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. 1934 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14, Public Health Committee. Mayor. Councillor J. E. PEARSON, J.P. Chairman. Councillor W. TAYLOR. Vice-Chairman. Councillor C. G. BLANCHARD. Alderman Mrs. E. M. Bateman. Councillor F. D. Chisnell. Councillor W. J. Coombs. Alderman W. H. Green, J.P., L.C.C. Councillor A. G. Howard. Councillor C. Russell. Councillor E. C. Sherwood. Councillor Mrs. L. E. White. Councillor A. H. Wild. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. G. E. Green. Vice-Chairman. Councillor Mrs. E. M. Colburn. Alderman Mrs. E. M. Bateman. Councillor W. J. Coombs. Councillor Mrs. B. M. Drapper. J.P. Councillor Mrs. A. Hayward. Councillor Mrs. M. Herlihy. Councillor E. C. Sherwood. Councillor W. Taylor. Alderman Mrs. E. M. L. Watson. Councillor Mrs. L. E. White. A2 Metropolitan Borough of Deptford. Public Health Department, Deptford Town Hall, S.E. 14. 10th April, 1935. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my sixth Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. The estimated population for statistical purposes is 101,380 and based upon this figure, the birth and death-rates per 1,000 of the population were 15.8 and 13.1, compared with 14.8 and 12.1 for the year 1933. The first two quarters of the year showed a high mortality, the increase being chiefly in respect of infectious diseases of early childhood, diseases of the circulatory system and cancer. The infantile mortality rate was 68, and the maternal death-rate 3.0—the latter rate being calculated upon 1,000 total (live and still) births. Regarding infectious disease the most important increase compared with 1933 was in respect of Diphtheria, which towards the end of the year evinced itself in a more virulent form. Only one case of Small-pox was notified. The work of the Sanitary Inspectors continues to be of the same high standard, and their increasing vigilance is largely responsible for the maintenance of a satisfactory sanitary environment, both in the workshop and the home. Considerable time was necessarily spent in a more intensive inspection of houses in certain parts of the Borough. As a result eight areas were represented to the Council as Clearance Areas. 6 The recording of these inspections in addition to the routine work of the department has thrown a large amount of extra duties upon the clerical staff—duties which have been admirably discharged. The purity of the food supply, primarily the responsibility of the Food Inspector, has been satisfactorily maintained. The Report of the Inspectors of the Ministry of Health upon their survey of the health services of the Borough showed that a satisfactory standard is being maintained by the Borough Council. In conclusion, to Dr. Donnelly and to Dr, Hill I desire to express my sincere appreciation of their valuable work in their respective spheres—Tuberculosis and Maternity and Child Welfare; and to the Staff generally my thanks for their loyal co-operation. 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. Size. Maintained by. 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Ground. Brookmill Road 1¼ acres Borough Council. 3. Telegraph Hill Recreation Ground. Telegraph Hill 45½ acres L.C.C. 4. Railways and adjoining land. 234 acres 5. Millwall Football Ground. 5½ acres 6. Canals 8 acres 7. St. Paul's Churchyard 2.2 acres 8. Reservoir 1 acre 9. Municipal Playing Fields Deptford Bridge 3½ acres Borough Council. Statistics. Area 1,564 acres Population: Census 1931 106,891 Estimated Resident population, 1934 101,380 Number of inhabited houses according to the Ratebooks (end of 1934) 19,400 Number of families or separate occupiers (1931) 29,248 Rateable Value (31.3.1934) £666,449 Estimated sum represented by a 1d. Rate £2,667 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:— 24th Sept., 1934 Men, 2,405 Women, 561 Juveniles, 163 I am indebted to the Public Assistance Officer for the following figures:— (a) Total number of Deptford Residents, including wives and children, on outdoor relief, during the week ended 29th December, 1934 — 4,717 (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1934:— £88,693 11s. 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 703. Of these, 648 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 55 persons, the same conditions being observed, the amount per head varied between 7s. 6d. and 10s. 6d. During the whole year 13,621 applications for fortnightly supplies were granted. Of this number, 12,823 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 are of interest in this connection: Male. Female. Total. Grand Total. Birth-rate. Live Births Legitimate 788 764 1,552 1,597 15.8 Illegitimate 20 25 45 Still-births, 45. Rate per 1,000 total births, 27.4. Death-rate. Deaths 1,327 13.1 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 2 1.2 Other Puerperal causes 3 1.8 Total 5 3.0 Death-rate of infants under one year of age, per 1,000 births: Legitimate 66 Illegitimate 133 Total 68 Deaths from Measles (all ages) 43 „ Whooping Cough (all ages) 18 „ Deaths from Diarrhcea (under 2 years) 26 Population. 1 he population for 1934, as given by the Registrar-General, was 101,380, the lowest on record. 11 Marriages. During the year 963 marriages took place, equivalent to a rate of 9.5 persons marrying per 1,000 of the population. By courtesy of the Superintendent Registrar the following gives details as to the places in which these marriages were conducted : Church of England 578 Other places of worship 79 In the Superintendent Registrar's Office 306 Total 963 Births. After allowing for inward and outward transfers, i.e., the addition of 598 children born of Deptford parents outside the Borough, and the deduction of 29 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,597. This is equivalent to a birth-rate of 15.8 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. Deptford. Crude rate per 1,000 population. England and Wales. Crude rate per 1,000 population. County of London. Crude rate per 1,000 population Average for 10 years, 1915 to 1924 2610 22.9 20.0 20.5 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 1934 1597 15.8 14.8 13.2* *Provisional figures. Still Births. 45 still-births were registered during the year as follows:— Legitimate Illegitimate Total Male 23 — 23 Female 21 1 22 12 Illegitimacy. The number of illegitimate births was equivalent to 2.8 per cent. of the total births. The figures relative to illegitimacy for previous years areas follows: Av. for 10 yrs 1915-1924 Av. for 5 yrs. 1925-1929 1930 1931 1932 1933 1934 No. of illegitimate births 77 58 59 55 56 51 45 Percentage of total births 2.9 3.0 3.4 3.2 3.3 3.4 2.8 Notification of Births. During 1934, the number of notifications received of births and still births actually occurring in the Borough was 1,045. After allowing for inward and outward transfers, the corrected figure was 1,628. The following is an analysis of these notifications: Births Notified in the Borough during Year 1934. Ward. Births notified. Alive Dead By whom notified Total Male Female Parent Doctor Midwife Canterbury 80 53 27 79 1 6 7 67 Clifton 59 31 28 59 — 5 7 47 Deptford Park 60 34 26 56 4 5 15 40 Evelyn 96 50 46 92 4 6 17 73 Hatcham 85 42 43 84 1 4 5 76 Pepys 50 26 24 48 2 7 12 31 St. Catherine's 44 24 20 44 — 9 11 31 St. John's 46 30 16 46 — 8 4 34 St. Paul's 138 65 73 135 3 3 7 128 St. Peter's 262 120 142 258 4 3 7 252 Town Hall 59 27 32 55 4 5 4 50 Vale 66 34 32 66 — 3 10 53 Totals 1045 536 509 1022 23 57 106 882 Deduct births not belonging to Borough 24 7 17 24 - 1 2 21 Total 1021 529 492 998 23 56 104 861 Add Births which occurred outside Borough 607 325 282 586 21 133* 474† Grand Total 1628 854 774 1584 44 56 237 1335 *Notifications received from Medical Officers of Health of other Boroughs. † Notifications received direct from Maternity Hospitals, etc. 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 685 Deduct deaths of "non-residents" 137 548 Add deaths of "residents" outside Borough 779 Nett deaths applicable 1,327 This is equivalent to a death-rate of 13.1 per 1,000 persons. Seasonal Mortality. Quarter ended. 1933 1934 No. Rate per 1,000 of population. No. Rate per 1,000 of population. March 416 16.2 429 16.9 June 282 11.0 319 12.2 September 225 8.7 295 11.6 December 324 12.6 284 11.2 The trend of the death-rate in recent years is shown by the following table:— Year. Deptford. England & Wales. London. No. Rate per 1,000 of the population. Average for 10 years, 1915-1924 1560* 14.1 13.6* 13.9 1925 1399 12.1 12.2 11.7 1926 1302 11.3 11.6 11.4 1927 1312 11.5 12.3 11.9 1928 1354 12.0 11.7 11.6 1929 1481 13.3 13.4 13.8 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 12.3 12.2 1934 1327 13.1 11.8† 11.9† *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 44 41 5 85 Evelyn 77 62 13 139 St. Paul's 81 68 16 149 Vale 67 49 8 116 Clifton 60 49 8 109 Canterbury 48 51 9 99 Hatcham 58 68 13 126 Pepys 44 47 6 91 St. Catherine's 38 47 8 85 St. Peter's 31 56 7 87 St. John's 87 37 6 124 Town Hall 60 57 9 117 695 632 108 1327 Causes of Death. An analysis of the causes of death will be found in Table 1 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), 1934. Average No. for 10 years 1915-24. Average 1925-1929 1930 1931 1932 1933 1934 Increase or decrease over 1933 Measles 0.8 27 20 24 1 23 1 43 + 42 Whooping Cough 7 24 13 3 11 9 9 18 + 9 Diphtheria 4 19 14 4 12 6 5 19 + 14 Influenza 42 70 35 6 20 26 52 11 - 41 Tuberculosis—Pulmonary 75 136 102 113 100 92 94 92 - 2 Non-pulmonary 8 32 18 14 14 13 10 10 — Cancer 110 133 159 156 174 183 137 189 + 52 Heart Disease 225 128 232 298 322 297 281 322 + 41 Cerebral Hæmorrhage, Embolism and Thrombosis 46 67 54 45 41 49 57 73 + 16 Bronchitis 42 140 95 47 55 53 52 60 + 8 Pneumonia (all forms) 67 154 121 73 113 82 84 84 - Nephritis 26 35 34 44 31 35 32 23 - 9 Diarrhœa and Enteritis 14 45 20 19 14 29 18 27 + 9 Violence (excluding Suicides) 30 48 49 64 30 36 37 49 + 12 Premature Birth, Malformation and Debility a - 36 86 49 40 45 48 45 50 + 5 15 Special Noteworthy Causes of Sickness or Invalidity. The foregoing table shows that, although yearly fluctuations occur, the most common causes of death, in descending sequence, are associated with the circulatory and respiratory systems and with malignant disease, the commonest single cause of death being heart disease. The following Table expresses as percentages of the total mortality the incidence in the various age groups:— Average 1915-24 Average 1925-29 1930 1931 1932 1933 1934 Under 1 year 16.3 9.4 8.6 7.2 8.3 6.5 8.1 From 1-2 years 4.7 2.7 1.8 1.6 3.0 1.0 2.9 „ 2-5 years 4.3 2.8 2.5 2.0 2.0 1.3 3.7 „ 5-15 years 3.9 2.9 2.3 2.2 1.8 2.4 1.7 „ 15-25 years 4.4 4.3 5.5 4.3 4.2 3.5 4.2 „ 25-45 years 12.3 10.5 11.1 10.2 8.8 10.0 7.4 „ 45-65 years 23.3 27.7 26.0 28.6 26.6 25.8 24.9 65 years and upwards 30.8 39.6 42.2 43.8 45.3 49.5 47.1 The infantile mortality rate for 1934 was 68 per 1,000 births and the following Table gives the death-rates for England and Wales, London and Deptford for previous years:— Deptford England & Wales London Year 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 1934 108 68 59* 67* * Provisional figures. 16 The following Table gives details of the causes of death in the various age groups:— Infantile Mortality, 1934. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total Deaths under 1 year. All Causes 28 2 1 6 37 23 22 16 10 108 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 .. 3 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 2 .. .. 6 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. . . .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. .. .. .. .. .. .. .. .. 1 Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. 1 .. .. 1 Pneumonia (all forms) .. .. .. .. .. 6 2 6 5 19 Diarrhœa .. .. .. .. .. 1 1 1 1 4 Enteritis .. .. .. 2 2 5 10 3 .. 20 Gastritis .. .. .. 1 1 .. .. .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. .. .. .. .. .. Injury at Birth 4 .. 1 .. 4 .. .. .. .. 4 Atelectasis 4 .. .. .. 5 .. .. .. .. 5 Congenital Malformations 1 1 .. 1 3 3 .. .. .. 6 Premature Birth 16 1 .. .. 17 2 .. .. .. 19 Atrophy, Debility, and Marasmus 3 .. .. 1 4 4 5 4 1 18 Other Causes .. .. .. .. .. .. .. .. .. .. Totals 28 2 l 6 37 23 22 16 10 108 Death-rate in each agegroup per 1,000 births 17.5 1.3 0.6 3.8 23.2 14.4 13.8 10.2 6.4 68 Percentage of total deaths in each agegroup 25.9 1.9 0.9 5.6 34.3 21.3 20.4 14.8 9.2 100 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 1934 25.9 1.9 0.9 5.6 34.3 21.3 20.4 14.8 9.2 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 218 persons who had been residents of the following districts:- Deptford 64 East Ham 1 Greenwich 34 Hornsey 1 Camberwell 4 Erith 1 Bermondsey 26 Ewell 1 Lewisham 9 Portsmouth 1 Woolwich 59 Fulham 1 Welling 2 Highbury 1 Lambeth 2 New Maiden 1 Poplar 2 Holland 1 Wanstead 1 Denmark 1 Bromley 1 Unknown 3 Sidcup 1 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. 218 130 88 151 107 9 3 6 3 In 61 cases no inquests were held, the necessary certificate being issued by the Coroner. The causes of death were as follows:— Natural causes 124 Accidental causes 61 Suicide while of unsound mind 23 Open verdicts 7 Misadventure 1 Murder 2 Total 218 3 bodies were left at the Mortuary, after the inquest, to await burial, owing to advanced decomposition. 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 Assistant Medical Officer of Health.) S. Eleanor Hill, M.D., B.S. (Maternity and Child Welfare.) M. I. Outram, M.B., CH.B., D.P.H. (Part-time Maternity and Child Welfare.) Obstetric Consultant. W. Gilliatt, M.D., F.R.C.S. (For Maternity Home and under Puerperal Fever and Pyrexia Regulations.) Obstetric Consultants. G. F. Gibberd, F.R.C.S. A. L. Walker, F.R.C.S. Bacteriologist. Arthur Davies, M.D., M.R.C.P. (Dreadnought Hospital) Dentist. J. Eric Magraw, L.D.S. Public Analyst. Henry G. Harrison, M.A., F.I.C. Deputy Public Analyst. Hugh A. Williams, A.C.G.F.C., 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. 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. s.i.e b. 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. Cloke General and Children's Training, c.m.b., New H.V. Cert. 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. (Resigned 11th J uly, 1934) *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.). *Part-time only at Infant Welfare Centres. 22 Tuberculosis Dispensary. 0 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 Disinfectors—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, diarrhoea, poliomyelitis and ophthalmia neonatorum. During epidemic periods, pneumonia and influenzal pneumonia (all ages) are included. Payment is made by the Borough Council at the rate of 1s. 3d. per nursing visit. 23 The following is a summary of the cases visited on behalf of the Borough Council by members of the District Nursing Associations:— Condition. Children under 5 years Others Total cases nursed Cases Visits Cases Visits Measles 24 446 8 119 32 Ophthalmia Neonatorum 11 255 11 Pneumonia 17 419 1 42 18 Thread Worms 1 8 1 Conjunctivitis 2 48 2 Diarrhoea 4 13 4 Chicken-pox 2 7 2 Whooping cough 3 40 3 Otorrhoea 2 58 2 Bronchitis 5 67 5 Maternity Case 2 29 2 71 1361 11 190 82 Mid wives. The Borough Council is not the supervising authority under the Midwives Acts. From a return provided by the County Council, the number of midwives practising in the Borough is estimated at twenty. No subsidy was paid to midwives during the year under report, but the Council decided to include in the financial estimates for the year 1935/36 a sum of £15 for the provision of midwives, in necessitous cases, either to act as midwives or, where a doctor is in attendance, to act as maternity nurses. 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. 24 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. 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, the Borough Council, by arrangement, sends 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. 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." 25 Institutional provision for Unmarried Mothers, Illegitimate Infants, etc. No provision. Ambulance Facilities. These were fully set out in my report for 1930. The facilities for the removal without charge of parturient women to hospitals within the County of London which, hitherto, have been available only between the hours of 11 p.m. and 8 a.m., are now extended to cover the period by day as well as by night. Health Visiting. See " Maternity and Child Welfare." Infant Life Protection. For details, see " Maternity and Child Welfare." Orthopœdic Treatment. No scheme has been adopted, individual children being referred to private doctors or to hospitals. 26 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). Venereal Diseases. Miller Hospital, Greenwich, S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Hospital, Morden Hill, Lewisham, S.E. 13. Clinic Hours— Men: Tuesday 5.30 p.m. Thursday 9.30 a.m. Women: Monday, 3 p.m. Thursday, 6.15 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. Any week-day, 9 a.m. to 8 p.m. King's College Hospital, Denmark Hill, S.E. 5. Syphilis—Tuesday, 4.30 p.m. Wednesday and Friday, 11a.m. Thursday, 2 p.m. Gonorrhoea—Monday, 2 p.m. Men. 6 p.m., Women and Children. Wednesday, 6 p.m., Women and Children. Thursday, 5 p.m., Men. Friday, 2 p.m., Women and Children. 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. 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. 9.30a.m. Day Nursery School. (Open Air) The "Rachael McMillan" Memorial School. Sanitary Circumstances, etc., AND Factory and Workshops Acts. 28 SANITARY WORK. In accordance with my usual practice, I submit herewith the general statement as to the past year's work, together with comparative figures for previous years:— 1929 1930 1931 1932 1933 1934 Total primary inspections 5,825 8,004 7,592 6,652 8,166 8,039 Total re-inspect ions 14,545 18,167 20,461 17,284 18,105 17,704 Total Intimation Notices served 2,860 3,458 3,552 2,623 2,748 2,656 Total Statutory Notices served 302 1,078 1,104 687 777 632 Total Housing Act Notices served 3 42 12 10 18 4 Total premises on which works were completed 2,831 3,855 3,941 2,990 3,116 2,977 Total improvements effected during the year 9,234 12,053 14,116 10,928 12,440 11,185 It will be noted that the high standard which has been attained during the past few years has been maintained. In addition to the above, 2,642 inspections and calls have been made by the Food Inspector. 29 Summary of Sanitary Work carried out during the year 1934. Number of district. Compara- tive figures for 1933. 1 2 3 4 5 6 7 Totals Inspections— On complaint 128 240 173 208 187 131 118 1242 1049 House-to-house— 1. Where defects found 232 187 211 208 94 119 55 1106 1238 2. Where no defects found 74 49 91 79 33 65 35 426 349 On occurrence of Infection 118 142 120 146 187 190 156 1059 1320 On Notice from builder 75 43 48 71 49 55 70 411 344 Reference from T. B. Dispensary 2 5 3 5 9 3 3 30 14 Market Inspection 12 13 13 13 12 12 14 89 88 Factories 2 24 17 9 16 11 3 82 79 Workshops 3 4 19 2 6 9 10 53 44 Milk premises 35 117 53 21 35 69 18 348 395 Workplaces 11 3 30 5 2 5 2 58 92 Food premises (restaurants, etc.) 29 6 65 9 15 8 12 144 160 Butchers' premises ... 1 13 4 5 11 3 37 50 Fish premises 26 21 20 51 28 35 26 207 218 Common Lodging Houses ... 8 53 ... ... 14 18 93 146 Offensive businesses ... ... 28 1 ... ... 1 30 26 Ice Cream premises 3 19 35 9 9 32 7 114 154 Bakehouses 19 9 12 22 13 9 11 95 102 Outworkers' premises 11 9 13 2 14 8 8 65 107 Miscellaneous inspections 207 350 385 263 251 540 354 2350 2191 Total inspections 1044 1250 1402 1128 965 1326 924 8039 8166 Re-inspections, Calls, etc. 2146 2186 2635 2887 2384 2475 2991 17704 18105 Smoke observations 2 2 7 ... 2 1 4 18 19 Notices Served— Intimation 436 394 365 530 333 331 267 2656 2748 Statutory 48 131 79 187 70 82 35 632 777 Housing Act (Sec. 17) ... 1 ... ... ... 3 ... 4 18 Premises in respect of which notices were complied with 526 435 415 575 345 370 311 2977 3116 Premises in respect of which works in compliance with notices served during the year 1934 were outstanding at the end of the year 53 52 22 50 47 59 31 314 279 Description of Sanitary Improvemeuts effected during the year— Number of rooms cleansed 767 802 677 814 496 441 202 4199 4517 Defective roofs repaired 68 103 32 70 33 61 26 393 473 Gutters or rainwater pipes pro vided or repaired 75 108 50 72 34 38 23 400 427 Dampness abated Yards and forecourts paved o 33 66 80 54 42 75 36 386 502 paving repaired 5C 77 72 48 55 52 42 396 467 Water Fittings repaired 15 11 12 20 11 16 24 109 117 30 Summary of Sanitary Work—continued. Number of District. Comparative figures for 1933. 1 2 3 4 5 6 7 Totals Sinks and waste-pipes renewed or repaired 93 154 43 79 47 121 48 585 602 Drains entirely reconstructed ... 5 2 13 22 2 20 64 91 Drains partially reconstructed 6 5 7 11 11 27 29 96 100 Drains unchoked and cleansed 19 24 28 22 23 18 21 155 139 Soil and vent pipes renewed or repaired 10 2 15 16 9 25 41 118 119 Gullies provided, unchoked, etc. 8 15 20 23 35 29 63 193 228 Manholes, chambers, fresh-air inlets, etc., provided or repaired 17 14 12 28 33 24 43 171 203 Premises in which repairs were effected to w.c's. 141 236 267 192 107 189 151 1283 1466 Repairs effected to windows, sashes, etc. 130 127 103 113 63 95 19 650 780 Repairs to stoves, coppers and flues 38 156 126 100 50 70 26 566 658 Repairs to stairs, doors, etc. 36 30 62 50 20 19 10 227 300 Repairs to floors 34 64 57 28 27 38 28 276 334 Fish shops limewashed 22 10 12 32 14 26 22 138 120 Bakehouses limewashed 10 4 8 11 ... 5 10 48 46 Ventilation and lighting improved 23 6 9 48 5 10 5 106 110 Offensive accumulations removed 3 10 6 6 11 1 37 45 Dustbins provided 90 48 47 83 72 52 35 427 463 Miscellaneous repairs and improvements effected 12 8 29 40 23 28 22 162 133 Total repairs and improvements effected 1700 2075 1780 1973 1238 1472 947 11185 12440 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. 1,532 house-to-house inspections were made. These inspections were carried out in the following streets:— Addey Street Adolphus Street Alexandra Street Alpine Road Ashmead Road Berthon Street Bolina Road Brockmill Road Childeric Road Childers Street Chipley Street Church Street Deloraine Street Dennett's Road Desmond Street Dorking Road Douglas Street Etta Street Fawcett Road Franklin's Grove Friendly Street Gellatly Road Glenville Grove Hales Street Haydock Road Knoyle Street Leonidas Street Liardet Street Napier Street Norfolk House Rectory Buildings Reginald Road Rollins Street Rolt Street St. John's Road Sanford Street Shardeloes Road Somerville Road Stanley Street Vansittart Street Walsham Road Warwick Street Whitcher Street 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. 1934 £ s. d. £ s. d. July 27 L.C.C. (General Powers) Act, 1928—Sec. 28—Application for order for compulsory removal of aged or infirm person to hospital from 14 Wallbutton Road - - Order made for removal and detention at St. Alfege Hospital for 3 months. 30 Applicant for warrant to enter above premises by force if necessary — — Order made and person removed to hospital. Aug. 10 Non compliance with statutory notice served in respect of drainage at 9 Camplin Street - 4 0 Order for work to be carried out within 7 days. Necessary work eventually carried out by the Council and proceedings instituted for recovery of costs from owner. Nov.'27 Non-compliance with statutory notice served in respect of 74 Reculver Road - - Work carried out prior to hearing. Adjournment for roof repairs to be tested. 27 Do. do. 68 Render St. — — Do. do. 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 weekended 10th November, in what is known as National Rat Week, the 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 found necessary to apply to the Court for one 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. Twelve samples were taken in 1934. 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 64 premises was entirely reconstructed during the year, in 96 instances partly reconstructed, and in 155 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, and a recurrence of this trouble took place upon the 25th June. The premises affected were immediately visited with a view to the abatement of any insanitary conditions. 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 c 34 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. 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, 67 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 152 new premises could be properly granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. Two certificates were applied for and granted 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 3lst December, 1934, 12 visits were made, on the following dates:— February 21st; March 8th and 29th; April 26th; May 10th; June 29th; July 24th; August 23rd; October 8th; November 12th; and December 10th and 31st. 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 112 5 — Workshops 148 8 — Workplaces 908 21 — Total 1168 34 — The types of premises inspected were as follows:— Type. Factories, Number. Workshops, Number. Workplaces, Number. Bakehouses 18 30 Chemical Works 3 4 Cinemas, etc. 1 6 Dressmakers, Milliners, etc. 12 12 Engineering, general 37 3 ,, motoring 8 10 7 Foundries 5 Food preparation 16 5 424 Glass bottle makers 1 Laundries, Cleaners, etc. 4 6 1 Marine Stores 3 9 Paint and Varnish Works 4 Printers 4 1 Shoeing Forges 1 Stables, etc. 81 Sawmills 7 Timber Stores 1 1 12 Tar Refiners 2 Tailors 3 5 8 Woodwork, Joiners, etc. 13 6 Woodchoppers 5 5 5 Whitening Manufacturers 3 Offensive trades 4 Miscellaneous 71 55 73 Totals 209 148 638 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 32 30 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors 2 1 — — Other Nuisances 35 32 — — Sanitary Accommodation Insufficient — — — — Unsuitable or defective 15 13 — — Not Separate for Sexes — — — — Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bakehouse (sec. 101) — — — — Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) — — — — Other Offences (excluding offences relating to outwork) — — — — Total 84 76 — — The number of inspections made to Home Workers' Dwellings was 65. 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 two instances; notices were served and the conditions remedied. Housing. 38 HOUSING CONDITIONS. In a district where so much old property exists, there is need for constant supervision, and the details given both under " Sanitary Administration " and in the following tabular statements illustrate the large amount of work carried through. Considerable time was also necessarily spent upon a general survey of the Borough with a view to the ascertainment of any houses which could be represented to the Council as falling within the scope of either Part I or Part II of the Housing Act. The following is a record of the Representations made during 1934 :— Clearance Areas. Area No. of houses No. of persons Watson Street 5 14 Stanhope Street 94 629 Pomeroy Street No. I 2 7 Do. No. II 4 39 Kender Place 31 154 Spring Street 22 180 Mary Ann Buildings 19 89 Albert Cottages 7 42 > Individual Dwelling-Houses. 4 Parts or Buildings Separately Let. 1 Underground Sleeping Rooms. 5 The following table records the work done in connection with housing inspection : — 1. Unfit Dwelling-Houses. I aspect ion— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6639 (6) Number of inspections made 6782 39 Inspection—continued. (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925 1532 (b) Number of inspections made for this purpose 1532 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 189 (4) Number of dwelling-houses (exclusive of those in (3) found not to be in all respects reasonably fit for human habitation 2624 . 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) 2338 . 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 4* (2) Number of dwelling-houses which were rendered fit after service of formal Notice :— (a) By owners —* (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) 632 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices :— (a) By owners 627 (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 4 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 2l *Works carried out by owners early in 1935. † Relating to houses in respect of which Demolition Orders were made in 1933. 40 (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 41 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil ‡ Five underground sleeping rooms in four separate tenements. The following is a record of the action taken in addition to that shown under (C) and (D) above in respect of the balance of the Representations made by me up to the 31st December, 1934 :— Houses or parts of houses. Dwelling-houses demolished upon a Clearance Area (Fisher's Rents) 11 Watson Street Area—Clearance Order made. Stanhope Street Area. Pomeroy Streef No. I and No. II Areas. Render Place Area. L.C.C. asked to deal with these Areas. Spring Street Area, Mary Ann Buildings Area. L.C.C. asked by Borough Council to pass necessary resolutions, purchase properties and convey to Borough Council the cleared sites on basis of actual cost. Albert Cottages Area Under consideration. No. Undertakings accepted in respect of individual dwelling- houses 1 Undertakings accepted in respect of part of house separately occupied 1 During the year the County Council proceeded with the purchase and development of the following Clearance Areas :— Bate Place Area 0.5 acres Bronze Street Area 2.86 „ Speedwell Street Area 2.65 ,, 41 Upon the land known as the Honor Oak Estate, the County Council have now completed within the Borough of Deptford seven blocks comprising 192 tenements and 8 shops. Private enterprise built 47 houses. 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 1934:— Families Downham Estate 120 Honor Oak Estate 108 Bellingham Estate 54 Deptford Park Estate 47 Becontree Estate 42 St. Helier Estate 40 Hughes' Fields Estate 34 East Greenwich Estate 16 Other estates 15 Total 476 This total represents 99 more families than were housed during the year 1933. 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. The following is a tabular statement of the visits made by Mr. Yates, Food Inspector:— No. of Visits. Market inspection 96 Food premises (Restaurants, etc.) 312 Fish premises 21 Slaughterhouses 202 Butchers' premises 854 Milk premises 47 Miscellaneous 67 St. George's Wharf 108 Calls (Stalls, etc.) 935 2642 I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 33 applications for registration (including 27 transfers) in respect of premises were granted during the year. At the end of the year there were 155 premises registered for the sale of milk. In addition to the above, 79 persons were registered for the sale of unopened bottled milk only, and 30 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 348 inspections of milk shops were made by the District Sanitary Inspectors and 47 by the Food Inspector. Two Intimation notices were served and many minor matters were remedied as the result of verbal intimation by the Inspectors. 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" (Pasteurised) Milk at or from one shop. Two retailers „ Grade "A" (Tuberculin Tested) Milk at two shops. Ten „ „ Pasteurised Milk at or from 23 shops. Four retailers whose premises are outside the Borough to sell Pasteurised Milk within the Borough. Three retailers whose premises are outside the Borough to sell Grade "A" (Tuberculin Tested) Milk within the Borough. One retailer whose premises are outside the Borough to sell Grade "A" (Pasteurised) Milk within the Borough. Bacteriological Examination of Milk. Thirty-one samples of Milk were examined bacteriologically with the following results:— Designation. Total Count in 1 cc. Designation. Total Count in 1 cc. Grade "A" Tuberculin Tested 6,900 Pasteurised 6,720 „ „ „ 6,300 „ 38,100 „ „ „ 6,700 „ 27,400 „ „ „ 3,100 „ 141,000* „ „ „ 3,300 „ 8,000 „ „ „ 1,690 „ 564,000* „ „ „ 1,530 „ 4,326 „ „ „ 2,560 „ 7,086 „ „ „ 120,000 „ 3,500 „ „ „ 684 „ 7,550 „ „ „ 2,320 „ 4,900 Pasteurised 30,600 „ 9,200 „ 13,500 „ 24,500 „ 5,360 „ 11,400 „ 9,000 „ 116,000* „ 820 *These samples showed a microbic content above the Standard. 46 In the case of samples not within the standard, the results were reported to the Ministry of Health and to the County Medical Officer concerned. Animal Inoculation. Thirty-six 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, 202 visits having been paid by the Food Inspector. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 242 bullocks. 66 calves. 1816 sheep. 249 pigs. The Borough Council has licensed 7 slaughtermen in connection with these premises. Destroyed—Surrendered at Slaughterhouses. Bullocks' mesenteric fat, 1. Bullocks' head and tongue 9. Bullock (entire) 1. Bullocks' plucks 2. Bullocks' kidneys 1 set. Bullocks' livers 41. Bullocks' lungs 6. Bullocks' offal 3 sets. Pigs' lungs 9. Pigs' heads 2. Pigs (entire) 3. Pigs' plucks 5. Pigs' livers 11. Sheep's lungs 3. (b) Poultry Slaughterer. There is one poultry slaughtering establishment. During the year 9,266 head of poultry were slaughtered. (c) Shops and Stalls. The following Food Stalls are registered:— Fruit, Vegetables 41 Ice Cream and/or Baked Chestnuts 17 Coffee Stalls 7 Fish and/or Poultry 8 Meat 4 Grocery 7 Refreshments 2 Proprietary Medicines 3 Confectionery 1 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, and all places already registered, regular inspection is made. 95 premises were so registered at the end of the year under report. 3. Other Food Premises. {a) Workshop Bakehouses. There are 30 such bakehouses in the Borough, 10 of which are underground. 59 inspections were made during the year. 1 Intimation notice was served for the remedy of general defects and apart from minor defects, remedied upon verbal intimation, 59 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. 207 inspections were made by the District Sanitary Inspectors and 21 by the Food Inspector. 180 Notices were served for cleansing, and 1 for general matters. (d) Ice Cream Premises. There were 165 separate premises recorded. To these, 114 visits were paid. 1 Intimation notice was served, and many verbal intimations were given regarding minor matters. (e) Other Premises. There are 316 miscellaneous premises connected with food preparation or sale, and 1,414 inspections were made to these. Seven Notices to remedy insanitary conditions was served, in addition to numerous verbal intimations regarding minor matters. (f) St. George's Wharf. Public Health (Imported Food) Regulations, 1925. 48 During the year 1934, large quantities of foodstuffs were imported at the Wharf, and the following is a summary of the work done:— Description. Weight. Examination Remarks. Fruit Pulp 130 cases 10 per cent. „ 2916 „ Overside Beans 14668 bags Overside „ 75 tons Overside 3006 bags 10 per cent. Onions 240 „ 2 per cent. Flour 80133 „ Overside „ 30 tons Overside „ 331 bags 10 per cent. Preserves 5017 cases 10 per cent. „ 20 „ Overside Condensed Milk 7454 „ 10 per cent. „ „ 34750 „ Overside Yeast 8 „ 10 per cent. Peas 1566 „ 10 per cent. „ 4879 „ Overside Dates 30 „ 10 per cent. „ 1355 „ 2 per cent. „ 5930 „ Overside Chocolate Cubes and Biscuits 64 „ Stopped for analysis. Found to contain boric preservative. Re-exported 22.3.34. Cheese 64 cases 10 per cent. Raisins 100 „ 10 per cent. Egg Albumen 338 „ 10 per cent. Corned Beef 550 „ Overside Hams 320 „ 10 per cent. „ 226 „ 2 per cent. „ 100 „ Overside Coffee 904 bags Overside Bacon 200 bales Overside „ 200 „ 10 per cent. Confectionery 466 cases 10 per cent. „ 25 „ Overside Packet Soups 2168 „ 10 per cent. Tinned Vegetables 203 „ 10 per cent. „ „ 200 „ Overside Flour Foods 694 „ 10 per cent. „ „ 200 „ Overside Casein 488 „ 10 per cent. Tinned Fish 883 „ 10 per cent. Walnuts 17 „ 10 per cent. Aimonds 82 „ 10 per cent. „ 845 „ Overside 49 Description. Weight. Examination. Remarks. Figs 1000 „ 10 per cent. Sausage Casings 29 casks 10 per cent. Fish 821 cases 10 per cent. „ 1633 „ Overside Honey 13 „ 10 per cent. Biscuits 2243 „ 10 per cent. „ 33 „ Overside Grape-fruit 746 „ 10 per cent. Butter 366 „ 10 per cent. „ 900 „ 2 per cent. 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. The following quantities of food were voluntarily surrendered during the year:— Meat Meat Beef, 16 lbs. Sheep's lungs, 3 sets Bullocks' mesenteric fat, 1 set Veal, 15 lbs. Bullocks' livers, 41 Bullocks' lungs, 6 Fish Bullocks' offal, 3 sets Shake Bullocks' heads and tongues, 9 Herrings, 45 1bs. Bullock (entire), 1 Fowl Ham, 17½ lbs. Chickens, 14 Meat, 1 cwt. 3 qrs, 16 lbs. Turkeys, 10 Pigs (entire), 3 Pigs' plucks, 5 Fruit Pigs' livers, 11 Tomatoes, 2 cwt. 21 lbs. Pigs' heads, 2 Pigs' lungs, 9 Vegetable Pork, 50 lbs. Celery, 3 cwt. Cauliflowers, 4 cwt. 3 qrs. 50 III. Food Poisoning. The following is an analysis of the notifications received, grouped according to the causal agent:— Food. No. of cases. Tinned Salmon 2 cases Ham 3 „ Fried Fish 2 „ Meat Pie 3 „ Beef Sausages 1 „ Mussels 1 „ Fish 1 „ Stewed Plums 1 „ Pressed Beef 1 „ (Uncertain) 2 „ 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. In any case where a particular food appears to be definitely incriminated, bacteriological and chemical examination of the food, and serological examination of the patient's blood, excreta, etc., are carried out and the results communicated to the Ministry. 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, the Babies' Hospital, the Maternity Home, 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 and chemical content 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. 51 The following is a statement of the sampling done and results obtained in 1934:— Total. Number Adulterated. Percentage of samples adulterated. Formal samples Informal samples 306 194 4 10 1.9 % 5.2 % Total 500 14 2.8 % 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 1933 500 1.4 The following is a statement of the samples purchased and submitted for analysis during 1934. D 2 52 Food and Drugs (Adulteration) Act, 1928. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Formal Samples— Almonds, Oil of 1 .. 1 .. Arrowroot, Ground 1 .. 1 .. Aspirin Tablets 1 .. 1 .. Baking Powder 1 .. 1 .. Beef, Minced 4 .. 4 .. Beer 2 .. 2 .. Brawn 1 .. ] .. Brandy 1 .. 1 .. Butter 7 .. 7 .. Chocolates 2 .. 2 .. Chocolate Easter Eggs 3 .. 3 .. Christmas Pudding 1 .. 1 .. Cocoa 1 .. 1 .. Coffee 1 .. 1 .. Curry Powder 1 .. 1 .. Dripping 5 .. 5 .. Faggots 1 .. 1 .. Fish Paste 1 .. 1 .. Fruits, dried 3 .. 3 .. Gin 3 .. 3 .. Ginger, ground 1 .. 1 .. Jam 1 .. 1 .. Lard 1 .. 1 .. Linseed, crushed 1 .. 1 .. Milk 212 .. 215 1.4 Mincemeat 1 .. 1 .. Mustard condiment 1 .. 1 .. Mustard 2 .. 2 .. Olive Oil, B.P. 1 .. 1 .. Pepper 4 .. 4 .. Rice, ground 1 .. 1 .. Rum 2 .. 2 .. Saveloy 1 .. 1 .. Sausages 8 .. 8 .. „ Preserved 7 .. 7 .. Soup Powder 1 .. 1 .. Spice, mixed 1 .. 1 .. Tea 1 .. 1 .. Vinegar 4 .. 4 .. „ Malt 1 .. 1 .. Whisky 5 1 6 16.6 Wine, non-alcoholic 4 •• 4 .. Total Formal Samples 302 4 306 13 Informal Samples— Baking Powder 1 .. 1 .. Beef, minced 2 .. 2 .. Biscuits 5 .. 5 .. „ fruit cubes 1 1 100.0 „ chocolate fingers 3 3 100.0 „ „ cubes 1 1 100.0 „ half sandwich 1 1 100.0 „ chocolate 4 .. 4 .. Carried forward 12 6 18 53 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Brought forward 12 6 18 Informal Samples—contd. Butter 6 .. 6 .. Cake 1 .. 1 .. Cayenne Pepper 2 .. 2 .. Cheese 2 .. 2 .. Chocolate Cream 1 .. 1 .. Cream 3 .. 3 .. Curry Powder 1 .. 1 .. Dripping 1 .. 1 .. Egg Substitute Powder 2 .. 2 .. Fish Paste 8 .. 8 .. Fish Cake 1 .. 1 .. Fruits, dried 6 .. 6 .. Ginger, ground 1 .. 1 .. Herrings, bottled 1 .. 1 .. Honey 1 .. 1 .. Horseradish Cream 2 .. 2 .. Jam 5 .. 5 .. Jelly, Table 15 .. 15 .. Lard 1 .. 1 .. Lemonade Powder 2 .. 2 .. Lemon Cheese 2 .. 2 .. Lemon Curd 2 .. 2 .. Margarine 1 .. 1 .. Marmalade 2 .. 2 .. Mayonnaise 1 .. 1 .. M eat Pastes 5 .. 5 .. Meat Pie 5 .. 5 .. Milk 2 .. 2 .. Milk, dried 5 .. 5 Milk, Condensed 12 .. 14 14.3 Mincemeat 2 .. 2 .. Mustard 1 .. 1 .. Mustard Condiment 1 .. 1 .. Mustard Compound 1 .. 1 .. Pepper 1 .. 1 .. Raspberry Powder 1 .. 1 .. Sausage 2 .. 2 .. Sausage Roll 1 .. 1 .. Sauce 7 .. 7 .. Soda Bicarbonate 1 .. 1 .. Sweets 13 .. 13 .. Spice, mixed 1 .. 1 .. Tea .. .. 2 1000 Tinned Foods 34 .. 34 .. Vinegar 4 .. 4 .. „ Malt 3 .. 3 .. Total Informal samples 184 10 194 52 54 Action Taken in regard to Formal Samples Purchased during the year 1934. Simple No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 5 G Milk 11 per cent. abstraction of fat. - - Vendor cautioned 12 TM Milk 8 per cent. added water - 4 4 0 Summons dismissed on payment of costs by defendant. 17 G Milk 17 percent. added water - 3 3 0 Do. 180 Y Whisky 15 per cent. excessive water. — 2 2 0 Do. 55 Public Health (Preservatives, etc. in Food) Regulations, 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. Frank Standish 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 issue of leaflets. At the Tuberculosis Dispensary, information—both verbal and printed—as to food values, is imparted at classes at which tuberculous persons or their wives attend. The practical side is not overlooked as demonstrations are also given in connection with the preparation and cooking of meals particularly suitable for tuberculous persons. Infectious and other Diseases. 58 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 1934. 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 1 .. .. .. 1 .. .. .. l .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 310 3 86 181 30 10 .. .. 309 19 .. 10 9 .. .. .. .. Erysipelas 55 1 .. 2 8 12 22 10 30 .. .. .. .. .. .. .. .. Scarlet Fever 552 3 164 294 53 37 1 .. 528 1 .. .. 1 .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 6 .. .. .. 1 5 .. .. 6 2 .. .. .. .. 2 .. .. Puerperal Pyrexia 15 .. .. .. 5 10 .. .. 12 3 .. .. .. 1 1 l .. Cerebro-Spinal Meningitis 3 .. 1 2 .. .. .. .. 3 1 .. 1 .. .. .. .. .. Poliomyelitis and Polioencephalitis 3 .. 1 1 1 .. .. .. 3 .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. 1 .. .. .. 1 1 .. .. .. 1 .. .. .. Ophthalmia Neonatorum 21 21 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. Anthrax 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 34 16 18 .. .. .. .. .. 5 26 24 2 .. .. .. .. .. *Acute Primary and Acute Influenzal Pneumonia 137 9 41 18 13 19 28 9 24 84 19 14 1 5 4 19 22 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Fox 107 6 39 57 4 1 .. .. 3 .. .. .. .. .. .. .. .. Posterior Basal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1247 59 350 555 117 96 51 19 929 137 43 27 11 7 7 20 22 * The deaths from Pneumonia include all forms of that disease, including many cases not notifiable as "Acute." 59 SEASONAL INCIDENCE OF NOTIFIABLE INFECTIOUS DISEASES. Disease. 1st quarter 2nd quarter 3rd quarter 4th quarter Total for year Diphtheria 58 66 64 122 310 Erysipelas 14 10 9 22 55 Scarlet Fever 159 117 106 170 552 Enteric Fever ... ... ... 1 1 Puerperal Fever 2 ... 2 2 6 Puerperal Pyrexia 5 3 5 2 15 Cerebro-spinal Meningitis 3 ... ... ... 3 Poliomyelitis 3 3 Ophthalmia Neonatorum 3 7 7 4 21 Infantile Diarrhoea, etc. 2 3 21 8 34 Acute Primary and Influenzal Pneumonia 50 40 12 35 137 Chicken Pox 42 14 29 22 107 Malaria ... ... ... ... ... Encephalitis Lethargica ... 1 ... ... 1 Anthrax 1 ... ... ... 1 Small Pox ... 1 ... ... 1 Totals 339 262 258 388 1247 Scarlet Fever. Year No. of Cases Attack Rate per 1,000 population No. of Deaths Case Mortality per cent. Average 1915-24 481 4.2 6 1.2 „ 1925-29 444 4.0 2.4 0.54 1930 571 5.1 3 0.5 1931 442 4.1 6 1.3 1932 580 5.5 4 0.7 1933 732 7.1 — 0.0 1934 552 5.4 1 0.2 Scarlet Fever, during 1934, showed a decrease, the cases being mainly mild. 60 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1934. 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 1 .. .. .. .. .. 1 .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 310 22 48 39 44 27 23 34 11 17 5 13 27 Erysipelas 55 3 6 7 6 1 5 9 3 7 1 5 2 Scarlet Fever 552 21 50 47 47 36 44 99 41 55 35 25 52 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. .. .. .. 1 .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 6 1 1 .. .. .. 1 2 .. .. .. .. 1 Puerperal Pyrexia 15 .. 2 1 1 3 3 1 1 .. 2 .. 1 Cerebro-Spinal Meningitis 3 .. .. 1 1 .. .. .. 1 .. .. .. .. Poliomyelitis and Polioencephalitis 3 .. 1 .. 2 .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 21 2 2 5 3 .. .. 2 1 1 1 3 1 Anthrax 1 1 .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) , 34 1 1 21 7 .. .. .. .. .. .. 2 2 Acute Primary and Acute Influenzal Pneumonia 137 10 7 15 19 23 16 12 8 4 4 13 6 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. 1 .. .. .. .. .. .. .. .. .. .. Chicken Pox 107 12 16 11 16 10 13 5 1 5 5 7 6 Posterior Basal Meningitis •• .. .. .. .. .. .. .. .. .. .. .. .. Totals 1247 73 135 147 146 100 106 164 68 89 53 68 98 61 Diphtheria. In the fourth quarter of the year there was a large increase in notifications, and co-incidentally cases of a more severe type came under notice. The number of deaths, which in recent years had fallen, reverted to the average for the years 1915-1924. 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 1934 310 3.1 19 6.2 In this connection, 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 Schick Tests. Total. Fully Inoculated. Partly Inoculated. No. of Inoculations given. Negative. Unknown Result. 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 1934 2 8 - 10 11 - 33 Positive. Number of Schick Re-tests. Total. Negative. Unknown Result 1927 - - — - 1928 34 134 13 181 1929 8 55 3 66 1930 5 39 1 45 1931 3 21 2 26 1932 2 15 — 17 1933 1 — — 1 1934 3 21 — 24 62 In all cases where a full immunizing course has Deen given, parents are requested to bring their children for the purpose of having a Schick re-test carried out. Small-pox. 1934—One case. 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:— Year. Year. 1929 (1-31 December) 61 1932 172 1930 445 1933 156 1931 152 1934 107 Anthrax. One case of Anthrax was notified in 1934. Treated at St. Olave's Hospital—Recovered. 63 Return made on or before the 9th of February, 1935, by Mr. E. S. Elliott, Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1933, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1933. Number of these Births duly entered by 31st Jan., 1935. No. of Births which on 31st Jan.. 1935 remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1935 not accounted for. Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1934. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1934. 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 611 214 3 - 235 26 8 2 32 91 - - South Deptford 458 222 - 16'2 12 4 6 23 22 - - Total 1069 436 3 - 404 38 12 8 55 113 616 423 Dated, February 5th, 1935. Successfully vaccinated after the declaration of conscientious objection, Nil. Total Number of Certificates for Year 1934 sent to other Vaccination Officers, 63. 64 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 1934 Cases 3 3 2 4 4 2 1 5 7+3 Deaths 1 — — 4 2 2 4 5 2 1 flncluding 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 1934 Cases 4 3 1 1 4 — 1 3 1 3 Deaths — — — — 1 — — — — — Encephalitis Lethargica. During the five years terminating 1924 (in which year the incidence reached its peak) the average annual number of cases notified was three. The subsequent figures were:— 1925 1926 1927 1928 1929 1930 1931 1932 1933 1G34 Cases 9 8 3 3 3 — — 1 — 1 Deaths 5 222 1 — — 22 1 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 Noti fied. 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 1934 137 84 0.8 65 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 1934 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 1933 1934 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 1934 Cases Notified 66 75 12 26 37 23 34 Deaths 28 15 17 9 23 15 27 All cases of Infantile Diarrhoea are investigated by the Health Visitors with the object of securing nursing assistance or hospital traatment 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 vears. 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 1934 6 2 1.2 From 1933 onwards, the death-rate is calculated per 1,000 total (live and still) births. E 66 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 1934 Cases 5 16 12 6 10* 17 17 15 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. Three deaths occurred. 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 1934 Cases 14 9 18 14 26 21 11 8 21 The following is a statement of the results of treatment in respect of the cases notified in 1934:— Vision Vision Since died Notified Treated unim- im- Total other At home In hospital paired paired blindness Causes 21 19 2 21 — — 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. 67 Erysipelas. 5 5 cases were notified during the year. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. Enteric Fever. One case was notified and recovered. Other Notifiable Disease. With the exception of Tubarculosis, which occupies a separate section of this Report, no notifiable disease, other than the foregoing, occurred during 1934. II. NON-NOTIFIABLE DISEASES. In the absence of formal notification, the reports from the head teachers of schools and a perusal of the death returns give some idea of the prevalence of these diseases. Their importance, however, cannot be stated and judged by the death-rate, for they are peculiarly liable to be the precursors of much chronic-disability and ill-health, the extent of which it is not possible to assess. This particularly applies to the following:— Influenza. The following indicates the mortality directly attributed to Influenza since 1920:— No. of Deaths. Percentage of total Deaths. Death rate per 1,000 population. Average 1920-1924 34 2.4 0.29 1925-1929 35 2.5 0.31 1930 6 0.5 0.05 1931 20 1.6 0.19 1932 26 2.0 0.25 1933 52 4.2 0.51 1934 11 0.8 0.11 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 1934 43 3.2 0.42 e2 68 Measles is not a notifiable disease, but during the year under report 1,369 cases were heard of through schools and other sources, and visited by the Health Visitors. The outbreak reached its peak between February and March. The children affected were chiefly from 3 to 6 years of age. Where the home accommodation was unsuitable, the patients were removed to hospital, and in 24 other instances nursing assistance was provided by the Council. 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 1934 18 1.4 0.18 Bacteriological Facilities. The Council's general bacteriological work is conducted at the Seamen's Hospital, Greenwich, while sputum for tubercle bacilli is ordinarily examined at the Tuberculosis Dispensary. The following is a summary of the work done:— Laboratory Work at Seamen's Hospital, Greenwich, 1934. Material. Number Positive. Number Negative. Total. Swabs for Diphtheria 177 884 1061 Swabs for Virulence Test — 2 2 Samples of Disinfectants 1 3 4 Sputum for Tuberculosis 13 55 68 Blood for Enteric Fever — 3 3 Urine for T.B. — 2 2 Stool for Enteric — 2 2 Stool for Dysentery — 1 1 Swab from ear for Hcemolytic Streptococci — 1 1 Hairs for Ringworm — 1 1 Swimming bath water — 12 12 'Note.—Other examinations are reported under " Food." 69 At the Tuberculosis Dispensary, 884 specimens of sputum were examined. Of these, 675 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 209 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 1090 ., ,, ,, Requests, rooms only 95 ,, ,, ,, „ bedding only 81 ,, ,, ,, Verminous conditions 190 ,, ,, ,, (Removals to L.C.C. establishments) 54 ,, ,, ,, (Private removals) 13 Total premises visited 1523 Number of rooms disinfected, formalin spray 1555 ,, ,, ,, sulphur 343 Total 1898 Number of articles disinfected (steam disinfector) 19346 Number of books disinfected (formalin lamp) 1007 ,, ,, articles destroyed at owners' request 1260 Special disinfections, etc.:— Verminous furniture—Four 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. 70 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 at e occasionally provided with a cleansing bath in a separate structure. During the year, 46 adults and 2,111 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. One case was so dealt with in 1934. 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. 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 1934 189 14.2 1.9 Disinfectants. III. OTHER DISEASES Gancer 71 Deaths from Cancer by Sex and Age. Average, Year Sex Under 25 years 25 to 45 years 45 to 65 years 65 to 75 years 75 years and upwards Totals 1925-29 Male 1.0 5.8 38.0 24.4 11.0 Female 0.6 7.4 36.2 21.2 13.4 1930 Male 1 3 36 24 15 79 Female 1 13 30 16 17 77 Total 2 16 66 40 32 156 1931 Male 1 4 47 24 11 87 Female — 8 43 22 14 87 Total 1 12 90 46 25 174 1932 Male 1 5 41 31 17 95 Female 1 5 39 29 14 88 Total 2 10 80 60 31 183 1933 Male 1 4 33 24 14 76 Female — 4 30 13 14 61 Total 1 8 63 37 28 137 1934 Male — 3 42 29 15 89 Female — 5 48 26 21 100 Total — 8 90 55 36 189 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. 74 TUBERCULOSIS. The following is a tabular statement of the cases coming to our knowledge by notification and otherwise:— Year. Pulmonary. Non-Pulmonary. M. F. Total per 1.000 of population. M. F. Total per 1.000 of population Average 1920-1924 129 104 2.02 39 36 0.66 1925 133 104 2.04 41 37 0.67 1926 107 73 1.56 29 22 0.44 1927 112 88 1.76 30 32 0.54 1928 103 76 1.59 35 18 0.47 1929 118 89 1.86 27 20 0.42 1930 97 84 1.63 35 17 0.47 1931 104 77 1.69 19 25 0.41 1932 107 88 1.82 23 22 0.42 1933 96 73 1.64 13 15 0.27 1934 82 63 1.43 29 23 0.51 The figures tor 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:— England and Wales, per 1,000 population. Deptford. per 1.000 population. Year. Pulmonary* Non-pulmonary. Pulmonary* Non-pulmonary. Average 1915-1924 0.99 0.29 1.17 0.28 1925 0.83 0.21 0.89 0.17 1926 0.77 0.19 0.79 0.11 1927 0.79 0.18 1.04 0.09 1928 0.75 0.17 0.95 0.21 1929 0.79 0.17 0.81 0.10 1930 0.74 0.16 1.02 0.13 1931 0.74 0.15 0.93 0.13 1932 0.69 0.15 0.86 0.12 1933 0.69 0.13 0.91 0.10 1934 — ; 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 1934:— 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, 1934, to the 'By international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under " Pulmonary," are now included under " Non pulmonary Tuberculosis." 75 Report of Tuberculosis Officer—continued. 31st December, 1934, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 171 ; 129 Pulmonary Tuberculosis and 42 Non-pulmonary, as compared with 149 Pulmonary and 24 Non-pulmonary for the previous year. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1934 to the 31st December, 1934. Notifications on Form A. Age Periods. Total Notifications on Form A. 0-] 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications. Pulmonary— Males ... 1 1 2 3 12 17 11 9 9 8 73 120 Females ... ... 1 2 3 8 11 15 6 9 1 ... 56 84 Non-Pulmonary Males ... '2 4 4 2 4 6 1 ... ... 1 24 26 Females ... ... 5 3 1 2 3 2 2 ... ... 18 22 76 Report of Tuberculosis Officer- —continued. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, otherwise than by formal notification. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up Total Cases Pulmonary—Males ... 1 ... ... 1 2 2 1 1 1 ... 9 „ —Females ... ... 1 ... 1 4 1 ... ... ... ... 7 Non-Pulmonary—Males ... 3 ... ... ... 2 ... ... ... ... ... 5 „ —Females 2 ... 3 ... ... ... ... ... ... ... 5 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— No. of Cases. Source of Information. Pulmonary. Non-Pulmonary. Death Returns Registrars 2 transferable deaths from Registrar-General 4 2 Posthumous notifications 3 " Transfers" from other areas (other than transferable deaths) 9 5 Form D (from Sanatorium) 1 - 77 Report of Tuberculosis Officer—continued• Supplemental Return—continued. Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1.934, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of Deptford 316 227 513 91 105 196 739 Number of cases removed from the Register during the year, inter alia of:— 1. Withdrawal of notification ... ... ... ... ... ... ... 2. Recovery from the disease 12 11 23 11 5 16 39 3. Death 64 36 100 3 1 4 104 78 Report of Tuberculosis Officer—continued. Notes on Tables of Notifications. Of the cases learned from the death returns, one was a case of meningitis, three were cases of pulmonary tuberculosis (two of whom were hospital cases), and the other of whom had been only two weeks in the borough. Of the cases notified after death, four were cases of meningitis and one a case of pulmonary disease. Four of the non-pulmonary cases died before the end of the year, three within a month of notification and one within two months of notification. 28 of the pulmonary cases died before the end of the year. 10 died within a month of notification. 6 ,, „ two months ,, 7 ,, ,, three ,, ,, Explanations have been requested from notifying doctors in cases where patients died very soon after notification or from doctors certifying cause of death where patient died un-notified. 79 Report of Tuberculosis Officer—continued. Home accommodation of 146 of the Cases notified in 1934 (hospital, lodging-house and "diagnosis not confirmed" cases omitted). CASES and Number in Family. 114 Pulmonary Tuberculosis. 32 Non-Pulmonary Tuberculosis. 77 Cases with T.B. in Sputum. Rooms. 37 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. 4 of 1 lof 1 2 of 1 3 of 1 3 of 2 4 of 2 4 of 2 lof 2 lof 2 1 of 2 4 of 2 2 of 2 1 of 2 5 of o 3 of 3 3 of 3 1 of 3 3 of 3 1 of 3 2 of 3 5 of 3 2 of 3 2 of 4 3 of 4 6 of 4 1 of 4 2 of 4 2 of 4 1 of 4 2 of 4 1 of 4 1 of 4 3 of 4 2 of 4 1 of 4 1 of 5 4 of 5 3 of 5 2 of 5 1 of 5 2 of 5 1 of 5 3 of 5 2 of 5 1 of 5 1 of 5 1 of 5 2 of 5 1 of 6 6 of 6 2 of 6 3 of 6 l of 6 2 of 6 l of 6 1 of 6 l of 6 2 of 6 1 of 6 3 of 7 lof 7 l of 7 1 of 7 2 of 7 lof 7 lof 7 l of 8 1 of 8 1 of 8 1 of 8 l of 8 1 of 8 1 of 8 1 of 9 l of 9 l of 9 l of 10 1 of 9 lof 10 29 had a separate room. 9 had a separate room. 9 had separate room. 7 had separate bed with 1 other in room 4 had separate bed but 1 other in room. 2 had separate bed, but 1 other in room. 3 „ „ 3 „ „ 3 ,, „ 2 3 „ „ 2 ,, 1 ,, ,, 3 ,, 15 had another in bed. 1 „ „ 3 1 „ „ 4 „ „ 2 ,, ,, 1 „ „ 1 „ „ 4 ,, 27 had another in bed. 2 „ „ 2 ,, 9 had another in bed. 5 ,, ,, & 1 other in room 2 had 2 others ,, 2 1 „ „ 1 „ „ 1 had 2 others ,, 1 „ „ 2 1 .. 2 „ „ 1 3 2 others ,, 1 „ „ 3 1 „ „ 1 1 „ „ 4 80 Report of Tuberculosis Officer—continued. The number of deaths for the year is 102 as compared with 104 for 1933. 1931 1932 1933 1934 Pulmonary deaths 100 92 94 92 Non Pulmonary deaths 14 13 10 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 1934. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary m f m f m f m f 0 - - - - - - - - 1 2 1 5 7 2 - 3 3 5 1 3 4 3 - - - - 10 2 3 4 4 - - 1 - 15 4 9 2 2 6 4 2 - 20 14 15 6 3 5 7 - - 25 19 16 6 2 9 8 - - 35 12 6 1 - 7 8 - - 45 10 9 - 2 12 5 - - 55 10 1 - - 11 2 - - 65 and upwards 8 - 1 - 6 - 1 - Totals 82 63 29 23 58 34 7 3 *Note—Including 26 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 1934. Not notified 6 Died before notification — Died within one week of notification 3 ,, ,, one week to one month 12 „ ,, one month to six months 22 ,, ,, six months to one year 13 ,, ,, one to two years 13 ,, ,, two to three years 9 „ „ three to four years 5 „ „ four to five years 2 „ „ five to six years 1 ,, „ six to seven years 2 M „ seven years and upwards 4 92 81 Report of Tuberculosis Officer—continued. The notifications of non-Pulmonary Tuberculosis were as follows:— Meningitis 1 Bones and joints 20 Peripheral glands 14 Skin and other organs 2 Abdominal 5 Total 42 Revision of Notification Register. During the year 242 cases of Pulmonary and 51 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 1934 as follows:— MALES FEMALES Total Under 15 Over 15 Under 15 Over 15 Pulmonary Tuberculosis 31 285 25 202 543 Non-Pulmonary Tuberculosis 48 43 62 43 196 Totals 79 328 87 245 739 Disinfection was carried out in 306 rooms, and articles of bedding, clothing, &c., were removed for sterilization. f 8-2 Report of Tuberculosis Officer—continued. Memo 37/T. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1934. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 43 32 3 6 12 14 4 3 55 46 7 9 117 352 (b) Diagnosis not completed . — — — — — — — — 7 6 5 2 20 (c) Non-tuberculous ... — — — — — — — — 69 76 34 36 215 B. Contacts examined during the vear:— {a) Definitely tuberculous — 2 1 2 — — — — — 2 1 2 5 171 (b) Diagnosis not completed ... — — — — — — — — 2 5 1 4 12 (c) Non-tuberculous ... — — — — — — — — 31 36 50 37 154 C.—Cases written oft the Dispensary Register as (a) Recovered... 7 4 3 3 2 1 1 1 9 5 4 4 22 410 (6) Non-tuberculous (including any such cases previously diagnosed and enter on the Dispensarv Register as T.B.) — — — — — — — — 107 117 87 77 388 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 209 153 12 24 37 35 32 28 246 188 44 52 530 563 (b) Diagnosis not completed ... — — — — — — — — 9 11 7 6 33 83 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 596 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 56 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 122 4. Cases written off during the year as Dead (all causes) ... 80 5. Number of attendances at the Dispensary (including Contacts) 2800 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 146 Number of G.P. 36 reports from practitioners 167 7. Number of consultations with medical practitioners: — (a) Personal 19 (b) Other 85 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 242 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes successful 3256 unsuccessful 642 3898 Visits to cases non-Dispensary cases successful 1566 unsuccessful 358 1924 10. Number of (a) Specimens of sputum, &c, examined 675 (b) X-ray examinations made in connection with Dispensary work 184 (c) Sputum examinations for non-Dispen- sary cases 209 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 3 12. Number of " T.B. plus " cases on Dispensary Register on the 31st December 283 Notes on Table I. It will be noted that the number of persons on the Dispensary Register on the 31st December, 1934 is 563, a slight decrease over figure at end of 1933. The number of patients coming into the Borough from other areas and of cases which had been lost F2 84 Report of Tuberculosis Officer—continued. sight of and returned to the Register, being 56 as compared with 23 in the previous year. " Transfers to other areas" and " Cases lost sight of " were 122 as compared with 108 in 1933. 80 deaths of Dispensary patients occurred, compared with 73 in the previous year. One patient had Ultra-violet light treatment for lupus. Twenty-seven patients have had artificial pneumothorax treatment "refills," making in all 433 attendances as compared with 379 in 1933. The treatment is arranged for at the Brompton, St. Thomas', Grove Park and Colindale Hospitals. Intimation was received from the County Medical Officer of Health that " refills " could be given at the local County Council General Hospital, either by the hospital staff or by the Tuberculosis Officer himself. If the latter course were adopted, the charge to this Council (including the necessary X-ray screening connected therewith) would be half that which would be made if the work was carried out by the hospital staff. This offer has been accepted and the Tuberculosis Officer is now doing a certain number of refills at St. Alfege Hospital. It is considered advisable in the interests of patients that one physician, having a knowledge of the course and progress of a particular case, should carry on the treatment. For this reason it was deemed expedient to allow patients whose artificial pneumo-thorax treatment had been started at a particular hospital to return there, on discharge from sanatorium, for refills. For the same reason, where a hospital asks that a patient, having this treatment there, should be one for whose payments the Council would accept liability, or where the patient himself asks to be allowed to go to any particular hospital, it is wise to accede to this, as the patient's confidence and co-operation is very important. For the above reasons and in consideration of the time involved, it is evident that not all cases can, with advantage, be taken over by the Tuberculosis Officer. 85 Report of Tuberculosis Officer—continued. Examination and Supervision of Contacts. Analysis of contacts of 166 of the cases primarily notified daring the year (including cases notified after death but excluding lodging-house cases and 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 No. of above seen at 166 81 45 40 Dispensary 104 69 22 13 Total contacts of cases seen at Dispensary— Adults 221 154 37 30 Children 112 71 17 24 No. of above contacts examined at Dispensary— Adults 54 36 12 6 Children 53 37 10 6 No. of notified cases not seen at Dispensary 62 12 23 27 Total contacts of above— Adults 101 19 32 50 Children 52 12 18 22 No. of above contacts examined at Dispensary — Adults 18 6 1 11 Children 17 6 — 11 Total School Contact Cards sent to School Medical Officer 88 (a) Classified as examined at Dispensary— Class 1* 9 Class 2* 34 (b) classifed as not amined at Dispensary Class 3* 45 *Class 1—Unsatisfactory cases. *Class 2—Apparently healthy cases. *Class 3—Not examined. Approximately sixty-two 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 sana- 86 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. 29 % of the total contacts were examined before the end of the year. 43% of the child ,, ,, ,, 22 % of the adult ,, ,, ,, Of the contacts of cases seen at the Dispensary, approximately 32 per cent. of the total and 47 per cent. of the child contacts were examined. Of the contacts of cases not seen at the Dispensary 18 per cent. of the total and 33 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 half the number. Figures for some years past show a similar percentage. In considering the number of contacts examined during the year, it is desirable to point out that in the Ministry of Health table (page 82), the term "contact" is restricted to persons who come, on advice, for examination purely as the result of recent notification of some member of the household. If a person comes because he has a cough or other suspicious symptoms and wishes to be examined to see if he is all right, he is not classed as a contact but as a "suspect." Five contacts, as defined above, were found to be tuberculous during the year under report, but 35 persons who had another member of their respective households notified in previous years, were seen during 1934 and found to be suffering from tuberculosis. The Tuberculin Testing of child contacts of tuberculosis was continued and the results, with notes as to action taken, are given below. 87 Report of Tuberculosis Officer—continued. 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. If any doubtful appearances were found, or if the child was in an unsatisfactory state of health, recommendations were made for treatment such as a period of convalescent treatment. Result of Tuberculin Skin Tests of 108 Children. Age 1-2 Group (12) Age 2—5 Group (19) Age 5—12 Group (58) Age 12—15 Group (19) 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 — — 2 — — 1 2 — 2 — 1 — Negative 1 1 4 5 3 2 12 8 3 5 1 1 Positive — — 4 — 1 7 5 5 21 2 1 8 In this group in one of the positive reactors with abnormal X-ray appearances, the parents refused convalescent treatment which was recommended. Another showed X-ray evidence of infection but left the district. One of the positive reactors showed suspicious X-ray appearances, but the parents were unwilling to let the child go away. Another sent to hospital for observation was subsequently notified. Six T.B. + contacts, + reactors, showed X-ray evidence of old disease. One with suspicious X-ray appearances was sent for convalescent treatment. Two positive reactors showed evidence of active disease and were sent to sanatorium. 88 Report of Tuberculosis Officer—continued. Dental Treatment. The number of patients for whom dental treatment was provided was 50 compared with 41 in 1933. 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. The Borough Council provides the services of a Dental Surgeon, who attends weekly. Treatment is free but, in the provision of dentures, persons able to contribute to the cost are assessed after consideration of a recommendation of the Tuberculosis Care Committee, by 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 12 patients were as follows:— £ s. d. Total cost of dentures and repairs 35 6 2 Total cost of free cases 14 8 0 Contributions from Approved Societies 7 8 6 ,, Public Assistance Committee 10 13 0 ,, Red Cross Society 1 16 8 ,, Patients 1 0 0 The Dental Surgeon, Mr. J. Eric Magraw, reports the following as a summary of the year's work:— Fillings. Cases. 50 Attendances. 243 Extractions. 115 Amalgam 19 ^ Plastic. 23 Scalings. 88 Dentures. 15 Repairs 8 Insured Persons. The number of insured persons on the Dispensary Register at the end of the year was 283. The number of reports from panel doctors in respect of patients on domiciliary treatment was 167. 89 Report of Tuberculosis Officer—continued. 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, 130 were sent by doctors. 186 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 continue the services of the part-time Visitor so that satisfactory home-visiting was obtained. The number of visits paid by the Health Visitors was 5,822 compared with 6,170 in the previous year. Reports are made on the undermentioned points respecting home conditions, contacts, etc.:— (a) Whether any assistance seems needed for the patient or family, and action taken, such as reference to the Secretary to the Tuberculosis Care Committee. (b) The health of Contacts, and whether they will attend the Dispensary for examination or go to their own doctors. (c) The extent to which the patient is taking care to prevent the spread of infection by following the advice given. (d) The sanitary condition of the home, defects reported and action taken to abate nuisances. In general, the aim has been to concentrate not only on the patient but on the family to prevent infection, to see that early disease is detected, and to improve home conditions from the sanitary and economic viewpoints. 197 of the new attenders were referred by the Council's staff. 90 Report of Tuberculosis Officer—continued. Bacteriological examinations of Sputa. The number of examinations of specimens for Dispensary cases was 675, as compared with 756 in 1933. In addition, 209 specimens were sent by practioners for examination. X-ray Diagnosis. The number of X-ray examinations is 184 compared with 164 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 51 persons. Institutional Treatment. 143 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. 12 patients refused treatment. 291 reports on the condition of the patients treated in previous years were sent to the County Council. 27 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. Deaths. Of the total deaths of Dispensary patients during 1934— 15 died within 3 months from the date of the first attendance. 6 ,, ,, 6 ,, ,, ,, ,, 9 12 43 ,, after 12 ,, ,, ,, ,, In addition, 7 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. 91 Report of Tuberculosis Officer—continued. 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., repouse metal work, leather work, gloves, trays, stools, mats, and embroidered bags, etc. An Exhibition of the work from the Deptford Centre and those of twelve other boroughs was held in October at the Carpenters' Hall in the City, and was opened by the Lord Mayor. Deptford stall sales amounted to £29 15s. 8d., of which £19 18s. was taken in cash. 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 outing to the seaside and another tea and evening entertainment, Councillor W. Taylor and other members of the Tuberculosis Care Committee assisting by providing artistes and refreshments. Thanks are due to the Manager and to artists from the New Cross Cinema, New Cross Empire and to other friends who gave their services. Mrs. Monk also obtained for the class, £9 9s. Od. This sum was raised through the kindness of Miss Mildred Campbell, who devoted to the object an excellent performance of " Cinderella," by her pupils. Cookery Class. During 1933 and 1934 there was considerable discussion upon the question of nourishment and the adequacy or otherwise of family incomes in this connection. It was considered advisable that an attempt should be made to give our women patients and 92 Report of Tuberculosis Officer—continued. the wives or mothers of patients some elementary instruction on food values, their composition, the various elements contained in commonly used articles of food, and the quantities of each required in the daily diets of adults and children of varying ages. To do this in such a way as to avoid the use of complicated figures liable to confuse people not accustomed to decimals and fractions, is not an easy task. However, a small pamphlet was published as propaganda matter, and steps were taken to establish a cookery class for the purpose of demonstrating in a practical manner the economic preparation and cooking of the less expensive but none the less nourishing articles of food, and presenting them to the table in the form of attractive dishes tending to stimulate the appetite. The South Metropolitan Gas Company were approached and they very generously agreed, not only to instal a cooker free of cost, but also to supply an instructress. These classes are now held each Tuesday with an average attendance of eighteen women. The teacher makes out a menu, such as a day's dietary, containing the necessary amounts of protein, carbohydrate, fat and vitamins, for a family of father, mother and three children of given ages. These menus are typed and given to the members of the class, who then see the various dishes prepared and cooked. The Secretary of the Care Committee refers in her report to the beneficial effects of these classes as reflected in the homes. To face page 92 Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a) PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 19S4 of all paiients remaining on the Dispensary Register; and (6) 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 1132 1933 1934 Class T.B. minus Class T.B. plus Clas-. T.B. minus Class T.B. plus s Class T B. minu Class T.B. plus Class T.B. minus. Class T.B. plus. Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. pit's 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 1 Group 3 Total (Class T.B. plus) Group 1 | Group 2 Group 3 Total (Class T.B. plus) Gro^P I 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) (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 4 3 4 7 1 2 l 4 4 4 l 2 2 4 3 2 3 5 3 3 3 6 3 4 7 l l 2 F. 3 1 2 3 l 1 1 1 3 1 2 3 2 2 1 1 4 4 1 1 Children 1 1 1 2 2 2 l 1 1 3 1 1 2 Disease not arrested Adults M. 2 5 9 14 3 l 4 3 l 4 1 2 3 1 1 4 l 6 1 1 6 l 8 3 11 2 16 6 12 12 6 2 19 3 24 8 3 14 8 25 F. 1 5 10 15 2 2 5 5 1 1 2 2 3 2 5 3 9 9 2 2 7 2 11 5 2 8 l 11 8 4 10 14 8 2 15 2 19 Children 2 1 1 1 2 6 3 1 4 Condition not ascertained during the Year 2 2 2 l 2 l 3 1 1 1 4 l 1 4 3 1 4 2 2 2 2 2 Total on Dispensary Register at 31st December 13 15 27 42 2 3 7 3 13 3 13 i 14 6 5 7 12 9 4 12 4 20 12 1 19 2 22 17 9 30 6 45 14 5 21 2 28 16 6 31 3 40 22 8 30 10 48 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 34 16 10 26 2 2 1 2 2 1 1 1 F. 59 10 6 16 3 1 1 1 Children 62 6 2 1 2 Lost sight of or otherwise removed from Dispensary Register 359 76 139 16 231 17 3 12 9 24 10 8 30 2 40 18 9 18 1 28 26 6 22 1 29 15 4 23 2 29 8 6 12 2 20 9 4 17 2 23 12 3 18 1 22 3 1 1 Dead Adults M. 38 39 147 36 222 3 4 20 15 39 2 1 28 8 37 2 2 16 11 29 4 2 21 10 33 3 20 8 28 2 2 17 3 22 3 22 8 33 1 1 15 9 25 7 7 F. 34 22 78 31 131 2 7 7 16 4 20 10 34 6 9 15 £ 4 13 9 26 1 1 13 12 26 2 2 9 10 21 2 18 4 22 5 4 6 10 4 3 7 Children 10 4 2 9 1 1 1 2 1 1 1 1 1 1 1 2 1 1 Total written off Dispensary Register 596 167 383 85 635 30 9 43 32 84 16 13 80 21 114 22 11 40 21 72. 34 13 57 20 90 20 5 56 22 83 12 10 38 15 63 11 7 58 15 80 18 4 37 16 57 3 1 5 10 16 Grand Totals 609 182 410 85 677 32 12 50 35 97 19 13 93 22 128 28 16 47 ' 21 84 43 17 69 24 110 32 6 75 24 105 29 19 68 21 108 25 12 79 17 108 34 10 68 19 97 25 9 35 20 64 Report of Tuberculosis Officer—continued. (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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 1934 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs Peripheral Glands Total. Bones and Joints Abdominal Other Org.«ns 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. 3 3 l 1 l l 1 1 3 3 l 1 2 2 2 F. 2 l 3 l l l l 2 l 1 1 1 2 Child ren 3 l 4 1 1 2 1 l 2 1 l 2 l 2 l 2 6 l l 2 4 4 1 2 3 Disease not arrested Adults M. 1 l l 3 l 1 l 1 2 2 2 1 3 1 1 2 2 3 4 7 F. 3 3 l l 2 2 2 1 1 1 1 1 1 1 1 2 7 2 9 Children 2 2 2 2 2 2 1 1 3 l 4 1 1 2 4 1 5 1 l 1 3 3 2 1 6 Condition not ascertained during the year 1 1 2 2 l 1 1 l 2 2 1 3 2 l l l 5 l 2 3 Total on Dispensary Register at 31st December 12 4 3 19 4 l 2 7 5 l 2 8 5 l l 7 5 1 3 9 6 3 l 2 12 7 l 3 3 14 7 l 10 18 6 2 6 14 13 2 2 7 24 Transferred to Pulmonary 2 1 1 4 2 l 1 4 1 1 2 2 1 1 1 1 2 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 15 3 1 4 23 2 1 3 2 l 3 1 1 F. 9 1 3 13 4 4 Children 17 6 52 75 1 1 1 l 1 4 7 4 4 3 3 1 1 Lost sight of or otherwise removed from Dispensary Register 43 10 10 55 118 l 1 8 10 2 3 3 5 13 6 2 4 1 13 4 2 1 2 6 4 2 3 5 14 3 2 7 12 6 l l 2 10 2 2 4 4 5 9 Dead 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 sary Register 100 21 16 115 252 4 1 1 9 15 4 5 4 13 26 7 4 4 6 21 5 3 1 6 15 4 2 3 6 15 3 2 7 12 9 2 1 3 15 4 2 6 4 5 9 Grand Totals of a and b (excluding those transferred to Pulmonary) 112 21 20 118 271 8 2 1 11 22 9 6 4 15 34 12 5 5 6 28 10 3 2 9 24 10 5 4 8 27 10 3 3 10 26 16 2 2 13 33 10 2 8 20 17 7 2 7 33 93 Report of the Work of the Tuberculosis Care Committee, 1 934 During the past year important changes and developments, with far-reaching effects, have taken place in connection with the work of the Tuberculosis Care Committee. In August, assessments towards the cost of institutional treatment for tuberculosis were abolished by the London County Council, a drastic change that, however, made little difference in the volume of the work, in so far as Deptford is concerned ; accounted for by the facts that only in a very small proportion of cases was an assessment made, and that the procedure for dealing with new cases remains practically unaltered. The number of cases to be dealt with by the Care Committee has been increased considerably by the addition of cases admitted to General Hospital, as reported upon last year. During the early part of the year under review, arrangements were made between the Borough Council and the South Metropolitan Gas Company for a series of cookery demonstrations to be held at the Health Centre—the gas cooker is supplied by the Gas Company, who also provide the services of a lady demonstrator. A grant made by the Borough Council is disbursed by the Care Committee for the small necessary expenses incurred for the provisions and cleaning. Economical, nourishing and appetising meals are prepared and cooked, and a typed copy of the recipes is presented to each member of the class. The real interest and keenness displayed by the wives and mothers of our tuberculous patients, together with their regular attendance, justifies the experiment, which can be considered a complete success. Another happening of importance occurred during the latter part of the year, when we became affiliated to the National Association for the Prevention of Tuberculosis. This event draws attention to a most important feature of our work. How much better prevention is than cure no one knows better than a Tuberculosis Care Committee worker, and we count it a privilege to be associated with a body that directs its main efforts to this end. Affiliation makes it possible to participate in the benefits derived from the Christmas Seal Sales, held under the auspices of the Association. Each Committee is responsible for organising 94 the sale in its own area, and retains the whole amount collected. Our first effort in this direction met with a generous response— £91 16s. 2d. was collected. Expenses amounted to £11 11s. 9d., leaving £80 4s. 5d. As the work of the Care Committee progresses, the need of a fund of our own becomes more apparent. We are most grateful to all those whose kindness and generosity have enabled us to start one, and increased our power to help those in trouble. During the year, 248 patients have been recommended for treatment. 1,094 visits have been paid to patients at home and in hospital. 1,226 persons have been interviewed at the Dispensary by the Care Committee. 1,096 cases have been considered by the Committees at their meetings. 2 children have been boarded out under the Contact Scheme, and one child was boarded out by the United Services Fund, while the mother was in sanatorium. Every case has been dealt with individually, and efforts made where necessary to assist the patient and the family to adjust their lives to the altered conditions imposed upon them, as a consequence of having contracted tuberculosis. Through appropriate societies and our own fund, we have helped those in need in many and various ways—clothing, beds, moving expenses, fares to hospital, extra nourishments, comforts for the dying, and pocket money for destitute and friendless cases in hospitals, are some of the forms of help it has been our privilege to offer. If really effective care work is to be performed, and to take its proper place as an adjunct to treatment, financial assistance is practically indispensable, and necessity rather than qualifications must constitute the claim. The equal importance of educating the patient and the family, and where possible helping them to be self-supporting, is not lost sight of—the double aim, we trust, works for the common good. For the fourth year in succession, our Chairman was elected Chairman of the Standing Conference of the Metropolitan Borough Care Committees. The Committees representatives have attended all the meetings held, and many useful suggestions and recommendations have been forwarded to the London County Council. 95 As the result of one recommendation made, and a deputation from the Conference to the Council, it was agreed that dependent contacts of tuberculous persons in cases where the family was in receipt of relief from the Public Assistance Committee, should be granted extra nourishment in addition to the ordinary family allowance. This instance will serve to indicate the value of the work that can be done by this particular body. Looking back over the year, we feel that real progress has been made. Looking forward, we realise how much there is still to be done, and know that we must not relax our efforts to enlist the help and sympathy of the community to aid us in the great fight. Maternity and Child Welfare. G 98 MATERNITY AND CHILD WELFARE. The chief activities of the scheme of the Deptford Borough Council include the following:— 1. The provision of a staff of Women Health Visitors for, inter alia, domiciliary visiting in connection with expectant and nursing mothers and children, certain infectious and contagious diseases, maternal and infant deaths and still-births, applications for admission to hospital or convalescent homes, the issue of milk and a variety of other duties not easily classified. 2. The provision, equipping and staffing of certain centres, including Infant, Ante-natal and Post-natal Clinics, Artificial Light and Dental treatment. 3. The provision of the service of Consulting Obstetricians. 4. The maintenance of a Maternity Home and the provision of accommodation in hospital for certain maternity cases. 5. The provision of sterile maternity outfits. 6. The provision of home nursing for certain mothers and children. 7. The provision of a "Home Help" before, during, or after confinement. 8. Accommodation in Convalescent Homes for Mothers and Children. 9. Hospital provision, both in-patient and out-patient, for certain infants. 10. The supplying of milk, either free, or at a reduced price. 11. Compensation to midwives in respect of "booked" cases sent to hospital. 12. Health Education by means of addresses and the distribution of booklets and leaflets. 1. Health Visiting. The following is a numerical summary of the home visits made by the individual Health Visitors and a statement of the reasons originating the visits. 99 Summary of Visits paid by Health Visitors, 1934. Wards (approximate) Deptford Park and Evelyn (part) St. Paul's and Evelyn (part) Vale and Clifton Canterbury and Hatcham Pepys and St. Catherine's St. Peter's St. John's and Town Hall Total. *Miss Robus Visits 1319 .. .. .. .. .. 1319 Revisits 2150 .. .. .. .. .. 2150 Total 3469 .. .. .. .. .. 3469 Miss Little Visits .. .. .. .. 1013 .. 1013 Revisits .. .. .. .. 1583 .. 1583 Total .. .. .. .. 2596 .. 2596 †Miss O'Loughlin Visits .. .. 919 .. .. .. 919 Revisits .. .. 2038 .. .. .. 2038 Total .. .. 2957 •• .. .. 2957 Miss Stowell Visits .. .. .. 911 .. .. 911 Revisits .. .. .. 2294 .. .. 2294 Total .. .. .. 3205 .. .. 3205 Miss Reynolds Visits .. .. .. .. .. 906 906 Revisits .. .. .. .. .. 2308 2308 Total .. .. .. .. .. 3214 3214 Miss Holland Visits .. .. .. .. .. 398 398 Revisits .. .. .. .. .. 2090 2090 Total .. .. .. .. .. 2488 2488 Miss Cloke (Commenced August 1st) Visits .. 250 .. .. .. .. 250 Revisits .. 998 .. .. .. .. 998 Total .. 1248 .. .. .. .. 1248 Miss Hudson (Temporary Visits .. .. 701 .. .. .. 701 Revisits .. .. 1630 .. .. .. 1630 Total .. .. 2331 .. .. .. 2331 Total Visits 1319 250 1620 911 1013 1304 6417 Revisits 2150 998 3668 2294 1583 4398 15091 Total 3469 1248 5288 3205 2596 5702 21508 *Miss Robus was transferred to St. Paul's and Evelyn (part) Wards from Deptford Park, etc., District, on August 1st. †Miss O'Loughlin was transferred from Deptford Park District to Vale and Clifton Wards on August 1st. G2 100 Analysis of Visits paid by Health Visitors, 1934. To infants under 5 years Enquiries re Visits. Re-visits. Total. Births 1588 11721 13309 Still-births 41 — 41 Infant deaths 156 — 156 Ophthalmia Neonatorum 27 33 60 Measles 686 687 1373 Suspected Measles 90 1 91 Infant Diarrhoea 44 23 67 Pneumonia 41 69 110 Whooping Cough 172 112 284 Poliomyelitis 1 12 13 Meningitis 1 1 2 Scarlet Fever recoveries 109 13 122 Scabies 27 16 43 Visits to Foster Children 17 112 129 Miscellaneous visits 151 7 158 Total (under 5 years) 3,151 12,807 15,958 To infants over 5 years Enquiries re Measles 513 339 852 Suspected Measles 31 8 39 Scarlet Fever recoveries 162 14 176 Whooping Cough 107 47 154 Scabies 40 39 79 Poliomyelitis 2 3 5 Encephalitis Lethargica — 1 1 Pneumonia 4 3 7 Visits to Foster Children 5 63 68 Miscellaneous visits 423 54 477 Total (over 5 years) 1287 571 1858 Other visits To expectant mothers 1040 411 1451 To Puerperal Fever or Pyrexia 11 9 20 Maternal death 3 - 3 To Common Lodging Houses 16 52 68 Total other visits 1,070 472 1,542 Unsuccessful visits 909 1241 2150 Totals 6,417 15,091 21,508 In the case of the 1,588 infants visited shortly after birth, it was found that 1,427 infants were being breast-fed and 68 partly breast-fed. Only 93 were entirely hand-fed. 101 Student Health Visitors. By arrangement with the College of Nursing, we have had four students, each for a period of six weeks, working with the Health Visitors. The students are State Registered Nurses and qualified midwives, who are taking a course of instruction for the Health Visitors' Certificate, and do part of their practical work with us. They help in the Infant Welfare Centres and do a certain number of re-visits, measles visits, etc., under the supervision of the Health Visitors. Attendances of Health Visitors at Clinics. Health Visitor. Infant Welfare. AnteNatal. Light. Schick. Dental. Total Miss Robus 93 10 — — — 103 Miss Little 112 2 11 — — 125 Miss O'Loughlin 112 1 — — 50 163 Miss Stowell 103 10 9 — — 122 Miss Reynolds 127 — 1 — — 128 Miss Holland 52 17 138 — 2 209 Miss Clubbe 167 167 71 8 — 413 Miss Gibson 198 47 — — — 245 Miss Cloke 51 2 — — — 53 Temporary Visitor 62 2 — — — 64 Total 1,077 258 230 8 52 1,625 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 are greatly appreciated. The following is a summary of the work done at the various Infant Welfare Clinics during the year:— (For details, see Appendix, Table IV.) Clinic. No. of times open. New Cases Attendances Consultations with Doctor Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under 1 year 1—5 years Gosterwood Street 49 170 30 200 3295 3495 2471 1024 1407 Napier Street 49 154 31 185 3302 3487 2585 902 1448 Besson Street 48 192 23 215 4060 4275 3189 1086 1378 Ilderton Road 51 92 7 99 2424 2523 179,3 730 1066 Goldsmiths' College 51 119 34 153 3272 3425 2486 939 1277 Hales Street 52 144 35 179 2721 2900 1836 1064 1547 St. George's Hall 51 131 26 157 3349 3506 2280 1226 1438 St. John's, Harton St. 51 89 7 96 2588 2684 1985 699 1229 Totals 402 1091 193 1284 25011 26295 18625 7670 10790 The Health Visitors collectively made 1,077 attendances at these Clinics. 102 The Hostel of Our Lady. 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, 171 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, 24 cases being thus dealt with. The co-operation of the Medical Practitioners and of the Midwives is sought and to them is forwarded the Report of the Medical Officer upon any woman sent by them for examination. Ante-Natal Clinic. The work of the Ante-natal Clinic during recent years is illustrated by the following figures. Year. No. of individual women attending. Average number of attendances per week. Total number of attendances made. 1922 311 19 938 1923 369 29 1439 1924 513 30 1497 1925 588 45 2268 1926 595 46 2292 1927 738 45 2241 1928 815 55 2777 1929 929 56 2915 1930 973 64 3212 1931 980 64 3289 1932 880 58 2994 1933 887 61 3182 1934 905 56 2931 The following is the text of Dr. Hill's Report for 1934:— Ante-Natal Clinic Statistics, 1934. Total number of Patients on Register 905 New Cases 751 Total Attendances 2931 Normal 192 Not pregnant 43 103 Abnormalitie:— Albuminuria 51 Anaemia 57 Ante-partum Haemorrhage 12 Arthritis of Knee 1 Asthma 1 Bronchitis 8 Contracted Pelvis 22 Cystitis 1 Dental Caries 381 Dyspepsia 3 Fistula 1 Glycosuria 8 Haemorrhoids 34 Hernia 2 Hydramnios 6 Indrawn nipples 32 Leucorrhœa 10 Malpresentation 21 Oedema 8 Ovarian Cyst 2 Pruritis 2 Psoriasis 1 Pyelitis 2 Scabies 3 Sciatica 10 Twins 6 Vomiting (excessive) 7 Varicose veins 64 Post-Natal Clinic. This branch of the work is conducted every Tuesday forenoon. New cases 186 Total attendances 203 Amongst the patients seen the following defects were found and dealt with:— Retroversion 9 Haemorrhoids 3 Cracked Nipple 2 Phlegmasia Alba Dolens 1 Breast Abscess 2 Leucorrhœa 2 In connection with both the Ante-natal and Post-natal work close co-operation is maintained with medical practitioners, midwives and hospitals. Reports sent to Tuberculosis Officer 7 Ditto to midwives 156 Ditto to doctors 153 Total number of cases referred by letter to hospitals, 30. 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 135 Total attendances made 762 104 (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 40 47 1 20 68 400 February 68 25 1 20 74 479 March 74 15 2 38 53 411 April 53 28 7 28 60 399 May 60 15 2 51 26 421 June 26 3 1 24 6 98 July 6 - - 6 - 6 August (No attendances) September — 12 1 — 13 39 October 13 18 2 2 31 153 November 31 37 3 6 65 358 December 65 10 — 13 62 292 Total 210 20 208 3,056 Classification of Patients during Year. Admissions. Re-admissions. Rickets 30 2 Malnutrition 22 5 Anaemia 55 2 Cervical Adenitis 15 2 Muscular Weakness 11 1 Delayed Dentition 47 5 Bronchitis 3 1 Curved Tibiae 8 2 Otorrhcea 3 — Genu Valgum 4 — Underweight 2 — Chronic Asthma 1 — Insomnia 2 — Post Whooping Cough 2 - Post Bronchitis 1 - Post Pneumonia 1 - Post Operative Debility 1 — Eczema 1 - Flat foot - 210 20 105 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 1934:— Cases. Extractions. Fillings. Scalings, Silver Nitrate etc. Gas Cases. Dentures Supplied. Repair'd Mothers 122 316 118 107 — 30 1 Children 41 70 5 99 20 — — In the case of the fillings for mothers, 71 were amalgam and 47 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. 106 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 1934 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 1934:— Cases admitted, 247. Average stay, 2 weeks. Cases delivered by midwives. 223. „ „ „ doctors, 5. Cases in which medical advice sought, 19. Cases notified as puerperal fever, Nil. „ „ „ puerperal pyrexia, Nil. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, 1. Maternal deaths, Nil. Foetal deaths (a) Stillborn, 4. (b) Within 10 days of birth, 2.* * Prematurity, Cholemia. 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 1934, it was not found necessary to call Mr. Gilliatt to the Home. Cases not admitted to the Maternity Home. During 1934, a total of 102 applications for admission were refused, owing to the available accommodation being fully booked. 107 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 86 Sold at half price 4 Sold at full price 14 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 27 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 1934, 24 cases were sent away. 9. Hospital Provision for Infants. (a) Deptford Babies' Hospital, Breakspears Road. During the year under review, substantial use was made of the facilities afforded at this hospital, established for the dietetic treatment of ailing infants and for difficulties associated with breast-feeding. The accommodation consists of 16 cots, together with two beds for mothers and infants and two cots for isolation purposes, while the breast-feeding clinic is housed in a detached building. The following cases received treatment:— 86 children admitted, of which 36 were sent by the Borough Council. 108 1074 test feeds were conducted at the Breast-feeding Clinic, of which all were sent by the Borough Council. 35 mothers with infants admitted as in-patients for restoration of Breast-feeding. With the opening of this hospital, the Borough Council ceased to make use of St. Thomas' Babies' Hospital, Kennington, for the aforesaid purposes. 10. Supply of Milk and Accessory Foods. The Borough Council's scheme provides for the issue of fluid and dried milk, at full cost, or free, or at half-cost, according to a Scale of Necessity, to (a) Expectant mothers during the last three months of pregnancy. (b) Nursing mothers. (c) Children up to three years, also, in exceptional circumstances to children between three and five years of age. The issue is in general accordance with the Minister of Health's Circular No. 185. Various brands of dried milk are issued, labelled specially to the Council's directions to avoid the use of trade names. In 1934, the following free or half-price issues were authorised:— 13,621 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 14 instances this policy was carried into effect, involving a total expenditure of £7 0s. 109 12. Health Education. As 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 individual mothers upon the maintenance of their children's health 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. 13. Maternal IVSortality. 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. 13. Infant Life Protection. In order to discharge the duties of registration and inspection of Fostermothers and Fosterchildren the Deptford Borough Council has appointed each of its seven District Health Visitors as an Infant Protection Visitor, and Dr. S. E. Hill, Maternity and Child Welfare Officer. is also authorised to visit. The following table shows the numbers on the Register during the year under report:— No. at end of 1933. Added. Removed. No. at end of year 1934. Fostermothers 20 14 10 24 Fosterchildren 23 18 13 28 Central Clinic. The Maternity and Child Welfare Committee has been desirous for some time of providing better facilities for its work by the establishment of a Central Clinic. Excellent as the results have been at the various branch clinics, there are obvious disadvantages in the use of premises not particularly adapted for the purpose. Moreover, the use 110 of a centrally situated clinic will permit of the development of certain ancillary branches of the Maternity and Child Welfare service. The Committee decided, therefore, to recommend the Council to acquire certain premises in Amersham Road, which will afford, in conjunction with a portion of adjacent land (already in the possession of the Council), a suitable site for the erection of the modern building contemplated by the Council and now sanctioned by the Ministry of Health. Appendix. 112 Table 1. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1934. CAUSES OF DEATH. Sex. All Ages 0— l— 2— 5— 15— 25— 35— 45— 55— 65— 75- All causes M 695 55 22 27 9 32 29 25 58 134 157 147 F 632 53 16 22 13 24 17 27 53 86 132 189 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. F . ... .. . . . . , . .. .. .. . . . . .. .. Measles M 25 3 10 11 1 .. .. .. .. .. .. .. F 18 1 6 9 2 .. .. .. .. .. .. .. Scarlet Fever M 1 .. .. .. 1 .. .. .. .. . . . . .. F .. .. .. .. .. .. .... .. .. .. .. .. Whooping Cough M 6 1 3 2 . . .. .. .. . . . , . . . , F 12 5 3 4 .. .. .. .. .. .. .. .. Diphtheria M 9 .. 1 5 3 .. .. .. . , .. .. .. F 10 .. .. 4 6 .. .. .. , . .. , . , . Influenza M 7 .. .. .. .. .. 3 1 1 .. .. 2 F 4 .. .. .. .. .. .. .. .. 2 1 1 Encephalitis Lethargica M 1 .. .. .. .. 1 .. .. .. .. , , .. F .. .. .. .. .. .. .. .. .. .. .. . . Cerebro-spinal Fever M , , .. .. .. .. .. .. .. , , . . , . .. F 1 .. .. 1 .. .. .. .. . , . . , , , , Tuberculosis of respiratory system M 58 .. 1 1 .. 11 9 7 12 11 5 1 F 34 • . .. .. 11 8 8 5 2 .. .. Other Tuberculous Diseases M 7 .. 2 1 .. 2 .. .. , . , , 1 .. F 3 .. 1 2 .. .. .. .. .. .. .. .. Syphilis M 2 .. .. .. .. .. .. .. .. 2 .. .. F .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane, tabes dorsalis M 6 .. .. .. .. .. .. 2 1 2 1 .. F 2 .. .. .. .. .. .. .. l .. 1 .. Cancer, malignant disease M 89 .. .. .. .. .. 2 1 8 34 29 15 F 100 .. .. .. .. .. 1 4 20 28 26 21 Diabetes M 4 .. .. .. .. .. .. 1 .. .. 1 2 F 5 .. .. .. .. .. .. .. .. 1 4 .. Cerebral Haemorrhage, etc. M 36 .. .. .. .. .. .. . . 3 8 12 13 F 37 .. .. .. .. .. .. .. 1 8 13 15 Heart Disease M 153 .. .. .. .. 5 7 2 8 25 48 58 F 169 .. .. .. .. 4 4 2 7 22 43 87 Aneurysm M 3 .. .. .. .. 1 . . . . .. .. 2 , . F 2 .. .. .. .. .. .. .. .. 1 1 .. Other Circulatory Diseases M 29 .. .. .. .. .. .. .. 2 12 9 6 F 18 .. .. .. .. • • .. 1 1 1 6 9 Bronchitis M 46 .. .. .. .. .. .. .. 1 14 13 17 F 14 .. 1 .. .. .. .. .. .. 1 5 7 Pneumonia (all forms) M 43 10 3 6 1 2 1 1 5 4 4 6 F 41 9 4 1 .. 3 1 1 4 6 4 8 Other Respiratory Diseases M 5 .. . . .. .. .. .. .. 2 2 1 . . F 3 .. .. .. .. .. .. .. 1 1 .. 1 Peptic Ulcer M 14 .. .. .. .. 1 1 4 2 2 4 .. F 5 .. .. .. .. • • .. .. 1 1 3 .. Diarrhoea, &c. M 14 12 2 .. .. .. .. .. .. .. .. .. F 13 12 .. .. .. .. 1 .. .. .. .. .. Appendicitis M 1 .. .. .. .. .. .. • • L • • , , , , F 3 .. .. .. .. .. .. 1 1 1 .. .. 113 Table 1—continued. CAUSES OF DEATH. Sex. All Ages. 0— 1 — 2— 5— 15— 25- 35— 45— 55— 65— 75— Cirrhosis of Liver M 1 .. .. .. .. .. .. .. .. .. 1 .. F 1 .. .. .. .. .. .. 1 .. .. • • .. Other diseases of Liver, etc. M 2 .. .. .. .. .. .. .. • • .. .. 2 F 5 .. .. .. .. .. .. 1 1 .. 2 1 Other Digestive Diseases M 15 .. .. .. .. 1 .. 1 1 7 4 1 F 8 .. .. .. 1 .. .. 2 .. 1 2 1 Acute and chronic Nephritis M 11 .. .. .. .. 1 .. 1 .. 2 4 3 F 12 .. .. .. .. 1 .. 1 1 1 5 3 Puerperal Sepsis F 2 .. .. .. .. .. .. 2 .. .. .. .. Other Puerperal causes F 3 • • .. .. .. 1 .. 1 1 • • • • • • Congenital Debility, Premature Birth, Malformations etc. M 25 24 .. .. .. .. 1 .. .. .. .. .. F 25 25 .. .. .. .. .. .. • • .. .. .. Senility M 7 .. .. .. .. .. .. .. .. .. 1 6 F 22 . . .. .. .. .. .. .. .. 1 5 16 Suicide M 7 .. .. .. .. .. .. 2 3 2 .. .. F 5 .. .. .. .. .. 1 1 1 .. 2 .. Other violence M 29 1 .. 1 1 5 3 2 2 4 5 5 F 20 .. .. . . 1 2 .. • • 3 3 1 10 Other defined diseases M 39 3 .. .. 1 2 2 .. 6 3 12 10 F 34 1 .. 1 3 2 1 1 4 5 8 8 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. •• .. •. .. F 1 .. .. .. .. .. .. .. .. .. .. 1 H 114 Table II. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION OR DESTROYED AT OWNERS' REQUEST. 1934 Premises Visited Articles for Disinfection Articles Destroyed (Owners' Request) Books Cleansing Station. Towels Lodging Houses Infectious Diseases Requests Bedding only Removals Private Removals L.C.C. Verminous Total Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total Beds Pillows Bolsters Mattresses Sheets Blankets Odd Articles Total D .B.C. Library. Private : Total Persons Cleansed Articles Stoved January 115 7 14 5 ... l 142 78 219 61 75 146 276 1025 1880 4 9 2 7 ... 11 21 54 63 91 154 149 1 10 February 8'2 11 12 2 ... 6 113 58 151 56 51 120 194 615 1275 5 10 2 7 ... 2 182 208 56 21 77 183 2 13 March 92 7 2 1 ... 6 108 70 161 55 56 100 199 598 1239 3 2 ... ... ... 4 12 21 70 306 376 186 5 10 April 79 9 4 1 ... 17 110 60 165 44 54 92 173 516 1104 5 18 4 12 5 6 488 538 23 3 26 140 3 20 May 91 7 3 3 ... 31 135 61 156 52 56 113 160 439 1037 7 6 2 2 ... ... 15 32 44 89 133 199 5 26 June 79 12 10 1 ... 16 118 61 158 51 58 109 119 406 962 10 5 2 9 2 ... 1 29 12 ... 12 253 6 35 July 84 8 2 ... ... 29 123 53 120 40 43 86 80 299 721 2 2 3 7 ... 1 2 17 14 10 24 240 5 26 August 70 15 14 ... ... 33 132 60 169 52 54 107 152 402 996 5 6 1 11 3 4 53 83 12 ... 12 20 2 13 September 70 7 4 ... 18 17 116 104 237 65 82 138 172 562 1360 8 6 2 4 5 2 179 206 21 10 31 246 5 26 October 116 3 6 ... 30 18 173 136 337 112 126 185 332 1474 2702 3 4 2 ... ... ... 12 21 25 37 62 254 4 24 November 123 5 3 ... 4 12 147 119 285 80 79 223 279 924 1989 ... 2 ... 1 ... ... 20 23 62 ... 62 254 6 45 December 89 4 7 • 2 4 106 84 209 69 68 122 231 757 1540 4 4 2 6 ... ... 12 28 38 ... 38 154 2 15 1090 95 81 13 54 190 1523 944 2367 737 802 1541 2367 8047 16805 56 74 22 66 15 30 997 1260 440 567 1007 2278 46 263 115 Table III. SHOWING NUMBER OF ROOMS DISINFECTED. 1934 Scarlet Fever Diphtheria Pulmonary Tuberculosis Scabies Measles Cancer Puerperal Fever Small Pox Cerebro-Spinal Meningitis Chicken Fox Encephalitis Lethargica Impetigo Infantile Paralysis Typhoid Fever Formalin Spray Sulphur Fumigated Verminous Total Rooms Infectious Requests January 80 21 32 4 • • 2 3 .. 2 .. .. .. .. .. 144 13 l 158 February 59 14 18 6 3 2 * .. .. .. .. .. .. .. 102 35 16 153 March 52 26 24 2 8 2 1 • • 1 .. .. .. .. .. 116 15 17 148 April 28 20 49 1 4 1 .. 4 • • .. l .. .. .. 108 11 27 146 May 41 23 43 7 5 3 .. .. .. .. .. .. .. .. 122 14 50 186 June 42 26 26 3 2 2 .. .. .. 1 .. .. .. .. 102 20 33 155 July 37 26 31 1 3 2 .. .. .. .. .. .. .. .. 100 12 45 157 August 35 24 23 3 .. 2 .. .. .. .. .. .. 1 88 19 66 173 September 53 15 19 3 1 2 1 .. .. .. .. .. .. .. 94 9 27 130 October 75 13 20 7 .. .. .. .. .. .. .. .. .. 1 146 6 35 187 November 75 50 11 14 .. .. .. .. .. 1 .. .. .. .. 151 8 19 178 December 56 40 10 5 .. .. .. .. .. .. .. 1 .. .. 112 8 7 127 633 328 306 56 26 18 5 4 3 2 I 1 1 1 1385 170 343 1898 H2 116 GOSTERWOOD STREET CLINIC. 1934 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. J anuary 5 17 1 5 2 25 318 343 148 February 4 8 1 1 4 14 218 232 107 March 4 7 2 1 ]0 212 222 91 April 4 8 1 2 11 239 250 94 May 3 11 3 2 16 198 214 85 June 4 13 2 15 247 262 112 July 5 23 2 2 5 32 363 395 154 August 3 8 1 2 2 13 213 226 78 September 4 10 1 1 4 16 300 316 113 October 5 9 1 5 15 403 418 166 November 4 10 1 3 3 17 294 311 129 December 4 13 1 1 1 16 290 306 130 Total 49 137 13 20 30 200 3295 3495 1407 NAPIER STREET CLINIC. 1934 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 17 1 5 23 310 333 139 February 4 14 3 17 251 268 120 March 4 6 1 4 11 237 248 117 April 3 9 2 4 15 199 214 116 May 5 14 1 15 266 281 109 June 4 9 1 3 2 15 267 282 104 July 5 17 2 2 2 23 402 425 146 August 3 9 1 3 13 261 274 114 September 4 11 3 2 16 287 303 127 October 5 11 4 5 20 350 370 148 November 4 6 3 3 12 292 304 125 December 3 4 1 5 180 185 83 Total 49 127 9 18 31 185 3302 3487 1448 117 GOLDSMITHS' COLLEGE CLINIC. 1934 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 8 1 5 14 295 309 120 February 4 10 1 4 15 186 201 88 March 4 4 1 7 12 208 220 96 April 4 15 2 17 220 237 98 May 5 10 1 5 16 303 319 121 Jane 4 6 1 2 1 10 264 274 105 July 4 8 1 4 13 278 291 109 August 5 16 2 1 3 22 382 404 143 September 4 7 2 2 1 12 305 317 101 October 5 6 1 6 365 371 118 November 4 4 2 2 8 277 285 109 December 3 5 1 2 8 189 197 69 Total 51 98 7 14 34 153 3272 3425 1277 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC. 1934 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed, Hand. Ages 1—5. January 4 9 1 2 12 240 252 145 February 4 11 2 1 4 18 237 255 159 March 5 10 5 1 16 180 196 110 April 4 12 1 5 5 23 212 235 143 May 5 10 3 3 16 286 302 156 June 4 5 1 4 1 11 208 219 135 July 4 20 5 25 239 264 138 August 5 10 1 11 295 306 150 September 4 5 1 1 4 11 229 240 116 October 4 8 1 2 11 210 221 91 November 5 6 1 2 6 15 239 254 125 December 4 8 2 10 146 156 79 Total 52 114 . 7 23 35 179 2721 2900 1547 118 Besson street clinic. 1934 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 16 2 5 1 24 429 453 150 February 4 10 1 5 16 306 322 97 March 4 11 2 1 1 15 253 268 107 April 3 10 2 3 3 18 262 280 100 May 4 11 2 1 14 368 382 122 June 4 18 3 3 24 341 365 126 July 5 21 4 5 4 34 436 470 143 August 3 9 1 3 13 279 292 89 September 4 11 1 12 348 360 111 October 5 15 2 1 2 20 456 476 132 November 4 11 1 1 2 15 358 373 119 December 3 8 1 1 10 224 234 82 Total 48 151 16 25 23 215 4060 4275 1378 ILDERTON ROAD CLINIC. 1934 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 3 3 199 202 94 February 4 8 1 1 2 12 165 177 78 March 4 4 2 1 7 156 163 76 April 4 8 1 1 10 173 183 82 May 5 15 2 1 21 250 271 124 June 4 7 1 8 210 218 84 July 4 2 1 2 5 216 221 83 August 5 6 7 251 258 110 September 4 5 1 1 1 8 220 228 77 October 4 7 1 8 219 227 86 November 5 5 1 6 233 239 106 December 4 4 4 132 136 66 Total 51 74 7 11 7 99 2424 2523 1066 119 ST. GEORGE'S HALL, SHARDELOES ROAD. 1934 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5 January 4 10 2 3 15 295 310 139 February 4 10 5 15 285 300 131 March 4 10 1 1 12 295 307 121 April 4 5 1 5 7 18 289 307 126 May 4 4 1 5 276 281 114 June 5 13 2 2 17 309 326 125 July 4 11 2 3 16 225 241 110 August 5 17 17 314 331 132 September 4 7 1 2 10 314 324 109 October 4 6 1 7 274 281 108 November 5 5 1 4 10 295 306 128 December 4 11 1 2 1 15 178 193 95 Total 51 109 6 16 26 157 3349 3507 1438 ST. JOHN'S CLINIC. 1934 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 3 1 1 5 210 215 104 February 4 8 1 1 1 11 161 172 99 March 4 6 1 1 1 9 178 187 81 April 4 8 1 9 182 191 94 May 5 7 2 9 261 270 125 June 4 7 1 8 213 221 95 July 4 6 3 9 225 234 107 August 5 2 3 1 6 273 279 128 September 4 8 1 1 10 234 244 100 October 5 8 1 9 288 297 126 November 4 6 3 9 217 226 105 December 3 1 1 2 146 148 65 Total 51 70 7 12 7 96 2588 2684 1229 INDEX PAGE A Acreage 8 Acute Primary Pneumonia 64 Acute Influenzal Pneumonia 64 Acute Poliomyelitis 64 Albany Deptford Babies' Hospital 107 Ambulance Facilities 25 Ante-natal Examination 102 Ante-natal Clinic 102 Area and Population 8 Artificial Light Clinic 104 B Bacteriological Examination 68 Births 11 „ illegitimate 12 „ Notification of 12 c Cancer 70 Canal Boats Acts 34 Causes of Sickness 15 Cerebro-spinal Meningitis 64 Chicken pox 62 Cleansing Station 70 Clinics and Centres 26 Committee, Public Health 3 „ Maternity and Child Welfare 3 Convalescent Treatment 107 ii PAGE D Deaths 13 Death-rate 13 „ comparisons 13 „ during 10 years 13 Deaths in Wards 14 „ percentage in age groups 15 „ causes of 112 „ ages at 15 „ Infantile, causes 16 „ Infectious disease 58 Deptford Babies' Hospital 107 Diabetes and Insulin 71 Diarrhœa 65 Diphtheria 61 Disinfection 69 Disinfestation 69 Dysentery 65 E Encephalitis Lethargica 64 Enteric Fever 67 Erysipelas 67 F Factory and Workshop Act 35 Food Inspection 44 „ Poisoning 50 „ Sampling 51 „ Unsound 49 Foster Children 109 H Health Committee 3 Health Visitors, Visits 99-100 Health Education 109 Home Helps 107 iii PAGE H— continued. Home Nursing 107 Housing 38 House-to-house Inspections 31 I Illegitimate Births 12 Infant Life Protection 109 Infant Mortality 16 „ from Diarrhoea and Enteritis 65 „ Table of causes 16 Infant Welfare Centres 101, 116 Infectious Diseases, Notifications 58 Infective jaundice 71 Influenza 67 Insulin and Diabetes 71 L Laboratory Work at the Seamen's Hospital 68 Legal Proceedings 31 M Malaria 65 Marriages 11 Maternal Mortality 109 Maternal and Child Welfare Committee 3 Maternity Home 106 „ Consultant 106 Maternity Outfits 107 Measles 67 Midwives 23, 105 Milk, Bacteriological Examination 45 „ Supply to Nursing Mothers, etc. 108 Mortality of Infants 16 Mortuary Report 17 Municipal Maternity Home 106 IV. PAGE N Notification of Births 12 Nursing Arrangements 22 „ in the Home 22 Nutrition 55 O Obstetricians, consulting 105 Ophthalmia Neonatorum 66 P Physical Features of Borough 8 Population 10 Pneumonia 64 Post-natal Clinic 103 Public Health Committee 3 Puerperal Fever 65 „ Pyrexia 66 R Ranyard Nurses 22 Rats 32 S Sanitary Inspectors' work 28 Scarlet Fever 59 Small-pox 62 Social Conditions 9 Staff, List of 20 Still-births 11 T Tuberculosis—Care Committee 93 „ Report of Tuberculosis Officer 74-95 „ General 74 V PAGE T— continued. Tuberculosis—Home accommodation 79 „ Notification Table 75 ,, Revision of Register 81 „ Supervision of Contacts 85 „ Dental Treatment 88 V Vaccination 63 w Whooping Cough 68