (r.s.i.) * ,, W. C. Smart, Cert s.i.e.b. (London), c.m.b. ,, E. T. White, Cert Gen. Training; c.m.b , i.s.t.m., Health Visitor (r.s.i.) * Appointed as Sanitary Inspector and Health Visitor. Municipal Maternity Home. 52 Wickham Road, S.E. 4. Medical Officer—Dr. S. E. Hill, m.d., b.s. Matron—Miss K. Smith, Cert. General Training and c.m.b Sister—Miss A. Cross „ ,, ,, „ Nurses—A Packer, Cert. Gen Training and c.m.b. M. L J. Pearce ,, ,, ,, ,, ,, S. Wass, Cert. Gen. Training. Tuberculosis Dispensary. Hilary House, 78 Amersham Vale, S.E. 14. Tuberculosis Officer—J. A. Harbison, m.d., d.p.h., Secretary, Tuberculosis Care Committee. Miss A. I. Baird, Cert. Gen. Training, c.m.b., i.s.t.m., r.s.i., Health Visitor. Tuberculosis Nurses—Miss E. M Porteous. Miss G. L. Le Maitke. Dispenser—Miss G. F. Greig. Caretaker Attendant—G. Abbott. Mortuary and Coroner's Court. Watson Street, S.E. 8. Mortuary Keeper—g. W, J. Wagner, Cleansing Station. Watson Street. Attendant—Mrs. Wagner. Disinfecting Station. Watson Street, S.E. 8. Chief Disinfector—c. F. Dowsett. T. Lyons. F. Smith. J. Lloyd. Infant Mortality Rates from 1901 to 1923. Deptford County of London England and Wales Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross Road, S E. 14. July, 1924. 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 my Annual Report for the year 1923. Some excellent results have to be recorded. The accompanying chart gives a review at a glance of the fall in the infant mortality rate; any industrial borough which has a rate of 59 per 1,000 born can afford to be pleased. The influence of the six infant welfare centres in helping to save infant life can be discerned by noting the following :—There were 2,428 births in the Borough in the year under report, and 143 infants died before reaching their first birthday. Two thousand six hundred and twenty-one different infants under five years of age attended the centres. Of the 143 infants who died, only 28 deaths occurred amongst infants who had attended the centres. Certain corrections must be made before drawing deductions; for example : 39 of the 143 deaths occurred before the infants had lived 14 days, and another 14 infants died between the 14th and 28th days of life. Obviously this number, 53, dying before the completion of the first month of life, must be ignored for our purposes, inasmuch as infants as a general rule are not expected to be brought to the centres until they are one month old. This then leaves a balance of 62 infant deaths occurring amongst the comparatively small number of babies who are not brought to the centres as against only 28 deaths occurring amongst the great majority which are so brought. By all means make further allowances and say that presumably some of the 62 were delicate and so forth, and could not be brought to the centres. I have my doubts. In any case, these latter were visited at their homes by the Health Visitors. We must deduce that the medical infant consultations at our infant welfare centres, the lecturettes, the weighing, the stimulus of friendly rivalry between the mothers, etc., etc., are of prime value. 2 I believe that some, at least, possibly only a few, of the mothers who do not accept the kind invitation to attend the centres for their babies' benefit, are of the feckless, it may be careless, order, who, unintentionally of course, let their babies slip through their fingers and so help to swell the infantile mortality rate. The local authorities in England have done and are doing great things for the burgesses, but the maximum of success will only be attained when every individual citizen responds and meets the local authorities half way. Every man and woman must develop a high hygienic sense and put it into practice. A chart will be found in the Report showing the fall in the death rate from tuberculosis, both pulmonary and ' other tuberculosis." It is most gratifying to record that 95 died of pulmonary tuberculosis as compared with 133 in the previous year, and that 17 as compared with 31 died from non-pulmonary forms of tuberculosis. A very full report on tuberculosis will be found in the text. Those valuable institutions, the Miller General Hospital and the Greenwich and Deptford Hospital have been linked up with our Tuberculosis Dispensary, and we may look forward with confidence to a continuation of the good work. I have little to add to my remarks on Housing made last year. No citizen can reproach the Council, as every available bit of ground was built upon years ago. The question now before us is to think of the housing of those people who will be temporarily displaced in what I feel sure will be an early thrustful move forward in the clearance of an area or areas. This question is ever present in the mind of your Council. Meanwhile, a steady house-to-house inspection is made by your Sanitary Inspectors to ascertain the existence of defects. No doubt, as the machine moves forward and the value of the Inspectors' good work becomes increasingly manifest, it will be your wish that the present tentative standard of 16 houses per Inspector every fortnight will be revised in an upward direction ; meanwhile it is my hope to return to my first love, Housing, myself, and to carry out an inspection of the least satisfactory property in the Borough. The success of the Maternity Home is an established fact, the number of admissions having increased from 129 in 1922 to 200 in 1923. Full particulars will be found in the Report. In connection with the public food supply, there is still further need for protecting the general public. 3 No doubt one is tilting against long established custom, nevertheless it is time that regulations were made to prevent meat being exposed in shops with open fronts. Dust and road refuse are blown upon the meat. A prominent surgeon told me recently that when motoring in the West End he felt some dust driving into his eye. Out of curiosity he called in at his hospital and asked the bacteriologist to make cultures from the dust to see what germs were present. Tubercle and diphtheria bacilli were found ! Think then what must happen to the meat which, throughout the whole of London is placed in front of the shops, exposed to dust and germs as well as, on rare occasions, to the paws of ladies with discriminating tastes! More stringent regulations are required as regards the traffic of meat through the streets. No foodstuff intended for sale on stalls or barrow should be stored in stables or in living or sleeping rooms; this has been known in London, The fact of the matter is, except for one thing, the public health has reached a very high standard in this country. The exception is the food question. More intense food inspection, more consideration for the consumer and less for the casual itinerant vendor, etc., etc.—these are required. Your Medical Officer once again, through your Council and with its permission, offers to give any group, body or association in Deptford an address on any subject dealing with health. I have dealt with Cremation in the present Report as the educational subject of the year. It is by means of education, and religion of course, that we can raise " all sorts and conditions of men." Your Health Department is here waiting to be consulted by the public and to do anything it can. This spirit exists through the whole Department, to the loyalty and kindness of each member of which, as well as to the gratitude I feel for your unfailing kindness and support to myself I have the honour to bear witness. Your obedient Servant, Charles S. Thomson, Medical Officer of Health. 4 Summary of Vital and Mortality Statistics for 1923. 1923. 1922. Area 1,564 acres 1,564 acres Population— Census 1911 109,496 109,496 Census 1921 112,534 112,534 Estimated to middle of year 114,900 114,100 Number of inhabited dwellings (Census 1921) 18,122 18,122 Average number of persons per dwelling 6·3 6·3 Density 73 per acre 73 per acre Length of Public Streets 53 miles approx. 53 miles approx. Rateable Value £644,259 £657,730 1d. Rate produces (approximately) £2,611 £2,621 Cost of administration of Public Health Department £4,248 £4,248 Marriages 862 976 Marriage Rate 7·5 8·6 Births 2,428 2,631 Birth Rate 21·1 23·1 Birth Rate, average for the last 10 years 24·4 24·7 Deaths 1,272 1,574 Death Rate 11·1 13·8 Death Rate, average for the last 10 years 14·8 14·7 Infantile Mortality 59 per 1,000 births 74 per 1,000 births Infantile Mortality, average for the last 10 years 96 per 1,000 births 97 per 1,000 births Zymotic Death Rate 0·6 1·4 Deaths from Measles (all ages) 8 59 Deaths from Whooping Cough (all ages) 12 35 Deaths from Diarrhœa and Enteritis (under 2 years of age) 18 11 'Structurally separate dwellings occupied by private families, i.e., houses and self contained flats. Area and Population. Births and Deaths. 7 Area and Population. Acres. Estimated Population. 1564 114,900 The population of Deptford to the middle of 1923 has been estimated by the Registrar-General as 114,900. This estimate has been based on the adjusted 1921 figures, after allowing for the varying rate of natural increase as evidenced by the births and deaths, and of migration as indicated from other sources, such as the changes in the numbers on the Parliamentary Register and the migration returns from the Board of Trade. The population for each of the various wards, based on this estimate, was as follows :— East 21,776 South 13,338 North 24,445 * South-East 13,369 North-West 24,590 South-West 17,382 As the Borough has an area of 1,564 acres, the density of the population on this estimate is 73 persons per acre approximately. Births. Births. Birth rate per 1,000. 2,428 21.1 The total number of births registered in the Borough was 2,286 and of these 85 were transferred to other districts, as the permanent addresses of the parents were outside this Borough. Similarly, 227 births occurring outside of the Borough, in maternity hospitals, were transferred to Deptford, making a total of 2,428 births in all belonging to Deptford. Of these, 1,210 were males and 1,218 were females. This figure gives a birth-rate of 21.1 per 1,000 of the estimated population, as compared with 23-1 for the year 1922. The birth-rate for England and Wales for 1923 was 19.7 ,, „ the 105 County Boroughs and Great Towns was 20.4 „ „ the 157 Smaller Towns was 19.8 „ „ the County of London was 20.2 The rate for Deptford was therefore higher than the average for the country as a whole. Table I shows the number of births and birth-rates for the past ten years :— 8 Table 1. Year. Estimated population. Births. No. Rate per 1000. 1913 109,280 3106 28·0 1914 109,182 3121 28·6 1915 110,299 2955 26·8 1916 110,299 2918 26·5 1917 115,403 2329 20·1 1918 114,328 2093 18·3 1919 115,843 2426 20·5 1920 115,772 3276 28·3 1921 113,500 2667 23·5 1922 114,100 2631 23·1 Average for 10 years 112,801 2752 24·4 1923 114,900 2428 211 Illegitimate Births. The illegitimate births numbered 57 or 2-4 per cent, of the total births. These occurred in the several wards as follows :— East ... ... 25 South ... ... 9 North ... ... 10 South-East ... 4 North-West ... 5 South-West ... 4 As far as can be ascertained, the occupations of the mothers in these cases were :—Domestic servants 9 ; Factory hands 7 ; Barmaids 5 : Shop assistants 4; Drapers' assistants 4; Laundry workers 3. The remaining births occurred outside the Borough and the information as to occupation is not available. Under the provisions of the Notification of Births Act, 1907, intimations have been received from medical men, parents and others with respect to 2,332 births. Omitting still births, which numbered 47, this gives a percentage of births notified to those registered of 94. Marriages. Marriages. Marriage Rate 862 7-5 The Superintendent Registrar has kindly furnished me with the particulars. There were 862 marriages in the Borough during 1923 as compared with 976 in the previous year. The marriage rate was equal to 7*5 per 1,000 of the population as compared with 8'6 for the year 1922. 9 The marriages were celebrated in the following places :— 573 in Churches of England. 71 in other places of worship. 218 in the Superintendent Registrar's Office. 862 Total Deaths- Deaths. Death Rate. 1,272 11•1 The deaths registered in Deptford numbered 822 equalling a death- rate of 7•2, as compared with 1,063 and a death-rate of 9•3 for the preceding year. Of this number, 161 were non-parishioners. The deaths of Deptford residents occurring outside the Borough in public institutions were 611, making a total of 1,272 deaths belonging to this Borough. Of these 671 were males and 601 were females. The death rate was 11•1, compared with 13•8 in 1922. The death-rate for England and Wales was 11•6 „ „ for the 105 County Boroughs and Great Towns was 11•6 „ „ for the 157 Smaller Towns was 10•6 „ „ for the County of London was 11•2. The following table shows the number of deaths which have occurred during the past ten years, with the respective rates :— Table II. Year. Estimated Population. Deaths. No. Rate per 1000. 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 1921 113,500 1382 12.2 1922 114,100 1574 13.8 Average for 10 years 109,906 1628 14.8 1923 114,900 1272 11.1 * Civil population. 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:- 10 Table III. Ward. Deaths. Death Kate per 1,000. Males. Females. Children under 1 year. Total. East Ward 160 127 46 287 13.2 North Ward 126 125 30 251 10.3 North-West Ward 114 106 22 220 8.9 South Ward 61 84 9 145 10.9 South-East Ward 108 69 17 177 13.2 South-West Ward 102 90 19 192 11.0 The proportion which the mortality at various ages bears to the total number of deaths during 1923 and the previous year is as follows:— Table IV. 1922 1923 Under 1 year 12.4 per cent. 11.2 per cent. 1 to 2 years 6.7 2.8 " 2 to 5 „ 6.1 2.8 " 5 to 15 „ 4.4 4.0 " 15 to 25 „ 4.6 4.2 " 25 to 45 „ 11.9 12.1 " 45 to 65 „ 24.2 27.9 " 65 years and upwards 29.7 35.0 " Infantile Mortality. Infant Deaths. Infantile Mortality Rate. 143 59 143 Infants died before attaining the age of one year, i.e., 59 per 1,000 of the births registered. Of this number 8 were illegitimate, representing an illegitimate infant mortality rate of 140 per 1,000. 1 he mortality amongst infants in the various wards is shown in the following table:— Table V. Ward. Births Registered Deaths under 1 year of age. Infantile mortality per 1000 Births. East 555 46 83 North 496 30 60 North-West 464 22 47 South 426 9 21 South-East 234 17 73 South-West 253 19 75 11 Comparative table of infantile deaths from Diarrhoea and Enteritis. Table VI. RATE PER 1000 BIRTHS. Diarrhoea and Enteritis under two years. Total deaths under one year. England and Wales 7.7 69 105 Great Towns 9.9 72 157 Smaller Towns 6.4 69 County of London 10.2 60 Deptford 7.4 59 Table VII. TABLE SHOWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1923 Births 2428 Deaths 1272 Excess of Births over Deaths 1156 Table VIII. INFANTILE MORTALITY RATE FOR THE PAST TEN YEARS. Year. Deaths under 1 year. Infantile Mortality Rate. 1913 350 113 1914 309 99 1915 391 132 1916 258 88 1917 239 102 1918 205 97 1919 207 85 1920 259 79 1921 234 88 1922 195 74 Average for 10 years 265 96 1923 143 59 12 Table No. IX. METROPOLITAN BOROUGH OF DEPTFORD. VITAL STATISTICS OF WHOLE DISTRICT DURING 1923 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. Uuder 1 year of Age. At all Ages. Uncorrected Number. Nett. of Nonresidents registered in the District of Residents not registered in the District. Number. Rate per 1.000 Nett Births. Number. Rate. Number Kate. Number. Hate. 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 1,361 133 230 696 205 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 1,003 87 207 612 259 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 1922 114,100 2,515 2,631 23.1 1,063 9•3 224 735 195 74 1.574 13•8 1923 114,900 2,286 2,428 21.1 822 7•2 161 611 143 59 1,272 11•1 Area of District in acres (land and inland 1,564. water). Total population at all ages 112,534. Total families or separate occupiers, 28,007. At census 1921 13 Table No. X. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at, Death during the Year 1923. Nett Deaths at the subjoined Ages of ''Residents'' whether occurring within or without the District. CAUSES OF DEATH. 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 under 75 years. 75 and upwards.| 1 2 3 4 5 6 7 8 9 10 n All causes 1272 143 36 35 51 53 154 355 222 223 Enteric Fever 2 .. .. .. 1 .. .. 1 .. .. Small pox .. .. .. .. .. .. .. .. .. .. Measles 8 3 3 2 .. .. .. .. .. .. Scarlet Fever 2 .. .. 1 1 .. .. .. .. .. Whooping Cough 12 6 2 4 .. .. .. .. .. .. Diphtheria and Croup 33 3 2 14 13 1 .. .. .. .. Influenza 21 .. 1 2 .. 3 3 9 1 2 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. Meningococcal meningitis .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system 95 .. .. .. 1 26 37 27 1 3 Other Tuberculous Diseases 17 2 3 2 7 1 1 1 .. .. Cancer, malignant disease 140 .. .. .. .. .. 12 74 41 13 Rheumatic Fever 4 .. .. .. 2 .. .. 2 .. . Diabetes 12 .. .. .. .. .. 1 7 3 1 Cerebral Haemorrhage, &c. 76 .. 1 .. .. .. 5 26 21 23 Heart Disease 147 1 .. .. 2 3 14 54 57 36 Arterio-sclerosis 24 .. .. .. .. .. .. 5 9 10 Bronchitis 72 8 1 .. 1 .. 2 18 13 29 Pneumonia (all forms) 91 15 11 5 5 3 11 28 12 6 Other Respiratory Diseases 14 .. .. 1 1 .. 1 5 4 2 Ulcer of Stomach or Duodenum 12 .. .. .. .. .. 4 6 2 .. Diarrhæa, &c. 22 17 1 .. 2 .. 1 1 .. .. Appendicitis and Typhlitis 9 .. .. 1 1 2 1 4 •• •• Cirrhosis of Liver 9 .. .. .. .. .. 2 4 3 • • Acute and chronic Nephritis 33 .. 1 .. .. 1 10 16 1 4 Puerperal Sepsis 2 .. .. .. .. .. 2 .. .. .. Other accidents and diseases of Pregnancy and Parturition 6 .. .. .. .. 2 3 1 .. .. Congenital Debility and Malformation, including Premature Birth 58 58 .. .. .. .. .. .. .. .. Suicides 7 .. .. .. .. .. 2 4 1 .. Other deaths from violence 45 3 1 .. 5 2 10 13 5 6 Other defined diseases 276 27 6 3 9 9 32 64 48 88 Diseases ill-defined or unknown 3 .. 3 .. .. .. .. .. .. .. 14 Table No. XI. METROPOLITAN BOROUGH OF DEPTFORD. Infantile Mortality, 1923. 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 32 7 6 8 53 25 27 18 20 143 Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. 1 1 Measles .. .. .. .. .. .. .. .. 2 3 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 1 .. 4 6 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 3 Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 1 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. .. .. .. .. .. .. .. 1 1 Convulsions 1 2 .. 2 5 2 3 1 1 12 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 2 .. 3 1 2 1 1 8 Pneumonia (all forms) .. .. .. 2 2 .. 3 6 4 15 Diarrhæa .. .. .. .. .. 2 3 3 1 9 Enteritis .. .. .. .. .. 2 4 2 .. 8 Gastritis .. .. .. .. .. 1 1 .. .. 2 Syphilis .. .. .. .. .. 2 1 .. .. 3 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. 2 .. .. .. 2 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis 1 .. .. 1 2 .. .. .. .. 2 Congenital tions 3 1 1 .. 5 4 1 .. .. 10 Premature Birth 23 1 1 2 27 1 .. .. .. 28 Atrophy, Debility, and Marasmus 2 2 2 .. 6 6 6 .. 2 20 Other Causes .. .. .. 1 1 1 2 2 .. 6 32 7 6 8 53 25 27 18 20 143 15 Table No. XII. METROPOLITAN BOROUGH OF DEPTFORD. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1923. 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 417 7 131 223 36 20 .. .. 78 68 182 21 27 41 409 Erysipelas 57 3 1 3 12 14 20 .. 31 6 10 3 3 4 9 Scarlet fever 349 1 86 222 31 9 .. .. 61 63 82 33 32 78 331 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 10 .. .. 6 .. 4 .. .. 6 2 .. .. .. 2 10 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued lever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 7 .. .. .. 3 3 1 .. 2 1 2 1 .. 1 7 Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 3 .. 1 2 .. .. .. .. 1 .. 1 1 .. .. 3 Pulmonary Tuber 242 .. 2 21 58 102 50 9 75 51 43 20 34 19 208 Other forms of Tuberculosis 94 5 19 47 14 7 2 .. 44 18 8 8 8 8 42 Ophthalmia Neonatorum 15 15 .. .. .. .. .. .. 5 2 3 1 2 2 6 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhæa and Enteritis 33 12 21 .. .. .. .. .. 19 7 1 .. 5 1 4 Acute Pneumonia 74 6 20 14 7 12 14 1 37 7 18 1 7 4 5 Malaria 4 .. .. .. .. 3 1 .. 2 2 .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enceph. Lethargica . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chickenpox 70 2 20 46 1 1 .. .. 9 4 30 7 15 5 .. Measles 204 7 126 66 4 1 .. •• 39 33 67 11 30 24 9 Totals 1579 58 427 650 166 176 88 14 409 264 447 107 163 189 1043 91 Table XIII. 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 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 1921 2 0.02 — — 1 0.01 13 0.11 14 0.12 13 0.11 55 0.48 98 0.86 1922 2 0.02 — — 59 0.52 11 0.10 35 0.31 39 0.34 11 0.10 157 1.38 f Average for 10 years 2 0.02 — — 33 0.30 7 0.06 26 0.24 19 0.17 53 0.49 141 1.28 1923 2 0.02 — — 8 0.07 2 0.02 12 0.10 33 0.29 18 0.16 75 0.65 17 CREMATION. Cremation has undoubtedly caught the public imagination: whilst thoughtful men and women have already decided upon this question for themselves, many have been roused to make enquiry following upon the announcement that, in future, Cremation must precede the burial before interment in Westminster Abbey. My reason for bringing this subject before you is that I am convinced that until Cremation is widely adopted we shall continue to run the risk of contracting disease. Now this is a somewhat startling statement to make. I admit at once that it cannot be proved, but of this, more anon. The progress of the Cremation movement is slower than sanitarians, economists and lovers of the aesthetic could wish for, and I am satisfied that the main reason is that the subject is not brought before the mass of the people as it should be. I have searched into the literature on Cremation in order that I may do justice to the subject, and it is with pleasure that I here acknowmy indebtedness to Dr. Killick Millard, the well-known and esteemed Medical Officer of Leicester, whose Chadwick Lecture on "The Disposal of the Dead" will be treasured by those who have been fortunate enough to secure a copy. I have made free use of his lecture so far as the historical part is concerned. With human beings as with the lower animals, death is repellant. People do not like to think of it; they do not mind lifting up their voices and singing hymns in church expressing a yearning to enter the Golden Gates forthwith, but any reference, outside the church, to the possibility of so doing is carefully avoided. The subject is practically taboo with practically all of us; we refuse to face the only certain fact there is, the fact of death. In the words of Claudio in" Measure for Measure," " O Isabel, death is a fearful thing . . . . To die and go we know not where ; to lie in cold obstruction and to rot; this sensible warm motion to become a kneaded clod." The question of the disposal of the dead has always been a problem. Lower animals will drag a body out of the burrow or nest to get it away, whilst the gorilla is said to cover up the body of a dead mate with branches. In days that are far back in the world's history, cave men took out their dead and covered them with branches or earth and stones. As implements improved, the body was buried in a hollow in 18 the ground. Next came the use of hollow trunks of trees as coffins. At a later date dwellers in tents deposited their dead in caves, closing the entrance with piles of loose stones, ashes and burnt wood. Still later, tomb caves were cut out of the soft limestone. In the stone age cave burial was not so common as burial in barrows. A barrow consisted of a chamber made with slabs of stone, large enough to hold a body in the sitting position: thereafter the whole was covered with earth. This barrow burial was common in the bronze age. Research has disclosed the fact that bodies were sometimes burned and the ashes finally buried in barrows. The iron age brought improvement in implements, and burials in graves became more common. Apart from ancient Egypt, the earliest cemeteries were near Bologna, but even there the remains were sometimes burned before burial. This burning was primitive, the body being simply placed in the centre of a bonfire of large dimensions. The process was incomplete, being quite unlike the modern scientifically constructed crematory furnace. In ancient Egypt, burial customs and rites were most elaborate. An attempt was made to preserve the body indefinitely against decay and corruption by means of embalming. The heat and dryness enabled the process to be carried out successfully, but in spite of the climatic advantages, embalming does not prevent the ravages of death, nor does it preserve the attributes of life, therefore the results of embalming must be regarded as a miserable failure. The most beautiful mummy is but a poor parody of life. Sir Thomas Browne in his "Urn Burial" says: "Egyptian ingenuity was more unsatisfied, contriving their bodies in sweet consistencies, to attend the return of their souls. But all is vanity, feeding the wind and folly. Egyptian mummies which Cambyses or time hath spared, avarice now consumeth. Mummy is become merchandise. Mezrain cures wounds and Pharoah is sold for balsam." The practice of embalming in Egypt fitted in with the religious belief of the nation. It was believed that the body was the habitation of an ethereal something, the spirit, which at the time of death assumed a form less material than the frame it had quitted, but representing as a coloured shadow the exact image of the individual, trait for trait. This shadowy existence has been given the name of the "double." It was supposed to have the same needs and desires as the original and to be a continuation of its life. It was ordained at some future time, after a 19 series of transformations in some unknown region, to rejoin the body. It was therefore important to preserve the body against destruction until the time when the spirit or " double " should rejoin it. Hence the elaborate procedure and ritual in connection with embalment, the liberal supply of mummified provisions, ducks, geese and loaves of bread, with furniture and treasures of every description placed in the tomb. This we have lately had brought home to us by the contents of Tutankhamen's tomb. The poor were buried in the sand on a bed of charcoal, wrapped in a simple straw mat, when, owing to the dryness of the sand, the body soon became naturally mummified. In ancient Greece, during the Heroic Age, it was an honour to be burnt at death and a disgrace not to be burned. The slain in battle were also frequently burned on sanitary grounds. In ancient Rome burning was also very common, and cinerary urns containing the ashes abound. In India, amongst the Hindoos burning the body is the approved method ; on the banks of the Ganges this process is continually going on at the "Burning Ghats." The crude and primitive method there adopted leads to serious nuisance and is totally different from modern cremation in a scientifically constructed reverberatory furnace. The Parsees expose their dead in " Tombs of Silence " on slabs of stone. Within two hours or so, flocks of vultures have entirely stripped the flesh from the bones. Disgusting as this may seem to us, it is preferable to the method of disposal of the dead in England, where we leave the body in the grave to rot and poison the air, soil and water. The more enlightened Parsees are now adopting cremation. Cremation was given up a few centuries after the dawn of the Christian era. The early Christians were against it, probably because it conflicted with the doctrine of the resurrection of the actual body; indeed, Dr. Hilliard states that this is one of the reasons officially put forward by a certain Church to-day in justification of the refusal of that Church to sanction cremation. Modern cremation was revived in Italy about the year 1876 at Milan, and the Cremation Society of England was founded by a surgeon, Sir Henry Thompson, about the same time. The first crematorium, at Woking, was opened for public use in 1885. The movement has grown steadily, and now we find 84 crematoria in the United States, 55 in Germany, 28 in Italy, 13 in Switzerland, 6 in France, 5 in Scandinavia, 1 in Holland and 2 in Czecho-Slovakia, 20 with more under construction. In Britain there are 15, where over 2,000 cremations took place in 1922. A striking point in connection with Czecho-Slovakia is the rapid growth of its popularity. Thousands of people have joined the Cremation Society, men and women eminent in science, art and politics. One has only to scan the list of people in England to see that cremation appeals to lovers of beauty and art, to the enlightened and thoughtful, to sanitarians; there are many people who, whatever harm they may do their fellow men while living, are determined not to do any harm when dead. Now we must consider the arguments in favour of cremation and against alike. The first argument in favour which I shall take is the Hygienic argument. About the middle of the last century, overcrowding in graveyards had become a scandal. At the request of the Home Secretary, Sir Edwin Chadwick enquired into and reported on the practice of interment in towns, to both Houses of Parliament in 1843. Following upon his criticisms a special Commission was appointed and their Report was published in 1850. A truly shocking state of affairs was revealed. The Metropolitan graveyards were found to have been overcrowded for years. The graves had become black, unctuous and foul; in many cases the ground of the churchyard had risen many feet above its original level. The Bethnal Green burial ground, 2½ acres in size, had, since its opening in 1746, admitted 56,000 bodies. In the Bunhill Fields burial ground of less than four acres, 107,416 bodies had been interred in 129 years. In the London burial grounds of 203 acres, close to inhabited houses, 50,000 bodies were deposited annually. One cannot give here the gruesome and revolting evidence, suffice it to say that 4,000 old burial grounds were closed. The burial regulations now require a minimum space for adult graves of nine feet by four feet and only one body can be buried at a time unless members of the same family. No unwalled grave can be reopened within fourteen years except for another member of the same family, and then one foot of earth must be left undisturbed above the last coffin. No coffin can be buried less than four feet from the level of the ground. This last regulation is scientifically wrong because it is in the top four feet of soil that we find germ activity at its height which breaks up the body most rapidly. But to propose to bury anyone in the top four feet would 21 never do, so we bury people deep down and fondly imagine that which is out of sight will not disturb us. Now the rapid growth of cities is making the finding of room for cemetery extension a very difficult matter, and nowhere is this more so than in London. I have already told you that earth burial is not without danger to the living. Under the varying conditions of ordinary burial, bacteria live and thrive for years; it has been proved beyond the shadow of a doubt that germs come to the surface, but we have not been able to prove to what extent disease is or may be spread by earth burial. We know that contaminated earth carries germs which cause disease, but we cannot tell you how some of these diseases which cost the country millions every year are carried from one part of the country to another. Why did so many non-combatant millions die during and after the war from a disease which, to hide our ignorance, we called influenza? I think I know. Another thing. People speak of the departed as being "At rest." or "At peace," "Life's fitful fever is o'er." It sounds well and I would be the last to trespass upon any sentiment of the kind. But is it true? So far as the body is concerned it is a pure myth. With the advent of death, changes of a revolutionary character commence with devastating rapidity and continue until the slow process of putrefaction is complete, a matter of years. The question of earth burial versus cremation must be decided by the living. Which process is likely to be in the best interests of the public health? On the one hand, the rapid reduction, without offence, of the body into ashes in an hour-and-a-half; on the other the long drawn out offensive process which after many years sees the body reduced to the same elements. The second argument in favour is the Aesthetic Argument. Many people have joined the Cremation Society on purely aesthetic grounds. They deplore the evidence of decay and neglect, the tumbled tombstones, the ill-kempt appearance of so many cemeteries. How can anyone prefer a grave to the beautiful cleansing of fire; from the earliest days it is spoken of—a cleansing fire. Sentiment has stood in the way of cremation, but sentiment will yet lead to its general adoption. Each burial has retained its hold on the people because it has been hallowed and sanctioned by centuries old tradition, and has been interwoven too with their religious beliefs. The new generation believe 22 that it is less repulsive for their bodies to be resolved into their elements quickly, inoffensively and scientifically in the purifying flame than for them to undergo the lingering, loathsome process of putrefaction. In the physical sense we cannot depend upon the bodies buried in the ground being undisturbed. Have we not read in the past of the removal of human remains from graveyards to make room for the requirements of the living ? There is no fear of such disturbance by cremation. " Why hide reasons or affections eyes, The grave pollutes, the furnace purifies." Think of the words of Macterlinck—" Purified by fire the memory lives in the heights of a beautiful idea; and death is not but an immortal birth cradled in flames." Much might be made of the Economic Argument, the cost of the ground for cemetery extensions, etc., but I shall pass on to the case against cremation. Let us show every courtesy to the views of the different religious denominations. The views of the Rt. Rev. Dr. Gore, late Bishop of Oxford, probably represents those of the overwhelming majority of the Church of England. the Church of Scotland, and of the Free Churches of these countries. Dr. Gore says—" What I should desire when I do myself die is that my body should be reduced rapidly to ashes so that I may do no harm to the living." I have been at pains to ascertain the reasons given on the grounds of religion against cremation. Dr. Herring states that the Jews discourage cremation but do not absolutely forbid it; they prevent pit burial as far as possible. He states that the Roman Catholics do not allow cremation under any circumstances, although they permit pit burial. The late Sir Malcolm Morris said that he asked leading Roman Catholic friends of his why they were against cremation. It was not an Article of Faith but was a matter pertaining to the resurrection of the body. To give Sir Malcom's own words—" Now, those of us that have got a faith, and really believe that we are going to rise, cannot for one moment doubt that there is no greater difficulty to rise from the ashes of the body after it has been burned for an hour than to rise from the powder and the gases that have been allowed to decompose for months and years in the tomb. Surely one cannot doubt that the Almighty, who has got the power on the one hand, will not have the power on the other." 23 The next objection against Cremation is that of Cost. One hears that cremation is a rich man's luxury. You will be surprised to hear that except in the case of pit burial which is, of course, the cheapest, Cremation is cheaper than burial. Let me give you an illustration of how the cost works out in actual practice—the comparative costs. A man dies in London. Burial is proposed. A lair costs £8. The cost of everything including burial charges and undertaker's charges is from £30 to £35. That is a fair statement of the cost: I have had it checked. If a monument be put up at this private grave, an additional £10 is required. There is maintenance of the grave and tombstone erected, as well. In the case of Cremation, there is no reason why the undertaker's charges for funeral incidentals should differ materially whether a body is buried or cremated. The same hearse, carriages and men are employed. The Crematorium in London is more accessible than many cemeteries. The coffin is the same, except that an expensive hard wood coffin is undesirable, while a lead coffin or an outer case is unnecessary. The undertaker's services are the same in either case, while from the undertaker's point of view there should be more profit with the simpler coffin for cremation than with an expensive coffin for burial, but, putting his account at £20, we have to add the cremation fee £6 6s., clergyman's fee 10/6, medical certificate £1 1s., and a niche in the Columbarium £6 6s. Total £34 3s. 6d. This represents a saving of £5 or more on the cost of burial as stated above. It must also be remembered that a niche in the Columbarium constitutes a permanent memorial free of all liability for maintenance. Now in about 50 per cent. of cases cremated at Golder's Green, the deceased has left instructions that the ashes are to be dispersed in the Garden of Rest, which latter is maintained as a permanent and natural Memorial. Where the ashes are so dispersed instead of being placed in an urn in a niche of the Columbarium, the £6 6s. is saved, and a charge of £1 1s. for the dispersal of the ashes is substituted. This gives a maximum total of £28 17s. 6d. The undertakers base their charges for cremation for the middle classes to whom cremation is now available, and in the London area they have fixed a minimum rate of £15 for a cremation funeral, all in, which confirms my figures given above with a good margin for incidentals. 24 Let us then hear no more criticism about the alleged heavy cost of cremation; it is a fable. If you wish to consider cremation, write to Mr. G. A. Noble, Secretary of the Cremation Society of England, 52 New Cavendish Street, W. 1, and ask for any information and he will send you literature. The Cremation Society has no monetary interest in any shape or form; there is no vested interest. The next objection brought against cremation is that it affords a splendid opportunity for the poisoner to escape from his crime. What a foolish objection that is. Look at death certification as we know it to-day tor purposes of ordinary burial. Has it ever struck you that the vast majority of death certificates for burial are signed by medical men who have not seen the body of their late patient, the dead body I mean? They accept the word of the relatives that the patient has died. No wonder there is a Society for the prevention of Premature Burial. Under the present system of Death Certification, a hopelessly obsolete system, it is not necessary for the doctor to see the body before he signs the death certificate. Sir William Willcox, the Home Office toxicologist, says that there have been instances in which death certificates have been given where the person has not been dead, where the friends have thought he was dead and have gone to the doctor for a certificate and have got one. This lax system of death certification would not prevent the burial of persons who had been poisoned. Still, the body is there, in the grave, for examination if suspicion arises later. The record of notable crimes shows that in many recent poisoning cases a death certificate had been filled in and nothing would have happened had it not been that some interest, financial or otherwise, had led some other people to raise complaints and make inquiries and so an exhumation has been ordered. The whole death certification position at the present time is very unsatisfactory, and the governments of the country have been greatly wanting in their duty. As far back as 1893, a Select Committee enquired into and reported on Death Certification, yet nothing has been done. The medical profession and medical press have complained year after year and no one has taken any notice. Now what do we find in the way of certification before cremation? There is a far more stringent system here than in the case of earth burial. Two doctors' certificates have to be signed, one by the family doctor and the other by an expert or specialist with special qualifications. These two form a great safeguard against the concealment of crime. 25 When a man dies in France the family doctor has to notify a strange doctor called the Agent Verificateur. This doctor comes and examines the body, asks questions and finally signs the certificate. Some alteration in the Cremation Act of 1902 is required. The present Act states that no crematorium can be erected within 50 yards of the highway or 200 yards of a dwelling house. The latter restriction was lifted from the Burial Act, 1855, for burial. These restrictions have hampered the search for sites for more crematoria in London. Golders Green Crematorium was built before the Act was passed. Houses were built close up and the public use the grounds as a pleasure resort. The process of cremation is inoffensive. There is one matter which requires careful attention. The fees charged by medical men for the medical certificates. The family doctor fills in the first and the second doctor is a medical officer of health, a police surgeon, a physician or surgeon of 50 beds at a hospital, a medical man appointed by the cremation authority or the medical referee. There is some considerable dissatisfaction concerning the fees charged. It is true that the second doctor has a responsible task. He must make a careful examination and must ask questions of different people. I understand that £2 2s. is charged by numerous doctors. Nothing should be done to discourage cremation. The best plan would be, where cremation is proposed, to write at once to the Secretary of the Cremation Society, 52 New Cavendish Street, W. 1, and ask him to send the Society's medical referee to fill in the second form. His fee is £1 1s. Personally I consider that cremation is a public health matter and the Medical Officer of Health should be called in to inquire and sign in all cases, and that no fee should be charged. In fixing his salary the local authority should take this into account and, when cremation becomes general, further consideration would be necessary. Meanwhile it is argued that if a tariff is placed on an article, it must cost more to the consumer. Having disposed of the case against cremation, I come now to a view which is gaining strong support. Why should cremation not be undertaken as a public measure by municipal authorities? We isolate our infectious diseases at the cost of the rates. A person who has small-pox or scarlet fever is sent to an isolation hospital and it is paid out of the rates. In the same way, in 26 the case of a person who dies and whose body must necessarily pollute a certain portion of ground if he is buried, why should not cremation be carried out by the municipal authority as a sanitary and public health measure ? You have only to educate the public to it and get the Home Secretary to introduce a Bill to give permissive powers to all local authorities to perform cremation upon anyone who wants it. Naturally the wealthier people would not avail themselves of it, but it would be a great boon to the poorer classes. Many poor people find it a great tax upon their resources to bury their dead. It induces them to spend a great proportion of their hard earned money on funeral ceremonies, which they cannot afford. Sanitary authorities should not, to begin with, provide crematoria of their own, but should link up with the local cremation authorities for the cremation of the dead. Personally, I do not favour granting this boon free of charge as some suggest; it is of course a matter of opinion. I think that where working men are paying into a burial society, those payments should be transferred to the Cremation Society until such time as the local sanitary authorities link up with the Cremation Society. Until this is done, men and women whose minds are made up should pay their cremation fee in advance. You can do this by paying £5 once or £1 a year for five years to the Secretary of the Cremation Society; there would then be no cremation fee to be paid at death. Let me close with an appeal to you to throw aside your apathy and indifference and your fatal indecision towards this question. The Cremation Society has no vested interests, therefore it has little or no money to throw away in advertising. In every public library and town hall, the literature of the Society should be made available to the public at a cost to the rates of some six shillings. Think, lastly, of the present day cemetery; it is not beautiful, it is a depressing and mournful place. Seas of gravestones, acres of tombs, some upstanding, others being erected, but many tumbling over, passing where everything must eventually go—to destruction and decay. The idea of placing a body in a small piece of land, there to rest in peace until the last trump, is not true, for we know graves are disturbed, and the cemetery itself must become derelict in a few years. 27 The ideals of a cremationist are more beautiful. A dignified building, surrounded with a beautiful garden, a well-appointed chapel, the committal of the body, not to a furnace, not to a fire, but to a super-heated chamber, where the mortal remains are swiftly disintegrated and reduced to a mere handful of harmless white ashes, which can be preserved anywhere desired, or placed in an urn in the Columbarium. Cremation is carried out with simple reverence and with a total absence of the harrowing details of burial. Burial with its attendant horrors of a wet day, the clay, the coffin being lowered into the grave, and the casting of the earth upon the coffin, causes one to shudder at the the thought of leaving one's beloved ones there alone. Infectious and other Diseases. 30 INFECTIOUS AND OTHER DISEASES. Under the provisions of the Public Health (London) Act, 1891, and the Tuberculosis Regulations, 1,579 cases of infectious diseases were notified, as compared with 1,635 in 1922. In the Table 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 Diarrhoea, 75 deaths were ascribed, and the death-rate was 0 • 65 per 1,000 as against 1.38 in the preceding year. A preceding table indicates the number of deaths and the death-rates from these diseases during the past ten years. Small-Pox. No cases of Small-Pox were notified during the year. Scarlet Fever. 349 persons were notified as suffering from this disease during the year under report as compared with a total of 547 for the previous year. Included in this total are 16 patients who, after removal to hospital, were certified to be not suffering from the disease in question. There were 2 deaths as compared with 39, 13 and 2 in the three preceding years. Diphtheria. The total number of patients certified to be suffering from Diphtheria was 417 as compared with a total of 459 for the previous year. Of this number 18 were errors of diagnosis There were 33 deaths as compared with 11, 13 and 21 for the three preceding years. Enteric Fever. Ten cases of Enteric Fever were notified, as compared with 7 in the previous year. Included in this total is one patient who, after removal to hospital, was certified to be not suffering from the disease. 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. 74 cases were notified during the year. 31 Puerperal Fever. Seven cases of Puerperal Fever were notified as compared with a similar number in the previous year. In one instance the diagnosis was incorrect. There were 2 deaths. Ophthalmia Neonatorum. Fifteen 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. 6 cases were admitted to hospitals. From subsequent enquiries it has been ascertained that 11 patients recovered with no apparent impairment of vision. One infant died from other causes; in two cases the eyes " appear well, but slight discharge occasionally," and at the time of writing the remaining infant is still attending hospital with every prospect of complete recovery. Measles. Under the Deptford (Measles) Regulations, 1922, made by the Ministry of Health on the request of this Council, Measles is now a notifiable disease. These regulations came into operation on the 11th September, 1922, and terminate on September 11th, 1927. 204 cases were notified during the year under report, and 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 1923, 33 such cases were notified. Diarrhoea and Enteritis caused 22 deaths during the year, and of this number, 18 were children under two years of age. Cerebro-Spinal Meningitis. No patients were notified as suffering from this disease during the year. Malaria. Four cases of Malaria were notified in the persons of ex-service men who had contracted the disease in the East. 32 Poliomyelitis. Three patients were notified. In one instance the diagnosis was incorrect; the patient died from Lobar Pneumonia. In the remaining two instances the patients are still under treatment (massage, etc.). Table XIV. Hospital Disposal of Notifiable Diseases during 1923. DISEASE Total Cases Notified Cases admitted to Hospital. Total Deaths. Diphtheria 417 409 33 Scarlet Fever 349 331 2 Enteric Fever (including Parataphoid) 10 10 2 Puerperal Fever 7 7 2 Pneumonia 74 5 91 Measles 204 9 8 Diarrhœa and Enteritis 33 (under 2 years) 4 18 Erysipelas 57 9 — Poliomyelitis 3 3 - Summary of Nursing Arrangements, Hospitals and other Institutions Available for the District. In my Report last year I dealt fully with this section, and it is not necessary to repeat the information again. I regret that I overlooked a very useful organisation which was initiated some five or six years ago by Mr. Councillor Aucutt. This is a Nursing Association on the Provident principle for Brockley and Crofton Park. This Association covers a wide area and is connected with Ranyard House. One of their nurses is resident and there is a visiting sister who attends che monthly Committee meetings. A great deal of excellent work is carried out by this Association. Since its inception Mr. Councillor Aucutt has been Chairman, and it is earnestly to be hoped that he may be at the helm, fortified by his able co-workers, for very many years to come. 33 Table XXII. clinics and treatment centres. Maternity & Child Welfare. (1) Infant Consultations. Daily from 2 p.m. Monday, Gosterwood Street Tuesday, Napier Street Wednesday, Erlam Road Thursday, Goldsmiths' College Do. Princess Louise Institute, Hales Street Friday, Besson Street (2) Ante Natal Clinic. From 10 a.m. to 1 p.m. Tuesday, Napier Street Wednesday do. special infant consultations. Wednesday, Napier Street. 11 a.m. Dental Inspection. Alternate months at Tuberculosis Centre. Dental Treatment. Alternate months, Albury Street Clinic (Rachael McMillan). Venereal Diseases. Miller Hospital, Greenwich, S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Lewisham, Morden Hill, S.E. 13. Male and Female, Daily. 9 a.m. to 10 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. Various hours, daily, except Saturday. King's College Hospital, Denmark Hill, S.E. 5. Various hours, daily, except Saturday. School Clinics. Deptford Eye and Tuesday and Thursday School Minor 2 p.m. Treatment Ailments Centre (Eye) Deptford Green Do. Ear, Friday. 2 p.m. Minor Operations Ailments Monday, 2 p.m., at Cyril Henry Centre, Woolwich Do. Skin Wednesday, 2 p.m. Ailments 20 Albury Teeth Monday, 9.30 a.m. and Street 1.30 p.m Tuesday, 1.30 p.m. Wednesday, 1.30 p.m. Thursday, 1.30 p.m. Friday, 9.30a.m., 1.30p.m. Gas, Tuesday, 9.30 a.m. Inspections, Wednesday and Thursday, 9.30 a.m. Tuberculosis Dispensary. Monday, 9.30 a.m. to 1 p.m. Men Tuesday, do. Women (Thursday, 2 p.m. to 3 p.m., Children not at School) Tuesday, 6.30 p.m.-7.30 p.m., Men and Women at work. Wednesday, 9.30 a.m. onwards, Secretary's Consultations. Thursday, 9.30 a.m.-l p.m., Men Friday, 9.30 a.m.-l p.m., Women. Day Nursery. Albury Street (Closed at present) Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. 34 Hospitals Provided or Subsidised by the Local Authority in this District. (1) Tuberculosis. Cases put forward from our Tuberculosis Dispensary are sent by the County Council to various sanatoria, hospitals, etc. The Greenwich Board of Guardians send cases away also. (2) Maternity. The Municipal Maternity Home is discussed elsewhere. (3) Children. The Albury Street Sick Babies' Home locally, and hospitals such as Vincent Square, Evelina and Great Ormond Street. (4) Fever. Metropolitan Asylums Board's Infectious Diseases Hospitals. Institutional Provision for Married Mothers, Illegitimate Infants and Homeless Children in the District. Rest homes by the seaside, such as All Saints' Church, Margaret Street, provides, are taken advantage of by those married mothers who can pay a reasonably small fee. The Guardians similarly, send away cases. Ambulance Facilities. (a) Infectious Cases. Ambulance service is available for infectious cases at any hour of the day or night upon application to the Metropolitan Asylums Board, either at the Head Office, by telephone, or at any of the ambulance stations attached to the hospitals. The one situate in this Borough is in Old Kent Road, adjoining White Post Lane. (b) Non-infectious Cases. The ambulance service of the M.A.B. is also available for the conveyance of patients who are not suffering from infections diseases, application being made in the usual manner. For such cases a charge of 10s. is made. The L.C.C. ambulances are available for use in street accidents, as also are the police ambulances. The L.C.C. Stations are as follows :— North End Road, Fulham Buckner Road, Brixton Herbrand Street, Russell Square St. George's Market, London Rd. Montclare St., Bethnal Green Southwark, S.E. High Road, Lee Woolmore Street, Poplar 35 For the conveyance of non-infectious patients who are unable to pay the fees charged by the M.A.B., the Council made arrangement with the Greenwich Guardians for the use of their ambulance. The British Red Cross Society also have ambulances, stationed at St. John's Gate, Clerkenwell. A charge is usually made for their use, but in necessitous cases no charge is made. The London Ambulance Service is also available for the conveyance of expectant mothers for whom urgent necessity arises during the night, between the hours of 11 p.m. and 8 a.m. Application is made by telephone, and all patients booking at the Maternity Home are given a card of printed instructions with regard to these facilities. Laboratory Work at Seaman's Hospital, Greenwich. Material. Total Specimens examined. N umber Positive. Number Negative. Swabs for Diphtheria 992 168 824 Blood for Enteric Fever 7 2 5 Sputum for Tuberculosis 34 7 27 Urine for Typhoid 1 — 1 Urine (M.C.W.) 2 — 2 Total 1036 177 859 In addition to the above, 665 specimens of sputa were examined at the Council's Tuberculosis Dispensary, of which 100 were "positive" and 565 were "negative." Diphtheria anti-toxin is kept available at the Town Hall for practitioners requiring it in an emergency. Where the patient can pay for it, cost price is charged. In London, there is not the same great need for anti-sera at the Public Health Department as in the provinces, simply because when a practitioner sees a diphtheria case in a house he rings up the telephone and the case is removed to hospital rapidly, where the necessary serum is given. By-Laws and Regulations of Borough Council. 1. For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. 36 2- For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knackers' yard, butcher's shop or fishmonger's shop or dunghill into any uncovered place, whether or not surrounded by a fence or wall. 3. For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. 4. As to the paving of yards and'open spaces in connection with a dwelling house. 5. For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. 6. With respect to the keeping of waterclosets supplied with sufficient water for their effective action. 7. With respect to houses let in lodgings or occupied by members of more than one family. 8. With respect to the decent conduct of persons using the Public Lavatories and Sanitary Conveniences provided and maintained by the Council. By-Laws and Regulations made by the L.C.C. 1. Drainage by-laws. 2. Deposit of drainage plans. 3. Closing and filling up of cesspools and privies. 4. Removal and disposal of house and other refuse. 5. Removal of fæcal and offensive matter by road. 6. Waterclosets, earthclosets and privies. 7. Ashpits. 8. Cesspools. 9. Receptacles for dung. 10. Conveyance of carcases for dead horses through streets. 11. Regulations as to Dairies, Cowsheds and Milkshops. TUBERCULOSIS. To the Medical Officer of Health. Sir, I have pleasure in submitting herewith the Annual Report on Tuberculosis work in the Borough. Notifications. The following Table gives a summary of the Notifications received for the period from 1st January, 1923 to 29th December, 1923 :— Deaths from Tuberculosis and Cancer, 1901 to 1923. Tuberculosis Cancer 37 Table XXIII. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 31st December, 1922 to 29th December, 1923. 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 LawInstitu tions. Sanatoria. Under 5 5-10 10-15 Total Primary Notifications, Pulmonary— Males ... ... 5 3 11 16 32 25 25 8 7 132 172 ... ... 1 1 1 21 123 Females ... 2 1 12 14 17 31 14 10 7 2 110 133 ... ... ... ... ... 9 55 Non-Pulmonary Males 5 10 14 7 2 2 1 2 ... ... ... 43 46 ... ... ... ... ... 7 13 Females ... 9 19 7 6 4 4 ... 2 ... ... 51 57 ... ... ... ... ... 10 12 38 As in previous years the age groups 25 to 35 shows a higher total than the other groups. The total primary notifications show an increase of 34 on the previous year (13 more males and 21 more females) in Pulmonary Tuberculosis, and an increase of 21 in non-Pulmonary Tuberculosis (6 more males and 15 more females). As the death-rate has fallen this may be taken to indicate some improvement in the notification of cases. In 1923, 7 deaths occurred from cases of Pulmonary Tuberculosis which had not been notified during life, as compared with 25 in 1922 and 43 in 1921. The time of notification of cases is still far from satisfactory as the following Table shows. Probably this is chiefly due to delay in consulting a medical man. Pulmonary Tuberculosis. Interval between Notification and Death in 1923. Not notified 7 Died before receipt of notification 11 Died within one week of notification 4 „ „ one week to one month 3 „ „ one month to three months 11 „ „ three months to six months 7 „ „ six months to one year 19 „ ,, one to two years 11 „ „ two to three years 10 „ „ three to four years 2 ,, „ four to five years 4 „ „ five to six years 2 „ „ six to seven years 2 „ ., seven to eight years 1 „ „ eight to nine years 1 95 From the above table it will be seen that in 7.4 per cent. of deaths no notification was received during life, and in 18.9 per cent. notification was only received within one month of death. In the unnotified deaths the attention of the practitioners concerned has been drawn to his failure to comply with the Tuberculosis Regulations. 39 The notifications of non-Pulmonary Tuberculosis were as follows:— Glands 55 Ankle Joints 1 Meninges 10 Mesenteric 2 Knee 4 Arm 1 Hip 4 Bladder 1 Peritoneum 3 Intestine 1 Spine 3 Thumb 1 Kidney 2 Lupus 1 Mediastinal 2 Abdomen 1 Multiple 2 Total 94 The notification according to wards was:— Pulmonary. Non-Pulmonary. East 75 44 North 51 18 North-West 43 8 South 20 8 South-East 34 8 South-West 19 8 Totals 245 94 The above table strikingly illustrates the direct relationship between housing conditions and the incidence of Tuberculosis. In the East Ward where the overcrowding evils are worst the notification rate is 3.4 per 1,000 of the population. In North Ward 2.3 per 1,000, and in South-West Ward, where housing and general conditions are of higher standard the notification rate is 1.1 per 1,000. The following table gives the number of deaths and notification rate per 1,000 for Pulmonary and non-Pulmonary Tuberculosis during 1923 and a comparison with the three previous years:— Year. Deaths. P.T. Deaths. O.T. Notifications P.T. Notifications O.T. Population. Total Deaths. Total Rate Total Notification. Notification rate per 1000 1920 128 1•1 29 0•3 250 2•1 68 0•6 115636 157 1•4 318 2•7 1921 121 1•1 31 0•3 225 2•0 66 0•6 113500 152 1•3 291 2•6 1922 133 1•2 31 0•2 208 1•8 75 0•7 114100 164 1•4 283 2•5 1923 95 0•8 17 0•1 242 2•1 94 0•8 114900 112 0•97 336 2•9 40 Prevention and Treatment of Tuberculosis. The centre of the anti-tuberculosis work in the Borough is the Tuberculosis Clinic, and here the work is co-ordinated with that of all the agencies dealing with the prevention and treatment of the disease such as the Health and Pensions Ministries, the London County Council, the Poor Law Authorities, the hospitals, the medical practitioners, and the various societies engaged in anti-tuberculosis and social welfare work. With the Clinic staff and the medical practitioners rests the major portion of the responsibility for the success of the work, as they must discover the disease and deal with it at the source of infection. Between the two units the closest co-operation is necessary. The essential functions of the Tuberculosis Clinic are :— (1) Detection of cases of Tuberculosis. (2) Prevention of the spread of infection. (3) The arrangement of treatment, and the treatment of a certain number of cases. Detection of Cases. During the year, 761 people presented themselves for the first time at the Clinic, which with 25 cases under observation for diagnosis from the previous year made a total of 786 cases for diagnosis. Of these, 108 were found to be suffering from Pulmonary Tuberculosis, and 34 from other forms of Tuberculosis. It is to be regretted that many cases still present themselves at the Clinic for the first time in whom the disease is well established and the hope of permanent arrest of the disease is very slender. In the great majority of these cases, this state of things has been found due to the carelessness of the patient who has deferred seeking proper medical advice until the symptoms have become very severe or the disease has interfered with working capacity. Every effort is made by consultation and co-operation with the local practitioners to encourage them to avail themselves of the facilities for diagnosis which the Clinic offers, and on the whole these are freely used. Of the 761 new cases during the year, 207 were sent by the local practitioners, 38 were referred by hospitals, 23 were referred by school medical officers, 212 attended to seek advice on their own initiative, and 281 (mainly contacts) on the advice of the Clinic staff. The examination and re-examination of those in contact with positive cases is an important part of the work which everything is done 41 to encourage. During the year, 284 contacts were examined at the Clinic. Of these, 10 were found to be suffering from Pulmonary Tuberculosis, i.e., 3-5 per cent. With a view to assisting in the diagnosis certain cases under observation are sent to the Miller Hospital for radiography. Nineteen such cases were sent during 1923. In cases in which, after a period of observation at the Clinic the diagnosis was still uncertain a period of intensive observation in hospital was arranged, either at Brompton or one of the other chest hospitals. Eighteen such cases were sent for observation during the year. Of these a positive diagnosis was made in 7 cases and sanatorium treatment arranged. Sixty-six deaths occurred during 1923 among the patients who had attended the Clinic. The period which elapsed between the first attendance and death varied between two months in one case and ten years in another. 3 cases had attended for the first time within 3 months of death. 7 do. do. do. 6 do. 15 do. do. do. 12 do. 17 do. do. do. 24 do. 24 do. do. do. more than 2 years before. The following table summarises the work done at the Clinic during the year:— 42 Table XXIV. Metropolitan Borough of Deptford. Return of work carried out in connection with the Tuberculosis Dispensary for the year 1923. Number of Under observation at the Dispensay on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the | Dispensary on Dec. 31. pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from T uberculosic. Pulmonary. Non-Pulmonary. (a) All persons (including "Contacts") Adults M 8 139 147 57 6 73 6 5 F 8 241 249 43 5 192 5 4 Children under 15 M 4 186 190 3 9 175 1 2 F 5 195 200 6 14 178 2 1 Total • • 25 761 786 108 34 618 14 12 Adults M 3 33 35 5 1 27 1 2 (b) "Contacts" included in (a) F 2 98 99 5 — 94 — 1 Children under 15 M - 71 71 — 3 68 — — F - 79 79 - — 79 — - (c) Insured persons included in (a) M 6 113 116 49 2 60 5 3 F 2 66 67 18 4 45 — 1 1 Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 573 2 Total number of attend-, ances of patients at the Insured 2147 Dispensary during the year Uninsured 3344 3 Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 319 4 Number of cases in which the period of observation at the Dispensary exceeded two months 48 5 Number of insured patients under domiciliary treatment on Dec. 31st. 81 6 Number of reports received trom surance Practitioners in respect of insured patients under domiciliary treatment during the year 2 7 Number of persons referred to ated hospital for consultation — 8 Number of consultations with medical practition- Insured.. 4 ers at the homes of patients Uninsured 7 9 Number of other visits paid by Tuberculosis Officers to the homes of patients 380 10 Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 5079 11 Number of specimens of sputum amined in connection with the work of the Dispensary 665 43 Revision of the Register. An enquiry card showing all the essential particulars of the case is made out for every notified case on the primary visit, and the notes on subsequent visits are made on this card. These cards have thus constituted an effective register of all the known cases of tuberculosis within the Borough. In order that the time of the Visitors might be utilised to the best advantage, it was decided in 1923 to revise this register with a view to eliminating many of the cases which were being periodically visited. In many of the cases the patient had enjoyed good health and a full working capacity, with freedom from symptoms for five years and upwards. The cards of these patients were removed from the active register. In other cases the subsequent notes or subsequent examinations at the Clinic had left the original diagnosis doubtful, and efforts were made, in most cases successfully, to get these patients to the Clinic, so that they could be re-assured and the necessity for further visiting removed. For visiting purposes the cards are grouped in wards (South and South-East being grouped together). The following table gives the number of cases thus removed from the active register :— Pulmonary Tuberculosis. Other Tuberculosis. East Ward 58 71 North Ward 32 53 South and South-East Ward 14 28 North-West Ward 27 48 South-West Ward 7 12 Total 138 212 After the removal of the cases, the totals for the respective wards were:— Pulmonary Tuberculosis. Other Tuberculosis. East Ward 280 206 North Ward 212 73 South and South-East Ward 143 48 North-West Ward 158 71 South-West Ward 92 40 Total 885 438 44 Prevention. The primary responsibility of the Clinic is the prevention of infection. For this purpose the Clinic forms part of, and keeps in the closest touch with the Public Health Department. Disinfections are immediately arranged on the departure of a patient from a house, either to sanatorium, hospital, or to another residence and on notification of the occurrence of a death. Stress is laid in visiting on the possibilities of infection and the necessity of proper disposal of the sputum, in obtaining as far as possible the isolation of the patient, and the urgency of having the contacts examined. Every endeavour is made to keep in touch with all notified cases, and the visits are so arranged as to intensify the following-up system. Treatment. It is the duty of the Tuberculosis Clinic to see that every case of Tuberculosis or suspected Tuberculosis receives adequate treatment. The majority of the cases are referred to sanatoria or hospitals or to their family doctors. During the year 194 cases were admitted to sanatorium through the London County Council, whilst in 9 cases, admission to sanatorium was arranged through the Guardians. Two cases were admitted to private sanatoria. Of the above total 37 cases were re-admissions. In four cases shelters have been provided for patients where there was sufficient open space to enable the patient to benefit by the use of them. These are frequently visited to see that they are properly kept and that the best use is being made of them. In a number of cases grants of extra nourishment (milk and eggs) have been made. As far as possible, it is arranged that these grants shall be given to those patients who require it to attain or maintain a working capacity. A certain number of cases are treated at the Clinic, but it is the object of the Clinic to act rather as a clearing house than to function as a treatment centre. Every new case attending the Clinic in which a positive diagnosis is made is referred to the Secretary of the Tuberculosis After-Care Committee so that the fullest advantage may be taken of the assistance offered by this Committee. It gives me pleasure to record my sincere thanks to every member of the staff for their assistance in carrying out the work entrusted to us. Very faithfully yours, J. A. Harbison, M.D. A. Hendry Photo. New Cross. Audrey Martin. Breast Fed. 7 months. Weight 23 lbs. 2 ozs. General Sanitary Administration. Work of Sanitary Inspectors. During the year the District Sanitary Inspectors made 22,990 visits in all to 5,636 premises. 2,885 systematic house-to-house inspections were made. Numerous sanitary improvements and repairs were effected, as shown in the following table:— 47 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1923. Table No. XXV. Number of District. 1 2. 3 4 5 6 7 Totals Inspections — On complaint 9 43 52 19 55 49 20 247 House-to-house 453 488 424 465 309 381 365 2885 infectious diseases 85 76 89 90 154 132 127 753 Notice from builder 16 14 32 16 61 15 18 172 New houses for water certificate ... ... ... ... 2 ... ... 2 Other inspections 236 208 259 177 211 255 231 1577 Total 799 829 856 767 792 832 761 5636 Reinspections, Calls, etc.— Total 2538 2490 2522 2555 2666 2296 2287 17354 Notices Served — Intimation (Public Health Act) 578 443 597 513 438 553 465 3587 Statutory ( Do, ) 8 33 62 30 9 28 48 218 Under Rats and Mice (Destruction) Act ... ... ... ... ... 3 ... 3 Housing, Town Planning, etc.. Act, 1919, Sec. 28 ... ... ... ... ... ... ... ... Cleansing and Repairs— Number of premises, etc., cleansed 185 197 198 346 295 320 291 1832 Ventilation improved (number of premises) 225 81 5 13 2 ... ... 326 Number of roofs repaired 87 98 148 90 113 85 104 735 Dampness abated (number of premises) 44 21 26 43 67 107 41 349 Gutters and rainwater pipes provided or repaired 86 78 82 112 101 98 66 623 Yards and forecourts paved ... 11 2 5 50 2 ... 70 Yard and forecourt paving repaired 104 8 5 43 ... 91 47 298 Scullery floors paved, or paving repaired 20 17 27 14 15 11 15 119 Coppers provided and repaired 95 ... 31 29 35 31 38 259 Other repairs and improvements 248 73 202 222 230 186 135 1296 Water Supply- Fittings repaired (number of premises) 21 25 45 65 4 22 11 193 Cisterns cleansed ... ... ... ... 2 1 ... 3 ,, provided ... ... *... ... ... ... ... ... ,, covered 11 ... 2 2 ... ... ... 15 ,, abolished ... ... ... ... 1 ... ... 1 Potable water supply provided from Service ... ... ... ... 11 ... ... 11 Additional facilities provided in tenement houses ... ... ... ... ... ... ... Other improvements ... ... 21 ... ... ... ... 21 48 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1923—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals Drainage— Drains re-constructed (number of premises) 9 8 21 3 22 10 ... 73 Drains cleansed and amended 27 33 43 30 49 15 24 221 Gully traps fixed 16 14 41 6 31 ... 2 110 Soil and Vent Pipes fixed 3 4 24 3 82 8 7 81 Do. repaired 15 ... 7 ... 5 1 6 34 New Covers provided to inspection chambers 4 ... 2 1 4 2 2 15 Waste and rainwater pipes disconnected from drains ... ... 5 1 3 1 ... 10 Water Closets- Old waterlosets abolished ... ... ... ... 2 ... ... 2 New waterclosets provided 7 ... ... 5 2 ... ... 14 New pan and trap only, provided 17 14 54 22 64 25 18 214 Defective flush remedied 81 24 40 14 51 32 27 269 Pans cleansed ... 11 2 6 10 5 17 51 Seats provided or repaired 32 ... 2 6 4 3 2 49 Roofs repaired 48 9 16 18 19 2 9 121 Walls, etc., repaired or cleansed 75 20 61 104 60 141 35 496 Doors repaired or renewed 14 ... 17 2 6 3 11 53 Ventilation improved ... ... ... ... ... ... ... ... Floors repaired 14 15 2 1 ... ... 7 39 Other repairs or improvements 20 ... 3 ... ... ... ... 23 Urinals— Cleansed 4 8 1 1 ... 1 ... 17 Repaired ... ... 1 1 ... ... ... 2 Dung Receptacles- Provided ... 1 ... ... ... ... ... 1 Repaired 4 ... 1 ... ... 1 ... 6 Abolished ... ... ... ... ... ... ... ... Overcrowding- Cases abated 5 ... ... 1 ... 2 ... 8 Nuisances arising from the keeping of animals— Number of nuisances abated 1 ... 1 ... 1 1 11 17 Offensive accumulations Number of accumulations removed 13 ... 6 ... 9 5 18 46 49 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1923— continued. Table— continued. Number of District. 1 2 8 4 5 6 7 Totals. Smoke Nuisances- Number of observations of shafts made 7 ... ... 10 ... 2 4 23 Number of nuisances from black smoke discovered ... ... ... 6 ... 1 ... 7 Number of notices served ... ... ... 1 ... 1 ... 2 Dustbins— Provided or repaired 96 87 130 97 81 65 81 637 General— Other miscellaneous nuisances abated ... ... 19 ... ... 27 41 87 District No. 1.—Inspector Simpson (East Ward). District No 2.—Inspector Shelley (East Ward). District No. 3 —Inspector Kemp (S.W. and part N.W. Wards). District No. 4.—Inspector Hewett (North Ward). District No. 5.—Inspector Allam (S. and S.E. Wards and part s.W. Ward). District No. 6.—Inspector Yates (part N. and N.W. Wardsand throughout Borough for rat work.) District No. 7.—Inspector Mayo (part N.W. Ward). 50 HOUSE-TO-HOUSE INSPECTIONS. House-to-house inspections were made in the following streets during the year 1923:— Inspector Simpson.—East Ward. Total premises inspected. Number in which defects were found. Alva Street 11 11 Amelia Terrace 1 1 Bronze Street 31 31 Bates Place 5 4 Berthon Street 13 13 Creek Street 11 11 Crossfield Street 5 4 Church Street 107 103 Deptford House 9 7 Giffin Street 68 63 Knott Street 18 17 Reginald Street 2 2 Reginald Place 1 1 Rectory Buildings 135 103 Stanhope Street 36 36 Total 453 407 Inspector Shelley—East Ward. Baildon Street 55 49 Comet Street 20 8 Glenville Grove 9 9 Kerry Road 19 7 Speedwell Street 74 45 Napier Street 112 58 Watson Street 61 26 Douglas Street 138 89 Total 488 291 51 Inspector Kemp—North-west and South-west Wards. Eckington Gardens 26 19 Rutts Terrace 20 17 Gellatly Road 40 26 Billington Road 38 10 Somerville Road 38 18 Lubbock Street 13 9 Camplin Street 20 5 Senate Street 8 8 Hunsdon Road 8 4 Selden Road 23 22 Briant Street 32 28 Dennetts Road 93 61 Besson Street 47 28 Queens Road 15 11 Kender Place 3 3 Total 424 269 Inspector Hewett—North Ward. Grove Street 125 93 Bingley Place 9 8 Kempslade Street 9 3 Greenfield Street 21 18 Hoopwick Street 1 1 Boscawen Street 48 33 Hood Street 12 10 Childers Street 87 60 Corston Street 36 27 Staunton Street 53 38 Shere Road 62 42 Dorking Road 2 1 Total 465 334 Inspector Allam South and South east Wards. Foxwell Street 37 35 Heston Street 40 35 Tolhurst Street 4 4 Vulcan Road 16 9 Vulcan Terrace 3 1 Tanners Hill 100 60 Vanguard Street 26 19 Upper Brockley Rd. 28 16 Wickham Road 40 15 Friendly Street 15 14 Total 309 208 52 Inspector Yates—North and North-west Wards. Oareboro' Road 71 62 Folkestone Gardens 119 82 Alloa Road 41 35 Nynehead Street 11 10 Cottesbrook Street 20 19 Milton Court Road 65 58 Sanford Street 24 22 Chipley Street 28 27 Liftbridge Cottages 2 2 Total 381 317 Inspector Mayo—North-west Ward. Sharratt Street 15 12 Reculver Road 55 49 Bolina Road 76 39 Fawcett Road 35 26 Oldfield Villas 5 5 Oldfield Road 2 1 Hornshay Place 12 7 Eugenia Road 48 30 Upcott Street 31 18 Lovelinch Street 43 28 Wagner Street 7 6 Cornbury Road 36 30 Total 365 251 Grand Total 2285 2077 Factory and Workshops Act. 54 Table XXVI. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1923. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1922 Added 1923 Removed 1923 On register at end of 1923 Milk premises 149 6 .. 155 440 13 .. Cowsheds .. .. .. .. .. .. .. Slaughter-houses 2 .. .. 2 60 .. .. Other offensive trade premises 2 .. .. 2 27 1 .. Ice cream premises 111 20 .. 134 300 14 .. Fried fish, etc., shops 44 1 .. 45 260 20 .. Restaurants 52 .. .. 50 102 6 .. Other food premises 25 1 .. 26 139 4 .. Hairdressers' premises .. 51 .. 51 60 .. .. Table XXVII. 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 1923. CLASS OF WORK. Number of Places Number of Inspections. Number of Notices. Number of Prose cutions. On Register at end ol 1922 Added 1923. Removed 1923. On Register at end of 1923 Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories Factory Laundries 3 3 17 9 1 Factory Bakehouses 15 1 16 30 93 Other Factories 189 24 6 207 609 430 45 Workshops Workshop Laundries 5 5 18 14 Work shop Bakehouses 45 3 42 87 262 7 Other Workshops 107 18 7 118 214 223 10 Workplaces Places where Food is prepared for Sale 121 2 2 121 228 491 29 Workplaces other than the above 63 7 3 67 87 83 1 Home-workers' Premises 329 40 69 300 314 304 2 Total 877 92 90 878 1604 1909 95 55 Table XXVIII. METROPOLITAN BOROUGH OF DEPTFORD This Table is by request of the Secretary of State. Annual Report of Medical Officer of Health for the year 1923 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) 532 46 Workshops (including Workshop Laundries) 499 17 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 574 30 Total 1605 93 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 61 61 Want of Ventilation Overcrowding Want of Drainage of Floors Other Nuisances 8 8 Sanitary Accommodation Insufficient 11 11 Unsuitable or defective 35 35 Not Separate for Sexes 1 1 Offences under the Factory and Worhshcp 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 116 116 56 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. Contractors. Workmen. Contractors. Workmen. 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— Making, etc. 44 1 221 16 14 21 70 2 Cleansing and Washing 1 Fur-pulling 1 2 Total 45 1 224 16 14 21 70 2 57 Table—continued. 4—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 42 Dressmaking 16 Laundries 5 Millinery 14 Tailoring 15 Wheelwrights (Smiths, &c ) 19 Others 54 Total number of Workshops on Register 165 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) 29 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 9 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 16 58 CANAL BOATS ACTS. Annual Report for the Year ended 31st December, 1923. To the Medical Officer of Health. Sir, I beg to report for the year ended December 31st, 1923, that for the purpose of Canal Boats inspection, I made 19 visits, on the following dates, viz. :— January 23rd, February 19th, March 8th and 26th, April 17th and 25th, May 14th, June 5th and 18th, July 10th, August 1st, September 10th and 14th, October 19th, 25th and 29th, November 30th and December 12th and 18th. Number of visits - - 19 Number of boats inspected - Nil This Borough is not a Registration Authority. 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 Sanitary Inspector. I am, Sir, Your obedient Servant, F. Hewett, Canal Boat Inspector. January 4th, 1924. UNSOUND FOOD. During the year, the following quantities of food were brought to the notice of this Department, voluntarily by the owners, found to be unsound, and destroyed :— Bacon ... 1 cwt. 3 qrs. 9 lbs. Roe ... ... 1 box Cherries ... ... 13 baskets Sardines ... ... 216 tins Fish in Tomato ... 21 tins Tomatoes ... ... 10 boxes Mackerel ... ... f box Winkles ... ... 4 cwt. Plaice . ... ... lli stone SALE OF FOOD AND DRUGS ACTS. 603 samples were purchased and submitted to the Public Analyst for analysis. Of this number, 22 or 3-6 % were adulterated. In 13 instances legal proceedings were taken, and fines and costs amounting to ^43 16s. were inflicted. 59 Table XXIX. Proceedings Taken with regard to Samples Purchased during the year. Simple No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 9 SY Milk 12 per cent. abstraction of fat — — Dismissed. 2 0 0 Warranty proved. 22 o 29 ,, ,, 2 0 0 Master and servant both fined. 23 k 11 ,, ,, — 2 2 0 - 26 k ,, 10 ,, ,, — 2 2 0 - 14 t ,, 13 ,, ,, - - Dismissed. 19 t ,, 7 ,, ,, - - Warranty proved. Dismissed. 31 k Tinned fish in Tomato 4 97 gr. per lb. tin — 2 2 0 Warranty proved. Summons dismissed on payment of costs 79 A Milk 23 per cent. abstraction of fat 10 0 0 6 6 0 — 59 h Medicine (panel prescription) 73 per cent. deficient in Potassium Iodide - 2 2 0 Summons dismissed on payment of costs, Defendant pleaded carelessness of 66 Y ,, 10.8 per cent. excess potassium Iodide - — Assistant. Summons withdrawn on advice of Councel. 65 Y ,, 16.8 per cent. excess of Total Bromides — — Summons withdrawn. Council to pay £2 2s. 0d. costs. 60 k ,, 8.5 per cent. deficient in Bromides 1 0 0 5 5 0 - 59 t ,, 9 ,, ,, 1 0 0 5 5 0 — 15 S Butter 0.5 per cent. excess of water — - Vendor cautioned. 16 a Milk 2 per cent. abstraction of fat — — Vendor cautioned. 17 A ,, 1 per cent. added water — — Vendor cautioned 8 a Separated Milk 3 per cent. added water — — Vendor cautioned 32 k Sardines 0.70 gr. per lb. tin - — Vendor cautioned. 33 k ,, 126 gr ,, ,, — — Vendor cautioned 34 k Peas 0.61 gr. per lb. Copper — — Vendor cautioned. 35 K ,, 0.48 gr. ,, ,, — — Vendor cautioned. 57 H Mustard 20 per cent. starchy farina 0 10 0 2 2 0 - SUMMARY £ s. d. Fines 16 10 0 Costs 27 6 0 43 16 0 60 Table XXX. Legal Proceedings taken under Public Health Act and By-Laws. Premises. Offence. Fine. Costs. Remarks. £ s. d. £ s. d. 117 St. Asaph Road .. Non-compliance with statutory notice 1 1 0 1 1 0 And Order for necessary work to be carried out within 28 days 41 Pepys Road do. - 2 2 0 And Order for necessary work to be carried out within 21 days. SUMMARY £ s. d Fines l 1 0 Costs 3 3 0 £1 4 0 61 Table XXXI. Samples taken during 1923. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulter ation. Baking Powder 8 .. 8 .. Beers as under— Ale 1 .. 1 .. Mild Ale 4 .. 4 .. Bitter 7 .. 7 .. Burton 5 .. 5 .. Stout 4 .. 4 .. Butter 60 .. 61 1.6 Cake 2 .. 2 .. Cocoa 21 .. 21 .. Cocoanut, Desiccated 1 .. 1 .. Coffee 4 .. 4 .. Dripping 1 .. 1 .. Ground Ginger 1 .. 1 .. Lard 2 .. 2 .. Margarine 2 .. 2 .. Medicine (panel prescriptions) 8 5 13 38.5 Milk 396 9 405 2.2 Milk, condensed 3 .. 3 .. Milk, separated 6 1 7 14.3 Mustard 16 1 17 5.9 Mustard Condiment 1 .. 1 .. Pepper 12 .. 12 .. Sausage 1 .. 1 .. Tinned goods, as under— Small fish in tomato .. 1 1 100 Sardines .. 2 2 100 Peas .. 2 2 100 Brisling 1 .. 1 .. Vinegar 9 .. 9 .. Vinegar, Malt 2 .. 2 .. Informal Samples— Cocoa 1 .. 1 .. Dried Milk 1 .. 1 1 Tea 1 .. 1 .. Totals 581 22 603 3.6 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. 62 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 1,335. 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 XXXII. SHOWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES. 1923 Date * Small Pox. Scarlet Fever. Diphtheria. Erysipelas Enteric Fever. Puerperal Fever. Pulmonary Tuberculosis. Cancer. Chicken Pox. Measles. Pneumonia. Scabies. Syphilis. Requests. Senile Decay January .. 55 71 1 .. 2 43 .. .. .. .. .. .. 6 .. February .. 49 55 .. .. 1 17 1 .. .. .. .. .. .. .. March .. 35 46 .. .. 1 27 .. 1 .. .. .. .. 5 .. April .. 24 42 .. .. .. 48 1 .. 1 .. .. .. 2 .. May .. 26 46 .. .. .. 25 4 .. 2 1 1 1 .. .. June .. 31 41 1 2 .. 22 4 .. 1 .. 1 .. .. .. July .. 13 26 2 .. .. 18 2 .. .. .. .. .. 9 1 August .. 14 16 .. 1 .. 19 2 2 .. .. .. .. 2 .. September 8 19 17 .. 1 .. 25 4 .. .. .. .. .. 2 .. October .. 26 20 .. 9 .. 18 1 .. .. 1 .. .. 1 .. November .. 36 9 .. 2 1 26 3 .. 5 .. .. .. 4 .. December .. 33 22 .. .. .. 28 2 .. 3 1 .. .. .. .. Total 8 361 411 4 15 6 316 24 3 12 3 2 1 31 1 * Contacts. 63 Table XXXIII. SHOWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1923. Date 1923 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses. Sheets. Blankets. Odd articles Articles destroyed. January 165 185 94 225 78 47 123 203 285 2 mattresses, 1 bed, 1 bolster, 2 pillows. February 119 123 79 176 51 30 86 182 198 13 odd articles. March 105 119 66 117 56 20 66 120 141 1 bed, 2 mattresses, 4 pillows, 1 bolster, 4 blankets, 19 odd articles. April 105 126 53 132 35 23 66 101 138 3 beds, 2 palliasses, 1 bolster, 4 pillows, 2 blankets, 10 odd articles May 119 147 68 136 55 28 67 132 152 2 beds, 2 mattresses, 3 pillows, 5 odd articles. June 102 109 55 124 44 31 66 116 167 1 bed. July 71 85 30 80 25 14 22 29 53 l bed, 1 bolster, 3 pillows, 2 sheets, 5 odd articles. August 66 81 35 56 20 8 32 32 86 3 beds, 2 mattresses, 1 bolster, 4 pillows, 2 sheets, 5 odd articles. September 85 97 40 84 26 21 36 60 80 1 bed, 2 mattresses. October 74 82 52 96 35 13 60 84 98 2 beds, 2 palliasses, 2 odd articles. November 79 88 34 110 55 40 50 80 152 3 beds, 1 mattress, 2 pillows, 3 odd articles. December 84 93 49 102 42 15 46 80 127 5 beds, 3 mattresses, 2 bolsters, 4 pillows, 7 odd articles. Total 1174 1335 655 1438 522 290 720 1219 1677 verminous premises 80 premises consisting of 138 rooms were fumigated during the year. books. 242 Library books were fumigated during the year. cleansing station. 767 articles of clothing, etc., were disinfected during the year. 1,441 children received baths. In 71 instances a second bath was required within a month, and in 2 instances, a third bath, making a total of 1,514 baths given during the year. Summary. Total number of Premises disinfected 1174 ,, ,, Rooms „ 1335 ,, ,, Beds ,, 655 ,, „ Pillows „ 1348 ,, ,, Bolsters ,, 542 ,, ,, Mattresses ,, 290 „ ,, Sheets „ 720 ,, ,, Blankets ,, 1219 ,, „ Odd Articles „ 1677 Total articles 6451 64 Total number of Beds destroyed 23 ,, , Mattresses „ 14 ,, „ Palliasses ,, 4 „ ,, Pillows ,, 26 ,, ,, Sheets ,, 4 ,, „ Bolsters ,, 7 ,, ,, Blankets ,, 6 ,, ,, Odd Articles ,, 69 Total 153 N.B.—The above Articles were destroyed at the request of the owners. Special Cases. Jan 2nd—St. Asaph Road Cancer. 1 mattress, 3 pillows, 1 bolster, 1 sheet, 14 odd articles- disinfected. ,, 31st—Gosterwood Street Cancer. 1 bed, 2 pillows, 2 bolsters, 1 odd article—disinfected. Feb. 7th—Wickham Road. Cancer. 1 mattress—disinfected. April 27th—New Cross Road. Cancer. 1 mattress, 4 pillows, 1 bolster. 2 sheets, 4 blankets, 6 odd articles—disinfected. May 31st—Finland Road. Cancer 1 bed, 1 bolster, 2 pillows, 5 blankets, 4 c dd articles—disinfected. June 6th—Upper Brockley Road. Cancer. 2 mattresses, 4 pillows. 1 bolster, 2 sheets, 1 odd article—disinfected. ,, 12th—Evelyn Street. Cancer. 1 mattress, 3 pillows, 1 bolster, 1 odd article—disinfected. July 2nd—Rectory Buildings. Cancer. 1 bed, 1 sheet, 1 odd article—disinfected. ,, 20th—Brocklehurst Street. Cancer. 1 bed, 4 pillows, 2 blankets, 7 odd articles— disinfected. „ 25lh—Lucas Street. Cancer. 1 bed, 1 mattress—disinfected. August 2nd—Lewisham High Road. Cancer. 1 bed, 1 mattress, 1 bolster, 3 pillows, 5 odd articles—destroyed „ 13th—Amersham Road. Cancer. 1 bed, 5 pillows, 1 bolster, 1 mattress, —disinfected. Sept. 8th—Gosterwood Street. Cancer. 2 beds, 2 pillows, 1 bolster, 2 odd articles—disinfected. ,, 11th—Breakspears Road. Cancer. 2 mattreses, 2 pillows, 2 bolsters, 3 sheets —disinfected. 22nd—Gellatley Road. Cancer. 1 bed, 4 blankets, 5 odd articles—disinfected. Oct. 4th—Angus Street. Cancer. 1 bed, 1 mattress—disinfected. Nov. 9th—Idonia Street. Cancer. 1 bed, 3 pillows, 2 bolsters, 1 sheet, 1 blanket, 7 odd articles—disinfected. ,, 21st—Clifton Hill. Cancer. 1 mattress, 4 pillows, 1 bolster, 5 blankets, 1 sheet, 10 odd articles—disinfected. 1 bed, 2 odd articles—destroyed. ,, 29th—Haydock Road. Cancer. 1 mattress, 1 sheet, 3 blankets, 2 odd articles—disinfected. Dec. 1st—New Cross Road. Cancer. 1 bed, 2 pillows, 1 bolster, 2 sheets, 3 blankets, 9 odd articles—disinfected. ,, 27th—Arica Road. Cancer. 1 bed, 2 blankets, 1 odd article—disinfected. 2 beds, 2 bolsters, 4 pillows, 5 odd articles—destroyed. Mortuary Report for the year ended 31st December, 1923 Bodies Received, etc. Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Un- known. Deposited to await burial only. Infectious. 104 59 45 100 62 10 — 4 1 65 Eight bodies were detained after inquests to await burial owing to lack of accommodation at the homes, and three owing to advanced decomposition. One body (infectious) was deposited to await burial. Boroughs of which deceased persons were residents. Deptford 64 Bethnal Green 1 Greenwich 10 Southwark 1 Lewisham 5 Lambeth 1 Camberwell 5 Bermondsey 9 Bromley 1 Woolwich 3 Finsbury 1 Stepney 2 Liverpool 1 Summary of Visits paid by Health Visitors. Ward (approximate) Visits E. N. N.W. S. & S.E. S.W. Total. Miss White (Jan. 1st to Aug. 30th) 516 •• •• •• •• 565 Revisits 565 •• •• •• •• 555 Total 1081 •• •• •• •• 1081 Miss Clubbe Visits •• •• •• •• 691 691 Revisits •• •• •• •• 2751 2751 Total •• •• •• •• 3442 3442 Miss Holland Visits •• •• •• 796 •• 793 Revisits •• •• •• 2424 •• 2424 Total •• •• •• 3220 •• 3220 Miss Piper Visits •• 702 •• •• •• 702 Revisits •• 3061 •• •• •• 3061 Total •• 3763 •• •• •• 3763 Miss Smart Visits 944 •• •• •• •• 944 Revisits 1771 •• •• •• •• 1771 Total 2715 •• •• •• •• 2715 Miss Stowell Visits •• •• 844 •• •• 844 Revisits •• •• 2925 •• •• 2925 Total •• •• 3769 •• •• 3769 Miss Reynolds (Sept. 13th onward) Visits 278 •• •• •• •• 278 Revisits 1183 •• •• •• •• 1183 Total 1461 •• •• •• •• 1461 Total Visits 1738 702 844 796 691 4771 Revisits 3519 3061 2925 2424 2751 14680 Total 5257 3763 3769 3220 3442 19451 66 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 2349 12204 14553 Still Births 53 1 54 Infant Deaths 143 3 146 Expectant Mothers 435 369 804 Ophthalmia Neonatorum 19 30 49 Measles 365 513 878 Infantile Diarrhoea 32 36 68 Scabies in children 5 5 10 Verminous Children 15 5 20 Puerperal Fever 7 2 9 Pneumonia 23 30 53 Miscellaneous 528 6 534 Unsuccessful visits 539 1276 1815 Scarlet Fever recoveries 248 185 433 Whooping cough 7 14 21 Poliomyelitis 1 — 1 Erysipelas 2 1 3 Totals 4,771 14,680 19,451 Births Notified, Year 1923. Ward. Births Notified. Alive. Dead. By whom Notified. Total. Male Female. Parent. Doctor. Midwife other Person. East 532 273 259 523 9 51 109 366 6 North 485 330 255 480 5 54 219 210 2 North-west 439 227 212 424 15 79 141 214 5 South 411 213 198 406 5 72 111 224 4 South-east 222 104 118 215 7 49 65 97 11 South-west 243 120 123 237 6 79 48 109 7 2332 1167 1165 2285 47 384 693 1220 35 Milk supplied to Necessitous Mothers and Children. During the year 7,961 applications were received and were dealt with as follows:— Granted free 5730 „ at half-price 2200 Refused 29 Grants at hall-price refused by applicant 2 7,961 67 Dried Milk, Virol, &c. During the year the following amounts of dried milk, Virol, &c., were distributed, mostly at cost price, to the mothers attending the Infant Welfare Centres: Glaxo 3172 1 lb. packets Cow and Gate 2104 „ Trufood 39 „ Lactogal 84 tins Virol 42 28 lb. tins Ambrosia 1697 1 lb. packets Lacta 1736 „ "Winsome" 48 „ Maternity Home Particulars of cases admitted during the year 1923:— Cases admitted, 200. Average stay, Two weeks. Cases delivered by midwives, 188. „ „ „ doctors, 12. Cases in which medical advice sought, 23. (a) Ante-natal, 1 (continued and excessive vomiting). (b) During labour, 12 (Prolonged labour). (c) After labour, 4 (Adherent placenta (1). Rise of Temperature (2), Puerperal Insanity (1)). (d) For infant, 6 (l, Malformation. 2, Stillborn. 3, Dangerous feebleness). Cases notified as puerperal sepsis, Nil. Temperature rose above 100.4 for 24 hours with rise in pulse, 2. Notified as Ophthalmia Neonatorum, Nil. Inflammation (eyes), Nil. Infants not entirely breast fed, 2 (a) insufficient breast milk. (b) Phthisis. Maternal deaths, Nil. Fœtal deaths, 6 (2 Stillborn, 4 Prematurity.) 68 NAPIER STREET CLINIC. 1923. 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 27 4 2 3 36 313 349 143 February 4 14 2 3 7 26 277 303 109 March 4 12 1 2 4 19 255 274 111 April 4 14 2 5 • • 21 215 236 97 May 3 13 1 1 1 16 246 262 111 June 4 18 • • 1 2 21 286 307 137 July 5 9 1 3 3 16 336 352 129 August 3 9 • • 1 2 12 209 221 87 September 4 11 .. 3 4 18 267 285 137 October 4 23 1 2 6 32 283 315 137 November 4 11 2 3 6 22 301 323 144 December 4 7 1 2 4 14 190 204 103 Total 47 168 15 28 42 253 3178 3431 1445 ERLAM ROAD CLINIC. 1923. 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 9 • • • • • • 9 216 225 104 February 4 4 2 1 2 9 161 170 82 March 4 16 1 • • 3 20 168 188 98 April 3 10 • • •• 1 11 135 146 63 May 5 17 3 2 5 27 246 273 119 June 4 7 1 • • 4 12 201 213 97 July 4 13 •• • • 4 17 186 203 79 August 4 7 1 2 1 11 195 206 99 September 4 14 2 3 2 21 231 252 116 October 5 15 • • 1 2 18 216 234 95 November 4 8 1 1 5 15 206 221 100 December 3 6 • • • • 1 7 126 133 79 Total 49 126 11 10 30 177 2287 2464 1131 69 GOLDSMITHS' COLLEGE CLINIC. 1923. 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 24 •• 4 3 31 347 378 120 February 4 10 •• 3 6 19 353 372 142 March 4 20 2 3 3 28 352 380 145 April 4 31 3 4 3 41 346 387 127 May 5 13 1 1 4 19 474 493 159 June 4 15 2 2 5 24 405 429 143 July 4 19 1 3 5 28 361 389 145 August 5 28 2 5 4 39 437 476 167 September 4 24 1 4 11 40 438 478 151 October 3 17 •• •• 3 20 352 372 120 November 5 19 1 6 2 28 453 481 190 December 3 12 1 1 •• 14 267 281 108 Total 49 232 14 36 49 331 4585 4916 1717 BESSON STREET CLINIC. 1923. 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 13 1 3 6 23 312 335 128 February 4 4 •• 1 4 9 294 303 96 March 4 6 1 •• •• 7 237 244 85 April 4 13 5 4 4 26 245 271 96 May 4 11 2 2 2 17 243 260 74 June 5 12 1 5 3 21 335 356 141 July 4 10 2 4 5 21 242 263 101 August 5 15 •• 4 5 24 296 320 131 September 4 14 •• 2 4 20 320 340 114 October 3 10 1 1 6 18 141 159 67 November 5 21 1 •• 6 28 335 363 148 December 3 4 •• 2 2 8 131 139 62 Total 49 133 14 28 47 222 3131 3353 1243 70 GOSTERWOOD STREET CLINIC. 1923. 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 27 3 3 1 34 412 446 128 February 4 21 1 4 4 30 373 403 142 March 4 11 2 1 4 18 332 350 110 April 4 11 1 1 4 17 302 319 118 May 3 7 2 3 2 14 250 264 93 June 4 11 4 3 1 19 328 347 128 July 5 20 2 5 3 30 447 477 133 August 3 10 3 5 3 21 271 292 109 September 4 16 1 3 1 21 360 381 134 October 4 17 5 2 6 30 339 369 129 November 4 6 •• •• 3 9 306 315 98 December 4 3 •• 1 3 7 275 282 121 Total 48 160 24 31 35 250 3995 4245 1443 HALES STREET CLINIC. 1923. 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 11 1 5 6 23 324 347 163 February 4 17 •• 3 5 25 288 313 175 March 4 10 1 2 3 16 325 340 82 April 4 16 2 2 7 27 261 288 151 May 5 14 •• 7 8 29 340 369 178 June 4 18 2 3 2 25 278 303 24 July 4 17 • • 1 4 22 224 246 125 August 5 12 •• 4 2 18 315 333 136 September 4 22 1 6 4 33 241 271 138 October 3 13 • • 3 3 19 237 256 110 November 5 9 2 •• 8 19 320 339 155 December 3 8 1 •• 10 19 203 222 127 Total 49 167 10 36 62 275 3356 3630 1564 71 Table showing Attendances at the Ante-natal Centre and Special Clinic for Babies During 1923. Ante-natal Examinations. Babies' Special Clinic. Period. Number. Number. Four weeks ended Jan. 4 (6 sessions) 88 (3 sessions) 20 Two „ „ „ 18 (4 „ ) 61 (2 „ ) 12 „ „ „ Feb. 1 (4 „ ) 46 (2 „ ) 16 „ „ „ „ „ 15 (4 „ ) 66 (2 „ ) 14 „ „ „ Mar. 1 (4 „ ) 63 (2 „ ) 15 „ „ „ „ 15 (4 „ ) 51 (2 „ ) 12 Four „ „ Apr. 12 (7 „ ) 121 (4 „ ) 10 Two „ „ „ 26 (4 „ ) 52 (2 „ ) 8 Four „ „ May 24 (7 „ ) 95 (4 „ ) 16 Two ,, „ June 7 (4 „ ) 102 (2 „ ) 16 „ „ „ „ 21 (4 „ ) 66 (2 „ ) 11 „ „ „ July 5 (3 „ ) 42 (2 „ ) 6 „ „ „ „ 19 (4 „ ) 65 (2 „ ) 8 Six „ „ Aug. 30 (11 „ ) 154 (6 „ ) 31 Two „ ,, Sept. 13 (4 „ ) 53 (2 „ ) 9 „ „ „ „ 27 (4 „ ) 63 (2 „ ) 15 „ „ „ Oct. 11 (4 „ ) 49 (2 „ ) 14 „ „ „ „ 27 (4 „ ) 50 (2 „ ) 15 „ „ „ Nov. 8 (4 „ ) 51 (2 „ ) 12 „ „ „ „ 22 (4 „ ) 48 (2 „ ) 15 „ ,, ,, Dec. 6 (4 „ ) 39 (2 „ ) 12 Four ,, „ Jan. 3,3924 (6 „ ) 62 (3 „ ) 11 Dr. Hill's Report on the Ante-Natal Clinic. There has been a considerable increase in the number of attendances at the Ante-Natal Centre during the year, and the arrangements in this connection have shown some development. The Ante-Natal Clinic is held at the Napier Street Mission Hall on Tuesday and Wednesday from 9 a.m. to 12.30 or 1 p.m. Expectant mothers enter by the hall where perambualtors, sometimes toddlers, are left, and pass into the smaller hall where a Health Visitor writes the names in a register, fills in particulars on their card and tests specimens of urine. As time allows, or opportunity occurs, she gives advice to mothers as to the care of their health, preparations for their confinement and the making of babies' clothes, etc. The mothers then go three or four at a time into a further room to get ready in turn to see the doctor. The doctor keeps a record of her routine examination of each patient, in her private register, giving advice both verbally and also by means of a 72 printed booklet, which is supplied to all expectant mothers. An appointment is made for the next interview, the date being entered in the Health Visitor's register. Each Health Visitor is given the names and addresses of all expectant mothers in her area who have attended the Ante-Natal Clinic, and she makes usually one ante-natal visit to the patient's home. Special visits are also made to enquire after the welfare of mothers who have arranged to come again to the clinic and who fail to attend, or where there is any reason for anxiety. The expectant mothers attending the centre may be classified in several groups:— 1. Those seeking admission to the Council's Maternity Home. 2. Those arranging to go into the Greenwich and Deptford Hospital. 3. Those who have booked with a midwife. 4. Those who have not yet made any arrangements. Among the latter are a small proportion of purely gynaecological patients, who are referred to their own doctor for treatment, or to a hospital, according to the circumstances of the case. A certain number come merely to be assured as to the existence of a suspected pregnancy, or to solve a doubt as to the probable date of a confinement, and a few to ask advice as to what arrangements it will be best to make. Patients belonging to the first three groups are kept under observation at intervals, an examination of the urine being made at least once a week during the later months of pregnancy. Patients in whom any serious abnormality or complication is found are advised to go into hospital. As a rule admission is easily obtained, by means of a letter of recommendation, to King's College Hospital or to the Greenwich and Deptford Hospital. Patients other than those receiving Poor Law relief can be admitted to the maternity wards of the Guardians' hospital on payment of very moderate fees, and may avail themselves of this. Expectant mothers seeking admission to the Council's Maternity Home are first examined by the doctor, who makes other arrangements for cases presenting any serious complication, such as contracted pelvis or any form of infectious disease. Each mother for the Council's Maternity Home is then given an application form on which details as to the family, income, rent, etc., are entered, in order that the Ladies' Sub-Committee may make the necessary assessment as to fees, and this form is sent to the Matron at the Home. The fees vary according 73 to the patient's means, but due regard is paid to all the circumstances of each case, and any mother who is not satisfied with her assessment or has any further statement to add, is invited to meet the Ladies' Sub-Committee and talk it over; where the Committee find any good reason for doing so, a re-assessment is made. Many mothers prefer this arrangement to the plan formerly adopted of asking every applicant to meet the Committee. As soon as the fees are arranged the patient pays a booking fee of 10s. 6d., and the rest by instalments or as may be convenient to herself, but all money has to be paid to the Matron before admission. New patients are always asked to attend at the Ante-Natal Clinic for the first time on Tuesdays, and the Wednesday Clinic is reserved for those who have reached the later months of pregnancy, the aim being to see only a few mothers on that morning and to avoid keeping any of them waiting any length of time. On Tuesdays the attendances vary greatly and it is impossible to do the work properly if too large a number come on one day. On an average at least twenty minutes is required for each new patient. When there are many new ones son e must inevitably be kept waiting, and a few industrious mothers bring their knitting or sewing with them. It is very desirable that a properly organised sewing club should be arranged for Tuesday morning, but at present no teacher is available. Lectures could also be given while the mothers are waiting their turn to see the doctor, but when the waiting room is full the Health Visitor is so fully occupied with her clerical work and testing that she has no time to give health talks. The most useful work is done on a slack morning when she can teach them more individually; there is certainly scope for one more worker at this clinic. The following figures show the number of attendances as compared with the previous year:— 1222 1923 New Cases 311 369 Total attendances 938 1439 Number of sessions 55 98 Comments:— Dr. Hill's report brings out one or two little criticisms which may be read "between the lines." Perhaps it may be urged that officials are always wanting something; but frankly, we do need a good antenatal centre in the Borough. The doctor's examination room is small and not too well lit. The mothers' dressing room is not an ideal one. I wonder whether the Carnegie Trust would care to do for us that which has been so well done in Shoreditch ? 74 THE MUNICIPAL MATERNITY HOME. The number of confinements in 1923 was 200 as compared with 129 in 1922. The staff arrangements were completed during the year. The Matron is a qualified midwife, as also are the members of the nursing staff. Dr. S. E. Hill is the clinician in charge, and if necessary she calls in one of the practitioners who form the rota. The services of Dr. Gilliatt of King's College Hospital were retained for cases presenting exceptional difficulties of a major character. If Dr. Hill considers it necessary Dr. Gilliatt is called in in consultation at a fee of £5 5s. This occurred twice in 1923, at a total cost of £10 10s. Where a possibility of major operation interference may be deemed necessary the patient would be removed to King's College Hospital if Dr. Gilliatt and Dr. Hill considered her fit for removal, but if not fit the patient would be operated upon in the Home at a fee agreed upon between Dr. Gilliatt and the Council—usually twenty guineas. No such operative interference was necessary in 1923. One patient was removed to King's College Hospital. Should any operation be required at King's College Hospital no fee would be charged by Dr. Gilliatt, but the hospital would charge the Borough Council 11s. a day for the first twenty-one days during which the patient remained at the hospital. With respect to the case removed to hospital during 1923, the husband repaid to the Council the sum of £2 2s. per week while his wife was in hospital. With respect to the character of cases for which the Council agreed to pay 11s. a day for twenty-one days, it should be noted that this payment refers to any case which is due to or arises out of the actual confinement. In the event of a patient while in the Council's Home contracting any illness or disease not associated with the confinement, the cost of any treatment incurred by reason of such patient having to be transferred from the Home to a general or special hospital is not included in the fee charged by the Council; the patient must settle direct with the hospital in respect of any charge for her treatment there. It is, of course, patent that the ante-natal work should preclude to a great extent the possibility of any operation arising during a confinement at the Home. No expectant mother can enter the Home unless passed at the Ante-Natal Clinic. No abnormal case is admitted to the Home, but the kindliest interest is taken in any such cases ascertained at the Ante-Natal Clinic, and they are speedily brought under the care of the gynaecologist at King's College Hospital. 75 Where any mother remains in the Home longer than the usual 14 days an extra 3s. a day is charged commencing on and including the seventeenth day. If the case involves extra nursing something more may be charged. The maximum fee charged at the Home is £4 4s. per week, but the average fee is between £2 and £3. The most sympathetic consideration is given to poorer inhabitants of the Borough and a reduction is made. Consistent with efficiency and comfort, the Maternity Home is run by the Committee as economically as can possibly be done. During the year the Committee drew up a Form of Application for those desirous of entering the Home. This form contains questions as to earnings, rent, number in family, maternity benefit, etc. and has to be signed by the parents. To obtain a form the applicant has to visit the Ante-Natal Clinic, Napier Street, on Tuesday or Wednesday morning at 10 a.m., and receives the same from Dr. Hill, together with an envelope. This is posted or delivered to the Matron at the Maternity Home, 52 Wickham Road. The forms are brought to the Maternity Home Ladies' Sub committee, who consider each case and assess the same. The facts are reported to the parent Maternity and Child Welfare Committee, who confirm the assessments. A letter is written to the applicant informing her of the assessment and requesting her to call at the Home to see the Matron, when she signs the agreement on the back of the form and pays the booking fee of 10s. 6d. If a mother demurs at the assessment, she may come to the next Sub-Committee and state her case for further consideration. The full fee has to be paid before the mother enters the Home. SOME NOTES ON THE PUBLIC HEALTH YEAR. Barbers' Shops. About the year 1904 the Guild of Hairdressers actively took up the question of the promotion of cleanliness and asepsis in the conduct of hairdressers' establishments, and, after consultation with the Medical Officer of Health of the City of London, the Guild drew up a code of regulations, the observance of which, it was hoped, would effectively safeguard customers against those risks which are undoubtedly present where the business of a hairdresser is not carried on with the strictest cleanliness. 76 The Guild approached the Hampstead Council asking for its co-operation, and submitting a code of requirements which they had drawn up detailing the structural and sanitary arrangements of such premises, of which the following is a copy:— "That all saloons are adequately ventilated and in a cleanly condition. This specially applies to those in basements. That all drains have been inspected and tested and found to be in a good condition, trapped and ventilated (all lavatory basins must be separately trapped). The following disinfectants to be used, viz., Cyllin solution, in the proportion of one teaspoonful of Cyllin to one quart of water, or Izal solution in the proportion of one teaspoonful in one pint of water. This certificate will remain in force during the pleasure of the Council." One hairdresser made application, and carried out certain works required, and a certificate as above was granted. This was the first of the kind issued in any Metropolitan Borough (1904). The Medical Officer of Health for Hampstead stated that only one man applied and the latter hung his certificate in his shop. The other hairdressers did not think it worth while. The barber who complied with the conditions did not raise his prices. In Bermondsey, regulations were instituted in 1909, but after 1911 no applications were made. In the City of London certificates are given to hairdressers who comply with regulations; the certificates are given annually. With the example of these and other authorities before me, I proceeded, not with too great hope of gaining the co-operation of the barbers, to approach the local hairdressers to sound them on the subject. The aim and object was to raise the standard, to inform the public so that they might demand an improved service. The Secretary of the local branch of the Barbers' Federation wrote asking whether I could meet some of the representatives at the Town Hall. A very satisfactory meeting was held with five representatives of the Incorporated Society of Hairdressers. They seemed to be anxious to carry out their duties on advanced hygienic lines; in fact, out of the 50 (approximately) barbers in the Borough a number were anxious to be registered at the Town Hall. 77 Very careful attention was given by the Health Committee to the product of the joint deliberations of the Medical Officer of Health and the barbers, and finally the Council agreed to the issue of the following certificate and terms of the regulations:— Borough of Deptford. This is to certify that we, the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford, within the County of London, have recognised the premises of at in the above Borough, as suitable for the business of a Hairdresser, subject to compliance with the Regulations hereinafter named. Dated this day of , 19... Mayor. Town Clerk. Regulations. 1. All shelves, fittings and tables on which tools are placed to be of glass, marble, slate, or other impervious material. 2. Reasonably clean towels, etc., to be used for each customer and a fresh piece of clean paper or clean linen to be placed on the back of the chair or head rest. 3. No general powder puffs to be used, but powder pulverisers or cotton wool to be substituted; rubber sponges or cloths may be used, but must be thoroughly rinsed before using. All sponges and cloths must be placed in boiling water for ten minutes daily. 4. All razors, scissors, combs or other tools to be placed in disinfectant solution before using. The solution must be made up by adding half-a-teaspoonful of Cyllin or Izal to half-a-pint of warm water. 5. Razors to be wiped on paper. 6. Hairbrushes to be cleansed as often as necessary. Mechanically-driven brushes to be used only after a wet shampoo. 7. Shaving brushes to be placed in the disinfectant solution before using. 8. Bar shaving soap may be used, but must be disinfected before using; but liquid, or powder or cream is to be preferred. 78 9. Cut hair, falling on the floor must not be allowed to accumulate, floors to be thoroughly cleansed twice weekly with soap and water containing one teaspoonful of the disinfectant to one quart of water. 10. Alum blocks may be used as a styptic, but only after submerging same in hot water for one minute. A liquid or powder may be applied on towel or cotton wool, or by spraying. 11. The most scrupulous cleanliness to be observed in all that pertains to the business. 12. The operator to wear a clean overall and to wash his hands before attending to each customer. 13. No customer suffering from a skin or hair affection to be attended to, save at his own home, or office, or in a private room. 14. Clean hot water to be used in shaving each customer. 15. The following sanitary requirements must be observed:— The ventilation and cleanliness of the saloon must be adequate. Drains must be inspected and found to be in good condition, trapped and ventilated. All lavatory basin wastes must be trapped. An ample supply of water must be laid on. The Borough Council decided that subject to the premises being found satisfactory on inspection, and on the receipt by the Council of an undertaking in writing signed by the proprietor of the premises to comply with the regulations, a certificate in the form set out above be issued by the Council recognising the premises as suitable for the business of a hairdresser, subject to compliance with the Regulations, such certificate to be effective for a period of twelve months from the date of issue. It is regrettable that only two barbers in the Borough, so far, have made application and received the certificate. Typhoid (Enteric) Fever. Within the last twenty-five years a great fall in the incidence of this disease has taken place throughout the country. The cases which have been notified in the Borough during the last ten years are:— Year 1913 17 cases Year 1918 14 cases 1914 9 „ 1919 8 „ 1215 37 „ 1920 11 „ 1916 5 „ 1921 9 „ 1917 10 „ 1922 7 „ 79 The following record will serve to show the importance of the "carrier":—On 20th October, 1923, I received a notification of enteric fever occurring in a child, E.H., 6 years, living at P. Street. The child was removed to the South-Eastern Hospital. The last date on which he attended school was 9th October. He was taken ill on the 9th and the doctor was called in on the 10th, in view of his feverish condition. The nature of the illness became manifest on the 18th, the diagnosis being confirmed by a Widal test. 1 visited the house and made an appointment to meet all the members of the three families living there next day (Sunday). The three families were closely related, comprising thirteen people, living in seven rooms, of which four were bedrooms. Three brothers were the heads of the three families. Taking the patient's family first; this consisted of E.G.H., 35 years, who shares a bed with his son, the patient E.H. The father, E.G.H., is an engine driver on the London, Brighton Railway and has lived for five years at P. Street. His health history was good with no recollection of any transient febrile disorder such as might have been a mild typhoid attack. He said that the patient, his son, had had headache, pains in the abdomen, sickness and vomiting. The father had had diarrhoea for one day himself. A sample of the father's faeces was taken for a bacteriological examination, but proved negative The second family consisted of J.H.H. (brother of E.G.H. above) his wife F.H., his sister T.H., and five children, namely C.H., male, 13 years, T.A.H., female, 9 years, L.H., male 8 years, E.H., female, 5 years and B.H., female, 4 years. The health history of the family was as follows:—The father, J.H.H., had pleurisy and pneumonia in December, 1921 and was six weeks in bed. His physical signs ware slow in clearing up and the family doctor sent him to the Tuberculosis Dispensary for co-operative observation. His chest cleared up and since then his health has been satisfactory. In the past, one has come across cases in which an attack of pneumonia has been a complication of a true typhoid infection, so it was felt advisable that samples of his dejecta should be examined lest he should be a typhoid carrier. Mrs. J.H.H. had a goitre for which she was receiving medical treatment. The sister, T.H. had suffered from anaemia and constipation. The child C.H., aged 13 years, though seemingly in perfect health, had diarrhoea on the 14th and 15th. His blood serum gave a negative Widal. The fæces were negative, no B. Typhosus being isolated. 80 T.A.H., female, age 9 years, had a headache on Sunday, 21st, which cleared off by the next day. L.H., male 8 years, had diarrhœa on the 19th and 20th. A Widal test was negative. E.H., male, 5 years, is usually loose, Widal, negative here. 1 have explained to the Committee before that a lapse of days has to take place before certain substances in the blood are formed—where infection with a typhoid bacillus has taken place—whereby a positive Widal, that is an agglutination can be secured. The health history of the third family was of the first importance, and this should be read carefully. J.T.H., the father, left England on 1st March, 1912 and arrived in the Argentina on 23rd March. He worked as a locomotive fireman and driver at Tucamen, 700 miles inland from Buenos Ayres. There were numerous cases of enteric fever there and he contracted the disease and was ill during March, April and May, 1913. He left the Argentine in September, 1915 and enlisted in the Army in England on November, 10th, 1915, leaving for France in February, 1917. He was discharged from the Army in February, 1919, and returned to his home at 79 M. C. Road. His daughter, P.H., contracted enteric fever in 1920. His wife contracted the disease in August, 1923, dying in a few days, the provisional diagnosis being confirmed at a post mortem. It should be particularly noticed that this family moved on 20th September, 1923 to join the other two families at 18 P. Street. The arrival of this family at 18 P. Street and the illness of E.H. on 9th October gave rise to a suspicion that either J.T.H. or his daughter, P.H., or both, were carriers. Enquiry was made as to the sleeping arrangements and these were found to be—First bedroom: E.G.H. and son (the patient), aged 6 years, slept in one bed. J.T.H. and son, J.H., 17 years, slept in a second bed. Second bedroom: Miss T.H. (aunt) and P.H., aged 19 years (daughter of J.T.H., who formerly had enteric fever), slept in one bed. Third bedroom: J.H.H. and wife, F.H., and daughter, B.H., aged 4 years, slept in one bed. Fourth bedroom. In one bed, C.H. (male, aged 13 years), and L.H. (male, aged 8 years), In second bed, T.A.H. (female, aged 9 years) and E.H. (female, aged 5 years). There are two kitchens, one used by J.H.H., his wife and five children. The second kitchen is used by J.H., his son J.H., (aged 17 years), P.H. (19 years), and E.G.H. and his son, E.H. (the patient) and aunt, T.H. When the child E.H. was taken ill on 9th October, his aunt T.H. stopped sleeping with her neice, P.H., and slept with the child E.H. 81 Full enquiry was made into the possibilities of infection by milk, mussels, watercress, etc., but with no connecting link. Serum tests and examination of faeces gave no assistance, but on the removal to hospital, for purely observation purposes, of J.T.H. and his daughter, P.H., the Typhoid bacillus was found in the urine of both. This completed the chain. The father contracted the disease in 1912 in Tucamen. His daughter contracted the disease from the father in 1920. His wife contracted enteric fever in August, 1923, either from the daughter or father. The child, E.H., contracted the disease from father or daughter. I found that the daughter was baking the bread for the family. The aunt, T.H. was next taken ill, no doubt being infected by the child E.H., with whom she slept. All the members of the families were inoculated against the disease and no other cases occurred. These had been the first cases in the Borough for many months; the discovery of the B. Typhosus in the urine of father and daughter left no doubt as to the source of the trouble. House-to-House Inspections. A full record of this work will be found elsewhere in the tables and records of this Report. Until 1923 house-to-house inspection in this Borough had been confined practically to homes of the working class. The Local Government Board's view was that the Local Authorities are not restricted to the inspection of houses coming within the limitation as to rent laid down in Section 14 of the Housing, Town Planning, etc., 1909, though preference should be given to those requiring it most. The Council decided to make an inspection of better class houses, and as the tenants of the same were not familiar with the fact that inspection was to be expected, it was agreed that the Medical Officer of Health should give a few days' notice of the proposed inspection in such houses. Each Inspector was requested to carry out a total inspection of not less than sixteen houses each fortnight. In each of the Medical Officer of Health s fortnightly reports, the address of such houses, together with a statement of the number of houses in which defects were found, was to be given. The following is a record of the number of house-to-house inspections carried out in recent years:— 1911 2,134 1915 2,243 1919 1,944 1912 2,479 1916 1,784 1920 2,036 1913 3,269 1917 827 1921 1,412 1914 2,496 1918 412 1922 1,839 82 The number of houses in the Borough is 18,122. The following streets in the Borough have not been inspected yet:— East Ward—High Street and New Cross Road. North Ward—Evelyn Street. North-West Ward—Edric Road, Billington Road, Casella Road, Nettleton Road (part of), Leylang Road, and New Cross Road (part of). South Ward—Excepting Foxwell Street, Martin's Buildings and Tolhurst Street, none of this ward has been done. South-East Ward—Lewisham High Road, Tyrwhitt Road, Tressillian Road, Albert Road, Clifton Road, Carlton Road, Crescent Way, Hilly Fields Crescent and Cliff Terrace. South-West Ward—Troutbeck Road, Jerningham Road, Pepys Road, Waller Road, Erlanger Road, Musgrove Road, Ommaney Road, Arbuthnot Road, Kitto Road, Drakefell Road, Bousfield Road, Gellatly Road, Lausanne Road, Aspinall Road, St. Asaph Road, Avignon Road and Queens Road (part of). Section 28 Housing and Town Planning Act, 1919. This valuable section of the Act is at present not in full use. Under this section if a notice of twenty-one days failed to have the houses made fit for human habitation, the Council could do the work and recover the cost in the manner provided by the Act. The usefulness of this section has been largely destroyed owing to adverse decisions in the Law Courts, in asmuch as it has been decided that an owner has a right of appeal AFTER the work has been done by a borough council. It is desirable that the Act should be amended to prevent an appeal after the work has been carried out. At present the owners can appeal to the Minister of Health on two grounds, (1) Unreasonable requirements of the notice. (2) Excessive cost incurred by the borough council in the execution of the works. The present state of affairs means that a Medical Officer of Health has to exercise extreme care in specifying the particular works requiring to be carried out, and to prevent an owner from alleging that the cost of the work is excessive, tenders should be obtained for carrying out the work. Section 28 should be revised by a clause in the new Housing Bill. 83 Chemists' Prescriptions, Analyses of. The London Insurance Committee asked us some time ago to co-operate in order to ascertain whether the prescriptions made up by chemists under the National Health Insurance Acts were properly compounded, whether the medicines supplied to insured patients were in all respects according to prescription. Twelve prescriptions were issued and following the receipt of the Public Analyst's reports certain prosecutions were undertaken. Two chemists were fined £1 each and £5 5s. costs. The unsatisfactory feature of the cases was that the London Insurance Committee refused to pay any part of the cost of the proceedings. Diphtheria Contacts. In January, 1923, I commenced examining every contact of each notified case of diphtheria whom I could persuade to attend at the Town Hall for the purpose. The idea that the nose and throat of every contact should be swabbed has been given up. Only those who present signs of catarrh, redness, incrustation, patches, etc., should be swabbed. In ordinary healthy throats the diphtheria bacillus may or may not be found in a series of successive swabs. The presence of a diphtheria bacillus, without clinical signs, is of no consequence as a rule. A question may arise where the presence of a carrier in a family or a class at school is suspected. The era of swabbing all and sundry has passed. No authority nowadays is going, moreover, to spend 3s. 6d. a time on a dozen contacts' throats. Each outburst must be treated on its own merits. If a diphtheria bacillus is found, a question arises as to whether it is a virulent or a non-virulent one; this involves the use of guinea pigs at 10s. 6d. each, an expense which cannot often be justified. As a disease, diphtheria is of much more importance than others which seem to hold the attention of the people. Diphtheria is a killing disease. It is quite possible that diphtheria could be practically expelled from London. By the Shick test one can tell whether a child is liable to take diphtheria or not, and by means of a simple inoculation it is possible to make any unprotected child safe from infection. Dozens of children have now been protected in the Westminster area. What chance is there of making the London children safe against diphtheria? Look what is happening with regard to small-pox and vaccination. Thanks to vaccination small-pox was expelled from the country. A new generation arose who objected to 84 having their children "corrupted" by vaccination. The result is that any protection against small-pox handed down from the parents' cells to the child is dying out, and now we find that small-pox is settling down quietly as a welcome guest in our country. The wicked vaccinators who have made money through vaccinating the public are put in their place, so all is well. Just so. Meanwhile, with regard to diphtheria, I saw and examined 937 people at the Town Hall during 1923. Practically all of these were contacts of notified cases, though occasionally a child was sent from a school suffering from a sore throat. Again the Invalid Children's Aid Association sent children for a swab before admitting the same to one of their homes in the country. Of the 937, 522 were examined, 415 were swabbed, of whom 344 were "negative" and 71 "positive." The large number swabbed will not be repeated, in fact those swabbed in the last quarter were few compared with the first quarter of the year. Two contacts who came to the Town Hall were found to be suffering from clinical diphtheria, and were sent off to hospital forthwith. In all positive cases rigorous treatment was carried out. Our usual practice now is to see that all contacts obtain formamint tablets for the fauces. Several children were referred to the school clinics owing to the presence of enlarged tonsils and adenoids. Much school time was saved by giving re-admission certificates to contacts of school age whose throats did not give rise to any suspicion. This work, I am convinced, is of considerable value. It may be a coincidence that the number of cases of diphtheria has diminished. Diphtheria, however, will never be extinguished until the Shick test and toxin-antitoxin injections are used. It can be done, and the first step in this direction is public education. Rat Work. Inspector Yates carried out 128 inspections in connection with rat infestation in dwelling houses, shops, timber yards, stores, etc. In the majority of cases the cause of the nuisance was traced to defective drains which, when reconstructed or repaired led to an abatement of the nuisance. In several instances rats gained entry into premises from open spaces. Places which afforded harbourage were cleared and all means of obtaining food were cut off by making premises rat proof. Traps and rat poisons were of great service. The age and construction of some buildings in certain areas in the Borough make the task of rat extermination a more difficult one than would otherwise be the case, but owners and occupiers have been most helpful in leaving no stone unturned to quell the rodents. 85 Preservatives in Food. Considerable attention was given to this subject by the Council, who wrote to the Ministry of Health asking that further consideration should be given to the whole subject of preservatives in food. The Council felt that a new Committee should be appointed to take evidence and bring the recommendations up to date, and that the Ministry should initiate legislation on the lines suggested by the new Committee. It is desirable that the Ministry should prescribe the limits of the amount of chemical preservatives allowed and also regulate the conditions of sale of foodstuffs containing preservatives. In the course of the year the Analyst found, in samples taken to him by the Inspectors, that one tin of fish in tomato contained 4.97 grains per pound, of tin; a tin of peas contained .61 grains of copper, that is 2.4 grains of copper sulphate per pound, and another contained .48 grains of copper. As these latter two were the first cases of the kind in the Borough, the Council decided to issue warning notices in the local press and in a trade journal that, in future, prosecutions would follow where, on analysis, copper sulphate, tin or other metals or their salts were found in tinned food. Numerous samples of beer were analysed but all were free from arsenic within the Royal Commission limit. The Council condemned the present practice of some roundsmen who take stale bread back to the shop in exchange for fresh from some customers. This stale bread is moistened, put back in the oven and sold over again. The practice is indefensible, but difficult to stop. The wrapping of bread in paper coverings for delivery or sale was felt to be desirable, though enquiry brought out certain existing difficulties. Acts, Bye-laws, Orders, Regulations, etc. Though the Milk and Dairies (Amendment) Act, 1922 came into operation on 1st September, 1922, a word as to its importance is opportune. As one who has been long enough in the public health service to learn how surely and steadily, though perhaps slowly, needed reforms crystallize in public health matters, I rejoice to see how already the public is demanding a pure milk supply. Those who believe in the British public as I do, and who spend many a long hour in writing up this and the other subjects to help on a pure food supply, are heartened at the questions and the demand for the best which are now vocal. It is true that only two dealers applied in Deptford for licences to sell Certified Milk, still a start has been made. In London much of the public milk supply 86 is said to be pasteurised—after a manner it may be, but all is to the good. Milk purveyors must produce a pure article or go to the wall. That patient animal, the public, is asking for a better deal and of course, the sanitarian is glad. Now, Section 2 empowers a local authority to refuse to register a retail purveyor of milk or to remove such a person from the register. This means that the gentleman who waters his milk will meet with short shrift. In Deptford, as elsewhere, the problem is what is to be done with the small mixed dealer who sells coal, sticks, milk, pepper, sweets and clothing. Milk should not be sold with these. This is a 1924 question, so I shall not say more here on that point. The Milk (Special Designations) Order, 1923 came out in May, 1923. The Public Health (Condensed Milk) Regulations came into operation on 1st October, 1923. Every tin containing condensed milk must be labelled accurately in accordance with the First Schedule of the Regulations. Full cream, unsweetened must contain not less than 9 per cent. of milk fat and 31 per cent. of all milk solids including fat. The same applies to sweetened full cream. Unsweetened skim milk must contain 20 per cent. of all milk solids including fat, and sweetened skimmed milk must contain 26 per cent. The Public Health (Dried Milk) Regulations, dated 24th July, 1923 requires that tins or receptacles of dried milk for human consumption must be specially labelled. Dried full cream milk must state on the label "This tin contains the equivalent of (a) pints of milk." Dried partly skimmed milk and dried machine-skimmed milk must exhibit certain statements with regard to babies. Dried full cream milk must contain not less than 29 per cent. of milk fat, and dried partly skimmed milk must contain not less than 15 per cent. of milk fat. The London County Council issued Bye-laws respecting the business of a dresser of fur skins. Circulars 426 and 476 from the Ministry of Health dealt fully with cancer. Tuberculosis and Poor Law Authorities. At the Conference on Tuberculosis held at the County Hall, a resolution was passed that in the opinion of the Conference it was desirable that Tuberculosis Officers should be appointed visiting consulting physicians for tuberculosis at 87 Poor Law Infirmaries in their areas. The Public Health Committee of the Borough Council agreed that the principle was a desirable one and referred the matter to the Medical Officer of Health to confer with the Medical Superintendent of the Greenwich and Deptford Hospital for further report. The arrangements finally agreed to were of a very satisfactory nature and were finally welcomed by the County Council who had asked for information as to any steps taken in the matter. The Tuberculosis Officer now visits the Greenwich and Deptford Hospital once a week on a fixed day and is given a list and directed to the wards where Deptford patients suffering from tuberculosis are situated. Here a sheet is found attached to the usual case paper for the Tuberculosis Officer's suggestions as to whether sanatorium or other treatment is necessary. His suggestions are carefully considered by the Medical Officers of the Institution. These patients remain under the control of the Greenwich Guardians and their Medical Superintendent as to treatment and date of discharge. By this scheme the Deptford Tuberculosis Officer is able to maintain continuity of supervision, and co-ordination is achieved in the work of public authorities in dealing with tuberculosis. The Tuberculosis Officer is able to obtain information from the case sheets, of value to the Public Health Department. He learns the date of discharge of the patients and so is in a position to advise the Secretary of the Tuberculosis Care Committee. Small-pox. No cases occurred during the year but the Medical Officer's services were requisitioned from lime to time for consultation in suspicious cases. Smoke Abatement. Numerous observations were made by the Inspectors and warning letters were sent. No prosecution was undertaken during the year. Applications for Milk. Where a fourth application for milk is made by an employed person, enquiry is made as a routine of his employer to confirm the wages stated on the application form. During the year a small number of discrepancies were ascertained, and in these cases the parents were invited to explain the discrepancy at the Committee meeting. With one exception repayments were made by the parents to account for such discrepancies. 88 Albury Street Babies' Home. This valuable Home continues its good work. To ascertain the average cost per cot per week it is necessary to assume that the full capacity of the Home is utilised. There are now sixteen cots in the Home. From the 1st April, 1923 until the 30th September, 1923, 2,928 days or 418.28 weeks are available. The actual occupation for that time was 2,468 days or 352.57 weeks. The average weekly cost per cot per annum was £1 16s. 5d. The Council now have eight cots at call in place of four as formerly. The grant given by the Council has been increased from £200 to £400. The number of babies sent in by Dr. Hill and myself was 40 in the calendar year 1922, and 54 in 1923. The grant given by the Ministry of Health towards the Home is approximately £520. Health Week in the Borough was again held during the first week of October and was largely taken advantage of by the public. INDEX. A PAGE Acres 7 Acts 85-86 Acute Primary Pneumonia 30 Acute Influenzal Pneumonia 30 Ambulance Facilities 34 Albany Street Babies' Hospital 88 „ „ Grants 88 „ „ Admissions 88 Ante-Natal Clinic 71 „ „ Dr. Hill's Report 71-72 Applications for Milk 87 B Bakehouses 57 Barbers' Shops 75 „ Regulations 77-78 „ Certificates 77 Bedding destroyed 64 „ disinfected 63 Besson Street Clinic 69 Births 7 Birth-rate 7 Births, illegitimate 8 Table 8 Births and Deaths Table 11 Births Notified Table 66 Books disinfected 63 By-laws 35, 36, 85, 86 c Canal Boats Act 58 Cautions to Vendors 59 Carnegie Trust 73 Cancer, disinfection for 64 i. C—continued. PAGE Cerebro-Spinal Meningitis 31 Chemists' Prescriptions 83 Cleansing Station 63 Clinics 33 Clothing disinfected 63 Cremation 17-27 D Deaths 9 „ Causes of 13 „ Rate 9 „ Table 9 Diphtheria 30 „ Contacts 83 Diarrhœa and Enteritis 31 Disinfection 62 Dressmaking 57 E Enteric Fever 30, 78-81 Erlam Road Clinic 68 Expectant Mothers 72 F Fees, Municipal Maternity Home 74-75 Food Preservatives 85 G Goldsmiths' College Clinic 69 Gosterwood Street Clinic 70 Greenwich and Deptford Hospital 72 Gilliatt, Dr. 74 H Hairdressers 75-78 Harbison, Dr. 36-44, 87 Hales Street Clinic 70 iii. H— continued. PAGE Health Visitor's Visits 65 „ Summary of Work 66 Health Week 88 Home Work 56 House-to-house Inspections 50, 51, 52, 81, 82 Hospitals 34 Hill, Dr. 71, 72, 73, 74, 88 I Infant Mortality 10 „ for 10 years 11 „ Table of Causes 14 Infant Welfare Clinics 68, 69, 70 Infectious Diseases 30 „ Table 15 „ „ for 10 years 16 „ Death-rate 16 „ Hospital disposal of 32 K King's College Hospital 72 L Laboratory Work 35 Laundries 57 Legal Proceedings 59-60 M Marriages 8 Marriage Rate 8 Maternity Home Statistics 67, 72, 73, 74, 75 Malaria 31 Measles 31 Milk Applications 87 „ Prosecutions 59 iv. M—continued. PAGE Milk (Dried) Distribution 67 „ for Necessitous Mothers 66 Mortality Tables 10 Mortuary Report 64-65 Millinery 57 N Napier Street Clinic 68 Nursing Arrangements 32 O Ophthalmia Neonatorum 31 Orders 85-86 P Panel Chemist Prosecutions 59 Pneumonia 30 Poliomyelitis 32 Population 7 Proceedings re Samples 59 Puerperal Fever 31 Preserved Food 85 R Rat Work 84 Register of Milk Premises 54 „ of Factories, Workshops 54, 55, 57 Regulations, Barbers' 77 Regulations 85, 86 Room disinfection 62 S Sale of Food and Drugs Acts 58 Samples Analysed Table 61 Sanitary Administration 45 „ Inspectors, Work of 46 Table of Work 47, 48, 49 V. S—continued. PAGE Scarlet Fever 30 Section 28 Housing and Town Planning Act, 1919 82 Shelter 61 Small-pox 42, 87 Smoke Abatement 87 T Tinned Fish in Tomato 59 Treatment Centres 33 Tuberculosis Report 36-44 „ Notifications Table 37 „ Interval between Notification and Death 38 „ Deaths and Death-rate 39 ,, Prevention and Treatment 40-44 „ Table of Work 42 „ Register 43 „ and Poor Law Authority 86-87 Typhoid Fever 30, 78-81 U Underground Bakehouses 57 Unsound Food 58 V Vendors cautioned 59 Verminous premises 63 Virol 67 Vital Statistics 4 „ for 10 years 12 W Ward Area 7 „ Death-rates 10 „ Infant Mortality Rate Table 10 z Zymotic Enteritis 14, 15, 31 Frederick Petty, aged 8 months. Weight 21 lbs. 3 ozs. 10th Child. Mother 47 years of age. All family breast fed.