ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY F. LEONARD KEITH, m.d., Ch.b., d.p.h., L.d.s., Medical Officer of Health. 1 935 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health Committee. Major. Councillor J. HARRINGTON, J.P. Chairman. Councillor C. G. BLANCHARD. Vice-Chairman. Councillor E. C. SHERWOOD. Alderman Mrs. E. M. Bateman. Councillor F. D. Chisnell. Councillor W. J. Coombs. Councillor Mrs. B. M. Drapper, J.P. Councillor A. G. Howard. Councillor C. Russell. Councillor W. Taylor. Councillor Mrs. L. E. White (deceased). Councillor A. H. Wild. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. E. M. Colburn. Vice-Chairman. Councillor Mrs. G. E. Green. 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 (deceased). A2 Metropolitan Borough of Deptford. Public Health Department, Deptford Town Hall, S.E. 14. 11th June, 1936. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford, Mr. Mayor, Ladies and Gentlemen, I have the honour to present my seventh Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. The estimated population for statistical purposes was 99,500 and based upon this figure, the birth and death-rates per 1,000 of the population were 14.4 and 11.1, compared with 15.8 and 13.1 for the year 1934. The infantile mortality rate was 52, and the maternal death-rate 0-7—the latter rate being calculated upon 1,000 total (live and still) births. Regarding infectious disease the notifications of Scarlet Fever decreased to 252 —the lowest for many years — the incidence of Pneumonia, Measles and Whooping Cough was light, while there was comparative freedom from Influenza. The routine work of the Sanitary Inspectors was considerably curtailed by reason of the duties laid upon the Borough Council by the sections of the Housing Act, 1935, relating to overcrowding. Owing to the duty of ascertaining the number of houses in which overcrowding existed, extra staff had to be employed. This, however, still left the permanent sanitary and clerical staff with greatly increased duties and, under these circumstances, the figures given in the section of the 6 Report dealing with Sanitary Administration redound much to their credit. The purity of the food supply, primarily the responsibility of the Food inspector, has been satisfactorily maintained. 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 l¼ 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 4½ acres Borough Council. Statistics. Area 1,564 acres Population: Census 1931 106,891 Registrar-General's Estimated Resident population, 1935 99,500 Number of inhabited houses according to the Ratebooks (end of 1934) 19,400 Number of families or separate occupiers (1931) 29,248 Number of structurally separate dwellings (Housing Survey, 1935) 18,572 Rateable Value (April, 1935) £666,006 Estimated sum represented by 1d. Rate £2,675 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:— 30th Dec., 1935 Men, 3,928 Women, 1,018 Juveniles, 264 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, at the end of 1935 :— 3,873 (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1935:— £92,309 7s. 9½d. 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 605. Of these, 542 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 63 persons, the same conditions being observed, the amount per bead varied between 7s. 6d. and 10s. 6d. During the whole year 12,772 applications for fortnightly supplies were granted. Of this number, 11,586 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 702 695 1,397 1,432 14.4 Illegitimate 20 15 35 Still-births, 43. Rate per 1,000 total births, 29.2. Death-rate. Deaths 1,106 11.1 Percentage of total deaths occurring in Institutions 59 Death-rate or infants under one year of age, per 1,000 births Legitimate 52 Illegitimate 57 Total 52 Deaths from Measles (all ages) 1 „ Whooping Cough (all ages) 5 „ Deaths from Diarrhoea (under 2 years) 16 Population. The population for 1935, as given by the Registrar-General, was 99,500, the lowest on record. Number of women dying in, or in consequence of, childbirth: Rate per 1,000 (live and still) births. From Puerperal Sepsis — - Other Puerperal causes 1 0.7 Total 1 0.7 11 Marriages. During the year 943 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 582 Other places of worship 85 In the Superintendent Registrar's Office 276 Total 943 Births. After allowing for inward and outward transfers, i.e., the addition of 602 children born of Deptford parents outside the Borough, and the deduction of 35 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,432. This is equivalent to a birth.rate of 14.4 per 1,000 of the population and, after Subtraction of deaths, represents only a natural increase of 3.3 per 1,000 of the population. The following table illustrates the steady fall that has taken place : BIRTHS. No. Deptford. Crude rate per 1,000 population. England and Wales. Crude rate per 1,000 population. County of London. Crude rate per 1,000 population Average for 10 years, 1915 to 1924 2610 22.9 20.0 20.5 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 1935 1432 14.4 14. 7* 13.3* *Provisional figures. Still-Births. 43 still-births were registered during the year as follows:— ] Legitimate Illegitimate Total Male 21 1 22 Female 20 1 21 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 vrs. 1915-24. Av. for 5 yrs. 1925-29 1930 1931 1932 1933 1934 1935 No. of illegitimate births 77 58 59 55 56 51 45 35 Percentage of total births 2.9 3.0 3.4 3.2 3.3 3.4 2.8 2.4 Notification of Births. During 1935, the number of notifications received of births and still births actually occurring in the Borough was 862. After allowing for inward and outward transfers, the corrected figure was 1,453. The following is an analysis of these notifications: Births Notified in the Borough during Year 1935. Ward. Births notified. Alive Dead By whom notified Total Male Female Parent Doctor Midwife Canterbury 51 23 28 48 3 2 3 46 Clifton 37 17 20 36 1 2 9 26 Deptford Park 53 24 29 51 2 1 11 41 Evelyn 81 35 46 81 — 2 6 73 Hatcham 55 27 28 55 — 3 4 48 Pepys 50 26 24 50 — 4 7 39 St. Catherine's 43 21 22 43 — 3 4 36 St. John's 41 20 21 38 3 — — 41 St. Paul's 95 51 44 95 - 1 3 91 St. Peter's 250 134 116 245 5 6 9 235 Town Hall 37 19 18 36 1 5 3 29 Vale 69 35 34 69 — 2 5 62 Totals 862 432 430 847 15 31 64 767 Less Outward Transfers 22 13 9 21 1 - — 22 Total 840 419 421 826 14 31 64 745 Add Inward Transfers 613 297 316 593 20 - 110* 503t Grand Total 1453 716 737 1419 34 31 174 1248 Notifications received from Medical Officers of Health of other Boroughs. †Notifications received from Midwives at London County Council and General 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 525 Deduct deaths of "non.residents" 71 454 Add deaths of "residents" outside Borough 652 Nett deaths applicable 1,106 This is equivalent to a death.rate of 11.1 per 1,000 persons. Seasonal Mortality. Quarter ended. 1934 1935 No. Rate per 1,000 of population. No. Rate per 1,000 of population. March 429 16.9 315 12.7 June 319 12.2 283 11.4 September 295 11.6 254 10.2 December 284 11.2 254 10.2 The trend of the death.rate in recent years is shown by the following table:— Year. Deptford. Ergland & 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 1935 1106 11.1 11.7† 11.4† 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 43 23 8 66 Evelyn 50 60 8 110 St. Paul's 64 38 9 102 Vale 57 51 5 108 Clifton 54 45 6 99 Canterbury 43 37 6 80 Hatcham 57 53 6 110 Pepys 35 38 6 73 St. Catherine's 30 49 7 79 St. Peter's 38 44 5 82 St. John's 82 19 4 101 Town Hall 44 52 4 96 597 509 74 1106 Causes of Death. An analysis of the causes of death will be found in Table I of the Appendix. The following is a comparative statement of the chief causes of mortality in recent years : Cause of Death Rate per 1 000 deaths all causes), 1935. Average No. for 10 years 1915-24. Average 1925-1929 1930 1931 1932 1933 1934 1935 Increase or decrease over 1934 Measles 0.8 27 20 24 1 23 I 43 1 - 42 Whooping Cough 7 24 13 3 11 9 9 18 5 — 13 Diphtheria 4 19 14 4 12 6 5 19 10 — 9 Influenza 42 70 35 6 20 26 52 11 6 — 5 Tuberculosis—Pulmonary 75 136 102 113 100 92 94 92 83 — 9 Non-pulmonary 8 32 18 14 14 13 10 10 6 — 4 Cancer 110 133 159 156 174 183 137 189 167 — 22 Heart Disease 225 128 232 298 322 297 281 322 260 — 62 Cerebral Haemorrhage, Embolism and Thrombosis 46 67 54 45 41 49 57 73 60 13 Bronchitis 42 140 95 47 55 53 52 60 46 — 14 Pneumonia (all forms) 67 154 121 73 113 82 84 84 64 — 20 Nephritis 26 35 34 44 31 35 32 23 20 - 3 Diarrhoea and Enteritis 14 45 20 19 14 29 18 27 19 — 8 Violence (excluding Suicides) 30 48 49 64 30 36 37 49 42 — 7 Premature Birth, Malformation and Debility 36 86 49 40 45 48 45 50 27 — 23 15 Special Noteworthy Causes of Sickness on Invalidity. The foregoing table shows that, although yearly fluctuations occur, the main features correspond very closely with the average experience. The steady decline in mortality in infancy and early childhood will be noted, while at the other extreme of life it will be observed that the deaths over 65 years of age, steadily increasing, now provide 49 per cent. of the total mortality. Moreover, people of advanced age are dying more from the effects of degenerative diseases than from acute disease. Thus, diseases of the heart, which bulk so prominently, are almost entirely due to muscular degenerations associated with advancing years. Cerebral haemorrhage and Arterio.sclerosis have their origin in degenerative changes in the arterial system, while the Bronchitis of the aged is closely connected with heart and arterial degeneration. The following Table expresses as percentages of the total mortality the incidence in the various acre groups:— Average 1915.24 Average 1925.25 1930 1931 1932 1933 1934 1935 Under 1 year 16.3 9.4 8.6 7.2 8.3 6.5 8.1 6.7 From 1.2 years 4.7 2.7 1.8 1.6 3.0 1.0 2.9 0.6 „ 2.5 years 4.3 2.8 2.5 2.0 2.0 1.3 3.7 1.1 „ 5.15 years 3.9 2.9 2.3 2.2 1.8 2.4 1.7 1.9 „ 15.25 years 4.4 4.3 5.5 4.3 4.2 3.5 4.2 3.5 „ 25.45 years 12.3 10.5 11.1 10.2 8.8 10.0 7.4 8.9 „ 45.65 years 23.3 27.7 26.0 28.6 26.6 25.8 24.9 27.9 65 years and upwards 30.8 39.6 42*2 43.8 45.3 49.5 47.1 49.4 The infantile mortality rate for 1935 was 52 per 1,000 births and the following Table gives the death-rates for England and Wales, London and Deptford for previous years:— Year Deptford England & Wales London No. Death-rate per 1.000 Births Death-rate per 1,000 Births Death-rate per 1,000 Births Average for 10 years 1915-1924 231 90 87 85 Average 1925-1929 129 64 71 65 1930 107 61 60 59 1931 93 53 66 65 1932 108 65 65 66 1933 82 54 64 59 1934 108 68 59 67 1935 74 52 57* 58* * Provisional figures. 16 The following Table gives details of the causes of death in the various age groups:— Infantile Mortality, 1935. 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 20 3 2 3 28 19 8 10 9 74 Smallpox .. .. .. .. .. .. .. •• .. .. Chicken Pox .. .. .. .. .. .. .. • • .. .. Measles .. .. .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. • • .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. 4 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. .. .. 1 1 1 .. .. .. 2 Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. 1 .. .. 1 Pneumonia (all forms) .. .. .. .. .. 5 2 6 3 16 Diarrhœa .. .. .. .. .. 1 1 1 1 4 Enteritis .. .. .. 2 2 4 1 1 3 11 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. .. .. .. .. .. Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 4 .. .. .. 4 .. .. .. .. 4 Congenital Malformations 1 1 1 .. 3 3 .. .. .. 6 Premature Birth 8 1 l .. 10 .. .. .. .. 10 Atrophy, Debility, and Marasmus 3 1 .. .. 4 4 2 .. .. 10 Other Causes .. .. .. .. .. .. .. .. .. .. Totals 20 3 2 3 28 19 8 10 9 74 Death-rate in each agegroup per 1,000 births 14.0 2.1 1.4 2.1 19.6 13. 3 5.7 7.1 6.4 52 Percentage of total deaths in each agegroup 27.0 4.1 2.7 4.1 37 .9 25.7 10.7 13.5 12.2 100 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 1935 27.0 4.1 2.7 4.1 37.9 25.7 10.7 13.5 12.2 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 186 persons, of whom 58 had been residents of Deptford. Particulars of the bodies received were as follows : Total. Male. Female. Inquests. Postmortems. Under 1 year of age. Deposited to await burial only. Infectious. 186 129 57 124 78 8 l 2 In 37 cases no inquests were held, the necessary certificate being issued by the Coroner. The causes of death were as follows:— Natural causes 98 Misadventure 1 Accidental causes 62 Murder 1 Suicide while of unsound mind 13 Total 186 Open verdicts 11 B 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, c.b.e., 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) Dental Surgeon. J. Eric Macraw, L.D.S. Public Analfst. Henry G. Harrison, M.A., F.I.C. Deputy Public Analyst. Hugh A. Williams, a.c.g.e.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. (deceased) P. J. Russell, m.b., b.ch., b.a.o., l.m. 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. R. W. Allen Cert. R.S.I., Joint Board. Meat Cert. R.S.I. H. E. Green Cert. R.S.I. Joint Board. Meat Cert. R.S.I. W. S. Gregory Cert. R.S.I. Joint Board. Meat (Resigned May, 1935) Cert. R.S.I. Frederick Hewett Cert. S.I.E.B. (Lond.), Meat Cert. R.S.I. Thomas R. W. Mason Cert. S.I.E.B. (Lond.) William F. Mayo Cert. S.I.E.B. (Lond.) Arthur C. Webster Cert. S.I.E.B. (Lond.), Cert. R.S.I. Meat Cert. R.S.I. G. F. Wilton Cert. R.S.I. Joint Board. Meat Cert. R.S.I. Albert Yates Cert. S.I.E.B. (Lond.), Meat (Food Inspector) Cert. S.I.E.B. Temporary Inspectors (April—December). R. Downes Cert. R.S.I. Joint Board. W. Sumner Cert. R.S.I. Joint Board. 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 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. Secretary, Tuberculosis Care Committee—Miss B. Leweliin. 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—A. T. Capstick 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 Is. 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 1 10 1 34 2 Ophthalmia Neonatorum 4 69 4 Pneumonia 13 317 2 47 15 Thread Worms 1 9 1 9 2 Conjunctivitis 1 14 1 Diarrhoea 1 27 1 Inflamed eyelid 1 14 1 Whooping cough 2 39 2 Impetigo 1 1 1 Septic spots 1 9 1 Maternity Cases 5 70 5 26 509 9 160 35 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-two. 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. During the year under report the midwife's fee was paid in three instances. 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." Orthopaedic Treatment. No schema 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). Tuberculosis Dispensary. Health Centre, Harton Street. Monday & Thursday, 9.30 to 11 a.m. Men. Tuesday evening, 6.30 to 7.30 p.m., Men and Women at work. Tuesday and Friday, 9.30 to 11 a.m., Women. Thursday, 2 to 3 p.m., Children not at school and Women at work, latter by appointment. Saturday, 9.30 to 11 a.m., Children attending school. Secretary's Consultations. 9.30 a.m. daily. Venereal Diseases. Miller Hospital, Greenwich, S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Hospital, Morden Hill, Lewisham, S.E. 13. Clinic Hours— Men : Tuesday 5.30 p.m. Thursday 9.30 a.m. Women : Monday, 3 p.m. Thursday, 6.15 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. Any week-day, 9 a.m. to 8 p.m. King's College Hospital, Denmark Hill, S.E. 5. Syphilis—Tuesday, 4.30 p.m. Wednesday and Friday, 11a.m. Thursday, 2 p.m. Gonorrhoea—Monday, 2 p.m. Men. 6 p.m., Women and Children. Wednesday, 6 p.m., Women and Children. Thursday, 5 p.m., Men. Friday, 2 p.m., Women and Children. School Clinics. Deptford School Treatment Centre. Lady Florence Institute, Reginald Square— Eye and Minor Ailments (Eye) : Tuesday and Friday, 2 p.m. Ear, Minor Ailments: Friday, 9.30 a.m. Operations. Monday, 2 p.m., at Cyril Henry Centre, Woolwich. Skin Ailments : Wednesday, 2 p.m. Teeth : Alt. Mondays, 9.30 a.m. and 1.30 p.m Tuesday, 1.30 p.m. Wednesday, 9.30 a.m. and 1.30 p.m. Thursday, 1.30 p.m. Friday, 9.30 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 1935 Total primary inspections 5,825 8,004 7,592 6,652 8,166 8,039 10,854 Total tions - 14,545 18,167 20,461 17,284 18,105 17,704 20,112 Total Intimation Notices served 2,860 3,458 3,552 2,623 2,748 2,656 2,850 Total Statutory Notices served 302 1,078 1,104 687 777 632 698 Total Housing Act Notices served 3 42 12 10 18 4 1 Total premises on which works were completed - 2,831 3,855 3,941 2,990 3,116 2,977 3,256 Total improvements effected during the year - 9,234 12,053 14,116 10,928 12,440 11,185 11,301 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, 2,344 inspections and calls have been made by the Food Inspector. 29 Summary of Sanitary Work carried out during the year 1935. Number of District. tive figures for 1934. 1 2 3 4 5 6 7 8 9 Totals Inspections — On complaint 207 166 231 184 189 102 111 102 102 1394 1242 House-to-house— 1. Where defects found 1G1 71 76 122 110 174 57 146 121 1038 1106 2. Where no defects found GO 10 53 78 18 48 43 54 68 432 426 On occurrence of Infection 84 65 105 101 156 99 102 12 41 765 1059 On Notice from builder 220 43 53 59 46 46 72 13 34 586 411 Reference from T. B. Dispensary 5 3 3 1 6 3 . • • 1 22 30 Market Inspection 14 15 3 15 15 15 13 • . . • • • 90 89 Factories 3 11 7 6 27 7 3 2 7 73 82 Workshops . . . 2 7 9 3 2 1 • .. 9 33 53 Workplaces 12 3 4 8 7 2 1 8 8 53 58 Food premises (restaurants, etc.) 20 154 42 12 22 4 5 2 261 144 Butchers' premises ... 2 • . . 3 9 ■ . 1 • a • 15 37 Ice Cream premises 27 44 11 12 20 30 4 15 26 189 114 Milk premises 27 63 16 12 55 77 15 16 39 320 348 Bakehouses 18 4 12 25 18 13 4 ... 10 104 95 Fish premises 25 11 t? 42 26 21 20 4 16 173 207 Offensive businesses • • . ... 15 2 • • * 3 ... 20 30 Outworkers premises 17 7 9 14 13 37 5 9 13 124 65 Common Lodging Houses 8 2 30 1 4 8 21 ... ? 77 93 Miscellaneous inspections 162 165 271 254 268 243 302 117 130 1912 2350 Shops Act Inspections 26 3 2 20 10 77 36 46 59 279 ... Special Housing Survey Insp'tions 348 199 595 317 416 311 334 170 201 2894 ... Total inspections 1444 1041 1555 1294 1432 1328 1152 716 892 10854 8039 Re-inspections, Calls, etc. 2181 1519 1876 2470 2288 2710 2737 2313 1968 20112 17704 Smoke observations 4 ... 1 ... 1 1 1 1 9 18 Notices Served — Intimation 370 242 309 379 389 333 239 315 274 2850 2656 Statutory 65 74 61 128 90 90 31 110 49 698 632 Housing Act (Sec. 17) . . . ■ . . 1 . • . ... 1 4 Premises in respect of which notices were complied with 580 291 290 444 433 411 279 272 256 3256 2977 Premises in respect of which works in compliance with notices served during the year 1935 were outstanding at the end of the year 33 19 51 20 31 19 23 41 37 274 314 Description of Sanitary provements effected during the year- Number of rooms cleansed 510 535 260 481 527 542 270 343 279 3747 4199 Defective roofs repaired 76 72 53 93 95 79 56 82 41 647 393 Gutters or rainwater pipes provided or repaired 68 72 28 60 63 94 26 32 20 463 400 Dampness abated 44 45 57 45 87 112 36 41 28 495 386 Yards and forecourts paved or paving repaired 49 35 8 25 74 64 38 7 25 325 396 Water Fittings repaired 110 2 16 14 11 11 9 10 9 192 109 30 Summary of Sanitary Work—continued. Number of District. Comparative figures for 1934. 1 2 3 4 5 6 7 8 9 Totals Sinks and waste-pipes renewed or repaired 189 106 58 87 103 152 55 80 74 904 585 Drains entirely reconstructed ... 2 8 14 24 ... O ZJ 50 64 Drains partially reconstructed 12 15 7 14 14 17 31 7 10 127 96 Drains unchoked and cleansed 18 29 17 35 23 7 12 7 6 154 155 Soil and vent pipes renewed or repaired 11 1 7 5 13 123 26 29 9 224 118 Gullies provided, unchoked, etc 17 6 11 17 31 74 58 15 10 239 193 Manholes, chambers, fresh-air inlets, etc., provided or repaired 11 7 8 24 30 50 58 3 9 200 171 Premises in which repairs were effected to w.c's. 160 148 116 158 122 239 129 71 86 1229 1283 Repairs effected to windows, sashes, etc. 104 94 35 90 88 98 20 95 34 658 650 Repairs to stoves, coppers and flues 37 80 36 56 34 73 20 46 17 399 566 Repairs to stairs, doors, etc. 23 19 16 18 13 38 13 33 16 189 227 Repairs to floors 18 34 14 29 30 38 17 38 20 238 276 Fish shops limewashed 18 5 3 29 10 12 16 4 1 98 138 Hakehouses limewashed 11 2 6 10 6 6 5 ... 5 51 48 Ventilation and lighting improved 18 7 14 34 2 25 4 ... 3 107 106 Offensive accumulations removed 7 3 8 4 2 2 4 8 2 40 37 Dustbins provided 50 31 23 61 113 37 30 13 39 397 427 Miscellaneous repairs and improvements effected 16 8 25 22 18 15 15 8 1 128 162 Total repairs and improvements effected 1577 1356 826 1413 1517 1922 972 972 746 11301 11185 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 (ResignedMay, 1935) St. Paul's (part) and St. John's (part) Wards. Allen 4 ,, Hewett Vale and St. Paul's (part) Wards. 5 ,, Green Canterbury and Hatcham (part) Wards. f» ,, Wilton Hatcham (part) Pepys and St. Catherine's Wards. 7 ,, Mason St. Peter's, St. John's (part) and Town Hall Wards. 8 ,, Downes (Temporary from 8.4.35) Hatcham (part) and Pepys (part) Wards. 9 ,, Sumner (Temporary from 8.4.35) St. John's and St. Peter's (part) Wards. 31 House-to-House Inspections. 1,470 house-to-house inspections were made. These inspections were carried out in the following streets:— Adolphus Street Alpine Road Alverton Street Amersham Road Arica Road Besson Street Bclina Road Briant Street Childeric Road Clandon Street Clifton Hill Crooke Road Dennett's Road Endwell Road Evelyn Street Faulkner Street Fawcett Road Florence Cottages Florence Street Goodwood Road Gosterwood Street Grinstead Road Hart's Lane Hicks Street Render Grove Render Place Kerry Road Lind Street Lubbock Street Mason's Grove Mornington Road Napier Street Nynehead Street Oscar Staeet Pagnell Street Rectery Buildings Reculver Road St. John's Road St. Norbert Road Seymour Street Shardeloes Road Sharratt Street Snead Street Silwood Street Strickland Street Trundley's Terrace Vance Street Whitcher Street Legal Proceedings. The following is a full list of legal proceedings instituted during the year under report, with the exception of those dealing with Food and Food premises, particulars of which will be found in a later section of this Report:— Date Nature of Offence. Fine Costs Remarks. 1935 £ s. d. £ s. d. Jan. 2 74 Reculver Road Non-compliance with notice - 3 3 0 Order for work to be carried out within 7 days. „ 2 137 Silwood Street do. - Summons withdrawn— works completed prior to hearing. „ 2 68 Render Street do. - - Do. do. Apr. 17 62 Tressillian Road do. - 3 3 0 Order—28 days. May 10 58 Warwick Street do. - 3 3 0 Summons withdrawnworks completed prior to hearing. June 5 68 Render Street do. - 1 1 0 Order—7 clays. „ 19 2 Reculver Road do. - 1 1 0 Order—7 days. ,, 19 4 Reculver Road do. - 1 1 0 Order—7 days July 5 196 Drakefell Road do. - 1 1 0 Order—7 days. ,, 10 2 Rose Cottages do. - 10 6 Order—14 days, „ 10 2 Reculver Road—non-compliance with Magistrate's Order 1 0 0 10 6 „ 10 4 Reculver Road do. do. 1 0 0 10 6 Aug. 6 8 Summer Street Non-compliance with notice - 10 6 Order—7 days. „ 6 10 Summer Street do. - 10 6 Order—7 days. Sept. 95 Lewisham High Rd. do. - - Dismissed — Magistrate held that defendant was not owner within ing of Public Health Act. Oct. 25 10 Vesta Road—Premises with out water supply - - Adjourned sine die. Occupier removed to mental hospital. 32 Miscellaneous Matters. Smoke Abatement. The problem of nuisance from the emission of smoke is one constantly before the staff. Verbal warnings were giver in several instances, but it was not found necessary to serve any notices. Offensive Trades (other than Slaughterhouses). The following are the only instances in the Borough:— Skin Dressers, 2; Soap Boilers, 2; Fat Melters, 2. Slaughterers of Poultry, 1. Only five premises are involved, as in two instances the same premises are registered for both soap-boiling and fat-melting. Inspection is regularly carried out. The premises and the conduct of the business are satisfactory, no notices having to be served. Rag and Bone Dealers. Persons or firms known to carry on business as above, are regularly inspected. No proceedings were taken in respect of contraventions of the By-laws. Offensive Matter Conveyed through Streets. Observation is kept to ensure that offensive matter is not conveyed through the streets, either in unsuitable receptacles or during prohibited hours. It was not found necessary to institute legal proceedings during the year under report. Rats and Mice (Destruction) Act, 1919. Under this Act, the responsibility for the destruction of rats is thrown upon the occupier of any premises infested and, as occupiers occasionally experience difficulty in procuring rat poison, the Council authorises the issue of such, free of charge, in cases recommended by the Sanitary Inspectors. The Inspectors, by reason of their routine examination of premises, remedying of defective drains and sealing off of disused drains, may be said to be carrying out the spirit of the Act throughout the whole year. During "Rat Week," further assistance is sought from the Borough Engineer, and the following is the text of a Report to the Council:— Extermination of Rats. Acting in conjunction with other local authorities, during the week ended 9th November, in what is known as National Rat Week, we gave instructions for this Council's sewers to be baited for the purpose of exterminating rats. 33 An inspection of the side entrances and manholes where the poison was placed a few days after baiting, it was found that approximately two-thirds of the baits had been eaten and many dead rats were found. There is no doubt that a considerable number of rats was also washed away by the water. During the same week the London County Council laid over 1,400 baits in their sewers in this Borough, of which approximately 900 were consumed. In view of the considerable success which resulted from this annual campaign, we considered that the baiting of the sewers should be undertaken at least twice each year by all local authorities acting together. Removal of Aged and Infirm Persons. It was not found necessary to apply to the Court for any Orders 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 1935. 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 50 premises was entirely reconstructed during the year, in 127 instances partly reconstructed, and in 154 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. Some flooding occurred on the 25th June, when all affected premises were 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. Street Cleansing. The Borough is divided into 42 sweepers' districts, each man having a special vehicle comprising two galvanised steel containers in a frame mounted on a chassis fitted with pneumatic tyred wheels. The containers are detachable, and are collected by motor vehicles and replaced with empty bins which have been cleansed. c 34 The motor vehicles convey the full containers to the shoot, where they are emptied and cleansed. This system obviates the use of the large refuse bins throughout the Borough, and results in a much more hygienic collection of street refuse. Fouling of Footways by Dogs. On several occasions the question has been raised as to the desirability of making a byelaw to deal with the nuisance caused by persons allowing dogs to deposit excreta on the footways of the Borough, and during the year under report the Council made the following byelaw:— "Byelaw for the Good Rule and Government of the Metropolitan Borough of Deptford, and for the prevention and suppression of nuisances, made under Section 38 of the London County Council (General Powers) Act, 1934, by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Dogs Fouling Footways. No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against the foregoing byelaw shall be liable on summary conviction to a Fine not exceeding Five Pounds." Shops Act, 1934. The above Act came into operation on the 30th December, 1934. Under this Act certain new duties are administered by the local sanitary authorities, particularly with regard to the ventilation and the temperature of shops, and the provision of sanitary conveniences. In order to obviate delay in the enforcement of the provisions of this Act, the Council has delegated to the Public Health Committee its powers and duties under the Act. House Refuse. Storage, except for approximately 82 covered ashpits, is effected in movable ash.-bins. Removal, weekly as a rule, but twice weekly in the case of certain large London County Council and other buildings, and certain restaurants and bakers' shops, is entirely done by motor transport, iron covered vehicles being used, together with, towards the end of the year, the use of one internal loading vehicle. Disposal is effected, under contract, by barge to Rainham. 35 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, 56 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 184 new premises could be properly granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. No certificates were applied for or 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 Oificer of Health. Sir, I beg to report that during the year ended 31st December, 1935, 10 visits were made, on the following dates: — 6th and 8th February, 3rd April, 9th and 27th May, 21st June, 11th July, 7th August, 11th October and 18th November. No boats were found on such visits. The arrangements made for the inspection of Canal Boats are:—Periodical inspection by a 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. c2 36 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 93 3 - Workshops 137 5 - Workplaces 1011 12 - Total 1241 20 - The types of premises inspected were as follows:— Type. Factories, N umber. Workshops, Number. Workplaces, Number. Bakehouses 17 28 Chemical Works 2 5 Cinemas, etc. 1 7 Dressmakers, Milliners, etc. 3 17 12 Engineering, general 33 7 ,, motoring 9 10 12 Foundries 6 Food preparation 19 5 348 Glass bottle makers 2 Laundries, Cleaners, etc. 5 6 Marine Stores 4 12 Paint and Varnish Works 3 1 Printers 4 2 Shoeing Forges 1 Stables, etc. 76 Sawmills 7 Timber Stores 2 11 Tar Refiners 4 Tailors 1 5 6 Woodwork, Joiners, etc. 18 6 Woodchoppers 6 6 5 Whitening Manufacturers 4 Offensive trades 4 Miscellaneous 81 63 75 Totals 228 169 564 37 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 11 11 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances 13 13 — — Sanitary Accommodation Insufficient 1 1 — — Unsuitable or defective 5 5 — — 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 30 30 — — The number of inspections made to Home Workers' Dwellings was 124. Certain insanitary conditions, but not of such degree as to merit the term "unwholesome," were found in one instance. Notice was served and the conditions were remedied. Housing. 39 HOUSING ACT, 1935. OVERCROWDING SURVEY. During the year under report, one of the most important undertakings of recent years was commenced. I refer, of course, to the survey made throughout the country to ascertain the extent to which overcrowding existed, and the request to local authorities to submit schemes to deal with the conditions found. To secure co-ordination throughout the Metropolis, the London County Council (the "authority" so far as London was concerned) supplied various forms to each Borough, with the request that the preliminary investigations for the Survey should be completed by the middle of December. Accordingly, a number of clerical assistants were engaged to prepare the preliminary details as to occupation, etc., on Form A. These forms were duly completed and the 20 enumerators commenced their work of obtaining the particulars as to occupation on the 1st November. Six weeks was the time scheduled by the London County Council, and on the 12th December, 18,562 forms had been completed in this connection. The thoroughness of the investigation can be gauged when I say that particulars in only 10 cases remained to be obtained; this was done subsequently by letter, and the whole of the 18,572 structurally separate dwellings were covered. Whilst these enquiries were going on, the clerks were engaged in dealing with the forms as they came in daily. This necessitated working out in each letting in every dwelling as to whether the family was (i) definitely overcrowded, (ii) possibly overcrowded or (iii) satisfactory. (ii) possibly overcrowded or (iii) satisfactory. The following scale, as laid down by Statute was used in this connection:— Number of rooms in each letting Permitted number Actual Reduced (a) (b) (c) 1 2 1½ 2 3 2½ 3 5 4 4 7½ 6 5 10 8 6 12 9½ 7 14 11 8 16 13 If the actual permitted number was less than the number or persons at the premises, the family was overcrowded; if the number of persons 40 was below or equal to the actual permitted number but equal to or greater than the reduced permitted number, the family was possibly overcrowded. From these particulars it was ascertained that in 910 premises there was definite overcrowding and in 3,113 premises possible overcrowding. These latter were then transferred to Form B in order that particulars as to size of rooms could be obtained. The work of measuring up in these 3,113 premises was commenced by the 9 survey assistants and the Sanitary Inspectors on the 11th November and was duly completed to schedule. On the scale, the permitted number according to size of rooms was as follows — Permitted No, Size of Rooms. of Persons. 110 square feet or over 2 90 ,, ,, but under 110 square feet 1½ 70 „ „ „ 90 „ 1 50 ,, ,, ,, 70 ,, ½ Under 50 square feet Nil In this connection, it should be noted that every room in the house had to be measured up in these cases. For instance, a house might contain four families, only one of which was possibly overcrowded, but the measurement of the rooms occupied by all four families had to be obtained and subsequently worked out by the clerks. In 375 cases out of the 3,113, definite overcrowding was found to exist, whilst a further 97 cases have been recorded "for review" as being cases in which, owing to the ages of children, etc., overcrowding will doubtless develop within the next two years. The following is a concise statement as to this aspect of the Survey:— i. Number of structurally separate dwellings 18,572 ii. Number of these found definitely overcrowded 910 iii. Number of these found possibly overcrowded 3,113 iv. Number of iii found definitely overcrowded (on ing up) 375 v. Number for review 97 Definite overcrowding is existing in the Borough, therefore, in 1,287 dwellings, or 6.9 per cent. The number of cases of overcrowding in these dwellings is 1,317. 41 This part of the Survey having been completed, Form C had next to be considered, giving a summary of the Survey under the following heads:— i. The total number of dwellings belonging to the Borough Council in the Borough. ii. The total number of dwellings belonging to the London County Council in the Borough. iii. The total number of dwellings belonging to any other local authority in the Borough. iv. The total number of dwellings in each ward in the Borough, including any dwellings in that ward belonging to that Council or the London County Council 'a separate form for each ward). v. The total number of dwellings in the Borough as a whole including those of the Borough and County Council. For the purpose of record and as a matter of interest generally a Table is appended, giving information as to the position in the Borough as a whole Size of family (in equivalent number of persons) Totals of Families Size of family in equivalent number of persons) Totals of Families Overcrowded Not Overcrowded Total Overcrowded Not Overcrowded Total 1 — 4,726 4,726 8 56 93 149 1½ 5 92 97 8½ 28 26 54 2 †76 8,141 8,217 9 21 47 68 2½ 65 2,690 2,755 9½ 16 10 26 3 101 5,199 5,300 10 11 5 16 3½ 163 1,055 1,218 10½ 7 3 10 4 179 2,791 2,970 11 1 1 2 4½ 63 547 600 11 3 — 3 5 76 1,566 1,642 12 — - — 5½ 138 295 433 12¼ 1 — 1 6 155 611 766 13 1 — 1 and over 6½ 75 135 210 Totals of Dwellings Over Crowded †l,317 — — 7 58 296 354 Not Over Crowded - 28,407 — 7½ 28 78 106 Total — — 29,724 †Including overcrowded families with insufficient accommodation to secure proper sex separation. 42 Similar statements were prepared in respect of each ward, as required under heading (iv), and the following brief summary shows the extent to which each ward is affected:— Deptford Park 137 families overcrowded comprising 736 persons Evelyn 157 „ „ „ 845 „ St. Paul's 375 „ „ „ 1800 „ Vale 104 „ „ „ 492 „ Clifton 87 „ „ „ 448 „ Canterbury 117 „ „ „ 660 „ Hatcham 99 „ „ „ 475 „ Pepys 35 „ „ „ 204 „ St. Catherine's 56 „ „ „ 291 „ St. Peter's 27 „ „ „ 124 „ St. John's 37 „ „ „ 187 „ Town Hall 84 „ „ „ 372 „ Additional information was also extracted and forwarded to the London County Council at a later stage regarding the tenants on their estates found in overcrowded conditions, and also those occupying accommodation considerably in excess of their requirements. Subsequently, in the early part of 1936, various further tables were completed showing the estimated number of houses required to abate the overcrowding disclosed as the result of the Survey. The final analysis of these tables can be summarised in the following statement:— Additional dwellings required on the standard of Table I in the First Schedule to the 1935 Act (Table F) Additional dwellings required on the standard of 1½ persons a room (using the percentages in Table G) Size Number 3 rooms 4 rooms 5 rooms 6 rooms 7 rooms 8 rooms 9 rooms 10 rooms Total 3 rooms 168 134 26 8 — - - - - 168 4 „ 162 — 64 90 8 - - - - 162 5 „ 47 — — 10 16 18 3 - - 47 6 „ 4 — — — — 1 2 1 - 4 7 „ 1 - - - - - - 1 - 1 Totals 382 134 90 108 24 19 5 2 - 382 43 Inspection of District. During the year a further inspection of the Borough was made with a view to the ascertainment of any houses which could be represented to the Borough Council as falling within Part I or Part II of the Housing Act, 1930. Apart from those areas already recorded in the report for 1934 and those which the London County Council contemplated dealing with, the following houses or parts of houses were officially "represented" to the Council during 1935:— Individual Dwelling-Houses. 2 Parts of Buildings. 1. Underground Rooms. 7 The following table records the work done in connection with housing inspection:— 1. Unfit Dwelling-Houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6265 (b) Number of inspections made 6363 (c) Special Housing Survey Inspections (not included above) 2894 (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925 1470 (b) Number of inspections made for this purpose 1470 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those in (3) found not to be in all respects reasonably fit for human habitation 2830 2. Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers (on service of Intimation Notices) 2532 44 3. Action under Statutory Powers. (A) Proceedings under Secs. 17, 18 and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1* (2) Number of dwelling-houses which were rendered fit after service of formal Notice:— (a) By owners 5* (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) 698 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices:— (a) By owners 696 (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 — (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5† (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 6 (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 *Four of these relate to houses in respect of which notices were served in 1934. †Relating to houses in respect of which Demolition Orders were made in 1933/34. The following is a record of the action taken in addition to that shown under (C) and (D) above in respect of Representations made by me:— Houses or parts of bouses. Houses Demolished. (а) Watson Street Area 5 (b) Mary Ann Buildings Area (Demolished by L.C.C. at cost of Borough Council) 19 45 No. Undertakings accepted in respect of individual dwelling- houses 2 "No action" in respect of part of house 1 During the year the County Council proceeded with the development of the following Clearance Areas:— Bronze Street Area 2.86 acres Speedwell Street Area 2.65 „ During the year the London Council declared their intention of dealing with the following areas as Clearance Areas:— Frankham Street (Nos. 1-5) Areas 2.07 acres Addey Street (Nos. 1 and 2) Areas 2.68 „ Private enterprise built 102 houses and flats. 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 1935:— Families Downham Estate 92 Honor Oak Estate 64 Bellingham Estate 34 Deptford Park Estate 3 Becontree Estate 34 St. Helier Estate 44 Hughes' Fields Estate 41 Mottingham Estate 17 Bate Place Estate 16 Other estates 9 Total 354 This total represents 122 less families than were housed during the year 1934. Food. 48 INSPECTION AND SUPERVISION OF THE FOOD SUPPLY. This naturally falls under three headings:— I. Supervision of premises where food is stored, prepared, or from which it is sold or distributed. II. Examination of food as to its soundness. III. Sampling of food to determine its composition or sophistication. These duties are distributed amongst the members of the Inspectorial Staff and, although the Food Inspector is primarily responsible for the purity of the food, this duty, particularly in respect of milk and the soundness of food, is shared, but to a less degree, by all the Inspectors. The following is a tabular statement of the visits made by Mr. Yates, Food Inspector:— No. of Visits. Market inspection 103 Food premises (Restaurants, etc.) 230 Fish premises 38 Slaughterhouses 192 Butchers' premises 926 Milk premises 25 Miscellaneous 68 St. George's Wharf 37 Calls (Stalls, etc.) 725 2344 Inspector Webster took over St. George's Wharf in May. He made 169 visits to the end of the year. I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 28 applications for registration (including 26 transfers) in respect of premises were granted during the year. At the end of the year there were 150 premises registered for the sale of milk. In addition to the above, 86 persons were registered for the sale of unopened bottled milk only, and 31 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 320 inspections of milk shops were made by the District Sanitary Inspectors and 25 by the Food Inspector. One Intimation notice was served and many minor matters were remedied as the result of verbal intimation by the Inspectors. 49 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. Three retailers „ Grade "A" (Tuberculin Tested) Milk at three shops. Ten „ „ Pasteurised Milk at or from 20 shops. Three retailers whose premises are outside the Borough to sell Pasteurised Milk within the Borough. Two 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. Forty 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 2,960 Pasteurised 6,800 „ „ „ 2,550 „ 45,200 „ „ „ 2,380 „ 18,200 „ „ „ 1,730 „ 11,100 „ „ „ 18,500 „ 9,600 „ „ „ 5,750 „ 20,390 „ „ „ 979,000* „ 9,100 „ „ „ 32,300† „ 1,550 „ „ „ 2,520† „ 13,000 „ „ „ 98.100 „ 8,800 Pasteurised 9,980 „ 27,500 „ 13,000 „ 64,100 „ 1,480 „ 2,900 „ 22,500 „ 46,000 „ 11,700 „ 11,300 „ 18,400 „ 17,040 „ 6,400 „ 12,600 „ 23,500 „ 3,670 „ 9,650 „ 1,056 „ 8,900 „ 1,430 *These samples showed a microbic content above the Standard. †B.Coli present in1/100 c.c. D 50 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. Twenty-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, 192 visits having been paid by the Food Inspector. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 254 bullocks. 69 calves. 1922 sheep. 256 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 1. Bullock (entire) 2. Bullocks' head 1. Bullocks' livers 26. Bullocks' lungs 6. Pigs' heads 2. Pigs (entire) 2. Pigs' plucks 5. Pigs' livers 4. Sheep's lungs 2. Sheep's liver 1. Sheep's plucks 7. (b) Poultry Slaughterer. There is one poultry slaughtering establishment. During the year 7,435 head of poultry were slaughtered. (c) Shops and Stalls. The following Food Stalls are registered Fruit, Vegetables 36 Meat 2 Ice Cream and/or Baked Grocery 5 Chestnuts 11 Refreshments 6 Fish and/or Poultry 7 Proprietary Medicines Regular inspection is carried out, particularly at such times as business is being actively carried on. 51 (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. 92 premises were so registered at the end of the year under report. 3. Other Food Premises. (a) Workshop Bakehouses. There are 28 such bakehouses in the Borough, 7 of which are underground. 68 inspections were made daring the year. 2 Intimation notices were served for the remedy of general defects and apart from minor defects, remedied upon verbal intimation, 56 Notices were served for cleansing. (b) Factory Bakehouses. These number 17, of which 3 are underground. 36 inspections were made, 34 Notices were served for clea nsing. (c) Fried Fish Shops and Fish Curers. The number kept under observation during the year was 46. 173 inspections were made by the District Sanitary Inspectors and 38 by the Food Inspector. 184 Notices were served for cleansing, and 1 for general matters. (d) Ice Cream Premises. There were 163 separate premises recorded. To these, 189 visits were paid, and many verbal intimations were given regarding minor matters. (e) Other Premises. There are 330 miscellaneous premises connected with food preparation or sale, and 1,432 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. During the year 1935, large quantities of foodstuffs were imported at the Wharf, and the following is a summary of the work done:— 1st January to 9th May, 1935—Inspector Yates. Description. Weight. Examination. Remarks. Biscuits 664 cases 48 cases Flour & Flour Foods 129 „ 12 „ „ 171 bags 6 bags „ 14080 „ Overside D2 52 Description. Weight. Examination. Remarks. Preserves 1189 cases 116 cases Condensed Milk 2150 „ 59 „ „ „ 14899 „ Overside Dried Vegetables 1270 bags 53 bags „ „ 555 „ Overside Confectionery 126 cases 14 cases Tinned Meats 1515 „ 78 cases Raisins 1300 „ Overside Casings 28 „ 7 cases Cheese 1 case 1 case Sugar 500 bags 10 bags „ 1000 „ Overside Lard 7213 cases 135 cases „ 1000 „ Overside Tinned Fish 2 „ Thorough Fruit Pulp 1 case 1 case Dates 10 cases 1 „ „ 2236 „ Overside Packet Soups 560 „ 11 cases 10th May to 31st December, 1935—Inspector Webster. Prepared Mustard 167 cases 13 cases „ „ 40 pails 1 pail Dates 4107 cases 59 cases Honey 5 casks 5 casks Raisins 49 bags 3 bags Mushrooms (Jars) 96 cases 11 cases 1 jar destroyed — damaged. Fresh Fruit 1872 „ 87 Bottled Fruits 116 „ 12 „ Evaporated and Condensed Milk 2467 „ 51 „ Vegetables 1817 bags 47 bags „ 32 cases 6 cases „ 160 crates 10 crates „ 1 cask 1 cask Mustard 4 casks 4 casks Egg Yolk 2 casks 1 cask Contained 116.2grs. per pound boron. Ministry informed. Released for trade purposes. Tinned Vegetables 282 cases 31 cases Butter 616 „ 52 „ Casein 424 bags 28 bags Mineral Waters 3 cases 2 cases 53 Description. Weight. Examination. Remarks. Preserved Meat 1 case 1 case Rice and Tapioca 139 cases 10 cases Tinned Mushrooms 564 „ 80 „ Tinned Fish 551 „ 59 „ 1 tin destroyed, blown Fruit Pulp 510 casks 51 casks „ 108 cases 80 cases 4 tins destroyed,blown 1 sample contained 2280 parts per million sulphurdioxide. Action taken — broken down by Jam manufacturer, 5 lbs. pulp to 33 lbs. fresh fruit Eggs 7149 cases 400 cases 4 cases destroyed damaged. Casings 216 casks 90 casks „ 1 tin 1 tin Wines, Spirits and Syrup 1511 cases 117 cases 10 bottles destroyed— damaged. Biscuits 661 „ 72 „ Dried Vegetables 1194 bags 61 bags Tinned Hams 942 cases 12 cases Flour 105 „ 13 „ „ 2123 bags 42 bags Colouring 5 cases 3 cases Vinegar 33 casks 6 casks „ 83 cases 7 cases Confectionery 1107 „ 114 „ One sample contained boric acid 1.82 grains per pound. Ministry informed. Medical Officers notified. Consignments traced and destroyed. Preserved Fruit 129 cases 19 cases Wafers 137 „ 19 „ 2 sample cases troyed, contained boric acid .49 grains per lb. Soups 829 „ 12 „ Lard 1100 „ 10 „ Fish Sauce and Flavouring 12 „ 2 „ Middlings 132 bags 6 bags Coffee 24 „ 1 bag Edible Oil 30 barrels 1 barrel 54 Description. Weight. Examination. Remarks Overside Butter 5764 boxes Casein 556 bags Dates 4635 cases Confectionery 6 „ Casings 49 casks Fruit Pulp 594 „ „ 661 cases Tinned Hams 4963 „ Flour & Maize Flour 45434 bags Mineral Waters 1370 cases Middlings 5652 bags Oranges 600 cases Raisins 1199 „ Tallow 57 casks M.O.H. Port of London informed. Vegetables:— Peas, Beans and Lentils 10066 bags Wines, Spirits and Syrup 7376 cases „ 29 casks „ 217 packages Wheat 700 bushels Bonded Tinned Mushrooms 146 cases Mushrooms (Jars) 20 „ Tinned Herrings 14 „ Beans 20 bags Dates 45 cases Wines and Spirits 2520 „ „ „ 24 casks Transhipments Tinned Mushrooms 12 cases Casings 4 casks Dried Grapes 21 cases Tallow 590 casks M.O.H. Port of London informed. Mushrooms (Jars) 2 cases Liquorice Juice 3 „ 55 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 Beef, 1 forequarter. Beef and mutton pieces, 120 lbs. Bullocks' mesenteric fat, 1 set Bullocks' livers, 26 Bullocks' lungs, 6 Bullocks' head and tongue, 1 Bullocks' head, 1. Bullocks (entire), 2 Pigs (entire), 2 Pigs' plucks, 5 Pigs' livers, 4 Pigs' heads, 2 Pork, 13 lbs. Rabbits, 12 Meat Sheep's lungs, 2 sets Sheep's liver, 1 Sheep's plucks, 7 Fish Skate, 84 lbs. Tinned Sild, 2338 tins. Fowl Chickens, 4 Turkeys, 5 Vegetable Lettuce, 60 lbs. III. Food Poisoning. The following is an analysis of the notifications received, grouped according to the causal agent:— Food. No. of cases. Tinned Salmon 1 case Fried Fish 1 „ Boiled Lamb 2 cases Rock Salmon 1 case Pork Chop 1 „ Shrimps 1 „ Mushrooms 1 „ Tinned Pears 1 „ (Uncertain) 1 „ 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. 56 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 536 samples, formal and informal, were taken during the year, equivalent to 5 samples pet 1,000 of the population. The following is a statement of the sampling done and results obtained in 1935:— Total. Number Adulterated. Percentage of samples adulterated. Formal samples 248 9 3.6 % Informal samples 288 29 10.1 % Total 536 38 7.1 % The adulteration in respect of samples submitted for analysis during the previous seven years is as follows:— Year. Number of Samples taken. Percentage Adulterated. 1928 604 1.8 1929 590 1.8 1930 550 3.5 1931 507 2.6 1932 500 1.4 1933 500 1.4 1934 500 2.8 The following is a statement of the samples purchased and submitted for analysis during 1935. 57 Food and Drugs—Samples Taken. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Formal Samples, taken under the Food and Drugs (Adulteration) Act— Beef, minced 1 .. 1 .. Butter 5 .. 5 .. Chicken and Ham Roll 2 .. 2 Custard and Blanc mange Powder 2 .. 2 Dripping 1 .. 1 . . Jam 1 1 2 50 0 Jelly, Table 1 .. 1 , , Lemonade Powder 3 .. 3 Margarine 1 .. 1 Mercury Pills 1 1 100 0 Mercury Ointment 4 4 8 500 Milk 187 2 189 11 Milk, sterilised 3 .. 3 Mustard 2 .. 2 Pepper 2 .. 2 Sausage 2 .. 2 m # „ Preserved 1 .. 1 „ Breakfast 2 .. 2 Spirts 13 1 14 7*7 Vinegar 3 .. 3 „ Malt 1 .. 1 Wine, non-alcoholic 2 .. 2 . . Total Formal Samples 239 9 248 3 6 Informed Samples and Samples taken under the Imported Food Regulations— Apple Juice 1 .. 1 Baking Powder 1 .. 1 Biscuits 6 .. 6 Butter 5 .. 5 Cakes, Sponge 1 .. 1 Cheese 1 .. 1 Chocolate Biscuits and Wafers 16 1 17 5 9 Chocolates 1 .. 1 .. Cocoa 2 .. 2 .. Cod Liver Oil with Malt Extract 1 .. 1 .. Coffee 1 .. 1 .. Coffee Tablets 2 .. 2 .. Coffee and Chicory 1 .. 1 Confectionery 3 .. 3 .. Cooking Fat 1 .. 1 Condensed Milk 7 .. 7 .. Cream 5 .. 5 .. Cream, tinned 2 .. 2 .. Easter Eggs, Chocolate 6 .. 6 .. Egg Yolk .. 1 1 .. Fish, tinned 75 11 86 12.8 Fish Paste 2 .. 2 .. Fish Sauce Preserve 1 .. 1 .. Carried forward 141 13 154 58 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulteration. Brought forward 141 13 154 Informal Samples—contd. Flour 2 .. 2 12.5 Fruit Pulp 7 1 8 .. Fruits, tinned 12 .. 12 .. Fruits, dried 6 .. 6 .. Galantine Roll 1 .. 1 .. Grape Fruit Squash 1 .. 1 .. Haricot Beans in Tomato Sauce 1 .. 1 .. Herbs, dried 2 .. 2 .. Honey, prepared 1 .. 1 .. Jam 4 5 9 55.5 M eat Paste 2 .. 2 .. Menthol Pellets 1 .. 1 .. Mercurial Ointment 2 .. 2 .. „ Pills 2 .. 2 .. Mercury Ointment .. 1 1 100.0 Pills .. l 1 100.0 Milk 2 .. 2 .. Jelly, Table 2 .. 2 .. Jellied Eels 1 .. 1 .. Lemon Squash 1 .. 1 .. Marmalade 1 .. 1 .. Milk and Milk Foods, dried 5 .. 5 .. Mushrooms, tinned 4 .. 4 .. Mustard Compound 1 .. 1 .. „ Prepared 1 .. 1 .. Mustard .. 1 1 100.0 Olive Oil, B.P. 1 .. 1 .. Oxtail Soup 1 .. 1 .. Pastries, Fancy 1 .. 1 .. Pepper 1 .. 1 .. Pepper Compound 1 .. 1 .. Peas 1 .. 1 .. Peas, tinned 2 .. 2 .. Rice, Cream 2 .. 2 .. Salmon 1 .. 1 .. Sardines, tinned .. 5 5 100.0 Sauce 2 .. 2 .. Sausage and Baked Beans in Tomato Sauce 1 .. 1 .. Shredded Beef Suet 1 .. 1 .. Soup Powder 3 .. 3 .. Sweets 17 .. 17 .. Syrup, Golden 1 .. 1 .. Tea 1 .. 1 .. Tonic Food 1 .. 1 .. Vinegar 1 .. 1 .. Vinegar Wine 1 1 .. Vitoleum Cream 1 1 .. Wafers 7 2 9 22.2 Vegetables, tinned 7 .. 7 .. Wine, alcoholic 1 .. 1 .. Total Informal, etc., Samples 259 29 288 10 1 59 Action Taken in regard to Formal Samples Purchased Food and Drugs (Adulteration) Act during the Year 1935. Sample No. Article. Particulars of Adulteration or Infringement, Fine. Costs. Remarks. £ s. d. £ s. d. 41 Y Black currant Jam 6 per cent. deficient in black currant fruit - Attention of manufacturers drawn. 5 H Milk 3 per cent. fat abstraction — — Vendor cautioned 6 H Milk 6 per cent. do. — — Do. 277 Y Mercury Ointment 67.6 per cent. deficient in Mercury — 3 3 0 Summons dismissed on payment of costs 281 Y Do. 62 6 per cent. do. — 3 3 0 Do. 285 Y Do. 6.3 per cent. do. — — Vendor cautioned. 286 Y Do. 64.6 per cent. do. — 3 3 0 Summons dismissed on payment of costs 276 Y Mercury Pills 34 per cent. deficient of B.P. Mercury Pill 2 0 0 3 3 0 — 303 Y Gin 5.5 per cent. added water — 4 4 0 Summons dismissed on payment of costs 60 Action Taken in regard to Informal Samples. Sample No Article Particulars of Adulteration or Infringement Action taken. 19 Y Raspberry Jam 11 per cent. deficient in raspberry fruit Formal sample purchased (proved genuine) 33 Y Black Currant Jam 8 per cent. deficient in black current fruit Do. do. 43 Y Do. 5 per cent. do. Do. do. 44 Y Do. 10 per cent. do. Do. do. 54 Y Plum Jam 12 per cent. deficient in plum fruit Do. do. 116 Y Tinned Sild Tin, 3.0 grains per lb. Tradesmen's stocks (2,338 tins) voluntarily surrendered Ministry of Health notified. 119 Y Do. Tin, 3.8 do. 120 Y Do. Tin, 6.7 do. 124 Y Do. Tin, 4.9 do. 130 Y Do. Tin, 2.6 do. 146 Y Do. Tin, 2.24 do. 150 Y Do. Tin, 3.36 do. 155 Y Do. Tin, 3.78 do. 156 Y Do. Tin, 4.34 do. 156 Y Do. Tin, 2.87 do. 185 Y Do. Tin, 3.99 do. 306 Y Tinned Sardines Lead, 48 parts per million 1,016 tins voluntarily surrendered and destroyed. Ministry of Health informed. 307 Y Do. Lead, 34 do. 308 Y Do. Lead, 41 do. 309 Y Do. Lead, 33 do. 310 Y Do. Lead, 61 do. 270 Y Mercury Pills 38 per cent. deficient in B. P. Mercury Pill Formal sample purchased 273 Y Mercury Ointment 643 deficient in Mercury Do. do. 111 W Wafers Contained an added preservative— Sample cases destroyed. Boric acid 0 49 gr. per lb. 117 W Do. Do. 0 49 do. Do. do. 128 W Mustard A preparation of mustard containing common salt 5 6 per cent. and acetic acid 31 per cent. Wrongly described on Manifest, should read "Prepared Mustard." 194 W Egg Yolk Boric acid, 116 gr. per lb. Released for tannery purposes. 186 W Chocolate Wafers Boric acid, 1.82 gr. per lb. Ministry informed. Wafers traced and destroyed. 146 W Black Currant Fruit Pulp Sulphur dioxide 2280 parts per million Broken down by jam manufacturers. 5 lb. pulp to 33 lbs. fresh fruit (.0346) 61 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 founVl 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 to 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 and drugs is carried out by the Public Analyst, Mr. Henry G. Harrison, M.A., F.I.C., and his deputy, Mr. Hugh Amphlett Williams, a.C.G.F.C., F.l.c. The examination of food from a bacteriological standpoint is carried out at the Pathological Department of the Seamen's Hospital, Greenwich. 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. 64 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 1935. INCIDENCE AND MORTALITY BY AGE GROUPS. Notifiable Disease At all Ages Total Cases Notified. At Ages—Years TotalCases Removed to Hospital Total Deaths Deaths at Ages—Years Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 301 3 78 168 33 14 4 1 299 10 .. 4 6 .. .. .. .. Erysipelas 56 2 .. 3 2 9 29 11 40 .. .. .. .. .. .. .. .. Scarlet Fever 262 4 93 124 25 16 .. .. 251 .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. Puerperal Pyrexia 9 .. .. .. 4 5 .. .. 9 1 .. .. .. .. l .. .. Cerebro-Spinal Meningitis 2 .. 2 .. .. .. .. .. 2 4 2 2 .. .. .. .. .. Poliomyelitis and Polioencephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 11 11 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 12 8 4 .. .. .. .. .. 1 16 15 1 .. .. .. .. .. *Acute Primary and Acute Influenzal Pneumonia 77 6 18 6 13 11 17 6 11 64 16 3 1 2 2 19 21 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 123 2 37 66 16 .. 1 1 4 .. .. .. .. .. .. .. Posterior Basal Meningitis 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Totals 859 37 232 367 95 57 52 19 623 95 33 10 7 2 3 19 21 *The deaths from Pneumonia include all forms of that disease, including many cases not notifiable as "Acute." 65 SEASONAL INCIDENCE OF NOTIFIABLE INFECTIOUS DISEASES. Disease. 1st quarter 2nd quarter 3rd quarter 4th quarter Total for year Diphtheria 86 66 70 79 301 Erysipelas 18 14 13 11 56 Scarlet Fever 98 63 45 56 262 Enteric Fever ... ... 1 1 2 Puerperal Fever ... ... 1 ... 1 Puerperal Pyrexia 1 4 2 2 9 Cerebro-spinal Meningitis 1 ... 1 ... 2 Poliomyelitis ... ... ... ... ... Ophthalmia Neonatorum 2 4 1 4 11 Infantile Diarrhœa, etc. ... ... 11 1 12 Acute Primary and Influenzal Pneumonia 36 18 11 12 77 Chicken Pox 25 41 21 36 123 Encephalitis Lethargica 1 ... ... ... 1 Anthrax ... ... ... 1 1 Small Pox ... ... ... ... ... Posterior Basal Meningitis ... ... 1 ... 1 Totals 268 210 178 203 859 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 1935 252 2.6 - 0.0 Scarlet Fever, during 1935, showed a great decrease, the cases being of the mild character experienced in recent years. e 66 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1935. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Town Hall Deptford Park Evelyn St. Paul's Vale Clifton Canterbury Hatcham Pepys St. Catherine's St. Peter's St. John's Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 301 23 28 62 33 17 26 23 4 25 .. 16 25 Erysipelas 56 2 5 6 5 3 5 9 3 4 3 4 7 Scarlet Fever 262 12 22 17 25 9 24 43 19 32 24 12 23 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 1 .. .. .. .. .. .. .. .. .. .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 1 1 .. .. .. .. .. .. .. .. .. .. .. Puerperal Pyrexia 9 .. .. .. .. 1 2 .. .. 4 .. .. .. Cerebro-Spinal Meningitis 2 .. .. .. 1 .. .. .. .. 1 .. .. .. Poliomyelitis and Polioencephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 11 .. .. 2 2 3 1 .. .. 1 .. 1 1 Anthrax 1 .. .. .. .. .. .. 1 .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 12 .. 1 3 4 1 .. .. .. 1 1 1 .. Acute Primary and Acute Influenzal Pneumonia 77 4 9 8 4 9 11 11 5 4 2 5 5 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. .. .. .. 1 .. .. .. .. .. Chicken Pox 123 18 7 2 17 28 16 3 6 12 1 3 10 Posterior Basal Meningitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. Totals 859 61 73 101 91 71 85 91 38 84 50 42 72 67 Diphtheria. The following table shows the incidence and mortality from Diphtheria in 1935 as compared with previous years:— 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 2.4 193 3 236 2.3 5 2.1 1934 310 3.1 19 6.2 1935 301 3.0 10 3.3 The Borough Council has established a clinic for the purpose of providing means by which parents may have their children protected by artificial immunisation. With proper safeguards as adopted there, it may confidently be said that no risk attaches to the method. The work of the Diphtheria Immunisation Clinic has been undertaken by Dr. Donnelly, who has very kindly furnished me with the following Report:— Schick testing and inoculation began in March, 1927. The figures for successive years are as follows:— Year. Positive. Number of Negative. Schick Tests. Unknown Result. Total. Fully Inoculated. Partly Inoculated. No. of Inoculations given. 1927 214 152 8 374 410 15 1233 1928 85 75 14 174 168 65 580 1929 21 27 7 55 72 15 221 1930 15 27 - 42 65 3 199 1931 6 7 — 13 17 5 58 1932 3 - 1 4 11 - 33 1933 5 4 - 9 32 1 97 1934 2 8 - 10 11 - 33 1935 45 16 - 61 164 14 514 Number of Schick Re-tests. Positive. Negative. Unl <nown Result. Total. 1927 - - - - - 1928 34 134 13 181 1929 8 55 3 66 1.930 5 39 1 45 1931 3 21 2 26 1932 2 15 - 17 1933 1 - - 1 1934 3 2.1 — 24 1935 4 99 - 103 e2 68 In all cases where a full immunizing course has been given, parents are requested to bring their children for the purpose of having a Schick re test carried out. Small-pox. 1935—Nil. Vaccination. No vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. Chicken-pox. Since made compulsorily notifiable, the number of notifications have been as follows:— Year. Year. 1929 (1-31 December) 61 1933 156 1930 445 1934 107 1931 152 1935 123 1932 172 Anthrax. One case of Anthrax was notified in 1935. Treated at St. Alfege's Hospital—Bacteriological examination did not show the presence of the specific organism. 69 Return made on or before the 10th of February, 1936, by Mr. E. S. Elliott, Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1934, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1934. 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 children under 14 received during Calendar Year 1936. No. c f Declarations of Conscientious Objections actuallyreceived by Vaccination Officer during the Calendar Year 1935. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Certificates of Conscientious Objection received. Dead. Un vaccinated. Postponement by Medical Certificate. Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. North Deptford 593 203 2 - 216 30 8 4 26 104 - - South Deptford 434 186 - - 184 16 4 3 18 23 - - Total 1027 389 2 - 400 46 12 7 44 127 600 346 Dated, February 6th, 1936. Successfully vaccinated after the declaration of conscientious objection, 1. Total Number of Certificates for Year 1935 sent to other Vaccination Officers, 100. 70 Pneumonia. Both Acute Primary and Influenzal Pneumonia are notifiable, and a statement of the notifications received and deaths recorded are as follows:— No. of cases Notified. No. of deaths (all forms of Pneumonia.) Death rate per 1,000 population. Average 1920-1924 94 137 1.2 1925-1929 172 121 1.0 1930 74 73 0.7 1931 101 113 1.0 1932 104 82 0.7 1933 157 84 0.8 1934 137 84 0.8 1935 77 64 0.6 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 1935 Cases 3 3 2 4 4 2 1 5 7† 3 3† Deaths 1 - - 4 2 2 4 5 2 1 4 ( Including one case of Posterior Basal Meningitis. Acute Poliomyelitis. The average number of notifications received between 1915-1924 was two. The figures since 1924 are as follows:- 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 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 There The subsequent figures were:— 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Cases 9 8 3 3 3 - - 1 - 1 1 Deaths 5 2 2 2 1 - - 2 2 1 - All cases are periodically re-visited and treatment offered. 71 Malaria. Since the 1st January, 1928, Malaria, induced therapeutically, is notifiable if liable to recur. Average 1920-1924 Average 1925-1923 1930 1931 1932 1933 1934 1935 Cases 8 4 2 =- 1 1 - - No deaths have been registered from this cause Dysentery. The figures are as follows:— Average 1920-1924 (total) Average 1925-1929 1930 1931 1932 1933 1934 1935 Cases 3 2.5 - - - - - - Deaths - 0.4 - - - - - - Infantile Diarrhœa. Since 1920, this has been notifiable in the case of children under two years of age, and the following are particulars of notifications received and deaths:— Average 1920-1924 Average 1925-29 1930 1931 1932 1933 1934 1935 Cases Notified. 66 75 12 26 37 23 34 12 Deaths 28 15 17 9 23 15 27 16 All cases of Infantile Diarrhoea are investigated by the Health Visitors with the object of securing nursing assistance or hospital treatment where such is required. Insanitary conditions are passed to the District Sanitary Inspector to be dealt with. Puerperal Fever. The following is a tabular statement of the notifications and deaths in recent years. Year. Cases. Deaths. Death-rate per 1,000 births. Average 1915-1924 7 4 1.6 1925-1929 8 3 1.7 1930 8 3 1.7 1931 5 4 2.3 1932 2 2 1.2 1933 4 6 3.8 1934 6 2 1.2 1935 1 - - From 1933 onwards, the death-rate is calculated per 1,000 total (live and still) births. 72 Puerperal Pyrexia. Since 1st October, 1926, notification is compulsory in the case of any woman who, within 21 clays 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 1935 Cases 5 16 12 6 10:; 17 17 15 15 9 * Includes one subsequently notified as Puerperal Fever and dealt with under that heading. Of the 9 cases notified, 6 had been confined in hospital and 3 at home. All the latter were subsequently sent to hospital. One death 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 1935 Cases 14 9 18 14 26 21 11 8 21 11 The following is a statement of the results of treatment in respect of the cases notified in 1935:— Notified Treated Vision unimpaired Vision impaired Total blindness Since died from other Causes At home In hospital 11 11 — 11 - - - Apart from true cases of Ophthalmia, midwives have to report cases of inflammation of the eye, and these, together with cases of Ophthalmia, are kept under observation by the Health Visitors. The Borough Council has made arrangements with certain local nursing organisations, viz., the Ranyard Nursing Association and the Queen's Nurses, Rotherhithe, for a nurse to visit and carry out the treatment prescribed. Where, for any reason, hospital in-patient treatment is deemed advisable, facilities are provided at St. Margaret's Hospital, Kentish Town. 73 Erysipelas. 56 cases were notified during the year. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. Enteric Fever. Two cases were notified—there were no deaths. Other Notifiable Disease. With the exception of Tuberculosis, which occupies a separate section of this Report, no notifiable disease, other than the foregoing, occurred during 1935. 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 1935 6 0.5 0.06 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 1935 1 0.09 0.01 74 Measles is not a notifiable disease, but during the year under report 73 cases were heard of through schools and other sources, and visited by the Health Visitors. Where the home accommodation was unsuitable, the patients were removed to hospital, and in one other instance 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 1935 5 0.5 0.05 Cases of Whooping-cough selected either because unsuitable home conditions or of the presence of other young children in the home, or on account of complications, are sent into hospital. 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, 1935. Material. Number Positive. Number Negative. Total. Swabs for Diphtheria 163 893 1056 Swabs for Virulence Test 1 1 2 Samples of Disinfectants 3 3 6 Sputum for Tuberculosis 8 56 64 Blood for Enteric Fever — 7 7 Urine for T.B., etc. 3 2 5 Swimming bath water 3 9 12 Maternity Outfit for Sterility — 1 1 Scrubbing brush for Anthrax — 1 1 •Note.—Other examinations are reported under " Food." 75 At the Tuberculosis Dispensary, 713 specimens of sputum were examined. Of these, 505 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 208 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 896 „ „ „ Requests, rooms only ... 83 „ „ „ „ bedding only 70 „ „ „ Verminous conditions 222 „ „ „ Removals 35 Total premises visited 1306 Number of rooms disinfected, formalin spray 1282 „ „ „ sulphur 391 Total 1673 Number of articles disinfected (steam disinfector) 19700 Number of books disinfected (formalin lamp) 283 „ „ articles destroyed at owners' request 833 „ „ adults from Common Lodging Houses cleansec I 60 Special disinfections, etc.:— Verminous furniture—Seven 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. 76 So far as the structure of the house is affected, the procedure followed is in accordance with the provisions of the Public Health (London) Act, viz., cleansing by the owner, disinfection by the officers of the Borough Council, supplemented by the loan to the occupiers of a hand-spraying machine for the periodical application of an insecticide fluid. Clothing and bedding are disinfected by steam. For personal disinfestation, the Borough Council maintains a Cleansing Station and provides the services of a Cleansing Attendant. This station, by arrangement with the London County Council, is primarily used for school children. Male adults are occasionally provided with a cleansing bath in a separate structure. During the year, 60 adults and 1,412 children were cleansed. In addition, 947 treatments were given to children suffering from scabies. 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 1935. No routine supply of disinfectants for general purposes is made but, in the case of tuberculosis and other infectious diseases, a liquid preparation, having a guaranteed Rideal-Walker co-efficient of 18-20, is supplied upon request. The precautions prescribed in respect of blue fluted bottles and labelling are observed. III. OTHER DISEASES. Cancer. Disinfectants. 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 1935 167 15.1 1.7 77 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 C 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 1935 Male — 5 34 36 26 101 Female — 2 26 21 17 66 Total - 7 60 57 43 167 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. 80 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 pop illation. 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 1935 91 68 1.60 20 17 0.37 The figures for the years 1923 onwards are not strictly comparable with those of previous years as they include cases, although not formally notified, which have come to the knowledge of the Medical Officer of Health. The Death-rate in recent years is as follows:— Year. England and Wales, per 1,000 population. Deptford. per 1,000 population. Pulmonary* Non-pulmonary. Pulmonary* Non-pulmonary. Average 1915-1924 0.99 0.29 1.17 0.28 1925 0.83 0.21 0.89 0.17 1926 0.77 0.19 0.79 0.11 1927 0.79 0.18 1.04 0.09 1928 0.75 0.17 0.95 0.21 1929 0.79 0.17 0.81 0.10 1930 0.74 0.16 1.02 0. 13 1931 0.74 0.15 0.93 0.13 1932 0.69 0.15 0.86 0.12 1933 0.69 0.13 0.91 0.10 1934 0.64 0.13 0.91 0.10 1935 — 0.83 0.06 Dr. N. M. Donnelly, the Tuberculosis Officer, reports as follows:— I have pleasure in submitting herewith the Annual Report on Tuberculosis work in the Borough in 1935. Notifications. The following table gives a summary of the notifications received from the 1st January, 1935, to the 'liy international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under " Pulmonary," are now included under " Noti. pulmonary Tuberculosis.'' 81 Report of Tuberculosis Officer—continued. 31st December, 1935, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 174; 135 Pulmonary Tuberculosis and 29 Non-pulmonary, as compared with 129 Pulmonary and 42 Non-pulmonary for the previous year. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1935 to the 31st December, 1935. 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 Notificatioi s. Pulmonary— Males ... 1 JL 1 1 8 5 17 20 12 9 4 78 116 Females ... ... 2 ... 12 15 13 5 4 3 3 57 84 Non-Pulmonarv Males ... 3 o 3 4 1 2 2 17 19 Females ... ... 1 1 2 1 2 3 1 1 ... ... 12 15 S3 O o O* ■2 o C/j C/5* o o o 0 o+» 1 3° ^ to rs 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 G5 and up Total Cases Pulmonary—Males 2 ... ... 1 2 2 2 2 ... 2 13 „ —Females 1 ... ... 1 2 5 ... ... 1 1 11 Non-Pulmonary—Males ... ... ... ... 2 ... 1 ... ... ... 3 „ —Females ... 1 2 ... 1 ... 1 ... ... ... 5 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Non-Pulmonary. Death Returns j [ from local Registrars... transferable deaths from Registrar-General 2 7 2 Posthumous notifications 6 " 1 ransfers " from other areas (other than transferable deaths) 7 6 Form D (from Sanatorium) 2 *§• o <4. o a o o* o Co . CO € o f5> o o ?•+. *■». s oc S co 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, 1935, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of Deptford 310 223 533 82 102 181 717 Number of cases removed from the Register during the year, inter alia of :— 1. Withdrawal of notification ... ... ... ... ... ... ... 2. Recovery from the disease 9 8 17 8 5 13 30 3. Death 49 26 75 2 ... 2 77 f2 84 Report of Tuberculosis Officer—continued, Notes on Tables of Notifications. Though the tables show that 15 cases died before coming to the notice of the Medical Officer of Health, 8 (6 pulmonary and 2 nonpulmonary) through death returns, 7 (6 pulmonary and 1 non-pulmonary), by posthumous notification, there does not appear to be any marked failure to carry out the duty of immediate notification. Of the 3 non-pulmonary cases 2 were cases of meningitis and 1 of miliary tuberculosis; of the 12 pulmonary cases, 1 was a child notified as dying of pulmonary disease and meningitis, 1 a case notified as dying in a mental hospital who had been there for years. 1 had been in the borough for only 5 months and had been notified elsewhere. 2 were cases of tuberculous broncho-pneumonia, 1 a case of broncho-pneumonia and pulmonary tuberculosis admitted to hospital from a lodging-house only three days before death, 1 a woman admitted to hospital a day before death, and 1 who died from sudden hæmorrhage. Of the remainder one was a case of diabetes with pulmonary tuberculosis, and in the case of one of the others the patient's doctor wrote explaining lateness of notification. Five pulmonary and 6 non-pulmonary cases which were transferred into the borough were not notified in the area before the end of the year. Where such cases originate at a hospital they are seldom seen at Dispensary and may not have occasion to call in a local doctor, so that they may remain formally unnotified. They are however visited, and the patient and his home kept under supervision as in the case of patients formally notified. In 8 of the cases notified, 7 pulmonary and 1 non-pulmonary, the diagnosis was subsequently not confirmed. Eleven of the cases notified died within a month of notification. One died of meningitis 2 from causes other than tuberculosis, 6 were admitted to hospital (3 from lodging-houses) within from 3 days to 3 weeks before death. 85 Report of Tuberculosis Officer—continued. Home accommodation of 153 of the Cases notified in 1935 (hospital, lodging-house and "diagnosis not confirmed" cases omitted). 124 Pulmonary Tuberculosis. 29 Non-Pulmonary Tuberculosis. 73 Cases with T.B. in Sputum. Rooms. 51 Cases in which T.B. not known to be present in Sputum. Rooms. Rooms. 1 2 3 4 5 or more 1 2 3 4 5 or more 1 2 3 4 5 or more CASES and Number in Family 3 of 1 3 of 1 2 of 1 4 of 1 1 of 1 3 of 2 9 of 2 2 of 2 2 of 2 2 of 2 l of 2 l of 2 1 of 2 1 of o 6 of 3 2 of 3 6 of 3 l of 3 3 of 3 3 of 3 4 of 3 5 of 3 4 of 3 l of 3 l of 3 1 of 4 3 of 4 2 of 4 5 of 4 2 of 4 4 of 4 5 of 4 2 of 4 1 of 4 2 of 4 1 of 4 1 of 4 2 of 5 1 of 5 4 of 5 2 of 5 3 of 5 11 of 5 8 of 5 1 of 5 2 of 5 2 of 5 5 of 6 l of 6 lof 6 2 of 6 1 of 7 2 of 7 2 of 7 1 of 7 2 of 7 2 of 8 1 of 8 1 of 8 2 of 9 lof 9 1 of 9 1 of 9 l of 9 1 of 10 1 of 10 l of 10 1 of 11 1 of 11 26 had a separate room. 21 had a separate room. 6 had separate room. 2 had separate bed with 1 other in room 1 had separate bed but 1 other in room. 2 had separate bed, but 1 other in room 4 „ „ „ 2 „ „ 3 ,, ,, 2 4 „ „ „ 2 „ 31 had another in bed. 2 ,, ,, 3 1 „ „ „ 3 „ „ 5 ,, ,, & 1 other in room 16 had another in bed. 1 4 ,, 2 ,, ,, & 2 others in room 5 ,, „ 1 „ 7 had another in bed. 3 ,, ,, & 3 others in room 1 „ „ 2 „ 2 „ „ 1 „ 1 had 2 others ,, 2 „ 3 „ „ 2 „ 1 „3 „ „ 1 „ „ 4 „ 1 2 others ,, 2 1 „ „ 3 „ 86 Report of Tuberculosis Officer—continued. The number of deaths for the year is 89 as compared with 102 for 1934. 1931 1932 1933 1934 1895 Pulmonary deaths 100 92 94 92 83 Non Pulmonary deaths 14 13 10 10 6 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 1935. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 – 1 – – – – – 1 1 3 2 3 2 – 1 1 1 5 1 – 2 3 – 1 – – 10 1 – 3 2 1 2 – – 15 9 13 6 2 3 2 1 – 20 7 17 1 2 4 4 1 – 25 19 18 1 4 10 11 – – 35 22 5 2 1 8 3 1 – 45 14 4 2 1 14 1 – – 55 9 4 – – 7 4 – – 65 and upwards 6 4 – – 3 4 – – Totals 91 68 20 17 50 33 4 2 *Note—Including 32 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 1935. Not notified 9 Died before notification 6 Died within one week of notification 5 ,, ,, one week to one month 6 ,, „ one month to six months 17 ,, ,, six months to one year 6 ,, „ one to two years 8 ,, ,, two to three years 7 „ ,, three to four years 2 ,, „ four to five years 5 ,, „ five to six years 5 „ „ six to seven years — ,, ,, seven years and upwards 7 83 87 Report of Tuberculosis Officer—continued. The notifications of non-Pulmonary Tuberculosis were as follows:— Peripheral glands 11 Bones and joints 9 Abdominal 8 Genito-urinary 1 Total 29 Revision of Notification Register. During the year 164 cases of Pulmonary and 45 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 1935 as follows:— MALES FEMALES Total Under 15 Over 15 Under 15 Over 15 Pulmonary Tuberculosis 27 283 22 201 533 Non-Pulmonary Tuberculosis 42 40 61 41 184 Totals 69 323 83 242 717 Disinfection was carried out in 264 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 88 Report of Tuberculosis Officer—continued. Memo 37/T. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1935. 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 58 44 3 2 7 7 5 1 65 51 8 3 127 300 (b) Diagnosis not completed – – – – – – – – 5 8 2 1 16 (c) Non-tuberculous – – – – – – – – 60 84 57 46 247 B.—Contacts examined during the year:— (a) Definitely tuberculous – – – – – – – – – – – – – 121 (b) Diagnosis not completed – – – – – – – – 1 3 3 4 11 (c) Non-tuberculous – – – – – – – – 13 35 31 31 110 C.—Cases written off the Dispensary Register as (a) Recovered 10 6 2 2 1 3 4 3 11 9 6 5 31 419 (b) Non-tuberculous (including any such cases previously diagnosed and enter on the Dispensarv Register as T.B.) – – – – – – – – 82 131 93 82 388 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 192 149 9 18 34 36 29 27 226 185 38 45 494 521 (b) Diagnosis not completed – – – – – – – – 6 11 5 5 27 89 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 563 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 42 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 103 4. Cases written off during the year as Dead (all causes) 73 5. Number of attendances at the Dispensary (including Contacts) 2335 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 116 Number of G.P. 36 reports from practitioners 113 7. Number of consultations with medical practitioners:— (a) Personal 12 (b) Other 76 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 186 9. Number of visits by Nurses or Health Visitors to Homes successful 2765 for Dispensary purposes unsuccessful 708 3473 Visits to cases non-Dispensary cases successful 1483 unsuccessful 330 1813 10. Number of (a) Specimens of sputum, &c., examined 505 (b) X-ray examinations made in connection with Dispensary work 189 (c) Sputum examinations for non-Dispen- sary cases 208 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 264 Notes on Table I. It will be noted that the number of persons on the Dispensary Register on the 31st December, 1935 is 521, a slight decrease over figure at end of 1934. The number of patients coming into the Borough from other areas and of cases which had been lost 90 Report of Tuberculosis Officer—continued. sight of and returned to the Register, being 42 as compared with 56 in the previous year. "Transfers to other areas" and "Cases lost sight of" were 103 as compared with 122 in 1934. 73 deaths of Dispensary patients occurred, compared with 80 in the previous year. One patient had Ultra-violet light treatment for lupus. Twenty-four patients have had artificial pneumothorax treatment at the Brompton, St. Thomas'. Grove Park and Colindale Hospitals, making 265 attendances. In 1934, 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. 51 refills have been given at St. Alfege's Hospital by the Tuberculosis Officer to 7 patients in addition to those mentioned above. 91 Report of Tuberculosis Officer—continued. Examination and Supervision of Contacts. Analysis of contacts of 157 of the cases primarily notified during the year (including cases notified after death but excluding lodging-house cases and cases in which the diagnosis was not confirmed):— Total T.B. Positive T.B. Negative Non-Pulmonary 1. No. of patients notified 157 74 55 28 II. No. of above seen at Dispensary 105 65 33 7 (a) Total contacts of cases seen at Dispensary— Adults 232 137 83 12 Children 99 57 27 15 (a') No. of above contacts examined at Dispensary— Adults 40 28 11 1 Children 52 30 16 6 III. No. of notified cases not seen at Dispensary 52 9 22 21 (a) Total contacts of cases not seen at Dispensary— Adults 116 16 33 67 Children 42 8 16 18 (a') No. of above contacts examined at Dispensary- Adults 16 2 7 7 Children 22 5 8 19 Total School Contact Cards sent to School Medical Officer 83 (a) Examined at Dispensary— Class 1* 17 Class 2* 37 (b) Not examined at Dispensary— Class 3* 29 *Class 1—Unsatisfactory cases. *Class 2—Apparently healthy cases. *Class 3—Not examined. Approximately sixty-four 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 92 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. 28 % of the total contacts were examined before the end of the year. 53% of the child „ ,, ,, 16 % of the adult ,, ,, „ 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 88), 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." No contacts, as defined above, were found to be tuberculous during the year under report, but 30 persons who had another member of their respective households notified in previous years (over half of whom were known to be cases with Tubercle Bacilli in sputum), were seen during 1935 and found to be suffering from tuberculosis. The Tuberculin Testing of child contacts of tuberculosis was continued and the results are given below. In most of the cases giving a positive result to the test, and also in a few negative cases, an X-ray examination was made. 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. 93 Report of Tuberculosis Officer—continued, Result of Tuberculin Skin Tests of 92 Children. Age 1—2 Group (7) Age 2—5 Group (18) Age 5—12 Group (49) Age 12—15 Group (18) 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 C ontacis of T.B. + cases Not known to be contacts Contacts of T.B. – cases C ontacts of T.B. + cases Test not completed 1 – – 2 2 1 1 2 1 – 1 – Negative 2 – l 3 2 3 17 5 4 1 1 2 Positive — 1 2 2 – 3 4 4 11 4 1 8 94 Report of Tuberculosis Officer—continued. From the Tuberculin Testing and X-ray examination during the last five years of children of school age and under, who have been examined as "contacts," or because of some symptoms or signs suggesting tuberculosis, it would appear that in children from 4 to 14, very few cases of active pulmonary tuberculosis occur. Children of pre-school age, contacts of persons suffering from pulmonary disease with Tubercle Bacilli in the sputum, who show by the Tuberculin Test that they have had infection, but in whom no abnormal sign can be detected, either because they are absent or the child is very difficult to examine, will in some cases unexpectedly give X-ray evidence of lung disease, and such examination in these cases seems of value. Adolescent and young adult contacts, among whom the deathrate is so high, and whom particularly it would be most desirable and useful to keep under periodical supervision after a case has occurred in the household, are those it is most difficult to get to attend for even one examination. Dental Treatment. The number of patients for whom dental treatment was provided was 52 compared with 50 in 1934. 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. 95 Report of Tuberculosis Officer—continued. The income and expenditure in connection with the supply of dentures and repairs to dentures to 18 patients were as follows:— £ s. d. Total cost of dentures and repairs 50 8 0 Total cost of free cases 25 9 6 Contributions from Approved Societies 11 7 0 „ Public Assistance mittee 10 9 0 ,, Patients 3 2 6 The Dental Surgeon, Mr. J. Eric Magraw, reports the following as a summary of the year's work:— Fillings. Cases. Attendances. Extractions. Amalgam. Plastic. Scalings. Dentures. Repairs 52 254 96 17 11 124 22 6 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 putients on domiciliary treatment was 113. 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, 136 were sent by doctors. 183 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 was 88. 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. 00 Report of Tuberculosis Officer—continued. 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 5,286 compared with 5,822 in the previous year. Reports are made on the undermentioned points respecting home conditions, contacts, etc.:— (а) 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. 163 of the new attenders were referred by the Council's staff. Bacteriological examinations of Sputa. The number of examinations of specimens for Dispensary cases was 505. In addition, 208 specimens were sent by practioners for examination. X-ray Diagnosis. The number of X-ray examinations is 178 compared with 184 in the previous year. These are in addition to cases screened in connection with artificial pnemo-thorax treatment. 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 48 persons. Institutional Treatment. 133 patients were recommended to the London County Council for institutional treatment. 4 patients refused treatment. 12 recommendations were also made from 97 Report of Tuberculosis Officer—continued. Dispensary for direct admission to London County Council general hospitals, and 67 patients sent to general hospital from other sources were seen at hospital by the Tuberculosis Officer. (269 reports on the condition of the patients treated in previous years were sent to the County Council). In the case of patients attending voluntary 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 1935— 14 died within 3 months from the date of the first attendance. 3 ,, ,, 6 ,, ,, ,, ,, 5 „ „ 12 „ „ „ „ 47 ,, after 12 ,, ,, ,, ,, In addition, 4 patients on the Register, but who were not Dispensary attenders, died. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take any action in relation to any tuberculous employee in the milk trade. Christmas Gifts. We have to thank Miss Greig our Dispenser who this year, again, provided a pleasant afternoon for many of our child patients. Cakes and toys distributed to the children were obtained from the Clerical Staff Xmas Gift Fund of the Prudential Insurance Company, through Miss Greig's efforts. Handicraft Centre. To Mrs. Monk, who submits the following report, great thanks are due for the time she devotes to this work and the trouble she takes in eliciting support from various sources:— "The Handicraft Class still proves to be a most successful effort. Every year sees some addition to the work undertaken. Besides glove-making, leather and wicker-work, etc., one student g 98 Report of Tuberculosis Officer—continued. is now embarking on most attractive evening shawls, which should be very popular. Another student specialises in artistic bracelets. There is, in fact, a variety of work. They, or we, are a very happy family. "I am confident that Handicraft Classes are an essential part of an ultimate cure ; they create something to do, something to talk about, an escape from the surroundings which are too often dull and uninteresting. "There is tremendous competition and keenness in the work, and a general feeling in the classroom that life is not so hopeless after all. "The outing to Eastbourne and Wannock Tea Gardens in July was most enjoyable as was also the Christmas party and entertainment. "Thanks are due to the Chairman and members of the Care Committee, Mrs. Sains and Mrs. Mabbs, also the staff at the Dispensary and Miss Campbell for again giving a display, the proceeds of which will help this year's Outing Fund." Cookery Class. These classes have been continued through the year, and the fact that many of the women who came to the first classes have continued their attendances shews that Miss Rankin, the instructress from the South Metropolitan Gas Company, has retained their interest with a variety of useful menus. During the year following on their Report on Nutrition, the British Medical Association published a booklet giving varied menus for every day for a period of three weeks, which menus embodied the quantities and kind of foods laid down in the report as necessary. The cooking of these has been demonstrated at the classes, the quantities and cost of articles as purchased locally being given. To face page 99 Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a.) pulmonary tuberculosis. Supplementary Annual Return showing in summary form la) the condition at the end of 1935 of all paiients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the Patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus. Class T.B. plus. Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus 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. | lus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B plus) Group 1 Group 2 Group 3 Total Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 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) (a) Remaining on Dispensary Register on 81st December. Disease arrested Adults M. 3 4 3 7 1 2 1 4 2 2 1 3 4 l 2 2 1 2 2 4 3 6 9 5 l l 2 2 2 F. 2 3 4 7 1 1 1 2 1 1 2 2 2 1 4 4 1 l 1 2 1 1 Children ... 1 1 1 1 2 1 1 2 2 1 1 Disease not arrested Adults M. 2 9 11 3 3 3 3 1 2 1 3 1 4 5 1 5 2 8 2 5 7 2 l 6 7 4 3 13 1 17 6 4 10 3 17 9 6 28 34 F. 6 3 2 2 3 3 1 1 2 2 4 2 6 1 l 7 8 1 1 4 I 6 1 l 8 9 4 5 5 7 12 12 15 3 18 3 24 Children 2 3 3 3 5 Condition not ascertained during the Year ... 2 2 1 1 1 1 2 1 1 2 3 l 1 1 1 2 3 Total on Dispensary Register at 31st December ... 6 9 24 33 2 1 7 1 9 l 9 9 4 '5 6 11 6 3 9 3 15 5 2 16 2 20 10 6 21 2 29 12 4 16 20 13 5 22 l 28 16 7 22 3 32 29 9 46 3 58 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 37 16 11 27 2 2 1 2 1 3 2 2 1 1 2 1 1 F. 61 10 7 17 3 1 1 l 1 1 1 Children ... 62 1 1 7 2 1 3 Lost sight of or otherwise removed from Dispensary Register ... 362 78 140 16 234 17 4 13 10 27 10 8 32 2 42 18 9 19 1 29 28 6 25 1 32 20 5 24 3 32 15 9 17 3 29 11 5 21 3 29 15 5 23 l 29 10 1 5 2 8 3 2 2 4 Dead Adult M. 39 41 148 36 225 3 4 20 16 40 2 1 28 9 38 2 2 16 11 29 5 2 22 11 35 4 22 9 31 2 3 20 5 28 25 8 33 2 1 19 11 31 1 4 11 15 3 5 3 8 F. 34 23 78 31 132 2 7 7 16 4 23 10 37 6 9 15 2 4 13 9 26 1 1 13 12 26 2 2 10 11 23 2 2 18 4 24 5 1 5 6 12 2 6 5 13 1 1 1 Children ... 10 4 3 2 9 1 1 1 2 1 1 1 1 1 1 1 2 2 1 3 Total written off Dispensary Register ... 605 173 387 85 645 31 10 44 34 88 16 13 85 23 121 24 11 41 21 73 40 13 63 21 97 26 6 60 24 90 19 14 47 19 80 13 7 1 65 16 88 22 7 47 18 72 11 5 16 18 39 7 2 7 4 13 Grand Totals ... 611 182 411 85 678 33 11 51 35 97 17 13 94 . 23 130 28 16 47 21 84 46 16 72 24 112 31 8 76 26 110 29 20 68 21 109 25 11 81 16 108 35 12 69 19 100 27 12 38 21 71 36 11 53 7 71 Report of Tuberculosis Officer—continued. (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 of all patients remaining on the Dispensary Register ; and (6) 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 1935 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 Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested Chlld"Adults ren M. 2 2 l 1 1 1 2 l 3 4 2 1 1 4 1 2 3 F. 1 1 2 1 l 1 1 l 1 2 2 1 1 2 ... 3 3 1 1 2 2 3 1 4 1 2 l 2 6 2 1 3 4 4 1 1 2 4 1 1 Disease not arrested Chlid- Adults ren M. 1 1 2 1 1 2 2 1 1 2 1 3 3 2 1 6 F. 3 3 1 1 1 1 2 3 3 1 1 2 2 5 1 6 3 1 1 1 6 ... 1 1 2 2 1 1 1 1 2 l 3 3 1 4 1 1 2 2 1 3 2 4 6 Condition not ascertained during the year 2 2 1 1 1 1 1 1 l 1 2 1 1 1 1 l 3 Total on Dispensary Register at 31st December 9 4 1 14 1 2 3 5 1 7 6 6 4 2 6 5 2 l 2 10 7 2 1 1 11 6 l 10 17 5 1 2 7 15 11 2 4 2 19 8 1 3 6 18 Transferred to Pulmonary 2 1 1 4 3 1 1 5 1 1 2 2 1 1 1 3 1 1 2 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Child- ren Adults M. 16 3 1 4 24 2 1 3 2 1 3 1 1 F. 10 1 3 14 5 5 1 1 ... 17 6 53 76 1 1 2 1 1 1 4 7 1 4 5 4 4 1 1 2 1 1 1 1 Lost sight of or otherwise removed from Dispensary Register 45 10 10 56 121 1 1 1 8 11 2 3 3 5 13 7 2 5 1 15 4 2 2 2 10 6 2 3 5 16 4 2 2 8 16 7 1 l 4 13 3 2 5 7 5 5 17 1 1 2 Dead Children Adults M. 8 1 9 1 1 1 1 1 1 1 1 1 1 1 1 F. 5 3 8 1 1 1 1 2 ... 4 2 6 1 1 1 1 2 1 1 Total written off Dispensary Register 105 21 16 116 258 6 2 1 9 18 4 5 4 14 27 8 6 5 6 25 5 2 2 7 16 6 3 3 6 18 4 2 2 9 17 10 2 l 6 19 5 2 7 7 5 5 17 1 1 2 Grand Totals of a and b (excluding those transferred to Pulmonary) 114 21 20 117 272 7 2 1 11 21 9 6 4 15 34 14 6 5 6 31 9 2 2 9 22 11 5 4 8 28 11 4 3 10 28 16 2 2 16 36 10 1 2 9 22 18 7 4 7 36 8 1 4 7 20 99 Report of Work of the Tuberculosis Care Committee, for 1935. Before commencing our report on the year's work, we wish to place on record our deep regret and sense of loss occasioned by the death of Mr. Harris, a member of the Committee and a representative of the Friendly Societies. His interest in the work was marked ; we shall miss him greatly, and will always remember with gratitude his kindness and help. Looking back over the year the most notable fact is that we have been able to help the people under our care, financially, as never before, through the fund raised by the sale of Christmas Seals, and reported on last year. What was once a dream is now reality. We have a fund of our own and feel that our work is more effective and productive of better results in consequence. We are happy to be able to report that by the same means again this year we have raised the sum of £90. The expenses of the sale amounted to £10 3s., leaving the sum of £19 17s. to disburse during the coming year. A statement of accounts and a brief report indicating the uses that the money collected has been put to, will be issued in pamphlet form. With regard to the general work, we have adjusted ourselves to the changes made and reported on last year, with no difficulty. In Care work, change usually is only another name for progress, and is welcomed. During the year, 216 patients have been recommended for treatment. 1,080 visits have been paid to patients at home and in hospital. 1,056 persons have been interviewed at the Dispensary by the Secretary. 1,030 cases have been considered by the Committee at their meetings. Ten children were accepted by the London County Council for boarding-out under the Contact"Scheme. In two of these cases the parents withdrew their consent, and in two other cases the Council considered hospital treatment was required instead of boarding out. This is a most helpful scheme and can be applied in cases where children are in close contact with an advanced infectious case, and also when a mother is being sent away for institutional treatment and is unable to make arrangements for the care of her children through other sources. Four mothers were enabled to G2 100 accept institutional treatment this year, with an easy mind, knowing that their children were being well cared for. The usual meetings of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees were held at the County Hall, and many matters relating to the welfare of tuberculous patients were discussed. Our Chairman was again elected Chairman of the " Conference "—a tribute to his well-known interest in Tuberculosis Care work. We are pleased to be able to report that several of our tuberculous families who have been living under particularly bad and overcrowded conditions, have been granted accommodation on the London County Council's estates, preferential treatment being given to such cases. We feel sure that the improved conditions under which they will live will be beneficial, not only to the patients, but to those in contact with them, particularly the children. Although our housing problem cannot be demolished at the same rate as the slums, because unfortunately overcrowding is not confined to slum areas, we feel that we can look forward to a great improvement in conditions generally. Developments of the nature referred to are of extreme importance in connection with the work of prevention, and it is most encouraging to observe that causes are being recognised and attacked, as well as the effects being dealt with. A report on Care work is incomplete without an acknowledgment of the help and co-operation extended to the Committee by the local organisations, both public and voluntary, working in the Borough, and we desire to take this opportunity of thanking them. Maternity and Child Welfare. 102 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. Payment of midwife's fee in certain necessitous cases. 13. 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. 103 Summary of Visits paid by Health Visitors, 1935. Wards (approximate) Deptford Park and Kvelyn (part) St. Paul's and Evelyn (part) Vale and Clifton Canterbury and Hatcham Fepys and St. Catherine's St. Peter's St. John's and Town Hall Total Miss Robus Visits 876 .. .. .. .. .. 876 Revis'ts 2184 .. .. .. .. .. 2184 Total 3060 .. .. .. .. .. 3060 Miss Cloke Visits .. 445 .. .. .. .. 445 Revisits .. 2422 .. .. .. .. 2422 Total .. 2867 .. .. .. .. 2867 Miss O'Loughlin Visits .. .. 699 .. .. .. 699 Revisits .. .. 2419 .. .. .. 2419 Total .. .. 3118 .. .. .. 3118 Miss Stowell Visits .. .. .. 667 .. .. 667 Revisits .. .. .. 2432 .. .. 2432 Total .. .. .. 3099 .. .. 3099 Miss Reynolds Visits .. .. .. .. .. 703 703 Revisits .. .. .. .. .. 2340 2340 Total .. .. .. .. .. 3043 3043 Miss Holland Visits .. .. .. .. .. 348 348 Revisits .. .. .. .. .. 2404 2402 Total .. .. .. .. .. 2750 2750 Miss Little Visits .. .. .. .. 783 .. 783 Revisits .. .. .. .. 1330 .. 1330 Total .. .. .. .. 2113 .. 2113 Total Visits 876 445 699 667 783 1051 4521 Revisits 2184 2422 2419 2432 1330 4742 15529 Total 3060 2867 3118 3099 2113 5793 20050 104 Analysis of Visits paid by Health Visitors, 1935. To infants under 5 years Enquiries re Visits. Re-visits. Total. Births 1486 13132 14618 Still-births 38 – 38 Infant deaths- 77 – 77 Ophthalmia Neonatorum 18 21 39 Measles 73 61 134 Suspected Measles 1 – 1 Infant Diarrhœa 11 10 21 Pneumonia " 21 23 44 Whooping Cough 75 75 150 Meningitis 3 – 3 Scarlet Fever recoveries 62 10 72 Scabies 31 35 66 Visits to Foster Children 19 100 119 Miscellaneous visits 245 8 253 Total (under 5 years) 2,160 13,475 15,635 To infants over 5 years Enquiries re Measles 78 57 135 Scarlet Fever recoveries 64 18 82 Whooping Cough 66 39 105 Scabies 96 80 176 Poliomyelitis 1 2 3 Encephalitis Lethargica – 1 1 Pneumonia - 3 2 5 Visits to Foster Children 7 67 74 Miscellaneous visits 304 82 386 Total (over 5 years) 619 348 967 Other visits To expectant mothers - 1035 523 1558 To Puerperal Fever or Pyrexia - 5 2 7 To Common Lodging Houses- 16 41 57 Total other visits 1,056 566 1,622 Unsuccessful visits 686 1140 1826 Totals 4,521 15,529 20,050 In the case of the 1,486 infants visited shortly after birth, it was found that 1,332 infants were being breast-fed and 85 partly breast-fed. Only 69 were entirely hand fed. 105 Student Health Visitors. By arrangement with the College of Nursing, we have had 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 107 6 – – – 113 Miss Little 95 3 – – – 98 Miss O'Loughlin 98 2 – – 63 163 Miss Stowell 117 4 – – – 121 Miss Reynolds 106 —– 13 – – 119 Miss Holland 54 5 141 – 3 203 Miss Clubbe 155 187 85 30 – 457 Miss Gibson 174 43 – – – 217 Miss Cloke 96 2 14 – 30 142 Total 1,002 252 253 30 96 1,633 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 Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under year 1—5 years Consultations with Doctor Gosterwood Street 48 171 27 198 3626 3824 2894 930 1559 Napier Street 48 157 22 179 3093 3272 2342 930 1350 Besson Street 49 183 18 201 4170 4371 3202 1169 1327 Ilderton Road 50 85 18 103 2549 2652 1779 873 1049 Goldsmiths' College 51 142 17 159 3527 3686 2543 1143 1206 Hales Street 50 115 25 140 2212 2352 1519 833 1262 St. George's Hall 50 143 28 171 3220 3391 2411 980 1320 St. John's, Harton St. 51 77 17 94 2334 2428 1621 807 1185 Totals 397 1073 172 1245 24731 25976 18311 7665 10258 The Health Visitors collectively made 1,002 attendances at these Clinics. 106 (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, 13 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 1935 887 61 2984 The following is the text of Dr. Hill's Report for 1935:— Ante-Natal Clinic Statistics, 1935. Total number of Patients on Register 887 New Cases 712 Total Attendances 2984 Normal 146 Not pregnant 29 107 Abnormalities:— Albuminuria 34 Hydramnios 5 Anaemia 61 Leucorrhcea 19 Ante-partum Haemorrhage 14 Malpresentation 19 Bartholini Abscess 1 Morbus Cordis 11 Bronchitis 6 Oedema 15 Chorea 1 Pleurodynia 1 Contracted Pelvis 13 Pruritis 3 Deformed Nipples 36 Pyelitis 2 Dental Caries 411 Retroversion 2 Dyspepsia 16 Scabies 2 Eczema of Nipples 1 Sciatica 10 Epileptic Fits 1 Twins 1 Fibroid 4 Urticaria 2 Goitre 2 Varicose veins 53 Haemorrhoids 23 Venereal Disease 1 Hernia 1 Vomiting 12 Post-Natal Clinic. This branch of the work is conducted every Tuesday forenoon. Total on Register 181 New cases 171 Total attendances 204 Amongst the patients seen the following defects were found and dealt with:— Anaemia 6 Breast Abscess or Inflamed Nipple 5 Cystocele 1 Dental Caries 1 Fibroids 1 Haemorrhoids 5 Leucorrhcea 3 Retroversion 12 In connection with both the Ante-natal and Post-natal work close co-operation is maintained with medical practitioners, midwives and hospitals. Remedial exercises were taught to post-natal cases in 21 instances. Reports sent to Tuberculosis Officer 1 Ditto to midwives 152 Ditto to doctors 19 Total number of cases referred by letter to hospitals, 19. 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 174 Total attendances made 986 108 (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 1935 Patients on Register at commencement of cach month. New Patients admitted Patients Readmitted Patients Discharged Patients on Register at the end of month Total Attendances January 62 36 – 27 71 425 February 71 26 2 25 74 472 March 74 17 – 23 68 523 April 68 19 – 31 56 329 May 56 13 – 23 46 332 June 46 1 – 41 6 147 July 6 – – 4 2 31 August 2 – – 1 1 18 September 1 4 3 1 7 9 October 7 28 5 4 36 165 November 36 31 4 6 65 295 December 65 7 1 22 51 277 Total 182 15 208 3,023 Classification of Patients during Year. Admissions. Re-admissions. Children— Rickets 14 3 Malnutrition 21 4 Anaemia 41 2 Cervical Adenitis 14 – Muscular Weakness 20 2 Delayed Dentition 37 3 Curved Tibiae 12 1 Rheumatism 1 – Genu Valgum 3 – Anorexia 3 – Insomnia 1 – Post Pneumonia 1 – Post Infectious Debility – – Flat feet 3 PPP Adults (Post-natal)— Delayed Lactation 2 Mastitis 8 182 15 109 Where more than one disease is exhibited by any individual child, the case is classifiel 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 1935:— Cases. Extractions. Fillings. Scalings, Silver Nitrate etc. Gas Cases. Dentures Supplied. Repair'd Mothers 182 427 266 162 – 48 2 Children 87 121 28 224 30 – – In the case of the fillings for mothers, 193 were amalgam and 73 plastic. Pending the opening of the new Central Clinic, cases requiring extractions under a general anaesthetic are referred for such to the Miller or St. John's Hospital, thereafter returning to the Dental Clinic for completion of treatment. 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 W. Gilliatt, Esq., c.v.o., m.d., f.r.c.s., of 103 Harley Street, W., who 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. 110 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 1935 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 1935:— Cases admitted, 208. Average stay, 2 weeks. Cases delivered by midwives. 201. „ „ „ doctors, 7. Cases in which medical advice sought, 24. Cases notified as puerperal fever, Nil. ,, ,, ,, puerperal pyrexia, Nil. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. Fcntal deaths (a) Stillborn, 4. (b) Within 10 days of birth, 1.* * P.M. exam.: Cholemia and Congenital Convulsions. 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) W. Gilliatt, Esq., C.V.O., M.D., 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 1935, it was found necessary to call the Consultant to the Home on one occasion. Dr. Edwin C. Warner was called in once in connection with a baby suffering from Seborrhœic Eczema, under the arrangement by which the services of a children's specialist are available. Cases not admitted to the Maternity Home. During 1935, a total of 104 applications for admission were refused, owing to the available accommodation being fully booked. 111 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 78 Sold at half price 3 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 9 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 1935, 25 cases were sent away. 9. Hospital Provision for Infants. (a) Deptford Babies' Hospital, Breakspears Road. During the year under review, continued 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:— 95 children admitted, of which 42 were sent by the Borough Council. 112 870 test feeds were conducted at the Breast feeding Clinic, of which all were sent by the Borough Council. 39 mothers with infants were admitted as in-patients for restoration of Breast-feeding. 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 1935, the following free or half-price issues were authorised:— 12,772 families were given fortnightly supplies. Fluid milk formed the bulk of this supply, dried milk being issued only on the recommendation of the Centre Medical Officers. Issues of Cod Liver Oil and Malt and Virol are made upon medical advice to debilitated children, the parent paying cost price, where able. 11. Compensation to Midwives. Where an expectant mother, referred to the Ante-natal Clinic by a midwife with whom she has " booked," is found to be suffering from some abnormality which necessitates her confinement in hospital, the Council pay to the midwife a portion of her prospective fee which would be otherwise lost. In 13 instances this policy was carried into effect, involving a total expenditure of £6 10s. Payment of Midwives' Fees. In three instances the Council paid the fee of the midwife for her attendance in necessitous cases. 113 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 Mortality. In accordance with the requirements of the Ministry of Health a confidential report is made in the case of every maternal death, the information being collated for statistical purposes. Should occasion arise, the services of W. Gilliatt, Esq., c.v.o., 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 1934. Added. Removed. No. at end of year 1935. Fostermothers 24 11 13 22 Fosterchildren 28 24 22 30 Central Clinic. During the year, the building of the new Central Clinic was put in hand. The freehold of three houses in Amersham Road was acquired by purchase and, in conjunction with a vacant piece of land already belonging to the Borough Council, a suitable site became available for this purpose. H 114 The accommodation will consist of the following:— The Clinic is an independent building, the principal elevations being on the north-west and south-west sides, having verandahs with balconies over, the latter being covered with a glass roof. The principal room on the the ground floor is the Main Hall, 40 ft. by 36 ft., provided with folding screens, opening on to the verandahs. Grouped around the Main Hall are the following offices:— Two Doctors' Rooms, Two Health Visitors' Rooms, each containing a Weighing Room, Dentist Room with Recovery Room adjoining, Kitchen, and Male and Female Lavatory accommodation. The Dispensary, which was previously in the Administrative Block, has now bsen incorporated in the Clinic Building, and consists of a glazed structure in the Main Hall. The principal room on the first floor is the Sunlight Room, 40 ft. bv 36 ft., with folding screens on the north-west side opening on to a balcony. A portion of the room is screened off permanently on two sides with a screen 6 ft. high, to form an access passage. Around the Sunlight Room are grouped the following offices:— General Dressing Rooms, Health Visitors' Room, Doctors' Room, Toddlers' Room, Staff Lavatory, Isolation Room, Gymnasium, and Nursery with Bath and Lavatory accommodation attached, together with an emergency Fire Exit. The Administrative Block, designed to face the road, contains the following accommodation:— Ground Floor— Front entrance, giving access to four Health Visitors' Rooms, large Store Room, and a Porter's Room on left affording control over traffic through both the main entrance to the administrative block, and the side entrance, which will be the main entrance to the Clinic Building. First Floor — Caretaker's Quarters containing Living Room, 1 wo Bedrooms, Kitchen, Bathroom and Lavatory. Clerk's office with separate w.c., and Slip Room adjoining for the use of Health Visitors. 1 he Caretaker's Quarters are entered by a private door from the landing. It is hoped that the Building will be ready for occupation in June. Appendix. H2 116 Table 1. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1935. CAUSES OF DEATH. Sex. All Ages 0- 1— 2 — 5— 15 - 25— 35 — 45— 55— 65— 75- All causes M 597 49 2 8 11 24 30 28 69 112 139 125 F 509 25 5 4 10 15 23 17 51 76 105 178 Typhoid and Paratyphoid M . . . . . . . . . . . . . . . . . . . . . . . . Fevers F . . . . . . . . . . . . . . . . . . . . . . . . Measles M 1 1 . . . . . . . . . . . . . . . . . . . . F . . . . . . . . . . . . . . . . . . . . . . . . Scarlet Fever M . . . . . . . . . . . . . . . . . . . . . . . . F . . . . . . . . . . . . . . . . . . . . . . . . Whooping Cough M l 1 . . . . . . . . . . . . . . . . . . . . F 4 3 . . . . . . . . . . . . . . . . . . . . Diphtheria M 3 . . . . 2 l . . . . . . . . . . . . . . F 7 . . 1 1 5 . . . . . . . . . . . . . . Influenza M 5 . . . . . . 1 . . . . . . 1 1 2 . . F 1 . . . . . . . . . . 1 . . . . . . . . Encephalitis Lethargica M . . . . . . . . . . . . . . . . . . . . . . . . F . . . . . . . . . . . . . . . . . . . . . . . . Cerebro-spinal Fever M 1 1 . . . . . . . . . . . . . . . . . . . . f 3 1 1 1 . . . . . . . . . . . . . . . . Tuberculosis of respiratory S) stem M 50 . . . . . . . . 8 1o 8 14 7 2 1 f 33 . . . . . . . . 8 11 3 1 4 3 1 Other Tuberculous Diseases M 4 . . 1 . . . . 2 . . 1 . . F 2 1 . . 1 . . . . . . . . . . . . . . . . Syphilis M 1 . . . . . . . . . . . . . . . . 1 . . . . f 2 . . . . . . . . . . . . . . 1 1 . . . . General Paralysis of the M 2 . . . . . . . . . . . . . . 1 . . 1 . . Insane, tabes dorsalis F 1 . . . . . . . . . . . . . . 1 . . . . . . Cancer, malignant disease M 101 . . . . . . . . . . . . 1 8 26 36 26 F 66 . . . . . . . . . . . .V. . 2 16 10 21 17 Diabetes M 1 . . . . . . . . . . . . . . . . . . 1 . . F 18 . . . . . . . . . . . . 2 2 3 7 2 Cerebral Haemorrhage, etc. M 24 . . . . . . . . . . . . . . 3 6 7 8 f 36 12 10 14 Heart Disease M 125 . . . . . . . . 1 3 6 9 28 40 35 F 135 . . . . . . . . 3 3 4 11 17 31 65 Aneurysm M 2 . . . . . . . . . . . . 1 1 . . . . . . F 1 . . . . . . . . . . . . . . . . 1 . . . . Other Circulatory Diseases M 14 . . . . . . . . . . . . . . 3 3 4 4 F 24 . . . . . . . . . . . . 1 1 4 5 13 Bronchitis M 26 1 . . . . . . . . . . 1 4 4 7 9 F 20 . . . . . . . . 1 . . . . 2 1 4 12 Pneumonia (all forms) M 3G 10 . . . . . . 1 . . . . 6 5 10 2 F 28 6 . . . . . . 1 1 . . 2 6 5 4 Other Respiratory Diseases m 11 .. . . . . . . 1 1 2 . . 4 2 1 1 F 4 . . . . . . . . . . . . . . 1 2 . . 1 Peptic Ulcer M 6 . . . . . . . . 1 1 2 1 1 • • 1 f 4 .. 1 1 2 1 Diarrhoea, &c. M 13 10 . . . . . . . . 1 . . . . 1 . . F 6 5 . . . . . . . . . . . . . . • • • • 1 Appendicitis M 5 • • 2 • • • • • • • • 2 1 • • • • F 4 • • • • • • 1 1 • • 2 • • • • • • 117 Table I— continued. CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5- 15— 25- 35— 45— 55- 65— 75- Cirrhosis of Liver M 4 .. .. .. .. .. .. .. 1 3 .. .. F 1 .. .. .. .. .. .. .. .. 1 .. .. Other diseases of Liver, etc. M 2 .. .. .. .. .. .. .. .. .. 2 .. F 5 .. .. .. .. .. .. .. 1 3 .. 1 Other Digestive Diseases M 18 1 .. .. .. .. 1 .. 2 6 3 3 F 11 1 .. .. .. .. .. .. 3 1 3 3 Acute and chronic Nephritis M 11 .. .. .. .. .. 2 1 3 1 2 .. F 9 .. .. .. .. .. 1 l .. 1 4 2 Puerperal Sepsis F .. .. .. .. .. .. • • .. .. .. .. .. Other Puerperal causes F 1 .. .. .. .. .. 1 .. .. .. .. .. Congenital Debility, Premature Birth, Malformations etc. M 18 18 .. .. .. .. .. .. .. .. .. .. F 9 8 1 .. .. .. .. .. .. .. .. .. Senility M 27 .. .. .. .. .. .. .. .. .. 6 21 F 32 .. .. .. .. .. .. .. .. 1 2 29 Suicide M 12 .. .. .. .. .. 1 3 2 3 2 1 F 2 .. .. .. .. .. 1 .. .. .. 1 .. Other violence M 32 4 .. 2 2 6 3 1 4 3 2 5 F 10 .. .. .. .. .. 1 .. 2 .. 3 4 Other defined diseases M 40 2 .. 1 2 2 2 1 5 8 10 7 F 30 .. .. .. 1 1 .. 4 5 7 4 8 Causes ill-defined or unknown M 1 .. .. .. .. .. .. .. .. .. .. 1 F .. .. .. .. .. .. .. .. .. .. .. .. 118 Table II. SHOWING NUMBER OF PREMISES VISITED AND ARTICLES COLLECTED FOR DISINFECTION OR DESTROYED AT OWNERS' REQUEST. 1935 Premises Visited Articles Stoved Articles Destroyed at Owners' Request Books Cleansing Station Lodging Houses Infectious Diseases Requests Bedding only Removals Private Verminous Beds Bolsters Pillows Mattresses Sheets Blankets Miscellan'us Total Beds Bolsters Pillows Mattresses Sheets Blankets Miscellan'us Books Total D.B.C. Library Private Total Towels Blankets Wearing Apparel Total Persons Cleanse Wearing Apparel Stoved January 112 6 9 3 6 93 68 230 77 127 278 671 1544 5 3 4 5 2 2 18 ... 39 30 12 42 260 67 901 1228 4 37 February 86 7 6 9 5 51 60 184 54 96 201 526 1172 3 3 4 4 1 ... 96 24 13 36 16 52 332 80 813 1225 11 80 March 88 4 5 ... 10 62 57 165 54 105 162 528 1133 2 1 4 3 ... 3 93 6 115 29 11 40 384 73 547 1004 3 19 April 79 8 5 3 12 72 47 152 47 109 197 521 1145 1 ... 3 8 1 3 8 ... 24 33 ... 33 230 47 346 623 2 11 May 78 11 4 4 41 35 37 92 39 69 95 195 562 2 ... ... 1 ... ... 1 ... 4 27 ... 27 350 40 596 986 1 10 June 77 4 8 ... 46 43 38 128 42 75 113 338 777 6 3 6 11 ... 3 40 12 81 14 ... 14 272 21 347 640 4 26 July 65 12 7 1 32 41 40 140 47 85 68 296 717 8 3 11 11 5 4 75 ... 117 8 ... 8 317 19 271 607 2 16 August 57 9 11 3 18 27 27 78 26 55 41 125 379 13 1 2 8 ... 1 23 ... 4 5 ... 5 34 ... 10 44 4 21 September 61 10 2 2 17 30 32 128 48 75 91 204 698 7 2 11 8 4 5 142 . . . 17 7 2 9 259 1 242 502 4 26 October 62 6 5 4 17 47 35 111 32 72 133 305 735 2 ... 3 2 ... ... 11 45 63 15 ... 15 371 28 544 943 6 31 November 75 5 5 2 12 47 38 128 34 82 123 243 695 3 2 6 3 ... ... 15 ... 29 19 ... 19 325 26 398 749 8 49 December 56 1 3 4 6 46 30 121 30 77 125 222 651 1 ... ... ... ... ... 1 ... 2 18 1 19 242 31 251 524 11 91 896 83 70 35 222 594 509 1657 530 1027 1627 4264 10208 53 18 54 64 13 21 523 87 833 241 42 283 3376 433 5266 9075 60 417 119 Table III. SHOWING NUMBER OF ROOMS DISINFECTED. 1935 Diphtheria Scarlet Fever Pulmonary Tuberculosis Scabies Cancer Chicken Fox Measles Erysipelas Impetigo Puerperal Fever Bronchitis Cerebro-Spinal Meningitis Anthrax Formalin Spray Sulphur Fumigated Verminous Total Rooms Infectious Requests January 40 47 25 15 l .. .. 1 .. .. .. .. .. 129 9 9 147 February 39 37 20 14 .. .. .. .. .. .. .. .. .. 110 24 9 142 March 16 39 37 16 3 .. .. 1 .. .. 1 1 .. 114 4 11 135 April 30 37 25 21 1 .. .. 3 .. .. .. .. .. 117 14 17 146 May 14 18 28 23 1 5 2 .. 1 .. .. .. .. 92 25 73 190 June 31 26 21 9 2 2 1 .. .. 1 .. .. .. 93 7 82 185 July 29 14 18 9 3 2 1 .. .. .. .. .. 76 30 51 157 August 27 14 23 .. .. 1 .. .. .. .. .. .. .. 65 20 26 111 September 21 22 17 11 3 .. .. .. .. .. .. .. .. 74 16 37 127 October 15 25 13 15 .. .. 2 2 .. .. .. .. .. 72 11 40 12c November 29 23 31 12 1 2 .. 1 .. .. .. .. .. 99 11 21 131 December 31 12 6 11 1 1 2 .. .. .. .. .. 1 65 5 12 82 322 314 264 156 16 11 9 9 1 1 1 1 1 1106 176 391 1672 120 GOSTER WOOD STREET CLINIC. 1935 No. of New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. times Clinic opened. Breast Fed. Mixed. Hand. Ages 1—5. January 4 17 1 1 1 20 271 291 120 February 4 11 2 3 16 312 328 137 March 4 16 1 2 7 26 322 348 134 April 4 14 1 1 1 17 316 333 141 May 3 13 4 5 22 245 267 117 June 3 11 1 1 13 258 271 111 July 5 10 1 2 2 15 401 416 172 August 3 7 1 8 246 254 86 September 5 19 2 21 378 399 166 October 4 11 1 2 14 290 304 135 November 4 8 1 1 1 11 295 306 117 December 5 13 2 15 292 307 123 Total 48 150 6 15 27 198 3626 3824 1559 NAPIKK STREET CLINIC. 1935 No. of times Clinic opened. New Cases. Total New Cases. 1 Total Old Cases. V Total New and Old Cases Consultations with Doctor Breast Fed. Mixed. Hand. Ages 1—5 January 4 9 5 1 15 277 292 139 February .. 4 12 1 13 263 276 121 M arch 4 11 1 2 14 245 259 107 April 4 12 2 14 235 249 96 May 4 9 2 2 13 213 226 109 June 3 15 2 5 2 24 155 179 63 July 5 14 1 4 3 22 327 349 136 August 3 14 2 3 19 208 227 99 September .. 4 9 1 2 12 268 280 96 October 5 13 1 1 15 368 383 147 November .. 4 6 1 3 10 297 307 123 December .. 4 3 1 1 3 8 237 245 114 Total 48 127 8 22 22 179 3093 3272 1350 121 GOLDSMITHS' COLLEGE CLINIC. 1935 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 10 2 1 13 336 349 115 February 4 8 1 1 3 13 231 244 86 March 4 11 1 2 14 291 305 95 April 4 14 1 3 3 21 254 275 116 May 5 12 3 2 17 383 400 144 June 4 14 2 16 258 274 88 July 5 7 1 1 9 374 383 119 August 4 8 2 1 11 283 294 77 September 1 9 2 1 12 277 289 94 October 5 11 2 1 14 362 376 119 November 4 7 1 1 9 290 299 100 December 3 8 1 1 10 188 198 53 Total 51 119 3 20 17 159 3527 3686 1206 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC. 1935 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 9 217 226 118 February 4 11 1 1 5 18 169 187 103 March 4 10 4 14 153 167 101 April 3 6 3 9 98 107 65 May 5 13 3 4 20 235 255 144 June 4 6 1 7 176 183 104 July 4 7 1 1 9 198 207 111 August 5 8 2 1 11 243 254 121 September 4 11 2 3 16 180 196 84 October 5 9 1 3 13 226 239 131 November 4 1 1 1 1 4 184 188 103 December 3 5 1 3 1 10 133 143 77 Total 50 95 10 10 25 140 2212 2352 1262 122 BESSON STREET CLINIC. 1935 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 12 2 1 15 368 383 139 February 4 11 1 4 3 19 326 345 106 March 4 9 1 2 2 14 334 348 118 April 4 14 2 2 18 334 352 125 May 4 13 2 2 17 353 370 106 June 3 14 2 1 17 246 263 52 July 5 23 2 1 1 27 459 486 159 August 3 8 2 2 1 13 275 288 81 September 4 7 2 2 11 345 356 103 October 5 16 3 2 2 23 458 481 127 November 4 13 1 1 2 17 376 393 116 December 4 8 1 1 10 296 306 95 Total 49 148 16 19 18 201 4170 4371 1327 ILDERTON ROAD CLINIC. 1935 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 9 2 1 2 14 243 257 105 February 4 4 2 3 6 15 254 269 97 March 4 8 2 10 233 243 101 April 3 4 1 1 1 7 166 173 67 May 5 6 6 290 296 119 June 4 5 2 1 2 10 204 214 82 July 4 4 4 219 223 80 August 5 5 1 1 7 258 265 90 September 4 4 1 2 7 195 202 79 October 5 6 3 2 11 212 223 101 November 4 6 1 7 153 160 68 December 3 3 1 1 5 122 127 60 Total 50 64 12 9 18 103 2549 2652 1049 123 ST. GEORGE'S HALL, SHARDELOES ROAD. 1935 No. of times Clinic opened New Cases Total New Cases Cases. Total New and Old Cases tations with Doctor Breast Fed. Mixed. Hand. Ages 1—5 January 4 9 1 10 242 252 106 February 4 8 1 9 208 217 88 March 5 10 2 3 7 22 315 337 131 April 3 9 1 10 207 217 85 May 5 12 1 5 18 331 349 138 June 4 12 5 1 18 274 292 103 July 4 8 1 3 3 15 269 284 116 August 5 6 1 7 312 319 93 September 4 9 2 3 4 18 251 269 104 October 4 7 1 1 3 12 268 280 128 November .. 5 19 2 2 23 332 355 138 December .. 3 4 2 3 9 211 220 90 Total 50 113 10 20 28 171 3220 3391 1320 ST. JOHN'S CLINIC. 1935 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5 January 5 11 2 13 213 226 109 February 4 4 2 6 162 168 85 March 4 6 1 1 5 13 195 208 110 April 4 5 5 165 170 83 May 5 9 1 1 11 244 255 128 June 4 3 4 7 188 195 101 July 5 8 3 3 14 226 240 92 August 4 2 2 185 187 81 September 4 7 7 176 183 81 October 5 1 1 1 3 254 257 139 November 4 4 1 3 8 194 202 105 December 3 5 5 132 137 71 Total - 51 64 4 9 17 94 2334 2428 1185 INDEX PAGE A Acreage 8 Acute Primary Pneumonia 70 Acute Influenzal Pneumonia 70 Acute Poliomyelitis 70 Albany Deptford Babies' Hospital 21, 111 Ambulance Facilities 25 Ante-natal Examination 106 Ante-natal Clinic 106 Area and Population 8 Artificial Light Clinic 108 B Babies' Hospital 111 Bacteriological Examination 74 Births 11 „ illegitimate 12 „ Notification of 12 c Cancer 76 Canal Boats Acts 35 Causes of Sickness 15 Cerebro-Spinal Meningitis 70 Chicken pox 68 Cleansing Station 75 Clinics and Centres 26, 112 Committee, Public Health 3 „ Maternity and Child Welfare 3 Convalescent Treatment 111 Central Clinic 113 i. PAGE D Deaths 13 Death-rate 13 „ comparisons 13 „ during 10 years 13 Deaths in Wards 14 „ percentage in age groups 17 „ causes of 116 „ ages at 15 „ Infantile, causes 16 „ Infectious disease 64 Deptford Babies' Hospital 111 Diabetes and Insulin 77 Diarrhœa 71 Diphtheria 67 Disinfection 75 118, 119 Disinfestation 75 Dysentery 71 E Encephalitis Lethargica 70 Enteric Fever 73 Erysipelas 73 F Factory and Workshop Act 36 Food Inspection 48 „ Poisoning 55 „ Sampling 56 „ Unsound 55 Foster Children 113 H Health Committee 3 Health Visitors, Visits 103-104 Health Education 113 Home Helps 111 iii PAGE H— continued Home Nursing 111 Housing 39 House-to-house Inspections 31 I Illegitimate Births 12 Infant Life Protection 113 Infant Mortality 15 „ Table of causes 16 Infant Welfare Centres 105, 120 Infectious Diseases, Notifications 64 Infective Jaundice 77 Influenza 73 Insulin and Diabetes 77 L Laboratory Work at the Seamen's Hospital 74 Legal Proceedings 31 M Malaria 71 Marriages 11 Maternal Mortality 113 Maternity and Child Welfare Committee 3 Maternity Home 24, 110 „ Consultant 110 Maternity Outfits 111 Measles 73 Midwives 23, 112 Milk, Bacteriological Examination 49 „ Supply to Nursing Mothers, etc. 112 Mortality of Infants 15 Mortuary Report 17 Municipal Maternity Home 24 iv PAGE N Notification of Births 12 Nursing Arrangements 22 „ in the Home 22 Nutrition 61 O Obstetricians, consulting 109 Ophthalmia Neonatorum 72 Overcrowding Survey 39 P Physical Features of Borough 8 Population 10 Pneumonia 70 Post-natal Clinic 107 Public Health Committee 3 Puerperal Fever 71 ,, Pyrexia 72 R Ranyard Nurses 22 Rats 32 s St John's Home 107 Sanitary Inspectors' work 28 Scarlet Fever 65 Small-pox 68 Social Conditions 9 Staff, List of 20 Still-births 11 T Tuberculosis—Care Committee 99 „ Cookery Class 98 V PAGE T— continued Tuberculosis—Report of Tuberculosis Officer 80 „ General 80 „ Handicraft Centre 97 „ Home accommodation 85 „ Notification Table 81 „ Revision of Register 87 „ Supervision of Contacts 91 „ Dental Treatment 94 V Vaccination 69 w Whooping Cough 74