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. * 1 932 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health Committee. JOHN SPEAKMAN, Esq., J.P., L.C.C. Chairman Councillor A. G. HOWARD. Vice Chairman Councillor E. C. SHERWOOD. Councillor A. Aplin. Councillor F. B. Buttery. Councillor Mrs. B. M. Drapper, J.P. Councillor W. H. Green, J.P., L.C.C. Councillor J. G. Hicks, J.P. Councillor Mrs. C. Rogers. Councillor W. Taylor. Councillor Mrs. G. Tiffen, J.P. Councillor Mrs. L. E. White. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. M. Herlihy. Vice-Chairman. Councillor Mrs. B. M. Drapper, J.P. Councillor A. Aplin. Councillor Mrs. E. M, Bateman. Councillor Mrs. A. A. Cheason. Councillor Mrs. G. E. Green. 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 Borongh of Deptford. Public Health Department, Deptford Town Hall, S.E. 14. 30th May, 1933. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford Mr. Mayor, Ladies and Gentlemen, I have the honour to present my fourth Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. 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 for 1932 was 15.9 per 1000 population as compared with 16.3 in 1931. The death-rate in 1932, as compared with 1931, showed a slight rise, viz., from 12.0 to 12.2 per 1,000 persons. The incidence of infectious disease generally showed some increase, but the cases were mainly of a mild type. In the section dealing with the sanitary circumstances of the Borough, the work of the Sanitary Inspectors is outlined. During 1932, the volume of work, whether judged by the number of inspections made or sanitary improvements effected, reflects great credit upon the Inspectorial Staff. The housing situation so far as existing property is concerned remains the same difficult problem. Continual vigilance is required to keep property—much of it suffering from the defects incidental to its common use by two or more families—in an even reasonable habitable condition. 6 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. During the year, the Borough Council lost the services of one of its most efficient Officers by the death of Mr. Harry Allam. Although handicapped by ill-health over a prolonged period, it was characteristic of Mr. Allam that he insisted upon continuing to discharge his duties until a few days before his sudden death. The Staff has responded well to the ever increasing duties devolving upon the Public Health Department. I should like to express my appreciation of the work done by Dr. Donnelly and Dr. Hill in their respective Departments of Tuberculosis and Maternity and Child Welfare and my thanks to the Staff generally, for their loyal assistance in carrying out so efficiently the work of the Public Health Department. 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. Mainta ined by. 1. Deptford Park Evelyn Street 22 acres .. L.C.C. 2. Ravensbourne Recreation Ground. Brookmill Road 1½ acres Borough Council. 3. Telegraph Hill Recreation Ground. Telegraph Hill 45 acres L.C.C. 4. Railways and adjoining land. 234 acres 5. Mill wall Football Ground. 5½ acres 6. Canals 8 acres 7. St. Paul's Churchyard 2.2 acres 8. Reservoir 1 acre 9. Municipal Playing Fields Deptford Bridge 3½ acres Statistics. Area 1,564 acres Population: Census 1931 106,891 Estimated Resident population, 1932 105,100 Number of "structurally separate dwellings" occupied (193] 17,750 ■ ) Number of families or separate occupiers (1931) 29,248 Rateable Value (31.3.1932) £642,733 Estimated sum represented by a Id. Rate £2,641 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 following figures have been kindly supplied to me by the Manager of the Deptford Labour Exchange:— Number of Unemployed:— 26th Sept., 1932 Men, 4,320 Women, 473 Juveniles, 267 23rd Jan., 1933 „ 4,732 „ 924 „ 331 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 31st December, 1932:— Unemployment 5,829 (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1932:— £84,929 15s. 7d. A further index of the economic position is afforded by the details of the incomes of persons receiving milk through the Council's scheme. In 1932 a very large increase of applications was experienced. An Analysis of the applications made in December showed that the number of persons granted milk was 917. Of these, 870 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 47 persons, the same conditions being observed, the amount per bead varied between 7s. 6d. and 10s. 6d. During the whole year 21,671 applications for fortnightly supplies were granted. Of this number, 20,343 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. 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. 10 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. 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 : Male. Female. Total. Birth-rate. Live ( Legitimate 809 804 1,613 ) Births j Illegitimate 29 27 56 Still-births, 48. Rate per 1,000 total births, 28.0. Death-rate. Deaths 1,290 12.2 Percentage of total deaths occurring in Institutions 57 Number of women dying in, or in consequence of, childbirth: Rate per 1,000 births. From Puerperal Sepsis 2 1.2 Other Puerperal causes 3 1.7 Total 5 2.9 Death-rate of infants under one year of age, per 1,000 births : Legitimate 60.9 Illegitimate 178.6 Total 65.0 Deaths from Measles (all ages) 23 „ Whooping Cough (all ages) 9 „ Deaths from Diarrhoea (under 2 years) 23 Population. 1 he population for 1932, as given by the Registrar-General, was 105,100, the lowest on record. 11 Marriages. During the year 891 marriages took place, equivalent to a rate of 8.5 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 74 In the Superintendent Registrar's Office 289 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 512 children born of Deptford parents outside the Borough, and the deduction of 32 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,669. This is equivalent to a birth.rate of 15.9 per 1,000 of the population and represents only a natural increase of 3.7 per 1,000 of the population. The following table illustrates the steady fall that has taken place : No. BIRTHS. County of London. Crude rate per 1,000 population Deptford. Crude rate per 1,000 population. England and Wales. Crude rate per 1,000 population. Average for 10 years, 1915 to 1924 2610 22.9 20.0 20.5 Average 1925 to 1929 1976 17.4 17.2 16.7 1930 1761 15 9 16.3 15.7 1931 1745 16.3 15.8 15.0 1932 1669 15.9 15.3 14.3 Still-Births. 48 still-births were registered during the year as follows:— Legitimate Illegitimate Total Male 21 1 22 Female 24 2 26 12 Illegitimacy. The number of illegitimate births was equivalent to 3.3 per cent, of the total births. The figures relative to illegitimacy for previous years areas follows: Av. for 10 yrs. 1915.1924.' Av. for 5 yrs. 1925.1929 1930 1931 1932 No. of illegitimate births 77 58 59 55 56 Percentage of total births 2.9 3.0 3.4 3.2 3.3 Notification of Births. During 1932, the number of births to Deptford mothers (after allowing for inward and outward transfers) was registered as 1,669, and the number of notifications received of births actually occurring in the Borough was 1,181. The following is an analysis of these notifications: Births Notified in the Borough during Year 1932. Ward. Births notified. Alive Dead Bv whom notified Total Male Female Parent Doctor Midwife Other person Canterbury 111 54 57 108 3 5 16 90 — Clifton 69 40 29 68 1 2 10 53 4 Deptford Park 71 36 35 69 2 2 21 47 1 Evelyn 124 64 60 123 1 3 23 95 3 Hatcham 81 47 34 78 3 6 7 66 2 Pepys 59 30 29 57 2 6 23 28 2 St. Catherine's 40 23 17 40 - 4 14 21 1 St. John's 55 27 28 55 - 3 5 47 — St. Paul's 157 74 83 157 - 5 7 144 1 St. Peter's 272 129 143 264 8 7 15 248 2 Town Hall 55 22 33 54 1 5 9 40 1 Vale 112 63 49 108 4 4 11 94 3 Totals 1206 609 597 1 181 25 52 161 973 20 Deaths. In order to express the number of deaths as a death-rate applicable to the Borough, it is necessary to make allowance in rcspect of deaths 13 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 656 Deduct deaths of "non.residents" 122 534 Add deaths of "residents" outside Borough 756 Nett deaths applicable 1,290 This is equivalent to a death.rate of 12.2 per 1,000 persons. Seasonal Mortality. Quarter ended. No. 1931 No. 1932 Rate per 1,000 of population. Rate per 1,000 of population. March 453 16.9 453 17.2 June 264 9.9 275 10.5 September 278 10.4 249 9.5 December 289 10.8 313 11.9 The trend of the death-rate in recent years is shown by the following table:— Year. Deptforc No. 3. England & Wales. London. Rate per 1,000 of the population. Average for 10 years, 1915.1924 1560* 14.1 13.6* 13.9 1925 1399 12.1 12.2 11.7 1926 1302 11.3 11.6 11.4 1927 1312 11.5 12 12.3 11.9 1928 1354 12.0 11 11.7 11.6 1929 1481 13.3 13 13.4 13.8 1930 1250 11.3 11 11.4 11.4 1931 1284 12.0 12 12.3 12.4 1932 1290 12.2 12 12.0 12.3 *Civilian population only from 1915.1920. 14 Deaths—Sex and Ward Distribution. Ward. Males. Females Children under 1 year. Total deaths. Deptford Park 28 32 6 60 Evelyn 73 45 12 118 St. Paul's 88 62 15 150 Vale 73 56 14 129 Clifton 55 42 5 97 Canterbury 48 51 13 99 Hatcham 65 58 3 123 Pepys 40 47 6 87 St. Catherine's 30 43 7 73 St. Peter's 35 69 4 104 St. John's 94 48 10 142 Town Hall 53 55 13 108 682 608 108 1290 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), 1932. Average No. for 10 years 1915-24. Average 1925-1929 1930 1931 1932 Increase or decrease over 1931 Measles 18 27 20 24 1 23 + 22 Whooping Cough 7 24 13 3 11 9 - 2 Diphtheria 5 19 14 4 12 6 - 6 Influenza 20 70 35 6 20 26 4- 6 Tuberculosis—Pulmonary 71 136 102 113 100 92 - 8 Non-pulmonary 10 32 18 14 14 13 - 1 Cancer 142 133 159 156 174 183 + 9 Heart Disease 230 128 232 298 322 297 - 25 Cerebral Haemorrhage, Embolism and Thrombosis 38 67 54 45 41 49 + 8 Bronchitis 41 140 95 47 55 53 - 2 Pneumonia (all forms) 63 154 121 73 113 82 - 31 Nephritis 27 35 34 44 31 35 4- 4 Diarrhoea and Enteritis 23 45 20 19 14 29 + 15 Violence (excluding Suicides) 28 48 49 64 30 36 4- 6 Premature Birth Malformation and Debility 37 86 49 40 45 48 4- 3 15 Special Noteworthy Causes of Sickness or Invalidity. The foregoing table shows 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 commonest single cause of death being heart disease. 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 1932 Under 1 year 16.3 9.4 8.6 7.2 8.3 From 1.2 years 4.7 2.7 1.8 1.6 3.0 ,, 2.5 years 4.3 2.8 2.5 2.0 2.0 ,, 5.15 years 3.9 2.9 2.3 2.2 1.8 ,, 15.25 years 4.4 4.3 5.5 4.3 4.2 ,, 25.45 years 12.3 10.5 11.1 10.2 8.8 ,, 45.65 years 23.3 27.7 26.0 28.6 26.6 65 years and upwards 30.8 39.6 42.2 43.8 45.3 The infantile mortality rate for 1932 was 65 per 1,000 births and the following Table gives the death-rates for England and Wales, London and Deptford for previous years:— Year Deptford No. Death-rate per 1.000 Births England & Wales Death-rate per 1,000 Births London Death-rate per 1,000 Births Average for 10 years 1915.1924 231 90 87 85 Average 1925.1929 1 129 64 71 65 1930 107 61 60 59 1931 93 53 66 65 1932 108 65 65 66 16 The following Table gives details of the causes of death in the various age groups:— Infantile Mortality, 1932. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total Deaths under 1 year. All Causes 31 3 4 3 41 23 21 21 2 108 Smallpox .. .. .. 1 1 .. .. .. .. 1 Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. l .. l Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. .. .. .. .. .. 3 3 .. 6 Convulsions 1 .. .. .. .. 1 . . 1 .. 4 Laryngitis .. .. .. .. .. .. . . .. .. .. Bronchitis 1 .. .. .. 2 3 1 2 .. 8 Pneumonia (all forms) .. .. .. .. 2 4 4 5 2 17 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. 2 6 8 4 .. 20 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying 1 .. .. .. 1 .. .. .. .. 1 Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 6 .. .. .. 6 1 .. .. .. 7 Congenital Malformations 4 1 .. .. 5 .. 2 1 .. 8 Premature Birth 11 1 .. .. 12 1 .. .. 13 Atrophy, Debility, and Marasmus 3 .. .. .. 3 5 3 3 .. 14 Other Causes 3 1 .. .. 4 1 • • • • .. 5 Totals 31 3 4 3 41 23 21 21 2 108 Death-rate in each agegroup per 1,000 births 18.6 1.8 2 .4 1.8 24.6 13.8 12.6 12.6 1.2 647 Percentage of total deaths in each agegroup 287 2.8 3.7 2.8 38.0 21.3 19.4 19.4 1.9 100 17 The following Table illustrates the trend of infant mortality during recent years in regard to deaths 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 1932 28.7 2.8 3.7 2.8 38.0 21.3 19.4 19.4 1.9 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 326 persons who had been residents of the following districts:— Deptford 88 Greenwich 67 Bermondsey 50 Woolwich 66 Lewisham 10 Camberwell 4 Lambeth 1 Southwark 3 Poplar 2 Kensington 2 Beckenham 2 East Ham 1 Leytonstone 1 St. Mary Cray 1 Rochester 1 Halstead Essex, 1 Hoddesden, Herts. 1 Coventry 1 Belvedere 2 Edmonton 1 Addiscombe 1 Southfields 1 Downham 1 Erith 1 Bromley 1 Bexley Heath 1 British Somaliland 1 Southampton 1 Unknown 13 B 18 Particulars of the bodies received were as follows: Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Unknown. Deposited to await burial only. I nfectious. 326 204 122 224 180 30 13 5 2 In 97 cases no inquests were held, the necessary certificate being issued by the Coroner. The causes of death were as follows:— Natural causes 179 Accidental causes 103 Suicide while of unsound mind 26 Open verdicts 117 Wilful Murder 1 Total 326 27 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. General Provision of Health Services. 20 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.il (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). 21 Clerks. A. G. W. Pettitt G. A. Langley S. Burridge E. J. Elliott J. E. Waring 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 Hevvett Cert. s.i.e.b. (Lond.), Meat Cert. r.s.I. Harry Allam (died 12.10.32) 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). G.F.Wilton. „ „ „ „ (Appointed 12th Dec., 1932.) „ „ „ „ (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. I 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.) Tubcrculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. 'Appointed as a Sanitary Inspector and Health Visitor. fPart-time only at Infant Welfare Centres. 22 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 Wickham Road, S.E. 4. Matron — Miss K. Smith (General Training, C.M.B.) Sister—Miss A. M. Cross ,, „ Nurses — Miss A. Packer ,, „ Miss L. Voysey (Women's Hosp. Tr., C.M.B.) Miss H. Alliston (General Training, C.M.B.) Miss N. Wood „ ,, ,, 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). The 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 1s. 3d. per nursing visit. 23 The following is a summary of the cases visited on behalf of the Borough Council by members of the District Nursing Associations:— Condition. Children under 5 years Others Total cases nursed Cases Visits Cases Visits Measles 3 50 3 Ophthalmia Neonatorum 8 140 8 Pneumonia 6 126 7 137 13 Prematurity 1 18 1 Thread Worms 1 5 1 Pemphigus 1 15 1 Mastitis 1 17 1 Diarrhœa 1 11 1 Breast Abscess 1 17 1 21 365 9 171 30 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 approximately 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. 24 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 were sent from the Infant Welfare Centres to the Deptford Fund Babies' Home, Albury Street until its closure upon the 14th June. Mothers and Infants are 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. I hese were fully set out in my report for 1930, and no material change in the arrangements has taken place. 25 CLINICS AND TREATMENT CENTRES. Maternity & Child Welfare. (1) Infant Consultations. Daily from 2 p.m. Monday, Gosfprwood Street Tuesday, Napier Street Do. Besson Street Wednesday, Goldsmiths' College. Do. "St. John's Hall, Harton Street. Thursday, Baptist Institute, Ilderton Road. Thursday, Princess Louise Institute, Hales Street Friday, St. George's Hall, Shardeloes Road. Health Centre, Harton St. (2) Maternity Clinic. Tuesday Wednesday" Friday (9 a.m. to 1 p.m.) *Post Natal Cases. (3) Dental Inspection (monthly). ,, Treatment (weekly). (4) Artificial Sunlight Centre. (By appointment.) (5) Diphtheria Immunisation Clinic. Wednesday (2 p.m.) Tuberculosis Dispensary. Health Centre, Harton Street. Monday & Thursday, 9.30 to 11 a.m. Men. Tuesday evening, 6.30 to 7.30 p.m., Men and Women at work. Tuesday and Friday, 9.30 to 11 a.m., Women. Thursday, 2 to 3 p.m., Children not at school and Women at work, latter by appointment. Saturday, 9.30 to 11 a.m., Children attending school. Secretary's Consultations. 9.30 a.m. daily. Venereal Diseases. Miller Hospital, Greenwich,S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Hospital, Morden Hill, Lewisham, S.E. 13. Clinic Hours— Men : Tuesday 5.30 p.m. Thursday 9.30 a.m. Women : Monday, 3 p.m. Thursday, 6.15 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. Any week-day, 9 a.m. to 8 p.m. King's College Hospital, Denmark Hill, S.E. 5. Syphilis—Tuesday, 4.30 p.m. Wednesday and Friday, 11a.m. Thursday, 2 p.m. Gonorrhoea—Monday, 2 p.m. Men. 6 p.m., Women and Children. Wednesday, 6 p.m., Women and Children. Thursday, 5 p.m., Men. Friday, 2 p.m.. Women and Children. School Clinics. Deptford School Treatment Centre. Lady Florence Institute, Reginald Square— Eye and Minor Ailments (Eye) : Tuesday and Friday, 2 p.m. Ear, Minor Ailments: Friday, 9.30 a.m. Operations. Monday, 2 p.m., at Cyril Henry Centre, Woolwich. Skin Ailments Wednesday, 2 p.m. Teeth : Alt. Mondays, 9.30 a.m. and 1.30 p.m. Tuesday, 1.30 p.m. Wednesday, 9.30 a.m. and 1.30 p.m. Thursday, 1.30 p.m. Friday, 9.30a.m., 1.30p.m. Gas, Tuesday, 9.30 a.m. Inspections, Alt. Mondays and Thursday, 9.30 a.m. Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. 26 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. 28 Sanitary Work. For the Public Health Department, 1932 proved a very unfortunate year in respect of illness amongst ihe Inspectorial Staff. As a result it will be observed that there is a considerable drop in the annual figures as compared with the previous year. If, however, allowance be made for the period of absence of Inspectors from sickness, the routine work of the department has been maintained up to the standard set last year, a "peak" year so far as sanitary inspection work was concerned. In the circumstances, therefore, it is felt that the work for the year may be considered to be quite satisfactory. An analysis of the actual inspections brings to light the fact that the decrease is due almost entirely to less house-to-house inspections being carried out. With a depleted staff this is obviously the first item to be curtailed if the remaining work of the department is to be maintained. maintained. This curtailment incidentally shows .itself in the fewer number of notices served and improvements effected. 1929 1930 1931 1932 Total primary inspections 5,825 8,004 7,592 6,652 Total re-inspections 14,545 18,167 20,461 17,284 Total Intimation Notices served 2,860 3,458 3,552 2,623 Total Statutory Notices served 302 1,078 1,104 687 Total Housing Act Notices served 3 42 12 10 Total Public Health Act, Section 41 (Drainage) Notices served 15 74 55 Total premises on which works were completed 2,831 3,855 3941 2,990 Total improvements effected during the year 9,234 12,053 14,116 10,928 29 Summary of Sanitary Work carried out during the year 1932. Number of District. Comparative figures for 1931. 1 2 3 4 5 6 7 Totals Inspections— On complaint 140 130 149 181 236 110 130 1076 946 House-to-house— 1. Where defects found 255 37 182 245 107 223 114 1163 1893 2. Where no defects found 117 6 15 94 44 113 126 515 991 On occurrence of Infection 188 178 227 141 170 271 174 1349 1031 On Notice from builder 51 26 37 36 41 40 77 308 279 Reference from T. B. Dispensary ... 3 5 5 7 4 3 27 23 Market Inspection 15 4 14 15 14 9 17 88 91 Factories 1 5 23 10 11 10 8 68 79 Workshops 2 1 13 4 5 4 6 35 49 Workplaces 9 2 17 5 3 8 6 49 55 Butchers'premises 3 3 7 6 15 15 10 59 16 Fish premises 26 16 15 26 25 31 36 175 260 Food premises (restaurants, etc.). 14 7 27 15 10 38 21 132 58 Milk premises 19 20 54 23 44 41 14 215 255 Offensive businesses ... ... 4 2 ... ... 1 7 10 Ice Cream premises 10 7 27 9 12 11 17 93 120 Bakehouses 17 16 9 21 19 14 12 108 140 Outworkers' premises 8 3 6 5 6 22 19 69 112 Miscellaneous inspections 159 106 122 118 132 229 250 1116 1184 Total inspections 1034 570 953 961 900 1193 1041 6652 7592 Re-inspections, Calls, etc. 2833 1239 2599 2570 1988 2435 3620 17284 20461 Smoke observations 1 6 3 1 2 ... 1 14 18 Notices Served— Intimation 469 220 334 502 337 426 335 2623 3552 Statutory 89 62 100 202 64 98 72 687 1104 Under Sec. 17 Housing Act, 1930 ... ... 1 ... 1 ... 8 10 12 Under Public Health (London) Act, 1891, Sec. 11 7 ... 2 2 8 12 24 55 74 Premises in respect of which notices were complied with 545 253 377 567 350 513 385 2990 3941 Premises in respect of which works in compliance with notices served during the year 1932 were outstanding at the end of the year 46 25 20 34 29 49 42 245 345 Description of Sanitary Im = provements effected during the year— Number of rooms, cleansed 894 331 828 878 561 415 433 4340 5800 Defective roofs repaired 71 59 111 109 55 112 46 563 870 Dampness abated 86 27 39 82 63 85 47 429 508 Gutters or rainwater pipes provided or repaired 47 46 74 78 31 42 33 351 588 Yards and forecourts paved or paving repaired 49 30 93 51 37 48 51 359 459 Water Fittings repaired 11 6 10 21 7 13 26 94 116 30 Summary of Sanitary Work—continued. Numbsr of District. Comparative figures for 1930. 1 2 3 4 5 6 7 Totals Premises in which repairs were effected to w.c's. 179 88 267 206 86 166 228 1220 1462 Dustbins provided 70 37 66 63 95 84 43 458 644 Repairs effected to windows, sashes, etc. 71 57 83 134 76 100 30 551 778 Repairs to stoves coppers and flues 50 40 114 99 36 102 29 470 489 Repairs to stairs, doors, etc. 9 12 71 53 16 31 9 201 197 Repairs to floors 13 18 110 42 18 37 18 256 301 Fish shops limewashed 13 9 4 19 5 17 24 91 165 Bakehouses limewashed 10 6 4 13 1 6 9 49 62 Ventilation and lighting improved 6 2 2 45 2 12 2 71 117 Sinks and waste-pipes repaired 48 37 78 106 50 34 114 467 555 Offensive accumulations removed ... 1 7 3 3 11 10 35 40 Overcrowding abated 1 ... ... ... . . . ... ... 1 ... Drains entirely reconstructed 9 8 11 9 8 15 26 86 88 Drains partially reconstructed 21 6 5 8 11 11 31 93 89 Drains unchoked and cleansed 12 12 16 28 45 18 12 143 176 Soil and vent pipes renewed or repaired 10 3 5 15 8 23 33 97 103 Gullies renewed or repaired 21 15 20 33 24 32 56 201 218 Inspection chambers, etc. provided or repaired 19 16 15 36 20 37 52 195 178 Miscellaneous repairs and improvements effected 11 1 11 30 16 18 20 107 73 Total repairs and improvements effected 10928 14166 Reference to Districts. District No. Inspector. Wards (approximate) 1 Inspector Allam, died 2.10.32 Deptford Park and Clifton Wards. ,, Mayo, from 1.11.32 Do. 2 ,, Mayo Evelyn Ward ,, Webster, from 2.12.32 Do. 3 ,, Webster St. Paul's Ward. ,, Wilton, from 12.12.32 Do. 4 ,, Hewett Vale Ward. 5 ,, Green Canterbury and Hatcham (part) Wards. 6 ,, Kemp Hatcham (part) Pepys and St. Catherine's Wards. 7 ,, Mason St. Peter's, St. John's and Town Hall Wards 31 House-to-House Inspections. 1,678 house-to-house inspections were made. These inspections were carried out in the following streets:— Arica Road Amersham Vale Alvar Street Batavia Road Baildon Street Batches Cottages Bawtree Road Berthon Street Besson Street Blockhouse Street Bronze Street Brookmill Road Blackhorse Road Bestwood Street Childeric Road Chubworthy Street Cockle's Cottages Copperas Square Clifton Hill Comet Street Dennett's Grove Dugald Street Edale Road Evelyn Buildings Florence Road Folkestone Gardens Gibbon Road Hamar Place Hathway Street Render Street Knott Street Lindo Street Martha Place Mona Road New Cross Road Norfolk House Pender Street Providence Place Prospect Place Reculver Road Railway Grove Reginald Square Ruddigore Road Rutt's Terrace Rudford Road Selden Road Senate Strret Slowgrove Cottages Speedwell Street Stanhope Street Stockholm Road Walpole Road Watson Street Wotton Road Wybourne Cottages 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. 1932 Non-compliance with statutory notice served in respect of— £ s. d. £ s. d. May 20 128 Milton Court Road 10 6 Magistrate's Order made for necessary work to be carried out within 7 days. ,, 20 98 Do. do. - 10 6 Do. June 20 137 Silwood Street 3 3 0 Magistrate's Order for necessary work to be carried out within 10 days. Nov. 23 9 Foxberry Road - 3 3 0 Magistrate's Order for necessary work to be carried out within 7 days. 32 Miscellaneous Matters. Smoke Abatement. The problem of nuisance from the emission of smoke is one constantly before the staff. Verbal warnings were given in several instances, but it was not found necessary to serve any notices. Offensive Trades (other than Slaughterhouses). The following are the only instances in the Borough:— Skin Dressers, 2; Soap Boilers, 2; Fat Melters, 2. Slaughterers of Poultry, 1. Only five 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 not found necessary to institute legal proceedings during the year under report. Rats and Mice (Destruction) Act, 1919. Under this Act, the responsibility for the destruction of rats is thrown upon the occupier of any premises infested and, as occupiers occasionally experience difficulty in procuring rat poison, the Council authorises the issue of such, free of charge in cases recommended by the Sanitary Inspectors. 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," further assistance is sought ftom 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 weekended 12th November, in what is known as National Rat Week, this 33 Council's sewers were treated for the purpose of exterminating rats. From reports received it appears that considerable success has 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 not found necessary to obtain any Order during the year. Swimming Baths. 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. Three samples were taken in 1932. Sewerage and Drainage. All drainage work, except in new buildings, whether done voluntarily by the owner or as a result of Notices under Statute, is supervised by the Sanitary Inspectors. The drainage in connection with 86 premises was entirely reconstructed during the year, in 93 instances partly reconstructed, and in 143 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 1932. 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. Removable, 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. 34 Rag Flock Acts, 1911 to 1928. No premises are known to exist which would fall within the purview of these Acts. Co-operation with the District Surveyor. The Public Health Department continues to act in close co-operation with the District Surveyor. During the year, 75 cases, apparently falling within the jurisdiction of the District Surveyor were referred to him. Water Certificates. The Borough Council was advised that Certificates in respect of an efficient water supply in four new premises could be properly granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. One certificate was 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 Oificer of Health. Sir, I beg to report that during the year ended 31st December, 1932, 13 visits were made, on the following dates: — April 15th and 19th; June 6th and 30th; July 7th, 12th and 27th; August 30th; September 5th; October 7th and 28th; and December 13th and 19th. No boats were found upon such visits. 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. 35 FACTORY AND WORKSHOPS ACTS. In conformity with Section 132, the following is an epitomised statement of the administration of these Acts:— Premises. Inspections. Number of Inspections. Written Notices. Occupiers prosecuted. Factories 117 6 — Workshops 563 2 - Workplaces 1020 11 - Total 1700 19 - The types of premises inspected were as follows:— Type. Factories, Number. Workshops Number. Workplaces, Number. Bakehouses 20 32 Chemical Works 2 3 Cinemas, etc. 1 6 Cord Makers 3 Dressmakers, Milliners, etc. 3 13 11 Engineering, general 32 1 ,, motoring 7 7 Foundries 6 Food preparation 16 259 14 Glass bottle makers 2 2 Laundries and Cleaners 4 5 Machine Belt Makers 2 Marine Stores 6 5 Paint and Varnish Works 4 1 Printers 4 1 Shoeing Forges 3 Stables, etc. 54 Sawmills 7 Timber Stores 1 14 Tar Refiners 4 Tailors 1 4 7 Toymakers 1 1 Woodwork (joiners, turners,&c.) 14 5 Woodchoppers 5 2 4 Whitening Manufacturers 3 Miscellaneous 59 32 52 Totals 199 379 167 36 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 1 1 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage ot Floors — — — — Other Nuisances 43 43 — — Sanitary Accommodation Insufficient 1 1 — — Unsuitable or defective 3 3 — — Not Separate for Sexes — — — — Offences under the Factory and Workshcp 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 48 48 — — The number of inspections made to Home Workers' Dwellings was 69. 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 one instance, notice was served and the conditions remedied. Housing. 38 HOUSING CONDITIONS. The area of Deptford is 1,564 acres, and the population 106,891 persons, giving an over-all density of 68.3 persons per acre. According to the Census figures now available, the population during the last decennium decreased by 5,643 persons, or approximately 5 per cent., the natural increase in population (i.e., excess of births over deaths) which was 6.6 per cent., being more than offset by a net outward migration movement of 11.6 per cent. Co-incidentally with this, there has been a relative increase in the number of persons, and especially of males, in the younger age groups. With a sustained high marriage rate it is therefore not surprising that the number of individual families increased during the last decennium by 1,241 or 4.5 per cent. Housing conditions can usefully be considered in the light of available information from the following points of view:—the number of actual dwellings, the number of rooms contained therein and the number and size of the private families occupying them. At the outset it should be understood that the term "private family" includes any person or group of persons who are in separate occupation of premises or part of premises, and "structurally separate dwelling" denotes a room or set of rooms having separate access to street or to a common staircase. A private house which has not been "structurally subdivided" ranks as a single unit even though occupied by several families. Excluding institutions, etc., housing non-private families, there are 17,750 separate dwellings at the Census in 1931, occupied by 29,248 families, an excess of 11,498 private families over occupied dwellings. The number of occupied dwellings in the intercensal period decreased by 125, while the number of families per occupied dwelling increased by 1.57 in 1921 to 1.65 in 1931. There has been a decrease in the size of private families, the average now being 3-56 persons, and a decrease in the number of rooms per occupied dwelling, the average now being 3.62 rooms. Of the total 17,750 structurally separate dwellings, the following are the details of the family occupation:— 8,244 occupied by one private family, 7,833 by two families, and 1,673 by three or more families. Consideration may also be given to another feature of the housing situation, viz., the number of persons per room occupied. In 1921 the number was 1.05 person per room occupied, contrasted with 0.98 in 39 1931. It must not be inferred, however, that this implies a corresponding general improvement in housing conditions. The density per room varies with the size of the family. Thus, at the lower end of the scale, the smallest families show a room density of from 0-49 to 1.01 (1.01 in the case of a family of four persons), while for the largest families the comparable figure rises to three times this amount. It is not unusual to take a figure of two persons per room as some indication of the probable amount of overcrowding that exists. It is not an actual index as, of course, no cognisance is taken either of the size of the room or of the age or sex distribution of the inmates. But it can safely inferred that, where a proportionately large number of the population is housed at a density of more than two persons per room, the incidence of overcrowding will be relatively high. In Deptford in 1931, there were 1,862 families (6.4 per cent.), comprising 11,426 persons (11 per cent.) living at a density of more than 2 per room. Of these, 3,253 were housed at over 3 per room. The records of the Sanitary Inspectors show that overcrowding continues to be one of the most pressing problems in the Borough, while the increasing disproportion between the number of families and available dwellings stresses the need for further housing accommodation. Owing to the fact that all suitable building land in the Borough is already built upon, further housing accommodation is largely dependent upon vacancies being found upon the London County Council estates. During 1932 the following figures indicate the number of families for whom provision has been made:— Families accommodated:— (a) Preferentially on recommendation of the Borough Council 43 (b) From the London County Council general list 198 241 Unfit houses and parts of houses and underground sleeping rooms constitute-a further urgent problem. With the development of a site at Brockley, the London County Council has signified its willingness to provide re-housing in connection with any scheme the Deptford Borough Council adopts for dealing with such property as falls within the above description. Accordingly, the following properties have been officially represented to the Borough Council and, although the 40 sentations were actually made in January, 1933, they are included here in order to complete the above statement. 1. Underground Sleeping Rooms. Number of Rooms. Approximate Population. 3 7 2. Unfit Dwelling Houses. Number of Houses. Approximate Population. 6 37 3. Parts of Buildings Separately Let. Number. Approximate Population. 5 26 4. Clearance Areas. Area "A" comprising 11 dwelling houses, approximate population 48. Area "B" comprising 17 dwelling houses, approximate population 87. The Council resolved to take the necessary steps as prescribed by the Housing Act, 1930, in every instance except in the case of one unfit house, in respect of which the Public Health Committee decided to take no action. 1. Unfit Dwelling-Houses. I nspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5502 (b) Number of inspections made 5623 (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925 1678 (b) Number of inspections made for this purpose 1678 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 42* (4) Number of dwelling-houses (exclusive of those in (3) found not to be in all respects reasonably fit for human habitation 2608 *This figure represents the total number of houses or parts of houses forming the subject of "representation" by the Medical Officer of Health. 41 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) 1927 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 10 (2) Number of dwelling-houses which were rendered fit after service of formal Notice:— (a) By owners 11* (b) By Local Authority in default of owners — *This figure includes one premises notice in respect of which was served in 1932 and complied with in 1933. (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) 681 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices:— (а) By owners 781 (б) By Local Authority in default of owners — In addition to the above, inspections were made of certain other dwelling-houses which it is understood will be dealt with in connection with the housing schemes to be undertaken by the London County Council. (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 — 42 (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 Food. \ 44 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 this control has been somewhat extended by the London County Council (General Powers) Act, 1932 in respect of certain articles of food. Henceforth, any premises used or proposed to be used for the preparation or manufacture of sausages, or potted, pressed, pickled or preserved meat, fish or other food intended for sale, shall be registered with the Sanitary Authority, discretionary power being given, under certain safeguards, to refuse to register or to remove from the register premises deemed unsuitable. Power to guard against contamination by persons handling food is either lacking or is inadequate, but it is of interest to note that, by the above-mentioned Act, the London County Council is empowered to make by-laws for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport or exposure for sale of any article intended to be sold for food. The need for such by-laws has been manifest for a considerable time. 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 93 Food premises (Restaurants, etc.) 223 Fish premises 17 Slaughterhouses 226 Butchers' premises 403 Miscellaneous 78 St. George's Wharf 136 Calls (Stalls, etc.) 983 2160 45 I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 21 applications for registration (including 14 transfers) in respect of premises were granted during the year. At the end of the year there were 164 premises registered for the sale of milk. In addition to the above, 52 persons were registered for the sale of unopened bottled milk only, and 20 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 215 inspections of milk shops were made and a general improvement in the conditions of storage has resulted. Many minor matters were remedied as the result of verbal intimation by the Inspectors. Legal Proceedings (other than in connection with adulteration). No infringements were detected calling for legal action during the year. 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 one shop. One ,, „ Grade "A" Milk at or from one shop. Two retailers to sell Grade "A" (Tuberculin Tested) Milk at two shops in all. Two retailers to sell Pasteurised Milk at or from nine shops. One retailer whose premises are outside the Borough to sell Pasteurised Milk within the Borough. 46 Bacteriological Examination of Milk. Fourteen samples of Graded Milk were examined bacteriologically with the following results:— Designation. Total Count in 1 cc. Coliform Bacillus. Grade "A" Tuberculin Tested 4,200 ” ” ” 6,600 ” ” ” 3,900 ” ” ” 1,680 ” ” ” 10,400 Present in l/l00th cc. ” ” ” 1,090,000* ” ” ” ” ” 76,320 ” ” Pasteurised 8,000 ” 62,200 ” 5,800 ” 5,800 ” 43,000 ” 7,000 ” 5,000 *This sample showed a microbic content above the Standard. 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. Thirty-three 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, 258 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. During the year, five cold stores situated in cellars, were discontinued and reconstructed on ground floor level. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 238 bullocks. 57 calves. 1852 sheep. 242 pigs. 47 Destroyed—Surrendered at Slaughterhouses. Beef, 4 forequarters. Bullock's head and tongue 3. Bullock (entire) 3. Bullocks' plucks 4. Bullocks' livers 31. Bullocks' lungs 2. Pigs' lungs 5. Pig (entire) 1. Pigs' plucks 2. Pig's livers 14. Pork 8 lbs. Sheep's plucks 2. Sheep's liver 1. Sheep's lungs 5. (b) Shops and Stalls. Regular inspection is carried out, particularly at such times as business is being actively carried on, 2,408 visits being made during the year. (c) Premises used for the preparation of sausages and preserved meat or fish or other food. In respect of all applications for registration of such premises, a detailed inspection was made and, in many cases, improvements were effected prior to their registration. 45 premises were so registered at the end of the year under report. From the nature of the business carried on, it is necessary to maintain effective surveillance, and frequent visits are paid with this object in view. 3. Other Food Premises. (a) Workshop Bakehouses. There are 29 such bakehouses in the Borough, 10 of which are underground. 72 inspections were made during the year. Apart from minor defects, remedied upon verbal intimation, 58 Notices were served for cleansing. (b) Factory Bakehouses. These number 18, of which 3 are underground. 36 inspections were made, 36 Notices were served for cleansing and one for the remedying of general defects. (c) Fried Fi*h Shops and Fish Curers. The number kept under observation during the year was 44. 192 inspections were made, 176 Notices were served for cleansing, and 1 for general matters. {d) Ice Cream Premises. There were 158 separate premises recorded. To these, 93 visits were paid. Many verbal intimations were given regarding minor matters. Particular stress is laid upon instructions regarding the cleanly conduct of the business. 48 (e) Other Premises. There are 194 miscellaneous premises connected with food preparation or sale, and 817 inspections were made to these. One Notice to remedy insanitary conditions was served, in addition to numerous verbal intimations regarding minor matters. (/) St. George's Wharf. Public Health (Imported Food) Regulations, 1925. II. Unsound Food. Regular supervision of all food premises and street traders is maintained, and tradesmen are encouraged to seek the opinion of the Inspectors as to any food considered suspect, with a view to its surrender and destruction. During the year 1932, large quantities of foodstuffs were imported at the Wharf, and the following is a summary of the work done:— Description. Weight. Examination. Remarks. Fish (tinned) 36 cases 10 per cent. 169 cases destroyed Fruit 1,162 „ 10 per cent. ,, (tinned and bottled) 1,843 „ 10 per cent. „ 1,228 „ Overside Vegetables 12,222 „ 10 per cent. ,, (tinned) 97 „ 10 per cent. Flour foods 2,880 „ 10 per cent. „ 100 tons „ „ 1,200 cases „ „ 100 tons Overside Biscuits 111 case s 10 per cent. Margarine 12 „ 10 per cent. Cheese 90 cases 10 per cent. Chocolate 354 „ 10 per cent. Condensed Milk 44,338 „ 10 per cent. „ „ 38,301 „ Overside Confectionery 305 „ 10 per cent. Soup (packet) 7,555 „ 10 per cent. Meat Extract 637 „ 10 per cent. Eggs 6,908 „ 10 per cent. Pickles 7 „ 10 per cent. Preserves 5,193 „ 10 per cent. Miscellaneous 2,796 „ 10 per cent. „ 16 10 per cent. 49 The following quantities of food were voluntarily surrendered during the year:— Apples, 9 cwt. 62 lbs. Beef, 4 forequarters Beetroot, 2 cwt. Bullocks (entire), 3 Bullocks' heads and tongues, 3 Bullocks' livers, 32 Bullocks' lungs, 7 Bullocks' plucks, 4 Codfish, 56 lbs. Condensed milk, 128 tins Chickens, 42 Fruit pulp, 2½ tons Gooseberries, 25 tins Haddocks, 42 lbs. Lamb, 84 lbs. Pig (entire), 1 Pigs' kidneys, 28 lbs. Pigs' livers, 14 Pigs' lungs, 5 Pigs' plucks, 4 Pork, 6 lbs. Pears, 6 lbs. Potatoes, 12 tons 9 cwt. Quince pulp, 2 tons 11 cwt. 3 qrs. Rabbits, 3 cwt. 21 lbs. Salmon, 13 tins Salmon (chilled), 12 lbs. Sheeps' plucks, 2 Sheeps' lungs, 8 Sheep's liver, 1 Skate wings,10½ lbs. Turkeys, 18 Soles, 42 lbs. Winkles, 3 qrs. 7 lbs. III. Food Poisoning. During the year the compulsory notification by medical practitioners of persons suffering or suspected to be suffering from food poisoning came into effect. It is to be noted that no definition of food poisoning is given in the Act, and some cases were accordingly notified where the suspected food did not fall within the category of those foods which we have been hitherto accustomed to regard as of potential danger. The following is an analysis of the notifi according to the causal agent:— cations received, grouped Food. No. of cases. Tinned Salmon 1 case Sardine Paste 1 ,, Liver 1 „ Tomatoes 1 „ Fried Fish 1 „ Sardines 1 „ Tinned Plums 1 „ Porridge 1 ,, Pork 1 „ (Uncertain) 1 „ In addition to a copy of each certificate being forwarded to the County Medical Officer, arrangements also have been made to transmit to him information in respect of cases of general interest as affecting the Metropolis as a whole. 50 IV. Food Sampling. In addition to the previous routine procedure, sampling of milk, by arrangement with the County Medical Officer, was commenced at the South-Eastern Hospital and at the public elementary schools in the Borough. In the case of hospital samples, the chemical content and bacterial count were ascertained, while the school supplies were investigated for the presence of tubercle and for chemical content. Occasional examination for tubercle was also made of milk coming direct to one of the railway stations. Frequency of Sampling.—A total of 508 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 1932:— Total. Number Adulterated. Percentage of samples adulterated. Formal samples 338 10 3.0 % Informal samples 170 5 2.9 % Total 508 15 2.95 % The adulteration in respect of samples submitted for analysis during the previous six years is as follows:— Year. Number of Samples taken. Percentage Adulterated. 1926 552 1.3 1927 601 1.5 1928 604 1.8 1929 590 1.8 1930 550 3.5 1931 507 2.6 The following is a statement of the samples purchased and submitted for analysis during 1932. 51 Food and Drugs (Adulteration) Act, 1928. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Formal Samples— Arrowroot 1 .. 1 .. Aspirin Tablets 1 .. 1 .. Boracic Acid, B.P. 1 .. 1 .. Boracic Acid Ointment B.P. 1 .. 1 .. Brawn 1 .. 1 .. Butter.. 7 .. 7 .. Chocolate Easter Eggs 8 .. 8 .. Christmas Pudding 1 .. 1 .. Chutney 1 .. 1 .. Cocoa 1 .. 1 .. Coffee 2 .. 2 .. Curry Powder 1 .. 1 .. Dripping 6 .. 6 .. Flaked Rice 1 .. 1 .. Fish Paste 2 .. 2 .. Gravelots 1 .. 1 .. Ground Cinnamon 1 .. 1 .. Ground Ginger 2 .. 2 .. Indigestion Tablets 1 .. 1 .. Jam 2 .. 2 .. Lard 1 .. 1 .. Margarine 1 .. 1 .. Milk 230 7 237 30 Mild Mercurial Ointment 1 .. 1 .. Mincemeat 2 .. 2 .. Mustard 6 .. 6 .. Mixed Spice 2 .. 2 .. Pepper 7 .. 7 .. Sauce 1 .. 1 .. Sausages 7 .. 7 .. ,, Preserved 3 .. 3 .. Sweets 4 .. 4 .. Sterilised Milk 4 .. 4 .. Spirits— .. .. Gin 1 3 4 750 Whisky 4 .. 4 .. Vinegar 8 .. 8 .. ,, Malt 1 .. 1 .. Wine, non-alcoholic 2 .. 2 .. Zinc Ointment 1 .. 1 .. Total Formal Samples 328 10 338 3. 0 Informal Samples— .. .. Almond Oil, B.P. 1 .. 1 .. Aspirin Tablets 3 .. 3 .. Baking Powder 1 .. 1 .. Butter 33 .. 33 .. Borax B.P. 1 .. 1 .. Carried forward 39 .. 39 52 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Brought forward 39 39 Informal Samples—contd. Camphorated Oil, B.P. 1 .. 1 .. Castor Oil, B.P. 3 .. 2 .. Cheese 1 .. 1 .. Chocolate 3 .. 2 .. Cocoa 4 .. 4 .. Compound Bismuth Lozenges, B.P. 1 .. 1 .. Compound Liquorice Powder, B.P. 1 .. 1 .. Condensed Milk 10 .. 10 ... Coffee and Chicory Extract 1 .. 1 .. Cream 7 .. 7 .. Curry Powder 1 .. 1 .. Custard Powder 1 .. 1 .. Dripping 1 .. 1 .. Dried Fruits 8 .. 8 . . Eucalyptus Oil, B.P. 1 .. 1 . . Fish Paste 3 .. 2 .. Flour 1 .. 1 .. Ground Rice 1 .. 1 .. Ground Cinnamon 1 .. 1 .. Ground Ginger 1 .. 1 .. Grape Juice, solidified - .. 1 100.0 Gravy Salt 3 .. 3 .. Honey 3 .. 3 .. Jam 5 .. 5 .. Lard Substitute 1 .. 1 .. Lemonade Tablets 1 .. 1 .. Margarine 5 .. 5 .. Marmalade 3 .. 2 .. Milk 19 3 22 132 ,, sterilised 4 .. 4 .. Mixed Spice 1 .. 1 .. Mushrooms in Butter - 1 1 10.0 Olive Oil, B.P 1 .. 1 .. Orangeade Tablets 1 .. 1 .. Pepper 3 .. 3 .. Sauce 2 .. 2 .. Sausages 5 .. 5 .. Seidlitz Powder, B.P. 1 .. 1 .. ,, double strength 1 .. 1 .. Sulphur Tablets 1 .. 1 .. Sweets 2 .. 2 .. Tinned Peas 2 .. 2 .. Tinned Salmon 1 .. 1 .. Turkey and Tongue Paste 2 .. 2 .. Vegetable Extract 1 .. 1 .. Vinegar 7 .. 7 .. Wine, non-alcoholic 1 .. 1 .. Wine Essences 2 .. 2 .. Yeast 2 .. 2 .. Total Informal samples 186 5 170 2.9 53 Action Taken in regard to Formal Samples Purchased during the Year 1932. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. gk Milk 6 per cent, added water 1 1 0 Summons dismissed on payment of costs 4TM Milk 6 per cent. milk fat abstracted - 3 3 0 Summons dismissed on payment of costs 2 Y Milk 7 do. do. - - Vendor cautioned 5 Y Milk 1 do. do. - - Vendor cautioned 8 a Milk 2 per cent. added water - - Vendor cautioned 12 A Milk 7 per cent. milk fat abstracted - 4 4 0 Summons dismissed on payment of costs .127 Y Milk 32 do. do. - 4 4 0 Summons dismissed on payment ot costs 393 Y Gin Excessive water 0.76 per cent. - - Vendor cautioned 396 Y Gin Excessive water 14.7 per cent. 10 0 0 3 13 6 - 399 Y Gin Excessive water 2.9 per cent. 2 0 0 3 13 6 - Action Taken in regard to Informal Samples. Sample No Article Particulars of Adulteration or Infringement. Action taken. 38 y Mushrooms in Butter Copper, 0.105grs. per lb. Importers notified. Cooking in copper pans discontinued. 115 y Solidified Grape Juice Sulphur Dioxide, 355 parts per million in excess of maximum for solid glucose, viz., 70 parts per million M.O.H. of area to which goods consigned, notified. 157 y Milk 9 per cent. milk fat abstracted Formal samples subsequently taken. 165 y Milk 7 per cent. added water o o q 243 y Milk 3 per cent. added water o -a o q 54 Public Health (Preservatives, etc. in Food), 1925 to 1927. It was not found necessary to take any action under these Regulations beyond that noted in the table above. Artificial Cream Act, 1929. One factory for the manufacture of synthetic cream is situated in the Borough. Public Health (Condensed Milk) Regulations, 1923 to 1921. Three samples of condensed, full cream (sweetened), six samples of condensed, machine-skimmed (sweetened) and one sample of full cream unsweetened milk were taken for analysis and found to be genuine and properly labelled. Public Health (Dried Milk) Regulations, 1923 to 1927. It was not found necessary to take any action under the above 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 Councils 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. (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. 56 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 1932. Notifiable Disease At all Ages INCIDENCE AND MORTALITY BY AGE GROUPS. 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 65 and up Smallpox 57 3 6 25 15 3 4 l 57 1 1 .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 249 2 72 137 21 16 1 .. 249 6 .. 2 4 .. .. .. .. Erysipelas 73 1 6 3 6 19 29 .. 39 1 .. .. .. .. 1 .. .. Scarlet Fever 580 8 188 316 39 27 2 .. 577 4 .. 3 .. .. l .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. 1 .. .. .. .. 2 1 .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. .. .. Puerperal Pyrexia 17 .. .. .. 7 9 1 .. 14 .. .. .. .. .. .. .. .. Cerebro-Spinal Meningitis 5 4 1 .. .. .. .. .. 5 4 4 .. .. .. .. .. .. Poliomyelitis and Polioencephalitis 3 .. 3 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 11 11 .. .. .. .. .. .. 3 .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 37 22 15 .. .. .. .. .. .. 23 23 .. .. .. .. .. .. * Acute Primary and Acute Influenzal Pneumonia 104 9 14 8 11 28 26 8 21 82 19 14 1 .. 10 22 16 Malaria 1 .. .. .. .. 1 .. .. 1 .. .. .. 1 .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 172 8 42 111 7 1 3 .. 5 .. .. .. .. .. .. .. .. Totals 1314 68 347 601 106 107 66 19 977 122 4.7 19 5 12 22 17 *The deaths from Pneumonia include all forms of that disease, including many cases not notifiable as "Acute." 57 SEASONAL INCIDENCE OF NOTIFIABLE INFECTIOUS DISEASES. Disease. 1st quarter 2nd quarter 3rd quarter 4 th quarter Total for year Smallpox 29 28 57 Diphtheria 43 68 73 65 249 Erysipelas 16 20 15 22 73 Scarlet Fever 147 153 113 167 580 Enteric Fever 1 1 ... ... 2 Puerperal Fever ... 1 ... 1 2 Puerperal Pyrexia 3 5 4 5 17 Cerebro-spinal Meningitis 1 2 1 1 5 Poliomyelitis ... ... ... 3 3 Ophthalmia Neonatorum 3 3 4 1 11 Infantile Diarrhoea, etc. 1 7 14 15 37 Acute Primary and Influenzal Pneumonia 52 20 6 26 104 Encephalitis Lethargica 1 1 Chicken Pox 66 62 25 19 172 Malaria 1 ... ... ... 1 Totals 363 371 255 325 1314 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 1932 580 5.5 4 0.7 Scarlet Fever, during 1932, showed some increase. 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. 58 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE \EAR 1932. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Deptford Park Evelyn St. Paul's Vale Clifton Canterbury Hatcham Pepys St. Catherine's St. Peter's St. John's Town Hall Smallpox 57 7 8 18 2 3 9 .. 9 1 .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 249 13 28 41 25 37 24 34 13 3 6 11 14 Erysipelas 73 6 11 15 11 5 5 5 1 1 3 5 5 Scarlet Fever 580 31 78 85 48 103 53 49 17 26 6 38 46 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. .. .. .. .. 1 .. .. 1 Relapsing Fever .. • • .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. .. .. .. 1 1 .. .. .. Puerperal Pyrexia 17 1 4 .. 1 .. 1 .. 1 .. .. 1 1 Cerebro-Spinal Meningitis 5 .. 2 2 .. .. .. .. .. 1 .. .. .. Poliomyelitis and Polioencephalitis 3 .. 1 2 .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 11 1 .. 4 1 .. 2 .. .. 1 .. 1 1 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 37 1 7 13 8 1 .. .. .. .. 7 Acute Primary and Acute Influenzal Pneumonia 104 5 9 11 9 5 14 13 11 4 8 8 7 Malaria 1 .. .. .. 1 .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. 1 .. .. .. .. .. .. .. .. Chicken Pox 172 7 12 26 13 17 5 4 3 35 16 12 22 Totals 1314 72 160 217 120 175 114 106 56 74 40 83 97 59 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 1932 249 2.3 6 2.4 Parents should consider as to 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 1932 3 - 1 4 11 - 33 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 1932 2 15 - 17 Schick tests are performed 9 to 12 months after the completion of three inoculations, even in the case of children under 6 years. These 60 are not tested in the first instance as the proportion of reaction is so high that inoculations are given without test. All re-tested who gave a plus reaction were re-inoculated. Small-pox. Fifty-seven cases were notified during the year, all being of a mild type with the exception of an infant which contracted the disease a few days after birth. In this case there was a profuse rash with marked constitutional symptoms, and death ensued. Vaccination. No vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. Chicken-pox. Since made compulsorily notifiable, the number of notifications have been as follows:— 1929 (1-31 December) 61 1930 445 1931 152 1932 172 In many instances the medical practitioner referred the case to the Medical Officer of Health and a diagnosis of Small-pox was arrived at. 61 Return made on or before the 9th of February, 1933, by Mr. E. S. Ei.liott, Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1931, inclusive :— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1931. Number of these Births duly entered by 31st Jan., 1933. No, of Births which on 31st Jan.. 1933 remained unentered in the Vaccination Register on account of— No. of these births remaining on 1st Jan., 1933 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1932. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1932. 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 836 300 4 - 335 27 19 3 22 126 South Deptford 515 247 2 - 182 17 13 8 21 25 Total 1351 547 6 - 517 44 32 11 43 151 607 453 Dated February 7th, 1933. Successfully vaccinated after the declaration of conscientious objection, 1. Total Number of Certificates for Year 1932 sent to other Vaccination Officers, 72. 62 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 1932 Cases 3 3 2 4 4 2 1 5 Deaths 1 — — 4 2 2 4 5 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 1932 Cases 4 3 1 1 4 — 1 3 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 1932 Cases 9 8 3 3 3 — — 1 Deaths 5 2 2 2 1 — — 2 There is an unfortunate tendency to physical, moral or mental sequelæ, 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 1932 104 82 0.7 63 Malaria. Since the 1st January, 1928, Malaria, induced therapeutically, is notifiable if liable to recur. Average 1920-1924 Average 1925-1929 1930 1931 1932 Cases 8 4 2 — 1 No deaths have been registered from this cause. Dysentery. The figures are as follows:— Average 1920-1924 (total) Average 1925-1929 1930 1931 1932 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 1932 Cases Notified 66 75 12 26 37 Deaths 28 15 17 9 23 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 1932 2 2 1.2 64 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 irrespective of the cause. The notifications received have been as follows:— 1926 (part) 1927 1928 1929 1930 1931 1932 Cases 5 16 12 6 10* 17 17 * Includes one subsequently notified as Puerperal Fever and dealt with under that heading. 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 1932 Cases 14 9 18 14 26 21 11 The following is a statement of the results of treatment in respect of the cases notified in 1932:— Notified Treated At home In hospital Vision unimpaired Vision impaired Total blindness Since died from other Causes 11 8 3 11 - - - 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. Erysipelas. 73 cases were notified during the year, and there was 1 death. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. 65 Enteric Fever. There were two cases notified, and one death. 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 1932. 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 1932 26 2.0 0.25 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 1932 23 1.8 0.22 E 66 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 six instances serum was applied for and used with beneficial results. 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 1932 9 0.7 0.09 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, 1932. Material. Number Positive. Number Negative. Total. Swabs for Diphtheria 129 886 1015 Sputum for Tuberculosis 13 62 75 Blood for Enteric Fever 2 5 7 Urine for T.B. — 1 1 Stool for Enteric — 2 2 Dust from Stone-crushing Plant — 1 1 Maternity outfit for sterility — 1 1 Swab for Lochial discharge 1 - 1 Urine for examination — 1 1 Nasopharyngeal swab for Meningitis — 1 1 *Note.—Other examinations are reported under "Food." 67 At the Tuberculosis Dispensary, 1,037 specimens of sputum were examined. Of these, 669 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 368 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 1111 ,, „ ,, Requests, rooms only 64 „ „ „ „ bedding only 59 ,, ,, ,, Verminous 110 Total premises visited 1344 Number of rooms disinfected, formalin spray 1531 ,, „ „ sulphur 197 Total 1728 Number of articles disinfected (steam disinfector) 12429 Number of books disinfected (formalin lamp) 763 ,, ,, articles destroyed at owners' request 649 Special disinfections, etc.:— Small-pox disinfection—Dustbins collected and contents burned. Verminous furniture—three van loads destroyed. 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. e2 68 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, 22 adults and 1,728 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 1932. 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 Deaths. 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 1932 142 11.0 1.3 69 Deaths from Cancer by Sex and Age. Average, Year Sex Under 25 years 25 to 45 years 45 to 65 years 65 to 75 years 75 years and upwards Totals 1925-29 Male 1.0 5.8 38.0 24.4 11.0 Female 0.6 7.4 36.2 21.2 13.4 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 1932 Male 1 5 41 31 17 95 Female 1 5 39 29 14 88 Total 2 10 80 60 31 183 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. 72 TUBERCULOSIS. The following is a tabular statement of the cases coming to our knowledge by notification and otherwise:— Year. Pulmonary. Non-Pulmonary. M. F. Total per 1,000 of population. 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 1932 107 88 1.82 23 22 0.42 The figures for the years 1923 onwards are not strictly comparable with those of previous years as they include cases, although not formally notified, which have come to the knowledge of the Medical Officer of Health. The Death-rate in recent years 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 0.74 0.15 0.93 0.13 1932 . . 0.86 0.12 The Scheme of the Borough Council for dealing with Tuberculosis has followed along former lines, under the able direction of Dr. N. M. Donnelly, the Tuberculosis Officer. The following is the text of Dr. Donnelly's Report for 1932:— 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 the 3rd January, 1932, to the 31st December, 1932, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 211; 176 Pulmonary Tuberculosis and 35 Non-pulmonary, as compared with 160 Pulmonary and 28 Non-pulmonary for the previous year. *By international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under "Pulmonary," arc now included under "Nonpulmonary Tuberculosis.'' 73 Report of Tuberculosis Officer—continued. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 3rd January, 1932, to 31st December, 1932. Notifications on Form A. Age Periods. Total Notifications on Form A. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications Pulmonary— Males ... ... 1 2 6 17 23 18 19 8 3 97 148 Females ... ... ... 2 13 22 24 10 1 4 3 79 114 Non-Pulmonary Males ... 4 3 5 3 1 ... 1 1 ... ... 18 18 Females ... 3 4 2 3 ... 1 2 1 1 ... 17 18 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 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up Total Cases Pulmonary—Males ... ... ... ... ... 1 1 2 4 2 ... 10 „ —Females ... ... ... ... ... 4 3 1 1 ... ... 9 Non-Pulmonary—Males ... 1 1 2 1 ... ... ... ... ... ... 5 „ —Females 1 2 ... ... 1 1 ... ... ... ... ... 5 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 5 3 Posthumous notifications 5 3 "Transfers" from other areas (other than transferable deaths) 8 2 Forms C and D (admissions and discharges from Institutions) 1 2 75 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 361 296 657 115 109 224 881 Number of cases removed from the Register during the year, inter alia of:— 1. Withdrawal of notification ... ... ... ... ... ... ... 2. Recovery from the disease 16 9 25 14 7 21 46 3. Death 55 26 91 4 2 6 97 76 Report of Tuberculosis Officer—continued. Notes on Tables of Notifications. Of the cases first learned of from the death returns, one had never lived at the address given, three had been away from the Borough for a considerable time before death, one being a mental hospital case, and one case was diagnosed post mortem. Of the cases notified after death— One was a case of Mediastinitis, diagnosed post mortem. Four were cases of Meningitis. One was a case of Meningitis with Pulmonary Tuberculosis. One was a case of Miliary Tuberculosis. Five were hospital cases. Of the Primary Notifications— Fourteen cases of Pulmonary and two of Non-pulmonary Tuberculosis died within one month of notification. Ten Pulmonary and two Non-pulmonary cases died within three months of notification. Seven Pulmonary cases died within six months of notification, Three Pulmonary cases died within 12 months of notification. Of the cases dying within one month of notification— One was a case of Meningitis. One was a case of Miliary Tuberculosis. One was a case of acute lung disease known at the Dispensary. Six were hospital cases. Seven were notified by practitioners. Of the cases dying within three months of notification— One was a case of acute Cervical Caries. One was a case of old hip disease. Three were cases only a short time resident in the Borough. Two were not diagnosed until sent to the Dispensary. One was not diagnosed before the date notified by the practitioner. Two did not see a doctor until date of notification. Two were hospital cases. 77 Report of Tuberculosis Officer—continued. Home accommodation of 207 Cases notified in 1932 (hospital and lodging-house cases omitted). 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. 4 cases. 11 of 1 10 CASES. 8 of 1 6 cases. 1 of 2 1 of 2 2 of 2 1 of 2 3 of 2 4 of 2 4 of 2 2 of 2 l of 2 3 of 2 1 of 2 l of 2 1 of 3 1 of 3 1 of 3 1 of 3 2 of 3 1 of 3 7 of 3 6 of 3 4 of 3 5 of 3 2 of 3 4 of 3 2 of 3 2 of 3 1 of 4 1 of 4 1 of 4 5 of 4 6 of 4 3 of 4 3 of 4 3 of 4 4 of 4 3 of 4 1 of 5 3 of 5 3 of 5 5 of 5 4 of 5 3 of 5 7 of 5 l of 5 1 of 5 l of 6 2 of 6 1 of 6 l of 6 8 of 6 3 of 6 2 of 6 1 of 6 1 of 7 2 of 7 2 of 7 5 of 7 2 of 7 l of 7 3 of 7 1 of 8 2 of 8 l of 8 1 of 8 3 of 8 1 of 8 2 of 8 1 of 8 1 of 10 1 of 9 1 of 10 2 of 9 l of 10 7 had a separate room. 44 had a separate room. 17 had separate room. 10 had separate bed with 2 others in room 3 had separate bed but 1 other in room. 4 had separate bed, but 1 other in room. 2 „ „ 3 „ „ 3 „ „ 2 „ 6 „ „ 2 „ 13 had another in bed. 2 „ „ 3 „ 13 had another in bed. 4 „ „ & 1 other in room 39 had another in bed. 4 „ „ 1 „ 1 „ „ 2 „ 10 „ „ 1 „ 1 „ „ 2 „ 2 „ „ 3 „ 3 „ „ 2 „ 4 had 2 others in bed. 3 had 2 others 1 „ „ 3 „ 1 ,, 2 „ 2 „ 1 „ „ 6 „ 6 had 2 others in bed. 1 „ 2 ,, „ 1 „ 1 „ 2 „ 6 „ 1 had 3 others in bed. 78 Report of Tuberculosis Officer—continued. The number of deaths for the year is 105 as compared with 114 for 1931. 1931 1932 Pulmonary deaths 100 92 Non Pulmonary deaths 14 13 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 1932. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary m f m f m f m f 0 - - — 1 - 1 - - 1 - - 4 3 - - 2 1 5 1 - 4 6 2 1 — - 10 2 2 6 2 — - — 1 15 6 13 5 3 9 5 1 1 20 17 22 2 1 7 6 1 2 25 24 28 — 2 11 8 — — 35 19 13 1 2 8 4 1 — 45 21 2 1 1 8 5 1 — 55 12 5 7 1 7 5 1 1 65 and upwards 5 3 - — 3 2 — — Totals 107 88 23 22 55 37 7 6 Note—Including 29 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 1932. Not notified 5 Died before notification 5 Died within one week of notification 6 „ one week to one month 8 „ „ one month to three months 19 ,, ,, six months to one year 10 ,, ,, one to two years 12 ,, ,, two to three years 11 „ „ three to four years 5 „ „ four to five years 3 „ „ five to six years 1 „ „ six to seven years 3 „ „ seven years and upwards 4 92 79 Report of Tuberculosis Officer—continued. The notifications of non-Pulmonary Tuberculosis were as follows:— Meningitis 3 Genito-urinary 3 Peripheral glands 10 Skin and other organs 3 Abdominal 4 Bones and joints 12 Total 35 Revision of Notification Register. During the year 173 cases of Pulmonary and 44 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 "recovered" 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 1932 as follows:— MALES FEMALES Under15 Over 15 Under 15 Over 15 Total Pulmonary Tuberculosis 36 325 30 266 657 Non-Pulmonary Tuberculosis 71 44 67 42 224 Totals 107 369 97 308 881 Disinfection was carried out in 349 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 80 Report of Tuberculosis Officer—continued. Supervision of Contacts. Analysis of contacts of 217 of the cases primarily notified during the year (including cases notified after death but excluding cases in which the diagnosis was not confirmed):— Deptford Park, Eyelyn, Vale and St. Paul's Wards. Remainder of Borough. Total T.B. Positive T.B. Negative Non-Pulmonary Total T.B. Positive T.B. Negative Non-Pulmonary No. of patients notified 61 41 9 11 156 81 45 30 No of above seen at Dispensary 34 27 6 1 90 64 18 8 Total contacts of cases seen at Dispensary— Adults 96 78 13 5 196 118 52 26 Children 47 43 3 1 72 45 15 12 No. of above contacts examined at Dispensary— Adults 9 6 3 — 28 17 6 5 Children 16 16 — — 39 25 7 7 No. of notified cases not seen at Dispensary 27 14 3 10 59 16 24 19 Total contacts of above— Adults 60 31 6 23 118 36 27 55 Children 60 27 3 30 41 16 6 19 No. of above contacts examined at Dispensary — Adults 8 5 — 3 14 6 6 2 Children 40 22 2 16 15 9 3 3 Total School Contact Cards sent to School Medical Officer 64 45 (a) Classified as examined at Dispensary— Class 1* 13 10 Class 2* 23 24 (b) Classified as not examined at Dispensary— Class 3* 28 11 *Class 1—Unsatisfactory cases. *Class 2—Apparently healthy cases. *Class 3—Not examined. The Tuberculin Testing of child contacts of tuberculosis referred to in last year's report, was continued and the results, with notes as to action taken, are given below. In most of the cases giving a positive result to the test, and also in a few negative cases, an X-ray examination was made, and 81 Report of Tuberculosis Officer—continued. 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 (l to 2 years)—Six children were tested in this Group. In three the test was not completed; the other three gave a negative result. Group 2 (2 to 5 years)—19 children were tested, 10 being contacts of T.B. positive cases, six of T.B.— cases and three were not known to be contacts. Of the 10, one did not have the test completed and three gave a negative result. The remaining 6 gave positive results. For one of these convalescent treatment was recommended but was declined by mother. Of the six T.B.— cases the test was not completed in three. Of the other three, two were negative and one positive. One of the three children not known to be contacts gave a positive result. Group 3 (5 to 12 years)—80 children were tested. Six T.B. positive contacts, four T.B. negative contacts and three not known as contacts did not complete the test. Seven T.B. positive contacts, nine T.B. negative contacts, and nine not known as contacts gave a negative result. Twenty-eight T.B. positive contacts, six T.B. negative contacts and eight not known as contacts gave a positive result. Of these 28, one, whose X-ray was suspicious, was sent to hospital for observation, and later notified as a case of Pulmonary Tuberculosis. One of the T.B. negative cases giving a positive result to the Tuberculin test, was similarly dealt with and also notified. It is interesting in this case that the patient of whom this child was a contact later developed a positive sputum. Five of the T.B. positive contact positive reactors were recommended for convalescent treatment. Three of the positive reactors not known to be contacts were recommended for convalescent treatment. Group 4 (12 to 15)—Sixteen children were tested, but two T.B.+ contacts did not complete the test. Three, who were not f 82 Report of Tuberculosis Officer - continued, definitely contacts of any case of tuberculosis, gave two positive results and one negative. Two were contacts of T.B. — cases, one giving a + and one a negative result. Of the other 9 T.B.+ contacts, six were + and three negative. In these results some apparent discrepancies, such as a contact of a T.B.+ case giving a negative result, or a contact of a T.B. — case giving a + result, may be accounted for by shortness of time of contact in the first instance, or by the possibility that, in the second case, there may have been an unknown common source of infection for the T.B. — case and its contact. 83 Report of Tuberculosis Officer—continued. Memo 37/t. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1932. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 55 53 2 1 6 7 9 8 61 60 11 9 141 (b) Doubtfully tuberculous - - - - - - - - 9 11 10 6 36 (c) Non-tuberculous - - - - - - - - 74 74 40 50 238 B.—Contacts examined during the year:— (a) Definitely tuberculous - - - - - - - - - - - - - *(b) Doubtfully tuberculous - - - - - - - - 1 6 4 1 12 (c) Non-tuberculous - - - - - - - - 25 46 74 57 202 C.—Cases written off the Dispensary Register as (a) Cured 14 7 3 - 3 2 7 5 17 9 10 5 41 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 104 134 118 111 467 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 225 181 17 24 28 32 40 36 253 ?] 3 57 60 583 (b) Diagnosis not completed — 10 17 15 7 49 'Remaining undiagnosed 31st December. F2 84 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 602 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 55 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 79 4. Cases written off during the year as Dead (all cauies) 67 5. Number of attendances at the Dispensary (including Contacts) 3010 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 154 Number of G.P. 36 reports from practitioners 189 7. Number of consultations with medical practitioners:- (a) Personal 27 (b) Other 95 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 198 9. Number of visits by Nurses or Health Visitors to Homes successful 2992} for Dispensary purposes unsuccessful 685} 3677 successful 1413 } Visits to cases non-Dispensary cases unsuccessful 362} 1775 10. Number of (a) Specimens of sputum, &c, examined 669 (b) X- ray examinations made in connection with Dispensary work 149 (c) Sputum examinations for sary cases 368 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 337 Notes on Table I. It will be noted that the number of persons on the Dispensary Register on the 31st December, 1932 is 632, a slight increase over figure at end of 1931. The number of patients coming into the borough from other areas and of cases which had been lost sight 85 Report of Tuberculosis Officer—continued. of and returned to the Register, is 55 as compared with 23 in the previous year. "Transfers to other areas" and "Cases lost sight of "are 79 as compared with 103 in 1931. 67 deaths of Dispensary patients occurred, compared with 75 in the previous year. Three patients had Ultra-violet ray treatment. Thirteen patients have had artificial pneumothorax treatment, making in all 160 attendances as compared with 77 in 1931. The treatment is arranged for at the Brompton, St. Thomas' and Grove Park Hospitals. The number of patients for whom dental treatment was provided was 51 compared with 52 in 1931. 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 48 7 0 Total cost of free cases 18 1 10 Contributions from Approved Societies 9 19 0 „ Public Assistance Committee 7 13 0 „ Red Cross Society 0 7 6 „ Patients 7 3 6 „ Hospital Saturday Fund 5 2 2 86 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. 51 255 110 24 22 102 17 8 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. Owing to an accident, one of the Health Visitors was absent from duty from March to December, during which time a temporary Visitor was employed. The number of visits paid by the Health Visitors was 5,452 compared with 4,810 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. 256 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 87 Report of Tuberculosis Officer—continued. maintained, 368 as against 353 in 1931. The number of examinations of specimens for Dispensary cases was 669, as compared with 660 in 1931. X-ray Diagnosis. The number of X-ray examinations is 149 compared with 138 in the previous year. Cases were X-rayed in connection with the Tuberculin Test as reported last year. Insured Persons. The number of insured persons on the Dispensary Register at the end of the year was 294. The number of reports from panel doctors in respect of patients on domiciliary treatment was 189, compared with 149 in 1931. Co-operation with the Medical Profession. Co-operation with medical practitioners continues on the same lines as hitherto. Of the new cases attending the Dispensary, 182 were sent by doctors, compared with 174 in the previous year. 256 were sent by staff. 255 reports on "Z" cards were made to doctors regarding panel patients as against 203 in 1931. In addition, numerous letters were written to doctors and hospitals about patients. Extra Nourishment. 44 recommendations were made to the Public Assistance Authorities for extra nourishment in addition to grants made by the Borough to 58 persons. Institutional Treatment. 175 patients were recommended to the London County Council for institutional treatment, 12 of which the London County Council were unable to accept under the Tuberculosis Scheme, and were referred to general hospitals. Three patients refused treatment and two died before admission. 353 reports on the condition of the patients treated in previous years were sent to the County Council. 31 recommendations were made from Dispensary for direct 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. Reports are asked for subsequently each year from the hospital doctor so that the patient's progress can be supervised. 88 Report of Tuberculosis Officer—continued. Deaths. Of the total deaths of Dispensary patients during 1932— 14 died within 3 months of the first attendance. 7 „ „6 „ „ „ 10 „ „ 12 „ ,, „ 32 „ „ 12 „ „ „ In addition, 4 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. Christmas 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. Articles now made, are felt animals, gollywogs, etc., repousee metal work, leather work, gloves, trays, stools, mats, and embroidered bags, etc. 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 sales amounted to £44 10s. lOd. An Exhibition was held at the Town Hall also in June and resulted in orders amounting to £25 being received. 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. Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a) PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 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 1932 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. 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) Class T.B. min Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 8 Total (Class t.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 7 2 7 9 3 3 l 5 5 2 2 2 4 1 2 3 l F. 3 1 4 5 3 1 1 2 2 2 1 2 2 4 2 3 3 l l Childrer 4 1 1 2 3 3 2 1 Disease not arrested Adults M. 1 5 16 21 I 4 2 7 l 7 l 9 4 5 9 2 10 3 15 2 1 17 2 20 7 7 22 2 31 5 3 30 5 38 F. 6 11 l 18 1 3 3 3 3 1 1 4 5 2 2 7 2 11 3 16 2 18 7 3 16 5 24 8 4 25 5 33 Children 2 1 1 1 2 3 l 1 4 1 1 1 3 1 Condition not ascertained during the Year 10 5 4 9 l 1 2 1 2 2 1 1 2 5 5 1 1 2 4 1 3 4 1 2 2 Total on Dispensary Register at 31st December 25 20 42 l 63 8 2 12 2 16 7 l 19 l 21 7 8 13 21 13 5 28 6 39 13 2 35 5 42 22 12 42 8 62 15 7 57 9 73 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 32 16 8 24 1 1 F. 56 9 5 14 1 Children 60 2 2 3 Lost sight of or otherwise removed from Dispensary Register 339 75 130 15 220 15 2 10 8 20 10 6 24 2 32 17 5 14 l 20 20 3 10 1 14 11 2 14 1 17 3 4 5 2 11 1 1 3 1 5 Dead Adults M. 38 39 141 36 216 3 4 20 15 39 2 1 28 8 37 1 1 16 11 28 4 2 18 8 28 3 14 8 22 1 8 3 12 2 4 4 10 F. 34 20 76 31 127 2 7 7 16 4 20 10 34 5 9 14 2 4 12 9 25 1 1 8 11 20 2 1 4 7 12 1 4 1 5 Children 10 3 3 2 8 1 1 1 2 1 1 1 1 1 1 1 Total written off Dispensary Register 569 162 365 84 611 23 8 39 31 78 12 11 72 21 104 19 6 35 21 62 26 9 41 18 68 16 3 36 20 59 5 6 17 12 35 2 3 11 7 21 Grand Totals 594 182 407 85 674 31 10 51 33 94 19 12 91 22 125 26 14 48 21 83 39 14 69 24 107 29 5 71 25 101 27 18 59 20 97 17 10 68 16 94 Report of Tuberculosis Officer—continued. (b)NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 of all patients remaining on the Dispensary Register ; and (&) 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 1932 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs 1 Peripheral Glands Total Bones and Joints. Abdominal Other Organs Periphereal Glands Total Bones and Joints Abdominal Other Organ Peripheral Glands Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. A bdominal. 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. 2 l 3 1 1 l l 2 F. l 1 l l 2 1 1 l 1 l l Chile ren 7 3 10 1 1 2 4 l l 2 1 l 2 l 2 3 l l l 3 l 1 2 Disease not arrested Adults M. 1 1 1 3 1 1 3 3 4 1 l 6 2 3 5 F. 2 4 1 7 1 1 l 1 2 2 l 1 2 1 3 2 1 1 4 Children 1 1 1 1 2 2 1 3 1 4 3 2 5 4 4 8 3 6 9 Condition not ascertained during the year 3 3 6 1 1 2 1 l 2 2 2 1 l l 3 2 2 / 4 2 1 3 5 1 2 8 Total on Dispensary Register at 31st December 16 5 10 31 4 l 4 9 4 2 l 3 10 5 4 l 10 5 l l 4 11 8 3 2 4 17 8 4 3 7 22 12 1 2 11 26 Transferred to Pulmonary 1 1 1 1 2 1 1 1 1 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 14 3 1 4 22 1 1 2 1 1 2 1 1 F. 9 1 2 12 4 4 Children ... 16 6 49 71 1 1 1 l 3 5 3 3 2 2 Lost sight of or otherwise removed from Dispensary Register 37 10 10 53 110 1 l 6 8 2 3 2 5 12 5 4 1 10 3 l 2 6 2 1 1 3 7 1 3 4 2 2 Dead Adults M. 8 1 9 1 1 1 1 1 1 1 1 F. 4 2 6 1 1 1 1 Children ... 4 2 1 7 1 l 2 Total written off Dispensary Register 92 21 15 109 237 3 l l 7 12 4 4 3 12 23 6 1 4 5 16 4 2 5 11 2 1 1 3 7 1 3 4 4 4 Grand Totals of a and b (excluding those transferred to Pulmonary) 108 21 20 119 268 7 2 l 11 21 8 6 4 15 33 11 5 4 6 26 9 3 l 9 22 10 4 3 7 24 9 4 3 10 26 16 1 2 11 30 89 Report on Work of the Tuberculosis Care Committee, 1 932. We have to report with great regret, the deaths of Miss Pay and Mr. Peters. Miss Pay represented the Invalid Children's Association ; she was a most regular attendant at the meetings, and took a keen and practical interest in the work. Mr. Peters represented the Friendly Societies, and although he was unable to attend the meetings as often as he would have wished to do, never lost an opportunity of evincing his interest in the work. We shall miss them both. That the past year has, owing to existing conditions, been one of the most difficult encountered for some time, will, we think, be generally conceded. Many, to whom poverty has, hitherto, been only a name, are now experiencing it, and the consequent strain and fret has had its effect. Our help has been needed more than ever. With the aid of the many kindly societies—who co-operate with us so effectively—we have, to some small extent, been able to assist those for whom we are working. Casual and temporary aid, however, which so often is all that we can give, merely touches the fringe of our problem. A consistently good standard of living, together with better accommodation for tuberculous patients and family, is needed, to produce lasting and effective results. Each of these two factors have, for many years, been the great stumbling block in the way of progress. Some there are, of course, who have these advantages, but unfortunately there is a large proportion who have not. Because of the conditions they return to, many of our patients do not get a fair chance to continue the good work begun at sanatorium. It should therefore be the aim and object of all to work for a better state of affairs, as a means to a very desirable end, and we feel that we have a right to call on them to do so. Every year we realise more and more that prevention should be our great concern. Unfortunately, the well are let alone too much, until they too become victims, and eligible for care and attention. The National Association for the prevention of Tuberculosis is drawing attention to this side of Care Work, and by its very title, reminds the general public that it is a work in which all can share. " Care Work " was one of the principle topics of discussion at their Conference this year, and our Chairman 90 was invited to speak on the subject. By a happy coincidence our two best recent examples of constructive care work were achieved with the aid of the Association, and illustrated clearly to the delegates the value of the work of the Conference and of Care Committees. Briefly, the two patients assisted were youths who were trained for special work, and found positions on completion of training. They have maintained a good standard of health, and have kept their positions up to the present time, one for over two years, and the other for one year, and will, we hope in due course, be added to the small list of "cured." Our Chairman was again, this year, elected Chairman of the "Standing Conference" of Metropolitan Borough Tuberculosis Care Committees. At the meetings held at the County Hall, the main object of discussion has been the additional work that from 1st April, 1933, will devolve upon the Care Committees in connection with the assessments of persons undergoing residential treatment for tuberculosis. The welfare of these patients has been the single thought in the mind of the Conference, and all our work and influence has been directed to this end. With regard to the change in procedure as regards "assessments," we shall be in a better position to report on the ma'ter next year, when the scheme will have been in operation long enough to enable us to judge its merits by results. We would like to take this opportunity of placing on record our appreciation of the splendid work done in connection with the Conference by the Honorary Secretary, Miss M. Talbot Kelly. 175 patients have this year been recommended for Institutional treatment, and referred to the Care Committee, in order that any difficulties which might interfere with treatment be dealt with and cleared away. A number of these have had to be provided with clothing from appropriate sources, and action taken in many cases to ensure that the home be maintained during a patient's absence. 924 visits have been paid to patients in their homes. 1,506 persons have been interviewed by the Care Committee at the Dispensary. 910 cases have been submitted to the Committee on the Agenda. 91 It must be somewhat difficult to realise the nature of the work these figures represent, and it is equally difficult for us to enlighten readers to any appreciable extent, in a brief report. Among other things, we assisted a tuberculous girl and her widowed mother to remove to a cottage in the country. Regular help has been obtained for a number of families to maintain their homes during a patient's absence. Grants for nourishments for delicate members of a patient's family have been procured. Separate beds have been supplied. Children have been boarded out. For a lonely girl, without any means, in a sanatorium, a friend was found, who wrote to, and sent her pocket money monthly : and this year particularly, the need for grants of clothing and boots has been urgent. This want we have, with the aid of our many friends and the Mayor's Distress Fund, met to a large extent. We do not wish to leave the impression that the Care Committee limits its work to assessments and material help. We have no limitations, and it is therefore difficult to define our activities. We can only sum up our work by stating that we endeavour to deal with any difficulty, trouble, or emergency that may affect the lives of our people, and act as a connecting link between them and other sources of help—and this as an aid to treatment. Looking back over the year we feel that we can say "Although we have not been able to do as much as we wanted—we have done what we could." Maternity and Child Welfare 94 MATERNITY AND CHILD WELFARE. The chief activities of the scheme of the Deptford Borough Council include the following:— 1. The provision of a staff of Women Health Visitors 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. 95 Summary of Visits paid by Health Visitors, 1932. Wards (approximate) Deptford Park and hvelyn (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 H Total. Miss Robus Visits 966 .. .. .. .. .. 966 Revists 1701 .. .. .. .. .. 170 1 Total 2667 .. .. .. .. .. 2667 Miss Little Visits .. .. .. .. 581 .. 581 Revisits .. .. .. .. 819 .. 819 Total .. .. .. .. 1400 .. 1400 Miss O'Loughlin Visits .. 1247 .. .. .. .. 1247 Revisits .. 2216 .. .. .. .. 2216 Total .. 3463 .. .. .. .. 3463 Miss Smart Visits .. .. 715 .. .. .. 715 Revisits .. .. 636 .. .. .. 636 Total .. .. 1351 .. .. .. 1351 Miss Stowell Visits .. .. .. 889 .. .. 889 Revisits .. .. .. 2061 .. .. 2061 Total .. .. .. 2950 .. .. 2950 Miss Reynolds Visits .. .. .. .. .. 487 487 Revisits .. .. .. .. .. 1172 1172 Total .. .. .. .. .. 1659 1659 Miss Holland Visits .. .. .. .. .. 516 516 Revisits .. .. .. .. .. 2110 2110 Total .. .. .. .. .. 2626 2626 Miss Rhodes Visits .. .. .. .. 267 .. 267 Miss Taylor Revisits .. .. .. .. 377 .. 377 (Temporary) Total .. .. .. .. 644 .. 644 Miss Hillyer Visits .. .. .. .. .. 247 247 Miss Cloke (Temporary) Revisits .. .. .. .. .. 379 379 Total .. .. .. .. .. 626 626 Total Visits 966 1247 715 889 848 1250 5915 Revisits 1701 2216 636 2061 1196 3661 11471 Total 2667 3463 1351 2950 2044 4911 17386 96 Analysis of Visits paid by Health Visitors, 1932. Visits. Re-visits. Total. Birth enquiries 1692 9654 11346 Still-birth enquiries 34 — 34 Visits re infant deaths 132 — 132 Visits to expectant mothers 901 483 1384 „ re Ophthalmia Neonatorum 26 34 60 „ re Measles 979 405 1384 „ re Suspected Measles 66 22 88 „ re Infantile Diarrhæa 39 17 56 „ re Puerperal Fever 1 — 1 „ re „ Pyrexia 7 1 8 „ re Pneumonia 17 14 31 „ re Encephalitis Lethargica 1 2 3 „ re Poliomyelitis 3 4 7 „ re Whooping Cough 190 64 254 „ re Scabies 15 9 24 „ re Verminous Children 10 — 10 „ re Scarlet Fever recoveries 174 23 197 Miscellaneous visits 653 60 713 Unsuccessful visits 975 679 1654 Total 5,915 11,471 17,386 In the case of the 1,692 infants visited shortly after birth, it was found that 1,521 infants were being breast-fed and 58 partly breast-fed. Only 113 were entirely hand-fed. Attendances of Health Visitors at Clinics. Health Visitor. Infant Welfare. AnteNatal. Light. Schick. Dental. Total. Miss Robus 117 17 1 — 2 137 Miss Little 101 4 — — — 105 Miss O'Loughlin 107 6 10 — 44 167 Miss Smart 76 7 — — — 83 Miss Stowell 107 12 19 — — 138 Miss Reynolds 75 11 15 — — 101 Miss Holland 55 7 160 — 1 223 Miss Clubbe 149 135 61 5 — 350 Miss Gibson (part time) 146 96 ... — — 242 Temporary Visitors 83 4 — — — 87 Total 1,016 299 266 5 47 1,633 97 2. Welfare Centres. (a) Infant Welfare. At the commencement of the year there were nine Centres located in different parts of the Borough, one of these being a voluntary Centre. During the year, it was decided to close the Municipal Centre in Church Street and transfer the staff to the voluntary Centre. 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 Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under 1 year 1—5 years Consultations with Doctor Gosterwood Street 47 160 21 181 3275 3456 2385 1071 1465 Napier Street 51 148 40 188 2968 3156 2329 827 1568 Besson Street 48 162 23 185 4015 4200 3014 1186 1444 Erlam Road 52 100 15 115 1990 2105 1437 668 1005 Goldsmiths' College 52 131 26 157 2970 3127 2199 928 1266 Hales Street 51 153 41 194 2594 2788 1735 1053 1488 St. George's Hall 52 147 25 172 3874 4046 2916 1130 1585 St. John's, Harton St. 52 108 36 144 2746 2890 2052 838 1613 Church Street (January-April) 12 25 9 34 523 557 364 193 267 Totals 417 1134 236 1370 24955 26325 18431 7894 11701 The Health Visitors collectively made 1,016 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, 138 children were seen. (b) Maternity Clinics. These are conducted at the Health Centre, Harton Street, four Sessions par 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. G 98 Provision is made for X-Ray examination as an aid in the diagnosis of obscure cases, 12 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. Ante-Natal Clinic. The work of the Ante-natal Clinic daring recent years is illustrated by the following figures. Year. No. of individual women attending. Average number of attendances per week. Total number of attendances made. 1922 311 19 938 1923 369 29 1439 1924 513 30 1497 1925 588 45 2268 1926 595 46 2292 1927 738 45 2241 1928 815 55 2777 1929 929 56 2915 1930 973 64 3212 1931 980 64 3289 1932 880 58 2994 The following is the text of Dr. Hill's Report for 1932:— Ante-Natal Clinic Statistics, 1932. Total number of Patients on Register 880 New Cases 699 Total Attendances 2994 Normal 127 Not pregnant 40 Abnormalities:— Albuminuria 72 Anaemia 72 Ante-partum Haemorrhage 11 Bronchitis 6 Cirrhosis of Liver 1 Cyst (ovarian) 1 Hydramnios 2 Leucorrhoea 9 Morbus Cordis 25 Malpresentation 25 Oedema 16 Pleurisy 1 99 Abnormalities—continued. Contracted pelvis 8 Dental Caries 62 Dyspepsia 17 Deformed Nipples 36 Fibroid 4 Glycosuria 7 Goitre 1 Haemorrhoids 13 Hernia 2 Phlebitis 2 Pruritis 1 Pyelitis 4 Retroversion 1 Sciatica 10 Tuberculosis 4 Twins 2 Vomiting (excessive) 42 Varicose veins 54 Post-Natal Clinic. This branch of the work is conducted every Wednesday forenoon. New cases 167 Total attendances 176 Amongst the patients seen the following defects were found and dealt with:— Breast Abscess 2 Retroversion 1 Ovarian Cyst 1 Unhealed rupture of perinaeum 1 In connection with both the Ante-natal and Post-natal work close co-operation is maintained with medical practitioners, midwives and hospitals. Reports sent to Tuberculosis Officer 7 Ditto to midwives 186 Ditto to doctors 169 Total number of cases referred by letter to hospitals, 159. St. John's Home. A voluntary ante-natal clinic, amongst other activities, is provided at the St. John's Home, Watson Street, and co-operation exists between this clinic and the municipal clinic. The following particulars have been kindly given to me:— Number of mothers attending 150 Total attendances made 670 (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. G2 100 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 58 28 1 24 63 405 February 63 22 — 15 70 484 March 70 22 1 20 73 411 April 73 26 1 32 68 478 May 68 25 1 18 76 445 June 76 6 - 63 19 321 July 19 3 - 13 9 83 August 9 — - 5 4 35 September 4 6 1 — 1 1 42 October 11 25 - 3 33 148 November 33 25 - 6 52 274 December 52 22 - 9 65 287 Total 210 5 208 3,413 Classification of Patients during Year. Admissions. Re-admissions Rickets 40 1 Malnutrition 35 2 Anaemia 51 — Cervical Adenitis 5 — Muscular Weakness 14 1 Delayed Dentition 32 — Bronchitis 3 — Curved Tibiae 8 — Delayed Walking — 1 Post Pnemonia 2 — Otorrhcea 7 — Genu Valgum 3 — Post Bronchitis 1 — Chronic Bronchitis 2 — Bronchial Asthma 1 — Flat Foot 1 — Asthenia 1 - Knock Knee 2 — Eczema of Scalp 1 — Abscess in Neck 1 210 5 101 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 1932:— Scalings, Cases. Extractions. Fillings. Silver Nitrate Gas etc. Cases. Mothers 97 309 116 89 - Children 58 114 18 73 30 In the case of the fillings for mothers, 78 were amalgam and 38 plastic. 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. The Borough Council makes 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. 102 The scheme provides for the recovery of all or part of the Consultant's fee where circumstances warrant it. In one instance a Consultant was called in. 4. The Maternity Home. The record of the Municipal Maternity Home shows that the work carried out during 1932 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 1932:— Cases admitted, 227. Average stay, 2 weeks. Cases delivered by midwives. 212. ,, ,, ,, doctors, 10. Cases in which medical advice sought, 91. Cases notified as puerperal fever, Nil. ,, „ „ puerperal pyrexia, Nil. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. Foetal deaths (a) Stillborn, 8. (b) Within 10 days of birth, 5. 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 1932, Mr. Gilliatt was called to the Home once. Cases not admitted to the Maternity Home. During 1932, a total of 60 applications for admission were refused, 57 owing to the available accommodation being fully booked, and three upon medical grounds. 103 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. Daring the year 30 cases were nursed. 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 21 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 homes, admission being made either direct or, in the case of children, through the Invalid Children's Aid Association. During 1932, 20 cases were sent away. 9. Hospital Provision for Infants. (a) Deptford Babies' Hospital, Albury Street. The Hospital Board having decided to secure more suitable premises, closed their hospital in Albury Street in June, 1932. A large house with spacious grounds in Breakspears Road has been acquired, and is now being adapted for the more extended sphere of work which is contemplated. It is proposed to admit delicate children as hitherto, and to provide facilities for the in-patient and out-patient treatment of mothers who experience difficulty in breast-feeding their infants. Until the date of closing down, three babies were admitted to the Babies' Hospital at the cost of the Borough Council. (b) St. Thomas' Babies' Hostel, Kennington. (l) In-patient Treatment. Mothers and Infants, where difficulty in breast-feeding is experienced, and occasionally infants alone, are sent 104 to this hostel with very satisfactory results. During 1932, seven mothers with their infants were referred for treatment. (2) Out-patient Treatment. This is provided in order that "test feeds" may be carried out. "Test Feeds" are also conducted at the Town Hall and Harton Street. During 1932, 219 "Test Feeds" were so undertaken. 10. 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 1932, the following free or half-price issues were authorised:— 21,671 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, where able. 11. Compensation to Midwives. Where 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, the Council pay to the midwife a portion of her prospective fee which would be otherwise lost. In three instances this policy was carried into effect, involving a total expenditure of £1 10s. 105 12. Health Education. The primary consideration of the work of the Medical Officers at the Clinics and the Health Visitors in the Homes is essentially that of education, the giving of advice to mothers upon the maintenance of their children's health. This is supplemented by periodical "talks" to mothers at the Welfare Centres, the special clinics and at the Antenatal Centre where instruction upon, and assistance in, the cutting out of infant garments is given. Various leaflets upon the feeding of children, the health of the mother before and after confinement, and common ailments are provided and, under the auspices of the Borough Council, a Deptford edition of the periodical Better Health is issued. 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. 108 Table 1. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1932. CAUSES OF DEATH. Sex. All Ages 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75 All causes M 682 63 26 15 10 28 29 34 77 124 132 144 F 608 45 13 11 12 26 24 26 57 86 126 182 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 1 .. Measles M 13 1 9 3 .. .. .. .. .. .. .. .. F 10 .. 6 3 1 .. .. .. .. .. .. .. Scarlet Fever M 3 .. 2 1 .. .. .. .. .. . . . . .. F 1 .. .. .. .. .. .. .. .. .. .. .. Whooping Cough M 5 1 4 .. .. .. .. .. .. .. .. .. F 4 .. 2 2 .. .. .. . . . . . . . . .. Diphtheria M 4 .. 1 1 .. .. .. .. .. .. .. .. F 2 .. .. .. .. .. .. .. .. .. .. Influenza M 8 .. .. .. .. 1 .. 1 .. 2 1 1 F 18 .. .. .. .. 1 .. .. 1 4 5 7 Encephalitis Lethargica M .. .. .. .. .. .. .. .. .. .. .. .. F 2 .. .. .. .. .. .. .. 1 .. 1 .. Cerebro-spinal Fever M 4 4 .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system M 55 2 16 11 8 8 7 3 • • F 37 1 .. .. 1 11 8 4 5 5 2 .. Other Tuberculous Diseases M 7 .. 1 1 .. 2 .. 1 1 1 .. .. F 6 .. .. 1 1 3 .. .. .. 1 .. .. Syphilis M 2 .. .. .. .. .. .. .. 1 1 .. .. F .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane, tabes dorsalis M 5 .. .. .. .. .. .. .. 1 4 .. .. F 3 .. .. .. .. .. .. 1 1 1 .. .. Cancer, malignant disease. M 95 .. .. 1 .. .. 1 4 16 25 31 17 F 88 .. .. 1 .. .. 1 4 16 23 29 14 Diabetes M 3 .. .. .. .. .. .. .. 1 1 1 .. F 5 .. .. .. .. .. .. .. .. 1 3 1 Cerebral Haemorrhage, etc. M 21 .. .. .. .. .. .. .. 3 2 8 8 F 28 .. .. .. .. .. .. .. 2 2 8 16 Heart Disease M 148 .. .. .. .. 4 .. 2 12 28 48 50 F 149 .. .. .. .. 5 .. 8 13 20 37 62 Aneurysm M 5 .. .. .. .. .. .. .. 3 2 .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Other Circulatory Diseases M 40 .. .. .. .. .. .. 1 1 8 10 20 F 24 .. .. .. .. .. 1 .. .. 2 10 11 Bronchitis M 28 2 .. 1 .. .. .. 1 4 6 4 10 F 25 1 1 .. .. .. .. .. 1 .. 5 17 Pneumonia (all forms) M 43 12 5 4 .. .. 3 5 5 8 .. 1 F 39 7 3 2 .. .. 2 .. 4 5 5 10 Other Respiratory Diseases M 6 .. .. .. .. .. 2 .. 2 .. .. 2 F 5 .. .. .. .. .. .. .. 1 1 1 2 Peptic Ulcer M 8 .. .. .. .. .. 1 2 4 1 .. F 3 .. .. .. .. .. .. .. .. 2 .. 1 Diarrhoea, &c. M 15 11 .. .. .. .. .. .. 1 1 .. 1 F 14 12 .. .. .. .. .. 1 .. .. 1 .. Appendicitis M 3 .. .. .. .. .. 1 .. .. 2 .. .. F 4 .. .. .. .. .. .. .. 2 .. 2 .. 109 Table 1—continued. CAUSES OF DEATH. Sex. All Ages. 0— 1 — 2— 5- 15- 25- 35— 45— 55— 65— 75— Cirrhosis of Liver M 3 .. .. .. .. .. .. .. .. 2 1 .. F 3 • • .. .. .. .. 1 .. 2 .. .. .. Other diseases of Liver, etc. M .. .. .. .. .. .. .. .. .. .. .. .. F 3 .. .. .. .. .. .. .. .. .. 3 .. Other Digestive Diseases M 15 1 2 .. .. .. .. 1 3 3 5 .. F 12 .. .. .. .. .. .. .. .. 6 3 3 Acute and chronic Nephritis M 23 .. .. 1 .. .. 1 2 3 6 4 6 F 12 .. .. .... .. 3 1 .. .. 4 2 2 Puerperal Sepsis F 2 .. .. .. .. .. 2 .. .. .. .. .. Other Puerperal causes F 3 .. .. .. .. .. .. 3 .. .. .. .. Congenital Debility, Premature Birth, tions etc. M 30 29 .. 1 .. .. .. .. .. .. .. .. F 18 18 .. .. .. .. .. .. .. .. .. .. Senility M 13 .. .. .. .. .. .. .. .. .. 2 11 F 29 .. .. .. .. .. .. .. .. .. 1 28 Suicide M 6 .. .. .. .. .. .. .. 1 1 3 1 F 3 .. .. .. .. .. .. 2 1 .. .. .. Other violence M 25 1 .. .. 2 .. 2 5 .. 4 3 4 F 11 3 .. .. .. .. .. 1 .. 1 2 4 †Other defined diseases M 46 1 .. .. 4 .. 1 1 7 9 8 12 F 42 3 .. .. 4 .. 5 2 7 8 4 4 Causes ill-defined or known M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 1 .. *Small-pox M .. .. .. .. .. .. .. .. .. .. .. .. F 1 1 .. .. .. .. .. .. .. .. .. .. *Special Causes included in † above. Table II. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION OR DESTROYED AT OWNERS' REQUEST. 1932 Premises Vistited Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Books At tides Destroyed (Owners' Request) Cleansing Station Verminous Persons 1 nfectious Disc- Requests Bedding only D.BC. Library Private Total Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Wearing Apparel Towels Blankets Total Baths Wearing Apparel Stoved January 72 7 9 48 128 38 28 76 140 273 731 36 ... 36 5 ... ... 3 ... ... ... 8 ... 110 ... 110 5 38 February 99 4 5 39 116 42 30 75 141 358 801 29 25 54 8 3 l 3 1 ... 30 46 ... 152 ... 152 ... ... March 105 7 5 55 133 48 34 91 147 508 1016 26 130 156 1 2 l 3 2 ... 23 32 ... 152 ... 152 4 21 April 87 10 4 57 133 47 38 75 132 327 809 34 64 98 3 5 l 4 ... ... ... 13 ... 146 ... 146 5 34 May 125 7 5 64 169 52 48 110 195 450 1088 41 38 79 4 4 ... 7 6 3 47 71 ... 185 ... 185 .. ... June 94 7 4 56 131 39 37 91 102 381 837 16 1 17 1 ... l 5 ... ... 6 13 20 221 5 246 2 15 July 89 5 6 67 164 43 27 94 127 341 863 28 2 30 2 ... ... 1 ... ... ... 3 ... 133 ... 133 1 6 August 61 4 2 47 91 27 20 61 48 143 437 26 59 85 2 6 1 4 4 2 343 362 ... 39 ... 39 ... ... September 106 4 6 75 151 61 40 117 125 318 887 45 12 57 4 4 l 6 3 ... 66 84 34 225 2 261 ... ... October 93 4 6 66 152 49 40 92 185 411 995 35 46 81 2 ... l 6 ... ... ... 9 ... 188 ... 188 1 3 November 77 3 6 38 125 41 23 68 363 230 888 28 8 36 1 1 l 3 ... ... ... 6 ... 188 ... 188 2 17 December 103 2 1 60 133 36 34 103 168 455 989 34 ... 34 1 ... l ... ... ... ... 2 ... 144 ... 144 ... 10 1111 64 59 672 1626 523 399 1053 1873 4195 10341 378 385 763 34 25 9 45 16 5 515 649 54 1883 7 1944 22 144 110 111 Table III. SHOWING NUMBER OF ROOMS DISINFECTED. 1932 Scarlet Fever Diphtheria Pulmonary Tuberculosis Small-Pox Measles Scabies Cancer Chicken Pox Pneumonia Erysipelas Puerperal Fever Typhoid Fever Cerebro-Spinal Meningitis Formalin Spray Fumigated Infectious Requests Total Rooms Verminous Premises Rooms R'ms. R'ms January 37 14 21 23 1 .. 2 .. 1 .. .. .. .. 99 9 108 7 14 February 48 15 43 46 5 2 .. .. .. 1 1 .. .. 161 5 166 1 1 March 61 10 31 19 6 2 .. 2 .. .. .. 2 l 134 8 142 4 6 April 40 9 36 18 14 2 .. 2 .. .. 2 .. .. 123 19 142 5 10 May 55 45 46 31 10 .. 4 .. .. 2 .. .. l 194 10 204 11 18 June 46 26 28 .. 3 2 4 1 .. .. .. 1 l 112 10 122 15 32 July 50 25 25 .. 1 .. 1 3 2 .. .. .. .. 107 5 112 16 27 August 30 20 19 .. .. 3 .. .. .. .. .. .. .. 72 4 76 25 45 September 47 34 26 .. .. 7 .. .. .. .. .. .. .. 114 7 121 15 27 October 57 28 20 .. 1 1 1 .. .. .. .. .. .. 108 4 112 3 4 November 52 12 22 .. .. 8 4 .. .. .. .. .. .. 98 5 103 6 8 December 61 18 32 .. 1 3 4 1 1 .. .. .. .. 121 2 123 2 5 584 256 349 137 42 30 20 9 4 3 3 3 3 1443 88 1531 110 197 112 GOSTERWOOD STREET CLINIC. 1932 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 17 1 4 22 292 314 142 February 5 6 2 2 1 11 330 341 142 March 3 7 1 3 1 12 223 235 90 April 4 17 2 1 2 22 301 323 138 May 4 19 3 22 261 283 117 June 4 10 1 11 298 309 130 July 4 8 1 9 199 208 91 August 4 8 1 4 13 206 279 112 September 4 7 2 3 12 304 316 131 October 5 9 2 2 5 18 367 385 163 November 4 12 1 1 4 18 258 276 119 December 3 8 1 1 10 178 188 90 Total 48 128 13 18 21 180 3277 3457 1465 NAPIER STREET CLINIC. 1932 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5 January 4 11 1 5 17 258 275 158 February 4 12 1 1 4 18 242 260 130 March 5 6 1 11 18 205 223 97 April 4 12 1 6 6 25 256 281 149 May 5 11 1 1 13 224 237 128 June 4 8 5 13 254 267 132 July 4 8 1 2 11 254 265 116 August 5 17 1 18 249 267 110 September 4 10 1 2 1 14 253 267 113 October 4 12 3 5 20 280 300 155 November 5 16 1 1 3 21 315 336 188 December 3 2 2 3 7 178 185 92 Total 51 125 5 25 40 195 2968 3163 1568 113 GOLDSMITHS' COLLEGE CLINIC. 1932 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 1 1 12 251 263 113 February 4 7 1 8 214 222 79 March 5 3 1 1 5 261 266 94 April 4 10 1 5 16 238 254 94 May 4 9 3 6 18 210 228 118 June 5 12 2 3 17 307 324 115 July 4 4 1 5 226 231 81 August 5 10 2 2 2 16 257 273 103 September 4 12 4 1 17 228 245 104 October 4 11 1 3 15 242 257 123 November 5 7 1 2 10 312 322 142 December 4 12 3 8 18 224 242 100 Total 52 107 4 20 26 157 2970 3127 1266 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC. 1932. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 16 5 21 196 217 110 February 4 5 5 153 158 78 March 4 4 4 8 174 182 79 April 4 13 1 4 18 213 231 113 May 4 10 1 5 16 178 194 113 June 5 18 3 2 1 24 278 302 174 July 4 11 3 1 10 25 238 263 127 August 5 10 1 1 3 15 248 263 126 September 4 11 5 2 1 19 246 265 145 October 4 6 2 6 14 242 256 154 November 4 7 1 2 1 11 216 227 139 December 5 7 1 1 9 222 231 120 Total 51 118 18 8 41 185 2604 2789 1488 114 BESSON STREET CLINIC. 1932. 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 1 4 15 333 348 131 February 4 12 1 1 14 341 355 118 March 4 8 1 1 10 280 290 114 April 4 17 1 4 4 26 346 372 130 May 4 11 1 3 4 19 331 350 129 June 4 12 1 1 14 346 360 112 July 4 8 2 2 12 335 347 128 August 4 17 3 3 1 24 360 384 120 September 4 8 2 10 345 355 111 October 4 8 1 2 11 353 364 120 November 5 6 5 4 1 16 421 437 140 December 3 8 4 2 14 224 238 91 Total 52 125 13 24 23 185 4015 4200 1444 ERLAM ROAD CLINIC. 1932. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 4 1 1 6 182 188 94 February 4 7 1 8 124 132 63 March 3 7 1 8 113 121 68 April 5 11 1 12 206 218 106 May 4 7 1 5 13 131 144 67 June 4 2 1 3 134 137 57 July 5 10 2 1 2 15 205 220 100 August 4 5 3 1 9 141 150 77 September 5 14 1 1 2 18 233 251 106 October 4 4 1 3 8 185 193 88 November 4 4 1 5 180 185 89 December 5 6 3 1 10 156 166 90 Total 52 81 7 12 15 115 1990 2105 1005 115 ST. GEORGE'S HALL, SHARDELOES ROAD. 1932. No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consul tations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5 January 5 12 1 4 2 19 358 377 173 February 4 4 3 1 8 267 275 121 March 3 8 1 1 10 214 224 95 April 5 10 3 3 16 360 385 129 May 4 4 5 3 5 17 242 259 98 June 4 13 2 2 17 290 307 118 July 5 17 2 3 22 347 369 130 August 4 9 1 1 11 284 295 110 September 5 9 1 1 3 14 422 436 172 October 4 8 4 2 2 16 318 334 126 November 5 7 3 2 12 376 388 15] December 5 8 2 10 387 397 162 Total 53 109 16 22 25 172 3874 4046 1585 ST. JOHN'S CLINIC. 1932. No. of times Clinic opened. New Crises. 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 9 182 191 122 February 4 8 7 15 173 188 130 March 5 7 2 4 13 218 231 147 April 4 7 1 2 3 13 208 221 138 May 4 9 1 10 212 222 130 June 5 7 2 1 10 284 294 155 July 4 2 2 4 229 233 94 August 5 6 1 2 2 11 285 296 133 September 4 4 3 1 3 11 236 247 137 October 4 6 4 5 15 228 243 114 November 5 10 3 6 19 294 313 177 December 4 11 3 14 197 211 136 Total 52 85 8 15 36 144 2746 2890 1613 H2 116 CHURCH STREET CLINIC. 1932 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed Mixed Hand. Ages 1—5 January 4 16 5 21 196 217 110 February 4 5 5 153 158 78 March 4 4 4 8 174 182 79 April Total 12 25 9 34 523 557 267 INDEX. A PAGE Acute Poliomyelitis 62 Aged and Infirm Persons, Removal to Hospital 33 Agricultural Produce (Grading and Marking) Act, 1928 54 Ante-natal Clinic 98 Area of Borough 8 Artificial Light Clinic 99-100 B Babies' Hospital (Deptford Fund) 103 Bacteriological Work 66 Bakehouses 47 Births 11 ,, illegitimate 12 ,, Notification of 12 c Cancer 68 Canal Boats Act, Inspector's Report 34 Cerebro-spinal Meningitis 62 Chicken pox 60 Clinics and Treatment Centres—List of 25 Condensed Milk Regulations 54 Convalescent Treatment 103 D Deaths 12-15 ,, Table showing causes at different age periods 108-109 „ of Infants 16 Dental Clinic, Maternity and Child Welfare 101 ,, Tuberculosis 85 ii. D—continued. PAGE Diabetes 69 Diarrhœa, Infantile 63 Diphtheria 59 Disinfection 67, 110, 111 Disinfestation 67 District Surveyor, co-operation with 34 Dried Milk Regulations 54 Dysentery 63 E Encephalitis Lethargica 62 Enteric Fever 65 Erysipelas 64 F Factories and Workshops 35-36 Fish Shops, Fried 47 Fish Curers 47 FOOD 43-54 „ Premises 45-48 „ Imported 48 „ Unsound 48 „ Poisoning 49 „ Sampling, Food and Drugs (Adulteration) Act 50-54 Foreword 5-6 H Handicraft Class for Tuberculous Patients, Report on 88 Health Education 104 HEALTH SERVICES, General Provision of 19-26 Health Visitors, Summary of Visits paid by 95-96 Home Helps 103 Home Nursing 103 House-to-house Inspections 31 HOUSING 38-42 iii. H—continued. PAGE I Ice Cream premises 47 Illegitimacy 12 Imported Food 48 Infant Welfare Centres, Summary of Work at 97 „ „ Tables showing attendances at 112-116 Infantile Mortality 16-17 INFECTIOUS AND OTHER DISEASES 55-69 Influenza 65 Insulin, supply of 69 L Legal Proceedings, general 31 „ Food and Drugs 53 Lewellin, Miss, Report of 88 M Malaria 63 Marriages 11 Maternal Mortality Reports to Ministry 105 MATERNITY AND CHILD WELFARE COMMITTEE 3 MATERNITY AND CHILD WELFARE 94-105 Maternity Clinics, Tables 98-100 Maternity Home 24, 102 Maternity Outfits, provision of 103 Measles 65 Meat Premises 46 Midwives, compensation to 104 Milk, Graded 45 „ Bacteriological Examination 46 Milk Shops 45 „ Supply of, to Necessitous Mothers and Infants 104 Mortuary, Public 17-18 IV. PAGE N Nursing in the Home 23-24 Nutrition—Dissemination of Knowledge 54 o Obstetricians, consulting 101 Offensive Trades 32 Offensive Matter, conveyance through streets 32 Ophthalmia Neonatorum 64 P PHYSICAL FEATURES AND VITAL STATISTICS OF BOROUGH 7-18 Pneumonia 62 Poliomyelitis, acute 62 Population 10 Post-natal Clinic 99 PUBLIC HEALTH COMMITTEE 3 Puerperal Fever 63 „ Pyrexia 64 R Rag and Bone dealers 32 Rateable Value 8 Rats and Mice (Destruction) Act 32 Refuse Collection 33 s SANITARY CIRCUMSTANCES OF THE BOROUGH 27-36 Sanitary Inspectors, work of, Table 29-31 Scarlet Fever 57 Schick Testing 59 Sewers and Drains, supervision of 33 Sickness, Noteworthy causes of 15 Slaughterhouses 46 V. PAGE S—continued. Smallpox 60 Smoke abatement 32 Social Conditions of Population 9 Staff of Public Health Department 20-22 St. John's Home 99 St. Thomas's Hostel 103 Still births 11 Swimming Baths, examination of water 33 T TUBERCULOSIS 72-91 Tuberculosis Care Committee, work of 89 „ Handicraft Class, Report on 88 „ Summary of Notifications 73-75 „ New Cases and Deaths 78 „ Interval between Notification and Death 78 „ Revision of Register 79 „ Supervision of Contacts 80-82 „ Memo. 37 T., Table 1 83-84 „ Annual Return facing page 88 „ Co-operation with Medical Practitioners, etc. 86 „ Home accommodation of Patients 77 „ Dental Treatment 85 „ Vists to homes 86 V Vaccination Return 61 w Water Certificates 34 Whooping Cough 66