DEPT 21 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. Member Executive Committee National Baby Week Council. Examiner in Hygiene, University of London (Goldsmiths' College). Associate of the British Association for Physical Training. Medical Officer of Health. 1 927 DEPTFORD: Gaylard & Son, 44G New Cross Road, S.E. 14 Public Health Committee. Mayor. Councillor Mrs. B. M. DRAPPER, J.P. Chairman. Councillor E. C. WOOD. Vice=Chairman. Councillor W. H. GREEN, J.P. Alderman Mrs. G. E. Green Alderman R. L. W. Hall Alderman W. Taylor Councillor Mrs. A. A. Cheason Councillor A. G. Howard Councillor J. C. Manifold Councillor Mrs. G. Tiffen, J.P. Councillor E. H. Warcup Councillor Mrs. L. E. White Maternity and Child Welfare Committee. Chairman. Alderman Mrs. G. E. Green Vice-Chairman. Councillor Mrs. G. Tiffen, J.P. Alderman R. L. W. Hall Alderman W. Taylor Councillor A. J. Boyd Councillor Mrs. A. A. Cheason Councillor W. H. Green, J.P. Councillor Mrs. M. Herlihy Councillor J. C. Manifold Councillor E. H. Warcup Councillor Mrs. L. E. White a 2 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. N. M. Donnelly, m.b., 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. 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). Thomas R. W. Mason ,, s.i.e.b (London). Arthur C. Webster ,, s.i.e.b. (London). ,, Royal Sanitary Institute. ,, ,, ,, ,, (Meat and other Foods). Health Visitors. Miss E. Clubbe, Certs. General Training; c.m.b. and Health Visitor (r.s.i.) „ M. Little „ „ „ c.m.b. ,, E.E. Reynolds „ „ „ c.m.b. ,, M. F. Robus „ ,, ,, 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. Light Treatment Centre. Nurse in Charge— Miss E. Holland, Cert, c.m.b., Cert. Health Visitor (r.s.i.), Cert. Sanitary Inspector (r.s.i.). 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, ,, ,, ,, V. Hampson „ ,, ,, M. Baxendale, ,, ,, ,, Tuberculosis Dispensary. Hilary House, 78 Amersham Vale, S.E. 14. Tuberculosis Officer—N. M. Donnelly, m.b , d.p.h., Secretary, Tuberculosis Care Committee. Miss B. Lewellin. Tuberculosis Nurses—Miss E. M. Porteous. Miss A. M. Roy. 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—T. Lyons. J. Crisp. F. Smith. J. Lloyd. General Assistant. E. H. Evans Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross Road, S.E. 14. May, 1928. To The Worshipful the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Madam Mayor, Ladies and Gentlemen, I have the honour to present to you my seventh Annual Report on the sanitary circumstances, sanitary administration and vital statistics of the Borough, together with observations on the matters upon which it is considered desirable to report. In Circular 834, the Ministry of Health point out that this Report should be of a more simple character than the full Survey Reports which are called for periodically. The following are some of the principal features of the year:— 1. A faint rise in the general death-rate from 11.3 to 11.5, yielded nevertheless a rate lower than that for England and Wales as a whole (12.3) and lower than that for the County of London (11.9). The death-rates for the 107 County Boroughs and great towns was 12.2. 2. The Infant Mortality rate, 58 per 1,000 born, was again gratifyingly low; the record of 56 was obtained in the year 1926. It should be noted, however, that whereas in 1926 there were 119 infant deaths, the number in 1927 was 111. Why, then, was the 1927 rate higher than the rate in 1926? It is due to the fact that this rate is calculated on the number of births in a given year. In 1926 the births numbered 2,108, whilst in 1927 they numbered 1908—a fall of 200— 2 which arithmetically gives us a higher infant mortality rate for 1927 than for the previous year, although as an actual fact fewer infants died in 1927 than in the previous year. In the body of the Report a table will be found setting forth the number of deaths of infants for the past ten years; this table shows that as recently as 1921 the number of infant deaths was more than twice the number for the year now under review. This is progress. It remains to be noted that the infant mortality rate for the County of London in 1927 was 59, for England and Wales 69, and for the 107 County Boroughs and great towns 71. 3. A fall in the Birth-rate from 18.2 to 16.8, compares with the County rate of 16.1, England and Wales 16.7, and the great towns 17.1. Two hundred fewer births in one year in the Borough !! Is this a good thing for the country? We certainly wish to populate the Empire with our own people, but the decline of births is, on the whole, a good thing. It is better to see small families, well fed and dressed, than to have large families and to see the struggle to bring them up. Best of all is it to think that wives are no longer old before their time, thanks to over production. 4. The Deaths from Pulmonary Tuberculosis show an increase of 28 over the previous year, numbering 119; this is the largest number since 1922. Doubtless the climatic conditions of the year 1927 hastened the end in some cases, but with the prevailing crowding of families in houses, we cannot expect that our efforts to stamp out this disease will be as rapid as we could wish. Non-pulmonary tuberculosis, which implies tuberculous glands, bones, etc., accounted for 13 deaths, compared with a similar number for the previous year. 5. Cancer deaths for the last six years have numbered respectively 146, 140, 148, 164, 159 and 170. Earnest endeavours are being made to find the cause of cancer. 6. Heart Disease. This is the greatest killing disease in the country, and the deaths for the last six years have numbered locally 164, 147, 173, 176, 188 and 222. People must die of something eventually, so that many deaths from heart trouble after the age of 65 must be expected. Wear and tear are the principal causes of heart trouble and the speeding-up of life generally within recent years is the principal factor responsible. 3 As Rheumatic Fever in the young is a cause of heart disease, one turns with interest to study the numbers of deaths at different age groups from 5 to 45 years. There is no cause for alarm here. Between the ages of 45 and 65 there is a steady increase, but this is more likely to be due to wear and tear. Much attention is now being given to the subject of Rheumatism. Formerly, alcohol was a serious factor in the production of heart disease, and doubtless many cases still arise from over indulgence. On the whole, people do not drink to excess nowadays. 7. Housing. As usual, this is the most clamant condition with which we have to deal. It is gratifying to read in the press that a great housing and slum clearance scheme is under consideration; it is essential therefore that our knowledge of this subject as far as the Borough of Deptford is concerned should be up-to-date, so that our claims may receive early attention. To commence with, we have some 800 houses involved in areas which were "represented" as far back as 1920 under the Housing Acts. These 800 houses are still standing four-square to the world and they smirk at me every time I pass them. The areas in question are known respectively as the Frankham Street, Bronze Street, Baildon Street and Speedwell Street areas; their demolition is long overdue. The London County Council has recently demolished 22 houses in Watergate Street. These have been replaced by Blake House (17 tenements) and Hawkins House (50 tenements). In addition to this, the London County Council, within recent years, has provided houses for 444 Deptford families on the Downham Estate, and "the full quota of ten per cent. to Deptford has been provided on the Bellingham Estate." I feel that, relatively, the County Council has done very well by us in accordance with the houses they have built, but the Housing question locally is mainly one of providing for the needs of the many, many families whose breadwinners can neither afford the time nor the railway, car or 'bus fares to travel to and from Downham, etc.; nor 4 can many afford the rents. I am afraid that a man earning round about £3 per week is not likely to meet with much success when applying for a house. A rent of 15s. 6d. for a three-room cottage at Becontree is beyond his powers. Numbers without end must live in Deptford to be near their work, to report for duty at 7 a.m. What is the position ? What are the needs in Deptford? Before dealing with these questions we must examine that tricky word "overcrowding." It is true that this pre-war word is not out of date; if slavishly adhered to it can give a wrong impression. By "overcrowding" the Registrar-General means a house in which there are over two persons per room. Yes, but what size of room, and of what cubic capacity, one asks? Manchester, amongst other things, looks at the problem from the number of people per bedroom: over 2½ persons per bedroom is considered overcrowding. To be scrupulously fair we have, in the overcrowding figures given below, counted two children under ten years of age as one adult; thus the figures hardly represent the full facts. Now the true way to ascertain the Borough's needs is to take several streets of houses of average "class," and ascertain not only the overcrowding but also the number of families there are per house. It is of course quite a common experience to find two families in a house without overcrowding. The existence of two or more families in a small house which is not adapted for the needs of more than one, is in itself sufficient evidence of the need for more accommodation; there is bound to be either friction or heartburning, or at least inconvenience where there are two families in one house. In 1927, we ascertained once again the Borough's needs in two ways : (a) By house-to-house inspection of 2,832 houses. In making these inspections the Sanitary Inspectors were not asked to go to any special streets; they took those which were due, in the course of time, for routine inspection. (b) By inspection of houses on complaint or as the result of the occurrence of cases of infectious diseases. In the body of the Report I shall deal with these later. As regards (a), the number of families living in the 2,832 houses was 4,851. Of these, 2,718 families, or 56 per cent., were living two families per house; i.e., 1,359 houses contained two families each. 822 5 families, or over 16 per cent., were living three families per house; i.e., 274 houses contained three families each. 128 families were living four families per house, and 20 families five per house. In the body of the Report I have given a table in which will be found the names of the streets examined, and the details. Amongst the 2,832 houses there were 264 cases of overcrowding, on the RegistrarGeneral's definition. At the lowest estimate, 3,378 families, or 69 per cent. of the 4,851 families should have a house or flat. There are some 18,000 structurally self-contained dwellings in the Borough and 28,000 families. We believe that the 2,832 houses in question give a fair index of the conditions in the majority of the wards of the Borough. The worst conditions were found as the result of complaint. (See in the Report.) Here we may give a table, kindly prepared by Dr. N. M. Donnelly, Tuberculosis Officer, dealing with the sleeping accommodation of 196 of the cases of Tuberculosis notified during 1927:— Separate room One other in room Two others in room Three others in room Four others in room Five others in room Separate bed One other in bed Two others in bed Three others in bed 46 Non-pulmonary cases 8 11 10 7 7 3 18 19 7 2 51 Pulmonary cases (not known if T.B. in sputum) 14 26 7 4 - - 18 28 5 - 99 Pulmonary cases with T.B. in sputum 36 35 17 8 1 2 40 44 12 3 The Borough's Needs. We need the immediate erection of a large number of five-storey buildings such as Blake House, erected by the County Council on the Watergate Street area. Not less than fifty such buildings should be erected each year following the demolition of each part of the condemned areas. Certain families displaced from the demolished areas should be promoted to houses vacated by those who enter the said buildings. Each year a faithful and painstaking record would be made by your officers to ascertain the exact moment at which further new buildings would no longer be required. 6 At present there are thousands in the Borough who, through lack of privacy, are disheartened and discouraged. 8. Prevention of Diphtheria. Hitherto our efforts to control Diphtheria included an examination of contacts, swabbing where a "carrier" was suspected, advice in cases where there was some oro-nasal abnormality, the administration of local antiseptics, the examination of cases after leaving hospital, etc. On the 16th March we introduced the Schick Test and Inoculation against Diphtheria. By the end of 1927, 647 persons, practically all children, had come forward for the test and the inoculation where necessary. A statement on the subject is given herein. No adverse incident of any kind falls to be recorded. I am satisfied that the fall in the incidence of Diphtheria is to some extent due to the inoculation: we are not having so many "return" cases as formerly. Parents have repeatedly expressed their thanks for this preventive work. 9. New Legislation. During the year the following Acts and Regulations came into force:— The London County Council (General Powers) Act, 1927, Part VI of which gives power to destroy pigeons and doves, and to enforce where practicable, natural lighting and, in all cases, artificial lighting from sunset to 11 p.m., of staircases of tenement buildings (other than houses-let-in-lodgings for which by-laws already exist). The Public Health (Infectious Diseases) Regulations give additional powers in respect of "Carriers." The Public Health (Preservatives in Food) Amendment Regulations, 1927 modify the previous Regulations as regards existing stocks of ham and bacon. The Births and Deaths Registration Act, 1926 came into force on July 1st, 1927. Stillbirths became registrable. 10. It now only remains to be added that many interesting articles will be found in the Report, written by Drs. Donnelly and Hill, Miss Lewellin, Secretary of the Tuberculosis Care Committee, and Inspector Yates, on Tuberculosis, Maternity and Child Welfare work, Tuberculosis After-Care, and Rat Extermination, respectively. 7 The question of Smoke Abatement, though steadily aimed at, is handicapped for want of by-laws dealing with permissible time of smoke emission per hour or half-hour. A Committee is taking evidence on the subject and it is hoped that by-laws will be forthcoming soon. During the year plans were prepared for a new Public Health Centre at Harton Street, Deptford Broadway. This building was opened in January, 1928, and though the subject should be reserved until next year's Report, some details will be found herewith. In conclusion, I have to express my cordial thanks to you for your unfailing kindness and cordial support, and to the staff for loyal work well done. Your obedient Servant, Charles S. Thomson, Medical Officer of Health. 8 Summary of Vital and Mortality Statistics. 1927. 1926. 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 113,800 115,700 *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 6.3 6.1 Density 73 per acre 74 per acre Length of Public Streets 53 miles approx. 53 miles approx. Rateable Value £676,258 £674,434 1d. Rate produces (approximately) £2,762 £2,741 Cost of administration of Public Health Department £4,426 £4,310 Marriages 927 842 Marriage Rate 8.1 7.3 Births 1,908 2,108 Birth Rate 16.8 18.2 Birth Rate, average for the last 10 years 21.2 22.1 Deaths 1,312 1,302 Death Rate 11.5 11.3 Death Rate, average for the last 10 years 13.2 13.5 Infantile Mortality (total) 58 per 1,000 births 56 per 1,000 births Infantile Mortality of illegitimate babies 154 per 1,000 births 130 per 1,000 births Infantile Mortality, average for the last 10 years 78 per 1,000 births 81 per 1,000 births Zymotic Death Rate 0.3 0.7 Deaths from Measles (all ages) — 31 Deaths from Whooping Cough (all ages) 11 5 Deaths from Diarrhoea and Enteritis (under 2 years of age) 8 19 •Structurally separate dwellings occupied by private families, i.e., houses and self contained flats. Area and Population. Births and Deaths. 11 Area and Population. Acres. Estimated Population. 1,564 113,800 The population of Deptford to the middle of 1927 has been estimated by the Registrar-General as 113,800. 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, and on the estimated population at the revision of ward boundaries in 1925, was as follows:— Deptford Park 9,261 Hatcham 10,997 Evelyn 10,847 Pepys 8,303 St. Paul's 10,781 St. Catherine's 7,812 Vale 11,152 St. Peter's 6,837 Clifton 12,353 St. John's 7,329 Canterbury 9,945 Town Hall 8,183 As the Borough has an area of 1,564 acres, the density of the population on this estimate is 73 persons per acre approximately. Social Conditions. Chief occupations of the inhabitants : the influence of any particular occupation on public health. I have dealt so fully with the details of this subject in my last Annual Report, that anything here would be vain repetition. Last year I described a number of factories and workshops in the Borough which I had visited, and this year another batch is given; it is intended that this will be a regular feature year by year, so that we may eventually have a complete record available of the chief occupations of the inhabitants. No evidence has been forthcoming to show that any local occupation exercises an adverse influence on the health of the workers engaged therein. 12 While quite a large number of inhabitants work in other boroughs, we have in Deptford such occupations as Engineering: one thousand men and fifty women are employed by one firm alone. Sheet Iron Workers and Galvanisers. Close on six hundred men and a handful of women are engaged by another firm. A third firm has 440 employees, mostly women, engaged in tin box manufacture. Electrical work of all kinds, sewing machines, skin cleaning, belting manufacture, glass works, trunk making, steel girders, machine works, medicated salts, colour printing, laundries, and a shirt factory (which last has some 800 employees), all serve to give an idea of occupations in the borough. I have described most of these in past reports, so will now proceed to discuss those firms which I have personally visited in 1927. Chemical Works. The work here is carried out in two departments : sugar refining and chemical works proper. Sugar Refining. In the top storey we found bags of rice meal. The meal is emptied into cylindrical vacuum boilers, where the starch is extracted from the rice meal, thus converting it into sugar. In this form it is termed "caramel." It is used in beers, stouts, ales, sometimes in the place of hops. "Caramel" is also sent to confectionery works for use in the preparation of sweets ; it is also sent to gravy-salt works for colouring. Chemicals. Bisulphide of lime and calcium salts are manufactured for different purposes; also, cakes of soda for washing out beer barrels. Sodium hypochlorite solution is manufactured and is used for washing out those tubes through which beer is passed from the barrels to the engines in the public houses. Isinglass is made (for refining beer) in the form of tablets along with potassium salts. A preparation is made from bitumen for lining the inside of beer vats. There are 24 male employees, for whom there are two pedestal w.c.'s in separate compartments. Across the road, in that part of the works near Gosterwood Street, there are two w.c.'s and four modern stall urinals of glazed earthenware—modern and highly satisfactory. The ventilation, heating and lighting, are all good. Owing to the nature of the manufacturing process, the premises generally cannot be kept clean and dry. 13 Oil Refining. This firm carry on the business of oil refining and distilling. Via the canal, the firm receive from abroad tons of crude oil in tank barges. The oil is placed in large stills and distilled. The refined oil is sold as lubricating oil for machinery generally. According to the distilling process it has been through, the resultant oil is classified in different weights; thus, there is heavy oil for cylinders, etc., on the one hand, and light oil for sewing machines on the other. Resin. This is brought in barrels and distilled for the purpose of making printers' ink. The resin is purified and refined for various commercial processes, e.g., for polishes for hats, for gums and varnishes, etc. Pitch. This is distilled and oil is added and is treated according to grade or quality of the pitch required. 24 men are employed, for whom there are four pedestal w.c.'s with glazed brick surroundings, and three urinals; these are excellent. Owing to the nature of the process, things are dirty generally. Confectionery Works. This firm is engaged in the manufacture of boiled sweets and chocolates. The premises consist of a one-storey building which is well lighted and ventilated. These premises were not made originally for the purpose of confectionery making, but have been adapted for the purpose. The process consists of boiling refined cane sugar and glucose in gas heated copper pans. Various other ingredients are added according to the particular sweet which is being made (various fruit flavours, butter, peanuts, cocoanut, raisins, tartaric acid—for acid drops). The whole mass is run out upon tables and is moulded or pressed into different shapes, or rolled out into long stalks and cut off to the required length. The chocolate used at these works is imported ready made from Holland and is melted and used for encasing various sweetmeats. All the ingredients used are imported ready for the process of manufacture, with the exception of the peanuts, which are roasted in a rotary roaster, with the object in view of removing the outer skin and cooking the nut. Cleanliness. The workrooms have been colour-washed throughout and the floors covered with fresh sawdust daily. If this were not b 14 done, the floors would become sticky and dirty owing to the process. The firm employs 50 females and 6 males and the sanitary accommodation for each sex consists of two w.c.'s. These are of modern pedestal type in separate enclosures. Recently our Inspector caused the women's w.c.s to be screened and ventilated satisfactorily. No accommodation, beyond a cloakroom, is provided for meals, but practically all the employees go home nearby at meal times. Two points of interest—here is a food process in which the sweet is handled in process of manufacture and yet I could hardly see a single wash hand basin. Again, in the peanut roasting room, the room was dirty and the hands of the women seemed none too clean. I expressed my views pointedly to the manager. This room has now been thorougly cleaned and the Inspector has supervised the putting up of an ablution bench with basins, towels and soap. Confectionery Manufacturer. The works consist of two long well lighted and well ventilated workshops. In one of these the floor is boarded and is treated as described above. The floor in the other is made of a hard impervious patent material, easily cleaned and far more satisfactory than if made of wood or cement. The process is just the same as in the above workshop, and the ingredients are imported. Thirty females and twelve males are employed. The female sanitary accommodation consists of two w.c.'s in separate well-ventilated enclosures; the w.c.'s are of a modern pedestal type. The women's accommodation is in a yard by itself and is excellent. There are two w.c.'s for men, and in one of them our Inspector has recently given instructions for improved ventilation and lighting. This work was in process of completion on my visit. A room is provided in which the women can have their meals. Two things struck me. The washing accommodation consists of sinks and taps, without soap or towels. This is now being remedied. Again, the ground at the rear contained barrels, cases and lumber, and the ground was uneven. The cases have now been taken away and the surface of the ground is being levelled to prevent the possibility of puddles accumulating, and to enable the whole yard to be kept clean and tidy. 15 Cattle Food. This is a two-storey building used for the manufacture of cattle food. Cocoa-nut husks are received in bags on the top storey, and they are shot down through hoppers into the machines on the floor below, where the contents are ground into fine powder. These are wrapped in bags and sold as cattle food. Waste chocolate is received here and is ground again into powder. The premises are well lit by casement windows; ventilation, by doors and windows, is also satisfactory. The floors were of wood and were unavoidably dusty owing to the process carried on. Heating was effected by means of steam pipes. The number of employees is seven men, for whom there is one pedestal w.c. There are two female clerks for whom there is one w.c. Paint Works. This business has been established for over five years, having removed from a site in New Cross Road, where it existed for some ten years previously. There was a laundry previously on the present site. The ground generally in the vicinity is littered with metallic scraps and builder's refuse ; the manager informed us that he is slowly clearing this up. The works consist of a two-storey building; the top storey is used as a store-room and packing-house; the ground floor contains the machinery for grinding and mixing the colours. The latter arrive in powder form from different colour merchants and are ground in a rotary mill to a finer powder, passing over rotary drums where the colour powder is mixed with oil, turpentine, etc. Other colours are added, such as green, yellow, etc., in accordance with the particular shade required. There is another room on the ground floor used as a storeroom for paints. As the paint is made it trickles into the drum, which, after being filled, is labelled and despatched. The second room is used for putting up smaller tins from the large stock tins. The lighting and ventilation of the premises is good, and there are four taps, with soap and towel, for washing accommodation in the yard. Seven men are employed for whom there is one satisfactory pedestal w.c. This was installed at our request last summer. 2b 16 Clinical Thermometer Makers. Eight men are employed at this small workshop, for whom there is one w.c., which is shared by the adjoining milk dealer. The workshop is well lit, clean and well ventilated, Long glass tubes arrive at the shop and here they are graduated after being cut to the required length. The ends are then closed by means of a bunsen burner, and the half-prepared thermometers despatched. A Pharmaceutical Workshop. This is a two-storey building comprising part of the old pre-existing laundry. It is constructed of brick, with wood floors, and is excellently lit and ventilated; the upper floor is lit by means of skylights. Alterations have been carried out to adapt the place to its present use and make it in every way a very satisfactory workshop. The rooms are heated by gas radiators and the whole is kept scrupulously clean. The large main room is on the second storey and is used mainly for bottling and labelling various medical requisites such as corn paint, pectoral balsam, and a host of others. The ground floor is used mainly as a store for receiving and packing goods, and there is. a small laboratory for the manager. The old engine house is used for cleaning and drying bottles, the latter process being carried out in a specially equipped heating chamber at about 90° F. The work at these premises is entirely wholesale. There are thirty girls employed, for whom there are four excellent pedestal w.c.'s in well-ventilated separate enclosures. As a matter of fact, the present sanitary accommodation is considerably in excess of that required, but the manager is expecting to increase his staff, as the work is developing steadily. We have asked the manager to provide proper dustbins to take the place of the present boxes ; of course, most of the refuse is packing material, shavings, etc., and this is burned in the furnace. In addition, there are five men employed, for whom there is one w.c. Paint and Varnish Manufacturers. This is a three-story building built of brick, originally used as a printing works, but adapted to its present use. This firm manufactures its own specialities. The top floor is used for storage purposes only; here we found girls engaged in filling tins with enamel, labelling and 17 packing the same. Goods are despatched throughout the world. The middle floor contains machinery for mixing and filling into the larger drums; the same is found on the ground floor. Here also tins are coloured by a patent spray process. Ventilation. On the ground and top floors this is satisfactory; in the former there are open doors and windows, and in the top floor windows and skylights. As regards the middle floor we discussed the ventilation with the Factory Inspector. Sanitary Accommodation. There are three w.c.'s for 15 females; these are pedestal w.c.'s in separate compartments, and they are well ventilated. Washing accommodation consists of small sinks, towels, etc. 45 males are employed, for whom there are three w.c.'s and a lip urinal. We have requested the firm to cleanse these w.c.'s and the urinal, and to improve the lighting and ventilation of the same. Heating. This is carried out by steam. Lighting. This is satisfactory, both naturally and artificially, the latter being by means of electricity. We drew the manager's attention to the general untidy and dirty condition of the front of the building, where straw, barrels, and general litter abounded. There is a good incinerator for consuming the factory waste, etc.; the outlet pipe passes into the main boiler shaft. Following the coal strike the boiler is now heated by oil fuel, and in view of the ease with which this can be controlled, and the satisfactory results from the use of the same, the firm does not intend to return to the use of coal. From our point of view this is important, as an extension of the same would help us as regards the smoke nuisance. There is a mess room for the girls, but none for the men, practically all of whom, we were informed, live near at hand. A Gas Mantle Company. These premises stand back some thirty-five yards from Evelyn Street. They consist of a two-storey building devoted to the manufacture of incandescent gas mantles. The manager's office, a small one, is situated on the first floor ; there is a small laboratory adjoining this containing the usual chemical preparations used in the process. Passing from the laboratory we come to the weaving room, where there were some thirty girls engaged in "weaving the stocking." The 18 stocking is woven, by rotating machines, from the Ramie thread. The stocking is then cut into lengths, say of four inches, so yielding little cylindrical tubes. The end of each of these small lengths is treated with a red-coloured solution and then an asbestos top is tied on and the end is closed with the aid of a small wooden contrivance. These embryonic mantles are then put upon trays and are taken into a separate small chamber where they are saturated in a solution of sodium thoriate. Iron trays are now packed with these and the trays are carried downstairs to the "iron and concrete" room on the ground floor. The expression "iron and concrete room" is our own: it conveys the idea of a room which is bare as regards ordinary perishable or inflammable furniture. There are tall iron crates in this room into which the trays are fitted after their contents, the soaked embryonic mantles, have been treated, as now to be mentioned. Over near the wall were a number of burners, burning with a fierce blue flame under a pressure of 14 lbs. to the square inch. An equal mixture of gas and air is burned, the resulting flame not yielding any "yellow" or carbon-yielding products. The mantles are subjected to this intense heat and the fabric of the mantle, the original stocking made of Ramie fibre, is consumed, leaving a flame of fine ash in the form of thorium salts. This mantle is now capable of sustaining 100 times its own weight. The mantles are then taken into the asbestos chamber where they are stiffened by soaking in collodion. This is the final process. Finally, the mantles are packed in boxes and are sent off to the Straits Settlements, Fiji Islands, etc., and other places in the British Empire. There are only some eight other firms engaged in this trade in the United Kingdom. Premises. The ground floor is constructed of iron and concrete; the fumes and heat from the burners and mantles are drawn off into a large tube by means of an exhaust fan. They are then driven up a shaft by another fan into the outside air. On this floor are two pedestal w.c.'s, each in a separate compartment, both well ventilated. There are two enamelled iron sinks with cold water, soap and towels. A packing room is situated next to the iron room. As regards the "weaving room" the floor, which is quite dry, is made of wood and rests on concrete. From this room a passage leads to three w.c.'s of the same type as those mentioned above. There is a firescape at each end of the room. The ventilation of the whole is by means of open doors, casement windows, louvres, and skylights in the roof. In the 19 iron room on the ground floor, the intense heat evolved by the burners raises the temperature of this room by radiation; from this room the weaving room just overhead is heated by conduction and convection. Particularly in the iron room and less so in the weaving room there is a peculiar aroma arising from the incandescent mantles. The walls are due for cleansing in February. It is noteworthy that the girls in the iron room wear blue tinted glasses to protect their eyes from the glare of the incandescent mantles. This is important. I remember years ago it was alleged that men engaged in the glass-blowing trade were suspected as suffering unduly from cataract owing to the glare. The number of female employees is 77. Bag, Sack and Tarpaulin Makers. The building consists of three floors built in two sections with communicating bridges between. On the ground floor are loading rooms where lorries come with raw material and take away the finished article. On this floor there is the employees' cloakroom and also the messroom; nearly all the employees live close at hand. The female sanitary accommodation consists of six pedestal w.c.'s in separate enclosures which are well ventilated by means of louvres and gratings in the wall; for ablution purposes there are two square enamelled iron sinks with soap and towels. Drinking water is specially provided from the main. The raw material, received on the ground floor, arrives from Dundee (two-thirds) and from India (one-third). This is known as "Hessian," and the Indian material is of coarser make or fibre. When the bales of this material arrive they are as hard to the touch as stone or iron. They are taken on to the first floor and are separated out with a metal rod or bar. When a considerable length of this, say eight yards, has been unrolled, it is lifted on to a long table. A young woman pulls the end to a measured line on the table and a second young woman cuts through the length required opposite another table mark, with the aid of a long knife worked by a lever. The same process is repeated again and again, the same lengths being cut for a particular type or size of bag which is to be made. The bags to be made are of different sizes according to the purpose for which they are designed. Some, for example, are for retailers of coal; in this case the finished bag is brushed over with a tarry solution before being sold. Other sized bags are made for the following purposes ;—(a) Cement, 20 for the Association of Portland Cement Manufacturers ; (6) Molassin Meal; (c) Union Coal Co., bags; (d) Market gardeners; (e) Messrs. Paget, of Bristol, for feeding material; (f) Leeds Co-operative Stores; (g) Garton & Sons, seedsmen; (h) Small potato bags for market garden use. Various kinds of different sewing machines are used for different sets of bags required. In different industries in Deptford and elsewhere I have been struck with the veritable inferno created by the noise of machinery. One's admiration goes out to the brains which conceived all such machinery, but it would be a fine thing if the nerveracking, deafening noise could be eliminated somehow. The sewing machines used in this factory are worked by electric power, the women skilfully direct the edges to be sewn from end to end. We were struck by the concentration shown by those manipulating the machines and material; how greedily the machines "eat up" the goods ! The rooms on the different floors are large and spacious. The wooden floors are dry but the nature of the work tends towards dust collection. The ventilation is good, being effected by windows and doors. Steam pipes and radiators are in use. General cleanliness is good, though dust collection had to be mentioned to the manager. We also pointed out that the yard outside must be kept clean. There are 50 females and 9 males employed, and for these there are one w.c. and one glazed earthenware stall urinal for the men, while the female accommodation has been mentioned above. Instructions were given for the male w.c. to be hosed down. Spinning Company. This one-storey building contains a machine shop, a spinning shop, a carding and operating shop, and stores devoted to the making of string and cords. The workshops are lighted by windows, and skylights in the roof, and this is quite satisfactory, whilst ventilation, secured by louvres in skylights, and open windows, was good. The sanitary accommodation for the 28 males consists of one w.c. and one urinal. The men's urinal was dirty and is to be cleansed with acid and then tarred. For the 135 females there are four w.c.'s. It will be noticed that this number does not conform to the legal requirements and we are drawing the attention of the firm to the deficiency, six are essential as there must be one w.c. for every 25. We were not satisfied 21 with the existing sanitary accommodation as a whole. Notice to cleanse is being sent also, and improvements in the lighting and ventilation are being required. Just at the side of the w.c.'s some refuse had been left lying, and we are requesting the installation of a dustbin. For the ten females in the office staff one satisfactory w.c. is provided. Process. The stranded hemp arrives in bales on the canal from India and China. The bales are opened and the hemp is passed through separating machines dividing the hemp into strands. The strands are then passed through mixing machines, thus mixing the strands according to the quality or description of the cord required. The stranded hemp is then passed through a cord-making machine, coming out as the finished article, wound upon reels or into bundles or coils as required. The noise created by the machinery is very great. The floors are of cement with wood for the employees to stand upon. Whiting Works. These works are devoted to the manufacture of whiting. Spread over an acre and a half of ground the works consist of a series of sheds roofed over with galvanised iron. The ground is impregnated with whiting dust, and much space is taken up by the tanks and reverberatory furnace. Crude chalk is brought from Purfleet via the canal by means of barges. Men can be seen unloading the contents direct into the works. A man shovels the chalk into a crushing mill. This is about 12 or 15 feet in diameter, and as the apparatus revolves on a plane parallel with the ground, it crushes the chalk and mixes it intimately with water. The finely ground chalk and water flows through a series of settling tanks. Imagine 50 of these tanks, each 9 feet by 6 feet and probably 7 feet deep. The tanks are contiguous, and they communicate by a small opening in the wall of each. The chalky fluid passes slowly from the first tank right through each until the final row of six tanks is reached. The flow movement is hardly perceptible. All this time—two weeks are spent in flowing from start to finish—the coarser and extraneous matters fall to the bottom of the tanks. The fine grains are kept in suspension and do not settle until the last six tanks are reached. The waste liquor or water is drawn off. Sometimes this is allowed to run to waste, but then again it may be pumped back to the mill, so being used over again with fresh pulverised chalk. When it is estimated that the last tanks contain a sufficient 22 deposit of the refined material, e.g., whiting proper, the superjacent fluid is drawn off and men enter the tanks and dig out the deposit. The latter is then placed on to the large flat top or surface of the reverberatory kiln. The masses lie smoking (fluid given off) and drying for 48 hours. The kiln is heated by coke which is inserted through the furnace doors. Once dried, the masses are removed. Some is sent out in lump form, while some again is passed into a special mill where it is ground into a fine powder and is then packed into bags. Nineteen men are employed for whom one w.c. is provided. We have a difficulty here. When the wind is blowing in a certain direction, fine whiting dust is carried over on to the back of the houses in Grinstead Road. We have, before this, received complaints from the householders to the effect that this dust affects their washing, etc. The works, however, were established before the houses were built. It is a genuine difficulty, for even if a screen were put up it would be a costly process, and would need to be very long and very high. Further, the question arises as to who would need to pay the cost of the same. Tar Refiners. At these works tar is refined, thereby yielding valuable extracts. The works consist of office buildings and stores, the remainder of the ground being taken up by storage tanks, stills, condensers, etc. Tar is received in a crude form from various gas works in the south. It is passed into stills and distilled, and then into the condensers. The products obtained are naphtha, creosol, and green oils, the residue being pitch. The products undergo a further refining process in receiving tanks, and are then sent out to various commercial firms. Sixteen men are employed here, for whom one w.c. is provided. There is also a w.c. for the office staff. The men's w.c. is constructed in a small brick enclosure, and is of the pedestal type ; it is wellventilated and clean. Asphalt Manufacturers. The works consist of big sheds, under which the kilns and melting pots are situated. Crude chalk is brought up the canal by barge and is received directly into the works, this is placed on a coke-heated kiln and is thoroughly dried. The chalk is then ground and sand added. This mixture is then placed in melting coppers and bitumen is added; as the latter melts the whole is thoroughly mixed. The resulting 23 mixture—asphalt—is ladled out into casks which find their way to all parts of the Empire; thousands of tons are sent annually to Calcutta. Only three men are employed here constantly and one w.c. is provided for their use. This is of approved pattern; the ventilation is satisfactory. Distillers. These stores have subterranean passages which burrow for some distance beneath the ground. Wines and whisky are received in barrels and are bottled in the premises and then sent out. Gin is made on the premises through the double distillation of raw spirit. Juniper berry juice and orris root are added during the process. The sanitary accommodation consists of seven w.c.'s and one urinal for the 56 male employees and five w.c.'s for the 30 females. The w.c.'s are of modern pedestal type, each in a separate enclosure. Numerous lavatory basins are provided for the employees. Bottles are washed by means of up-todate plant, supplied with hot and cold water; the bottles are then drained and placed in a warm chamber to dry thoroughly. The lower floors are divided into stores; on the upper floors, bottling, labelling and packing takes place. The lighting, ventilation and heating—this latter is affected by steam—are all satisfactory. Some 30,000 to 40,000 gallons of Colonial wine, mostly Burgundy, are received and bottled; the demand for this wine is growing—whisky, etc., being so expensive. Births. Births. Birth rate per 1,000. 1,908 16.8 The total number of births registered in the Borough was 1,703, and of these 90 were transferred to other districts, as the permanent addresses of the parents were outside this Borough. Similarly, 295 births occurring outside of the Borough, in maternity hospitals, &c., were transferred to Deptford, making a total of 1,908 births in all belonging to Deptford. Of these, 937 were males and 971 were females. This figure gives a birth-rate of 16.8 per 1,000 of the estimated population, as compared with 18.2 for the year 1926. The birth-rate for England and Wales for 1927 was 16.7. „ „ the 107 County Boroughs and Great Towns was 17.1 „ „ the 155 Smaller Towns was 16.4 „ „ the County of London was 16.1 The rate for Deptford was therefore very slightly 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. 24 Table I. Year. Estimated Births. population. No. Rate per 1000. 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 1924 1] 5,200 2376 20.6 1925 115,900 2175 18.8 1926 115,700 2108 18.2 Average for 10 years 115,065 2451 21.2 1927 113,800 1908 16.8 Illegitimate Births. The illegitimate births numbered 52 or 2.7 per cent, of the total births. These occurred in the several wards as follows :— Deptford Park 4 Hatcham 4 Evelyn 3 Pepys 3 St. Paul's 6 St. Catherine's 3 Vale 4 St. Peter's 3 Clifton 4 St. John's 9 Canterbury 3 Town Hall 6 As far as can be ascertained, the occupations of the mothers in these cases were:-Domestic servants 13; Factory hands 11; Barmaids 3: Shop assistants 5; Typists, etc., 2. 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 1,731 births. Omitting still-births, which numbered 40, this gives a percentage of births notified to those registered of 89. Midwives notified 1,156; doctors 422; parents 143; other persons 10. Marriages. Marriages. Marriage Rate 927 8.1 The Superintendent Registrar has kindly furnished me with the particulars. There were 927 marriages in the Borough during 1927 as 25 compared with 842 in the previous year. The marriage rate was equal to 8.1 per 1,000 of the population as compared with 7.3 for the year 1926. The marriages were solemnised in the following places:— 600 in Churches of England. 79 in other Places of Worship. 248 in the Superintendent Registrar's Office. 927 Total Deaths Deaths. Death Rate. 1,312 11.5 The deaths registered in Deptford numbered 745 equalling a deathrate of 6.5, as compared with 798 and a death-rate of 6.9 for the preceding year. Of this number, 115 were non-parishioners. The deaths of Deptford residents occurring outside the Borough in public institutions were 682, making a total of 1,312 deaths belonging to this Borough. Of these 693 were males and 619 were females. The death rate was 11.5, compared with 11.3 in 1926. The death-rate for England and Wales was 12.3 „ „ for the 107 County Boroughs and Great Towns was 12.2 „ „ for the 155 Smaller Towns was 11.3 „ ,, for the County of London was 11.9. The following table shows the number ot deaths which have occurred during the past ten years, with the respective rates:— Table II. Year. Estimated Population. Deaths. No. Rate per 1000. 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 1272 11.1 1924 115,200 1379 12.0 1925 115,900 1399 12.1 1926 115,700 1302 11.3 Average for 10 years 112,170 1467 13.2 1927 113,800 1312 11.5 * Civil population. 26 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:— Table III. Ward. Deaths. Death Kate per 1,000. Males. Females. Children under 1 year Total. Deptford Park 43 42 6 85 9.2 Evelyn 61 61 10 122 11.2 St. Paul's 94 65 16 159 14.7 Vale 61 64 9 125 11.2 Clifton 65 45 20 110 8.9 Canterbury 48 40 14 88 8.8 Hatcham 68 64 5 132 12.0 Pepys 49 56 3 105 12.6 St. Catherine's 45 46 6 91 11.6 St. Peter's 35 38 5 73 10.7 St. John's 61 46 6 107 14.6 Town Hall 63 52 11 115 14.1 Whole Borough 693 619 111 1,312 11.5 The proportion which the mortality at various ages bears to the total number of deaths during 1927 and the previous year is as follows Table IV. 1926 1927 Under 1 year 9.1 per cent. 8.5 per cent. 1 to 2 years 3.4 1.8 2 to 5 „ 3.0 2.5 5 to 15 „ 2.6 3.3 15 to 25 „ 4.5 4.6 25 to 45 „ 11.1 10.0 45 to 65 „ 27.5 29.4 65 years and upwards 38.8 39.9 Infantile Mortality. Infant Deaths. Infantile Mortality Rate. 111 58 111 Infants died before attaining the age of one year, i.e., 58 per 1,000 of the births registered. Of this number 8 were illegitimate, representing an illegitimate infant mortality rate of 154 per 1,000. 27 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 mortality per 1000 Births. Deptford Park 155 6 39 Evelyn 192 10 52 St. Paul's 269 16 59 Vale 214 9 42 Clifton 178 20 112 Canterbury 151 14 93 Hatcham 143 5 35 Pepys 106 3 28 St. Catherine's 90 6 67 St. Peter's 140 5 36 St. John's 111 6 54 Town Hall 159 11 69 Infantile Mortality Rates. England and Wales 69 107 Great Towns 71 155 Smaller Towns 68 London 59 Comparative table of infantile deaths from Diarrhoea and Enteritis. Table VI. RATE PER 1000 BIRTHS. Diarrhœa and Enteritis under two years. Total deaths under one year. England and Wales 6.3 69 107 Great Towns 8.3 71 155 Smaller Towns 5.0 68 County of London 7.5 59 Deptford 4.2 58 28 Table VII. TABLE SHOWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1927. Births 1908 Deaths 1312 Excess of Births over Deaths 596 Table VIII. INFANTILE MORTALITY RATE FOR THE PAST TEN YEARS Year. Deaths under 1 year. Infantile Mortality Rate. 1917 239 102 1918 205 97 1919 207 85 1920 259 79 1921 234 88 1922 195 74 1923 143 59 1924 180 76 1925 137 63 1926 119 56 Average for 10 years 192 78 1927 111 58 Deaths from Puerperal Sepsis — Deaths of women in, or in consequence of childbirth 2 Table No. IX. METROPOLITAN BOROUGH OF DEPTFORD. VITAL STATISTICS OF WHOLE DISTRICT DURING 1927 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. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1.000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 7.9 209 673 180 76 1,379 12.0 1925 115,900 2,017 2,175 18.8 818 7.1 142 723 137 63 1,399 12.1 1926 115,700 1,881 2,108 18.2 798 6.9 149 653 119 56 1,302 11.3 1927 113,800 1,703 1,908 16.8 745 6.5 113 682 111 58 1,312 11.5 Area of District in acres (land and inland water). 1,564. Total population at all ages 112,534. Total families pr separate occupiers, 28,007. At census 1921 29 30 Table No. X. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at, Death during the Year 1927. CAUSES OF DEATH. Nett Deaths at the subjoined Atles of "Residents" whether occurring within or without the District. All Ages. 1 Under 1 year. 1 and urrder 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, j 1 2 3 4 5 6 7 8 9 10 11 All causes 1312 111 23 33 43 61 131 386 266 258 Enteric Fever 2 .. .. .. 1 .. 1 .. .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever 2 .. 1 1 .. .. .. .. .. Whooping Cough 11 6 3 2 .. .. .. .. .. .. Diphtheria 14 1 2 3 7 1 .. .. .. .. Influenza 39 .. 2 3 4 2 2 12 9 5 Encephalitis Lethargica 2 .. .. .. .. .. 1 1 .. .. Meningococcal meningitis .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system 119 .. .. 2 5 31 46 31 4 .. Other Tuberculous Diseases 13 2 1 4 2 2 1 1 .. .. Cancer, malignant disease 170 .. .. .. .. 1 7 77 58 27 Rheumatic Fever 3 .. .. .. .. .. 2 1 .. .. Diabetes 6 .. .. .. .. .. 2 2 2 .. Cerebral Haemorrhage, &c. 56 .. .. .. 1 .. 1 20 16 18 Heart Disease 222 .. .. .. .. 3 23 75 57 64 Arterio-sclerosis 57 .. .. .. .. .. .. 21 16 20 Bronchitis 87 5 3 .. 2 1 3 21 18 34 Pneumonia (all forms) 120 18 11 11 2 5 7 23 23 20 Other Respiratory Diseases 15 .. .. .. .. 1 .. 6 3 5 Ulcer of Stomach or Duodenum 10 1 .. .. .. .. 4 4 .. 1 Diarrhoea, &c. 8 7 1 .. .. .. .. .. .. .. Appendicitis and Typhlitis 7 .. .. .. 2 2 .... 2 1 .. Cirrhosis of Liver 6 .. .. .. .. .. .. 3 3 .. Acute and chronic Nephritis 49 .. .. .. 3 1 5 19 14 7 Puerperal Sepsis .. .. .. .. .. .. .. .. .. . . Other accidents and diseases of Pregnancy and Parturition 2 .. .. .. .. 1 1 .. .. .. Congenital Debility and Malformation, including Premature Birth 45 44 .. .. 1 .. .. .. .. .. Suicides 11 .. .. .. 1 1 8 .. 1 Other deaths from violence 39 3 .. 1 6 5 4 13 3 4 Other defined diseases 197 24 .. 6 6 4 20 46 39 52 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. 31 Table No. XI. METROPOLITAN BOROUGH OF DEPTFORD. Infantile Mortality, 1927. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total Deaths under 1 year. A1I Causes 33 8 5 3 49 21 16 13 12 111 Small pox .. .. .. .. .. .. .. .. .. .. Chicken pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 2 1 3 6 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. 1 .. .. 1 .. .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. 1 .. 1 Other Tuberculous .. .. .. .. .. .. .. 1 .. 1 Meningitis (not tuberculous) .. .. .. .. .. .. • • .. .. .. Convulsions 1 1 .. 1 3 1 1 .. .. 5 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 4 .. .. i 5 Pneumonia (all forms) 1 .. .. .. 1 2 5 6 4 18 Diarrhœa .. .. .... . ... .. .. 1 .. .. 1 Enteritis 1 .. .. .. 1 2 3 .. .. 6 Gastritis 1 .. .. .. 1 .. .. .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. 1 .. 1 .. 2 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis 4 2 1 .. 7 1 .. .. .. 8 Congenital Malformations 3 2 .. .. 5 .. 1 .. . 1 7 Premature Birth 14 1 1 1 17 .. .. .. .. 17 Atrophy, Debility, and Marasmus 5 1 3 .. 9 8 2 1 .. 20 Other Causes 1 .. .. l 2 2 1 2 2 9 33 8 5 3 49 21 16 13 12 111 c2 Infectious and other Diseases. Table No. XII. METROPOLITAN BOROUGH OF DEPTFORD. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1927. Notifiable Disease At all Ages. At Ages—Years Total Cases Removed to Hospital. Under 1 1 to 5 5 to IS 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 412 7 121 214 47 22 1 .. 411 Erysipelas 71 1 3 7 12 14 25 9 22 Scarlet Fever 400 3 112 233 39 11 2 .. 390 Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 10 .. 2 3 2 .3 .. .. 9 Relapsing Fever .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 1 1 .. .. o Puerperal Pyrexia 16 .. .. .. 6 10 .. .. 7 Cerebro-Spinal Meningitis 2 .. .. .. 1 1 .. .. 2 Poliomyelitis and Polioencephalitis 1 . ,.. .. 1 .. .. .. .. .. Pulmonary Tuberculosis 172 .. 3 10 45 69 41 4 288 Other Tuberculosis 54 2 10 19 8 11 3 1 38 Ophthalmia Neonatorum 9 9 .. .. .. .. . . .. 2 Anthrax .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 54 28 26 .. .. .. .. .. 1 Acute Primary and Acute Influenzal Pneumonia 197 8 37 37 28 49 22 16 62 Malaria 6 .. .. .. .. 5 1 .. .. Dysentery 1 .. .. .. .. 1 .. 1 Encephalitis Lethargica 3 .. .. .. .. 3 .. 2 Measles 46 8 27 9 2 •• .. •• 7 Totals 1456 66 341 533 191 197 98 30 1244 34 Table No. XIII. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1927. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Deptford Park Evelyn St. Paul's Vale Clifton Canterbury Hatcham Pepys St. Catherine's St. Peter's St. John's Town Hall Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. • • .. .. .. .. •• .. .. Diphtheria, including Membranous 412 39 58 45 42 43 40 79 13 8 7 16 27 Erysipelas 71 6 5 18 3 6 8 9 8 1 3 3 6 Scarlet Fever 400 39 41 33 44 28 39 31 39 20 82 32 22 Typhus Fever .. .. .. .. .. .. .. .. .. .. . . .. .. Enteric Fever 10 .. 2 1 .. .. .. .. .. 3 2 1 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. •..• Continued Fever .. .. .. .. .. .. .. .. .. .. • • .. .. Puerperal Fever 2 .. .. .. .. .. .. .. .. 1 1 .. .. Puerperal Pyrexia 16 .. 8 .. 4 2 1 .. .. .. 4 .. 2 Cerebro-Spinal Meningitis 2 .. .. .. .. .. 1 1 .. .. .. .. .. Poliomyelitis and Polioencephalitis 1 .. .. .. .. .. .. .. .. .. .. 1 .. Pulmonary Tuberculosis 172 18 16 20 18 22 12 24 10 9 6 10 7 Other Tuberculosis 54 6 3 12 7 3 6 6 2 2 4 2 1 Ophthalmia Neonatorum 9 1 .. .. .. 1 1 1 .. .. 1 3 1 Anthrax .. .. .. .. .. .. • • .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 54 1 9 24 11 .. .. 1 .. .. .. 5 3 Acute Primary and Acute Influenzal Pneumonia 197 11 12 29 27 19 8 54 9 7 2 8 11 Malaria 6 .. .. 3 .. .. 1 1 .. .. .. .. 1 Dysentery 1 .. .. .. 1 .. .. .. .. .. .. .. .. Encephalitis Lethargica 8 .. .. .. .. .. .. 1 1 1 .. .. .. Measles 46 .. 8 4 7 5 2 10 4 2 .. 4 5 Totals 1456 121 147 189 164 129 119 218 81 54 62 85 87 35 36 INFECTIOUS AND OTHER DISEASES. Under the provisions of the Public Health (London) Act, 1891, the Tuberculosis Regulations, and the Deptford (Measles) Regulations, 1922, 1,456 cases of infectious diseases were notified, as compared with 2,578 in 1926. In a table on another page will be found a list of cases notified, and their distribution in the several Wards. To the seven principal epidemic diseases, viz.:—Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever and Infantile Diarrhoea, 37 deaths were ascribed, and the death-rate was 0.33 per 1,000 against 0.67 in the preceding year. On another page will be found a table indicating the number of deaths and death-rates from these diseases during the past ten years. Small-Pox. No person was notified as suffering from Small-pox during the year. Scarlet Fever. 1921 951 cases 1925 310 cases 1922 547 „ 1926 399 „ 1923 349 „ 1927 400 „ 1924 291 „ 400 persons were notified as suffering from this disease during the year under report as compared with a total of 399 for the previous year. Included in this total are eight patients who, after removal to hospital, were certified to be not suffering from the disease in question; also 3 cases which occurred amongst the staff of the South-Eastern Hospital. There were 2 dsaths as compared with 1, 3 and 2 in the three preceding years, giving a death-rate of 0.02 per 1,000 population, as compared with 0.01 for England and Wales, and 0.01 for the County of London. With only two deaths to record out of 400 cases, it might be said that Scarlet Fever is becoming almost a respectable disease. It would, however, be risky to lull oneself into a sense of false security, as the disease remains an infectious disease, and further, the possibilities of permanent damage to the kidneys should not be overlooked. No use was made of the Dick test in the Borough. 37 Diphtheria. The total number of patients certified to be suffering from Diphtheria was 412 as compared with a total of 582 for the previous year. Of this number 24 were errors of diagnosis, and 30 were cases amongst the Staff of the South-Eastern Hospital. There were 14 deaths as compared with 19, 23 and 15 for the three preceding years, giving a death rate of 0.12 per 1,000 population as compared with 0.07 for England and Walgs, and 0.09 for London. Year 1921 - 363 notifications; 13 deaths „ 1922 - 459 „ 39 „ „ 1923 - 417 „ 33 „ ,, 1924 - 374 „ 15 „ „ 1925 - 610 „ 23 „ „ 1926 - 582 „ 19 „ „ 1927 - 412 „ 14 „ In my report last year a full statement was made on this subject. The causes, the prevention, the question of immunity, the Schick test, Inoculation, etc., etc., were dealt with at length. It is not necessary to recapitulate. The table given herewith speaks eloquently of the work done as regards testing and inoculation. This work has been carried on without incident, without any disturbing event, and has been gratefully received by the parents. All parents were circulated through the schools. Some 650 children attended during the first year and although many thousands might have been brought, still this was, in a relative sense, a good beginning. Nevertheless, many of those inoculated were contacts of actual cases; many parents are willing to have their children inoculated if a case occurs in the family. A child comes home from hospital after diphtheria and, though cured of the disease, the germ is frequently stored in the tonsils or in the tissues at the back of the nose. Some time after, the germ passes out of the tonsil, etc., and is conveyed to another member of the family with the result that another case of diphtheria occurs. How often have I seen this happen ! If diphtheria occurs in a family it is madness not to have the other children inoculated; this is the only possible way in which they can be protected against the disease. During the year 1927 the contacts of all cases of diphtheria were examined by me. Further, children coming from hospital after diphtheria were likewise examined. Schick test and Inoculation have 38 been preached in season and out of season. Some there are who listen to the expert and so are saved; many there are however, who refuse to take heed to the words of wisdom. Too often, alas, one has seen Return ' cases where there ought not to have been any. "If only I had listened to your advice" is a cry that has been uttered more than once. Diphtheria Prophylaxis. Number of people who attended. Number 6 years and over. Number 5 years and under. Number Schicked. Number Schick Positive. Number Schick Negative. Number Inoculated. Total Inoculations given. 647 374 273 374* 214 152 425 1233 * Eight, previously Schicked, failed to turn up for the reading of the test. Forty-two Inoculations were not given, as fifteen people missed these through refusals to attend to complete, or through illness given as Mumps, Fretfulness, etc. Enteric Fever. 1921 9 cases 1925 4 cases 1922 7 „ 1926 2 „ 1923 10 „ 1927 10 „ 1924 20 „ Ten cases of Enteric Fever were notified as compared with 2 in the previous year. There were two deaths. Only three of these cases were enteric fever proper, the remaining being Paratyphoid B. fever. The following description of some of the cases gives an indication of the work entailed in tracing the source:— (1) O.B., female, three years, of Brockley Road, was notified on June 6th. Some days previously she had had diarrhœa and abdominal pains, accompanied by straining. A blood culture proved the presence of the Bacillus Paratyphoid B and the case developed on true clinical lines. Early in May, the patient had eaten watercress obtained from a shop "E"; she had also eaten ice cream obtained from an unknown street cycle-vendor. No other article of food associated by repute with intestinal diseases had been eaten. Enquiry into the past and present health history of the two families living in the house did not disclose any suspicion of disease which would call for examination of certain products. Before discussing steps taken, it is necessary to deal with other cases. (2) W.B., male, 36 years, of Arica Road, was notified on June 9th as a case of Paratyphoid B. A clerk by occupation, his illness commenced on May 30th with headache and vomiting; diarrhoea and 39 abdominal pains were noted on June 8th and 9th. His blood serum gave a positive agglutination in dilutions of 1 in 10 up to 1 in 5,000 with the Bacillus Paratyphoid B. An abdominal rash meanwhile formed a sign. The patient had eaten watercress obtained from the same shop "E" as in O.B.'s case. All the other food and family history enquiries were negative and no "carrier" was responsible. (3) L.L., male, 22 years, Drakefell Road, a clerk, was notified as having Paratyphoid B fever on June 8th. For some days he had had loss of appetite, a bad taste in the mouth and abdominal pains. The blood test was negative, but a consultant who was called in diagnosed Paratyphoid B. fever. Watercress had been eaten, the same having been purchased at two shops, one of which was the same as that in the two cases mentioned above. All other cases were negative. (4) E.C., female, 19 years, Wallbutton Road, was notified on June 14th. A music teacher, she taught at home and at people's houses. There had been abdominal discomfort, headache and dizziness for some days. Ice cream had been eaten a month before the illness commenced, but the patient was certain she had not consumed watercress. An outbreak of four cases of the kind occurring close to each other, both geographically and in point of time, called for further investigation. Communications were addressed to the Medical Officers of Health of London Boroughs enquiring into the history of such cases as had occurred within recent weeks in their respective districts. Replies pointed to the following as causes:—(a) infected oysters consumed in France; (b) infection in America; (c) infected water at Gravesend; (d) three cases were caused through consuming watercress. In our four cases the evidence pointed (l) in the direction of watercress ; (2) ice cream; (3) possibly milk and (4) perhaps a " carrier." Milk submitted for bacteriological examination was found to be "negative," and enquiry as to the health history, recent and remote, of employees and their families gave no grounds for anxiety. The milk arrived at the depot in question in bottles. Next, the watercress premises were inspected and found to be untidy. No history of illness was found in the salesmen and their families. There was no watercress on the premises at the time of inspection, but it was ascertained that the source of supply was from a vendor "T," who had a place at the Borough Market, Southwark. Dr. Wilson, 40 Medical Officer for Southwark, kindly visited these premises and enquired as to the health of the people concerned. He ascertained that "T"s watercress was obtained from two sources, viz., from "W" in Hertford and from "S" in Kent. Samples of "T"s watercress were taken for bacteriological examination and letters were sent to the Medical Officers of Health for the Counties of Hertford and Kent asking whether the watercress beds were sewage contaminated. While awaiting replies, the places of business at which the patients worked were enquired into, but without result. The ice cream firms were taken in hand and a local depot was examined and found to be clean. The Medical Officers of the districts in which the ice cream was manufactured were asked to visit the factories concerned to enquire as to the health of the staffs and as to methods of manufacture, etc. It was ascertained that none of the staff nor their families had ever suffered from gastric or abdominal trouble. Sundry other enquiries were made such as an examination of water supply and the bacteriological examination of a sample of excrement. Evidence gradually pointed in the direction of the watercress as the peccant food. In neither case did the samples of watercress, originally hailing from Kent and Hertford, present the germ on bacteriological examination— admittedly a difficult thing to find, just like looking for a needle in a haystack. There was, however, evidence of Colon germs (intestinal germs) present. The Medical Officer for Hertfordshire wrote that he had visited the watercress beds and had found the water supply of the same was spring water of good quality and pure. None of the workers living in the vicinity had any history of illness. Some of the houses were in rather close proximity to the watercress beds and there was a possibility of occasional contamination; he added he was referring the matter to the local Medical Officer of Health who, at the time, was away on holiday. Later, the County Medical Officer wrote again saying : "A cesspool in a field which takes the sink waste from a house overflows into the cress beds from which the cress was obtained. The matter is being taken up with the owner of the property and I trust to be able to prevent the pollution in future." Still later I was informed that the cesspool had been cleaned out and arrangements made to do away with the portion of the beds in proximity to the cesspool. It may well be that this was the source of the trouble. 41 (5) H.S., a lad of 13 years, living in Malpas Road, was notified on July 2nd as having Paratyphoid B. He had visited a coast town in company with a party of lads and while there had been sick. That being so, one would suspect infection on a prior date, but, it is curious that he was not notified until fourteen days after. He denied that he had eaten any suspicious foodstuffs; he may have partaken something of the kind and probably forgot. Acute Primary Pneumonia and Acute Influenzal Pneumonia. 1921 47 notifications; 119 deaths 1922 125 ,, 201 „ 1923 74 ,, 91 „ 1924 144 ,, 150 „ 1925 153 ,, 114 „ 1926 185 ,, 108 „ 1927 197 ,, 120 „ These diseases are compulsorily notifiable under the Public Health (Infectious Diseases), Regulations, 1927. 197 cases were notified during the year, as against 185 in the previous year. This table shews an unsatisfactory state of affairs, and proves that Pneumonia is not being notified as it ought to be. All cases of Pneumonia do not die. If a case of Pneumonia is not notified, one cannot make enquiries as to presence or absence of nursing assistance, home helps, environment, etc. Puerperal Fever and Puerperai Pyrexia. 1921 11 cases Puerperal Fever; 4 deaths 1922 7 „ ,, 3 „ 1923 7 ,, ,, 3 ,, 1994 6 ,, ,, 3 „ 1925 17 „ ,, 7 „ 1926 10 „ „ 2 „ 1927 2 „ ,, — ,, There were two cases of Puerperal Fever and 16 of Puerperal Pyrexia during the year. Puerperal Pyrexia became notifiable on 1st October, 1926. 42 It is gratifying to report that only two cases of Puerperal Fever occurred during the year. In the first case the patient, aged 21 years, was sent to hospital, delivery being obstructed and craniotomy found to be essential. The doctor in his report wrote "The probable cause of the pyrexia was infection after rupture of the membranes before the birth of the child. Whether the infection came from a previously septic vagina or was introduced from without is unknown." This case serves to show that if all pregnant women were examined at the Ante-natal Centre, any narrowness, etc., would be detected and such operations as craniotomy would, to a large extent, become unnecessary. The second case followed a miscarriage, the patient being sent to hospital. The case was notified to us some eleven days afterwards. Puerperal Pyrexia. Case No. 1. Forceps were required, as delivery was obstructed. Some injury to tissues unavoidable. Patient removed to hospital. 2. Case of prolonged labour. No ante-natal visits paid by patient. 3. Normal labour. Temperature due to bladder affection. Dr. Gilliatt called in consultation. 4. No assignable cause. 5. Patient had made no arrangements for her confinement in the way of engaging a doctor or midwife; her mother, a handy woman, attended her. A midwife was called in afterwards and later a doctor. Patient developed Pneumonia and was removed to hospital. No ante-natal supervision. Infection may have been conveyed by the handy woman. 6. Case of delayed labour. Forceps required, and the afterbirth had to be removed. No ante-natal visits paid. 7. Temperature due to influenza. 8. No assignable cause. 9. Temperature due to influenza. 10. Temperature due to influenza. In the remaining six cases there was no assignable cause. One or two points are quite clear. We shall continue to have these cases so 43 long as women do not undergo ante-natal supervision. I am bound to state that the municipalities have been much more alive to the need of such ante-natal supervision than have the doctors in practice. Next, it is essential that there should be provision of hospitals with laboratories attached for the study of the causation of the disease. With reference to the provision by the Council of consultative facilities, Dr. Gilliatt was called in three times during the year at a cost of twelve guineas in all. The Pathologist's services were requisitioned once to make a bacteriological examination of a sample of urine. Ophthalmia Neonatorum. 9 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. From subsequent enquiries it has been ascertained that no patient suffered any impairment of vision. One child subsequently died from erysipelas 2 of the 9 cases notified were removed to hospital. In no disease is more intensive work done than in Ophthalmia Neonatorum; this can be ascertained from the full records disclosed on the Health Visitors' cards of enquiry. Their function is to see that every step has been taken and is being maintained to prevent injury to vision. Where necessary, visits have been paid by Dr. Hill or myself. Vision Vision Notified Treated unira- im- Total Deaths At home In hospital paired paired ' blindness 9 7 2 9 0 — 1* •Died from Erysipelas. Measles. Under the Deptford (Measles) Regulations, 1922, made by the Ministry of Health on the request of this Council, Measles was made a notifiable disease. These Regulations came into operation on the 11th September, 1922, and terminated on the 11th September, 1927, but were then extended by further Regulations which will terminate on the 11th September, 1932. 46 cases were notified during the year under report, and were visited by your Health Visitors and a special nurse, and arrangements were made by the Ranyard Nurses 44 ciation for daily visits of a nurse to such cases as your Medical Officer of Health deemed advisable. Diarrhoea and Enteritis. Infantile Diarrhoea occurring in children of two years of age and under is notifiable in this Borough by Order of the Council dated 27th July, 1920. During the year 1927, 54 such cases were notified, and 1 of this number was admitted to hospital. Diarrhcea and Enteritis caused 8 deaths during the year, all being children under two years of age. Epidemic Cerebrospinal Meningitis. 2 patients were notified as suffering from this disease during the year: one patient was subsequently certified not to be suffering from this disease, and the other was a nurse at the Soulh-Eastern Hospital. There were no deaths ascribed to this cause. Malaria. 6 cases of Malaria were notified in the persons of ex-service men who had contracted the disease in the East. Encephalitis Lethargica. 3 cases were notified during the year. There were two deaths ascribed to this cause, and the remaining patient subsequently died from other causes. Apart from enquiries made on receipt of a notification, quarterly visits are made with a view to ascertaining whether sequelae have developed. Acute Anterior Poliomyelitis and Polioencephalitis. 1 patient was notified as suffering from this disease, a girl of 5 years. The disease was ushered in with abdominal pains, headache and vomiting. Partial paralysis of right leg followed, but this improved steadily. Dysentery. 1 case (fatal) was notified in a female of 31. She developed Dysentery whilst a patient in hospital. 45 Table XIV. Hospital Disposal of Notifiable Diseases during 1927. DISEASE Total Cases Notified Cases admitted to Hospital. Total Deaths. Diphtheria 412 411 14 Scarlet Fever 400 390 2 Enteric Fever 10 9 2 (including Paratyphoid) Puerperal Fever 2 2 — Puerperal Pyrexia 16 7 — Pneumonia 197 62 120 Measles 46 7 — Diarrhoea and Enteritis 54 1 8 (under 2 years of age) Erysipelas 71 22 3 Poliomyelitis 1 — — Encephalitis Lethargica 3 2 2 Ophthalmia Neonatorum 9 2 — Prevalence of, and Control Over Infectious Diseases. The Table giving the incidence of notifiable diseases for the year 1927 will be found elsewhere in the report. This table gives the cases in accordance with the age groups requested by the Ministry of Health. 46 The following Table gives the incidence of the infectious diseases over the last five years:— Table XV. List of Infectious Diseases for the Past Five Years. Disease. Notified in Admitted to Hospital. Total Deaths. 1923 1924 1925 1926 1927 1923 1924 1925 1926 1927 1923 1924 1925 1926 1927 Smallpox 0 *1 0 0 0 0 1 0 0 0 0 0 0 0 0 Scarlet Fever 349 291 310 399 400 331 278 303 385 390 2 2 3 1 2 Diphtheria 417 374 610 582 412 409 371 606 579 411 33 15 23 19 14 Enteric Fever (including Paratyphoid) 10 20 4 2 10 10 20 4 2 9 2 3 0 2 2 Puerperal Fever 7 6 17 10 2 7 5 15 9 2 2 3 7 2 — Pneumonia 74 144 153 185 197 5 6 16 52 62 91 150 114 108 120 Erysipelas 57 79 65 57 71 9 20 19 15 22 0 0 0 0 3 Cerebro-Spinal gitis 0 *1 3 3 2 0 1 3 3 2 0 0 1 3 0 Poliomyelitis 3 2 4 3 1 3 2 2 2 0 0 0 0 0 0 Malaria 4 5 5 8 6 0 0 0 0 0 0 0 0 0 0 Dysentery 0 1 0 3 1 0 0 0 3 1 0 0 0 0 1 Measlest 204 1282 1207 961 46 9 92 109 52 7 8 34 31 31 0 Encephalitis Lethargica 0 24 9 8 3 0 13 7 5 2 0 6 5 2 2 Was not a true case. Measles became notifiable in September, 1922. Table XVI. Deaths and Death Rates from Principal Infectious Diseases. Year Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Diarrhea and Enteritis (under 2 years) Total No. of 1 Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate 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 1924 3 0.03 — — 34 0.30 2 0.02 15 0.13 15 0.13 16 0.14 85 0.74 1925 — — — — 31 0.27 3 0.03 17 0.15 23 0.20 12 0.10 86 0.74 1926 2 0.02 — — 31 0.27 1 0.01 5 0.04 19 0.16 19 0.16 77 0.67 Average for 10 years 2 0.02 — — 25 0.23 5 0.04 19 017 21 0.19 28 0.25 99 0.89 1927 2 0.02 — — — — 2 0.02 11 0.10 14 0.12 8 0.07 37 0.33 47 d2 Table XVII. No vaccinations or revaccinations were performed by the M.O.H. under the Public Health (Smallpox Prevention) Regulations, 1917. Mr. E. S. Elliott has again kindly obliged us with the following information. Supplemental Vaccination Return for 1926. Return made on or before the 9th of February, 1928, by Mr. E. S. Elliott, Vaccination Officer of the several Districts of the Greenwich Union, respecting the vaccination of children whose births were registered in his District from 1st January to 81st December, 1926, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec 1926. Number of these Births duly entered by 31st Jan 1928. No. ot Hirths which on 31st Jan. 1928 remained unentered in the Vaccination Renter on account of— No. of these births remaining on 1st Jan., 1928 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1927. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1927. Success- fully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Certificates of Conscientious Objection received. Dead. Unvaccinated- Postponement by Medical Certificate. Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. South Deptford 574 299 2 — 200 14 18 8 3 30 — — North Deptford 675 278 2 — 249 32 19 2 10 83 — — East Deptford 819 292 4 — 208 37 40 11 18 209 — — East Greenwich 869 429 1 — 245 45 21 8 30 90 — — West Greenwich 349 171 2 — 118 18 5 4 3 27 — — Total 3285 1469 11 — 1020 146 103 33 64 439 1644 897 48 Dated February 3rd, 1928. E. S. Elliott, Vaccination Officer. Total Number of Certificates for Year 1927 sent to other Vaccination Officers, 162. 49 Notifications of Illness in Scholars. All notices received from the Education Authorities are carefully scrutinised, and scholars who are reported to have sere throats are requested to attend at the Public Health Department where they are examined by the Medical Officer of Health. The Shelter. The Public Health (London) Act, 1891, Section 60, Sub-Section 4, imposes on the Sanitary Authority the duty of making provision for the temporary housing of persons who are compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the Sanitary Authority. The accommodation provided consists of a detached building containing two separate and distinct tenements, each consisting of two bedrooms, kitchen, larder, bathroom, and w.c. The shelter was not used during the year. Disinfection. The disinfection of infected clothing and bedding has been carried out at the Disinfecting Station,Watson Street, by means of two machines of the Washington-Lyons pattern with independent boilers. The number of rooms disinfected by the Council's staff during the year was 1,552. 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. 50 Table XVIII. SHOWING NUMBER OF ROOMS DISINFECTED. 1927 Scarlet Fever Diphtheria Pulmonary Tuberculosis Cancer Scabies Typhoid Fever Pneumonia Puerperal Fever Enteric Fever Erysipelas Measles Ch;cken Pox Encephalitis Lethargica Infantile Paralysis Neonatorum Cerebro-Spinal Meningitis Formalin Spray Fumigated Infectious Requests Total Rooms Verminous Premises Rooms  R'ms R'ms January 40 42 38 2 .. .. 2 2 1 .. .. .. .. .. .. l 128 5 133 4 6 February 33 32 33 2 2 .. 1 .. 1 .. .. .. .. l .. .. 105 5 110 6 7 March 43 47 34 4 3 .. .. .. .. 3 .. .. .. .. .. .. 134 5 139 1 1 April 39 43 31 2 3 3 .. .. .. .. l .. .. .. .. .. 122 5 127 12 21 May 33 39 29 .. .. .. .. 1 .. .. 1 .. .. .. .. .. 103 5 108 14 26 June 30 34 24 3 2 3 1 .. .. .. .. .. .. .. .. .. 97 2 199 9 32 July 46 26 29 5 .. 5 .. .. .. .. .. .. .. .. l .. 112 2 114 7 8 August 18 26 27 1 .. .. .. .. .. .. 2 .. .. .. .. .. 74 3 77 15 24 September 25 31 24 1 2 .. .. 1 2 1 .. 3 .. .. .. .. 90 3 93 4 7 October 47 46 42 .. 4 .. 2 1 .. .. .. .. .. .. .. .. 142 1 143 5 10 November 63 33 36 2 2 3 .. 1 .. .. .. .. .. .. .. .. 143 1 144 4 5 December 44 40 20 1 .. .. 2 .. .. 2 .. .. .. .. .. .. 109 5 114 3 4 461 439 367 23 18 14 8 6 4 6 4 3 3 l l l 1359 42 1501 84 151 Table XIX. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION. OR DESTROYED AT OWNERS' REQUEST. 1927 Premises Beds Pillows Bols'ers Mattresses Sheets Blankets Odd Articles Total Books Articles Destroyed (Owners' Request) Cleansing Station Infectious Requests D.B.C. Library Privaje Beds Pillows Bolsters Mattresse* Sheets Blankets Odd Articles Total Wearing Apparel Towels Blankets Total  January 109 13 71 177 58 45 138 197 574 1260 16 4 6 6 2 2 1 2 3 22 45 121 5 171 February 81 14 54 121 35 30 106 144 566 1056 50 40 1 4 ... 2 1 ... 1 9 26 153 5 184 March 108 16 79 163 61 18 136 171 612 1240 34 6 2 4 2 5 2 1 9 25 26 256 3 285 April 97 19 66 146 51 26 80 136 346 851 23 5 2 1 ... 2 ... 2 ... 7 44 153 7 204 May 81 4 43 126 43 28 84 140 281 745 27 12 1 ... ... 1 ... ... 40 42 22 165 3 190 June 82 4 52 123 38 29 92 102 272 708 17 ... 6 2 ... 5 ... ... ... 13 47 237 6 290 July 89 12 45 127 44 28 90 103 325 762 15 3 ... ... ... 3 ... ... 1 7 29 143 6 178 August 61 10 39 89 24 26 85 96 239 598 6 20 1 ... 1 6 ... ... ... 8 13 72 2 87 September 72 9 42 103 29 25 72 113 213 597 27 ... 1 ... ... 2 ... ... 9 12 78 230 14 322 October 106 11 68 157 39 33 123 176 466 1062 28 8 2 ... ... ... ... ... 7 9 8 235 3 246 November 113 11 79 186 52 50 132 218 552 1269 32 2 1 ... ... ... ... ... 12 13 59 200 10 269 December 95 6 76 161 41 25 97 165 404 975 32 4 1 .... ... 3 ... ... ... 4 22 129 4 155 1094 129 714 1679 521 363 1235 1761 4850 11123 307 104 27 17 5 31 4 5 82 171 419 2094 68 2581 51 52 Summary. Number of premises visited: Infectious diseases 1094 ,, „ „ Requests, bedding only 129 „ „ „ Verminous 84 Total premises visited 1307 Number of'rooms disinfected, formalin spray 1401 „ „ „ sulphur 151 Total 1552 Number of articles disinfected (steam disinfector) 13704 Number of books disinfected (formalin lamp) 411 „ „ articles destroyed at owners' request 171 Special disinfections, etc.:— 20th July. One taxicab from Margate. 28th October. Furniture, etc.. destroyed at owner's request. No cases of rabies or anthrax occurred locally. Cleansing of children found verminous at school is carried out at the Centre in Watson Street. Verminous bedding, etc., is disinfected there also; in addition, verminous houses are sprayed with solution. A special spray was bought for the purpose. General Provisions of Health Services in the Borough. 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, at 52 Wickhani Road, S.E. 4. (See Reports later). (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. 53 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) Infections 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, City 7200, 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 infectious 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 are also 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 High Road, Lee Woolmore Street, Poplar Peckham Road 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. 54 clinics and treatment centres. Maternity & Child Welfare. (l) Infant Consultations. Daily from 2 p.m. Monday, Gosterwood Street Tuesday, Napier Street Wednesday, Erlam Road Thursday, Goldsmiths' College Do. Princess Louise Institute, Hales Street Friday, Besson Street (2) Ante Natal Clinic. From 9 a.m. to 1 p.m. Tuesday Wednesday Thursday Health Centre, Harton Street. special infant consultations. Wednesday, 10 a.m., Health Centre, Harton Street. Dental Inspection and Treatment. \lternate months at Health Centre, Harton Street. Artificial Sunlight Centre. At Health Centre, Harton Street. (By appointment.) Tuberculosis Dispensary. Health Centre, Harton Street. Monday & Thursday, 9.30 to 11 a.m. Men. Tuesday evening, 6.30 to 7.30 p.m., Men and Women at work. Tuesday and Friday, 9.30 to 11 a.m., Women. Thursday, 2 to 3 p.m., Children not at school and Women at work, latter by appointment. Saturday, 9.30 to 11 a.m., Children attending school. Wednesday, 9.30 a.m. onwards, Secretary's Consultations. Venereal Diseases. Miller Hospital, Greenwich,S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Hospital, Morden Hill, Lewisham, 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 (Eve) Tuesday and 2 p.m. Thursday Do. Ear. Minor Ailments Friday. 2 p.m. Operations Monday. 2 p.m., at Cyril Henry Centre. Woolwich Do. Skin Ailments Wednesday, 2 p.m. 20 Albury Street Teeth Monday, 9.30 a.m. and 1.30 p. in Tuesday, 1.30 p.m. Wednesday, 1 .30 p.m. Thursday, 1.30 p.m. Friday. 9.30a.m.. 1.30 p.m. Gas. Tuesday. 9.30 a.m. Inspections. Wednesday and Thursday, 9.30 a.iu. Day Nursery. Albury Street (closed at present) Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. 55 The Infant Welfare Centres are held in halls let to us by different religious organisations. There are two exceptions, viz.: the Goldsmiths' Centre, held in a class room at Goldsmiths' College, London University, Lewisham High Road, and at the Princess Louise Centre, Hales Street. The Princess Louise Centre is a voluntary one, except that the Council provides two Health Visitors as well as the Medical Officer. In the six Infant Welfare Centres there are voluntary Workers whose services are prized by the Council and officers. Until 1922, one Ante-Natal Clinic was held in the morning at the Napier Street Centre. A second session was opened on Wednesday forenoons in view of the increasing numbers attending. Yet again a third session had to be opened on Thursday mornings. Dr. Hill attends from 10 a.m. until 1 or 1.30 p.m. In addition to the AnteNatal examinations, any urgent cases from any of the Infant Welfare Centres are seen on Wednesday forenoon. (Public Health Officers of the Local Authority, see facing page one.) Professional Nursing in the Borough. (a) General. 1. There is one nursing home in the Borough, situated in Tressillian Road, Hilly Fields, Brockley, to which surgical and medical cases are sent by medical practitioners. On emergency, a maternity case can be admitted, but medical and surgical cases form the great bulk. Nurses can be obtained from this home to visit at patients' homes. No definite statement can be made, but as Deptford is an industrial borough, it is fairly certain to say that the overwhelming majority of serious surgical cases and many medical cases are removed to hospital for treatment. 2. 23 St. Margaret's Road: Nursing home and Midwifery. 3. 37 Breakspears Road: ditto 4. 74 St. John's Road: Maternity only. 5. 13 Vesta Road. 6. Much valuable work is carried out by the St. John the Divine Nursing Association, situated in Watson Street, New Cross Road. The staff consists of a sister-in-charge, two general trained nurses, and two certified C.M.B's. All live in. Their services are obtained through doctors, clergymen and private persons. The staff covers a wide field in its operations, and touches upon a portion of Greenwich at Creek Road and Prince Street. 56 7. St. John's and the Congregational Church in Lewisham High Road enjoy the services of a nurse who resides in Upper Brockley Road. No midwifery is undertaken. 8. The Deptford Mission has a nurse whose sphere of work is mainly east of High Street. 9. Two nurses are attached to'St. James' Church, their headquarters being in Pagnell Street. 10. Eight or nine years ago a Nursing Association, on the Provident principle, was established for Brockley and Crofton Park. The Association covers a wide area and is connected with Ranyard House. One of the nurses is resident and there is a visiting sister who attends the monthly Committee meetings. Excellent work is accomplished. 11. The Borough Council pays for the services of a Ranyard Nurse or a St. John's Nurse in certain cases approved by the Medical Officer, such as pneumonia in children under five years. The fee paid is Is. 3d. per visit. (b) Infectious Diseases, Measles, etc. Practically all cases of the major forms of infectious disease are sent into hospital. Of the so-called minor diseases, such as measles and whooping cough, a number are sent to the M.A.B. hospitals. The Council provides a whole-time nurse during an epidemic of measlss, and the Health Visitors also visit cases. The general rule is that if the home surroundings are insanitary, overcrowded, etc., or if complications are threatened, and provided the family doctor is willing (many can only pay for one visit by a doctor), the patient is sent into hospital. Circumstances decide the action necessary, thus the services of a Ranyard Nurse may be requisitioned. Measles became notifiable in Deptford in September, 1922, so that little time is lost in ascertaining cases. Information concerning whooping cough is derived mainly from head teachers. The Health Visitors visit such cases as their already extensive duties permit. In all cases where any sanitary defect is found, information is promptly conveyed to the department for necessary action. (c) Midwivcs. These are under the supervision of the London County Council. There are some nineteen in the Borough, of whom five are at the Municipal Maternity Home. No subsidy is paid to midwives locally. 57 (d) Registration of Maternity Homes. The London County Council is the Local Supervising Authority. (e) Chemical Work. The Report concerning Food and Drugs will be found in the tables given hereafter. Laboratory Work at Seamen's Hospital, Greenwich. Material. Total Specimen examined. Number Positive Number Negative  Swabs for Diphtheria 1222 161 1061 Blood for Enteric Fever 7 4 3 Faeces and urine for Enteric Fever and Paratyphoid 5 — 5 Sputum for Tuberculosis 44 7 37 Urine for „ 1 — 1 „ B. Coli 1 — 1 Milk for Paratyphoid 1 — 1 Ice Cream 6 — 6 Watercress 2 — 2 Milk (Guinea pig inoculation) 1 — 1 Cream bun 1 — 1 Moss from uterus 1 — 1 Total 1292 172 1120 In addition to the above, 856 specimens of sputa were examined at the Council's Tuberculosis Dispensary, in connection with Dispensary work and 303 specimens, for private practitioners, from persons not on the Dispensary Register. 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 on the telephone and the case is removed to hospital rapidly, where the necessary serum is given. 58 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. 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 the decent conduct of persons using the Public Lavatories and Sanitary Conveniences provided and maintained by the Council. 8. Street Trading. 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 of dead horses through streets. 11. Regulations as to Dairies, Cowsheds and Milkshops. 12. By-laws with respect to houses divided into separate tenements, etc. General Sanitary Administration. 60 SANITARY CIRCUMSTANCES OF THE AREA. Closet Accommodation. The closet accommodation in Deptford is entirely of the water carriage type. During the year under report 1,191 defects were remedied or improvements effected in water closets as the result of inspections and notices served by the Sanitary Inspectors. Scavenging. House refuse is removed once weekly from all premises in the Borough. During the year 1927, 608 new dustbins were provided by owners as the result of inspections and notices served by the Sanitary Inspectors. A twice-weekly removal of house refuse is desirable in the east end of the Borough and also in the Pomeroy-Besson Street area. A canvas or other covering should be placed on the top of the carts to prevent dust, etc., from being blown off the same. An occasional tendency to overfilling of the carts might be counteracted by providing more of them. Work of Sanitary Inspectors. During the year the District Sanitary Inspectors made 20,399 visits in all to 5,863 premises. 2,895 systematic house to-house inspections were made. Numerous sanitary improvements and repairs were effected, as shown in the following table:— 61 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1927. Table No. XX. Number of District. 1 2 3 4 5 6 7 Totals  Inspections— On complaint 14 32 13 12 28 114 18 237 House-to-house 310 492 494 485 449 318 347 2895 Infectious diseases 140 106 103 133 130 176 131 919 Notice from builder 29 18 21 10 34 73 20 205 New houses for water certificate... ... ... ... ... 1 ... ... 1 Other inspections 201 254 130 212 176 333 300 1606 Total 694 902 767 852 818 1014 816 5863 Re-inspections, Calls, etc.— Total 1582 2511 1914 2217 1864 2349 2099 14536 Notices Served— Intimation (Public Health Act) 376 580 525 527 475 458 437 3378 Statutory ( Do.) 6 87 19 11 29 15 32 199 Under Rats and Mice (Destruction) Act (see Report) ... ... ... ... ... ... ... ... Housing, Town Planning, etc., Act, 1919, sec. 28 ... ... ... ... ... ... ... ... Cleansing: and Repairs— Number of premises, etc., cleansed 190 225 330 346 304 250 258 1903 Ventilation improved (number of premises) ... 24 71 3 1 2 1 102 Number of roofs repaired 78 148 66 123 115 107 104 741 Dampness abated (number of premises) 29 97 76 192 38 51 15 498 Gutters and rainwater pipes provided or repaired 39 114 64 64 119 99 110 609 Yards and forecourts paved 7 8 1 9 1 26 Yard and forecourt paving repaired 60 69 32 84 36 40 33 354 Scullery floors paved, or paving repaired 4 10 14 14 9 11 17 79 Coppers provided and repaired 8 32 15 17 27 23 64 186 Other repairs and improvements 78 267 151 144 150 260 182 1232 Water Supply— Re-instated ... 4 ... ... ... ... ... 4 Fittings repaired (number of premises) 8 15 54 7 4 8 14 110 Cisterns cleansed ... ... ... ... ... ... ... ... „ provided ... ... ... ... ... ... ... ... ,, covered ... ... ... ... ... 3 ... 3 ,, abolished ... 1 ... ... ... 4 ... 5 Potable water supply provided from Service ... ... ... ... ... ...2 ...... 2 Additional facilities provided in tenement houses ... ... ... ... ... ... ... ... Other improvements ... ... ... ... ... 3 ... 3 B 62 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1927—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals  Drainage— Drains re-constructed (number of premises) 7 5 8 ... 1 36 7 64 Drains cleansed and amended 33 44 20 25 32 48 14 216 Gully traps fixed 11 5 13 3 ... 58 3 93 Soil and Vent Pipes fixed 12 12 10 3 3 30 5 75 Do. repaired ... 7 ... ... 13 2 ... 22 New Covers provided to inspection chambers ... 7 2 2 3 17 ... 31 Waste and rainwater pipes disconnected from drains 7 5 1 ... ... 3 ... 16 Chambers provided and access eyes 4 5 10 1 3 31 1 55 Sinks and sink waste pipes provided 6 10 118 31 12 26 24 227 Sinks and sink waste pipes repaired or trapped ... ... ... ... 10 157 ... 167 Water Closets- Old waterclosets abolished ... ... ... ... ... ... ... ... New waterclosets provided 2 ... 3 ... 3 8 1 17 New pan and trap only, provided 35 22 40 33 20 91 24 265 Defective flush remedied 15 30 12 43 14 21 41 176 Pans cleansed ... 1 5 ... 6 14 14 40 Seats provided or repaired 1 3 7 2 8 8 19 48 Roofs repaired 20 17 13 13 20 13 23 119 Walls, etc., repaired or cleansed 21 38 61 79 45 57 75 376 Doors repaired or renewed ... 12 5 ... 6 8 27 58 Ventilation improved ... ... 1 ... ... ... 1 2 Floors repaired ... ... ... 4 1 2 2 9 Other repairs or improvements ... 14 ... ... ... 38 29 81 Urinals— Cleansed ... ... ... ... 1 4 ... 5 Repaired ... ... ... ... 2 2 ... 4 Dung Receptacles- Provided ... ... ... ... ... ... ... ... Repaired ... ... ... ... ... ... ... ... Abolished ... ... ... ... ... 1 ... 1 Overcrowding- Cases abated 3 1 1 ... ... ... ... 5 Nuisances arising from the keeping of animals— Number of nuisances abated ... ... 1 1 4 2 ... 8 Offensive accumulations— Number of accumulations removed 4 4 2 5 4 58 5 82 63 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1927 —continued. \ Table— continued. Number of District. 1 2 3 4 5 6 7 Totals  Smoke Nuisances— Number of observations 3 6 ... 5 2 ... 17 33 Number of nuisances from black smoke ... 4 ... 1 ... ... ... 5 Number of notices served ... 2 ... 1 ... ... ... 3 Dustbins- Provided or repaired 76 115 52 121 99 85 60 608 General— Other miscellaneous nuisances abated ... 7 8 ... 10 15 121 161 District No. Inspector. Districts (approximate) 1 nspector Simpson St. Catherine's, Hatcham and Pepys Wards 2 ,, Kemp Canterbury Ward 3 „ Hewett Vale Ward 4 ,, Allam Clifton and Deptford Park Wards 5 „ Mayo Evelyn Ward 6 ,, Mason. St. John's, St. Peter's and Town Hall Wards. 7 ,, Webster St. Paul's Ward. B2 64 Legal Proceedings Under the Public Health Act and Bylaws. Premises. Nature of Offence. Result of Proceedings.  125 Arica Road Non-compliance with statutory notices:— (a) General Nuisance (b) Dustbin Fined £1 and £1 Is. costs. Fined £1 and £1 1s. costs. 114 St. Asaph Road Non-compliance with statutory notice Fined £2 and £2 2s. costs. Necessary works completed before hearing of summons. 116 St. Asaph Read Non-compliance with statutory notice Fined £2 and £2 2s costs, and Order for works to be completed within 28 days. HOUSE-TO-HOUSE INSPECTIONS. House-to-house inspections were made in the following streets during the year 1927:— Inspector Simpson— Street or Road. Total premises inspected. Number in which defects were found.  Briant Street 2 2 Brighton Grove 9 9 Dennetts Road 80 56 Harts Lane 3 3 Render Street 48 41 Lindo Street 5 5 Lausanne Road 2 — Mona Road 12 8 New Cross Road ... 14 7 Pomeroy Street 44 33 Rose Cottages 4 4 Selden Road 27 27 Somerville Road 60 39 Total 310 234 65 Inspector Kemp— Street or Road Total premises inspected Number in which defects were found  Cornbury Road 49 39 Uderton Road 13 2 Rollins Street 35 28 Lovelinch Street 72 52 Senegal Road 62 53 Edale Road 17 16 Eugenia Road 45 31 Hornshay Street 25 15 Hornshay Place 12 9 Wagner Street 1 6 White Post Lane 3 2 Stockholm Road 6 5 Canterbury Road 63 40 Silwood Street 16 13 Haydock Road 35 24 Fawcett Road 25 23 Oldfield Road 4 4 Hunsdon Road 3 3 Total 310 234 Inspector Hewett— Payne Street 26 26 Douglas Street 4 3 Dorset Terrace 4 4 Idonia Street 55 48 Railway Grove 84 53 Adolphus Street 70 43 Warwick Street 39 23 N apier Road 3 1 Hereford Place 9 7 Stanley Street 25 20 Glenville Grove 27 20 Mornington Road 32 16 Achilles Street 37 29 Kerry Road 51 34 Trim Street 28 15 Total 494 342 66 Inspector Allam— Street or Road. Total premises inspected. Number in which defects were found  Scawen Road 21 11 Chipley Street 4 4 Ruddigore Road 25 23 Trundleys Road 206 142 Clifton Hill 51 39 Bawtree Road 43 40 Childeric Road 50 46 Bestwood Street 14 14 Whitcher Street 71 27 Total 485 346 Inspector Mayo— Croft Street 12 8 Col wick Street 45 35 Col wick Terrace 4 2 Windmill Lane 51 35 Kempslade Street 25 13 Hoop wick Street 28 15 Edward Street 40 25 Childers Street 61 38 Staunton Street 57 43 Corston Street 37 30 Clyde Street 30 24 Grinling Place 12 11 Abinger Road 47 30 Total 449 309 Inspector Mason— Albyn Road 11 4 Arica Road 68 40 Bolden Street 24 11 Brookmill Road 62 41 Cranbrook Road 43 25 Lind Street 22 13 St. Asaph Road 65 50 St. Norbert Road 23 12 Total 318 196 67 Inspector Webster— Street or Road Total premises inspected. No. in which defects were found  Addey Street 54 53 Alvar Street 11 11 Bronze Street 8 8 Church Street 10 10 Crossfield Street 9 9 Creek Street 36 31 Dugald Street 1 1 Ffinch Street 20 19 Frankham Street 9 9 Hales Street 61 52 Hosier Street 27 27 Hyde Street 1 1 Leonidas Street 12 12 Reginald Square 52 43 Stanhope Street 36 34 Total 347 320 Grand Total 2895 2112 68 Offensive Trades. As regards offensive trades, there are two in the Borough, viz.:— (1) Hill & Son, Ltd., Frankham Street, (2) Wheen & Son, Copperas Street. Both of these firms were fully described in my Report for 1926. Other Sanitary Conditions Requiring Notice. Beyond those mentioned under the different sections of this Report, there is no condition calling for special mention. Schools. From time to time, owing to a somewhat excessive prevalence of infectious disease amongst the scholars, the sanitary accommodation at certain elementary schools has been the subject of special inspection by your district Sanitary Inspectors, and such minor defects as may have been found have been promptly remedied by the Education Authority. HOUSING. General. Number of houses erected during the year:— Blake House, New King Street, 17 tenements. 1. Unfit Dwelling-houses. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5863 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated Regulations) 1925 2895 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of above) found not to be in all respects reasonably fit for human habitation 3378 2. 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. 69 3. Action under Statutory Powers. (а) Proceedings under Sec. 3 of the Housing Act, 1925 (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit:— (1) By owners — (2) By Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3378 (2) Number of dwelling-houses in which defects were remedied:— (а) By owners 3378 (b) By Local Authority in default of owners — (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 Nil. The results of no fewer than 2,895 inspections were recorded on house-to-house inspection cards. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Action taken: inspection of dairies; administration of the Milk and Dairies Order, 1925, and the Milk (Special Designations) Order, 1923. In my Survey Report of 1925 I dealt with all the milk sellers on the Register in consequence of the Milk and Dairies (Amendment) Act, 1922. I pointed out that out of 122 purveyors of milk, 38 premises were satisfactory; 57 were fair; the remaining 27 being unsatisfactory. Such things as coal, vinegar, paraffin oil, etc., were found to be sold by small retailers of milk. The Council issued a serious warning to all purveyors as to the necessity for cleanliness and clean methods, etc. At a public meeting at the Town Hall, I impressed upon the public 70 the need for purchasing milk in bottles only—either the ordinary milk, or, if they could afford it, one or other of the higher grades of milk. An analysis was made of the proportion of bottled milk as against that sold "loose" in cans, and it was noted that public opinion was moving strongly in the direction of a "milk" conscience. At the end of 1927 the number of milk sellers on the Register was 179 of which number 38 were dairymen and 141 milk sellers. Thirty-three applications for registration were made, of which number 13 were transfers of ownership of milk sellers' business. There was one transfer and consequent re-registration of the business of a dairyman. Three applications for registration of new businesses as milk sellers were passed. Thirteen applications for registration for the sale of sterilised bottled milk only were successful. The Council refused three applications on the grounds of unsuitability of the premises or on account of other commodities, such as pickles, paraffin, etc., being sold. Each of such applicants was invited, under Section 2 (1) of the Milk and Dairies (Amendment) Act, 1922, to attend before the Public Health Committee and shew cause why the Committee should not refuse to register him, etc. The attitude of the Council is that no person need apply for such registration unless his premises, methods, etc., can successfully withstand the severest scrutiny and cross-examination. Licences were granted in January, 1927, to Messrs. Edwards & Sons, Ltd. (United Dairies), to sell (a) Pasteurised Milk, (b) Certified Milk, (c) Grade A (Tuberculin Tested) Milk, id) Grade A Pasteurised Milk, (e) Grade A Milk, at their premises at 84 Endwell Road, 95 High Street and 295 New Cross Road. Licences were also granted to Messrs. R. Higgs & Sons Dairies, Ltd. (United Dairies) to sell at their premises at 389a Queens Road (a) Pasteurised Milk, (b) Grade A (Tuberculin Tested) Milk, (c) Grade A Milk, and (d) Certified Milk. No bottling for these firms is done in the Borough. Sterilized, bottled milk is sold by seven firms; in one case the premises are situated within the Borough. The methods of handling and distribution of milk in the Borough shew a marked and steady improvement. The can is rapidly disappearing, giving way to the glass bottle; some retailers have entirely dispensed with the can, whilst others are not renewing the cans as they become unlit for further use, but are replacing with bottles. The 71 improvement cannot be questioned when one compares the glass bottles, filled and capped at the retailers' premises, to the can, filled in the street under varying climatic conditions. It would be a great step forward if we could abolish the practice of filling jugs in the street and in shops, and only allow milk to be sold in bottles, thus protecting it from the menace of dirt and dust. Retailers have commented upon the extra work involved in the cleansing and drying of the bottles, and this is a very important point, for a badly cleaned bottle or a bottle insufficiently dried is a potential source of danger. Some retailers realize that new and more hygienic methods of milk distribution are firmly established, and that the more hygienic their methods for storing and handling, the longer and better the milk will keep. Bottle-filling machines are being used on several retailers' premises; these are excellent appliances, but they must be kept scrupulously clean. Enquiries are also being made as to the cost and suitability of bottle washing machines, steam sterilising and drying apparatus. Several firms who manufacture dairy appliances, etc., are placing on the market washing-and sterilising plant suitable for large and small retailers. I am convinced that the installation of a suitable plant would not only result in the saving of time and labour to the retailer, but would ensure the consumer getting a more sterile milk: without doubt, there will be a great advance in this direction in the future. The small shop, where milk is sold along with all kinds of domestic requisites, is still with us, but these are inspected frequently to ensure that all possible precautions are taken to prevent contamination. It seems to me that time alone will settle the fate of these small 'mixed' shops. The public is learning more and more every month what it wants in the way of milk. The retailer who will not or who cannot modernise his methods will be left behind. During 1926 the Council approached the Metropolitan Boroughs' Standing Joint Committee with a view to requiring the registration of shops in which sterilised milk is sold in bottles. This has now been accomplished. Sedimentation Test. During the year 54 samples of milk were taken and examined for cleanliness by means pf the Sutherland Thompson & Co.'s apparatus. 72 We can with certainty report that there was a marked improvement during the year. Any retailer whose milk was found to be in any way below a very high standard of cleanliness was warned, and a further sample examined at an early date. Milk and Cream Regulations 1912 and 1917 1. Milk and Cream not sold as preserved cream:— (a) Number of samples examined for preservatives Milk 265 Cream 4 {b) Number in which preservative was reported to be present and percentage in each sample— Milk Nil Cream Nil 2. Cream sold as preserved cream:— Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct: — 1. Correct statements made 1 2. Statements incorrect — Total 1 The Milk and Dairies Order, 1926 came into operation on the 1st October, 1926. By order of the Council a copy was sent to every person on the Register, and the Inspector has visited all premises and persons concerned and explained their obligations under the Order. The Register has been revised. There are no cowkeepers in the Borough. No case occurred in which milk acted as a vehicle of infection. In two cases persons delivering milk were warned, as in J926, that bottles must not be filled in the street. The Milk and Dairies Consolidation Act, 1925. Under the provisions of this Act, many notices were received by the Food and Drugs Inspectors demanding that samples should be taken in course of delivery to retailers, but, acting on instructions, the Inspectors did not find it necessary to take any such samples in course of delivery because the Public Analyst was able to inform them within reasonable time that the original samples, i.e., those purchased from the retailers, were genuine. No samples were taken by other authorities at our request. 73 (b) Meat. Action taken with regard to Meat and other foods, slaughterhouses, etc. The following table deals with the state of affairs re windows, at the commencement of 1924 and at the close of 1927:— 1924 1927  Butchers' shops with windows 51 58 Do. without windows 15 8 Bacon dealers' shops with windows 166 166 Do. without windows 2 2 Beef and bacon shops with windows 3 3 The number of butchers' stalls has been reduced from 7 to 5, while there is still one bacon stall in Douglas Street. Two years ago I reported that these Regulations caused an immense amount of work; it is satisfactory to record that this work, together with the persuasive effect of four prosecutions, has virtually extinguished trestles and boards in front of shop windows. The great majority of butchers give no trouble; one or two, however, still endeavour to push out a trestle occasionally, but these are soon detected and persuaded to conform. In the Court cases, the magistrate ruled that meat should be kept behind the window lines and should be covered with gauze. He would not enforce the putting in of windows, but the study of the table above will show that the "window" question is not an acute one in the Borough. During the summer of 1927, practically all butchers did their best, by various means, to combat the fly nuisance, and with varying degrees of success. It was noted particularly that fewer flies existed in shops provided with closed glass windows. With closed windows, electric fans, and certain liquid preparations (near to which the flies will not come) flies can be kept in check. The open shop presents the biggest difficulty, for an adequate protection of the meat in these instances is a genuine difficulty; this has been improved by the use of side blinds. The old-fashioned belief of the butchers that business can only be done provided the whole stock in-trade is spread out in front of the shop, half way across the footpath to the gutter, is no doubt hard to kill, but local butchers who have adopted the closed glass windows are now saying that it is far preferable to the openfronted shop, is cleaner in every way, that their trade has not suffered, and lastly, that the keeping quality of the meat is considerably improved. The standard of cleanliness of the butchers' shops and their cold stores 74 is good. All now have an adequate number of covered bins for the reception of bones, scraps, etc., and efforts are being made to procure a more frequent collection of the bones, etc., during the summer months. The street stalls and those in the Market are inspected daily, and are kept in conformity with the law. Apart from visits paid by the Food Inspector, Sanitary Inspectors, working in rota, visit the butchers' shops, stalls, etc., every Friday or Saturday evening to see that the Regulations are complied with. Slaughterhouses. The two local places are under constant observation. On only six occasions during the year have organs been rejected; these were affected with common parasitic diseases. Vehicles carrying meat into the Borough from Smithfield have been inspected on 98 occasions and in all cases the meat has been found covered with satisfactory material or the Regulations have been otherwise fulfilled. The animals slaughtered in the Borough during 1927 were:— Bullocks 292 Calves 100 Sheep 1100 Pigs 160 Joint visits were paid by the Food Inspector and myself to certain places where food is prepared:— Number Inspections & Calls  Restaurants 54 124 Fried fish premises 48 105 Oyster bars 2 6 Offal boilers 3 65 Other food premises (butchers' shops where sausages are made) 28 914 Confectionery works, etc. 4 52 139 1,266 Bakehouses. The standard of cleanliness is being well maintained, the bi-annual cleansing being carried out regularly and without trouble. The accumulation of refuse, in some cases, still presents a difficulty. It would be far better if a more frequent collection could be arranged. The washing facilities for the employees are provided in all bakehouses. Soap and towels are also provided. 75 Table XXI. Sale of Food and Drugs, Acts.—Samples Taken During 1927. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Almonds, ground 3 .. 3 .. Arrowroot 1 .. 1 .. Making Powder 5 .. 5 .. Beer 8 .. 8 .. Boric Acid Ointment 1 .. 1 .. Beef, Corned 1 .. 1 .. Bread and Butter 1 1 100 Blanc Mange Powder 1 .. 1 .. Butter.. 46 .. 46 .. Brawn 3 .. 3 .. Cake 4 .. 4 .. Camphorated Oil 2 .. 2 .. Castor Oil 1 .. 1 .. Cocoa 18 .. 18 .. Coffee 3 .. 3 .. Cheese 3 .. 3 .. Cream Buns 2 .. 2 .. Custard Powder 8 .. 8 .. Cider 1 .. 1 .. Coffee and Chicory 1 .. 1 .. Extract of Coffee with .. Chicory 3 .. 3 .. Cream 4 .. 4 .. „ preserved 1 .. 1 .. Dripping 9 .. 9 .. Dried Fruit, &c. 9 .. 9 .. Epsom Salts 1 .. 1 .. Fish Paste 1 .. 1 .. Ground Ginger 4 .. 4 .. Glycerine 5 .. 5 .. Gregory's Powder 1 .. 1 .. Gin _ 1 1 100 Glauber's Salts 1 .. 1 .. Ice Cream 7 .. 7 .. Jam 7 .. 7 .. Jellies 1 .. 1 .. Lemon Squash 4 .. 4 .. Lemonade Powder 5 .. 5 .. Lard 4 .. 4 .. Margarine 14 .. 14 .. Lemon Curd 1 .. 1 .. Magnesia, Citrate of 1 .. 1 .. Meat. Minced 2 1 3 33.3 Meat Paste 1 .. 1 .. Mincemeat 4 .. 4 .. Mustard 8 .. 8 .. Mustard Condiment 2 .. 2 .. Milk 261 4 265 1.5 Carried forward 473 7 480 .. 76 Samples taken during 1927—continued. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Brought forward 478 7 480 Condensed Milk, Machine Skimmed, sweetened 5 .. 5 .. ,, Full Cream, unsweetened 2 .. 2 .. ,, Full Cream, sweetened 6 .. 6 .. Separated Milk 2 .. 2 ... Sterilized Milk 5 .. 5 .. Dried Milk, Full Cream 5 .. 5 .. ,, Full Cream, modified 1 .. 1 .. Orange Squash 1 .. 1 .. Olive Oil 2 .. 2 .. Pepper 12 .. 12 .. Rolled Oats 3 .. 3 .. Rice, Ground 2 .. 2 .. Salmon and Shrimp Paste 1 .. 1 .. Sausage 10 .. 10 .. Sherbet 5 .. 5 .. Suet, Chopped 1 1 100 Breakfast Sausage 1 .. 1 .. Sweets 8 .. 8 .. Dried Peas 1 .. 1 .. Pickle 4 .. 4 .. Rice 1 .. 1 .. Sauce 3 .. 3 .. Sausage Meat 2 .. 2 .. Vinegar 15 .. 15 .. Tea 1 .. 1 .. Whisky 2 .. 2 .. Wine 4 .. 4 .. Wine, Non alcoholic 6 .. 6 .. Informal Samples. Bread and Butter 1 1 2 50 Cream Buns 1 .. 1 .. Meat Paste 1 .. 1 .. Meat Pie, &c. 2 .. 2 .. Peas 2 .. 2 .. Sweetmeats 2 .. 2 .. Totals -592 9 601 1.5 601 samples were purchased and submitted to the Public Analyst for analysis. Of this number 9 or 1-5 per cent, were adulterated. In four instances legal proceedings were taken, convictions being obtained in all cases. 77 Table XXII. Proceedings Taken in regard to Samples Purchased during the Year 1927. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 20K Milk 10 percent, added water 1 0 0 1 1 0 — 13M ,, 1 percent, added water — — Vendor cautioned. 14M ,, 1 per cent, added water — — Vendor cautioned. 27W ,, 19 per cent, added water 1 0 0 1 1 0 — 42Y Bread and Butter Margarine substituted for Butter — — Vendor cautioned. 40Y Bread and Butter Margarine substituted for Butter — — Informal sample. 22H Chopped Suet Moisture, 19 per cent., Rice Flour, 17.3 per cent. — — Vendor cautioned. 48M Gin 7.7 per cent, excessive water 0 10 0 3 3 0 — 69H Minced Meat Sulphur Dioxide, 1,500 parts per million 2 0 0 Costs included in Fine. — There were no prosecutions under the Milk and Cream Regulations, or under the Condensed and Dried Milk Regulations. Under the Condensed and Dried Milk Regulations, nearly 200 visits were paid to shops to see whether the goods were labelled in accordance with the requirements, and in no instance was any infringement ascertained. 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. Chat Haddocks 6 stone, 12 boxes Mackerel 3 stone Beef 12½ lbs. Megrims 15 stone Black Currants 4 baskets F 78 CANAL BOATS ACTS. Annual Report for the Year ended 31st December, 1927. To the Medical Officer of Health, Sir, I beg to report for the year ended December 31st, 1927, that for the purpose of Canal Boats inspection, I made 12 visits, on the following dates, viz.:— February 24th, April 1st, May 9th, July 1st, August 4th, September 9th and 23rd, October 5th and 21st, November 17th and 25th, December 22nd. No boats were found for inspection during the year ; there is no doubt that this method of conveying goods has been superseded as far as this portion of the Canal is concerned, which fact has been confirmed by waterside residents. 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, W. F. Mayo, Canal Boats Inspector. Factory and Workshops Act. 80 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. Fried fish shops and fish-curing premises.—The general condition of these premises is fairly satisfactory. The placing of the offal immediately in the tins supplied by the contractors and keeping it covered is important; also the condition of the tins requires frequent examination. This is particularly important during the summer months. 81 Table XXIII. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1927. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1926 Added . 1927 Removed 1927 On register at end of 1927 Milk premises 163 16 .. 179 294 7 .. Cowsheds .. .. .. .. .. .. .. Slaughter-houses 2 .. .. 2 78 .. .. Other offensive trade premises 2 .. .. 2 24 .. .. Ice cream premises 165 23 1 187 250 26 .. Fried fish, etc., shops 47 1 .. 48 96 7 .. Restaurants 51 2 l 52 75 14 .. Other food premises 26 1 .. 187 97 49 .. Hairdressers' premises 51 2 .. 53 25 .. .. Table XXIV. 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; 1927. CLASS OF WORK. Number of Places Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1926. Added 1927. Removed 1927. On Register at end of 1927. Undpr Factory Acts. 1 Under Public! Health Acts. Premises. Rooms Factories Factory Laundries Factory Bakehouses Other Factories 3 3 17 3 1 17 1 16 30 52 4 221 1 2 220 168 164 7 Workshop Laundries WorkshopBakehouses Other Workshops 4 4 17 4 Workshops 34 1 1 34 80 140 10 128 8 1 135 263 98 12 Places where Food is prepared for Sale Workplaces other than the above 130 1 131 239 360 35 Workplaces 70 70 89 92 5 Home-workers'Premises 247 32 215 225 47 Total 854 11 37 828 1128 960 74 82 Table XXV. METROPOLITAN BOROUGH OF DEPTFORD. This Table is by request of the Secretary of State. Annual Report o] Medical Officer of Health for the year 1927. On the Administration of the Factory and Workshop Act, 1901 in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1.—INSPECTION. Including Inspections made- by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections Written Notices Prosecutions. Factories (including Factory Laundries) 216 14 Workshops (including Work shop Laundries) 252 36 Workplaces (other than Outworkers' premises includec in Part 3 of this Report) 331 24 Total 799 74 2 —DEFECTS FOUND. PARTICULARS Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H M. Inspector. Want of Cleanliness 45 45 1 Want of Ventilation Overcrowding Want of Drainage of Floors 6 6 Other Nuisances Sanitary Accommodation Insufficient 4 4 Unsuitable or defective 15 15 Not Separate for Sexes 1 1 Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bakehouse (sec. 101) Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 71 71 1 83 Table—continued 3.—HOME WORK NATURE OF WORK. OUTWORKERS' LISTS. SECTION 107 OUTWORK IN UNWHOLESOME PREMISES. SECTION 108 OUTWORK IN INFECT. I) PREMISES SECTIONS 109. 110 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year. Once in the year. Failing to keep Or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109. 110) Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 l6 Wearing apparel— Making, etc. 28 12 213 37 Fur-pulling 1 2 Total 29 12 215 37 84 Table—continued. 4.—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 34 Dressmaking 19 Laundries 4 Millinery .. .. .. 16 Tailoring .. .. .. .. .. .. 14 Wheelwrights (Smiths, &c.) 23 Others 56 Total number of Workshops on Register 166 5.—OTHER MATTERS. Class- Number. Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Notified by H.M. Inspector Reports (of action taken) sent to v H.M. Inspector 5 Acts, but not under the Factory and Workshop Act (s. 5) 5 Other — Underground Bakehouses (s. 101).— Certificates granted during the year In use at the end of the year 16 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 2nd January, 1927, to the 31st December, 1927, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 226, 172 Pulmonary Tuberculosis and 54 Non-Pulmonary as compared with 166 Pulmonary and 47 Non-Pulmonary for the previous year. 85 Table XXVI. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 2nd January, 1927 to 31st December, 1927. Notifications on Form A. Total Notifications on Form A. Notifications on Form B. Number of Notifications on Form C Age Periods. Number of Primary Notifications. Total Notifications on Form B. Cases admitted to 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications Poor Law Institutions. Sanatoria. L nder 5 5-10 10-15 Total Primary Notifications Pulmonary— , Males ... 1 3 3 5 11 23 9 23 12 3 93 159 ... 57 110 Females ... 2 2 2 14 15 24 13 4 2 1 79 122 44 77 N on-Pulmonary Males 6 8 5 3 2 1 1 1 1 28 31 . . . 7 13 Females ... 2 4 4 2 2 1 7 2 2 26 27 5 ' 13 86 The number of deaths for the year is 132 as compared with 104 for 1926. 192g 1927 P.T. deaths ... ... 91 119 Non P.T. deaths ... 13 13 Analysis of the notifications and deaths for the year according to sex and age are given in the accompanying tables, following which is a table showing deaths according to Wards. Particulars of New Cases and of Deaths during the Year 1927. New Cases.* Deaths. Age Periods. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary m f m f m f m f 0 1 4 2 1 2 2 6 6 2 - 2 3 5 3 2 8 4 — 2 1 — 10 3 2 6 2 1 2 1 — 15 6 16 3 3 5 6 1 1 20 13 15 2 1 8 12 — - 25 26 27 2 7 10 7 — 1 35 11 15 1 2 17 12 — — 45 30 4 1 — 12 2 — 1 55 14 2 — 3 14 3 — — 65 and upwards 4 2 1 — 2 2 — — Totals 112 88 30 32 71 48 5 8 •Note—Including 36 cases which came to the knowledge of the Medical Officer of Health otherwise than by notification. Pulmonary Tuberculosis. Interval between Notification and Death in 1927. Not notified 17 Died before receipt of notification 7 Died within one week of notification 6 „ „ one week to one month 2 „ „ one month to three months 9 „ „ three months to six months 12 „ „ six months to one year 14 „ „ one to two years 17 „ „ two to three years 13 „ „ three to four years 7 „ „ four to five years 7 „ „ five to six years 2 „ „ six to seven years 1 „ „ seven years and upwards 5 119 87 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 dutv to notify all cases of Tuberculosis which they attend. The notifications of non-Pulmonary Tuberculosis were as follows :— Glands 19 Ankle 1 Peritoneum 7 Salpingitis 1 Spine 5 Kidney 1 Hip 7 Meninges 3 General 1 Lupus 1 Enteritis 1 Larynx 1 Ribs 2 Mastoid 1 Eyes 1 Lumbar Muscles 1 Ear 1 Total 54 Revision of Notification Register. During the year 212 cases of Pulmonary and 58 cases of NonPulmonary Tuberculosis were removed from the Register of Notifications either as cases in which the diagnosis was not confirmed or cases which were considered "cured" and not needing further supervision or as having died or left the district. With the addition of transfers from other areas and new notifications the Register stands at the end of 1927 as follows:— males Under 15 Over 15 females Under 15 Over 15 Total Pulmonary Tuberculosis 61 322 49 275 707 Non-Pulmonary Tuberculosis, 100 35 109 48 292 Totals 161 357 158 323 999 Disinfection was carried out in 367 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 88 TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1927. Diagnosis. polmonary. Non-Pulmonary. Total. (6) Adults. (6)Children. Adults. Children. Adults. Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (ia) Definitely tuberculous 56 57 3 ' 1 3 5 4 4 59 62 7 5 (b) Doubtfully tuberculous — — — — — — — — 72 73 50 37 (c) Non-tuberculous — — — — — — — — 33 34 51 38 B.—Contacts examined during the vear:— (a) Definitely tuberculous 1 1 — 1 — — — — 1 1 — 1 (b) Doubtfully tuberculous — — — — — — — — 6 14 25 17 (c) Non-tuberculous — — — — — — — — 13 26 42 32 C.—Cases written off the Dispensary Register as (a) Cured 5 12 11 2 1 2 6 6 6 14 17 8 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 100 128 149 112 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 243 177 32 28 21 22 36 44 264 199 68 72 (b) Diagnosis not completed — — — — — ` — — — 28 31 25 20 89 1. Number of persons on Dispensary Register on January 1st 789 2. Number of patients transferred from other areas and of " lost sight of "cases returned 27 3. Number of patients transferred to other areas and cases "lost sight of" 181 4. Died during the year 93 5. Number of observation cases under A (b) and B (b) of Table in which period of observation exceeded 2 months 217 6. Number of attendances at the Dispensary (including Contacts) 3577 7. Number of attendances of non-pulmonary cases at Ortho- — paedic Outstations for treatment or supervision 8. Number of attendances of patients at General Hospitals or other Institutions approved for the purpose, for (a) "Light" treatment 328 (b) Other special forms of treatment 29 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 49 10. Number of consultations with medical practitioners: — (a) At Homes of Applicants 14 (b) Otherwise 62 11. Number of other visits by Tuberculosis Officer to Homes 177 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4512 13. Number of (a) Specimens of sputum, &c., examined 856 (b) Specimens of sputum sent by doctors for nonDispensary patients 303 (c) X-ray examinations made in connection with Dispensary work 78 14. Number of Insured persons on Dispensary Register on the 31st December 353 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 191 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 - (b) Form G.P. 36 84 90 TUBERCULOSIS (a) PULMONARY Annual Return showing in summary form the condition of all Patients whose according to the years in which the Patients first came under Public Medical Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Alive Discharged as cured Adults M. 5 F. 11 l l Children M. 10 F. 2 Disease arrested Adults M. 36 5 18 23 F. 26 8 6 14 Children M. 16 F. 15 Disease not arrested Adults M. 9 3 46 14 63 F. 4 30 7 37 Children M. 1 1 2 F. 3 1 1 Condition not ascertained during the Year 41 6 12 4 22 Lost sight of or otherwise removed from Dispensary Register 83 8 16 5 29 Dead Adults M. 4 5 12 17 F. 2 2 9 11 Children M. F. Totals 267 31 137 52 220 91 SCHEME. TUBERCULOSIS. case records are in the possession of the Dispensary at the end of 1927, arranged Treatment for Pulmonary Tuberculosis, and their classification as shown on 1926 1927 Class T.B. minus Class T.B. plus Class T B. minus Class T.B. plus Group 1 Group 2 Gioup 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total, (Class T.B. plus) 1 2 5 3 18 6 27 7 38 9 42 4 1 10 4 15 5 4 27 10 11 2 5 2 1 1 5 1 4 5 6 4 1 5 4 4 6 14 20 1 10 10 1 6 7 4 7 11 1 1 2 1 1 27 5 40 36 81 18 5 68 37 110 92 (b) NON-PULMONARY Annual Return showing in summary form the condition of all Patients whose according to the years in which the Patients first came under Public Medical Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 Bones and Joints Abdominal Other Organs Peripheral Glands Total Alive Discharged as cured Adults M. l I F. l l 2 Children M. I 5 6 F. 2 2 2 6 Disease arrested * Adults M. 2 1 3 F. 3 3 Chldren M. 5 3 6 14 F. 7 1 8 16 Disease not arrested l Adults M. 5 l 6 F. 2 1 3 3 9 Children M. 1 3 4 F. 3 6 9 Transferred to Pulmonary Condition not ascertained during the Year 8 4 10 22 Lrst sight of or otherwise removed from Dispensary Register 16 6 5 27 54 Dead Adults M. 1 1 F. 1 1 Children M. F. Totals 57 19 9 72 157 93 TUBERCULOSIS. case records are in the possession of the Dispensary at the end of 1927, arranged Treatment, and their classification as shown on Form A. 1926 1927 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal Other Organs Periphereal Glands Total 1 l l l I l 2 2 l 3 2 1 3 1 2 l 1 1 2 3 1 2 3 2 1 3 3 3 3 3 3 l 1 3 8 ' 9 1 4 11 25 5 1 6 12 G 94 Deaths of Dispensary Patients, 1927 (i.e., persons suffering from tuberculosis). Died within 3 months of first attendance 15 ,, ,, 6 ,, ,, „ 9 ,, ,, 12 ,, ,, ,, 13 „ over 12 „ „ „ 48 85 Dental work. 15 patients were supplied with dentures or partial dentures, or repairs carried out. For others, extractions, scalings, etc., were done. As regards dentures; in the case of insured persons a part or the whole of the cost is obtained where possible from the approved society. Where the patient is on out-relief under the Poor Law, the Guardians have paid the entire cost, or part of the cost if a balance remained due in respect of an insured person. Five patients in such circumstances were referred to the Guardians. Persons not on out relief, and insured persons whose society did not pay all or any of the cost of the dentures, were assessed by a Sub-Committee of the Public Health. Committee for payment. Total cost of dentures and repairs to dentures £38 0 0 „ „ free cases 17 2 6 Contributions from approved societies 7 12 9 „ „ Guardians 8 15 0 „ „ Red Cross Society 1 15 0 „ „ patients (received) 1 17 6 „ (due) 2 10 0 Co-operation with Practitioners, School Authorities, County Council, etc. Co-operation with general medical practitioners by the use of "Z" cards, as explained in last year's report, is continued. 53"Z.l," 90 "Z.2,"14"Z.3" and 16 "Z.4" cards were sent during the year under report. 191 patients were sent to the Dispensary by doctors. 220 letters regarding patients were written to doctors, 158 to hospital authorities, 70 to the Medical Officer of Health and County Medical Officer. 95 266 Form C. IV progress reports about patients who had received institutional treatment through the County Council were sent to the County Medical Officer. 109 reports re Tuberculous ex-service men were sent to the Ministry of Pensions. 128 school contacts were referred, on "M.O. 333" cards, to the School Medical Officer. 64 of these children had been examined at the Dispensary. 39 other letters regarding children were written to the school authorities and the Invalid Children's Aid Association. 43 patients were recommended for admission to the Greenwich and Deptford Hospital. 93 recommendations were made to the Guardians for extra nourishment for patients and five cases were recommended to the Guardians for dentures. 214 patients were recommended to the London County Council for institutional treatment. In 27 cases the County Council were unable to accept (of this number, 7 patients had had such treatment previously and 2 were accepted later). Some of these patients had already been sent to the Greenwich and Deptford Hospital when offered a vacancy; 2 were too ill to move and 1 made private arrangements. 18 certificates were given to patients in regard to their physical condition, and 16 letters were written in an endeavour to assist patients to obtain better housing accommodation. 85 other letters were written to patients. Examination of Contacts. During the year 1927, 172 primary notifications of tuberculosis were received in respect of all the wards in the Borough with the exception of Vale and St. Paul's wards. Last year an analysis was made of the total contacts and the number of these examined at the Dispensary, in connection with notifications received of cases in the two abovementioned wards. This year a similar statement is given in respect of all the other wards. g2 96 Examined at Dispensary—87 Pulmonary Tuberculosis (T.B. in Sputum) Pulmonary Tuberculosis (T.B. not found in Sputum) Non-Pulmonary Tuberculosis Total Contacts 56 21 10 Adults Children Adults Children Adults Children 107 47 80 18 16 14 Contacts examined at Dispensary 20 21 21 14 3 8 Not Examined at Dispensary—85 Pulmonary Tuberculosis T.B. + (known) Pulmonary T uberculosis T.B. — Non-Pulmonary Tuberculosis 16 45 24 Total Contacts Adults Children Adults Children Adults Children 39 11 58 25 52 26 Contacts examined at Dispensary 2 5 4 5 0 5 Of the contacts examined, two contacts of a T.B. +case, one of a T.B.—case and one of a Non-pulmonary case were found to be definitely tuberculous by the end of the year. Of these 172 notified cases, 26 P.T. and 4 O.T. were dead by the end of the year. The proportion of the notified cases seen at the Dispensary is much smaller in these wards than in the St. Paul's and Vale wards, and it is again evident that a greater number of the contacts can be secured for examination if the notified case is seen at the Dispensary. Of the 138 notified cases mentioned in the above table, it will be noted that 72 were cases in which tubercle bacilli were found in the •sputum, and of these latter, 56 were seen at the Dispensary. Of the remaining 66 notified cases of pulmonary tuberculosis, it is not known that the bacilli were ever found in the sputum; 21 of these were seen at the Dispensary. Further statistics are now available with reference to results obtained in France by the administration to infants of an attenuated variety of tubercle bacillus so as to thereby immunise them against the ordinary disease-producing variety. These statistics are very 97 favourable, though their exact reliability is questioned, and it is hoped that the results of the research work of the Medical Council may be in agreement and the method sanctioned for general use. Yours faithfully, N. M. Donnelly, Tuberculosis Officer. Report of Miss Lewellin. Secretary of the Tuberculosis Care Committee. It is not possible to give a formal report on Tuberculosis Care Committee work, as this work from its very nature to be successful, must be dealt with as informally and unofficially as is consistent with a certain necessary amount of method and system. We like to presume that our readers are familiar with previous Reports in which the Committee's aims and objects are given in detail, as we do not wish to be guilty of the sin of repetition. We can however say, for the benefit of new readers, that our sole object is to help those suffering from Tuberculosis, and their families. We may perhaps claim that Care Committees may be termed the human link in the official chain forged by the responsible authorities for the better and smoother working of the machinery set up to deal with the complicated problem of Tuberculosis. During the year of 1927 many have been found needing our help and care, as the following figures indicate :— 1024 cases have been submitted to the Committee on the Agenda, some for information, many for discussion and decisions. 1290 visits have been paid to the patients' homes by the Secretary. 1244 persons have been interviewed by the Secretary at the Dispensary. 214 cases have been recommended for treatment and referred to the Care Committee for appropriate action. Here we may remark that figures are deceptive with regard to "care" work, the actual number of people brought under our care in connection with these 214 cases is this figure multiplied many times as Care Committee's workers are taught that patient and family must be regarded as the unit. 98 Of these cases, many are new, all have been visited and helped to make arrangements to go away for the period of treatment recommended. Often complete outfits of clothing have been obtained, children have been placed in homes in cases where the mother is the patient and could not otherwise have accepted treatment. Where the breadwinner is the patient, the maintenance of the family has been arranged for. When the case is a new one these first visits are important—there is much to accomplish. The patient has to be made to realise that the personal and intimate enquiries that have to be made are being asked in their interests and that the Care Committee is a body that strives to help and to make things easier for them, and perhaps this is a suitable moment to pay tribute to our Deptford people—they are so very generally friendly and trustful, and appreciative of anything done for them. With each of these new cases, unless it is obviously one that has come to us too late, in spite of many and constant disappointments, we hope that at least a measure of health may be regained, and maintained. In due course these patients return from the period of institutional treatment prescribed. Some there are for whom it is obvious little can be done except to make things as easy as possible for them until the inevitable end comes. Others are very much improved in health and with a reasonable chance of keeping moderately well provided that they can lead the right sort of life. During 1927, 179 patients were discharged from hospitals and sanatoria. In each case their very problematical future was discussed by the Care Committee who would like to do so much—and, in view of existing conditions can do so little—to solve the big problem of the future of patients returning from sanatoria: and at this stage, to speak frankly, we are no longer optimistic. The subject is, we know, at the moment, receiving the consideration of thoughtful men and women and we feel that there is little doubt but that some solution will be evolved in time. Unfortunately the remedy of the future does not assuage the pain of the present. Readers are aware of the conditions existing in many of the homes to which these patients return— our Medical Officer we know will not let them forget them—and it 99 would help if all would remember that Tuberculosis is the effect of many causes, and in remembering realise individual responsibility. Public opinion can remove even the "mountains" of slumdom. The future of the children in these homes in close contact with tuberculous patients fills us with anxious fears. We are glad to be able to report that the scheme for boarding-out children is still in existence, but this can only be applied in cases where the patient with whom they are in contact is in an advanced state and not likely to live for any lengthy period. This is a most valuable scheme and is more than "twice blessed," as in addition to removing children from the source of infection it builds up their health, and often gives them a conception of another kind of life, and one cannot help but feel that the beautiful and natural surroundings among which the " homes " are generally situated, make an impression on the childish minds that may bear fruit in future. This year 11 cases were recommended to and accepted by the London Council for boarding-out. In one case the parents reconsidered thei- decision, so that 10 children were actually sent away. Out of these 10, only in one instance is the patient with whom they were in contact alive. Unfortunately, in some cases where the need for removing children has become specially urgent, the parents have refused to part with them. Our appeals to local and other charitable agencies have as usual, met with a ready response, and the thanks of the Committee have been conveyed to the individual societies. Without their assistance it would be exceedingly difficult to carry out the work; under existing conditions help must be obtained from somewhere. To be unable to relieve the distress we meet, to even the small extent that we can do, would be heartbreaking. To complete our report we will give a few specimen cases to illustrate the necessity for, and value of, the help we ask for and receive : (l) Man with wife and one child, found to be suffering from tuberculosis and recommended for institutional treatment. He had always been in work and a provident man, so for the first three months of treatment his National Health Insurance benefits supplemented by payments from his sick clubs, provided a sufficient income to maintain the home during his absence. At the end of this period he wisely 100 wrote to the Care Committee for advice. Payments were reduced and even his capable and careful wife could no longer manage. They had never had to apply for public assistance and could not bring themselves to do so even then. If the Care Committee could not have found some way out it is certain that this man would have come home and tried to resume work. He was an ex-service man, fortunately, so we were able to obtain help from a fund for ex-service men. The exceptional merits of the case were recognised by a generous allowance to the wife, and the man remained away for his allotted period. In addition, dentures were obtained for the wife free of charge, it having been ascertained that her teeth had been extracted while her husband was working and in a position to provide these. The future we are afraid presents difficulties, but we are only dealing with the immediate present at the moment. (2) Patient, a young married woman with one child, who had spent a considerable period in hospital, became unfit to carry out her home work. Could not be persuaded to go into hospital again at the manent although it was obvious that later she would have little choice. "Her husband's earnings were too small to allow him to pay anyone to do the work for her. Through the Care Committee a grant was obtained to pay a woman to keep the home clean and care for the child for some weeks. Eventually the patient who was in an advanced state became too ill to remain at home and was admitted to hospital. (3) A patient, wife of an ex-service man; 3 children. Found to be suffering from tuberculosis and recommended for a course of institutional treatment. Referred to the Care Committee who found that the family was in serious financial difficulties. The husband was in regular work but earning very small wages. For some time the patient had been borrowing to meet extra expenses that arose. When she came to us she was repaying the money borrowed at the rate of 8s. per week, which meant that after rent and other contractural expenses were paid, 36s. a week was left to feed and clothe a family of five people. It was evident that this patient was not in a position to provide herself with sufficient nourishment which may have accounted for her state of health. Enquiries showed that husband and wife were a ve;:y respectable and united couple. Application for help was made to appropriate societies, an outfit of clothing was obtained for patient to 101 go away with, and a grant of £10 was received to settle up all debts, provide children with clothing and start the family clear again. This patient went away with a mind at rest, returned home very much improved in health, and what is most gratifying, has continued to improve since her return. This is obviously due to the way she lives; she endeavours to carry out the instructions given at the sanatorium and makes one realise the truth of a remark made by a speaker at one of the conferences held, that better results are obtained from living sensibly under bad conditions than foolishly under good ones. This case also emphasises the value of education. B. Lewellin. CANCER. Year No. of Deaths Year Deaths 1922 146 1925 164 1923 140 1926 159 1924 148 1927 170 Deaths from, at age periods. Year 2 to 5 years 5 to 15 years 15 to 25 years 25 to 45 years 45 to 65 years 65 years & upwards 75 years & over 1922 1 – – 10 76 59 – 1923 – – —– 12 74 41 13 1924 – – 1 10 62 43 32 1925 1 – – 17 82 37 27 1926 – – 2 9 72 51 25 1927 – – 1 7 77 58 27 Deaths from, in Men and Women at different age periods. Year Sex Under 25 years 25 to 45 years 45 to 65 years 65 to 75 years 75 years and upwards Totals 1925 Male 1 9 44 20 13 87 Female – 8 38 17 14 77 Total 1 17 82 37 27 164 1926 Male 1 4 36 24 9 74 Female 1 5 36 27 16 85 Total 2 9 72 51 25 159 1927 Male – 2 39 36 15 92 Female 1 5 38 22 12 78 Total 1 7 77 58 27 170 102 Looking at the death rates of cancer and tuberculosis, we find that in 1884 the death rate from tuberculosis, out of every million persons living, was 2,574, while that for cancer was 563. In 1920 the death rates were almost equal, viz.:—1,133 per million living, died from tuberculosis, and 1,166 from cancer. In 1925 the cancer rate was 1,336 as against 1,038 for tuberculosis. Part of this increase in cancer is due to greater accuracy in diagnosis. Rontgen rays were only discovered in 1895. Facilities for accurate diagnosis are now infinitely better. In view of the wide public interest in cancer throughout the world, official and unofficial bodies have been formed, the object being to reduce the mortality. Over three years ago a Departmental Committee was established by the Ministry of Health. Further, a British Empire Cancer Campaign, supported by voluntary subscriptions, came into being. The last mentioned body is spending money in research, whereas the Departmental Committee is an official body concerned with the disease from the National standpoint; it investigates statistical evidence, environmental conditions, field conditions, facilities for diagnosis and treatment and their results. It is an advisory body, and it has issued official memoranda on cancer, the first in the year 1923. A special Sub-Committee was formed of Medical Officers of large County Boroughs who were asked to make special investigations; thus a special investigation and report was made over a year ago on cancer of the breast. There are some interesting points in a consideration of the statistical side of cancer. In 1924 there were 50,389 deaths from cancer in England and Wales and of these, 23,099 occurred in males, and 27,290 in females. The greater number of deaths among women is due to the fact that women live to a greater age than men; they live so to speak, right on into the cancer age, for cancer is a disease of old age. The increase in deaths from cancer is largely amongst males, particularly in large cities. Studying this further, we find that the standardised death rate for every 100,000 living men was 90 during the four years before the war; this 90 per 100,000 rose to 97 in the year 1923, then to 100 in 1924. Cancer has therefore increased materially amongst men. As regards women, for the four years before the war, the rate was 97, and since then it has only risen to 98 in 1924. These facts should be known, as many women fear that so far as their sex is concerned, cancer is increasing by leaps and bounds. It is not so. 103 As to the cause of cancer, some believe that a definite infective agent enters the body, as in tuberculosis; others say that cancer is due to a permanent change occurring in the nutrition of a cell or groups of cells. The evidence as to the communicability or spread of cancer from one person to another is slight, but it is advisable to disinfect. We can say that tissues of the body affected by chronic inflammatory change, often resulting from long standing irritation or from a blow or injury are liable to become cancerous. In the skin we have seen chimney sweeper's cancer, the irritation from soot being the cause. Cancer occurs in workers in tar and paraffin and in cotton spinners exposed to mineral oil from the "mule." Cancer of the lip occurs in smokers and ulcer of the stomach may end in cancer. To prevent cancer as far as we understand it, workers should be guarded from the irritation of tar and paraffin. Middle aged people should get rid of anything of the nature of simple tumours, warts and papillomata, which are liable to chronic irritation. Early diagnosis is imperative and no one should delay in having an X-ray examination where there is the slightest reason for suspecting any growth or unusual conditions.. MATERNITY AND CHILD WELFARE. Summary of Work of Health Visitors. The work done by the health visitorsis summarised in the following Table:- 1st visits Re-visits Total Births 1907 7717 9624 Still Births 51 2 53 Infant Deaths under 1 year 108 – 108 Infant Deaths. 1 to 5 years 41 – 41 Expectant Mothers 586 276 862 Ophthalmia Neonatorum 11 17 28 Measles 46 32 78 Infantile Diarrhœa 54 25 79 Scabies in children 19 6 25 Verminous Children 46 13 59 Puerperal Fever 9 7 16 Puerperal Pyrexia 5 3 8 Pemphigus Neonatorum 4 7 11 Pneumonia 57 66 123 Miscellaneous 505 111 616 Unsuccessful visits 660 773 1433 Scarlet Fever recoveries 252 147 399 Encephalitis lethargica 1 8 9 Poliomyelitis 2 – 2 Erysipelas 4 – 4 Totals 4,368 9,210 13,578 104 In addition to the above visits, the Health Visitors spent in all 581 afternoons at sessions of the Infant Welfare Centres and 151 mornings at sessions of the Ante-Natal or Special Clinic; 6 attendances were also made at Dental Clinics, and 31 at Schick test and inoculation sessions. 193 "Test Feeds" were conducted at the Town Hall. Feeding.—In the 1,907 births visited it was found that 1,762 infants were being breast fed and 50 partly breast fed. Only 95 were entirely hand fed. Births Notified, Year 1927. Ward Births Notified. Alive. Dead. Parent. By whom Notified. Total. Male Female. Doctor. Midwife Other Person. Canterbury 144 70 74 142 2 12 58 74 – Clifton 129 61 68 127 2 8 27 94 – Deptford Park 122 68 54 120 2 6 59 56 1 Evelyn 166 88 78 161 5 15 55 95 1 Hatcham 100 54 46 98 2 13 29 58 – Pepys 71 33 38 70 1 12 34 25 – St. Catherine's 51 22 29 51 – 10 18 21 2 St. lohn's 84 40 44 81 3 18 23 43 – St. Paul's 244 118 126 238 6 9 16 218 1 St. Peter's 333 164 169 328 5 16 19 294 4 Town Hall 113 53 60 109 4 11 38 64 – Vale 174 93 81 166 8 13 46 114 1 1731 864 867 1691 40 143 422 1156 10 Milk supplied to Necessitous Mothers and Children. During the year 8,164 applications were received and were dealt with as follows:— Granted free 7311 „ at half-price 835 Refused (over scale) 18 8,164 Dried Milk, Virol, &c. The following amounts of dried milk, &c., were distributed to the mothers attending the Infant Welfare Centres, during the year 1927 and previous years. 1927 1926 1925 1924 Ambrosia 3,356 1 lb. packets 3,158 3,195 2,656 Cow and Gate 2,105 „ 1,581 1,903 1,897 Glaxo 730 „ 1,108 1,356 2,819 Lactogal 70 tins 93 69 68 Lacta – 1 lb. packets – – 29 Trufood 583 1 lb. tins 392 191 188 Recolac – „ – 36 9 Virol 12 28 lb. tins 24 28 36 105 Maternity Home. Particulars of cases admitted during the year 1927:— Cases in Home on 1st January, 1927, 11. Cases admitted, 248. Average stay, Two weeks. Cases delivered by midwives, 238. „ „ „ doctors, 10. Cases in which medical advice sought, 85. (a) Ante-natal, 3 (l, Ante-partum; 2, Albumnuria). (b) During labour, 10 (instrumental delivery). (c) After labour, 2 (Hæmatoma and Exhaustion). 61 Sutures of Perineum. (d) For infant, 2 (dangerous feebleness and Prematurity). Cases notified as puerperal sepsis, Nil. Temperature rose above 100.4 for 24 hours, 3. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Inflammation (eyes), Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. Foetal deaths, Stillborn, 4; Prematurity, 2. Ante-Natal Clinic Statistics, 1927. Attendances during the years: — 1926. 1927 New Cases 499 557 Total Attendances 2,292 2,241 Normal pregnancies 155 Anæmia 44 Albuminaria 84 Ante-partum hæmorrhage 4 Breech presentations 9 Bronchitis 5 Dental caries only 98 „ „ with other defects 125 Dyspepsia 12 Fibroids 5 Carried forward 541 106 Brought forward 541 Glycosuria 3 Haemorrhoids 13 Hernia (Rt. Inguinal) 1 Leucorrhæa 16 Lupus 1 Morbus Cordis 29 Nipples, deformed 9 Oedema 18 Ovarian Cyst 1 Phlebitis, acute 1 Phthisis 4 Contracted pelvis 4 Pruritus 6 Retroversions 5 Sciatica 4 Twins 2 Varicose veins 57 External version 11 Venereal disease 1 Excessive vomiting 11 Total 738 Referred to Hospital 45 Letters to doctors in private practice 11 „ Tuberculosis Officer 4 „ midwives 17 Post-natal examination 12 Not pregnant 40 The Infant Welfare Centres are held in halls let to us by different religious organisations. There are two exceptions, viz.: the Goldsmiths' Centre, held in a class-room at Goldsmiths' College, London University, Lewisham High Road, and at the Princess Louise Centre, Hales Street. The latter Centre is a voluntary one, except that the Council provides two Health Visitors as well as the Medical Officer. In the six Infant Welfare Centres there are voluntary workers whose services are prized by the Council and officers. 107 Until 1922, one Ante-Natal Centre was held in the morning at the Napier Street Centre. A second session was opened on Wednesday forenoons in view of the increasing numbers attending. Yet again, a third session had to be opened on Thursday mornings. Early in 1928 this work was transferred to the Deptford Health Centre, Harton Street. The numbers attending have now made it necessary to consider the question of a fourth morning session. Dr. Hill attends from 10 a.m. until 1 or 1.30 p.m. In addition to the Ante-Natal examinations, any urgent cases from any of the Infant Welfare Centres are seen on Wednesday forenoon. Attendances at Clinics and Treatment Centres. napier street clinic. 1927 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 5 5 2 12 178 190 102 February 4 10 2 3 15 209 224 106 March 5 10 3 3 3 19 254 273 126 April 3 15 2 1 18 149 167 83 May 4 15 6 20 275 295 126 June 5 14 1 1 4 20 181 201 78 July 4 15 1 1 17 280 297 109 August 5 16 2 1 1 20 256 276 119 September 4 9 1 5 15 229 244 94 October 3 8 1 2 11 254 265 89 November 5 15 1 16 269 285 111 December 3 17 1 2 20 142 162 82 Total 49 149 13 15 26 203 2676 2879 1225 108 ERLAM ROAD CLINIC. 1927. 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 6 1 1 8 144 152 76 February 4 13 3 2 18 183 201 95 March 5 6 2 1 1 10 207 217 102 April 3 7 1 1 9 131 140 69 May 4 7 2 1 10 159 169 66 June 5 6 2 1 3 12 187 199 59 July 4 9 1 1 3 14 152 166 79 August 5 5 5 170 175 78 September 4 10 1 3 1 15 176 191 87 October 3 7 1 8 148 156 72 November 5 6 1 1 8 225 233 110 December 3 2 2 82 84 45 Total 49 84 9 11 15 119 1964 2083 938 GOLDSMITHS' COLLEGE CLINIC. 1927 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5. January 4 15 2 2 3 22 394 416 132 February 4 15 1 4 4 24 365 389 146 March 5 7 2 4 3 16 512 528 150 April 3 13 3 2 2 20 239 259 85 May 4 19 1 2 2 24 377 401 116 June 5 16 2 4 2 24 413 447 62 July 4 14 3 6 23 307 330 105 August 4 11 1 12 348 360 125 September 5 15 2 3 4 24 326 350 135 October 4 18 2 1 3 24 287 311 109 November 4 16 1 2 8 27 386 413 156 December 5 15 1 2 1 28 311 359 154 Total 51 174 17 30 47 268 4265 4563 1475 109 BESSON STREET CLINIC. 1927. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. . Ages 1-5. January 4 11 1 2 3 17 239 256 92 February 4 5 2 2 9 249 258 104 March 4 10 2 1 13 280 293 110 April 4 12 1 5 18 309 317 115 May 4 10 1 2 13 254 267 82 June 4 3 2 5 207 214 80 July 5 12 1 1 1 15 236 251 107 August 4 14 1 1 1 17 209 226 109 September 5 11 2 1 14 315 329 142 October 4 11 1 3 2 17 167 184 79 November 4 10 1 2 13 235 248 111 December 5 13 1 3 1 18 243 251 136 Total 51 122 8 19 20 169 2943 3094 1267 GOSTERWOOD STREET CLINIC. 1927 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 14 1 1 16 323 339 175 February 4 13 1 1 15 202 217 108 March 4 14 4 18 282 300 129 April 3 9 2 11 210 221 95 May 5 21 1 4 26 327 353 137 June 3 15 1 2 18 205 223 72 July 4 10 2 3 3 18 235 253 102 August 4 8 1 9 229 238 106 September 4 7 1 8 185 193 98 October 4 22 2 2 1 27 246 273 129 November 4 11 1 12 236 113 December 3 7 1 8 156 164 77 Total 47 151 6 19 10 186 2824 3010 1341 110 HALES STREET CLINIC. 1927. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 9 6 4 19 180 199 104 February 4 19 4 1 24 239 263 162 March 5 9 1 3 3 16 309 325 193 April 3 4 1 3 8 157 165 83 May 4 21 4 3 1 29 262 291 190 June 5 11 5 2 18 258 276 135 July 4 7 1 2 2 12 207 219 134 August 4 16 1 4 3 24 189 213 107 September 5 5 1 5 2 13 271 284 126 October 3 3 3 8 14 177 191 124 November 4 15 2 6 23 254 277 158 December 5 11 1 2 3 17 268 285 170 Total 50 130 19 34 34 217 2771 2988 1686 111 Summary of Visits paid by Health Visitors. Wards (approximate) St. Paul's and Evelyn (part) Vale and Clifton Deptford Park and Evelyn (part) Canterbury and Hatcham St. Catherine's and Pepys St. John's. St. Peter's and Town Hall. Total. Miss Robus Visits .. .. 858 .. .. .. 858 Revisits .. .. 1541 .. .. .. 1541 Total .. .. 2399 .. .. .. 2399 Miss Smart Visits .. 742 .. .. .. .. 742 Revisits .. 528 .. .. .. .. 528 Total .. 1270 .. .. .. .. 1270 Miss Stowell Visits .. .. .. 641 .. .. 641 Revisits .. .. .. 2277 .. .. 2277 Total .. .. .. 2918 .. .. 2918 Miss Reynolds Visits .. .. .. .. .. 708 708 Revisits .. .. .. .. .. 1628 1628 Total .. .. .. .. .. 2336 2336 Miss Clubbe Visits .. .. .. .. 228 .. 228 Revisits .. .. .. .. 846 .. 846 Total .. .. .. .. 1074 .. 1074 Miss Fudge Visits .. .. .. .. 345 .. 345 Revisits .. .. .. .. 1138 .. 1138 Total .. .. .. .. 1483 .. 1483 Miss Little Visits 846 .. .. .. .. .. 846 Revisits 1252 .. .. .. .. .. 1252 Total 2098 .. .. .. .. .. 2098 Total Visits 846 742 858 641 573 708 4368 Revisits 1252 528 1541 2277 1984 1628 9210 Total 2088 1270 2399 2918 2557 2336 13578 Maternity Home—Cases not Admitted, Sixteen applications were not acceptable; of these, 13 were out-ofborough applications. In many cases the applications were refused as the Home was fully booked for the period desired. Invariably the applicant was advised as to the best steps to take. h2 112 SUNLIGHT TREATMENT CENTRE. Report for the Year 1927. Month New Patients Patients Readmitted Patients Discharged Total on Register Attendance Lamp used Hours Mins. January 17 42 4 55 378 41 35 February 22 5 6 76 485 44 32 March 19 1 17 79 623 41 5 April 30 – 33 76 755 51 5 May 21 – 28 69 764 55 0 June 7 1 17 60 447 25 10 July 21 2 26 57 218 12 0 September 13 2 12 60 470 33 25 October 18 3 16 65 522 33 25 November 21 3 18 71 506 33 45 December 34 4 34 75 727 43 20 Total 223 63 211 75 5,895 424 22 Classification of Patients on Treatment during the year 1927. Rickets 53 Bronchitis 7 Malnutrition 51 Arthritis 2 Anæmia 62 Tubercular Glands 1 Cervical Adenitis 3 Delayed Mental Development 2 Muscular Weakness 45 Delayed Dentition 32 Eczema 2 Chronic Cough 2 Bronchial Catarrh 11 Debility 9 Mastoid 1 Anorexia 3 Total 286 The popularity of the Sunlight Centre is rapidly increasing, and many mothers come to the Infant Welfare Centres with a request that their children may be allowed to have the treatment because the children of relatives and friends have gained so much benefit from it. It is to be noted that certain types of cases improve much more than others and that "malnutrition," due to improper feeding and dyspepsia, does not necessarily vanish even under ultra-violet ray treatment. Much can be done in such cases to help the mothers to 113 correct mistakes in the management of their children, and while they sit round the lamp, full use is made of the opportunity for giving detailed instructions as to diet, clothing, sleep, etc. It is found that thin, nervous children suffering from loss of appetite, fretfulness and inability to sleep, show great improvement after a prolonged course of treatment—say four to six months—whereas fat, rickety babies seem to get more benefit in the first two months although the loss of weight in these latter babies is apt to cause the mother to lose faith in the ultra-violet rays. Patience and tact is necessary on the part of the Nurse, and intelligent co-operation on the part of the mother, or the magical effects claimed by some vendors of the ultra-violet ray lamp will bring discredit on the method. One mother who brought her child once only to the Centre declared that he had got Measles from coming, although the illness developed on the day after his first treatment. A more intelligent lady who bravely attended all through the winter months assured us that her boy had never before been so entirely free from coughs and colds, in spite of the fact that we have the windows open. The cost of running the Light Treatment Centre for the year ended March 31st, 1928 was £395 3s. 4d. as compared with £371 14s. 4d. in the previous year. Babies' Home, Albury Street. The Babies' Home, Albury Street, is useful in the treatment of dietetic and sub-acute cases. The Council subsidised eight cots at £50 a year each, but later in 1926 it decided to pay £2 a week or part of a week, per case for any cases sent in by the Council's Medical Officers. This rate was altered to 6s. 6d. per patient per day, as from 1st January, 1927. The total number of new cases sent in during the year 1927 was fourteen. Mortuary Report for the year ended 31st December, 1927. Bodies Received, etc. Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Unknown. Deposited to await burial only. Infectious. 139 82 57 137 87 15 5 2 — 114 Ten bodies were detained after inquests to await burial owing to lack of accommodation at the homes, and 6 owing to advanced decomposition. One body was admitted to the Mortuary to await burial, by order of the Medical Officer of Health. Districts of which deceased persons were residents. Deptford 58 Poplar 2 Greenwich 18 Maida Vale 1 Lewisham 5 Lambeth 1 Camberwell 1 Southwark 1 Bermondsey 38 Sutton 1 Woolwich 9 West Ham 1 St. Marylebone 1 Sweden 1 Bethnal Green 1 Still Births. The Births and Deaths Registration Act, 1926, came into operation on June 1st, 1927. This Act requires that all still born children shall be duly registered with the Registrar of Births and Deaths in addition to being notified to the Medical Officer of Health. A still born child is any child born after the 28th week of pregnancy. The bodies of such infants must not be buried before a certificate is issued by the Registrar, or on the order of a Coroner, if there has been an inquest. From June 1st until December 31st, 1927, the number of still births registered with the Registrars was 26. Following the requirements of the Notification of Births Act, 1907, 40 still births were notified to your Medical Officer of Health during the year under report. Section 7 of the Act requires that when a still birth is registered, the relatives giving information must either (l) deliver to the Registrar a written certificate that the child was not born alive, signed by a registered medical practitioner or certified midwife who was in attendance at the birth or who has examined the body of the child, or (2) make a prescribed declaration to the effect that no practitioner or midwife was in attendance or had examined the body, or that his or her certificate cannot be obtained, and that the child was not born alive. When any case as indicated in (2) arises, i.e., where no doctor or midwife was in attendance at the birth or where his or her certificate cannot be obtained, the Registrar should communicate with the Medical Officer of Health for enquiry to be made in order that he may be in a position to 115 inform the Registrar whether he is satisfied that the child was really still born, or whether there are any suspicious circumstances attaching to the case. In a circular dated August 15th, 1927, the Ministry of Health drew attention to the provisions of the Cremation Act, 1902, and the Cremation Regulations, 1920, the former of which provides that no cremation of human remains shall take place except in an approved Crematorium, and the latter define the expression "human remains" as including the remains of a still born child; it is thus made clear that such remains cannot lawfully be disposed of by burning in a hospital furnace or incinerator. Underground Rooms. Section 96 of the Public Health (London) Act, 1891, gives the standard to which such rooms must conform, if separately occupied. During the year 1927 none such were found to be illegally occupied. Public Health (Imported Food) Regulationr, 1925. Part II, Sections 6, 7, 8 and 9. Part III, Section 2. The actual wharf frontage on the Thames-side appertaining to Deptford is small, being about half-a-mile in length. During the year various consignments of food-stuffs have been examined by the Medical Officer and the Inspector at the wharves on this frontage. On two occasions consignments of packed cheese were detained; in one case 288 lbs. of one parcel was surrendered to us for destruction, and in the other case the cheese was fit for food, but had been damaged during the voyage owing to bad packing. This parcel was allowed to pass on the understanding that it was re-conditioned: accordingly it was consigned to a city firm. The Public Health Department of the City of London was notified and it supervised the process of re-conditioning at a factory within the City. Cases of bubonic plague occurred upon two grain-carrying ships. We were notified by tha Port Sanitary Authority that the grain to be unloaded here was to be used for cattle feeding. This was done, the destinations of the various consignments of grain were ascertained, and the authorities concerned notified. Men working on these ships and living in the Borough were kept under observation during the incubation period. 116 HOUSING. In my introductory remarks I drew attention to the fact that the term "overcrowding," used as a measure of the need for more houses, was misleading. The correct way to assess the need is to study the number of cases in which there are two or more families living in one house. People do not live two families, or more, in a house because they want to; they do so because stark necessity forces them to do so. The letters we receive praying for accommodation—a house, a flat, anything decent anywhere—is a proof of the above statement and bears witness to the crying need. The following table, comprising 28 streets, gives an illustration of the existing state of affairs. It should be borne in mind that these streets were examined as a routine in the course of house-to-house inspection and not on complaint. A total of some 88 streets were so inspected during the year 1927. Housing Statistics—Selected Streets. Number of houses inspected Houses containing 1 family Houses containing 2 families Houses containing 3 families Houses containing 4 families Houses containing 5 families Number of families overcrowded Total families concerned Adolphus Street 71 12 46 13 ... ... 6 143 St. Asaph Road 63 13 49 1 ... ... ... 114 Bawtree Road 38 3 30 4 1 ... 1 79 Brookmill Road 50 12 36 2 ... ... 5 90 Bronze Street 8 3 4 1 ... ... 3 14 Canterbury Road 63 17 39 7 ... ... 4 116 Church Street 10 ... 1 6 2 1 12 33 Clyde Street 30 9 16 5 ... ... ... 56 Colwick Street 49 16 26 7 ... ... 7 89 Corston Street 37 9 23 5 ... ... 2 70 Cornbury Road 51 5 28 18 ... ... 11 115 Crossfield Street 9 ... 2 2 3 2 13 32 Dennetts Road 81 25 48 7 1 ... ... 146 Edale Road 16 ... 8 5 2 1 4 44 Eugenia Road 45 1 37 6 1 ... 5 97 Frankham Street 9 2 5 1 1 ... 2 19 Hales Street 62 18 28 10 6 ... 40 128 Haydock Road 36 ... 35 1 ... ... 4 73 Kender Street 45 32 7 5 1 ... 1 65 Kerry Road 51 12 32 7 ... ... ... 97 Lovelinch Street 72 8 54 10 ... ... 3 146 Mornington Road 32 9 16 5 2 ... 4 64 Pomeroy Street 52 28 16 7 1 ... 4 85 Reginald Square 51 34 15 1 1 ... 6 71 Senegal Road 62 2 60 ... ... ... 2 122 Stanhope Street 36 7 15 12 2 ... 22 81 Trundley Road 204 101 92 9 2 ... 6 320 Windmill Lane 29 11 14 3 1 ... ... 52 Totals 1362 389 782 160 27 4 167 2561 117 Houses inspected on complaint. In the past few years a great mass of correspondence has followed upon receipt of letters drawing attention to the conditions under which the writers live. On receipt of such a letter a Sanitary Inspector investigates and reports, and usually a letter is sent to the County Council Housing Department drawing attention to the case. The County Council authorities go into the circumstances of the case, but it is clear that for one reason or another many are disappointed. One cannot hope to tabulate more than a mere tithe of the letters we receive, but it is necessary that this should be done so that the facts may be fully appreciated and continued efforts may be made to help people. Herewith I give a list of thirty cases—only thirty—taken from the top of the file; the circumstances under which they are living make one wonder what is going to happen to the rising generation. The letters sometimes speak of ill-health, and small wonder. Notice the cases in which the cubic capacity of the room is given—the one room in which children are being brought up. Are we not a trifle eccentric or at any rate illogical? On the one hand we hold flag days, hospital fetes, hospital Sundays, collections and what not, to find the wherewithal to help our splendid hospitals. We pay Medical Officers, Sanitary Inspectors and Health Visitors to keep people healthy. On the other hand, we keep people bunched together in houses, sometimes overcrowded; sometimes we come across a family living in one room. Look how the table brings out the fact that young children are being brought up in one room, sometimes with a cubic capacity allowance for which a factory owner or lodging house keeper would be rapped over the knuckles if his workpeople were similarly treated. Sometimes the family doctor encloses a letter advising better accommodation for the family in question; more rarely reference is made to the fact that a child is tuberculous or threatened with tubercle. We read that the wife is expecting another baby. How, pray, can her confinement be carried out with surgical precautions under such conditions ? And so we have enquiries about a Maternal Mortality Question!! It is all very sad and it makes one feel that it would be better to be born a racehorse or a greyhound; I am certain their accommodation is relatively much better than that of some people. 118 The department concerned at the County Council has courteously replied to all the recommendations made. Evidently there is accommodation to be bad at Becontree, but this is too far away for many who must live near their work, Sometimes cases have to be refused because the family means lead one to infer that the rent would be too much for them. I have dealt with the remedy elsewhere—the demolition of condemned areas, the erection of flats, the moving-up of families according to circumstances. The following is the table giving some details in the case of thirty of the families whose cases were investigated on complaint. Applicant's Address. Husband's Work. Rooms Occupied. Number in family and circumstances. Remarks. 1. Oldfield Road Dock work casual One Man, wife, four children, 7 yrs. to 8 mos. Total cub. capacity, 1057 cub. feet. Has 1 bed, 1 cot and 1 box. Offers to pay 10s. rent, wants flat at Watergate Street. Specially recommended to L.C.C. 2. Cottesbrooke Street Clerk, £4 10s. per week One small bedroom. Share one small living room with another couple. Family washing done here. Man, wife, 3 children, 4 yrs. to 1 month. Would consider Becontree Recommended to L.C.C. 3. Pomeroy Street – One room 5 people Recommended 4. Blackhorse Road Main layer, £2 17s. per week One room. Rent 5s. 4d. Man, wife, 4 children, 9 yrs. to 3 months. Recommended 5. New Cross Road – One room, family has ill-health Man, wife, 2 children, 3 yrs. and 6 months. Recommended 6. Crossfield Street Fireman, £2 17s. 6d. permanently employed One room 724½ cub. feet one bed, others make up on the floor. Man, wife, 6 children under 10 years. Refused by L.C.C, for Becontree. 7. Hyde Street Stoker £2-£3 per week One room, 1260 cubic feet. Man, wife, 3 children under 5 8. Clandon Street Marine engineer, £3 7s per week. Living room and bedroom, each 720 cubic feet. Man, wife, 4 children under 6 Recommended to L.C.C. 9. Liardet Street In regular work. One room Man, wife, 3 children under 8 10. Fawcett Road Hairdresser 2 small rooms, 700 and 340 cubic feet. Man, wife, 5 children under 9 Willing to pay 14s. anywhere. Recommended to L.C.C. 119 Applicant's Address. Husband's Work. Rooms Occupied. Number in family and circumstances. Remarks. 11. Blackhorse Road Yard foreman, £4 per week 2 rooms, rent 6s. 8d. Man, wife, 4 children under 11 12. Dennetts Road £2 4s. per week One room Husband died of Tuberculosis. Wife, 7 children L.C.C. refused accommodation, but would help if financial circumstances improve. 13. Brookmill Road Works at Met. Water Board. Two small rooms Man, wife, 3 girls and boy, father and daughter tuberculous L.C.C.refused income insufficient, cannot pay 12s. 6d. rent 14. Baildon Street Stoker, £3 per week. Two rooms Man, wife, 3 sons aged 14, 8 and 5, 2 girls aged 17 and 4 years. L.C.C. refused 15. Rolt Street Bus driver, said to earn £4 8s. per week Two rooms Man, wife, boy 11, girl 4 Recommended to L.C.C. 16. Childers Street Engineer £4 10s. p. week Two rooms Man, wife, 2 boys and girl, mother expectant Recommended to L.C.C. 17. Benmore Street One room Man, wife, 3 children Recommended to L.C.C. 18. Fawcett Road Dock labourer One room. 1,300 cub. feet Man, wife, 2 daughters, 16 & 15 Recommended to L.C.C. 19. Render Street One room Man, wife, 2 children, 8 & 5, child tuberculous Recommended to L.C.C. 20. Knott Street Man, wife. 5 children L.C C. refused 21. Crossfield Street Builder's labourer, about £3. One room 3s. 6d. Man, wife, 6 children under 13. 22. Tanners Hill Crane driver, £3 per week Two rooms, one not used owing to lack of light, vent., etc. Man, wife, 2 children under 5 years 23. Junction Road In regular work, could pay 13s. rent. Two rooms Man, wife, 2 boys under 5 share 2 rooms with wife's mother and 2 adult sisters. All 7 sleep in one room. Recommended to L.C.C. 24. Windmill Lane In regular work, could pay 13s. rent. One room Man, wife, 3 children under 5 yrs. Recommended to L.C.C. 25. Evelyn Street Ex-soldier in regular work, could pay 15s. rent One room under 1,000 cub. feet Man, wife, 4 daughters under 6 years. Recommended to L.C.C. 120 Applicant's Address. Husband's Work. Rooms Occupied. Number in family and circumstances. Remarks. 26. Hyde Street Bricklayer, £4 per week One room Man, wife, 2 children under 3 yrs. Recommended to L CC. 27. Reculver Road Dock labourer, could pay up to 12s. rent One room, 1,000 cab. feet Man, wife, 2 chi1dren under 8 yrs. Recommended to L C.C. 28. Reculver Road Works at brewery One room Man, wife, 3 children, wife expectant Recommended to L.C.C. 29. Giffin Street Builder's labourer, £2 19s. 4d. One room, 700 cub. feet Man, wife. 4 children under 12 yrs. Children sleep on floor as there is only room for 1 bed. Recommended to L.C.C. 30. Church Stree £3 2s. per week One room Man, wife, 2 children under 5 yrs. wife expectant THE RATS AND MICE DESTRUCTION ACT, 1919. By Inspector Albert E. Yates. It may be of interest to preface this report with a brief description of the rat and a few facts and figures as to its life and activities; for the serious possibilities of rat infestation and the work of rat repression are often regarded as matters of minor importance. There are two chief kinds of rats. The black rat, or the common rat of India, and the brown rat, both species coming from the East. The black rat is usually found in the neighbourhood of docks and wharves, brought over in merchandise or escaping from vessels coming from the East; it is usually a clean feeder. The brown rat will thrive in any situation, in town or country, and can be found in fields or gardens, drains or sewers, stables or refuse dumps, factories, dwelling houses, and in fact in any place that affords harbourage and a food supply. The brown rat will feed on filth and garbage as well as on clean food, thus being a dangerous factor to be dealt with. The number of rats in this country is difficult to estimate but it appears to be generally agreed that the rat population of Great Britain amounts to at least 40,000,000. Rats multiply at an alarming rate; the female rat becomes a mother at eight weeks old. The average litter numbers from six to ten and she may have six litters in the course of a year. It is quite possible for a single pair of rats to have 800 descendants in twelve months. 121 These figures make it obvious that efforts directed towards rat destruction for a limited period are of little value, for the rat colony can rapidly breed up to full strength again. It has been definitely proved that rats, infected with plague, play an important part in the propagation of this disease and that the rat flea carries the germ from rat to man. With the pig as intermediary hosts, rats assist in the spread of Trichinosis (Trichina Spiralis) and certain tape worms. Besides being the carriers of plague, rats are known to transmit spirochaetal jaundice or Weil's disease, and infected rats have been found in Japan, Germany, America and Britain. Rats, it is believed, may cause the spread of Foot and Mouth Disease, Swine Fever and other diseases. It is not suggested that the potentiality of the rat as a carrier of disease is limited to the diseases mentioned. There is scarcely any known pathogenic parasite which can survive for a short time in the intestine of the rat which may not occasionally be transmitted by this agency to man or the lower animals, contaminated food being the medium. The economic loss due to rats calls for serious consideration. It was stated at the recent Sanitary Institute Congress, that the cost of feeding a rat is about 28s. per annum. The total cost to the country is £70,000,000 per annum, owing to the vast quantities of food stuffs consumed, contaminated or destroyed by rats and to the enormous material damage wrought by them. The destruction of food, merchandise and property by rats is so great that these alone justify active measures of suppression. Rats destroy growing grain, damage cloth and wool, eat fruit, vegetables and all food stuffs; they destroy, by contamination, as much or more than they eat and it must be remembered that the rat may have a run from a drain or sewer or any place where filth or garbage may be, hence they gain access to a food store, restaurant, kitchen or even, to the domestic larder. There is, therefore, considerable danger as regards food poisoning. The work of rat destruction, together with preventive measures, is carried on steadily in the Borough throughout the year; drains are repaired or reconstructed and watch is kept to prevent accumulations 122 of refuse. Refuse may afford harbourage or food supply for the rat and proofing work is required where there is a possibility of rats gaining access to property. The greatest difficulties are met with in the older areas of the Borough, for here are old buildings which do not lend themselves readily to the work of rat proofing; these have been harbourage of rats for many years. Below the surface are many old drains, long disused. These are more or less impossible to trace and they afford runs and harbourage to colonies of rats. The task of tracing the source of infestation in cases of this description present many difficulties but steady progress is being made and maintained. The premises on the river frontage are well safeguarded, the occupiers taking all possible precautions against infestation for their own protection. During the two weeks previous to Rat Week, inspections were made in various areas in the Borough where rat infestation was most apparent, with a view to ascertaining the actual source of infestation. Wherever possible, occupiers were interviewed and nearly 100 letters were sent to occupiers of premises upon whom the responsibility of clearing the premises of rats rested. This letter also pointed out the advisability and necessity of concerted action on the part of all concerned. Seventeen notices under the Rats and Mice Destruction Act, 1919, were served upon occupiers whose premises were, in our opinion, a source of infestation to the neighbourhood. Advice was given as to the best methods of rat proofing, and lists giving the names of rat poisons, where obtainable and the methods of using the same, were distributed. Any accumulations of refuse likely to give harbourage to rats were removed and steps taken to prevent any similar accumulation in the future. The banks of the Rivers Ravensbourne and Quaggy within the Borough boundary were cleared of all bushes and undergrowth in order to destroy any harbourage for rats. The river banks in question are now inspected daily and traps and snares set. As many as 37 rats in one week have been caught at this place. 123 Generally speaking, the response on the part of occupiers especially those with stock on their premises which could be destroyed or damaged by rats was good. Such occupiers were anxious to do all possible to free their premises and to take steps to prevent further infestation. The results, as indicated by the rats destroyed, are very satisfactory. It may be observed that, although Rat Weeks serve a good and useful purpose in organising a general and concerted attack on rat invaders, the good work is often nullified and the attack eventually becomes of little value, unless it is steadily followed up during the year from week to week. This is done in the Borough. ***** The Borough Engineer has kindly provided us with a copy of his report to the Highways Committee on the work he has carried out with reference to baits in the sewers. Report to Works Committee. November, 1927. National Rat Week—1st-6th November. As instructed by the Committee, I duly purchased from Messrs. Evans Sons, Lescher & Webb, Ltd., 9 half-gallon bottles of " Liverpool Virus " at a cost of £13 7s. 9d. This poison was mixed with a quantity of oats and a small quantity of aniseed, and placed in 110 side entrances leading to brick sewers and 45 manholes on pipe sewers. After an elapse of eight days an inspection was made of the side entrances and manholes where the poison was placed and it was discovered that all the poison had disappeared and that over two dozen rats were found lying dead. In view of the fact that "Liverpool Virus" is well known to be a most effective destroyer of rats, there is no doubt that the poison having been eaten by the rats, a considerable number was washed away by the water in the sewers. I might add that I have received a telephonic communication from the London County Council, Chief Engineer's Department, to the effect that during the Rat Week they laid 1,488 baits, out of which 581 were eaten by rats, which the London County Council consider to be very satisfactory. H. Morley Lawson, Borough Surveyor. 124 Health Week. This was held at the Borough Hall from Monday to Friday (inclusive), October 24th to 28th. A programme was handed into every house in the Borough. The following are the details:— Monday, October 24th. 2 p.m. Infant Consultations. 3.15 p.m. Address to Mothers by Dr. Margaret Emslie. " The Only Way for Baby." 6-7 p.m. Films for Children (see list). 7-7.30 p.m. Films for Adults (see list). 8 p.m. Lecture by Sir George Newman, K.C.B., M.D. (Chief Medical Officer to the Ministry of Health). " The Primary Importance of Health." Chairman— His Worship the Mayor (Ald. R. L. W. Hall, J.P.). Supported by the Member of Parliament for the Borough (The Rt. Hon. C. W. Bowerman, P.C., M.P.). Tuesday, October 25th. 2 p.m. Infant Consultations. 3.15 p.m. Address to mothers by Dr. Naomi Tribe. "Ante Natal Care." 6-7 p.m. Films for Children (see list). 7-7.40 p.m. Films for Adults (see list). 8 p.m. Lecture by Dr. H. A. Ellis (of Harley Street). " What Tuberculosis Means." Chairman—Councillor Mrs. B. M. Drapper, J.P. Wednesday, October 26th. 2 p.m. Infant Consultations. 3.15 p.m. Address to Mothers by Miss Margaret Green." "The Arch of Health." 6-7 p.m. Films for Children (see list). 7-7.40 p.m. Films for Adults (see list). 8 p.m. Women's Evening. Lecture by Dr. Rose Turner (British Social Hygiene Council). Chairman—Councillor Mrs. L. E. White. Thursday, October 27th. 2 p.m. Infant Consultations. 3.15 p.m. Address to Mothers by Dr. S. Eleanor Hill (Maternity and Child Welfare Medical Officer). 6-7 p.m. Films for Children (see list). 7-7.40 p.m. Films for Adults (see list). 8 p.m. Lecture by Dr. Stella Churchill. "Problems of the Working-Class Mother." Chairman—Miss Ishbel Macdonald. 125 Friday, October 28th. 2 p.m. Infant Consultations. 3.15 p.m. Address to Mothers by Dr. Mabel Brodie. "The Homes We Live In." 6-7 p.m. Films for Children (see list). 7-7.40 p.m. Films for Adults (see list). 8 p.m. Men's Evening. Lecture by Mr. E. B. Turner, F.R.C.S. (British Social Hygiene Council). Chairman—Councillor A. G. Howard. Films at the Borough Hall. The display of Films each evening was selected from the following : for adults. "The Leaflet." "Empire Builders." "Safety First Council." "A Hundred Years of Progress." for children and adults. "Where there's Life there's 'Ope." "Air and Sun." "The Bermondsey Milk Film." "The Care of the Teeth." "Don't Wait till it Hurts." "A Brush with the Enemy." "Giro, the Germ." Films at the Cinemas. The Proprietors of the following Cinemas kindly agreed to include a few short Films on Health matters during the week:— The Broadway Theatre Cinema. The Brockley Palladium. The Deptford Electric Palace. The Palladium Cinema, Broadway. New cross Kinema.—By courtesy of the Proprietors a special session was devoted to School Children on Saturday morning, October 29th. Admission, which was restricted to certain age groups, was by ticket only. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. No certificates were granted under Section 2 of this Act, to the effect that premises were not in all respects reasonably fit for human habitation. Deptford Health Centre. This new building (which was opened in January, 1928), is of stock brickwork with cement mortar, with red brick facings and Portland stone dressings. The partitions between the various rooms are formed of three-inch coke breeze slabs set in cement. The whole of the interior walls are coated with sirapite plaster and distempered. j 126 The roof is of ordinary timber construction covered with best blue Bangor bricks laid on felt covered boarding. The floors are of grooved and tongued pitch pine blocks on a concrete foundation. The whole of the interior doors are "Knowledge" patent oregon pine flush doors. The building faces Harton Street, but in order to secure separate entrances to the various departments, all the entrances have been placed at the sides of the building. It will be seen from the plan which will be found at the commencement of this Annual Report that the Light Treatment and Ante-natal (or Schick Test) waiting rooms face Harton Street. Proceeding from these along the corridor there are, on the right, dressing cubicles, Ante-natal and Schick Test rooms, Tuberculosis Care Committee Secretary's room, Clerk's and Tuberculosis Health Visitors' rooms, and finally, the Laboratory. On the left are staff lavatories, cloak room, dental room and dental recovery room, and male staff lavatory. A hall divides the above-mentioned portion of the building from the large Tuberculosis waiting room. Leading from the latter is a passage to the Tuberculosis Officer's consulting room and an entrance to the Nurses' Records room. The patient passes into a dressing cubicle en route to the Doctor's room. On the far side of the Tuberculosis waiting room there is a Porter's room, store room, lavatories, etc., and a coal repository. The cost of this Centre was £5,396 0s. 7d. and the cost of equipment was ,£264 11s. 4d. The plans were drawn up by the Borough Engineer and Surveyor, Mr. H. Morley Lawson, after consultation with the Medical Officer of Health. The contract for erection was secured by Messrs. Burnand & Pickett, of Wallington, Surrey. Ice Cream. For some considerable time past the Borough Council has received from us reports to the effect that makers and vendors of ice cream should be registered and also that the Council should have power to refuse registration or to remove from the register any maker or vendor for various reasons. In 1928 your Medical Officer attended before the Parliamentary Committee engaged in considering the London County Council (General Powers) Act, 1928 with a view to supporting the County Council's plea that there should be registration. The Parliamentary Committee agreed. At present Part VIII of the London 127 County Council (General Powers) Act, 1902, gives certain powers of control and defines certain conditions which must be observed pertaining to the manufacture, storage and sale of ice cream with the object of ensuring clean and sanitary conditions. Itinerant vendors have to exhibit the name and address of the manufacturer on the barrow. In addition the London County Council (General Powers) Act, 1908 prescribes certain sanitary provisions which must be complied with in any premises in which any article intended for food is sold, prepared for sale, etc., etc. The Public Health (London) Act, 1891, Section 47, empowers Medical Officers of Health and Sanitary Inspectors to enter any premises and inspect any food sold or exposed for sale, or deposited in any place for the purpose of sale or of preparation for sale. The question of the composition of ice cream, a most important matter, is now engaging attention with a view to arriving at a standard. The sooner this is settled the better. The Milk and Dairies Order, 1926. Under Section 19, Sub-sections 1 to 4, four cases occurred during 1927, in which young men employed in connection with dairies were examined in view of the fact that they had been in contact with a person suffering from an infectious disease. In two cases the disease was Diphtheria, and in two, Scarlet Fever. In the former cases the youths were kept off work for twenty-four hours pending the result of swabs. In all four cases the milk vessels and the perambulators were scoured thoroughly. The firms cordially co-operated. The numerous sections of the Order have been applied and have been satisfactorily met. A point of interest under Section 6 is that a dairyman and his premises must both be registered. A person who sells unopened bottles of milk in a shop must be registered as a dairyman, but the premises are not registrable as dairy premises. The expression "purveyor of milk" includes a seller of milk, whether wholesale or by retail. The expression "dairyman" includes any occupier of a dairy or any purveyor of milk. Your Medical Officer visited all premises from which unopened bottles of milk are sold. Vendors were instructed not to open any bottle with a view to selling one pennyworth, etc. J2 128 The Bakehouses Welfare Order, 1927. This Order came into force on 1st May, 1927 and it requires the occupier of every factory and workshop in which is carried on the baking of bread or flour confectionery to observe the following:— (a) Provide and maintain for the use of all persons employed therein, who handle any dough or any of the ingredients of bread or flour confectionery, suitable washing facilities conveniently accessible; (b) Provide for the use of all persons employed in the bakehouse, suitable accommodation for clothing put off during working hours, with adequate arrangements for drying the clothing if wet; (c) Keep prominently displayed in the bakehouse the Official Cautionary Notice as to the prevention and cure of dermatitis among workers handling flour and sugar; (d) Maintain certain arrangements for first aid treatment of injuries occurring in bakehouses, and (e) Provide for such workers an adequate supply of wholesome drinking water. Public Health (Condensed Milk) Regulations, 1923. Public Health (Dried Milk) Regulations, 1923 and Amending Regulations, 1927. Public Health (Preservatives, etc. in Food) Regulations, 1925. Public Health (Preservatives, etc. in Food) Amendment Regulations, 1926. These Regulations have been the subject of full Reports to the Public Health Committee. It is desirable that some record should be made of the many Acts, Regulations, etc., dealing with food, and I take the liberty of suggesting that close attention should be paid to the essay on "A Review of Food Legislation" given at the end of this Annual Report. Here it may be said as regards condensed and dried skimmed milks that attention is paid to the proper labelling of these. The words "Unfit for Babies" must be printed on the outside of any paper or other wrapper in which tins of such milk are enclosed. Further, these words must be printed on tins of condensed skimmed milk, dried, skimmed or dried machine-skimmed milk. The Regulations come into force (these are dated November 14th, 1927) on 1st September, 1928. 129 London County Council (General Powers) Act, 1927. Sale of Food by Street Traders. By the 1st November, 1927, stall holders had to be licensed by the Borough Councils. An exception is made in the case of those who ordinarily move from place to place in pursuit of, and while conducting their trade. Those applying for licences must state the nature of the articles they propose to sell or expose or offer for sale and the place where such articles will be stored before being exposed for sale. Any such licence issued shall be in a form prescribed by the Secretary of State, and may prescribe the class or classes of articles or filings which may be sold, or exposed or offered for sale under such licence, provided that no article of food shall be classed with any other commodity. Section 36 requires Borough Councils to make bye-laws relating to various matters including the deposit and removal of refuse, the storage and the sanitary supervision of articles intended to be sold or exposed or offered for sale, etc., etc. Infectious Disease. Public Health (Pneumonia, Malaria, Dysentery) Regulations, 1919. On January 1st, 1928 these Regulations were superseded by the Infectious Diseases (London) Regulations 1927, dated 22nd December, 1927. Trench Fever is no longer notifiable and cases of Malaria induced in institutions for therapeutic purposes need not be notified unless for special reasons. Influenza. In January, 1927 some alarm was created by articles in the press on this subject. I had kept in touch with the general medical practitioners and they informed me that in addition to attending numerous simple catarrhs, they had a goodly number of cases of Influenza. The point, however, is that there was no justification for any belief that the cases resembled the so-called Influenza which caused such havoc in 1919 and 1922. The Ministry of Health in Circular 761 stated that the 1919 Memorandum on Influenza had been revised. While there was no cause for serious anxiety, it was advisable to consider what facilities could be provided for helping people in need of such as nursing and prescription filling assistance. Sir George Newman advised the organisation of the available nursing services and the 130 vision of help in influenza-stricken households. The Council agreed to the provision of nursing assistance and home helps where necessary. The doctors informed me that the local nursing associations were able to cope with the work, and promised to telephone me if further help should be required. Every effort was made through voluntary and official sources to ascertain cases of hardship. One was found in which a household was in difficulties through the illness of both the father and mother. A home-help was promptly provided, and she rendered satisfactory service. The epidemic never assumed the proportions which some newspaper articles seemed to think it did. Occupational Therapy for Tuberculous Patients. Reports were submitted to the Public Health Committee on this subject, and in 1928 a Handicraft Centre was opened at Harton Street. Rheumatic Fever and Rheumatism. Reports were presented to the Public Health Committee in which the question of making Rheumatic Fever notifiable was considered. It was decided to adjourn consideration pending the receipt of information touching the result of the work recently commenced in another borough. Public Health (Prevention of Tuberculosis) Regulations, 1925. No person suffering from tuberculosis of the respiratory tract is allowed to work in connection with a dairy which would involve milking, treatment of milk, or handling milk vessels, and if a local authority is satisfied that a person residing in their district who is so working, is so suffering and is in an infectious state, they may require such person to discontinue his occupation. No action of the kind has been taken since the commencement of these Regulations. The Council is prepared to have employees, engaged in such work, and either present employees or any about to be appointed, examined by the Tuberculosis Officer. Tuberculosis Care Committee. This Committee is constituted of: Chairman and Vice-Chairman, Public Health Committee and six other members of the Borough Council, two members of the Greenwich Guardians, and one 131 tative of each of the following bodies:—Invalid Children's Aid Association, Insurance Committee for the County of London, War Pensions Committee, Miller Hospital, Friendly Societies, Trades Unions, Panel Committee for the County of London, Soldiers and Sailors Families' Association and British Red Cross. There are three representatives of social and charitable organisations, whilst the Medical Officer of Health, Tuberculosis Officer, Divisional School Medical Officer, District Organiser of School Care Committee and Secretary of the Committee make up the number. There is also provision for one member of the District Nursing Association, at the moment vacant. A return is given each month to the Public Health Committee of the Secretary's visits. The principal duties of the After Care Committee are—to assess cases, receive reports on children in sanatoria or hospitals, receive reports on cases on return home, to endeavour to find work for patients, to obtain clothing for patients entering sanatoria, etc., from the Guardians, Charity Organisation Society, the Red Cross Society, and Soldiers' and Sailors' Fund. To all of these our hearty thanks go out for much kindness received. May we especially thank Mr. Cornish, of the Guardians. A REVIEW OF FOOD LEGISLATION. The importance of adequate and correct nutrition cannot be too strongly emphasised. Feeding, in fact, makes or mars a nation's health; and such is the close relation between health and proper nutrition that no nation can afford to neglect anything favouring the establishment and maintenance of a sound and wholesome food supply and the propagation among the people of a knowledge of nutrition sufficient to enable them to model their daily dietary on lines indicated by latest scientific knowledge. In particular there is called for some means of protecting the public from the few who fail to realise their responsibilities and who deliberately or otherwise tamper with the national food supplies, either by adulteration, or by the addition of undesirable chemical preservatives, or, again, by exposing food to contamination with dirt and infection by micro-organisms with subsequent grave danger to the health of the consumer. 132 To consider first of all adulteration, it is easy to see why this is practised, when it is remembered that coffee costs half-a-crown a pound and chicory only sixpence. It is thus highly profitable to adulterate coffee with chicory—profitable, that is, until detection of the practice is followed by a substantial fine. In the same way flour is added to mustard, inferior flour to wheaten flour, pepper to ginger to increase the pungency, barleymeal to oatmeal to improve the appearance, and so on. This sophistication of food by unscrupulous traders is no longer common. Attempts on the part of the authorities to suppress this undesirable practice have a history which goes back to very ancient times. The early sanitary enactments of the Jews are still preserved for us in the Old Testament, and those dealing with meat were extremely strict. The ancient Egyptians have left records of food adulteration; Pliny relates how bakers used to defraud their customers by selling adulterated bread; and in both ancient Greece and Rome wine was badly sophisticated. In this country, bread, as a staple food was very early the subject of legislation. In the reign of Edward IV, for example, we read that the Lord Mayor of London "did sharpe correction upon bakers for making bread otherwise than of floure and light of weighte, and caused divers of them to be put in the pillory." Various minor enactments were made dealing with other foods, the punishments for infringing these rules ranging from a small fine to being dragged through the streets on a hurdle, confinement in the pillory, and subsequent banishment from the town or prohibition from carrying on the trade in connection with which the fraud was perpetrated. it was not until the early part of the 19th century that concerted effort was made to legislate against defects in food production: and in 1875 there was passed an Act "To Make Better Provision for the Sale of Food and Drugs in a Pure State." This Act repealed earlier Acts dealing with adulteration, and it was the first of a series of Acts, which, under the title of The Sale of Food and Drugs Acts, 1875-1927' constitute our means of dealing legally with food sophistication. These Acts include a wide and intricate series of orders and regulations; but the first Act of 1875 may be regarded as the starting point of food legislation in this country. Earlier Acts were incomplete, unpractical, 133 and isolated; whilst later Acts were more or less in the way of being Amending Acts which altered minor points in the mother Act, or, as in the recent Preservative Regulations, broke fresh ground, thus bringing the Acts into closer agreement with modern knowledge. The Act of 1875 started off by defining food as "every article used for food or drink by man, other than drugs or water," a very comprehensive and simple, yet effective definition. It then proceeded to state that "no person shall sell to the prejudice of the purchaser any article of food .... which is not of the nature, substance, and quality of the article demanded" and set out in some detail methods to be adopted by Inspectors when taking samples of suspected food. Here matters were not quite so clear. In the first place it was necessary in 1879 in the Sale of Food and Drugs (Amendment) Act to state that if an Inspector bought an adulterated sample for analysis he was just as much prejudiced as if he had bought it in the ordinary way for consumption. Secondly, it was difficult to define exactly what was meant by the terms "nature, substance, and quality demanded," and many conflicting decisions were given by magistrates, so that what one trader was punished for in one district, another trader, to use a popular phrase, " got away with it " in another district. In the case of spirits, for instance, it was obvious that when a man bought whisky he did not expect pure alcohol. By the Sale of Food and Drugs (Amendment) Act of 1879, this particular point was cleared up, and it was stated that the legal standard for spirits was to be 25 degrees under proof, this being altered later, by the Licensing Act of 1921 to 35 degrees under proof. The same applies to brandy, rum and gin. Unfortunately there is still lacking any definite standard of purity for many foods, with the result that there is a great deal of confusion. It is impossible at present to deal with some forms of adulteration, simply because there is no authority for saying that when a man asks for such and such a food he expects an article of such and such a nature, substance and quality. However, since the initial Act of 1875 over 90 per cent. of prosecutions under the act have been in respect of this section. 134 In 1887 a Margarine Act was framed. It defined Margarine and prescribed how every packet of this food should be marked with the word "Margarine" in letters not less than one quarter of an inch in height. Subsequent regulations changed the definition of margarine and increased the size of the letters on the wrapper to three quarters of an inch square. In the year 1899 a second Sale of Food and Drugs Act was passed, giving effect to the recommendations of a Committee appointed five years earlier. This Act dealt with butter, margarine, cream and milk. It limited the proportion of butter in margarine to 10 per cent. Among other things it gave power to make subsequent regulations dealing with these foods: and both the Sale of Milk Regulations, 1901-12, which specified certain standards for milk, e.g., that it should be regarded as adulterated if it contained less than 3 per cent. of fat, and the Sale of Butter Regulations, 1912, which, among other things, limited the percentage of water in butter to 16 per cent., were brought into force by yirtue of the authority of the 1899 Act. It will be seen that food legislation is too complex to be easily interpreted chronologically; and it will perhaps be useful to take two important foods, milk and meat, and by tracing the successive measures taken in respect of them, to indicate the way in which food legislation has developed. The most recent legislation in respect of milk is the Milk and Dairies Act of 1926. This has been devised with a view to securing a comprehensive and simple system of controlling the production, handling, and distribution of milk and for the prevention of contamination. It arranges for veterinary inspection of cows with a view to eliminating infected animals from herds. It empowers a Medical Officer of Health to stop a milk supply or suspend an employee for a specific period. A similar measure is the Milk and Dairies Consolidation Act of 1915, which came into force in September, 1925. This was also designed with the object of preventing the sale of tuberculous milk; and it also made it an offence to sell milk from animals suffering from foot and mouth and other diseases. It provided for the slaughter of tuberculous animals. In 1922 the Milk and Dairies Amendment Act came into force : it dealt with the registration of purveyors of milk and gave power to 135 refuse registration or to remove a name from the register on account of some act or default re distribution, quality or storage. It prohibited the addition of colouring matter or water to milk. In this way the earlier Act defining a minimum of 3 per cent. of fat in milk was strengthened, for it made illegal the watering down of a milk richer in fat than the legal minimum. Under the 1922 Act power was given to the Minister of Health to make the Milk (Special Designations) Order of 1923. This order came into force principally as a result of the conviction that the low per capita consumption of milk in this country was due to the fact that it was unattractive to consumers because of defects in production and distribution. Dirt was found too frequently settling at the bottom of receptacles, and the housewife hesitated to lay out much money upon a food which was likely to sour very quickly. It was felt that this was unsatisfactory, for milk occupies a unique position in the dietary, not only because it is rich in salts and vitamins, but also owing to the high biological value of the fat and protein. Milk-grading schemes were therefore inaugurated, and attempts made to secure the intelligent co-operation of farm workers and induce them to carry out the simple technique necessary to yield clean milk. The idea rapidly increased in popularity; keen interest and competition between milk producers were stimulated ; and by far the most important, the Order exerted a profound educational effect upon the public. Four grades of milk were specified as follows: Certified milk produced from cows which must pass a tuberculin test every six months and veterinary examination at three-monthly intervals. The milk must be bottled on the farm and must reach a stated standard of bacteriological purity. Grade A Tuberculin Tested Milk is subjected to the same conditions as Certified Milk as regards the testing of the cattle; but it must be bottled only before distribution and must reach a stated standard of bacterial purity. Grade A milk must satisfy the same conditions as the Tuberculin Tested variety, with the only exception that the tuberculin test is omitted. Finally, Pasteurised Milk is milk which has been held at a temperature of 145° F. to 150° F, for at least half-an-hour and then cooled to not more than 55° F. It must not be heated more than once, and must not contain more than 100,000 organisms per cc. 136 Latest reports indicate that the annual production of graded milks is increasing, and that the market for them is steadily widening as their virtue becomes apparent. Further milk regulations which deserve mention are the Condensed Milk Regulations 1923-27, and the Dried Milk Regulations, 1923-27. These deal with the composition of tinned milks, and an important proviso is that which makes necessary the use of the words "Unfit for Babies" upon tins of skimmed or separated milk. Reference to these few orders, acts and regulations concerning milk give an idea of the trend of food legislation. Primarily it is necessary to define a standard of quality; then efforts are made to improve quality above the legal minimum and also to produce the milk in a cleanly fashion. The question of the use of preservatives in milk will be dealt with later. Considering, next, legislation dealing with the inspection of meat, this again is principally devoted to preventing the sale of meat from diseased animals and with the maintenance of a high sanitary standard in slaughterhouses. Recent legislation has concerned itself with the methods of distribution and sale of this commodity. Early legislation dealing with the inspection of meat, etc., was far from satisfactory, and in 1921 a Departmental Committee was appointed to go thoroughly into the matter with a view to securing greater uniformity in methods of meat inspection in various parts of the country. A memorandum, Number 62, was issued in 1922, giving detailed instructions to meat inspectors. The position was far from satisfactory, however; in 1923, for instance it was found that at Smithfield Market, although the amount of home-killed meat was only one-fifth of imported meat, yet twice as much diseased home-killed meat was detected as imported diseased meat. Of home-killed meat 171,884 pounds out of 76,841 tons were diseased; of imported meat only 94,511 pounds out of 362,151 tons were diseased. Attempts were made to improve this deplorable situation; and in 1925 there came into force the Public Health (Meat) Regulations, 1924. These contained provisions in regard to the slaughtering and marking of meat; and three sections were devoted to the question of contamination by dirt during transit and sale. As you are aware several 137 prosecutions have since been made of persons handling meat in a careless manner. It is unnecessary to deal with other foods, or to mention in detail the almost bewildering mass of acts, orders, and regulations, with their amending and consolidating acts. Their effect is to be found in the slow but steady improvement recorded year by year in the statistics of adulteration collated from the reports of Sale of Food and Drugs Act authorities in various parts of the country. In 1877 approximately 20 per cent. of all samples were found to be adulterated, that is, one out of five was condemned. To-day, the percentage is roughly six, and it slowly drops year by year. The number of samples examined yearly is about 120,000. Legislation has, of course, something to do with this improvement, but education has a great deal more. There has grown up a public opinion which will not tolerate frauds that were perpetrated with impunity years ago. For instance, there was once in London a more or less open trade in exhausted tea leaves, which had been dried, immersed in a solution of gum, again dried, and then sold to tea-shops and eating houses at a rate of 2d. a pound. That sort of thing would not be tolerated at the present day, legislation or no legislation. We may now consider food legislation dealing with the use of chemical preservatives to prevent the rapid decomposition of food; and two regulations will have to be dealt with. In 1912 were passed the Public Health (Milk and Cream) Regulations which prohibited the use of preservatives in milk and restricted their use in cream; and in 1927 there came into force the Public Health (Preservatives and Colouring Matters in Food) Regulations, which prohibited the use of preservatives in any foods but those specifically mentioned in a comparatively short list and which stated the maximum amounts of the permitted preservatives, sulphurous and benzoic acids and their salts, and, in brief, very drastically reduced the use of chemical preservatives and colouring matters in food. The decomposition of food is brought about by the action of microorganisms such as bacteria and moulds, and without these living agents relatively little change occurs. This is why food may be kept good for years by heating it sufficiently to kill all living bacteria and moulds and immediately sealing it up in a glass metal container so that no new 138 living bodies can develop in it. Such food is sterile food and it will keep almost indefinitely. The problem of preserving food therefore resolves itself simply into putting a stop to the activities of microbes, by killing them or by preventing them from carrying on their usual decomposition-causing functions. The application of heat is one non-objectionable method of preserving food, and it is used widely in the pasteurisation of milk, which is raised to a temperature of 60-70° C. for half an hour, the result being an enormous reduction in the number of bacteria it contains and consequently an increase in the length of time during which the milk will remain sweet. Drying is another useful method of preserving food for the reason that bacteria cannot develop without water. All micro-organisms, bacteria, yeasts, and moulds, nourish themselves by taking in through their outer coverings water in which is dissolved whatever they require as food. Solid matter cannot pass through the cell wall of a microorganism, thus germs cannot exist in anything that is dry. Preservation by cold is another method which has a great deal to recommend it, and it is a method that is becoming more widely adopted since the coming into force of new regulations governing the use of preservatives in food, which will be dealt with in subsequent paragraphs. Cold paralyses bacterial activity, but does not kill micro-organisms. At 10° C. few bacteria grow; and below 0°C. no bacteria grow, for the simple reason that water freezes at this temperature and the bacteria are unable to get the liquid nourishment they require. Cold storage and refrigeration do not alter the chemical composition of food, and it is safe to say that the introduction of these two methods is revolutionising the distribution and storing of food, and has brought within the reach of the housewife in this country, foreign foods which would otherwise be nothing more or less than expensive luxuries. Indeed, cold storage is the only solution to the problem of feeding this country which produces only enough food to feed its inhabitants for about one and a half days a week. Having mentioned briefly the three more or less natural and nonobjectionable methods of keeping food, we pass to the less desirable preservation by chemicals. Such chemicals as boric acid, nitrous acid, 139 sulphurous acid, benzoic acid, salicylic acid, and formaldehyde when added to food exert a toxic action upon microbes, either destroying them or else paralysing their activities. Were this the whole story we should have useful and efficient preservatives for use in foods, but it is unfortunate that most of the chemicals that serve as food preservatives also have an undesirable effect upon health. Many of them are definitely poisonous in large doses; and it is safe to say that when taken in small amounts, day after day, in one food and another, they would have an increasingly deleterious effect upon the health. Chemical preservatives function by putting a stop to the decomposition of food, which is a fermentation of the same kind as the digestion of food. It is therefore apparent that chemical preservatives must retard digestion and cause digestive inefficiency and diseases of the alimentary canal and of the whole body. Further, preservatives are absorbed by the body more quickly than the kidneys can excrete them, the result being that they slowly accumulate in the body, throw a disproportionate strain on the kidneys and excretory organs, and finally cause illness which may or may not be definitely attributable to the constant taking of preservatives in all kinds of foods. It is often argued that chemical preservatives are used in foods to so small an extent that no harm could result. But what of the total amount of preservative taken into the body during the course of the day? Each food eaten would contribute its little quantity of preservative to that already taken into the body, and the total daily dose might easily exceed the limit of safety. Of course, could it be shown that chemical preservatives had to be used in foods and that the only alternative was the impossibility of providing urban communities with perishable foods, then these agents might be tolerated, even though harmful. But it cannot even be shown that such a necessity exists. In 1900-1 a Departmental Committee considered the question of the use of preservatives in foods, particularly milk and cream. Evidence was given by experts to the effect that without the use of boric acid in milk it would be impossible to supply London with this food in a fresh condition. The milk would inevitably turn sour before it could be delivered to the consumer. In spite of this evidence, regulations 140 came into force in 1912 forbidding the use of any "preservative substance" in milk, and stating a limit of 0.4 per cent. of boric acid in cream. In 1917 an amending order directed that a label should be affixed to preserved cream, with the wording "Not Suitable for Infants and Invalids." In spite of evidence to the contrary, preservative free milk was a success; and it at once became apparent that if so perishable a food as milk could be delivered to the consumer without the use of preservative there was a good probability that other less perishable foods could likewise do without the assistance of these chemicals. Following the pioneer work of the 1900-1 Committee, a Departmental Committee, appointed in 1923, considered the question of preservatives in food in the light of the experience gained, and in the following year submitted recommendations regarding the use of preservatives in foods. Many trade witnesses gave evidence as well as those concerned with the medical and scientific aspects of the problem, and one very interesting fact that came to light was that many retailers were selling at the same time and the same price, New Zealand butter which contained preservative and that which did not, without even knowing which was which. Briefly, the Committee recommended that the use of chemical preservatives in foods was unnecessary and should be prohibited except in a few specified cases. The Committee did not regard as preservatives, salt, saltpetre, sugar, vinegar, alcohol, spices or the substances introduced during "smoking." All other substances introduced into food to arrest, delay, or mask putrefaction or fermentation it regarded as chemical preservatives; it rejected the plea that these were harmless; and out of the many chemicals investigated the Committee named benzoic and sulphurous acids and their salts as being the only ones to be allowed in foods, and then only in the following:—sausages, jam, dried fruit, preserved (but not dried) whole fruit, beer and cider, alcoholic wines, non-alcoholic wines and cordials, fruit juices (sweetened and unsweetened), coffee extract, sweetened mineral waters and brewed ginger beer. In each case a limit for the amount of preservative to be used was specified, and the Committee recommended that the use of a preservative even in these permitted cases should be allowed only upon the condition that the nature and quantity of the preservative present in the food should be stated in some 141 way to be specified by the Ministry of Health. Somewhat similar recommendations were made in regard to colouring matters used in food, these being mainly metallic and coal tar colouring matters. Draft regulations were then issued embodying the recommendations above, and after discussion and criticism by those most concerned, the draft regulations, with a few minor alterations, and with a period of grace for certain foods, came into force as legal regulations on January 1st, 1927. Since that day the addition of preservatives has been illegal except in the case of the foods specified. These latter may contain limited amounts of sulphite or benzoate, provided they bear a label to that effect; and it can hardly be exaggerating to say that an enormous advance in public health has been made through the elimination of chemicals from common foods. How do these new preservative regulations affect the housewife, beyond enabling her to provide husband and children with chemicalfree foods? Principally, they affect her only in requiring that a more scrupulous degree of cleanliness shall be maintained in the storage of food before it is consumed and also that it shall be kept as cool as possible. Cleanliness and coolness are the two principal helps towards keeping food sweet, and even such a readily perishable food as milk may be kept sweet for several days in a cool larder or pantry, provided it is clean to start with and is kept in a covered receptacle. Let your larder be well ventilated, thoroughly clean, and free from dust, dirt and cobwebs. See that it is not visited by mice, beetles, spiders, cockroaches, slugs or flies; and in order to make assurance doubly sure, never leave food lying about uncovered upon the shelves. When purchasing foods give preference to that which is wrapped in some form of transparent or waxed paper. Keep all liquids in covered receptacles. Always buy bottled milk, and use the bottle as a milk jug, covering it with an inverted glass or cup, when not in use. Better still, wrap the bottle round with a cloth kept wet by standing in a basin or a dish of cold water. To keep food cool is not always so easy as it is to keep it clean. Electrical and other mechanical refrigerators are the best means of achieving this object, but they are unfortunately too expensive for every home. There are, however, many cheaper safes which tend to maintain themselves slightly cooler than the ordinary wooden safe. K 142 One of these consists of an outer framework of wire carrying muslin which is kept wet by means of the draining away of water contained in a tray; and by means of the evaporation of the water from the muslin the interior of the safe is kept cool during hot weather. Slate safes are cool. Refrigerators, worked by heat and by electricity, as well as water cooled and slate safes may be seen in the Museum of Hygiene, 28 Portland Place, W. INDEX. A PAGE Acute Anterior Poliomyelitis 44 Acute Influenzal Pneumonia 41 Acute Primary Pneumonia 41 Ambulance 53 Ante-Natal Clinic 55, 107 „ Statistics 105, 106 Area of Borough 8, 11 Asphalte Manufacturers 22 Attendances at Clinics 102-107 B Babies' Home 113 Bag Makers 19 Bakehouses 74 Bakehouses Welfare Order, 1927 128 Bellingham Estate 3 Births 1, 8, 23 „ illegitimate 24 Births and Deaths Registration Act, 1926 6 Birth-rate 2, 8, 23 Births Tables 24,21,104 c Canal Boats Act 78 Cancer 101-103 Cancer Deaths 2 „ Deaths Table 101 Cancer Campaign 102 Cattle Food 15 Census 8 K2 ii. C—continued. PAGE Cerebro-spinal Fever 44 Chemical Works 12, 57 Childbirth Deaths 28 Circular 834 8 Clinical Thermometer Makers 16 Clinics 54 Closet Accommodation 60 Confectionery Works 13, 14 D . Deaths 8 „ Infants 1, 8 „ Causes of, Table 30 Tables 25,28 „ in Wards 26 „ „ Table 26 „ Zymotic Rate 8 Death Rate 8, 25 Density 8 Diarrhœa and Enteritis, Deaths 8, 44 Table 27 Diphtheria 37, 38 „ Prevention 6, 38 „ Schick Test 6 „ Anti-toxin57 Disinfection 49 „ of Rooms, Table 50 „ of Articles, Table 51 „ Summary of work done 52 Distillers 23 Dried Milk 104 E Encephalitis Lethargica 44 Enteric Fever 38 iii F PAGE Factories 80 „ Table 81 „ Inspections of82 „ Defects found in 82 Families 8 Food and Drugs,Tables of Samples 75, 76 „ Prosecutions 77 Food Legislation, Review of 131-142 Food, Supervision of 69-74, 81 Fried Fish Shops 74 G Galvanisers 12 Gas Mantle Makers 17, 18 H Health Week 124-125 Health Services 52 „ Tuberculosis 52 „ Maternity 52 „ Ambulances 53 „ Fever 52 „ Children's Hospitals 52 Health Visitors, Summary 1ll Heart Disease Deaths 2 Hospital Disposal of Cases, Table 45 House-to-house Inspections 4, 64-67 „ „ and Families 4,5 Housing 3-6, 116-120 68, 69 Housing Representations 3 ,, Sleeping accommodation in tuberculous cases 5 Houses let in Lodgings 67 Home Workers, Table 83 iv. I PAGE Ice Cream 126, 127 Infant Mortality 1, 8, 97 „ of Illegitimates 8 „ Rates for 10 years, Table 28 Table 31 „ in Wards 27 Infant Welfare Centres 54,106-110 Infectious Diseases, Control of 45 „ Deaths, Table 47 „ Number of Cases 36 Tables 34,35,36 „ Nursing 56 Influenza 129-130 Inhabited Dwellings 8 L Laboratory Work 57 Laundries 81,82 Legal Proceedings 64 Legislation, New 6 London County Council (General Powers) Act,. 1927 6 London County Council (Sale of Food by Street Traders) 129 M Malaria 44 Marriages 8,24 Marriage Rate 8, 24 Maternity Home 105, 111 Maternity Homes, Registration of 57 Measles 43 „ Visits of Health Visitors to 103 Meat 73 Midwives 56 V. M—continued. PAGE Milk Supply 69-72 „ Condensed, Regulations 77 „ Dried, Regulations 77 „ and Cream, Regulations 72 „ and Dairies Order, 1926 72,127 „ and Dairies Consolidation Act 72 „ and Child Welfare 103 „ for Necessitous Mothers 104 Mortality Statistics 8,26 Mortuary Report 113 N Non-Pulmonary Tuberculosis Deaths 2 „ „ „ Notifications 86 o Occupations 11,12 „ and Health 11 Offensive Trades 68 Oil Refiners 13 Ophthalmia Neonatorum 43,103 Overcrowding 4 P Paint Works 15 „ and Varnish Manufacturers 16 Paratyphoid B. Fever 38,39 Pemphigus Neonatorum 103 Persons per Dwelling 8 Pneumonia 41,103 Population 8,11 „ in Wards 11 Pharmaceutical Workshop 16 Poliomyelitis 44 Professional Nursing 55,56 vi. P—continued. PAGE Public Health Centre 7,125,126 „ Streets, Length of 8 Puerperal Fever 41,42 „ Pyrexia 41,42 „ Sepsis, Deaths 28 „ Fever, Visits 103 Public Health Dept. Administration, cost of 8 „ „ (Condensed Milk) Regulations, 1923 128 „ „ (Dried Milk) Regulations, 1923 128 „ „ (Dried Milk Amendment) Regulations, 1927 128 „ „ (Infectious Disease) Regulations 6 „ ,, (Imported Food) Regulations, 1912 115 „ „ (Preservatives in Food Amendment) Regulations, 1927 6, 128 „ „ (Preservatives in Food) Regulations, 1925 128 Pulmonary Tuberculosis Deaths 2 R Rateable Value 8 Rats and Mice (Destruction) Act 120-123 Remedy of Sanitary Defects 68 Rent and Mortgage Increase Restriction Act 125 Rheumatic Fever 3 Review of Food Legislation 131-142 Restaurants 74 s Sanitary Administration 60 „ Inspectors' Work 60 „ „ Tables 61-63 Scavenging 60 Scabies, Visits of Health Visitors 103 Scarlet Fever 36 vii. S—continued. PAGE Schick Test and Inoculation against Diphtheria 38 Schools 68 Scholars, Illness of 49 Slaughterhouses 74 Smoke Abatement 7 Smallpox 36 Social Conditions 11 Separate Occupiers 8 Spinning Company 20 Still Births 103,114 Sputum, Examinations of 57 Sunlight Treatment 112,113 Sugar Refinery 12 T Tar Refiners 22 Tents, Vans and Sheds 67 Treatment Centres 54 Test Feeds 104 Tuberculosis 84 „ Care Committee, Secretary's Report 97-101 „ Contacts 95,96 „ Deaths 86 „ Dental Work 94 „ Dispensary Scheme 88 „ Care Committee 130,131 „ and Disinfection 87 „ New Cases 86 „ Notifications and Deaths 86 „ Non-Pulmonary 87 „ Notifications Table 85 „ Dispensary Patients' Deaths 94 „ Statistics for Dispensary 89-93 „ Revision of Register 87 „ and Medical Practitioners 94 „ Shelters 49 ,. Handicraft Centre 130 viii U PAGE Underground Rooms 115 „ Sleeping Rooms 67 „ Bakehouses 84 Unfit Dwelling Houses 68 Unsound Food 77 Ultra-Violet Rays Centre 112 V Vaccination, Table 48 Verminous Children 103 Vital Statistics, Summary of 8 „ . Table 29 w Wearing Apparel 83 Whiting Works 21 Whooping Cough, Deaths 8 Workshops, Table 81 „ and Workplaces 80 „ „ Table 81 „ „ „ and H.M. Inspector 84