Mletropolitan Borongh of With the Medical Officer of Healthe Complimenta. Frome Hall New Lrod Road 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. (Greecc). 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. 1928 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14 Public Health Committee. Magor. Councillor F. D. W. ROSS, J.P. Dhaixman. Alderman W. TAYLOR Dice=Dhairman. Councillor Mrs. G. E. GREEN Councillor Mrs. E. M. Bateman Councillor Mrs. B. M. Drapper, J.P. Councillor W. H. Green, J.P. Councillor J. G. Hicks Councillor A. G. Howard Councillor Mrs. K. M. Shade Councillor Mrs. G. Tiffen, J.P. Councillor Mrs. L. E. White Councillor E. C. Wood Maternity and Child Welfare Committee. Chairman. Councillor Mrs. B. M. Drapper, J.P. Vice-Chairman. Councillor Mrs. M. Herlihv Councillor Mrs. E. M. Bateman Councillor A. J. Boyd Councillor Mrs. A. A. Cheasor Councillor Mrs. G. E. Green Councillor W. H. Green, J.P. Councillor Mrs. K. M. Shade Alderman W. Taylor Councillor Mrs. G. Tiffen, J.P. 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, G. A. Langley, R. Wilson. 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 M. Fudge, 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. 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 ,, ,, ,, Health Centre, Harton Street. Tuberculosis Dispensary. 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. 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.). Ante Natal Centre—Dr. S. E. Hill. Health Visitor in Charge—Miss E. Clubbe. Mortuary and Coroner's Court. Cleansing Station. Watson Street, S.E. 8. Watson Street. Mortuary Keeper—G. W. J. Wagner, 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. March, 1929. To The Worshipful the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my eighth Annual Report on the sanitary circumstances, sanitary administration and vital statistics of the Borough. This Report is an Ordinary and not a Survey Report; it will be remembered that the Ministry of Health requested a Survey Report every five years and advised that the intervening reports should be ordinary reports. The Survey Report is, then, inter alia, a quinquennial grand inquest of the health services, etc., provided for the burgesses by your esteemed Council. Notwithstanding, it is clear that in the Ordinary Report the Ministry look for a statement as to any developments during the calendar year in question. In view of my departure to take up the post of Medical Superintendent Officer of Health for Belfast, I have felt that it would be a useful and helpful step to take, for my successor's sake, if I framed this report so as to give him a good introduction to the work as and when he takes up duty ; this of course would not interfere with the plan of the report as laid down by the Ministry of Health. It is only natural as I write that I should feel some pride in the services which I have, however imperfectly, helped you to extend or establish during my period as Medical Officer of Health. The Schick Test and the "Violet Rays" were initiated during my time, but we have also witnessed a distinct advance in pre-existing services. 6 The Municipal Maternity Home, which could admit some 300 cases annually—if we could arrange for confinements to take place with mathematical precision—admitted 261 cases during 1928. Moreover, many applicants had to be refused owing to the Home being fully booked up for the periods required. This is a result which we have been expecting during the last two or three years, and the time has now arrived for considering what is to be done in the matter of enlargement. For the benefit of your esteemed members who are not on the Maternity Committee, it may be said that for 20 years or more, the Maternal Mortality Rate of this country (but not as a rule of Deptford) has remained high. On the one hand, the infantile mortality rate has fallen, has been halved and more in that time, but as regards the expectant mother, practically just as many thousands of these good women, doing their duty by their country and carrying on the race, are dying in childbed or shortly after, as their sisters before them early this century. The causes are complex. Circumstances are largely to blame. One thing however is clear; there must be a great development of Maternity Homes in this country. Better midwifery practice is imperative, conducted under hygienic surroundings. So we return to our own Maternity Home. Here we have an institution, opened seven and a half years ago, in which no mother has died, and no woman has ever had Puerperal Fever. The organisation of this Home, and of course, of the Ante-Natal work preceding admission thereunto, has been faithfully worked out and studied, and so the Maternal Mortality Rate is nil, and I repeat that it is an extension of such municipal facilities which now require the kind continuous attention of your, and other, authorities. Coupled with this subject, is that of its hand-maiden, ante-natal woik. At the time of writing, there are three morning sessions at the Ante-Natal Clinic, but before this Report is in print, FYiday afternoon will be utilised for a fourth session. The old prejudice is breaking down. No longer does the kindly veteran woman forbid her married daughter to attend the Ante-Natal Centre because there were no such examinations in her young days. We began quietly and hopefully, and here, as in the case of the Schick Test, our best advertisers are those who have been our clients ; for, having once satisfied themselves that all is well, they have not hesitated to tell their friends, and they even conduct them to the Centre. The midwives too, are sending 7 cases to Dr. Hill, and the latter of course sends a reply in each case back to the midwife. In other cases Dr. Hill sends a letter to the Greenwich and Deptford Hospital if in this splendid institution the mother is going to be confined. Not many years will elapse before all pregnant women will receive ante-natal care, and as soon as my colleagues in general medical practice put their foot down and refuse to book a case for a conlinement unless the lady agrees to ante-natal care, so we will see a reduction in the regrettable difficulties which crop up at times on the day of the confinement or during the lying-in period. A sound and constructive ante-natal scheme throughout the country will break the ranks of the puerperal fever and complex midwifery foes ; make no mistake about that. Respecting Ultra Violet Rays, we may take those cases first which are sent by Dr. Donnelly for a course, at a cost of Is. per exposure, to the Miller Hospital. These are selected non-pulmonary tuberculous cases. There is a question to be settled yet as to whether Ultra Violet light treatment is of much use in such tuberculous cases unless given in association with open air and pure air treatment as, for example, at Hayling Island. As regards Maternity and Child Welfare cases there is not the slightest doubt but that this work has been a success. In the body of this report as well as in previous reports, facts and figures will be found which justify the small expenditure which this ameliorative agency has effected. Under Dr. Hill's clinical supervision Miss Holland has done well as Health Visitor in charge. Your Maternity Committee decided recently that each Health Visitor should be gradually initiated into the technique of this work, on the grounds that it is always well to have ample qualified manipulators at hand. This is purely a question of administr itij.i which Dr. Keith will be able to arrange with Dr. Hill's assistance. Meanwhile, Miss Gibson is a tower of strength and Miss Stowell will soon be quite expert. A further point to be noted is that the Committee felt compelled to limit patients to those coming through the child welfare clinics and who are not on the school register. From time to time someone would send a child of school age for a course of treatment, but this became embarrassing, and as the County Council have no fund from which to offer payment for school children treated at our Ultra Violet Ray Centre, it was felt necessary, with regret, to limit the cases to those not on the. school register. Sometimes I have sent cases from the Hales 8 Street Infant Welfare Centre; a minority of these did not arrive at the Ultra Violet Ray Centre, whilst others would break the sequence of their attendances at the sessions. To a certain extent a small minority of mothers are feckless, slow to seize upon a good thing. Some again have other children to think about so cannot attend. Enquiry should always be made where a mother fails to appear with the patient; should this really be due to some home difficulty, some effort should be made to get a neighbour to bring the child to the Centre. I am bound to say. however, that few cases of this kind occur. At the Ante-Natal Centre the nurse in charge, Miss Clubbe, gives valuable talks, and cuts out patterns for the mothers. A sewing class is needed here. In my reports a description of such classes in other boroughs will be found. Miss Clubbe makes urine examinations and generally acts as a fidus Achates to Dr. Hill. Where a mother fails to come on the day she is due for examination she is duly visited by a Health Visitor. The reason for absence is usually some simple one fortunately, but the visit should always be paid. Some day the Health Visitor may find an absentee expectant mother on the point of a rapidly developing eclamptic condition. Speaking of this dangerous ailment there is one delicate point. Suppose that Dr. Hill finds albumen in the urine of a woman—as happens in threatened eclampsia is Dr. Hill to advise treatment or send the case to the family doctor for such ? Accidents will happen in this world ; many people make light of their symptoms, whatever they portend, and will not go to their family doctor ; then again, the patient may not carry out her doctor's instructions, or the doctor may be out. Whatever betide, I know of one case in which a woman died. I think that, in a case of the kind, Dr. Hill should undertake at least, the dietetic treatment, as far as may be necessary. If the Health Visitor concerned is too busy, a district or Ranyard Nurse should visit daily at the patient's home and report daily by phone or letter to Dr. Hill. One must be exacting in such cases; moreover, few of such occur so the expense would be small. Where some abnormality is found at a routine Ante-Natal examination, the patient may be sent to her own doctor or direct to Dr. Gilliatt at King's College Hospital. We are living in the days of specialists and really, having regard to our National Maternal Mortality Rate, we cannot send expectant mothers, labouring under some abnormality, too quickly to such as Dr. Gilliatt. 9 I know full well that the British Medical Association, centrally and locally, would like to staff the Ante-Natal Centre and other Centres, with general medical practitioners. I have much sympathy with my colleagues in general medical practice ; their sphere of activity tends to grow narrower. Had I been a general practitioner, I would have raised this question, from the practitioner's point of view, twenty years ago. So far as Deptford is concerned, the Borough Council has courteously informed the local branch of the B.M.A. that they are satisfied with the present whole time Medical Officer arrangements. The local branch of the B.M.A. have published their reply, and in it some reference is made to the possibility of Public Health Committees and their Medical Officers perhaps unconsciously desiring to increase their own power and importance in mistake for disinterested zeal for the Public Health. It is a great pity that the whole time officer trend was not diagnosed by the Association's members and officials years and years ago. It just comes to this, that experts at the Ministry of Health and reasonably competent M.O.H.'s, like myself, have enquired into such grave matters as infant and maternal mortality. Enquiry has disclosed serious mortality rates; disclosure has led to action, and so to improvement. National and municipal interference has been necessary to organise and direct: the Authorities have educated and trained officers, burning with a desire to encompass mass improvements in Public Health. Kindly, self-sacrificing and competent though he is, the average general practitioner has not developed a communal interest in these problems; he has not been trained to it to any appreciable extent as a student. It is a pity that the British Medical Association did not find a fighter in their ranks twenty years ago, one perhaps with "a natural and perhaps unconscious desire to increase" the general practitioner's power and importance. The work of the Tuberculosis Department has moved serenely and well throughout the year. As from April 1st, 1929, a small sum will be available for a part-time Home Help where, say, a distressed mother suffering from Tuberculosis, is struggling along doing her best to bring up her children. Similarly, a little money has been ear-marked for cases in which Dr. Donnelly or his colleagues find an extra bed to be sine qua non. 10 During 1928, a Tuberculosis Handicraft Centre was inaugurated in the Health Centre. Mrs. Monk has taken a keen interest in this work and has been a great help to the officials concerned. As always, many people have been ever so kind. Herein will be found a Report by Miss E. Malcolm Forth, who has so ably conducted our Tuberculosis Handicraft Centre. This Centre is our most recent venture, and students—our patients—are well pleased with the class ; the work takes them " out of themselves " ; it is a therapeutic measure of value. Miss Lewellin, Secretary of the Tuberculosis Care Committee, has again written a Report on her experiences and work. One wonders how we managed before the Committee was formed. It will be remembered that I set out, some years ago, to make an examination of the factories and workshops in the Borough. Each year I published a description of a number of these trades and businesses in my Annual Report. It was hoped that in time, all the factories and workshops would be described. The aim and object was not just the immediate one of the amelioration of any defects, but to pave the way ultimately for the publication of a book, dealing in some detail, with Deptford's industries. A further instalment of visits paid and descriptions of factories and workshops will be found enclosed; the materialisation of the hopes expressed above must depend upon the selective activity of my successors. Some months ago, I gave the first report on the need of an antirheumatic clinic, to the Public Health Committee. Paddington and Kensington, to be sure, very favourably suited for this work, took the first steps by way of establishing a clinic of the kind. This is work well worth doing, and I trust it will be considered further. The establishment of a Cancer Clinic has never appealed to me, although there is one in an adjacent Borough. We already have two Hospitals fully equipped with all manner of diagnostic appliances in the vicinity. If the family doctor has a patient of over forty who has pain in the stomach or other symptoms, not quickly removed by ordinary treatment, he knows where to send his case for an X-Ray examination. Similarly, it is open to any person to walk into our Hospitals and arrange for an examination. It sounds well to have a Cancer Clinic, but is it really necessary ? There is one subject which might well be considered by the representatives of the Maternity and Child Welfare Committee. I 11 refer to the "Toddlers." We read in School Medical Officers' Reports that at the Entrance Examination (on the school roll) of children, a considerable number of these present defects. The organisation of a scheme for the medical inspection of toddlers is surely due. At present, in Deptford, we examine those who are brought to the clinics voluntarily but there is no definite scheme in the London Boroughs. This would entail increase of staff of course. The notification of Measles is now being dropped in Deptford, as the special scheme of inter-notification with the school authorities has proved satisfactory. Moreover, I found that notification did not really inform us of all cases occurring, as so many parents never call in a doctor at all. Small-pox has not visited the Borough in my time, but it remains a constant threat even though almost entirely of the mild variety. The cry of the anti-vaccinator has been loud in the land ; it may be he cries at his best—for the Public Vaccinator—when the disease sits down on his own doorstep. Again and again I have pointed out that diphtheria, and not so much small-pox, is the enemy. A thousand children have now been Schicked and/or inoculated. With so many thousands left unprotected, diphtheria must perforce remain with us. It is easy to persuade parents, in whose family a case of diphtheria has occurred, to bring their children for inoculation It is a great pity that so many more wait until this disease has visited their family before coming forward for inoculation. The Dick test is more a test for hospital staff purposes, and the Schultze-Charlton reaction, for doubtful cases, has not caught on with general practitioners. Serum for use in delaying the age of attack of measles is not likely to make much headway, at least, until some better plan is found than the present one. In any cases of infantile paralysis we disinfect, we stand by and offer to arrange-for massage and electricity if we think the need for this has not been taken advantage of. Cerebro-spinal Fever, a rare but fatal disease, calls for the use of West's swabs for the contacts. As regards Food. We have not had a case of food poisoning for some time. Such an enquiry is undertaken by the Medical Officer of Health. 12 The Meat Regulations are in active operation in Deptford—no trader is allowed to place meat on trestles in front of the window line. There are two or three traders in Deptford High Street who have been given much rope in this connection and a prosecution now seems inevitable. In Inspector Yates we have an able Food Inspector. I suggest that he should be allowed to take a short refresher course at the Royal Sanitary Institute every four years. Every year a Sanitary Inspector might well be sent for such a course whether he already has the certificate or no. It is important work and we are all the better for refresher courses. I am grateful to the Inspectors for their assistance. The Work of the Maternity and Child Welfare Health Visitors has always been of a very high order. This has been combined with a charm and willingness which has made the ladies and their work very dear to me. The clerical staff", too, has been admirable. My colleagues, Dr. Donnelly and Dr. Hill have been everything that one could desire, ardent and successful workers, the best of friends. It only remains for me to say that your Council, and of course the Committees, have been kindness itself to me. I have helped you as well as I could to push things on a bit, and my successor, Dr. Keith, will come into goodly heritage. Mr. Charles and Mr. Lawson have always been kind, and my last salute is to a true and able man, the Town Clerk of Deptford, Mr. Arthur Purkis. I shall look forward to visiting you from across the water when time and tide permit. With heartfelt gratitude to you all, I remain, Your obedient Servant, Charles S. Thomson, Medical Officer of Health. 18 Summary of Dital and Mortalitg Statistics. 1928.  Area 1,564 acres 1,564 acres Population— 109,490 Census 1911 109,496 Census 1921 112,534 112,534 Estimated to middle of year 112,400 113,800 *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 6.3 Density 73 per acre 73 per acre Length of Public Streets 53 miles up fir ox. 53 miles approx. Rateable Value £677,057 £676,258 Id. Rate produces (approximately) £2,776 £2,762 Cost of administration of Public Health Department £4,776 £4,426 Marriages 922 927 Marriage Rate 8.2 8.1 Births 1,827 1,908 Birth Rate 163 16.8 Birth Rate, average for the last 10 years 20.9 21.2 Deaths 1,354 1,312 Death Rate 12.0 11.5 Death Rate, average for the last 10 years 12.7 13.2 Infantile Mortality (total) 76 per 1,000 births 58 per 1,000 births Infantile Mortality of illegitimate babies 130per 1,000 births 154 per 1,000 births Infantile Mortality, average for the last 10 years 73 per 1,000 births 78per 1,000 births Zymotic Death Rate 0 7 0-3 Deaths from Measles (all ages) 30 Deaths from Whooping Cough (all ages) 15 11 Deaths from Diarrhoea and Enteritis (under 2 years of age) 20 ! 8 *Structurally separate dwellings occupied by private families, i.e., houses and self contained flats, Area and Population. Births and Deaths. 16 Area and Population. Acres. Estimated Population. 1,564 112,400 The population of Deptford to the middle of 1928 has been estimated by the Registrar-General as 112,400. 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 9,147 Hatcham 10,862 Evelyn 10,713 Pepys 8,201 St. Paul's 10,648 St. Catherine's 7,716 Vale 11,015 St. Peter's 6,753 Clifton 12,201 St. John's 7,239 Canterbury 9,823 Town Hall 8,082 As the Borough has an area of 1,564 acres, ths density of the population on this estimate is 72 persons per acre approximately. Social Conditions. Chief occupations of the inhabitants: the influence of any particular occupation on public health. No evidence has been forthcoming to show that any local occupation exercises an adverse influence on the health of the workers engaged therein. I have dealt fully with details of this subject in recent Annual Reports. In the portion of this Report devoted to Factories and Workshops will be found a description of various trade premises specially visited by your Medical Officer of Health during the year under report, 17 Births. Births. Birth-rate per 1,000 1,827 16-3 The total number of births registered in the Borough was 1,570, and of these 73 were transferred to other districts, as the permanent addresses of the parents were outside this Borough. Similarly, 330 births occurring outside the Borough, in maternity hospitals, &c., were transferred to Deptford, making a total of 1,827 births in all belonging to Deptford. Of these, 958 were males and 869 were females. This figure gives a birth-rate of 16.3 per 1,000 of the estimated population, as compared with 16.8 for the year 1927. The birth-rate for England and Wales for 1928 was 16.7. ,, ,, the 107 County Boroughs and Great Towns was 16.9. ,, ,, the 156 Smaller Towns was 16.6. ,, ,, the County of London was 15.9. The rate for Deptford was therefore very slightly lower than the average for the country as a whole. Table I shows the number of births and birth-rates for the past ten years. Table 1. Year. Estimated Births. population. No. Rate per 1000. 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 115,200 2376 20.6 1925 115,900 2175 18.8 1926 115,700 2108 18.2 1927 113,800 1908 16.8 Average for 10 years 115,445 2409 20.9 1928 112,400 1827 16.3 18 Illegitimate Births. The illegitimate births numbered 69 or 3-7 per cent, of the total births. These occurred in the several wards as follows Deptford Park 5 Hatcham 4 Evelyn 5 Pepys 5 St. Paul's 7 St. Catherine's 8 Vale 6 St. Peter's 5 Clifton 8 St. John's 5 Canterbury 6 Town Hall 5 As far as can be ascertained, the occupations of the mothers in these cases were:-Domestic servants 11; Factory hands 14; Barmaids 5: Shop assistants 6; Typists, etc., 4. 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 midwives, parents and others with respect to 1,584 births. Still-births, numbered 28. Midwives notified 1,144; doctors 355; parents 79; other persons 6. Marriages. Marriages. Marriage Rate 922 8.2 The Superintendent Registrar has kindly furnished me with the particulars. There were 922 marriages in the Borough during 1928 as compared with 927 in the previous year. The marriage rate was equal to 8.2 per 1,000 of the population as compared with 8.1 for the year 1927. The marriages were solemnised in the following places:— 595 in Churches of England. 85 in other Places of Worship. 242 in the Superintendent Registrar's Office. 922 Total Deaths. Deaths. Death Rate. 1,354 12.0 The deaths registered in Deptford numbered 716, equalling a deathrate of 6.5, as compared with 745 and a death-rate of 6.5 for the preceding year. Of this number 133 were non-parishioners. The deaths of Deptford residents occurring outside the Borough in public institutions were 771, making a total of 1,354 deaths belonging to this Borough. Of these 730 were males and 624 were females. The death rate was 12.0, compared with 11.5 in 1927. The death-rate for England and Wales was 11.7 „ „ for the 107 County Boroughs and Great Towns was 11.6 „ „ for the 156 Smaller Towns was 10.6 „ „ for the County of London was 11.6. 19 The following table shows the number of deaths which have occurred during the past ten years, with the respective rates:— Table II. Year. Estimated Population. Deaths. No. Rate per 1000. 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 1927 113,800 1312 11.5 Average for 10 years 113,198 1432 12.7 1928 112,400 1354 12.0 * Civil population. The following table gives the number of deaths belonging to each Ward, and the respective death rates. Deaths of residents occurring outside the Borough are allocated to their respective Wards:— Table III. Ward. Deaths. Death Rate per 1,000. Males. Females. Children under 1 year Total. Deptford Park 50 40 7 90 9.8 Evelyn 76 46 17 122 11.4 St. Paul's 100 94 39 194 18.2 Vale 70 58 11 128 11.6 Clifton 63 54 10 117 9.6 Canterbury 58 49 15 107 10.9 Hatcham 54 63 7 117 10.8 Pepys 41 51 8 92 11.2 St. Catherine's 40 38 4 78 10.1 St. Peter's 38 36 1 74 10.9 St. John's 72 46 5 118 16.3 Town Hall 68 49 15 117 14.4 Whole Borough 730 624 139 1,354 12.0 b2 20 The proportion which the mortality at various ages bears to the total number of deaths during 1928 and the previous year is as follows:— Table IV. 1927 1928 Under 1 year 8 . 5 percent. 10.3 percent. 1 to 2 years 1.8 „ 3.4 „ 2 to 5 „ 2.5 „ 2.6 „ 5 to 15 „ 3.3 „ 3.0 „ 15 to 25 „ 4.6 „ 4.0 „ 25 to 45 „ 10.0 „ 11.5 „ 45 to 65 „ 29.4 „ 26.2 „ 65 years and upwards 39.9 „ 39.0 „ Infantile Mortality. Infant Deaths. Infantile Mortality Rate. 139 76 139 Infants died before attaining the age of one year, i.e., 76 per 1,000 of the births registered. Of this number 9 were illegitimate, representing an illegitimate infant mortality rate of 130 per 1,000. The mortality amongst infants in the various wards is shown in the following table:— Table V. Ward. Births Registered. Deaths under 1 year of age. Infantile mortality per 1000 Births. Deptford Park 125 7 56 Evelyn 191 17 89 St. Paul's 271 39 144 Vale 169 11 65 Clifton 144 10 69 Canterbury 178 15 84 Hatcham 137 7 51 Pepys 95 8 84 St. Catherine's 118 4 34 St. Peter's 138 1 7 St. John's 129 5 39 Town Hall 132 15 114 21 Table VI. RATE PER 1000 BIRTHS. Diarrhœa and Enteritis under two years. Total deaths under one year. England and Wales 7.0 65 107 Great Towns 9.6 70 156 Smaller Towns 4.8 60 County of London 10.2 67 Deptford 10.9 76 Table VII. TABLE SHOWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1928 Births 1827 Deaths 1354 Excess of Births over Deaths 473 Table VIII. INFANTILE MORTALITY RATE FOR THE PAST TEN YEARS. Year. Deaths under 1 year. Infantile Mortality Rate. 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 1927 111 58 Average for 10 years 179 73 1928 139 76 Deaths from Puerperal Sepsis 7 Deaths of women in, or in consequence of childbirth 4 22 Table No. IX. METROPOLITAN BOROUGH OF DEPTFORD. VITAL STATISTICS OF WHOLE DISTRICT DURING 1928 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 ail 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 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 6.5 115 682 111 58 1,312 11.5 1928 112,400 1,570 1,827 16.3 716 6.5 133 771 139 76 1,354 12.0 Area of District in acres (land and inland water). 1,564 Total population at all ages 112,534. 28,007. At census 1921 Total families or separate occupiers, 23 Table No. X. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at, Death during the Year 1928. CAUSES OF DEATH. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2, and under 5 years 5 and under 15 years. 15 and under 25 year . 25 and under 45 years. 45 and under 85 years. 65 and under 75 years. 75 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes 1354 139 46 35 41 54 156 355 279 249 Enteric Fever 1 .. .. .. •• 1 .. .. .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Measles 30 8 10 9 3 .. .. .. .. .. Scarlet Fever 2 .. 1 .. 1 .. .. •• .. .. Whooping Cough 15 8 5 1 1 .. .. .. .. .. Diphtheria 13 1 3 6 3 .. .. .. .. .. Influenza 10 .. .. .. .. 2 2 2 2 2 Encephalitis Lethargica 2 .. .. .. .. .. .. 2 .. .. Meningococcal meningitis 6 3 1 2 Tuberculosis of respiratory system 107 1 .. 1 25 47 25 8 .. Other Tuberculous Diseases 24 1 3 5 6 3 5 1 .. .. Cancer, malignant disease 152 .. .. .. . . .. 18 60 46 28 Rheumatic Fever 2 .. .. .. 2 .. .. .. .. .. Diabetes 9 .. .. .. .. .. 1 3 5 .. Cerebral Haemorrhage, &c. 56 .. .. .. .. .. .. 25 15 16 Heart Disease 250 .. .. .. .. 8 12 82 78 66 Arterio-sclerosis 83 .. .. .. .. .. 4 23 30 26 Bronchitis 70 7 1 .. .. .. 3 10 21 28 Pneumonia (all forms) 118 25 16 3 .. 1 14 29 16 10 Other Respiratory Diseases 12 .. .. 2 .. .. 1 4 3 2 Ulcer of Stomach or Duodenum 9 .. .. .. .. 1 1 4 3 .. Diarrhœa, &c. 25 19 1 2 .. • • 2 1 .. .. Appendicitis and Typhlitis 8 .. .. .. .. 1 1 4 2 .. Cirrhosis of Liver 2 .. .. .. .. .. .. 1 1 .. Acute and chronic Nephritis 30 .. .. .. .. 1 3 16 6 4 Puerperal Sepsis 7 .. .. .. .. 1 6 .. .. .. Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. 1 3 .. .. .. Congenital Debility and Malformation, including Premature Birth 44 43 .. .. 1 .. .. .. .. .. Suicides 11 .. .. .. .. .. 2 7 2 .. Other deaths from violence 48 3 .. 1 4 4 14 8 6 8 Other defined diseases 203 21 3 4 11 5 17 48 35 59 Diseases ill-defined or known 1 .. 1 .. .. .. .. .. .. .. 24 Table No. XI. METROPOLITAN BOROUGH OF DEPTFORD. Infantile Mortality, 1928. 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 IS months Total Deaths under 1 year. All Causes 34 3 2 6 45 28 19 19 28 139 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken fox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 2 5 8 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 2 l 2 3 8 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not tuberculous) .. .. .. 1 1 .. l 1 2 5 Convulsions .. .. .. 1 5 2 .. .. 3 10 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. 1 2 2 2 .. 7 Pneumonia (all forms) .. .. .. .. .. 8 4 5 8 25 Diarrhœa .. .. .. .. .. 2 2 1 1 6 Enteritis .. .. .. .. .. 4 4 3 2 13 Gastritis .. .. .. .. .. .. .. 1 .. 1 Syphilis .. .. .. .. .. .. 1 .. .. 1 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. 1 1 .. .. 2 Injury at Birth 1 .. .. .. 1 l .. .. .. 2 Atelectasis 2 .. .. .. 2 .. .. .. .. 2 Congenital Malformations 4 .. .. 1 5 2 l 1 1 10 Premature Birth 19 .. .. 3 22 1 .. .. .. 23 Atrophy, Debility, and Marasmus 3 1 .. .. 4 3 1 1 1 10 Other Causes 4 .. .. .. 4 .. .. .. .. 4 34 3 2 6 45 28 19 19 28 139 Infectious and other Diseases. 26 Table No. XII. METROPOLITAN BOROUGH OF DEPTFORD. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1928. Notifiable Disease At all Ages. At Ages—Years Total Cases Removed to Hospital. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Smallpox .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 468 13 153 232 55 13 2 467 Erysipelas 76 .. 5 5 7 17 28 14 25 Scarlet Fever 454 .. 106 294 38 15 1 .. 442 Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 8 .. .. 3 2 2 1 .. 8 Relapsing Fever .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. Puerperal Fever 10 .. .. .. 2 8 .. .. 10 Puerperal Pyrexia 12 .. .. .. 3 9 .. .. 8 Cerebro-Spinal Meningitis 4 2 2 .. .. .. .. .. 4 Poliomyelitis and Polioencephalitis 1 .. 1 .. .. .. .. .. 1 Pulmonary Tuberculosis 166 .. .. 11 43 60 47 5 263 Other Tuberculosis 47 1 11 17 10 5 3 .. 42 Ophthalmia Neonatorum 18 18 .. .. .. .. .. .. 5 Anthrax .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 113 60 53 .. .. .. .. 5 Acute Primary and Acute Influenzal Pneumonia 153 10 33 19 17 37 30 7 44 Malaria 1 .. .. .. .. .. 1 .. .. Bacilliary Dysentery 3 1 1 .. .. .. 1 .. 1 Encephalitis Lethargica 3 .. .. .. 2 .. 1 .. 3 Measles 2317 101 1176 1020 16 4 .. .. 297 Totals 3854 206 1541 1601 195 170 115 26 1625 27 Table No. XIII. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1928. 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 Croup 468 29 54 59 34 39 49 66 14 19 14 32 59 Erysipelas 76 2 7 14 6 4 5 17 5 3 2 5 6 Scarlet Fever 454 33 58 45 30 34 54 56 27 42 22 23 30 Typhus Fever .. .. .. .. .. .. .. .. .. .. • • .. .. Enteric Fever 8 1 .. 1 1 .. .. 1 1 3 .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. • • .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 10 1 .. 2 2 1 1 1 1 .. .. 1 .. Puerperal Pyrexia 12 .. .. 2 .. .. 2 1 1 2 4 .. .. Cerebro-Spinal Meningitis 4 .. .. 2 .. 1 .. .. .. .. .. 1 .. Poliomyelitis and Polioencephalitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 166 9 11 17 16 22 15 22 10 9 7 l9 9 Other Tuberculosis 47 1 3 12 4 3 6 5 2 2 2 1 6 Ophthalmia Neonatorum 18 1 3 5 4 .. 1 1 .. .. .. .. 3 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 113 8 19 48 24 4 2 .. .. .. .. 6 2 Acute Primary and Acute Influenzal Pneumonia 153 1 10 32 21 14 15 31 6 7 .. 8 8 Malaria 1 .. .. 1 .. .. .. .. .. .. .. .. .. Bacilliary Dysentery 3 1 .. 1 .. .. .. .. 1 .. .. .. .. Encephalitis Lethargica 3 .. .. .. 1 .. .. .. .. .. 1 .. 1 Measles 2317 146 234 340 236 258 203 262 75 110 67 162 224 Totals 3854 233 399 582 379 380 353 463 143 197 119 258 348 28 INFECTIOUS AND OTHER DISEASES. Under the provisions of the Public Health (London) Act, 1891 the Tuberculosis Regulations, and the Deptford (Measles) Regulations, 1927, 3,854 cases of infectious diseases were notified, as compared with 1,456 in 1927. In a tible on another page will bs 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, 81 deaths were ascribed, and the death-rate was 0-72 per 1,000 against 0*33 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. Numbers of parishioners who had come in contact with cases of smallpox in other parts of the Metropolis were kept under observation. Scarlet Fever. 1921 951 cases 1925 310 cases 1922 547 „ 1926 399 „ 1923 349 „ 1927 400 „ 1924 291 „ 1928 454 „ 454 persons were notified as suffering from this disease during the year under report as compared with a total of 400 for the previous year. Included in this total are 12 patients who, after removal to hospital, were certified to be not suffering from the disease in question; also 5 cases which occurred amongst the staff of the South-Eastern Hospital. There were 2 deaths as compared with 2, 1 and 3 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 0.02 for the County of London. No use was made of the Dick test in the Borough. Diphtheria. Year 1921 363 notifications; 13 deaths „ 1922 459 39 „ „ 1923 417 33 „ „ 1924 374 15 „ „ 1925 610 23 „ „ 1926 582 19 „ „ 1927 412 14 „ „ 1928 468 13 „ 29 The total number of patients certified to be suffering from Diphtheria was 468 as compared with a total of 412 for the previous year. Of this number 24 were errors of diagnosis, and 13 were cases amongst the Staff of the South-Eastern Hospital. There were 13 deaths as compared with 14, 19 and 23 for the three preceding years, giving a death rate of 0-11 per 1,000 population as compared with 0.06 for England and Wales, and 0.09 for London. In my previous reports the causes, the prevention, the question of immunity, the Schick test, Inoculation, etc., etc., have been dealt with at length. During the year 1928 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 been carried out as per the annexed Table:— Diphtheria Prophylaxis. Number Schicked. Number Schick Positive. Number Schick Negative. Result Unknown. Number Inoculated. Number fully Inoculated. Number partly Inoculated. Total Inoculations given. 174 85 75 14 223 168 65 580 Number of Re-tests. Number Positive. Number Negative Result Unknown. 181 34 134 13 Enteric Fever. 1921 9 cases 1925 4 cases 1922 7 „ 1926 2 „ 1923 10 „ 1927 10 „ 1924 20 „ 1928 8 „ Eight cases of Enteric Fever were notified as compared with 10 in the previous year. There was one death. Five of these cases were enteric fever proper, three were Paratyphoid B. fever, whilst in the remaining two cases the patients were discharged from hospital as "not suffering," after a period of observation. Acute Primary Pneumonia and Acute InfSuenzal Pneumonia. 1921 47 notifications; 119 deaths 1922 125 „ 201 „ 1923 74 „ 91 „ 1924 144 „ 150 „ 1925 153 „ 114 „ 1926 185 „ 108 „ 1927 197 „ 120 „ 1928 153 „ 118 „ 30 These diseases are compulsorily notifiable under the Public Health (Infectious Diseases), Regulations, 1927. 153 cases were notified during the year, as against 197 in the previous year. This table shews that an unsatisfactory state of affairs still exists, and proves that Pneumonia is not being notified as it ought to be. 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 Puerperal 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 „ „ — „ 1928 10 „ „ 7 „ There were 10 cases of Puerperal Fever and 12 of Puerperal Pyrexia during the year. With reference to the provision by the Council of consultative facilities, Dr. Gilliatt was called in four times during the year at a cost of sixteen guineas in all. The Pathologist's services were requisitioned twice to make a bacteriological examination of a sample of urine. Ophthalmia Neonatorum. 18 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 pneumonia. 5 of the 18 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 31 been taken and is being maintained to prevent injury to vision. Where necessary, visits have been paid by Dr. Hill or myself. Vision Vision Family Notified Treated Total Totalremoved Deaths At home In hospital paired paired blindness Borough. 18 13 5 16 0 — 1* *Died of Pneumonia. 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. In view, however, of the closer co-operation now existing between the London County Council School Medical Service and the local Health Department, it has recently been decided to ask the Ministry to rescind these Regulations. 2,317 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 Association for daily visits of a nurse to such cases as your Medical Officer of Health deemed advisable. 297 cases were removed to hospital in order to provide necessary treatment for complications, whilst in some cases bad home conditions necessitated such action. There were 30 deaths. Diarrhœa and Enteritis. Infantile Diarrhœa 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 1928, 113 such cases were notified, and 5 of this number were admitted to hospital. Diarrhœa and Enteritis caused 25 deaths during the year, 20 being children under two years of age. Epidemic Cerebrospinal Meningitis. 4 patients were notified as suffering from this disease during the year. All the patients were removed to hospital, and, unfortunately, all four cases terminated fatally. Malaria. 1 case of Malaria was notified in the person of a man who had contracted the disease in India some years ago. 32 Encephalitis Lethargica. 3 cases were notified during the year. There were two deaths ascribed to this cause. 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 2½ years. Bacilliary Dysentery. 3 cases were notified during the year, one of which terminated fatally. Table XIV. Hospital Disposal of Notifiable Diseases during 1928. DISEASE Total Cases Notified Cases admitted to Hospital. Total Deaths. Diphtheria 468 467 13 Scarlet Fever 454 442 2 Enteric Fever (including Paratyphoid) 8 8 1 Puerperal Fever 10 10 7 Puerperal Pyrexia 12 8 4 Pneumonia 153 44 118 Measles 2317 297 30 Diarrhœa and Enteritis (under 2 years of age) 113 5 25 Erysipelas 76 25 1 Poliomyelitis 1 1 — Encephalitis Lethargica 3 3 2 Ophthalmia Neonatorum 18 5 - Cerebrospinal Meningitis 4 4 4 Bacilliary Dysentery 3 1 1 Prevalence of, and Control Over, Infectious Diseases. The Table giving the incidence of notifiable diseases for the year 1928 will be found elsewhere in the report. This table gives the cases in accordance with the age groups requested by the Ministry of Health. 33 Table XV. Deaths and Death Rates from Principal Infectious Diseases. Year Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Diarrhcea and Enteritis (under 2 years) Total No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate , No. of Deaths Rate No. of Deaths Rate 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 1927 2 0.02 - - — — 2 0.02 11 0.10 14 0.12 8 0.07 37 0.33 Average for 10 years 2 0.02 - - 22 0.20 5 0.04 18 0.16 20 0.18 23 0.21 90 0.80 1928 1 0.01 - - 30 0.27 2 0.02 15 0.13 13 0.11 20 0.18 81 0.72 34 Table XVI. 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 1927. Return made on or before the 9th of February, 1929, 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 31st December, 1927, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1927. Number of these Births duly entered by 31st Jan., 1929. No, of Births wnich on 3ist Jan.. 1929 remained unentered in the Vaccination Register on account of— No. of these births remaining on 1st Jan., 1929 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1928. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1928. Successfully 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 544 276 3 - 188 18 7 13 12 27 - - North Deptford 600 272 2 - 199 28 9 3 18 69 - - East Deptford 719 253 1 - 191 34 19 2 37 182 - - East Greenwich 814 412 1 - 227 40 20 12 32 70 - - West Greenwich. 317 157 l - 92 13 5 4 14 31 - - Total 2994 1370 8 - 897 133 60 34 113 379 1571 1309 Dated February 4th, 1929. E. S. Elliott, Vaccination Officer. Total Number of Certificates for Year 1928 sent to other Vaccination Officers, 159. 35 Notifications of Illness in Scholars. All notices received from the Education Authorities are carefully scrutinised, and scholars who are reported to have sore 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 1,802. 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. In the following Tables will be found particulars as to disinfection carried out during the year under report. c2 36 Table XVII. SHOWING NUMBER OF ROOMS DISINFECTED. 1928 Scarlet Fever Diphtheria Pulmonary Tuberculosis Measles Small-Pox Contacts Cancer Puerperal Fever Erysipelas Pneumonia Scabies Typhoid Fever Chicken Pox Cerebro-Spinal Meningitis Impetigo Whooping Cough Gangrene Encephalitis Lethargica Infantile Paralysis Dysentery Formalin Spray Fumigated Vermionous Infectious Requests Total Rooms Premises Rooms R'ms. R'ms. January 46 41 21 10 13 .. .. l .. 1 .. .. .. 2 .. .. .. .. .. 135 .. 135 4 7 February 21 38 33 16 2 l 3 .. .. .. 2 .. .. .. .. .. .. .. .. 116 11 127 1 1 March 39 22 27 45 .. 3 .. .. l 5 .. .. l .. .. .. .. .. .. 143 4 147 4 10 April 36 46 22 28 19 4 1 .. 3 .. .. .. l .. .. .. l .. .. 161 6 167 4 5 May 36 32 23 29 5 1 1 .. 2 1 .. 1 .. .. .. .. .. .. .. 131 2 133 9 13 June 36 89 38 16 .. 4 .. l .. .. .. .. .. .. 1 2 .. .. .. 187 6 193 7 12 July 43 32 33 12 .. 6 .. 2 2 .. .. .. .. .. 1 .. .. .. .. 131 9 140 10 15 August 25 34 23 2 .. 5 4 .. .. .. 2 2 .. .. .. .. .. .. l 98 11 109 7 9 September 48 42 39 .. .. 2 1 1 1 .. 3 .. .. .. .. .. .. l .. 138 4 142 8 13 October 55 31 21 .. .. 6 1 1 2 .. .. .. .. .. .. .. .. .. .. 117 7 124 9 13 November 54 55 24 .. .. .. .. 5 .. 3 .. .. .. .. .. .. .. .. .. 151 3 154 6 7 December 67 37 16 .. .. 3 1 1 .. .. .. .. .. .. .. .. .. .. .. 125 .. 125 1 1 506 499 330 158 39 35 12 12 11 10 7 3 2 2 2 2 l l l 1633 63 1696 70 106 37 Table XVIII. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION. OR DESTROYED AT OWNERS* REQUEST. 19-28 Premises Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Books Articles Destroyed (Owners' Request) Cleansing Station Infectious Requests I).B.C. Library Private Beds Pillows Bolsters Mattresse: Sheets Blankets Odd Articles Total Wearing Apparel Towels Blankets Total January 121 5 91 185 54 38 113 225 667 1373 33 5 2 ... ... l ... ... 27 30 20 118 2 140 February 100 6 60 142 36 29 82 158 394 901 25 10 1 2 ... l 4 2 14 24 15 156 2 173 March 112 8 108 215 54 41 166 281 529 1394 34 46 9 4 4 6 1 6 22 52 5 214 3 222 April 134 6 75 174 55 35 143 214 474 1170 36 5 1 1 1 2 ... ... 10 15 ... 85 ... 85 May 117 5 73 160 38 24 112 170 381 958 26 ... 2 1 1 4 ... ... 12 20 3 188 ... 191 June 135 1 84 194 56 52 253 183 621 1443 31 28 1 ... ... 1 ... ... ... 2 13 254 2 269 July 106 6 65 124 41 30 78 75 183 596 20 ... 4 ... ... 4 ... ... 42 50 16 226 4 246 August 77 5 64 129 45 28 89 114 338 807 23 2 6 ... 3 6 ... ... 20 35 ... 21 ... 21 September 95 4 58 150 54 36 96 124 308 826 13 ... 2 6 2 1 ... 3 3 17 10 228 1 239 October 97 8 73 172 50 34 108 132 483 1052 24 4 4 4 1 8 1 ... 26 39 ... 204 ... 204 November 125 8 81 201 67 38 131 207 477 1202 21 6 2 2 1 2 ... ... 4 11 ... 230 ... 230 December 108 3 64 157 55 37 111 200 435 1059 16 5 ... ... ... ... ... ... ... ... ... 85 ... 85 1327 65 896 2003 605 422 1482 2083 5290 12781 302 111 34 20 13 31 6 11 180 295 82 2009 14 2105 38 Summary. Number of premises visited: Infectious diseases 1327 „ „ „ Requests, bedding only 65 „ „ „ Verminous 70 Total premises visited 1462 Number of rooms disinfected, formalin spray 1633 „ „ „ „ requests 63 „ „ „ sulphur 106 Total 1802 Number of articles disinfected (steam disinfector) 14886 Number of books disinfected (formalin lamp) 413 „ „ articles destroyed at owners' request 295 Special disinfections, etc.:— May. Two L.C.C. trams. August. 74 bales of rags, 6 bags of rubber—weight about 6 tons. 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 Wickhatn Road, S.E. 4. (See Reports elsewhere). (3) Children. The Albury Street Sick Babies Home, locally, and hospitals such as Vincent Square, Evelina and Great Ormond Street. (4) Fever. Metropolitan Asylums Board's Infectious Diseases Hospitals. Institutional Provision for Married Mothers, Illegitimate Infants and Homeless Children in the District. Rest homes by the seaside (such as All Saints Church, Margaret Street, provides), are taken advantage of by those married mothers who can pay a reasonably small fee. The Guardians, similarly, send away cases. 39 Ambulance Facilities. (a) Infectious Cases. Ambulance service is available for infectious cases at any hour of the day or night upon application to the Metropolitan Asylums Board, either at the Head Office, by telephone, 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. 40 clinics and treatment centres. Maternity & Child Welfare. (]) Infant Consultations. Daily from 2 p.m. Monday, Gosterwood Street Tuesday, Napier Street Do. Besson Street Wednesday, Erlam Road Thursday, Goldsmiths' College Do. Princess Louise Institute, Hales Street Friday, St. George's Hall, Shardeloes Road. (2) Ante Natal Clinic. From 9 a.m. to 1 p.m. Tuesday Health Centre, Wednesday Harton Street. Thursday Friday (from 2 p.m.) Do. special infant consultations. Wednesday, 10 a.m., Health Centre, Harton Street. Dental Inspection and Treatment. Alternate 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 Eye and Tuesday and Thursday, School Minor 2 p.m. Treatment Ailments Centre (Eye) Deptford Green Do. Ear, Friday, 2 p.m. Minor Operations Ailments Monday, 2 p.m., at Cyril Henry Centre, Woolwich Do. Skin Wednesday, 2 p.m. Ailments 20 Albury Teeth Monday, 9.30 a.m. and Street 1.30 p.m Tuesday, 1.30 p.m. Wednesday, 1 .30 p.m. Thursday, 1.30 p.m. Friday, 9.30 a.m., 1.30 p.m. Gas, Tuesday, 9.30 a.m. Inspections, Wednesday and Thursday,9.30a.m. Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. 41 (Public Health Officers of the Local Authority, see facing page five.) 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. 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 1s. 3d. per visit. 42 (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 temporary whole-time nurse to visit cases during an epidemic of measles, and the Health Visitors also visit. 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. Information concerning measles and whooping cough is now derived mainly from head teachers. Where any sanitary defect is found, information is promptly conveyed to the department for necessary action. (c) Midwives. 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. (d) Registration of Maternity Homes. The London County Council is the Local Supervising Authority. Laboratory Work at Seamen's Hospital, Greenwich. Material. Total Specimens examined. Number Positive Number Negative. Swabs for Diphtheria 1324 204 1120 Blood for Enteric Fever 6 1 5 Faeces and urine for Enteric Fever, Paratyphoid and Dysentery 5 1 4 Sputum for Tuberculosis 50 9 41 Urine for B. Coli 1 - 1 Pig's foot (for causative germ) 1 - 1 Milk (Guinea pig inoculation) 6 - 6 Swabs for meningococcus 13 - 13 Total 1406 215 1191 In addition to the above, 706 specimens of sputa were examined at the Council's Tuberculosis Dispensary, in connection with Dispensary work and 232 specimens, for private practitioners, from persons not on 43 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. 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. 44 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. 46 SANITARY CIRCUMSTANCES OF THE AREA. Closet Accommodation. The closet accommodation in Deptford is entirely of the water carriage type. During the year under report 1,410 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 1928, 527 dustbins were provided or repaired by owners as the result of inspections and notices served by the Sanitary Inspectors. Work of Sanitary Inspectors. During the year the District Sanitary Inspectors made 22,089 visits in all to 6,105 premises. 3,160 systematic house-to-house inspections were made. Numerous sanitary improvements and repairs were effected, as shown in the following table:— 47 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1928. Table No. XIX. Number of District. 1 2 3 4 5 6 7 Totals Inspections— — On complaint 7 34 18 5 39 64 28 195 House-to-house 373 478 511 522 425 379 472 3160 Infectious diseases 145 136 90 108 145 216 130 970 Notice from builder 29 30 13 22 16 83 23 216 New houses for water certificate ... ... ... ... 2 12 ... 14 Other inspections 232 233 177 250 181 239 238 1550 Total 786 911 809 907 808 993 891 6105 Re-inspections, Calls, etc.— Total 1794 2507 2095 2195 2524 2099 2770 15984 Notices Served— Intimation (Public Health Act) 465 537 489 598 435 499 534 3557 Statutory ( Do. ) 6 82 18 20 24 50 60 260 Cleansing and Repairs— Number of premises, etc., cleansed 195 278 337 432 291 259 357 2149 Ventilation improved (number of premises) ... 16 12 ... 1 3 25 57 Number of roofs repaired 57 129 82 108 127 95 129 727 Dampness abated (number of premises) 28 86 74 167 64 75 48 542 Gutters and rainwater pipes provided or repaired 29 83 76 75 110 91 127 591 Yards and forecourts paved ... ... 3 93 1 6 ... 103 Yard and forecourt paving repaired 52 37 37 6 43 48 42 265 Scullery floors paved, or paving repaired 4 11 7 12 18 38 86 176 Coppers provided and repaired 20 36 42 16 29 15 58 216 Other repairs and improvements 70 223 125 134 210 237 340 1339 Water Supply— Re-instated ... ... 1 1 ... 1 ... 3 Fittings repaired (number of premises) 3 18 55 1 5 11 15 108 Cisterns cleansed ... ... ... ... ... ... ... ... „ provided ... ... ... ... ... ... ... ... ,, covered ... ... ... ... ... 2 ... 2 ,, abolished ... ... ... 1 ... 6 ... 7 Potable water supply provided from Service ... ... ... ... ... 1 ... 1 Additional facilities provided in tenement houses ... ... ... ... ... 2 1 3 Other improvements ... ... ... ... ... ... ... ... 48 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1928—continued. Number of District. 1 2 3 4 5 6 7 Totals Table—continued. Drainage — Drains re-constructed (number of premises) 5 28 11 ... ... 28 10 82 Drains cleansed and amended 82 41 37 33 31 25 25 224 Gully traps fixed 13 39 16 9 ... 49 13 139 Soil and Vent Pipes fixed 8 13 5 7 7 42 5 87 Do. repaired ... 10 ... 5 12 6 ... 33 New Covers provided to inspection chambers ... 2 5 2 4 24 6 43 Waste and rainwater pipes disconnected from drains 2 4 ... ... ... 6 ... 12 Chambers and access eves provided 4 18 7 ... ... 26 11 66 Other repairs or improvements 14 26 57 70 19 101 28 315 Water Closets- Old waterclosets abolished ... ... 1 ... ... ... 1 2 New waterclosets provided ... ... 2 ... ... 3 5 10 New pan and trap only, provided 84 56 27 45 11 87 29 289 Defective flush remedied 42 26 18 39 21 34 67 247 Pans cleansed ... 1 6 2 9 12 14 44 Seats provided or repaired 4 7 2 5 13 14 18 63 Roofs repaired 3 14 16 5 11 9 35 93 Walls, etc., repaired or cleansed 40 25 69 103 51 33 175 496 Doors repaired or renewed ... 4 5 3 14 7 17 50 Ventilation improved ... ... ... ... ... ... 2 2 Floors repaired ... 2 ... 2 12 2 13 31 Other repairs or improvements 15 14 ... ... 1 13 40 83 Urinals— Cleansed ... ... 1 ... 3 8 ... 12 Repaired ... ... ... ... 1 3 ... 4 Provided 1 ... ... 1 ... 4 ... 6 Cesspools— Abolished ... ... ... ... ... 1 1 2 Dung Receptacles— Provided ... ... ... ... ... ... ... ... Repaired ... ... ... ... 1 ... ... 1 Abolished ... ... ... ... ... ... ... ... Overcrowding- Cases abated 1 ... ... ... l ... ... 2 Nuisances arising from the keeping of animals— Number of nuisances abated ... 2 ... ... 4 1 2 9 Offensive accumulations— Number of accumulations removed 4 3 ... 2 4 2 1 16 49 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1928 —continued. Number of District. 1 2 3 4 5 6 7 Totals. Table—continued. Smoke Nuisances— Number of observations ... ... ... ... ... ... ... ... Number of nuisances from black smoke ... ... ... ... ... ... ... ... Number of notices served ... ... ... ... ... ... ... ... Dustbins— Provided or repaired 35 106 93 115 69 54 55 527 General— Other miscellaneous nuisances abated ... ... 2 ... 17 4 14 37 District No . Inspector. Districts (approximate) 1 Inspector 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. Legal Proceedings Under the Public Health Act and Bylaws. Premises. Nature of Offence. Result of Proceedings. 117 & 119 St. Asaph Rd. Non-compliance with statutory notices Order for works to be carried out within 28 days. Ditto Non-compliance with Magistrate's Order. Works eventually completed, Summonses dismissed on payment of £5 costs. d 50 HOUSE-TO-HOUSE INSPECTIONS. House-to-house inspections were made in the following streets during the year 1928:— Inspector Simpson— Street or Road. Total premises inspected. Number in which defects were found. Avonley Road 15 11 Brocklehurst Street 98 61 Barlborough Street 45 16 Boscawen Street 21 21 Briant Street 4 4 Evelyn Buildings 3 3 Faulkner Street 25 25 Hatcham Park Road 80 55 Lubbock Street 22 19 Martha Place 13 13 Pomeroy Street 11 8 Powers Place 12 12 Wrigglesworth Street 24 20 Total 373 268 Inspector Kemp— Street or Road Total premises inspected Number in which defects were found Junction Road 21 21 Hunsdon Road 47 16 Fawcett Road 47 34 Blockhouse Street 80 54 Cornbury Road 52 47 Upcot Street 59 26 Reculver Road 33 28 Edale Road 23 21 Haydock Road 19 10 Sharratt Street 22 18 Rollins Street 50 37 Lovelinch Street 17 5 Alpine Road 8 4 Total 478 321 51 Inspector Hewett— Street or Road. Total premises inspected. Number in which defects were found. Grove Street 15 15 Kerry Road 1 1 Trim Street 6 3 Arklow Road 27 15 Pagnell Street 72 49 Angus Street 38 26 Atkinson Street 22 15 Amersham Grove 34 21 Baildon Street 54 54 Speedwell Street 63 48 Slowgrove Cottages 4 4 Wybourne Cottages 3 1 Providence Place 7 6 Batches Cottages 2 2 Cockles Cottages 4 3 Comet Place 3 2 Comet Street 18 14 Edward Street 44 27 Clifton Hill 28 20 Amersham Vale 63 34 Douglas Street 3 3 Total 511 363 Inspector Allam— Street or Road. Total premises inspected. Number in which defects were found. Childeric Road 61 60 Grove Street 15 15 Bawtree Road 1 1 Whitcher Street 21 10 Sanford Street 45 22 Trundleys Road 7 4 Chubworthy Street 60 53 Nynehead Street 37 30 Knoyle Street 56 51 Alexandra Street 39 29 Grinstead Road 92 57 Milton Court Road 88 66 Total 522 398 d2 52 Inspector Mayo— Street or Road Total premises inspected Number in which Defects were found Grove Street 38 38 Boscawen Street 5 5 Hood Street 4 4 Windmill Lane 4 4 Plough Road 1 1 Abinger Road 46 32 Wotton Road 52 40 Alverton Street 42 22 Shere Road 70 54 Dorking Road 74 39 Rolt Street 89 48 Total 425 287 Inspector Mason— Street or Road Total premises inspected. Number in which Defects were found Arica Road 22 13 Brindley Street 22 8 Cranbrook Road 22 15 Foxwell Street 38 36 Fishers Rents 11 11 Grove Street 24 24 Luxmore Street 12 7 Martin's Buildings 8 8 Revelon Road 71 30 Spring Street 11 9 St. John's Road 94 49 Vulcan Road 16 11 Vulcan Terrace 5 2 Wilson Street 23 18 Total 379 241 53 Inspector Webster— Street or Road Total premises inspected. Number in which defects were found. Albury Street 6 6 Alvar Street 24 23 Church Street 108 96 Creek Street 2 2 Ffinch Street 5 5 Giffin Street 44 40 Hyde Street 68 65 Knott Street 5 5 Mary Ann Buildings 26 24 Norval Street 3 3 Pender Street 10 10 Rectory Buildings 111 61 Stanhope Street 36 32 Grove Street 24 24 Total 472 396 Grand Total 3160 2274 HOUSING. General. Number of houses erected during the year:— Hawkins House, New King Street 50 tenements. Brockley Gardens 12 houses. 1. Unfit Dwelling-houses. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6105 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated Regulations) 1925 3160 (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 3557 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 (on service of Intimation Notices) 3297 54 Action under Statutory Powers. (a) 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 (Statutory Notices) 260 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners 260 (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 3,160 inspections were recorded on house-to-house inspection cards. 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 several cases persons delivering milk were warned, as in 1927, 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 more than two samples in course of delivery because in most instances 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. 55 Table XX. Sale of Food and Drugs Acts.—Samples Taken During 1928. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Almonds, ground 2 .. 2 .. Baking Powder 1 .. 1 .. Beer 4 .. 4 .. Boracic Powder 2 .. 2 .. Brawn 3 .. 3 .. Bread and Butter 3 .. 3 .. Butter 44 2 46 4.3 Blanc Mange Powder 1 .. 1 .. Cocoa 15 .. 15 .. Cream 6 .. 6 .. Corned Beef 1 .. 1 .. Cake 13 13 .. Camphorated Oil 4 .. 4 .. Coffee and Chicory 5 .. 5 .. Coffee Extract 3 .. 3 .. Coffee & Chicory Extract 1 .. 1 .. Custard Powder 8 .. 8 .. Cream Buns 2 .. 2 .. Cream, Ice 2 .. 2 .. Cheese 2 .. 2 .. Dripping 3 .. 3 .. Epsom Salts 3 .. 3 .. Fish, tinned 2 .. 2 .. Fish Paste 2 .. 2 .. Fruits, dried 11 .. 11 .. Flour, Bun 1 .. 1 .. Glauber's Salts 1 .. 1 .. Glycerine 1 .. 1 .. Ground Ginger 2 .. 2 .. Honey 1 .. 1 .. Jam 5 .. 5 .. Jelly, table 2 .. 2 .. Lemonade Powder 7 .. 7 .. Lemon Squash 1 .. 1 .. Lime Juice .. 1 .. 1 .. Lard 7 .. 7 .. Magnesia, Citrate of 1 .. 1 .. Milk 263 .. 271 3.0 ,, Separated 1 .. 1 .. ,, Condensed 14 .. 14 .. ,, Dried 6 .. 6 .. ,, Sterilised 6 .. 6 .. Mineral Waters 6 .. 6 .. Mustard Condiment 1 .. 1 .. Mustard 10 .. 10 .. Mustard Compound 3 .. 3 .. Margarine 11 .. 11 .. Meat, Minced 4 .. 4 .. Carried forward 498 10 508 .. 56 Samples taken during 1928—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Brought forward 498 10 508 Mincemeat 6 .. 6 .. Meat Pie 1 .. 1 .. Oatmeal 1 .. 1 .. Olive Oil 5 .. 5 .. Pepper 11 .. 11 .. Pudding, Christmas 6 .. 6 .. Rice 3 .. 3 .. Sherbet 1 .. 1 .. Spirits 9 .. 9 .. Sweets 12 .. 12 .. Sauce 4 .. 4 .. Sausage 10 .. 10 .. Sausage Meat 1 .. 1 .. Sulphur Ointment 2 .. 2 .. Tea 2 .. 2 .. Vinegar 11 .. 12 8.3 Vinegar, malt 1 .. 1 .. Whisky 1 .. 1 .. Wine 4 .. 4 .. Wine, Non-alcoholic 3 3 .. Informal Sample. Sweets 1 .. 1 .. Totals 593 11 604 1.8 57 Table XXI. Proceedings Taken in regard to Samples Purchased during the year 1928. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks, £ s. d. £ s. d. 9a Butter Boric acid 4.2 grains per pound - - Vendor cautioned. 12A „ Boric acid 7.0 grains per pound - - - 25A Milk 7 per cent. milk fat abstracted - 4 4 0 Summons dismissed on payment of costs. 34H „ 3 per cent. added water - - Vendor cautioned. 37H „ 7 per cent. added water - - Summons dismissed. 38H „ 1 per cent. added water - - Vendor cautioned. 31M „ 5 per cent. milk fat abstracted - - Vendor cautioned. 38W „ 1 per cent. added water - - Vendor cautioned. 23Y „ 6 per cent. milk fat abstracted - 2 0 0 Summons dismissed on payment of costs. 55M Vinegar 7 per cent. excessive water Sample contained numerous living "vinegar eels." 1 0 0 1 0 0 - CANAL BOATS ACTS. Annual Report for the Year ended 31st December, 1928. To the Medical Officer of Health, Sir, I beg to report for the year ended December 31st, 1928, that for the purpose of Canal Boats inspection, I made 15 visits, on the following dates, viz. :— January 24th, March 19th, April 13th, May 16th, June 7th and 22nd, July 4th, August 7th and 9th, September 21st, October 2nd and 9th, November 24th, December 8th and 31st. No boats were found for inspection during the year. 58 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. 60 Table XXII. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1928. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1927 Added 1928 Removed 1928 On register at end of 1928 Milk premises 179 4 .. 183 355 9 .. Cowsheds .. .. .. .. .. .. .. Slaughter-houses 2 .. .. 2 76 .. .. Other offensive trade premises 2 2 .. 4 35 .. .. Ice cream premises 187 .. 11 176 219 18 .. Fried fish, etc., shops 48 1 .. 49 129 49 .. Restaurants 52 1 .. 53 110 14 .. Other food premises 27 1 .. 28 125 2 .. Hairdressers' premises 53 2 .. 55 27 .. .. Table XXIII. 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 1928. CLASS OF WORK. Number of Places Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1927. Added 1928. Removed 1928. On Register at end of 1928. Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories Factory Laundries 3 3 17 3 1 1 Factory Bakehouses 16 16 30 47 4 Other Factories 220 1 219 164 242 7 Workshop Laundries 4 4 17 4 Workshops Work shop Bakehouses 34 34 80 140 10 Other Workshops 135 9 144 275 166 12 Workplaces Places where Food is prepared for Sale 131 131 239 339 34 Workplaces other than the above 70 70 89 92 4 Home-workers' Premises 215 12 203 213 35 1 Total 828 9 13 824 1124 1068 73 61 Table XXIV. METROPOLITAN BOROUGH OF DEPTFORD. This Table is by request of the Secretary of State. Annual Report of Medical Officer of Health for the year 1928. 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) 292 12 Workshops (including Workshop Laundries) 310 22 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 431 38 Total 1033 72 2.—DEFECTS FOUND. PARTICULARS, Number of Defects. Number of 1 Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts. Want of Cleanliness 47 47 3 Want of Ventilation Overcrowding Want cf Drainage OF Floors 2 2 Other Nuisances Sanitary Accommodation Insufficient 1 1 Unsuitable or defective 10 10 Not Separate for Sexes 11 11 Offences under the Factory and Workershop 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 3 62 Table—continued. 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107 OUTWORK IN UNWHOLESOME PREMISES, SECTION 10S OUTWORK IN 1NFECTKD PREMISES SECTIONS 109, 110 Lists received from Employers. Notices served on Occupiers as to keeping or send lists. Prosecutions. Twice in the year. Once in the year. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Lists. Outworkers. Lists. Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Contractors. Workmen. Contractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— Making, etc. 18 5 119 23 Total 18 5 119 23 63 Special Reports. The following reports of special visits paid by your Medical Officer of Health and Inspector Yates were submitted to the Public Health Committee during the year:— 1. Artificial Stone and Asphalt Makers. These works, situated in Stockholm Road, consist of a large twostoreyed building and a spacious yard, the whole occupying the site between Stockholm Road and the canal. Stabling for 15 horses is situated on the first floor and this is reached by a long concrete road rising at a very easy gradient. We found the stable to be well lighted and ventilated, free from any odour, and scrupulously clean ; every place possible is kept limewashed. This firm is engaged in (a) The manufacture of artificial stone, and (b) Asphalt and tar-paving. Artificial Stone. Pieces of various kinds of stone, such as york stone, limestone, etc., along with granite, are pressed through crushers where they are broken into small pieces, and then again into very fine pieces; thereafter they are mixed with a certain quantity of very fine ballast. Different kinds of cement are added with the requisite amount of water. The whole is then mixed by hand and is ready for placing in the moulds. These moulds, which are constructed of wood, are made in the carpenters' shop, another spacious room. The mixture is placed in the moulds where it is allowed to set, the time varying in accordance with the size of the casting. Once it has thoroughly hardened the mould is removed; it is taken to pieces, being all in sections. The casting, at present in the rough state, is now subjected to a rubbing and cleaning-off process, fine sand and stone dust being used. Eventually the external faces become smooth and clean, and the whole gives an appearance of stone. The colours can be varied by adding colouring matter during the casting process. Cast in all sizes, this artificial stone can be used for all constructional or building works, such as sections for staircases, ornamental decorations, etc. An advantage is that this artificial stone is not affected by the London atmosphere, which, of course, readily attacks natural stone. The stone work is used in London and throughout the country generally. 64 Asphalt Tar Paving. Granite is passed through crushers until broken up to a required size. This is passed into a mixer where it is coated with a solution of tar, bitumen, oil, etc., to give it the necessary binding properties. This is generally used for the foundations of roads, paths, etc. The asphalt is imported in bulk from various parts of the Continent. It is remelted at the works and cast into blocks for convenience of transit. The asphalt is melted again at the street or road where it is to be used, and laid hot; sometimes it is mixed with small fragments of white stone, or stone dust, to give it a required appearance or colour. This is largely used for footpaths, tennis courts, etc. Sanitary Accommodation. As a rule 90 men are employed, for whom there are four w.c.'s and two urinals. In accordance with a suggestion recently made by us, the accommodation is being reconstructed on modern lines. One section, two w.c.'s and one urinal, has been completed (at the stone manufacture part of the premises), while work is at present proceeding on the second section. At the first section, the old w.c.'s, etc., which were situated within the workshops, were abolished ; the new w.c.'s and urinal are constructed outside the building. The enclosures are made of artificial stone impervious to water, and are designed to give the maximum amount of light, ventilation and privacy. Workshops. Owing to the nature of the industry carried on, it is impossible to keep all places clean and free from dust, but wherever possible walls are kept limewashed and the floors properly drained. Much of the work is carried on in the open air. By means of skylights, windows and open doors, a good standard of ventilation is maintained in the shops. 2. Foundry. Situated in Glenville Grove, this factory consists of long buildings, one and two storeys high, used as casting shops, machine shops, stores, offices, etc. The manufactures consist of all kinds of chemical plant, machinery, steam jacket pans, steam fittings, condensers, rotary vacuum pumps and blowers, plant for cellulose acetate, artificial silk industries, castings of all descriptions in iron, hard lead, and acid resisting alloys from 1 lb. in weight up to 1 ton. The well-known "Equifex" steam 65 disinfector is made here (a point of much interest to us), and this apparatus is installed in many hospitals and disinfecting stations throughout the Empire. Another industry which has just begun here is the production and making of gramophone records, of which more will be said below. There is a large and well-equipped laboratory in the factory where research and experiments are carried out in connection with various metals and alloys; but we did not press any questions here as each firm has its own trade secrets. Some of the metals produced here are so hard that steel tools will not touch them ; the necessary machinery of the castings is made by special grinding. Hygiene. The foundry and workshops are spacious and lofty and are well lighted and ventilated. The smelting is carried out in cokeheated (with hot blast) cupolas placed at the end of the casting shop. From these the molten metal is conveyed in ladles, carried by an overhead travelling crane, to the moulds prepared on the ground in various parts of the shop. There are 50 men on an average employed here for whom there are four w.c.'s of the trough pattern with one urinal enclosure. All these are well lighted and ventilated. Though clean and free from nuisance the trough w.c.'s are rather out-of-date and one would prefer more modern conveniences. We have, however, no sanitary grounds for requiring this alteration. Gramophone Records. The rooms used for the production of these are a joy to behold. Placed at the end of the factory they form really a factory within a factory. They comprise a machine room, a studio for the various artistes and a piano, and a recording room where the sound waves are actually recorded by the machines. The walls and ceilings of these rooms are constructed of composition slabs presenting a clean and smooth surface, while the floor is of cement. The whole presents a clean and most hygienic appearance. There is ample window space provided for lighting, while portions of the windows are made to open for ventilation. The sanitary accommodation is quite new, to enter which one passes from the machine room through ventilated lobbies. There are two w.c.'s and a lavatory basin for women, and one w.c., one urinal and one lavatory basin for men. The enclosures are constructed of impervious slab partitions with cement floors. There is provision for washing the floors, while lighting and ventilation is very good. As we were able to see rlightiy into ;he 66 female w.c.'s from the machine room we requested the manager to construct a screen facing the ventilated lobby. The sound waves produced in the studio by the singer or orator pass through a square tapering tube which is inserted in the wall separating the studio from the recording room. The sound waves are transmitted by special apparatus on to a waxed plate in the recording machine. The minute grooves thus formed on the wax plate are then transferred to a copper plate. The latter is next coated with a metallic preparation, rendering it very hard. From this pattern plate the ordinary gramophone records are made. The material used consists of a thin, semi-transparent sheet, reinforced in the centre with a very fine metallic mesh. Discs for the gramophone records are cut from this sheet. The copper pattern record is placed in a machine with the blank gramophone record upon it. Both are then enclosed between two plates, the upper being hollow. The plates are then powerfully clamped together and steam is passed through the upper plate, which softens the gramophone record. The clamps are then released and the newly-made record is taken out. It takes ten seconds from the insertion of the blank record until the completed record is removed from the machine. This record is noninflammable, quite flexible, and, it is claimed, it is indestructible. No fewer than 40,000 records can be printed from one pattern plate, and they are so light that two dozen can be carried with ease. 3. Chemical Manufacturers. This factory occupies a portion of the above-mentioned foundry buildings and was recently reconstructed and adapted for its present purposes. We met with a dry reception. From the smell of the atmosphere I was able to inform the manager that he manufactured amyl acetate; he was good enough to add that they made, also, various essences of a chemical nature. The factory consists of two large rooms, both well lighted and ventilated. The flooring is of cement, draining into channels. One w.c. is provided for the nine men employed, and this is situated in a small chamber opening off the office rooms. While the w.c. is satisfactory, the linoleum just below the basin was wet. I have written to H.M. Inspector of Factories drawing his attention to the unsatisfactory drainage of a section of the flooring at a point between the two rooms. 67 4. Rope and Cord Factory. This factory is situated in Oldfield Road and consists of a long onestorey building, together with three sheds, each 100 yards long, known as the rope walks. These sheds are well lighted and open at each end, the ventilation being very good. The main building, used for offices, packing rooms and stores, is also well lighted and ventilated. Hemp and jute brought here from various parts of the world arrive at the factory in the form of strings, having already passed through the spinning mill. The various grades are dealt with in accordance with the particular end in view, as for making signal halliards, light cordage for marine use, fishing lines, cordage for fishing nets, and different grades of cord and string for commercial or domestic use. Strings of hemp are stretched along the rope walks running through guides on frames. The number and thickness of the string vary according to the type of cord wanted. The ends of these long strands pass into a machine at the end of the shed and this twists the strands together until the thickness and requisite strength are obtained. Gently • grasping the cord, say 50 or 60 yards from the machine, one can feel the terrific speed at which the strands are rotating, although this cannot be detected with the naked eye. Next, the cord is passed through a shallow tank of water and then through the carding machine. This latter is a kind of comber which removes the short ends and pieces, thus leaving the outside of the cord clean and smooth. The cord is then dried and the external surface treated with size which acts as a protective agent. Once the size has dried, the cord is wound by winding machines into coils, or, in the case of string, into coils or balls of various sizes, as required. Thirteen men are employed at this factory for whom one w.c. and one urinal is provided. These are clean and the ventilation is good. There is one female employee for whom separate accommodation is provided. Washing facilities are provided in the form of a sink and soap and towels. 5. Toy Factory. Soft toys, such as teddy bears, are made at this factory, situated in New Cross Road. The process is simple. According to the toy required, the various coloured cloths are cut out to pattern. These are sewn together and are then stuffed with fine wood shaving and finished off. 68 The workshop consists of two fair-sized rooms opening into each other and well lighted and ventilated at each end by windows. We pointed out to the manageress that there was a tendency to closeness, and requested that attention should be given to the ventilation. Sanitary Accommodation. One w.c. is provided for the eleven female employees; the condition of the same is satisfactory. 6. Sign Manufacturers. In both these factories, situated in Rolt Street and Blackhorse Road, signs of all kinds are manufactured. Thus we saw enamelled copper letters for fixing upon glass, enamelled iron tablets and plates, electric signs, daylight signs, embossed and enamelled glass tablets, designs, etc., etc. At Rolt Street, the factory is constructed in the railway arches. The lighting and ventilation are good: the particular nature of the industry called for the installation of a special type of ventilation plant. At Blackhorse Road the work consists chiefly in the manufacture and embossing of glass signs and tablets, whilst wood letters and designs are also made. This is a spacious two-storey building divided into rooms in which the various processes are carried on until the particular article is finished off. The grinding agencies are on " wet " lines, so that there is no danger of any of the employees contracting lung disease through the inhalation of particulate glass which otherwise would float into the atmosphere. Special air ducts and exhaust fans confirm this protection, while the general ventilation of the factory is effected by open skylights and windows ; the natural and artificial lighting throughout are both good. It is pleasing to record that the firm provides milk for the girls who are employed in the aerograph process, while tea is provided free to the whole of the employees daily- Sanitary Accommodation. There is ample provision of soap and towels in connection with the washing accommodation. The w.c. section is modern, clean, well lighted and ventilated; this applies to both factories. At Blackhorse Road there are three w.c.'s for the 47 men and four for the 71 women. At Rolt Street there are two w.c.'s for the 12 men, and two for the 23 women employed. Copper Enamel Letters. The blanks are stamped out of thin sheet copper, then annealed and cleaned by brushes. In rare instances the letters are cut out by hand. The letters are then coated with gum by 69 the aerograph process, that is to say, the gum is blown on to the letters under air pressure; thereafter, powdered enamel is blown on by the same process. Next, the letters are fused or baked in a furnace, thus drying the enamel on the copper. After cooling and cleaning, the letters are ready for use. The spraying or aerograph process is carried out in specially constructed enclosures, these being ventilated by air ducts on which a powerful exhaust fan is working. The fumes of the gums and dust from the dry enamel are quickly drawn off. Enamel Plates. The plates are cut into shapes by the guillotine and are pickled in muriatic acid. The first coat of colour is now blown on to the plates by the aerograph process. This is followed by fusing or baking, cleaning, and finally re-fusing. The various colours are then blown on to the plate, and a stencil bearing the wording or design of the plate required is placed over it; the superfluous colour is then brushed out. When this operation is completed, the plate is once again fused, and then Anally cleaned. Embossed Glass Tablets. The tablet required is cut from a sheet of coloured glass and the edges are either ground smooth or bevelled. The surfaces of the tablet are completely covered by an acid-resisting preparation called asphaltum. The lettering or design is now traced by stencil upon the surface of the tablet, the pattern, etc., being actually traced in the asphaltum. Next, the tablet is placed in a bath of hydrofluoric acid and the acid attacks the portion of glass not protected by the asphaltum, thus embossing or eating into the glass, so forming the desired words or pattern. After 20 hours' exposure to the acid, the tablet is removed and then passed through weaker acid baths until eventually all the acid is washed off. By this time the lettering or design stands out white upon a coloured background. In other tablets on clear glass, the design is embossed in the same way, but is gilded or coloured as required. In further types the design is transferred to the tablet by means of stencil and is brushed out. Silvering Glass. The prepared tablets are placed upon a hot plate the temperature of which is about 150° Fahr. Silver nitrate solution is then poured over the surface of the glass. The heat passing through the glass from the hot plate below causes evaporation of the water, and a coat of silver nitrate is left on the glass. Glass letters are cut from sheets of glass either by hand or by sand-blast; they are then shaped, 70 cleaned off and polished by various grinding wheels and plates. Wood letters: these are cut out by machine, finished off and gilded or coloured as desired. 7. Foundry. This factory occupies part of the arches in Rolt Street and is devoted to general iron casting. Already I have described a similar process. Iron is smelted in a cupola, coke heated with blast ; then the metal is run into the required moulds. The ventilation of the factory was good. One w.c. is provided for the 12 men employed. The manager was asked to limewash the w.c. premises. 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 1st January, 1928, to the 29th December, 1928, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 213, 166 Pulmonary Tuberculosis and 47 Non-Pulmonary as compared with 172 Pulmonary and 54 Non-Pulmonary for the previous year. 71 Table XXV. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 1st January, 1928 to 29th December, 1928. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C Age Periods. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Cases admitted to 1-5 5-10 10-15 15-20 20-25 25-35 | 35-45 45-5; 55-65 65 and up Total Primary Notifications Poor Law Institutions. Sanatoria. Under 5 5-10 10-15 Total Primary Notifications Pulmonary— Males ... ... 2 5 8 14 16 19 18 11 4 97 154 ... ... ... ... ... 78 82 Females ... ... 1 3 9 12 16 9 11 7 1 69 105 ... ... ... ... ... 49 54 Non-Pulmonary Males ... 7 8 3 3 2 2 ... 1 1 ... 27 31 ... 2 ... 2 2 12 6 Females 1 4 3 1 2 3 3 ... 1 ... ... 18 25 ... ... ... ... ... 6 18 72 The number of deaths for the year is 131 as compared with 132 for 1927. 1927 1928 Pulmonary deaths 119 107 Non Pulmonary deaths 13 24 Analysis of the notifications and deaths for the year according to sex and age are given in the accompanying tables:— Particulars of New Cases and of Deaths during the Year 1928. Age Periods. New Cases * Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - - - 1 - - 1 - 1 - - 9 4 1 - 7 1 5 3 2 10 3 1 - 2 1 10 5 4 4 1 - - 2 1 15 9 9 3 2 4 5 - 1 20 14 12 2 3 9 7 - 2 25 18 20 3 3 12 12 2 - 35 20 9 2 - 12 11 3 - 45 19 11 1 1 9 3 1 - 55 11 8 1 - 10 3 - - 65 and upwards 4 1 - - 7 1 - - Totals 103 76 35 18 65 42 18 6 *Note—Including 19 cases which came to the knowledge of the Medical Officer of Health otherwise than by notification. Pulmonary Tuberculosis. Interval between Notification and Death in 1928. Not notified 6 Died before notification 3 Died within one week of notification 7 „ ,, one week to one month 10 „ „ one month to three months 11 ,, ,, three months to six months 10 ,, ,, six months to one year 12 ,, ,, one to two years 21 ,, ,, two to three years 9 ,, ,, three to four years 7 ,, ,, four to five years 5 ,, ,, five to six years 3 ,, ,, six to seven years 1 ,, „ seven years and upwards 2 107 73 Cases notified after the death of the patient are not now regarded as notified cases. Frequent reminders have been sent to the doctors attending these un-notified and late notified cases calling their attention to their duty to notify all cases of Tuberculosis which they attend. Of the non-pulmonary cases dying un-notified or before receipt of notification, almost all were due to either Tuberculous Meningitis or to Miliary Tuberculosis and of the similar cases of Pulmonary Tuberculosis, the majority were cases admitted to hospitals who died within a a very short time of admission. Among the notified cases (pulmonary and otherwise) dying before the end of one year from date of notification, 7 were due to Meningitis, 2 were inmates of mental hospitals ; 8 had been seen at the Dispensary and 18 had not been so seen but were either hospital cases or admitted to hospital immediately after notification. The notifications of non-Pulmonary Tuberculosis were as follows :— Meningitis 8 Genito-urinary 2 Peripheral glands 14 Skin and other organs 4 Abdominal 8 Bones and joints 11 Total 47 Revision of Notification Register. During the year 219 cases of Pulmonary and 55 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 1928 as follows:— MALES FEMALES Under 15 Over 15 Under 15 Over 15 Total Pulmonary Tuberculosis 52 315 46 261 674 Non-Pulmonary Tuberculosis. 102 37 101 50 290 Totals 154 352 147 311 964 Disinfection was carried out in 330 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 74 TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1928. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. 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):— (a) Definitely tuberculous 51 32 2 - 7 5 5 1 58 37 7 1 (6) Doubtfully tuberculous - - - - - - - - 58 74 48 42 (c) Non-tuberculous - - - - - - - - 26 25 45 24 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 -- - - - - - 1 1 - - (b) Doubtfully tuberculous - - - - - - - - 7 18 8 10 (c) Non-tuberculous - - - - - - - - 7 17 31 33 C.—Cases written off the Dispensary Register as (a) Cured 11 12 5 2 4 2 4 3 15 14 9 5 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 103 142 143 118 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 232 148 21 16 23 18 31 29 255 166 52 45 (6) Diagnosis not completed - - - - - - - - 8 18 11 11 75 1. Number of persons on Dispensary Register on January 1st 707 2. Number of patients transferred from other areas and of "lost sight of" cases returned 23 3. Number of patients transferred to other areas and cases "lost sight of" 115 4. Died during the year 78 5. Number of observation cases under A (b) and B (b) of Table in which period of observation exceeded 2 months 149 6. Number of attendances at the Dispensary (including Contacts) 3235 7. Number of attendances of non-pulmonary cases at Ortho pædic 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 536 (b) Other special forms of treatment 109 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 68 10. Number of consultations with medical practitioners:- (a) At Homes of Applicants 9 (b) Otherwise 38 11. Number of other visits by Tuberculosis Officer to Homes 126 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3809 successful 3108; unsuccessful 701 Visits to cases not on Dispensary Register 1047 successful 885; unsuccessful 162 13. Number of (a) Specimens of sputum, &c., examined for Dispensary patients 706 (b) Do. do. for non-Dispensary patients 232 (c) X-ray examinations made 84 14. Number of Insured persons on Dispensary Register on the 31st December 298 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 178 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 — (b) Form G.P. 36 37 76 77 Tuberculosis SCHEME. (a) PULMONARY TUBERCULOSIS. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment for Pulmonary Tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 Class T.B. minus Class T.B. plus Class T.b. minus Class t.b. plus Class T B. minus Class T.B. plus Class T.B. minus. Class t.b. plus. Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total, (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) 1 Discharged as cured Children Adults M. 14 1 l F. 20 1 1 1 3 M 17 F. 5 • Alive Disease arrested Children Adults M. 24 5 21 26 F. 24 5 4 9 # M. 7 F. 9 Disease not arrested Children Adults M. 5 1 29 10 40 2 2 11 5 18 4 18 10 28 13 5 27 3 35 F. 5 2 16 8 26 3 1 5 3 9 2 1 14 9 21 3 5 11 5 21 M. F. 2 2 co 1 1 4 2 Condition not during the Year ascertained 22 3 20 5 00 2 4 1 5 3 6 6 Lost sight of or removed from Register otherwise Dispensary 114 13 25 6 44 12 1 9 5 15 3 1 16 1 18 2 3 1 4 Dead Children Adults M. 5 2 11 18 31 Q 1 Q 1Q oo 1 7 1 d 91 7 7 14- F 3 4 17 21 O lo M. 5 10 15 3 13 lb o o F. 1 . Totals 274 34 132 65 231 28 4 47 1 1 44 95 17 2 64 47 113 20 10 48 19 77 78 79 (b) NON-PULMONARY TUBERCULOSIS. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal Other Organs Periphereal Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Discharged as cured Children Adults M. 1 1 1 1 4 F. 1 1 2 M. 2 9 11 F. 4 3 4 11 « Alive Disease arrested ren Adults M. 2 2 1 1 6 F. 3 1 4 M. 4 2 6 12 F 5 7 12 ' Disease not arrested Children Adults M. 3 1 4 1 1 2 2 l 3 3 2 3 8 F. 1 1 1 3 1 1 2 1 1 2 2 M. 4 1 1 6 1 1 2 4 1 2 3 1 2 3 F. 2 2 1 4 5 1 l 3 5 Transferred to Pulmonary Condition not ascertained during the Year 2 G 8 4 1 5 1 1 Lost sight of or otherwise removed from Dispensary Register 22 9 5 33 G9 1 1 1 3 6 2 1 3 Dead Children Adults M. 2 2 1 1 F. 1 1 1 1 M. F. Totals 57 19 9 72 157 9 1 4 11 25 5 2 6 13 6 3 6 2 17 80 Deaths of Dispensary Patients, 1928 (i.e., persons suffering from tuberculosis). Died within 3 months of first attendance 11 ,, ,, 6 ,, ,, ,, 10 ,, ,, 12 ,, ,, ,, 12 „ over 12 „ „ „ 44 77 Dental Work. 68 patients, who made 317 attendances in all, were treated during the year. The following work was carried out:— Extractions 156 Fillings 48 Scalings 1 Gum treatment 70 Dentures supplied 40 „ repaired 9 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 £100 13 10 ,, „ free cases 45 9 7 Contributions from approved societies 27 8 11 ,, „ Guardians 12 10 0 ,, „ Red Cross Society 4 2 9 ,, ,, patients (received) 10 8 1 ,, „ ,, (due) 0 14 6 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. 78 "Z.l," 78 "Z.2," 6 "Z.3" and 23 "Z.4" cards were sent during the year under report. 81 147 patients were sent to the Dispensary by doctors. 17 patients, making in all 523 attendances, were on Light Treatment during the year. As regards the value of General Light Treatment, cases have not shown any remarkable results. Finsen light treatment for lupus gives excellent results, but is slow; general light baths in conjunction with it give the best results. 219 Form C. IV progress reports about patients who had received institutional treatment through the County Council were sent to the County Medical Officer. 65 reports re Tuberculous ex-service men were sent to the Ministry of Pensions. 133 school contacts were referred, on "M.O. 333" cards, to the School Medical Officer. 58 of these children had been examined at the Dispensary, the others being contacts of notified cases who had not been seen at the Dispensary. 148 patients were recommended to the London County Council for institutional treatment. In 19 cases the County Council were unable * to accept (of this number, 15 patients had had such treatment previously). Institutional treatment was refused by the patient in eight instances. Home Accommodation of Notified Cases. In the case of 70 patients, including 11 transfers, who had T.B. in sputum:— 20 had separate room. In 31 cases patients had separate bed. 28 had one other in room. In 35 ,, there was 1 other in bed. 16 had two others ,, In 4 ,, there were 2 others in bed. 4 had three „ „ 1 had four ,, ,, 1 had six ,, ,, In the case of 61 patients with lung disease, but where it was not known if T.B. were found in sputum:— 26 slept in separate room. 33 had a separate bed. 19 had one other in room. 27 had one other in bed. 11 had two others in room. 1 had three others in bed. 4 had three ,, ,, 1 had five ,, „ In the case of 38 non-pulmonary cases notified:— 9 had separate room. 22 had a separate bed. 11 had one other in room. 9 had one other in bed. 7 had two others in room. 7 had two others in bed. 5 had three ,, ,, 5 had four „ ,, 1 had six „ ,, f 82 In March, -1928, I reported to the Public Health Committee on the question of establishing at the Dispensary a Handicraft class for unemployed patients as a method of after-care treatment, not as a means of earning a livelihood. In the autumn of this year a beginning was made, and Miss Forth, the teacher of the class, gives a report on the subject elsewhere. Miss Forth is a London County Council Instructress. The County Council provide a teacher for such classes when a sufficient number of pupils is obtained, and where a small fee (which is reduced according to individual circumstances) is paid. One of the conditions laid down is that patients in an infectious condition, i.e., who have tubercle germs in the expectoration, are not to be admitted. This reduces to a small figure the number of patients who can be admitted, and we have found that several of these being in pretty good health leave the class to take up work, permanent or temporary, giving irregular attendances and unsatisfactory working of the class. This condition excludes the very type of patient to whom the class would be a great help physically by providing an interest and occupation in the rather hopeless and apathetic condition into which they tend to fall when unfit for or unable to get employment. The risk to a teacher from such, who could be selected, careful patients, is really trifling, and I hope that steps will be taken in this matter with a view to having the condition withdrawn as long, of course, as the teacher understands the position and is willing to carry on the work. It has been suggested that a patient already trained in such work might act as instructor to a class, but such a person would lack the experience and knowledge necessary for successful teaching, and would not have the range of subjects to interest different patients that a trained teacher has. Yours faithfully, N. M. Donnelly, Tuberculosis Officer. 83 Report of Miss Lewellin. Secretary of the Tuberculosis Care Committee. A further year's work has been added to the Care Committee's record which we hope has not diminished its prestige. With each succeeding year we become more widely recognised and, we think, our usefulness more appreciated, our work merges closely into other local organisations and we feel part of a great whole that is working for the betterment of our Deptford people. We are afraid that these societies consider us inveterate beggars, but they are so universally good to us that we can only conclude that they consider us deserving. Our thanks are due to them all. The British Legion, The Red Cross Society, The United Services Fund, The Charity Organisation Society, The Invalid Children's Aid Society, The Mayor's Fund and the Rotary Club have all helped us during the past year; also, in addition, valuable aid has been rendered by the School Care Committees in connection with our children's cases. The Board of Guardians, too, has co-operated with us and helped us in many difficulties that could be solved by no other body. The wise, kindly and practical advice of the Clerk to the Guardians has always been at our service in these difficult and special problems. Although our reports can vary little from year to year, we welcome the opportunity of letting you know a little more about our work, of asking for your help and support, and of reminding you that we are still wanting, working and hoping for developments that will in the future make the great white scourge an evil of the past. We meet each year the same perplexities and troubles which have been dealt with in detail in our previous reports and which we do our best to help. The means of help are added to, slowly certainly, but surely too, we hope. We can report at least, one definite step forward, a cherished project of the Care Committee has this year come into being, namely, a Handicraft Class. In our report for the year 1926 we mentioned this as a possibility. Now it is an established fact. A report of this interesting development will be found elsewhere, and we trust that the perusal of it will enlist the sympathy and support of our readers. During the past year we have operated from the new Health Centre in Harton Street, where our work has been carried out amid comfortable and congenial surroundings. f2 84 Another feature, too, is that under the same roof other phases of the Council's work function, we see the children of our tuberculous patients under the healing rays at the Sunlight Centre, the wives and mothers seeking advice at the Ante-Natal Clinic, and feel that we are not working alone; and the knowledge that the combined results of all of us must in time evolve that dream of the future, a healthy people, gives us courage, and truly we need encouragement in our particularly sad and tragic branch of the work. This year 148 patients have been recommended for treatment and referred to the Care Committee. As usual, each case has been visited and helped to make arrangements to enable them to accept treatment. For the benefit of new readers we must repeat ourselves and remark that "help" generally implies that clothing has been obtained, arrangements made for the care of the children, maintenance of the family, etc. It is with sorrow that we state that some of these 148 patients are no longer alive ; some are still away, others have returned to their home, in some cases such sad and sorry homes where the only cause for surprise is that any member of the family is well and not that one member is ill. For many of our cases we can see no prospect of substantial improvements in conditions during their shortened lives, lack of means being just as an insuperable a bar to a better state of things as dearth of suitable accommodation. Our only hope lies in the thought that the future generation will not suffer in the same way, and to this end we are working. A pleasing feature of Care Committee work is that the welfare of the family in contact with our patient is of matter to us. If any action of ours can help them to escape the danger to which they are unavoidably exposed, then surely can our work be called blessed. A healthy person is such an asset to the State that the duty of keeping them well seems as important, looked at from an economic point of view, as the care of the sick is from a humane standpoint. The latter we know will be always cared for; we are not so sure about the former. In connection with these patients returning from a course of institutional treatment it is noticeable that with many of them careful habits have been acquired, together with a love of fresh air, thus the benefits of sanatorium treatment cannot be said to be confined to the patient alone but benefit those in contact with them at home also. Education is indeed a potent weapon with which to fight this terrible but preventable disease. 85 1,154 visits have been paid to the homes of patients by the Secretary. No friendly visitor need feel unwelcome. One must assume that the foundations of public work and visitation have been well and truly laid in Deptford. There is so little suspicion or mistrust to overcome. 1,087 persons have been interviewed at the dispensary by the Secretary. Perhaps a brief summary of a series of interviews that occurred one morning during this year may illustrate what these figures stand for— (1) Patient recommended to go away for treatment; would not go unless arrangements could be made for the care of five of her children while she was away. Could we advise her? Case was gone into to see if relations or friends could take charge of them; this was impossible and the Guardians were approached. The matter was arranged, and the patient accepted treatment. (2) Patient called to tell us that she was afraid that she would have to undergo an operation, was feeling worried and nervous. A little chat and an expression of sympathy sent her away feeling more cheerful. (3) Relative of patient who was dying at home called to ask if we could provide a bed rest. A depot was telephoned to and arrangements made for the provision of a bed rest the same day at a nominal charge of threepence a week. (4) Mother, with young patient just returned from sanatorium, attended dispensary, interviewed, and enquiries made in order to ascertain whether the mother could provide the girl with sufficient nourishing food. (5) Another patient recommended to go away for treatment referred to us by the Tuberculosis Officer as she would not go away unless arrangements could be made for the care of her young children. This also was a case where there were no relations who could help. The Guardians again came to the rescue and the patient went away. (6) Patient receiving extra nourishment referred by Tuberculosis Officer with renewal form. Order sent to dairy for continuation of grant, and friendly enquiries made as to how she was getting on. (7) Sister of a patient lately returned from sanatorium called and asked us to treat her visit as confidential. Would we call and see patient. She was anxious to return to sanatorium as a maid but would not ask herself. The outcome of this was that at our request the Matron engaged the girl. 86 (8) Mother-in-law of patient called to say that the patient was very ill, but that her husband would not agree to let her be admitted to hospital, and we were requested to see if we could do anything in the matter. An immediate visit was paid, but without results to begin with; but eventually admission to hospital was arranged, and arrangements made for only child to stay with friends. 799 cases have been before the Committee on the agendas, and reported on; cases in which the Committee has been asked to forward a recommendation to the London County Council as to the amount the patient should be asked to contribute towards the cost of treatment, have been carefully considered, and in recommending the amount a unanimous effort is always made to avoid causing hardship. A sad feature on the Agendas is the report of deaths. This year particularly we seem to have lost many old friends, not old, alas, in point of years. Many of them promising young lives. Among them a gifted artist whose talent was discovered accidentally during treatment in sanatorium, who, through the Committee, had a period of training in an art school on his return home. At the expiration of a year's course, work in a studio was found for him. Unfortunately his health gave way again, and after a further period of treatment and many weary months in bed at home he passed away at the age of 25 years. We would not have readers feel that this big effort on the part of the Committee and the patient was fruitless, he had at least a period of very real happiness and fulfilment, and has left behind some beautiful little specimens of the work he loved so much. The London County Council's boarding-out scheme has been as useful as ever to us during the past year. No reasonable application for the removal of a child or children from a home where a patient is dying has been refused. There is little delay in getting them away, and their return is as unhurried as their departure is speedy. Twelve children were accepted by the Council this year ; in three cases parents withdrew their consent after acceptance, leaving nine children placed. It is with regret that we have to report the loss of one of our members by death. Miss Williamson will be greatly missed; she was a most consistently regular attendant at our meetings and was keenly interested in the work. 87 We as usual append a brief history of a few of the cases assisted during the year. (1) A patient was unable to get about otherwise than in a bath chair of her own which she put to considerable use. Repairs to this became necessary which could not be carried out owing to lack of means. A grant was obtained for this purpose; arrangements were made for another patient (for whom a grant had been obtained to set him up as a tool smith) to do the work, and the chair has been in constant use since. (2) Patient found to be short of bedding. A gift of warm blankets obtained. (3) Young girl of 18 returned from sanatorium in an infectious state ; only available sleeping accommodation at home was a bed shared with two sisters. Girl was very ill and could not be induced to stay away from her mother any longer. Bed and bedding was obtained, an empty room became available through a lodger leaving, and the girl was made comfortable at home. The Council was asked to board out a younger sister who remained away until after the patient's death. (4) Patient, a married woman with two children, refused treatment, obviously in a distressed nervous state. Friendly questioning by the Committee finally brought her trouble to light. She was in debt to a moneylender to the extent of £8 13s. 6d., and was being pressed for payment; out of a totally inadequate household allowance from her husband of £1 14s. a week she was trying to pay back a debt at rate of 5s. a week, she herself often going without food to do so. She had commenced to borrow about four years ago when one of the children was ill and added to the debt when domestic emergencies arose. Enquiries were made and personal references obtained from responsible people who had known her for years, who spoke most highly of her character. A member of the Committee interviewed the moneylender and arranged that if the sum of £5 5s. was paid down the debt would be counted as cleared and a receipt in full given. A big effort was made and this amount collected from various sources. The woman went away with an outfit of clothing obtained from a further source and returned home improved in health to start afresh clear of debt for the first time for years. And a gratifying feature of this case is that on her return her husband took over the burden of managing the money 88 from her (which means that he has considerably less pocket money). There is a new understanding in the home which makes for increased happiness. These are only a few of the many cases we have been privileged to help. We have had a very fair share of space and generous as our M.O.H. is, we must not encroach further. We would like to express our regret that he will not be here to call us to order next year. The Care Committee will lose a friend, and what the friendship and co-operation of the M.O.H. means to a Care Committee, well, this perhaps only a Care Committee worker can fully realize. We will simply say that we shall miss him, and we wish him well in his new and important work. Many more elaborate compliments will be paid to him, but not any more real. B. Lewellin. Our Tuberculosis Handicraft Centre. Report by Miss E. Malcolm Forth, Instructress. Reports, apparently favourable, of the work done in my evening institute class at Morden Terrace, Lewisham, came to the ears of a member of the Borough of Lewisham Tuberculosis Care Committee. During recent years the arts and crafts movement has been quietly growing in importance, and the work done in the London County Council classes counts for much more, artistically speaking, than the mild "handwork" that used to be recommended for them. So that when the member of committee came to see me I was able to show her some sound work, and to tell her that she could use the London County Council organisation to commence what seems to have been a dream of some years among borough tuberculosis workers, the use of handicrafts as a curative treatment for their patients. I was glad that 1 was able to take the first class of the kind, because my experience during the war, when I was prescribed as a treatment for shell-shock cases, and the number of my students since who have told me that they have come to my classes because of a doctor's advice, to take their minds off themselves and their nervous 89 and other troubles, and the good results thereafter following, told me that here was a great field of usefulness, and my imagination was fired. The experiment has been justified by its success. By this time, in none of the three classes which I teach, do I remember that I am teaching sick people. Lewisham students have their own way of expressing their contentment. For two years they were the show class and were inspected, examined and ceremonially visited by every possible authority, I should think, in London, so that now even a Royal visit would not unduly agitate us. The students were continually bringing me little newspaper cuttings. We were in the papers again. I know that for the members of this group life without Monday morning arts and crafts class would be more than incomplete. At Deptford and Greenwich, where the workrooms are larger and therefore more suggestive of a workshop, a low whistle often fills the air, the whistle of men contentedly working. One imitates exactly the blackbird's note. "Turn out that blackbird," I say, but I really do not mean it. It may mean spring and new life, here indoors, as well as outside. Oh yes! there are women in the class as well. They show their satisfaction by busily-moving fingers, and happy little conversations among themselves. They work at several different crafts, leatherwork, glove-making, leather flower-making, stool-seating with sea grass, cane-edged trays and fruit baskets, raffia-work, embroidery of the peasant variety, etc. I have a list of over twenty possible occupations. Some take kindly to one thing, some to another, but we never have a downright failure. Something useful and not too uncomely is always produced. Leather-work is the most popular, because it gives the greatest artistic scope, and the results are the most useful. It is also the most expensive, but not nearly so expensive as people think. The absolutely necessary tools are not nearly so numerous as the text-books lead one to suppose, and if the materials are notxheap, the finished articles are worth a good deal more. And we have found it can be disposed of, and the work made to pay its own way. Here may I quite plainly say that there is no idea of teaching these people a "trade." The terms of my engagement with the London County Council forbid me from encroaching in any way at all upon the realms of "trade." With the money side I may have nothing whatever 90 to do, nor any other instructor like me. I do, however, expect my students to work to a very high standard, so that their work placed side by side with a trade article, may satisfy the "man in the street" by its equally fine finish, and at the same time have that something more which only the hand-made article can have. If their work is disposed of, it is privately, in the same way as the artist and art craftsman disposes of his to his patrons, a field apart from trade. With the help of a businesslike and enthusiastic voluntary worker (an absolute necessity if these classes are to run properly), the work can be made to justify itself financially. All the work sent to the last Imperial Institute Show and Sale was sold, and all the men received stars, and the excellent finish of their work was favourably commented upon. Several of them have a useful little connection of their own in their private circles. E. Malcolm Forth. 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 1928 was five. Mortuary Report for the year ended 31st December, 1928. Bodies Received, etc. Total. Male. Female. I nquests. Postmortems. Under 1 year of age. Unknown. Deposited to await burial only. I nfectious. 248 149 99 228 153 35 13 2 2 In 18 instances post mortem examinations were made by order of the Coroner, who then issued certificates without holding inquests. 15 bodies were detained after inquests to await burial owing to lack of accommodation at the homes, and 7 owing to advanced decomposition. Two infectious bodies were admitted to the Mortuary to await burial, by order of the Medical Officer of Health. 91 Districts of which deceased persons were residents. Deptford 91 Poplar 3 Greenwich 29 Fulham 1 Lewisham 31 Gerrards Cross, Bucks 1 Camberwell 7 Twickenham 1 Bermondsey 41 Winchmore Hill 1 Woolwich 23 Sweden 2 Sidcup 2 Unknown 14 Bromley 1 CANCER. Year No. of Deaths Year No. of Deaths 1922 146 1926 159 1923 140 1927 170 1924 148 1928 152 1925 164 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 to 75 years 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 1928 — — — 18 60 46 28 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 1928 Male - 7 38 20 11 76 Female - 11 22 26 17 76 Total - 18 60 46 28 152 92 MATERNITY AND CHILD WELFARE. Summary of Work of Health Visitors. The work done by the health visitors is summarised in the following Table:— 1st visits Re-visits Total Births 1810 5585 7395 Still Births 44 — 44 Infant Deaths under 1 year 109 — 109 Infant Deaths, 1 to 5 years 57 — 57 Expectant Mothers 587 210 797 Ophthalmia Neonatorum 19 29 48 Measles 2195 1649 3844 Infantile Diarrhœa 108 62 170 Scabies in Children 8 4 12 Verminous Children 5 1 6 Puerperal Fever 9 — 9 Puerperal Pyrexia 5 — 5 Pneumonia 46 56 102 Miscellaneous 437 42 479 Unsuccessful visits 632 466 1098 Scarlet Fever recoveries 205 33 238 Encephalitis lethargica 1 8 9 Poliomyelitis 1 1 2 Erysipelas 3 — 3 Diphtheria 1 1 2 Cerebrospinal meningitis 2 — 2 Visits to-families in flooded area 73 — 73 Totals 6,357 8,147 14,504 In addition to the above visits, the Health Visitors spent in all 572 afternoons at sessions of the Infant Welfare Centres and 51 mornings at sessions of the Ante-Natal Clinic; 34 attendances were also made at Dental Clinics, 37 at Schick test and inoculation sessions, and 19 to Light Treatment sessions. 213 "Test Feeds" were conducted at the Town Hall. Feeding.—In the 1,810 births visited it was found that 1,654 infants were being breast fed and 63 partly breast fed. Only 93 were entirelv hand fed. Births Notified, Yean 1928. Ward. Births Notified, Alive. Dead. By whom Notified. Total. Male. Female. Parent. Doctor. Midwife Other Person. Canterbury 140 76 64 137 3 8 45 87 - Clifton 114 56 58 111 3 3 28 81 2 Deptford Park 98 49 49 96 2 2 48 48 — Evelyn 149 72 77 146 3 6 46 96 1 Hatcham 81 40 41 80 1 7 21 53 — Pepys 67 36 31 63 4 12 28 27 — St. Catherine's 48 24 24 47 1 10 18 20 — St. John's 83 45 38 83 — 5 16 62 — St. Paul's 243 126 117 239 4 6 29 208 — St. Peter's 337 180 157 334 3 9 12 315 1 Town Hall 80 40 40 78 2 6 23 51 — Vale 144 79 65 142 2 5 41 96 2 1584 823 761 1556 28 79 355 1144 6 93 Milk supplied to Necessitous Mothers and Children During the year 7,520 applications were received and were dealt with as follows:— Granted free 6889 ,, at half-price 596 Refused (over scale) 35 7,520 Dried Milk, Virol, &c. The following amounts of dried milk, &c., were distributed to the mothers attending the Infant Welfare Centres, during the year 1928:— Ambrosia 3,115 1 lb. packets Cow and Gate 1,944 ,, Glaxo 473 ,, Lactagol 88 tins Trufood 1,331 1 lb. tins Virol 14 28 lb. tins Radio Malt 358 tins Maternity Home. Particulars of cases admitted during the year 1928:— Cases in Home on 1st January, 1928, 8. Cases admitted, 261. Average stay, Two weeks. Cases delivered by midwives, 256. ,, ,, ,, doctors, 5. Cases in which medical advice sought, 91. (a) Ante-natal, 4. (b) During labour, 6. (c) After labour, 1 (Eclampsia). (d) Stillbirths, 3. (e) Fœtal deaths, 5. (f) Influenza, 1. (g) Sutures, 71. Cases notified as puerperal sepsis, Nil. Temperature rose above 100.4 for 24 hours, 1 (Influenza). Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Inflammation (eyes), Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. 94 Ante-Natal Clinic Statistics, 1928. Attendances during the years:— Number on Register 815 New Cases 692 Total Attendances 2,777 Normal pregnancies 228 Anaemia 47 Albuminaria 36 Ante-partum haemorrhage 5 Bronchitis 3 Cyst of Bartholini 3 Chorea 2 Dental caries only 118 „ ,, with other defects 97 Dyspepsia 14 Fibroids 4 Glycosuria 6 Haemorrhoids 25 Hydramnios 10 Leucorrhœa 6 Lupus 1 Malpresentations 12 Morbus Cordis 26 Nipples, deformed 23 Oedema 21 Pyelitis 2 Pruritis 6 Phthisis 2 Contracted pelvis 12 Prolapse 1 Psoriasis 2 Retroversions 2 Sciatica 4 Twins 3 Varicose veins 63 External version 8 Surgical Tuberculosis 4 Excessive vomiting 21 95 Referred to Hospital 80 Letters to doctors in private practice 23 ,, Tuberculosis Officer 1 ,, midwives 30 Post-natal examination 9 Not pregnant 30 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 seven Infant Welfare Centres there are voluntary workers whose services are prized by the Council and officers. In September, 1928, a fresh Infant Welfare Centre was established at St. George's Hail, Shardeloes Road, with the object of relieving the pressure at the Goldsmiths' College Centre. 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 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. 96 Attendances at Clinics and Treatment Centres. gosterwood street clinic. 1928 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 12 2 2 16 156 172 110 February 4 13 13 236 249 108 March 4 11 1 12 208 220 99 April 4 12 1 13 193 206 96 May 3 7 2 9 140 149 65 June 4 19 6 3 28 235 263 125 July 4 13 3 3 19 277 296 155 August 4 7 1 1 9 166 175 79 September 4 12 1 13 244 257 111 October 4 10 1 1 12 227 239 103 November 4 14 1 15 255 270 118 December 4 11 1 12 216 228 100 Total 47 141 2 16 12 171 2553 2724 1269 NAPIER STREET CLINIC. 1928. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. . Ages 1—5 January 4 15 1 3 2 21 288 309 121 February 4 5 3 8 243 251 109 March 4 9 1 1 11 221 232 95 April 4 5 2 4 1 12 156 168 72 May 3 4 3 3 2 12 167 179 88 June 4 15 1 1 17 197 214 88 July 4 12 2 1 3 18 266 284 147 August 4 8 2 10 150 160 79 September 4 15 1 1 17 238 255 128 October 4 14 1 3 3 21 368 389 156 November 4 7 3 1 2 13 289 302 143 December 4 1 1 1 3 169 172 96 Total 47 110 14 21 18 163 2752 2915 1322 97 BESSON STREET CLINIC. 1928. 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 14 1 1 16 258 274 128 February 4 10 2 3 2 17 277 294 118 March 5 11 6 17 295 312 138 April 3 12 2 1 15 215 230 95 May 4 10 1 1 12 244 256 110 June 5 15 3 18 338 356 156 July 4 17 1 1 4 23 258 281 105 August 5 16 1 5 22 346 368 145 September 3 7 1 8 235 243 84 October 5 12 3 15 421 436 171 November 5 2 3 5 341 346 126 December 3 6 1 1 8 179 187 77 Total 50 132 8 14 22 176 3407 3583 1453 ERLAM ROAD CLINIC. 1928. 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 3 12 181 193 98 February 5 13 1 14 218 232 119 March 4 6 1 7 142 149 85 April 3 10 1 1 12 125 137 68 May 5 12 12 183 195 93 June 4 9 2 1 12 182 194 85 July 4 7 7 198 205 87 August 5 9 1 10 219 229 87 September 4 3 3 2 8 172 180 72 October 4 8 1 9 214 223 98 November 4 2 1 5 8 191 199 88 December 3 116 116 55 Total 49 88 6 7 10 111 2141 2252 1035 G 98 GOLDSMITHS COLLEGE CLINIC. 1928. 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 22 7 7 36 408 444 154 February 4 18 3 4 5 30 394 424 156 March 5 17 2 6 2 27 472 499 175 April 3 21 4 4 4 33 282 315 115 May 5 28 1 1 4 34 533 567 182 June 4 27 1 2 2 32 463 495 153 July 4 16 3 2 1 22 469 491 147 August 5 25 3 5 4 37 604 641 189 September 4 22 6 3 31 480 511 161 October 4 8 1 6 15 301 316 115 November 5 8 1 1 2 12 333 345 141 December 3 7 1 8 182 190 73 Total 50 219 18 39 41 317 4921 5238 1761 HALES STREET CLINIC. 1928. 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 12 1 2 15 203 218 126 February 4 12 1 13 191 204 71 March 5 10 1 4 6 21 196 217 140 April 3 8 2 10 111 121 79 M ay 5 11 4 2 8 25 229 254 166 June 4 14 2 3 19 191 210 120 July 4 13 2 1 16 174 190 102 August 5 7 1 1 9 205 214 69 September 4 17 2 1 2 22 166 188 64 October 3 12 3 15 191 206 98 November 5 9 1 1 11 266 277 147 December 3 5 1 6 133 139 59 Total 49 130 8 17 27 182 2256 2438 1241 99 ST. GEORGE'S HALL CLINIC (Opened September 28th). 1928. 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 September 1 2 1 3 50 53 14 October 4 14 1 2 2 19 361 380 129 November 5 17 1 5 23 359 382 148 December 4 4 1 1 6 173 179 69 Total 14 37 1 5 8 51 943 994 360 *These cases were transferred from Goldsmiths' Centre. 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. 1228 Miss Robus Visits .. .. 1228 .. .. .. Revisits .. .. 1381 .. .. .. 1381 Total .. .. 2609 .. .. .. 2609 Miss Smart Visits .. 930 .. .. .. .. 930 Revisits .. 369 .. .. .. .. 369 Total .. 1299 .. .. .. .. 1299 Miss Stowell Visits .. .. .. 930 .. .. 930 Revisits .. .. .. 1845 .. .. 1845 Total .. .. .. 2775 .. .. 2775 Miss Reynolds Visits .. .. .. .. .. 1217 1217 Revisits .. .. .. .. .. 1668 1668 Total .. .. .. .. .. 2885 2885 Miss Fudge Visits .. .. .. .. 777 .. 777 Revisits .. .. .. .. 1703 .. 1703 Total .. .. .. .. 2480 .. 2480 Miss Little Visits 1275 .. .. .. .. .. 1275 Revisits 1181 .. .. .. .. .. 1181 Total 2456 .. .. .. .. .. 2456 Total Visits 1275 930 1228 930 777 1217 6357 Revisits 1181 369 1381 1845 1703 1668 8147 Total 2456 1299 2609 2775 2480 2885 14504 G 2 100 Maternity Home—Cases not Admitted. One hundred applications were not acceptable, owing to the Home being fully booked for the period desired. One case was refused on medical grounds. Invariably the applicant was advised as to the best steps to take. SUNLIGHT TREATMENT CENTRE. Report for the Year 1928. Month New Patients Patients Readmitted Patients Discharged Total on Register Attendance January 17 1 11 82 657 February 18 1 21 80 680 March 29 3 34 78 661 April 18 5 25 76 509 May 25 11 20 92 621 June 24 5 36 85 692 July 8 1 59 35 419 August — — — — — September 15 1 11 40 257 October 30 3 5 68 473 November 32 8 16 92 604 December 13 5 11 99 405 Total 229 44 249 99 5,978 Classification of Patients on Treatment during the year 1928. Rickets 52 Talipes 1 Malnutrition 54 Curved Tibia 2 Anaemia 95 Post Measles 10 Cervical Adenitis 9 Sleeplessness 2 Muscular Weakness 40 Chronic Catarrh 1 Delayed Dentition 40 Post Pneumonia 2 Chronic Cough 3 Nervousness 1 Debility 16 Pulmonary Catarrh 1 Anorexia 2 Catarrhal Jaundice 1 Bronchitis 10 Mastoid 2 Total 344 INDEX A PAGE Acute Anterior Poliomyelitis 32 Acute Influenzal Pneumonia 29 Acute Primary Pneumonia 29 Ambulance Facilities 39 Ante-Natal Clinic Statistics 94 Ante-Natal Work 6 Area of Borough 16 Artificial Stone Manufacturers 63 Asphalte Manufacturers 63 Attendances at Clinics 96-99 B Babies' Home, Albury Street 90 Births 16 „ illegitimate 18 Birth-rate 17 Births Tables 17 By-laws, List of 43 c Canal Boats Act, Inspector's Report 57, 58 Cancer 91 Cerebro-spinal Fever 31 Chemical Works 66 Childbirth Deaths 6, 30 Clinics, List of 40 Closet Accommodation 46 D Deaths 18-24 „ Infants 20, 24 ii. D—continued. PAGE Deaths Causes of, Table 23 „ in Wards 19 „ Infectious Diseases 28, 33 Death Rate 18 Density of Population 16 Diarrhoea and Enteritis, Deaths 31 ,, „ Table 21 Diphtheria 28 „ Schick Test 29 Disinfection 35-38 Dried Milk, Supplied at Centres 93 Dysentery 32 E Encephalitis Lethargica 32 Enteric Fever 29 F Factories and Workshops, Tables 60-62 Factories, Inspections of, Special Reports 63 Food and Drugs,Tables of Samples 55-56 ,, Prosecutions 57 Foundry 62, 70 G Gramophone Record Makers 65 H Health Services, List of 38-42 Health Visitors, Summary 99 Hospital Disposal of Cases, Table 32 House-to-house Inspections, Lists 50-53 Housing 53-54 „ Sleeping accommodation in tuberculous cases 81 Home Workers, Table 62 iii. I PAGE Infant Mortality 20 ,, of Illegitimates 20 „ Rates for 10 years, Table 21 ,, Table of Causes of Death 24 ,, in Wards 20 Infant Welfare Centres 96-99 Infectious Diseases, Control of 28-39 ,, Deaths, Table 33 „ Cases Notified, Table 26-27 L Laboratory Work 42 Legal Proceedings 49 „ Food and Drugs 57 M Malaria 31 Marriages 18 Maternal Mortality 6 Maternity Home 6,93 „ Cases not admitted 100 Measles 31 Milk and Dairies Order, 1926 54 ,, and Dairies Consolidation Act 54 „ for Necessitous Mothers and Children 93 Mortality Statistics 13, 18-24 Mortuary Report 90 N Non-Pulmonary Tuberculosis 73 o Ophthalmia Neonatorum 30 iv. P PAGE Persons per Dwelling 13 Pneumonia 29 Population 13, 16 ,, in Wards 16 Poliomyelitis 32 Professional Nursing 41 Puerperal Fever 30 „ Pyrexia 30 Public Health Dept. Administration, cost of 13 Pulmonary Tuberculosis Deaths 72 R Rateable Value 13 Remedy of Sanitary Defects 47-49 Rope and Cord Factory 67 R Sanitary Administration 46 „ Inspectors' Work 46 ,, ,, Tables 47-49 Scarlet Fever 28 Schick Test and Inoculation against Diphtheria 29 Scholars, Illness of 35 Shelter 35 Sign Manufacturers 68 Smallpox 28 Social Conditions 16 Separate Occupiers 13 Sputum, Examinations of 42 Sunlight Treatment 7,100 T Treatment Centres 40 Test Feeds 92 Toy Factory 67 v. T—continued. PAGE Tuberculosis 9, 70-90 „ Care Committee, Secretary's Report 83-88 „ Dental Work 80 „ Home accommodation 81 „ and Disinfection 73 „ New Cases 72 ,, Notifications and Deaths 72 „ Non-Pulmonary 73 ,, Notifications Table 71 ,, Dispensary Patients' Deaths 80 ,, Statistics for Dispensary 74-79 ,, Revision of Register 73 ,, and Medical Practitioners 80 Handicraft Centre 88-90 U Ultra-Violet Rays Centre 7, 100 V Vaccination, Table 34 Vital Statistics, Summary of 13 Table 22 w Workshops, Tables 60-62