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. Councillor A. Aplin. Councillor Mrs. E. M. Bateman. Councillor C. G. Blanchard. Councillor F. B. Buttery. Councillor Mrs. B. M. Drapper, J.P. Councillor W. H. Green, J.P., L.C.C. Councillor A. G. Howard. Councillor Mrs. C. Rogers. Councillor Mrs. L. E. White. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. B. M. Drapper, J.P. Vice-Chairman. Councillor Mrs. G. E. Green. Councillor A. Aplin. Councillor Mrs. E. M. Bateman. Councillor Mrs. A. A. Cheason. Councillor Mrs. E. M. Colburn. Councillor Mrs. M. Herlihy. Councillor Mrs. C. Rogers. Councillor E. C. Sherwood. Councillor W. Taylor. Councillor Mrs. L. E. White. A 2 Metropolitan Sorongl) of Brptforii. Public Health Department, Deptford Town Hall, S.E. 14. 10th April, 1934. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford, Mr. Mayor, Ladies and Gentlemen, I have the honour to present my fifth Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. The estimated population for statistical purposes is 102,800 and based upon this figure, the birth and death-rates per 1,000 of the population were 14.8 and 12.1, compared with 15.9 and 12.2 for the year 1932. The birth-rate was therefore the lowest on record. The infantile mortality rate was 54, and the maternal death-rate 5.7— the latter rate being calculated upon 1,000 total (live and still) births. Regarding infectious disease the chief increase compared with 1932 was in respect of Scarlet Fever. The cases were in the main of a mild type, no deaths being recorded. No case of Small-pox was notified. The improvement of the sanitary circumstances of the district, and the securing and maintenance of a satisfactory sanitary environment in the fullest sense of the word, have been most ably undertaken by the Sanitary Inspectors, who have again carried through a very large volume of work. The closure of parts of houses and the demolition of unfit houses, whether regarded individually or collectively, received considerable attention during the year. Two Clearance Areas were "represented" 6 to the Borough Council, while the London County Council decided to take action in respect of three. The purity of the food supply, primarily the responsibility of the Food Inspector, has been satisfactorily safeguarded. During the year, Inspectors of the Ministry of Health conducted a survey of the health service of the borough. Their report is not yet to hand. In conclusion, to Dr. Donnelly and to Dr, Hill I desire to express my high appreciation of their valuable work in connection with Tuberculosis and Maternity and Child Welfare respectively, and to the Staff generally my thanks for their loyal co-operation during the year. 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 parts 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. 1. Deptford Park 2. Ravensbourne ation Ground. 3. Telegraph Hill ation Ground. 4. Railways and ing land. 5. Millwall Football Ground. 6. Canals 7. St. Paul's Churchyard 8. Reservoir 9. Municipal Playing Fields Evelyn Street . Brookmill Road Telegraph Hill . Size. 22 acres I¼ acres 45½ acres 234 acres 5½ acres 8 acres 2.2 acres 1 acre Deptford Bridge 3½ acres Statistics. Maintained by. L.C.C. Borough Council. L.C.C. Area Population: Census 1931 Estimated Resident population, 1933 Number of inhabited houses according to the Rate books (end of 1933) Number of families or separate occupiers (1931) Rateable Value (31.3.1933) Estimated sum represented by a Id. Rate Borough Council. 1,564 acres 106,891 102,800 19,400 29,248 £659,854 £2,695 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 registered as Unemployed:— 23rd Oct., 1933 Men, 3,365 Women, 650 Juveniles, 62 22nd Jan., 1934 ,, 3,510 ,, 852 ,, 265 I am indebted to the Public Assistance Officer for the following figures:— (a) Total number or Deptford Residents, including wives and children, on outdoor relief, during the week ended 30th December, 1933:— Unemployment 4,826 (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1933:— £85,755 lis. 3d. A further index of the economic position is afforded by the details of the incomes of persons receiving milk through the Council's scheme. An Analysis of the applications made in December showed that the number of persons granted milk was 747. Of these, 713 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 34 persons, the same conditions being observed, the amount per head varied between 7s. 6d. and 10s. 6d. During the whole year 18,151 applications for fortnightly supplies were granted. Of this number, 17,237 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. Totaf Birth-rate. Live Legitimate 784 685 1,469 1,520 14.8 Births Illegitimate 31 20 51 Still-births, 56. Rate per 1,000 total births, 35.5. Death-rate. Deaths 1,247 12.1 Percentage of total deaths occurring in Institutions 60 Number of women dying in, or in consequence of, childbirth: Rate per 1,000 (live and still) births. From Puerperal Sepsis 6 3.8 Other Puerperal causes 3 1.9 Total 9 5.7 Death-rate of infants under one year of age, per 1,000 births: Legitimate 52 Illegitimate 118 Total 54 Deaths from Measles (all ages) 1 ,, Whooping Cough (all ages) 9 „ Deaths from Diarrhoea (under 2 years) 15 Population. 1 he population for 1933, as given by the Registrar-General, was 102,800, the lowest on record. 11 Marriages. During the year 864 marriages took place, equivalent to a rate of 8.4 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 503 Other places of worship 83 In the Superintendent Registrar's Office 278 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 488 children born of Deptford parents outside the Borough, and the deduction of 37 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,520. This is equivalent to a birth-rate of 14.8 per 1,000 of the population and, after subtraction of deaths, represents only a natural increase of 2.7 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 1933 1520 14.8 14.4* 13.2* Still-Births. 56 still-births were registered during the year as follows:— Legitimate Illegitimate Total Male 31 — 31 Female 23 2 25 * Provisional figures. 12 Illegitimacy. The number of illegitimate births was equivalent to 3.4 per cent, of the total births. The figures relative to illegitimacy for previous years areas follows Av. for 10 vrs. 1915-1924. Av. for 5 yrs. 1925-1929 1930 1931 1932 1933 No. of illegitimate births 77 58 59 55 56 51 Percentage of total births 2.9 3.0 3.4 3.2 3.3 3.4 Notification of Births. During 1933, the number of notifications received of births and still births actually occurring in the Borough was 1,077. After allowing for inward and outward transfers, the corrected figure was 1,479. The following is an analysis of these notifications: Births Notified in the Borough during Year 1933. Ward. Births notified. Alive Dead By whom notified Total Male Female Parent Doctor Midwife Canterbury 67 38 29 66 1 5 9 53 Clifton 72 36 36 71 1 5 15 52 Deptford Park 72 38 34 70 2 7 18 47 Evelyn 112 49 63 108 4 6 19 87 Hatcham 64 28 36 62 2 6 3 55 Pepys 51 23 28 50 1 6 11 34 St. Catherine's 44 26 18 43 1 5 11 28 St. John's 47 29 18 43 4 2 8 37 St. Paul's 147 83 64 144 3 2 4 141 St. Peter's 256 137 119 248 8 14 9 233 Town Hall 47 26 21 44 3 3 8 36 Vale 98 57 41 96 2 9 16 73 Totals 1077 570 507 1045 32 70 131 876 Deduct births not belonging to Borough 32 18 14 31 1 3 5 24 Total 1045 552 493 1014 31 67 126 852 Add Births which occurred outside Borough 434 239 195 423 11 434 Grand Total 1479 791 688 1437 42 67 126 1286 13 Deaths. In order to express the number of deaths as a death-rate applicable to the Borough, it is necessary to make allowance in respect of deaths of persons occurring within, but belonging outside the Borough, and, conversely, for those who died while temporarily living outside Deptford. Total deaths registered in the Borough 580 Deduct deaths of "non-residents" 78 502 Add deaths of "residents" outside Borough 745 Nett deaths applicable 1,247 This is equivalent to a death-rate of 12.1 per 1,000 persons. Seasonal Mortality. Quarter ended. 1933 1932 No. Rate per 1,000 of population. No. Rate per 1,000 of population. March 416 16.2 453 17.2 June 282 11.0 275 10.5 September 225 8.7 249 9.5 December 324 12.6 313 11.9 The trend of the death-rate in recent years is shown by the following table:— Year. Deptford No. Ergland & 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 12.3 11.9 1928 1354 12.0 11.7 11.6 1929 1481 13.3 13.4 13.8 1930 1250 11.3 11.4 11.4 1931 1284 12.0 12.3 12.4 1932 1290 12.2 12.0 12.3 1933 1247 12.1 12. 31 12.21 *Civilian population only from 1915-1920. † Provisional figures. 14 Deaths—Sex and Ward Distribution. Ward. Males. Females Children under 1 year Total deaths Deptford Park 41 37 1 78 Evelyn 72 65 9 137 St. Paul's 85 51 15 136 Vale 64 62 10 126 Clifton 48 39 9 87 Canterbury 52 45 7 97 Hatcham 56 54 8 110 Pepys 47 43 3 90 St. Catherine's 39 40 5 79 St. Peter's 37 47 5 84 St. John's 69 42 3 111 Town Hall 55 57 7 112 665 582 82 1247 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), 1933. Average No. fori 10 years 1915-24.j Average 1925-1929 1930 1931 1932 1933 Increase or decrease over 1932 Measles 0.8 27 20 24 1 23 1 - 22 Whooping Cough 7 24 13 3 11 9 9 — Diphtheria 4 19 14 4 12 6 5 - 1 Influenza 42 70 35 6 20 26 52 + 26 Tuberculosis—Pulmonary 75 136 102 113 100 92 94 + 2 Non-pulmonary 8 32 18 14 14 13 10 - 3 Cancer 110 133 159 156 174 183 137 - 46 Heart Disease 225 128 232 298 322 297 281 - 16 Cerebral Haemorrhage, Embolism and Thrombosis 46 67 54 45 41 49 57 + 8 Bronchitis 42 140 95 47 55 53 52 - 1 Pneumonia (all forms) 67 154 121 73 113 82 84 4- 2 Nephritis 26 35 34 44 31 35 32 - 3 Diarrhoea and Enteritis 14 45 20 19 14 29 18 - 11 Violence (excluding Suicides) 30 48 49 64 30 36 37 + 1 Premature Birth, Malformation and Debility 36 86 49 40 45 48 45 - 3 15 Special Noteworthy Causes of Sickness or1 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 L925.1929 1930 . 1931 1932 1933 Under 1 year 16.3 9.4 8.6 7.2 8.3 6.5 From 1.2 years 4.7 2.7 1.8 1.6 3.0 1.0 ,, 2.5 years 4.3 2.8 2.5 2.0 2.0 1.3 ,, 5.15 years 3.9 2.9 2.3 2.2 1.8 2.4 ,, 15.25 years 4.4 4.3 5.5 4.3 4.2 3.5 ,, 25.45 years 12.3 10.5 11.1 10.2 8.8 10.0 ,, 45.65 years 23.3 27.7 26.0 28.6 26.6 25.8 65 years and upwards 30.8 39.6 42.2 43.8 45.3 49.5 The infantile mortality rate for 1933 was 54 per 1,000 births and the following Table gives the death.rates for England and Wales, London and Deptford for previous years:— Year Deptford England & Wales London No. Death-rate per 1.000 Births Death-rate per 1,000 Births Death-rate per 1,000 Births Average for 10 years 1915.1924 231 90 87 85 Average 1925.1929 129 64 71 65 1930 107 61 60 59 1931 93 53 66 65 1932 108 65 65 66 1933 82 54 64* 59* *Provisional figures. 16 The following Table gives details of the causes of death in the various age groups:— Infantile Mortality, 1933. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. to 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 25 6 4 .. 35 12 15 14 6 82 Smallpox .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. • • 3 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 Meningitis (not tuberculous) .. .. . .. .. .. .. .. 1 1 Convulsions .. .. .. .. .. .. .. 1 .. 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. l .. .. .. ..1 Pneumonia (all forms) .. .. .. .. .. .. l .. 4 3 ..9 Diarrhoea .. .. .. .. .. .. .. .. .. .... Enteritis .. .. .. .. .. 2 .. 4 .. ..13 Gastritis .. .. .. .... .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .... .. .. .. .. .. .. .. .. .. Suffocation, overlaying.. .. .. .. .. .. .. .. .. .. .. Injury at Birth .. 1 .. .. 1 .. .. 1 .. 2 Atelectasis .. .. .. .. 3 .. .. .. .. 3 Congenital Malformations 2 2 .. .. 4 .. 1 1 .. 6 Premature Birth 16 2 3 .. 21 .. .. .. .. 21 Atrophy, Debility, and Marasmus 4 1 1 .. 6 5 5 1 1 18 Other Causes .. .. •• .. .. 1 .. .. .. 1 Totals 25 6 4 •• 35 12 15 14 6 82 Death-rate in each agegroup per 1,000 births.. 164 3.9 2.6 " 23.0 7.9 9.9 9.2 3.9 54 Percentage of total deaths in each agegroup 30.5 7.3 4.9 .. 42.7 14.6 18.3 17.1 7.3 100 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 1933 30.5 7.3 4.9 - 42.7 14.6 18.3 17.1 7.3 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 303 persons who had been residents of the following districts:— Deptford 82 Greenwich 55 Camberwell 9. Bermondsey 30 Lewisham 10 Woolwich 80 Southwark 5 Lambeth 3 Battersea 1 Poplar 1 Holborn 1 Bethnal Green 1 Islington 1 Willesden 1 East Ham 4 Bexley 2 Barking 1 Northfleet 1 Sidcup 1 Strood, Kent 1 Staplehurst, Kent 1 Welling, Kent 1 Chatham 1 Grays, Essex 1 Westcliff.on.Sea 1 Upton Park 1 Keighley, Yorks 1 North Shields 1 Unknown 5 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. Infectious. 303 174 129 202 155 16 11 l 1 In 100 cases no inquests were held, the necessary certificate being issued by the Coroner. The causes of death were as follows:— Natural causes 161 Open verdicts 15 Accidental causes 99 Misadventure 1 Suicide while of unsound mind 27 Total ... 303 2 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. B2 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 \ssistant Medical Officer of Health.) S. Eleanor Hill, m.d., b.s. (Maternity and Child Welfare.) M. I. outram, m.b., ch.b., d.p.h. (Part-time Maternity and Child Welfare.) Obstetric Consultant. W. Gilliatt, m.d., f.r.c.s. (For Maternity Home and under Puerperal Fever and Pyrexia Regulations.) Obstetric Consultants. G. F. Gibberd, f.r.c.s. A. L. W^alker, 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.) (resigned 30-4-33) Meat Cert. r.s.i. Frederick Hewett Cert. s.i.e.b. (Lond.), Meat Cert. r.s.i. Albert Yates Cert. s.i.e.b. (Lond.), Meat (Food Inspector) Cert. r.s.i. 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 Cert. r.s.i. G. F. Wilton Cert. r.s.i. Joint Board. Meat Cert. R.S.I. W. S. Gregory Cert. R.S.I. Joint Board. Meat Cert, r.s.i. Health Visitors. Miss E. Holland General Training, c.m.b., h.v. (r.s.i.), s.i. (r.s.i.) Miss M. Little General Training, c.m.b., New H.V. Cert. Miss K. O' Loughlin General and Children's Training, c.m.b., New H.V. Cert. Miss E. E. Reynolds General Training, c.m.b. Miss M. F. Robus General Training, c.m.b., h.v. (r.s.i.) Miss E. T. Stowell General Training, c.m.b., h.v. (r.s.i.) *Miss W. C. Smart Cert. s.i.e.b. (Lond.), c.m.b. †Miss A. M. Gibson General Training, c.m.b. Massage. Health Centre, Harton Street. Ante-natal and Post-natal Centres. Health Visitor in charge—Miss E. Clubbe, Gen. Training, c.m.b., h.v. (r.s.i.) Attendant—Mrs. Stacey Light Treatment Department. Health Visitor in charge— Miss E. Holland, Gen. Training, c.m.b., h.v. (r.s.i.), S.I. (r.s.i.). *Appointed as a Sanitary Inspector and Health Visitor. †Part-time only at Infant Welfare Centres. 22 Tuberculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. Tuberculosis Health Visitors— Miss E. M. Porteus, Gen. Training, H.V. (r.S.I.), Tuberculosis Cert. (r.S.I.) Miss A. M. Roy, Gen. Training, C.M.B., h.v. (r.S.I.), Tuberculosis Cert. (r.S.I.) Dispenser Clerk—Miss G. F. Greig (Asst. Soc. Apothecaries, Cert.) 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 Disinjectors—F. Smith and F. Peache. 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, diarrhœa, 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 Cases Visits Cases Visits nursed Measles 1 4 1 Ophthalmia Neonatorum 8 168 8 Pneumonia 1 35 1 26 2 Thread Worms 2 9 2 Mastitis 2 35 2 Diarrhœa 1 11 1 Chicken-pox 1 10 1 Influenza 1 12 1 Maternity Case 1 18 1 16 272 3 56 19 Midwives. The Borough Council is not the supervising authority under the Midwives Acts. From a return provided by the County Council, the number of midwives practising in the Borough is estimated at twenty. No subsidy is paid to midwives locally. 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. Since the opening of the Albany Deptford Babies' Hospital, on the 11th July, 1933, the Borough Council, by arrangement, has sent debilitated infants requiring dietetic treatment for in-patient treatment. In addition, mothers and infants requiring supervision in connection with breast-feeding are either admitted or treated as out-patients. These arrangements are in substitution for the previous procedure which provided for the sending of all such cases to St. Thomas' Hostel, Kennington. General in-patient and out-patient treatment is provided at such London hospitals as Vincent Square, Evelina and Great Ormond Street, and locally, at St. Alfege, the Miller and St. John's Hospitals. Maternal Mortality. See "Maternity and Child Welfare." Institutional provision for Unmarried Mothers, Illegitimate Infants, etc. No provision. Ambulance Facilities. These were fully set out in my report for 1930, and no material change in the arrangements has taken place. 25 CLINICS AND TREATMENT CENTRES. Maternity & Child Welfare. (l) Infant Consultations. Daily from 2 p.m. Monday, Gosterwood Street Tuesday, Napier Street Do. Besson Street Wednesday, 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. Ante-natal—Wednesday, 9 a.m. Post-natal—Tuesday, 9 a.m. (3) Dental Inspection (monthly). ,, Treatment (weekly). (4) Artificial Sunlight Centre. (By appointment.) (5) Diphtheria Immunisation Clinic. Wednesday (2 p.m.) (by appointment). Tuberculosis Dispensary. Health Centre, Harton Street. Monday & Thursday, 9.30 to 11 a.m. Men. Tuesday evening, 6.30 to 7.30 p.m., Men and Women at work. Tuesday and Friday, 9.30 to 11 a.m., Women. Thursday, 2 to 3 p.m., Children not at school and Women at work, latter by appointment. Saturday, 9.30 to 11 a.m., Children attending school. 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. Gonorrhœa—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, 9.30 a.m., 1.30 p.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." Infant Life Protection. As from the 1st April, 1933, the Borough Council assumed the duties delegated by the London County Council. (For details, see "Maternity and Child Welfare.") Orthopcedic Treatment. No scheme has been adopted, individual children being referred to private doctors or to hospitals. Sanitary Circumstances, etc., AND Factory and Workshops Acts. 28 SANITARY WORK. The following figures show the growth of the work since 1929. It It will be noted that the number of inspections has again reached, and even slightly surpassed, the excellent figures attained in 1930 and 1931, and that there is also a slight increase on last year's figures in re-inspections, notices served and works completed. 1929 1930 1931 1932 1933 Total primary inspections 5,825 8,004 7,592 6,652 8,166 Total re-inspections 14,545 18,167 20,461 17,284 18,105 Total Intimation Notices served 2,860 3,458 3,552 2,623 2,748 Total Statutory Notices served 302 1,078 1,104 687 777 Total Housing Act Notices served 3 42 12 10 18 Total Drainage Notices served - 15 74 55 75 Total premises on which works were completed 2,831 3,855 3,941 2,990 3,116 Total improvements effected during the year 9,234 12,053 14,116 10,928 12,440 29 Summary of Sanitary Work carried out during the year 1933. Number of District. Comparative figures for 1932. 1 2 3 4 5 6 7 Totals Inspections — On complaint 128 184 126 218 194 101 98 1049 1076 House-to-house— 1. Where defects found 315 252 221 202 99 111 38 1238 1163 2. Where no defects found 83 52 58 78 18 29 31 349 515 On occurrence of Infection 164 192 223 187 177 182 195 1320 1349 On Notice from builder 60 57 36 30 48 42 71 344 308 Reference from T.B. Dispensary 2 5 4 ... 2 1 ... 14 27 Market Inspection 14 13 13 13 14 9 12 88 88 Factories 2 18 12 12 25 5 5 79 68 Workshops 5 3 12 5 10 4 5 44 35 Workplaces 11 6 56 6 6 6 1 92 49 Butchers' premises 2 1 16 2 17 11 1 50 59 Fish premises 30 25 22 43 37 38 23 218 175 Common Lodging Houses 9 ... 57 ... 8 36 36 146 Food premises (restaurants, etc.) 41 5 42 10 42 13 7 160 132 Milk premises 47 106 75 18 64 67 18 395 215 Offensive businesses ... ... 20 2 ... ... 4 26 7 Ice Cream premises 16 37 37 15 12 33 4 154 93 Bakehouses 28 6 17 19 20 4 8 102 108 Outworkers' premises 26 12 13 6 18 32 ... 107 69 Miscellaneous inspections 180 314 357 206 231 376 527 2191 1116 Total inspections 1163 1288 1417 1072 1042 1100 1084 8166 6652 Re-inspections, Calls, etc. 2377 2284 3019 2651 2243 2198 3333 18105 17284 Smoke observations 1 5 ... ... 3 1 9 19 14 Notices Served — Intimation 483 452 479 499 318 283 234 2748 2623 Statutory 69 162 167 201 54 87 37 777 687 Housing Act ... ... ... ... ... 17 1 18 10 Metropolis Management Act . . 2 4 15 9 "5 15 25 75 55 Premises in respect of which notices were complied with 554 437 511 528 374 383 329 3116 2990 Premises in respect of which works in compliance with notices served during the year 1933 were outstanding at the end of the year 56 58 38 40 29 33 25 279 245 Description of Sanitary Improvements effected during the year- Number of rooms, cleansed 767 949 835 777 532 456 201 4517 4340 Defective roofs repaired 82 104 67 75 43 68 34 473 563 Gutters or rainwater pipes provided or repaired 98 96 95 55 24 38 21 427 351 Dampness abated 53 75 151 79 58 65 21 502 429 Yards and forecourts paved or paving repaired 82 48 138 42 46 39 72 467 359 Water Fittings repaired 23 16 16 27 9 13 13 117 94 30 Summary of Sanitary Work—continued. Number of District. Comparative figures for 1932. 1 2 3 4 5 6 7 Totals Sinks and waste-pipes renewed or repaired 124 101 61 113 50 84 69 602 467 Drains entirely reconstructed ... 2 7 4 16 6 56 91 86 Drains partially reconstructed 19 7 12 11 8 22 21 100 93 Drains unchoked and cleansed 21 13 30 26 18 22 9 139 143 Soil and vent pipes renewed or repaired 12 2 28 11 12 19 35 119 97 Gullies provided, unchoked, etc. 15 13 20 10 29 29 112 228 201 Manholes, chambers, fresh-air inlets, etc., provided or repaired 23 12 25 17 30 20 76 203 195 Premises in which repairs were effected to w.c's. 162 282 383 179 101 190 169 1466 1220 Dustbins provided 56 53 97 60 101 60 36 463 458 Repairs effected to windows, sashes, etc. 143 106 177 150 73 106 25 780 551 Repairs to stoves coppers and flues 37 159 207 108 48 76 23 658 470 Repairs to stairs, doors, etc. 39 41 125 36 8 37 14 300 201 Repairs to floors 21 80 101 52 28 38 14 334 256 Fish shops limewashed 17 11 9 29 12 21 21 120 91 Bakehouses limewashed 12 4 8 13 1 2 6 46 49 Ventilation and lighting improved 24 6 6 29 1 42 2 110 71 Offensive accumulations removed 8 5 24 5 ... ... 3 45 35 Miscellaneous repairs and improvements effected 11 6 36 29 20 14 17 133 108 Total repairs and improvements effected 12440 10928 Reference to Districts. District No. Inspector. Wards (approximate) 1 Inspector Mayo Deptford Park (part) and Clifton Wards. 2 ,, Webster Evelyn and Deptford Park (part) Wards. 3 „ Gregory St. Paul's (part) and St. John's (part) Wards. 4 ,, Hewett Vale and St. Paul's (part) Wards. 5 ,, Green Canterbury and Hatcham (part) Wards. 6 ,, Wilton Hatcham (part) Pepys and St. Catherine's Wards. 7 ,, Mason St. Peter's, St. John's (part) and Town Hall Wards. 31 House-to-House Inspections. 1,587 house-to-house inspections were made. These inspections were carried out in the following streets:— Abinger Road Achilles Street Addey Street Alverton Street Amersham Vale Berthon Street Bestwood Street Blackhorse Road Blockhouse Street Bolden Street Brookmill Road Childeric Road Childers Street Chipley Street Corston Street Creek Street Dorking Road Douglas Street Evelina Road Fawcett Road Foxwell Street Frankham Street Haydock Road Idonia Street Leonidas Street Martha Place Martin's Buildings Mason's Cottages Milton Court Road Octavius Street Payne Street Reculver Road Reginald Road Reginald Square Rudford Road St. Donatt's Road Sanford Street Shere Road Somerville Road Tolhurst Street Trundley's Road Wotton Road Legal Proceedings. The following is a full list of legal proceedings instituted daring 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. 1933 £ s. d. £ s. d. April 27 No sanitary convenience at Factory, 407J New Cross Road. - 6 6 0 Proper sanitary conveniences provided. Mav 11 „ 25 June 1 Non-compliance with statutory notice served in respect of— 143 Silwood Street. - 2 2 0 Order made for work to be carried out within 7 days. „ 1 39 Baildon Street - 2 2 0 Works completed before hearing. 1 No dustbin Do. 5 0 costs included above Dustbin provided before hearing. Oct. 4 Non-compliance with statutory notice served in respect of— 78 Upper Brockley Road - 2 2 0 Order made for work to be carried out within 7 days. 24 Non-compliance with Magistrate's Order made in respect of above 1 0 0 2 2 0 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 from the Borough Engineer, and the following is the text of a Report to the Council Extermination of Rats. "Acting in conjunction with other local authorities, during the week ended 11th 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. It was not found necessary to apply to the Court for 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. Six samples were taken in 1933. 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 91 premises was entirely reconstructed during the year, in 100 instances partly reconstructed, and in 139 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 1933. 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. The main and permanently paved roads are swept by motor machine broom early each morning. Motor street watering machines are used for street watering and flushing courts and alleys. Street gullies are cleansed by a motor vacuum gully emptier. House Refuse. Storage, except for approximately 82 covered ashpits, is effected in movable ash-bins. Removal, weekly as a rule, but twice 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, together with, towards the end of the year, the use of one internal loading vehicle. Disposal is effected, under contract, by barge to Rainham. c 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 284 new premises could be properly granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. No certificates were applied for in connection with the above. Canal Boats. The following is the text of the Annual Report of the Canal Boats Inspector:— To the Medical Officer of Health. Sir, I beg to report that during the year ended 31st December, 1933, 14 visits were made, on the following dates:— February 3rd and 23rd; March 22nd and 28th; April 19th; May 25th; June 21st; July 5th and 27th; September 18th; October 20th; November 15th; and December 22nd and 29th. 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:— Inspections. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories 105 5 1 Workshops 146 18 - Workplaces 1069 31 - Total 1320 54 1 The types of premises inspected were as follows:— Type. Factories, Number. Workshops, Number. Workplaces, Number. Bakehouses 18 29 Chemical Works 3 3 Cinemas, etc. 1 7 Dressmakers, Milliners, etc. 11 8 Engineering, general 35 2 ,, motoring 8 8 3 Foundries 5 Food preparation 17 2 406 Glass bottle makers 1 Laundries, Cleaners, etc. 5 4 Marine Stores 4 6 Paint and Varnish Works 3 Printers 4 1 Shoeing Forges 2 Stables, etc. 74 Sawmills 7 Timber Stores 2 13 Tar Refiners 2 Tailors 2 4 6 Woodwork, Joiners, etc. 15 4 Woodchoppers 5 5 5 Whitening Manufacturers 3 Miscellaneous 66 55 66 Totals 199 137 594 C2 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 29 24 - - Want of Ventilation 1 1 - - Overcrowding - - - - Want of Drainage of Floors - - - - Other Nuisances 36 35 - - Sanitary Accommodation Insufficient 1 1 - 1 Unsuitable or defective 13 13 - - Not Separate for Sexes - - - - Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bake house (sec. 101) - - - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - - - - Other Offences (excluding offences relating to outwork) - - - - Total 80 74 - 1 The number of inspections made to Home Workers' Dwellings was 107. 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 estimated population 102,800 persons, giving an over-all density of 66 persons per acre. Much of the property is old and exhibits the inherent structural defects associated with age. The unsatisfactory housing conditions are further aggravated by the use, without special adaptation, of most of the houses for two or more tenants. The major problem that faces us is the question of overcrowding which continues in an acute form, and for which no solution has been found. It might be thought that, as the population as revealed by the last census figures showed a decrease, overcrowding would gradually find a natural solution. Any improvement from this cause is negatived by the increase in the number of families. During the last decennium this increase amounted to 4.5 per cent., and there is now a total excess of 11,498 private families over occupied buildings. It can be seen, therefore, how far we are from attaining the ideal standard of one family to each house. Nor is there any sign of probable improvement in the immediate future. The subsidy in respect of the re-housing of overcrowded families is limited only to those living in "improvement" and "clearance" areas, a very small proportion of the total. It ignores entirely the relief of overcrowding in the case of hundreds of families living more than three persons per room in houses above the standard suitable for inclusion in a clearance scheme. To relieve these we are now largely dependent upon private enterprise—stimulated by Government guarantee against loss in the case of building societies, etc.—to erect houses for letting. Experience seems to point, however, to the fact that houses built by private enterprise are practically entirely built for sale. Thus amongst a total of 143 structurally separate flats and houses built by private enterprise in Deptford during 1933, only 14 were built to let. The general alleviation of overcrowding by this means would appear to be purely illusory and, indeed, there is a possibility (if not a probability) that conditions may get worse for, with the flow of time, families grow more numerous and larger, their children older, and overcrowding more inevitable. 39 Individual unfit houses and underground sleeping rooms received further attention during the year, and the following additional Representations were accordingly made:— Individual Dwelling-Houses. Number of houses. Approximate Population. 2 10 Parts of Buildings Separately Let. Number. Approximate Population. 2 5 Underground Sleeping Rooms. Number of Rooms. Approximate Population. 1 1 In accordance with the requirements of the Ministry of Health, the following Table is appended:— 1. Unfit Dwelling-Houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6509 (b) Number of inspections made 6612 (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925 1587 (b) Number of inspections made for this purpose 1587 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those in (3) found not to be in all respects reasonably fit for human habitation 2694 *2 Parts of houses separately let. 2 Individual houses. 1 Underground sleeping room. 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) 2101 40 3. Action under Statutory Powers. (A) Proceedings under Secs. 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 18 (2) Number of dwelling-houses which were rendered fit after service of formal Notice:— (a) By owners 18 (b) By Local Authority in default of owners (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) 777 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices:— (а) By owners 707 (b) By Local Authority in default of owners (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 3 (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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit The following is a record of the action taken in respect of the balance of the Representations made by me up to the 31st December, 1933 :— Houses or parts of bouses. Dwelling-houses upon a Clearance Area in respect of which Demolition Orders were made 11 Dwelling-houses represented upon a Clearance Area subsequently included by the London County Council in larger area 17 41 Houses or parts of houses. Undertakings accepted in respect of individual dwelling- houses 4 Undertakings accepted in respect of tenements or underground rooms 6 Part of house separately let—Whole house subsequently vacated, and conditions effectively remedied by owner 1 Individual house represented in 1932—No action by Council 1 Parts of houses represented in 1933, but not dealt with until 1934 2 The London County Council provide accommodation upon their various estates, for families from Deptford, and the following figures indicate the number of families for whom provision was made in 1933 :— Families accommodated:— (а) Preferentially on recommendation of the Borough Council 123 (b) From the London County Council general list 251 374 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. I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 29 applications for registration (including 16 transfers) in respect of premises were granted during the year. At the end of the year there were 163 premises registered for the sale of milk. In addition to the above, 74 persons were registered for the sale of unopened bottled milk only, and 25 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. Bottling of milk is carried out at 23 premises. There are no cow-houses in the Borough. During the year 395 inspections of milk shops were made. Many minor matters were remedied as the result of verbal intimation by the Inspectors. The following is a tabular statement of the visits made by Mr. Yates Food Inspector:— No. of Visits. Market inspection 89 Food premises (Restaurants, etc.) 403 Fish premises 140 Slaughterhouses 210 Butchers' premises 1388 Miscellaneous 76 St. George's Wharf 130 Calls (Stalls, etc.) 1374 3810 45 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. One ,, ,, Grade " A " (Tuberculin Tested) Milk at one shop. One ,, ,, Pasteurised Milk at or from nine shops. One retailer whose premises are outside the Borough to sell Pasteurised Milk within the Borough. One retailer whose premises are outside the Borough to sell Grade "A" (Tuberculin Tested) Milk within the Borough. Bacteriological Examination of Milk. Twenty samples of Milk were examined bacteriologically with the following results:— Designation. Total Count in 1 cc. Coliform Bacillus. Grade "A" Tuberculin Tested 2,900 „ „ „ 3,100 „ „ „ 406,000* „ „ „ 19,600 Present in 1 /100th cc. „ „ „ 32,900 ditto „ „ „ 6,200 „ „ „ 3,000 „ „ „ 5,900 „ „ „ 44,700 „ „ „ 28,600 „ „ „ 3,600 Pasteurised 6,000 „ 9,800 „ 53,600 „ 4,126 „ 3,370 „ 107,000* „ 27,100 Raw Milk 15,700 „ 6,360 * This sample showed a microbic content above the Standard. 46 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-five 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, 210 visits having been paid. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 240 bullocks. 56 calves. 1834 sheep. 146 pigs. The Borough Council has licensed 7 slaughtermen in connection with these premises. {b) Poultry Slaughterer. There is one poultry slaughtering establishment. During the year 9,019 head of poultry were slaughtered. Destroyed—Surrendered at Slaughterhouses. Beef, 2 forequarters, and 1 cwt. 2 qrs. 16 lbs. Bullocks' head and tongue 3. Bullock (entire) 1. Bullocks'plucks 2. Bullocks'kidneys 1 set. Bullocks' livers 43. Bullocks' lungs 3. Bullocks' offal 5 sets. Pigs' lungs 5. Pig (entire) 1. Pigs' plucks 7. Pigs' livers 4. Pork 1 leg and 14 lbs. Sheep's lungs 7. (c) Shops and Stalls. The following Food Stalls are registered Fruit, Vegetables 44 Meat 2 Ice Cream and/or Baked Grocery 7 Chestnuts 19 Refreshments Coffee Stalls 6 Proprietary Medicines 1 Fish and/or Poultry 6 Regular inspection is carried out, particularly at such times as business is being actively carried on. 47 (d) 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. 94 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. 66 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 Fish Shops and Fish Curers. The number kept under observation during the year was 45. 358 inspections were made, 180 Notices were served for cleansing, and 8 for general matters. (d) Ice Cream Premises. There were 162 separate premises recorded. To these, 154 visits were paid. Many verbal intimations were given regarding minor matters. (e) Other Premises. There are 194 miscellaneous premises connected with food preparation or sale, and 1,951 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. 48 During the year 1933, large quantities of foodstuffs were imported at the Wharf, and the following is a summary of the work done:- Description. Weight. Examination. Remarks. Preserves 5,090 cases 10 per cent. „ 500 „ Overside Chocolate 2 „ 10 per cent. Tinned Vegetables - 279 „ 10 per cent. Figs 1,650 „ 10 per cent. „ 1,340 „ Overside Condensed Milk 26,994 „ 10 per cent. „ „ 95,760 „ Overside Packet Soup 1,695 „ 10 per cent. Malt Extract 200 „ 10 per cent. Eggs 89 „ 10 per cent. Fresh Fish 13 „ 10 per cent. Flour 2,843 „ 10 per cent. „ 12,847 „ Overside Sausage Casings 15 „ 10 per cent. Tinned Fish 460 „ 10 per cent. Lentils 30 bags 10 per cent. Casein 833 „ 10 per cent. Fruit Pulp 10,496 cases 10 per cent. „ 1,413 „ Overside „ 41 „ Thorough. Destroyed. Bacon 16 tons 10 per cent. Tomato Juice 100 cases 10 per cent. Cream Wafers 33 „ 10 per cent. Cheese 102 „ 10 per cent. Cider „ barrels 10 per cent. Flour Foods 1,597 cases 10 per cent. Honey 6 „ 10 per cent. Confectionery 249 „ 10 per cent. Beans 882 „ 10 per cent. Coffee 110 „ 10 per cent. „ 2,072 „ Overside 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. 49 The following quantities of food were voluntarily surrendered during the year:— Meat Game Beef, 2 forequarters Rabbits, 32 Beef, 1 cwt. 2 qrs. 14 lbs. Bullocks' livers, 43 , , Bullocks' lungs, 3 Apples 6 cwt. 3 qrs. Bullocks' plucks, 2 Pears' 4 c,wt 3 q,rs' Bullocks' offal, 5 sets Oranges, 1 cwt. 1 qr. Bullocks' heads and tongues, 3 Black currant „ Bullock (entire), 1 „ ,, 2 tons 15 cwt. 2 qrs. Bullocks' kidneys, 1 set Vegetable Pigs (entire), 2 Mushrooms, 6 baskets Pigs' plucks, 7 Tinned Food Pigs' livers, 4 Condensed milk, 50 tins Pork, leg, 1 Cream, 10 tins Pork, 12 lbs. Gooseberries, 9 tins Sheep's lungs, 14 sets Mixed Fruit, 43 tins. pisj1 Pilchards, 19 tins Haddocks, 14 lbs. PineaPPle. 221 tins Dabs, 70 lbs. Peas, 38 tins Pears, 5 tins Fowl Salmon, 460 tins Chickens, 11 Tomatoes, 9 tins Turkeys, 2 III. Food Poisoning. The following is an- analysis of the notifications received, grouped according to the causal agent:— Food. No. of cases. Tinned Crab 1 case Ham 1 ,, Fried Fish 2 ,, Meat Pie 1 „ Fish Paste 1 ,, Pork and Rabbit 1 ,, Fish 1 ,, (Uncertain) 5 ,, In addition to a copy of each certificate being forwarded to the County Medical Officer, information, in respect of cases of general interest as affecting the Metropolis as a whole is also transmitted to him. D 50 IV. Food Sampling. In addition to the usual routine procedure by which food samples are obtained, sampling of milk is also carried out 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 are ascertained, while the school supplies are investigated for the presence of tubercle and for chemical content. Occasional examination for tubercle is also made of milk coming direct to one of the railway stations. Frequency of Sampling.—A total of 500 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 1933:— Total. Number Adulterated. Percentage of samples adulterated. Formal samples 380 3 0.8 % Informal samples 120 4 3.3 % Total 500 7 1.4 % The adulteration in respect of samples submitted for analysis during the previous seven 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 1932 500 1.4 I he following is a statement of the samples purchased and submitted for analysis during 1933. 51 Food and Drugs (Adulteration) Act, 1928. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. formal Samples— Barley 1 .. 1 .. Beef, Minced 1 .. 1 .. Boric Acid 1 .. 1 .. Butter 24 .. 24 .. Cheese 2 .. 2 .. Christmas Pudding 3 .. 3 .. Coconut, desiccated 1 .. 1 .. Coffee 5 .. 5 .. Cream 1 .. 1 .. Curry Powder 1 .. 1 .. Dripping 2 .. 2 .. Faggots 1 .. 1 .. Fat, cooking 1 .. 1 .. Fruits, dried 1 .. 1 .. Fruits, crystallised 1 .. 1 .. Ginger, ground 1 .. 1 .. Ginger, crystallised 2 .. 2 .. Jam 1 .. 1 .. Lard 2 .. 2 .. Lysol, B.P. 2 .. 2 .. Lysol Solution 1 .. 1 .. Margarine 4 .. 4 .. Milk 242 .. 242 .. Mincemeat 4 .. 4 .. Mustard 2 .. 2 .. Oil, frying 1 .. 1 .. Olive Oil 1 .. 1 .. Paraffin, liquid medicin'l B.P. 1 .. 1 .. Parrish's Food, B P. 4 2 6 33.3 ,, special formula 2 .. 2 .. Peas, dried 1 .. 1 .. Pepper 5 .. 5 .. Rice, ground 1 .. 1 .. Sausage, beef .. 1 1 100.0 Sausages 7 .. 7 .. ,, Preserved 5 .. 5 .. Sa\eloy 1 .. 1 .. Spirits 16 .. 16 .. Spice, mixed 1 .. 1 .. Sweets 3 .. 3 .. Veal, ham & chicken roll 2 .. 2 .. Vinegar 11 .. 11 .. ,, Malt 2 .. 2 .. Wine, non-alcoholic 5 .. 5 .. Zinc Ointment 1 .. 1 .. Total Formal Samples 377 3 380 0.8 Informal Samples-— Beans, baked,inTomatosauce 1 .. 1 .. Boracic Ointment, B.P. 1 .. 1 .. Borax, B.P. 1 .. 1 .. Bread 1 .. 1 .. Butter 10 .. 10 .. Cake 12 .. 12 .. Carried forward 26 26 D2 52 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Brought forward 26 26 Informal Samples— contd. Cheese 1 .. 1 .. Chicken & Ham roll 1 .. 1 .. Chocolate 2 .. 2 .. Chocolate Easter Egg 6 .. 6 .. Chocolate Mice 1 .. 1 .. Chocolate Walnut 1 .. 1 .. Cod Liver Oil & Malt Extract 1 .. 1 .. Coffee 1 .. 1 .. Cream 2 .. 2 .. Cream, tinned 4 .. 4 .. Curry Powder 1 .. 1 .. Custard Powder 1 .. 1 .. Fish Paste 2 .. 2 .. Gentian, Concentrated Compound Infusion of 1 .. 1 .. Herrings in Tomato Sauce 2 .. 2 .. Jam 3 .. 3 .. Liquorice Powder, Compound B.P. 1 .. 1 .. Linseed, crushed, B.P. 1 .. 1 .. Lard 1 .. 1 .. Lemonade Powder 1 .. 1 .. Lysol, BP 1 .. 1 .. Margarine 4 .. 4 .. Meat Pastes 4 .. 4 .. Milk, Condensed 1 .. 1 .. Milk, dried 4 .. 4 .. Mint, dried 1 .. 1 .. Mushrooms 2 .. 2 .. Mustard 3 .. 3 .. Olive Oil, B.P 2 .. 2 .. Ox Tongue Paste 1 .. 1 .. Peas, tinned 1 .. 1 .. Paraffin, liquid medicin'l B.P. 1 .. 1 .. Parrish's Food, B.p. 1 1 2 50.0 Peas 3 .. 3 .. Peas, tinned 1 .. 1 .. Pepper 2 .. 2 .. Quinine Sulphate, B.P. 1 .. 1 .. Sardines 1 .. 1 .. Sausages 7 3 10 30.0 Sausages, preserved 1 .. 1 .. Sausage Roll 1 .. 1 .. Sild in Tomato 1 .. 1 .. Sugar 4 .. 4 .. Sweets 1 .. 1 .. Tartar, Cream of, B.P. 1 .. 1 .. Tomato Sauce 1 .. 1 .. Veal Brawn 1 .. 1 .. Vinegar 1 .. 1 .. Wine, non-alcoholic 2 .. 2 .. Zinc Ointment 1 .. 1 .. Total Informal samples 116 4 120 3.3 53 Action Taken in regard to Formal Samples Purchased during the Year 1933. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 232 Y Parrish's Food, B.P. Deficient in Iron, about 7 per cent. - Vendor cautioned 235 Y Parrish's Food, B.P. Deficient in Iron, about 73 per cent., and in Tricalcium Phosphate about 44 per cent. — 3 3 0 Summons dismissed on payment of costs 277 Y Beef Sausage Sulphur Dioxide, 110 parts per million. — - Vendor cautioned Action Taken in regard to Informal Samples. Sample No Article Particulars of Adulteration or Infringement. Action taken. 192 Y Sausages Sulphur Dioxide, 110 parts per million. Formal samples purchased 193 Y Sausages Sulphur Dioxide, 140 parts per million. Do. do. 198 Y Sausages Sulphur Dioxide, 150 parts per million. Do. do. 230 Y Parrish's Food Deficient in Iron, about 8 per cent. Do. do. 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. The preparation in question, however, does not come within the definition of " Artificial Cream." 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. Misdescription or Misrepresentation or Improper Labelling. Under the Agricultural Produce (Grading and Marking) Act, 1928, various Regulations, and under the Merchandise Marks Act, various Orders in Council have been made. Tradesmen have been circularised as co their duty thereunder. Verbal intimation of infringements was given in a few instances where foods, the subject of marking Orders, were found to be imperfectly marked. 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 1933. INCIDENCE AND MORTALITY BY AGE GROUPS. Notifiable Disease At all Ages Total Cases Notified. At Ages—Years Total Cases Removed to Hospital Total Deaths Deaths at Ages—Years Under 1 1 to 5 5 to 15 15 to 25 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 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 236 3 72 121 22 13 5 .. 235 5 .. 3 2 .. .. .. .. Erysipelas 90 3 3 5 5 31 30 13 51 .. .. .. .. .. .. .. .. Scarlet Fever 732 6 217 419 59 27 4 .. 720 .. .. .. .. .. .. .. .. Typhus Fever . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. 1 1 .. .. 2 1 .. .. .. .. 1 .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 4 .. .. .. .. 4 .. .. 4 6 .. .. .. .. 6 .. .. Puerperal Pyrexia 15 .. .. .. 4 11 .. .. 13 3 .. .. .. 3 .. .. Cerebro-Spinal Meningitis 6 1 2 .. 1 1 1 .. 6 2 1 1 .. .. .. .. .. Poliomyelitis and Polioencephalitis 1 .. 3 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Knceplialitis Lethargica . . .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 2 .. Ophthalmia Neonatorum 8 8 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 23 15 8 .. .. .. .. .. .. 15 13 2 .. .. .. .. .. * Acute Primary and Acute Influenzal Pneumonia 157 2 6 12 24 48 44 21 63 84 9 11 .. .. 4 27 30 Malaria 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Fox 156 12 42 90 9 3 .. .. 3 .. .. .. .. .. .. .. .. Posterior Basal Meningitis 1 1 .. • • .. .. •• .. 1 .. .. .. .. .. .. .. .. Totals 1432 51 351 647 125 139 85 34 1100 118 23 17 5 14 29 30 * 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 4th quarter Total for year Diphtheria 72 48 50 66 236 Erysipelas 20 31 20 19 90 Scarlet Fever 129 136 169 298 732 Enteric Fever ... ... . . . 2 2 Puerperal Fever 1 1 1 1 4 Puerperal Pyrexia 3 2 6 4 15 Cerebro-spinal Meningitis 3 1 1 1 6 Poliomyelitis . . . ... 1 ... 1 Ophthalmia Neonatorum 2 3 1 2 8 Infantile Diarrhoea, etc. ... 6 13 4 23 Acute Primary and Influenzal Pneumonia 104 25 8 20 157 Chicken Pox 87 32 27 10 156 Malaria 1 ... ... ... 1 Posterior Basal Meningitis ... ... ... 1 1 Totals 422 285 297 428 1432 Scarlet Fever. Year No. of Cast s 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 1933 732 7.1 — 0.0 Scarlet Fever, during 1933, showed a very considerable increase. The cases were mainly mild, and there were no deaths. 58 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1933. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Deptford Park Evelyn St. Paul's Vale Clifton Canterbury Hatcham Pepys St. Catherine's St. Peter's St. John's Town Hall Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 236 10 32 28 31 13 23 42 8 20 7 12 10 Erysipelas 90 5 10 15 5 5 10 7 7 8 5 6 7 Scarlet Fever 732 51 83 121 92 60 50 48 37 38 20 62 70 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. 1 .. .. .. .. .. 1 .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 4 .. 3 .. .. .. .. 1 .. .. .. .. .. Puerperal Pyrexia 15 1 4 .. 3 2 .. .. .. 1 1 1 Cerebro-Spinal Meningitis 6 .. 3 1 1 .. .. 1 .. .. .. .. .. Poliomyelitis and Polioencephalitis 1 1 .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 8 1 2 .. 1 .. 2 1 .. .. 1 .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 23 2 2 14 2 .. .. .. .. .. .. .. 3 Acute Primary and Acute Influenzal Pneumonia 157 10 26 17 12 13 11 18 7 10 3 9 21 Malaria 1 .. .. .. 1 .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 156 5 11 22 9 34 12 30 2 1 6 12 12 Posterior Basal Meningitis 1 .. .. .. .. .. .. .. 1 .. .. .. .. Totals 1432 86 176 218 157 128 108 148 62 79 43 103 124 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 1933 236 2.3 5 2.1 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 1933 5 4 — 9 32 1 97 Number of Schick Re-tests. Positive. Negative. Unknown Result. Total. 1927 — - - - 1928 34 134 13 181 1929 8 „ 3 66 1930 5 39 1 45 1931 3 21 2 26 1932 2 15 — 17 1933 1 — — 1 In all cases where a full immunizing course has been given, parents are requested to bring their children for the purpose of having a Schick re test carried out. The response to this request leaves much to be desired. 60 Small-pox. 1933—Nil. 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 1932 172 1930 445 1933 156 1931 152 Anthrax. Following upon the occurence of a case of Anthrax in the Borough of Southwark, it was ascertained that the patient had been last employed at a brush-making establishment in this Borough. Samples of hair and brushes from this workshop were examined bacteriological, and anthrax spores were detected in connection with the following:— 27 bundles of unwashed Chinese horsehair. 22 large bundles of dressed Chinese horsehair. The consignment was destroyed. 61 Return made on or before the 9th of February, 1934, by Mr. E. S. Elliott, Vaccination Officer, respecting the vaccination of children whose births were registered' from 1st January to 31st December, 1932, inclusive : — Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1932. Number of these Births duly entered by 31st Jan., 1934. No. ot births which on 31st Jan. 1934 remained unentered in the Vaccination Register on account of— No. of these births remaining on 1st Jan., 1934 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1933. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1933. 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 702 230 4 — 264 30 14 2 45 113 - - South Deptford 487 224 4 - 186 17 7 6 23 20 - - Total 1189 454 8 — 450 47 21 8 68 133 593 407 Dated, February 7th, 1934. Successfully vaccinated after the declaration of conscientious objection, 2. Total Number of Certificates for Year 1933 sent to other Vaccination Officers, 59. 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 1933 Cases 3 3 2 4 4 2 1 5 7t Deaths 1 .. 4 2 2 4 5 2 f Including one case of Posterior Basal Meningitis. 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 1933 Cases 4 3 114.131 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 1933 Cases 9 8 3 3 3 . . 1 Deaths 5 2 2 2 1 . . 2 2 All cases are periodically re.visited and treatment offered. 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 1933 157 84 0.8 63 Malaria. Since the 1st January, 1928, Malaria, induced therapeutically, is notifiable if liable to recur. Average Average 1920.1924 1925.1929 1930 1931 1932 1933 Cases 8 4 2 . 1 1 No deaths have been registered from this cause. Dysentery. The figures are as follows:— Average Average 1920.1924 (total) 1925.1929 1930 1931 1932 Cases 3 2 . 5 Deaths . 0.4 Infantile Diarrhoea. 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 Average 1920.1924 1925.29 1930 1931 1932 1933 Cases Notified 66 75 12 26 37 23 Deaths 28 15 17 9 23 15 All cases of Infantile Diarrhoea are investigated by the Health Visitors with the object of securing nursing assistance or hospital trsatment 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 1933 4 6 3.8 From 1933 onwards, the death.rate is calculated per 1,000 total (live and still) births. 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 1933 Cases 5 16 12 6 10* 17 17 15 * Includes one subsequently notified as Puerperal Fever and dealt with under that heading. Of the 15 cases notified, 11 had been confined in hospital and 4 at home. Of the latter, 2 were subsequently sent to hospital, in one case after consultation with the Council's Consultant. Of the total cases, three died, death being due to septic endometritis in two instances. In the third case confinement occurred at 6½ months, aggravated by pulmonary tuberculosis. 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 1933 Cases 14 9 18 14 26 21 11 8 The following is a statement of the results of treatment in respect of the cases notified in 1933:— Vision Vision Since died Notified Treated unim- im- Total other At home In hospital paired paired blindness Causes 8 8- 8 - - - 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. 65 Erysipelas. 90 cases were notified during the year. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. 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 1933. 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 Influenza since 1920:— the mortality directly attributed to 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 1933 52 4.2 0.51 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 0.01 1932 23 1.8 0.22 1933 1 0.08 0.01 66 Towards the end of the year, there were some indications that the expected epidemic had commenced. Whooping.Cough. 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 1933 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. 1 he 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 149 964 1113 Sputum for Tuberculosis 9 36 45 Blood for Enteric Fever — 3 3 Urine for T.B. — 1 1 Stool for Enteric 1 — 1 Stool for occult blood 1 — 1 Post nasal swab for Meningococcus 1 2 3 Effluent from sewer — 1 1 Swimming bath water 6 — 6 *Note.—Other examinations are reported under " Food." 67 At the Tuberculosis Dispensary, 1,013 specimens of sputum were examined. Of these, 756 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 257 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 1256 ,, ,, ,, Requests, rooms only. 87 ,, ,, ,, ,, bedding only 68 ,, ,, ,, Verminous 172 Total premises visited 1583 Number of rOoms disinfected, formalin spray 1590 „ „ ,, sulphur 331 Total 1921 Number of articles disinfected (steam disinfector) 15834 Number of books disinfected (formalin'lamp) 655 „ ,, articles destroyed at owners' request 785 Special disinfections, etc.:— Verminous furniture—Two 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 be 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, disinfection by the officers of the Borough Council, supplemented by the loan to the occupiers of a hand.spraying machine for the periodical application of an insecticide fluid. Clothing and bedding are disinfected by steam. For personal disinfestation, the Borough Council maintains a Cleansing Station and provides the services of a Cleansing Attendant. This station, by arrangement with the London County Council, is primarily used for school children. Male adults are occasionally provided with a cleansing bath in a separate structure. During the year, 26 adults and 1,858 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 1933. 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 1933 137 11.0 1.3 69 Deaths from Cancer by Sex and Age. Average, Year U Sex nder 25 years 25 to 45 years 45 to 65 years 65 to 75 years ai 75 years id 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 1933 Male 1 4 33 24 14 76 Female — 4 30 13 14 61 Total 1 8 63 37 28 137 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. M. Pulmonary. Total per 1.000 of population. Non.Pulmonary. F. M. F. Total per 1.000 of population Average 1920-1924 129 104 2.02 39 36 0.66 1925 133 104 2.04 41 37 0.67 1926 107 73 1.56 29 22 0.44 1927 112 88 1.76 30 32 0.54 1928 103 76 1.59 35 18 0.47 1929 118 89 1.86 27 20 0.42 1930 97 84 1.63 35 17 0.47 1931 104 77 1.69 19 25 0.41 1932 107 88 1.82 23 22 0.42 1933 96 73 1.64 13 15 0.27 I he 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* N on.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 0.69 0.15 0.86 0.12 1933 - — 0.91 0.10 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 1933:— 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 1st January, 1933, to the *By international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under "Pulmonary," are now included under "Non. pulmonary Tuberculosis." 73 Report of Tuberculosis Officer—continued. 31st December, 1933, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 173 ; 149 Pulmonary Tuberculosis and 24 Non-pulmonary, as compared with 176 Pulmonary and 35 Non-pulmonary for the previous year. Public Health (Tuberculosis) Regulations,' 1930. Summary of Notifications during the period from the 1st January, 1933 to the 31st December, 1933. 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 Pulmonarv— Males ... 2 1 ... 9 11 21 8 21 7 3 83 133 Females ... 2 3 2 10 12 17 10 7 3 ... 66 101 Non-Pulmonary Males ... 1 2 ... 2 ... 2 2 1 ... ... 10 12 Females ... 0 1 3 1 1 3 1 1 ... 1 14 15 74 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 ... ... ... ... ... 3 4 ... 3 2 13 „ —Females ... ... ... ... 1 1 3 1 1 ... ... 7 Non-Pulmonary—Males ... ... 1 ... ... ... ... 2 ... ... ... 3 „ —Females ... ... ... ... ... ... 1 ... ... ... ... 1 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 4 - transferable deaths from Registrar-General 4 1 Posthumous notifications 4 - "Transfers" from other areas (other than transferable deaths) 6 2 Forms C and D (admissions and discharges from Institutions) 2 1 75 Report of Tuberculosis Officer—continued. Supplemental Return—continued. Notification Register. Pulmonary Non-pulmonary Total Males Females Total Males Females Total Cases 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 362 266 628 95 98 193 821 Number of cases removed from the Register during the year, inter alia of:— 1. Withdrawal of notification ... ... ... ... ... ... 2. Recovery from the disease 9 9 18 9 7 16 34 3. Death 46 40 86 7 4 11 97 76 Report of Tuberculosis Officer—continued, Notes on Tables of Notifications. Of the cases learned of from the death returns, two were cases of non-pulmonary tuberculosis who died in hospital—one a case of general tuberculosis, and one a case of tuberculosis of the adrenale. Five were cases of pulmonary tuberculosis, on two of whom post mortem examinations were made. Of the cases notified after death, all were notified from hospital. One was a case of non-pulmonary tuberculosis diagnosed after post mortem examination; the others were cases of pulmonary tuberculosis who had been only a short time in hospital. Of the primary notifications, all but one of the non-pulmonary cases were notified from hospital. Two died of meningitis within a month of notification, one died of sacroiliac disease within two months of notification, and one died of abdominal tuberculosis within three months of notification. Of the pulmonary cases notified, seven, of whom five were hospital cases, died within a month of notification. Six, of whom two were hospiial cases, died within three months of notification. 77 Report of Tuberculosis Officer—continued. Home accommodation of 150 Cases notified in 1933 (hospital and lodging-house cases omitted). CASES and Number in Family. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Cases with T.B. in Sputum. Rooms. Cases in which t.b. not known to be present in Sputum. Rooms. 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. 2 of 1 2 of 1 2 of 2 3 of 2 3 of 2 1 of 2 1 of 2 1 of 2 4 of 2 lof 2 1 cf2 2 of 2 5 of 3 3 of 3 3 of 3 lof 3 ] of 3 lof 3 4 of 3 2 of 3 1 of 3 2 of 3 1 of 3 1 of 4 3 of 4 7 of 4 lof 4 2 of 4 5 of 4 2 of 4 3 of 4 2 of 4 3 of 4 2 of 4 1 of 4 2 of 4 1 of 4 1 of 4 4 of 5 6 of 5 6 of 5 2 of 5 2 of 5 lof 5 2 of 5 1 of 5 1 of 5 o of 6 2 of 6 lof 6 lof 6 lof 6 1 of 6 lof 6 lof 6 2 of 6 1 of 6 lof 7 lof 7 lof 7 lof 7 1 of 7 1 of 7 lof 8 lof 8 lof 8 1 of 8 lof 8 lo f8 2 of 8 1 of 8 lof 8 1 of 9 lof 9 1 of 10 lof 10 lof 10 5 of 10 lof 10 lof 12 lof 12 25 had a separate room. 15 had a separate room. 1 had separate room. 6 had separate bed with 1 other in room 1 had separate bed but 1 other in room. 1 had separate bed, but 1 other in room 9 9 2 ,, ,, 2 4 ,, ,, 2 ,, 1 3 »» »» »><-*>> 18 had another in bed. 2 , ,, 3 ,, 34 had another in bed. 5,, ,, 1 ,, 8 had another in bed. 5 ,, ,, & 1 other in room 1,, ,, 2 ,, 2 1 ,, ,, 1 ,, 1 ,,2 1,, ,, 3 ,, 2 ,, ,, 2 ,, 2 had 2 others ,, 2 ,, ,, 4 ,, 2 i, 2 ,, 1 ,, 1 had 2 others in bed. 1 ,, 3 1 ,, 2 ,, ,, 1 „ 1,, 2 ,, ,, 2 1,, 2 ,, ,, 4 ,, 2 ,, 3 ,, ,, 1,, 3 ., 4 78 Report of Tuberculosis Officer—continued. The number of deaths for the year is 104 as compared with 105 for 1932. 1931 1932 1933 Pulmonary deaths 100 92 94 Non Pulmonary deaths 14 13 10 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 1933. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non -Pulmonary m f m f m f m f 0 1 - - - 1 - - - 1 2 2 1 2 - - 1 - 5 1 3 3 1 - - — - 10 2 - 3 - 1 2 - 15 9 11 2 1 4 8 2 - 20 11 13 — 1 4 7 - - 25 24 20 2 4 7 11 - - 35 12 11 4 1 10 6 1 - 45 21 8 1 1 11 5 - 2 55 10 3 - - 12 2 2 - 65 and upwards 5 - - 1 3 2 - - Totals 96 73 13 15 52 42 8 2 Note—Including 24 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 1933. Not notified 8 Died before notification 4 Died within one week of notification 7 ,, ,, one week to one month 9 „ „ one month to three months 21 „ ,, six months to one year 10 ,, ,, one to two years 13 ,, „ two to three years 15 „ „ three to four years 2 ,, „ four to five years 3 „ „ five to six years 1 „ „ six to seven years „ „ seven years and upwards 1 94 79 Report of Tuberculosis Officer—continued. The notifications of non-Pulmonary Tuberculosis were as follows:— Meningitis 3 Genito-urinary 1 Peripheral glands 8 Skin and other organs 1 Abdominal 4 Bones and joints 11 Total 28 Revision of Notification Register. During the year 190 cases of Pulmonary and 63 cases of Non-Pulmonary Tuberculosis were removed from the Register of Notifications either as cases in which the diagnosis was not confirmed or cases which were considered "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 1933 as follows:— MALES FEMALES Total Un ider 15 Over 15 Under 15 Over 15 Pulmonary Tuberculosis 34 328 30 236 628 Non-Pulmonary Tuberculosis 57 38 61 37 193 Totals 91 366 91 273 821 Disinfection was carried out in 288 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 80 Report of Tuberculosis Officer—continued. Supervision of Contacts. Analysis of contacts of 170 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, Evelyn, Vale and St. Paul's Wards. Total T.B. Positive T.B. Negative Non-Pulmonary No. of patients notified 170 89 59 22 No of above seen at Dispensary 103 64 34 5 Total contacts of cases seen at Dispensary— Adults 224 144 70 10 Children 127 75 43 9 No. of above contacts examined at Dispensary— Adults 47 37 10 — Children 60 37 14 9 No. of notified cases not seen at Dispensary 67 25 25 17 Total contacts of above- Adults 122 46 34 42 Children 37 12 6 19 No. of above contacts examined at Dispensary - Adults 14 8 6 — Children 13 6 4 3 Total School Contact Cards sent to School Medical Officer 117 (a) Classified as examined at Dispensary— Class 1* 18 Class 2* 47 (b) Classified as not examined at Dispensary— Class 3* 52 *Class 1—Unsatisfactory cases. *Class 2—Apparently healthy cases. *Class 3—Not examined. Approximately sixty per cent, of the cases notified, excluding those notified after death, were seen at the Dispensary before the end of the year. Probably many of the remainder will be seen during the present year; these latter being cases notified late in the year under report or patients who were sent direct to 81 Report of Tuberculosis Officer—continued. torium from some other institution and who will attend Dispensary on discharge. Similarly as regards contacts ; several contacts of cases notified late in the year attend in the early part of the following year and are not therefore included in the table dealing with the examination of contacts of cases notified during the year. 27 % of the total contacts were examined before the end of the year. 47% of the child ,, ,, ,, 17 % of the adult ,, ,, ,, Of the contacts of cases seen at the Dispensary, approximately 30 per cent, of the total and 50 per cent, of the child contacts were examined. Of the contacts of cases not seen at the Dispensary 17 per cent, of the total and 30 per cent, of the child contacts were examined. From the above figures it is evident that where the original case comes directly under the Dispensary organisation, contacts are more readily persuaded to attend for examination. It is of interest to note that the number of child contacts is much smaller than the number of adult contacts, approximately 30 per cent, of the total. Figures for previous years show a similar percentage. The Tuberculin Testing of child contacts of tuberculosis 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 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. F 82 Report of Tuberculosis Officer—continued. Age 1-2 Group Age 2—5 Group Age 5—12 Group Age 12—15 Group Not known to be contacts Contacts of T.B. — cases Contacts of T.B. + cases Not known to be contacts Contacts of T.B.— cases Contacts of T.B. + cases Not known to be contacts Contacts of T.B. cases Contacts of T.B. + cases Not known to be contacts Contacts of T.B.- cases Contacts of T.B. + cases Test not completed - 1 but Neg. to 2 doses - 1 3 3 2 2 3 1 - 1 Negative - 2 1 10 6 2 12 13 5 2 2 1 Positive - — 4 2 1 4 4 5 13 2 2 7 In this group one of the children who had abnormal signs in one lung and one in whom no abnormal signs were detected (both T.B. + contacts and + reactors) showed definite X-ray evidence of tuberculosis. One negative reactor was contact of a case in which sputum was found -)- only by concentration method of examination. One child in this group, age 4, a contact of a T.B. + case and + reactor, showed definite X-ray evidence of disease. One T.B. + contact a + reactor to a small dose showed X-ray evidence of old disease. Two + reactors to small doses in this group showed X-ray evidence of old disease. 83 Report of Tuberculosis Officer—continued. Memo 37/t. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1933. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children. 1 M. j F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 63 47 — 2 5 6 2 4 68 53 2 6 129 393 (b) Diagnosis not completed — - - - - - - - 11 8 4 2 25 (c) Non-tuberculous ... — — — — — — — — 75 91 37 36 239 1 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 — 2 1 — — — 1 1 — 2 2 51 213 (b) Diagnosis not completed - - - - - - - - 2 1 4 5 12 (c) Non-tuberculous - - - - - - - - 32 60 52 52 196 C.—Cases written off the Dispensary Register as (a) Recovered 3 5 3 1 1 — 2 5 4 5 5 6 20 484 (b) Non-tuberculous (including any such cases previously diagnosed and enter on the Dispensarv Register as T.B.) - - - - - - - - 111 163 97 93 464 D.— Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 232 173 16 22 30 33 31 28 262 206 47 50 565 596 (b) Diagnosis not completed - - - - - - - - 10 7 6 8 31 84 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 632 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 23 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 108 4. Cases written off during the year as Dead (all causes) 73 5. Number of attendances at the Dispensary (including Contacts) 3131 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 165 Number of G.P. 36 reports from practitioners 171 7. Number of consultations with medical practitioners:— (a) Personal 22 (b) Other 105 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 220 9. Number of visits by Nurses or Health Visitors to Homes successful 3416 for Dispensary purposes unsuccessful 675 4091 Visits to cases non-Dispensary cases successful 1697 unsuccessful 382 2079 10. Number of (a) Specimens of sputum, &c, examined 756 (b) X-ray examinations made in connection with Dispensary work 164 (c) Sputum examinations for sary cases 257 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(&) above 3 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 325 Notes on Table I. It will be noted that the number of persons on the Dispensary Register on the 31st December, 1933 is 596, a slight decrease over figure at end of 1932. This is largely due to the number of patients coming into the Borough from other areas and of cases which 85 Report of Tuberculosis Officer—continued. bad been lost sight of and returned to the Register, being 23 as compared with 55 in the previous year and to "Transfers to other areas" and "Cases lost sight of" being 108 as compared with 79 in 1932. 73 deaths of Dispensary patients occurred, compared with 67 in the previous year. Two patients had Ultra-violet ray treatment, one for lupus and one for tuberculous disease of the larynx. Twenty-five patients have had artificial pneumothorax treatment, making in all 379 attendances as compared with 160 in 1932. 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 41 compared with 51 in 1932. 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 to 17 patients were as follows:— £ s. d. Total cost of dentures and repairs 54 9 0 Total cost of free cases 21 0 2 Contributions from Approved Societies 7 18 0 „ Public Assistance mittee 18 2 4 „ Red Cross Society 4 0 0 „ Patients 2 8 6 „ Voluntary sources 1 0 0 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. 41 221 117 13 17 102 25 8 Insured Persons. The number of insured persons on the Dispensary Register at the end of the year was 304. The number of reports from panel doctors in respect of patients on domiciliary treatment was 171, compared with 189 in 1932. 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, 160 were sent by doctors, compared with 182 in the previous year. 234 reports on "Z" cards were made to doctors regarding panel patients In addition, numerous letters were written to doctors and hospitals about patients. Consultations with medical practitioners. The number of consultations between practitioners and the Tuberculosis Officer continues to 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. As the Health Visitor who sustained an accident in 1932 has not been able to resume full duty, it was necessary to obtain the services of a part-time Visitor towards the end of the year, so that satisfactory home-visiting was obtained. The number of visits paid by the Health Visitors was 6,170 compared with 5,452 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. 87 Report of Tuberculosis Officer—continued. (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. 189 of the new attenders were referred by the Council's staff. Bacteriological examinations of Sputa. The number of specimens sent by practitioners for examination was 257 as against 368 in 1931. The number of examinations of specimens for Dispensary cases was 756, as compared with 669 in 1932. X-ray Diagnosis. The number of X-ray examinations is 164 compared with 149 in the previous year. Cases were X-rayed in connection with the Tuberculin Test as reported last year. Extra Nourishment. Recommendations were made to the Public Assistance Authorities for extra nourishment in the case of patients receiving Public Assistance in addition to grants made by the Borough to 63 persons. Institutional Treatment. 158 patients were recommended to the London County Council for institutional treatment, 9 of which the London County Council were unable to accept under the Tuberculosis Scheme, and were referred to general hospitals. Two patients refused treatment. 298 reports on the condition of the patients treated in previous years were sent to the County Council. Recommendations were also 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 1933— 4 died within 3 months from the date of the first attendance. 5 „ „ 6 „ „ „ „ 11 „ „ 12 „ „ „ „ 37 „ after 12 „ „ „ „ In addition, 16 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 those of Lewisham, Camberwell and Lambeth was held at the Borough Hall, and was opened by the Mayor. I am informed by Mrs. Monk that sales amounted to £41 17s. 10d. for Deptford and £36 17s. 10d. for the other boroughs. 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. To face page 88 Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a) PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 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 classification 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 1933 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 j Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B plus) Group 1 Group 2 Group 3 Total Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group I Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 6 3 6 9 1 2 3 1 5 5 2 1 1 2 3 2 3 5 3 3 3 3 2 2 F. 2 4 4 1 1 1 1 2 2 1 2 1 3 1 1 1 2 1 3 3 Children ... 4 1 1 1 3 4 1 1 1 3 Disease not arrested Adults M. 5 15 20 1 3 3 7 5 1 6 2 2 4 1 6 2 9 1 12 2 15 4 5 15 2 22 5 3 19 1 23 8 2 33 9 44 F. 5 8. 13 2 2 3 3 1 2 3 2 1 5 3 9 2 10 1 11 5 2 14 3 19 4 4 17 1 22 16 2 15 4 21 Children ... 1 1 1 2 2 1 1 1 3 1 5 Condition not ascertained during the Year 8 6 6 1 1 2 2 2 2 1 1 2 2 3 3 4 1 2 3 5 1 3 4 Total on Dispensary Register at 31st December 20 14 39 53 2 3 9 3 15 5 17 l 18 6 7 7 14 12 5 19 6 30 13 1 29 5 35 22 9 35 6 50 10 7 36 2 45 29 4 48 13 65 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 34 16 8 24 2 2 F. 58 10 5 15 3 Children ... 60 5 2 Lost sight of or otherwise removed from Dispensary Register 353 75 134 16 225 17 3 11 9 23 10 7 26 2 35 18 7 18 1 26 23 3 16 1 20 12 3 18 1 22 4 5 6 2 13 6 1 11 2 14 3 6 6 Dead Adults M. 38 39 145 36 220 3 4 20 15 39 2 1 28 8 37 2 2 16 11 29 4 2 20 9 31 3 14 8 22 1 1 15 3 19 2 ,3 7 22 1 5 1 7 F. 34 21 77 31 129 2 7 7 16 4 20 10 34 5 9 14 2 4 13 9 26 1 1 11 11 23 2 2 8 10 20 2 11 4 15 1 2 3 5 Children 10 3 3 2 8 1 1 1 2 1 1 1 1 1 1 1 2 Total written off Dispensary Register 587 164 372 85 621 29 9 41 32 82 14 12 74 21 107 20 9 39 21 69 29 9 50 19 78 17 4 43 20 67 7 8 29 15 52 8 3 36 14 53 4 1 13 4 18 Grand Totals 607 178 411 85 674 31 12 50 35 97 19 12 91 22 125 26 16 46 21 83 41 14 69 25 108 30 5 72 25 102 29 17 64 21 102 18 10 72 16 98 33 5 61 17 83 Report of Tuberculosis Officer—continued. (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 1932 1933 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal Other Organs Periphereal Glands Total Bones and Joints Abdominal Other Organ Peripheral Glands Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs Peripheral Glands Total. Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 2 l 3 1 1 1 1 2 2 2 1 l 2 F. 3 2 5 1 1 2 1 1 1 1 Children ... 3 1 4 l 1 2 1 1 1 1 2 1 1 1 3 1 2 3 l 1 2 4 Disease not arrested Adults M. 1 1 1 3 l 1 2 2 2 1 3 1 2 3 2 2 4 F. 3 3 1 1 1 1 1 1 1 1 I l 2 2 l 3 2 3 5 Children ... 3 3 2 2 3 1 4 2 1 3 3 3 6 5 11 1 l 3 5 Condition not ascertained during the year 5 5 1 1 I 1 2 2 2 1 1 3 l l I 6 1 1 1 3 Total on Dispensary Register at 31st December 14 4 5 23 5 1 2 8 5 1 2 8 4 2 l 7 4 l 3 8 7 2 2 4 15 7 2 3 4 16 11 2 10 23 5 l 8 14 Transferred to Pulmonary 1 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 15 3 1 4 23 1 1 2 1 1 2 1 1 F. 9 1 2 12 4 4 Children ... 17 6 50 73 1 1 1 l l 4 7 4 4 3 3 1 1 Lost sight of or otherwise removed from Dispensary Register 40 10 10 55 115 1 l 8 10 2 3 3 5 13 6 2 4 1 13 4 2 2 8 3 1 2 3 9 3 1 6 10 2 l 3 2 2 Dead 1 Adults M. 8 1 9 1 1 1 1 1 1 1 1 1 1 F. 4 3 7 1 1 1 l 2 Children 4 2 1 7 1 1 2 1 1 2 1 1 Total written off Dispensary Register 97 21 16 112 246 3 l l 9 14 4 5 4 13 26 7 3 4 6 20 5 3 6 14 3 1 2 4 10 3 1 6 10 5 2 1 8 4 4 Grand Totals of a and b (excluding those transferred to Pulmonary) 111 21 20 117 269 8 2 l 11 22 9 6 4 15 34 11 5 5 6 27 9 3 l 9 22 10 3 4 8 25 10 3 3 10 26 16 2 2 11 31 9 1 8 18 89 Report on Work of the Tuberculosis Care Committee, 1933. Before beginning our report on the work of the Tuberculosis Care Committee, we must place on record our deep regret and sense of loss occasioned by the death of Councillor Mrs. Tiffen, J.P., after a short illness, on 3rd November, 1933. She was one of the oldest members of the Tuberculosis Care Committee and a consistently regular attendant. Her exceptional knowledge of individual cases was particularly invaluable. She leaves a blank that will be hard to fill, and will be greatly missed. Looking back over the year, the outstanding feature of the work is the additional duties that have devolved upon the Care Committee in connection with the amendment of the Council's Scheme for the treatment of Tuberculosis, which came into effect on 1st April, 1933. As from that date all persons receiving residential treatment for Tuberculosis were brought within the scope of this scheme. Prior to 1st April, 1933, certain cases were dealt with under the scheme and were assessed by the Tuberculosis Care Committees, the assessment being reviewed by the Public Health Committee of the London County Council. The remainder, most of whom were patients in General Hospital, were assessed by the Local Public Assistance Committee. Under the new arrangement, the assessment of every case receiving residential treatment for Tuberculosis will be dealt in the first place by the Tuberculosis Care Committee and reviewed by the Public Assistance Committee. This ensures uniform treatment, and enables the Committee to establish the intimate and personal touch with every case that is so essential to Care work. The welfare of the tuberculous persons and their families is of primary importance to the care Committees. Because of this, every effort was made by the Standing Conference of Borough Council Tuberculosis Care Committees, to urge that the assessment of contributions towards the cost of residential treatment should continue to be undertaken by the Care Committees, and it is a matter for congratulation that this end has been achieved. From the Care Committee point of view, the fact that every case sent away for treatment is now dealt with in the first place 90 by the Committees, gives cause for satisfaction. There is a sense of completeness in the work that was formerly lacking, which is beneficial to all concerned. As from 1st April, 1933, the date on which the change was effected, 121 cases have been admitted to general hospitals. 37 of these cases have been transferred either to or from sanatoria, or other hospitals, leaving 84 cases, which can be classified definitely as an addition to the ordinary work. With regard to the 37 transferred cases, it is not possible to state how many under the old arrangements would have been dealt with by the Care Committee, and how many retained by the Public Assistance Committee to deal with. It will, however, be reasonable to allow that 18 of these might be extra cases, making a total of approximately 102 additional cases to be assessed by the Care Committee over a period of nine months. During the year 1931, 177 patients were recommended for treatment under the Tuberculosis Scheme. In 1932, 175 patients were recommended. In 1933, 167 patients were recommended, apart from the 102 Public Assistance cases mentioned above. It will therefore be obvious that the cases taken over from the Public Assistance Committee will add substantially to the work, particularly to that part relating to assessments. With regard to the general work there has been no change in procedure, except that regular visiting at our local general hospitals is now in force. This addition can be regarded as a most useful development, and brings the Committee into touch with a type of patient particularly in need of help. We can feel that to some lonely, homeless, and often friendless patients we have been of practical use. 993 visits have been paid to patients in hospital and at home, 1,468 persons have been interviewed by the Care Committee, and 1426 cases have been submitted to the Care Committee on the agendas. With regard to our chronic difficulties, namely, lack of means, and unsuitable housing conditions, usually the result of unemployment, these still exist. A few of our cases have been re-housed, and we hope some others will be in the near future. This lets a gleam of light into the darkness of our housing problem, and encourages us to hope that conditions will eventually improve. 91 For very many of our people, the past year has been hard and difficult. For our most needy cases we have as usual applied to our friends and to appropriate societies for help. The response to our appeals is most cheering and encouraging, and clearly shows that the claims of tuberculous persons for special sympathetic consideration is recognised. For their kindness and generosity we tender our most heartfelt thanks. With the help extended, much has been accomplished; beds, blankets, clothing, extra nourishment, special allowances spread over lengthy periods, and fares to hospitals have been provided—these to our sick people have a value beyond the mere material one. It is so often said, It is nice to feel that someone is thinking of you." In view of the increasing need for small emergency grants, the Committee decided, during the latter part of the year, to raise a fund to meet this demand. The amount in hand is very limited at present, and is only available when immediate help is urgently required. In many cases that we deal with the "little" at the right moment means "so much," that already we have had cause to bless this fund. Five children have been boarded out under the London County Council's Contact Scheme. The operation of the scheme in these particular cases removed a load of anxiety from the parent's minds, and has been most helpful to all concerned. Our Chairman was, this year, elected Chairman of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees, for the third time in succession. This, we think, may be accepted as evidence that his practical sympathy and interest in the general work and welfare of the Committees is appreciated. Through the Conference, a visit to the Pinewood Sanatorium was arranged; 29 members joined the party, and 13 Committees, including Deptford, were represented. The representatives could not fail to be impressed with the beautiful situation of the Sanatorium, the general management, and the particular care given to patients by the Medical Superintendent. Inevitably, however, our thoughts turn to the homes that some of these men, women and children, who have been given such a wonderful start on the road to recovery in these well-equipped 92 institutions, will have to return to, and we realise with dismay that no " scheme" can achieve the results aimed at under existing conditions. To alter this state of affairs is the aim and object of every Care Committee, and to this end we are working ; perhaps almost invisibly at times. We can, and do, in some few individual cases alter conditions, and improve them in many others, with gratifying results, but the whole problem is so immense and the remedies so far outside our scope, that we feel at times almost helpless. We do not lose heart, however, and continue to work and hope that the " better days " so earnestly desired may dawn in our times. 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. H ealth 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, 1 933. 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 Hall Total. Miss Robus Visits .. 993 .. .. .. .. 993 Revisits 2138 .. .. .. .. 2138 Total ... 3131 .. .. .. .. 3131 Miss Little Visits .. .. .. .. 785 .. 785 Revisits .. .. .. .. 1401 .. 1401 Total .. .. .. 2186 .. 2186 Miss O'Loughlin Visits 596 .. .. .. .. .. 596 Revisits 2191 .. .. .. .. .. 2191 Total 2787 .. .. .. .. .. 2787 Miss Smart Visits .. .. 805 .. .. .. 805 Revisits .. .. 1223 .. .. .. 1223 Total .. .. 2028 .. .. .. 2028 Miss Stowell Visits .. .. .. 692 .. .. 692 Revisits .. .. .. 2596 .. .. 2596 Total .. .. .. 3288 .. .. 3288 Miss Reynolds Visits .. .. .. .. .. 630 630 Revisits .. .. .. .. .. 2282 2282 Total .. .. .. .. .. 2912 2912 380 Miss Holland Visits .. .. .. .. .. 380 Revisits .. .. .. .. .. 2626 2626 Total .. .. .. .. .. 3006 3006 Miss Cloke (Temporary) January Visits .. .. 78 .. .. .. 78 Revisits .. .. 214 .. .. .. 214 Total .. .. 292 .. .. .. 292 Miss Hudson ( temporary) December Visits .. .. 41 .. .. .. 41 Revisits .. .. 248 .. .. .. 248 Total .. .. 289 .. .. .. 289 Total Visits 596 993 924 692 785 1010 5000 Revisits 2191 2138 1685 2596 1401 4908 14919 Total 2787 3131 2609 3288 2186 5918 19919 96 Analysis of Visits paid by Health Visitors, 1933. To infants under 5 years Enquiries re Visits. Re-visits Total. Births 1539 12634 14173 Still-births 39 - 39 Infant deaths 99 - 99 Ophthalmia Neonatorum 25 33 58 Measles 62 54 116 Suspected Measles 6 2 8 Infant Diarrhoea 20 6 26 Pneumonia" 4 3 7 Whooping Cough 90 49 139 Poliomyelitis 1 13 14 Meningitis 3 4 7 Scarlet Fever recoveries 77 18 95 Scabies 1 1 2 Visits to Foster Children 21 43 64 Miscellaneous visits 161 5 166 Total (under 5 years) 2,148 12,865 15,013 To infants over 5 years Enquiries re Measles 131 38 169 Suspected Measles 2 - 2 Scarlet Fever recoveries 119 15 134 Whooping Cough 55 17 72 Scabies 16 12 28 Encephalitis Lethargica — 1 1 Pneumonia 1 1 2 Visits to Foster Children 28 41 69 Miscellaneous visits 436 84 520 Total (over 5 years) 788 209 997 Other visits To expectant mothers 1085 447 1532 To Puerperal Fever or Pyrexia 12 9 21 Maternal death 1 - 1 To Common Lodging Houses (formal inspections) 14 - 14 Total other visits 1,112 456 1,568 Unsuccessful visits 952 1389 2341 Totals 5,000 14,919 19,919 In the case of the 1,539 infants visited shortly after birth, it was found that 1,423 infants were being breast-fed and 55 partly breast-fed. Only 61 were entirely hand-fed. 97 Attendances of Health Visitors at Clinics. Health Visitor. Infant Welfare. AnteNatal. Light. Schick. Dental. Total Miss Robus 97 6 14 — — 117 Miss Little 139 1 1 — 1 142 Miss O'Loughlin 88 — 15 — 44 147 Miss Smart 60 3 — — — 63 Miss Stowell 105 4 1 — — 110 Miss Reynolds 132 1 2 — — 135 Miss Holland 51 6 138 — — 195 Miss Clubbe 186 196 70 3 —- 455 Miss Gibson (part time) 146 96 - - - 242 Temporary Visitors 7 — - - - 7 Total 1,011 313 241 3 45 1,613 2. Welfare Centres. (a) Infant Welfare. There are eight Centres located in different parts of the Borough, one of these being a 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 Consultations with Doctor Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under 1 year 1—5 years Gosterwood Street 48 174 28 202 3390 3592 2284 1308 1413 Napier Street 48 155 31 186 3019 3205 2254 951 1597 Besson Street 48 181 38 219 3995 4214 2932 1282 1438 Ilderton Road 51 93 18 111 2443 2554 1644 910 1125 Goldsmiths' College 51 102 30 132 3188 3320 2374 946 1312 Hales Street 51 164 55 219 3198 3417 2048 1369 1894 St. George's Hall 51 130 37 167 3799 3966 2645 1321 1579 St. John's, Harton St. 51 96 14 110 2684 2794 1944 850 1474 Totals 399 1095 251 1346 25716 27062 18125 8937 11832 The Health Visitors collectively made 1,011 attendances at these Clinics. G 98 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, 136 children were seen. (b) Maternity Clinics. These are conducted at the Health Centre, Harton Street, four Sessions per week being devoted to this purpose. The service provided is designed to secure efficient ante-natal and postnatal care. At present one of the Sessions is more or less set aside for post-natal work. Provision is made for X-Ray examination as an aid in the diagnosis of obscure cases. 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 during recent years is illustrated bv 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 1933 887 61 3182 The following is the text of Dr. Hill's Report for 1933 Ante-Natal Clinic Statistics, 1933. Total number of Patients on Register 887 New Cases 729 Total Attendances 3182 Normal 203 Not pregnant 42 99 Abnormalities:— Albuminuria 41 Indrawn nipples 31 Anaemia 82 Leucorrhcea 7 Anencephalic Foetus 1 Lipoma 1 Ante-partum Haemorrhage 11 Morbus Cordis 20 Bronchitis 6 Malpresentation 24 Contracted Pelvis 1 Oedema 14 Cystitis 1 Pleurisy 1 Dental Caries 392 Pulmonary Tuberculosis 2 Dyspepsia 9 Pruritis 3 Fibroids 3 Pyelitis 2 Glycosuria 6 Retroversion 13 Glossitis 2 Sciatica 5 Haemorrhoids 29 Twins 4 Hernia 1 Vomiting (excessive) 28 Hydramnios 6 Varicose veins 54 Post-Natal Clinic. This branch of the work is conducted every Tuesday forenoon. New cases 188 Total attendances 210 Amongst the patients seen the following defects were found and dealt with :— Breast Abscess 7 Retroversion 11 H ernia 1 Unhealed rupture of Torn Cervix 3 perinaeum 1 Fibroid 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 6 Ditto to midwives 161 Ditto to doctors 164 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 158 Total attendances made 764 G2 100 (c) Artificial Light Clinic. Both the Mercury Vapour and the Carbon Arc type lamps are in use. All children given this form of treatment are selected upon medical grounds and are kept under careful supervision. The following is a statement of the year's work :— Month Patients on Register at commencement of each month. New Patients admitted Patients Readmitted Patients Discharged Patients on Register at the end of month Total Attendances January 65 30 - 21 74 470 February 74 21 - 19 76 506 March 76 25 - 33 68 532 April 68 19 - 24 63 272 May 63 16 1 25 55 361 June 55 1 - 45 11 122 July 11 — - 11 — 27 August (No attendances) September ( ditto ) October — 23 3 — 26 116 November 26 26 1 4 49 295 December 49 7 1 17 40 231 Total 168 6 199 2,932 Classification of Patients during Year. Admissions. Re-admissions Rickets 35 - Malnutrition 25 - Anaemia 23 3 Cervical Adenitis 13 — Muscular Weakness 21 1 Delayed Dentition 31 2 Bronchitis 1 — Curved Tibiae 7 - Otorrœa 3 — Genu Valgum 3 — Underweight 1 — Mediastinal Glands 1 — Knock Knee 1 — Rheumatoid Arthritis 1 — Eczema 2 — 168 6 101 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 1933 :— Cases. Extractions. Fillings. Scalings, Silver Nitrate etc. Gas Cases. Dentures Supplied. Repair'd Mothers 89 267 112 79 — 9 1 Children 72 163 35 101 40 — — In the case of the fillings for mothers, 73 were amalgam and 39 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.l, 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. 4. The Maternity Home. The record of the Municipal Maternity Home shows that the work carried out during 1933 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 1933 :— Cases admitted, 249. Average stay, 2 weeks. Cases delivered by midwives. 221. ,, ,, ,, doctors, 10. Cases in which medical advice sought, 28. Cases notified as puerperal fever, Nil. „ ,, ,, puerperal pyrexia, 1. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. Foetal deaths (a) Stillborn, 7. (b) Within 10 days of birth, 1.* * Congeniial feebleness, Atelectasis 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 1933, Mr. Gilliatt was called to the Home once. Cases not admitted to the Maternity Home. During 1933, a total of 139 applications for admission were refused, owing to the available accommodation being fully booked. 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. During the year under report the following issues were made :— Free 100 Sold at half price 8 Sold at full price 18 6. Provision of Home Nursing. Arrangements have been made for the provision of a District Nurse in certain types of illness. 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 17 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 1933, 13 cases were sent away. 9. Hospital Provision for Infants. (a) Deptford Babies' Hospital, Albury Street. Following upon the voluntary closure of their hospital in Albury Street, the Hospital Board purchased a large house with spacious grounds in Breal<spears Road. Extensive alterations were carried out, and eventually, upon the 11th July, 1933, the building was formally opened. The accommodation for in-patients consists of sixteen cots, together with two beds for mothers and infants, and two cots for isolation purposes. In the grounds a large single-storey building has been erected in which a breast-feeding clinic is conducted 104 The Borough Council in financially supporting this Hospital makes a condition that certain members of the staff shall have special training in Mothercraft, and as a result, there is now established a Hospital in which the Nursing Staff is particularly well qualified to deal with Deptford's ailing children. The medical direction, so far as the in-patient children are concerned, is in the very capable hands of the Board's Medical Officer, Dr. Proctor, while those mothers and infants admitted on account of difficulties in breast-feeding are the sole charge of the Borough Council's experienced Maternity and Child Welfare Officer, Dr. Hill. The care of out-patient infants at the breast-feeding clinic devolves upon whichever of these two Officers refers the infant for treatment. During 1933, the following cases were treated 47 children admitted, of which 21 were sent by the Borough Council. 74 infants attended the Breast-feeding Clinic, of which all were sent by the Borough Council. 9 mothers with infants admitted as in-patients for restoration of Breast-feeding. (b) St. Thomas' Babies' Hostel, Kennington. Prior to the opening of the Depiford Babies' Hospital, mothers and infants, where difficulty in breast-feeding was experienced, and occasionally infants alone, were sent to this hostel. During 1933, 6 mothers with their infants and 1 infant without its mother were referred for treatment. " Test Feeds" were also conducted at the Town Hall and Harton Street. During 1933, 255 "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 («) 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. 105 Various brands of dried milk are issued, labelled specially to the Council's directions to avoid the use of trade names. In 1933, the following free or half-price issues were authorised :— 18,151 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. 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 13 instances this policy was carried into effect, involving a total expenditure of £6 10s. 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 was 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. 106 13. Infant Life Protection. In April, 1933, by virtue of the Transfer of Powers Order, made by the Minister of Health under Sec. 64 of the Local Government Act, 1929, the duties of registration and inspection of Fostermothers and Fosterchildren were transferred from the County Council to the Metropolitan Borough and City Councils. This Council accordingly appointed each of its seven District Health Visitors as an Infant Protection Visitor, and Dr. S. E. Hill, Maternity and Child Welfare Officer, was also authorised to visit. The following table shows the numbers on the Register during the year under report:— No. at time of transfer. Added. Removed. No. at end of year 1933. Fostermothers 20 9 9 20 Fosterchildren 27 14 18 23 Appendix. 108 Table 1. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1933. CAUSES OF DEATH. Sex. All Ages 0- l— 2— 5— 15- 25— 35— 45— 55— 65— 75- All causes M 665 51 5 11 18 22 23 39 63 133 158 142 F 582 31 7 5 12 22 27 36 41 84 128 189 Typhoid and Paratyphoid M 1 .. .. .. .. .. 1 .. .. .. .. .. Fevers F .. .. .. .. .. .. .. .. .. .. .. .. Measles M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. 1 .. .. .. .. .. .. .. .. Scarlet Fever M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough M 6 2 1 2 1 .. .. .. .. .. .. .. F 3 1 1 .. 1 .. .. .. .. .. .. .. Diphtheria M 3 .. .. 1 2 .. .. .. .. .. .. .. F 2 .. .. 2 .. .. .. .. .. .. .. .. Influenza M 25 1 .. .. 1 .. 2 4 5 3 5 4 F 27 .. .. 1 1 1 .. 2 2 5 7 8 Encephalitis Lethargica M 2 .. .. .. .. .. .. .. 2 .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever M 2 1 .. 1 .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system M 52 1 .. .. .. 8 7 10 11 12 2 1 F 42 .. .. .. 1 15 11 6 5 2 2 .. Other Tuberculous Diseases M 8 .. .. 1 2 2 .. 1 .. 2 .. .. F 2 .. .. .. .. .. .. .. 2 .. .. .. Syphilis M 3 .. .. .. .. .. .. .. .. 3 .. .. F 2 .. .. .. .. .. .. 1 .. .. .. 1 Ceneral Paralysis of the Insane, tabes dorsalis M 4 .. .. .. .. .. .. 1 .. 1 2 .. F 1 .. .. .. .. .. .. .. 1 .. .. .. Cancer, malignant disease M 76 .. .. .. .. 1 .. 4 10 23 24 14 F 61 .. .. .. .. .. 3 1 9 21 13 14 Diabetes M 5 .. .. .. .. .. .. .. .. 1 3 1 F 11 .. .. .. .. .. .. 1 .. 2 4 4 Cerebral Haemorrhage, etc. M 29 .. .. .. .. .. .. 1 1 7 12 8 F 28 .. .. .. .. .. .. .. .. 9 9 10 Heart Disease M 135 .. .. .. .. 1 2 4 8 26 44 50 F 146 .. .. .. 1 1 2 5 6 13 47 71 Aneurysm M 2 .. .. .. .. .. .. .. .. 2 .. .. F 2 .. .. .. .. .. .. .. .. .. 1 1 Other Circulatory Diseases M 39 .. .. .. .. .. .. .. 1 7 17 14 F 22 .. .. .. .. .. .. .. 1 1 8 12 Bronchitis M 35 1 .. .. .. .. 1 .. 3 7 8 15 F 17 .. .. .. .. .. .. 2 1 2 4 8 Pneumonia (all forms) M 46 5 2 2 1 .. 1 2 4 15 8 6 F 38 4 6 1 2 .. l .. 4 4 6 10 Other Respiratory Diseases M 13 1 .. 2 1 2 .. .. 1 4 1 1 F 2 1 .. .. .. .. .. .. .. .. .. 1 Peptic Ulcer M 19 .. .. .. .. .. l 2 5 4 2 5 F 4 .. .. .. .. .. .. .. .. 2 1 1 Diarrhoea, &c. M 8 6 2 .. .. .. .. .. .. .. .. .. F 10 7 .. .. .. .. .. .. 1 .. 1 1 Appendicitis M 6 .. .. 1 1 .. 1 1 1 .. .. 1 F 4 .. .. .. .. 1 1 .. .. 1 1 .. 109 T able 1—continued. CAUSES OF DEATH. Sex. All Ages. 0— l— 2— 5— 15— 25- 35— 45— 55— 65— 75- Cirrhosis of Liver M .. .. .. .. .. .. .. .. .. .. .. .. F 4 .. .. .. .. .. .. 1 .. 1 .. 2 Other diseases of Liver, etc. M 3 .. .. .. .. .. .. .. 1 1 1 .. F 3 .. .. .. .. .. .. l .. .. 2 .. Other Digestive Diseases M 12 2 .. .. 1 .. 1 l 1 2 3 1 F 15 1 .. .. .. 1 .. .. 2 7 3 1 Acute and chronic Nephritis M 19 .. .. .. .. 2 .. .. .. 6 6 5 F 13 .. .. .. .. 1 .. .. l 3 4 4 Puerperal Sepsis F 6 .. .. .. .. .. 2 4 .. .. .. .. Other Puerperal causes F 3 .. .. .. .. .. 2 1 .. .. .. .. Congenital Debility, Premature Birth, M 28 28 .. .. .. .. .. .. .. .. .. .. tions etc. F 17 17 .. .. .. .. .. .. .. .. .. .. Senility M 9 .. .. .. .. .. .. .. .. .. 1 8 F 28 .. .. .. .. .. .. .. .. .. 2 26 Suicide M 12 .. .. .. 1 .. 2 1 6 2 .. .. F 9 .. .. .. .. 2 2 2 2 .. 1 .. Other violence M 18 .. .. 1 5 1 1 2 1 2 4 1 F 19 .. .. .. 3 .. .. 1 1 5 2 7 Other defined diseases M 45 3 .. .. 2 5 3 5 2 3 15 7 F 39 .. .. .. 3 .. 3 8 3 6 9 7 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 1 .. Table II. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION OR DESTROYED AT OWNERS' REQUEST. 1933 Premises Visited Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total D.RC. Library Books Articles Destroyed (Owners' Request) Cleansing Station Infectious Diseases Requests Bedding only Private Total Beds Pillows Bolsters Mattresses Sheets Blanuets Odd Articles Total Wearing Apparel Towels Blankets Total January 82 11 3 78 169 40 24 119 191 508 1129 22 3 25 2 4 2 1 4 6 58 77 ... 127 ... 127 February 95 13 7 53 155 42 41 99 193 395 978 33 10 43 6 8 1 3 1 7 122 148 ... 130 ... 130 March 86 ... 6 62 140 51 24 88 140 296 801 44 10 54 3 ... 1 3 ... ... 8 15 ... 236 ... 236 April 72 7 3 53 111 60 35 69 119 250 697 25 9 34 8 11 6 4 ... 1 10 40 ... 126 ... 126 May 92 10 10 61 150 46 46 90 147 544 1084 24 3 27 3 4 1 1 ... 3 75 87 ... 223 ... 223 June 84 5 10 64 114 48 23 55 89 230 623 30 29 59 6 9 2 10 3 5 67 102 ... 224 ... 224 July 100 12 8 65 149 44 67 116 158 604 1203 56 23 79 8 16 3 7 1 3 45 83 5 176 1 182 August 73 9 5 40 146 39 26 63 56 125 495 20 ... 20 3 5 1 8 ... ... 24 41 ... 10 ... 10 September 118 3 4 74 161 54 54 104 104 331 882 17 1 18 6 4 1 3 ... ... 1 15 ... 266 ... 266 October 152 2 4 116 267 82 68 191 242 628 1594 80 24 104 2 ... ... 1 ... 24 27 ... 202 ... 202 November 162 8 4 105 283 73 85 185 370 1090 2191 50 65 115 8 5 4 9 ... 2 2 30 ... 198 ... 198 December 140 7 4 96 244 77 67 152 348 1123 2107 75 2 77 3 12 2 6 2 6 89 120 7 118 1 126 1256 87 68 867 2089 656 560 1331 2157 6124 13784 476 179 655 58 78 24 56 11 33 525 785 12 2036 2 2050 110 Table III. SHOWING NUMBER OF ROOMS DISINFECTED. 1933 Scarlet Fever Diphtheria Pulmonary Tuberculosis Scabies Measles Chiclten Pox Pneumonia Erysipelas Puerperal Fever Cerebro-Spinal Meningitis Whooping Congh Mumps Gangrene Infantile Paralysis Typhoid Fever Cancer Furniture before Removal Formalin Spray Fumigated Infectious Requests Total Rooms Verminous Premises Rooms R'ms. R'ms. January 47 13 19 3 l 9 .. .. .. .. .. .. .. .. .. .. .. 92 13 105 .. .. February 44 26 18 8 9 1 2 l .. .. 2 .. .. .. .. .. .. 111 15 126 3 6 March 39 25 22 5 3 .. .. .. l l .. .. .. .. .. l .. 97 .. 97 8 10 April 42 18 19 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 80 16 96 15 23 May 53 14 25 6 2 1 .. 2 .. l .. l .. .. .. .. .. 105 15 120 20 37 June 47 18 25 3 .. .. .. 1 l .. .. .. 1 .. .. .. .. 96 8 104 12 23 July 72 19 17 3 .. 1 2 .. .. l .. .. .. l .. .. l 117 18 135 10 16 August 40 18 23 .. .. .. 2 .. .. .. .. .. .. .. .. l .. 84 9 93 44 98 September 77 19 28 1 1 .. 1 .. .. .. .. .. .. .. .. 2 11 140 3 143 27 49 October 122 32 28 .. .. .. .. .. 1 .. .. .. .. .. .. 1 4 ' 1S8 5 193 23 47 November 126 15 38 7 .. .. .. 1 .. .. .. .. .. .. .. 5 3 195 10 205 9 21 December 85 26 26 12 .. .. .. 2 .. .. .. .. .. .. 1 9 2 163 10 173 1 1 794 243 288 49 16 12 7 7 3 3 2 l 1 1 1 19 21 1468 122 1590 172 331 TIT 112 GOSTERWOOD STREET CLINIC. 1933 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 10 1 3 14 236 250 114 February 4 11 2 6 19 257 276 110 March 4 10 1 3 14 231 245 107 April 3 16 1 3 20 221 241 96 May 5 31 2 5 7 45 435 480 180 June 3 4 2 3 9 250 259 94 July 5 17 1 2 3 23 382 405 142 August 3 9 1 1 1 12 227 239 83 September 4 7 7 302 309 125 October 5 18 18 400 418 154 November 4 10 1 1 12 262 274 126 December 3 7 2 9 187 196 82 Total 48 150 8 16 28 202 3390 3592 1413 NAPIER STREET CLINIC. 1933 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 9 5 3 17 265 282 139 February 4 11 1 12 239 251 142 March 4 11 9 4 24 246 270 139 April 3 3 2 1 6 174 180 77 May 5 15 3 2 4 24 325 349 201 June 3 10 1 2 2 15 203 218 93 July 4 13 1 2 2 18 277 295 145 August 4 17 1 18 277 295 143 September 4 10 1 6 17 255 272 124 October 5 10 1 2 5 18 333 351 178 November 4 8 2 10 258 268 135 December 3 4 1 2 7 167 174 81 Total 48 121 7 27 31 186 3019 3205 1597 113 GOLDSMITHS' COLLEGE CLINIC. 1933 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 4 1 5 240 245 106 February 4 5 1 1 3 10 232 242 90 March 5 7 1 2 10 332 342 136 April 4 12 4 16 265 281 118 May 5 5 2 1 8 277 285 114 June 4 8 2 2 12 296 308 108 July 4 6 2 8 273 281 117 August 5 12 1 2 5 20 311 331 131 September 1 8 3 11 261 272 97 October 4 11 3 14 238 252 97 November 5 5 4 9 300 309 132 December 3 6 3 9 163 172 66 Total 51 89 2 11 30 132 3188 3320 1312 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC. 1933 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 2 4 9 31 211 242 154 February 4 13 2 3 7 25 269 294 176 March 5 16 2 5 23 305 328 188 April 3 5 1 2 8 173 181 102 May 4 11 4 2 4 21 262 283 166 June 5 18 1 2 21 310 361 192 July 4 6 1 5 1 13 258 271 152 August 5 8 5 5 18 319 337 154 September 4 12 1 2 4 19 264 283 150 October 4 2 1 3 6 262 268 143 November 5 10 1 8 19 320 339 194 December 4 7 3 5 15 215 230 123 Total 51 124 10 30 55 219 3198 3417 1894 H 114 BESSON STREET CLINIC. 1933 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed Mixed. Hand. Ages 1-5. January 5 15 2 5 5 27 369 396 150 February 4 12 2 1 15 328 343 113 March 4 9 2 1 2 14 347 361 141 April 3 6 2 8 260 268 94 May 5 18 4 1 2 25 380 405 135 June 3 10 1 5 16 239 255 94 July 4 9 1 10 308 318 107 August 4 11 3 2 4 20 327 347 106 September 4 19 2 3 4 28 332 360 117 October 5 18 3 3 3 27 487 514 160 November 4 10 1 2 4 17 378 395 126 December 3 4 1 1 6 12 240 252 95 Total 48 141 19 21 38 219 3995 4214 1438 ILDERTON ROAD CLINIC. 1933 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 7 1 1 9 159 168 85 February 4 6 1 1 8 200 208 95 March 5 8 2 3 13 213 226 116 April 3 7 2 9 143 152 78 May 4 4 1 1 6 197 203 91 June 5 11 1 1 13 243 256 109 July 4 9 9 170 179 74 August 5 9 1 2 2 14 291 305 119 September 4 5 1 1 7 213 220 77 October 4 3 2 1 6 224 230 90 November 5 6 2 1 9 247 250 112 December 4 3 1 4 8 143 151 79 Total 51 78 8 7 18 114 2443 2554 1125 115 ST. GEORGE'S HALL, SHARDELOES ROAD. 1933 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 7 1 3 11 285 296 123 February 4 4 1 1 1 7 262 269 111 March 5 12 2 2 16 354 370 151 April 3 7 1 2 10 233 243 92 May 4 11 1 1 2 15 314 329 125 June 5 14 1 1 4 20 384 404 158 July 4 10 1 b 5 21 315 336 131 August 4 4 3 3 10 320 330 125 September 5 7 2 2 6 17 412 429 164 October 4 7 4 2 13 317 330 134 November 4 10 1 3 14 316 330 133 December 5 8 1 4 13 287 300 132 Total 51 101 10 19 37 167 3799 3966 1579 ST. JOHN'S CLINIC. 1933 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 4 1 2 7 228 235 135 February 4 3 1 1 1 6 •111 233 133 March 5 10 3 2 15 281 296 179 April 4 6 3 1 10 205 215 116 May 5 9 1 ] 11 266 277 155 June 4 6 6 214 220 113 July 4 7 2 1 10 213 223 105 August 5 6 1 2 9 245 254 104 September 4 12 1 13 220 233 134 October 4 6 2 2 10 209 219 99 November 5 7 2 9 278 287 140 December 3 2 1 1 4 98 102 61 Total 51 78 3 15 14 110 2684 2794 1474 H2 INDEX. PAGE A Acreage 8 Acute Primary Pneumonia 62 Acute Influenzal Pneumonia 62 Acute Poliomyelitis 62 Albany Deptford Babies' Hospital 24 Ambulance Facilities 24 Ante-natal Examination 98 Ante-natal Clinic 98 Area and Population 8 Artificial Light Clinic 100 B Bacteriological Examination 66 Births 11 „ illegitimate 12 „ Notification of 12 c Cancer 68 Canal Boats Acts 34 Causes of Sickness 15 Cerebro-spinal Meningitis 62 Chicken pox 60 Cleansing Station 67 Clinics and Centres 25, 112 Committee, Public Health 3 „ Maternity and Child Welfare 3 Convalescent Treatment 103 ii. PAGE D Deaths 13 Death-rate 13 „ comparisons 13 „ during 10 years 13 Deaths in Wards 14 „ percentage in age groups 17 „ causes of 108 „ ages at 15 „ Infantile, causes 16 „ Infectious disease 56 Deptford Babies' Hospital 103 Diabetes and Insulin 69 Diarrhœa 63 Diphtheria 59 Disinfection 67, 110 Disinfestation 67 Dysentery 63 E Encephalitis Lethargica 62 Enteric Fever 65 Erysipelas 65 F Factory and Workshop Act 35 Food Inspection 44 „ Poisoning 49 „ Sampling 50 „ Unsound 48 Foster Children 106 H Health Committee 3 Health Visitors, Visits 95-96 Health Education 105 Home Helps 103 iii. page H—continued. Home Nursing 103 Housing 38 House-to-house Inspections 31 I Illegitimate Births 12 Infant Life Protection 105 Infant Mortality 16 „ from Diarrhoea and Enteritis 63 „ Table of causes 16 Infant Welfare Centres 97, 112 Infectious Diseases, Notifications 56 Infective Jaundice 69 Influenza 65 Insulin and Diabetes 69 L Laboratory Work at the Seamen's Hospital 66 Legal Proceedings 31 M Malaria 63 Marriages 11 Maternal Mortality 105 Maternal and Child Welfare Committee 3 Maternity Home 24, 102 „ Consultant 102 Maternity Outfits 103 Measles 65 Midwives 23, 105 Milk, Bacteriological Examination 45 „ Supply to Nursing Mothers, etc. 104 Mortality of Infants 16 Mortuary Report 17 Municipal Maternity Home 24, 102 iv. PAGE N Notification of Births 12 Nursing Arrangements 22 „ in the Home 22 Nutrition 54 o Obstetricians, consulting 101 Ophthalmia Neonatorum 64 P Physical Features of Borough 8 Population 10 Pneumonia 62 Post-natal Clinic 99 Public Health Committee 3 Puerperal Fever 63 „ Pyrexia 63 R Ranyard Nurses 22 Rats 32 s Sanitary Inspectors' work 28 Scarlet Fever 57 Small-pox 60 Social Conditions 9 Staff, List of 20 Still-births 11 T Tuberculosis—Care Committee 89 „ Report of Tuberculosis Officer 72 „ General 72 V. PAGE T—continued. Tuberculosis—Home accommodation 77 „ Notification Table 73 „ Revision of Register 79 „ Supervision of Contacts 80 „ Dental Treatment 85 V Vaccination 61 w Whooping Cough 66