DEPT 18 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). Fellow of the Royal Institute of Public Health. Fellow and Member of the Council of the Institute of Hygiene. Member of the Royal Sanitary Institute. President of the New Cross Medical Society. Member Executive Committee National Baby Week Council. Medical Officer of Health. 1924 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health Committee. Mayor. Councillor F. J. BRYER, J.P. Chairman. Councillor Mrs. B. M. DRAPPER, J.P. Vice Chairman Councillor W. TAYLOR. Alderman Mrs. G. E. Green Alderman W. H. Green, J.P. Councillor Mrs. A. A. Cheason Councillor A. G. Howard Councillor W. F. Marchant, M.A., O.B.E., L.C.C. Councillor Mrs. G. Tiffen Councillor Miss K. P. Warcup Councillor Mrs. L. E. White Councillor E. C. Wood Maternity and Child Welfare Committee. Chairman. Alderman Mrs. G. E. Green Vice-Chairman. Councillor Mrs. G. Tiffen Alderman W. H. Green, J.P. Councillor Mrs. A. A. Cheason Councillor Mrs. B. M. Drapper, J.P. Councillor F. J. Kemp Councillor W. F. Marchant, M.A., O.B.E., L.C.C. Councillor J. Speakman Councillor W. Taylor Councillor Miss K. P. Warcup Councillor Mrs. L. E. White Staff of the Public Health Department. Medical Officer of Health and Administrative Tuberculosis Officer. Charles. S. Thomson, m.d., ch b. (University of Glasgow), b.hy. and 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. Insp. (r.s.i.) ,, E.E.Reynolds,, „ ,, c.m.b. „ M. F. Robos ,, ,, ,, 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. * 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. L. Voysey, ,, ,, ,, A, Chatters, ,, ,, ,, 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 B. Lewellin. Tuberculosis Nurses—Miss E. M. Porteous. Miss E. G. Griffiths. 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. General Assistant. E. H. Evans. Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross Road, S.E. 14. 30th April, 1925. To His Worship the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Ladies and Gentlemen, I have the honour to present to you the Annual Report for the year 1924, dealing with the health and sanitary circumstances of the Borough. This report forms one of the "Ordinary" annual reports, but next year's will be, at the request of the Ministry of Health, a "Survey" report; this latter will deal, amongst other things, with the progress made in the borough during the preceding five years, in the improvement of the public health. In many respects the year that has passed has been a satisfactory one. The increasing numbers of expectant women attending the Antenatal centre, necessitated the institution of a third session. In the course of her report, Dr. Hill has given a Table from which some idea can be obtained of the ailments from which expectant women suffer. Think of the sufferings of, and the risks taken by many expectant women, who pass on to their confinement without the protection and security which attendance at the ante-natal centre affords. An increase in the infant mortality rate, from 59 to 76 per 1,000 born, need cause no apprehension; the rate of 76 is the third best in the history of the borough, and it was obtained in the teeth of a raging Measles epidemic which lasted several months. I am concerned at the loss of 45 infants from Pneumonia and 11 from Bronchitis. Some Measles cases terminate as fatal Pneumonias, and Measles we certainly will have every two to three years; even so we should not lose so many infants from Pneumonia and Bronchitis. The Borough provides nursing assistance, but the main remedy is to be found in the supply 2 of more houses, in diminishing overcrowding, and in taking down slums. No fever than 16 of these 45 Pneumonia deaths occurred in the East Ward as well as 4 of the 11 Bronchitis deaths. There was a time when people said, with a superior air of finality "the weakest must go to the wall." These were they who, when confronted with the still, stagnant air of the slums, spoke of the "privileges of the poor." Public opinion has changed but, alas, we still have our slums. Part of our east end was condemned years ago, but it still stands. The following figures speak for themselves. The Infant mortality rate for the Borough is 76, for the East Ward it is 100. The general mortality rate for the Borough is 12.0: for the North-West ward 10'3 (the best): for the East 15.2 (the worst). Why are the notifications in the case of Pulmonary Tuberculosis four times greater, and in the case of non-Pulmonary Tuberculosis eight times more in the East Ward than in the South Ward? We provided a dentist for our poorer Tuberculous brethren; what we need most of all for part of the East Ward is a house-breaker. A chain is only as strong as its weakest link. May it be soon then that the County Council may be able, in their considerations, to find the money to pull down this area; right heartily are they helping us at Watergate Street. Sixteen children in the borough died from Diarrhoea and Enteritis: a rate of 6.7 per 1,000 births, as compared with 8.4 for London County, 7.3 for England and Wales, and 9.2 for the 105 great towns. The Diphtheria notifications fell from 417 in 1923, to 374 (of which latter the diagnosis in 21, was not upheld). I examined 855 contacts, finding 2 actually suffering from the disease. Two hundred and sixty seven of the contacts examined were adults. Seventy-four were swabbed, and of these, 8 were "positive." As I have explained before, there is no justification for the existence of Diphtheria. By means of the Schick test we can determine whether a person is susceptible, and by a minute inoculation we can protect the susceptible. Until our University professors teach students of Public Health how to become efficient public speakers and instructors, we shall tend to remain faced with a general public who know little of the means whereby they, and theirs, can be protected from Diphtheria and other diseases. Steady public instructions by lectures and reports, will reap a rich reward in time. Although cases of Ophthalmia Neonatorum increased from 15 to 25, the rapid action taken prevented a single case of impaired vision. I have felt it to be necessary to say a few words in the text concerning 3 Encephalitis Lethargica; this insidious and alarming disease killed 6 out of 24 patients. Scarlet Fever fell from 349 to 291 cases, and Puerperal Fever, from 7 to 6. A chart will be found illustrating the deaths from Cancer, for several years; 148 victims this year, 8 more than last. In Dr. Harbison's report, it will be seen that deaths from Tuberculosis rose from 95 to 104, of which 49 were between 25 and 45 years of age. The greatest cause of death was Heart Disease, 173, and of these, 60 died between 45 and 65. Heart disease is frequently the handmaiden of Arterio-sclerosis (hardened arteries). This is largely a preventible disease, and I have accordingly made it the subject of this year's educational article. Nearly all deaths from cirrhosis of the liver, together with some deaths from kidney and heart disease and arterio-sclerosis, are justifiably attributable to alcoholism. The acute prohibitionist refuses to be comforted, but one can rejoice at the improvement in the drinking habits of the nation. Something must be done to remedy the tragedy of little children being kept waiting in the cold until father or mother chooses to leave the public house; it is a scandal. Fit men and women are wanted for this country, therefore parents must see that their children are brought up as total abstainers and they must show them a good example. The distribution of milk, free or at half-price, involves a scrutiny of the income and rent of the family concerned. One is driven to the conclusion that in many cases the wages are inadequate. There would seem to be a good case for the protagonists of birth control, though there is surely something higher for healthy people to aspire to than this. The cult of birth control has become something of a religion with some. None the less it is justifiable in the case of women whose burden is already heavy enough and in certain other cases. In 1924, 67 infants died in the Borough from congenital debility, malformation, and premature birth. Who shall say that in these cases birth control would not have been better? During the year I delivered a number of lectures in the Borough; intensive public health propaganda work is required. Your Council has kindly placed the Town Hall at my disposal on alternate Wednesday evenings from October to March inclusive. The big success of Health Week, thanks to you, to the whole staff, and to the public, has led to a demand for more information. 4 Herein will be found a full record of the patient and faithful work of your able Health Visitors (Maternity and Child Welfare and Tuberculosis) and Sanitary Inspectors. Not many Boroughs can boast of 2,809 house-to-house inspections and 22,856 inspections involving 5,461 houses. The clerical staff, as usual, has answered every call faithfully. Unitedly we thank you for the kind support, the trust and confidence you have placed in us. Mr. Purkis, the doyen of Town Clerks, and every individual member of the Town Hall, have added to that pleasure which is ours in serving you and those whom you represent. Your obedient Servant, Charles S. Thomson, Medical Officer of Health. 5 Summary of Vital and Mortality Statiatics. 1924. 1923. 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 115,200 114,900 Number of inhabited dwellings (Census 1921) 18,122 18,122 Number of families or separate occupiers (1921) 28,007 28,007 Average number of persons per dwelling 6•4 6•3 Density 74 per acre 73 per acre Length of Public Streets 53miles a pprox. 53 miles approx. Rateable Value £647,431 £644,259 1d. Rate produces (approximately) £2,624 £2,611 Cost of administration of Public Health Department £4,246 £4,248 Marriages 848 862 Marriage Rate 7•4 7•5 Births 2,376 2,428 Birth Rate 20•6 21•1 Birth Rate, average for the last 10 years 23•7 24•4 Deaths 1,379 1,272 Death Rate 12•0 11•1 Death Rate, average for the last 10 years 14•4 14•8 Infantile Mortality (total) 76 per 1,000 births 59 per 1,00 births Infantile Mortality of illegitimate babies 172 per 1,000 births 140 per 1,000 births Infantile Mortality, average for the last 10 years 90 per 1,000 births 96 per 1,000 births Zymotic Death Rate 0•7 0•6 Deaths from Measles (all ages) 34 8 Deaths from Whooping Cough (all ages) 15 12 Deaths from Diarrhœa and Enteritis (under 2 years of age) 16 18 *Structurally separate dwellings occupied by private families, i.e., houses and self contained nats. Area and Population. Births and Deaths. 9 Area and Population. Acres. Estimated Population. 1564 115,200 The population of Deptford to the middle of 1924 has been estimated by the Registrar-General as 115,200. 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 21,832 South 13,372 North 24,509 South-East 13,404 North-West 24,655 South-West 17,428 As the Borough has an area of 1,564 acres, the density of the population on this estimate is 74 persons per acre approximately. Births- Births. Birth rate per 1,000. 2,376 20.6 The total number of births registered in the Borough was 2,177, and of these 65 were transferred to other districts, as the permanent addresses of the parents were outside this Borough. Similarly, 264 births occurring outside of the Borough, in maternity hospitals, were transferred to Deptford, making a total of 2,376 births in all belonging to Deptford. Of these, 1,232 were males and 1,144 were females. This figure gives a birth-rate of 20.6 per 1,000 of the estimated population, as compared with 21.1 for the year 1923. The birth-rate for England and Wales for 1924 was 18.8 „ „ the 105 County Boroughs and Great Towns was 19.4 „ ,, the 157 Smaller Towns was 18.9 „ „ the County of London was 18.7 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:— 10 Table 1. Year. Estimated population. Births. No. Rate per 1000. 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 1923 114,900 2428 21•1 Average for 10 years 113,363 2684 23•7 1924 115,200 2376 20•6 Illegitimate Births. The illegitimate births numbered 58 or 2.4 per cent. of the total births. These occurred in the several wards as follows:— East 24 South 7 North 9 South-East 4 North-West 7 South-West 7 As far as can be ascertained, the occupations of the mothers in these cases were:—Domestic servants 10; Factory hands 8; Barmaids 3: Shop assistants 5; Typists 2; Laundry workers 5. 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 2,190 births. Omitting still births, which numbered 55, this gives a percentage of births notified to those registered of 89. Midwives notified 1,249; doctors 581; parents 332; other persons 28. Marriages. Marriages. Marriage Rate 848 74 The Superintendent Registrar has kindly furnished me with the particulars. There were 848 marriages in the Borough during 1924 as compared with 862 in the previous year. The marriage rate was equal to 7.4 per 1,000 of the population as compared with 7.5 for the year 1923. 11 The marriages were celebrated in the following places:— 563 in Churches of England. 80 in other places of worship. 205 in the Superintendent Registrar's Office. 848 Total Deaths. Deaths. Death Rate. 1,379 12.0 The deaths registered in Deptford numbered 915 equalling a deathrate of 7.9, as compared with 822 and a death-rate of 7.2 for the preceding year. Of this number, 209 were non-parishioners. The deaths of Deptford residents occurring outside the Borough in public institutions were 673, making a total of 1,379 deaths belonging to this Borough. Of these 760 were males and 619 were females. The death rate was 12.0, compared with 11.1 in 1923. The death-rate for England and Wales was 12.2 „ „ for the 105 County Boroughs and Great Towns was 12.3 „ „ for the 157 Smaller Towns was 11.2 „ „ for the County of London was 12.1. 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. 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 1923 114,900 1372 11•1 Average for 10 years 110,468 1582 14•4 1924 115,200 1379 12•0 * 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:— 12 Table III. Ward. Deaths. Death Rate per 1,000. Males. Females. Children under 1 year. Total. East Ward 187 144 53 331 15•2 North Ward 151 116 36 267 10•9 North-West Ward 145 110 36 255 10•3 South Ward 75 92 22 167 12•5 South-East Ward 117 61 22 178 13•3 South-West Ward 85 96 11 181 10•4 The proportion which the mortality at various ages bears to the total number of deaths during 1924 and the previous year is as follows:— Table IV. 1923 1924 Under 1 year 11•2 per cent. 13•1 per cent. 1 to 2 years 2•8 „ 4•4 „ 2 to 5 „ 2•8 „ 3•4 „ 5 to 15 „ 4•0 „ 3•1 „ 15 to 25 „ 4•2 „ 4•1 „ 25 to 45 „ 12•1 „ 12•8 „ 45 to 65 „ 27•9 „ 24•0 „ 65 years and upwards 35•0 „ 35•1 „ Infantile Mortality. Infant Deaths. 180 Infantile Mortality Rate. 76 180 Infants died before attaining the age of one year, i.e., 76 per 1,000 of the births registered. Of this number 10 were illegitimate, representing an illegitimate infant mortality rate of 172 per 1,000. The 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 mort ility per 1000 Births. East 531 53 100 North 510 36 71 North-West 469 36 77 South 375 22 59 South-East 252 22 87 South-West 239 11 46 Infant Mortality Rates from 1901 to 1924. 13 Comparative table of infantile deaths from Diarrhœa and Enteritis Table VI. RATE PER 1000 BIRTHS. Diarrhœa and Enteritis under two years. Total deaths under one year. England and Wales 7•3 75 105 Great Towns 9•2 80 157 Smaller Towns 6•2 71 County of London 8•4 69 Deptford 6•7 76 Table VII. TABLE SHOWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1924. births 2376 deaths 1379 Excess of Births over Deaths 997 Table VIII. INFANTILE MORTALITY RATE FOR THE PAST TEN YEARS Year. Deaths under 1 year. Infantile Mortality Rate. 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 1923 143 59 Average for 10 years 244 90 1924 180 76 14 Table No. IX. METROPOLITAN BOROUGH OF DEPTFORD. VITAL STATISTICS OF WHOLE DISTRICT DURING 1924 AND PREVIOUS YEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Under 1 year of Age. At all Ages. of Nonresidents registered in the District- of Residents not registered in the District. Number. Rate. Number. Rate per 1.000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1914 109,182 3,071 3,121 28•6 1,145 10•5 163 616 309 99 1,598 14•6 1915 110,299 2,891 2,955 26•8 1,406 12•7 144 700 391 132 1,962 17•8 1916 110,299 2,838 2,918 26•5 1,126 10•2 135 675 258 88 1,666 15•1 1917 103,527 2,262 2,329 20•4 1,091 10•5 161 733 239 102 1,663 16•0 1918 102,036 2,085 2,093 18•3 1,361 13•3 230 696 205 97 1,827 17•9 1919 111,205 2,396 2,426 20•5 1,051 9•5 202 620 207 85 1,469 13•0 1920 115,636 3,191 3 276 28•3 1,003 8•7 207 612 259 79 1,408 12•2 1921 113,500 2,549 2,667 23•5 932 8•2 213 663 234 88 1,382 12•2 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 1924 115,200 2,177 2,376 20•6 915 79 209 673 180 76 1,152 12•0 Area of District in acres (land and inland water). 1,564. Total population at all ages 112,534. Total families or separate occupiers, 28,007. At census 1921 15 Table No. X. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at, Death during the Year 1924. CAUSES OF DEATH. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years- 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years 75 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes 1379 180 61 47 43 57 177 331 247 236 Enteric Fever 3 .. .. .. 1 .. 1 1 .. .. Small pox .. .. .. .. .. .. .. .. .. .. Measles 34 6 18 9 1 .. .. .. .. .. Scarlet Fever 2 .. .. 1 .. 1 .. .. .. .. Whooping Cough 15 5 6 4 .. .. .. .. .. .. Diphtheria and Croup 15 1 1 6 7 .. .. .. .. .. Influenza 46 1 3 .. .. 2 6 17 10 .. Encephalitis Lethargica 6 .. .. .. 2 1 1 2 .. .. Meningococcal meningitis .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system 104 .. 1 1 2 22 49 28 1 .. Other Tuberculous Diseases 23 5 2 4 5 1 4 1 1 .. Cancer, malignant disease 148 .. .. .. .. 1 10 62 43 32 Rheumatic Fever 4 .. .. .. 1 2 .. 1 .. .. Diabetes 14 .. .. .. .. .. 3 6 2 3 Cerebral Hæmorrhage, &c. 64 .. .. .. .. .. 1 20 26 17 Heart Disease 173 .. .. .. 5 5 18 60 46 39 Arterio-sclerosis 32 .. .. .. .. .. .. 9 16 7 Bronchitis 91 11 2 1 .. 1 3 15 27 31 Pneumonia (all forms) 150 45 20 13 4 5 25 18 13 7 Other Respiratory Diseases 15 1 2 .. .. 2 3 5 .. 2 Ulcer of Stomach or Duodenum 11 .. .. .. .. 1 3 5 2 .. Diarrhoea, &c. 21 13 3 .. 1 .. 1 .. 1 2 Appendicitis and Typhlitis 11 .. .. .. 2 1 .. 5 2 1 Cirrhosis of Liver 8 .. .. .. .. .. 3 3 1 1 Acute and chronic Nephritis 36 .. .. 1 .. .. 9 21 3 2 Puerperal Sepsis 3 .. .. .. .. .. 3 .. .. .. Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. 2 2 .. .. .. Congenital Debility and Malformation, including Premature Birth 68 67 .. .. 1 .. .. .. .. .. Suicides 12 .. .. .. .. .. 5 4 3 .. Other deaths from violence 38 1 1 5 1 7 5 9 4 5 Other defined diseases 227 24 1 2 10 3 22 39 46 80 Diseases ill-defined or unknown 1 .. 1 .. .. .. .. .. .. .. 16 Table No. XI. METROPOLITAN BOROUGH OF DEPTFORD. Infantile Mortality, 1924. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 1months. Total Deaths under 1 year. All Causes 55 8 7 5 75 29 16 26 34 180 Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. 6 .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 3 2 .. Diphtheria and Croup .. .. .. .. .. 1 .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. 1 .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. 2 2 Abdominal Tuberculosis .. .. .. .... .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. 1 .. .. 2 3 Meningitis (not tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 4 .. .. .. 4 2 .. 1 .. 7 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 .. .. 1 3 1 2 4 11 Pneumonia (all forms) .. .. 1 2 3 9 7 12 14 45 Diarrhœa .. .. .. .. .. 1 2 2 .. 5 Enteritis .. .. 1 .. 1 2 2 1 2 8 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .... .. .. .. .. .. 1 1 Suffocation, overlaying 1 .. .. .. 1 .. .. .. .. 1 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis 7 .. .. 1 8 .. .. .. .. 8 Congenital Malformations 7 2 .. .. 9 1 .. .. .. 10 Premature Birth 26 3 4 .. 33 2 1 .. .. 36 Atrophy, Debility, and Marasmus 6 2 1 1 10 5 3 3 .. 21 Other Causes 2 .. .. .. 2 1 .. 2 1 6 Influenza .. .. .. 1 1 •• .. .. .. 1 55 8 7 5 75 29 16 26 34 180 17 Table No. XII. METROPOLITAN BOROUGH OF DEPTFORD. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1924. 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-W est Ward Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox* 1* .. .. .. .... 1 .. .. .. .. .. .. 1 .. 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 374 9 104 194 38 28 1 .. 108 53 76 32 71 34 371 Erysipelas 79 2 1 3 19 23 23 .. 26 12 21 2 6 12 20 Scarlet fever 291 .. 99 156 20 15 1 .. 67 78 73 21 19 33 278 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 20 .. .. 5 9 4 2 .. 6 4 .. 1 4 1 20 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 6 .. .. .. 2 4 .. .. 2 8 .. .. .. 1 5 Cerebro-Spinal Meningitis* 1* .. .. .. 1 .. .. .. 1 .. .. .. .. .. 1 Poliomyelitis 2 .. 2 .. .. .. .. .. 1 1 .. .. .. .. 2 Pulmonary Tuberculosis 244 .. 3 27 67 104 41 2 72 36 61 18 23 34 248 Other Tuberculosis 78 .. 18 41 5 12 2 .. 34 8 11 4 9 12 66 Ophthalmia Neonatorum 25 25 .. .. .. .. .. .. 6 3 5 .. 5 6 10 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis 20 12 8 .. .. .. .. .. 66 3 2 1 6 2 12 Acute Pneumonia 144 24 49 16 16 19 13 .. 62 15 31 9 19 8 6 Malaria 5 .. .. .. .. 4 1 .. 2 3 .. .. .. .. .. Dysentery 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. Enceph. Lethargica 24 .. 3 7 7 4 3 .. 2 1 7 1 4 9 13 Measles 1282 56 776 433 11 6 .. .. 247 319 273 145 145 153 92 Totals 2597 128 1063 882 195 225 87 17 642 539 564 234 312 306 1145 Subsequently found not to be suffering from the disease in question. 18 Table XIII. Deaths and Death Rates from Principal Infectious Diseases. Year Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Diarrncea and Enteritis (under 2 years) Total No. of Deaths Rate No. of Deaths Rate N o. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate 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 1923 2 0•02 - — 8 0•07 2 0•02 12 0•10 33 0•29 18 0•16 75 0•65 Average for 10 years 2 0•02 - - 29 0•26 6 0•06 23 0•21 20 0•18 46 0•42 127 1•16 1924 3 0•03 — — 34 0•30 2 0•02 15 0•13 15 0•13 16 0•14 85 0•74 Infectious and other Diseases. 20 INFECTIOUS AND OTHER DISEASES. Under the provisions of the Public Health (London) Act, 1891, and the Tuberculosis Regulations, 2,597 cases of infectious diseases were notified, as compared with 1,579 in 1923. In a preceding Table will be found a list of cases notified and their distribution in the several Wards. The increase is entirely due to Measles. To the seven principal epidemic diseases, viz.:— Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever and Infantile Diarrhoea, 85 deaths were ascribed, and the death-rate was 0.74 per 1,000 as against 0.65 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. One person was notified as suffering from Small-Pox during the year, but was subsequently found not to be suffering from this disease. Scarlet Fever. 291 persons were notified as suffering from this disease during the year under report as compared with a total of 349 for the previous year. Included in this total are 4 patients who, after removal to hospital, were certified to be not suffering from the disease in question. There were 2 deaths as compared with 2, 11 and 13 in the three preceding years. Diphtheria. The total number of patients certified to be suffering from Diphtheria was 374 as compared with a total of 417 for the previous year. Of this number 21 were errors of diagnosis. There were 15 deaths as compared with 33, 39 and 13 for the three preceding years. Enteric Fever. 20 cases of Enteric Fever were notified, as compared with 10 in the previous year. Included in this total are 5 patients who, after removal to hospital, were certified to be not suffering from the disease. There were three deaths. Acute Primary Pneumonia and Acute Influenzal Pneumonia. These diseases are compulsorily notifiable under the Public Health (Pneumonia, Malaria, Dysentery, etc., Regulations), 1918. 144 cases were notified during the year. 21 Puerperal Fever. Six cases of Puerperal Fever were notified as compared with a similar number in the previous year. There were 2 deaths. Ophthalmia Neonatorum. 25 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. 10 cases were admitted to hospitals. From subsequent enquiries it has been ascertained that 21 patients recovered with no apparent impairment of vision, 3 infants died from other causes, and in the remaining case the infant left the Borough at the age of one month while still under treatment. 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. 1,282 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 1924, 20 such cases were notified. Diarrhoea and Enteritis caused 21 deaths during the year, and of this number, 16 were children under two years of age. Cerebro-Spinal Meningitis. One patient was notified as suffering from this disease during the year, but, after removal to hospital, the patient was certified not to be suffering from this disease. Malaria and Dysentery. Five cases of Malaria were notified in the persons of ex-service men who had contracted the disease in the East. One case of Amoebic Dysentery was notified. Eucephalitis Lethargia. 24 cases were notified. 22 Poliomyelitis. Two patients were notified. Table XIV. Hospital Disposal of Notifiable Diseases during 1924. DISEASE Total Cases Notified Cases admitted to Hospital. Total Deaths. Diphtheria 374 371 15 Scarlet Fever 291 278 2 Enteric Fever (including Parataphoid) 20 20 3 Puerperal Fever 6 5 3 Pneumonia 144 6 150 Measles 1,282 92 34 Diarrhœa and Enteritis (under 2 years of age) 20 12 19 Erysipelas 79 20 — Poliomyelitis 2 2 — Encephalitis Lethargica 24 13 6 Summary of Nursing Arrangements, Hospitals and other Institutions Available for the District. I have described these arrangements fully in my last two reports and will do so again in next year's "Survey" report. 23 Table XV. clinics and treatment centres. Maternity & Child Welfare. (l) Infant Consultations. Daily from 2 p.m. Monday, Gostprwood Street Tuesday, Napier Street Wednesday, Erlam Road Thursday, Goldsmiths' College Do. Princess Louise Institute, Hales Street Friday, Besson Street (2) Ante Natal Clinic. From 9 a.m. to 1 p.m. Tuesday, Napier Street Wednesday do. special infant consultations. Wednesday, Napier Street. 10 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 School Treatment Centre Deptford Green Eye and Minor Ailments (Eye) Tuesday and 2 p.m. Thursday Do. Ear, Minor Ailments Friday. 2 p.m. Operations Monday. 2 p.m., at Cyril Henry Centre, Woolwich 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. Do. Skin Ailments Wednesday, 2 p.m. 20 Albury Street Teeth Monday, 9.30 a.m. and 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. Day Nursery. Albury Street (closed at present) Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. 24 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 25 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. Number Positive. Number Negative. Swabs for Diphtheria 811 115 696 Blood for Enteric Fever 23 7 16 Sputum for Tuberculosis 18 5 13 Urine for Typhoid 4 — 4 Faeces for Typhoid 2 — 2 Faeces for Dysentery 1 — 1 Celery for Typhoid 1 — 1 Blood for parasites 1 — 1 Total 861 127 734 In addition to the above, 709 specimens of sputa were examined at the Council's Tuberculosis Dispensary, of which 116 were "positive" and 593 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. 26 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 faecal 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 from 30th December, 1924, to the 3rd January, 1925 27 Table XVI. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 30th December, 1923 to 3rd January, 1925. 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 ... 1 4 5 12 18 35 30 21 8 2 136 170 ... ... ... ... ... 44 117 Females ... 2 5 13 12 25 28 11 9 3 ... 108 145 ... ... ... ... ... 28 59 Non-Pulmonarv Males ... 11 12 9 2 1 4 2 2 ... ... 43 49 ... ... ... ... ... 8 34 Females ... 7 14 5 2 ... 3 3 ... ... ... 34 37 ... 1 ... 1 1 3 21 28 As usual, the age group to show the heaviest incidence is that between 25 and 35. The total primary notifications show an increase of 4 among males and a decrease of 2 among females for Pulmonary Tuberculosis. In non-Pulmonary Tuberculosis the figures are the same as last year for males (43), but show a decrease of one-third of last year's total (51) among females. In 1924, 10 deaths occurred in cases of Pulmonary Tuberculosis not notified during life, as compared with 7 in 1923, 25 in 1922 and 43 in 1921. The following shows the interval between notification and death in the case of the 104 deaths from Pulmonary Tuberculosis during 1924:— Pulmonary Tuberculosis. Interval between Notification and Death in 1924. Not notified 10 Died before receipt of notification 3 Died within one week of notification 5 „ „ one week to one month 8 „ „ one month to three months 13 „ „ three months to six months 9 „ „ six months to one year 20 „ „ one to two years 16 „ ,, two to three years 8 „ „ three to four years 3 „ „ four to five years 2 „ „ five to six years' 3 „ „ six to seven years 2 „ ,, seven to ten years 2 104 Cases notified after the death of the patient are not now regarded as notified cases. Frequent reminders have been sent to the doctors attending these un-notified and late notified cases calling their attention to their duty to notify all cases of. Tuberculosis which they attend. 29 The notifications of non-Pulmonary Tuberculosis were as follows:— Glands 41 Meninges 2 Peritoneum 9 Salpynx 2 Spine 7 Fingers 2 Hip 5 Hand 1 Ribs 4 Lupus 1 Abdomen 3 Nose 1 Total 78 The notification according to wards was:— Pulmonary. Non-Pulmonary. East 72 34 North-West 61 11 South-West 34 12 North 36 8 South-East 23 9 South 18 4 Totals 244 78 As in 1923, the heaviest incidence is in East Ward. The number of cases notified in North Ward shows a decrease of 25, whilst in North-West Ward there is an increase of 21 and in South-West an increase of 19. The notification rates per 1000 of the population are:— East Ward 4.9 per 1000 South-East Ward 2.4per 1000 North-West Ward 2.9 „ „ North Ward 1.8 „ „ South-West Ward 2.6 „ „ South ward 1.6 „ „ The following table gives the number of deaths and notification rate per 1000 for Pulmonary and non-Pulmonary Tuberculosis during 1924, and a comparison with the four previous years:— Year. Deaths. P.T. Deaths. O.T. Notifica tions 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 •7 1921 121 1•1 31 0•3 225 2•0 66 0•6 113500 152 1•3 291 •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 1924 104 0•9 23 0•2 244 2•1 78 0•7 115200 127 1•1 322 2•8 It will thus be seen that there is in 1924 a slight rise in the death rate, but this rise has been fairly general throughout England and Wales. Furthermore, last year we had an unusual fall to record. 30 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 voluntary bodies engaged in Anti-Tuberculosis work. The success of the work must depend primarily on the early detection of the cases and their prompt treatment, and on the enforcement among the cases of strict preventive measures. For the former the main responsibility must rest with the medical practitioners and the Clinic staff. Between these two units there must be the closest co-operation. The medical practitioners are encouraged to avail themselves of the assistance of the Clinic in placing at their disposal the aids to the diagnosis of their doubtful or suspected cases. In every case which is referred to the Clinic for examination a report is furnished to the practitioners as soon as a diagnosis is made. Where a positive diagnosis is made the practitioner is immediately informed and requested to notify the case. Suitable treatment is suggested and every assistance offered as far as possible to arrange such treatment. Positive cases are also referred to the Secretary of the After-Care Committee, so that, if it is necessary, the fullest advantage may be taken of the assistance which this Committee offers. Cases in which a negative diagnosis is made are promptly returned to the practitioner who sends them, and to whom a report is also sent. Detection of Cases.—During the year 633 persons presented themselves for the first time at the Clinic, which, with 14 cases under observation for diagnosis from the previous year, made a total of 647 cases for diagnosis. Of these, 106 were found to be suffering from Pulmonary Tuberculosis and 33 from other forms of Tuberculosis. It is regrettable to have to record that only 30 per cent. of these were incipient cases, and too many still present themselves in which the disease is well established. Most of these cases had only sought medical advice for the first time either on presenting themselves at the Dispensary or a week or two before it when they consulted their own doctors. In some cases, however, the tuberculous condition was masked by other conditions to which treatment had been previously directed, and so the disease was considerably advanced before being discovered. But in the type of disease which has an insidious catarrhal 31 onset the patients only too often put off seeking medical advice until the symptoms have become very severe or the disease has interfered with working capacity. It was found in some of these cases that a negative diagnosis had been made previously by the practitioner on the strength of one physical examination followed by one examination of sputum in which tubercle bacilli was not found. The patients, relying on this negative diagnosis, had not sought further medical advice until the disease was well established. Every effort is made by consultation and co-operation with the practitioners to encourage them to avail themselves of the assistance which the Clinic offers in the diagnosis of doubtful cases. During the year 42 consultations were held with local practitioners. Of the 633 new cases who attended the Clinic during the year, 131 were sent by local practitioners, 25 were referred by hospitals, 27 were referred by school medical officers, 284 attended on their own initiative and 166 (contacts) on the advice of the Clinic staff. The examination and re-examination of those in contact with positive cases has been persistently advised. During the year 194 contacts were examined at the Clinic. Under the arrangement with the London County Council, by which contacts of school age are examined by the school medical officer instead of at the Clinic, 144 contacts have been examined at the schools. In 45 cases the examination of the contacts was carried out by the practitioners notifying the cases. The transfer of the examination of contacts of school age to the school medical officer has naturally resulted in a decrease (91) in the total number of contacts examined at the Clinic. Of these contacts 14 adults (7 male and 7 female) and 2 children (1 male and 1 female) were found to have contracted Pulmonary Tuberculosis. 82 deaths occurred among cases attending the Clinic during 1924. The period which elapsed between first attendance and death varied between one month in one case and 11 years in another. 12 cases attended for the first time within 3 months of death. 20 do. do. do. 6 do. 11 do. do. do. 12 do. 10 do. do. do. 24 do. 29 do. do. do. more than 2 years before. The following table summarises the work of the Clinic during 1924:- 32 Table XVII. Metropolitan Borough of Deptford. Return of work carried out in connection with the Tuberculosis Dispensary for the year 1924. Number of Under observation at the Dispensary 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 Tuberculosis. Pulmonary. Non-Pulmonary. (a) All persons (including "Contacts ") Adults. M 6 156 162 62 5 82 11 2 F 5 185 190 39 7 132 8 4 Children under 15 M 1 161 162 1 13 140 4 4 F 2 131 133 4 8 113 6 2 Total .. 14 633 647 106 33 467 29 12 (b) "Contacts" included in (a) Adults M 1 38 39 7 — 30 1 1 F — 58 58 7 1 44 5 1 Children under 15 M — 48 48 1 4 41 1 1 F — 49 49 1 1 46 1 — M 5 119 124 40 4 71 8 1 (c) Insured persons included in (a) F — 60 60 16 2 36 4 2 1 Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 81st December 511 2 Total number of ances of patients at the Dispensary during the year Insured 2027 Uninsured 3510 3 Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 271 4 Number of cases in which the period of observation at the Dispensary exceeded two months 69 5 Number of insured patients under domiciliary treatment on Dec. 31st 39 6 Number of reports received from surance Practitioners in respect of insured patients under domiciliary treatment during the year 17 7 Number of persons referred to ated hospital for consultation - 8 Number of consultations with medical practition- ers at the homes of patients Insured 15 Uninsured 27 9 Number of other visits paid by Tuberculosis Officers to the homes of patients 331 10 Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 4571 11 Number of specimens of sputum amined in connection with the work of the Dispensary 709 33 Revision of the Register. On the notification of every case of Tuberculosis an enquiry card, showing all the essential particulars of the case, is made out, and notes as to subsequent visits, treatment and general progress of the case, are entered periodically on these cards. They thus constitute an effective register of all the known cases of Tuberculosis within the Borough. Last year it was decided to establish an annual general revision of the register, in order that the time of the Tuberculosis Visitors might be used to the best advantage, by eliminating many of the cases who did not require further visiting, either because the disease had been permanently arrested, or the original diagnosis had not been subsequently upheld, and the consent of the doctor notifying the case was obtained to remove the name from the register. The cards of all such cases are placed in a separate cabinet, so that a register of all the cases thus removed from the register is kept. Such removals are also notified to the Medical Officer of Health. It is proposed in the coming year to carry out this revision quarterly. 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 current register:— Pulmonary Tuberculosis. Other Tuberculosis. East Ward 48 79 North Ward 34 22 North-West Ward 34 17 South and South-East Wards 31 14 South-West Ward 24 11 Total 171 143 After the removal of the cases, the totals for the respective wards were:— Pulmonary Tuberculosis. Other Tuberculosis. East Ward 247 149 North Ward 182 57 North-West Ward 143 58 South and South-East Wards 134 43 South-West Ward 74 31 Total 780 338 34 Dental Treatment. In a disease in which the assimilation of nourishment is so important it is an essential, if treatment is to be successful, that the patient should have efficient teeth. For this part of the work we have had hitherto to depend on the Hospitals, but arrangements have just been concluded to establish a Dental Clinic at the Tuberculosis Clinic, where in future our Dentist, Mr. Magraw, will attend at least fortnightly to carry out any such dental work as is recommended. Prevention. The prevention of infection is one of the main objects of the anti-Tuberculosis work. 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 the patient from the home either to Sanatorium, Hospital or to another residence; and on notification of the occurrence of a death from Tuberculosis within the Borough. Stress is laid in visiting on the possibilities of infection and the necessity for the proper disposal of the sputum. The isolation of the patient in the home is as far as possible arranged and contact examination strongly urged. Sputum flasks are distributed free. Treatment. It is the duty of the Tuberculosis Clinic to see that every case is receiving suitable and adequate treatment; but only a limited number of cases are treated at the Clinic, as the object is rather to arrange for treatment elsewhere so that the main function of the Clinic, that of the clearing house, may be preserved. Sanatorium. Sanatorium treatment is arranged mainly through the London County Council. During the year 157 cases were admitted to Sanatoria through the L.C.C. Of these 27 cases were re-admissions. Admission to private Sanatoria was arranged in three cases. Every new case in which a positive diagnosis is made, is referred to the Secretary of the After Care Committee, so that the fullest advantage may be taken of the assistance offered by this Committee. No specific proven remedy for the disease has yet appeared and until it does, general hygienic measures must still be our chief bulwark. Changes in staff during the year often called for additional effort to tide over the inter-regna which these involved, and I desire to record my most sincere thanks to every member of the staff for their ready assistance in carrying out the work entrusted to us. J. A. Harbison, M.D. 35 On commencing duty Miss Lewellin, who succeeded Miss Baird as Secretary of the Tuberculosis Care Committee, received from me an outline of her task. I asked her to prepare a little report and to tell of things as she found them. She is carrying out her task well, as will be seen from the following To the Medical Officer of Health: The work of the Tuberculosis Care Committee and the duties of the Secretary have been outlined in a previous report. They remain the same, though with the development of the work their sphere has become enlarged. In the following report they are touched on respectively, as far as passible. Actually, the work of the Committee is so comprehensive that it is hard to define its limitations. The chief aim and object is to help and advise patients in their troubles and difficulties, and to make them feel that the Committee is a friendly body which takes a real and sympathetic interest in their welfare. The Committee is in close touch with the various organisations jn the Borough through whom help can be obtained. For ex-service men and their families the Red Cross Society and the United Services' Fund are available; for other cases we have the Charity Organisation Society and the Guardians. These bodies respond most generously to appeals. Through them, grants for clothing outfits are obtained for necessitous patients who are recommended for a course of sanatorium treatment. Beds and bedding, where urgently required in a patient's interest, are provided, and, in the case of ex-service men, money grants to meet various emergencies are given. Cases attending the Dispensary, where treatment is recommended, and it is considered that assistance of any kind is required, are referred to the Secretary by the Tuberculosis Officer. The Secretary then visits the home of the patient, and certain necessary particulars as to environment and financial circumstances are obtained. These enquiries often bring to light hardship, which perhaps is not apparent on the surface. Where necessary the case is put in touch immediately with an appropriate society, and help is obtained. Patients and their families are found most appreciative of the offer of treatment, and of the efforts made on their behalf. Friendly relations are established between the family and the Secretary, and the patient goes away with an easier mind, knowing that members of the family can at any time apply to the Secretary for help and advice 36 in emergencies that may arise; also that the home will be visited. Patients' appreciation of interest taken is evinced by letters received from them while away. In certain cases contributions towards the cost of treatment are applied for, but ex-service men in receipt of pensions for tuberculosis, and insured heads of families whose income falls below a certain standard are exempt. In other cases, where it appears that a contribution can be afforded, an assessment in accordance with ability to pay is made by the Care Committee. Hardship should not occur as the result of this; the Care Committee deal sympathetically and leniently with all cases, and the London County Council generally accept their recommendation, and make every allowance for hard cases. The contributions are collected weekly by the Secretary and forwarded to the London County Council at the end of every month. Health reports in respect of children undergoing treatment away are received periodically from the London County Council; on receipt of these the Secretary visits the home and informs the parents as to the child's condition. An important feature of the work is "after care" of patients returning from sanatorium; under the present existing conditions as regards housing and unemployment it is quite the most difficult. Every patient is visited on discharge by the Secretary, and the problem of the future gone into. A report on the physical condition, home surroundings and circumstances is submitted to the Care Committee. A small proportion of cases it is found return to their former employers, and are, if possible, given light work. The larger number are unfortunately either unfit for work or are unable to find suitable employment. The Care Committee does what it can, but openings are few and far between. Many of these cases are without means of any kind, and are at once put in touch with the Guardians, or, if ex-service men, with the Red Cross Society or United Services' Fund. Many patients return to appalling surroundings, often to share the room with the rest of the family. In some cases the room is too small to allow of a second bed being put up, which means that parents, one of whom may be suffering from tuberculosis, share a bed with one or more children. Patients returning from sanatorium to such homes cannot be expected to maintain the improvement made while away. Until increased accommodation is available the situation cannot 37 be eased. The lack of accommodation may therefore be said to be one of the biggest difficulties in connection with Care Committee work, although one can in destitute cases apply to the Guardians for financial relief. A Fund to be used at the discretion of the Care Committee, and to be applied for purposes which do not come within the scope of the various societies, would be a boon. Financial troubles do much to retard a patient's progress, and help at an opportune time may lift a load off a patient's mind quite out of proportion to the outlay. The outstanding features of the Committee's work have been stated briefly; enough, however, has perhaps been said to indicate its usefulness. B. Lewellin. General Sanitary Administration. Work of Sanitary Inspectors. During the year the District Sanitary Inspectors made 22,856 visits in all to 5,461 premises. 2,809 systematic house-to-house inspections were made. Numerous sanitary improvements and repairs were effected, as shown in the following table:— 41 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1924. Table No. XVIII. Number of District. 1 2 3 4 5 6 7 Totals Inspections— On complaint 3 32 23 11 29 30 17 145 House-to-house 398 397 427 458 353 358 418 2809 Infectious diseases 132 58 77 85 167 100 101 720 Notice from builder 13 7 32 27 67 36 22 204 New houses for water certificate ... ... ... ... ... ... ... ... Other inspections 216 200 269 166 212 302 218 1583 Total 762 694 828 747 828 826 776 5461 Re-inspections, Calls, etc.— Total 2453 2409 2457 2466 2373 2680 2557 17325 Notices Served— Intimation (Public Health Act) 539 427 551 467 430 577 491 3482 Statutory ( Do. ) 6 25 50 25 5 23 32 166 Under Rats and Mice (Destruction) Act ... ... ... ... ... 2 ... 2 Housing, Town Planning, etc., Act, 1919, Sec. 28 ... ... ... ... ... ... ... ... Cleansing and Repairs- Number of premises, etc., cleansed 333 205 206 326 299 380 323 2072 Ventilation improved (number of premises) ... ... 9 1 7 ... 1 18 Number of roofs repaired 14 48 133 84 89 135 126 629 Dampness abated (number of premises) 42 10 36 29 78 115 61 371 Gutters and rainwater pipes provided or repaired 89 103 74 84 101 85 84 620 Yards and forecourts paved ... 23 ... 9 ... ... ... 32 Yard and forecourt paving repaired 120 ... 47 37 52 50 58 364 Scullery floors paved, or paving repaired 29 ... 23 3 17 9 33 114 Coppers provided and repaired 76 21 38 24 25 36 39 259 Other repairs and improvements 209 78 240 178 192 175 200 1272 Water Supply— Re-instated ... ... ... 7 6 ... 5 18 Fittings repaired (number of premises) 33 13 37 28 2 5 ... 125 Cisterns cleansed ... ... ... ... 1 ... ... 1 ,, provided ... ... ... ... ... ... ... ... ,, covered ... 3 ... 1 1 ... ... 5 „ abolished ... ... ... ... 2 ... ... 2 Potable water supply provided from Service ... 3 ... ... ... ... ... 3 Additional facilities provided in tenement houses ... ... ... ... ... ... ... ... Other improvements ... ... 15 ... ... ... ... 15 42 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1924—continued. Table —continued. Number of District. 1 2 3 4 5 6 7 Totals Drainage — Drains re-constructed (number of premises) ... ... 15 8 12 46 6 87 Drains cleansed and amended 31 20 35 40 46 24 35 231 Gully traps fixed 5 3 46 19 41 1 8 123 Soil and Vent Pipes fixed ... ... 28 5 36 7 4 80 Do. repaired 1 2 6 1 ... 2 7 19 New Covers provided to inspection chambers ... ... ... 4 2 ... 4 10 Waste and rainwater pipes disconected from drains ... 18 32 ... 2 ... 1 53 Chambers provided and access eyes 1 ... 10 7 10 ... ... 28 Water Closets- Old waterclosets abolished ... ... ... 1 1 ... ... 2 New waterclosets provided 2 ... ... 1 4 ... ... 7 New pan and trap only, provided 30 14 47 16 61 24 15 207 Defective flush remedied 194 32 31 15 40 36 22 370 Pans cleansed ... 6 ... 3 5 9 6 29 Seats provided or repaired 16 3 4 6 7 2 10 48 Roofs repaired 36 5 13 11 21 4 13 103 Walls, etc., repaired or cleansed 141 11 60 71 61 97 63 507 Doors repaired or renewed 10 6 19 3 ... 1 3 42 Ventilation improved ... ... 1 ... ... 4 ... 5 Floors repaired 9 9 6 ... 5 1 5 35 Other repairs or improvements 10 ... 9 1 11 14 11 56 Urinals— Cleansed ... ... 3 ... ... ... ... 3 Repaired ... ... 2 2 ... ... ... 4 Dunar Receptacles— Provided ... 1 ... ... ... ... ... 1 Repaired ... ... ... ... ... ... ... ... Abolished ... ... ... ... ... ... ... ... Overcrowding- Cases abated 7 ... 2 ... ... ... ... 9 Nuisances arising from the keening of animals— Number of nuisances abated 1 ... 1 ... 3 ... 8 13 B Number of accumulations removed 18 9 3 • •• 6 1 9 46 43 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1924 -continued. Table —continued. Number of District. 1 2 3 4 5 6 7 Totals. 11 15 26 10 1 1 15 79 Smoke Nuisances- Number of observations of shafts made Number of nuisances from black smoke discovered 1 ... 2 7 ... ... 1 11 Number of notices served 1 ... 2 2 ... ... 1 6 Dustbins- Provided or repaired 109 92 146 79 75 94 101 696 General— Other miscellaneous nuisances abated ... ... 10 11 ... 12 ... 33 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 Ai.lam (S. and S.E. Wards and part S.W. Ward). District No. 6.—Inspector Yates (part N. and N.W. Wards and throughout Borough for rat work ) District No. 7.—Inspector Mayo (part N.W. Ward). 44 HOUSE-TO-HOUSE INSPECTIONS. House-to-house inspections were made in the following streets during the year 1924:— Inspector Simpson.—East Ward. Street or Road. Total premises inspected. Number in which defects were found. Alvar Street 24 22 Addey Street 26 24 Broadway 5 2 Bronze Street 19 19 Church Street 23 15 Creek Street 24 24 Crossfield Street 51 47 Ffinch Street 11 11 Frankham Street 4 4 Hales Street 27 24 Hamilton Street 56 51 Hosier Street 48 47 Hyde Street 46 45 Knott Street 5 5 Mary Ann's Buildings 28 27 Reginald Road 1 1 Total 398 368 Inspector Shelley—East Ward. Amersham Grove 40 16 Arklow Road 11 6 Baildon Street 12 12 Glenville Grove 8 7 Idonia Street 58 33 Kerry Road 36 16 Napier Street 19 12 Octavius Street 35 15 Payne Street 47 33 Speedwell Street 78 47 Trim Street 33 10 Vance Street 20 10 Total 397 217 45 Inspector Kemp—North-west and South-west Wards. Billington Road 33 20 Brighton Grove 10 8 Bousfield Road 28 13 Dennetts Grove 26 26 Dolling's Place 8 8 Evelyn Buildings 14 11 Faulkner Street 34 29 Franklin's Grove 6 6 Gellatly Road 50 19 Hunsdon Road 21 14 Render Street 73 49 Martha Place 13 12 Mason's Cottages 10 9 Mason's Grove 13 13 Monson Road 80 40 Pomeroy Street 8 8 Total 427 285 Inspector Hewett—North Ward. Abinger Road 75 50 Alverton Street 42 25 Blackhorse Road 51 51 Childers Street 7 7 Dorking Road 68 45 Etta Street 69 38 Gosterwood Street 58 47 Kent Terrace 5 5 New King Street 2 1 Prince Street 6 * 6 Rowley Street 4 4 Watergate Street 18 13 Wotton Road 53 39 Total 458 331 Inspector Allam South and South east Wards. Florence Cottages 15 13 Florence Grove 9 7 Friendly Street 98 73 Harton Street 40 30 Heston Street 33 30 Pearson's Avenue 2 2 Revelon Road 20 13 Thornville Street 1 1 Vanguard Street 39 31 Wickham Road 91 14 Wilson Street 5 5 Total 353 219 46 Inspector Yates—North and North-west Wards. Alloa Road 38 34 Bestwood Street 14 14 Childeric Road 26 20 Chubworthy Street 22 19 Desmond Street 19 17 Folkestone Gardens 105 76 Hicks Street 19 11 Lee Terrace 5 5 Milton Court Road 76 72 Marchant Street 5 5 Nynehead Street 29 25 Total 358 298 Inspector Mayo—North-west Ward. Alpine Road 35 22 Cornbury Road 39 35 Edale Road 44 41 Hunsdon Road 54 33 Ilderton Road 32 7 Lovelinch Street 32 18 Rollins Street 38 32 Rudford Road 23 23 Senegal Road 64 51 Silwood Street 25 24 Upcot Street 32 13 Total 418 299 Grand Total 2809 ... 2017 HOUSING. 1. General. Number of houses erected during the year Nil. 2. Unfit Dwelling Houses. (a) Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5461 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District Regulations) 1910 2809 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. 47 (4) Number of dwelling-houses (exclusive of above) found not to be in all respects reasonably fit for human habitation 3484 (b) Remedy of defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers Nil. (c) Action under Statutory Powers. (1) Proceedings under Sec. 28 of the Housing, Town Planning, &c., Act, 1919. (a) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. {b) Number of dwelling houses which were rendered fit:— (1) By owners — (2) By Local Authority in default of owners — (c) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (2) Proceedings under Public Health Acts. (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3484 (b) Number of dwelling-houses in which defects were remedied :— (1) By owners 3148 (2) By Local Authority in default of owners — (3) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909 Nil. Factory and Workshops Act. 50 FACTORIES, WORKSHOPS, WORKPLACES, OUTWORKERS, etc. These premises were periodically inspected during the year, special attention being paid to the Sanitary accommodation provided for the use of persons employed. Sec. 38 P.H. (L) Act, 1891, etc., also to cleansing the reception, checking and issuing of outworkers' lists and the keeping of the necessary registers. The outworkers' register entails much work owing to the constant change of address and to removals. Factories. The number of Factories on the register at the end of the year was 231, made up as follows:—Factory Laundries 3, Factory Bakehouses 16, other Factories 212. Other Factories include Offensive Businesses 2, Food Premises 22. The number of Factories shows a net increase of 5. Workshops. The number of Workshops on the register at the end of the year was 173 made up as follows:—Workshop Laundries 4, Workshop Bakehouses 43, other Workshops 126. Workplaces. Workplace includes any place where work is done permanently and where people assemble together to work permanently. The kitchens of Restaurants, Hotels, etc., come within the meaning of the term " Workplace " also included are Stables, Builders'Yards, Timber Stores, etc. The number of Workplaces on the register at the end of the year was 199 ; this number includes 126 food premises. Number of visits paid 510. Outworkers. This system of home work is in a fluctuating condition, one cause being the poor remuneration and a continual alteration of the registers results, though not solely from this cause but also from the frequent removal of the outworkers to different contractors and to change of address and change of employers. The cases of Infectious disease notified each day are checked with the outworkers' lists. Four cases of Infectious disease occurred on the premises of outworkers during the year. In only one case was wearing apparel found in course of manufacture. Three dresses were removed from the house, disinfected and returned to the factory. The number of outworkers on the register at the end of the year was 301; forty new names were added and 39 names removed from the register. There has been a marked decline in the numbers of persons actively employed during the year and since making up this report. 51 Table XIX. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1924. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of | proceedings On register at end of 1923 Added 1924' Removed 1924 On register at end of 1924 Milk premises 155 2 2 155 368 7 Cowsheds .. .. .. .. .. .. .. Slaughter-houses 2 .. .. 2 36 3 .. Other offensive trade premises 2 .. .. 2 15 .. .. Ice cream premises 134 14 5 143 170 7 .. Fried fish, etc., shops 45 4 .. 48 239 29 .. Restaurants 50 1 2 51 78 5 .. Other food premises 26 2 .. 28 95 2 .. Hairdressers' premises 51 .. .. 51 21 .. .. Table XX. 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 1924. CLASS OF WORK. Number of Places Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1923 Added 1924. Removed 1924. On Register at end of 1924. Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories - Factory Laundries 3 3 17 6 Factory Bakehouses 16 16 30 82 3 Other Factories 207 18 13 212 597 309 39 Workshop Laundries 5 1 4 17 10 Workshops- Workshop Bakehouses 42 1 43 88 199 6 Other Workshops 118 14 6 126 232 136 3 Workplaces- Places where Food is prepared for Sale 121 6 1 126 233 432 36 Workplaces other than the above 67 7 1 73 92 78 1 Home-workers'Premises 300 40 39 301 315 166 2 Total 879 86 61 904 1621 1118 80 52 Table XXI. METROPOLITAN BOROUGH OF DEPTFORD. This Table is by request of the Secretary of State. Annual Report oj Medical Officer of Health for the year 1924 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. Inspections. Number of Written Notices. Prosecutions. Factories (including Factory Laundries) 397 32 Workshops (including Workshop Laundries) 345 9 Workplaces (other than Outworkers' premises included in Part 3of this Report) 510 37 Total 1252 78 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 35 35 Want of Ventilation Overcrowding Want of Drainage of Floors Other Nuisances 6 5 Sanitary Accommodation Insufficient 1 1 Unsuitable or defective 24 24 Not Separate for Sexes 2 1 Offences under the Factory and Worhshcp Act. Illegal Occupation of Underground Bakehouse (sec. 101) Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) 6 6 Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 74 72 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. Out-workers. Lists. Outworkers. Failing to keep or permit inspection or lists. Failing to send lists. Contractors. Workmen. Contractors. Work- men. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— Making, etc. 42 8 210 65 5 Cleansing and Washing 1 Fur-pulling 1 2 Total 43 8 219 65 5 53 54 T able—continued. 4 —REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 43 Dressmaking 13 Laundries 4 Millinery 14 Tailoring 15 Wheelwrights (Smiths, &c.) 24 Others 61 Total number of Workshops on Register 174 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) 20 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 6 Reports (of action taken) sent to H.M. Inspector 6 Other Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 16 55 CANAL BOATS ACTS. Annual Report for the Year ended 31st December, 1924 To the Medical Officer of Health, Sir, I beg to report for the year ended December 31st, 1924, that for the purpose of Canal Boats inspection, I made 17 visits, on the following dates, viz.:— January 5th, February 5th, March 6th and 18th, April 15th May 19th and 30th, June 3rd and 23rd, July 10th, August 7th, September 12th, October 1st and 15th, November 7th and 28th, and December 3rd. Number of visits 17 Number of boats inspected Nil No boats were found for inspection, there being very little traffic on the canal during the year. This Council is not a Registration Authority under the above Acts. 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 1st, 1925. 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 :— Apples 6 boxes Roe 4 stone Cods' roe 1 trunk Salmon 4 tins Eels 9 lbs. Skate 1 box and 4½ stone Haddock 2 boxes and 4½ stone Tomatoes 3 bundles and 4 bxs. Ham 1 cwt. 1 qr. 17lbs. Tinned beetroot and Kippers 2 boxes red cabbage 15 cases Lemon soles 1 box Whelks 1 bushel Mixed fish 2 boxes Whiting 1 trunk Rabbits 45 lbs. 56 On December 8th Inspector Snowdon saw deposited at a meat store off Alpha Road, at the rear of New Cross Road, a piece of loin of beef which was, in his opinion, unsound and unfit for human consumption. There was a sausage-making machine in close proximity. The meat was seized, condemned by a Justice and destroyed. Legal proceedings instituted against the butcher resulted in a fine of £1 and £5 5s. costs. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Information was received that 344 cases of condensed milk, each containing 48 tins, lying at St. George's Wharf, Plough Road, were not properly labelled in accordance with the above regulations. Samples of the milk were submitted to the Government Analyst and were found to be in order. The tins were thereafter re-labelled under the supervision of Inspector Hewett and subsequently released. SALE OF FOOD AND DRUGS ACTS. 603 samples were purchased and submitted to the Public Analyst for analysis. Of this number, 17 or 2.8 % were adulterated. In only one instance were legal proceedings taken, and in this case the magistrate dismissed the summons on payment by the defendant of £2 costs. 57 Table XXII. Proceedings Taken in regard to Samples Purchased during the year 1924. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. 7 m Milk 14 per cent, milk fat abstracted £ s. d. £ s. d. 2 0 0 Dismissed on payment of costs. Vendor cautioned. 13 h " 4 — — 35 sy ,, 8 „ — — Vendor left district before institution of proceedings. Vendor cautioned. 36 h Vinegar 1 per cent, excessive water — — 53 a Arrowroot Custard Cornflower (Maize) 60 per cent. — — — 63 s Milk 1 per cent, added water — — Vendor cautioned. 71 sy Fish Paste Boric acid 2.4 grains per lb — — Vendor cautioned. 81 s Salmon and Shrimp Paste „ 3.9 — — Vendor cautioned 69 a Milk 3 per cent, milk fat abstracted — — Vendor cautioned 79 a Beel Boric acid 3.5 grains per lb — — Vendor cautioned. 79 s Sausage Sausage ,, 12. 9 — — Vendor cautioned 80 S Pork Sausage „ 11.9 — — Vendor cautioned. 79 h Raisin Wine Alcohol 23.18 p. c. proof spirit — — — 80 H Ginger ,, „ 17 .74 — — — 83 H Orange ,, „ 25.48 — — — 84 H Ginger ,, ,, 19.56 — — — 80 SY Ginger ,, Salicylic acid 2.2 grains per pint — — — 58 Table XXIII. Samples taken during 1924. Articles. N umber Genuine. Number Adulterated. Total. Percentage of Adulteration. Arrowroot Custard .. 1 1 100 Baking Powder 5 .. 5 .. Barley, pearl 5 .. 5 .. Beef, corned 2 .. 2 .. Boric Acid Ointment 1 .. 1 .. Beef Sausage .. .. 1 100 Butter 71 .. 71 .. Cake, sponge 2 .. 2 .. Camphorated Oil 6 .. 6 .. Castor Oil 3 .. 3 .. Cocoa 10 .. 10 .. Coffee 6 .. 6 .. Coffee and Chicory 1 .. 1 .. Cream, preserved 3 .. 3 .. Dripping 7 .. 7 .. Dried Milk, full cream 6 .. 6 • • modified 2 .. 2 .. Fish Paste 1 .. 2 50 Glycerine 1 .. 1 .. Ground Ginger 1 .. 1 .. Lard 10 10 Milk 361 .. 366 1.4 Milk, separated 3 .. 3 .. Mustard 15 .. 15 .. Non-alcoholic Wines 8 .. 13 38.5 Olive Oil 1 .. 1 .. Pepper 21 .. 21 .. Pork Sausage 1 .. 1 .. Rice, ground .. 1 1 100 Rice 5 .. 5 .. Sausage 7 1 8 12. 5 Salmon and Shrimp Paste .. 1 1 100 Sulphur Ointment 3 .. 3 .. Vinegar 13 1 14 7.1 ,, malt 1 .. 1 .. Zinc Ointment 4 .. 4 •• Totals 586 17 603 2.8 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. 59 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 1,215. 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 XXIV. SHOWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES. 1924 Date * Small Pox. Scarlet Fever. Diphtheria. Erysipelas. Enteric Fever. Pulmonary Tuberculosis. Puerperal Fever, Cancer. Pneumonia. Measles. Requests. Scabies. Encephalitis Lethargica. Senile Decay Diarrhoea. January .. 20 9 .. 31 1 1 1 6 .. .. .. .. .. February .. 10 13 .. .. 24 .. 5 .. 6 .. .. .. .. .. March .. 13 28 .. .. 23 .. 1 1 5 2 .. .. .. .. April .. 28 15 .. 1 29 .. .. .. 3 1 .. .. .. .. May .. 13 23 .. 1 28 .. 3 .. 3 2 .. .. .. .. June .. 29 18 .. 3 19 .. 2 .. 2 .. .. .. .. .. July .. 24 21 .. 3 38 .. 15 .. .. 1 .. . . .. .. August .. 25 20 .. 1 21 .. 1 .. .. 3 .. .. .. .. September .. 28 30 .. 5 19 .. 1 .. .. 2 .. .. .. .. October .. 24 48 .. .. 18 .. .. .. .. 2 .. .. .. .. November .. 29 56 .. 3 32 .. 1 .. .. 2 1 .. .. .. December .. 47 56 2 1 25 2 1 .. .. 4 5 .. Total 7 290 337 4 18 307 3 31 5 25 19 4 1 1 * This disinfection was carried out on suspicion of small-pox. The patient was subsequently found not to be suffering from an infectious disease. 60 Table XXV. SHOWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1924. Date 1924 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses. Sheets. Blankets. Odd articles Articles destroyed. January 71 70 38 68 22 10 37 62 79 1 bed. 2 mattresses, 2 palliasses, 2 bolsters, 1 pillow, 1 bag of books February 55 60 24 73 22 9 26 45 62 2 beds, 2 pillows, 1 bolster, 2 blankets, 12 odd articles March 70 80 42 79 30 11 33 55 118 1 bed, 2 mattresses April 72 85 35 79 32 14 48 78 107 1 mattress May 89 112 36 81 28 16 35 50 96 June 92 103 44 91 29 15 40 50 78 1 bed July 102 127 42 99 31 19 28 47 89 5 mattresses, 2 beds, 4 pillows, 1 bolster, 2 sheets, 21 odd articles August 82 96 28 77 28 22 27 53 78 September 100 105 43 118 40 28 73 86 147 1 bad, 1 mattress October 98 103 68 134 42 20 58 102 175 1 bed, 2 mattresses November 116 130 67 147 50 29 75 105 279 December 132 144 83 166 50 24 81 153 229 3 beds, 3 mattresses, 2 palliasses, 1 bolster, 3 pillows, 6 odd articles Total 1079 1215 550 1212 404 217 561 886 1537 verminous premises 90 premises consisting of 158 rooms were fumigated during the year. books. 231 Library books were fumigated during the year. cleansing station. 1,188 articles of clothing, etc., were disinfected during the year. 1,749 children received baths. In 69 instances a second bath was required within a month, and in 14 instances a third bath, making a total of 1,832 baths given during the year. Summary. Total number of Premises disinfected 1079 Rooms 1215 Beds 550 Pillows 1212 Bolsters 404 Mattresses 217 Sheets 561 Blankets 886 Odd Articles 1537 Total articles 5367 61 Total number of Beds destroyed 12 Mattresses 16 Palliasses 4 Pillows 10 Sheets 2 Bolsters 5 Blankets 2 Odd Articles .40 Total 91 N.B.—The above Articles were destroyed at the request of the owners. Special Cases. Jan. 30th—Wickham Road. Cancer. 1 mattress, 1 bolster, 1 pillow— destroyed. Feb. 2nd—Reginald Street. Cancer. 1 bed, 2 pillows, 2 sheets, 3 odd articles—disinfected. ,, 5th—Folkestone Gardens. Cancer. 1 bed, 3 pillows, 1 bolster, 1 blanket, 3 odd articles—disinfected. March 25th—Brockley Road. Cancer. 1 bed, 2 pillows, 1 bolster, 4 blankets, 2 odd articles—disinfected. May 2nd—Colwick Street. Cancer. 1 bed, 2 pillows, 2 bolsters—disinfected. ,, 9th—Clifton Hill. Cancer. 1 bed, 2 pillows, 1 bolster—disinfected. „ 9th—Casella Road. Cancer. 1 bed, 1 bolster, 1 pillow—disinfected. June 21st—Ashmead Road. Cancer. 1 mattress, 2 blankets, 1 odd article— disinfected. July 1st—New Cross Road. Cancer. 1 bed, 5 pillows, 1 bolster, 3 blankets, 8 odd articles—disinfected. ,, 3rd—Hatcham Park Road. Cancer. 1 bed, 1 pillow, 1 bolster— disinfected, ,, 28th—Goodwood Road. Cancer. 1 bed, 6 pillows, 1 bolster—disinfected. ,, 29th—Tressillian Crescent. Cancer. 2 pillows, 1 bolster, 2 blankets, 12 odd articles—disinfected. August 6th—Rollins Street. Cancer. 1 bed, 1 bolster, l odd article—disinfected. Sept. 13th—Revelon Road. Cancer. 1 mattress, 3 pillows, 1 bolster, 3 odd articles—disinfected. ,, 24th—High Street. Cancer. 1 mattress, 3 pillows, 1 bolster, 2 odd articles—disinfected. Dec. 1st—Florence Street. Cancer. 1 mattress, 1 pillow—disinfected. „ 17th—Evelyn Street. Cancer. 1 pillow, 1 blanket, 3 odd articles— disinfected. Mortuary Report for the year ended 31st December, 1924. Bodies Received, etc. Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Unknown. Deposited to await burial only. Infectious. 135 83 52 132 79 24 3 2 i 62 Ten bodies were detained after inquests to await burial owing to lack of accommodation at the homes, and three owing to advanced decomposition. Five bodies were left after inquest to await burial by the Guardians. Boroughs of which deceased persons were residents. Deptford 78 Bermondsey 18 Greenwich 17 Woolwich 7 Lewisham 8 Poplar 2 Camberwell 5 Summary of Visits paid by Health Visitors. Ward (approximate) E. N. N.W. S. & S.E. S.W. Total. Miss F. M. Hollands (temporary, from March—May 2nd) Visits .. 96 .. .. .. 96 Revisits .. 231 .. .. .. 231 Total .. 327 .. .. .. 327 MissRobus (May—Dec.) Visits .. 514 .. .. .. 514 Revisits .. 1624 .. .. .. 1624 Total .. 2138 .. .. .. 2138 Miss Holland Visits .. .. .. 947 .. 947 Revisits .. .. .. 1850 .. 1850 Total .. .. .. 2797 .. 2797 Miss Piper (Jan.—Mch.) Visits .. 407 .. .. .. 407 Revisits .. 577 .. .. .. 577 Total •• 984 .. .. .. 984 Miss Smart Visits 1227 .. .. .. .. 1227 Revisits 1196 .. .. .. .. 1196 Total 2423 .. •• .. .. 2423 Miss Stowell Visits .. .. 785 .. .. 785 Revisits .. .. 3020 .. .. 3020 Total •• .. 3805 .. .. 3805 Miss Reynolds Visits 866 .. .. .. .. 836 Revisits 2540 .. •• .. .. 2540 Total 3406 .. .. .. .. 3406 Miss Clubbe Visits .. .. .. .. 784 784 Revisits .. .. •• •• 2202 2202 Total .. .. .. ... 2286 2986 Total Visits 2093 1017 785 947 784 5626 Revisits 3736 2432 3020 1850 2202 13240 Total 5829 3449 3805 2797 2986 18866 63 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 2240 10307 12547 Still Births 51 2 53 Infant Deaths 166 166 Expectant Mothers 483 254 737 Ophthalmia Neonatorum 26 54 80 Measles 1279 1486 2765 Infantile Diarrhœa 11 5 16 Scabies in children 5 2 7 Verminous Children 15 5 20 Puerperal Fever 4 4 8 Pneumonia 86 123 209 Miscellaneous 563 74 637 Unsuccessful visits 485 780 1265 Scarlet Fever recoveries 209 144 353 Encephalitis lethargica 1 — 1 Erysipelas 2 — 2 Totals 5,626 13,240 18,866 In addition to the above visits, the Health Visitors spent in all 542 afternoons at sessions of the Infant Welfare Centres and 106 mornings at sessions of the Ante-Natal or Special Clinic; 6 attendances were also made at Dental Clinics. Feeding.—In the 2,240 births visited it was found that 2,104 infants were being breast fed and 56 partly breast fed. Only 80 were entirely hand fed. Births Notified, Year 1924. Ward. Births Notified. Alive. Dead. By whom Notified. Total. Male. | Female Parent. Doctor. Midwife Other Person. East 493 262 231 483 10 38 111 342 2 North 465 248 217 450 15 45 202 216 2 North-west 430 224 206 420 10 71 117 234 8 South 338 159 179 329 9 52 34 246 6 South-east 224 113 111 221 3 57 6O 106 1 South-west 240 131 109 232 8 69 57 105 9 2190 1137 1053 2135 55 332 581 1249 28 Milk supplied to Necessitous Mothers and Children. During the year 8,380 applications were received and were dealt with as follows :— Granted free 6197 at half-price 2149 Refused (over scale) 34 8,380 64 Dried Milk, Virol, &c. The following amounts of dried milk, &c., were distributed to the mothers attending the Infant Welfare Centres, during the year 1924. The previous year's figures are given for comparison. Year 1924 Year 1923 2,819 1 lb. packets 3,172 Ambrosia 2,656 1,697 Cow and Gate 1,897 2,104 Trufood 188 1 lb. tins 39 Lactogal 68 tins 84 Virol 36 28 lb. tins 42 Lacta 29 1 lb. packets 1736 Recolac 9 1 lb. tins — Winsome — 48 Maternity Home Particulars of cases admitted during the year 1924 :— Cases admitted, 176. Average stay, Two weeks. Cases delivered by midwives, 168. doctors, 8. Cases in which medical advice sought, (a) Ante-natal, (threatened abortion, Albuminuria and Influenza), 4. (b) During labour, (Prolonged labour). 8 (c) After labour, Nil. (.d) For infant, (Premature and Dangerous feebleness), 4. Cases notified as puerperal sepsis, Nil. Temperature rose above 100.4 for 24 hours with rise in pulse, 1. Notified as Ophthalmia Neonatorum, Nil. Inflammation (eyes), 1. Infants not entirely breast fed, 1 (depressed nipples and insufficient breast milk.) Maternal deaths, Nil. Fœtal deaths, (2 Premature and 3 Stillborn.) 65 NAPIER STREET CLINIC. 1924. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 18 1 4 3 26 354 380 200 February 4 22 .. 4 2 28 272 300 155 March 5 9 •• 4 4 17 297 314 147 April 3 11 2 4 4 21 334 355 167 May 4 17 .. 1 3 21 317 338 129 June 4 11 1 3 2 17 247 264 111 July 4 19 2 5 4 30 358 388 169 August 4 11 .. 2 3 16 237 253 109 September 5 21 2 .. 2 25 357 382 167 October 3 8 .. 4 3 15 210 225 114 November 4 9 2 3 3 17 257 274 145 December 5 13 .. 2 4 19 239 258 138 Total 49 169 10 36 37 252 3479 3731 1751 ERLAM ROAD CLINIC. 1924. No. of times Clinic opened. Breast Fed. New Cases. Total New Cases. Total Old Cases Total New and Old Cases. Consultations with Doctor. Mixed. Hand. Ages 1—5 January 5 14 1 2 3 20 219 239 122 February 4 6 1 .. 2 9 182 191 108 March 4 6 .. 1 3 10 227 237 114 April 4 5 •• 3 2 10 200 210 100 May 4 11 1 2 4 18 244 262 74 June 4 4 .. 3 .. 7 204 211 103 July 5 21 •• • • 2 23 251 274 112 August 4 10 2 2 1 15 207 222 109 September 4 9 1 .. 2 12 250 262 102 October 4 15 1 .. 6 22 253 275 120 November 4 11 1 1 5 18 223 241 106 December 4 7 1 .. 5 13 193 206 102 Total 50 119 9 14 35 177 2653 2830 1272 66 GOLDSMITHS' COLLEGE CLINIC. 1924. 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 25 1 4 8 38 373 411 151 February 4 12 1 3 .. 16 284 300 127 March 4 14 .. 2 5 21 360 381 164 April 3 16 1 2 4 23 249 272 126 May 5 14 4 1 9 28 424 452 127 June 4 14 1 4 6 25 319 344 173 July 5 21 1 3 2 27 458 485 184 August 4 13 1 4 3 21 342 363 144 September 4 14 3 1 .. 18 338 356 131 October 4 20 1 6 5 32 352 384 165 November 4 27 .. 2 4 33 336 369 170 December 3 6 .. 3 1 10 232 242 108 Total 49 196 14 35 47 292 4067 4359 1770 BESSON STREET CLINIC. 1924. No. of times Clinic opened. New Cases- Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 15 3 2 7 27 249 276 118 February 5 7 1 2 5 15 282 297 135 March 4 12 2 • • 1 15 283 298 136 April 3 7 1 1 .. 9 189 198 87 May 5 12 1 2 5 20 358 878 99 June 4 16 .. 2 2 20 288 308 136 July 4 9 .. .. 2 11 283 294 87 August 5 17 2 2 5 26 337 363 135 September 4 11 1 .. 2 14 297 311 120 October 4 14 • • 1 6 21 343 364 134 November 4 5 4 3 6 18 253 271 116 December 3 5 •• •• 1 6 168 174 75 Total 49 130 15 15 42 202 3330 3532 1378 67 GOSTERWOOD STREET CLINIC. 1924. No. of times Clinic opened. Breast Fed. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Mixed. Hand. Ages 1-5. January 4 5 2 5 4 16 262 278 122 February 4 12 1 3 2 18 223 241 124 March 5 11 3 4 4 22 372 394 167 April 3 16 1 1 1 19 198 217 108 May 4 26 1 5 1 33 277 310 103 June 4 27 3 1 1 32 313 345 149 July 4 16 2 1 3 22 272 294 121 August 3 14 .. 5 .. 19 241 260 103 September 5 24 .. 4 4 32 408 440 163 October 3 6 4 3 2 15 217 232 89 November 4 9 3 3 4 19 312 331 138 December 5 13 1 2 2 18 300 318 117 Total 48 179 21 37 28 265 3395 3660 1594 HALES STREET CLINIC. 1924. 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 19 1 .. 7 27 273 300 174 February 4 5 1 3 2 11 189 200 98 March 4 13 .. 4 9 26 238 264 160 April 3 5 1 1 7 14 175 189 100 May 5 20 .. 3 6 29 314 343 83 June 4 13 .. 1 2 16 246 262 70 July 5 19 .. 6 5 30 304 334 115 August 4 1.6 1 1 4 22 274 296 113 September 4 15 •• 1 5 21 246 267 75 October 4 18 1 1 5 25 285 310 157 November 4 16 .. 2 1 19 281 300 166 December 3 5 1 1 3 10 195 205 101 Total 49 164 6 24 56 250 3020 3270 1412 68 Table showing Attendances at the Ante-natal Centre and Special Clinic for Babies During 1923. Ante-natal Examinations. Period. Number. Babies' Special Clinic. Number. Two weeks ended Jan. 17 (4 sessions) 59 (2 sessions) 5 31 (4 „ ) 54 (2 „ ) 7 Feb. 14 (4 „ ) 49 (2 „ ) 2 28 (4 „ ) 53 (2 „ ) 4 Mar. 13 (4 „ ) 55 (2 „ ) 14 27 (4 „ ) 46 (2 „ ) 7 Four Apr. 24 (7 „ ) 98 (6 „ ) 8 Two May 9 (3 „ ) 68 (2 „ ) 3 Two 23 (4 „ ) 40 (2 „ ) 5 Four June 19 (7 „ ) 119 (4 „ ) 12 Two July 3 (4 „ ) 68 (2 „ ) 9 17 (4 „ ) 69 (2 „ ) 10 Six Aug. 28 (11 „ ) 200 (5 „ ) 18 Two Sept. 12 (4 „ ) 64 (2 „ ) 6 26 (4 „ ) 66 (2 „ ) 4 Oct. 9 (4 „ ) 64 (2 „ ) 7 23 (4 „ ) 73 (2 „ ) 3 Four Nov. 20 (8 „ ) 132 (4 „ ) 2 Two Dec. 4 (4 „ ) 87 (2 „ ) 6 Four Jan. 6, 1925 (7 „ ) 154 (3 „ ) 3 Dp. Hill's Report on the Arite-Natal Clinic. 1. Total number of cases examined was 513 ; of these 463 were new patients, and 50 had attended previously in 1923. 2. Total number of re-visits paid by these patients was 984. 3. Making the total number of attendances 1,497. 4. Number of patients visited ante-natally in their own homes by the Health Visitors, 483. 5. Number of patients admitted to Maternity Home, 176. 6. Number of patients delivered in hospital or in their own homes, 337. 7. Number of patients delivered at the Maternity Home who required instruments, 11. Of those 10 were delivered by Dr. Hill and 1 by a rota doctor. The services of the specialist, Dr. Gilliatt, were not required at the Maternity Home during 1924, but 5 patients were sent to him at King's College Hospital for consultation; of these, 3 were admitted to the Hospital and 2 were confined in the Maternity Home. Several other patients who had not applied for admission to the Home were 69 sent from the Ante-Natal Clinic to Dr. Gilliatt for advice at King's College Hospital. Total number of patients referred to hospitals from the ante-natal clinic 52 Number of cases referred to private doctor for treatment 20 Number of letters written to midwives about their patients 13 Number of patients found to be quite normal 150 Number of patients suffering from carious teeth but otherwise quite normal 75 Number of patients suffering from dental caries in addition to other defect 80 Total number of cases of dental caries 155 i.e., about 30 per cent, of all patients who attended. Of these, some were advised to go to their own dentist, others were referred to the Miller or Guys Hospital for treatment, but patients who were in poor circumstances and who could not spare time or money to go to hospital were generally treated by the Council's dentist, Mr. Magraw, who has charge of the Dental Clinic at Albury Street. This is the easiest method of obtaining treatment from the mother's point of view. Unfortunately, the sum allowed for this purpose was exhausted in nine months, and for the last three months of the year patients had to take their chance elsewhere. Those who got so far as Guys Hospital Dental Clinic speak very highly of it, but many say they have not the time to go, and full fares have to be paid, as the clinic is on Saturdays. Abnormalities and defects, other than Dental Caries:— Albuminuria 31 Haemorrhoids 15 Anaemia 40 Haemorrhage 11 Arthritis 2 Hydramnios 1 Bronchitis 2 Hernia 2 Contracted Pelvis 4 Hepatitis 1 Congenital dislocation of Lipomata (multiple) 1 hip 1 Mastitis 1 Conjunctivitis 1 Mental deficiency 1 Carbuncle 1 Malpositions rectified 12 Curvature of spine 1 Morbus Cordis 23 Cystitis 1 Pulmonary Tuberculosis 7 Deformed or depressed Pruritus 2 nipples 5 Prolapse 1 Dead foetus 1 Retroflexion 8 Dyspepsia 23 Oedema 12 Excessive vomiting 5 Scabies 1 Eczema 2 Sciatica 3 Fibroid 3 Venereal disease 4 Goitre 1 Varicose veins 58 Patients examined and found to be not pregnant 24 70 During the latter part of the year it was found that the number of patients attending the two weekly sessions of the Ante-Natal Clinic was so large that it would be necessary to have a third session, in order that the proper amount of attention might be given to each. It was found possible to arrange for the use of the same rooms on Thursday morning from 9 a.m. till 12.30 p.m. Better accommodation is most desirable for this clinic, and a sewing class, with regular lectures for the mothers whilst they are waiting, is urgently needed. THE PUBLIC MILK SUPPLY. The milk supply in Deptford is derived from The United Dairies "combine," represented by Messrs. Edwards & Sons, Ltd., and R. Higgs & Sons' Dairies, Ltd. Most of the small retailers get their milk supply through the " combine." "Outside" companies are (a) The Royal Arsenal Co-operative Society, Limited, (b) Express Dairy Company, Limited, (c) Marlow's. Two firms are licensed to sell certified milk and Grade A milk, viz., Messrs. Edwards and R. Higgs. Milk is supplied through the Clinics and the Town Hall, in accordance with the Act, to expectant and nursing mothers, infants and children up to three years, and, on a medical certificate, to children over three and up to five years. The estimate provides for the expenditure of £3000 on milk (£3750 less £700 on sales of milk and drugs). Applicants fill in a form and, after deducting rent, free milk is given where the family income per head falls below 7s. 6d., half price is charged if this should be between 7s. 6d. and 10s. 6d. Full enquiries are made to check the facts stated on the forms, where necessary. Some sad cases come to the notice of the Committee. Here is a man, for instance, earning £4 6s. 5d. a week, a fair wage, comparatively speaking. He has twelve children and has made 24 applications for milk ; the income per head is 5s. 3d. The milk is necessary. I could quote many cases, men with £l 10s. a week and five children—all on the free list. What is to be done ? Either pay a bigger wage or give pensions to super-mothers, or what ? Birth control ? Many say that a man should not have more children than he can keep. Again, birth control is frowned upon and continence is advised. Is it possible or is it advisable, some ask. It certainly seems 71 necessary, things being as they are. Perhaps birth control would not be frowned upon so much if steps were taken to stop the vulgar flaunting in shop windows and easy sale of contraceptives. Concerning milk as it is bought, a distinct advance has been made in the year under review. Dr. Hill, at my suggestion, has advised mothers at the Clinics to taste the milk every day before preparing the child's food, and to complain at the dairy if it is not satisfactory. It is reported that the milk has improved after this has been done. Mothers are advised to press for delivery of the milk in sealed glass bottles, but they are warned against purchasing milk where the bottle does not bear the date of production on the label. The fact is that if milk is thoroughly cleaned, then bottled, the absence of dirt delays souring. Thus, if one enters a shop and asks for a bottle of milk it is far from being impossible that a purchaser may run the risk of receiving a bottle of milk which is several days old : this, of course, might conceivably happen where the vendor did not sell much milk and where the purchaser sees no label stating the date of production. I warn people not to buy bottled milk in shops where there is no label on the bottles stating the day of production. Dr. Hill reports as follows: Most retail milkmen are willing to deliver the milk in glass bottles, and the practice of calling it "nursery milk "and charging Id. extra per pint is now being dropped. Some roundsmen, possibly because they find that the extra weight of the bottles involves extra work in distribution, declare that the milk is exactly the same as that which they have in their cans. So it should be, but it is not exposed to contamination in the street if delivered in a glass bottle with a sealed cap over it. I have been sometimes told that the glass bottles are simply filled up from the can in the street, and have, in fact, seen this done (but not in Deptfoid). Such practice should be absolutely forbidden. It is desirable that in addition to the ordinary cardboard disc in the neck of the bottle a complete cap should be placed over the top of the bottle, and it should be sealed down before it leaves the farm. The date of production should also be stated. Less valuable fluids (e.g., whiskey, etc.) are always sold in sealed bottles. This is more necessary in the case of milk owing to the risk to infant life. In dealing—as a customer—with two well-known firms in East Ham I found that the milk supplied to me in glass bottles, after I had made serious complaints to the management, was very much better in 72 quality than the ordinary roundsman's supply from the churn. I do not speak merely in respect of the fat percentage, which is of less immediate importance, than of the freshness of the milk. Stale pasteurised milk is very poisonous to young infants. From observations in the Infant Welfare centres, I believe that gastro-intestinal symptoms are more often caused by the toxins in stale milk than by actual bacterial infections. The glass bottle is, of course, no protection against this, but if all milk for inlants were supplied in glass bottles with sealed caps, and the date of milking on the cap, a great improvement would be effected. Several firms in Deptford are now undertaking to supply all customers with milk in glass bottles, but the bottles are not sealed or dated, and the milk varies in quality. At present the standard can only be kept up by constant watchfulness on the part of the customer-and constant grumbling. But I am asking all mothers to grumble until they get pure milk. Grade "A," Certified Milk. I have now a fair number of mothers who are willing to pay extra and buy Grade "A," Certified Milk for their babies. Those who do so are delighted with it, and some tell me that they and their husbands drink it as well, and that they had not before realized what real milk should taste like. If the price of certified milk could be even slightly reduced it would be brought within the means of many more families. Contra indications for fresh milk. Dried milk is used in the following circumstances: — (a) Where there is tuberculosis in the household. (b) In one-room homes, where milk cannot be kept. (c) If the clothing and person of the mother or baby are dirty. (d) If the mother is of poor intelligence, e.g., if the mother tells me the milk disagrees with the baby and I find she is keeping it warm from one feed to the next in a thermos flask. (e) In hot weather, if the mother tells me she cannot keep fresh milk. (/) If the Health Visitor reports that the home conditions are unsuitable. I always insist on the babies' milk being boiled, then rapidly cooled. 73 During the year one milkman was struck off the roll, his record including 23 per cent, fat abstraction in one instance. Notices were put in the press concerning the requirements of the Public Health (Condensed Milk) and Dried Milk Regulations. A number of applications for registration as milk sellers were refused. A circular was drawn up and issued to milk vendors to the effect that the Council was concerned with the present conditions under which milk was sold in small shops—steps to be taken after the lapse of a reasonable interval. Exhaustive enquiries were made as to the possibility of milk as a vehicle in the production cf diphtheria in local cases, but in not one single instance could milk be blamed. OTHER FOODS. Dr. Harbison enquired into an outbreak of six cases of acute gastroenteritis and found that bread scraps had been eaten which had been infected with the Bacillus Aertrycke. The Council decided that each inspector in turn should inspect food sold from stalls and barrows on Saturday evenings in and around the High Street—Douglas Street area. In no case has any peccant food been detected. At my request, Inspector Snowdon has kindly prepared some notes on places where food is prepared, etc. :— Places where Food is prepared for Sale. I have the honour to report that these premises were regularly inspected during the year. Number of premises on the register, 126. Number of inspections, 432. Notices served, 36. These premises include fried fish shops and ham and beef and pork shops, sausage makers and offal boilers, eel-pie shops, oyster bars, restaurants, coffee shops and hotel kitchens, and any places where food is cooked or prepared for sale to the public or intended for human consumption. Constant attention is necessary in order to keep these various premises in a clean and satisfactary condition. Generally speaking, the premises have been well maintained; it has been found necessary to serve notices in only 36 instances. Our powers of inspection, etc., are taken from the L.C.C. (General Powers) Act, 1900. Sec. 8 (d) says:—" Due cleanliness shall be observed with regard to such room (or rooms used for cooking food, 74 etc.), shop, or other part of a building, and all articles, apparatus, and utensils therein, and shall be observed by persons engaged in such room, shop, or part of a building." Cartage of Food through the Streets. Meat (butcher's meat, bacon, etc.). Objectionable practice of carting meat (uncovered) in open carts through the streets, the carter in dirty overalls sitting on the meat. To avoid the possibility of the above, all meat should be conveyed in properly made, insulated vans, same to be frequently cleansed, lime-washed, etc. Milk. Say milk leaves the depot perfectly cooled and clean. In retail delivery this excellent condition is immediately destroyed— dipping the milk into open cans, etc. Mr. Straus, the American philanthropist and pioneer of pasteurised milk depots, strongly condemned our methods of milk distribution. He emphasised that milk should start pure and that every effort to maintain purity should be made while the milk is on its way to the consumer. Ice Cream Manufacture. These premises received constant attention during the season of the year in which the business is carried on, and in many cases necessary cleansing was ordered and later carried out. Several of the premises situated in the small streets are of an unsuitable nature for a business of this kind and require constant inspection to keep them up to a reasonable standard. In the case of street barrows a marked improvement has been brought about. The objectionable glass, necessitating a supply of clean water for washing, has by persuasion nearly disappeared, and has been replaced by the "cornet" or the " wafer." I also have pleasure in reporting that an increased number of traders have discontinued making the cream themselves, procuring their supplies from the wholesale manufacturer, either in the form of cream or ice-bricks. This trade is generally conducted on the principle of "sale or return." Slaughterhouses. The following slaughterhouses in the Borough are at present licensed by the L.C.C.— 180, Brockley Road. 13a, High Street. 75 The slaughterhouses were cleansed and lime-washed each quarter as required by the By-laws, and all bones kept in a satisfactory manner, the quality of meat killed being good. During the year humane slaughtering was introduced into the two slaughterhouses. This new method of slaughtering has proved highly satisfactory. Your obedient Servant, J. V. Snowdon. A number of samples of salmon and shrimp paste, sausages, etc., were examined for preservatives. It is curious to note the attitude which different firms take when informed that preservative has been found in their wares. One firm sent their chemist to see me to justify the addition of preservatives ! !! Their chemist, mark you. So food is evidently manipulated by the scientists. Another firm sent a director to explain that his firm were totally unaware that the food had been so treated, and he submitted correspondence showing that the food in question had been withdrawn from their many branches. He also submitted a letter to the wholesalers asking them to instruct their salesmen not to call. One hopes that the ordinary man in the street will get a square deal and that the new Public Health draft Regulations will become law. If a navvy wants boracic acid let him go into a druggist's and buy his poison ; at present he cannot look a sausage in the face without wondering whether it has been through the laboratories, gathering dope by the way. Encephalitis Letliargica, though not really a new disease, has lately received close attemion by medical experts. Probably it is a sequel to toxins elaborated during an attack of influenza. There are numerous symptoms, such as drowsiness, headache, dizziness, squint, (oscillation of eyeballs), deafness, twitchings of limbs, temperature, etc. In different cases the symptoms vary in number and kind. While some cases end fatally, chief attention is being focussed on the unfortunate final results noticed in some. It should be understood that the following two cases are exceptional; the fact of their occurrence, however, necessitates following up, in every case, no matter how mild the original attack may have been. Case 1. A girl of 15, after an attack of acute chorea, developed sleepiness, even at meals, and from being of a placid disposition 76 became bad tempered. Her face became mask like and expressionless. Alteration in voice and gait were noted. Treatment included daily exercises to improve her gait. The general health improved, but her temper was readily aroused, especially when strangers found it difficult to understand her speech. Case II. A boy of 16, after several of the above-mentioned symptoms had appeared, developed an alteration in his mental condition. He would forget that he had written a letter and would write it again. When allowed up, he would frequently forget where he had put things. He developed a violent and erratic temper and suffered from the delusion that he was in charge of the ward and everyone there. Originally intelligent and well behaved, he became noisy and foolish at times. My point in mentioning these two cases is that if even a small number of such cases arise annually, leading to mental or physical aberration or abnormality, special consideration will have to be given to their education. A special school or schooling may be necessary. Encephalitis lethargia must be taken seriously. Health Week. Commencing on October 6th, this annual effort was largely attended. Boy Scouts distributed over 15,000 circulars to different houses in the Borough. The evening lectures attracted audiences of over 400, and the hall was crowded every afternoon by school children, who received lectures and demonstrations. Lectures were delivered at night by Drs. Hill, Saleeby, Harbison, and the Medical Officer. V.D. films were exhibited and explained by special lectures. Staff. After some years of faithful work, Miss Piper and Miss Baird resigned. Miss Piper became the matron of the Edith Cavell Memorial Convalescent Home and Miss Baird returned home in view of a domestic bereavement. Miss Le Maistre demitted office as Tuberculosis Health Visitor, her health causing a little trouble. They will be loyally remembered by all their colleagues. OLD AGE DEFERRED. By the Medical Officer. When a man celebrates his fortieth birthday he has reached the old age of his youth and the youth of his old age. Youth is the period during which his powers are developing, and this stage may be likened 77 to the ascent to the mountain top. Man ascends until he reaches 30 years of age. Middle age is a variable period; it is the stage during which he marches along on the plateau of the mountain. Some men come to the end of middle age, to the end of the plateau, at 45 or 50, and enter upon the third stage, old age, which may be likened to the descent from the plateau, a descent that◦oftimes is rapid. My object is to tell men and women of 40, aye, of 50 or even 60, how the stage of middle age can be prolonged until 70 or 75, how the plateau on the mountain top may be made a long one, receding into the far-distant horizon before the inevitable decline to old age. What a tragedy it is to see men and women of only 50 stumble over the edge of the middle-age plateau and descend rapidly to the grave. It is a black moment when the heralds proclaim the passing of the dead, and the great officers break their staves. But it is sadder still when it is the victim's own hand that breaks the staff in public. Men of 40 have it in their power, not only to avoid disaster at 55 or 60, but to live through a healthy, active middle age until 70, with yet another 20 years of comfortable life to look forward to as their strength gradually fails. During the stage of youth, youth has its modest " fling," but at 40, and before, we must follow Bacon's advice, discerning the coming on of years, and thinking not to do the same things still, for age will not be defied. There can be no place for "flings" after 30; we must study the pleasures which are the privilege of maturity. It is our bounden duty to live as long as we can; we must get the most out of life, and put the most into it that we can for humanity's sake. The chronic bon viveur, the gay Lothario, the glutton and wine-bibber who dies early, is a suicide. Jerome K. Jerome did not approve of suicides, as they pushed themselves into the next world before they were asked. To be fit at 40, and to enter into the promised land of a joyous middle age, with peace at eventide on the horizon of our vision, we must take early cognisance of what is called our intake and our output, that is, of the food and drink we consume and of the smooth and efficient disposal of waste products. We must study the air we breathe, exercise and rest, circulation and respiration. The consequences of life's actions and conduct will have to be faced. Nature never forgets to send in the bill for all our moral and physiological sins. The body and mind must both be studied. A man's brain may be perfect, but if the body is neglected or misused disease comes sooner or later and impairs man's usefulness. It means living soberly, 78 wisely and purely. Habitual intemperance and the grosser sins of life are contraventions of the moral law. The man of 40 to 45 must be self-denying in eating and drinking, and play in moderation. In youth, restoration or new growth takes place rapidly; in middle age the balance between wear and restoration is approximately equal; in old age the ever-changing cells of our bodies renew themselves but slowly. In the book of Job we are told "Thou shalt come to thy grave in a full age, like as a shock of corn cometh in in his season." We cannot hope to do so if we overeat or overstimulate, if we sleep in close, badly-ventilated, overcrowded, sunless, insanitary houses. We should never become senile. Senility is not a law of nature, and it is evidence and proof that the law has been broken. Senility is not the result of wearing out or overwork. Senility means the cessation of renewal rather than the destruction of existing tissues. As I shall show you presently, the centre of vital power is in man's ductless glands. These glands, called the endocrines, were referred to first by Brown Sequard in 1889; if these glands fail senility ensues; if kept in good condition they have the power to postpone senile decay. Premature old age is manifested in wasting and slackening of the muscles; there is a loss of spring and elasticity; the walk becomes slow and shuffling, the breath short; there is pallor and sallowness of the skin and vacuity of the expression. The spirit shows loss of memory ; the mind dwells upon the past. Perception is dulled; it cannot take in new ideas. They become irritable and impatient and sink into their anecdotage. A man of 55, as I shall show you presently, has no right to be bald, somewhat deaf, stiff in the muscles, obese, with teeth going or gone and some varicose veins to assist him downhill. He is generally a man who has denied or never heard that dietetics and the hygiene of the intestine should be man's first care if he wishes to live to 90. The man of 40 should know his own capacities and limitations. Common sense and intellectual honesty are needed to reach old age. At 40 the question is, shall we dig our own grave with our teeth ? Until 30 we do strange things ; we eat too much at a time, and eat incongruous mixtures. We seem to recover as if our animal economy could meet all demands and emergencies, but we leave some mark on our reserve of power. If we do this after 40 our excretary organs, our kidneys, etc., that should clear away the rubbish heaps, cannot cope with the strain; hence we become rheumatic, gouty and suffer from kidney disease. 79 When we add to over indulgence in food and drink the strain of social and business ambitions, worry, emotional states, anger and grief, then our errors are followed by structural changes tn our organs. The mad and ineffectual race for life becomes the triumphant race for death. I cannot understand why so many of our fellow men should prefer the high blood pressure, the corpulence, the mental depression, memory weakness and constipation with its consequent blood poisoning, all of which they get in return for indiscretions in eating and drinking. When will people learn to cut down their intake after 40, and pay a little attention to the hygiene of the intestine. The wise, who do this, have a clear eye in their heads, a retentive memory, an elastic step, an unirritated brain, resilient and elastic arteries, and a green old age as their reward. Careless dietetic habits and the wear and tear of life can be detected not only in the tortuous stiff arteries and the dry skin, for an analysis of a man's waste products at 40 or 45 sometimes discloses incipient and early alteration in the kidneys. The food is not assimilated properly and converted into energy; hence the waste material irritates the kidneys and the endocrines, i.e., the all-important ductless glands. These ductless glands are:—The thyroid gland situated in the neck, the thymus gland; the pituitary and pineal glands in the brain, the suprarenal glands, which are found one on the top of each kidney, the pancreas, and finally the gonnidia or reproductive glands. Of these, the thyroid is probably the most important. Each of these glands has an internal secretion, and if this is deficient much harm is done to the system. These glands all work together: if you damage one you tend to injure the others. Now take the thyroid gland. The late Sir Victor Horsley, the eminent surgeon, said that old age was due to degeneration of the thyroid gland. The thyroid governs the vital processes of the body. If it acts deficiently, then we become an easier prey to intoxications and infection; the invading germs, which we all encounter, find their fell work made easy. A deficient thyroid gland is responsible for a host of signs and symptoms, e.g., a wrinkled dry skin, lax muscles, apathy, somnolence, falling out of the hair, obesity, premature greyness of the hair, headaches, migraine, neuralgia, etc. A healthy thyroid should contain a quantity of colloid fluid containing iodine; but if the thyroid degenerates, it developes an undue proportion of connective tissue, a fatty degeneration of the lining cells, and a deficiency in colloid fluid and hence in iodine. The age of a man depends upon the quality of his thyroid gland. If this gland is senile then the other ductless glands tend to lose their 80 tone. A very deficient thyroid gives rise to a disease called Myxoedema, not seen so frequently nowadays. . Another endocrine is the pituitary gland. Deficiency in this gland leads to obesity, some degree of dwarfism, and arrested development of sexual characteristics. This is a very rare disease. Another kind of defective pituitary leads to Acromegaly or giantism, fortunately very rare also. The other endocrine glands also secrete stimulant which we call a hormone, and these hormones pass in to the circulation and influence the activities of each of the others and are required to keep us healthy. The stimulant from the Suprarenal glands maintains a proper degree of tonicity in the arteries. Remember that the thyroid gland is to the human body the same as a draught is to a fire. The pancreas not only digests proteins, carbohydrates and fats, but it has an internal secretion concerned with the utilisation of the sugar and the tissues. The same story is true of the reproductive glands. They secrete a stimulant or hormone necessary for health. You have all heard of Voronoff of Paris. He proved that the internal secretion of the male reproductive glands could work miracles. He rejuvenated men, delayed and dispersed senility, renewed mental and muscular vigour by engrafting into men a certain organ from chimpanzees. It is perfectly true and not simply a joke, as some would like to make out. The engrafted gland gave its secretion to the new host, the man, and altered his health for the better. The only difficulty is that it is expensive, as a chimpanzee costs 100 guineas, apart from the cost of the operation. To sum up concerning the endocrine glands; without healthy and efficient endocrine glands the blood becomes impoverished. Weak glands lead to different diseases—for example, obesity, which is a disease due to a weakness of one of four glands, these being the thyroid, pituitary, thymus, or the gonads. The great enemies of these glands are the toxins, that is poisons, whether arising from within the body or admitted from without. These toxins lead to degeneration of the glands, so we find quite a number of men of 50 whose vitality is declining. They reach old age prematurely. Far too soon they develope into men of whom Bacon said : " They object too much and consult too long, adventure too little and seldom drive business home to the full period, but content themselves with the mediocrity of success." And all because their glands have declined prematurely in vigour. I will explain in a moment how this is brought about, but let me give you a word of comfort. Even in a man of 55 or maybe more, 81 medical men can work wonders in restoring vitality by the use of medicaments consisting of extracts or tablets made from corresponding glands taken from animals. This is a comparatively recent development in the science of medicine ; it is called organotherapy. Some old fashioned folk are sceptical and not sure what to think when they hear of doctors taking an obese or it may be a senile or otherwise somewhat defective man, and making a new man of him. It is true, but let no person proceed to experiment upon himself with these extracts; they must only be used under medical supervision, otherwise accidents will happen. Now I want you to turn with me from the theoretical to the more practical side of this paper, and see just how all these evils are brought about and how they can be prevented or cured if caught in time. This involves consideration of diet, which in turn includes the intestine—intake and output. Again we must consider high blood pressure and what is called Arterio-sclerosis, that is hardening of the arteries, a condition which does far more damage than cancer ever did or ever will do. The lad of 40 and the man of 60 must have grasped by now that fitness at 40 up to 75 and 90 years of age is a question of whether we keep toxins or poisons from getting into our systems or from developing within our systems. The young man of 40 must keep new mottoes above the head of his bed, such as "Keep your endocrines fit," "Toxins destroy the endocrines," and "The duration of our lives depends upon the renewing force of our glandular system." Our whole life and well-being depend upon the proper digestion of our food. Good digestion requires consideration of choice of food, also of cooking and of the bodies into which we put the food. Thus, we need 32 good teeth and 32 bites for each mouthful of food. Visit the dentist every six months if you want to live long. Pyrrœha poisons the system and is a cause of anaæmia, rheumatism and arthritis, to mention only three diseases. Proper chewing enables the saliva to act upon the food. Bolting the food in lumps does not allow the gastric juice to mix properly with it. Take time between each course and never read at meals. Do not sit down to meals exhausted physically or mentally. The angry man or woman must cool before eating. Avoid monotony in eating. It was a well-meaning but slightly confused Eton boy who said that the custom that a man should have only one wife was first instituted by the Greeks, who called it monotony! Give your food time to digest. Dinner at night is better for that reason than a full 82 mid-day meal. The quantity of food we should take depends, in part, on the mental and physical work we have to do, but, as I shall show, that statement requires some qualification. Eat meat once a day only and hardly ever at all if the blood pressure is high. I shall speak of blood pressure in a moment. Old people should eat in strict moderation, their food should be simple in quality and contain little or no starchy foods. Everybody over 40 should take enough food to maintain the lightest weight consistent with perfect health. It is sheer nonsense for a man to think that at 55 he should weigh a stone more than he did at 30. Simple diet consists of wholemeal bread—not white bread—plain biscuits, plain puddings, vegetables, fruit, some meat, fish, milk, butter and cheese. Take few condiments; never take alcohol before night and take very little of it even then. A man of 4.0 or over should never drink beer, it makes him corpulent. Now, until recent years everybody talked about the caloric value of food. If soldiers were going on a route march, we worked out the number of calories each man required. A small calorie is the amount of heat required to raise one gramme of water through one degree Centigrade. The large calorie is equal to 1,000 small calories. The caloric value of any food is determined by a calorimeter, and is a measure of the energy which is given out by the complete oxidation of the substance. It was said that the food the average man required was from that which yielded 2,500 or 3,000 calories. These calories were obtained from certain proximate principles called proteins, carbohydrates and fats, which, with salts and water, supplied us with our nourishment. Further observations taught which foods supplied proteins and which carbohydrates and which fats, and how the three proximate principles acted. Thus, proteins are present in all animal foods, in eggs, and, to a small extent, in cereals and pulses. Carbohydrates come from vegetables, cereals, pulses and sugar, whilst fats are found in the fat of meats, in butter, animal oils derived from fish and to a lesser extent from vegetable oils. The proteins we eat make up the loss of structure from wear and tear; carbohydrates and fats give heat and energy for work. Fat supplies more energy than carbohydrates or proteins ; and so, knowing these things, our physiologists proceeded to work out diets which, by weight, would supply men engaged in active or sedentary work with all that was required to keep a man or woman fit. It was all very good, and though we must always make use of such information, a change came over the scene when we discovered vitamins. 83 Nowadays, we must go further than merely say that bread consists of carbohydrates, cheese of proteins and fat, that pork takes longer to digest than veal, veal longer than roast beef, and roast beef longer than boiled and raw meet. Vitamins have made us alter our food perspective, for vitamins vitalise the tissues. They are largely present in the outer coverings of rice, corn, and also in eggs and potatoes. There are none in fine white bread, but are present in brown bread containing all parts of the grain. What folly it is for people to eat white bread! Milk contains vitamins ; remember the couplet: " A pint of milk, egg, orange and greens Give us our daily vitamins. ' Lack of vitamins lead to deficiency diseases such as rickets, scurvy, beri-beri, etc. Much work has yet to be done on this subject; I only mention them to show that vitamins rather than calories are important. Every man of 40 who would live to 90 must become a food specialist; the smooth working of his alimentary system is the key to the door leading to a green old age. He must eat fresh foods and give up the fancy cooking which wrecks the vitamins. He scorns knowledge and says his doctor can cure him when necessary. But at 50 nature presents the bill in the form of symptoms of the destructive process. There is an excess of food intake over output. Corpulence is the proof of over-worked digestive and assimilative organs. The wrong foods are eaten, the heart and liver become encased in fat, so he gets short-winded and the liver breaks down : toxins spread and he gets injured endocrines, gout, obesity, high blood pressure, arterio-solerosis, heart disease, apoplexy and death. He eats four meals a day instead of two; it would take a 40-mile walk a day to oxidise half of what he eats. Sick animals starve ; sick human beings ought to do the same, but they prefer to lap up beef tea. Moderation in eating is imperative. As that fine writer, Dr. Leonard Williams, says : " People keep talking about the need for eating to keep up their strength." So when told that they are poisoning themselves they are astonished. Excessive intake is fatal. Butcher's meat contains no vitamins; it is less healthy than fish, fowl or game. Rice pudding is made of decorticated rice, boiled milk and refined sugar, a combination which contains no vitamins and no salts. Instead of taking the ordinary table sugar, that is cane sugar, which is liable to irritate the stomach, we should take invert sugar in the form of the readily assimilable honey. Eat more uncooked and unconcentrated foods. Our usual food does not contain the salts we need, such as salts of calcium, iodine, magnesium, 84 sodium, potassium and iron. The herring and the cod give us our iodine. Take iodised salt, and not the artificial salt we at present keep in our salt cellars. Milk and green vegetables give us our mineral salts. Green vegetables and eggs contain iron. Phosphorus is derived from milk, egg yolk and cereals. Iodine is obtained from green vegetables and cod liver oil. Fruits and vegetables correct an overacid diet. Now we come to output, the throwing off of waste products. You have all heard of Sir Arbuthnot Lane, the surgeon. He has written illuminatingly on constipation and its cure. Many people think their bowels are in excellent order because they have a daily habit. Many of these have the lining of their lower bowel manured with stagnant material; hence they go on absorbing poisons into their system. The stagnation in the bowel converts the normal friendly germs into enemies. We would never develope this intestinal stasis, as it is called, if we ate natural foods. Drink plenty of water between meals and fast for a day from time to time ; it redresses the balance between intake and output. Hot baths, with or without massage, and electricity act similarly. Hot air, vapour or water baths, exercise such as walking, tennis, golf, all act by raising the temperature and so promoting oxidation. In the home great benefit can be obtained by using the sculling machine or Sandow's developer. A three-miles walk daily is best of all. Hot baths and Turkish baths pre-suppose that the heart is not weak. Despite facetious comments, I recommend a three-days fast at times, drinking lots of alkaline fluids, such as Vichy water, the while. One can quite well go to work. By the third day the faster is drawing upon his reserves and is oxidising the deleterious matters which were clogging and slowing the wheels of being. One of the cleverest men was he who drew up those advertisements of Kruschen, showing a man jumping over a gate. Personally, 1 don't believe in spending 1s. 9d. on Kruschen; I simply spend a few pence on one ounce of Epsom salts, one ounce of Glauber salts and one ounce of sodium phosphate. These 1 dissolve in 20 fluid ounces of water. A wine glassful every other morning is of great value. If we neglect the hygiene of the intestine by over eating and want of exercise then constipation may ensue and so poisons absorb into the system. If long continued, constipation causes distention, then lengthening of the colon; bands are formed which contract and kink the bowel. Hence the contents are 85 retained. Toxins are absorbed, the muscles and kidneys are weakened, and the liver and pancreas degenerate. The injury to the nervous system is shown in headaches, rheumatic and neuralgic pains, mental depression and irritation, with lack of energy. The skin becomes inelastic and is pigmented, and acneiform eruptions appear on the skin. The nails become coarse and unsightly, the ears congested and of a purple colour. Colitis is due to intestinal stasis and improper feeding; an unsuitable dietary, consisting of too many cooked meats, not only leads to the promotion of constipation, but as it contains no vitamins, the absence of the vitamins and the presence of toxins in the circulation cause starvation and poisoning of the endocrine glands. A man who, at 55, finds himself guilty of such dietetic errors and of constipation has yet time to recover himself. The treatment of constipation is mainly dietetic. Eat more fruit and salads and less meat. Uncooked fruits and vegetables and dairy produce will prevent dyspepsia, eczema, and arthritis. Meat once a day is enough. At first it is advisable to clear the intestines by using the simple salts I have alluded to above. A visit to Bath, Buxton or Harrogate, for the waters there, for those who can afford it, is valuable. Keep the kidneys flushed with lots of water, or Potass water between meals. Baths, massage and electricity keep the skin acting, thereby helping the elimination of poisons. Heliotherapy, that is sunlight treatment either natural or by artificial lamps, stimulates the skin and detoxicates the bodily fluids; avoid the heat of the sun during sunlight treatment. Sunlight is a great antiseptic; it increases the calcium and phosphorus in the blood and also increases its bactericidal action. To keep the lungs clean, vigorous action in the open air is indicated. Take the French breakfast of coffee and a roll in place of the heavy English breakfast. Get away from that foolish idea of gorging to " keep up your strength," for overeating does not keep up but ruins the strength. Personally, my breakfast consists only of either two small apples or a grape fruit, with a large cup of unsweetened tea. Here, let me say, that this treatment I am now outlining is an admirable one for obesity as well as constipation. A brain worker should not take a heavy lunch at 1 o'clock ; if he does he must sleep for an hour or two afterwards. A heavy lunch determines a flow of blood to the stomach to promote digestion. If therefore a man resumes his brain work just after a heavy lunch he gets dyspepsia. A good lunch would be bread, cheese, butter, an omelette, and a salad 86 of raw vegetables (well cleansed), some raw fruits to follow, with a little cream. Dr. Leonard Williams insists that salads should consist of a variety such as lettuce, cucumber, tomatoes, mustard and cress, watercress, radishes, young cabbage, young carrots, brussels sprouts, nasturtium leaves, dandelion leaves, parsley, onion and beetroot. Use any kind of dressing. Take uncooked fruits with no sugar in place of pudding. Tea and coffee after lunch retard digestion. I would suggest a cup of weak tea instead of the heavy black coffee. Our man of 45 and 50 should not indulge in the foolish afternoon tea with cake, bread and butter ; simply take a cup of tea and nothing else. The stomach takes four hours to deal with a meal, and a brain worker should come with an appetite to his 7 o'clock dinner. Of course, if a man is dieting himself for obesity, he should not eat potatoes and never take sweets or sugar; beer is strictly forbidden, but a little whisky may be taken by the man who is used to it. At the evening dinner, fish, fowl or game is better than veal, pork or roast beef. Fruit salad and a little cream, with savoury cheese, complete a good dinner. Eat nothing after 8 p.m., for bearing in mind that a solid meal takes four hours to digest, anything eaten after 8 p.m. may wake you up at 2 in the morning; many insomnias are dyspeptic in nature. If one has a tendency to insomnia a hot bath before bed time helps; hypnotics should never be taken. Believe me or not, such a diet will help a man to be middle-aged until 70, and will make a new man of the surfeited, corpulent, poisoned man we meet so often in the streets. Could these men just see the heart-broken fight which their livers are making with the toxins from their concentrated, devitalised foods, could they see the liver congestion, they might amend and flee from the wrath to come. But no, they will not give up their gross feeding, consequently their auto-intoxication brings us to the consideration of the last and almost the most important part of my paper, that is, the production of a high blood pressure, leading eventually to arteriosclerosis, with a general break up of heart, kidneys and blood vessels. To illustrate the seriousness of high blood pressure and arteriosclerosis, that is thickened arteries, let me explain that although the average duration of life has increased during the past 50 years, nevertheless the death rate of men between 45 and 65 has increased. Further, one-third of all the deaths between 55 and 65 are due to disease of the heart and blood vessels. Nearly 40 per cent, of the deaths of people over 60 years are from diseases of the blood vessels and Bright's disease. We talk of cancer with bated breath, but that 87 is not so serious as arterio-sclerosis. To explain how high blood pressure comes to pass. Between each heart-beat the circulation is kept up by the contractile power of our elastic arteries. The tension in the arteries can be estimated bv an instrument called a sphygmomanometer. Now in arterio-sclerosis the arteries lose their elasticity because a gritty deposit settles in their walls. This deposit lessens the bore or the lumen of the arteries, hence the blood cannot be forced through them. The left side of the heart tries to overcome the resistance in the stiff arteries, and so becomes overworked and finally enlarged. The blood pressure becomes high and there is a danger of rupture of the blood vessels and apoplexy. The causes of high blood pressure and arterio-sclerosis are not far to seek. Generally several causes operate together. The high speed of life in business and the whirl and gaiety of the social round; late hours, over-feeding, over-smoking, continual excitement; drinks, dances and dinners. It is not so much the drinks as the drinks between the drinks which do the damage. Strong coffee and strong tea are far from blameless. Passions such as anger, worries and anxieties play their part. Intestinal stasis, constipation, lead to absorption of poisons, and these irritate the blood vessels. If H.B.P. lasts for a year or two then A.S. must follow. The symptoms of H.B.P. are increased shortness of breath, giddiness, singing in the ears on stooping, and a constant sense of fatigue out of proportion to the work that has been done. Every man of 45 and 50 and over should have his blood pressure estimated every year by his doctor. It is no use burking the issue. If the pressure is up, face the facts, be honest and cut out bad habits, such as the other little drinks which do us lots of harm. Early hours, long nights, no excitement, the minimum of stimulants, change of scene, plain and simple diet, must be the rule. No more rich gravies, no strong meat soups. Black coffee and strong cigars must go, even pipe smoking may have to be stopped; the cigarette smoker who inhales is passing nicotine into his system and this by itself is a powerful raiser of the blood pressure. The patient should go in for fasts, his intake must be brought down and output increased. Dairy produce must take the place of strong meats; the simple life must be lived. In conclusion, I appeal to all men and women between 40 and 60 to lead the simple life. There is no hope for the person who refuses to amend his ways if high blood pressure is diagnosed, for nature will be certain to send in the bill. Get back to nature's simple laws and she will reward you with a long middle-age period, and will give you light in the evening of your days. INDEX. A Acute Primary Pneumonia PAGE 20 Acute Influenzal 20 Acromegaly 80 Admissions to Maternity Home 68 Ailments of Expectant Women 1, 69 Alcoholism 3 Alkaline fluids 84 Ambulance Facilities 24 Analysis of Foods and Drugs 58 Ante-Natal Clinic 1 Attendance Table 68 Cases referred to Hospital 69 Dental cases at 69 Dr. Hill's Report 68 Ante-Natal Home visits 68 Applications for Milk 70 Area of Borough 5, 9 Arthritis 81 Arterio-sclerosis 3, 81, 86, 87 B Bakehouses 54 Bath 85 Birth Control 3, 70 Births registered 5, 9 notified 63 illegitimate 10 mothers' occupation 10 Notification Act, 1907 10 Birth-rate 5 average for 10 years 5 Table 10, 13 Births, transferable 9 Books disinfected 60 Bottled Milk 71 ii. B—continued. PAGE Bright's Disease 86 Bronchitis 1 Buxton 85 By-laws of Borough Council 25 L.C.C. 26 c Calories 82 Canal Boats Acts 55 Cancer Deaths ... Cerebro-Spinal Meningitis 21 Cleansing Station 60 Clinics, Infant Welfare 23, 65, 66, 67 School 23 Condensed Milk Regulations 56, 73 Condiments 82 Constipation 84 Cost of Health Department 5 Corpulence 84 Cowsheds 51 D Deaths 5,11 Death Rate 5, 11 Deaths, average 10 years 5 Causes of Table 15 Infectious Diseases 18 Diarrhœa 2 in Wards 12 rates 12 Non-Parishioners 11 Parishioners outside Borough 11 Table for 10 years 11 Infant Table 16 Defects in Factories and Workshops 52 Laundries 52 Defect Notices re Houses 47 iii. D—continued. PAGE Density of Population 5 Dental Treatment for Tubercular persons 34 at Ante-Natal Centre 99 Diarrhoea and Enteritis 5,13, 21 Diet 82 Diphtheria 20 Notifications 2 Contacts 2, 25 Disinfections 59 Bedding 60 Books 60 Tuberculosis 34 Dried Milk 64, 72 Dwellings, unfit 46, 47 E Eating and Drinking 78 Encephalitis Lethargica 3, 21, 75, 76 Endocrines 78, 79, 80 Enteric Fever 20 Expectant Women, ailments of 1,69 F Factories 50 Families in Borough 5 Food and Drugs Acts 56 Food, analysis 85 Food, cartage through streets 74 Food, unsound 55 Fried Fish Shops 51 Fruits 84 G Grade A Certified Milk 72 iv. H Harbison, Dr. on Tuberculosis PAGE 26-34 on Food Poisoning 73 Health Week 3, 76 Heart Disease, deaths 3 Heliotheraphy 85 Hill, Dr. on Milk 71, 72 Report of (Maternity and Child Welfare) 1, 68 High Blood Pressure 83, 86, 87 Home Work 53 House-to-house Inspections 44, 45, 46 Hospitals provided 24 Humane slaughtering 75 I Ice Cream 74 Premises 51 Infant Mortality 5, 12 Illegitimate 5, 12 average 10 years 5 Rate 1, 12, 13 for Wards 12 Infectious Disease and Outworkers 50 Notifications 17 Deaths 18 Death-rates 18 Inhabited Dwellings, number of 5 Inspection of Factories and Workshops 51, 52 „ House-to-House 44,45,46 Intake and Output 77 Iodine 84 Iodised Salt 84 L Laboratory (Bacteriological) Work 25 Laundries 52 Lectures 3 Lewellin, Miss 35-37 V. M Massage PAGE 84 Marriages 5, 10 Marriage Rate 5, 10 „ where Celebrated 11 Maternity Home Statistics 64 Malaria and Dysentery 21 Measles 21 „ deaths from 5 „ epidemic 1 Milk Bottles 71 „ Expenditure 70 „ Premises 51 „ Stale 72 ,, Grade A Certified 72 „ for Necessitous Mothers 63 Mortuary Report 61 „ Statistics 5 Myxœdema 80 0 Ophthalmia Neonatorum 2,21 Obesity 80,85,86 Old age deferred 76 Outworkers 50 Offensive trades 51 P Pertusses 5 Poliomyelitis 2 Pneumonia 1 Population 5, 9 „ for Wards 9 Premises, re Sale of Foods 73 Preservatives in Food 75 Propoganda 3 Public Milk Supply 73 Puerperal Fever 21 „ „ notifications 3 vi. R PAGE Rateable Valve ... ... Ranyard Nurses ... 21 Restaurants ... 51 Registered Workshops ... 54 Rheumatism ... 78 S Sale of Food and Drugs Acts 56 Salads 88, 56 Samples, proceedings re 57 Scarlet Fever, notifications 3 Scarlet Fever 20 Senility 78 Slaughterhouses 51,74 Staff 76 Stale Milk 72 Sputum Examinations 25 „ Flasks 34 Sunlight 85 T Thyroid Gland 79 „ „ deficiency 79 Treatment Centres 23 Turkish Baths 84 Tuberculosis Dispensary 32 Tuberculosis, Disinfection in 34 Tuberculosis Officer's Report 26-34 „ Notifications 27 „ in Wards 29 „ Prevention of 34 „ Sanatoria 34 „ „ Cases admitted 34 „ Treatment of 30 „ Register 33 „ Dental Treatment 34 vi i. u PAGE Unsatisfactory Milk ... 71 Unfit Dwelling Houses ... 46 V Vegetables 84 Verminous premises 60 Vitamines 83 Visits of Health Visitors 62 Vital Statistics 5 Voronoff 80 w Wear and Tear 79 Work of Health Visitors 63 Workshops 50 Workplaces 50