DEPT 22 THE METROPOLITAN Borough of Deptford. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 BY F. LEONARD KEITH, M.D.,D.P.H.,L.D.S. (Prepared in accordance with the requisitions of the Ministry of Health.) 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. 1 937 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health and Housing Committee. Manor. Councillor F. BRIGHT, J.P. Chairman. Councillor E. C. SHERWOOD. Vice Chairman. Councillor W. TAYLOR. Alderman R. Anderson, B.A. Alderman Mrs. E. M. Bateman. Councillor C. G. Blanchard. Councillor F. T. Chisnell. Councillor Mrs. A. Manley. Councillor Mrs. M. F. Morrell. Councillor Mrs. A. M. Ott. Alderman Mrs. E. M. L. Watson. Councillor A. H. Wild. Maternity and Child-Welfare Committee. Chairman. Councillor Mrs. G. E. Green. Vice-Chairman. Councillor Mrs. E. M. Colburn. Alderman R. Anderson, B.A. Alderman Mrs. E. M. Bateman. Councillor Mrs. A. Hayward. Councillor Mrs. M. Herlihy. Councillor Mrs. A. Manley. Councillor Mrs. M. F. Morrell. Councillor Mrs. E. C. Pearson. Councillor E. C. Sherwood. Alderman Mrs. E. M. L. Watson. A2 Metropolitan Borough of Deptford. Public Health Department, Deptford Town Hall, S.E.14. 28th June, 1938. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my ninth Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. The estimated population for statistical purposes was 96,580 and based upon this figure, the birth and death-rates per 1,000 of the population were 15.1 and 11.7, compared with 15.7 and 12.2 for the year 1936. The infantile mortality rate was 45, 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 1937 than in 1936, a total of 657 cases being notified as compared with 762 during the previous year. The widespread prevalence of dysentery (Sonne type) had its counterpart in the Borough—20 cases being notified. The work of the Sanitary Inspectors is outlined in the section dealing with the sanitary circumstances of the Borough, which, in amount and variety, reflects great credit upon the inspectorial staff. The purity of the food supply, primarily the duty of the Food Inspector, has been satisfactorily safeguarded. The efforts the Council are making to improve the sanitary conditions of underground rooms are included in the section dealing with Housing. The office work in connection with the relief of overcrowding and improvement in sanitary environment has grown tremendously of recent years, and has necessitated the elaboration of a system of keeping these matters under constant review. Much of the credit for the smooth working of this scheme was due to the painstaking and conscientious devotion to duty of the late Mr. A. G. W. Pettitt, whose sudden death, at a comparatively early age, occasioned the greatest regret amongst his colleagues. Disciplinary matters affecting certain members of the female staff are referred to in the section entitled "General Provision of Health Services." 6 The subject of maternal mortality and morbidity is naturally one of supreme interest to all Authorities administering Maternity and Child Welfare schemes. To the implications associated with the known mortality amongst mothers, attention is necessarily directed, and tends to dwarf, the even more important subject of ill-health amongst women after confinement. Of the extent of ill-health amongst mothers we have no actual statistical data. That it is extensive the hospital records of gynaecological out-patient departments give ample proof. A contribution towards a reduction in this ill-health may be found to result from the working of the new Midwives' Act and the London County Council's scheme for domiciliary midwifery, and the linking up with the Borough Council's Maternity Service. The provision by the London County Council of a municipal midwifery service (available, at a maximum fee of £2, for any woman who applies for it) naturally raises the question as to whether any alteration should be made in the class of cases admitted to the Maternity Home. When the Home was opened, the general overcrowding and unsatisfactory home conditions made the admission of cases likely to follow even a normal course, very desirable. Since then overcrowding has been lessened and the London County Council domiciliary midwifery service has come into being. In view of this, the point arises whether the time has not arrived when the restriction upon the admission to the Home of abnormal cases should not be lifted. From the point of view of the potential patient it seems a hardship that the presence of some abnormality debars her from enjoying the excellent care received by patients in the Deptford Council's Maternity Home, with its highly trained staff. In this connection it is of interest to note that, of the seven maternity homes provided by Metropolitan Borough Councils, three make provision for the admission of abnormal cases. It would appear that in the case of two of those boroughs providing these extra facilities (both having a resident medical officer) the total cost per patient per week is materially less than in the case of Deptford, where the cost for the year ending 31st March, 1937, was over £6 per patient per week. To Dr. Donnelly and to Dr. Hill I desire to express my sincere appreciation of their valuable work in their respective spheres— Tuberculosis and Maternity and Child Welfare; and to the Staff generally my thanks for their loyal co-operation. Your obedient Servant, F. Leonard Keith, Medical Officer of Health. Physical Features and Vital Statistics. 8 Physical Features. The Metropolitan Borough of Deptford, as constituted by the London Government Act, 1899, is situated to the south of the Thames, being bordered, roughly, on the north by Bermondsey, on the south by Lewisham, while Camberwell and Greenwich lie to the west and east respectively. A small portion, roughly half a mile long, fronts the river. Roughly rectangular in shape, its greatest length is approximately two-and-a-half miles, and width one-and-half miles. The altitude presents considerable variation, much of that portion of the Borough to the north of New Cross Road and Queen's Road being, on an average, only 15 feet above mean sea level, while the rest of the Borough shows an altitude varying from 80 feet to 160 feet at Telegraph Hill. The soil varies, parts showing London clay formation, other parts being of a more alluvial character. The area of the Borough is given as 1,564 acres, but this for effective purposes is considerably encroached upon by reason of the Surrey canal and various railway lines which traverse the district. The permanent open spaces are as follows:— Situation. Size. Maintained by. 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Ground. Brookmill Road l1/4 acres . Borough Council. 3. Telegraph Hill Recreation Ground. Telegraph Hill 45£ acres. L.C.C. 4. Railways and adjoining land 234 acres 5. Millwall Football Ground 51/2 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. St. Paul's Playground 0.50 acres „ 11. Lewisham High Road Gardens .88 acre „ Statistics. Area 1,564 acres Population: Census 1931 106,891 Registrar-General's Estimated Resident population, 1937 96,580 Number of inhabited houses according to the Rate books (end of 1937) 18,250 Number of families or separate occupiers (1931) 29,248 Number of structurally separate dwellings (Housing Survey, 1935) 18,572 Rateable Value, April 1937 £667,934 Estimated sum represented by a 1d. Rate (1937/8) £2,684 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:— 18th Oct., 1937 Males, 1,799 Females, 584 I am indebted to the Public Assistance Officer for the following figures:— (a) Total number or Deptford Residents, including wives and children, on outdoor relief, at the end of 1937: — Men, 897 Women, 1,247 Children, 530 (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1937:— £61,370 9s. 5d. 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 473. Of these, 396 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 77 persons, the same conditions being observed, the amount per head varied between 7s. 6d. and 10s. 6d. During the whole year 13,133 applications for fortnightly supplies were granted. Of this number, 10,717 applications were in respect of families in receipt of an income, after deduction of rent, of less than 7s. 6d. per head per week, and in the remainder, the amount varied from 7s. 6d. to 10s. 6d. Education facilities in respect of elementary, secondary and technical education are well provided, while the Borough Council has made a valuable contribution in establishing a Central and two Branch Libraries 10 Swimming pools with chlorination plants to ensure cleanliness of the water, slipper baths and washhouses are maintained by the Borough Council and are largely used. The chief industries are those associated with the metal trade, stone and slate works, paper works, tarpaulin making, spinning and sackmaking. Figures dealing with the number of births and deaths and the mortality from certain specified diseases serve as a rough index of the health of a community, and the following extracts from the vital statistics are of interest in this connection : Male. Female. Total. Grand Total. Birth-rate. Live Births Legitimate 724 696 1,420 1 1,462 15.1 Illegitimate 25 17 42 Still-births, 60. Rate per 1,000 total births, 39.4. Death-rate. Deaths 1,139 11.7 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 infa-nts under one year of age, per 1,000 live births: Legitimate 45 Illegitimate 48 Total 45 Deaths from Measles (all ages) 1 ,, Whooping Cough (all ages) 10 „ Deaths from Diarrhoea (under 2 years) 11 Population. The population for 1937, as given by the Registrar-General, was 96,580, the lowest on record. 11 Marriages. During the year 936 marriages took place, equivalent to a rate of 19.4 persons marrying per 1,000 of the population. By courtesy of the Superintendent Registrar the following gives details as to the places in which these marriages were conducted: Church of England 596 Other places of worship 75 In the Superintendent Registrar's Office 265 Total 936 Births. After allowing for inward and outward transfers, i.e., the addition of 708 children born of Deptford parents outside the Borough, and the deduction of 25 children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,462. This is equivalent to a birth-rate of 15.1 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: BIRTHS. No. Deptford. Crude rate per 1.000 population. England and Wales. Crude rate per 1.000 population. County of London. Crude rate per 1,000 population Average for 10 years, 1915 to 1924 2610 22.9 20.0 20.5 Average 1925 to 1929 1976 17.4 17.2 16.7 1930 1761 15.9 16.3 15.7 1931 1745 16.3 15.8 15.0 1932 1669 15.9 15.3 14.3 1933 1520 14.8 14.4 13.2 1934 1597 15.8 14.8 13.2 1935 1432 14.4 14.7 13.3 1936 1548 15.7 14.8 13.6 1937 1462 15.1 14.9 13.3 Still-Births. 60 still-births were registered during the year as follows:— Legitimate Illegitimate Total Male 30 3 33 Female 27 — 27 ]2 Illegitimacy. The number of illegitimate births was equivalent to 2.9 per cent, of the total births. The figures relative to illegitimacy for previous years areas follows: Av. for 10 vrs. 1915-24. Av. for 5 yrs. 1925-29 Av. for 5 yrs. 1930-34 1936 1936 1937 No. of illegitimate births ... 77 Percentage of total births ... 2.9 58 3.0 53 3.2 35 2.4 47 3.0 42 2.8 Notification of Births. During 1937, the number of notifications received of births and still births actually occurring in the Borough was 782. After allowing for inward and outward transfers, the corrected figure was 1,472. The following is an analysis of these notifications: Births Notified in the Borough, Year ending 31/12/37. Ward. Births notified. Alive Dead Parent By whom notified Total Male Female Doc tor Midwife Other Deptford Park 36 22 14 36 — — 6 28 2 Evelyn 75 35 40 68 7 — 7 65 3 St. Paul's 59 39 20 59 — — — 57 2 Vale 73 33 40 72 1 — 4 66 3 Clifton 36 20 16 36 — — 4 26 6 Canterbury 49 30 19 48 1 — 5 43 1 Hatchatn 43 20 23 42 1 1 3 36 3 Pepys 36 18 18 35 1 3 5 26 2 St. Catherine's 44 23 21 42 2 — 12 32 — St. Peter's 237 129 108 231 6 2 7 225 3 St. John's 44 19 25 43 1 1 2 40 1 Town Hall 50 27 23 48 2 3 2 37 8 Total 782 415 367 760 22 10 57 681 34 Less Births notified in the Borough, but transferred to other authorities 19 10 9 19 — — 2 17 — 763 405 358 741 22 10 55 664 34 Add Births occurring in out-of-Borough Institutions 709 362 347 671 38 1 — 707 1 Grand Total 1472 767 705 1 412 60 11 55 1371 35 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 death; 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 491 Deduct deaths of "non-residents" 83 408 Add deaths of "residents" outside Borough 731 Nett deaths applicable 1,139 This is equivalent to a death-rate of 11.7 per 1,000 persons. Seasonal Mortality. Quarter ended. No. 1936 Rate per 1,000 of population. No. 1937 Rate per 1,000 of population. March 378 15.3 354 14.7 June 278 11.2 301 12.5 September 216 8.7 197 8.2 December 330 13.4 287 11.9 The trend of the death-rate in recent years is shown by the following table:— Deptford England & Wales. London. Year. 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 1937 1139 11.7 12.4 12.3 14 Deaths—Sex and Ward Distribution. Ward. Males. Females Children under 1 year. Total deaths. Deptford Park 40 32 6 72 Evelyn 55 53 7 108 St. Paul's 42 47 3 89 Vale 63 40 5 103 Clifton 50 45 5 95 Canterbury 35 37 7 72 Hatcham 63 52 4 115 Pepys 47 45 4 92 St. Catherine's 31 38 5 69 St. Peter's 43 44 5 87 St. John's 91 42 8 133 Town Hall 64 40 7 104 624 515 66 1139 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 ner 1.000 deaths (all causes). 1936. Average No. for 10 years 1915-24. Average 1925-1929 Average 1930-1934 1935 1936 1937 Increase or decrease over 1936[/##] Measles 75 27 20 18 1 9 1 - 8 Whooping Cough 5.8 24 13 10 5 7 10 + 3 Diphtheria 5.0 19 14 9 10 6 3 - 3 Influenza 5.8 70 35 23 6 7 27 + 20 Tuberculosis—Pulmonary 5.4 136 102 100 83 65 66 + 1 Non-pulmonary 9.1 32 18 12 6 11 9 - 2 Cancer 146 133 159 168 167 176 162 -14 Heart Disease 247 128 232 304 260 298 357 + 59 Cerebral Haemorrhage, Em bolism and Thrombosis 55 67 54 53 60 66 36 - 30 Bronchitis 61 140 95 53 46 73 33 -40 Pneumonia (all forms) 52 154 121 87 64 63 83 + 20 Nephritis 23 35 34 33 20 28 31 + 3 Diarrhoea and Enteritis 17 45 20 21 19 20 12 - 8 Violence (excluding Suicide 40 48 49 43 42 48 25 - 23 Premature Birth, Malforma tion and Debility 38 86 49 45 27 40 33 - 7 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 Average 1930-34 1935 1936 1937 Under 1 year 16.3 9.4 7.7 6.7 6.4 5.8 From 1-2 years 4.7 2.7 2.0 0.6 1.5 0.5 „ 2-5 years 4.3 2.8 2.3 1.1 1.2 0.5 „ 5-15 years 3.9 2.9 2.1 1.9 1.2 1.0 ,, 15-25 years 4.4 4.3 4.3 3.5 2.9 3.2 „ 25-45 years 12.3 10.5 9.5 8.9 8.2 7.6 „ 45-65 years 23.3 27.7 26.4 27.9 27.4 28.5 65 years and upwards 30.8 39.6 45.6 49.4 51.2 52.8 The infantile mortality rate for 1937 was 45 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 1937 66 45 58 60 16 The following Table gives details of the causes of death in the various age groups:— Infantile Mortality, 1937. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total Deaths under 1 year. All Causes 17 6 2 6 31 9 10 10 6 66 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 3 3 .. 7 Diphtheria and Croup .. .. .. .. .. .. .. .. 2 2 Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .... .. .. .. .. .. .. .. .. .. Convulsions .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. Pneumonia (all forms) .. .. .. .. .. .. 1 4 1 6 Diarrhoea .. .. .. 1 1 .. .. .. .. 1 Enteritis .. .. .. .. .. 3 2 2 2 9 Gastritis .. .. .. .... .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying.. .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis 3 .. .. .. 3 .. .. .. .. 3 Congenital Malformations .. 2 .. .. 2 .. .. .. .. 2 Premature Birth 14 3 1 . . 18 .. .. .. .. 18 Atrophy, Debility, and Marasmus .. .. 5 5 4 3 .. .. 12 Other Causes .. 1 1 2 1 1 .. 4 Totals 17 6 2 6 31 9 10 10 6 66 Death-rate in each agegroup per 1,000 births 11.6 4.1 1.4 4.1 21.2 6.1 6.9 6.9 4.1 4.5 Percentage of total deaths in each agegroup 25.8 9.1 3.0 9.1 47.0 13.7 15.1 15.1 9.1 100 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 8-4 weeks Total under 4 weeks 4 weeks to 8 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 1930-1934 27.8 3.9 4.4 2.6 38.2 19.9 17.2 15.4 9.1 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 1937 25.8 9.1 3.0 9.1 47.0 13.7 15.1 15.1 9.1 Conditions of Occupation or Environment prejudicially affecting Health. Occupation. No specially detrimental effects amongst workers in any trade has been reported. Environment. Overcrowding still presents difficulty in effecting an improvement in public health. Public Mortuary. During the year there were received the bodies of 259 persons, of whom 53 had been residents of Deptford. Particulars of the bodies received were as follows: Month, 1937 Male Female Inquests Post-Mortems Under 1 year January 12 5 15 14 2 February 16 7 17 14 2 March 22 8 21 17 — April 14 9 12 17 1 May 7 8 5 12 — June 9 9 8 13 1 July 13 5 11 9 — August 3 2 3 3 — September 13 7 — — — October 12 8 16 13 — November 20 8 16 21 2 December 16 16 14 27 2 Total 157 92 138 160 10 B 18 Inquests. Natural Causes Accidental Causes Suicide Misadventure Murder Open Verdict January 13 5 1 — — — February 16 5 4 — — — March 19 7 3 — — 1 April 18 2 2 — — 2 May 14 1 — — — — June 15 4 — — — — July 11 5 1 — — 1 August 3 2 — — — — September 11 5 4 — — — October 10 7 2 — — 1 November 24 3 2 — — 1 December 28 4 — — — 2 Total 182 50 19 — — 8 Bodies Received. 1987 Deptford Other Districts January 3 16 February 5 20 March 5 25 April 5 19 May 5 10 June 6 13 July 3 15 August 1 4 September 2 18 October 5 15 November 6 24 December 7 27 53. 206 Total 259 General Provision of Health Services. B2 '20 Staff of Public Health Department.. Medical Officer of Health and Administrative Tuberculosis Officer. f. Leonard Keith, m.d., ch.b., d.p.h., l.d.s. Assistant Medical Officers. n. M. Donnelly, m.b., d.p.h., (Tuberculosis Officer and Assistant Medical Officer of Health.) S. Eleanor Hill, m.d., b.s. (Maternity and Child Welfare.) m. i. outram, m.b., ch.b., d.p.h. (Part-time Maternity and Child Welfare.) 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. G. F. Gibberd, f.r.c.s. A. L. Walker, f.r.c.s. Bacteriologist. Arthur Davies, m.d., m.r.c.p. (Dreadnought Hospital) Dental Surgeon. J. Eric Magraw, l.d.s. Public Analyst. Henry G. Harrison, m.a., f.i.c. (retired) Hugh A. Williams, a.c.g.f.c., f.i.c. Additional Public Analyst. A. E. Brown, b.sc. (Lond), f.i.c. Public Vaccinators. Gavin A. E. Argo, m.b., ch.b. J. Stanley Davies, m.a., m.b., c.m., l.m. (retired) J. M. A. Loftus, m.d. 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 F. G. Leaper 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. G. 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) tMiss 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. (R.S.I) 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. * Died 4th July, 1937. †Part-time only at Central Clinic. 22 Tuberculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. Tuberculosis Health Visitors— Miss A. M. Roy, Gen. Training, 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 (retired) Miss Margaret Mailer 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 During the year the conduct of certain members of the female staff was considered by the Maternity and Child Welfare Committee in connection with failure to carry out instructions of that Committee and/or in connection with matters of discipline. Such action as was taken failed, in at least one instance, to put an effectual stop to this difficulty with the result that an undue proportion of my time was spent upon investigations connected therewith and I therefore found it necessary to address the following statement to the Public Health and Housing Committee:—•" By reason of the disregard of certain Health Visitors to observe the instructions of the Maternity and Child Welfare Committee, a substantial amount of my time has been spent lately upon investigating these matters. I report this as I feel that this encroachment upon my time will,if continued, have an adverse effect upon the discharge of my statutory duties as Medical Officer of Health in the administration of the various Statutes and the Orders and Regulations of the Ministry of Health." 23 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). St. John's Nurses (Parish of St. Paul with St. Mark). The Ranyard Nurses (the remainder of the Borough). The work is carried out in close co-operation with the Health Services of the Council, particularly in regard to the work of the Maternity and Child Welfare Centres and the Tuberculosis Dispensary. Nursing is undertaken on behalf of the Borough Council of children up to the age of five years suffering from measles, whooping cough, diarrhœa, poliomyelitis and ophthalmia neonatorum. During epidemic periods, pneumonia and influenzal pneumonia (all ages) are included. Payment is made by the Borough Council at the rate of 1s. 3d. per nursing visit. 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 vears Others Total cases nursed Cases Visits Cases Visits Measles 1 13 l Ophthalmia Neonatorum 5 96 5 Pneumonia 10 153 l 26 11 Thread Worms 2 19 2 Conjunctivitis 4 47 4 Diarrhœa 1 4 1 Ear trouble 1 11 1 Whooping cough 2 72 2 Tonsillitis 1 5 1 Impetigo 2 41 2 Post Natal Complications 8 207 8 Bronchitis 5 65 5 Pemphigus Neonatorim 3 55 3 High Temperature 1 2 1 Eczema 1 33 1 Swollen Glands 1 10 1 Septic Knee 1 13 1 41 639 9 233 50 24 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 141 Visits 4,262 Surgery Patients 678 Attendances 4,119 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 has hitherto made provision for the attendance 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 midwive's fees were paid in three instances. In view of the coming into force of the London County Council Scheme for the provision of domiciliary midwifery, this provision by this Borough Council was discontinued as from the beginning of the year 1938. 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. 25 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. Olaves 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. (See " Maternity and Child Welfare.") General in-patient and out-patient treatment is provided at such London hospitals as Vincent Square, Evelina and Great Ormond Street, and locally, at St. Alfege, the Miller and St. John's Hospitals. Maternal Mortality. See " Maternity and Child Welfare." Institutional provision for Unmarried Mothers, Illegitimate Infants, etc. No provision. Ambulance Facilities. These were fully set out in my report for 1930. Health Visiting. See " Maternity and Child Welfare." Infant Life Protection. For details, see " Maternity and Child Welfare." Orthopcedic Treatment. No scheme has been adopted, individual children being referred to private doctors or to hospitals. Municipal Foot Clinic. This Clinic continues to be well attended and, from April, the number of Sessions was increased. There are now four afternoon and four evening Sessions and, of the latter, the Session held on Thursday evening is reserved for persons making special appointments. The Staff comprises two Chiropodists. 286 Sessions were held during the year, at which 4,599 treatments were given. The receipts totalled ₤200. 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 4.30 p.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 4.30p.m. and 6 to8.30 p.m. Special appoint ment 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, 11a.m. Thursday, 2 p.m. Gonorrhœa—Monday, 2 p.m. Men. 6 p.m., Women and Children. Wednesday, 6 p.m., Women and Children. Thursday, 5 p.m., Men. Friday, 2 p.m.. Women and Children. School Clinics. Deptford School Treatment Centre. Lady Florence Institute, Reginald Square — Eye and Minor Ailments (Eye) : Tuesday and Friday. 2 p.m. Ear. Minor Ailments: Friday, 9.30 a.m. Operations. Monday. 2 p.m., ai Cyril Henry Centre. Woolwich. Skin Ailments : Wednesday, 2 p.m. Teeth : Alt. Mondays. 9.30 a.m. and 1.30 p.m. Tuesday. 1.30 p.m. Wednesday. 9.30 a.m. and 1.30 p.m. Thursday. 1.30 p.m. Friday. 9.30 a.m., 1.30 p.m. Gas, Tuesday. 9.30 a.m. Inspections. Alt. Mondays and Thursday. 9.30a.m. Day Nursery School. (Open Air) The " Rachael McMillan" Memorial School. Sanitary Circumstances, etc., AND Factory and Workshops Acts. 28 SANITARY WORK. In accordance with my usual practice, I submit herewith the general statement as to the past year's work, together with comparative figures for previous years :— 1931 1932 1933 1934 1935 1936 1937 Total primary inspections 7,592 6,652 8,166 8,039 10,854 8,184 11,040 Total re-inspections 20,461 17,284 18,105 17,704 20,112 16,906 23,779 Total Intimation Notices served 3,552 2,623 2,748 2,656 2,850 2,431 3,121 Total Statutory Notices served 1,104 687 777 632 698 658 805 Total Housing Act Notices served :t 12 10 18 4 1 - 1 Total premises on which works were completed 3,941 2,990 3,116 2,977 3,256 2,863 2,997 Total improvements effected during the year 14,116 10,928 12,440 11,185 11,301 9,947 1,1210 I am satisfied that the high standard reached in previous years has been maintained. In addition to the above, 2,050 inspections and calls have been made by the Food Inspector, Mr. Yates. 255 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 1937. Number of District. Com tive figures for 1936. inspections — 1 2 3 4 5 6 7 8 9 Totals On complaint 168 102 308 181 211 200 144 144 110 1568 1341 House-to-house— 1. Where defects found 232 204 85 188 154 214 118 31 106 1332 876 2. Where no defects found 42 40 8 78 27 25 60 9 25 314 202 On occurrence of Infection 51 36 110 49 100 96 54 42 40 578 613 On Notice from builder 148 42 68 50 58 74 103 24 20 587 539 Reference from T.B. Dispensary 5 1 1 2 3 6 2 ... 2 22 20 Market Inspection 14 12 14 10 13 13 11 ... ... 87 87 Factories 2 4 ... ... 9 ... ... ... 424 439 106 Workshops and workplaces 7 1 ... ... 1 ... ... ... 544 553 78 Food premises 33 269 14 12 37 9 15 ... 1 390 387 Butchers' premises ... ... ... 1 8 2 1 ... ... 12 19 Milk premises 41 89 28 14 74 80 2 ... ... 328 348 Offensive businesses ... ... 9 ... ... ... 1 ... ... 10 29 Common Lodging Houses 8 ... 13 ... ... ... 17 3 ... 49 52 Ice Cream premises 10 35 38 28 20 30 10 ... ... 171 111 Fish Shops 24 17 9 35 12 29 21 1 ... 148 223 Bakehouses 17 ... 24 18 18 8 6 ... ... 91 89 Outworkers' premises 19 5 15 6 26 37 16 2 ... 126 101 Miscellaneous inspections 138 90 334 119 271 257 214 58 49 1530 1781 Shops Act Inspections ... ... ... ... ... ... ... ... 630 630 46 Special Housing Inspections 49 71 210 76 72 82 161 1038 85 1844 1022 Poisons Act Inspections ... ... ... ... ... ... ... ... 231 231 114 Total inspections 1008 1018 1288 867 1122 1162 956 1352 2267 11040 8184 Re-inspections, Calls, etc. 2633 2377 2234 2573 2666 2986 3374 2493 2443 23779 16906 Smoke observations 1 6 ... 2 1 ... 2 ... ... 12 23 Notices Served — Intimation 443 315 425 451 403 447 281 127 229 3121 2431 Statutory 26 99 138 159 78 170 55 42 38 805 658 Housing Act ... 1 ... ... ... ... ... ... ... 1 ... Premises in respect of which notices were complied with 477 275 358 469 376 477 294 96 175 2997 2863 Premises in respect of which works in compliance with notices served during the year 1937 were outstanding at the end of the year 58 68 88 45 60 52 45 14 8 438 261 Description of Sanitary Improvements effected during; the year- Number of rooms cleansed 666 617 329 581 528 384 247 140 171 3663 3201 Defective roofs repaired 89 109 98 99 85 84 55 27 48 694 558 Gutters, ec., provided or repaired 77 109 39 60 57 62 38 23 19 484 372 Dampness abated 47 80 81 90 68 106 58 16 25 571 431 Yards, etc., paved or repaired 73 69 14 37 39 30 21 7 13 303 295 Water Fittings repaired 19 4 7 15 9 13 30 12 4 113 202 Sinks, etc , renewed or repaired 100 108 40 98 84 163 88 39 21 741 794 Drains entirely reconstructed 1 1 2 3 10 6 11 4 ... 38 43 30 Summary of Sanitary Work —continued. 1 2 Number of District. Comparative figures for 1936. 3 4 5 6 7 8 9 Totals Drains partially reconstructed 17 6 5 12 17 20 25 2 2 106 129 Drains unchoked and cleansed 14 7 31 19 25 9 10 6 18 139 150 Soil pipes, etc., renewed or repaired 4 2 6 2 22 194 42 19 2 293 245 Gullies provided, unchoked, etc 13 11 5 8 28 48 50 19 1 183 237 Manholes, etc., provided or repaired 18 9 6 9 26 20 33 11 3 135 161 Premises in which repairs were effected to w.c's. 176 209 93 184 150 199 185 43 161 1400 1136 Dustbins provided 50 19 69 46 64 104 27 6 18 403 334 Window repairs 154 115 46 115 86 76 20 15 56 683 523 Stove and copper repairs 41 137 42 62 46 49 19 6 55 457 364 Stair and door repairs 21 48 21 25 20 16 3 11 172 148 Flooring repaired 30 68 13 28 33 23 16 9 24 244 197 Ventilation, heating and lighting improved 5 6 3 35 2 23 5 1 11 91 106 Fish shops limewashed 18 15 7 30 8 25 20 ... ... 123 146 Bakehouses limewashed 11 ... 10 11 5 6 5 ... ... 48 42 Accumulations removed 6 4 6 4 4 4 10 1 1 40 35 Miscellaneous repairs 9 3 9 19 10 17 8 7 4 86 98 Total repairs and improvements effected 1659 1756 982 1592 1426 1681 1030 416 668 11210 9947 Reference to Districts. District No. Inspector. Wards (approximate) 1 Inspector Mayo Deptford Park (part) and Clifton Wards. 2 „ Webster Deptford Park (part) and Evelyn Wards. 3 „ Allen St. Paul's (part), Evelyn (part), and St. John's Wards. 4 „ Hewett St. Paul's (part) and Vale Wards. 5 ,, Green Canterbury and Hatcham (part) Wards. 6 ,, Wilton Hatcham (part) Pepys and St. Catherine's Wards. 7 Mason St. Peter's and Town Hall Wards. 8 ,, Troughton Housing Inspector. 9 ,, Fitzherbert Factories and Workshops, Shops Acts, and Pharmacy and Poisons' Act Inspector. 31 House-to-House Inspections. 1,646 house-to-house inspections were made. These inspections were carried out in the following streets: - Adolphus Street Edward Street Lovelinch Street Arica Road Foxberry Road Napier Street Alpha Road Ffinch Street Norfolk House Barlborough Street Florence Cottages Omega Street Batavia Road Florence Grove Oareboro Road Bawtree Road Florence Terrace Railway Grove Brocklehurst Street Grinling Place Rokeby Road Bestwood Street Grove Sreet Rollins Street Bousfield Road Hamilton Street Rudford Road Brookmill Road Hoopwick Terrace Sayes Street Blackhorse Road Hyde Street Scawen Road Canterbury Road Hay dock Road Senate Street Colwick Street Hanlon Street Staunton Street Colwick Terrace Idonia Street Senegal Road Cornbury Road Ilderton Road St. Asaph Road Clyde Street Kempslade Street Windmill Lane Chubworthy Street Lindo Street Wotton Road Dundalk Road Ludwick Road Wrigglesworth 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. 1937 £ s. d. £ s. d. Magistrate's Order. (14 days). Feb. 24 78 Lewisham High Road Non-compliance with statutory notice. — 3 3 0 Oct. 20 03 Cornbury Road (a) No dustbin (b) Accumulation of refuse — 1 1 0 Dustbin provided and accumulation removed prior to hearing. 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. Offensive Trades (other than Slaughterhouses). The following are the only instances in the Borough :— Skin Dressers, 2 ; Soap Boilers, 2 ; Fat Melters, 2. Slaughterers of Poultry, 1. Only five premises are involved, as in two instances the same premises are registered for both soap-boiling and fat-melting. Inspection is regularly carried out. The premises and the conduct of the business are satisfactory, no notices having to be served. Rag and Bone Dealers. The premises of 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. 33 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. The London County Council in reply stated that it was that Council's practice to bait its sewers throughout the year, and to increase considerably the number of baits laid during rat week. Removal of Aged and Infirm Persons. It was found necessary to apply to the Court for an Order during the year for the compulsory removal of one aged and infirm person 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. Nine samples were taken in 1937. One swimming pool, privately owned, is in the Borough. 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 38 premises was entirely reconstructed during the year, in 106 instances partly reconstructed,and in 139 premises the drains were unstopped and cleansed. Flooding. Certain portions of the Borough, notably the Clifton Rise area, are liable to flooding in times of heavy rainfall and this recurred in July 1937. As upon previous occasions, the basement of the Town Hall (in which the offices of the Sanitary Inspectors are situated) was flooded to a considerable depth with polluted storm water. The Sanitary Inspectors requested that consideration should be given by the Council to more suitable accommodation being found for them and the matter was referred to a special sub-committee. 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. c 34 Street Cleansing. As reported last year, the sweepers are provided with trucks which carry two refuse containers and the acquisition of a type of vehicle permitted of these being emptied upon the beat without the necessity of conveying them to the Depot. As this system has proved satisfactory, the Council decided to extend the service by purchasing a second vehicle of the type mentioned. Fouling of Footways by Dogs. The Council has made a byelaw dealing with this nuisance. Shops Act, 1934. In the course of their routine inspections the Sanitary Inspectors pay attention to the ventilation and the temperature of shops, and the provision of sanitary conveniences. 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 East Tilburg Common Lodging Houses. At a women's lodging house, the proprietor desired to reduce the accommodation from 69 to 35, and his licence was accordingly amended. Rag Flock. No premises are known to exist which would fall within the purview of the provisions in the Public Health Act. Co-operation with the District Surveyor. The Public Health Department continues to act in close co-operation with the District Surveyor. During the year, 64 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 three new premises could be properly granted. Increase of Rent and Mortgage Interest (Restrictions) Acts. Three certificates were granted in connection with the above. 35 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, 1937, 10 visits were made, on the following dates: — 22nd January, 19th March, 1st and 27th April, 12th July, 24th August, 26th October, 14th and 22nd 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. 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 449 7 — Workshops 293 9 — Workplaces 1060 18 — Total 1802 34 — The types of premises inspected were as follows :— Type. Factories, N umber. Workshops, Number. Workplaces, Number. Bakehouses 18 26 Chemical Works 4 3 Cinemas, etc. 6 Dressmakers, Milliners, etc. 1 15 9 Engineering, general 36 6 „ motoring 12 11 5 Foundries 6 Food preparation 23 4 346 Glass bottle makers 3 1 Laundries, Cleaners, etc. 3 4 6 Marine Stores 6 Paint and Varnish Works 3 1 Printers 7 1 Shoeing Forges 4 Stables, etc. 57 Sawmills 12 Timber Stores 6 9 Tar Refiners 4 Tailors 2 7 4 Woodwork, Joiners, etc. 9 2 Woodchoppers, etc. 1 3 5 Whitening Manufacturers 6 Offensive trades 4 Miscellaneous 69 53 64 Totals 229 141 517 37 DEFECTS FOUND. PARTICULAR. Number of Defects' Number of Prosecutions. Found. Remedied . Referred to H M. Inspector. Nuisances under the Public Health Acts. Want of Cleanliness 6 6 — — Want of Ventilation — — — Overcrowding — — — — Want of Drainage ol Floors — Other Nuisances 8 8 — — . Sanitary Accommodatio Insufficient 2 2 — — Unsuitable or defective 43 43 — — Not Separate for Sexes — — — — Offences under the Factory and Workshop A ct. 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 59 59 The number of inspections made to Home Workers' Dwellings was 126. 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 II or Part III of the Housing Act, 1936 and the following houses or parts of houses were officially " represented " to the Council during 1937 :— Individual Dwelling-Houses. 8 Parts of Buildings. 21 Underground Rooms. 151 The following table records the work done in connection with housing inspection : — 1. Unfit Dwelling-Houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6003 (b) Number of inspections made for the purpose 6106 (c) Special Housing Survey Inspections (not included above) 1844 (2) Number of dwelling-houses (included in (l) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925-1932 1646 (b) Number of inspections made for this purpose 1646 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dwelling-houses (exclusive of those in (3) found not to be in all respects reasonably fit for human habitation 3003 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) 2259 41 3. Action under Statutory Powers. (A) Proceedings under Secs. 9, 10 and 16 of the Housing Act, 1936 (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 emedied (Statutory Notices 805 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices (a) By owners 738 (b) By Local Authority in default of owners — (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (]) Number of dwelling houses in respect of which Demolition Orders were made — (2) Number of dwelling houses demolished in pursuance of Demolition Orders — (D) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of underground rooms in respect of which Closing Orders were made 62 (2) Number of underground rooms in respect of which Closing Orders were determined, the room having been rendered fit 3 (3) Number of parts of Buildings in respect of which closing order was made 13 (E) Proceedings under Section 25 of the Housing Act, 1936:— (1) Number of Clearance Areas declared 2 (2) Houses comprised therein 6 (3) Houses demolished 3 42 (F) Housing Act, 1936:—Part IV. Ward Dwellings overcrowded at the end of the year No. of families dwelling therein No. of persons dwelling therein No. of new cases reported during year No. of cases relieved during year No. of persons concerned Canterbury 32 34 173 l 12 62½ Clifton 15 16 89½ 2 14 65 Deptford Park 30 31 177 — — — Evelyn 49 49 265 — — — Hatcham 24 30 131 2 15 64* Pepys 8 8 36½ 2 5 16 St. Catherines 17 17 106½ 7 6 26½ St. Johns 10 10 54½ 3 4 19 St. Pauls 78 78 355½ 10 70 282½ St. Peters 7 7 37 — 2 7½ Town Hall 13 13 58 4 15 54 Vale 27 29 122 6 12 64 Total 310* 322 1605½ 37 155 661½ *It is realised that this 6gure does not include cases which have possibly become overcrowded since the Survey With the appointment of an additional permanent Sanitary Inspector it will now be possible to periodically review the position In one instance where overcrowding had arisen after the " appointed day," the Council resolved that Notices should be served upon the Owner and Occupier of the premises. Undertakings accepted in respect of parts of houses. (a) To cease using for human habitation 4 (b) To make fit 2 Undertakings accepted in respect of underground rooms. (a) To make fit 68 (b) To cease use for human habitation 28 Underground rooms in which no action was taken 3 Parts of Houses „ „ „ 2 43 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. Tenements Accommodating 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 1 block—37 „ 183 „ (Crossfield Estate) Speedwell Street Area 2 blocks—180 ,, 942½ „ (Speedwell Estate) In Course of Provision. Addey Street Areas 5 blocks 193 tenements 947 persons Number of Acreage Persons being tenements to displaced be provided Frankham Street Areas 2.88 1,020 104 (1-5) with added lands, Christ Church and 69-75 Church Street. During the year, the Tanner's Hill Area (mentioned in last year's Report as an Area with which the L.C.C. proposed to deal) was the subject of a Clearance Order subsequently confirmed by the Minister of Healh. The L.C.C. also announced their intention to deal with areas to be known as the Evelyn Street (Nos. 1 and 2) Areas the Grove Street (Nos. 1, 2, 4, 5 and 6) Areas. Private enterprise built 2 houses. 44 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 1937:— Estate Families Honor Oak 107 Mottingham 146 Downham 65 Speedwell Street 15 Hughes' Fields 59 Meridian, Greenwich 43 Bellingham 75 Becontree 29 Thornhill, Charlton 26 St. Helier 5 Deptford Park 12 Haddo Street, Greenwich 49 Crossfield Street 9 Others 24 Total 664 For information, the number of Deptford families rehoused during recent years was as follows:— 1936—789, 1935—354, 1934—476, 1933—377, 1932—241, 1931—217 Food. 46 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.) 154 Fish premises 24 Slaughterhouses 233 Butchers' premises 922 Milk premises 13 Miscellaneous 71 Calls (Stalls, etc.) 537 2050 Inspector Webster deals with the inspection of imported food at St. George's Wharf. He made 255 visits during the year under review. I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 17 applications for registration (including 11 transfers) in respect of premises were granted during the year. At the end of the year there were 121 premises registered for the sale of milk. In addition to the above, 105 persons were registered for the sale of unopened bottled milk only, and 37 persons or firms trading from premises outside the Borough were registered as purveyors within the Borough. Bottling of milk is carried out at 23 premises. Metropolitan Borough of Deptford. With the Medical officer of Health's Compliments. Town Hall. New Cross Road, S. E. 47 There are no cow-houses in the Borough. During the year 328 inspections of milk shops were made hy the District Sanitary Inspectors and 13 by the Food Inspector. One Intimation notice was served and many minor matters were remedied as the result of verbal intimation by the Inspectors. Administration of the Milk (Special Designations Order), 1936. At the end of the year, the following retailers were registered:— 2 retailers „ Tuberculin Tested Milk at 2 shops. 3 „ „ Pasteurised Milk at or from 16 shops. 1 retailer whose premises are outside the Borough to sell Pasteurised Milk within the Borough. 2 retailers whose premises are outside the Borough to sell Tuberculin Tested Milk within the Borough. Bacteriological Examination of Milk. 32 samples of Milk were examined bacteriologically with the following results: — Tuberculin Tested 4 samples Coliform bacillus not present Semi-solid Milk (used for Ice-cream making) 1 sample Coliform bacillus not present Total Count Total Count Designation. in 1 cc. Designation. in 1 cc. Pasteurised 55,450 Pasteurised 15,123 „ 80,800 „ 10,450 „ 28,600 „ 44,00 „ 14,500 „ 22,050 „ 4,600 „ 17,400 „ 6,800 „ 14,73 „ 65,100 „ 8,850 „ 10,850 „ 10,133 „ 5,080 „ 21,00 „ 20,100 „ 48,800 „ 15,200 „ 7,433 „ 6,700 „ 2,950 „ 61,50 „ 9,950 „ 2,4750 48 In the case of samples not within the standard, the results would be reported to the Ministry of Health and to the County Medical Officer concerned. Animal Inoculation. 22 samples of milk were submitted to the bacteriologist for the detection of Tubercle Bacilli (guinea pig inoculation), all with negative results. 2. Meat Premises, (a) Slaughterhouses. There are two slaughterhouses in the Borough and these were kept under regular and efficient supervision, 233 visits having been paid by the Food Inspector. The following is a statement of the animals slaughtered and the carcases or offal destroyed. Slaughtered. 244 bullocks. 46 calves. 1533 sheep. 88 pigs. The Borough Council has licensed 7 slaughtermen in connection with these premises. Destroyed—Surrendered at Slaughterhouses. Bullock's mesenteric fat, 2. Bullocks' heads and tongues 7. Bullock's kidney and tongue 1. Bullocks' livers 19. Bullocks' lungs 3. Pig's head 1. (b) Poultry Slaughterer. There is one poultry slaughtering establishment. During the year 7,957 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 premises, and all places already registered, regular inspection is made. 100 premises were so registered at the end of the year under report. 49 3. Other Food Premises. (a) Workshop Bakehouses. There are 26 such bakehouses in the Borough, 6 of which are underground. 56 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. (b) Factory Bakehouses. These number 18, of which 4 are underground. 35 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 46. 148 inspections were made by the District Sanitary Inspectors and 24 by the Food Inspector. 182 Notices were served for cleansing. (d) Ice Cream Premises. There were 149 separate premises recorded. To these, 171 visits were paid, and many verbal intimations were given regarding minor matters. (e) Other Premises. There are 346 miscellaneous premises connected with food preparation or sale, and 390 inspections were made to these, in addition to numerous visits by the Food Inspector. Numerous verbal intimations regarding minor matters were given. (/) St. George's Wharf. Public Health (Imported Food) Regu lations, 1925. During the year 1937, large quantities of foodstuffs were imported at the Wharf, and the following is a summary of the work done:— Inspector Webster. Kxtent of Description. Quantity Examination. Remarks. Anchovies in tins • cases 360 14 Apples „ 2 2 Apricots „ 1 1 Beans bags 240 20 Beer casks 25 2 Biscuits cases 805 77 Blackcurrant pulp „ 84 7 casks 67 7 d During the year 1937, 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 Examination. Remarks. Anchovies in tins cases 360 14 Apples „ 2 2 Apricots „ 1 1 Beans bags 240 20 Beer casks 25 2 Biscuits cases 805 77 Blackcurrant pulp „ 84 7 casks 67 7 d 50 Description. Quantity. Extent of Examination. Remarks. Butter cases 28 3 casks 392 30 Carmine cases 7 4 Casein bags 73 6 Casings casks 133 24 One sample Chicory bags 1,419 50 packages 207 10 Cider cases 3 1 Cocoa case 1 1 Cocoa butter bales 170 12 Condensed milk barrels 1,264 60 cases 1,011 49 Dates „ 2,453 197 11 samples. 3 of which contained caustic potash, 5 cases destroyed Eggs „ 1,535 129 Fish in tins „ 9 4 Flour bags 1,384 49 Fruits in spirits cases 75 8 Fruits in tins „ 100 10 Grape fruit juice baskets 3,975 300 (Solid) „ cases 3 2 casks 10 1 Herrings in tins cases 788 97 Honey „ 1 1 Jam „ 1 1 Lard „ 10 10 Stopped — No official certificate Licorice juice „ 5 1 Liquors „ 5 1 Macaroni bundles 675 50 cases 8 2 Maize bags 120 5 Meat in tins cases 96 7 Meat paste „ 27 9 Middlings bags 120 5 Milk powder „ 800 80 51 Description. Quantity. Extent of Examination Remarks. Milk Powder cases 9,954 567 1 sample genuine crates 3,583 148 Mineral water cases 8 6 Mushrooms in jars jars 102 18 Mushrooms in tins tins 811 93 Mustard casks 2 1 Mustard (prepared) cases 646 64 packages 20 1 Oats cases 65 6 Peas bags 1,000 120 Pectin (apple juice) casks 268 23 Red Pepper cases 60 6 Rice (Ground) „ 29 3 Rice (Ground and Cream) „ 133 21 Sausages in Tins „ 95 11 1 tin opened Semolina „ 42 9 Soup Powders „ 479 25 Spirits „ 17 8 Strawberry Pulp „ 50 5 „ 71 5 Sweets „ 765 99 Tapioca „ 136 19 Vegetables in Tins „ 2,153 222 2 samples genuine Vinegar in Bottles „ 97 11 Vinegar in Casks casks 51 11 Wafers cases 4,187 358 1 sample genuine Wine baskets 4 1 cases 388 52 packages 1 1 52 Transhipped Description Quantity Casings casks 12 Cocoa Butter bales 53 Dates cases 140 Hams „ 99 Herrings in Tins „ 11 Mushrooms in Tins „ 29 In Bond Description Quantity Blackcurrant Pulp cases 150 casks 46 Cocoa Beans cases 58 Dates „ 20 Fruits in Spirits „ 10 Herrings in Tins „ 68 Lentils bags 14 Liquors cases 31 Meat Paste „ 10 Mushrooms in Jars „ 85 Mushrooms in Tins „ 362 Spirits „ 28 Syrup „ 8 Vegetables in Tins „ 1 Wine „ 631 Overside Description Quantity Apricots cases 498 Beans bags 9,857 Blackcurrant Pulp cases 1,542 casks 695 Cocoa Butter bags 144 bales 1,689 barrels 301 Coffee bags 60 Condensed Milk barrels 1,847 cases 25,319 53 Description Quantity Dates cases 890 Flour bags 22,524 Lentils „ 30 Liquors cases 2,406 Middlings bags 1,604 Milk Powder cases 600 crates 1,000 bags 2,300 Mineral Water cases 2,431 Peas bags 1,868 tons 50 Spirits cases 204 Sugar bags 350 Syrups cases 166 Tomato Juice „ 2,245 Vegetable in Brine barrels 148 Wine cases 17,479 casks 134 packages 23 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 Fowl Beef, 28 stone Turkeys, 4 Bullocks' livers, 19 Chickens, 3 Bullocks' lungs, 3 Bullocks' heads and tongues, 7 Bullock's mesenteric fat, 2 Bullock's kidney, 1 Pig's head and tongue, 1 Tinned Food, etc. Pigs' feet, 14 lbs. Sild, 273 tins Rabbits, 1 parcel Jam, 18 lbs. Peaches, 95 tins Fish Rusk, 1 cwt. Dogfish, 5 stone Sausage, 70 lbs. 54 Anthrax—Destruction of Animal Food. On or about the 28th August, a carcase of a cow, infected with anthrax, was delivered to an address in Walworth among other meat intended for animal feeding (Cats' Meat). A consignment of 70 pounds of meat from this address was despatched on the above date to a Cat's meat vendor's shop in this Borough. Owing to prompt notice given to the Public Health Department by the Police the whole of this consignment was secured and destroyed. The premises and all utensils were thoroughly disinfected. III. Food Poisoning. The following is an analysis of the notifications received, grouped according to the causal agent:— Food. No. of cases. Pork 3 Tinned Salmon I Sardines 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., would be carried out. 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. 55 Frequency of Sampling.—A total of 521 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 done and results obtained in 1937:— Total. Number Adulterated. Percentage of samples adulterated.* Formal samples 323 28 8.7 % Informal samples 182 11 6.0% Imported Food samples 16 3 18.7 % Total 521 42 8.1 % *Including incorrect labelling. The adulteration in respect of samples submitted for analysis during previous years is as follows:— Year. Number of Samples taken. Percentage Adulterated. 1928 604 1•8 1929 590 1•8 1930 550 3•5 1931 507 2•6 1932 500 1•4 1933 500 1•4 1934 500 2•8 1935 536 7•1 1936 536 6•7 The following is a statement of the samples purchased and submitted for analysis during 1937. 56 Food and Drugs—Samples Taken. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulterated Samples. Formal Samples, taken under, the Food and Drugs (A dulteration) Act— Aspirin tablets 1 .. 1 .. Beer 4 .. 4 .. Bicarbonate of soda 1 .. 1 .. Brawn, pork 1 .. 1 .. Butter 2 .. 2 .. Boracic ointment, B.P. 1 .. 1 .. Biscuits, chocolate 1 .. 1 .. Beef, minced 9 1 10 10 Beef 2 .. 2 .. Cake 2 .. 2 .. Cocoa 1 .. 1 .. Cocktail (non-alcoholic) 1 .. 1 .. Dripping 1 .. 1 .. Fish paste 1 .. 1 .. Milk 227 14 241 5•8 Mustard pickle .. 1 1 100 Pepper 3 .. 3 .. Pork and beans, with tomato sauce .. 2 2 100 Rum 1 .. 1 .. Sausages 8 2 10 20 Spirts 13 2 15 13 Sweets 8 2 10 20 Vinegar 5 2 7 28• 5 Wine, non-alcoholic 2 .. 2 .. Zinc ointment, B.P. .. 2 2 100 Total formal samples . 295 28 323 8•7 Informal Samples— Bacon 6 .. 6 .. Beans, with pork and tomato sauce 2 .. 2 .. Bicarbonate of soda 1 .. 1 .. Butter 4 .. 4 .. Boracic ointment, B.P. .. 1 1 100 Cherries, glace 2 .. 2 .. Coconut, desiccated 1 .. 1 .. Coffee 1 .. 1 .. Coffee and chicory extract 3 .. 3 .. Cornflour 1 .. 1 .. Cream, tinned 2 1 3 33•3 Currants and sultanas 7 .. 7 .. Curry Powder 1 .. 1 .. Damsons, bottled 1 .. 1 .. Dates 1 .. 1 .. Fat, cooking 1 .. 1 .. Carried forward 34 2 36 57 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulterated Samples. Brought forward 34 2 36 Informal Samples—contd. Fish, tinned 5 .. 5 .. Flour, egg, self-raising 1 .. 1 .. Flour 6 .. 6 .. Fruits, dried 19 .. 19 .. Fruit, tinned 7 1 8 12.5 Gelatine 5 .. 5 .. Ginger, crystalliised 1 .. 1 .. Jam, black currant 1 .. 1 .. Jam, raspberry, seedless 1 .. 1 .. Jam, strawberry 1 .. 1 .. Jelly, table 2 .. 2 .. Lemonade powder 1 .. 1 .. Malt extract, with cod liver oil 1 .. 1 .. Macaroni, cut 1 .. 1 .. Margarine .. 1 1 100 Meat paste 9 .. 9 .. Milk 1 .. 1 .. Milk, condensed 2 .. 2 .. Milk, dried 3 .. 3 .. Milk food, modified 2 .. 2 .. Mincemeat 1 .. 1 .. Mint, dried 1 .. 1 .. Pickles 1 .. 1 .. Pepper 1 .. 1 .. Parrish's chemical food 1 .. 1 .. Peas, tinned 1 .. 1 .. Peel chopped 2 .. 2 .. Pork and beans, with tomato sauce .. 1 1 100 Pineapple, glace 1 .. 1 .. Rice ground 1 .. 1 .. Salad cream 2 .. 2 .. Sild, tinned 8 3 11 27•3 Sage 1 .. 1 .. Stuffing, sage and onions 1 .. 1 .. Sultanas 1 .. 1 .. Sweets 20 2 22 9.1 Tea siftings 1 .. 1 .. Treacle 2 .. 2 .. Tripe 2 •• 2 .. Zinc ointment, B.C. .. 1 1 100 Vinegar 6 • • 6 .. Wine, alcoholic 10 .. 10 .. Wine, non alcoholic 4 .. 4 .. Total Informal Samples 171 11 182 60 58 Samples Taken— continued. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulterated Samples. Imported Food Samples— Confectionery 1 .. 1 .. Dates 8 3 11 27.3 Milk powder 1 .. 1 .. Peas, tinned 1 .. 1 .. Spinach, tinned 2 .. 2 .. Total 13 3 16 18•7 Action Taken in regard to Formal Samples Purchased under the food and drugs (adulteration) act during the year 1937. Sample No. Article. Particulars of Adulteration or Infringement. Fine Costs. Remarks. £ s. d. £ s. d. 30 Y Milk 8 per cent. milk fat abstracted — — Warning letter 47 Y Do. 1 per cent. added water — — Do. 51 Y Do. Do. — — Do. 26 S Do. Do. — — Do. 66 Y Do. 37 per cent. milk fat abstracted — — — 67 Y Do. 0.7 per cent. added water — — Do. 68 Y Do. 1 per cent. do. — — Do. 71 Y Do. 0.8 per cent. do. — — Do. 72 Y Do. 0.8 per cent do. — — Do. 27 Y Pork and Beans with Tomato Sauce The sample contained no pork. — — Do. 65 Y Do. Do. — 26 5 0 Dismissed under Probation of Offenders Act upon payment of costs 73 Y Zinc Ointment Zinc Oxide 26.3 per cent. deficient 2 0 0 5 5 0 — 74 Y do. do. 44•0 per cent. deficient 2 0 0 6 6 0 — 171 Y Beef minced Sulphur Dioxide 210 parts per million - 5 5 0 Dismissed under Probation of Offenders Act upon payment of costs 3 W Milk 3 per cent. added water - - Warning letter 59 Action Taken in regard to Formal Samples Purchased under the food and drugs (adulteration) act during the Year 1937—continued. /###]Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 121 Y Milk 0.6 percent. milk fat abstracted Warning letter 164 Y Sausage Beef Sulphur Dioxide 150 parts per million „ 165 Y Sausage Pork Sulphur Dioxide 60 parts per million „ 157 Y Sweets Clear Mints Sulphur Dioxide 780 parts per million 5 0 0 7 7 0 Conviction obtained against wholesaler. Summons against retailer dismissed under Probation of Offenders Act on payment of £3 3s. costs 182 Y Sweets Glacier Mints Sulphur Dioxide 230 parts per million Warning letter 147Y Vinegar Acetic Acid 3•4 grammes per 100 cubic centimetres corresponding to a deficiency of 15 per cent. 1 0 0 5 0 0 Summons against servant withdrawn 234 Y Milk 1 per cent. added water Warning letter 8 G Do. 1 per cent. do. 366 Y Gin 1•8 per cent. excessive water " 60 Action Taken in regard to Informal Samples. Sample No Article Particulars of Adulteration or Infringement Action taken. 64 Y Boracic Ointment Boric Acid 27 per cent. excessive Formal sample taken 61 Y Cream, tinned Milk fat 23•9 per cent. only. (The label guaranteed that the cream was of the very highest quality) - 69 Y Fruit, tinned (Prunes) Tin 3•08 grs. per lb. Stock surrendered and destroyed 12 Y Pork and Beans with Tomato Sauce The sample contained no pork Formal sample taken 8 Y Margarine Gennine, but improperly labelled Matter taken up with wholesalers 9 Y Sild, tinned Tin, 3•57 grs. per lb. Stock surendered and destroyed 11 Y Do. Tin, 4•27 grs. do. Do. do. 25 Y Do. Do. do. Do. do. 63 Y Zinc Ointment Zinc Oxide 28 per cent. deficient Formal sample taken 106 W Dates Potassium hydroxide and carbonate equivalent to 0.075 per cent, caustic potash Imported Food— 107 W Do. Potassium hydroxide and carbonate equivalent to 0•047 per cent. caustic potash Do. 108 W Do. Potassium hydroxide and carbonate equivalent to 0•014 per cent. caustic potash Do. 155 Y Sweets, Clearmints Sulphur dioxide 780 parts per million Formal sample taken 224 Y Do. Sulphur dioxide 210 parts per million Do. do. 17 A Milk Contained a small proportion of added water Warning letter 339 Y Mustard Pickles Sulphur dioxide 44 parts per million Do. 301 Y Wood Vinegar Infested with vinegar eels and unfit for human consumption Matter taken up with manufacturers 364 Y Whisky 0•1 per cent. excessive water Warning letter 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. In one instance legal proceedings were instituted against a retailer for exposing for sale Imported raw tomatoes not properly marked. A fine of £5 with £5 5s. Od. costs was imposed. Chemical and Bacteriological Examinations. The chemical examination of food and drugs is carried out by the Public Analyst, Mr. Hugh Amphlett Williams, A.C.G.F.C., F.I.C., and in his absence, by the additional Public Analyst, Mr. A. E. Brown, B.sc., 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 given as a routine procedure to persons attending there. 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 1987. INCIDENCE AND MORTALITY BY AGE GROUPS. Notifiable Disease At all Ayes Total Cases Notified. At Ages—Years Total Cases Removed to Hospital Total Deaths Deaths it Ages—Years Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup. 168 5 52 86 13 12 .. .. 168 3 2 .. 1 .. .. .. .. Erysipelas 31 .. .. 5 2 7 13 4 15 .. .. .. .. .. .. .. .. Scarlet Fever 174 .. 56 97 10 9 2 .. 169 1 .. 1 .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 7 .. 1 2 2 1 1 .. 7 .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. .. 4 1 .. .. 5 .. .. .. .. .. .. .. .. Puerperal Pyrexia 22 .. .. .. 13 9 .. .. 22 1 .. .. .. 1 .. .. .. Cerebro-Spinal gitis 1 .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. Poliomyelitis and encephalitis 5 .. 1 4 .. .. .. .. 5 .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. 2 .. .. .. .. 1 1 .. Ophthalmia Neonatorum 5 5 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 29 15 14 .. .. .. .. .. 19 11 10 1 .. .. .. .. .. *Acute Primary and Acute Influenzal Pneumonia 117 7 28 10 11 19 23 19 36 83 6 4 .. 2 6 27 38 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery 20 .. 6 4 2 4 4 .. 2 .. .. .. .. .. .. .. .. Chicken fox 73 4 9 56 2 2 .. .. 2 .. .. .. .. .. .. .. .. Posterior Basal Meningitis .. .. •• .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 657 36 167 265 59 64 43 23 452 101 18 6 1 3 7 28 38 * The deaths from Pneumonia include all forms of that disease, including many cases not notifiable as "Acute." 65 SEASONAL INCIDENCE OF NOTIFIABLE INFECTIOUS DISEASES. Disease. 1st quarter 2nd quarter 3rd quarter 4th quarter Total for year Diphtheria 57 24 25 62 168 Erysipelas 9 11 8 3 31 Scarlet Fever 33 34 52 55 174 Enteric Fever 4 ... 1 2 7 Puerperal Fever 2 1 2 ... 5 Puerperal Pyrexia 3 7 8 4 22 Cerebrospinal Meningitis ... .. 1 ... 1 Poliomyelitis ... ... 4 1 5 Ophthalmia Neonatorum 2 ... 2 1 5 Infantile Diarrhœa, etc. 5 7 8 9 29 Acute Primary and Influenzal Pneumonia 51 24 11 31 117 Chicken Pox 11 26 26 10 73 Encephalitis Lethargica ... ... ... ... ... Dysentery ... ... ... 20 20 Small Pox ... ... ... ... ... Posterior Basal Meningitis ... ... ... ... ... Malaria ... ... ... ... ... Totals 177 134 148 198 657 Scarlet Fever. Year No. of Casas 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•4 1937 174 1•8 1 0•6 The cases notified continue to be of the mild character experienced in recent years. E 66 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1937. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Deptford Park Evelyn St. Paul's Vale Clifton Canter bury Hatcham Pepys St. Catherine's . St. Peter's St. John's Town Hall Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 168 12 20 15 17 10 10 22 7 9 5 18 23 Erysipelas 31 1 3 6 2 .. 3 7 2 2 2 1 2 Scarlet Fever 174 16 40 10 14 13 6 20 8 16 15 4 12 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 7 .. 3 .. 1 .. .. .. .. 1 1 .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. 2 2 2 1 .. 2 1 3 3 4 Puerperal Pyrexia 22 .. 1 .. .. .. 1 .. 1 .. 2 .. .. Cerebro-Spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. Poliomyelitis and Polioencephalitis 5 .. .. 1 .. .. .. .. .. 2 1 .. 1 Ophthalmia Neonatorum 5 .. .. 1 1 1 1 .. .. .. .. 1 .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years) 29 1 4 7 2 2 2 2 1 3 1 1 3 Acute Primary and Acute Influenzal Pneumonia 117 12 21 8 9 4 15 12 9 4 6 10 7 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Bacilliary Dysentery 20 5 2 .. 1 .. 11 .. .. 1 .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 73 5 1 .. 3 2 8 6 1 28 12 1 6 Posterior Basal Meningitis .. .. .. .. .. •• .. .. .. .. .. •• .. Totals 657 52 95 51 52 34 58 71 31 67 48 39 59 67 Diphtheria. The following table shows the incidence and mortality from Diphtheria in 1937 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 1937 168 1•7 3 1•8 The Borough Council has established a clinic for the purpose of providing means by which parents may have their children protected by artificial immunisation. With proper safeguards as adopted there, . it may confidently be said that no risk attaches to the method. The work of the Diphtheria Immunisation Clinic has been undertaken by Dr. Donnelly, who has very kindly furnished me with the following Report:— Schick testing and inoculation began in March, 1927. The figures for successive years are as follows :— Year. Positive. Number of Negative. Schick Tests. Unknown Result. Total. Fully Inoculated. Partly Inoculated. No. of Inoculations given. 1927 214 152 8 374 410 15 1233 1928 85 75 14 174 168 65 580 1929 21 27 7 55 72 15 221 1930 15 27 — 42 65 3 199 1931 6 7 - 13 17 5 58 1932 3 — 1 4 11 — 33 1933 5 4 — 9 32 1 97 1934 2 8 — 10 11 — 33 1935 45 16 — 61 164 14 514 1936 14 7 — 21 73 — 105 1937 21 11 - 32 131 - 131 e2 68 Number of Schick Re-tests. Year. 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 1937 1 70 1 72 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. 1937—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 1934 107 1930 445 1935 123 1931 152 1936 71 1932 172 1937 73 1933 156 69 Return made on or before the 13th of February, 1938, by Mr. E. S. Elliott, Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1936, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1936. Number of these Births duly entered by 31st Jan., 1938. No. ot Mirtns which on 31st Jan. 1938 remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1938 not accounted for. Total No. of Certificates of successful Primary Vaccination children under 14 received during Calendar Year 1931. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1937. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Certificates of Conscientious Objection received. Dead, Unvaccinated. Postpone ment byMedical Certificate. Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. North Deptford 459 145 1 179 13 3 1 44 73 - - South Deptford 424 154 2 - 210 5 2 3 29 19 - - Total 983 299 3 — 389 18 5 4 73 92 524 361 Dated February 9th, 1938. Successfully vaccinated after the declaration of conscientious objection, Nil. Total Number of Certificates for Year 1937 sent to other Vaccination Officers, 120. 70 Infectious Diseases of the Nervous System. The incidence of Cerebrospinal Meningitis, Acute Anterior Poliomyelitis and Encephaliti; 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:— Average Average 1925 1929 1930-1934 1935 1936 1937 Cases 3 3-6 .3† 3 1 Deaths 1.4 3 4 2 †Including one case of Posterior Basal Meningitis. Acute Poliomyelitis. The average number of notifications received between 1915-1924 was two. The figures since 1924 are as follows: — Average Average 1925-1929 1930-1934 1935 1936 1937 Cases2.6 1.6 — — 5 Deaths ... ... — 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 :— Average Average 1925-1929 1930-1934 1935 1936 1937 Cases 5 0.4 1 — Deaths 2.4 1 — 12 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 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 1937 117 83 0·9 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 Average 1920-1924 1925-1929 1930-1934 1935 1936 1937 Cases ... 8 4 0.8 — 2 — No deaths have been registered from this cause. Dysentery. The figures are as follows:— Average Average Average 1920-1924 (total) 1925-29 1930-1234 1935 1936 1937 Cases ... 3 2.5 0 — 1 20 Deaths ... — 0.4 0 — — — The 20 notifications of Dysentery were received during the period from 27th October to the end of the year. Bacteriological tests were carried out in 19 cases (including 3 cases notified from hospitals); the remaining case did not submit to test. B. Dysenteriæ (Sonne) was isolated in 6 cases, the remaining 13 proving negative. Deptford was not the only borough affected; a perusal of the notifications for the County of London showed that the epidemic was widespread throughout the Metropolis. 72 Infantile Diarrhœa. Since 1920, this has been notifiable in the case of children under two years of age, and the following are particulars of notifications received and deaths :— Average Average Average 1920-24 1925-29 1930-34 1935 1936 1937 Cases Notified 66 75 26 12 58 29 Deaths 28 15 18 16 18 11 All cases of Infantile Diarrhœa are investigated by the Health Visitors with the object of securing nursing assistance or hospital treatment where such is required. Insanitary conditions are passed to the District Sanitary Inspector to be dealt with. Puerperal Fever. The following is a tabular statement of the notifications and deaths in recent years. Year. Cases. Deaths. Death-rate per 1,000 births.  Average 1915-1924 7 4 1·6 1925-1929 8 3 1·7 1930 8 3 1·7 1931 5 4 2·3 1932 2 2 1·2 1933 4 6 3·8 1934 6 2 1·2 1935 1 — — 1936 2 — — 1937 5 — — 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:— Average 1926 (part) 1927 1928 1929 1930-34 1935 1936 1937 Cases 5 16 12 6 15 9 10 22 73 Of the 22 cases notified, 21 had been confined in hospital and 1 at home. 1 death occurred. The history given was that the patient had been in indifferent health all through the pregnancy. Spontaneous delivery was followed by severe post partum hæmorrhage, which caused her to be removed to hospital. Within 2½ hours of her arrival blood transfusion was carried out. The following day she appeared better, but complained of severe backache, and there was tenderness in both loins. Symptoms of uraemia developed and she died upon the fourth day after confinement. The post-mortem examination showed anaemia and acute inflammation and infarction of kidneys. 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:— Average 1926 (part) 1927 1928 1929 1930-34 1935 1936 1937 Cases ... 14 9 18 14 17 11 11 5 The following is a statement of the results of treatment in respect of the cases notified in 1937:- Vision Vision Since died Notified Treated Total Totalother At home In hospital paired paired blindness Causes 5 4 1 5 — — — Apart from true cases of Ophthalmia, midwives have to report cases of inflammation of the eye, and these, together with cases of Ophthalmia, are kept under observation by the Health Visitors. The Borough Council has made arrangements with certain local nursing organisations, viz., the Ranyard Nursing Association, the Queen's Nurses, Rotherhithe, and the St. John's Nurses 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. 74 Erysipelas. 31 cases were notified during the year. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. Enteric Fever. 7 cases were notified, but the diagnosis in one case was revised to Dysentery. 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, was reported during 1937. II. NON-NOTIFIABLE DISEASES. In the absence of formal notification, the reports from the head teachers of schools and a perusal of the death returns give some idea of the prevalence of these diseases. Their importance, however, cannot be stated and judged by the death-rate, for they are peculiarly liable to be the precursors of much chronic disability and ill-health, the extent of which it is not possible to assess. This particularly applies to the following:— Influenza. The following indicates the mortality directly attributed to Influenza since 1920:- No. of Deaths. Percentage of total Deaths. Death rate per 1,000 population.  Average 1920-1924 34 2·4 0·29 1925-1929 35 2·5 0·31 1930-1934 23 1·8 0·22 1935 6 0·5 0·06 1936 7 0·6 0·07 1937 27 2·4 0·28 75 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 1930-1934 18 1·4 0·17 1935 1 0·09 0·01 1936 9 0·7 0·09 1937 1 0·09 0·01 Measles is not a notifiable disease, but during the year under report 21 cases were heard of through schools and other sources, and visited by the Health Visitors. Where the home accommodation was unsuitable, the patients were removed to hospital, and in one other instance nursing assistance was provided by the Council. Whooping-Cough. The fatality in past years is as follows:— No. of Deaths. Percentage of total Deaths. Death-rate per 1,000 population.  Average 1915-1924 24 1·5 0·22 1925-1929 13 0·9 0·11 1930-1934 10 0·7 0·1 1935 5 0·5 0·05 1936 7 0·6 0·07 1937 10 0·9 0·10 Cases of Whooping-cough selected either because of unsuitable home conditions or the presence of other young children in the home, or on account of complications, are sent into hospital. 138 cases were heard of through schools, etc., and visited by health visitors. Tetanus. A supply of Anti-toxin is kept at the Town Hall for issue to practitioners on request. 76 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, 1937. Material. Number Positive. Number Negative. Total.  Swabs for Diphtheria 122 715 837 Samples of Disinfectant Powder 1 1 2 Sputum for Tuberculosis 31 52 83 Fæces for Enteric Fever 3 6 9 Fæces for Dysentery 3 10 13 Swimming bath water — 9 9 Urine for Enteric 2 1 3 Blood „ „ 2 — 2 Urine for Tuberculosis — 2 2 Pus „ „ — 2 2 Vomit for Coliform baccilus 1 — 1 Urine for Albuminuria — 2 2 Swab from eye — 1 1 Urea concentration 1 — 1 Maternity outfit for sterility — 1 1 Body of cat for anthrax — 1 1 *Note.—Other examinations are reported under " Food." At the Tuberculosis Dispensary, 893 specimens of sputum were examined. Of these, 634 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 259 specimens. Disinfection. The following is a summary of the work carried out. Full deatails are shown in tabular form in the Appendix (Tables II and III). Number of premises visited: Infectious diseases 595 „ „ „ Requests, rooms only 74 „ „ „ „ bedding only 76 „ „ „ Verminous conditions 159 „ „ „ Removals 18 Total premises visited 922 77 Number of rooms disinfected, formalin spray 870 ,, ,, ,, sulphur 272 Total 1142 Number of articles disinfected (steam disinfector) 17422 Number of books disinfected (formalin lamp) 302 „ „ articles destroyed at owners' request 488 „ ,, adults from Common Lodging Houses cleansed 36 „ ,, treatments for adults suffering from scabies 45 A quantity of meat (anthrax) and five van-loads of verminous furniture were destroyed. Disinfection of bedding and clothing is carried out by means of two Washington-Lyons machines; books, etc., in a formalin chamber, while rooms are sprayed with formalin or fumigated with sulphur. Shelter for Contacts. The Council has made provision for the temporary accommodation of contacts of infectious disease who may be required to leave their dwellings during the process of disinfection. The shelter was not used for this purpose during the year. Disinfestation. Verminous conditions, whether in the home, of wearing apparel or personal in character, come within the purview of the Council's activities. 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 Bathing Centre and provides the services of a Cleansing Attendant. This station, by arrangement with the London County Council, is primarily used for school children, but is available for adults at other hours. During the year, 36 adults and 1,541 children were cleansed. In addition, 1,039 treatments were given to children and 45 to adults suffering from scabies. 78 Bathing Station. During the year the work of erecting a Bathing Station, the plans of which had been approved by the Council in 1936, was concluded and the Station was formally opened on the 5th July by the Chairman of the Public Health and Housing Committee, Councillor E. C. Sherwood. The Bathing Station which is admirably equipped, is proving of the greatest service. 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 1930-1934 159 12·4 1·5 1935 167 15·1 1·7 1936 176 14·6 1·8 1937 162 14·2 1·7 79 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 1930-34 Male 0·8 3·8 39·0 26·4 14·4 Female 0·4 7·0 38·0 21·2 16·0 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 1937 Male — 10 33 28 18 89 Female — 4 32 20 17 73 Total — 14 65 48 35 162 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:- Pulmonary. Non-Pulmonary. Year. 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 „ 1925-1934 106 81 1·70 28 23 0·46 1935 91 68 1·60 20 17 0·37 1936 87 54 1·43 18 17 0·35 1937 80 71 1·56 13 12 0·26 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. Pulmonary* Non-pulmonary. Deptford. per 1,000 population. Pulmonary* Non-pulmonary. Average 1915-1924 0·99 0·29 1·17 0·28 „ 1925-1934 0·74 0·16 0·91 0·13 1935 0·61 0·11 0·83 0·06 1936 — — 0·66 0·11 1937 — — 0·69 0·09 Dr. N. M. Donnelly, the Tuberculosis Officer, reports as follows :— I have pleasure in submitting herewith the Annual Report on Tuberculosis work in the Borough in 1937. *By international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under " Pulmonary," are now included under " Nonpulmonary Tuberculosis." 83 Report of Tuberculosis Officer—continued. Notifications. The following table gives a summary of the notifications received from the 1st January, 1937, to 31st December, 1937, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 156; 137 Pulmonary Tuberculosis and 19 Non-pulmonary, as compared with 128 Pulmonary and 28 Non-pulmonary for the previous year. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from the 1st January, 1937 to the 31st December, 1937 Notifications on Form A. Total Notifications on Form A. 92 75 12 9 Age Periods Total Primary Notifications, 71 66 11 8 65 and up ... 2 ... ... 55-65 10 4 2 ... 45-55 11 4 2 ... 35-45 6 4 1 2 25-35 12 18 3 1 20- 25 12 18 1 2 15-20 13 11 ... ... 10-15 ... 1 1 1 5-10 3 1 ...... 1 1-5 2 3 1 1 0-1 2 ... ... ... Pulmonary— Males Females Non-Pulmonary Males Females F2 84 Report of Tuberculosis Officer -continued. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, otherwise than by formal notification. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up Total Cases Pulmonary—Males ... ... ... ... 2 2 1 1 1 2 ... 9 „ —Females ... ... ... ... 2 ... 1 ... 1 ... 1 5 Non-Pulmonary—Males ... ... ... ... 1 1 ... ... ... ... ... 2 „ —Females 1 ... 1 1 ... ... ... ... ... 1 ... 4 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— No. of Cases. Source of Information. Pulmonary. Non-Pulmonary. Death Returns from local Registrars 1 1 transferable deaths from Registrar-General 4 — Posthumous notifications ... 1 " Transfers " from other areas (other than transferable deaths) 8 4 Form D (from Sanatorium) 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 332 221 553 72 95 167 720 Number of cases removed from the Register during the year, inter alia of:— 1. Withdrawal of notification ... ... ... ... ... ... ... 2. Recovery from the disease 11 7 18 5 4 9 27 3. Death 47 18 65 4 1 5 70 4. Otherwise, e.g., left Borough, etc. 16 43 59 16 10 26 85 86 Report of Tuberculosis Officei—continued Notes on Tables of Notifications. The case of non-pulmonary disease learned of from the Death Returns was one in which the doctor in attendance believed the case to have been previously notified. Four of the five cases learned of from the Death Returns were transferable deaths, not in the Borough, and one a post-mortem diagnosis. Of the cases of non-pulmonary disease notified after death, one was a case of meningitis and one a case of hip disease, notified from hospital. In one case notified as suffering from non-pulmonary disease the diagnosis was not confirmed subsequently. Similarly, in six of the cases notified as suffering from pulmonary tuberculosis diagnosis was not confirmed. 22 of the pulmonary cases died before the end of the year. 8 died within one month of notification. 6 „ „ two months „ 2 „ „ three „ „ Most of these were cases of acute disease or cases notified from hospital. Explanations have been requested from notifying doctors where patients have died very soon after notification, or from doctors certifying causes of death where patients died un-notified. Of 35 cases who transferred into the Borough during the year 23 were seen and formally notified. It is unsatisfactory from the preventive aspect that a proportion of cases die un-notified in an area, or notified only a short time before death. Some patients with chronic disease who transfer from one area to another do not wish to attend the Dispensary, and even dislike being visited. If they think they know how to look after themselves a doctor may not be called in till near death. The Supplemental Return may include deaths of persons who have not really resided in the area for years, such as. mental hospital cases. Also lodging-house residents, who move frequently from one area to another, may not be known of in the area in which they die until they enter hospital, when very ill, although they may have been notified previously in some other area. 87 Report of Tuberculosis Officer—continued. Home accommodation of 135 of the Cases notified in 1937 (mental hospital, lodging-house and "diagnosis not confirmed" cases omitted). CASES and Number in Family. 115 Pulmonary Tuberculosis. 20 Non-Pulmonary Tuberculosis. 78 Cases with T.B. in Sputum. Rooms. 37 Cases in which T.B. not known to be present in Sputum. Rooms. Rooms. 1 2 3 4 5 or more 1 2 3 4 5 or more 1 2 3 4 5 or more 2 of 1 1 of 1 2 of 1 l of l 2 of 2 2 of 2 6 of 2 4 of 2 2 of 2 2 of 2 3 of 2 1 of 2 1 of 2 3 of 2 3 of 2 1 of 3 3 of 3 4 of 3 3 of 3 3 of 3 4 of 3 1 of 3 1 of 3 1 of 3 2 of 4 7 of 4 6 of 1 5 of 4 2 of 4 2 of 4 l of 4 1 of 4 1 of 4 1 of 5 3 of 5 2 of 5 6 of 5 1 of 5 2 of 5 1 of 5 1 of 5 1 of 5 2 of 6 3 of 6 3 of 6 2 of 6 8 of 6 1 of 6 3 of 6 4 of 7 1 of 7 1 of 8 1 of 8 1 of 8 1 of 9 1 of 9 1 of 12 20 had a separate room 8 had a separate room. 2 had separate room. 8 had separate bed with 1 other in room 5 had separate bed but 1 other in room. 2 had separate bed, but 1 other in room 2 ,, ,, ,, 2 ,, ,, 1 ,, ,, 2„ 2 ,, ,, 2 ,, 1 ,, ,, ,, 3 ,, ,, 12 had another in bed. 1 ,, ,, 3 ,, 36 had another in bed 5,, ,, 1 ,, 12 had another in bed. 6 ,, ,, & 1 other in room 1 „ „ 2 „ 1 ,, ,, 1 ,, 3 ,, ,, & 2 others in room 5 had 2 others „ 2 ,, ,, 2 ,, 1 „ „ &3 1 ,, ,, 3 „ 1 had 2 others in bed 1 2others ,, 2 „ 14 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 75 as compared with 76 for 1936. 1931 1932 1933 1934 1935 1936 1937 Pulmonary deaths 100 92 94 92 83 65 66 Non Pulmonary deaths 14 13 10 10 6 11 9 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 1937. Age Periods. New Cases.* Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary m f m f m f m f 0 2 - 1 - - 1 1 2 3 1 1 - - 5 3 1 - 2 - - 10 - 1 1 2 - - - - 15 15 13 1 - 4 3 - - 20 14 18 2 2 8 8 - - 25 13 19 3 1 5 4 1 - 35 17 4 1 2 8 1 1 - 45 12 5 2 - 13 2 1 - 55 12 4 2 1 6 1 1 1 65 and upwards — 3 — — 1 2 3 - Totals 80 71 13 12 45 21 7 2 *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 Deaths in 1937. Not notified 5 Died before notification 1 Died within one week of notification 4 „ „ one week to one month 5 „ „ one month to six months 16 „ „ six months to one year 6 „ „ one to two years 4 „ „ two to three years 6 „ „ three to four years 5 „ „ four to five years 4 „ „ five to six years 3 „ „ six to seven years 4 „ „ seven years and upwards 3 66 89 Report of Tuberculosis Officer-continued. The notifications of non-Pulmonary Tuberculosis were as follows:- Peripheral glands 6 Meninges 1 Abdominal 5 Bones and joints 6 Skin 1 - Total 9 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 1. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Tear 1937. 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 41 38 1 3 8 3 2 2 49 41 3 5 98 319 (b) Diagnosis not completed — - - - - - - - 8 — 1 2 11 (c) Non-tuberculous - - - - - - - - 87 76 13 34 210 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 4 6 2 — — — — 2 4 6 2 141 188 (b) Diagnosis not completed - - - - - - - - - 3 2 5 10 (c) Non-tuberculous - - - - - - - - 38 44 37 45 164 C.—Cases written off the Dispensary Register as (a) Recovered 12 3 1 2 3 — 3 3 15 3 4 5 27 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as T.B.) - - - - - - - - 133 126 55 81 395 4-22 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 189 135 18 17 24 31 16 18 213 166 34 35 448 167 (b) Diagnosis not completed - - - - - - - - 8 1 3 7 19 91 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 502 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 41 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 98 4. Cases written off during the. year as Dead (all causes) 63 5. Number of attendances at the Dispensary (including Contacts) 2336 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 148 Number of G.P. 36 reports from practitioners 56 7. Number of consultations with medical practitioners: (a) Personal 14 (b) Other. 161 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 196 9. Number of visits by Nurses or Health Visitors to Homes successful 2916 for Dispensary purposes unsuccessful 454 2856 successful 1470 101A Visits to non-Dispensary cases unsuccessful 352 1810 10. Number of (a) Specimens of sputum, &c., examined 634 (b) X-ray examinations made in connection with Dispensary work 263 (c) Sputum examinations for sary cases 259 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(6) above — 12. Number of " T.B. plus " cases on Dispensary Register on the 31st December 255 Notes on Table I. It will be noted that the number of persons on the Dispensary Register on the 31st December, 1937 is 467, a slight decrease over figure at end of 1936. 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 41 as compared with 56 in the previous year. "Transfers to other areas "and "Cases lost sight of" were 98 as compared with 123 in 1936. 63 deaths of Dispensary patients occurred, compared with 51 in the previous year. 92 Report of Tuberculosis Officer—continued. One patient had Ultra-violet light treatment for lupus. 18 patients have had artificial pneumothorax treatment at the Brompton, St. Thomas', Grove Park, Colindale, The Miller, St. John's and St. Alfege's Hospitals as out-patients, making 206 attendances. 218 refills have been given at St. Alfege's Hospital by the Tuberculosis Officer to 19 patients in addition to those mentioned above. Examination and Supervision of Contacts. Analysis of contacts of 143 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 monary I. No. of patients notified 143 84 39 20 II. No. of above seen at Dispensary 115 68 36 11 (a) Total contacts of cases seen at Dispensary— Adults 254 160 76 18 Children 72 44 25 3 (a') No. of above contacts examined at Dispensary— Adults 64 46 14 4 Children 53 36 14 3 III. No. of notified cases not seen at Dispensary 28 16 3 9 (a) Total contacts of cases not seen at Dispensary— Adults 66 40 6 20 Children 26 12 2 12 (a') No. of above contacts examined at Dispensary — Adults 13 11 2 0 Children 10 7 0 3 Total School Contact Cards sent to School Medical Officer 55 (a) Examined at Dispensary— Class 1* 13 Class 2* 19 (b) Not examined at Dispensary— Class 3* 23 *Class 1—Unsatisfactory cases. *Class 2—Apparently healthy cases. *Class 3—Not examined. 93 Report of Tuberculosis Officer—continued. 81 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. 33 % of the total contacts were examined before the end of the year. 63% of the child „ „ „ 24% of the adult „ „ „ It is of interest to note that the number of child contacts is increasingly much smaller than the number of adult contacts— approximately in 1937 only 30 per cent. 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 contact with a case of tuberculosis. Of 22 cases found to be tuberculous during the year—("contacts" or who had been living in contact with cases notified in this or previous years)—20 had been living in contact with cases in which Tubercle Bacilli had been found in the sputum. The Tuberculin Testing of child contacts of tuberculosis was continued, the results being similar to those in previous years. 94 Report of Tuberculosis Office)—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 tha 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. Thirty-seven 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 formerly in the case of patients requiring dentures who were on Public Assistance, the Public Assistance Committee was asked to cover the cost, such cost is now borne entirely by Council under the Tuberculosis Scheme. The income and expenditure in connection with the supply of dentures and repairs to dentures to 9 patients were as follows :— £ s. d. Total cost of dentures and repairs 18 18 6 Total cost of free cases 9 19 8 Contributions from Approved Societies 8 18 10 95 Report of Tuberculosis Officer—continued. The Dental Surgeon, Mr. J. Eric Magraw, reports the following as a summary of the year's work:— Cases. Attendances. Extractions. Fillings. Scalings. etc. Dentures. Repairs 34 200 54 44 120 8 4 Insured Persons. The number of insured persons on the Dispensary Register at the end of the year was 274. The number of reports from panel doctors in respect of patients on domiciliary treatment was 58. 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, 168 were senc by doctors. 186 reports on " Z " cards were made to doctors regarding panel patients. In addition, numerous letters were written to doctors and hospitals about patients. Consultations with medical practitioners. The number of consultations between practitioners and the Tuberculosis Officer was further increased to 175. 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 4,666. Reports are made on the undermentioned points respecting home conditions, contacts, etc.:— (a) Whether any assistance seems needed for the patient or family, and action taken, such as reference to the Secretary to the Tuberculosis Care Committee. (b) The health of Contacts, and whether they will attend the Dispensary for examination or go to their own doctors. (c) The extent to which the patient is taking care to prevent the spread of infection by following the advice given. (d) The sanitary condition of the home, defects reported and action taken to abate nuisances. 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. 145 of the new attenders were referred by the Council's staff. 38 attended voluntarily. Bacteriological examinations of sputa. The number of examinations of specimens for Dispensary cases was 634. In addition, 259 specimens were sent by practitioners for examination. X-ray Diagnosis. The number of X-ray examinations is 263 compared with 216 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 49 persons. Institutional Treatment. 125 patients were recommended to the London County Council for institutional treatment. 4 patients refused treatment. In some urgent cases (16) recommendations were also made from Dispensary for direct admission to London County Council general hospitals, and 58 patients sent to general hospital from other sources were seen therein by the Tuberculosis Officer. 181 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 1937— 3 died within 1 month from the date of the first attendance. 6 died within 3 months „ ,, „ 4 ,, ,, 6 ,, ,, ,, ,, 10 ,, ,, 12 ,, ,, ,, ,, ,, 34 ,, after 12 ,, ,, ,, ,, In two other patients the cause of death was not tuberculosis. In addition, 3 patients on the Register, but who were not Dispensary attenders, died. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take any action in relation to any tuberculous employee in the milk trade. Christmas Gifts. We have to thank Miss Greig our Dispenser who this year, again, provided a pleasant afternoon for many of our child patients. Cakes and toys distributed to the children were obtained from the Clerical Staff Xmas Gift Fund of the Prudential Insurance Company, through Miss Greig's efforts. Handicraft Centre. The Handicraft Classes have continued to be a useful therapeutic measure occupying pleasantly 14-18 patients who come on Friday afternoons for two hours, providing for some at least, means of employing their leisure at home, particularly those who make gloves or do embroidery work. As previously, leather and metal work, felt toys, trays, stools and mats are produced. Miss Forth the teacher interests the patients in the particular work they wish to do; to her and to Mrs. Monk who still attends to purchases, accounts and general management great thanks are due for keeping the patients happy and in regular attendance. The usual summer pic-nic and the winter tea and entertainment took place with apparently none but beneficial reactions. The G 98 Report of Tuberculosis Officer—continued. Managers of New Cross Kinema and the Empire again helped through the artistes who generously gave " turns." To them and to Mrs. Campbell and other friends who assisted, thanks are due, particularly to Councillor Taylor, as also to other members of the Care Committee. Artificial Light Treatment. In order that this form of treatment may be given to specially selected cases, the Council authorised the installation of the necessary equipment, viz., two carbon arc lamps. Report of Work of the Tuberculosis Care Committee, for 1937. Before commencing our report on the year's work, we wish to place on record our deep regret and sense of loss occasioned by the death of Miss Warcup, an old and valued member of the Committee. There are no important changes in connection with the work to report on during the year 1937, but the foundation has been laid for changes in the administration of the regulations for the provision of clothing for patients undergoing residential treatment by discussions between the Standing Conference of Metropolitan Boroughs' Tuberculosis Care Committees, and the appropriate authorities of the London County Council, which will come into effect in 1938 and will be reported on in due course. The Conference has also been busy with preparations for a Sale and Exhibition of Handicrafts, which will take place in 1938, and results will appear in the report for that year. Useful work has been accomplished by this body during 1937—a large amount of credit for the successful issue of which is due to the Chairman and Honorary Secretary of the Conference who have dealt with much of the detailed work of the matters referred to. During the year, 203 cases have been recommended for treatment. 1,069 visits have been paid to patients at home and in hospital. 1,087 persons have been interviewed at the Dispensary by the Secretary. 99 957 cases have been considered by the Committee at their meetings. In every case we have tried to help in the manner best suited to their needs. Three children were recommended and accepted by the London County Council for boarding out. In one case the parents withdrew their consent after arrangements had been made. The sale of Christmas Seals this year realised the amount of £112 Is. lOd. The expenses amounted to £8 3s. 11d., leaving the sum of £103 17s. lid. available for grants. This alone is not sufficient for our needs, and additional help is obtained from other appropriate sources—principally for ex-service men—such as weekly allowances for the home, where the breadwinner is undergoing treatment, complete outfits of clothing for patients who are going away and are eligible for help from voluntary sources, and cases where a larger grant is required for an emergency than we are justified in allowing from our small fund. In the campaign for " Prevention " which is the underlying motive of the Committee's work, money plays an important part, and we'hope as time goes on, to have a larger fund to draw on. A report that is now issued annually by the Care Committee, will enable readers to judge better as to the need for help, and realize what we have been able to do, only because we have a " Fund." It will also give an insight into the. human and personal side of our activities, which cannot be gained from this brief outline of the year's work, which may be likened to the bare framework on which we build as " well and truly " as we can. Before ending, we wish as usual, to acknowledge most gratefully, the help and co-operation extended to the Committee from all the organisations with which we come in contact. G2 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. 12. Health Education by means of addresses and the distribution of booklets and leaflets. 1. Health Visiting. The following is a numerical summary of the home visits made by the individual Health Visitors and a statement of the reasons originating the visits. 103 Summary of Visits paid by Health Visitors, 1937. Health Visitor District Visits Re-visits Total Miss Robus Deptford Park and Evelyn (part) Wards 907 2350 3257 Miss Cloke St. Paul's and Evelyn (part) Wards 706 2952 3658 Miss O'Loughlin Clifton, Vale and Canterbury (part) Wards 840 3415 4255 Miss Sherborne Canterbury and Hatcham Wards 541 2729 3270 Miss Reynolds St. John's (part), Town Hall and St. Peter's Wards 598 2242 2840 Miss Holland St. John's (part) Ward 309 2447 2756 Miss Little Pepys' and St. Catherine's Wards 821 2038 2859 Totals 4,722 18,173 22,895 Analysis of Visits paid by Health Visitors, 1937. To infants under 5 years Enquiries re Visits. Re-visits. Total. Births 1406 15283 16689 Still-births 56 — 56 Infant deaths 66 — 66 Ophthalmia Neonatorum 10 8 18 Measles 21 17 38 Poliomyelitis 1 4 5 Infant Diarrhœa 17 13 30 Pneumonia " 27 33 60 Whooping Cough 147 109 256 Infectious Disease hospital recoveries 71 11 82 Scabies 17 23 40 Visits to Foster Children 14 109 123 Miscellaneous visits 236 33 269 Unsuccessful visits 157 464 621 Total (under 5 years) 2,246 16,107 18,353 104 To children over 5 years Enquiries re Measles 31 10 41 Poliomyelitis 2 — 2 Infectious Disease recoveries 16 21 37 Whooping Cough 109 78 187 Scabies 72 55 127 Infant Diarrhœa 2 — 2 Pneumonia 1 2 3 Visits to Foster Children — 19 19 Miscellaneous visits 330 108 438 Total (over 5 years) 563 293 856 Other visits To expectant mothers 1133 459 1592 To Puerperal Fever or Pyrexia 18 5 23 Maternal death enquiry 1 — 1 To Common Lodging Houses 8 42 50 Total other visits 1,164 502 1,666 Unsuccessful visits 749 1271 2020 Totals 4,722 18,173 22,895 In the case of the 1,406 infants visited shortly after birth, it was found that 1,229 infants were being breast-fed and 102 partly breast-fed. Only 75 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 Toddlers' Ante- Welfare Clinic Natal Light Massage Schick Dental Total Miss Robus 75 — 2 1 — — 1 79 Miss Little 120 — 2 — — — — 122 Miss O'Loughlin 70 — 4 3 — — 9 86 Miss Stowell — 95 — — — — — 95 Miss Reynolds 53 — 4 2 — — — 59 Miss Holland 33 5 8 163 — — — 209 Miss Clubbe 208 — 217 — — 14 — 439 Miss Gibson — — 195 — 193 — — 388 Miss Cloke 58 — 8 6 — — 7 79 Miss Sherborne 83 — 4 — — — 1 88 Total 700 100 444 175 193 14 18 1,644 2. Welfare Centres. (a) Infant Welfare. In addition to maintaining the Clinics held at Gosterwood Street and Ilderton Road and staffing the Princess Louise Institute Clinic, the Council has provided a Central Clinic in Amersham Road. The Services provided there include Ante- and Post-Natal Clinics, Artificial Sunlight and Dental Treatment, Gymnasium and Massage facilities and Day Nursery accommodation. In addition a Toddlers' Clinic and Sewing and Cookery Classes, are held. 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 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 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 1 Under year 1-5 years Gosterwood Street 49 102 18 120 2229 2349 1896 453 1061 Central Clinic Monday sessions 47 108 14 122 2351 2473 1851 622 864 Tuesday Do. 51 90 15 105 2152 2257 1722 535 820 51 98 14 112 2754 2866 2016 850 1235 Wednesday Do. 52 77 10 87 1874 1961 1390 571 989 51 90 32 122 2313 2435 1777 658 864 Thursday Do. 51 37 9 46 1454 1500 1130 370 552 51 64 7 71 1260 1331 1098 233 444 Friday Do. 51 132 28 160 2742 2902 2177 725 1221 51 102 9 111 2180 2291 1705 586 851 Hales Street 52 137 33 170 2045 2215 1514 701 980 Ilderton Road 49 111 5 116 2342 2458 1914 544 1000 Toddlers' Clinic 100 — 556 556 231 787 — 787 787 Totals 706 1148 750 1898 25927 27825 20190 7635 11668 The Health Visitors collectively made 1,644 attendances at these Clinics. (b) Maternity Clinics. These are conducted at the Central Clinic, Amersham Road and at a newly established Clinic held at Clyde Street Baths, four Sessions per week at the former and one Session per week at the latter, 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 at the Central Clinic 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, 33 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. Closest co-operation exists between the L.C.C. Hospital Maternity Departments and the Council's Clinics. 107 Ante-Natal Clinic. The work of the Ante-natal Clinic during recent years is illustrated by the following figures. Year. No. of individual women attending. Average number of attendances per week. Total number of attendances made. 1922 311 19 938 1923 369 29 1439 1924 513 30 1497 1925 588 45 2268 1926 595 46 2292 1927 738 45 2241 1928 815 55 2777 1929 929 56 2915 1930 973 64 3212 1931 980 64 3289 1932 880 58 2994 1933 887 61 3182 1934 905 57 2931 1935 887 57 2-984 1936 888 59 3090 1937 899 63 3278 The following is the text of Dr. Hill's Report for 1937:— Ante-Natal Clinic Statistics, 1937. Total number of Patients on Register 899 New Cases 725 Total Attendances 3,278 Normal 120 Not pregnant 26 Abnormalities:— Albuminuria 56 Hydramnios 10 Anaemia 73 Leucorrhoea 9 Ante-partum Haemorrhage 6 Malpresentation 27 Bartholini Abscess 1 Morbus Cordis 11 Bronchitis 4 Oedema 22 Cataract 1 Ovarian cyst 1 Chorea 1 Phlebitis 2 Contracted Pelvis 17 Psoriasis 1 Cystitis 2 Pruritis 6 Deformed Nipples 45 Pyelitis 1 Dental Caries 424 Retroversion 4 Dyspepsia 8 Syphilis (congenital) 1 Fibroid 2 Sciatica 13 Gastric Ulcer 1 Twins 6 Goitre 1 Varicose veins 75 Haemorrhoids 38 Vomiting 1 Hernia 3 108 Post-Natal Clinic. This branch of the work is conducted every Tuesday forenoon. Total on Register 161 Total attendances 171 Amongst the patients seen the following defects were found and dealt with :— Albuminuria 2 Mastitis 4 Anaemia 6 Retroversion 12 Breast Abscess or Inflamed Subinvolution 2 Nipple 4 Unhealed tears of cervix 2 Fibroid 4 Unhealed tears of perineum 2 Haemorrhoids ... ... 7 Remedial exercises were taught to 109 patients. 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 Tuberculosa Officer 2 Ditto to midwives 132 Ditto to doctors 20 Total number of cases referred by letter to hospitals 139 Do. do. sent for X-ray 33 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 Clinics held 145 Total attendances made 626 (c) Artificial Light Clinic. Both the Mercury Vapour and the Carbon Arc type lamps are in use, and, in order to bring this form of treatment more up to date, it has been decided to instal a centrallyplaced Mercury Vapour lamp together with two ancilliary lamps of the " Sollux " type, to aid the efficiency of Ultra-violet radiation. 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 1937. 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 /ears 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 1 Year 1—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. January 9 73 1 3 6 46 ... 1 ... ... ... ... 1 31 1 3 14 88 ... 1 57 550 9 5 621 February 14 88 ... 1 3 30 ... 3 ... ... ... 1 1 32 ... 3 16 86 ... 2 57 696 ... 10 763 March 16 86 ... 2 2 8 ... 1 ... ... ... ... 1 29 ... 2 17 65 ... 1 35 518 ... 9 562 April 17 65 ... 1 8 37 ... 1 ... ... ... ... 3 57 ... 1 22 45 ... 1 59 519 ... 4 582 May 22 45 ... 1 8 22 ... 1 ... ... ... ... 2 20 ... 2 28 47 ... ... 64 390 ... 1 455 June 28 47 ... ... 3 7 ... 3 ... ... ... 1 6 51 ... 3 4 24 ... 1 61 276 ... 9 346 July 4 24 ... 1 ... 3 ... ... ... 1 ... ... ... 23 ... 1 ... 9 ... ... 20 101 ... 1 122 August ... 9 ... ... 2 2 ... 2 ... ... ... ... ... 1 ... 1 2 10 ... 1 6 44 ... 5 55 September 2 16 ... 1 7 23 ... 3 1 3 ... ... ... 7 ... 1 10 29 ... 3 34 171 ... 20 225 October 10 29 ... 3 7 29 ... 3 ... 4 ... ... ... 5 ... 5 17 57 ... 1 87 355 ... 15 457 November 17 57 ... 1 2 49 ... 5 ... ... ... ... 3 11 ... 2 16 95 ... 4 68 660 ... 27 755 December 16 95 ... 4 3 20 ... ... ... ... ... ... 5 31 ... 3 14 84 ... 1 23 466 ... 7 496 Totals ... ... 51 276 ... 23 1 8 ... 2 22 298 1 27 ... ... ... ... 571 4,746 9 113 5,439 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 l Yr. Over 1 Yr. AnteNat. PostNat. Anaemia 12 62 ... 2 ... 2 ... ... Rickets 18 49 ... ... ... 2 ... ... Muscular Weakness 1 22 ... ... ... 1 ... ... Myasthenia 4 3 ... ... ... ... ... ... Delayed Dentition 9 37 ... ... ... 1 ... ... Curved Tibia 1 36 ... ... 1 1 ... ... Malnutrition 3 15 ... ... ... ... ... ... Abscesses ... 1 ... 1 ... ... ... ... Cervical Adenitis 1 11 ... ... ... ... ... ... Genu Valgum ... 21 ... ... ... ... ... ... Asthma ... 1 ... ... ... ... ... ... Otorrrhœa 1 2 ... ... ... ... ... ... Neuritis ... ... ... 1 ... ... ... ... Mastits ... ... ... 17 ... ... ... 3 Undersized ... 1 ... ... ... ... ... ... Bronchitis ... 6 ... ... ... ... ... ... Underweight ... 3 ... ... ... ... ... ... Post Whooping ... ... ... ... ... ... ... ... Cough ... 1 ... ... ... ... ... ... Right Intoeing ... 1 ... ... ... ... ... ... Flat Foot ... 3 ... ... ... ... ... ... Infantile Eczema ... 1 ... ... ... ... ... ... Cracked Nipples ... ... ... 2 ... ... ... ... Marasmus 1 ... ... ... ... ... ... ... Totals 51 276 ... 23 1 7 ... 3 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 January 1st, 1937, 32. Do. December 31st, 1937, 49. New Cases 176 (including 4 under 1 year of age). Discharged 159. Attendances 2,241. 111 (e) Day Nursery. This provides for the reception of selected children upon five days each week. Total Number of Attendances 2,556. Number of Individual Children on Register December 31st, 24. By reason of affiliation to the National Society of Day Nurseries, scholarship students who are training at the Council's Day Nursery are eligible to sit for the examination and obtain the Certificate of the Society. (/) Sewing Class. 247 attendances of Mothers were registered during the year. (g) Toddlers' Clinic.—Number of Clinics held, 100 Total number of Inspections made, 787 New cases, 556 Old cases, 231 Summary of Defects found. Deformed 1 Imperforate Hymen 1 Tonsils 105 Cervical Adenitis 20 Dental Caries 155 Malnutrition 5 Rickets 9 Enuresis 21 Genu Valgum 122 Strabismus 1 Flat Foot 71 Umbilical Hernia 8 Curved Tibiae 43 Talipes 1 Deformity of Chest 8 Tongue tie 1 Lordosis 1 — Heart defects 2 Total 580 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 1937 :— Scalings, Cases. Extractions. Fillings. Silver Nitrate Gas Dentures etc. Cases Supplied. Repaired. Mothers 232 377 427 223 87 43 2 Children 163 183 89 289 102 — — 112 3. Consulting Obstetricians. The circumstances under which the services of Consulting Obstetricians can be requisitioned may be summarised as follows:— (a) hi the case of Puerperal Fever or Pyrexia. Any Practitioner can obtain the assistance of the Council's Consulting Obstetrician, 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.l. The scheme provides for the recovery of ail 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 1937 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 1937 :— Cases admitted, 210. Average stay, 2 weeks. Cases delivered by midwives. 195. „ „ „ doctors, 11. Cases in which medical advice sought, 18. Cases notified as puerperal fever, Nil. „ „ ,, puerperal pyrexia, Nil. Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, 2. Maternal deaths, Nil. Foetal deaths (a) Stillborn, 6. (b) Within 10 days of birth, 6. So far as is practicable, only cases likely to follow a normal course 113 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 1937, it was found necessary to call the Consultant to the Home on 4 occasions for 5 consultations. Cases not admitted to the Maternity Home. During 1937, a number of applications for admission were refused, owing to the available accommodation being fully booked. 5 applicants withdrew their applications after assessment. 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 65 Sold at half price 17 Sold at full price 13 6. Provision of Home Nursing. Arrangements have been made for the provision of a District Nurse in certain types of illness. Full details of these appear under "• Nursing in the Home." 7. Provision of Home Helps. The scheme for this form of domestic assistance makes provision for the service of a Home Help during labour and the first three months from the date of confinement and, in exceptional cases during pregnancy. In 17 instances, Home Helps were provided during the year under report. 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 1937,10 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:— 107 children admitted, of which 39 were sent by the Borough Council. 589 test feeds were conducted at the Breast-feeding Clinic, of which all were sent by the Borough Council. 29 mothers with infants were admitted as in-patients for restoration of breast-feeding. 1 O. 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 1937, the following free or half-price issues were authorised :— 13,133 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 9 instances this policy was carried into effect, involving a total expenditure of £4 10s. 0d. Payment of Midwives' Fees. In three 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 and cookery demonstrations given. 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 1936. Added. Removed. No. at end of year 1937. Fostermothers 22 8 11 19 Fosterchildren 27 13 20 20 Appendix. 118 Table I. Causes of Death at Different Periods of Life in the Metropolitan Borough of Deptford, 1937. CAUSES OF DEATH. Sex. All Ages 0– 1– 2– 5– 15– 25– 35– 45– 55– 65– 75– All causes M 624 34 3 2 9 17 26 30 66 117 161 159 F 515 32 3 4 3 20 12 18 49 93 119 162 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Measles M 1 1 .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. 1 .. .. .. .. .. .. .. .. Whooping Cough M 4 4 .. .. .. .. .. .. .. .. .. .. F 6 3 2 .. 1 .. .. .. .. .. .. .. Diphtheria M 2 1 .. .. 1 .. .. .. .. .. .. .. F 1 1 .. .. .. .. .. .. .. .. .. .. Influenza M 9 .. .. .. .. .. .. .. 2 2 3 2 F 18 .. .. .. .. 1 1 2 2 3 3 6 Encephalitis Lethargica M 1 .. .. .. .. .. .. 1 .. .. .. .. F 1 .. .. .. .. .. .. .. .. 1 .. .. Cerebro-spinal Fever M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory sxstem M 45 .. .. .. .. 12 5 8 13 6 1 .. F 21 .. .. .. .. 11 4 1 2 1 2 .. Other Tuberculous Diseases M 7 .. .. .. .. .. 1 1 1 I 2 1 F 2 1 .. .. .. .. .. .. .. 1 .. .. Syphilis M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane, tabes dorsalis M 3 .. .. .. .. .. .. .. 1 1 1 .. F 2 .. .. .. .. .. .. .. 1 1 .. .. Cancer, malignant disease M 89 .. .. .. .. .. 5 5 13 20 28 18 F 73 .. .. .. .. .. .. 4 13 19 20 17 Diabetes M 2 .. .. .. .. .. .. .. .. .. 1 1 F 7 .. .. .. .. .. .. .. .. .. 5 2 Cerebral Hæmorrhage, etc. M 15 .. .. .. .. .. .. 1 .. 4 3 7 F 21 .. .. .. .. .. .. .. .. 7 9 5 Heart Disease M 181 .. .. .. .. 2 3 3 15 30 58 70 F 176 .. .. .. .. 1 2 1 6 32 40 94 Aneurysm M 2 .. .. .. .. .. .. .. .. 1 1 .. F 1 .. .. .. .. .. .. .. 1 .. .. .. Other Circulatory Diseases M 29 .. .. .. .. .. .. .. .. 6 10 13 F 25 .. .. .. .. .. .. .. 4 6 a 6 Bronchitis M 15 .. .. .. .. .. .. 1 .. 3 7 4 F 18 .. .. .. .. .. .. .. .. 2 7 9 Pneumonia (all lorms) M 46 2 3 .. .. 1 2 2 2 10 15 9 F 37 4 .. 1 .. 1 .. 2 8 7 6 8 Other Respiratory Diseases M 7 .. .. .. .. 1 .. .. 1 3 2 .. F 3 .. .. .. .. .. .. .. 1 .. 1 1 Peptic Ulcer M 10 .. .. .. .. .. 2 .. 4 4 .. . . F 1 .. .. .. .. .. .. .. .. .. 1 .. Diarrhœa, &c. M 6 6 .. .. .. .. .. .. .. .. .. .. F 6 4 1 .. .. .. .. .. .. 1 .. .. Appendicitis M 3 .. .. .. .. .. .. .. 1 2 .. .. F 7 .. .. 2 .. 2 1 .. 1 1 .. .. 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 . . . . . . . . . . . . . . 2 1 . . . . F 1 . . . . . . . . . . . . . . . . 1 . . . . Other diseases of Liver, etc. M 2 . . . . . . . . . . . . . . . . 1 1 . . F 1 . . . . . . . . . . . . . . . . 1 . . . . Other Digestive Diseases M 9 2 . . 1 . . . . . . . . 1 2 1 2 F 6 . . . . . . . . . . . . 1 . . 2 3 . . Acute and chronic Nephritis M 16 . . . . . . . . . . 2 . . 2 2 4 6 F 15 . . . . . . . . 1. . . . 1 3 3 1 5 1 Puerperal Sepsis F . . . . . . . . . . . . . . . . . . . . . . . . Other Puerperal causes F 1 . . . . . . . . 1 . . . . . . . . . . . . Congenital Debility, Premature Birth, Malformations, etc. M 16 16 . . . . . . . . . . . . . . . . . . . . F 17 16 . . . . . . 1 . . . . . . . . . . . . Senility M 13 . . . . . . . . . . . . . . . . . . 3 10 F 9 . . . . . . . . . . . . . . . . . . 1 8 Suicide M 13 . . . . . . . . . . 1 2 3 4 2 1 F 3 . . . . . . . . . . . . 2 1 . . . . . . Other violence M 13 . . .. . . 2 . . 3 . . 2 2 1 3 F 12 2 . . . . 1 1 2 1 . . 1 2 2 Other defined diseases M 62 2 . . 1 6 1 2 6 3 12 17 12 F 23 1 . . . . . . 1 1 1 6 5 5 3 Causes ill-defined or unknown M . . . . . . . . . . . . . . . . . . . . . . . . F . . . . . . . . . . . . . . . . . . . . . . . . 1 Table II. SHOWING NUMBER OF ARTICLES DISINFECTED OR DESTROYED AT OWNER'S REQUEST. 1937 Articles Stoved Articles Destroyed at Owner's Request Books Bathing Station Lodging Houses Beds Pillows Bolsters Mattresses Sheets Blankets Miscellan'us Total Beds Pillows 1 Bolsters Mattresses Sheets Blankets Miscellan'us Books Total D.B.C. Library Private Total Towels Blankets Wearing Apparel Total Persons I Cleanse.1 Wearing Apparel Stoved January 46 126 33 30 73 108 363 779 7 7 4 7 1 l 49 24 100 14 ... 14 198 20 244 462 3 20 February ... 56 148 39 45 114 169 380 951 ... ... ... 3 ... ... ... ... 3 15 13 28 320 35 369 724 3 27 March 23 119 25 32 76 107 244 632 2 2 ... 3 ... ... 14 ... 21 17 ... 17 247 23 276 546 2 13 April 17 70 17 25 48 82 188 447 8 2 1 1 ... ... 26 ... 41 6 ... 6 319 32 494 845 3 19 May 29 91 18 36 65 98 229 566 4 3 1 1 ... ... 8 ... 17 20 ... 20 292 32 560 884 4 29 June 27 63 20 25 52 68 177 432 2 1 1 4 ... ... 45 ... 53 3 ... 3 374 31 514 919 3 18 July 23 68 16 21 47 86 115 376 3 ... ... 3 ... ... 38 ... 44 13 ... 13 256 29 414 699 1 6 August 20 62 15 24 34 36 111 302 5 4 2 4 ... ... 4 ... 19 11 ... 11 126 20 275 421 1 7 September... 30 106 30 38 75 85 250 614 2 12 3 6 4 1 17 ... 45 20 12 32 406 21 397 824 3 28 October 66 151 33 66 142 196 348 1002 1 3 1 1 ... ... 33 ... 49 17 ... 17 351 19 341 711 6 44 November ... 69 145 37 69 140 203 507 1170 9 7 4 6 2 ... 49 ... 77 8 1 9 453 35 467 955 4 26 December ... 48 145 27 41 101 163 401 926 3 5 ... 3 1 1 16 ... 29 20 112 132 432 69 477 978 3 20 460 1294 310 452 967 1401 3313 8197 46 46 17 45 8 3 299 24 498 164 138 302 3774 366 4828 8968 36 257 120 1 Table III. SHOWING NUMBER OF PREMISES VISITED AND ROOMS DISINFECTED. 1937 Premises Visited Rooms Disinfected Infectious Diseases Requests Bedding only Removals Verminous Scarlet Fever Diphtheria Pulmonary Tuberculosis Scabies 1 Cancer T vphoid Fever Erysipelas Puerperal Fever \V hoo-<injj Cough CerebroS inill. Meningitis Anthrax Infantile Paralysis Formalin Sprav Sulphur Total Rooms Infectious Diseases Requests Kemovals Ver- I minous January 48 10 10 3 8 6 22 22 10 2 .. 3 .. .. .. .. .. 65 22 6 12 105 February 58 6 3 5 9 9 22 23 14 .. 4 .. .. .. .. .. .. 72 8 6 16 102 March 54 5 5 2 8 13 17 35 5 .. 2 .. .. .. .. .. .. 72 7 3 14 96 April 34 6 8 3 11 7 8 19 4 3 .. 2 .. .. .. .. .. 43 11 5 18 77 May 40 4 11 .. 11 18 8 23 6 .. .. .. l .. .. .. .. 56 4 .. 18 78 June 34 10 6 1 31 11 7 15 5 3 .. 1 .. .. .. .. .. 42 13 2 53 110 July 38 4 9 .. 18 17 8 20 4 .. .. 1 .. .. .. .. .. 50 4 •• 35 89 August 41 5 7 1 17 11 7 19 4 1 .. .. .. l l l .. 45 9 1 26 81 September 51 7 6 .. 17 26 13 11 5 1 1 .. l .. .. .. 1 59 16 .. 27 102 October 65 3 3 .. 9 29 21 6 12 1 1 .. .. .. .. .. .. 70 3 .. 17 90 November 69 7 7 2 9 21 23 9 22 1 .. .. .. .. .. .. .. 76 8 3 18 105 December 63 7 1 1 11 18 28 19 12 .. .. .. .. l .. .. .. 78 9 2 18 107 595 74 76 18 159 186 184 221 103 12 8 7 2 2 l l l 728 114 28 272 1142 121 122 MONDAY SESSIONS AT ST. LUKE'S HALL, GOSTERWOOD STREET 1937 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~i- J anuary 4 11 1 2 14 183 197 88 February 4 4 1 1 1 7 192 199 84 March 4 4 1 2 7 186 193 85 April 4 7 1 1 9 189 198 75 May 4 12 2 2 2 18 164 182 95 June 4 8 1 2 11 195 206 79 July 4 3 2 5 207 212 88 August 5 10 2 1 13 180 193 80 September 4 7 3 10 203 213 115 October 4 6 1 3 10 195 205 79 November 5 11 1 1 13 221 234 121 December 3 2 1 3 114 117 72 Total .. 49 85 4 13 18 120 2229 2349 1061 CENTRAL CLINIC—MONDAY SESSIONS 1937 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 1 2 1 2 1 6 219 225 71 February 4 4 1 5 194 199 66 March 4 8 1 9 201 210 75 April 4 2 2 3 7 226 233 82 May 3 6 1 7 141 148 56 June 4 10 1 2 13 183 196 73 July 4 2 1 2 1 6 181 187 68 August 4 16 16 189 205 65 September 4 22 2 4 3 31 192 223 69 October 4 5 3 8 224 232 74 November 5 8 2 1 11 260 271 101 December 3 1 2 3 141 144 64 Total 47 86 9 13 14 122 2351 2473 864 123 CENTRAL CLINIC—TUESDAY SESSIONS (Hatcham-Pepys District) 1937 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 8 8 176 184 65 February 4 4 1 5 192 197 74 March 5 4 1 2 5 12 214 226 86 April 4 4 2 3 9 196 205 73 May 4 4 2 2 1 9 140 149 51 June 5 11 5 16 174 190 66 July 4 4 1 5 167 172 63 August 5 5 1 6 184 190 60 September 4 5 2 2 9 172 181 63 October 4 5 1 4 10 185 195 77 November 5 7 1 3 11 228 239 92 December 3 4 1 5 124 129 50 Total 51 65 6 19 15 105 2152 2257 820 CENTRAL CLINIC—TUESDAY SESSIONS (VALE DISTRICT) 1937 No. of times Clinic opened. New Cases. Total New Cases Total Old Cases. Total New and Old Cases- Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5. January 4 4 1 2 7 222 229 108 February 4 7 1 1 1 10 224 234 101 March 5 3 2 2 7 221 228 102 April 4 8 1 1 10 208 218 88 May 4 6 1 1 1 9 183 192 86 June 5 7 1 8 257 245 98 July 4 9 1 1 11 204 215 91 August 5 7 2 1 10 282 292 112 September 4 7 1 8 261 269 108 October 4 10 1 1 1 13 261 274 115 November 5 8 3 1 3 15 290 305 142 December 3 3 1 4 161 165 84 Total 51 79 13 6 14 112 2754 2866 1235 124 CENTRAL CLINIC—WEDNESDAY SESSIONS (ST. JOHN'S DISTRICT) 1937 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 8 1 9 141 150 85 February 4 3 1 2 6 171 177 85 March 5 2 2 4 160 164 82 April 4 4 2 1 7 142 149 66 May 4 1 1 2 95 97 49 June 5 6 1 8 186 194 98 July 4 11 3 1 15 162 177 87 August 4 4 1 1 6 157 163 69 September 5 10 2 12 201 213 108 October 4 2 1 1 4 136 140 70 November 4 3 1 2 6 150 156 86 December 5 6 1 1 8 173 181 104 Total 52 60 7 10 10 87 1874 1961 989 CENTRAL CLINIC—WEDNESDAY SESSIONS (TOWN HALL-ST. PETER'S DIST.) 1937 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 5 1 5 11 204 215 76 February 4 4 2 6 192 198 62 March 5 4 2 3 2 11 243 254 90 April 4 4 1 1 3 9 179 188 69 May 3 5 3 8 137 145 57 June 5 5 1 1 6 13 233 246 90 July 4 4 2 1 7 185 192 63 August 4 10 1 1 12 160 172 67 September 0 7 2 3 12 224 236 87 October 4 2 1 2 2 7 170 177 54 November 4 10 1 2 4 17 201 218 69 December 5 7 1 1 9 185 194 80 Total 51 67 7 16 32 122 2313 2435 864 125 CENTRAL CLINIC—THURSDAY SESSIONS (Deptford Park-Evelyn Dist.) 1937 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 5 2 7 121 128 39 February 4 2 2 4 124 128 55 March 3 3 3 106 109 46 April 5 8 1 1 10 183 193 66 May 4 4 1 5 123 128 53 June 4 1 2 3 127 130 40 July 5 1 1 129 130 47 August 4 1 1 2 107 109 30 September 5 2 1 1 4 138 142 60 October 4 110 110 43 November 4 3 1 4 100 104 39 December 5 2 1 3 86 89 34 Total 51 32 2 3 9 46 1454 1500 552 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC 1937 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1-5 January 4 10 1 1 12 149 161 77 February 4 5 1 2 5 13 168 181 91 March 4 7 4 11 116 127 53 April 5 8 1 5 6 20 177 197 100 May 4 6 1 2 2 11 146 157 70 June 4 6 3 3 12 189 201 52 July 5 6 2 2 10 227 237 86 August 4 12 3 2 3 20 156 176 70 September 5 11 2 2 3 18 155 173 85 October 4 9 2 2 13 191 204 99 November 4 12 4 16 205 221 107 December 5 7 1 4 2 14 166 180 90 Total 52 99 10 28 33 170 2045 2215 980 126 CENTRAL CLINIC—THURSDAY SESSIONS (VALE DISTRICT) 1937 No. of times Clinic opened. New 0ases. T olal New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed Mixed. Hand Ages 1-5 January 4 6 1 1 1 9 67 76 28 February 4 6 1 7 93 100 37 M arch 3 1 1 69 70 18 April 5 2 1 1 4 115 119 34 May 4 4 2 1 7 74 81 23 June 4 5 1 6 97 103 49 July 5 4 1 5 141 146 40 August 4 4 1 5 120 125 33 September 5 8 3 1 12 136 148 50 October 4 7 7 124 131 40 November 4 1 1 121 122 48 December 5 5 1 1 7 103 110 44 Total 51 53 5 6 7 71 1260 1331 444 ILDERTON ROAD CLINIC 1937 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Hand. Ages 1—5 January 4 10 1 11 142 153 74 February 4 8 1 1 10 170 180 80 March 3 3 2 1 6 126 132 53 April 3 8 2 10 218 228 90 May 4 11 1 1 1 14 175 189 72 June 4 4 4 190 194 72 July 5 9 6 1 16 242 258 90 August 4 8 8 202 210 81 September 5 8 1 3 2 14 254 268 97 October 4 5 5 213 218 90 November 4 9 2 11 208 219 105 December 5 3 1 2 1 7 202 209 96 Total 49 86 12 13 5 116 2342 2458 1000 127 CENTRAL CLINIC—FRIDAY SESSIONS (Hatcham-Pepys District) 1937 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 Jauuary 5 7 3 3 13 195 208 111 February 4 6 1 1 3 14 199 213 96 March 3 7 2 1 10 145 155 66 April 5 11 2 5 18 274 292 125 May 4 9 1 2 12 216 228 92 June 4 7 2 9 227 236 99 July 5 11 1 4 1 17 266 283 103 August 4 8 2 3 13 230 243 84 September 4 7 1 2 1 11 219 230 91 October 5 5 3 5 13 309 322 134 November 4 6 7 3 16 243 259 116 December 4 9 3 1 1 14 219 233 104 Total 51 18 11 28 28 160 2742 2902 1221 CENTRAL CLINIC—FRIDAY SESSIONS (St. Catherine's District) 1937 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 1 2 1 4 164 168 74 February 4 4 1 1 6 152 158 68 March 3 6 6 102 108 39 April 5 5 2 1 8 226 234 87 May 4 5 2 2 9 152 161 54 June 4 9 3 1 13 169 182 52 July 5 4 1 3 1 9 217 226 76 August 4 11 4 2 17 182 199 65 September 4 5 2 1 1 9 195 204 76 October 5 8 4 2 2 16 248 264 95 November 4 5 5 194 199 76 December 4 6 3 9 179 188 89 Total 51 69 13 20 9 111 2180 2291 851 I N DEX. PAGE A Acreage 8 Acute Primary Pneumonia 70 Acute Influenzal Pneumonia 70 Acute Poliomyelitis 70 Albany Deptford Babies' Hospital... ... 25, 114 Ambulance Facilities ... .. 25 Ante-natal Examination J06 Ante-natal Clinic 107 Anthrax 54 Area and Population 3 Artificial Light Clinic .. 108 B Babies' Hospital 114 Bacteriological Examination 61,76 Bathing Station 78 Births 11 „ illegitimate 12 ,, Notification of 12 c Cancer 78 Canal Boats Acls 35 Causes of Sickness 15 Central Clinic 105 Cerebio-spinal Meningitis 70 Chicken pox 68 Cleansing Station 78 Clinics and Centres 26, 105 Committee, Public. Health 3 „ Maternity and Child Welfare 3 Convalescent Treatment 114 ii. PAGE D Day Nursery 111 Deaths 13 Death-rate 13 „ comparisons 13 „ during 10 years 13 Deaths in Wards .. 14 „ percentage in age groups 15 „ causes of 14,118 „ ages at 15 „ Infantile, causes 16 ,, Infectious disease 64 Denial Clinic 111 Deplford Babies' Hospital 114 Diabetes and Insulin 79 Diarrhoea 72 Diphtheria 67 Disinfectants 78 Disinfection 76, 120,121 Disinfestation 77 Dysentery 71 E Encephalitis Lethargica 70 Enteric Fever 74 Erysipelas 74 F Factory and Workshop Act 36 Food Inspection 46 Poisoning 54 „ Sampling 54 ,, Unsound 53 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, 122-127 Infectious Diseases, Notifications 64 Infective Jaundice 79 Influenza 74 Insulin and Diabetes 79 L Laboratory Work at the Seamen's Hospital 76 Legal Proceedings 31 M Malaria 71 Marriages 11 Massage and Exercises 110 Maternal Mortality 115 Maternity and Child Welfare Committee 3 Maternity Home 25,112 „ Consultant 113 Maternity Outfits 113 Measles 75 Midwives 24, 115 iv. PAGE M—continued. Milk, Bacteriological Examination 47 ,, Supply to Nursing Mothers, etc. 114 Mortality of Infants 15 Mortuary Report 17 Municipal Maternity Home 25 Municipal Foot Clinic 25 N Notification of Births 12 Nursing Arrangements 23 Nutrition 61 O Obstetricians, consulting 112 Ophthalmia Neonatorum 73 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 23 R Ranyard Nurses 23 Rats 32 v. PACK s St. John's Home 108 St. John's Nurses 23 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 Ill Tuberculosis—Care Committee 99 „ Report of Tuberculosis Officer 82 „ General 82 „ Handicraft Centre 97 „ Home accommodation 87 „ Notification Table 83 „ Revision of Register 85 „ Supervision of Contacts 92 „ Dental Treatment 94 V Vaccination 69 w Whooping Cough 75