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. 1 936 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health and Housing Committee. Mapor. Councillor H. A. WALDEGRAVE, J.P. Chairman. Councillor E. C. SHERWOOD. Vice= Chairman. Councillor W. TAYLOR. Alderman Mrs. E. M. Bateman. Councillor C. G. Blanchard. Councillor F. T. Chisnell. Councillor W. J. Coombs. Councillor Mrs. B. M. Drapper, J.P. Councillor A. G. Howard. Councillor Mrs. M. F. Morrell. Councillor C. Russell. Councillor A. H. Wild. Maternity and Child Welfare Committee. Chairman. Councillor Mrs. E. M. L. watson. Vice-Chairman. Councillor Mrs. B. M. Drapper, J.P. Alderman Mrs. E. M. Bateman. Councillor Mrs. E. M. Colburn. Councillor W. J. Coombs. Councillor Mrs. G. E. Green. Councillor Mrs. A. Hayward. Councillor Mrs. M. Herlihy. Councillor Mrs. M. F. Morrell. Councillor E. C. Sherwood. Councillor W. Taylor. A3 Metropolitan Borough of Deptford. Public Health Department, Deptford Town Hall, S.E. 14. 11th June, 1937. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my eighth Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. The estimated population for statistical purposes was 98,900 and based upon this figure, the birth and death-rates per 1,000 of the population were 15.7 and 12.2, compared with 14.4 and 11.1 for the year 1935. The infantile mortality rate was 50, and the maternal death-rate 0.6—the latter rate being calculated upon 1,000 total (live and still) births. The incidence of infectious disease was less in 1936 than in 1935, a total of 762 cases being notified as compared with 859 during the previous year. The work of the Sanitary Inspectors is outlined in the section dealing with the sanitary circumstances of the Borough. The amount and variety of work accomplished reflects great credit upon the inspectorial staff. The purity of the food supply, primarily the duty of the Food Inspector, has been satisfactorily safeguarded. 6 In the section dealing with Housing is detailed the steps the Borough Council has taken, inter alia, in dealing with underground rooms. A summary of the activities of the London County Council in providing new housing accommodation is also included. 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 :— Maintained Situation. Size. by. 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Brookmill Road 1¼ acres Borough Ground. Council. 3. Telegraph Hill Recreation Telegraph Hill 45½ acres L.C.C. Ground. 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 5.80 acres Borough Council. 10. Mary Ann Buildings Chil0.50 acres ,, drens' Playground. 11. Lewisham High Road Gardens .88 acre ,, Statistics. Area 1,564 acres Population: Census 1931 106,891 Registrar-General's Estimated Resident population, 1936 98,900 Number of inhabited houses according to the Rate books (end of 1936) 18,400 Number of families or separate occupiers (1931) 29,248 Number of structurally separate dwellings (Housing Survey, 1935) 18,572 Rateable Value (6/4/36) £666,933 Estimated sum represented by a 1d. Rate (1936 7) £2,717 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 :— 14th Dec., 1936 Men, 1,918 Women, 436 Juveniles, 39 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 1936 :• — 3,266 (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1936:— £73,547 4s. 2d. 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 530. Of these, 428 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 102 persons, the same conditions being observed, the amount per head varied between 7s. 6d. and 10s. 6d. During the whole year 11,009 applications for fortnightly supplies were granted. Of this number, 9,504 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 Legitimate 764 737 1,501 1,548 15.7 Births Illegitimate 22 25 47 Still-births, 56. Rate per 1,000 total births, 34.9. Death-rate. Deaths 1,202 12.2 Percentage of total deaths occurring in Institutions 64 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 0.6 Total 1 0.6 Death-rate of infants under one year of age, per 1,000 live births : Legitimate 48 Illegitimate 106 Total 50 Deaths from Measles (all ages) 9 ,, Whooping Cough (all ages) 7 „ Deaths from Diarrhoea (under 2 years) 18 Population. The population for 1936, as given by the Registrar-General, was 98,900, the lowest on record. 11 Marriages. During the year 965 marriages took place, equivalent to a rate of 19.5 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 614 Other places of worship 75 In the Superintendent Registrar's Office 276 Total 965 Births. After allowing for inward and outward transfers, i.e., the addition of 690 children born of Deptford parents outside the Borough, and the deduction of 27 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,548. This is equivalent to a birth.rate of 15.7 per 1,000 of the population and, after subtraction of deaths, represents only a natural increase of 3.4 per 1,000 of the population. The following table illustrates the steady fall that has taken place : No. BIRTHS. County of London: Crude rate per 1,000 population Deptford. Crude rate per 1,000 population. England and Wales. Crude rate per 1,000 population. Average for 10 years, 1915 to 1924 2610 22.9 20.0 20.5 Average 1925 to 1929 1976 17.4 17.2 16.7 1930 1761 15.9 16.3 15.7 1931 1745 16.3 15.8 15.0 1932 1669 15.9 15.3 14.3 1933 1520 14.8 14.4 13.2 1934 1597 15.8 14.8 13.2 1935 1432 14.4 14.7 13.3 1936 1548 15.7 14.8 13.6 Still.Births. 56 still.births were registered during the year as follows :— Legitimate Illegitimate Total Male 32 — 32 Female 23 1 24 12 Illegitimacy. The number of illegitimate births was equivalent to 3 per cent. of the total births. The figures relative to illegitimacy for previous years areas follows : Av. for 10 yrs. 1915-24. Av.for 5 yrs. 1925-29 1930 1931 1932 1933 1934 1935 1936 No. of illegitimate births 77 58 59 55 56 51 45 35 47 Percentage of total births 2.9 3.0 3.4 3.2 3.3 3.4 2.8 2.4 3.0 The following is an analysis of these notifications: Births Notified in the Borough, Year ending 31/12/36. Ward. Births notified. By whom notified Total Male Female Alive Dead Parent Doctor Midwife Others Deptford Park 40 17 23 40 - — 11 28 1 Evelyn 94 45 49 88 6 — 14 76 4 St. Paul's 91 40 51 91 — — — 90 1 Vale 79 33 46 78 1 — 4 72 3 Clifton 44 20 24 42 2 1 4 37 2 Canterbury 55 27 28 55 - 1 1 50 3 Hatcham 51 22 29 49 2 2 3 43 3 Pepys 45 19 26 43 2 1 6 34 4 St. Catherine's 42 33 9 42 - 1 8 29 4 St. Peter's 256 125 131 251 5 4 9 240 3 St. John's 39 16 23 39 - - 2 34 3 Town Hall 49 28 21 49 - 2 4 40 3 Total 885 425 460 867 18 12 66 773 34 Less Births notified in the Borough, but transferred to other authorities 19 9 10 19 - 1 1 17 - 866 416 450 848 18 11 65 756 34 Add Births occurring in out-of-Borough Institutions 719 393 326 684 35 - - 719 - Grand Total 1585 809 776 1532 53 11 65 1475 34 Notification of Births. During 1936, the number of notifications received of births and still births actually occurring in the Borough was 885. After allowing for inward and outward transfers, the corrected figure was 1,585. 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 558 Deduct deaths of " non-residents " 129 429 Add deaths of " residents " outside Borough 773 Nett deaths applicable 1,202 This is equivalent to a death-rate of 12.2 per 1,000 persons. Seasonal Mortality. Quarter ended. 1935 1936 No. Rate per 1,000 of population. No. Rate per 1,000 of population. March 315 12.7 378 15.3 June 283 11.4 278 11.2 September 254 10.2 216 8.7 December 254 10.2 330 13.4 The trend of the death-rate in recent years is shown by the following table:— Year. Deptford. England & Wales. London. No. Rate per 1,000 of the population. Average for 10 years, 1915-1924 " 1560 14.1 13.6 13.9 1925 1399 12.1 12.2 11.7 1926 1302 11.3 11.6 11.4 1927 1312 11.5 12.3 11.9 1928 1354 12.0 11.7 11.6 1929 1481 13.3 13.4 13.8 1930 1250 11.3 11.4 11.4 1931 1284 12.0 12.3 12.4 1932 1290 12.2 12.0 12.3 1933 1247 12.1 12.3 12.2 1934 1327 13.1 11.8 11.9 1935 1106 11.1 11.7 11.4 1936 1202 12.2 12.1 12.5 14 Deaths—Sex and Ward Distribution. Ward. Males. Females Children under 1 year. Total deaths Deptford Park 45 24 2 69 Evelyn 70 45 12 115 St. Paul's 68 64 12 132 Vale 54 53 12 107 Clifton 57 40 5 97 Canterbury 45 24 3 69 Hatcham 66 47 7 113 Pepys 43 57 4 100 St. Catherine's 37 49 7 86 St. Peter's 34 54 4 88 St. John's 84 35 5 119 Town Hall 54 53 4 107 657 545 77 1202 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), 1936. Average No. for 10 years 1915-24. Average 1925-1929 1930 1931 1932 1933 1934 1935 1936 Increase or decrease over 1935 Measles 7.5 27 20 24 1 23 1 43 1 9 + 8 Whooping Cough 5.8 24 13 3 11 9 9 18 5 7 + 2 Diphtheria 5.0 19 14 4 12 6 5 19 10 6 - 4 Influenza 5.8 70 35 6 20 26 52 11 6 7 + 1 Tuberculosis—Pulmonary 54 136 102 113 100 92 94 92 83 65 -18 Non-pulmonary 9.1 32 18 14 14 13 10 10 6 11 + 5 Cancer 146 133 159 156 174 183 137 189 167 176 + 9 Heart Disease 247 128 232 298 322 297 281 322 260 298 + 38 Cerebral Haemorrhage, Em holism and Thrombosis 55 67 54 45 41 49 57 73 60 66 + 6 Bronchitis 61 140 95 47 55 53 52 60 46 73 + 17 Pneumonia (all forms) 52 154 121 73 113 82 84 84 64 63 + 2 Nephritis .. 23 35 34 44 31 35 32 23 20 28 + 8 Diarrhoea and Enteritis 17 45 20 19 14 29 18 27 19 20 + 1 Violence (excluding Suicides) 40 48 49 64 30 36 37 49 42 48 + 6 Premature Birth, Malformation and Debility 33 86 49 40 45 48 45 50 27 40 + 13 15 Special Noteworthy Causes of Sickness or Invalidity, None. The following Table expresses as percentages of the total mortality the incidence in the various age groups :— Average 1915-24 Average 1925-29 1930 1931 1932 1933 1934 1935 1936 Under 1 year 16.3 9.4 8.6 7.2 8.3 6.5 8.1 6.7 6.4 From 1-2 years 4.7 2.7 1.8 1.6 3.0 l.0 2.9 0.6 1.5 ,, 2-5 years 4.3 2.8 2.5 2.0 2.0 1.3 3.7 1.1 1.2 ,, 5-15 years 3.9 2.9 2.3 2.2 1.8 2.4 1.7 1.9 1.2 „ 15-25 years 4.4 4.3 5.5 4.3 4.2 3.5 4.2 3.5 2.9 ,, 25-45 years 12.3 10.5 11.1 10.2 8.8 10.0 7.4 8.9 8.2 ,, 45-65 years 23.3 27.7 26.0 28.6 26.6 25.8 24.9 27.9 27.4 65 years and upwards 30.8 39.6 42.2 43.8 45.3 49.5 47.1 49.4 51.2 The infantile mortality rate for 1936 was 50 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 1936 77 50 59 66 16 The following Table gives details of the causes of death in the various age groups :— Infantile Mortality, 1936. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. '1 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 1 months Total Deaths under 1 year. All Causes 19 7 l 6 33 15 13 13. 3 77 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken Pox . . .. .. .. .. .. .. . . .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 1 1 .. 3 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. 1 . . 1 Abdominal Tuberculosis . . .. .. .. .. .. .. . . .. . . Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. 1 .. .. 1 .. .. 1 . . 2 Convulsions .. .. .. .. .. .. .. .. 1 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 1 .. 1 .. 2 Pneumonia (all forms) .. .. .. .. .. .. 1 4 .. 5 Diarrhoea .. .. .. 1 1 .. .. .. .. 1 Enteritis .. .. .. .. .. 6 5 4 2 17 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis . . .. .. .. .. .. .. .. .. .. Rickets . . .. .. .. .. .. .. .. .. .. Suffocation, overlaying. .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. .. Atelectasis 3 .. .. .. 3 .. .. .. .. 3 Congenital Malformations .. 2 .. .. 2 1 .. 1 .. 4 Premature Birth 16 4 1 .. 21 1 .. .. .. 22 Atrophy, Debility, and Marasmus .. .. .. 5 5 4 5 .. .. 14 Other Causes Totals .. 19 .. 7 •• l .. 6 .. 33 1 15 1 13 .. 13 .. 3 2 77 Death-rate in each agegroup per 1,000 births. 12.3 4.5 0.6 3.8 21.3 9.7 8.4 8.4 1.9 50 Percentage of total deaths in each agegroup 247 9.1 1.3 7.8 42.9 19.5 16.9 16.9 3.8 100 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 1936 24.7 9.1 1.3 7.8 42.9 19.5 16.9 16.9 3.8 Conditions of Occupation or Environment prejudicially affecting Health. Occupation. No specially detrimental effects amongst workers in any trade has been reported. Environment. Overcrowding still constitutes a most formidable barrier to an improvement in public health. Public Mortuary. During the year there were received the bodies of 314 persons, of whom 100 had been residents of Deptford. Particulars of the bodies received were as follows: Month, 1936 Male Female Inquests Post-Mortems Under 1 year January 5 7 2 12 1 male February 15 9 14 18 1 male 1 female March 15 3 18 8 — April 14 8 13 13 — May 25 10 17 23 2 males 3 females June 19 11 20 17 — July 19 14 25 19 1 male 2 females August 21 10 22 15 — September 14 7 18 8 1 male October 21 14 31 18 — November 11 6 12 9 1 male December ... 21 15 24 19 2 males 1 female Total 200 114 216 179 16 B 18 Inquests. Natural Causes Accidental Causes Suicide Misadventure Murder Open Verdict January 10 1 — — — 1 February 17 6 1 — — — March 10 5 2 — — 1 April 14 7 — — — 1 May 23 10 1 — — 1 June 17 10 2 — — 1 July 18 11 4 — — — August 19 8 3 1 — — September 11 7 1 — — 1 October 27 7 2 — — — November 11 3 2 — — 1 December 24 9 3 — — — Total 201 84 21 1 — 7 Bodies Received. 1936 Deptford Other Districts January 5 7 February 7 17 March 6 12 April 7 15 May 10 25 June 12 18 July 13 20 August 8 23 September 7 13 October 8 28 November 7 10 December 10 26 100 214 Total 314 Mortuary. Consideration was given during the year to the re-arranging of the accommodation so as to improve the facilities for the private and reverend viewing of bodies. It was also decided to install a Refrigerator Chamber. The Refrigerator is of the six-cell type consisting of three two-tier cubicles and has proved in practice very satisfactory. General Provision of Health Services. 20 Staff of Public Health Department. Medical Officer of Health and Administrative Tuberculosis Officer. F. Leonard Keith, m.d., ch.b., d.p.h., l.d.s. Assistant Medical Officers. N. M. Donnelly, m.b., d.p.h., (Tuberculosis Officer and \ssistant Medical Officer of Health.) S. Eleanor Hill, m.d., b.s. (Maternity and Child Welfare.) m. I. outram, m.b., ch.b., d.p.h. (Part-time Maternity and Child Welfare.) B. M. Playfair, m.d., d.p.h., (Part-time Maternity and Child Welfare.) Obstetric Consultant. J. H. Peel, m.d., f.r.c.s. (For Maternity Home and under Puerperal Fever and Pyrexia Regulations.) Obstetric Consultants. Ci. 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 Mag raw, l.d.s. Public Analyst. Henry G. Harrison, m.a., f.i.c. Deputy Public Analyst. Hugh A. Williams, a.c.g.f.c., f.i.c. Public Vaccinators. Gavin A. E. Argo, m.b., ch.b. J. Stanley Davies, m.a., m.b., c.m., l.m. 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 G. B. Allen 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. 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 Cert. s.i.e b. (Food Inspector) 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 W. R. Sherborne... 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. Central Child Welfare Clinic. Ante-natal and Post-natal Centres. Health Visitor in charge—Miss E. Clubbe, Gen. Training, c.m.b., h.v. 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.). Day Nursery. Health Visitor in charge— Miss E. T. Stowell, Gen. Training, c.m.b., H.v. (r.S.I.) Assistant Nurse—Miss G. H. Howard. Clerk—Miss D. Watkins. Attendant and Caretaker—W. S. Saunders. *Part-time only at Infant Welfare Centres. 22 Tuberculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. Tuberculosis Health Visitors— Miss A. M. Roy, Gen. Training, c.m.b. h.v. (r.s.i.), Tuberculosis Cert, (r.s.i.) Miss E. A. Coles, Children's Training, c.m.b.. h.v. (r.s.i.), Tuberculosis Certs. (Brompton Hospital), Public Health Diploma (Battersea Polytechnic). 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). St. John's Nurses (Parish of St. Paul with St. Mark). The work is carried out in close co-operation with the Health Services of the Council, particularly in regard to the work of the Maternity and Child Welfare Centres and the Tuberculosis Dispensary. Nursing is undertaken on behalf of the Borough Council of children up to the age of five years suffering from measles, whooping cough, diarrhoea, poliomyelitis and ophthalmia neonatorum. During epidemic periods, pneumonia and influenzal pneumonia (all ages) are included. Payment is made by the Borough Council at the rate of 1s. 3d. per nursing visit. 23 The following is a summary of the cases visited on behalf of the Borough Council by members of the District Nursing Associations:— Condition. Children under 5 years Others Total cases nursed Cases Visits Cases Visits Measles 21 280 3 46 24 Ophthalmia Neonatorum 7 259 7 Pneumonia 6 84 2 50 8 Thread Worms 1 19 1 Conjunctivitis 3 44 3 Diarrhoea 1 5 1 Ear trouble 2 69 2 Whooping cough 2 28 1 6 3 Neck Abscess 1 11 1 Circumscission 1 10 1 Maternity Cases 5 53 5 Bronchitis 7 87 7 52 896 11 155 63 A considerable amount of work is undertaken by the Nursing Sisters of St. John the Divine and the following figures have been supplied to me as indicating the scope of some of their activities:— General District Nursing Patients 196 Visits 5,262 Surgery Patients 428 Attendances 3,776 Midwives. The Borough Council is not the supervising authority under the Midwives Acts. From a return provided by the County Council, the number of midwives practising in the Borough is estimated at twenty-two. The Council decided to include in the financial estimates for the year 1936 37 a sum of £\5 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 five instances. 24 Laboratory Facilities. See "Food" and "Infectious Diseases." HOSPITALS. Infectious Diseases. Under the provisions of the Local Government Act, 1929, hospital accommodation for the isolation and treatment of infectious diseases, including small-pox, is organised and maintained by the London County Council for the County of London as a whole. The South-Eastern Hospital, situated in Deptford, has approximately 480 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.") 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. Health Visiting. See "Maternity and Child Welfare." Infant Life Protection. For details, see "Maternity and Child Welfare." Orthopaedic Treatment. No scheme has been adopted, individual children being referred to private doctors or to hospitals. Municipal Foot Clinic. With the completion of the Central Maternity and Child Welfare Clinic and the transfer thereto of the Ante-Natal and Light Treatment Clinics from the Health Centre, Harton Street, the vacated accommodation at the Health Centre became available for a project long under consideration, namely, the establishment of a Municipal Foot Clinic. The rooms available permitted of the provision of seven cubicles, each curtained off for privacy, four being placed in one room and three in the other to permit of the separation of sexes. The equipment for each cubicle consists of chair, foot-rest, trays and instruments, while, for general use, is also provided certain apparatus such as vibrator, nail drill, infra-red lamp, etc. Two fully-qualified chiropodists were engaged and, at first, two sessions weekly were provided. The response of the public to this new venture of the Borough Council was so great that two further sessions every week were made available and, at a later date, authority was given to hold, as and when required, a special appointment session to meet the need of those persons who could attend only at special hours. The number of persons for whom treatment could not be provided within the limits of the scheme appeared to warrant an increase in the number of sessions, and this matter received favourable consideration by the Public Health Committee. I should like to express my appreciation of the help afforded me in the setting up of this Clinic by Mr. F. R. Bride, B.Sc., Head of the School of Chiropody, Chelsea Polytechnic. 26 CLINICS AND TREATMENT CENTRES. Maternity & Child Welfare. Central Clinic, Amersham Road Infant Welfare Sessions, Daily 2 p.m. Ante-natal Clinic,Wednesday, 10a.m. (Other Sessions by appointment) Post-natal Clinic, Tuesday, 10 a.m. Toddlers' Clinic, Monday and Thursday, 10 a.m. Day Nursery, Monday to Friday. Light Treatment, by appointment. Dental Inspection and Treatment, by appointment. Diphtheria Immunisation, by appointment. Outlying Child Welfare Clinics Monday, Gosterwood Street, 2 p.m. Thursday, Baptist Institute, Ilderton Road, 2 p.m. Thursday, Princess Louise Institute, Hales Street, 2 p.m. Health Centre, Harton St. Foot Clinic — Sessions:— Monday - 6 p.m to 8.30 p.m. Tuesday - 2 to 4.30p.m. and 6 to 8.30 p.m. Wednesday 2 p.m. to 4.30 p.m. Thursday - 2 p.m. to 4 30 p.m. Friday - 2 to 4.30 p.m. and 6 to 8.30 p.m. Special appointment Session— Thursday - 6 p.m. to 8.30 p.m. Tuberculosis Dispensary. Health Centre, Harton Street. Monday & Thursday, 9.30 to 11 a.m. Men. Tuesday evening, 6.30 to 7.30 p.m., Men and Women at work. Tuesday and Friday, 9.30 to 11 a.m., Women. Thursday, 2 to 3 p.m., Children not at school and Women at work, latter by appointment. Saturday, 9.30 to 11 a.m., Children attending school. Secretary's Consultations. 9.30 a.m. daily. Venereal Diseases. Miller Hospital, Greenwich,S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Hospital, Morden Hill, Lewisham, S.E. 13. Clinic Hours— Men: Tuesday 5.30 p.m. Thursday 9.30 a.m. Women: Monday, 3 p.m. Thursday, 6.15 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. Any week-day, 9 a.m. to 8 p.m. King's College Hospital, Denmark Hill, S.E. 5. Syphilis—Tuesday, 4.30 p.m. Wednesday and Friday, 11 a.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, 9.30 a.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:— 1930 1931 1932 1933 1934 1935 1936 Total primary inspections 8,004 7,592 6,652 8,166 8,039 10,854 8,184 Total re-inspections 18,167 20,461 17,284 18,105 17,704 20,112 16,906 Total Intimation Notices served 3,458 3,552 2,623 2,748 2,656 2,850 2,431 Total Statutory Notices served 1,078 1,104 687 777 632 698 658 Total Housing Act Notices served 42 12 10 18 4 1 - Total premises on which works were completed 3,855 3,941 2,990 3,116 2,977 3,256 2,863 Total improvements effected during the year 12,053 14,116 10,928 12,440 11,185 11,301 9,947 The drop in the figures for 1936 is in part accounted for by the fact that in 1935, two temporary Inspectors were employed for a period of nine months and also that during 1936 considerable time was spent on extensive housing inspections. I am satisfied that the high standard reached in previous years has been maintained. In addition to the above, 2,429 inspections and calls have been made by the Food Inspector, Mr. Yates, and 283 visits were made to St. George's Wharf by Inspector Webster for the purpose of the examination of imported foods. 29 Summary of Sanitary Work carried out during the year 1936. Number of District. Comparative figures for 1935. 1 2 3 4 5 6 7 8 9 Totals Inspections— On complaint 159 97 290 210 174 106 143 91 71 1341 1394 House-to-house— 1. Where defects found 190 81 19 143 194 239 ... 6 4 876 1038 2. Where no defects found 70 11 4 53 37 22 ... 1 4 202 432 On occurrence of Infection 95 34 109 75 94 61 63 29 53 613 765 On Notice from builder 188 40 35 53 48 51 64 15 45 539 586 Reference from T.B. Dispensary 2 1 6 2 3 ... ... 5 1 20 22 Market Inspection 14 13 12 11 13 13 11 ... ... 87 90 Factories 16 11 16 28 22 2 4 6 1 106 73 Workshops 5 3 3 6 7 ... 2 6 2 34 33 Workplaces 14 1 1 7 10 2 3 2 4 44 53 Food premises (restaurants, etc.) 46 283 8 12 13 3 11 8 3 387 261 Butchers' premises 3 ... 1 1 4 3 ... 7 ... 19 15 Ice Cream premises 15 14 8 18 19 14 4 18 1 111 189 Milk premises 53 45 59 13 76 51 8 31 12 348 320 Bakehouses 16 ... 16 17 21 12 4 ... 3 89 104 Fish premises 41 17 14 66 15 17 17 25 11 223 173 Offensive businesses ... ... 24 2 ... ... 3 ... ... 29 20 Outworkers' premises 2 1 1 12 23 33 10 10 9 101 124 Common Lodging Houses ... 8 14 ... ... 12 15 ... 3 52 77 Shops Act Inspections 23 5 7 4 5 2 ... ... ... 46 279 Special Housing Inspections 104 74 416 117 130 53 79 37 12 1022 2894 Poisons Act Inspections 13 5 51 12 11 6 12 3 1 114 ... Miscellaneous inspections 181 98 394 322 277 154 197 101 57 1781 1912 Total inspections 1250 842 1508 1184 1196 856 650 401 297 8184 10854 Re-inspections, Calls, etc. 2443 1368 1708 2567 2629 2040 2116 940 1095 16906 20112 Smoke observations 15 5 1 ... ... 1 1 ... ... 23 9 Notices Served— Intimation 376 186 309 445 405 330 176 115 89 2431 2850 Statutory 76 45 121 144 70 105 41 44 12 658 698 Premises in respect of which notices were complied with 536 200 345 454 436 364 213 165 150 2863 3256 Premises in respect of which works in compliance with notices served during 1936 were outstanding at the end of the year 36 24 53 45 24 44 23 6 6 261 274 Description of Sanitary provements effected during the year- Number of rooms cleansed 547 334 401 480 639 450 119 158 73 3201 3747 Defective roofs repaired 77 66 93 76 78 60 35 51 22 558 647 Gutters or rainwater pipes vided or repaired 84 42 33 58 52 53 17 24 9 372 463 Dampness abated 36 28 67 78 67 94 26 23 12 431 495 Yards and forecourts paved or paving repaired 39 24 12 37 66 67 18 14 18 295 325 Water Fittings repaired 70 4 9 24 10 32 29 3 21 202 192 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 144 65 57 86 120 223 39 33 27 794 904 Drains entirely reconstructed 3 ... ... 2 5 6 11 3 13 43 50 Drains partially reconstructed 16 9 7 9 8 16 38 11 15 129 127 Drains unchoked and cleansed 13 11 25 29 26 6 23 15 2 150 154 Soil and vent pipes renewed or repaired 7 1 3 3 16 163 23 16 13 245 224 Gullies provided, unchoked, etc. 14 4 11 10 21 61 48 25 43 237 239 Manholes, chambers, fresh-air inlets, etc., provided or repaired 12 3 14 13 21 28 33 10 27 161 200 Premises in which repairs were effected to w.c's. 152 116 107 150 157 217 96 55 86 1136 1229 Repairs effected to windows, sashes, etc. 115 53 48 88 98 59 11 35 16 523 658 Repairs to stoves, coppers and flues 39 70 51 59 63 31 17 22 12 364 399 Repairs to stairs, doors, etc. 8 20 22 23 28 18 8 20 1 148 189 Repairs to floors 18 38 27 35 30 17 5 19 8 197 238 Fish shops limewashed 27 11 9 41 9 13 13 15 8 146 98 Bakehouses limewashed 10 ... 7 10 4 6 3 ... 2 42 51 Ventilation and lighting improved 10 6 3 41 9 33 1 1 2 106 107 Offensive accumulations removed 7 7 4 3 1 8 3 2 35 40 Dustbins provided 55 18 33 54 87 32 15 21 19 334 397 Miscellaneous repairs and improvements effected 16 5 16 14 10 8 13 8 8 98 128 Total repairs and improvements effected 1519 928 1062 1424 1627 1694 649 585 459 9947 11301 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 „ Allen St. Paul's (part) and St. John's (part) Wards. 4 „ Hewett Vale and St. Paul's (part) Wards. 5 „ Green Canterbury and Hatcham (part) Wards. 6 & 8 „ Wilton Hatcham (part) Pepys and St. Catherine's Wards. 7 & 9 „ Mason St. Peter's, St John's (part) and Town Hall Wards. 31 House-to-House Inspections. 1,078 house-to-house inspections were made. These inspections were carried out in the following streets:— Alloa Road Amersham Grove Angus Street Arica Road Atkinson Street Bawtree Road Bclina Road Brockill Crescent Brocklehurst Street Chilton Street Colwick Street Cornbury Road Croft Street Dundalk Road Edward Place Eugenia Road Finland Road Gosterwood Street Grinstead Road Haydock Road Hyde Street Pagnell Street Queen's Road Reculver Road Revelon Road Seymour Street Sharratt Street Simla Street Strickland Street Woodpecker Road Yeoman 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. 1936 £ s. d. £ s. d. Jan. 15 6 Drakefell Road (Tenement house) Overcrowding. 1 0 0 4 4 0 „ 21 59 Pomeroy Street Non-compliance with statutory notice. - - Works completed prior to hearing. Adjourned sine die in order to observe effectiveness of roof repairs Feb. 5 59 Pomeroy Street (Defective roof) - 2 2 0 Magistrate's Order, (7 days). „ 14 68 Reculver Road Non-compliance with statutory notice. - 2 2 0 Magistrate's Order, (10 days). „ 14 70 Reculver Road Non-compliance with statutory notice. - 2 2 0 Magistrate's Order, (10 days). June 2 117 St. Asaph Road Non-compliance with statutory notice. - 2 2 0 Magistrate's Order, (7 days). July 7 117 St. Asaph Road Non-compliance with Magistrate's order. 1 0 0 3 3 0 „ 14 59 Pomeroy Street Non-compliance with statutory notice. 1 1 0 Magistrate's Order, (14 days). 32 Miscellaneous Matters. Smoke Abatement. The problem of nuisance from the emission of smoke is one constantly before the staff. Verbal warnings were given in several instances, and 4 notices were served. 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 m 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 7th 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 poison was placed having been made a few days after baiting, it was found that the majority of the baits had been eaten and many dead rats were found. There is no doubt that considerable numbers of rats were also washed away by the water. During the same week the London County Council laid over 1,600 baits in their sewers in this Borough, of which approximately 1,200 were consumed. In view of the considerable success which results from this annual campaign, the Council considered that the baiting of the sewers should be undertaken more frequently and a communication was addressed to the London County Council on these lines. Removal of Aged and Infirm Persons. It was found necessary to apply to the Court for Orders during the year for the compulsory removal of two aged and infirm persons to hospital. Swimming Baths. At all the Baths maintained by the Borough Council a chlorination plant is installed and periodical sampling is conducted to ensure that a high standard of water purity is maintained. Six samples were taken in 1936. 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 43 premises was entirely reconstructed during the year, in 129 instances partly reconstructed,and in 150 premises the drains were unstopped and cleansed. Flooding. Certain portions of the Borough, notably the Clifton Hill area, are liable to flooding in times of heavy rainfall, but none occurred in 1936. 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. As mentioned in last year's Report, the Council adopted certain proposals for reorganising the system of street cleansing in the Borough, which resulted in the orderly barrow then in use being c 34 replaced by a special vehicle comprising two galvanised steel containers n a frame, mounted on a chassis fitted with pneumatic tyred wheels. The containers being detachable from the chassis were collected by motor vehicles, which conveyed the full containers to the shoot, where they were emptied. During 1936 the Borough Engineer reported that he was not satisfied with the working of this system, having regard to the time spent in loading the containers on to motor vehicles and conveying them to the Depot, where they were emptied by hand, then reloading the motors with empty bins and distributing these to the sweepers. Consideration was given to a type of vehicle, subsequently acquired, by means of which the two containers would simultaneously be hoisted from the sweeper's truck into the vehicle and the contents tipped into it, the containers being returned to the truck ; the whole process taking only a fraction of the time now occupied in loading the full containers on to the present lorry. When the vehicle is fully loaded — and it will take from 3-4 tons of refuse — it proceeds to the Depot, and being provided with tipping gear, the contents can be shot into a barge in a very few minutes. The adoption of this new method results in a considerable saving of time, and in a more efficient system of picking up and emptying the street refuse containers. Fouling of Footways by Dogs. The Council has made a byelaw dealing with this nuisance. Shops Act, 1934. The duties with regard to the ventilation and the temperature of shops, and the provision of sanitary conveniences continue to engage the attention of the Sanitary Inspectors. 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, 63 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 309 new premises could be properly granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. No certificates were granted in connection with the above. Canal Boats. The following is the text of the Annual Report of the Canal Boats Inspector:— To the Medical Officer of Health. Sir, I beg to report that during the year ended 31st December, 1936, 12 visits were made, on the following dates:— 24th January, 28th February, 13th March, 5th and 19th April, 19th June, 8th July, 25th August, 20th October, 4th and 27th November, and 17th December. 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 135 3 — Workshops 89 4 — Workplaces 799 — — Total 1023 7 — The types of premises inspected were as follows:— Type. Factories, Number. Workshops, Number. Workplaces, Number. Bakehouses 18 26 Chemical Works 3 1 Cinemas, etc. 6 Dressmakers, Milliners, etc. 4 19 9 Engineering, general 25 4 „ motoring 8 10 1 Foundries 6 Food preparation 23 4 346 Glass bottle makers 1 1 Laundries, Cleaners, etc. 6 3 Marine Stores 3 8 Paint and Varnish Works 3 Printers 7 1 Shoeing Forges 1 Stables, etc. 62 Sawmills 9 Timber Stores 1 6 Tar Refiners 5 Tailors 1 6 6 Woodwork, Joiners, etc. 7 2 Woodchoppers, etc. 4 4 4 Whitening Manufacturers 4 Offensive trades 4 Miscellaneous 65 55 65 Totals 204 140 513 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 1 1 — - Want of Ventilation — — - - Overcrowding — — - - Want of Drainage of Floors — — - - Other Nuisances 2 2 - - Sanitary Accommodation Insufficient 1 1 - - Unsuitable or defective 4 4 - - 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 8 8 - - The number of inspections made to Home Workers' Dwellings was 101. In no case were insanitary conditions found calling for action under the Factory and Workshop or Public Health Act. Housing. 40 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 and the following houses or parts of houses were officially "represented" to the Council during 1936:— Individual Dwelling-Houses. 4 Parts of Buildings. 2 Underground Rooms. 64 The following table records the work done in connection with housing inspection:— 1. Unfit Dwelling-Houses. Inspection— (l) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5431 (b) Number of inspections made ... 5525 (c) Special Housing Survey Inspections (not included above) 1022 (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925-1932 1078 (b) Number of inspections made for this purpose 1078 (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 (4) Number of dwelling-houses (exclusive of those in (3) found not to be in all respects reasonably fit for human habitation 2424 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) 2321 41 3. Action under Statutory Powers. (A) Proceedings under Sees. 17, 18 and 23 of the Housing Act, 1930 (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit after service of formal Notice:— {a) By owners — (b) By Local Authority in default of owners — (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (Statutory Notices) 658 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices:— (а) By owners 535 (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 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 1 (D) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of underground rooms in respect of which Closing Orders were made 25 (2) Number of underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 (3) Number of parts of Buildings in respect of which closing order was made 1 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. Houses Demolished. (a) Crossfield Street 1 42 (E) Housing Act, 1935:- (1) Number of houses visited under Sec. 1 (1935-36) 18572 (2) Number of families found to be living under overcrowded conditions 1317 (3) Number of persons concerned in (2) 6604 (4) Number of cases of overcrowding relieved 101 Undertakings accepted in respect of individual dwelling houses. (a) To cease using for human habitation 1 (b) To make fit 1 Undertakings accepted in respect of underground rooms to make fit *25 Underground rooms in which no action was taken 1 * Including cases not formally represented. During the year the London County Council developed their Speedwell Street and Bronze Street Areas and commenced operations upon the Frankham Street Areas (1-5) and Addey Street Areas (l and 2). In view of the magnitude of the London County Council housing undertakings in Deptford I append a summary of the accommodation provided or in course of provision:— London County Council Housing In Deptford. Provided. Accommodating Tenements Hughes Fields Estate 4 blocks—121 tenements 624½ persons. Deptford Park Estate 2 „ 102 „ 492 „ Honor Oak Estate 7 „ 192 „ 876 „ Bronze Street Area 3 „ 125 „ 655 „ (Crossfield Estate) Bate Place Area (Crossfield Estate) 1 Block—37 „ 183 „ Speedwell Street Area (Speedwell Estate) 2 blocks—180 „ 942½ „ In Course of Provision. Area Acreage Persons being displaced Number of tenements to be provided 1. Frankham Street Areas (1-5) with added lands, Christ Church and 69-75 Church Street. 2.88 1,020 104 2. Addey Street Areas (l and 2) with added lands. 5.22 912 180 43 The L.C.C. also announced their intention to deal with an area to be known as the Tanner's Hill Area. Private enterprise built 3 houses. The London County Council provide accommodation upon their various estates, for families from Deptford, and the following figures indicate the number of families for whom provision was made in 1936:— Estate Families Honor Oak 139 Mottingham 128 Bronze Street 110 Downham 79 Speedwell Street 65 Hughes' Fields 45 Thames Street, S.E. 10 42 Meridian, S.E. 10 38 Bellingham 30 Becontree 25 Thornhill, S.E. 7 22 East Greenwich 18 St. Helier 15 Deptford Park 10 Swan Lane, S.E. 16 6 Others 17 Total 789 For information, the number of Deptford families rehoused during recent years was as follows:— 1935—354, 1934—476, 1933—377, 1932—241, 1931—217. Food. 40 INSPECTION AND SUPERVISION OF THE FOOD SUPPLY, This naturally falls under three headings: — I. Supervision of premises where food is stored, prepared, or from which it is sold or distributed. II. Examination of food as to its soundness. III. Sampling of food to determine its composition or sophistication. These duties are distributed amongst the members of the Inspectorial Staff and, although the Food Inspector is primarily responsible for the purity of the food, this duty, particularly in respect of milk and the soundness of food, is shared, but to a less degree, by all the Inspectors. The following is a tabular statement of the visits made by Mr. Yates, Food Inspector:— No. of Visits. Market inspection 96 Food premises (Restaurants, etc.) 165 Fish premises 31 Slaughterhouses - 243 Butchers' premises 1037 Milk premises 62 Miscellaneous 85 Calls (Stalls, etc.) 710 2429 Inspector Webster deals with the inspection of imported food at St. George's Wharf. He made 283 visits during the year under review. I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 26 applications for registration (including 7 transfers) in respect of premises were granted during the year. At the end of the year there were 144 premises registered for the sale of milk. In addition to the above, 111 persons were registered for the sale of unopened bottled milk only, and 34 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. 47 There are no cow-houses in the Borough. During the year 348 inspections of milk shops were made by the District Sanitary Inspectors and 62 by the Food Inspector. One Intimation notice was served and many minor matters were remedied as the result of verbal intimation by the Inspectors. Legal Proceedings (other than in connection with adulteration). Legal Proceedings were instituted against a dairyman and his servant for filling and closing milk bottles in the public highway. The case against the dairyman was dismissed under the Probation of Offenders Act and the servant was fined 20s. with 3s. Od. costs. Administration of the Milk (Special Designations Order), 1936. At the end of the year, the following retailers were registered :— 1 retailer to sell Accredited Milk at 1 shop. 4 retailers ,, Tuberculin Tested Milk at 4 shops. 8 „ ,, Pasteurised Milk at or from 20 shops. 5 retailers whose premises are outside the Borough to sell Pasteur ised Milk within the Borough. 1 retailer whose premises are outside the Borough to sell Accredited Milk within the Borough. 1 retailer whose premises are outside the Borough to sell Tuberculin Tested Milk within the Borough. Bacteriological Examination of Milk. 52 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 50,853 Grade " A " Tuberculin Tested 31,466 „ „ „ 8,700† 99 99 99 398,000* „ „ „ 17,450† „ „ „ 148,000† „ „ „ 47,500† „ „ „ 16,600 „ „ „ 12,850 „ „ „ 149,400 „ „ „ 14,000 „ „ „ Uncountable* „ „ „ 19,000 „ „ „ *These samples showed a microbic content above the Standard. †B.Coli present in 1/100 c.c. 48 Designation. Total Count in 1 cc. Designation, Count in 1 cc. Pasteurised 15,200 Pasteurised 13,500 „ 1,850 „ 8,200 „ 4,880 „ 18,300 „ 500 „ 8,900 „ 1,486 „ 19,100 „ 1,290 „ 4,533 „ 416 „ 6,350 „ 893 „ 4,900 „ 1,163 „ 16,350 „ 2,233 „ 38,600 „ 12,700 „ 750 „ 4,650 „ 14,806 „ 13,200 „ 1,593 „ 9,550 „ 8,950 „ 3,933 „ 6,500 „ 4,150 „ 11,200 „ 5,820 „ 14,300 „ 9,500 „ 2,900 „ 4,850 „ 3,273 „ 18,700 „ 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. 34 samples of milk were submitted to the bacteriologist for the detection of Tubercle Bacilli (guinea pig inoculation), all with negative results. v 2. Meat Premises, {a) Slaughterhouses. There are two slaughterhouses in the Borough and these were kept under regular and efficient supervision, 243 visits having been paid by the Food Inspector. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 262 bullocks. 71 calves. 1934 sheep. 245 pigs. The Borough Council has licensed 7 slaughtermen in connection with these premises. Destroyed—Surrendered at Slaughterhouses. Bullock's mesenteric fat, 1. Bullocks' heads and tongues 2. Bullock (entire) 2. Bullocks' livers 20. Bullocks' lungs 20. Pig's head 1. Pig's offal 1. Pig's pluck 1. Pigs' livers 3. Sheep's lungs 2. Sheep (entire) 1. 49 (6) Poultry Slaughterer. I here is one poultry slaughtering establishment. During the year 6,945 head of poultry were slaughtered. (c) Shops and Stalls. The following Food Stalls are registered:— Fruit, Vegetables 32 Meat 3 Ice Cream and/or Baked Grocery 6 Chestnuts 13 Refreshments 6 Fish and/or Poultry 9 Medicines 4 Regular inspection is carried out, particularly at such times as business is being actively carried on. (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 pre-nises, and all places already registered, regular inspection is made. 99 premises were so registered at the end of the year under report. 3. Other Food Premises. (a) Workshop Bakehouses. There are 26 such bakehouses in the Borough, 6 of which are underground. 55 inspections were made during the year. 1 Intimation notice was served for the remedy of general defects and apart from minor defects, remedied upon verbal intimation, 52 Notices were served for cleansing. (h) Factory Bakehouses. These number 18, of which 4 are underground. 34 inspections were made, 36 Notices were served for cleansing. (c) Fried Fish Shops and Fish Curers. The number kept under observation during the year was 53. 223 inspections were made by the District Sanitary Inspectors and 31 bv the Food Inspector. 189 Notices were served for cleansing. (d) Ice Cream Premises. There were 189 separate premises recorded. To these, 111 visits were paid, and many verbal intimations were given regarding minor matters. (e) Other Premises. There are 338 miscellaneous premises connected with food preparation or sale, and 406 inspections were made to these, in addition to numerous visits by the Food Inspector. Numerous verbal intimations regarding minor matters were given. d 50 (f) St. George's Wharf. Public Health (Imported Food) Regu lations, 1925. During the year 1936, large quantities of foodstuffs were imported at the Wharf, and the following is a summary of the work done:- Inspector Webster. Description. Quantity Extent of Examinatio n. Remarks. Albumen cases 20 4 Almonds 2 1 Anchovies in tins 647 54 1 tin destroyed Beans bags 775 57 Beans in tins cases 1 1 Beef dripping 2 2 Conditional admission. No cert., re-exported Biscuits 3 1 1 sample, genuine Blackcurrant pulp casks 107 19 Sample, suitable for jam „ „ cases 542 67 Sample free from preservative, 7 tins destroyed Brandy 1 1 Broken biscuits 30 8 10 stopped, released after examination Butter casks 442 32 2 samples genuine Casein bags 1060 42 Capers in vinegar case 1 1 Carmine cases 8 6 Casings casks 220 42 Champagne cases 831 36 Cheese „ 162 15 Cherries in brandy „ 7 1 Cherries in jars „ 25 4 Chestnut flour „ 7 3 Chocolate „ 113 17 Chocolates „ 2 1 Chocolate biscuits „ 278 30 4 samples genuine, 45 cases stopped Choc, finger biscuits „ 402 53 Choc, finger wafers „ 2 1 2 cases stopped, 1 sample genuine Chocolate sandwich „ 2 1 Condensed Milk „ 760 45 Confectionery (cornets) „ 5 1 1 sample, 116W, 0'091 per cent, boric acid added preservative. Ministry informed. Cream barley „ 7 4 Cream rice „ 51 14 51 Description, Quantity. Extent of Examinatiom Remarks. Cucumbers cases 14 1 Chocolate cube wafers „ 443 37 1 sample genuine, 4 cases stopped Dates „ 721 98 ½ case stopped Eggs „ 12280 566 3 cases destroyed, damaged Flour bags 869 37 Fruit cubes cases 940 54 1 sample genuine, 4 cases stopped Fruit wafers ,, 1297 116 2 samples genuine, 15 cases stopped Ginger bread „ 7 4 Glucose bags 160 5 Grape juice case 1 1 Ground rice cases 79 13 Hams „ 200 16 Herrings in tins „ 772 82 1 tin destroyed Honey casks 4 4 Horse radish bags 23 2 Leeks in tins cases 30 1 Lemons „ 543 55 Lemonade „ 6 2 Liqueur „ 3 1 Lobster in tins „ 71 6 12 cases destroyed, 3 samples, 1 unsatisfactory on bacteriological examination Maize cornflour cases 320 12 Meat paste 10 4 Middlings bags 3269 145 Milk chocolate biscuits cases 5 4 1 sample genuine, 5 stopped Milk choc, finger bisc. „ 3 2 Mineral waters „ 3 2 Mushrooms in jars „ 268 41 - Mushrooms in tins „ 792 97 1 sample genuine Mustard prepared „ 424 25 „ „ buckets 50 5 „ „ packages 4 4 „ „ casks 2 2 Macaroni cases 492 18 Nuts bags 325 20 Onions cases 3504 1050 26 cases and loose quantity of 1 ton 2 cwt. 3 qrs. 3 lbs- destroyed Oats „ 137 8 Oranges „ 2707 300 3 cases destroyed B2 52 Description. Quantity. Extent of Examination Remarks. Peas bags 741 41 1 sample genuine Peas in tins cases 30 1 Plums in jars „ 17 4 Pectin apple juice casks 130 11 Pickles cases 33 2 Potatoes bags 210 20 Peaches in jars cases 3 1 Potato fecule „ 35 7 Potato flour „ 7 3 Preserves 5 1 Raisins „ 1290 22 Raspberries in jars „ 4 2 Sago „ 19 6 Saline salts ,, 4 1 Sardines „ 67 9 Sauerkrout „ 14 1 Sausages „ 8 2 Semolina „ 34 15 Soup powders „ 525 12 Spaghetti „ 10 1 Starch flour bags 40 2 Strawberries in spirit cases 10 1 Strawberry juices „ 5 1 Sweets „ 737 71 Syrup „ 12 1 Tunny fish in tins „ 28 3 Tapioca „ 154 24 Vegetables in jars „ 10 1 Vegetables in tins „ 1109 92 1 sample genuine Vinegar casks 54 11 Vinegar in bottles cases 179 16 Wafer biscuits „ 427 40 4 cases stopped, 4 samples genuine Wine „ 16 7 TRANSHIPPED Description Quantity Black currant pulp cases 50 Casings casks 34 Chille bags 6 Flour cases 13 Herrings in tins 52 Mushrooms in jars 50 Mushrooms in tins 26 Salted herrings barrels 25 ,, „ cases 2 Vegetables in tins „ 3 Wine „ 5 53 Free Entry Description Quantity Wine cases 24 for use of the Belgian Ambassador Cleared by Customs and Delivered before Examination Capers in brine casks 3 Condensed milk (sweetened) cases 75 Flour „ 17 Ham and sausage ,, 4 Tinned herrings „ 12 Wine „ 4 In Bond Black currant pulp cases 5 Brandy 6 Butter 100 Champagne 3648 Chille bags 4 Coffee 9 Cured hams cases 6 Herrings in tins ,, 359 Mushrooms in jars ,, 34 Mushrooms in tins 289 Preserves 4 Spirits 12 Wine 679 ,, casks 1 Overside. Anchovies in tins cases 6293 Beans bags 2810 Black currant pulp casks 324 ,, ,, cases 612 Brandy casks 40 ,, cases 284 Butter cases 750 Champagne ,, 9058 Chestnuts in syrup 10 Cocoa butter bales 383 „ „ casks 381 Coffee bags 22 Dates cases 2535 Flour bags 43616 Grape fruit cases 700 Lentils bags 50 54 Description Quantity Liquor cases 1634 „ casks 2 „ packages 13 Liqueurs cases 599 Maize cornflour bags 1300 Middlings 4862 Mineral waters cases 3215 Oranges 19092 Peas bags 4013 Preserves cases 1016 Rice bags 1073 Sardines cases 3911 Spirits 271 Starch flour bags 4860 Sweets cases 50 Syrup „ 88 Tinned hams ,, 403 Wine ,, 7932 ,, casks 379 ,, baskets 6 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 Bullocks (entire), 2 Bullocks' livers, 20 Bullocks' lungs, 7 Bullocks' heads and tongues, 2 Leg of Veal, 1 Pig's pluck, 1 Pigs' livers, 3 Pig's head, 1 Pig's offal, 1 Side of pork, 1 Pickled pork, 320 lbs. Sheep's lungs, 2 Sheep (entire), 1 Leg of mutton, 1 Fish Plaice, 1 cwt. Whelks, 56 lbs. Mussels, 1 cwt. Fowl Turkeys, 14 Chickens, 3 Tinned Food Sild, 1016 tins Prunes, 4 tins 55 III. Food Poisoning. The following is an analysis of the notifications received, grouped according to the causal agent:— Food. No. of cases. Stout 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. 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, if positive, 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 for chemical analysis during the year, equivalent to 5 samples per 1,000 of the population. The following is a statement of the sampling clone and results obtained in 1936 :— Total. N limber Adulterated. Percentage of samples adulterated. * Formal samples 268 15 5.6 % Informal samples 239 19 7.9 % Imported Food samples 29 1 3.4 % Total 536 35 6.5 % "Including incorrect labelling. 50 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 1.3 1930 550 3.5 1931 507 2.6 1932 500 1.4 1933 500 1.4 1934 500 2.8 1935 536 7.1 The following is a statement of the samples purchased and submitted for analysis during 1936. 57 Food and Drugs—Samples Taken. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulterated Samples. Formal Samples, taken under the Food and Drugs (Adulteration ) A ct— Almonds, ground 3 .. 3 .. Arrowroot 1 .. 1 .. Beef, minced 2 .. 2 .. Butter 4 .. 4 .. Cheese 1 .. 1 .. Cocoa 1 .. 1 .. Coffee 1 .. 1 .. Curry Powder 1 .. 1 .. Dripping 3 .. .. Fat, cooking 1 .. 1 .. Fruit, (dried), Sultanas 1 .. 1 .. Ginger, ground 1 .. 1 .. Glycerine 1 1 100 Grey powder 1 3 4 75 Jam 2 .. 2 .. Margarine 2 .. 2 . . Milk 195 3 198 1.5 Milk, sterilised .. 3 .. Mustard 1 .. 1 .. Nutmeg, ground 2 .. 2 .. Pepper 4 .. 4 .. Pepper, black (whole) .. 1 1 100 Sausage 5 .. 5 .. Spirts 10 6 16 37.5 Suet, chopped . . 1 1 100 Vinegar 2 .. 2 .. ,, Malt 2 .. 2 .. Wine, non-alcoholic 4 .. 4 . . Total Formal Samples 253 15 268 5.6 Informal Samples— Aspirin tablets, 5 gr, 3 .. 3 .. Baked beans in tomato sauce 1 .. 1 .. Baking powder 1 .. 1 .. Banana curd 1 .. 1 .. Biscuits and wafers 3 .. 3 .. Biscuits, chocolate 1 .. 1 .. Blancmange 1 .. 1 .. Butter 5 .. 5 .. Cake 2 .. 2 .. Cheese 6 .. 6 .. Cherries, glace 1 .. 1 .. Chocolate 5 .. 5 .. Chocolate, white 1 .. 1 .. Chutney 2 .. 2 .. Cinnamon 1 .. 1 .. Cinnamon powder 1 .. 1 .. Cocoa 3 .. 3 .. Coconut, desiccated 1 .. 1 .. Cod Liver Oil & Malt Extract 3 .. 3 .. Coffee 1 .. 1 .. Carried forward 43 .. 43 58 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulterated Samples. Brought forward Informal Samples—contd. 43 .. 43 Coffee and Chicory Extract 1 .. 1 .. Cream G .. 6 .. Curry powder 1 .. 1 .. Dripping 1 .. 1 .. Egg substitute powder 1 .. 1 .. Fat, cooking 1 .. 1 .. Fish fillets 2 .. 2 .. Fish paste 2 .. 2 .. Fish, tinned 17 1 18 55 Fruit, tinned 2 2 4 50 Fruit, dried 11 .. 11 .. Fruit juices 4 .. 4 .. Ginger, ground 3 .. 3 .. Glycerine 4 1 5 20 Grey powders 2 5 7 71 Guaiacol tablets 1 .. 1 .. J am 5 2 7 28.6 Jelly, table 10 .. 10 .. Lemonade powder 2 .. 2 .. Lemon barley powder 1 .. 1 .. Margarine 7 5* 12 41.7 Meat paste 3 .. 3 .. . Meats, tinned 9 .. 9 .. Meat pie 1 .. 1 .. Milk 1 .. 1 .. Milk, condensed 1 .. 1 .. Milk, dried and Milk foods.. 5 .. 5 .. Mincemeat 6 .. 6 .. Mince tart 1 .. 1 .. Mineral waters 4 .. 4 .. Mustard 2 .. 2* .. Nutmeg, ground 1 .. 1 .. Olive Oil 4 .. 4 .. Orangeade powder 1 .. 1 .. Pepper 7 .. 7 .. Pepper, black (whole) 4 2 6 33.3 Puddings, Roly Poly, tinned 3 .. 3 .. Salad Tomato Cream 1 .. 1 .. Sardines, tinned 5 .. 5 .. Sauce 5 .. 5 .. Sild, tinned 4 1 5 20 Soup, tinned 2 . . 2 .. Spice, mixed 2 .. 2 .. Suet, shredded 1 .. 1 .. Sugar 6 .. 6 .. Sweets 2 .. 2 .. Syrup, Fruit 1 .. 1 .. Tripe 2 .. 2 .. Vegetables, tinned 2 .. 2 .. Vinegar 5 .. 5 .. Wheat flakes ] • . 1 .. Wheat, Semolina 1 .. 1 .. Total Informal Samples 220 19 232 79 Note—Incorrect labelling. 59 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulterated Samples. Imported Food Samples— Biscuils and wafers 14 .. 14 .. Butter 1 .. 1 .. Chocolate Cracknel Biscuits 1 .. 1 . . Confectionery (cornets . . .. 1 100 Fish, tinned 6 .. 6 .. Fruit in brine (for jam) 1 .. 1 .. Fruit pulp (Blackcurrant) .. 1 .. 1 .. Mushrooms in butter, tinned 1 .. 1 .. Peas, dried 1 .. 1 .. Peas, tinned 1 .. 1 .. Wafers 1 .. 1 .. Total 28 1 29 3.4 Action Taken in regard to Formal Samples Purchased under the food and drugs (adulteration) act during the year 1936. Simple No. Article. Particulars of Adulteration or Infringement, Fine. Costs. Remarks. £ s. d. £ s. d. 6 M Milk 20 per cent, added water 17 0 0 3 3 0 — 2 TM Milk 12 per cent. do. - - Warning letter (third portion broke) 80 V Grey Powder 71.2 per cent. deficient in Mercury Warning letter (third portion in sufficient to effec analysis) 81 Y Do. 17.4 per cent. Calomel, 82.6 per cent. Sugars and Starch 2 0 0 5 5 0 - 8 7Y Do. 52.7 per cent. deficient in Mercury and 36.2 per cent. Sugar present - 3 3 0 Dismissed under Pro bation of Offender Act 112 Y Black Pepper (whole) 23.96 per cent. Pimento (Allspice), 0.05 per cent. Rice - 2 2 0 Dismissed on pay ment of costs 113 Y Gin 1.6 per cent, excess water — — Vendor cautioned. 123 Y Do, 1.0 per cent. do. — — Do. 128 Y Do. 2.6 per cent. do. — — Do. 214 Y Chopped Suet Wheat Flour 15.2 per cent. — — Do. 279 Y Milk 29 per cent. fat abstracted — — Warning letter 280 Y Black Currant Jam Contained 24 per cent, of black currant fruit instead of 30 per cent. - - Do. 347 Y Whisky 1.2 percent. excess water — — Vendor cautioned 359 Y Do. 0.3 per cent. do. — — Do. 367 Y Do. 1.5 per cent. do. — — Do. 60 Action Taken in regard to Informal Samples. Sample No Article Particulars of Adulteration or infringement Action taken. 116 V Glycerine 0.51 per cent. Oil (a foreign ingredient) Formal sample purchased 43 Y Grey Powders 77.8 per cent, deficient in Mercury Do. do. 44 Y Do. 58.1 per cent. do. Do. do. 64 Y Do. 64.8 per cent. do. Do. do. 65 Y Do. Calomel 31.2 per cent., Sugar 68 8 per cent. Do. do. 66 Y Do. 38.1 per cent, deficient in Mercury Do. do. '297 Y Jam 16 per cent, black currant fruit instead of 30 per cent. Do. do. 331 Y Do. 23 per cent, black currant fruit instead of 30 per cent. Do. do. 241 Y Margarine Improperly labelled Warning letter. 275 Y Do. Do. Do. do. 276 Y Do. Do. Do. do. 291 Y Do. Do. Do. do. 292 Y Do. Do. Do. do. 107 Y Pepper, Black (whole) Pimento (Allspice) 20 per cent. Formal sample purchased HOY Do. Foreign matter 0.17 per cent. Do. do. 82 Y Tinned Sild Tin, 3.43 grains per lb. Stock voluntarily surrenrendered and destroyed. 325 Y Do. Tin, 2.59 do. Do do. 116 w Confectionery (Cornets) Boron preservative 6.37 grains per lb. Imported Food— Ministry of Health and M.O.H. of districts informed ; consignment re-exported. 49 Y Tinned Prunes Tin, 2 87 do. Stock voluntarily surrendered and destroyed. 73 Y Do. Tin, 2.38 do. Do, do 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 found necessary to take any action under the above Regulations. Offences other than Adulteration. Misdescription or Misrepresentation or Improper Labelling. Under the Agricultural Produce (Grading and Marking) Act, 1928, various Regulations, and under the Merchandise Marks Act, various Orders in Council have been made. Tradesmen have been circularised as 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.I.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 by talks and cookery demonstrations at the Central Clinic 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 Total Cases Notified. At Ages—Years TotalCases Removed to Hospital Total Deaths Deaths at Ages—Years At all A(jes 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 208 1 58 126 11 12 .. 208 6 .. 3 2 .. 1 .. .. Erysipelas 41 2 4 10 18 .. 22 .. .. .. .. .. .. .. .. Scarlet Fever 267 3 76 143 22 21 2 .. 261 1 .. .. .. .. .. .. .. Typhus Fever . . .. .. .. .. • , .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 .. .. .. 2 2 1 5 .. .. .. .. .. .. .. .. Relapsing Fever .. . . .. .. .. . .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever •2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. .. .. Puerperal Pyrexia 10 . . .. .. 3 7 .. .. 7 1 .. .. .. .. 1 .. .. Cerebro-Spinal Meningitis 3 .. .. .. 1 .. .. .. 3 2 l 1 .. .. .. .. .. Poliomyelitis and Polioencephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. Ophthalmia Neonatorum 11 11 4 1 .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under''2 years) 58 38 20 .. .. .. .. .. 4 18 18 .. .. .. .. .. .. * Acute Primary and Acute Influenzal Pneumonia 83 3 19 11 12 16 16 6 17 63 5 7 .. 1 11 21 18 Malaria •2 .. .. .. .. 1 1 .. 2 .. .. .. .. .. .. .. .. Bacilliary Dysenterv 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Chicken Fox 71 1 18 49 3 .. .. .. 2 .. .. .. .. .. .. .. .. Posterior Basal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 762 57 196 333 54 71 38 13 535 92 24 12 2 1 14 21 18 * 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 4 th quarter Total for year Diphtheria 59 36 42 71 208 Erysipelas 9 10 9 13 41 Scarlet Fever 52 65 66 84 267 Enteric Fever 2 3 5 Puerperal Fever ... 1 ... ... 1 2 Puerperal Pyrexia... 2 2 2 4 10 Cerebro.spinal Meningitis 2 1 ... ... 3 Poliomyelitis ... ... ... Ophthalmia Neonatorum 4 1 1 5 11 Infantile Diarrhoea, etc. 1 1 15 41 58 Acute Primary and Influenzal Pneumonia 42 18 5 18 83 Chicken Pox 45 9 3 14 71 Encephalitis Lethargica ... ... ... ... ... Dysentery ... ... ... 1 1 Small Pox ... ... ... ... ... Posterior Basal Meningitis ... ... ... ... ... ... Malaria 1 ... 1 ... 2 Totals 218 155 147 252 762 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 1936 267 2.7 1 0.0 The cases notified continue to be of the mild character experienced in recent years. E WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1936. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Deptford Park Evelyn St. Paul's Vale Clifton Canterbury Hatcham Pepys St. Catherine's St. Peter's St. John's Town Hall Smallpox .. .. .. .. .. .. .. .. .. .. .. .. ... . Cholera .. .. .. .. ... . .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup •208 21 19 34 17 20 25 12 11 8 4 20 17 Erysipelas 41 9 7 3 5 2 5 1 2 2 3 2 Scarlet Fever 267 15 31 17 30 16 34 23 21 1-2 21 23 24 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 2 .. .. .. .. 1 .. .. 1 .. .. 1 Relapsing Fever .. .. .. .. ... ... .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. . . .. .. .. .. ... . .. .. .. Puerperal Fever 2 . ... .. .. .. .. ... .. 1 .. .. .. 1 Puerperal Pyrexia 10 .. 3 .. .. .. ... .. 2 3 .. 1 Cerebro-Spinal Meningitis 3 . . 1 .. 1 .. .. 1 .. . . Poliomyelitis and Polioencephalitis .. .. .. . . .. .. .. , . .. .. .. .. .. Ophthalmia Neonatorum 11 1 2 1 .. 1 1 .. .. .. 2 2 Anthrax .. .. .. .. .. .. .. .. .. .. .. ,. .. Infantile Diarrhoea and Enteritis (under 2 years) 58 2 9 32 4 1 .. .. 1 1 1 5 2 Acute Primary and Acute Influenzal Pneumonia 83 5 4 4 4 13 12 13 7 .. 4 2 5 9 Malaria •2 .. .. 1 .. .. .. .. 1 .. .. .. .. Bacilliary Dysentery 1 .. .. .. .. .. .. .. .. 1 .. .. Encephalitis Lethargica . . . . .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 71 24 3 1 8 10 8 1 2 9 2 3 Posterior Basal Meningitis • • .. ... .. .. .. .. .. .. .. .. .. .. Totals 762 70 81 97 77 65 84 49 45 42 30 61 61 67 Diphtheria. The following table shows the incidence and mortality from Diphtheria in 1936 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 1933 236 2.3 5 2.1 1934 310 3.1 19 6.2 1935 301 3.0 10 3.3 1936 208 2.1 6 2.9 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 Schick Tests Total. Fully Inoculated. Partly Inoculated. No. of Inoculations given. Negative. Unknown Result. 1927 214 152 8 374 410 15 1233 1928 85 75 14 174 168 65 580 1929 21 27 7 55 72 15 221 1930 15 27 — 42 65 3 199 1931 6 7 — 13 17 5 58 1932 3 — 1 4 11 — 33 1933 5 4 — 9 32 1 97 1934 2 8 — 10 11 — 33 1935 45 16 — 61 164 14 514 1936 14 7 21 73 — 105 Number of Schick Re.tests. Positive Negative. Unknown Result Total. 1927 1928 34 134 13 181 1929 8 55 3 66 1930 5 39 1 45 1931 3 21 2 26 1932 2 15 — 17 1933 1 — 1 1934 3 21 — 24 1935 4 99 — 103 1936 1 69 — 70 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. 1936- 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 1936 71 69 Return made on or before the 13th of February, 1937, by Mr. E. S. Elliott, Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1935, inclusive :— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1935. Number of these Births duly entered by 31st Jan., 1937. No. of Births which on 31st Jan. 1937 remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan.. 1937 not accounted for. Total No. of Certificates of successful Primary Vaccination children under 14 received during Calendar Year 1936. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1936. Successfully Vaccinated. 1 nsusceptible of Vaccination. Had Smallpox. Certificates of Conscientious Objection received. Dead, Unvaccinated. Postponement by Medical Certificate. Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. North Deptford 441 16-2 169 12 7 3 26 62 South Deptford 423 186 i 166 11 3 5 27 24 Total 864 34 S l — 335 23 10 8 53 86 598 377 Dated February 9th, 1937. Successfully vaccinated after the declaration of conscientious objection, Mil. Total Number of Certificates for Year 1936 sent to other Vaccination Officers, 108. 70 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:— 19-25 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Cases 3 3 2 4 4 2 1 5 7+ 3 3 + 3 Deaths 1 — — .4 2 2 4 5 2 1 4 2 flncluding 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 1936 Cases 4 3 1 1 4 — 1 3 1 3 — — Deaths - - - - 1 - - - - - - - V Encephalitis Lethargica. During the five years terminating 1924 (in which year the incidence reached its peak) the average annual number of cases notified was three. The subsequent figures were :— 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Cases 9 8 3 3 3 — — 1 — 1 1 — Deaths 5 2 2 2 1 2 2 1 1 All cases are periodically re-visited and treatment offered. Pneumonia. Both Acute Primary and Influenzal Pneumonia are notifiable, and 71 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 1936 83 63 0.6 For the treatment of Pneumonia a stock of Vaccines and Sera for issue to Practitioners is kept at the Town Hall. Malaria. Since the 1st January, 1928, Malaria, induced therapeutically, is notifiable if liable to recur. Average Average 1920.1924 1925.1929 1930 1931 1932 1933 1934 1935 1936 Cases 8 4 2 - 1 1 — — 2 No deaths have been registered from this cause. Dysentery. The figures are as follows:— Average Average 1920.1924 (total) 1925.1929 1930 1931 1932 1933 1934 1935 1936 Cases 3 2.5 — — — . . - — 1 Deaths — 0.4 — — — — — — — Infantile Diarrhoea. Since 1920, this has been notifiable in the case of children under two years of age, and the following are particulars of notifications received and deaths:— Average 1920.1924 Average 1925.29 1930 1931 1932 1933 1934 1935 1936 Cases Notified. 66 75 12 26 37 23 34 12 58 Deaths 28 15 17 9 23 15 27 16 18 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. 7.2 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 — 1936 2 — From 1933 onwards, the death.rate is calculated per 1,000 total (live and still) births. Puerperal Pyrexia. Since 1st October, 1926, notification is compulsory in the case of any woman who, within 21 days subsequent to confinement, develops a temperature of 100.4° F. where such temperature continues for, or recurs within, a period of 24 hours irrespective of the cause. The notifications received have been as follows:— 1926 (part) 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Cases 5 16 12 6 10* 17 17 15 15 9 10 * Includes one subsequently notified as Puerperal Fever arid dealt with und that heading. er Of the 10 cases notified, 5 had been confined in hospital and 5 at home. 3 of the latter were subsequently sent to hospital. 1 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 1936 Cases 14 9 18 14 26 21 11 8 21 11 11 73 The following is a statement of the results of treatment in respect of the cases notified in 1936:— Notified Treated Vision unimpaired Vision impaired Total blindness Since died from other Causes At home In hospital 11 10 — 10 — — 1 Apart from true cases of Ophthalmia, midwives have to report cases of inflammation of the eye, and these, together with cases of Ophthalmia, are kept under observation by the Health Visitors. The Borough Council has made arrangements with certain local nursing organisations, viz., the kanyard Nursing Association and the Queen's Nurses, Rotherhithe, for a nurse to visit and carry out the treatment prescribed. Where, for any reason, hospital in-patient treatment is deemed advisable, facilities are provided at St. Margaret's Hospital, Kentish Town. Erysipelas. 41 cases were notified during the year. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. Enteric Fever. 5 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 1936. 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 74 of which it is not possible to assess. This particularly applies to the following:— Influenza. The following indicates the mortality directly attributed to nfluenza 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 1936 7 0.6 0.07 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 1936 9 0.7 0.09 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. 75 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 1936 7 0.6 0.07 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. Tetanus. A supply of Anti.toxin is kept at the Town Hall for issue to % practitioners on request. 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, 1936. Material. Number Positive. Number Negative. Total. Swabs for Diphtheria . 155 812 967 Samples of Disinfectants — 2 2 Sputum for Whooping Cough . — 2 2 Faeces for Enteric Fever — 2 2 Faeces for Dysentery — 1 1 Swimming bath water . — 6 6 Swabs for Haemolytic Streptococci — 21 21 *Note.—Other examinations are reported under " Food. " 76 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 725 ,, ,, ,, Requests, rooms only 71 „ bedding only 88 ,, ,, ,, Verminous conditions 192 ., ,, ,, Removals 32 Total premises visited 1108 Number of rooms disinfected, formalin spray 1053 ,, ,, ,, sulphur 306 Total 1359 v Number of articles disinfected (steam disinfector) 19353 Number of books disinfected (formalin lamp) 246 ,, ,, articles destroyed at owners' request 563 ,, ,, adults from Common Lodging Houses cleansed 40 Disinfection of bedding and clothing is carried out by means of two W ashington-Lyons machines ; books, etc., in a formalin chamber, while rooms are sprayed with formalin or fumigated with sulphur. Shelter jor 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 useJ for this purpose during the year. 77 Disinfestation. Verminous conditions, whether in the home, of wearing apparel or personal in character, come within the purview of the Council's activities. 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, 48 adults and 1,646 children were cleansed. In addition, 934 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 1936. Bathing Station. The Public Health Committee reviewed during the year the existing facilities for the treatment of children suffering from verminous conditions, including scabies. Originally, ordinary verminous conditions were treated in one of the flats of the temporary shelter situated in the Council's premises at Watson Street; a second flat was utilised subsequently in order, particularly, that children suffering from scabies might receive treatment locally. These arrangements were regarded as a temporary expedient, as the Committee felt that the existing building was not only structurally unsuitable for the purpose, but might at any time be required for its original purpose, viz., the reception of persons displaced from their homes during disinfection of same. Accordingly, consideration was given to the erection of a Bathing Station upon vacant land in the Council's possession at the rear of the Coroner's Court. After 78 ation with the County Council, a decision was reached that a new Bathing Station should be erected according to plans approved by the Borough Council, the work to be commenced early in 1937. Disinfectants. No routine supply of disinfectants for general purposes is made but, in the case of tuberculosis and other infectious diseases, a liquid preparation, having a guaranteed Rideal.Walker co.efficient of 18.20, is supplied upon request. The precautions prescribed in respect of blue fluted bottles and labelling are observed. III. OTHER DISEASES. Cancer. The incidence of Cancer is so intimately bound up with the sex and age distribution of the population that only a very general inference can be drawn from the following figures:— Year No. of Deaths. Percentage of total Deaths. Rate per 1,000 population. Average 1915.1924 133 8.5 1 .2 1925 1929 159 11.6 1.4 1930 156 12.6 1.4 1931 174 13.5 1.6 1932 142 11.0 1.3 1933 137 11.0 1.3 1934 189 14.2 1.9 1935 167 15.1 1.7 1936 176 14.6 1.8 ?y Deaths from Cancer by Sex and Age. Average, Year Sex Under 25 years 25 to 45 years 45 to 65 years 65 to 75 years 75 years and upwards Totals 1925.29 Male 1.0 5.8 38.0 24.4 11.0 Female 0.6 7.4 36.2 21.2 13.4 1930 Male 1 3 36 24 15 79 Female 1 13 30 16 17 77 Total 2 16 66 40 32 156 1931 Male 1 4 47 24 11 87 Female — 8 43 22 14 87 Total 1 12 90 46 25 174 1932 Male 1 5 41 31 17 95 Female 1 5 39 29 14 88 Total 2 10 80 60 31 183 1933 Male 1 4 33 24 14 76 Female 4 30 13 14 61 Total 1 8 63 37 28 137 1934 Male — 3 42 29 15 89 Female — 5 48 26 0 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 1936 Male 3 32 36 21 92 Female — 9 35 21 19 84 Total — 12 67 57 49 176 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. 82 TUBERCULOSIS. The following is a tabular statement of the cases coming to our knowledge by notification and otherwise:— Year. Pulmonary. Non.Pulmonary. M. F. Total per 1.000 of population. M. F. Total per 1.000 of population Average 1920.1924 129 104 2.02 39 36 0.66 1925 133 104 2.04 41 37 0.67 1926 107 73 1.56 29 22 0.44 1927 112 88 1 .76 30 32 0.54 1928 103 76 1.59 35 18 0.47 1929 118 89 1.86 27 20 0.42 1930 97 84 1.63 35 17 0.47 1931 104 77 1.69 19 25 0.41 1932 107 88 1.82 23 22 0.42 1933 96 73 1.64 13 15 0.27 1934 82 63 1.43 29 23 0.51 1935 91 68 1 .60 20 17 0.37 1936 87 54 1.43 18 17 0.35 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 Q. 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 0.61 0.11 0.83 0.06 1936 — — 0.66 0.11 I)r. 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 1936. *By international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under " Pulmonary," are now included under " Non. pulm onary Tu berculosis.'' 83 Report of Tuberculosis Officer—continued. Notifications. The following table gives a summary of the notifications received from the 1st January, 1936, to 31st December, 1936, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 156; 128 Pulmonary Tuberculosis and 28 Non-pulmonary, as compared with 135 Pulmonary and 29 Non-pulmonary for the previous year. PUBLIC HEALTH (TUBERCULOSIS) REGULVTIONS, 1930. Summary of Notifications during the period from the 1st January, 1936 to the 31st December, 1936. Notifications on Form A. Age Periods. Total Notifications on Form A. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications, Pulmonary— Males ... 2 2 1 8 11 18 12 17 9 3 83 120 Females 1 1 3 2 5 11 14 6 1 1 ... 45 68 Non-Pulmonary Males ... 3 3 3 ... 2 1 ... ... ... 3 15 15 Females ... 1 3 2 4 1 J 1 ... 1 ... ... 13 14 84 Rehort of Tuberculosis Officer continued. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, otherwise than by formal notification. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up Total Cases Pulmonary — Males ... ... ... ... ... ... 1 2 1 ... ... 4 „ —Females ... ... ... ... ... 2 6 1 ... ... .... 9 Non-Pulmonary—Males ... 1 ... ... ... 1 ... ... 1 ... ... 3 „ —Females 1 1 ... ... ... ... 1 ... ... 1 ... 4 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Non-Pulmonary. Death Returns from local Registrars - - transferable deaths from Registrar-General 3 3 Posthumous notifications 2 2 " Transfers " from other areas (other than transferable deaths) 7 1 Form D (from Sanatorium) 1 1 85 Report of Tuberculosis Officer—continued. Supplemental Return—continued. NOTIFICATION REGISTER. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1936, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of Deptford 322 224 546 84 99 183 729 Number of cases removed from the Register during the year, inter alia of:— 1. Withdrawal of notification ... ... ... ... ... ... ... 2. Recovery from the disease 3 7 10 2 6 8 18 3. Death 39 23 62 ... 2 2 64 86 Report of Tuberculosis Officer—continued, Notes on Tables of Notifications. 11 cases died before coming to the notice of the Medical Officer of Health, 3 (l pulmonary and 2 non-pulmonary) through death returns, 8 (6 pulmonary and 2 non-pulmonary), by posthumous notification. Of the 4 non-pulmonary cases 1 was a case of meningitis and 1 of miliary tuberculosis, 1 was a mental hospital case, and in the other case the patient was said to have been ill only one day before admission to hospital. Of the 7 pulmonary cases, 1 was a case notified as dying in a mental hospital, 1 was a case of tuberculous madiastinal glands, 1 was a case in which the postmortem examination revealed tuberculosis, and 3 were hospital cases admitted shortly before death. In one case the patient's doctor wrote explaining lateness of notification. 11 of the pulmonary cases notified died within a month of notification. 7 pulmonary and 3 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 9 of the cases notified the diagnosis was subsequently not confirmed. 87 Report of Tuberculosis Office)—continued. Home accommodation of 141 of the Cases notified in 1936 (mental hospital, lodging-house and "diagnosis not confirmed" cases omitted). CASES and Number in Family. 113 Pulmonary Tuberculosis. 28 Non-Pulmonary Tuberculosis. 80 Cases with T.B. in Sputum. Rooms. 33 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 6 of 1 1 of 1 2 of 1 1 of 1 2 of 2 6 of 2 7 of 2 2 of 2 4 of 2 1 of 2 1 of 2 1 of 3 2 of 3 6 of 3 6 of 3 3 of 3 1 of 3 l of 3 4 of 3 2 of 3 2 of 3 1 of 4 1 of 4 3 of 4 4 of 4 3 of 4 1 of 4 1 of 4 3 of 4 4 of 4 3 of 4 1 of 4 1 of 4 2 of 4 1 of 5 3 of 5 7 of 5 l of 5 l of 5 1 of 5 1 of 5 2 of 5 2 of 5 2 of 6 1 of 6 2 of 6 1 of 6 l of 6 1 of 6 3 of 6 l of 7 4 of 7 1 of 7 2 of 8 1 of 8 l of 8 l of 8 2 of 9 l of 9 lof 9 2 of 10 1 of 10 1 of 10 1 of 12 1 of 12 1 of 11 29 had a separate room. 10 bad a separate room. 8 had separate room. 7 had separate bed with 1 other in room 2 had separate bed but 1 other in room. 2 had separate bed, but 1 other in room. 1 2 1 2 4 „ n 2 „ 34 had another in bed. 16 had another in bed. 8 had another in bed. 5 „ „ & 1 other in room 1 „ „ 1 „ 2 „ 1 2 „ „ & 2 others in room 1 „ 2„ 2 „ „ 2 2 had 2 others in bed 2 had 2 others „ 2 „ 1 .. „ 3 1 2 others „ 2 26 Families who applied for accommodation on L.C.C. Estates and who had received letters from the Tuberculosis Officer supporting their applications, received the desired accommodation and left the Borough. 88 Report of Tuberculosis Officer continued. The number of deaths for the year is 76 as compared with 89 for 1935. 1931 1932 1933 1934 1935 1936 Pulmonary deaths 100 92 94 92 83 65 Non Pulmonary deaths 14 13 10 10 6 11 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 1936. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary m f m f m f m f 0 - 1 - 1 - - - 1 1 2 1 4 2 1 - 1 1 5 2 3 3 3 - 1 - - 10 1 2 3 2 - - - - 15 8 5 - 4 2 4 1 - 20 11 13 3 1 1 4 1 1 25 19 20 1 2 10 9 - - 35 14 7 - - 4 4 - 1 45 18 1 1 1 11 1 1 - 55 9 1 - 1 6 3 - - 65 and upwards 3 - 3 - 4 - - 1 Totals 87 54 18 17 39 26 4 7 Note—Including 20 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 1936. Not notified 3 Died before notification - Died within one week of notification 5 „ „ one week to one month 4 „ „ one month to six months 15 „ „ six months to one year 7 „ „ one to two years 3 „ „ two to three years 5 „ „ three to four years 4 „ „ four to five years 3 „ „ five to six years 4 „ „ six to seven years 5 „ „ seven years and upwards 7 65 89 Report of Tuberculosis Officer—continued. The notifications of non-Pulmonary Tuberculosis were as follows:— Peripheral glands 10 Meninges 2 Abdominal 5 Bones and joints 9 Skin 2 Total 28 Revision of Notification Register. During the year 141 cases of Pulmonary and 28 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 1936 as follows:— MALES FEMALES Total Under15 Over 15 Under 15 Over 15 Pulmonary Tuberculosis 33 289 23 201 546 Non-Pulmonary Tuberculosis 42 42 57 42 183 Totals 75 331 80 243 729 Disinfection was carried out in 221 rooms, and articles of bedding, clothing, &c., were removed for sterilization. 90 Report of Tuberculosis Officer—continued. Memo 37 T. Table I. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1936. 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 57 32 3 3 4 4 3 7 61 36 6 10 113 393 (b) Diagnosis not completed - - - - - - - - 12 9 7 3 31 (c) Non-tuberculous - - - - - - - - 81 92 41 35 249 B. -Contacts examined during the year:— (a) Definitely tuberculous 2 - 1 1 - - - - 2 - 1 1 41 173 (b) Diagnosis not completed - - - - - - - - - - 1 - 1 (c) Non-tuberculous - - - - - - - - 28 53 47 40 168 C.—Cases written oft the Dispensary Register as (a) Recovered 3 6 1 2 1 3 1 6 4 9 2 8 23 467 (b) Non-tuberculous (including any such cases previously diagnosed and enter on the Dispensarv Register as T.B.) - - - - - - - - 114 156 94 80 444 D. -Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 202 140 13 17 29 29 24 21 231 169 37 38 475 502 (b) Diagnosis not completed - - - - - - - - 11 7 6 3 27 91 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 521 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 56 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 123 4. Cases written off during the year as Dead (all causes) 51 5. Number of attendances at the Dispensary (including Contacts) 2680 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 127 Number of G.P. 36 reports from practitioners 94 7. Number of consultations with medical practitioners:— (a) Personal 23 (b) Other 141 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 212 9. Number of visits by Nurses or Health Visitors to Homes successful 2909 ) for Dispensary purposes unsuccessful 432 3341 successful 1554 10,r. Visits to cases non-Dispensary cases unsuccessfu llb 1830 10. Number of (a) Specimens of sputum, &c., examined 677 (b) X-ray examinations made in connection with Dispensary work 216 (c) Sputum examinations for sary cases 274 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 268 Notes on Table It will be noted that the number of persons on the Dispensary Register on the 31st December, 1936 is 502, a slight decrease over figure at end of 1935. The number of patients coming into the Borough from other areas and of cases which had been lost sight of and returned to the Register, being 56 as compared with 42 in the previous year. " Transfers to other areas" and " Cases lost sight of " were 123 as compared with 102 in 1935. 51 deaths of Dispensary patients occurred, compared with 73 in the previous year. 92 Report of Tuberculosis Officer—continued. One patient had Ultra-violet light treatment for lupus. 19 patients have had artificial pneumothorax treatment at the Brompton, St. Thomas', Grove Park and Colindale Hospitals, making 226 attendances. 182 refills have been given at St. Alfege's Hospital by the Tuberculosis Officer to 14 patients in addition to those mentioned above. Examination and Supervision of Contacts. Analysis of contacts of 146 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 I. No. of patients notified 146 85 32 29 II. No. of above seen at Dispensary 114 78 25 11 (a) Total contacts of cases seen at Dispensary Adults 226 147 52 27 Children 109 60 26 23 (a ) No. of above contacts examined at Dispensary— Adults 59 41 10 8 Children 72 44 14 14 III. No. of notified cases not seen at Dispensary 32 7 7 18 (a) Total contacts of cases not seen at Dispensary— Adults 70 12 20 38 Children 29 10 3 16 (a') No. of above contacts examined at Dispensary — Adults 15 2 6 7 Children 13 3 1 9 Total School Contact Cards sent to School Medical Officer 57 (a) Examined at Dispensary- Class 1* 20 Class 2* 24 (b) Not examined at Dispensary— Class 3* 3 Class 1—Unsatisfactory cases. Class 2—Apparently healthy cases. *Class 3—Not examined. 93 Report of Tuberculosis Officer—continued. 85 per cent, of the cases notified, excluding those notified after death, were seen at, or in connection with 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 sanatorium 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. 39 % of the total contacts were examined before the end of the year. 66% of the child ,, ,, ,, 26 % 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 92), 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," even though he may have been living in ccntact with a case of tuberculosis. 4 contacts, as defined above, were found to be tuberculous during the year under report, but 25 persons who had another member of their respective households notified in previous years (18 of whom were known to be cases with Tubercle Bacilli in sputum), were seen during 1936 and found to be suffering from tuberculosis. The Tuberculin Testing of child contacts of tuberculosis was continued, the results being similar to those in previous years. 94 Report of Tuberculosis Officer—continued. The Health Visitors impress particularly on parents the advisability of young adult contacts coming for examination and, when re-visiting, enquire especially about their health, as secondary cases may not develop symptoms for even some years after the primary case. These adolescent and young adult contacts, among whom the death-rate 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. Twenty-six cases were referred to the Dental Surgeon for treatment. Frequently when dental cases are seen at the Dispensary they are febrile, and the treatment most urgently needed is rest; so dental treatment may be postponed, and in some cases is eventually carried out while the patient is in an institution. The Borough Council provides the services of a Dental Surgeon, who attends weekly. Treatment is free but, in the provision of dentures, persons able to contribute to the cost are assessed after consideration of a recommendation of the Tuberculosis Care Committee, by the Public Health Committee in respect of any balance remaining after contributions from insurance societies or voluntary associations have been taken into account. Where the patient is on out-relief the Public Assistance Committee have been asked to meet the cost. The income and expenditure in connection with the supply of dentures and repairs to dentures to 18 patients were as follows:— £ s. d. Total cost of dentures and repairs 38 6 6 Total cost of free cases 20 19 8 Contributions from Approved Societies 7 3 4 „ Public Assistance Committee 5 0 0 „ Patients 5 3 6 95 Report of Tuberculosis Officer—continued. The Dental Surgeon, Mr. J. Eric Magraw, reports the following as a summary of the year's work:— Fillings. Cases. Attendances. Extractions. Amalgam. Plastic. etc. Dentures. Repairs 44 194 44 13 15 110 17 4 Insured Persons. The number of insured persons on the Dispensary Register at the end of the year was 300. The number of reports from panel doctors in respect of patients on domiciliary treatment was 94. 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, 167 were sent by doctors, as compared with 136 in the previous year. 185 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 164. In many cases the practitioner does not meet the Tuberculosis Officer, but asks the latter to visit the patient and let him know his opinion later. The Ministry of Health now limits the term " Personal Consultations" to those cases in which the practitioner attends and consults with the Tuberculosis Officer at the patient's bedside. Visits to Homes. The number of visits paid by the Health Visitors was 5,171. Reports are made on the undermentioned points respecting home conditions, contacts, etc.:— (a) Whether any assistance seems needed for the patient or family, and action taken, such as reference to the Secretary to the Tuberculosis Care Committee. (b) The health of Contacts, and whether they will attend the Dispensary for examination or go to their own doctors. (c) The extent to which the patient is raking 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. 96 Report of Tuberculosis Officer—continued- 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. 1 76 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 677 an increase of 1 72 on the figure for 1935. In addition, 274 specimens were sent by practioners for examination, an increase of 66 on the number sent in 1935. X-ray Diagnosis. The number of X-ray examinations is 216 compared with 178 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 47 persons. Institutional Treatment. 133 patients were recommended to the London County Council for institutional treatment. 8 patients refused treatment. In some urgent cases recommendations were also made from Dispensary for direct admission to London County Council general hospitals, and 73 patients sent to general hospital from other sources were seen therein by the Tuberculosis Officer. 228 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. 97 Report of Tuberculosis Officer—continued. Deaths. Of the total deaths of Dispensary patients during 1936— 10 died within 3 months from the date of the first attendance. 3 „ „ 6 „ „ „ „ 4 „ „ 12 „ „ „ „ 33 „ after 12 „ „ „ „ In one patient the cause of death was Diphtheria. In addition, 2 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. Mrs. Monk, who continues to devote much time and interest to carrying on so happily the Handicraft Classes for patients who after institutional treatment are unfit for work or unemployed, writes as follows :— " The Class still proves that some such effort is necessary. " The patients in many of the sanatoriums to day have the opportunity of learning simple handicraft; few are able to carry on their former jobs and they really need an interest in life and undoubtedly benefit by attending the Handicraft Class. " The interest the students take in each others troubles or joys have made it a real pleasure to work with them. " We call them students as this is much preferred to the word patients. g 98 Report of Tuberculosis Officer—continued. "I shall always repeat that Handicraft Classes are an essential part of an ultimate cure; occupation and a cheerful atmosphere help enormously; the students compare their weights, progress, and there is almost a competition to get well first. " Thanks are due to the Chairman and members of the Care Committee, Mrs. Saines, Mrs. Mabbs, Mrs. Harrington, Mrs. Pearson, Alderman Mrs. Watson also the staff at the Dispensary, and especially Miss Campbell for again giving a display, the proceeds of which will help this year's Outing Fund and make it possible for us to have an enjoyable time." " A really excellent concert soon after Christmas was given, and to the Managers of local places of entertainment, on whose request artists performing at the time in the locality gave their services, our sincere thanks are due, as also to the artists themselves. A substantial tea was not the least enjoyable item on the programme." Cookery Class. Owing to an insufficient number of new attenders, these classes have been temporarily discontinued, though many of the original attenders kept up their interest throughout. * It is hoped to resume the classes when the number of new women patients expressing their desire to attend would justify such a procedure. To face Page 99. Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a.) PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1936 of all paients remaining on the Dispensary Register; and (6) the reasons for the removal of all cases written oft 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 1936 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. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total(Class T.B plus) Group 1 Group 2 Group 3 Total Class T.B.plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total(Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group I Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) 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 31st December. Disease arrested Adults M. l l l 2 3 l 4 2 2 2 2 l l 2 l l l 4 1 6 7 4 1 l 2 2 1 3 4 2 F. l 2 l 3 1 1 2 2 1 1 1 2 2 2 1 4 5 1 l 1 2 1 1 2 3 3 Chil drer 1 2 1 1 2 2 1 1 2 l 1 Disease not arrested Adults M. 1 1 5 6 4 4 1 1 l 2 2 l 4 5 2 6 l 9 3 7 10 1 3 3 2 l 10 l 12 4 2 7 9 4 5 23 28 12 6 26 4 36 F. 6 6 1 1 2 2 1 2 1 3 1 3 3 1 1 3 l 5 3 3 2 1 7 8 2 6 6 3 6 6 8 6 12 3 21 7 3 11 3 17 Children 1 1 1 4 1 1 5 5 Condition not ascertained during the Year 2 1 3 1 1 1 1 1 1 2 1 2 1 3 4 1 1 1 1 2 Total on Dispensary Register at 31st December 3 6 14 20 1 9 l 10 6 6 2 4 5 9 4 2 8 2 12 5 3 12 2 17 9 5 22 2 29 9 2 12 14 13 4 22 l 27 16 4 16 20 18 12 36 3 51 24 9 37 7 53 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 38 16 11 27 2 2 1 2 1 3 2 3 2 1 3 1 1 F. 62 10 8 18 3 1 1 1 l 1 2 1 1 2 1 1 Children 62 1 1 8 2 2 3 1 Lost sight of or otherwise removed from Dispensary Register 365 80 149 16 245 18 5 13 10 28 12 8 35 2 45 19 10 20 l 31 30 6 26 1 33 22 5 28 3 36 17 10 20 3 33 13 6 23 3 32 17 6 25 l 32 13 1 11 2 14 10 3 15 18 4 2 1 3 Dead Adults M. 39 41 150 36 227 3 4 20 16 40 2 1 28 9 38 2 2 17 11 30 5 2 23 11 36 4 22 10 32 2 3 20 5 28 29 8 37 3 1 19 11 31 1 2 6 14 22 3 10 5 13 2 3 2 5 F. 34 23 78 31 132 2 7 7 16 4 23 10 37 6 9 15 4 13 10 27 1 1 13 12 26 2 2 10 12 24 2 2 20 4 26 5 1 6 6 13 2 9 5 16 3 2 1 3 5 2 7 Children ... 10 4 3 2 9 1 1 1 2 1 1 1 1 1 1 1 2 3 1 4 1 1 Total written off Dispensary Register 610 175 399 85 659 33 11 44 34 89 18 14 88 23 125 27 13 44 2] 78 43 14 65 22 101 28 6 64 25 95 22 15 50 20 85 15 8 73 16 97 25 8 50 18 76 14 8 27 21 56 16 3 27 4 34 6 11 5 16 Grand Totals 613 181 413 85 679 34 11 53 35 99 18 14 94 23 131 29 17 49 21 87 47 16 73 24 113 33 9 76 27 112 31 20 72 22 114 24 10 85 16 111 38 12 72 19 103 30 12 43 21 76 34 15 63 7 85 30 9 48 12 69 SHOK 091 Report of Tuberculosis Officer—continued. (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1936 of all patients remaining on the Dispensary Register and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 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 j Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Principal Glands Total Class T.B. minus Class T.B. plus Group 1 "roup 2 Group 3 rotal (Class T.B. plus) [a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. l l 1 l 1 1 l 1 2 1 1 1 F. 1 l l 1 1 3 4 1 1 1 1 1 Children 2 2 2 2 2 2 l 1 2 l 3 2 3 5 1 l 2 1 l 2 l 1 Disease not arrested Adults M. 1 1 1 l l l 1 — 1 3 3 2 2 4 F. 2 2 l l l 2 2 2 3 l 4 2 1 3 l 2 1 4 Children 1 1 l 1 1 1 2 1 1 2 I 1 1 1 2 1 3 5 8 8 Condition not ascertained during the year 1 1 1 1 2 1 l 2 2 2 1 1 1 l 2 1 9, 3 Total on Dispensary Register at 31st December 4 3 7 1 1 2 2 4 4 4 3 1 4 4 l l 6 4 2 l 2 9 6 5 11 5 1 1 4 11 9 1 3 l 14 7 3 6 16 8 2 2 4 16 Transferred to Pulmonary 3 1 1 5 3 l 1 5 1 1 1 2 2 1 1 1 3 2 l 3 1 1 1 1 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered "Adults M. 16 3 1 4 24 2 1 3 2 1 3 1 1 1 1 F. 10 1 3 14 5 5 1 1 9. 1 3 Child ren 18 6 54 78 1 l 2 1 l 4 7 1 4 5 4 4 1 l 2 4 1 1 1 1 2 2 Lost sight of or otherwise removed from Dispensary Register 48 10 10 56 124 2 1 l 9 13 5 4 3 5 17 9 2 5 1 17 5 2 2 3 12 6 3 4 5 18 5 2 2 8 17 7 l 2 7 17 4 l 2 7 9 6 1 6 22 1 1 3 5 2 2 Dead Adults M. 8 1 1 10 1 1 1 1 1 1 1 1 1 1 1 F. 5 3 8 1 1 1 1 2 Children 4 2 6 1 1 1 1 2 1 1 Total written on Dispensary Register 109 21 17 117 264 7 2 1 10 20 7 6 4 14 31 10 6 5 6 27 6 2 2 8 18 7 4 4 7 22 6 2 2 8 18 12 2 2 11 27 6 l 4 11 9 6 1 6 22 1 1 3 5 2 2 Grand Totals of a and b (excluding those transferred to Pulmonary) 113 21 20 117 271 7 2 1 11 21 6 4 16 35 14 6 5 6 31 9 2 2 9 22 11 5 4 8 28 10 4 3 10 27 18 2 2 16 38 11 l 2 8 22 18 7 4 7 36 8 4 9 21 8 2 2 6 18 Shok 091 99 Report of Work of the Tuberculosis Care Committee, for 1936. Reviewing the work of the past year no changes of procedure are apparent. As always, many calls for help have been received to which we have been able to respond, in some cases by enlisting the help of an appropriate society, and in others from our own fund. We can report with great pleasure that the sum of £100 was raised by the sale of Christmas Seals, a slight increase on the two previous years. The expenses amounted to £l 1s. 1d., leaving the sum of £98 18s. l1d. available for disbursement. A statement of accounts will be published, together with a report which will give readers an insight into various aspect? of "Care Work" which are not dealt with here. 218 cases were recommended for treatment during the year. Appropriate action was taken by the Committee in every case. 1,092 visits have been paid to patients at home or in hospital. 1,122 persons have been interviewed at the Dispensary by the Secretary. 906 cases have been considered by the Committee at their meetings. 8 children were accepted for boarding out under the London County Council's contact scheme; two were found to be in need of treatment in hospital, the remaining six were placed in suitable homes through the Invalid Children's Aid Association. Behind this group of figures lie sickness, suffering and sorrow, the extent of which is known perhaps only to the Care Committee. This knowledge entails responsibility. Although the Committee do not shrink from the burden, yet, because it is heavy, they are impelled to call for help to lighten it from those outside the work—and not in vain. Sympathy, understanding and financial help are given, in what generous measure can be observed by referring to the report on the result of our Christmas Seal Sale. The comfort and help that we are able to render through the kindness of our many friends cannot be measured in terms of money only; the kindly thought behind the gift that meets material needs has a value all its own. Progress in re-housing our tuberculous patients and their families has been maintained, the preferential treatment accorded to such cases G2 100 being consistent and helpful. In connection with this particular development our "Emergency Fund" is most useful. So many would find it impossible to meet the expenses of removal and consequent incidental outlay without assistance, and would, lacking help, either have to continue to exist under the old conditions or enter on the new life burdened with debt. The meetings of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees have been held as usual at the County Hall, and matters of general interest have been discussed to mutual advantage. Our Chairman was again elected Chairman of the Conference; here, too, we might almost state "as usual." Finally, the Committee desire to place on record their thanks to all those who have helped us to do what has been done. "Union is strength," and much would of necessity have been left undone without the assistance and co-operation so freely extended. 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, Post-natal and Toddlers' Clinics, Artificial Light and Dental treatment and Day Nursery. 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. 11. 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. 108 Summary of Visits paid by Health Visitors, 1936. Health Visitor District Visits Re-visits Total Miss Robus Deptford Park and Evelyn (part) Wards 1211 1854 3065 Miss Cloke St. Paul's and Evelyn (part Wards 791 2145 2936 Miss O'Loughlin Clifton and Vale Wards 946 2312 3258 Miss Stowell (Jan. to 22 June) Canterbury and Hatcham Wards 432 938 1370 Miss Sherborne (July to Dec.) Do 363 1209 1572 Miss Reynolds St. John's (part), Town Hall and St. Peter's Wards 810 2272 3082 Miss Holland St. John's (part) Ward 513 2125 2638 Miss Little Pepys' and St. Catherine's Wards 792 1240 2032 Totals 5,858 14,095 19,953 Analysis of Visits paid by Health Visitors, 1936. To infants tinder 5 years Enquiries re Visits. Re-visits Total. Births 1562 11603 13165 Still-births 47 4 51 Infant deaths- 83 1 84 Ophthalmia Neonatorum 13 16 29 Measles 572 323 895 Suspected Measles 65 — 65 Infant Diarrhoea 45 22 67 Pneumonia 16 22 38 Whooping Cough 145 90 235 Meningitis 1 — 1 Scarlet Fever recoveries 45 6 51 Scabies 20 2 22 Visits to Foster Children 6 90 96 Miscellaneous visits 289 48 337 Total (under 5 years) 2,909 12,227 15,136 104 To children over 5 years Enquiries re Measles 387 130 517 Suspected Measles 44 — 44 Scarlet Fever recoveries 67 4 71 Whooping Cough 73 31 104 Scabies 70 32 102 Encephalitis Lethargica — 1 1 Pneumonia 3 8 11 Visits to Foster Children 1 63 64 Miscellaneous visits 356 67 423 Total (over 5 years) 1,001 336 1,337 Other visits To expectant mothers 1027 387 1414 To Puerperal Fever or Pyrexia 7 — 7 Maternal death enquiry 1 — 1 To Common Lodging Houses 12 48 60 Total other visits 1,047 435 1,482 Unsuccessful visits 901 1097 1998 Totals 5,838 14,095 19,953 In the case of the 1,562 infants visited shortly after birth, it was found that 1,411 infants were being breast-fed and 67 partly breast-fed. Only 84 were entirely hand-fed. 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. 105 Attendances of Health Visitors at Clinics. Health Visitor Infant ' Welfare Toddlers' Clinic AnteNatal Light Massage Schick Dental Total Miss Robus 125 - 2 11 — — — 138 Miss Little 102 — 4 — — — 1 107 Miss O'Loughlin 92 — — 19 — — 55 166 Miss Stowell 66 47 4 - — — — 117 Miss Reynolds 105 — 2 - - - 1 108 Miss Holland 62 2 13 158 - - 3 238 Miss Clubbe 180 — 192 39 — 19 — 430 Miss Gibson 103 — 122 — 82 — — 307 Miss Cloke 103 - - - - - 43 146 Miss Sherborne 74 — — — — — 2 76 Total 1,012 49 339 227 82 19 105 1,833 2. Welfare Centres. Central Clinic. (a) Infant Welfare. As indicated in last year's Report, it was decided to erect a new Central Clinic in order to centralise, so far as possible, the Maternity and Child Welfare Services, while continuing the Clinics held at Gosterwood Street and Ilderton Road and carrying on the Staffing of the Princess Louise Institute Clinic. The new Clinic was officially opened upon the 11th July, 1936, by the Right Honourable Arthur Greenwood, P.C., LL.D., M.P. The Services provided include Ante- and Post-Natal Clinics, Artificial Sunlight and Dental Treatment, Gymnasium and Massage facilities and Day Nursery accommodation. It has thus been possible to extend the scope of the work by the inception of a Toddlers' Clinic and of Sewing and Cookery Classes, together with periodical talks on Food Values. In order to afford an opportunity to senior girls in London County Council Schools who have been awarded Scholarships in Mothercraft and Infant Welfare, the Borough Council agreed to accept a fixed number of such scholars for training at the Central Clinic. In the course of receiving such training these girls assist materially in the various departments, although their chief work is in connection with the Day Nursery, Sunlight and Toddlers' Clinics. At all the Welfare Clinics the services of those ladies who assist in a voluntary capacity are greatly appreciated. For the Cookery Classes the South Metropolitan Gas Company supplied the services of a Demonstrator and all necessary appliances, and the value of various foodstuffs formed the subject-matter of talks by one of the Health Visitors. 106 The following is a summary of the work done at the various Infant Welfare Clinics during the year :— (For details, see Appendix, Table IV.) Clinic. No. of times open. New Cases Attendances Consultations with Doctor Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under year 1—5 years Gosterwood Street 74 183 19 202 3425 3627 2893 734 1589 Napier Street 57 163 19 182 3522 3704 2738 966 1371 Besson Street 50 194 14 208 3974 4182 3061 1121 1465 Ilderton Road 51 105 18 123 2422 2545 1770 775 1069 Goldsmiths' College 76 170 37 207 3924 4131 3041 1090 1421 Hales Street 51 142 13 155 2520 2675 1965 710 1149 St. George's Hall 50 125 32 157 3400 3557 2627 930 1382 St. John's, Harton St. 53 88 6 94 2398 2492 1803 689 1257 Toddlers' Clinic 49 — 313 313 23 336 — 336 336 Totals 511 1170 471 1641 25608 27249 19898 7351 11039 The Health Visitors collectively made 1,012 attendances at these Clinics. (b) Maternity Clinics. These are conducted now at the Central Clinic, Amersham Road, four Sessions per week being devoted to this purpose. The service provided is designed to secure efficient ante-natal and post-natal 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, 34 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 bv the following figures. Year. No. of individual women attending. Average number of attendances per week. Total number of attendances made. 1922 311 19 938 1923 369 29 1439 1924 513 30 1497 1925 588 45 2268 1926 595 46 2292 1927 738 45 2241 1928 815 55 2777 1929 929 56 2915 1930 973 64 3212 1931 980 64 3289 1932 880 58 2994 1933 887 61 3182 1934 905 57 2931 1935 887 57 2984 1936 888 59 3090 107 The following is the text of Dr. Hill's Report for 1936:— Ante-Natal Clinic Statistics, 1936. Total number of Patients on Register 888 New Cases 704 Total Attendances 3,090 Normal 157 Not pregnant 16 Abnormalities:— Albuminuria 22 Anaemia 55 Ante-partum Hæmorrhage 12 Bartholini Abscess 1 Bronchitis 5 Chorea 1 Contracted Pelvis 17 Deformed Nipples 28 Dental Caries 419 Dyspepsia 12 Fibroid 5 Goitre 1 Haemorrhoids 39 Hernia 1 Hydronephrosis 1 Hydramnios 4 Leucorrhœa 18 Malpresentation 38 Morbus Cordis 14 Oedema 15 Phlebitis 1 Phthisis 2 Pleurisy 1 Pyelitis 2 Retroversion 6 Scabies 5 Sciatica 16 Twins 4 Urticaria 1 Varicose veins 61 Vomiting (excessive) 7 Post-Natal Clinic. This branch of the work is conducted every Tuesday forenoon. Total on Register 184 Total attendances 195 Amongst the patients seen the following defects were found and dealt with:— Anaemia 2 Breast Abscess or Inflamed Nipple 6 Cervical laceration 2 Cystocele 1 Fibroids 2 Foot Drop 1 Galactocele 1 Haemorrhoids 3 Leucorrhœa 2 Referred to hospital for treatment 1 Retroversion 8 Subinvolution 1 108 In connection with both the ante-natal and post-natal work close co-operation is maintained with medical practitioners, midwives and hospitals. Reports sent to Tuberculosis Officer 4 Ditto to midwives 150 Ditto to doctors 26 Total number of cases referred by letter to hospitals 139 Do. do. sent for X-ray 34 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 199 Total attendances made 970 (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:— 109 1936, Months. Patients on Register at commencement of each month. New Patients Admitted. Patients Re-admitted. Patients Discharged. Patients on Register at end of month. Attendances each month. Total Attendance for each month Under 1 Year 1—5 V ears A.-N. P.-N. Under 1 Year 1—5 Years A.-N. P.-N. Under 1 Year I -5 Years A.-N. P.-N. Under 1 Year 1—5 Years A.-N. P.-N. Under 1 Year 1—5 Years A -N. P.-N. Under ] Year 1—5 Years A.-N. P.-N. January 6 44 ... 1 8 33 1 5 ... 1 ... ... 1 16 ... 3 13 62 1 3 41 347 3 13 404 February 13 62 1 3 2 18 ... 2 ... 3 ... 1 1 31 ... 4 14 52 1 2 29 371 6 17 423 March 14 52 1 2 3 17 ... ... ... ... ... ... 3 17 ... ... 14 52 1 2 34 442 8 18 502 April 14 52 1 2 6 12 1 4 ... 1 ... ... 3 28 ... 3 17 37 2 3 33 290 11 15 349 May 17 37 2 3 ... 7 1 2 ... ... ... ... 2 30 1 4 14 15 2 1 35 231 4 20 290 June 14 15 2 1 ... 1 ... ... ... ... ... ... 12 11 2 1 1 6 ... ... 8 92 4 ... 104 July 1 6 ... ... 1 4 ... 1 ... ... ... ... ... 1 ... ... 2 9 ... 1 1 16 ... 1 18 August 2 9 ... 1 ... 7 ... ... ... 1 ... ... ... 3 ... 1 1 15 ... ... 6 63 ... 1 70 September 1 15 ... ... 1 17 ... 2 ... 2 ... ... ... 5 ... ... 2 29 ... 2 7 170 ... 6 183 October 2 29 ... 2 4 27 2 5 ... 3 ... ... 3 11 ... 4 4 47 2 3 30 285 4 21 340 November 4 47 2 3 3 29 ... 3 ... 1 ... ... ... 10 1 4 8 66 1 2 34 401 4 24 463 December 8 66 1 2 2 28 ... 3 ... ... ... ... 1 21 ... 2 9 73 1 3 30 399 5 14 448 Totals ... ... ... ... 30 200 5 27 ... 12 ... 1 26 184 4 26 ... ... ... ... 288 3,107 49 150 3,594 A.-N.—Anti-Natal. P.-N.—Post-Natal, 110 Classification of Patients admitted during the Year. Diseases. Admissions. Re-admissions. Under 1 Yr. Over 1 Yr. AnteNat. Post Nat. Under 1 Yr. Over 1 Yr. AnteNat. Post Nat. Rickets 3 27 ... ... ... 1 ... ... Anæmia 5 49 4 3 ... 6 ... ... Delayed Dentition 13 37 ... ... ... 2 ... ... Malnutrition 2 12 ... ... ... 2 ... ... Genu Valgum 1 12 ... ... ... 1 ... ... Cervical Adenitis 1 7 ... ... ... ... ... ... Curbed Tibiae 1 26 ... ... ... ... ... ... Insomnia ... 2 ... ... ... ... ... ... Neurasthenia ... 1 ... ... ... ... ... ... Muscular Weakness 2 18 ... ... ... ... ... ... Rheumatism ... ... 1 ... ... ... ... ... Arthritis ... ... ... ... ... ... ... ... Underweight ... 3 ... ... ... ... ... ... Swollen Gland 1 ... ... ... ... ... ... ... Bronchitis ... 5 ... ... ... ... ... ... Mastitis ... ... ... 21 ... ... ... ... Muscular Asthenia 1 ... ... ... ... ... ... ... Abscess of Jaw ... ... ... ... ... ... ... ... Infantile Paralysis ... 1 ... ... ... ... ... ... Backache ... ... ... 1 ... ... ... ... Totals 30 200 5 27 ... 12 ... 1 Where more than one disease is exhibited by any individual child, the case is classified under the heading denoting the most important cause. In association with the Light Clinic, breathing and Swedish exercises are taught and massage is given. (d) Massage and Exercises. On Register, July to December, 63, including 1 under 1 yr. of age. Do. still 32 Discharged 31 Attendances 657 (e) Day Nursery. This provides for the reception of selected children upon five days each week. Nursery open 105 days. Total Number of Attendances, 945. Number of Individual Children, 443. Number of Artificial Light Treatments given to these Children, 50. 1ll (f) Sewing Class. Towards the end of the year the Committee decided that one of the Health Visitors should attend, with a view to assisting Mothers in the making of suitable garments for children. The following attendances of Mothers were registered:— December 9th 2 „ 16th 6 „ 23rd 2 „ 31st 4 14 (g) Toddlers' Clinic.— Report, July 6th to December 31st. Number of Clinics held, 49. Total number of Inspections made, 336. Number of Individual Children, 313. Summary of Defects found. Tonsils 83 Dental Caries 68 Rickets 4 Genu Valgum 55 Flat Foot 31 Curved Tibiae 9 Deformity of Chest 18 Lordosis 2 Cervical Adenitis 18 Malnutrition 3 Enuresis 11 Strabismus 3 Umbilical Hernia 2 Dermoid Cyst 1 Total 308 All children exhibiting defects were referred to their own Doctor or to Hospital. (h) 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 1936:— Cases. Extractions. Fillings. Scalings, Dentures Silver Nitrate etc. Gas Cases. Supplied. Repair'd Mothers 170 282 333 142 22 47 2 Children 108 169 62 263 48 - - In the case of the fillings for mothers, 233 were amalgam and 100 plastic. 112 Pending the opening of the new Central Clinic, cases requiring extractions under a general anaesthetic were 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. During the year, the Committee received with regret the resignation of W. Gilliatt, Esq., C.V.O., M.D., F.R.C.S., who had acted for a number of years as Consulting Obstetrician, and appointed in his stead J. H. Peel, Esq., M.D., F.R.C.s. (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. 1. 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 1936 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 1936 : Cases admitted, 213. Average stay, 2 weeks. Cases delivered by midwives. 207. „ „ „ doctors, 6. Cases in which medical advice sought, 17. 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. Fœtal deaths (a) Stillborn, 5. (6) Within 10 days of birth, 2.* P.M. exam.: Melœna Neonatorium :Prematurity. 113 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) J. H. Peel, Esq., 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 1936, it was found necessary to call the Consultant to the Home on one occasion. Cases not admitted to the Maternity Home. During 1936, a total of 99 applications for admission were refused, owing to the available accommodation being fully booked. 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 71 Sold at half price 12 Sold at full price 20 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 10 instances, Home Helps were provided during the year under report. H 114 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 1936, 10 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:— 117 children admitted, of which 41 were sent by the Borough Council. 630 test feeds were conducted at the Breast-feeding Clinic, of which all were sent by the Borough Council. 30 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 six 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 1936, the following free or half-price issues were authorised:— 11,009 families were given fortnightly supplies. 115 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 8 instances this policy was carried into effect, involving a total expenditure of £4 0s. 0d. Payment of Midwives' Fees. In five instances the Council paid the fee of the midwife for her attendance in necessitous cases. 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 John H. Peel, Esq., m.d., f.r.c.s., are available in this connection. H2 116 14. 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 1935. Added. Removed. No. at end of year 1936. Fostermothers 22 8 8 22 Fosterchildren 30 9 12 27 Appendix. 118 Table 1. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1936. CAUSES OF DEATH. Sex. All Ages 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75- All causes M 657 46 9 13 7 21 20 25 71 128 166 151 F 545 31 9 2 7 14 25 29 49 81 119 179 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Measles M 6 .. 2 4 .. .. .. .. .. .. .. .. F 3 .. 3 .. .. .. .. .. .. .. .. .. Scarlet Fever M 1 .. .. 1 .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough M 5 2 3 .. .. .. .. .. .. .. .. .. F 2 1 1 .. .. .. .. .. .. .. .. .. Diphtheria M 1 .. .. 2 1 .. .. 1 .. .. .. .. F 2 .. .. 1 l .. .. .. .. .. .. .. Influenza M 2 .. .. .. .. .. 1 .. .. 1 .. .. F 5 .. .. .. .. .. .. .. 1 1 1 2 Encephalitis Lethargica M 1 .. .. .. .. .. .. 1 .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever M 2 1 .. 1 .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system M 39 .. .. 1 .. 3 10 4 11 6 3 1 F 26 .. .. .. .. 8 9 4 1 3 .. .. Other Tuberculous Diseases M 4 .. 1 .. .. 2 .. .. 1 .. .. .. F 7 1 .. 1 .. 1 .. 1 .. 2 1 .. Syphilis M 2 .. .. .. .. .. .. .. .. 1 1 .. F .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane, tabes dorsalis M 4 .. .. .. .. .. .. .. 2 2 .. .. F 1 .. .. .. .. 1 .. .. .. .. .. .. Cancer, malignant disease M 92 .. .. .. .. .. .. 3 9 23 36 21 F 84 .. .. .. .. .. 3 6 15 20 21 19 Diabetes M 5 .. .. .. .. .. .. .. .. 1 3 1 F 9 .. .. .. .. .. .. .. .. 4 2 3 Cerebral Hæmorrhage, etc. M 39 .. .. .. .. .. .. .. .. 5 22 12 F 27 .. .. .. .. .. .. .. 4 7 4 12 Heart Disease M 136 .. .. .. .. 4 2 5 13 32 38 42 F 162 .. .. .. .. 1 3 4 8 18 52 76 Aneurysm M 4 .. .. .. .. .. .. .. 2 1 .. 1 F 2 .. .. .. .. .. .. .. .. 1 .. 1 Other Circulatory Diseases M 28 .. .. .. .. .. .. .. 1 5 12 10 F 20 .. .. .. .. .. .. .. 1 1 6 12 Bronchitis M 45 .. .. .. .. .. .. .. 5 10 12 18 F 28 2 .. .. .. .. .. 1 2 2 8 13 Pneumonia (all forms) M 38 3 3 1 .. 1 2 3 5 10 6 4 F 25 2 3 .. .. .. 2 4 4 2 2 6 Other Respiratory Diseases M 7 .. .. .. 1 .. .. .. 2 2 1 1 F 2 .. .. .. .. .. .. .. .. .. .. 2 Peptic Ulcer M 15 .. .. .. .. 1 1 2 3 5 2 1 F 2 .. .. .. .. .. .. 1 .. 1 .. .. Diarrhoea, &c. M 16 15 .. .. .. .. .. .. .. 1 .. .. F 4 3 .. .. .. .. .. .. .. .. .. 1 Appendicitis M 7 .. .. .. 1 1 .. .. 1 2 2 .. F 2 .. .. .. .. .. .. .. 2 .. .. .. 119 Table I—continued CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5— 15— 25- 35- 45— 55— 65— 75— Cirrhosis of Liver M 3 .. .. .. .. .. .. .. 1 1 .. 1 F 2 .. .. .. .. .. .. .. 1 1 .. .. Other diseases of Liver, etc. M 2 .. .. .. .. .. .. .. .. 1 .. 1 F 6 .. .. .. .. .. .. .. .. 2 2 2 Other Digestive Diseases M 11 .. .. .. .. .. .. .. .. 2 7 1 F 12 .. .. .. .. .. .. 2 .. 3 3 4 Acute and chronic Nephritis M 16 .. .. .. .. 1 .. 2 3 2 4 4 F 12 .. .. .. .. .. .. 2 2 2 2 4 Puerperal Sepsis F .. .. .. .. .. .. .. .. .. .. .. .. Other Puerperal causes F 1 .. .. .. .. .. 1 .. .. .. .. .. Congenital Debility, Premature Birth, Malformations, etc. M 20 20 .. .. .. .. .. .. .. .. .. .. F 20 20 .. .. .. .. .. .. .. .. .. .. Senility M 19 .. .. .. .. .. .. .. .. .. 1 18 F 14 .. .. .. .. .. .. .. .. .. 2 12 Suicide M 5 .. .. .. .. .. 1 .. 1 3 .. .. F 5 .. .. .. .. .. .. .. .. 3 2 .. Other violence M 34 3 .. 1 3 6 1 .. 3 7 4 6 F 14 .. 1 .. .. 1 .. .. 2 1 4 5 Other defined diseases M 45 2 .. 1 .. 2 l 5 8 5 12 8 F 46 2 1 .. .. 2 6 4 6 7 7 6 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 120 Table II. SHOWING NUMBER OF ARTICLES DISINFECTED OR DESTROYED AT OWNER'S REQUEST. 1936 Articles Stoved Articles Destroyed at Owner's Request Books Bathing Station Lodging Houses Beds Holsters Pillows Mattresses Sheets Blankets Miscellan'us Total Beds Bolsters Pillows Sheets Blankets Mattresses Miscellan'us Books Total D.B.C. Library Private Total Towels Blankets Wearing Apparel Total Persons Cleanse Wearing Apparel January 65 52 159 33 91 141 370 914 4 2 9 ... 1 7 47 46 116 30 ... 30 331 63 468 862 6 35 February 45 37 89 23 48 93 222 557 6 1 11 1 1 11 8 ... 39 6 ... 6 551 99 890 1540 6 52 March 41 39 118 43 70 150 399 860 3 1 5 2 ... 2 18 ... 31 30 ... 30 448 104 935 1487 5 42 April 51 42 127 41 98 140 344 843 4 1 ... ... 1 2 24 ... 32 22 ... 22 317 45 585 947 ... ... May 44 38 106 40 72 99 269 668 8 3 7 ... ... 6 21 ... 45 26 ... 26 420 20 478 918 2 10 June 32 40 82 39 66 93 356 708 2 ... ... ... ... 4 ... ... 6 23 2 25 306 13 277 596 4 26 July 41 34 118 46 78 99 288 704 7 2 3 ... 4 3 8 ... 27 18 26 44 310 24 188 522 2 13 August 20 10 77 35 81 102 356 681 2 1 2 2 2 3 22 ... 34 5 ... 5 85 3 17 105 1 6 September 45 34 129 57 85 108 273 731 6 3 7 ... ... 6 146 ... 168 5 2 7 368 29 305 702 8 63 October 52 55 156 63 108 152 418 1004 3 1 7 ... ... 3 21 ... 35 26 ... 26 281 36 258 575 4 20 November 42 37 111 42 82 99 270 683 3 1 5 ... ... 3 4 ... 16 21 ... 20 325 35 431 791 6 48 December 38 36 95 34 65 135 387 790 4 1 2 ... ... 6 1 ... 14 4 ... 4 324 35 469 828 4 22 516 454 1367 496 944 1414 3952 9143 52 17 58 5 9 56 320 46 563 216 30 246 4066 506 5301 9873 48 337 121 Table III. SHOWING NUMBER OF PREMISES VISITED AND ROOMS DISINFECTED. 1936 Premises Visited Rooms Disinfected Infectious Diseases Requests Bedding only Removals Verminous Scarlet Fever Diphtheria Pulmonary Tuberculosis Scabies Measles Cancer Erysipelas Whooping Cough Typhoid Fever Mumps Formalin Spray Sulphur Total Rooms Infectious Diseases Requests Removals Verminous January 85 12 4 2 6 21 31 36 11 2 1 .. .. .. 102 20 2 10 134 February 43 8 18 1 7 10 12 22 5 1 2 .. .. .. .. 52 9 2 10 73 March 71 3 12 2 6 33 17 23 13 4 .. .. .. .. .. 90 4 4 7 105 April 59 5 5 2 15 28 13 17 16 4 .. .. .. .. .. 78 7 2 28 115 May 61 6 8 5 40 18 18 22 5 6 1 .. .. .. .. 70 8 6 69 153 June 57 7 7 1 29 30 11 14 7 6 1 .. .. .. .. 69 9 2 53 133 July 64 9 10 4 25 37 26 22 5 .. 1 .. .. 1 3 95 14 9 16 134 August 35 2 7 3 21 19 6 10 .. .. 1 2 2 2 .. 42 3 4 15 94 September 62 10 5 4 19 30 16 15 14 .. 3 .. .. .. .. 78 15 5 35 133 October 71 6 3 2 15 33 24 12 9 .. 3 .. 1 .. .. 82 10 3 19 114 November 64 2 5 2 4 29 25 15 5 .. 2 .. .. .. .. 76 3 4 6 89 December 53 1 9 4 5 24 20 13 6 .. 1 2 .. .. .. 66 1 7 8 82 725 71 88 32 192 312 219 221 96 23 16 4 3 3 3 900 103 50 306 1359 122 GOSTERWOOD STREET CLINIC AND GROUP SESSIONS AT CENTRAL CLINIC. 1936 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 7 3 2 12 268 280 127 February 4 8 1 1 10 244 254 109 March 5 13 1 2 4 20 321 341 152 April 3 7 3 1 11 185 196 88 May 4 12 2 3 1 18 270 288 121 June 4 15 2 17 290 307 122 July 8 20 2 1 23 279 302 150 August 9 14 14 290 304 128 September 8 22 2 3 1 28 319 347 173 October 8 16 1 2 19 344 363 169 November 10 17 1 5 23 384 407 167 December 7 6 1 7 231 238 83 Total 74 157 12 14 19 202 3425 3627 1589 NAPIER STREET CLINIC GROUP. 1936 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 3 6 1 7 175 182 91 February 4 13 3 4 20 240 260 120 March 4 15 3 2 20 327 347 156 April 3 5 3 1 9 199 208 75 May 4 6 2 1 1 10 281 291 113 June 4 17 4 2 23 319 342 139 July 4 14 1 3 18 283 301 108 August 4 10 2 5 3 20 319 339 103 September 4 11 1 1 1 14 372 386 140 October 6 18 1 1 20 329 349 105 November 8 6 3 9 316 325 98 December 9 7 3 1 1 12 362 374 123 Total 57 128 24 11 19 182 3522 3704 1371 123 GOLDSMITHS' COLLEGE CLINIC. 1936 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 10 1 4 4 19 319 338 123 February 4 6 3 2 2 13 281 294 98 March 4 9 1 2 4 16 274 290 100 April 5 6 1 7 321 328 110 May 4 11 2 1 14 283 297 79 June 4 14 14 278 292 88 July 3 16 2 2 20 391 411 164 August 7 18 1 2 4 25 295 320 123 September 9 13 6 19 449 468 155 October 8 18 3 6 27 320 347 126 November 9 6 7 1 3 17 307 324 112 December 9 8 1 2 5 16 406 422 143 Total 76 135 17 18 37 207 3924 4131 1421 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC. 1936 No. of times Clinic opened. New Cases. Total New Cases- Total Old Cases. Total New and Old Cases- Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 5 15 4 3 22 235 257 116 February 4 8 1 9 177 186 98 March 4 7 1 2 10 194 204 79 April 4 11 1 3 1 16 191 207 100 May 4 8 1 1 1 11 181 192 95 June 4 8 1 5 14 225 239 96 July 5 8 2 10 265 275 106 August 4 4 4 1 2 11 233 244 93 September 4 6 1 1 1 9 189 198 89 October 5 13 2 2 3 20 246 266 93 November 4 8 2 2 12 176 188 82 December 4 10 1 11 208 219 102 Total 51 106 14 22 13 155 2520 2675 1149 124 BESSON STREET GROUP. 1936 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5. January 4 6 3 1 4 14 230 244 71 February 4 11 1 3 1 16 332 348 106 March 5 15 1 3 1 20 426 446 136 April 3 6 3 9 248 257 78 May 4 8 2 1 11 305 316 111 June 4 21 3 1 1 26 315 341 130 July 4 18 3 4 2 27 296 323 117 August 4 11 3 2 16 345 361 127 September 5 16 1 5 1 23 478 501 183 October 4 11 4 1 16 364 380 133 November 4 7 3 7 2 19 334 353 148 December 5 8 2 1 11 301 312 125 Total 50 138 20 36 14 208 3974 4182 1465 ILDERTON ROAD CLINIC. 1936 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 7 6 1 14 217 231 108 February 4 7 1 8 170 178 84 March 4 11 1 3 1 16 183 199 92 April 4 10 2 3 4 19 251 270 108 May 4 7 7 209 216 90 June 4 4 1 2 1 8 234 242 97 July 5 8 1 1 3 13 232 245 99 August 4 5 1 1 7 188 195 60 September 4 3 1 2 2 8 191 199 71 October 5 8 2 1 11 234 245 106 November 4 4 2 1 7 154 161 75 December 4 2 1 2 5 159 164 79 Total 51 76 15 14 18 123 2422 2545 1069 125 ST. GEORGE'S HALL GROUP. 1936 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5 January 5 16 3 4 6 29 380 409 176 February 4 13 2 1 16 287 303 139 March 4 8 3 11 303 314 114 April 3 7 3 2 12 212 224 91 May 5 12 2 2 16 325 341 119 June 4 9 1 1 3 14 262 276 114 July 5 8 1 4 13 287 300 100 August 4 6 1 1 8 229 237 75 September 4 6 2 8 265 273 102 October 5 10 4 14 338 352 143 November 4 4 1 1 4 10 285 295 113 December 3 5 1 6 227 233 96 Total 50 104 10 11 32 157 3400 3557 1382 ST. JOHN'S CLINIC GROUP (CENTRAL CLINIC). 1936 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 11 227 238 135 February 4 4 1 5 189 194 111 March 4 11 1 12 182 194 103 April 5 6 1 1 8 236 244 132 May 4 5 1 6 181 187 81 June 4 5 1 2 8 204 212 108 July 5 10 10 224 234 108 August 4 4 1 5 181 186 78 September 5 10 1 11 235 246 118 October 4 3 1 3 7 191 198 88 November 4 5 5 164 169 83 December 5 5 1 6 184 190 112 Total 53 79 2 7 6 94 2398 2492 1257 INDEX. PAGE A Acreage 8 Acute Primary Pneumonia 70 Acute Influenzal Pneumonia 70 Acute Poliomyelitis 70 Albany Deptford Babies' Hospital 24, 114 Ambulance Facilities 25 Ante-natal Examination 106 Ante-natal Clinic 106 Area and Population 8 Artificial Light Clinic 108 B Babies' Hospital 114 Bacteriological Examination 61,75 Bathing Station 77 Births 11 „ illegitimate 12 ,, Notification of 12 C Cancer 78 Canal Boats Acts 35 Causes of Sickness 15 Central Clinic 105 Cerebro-spinal Meningitis 70 Chicken pox 68 Cleansing Station 77 Clinics and Centres 26, 105 Committee, Public Health 3 „ Maternity and Child Welfare 3 Convalescent Treatment 114 ii. PAGE D Day Nursery 110 Deaths 13 Death-rate 13 „ comparisons 13 „ during 10 years 13 Deaths in Wards 14 „ percentage in age groups 17 „ causes of 14. 118 „ ages at 15 „ Infantile, causes 16 „ Infectious disease 64 Dental Clinic 111 Deptford Babies' Hospital 114 Diabetes and Insulin 79 Diarrhœa 71 Diphtheria 67 Disinfectants 78 Disinfection 76, 120, 121 Disinfestation 77 Dysentery 71 E Encephalitis Lethargica 70 Enteric Fever 73 Erysipelas 73 F Factory and Workshop Act 36 Food Inspection 46 „ Poisoning 55 „ Sampling 55 „ Unsound 54 Foot Clinic 25 Foster Children 116 iii. PAGE H Health Committee 3 Health Visitors, Visits 103-104 Health Education 115 Home Helps 113 Home Nursing 113 Housing 39 House-to-house Inspections 31 I Illegitimate Births 12 Infant Life Protection 116 Infant Mortality 15 „ Table of causes 16 Infant Welfare Centres 105, 122-125 Infectious Diseases, Notifications 64 Infective Jaundice 79 Influenza 74 Insulin and Diabetes 79 L Laboratory Work at the Seamen's Hospital 75 Legal Proceedings 31 M Malaria 71 Marriages 11 Massage and Exercises 110 Maternal Mortality 115 Maternity and Child Welfare Committee 3 Maternity Home 24, 112 „ Consultant 113 Maternity Outfits 113 Measles 74 Midwives 23, 115 iv. PAGE M—continued. Milk, Bacteriological Examination 47 ,, Supply to Nursing Mothers, etc. 114 Mortality of Infants 15 Mortuary Report 18 Mortuary 18 Municipal Maternity Home 24 Municipal Foot Clinic 25 N Notification of Births 12 Nursing Arrangements 22 „ in the Home 22 Nutrition 61 o Obstetricians, consulting 112 Ophthalmia Neonatorum 72 P Physical Features of Borough 8 Population 10 Pneumonia 70 Post-natal Clinic 107 Public Health Committee 3 Puerperal Fever 72 „ Pyrexia 72 Q Queen's Nurses 22 R Ranyard Nurses 22 Rats 32 I V. PAGE s St. John's Home 108 St. John's Nurses 22 Sanitary Inspectors' work 28 Scarlet Fever 65 Sewing-class 111 Small-pox 68 Social Conditions 9 Staff, List of 20 Still-births 11 T Tetanus—Supply of Anti-toxin 75 Toddlers' Clinic 111 Tuberculosis—Care Committee 99 „ Cookery Class 98 Tuberculosis—Report of Tuberculosis Officer 82 „ General 82 „ Handicraft Centre 97 „ Home accommodation 87 „ Notification Table 83 „ Revision of Register 89 „ Supervision of Contacts 92 „ Dental Treatment 94 V Vaccination 69 w Whooping Cough 75