Metropohtan Borough of Deptford. ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY F. LEONARD KEITH, m.d., Ch.b., d.p.h., l.d.s., Medical Officer of Health. 1931 DEPTFORD: Gaylard 8c Son, 446 New Cross Road, S.E. 14. Public Health Committee. Mayor. Councillor G. W. STRONG, J.P. Chairman. Councillor Mrs. B. M. DRAPPER, J.P. Vice=Chairman Councillor A. G. HOWARD. Councillor A. Aplin. Councillor F. B. Buttery. Councillor Mrs. A. A. Cheason. Councillor W. H. Green, J.P., L.C.C. Councillor Mrs. C. Rogers. Councillor E. C. Sherwood. Councillor W. Taylor. Councillor Mrs. G. Tiffen, J.P. Councillor Mrs. L. E. White. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. G. E. Green. Vice-Chairman. Councillor Mrs. M. Herlihy. Councillor Mrs. E. M. Bateman. Councillor A. J. Boyd. Councillor Mrs. A. A. Cheason. Councillor Mrs. B. M. Drapper, J.P. Councillor Mrs. C. Rogers. Councillor E. C. Sherwood. Councillor W. Taylor. Councillor Mrs. G. Tiffen, J.P. Councillor Mrs. L. E. White. a 2 Metropolitan Borough of Deptford. Public Health Department, Deptford Town Hall, S.E. 14. 5th April, 1932. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford, Mr. Mayor, Ladies and Gentlemen, I have the honour to present my third Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. In the absence of any means for obtaining accurate knowledge as to the extent and nature of illness amongst the population, it is customary, in order to form some general idea of the public health, to take into account certain figures obtained from the birth and death returns and infectious disease notifications. The birth-rate, which had steadily declined to 15.9 in 1930, showed a slight recovery in 1931, viz., to 16.3 per 1,000 population. The death-rate in 1931, as compared with 1930, showed a slight rise, viz., from 11.3 to 12.0 per 1,000 persons, a rise mainly attributable to respiratory diseases. This increase was not manifested amongst children during the first year of life, the death-rate amongst infants having fallen to the relatively low figure of 53 per 1,000 born—a record for the Borough. The incidence of infectious disease generally showed some decline, and the cases were mainly of a mild type with certain exceptions, notably Diphtheria, which showed a raised death-rate. In the section dealing with the sanitary circumstances of the Borough, the work of the Sanitary Inspectors is outlined. During 6 1931, the volume of work, whether judged by the number of inspections made or sanitary improvements effected, is the largest in the history of the Borough, and reflects great credit upon the Inspectorial Staff. The housing situation remains the same difficult problem. Continual vigilance is required to keep property—much of it suffering from the defects of age, bad house-planning and common use by two or more families—in an even reasonably habitable condition. The purity of food has been carefully guarded by the Food Inspector, while all Inspectors have contributed to ensuring that the food supply in the Borough is of a high standard. I should like to express to the members of the Borough Council my thanks for their continued interest and support; to Dr. Donnelly and Dr. Hill my appreciation of the high standard of the work achieved in their respective departments of Tuberculosis and Maternity and Child Welfare ; to the Staff generally my acknowledgment of their efficient and loyal assistance and, to my colleagues in other departments, my thanks for their friendly co-operation. Finally, I desire to acknowledge with gratitude the help of the Town Clerk, who has brought his ripe judgment and long experience of municipal affairs to bear upon many problems submitted to him. Your obedient Servant, F. Leonard Keith, Medical Officer of Health. Physical Features and Vital Statistics. 8 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 Camberwell 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-half miles. The altitude presents considerable variation, much of that portion of the Borough to the north of New Cross Road and Queen's Road being, on an average, only 15 feet above mean sea level, while the rest of the Borough 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. 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. Brookmill Road 1¼ acres Borough Council. 3. Telegraph Hill Recreation Ground. Telegraph Hill 452 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 During 1931, the Borough Council concluded negotiations for the tenancy of a further piece of land in Brookmill Road, for use as a recreation ground. Statistics. Area 1,564 acres Population: Census 1921 112,534 Estimated Resident population, 1931 107,200 Number of inhabited houses (1921) 18,122 Number of families or separate occupiers (1921) 28,007 Rateable Value (31.3.1931) £655,415 Estimated sum represented by a 1d. Rate £2,624 Number of inhabited houses (December, 1931) accord- to Rate Books 19,030 9 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 two 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 two Branch Libraries. 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. 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 Public Assistance Committee. The following figures have been kindly supplied to me by the Manager of the Deptford Labour Exchange:— Number of unemployed at 31st December, 1931:— Men, 4,711 Women, 720 Juveniles, 164. I am indebted to the Public Assistance Officer for the following figures (a) Total number of Deptford Residents, including wives and children, on outdoor relief during the week ended 26th December, 1931:— Unemployment 2,305 Other causes 3,109 5,414 10 (b) Amount expended on outdoor relief in Deptford during year ended 26th December, 1931:— £73,730 19s. 4d. 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 829. Of these, 787 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 42 persons, the same conditions being observed, the amount per head varied between 7s. 6d. and 10s. 6d. During the whole year 11,311 applications for fortnightly supplies were granted. Of this number, 10,565 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 health of a community, and the following extracts from the vital statistics is of interest in this connection : Births Male. Female. Total. Legitimate 851 839 1,690 Illegitimate 27 28 55 Birth-rale. 16.3 Still-births, 55. Rate per 1,000 total births, 30.6. Death-rate. Deaths 1,284 12.0 Percentage of total deaths occurring in Institutions 57 Number of women dying in, or in consequence of, childbirth: From Sepsis 4. From other causes 2. Death-rate of infants under one year of age, per 1,000 births : Legitimate 51 Illegitimate 127 Total 53 Deaths from Measles (all ages) 1 „ Whooping Cough (all ages) 11 „ Deaths from Diarrhœa (under 2 years) 9 11 Population. The population for 1931, as given by the Registrar-General, was 107,200, compared with 115,900 in 1925. One of the factors in bringing this about has been the number of families for whom the London County Council has provided accommodation upon their estates outside Deptford. Thus, during the last six years, 1,952 Deptford families have been so accommodated. A further factor contributing to the decrease has been the fall in the birth-rate, viz., from 18.8 in 1925, to 16.3 in 1931, although this reduction has to some slight extent been offset by the lower death-rate which has fallen from 12.1 in 1925 to 12.0 in 1931. Marriages. During the year 879 marriages took place, equivalent to a rate of 8.2 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 528 Other places of worship 90 In the Superintendent Registrar's Office 261 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 453 children born of Deptford parents outside the Borough, and the deduction of 59 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,745. This is equivalent to a birth-rate of 16.3 per 1,000 of the population and the second lowest on record, and represents only a natural increase of 4.3 per 1,000 of the population. The following table illustrates the steady fall that has taken place: BIRTHS. No. Deptford. England and Wales. County of London. Crude rate per 1,000 population. Crude rate per 1,000 population. 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 1930 1761 15.9 16.3 15.7 1931 1745 16.3 15.8 15.0 12 Still-Births. 55 still-births were registered during the year as follows:— Legitimate Il'egitimate Total Male 27 5 32 Female 22 1 23 Illegitimacy. The number of illegitimate births was equivalent to 3.4 per cent. of the total births. The figures relative to illegitimacy for previous years are as follows: Av. for 10 yrs. Av. for 5 yrs. 1915-1924. 1925-1929 1930 1931 No. of illegitimate births 77 58 59 55 Percentage of total births 2.9 3.0 3.4 3.2 Notification of Births. Registration of birth is compulsory within six weeks of birth, and, in addition, the Notification of Births Act, 1907 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 1931, the number of births to Deptford mothers (after allowing for inward and outward transfers) was registered as 1,745, and the number of notifications received of births actually occurring in the Borough was 1,324. The following is an analysis of these notifications: Births Notified in the Borough during Year 1931. Ward. Births notified. Alive Dead By whom notified Parent Doctor Midwife Other person Total Male Female Canterbury 92 51 41 91 1 1 20 71 Clifton 99 46 53 99 — — 38 61 Deptford Park 89 45 44 87 2 — 32 56 1 Evelyn 117 56 61 114 3 2 21 94 Hatcham 102 46 56 100 2 5 19 78 Pepys 61 35 26 60 1 6 21 34 St. Catherine's 44 22 22 43 1 2 23 18 1 St. John's 55 30 25 53 2 1 6 48 St. Paul's 203 109 94 200 3 1 19 183 St. Peter's 295 140 155 293 2 11 14 270 Town Hall 58 36 22 57 1 4 13 41 Vale 109 56 53 109 — 1 20 87 1 Totals 1324 672 652 1306 18 34 246 1041 3 13 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 622 Deduct deaths of "non-residents" 69 553 Add deaths of "residents" outside Borough 731 Nett deaths applicable 1,284 This is equivalent to a death-rate of 12.0 per 1,000 persons. Seasonal Mortality. Quarter ended. No. 1930 Rate per 1,000 of population. No. 1931 Rate per 1,000 of population. March 355 13.0 453 16.9 June 296 10.7 264 9.9 September 301 10.8 278 10.4 December 298 10.7 289 10.8 The trend of the death-rate in recent years is shown by the following table:— Year. Deptford England & Wales. London. No. 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 1930 1250 11.3 11.4 11.4 1931 1284 12.0 12.3 12.4 *Civilian population only from 1915-1920. 14 Deaths—Sex and Ward Distribution. Ward. Males. Females Children under 1 year. Total deaths. Deptford Park 47 37 6 84 Evelyn 76 64 15 140 St. Paul's 80 60 18 140 Vale 69 49 14 118 Clifton 58 41 6 99 Canterbury 48 51 3 99 Hatcham 75 60 4 135 Pepys 46 40 5 86 St. Catherine's 29 29 4 58 St. Peter's 37 53 1 90 St. John's 76 52 8 128 Town Hall 49 58 9 107 690 594 93 1284 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), 1931. Average No. for 10 years 1915-24. Average 1925-1929 1930 1931 Increase or decrease over 1930 Measles — 27 20 24 1 - 23 Whooping Cough 9 24 13 3 11 + 8 Diphtheria 9 19 14 4 12 + 8 Influenza 16 70 35 6 20 + 14 Tuberculosis—Pulmonary 78 136 102 113 100 - 13 Non-pulmonary 11 32 18 14 14 - Cancer 136 133 159 156 174 + 18 Heart Disease 251 128 232 298 322 + 24 Cerebral Haemorrhage, Embolism and Thrombosis 32 67 54 45 41 - 4 Bronchitis 43 140 95 47 55 + 8 Pneumonia (all forms) 88 154 121 73 113 + 40 Nephritis 24 35 34 44 31 + 13 Diarrhoea and Enteritis 11 45 20 19 14 - 5 Violence (excluding Suicides) 23 48 49 64 30 - 34 Premature Birth Malformation and Debility 35 86 49 40 45 + 5 15 The following Table expresses as percentages of the total mortality the incidence in the various age groups:— Average 1915-1924 Average 1925-1929 1930 1931 Under 1 year 16.3 9.4 8.6 7.2 From 1-2 years 4.7 2.7 1.8 1.6 ,, 2-5 years 4.3 2.8 2.5 2.0 ,, 5-15 years 3.9 2.9 2.3 2.2 ,, 15-25 years 4.4 4.3 5.5 4.3 ,, 25-45 years 12.3 10.5 11.1 10.2 ,, 45-65 years 23.3 27.7 26.0 28.6 65 years and upwards 30.8 39.6 42.2 43.8 The infantile mortality rate for 1931 was 53 per 1,000 births and the following Table gives the death-rates 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 -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 69 59 1928 139 76 65 67 1929 141 76 74 70 1930 107 61 60 59 1931 93 53 66 65 16 The following Table gives details of the causes of death in the various age groups:— Infantile Mortality, 1931. 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 1 months Total Deaths under 1 year. All Causes 25 3 2 .. 30 24 13 12 14 93 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 2 .. 2 4 Diphtheria and Croup .. .. .. .. .. .. .. .. 2 2 Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. .. .. .. .. .. 1 1 .. 2 Convulsions 1 .. .. .. 1 .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. .. .. Pneumonia (all forms) .. .. .. .. .. 7 5 10 7 29 Diarrhœa .. .. .. .. .. 1 1 .. .. 2 Enteritis .. .. .. .. .. 4 1 1 1 7 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. .. .. .. .. .. Injury at Birth 3 .. 1 .. 4 .. .. .. .. 4 Atelectasis 3 .. .. .. 3 1 .. .. .. 4 Congenital Malformations 3 1 .. .. 4 4 2 .. .. 10 Premature Birth 14 2 .. .. 16 2 .. .. .. 18 Atrophy, Debility, and Marasmus 1 .. 1 .. 2 5 1 .. 1 9 Other Causes .. .. .. .. .. .. .. .. 1 1 Totals 25 3 2 •• 30 24 13 12 14 93 Death-rate in each agegroup per 1,000 births 14 3 17 1.1 .. 17.2 13.8 74 6.9 8.0 53 Percentage of total deaths in each agegroup 26.9 3.2 2.2 .. 32.3 25.6 14.0 12.9 15.1 100 17 The following Tables illustrate the trend of infant mortality during recent years in regard to the deaths from different diseases in the various age groups. 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 1925-1929 27.0 6.1 3.5 3.0 39.6 18.4 13.8 13.5 14.7 1930 27.1 4.7 7.5 4.7 44.0 16.8 14.0 13.1 12.1 1931 26.9 3.2 2.2 — 32.3 25.6 14.0 12.9 15.1 Mortality (Stated as Percentages) from Certain Defined Causes. Causes. Under Four Weeks. Nine to Twelve Months. Avg. 1915-24 Avg. 1925-29 1930 1931 Avg. 1915-24 Avg. 1925-29 1930 1931 Measles .. .. .. .. 1.2 1.8 3.7 .. Whooping Cough .. 0.06 .. .. 1.6 1.6 0.9 4.3 Convulsions 1.9 2.7 0.9 1.1 0.4 0.7 .. .. Bronchitis 1.3 0.8 .. .. 1.1 0.3 .. .. Pneumonia fall forms) .. 1.2 0.5 1.9 .. 5 0 5 3 1 9 312 Diarrhoea & Enteritis 0.5 0.5 19 .. 22 1.3 . . 9.7 Injury at Birth 0.8 1.4 1.9 4.3 . . . . . . .. Congenital Malformations 2.3 4.2 2.8 43 0.1 0.4 0.9 6.5 Atrophy, Debility and Marasmus 5.8 4.4 11.2 2.2 0.2 0.1 .. 7.5 Premature Birth 17.1 17.5 15.9 17.2 .. .. • • 2.2 Special Noteworthy Causes of Sickness on Invalidity. In the absence of any system by which information of current illness is available recourse must be had to consideration of the preceding mortality tables. These show that, although yearly fluctuations occur, the most common causes of death, in descending sequence, are associated with the circulatory and 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 1931, in comparison with the average annual deaths in the decennium 1915-1924, has more than doubled. B 18 In 1931, in fact, heart disease accounted for 251 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 for urgent attention. Influenza, bronchitis, pneumonia and cancer showed an increase in 1931; pulmonary tuberculosis which, formerly, in Deptford ranked as the third, now occupies the fourth 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. Public Mortuary. During the year there were received the bodies of 340 persons who had been residents of the following districts:— Deptford 86 Bexley Heath 2 Greenwich 40 Chatham 1 Bermondsey 51 Becontree 1 Woolwich 81 Chislehurst 1 Lewisham 30 Welling, Kent 1 Camberwell 4 Chingford 1 Holborn 2 Croydon Hammersmith 1 Oldham, Lancs 1 Lambeth 3 Greece 1 Southwark 5 Erith 1 Stepney 2 Dartford 1 Poplar 6 Wimbledon 1 Paddington 1 Stroud Green 1 Hampstead 1 Sweden 2 Kensington 1 Tuffnell Park 1 Westminster 3 Unknown 2 East Ham 3 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. 310 231 109 217 191 21 3 2 Nil 19 In 121 cases no inquests were held, the necessary certificate being issued by the Coroner. The causes of death were as follows: Natural causes 201 Open verdicts 13 Accidental causes 97 Misadventure 1 Suicide while of unsound mind 28 Total 340 43 bodies were left at the Mortuary, after the inquest, to await burial, owing to advanced decomposition, or there being no accommodation at the respective homes. B2 General Provision of Health Services. 22 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 Assistant 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. (For Maternity Home and under Puerperal Fever and Pyrexia Regulations.) Obstetric Consultants. G. F. Gibberd, F.R.C.S. A. L.' Walker, 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. Public Vaccinators. Gavin A. E. ARGO, M.B., CH.B. J. Stanley Davies, M.A., M.B., C.M., L.M. J. S. Doyle, M.C., M.B., B.CH., B.A.O., D.P.H. Vaccination Officer. E. S. Elliott. Assistant Administrative Officer. Charles A. Chapman, Cert. S.I.E.B. (Lond). 23 Clerks. A. G. W. Pettitt G. A. Langley S. Burridge E. J. Elliott R. Wilson (Resigned Sept., 1931.) J. E. Waring (Appointed Oct., 1931.) General Assistant. E. H. Evans Sanitary Inspectors and Sampling Officers. Arthur G. Kemp Cert. R.S.I., S.I.E.B. (Lond.) Meat Cert. R.S.I. Frederick Hewett Cert. S.I.E.B. (Lond.), Meat Cert. R.S.I. Harry Allam Cert. R.S.I., 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. 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. H. E. Green Cert. R.S.I. Joint Board. ,, ,, ,, ,, (Meat). Health Visitors. Miss E. Holland General Training, C.M.B., H.V. Miss M. Little ,, ,, ,, 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 (Gen. Training, C.M.B., H.V., R.S.I.) Tuberculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. *Appointed as a Sanitary Inspector and Health Visitor. †Part-time only at Infant Welfare Centres. 24 Tuberculosis Health Visitors — Miss E. M. Porteus (Gen. Training, h.v., Tuberculosis Cert.) Miss A. M. Roy (Gen. Training, c.m.b., h.v., Tuberculosis Cert.) Dispenser Clerk—Miss G. F. Greig (Asst. Soc. Apothecaries, Cert. Bacteriology.) Assistant Clerk—Miss Irene Pull Caretaker Attendant—G. Abbott Municipal Maternity Home, 52 YVickham 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.) :1:Miss W. Phebey (General Training, c.m.b.) Resigned Apr., 1931. Miss K. M. Tidball (General Training, c.m.b.) Resigned Apr., 1931, Miss R. G. Miller Appointed Apr., 1931. Resigned Sept., 1931. Miss H. Alliston ( Do. do. ) Appointed May, 1931. Mrs. E. Grant ( Do. do. ) Appointed Oct., 1931. ♦Resigned, to study for Health Visitors' Certificate. Mortuary and Coroner's Court, Watson Street, S.E. 8. Mortuary Keeper—G. W. J. Wagner 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 :— The Queen's Nurses (part of Canterbury Ward). 'Hie Ranyard Nurses (the remainder of the Borough). The work is carried out in close co-operation with the Health Services of the Council, particularly 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 Is. 3d. per nursing visit. '25 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 2 12 2 Ophthalmia Neonatorum 14 294 14 Pneumonia 8 144 1 16 9 Whooping Cough 2 31 2 18 337 8 144 1 16 27 Mid wives. 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. Laboratory Facilities. See "Food" and "Infectious Diseases." HOSPITALS. Infectious Diseases. Under the provisions of the Local Government Act, 1929, hospital accommodation for the isolation and treatment of infectious diseases, including small-pox, is organised and maintained by the London County Council for the County of London as a whole. The South-Eastern Hospital, situated in Deptford, has 511 beds. Since the passing of the National Insurance Act, 1911 and other measures, hospital and sanatorium accommodation for Tuberculosis is similarly provided by the London County Council. Accommodation for infectious cases for those who can pay for such is available at the London Fever Hospital, Liverpool Road, N. 26 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, St. Alfege Hospital, St. Thomas' 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' Hostel, Prince's Road, Kennington, S.E., for dietetic treatment, restoration of breast milk, etc., at a charge of 30s. per week, or for " test feeds" at 5s. per day. In-patient and out-patient treatment is provided, generally, at such London hospitals as Vincent Square, Evelina and Great Ormond Street. Maternal Mortality. See "Maternity and Child Welfare" Institutional provision for Unmarried Mothers, Illegitimate Infants, etc. No provision. Ambulance Facilities. These were fully set out in my Report for 1930, and no material change in the arrangements has taken place. 27 clinics and treatment centres. Maternity & Child Welfare. Venereal Diseases. (l) Infant Consultations. Miller Hospital, Greenwich,S.E. 10. Daily from 2 p.m. Monday, Gosterwood Street Male and Female, Daily, Tuesday, Napier Street 8 a.m. to 8 p.m. Do. Besson Street Wednesday, Goldsmiths' College. St. John's Hospital, Morden Hill, Do. St. John's Hall, Lewisham, S.E. 13. Harton Street. Male and Female, Daily, † Thursday, Baptist Hall, Church St. 8 a.m. to 10 p.m. Thursday, Princess Louise Institute, Hales Street Guy's Hospital, St. Thomas Street, S.E. 1. Friday, St. George's Hall, Shardeloes Road. 9 a.m. to 8 p.m. Do. St. Mary's, Erlam Road. Health Centre, Harton St. King's College Hospital, Denmark Hill, S.E. 5. (2) Maternity Clinic. Tuesday Wednesday* Friday (9 a.m. to 1 p.m.) Various hours, daily, except Saturday. Thursday (from 2 p.m.) *Post Natal Cases. (3) Dental Inspection (monthly). School Clinics. ,, Treatment (weekly). (4) Artificial Sunlight Centre. Deptford Eye and School Minor Tuesday and Thursday. 2 p.m. Friday, 2 p.m. (By appointment.) Treatment Ailments Centre (Eye) (5) Diphtheria Immunisation Clinic. Deptford Green Do. Ear, Wednesday (2 p.m.) Minor Ailments Operations Monday, 2 p.m., at Cyril Henry Centre, Woolwich Tuberculosis Dispensary. Do. Skin Wednesday, 2 p.m. Health Centre, Harton Street. Ailments 20 Albury Teeth Monday, 9.30 a.m. and Monday & Thursday, 9.30 to 11 a.m. Men. 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, 9.30 a.m. 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. Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. †This new Clinic, provided and staffed by officers of the Borough Council, was opened on the 6th August, 1931. The accommodation consists of large hall with two side rooms. Since its inception the attendances registered have demonstrated its popularity. 28 Health Visiting. See "Maternity and Child Welfare." Children Act, 1908. The Borough Council is not the Local Authority under this Act. Sanitary Circumstances, etc., AND Factory and Workshops Acts. 30 Sanitary Work. With the submission of the "Summary of Sanitary Work" for the year 1931, I append the following notes:— Although figures cannot always be indicative of the actual work carried out, the following comparative information will, doubtless, be of interest:— 1929 1930 1931 Total primary inspections 5,825 8,004 7,592 Total re-inspections 14,545 18,167 . 20,461 Total Intimation Notices served 2,860 3,458 3,552 Total Statutory Notices served 302 1,078 1,104 Total Housing Act Notices served 3 42 12 Total Met. Management Act Notices served - 15 74 Total premises on which works were completed 2,831 3,855 3,941 Total improvements effected during the year 9,234 12,053 14,166 It was in September, 1929, that the present scheme was put into operation. In 1930, there was a striking increase over previous years in the number of premises inspected. The year which has just closed shows a slight decrease in these primary inspections, but upon closer scrutiny of the figures for the various sections, the fact comes to light that this reduction is confined almost wholly to " Infectious Disease" and " Miscellaneous " inspections, whilst the year's total in respect of House-to-house" inspections shows an important increase to the extent of nearly 700. As will be readily appreciated, this latter increase necessitates more intensive re-inspection, and this is demonstrated in an increase of some 2,300 re-inspections. To take this particular item a stage further, it will be noted that whilst the number of notices served is only slightly in advance of the previous year's totals, the " improvements effected " figure shows a very material increase, thus illustrating that, as would be expected in this particular section of sanitary work, the " inspection " is of a more thorough and extensive nature. A further point may be mentioned to illustrate the effect of the scheme in general " speeding-up." The Council will be aware that notices under the Housing Act have been applied for from time to time. The figure in the above report under this head as to notices served, may, therefore seem somewhat small. An intimation notice is served when the original inspection is made, but it should be noted, however, 31 that it is the practice of the Inspectors to make a re-inspection before serving the Housing Act notice, and in a great many instances it has been found that the work, as per the Intimation Notice, was already in hand, and the service of the Housing Act notice thus rendered unnecessary. A similar remark of course applies to the Statutory Notices, inasmuch as the number served is considerably less than the number applied for from time to time at Committee and Council meetings. As was pointed out last year, the inauguration of the Scheme enabled more time to be devoted by the Food Inspector to the inspection of food premises, slaughterhouses, St. George's Wharf, etc., and this closer supervision has been maintained, as his 2,281 inspections and re-inspections will indicate. 32 Summary of Sanitary Work carried out during the year 1931. Number of District. 1 2 3 4 5 6 7 Totals Comparative figures for 1930. Inspections- On complaint 108 116 120 156 213 133 10C 946 1003 House-to-house— 1. Where defects found 287 410 241 361 170 217 207 1893 1374 2. Where no defects found 153 95 47 119 69 97 66 646 381 3. Spec. Housing Investigation 190 155 345 ... On occurrence of Infection 14G 122 148 87 J 73 214 141 1031 1427 On Notice from builder 34 47 34 22 22 47 73 279 298 Reference from T. B. Dispensary 5 4 1 5 5 2 1 23 37 Market Inspection 14 14 14 13 13 10 13 91 87 Factories 6 23 15 10 9 12 4 79 122 Workshops 1 7 12 7 7 6 9 49 1 Q9 Workplaces 11 13 7 9 3 6 6 55 Ion Butchers' premises 2 2 1 3 8 ■ •. 16 \ Fish premises 28 39 13 38 44 46 52 260 1 242 Food premises (restaurants, etc.) 7 7 9 12 9 6 8 58 J Milk premises 24 61 62 25 35 39 9 255 189 Offensive businesses 7 3 • • . 10 1 Ice Cream premises 7 34 27 12 7 11 22 120 130 Bakehouses 20 25 9 24 27 14 21 140 115 Outworkers' premises 7 7 12 13 16 54 3 112 208 Miscellaneous inspections 198 180 120 135 115 192 244 1184 2258 Total inspections 1058 1204 1090 1207 940 1114 979 7592 8004 Re-inspections, Calls, etc. 3060 3316 2961 3452 2071 2358 3243 20461 18167 Smoke observations ... 14 1 ... ... ... 3 18 24 Notices Served- Intimation 510 597 422 664 403 517 439 3552 3458 Statutory 114 162 136 279 121 143 149 1104 1078 Under Metropolis Management 5 3 4 1 7 22 32 74 15 Act, 1855 Under Sec. 17 Housing Act, 1930 2 2 2 6 12 42 Premises in respect of which notices were complied with 589 667 439 672 433 578 563 3941 3855 Premises in respect of which works in compliance with notices served during the year 1931 were outstanding at the end of the year 53 50 53 71 35 I 1 62 21 345 371 Description of Sanitary Improvements effected during the year- Number of rooms, cleansed 1102 889 781 1172 731 419 706 5800 4658 Defective roofs repaired 98 184 147 140 82 136 83 870 1093 Dampness abated 95 74 60 159 73 86 51 598 538 Clutters or rainwater pipes provided or repaired 36 162 109 107 59 67 48 588 627 Yards and forecourts paved or paving repaired 39 90 93 84 37 52 64 459 408 Water Fittings repaired 11 17 11 27 9 21 20 116 85 33 Summary of Sanitary Work—continued. Number of District. Comparative figures for 1930. 1 2 3 4 5 6 7 Totals Drains entirely reconstructed 2 20 8 4 12 42 88 643 Drains partially reconstructed 15 10 3 12 8 12 29 89 Drains unstopped and cleansed 34 22 23 22 17 28 30 176 Soil and vent pipes renewed or repaired 10 7 8 10 4 20 44 103 Miscellaneous repairs, etc., to drainage 33 38 32 40 18 83 152 396 Premises in which repairs were effected to w.c's. 187 170 298 249 93 200 265 1462 1186 Dustbins provided 104 107 57 113 92 100 71 644 673 Repairs effected to windows 82 237 69 147 122 97 24 778 617 Stoves and coppers repaired 61 62 72 107 81 69 37 489 401 Sinks and waste-pipes repaired or renewed 33 114 47 145 64 24 128 555 294 Flooring repaired or renewed 12 32 85 46 35 50 41 301 252 Fish shops limewashed 20 24 5 27 22 28 39 165 104 Bakehouses limewashed 7 10 J 11 13 6 14 62 65 Ventilation and lighting improved 2 6 4 67 5 28 5 117 24 Offensive accumulations removed 2 2 10 9 3 7 7 40 48 Repairs effected to woodwork, (stairs, doors, etc.) 15 24 40 45 11 40 22 197 Miscellaneous repairs and improvements effected 10 13 6 11 8 14 11 73 337 Total repairs and improvements effected 2008 2296 1981 2758 1591 1599 1933 14166 12053 Reference to Districts. District No. Wards (approximate) Inspector. 1 Deptford Park and Clifton Inspector Allam. 2 Evelyn Ward ,, Mayor 3 St. Paul's (part) and St. John's (part) ,, Webster. 4 Vale and St. Paul's (part) ,, Hewett. 5 Canterbury and Hatcham (part) ,, Green. 6 Hatcham (part) Pepys and St. Catherine's ,, Kemp. 7 St. Peter's, St John's (part) and Town Hall ,, Mason. 84 House-to-House Inspections. 2,539 house-to-house inspections were made, exclusive of 345 special inspections made in connection with housing investigation in St. Paul's and Vale Wards. These inspections were carried out in the following streets:— Adolphus Street Kempslade Street Alvar Street Kenwood Avenue Baildon Street Lee Terrace Bawtree Road Leonidas Street Besson Street Lind Street Briant Street Lubbock Street Brookmill Road Lucas Street Bush Road Ludwick Road Childers Street Mary Ann's Buildings Chilton Street Martin's Buildings Clandon Street Napier Road Clyde Street Norfolk House Colwick Street Norval Street Cornbury Road Oldfield Road Corston Street Oscar Street Cranbrook Road Pomeroy Street Croft Street Reginald Square Crooke Road Rolt Street Dennetts Road Rose Cottages Dollings Place Royal Naval Place Eckington Gardens St. Nicholas Street Edale Road Sayes Street Edward Street Scawen Road Elm Terrace Selden Road Erlam Road Seymour Street Eaulkner Street Stanhope Street Ffinch Street Staunton Street Folkestone Gardens Strickland Street Friendly Street Upcot Street Glenville Grove Vanguard Street Grinling Place Wagner Street Hamilton Street Warwick Street Hanlon Street Watson Street Hereford Place Windmill Lane Heston Street Woodpecker Road Hoopwick Street Wotton Road Hosier Street Yeoman Street Hyde Street Zampa Road 35 Legal Proceedings. The following is a full list of legal proceedings instituted during the year under report, with the exception of those dealing with Food and Food premises, particulars of which will be found in a later section of this Report— Date Nature of Offence. Fine Costs Remarks. Public Health London) Act, 1891— 1931 Non compliance with statutory notice served in respect of- £ s. d. £ s. d. May 27 72 Cornbury Road 3 3 0 Works completed prior to hearing. Do. 74 Do. 27 40 Speedwell Street 3 3 0 Order made for execution of necessary works within 14 days. ,, 27 Dustbin Do. Dustbin provided prior to hearing. Summons withdrawn. June 22 35 Cornbury Road - 4 4 0 Order made for execution of necessary works within 7 days. 22 39 Do. „ 22 43 Do. „ 22 45 Do. „ 22 53 Do. „ 22 57 Do. ,, 22 59 Do. 22 61 Do. ,, 22 55 Do. Work completed prior to hearing. ,, 29 8 Hornshay Place 1 0 1 1 0 Do. ,, 22 40 Rollins Street 5 0 2 0 0 Do. „ 22 28 Canterbury Road - 3 3 0 Order made for execution of necessary works within 10 days. July 3 Dustbin, 2 Cottesbrooke St. - 1 1 c Order made for provision of dustbin within 2 dys. Oct. 13 .158 Edward Street 2 2 0 Order made for execution of necessary works within 3 days. „ 26 170 Lewisham High Road 2 2 0 Order made against occupier for execution of necessary work within 3 days. Second summons against owner dismissed (no costs), Nov. 9 170 Do (non-compliance with Magistrate's Order) 1 2 6 3 3 0 6 summonses issued in respect of 6 days' noncompliance. Work subsequently carried out by Borough Council. „ 23 12 Summer Street 2 6 Necessary works carried out prior to hearing. ,, 23 Dustbin, 12 Summer Street 2 6 3 9 0 Dustbin provided prior to hearing. ,, 23 Dustbin, 10 do. 2 6 Do. Dec. 9 95 Wickham Road 10 10 0 Order for execution of necessary work within 21 days. 36 Legal Proceedings—continued. Date. Nature of Offence. Fine. Costs. Remarks. London County Council By-laws. £ s. d. £ s. 1 d. Ap. 16 Alteration to drainage without notice to Sanitary Authority at 16 Tyrwhitt Road l 0 0 2 2 0 July 30 Removal of offensive matter through streets during prohibited hours 1 0 0 1 0 0 July 30 Do. (second offence) 1 0 0 Do. Do. (against driver) l 0 0 Do. Do ( do. ) I 0 0 Aug. 6 Carrying out drainage work without notice to Sanitary Authority at Brockley Wesleyan Church, Brockley Road I 0 0 2 2 0 London County Council (General Powers) Act, Section 28. Ap. 29 Removal of infirm person from 26 Eckington Gardens to hospital - - Order made for removal to St. Alfege's Hospital. Miscellaneous Matters. Smoke Abatement. The problem of nuisance from the emission of smoke is one constantly before the staff. During the year, 2 Notices were served with resulting improvement. The production of smoke is dependent in the main upon the imperfect combustion of the volatile matters in bituminous coal. Combustion to be efficient depends upon a sufficiently high temperature and a sufficiency of air. In the ordinary domestic use of coal, these conditions cannot be attained and, as a result, smoke is liberated. The injurious effects of smoke upon the human subject need not be enlarged upon ; in the case of the vegetable kingdom, experimentally it can be shown that the rate of growth diminishes as atmospheric pollution increases, while the damage to buildings owing to the tarry nature of the deposit and the disintegrating effect of the sulphurous acids evolved is well known. It seems curious that, while we have legislated for the purity of food and water and for healthy housing and workshop standards, 37 restriction of smoke emission is directed against only the factory chimney. Without opening the vexed question as to the ratio in which the factory and the domestic chimney contribute to the smoke nuisance, it cannot be gainsaid that the domestic use of coal plays a most important part in the pollution of the air. As this pollution conduces to respiratory catarrh, rickets, etc., and deprives us of the biological effect of light, it becomes a matter of self-interest to each of us to do what we can to effect its reduction by adopting smokeless methods of heating and cooking. Before reviewing which methods are available, consideration has to be given as to whether heating is required for short or for long periods. Electricity, which can reach its maximum efficiency (up to 100%) quickly, provides at once an excellent form of energy but one which, under the present system of supply, is prohibitive in price for workingclass homes if required over a long period for heating purposes. Gas, consumed in fires of modern construction, has an efficiency of over 50 %, attains its heating power rapidly, and provides a very cheap form of fuel especially where heat is wanted quickly and for a short time. Anthracite, although capable of being burned as an open fire, is chiefly used in the closed stove. Neither electricity nor anthracite stoves nor gas fires, however, meet the old-fashioned prejudice in favour of the open fire. Those wedded to this form of heating could, however, still indulge their inclinations while reducing their contribution to the smoke problem by using one of the smokeless fuels prepared by the process of low temperature carbonisation. A type of open fire which has many advantages is the gas-coke fire. There is, of course, the initial expense of installation, as substantial fire-brick insulation at the back and sides and widely spaced bars to ensure efficient draught are essential. Inset grates making such provision and having a gas-ignition burner attached are now on the market. Amongst the many advantages of such a fire may be mentioned the following:—labour saving, being easily ignited and requiring little subsequent attention ; when lit burns with a brilliant incandescence ; produces no fumes and being practically smokeless reduces the necessity for frequent redecoration and sweeping of chimneys ; is an excellent source of radiant heat and initiates good ventilation ; finally, provides one of the cheapest means for supplying heat over a long period. The installation of such fires is much to be desired. 38 Offensive Trades (other than Slaughterhouses). The following are the only instances in the Borough:— Skin Dressers, 2; Soap Boilers, 2; Fat Melters, 2. Only four premises are involved, as in two instances the same premises are registered for both soap-boiling and fat-melting. 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. No 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. It was found necessary to institute legal proceedings in respect of two contraventions of the By-laws during the year under report. Fines and costs amounting to £5 were inflicted. 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. Acting in conjunction with other local authorities, during the week ended 7th November, in what is known as National Rat Week, this Council's sewers were treated for the purpose of exterminating rats. From reports received it appears that considerable success attended these efforts. 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. It was found necessary to obtain an Order in one instance during the year, the person in question being removed to St. Alfege's Hospital. Swimming Baths. That water in Swimming Baths may act as a vehicle for the passage of infection is now well established and the 39 necessity for effective means to prevent this risk is manifest. At all the Baths maintained by the Borough Council a chlorination plant is installed and periodical sampling is conducted to ensure that a high standard of water purity is maintained. 3 samples were taken in 1931. Sewerage and Drainage. 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. 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 177 premises was reconstructed during the year, and in 176 premises the drains were unstopped and cleansed. Flooding. Certain portions of the Borough, notably the Clifton Hill area, are liable to flooding in times of heavy rainfall, but none occurred in 1931. Closet Accommodation. All closets are upon the water-carriage system with the exception of two earth closets, located in a position inaccessible to a sewer. Scavenging. All street refuse is swept and picked up by the sweepers working with orderly barrows and conveyed to street refuse bins. Its collection and removal to the shoot is by low-loading, ironcovered motor lorry. Street gullies are emptied by mechanical means. House Refuse. Storage is practically completely effected in movable ashbins. Removal, weekly as a rule, but bi-weekly in the case of certain large London County Council and other buildings, and certain restaurants and bakers' shops, is entirely done by motor transport, iron covered vehicles being used. Disposal is effected, under contract, by barge to Rainham. Street Improvement. Nuisance having arisen by reason of the defective condition of a footway known as Comet Place, the matter was reported to the Council, which authorised the carrying out of repair work. Rag Flock Acts, 1911 to 1928. No premises are known to exist which would fall within the purview of these Acts. 40 Co-operation with the District Surveyor. The Public Health Department continues to act in close co-operation with the District Surveyor. Water Certificates. The Borough Council was advised that Certificates in respect of an efficient water supply in 3 new premises could properly be granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. No certificates were applied for in connection with the above. 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 ending December 31st, 1931, that for the purposes of Canal Boat Inspection, I made sixteen visits on the following dates:— January 28th; February 3rd; March 12th and 25th; April 14th and 24th; May 26th; June 23rd; August 5th, 6th and 28th; September 21st; October 2nd and 13th; November 27th and December 11th. On February 3rd, one boat was found, viz.:— "Isis," Registered No. 46/1279. Registered at Berkhampstead, 22nd November, 1927. Two adults and three children on board. No infringements detected. 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, (Signed) W. F. Mayo, Canal Boats Inspector. 41 FACTORY AND WORKSHOPS ACTS. In conformity with Section 132, the following is an epitomised statement of the administration of these Acts:— Inspections. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories 150 5 - Workshops 672 22 - Workplaces 730 19 - Total 1552 46 - The types of premises inspected were as follows:— Type. Factories, Number. Workshops, Number. Workplaces, Number. Bakehouses 20 32 Chemical Work 2 5 Cinemas, etc. 7 Cord Makers 4 Dressmakers, Milliners, etc. 4 22 9 Engineering, general 30 ,, motoring 5 11 Foundries 6 Food preparation 14 235 10 Glass bottle makers 2 2 Laundries and Cleaners 4 11 Machine Belt Makers 2 Marine Stores 8 4 Paint and Varnish Works 5 Printers 5 1 Shoeing Forges 3 Stables, etc. 42 Sawmills 6 Timber Stores 1 13 Tar Refiners 3 Tailors 1 8 6 Toymakers 3 Woodwork (joiners, turners,&c.) 10 3 Woodchoppers 1 5 4 Whitening Manufacturers 3 Miscellaneous 61 46 40 Totals 188 396 135 42 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 18 17 - - Want of Ventilation 1 - - - Overcrowding - - - - Want of Drainage of Floors 3 1 - - Other Nuisances 36 31 1 - Sanitary Accommodation Insufficient - — - - Unsuitable or defective 10 10 — - Not Separate for Sexes - - - - 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 68 59 1 - The number of inspections made to Home Workers' Dwellings was 108. 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. Five Notices were served and the conditions remedied. Underground Bakehouses. It will be recollected that Borough Councils are not empowered to remove from the Register such underground bakehouses as have been properly registered but have become disused. Suggestions have been made that this power should be granted. Pending such legislation, steps have been taken to supply the District Surveyor with a list of all underground bakehouses with a request that, should structural alterations be proposed with a view to their being again used, he will notify the Borough Council to that effect. Housing. 44 HOUSING CONDITIONS. The population of 107,200 persons is housed on an area containing out of approximately 20,000 rateable hereditaments, 19,000 working and middle-class dwellings. Much of this is old property exhibiting such inherent defects as dampness, defective ventilation or lighting and lack or inadequate provision of sanitary conveniences, such as proper provision for food storage, washing, etc. A large proportion of the houses are occupied by two or more families, and such occupation increases the wear and tear upon property already, in many instances, structurally unsuited for the purpose. So long as houses are inhabited it is necessary to keep them in a habitable condition, and there is therefore an everincreasing responsibility placed upon the inspectorial staff to prevent property going further down hill. Overcrowding continues to be one of the most difficult problems encountered. Inasmuch as the increase in the number of families exceeds the increase in the number of separate dwellings, the need for additional housing accommodation becomes increasingly manifest. Any estimate of the number of houses required should therefore be based as much upon the family as a unit as upon the number of persons per room or house. Owing to the fact that all suitable building land in the borough is already built upon, alleviation of overcrowding is largely dependent upon vacancies being found upon the London County Council estates. The Valuer of the London County Council has kindly furnished me with the following figures relative to the number of Deptford families so accommodated:— From the 1st January to 31st December, 1931 — Families accommodated— (a) Preferentially on recommendation of the Borough Council 67 (b) From the London Council General List 169 Total 236 In accordance with the requirements of the Ministry of Health, the following is a tabular statement of the Housing Statistics for 1931. General. Number of houses erected during the year 3 (Dwellings over shops, 6, 8 and 10 New King Street) 45 1. Unfit Dwelling-houses. Inspection. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6207 (b) Number of inspections made 6352 (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated Regulations) 1925 2884 (b) Number of inspections made for this purpose 2884 (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 those in (3)) found not to be in all respects reasonably fit for human habitation 3511 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) 2808 3. Action under Statutory Powers. (A) Proceedings under Sees. 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 12 (2) Number of dwelling-houses which were rendered fit after service of formal Notice:— (1) Byowners 18 (2) By Local Authority in default of owners — *This figure includes 7 premises notices in respect of which were served in 1930 and complied with in 1931. (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) 1097 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices:— (a) By owners 1074 (b) By Local Authority in default of owners 1 46 (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made (2) Number of dwelling houses demolished in pursuance of Demolition Orders (D) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — (E) Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which Notices were served requiring repairs (2) Number of dwelling houses which were rendered fit after service of formal Notices (a) By Owners (b) 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 (F) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which Closing Orders were made (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling house having been rendered fit (3) Number of dwelling houses in respect of which Demolition Orders were made — (4) Number of dwelling houses demolished in pursuance of Demolition Orders — •In pursuance of Section 19 of the Housing Act, 1930, notice was served upon the owner-occupier of a shop with dwelling rooms over, which premises were unfit for human habitation and were not capable of being rendered so fit at a reasonable expense. Having in mind the fact that the demolition would involve the shop premises, the Borough Council accepted an undertaking from the owner occupier that the dwelling rooms would not be used for human habitation, and her signature was appended to a written agreement to that effect. Food. 48 INSPECTION AND SUPERVISION OF THE FOOD SUPPLY. This naturally falls under three headings:— I. Supervision of premises where food is stored, prepared, or from which it is sold or distributed. II. Examination of food as to its soundness. III. Sampling of food to determine its composition or sophistication. These duties are distributed amongst the members of the Inspectorial Staff and, although the Food Inspector is primarily responsible for the purity of the food, this duty, particularly in respect of milk and the soundness of food, is shared, but to a less degree, by all the Inspectors. Apart from considerations of purity and soundness, the possibility of contamination as affecting the wholesomeness of food demands consideration. The existing powers of control are mainly directed towards the cleanliness of premises and power to guard against contamination by persons handling food during its preparation, distribution and sale is either lacking or inadequate. The need for legislation to effect this end has been felt for a considerable time, and it is of interest to note that the London County Council has drafted a Bill to enable the Council to make by-laws for the general protection of food sold, exposed for sale, or prepared or deposited for sale or for preparation for sale. The following is a tabular statement of the visits made by Mr. Yates, Food Inspector:— No. of Visits. Visits made re complaints 1 Market inspection 60 Food premises 200 Fish premises 39 Milk premises 1 Slaughterhouses 278 Bakehouses 2 Butchers' premises 278 Miscellaneous 84 St. George's Wharf 164 Calls (Stalls, etc.) 1174 2281 49 I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 72 applications for registration (including 39 transfers) in respect of premises were granted during the year. At the end of the year there were 170 premises registered for the sale of milk. In addition to the above, 46 persons were registered for the sale of bottled sterilised milk only, and 5 persons or firms trading from premises outside the Borough were registered as purveyors within the Borough. One wholesale premises (Sterilised Milk) is also on the Register. There are no cow-houses in the Borough. During the year 256 inspections of milk shops were made and a general improvement in the conditions of storage has resulted. Five formal notices under the Public Health (London) Act, 1891, were served, and many minor matters were remedied as the result of verbal intimation by the Inspectors. Legal Proceedings (other than in connection with adulteration). Legal proceedings were instituted in respect of two unregistered premises at or from which milk was sold, with additional summonses in respect of three unregistered persons carrying on the business of purveyors of milk at these premises. Fines and costs amounting to £l were inflicted. 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 eight shops. One retailer whose premises are outside the Borough to sell Grade "A" (Tuberculin Tested) Milk within the Borough. One retailer whose premises are outside the Borough to sell Pasteurised Milk within the Borough. D 50 Bacteriological Examination of Milk. Eleven samples of Graded Milk were examined bacteriologically with the following results:— Designation. Total Count in 1 cc. Coliform Bacillus. Grade "A" Tuberculin Tested 800 Present in 1/100th cc. „ „ „ 1,900 „ „ „ 5,000 „ „ „ 117,900 „ „ „ 632,000 Present in l/100th cc. „ „ „ 439,000 Pasteurised 35,000 „ 77,200 „ 60,400 „ 13,000 „ 8,500 The results of such examinations were reported to the Ministry of Health, and, in the case of samples not within the standard, to the County Medical Officer concerned. Animal Inoculation. Eight samples of milk were submitted to the bacteriologist for the detection of Tubercle Bacilli (Guinea pig inoculation), all with negative results. 2. Meat Premises. (a) Slaughterhouses. There are two slaughterhouses in the Borough and these were kept under regular and efficient supervision, 278 visits having been paid. It is now found possible to inspect all Beasts and Pigs and the majority of Sheep slaughtered. 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. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 243 bullocks. 58 calves. 1813 sheep. 115 pigs. Destroyed—Surrendered at Slaughterhouses. Bullock's head and tongue 1. Bullock (entire) 1. Bullocks' pluck 2. Bullocks' liver 30. Bullocks' lungs 4. Calf (entire) 1. Crow fat, set 1. Pigs' lungs 2. Pigs (entire) 2. Pigs' pluck 2. Pig's liver 1. Sheep (entire) 1. Sheep's pluck 2. Sheep's liver 1. *These samples showed a microbic content above the Standard. 51 (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; 151 such inspections were made during the year. (c) Sausage Factories and other places where meat is used in the preparation of edible foodstuffs are kept under observation. 3. Other Food Premises. (a) Workshop Bakehouses. There are 29 such bakehouses in the Borough, 10 of which are underground. 96 inspections were made during the year. Apart from minor defects, remedied upon verbal intimation, 58 Notices were served for cleansing, and one intimation notice for the remedying of general defects. (b) Factory Bakehouses. These number 18, of which 3 are underground. 46 inspections were made, 36 Notices were served for cleansing and one for the remedying of general defects. (c) Fried Fish Shops and Fish Curers. The number kept under observation during the year was 44. 299 inspections were made, 176 Notices were served for cleansing, and 3 for general matters. (d) Ice Cream Premises. There were 138 separate premises recorded. To these, 120 visits were paid. Many verbal intimations were given regarding minor matters, and one intimation notice was served. Particular stress is laid upon instructions regarding the cleanly conduct of the business. (e) Other Premises. There are 194 miscellaneous premises connected with food preparation or sale, and 552 inspections were made to these. One Notice to remedy insanitary conditions was served, in addition to numerous verbal intimations regarding minor matters. (f) St. George's Wharf. Public Health (Imported Food) Regulations, 1925. D2 52 The year 1931, again saw an increase in the quantity of foodstuffs imported at the Wharf, and the following is a summary of the work done:— Description. Weight. Examination. Remarks. Fish (tinned) 627 cases 10 per cent. Fruit 2,638 „ 10 per cent. „ 250 „ Overside „ (tinned and bottled) 1,359 „ 10 per cent. 200 „ Overside Vegetables 6,791 „ 10 per cent. 99 2,480 „ Overside ,, (tinned) 2,885 „ 10 per cent. Grain foods 8,341 pks. 10 per cent. „ „ 13,587 pks. Overside „ „ 70 tons Overside Biscuits 1,061 cases 10 per cent. Cheese 114 cases 10 per cent. Chocolate 1,050 „ 10 per cent. Condensed Milk 6,897 „ 10 per cent. „ „ 86,077 „ Overside Confectionery 539 „ 10 per cent. Soup (packed) 6,064 ,, 10 per cent. Sugar 30 „ 10 per cent. Vinegar 24 barrels 10 per cent. Tallow 10 tons Hams 138 cases 10 per cent. „ 14 cwt. 10 per cent. Meat Extract 262 cases 10 per cent. Egg Yolk 2 „ 10 per cent. Pickles 2,042 „ 10 per cent. Preserves 4,911 „ 10 per cent. *No official certificate. Stopped, released for soap-making. 1 bag meat extract stopped, no official certificate. 1 case (80 lbs.) tinned fruit destroyed. 7 tons, 19 cwt. 1 qr. potatoes destroyed (1st Sept., 1931). II. Unsound Food. Regular supervision of all food premises and street traders is maintained. Such inspection achieves the object not only of preventing the sale of unsound food, but of stimulating traders to obtain their supplies of really good quality, thus raising the quality all round. Tradesmen are encouraged to seek the opinion of the Inspectors as to any food considered suspect, with a view to its surrender and destruction. 53 The following is a statement of such surrenders:— Apples 6 cwt. 3 qrs. Meat, various 1 cwt. 8 lbs. Bananas 7 lbs. Megrims 3 stones Bullock (entire) 1 Plums 3 stones Bullock's Head and tongue 1 Pigs (entire) 4 Pears 3 qrs. 12 lbs. Bullocks' Livers 40 Pigs' livers 2 Lungs 3 Pigs' plucks 4 „ Plucks 5 Plaice 4 stones Calf (entire) 1 Potatoes 8 tons, 19 cwt. 1 qr. Cauliflowers 56 lbs. Chickens 27 Rabbits 49 Dogfish 1 qr.20 lbs. Salt pork 24 lbs. Fruit, tinned 134 tins Sheep (entire) 1 pulp 80 lbs. Sheep's heads 2 Greengages 2½ cwt. Sheep's plucks 3 Herrings 6 cwt. 2 qrs. Skate 4½ stones Lamb (entire) 1 Tomatoes 3 cwt. Lamb 3 cwt. Whelks 3 cwt. Mackerel 1 cwt. 14 lbs. Legal Proceedings. (Other than those in respect of adulteration, particulars of which will be found in a succeeding Table). Date Offence. Fine. Costs. Remarks. £ s. d. £ s. d. 1931 Merchandise Marks Act, 1926 and Orders made thereunder— July 21 Exposing for sale Imported Tomatoes not properly marked 8 10 0 12 12 0 4 summonses „ Exposing for sale Imported Fresh Apples not properly marked Milk and Dairies Order, 1926— Aug. 31 (a) Non-registration as dairyman - 1 0 0 Dismissed on payment of costs. „ (b) Premises not registered as dairy (32 Tanners Hill) „ (c) Non-registration as dairyman (2nd person) Oct. '21 (a) Non-registration as dairyman 10 0 - „ (b) Premises not registered as dairy (44 Staunton Street) 10 0 „ „ Food Poisoning. No instance of food poisoning was brought to my notice during the year. 54 III. Food Sampling. Frequency of Sampling.—A total of 507 samples, formal and informal, were taken during the year, equivalent to 5 samples per 1,000 of the population. The following is a statement of the sampling done and results obtained in 1931:— Total. Number Adulterated. Percentage of samples adulterated. Formal samples 336 4 1.2% Informal samples 171 9 5.3% Total 507 13 2.6% The adulteration in respect of samples submitted for analysis daring the previous six years is as follows:— Year. Number of Samples taken. Percentage Adulterated. 1925 698 2.1 1926 552 1.3 1927 601 1.5 1928 604 1.8 1929 590 1.8 1930 550 3.5 The following is a statement of the samples purchased and submitted for analysis during 1931. 55 Food and Drugs (Adulteration) Act, 1928. Articles. Number Genuine. N umber Adulterated. Total. Percentage of Adulteration. Formal Samples— Almonds, Ground 1 .. 1 .. Beef, Corned 1 .. 1 .. Beef, Minced 1 .. 1 .. Butter 21 .. 21 .. Cheese 1 .. 1 .. Coffee 1 .. 1 .. Coconut, Desiccated 1 .. 1 .. Cream 1 .. 1 .. Cream, tinned 2 .. 2 .. Custard Powder 1 .. 1 .. Dripping 2 .. 2 .. Easter Egg 6 .. 6 .. Fish Paste 1 .. 1 .. Gin 3 .. 3 .. Ginger, Ground 2 .. 2 .. Jam 1 .. 1 .. Jelly, Table 1 .. 1 .. Lard 2 .. 2 .. Lemonade Crystals 1 .. 1 .. Lemonade Powder 4 .. 4 .. Margarine 5 .. 5 .. Milk 231 .. 232 0.4 ,, Separated 1 .. 1 .. ,, Sterilised 5 .. 5 .. ,, Condensed, full cream unsweetened 1 1 2 50.0 ,, Condensed, full cream sweetened 1 .. 1 .. ,, Condensed, machine skimmed 4 .. 4 .. Mustard 3 .. 3 .. Peas, tinned 1 .. 1 .. Pepper 3 .. 3 .. Raspberry Powder 1 .. 1 .. Sardines 1 .. 1 .. Sausages 4 .. 6 33.3 ,, Preserved 2 .. 2 .. Sherbet 3 .. 3 .. Sweets 3 .. 3 .. Vinegar 6 .. 6 .. Whisky 3 .. 3 .. Total Formal Samples 332 4 336 1 56 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Informal Samples— Beef 1 .. 1 .. Bismuth Tablets, B P. 2 .. 2 .. Bouillon Extract 1 .. 1 .. Butter 50 .. 50 .. Brawn 1 .. 1 .. Cake 1 .. 1 .. Camphorated Oil 1 .. 1 .. Cheese 1 .. 1 .. Cod Liver Oil with Extract of Malt 1 .. 1 .. Coffee 3 .. 3 .. Cream 6 .. 6 .. Custard Powder 1 .. 1 .. Dried Milk, full cream 4 .. 4 .. Dripping 6 .. 6 .. Faggots 1 .. 1 .. Pish Eggs, tinned 1 .. 1 .. Fish Paste .. .. 3 .. Ginger, Ground 4 .. 4 .. Grape Juice 1 .. 1 .. Grape Juice, solidified .. .. 1 100.0 Herbs, dried 3 .. 3 .. Herrings in Tomato Sauce 1 .. 1 .. Jam 5 .. 5 .. Lard 2 .. 2 .. Lamb Tongues 1 .. 1 .. Lemon Crush 1 .. 1 .. Lemon Curd 1 .. 1 .. Lemonade Powder 1 .. 1 .. Margarine 2 .. 2 .. Milk Food 1 .. 1 .. Mushrooms in Butter .. 4 4 100 Mussels 1 .. 1 .. Mustard 5 .. 5 .. Nutmeg, Ground 1 .. 1 .. Orangeade Powder 1 .. 1 .. Pepper 2 .. 2 .. Sauce 1 .. 1 .. Sausages 7 3 10 30.0 Sausages, preserved 2 .. 2 .. Sheep Tongues 1 .. 1 .. Shredded Suet with Rice Flour 1 .. 1 .. Soup, Dried 12 .. 12 .. Spice, Mixed 1 .. 1 .. Sweets 7 .. 7 .. Toilet Cream 1 .. 1 .. Vinegar 11 1 12 8.3 Wafers .. . 1 .. 1 .. Total Informal samples 162 9 171 5.3 57 Action Taken in regard to Formal Samples Purchased during the year 1931. Simple No. Article. Particulars of Adulteration or Infringement, Fine. Costs. Remarks. £ s. d. £ s. d. 62Y Condensed Milk: Full Cream, unsweetened 22 per cent. deficient in milk solids - 3 3 0 Dismissed on payment of costs. 109Y Sausages Boric Acid 6 3 grains per pound 1 0 0 3 3 0 110Y Sausages Sulphur dioxide GO parts per million - - Summons withdrawn Defendant deceased 11h Milk 5 per cent. milk fat abstracted. - 2 2 0 Dismissed on payment of costs. Action Taken in regard to Informal Samples. Article Particulars of Adulteration Remarks Grape Juice (solidified) Presence of Sulphur Dioxide 380 parts per million M.O. H. of area to which goods consigned, notified Mushrooms in Butter Presence of Copper Released for re-exportation Sausages Presence of Preservatives Subsequently formal samples taken (see above) Public Health (Preservatives, etc. in Food), 1925 to 1927. It was not found necessary to take any action under these Regulations. Artificial Cream Act, 1929. One factory for the manufacture of synthetic cream is situated in the Borough. Public Health (Condensed Milk) Regulations, 1923 to 1927. One sample of condensed, full cream (sweetened), and four samples of condensed, skimmed (sweetened) milk were taken for analysis and found to be genuine and properly labelled. Two samples of condensed, full cream unsweetened milk were taken, one of which was found to be 22 per cent. deficient in milk solids. Legal proceedings were instituted, the magistrate dismissing the case on payment by the defendant of £3 3s. costs. 58 Public Health (Dried Milk) Regulations, 1923 to 1927. One sample of dried milk, full cream, was taken informally and submitted for analysis, proving to be genuine and to conform in all respects with the provisions of the Dried Milk Regulations. Offences other than Adulteration, (l) Misdescription or Misrepresentation. Under the Agricultural Produce (Grading and Marking Act, 1928), Regulations have been formulated which permit of the application of Grade Designations to certain articles of food which comply with stated conditions of quality and size or weight. The duties of the Borough Council are mainly concerned with the marking of graded produce, and regular inspection is carried out to this end. Under the Merchandise Marks Act, various Orders in Council have been made dealing with the marking of imported goods, and tradesmen have been circularised as to their duty thereunder. Verbal intimation of infringements was given in a few instances, but in the case of one tradesman the circumstances necessitated legal proceedings involving the infliction of fines and costs upon the defendant, amounting to £20 12s. (2) Improper, or absence of, labelling. No cases were brought to notice. Chemical and Bacteriological Examinations. The chemical examination of food is carried out by the Public Analyst, Mr. Henry G. Harrison, M.A., F.I.C. By arrangement with the Seamen's Hospital, Greenwich, Dr. Arthur Davies, M.R.C.P., examines all specimens from a bacteriological standpoint. Nutrition- Dissemination of Knowledge. The diet suitable for infants and young children, and food values generally are dealt with through the Welfare Centres and by the circulation of the publication known as Better Health. Infectious and other Diseases. 60 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 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 1931. INCIDENCE AND MORTALITY BY AGE GROUPS. Notifiable Disease At all Ages Total Cases Notified. At Ages-Years TotalCases Removed to Hospital Total Deaths Deaths at Ages—Years Under 1 1 to 5 5 to 15 15 to 25 5 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 66 and up Smallpox 37 .. 3 10 10 8 6 .. 37 .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 264 9 94 104 28 25 3 1 263 12 2 7 2 1 .. .. .. Erysipelas 59 2 .. 7 4 7 27 12 34 2 .. .. .. .. 1 1 .. Scarlet Fever 442 7 120 253 39 20 3 .. 438 6 .. 4 .. 1 1 .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. .. 2 3 .. .. 5 .. .. .. .. .. .. .. .. Puerperal Pyrexia 17 .. .. .. 7 10 .. .. 15 .. .. .. .. .. .. .. .. Cerebro-Spinal Meningitis 1 1 .. .. .. .. .. .. 1 4 2 1 .. .. .. .. 1 Poliomyelitis and Polioencephalitis 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 21 21 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 26 14 12 .. .. .. .. .. .. 9 9 .. .. .. .. .. .. Acute Primary and Acute Influenzal Pneumonia 101 6 16 12 9 35 11 12 20 113 29 8 l 3 11 25 36 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dvsentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 152 7 43 88 12 2 .. .. .. .. .. .. .. .. .. .. .. Totals 1128 68 288 474 111 112 50 25 818 146 42 20 3 5 13 26 37 The deaths from Pneumonia include all forms of that disease, including many cases not notifiable as "Acute." 61 SEASONAL INCIDENCE OF NOTIFIABLE INFECTIOUS DISEASES. Disease. 1st quarter 2nd quarter 3rd quarter 4th quarter Total for year Smallpox 15 19 ... 3 37 Diphtheria 97 67 57 43 264 Erysipelas 17 17 12 13 59 Scarlet Fever 111 101 84 146 442 Enteric Fever ... ... ... 2 2 Puerperal Fever 3 1 ... 1 5 Puerperal Pyrexia 5 6 2 4 17 Cerebro-spinal Meningitis 1 ... ... ... 1 Poliomyelitis ... ... ... 1 1 Ophthalmia Neonatorum 4 3 8 6 21 Infantile Diarrhœa, etc. 1 5 15 5 26 Acute Primary and Influenzal Pneumonia 40 19 8 34 101 Encephalitis Lethargica ... ... ... ... ... Chicken Pox 45 52 32 23 152 Malaria ... ... ... ... ... Totals 339 290 218 281 1128 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 „ 1925-29 444 4.0 2.4 0.54 1930 571 5.1 3 0.5 1931 442 4.1 6 1.3 Scarlet Fever, during 1932, showed some increase in virulence. The great majority of cases, however, were of the mild type seen of recent years. In such, the rash is frequently of so mild a character that it is not until desquamation occurs that a definite diagnosis is made. 62 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1930. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Debtford Park Evelyn St. Paul's Vale Clifton Canterbury Hatcham Pepys St. Catherine's St. Peter's St. John's Town Hall Smallpox 37 2 4 21 .. .. .. l .. l 4 3 l Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 264 19 28 22 20 21 28 41 21 8 9 18 29 Erysipelas 59 3 3 9 6 2 7 9 .. 5 3 6 6 Scarlet Fever 442 31 54 42 18 31 39 92 19 41 20 19 36 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 1 .. .. .. .. .. .. .. .. .. .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. 2 1 .. .. 1 1 .. .. .. .. .. Puerperal Pyrexia 17 5 .. 3 1 3 .. .. .. 1 1 .. 1 Cerebro-Spinal Meningitis 1 .. 1 .. .. .. .. .. .. .. .. .. .. Poliomyelitis and Polioencephalitis 1 .. .. .. .. .. 1 .. .. .. .. .. .. Ophthalmia Neonatorum 21 3 1 5 4 .. 1 .. .. 1 2 2 2 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 26 .. 2 18 6 .. .. .. .. .. .. .. .. Acute Primary and Acute Influenzal Pneumonia 101 12 8 14 7 11 9 17 7 4 2 6 4 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 152 19 10 17 6 13 10 7 22 20 10 13 5 Totals 1128 95 113 152 68 81 96 170 69 81 51 67 85 63 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 1925-29 496 4.3 14 2.8 1930 434 3.9 4 0.9 1931 264 2.5 12 4.5 It will be noted that, although there has been a reduction in the incidence of the disease, the case mortality has increased very considerably. This should lead parents to consider the advisability of protecting their children from the disease by the method of artificial immunisation. 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. 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. Number of Negative. Schick Tests. Unknown Result. Total. Fully Inoculated. Partly Inoculated. 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 1930 15 27 — 42 65 3 199 1931 6 7 - 13 17 5 58 Number of Schick Re-tests. Positive. Negative. Unknown Result. Total. 1927 - - - - 1928 34 134 13 181 1929 8 55 3 66 1930 5 39 1 45 1931 3 21 2 26 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 64 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 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. One case was notified in 1930. This case had been re-tested and found positive and had had only one re-inoculation before removal to hospital. In 1931—No cases. Small-pox. The Borough remained free from Small-pox from 1918 to 1929, in which year 15 cases occurred. During 1930, 48 cases, and in 1931, 37 cases, were notified. In view of the superficial similarity between Chicken-pox and Small-pox, the notification of the former disease is compulsory under the Deptford (Chicked-pox) Regulations, 1930. The supervision of Deptford residents, who were "contacts" of Small-pox cases in other boroughs, has entailed considerable additional work. 65 So far as the "following up" of contacts, who live in other boroughs, but who work in Deptford, is concerned, the relaxation of the Ministry's requirements in the matter of contact supervision, as indicated to the Boroughs of Poplar and Shoreditch and followed in Deptford, has been appreciated and has minimised the risk of loss of employment. Vaccination. No vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. E Chicken-pox. Since made compulsorily notifiable, the number of notifications have been as follows:— 1929 (1-31 December) 61 1930 445 1931 152 In many instances the medical practitioner referred the case to the Medical Officer of Health and a diagnosis of Small-pox was arrived at. 66 Return made on or before the 9th of February, 1932, by Mr. E. S. Elliott, Vaccination Officer respecting the vaccination of children whose births were registered from 1st January to 31st December, 1930, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from stJan. to 31st Dec., 1930. Number of these Births duly entered by 31st Jan., 1932. No. of Births which on 31st Jan. 1932 remained unentered in the Vaccination Register on account of— No. of these births remaining on 1st Jan., 1932 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1931. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1931. 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. North Deptford 747 310 2 - 235 32 21 — 23 124 - - South Deptford 497 228 3 — 204 12 9 8 16 17 — — *East Deptford 140 48 1 — 41 7 4 2 10 33 — — Total 1390 586 6 — 480 51 34 10 49 174 692 556 Dated February 4th, 1932. Total Number of Certificates for Year 1931 sent to other Vaccination Officers, 66. *For three months up to 3lst March, 1930, when District was abolished. 67 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 1930 1931 Cases 3 3 2 4 4 2 1 Deaths 1 — - 4 2 2 4* *In three instances the diagnosis was not established before the death of the patient. 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 1930 1931 Cases 4 3 1 1 4 — 1 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 1930 1931 Cases 9 8 3 3 3 - — Deaths 5 2 2 2 1 - — No cases were notified during 1931. There is an unfortunate tendency to physical, moral or mental sequelae, 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 Notified. No. of deaths (all forms of Pneumonia.) Death rate per 1,000 population. Average 1920-1924 94 137 1.2 1925-1929 172 121 1.0 1930 74 73 0.7 1931 101 113 1.0 E2 68 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 cally, is notifiable if liable to recur. Average 1920-1924 Average 1925-1929 1930 1931 Cases 8 4 2 — No deaths have been registered from this cause. Dysentery. The figures are as follows:— Average 1920-1924 (total) Average 1925-1929 1930 1931 Cases 3 2.5 — — Deaths — 0.4 — — Infantile Diarrhœa. Since 1920, this has been notifiable in the case of children under two years of age, and the following are particulars of notifications received and deaths:— Average 1920-1924 Average 1925-29 1930 1931 Cases Notified 66 75 12 26 Deaths 28 15 17 9 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 1925-1929 8 3 1.7 1930 8 3 1.7 1931 5 4 2.3 69 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 1927 1928 1929 1930 1931 Cases 5 16 12 6 10* 17 * Includes one subsequently notified as Puerperal Fever and dealt with under that heading. 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 or hospital accommodation 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 received:— 1926 (part) 1927 1928 1929 1930 1931 Cases 14 9 18 14 26 21 The following is a statement of the results of treatment in respect of the cases notified in 1931: Notified Treated Vision unimpaired Vision impaired Total blindness Since died from other Causes At home In hospital 21 19 2 20 1 — - 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 Council has made arrangements with certain local nursing organisations, viz., the Ranyard Nursing Association and the Queen's Nurses, Rotherhithe, for a nurse to visit and carry out the treatment prescribed. Where, for any reason, hospital in-patient treatment is deemed advisable, facilities are provided at St. Margaret's Hospital, Kentish Town. Towards the end of the year it was decided to address to any medical practitioner notifying a case of Ophthalmia a letter reminding him of this provision. 70 Erysipelas. 59 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. Enteric Fever. There were two cases notified, both of which recovered. 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 1931. 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 1925-1929 35 2.5 0.31 1930 6 0.5 0.05 1931 20 1.6 0.19 Measles. That Measles is a most important cause of death is often overlooked. The following is a statement of the mortality during recent years. No. of Deaths. Percentage of total Deaths. Death-rate per 1,000 population. Average 1915-1924 27 1.7 0.24 1925-1929 20 1.4 0.17 1930 24 1.9 0.22 1931 1 0.08 0.009 71 Only a few cases of Measles were reported towards the end of the year. Arrangements had been previously made to ensure the obtaining of early information of cases of suspected cases in schools in order that the Health Visitors might offer nursing assistance where necessary. For the prophylaxis of Measles, serum is available for use by medical practitioners. In no instance was application made for serum. Whooping-Cough. Amongst infectious diseases, Whooping-cough is accountable for the greatest number of deaths in very 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 1925-1929 13 0.9 0.11 1930 3 0.2 0.03 1931 11 0.9 0.10 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 remain 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, 1931. Material. Number Positive. Number Negative. Total. Swabs for Diphtheria 114 958 1072 Sputum for Tuberculosis 30 79 109 Blood for Enteric Fever — 7 7 Urine for T.B. — 2 2 Culture for Anthrax — 1 1 Blood for Blood Count 1 — 1 Swabs for Hæmolytic Streptococci — 13 13 Water from cistern in dwelling house 2 — 2 Specimen of silt taken from drain — 1 1 *Note.—Other examinations are reported under "Food." 72 At the Tuberculosis Dispensary, 1,013 specimens of sputum were examined. Of these, 660 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 353 specimens. 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 950 „ „ „ Requests, rooms only 74 „ „ „ „ bedding only 77 „ „ „ Verminous 80 Total premises visited 1181 Number of rooms disinfected, formalin spray 1327 „ sulphur 143 Total 1470 Number of articles disinfected (steam disinfector) 10290 Number of books disinfected (formalin lamp) 381 „ „ articles destroyed at owners' request 301 Special disinfections, etc.:— 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. 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 not used for this purpose 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. 73 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, disinfections 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, 5 adults and 1,933 children were cleansed. By special arrangement with the Camberwell Borough Council, facilities are available for adult females to be bathed at the Camberwell Cleansing Station at a cost of 5s. per case. No cases were so dealt with in 1931. 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:— Year No. of Deaths. Percentage of total Dea ths. Rate per 1,000 population. Average 1915-1924 133 8.5 1.2 1925-1929 159 11.6 1.4 1930 156 12.6 1.4 1931 174 13.5 1.6 74 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 Totals 1925 Male 1 9 44 20 13 87 Female — 8 38 17 14 77 Total 1 17 82 37 27 164 1926 Male 1 4 36 24 9 74 Female 1 5 36 27 16 85 Total 2 9 72 51 25 159 1927 Male — 2 39 36 15 92 Female 1 5 38 22 12 78 Total 1 7 77 58 27 170 1928 Male - 7 38 20 11 76 Female — 11 22 26 17 76 Total — 18 60 46 28 152 1929 Male 3 7 33 22 7 72 Female 1 8 47 14 8 78 Total 4 15 80 36 15 150 1930 Male 1 3 36 24 15 79 Female 1 13 30 16 17 77 Total 2 16 66 40 32 156 1931 Male 1 4 47 24 11 87 Female — 8 43 22 14 87 Total 1 12 90 46 25 174 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 during the year under report. Infective Jaundice. No case of this disease was reported to me. Tuberculosis. 76 TUBERCULOSIS. The incidence of Tuberculosis, as judged by notification, has shown a progressive decline. The following is a tabular statement of the cases coming to our knowledge by notification and otherwise:- Year. Pulmonary Total per 1.000 of population. Non-Pulmonary. M. F. M. F. Total per 1.000 of population 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 1930 97 84 1.63 35 17 0.47 1931 104 77 1.69 19 25 0.41 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 is as follows:- Year. England and Wales. per 1,000 population. Deptford. per 1,000 population. Pulmonary Non-pulmonary. 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 0.79 0.17 0.81 0.10 1930 0.74 0.16 1.02 0.13 1931 - — 0.93 0.13 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 1931:— 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 28th December, 1930, to the 2nd January, 1932, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 198; 160 Pulmonary Tuberculosis and 38 Non-pulmonary, as compared with 169 Pulmonary and 41 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 Nonpultnonary Tuberculosis." 77 Report of Tuberculosis Officer—continued. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from the 28th December, 1930, to 2nd January, 1932. Notifications on Form A. Age Periods. 0-] 1-5 5-10 10-15 15-20 '20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications Total Notifications on Form A. Pulmonary— Males ... 1 ... 2 10 8 24 15 13 13 3 89 139 Females ... ... 2 2 8 15 22 11 4 6 1 71 103 Non-Pulmonary Males ... 5 1 5 3 1 ... ... ... 1 16 18 Females 3 7 3 1 3 5 ... ... ... ... 22 25 78 Report of Tuberculosis Officer -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 l 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 ... 6 1 4 1 2 15 „ —Females ... ... ... ... 1 ... 5 ... ... ... ... 6 Non-Pulmonary—Males ... 1 ... ... ... ... 2 ... ... ... ... 3 „ —Females ... 1 ... 1 ... ... 1 ... ... ... ... 3 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Non-Pulmonary. Death Returns from local Registrars — — transferable deaths from Registrar-General 4 2 Posthumous notifications 6 2 "Transfers" from other areas (other than transferable deaths) 8 2 Forms C and D (admissions and discharges from Institutions) 3 - 79 Report of Tuberculosis Officer—continued. Supplemental Return—continued. Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of Deptford 357 282 639 116 110 226 865 Number of cases removed from the Register during the year, inter alia of:— 1. Withdrawal of notification ... ... ... ... ... ... 2. Recovery from the disease 17 15 32 15 14 29 61 3. Death 59 39 98 3 6 9 107 80 Report of Tuberculosis Office)—continued. Notes on Table of Notifications. Of the cases first known of from the death returns, four were Pulmonary Tuberculosis. In one of these the diagnosis was only established as the result of the post mortem examination; one was an asylum case and two died in hospital. The two non-pulmonary cases were general tuberculosis and tuberculous peritonitis respectively. Of the cases of Pulmonary Tuberculosis notified after death, four were notified from hospital. The non-pulmonary cases posthumously notified were meningitis cases dying in hospital. Of the cases notified for the first time during 1931, 37 died during the year, viz., 31 pulmonary and six non-pulmonary. Of the latter, three deaths were due to meningitis, two to abdominal tuberculosis and one notified as tuberculosis of the ribs. As regards the 31 deaths from pulmonary tuberculosis, almost all the patients died in hospital or had been in hospital up to a short time before death. Of these— 10 died within 1 month of notification. 14 „ „ 2 to 4 months of notification. 4 „ „ 6 „ „ 3 „ over 6 „ „ 81 Report of Tuberculosis Office)—continued. Home accommodation of 179 Cases notified in 1931 (omitting" hospital and lodging-house cases). CASES and Number in Family. Non-Pulmonary Tuberculosis. Pulmonary Tuberculosis. Rooms. Cases with T.B. in Sputum. Rooms. Cases in which T.B. not present or not known to be present. Rooms. 1 2 3 4 5 6 or more. 1 2 3 4 5 6 or more. 1 2 3 4 5 6 or more. 3 cases. 1 of 1 11 cases. 5 cases. 2 of 2 5 of 2 9 of 2 7 of 2 4 of 2 1 of 2 1 of 1 1 of 2 6 of 2 1 of 2 1 of 2 l of 3 2 of 3 1 of 3 6 of 3 5 of 3 5 of 3 1 of 2 2 of 3 5 of 3 2 of 3 1 of 3 1 of 4 1 of 4 2 of 4 1 of 4 1 of 4 2 of 4 2 of 4 7 of 4 4 of 4 2 of 3 3 of 4 2 of 4 4 of 4 1 of 5 1 of 5 1 of 5 1 of 5 2 of 5 3 of 5 2 of 5 6 of 5 2 of 5 1 of 5 2 of 5 1 of 6 1 of 6 3 of 6 1 of 6 3 of 6 4 of 6 1 of 6 1 of 6 2 of 6 1 of 7 1 of 7 2 of 7 4 of 7 1 of 7 3 of 8 1 of 8 1 of 8 1 of 10 1 of 10 8 had a separate room. 34 had a separate room. 16 had separate room. 1 had separate bed with 1 other in room. 7 had separate bed but 1 other in room. 2 had separate bed, but 1 other in room. 2 „ „ „ 2 „ „ 3 „ „ 2 „ 5 „ „ 2 „ 3 „ „ „ 3 „ „ 35 had another in bed. 18 had another in bed. 6 had another in bed. 11 „ „ 1 „ 5 „ „ 1 „ 1 „ „ & 1 other in room 4 ,, ,, 2 „ 3 „ „ 2 „ 1 „ „ 2 „ 1„„ 3„ 3 „ „ 3 „ 1 had 2 others in bed. 4 had 2 others 1 „ 2 „ 1 „ 1 ,, 2 1 „ 1 „ 3 „ 1 „ 1 „ 2 „ 2 „ 1 „ 4 „ 82 Report of Tuberculosis Officer—continued. The number of deaths for the year is 114 as compared with 127 for 1930. 1930 1931 Pulmonary deaths 113 100 Non Pulmonary deaths 14 14 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 1931. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - - - - - - - - 1 1 - 1 4 - - 1 - 5 — 2 5 7 - 1 1 4 10 2 2 1 4 1 1 — - 15 11 9 5 1 4 7 1 - 20 8 15 3 3 4 5 — - 25 30 27 3 6 12 13 1 4 35 16 11 - — 7 5 — 1 45 17 4 — — 18 5 — — 55 14 6 — — 11 3 — — 65 and upwards 5 1 1 — 3 — 1 — Totals 104 77 19 25 60 40 5 9 *Note—Including 27 cases which came to the knowledge of the Medical Officer of Health otherwise than by notification, viz., death returns, "transfers," posthumous notification, Forms C and D. Pulmonary Tuberculosis. Interval between Notification and Death in 1931. Not notified 4 Died before notification 6 Died within one week of notification 5 „ „ one week to one month 8 „ „ one month to three months 12 „ „ three months to six months 10 „ „ six months to one year 15 „ „ one to two years 16 „ „ two to three years 7 „ „ three to four years 8 „ „ four to five years 2 „ „ five to six years 1 „ ,, six to seven years 1 „ „ seven years and upwards 5 100 83 Report of Tuberculosis Officer—continued. The notifications of non-Pulmonary Tuberculosis were as follows:— Meningitis 6 Genito-urinary 1 Peripheral glands 12 Skin and other organs 2 Abdominal 6 Bones and joints 11 Total 38 Revision of Notification Register. During the year 196 cases of Pulmonary and 63 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 1931 as follows:— MALES FEMALES Under15 Over 15 Under 15 Over 15 Total Pulmonary Tuberculosis 38 319 35 247 639 Non-Pulmonary Tuberculosis 71 45 68 42 226 Totals 109 364 103 289 865 Disinfection was carried out in 348 rooms, and articles of bedding, clothing, &c., were removed for sterilization. Supervision of Contacts. Analysis of contacts of 188 cases primarily notified during the year (including cases notified after death but excluding cases in which the diagnosis was not confirmed):— Deptford Park, Evelyn, Vale and St. Paul's Wards. Remainder of Borough. No. of Patients notified 74 114 No. of above seen at Dispensary 42 67 84 Report of Tuberculosis Officer—continued. Deptford Park, Evelyn, Vale and St. Paul's Wards. Remainder of Borough. Adults. Children. Adults. Children. Total contacts of cases seen at Dispensary 111 42 151 65 Number of above Contacts examined at Dispensary 13 10 26 33 No. of notified cases not seen at Dispensary 32 47 Total contacts of above 76 27 89 28 Number of above contacts examined at Dispensary 15 9 11 6 Total School Contact Cards sent to School Medical Officer 42 60 (a) Classified as examined at Dispensary, Classes I and II ! 22 17 (b) Classified as not examined at Dispensary, Class III 20 43 Class I—Unsatisfactory cases. *Class II—Apparently healthy cases. Class III—Not examined. Notes regarding Contacts. As mentioned in last year's Report, Sir Robert Philip had towards the end of 1930 expressed his opinion that it was of great importance to determine the onset of tuberculosis infection in children. Infection does not necessarily produce actual clinically recognisable disease, but if a child known to be infected develops ill-health which cannot be ascribed to any other definite cause, that child, even though no definite signs of tuberculosis can be found, should be given such treatment as is practicable to raise its general health in order to prevent the infection developing into actual disease. The presence of infection can be detected by the Tuberculin Test. This is of course not new, but a form of the test called the "Mantoux Test" has recently come into extended use. During the year under report it was decided to get as many as possible of the child contacts of cases with tubercle bacilli in the sputum to be brought for such testing. To this end the Medical Officer of Health issued a leaflet for distribution by the Tuberculosis Health Visitors in the homes of patients, urging parents 85 Report of Tuberculosis Officer—continued. to have their children tested and regularly supervised at the Dispensary, so that the earliest beginningsof disease might be detected and treated. It is difficult to get a satisfactory number of contacts to attend for examina.ion in the ordinary way and many parents object to injections of any sort, but from April to the end of the year, 100 children between one and 15 years of age were tested. The results, with notes as to action taken, are given below. In practically all cases giving a positive result to the test, and also in a few negative cases, an X-ray examination was made, and if any doubtful appearances were found, or if the child was in an unsatisfactory state of health, recommendations were made for such treatment as was deemed advisable. Dividing the children into age groups:— Group 1 (1 to 2 years)—Only one child was tested in this Group. The father was suffering from advanced disease with tubercle bacilli in the sputum. The child gave a reaction to 0.1 mg. There were no abnormal physical signs, but the X-ray examination proving suspicious, the child was recommended for institutional observation, and though not diagnosed definitely tuberculous, it was recommended from sanatorium that further observation at dispensary was advisable. Group 2 (2 to 5 years)—17 children were tested, 16 being contacts of T.B. positive cases. Of the 16, 2 did not have the test completed and 7 gave a negative result. The father of one of these latter cases having advanced disease, the child was recommended for " boarding-out " away from home. The remaining eight gave positive results, and of these, one gave definite X-ray evidence of disease and was removed to sanatorium; convalescent treatment was recommended for another who was not in a good state of health. Group 3 (5 to 12 years)—In the 75 children tested in this group are included 21 who were not definitely known to have been in contact with any cases of tuberculosis. Three of these latter did not complete the test, 12 gave a negative reaction and 6 a positive reaction. Three of the negative reactors who were in an unsatisfactory state of health were recommended for convalescent treatment, and three for open air schools. 86 Report of Tuberculosis Officer—continued. Ten children in this group were contacts of cases of tuberculosis without tubercle bacilli in the sputum or of cases of non-pulmonary disease. Two of these did not complete the test, 7 gave a negative and 1 a positive result. Forty-four children were contacts of T.B. positive patients. Of these, 2 did not complete the test, 9 gave a negative result and 33 a positive result. One was sent for observation and was diagnosed as suffering from pulmonary tuberculosis, 4 were recommended for open-air schools and 9 were recommended for convalescent treatment. Group 4 (12 to 15)—Seven children were tested, but 2 did not complete the test. Two, who were not definitely contacts of any case of tuberculosis, gave positive results. One, who was considered tuberculous at a hospital out-patient department, was sent for observation, but was not definitely diagnosed as suffering from tuberculosis. One child, a contact of a T.B. negative case, and 3 children, contacts of T.B. positive cases, gave positive results, but did not appear to be in need of any treatment. 87 Rebort of Tuberculosis Officer—continued. Memo 37 t. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1931. Diagnosis. Pulmonary. Non-Pulmonary. Total Adults Children. Adults. Children. Adults. Children. Grand Total M. f. M. f. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 62 43 2 6 8 6 6 7 70 49 8 13 140 (b) Doubtfully tuberculous — — — — — — — — 7 9 4 7 27 (c) Non-tuberculous — — — — — — — — 68 97 50 34 249 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 2 — — — — — — 2 2 — — 4 *(b) Doubtfully tuberculous — — — — — — — — — 4 4 7 15 (c) Non-tuberculous — — — — — — — — 26 26 29 34 115 C.—Cases written off the Dispensary Register as (a) Cured 10 10 2 — 7 2 3 3 17 12 5 3 37 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 96 130 80 71 377 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 234 148 18 23 28 31 40 32 262 179 58 55 602 (b) Diagnosis not completed — — — — — — — — 7 14 10 17 "Remaining undiagnosed 31st December. 88 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 621 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 23 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 103 4. Cases written off during the year as Dead (all causes) 75 5. Number of attendances at the Dispensary (including Contacts) 2886 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 164 Number of G.P. 36 reports from practitioners 149 7. Number of consultations with medical practitioners: (a) Personal 16 (b) Other 80 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 206 9. Number of visits by Nurses or Health Visitors to Homes successful 2403 for Dispensary purposes unsuccessful 66 3072 successful 1408 Visits to cases non-Dispensary cases unsuccessful 330 1738 10. Number of (a) Specimens of sputum, &c, examined 660 (b) X-ray examinations made 138 in connection with Dispensary work (c) Sputum examinations for non-Dispensary cases 353 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 304 Notes on Table I. It will be noted that the number of persons on the Dispensary Register on the 31st December, 1931 is almost the same as at the beginning of the year. The number of patients coming into the Borough from other areas and of cases which had been lost sight of and returned to the Register, is 23 as compared with 19 in the 89 previous year. "Transfers to other areas" and "Cases lost sight of " are 103 as compared with 86 in 1930. 75 deaths of Dispensary patients occurred, compared with 82 in the previous year. Three patients had Ultra-violet ray treatment. Seven patients have had artificial pneumothorax treatment, making in all 77 attendances as compared with 33 in 1930. The treatment is arranged for at the Brompton and St. Thomas' Hospitals. The number of patients for whom dental treatment was provided was 52 compared with 41 in 1930. Frequently when dental cases are seen at the Dispensary they are febrile, and the treatment most urgently needed is rest ; so dental treatment may be postponed, and in some cases is eventually carried out while the patient is in an institution. 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 to 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 Public Assistance Committee 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 67 7 4 Total cost of free cases 19 8 6 Contributions from Approved Societies 15 16 0 ,, Public Assistance Committee 7 3 6 ,, Red Cross Society 1 12 6 ,, Patients 13 1 6 ,, Hospital Savings Assn. 1 16 4 ,, Hospital Saturday Fund 4 4 0 ,, Patients (unpaid) 4 5 0 90 Report of Tuberculosis Officer—continued. The Dental Surgeon, Mr. J. Eric Magraw, reports the following as a summary of the year's work:— Fillings. Cases. Attendances. Extractions. Amalgam. Plastic. Scalings. Dentures. Repairs. 52 270 67 28 31 94 28 10 Consultations with medical practitioners. The number of consultations between practitioners and the Tuberculosis Officer shows a further increase. In many cases the practitioner does not meet the Tuberculosis Officer, but asks the latter to visit the patient and let him know his opinion later. The Ministry of Health now limits the term "Personal Consultations" to those cases in which the practitioner attends and consults with the Tuberculosis Officer at the patient's bedside. Visits to Homes. The number of visits paid by the Health Visitors was 4,810 compared with 4,542 in the previous year. Reports are made on the undermentioned points respecting home conditions, contacts, etc.:— (a) Whether any assistance seems needed for the patient or family, and action taken, such as reference to the Secretary to the Tuberculosis Care Committee. (b) The health of Contacts, and whether they will attend the Dispensary for examination or go to their own doctors. (c) The extent to which the patient is taking care to prevent the spread of infection by following the advice given. (d) The sanitary condition of the home, defects reported and action taken to abate nuisances. In general, the aim has been to concentrate not only on the patient but on the family to prevent infection, to see that early disease is detected, and to improve home conditions from the sanitary and economic viewpoints. 193 of the new attenders were referred by the Council's staff. Bacteriological examinations of Sputa. The increase in the number of specimens sent by practitioners for examination is maintained, 353 as against 336 in 1930. 1 he number of examinations of specimens for Dispensary cases was 660, as compared with 615 in 1930. 91 Report of Tuberculosis Officer—continued. X-ray Diagnosis. The number of X-ray examinations is 138 compared with 90 in the previous year. The increase is chiefly due to cases X-rayed in connection with the Tuberculin Test. Insured Persons. I he number of insured persons on the Dispensary Register remains about the same as in 1930, but, as the result of more clerical assistance and a circular letter addressed by the Medical Officer of Health to practitioners, a further increase in the number of reports from panel doctors in respect of patients on domiciliary treatment has been manifested; this has permitted of a more exact estimate of the number of patients actually keeping under such treatment. Co-operation with the Medical Profession. Co-operation with medical practitioners continues on the same lines as hitherto. Of the new patients attending the Dispensary, 174 were sent by doctors, compared with 167 in the previous year. 203 reports on " Z " cards were made to doctors regarding panel patients. In addition, numerous letters were written to doctors and hospitals about patients. During the year, alterations were made in the Health Visitors' districts, by which their visiting areas and attendances at Clinics were more evenly divided. Extra Nourishment. 33 recommendations were made to the Public Assistance Authorities for extra nourishment in addition to grants made by the Borough to 64 persons. Institutional Treatment. 177 patients were recommended to the London County Council for institutional treatment, 19 of which the London County Council were unable to accept under the Tuberculosis Scheme, and were referred to general hospitals. Live patients refused treatment. 277 reports on the condition of the patients treated in previous years were sent to the County Council. 22 patients were recommended directly from Dispensary for admission to London County Council general hospitals. In the case of patients attending general hospitals who are recommended for sanatorium treatment, a copy of the discharge report is always sent to the hospital concerned on the patient's return, for the information of the doctor in charge of the case. 93 Report of Tuberculosis Officer continued- Reports are asked for subsequently each year from the hospital doctor so that the patient's progress can be supervised. Deaths. Of the total deaths of Dispensary patients during 1931 3 died within 3 months of the first attendance. 10 „ „ 6 „ „ „ 11 „ „ 12 „ „ „ 43 „ „ 12 „ „ „ In addition, 8 patients on the Register, but who were not Dispensary attenders, died. 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. Staff. In May, 1931, additional part-time clerical assistance was granted by the Council by the engagement of a temporary shorthand typist. This has enabled the Tuberculosis Officer and the Secretary of the Tuberculosis Care Committee, to whom part of the clerk's time is given, to deal more expeditiously with reports and correspondence with satisfactory results as shown by the figures. Christinas Gifts. We have to thank Miss Greig our Dispenser who this year, again, provided a pleasant afternoon for many of our child patients. Cakes and toys distributed to the children were obtained from the Clerical Staff Xmas Gift Fund of the Prudential Insurance Company, through Miss Greig's efforts. Handicraft Centre. The Handicraft Class has continued very successfully throughout the year, and an increased variety of articles have been made, such as felt animals, gollywogs, etc., repous6e metal work, one of the copper-framed mirrors being much admired and bought as a wedding gift. An Exhibition of the work from the Deptford Centre and other London boroughs was held at Carpenters' Hall, and was opened by the Lord Mayor. I am informed by Mrs. Monk that orders were taken amounting to £50. These exhibitions have been so Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the Patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classifi- cation at that time. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 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 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) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 8 9 7 16 l 2 3 4 4 l 5 l l l l l l F. 7 3 2 5 2 1 1 2 1 1 1 2 2 2 2 Children 3 3 1 l I Disease not arrested Adults M. 5 5 21 26 2 3 5 4 12 8 8 2 4 5 9 2 3 15 l 19 6 3 25 3 31 10 12 23 3 38 F. 5 12 17 2 5 2 7 2 2 1 1 5 1 7 2 2 10 l 13 4 3 17 3 23 13 2 11 6 19 Children ... 1 1 1 1 1 2 1 1 3 1 1 2 5 5 2 2 Condition not ascertained during the Year 10 9 6 15 1 1 1 2 2 1 1 1 7 1 5 6 2 2 2 1 1 Total on Dispensary Register at 31st December 33 32 48 80 11 5 15 7 27 7 17 l 18 7 9 10 l 20 16 8 32 3 43 17 6 44 6 56 28 14 37 9 60 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 26 11 6 17 F. 53 6 5 11 Children ... 58 2 2 2 Lost sight of or otherwise removed from Dispensary Register 333 74 126 15 215 15 2 8 6 16 10 6 21 2 29 15 5 13 1 19 15 3 8 1 15 5 11 11 1 1 2 1 4 Dead Adults M. 38 37 138 36 211 3 4 20 15 39 1 1 25 8 34 2 1 15 n 27 4 1 15 8 24 3 9 6 15 5 2 7 F. 34 19 76 31 126 2 6 7 15 4 20 10 34 4 8 12 1 3 10 9 22 1 1 5 10 16 1 1 4 3 8 ! Children ... 10 3 3 2 8 1 1 1 1 1 1 1 1 Total written off Dispensary Register 552 150 356 84 590 21 8 34 29 71 11 11 66 21 98 17 6 32 20 58 20 7 34 18 59 10 1 25 16 42 2 2 11 6 19 Grand Totals 585 182 404 84 670 32 13 49 36 98 18 11 83 22 116 24 15 42 21 78 36 15 66 21 102 27 7 69 22 98 30 16 48 15 79 Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a) PULMONARY TUBERCULOSIS. Report of Tuberculosis Officer—continued. (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs Peripheral Glands Total. * (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 1 l 2 2 1 3 2 l 3 1 l F. 1 1 1 1 2 2 1 1 Children ... 4 2 6 1 1 3 5 3 3 1 2 3 2 2 1 1 2 Disease not arrested Adults M. 1 1 2 1 1 1 1 2 2 1 3 3 1 1 2 7 F. 2 4 2 8 1 1 2 2 2 1 1 2 1 1 1 3 Children ... 6 1 7 2 1 3 2 2 1 1 2 4 2 2 8 2 1 2 5 5 1 5 11 Condition not ascertained during the year 2 1 5 8 4 1 1 6 2 1 3 1 1 1 1 4 2 2 1 5 Total on Dispensary Register at 31st December 16 1 5 12 34 6 1 6 13 4 5 2 6 17 6 4 3 13 5 2 3 5 15 7 4 2 5 18 8 2 3 8 21 Transferred to Pulmonary 1 1 1 1 2 1 1 1 1 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 14 3 1 4 22 1 ] 2 F. 9 1 2 12 2 2 Children ... 16 6 45 67 1 1 1 1 1 1 Lost sight of or otherwise removed from Dispensary Register 36 10 9 52 107 1 1 6 8 2 1 2 4 9 5 4 1 10 3 1 2 6 2 1 3 1 1 Dead Adults M. 8 1 9 1 1 1 1 1 1 F. 4 2 6 1 1 Children ... 4 2 1 7 1 1 2 Total written off Dispensary Register 91 21 14 104 230 2 1 1 6 10 4 2 2 6 14 6 1 4 3 14 4 2 2 8 2 1 3 1 1 Grand Totals of a and b (excluding those transferred to Pulmonary) 107 22 19 116 264 8 2 1 12 23 8 7 4 12 31 12 5 4 6 27 9 4 3 7 23 9 4 2 6 21 8 2 3 9 22 93 Report of Tuberculosis Officer—continued. successful that it is intended to repeat the same during the coming year. At the end of the year under report Mrs. Monk, who amid many other activities still finds time for the very considerable work attached to the supervision of purchases, sales, etc., organised for the class, another very enjoyable tea and evening entertainment, Councillor W. Taylor and other members of the Tuberculosis Care Committee assisting by providing artistes and refreshments. Mrs. Monk tells me that one of the girls who had been taught glove-making, obtained regular work for a time outside at this work. One of the men workers at leather work, who had such employment occasionally, was able to improve his skill and knowledge in a way which subsequently proved beneficial to him in his employment. It is found that attendance at the Centre braces the patient mentally, as evidenced by the improvement shown in personal appearance, etc. Report on Work of the Tuberculosis Care Committee 1931. It was anticipated that this year we might have had to report certain alterations in the functions of the Care Committee. No change however has as yet been effected, and we have recently been informed that the work shall be carried on in the same manner for a further year ending 3rd March, 1933. It is understood that before any proposed alterations are decided upon, the Care Committees, through the Standing Conference of Metropolitan Boroughs' Tuberculosis Care Committees, will be afforded an opportunity of submitting observations. At the last meeting of the "Conference" held at the County Hall in November, 1931, our Chairman, Councillor Walter Taylor was elected Chairman for the ensuing year. He will, we know, carry out the duties of this important position with his customary zeal and ability. The meetings of this body are, we consider, most helpful, discussion of difficulties common to us all, often leading to a solution. Through the Conference, a visit to Papworth Village Settlement was arranged in July for a limited number of members. A most 94 Report of Tuberculosis Officer—continued. enjoyable and instructive afternoon was spent viewing the Colony. Interest was added to the visit for Deptford representatives, owing to the fact that we have two patients there. One, a girl aged 18 years, has been away undergoing treatment in various Sanatoria since January, 1926 (her home conditions being totally unsuitable for her to return to). During this period she was transferred to "Papworth" in June, 1931, and hopes to settle eventually, and to become, by degrees, self supporting. This girl has kept in touch with the Care Committee since she first went away, six years ago, and we find it most interesting to watch her development, physically and otherwise. The other patient, a girl aged 27 years, entered the Colony in April, 1929. She is now employed on Clerical work, and has settled down very happily. She has recently been promoted to quarters in the Women's Hostel, opened by Queen Mary. A coveted privilege! In one of her interesting letters she describes her new home as a magnificient place. These two cases furnish ample proof, that, given good conditions and suitable environment, certain types of persons can, although suffering from this dread disease, attain to a certain standard of health, modified happiness and usefulness. During the year, 1,380 persons have been interviewed by the Secretary at the Dispensary. 952 visits have been paid to patients at their homes. 1,037 cases have been submitted to the Care Committee on the Agenda. Figures are somewhat cold facts in connection with "Care Work," but it must be taken for granted that behind these quoted, lies tragedy in bulk. I n carrying out our general work we have, this year particularly, encountered a large amount of distress, due to a great extent to the period of depression through which the country is passing and the consequent unemployment. Disastrous indeed from the Care Committee point of view, to the cases with which we deal, for while caring for those actually suffering from tuberculosis, the word "prevention" is always in our thoughts. We feel that Repot t of Tuberculosis Officer—continued. in every family where there is even one member suffering, or who has suffered from this disease (sometimes there have been two, three or even four) the remainder need better food and conditions to maintain their powers of resistance, than normally healthy families with a clean bill of health. This year, therefore, we have had to be more vigilant, and on the watch for distress than ever before. Our usual friends have responded nobly to our calls for aid. Our main sources of help are the local organisations, private and public, and are so well known that we need not enumerate them. The approximate value, as nearly as we can estimate, of grants received for individual cases this year, amounts to £230. The actual value probably exceeds this sum. In addition, we have also received parcels of worn clothing from kind friends. The purposes for which the grants were given are diverse and manifold. For an ex-musician, a violin was obtained. Substantial weekly allowances have been granted to families. Grants for help in homes where the mother has been too ill to fulfill her usual household duties, have been provided. Separate beds have been given, clothing and nourishments have been allowed, together with other forms of help, too numerous to mention. We realise the responsibility that devolves upon us in connection with our appeals, and appreciate the confidence placed in us by these societies. We earnestly endeavour to be fair to the applicant by not asking for too little, and just to the giver by not asking for too much. With regard to children boarded out, although we have to report that eight children were accepted for boarding out this year, under the County Council's Scheme for Contacts, none were actually sent away. In the case of four children, the patient died before the arrangements were completed, and in the other four cases, the parents withdrew their consent. These figures vary from year to year for no apparent reason. It will be remembered perhaps, that last year 13 children were sent away. 96 The United Services Fund has, in two cases, boarded out children during the entire year for us. One a baby aged two years, whose mother has had to undergo a lengthy period of sanatorium treatment, the other a boy aged 12 years, was boarded out in the country while the father was undergoing a period of treatment in sanatorium. On the father's death shortly after his return home, the Fund assumed full responsibility for the boy. He is still in his country home with a good foster mother, and making real progress with his education. These examples serve to show the uses of the Care Committee and the co-operation and support extended to them. Maternity and Child Welfare 98 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 now makes most comprehensive provision for the maintenance of the health of mothers and young children. The chief activities of the scheme include 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 and 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 provision of the service of Consulting Obstetricians. 4. The maintenance of a Maternity Home and the provision of accommodation in hospital for certain maternity cases. 5. The provision of sterile maternity outfits. 6. The provision of home nursing for certain mothers and children. 7. The provision of a "Home Help" before, during or after confinement. 8. Accommodation in Convalescent Homes for Mothers and Children. 9. Hospital provision, both in-patient and out-patient, for certain infants. 10. The supplying of milk, either free or at a reduced price. 11. Compensation to midwives in respect of "booked" cases sent to hospital. 12. Health Education by means of addresses and the distribution of booklets and leaflets. 1. Health Visiting. The following is a numerical summary of the home visits made by the individual Health Visitors and a statement of the reasons originating the visits. 99 Summary of Visits paid by Health Visitors, 1931. 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 940 .. .. .. .. .. 940 Revisits 1635 .. .. .. .. .. 1635 Total 2575 .. .. .. .. .. 2575 Miss Little Visits .. .. .. .. 831 .. 831 Revisits .. .. .. .. 1097 .. 1097 Total .. .. .. .. 1928 .. 1928 Miss O'Loughlin Visits .. 759 .. .. .. .. 759 Revisits .. 2188 .. .. .. .. 2188 Total .. 2947 .. .. .. .. 2947 Miss Smart Visits .. .. 827 .. .. .. 827 Revisits .. .. 1111 .. .. .. 1111 Total .. .. 1938 .. .. .. 1938 Miss Stowell Visits .. .. .. 589 .. .. 589 Revisits .. .. .. 2226 .. .. 2226 Total .. .. .. 2815 .. .. 2815 Miss Reynolds Visits .. .. .. .. .. 590 590 Revisits .. .. .. .. .. 1901 1901 Total .. .. .. .. .. 2491 2491 Miss Holland Visits .. .. .. .. .. 402 402 Revisits .. .. .. .. .. 1826 1826 Total .. .. .. .. .. 2228 2228 Total Visits 940 759 827 589 831 992 4938 Revisits 1635 2188 1111 2226 1097 3727 11984 Total 2575 2947 1938 2815 1928 4719 16922 62 100 Analysis of Visits paid by Health Visitors, 1931. Visits. Re-visits. Total. Birth enquiries 1793 10298 12091 Still-birth enquiries 43 — 43 Visits re deaths under 1 year 79 — 79 „ „ 1 to 5 years 35 — 35 Visits to expectant mothers 984 459 1443 „ re Ophthalmia Neonatorum 38 30 68 „ re Measles 55 57 112 „ re Suspected Measles 18 — 18 „ re Infantile Diarrhœa 25 8 33 „ re Puerperal Fever 4 4 8 „ re „ Pyrexia 14 8 22 „ re Pneumonia 26 14 40 „ re Encephalitis Lethargica — 1 1 „ re Poliomyelitis 1 — 1 „ re Whooping Cough 214 144 358 „ re Scabies 15 8 23 „ re Verminous Children 14 6 20 „ re Scarlet Fever recoveries 233 25 258 Miscellaneous visits 517 58 575 Unsuccessful visits 830 864 1694 Total 4,938 11,984 16,922 In the case of the 1,793 infants visited shortly after birth, it was found that 1,608 infants were being breast-fed and 60 partly breast-fed. Only 125 were entirely hand-fed. Attendances of Health Visitors at Clinics. Health Visitor. Infant Welfare. AnteNatal. Light. Schick. Dental. Total. Miss Robus 108 12 16 — — 136 Miss Little 101 4 18 1 1 125 Miss O'Loughlin 111 — — — 45 156 Miss Smart 108 6 — — — 114 Miss Stowell 111 7 1 - — 119 Miss Reynolds 133 11 — — — 144 Miss Holland 54 1 168 — — 223 Miss Clubbe 197 190 73 15 — 475 Miss Gibson (part time) 193 52 — — — 245 Total 1,116 283 276 16 46 1,737 101 2. Welfare Centres. (a) Infant Welfare. At the commencement of the year there were eight 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. During the year, a decision was taken to open a further Municipal Centre. Premises in Church Street were accordingly rented and the staff which formerly attended the voluntary centre was attached to the new centre. The attendances at this centre appeared to indicate that this extension of the Borough Council's activities was fully iustified. At all the Centres, the services of those ladies who assist in a voluntary capacity is very helpful and greatly appreciated. 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 Attendances. Consultations with Doctor Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under 1 year 1—5 years Gosterwood Street 49 193 28 221 3468 3689 2673 1016 1590 Napier Street 51 174 28 202 2641 2843 2174 669 1417 Besson Street 49 175 22 197 3696 3893 2716 1177 1541 Erlam Road 49 83 7 90 2031 2121 1523 598 1056 Goldsmiths' College 52 128 14 142 2971 3113 2286 827 1282 Hales Street 51 141 71 212 2557 2769 1750 1019 — St. George's Hall 49 142 19 161 3068 3229 2401 828 1322 St. John's, Harton St. 52 84 20 104 2204 2308 1567 741 1334 Church Street 21 52 18 70 873 943 608 335 - Totals 423 1172 227 1399 23509 24908 17698 7210 — The Health Visitors collectively made 1,116 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. In all, 473 children were seen. 102 (b) Maternity Clinics. These are conducted at the Health Centre, Harton Street, four Sessions per week being devoted to this purpose. The service provided is designed to secure efficient ante-natal and postnatal care. At present one of the Sessions is more or less set aside for post-natal work but, as the value of the service becomes more generally known, it is probable that an additional Session will be required. The Staffing, Equipment and Organisation of the Centre follows closely along the lines recommended in the Ministry of Health's Memorandum 145/M.C.W. In addition, provision is made for X-Ray examination as an aid in the diagnosis of obscure cases, ten cases being thus dealt with. The co-operation of the Medical Practitioners and of the Midwives is sought and to them is forwarded the Report of the Medical Officer upon any woman sent by them for examination. 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 atlendances 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 1930 973 64 3212 1931 980 64 3289 Ante-Natal Clinic. The following is the text of Dr. Hill's Report for 1931 Ante-Natal Clinic Statistics, 1931. Total number of Patients on Register 980 New Cases 800 Total Attendances 3289 Normal 163 Not pregnant 32 103 Abnormalities:— Albuminuria 103 Leucorrhcea 19 Anaemia 52 Morbus Cordis 40 Ante-partum Haemorrhage 14 Malpresentation 34 Bronchitis 9 Oedema 14 Cyst of Bartholine 1 Pleurisy 2 Chorea 2 Phlebitis 2 Contracted pelvis 26 Pruritis 6 Dental Caries 418 Peritonitis 1 Dyspepsia 32 Psoriasis 2 Disseminated Sclerosis 1 Retroversion 4 Deformed Nipples 30 Sciatica 11 Fibroid 4 Twins 4 Glycosuria 19 Vomiting (excessive) 27 Haemorrhoids 18 Varicose veins 34 Hydramnios 6 Post-Natal Clinic. It is of the utmost importance to ensure that no ill effects have resulted from the confinement, and mothers are urged to attend. This branch of the work is conducted every Wednesday forenoon, and there is a gratifying increase of mothers attending, although it has to be realised that, as Ante-natal cases are also seen at the same session, no expansion is possible without the devotion of an addition session to the work. Total number of cases on Register 179 New cases 176 Total attendances 192 Amongst the patients seen the following defects were found and dealt with Breast Abscess 1 Retroversion 7 Eczema or Cracked Unhealed rupture of Nipples 3 perinaDum 2 Close co-operation is maintained with medical practitioners, midwives and hospitals. Reports sent to midwives, 252. „ „ doctors 109. Completed reports returned by midwives, 141. Total number of cases referred by letter to hospitals, 167. 104 St. John's Home. A voluntary ante-natal clinic, amongst other activities, is provided at the St. John's Home, Watson Street, and co-operaiion exists between this clinic and the municipal clinic. The following particulars have been kindly given to me:— Number of Sessions held 102 Number of mothers attending 150 Total attendances made 432 (c) Artificial Light Clinic. Both the Mercury Vapour and the Carbon Arc type 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 Patients on Register at commencement of each month. New Patients admitted Patients Readmitted Patients Discharged Patients on Register at the end of month Attendance each month January 44 22 5 4 67 295 February 67 26 1 15 79 443 March 79 19 2 24 76 504 April 76 15 — 30 61 340 May 61 12 — 16 57 324 June 57 1 — 56 2 181 July 2 2 — — 4 14 August 4 8 — — 12 46 September 12 16 3 6 27 122 October 27 21 3 7 44 220 November 44 16 6 8 58 343 December 58 15 2 17 58 292 Total 173 22 183 3,124 Total attendances during the year 3,124 Total new patients admitted 173 Total patients re-admitted 22 105 Classification of Patients during Year. Admissions. Re-admissions Rickets 31 2 Malnutrition 30 8 Anaemia 38 5 Cervical Adenitis 8 1 Muscular Weakness 15 3 Delayed Dentition 28 1 Bronchitis 1 - Curved Tibia 6 2 Nervousness 2 — Post Pnemonia 1 — Tubercular Rib 1 — Genu Valgum 4 — Post Bronchial Pneumonia 1 - Post Infection Debility 1 - Post Pneumonia 1 -— Anorexia 2 — Arthritis 1 — Post Pertussis Debility 1 - Spastic Diplegia 1 — 173 22 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 those other Health Visitors who have attended an intensive Course in Light Therapy also attend 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. The Dental Surgeon, Mr. J. Eric Magraw, has furnished me with the following details of the work in 1931:— Scalings, Cases. Extractions. Fillings. Silver Nitrate Gas etc. Cases. Mothers 100 227 77 94 Children 61 124 19 91 30 In the case of the fillings for mothers, 52 were amalgam and 25 plastic. 106 3. Consulting Obstetricians. The circumstances under which the services of Consulting Obstetricians can be requisitioned may be summarised as follows:— (a) In the case of Puerperal Fever or Pyrexia. The Borough Council has an arrangement by which any Medical Practitioner may obtain the opinion of Mr. W. Gilliatt, m.d., f.r.c.S., of 103 Harley Street, W., (Mr. Gilliatt also acts in a consulting capacity in respect of any complicated midwifery cases in the Borough Council's Maternity Home; details given under Para.4.) (b) Complicated Midwifery Cases. In 1930, the Borough Council, upon my representation, decided to make provision for any Medical Practitioner to obtain the help of a Consultant where pregnancy or labour is abnormal. The following two Consultants have been appointed by the Borough Council:— Mr. George F. Gibberd, f.r.C.S., 121 Harley Street, W. 1, Mr. Arnold L.Walker, F.r.C.S., 44 Queen Anne Street, W.l. The scheme provides for the recovery of all or part of the Consultants fee where circumstances warrant it. 4. The Maternity Home. The record of the Municipal Maternity Home shows that the work carried out during 1931 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 1931:— Cases admitted, 242 (including 17 admissions for ante-natal treatment). Average stay, 2 weeks. Cases delivered by midwives, 219. „ „ „ doctors, 6. Cases in which medical advice sought, 75. Cases notified as puerperal fever, Nil. „ „ „ puerperal pyrexia, 2. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, 2. Maternal deaths, Nil. Foetal deaths (a) Stillborn, 5. (b) Within 10 days of birth, 1. 107 So far as is practicable, only cases likely to follow a normal course are admitted. Should an abnormality develop after the date of " booking," the patient is referred to hospital. To meet the case of a sudden emergency arising in a woman already admitted to the Maternity Home, the following facilities are provided:— (a) Mr. W. Gilliatt, F.R.C.S., in his capacity of Consulting Obstetrician, will visit the Home in consultation with the Medical Officer, Dr. Hill. (b) Should hospital treatment be then advised, the Borough Council has an arrangement with King's College Hospital for the treatment of the patient in that institution. During 1931, Mr. Gilliatt was called to the Home three times. Cases not admitted to the Maternity Home. During 1931, a total of 159 applications for admission were refused, 156 owing to the available accommodation being fully booked, and three upon medical grounds. 5. Provision of Maternity Outfits. The Borough Council now provides sterile maternity outfits for any women confined at home, the issue being free or at half cost price in necessitous cases. 6. Provision of Home Nursing. Arrangements have been made for the provision of a District Nurse in certain types of illness. During the year 17 cases were nursed under the Maternity and Child Welfare Scheme. Full details of these appear under "Nursing in the Home." 7. Provision of Home Helps. The scheme for this form of domestic assistance makes provision for the service of a Home Help during labour and the first three months from the date of confinement and, in exceptional cases during pregnancy. In seven instances, Home Helps were provided during the year under report. 8. Convalescent Treatment. Provision is made for the accommodation of mothers and children, selected upon medical grounds, in certain recognised convalescent 108 homes, admission being made either direct or, in the case of children, through the Invalid Children's Aid Association. During 1931, 16 cases were sent away. 9. Hospital Provision 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. Since the 1st April, 1930, the Exchequer Grant to it became payable through the Borough Council, which has to be satisfied, as a result of inspections made, of "the efficiency of the service provided." During 1931, nine babies were admitted under the scheme. (b) St. Thomas' Babies' Hostel, Kennington. (1) In-patient Treatment. Mothers and Infants, where difficulty in breast-feeding is experienced, and occasionally infants alone, are sent to this hostel with very satisfactory results. During 1931, ten mothers with their infants were referred for treatment. (2) Out-patient Treatment. This is provided in order that " testfeeds " may be carried out. 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, "Test Feeds "are conducted at the Town Hall and Harton Street. During 1931, 287 " 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. Should it be found possible, at some future date, to establish such a centre, it would meet 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. 109 l0. Supply of Milk and Accessory Foods. 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 general accordance with the Minister of Health's Circular No. 185. Various brands of dried milk are issued, labelled specially to the Council's directions to avoid the use of trade names. In 1931, the following free or half-price issues were authorised:— 11,311 families were given fortnightly supplies. Fluid milk formed the bulk of this supply, dried milk being issued only on the recommendation of the Centre Medical Officers. During the year it was observed that an increasing number of persons came within the Council's Scale of Necessity with a corresponding increase in the total amount of milk supplied. Issues of Cod Liver Oil and Malt and Virol are made upon medical advice to debilitated children, the parent paying cost price. 11. Compensation to Midwives. It occasionally happens that an expectant mother, referred to the Ante-natal Clinic by a midwife with whom she has "booked," is found to be suffering from some abnormality which necessitates her confinement in hospital. In such cases the Council pay to the midwife a portion of her prospective fee which would be otherwise lost. In four instances this policy was carried into effect, involving a total expenditure of £2. 12. 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 110 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. Efforts are also made to give insight to some students of the Goldsmiths' College and to student Health Visitors of the College of Nursing in regard to the work of Child Welfare. 13. Maternal Mortality. In accordance with the requirements of the Ministry of Health a confidential report is made in the case of every maternal death, the information being collated for statistical purposes. Should occasion arise, the services of Mr. W. Gilliatt, m.d., f.r.c.s., are available in this connection. Appendix. 112 Table I. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1931. CAUSES OF DEATH. Sex. All Ages 0— 1— 2— 5— 15 — 25— 35— 45— 55— 65— 75- All causes M 68G 49 1G 14 16 27 30 30 88 137 155 124 f 598 44 4 12 12 28 33 38 54 89 122 1G2 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. f .. .. .. .. .. .. .. .. .. .. .. .. Measles M 1 .. 1 .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever M 4 .. 2 1 .. .. .. 1 .. .. .. .. F 2 .. .. l .. 1 .. .. .. .. .. .. Whooping Cough M 9 4 3 .. .. .. .. .. .. .. .. F 2 2 .. .. .. .. .. .. .. .. .. .. Diphtheria M 6 1 1 2 1 1 .. .. .. .. .. . , F 6 1 1 3 l .. .. .. .. .. .. .. Influenza M 7 .. .. .. .. 1 .. 2 1 1 2 .. F 13 .. .. .. .. 2 .. 2 1 5 1 2 Encephalitis Lethargica M .. .. .. .. .. .. .. .. .. .. .. .. f .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever M 1 .. .. .. .. .. .. .. .. .. 1 .. F 3 2 .. 1 .. .. .. .. .. .. .. .. Tuberculosis of respiratory system M 60 .. .. .. l 8 12 7 18 11 3 .. f 40 .. .. 1 1 12 13 5 5 3 .. .. Other Tuberculous Diseases M 5 .. 1 .. l 1 1 .. .. .. .. 1 F 9 .. .. 1 3 .. 4 1 .. .. .. .. Syphillis M 2 .. .. .. .. .. .. l .. 1 .. .. F .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane, tabes dorsalis M 2 .. .. .. .. .. .. l .. 1 .. .. F 3 .. .. .. .. .. .. 1 1 1 .. .. Cancer, malignant disease M 87 .. .. .. .. .. 2 2 13 34 24 11 f 87 .. .. .. .. .. .. 8 19 24 22 14 Diabetes M 6 .. .. .. .. .. .. .. 1 .. 5 .. f 13 .. .. .. .. .. .. 1 2 2 4 4 Cerebral Haemorrhage, etc. M 16 .. .. .. .. .. .. .. .. 4 5 7 f 25 .. .. .. .. .. .. .. .. 4 9 12 Heart Disease M 167 .. .. .. 1 2 3 2 17 34 49 59 F 155 .. .. .. 3 7 5 10 12 24 39 55 Aneurysm M 6 .. .. .. .. 1 .. .. 1 3 1 .. F 1 .. .. .. .. .. .. .. .. 1 .. .. Other Circulatory Diseases M 25 .. .. .. .. .. .. .. 1 5 12 7 F 15 .. .. .. .. .. .. .. .. 3 3 9 Bronchitis M 30 .. .. 1 .. .. 1 1 6 7 8 6 f 25 .. .. .. 1 .. .. l .. 1 5 17 Pneumonia (all forms) M 66 15 5 1 .. 2 1 7 9 7 13 6 f 47 14 2 .. 1 1 2 1 3 6 9 . 8 Other Respiratory Diseases M 4 .. .. .. .. .. .. .. 2 1 1 .. F 3 .. .. .. .. .. 1 .. .. .. .. 2 Peptic Ulcer M 6 .. .. .. .. .. .. .. 1 3 1 1 f 5 .. .. .. .. .. .. 1 2 .. .. 2 Diarrhoea, &c. M 8 6 .. 1 .. .. .. .. .. .. 1 .. f 6 3 .. l .. .. .. 2 .. .. .. .. Appendicitis m 10 .. .. 3 1 1 .. .. 3 .. 2 .. F 5 .. .. .. 2 .. .. .. .. 1 1 1 113 Table 1—continued. CAUSES OF DEATH. Sex. All Ages. 0— l— 2— 5— 15— 25- 35 — 45— 55— 65— 75- Cirrhosis of Liver M 7 .. .. .. .. .. .. .. 3 1 3 .. F 3 .. .. .. .. .. .. .. 2 1 .. .. Other diseases of Liver, etc. M .. .. .. .. .. .. .. .. .. .. .. .. F 2 .. .. .. .. .. .. .. .. .. .. 2 Other Digestive Diseases M 8 .. .. .. .. 1 .. .. 1 4 2 .. F 12 .. .. .. .. .. .. .. .. 2 8 2 Acute and chronic Nephritis M 12 .. .. .. .. .. 1 .. 3 5 2 1 F 19 .. .. .. .. 1 1 .. 3 4 8 2 Puerperal Sepsis F 4 .. .. .. .. 1 2 1 .. .. .. .. Other Puerperal causes F 2 .. .. .. .. l 1 .. .. .. .. .. Congenital Debility, Premature Birth, M 24 23 1 .. .. .. .. .. .. .. .. .. tions etc. F 21 19 1 1 .. .. .. .. .. .. .. .. Senility M 16 .. .. .. .. .. .. .. .. .. 3 13 F 22 .. .. .. .. .. .. .. .. 1 3 18 Suicide M 8 .. .. .. .. .. .. 2 2 3 1 .. F 2 .. .. .. .. 1 1 .. .. .. .. .. Other violence M 23 .. .. 1 4 6 3 1 1 3 3 .. F 7 .. .. l .. .. .. .. .. 1 1 4 Other defined diseases M 59 2 .. l 6 3 6 3 5 9 12 12 F 39 3 .. 2 1 3 4 4 5 9 8 Causes ill-defined or unknown M 1 .. .. .. .. .. .. .. .. .. 1 .. F .. .. .. .. .. .. .. .. .. .. .. .. H 114 Table II. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION OR DESTROYED AT OWNERS' REQUEST. 1931 Premises Visited Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Books Articles Destroyed (Owners' Request) Cleansing Station Infectious Diseases Requests Bedding only D.B.C. Library Private Total Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Wearing Apparel Towels Blankets Total January 96 11 4 47 132 39 27 70 132 352 799 24 l 25 4 ... 1 3 ... ... ... 8 ... 144 ... 144 February 91 5 13 65 131 37 28 92 143 347 843 11 8 19 2 9 2 1 ... l 3 18 18 192 l 211 March 97 8 5 54 133 49 33 63 120 413 865 11 3 14 4 4 2 1 ... ... 53 64 24 222 3 249 April 92 4 3 51 137 43 40 105 142 368 886 18 4 22 2 ... ... 1 ... l 1 5 8 124 ... 132 May 72 10 6 40 96 40 39 82 96 218 611 19 22 41 3 3 1 2 ... ... 30 39 ... 186 ... 186 June 71 3 5 33 64 32 29 67 66 127 418 18 1 19 3 ... ... 4 ... ... ... 7 ... 279 ... 279 July 52 5 12 38 86 31 25 67 101 130 478 7 2 9 2 ... 2 6 ... ... ... 12 ... 217 ... 217 August 50 11 10 32 83 21 15 51 70 125 397 15 ... 15 1 ... ... 2 ... ... ... 3 26 38 4 68 September 77 6 4 46 111 30 27 85 83 256 638 33 3 36 3 3 1 4 ... 4 7 22 ... 210 ... 210 October 104 4 8 66 155 49 34 105 175 313 897 31 35 66 ... ... ... 1 ... ... 5 6 7 254 1 262 November 77 2 4 42 91 33 24 60 86 194 530 40 31 71 6 8 2 ... ... 1 97 114 ... 136 ... 136 December 71 5 3 34 107 36 18 145 100 246 686 37 7 44 1 ... ... 2 ... ... ... 3 ... 112 ... 112 950 74 77 548 1326 440 339 992 1314 3089 8048 264 117 381 31 29 11 27 ... 7 196 301 83 2114 9 2206 115 Table III. SHOWING NUMBER OF ROOMS DISINFECTED. 1931 Scarlet Fever Diphtheria Pulmonary Tuberculosis Small-Pox Cancer Scabies Chicken Pox Measles Erysipelas Puerperal Fever Cerebro-Spinal Meningitis Formalin Spray Fumigated Infectious Requests Total Rooms Verminous Premises Rooms R'ms. R'ms January 35 34 29 6 .. 3 1 2 1 1 .. 112 17 129 .. .. February 97 28 33 5 2 1 .. .. .. .. 1 107 6 113 4 5 March 31 31 38 22 2 1 1 .. 1 1 .. 128 14 142 5 10 April 33 22 33 32 2 • • .. 1 .. .. .. 123 9 132 4 5 May 37 11 23 15 .. 1 .. .. .. .. .. 87 13 100 27 56 June 30 21 33 .. 1 .. 5 .. 1 1 .. 92 6 98 11 18 July 23 29 22 .. 3 1 .. .. .. 1 .. 79 16 95 13 24 August 25 13 18 • • 3 .. .. .. .. .. .. 59 18 77 4 7 September 38 19 30 4 2 1 .. 1 .. .. .. 95 8 103 5 6 October 67 14 34 3 1 3 .. .. 1 .. .. 123 4 127 3 6 November 37 38 33 3 2 1 .. .. .. .. .. 114 3 117 1 2 December 54 11 22 .. .. .. .. 2 .. .. .. 89 5 94 3 4 447 271 348 90 18 12 7 6 4 4 1 1208 119 1327 80 143 116 GOSTERWOOD STREET CLINIC. 1931 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5. January 4 24 2 1 27 233 260 133 February 4 21 6 6 33 252 285 124 March 5 16 2 3 21 338 359 146 April 3 L5 2 2 19 230 249 119 May 3 6 1 3 10 258 268 105 June 5 10 1 2 13 418 431 169 July 4 8 2 2 4 16 319 335 136 August 4 14 1 15 236 251 95 September 4 20 4 2 26 305 331 148 October 4 11 1 3 15 357 372 173 November 5 16 1 3 20 307 327 148 December 4 4 2 6 215 221 94 Total 49 165 7 21 28 221 3468 3689 1590 NAPIER STREET CLINIC. 1931. 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 8 1 3 6 18 197 215 122 February 4 5 1 2 8 179 187 75 March 5 21 5 3 29 229 258 121 April 4 8 2 10 155 165 80 May 4 7 1 2 10 156 166 74 June 5 12 1 2 4 19 274 293 133 July 4 20 2 1 23 203 226 120 August 3 13 1 14 142 156 67 September 5 15 1 4 2 22 317 339 173 October 4 17 1 2 3 23 251 274 144 November 4 12 3 3 18 265 283 140 December 5 8 8 273 281 168 Total 51 146 4 24 28 202 2641 2843 1417 117 GOLDSMITHS' COLLEGE CLINIC. 1931 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 10 2 12 205 217 95 February 4 9 2 11 191 202 92 March 4 6 1 2 2 11 187 198 88 April 5 8 2 10 277 287 108 May 4 7 4 11 216 227 102 June 4 8 2 2 12 210 222 84 July 5 10 1 4 1 16 299 315 143 August 4 9 3 12 250 262 100 September 5 4 4 2 2 12 316 328 128 October 4 7 2 9 273 282 112 November 4 14 1 1 16 268 284 117 December 5 8 2 10 279 289 113 Total 52 100 6 22 14 142 2971 3113 1282 PRINCESS LOUISE INSTITUTE, HALES STREET AND CHURCH STREET CLINICS 1931. No. of times Clinic opened. New Cases. Total NewCases. Total Old Cases. Total New and Old Cases- Consultations with Doctor. Breast Fed. Mixed. Hand. Ages ,-5. Princess Louise January 5 18 4 8 30 318 348 174 February 4 8 3 11 242 253 90 March 4 9 2 2 13 222 235 98 April 4 10 4 14 207 221 108 May 4 5 3 8 168 176 74 June 4 10 1 11 157 168 64 July 5 13 4 3 20 268 288 128 Church Street August 4 3 1 1 5 112 117 59 September 4 12 1 4 17 131 148 89 October 5 16 2 1 7 26 244 270 139 November 4 10 3 13 229 242 111 December 4 4 2 3 9 157 166 81 Total 51 118 3 19 37 177 2455 2632 1215 118 BESSON STREET CLINIC. 1931. 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 8 3 3 14 279 293 129 February 4 12 2 2 16 266 282 128 March 5 19 2 2 2 25 309 334 142 April 3 7 2 2 11 245 256 98 May 3 6 1 1 8 242 250 101 June 5 24 2 7 3 36 365 401 160 July 4 8 1 9 315 324 124 August 3 10 1 1 12 261 273 105 September 5 11 3 4 18 416 434 151 October 4 9 2 2 13 338 351 124 November 4 17 1 1 19 323 342 129 December 5 10 2 2 2 16 337 353 150 Total 49 141 8 26 22 197 3696 3893 1541 ERLAM ROAD CLINIC. 1931. 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 6 2 1 9 189 198 128 February 4 7 1 8 170 178 89 March 4 3 3 159 162 86 April 3 4 2 6 130 13G 74 May 4 9 1 10 156 166 84 June 4 6 1 7 160 167 80 July 5 8 1 9 192 201 90 August 4 6 1 1 8 157 165 77 September 4 13 1 14 176 190 91 October 5 6 1 7 260 267 111 November 4 4 2 6 172 178 85 December 3 2 1 3 110 113 56 T otal 19 74 1 8 7 90 2031 2121 1056 1 19 ST. GEORGE'S HALL, SHARDELOES ROAD. 1931. 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 15 1 1 2 1 19 255 274 144 February 4 7 2 2 1 12 255 267 113 March 4 9 3 2 1 15 237 252 97 April 3 4 4 186 190 85 May 4 7 1 4 3 15 241 256 99 June 4 6 6 220 226 97 July 5 21 2 1 24 280 304 121 August 4 6 2 3 11 240 251 88 September 4 12 1 3 1 17 270 287 108 October 5 17 1 3 21 380 101 156 November 4 6 3 9 315 324 132 December 3 4 2 2 8 189 197 82 Total 49 114 10 18 19 161 3068 3229 1322 ST. JOHN'S CLINIC. 1931. No. of times Clinic opened. Breast Fed. New Mixed. 3nses. Hand. Ages 1-5 Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. January 4 2 o 4 191 195 114 February 4 4 1 1 6 189 195 93 March 4 3 2 5 153 158 82 April 5 5 2 3 10 195 205 126 May 4 9 2 1 12 173 185 99 June 4 7 1 1 9 163 172 99 July 5 12 12 210 222 117 August 4 6 2 8 160 168 91 September 5 10 2 12 221 233 139 October 4 3 3 3 9 207 215 134 November 4 4 1 3 8 173 181 113 December 5 4 2 1 2 9 169 178 127 Total 52 69 7 8 20 104 2204 2308 1334 INDEX A PAGE Aged and Infirm Persons, Removal to Hospital 38 Agricultural Produce (Grading and Marking) Act, 1928 58 Ante-natal Clinic 102 Area of Borough 8 Artificial Light Clinic 104-105 B Babies' Hospital, Albury Street 108 Bacteriological Work 71 Bakehouses 42, 51 Births 11 ,, illegitimate 12 ,, Notification of 12 c Cancer 73 Canal Boats Act, Inspector's Report 40 Cerebro-spinal Meningitis 67 Chicken pox 65 Clinics and Treatment Centres—List of 27 Condensed Milk Regulations 57 Convalescent Treatment 107 D Deaths 13 ,, Table showing causes at different age periods 112-113 ,, of Infants 16 Dental Clinic, Maternity and Child Welfare 105 ,, Tuberculosis 89 ii. D—continued. PAGE Diabetes 74 Diarrhoea. Infantile 68 Diphtheria 63 Disinfection 72, 114, 115 Disinfestation 72 District Surveyor, co-operation with 40 Dried Milk Regulations 58 Dysentery 68 E Encephalitis Lethargica 67 Enteric Fever 70 Erysipelas 70 F Factories and Workshops 41-42 Fish Shops, Fried 51 Fish Curers 51 FOOD 47-58 ,, Premises 49-51 ,, Imported 52 ,, Unsound 52 ,, Poisoning 53 ,, Sampling, Food and Drugs (Adulteratiod) Act 54-58 Foreword 5-6 H Handicraft Class for Tuberculous Patients, Report on 92 Health Education 109 HEALTH SERVICES, General Provision of 20-28 Health Visitors, Summary of Visits paid by 99-100 Home Helps 107 Home Nursing 24 & 107 House-to-house Inspections 34 HOUSING 43-46 III. H—continued. PAGE I Ice Cream premises 51 Imported Food 52 Infant Welfare Centres, Summary of Work at 100-101 ,, ,, Tables showing attendances at 116-119 Infantile Mortality 16-17 ,, ,, Table 16 INFECTIOUS AND OTHER DISEASES 59-74 Influenza 70 Insulin, supply of 71 L Legal Proceedings, general 35 ,, Food and Drugs 57 ,, Food Premises 49, 53 Lewellin, Miss, Report of 93 M Malaria 68 Marriages 11 Maternal Mortality Reports to Ministry 110 MATERNITY AND CHILD WELFARE COMMITTEE 3 MATERNITY AND CHILD WELFARE 98-110 Maternity Clinics, Tables 102-103 Maternity Home 106 Maternity Outfits, provision of 107 Measles 70 Meat Premises 50-51 Mid wives, compensation to 109 Milk, Graded 49 ,, Bacteriological Examination 50 Milk Shops 49 ,, Supply of, to Necessitous Mothers and Infants 109 Mortuary, Public 18 IV. PA.GE N Nursing in the Home 24 o Obstetricians, consulting 106 Occupations, chief of population 9 Offensive Trades 38 Offensive Matter, conveyance through streets 38 Ophthalmia Neonatorum 69 P PHYSICAL FEATURES AND VITAL STATISTICS OF BOROUGH 7-19 Pneumonia 67 Poliomyelitis, acute 67 Population 11 Post-natal Clinic 103 PUBLIC HEALTH COMMITTEE 3 Puerperal Fever 68 „ Pyrexia 69 R Kag and Bone dealers 38 Rateable Value 8 Rats and Mice (Destruction) Act 38 Refuse Collection 39 S SANITARY CIRCUMSTANCES OF THE BOROUGH 29-42 Sanitary Inspectors, work of, Table 32-34 Scarlet Fever 61 Sewers and Drains, supervision of 39 Sickness, Noteworthy causes of 17 Slaughterhouses 50 V. PAGE S—continued. Smallpox 64 Smoke abatement 36-37 Social Conditions of Population 9 Staff of Public Health Department 22-24 St. John's Home 104 St. Thomas's Hostel 108 Swimming Baths, examination of water 38 T TUBERCULOSIS 75 Tuberculosis Care Committee, work of 93 ,, Handicraft Class, Report on 92 ,, Summary of Notifications 77-79 ,, New Cases and Deaths 82 ,, Interval between Notification and Death 82 ,, Revision of Register 83 ,, Analysis of Contacts 83-84 ,, Memo. 37 T., Table 1 87-88 ,, Annual Return facing page 92 ,, Co-operation with Medical Practitioners, etc. 91 ,, Home accommodation of Patients 81 ,, Dental Treatment 89 ,, Vists to homes 90 V Vaccination Return 66 w Water Certificates 40 Whooping Cough 71