ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY F. LEONARD KEITH, M.D., D.P.H., L.D.S., Medical Officer of Health. 1929 DEPTFORD: Gaylard & Son, 440 New Cross Road, S.E. 14 Public Health Committee. Mayor. Alderman W. TAYLOR, J.P. Chairman. Councillor Mrs. G. E. GREEN. Oice=Dhaicman. Councillor E. C. WOOD. Councillor Mrs. E. M. Bateman Councillor Mrs. B. M. Drapper, J.P. Councillor W. H. Green, J.P., L.C.C. Councillor Mrs. M. Herliby Councillor J. G. Hicks, J.P. Councillor A. G. Howard Councillor T. Nugent Councillor Mrs. K. M. Shade Councillor Mrs. G. Tiffen, J.P. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. M. Herlihy Vice -Chainnan. Councillor Mrs. K. M. Shade Councillor Mrs. E. M. Bateman Councillor A. J. Boyd Councillor Mrs. A. A. Cheasor Councillor Mrs. B. M. Drapper, J.P. Councillor Mrs. G. E. Green Councillor W. H. Green, J.P., L.C.C. Councillor T. Portway Councillor Mrs. G. Tiffen, J.P. Councillor Mrs. L. E. White Metropolitan Borongh of Deptford. Public Health Department, Deptford Town Hall, S.E. 14. 14th May, 1930. To 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 first Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. Before doing so, I should like to allude to the great loss the Borough has sustained by reason of the departure of my predecessor, Dr. Charles S. Thomson, who vacated office in order to fill the important position of Superintendent Medical Officer of Health to the City of Belfast. In endeavouring to assess the health of a District, it is customary to take into account certain statistics, and it may be, perhaps, apposite that I should draw your attention to certain points which merit special consideration. The birth-rate, although showing a fractional increase over the figure for 1928, still remains at the low level it has now exhibited for some years, while the death-rate shows a 10 per cent, increase over the corresponding figure for the previous year. Too much stress need not be laid upon the actual increase in the death-rate which, although to some degree due to the influenza epidemic experienced in the early months of the year, is also associated with the fact that a greater number of persons reach the higher age-groups in which the percentage mortality is correspondingly high. What emerges, however, from a consideration of these rates, is that the natural increase or excess of 6 births over deaths is now reduced to a level which suggests in the future a population which, numerically, may become either stationary or only slowly progressive. As a sensitive index of the public health, the death-rate of infants under one year of age is sometimes referred to. In this connection it is somewhat disturbing to note that the raised infantile death-rate in 1928 was maintained, during 1929, at exactly the same level. Infectious disease, as exemplified by Scarlet Fever and Diphtheria, although showing a numerical increase, remained of the mild type experienced in recent years. The maintenance of a sanitary environment, whether in the workshop or the home, is a matter of paramount concern. The part of my Report, although necessarily abridged, dealing with the work of the Sanitary Inspectors shows the variety of duties undertaken and the volume of work accomplished. The sophistication of food, judged by the Reports of the Public Analyst, is not a serious matter in the Borough while, in regard to food, the soundness of which is considered suspect, Traders co-operate with the Inspectorial Staff by seeking their opinion before exposing such for sale. The housing shortage is too well known to need stressing : accommodation, especially for those persons living under overcrowded conditions, and at rentals within their capacity to pay, is urgently required. The standard of housing in respect of some of the existing property is not a high one, and its maintenance in a habitable condition can be secured only at the price of eternal vigilance on the part of the Sanitary Inspectors. In the correlation, recording and statistical presentation of the work of the Out-door Staff, there has been a large increase of work devolving upon, and efficiently carried out by, the clerical staff, under the very capable supervision of Mr. Chapman. In conclusion, I desire to express my gratitude to the Committee lor their collective and individual support: to Dr. Donnelly and 7 Dr. Hill and to the Staff generally my thanks are due for their loyal assistance. I acknowledge, gratefully, the ever-ready co-operation of my colleagues in other Departments, while I desire to record my indebtedness upon many occasions to the Town Clerk who, with broad vision and understanding, coupled with intimate knowledge of Local Government, has helped me with his counsel and advice in many difficulties. I remain, Your obedient Servant, F. Leonard Keith, Medical Officer of Health. Physical Features and Vital Statistics. 10 Physical Features. The Metropolitan Borough of Deptford, as constituted by the London Government Act, 1899, is situated to the south of the Thames, being bordered, roughly, on the north by Bermondsey, on the south by Lewisham, while Caniberwell and Greenwich lie to the west and east respectively. A small portion, roughly half a mile long, fronts the river. Roughly rectangular in shape, its greatest length is approximately two-and-a-half miles, and width one-and-a-half miles. The altitude presents considerable variation, much of that portion of the Borough to the north of New Cross Road and Queens Road being, on an average, only 15 feet above mean sea level, while the rest of the Uorough shows an altitude varying from 80 feet to 160 feet at Telegraph Hill. The soil varies, parts showing London clay formation, other being of a more alluvial character. The area of the Borough is given as 1,564 acres, but this for effective purposes is considerably encroached upon by reason of the Surrey canal and various railway lines which traverse the district. Statistics. Area 1,564 acres Population: Census 1921 112,534 Estimated mean Annual population, 1929 111,000 Number of inhabited houses (1921) 18,122 Number of families or separate occupiers (1921) 28,007 Rateable Value (1929) £679,847 Estimated sum represented by a Id. (District) Rate £2,797 The permanent open spaces are as follows:— Situation. Size. Maintained by. 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Ground. Brook mi 11 Road li acres Borough Council. 3. Telegraph Hill Recreation Ground. Telegraph Hill 45i acres L.C.C. 4. Railways and adjoining land. 234 acres 5. Millwall Football Ground. 5½ acres 6. Canals 8 acres 7. St. Paul's Churchyard 2.2 acres 8. Reservoir 1 acre 11 Social Conditions and Chief Occupations of the Population. Deptford, although in parts inhabited by persons financially comfortably situated, is essentially an industrial and working-class borough. Unemployment and under employment is common and the standard of life for many is, consequently, far below that which one would like to see. The housing shortage necessitates many of the inhabitants living under badly-Overcrowded conditions and, even where overcrowding does not exist, the unavoidable practice of letting, to iwo or more families, houses originally constructed for only one family creates great hardships to the occupiers. Incidentally, it causes still further deterioration of property already far from being in a structurally good condition. Education facilities in respect of elementary, secondary and technical education are well provided, while the Borough Council has made a valuable contribution in establishing a Central and Branch Library, and arranging for the opening of another Branch Library. Swimming pools with chlorination plants to ensure cleanliness of the water, slipper baths and washhouses are maintained by the Borough Council and are largely used. The chief industries are those associated with the metal trade, stone and slate works, paper works, tarpaulin making, spinning and sackmaking. The last census returns showed that the chief occupations pursued by the population, stated by sex, were in descending order as follows:— Males. Females. Labourers, including dock labourers. Domestic servants and charwomen. Shop assistants. Shopkeepers and business employees. Sempstresses. Teachers. Warehousemen. Packers and labellers. Drivers of lorries, vans, etc. Clerks. Fitters, tool-setters, and millwrights. Waitresses. Miscellaneous:—Milliners, telephone Engineers. operators, etc. Carpenters. Miscellaneous:—Porters, engine drivers, etc. 12 It is apparent from a consideration of the foregoing statement, that, assuming the nature of the occupations followed not to have materially altered, the bulk of the population is engaged in work for which remuneration stands at a comparatively low figure. As Public Health is intimately associated with Social Welfare an endeavour has been made to obtain information, admittedly incomplete, of the number of persons registered as unemployed or in receipt of relief from the Guardians. The following figures have been kindly supplied to me by the Manager of the Deptford Employment Exchange:— Number of unemployed at 31st December, 1929:— Men, 3,826. Women, 601. Juveniles, 194. I am indebted to the Clerk to the Greenwich Board of Guardians for the following figures:— (a) Total number of Deptford residents, including wives and children, on outdoor relief during the week ended 28th December, 1929 : Unemployed 2,776 Ordinary 3,142 5,918 (b) Amount expended on outdoor relief in Deptford during 1929: £99,250 16s. 8d. A further index of the economic position is afforded by the details of the incomes of persons receiving milk through the Council's scheme. Analysis of the applications made in December showed that the number of persons granted milk was 441. Of these, 413 persons were in receipt of a wage which, after deduction of rent, left less than 7s. 6d. per head in the family in the case of a further 28 persons, the same conditions being observed, the amount per head varied between 7s. 6d. and 10s. 6d. During the whole year 8,406 applications for fortnightly supplies were granted. Of this number, 7,778 applications were in respect of families in receipt of an income after deduction of rent, of less than 7s. 6d. per head per week, and in the remainder the amount varied from 7s. 6d. to 10s. 6d. Figures dealing with the number of births and deaths and the mortality from certain specified diseases serve as a rough index of the 13 health of a community, and the following extracts from the vital statistics is of interest in this connection : Male. Female Total. Birth-rate. Births Legitimate 931 873 1,804 16.8 Illegitimate 29 27 56 Death-rate. Deaths 13.3 Number of women dying in, or in consequence of, childbirth: From Sepsis 1. From other causes 1. Deaths of infants under one year of age, per 1,000 births: Legitimate 73 Illegitimate 161 Total 76 Deaths from Measles (all ages) 6 ,, Whooping Cough (all ages) 16 „ Deaths from Diarrhoea (under 2 years) 17 Population. The population for 1929 as estimated by the Registrar-General was 111,000. The main increment in life is from the excess of births over deaths, immigration having little and emigration only a moderate effect locally. After deducting from the total area of the Borough the space which is non-effective for the purpose of calculating the density of the population, such is found to be equivalent to 89 persons per acre. No attempt has been made to allocate the population according to wards, for an attempt to do so is founded upon an essentially uncertain premise inasmuch as, not only is the total population an "estimated" one, but there is no knowledge available as to the extent to which a movement of the population between wards takes place. Marriages. During the year 921 marriages took place, equivalent to a rate of 8-3 persons marrying per 1,000 of the population. By courtesy of the Superintendent Registrar the following gives details as to the places in which these marriages were conducted: Church of England 620 Other places of worship 69 In the Superintendent Registrar's Office 232 14 Births. The steadily-declining birth-rate in the country, generally, has its counterpart in Deptford. After allowing for inward and outward transfers, i.e., the addition of 448 children born of Deptford parents outside the Borough, and the deduction of 70 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,860. This is equivalent to a birthrate of 16-8 per 1,000 of the population and the second lowest on record. Owing to a slowing in the decline of the death-rate this reduced birth-rate represents only a natural increase of 3-5 per 1,000 of the population and suggests the possibility, in a few years time, of a population numerically either only slowly progressive or stationary. The following table illustrates the steady fall that has taken place BIRTHS. No. Deptford. Crude rate per 1,000 population. England and Wales. Crude rate per 1,000 population. County of London. Crude rate per 1,000 population Average for 10 years, 1915 to 1924 2610 22.9 20.0 20.5 1925 2175 18.8 18.3 18.0 1926 2108 18.2 17.8 17.1 1927 1908 16.8 16.7 16.1 1928 1827 16.3 16.7 16.2 1929 1860 16.8 16.3 15.9 Distribution of Births registered by sex, Legitamacy and Wards. Ward. Males. Females. Legitimate. Illegitimate Total. Deptford Park 69 78 143 4 147 Evelyn 112 96 205 3 208 St. Paul's 120 135 248 7 255 Vale 98 77 170 5 175 Clifton 90 79 163 6 169 Canterbury 72 73 140 5 145 Hatcham 84 60 141 3 144 Pepys 60 57 115 2 117 St. Catherine's 59 43 98 4 102 St. Peter's 51 67 113 5 118 St. John's 74 68 133 9 142 Town Hall 71 67 135 3 138 Whole Borough 960 900 1804 56 1860 Live births notified in the Borough 1,495 15 Illegitimacy. The number of illegitimate births was equivalent to 3-0 per cent, of the total births. These were allocated to the several wards as follows: Deptford Park 4 Hatcham 3 Evelyn 3 Pepys 2 St. Paul's 7 St. Catherine's 4 Vale 5 St. Peter's 5 Clifton 6 St. John's 9 Canterbury 5 Town Hall 3 The figures relative to illegitimacy for previous years areas follows: Av. for 10 yrs. 1915-1924. 1925 1926 1927 1928 1929 No. of illegitimate births 77 61 54 52 69 56 Percentage of total births 2.9 2.8 2.6 2.7 3.7 3.0 Notification of Birth. Registration of birth is compulsory within six weeks of birth, but, being frequently delayed until towards the expiry of that period, it would follow that, were this the only source of information of the birth the Council had, their Health Visitors would be unable to supervise the health of these children at a period when the rate of infantile mortality is the highest. Hence this has been obviated by the Notification of Births Act, 1907, which provides for the notification to the local Medical Officer of Health of all births and all still-births occurring after the 28th week of gestation. Interchange of notifications in respect of children of Deptford mothers born outside the Borough, and of mothers from other boroughs confined in Deptford, is provided for. During 1929, the number of births to Deptford mothers (after allowing for inward and outward transfers) was registered as 1,860, and the number of notifications received was 1,495. 16 The following is an analysis of these notifications: Births Notified in the Borough during Year 1929. Ward. Births notified. By whom notified Total Male Femalie Alive Dead Parent Doc tor - Midwife Other person Deptford Park 98 48 50 97 1 6 56 36 Evelyn 147 82 65 145 2 8 45 94 St. Paul's 246 122 124 242 4 5 20 221 Vale 131 72 59 129 2 11 27 93 Clifton 110 56 54 108 2 5 35 70 Canterbury 113 54 59 111 2 4 41 67 1 Hatcham 95 53 42 93 2 5 20 70 Pepys 48 25 23 48 — 5 16 27 St. Catherine's 45 28 17 45 — 9 15 21 St. Peter's 336 175 161 330 6 14 14 307 1 St. John's 71 35 36 71 — 7 13 51 Town Hall 77 41 36 76 1 5 18 54 Totals 1517 791 726 1495 22 84 320 1111 2 Deaths. In order to express the number of deaths as a death-rate applicable to the Borough, it is necessary to make allowance in respect of deaths of persons occurring within, but belonging outside the Borough, and, conversely, for those who died while temporarily living outside Deptford. Total deaths registered in the Borough 830 Deduct deaths of "non-residents" 139 691 Add deaths of "residents" outside Borough 790 Nett deaths applicable 1,481 This is equivalent to a death-rate of 13.3 per 1,000 persons, an increase of 10-8 per cent, over the figure of 1928. To some extent this is due to the epidemic of influenza in the early part of the year, and to the severe weather at that time, to which causes has been attributed the increased death-rate in the country generally. This increase is shown by a comparison of the deaths occurring in the several quarters of the years 1928 and 1929. 17 Seasonal Mortality. Quarter ended. No. 1928 Rate per 1,000 of population. No. 1929 Rate per 1,000 of population. March 383 13.6 596 21.5 June 333 11.9 322 11.6 September 330 11.7 234 8.4 December 308 11.0 329 11.9 The trend of the death-rate in recent years is shown by the following table:— Deptford. England & Wales. London. Year. No. Rate per 1,000 of the population. Average for 10 years, 1915-1924 1560* 14.1 13.6* 13.9 1925 1399 12.1 12.2 11.7 1926 1302 11.3 11.6 11.4 1927 1312 11.5 12.3 11.9 1928 1354 12.0 11.7 11.6 1929 1481 13.3 13.4 13.8 *Civilian population only from 1915-1920. Deaths—Sex and Ward Distribution. Ward. Males. Females Children under 1 year. Total deaths Deptford Park 55 33 15 88 Evelyn 85 69 13 154 St. Paul's 96 99 31 195 Vale 77 63 13 140 Clifton 49 58 14 107 Canterbury 56 56 13 112 Hatcham 57 69 9 126 Pepys 61 69 9 130 St. Catherine's 21 50 2 71 St. Peter's 42 53 3 95 St. John's 78 47 10 125 Town Hall 85 53 9 138 762 719 141 1481 18 Causes of Death. An analysis of the causes of death will be found in Table I of the Appendix. The following is a comparative statement of the chief causes of mortality in recent years : Cause of Death. Rate per 1.000 deaths 'all causes), 1929. Average No. for 10 years 1915-24. 1925 1926 1927 1928 1929 Increase or decrease over average for 1925-1928 Measles 4 27 31 31 — 30 6 -17 Whooping Cough 11 24 17 5 11 15 16 + 4 Diphtheria 2 19 23 19 14 13 3 -14 Influenza.. 47 70 34 22 39 10 70 +44 Tuberculosis —Pulmonary 61 136 104 91 119 107 90 -15 Non-pulmonary 7 32 21 16 13 30 11 - 9 Cancer 101 133 164 159 170 152 150 -11 Heart Disease 219 128 176 188 222 250 324 + 115 Cerebral Haemorrhage, Embolism and Thrombos's 32 67 55 56 56 56 47 -11 Bronchttis 76 140 123 83 87 70 112 + 21 Pneumonia (all forms) 98 154 114 108 120 118 146 + 31 Nephritis 21 35 33 28 49 30 31 - 4 Diarrhoea and Enteritis 15 45 17 25 8 25 22 + 3 Violence (excluding Suicides) 35 48 56 49 39 48 52 + 4 Premature Birth Malformation and Debility 37 86 51 49 45 44 55 + 8 The following Table expresses as percentages of the total mortality the incidence in the various age groups:— Average 1915-1924 1925 1926 1927 1928 1929 Under 1 year 16.3 9.8 9.1 8.5 10.3 9.5 From 1-2 years 4.7 2.9 3.4 1.8 3.4 2.3 „ 2-5 years 4.3 3.9 3.0 2.5 2.6 2.1 „ 5-15 years 3.9 3.5 2.6 3.3 3.0 2.0 ,, 15-25 years 4.4 4.1 4.5 4.6 4.0 4.1 „ 25-45 years 12.3 10.0 11.1 10.0 11.5 9.9 ,, 45-65 years 23.3 28.0 27.5 29.4 26.2 27.5 65 years and upwards 30.8 37.8 38.8 39.9 39.0 42.6 Infantile Mortality. The steady fall in the infantile mortality (i.e., in the deaths of children under one year of age) which had been manifest for some years, received a check in 1928 and the figures for 1929 show no 19 improvement on those for the previous year. This set-back appears general throughout the country, and the following Table gives the death-rates (calculated per 1,000 births) for England and Wales, London and Deptford for previous years:— Year Deptford England & Wales London No. Death-rate per 1.000 Births Death-rate per 1,000 Births Death-rate per 1,000 Births Average for 10 years 1915-1924 231 90 87 85 1925 137 63 75 67 1926 119 56 70 64 1927 111 58 65 59 1928 139 76 65 67 1929 141 76 74 70 We have in the past been accustomed to regard the decline in the infantile mortality rate as due to the greater care and supervision of the mother and child, improved midwifery, educational measures in connection with child nurture, the provision of nourishment in the form of milk for the necessitous, and to a raised standard of life generally. As these conditions still obtain (although it must be admitted that no exact measurement of the last proposition is possible) it is necessary to see to what causes we can allocate, however imperfectly, the slowing up of the previously steady reduction in infant deaths. The following matters may be considered in this connection:— 1. The reduced birth-rate results in a greater proportion of primiparous births amongst which class of children the death-rate is correspondingly high. 2. Illegitimate births represented 3-0 per cent, of the total births. The death-rate per 1,000 births amongst these illegitimate children was 161, as against 73 for legitimate children. 3. Influence of Season: The effect of adverse climatic conditions as provocative of infant ailments tends to a raising of the death-rate. Thus in the early months of the year, which it will be recalled were very severe, the mortality was unduly high, there being 55 deaths in the first quarter as against 86 in the remaining quarters of the year. 4. Incidence of Disease: Throughout the year respiratory diseases generally were much in evidence, and it is worthy of note that 31 b2 20 children under one year of age died of Pneumonia, as against an average of 18 for the years 1925, 1926 and 1927, during which the infantile mortality rate was falling. Diarrhoea accounted for 17 deaths against a similar average of 11. The following Table gives details of the causes of death in the various age-groups:— Infantile Mortality, 1929. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 1months Total Deaths under 1 year. All Causes 38 12 4 _1 55 26 19 23 18 141 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken fox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever . .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 1 3 1 5 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. ... ... .. 1 .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. 1 .. 1 Meningitis (not tuberculous) .. .. .. .. .. .. .. 2 .. 2 Convulsions 4 2 .. .. 6 8 .. .. 2 11 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. 1 5 .. 1 .. 7 Pneumonia (all forms) .. .. .. .. .. 4 7 11 9 31 Diarrhoea .. .. .. .. .. .. 1 .. .. 3 Enteritis .. .. .. 1 1 3 6 2 2 14 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. 2 .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. .. .. .. .. 1 Injury at Birth 1 2 .. .. 3 .. .. .. .. 3 Atelectasis 3 .. .. .. 3 .. .. .. .. 3 Congenital Malformations 5 2 1 .. 8 1 .. 1 1 11 Premature Birth 23 3 3 .. 29 1 .. .. .. 30 Atrophy, Debility, and Marasmus 2 2 .. .. 4 5 2 1 .. 12 Other Causes .. .. .. .. .. 2 .. 1 1 4 Totals 38 12 4 1 55 26 19 23 18 141 Death-rate in each agegroup per 1,000 births. 204 6.5 2.2 0.5 29.6 14.0 10.2 12.4 9.7 76 Percentage of total deaths in each agegroup 27 8.5 2.8 0.7 39 18.4 13.5 16.3 12.8 100 21 It is not sufficient to know that a certain number of babies died during" the year from the foregoing causes. It is necessary to ascertain how this compares with previous years, i.e., to ascertain whether the raised death-rate affects particular age groups, if so, which, and in respect of what diseases. Mortality (Stated as Percentages) in Age-groups. Year. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks to 3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Decennium 1915-1924 24.8 5.0 4.3 3.2 37.3 18.6 17.9 12.3 13.9 1925 30.5 4.4 3.9 2.8 41.6 16.4 8.9 14.5 18.6 1926 23.5 8.4 5.0 4.1 41.0 18.4 18.4 11.1 11.1 1927 29.7 7.3 4.5 3.7 44.2 18.9 14.4 11.7 10.8 1928 24.5 2.1 1.4 4.4 32.4 20.1 13.7 13.7 20.1 1929 26.9 8.5 2.8 0.7 38.9 18.4 13.5 16.4 12.8 Mortality (Stated as Percentages) from Certain Defined Causes. Causes. Under Four Weeks. Nine to Twelve Months. Avg. 1915-24 1925 1926 1927 1928 1929 Avg 1915-4 1925 1926 1927 1928 1925 Measles .. .. .. .. .. .. 1.2 28 25 .. 36 .. Whooping Cough 0.8 . . . 1.6 1.7 08 2.7 2.2 0.7 Convulsions 1.9 0.5 2.5 2.7 3.6 4.2 0.4 .. .. .. 2.2 1.4 Bronchitis 1.3 .. 1.7 0.9 0.7 0.7 .. 0.6 .. 0.9 .. .. Pneumonia, (all forms) 1.2 1.7 0.8 .. .. .. 5.0 8.3 2.5 3.6 5.7 6.4 Diarrhoea & Enteritis 0.5 .. 0.8 0.9 .. 0.7 2.2 .. 1.7 .. 2.2 2.8 Injury at Birth 0.8 1.7 0.8 1.8 0.7 2.1 .. .. .. .. .. .. Congenital Malformations 2.3 3.9 3.4 4.5 3.6 5.7 0.1 .. .. 0.9 0.7 0.7 Atrophy, Debility and Marasmus 5.8 3.9 4.2 8.1 2.9 2.8 0.2 0.6 .. .. 0.7 .. Premature Birth 17.1 15.0 21.0 15.3 15.8 20.5 .. .. .. .. .. .. Taking the two preceding tables in conjunction, what deductions can be drawn ? It will be first noted that, up to the year 1927 (during which period the infantile mortality rate had been gradually falling), the main improvement had been in the later months, the extent of this improvement being sufficient to more than counterbalance the continued high rate in the first four weeks of life. From 1928, when the infant death-rate substantially increased, the increase was chiefly felt in the age-groups, 22 6-12 months, while in 1929 there was, in addition, an increase in deaths under four weeks. It will be seen that, during these years, amongst children in the older age-group, pneumonia was much in evidence, while amongst infants under four weeks, convulsions, congenital malformations and premature births showed an actual increase. The continued high percentage of deaths occurring within the first four weeks of life (35 per cent, to 40 per cent, of the total) calls for comment. The figure in 1929 is actually higher than in the decennium 1915-1924. Mortality in the first few weeks of life is not amenable to those preventive measures which prove efficacious in later infancy. The high death-rate in the first four weeks, and especially in the first week of life is associated with conditions existing in the pre-natal period, and is closely connected with the causes responsible for the continued high mortality and morbidity amongst women in the lying-in period. It is not too much to say that maternal mortality and the early infant mortality both reflect the same problem, the solution to which has yet to be found. It stresses, however, the importance of every gravid woman's placing herself under medical supervision. By so doing, ill-health in the mother or mal-presentations of the child may be detected and remedied in time. Special Noteworthy Causes of Sickness or Invalidity. In the absence of any system by which information of current illness would be accessible to the Medical Officer of Health it is not possible to express an opinion, except in very general terms, as to what specific cause the bulk of illness amongst the population is attributable. Clearly, the death returns, dealing as they do mainly with the causes leading up to the fatal issue, give little information upon which any estimate of the amount of invalidity may be based. Thus, to take an extreme example : Pneumonia and cancer in 1929 caused practically the same number of deaths, but it is obvious that the extent and period of invalidity in the two cases would bear no possible relationship. Consideration, however, of the preceding mortality tables shows that although yearly fluctuations occur, the most common causes of death, in descending sequence, are associated with the circulatory and 23 respiratory systems and with malignant disease. The former preponderance of death from respiratory disease (largely due to the then high tuberculosis mortality) has given place to diseases of the heart and blood vessels. Heart disease has established itself firmly as the commonest single cause of death. Its recorded increase has been phenomenal ; the number of persons dying in 1929, in comparison with the average annual deaths in the decennium 1915-1924, has almost doubled. In 1929, in fact, heart disease accounted for 219 out of 1,000 deaths from all causes. Inasmuch as rheumatism has been shown to be the commonest forerunner of heart disease, it is obvious that the care of the rheumatic child calls urgently for attention. Influenza, bronchitis and pneumonia showed a marked increase in 1929; cancer remains fairly stationary at the higher level of recent years; pulmonary tuberculosis which, formerly, in Deptford ranked as the third, now occupies the fifth place as the cause of death. Conditions of Occupation or Environment prejudicially affecting Health. Occupation. No specially detrimental effects amongst workers in any trade has been reported. Environment. The adverse housing conditions and resulting overcrowding still constitute most formidable barriers to an improvement in public health. This matter is referred to under " Housing." Public Mortuary. During the year there were received the bodies of 333 persons who had been residents of the following districts:— Deptford 100 Greenwich 62 Lewisham 58 Bermondsey 50 Woolwich 38 Camberwell 5 Poplar 2 Shoreditch 1 St. Marylebone 1 City of London 2 Lambeth 1 Forest Gate 1 Walthamstow 2 Finchley 1 Beckenham 1 Barking 1 Sidcup 1 Erith 1 Wanstead 1 Bury St. Edmunds 1 South Shields 1 Bolton, Lanes. 1 Biggin Hill 1 24 Particulars of the bodies received were as follows: Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Unknown. Deposited to await burial only. Infectious. 333 189 144 294 182 22 3 1 2 In 38 cases no inquests were held, the necessary certificate being issued by the Coroner after the post mortem examination. The causes of death were as follows: Natural causes 182 Accidental causes 1l1 Suicide while of unsound mind 28 Open verdicts 10 Wilful murder 2 Total 333 17 bodies were left at the Mortuary, after the inquest, to await burial, there being no accommodation at the respective homes. 4 bodies were detained on account of advanced decomposition, and 2 infectious bodies were similarly detained. General Provision of Health Services. 26 Infectious Diseases. The provision of hospital accommodation for the isolation and treatment of infectious diseases, including small-pox, is organised and maintained for the County of London as a whole. (See footnote Since the passing of the National Insurance Act, 1911 and other measures, hospital and sanatorium accommodation for Tuberculosis has been similarly provided. Accommodation for infectious cases for those who can pay for such is available at the London Fever Hospital, Liverpool Road, N. Maternity. The Council's Maternity Home is situated at 52 Wickham Road, and has accommodation for 12 cases. (See Report ''Maternity and Child Welfare.") In addition, the following nursing homes, situated within the borough, and registered by the London County Council under the Nursing Homes Registration Act, have been approved for the reception of maternity patients:— 17 Breakspears Road. 23 Hilly Fields Crescent (Park Lodge) 74 St. John's Road. Amongst hospitals, not within the Borough, to which Deptford women are admitted for confinement are, Greenwich and Deptford Hospital, St. Thomas's Hospital, the General Lying-in Hospital, York Road, Lambeth, Queen Charlotte's Lying-in Hospital, and King's College Hospital. Children. Debilitated infants are sent from the Infant Welfare Centres to the Deptford Fund Babies' Home, Albury Street, the Borough Council paying at the rate of 6s. 6d. per day for such cases. Mothers and Infants are similarly sent to St. Thomas's Hostel, Prince's Road, Kennington, S.E., for dietetic treatment, restoration of breast milk, etc., at a charge of 30s. per week. In-patient and out-patient treatment is provided, generally, at such London Hospitals as Vincent Square, Evelina and Great Ormond Street. * During the year under report these services were administered by the Metropolitan Asylums Board. On the 1st April, 1930, under the provisions of the Local Government Act. 1929, the functions of this Authority were transferred to the London County Council. 27 Orthopœdic. Surgical orthopaedic treatment is carried out in special departments of various general hospitals within the metropolis to which Deptford patients are referred. Ambulance Facilities. Infectious cases are removed by the special ambulance service of the Central Authority (see footnote*). This service is also available for the conveyance of patients who are not suffering from infectious diseases on payment of a moderate fee. The ambulances of the British Red Cross Society are also available. County Council ambulances are available for use in accidents, and also for the conveyance of expectant mothers for whom urgent necessity arises during the night. Application is made by telephone and all patients booking at the Council's Maternity Home are given a card of printed instructions regarding these facilities. * During the year under report these services were administered by the Metropolitan Asylums Board. On the 1st April, 1930, under the provisions of the Local Government Act, 1929, the functions of this Authority were transferred to the London County Council. 28 CLINICS AND TREATMENT CENTRES. Maternity & Child Welfare. (l) Infant Consultations. Daily from 2 p.m. Monday, Gosterwood Street Tuesday, Napier Street Do. Besson Street Wednesday, Erlam Road Do. St. John's Hall, Harton Street. Thursday, Goldsmiths' College Do. Princess Louise Institute, Hales Street Friday, St. George's Hall, Shardeloes Road. Health Centre, Harton St. (2) Maternity Clinic. Tuesday Wednesday" Thursday (9 a.m. to 1 p.m.) Friday (from 2 p.m.) "Post Natal Cases. (3) Dental Inspection (monthly). ,, Treatment (weekly). (4) Artificial Sunlight Centre. (By appointment.) (5) Diphtheria Immunisation Clinic. Wednesday (2 p.m.) 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. Secretary's Consultations. 9.30 a.m. daily. 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, 8 a.m. to 10 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. 9 a.m. to 8 p.m. 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. 29 Staff of Public Health Department. Medical Officer of Health and Administrative Tuberculosis Officer. F. Leonard Keith, m.d., ch.b., d.p.h., l.d.s. Assistant Medical Officers. N. M. Donnelly, m.b., d.p.h., (Tuberculosis Officer and Vssistant Medical Officer of Health.) s. Eleanor Hill, m.d., b.s. (Maternity and Child Welfare.) M. I. outram, m.b., ch.b., d.p.h. (Part-time Maternity and Child Welfare.) Obstetric Consultant. W. Gilliatt, m.d., f.r.c.s. Bacteriologist. Arthur Davies, m.d., m.r.c.p. (Dreadnought Hospital) Dentist. j. Eric Magraw, l.d.s. Public Analyst. Henry G. Harrison, m.a., f.i.c. Chief Clerk. Charles A. Chapman, Cert, s.i.e.b. (Lond). Clerks. A. G. W. Pettitt S. Bur ridge G. A. Langley R. Wilson E. J. Elliott General Assistant. E. H. Evans Sanitary Inspectors and Sampling Officers. Robert D. J. Simpson Cert. R.s.L Arthur G. Kemp Cert. R.s.L, s.i.e.b. (Lond.) Meat Cert. R.s.L Frederick Hewett Cert, s.i.e.b. (Lond.), Meat Cert. R.s.L Harry Allam Cert. r.s.l, s.i.e.b. (Lond.), Meat Cert. R.s.i. Albert Yates Cert, s.i.e.b. (Lond.), S.i.e.b. (Food Inspector) Meat, etc. 30 Sanitary Inspectors and Sampling Officers—continued. William F. Mayo Cert, s.i.e.b. (Lond.) Thomas R. W. Mason Cert. s.i.e.b. (Lond.) Arthur C. Webster Cert, s.i.e.b. (Lond.), Cert. r.s.i. Meat Cert, r.s.i. Health Visitors. Miss M. Little General Training, c.m.b., H.v. Miss K. O'Loughlin „ „ „ Miss E. E. Reynolds „ „ Miss M. F. Robus „ „ „ Miss E. T. Stowell „ „ „ * Miss W. C. Smart Cert. s.i.e.b. (Lond.), c.m.b. † Miss A. M. Gibson General Training, c.m.b. Massage. Health Centre, Harton Street. Ante-natal and Post-natal Centres. Health Visitor in charge—Miss E. Clubbe (Gen. Training, c.m.b., h.v.) Attendant—Mrs. Stacey Light Treatment Department. Health Visitor in charge—Miss E. Holland (c.m.b., h.v., r.s.i.) Tuberculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. Tuberculosis Health Visitors—Miss E. M. Porteus (h.v. Tuberculosis Cert.), and Miss A. M. Roy (h.v., General Training, Tuberculosis Cert.) Dispenser Clerk—Miss G. F. Greig (Asst. Soc. Apothecaries, Cert. Bacteriology.) Caretaker Attendant—G. Abbott Municipal Maternity Home, 52 Wickham Road, S.E. 4. Matron—Miss K. Smith (General Training, c.m.b.) Sister—Miss A. M. Cross „ „ Nurses— Miss A. Packer „ „ Miss L. Voysey, Women's Hosp. Tr., c.m.b. Miss M. Baxendale, General Training Miss W. Phoebe, General Training, c.m.b. Mortuary and Coroner's Court, Watson Street, S.E. 8. Mortuary Keeper—G. W. J. Wagner * Appointed as a Sanitary Inspector and Health Visitor, † Part-time only at Infant Welfare Centres. 31 Cleansing Station, Watson Street. Attendant—Mrs. Barnett Disinfecting Station, Watson Street. Chief Disinfector—T. Lyons Disinfectors—J. Crisp and F. Smith. Driver—J. Lloyd Nursing in the Home. The following District Nursing Associations undertake the nursing of necessitous cases in their homes :— St. John the Divine Nurses (St. Paul's Ward and neighbourhood). The Queen's Nurses (part of Canterbury Ward). The Ranyard Nurses (the remainder of the Borough). The work is carried out in close co-operation with the Health Services of the Council, particulary in regard to the work of the Maternity and Child Welfare Centres and the Tuberculosis Dispensary. Nursing is undertaken on behalf of the Borough Council of children up to the age of five years suffering from measles, whooping cough, diarrhoea, poliomyelitis and ophthalmia neonatorum. During epidemic periods, pneumonia and influenzal pneumonia (all ages) are included. Payment is made by the Borough Council at the rate of 1s. 3d. per nursing visit. The following is a summary of the cases visited on behalf of the Borough Council by members of the District Nursing Associations:— Condition. Under Maternity and Child Welfare Scheme. Under Public Health Act. Total cases nursed Children under 5 years. Mothers Children under 5 years Others Cases Visits. Cases Visits Cases Visits Cases Visits Measles 13 152 13 Ophthalmia Neonatorum 6 108 6 Bronchitis 1 10 1 Pneumonia 11 125 6 146 17 Influenza 5 117 5 Confinement 1 17 1 19 260 1 17 12 135 11 263 43 32 Midwives. The Borough Council is not the supervising authority under the Midwives Acts. From a return provided by the County Council, the number of midwives practising in the Borough is estimated at twenty. No subsidy is paid to midwives locally. Maternal Sickness and Mortality. The Borough Council appointed Dr. W. Gilliatt, Obstetric Surgeon to King's College Hospital, as consultant under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926. Circular instructions were sent to all medical practitioners informing them that Dr. Gilliatt's services were available on notifying a case under these Regulations. As regards maternal deaths, the method of enquiry suggested by the Ministry of Health and the questionnaire issued by the Maternal Mortality Committee set up by the Ministry have been used. The information relating to such deaths is collected and compiled personally by the Medical Officer of Health. In 'cases where the circumstances are such as to warrant expert investigation, the Council has retained the services of Dr. Gilliatt to confer with the practitioner concerned and to report his investigations to the Medical Officer of Health. Health Education. Towards the end of the year under report, the Council entered into an agreement for the supply of 2,000 copies monthly of the periodical Better Health. This magazine is the publication of the Central Council of Health Education, the subject matter therein consisting of articles on health matters written by experts. The first local edition of this magazine was published in January, 1930. Sanitary Circumstances, etc AND Factory and Workshops Acts. 34 It is not too much to say that, upon the establishment and maintenance of a sanitary environment, more than upon any other single factor, depends the health of the population. The term " sanitary environment " has gradually expanded and extended and, co-incidentally, the work devolving upon the sanitary staff has increased to a great extent of recent years. In order to keep pace with changing conditions and to make it possible for the Medical Officer of Health to have at all times information as to the sanitary work in hand, a change of procedure was adopted during the year. Briefly, this consisted in : 1. The adoption of the loose leaf system for recording the conditions found upon inspection—a separate sheet being kept for each premises, and a continuous record thus secured of the work under notice. 2. The institution of a General Register compiled from the above records, in which are noted all complaints made, defects found and particulars of action taken (notice served or summons issued) with result. 3. The keeping of a House Inspection Card recording a general description of the premises together with a note of all inspections and a reference to the General Register as to nuisances found. This Inspection Card was designed to give a complete " life history " of the premises concerned. 4. All notices prepared in the clerical Office from the information collated as above. The system, having now been in operation since August, 1929, is working smoothly and with the co-operation of all concerned. 35 The following is a summary of the inspections carried out by the Sanitary Inspectors together with a statement of the improvements effected during the year:— Number of District. 1 2 3 4 5 6 7 Totals Inspections— On complaint 37 97 35 51 37 37 72 366 House-to-house 164 308 305 386 318 342 263 2086 Infectious diseases 173 174 134 150 168 175 242 1216 Notice from builder 31 66 46 38 40 46 115 382 New houses for water certificate ... 2 ... ... ... ... ... 2 Other inspections 117 226 292 236 287 318 297 1773 Total 522 873 812 861 850 918 989 5825 Re-inspections, Calls, etc.— Total 943 2518 2433 2411 2064 1953 2223 14545 Notices Served — Intimation (Public Health Act) 228 460 445 481 454 452 340 2860 Statutory ( Do. ) 20 39 58 35 98 25 27 302 Housing Act, Sec. 3 1 ... ... ... 2 ... ... 3 Cleansing and Repairs— Number of rooms, etc., cleansed 276 659 437 663 440 407 451 3333 Ventilation improved (number of premises) ... 2 ... 15 12 ... 7 36 Number of roofs repaired 36 102 128 86 75 60 36 523 Dampness abated (number of premises) 34 30 18 41 48 37 21 229 Gutters and rainwater pipes provided or repaired 29 85 85 88 45 22 56 410 Yards and forecourts paved or paving repaired 22 49 53 33 26 36 42 261 Scullery floors paved, or paving repaired 16 21 9 10 4 9 69 Coppers provided or repaired 6 24 44 25 14 24 8 145 Other repairs and improvements... 41 162 405 128 175 73 142 1126 Water Supply— 23 Re-instated ... 4 1 5 ... ... 13 Fittings repaired (number of premises) 2 6 11 36 25 16 ... 96 Cisterns cleansed ... ... ... ... ... ... ... ... ,, provided ... ... ... ... ... ... ... ... covered ... ... ... ... ... ... ... ... ,, abolished '... 4 ... ... 1 ... ... 4 C2 36 Table—continued.. Number of District. 1 2 3 4 5 6 7 Totals Drainage- Drains re-constructed (number of premises) ... 16 10 11 70 9 41 157 Drains cleansed and amended 12 47 21 32 26 46 39 223 Gully traps fixed ... 3 8 16 60 22 53 162 Soil and Vent Pipes fixed 1 6 9 14 12 13 23 78 Do. repaired 3 12 ... 2 5 2 7 31 New Covers provided to inspection chambers ... 10 9 5 1 1 6 32 Waste and rainwater pipes disconnected from drains ... 2 ... ... ... 15 7 24 Chambers and access eyes provided ... 4 4 8 28 4 22 70 Other repairs or improvements 4 9 4 8 7 3 23 58 Water Closets— Old waterclosets abolished ... ... ... ... ... ... 1 1 New waterclosets provided ... ... ... ... ... ... 1 12 New pan and trap only, provided 34 68 57 60 76 95 118 508 Defective flush remedied 16 30 59 22 20 28 21 196 Pans cleansed ... 7 12 3 ... ... 3 25 Seats provided or repaired ... 9 18 5 2 3 7 44 Roofs repaired 3 11 24 8 8 3 6 63 Walls, etc., repaired or cleansed 20 43 177 44 35 35 59 413 Doors repaired or renewed 2 7 16 6 7 ... 2 40 Ventilation improved ... 1 2 ... ... ... 3 6 Floors repaired 2 7 7 1 1 5 2 25 Other repairs or improvements 1 5 36 5 2 ... 14 63 Urinals— Cleansed ... 2 1 ... ... ... 11 14 Repaired ... ... 2 1 ... ... ... 3 Provided ... ... 1 3 ... ... 8 12 Cesspools— Abolished ... ... ... ... ... ... ... ... Dung Receptacles— Provided ... 4 2 ... 1 ... 1 8 Repaired ... 1 ... ... ... ... ... 1 Abolished ... ... ... ... ... ... 2 2 Overcrowding- Cases abated ... 1 ... 1 ... ... ... 2 Nuisances arising from the keeping of animals— Number of nuisances abated ... 6 2 ... ... ... 2 10 Offensive accumulations— Number of accumulations removed ... 7 9 3 2 1 2 24 37 Table—continued. Number of District. 1 2 3 4 5 6 7 Totals. Smoke Nuisances- Number of observations ... 6 20 ... 9 ... 7 42 Number of nuisances from black smoke ... 1 2 ... 7 ... 7 17 Number of notices served ... 1 2 ... 7 ... 1 11 Dustbins- Provided or repaired 33 74 85 77 70 59 51 449 General— Other miscellaneous nuisances abated 6 48 14 43 25 45 42 223 Premises on which works in compliance with notices served during the year 1929 were outstanding at the end of that year 55 91 36 69 123 65 74 513 District No Inspector. Districts (approximate) 1 Inspector Allam Clifton and Deptford Park Wards 2 ,, Mayo Evelyn Ward 3 ,, Webster St. Paul's Ward. 4 ,, Hewett Vale Ward 5 ,, Kemp Canterbury Ward 6 ,, Simpson St. Catherine's, Hatcham and Pepys Wards 7 ,, Mason St. John's, St. Peter's and Town Hall Wards. 38 House-to-house Inspections. A total of 2,086 House-to-house Inspections were made during the year, equivalent to 115 per 1,000 houses occupied. This compares very favourably with other boroughs. The houses inspected were situated in the following streets:— Alpine Road Amersham Vale Avignon Road Baildon Street Benmore Street Billington Road Bingley Place Blackhorse Road Bolina Road Bronze Street Camplin Street Canterbury Road Childeric Road Childers Street Chipley Street Cottesbrooke Street Crossfield Street Deloraine Street Dennetts Grove Dixon Road Douglas Street Dundalk Road Edric Road Edward Street Empire Place Etta Street Eugenia Road Finland Road Frankham Street Giffin Street Goodwood Road Gosterwood Street Hales Street Hamilton Street Heston Street Hornshay Place Hunsdon Road Idonia Street IIderton Road Knott Street Laurie Grove Lovelinch Street Milton Court Road Monson Road Napier Street New King Street Oareboro Road Octavius Street Providence Place Rectory Buildings Reculver Road Rollins Street Rolt Street Rudford Road Rutts Terrace Senegal Road Summer Street St. John's Road Vulcan Terrace Watson Street Wrigglesworth Street Wybourne Cottages 39 Legal Proceedings. The following is a full list of legal proceedings instituted during the year under report, with the exception of those instituted under the Food and Drugs (Adulteration) Act, 1928, and in connection with Food Premises, which will be found in a later section of this Report. Date Nature of Offence. Fine Costs Remarks. Public Health London) Act, 1891, and Bye-laws £ s. d. £ s. d. May 9 Non-compliance with statutory notice, 24 Florence Road 1 0 1 0 0 Magistrate's Order for execution of necessary work within 7 days. June 13 Premises without dustbin 42 Speedwell Street - - Dustbin supplied prior to hearing. Summons dismissed. June 13 Non-compliance with statutory notice, 42 Speedwell Street 1 0 0 3 3 0 Magistrate's Order for execution of neccessary work within 14 days. Aug 8 Fixing w.c. pan and trap at 17 Dundalk Road without notice 5 0 0 1 1 0 Aug 8 Improper dung receptacle, 2a Shardeloes Road Summons dismissed £1 1s costs against Council. (See report below of further proceedings) Oct 10 Fixing w.c. pan and trap at 66 Crossfield Street without notice. 1 0 0 1 1 0 Oct 30 Non-compliance with statutory notice, 137 Silwood Street 1 0 0 Magistrate's Order for execution of necessary work forthwith. Oct 30 Non-compliance with statutory notice (room overcrowded) 57 Napier Street 1 1 0 Magistrate's Order for abatement of nuisance within 7 days. Nov 7 Improper construction of dung receptacle, 2a Shardeloes Rd. 1 0 0 - Nov 7 Defective stable floor, 2a Shardeloes Road 1 0 0 - Nov 7 Removal of offensive matter by road during prohibited hours— Against owner of vehicle on Sept. 26th 15 0 - Oct. 4th 1 10 0 - Against driver of vehicle on Sept. 26th 1 0 0 - Oct. 4th 2 0 0 - Nov 15 Fixing w.c pan and trap without notice 2 6 - L.C.G. Bye-laws— Pag and Bone Dealers Nov 7 Rags stored in sleeping room, 86 Church Street 5 0 - Dec 5 Rags stored in shed which did not conform to L.C.C. ByeLaws, 6 Giffin Street - 2 0 Dec 5 Rags stored in room communicating with sleeping apartments, 6 Giffin Street - 2 0 L.C.C. (General Powers) Act, 1928—Sec. 28. Dec 7 "Aged and infirm person" Magistrate's Order for detention in hospital for 3 months. 10 Miscellaneous Matters. Smoke Abatement. The problem of nuisance from the emission of smoke is one constantly before the staff. During the year, 11 Notices were served with resulting improvement. The proposed by-laws when in operation, may give some assistance in administration, but the present complicated procedure renders difficult any effective action except for flagrant offences. Offensive Trades (other than Slaughterhouses). The following are the only instances in the Borough:— Skin Dressers 2 premises Soap Boilers 2 ,, Fat Melters 2 ,, Inspection is regularly carried out. The premises and the conduct of the business are satisfactory, no Notices having to be served. Rag and Bone dealers. Persons or firms known to carry on business as above, are regularly inspected. In the case of two premises proceedings were taken in respect of contraventions of the By-laws. Offensive Matter conveyed through Streets. Observation is kept to ensure that offensive matter is not conveyed through the streets, either in unsuitable receptacles or during prohibited hours. In two instances it was found necessary to institute legal proceedings in respect of contravention of the By-laws. Rats and Mice (Destruction) Act, 1919. The Inspectors, by reason of their routine examination of premises, remedying of defective drains and sealing off of disused drains, may be said to be carrying out the spirit of the Act throughout the whole year. During " Rat Week," however, further assistance is sought from the Borough Engineer, and the following is the text of a report to the Council:— " Extermination of Rats. " During the week ended the 9th November, this Council, acting in conjunction with other local authorities, in what is known as National Rat Week, baited the sewers in the Borough for the purpose of exterminating rats. " From reports received it appears that considerable success attended these efforts. We think it desirable, however, that the work of exterminating rats in the sewers should not be confined to this yearly effort but that it should be carried out at frequent intervals, and we have therefore given instructions accordingly." 41 Removal of Aged and Infirm Persons. Subject to certain safeguards, power is given to the Medical Officer of Health to apply to the Court for an Order for the removal to a hospital of an infirm person living in insanitary surroundings. In all the cases brought to my 1 notice, the persons concerned agreed voluntarily to their removal except in one instance, in which an Order had to be applied for. The Order was granted. Swimming Baths. During the year the Council opened a new bath complete with chlorination plant, and gave instructions that a similar means of ensuring the purity of the water should be provided in connection with the existing baths. The water is sampled from time to time with a view to an estimation being made of its purity from a bacteriological point of view. Emanations from Sewers. During the summer various complaints were received of noxious odours arising from certain manholes in the London County Council's sewers. Some of these complaints referred to possible injury to health, risk of " fever " and the like. While there is an absence of scientific proof of the latter contention, there can be no question that many people were seriously inconvenienced. It will be recollected that, following upon a report by the Commissioners appointed by the Secretary of State, in which the adequate and continuous ventilation of underground cavities was urged, the London County Council authorised the re-opening of certain ventilators upon their sewers. With the advent of the hot and dry weather there was a steadily increasing number of complaints of smell from these ventilating manholes. Representations were made to the London County Council with a view to securing the re-closing of those ventilators which were the source of serious inconvenience. Sewerage and Drainage. All drainage work except in new buildings, whether done voluntarily by the owner or as a result of Notices under Statute, is supervised by the Sanitary Inspectors. The drainage in connection with 157 premises was reconstructed during the year, and in 223 premises the drains were cleansed and amended. In addition, 455 repairs and improvements to drainage were effected. Inasmuch as questions of drainage intimately concern the departments of both the Borough Engineer and the Medical Officer of Health, the former supervising drainage of new buildings, there is the closest co-operation between the two departments concerned. 42 Refuse Collection. There is a weekly collection throughout the Borough, disposal being effected by barge. During the year 449 dustbins were provided by owners as a result of notices served. Co-oberation with the District Surveyor. It came to my notice that, in the execution of repairs under Dangerous Structure Notices served by the London County Council, hardship might fall upon tenants occupying houses certified in this way as dangerous. The District Surveyor now informs me of the issue of such notices in order that steps may be taken to ensure that tenants are not left exposed to the weather and, further, that their rights under the Rent, etc. (Restrictions) Act are not endangered. Water Certificates. The Borough Council was advised that certificates in respect of an efficient water supply in 39 new premises could properly be granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. In two instances certificates were applied for and, being favourably considered, were subsequently granted. Canal Boats. The following is the text of the Annual Report of the Canal Boats Inspector:— To the Medical Officer of Health. Sir, I beg to report for the year ended December 31st, 1929, that for the purpose of Canal Boats Inspection I made fifteen visits on the following dates:— January 8th and 28th ; February 2nd, 22nd and 25th ; April 11 and 23rd; May 7th; June 20th; July 3rd; August 9th and 23rd; October 29th ; November 22nd and December 31st. No boats were found for inspection during the year. The 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. Mayo, Canal Boats Inspector. 43 FACTORY AND WORKSHOPS ACTS. In conformity with Section 132, the following is an epitomised statement of the administration of these Acts:— Inspections. Premises. Inspections. Number of Written Notices. Occupiers prosecuted. Factories 274 14 — Workshops 1135 24 — Workplaces 98 20 2 Total 1507 58 2 The types of premises inspected were as follows Type. Factories, Number. Workshops, Number. Workplaces, Number. Bakehouses 18 35 Chemical Work 3 Cinemas, etc. 7 Cord Makers 2 Dressmakers, Milliners, etc. 20 Engineering, general 11 „ motoring 2 5 Foundries 5 Food preparation 15 167 3 Glass bottle makers 2 Laundries and Cleaners 4 4 Machine Belt Makers 2 Marine Stores 5 Paint and Varnish Works 4 Printers 2 Shoeing Forges 2 Stables, etc. 26 Sawmills 6 Timber Stores 7 Tar Refiners 2 Tailors 6 Toy makers 3 Woodwork (joiners, turners, &c.) 5 6 Wood choppers 4 Whitening Manufacturers 3 Miscellaneous 56 52 24 Totals 142 309 67 44 DEFECTS FOUND. PARTICULARS. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts. Want of Cleanliness 30 29 1 - Want of Ventilation — — - - Overcrowding — — - - Want of Drainage of Floors 4 4 - - Other Nuisances 33 25 - 2 Sanitary Accommodation Insufficient 2 2 - - Unsuitable or defective 26 21 - - Not Separate for Sexes 1 1 - — Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bakehouse (sec. 101) Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 96 82 1 2 For particulars, see previous Table of Legal Proceedings. The number of visits paid to Home Workers' Dwellings was 297. Certain insanitary conditions, but not of such degree as to merit the term "unwholesome," were found, either as a result of these visits or previous inspections, in nine instances. Notices were served and the conditions remedied. Housing. 46 HOUSING. There is an increasing tendency for larger houses, originally occupied by one family, to be adapted for use by two or more families. This entails supervision by the Sanitary Inspectors in order to ensure that provision is made for, inter alia, adequate water supply, and water closet accommodation. A large proportion—the number could be ascertained only by a house-to-house survey—of houses are already occupied by two or more families. Such occupation, coupled with the fact that many are structurally unsuited for the purpose, leads inevitable to a greater wear and increasing dilapidation. Only by continual vigilance on the part of the Inspectors can this class of property be kept in a habitable condition. Overcrowding continues to be one of the most difficult problems encountered. Houses or rooms which, when originally let, were not overcrowded become so through the flow of time as additions to the family take place. I am continually receiving applications from distressed tenants for houses upon the Borough Council or the London County Council estates. In those instances where the tenancy of a municipal house is granted, steps are taken to prevent the vacated house being re-let in such a manner that overcrowding will again exist. But such restriction is necessarily only of a temporary nature. Certain accommodation has been already provided by the Borough Council, as follows:— Housing, Assisted Scheme. No. of Dwellings. Brockley Housing Estate (Houses and flats) 246 Wickham Road, Nos. 27 and 31 (flats) 4 Housing of the Working Classes. Knotts Terrace 24 115 Evelyn Street 3 78 Amersham Vale 2 The London County Council upon their large housing estates, allocate fifty per cent, of the accommodation to residents nominated by the Borough Councils. The Valuer of the London County Council has 47 kindly furnished me with the following figures relative to the number of Deptford families accommodated upon the London County Council estates. From the 1st January, 1925 to 31st December, 1929 — Families accommodated— (a) Preferentially on recommendation of the Borough Council 561 (b) From the London Council General List 911 Total 1,472 The most pressing need at the present time is for more houses at rents within the means of those now living in unsatisfactory surroundings. The problem of providing sufficient houses is mainly a financial one. Largely it depends upon the question of State grants to local authorities in order that they may be in a position to meet a need which holds out no financial inducement to private enterprise to satisfy. The problem of slum clearance and the provision of houses for the more poorly-paid workers are two aspects of the same problem. Until the solution of the housing shortage is found, we must frankly face the fact that the money spent on our social services is not yielding anything like the full return we are entitled to expect. In accordance with the requirements of the Ministry of Health, the following is a tabular statement of the Housing Statistics for 1929. General. Number of houses erected during the year:— Clinton House, Watergate Street (L.C.C.) 37 tenements. 1. Unfit Dwelling-houses. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5825 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated Regulations) 1925 2086 (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 2863 48 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) 2501 3. 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 3* (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) 302 (2) Number of dwelling-houses in which defects were remedied:— (а) By owners 279 (б) By Local Authority in default of owners — (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 Nil. •Necessary repairs carried cut by owners in early part of year 1930. Food. 50 INSPECTION AND SUPERVISION OP THE FOOD SUPPLY. This falls naturally under three headings:— 1. Supervision of premises where food is stored, prepared, or from which it is sold or distributed. 2. Examination of food as to its soundness. 3. Sampling of food to determine its composition or sophistication. During the year the duties of the Inspectorial Staff were re-distributed in the following manner:— The purity of food became primarily the responsibility of one Inspector, although this duty, particularly in respect of milk and the soundness of food, was shared, but in a less degree, by all the Inspectors. The Food Inspector was relieved of certain District duties, e.g., smoke observations and sanitary inspection of premises, and these were allocated amongst the several District Inspectors. I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 21 applications for registration (including 13 transfers) in respect of premises were granted during the year, and one registered premises ceased to be used as such. At the end of the year, as a result, there were 168 premises registered for the sale of milk. In addition to the above 18 persons were registered for the sale of bottled sterilised milk only. From 11 premises, included above, Graded Milk could be sold. One wholesale premises (Sterilised Milk) is also on the Register. There are no cow-houses in the Borough. During the year 210 inspections of milk shops were made and a general improvement in the conditions of storage has resulted. In addition to verbal information, no formal notices under the Public Health (London) Act, 1891, were served, but many minor matters were remedied as the result of verbal information on the part of the Inspectors. 51 Legal Proceedings (other than in connection with adulteration). Date of Hearing. Offence. Result. July 4th Selling milk from unregistered premises Fined £l & 10s. costs. July 4th Carrying on trade of dairyman without do. being registered Oct. 10th Filling a bottle with milk other than Fined 10s. & upon registered premises 10s. costs. Administration of the Milk (Special Designations Order), 1923. At the end of the year, the following retailers were registered One retailer to sell Certified Milk at or from two shops. One ,, „ Grade "A" Milk at or from two shops. Three retailers to sell Grade "A" (Tuberculin Tested) Milk at four shops in all. One retailer to sell Pasteurised Milk at or from nine shops. Bacteriological Examination of Milk. Three samples of Graded Milk were examined bacteriologically with the following results:— Designation. Total]Count Bacillus Coli. Certified 197,000 in l/10thcc. Present Grade "A" (Tuberculin Tested) 3,430 in l/100thcc. Absent Grade "A" (Tuberculin Tested) 72,086 (present in 1 of 3 tubes) The results of such examinations were reported to the Ministry of Health, and, in the case of Certified Milk, to the Medical Officer of Health for the County in which is situated the farm of the producer. One sample of "Sterilised" bottled milk was submitted for bacteriological examination with negative result. Animal Inoculation. Six samples of milk were submitted to the bacteriologist for the detection of Tubercle Bacilli (Guinea pig inoculation), all with negative results. II. Meat Premises. (a) Slaughterhouses. There are two slaughterhouses in the Borough and these were kept under regular and efficient supervision, 201 visits having been paid. The co-operation of the owners has been successfully enlisted, and any meat or offal, where the slightest suspicion exists, is laid aside for inspection. d2 52 The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 255 bullocks. 59 calves. 2,059 sheep. 105 pigs. Destroyed. One pig carcase for tuberculosis. Sixty-four livers for parasitic diseases. (b) Shops and Stalls. Regular inspection is carried out with a view to the enforcement of the Public Health (Meat) Regulations. The markets are regularly patrolled, particularly at such times as business is being actively carried on. (c) Sausage Factories and other places where meat is used in the preparation of edible foodstuffs are kept under observation. III. Other Food Premises. (a) Workshop Bakehouses. There are 35 such bakehouses in the Borough, 12 of which are underground. 140 visits were paid during the year. Apart from minor defects, remedied upon verbal intimation, 70 Notices were served for cleansing. (b) Factory Bakehouses. These number 18, of which 2 are underground. 72 inspections were made and 36 Notices were served for cleansing. (c) Fried Fish Shops and Fish Curers. The number kept under observation during the year was 49. 197 Notices were served, 196 of which were for cleansing, and one for other defects. (d) Ice Cream Premises. There were 102 separate premises recorded. To these, 247 visits were paid and 3 Notices served in addition to many verbal intimations regarding minor matters. Particular stress is laid upon instructions regarding the cleanly conduct of the business. (e) Other Premises. There are 53 miscellaneous premises (ojher than retail shops) connected with food preparation or sale, and 92 inspections were made to these. 9 Notices to remedy insanitary conditions were served. (/) St. George's Wharf. Public Health (Imported Food) Regulations, 1925. During the latter part of the year a great increase took 53 place in the foodstuffs imported at the Wharf, and the following is a summary of the work done:— Date. Description. Weight. Examination. Remarks. Oct. 2 Tinned plums 4 tons Part, thorough 6 cwts. con- „ 3 Tinned cherries 25 tons Part, 10 per cent. demnecl „ 7 Raspberry pulp 4½ ,, 10 per cent 2 tins (20 lbs.) condemned „ 8 Tinned vegetables 25 cases 10 per cent . Satisfactory Biscuits 50 cases „ „ Chocolate 30 cases „ „ „ 9 Yeast 5 cases Samples taken „ Farina 20 bags 10 per cent Satisfactory „ 11 Tinned gooseberries 100 cases „ 2 tins (20 lbs.) condemned „ 15 Tinned gooseberries 61 cases Satisfactory Chocolate 4 „ „ „ Biscuits 25 ,. „ „ „ 17 Tinned gooseberries 100 „ „ „ 18 Tinned gooseberries in water 191 „ „ 1 tin condemned 22 Do. do. 250 „ „ 2 tins condemned Dates 140 tons „ 2 tins condemned Tinned vegetables 36 cases „ Satisfactory „ 25 Tinned gooseberries in syrup 75 cases „ Chocolate 32 cwts „ )> Dates 3,500 lbs „ 5 J „ 30 Tinned plums 95 cases Thorough 1 case of 6 tins (60 lbs.) condemned „ 31 Tinned salmon 200 „ 10 per cent. Satisfactory Gooseberries 100 „ n „ Cucumber in vinegar 125 gals. „ Vinegar 70 „ J? „ Mustard vegetable 15 casks „ „„ Nov. 5 serve Gooseberries in syrup 50 cases „ Samples taken „ 6 Sultanas 15 „ „ „ Fruit tablets 38 „ „ „ Chocolate 93 „ „ › 54 Date. Description. Weight. Examination. Remarks. Nov. 12 Sweets 25 cases 10 per cent. Satisfactory Biscuits 240 „ 99 99 „ 13 Chocolate 505 „ 99 Samples taken 14 Siberian salmon 200 „ 99 16 6-in. tins condemned „ 15 Vegetable preserve 125 „ 99 Samples taken Tinned plums 25 „ 99 5 tins condemned. 20 Blackberries 25 „ 99 Satisfactory Preserves 20 „ 99 99 „ 21 Tinned plums 116 „ 99 99 Tinned gooseberries 34 „ 99 99 „ 22 Biscuits and chocolate 169 „ 99 Samples taken Tinned plums 25 „ Thorough 15 tins condemned „ 26 Biscuits 113 „ 99 Samples taken & 27 Plums 166 „ 99 7 tins condemned Dec. 5 Vegetable preserve 25 „ 10 per cent. Samples taken Chocolate 40 „ 99 99 Confectionery 25 „ 99 99 Biscuits 248 „ 99 Satisfactory „ 6 Tinned gooseberries 100 „ 99 Samples taken Tinned blackberries 150 „ 99 10 (70 lbs.) condemned „ 10 Biscuits 369 „ ) 9 Satisfactory „ 11 Vegetable preserve 93 „ 99 99 „ 12 Dates 8 „ 99 99 Chocolate 163 „ J ) 99 Cheese (Hard) 5 „ Thorough 105 lbs. con- Cheese (Soft 3 barrels ,, demned „ 16 Chocolate 35 cases 10 per cent. Satisfactory Biscuits 110 „ 99 99 „ 19 Chocolate. 44 „ 99 99 „ 24 Chocolate 55 „ 99 99 Biscuits 224 „ „ 30 Biscuits 40 „ 99 99 „ 31 Chocolate 21 „ 99 99 Vegetable preserve 45 „ 99 99 Where samples were taken as indicated in the above list, the same were submitted for analysis. In each instance the Public Analyst certified the same to be genuine. Particulars of such analyses will be found in the table of informal samples analysed, on a succeeding page of this Report. 55 Unsound Food. Regular supervision of all food premises and street traders is maintained, and tradesmen are encouraged to seek the opinion of the Inspectors as to any food considered suspect, with a view to its surrender and destruction. The following is a statement of such surrenders:— Apples 3 cwt. Cut rabbit 24 lbs. Bullock's liver 24 lb. Sheep's livers 6 Cauliflowers 2¾ cwt. Skate wings 83 lbs. Grapes 24 barrels Soles ¾ cwt. Loganberries 14 tins Tomatoes 3 cwt. 48 lbs. Pig's head 1 Tomato soup 13 tins Pig's carcase 1 Tinned food 6 cwt. Rabbits 43 Turkey 1 Legal Proceedings. Date of Hearing. Offence. Result. Dec. 2nd ... Depositing for the purpose of sale Fined £25 and 32 unsound rabbits £5 5s. costs. Dec. 2nd ... Exposing for sale 3 unsound half Fined£25 and pig's heads £5 5s. costs. Food Poisoning. No instance of food poisoning was brought to my notice during the year. III. Food Sampling. A total of 601 samples, formal and informal, were taken during the year, equivalent to 54 samples per 1,000 of the population. Of these, 11 were found to be adulterated, representing a percentage of 1*8 of the total. The adulteration in respect of samples submitted for analysis during the past five years is as follows:— Year. Number of Samples taken. Percentage Adulterated. 1924 603 2.8 1925 698 2.1 1926 552 1.3 1927 601 1.5 1928 604 1.8 56 Food and Drugs Adulteration Act, 1928. Samples purchased during 1929. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Almonds, ground 1 .. 1 .. Aspirin Tablets, gr. V. 1 .. 1 .. Barley, Pearl 3 .. 3 .. Beef, Minced 4 .. 4 .. Brawn 2 .. 2 .. Butter 40 .. 40 .. Cake 9 .. 9 .. Cake Flour 1 .. 1 .. Camphorated Oil 2 .. 2 .. Cheese 2 .. 2 ..* * Chicken and Ham Roll 1 .. 1 .. Chocolate Egps 7 .. 7 .. Christmas Pudding 4 .. 4 .. Cocoa 13 .. 13 .. Coffee 1 .. 1 .. Coffee & Chicory 5 .. 5 .. Cornflour 1 .. 1 .. Cream, tinned 2 .. 2 .. Cream, Ice 1 .. 1 .. Custard Powder 8 .. 8 .. Dripping 8 .. 8 .. Epsom Salts 3 .. 3 .. Fish Cake 1 .. 1 .. Fish Paste 3 .. 3 .. Fruits, dried 6 .. 6 .. Fruits, crystallised 6 .. 6 .. Gin 3 .. 4 ..25 0 Ginger, Ground 4 .. 4 .. Glauber's Salts 2 .. 2 .. Ham and Tongue Paste 1 .. 1 .. Honey 1 .. 1 .. Jam 4 .. 4 .... Jelly Crystals 1 .. 1 .. Jelly, table 2 .. 2 .. Lard 9 .. 9 .. Lemonade Powder 6 .. 6 .. Linseed, crushed 1 .. 1 .. Margarine 17 .. 17 .. Meat Paste 1 .. 1 .. Meat Pie 3 .. 3 .. Milk 239 4 243 1.6 Condeensess- Full Cream, sweetened 3 .. 3 .. Skimmed, sweetened .. 2 .. 2 .. Mince Meat 5 .. 5 .. Mince Tart 1 .. 1 .. Mustard 8 .. 8 .. Mustard Compound 2 .. 2 .. Carried forward 450 5 455 .. 57 Samples taken during 1929—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Brought forward 450 5 455 Olive Oil 1 .. 1 .. Peas 4 .. 4 . . Pepper 12 .. 12 .. Pickles 1 .. 1 .. Rice 3 .. 4 25.0 Sardines 1 .. 1 .. Sauce 4 .. 4 .. Sausages 9 .. 9 .. Salmon Cutlet 1 .. 1 .. Sherbet 3 .. 3 .. Silde 1 .. 1 .. Sponge Mixture 1 .. 1 • • Suet .. .. 2 100.0 Suet and Rice Mixture 2 2 .. Sugar 1 .... 1 .. Sweets 21 .. 21 .. Soda, Bicarbonate of 2 .. 2 .. Tapioca 2 .. 2 .. Tea 8 .. 3 .. Vinegar 4 .. 5 20.0 Vinegar, malt 1 .. 1 .. Wines 3 .. 3 .. Wines & Cordials, Non-alcoholic 15 .. 15 .. hisky 2 .. 3 .. Informal Samples. Butter 4 .. 4 .. Biscuits 2 .. 2 .. Celery, tinned 2 .. 2 .. Cheese 3 .. 3 .. Cream Cheese 2 .. 2 .. Chocolate 14 .. 14 .. Chocolate Biscuits 3 .. 3 .. Dried Fruit 2 .. 2 .. Tinned Gooseberries 1 .. 1 .. Dried Milk, full cream 2 .. 2 .. Tinned Peas 3 .. 3 .. Bicarbonate of Soda . . .. 1 100.0 Sweets 3 .. 3 .. Yeast 2 .. 2 • • Totals 590 11 601 1.8 58 Proceedings Taken in regard to Samples Purchased during the year 1929. Simple No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ S. d. £ s. d. 8M Milk 1 per cent, deficiency in milk fat — - Vendor cautioned. 13 Y „ 2 per cent, deficiency in milk fat - - Do. do. 25 H „ 5 per cent, deficiency in milk fat - 1 1 0 Summons dismissed on payment of costs by defendant. 38 K Vinegar 12 per cent, excessive water - 3 3 0 Do. do. 49 H Milk 28 per cent, deficiency in milk fat 5 0 0 - Costs included in fine. 44 H Rice Foreign mineral matter present as "Facing" (0 41 per cent.) - - 163 Y Gin 3'8 per cent, excessive water - - 151 Y Whisky 18 per cent, excessive water - - Vendor cautioned. 84 K Suet Rice flour 20 3 percent. - - Admixture disclosed by label. 159Y „ Common salt 3 8 per cent. - - 47TM Bicarbonate of Soda Borax 57.5 per cent. - - Informal sample. Infectious and other Diseases. 6O PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 1. Notifiable Infectious Disease. The following Tables present a Summary of the cases notified, analysed according to age and ward distribution and seasonal incidence:— CASES OF INFECTIOUS DISEASE, EXCLUDING TUBERCULOSIS, NOTIFIED DURING THE YEAR 1929. INCIDENCE AND MORTALITY BY AGE GROUPS. Notifiable Disease At all Ages Total Cases Notified. At Ages—Years Total Cases Removed to Hospital Total Deaths Deaths at Ages—Years Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up Smallpox 15 .. .. 6 5 4 .. .. 15 .. .. .. .. .. .. .. .. Cholera • • .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 411 7 120 224 43 14 3 .. 411 3 .. 1 2 .. .. .. .. Erysipelas 52 3 .. .. 1 23 19 6 21 2 .. .. .. .. .. 2 .. Scarlet Fever 656 10 167 399 51 25 4 .. 650 4 .. 2 2 .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 6 .. .. 2 1 .. 3 .. 5 1 .. .. .. .. .. 1 .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. • • .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. . . 2 1 .. .. .. .. l .. .. Puerperal Pyrexia 6 .. .. .. 1 5 .. .. 3 .. .. .. .. .. .. .. .. Cerebro- Spinal Meningitis 4 1 1 1 1 • • .. .. 4 2 l .. .. 1 .. .. .. Poliomyelitis and Polioencephalitis 4 1 2 .. 2 .. .. .. 4 1 l .. .. .. .. .. .. Ophthalmia Neonatorum Anthrax 14 14 .. • • .. .. .. .. 1 .. .. .. .. .. .. .. .. nfantile Diarrhoea and Enteritis (under 2 years) 33 15 18 .. .. .. .. .. 0 17 17 .. .. .. .. .. .. Acute Primary and Acute Influenzal Pneumonia 172 7 31 19 24 35 29 27 74 146 31 27 4 4 12 30 38 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Baci'liary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 3 .. .... .. .. 1 .. 2 3 1 .. .. .. .. .. .. 1 †Measles 8 1 6 1 .. .. .. .. 2 6 .. 6 .. .. .. .. .. Chicken Pox 61 4 23 31 2 1 .. .. 5 .. .. .. .. .. .. .. .. Totals 1447 63 368 683 130 110 58 35 1202 184 50 36 8 5 13 33 39 1 he deaths from Pneumonia include all forms of that disease, including many cases not notifiable as "Acute." † Measles ceased to be notifiable on 31st March, 1929, The deaths relate to the whole year. 61 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1929. 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 15 1 .. .. .. .. 6 .. 8 .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 411 29 46 40 46 29 56 49 23 37 9 19 28 Erysipelas 52 5 5 9 3 3 1 9 2 4 3 2 6 Scarlet Fever 656 70 63 59 63 99 79 77 23 20 17 18 63 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 6 .. 1 1 .. 1 1 .. .. 1 1 .. .. Relapsing Fever .. .. .. .. .. • • .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. • • .. .. Puerperal Fever 2 1 .. .. .. 1 .. .. .. .. .. .. .. Puerperal Pyrexia 6 .. .. 1 .. .. .. 2 .. 1 1 1 .. Cerebro-Spinal Meningitis 4 .. .. .. .. 1 .. .. .. .. .. 3 .. Poliomyelitis and Polioencephalitis 4 1 1 1 .. .. 1 .. .. • • .. .. .. Ophthalmia Neonatorum 14 1 .. 2 3 2 .. 1 .. 1 2 1 1 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 33 3 1 11 9 1 .. .. .. .. 1 6 1 Acute Primary and Acute Influenzal Pneumonia 172 5 12 27 14 9 24 23 11 6 12 11 18 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 3 .. 1 .. .. 1 .. .. .. .. .. .. 1 Measles 8 .. 1 2 .. 1 .. 2 .. .. .. .. 2 Chicken Pox 61 .. 4 8 19 7 9 1 2 2 .. 2 7 Totals 1447 116 140 161 157 155 177 164 69 72 46 63 127 62 SEASONAL INCIDENCE OF NOTIFIABLE INFECTIOUS DISEASES. Disease. 1st quarter 2nd quarter 3rd quarter 4 th quarter Total for year Smallpox 1 ... ... 14 15 Diphtheria 86 68 94 163 411 Erysipelas 20 4 8 20 52 Scarlet Fever 117 108 129 302 656 Enteric Fever 1 1 4 ... 6 Puerperal Fever 1 1 ... ... 2 Puerperal Pyrexia 1 1 1 3 6 Cerebro-spinal Meningitis 2 1 1 4 Poliomyelitis 1 ... 2 1 4 Ophthalmia Neonatorum 3 6 3 2 14 Infantile Diarrhoea, etc. ... ... 25 8 33 Acute Primary and Influenzal Pneumonia 114 29 10 19 172 Encephalitis Lethargica 1 1 ... 1 3 Chicken Pox ... ... ... 61 61 Measles 8 ... ... ... 8 Totals 356 220 276 595 1447 * Notification of Measles ceased on 31 st March. Scarlet Fever. Year No. of Cases Attack Rate per 1,000 population No. of Deaths Case Mortality per cent. Average 1915-24 481 4.2 6 1.2 1925 310 2.7 3 0.9 1926 399 3.5 1 0.3 1927 400 3.5 2 0.5 1928 454 4.4 2 0.4 1929 656 5.9 4 0.6 Scarlet Fever of late years has become increasingly difficult to diagnose. The classical symptoms in many cases are practically absent, the rash fugitive in character, and, as a result, these atypical and abortive cases are liable to be "missed" and act as foci of further infection. Happily, the increased incidence has coincided with a decreased virulence as shown by the case mortality above set forth. 68 It would be unwise, of course, to conclude that, because comparatively few cases immediately end fatally, Scarlet Fever is little menace to the child population. Complications may follow the mildest cases and, in the interests of the patient and of other children in the home, isolation in hospital is as necessary to-day as hitherto. In order that certain cases of measles might be treated in hospital, some restriction upon the admission of cases of Scarlet Fever was inevitable. Fortunately, as practically every case in Deptford requires hospital isolation, little delay occurred in their admission. So far as is practicable all cases, after discharge from hospital, are kept under surveillance by the Health Visitors. Even where such children present no clinical signs, instances occur where they retain the power of infecting others. Diphtheria. Year No. of Cases Attack Rate per 1,000 population No. of Deaths Case Mortality per cent. Average 1915-24 322 2.8 19 5.9 1925 610 5.3 23 3.8 1626 582 5.0 19 3.3 1927 412 3.6 14 3.4 1928 468 4.1 13 2.8 1929 411 3.7 3 0.7 It will be noted that there has been a steady reduction in the mortality from Diphtheria, although the incidence as judged by notifications received has increased very materially. In large measure this increased incidence is more apparent than real owing to the extent to which bacteriological tests ate now used upon which to found a diagnosis of Diphtheria. During the year, " Swabbing" by the Public Health Department was abandoned, except in special cases, e.g., as an assistance in diagnosis of cases showing indefinite clinical symptoms or as a matter of individual convenience to expedite return to work where a " negative " swab is prescribed by the employer as a necessary precedent to re-admission to work. The perfunctory taking of a swab leads, in itself, to no definite results, for experience shows that a ' positive " swab may be only a transient phenomenon, while, even in expert hands a negative swab 64 may be obtained from a superficial smear of the tonsil which, later, when sectioned, may show the organism deeply buried in the crypts of the tonsil. Undue reliance placed upon the bacteriological results of a swab has, of late, tended to delay the placing under treatment of persons with clinical signs, and it cannot be too strongly urged that suspicion of diphtheria demands, not swabbing, but the early administration of anti-toxin. Similarly, the practice of labelling a person showing one positive swab a "carrier" is to be deprecated, and dealing with him, in the absence of clinical symptoms, by hospitalization, is illogical. To constitute the "carrier" state, positive swabs would require to be obtained weekly for a period of at least four weeks and, in order to eliminate error, they would need to be taken from at least both tonsils, both nostrils and the back of the throat, and the results checked by a Schick and virulence test. Obviously this is impracticable except, perhaps, in exceptional cases; but if swabbing for diagnosis is to be relied upon, no less stringent measures than the above would be adequate. The detection of "Carriers," except in a "closed community," assists only by possibly leading to the discovery and subsequent eradication of any unhealthy condition in the nose or throat of the carrier. To the general community it brings little benefit, for the remaining population still remains susceptible to diphtheria or to becoming themselves carriers. The procedure of dealing widely with carriers amongst the general population is impracticable and its cultivation will not appreciably reduce the general incidence of the disease. In the home, supervision would be best met by Schick testing. Amongst those who are Schick negative a search might be made for carriers of virulent strains of the diphtheria organism. Those who are Schick positive might then be closely observed for the development of any signs of diphtheria with, later, their active immunisation if they escape the disease. It is now fairly generally agreed that active immunisation affords a method by which parents may protect their children from an attack of diphtheria. The Borough Council has established a clinic for this purpose and, with proper safeguards as adopted there, it may confidently be said that no risk attaches to the method. 65 The work of the Diphtheria Immunisation Clinic has been undertaken by Dr. Donnelly, who has very kindly furnished me with the following Report:— Schick testing and inoculation began in March, 1927. The figures for successive years are as follows :— Year. Positive. Nunibet of ! Negative. Schick Tests. Unknown Result. Total. Fully Inoculated. Partly Inocuialed. No. of Inoculations given. 1927 214 152 8 374 410 15 1233 1928 85 75 14 174 168 65 580 1929 21 27 7 55 72 15 221 The number treated in 1929 were markedly fewer than in 1928, when proportionately large numbers attended after the schools were circularised at the commencement. For the month of January, 1929 the figures were: New Schick Tests, 5; Inoculation, 18; Re-tests, 22; Examined, 22. In July, 1929, the numbers for the month were: New Schick Tests, 1; Inoculation, 7 ; Re-tests, 4; Examined, 4. The Medical Officer of Health re-circularised the schools and the film on the Prevention of Diphtheria was exhibited locally. This was followed by an increase in the number of attendances, and for the month of December, 1929, the figures were : New Schick Tests, 12; Inoculation, 20; Re-tests, 2 ; Examined, 2. Schick tests are performed 9 to 12 months after the completion of three inoculations, even in the case of children under 6 years. These are not tested in the first instance as the proportion of reaction is so high that inoculations are given without test. All re-tested who gave a plus reaction were re-inoculated. A record was kept of the Notifications of Diphtheria occurring in persons who had been inoculated; three cases were notified in 1927. In one of these, only one inoculation had been given, and that merely a week previous to the occurrence of the disease. In the second case E  Positive. Number of Sckick Re-tests. Total. Negative. Unknown Result. 1927 - — - - 1928 34 134 13 181 1929 8 55 3 66 66 only two inoculations had been given when the disease occurred a week later. In the third case the patient had had three inoculations, but disease occurred two months later, evidently before the protective effect of the inoculation had developed. This may require up to nine months or more. 12 cases were notified in 1928. In one of these the diagnosis was not confirmed. In a second, only one prophylactic injection had been received. In 2 others, disease occurred within 1 month of third inoculation. ” 2 ” ” ” ” 5 months ” ” 3 9 ” ” ” ” ” ” ” 3 ” ” ” after 9 ” ” ” Two of these were in one family. None of these cases had come for re-tests to see if inoculations had been successful. One case was notified in 1929, disease occurring within a week of second inoculation. We have received notification of the disease in only one case which gave a negative Schick Test. Small-Pox. The Borough has remained free from Small-pox since 1918 but, during the year 15 cases occurred. The supervision of Deptford residents, who were "contact " of cases in other boroughs, entailed considerable additional work. Such contacts, during the working week are usually kept under supervision by the Medical Officer of Health of the borough in which the place of work is situated. During the weekend or when otherwise absent from work, the duty devolves upon this Public Health Department. It was felt desirable to make Chickenpox a notifiable disease, and an Order was put into force making such notification compulsory for a period of six months as from the 1st December, 1929. During the month of December, 61 notifications of Chicken-pox were received. In one further instance the medical practitioner referred the case to the Medical Officer of Health and, in conjunction, a diagnosis of small-pox was arrived at. Vaccination. No vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. 6 7 Return made on or before the 9th of February, 1930, 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, 1928, inclusive :— Registration SubDistricts comprised in t he Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1928. Number of these Births duly entered by 31st Jan., 1930. No. of Births which on 31st Jan. 1930 remained unentered in the Vaccination Register on account of— No. of these births remaining on 1st Jan., 1930 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1929. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1929. 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 513 268 2 — 176 20 12 6 15 14 - - North Deptford 528 235 1 — 182 28 8 3 23 48 - - East Deptford 672 213 1 — 202 42 25 9 45 135 - - East* Greenwich 862 402 — — 238 39 15 18 38 94 - - West Greenwich. 290 139 1 — 82 16 6 5 11 30 - - Total 2865 1275 5 — 880 145 66 41 132 321 1389 945 Toals 1924 3715 1879 14 946 169 89 55 63 500 1864 1081 1925 3420 1533 5 — 1042 149 88 36 52 515 1651 1033 1926 3285 1469 11 — 1020 146 103 33 64 439 1644 897 1927 2994 1370 8 — 897 133 60 34 113 379 1571 • 1309 Dated February 3rd, 1930. Total Number of Certificates for Year 1929 sent to other Vaccination Officers, 149. 68 INFECTIOUS DISEASES OF THE NERVOUS SYSTEM. The incidence of Cerebro-spinal Meningitis, Acute Anterior Poliomyelitis and Encephalitis Lethargica is separately set forth below:— Cerebro-spinal Meningitis. During the decennium 1915-1924, the yearly notifications averaged three cases. The figures since then are as follows:— 1925 1926 1927 1928 1929 Cases 3 3 2 4 4 Deaths. 1 — — 4 2 Acute Poliomyelitis. The average number of notifications received between 1915-1924 was two. The corresponding figures since 1924 are as follows : — 1925 1926 1927 1928 1929 Cases 4 3 1 1 4 Deaths- - — — 1 Encephalitis Lethargica. During the five years terminating 1924 (in which year the incidence reached its peak) the average annual number of cases notified was three. The subsequent figures were:— 1925 1926 1927 1928 1929 Cases 9 8 3 3 3 Deaths 5 2 2 2 1 Enquiry did not reveal any evidence of case to case infection, and no second case originated in the same house. There is an unfortunate tendency to physical, moral or mental sequels, and all cases are periodically re-visited and treatment offered. Pneumonia. Both Acute Primary and Influenzal Pneumonia are notifiable, and a statement of the notifications received and deaths recorded are as follows:— No. of cases. No. of deaths (all forms of Pneumonia.) Death rate per 1,000 population. 1920-1924 (Avg.) 94 137 1.2 1925 153 114 1.0 1926 185 108 0.9 1927 197 120 1.0 1928 153 118 1.0 1929 172 146 1.3 69 Malaria. Made notifiable originally to give information of cases of soldiers who had contracted Malaria abroad, the number of cases decreases each year. Since the 1st January, 1928, Malaria, induced therapeutically, is notifiable if liable to recur. Average 1920-1924. 1925 1926 1927 1928 1929 Cases 8 5 8 6 1 Nil No deaths have been registered from this cause. Dysentery. The figures are as follows:- 1920-1924 (total) 1925 1926 1927 1928 1929 Cases 3 - 3 1 3 - Deaths - - 1 1 - Infantile Diarrhœa. Since 1920, this has been notifiable in the case of children undei two years of age, and the following are particulars of notifications received and deaths:- Average 1920-1924 1925 1926 1927 1928 1929 Cases 66 48 125 54 113 33 Deaths 28 12 19 8 20 17 All cases of Infantile Diarrhoea are investigated by the Health Visitors with the object of securing nursing assistance or hospital treatment where such is required. Insanitary conditions are passed to the District Sanitary Inspector to be dealt with. Puerperal Fever. The following is a tabular statement of the notifications and deaths in recent years. Year. Cases. Deaths. Death-rate per 1,000 births. Average 1915-1924 7 4 1.6 1925 17 7 3.2 1926 10 2 0.9 1927 2 - - 1928 10 7 3.8 1929 1 0.5 70 In accordance with the requirements of the Ministry of Health, the circumstances associated with any maternal death are ascertained and a confidential Report forwarded to the Ministry. It is understood that the object of these Reports is to obtain amass of information, hitherto not available, upon which the Maternal Mortality Committee, set up by the Ministry, may issue a Report upon any facts or conclusions derived from their study. Puerperal Pyrexia. Since 1st October, 1926, notification is compulsory in the case of any woman who, within 21 days subsequent to confinement, develops a temperature of 100-4° F. where such temperature continues for, or recurs within, a period of 24 hours. The notifications received have been as follows:— 1926 (part) 1927 1928 1929 Cases 5 16 12 6 Obviously, from the definition, such cases are frequently not due to any complication associated with confinement. All cases are enquired into and, where nursing assistance is required, such is made available. Ophthalmia Neonatorum. As from the 1st October, 1926, notification to the Medical Officer of Health of such cases became wholly the responsibility of the doctor in attendance, the midwife being required to call in medical assistance and to take such action as is laid down by the Central Midwives Board. The following is a statement of notifications rec eived:— Year 1926 (part) 1927 1928 1929 Cases 14 9 18 14 1 he following is a statement of the results of treatment in respect of the cases notified in 1929:- Vision Vision Since died Notified Treated unira- im- Total from At home In hospital paired paired blindness Causes 14 13 1 11 l _ 2 Operation pending. Apart from true cases of Ophthalmia, midwives have to report cases of inflammation of the eye, and these, together with cases of Ophthalmia, are kept under observation by the Health Visitors. The Borough 71 Council has made arrangements with certain local nursing organisations, viz., the Ranyard Nursing Association and the St. John the Divine Nurses, for a nurse to visit and carry out the treatment prescribed. Erysipelas. 52 cases were notified during the year, and there were 2 deaths. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. Other Notifiable Disease. With the exception of Tuberculosis, which occupies a separate section of this Report, no notifiable disease, other than the foregoing, occurred during 1929, with the exception of Measles, which ceased to be notifiable on the 31st March, and is therefore dealt with in the succeeding portion of the Report. II. NON-NOTIFIABLE DISEASES. In the absence of formal notification, the reports from the head teachers of schools and a perusal of the death returns give some idea of the prevalence of these diseases. Their importance, however, cannot be stated and judged by the death-rate, for they are peculiarly liable to be the precursors of much chronic disability and ill-health, the extent of which it is not possible to assess. This particularly applies to the following :— Influenza. The following indicates the mortality directly attributed to Influenza since 1920:— No. of Deaths. Percentage of total Deaths. Death rate per 1,000 population. Average 1920-1924 34 2.4 0.29 1925 34 2.5 0.29 1926 22 1.7 0.19 1927 39 2.9 0.34 1928 10 0.7 0.09 1929 70 4.7 0.63 During the early part of 1929, there was a fairly heavy incidence of Influenza, the death-rate for the first quarter rising to 2'1 per 1,000 population, a fact which had a considerable bearing on the increased annual death-rate from all causes. 72 Measles. As was expected, Measles became epidemic towards the end of the year. Steps had been taken, in collaboration with the London County Council, by which early information of suspected cases should be available in order that the Health Visitors might keep such under supervision with a view to the provision of nursing assistance, etc. In view of the decision arrived at in 1927, when the accommodation in ths Metropolitan Asylums Board's Hospitals for cases of Measles and Scarlet Fever was not found sufficient to permit of the reception of all cases of those diseases, a process of selection was adopted and admission granted only upon the recommendation of the Medical Officer of Health. It was not found necessary to adopt this method of selection until January, 1930. That Measles is a most important cause of death is overlooked, and the following statement of the mortality during recent years illustrates the point. No. of Deaths. Percentage of total Deaths. Death-rate per 1,000 population. Average 1915-1924 27 1.7 0.24 1925 31 2.2 0.27 1926 31 2.4 0.27 1927 — — —. 1928 30 2.2 0.27 1929 6 0.4 0.05 Prophylaxis ot Measles. In December, 1929, the Public Health Committee considered a report submitted by me dealing with the administration of serum of patients convalescent from Measles. It was submitted that there was accumulating evidence to show that the use of such serum in the case of young children would, if given after exposure to infection, either prevent or modify an attack of Measles. The Committee agreed to a supply of serum being made available for use by medical practitioners, who were accordingly notified to this effect. In the few instances in which the serum has been used, the results have been exceedingly satisfactory. Inasmuch as the early infectivity of Measles has so far precluded any effective control of spread, it would appear that the more extensive use of serum coupled with good nursing, constitute the most potent means we have of combating one of the most fatal diseases of early childhood. 73 Whoopi rig.Cough. Amongst infectious diseases, Whooping.cough is accountable for the greatest number of deaths in young children. The fatality in past years is as follows:— No. of Deaths. Percentage of total Deaths. Death.rate per 1,000 population. Average 1915-1924 24 1.5 0.22 1925 17 1.2 0.15 1926 5 0.4 0.04 1927 11 0.8 0.10 1928 15 1.1 0.13 1929 16 1.1 0.14 It cannot be too strongly urged that good nursing and the keeping of the child in a warm, well.ventilated room for a sufficient period still remains our most effective means of warding off the risk of pneumonia which so frequently leads up to death. Bacteriological Facilities. The Council's general bacteriological work is conducted at the Seamen's Hospital, Greenwich, while sputum for tubercle bacilli is ordinarily examined at the Tuberculosis Dispensary. The following is a summary of the work done:— Laboratory Work at Seamen's Hospital, Greenwich, 1929. Material. Total Specimens examined. Number Positive Number Negative Swabs for Diphtheria 1105 202 903 Sputum for Tuberculosis 121 16 105 Blood for Enteric Fever 4 1 3 Diphtheria, Guinea pig inoculation virulence for 1 1 - Pleural effusion 1 — 1 Swabs for meningococcus 1 — 1 Smear from eye 1 — 1 At the Tuberculosis Dispensary, 1015 specimens of sputum were examined. Of these, 692 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 323 specimens. 74 Disinfection. The following is a summary of the work carried out. Full details are shown in tabular form in the Appendix (Tables II and III). Number of premises visited: Infectious diseases 1379 „ ,, ,, Requests, rooms only 60 ,, ,, ,, ,, bedding only 66 „ ,, ,, Verminous 107 Total premises visited 1612 Number of rooms disinfected, formalin spray 1741 „ ,, ,, sulphur 174 Total 1915 Number of articles disinfected (steam disinfector) 15774 Number of books disinfected (formalin lamp) 478 ,, ,, articles destroyed at owners' request 368 Special disinfections, etc.:— 32 bales of rags, 1 bag of rubber (weight l£ tons). Small-pox disinfection—Dustbins collected and contents burned. Disinfection of bedding and clothing is carried out by means of two Washington-Lyons machines, books, etc., in a formalin chamber, while rooms are sprayed with formalin or fumigated with sulphur. Towards the close of the year, the Public Health Committee had under consideration the question of the substitution of motor transport for the horse-drawn vans now in use. Shelter for Contacts. The Council has made provision for the temporary accommodation of contacts of infectious disease who may have been required to leave their dwellings during the process of disinfection. The shelter was used for this purpose once during the year. Disinfestation. Verminous conditions, whether in the home, of wearing apparel or personal in character, come within the purview of the Council's activities. 75 So far as the structure of the house is affected, the procedure followed is in accordance with the provisions of the Public Health (London) Act, viz., cleansing by the owner, disinfection by the officers of the Borough Council, supplemented by the loan to the occupiers of a hand-spraying machine for the periodical application of an insecticide fluid. Clothing and bedding are disinfected by steam. For personal disinfestation, the Borough Council maintains a Cleansing Station and provides the services of a Cleansing Attendant. This station, by arrangement with the London County Council, is primarily used for school children. Male adults are occasionally provided with a cleansing bath in a separate structure. During the year, 7 adults and 1853 children were cleansed. Disinfectants. No routine supply of disinfectants for general purposes is made but, in the case of tuberculosis and other infectious diseases, a liquid preparation, having a guaranteed Rideal-Walker co-efficient of 18-20, is supplied upon request. The precautions prescribed in respect of blue fluted bottles and labelling are observed. III. OTHER DISEASES. Cancer. The incidence of Cancer is so intimately bound up with the sex and age distribution of the population that only a very general inference can be drawn from the following figures:— ] No. of Deaths. Percentage of total Deaths. Rate per 1,000 population. Average 1915-1924 133 8.5 1.2 1925 164 11.7 1.4 1926 159 12.2 1.4 1927 170 13.0 1.5 1928 152 11.2 1.4 1929 150 10.1 1.4 76 Deaths from Cancer by Sex and Age. Year Sex Under 25 years 25 to 45 years '45 to 65 years 65 to 75 years 75 years and upwards Total 1925 Male 1 9 44 20 13 87 Female —- 8 38 17 14 77 T otal 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 1929 Male 3 7 33 22 7 72 Female 1 8 47 14 8 78 Total 4 15 80 36 15 150 Diabetes. To meet the difficulty that some uninsured persons might experience in obtaining supplies of Insulin, the Borough Council decided to make such provision for necessitous persons. In one instance a supply was granted. Dental Sepsis. We are so accustomed to tabulating diseases under certain specified official headings that we are apt to think of them rather in terms descriptive of their fatal issues than of their causation. In Dental Sepsis, we have a condition which, viewed either from its prevalence or its potential power to initiate a departure from health, is of the very first importance. The popular view that disease of the teeth and gums is a purely local condition and, at the worst, subjects the patient to pain and 77 discomfort, is no longer tenable. The effects of Dental Sepsis are farreaching: thus, while infection may remain localised to neighbouring tissues, tonsils, etc., it may, by means of the blood stream equally reach any part of the body and be the determining cause of such varied conditions as skin affections, rheumatic infection, arthritis, dyspepsia, pernicious anaemia or heart disease. Even congenital malformations, due to injury of the placental blood vessels, may originate in a maternal blood infection of dental origin. It is not too much to say that Dental Sepsis is the commonest focal infection, and responsible for much of the disability and disease of adult life. It cannot be too strongly stressed that periodical dental inspection will do much to prevent such disability. Such facilities are afforded in connection with the Maternity and Child Welfare service, the London County Council school service and, later, as an additional benefit for a section of the uninsured population. Between school-leaving age and the age at which an insured person becomes eligible for dental treatment under the National Health Insurance Act, no provision for conservative dental treatment has been made. This gap of five years (in future four-and-a-half years) coincides with adolescent life when the incidence of dental caries is at its highest, and the desirability of making provision for dental care at this period is very obvious. Tuberculosis. 80 TUBERCULOSIS. The incidence of Tuberculosis, as judged by notification, has shown a progressive decline. The following is a tabular statement of the notification received:- Year. M. Pulmonary Total per 1.000 of Population. Non.Pulmc mary. Total per 1,000 of population F. M. F. Average 1920-1924 129 104 2.02 39 36 0.66 1925 133 104 2.04 41 37 0.67 1926 107 73 1.56 29 22 0.44 1927 112 88 1.76 30 32 0.54 1928 103 76 1.59 35 18 0.47 1929 118 89 1.86 27 20 0.42 The figures for the years 1923 onwards, are not strictly comparable with those of previous years as they include cases, although not formally notified, which have come to the knowledge of the Medical Officer of Health. The Death.rate in recent years has also fallen as indicated below. Year. England and Wales, per 1,000 population. Deptford. per 1,000 population. Pulmonary.* Non.pulmonarv. Pulmonary* Non.pulmonary. Average 1915-1924 0.99 0.29 1.17 0.28 1925 0.83 0.21 0.89 0.17 1926 0.77 0.19 0.79 0.11 1927 0.79 0.18 1.04 0.09 1928 0.75 0.17 0.95 0.21 1929 - — 0.81 0.10 The Scheme of the Borough Council for dealing with Tuberculosis has followed along former lines, and, under the capable guidance of Dr. N. M. Donnelly, the Tuberculosis Officer, has, during the past year, accomplished a great amount of work. The following is the text of Dr. Donnelly's Report for 1929:— I have pleasure in submitting herewith the Annual Report on Tuberculosis work in the Borough. Notifications. The following table gives a summary of the notifications received from 30th December, 1928 to the 28th December, 1929, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 238; 195 Pulmonary Tuberculosis and 43 Non.pulmonary, as compared with 166 Pulmonary and 47 Non.pulmonary for the previous year. * By international agreement, cases of miliary tuberculosis which, prior to 1926, were classified under "Pulmonary," are now included under "Non. pulmonary T uberculosis," 81 Report of Tuberculosis Officer—continued. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from the 30th December, 1928, to 28th December, 1929. Notifications on Form A Notifications on Form B. Number of Notifications on Form C Age Periods. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Cases admitted to 0.1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications Poor Law Institutions. Sanatoria. Under 5 5-10 10-15 Total Primary Notifications Pulmonary— Males .... 2 3 5 15 19 17 15 23 9 4 112 152 ... ... ... ... ... 73 95 Females ... . 2 5 12 22 22 11 6 2 1 83 123 ... ... ... ... 38 58 N on-Pulmonary Males ... 6 9 1 2 2 3 ... 1 1 ... 25 27 ... 1 ... ... ...1 3 12 Females ... 3 3 3 1 ... 4 2 1 ... ... 17 23 ... ... ... ... ... 5 12 82 Report of Tuberculosis Officei—continued. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, otherwise than by formal notification. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up Total Cases Pulmonary—Males ... 1 ... 1 ... ... 2 2 ... ... ... 6 „ Females 1 ... ... ... ... 1 4 ... ... ... ... 6 Non-Pulmonary—Males ... ... ... ... 1 ... ... ... ... ... ... 1 ,, —Females ... 2 1 ... ... ... ... ... ... ... ... 3 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. Pulmonary No. of Cases. Non-Pulmonary. Death Returns from local Registrars... 2 1 transferable deaths from Registrar-General 4 2 Posthumous notifications 3 1 " 1 ransfers " from other areas (other than transferable deaths) 3 - 83 Report of Tuberculosis Officer—continued. The number of deaths for the year is 101 as compared with 131 for 1928. 1928 1929 Pulmonary deaths 107 90 Non Pulmonary deaths 24 11 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 1929. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - 1 - - - 1 - - 1 3 - 6 5 1 - - - 5 3 2 10 4 1 - - 3 10 6 5 1 3 2 - - 3 15 15 12 3 1 7 4 1 - 20 19 23 2 - 7 5 - - 25 19 26 3 4 10 9 2 - 35 17 11 - 2 8 10 - - 45 23 6 1 1 12 3 - 1 55 9 2 1 - 7 3 - - 65 and upwards 4 1 - - - - - 1 Totals 118 89 27 20 55 35 3 8 *Note—Including 16 cases which came to the knowledge of the Medical Officer of Health otherwise than by notification. Pulmonary Tuberculosis. Interval between Notification and Death in 1929. Not notified 6 Died before notification 3 Died within one week of notification 7 ,, ,, one week to one month 1 ,, „ one month to three months 16 „ ,, three months to six months 12 „ ,, six months to one year 10 ,, ,, one to two years 10 ,, ,, two to three years 5 „ „ three to four years 4 ,, ,, four to five years 5 ,, ,, five to six years 1 „ ,, six to seven years 4 „ ,, seven years and upwards 6 90 f2 84 Report of Tuberculosis Officer—continued. Cases notified after the death of the patient are not now regarded as notified cases. Reminders have been sent to the doctors attending these un-notified cases and late notified cases calling their attention to their duty to notify all cases of Tuberculosis which they attend. The notifications of non-Pulmonary Tuberculosis were as follows:— Meningitis 4 Genito-urinary 2 Peripheral glands 13 Skin and other organs— Abdominal 7 Bones and joints 17 Total 43 Revision of Notification Register. During the year 215 cases of Pulmonary and 66 cases of Non-Pulmonary 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 1929 as follows:— males females Under 15 Over 15 Under 15 Over 15 Total Pulmonary Tuberculosis 46 324 39 259 668 Non-Pulmonary Tuberculosis 103 40 89 45 277 Totals 149 364 128 304 945 Disinfection was carried out in 355 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 85 Report of Tuberculosis Officer—continued. Analysis of Contacts of Cases Notified during the Year. Vale and St. Paul's Wards. Remainder of Borough. Primary Form "A" Notification (No. of Patients) 52 186 Of the above—seen at Dispensary 30 107 Diagnosis not confirmed 6 1 Diagnosis confirmed 24 106 Adults Children Adults Children Total Contacts of the cases seen at Dispensary 58 19 242 108 Number of these Contacts examined at the Dispensary 8 18 29 26 Cases not seen at Dispensary 22 79 Cases notified after death 3 4 Cases learned of from death returns - 5 Adults Children Adults Children Total Contacts of these three latter classes 48 35 198 97 Contacts examined at Dispensary 3 6 18 10 St. Paul's and Vale Wards. Of the three cases notified after death, one was a child aged 5 that died of Tuberculous Broncho-Pneumonia. In one, the diagnosis was not made until the post-mortem, and the third case was a child that died from disease affecting the abdominal glands. School Contact Cards sent to School 60 Class I. 16 Medical Officer Class II. 15 Medical umcer Class III. 29 Class I—An unsatisfactory case. Remainder of Borough. Of the four cases notified on, or after death, one was a case of Pulmonary Tuberculosis. Two were cases of Meningitis, and one of Peritonitis, which was not diagnosed until the postmortem. Of the five cases culled from death returns, one was a case of Meningitis in a child two years old. One was a case of Pulmonary disease diagnosed just before death. The other three cases were Pulmonary disease, given in one case as a Secondary cause of death. Class I. 9 School Contact Cards sent to School 87 Class II.11 Medical Officer Class III. 67 Class II-Apparently healthy. Class III—Not examined. 866 Report of Tuberculosis Officer—continued. Memo 37/t. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1929. Diagnosis. Pulmonary. Non-Polmonary. 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 65 49 7 4 5 2 17 9 70 51 24 13 (b) Doubtfully tuberculous - - - - - - - - 56 62 45 38 (c) Non-tuberculous - — — — — - — — 25 36 26 19 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 3 - 1 - - - - 2 3 - 1 (b) Doubtfully tuberculous - - - - - - - - 13 17 22 18 (c) Non-tuberculous - - - - - - - - 16 14 16 12 C.—Cases written off the Dispensary Register as (a) Cured 2 11 1 4 3 2 3 3 5 13 4 7 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases fied in error) - - - - - - - - 109 130 108 91 D.—Number of Persons on Dispensary Register on ember 31st:— (a) Diagnosis completed 237 158 19 20 24 26 46 37 261 184 65 57 (6) Diagnosis not completed - - - - - - - - 12 22 12 10 87 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 566 2. Number of patients transferred from other areas and of "lost sight of" cases returned 31 3. Number of patients transferred to other areas and cases "lost sight of" 95 4. Died during the year 64 5. Number of observation cases under A (b) and B (b) of Table in which period of observation exceeded 2 months 22 6. Number of attendances at the Dispensary (including Contacts) 2865 7. Number of attendances of non-pulmonary cases at Ortho- — pasdic 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 84 (b) Other special forms of treatment 91 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 58 10. Number of consultations with medical practitioners: — (a) At Homes of Applicants 14 (b) Otherwise 54 11. Number of other visits by Tuberculosis Officer to Homes 94 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2871 successful 2228 ; unsuccessful 643 Visits to cases not on Dispensary Register 1529 successful 1186; unsuccessful 343 13. Number of (a) Specimens of sputum, &c., examined for Dispensary patients 692 (b) Do. do. for non-Dispensary patients 323 (c) X-ray examinations made 113 14. Number of Insured persons on Dispensary Register on the 31st December 301 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 235 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 — (b) Form G.P. 36 81 88 Report of Tuberculosis Officer—continued. Notes on Table 1. In a circular issued at the end of the year the Minister of Health desired that cases in London which were accepted for Institutional Treatment by the London County Council on recommendations sent to them from hospitals or sources other than the Dispensary should be included in the Dispensary Register even though never seen at the Dispensary. Accordingly 22 cases accepted in 1929, and 53 cases of other years are included under headings A, B, D. A difficulty arises in this connection as sufficient information is not always given by the London County Council when bringing a case to the notice of the Tuberculosis Officer to enable him to classify correctly. In one such case accepted recently for treatment in sanatorium, no notification of Tuberculosis had been received by us. On writing to the hospital where the case originated we were informed that the case had not been considered tuberculous. The slightly smaller number of attendances at the Dispensary is largely accounted for by a more strict adherence to the Ministry of Health Memorandum which pointed out that insured patients, having panel doctors, should in the ordinary course obtain their nonresidential treatment from the panel doctor, and that unless referred by their doctor to the Dispensary, their attendance once yearly for examination at the Dispensary should suffice, the panel doctor having the duty to send a report quarterly to the Tuberculosis Officer. If the patient comes of his own accord to the Dispensary when a report is due from his doctor, that report is not as a rule asked for. Many patients who have just had institutional treatment and who progress satisfactorily do not keep regularly under the eye of their doctor though it is pointed out to them that their disease is not cured even though they have done well at sanatorium and that it is important they go regularly to the doctor until he tells 89 Report of Tuberculosis Officer—continued. them further treatment from him is unnecessary. When the doctor reports to this effect, the patient is requested to come to see the Tuberculosis Officer who communicates with the doctor and suggests further treatment if this seems desirable. The large decrease in the number of cases to which light treatment is given is due to the conclusion reached, that, except in cases of lupus or other tuberculous skin disease, light treatment is of decided benefit only when combined with conditions associated with sanatorium treatment. The London County Council now only approve of such treatment for special cases under dispensary schemes. The decrease in home visits by the Tuberculosis Officer is accounted for by two months during which extra duties were carried out in general public health work. It is satisfactory that the number of specimens of sputum examined for practitioners has increased over last year's figure by nearly 100. X-ray examinations have increased by 29. The number of G.P. 36 reports from practitioners about their tuberculous panel patients has increased by 44. If the doctor does not send his report when due and the patient has not recently attended the Dispensary, a form is sent to the doctor, with the patient's name and address, and a request to forward a report. The Medical Officer of Health sent during the year a special circular to panel doctors drawing their attention to the importance attached by the Minister of Health to the furnishing of these reports. As regards "contact examinations" the figures given of the numbers examined at the Dispensary do not represent the total of contacts examined as a result of the notification, and home visits, by the Tuberculosis Health Visitor, for some are examined 90 Report of Tuberculosis Officer—continued. by their own doctor, and in the case of school children, a large number of contacts who are not brought to the Dispensary are examined by the school doctor to whom information is sent of the occurrence of a case of tuberculosis in the family. 147 cards of school contacts were sent to the Medical Officer during the year. Of these, 96 had not been examined at the Dispensary. These children are examined at school and the contacts of a case with tubercle germs in the sputum are seen frequently. Many adult contacts frankly refuse to be examined, saying they will come if they feel anything wrong. It will be observed that only three of the contacts examined during the year were found to be tuberculous, but several child contacts who were found to be in poor health though showing no definite signs of tuberculosis were referred for a period of convalescent treatment, through the Invalid Children's Aid Association, or the Guardians, and thus assisted in the best way to fight any infection they might have acquired. Some contacts showing no signs of tuberculosis will probably in subsequent years develop definite disease, but the prolonged supervision of contacts for an indefinite number of years is difficult. The number would soon become too large for any adequate supervision, also families resent visits and enquiries being kept up, particularly when the original case has got quite well, or died, or removed. It is, morever, doubtful, that people who are unwilling to attend in the first instance would be more likely to attend subsequently, merely on the Visitor's recommendation that they should do so if out of sorts. In this connection an inquiry was made at the end of the year into the notifications of tuberculosis occurring amongst the contacts of cases notified in 1924, who had been seen at the Dispensary, and in whom the diagnosis was beyond doubt, tubercle bacilli having been present in the sputum. Of 236 notifications of 91 Report of Tuberculosis Officer—continued. (1924) pulmonary tuberculosis, 169 were seen at the Dispensary. In the case of 23 the diagnosis was not confirmed. 90 of them were known to have tubercle bacilli in the sputum, and of these 82 were seen at the Dispensary. In the case of 11 of these, tuberculosis was notified in another member of the family between 1924 and the end of 1929. Another tuberculous case, not seen at the Dispensary, had a contact notified subsequently. Two of the 1924-notifications were themselves contacts of previously known cases. It is interesting to note that of the 236 notifications 104 are now known to be dead. 92 93 Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a.) PULMONARY Annual Return showing in summary form the condition of all Patients whose according to the years in which the Patients first came under Public Medical Form A. TUBERCULOSIS. case records are in the possession of the Dispensary at the end of 1929, arranged Treatment for Pulmonary Tuberculosis, and their classification as shown on Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 1929 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. 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) (iroup 1 Group 2 Group 3 Total (Class T.B. plus) ALIVE Discharged as cured Adults M. 44 3 2 5 F. 59 3 2 l 6 Children M. 28 F. 21 Disease arrested Adults M. 14 3 18 21 1 l F. 15 4 5 9 2 I l Children M. 3 1 F. 7 1 Disease not arrested 1 Adults M. 2 2 19 9 30 7 5 12 4 16 7 23 3 4 20 3 27 15 6 27 8 41 F. 2 1 15 9 25 2 5 2 7 1 1 9 3 13 5 2 5 4 11 15 5 19 5 29 Children M. 1 1 2 5 2 2 F. 2 4 2 1 3 Condition not ascertained during the Year 25 ] 13 3 17 1 I 5 6 3 4 1 5 5 2 5 1 8 Lost sight of or otherwise removed from Dispensary Register 131 15 34 10 59 15 1 11 6 18 9 2 33 2 37 6 1 8 1 10 2 3 3 Dead Adults M. 6 2 12 25 39 3 16 20 36 1 7 17 24 1 10 9 19 5 4 9 F. 3 5 18 23 5 11 16 5 19 24 4 4 8 2 4 1 5 Children M. 1 1 2 1 1 1 F. Totals 360 35 126 76 237 30 3 50 44 97 23 3 74 49 126 22 9 52 22 83 40 11 60 20 91 94 95 Report of Tuberculosis Officer—continued. (b) NON-PULMONARY Annual Return showing in summary form the condition of all Patients whose according to the years in which the Patients first came under Public Medical TUBERCULOSIS. case records are in the possession of the Dispensary at the end of 1929, arranged 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 1929 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organg 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 Alive Discharged as cured Adults M. 5 1 2 l 9 F. 5 1 2 8 Children M. 4 4 27 35 F. 5 5 16 26 Disease arrested Adults M. 5 1 2 8 l 1 F. 1 1 1 1 1 1 Chlidren M. 3 2 6 11 l 1 F. 4 6 10 Disease not arrested Adults M. 2 1 3 2 2 1 1 2 1 3 4 3 3 F. 1 3 1 5 1 1 2 3 5 2 1 2 5 1 1 Children M. 4 1 5 2 2 2 2 4 2 2 4 6 3 9 F. 1 1 1 1 l 3 2 3 5 1 1 1 3 3 1 3 7 Transferred to Pulmonary 1 1 Condition not ascertained during the Year 8 3 11 3 3 6 1 2 2 1 6 2 2 Lost sight of or otherwise removed from Dispensary Register 25 9 5 36 75 2 2 3 6 13 1 1 2 2 3 5 Dead Adults M. 2 2 1 l 1 1 F. 1 1 1 1 Children M. F. Totals 74 23 13 101 211 11 3 4 12 30 10 3 2 10 25 9 6 8 3 26 1 9 3 1 7 20 96 Report of Tuberculosis Officer—continued. Deaths of Dispensary Patients, 1929 [i.e., persons suffering from tuberculosis). Died within 3 months of first attendance 7 ,, ,, 6 ,, ,, „ - 13 ,, 12 ,, ,, ,, 7 ,, over 12 ,, ,, ,, 35 62 Co-operation with Practitioners, School Authorities, County Council, etc. Co-operation with general medical practitioners by the use of "Z" cards, as explained previously, is continued. 56 "Z.l," 73 "Z.2," 6 "Z.3" and 13 "Z.4" cards were sent during the year under report. Of the new patients attending the Dispensary during the year, 177 were sent by doctors, 170 by the staff and 6 by school medical officers. 157 cases applied of their own accord and the balance were referred to the Dispensary from other sources. 3 patients, making in all 84 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 gives the best results. 272 Form C. IV progress reports about patients who had received institutional treatment through the County Council were sent to the County Medical Officer. 147 school contacts were referred on "M.O. 333" cards, to the school Medical Officer. 171 patients were recommended to the London County Council for institutional treatment. In 24 cases the County Council were unable to accept (of this number most had had such treatment previously). Institutional treatment was refused by the patient in ten instances. 97 Report of Tuberculosis Officer—continued. Home Accommodation of Notified Cases. Vale and St. Paul's Wards. 21 positive tuberculous cases. In one case there were 4 others in the room. „ „ 3 „ „ In three cases ,, 2 ,, ,, In only one case the patient had a separate room. In one case there were two others in the patient's bed. In only five cases the patient had a separate bed. Other Wards. 82 positive tuberculous cases. In one case there were 5 others in the room. In five cases ,, 3 ,, „ In eleven cases ,, 2 ,, ,, In twenty-nine cases the patient had a separate room. In three cases there were 2 others in the bed. In thirty-six cases the patient had a separate bed. Notes by The Medical Officer of Health. During the year certain branches of the work were reviewed by the Medical Officer of Health and the Tuberculosis Officer and, in some instances, slight modifications were adopted. Those reviewed comprised the following: Work of the Health Visitors. In order that full information should be available as to home contacts, sleeping arrangements, financial conditions, etc., the Record Cards were re-cast with a view to providing for a quarterly survey of the above. Issue of Sputum Flasks. If only from an educational point of view, the issue of a flask to every case of pulmonary tuberculosis seems to be desirable, and this is now carried out. Shelter. The purchase of an additional shelter was sanctioned by the Committee. Artificial Light Treatment. Ultra-violet Light treatment is provided by arrangement with the Miller Hospital and the London Hospital at a cost of Is. per exposure. g 98 Finsen Light treatment is arranged for at the London or St. Thomas Hospital at a cost of 5s. per treatment. Pneumothorax Refills. These are given at the Brompton Hospital at a cost of 10s. 6d. per refill. X-Ray Photographs. By arrangement with the Miller Hospital these are made and reported upon at a cost of 10s. 6d. per case. A slight increase in the Estimates has been made to cover an expected increase in the number of cases submitted. Extra Nourishment. Grants of milk and eggs were made to 49 persons. The extent to which this provision has been made does not indicate the number of persons requiring assistance, as the total permissible expenditure is a fixed sum equivalent to £2 per 1,000 persons in the population. Dental Treatment. The Borough Council provides the services of a Dental Surgeon, who attends weekly. Treatment is free but, in respect of the provision of dentures, persons able to contribute towards the cost are assessed by a sub-committee of the Public Health Committee in respect of any balance remaining after contributions from insurance societies or voluntary associations have been taken into account. Where the patient is on out-relief the Guardians have been asked to meet the cost. The income and expenditure in connection with the supply of dentures were as follows:— £ s. d. Total cost of dentures and repairs 87 12 0 Total cost of Free cases 24 8 7 Contributions from Approved Societies 23 4 5 ,, Guardians 12 4 0 ,, Red Cross Society 16 10 0 „ Patients 11 5 0 1 he Dental Surgeon, Mr. J. Eric Magraw, reports the following as a summary of the year's work:— Fillings. Cases. Extractions. Amalgam. Plastic. Scalings. Dentures. 58 105 29 16 115 38 99 Work of the Tuberculosis Care Committee. The Secretary, Miss B. Lewellin, has kindly furnished me with the following Report upon the work of the Care Committee:— Reviewing the work of the Tuberculosis Care Committee during the past year, a noticeable feature is the fact that we have received a very generous response to our appeals for help, chiefly from our local charitable organisations and public social services. All these may indeed be termed "friendly societies" in so far as we are concerned. We have worked in co-operation with the Red Cross Society, the British Legion and the United Services Fund Local Committee, the Charity Organisation Society, the Invalid Children's Aid Association, the Mayor's Fund, the Rotary Club, the Board of Guardians and the Children's School Care Committees, also a few outside societies have been approached successfully. Our first duty, which is a very great pleasure, is to tender our thanks to them. The financial and other assistance we obtain from these societies is practically the framework on which Care Committee work is built. To be effective we must remove whatever difficulty we find obstructing the path of medical treatment. Advice and sympathy are helpful, but quite often our advice our people could not follow unless backed by financial aid, and our sympathy comfort little unless we alter the state of things that move our pity, where we have the power to. 171 cases have been recommended for institutional treatment during the year. These have received individual attention from the Care Committee. Where there have been difficulties in the way which might have prevented patients accepting treatment, an endeavour has been made to solve them. It is seldom that a solution cannot be found. Amongst these is a girl who has been admitted to Papworth Colony with a view to eventual settlement. From reports received she is well and happy and hopes later to become a self-supporting settler, following her normal occupation, i.e., clerical work. Two others, boys, have been admitted to Burrow Hill Training Colony which the National Association for the Prevention of Tuberculosis has adapted with a view to providing suitable accommodation for youths from 14 to 19 years of age, who g2 100 require residential treatment for tuberculosis and who are suitable for technical training in gardening or clerical work. It is gratifying to be able to report such cases, as this specialised form of treatment, combined with training, is a definite provision for the future, and an indication that an attempt is being made to solve one of our biggest problems. 1197 visits have been paid to patients in their homes by the Secretary. 1313 interviews have taken place in the Care Committee's office in the Dispensary. 821 cases have been submitted to the Care Committee on the agendas. The volume of work these figures stand for can, perhaps, only be realised by those who have an inside knowledge of Care work. Details would fill many pages and cannot even be touched upon in a brief report. Remarks made in previous reports apply again. We have found no noticeable improvement in conditions or in the provision of accommodation for our patients. Movement in this direction is unavoidably slow, to the point almost of invisibility, and on the part of patients themselves there is still an amount of dangerous ignorance to contend with. To illustrate this we can quote the case of a mother who on her return home from a course of institutional treatment was induced to sleep alone in a little sitting-room rarely used. Calling one day we found that her baby, aged two, had been put to sleep on the unmade bed With the little face pressed into the pillow on which the mother had lain all night. We are glad to be able to report that this child has now been removed from contact with the mother through the application of the London County Council's boarding-out scheme. When reporting on this scheme we tend to become enthusiastic, the results to the children concerned are so beneficial and so far-reaching. This year only three children have been sent away, the lowest number since the scheme was started. We must explain that this is not due to the fact that interest is waning, 101 but simply that it has happened that in many cases where our patients have died this year there have been no young contacts. Others with such contacts have perhaps died in hospital, and the usual proportion has refused to agree to part with the children. We think of one case in particular where the father lay dying at home for months under poor and bad conditions ; repeated efforts were made to induce the parents to allow the children to be boarded out, without success. Seven months later one of the children, a girl aged 13 years, was notified as suffering from pulmonary tuberculosis. She was sent away for treatment immediately, but is now seriously ill, and it is considered very doubtful if she will recover. An example such as this is a complete justification of the scheme. In cases where the Council's scheme could not be applied, three children have been boarded out through the United Services Fund, and a number have been placed in the Guardians' homes, the reason generally being that the mothers would otherwise have been unable to go away for sanatorium treatment. A pleasing part of Care Committee work this year has been the further successful development of our Handicraft class which we now consider to be firmly established. Most of our work is sheer tragedy. Amongst it the class stands out as a gleam of sunshine heartening patients and workers alike. A separate report will be found elsewhere and we trust our readers will not miss it. A very brief outline of a few of the cases helped through the Committee this year may be of interest:— (1) Patient, a married man with one child, returned from a course of treatment. Owing to lack of accommodation he was obliged to continue to share a bedroom with his wife and child, space would not allow for the erection of a separate bed for him. A little later on an extra room became available which however was useless to our patient unless we could provide him with bed and bedding. This was obtained for him. (2) A young patient, recommended for sanatorium treatment, was visited. It was observed that the mother was in an extremely bad state of health and was quite unfitted for either home duties 102 or to give our patient the care and attention she required. It was ascertained that a complete rest and change would help her to regain her health. Steps to obtain the necessary grant to pay for convalescence were taken, and the woman was sent away for a period of six weeks. (3) An ex-service man with a small pension, who had worked up a little business round (selling magazines and books) had the opportunity of renting or buying a stationery lock-up stall, which would enable him to add to his business and increase his profits, which he took. A rent of 5s. a week was charged, as he could not pay a lump sum down to purchase. This came to the knowledge of the Care Committee who watched results for a period and found that from the beginning our patient had covered expenses and made a small profit. From a business point of view it was obviously foolish to continue to hire the stall as a sum which would amount to less than one year's rent would purchase it. On the recommendation of the Committee a loan of £10 was obtained from an ex-service men's organisation, and the stall was purchased, the Committee undertaking to collect a weekly refund of 5s. a week. Payments have been made regularly by the man and are now almost completed : when they are, his income will be increased by 5s. a week, and the stall will be his own. More than a mere financial gain has been achieved. The effect on the man, both physically and mentally, is very marked; the development of his little business has given him a big interest in life and made him, with his pension, completely self-supporting without undue strain. We must add that before action was taken it was ascertained that the case was a non-infectious one, that disease was considered to have been arrested, and that with reasonable care it might be assumed that he could keep fit to carry on his work. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take any action in relation to any tuberculous employee in the milk trade. 103 Handicraft Class. This has continued its good work during the year, and Dr. Donnelly has kindly supplied me with the following notes upon its present position and possible future extension:— The Handicraft Class continued throughout the year, and, though the membership has changed considerably, some patients giving up attendance, and others obtaining employment, still an accession of new cases kept the attendances more regular and up to a better level. A few constant attenders have acquired much skill in some crafts as the Instructress points out in her report. Arrangements have been made to hold, early in 1930, in a hall in the City, and in conjunction with other boroughs that have started Handicraft Classes, an exhibition of work. It is hoped in this way to sell some of the work already completed and get publicity and further orders. Patients are allowed to retain the difference, or greater part thereof, between the cost of the materials and the selling price, so that even though a living is not made from the work done, at least a useful supplement to the patients' means of existence is earned. The beneficial effects of this on the mind of a patient who is unfit for work, or unable to get a suitable occupation, is undoubted. In consequence, his bodily condition benefits and he is assisted towards the arrest of his disease. So far, as was pointed out in last year's report, we have been confined to the non-pulmonary case, or the pulmonary case with no germs present in the expectoration. The question of making use of the vacant plot at the rear of the Health Centre has been under consideration for some time. It has now been decided to erect here a workroom hut where the Handicraft Class can carry on its work, and patients can come at any time the Centre is open and proceed with their handicraft in suitable surroundings with all necessary appliances to hand. If arrangements can be made as to the teacher, the pulmonary case with tubercle germs in the sputum could also be instructed. As the percentage of "unfitfor-work" is highest amongst these, and the depressing effects of the disease most marked on them, such occupation should give them added assistance in their prolonged struggle to overcome their disease, and give them mental comfort even though fighting a losing battle. 104 Tuberculosis Handicraft Class. Receipts and Payments for two years from May, 1928 to April, 1930. Receipts. Payments. £ s. d. £ s. d. Deptford Boro' Council— Raw materials and tools purchased 102 9 2 1928 17 10 8 1929 10 0 0 Petty Cash expenses, cluding students' fees 5 17 11 27 10 3 Other subscriptions and donations 36 15 1 Balance in hand 11 3 5 Net proceeds of sales of articles made, after allowing for cost of making 55 5 3 £119 10 7 £119 10 7 Llew. J. Gill, 30th April, 1930. Hon. Treasurer. In addition to the cash balance in hand the value of materials and working tools in stock is estimated to be £14 14s. During the above period 284 articles were made. To the Instructress, Miss E. Malcolm Forth, I am indebted for the following description of the activities of the Class:— Our Deptford Handicraft Centre, 1929. In my experience as a teacher, by now quite respectable, I have found that newly-formed classes, especially those of a pioneer nature, like our "T.B." classes, need very careful nurturing in the early days of their existence. They need constant and unremitting attention to the attendance, which will tend to be unaccountably fitful, however good the teaching may be. That teaching will need to be superlatively good, but without some personal or spell-binding influence by the teacher, quite apart from the subject studied, it will not be enough. Even so, the class will threaten, now and then, to drop below the necessary number, and so out of existence. Active measures have to be taken, postcards written, students visited, and so on. Then in the life of a class, most usually in its second year, but sometimes even later, there comes a moment when the corner is turned, it begins to live of its own life, and carries its teacher 105 along with it. I do not mean that she (or he) may relax at all. Never, never, may anyone engaged in continuative educational work relax. I mean that the life of the class as a class will be secure, and the teacher's effort can now be concentrated on the work, the heightening of its standard, the refinement of its quality. Our Handicraft Class, at Deptford has, I think I may say, turned that corner, reached that point of secure and self-sustained life. Our students are keen and eager, the atmosphere of the workroom animated and cheerful. We are a success, and my chief concern now is to be always ready at the right moment with some new idea, some fresh craft, or variation of a craft, to be attacked with zest. The making of stools with sea-grass seats has been a favourite activity this year. The actual woodwork of the stools has to be provided, but it is finished, stained and polished by the students, who then weave seats of various patterns in "sea grass," either natural or coloured. The firmness of our seats is particularly satisfactory, because they are woven as carefully underneath as on top, and there is a code of honour as to knots. There are necessarily a good many knots, but none show. A specially pleasing development has been glove-making. One student showed herself to have a talent for creating charming hand-made gloves, and has had so many orders that she is now collecting round her a little group of women students, and they form quite an important little glove-making industry. The gloves they make are worthy of the most elegant hands. Leather-work still goes on. This craft is suffering from over-production all over London, and is rather in abeyance at the moment. Yet we have executed some interesting orders in leather-work, and are now trying out some new ideas in the material. Cane-work is the latest addition to our activities. It is one of the more satisfying of the crafts, and we have been making cane-edged tea trays, and numbers of tea-pot stands where coloured tiles are surrounded by a neat plait of cane. As I write, 106 we are beginning some waste-paper baskets, into which we propose to work sea-grass as a decoration for the cane. The students look forward with hope to the time when a workshop will be built for them on the spare ground behind the Health Centre. Many of them would do more if the restricted conditions in their homes did not prevent them. A workshop would solve this problem. As I pointed out last year, the London County Council does not permit me to deal with the "making things pay" part of the work. My job is to teach as well as I know how, and to communicate, with the teaching, a healthful, curative, tendency of mind. Mrs. Monk looks after the finances, as a labour of love, and when we have the workshop she will be able to prove, even more than she has done so far, that our Handicrafts Class can pay its own way. Maternity and Child Welfare. 108 MATERNITY AND CHILD WELFARE. The Deptford Borough Council's Scheme for Maternity and Child Welfare has been developed from the beginning upon carefully considered lines and, during 1929, certain additions to the service were made. Such included the provision of sterile accouchement outfits; extension of dental treatment; and compensation, subject to certain safeguards, to midwives in respect of parturient women sent to hospital. The chief activities of the scheme includes the following 1. The provision of a staff of Women Health Officers for, inter alia, domiciliary visiting in connection with expectant and nursing mothers and children, certain infectious or contagious diseases, maternal and infant deaths and still births, applications for admission to hospital or convalescent homes, the issue of milk and a variety of other duties not easily classified. 2. The provision, equipping and staffing of certain centres, including Infant, Ante-natal and Post-natal Clinics, Artificial Light and Dental treatment. 3. The maintenance of a Maternity Home and the provision of accommodation in hospital for certain maternity cases. 4. The provision of home nursing for certain mothers and children. 5. The provision of a "Home Help" at the time of confinement. 6. Accommodation in Convalescent Homes for Mothers and Children. 7. Hospital provision for certain infants. 8. The supplying of milk, either free or at a reduced price. 9. Health Education by means of addresses and the distribution of booklets and leaflets. 1. Health Visiting. 1 he following is a numerical summary of the home visits made by the individual Health Visitors and a statement of the reasons originating the visits. 109 Summary of Visits paid by Health Visitors, 1929. Wards (approximate) Deptford Park and Evelyn (part) St. Paul's and Evelyn (part) Vale and Clifton Canterbury and Hatcham Pepys and St. Catherine's St. Peter's St. John's, and Town Hall. Total. Miss Robus Visits 833 .. .. .. .. .. 833 Revisits 1647 .. .. .. .. .. 1647 Total 2480 .. .. .. .. .. 2480 Miss Little Visits .. 398 .. .. 398 .. 796 Revisits .. 611 .. .. 595 .. 1206 Total .. 1009 .. .. 993 .. 2002 Miss O'Loughlin (from July 1st onward) Visits .. 513 .. .. .. .. 513 Revisits .. 865 .. .. .. .. 865 Total .. 1378 .. .. .. .. 1378 Miss Smart Visits .. .. 786 .. .. .. 786 Revisits .. .. 783 .. .. .. 783 Total .. .. 1569 .. .. .. 1569 Miss Stowell Visits .. .. .. 676 .. .. 676 Revisits .. .. .. 2030 .. .. 2030 Total .. .. .. 2706 .. .. 2706 Miss Fudge (Jan. to May 23rd) Visits .. .. .. .. 235 .. 235 Revisits .. .. .. .. 724 .. 724 Total .. .. .. .. 959 .. 959 Miss Reynolds Visits .. .. .. .. .. 751 751 Revisits .. .. .. .. .. 1604 1604 Total .... .. .. .. .. 2355 2355 Miss Holland Visits .. .. 165 .. .. .. 165 Revisits .. .. 669 .. .. .. 669 Total .. .. 834 .. .. .. 834 Total Visits 833 911 951 676 633 751 4755 Revisits 1647 1476 1452 2030 1319 1604 9528 Total 2480 2387 2403 2706 1952 2355 14283 110 Analysis of Visits paid by Health Visitors, 1929. Visits. Re-visits. Total. Birth enquiries 1871 8192 10063 Still-birth enquiries 54 - 54 Visits re deaths under 1 year 120 - 120 „ ,, 1 to 5 years 58 - 58 Visits to expectant mothers 761 277 1038 ,, re Ophthalmia Neonatorum 24 43 67 ,, re Measles 262 93 355 ,, re Infantile Diarrhœa 32 25 57 ., re Puerperal Fever and Pyrexia 7 2 9 ,, re Pneumonia 36 29 65 ,, re Encephalitis Lethargica — 12 12 ,, re Poliomyelitis 2 6 8 ,, re Erysipelas 3 4 7 ,, re Cerebro-spinal Meningitis 1 1 2 ,, re. Influenza 6 - 6 „ re Scabies 14 17 31 „ re Verminous Children 15 5 20 ,, re Scarlet Fever recoveries 343 48 391 Miscellaneous visits 457 40 497 Unsuccessful visits 689 734 1423 Total 4,755 9,528 14,283 In the case of the 1,871 infants visited shortly after birth, it was found that 1,699 infants were being breast-fed and 64 partly breast fed. Only 108 were entirely hand-fed. 2. Welfare Centres. (a) Infant Welfare. There were, during 1929, seven Centres located in different parts of the Borough. One of these was a voluntary centre although the medical and nursing staff was provided by the Borough Council. At all the Centres, the work of those ladies who assist in a voluntary capacity is greatly appreciated and very helpful. 1ll The following is a summary of the work done at the various Infant Welfare Clinics during the year:— (For details, see Appendix, Table IV.) Clinic. No. of times open. New Cases. Total New Cases Total Old Cases Total New and Old Cases Consultations with Doctor Breast Fed Mixed Hand Ages 1-15 years Gosterwood Street 49 172 2 19 18 211 3058 3269 1434 Napier Street 49 137 8 19 20 184 3090 3274 1500 Besson Street 49 147 10 23 35 215 3876 4091 1490 Erlam Road 49 78 7 7 8 100 2056 2156 943 Goldsmiths' College 50 163 12 20 20 215 3667 3882 1521 Hales Street 51 115 1 21 33 170 2015 2185 1187 St. George's Hall 50 112 3 14 16 145 3094 3239 1233 Totals 347 924 43 123 150 1240 20856 22096 9308 The Health Visitors collectively made 672 attendances at these Clinics. St. Francis Hostel. Although no recognised Clinic is held at this Hostel (which accommodates women and children), Dr. Hill attends fortnightly and gives advice to those mothers desirous of having their children examined. (b) Maternity Clinics. These are conducted at the Health Centre, Harton Street. During the year, the service provided was reviewed. It was decided, amongst other things, to make provision for a more complete co-operation between Doctors and Midwives and the Antenatal Clinic. This was effected by the issue of a report by the Maternity and Child Welfare Officer, Dr. Hill, to the Doctor or Midwife sending the patient, the report dealing with the conditions found as a result of her preliminary examination. The Obstetrical Attendant was asked, in return, to inform Dr. Hill of any untoward effects resulting from the confinement. In view of the importance of ascertaining and dealing with any post-natal condition, one of the four maternity sessions is now more or less set aside for this branch of the work. 112 The growth in the work of the Ante-natal Clinic during recent years is illustrated by the following figures:— Year. No. of individual women attending. Average number of attendances per week. Total number of attendances made. 1922 311 19 938 1923 369 29 1439 1924 513 30 1497 1925 588 45 2268 1926 595 46 2292 1927 738 45 2241 1928 815 55 2777 1929 929 56 2915 The following is the text of Dr. Hill's Report for 1929:— ANTE-NATAL CLINIC. Until the end of February three sessions were held weekly, but owing to the increase in numbers, it was found necessary to start a fourth session on Friday afternoons, beginning the first week in March. As the total number of new cases, 750, represents over 50 per cent. of the births actually taking place in the Borough during the year, it is unlikely that there will be any considerable increase in future years, for there will always be a proportion of mothers who do not need to attend the Municipal Centre. Ante-Natal Clinic Statistics, 1929. Attendances during the year:— Number on Register 929 New Cases 750 Total Attendances 2,915 Normal pregnancies 171 Neuritis 1 Anaemia 43 Nipples, deformed 34 Albuminuria 107 Oedema 35 Ante-partum hæmorrhage 9 Pruritis 10 Acute phlebitis 4 Phthisis 1 113 Ante-Natal Clinic Statistics, 1929—continued. Bronchitis 6 Pyorrhœa 16 Cyst of Bartholini 1 Contracted pelvis 10 Chorea 1 Psoriasis 1 Dental caries only 315 Retroversion 1 ,, ,, with other defects Sciatica 11 Dyspepsia 15 Twins 5 Epilepsy 2 Varicose veins 75 Fibroids 4 External version 9 Glycosuria 5 Venereal disease 1 Goitre 1 Surgical Tuberculosis 1 Haemorrhoids 17 Excessive vomiting 55 Hernia 3 Referred to hospital 100 Hydramnios 20 Letters to doctors. 37 Ischio rectal abscess 1 „ Tuberculosis Officer 4 Leucorrhœa 37 ,, Midwives 158 Leucoplakia 2 Reports received from wives 25 Lameness 3 Malpresentations 28 Not pregnant 35 Morbus Cordis ... 19 34 per cent. of all cases required dental treatment. POST NATAL CLINIC. This is held on Wednesdays concurrently with one session of the Ante-natal Clinic. All patients delivered in the Maternity Home are asked to attend, but the number is necessarily limited. Number of patients 32 Total number of attendances 56 Of the 32 patients examined, two were found to be suffering from retroversion of the uterus, and were treated. The condition was, in both cases, possibly due to the fact that these mothers live in upper rooms, with no water supply, and are obliged to carry pails of water upstairs. H 114 (c) Artificial Light Clinic. Both the Mercury Vapour and the Arc Type of lamps are in use. All children given this form of treatment are selected upon medical grounds and are kept under careful supervision. The following is a statement of the year's work:— Month New Patients Patients Readmitted Patients Discharged Total on Register Attendance January 30 104 27 107 652 February 13 1 16 105 505 March 16 5 52 74 517 April 18 10 30 72 550 May 26 2 32 68 593 June 8 3 24 55 456 July 3 0 40 18 118 August — - — — — September 10 1 4 25 111 October 15 5 5 40 193 November 14 7 11 50 243 December 11 3 15 49 232 Total 164 141 256 49 4,170 Classification of Patients during Year. Admissions. Re-admissions. Total. Rickets 33 23 56 Malnutrition 42 30 72 Anaemia 23 35 58 Cervical Adenitis — 8 8 Muscular Weakness 25 21 46 Delayed Dentition 21 13 34 Anorexia — 1 1 Bronchitis 5 3 8 Delayed Walking 1 0 1 Debility - 3 3 Curved Tibia 5 1 6 Post Measles — 1 1 Post Br. Pnemonia 2 1 3 Insomnia 1 0 1 Eczema 1 0 1 Post Bronchitis 3 0 3 Genu Valgum 2 0 2 Abscess of Neck 0 1 1 164 141 305 115 Where more than one disease is exhibited by any individual child, the case is classified under the heading denoting the most important cause. In association with the Light Clinic, breathing and Swedish exercises are taught and massage is given. The Clinic is in charge of Miss Holland but steps have been taken to permit of all the other Health Visitors attending an intensive Course in Light Therapy with a view to their attending certain sessions at the Clinic. (d) Dental Clinic. The Clinic deals with such expectant and nursing mothers, and children as are referred from the Welfare Centres. As it was impossible to deal with all cases, an increase was made in the Estimates to provide for an extension of this service. The Dental Surgeon, Mr. J. Eric Magraw, has furnished me with the following details of the work in 1929:— Cases. Extractions. Fillings Silver Nitrate . Scalings, etc. Gas Cases. Mothers 68 248 31 60 — Children 39 54 6 116 10 In the case of the fillings for mothers, 22 were amalgam and 6 plastic. 3. The Maternity Home. The record of the Municipal Maternity Home shows that the work carried out during 1929 is on the same high level as in previous years. The following are the details supplied to me by Dr. Hill concerning the cases admitted during 1929:— Cases in Home on 1st January, 1929, 8. Cases admitted, 263. Average stay, Two weeks. Cases delivered by midwives, 251. ,, ,, ,, doctors, 10. Cases in which medical advice sought, 88. Cases notified as puerperal sepsis, Nil. Temperature rose above 100.4 for 24 hours, Nil. H2 116 Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Inflammation (eyes), Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. Infant deaths (a) Stillborn, 4. (b) Post-natal, 3. So far as is practicable, only cases likely to follow a normal course are admitted but, in order to meet the case of a sudden emergency, the Borough Council has an arrangement with King's College Hospital for the treatment of the patient in that institution. The Borough Council has further appointed Dr. W. Gilliatt, who is upon the staff of the King's College Hospital, as Consulting Obstetrician, and he sees cases in the Home with Dr. Hill, as and when required. During 1929, these arrangements were made use of in the following instances:- Dr. Gilliatt visited the Home once only in 1929, and the patient whom he was asked to see was removed to King's College Hospital where a Cæsarian Section was performed. One other patient was removed to King's College Hospital on Dr. Gilliatt's advice, and three others who had booked for the Maternity Home were admitted to the Hospital instead, owing to complications arising during pregnancy. The cases were:— 1. Very excessive œdema followed by puerperal insanity. 2. Hydramnios with anencephalic fœtus. 3 and 4. Malpresentation. Cases not admitted to the Maternity Home. During 1929, 122 applications for admission were refused owing to the available accommodation being fully booked. The Committee, during the year, considered the possibility of enlarging the Home, but were reluctantly obliged to defer the matter. 4. Provision of Home Nursing. Arrangements have been made for the provision of a District Nurse in certain types of illness. During the year 19 cases were nursed under the Maternity and Child Welfare Scheme at a total cost of £16 5s. 0d. Full details of these appear upon p. 31. 117 5. Provision of Home Helps. The scheme for this provision was reviewed during the year. In 5 instances Home Helps were provided for a total period of 32 weeks. The cost to the Council was £24 5s. 0d. 6. Convalescent Treatment. Provision has been made for the accommodation of mothers and children in certain recognised Convalescent Homes. During 1929, however, no cases were sent away at the Council's expense. 7. Hospital In-patient Accommodation for Infants. (a) Deptford Babies' Hospital, Albury Street. The Borough Council's Scheme provides for the treatment of delicate and marasmic infants in this hospital. The institution, as from the 1st April, 1930, will be subject to inspection by an officer of the Borough Council. During 1929 four infants were referred for treatment, the rate of payment being 6s. 6d. per patient per day. (b) St. Thomas' Babies' Hostel, Kennington. An arrangement exists between the Council and this institution for the reception of mothers and infants where difficulty in breast feeding is experienced. During the year nine cases were sent, the rate of payment being 30s. per week. While the results of treatment at St. Thomas' Hostel are eminently satisfactory, the distance from Deptford is a drawback to full use being made of the facilities afforded. The importance of breast feeding as the only way to give a baby a healthy start in life is too well known to require stressing and, to meet, if only to a slight extent, the need of mothers who cannot travel to Kennington or to the Cromwell House at Highgate, "Test Feeds " are conducted at the Town Hall. During 1929, 288 "Test Feeds" were so undertaken. Obviously, this procedure is necessarily limited and the need for a local Centre which could be used as a Breast-feeding Clinic is manifest. In this connection, Dr. Hill reports:— "The most urgent need is for a suitable home for mothers who are in difficulties with the feeding of young children. Unfortunately, there is often a critical period when the baby is 3 or 4 weeks old, when trivial causes may seriously interfere with lactation and mothers are often persuaded to start artificial 118 feeding on quite insufficient grounds. Many such cases are absolutely cured by a few days' rest: in others, where the trouble is more serious only skilled observation can put the matter right. Single "test feeds" give only a very rough idea as to the state of affairs. A centre near at hand, where the baby could be left if necessary, while the mother had an opportunity of going home between the feeds, would make the scientific method of the "test feed" available for a much larger number of difficult cases. Two or three beds for the admission of mothers whose real trouble was nervous exhaustion, etc., would certainly save a good many infants from being bottle fed." Should it be found possible, at some future date, to establish such a centre, the need, at times urgent, for temporary resident accommodation for infants whose mothers are unable to look after them owing to illness, or who, themselves requiring hospital treatment, would thus be enabled to enter an institution with the knowledge that the baby would be cared for in their absence. 8. Supply of Milk. The Borough Council's scheme provides for the issue of fluid and dried milk, at full cost, or free, or at half-cost, according to a Scale of Necessity, to (a) Expectant mothers during the last three months of pregnancy. (b) Nursing mothers. (c) Children up to three years, also, in exceptional circumstances, to children between three and five years of age. The issue is in accordance with the Minister of Health's Circular No. 185. During the year, arrangements were made for the various brands of dried milk issued, to be labelled specially to the Council's directions to avoid the use of Trade names. In 1929, the following free or half-price issues were authorised:— Fluid Milk 8,406 fortnightly supplies. Dried Milk 4,516 1 lb. packets. There can be no doubt that the Council's provision of milk provides much needed increased resistance to the debilitating effects of overcrowding and the other concomitants of intensive urbanisation. 119 9, Health Education. The primary consideration in the work of the Medical Officers at the Clinics and the Health Visitors in the homes is essentially that of education, the giving of advice to mothers upon the maintenance of their children's health. This is supplemented by periodical "talks" to mothers at the Welfare Centres, the special clinics and at the Antenatal Centre where instruction upon, and assistance in, the cutting out of infant garments is given. Various leaflets upon the feeding of children, the health of the mother before and after confinement, and common ailments are provided and, under the auspices of the Borough Council, a Deptford edition of the periodical Better Health is issued. Appendix. 122 Table 1. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1929. CAUSES OF DEATH. Sex. All Ages 0— 1— 2— 5— 15— 25— 45— 65— 75— All causes M 762 87 19 14 12 30 71 228 173 128 F 719 54 15 17 17 31 75 180 134 196 Enteric Fever M .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. 1 .. .. Smallpox M .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. Measles M 3 .. 2 1 .. .. .. .. .. .. F 3 .. 1 2 .. .. .. .. .. .. Scarlet Fever M 2 .. .. 1 1 .. .. .. .. .. F 2 .. .. 1 1 .. .. .. .. .. Whooping Cough M 3 2 .. 1 .. .. .. .. .. .. F 13 3 6 3 1 .. .. .. .. .. Diphtheria M 1 .. .. 1 .. .. .. .. .. .. F 2 .. .. .. 2 .. .. .. .. .. Influenza M 18 .. 1 .. .. .. 3 9 4 .. F 52 .. 1 .. .. 1 9 14 11 16 Encephalitis Lethargica M 1 .. .. .. .. .. .. .. 1 .. f 1 .. .. .. .. .. 1 .. .. .. Meningococcal meningitis M 2 2 .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system M 55 .. 1 1 2 14 18 19 .. .. F 35 1 .. .. .. 9 19 6 .. .. Other Tuberculous Diseases M 3 .. .. .. .. 1 2 .. .. .. F 8 .. .. 3 3 .. .. 1 1 .. Cancer, malignant disease M 72 .. .. .. 1 2 7 33 22 7 F 78 .. .. .. .. 1 8 47 14 8 Rheumatic Fever M 2 .. .. 1 1 .. .. .. .. .. F 2 .. .. .. 1 1 .. .. .. .. Diabetes M 5 .. .. .. .. .. .. 3 2 .. F 7 .. .. .. .. .. 1 4 1 1 Cerebral Hæmorrhage, &c. M 17 .. .. .. .. .. 3 8 5 1 F 30 .. .. .. .. .. .. 13 8 9 Heart Disease M 174 .. 1 .. 1 1 5 52 61 53 f 150 .. .. .. .. 6 16 34 45 49 Arterio-sclerosis M 41 .. .. .. .. .. .. 11 21 9 F 21 .. .. .. .. .. .. 4 4 13 Bronchitis M 48 3 .. .. .. .. 2 13 15 15 F 64 4 .. .. l .. 1 8 14 36 Pneumonia (all forms) M 90 18 12 4 2 2 10 21 13 8 F 56 13 6 5 2 2 2 9 3 14 Other Respiratory Diseases M 9 1 .. .. .. 1 .. 4 1 2 F 4 1 .. .. .. 1 .. 1 .. 1 Ulcer of Stomach or Duodenum M 18 .. .. .. .. 1 3 9 2 3 F 2 .. .. .. .. .. 1 1 .. .. Diarrhoea, &c. M 12 11 .. .. .. .. .. 1 .. .. F 10 6 .. .. .. 1 3 .. .. .. Appendicitis and Typhlitis M 7 .. .. .. .. 2 3 .. 1 1 F 2 .. .. .. 1 .. .. 1 .. .. Cirrhosis of Liver M 1 .. .. .. .. .. .. .. 1 .. F 2 • • .. .. .. .. .. .. 2 .. 123 Table 1—continued. CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5— 15— 25- 45- 65— 75— Acute and chronic Nephritis M 15 1 .. .. .. .. .. 5 8 1 F 16 1 .. .. .. .. 1 7 2 3 Puerperal Sepsis M .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. 1 .. .. .. Other accidents and diseases of Pregnancy and Parturition M .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. 1 .. .. .. Congenital Debility and Malformation, Premature Birth M 36 35 1 .. .. .. .. .. .. .. F 19 18 .. .. .. .. .. 1 .. .. Suicides M 7 .. .. .. .. 1 1 5 .. .. F 3 .. .. .. .. .. 2 .. 1 .. Other deaths from violence M 30 1 .. 1 3 4 8 7 2 4 F 22 .. .. 1 1 3 .. 7 7 3 Other defined diseases M 90 12 1 3 1 1 6 28 14 24 F 112 7 1 2 3 5 9 21 21 43 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. 124 Table II. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION OR DESTROYED AT OWNERS' REQUEST. 1929 Premises Visited Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Books Articles Destroyed (Owners' Request) Cleansing Station Infectious Diseases Requests D.B.C. Library Private Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Wearing Apparel Towels Blankets Total January 88 11 64 130 36 26 94 173 352 875 22 1 6 ... ... 1 ... ... 24 31 24 129 1 154 February 82 14 59 129 37 20 73 148 341 807 8 3 2 ... 3 6 1 1 5 18 10 120 7 137 March 104 10 72 162 46 27 108 197 751 1363 31 17 5 3 1 5 2 3 5 24 ... 193 ... 193 April 106 14 65 140 52 52 116 176 391 992 19 36 6 5 4 6 ... ... 50 71 ... 147 ... 147 May 89 11 45 118 35 24 70 118 316 726 14 2 2 10 3 5 2 4 78 104 ... 220 ... 220 June 94 12 64 140 41 29 125 136 450 985 21 107 1 1 ... 1 ... ... 40 43 ... 206 ... 206 July 105 13 72 158 60 36 133 119 412 990 11 2 2 2 3 3 ... ... ... 10 ... 164 ... 164 August 74 7 42 87 37 31 72 87 232 588 ... 1 ... 2 1 7 ... ... 36 46 ... 28 ... 28 September 124 11 91 190 64 32 153 149 422 1101 15 8 1 4 ... 1 ... ... ... 6 ... 202 ... 202 October 206 9 170 357 101 54 252 369 791 2094 42 36 ... ... ... 2 ... ... ... 2 ... 222 ... 222 November 172 8 115 249 77 47 190 293 717 1688 30 28 1 3 ... 1 ... ... 2 7 ... 200 ... 200 December 135 3 92 226 67 45 159 260 677 1526 26 8 ... ... ... 6 ... ... ... 6 29 134 3 166 1379 126 951 2086 653 423 1545 2225 5852 13735 239 249 26 30 15 44 5 8 240 368 63 1965 11 2039 125 Table III. SHOWING NUMBER OF ROOMS DISINFECTED. 1929 Scarlet Fever Diphtheria Pulmonary Tuberculosis Cancer Measles Small-Pox Scabies Whooping Cough Erysipelas Pneumonia Chicken Pox Typhoid Fever Cerebro-Spinal Meningitis Puerperal Fever Encephalitis Lethargica Gangrene Mumps Enteric Fever . Formalin Spray Fumigated Infectious Requests Total Rooms Verminous Premises Rooms R'ms. R'ms January 43 23 24 3 .. .. 3 3 1 4 1 .. .. .. .. .. .. 105 6 111 1 7 February 30 33 24 4 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. 94 12 106 2 2 March 48 33 25 .. .. 5 .. 2 .. 2 .. .. 2 1 .. .. .. .. 118 9 127 3 3 April 40 28 35 8 6 .. 3 7 1 2 .. .. .. .. 1 .. .. .. 131 8 139 10 13 May 33 22 39 3 2 .. 2 2 1 2 .. .. .. .. .. .. 1 .. 107 8 115 18 30 June 41 23 37 1 3 .. 5 1 .. .. .. 2 .. .. .. .. .. .. 113 4 117 5 8 July 51 28 51 2 1 .. 1 .. 1 .. .. .. .. .. 1 .. .. 1 137 15 152 18 30 August 49 20 31 .. 1 .. .. .. 4 .. 3 3 .. .. .. .. .. .. 111 5 116 9 18 September 64 35 23 .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 124 16 140 24 38 October 132 71 19 4 4 13 .. .. .. .. .. .. .. .. .. .. .. .. 243 4 247 12 18 November 95 61 26 1 6 4 1 .. 1 .. .. .. .. 1 .. .. .. .. 196 9 205 3 5 December 85 45 21 1 1 2 4 1 1 .. .. .. 1 .. .. 2 .. .. 164 2 166 2 2 711 422 355 27 25 24 19 16 9 8 7 6 6 2 2 2 1 1 1643 98 1741 107 174 126 Attendances at Clinics and Treatment Centres. GOSTERWOOD STREET CLINIC. 1929 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 16 .. .. .. 16 206 222 118 February 4 12 .. 2 1 15 200 215 99 March 4 23 .. 3 .. 26 240 266 129 April 4 22 .. 4 5 31 288 319 138 May 3 10 .. .. .. 10 226 236 102 June 4 12 .. 1 2 15 273 288 113 July 5 20 2 .. .. 22 351 373 154 August 3 8 .. 2 .. 10 199 209 81 September 5 20 .. 4 6 30 384 414 175 October 4 8 .. 1 1 10 289 299 125 November 4 14 .. 2 1 17 220 237 96 December 5 7 .. .. 2 9 182 191 104 Total 49 172 2 19 18 211 3058 3269 1434 NAPIER STREET CLINIC. 1929. 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 23 4 5 32 275 307 161 February 4 7 1 3 11 171 182 73 March 4 6 3 9 291 300 146 April 4 12 1 13 266 279 117 May 3 7 3 1 11 203 214 82 June 4 11 2 1 3 17 244 261 110 July 5 14 2 16 317 333 133 August 3 13 2 1 16 179 195 92 September 5 14 3 1 18 264 282 143 October 4 12 1 4 17 357 374 177 November 4 11 1 2 14 268 282 127 December 5 7 3 10 255 265 139 Total 49 137 8 19 20 184 3090 3274 1500 127 BESSON STREET CLINIC. 1929. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed Mixed. Hand. Ages 1-5. January 5 14 3 17 328 345 153 February 4 8 1 1 10 211 221 109 March 4 18 4 4 2 28 300 328 139 April 4 17 1 3 2 23 311 334 118 May 3 17 2 5 24 265 289 96 June 4 12 5 1 18 319 337 115 July 5 11 2 1 14 403 417 143 August 3 9 2 2 13 249 262 87 September 4 14 1 1 16 348 364 117 October 5 10 3 8 21 447 468 158 November 4 8 2 1 6 17 337 354 132 December 4 9 1 1 3 14 358 372 123 Total 49 147 10 23 35 215 3876 4091 1490 ERLAM ROAD CLINIC. 1929. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 4 4 179 183 92 February 4 1 1 2 89 91 47 March 4 10 1 11 149 160 76 April 3 7 2 1 10 138 148 72 May 4 8 1 9 180 189 73 June 4 4 1 1 6 185 191 82 July 5 8 4 12 196 208 88 August 4 10 2 1 13 165 178 72 September 4 6 2 8 201 209 91 October 5 11 2 13 254 267 111 November 4 3 1 1 5 182 187 78 December 3 6 1 7 138 145 61 Total 49 78 7 7 8 100 2056 2156 943 128 GOLDSMITHS' COLLEGE CLINIC. 1929. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 14 3 17 272 289 119 February 4 6 2 1 9 208 217 99 March 4 18 2 8 2 30 286 316 131 April 3 20 2 2 24 229 253 110 May 5 14 1 1 1 17 379 396 145 June 4 18 1 3 1 23 337 360 133 July 4 18 1 1 3 23 288 311 157 August 5 14 1 1 2 18 360 378 144 September 4 14 1 1 16 337 353 112 October 5 13 3 3 19 440 459 175 November 4 11 2 1 1 15 315 330 122 December 3 3 1 4 216 220 74 Total 50 163 12 20 20 215 3667 3882 1521 PRINCESS LOUISE INSTITUTE CLINIC, HALES STREET. 1929. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 11 3 2 16 206 222 126 February 4 6 2 5 13 140 153 17 March 3 3 1 1 5 120 125 87 April 4 8 1 3 4 16 137 153 94 May 5 11 3 14 208 222 127 June 4 12 4 16 172 188 114 July 4 12 1 13 150 163 103 August 5 12 3 15 177 192 102 September 4 12 2 2 16 148 164 114 October 5 8 5 2 15 212 227 105 November 4 15 3 5 23 190 213 104 December 4 5 2 1 8 155 163 94 Total 51 115 1 21 33 170 2015 2185 1187 129 ST. GEORGE'S HALL CLINIC. 1929. 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 14 220 234 93 February 4 13 2 15 225 240 87 March 4 7 7 257 264 90 April 4 17 4 3 24 258 282 109 May 5 6 1 2 4 13 328 341 102 June 4 5 1 2 8 220 228 85 July 4 11 2 3 2 18 216 234 97 August 5 12 3 2 17 314 331 117 September 4 6 6 293 299 109 October 4 9 1 1 11 277 288 135 November 5 11 11 327 338 151 December 3 1 1 159 160 58 Total 50 112 3 14 16 145 3094 3239 1233 INDEX. A PAGE Aged and Infirm Persons, Removal to Hospital 41 Agricultural Produce (Grading and Marking) Act, 1928 58 Ambulance Facilities 27 Area of Borough 10 Artificial Light Clinic 114-115 B Babies' Hospital, Albury Street 117 Bacteriological Work 73 Bakehouses 52 Births 14 „ illegitimate 15 ,, Notification of 15 c Cancer 75 Canal Boats Act, Inspector's Report 42 Cerebro-spinal Meningitis 68 Clinics and Treatment Centres 28 Condensed Milk Regulations 58 Convalescent Treatment 117 D Deaths 16 „ Table showing causes at different age periods 122-123 „ of Infants 18 Dental Clinic, Maternity and Child Welfare 115 „ Tuberculosis 98 Dental sepsis 76 ii. D—continued. PAGE Diabetes 76 Diarrhoea, Infantile 69 Disinfectants, supply of 75 Disinfection 74, 124, 125 Disinfestation 74 District Surveyor, co-operation with 42 Dried Milk Regulations 58 Dysentery 69 E Encephalitis Lethargica 68 Erysipelas 71 F Factories and Workshops 43 Fish Shops, Fried 52 Fish Curers 52 FOOD 50-58 Food Premises 50-52 ,, Imported 53 „ Unsound 55 ,, Poisoning 55 Food Sampling, Food and Drugs (Adulteration) Act 55-58 Foreword 5-7 Forth, Miss E. Malcolm, Report on Handicraft Class 104-106 H Handicraft Class for Tuberculous Patients, Report on 103-106 Health Education 119 HEALTH SERVICES, General Provision of 25-32 Health Visitors, Summary of Visits paid by 109-110 Home Helps 117 Home Nursing 31-116 House-to-house Inspections 38 HOUSING 45-48 iii. PAGE I Imported Food 53 Infant Welfare Centres, Summary of Work at 110-111 „ „ Tables showing attendances at 126-129 Infantile Mortality 20-22 „ „ Table 21 INFECTIOUS AND OTHER DISEASES 59-77 Influenza 71 L Legal Proceedings, general 39 „ Food and Drugs 58 „ Food Premises 55 Lewellin, Miss, Report of 99-102 M Malaria 69 Marriages 13 Maternal Sickness and Mortality 32 MATERNITY AND CHILD WELFARE COMMITTEE 3 MATERNITY AND CHILD WELFARE 107-119 Maternity Clinics 111-113 Maternity Home 115-116 Measles 72 „ Prophylaxis 72 Meat Premises 51 Milk, Graded 51 „ Bacteriological Examination 51 Milk Shops 50 ,, Supply of, to Necessitous Mothers and Infants 118 Mortuary, Public 23 N Nursing in the Home 31 iv. O PAGE Occupations, chief of population 11 Offensive Trades 40 Offensive Matter, conveyance through streets 40 Ophthalmia Neonatorum 70 P PHYSICAL FEATURES AND VITAL STATISTICS OF BOROUGH 10-24 Pneumonia 68 Poliomyelitis, acute 68 Population 10, 13 PUBLIC HEALTH COMMITTEE 3 Puerperal Fever 69 „ Pyrexia 70 R Rag and Bone dealers ... ... ... 40 Rateable Value ... ... ... 10 Rats and Mice (Destruction) Act ... ... 40 Refuse Collection ... ... ... 42 s SANITARY CIRCUMSTANCES OF THE BOROUGH ... ... ... 33-44 Sanitary Inspectors, work of, Table ... 35-37 Sewers, emanations from ... ... 41 „ and Drains, supervision of... ... 41 Sickness, Noteworthy causes of ... ... 22 Slaughterhouses ... ... ... 51 Smallpox ... ... ... ... 66 Smoke abatement ... ... ... 40 Social Conditions of Population ... ... H Staff of Public Health Department ... 29-31 St. Francis Hostel ... ... m St. Thomas's Hostel ... ... ... 117 Swimming Baths, examination of water ... 41 V. T PAGE TUBERCULOSIS 79-106 Tuberculosis Care Committee, work of 99-102 „ Handicraft Class, Report on 103-106 „ Summary of Notifications 81-82 „ New Cases and Deaths 83 „ Interval between Notification and Death 83 „ Revision of Register 84 „ Analysis of Contacts 85 „ Memo. 37 T., Table 1 86-87 „ Annual Return 92-95 „ Co-operation with Medical Practitioners, etc. 96 „ Home accommodation of Patients 97 „ Revision of Record Cards 97 „ Issue of Sputum Flasks 97 „ Shelter, purchase of 97 „ Artificial Light Treatment 97 „ Dental Treatment 98 V Vaccination Return 67 w Whooping Cough 73