LIBRARY DEPT 23 THE METROPOLITAN Borough of Deptford. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR thE year 1988 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. 1938 deptford: Gaylard 4 Son, 446 New Cross Road. S.E. 14. Public Health and Housing Committee. Mapor. Councillor E. C. SHERWOOD, J.P. Chairman. Councillor W. TAYLOR. Vice=Chairman. Councillor C. G. BLANCHARD. Alderman R. Anderson, B.A. Alderman Mrs. E. M. Bateman. Councillor F. T. Chisnell. Councillor Mrs. A. Manley. Councillor Mrs. M. F. Morrell. Councillor Mrs. A. M. Ott. Councillor E. A. Robinson. 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. F. A. Coppen. Councillor Mrs. A. Hayward. Councillor Mrs. A. Manley. Councillor Mrs. M. F. Morrell. Councillor Mrs. E. C. Pearson. Councillor W. Taylor. Alderman Mrs. E. M. L. Watson. A2 Metropolitan Borough of Deptford. Public Health Department, Deptford Town Hall, S.E.14. 28th June, 1939. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Deptford. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my tenth Annual Report upon the sanitary circumstances, sanitary administration and vital statistics of the Borough. In doing so I desire to express my appreciation of the meticulous care shown by the Members of the Staff in the discharge of his or her duties—without such co-operation it would have been impossible to carry through the volume of work outlined in the following pages. SECTION A Physical Features and Vital Statistics. 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. 6 The permanent open spaces are as follows:— Situation. Size. Maintained by. 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Ground. Brookmill Road 1¼ acres Borough Council. 3. Telegraph Hill Recreation Ground. Telegraph Hill 45½ acres L.C.C. 4. Railways and adjoining land 234 acres 5. Millwall Football Ground 5½ acres 6. Canals 8 acres 7. St. Paul's Churchyard 2·2 acres 8. Reservoir 1 acre 9. Municipal Playing Fields Deptford Bridge 4½ acres Borough Council. 10. St. Paul's Playground 0·50 acres „ 11. Lewisham High Road Gardens ·88 acre „ At the end of the year consideration was being given by the Council to the securing of the tenancy of approximately two acre's of land adjacent to the Ravensbourne Recreation Ground for the purpose of an Open Space. Statistics. Area 1,564 acres Population: Census 1931 106,891 Registrar-General's Estimated Resident population, 1938 95,460 Number of inhabited houses according to the Rate books (end of 1938) 18,300 Number of families or separate occupiers (1931) 29,248 Number of structurally separate dwellings (Housing Survey, 1935) 18,572 Rateable Value, April 1938 £667,824 Estimated sum represented by a 1d. Rate (1937/8) £2,701 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:— 17th Oct., 1938 Males, 2,185 Females, 816 7 I am indebted to the Public Assistance Officer for the following figures:— (a) Total number of Deptford Residents, including wives and children, on outdoor relief, at the end of 1938 :—2,530. (b) Amount expended on outdoor relief in Deptford during year ended 31st December, 1938:— £59,001 7s. 11½d. 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 531. Of these, 454 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 10,228 applications for fortnightly supplies were granted. Of this number, 8,717 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. 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. Birth-rate. Live Births Legitimate 695 635 1,330 14·4 Illegitimate 23 26 49 Total 718 661 1,379 8 Still-births, 43. Rate per 1,000 total births, 30·2. Death-rate. Deaths 1,127 11·8 Percentage of total deaths occurring in Institutions 63 Number of women dying in, or in consequence of, childbirth: Rate per 1,000 (live and still) births. From Puerperal Sepsis — — Other Puerperal causes 2 1.4 Total 2 1·4 Death-rate of infants under one year of age, per 1,000 live births: Legitimate 53·4 Illegitimate 81·6 Total 54·3 Deaths from Measles (all ages) 2 „ Whooping Cough (all ages) 1 „ Deaths from Diarrhœa (under 2 years) 7 Population. The population for 1938, as given by the Registrar-General, was 95,460, the lowest on record. Marriages. During the year 969 marriages took place, equivalent to a rate of 20·3 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 610 Other places of worship 82 In the Superintendent Registrar's Office 277 Total 969 Births. After allowing for inward and outward transfers, i.e., the addition of children born of Deptford parents outside the Borough, and the deduction of children born inside the Borough, but whose parents reside normally outside its boundaries, the number of births registered as belonging to the Borough was 1,379. This is equivalent to a birth-rate of 14·4 per 1,000 of the population and, after subtraction of deaths, represents only a natural increase of 2·6 per 1,000 of the population. 9 The following table illustrates the steady fall that has taken place: No. BIRTHS. County of London. Deptford. England and Wales. Crude rate per 1,000 population. Crude rate per 1.000 population. 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 „ 1930-34 1658 157 15·3 143 1935 1432 14·4 14·7 13·3 1936 1548 15·7 14·8 13·6 1937 1462 15·1 14·9 13·3 1938 1379 14·4 15·1 13·4 Provisional figures. Still-Births. 43 still-births were registered during the year as follows:— Legitimate Illegitimate Total Male 21 1 22 Female 20 1 21 Illegitimacy. The figures relative to illegitimacy in 1938 and in previous years are as follows: Av. for 10 yrs. 1915-24. Av. for 5 yrs. 1925-29 Av. for 5 yrs. 1930-34 1935 1936 1937 1938 No. of illegitimate births 77 58 53 35 47 42 51 Percentage of total births 2·9 3·0 3·2 2·4 3·0 2·8 3·7 Notification of Births. During 1938, the number of notifications received of births and still births actually occurring in the Borough was 711. After allowing for inward and outward transfers, the corrected figure was 1,406. 10 The following in an analysis of these notifications: Birth Notified in the Borough, Year ending 31/12/38. Ward. Births notified. Alive Dead By whom notified Total Male Female Parent Doctor Midwife Other Deptford Park 29 12 17 27 2 1 3 22 3 Evelyn 65 35 30 64 1 — 2 60 3 St. Paul's 75 41 34 72 3 — 2 72 1 Vale 52 23 29 50 2 — 2 49 1 Clifton 37 19 18 37 — — 9 23 5 Canterbury 36 16 20 35 1 2 4 30 — Hatcham 37 16 21 37 — 2 1 29 5 Pepys 30 20 10 26 4 1 2 26 1 St. Catherine's 33 19 14 32 1 — — 31 2 St. Peter's 244 131 113 232 12 1 2 241 — St. John's 42 22 20 40 2 1 2 38 1 Town Hall 31 17 14 30 1 — 2 28 1 Total 711 371 340 682 29 8 31 649 23 Less Births notified in the Borough, but transferred to other authorities 14 8 6 13 1 - - 14 - 697 363 334 669 28 8 31 635 23 Add Births occurring in out-of-Borough Institutions 709 360 349 692 17 - 1 708 - Grand Total 1406 723 683 1361 45 8 32 1343 23 Deaths In order to express the number of deaths as a death-rate applicable to the Borough, it is necessary to make allowance in respect of deaths of persons occurring within, but belonging outside the Borough, and, conversely, for those who died while temporarily living outside Deptford. Total deaths registered in the Borough 473 Deduct deaths of "non-residents" 83 390 Add deaths of "residents" outside Borough 737 Nett deaths applicable 1,127 This is equivalent to a death-rate of 11.8 per 1,000 persons. 11 Seasonal Mortality. Quarter ended. 1937 1938 No. Rate per 1,000 of population. No. Rate per 1,000 of population. March 354 14·7 313 13·1 June 301 12·5 268 11·2 September 197 8·2 267 11·1 December 287 11·9 279 11·7 The trend of the death.rate in recent years is shown by the following table:— Year. Deptford. England & Wales. London. No. Rate per 1,000 of the population. Average for 10 years, 1915-1924 1560 14·1 13·6 13·9 1925-1934 1324 12.1 12.1 12.0 1935 1106 11.1 11·7 11·4 1936 1202 12·2 12·1 12·5 1937 1139 11·7 12·4 12·3 1938 1127 11·8 11·6 11·4 Causes of Death. An analysis of the causes of death will be found in Table 1 of the Appendix. The following is a comparative statement of the chief causes of mortality in recent years: Cause of Death. Rate per 1 000 deaths (all causes). 1938. Average No. for 10 years 1915.24. Average 1925-1929 Aveiage 1930-1934 1935 1936 1937 1938 Increase or decrease over 1937 Measles 1·8 27 20 18 1 9 1 2 + 1 Whooping Cough 0·9 24 13 10 5 7 10 1 - 9 Diphtheria 4·4 19 14 9 10 6 3 5 + 2 Influenza 70 70 35 23 6 7 27 8 -19 Tuberculosis—Pulmonary 48 136 102 100 83 65 66 54 -12 Non-pulmonary 8.8 32 18 12 6 11 9 10 + 1 Cancer 146 133 159 168 167 176 162 165 + 3 Heart Disease 313 128 232 304 260 298 357 353 - 4 Cerebral Hæmorrhage, Em bolism and Thrombosis 49 67 54 53 60 66 36 56 + 20 Bronchitis 30 140 95 53 46 73 33 34 + 1 Pneumonia (all forms) 66 154 121 87 64 63 83 75 - 8 Nephritis 24 35 34 33 20 28 31 27 - 4 Diarrhoea and Enteritis 6·2 45 20 21 19 20 12 7 - 5 Violence (excluding Suicides) 34 48 49 43 42 48 25 39 +14 Premature Birth tion and Debility 39 86 49 45 27 40 33 44 +11 12 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 1938 Under 1 year 16·3 9·4 7·7 6·7 6·4 5·8 6·6 From 1-2 years 4·7 2·7 2·0 0·6 1·5 0·5 0·4 „ 2-5 years 4·3 2·8 2·3 1·1 1·2 0·5 1·1 „ 5-15 years 3·9 2·9 2·1 1·9 1·2 1·0 0·7 „ 15-25 years 4·4 4·3 4·3 3·5 2·9 3·2 3·0 „ 25-45 years 12·3 10·5 9·5 8·9 8·2 7·6 7·5 „ 45-65 years 23·3 27·7 26·4 27·9 27·4 28·5 25·2 65 years and upwards 30·8 39·6 45·6 49·4 51·2 52·8 55·3 The infantile mortality rate for 1938 was 54 per 1,000 births and the following Table gives the death-rates for England and Wales, London and Deptford for previous years:— Year Deptford England & Wales (148 smaller towns) Death-rate Death-rate No. per 1.000 per 1,000 Births Births London Death-rate per 1,000 Births Average for 10 years 1915-1924 231 90 87 85 Average 1925-1929 129 64 71 65 „ 1930-34 99 60 63 63 1935 74 52 57 58 1936 77 50 59 66 1937 66 45 58 60 1938 75 54 51 57 13 The following Table gives details of the causes of death in the various age groups:- various age groups:- Infantile Mortality, 1938. 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 1 months Total Deaths under 1 year. All Causes 29 6 10 1 46 9 8 7 5 75 Smallpox .. .. .. .. .. .. .. .. .. .. Chicken pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarler Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. 1 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. 1 .. .. 1 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 1 1 Other Tuberculous .... .. .. .. .. .. .. .. .. .. Meningitis (not tuberculous) .. 1 .. .. 1 .. .. .. 1 Convulsions 1 .. .. .. 1 .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 .. 1 .. .. .. .. 1 Pneumonia (all forms) .. .. 4 .. 4 2 3 7 1 17 Diarrhœa .. .. .. 2 1 .. .. .. .. 1 Enteritis .. .. .. .. .. 4 1 .. 1 6 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. Suffocation, overlaying. .. .. .. .. .. .. .. .. .. .. Injury at Birth 4 .. 2 .. 6 .. .. .. .. 6 Atelectasis 1 .. 1 .. 2 .. .. .. .. 2 Congenital Malformations 1 1 .. .. 2 .. 1 .. .. 3 Premature Birth 21 3 .. .. 24 .. .. .. .. 24 Atrophy, Debility, and Marasmus 1 1 1 .. 3 2 2 .. .. 7 Other Causes .. .. 1 •• 1 •• 1 .. .. 2 Totals 29 6 10 1 46 9 8 7 5 75 Death-rate in each age. group per 1,000 births 20 9 4·3 7·2 0·7 33·1 6·5 5·7 5·1 3·6 54 Percentage of total deaths in each age. group 38·6 8·0 13·4 1·3 61·3 12·0 10·7 9·3 6·7 100 14 The following Table illustrates the trend of infant mortality during recent years in regard to deaths in the various age groups. Mortality (Stated as Percentages) in Age-groups. Year. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks to 3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Decennium 1915-1924 24·8 5·0 4·3 3·2 37·3 18·6 17·9 12·3 13·9 1925-1929 27·0 6·1 3·5 3·0 39·6 18·4 13·8 13·5 14·7 1930-1934 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 1938 38·6 8·0 13·4 1·3 61·3 12·0 10·7 9·3 6·7 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. Pubic Mortuaty. During the year there were received the bodies of 300 persons, of whom 71 had been resodents of Deptford. Particulars of the bodies received were as follows: Month, 1938 Male. Female. Inquests. PostMortems. Under 1 year. Deposited to Await Burial. January 15 11 20 20 2 males — 1 female — February 21 11 19 17 1 female — March 18 12 16 22 1 female — April 17 8 24 10 2 females — May 20 7 15 16 - —' June 9 5 8 10 1 female — July 16 2 10 10 — 1 August 14 2 17 6 1 male — 2 females — September 20 12 23 15 2 males — 1 female 1 October 11 4 8 10 1 female — November 13 6 3 20 2 males — 1 female — December - 22 6 10 20 — 1 Total 196 86 173 176 18 3 15 Inquests. Natural Causes Accidental Causes Suicide Misadventure Murder Open Verdict January 17 8 2 — — 2 February 21 8 3 — — 1 March 19 7 4 — — 1 April 13 9 3 — — 2 May 18 7 1 — — 1 June 10 2 1 — — 2 July 13 4 1 — — — August 9 4 4 — — 9 September 21 13 — — — 1 October 11 4 - — — 1 November 19 1 — 1 — 1 December 25 3 — — — — Total 196 70 19 1 — 14 Bodies Received. 1938 Deptford Other Districts January 6 23 February 12 21 March 6 25 April 5 22 May 7 20 June 2 13 July 6 12 August 4 15 September 7 28 October 5 11 November 5 17 December 6 22 71 229 Total 300 SECTION B. General Provision of Health Services. B 18 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 Deputy 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. (Fart-time Maternity and Child Welfare.) b. m. pl.ayfair, m.d., d.p.h., (Part-time Maternity and Child Welfare and G\naecological Clinic.) Obstetric Consultant. J. H. Peel, m.d., f.r.c.s. (For Maternity Home and under Puerperal Fever and Pyrexia Regulations.) Obstetric Consultants. J. B. Blaikley, f.r.c.s. A. L. Gunn, f.r.c.s. (Edin.) H. G. Taylor, 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. (resigned) W. H. Jennings, l.d.s., r.c.s. (Eng.) Public Analyst. 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. M. A. Loftus, m.d. (retired) P. J. Russell, m.b., B.ch., b.a.o., l.m. F. Murray, m.r.c.s., l.r.c.p. Vaccination Officer. E. S. Elliott. 19 Assistant Administrative Officer. Chari.es A. Chapman, Cert, s.i.e.b. (Lond). Clerks. G. A. Langley S. Burridge E. J. Elliott *J. E. Waring G. B. Allen L. C. Southgate R. J. G. Barber (temporary) General Assistant. E. H. Evans Sanitary Inspectors and Sampling Officers. R. W. Allen Cert. r.s.i. Joint Board., Meat Cert. r.s.i. T. R. A. Fitzherbert Ph. C., Cert, s.i.e.b. (Lond.), 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. tThomas R. W. Mason Cert. s.i.e.b. (Lond.) William F. Mayo Cert. s.i.e.b. (Lond.) J. E. Waring Cert. s.i.e.b. (Lond.), Meat Cert. r.s.i. 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. (r.s.i.) * Employed as whole-time Sanitary Inspector from 4th April, 1938. †From 4th April, 1938, employed whole time upon A.R.P. duty. {Part-time only at Central Clinic. B2 20 Light Treatment Department. Health Visitor in chargeMiss 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— R. McAllister. W. S. Saunders (resigned 16-10-38). Tuberculosis Dispensary. Secretary, Tuberculosis Care Committee—Miss B. Lewellin. Tuberculosis Health Visitors— Miss A. M. Roy, Gen. Training, c.m.b., h.v. (r.s.i.). Tuberculosis Cert. (r.s.i.) Miss E. A. Coles, Children's Training, c.m.b.. h.v. (r.S.I.), Tuberculosis Certs. (Brompton Hospital), Public Health Diploma (Battersea Polytechnic). Dispenser Clerk—Miss G. F. Greig (Asst. Soc. Apothecaries, Cert.) Assistant Clerk—Miss 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 21 Disinfecting Station, Watson Street. Chief Disinfector—T. Lyons Disinfectors—F. Smith and F. Peache Driver—J. Lloyd Laboratory Facilities. See " Food" and "Infectious Diseases." London Ambulance Service. Within the administrative county of London the London County Council provides ambulances, free of cost, for the conveyance to (a) Hospitals or private residences (except in the City of London") of Persons meeting with accidents or suffering from sudden illnesses in the streets, public places, places of employment, etc. (b) Hospitals of (i) Persons meeting with accidents in their homes; (ii) Persons suffering from illnesses in their homes if a medical practitioner certifies that the case is one of life or death, and provided that arrangements have been made for the reception of the patient in a hospital; (iii) Parturient women, if the case is one of urgency, whether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case; and (iv) Non-urgent cases of parturition provided that admission to a maternity bed has previously been arranged and a card (issued by the Council to hospitals, municipal maternity homes, etc.) for such admission obtained; *The Corporation of the City of London maintains its own ambulance service for dealing with cases of accident and illness occurring in the streets within the City area. 22 (c) The Council's hospitals for infectious diseases of patients subject to the fulfilment of certain conditions; and (d) The Council's hospitals and institutions for non-infectious cases of patients when application is made:— (i) through the Council's public assistance department; and (ii) by, or on behalf of, the Council's special, general, and mental hospitals. Ambulances and ambulance-omnibuses are also provided by the Council, when not required for the purposes stated above, on payment of charges, as laid down from time to time by the Council, for the conveyance of infectious and non-infectious cases between private houses, hospitals (other than to the Council's hospitals, etc., under the provisions of (a), {b), (c) and (d) above), and nursing homes, and for examinations, consultations and treatment by specialists or at special establishments. 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, diarrhoea, poliomyelitis and ophthalmia neonatorum. During epidemic periods, pneumonia and influenzal pneumonia (all ages) are included. Payment is made by the Borough Council at the rate of 1s. 3d. per nursing visit. 23 The following is a summary of the cases visited on behalf of the Borough Council by members of the District Nursing Associations:— Condition, Children under 5 years Others Total cases nursed Cases Visits Cases Visits Measles 39 412 21 242 60 Ophthalmia Neonatorum 4 67 4 Pneumonia 6 122 2 46 8 Thread Worms 2 17 2 Conjunctivitis 1 36 1 Diarrhoea 2 32 2 Ear trouble ... 2 28 2 Whooping cough ... 1 9 1 Circumcision ... 2 26 2 Impetigo 2 50 2 Post Natal Complications 3 28 3 Bronchitis 9 137 9 Influenza 1 13 1 Congestion of Lungs... 3 41 3 Eye Trouble ... 4 52 4 Mastitis 6 140 6 Ante-natal 1 42 1 Lung Trouble 1 63 1 Rheumatism ... 1 6 1 Swollen Glands 1 6 1 Boil 1 10 1 79 1045 36 580 115 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 256 Visits 13898 Surgery Patients 630 Attendances3091 24 Treatment Centres and Clinics. 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 Clinics—Infant Welfare Monday, Gosterwood Street, 2 p.m. Thursday, Baptist Institute, Ilderton Road, 2 p.m. Thursday, Princess Louise Institute, Hales Street, 2 p.m. Ante-natal—Thursday, Clyde Street Toddlers—Monthly, Ilderton Road Health Centre, Harton St. Foot Clinic — Sessions:— Monday 6 p.m. to 8.30 p.m. Tuesday 2 p.m. to 4.30 p.m. and 6 p.m. to 8.30 p.m. Wednesday 2 p.m. to 4.30 p.m. Thursday 2 p.m. to 4.30 p.m. Friday Special appointment Session— Thursday 6 p.m. to 8.30 p.m. Gynaecological Clinic Alternate Tuesdays 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. Dental Clinic—Alternate Tuesdays. Venereal Diseases. Miller Hospital, Greenwich, S.E. 10. Male and Female, Daily, 8 a.m. to 8 p.m. St. John's Hospital, Morden Hill, Lewisham, S.E. 13. Clinic Hours— Men: Tuesday 5.30 p.m. Thursday 9.30 a.m. Women : Monday, 3 p.m. Thursday, 6.15 p.m. Guy's Hospital, St. Thomas Street, S.E. 1. Any week-day, 9 a.m. to 8 p.m. King's College Hospital, Denmark Hill, S.E. 5. Syphilis—Tuesday, 4.30 p.m. Wednesday and Friday, 11 a.m. Thursday, 2 p.m. Gonorrhoea—Monday, 2 p.m. Men. 6 p.m., Women and Children. Wednesday, 6 p.m., Women and Children. Thursday, 5 p.m., Men. Friday, 2 p.m.. Women and Children. 25 School Clinics. Deptford School Treatment Centre, Lady Florence Institute, Reginald Square. Eye and Minor Ailments (Eye): Tuesday and Friday. 2 p.m. Ear, Minor Ailments: Friday, 9.30 a.m. Operations, Monday, 2 p.m. at Cyril Henry Centre, Woolwich. Skin Ailments: Wednesday, 2 p.m. Teeth : Alternate Mondays, 9.30 a.m. and 1.30 p.m. School Clinics—continued. 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. and 1.30 p.m. Gas, Tuesday, 9.30 a.m. Inspections. Alternate Mondays and Thursdays, 9.30 a.m. Day Nursery School. (Open Air) The " Rachael McMillan " Memorial School. Municipal Foot Clinic. Four afternoon and four evening sessions are held weekly, and, of the latter, the session held on Thursday evening is reserved for persons making special appointments. Owing to the increasing popularity of this service, it was found necessary. in order to avoid the turning away of a considerable number of persons, to engage an additional chiropodist to attend at each of the sessions. There are, therefore, two male and one female chiropodists on the staff. 408 sessions were held during the year, at which 6,669 treatments were given. The receipts totalled £292 5s. GynÆcological Clinic. In September the Council opened a clinic at Harton Street Health Centre at which women, both married or single, could attend for the diagnosis and treatment of conditions suggestive of derangement of the reproductive organs. Such conditions if not remedied at an early stage frequently incapacitate. The clinic is held fornightly and is in charge of Dr. Bessie Playfair, who is on the staff of the Royal Free Hospital. Dr. Playfair reports as follows :— No. of Sessions 8 New cases 31 Total attendances 58 26 Diseases Treated. Cervicitis 2 Menorrhagia 1 Cervical erosion 3 Sterility 4 Retroversion 2 Leucorrhœa 6 Cystocele and rectocele 1 Amenorrhœa 2 Cystocele only 1 Haemorrhoids 1 Vaginitis 1 Contraceptive advice 2 Vaginal atresia 1 Routine post-natals 8 Some patients were treated for more than one disease. Contraceptive advice is given strictly in accordance with the regulations of the Ministry of Health, and is available only to married women in whom pregnancy would be dangerous to health. HOSPITALS. Infectious Diseases. Under the provisions of the Local Government Act, 1929, hospital accommodation for the isolation and treatment of infectious diseases, including small-pox, is organised and maintained by the London County Council for the County of London as a whole. The South-Eastern Hospital, situated in Deptford, has approximately 480 beds. Since the passing of the National Insurance Act, 1911 and other measures, hospital and sanatorium accommodation for Tuberculosis is similarly provided by the London County Council. Accommodation for infectious cases for those who can pay for such is available at the London Fever Hospital, Liverpool Road, N. Maternity. The Council's Maternity Home is situated at 52 Wickham Road, and has accommodation for 12 cases. (See Report " Maternity and Child Welfare.") 27 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. Midwifery and Maternity Services. 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 (including municipal midwives) is estimated at twenty-two. Prior to the inception of the County Council's domiciliary midwifery scheme, various conferences of borough medical officers with the county medical officer were held, and, as a result, agreement was reached upon many aspects of the proposed service, which now functions smoothly in Deptford. The important part of the midwifery service, namely, the provision of a mobile emergency obstetrical unit, was under consideration at the end of the year and came into operation upon the 20th February, 1939. It is designed to deal with acute obstetrical emergencies in cases in which patients cannot be moved into hospital without undue risk and whose needs cannot be adequately dealt with by the obstetric consultant service of the Borough. 28 In view of the Midwifery—Prohibition of Unqualified Persons— Order, 1938, where it is believed that an unqualified person has received any remuneration for attending as a nurse on a woman in childbirth the fact is notified to the supervising authority. Institutional Provision for Mothers and Children.-—No provision. Health Visitors.—See " Maternity and Child Welfare." Child Life Protection.—Ditto. Orthopcedic Treatment.—No scheme has been made, but individual children are referred to private doctors or to hospitals. Dental Treatment.—See "Maternity and Child Welfare" and " Tuberculosis." SECTION C. Sanitary Circumstances, etc., AND Factory Act. 30 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 :— 1932 1933 1934 1935 1936 1937 1938 Total primary inspections 6,652 8,166 8,039 10,854 8,184 11,040 9,505 Total re-inspections - 17,284 18,105 17,704 20,112 16,906 23,779 19,968 Total Intimation Notices served 2,623 2,748 2,656 2,850 2,431 3,121 2,694 Total Statutory Notices served 687 777 632 698 658 805 824 Total Housing Act Notices served 10 18 4 1 – 1 32 Total premises on which works were completed - 2,990 3,116 2,977 3,256 2,863 2,997 2,585 Total improvements effected during the year - 10,928 12,440 11,185 11,301 9,947 1,1210 11,425 I am satisfied that the high standard reached in previous years has been maintained, and the apparent decline in 1938 is due to the fact that Inspector Troughton, who was engaged in a temporary capacity, resigned in December, 1937, and was not replaced. A further cause is to be found in the extra duties which the Inspectors are called upon to perform in connection with Housing. In addition to the above, 1,925 inspections and calls have been made by the Food Inspector, Mr. Yates. 251 visits were made to St. George's Wharf by Inspector Webster for the purpose of the examination of imported foods. 31 Summary of Sanitary Work carried out during the year 1938. Inspections — Number of District. 1 2 3 4 5 6 7 8 9 Totals Compara tive figures for 1937. On complaint 182 115 374 196 236 227 131 88 ... 1549 1568 House-to-house— 1. Where defects found 194 185 134 175 204 206 88 2 ... 1188 1332 2. Where no defects found 42 15 15 39 26 21 3 ... ... 161 314 On occurrence of Infection 108 63 136 68 109 72 63 7 ... 626 578 On Notice from builder 173 32 75 79 75 102 95 15 ... 636 587 Reference from T. B. Dispensary ... 1 1 1 4 2 ... ... ... 9 22 Market Inspection 13 13 13 13 3 13 13 13 ... 94 87 Factories 17 26 68 52 54 59 73 ... ... 349 439 Workshops and workplaces 29 21 103 57 52 35 68 ... ... 365 563 Food premises 23 254 2 11 62 5 15 ... ... 372 390 Butchers' premises ... ... ... 1 1 ... 1 ... ... 3 12 Milk premises 24 127 35 10 51 55 24 ... ... 326 328 Offensive businesses ... ... 7 1 ... ... 1 ... ... 9 10 Common Lodging Houses ... "8 15 ... 3 8 17 4 ... 55 49 Ice Cream premises 21 39 57 30 43 28 34 ... ... 252 171 Fish Shops 18 13 13 31 11 28 20 ... ... 134 148 Bakehouses 10 ... 13 11 11 6 47 ... ... 98 91 Outworkers' premises ... 10 9 2 10 17 9 ... ... 57 126 Miscellaneous inspections 131 82 309 81 122 185 187 41 ... 1138 1530 Office Inspections ... 5 2 1 4 5 18 34 ... 69 ... Housing Inspections 159 201 98 100 92 70 100 880 ... 1700 1844 Shops Act Inspections ... ... ... ... ... ... ... 88 ... 88 630 Poisons Act Inspections ... ... ... ... ... ... ... 227 ... 227 231 Total inspections 1144 1210 1479 959 1173 1144 997 1399 ... 9505 11040 Re inspections, Calls, etc. 2476 2206 2525 2655 3186 3194 2279 1447 ... 19968 23779 Smoke observations ... ... 3 ... 3 2 ... 21 ... 29 12 Notices Served— Intimation 381 284 470 429 421 405 253 51 269 f 3121 Statutory 44 93 190 148 119 158 66 6 8!4 805 Housing Act ... 5 ... ... ... 2? ... ... ... 32 1 Premises in respect of which notices were complied with 356 297 450 369 389 416 239 69 ... 2585 2997 Premises in respect of which works in compliance with notices served during the year 1938 were out standing at the end of the year 57 65 78 47 59 50 39 7 ... 402 438 Description of Sanitary Improvements effected during the year— Number of rooms cleansed 474 657 681 511 631 646 392 39 ... 4031 3063 Defective roofs repaired 85 118 118 59 79 124 74 12 ... 669 094 Gutters, etc.,provided or repaired 73 102 40 46 57 76 33 8 ... 435 484 Dampness abated 30 62 115 98 93 142 70 13 ... 623 571 Yards, etc., paved or repaired 52 100 21 13 78 31 32 1 ... 378 303 Water Fittings repaired 50 10 14 23 15 47 50 3 ... 212 113 Sinks, etc., renewed or repaired 153 77 75 77 127 156 112 9 ... 786 741 Drains entirely reconstructed 2 ... 3 3 9 14 15 ... ... 46 38 32 Summary of Sanitary Work—continued. Number of District Comparative figures for 1937. 1 2 3 4 5 6 8 9 Totals Drains partially reconstructed 6 19 8 20 10 10 17 4 ... 94 106 Drains unchoked and cleansad 11 5 22 31 12 12 10 21 ... 124 139 Soil pipes, etc., renewed or repaired 13 1 9 7 33 165 25 1 ... 254 293 Gullies provided, unchoked, etc 5 12 12 2 30 25 28 2 ... 116 183 Manholes, etc., provided or repaired 11 10 5 15 20 35 16 1 ... 113 135 Premises in which repairs were effected to w.c's. 174 199 226 139 200 236 167 49 ... 1390 1400 Dustbins provided 46 20 56 41 50 55 44 2 ... 314 403 Window repairs 91 154 46 61 123 114 31 13 ... 633 683 Stove and copper repairs 40 104 79 45 58 93 27 9 ... 455 457 Stair and door repairs 18 68 28 23 22 33 17 1 ... 210 172 Flooring repaired 20 80 12 35 32 47 16 4 ... 246 244 Ventilation, heating and lighting improved 19 7 3 47 8 24 11 1 ... 120 91 Fish shops limewashed 15 11 13 21 7 21 9 ... ... 97 123 Bakehouses limewashed 5 ... 8 6 8 5 2 ... ... 34 48 Accumulations removed I 3 2 2 1 4 4 2 ... 19 40 Miscellaneous repairs 7 3 1 7 1 3 3 1 ... 26 86 Total repairs and improvements effected 1401 1822 1597 1332 1704 2168 1205 196 11425 11210 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 ,, Waring Canterbury and Hatcham (part) Wards. 6 „ Wilton Hatcham (part) Pepys and St. Catherine's Wards. 7 ,, Green St. Peter's and Town Hall Wards. 8 „ Fitzherbert Factories and Workshops, Shops Acts, and Poisons' Act Inspector (also Housing) 33 House-to-House Inspections. 1,349 house-to-house inspections were made. These inspections were carried out in the following streets:— Alverton Street Grove Sreet Railway Grove Baildon Street Hood Street Royal Naval Place Bingley Place Heston Street Rutt's Terrace Blackhorse Road Hereford Place St. Asaph Road Brookmill Road Ilderton Road Selden Road Bush Road Kenwood Avenue Strickland Street Camplin Street Lovelinch Street Senegal Road Chubworthy Street Lausanne Road Snead Street Clyde Street Milton Court Road Staunton Street Czar Street Mona Road Vance Street Cottesbrooke Street Monson Road Vulcan Road Dennett's Grove Marchant Street Walpole Road Edale Road New King Street Watson Street Edward Street Norfolk House Windmill Lane Faulkner Street Prince Street Wrigglesworth Street Florence Terrace Ruddigore Road Warwick Street Greenfield Street Rudford Road Wilson Street Eradication of the Bed Bug. Verminous conditions, whether of the home, of wearing apparel or personal in character, come within the scope of the Council's activities. During the year under report, it was not found necessary to disinfest any Borough or County Council houses. 268 rooms in 140 privately owned houses were found to be in a verminous condition and were disinfested. The usual method employed is the application of Sulphur Dioxide. Where this is not practicable owing to pervious walls and floors or where it is impossible for damageable articles to be temporarily removed, spraying with Solution " D " is carried out. Before removal to Council houses, the belongings of tenants in whose homes traces of vermin are discovered, are sprayed with the above solution. All disinfestation is carried out by the Local Authority. The Sanitary Inspectors systematically revisit premises which have been disinfested and advise tenants as to measures to be taken to prevent re-infestation. Sprays and a supply of Solution " D " are issued to tenants on an Inspector's advice and used under the latter's supervision. 34 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 Section E of this Report:— Date Nature of Offence. Fine Costs Remarks. 1938 Feb. 1 10 Chubworthy Street (a) Drainage work carried out in an improper manner (A) Carrying out above work without notice £ s. d. £ s. d. 2 0 0 3 3 0 1 10 0 included above July 21 117 St. Asaph Road (a) Non-compliance with statutory notice – 2 2 0 Order for execution of work within 14 days Aug. 30 (b) Non-compliance with Magistrates' Order 0 10 0 1 11 6 July 21 Aug. 30 119 St. Asaph Road (a) Non-compliance with statutory notice (b) Non-compliance with magistrate's order – 2 2 0 Do. 0 10 0 1 11 6 Aug. 30 139 Silwood Street Non-compliance with statutorynotice – 1 1 0 Order for execution of work within 14 days Nov. 8 52 Somerville Road Non-compliance with statutory notice — 3 3 0 Order for execution of work within 7 days Nov. 8 56 Cornburv Road Non-compliance with statutory notice — 2 2 0 Order for execution of work within 14 days Nov. 14 8 St. John's Vale Non-compliance with statutory notice (choked drain) — — Drain cleared by Borough Council and cost subsequently repaid by owner Dec. 22 4 Reculver Road Non-compliance with statutory notice – 3 3 0 Order for execution of work within 10 days 35 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. In one instance, a bakehouse, written notice was served, leading to the substitution of gas firing. 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 occupier 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. c2 36 The Council, upon the 7th December, again gave consideration to the extermination of rats, and came to the conclusion that all local authorities, acting together, should undertake the baiting of the sewers more frequently, and a communication was addressed to the Standing Joint Committee of the Metropolitan Boroughs to this effect. The Standing joint Committee indicated, however, that they were not prepared to take any action at that time. Removal of Aged and Infirm Persons. It was not found necessary to apply to the Court for Orders during the year for the compulsory removal of aged and infirm persons to hospital. Swimming Baths. At all the Baths maintained by the Borough Council a chlorination plant is installed and periodical sampling is conducted to ensure that a high standard of water purity is maintained. Fifteen samples were taken in 1938. One swimming pool, privately owned, is in the Borough, and was sampled during the year. 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 46 premises was entirely reconstructed during the year, in 94 instances partly reconstructed,and in 124 premises the drains were unstopped and cleansed. Flooding. Certain portions of the Borough, notably the Clifton Rise area, are liable to Hooding in times of heavy rainfall, but no nuisance from this cause occurred during the year under report. Closet Accommodation. All closets are upon the water-carriage system with the exception of two earth closets, located in a position inaccessible to a sewer. Street Cleansing. The Borough is divided into " beats " for street cleansing purposes, each sweeper being responsible for a beat. The sweepers are provided with orderly barrows, and the type of barrow in use comprises two galvanised steel containers in a frame, mounted on 37 a chassis fitted with two pneumatic-tyred wheels. The containers are detachable, and the refuse collected in them is emptied into a refusecollecting vehicle as required during the day. The refuse is transported to the Council's wharf and barged to East Tilbury by contract. 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. The vehicles used are of the internal-loading type, the loading being performed from the front of the body. Disposal is effected, under contract, by barge to East Tilbury. Common Lodging Houses. Five premises are in the Borough, and all are inspected by day, and occasional night visits. 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, 57 cases, apparently falling within the jurisdiction of the District Surveyor were referred to him. Water Supply. The Borough Council was advised that Certificates in respect of an efficient water supply in three new premises, consisting of two private houses and one block of L.C.C. flats, could be properly granted. During the year consideration was given to premises in which a water supply, other than from the Metropolitan Water Board, was installed. Eight premises have wells, six of which are in use and two disused. In one instance the water was used for drinking purposes, and, upon its being sampled, an unsatisfactory report was returned and 38 a Metropolitan Water Board supply was substituted. In all other instances the water is used in connection with industrial or other such purposes, and the occupiers have been asked to post notices that the water is not to be used for human consumption. Steps have been taken to ensure that no surface contamination enters these wells. Six disused borings were also inspected and found to be filled in or sealed off at the surface. Increase of Rent and Mortgage Interest (Restrictions) Acts. One certificate was granted in connection with the above. Canal Boats. The following is the text of the Annual Report of the Canal Boats Inspector:— To the Medical Officer of Health. Sir, I beg to report that during the year ended 31st December, 1938, nine visits were made, on the following dates: — 21st January, 18th February, 18th March, 22nd June, 2nd and 22nd August, 19th September, 1st and 18th November. No Canal 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. 39 THE FACTORIES ACT, 1937. The Factories Act, 1937, which, except as otherwise provided, came into operation upon the 1st July, 1938, consolidates the Act of 1901 and the various Acts subsequently passed into one amending Act, which, so far as public health is concerned, brings matters relating to health into correct focus, in view of changed industrial conditions. The definition "Factory," by the abolition of the expression "Workshop," now comprises all premises formerly so described, together with such "Workplaces" as are affected by the Act by virtue of the method of occupation. It is to be noted that premises occupied by municipal authorities are brought within the ambit of the Act. The Medical Officer of Health is, by Section 128, required to report upon the matters contained in Parts I and VIII of the Act, and to give written notice to the Factory Inspector of any factory in which no Abstract of the Act is affixed. Part I deals with general health provisions, and matters relating to cleanliness, overcrowding, temperature, ventilation, drainage of floors are enforced by the Borough Council in factories in which mechanical power (as defined) is not used, subject to certain exemptions in the case of specified occupations and certain statutory undertakings and Crown factories. The provisions as to sanitary conveniences are enforced in all factories by the Borough Council. Part VIII deals with the furnishing to the Borough Council by the occupier of the names of persons engaged in certain classes of work as outworkers and the prohibition of employment of such persons in unwholesome premises. The Borough Council is given power to forbid work to be given out to any person living in a house in which infectious disease exists. In addition, the Council is charged with the responsibility of ensuring that the sanitary condition of bakehouses is maintained and the periodical certification of basement bakehouses. With a view to implementing the various parts of the Act, the register of Factories was checked with the records of the Factory Inspector and the premises visited. With regard to basement bakehouses, there are eight premises falling within this category. Each was visited and certain defects remedied and the Council recommended to grant a certificate of suitability. 40 In conformity with Section 128, the following is an epitomised statement of the administration of this Act:— Inspections. Number of Written Occupiers Premises. Inspections. Notices, prosecuted. Factories with mechanical power 353 14 – „ without „ „ 150 4 – Other premises 1014 6 – The types of premises inspected were as follows :— Bakehouses Printers Chemical Works Shoeing Forges Cinemas, etc. Stables, etc. Dressmakers, Milliners, etc. Sawmills Engineering, general Timber Stores „ motoring Tar Refiners Foundries Tailors Food preparation Woodwork, Joiners, etc. Glass bottle makers Woodchopper, setc. Laundries, Cleaners, etc. Whitening Manufacturers Marine Stores Offensive trades Paint and Varnish Works Miscellaneous DEFECTS FOUND. Defects found. Number of defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness 3 3 – Want of Ventilation — —. — – Overcrowding — — — – Want of Drainage ot Floors — — — – Other Nuisances 12 12 – – Sanitary Accommodation Insufficient 1 – Unsuitable or defect i ve 9 9 — — Not Separate for Sexes — — — – Total 25 24 – The number of inspections made to Home Workers' Dwellings was 57. In no case were insanitary conditions found calling for formal action under the Factory or Public Health Act. SECTION D. Housing. 4 2 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 1938 :— Individual Dwelling-Houses. 52 Parts of Buildings. 73 (at 38 individual premises). Underground Rooms. 13 (at 9 individual premises). 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) 5424 (b) Number of inspections made for the purpose 5537 (2) Number of dwelling-houses (included in (1) above) which were inspected, and (a) Recorded under the Housing (Consolidated) Regulations, 1925-1932 1349 (b) Number of inspections made for this purpose 1349 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 52 (4) Number of dwelling-houses (exclusive of those in (3)) found not to be in all respects reasonably fit for human habitation 2634 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) 1778 43 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 32 (2) Number of dwelling-houses which were rendered fit after service of formal Notice:— (a) By owners 20 (b) By Local Authority in default of owners (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (Statutory Notices) 824 (2) Number of dwelling-houses in which defects were remedied after service of Statutory Notices:— (a) By owners 807 (b) By Local Authority in default of owners — (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made (2) Number of dwelling houses demolished in pursuance of Demolition Orders (3) Number of dwelling houses made fit by owners 18 (D) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of underground rooms in respect of which Closing Orders were made 7 (2) Number of underground rooms in respect of which Closing Orders were determined, the room having been rendered fit 6* (3) Number of parts of buildings in respect of which closing order was made 28 (4) Number of parts of buildings in respect of which Closing Orders were determined 4 * Includes three cases where rooms were subsequently found not to be underground rooms. 44 (E) (l) Undertakings accepted in respect of the following number of parts of houses. (a) To cease using for human habitation (b) To make fit 8 (2) Undertakings accepted in respect of the following number of underground rooms. (a) To make fit 15* (b) To cease use for human habitation 1 (3) Number of underground rooms in which no action was taken — (4) Number of parts of houses in which no action was taken (F) Proceedings under Section 25 of the Housing Act, 1936:— (1) Number of Clearance Areas declared — (2) Houses comprised therein (3) Houses demolished 3 (G) Housing Act, 1936 :—Part IV. Details of overcrowding as ascertained during 1938 are as follows:— Correspond ing figures for 1937 (a) (l) Number of individual dwellings crowded at end of year 443 310 (2) Number of families dwelling therein 443 322 (3) Number of persons dwelling therein— adults 21151 children under 10 years 699 (b) Number of new cases of overcrowding reported during the year 343 37 (c) (l) Number of cases relieved during the year 210 155 (2) Number of persons concerned in such relief— adults 997 children under 10 years256 661½ •Including one made fit without formal undertaking. 45 The comparable figures for 1937 are also given, and, in considering these, it must be borne in mind that the original survey took place in 1935-1936, and no exhaustive investigation had been made between that time and the end of 1937. During 1938 the Council appointed two investigators to make a comprehensive survey and, as a result, 6,837 visits were paid and enquiries completed in six of the twelve wards, and instructions were given that the rest of the Borough was to be visited in the same manner. Only by such procedure can the extent of overcrowding be gauged, for the picture is a continually changing one. Relief of overcrowding of known cases is counterbalanced by an increase in the number of overcrowded families from natural causes, e.g., increasing age of children, marriages, etc., and it is of paramount importance that these new cases should be promptly ascertained. This object, by the Council's appointment of the two investigators, is being attained. (d) Re-overcrowding of houses in respect of which the Borough Council has taken steps to abate overcrowding. Two cases of re-overcrowding have been detected, viz.: (1) A two roomed tenement in L.C.C. dwellings, previously de-crowded, and becoming overcrowded by reason of a child arriving at the age of 1 year. (2) Three rooms occupied by 5i (equivalent) adults. This case has been referred to the Town Clerk for the necessary action. (e) Twelve cases of overcrowding since the "appointed day," included in the foregoing figures, have been reported to the Town Clerk for the necessary action to be taken. Of these cases, five have so far been abated, and negotiations are still proceeding with regard to the others. 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 :— 46 London County Council Housing In Deptford. Provided. Tenements Accommodating Hughes Fields Estate 4 blocks—121 tenements 6244 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 Frankham Street Areas 2 „ 89 „ 429 „ Tanner's Hill Areas ... 6 „ 148 „ 713 „ During the year, the Grove Street Areas were the subject of Clearance Orders made by the L.C.C. and awaiting the confirmation of the Minister. Subject to such confirmation, the lay-out assumes the erection of three blocks, containing 120 dwellings and housing 600 persons. Adjoining the area is a small parcel of land in Elm Terrace of which the Borough Council is the Lessee. The London County Council desire to acquire the Council's interest in this land so that it may be included in the scheme. During the year the Ministry of Health confirmed the Orders of the L.C.C. in respect of the Evelyn Street (Nos. 1 and 2) Areas, which totalled 0.7 acre, and being unsuitable for housing re-development was the subject of Clearance Orders. Private enterprise built 2 houses. 47 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 1938:— Estate Families Honor Oak 60 Mottingham 100 Downham 167 Speedwell Street 5 Hughes' Fields 23 Bellinghain 42 Becontree 14 Sumner, Peckham 6 St. Helier 4 Deptford Park 6 Haddo Street, Greenwich 10 Crossfield Street 17 Others 27 Total 481 For information, the number of Deptford families rehoused during recent years was as follows:— 1937—664, 1936—789, 1935—354, 1934—476, 1933—377, 1932—241, 1931—217 Amendment of the Regulations as to Underground Rooms.— During the year the Council decided that some relaxation of the paragraph dealing with the necessity for the provision of a horizontal damp-proof course appeared desirable; and obtained the sanction of the Ministry of Health to the incorporation of a paragraph as follows:— (1a) "or the rooms shall be protected against dampness by some other effectual means." SECTION E. Food. 50 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 93 Food premises (Restaurants, etc.) 137 Fish premises 24 Slaughterhouses 232 Butchers' premises 784 Milk premises 9 Ice cream premises 5 Miscellaneous 99 Calls (Stalls, etc.) 542 1925 Inspector Webster deals with the inspection of imported food at St. George's Wharf. He made 232 visits during the year under review. I. Food Premises. 1. Milkshops. Administration of the Milk and Dairies Order, 1926. 21 applications for registration (including 13 transfers) in respect of premises were granted during the year. At the end of the year there were 123 premises registered for the sale of milk. In addition to the above, 118 persons were registered for the sale of unopened bottled milk only, and 38 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. 51 There are no cow-houses in the Borough. During the year 326 inspections of milk shops were made by the District Sanitary Inspectors and 9 by the Food Inspector. Many minor matters were remedied as the result of verbal intimation by the Inspectors. Administration of the Milk (Special Designations) Orders, 1936 and 1938. 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 15 shops. 5 retailers 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. 42 samples of Milk were examined bacteriologically with the following results:— Tuberculin Tested 2 samples Coliform bacillus not present Pasteurised. 37 samples passed the Ministry of Health Standard. 3 samples were below standard, containing bacterial counts as follows:— Total Count in 1 cc. (а) 240,000 (б) 123,600 (c) 118,000 In the case of samples not within the standard, the results would be reported to the Medical Officer of Health of the district concerned. Animal Inoculation. 18 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, 232 visits having been paid by the Food Inspector. D2 52 The following is a statement of the animals slaughtered and the carcases inspected and condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 221 102 44 1677 71 Number inspected 221 102 44 950 71 All diseases except T.B. Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - 27 3 Percentage of the number in spected affected with disease other than T.B. 12.2 2.9 - - - Tuberculosis only Whole carcases condemned — - — — — Carcases of which some part or organ was condemned 5 2 2 Percentage of the number inspected affected with tuberculosis f 2.2 1.9 - - 2.8 (b) Poultry Slaughterer. There is one poultry slaughtering establishment. During the year 7,316 head of poultry were slaughtered. (c) Shops and Stalls. The following Food Stalls are registered:— Fruit, Vegetables 40 Meat and Poultry 1 Ice Cream and/or Baked Grocery 4 Chestnuts 10 Refreshments & Confectionery 8 Fish and or Poultry 5 Medicines 2 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. 98 premises were so registered at the end of the year under report. 53 3. Bakehouses. There are 45 bakehouses in the Borough, 8 of which are underground. 98 inspections were made during the year. 2 Intimation notices were served for the remedy of general defects, and other minor matters were remedied upon verbal intimation, 88 Notices were served for cleansing. Fried Fish Shops and Fish Curers. The number kept under observation during the year was 47. 134 inspections were made by the District Sanitary Inspectors and 24 by the Food Inspector. 182 Notices were served for cleansing. Ice Cream Premises. There were 157 separate premises recorded. To these, 252 visits were paid by the District Sanitary Inspectors and 5 by the Food Inspector, and many verbal intimations were given regarding minor matters. Other Premises. 124 inspections were made of restaurants and butchers' shops 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) Regulations, 1937. Inspector Webster pays regular visits to the Wharf with a view primarily to ascertaining that foodstuffs imported are fit for consumption. 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. The following quantities of food were voluntarily brought to the notice of the Inspectors during the year and destroyed as trade refuse :— Bullocks' livers 25 Apples 3 cwt. Bullocks' heads and tongues 6 Rabbits 248 Beef 11 lbs. Rock Salmon 6 stone 54 III. Food Poisoning. The following is an analysis of the notifications received, classified according to the suspected causal agent:— Food. No. of cases. Milk1 Uncertain 1 In addition to a copy of each certificate being forwarded to the County Medical Officer, information in respect of cases of general interest as affecting the Metropolis as a whole is also transmitted to him. 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. Occasionally samples of imported food are taken. The Committee agreed to substitute the "Press Cap" method in place of the method of sealing bottles used in milk sampling with sealing wax. This method of sealing has the advantage that it can be done with much more expedition, particularly in wet or windy weather, thereby saving the time of both the tradesmen and the Sampling Officer. Frequency of Sampling.—A total of 513 samples, formal and informal, and including 3 imported food samples, were taken for chemical analysis during the year, equivalent to 5.3 samples per 1,000 of the population. 55 The following is a statement of the sampling done and results obtained in 1938:— Total. Number Adulterated. Percentage of samples adulterated.* Formal samples 330 32 9.7% Informal samples 180 22 12.2 % Total 510 54 10.6 % Imported Food samples 3 *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 1937 521 8.1 The following is a statement of the samples purchased and submitted for analysis during 1938. 56 Food and Drugs—Samples Taken. Articles. Number Genuine. N umber Adulterated. Total. Percentage of Adulterated Samples. Formal Samples, taken under the Food and Drugs (Adulteration) Act— Ale 1 .. 1 .. Brandy 1 .. 1 .. Butter 2 .. 2 .. Cocktail 1 .. 1 .. Custard Powder 1 .. 1 .. Fish, canned sild 1 2 3 66.6 Fish paste 1 .. 1 .. Fruit, dried 1 .. 1 .. Gin 4 2 6 33.3 Ginger, ground 1 .. 1 .. Jellies .. 6 6 100 Liquorice powder 1 .. 1 .. Milk (including sterilised) 264 20 284 7.0 Mustard 2 .. 2 .. Nutmeg, ground 1 .. 1 .. Paraffin, liquid 1 .. 1 .. Pepper 2 .. 2 .. Quinine, ammoniated tincture of .. 1 1 100 Rum 1 .. 1 .. Spirts 5 .. 5 .. Suet, shredded 1 .. 1 .. Sweets 2 .. 2 .. Tapioca 1 .. 1 Vinegar, malt 1 .. 1 .. Vinegar, wood 1 .. 1 .. Vinegar .. 1 1 100 Wine, port 1 .. 1 .. Total formal samples 298 32 330 9.7 Informal Samples— Almonds, ground 1 .. 1 .. Arrowroot, ground 1 .. 1 .. Bacon 1 .. 1 .. Baking powder 1 .. 1 .. Barley, pearl 2 .. 2 .. Biscuits 5 .. 5 .. Black pudding 1 .. 1 .. Bread 1 .. 1 .. Butter 2 .. 2 .. Cheese 4 .. 4 .. Cinnamon 1 .. 1 .. Chocolate buns 1 .. 1 .. Chocolate roll 1 2 3 66.6 Chocolate sandwich 1 .. 1 .. Chutney mango 1 .. 1 .. Coffee 1 .. 1 .. Coffee and chicory extract 1 .. 1 .. Carried forward 26 2 28 57 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total Percentage of Adulterated Samples. Brought forward 26 2 28 Informal Samples—could. Cream, canned 1 .. 1 .. Cocoa 1 .. 1 .. Calomel ointment .. 1 1 100 Cherries, glace 1 1 Cornflour 1 .. 1 .. Cream, ice 1 .. 1 .. Custard Powder 1 .. 1 .. Dripping 1 .. 1 .. Epsom salts l .. 1 .. Egg substitute powder 1 .. 1 .. Fish, canned 8 .. 8 .. Fish, bottled 1 .. 1 .. Fish, fresh 2 .. 2 .. Flour, self-raising 2 .. 2 .. Flour 1 1 2 100 Fruits, canned 6 .. 6 .. Fruits, dried 2 .. 2 .. Fruit, fresh 2 .. 2 .. Figs, dried .. 1 1 100 Figs, stewing 1 .. 1 .. Gelatine 1 .. 1 .. Ginger, preserved 2 .. 2 .. Ginger wine essence 1 .. 1 .. Glycerine 1 .. 1 .. Herbs 2 .. 2 .. Honey 1 .. 1 .. Iodine, tincture of 2 .. 2 .. Jam 4 .. 4 .. Jellies, table 2 4 6 66.6 Lard 2 .. 2 .. Lemonade 1 .. 1 .. Lemonade powder 3 .. 3 .. Lemon cheese 2 .. 2 .. Liquorice powder compound .. 1 1 100 Malt extract, with cod liver oil 1 .. 1 .. Margarine .. 3 3 100 Meat paste 1 .. 1 .. Meat pastie 1 .. 1 .. Mercury ointment 1 .. 1 .. Milk, condensed 2 .. 2 .. Milk, dried 1 3 4 75 Milk foods, modified 3 .. 3 .. Milk .. 1 1 100 Mincemeat 2 .. 2 .. Olive oil 3 .. 3 .. Paraffin, liquid 1 .. 1 .. Parrish's chemical food 1 .. 1 .. Paste, chicken and ham 1 .. 1 .. Carried forward 102 17 119 58 Samples Taken—continued. Articles. Number Genuine. Number Adulterated. Total. Percentage of Adulterated Samples. Brought forward 102 17 119 Informal Samples—contd. Peas, canned 1 .. 1 .. Peas, split 1 .. 1 .. Pickles 1 .. 1 .. Pepper 3 .. 3 .. Quinine, ammoniated tincture of .. 1 1 100 Raspberry powder 1 .. 1 .. Rice, ground 1 .. 1 .. Sago 2 .. 2 .. Salt, table 1 .. 1 .. Sauce 2 .. 1 .. Salad cream 1 .. 1 .. Saveloys 1 .. 1 .. Sherbet 2 .. 2 .. Sild, canned .. 3 3 100 Soda water 1 .. 1 .. Soup powder 1 .. 1 .. Soup, canned 1 .. 1 .. Stuffing, sage and onion 1 .. 1 .. Sugar, foot 1 .. 1 .. Suet, shredded 2 1 3 33.3 Syrup, golden 2 .. 2 .. Sultanas and currants 4 .. 4 .. Sweets 17 .. 17 .. Tea 1 .. 1 .. Tripe 1 .. 1 .. Tomatoes 1 .. 1 .. Vinegar, malt 1 .. 1 .. Wine, non-alcoholic 4 .. 4 .. Zinc ointment 1 .. 1 .. Total Informal Samples 158 22* 180 12.2 Imported Foods— Informal Samples— Dried Peas 3 •• 3 •• Total Samples Analysed 459 54* 513 10.6 'Including 4 labelling offences 59 Legal Proceedings Taken in regard to Formal Samples Purchased under the Food and Drugs (Adulteration) Act during the Year 1938. Sample No. Article. Particulars of Adulteration or Infringement, Fine. Costs. Remarks. 24 Y Sterilised Milk 6 per cent. added water £ s. d. £ s. d. — 1 0 0 3 15 0 119 Y Gin 1.6 per cent. excess water — 3 3 0 Dismissed under Probation of Offenders Act. 134 Y Tinned Sild 4.06 grains per lb. tin 3 0 0 3 3 0 — 235 Y Table Jelly Benzoic acid 420 parts per million 10 0 2 2 0 — 236 Y 237 Y 238 Y 239 Y Do. Benzoic acid in varying amounts — — {Same defendant as above. Summons not proceeded with by Magistrate. 285 Y Ammoni- ated Tinctuie of Quinine 10 per cent, excess quinine sulphate 42 per cent, deficiency of ammonia 3 3 0 Dismissed under Probation of Offenders Act. 367 Y ,, Table Jelly Do. Benzoic acid 450 parts per million Do. 1 - 0 0 5 - 5 0 Do. Proceedings against wholesaler under Public Health (Regulations as to Food) Act, 1907. Public Health (Preservatives, etc. in Food) Regulations. It was not found necessary to take any action under these Regulations. 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 and 1927. It was not found necessary to take any action under the above Regulations. Public Health (Condensed Milk) Regulations, 1923 and 1927.— Samples taken proved genuine. 60 Offences other than Adulteration. Misdescription or Misrepresentation or Improper Labelling. Under the Agricultural Produce (Grading and Marking) Act, 1928, various Regulations, and under the Merchandise Marks Act, various Orders in Council have been made. Tradesmen have been circularised as to their duty thereunder. Verbal intimation of infringements was given in a few instances where foods, the subject of marking Orders, were found to be imperfectly marked. Chemical and Bacteriological Examinations. The chemical examination of food and drugs is carried out by the Public Analyst, Mr. 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. SECTION F. Infectious and other Diseases. 62 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 1938. INCIDENCE AND MORTALITY BY AGE GROUPS. Notifiable Disease At all Ages Total Cases Notified. At Ages—Years Total Cases Removed to Hospital Total Deaths Deaths at Ages—Years Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 55 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 177 7 69 83 11 7 .. .. 177 5 .. 5 .. .. .. .. .. Erysipelas 46 .. .. 2 4 16 16 8 27 .. .. .. .. .. .. .. .. Scarlet Fever 240 .. 87 121 13 17 1 .. 235 1 .. .. .. 1 .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever (including Paratyphoid Fever) 2 .. .. *1 .. .. .. 1 2 1 .. .. .. .. .. .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. .. .. Puerperal Pyrexia 25 .. .. .. 9 16 .. .. 23 .. .. .. .. .. .. .. .. Cerebro-Spinal Meningitis 3 .. 1 1 .. .. 1 .. 3 .. .. .. .. .. .. .. .. Poliomyelitis and Polioencephalitis 12 .. 6 5 1 .. .. .. 12 .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 15 15 .. .. .. .. .. .. 11 .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhœa and Enteritis (under 2 years) 31 20 11 .. .. .. .. .. 23 7 7 .. .. .. .. .. .. Acute Primary and Acute Influenzal Pneumonia 96 6 13 7 8 30 23 9 57 75 17 4 l .. 6 20 27 Malaria 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. Bacilliary Dysentery 12 1 1 5 2 1 2 .. 2 .. .. .. .. .. .. .. .. Chicken Fox 80 3 35 41 1 .. .. .. .. .. .. .. .. .. .. .. .. Posterior Basal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles Whooping-cough since 15 3 7 5 .. .. .. .. 120 .. .. .. .. .. .. .. .. 1-10-38 55 8 39 8 .. .. .. .. 26 .. .. .. .. .. .. .. .. Totals 812 64 269 279 49 90 43 18 721 89 24 9 l 1 6 20 28 • Diagnosis established in hospital as Dysentry and notified as such. 63 SEASONAL INCIDENCE OF INFECTIOUS DISEASES NOTIFIED IN 1938. Disease 1st quarter 2nd quarter 3rd quarter 4th quarter Total for year Diphtheria 63 31 35 48 177 Erysipelas 13 14 6 13 46 Scarlet Fever 59 70 39 72 240 Enteric Fever ... 1 ... 1 2 Puerperal Fever ... 1 ... 1 2 Puerperal Pyrexia 6 7 6 6 25 Cerebrospinal Meningitis 2 ... 1 ... 3 Poliomyelitis and Polioencephalitis ... ... 5 7 12 Ophthalmia Neonatorum 2 5 5 3 15 Infantile Diarrhœa, etc. 13 1 8 9 31 Acute Primary and Influenzal Pneumonia 36 22 6 32 96 Chicken Pox 32 19 13 16 80 Encephalitis Lethargica ... ... ... ... ... Dysentery 9 3 ... ... 12 Small Pox ... ... ... ... ... Posterior Basal Meningitis ... ... ... ... ... Malaria ... ... 1 ... 1 Measles ... ... ... 15 15 Whooping-cough ... ... ... 55 55 Totals 235 174 125 278 812 Scarlet Fever. Year No. of Cases Attack Rate per 1,000 population No. of Deaths Case Mortality per cent. Average 1915-24 481 4.2 6 1.2 ” 1925-29 444 4.0 2.4 0.54 ” 1930-34 575 5.4 2.8 0.54 1935 252 2.6 — 0.0 1936 267 2.7 1 0.4 1937 174 1.8 1 0.6 1938 240 2.5 1 0.4 The cases notified continue to be of the mild character experienced in recent years. 64 WARD DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1938. Notifiable Disease Total Cases in Borough Total Cases Notified in each Ward Deptford Park Evelyn St. Paul's Vale Clifton Canter bury Hatcbam Pepys St. Catherine's St. Peter's St. John's Town Hall Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, including Membranous Croup 177 15 30 8 15 9 30 17 8 8 12 12 13 Erysipelas 46 3 4 5 4 5 4 4 4 3 .. 5 5 Scarlet Fever 240 24 36 16 24 16 41 16 12 16 9 12 18 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. 1 .. .. .. .. .. .. .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. .. .. 1 .. .. .. .. 1 Puerperal Pyrexia 25 2 2 4 1 2 1 3 .. 2 4 2 2 Cerebro-Spinal Meningitis 3 .. 1 1 .. .. .. .. .. 1 .. .. .. Poliomyelitis and Polioencephalitis 12 1 2 .. 3 3 1 .. .. 1 1 .. .. Ophthalmia Neonatorum 15 1 2 .. 1 1 .. 2 2 1 1 3 1 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diarrhoea and Enteritis (under 2 years 31 1 3 11 2 3 1 2 .. 7 .. 1 .. Acute Primary and Acute Influenzal Pneumonia 96 6 21 8 10 5 12 7 3 6 1 10 7 Malaria 1 .. .. .. .. .. .. .. .. 1 .. .. .. Bacilliary Dysentery 13 7 .. .. 1 .. 2 .. .. .. 1 1 .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox 80 13 12 9 9 12 13 4 .. 3 3 1 1 Posterior Basal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. Measles From 1-10-38 15 2 8 1 .. .. 1 3 .. .. .. .. .. Whooping Cough 55 3 14 16 2 2 5 4 .. 4 4 .. 1 Totals 812 78 135 79 73 58 111 63 29 53 36 47 50 65 Diphtheria. The following table shows the incidence and mortality from Diphtheria in 1938 as compared with previous years:— Year No. of Cases Attack Rate per 1,000 population No. of Deaths Case Mortality per cent. Average 1915-2 322 2.8 19 5.9 „ 1925-29 496 4.3 14 2.8 „ 1930-34 299 2.8 9 3.2 1935 301 3.0 10 3.3 1936 208 2.1 6 2.9 1937 168 1.7 3 1.8 1938 177 1.8 5 2.8 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. Alum precipitated Toxoid is the prophylactic generally selected, although, occasionally, use is made of Toxoid antitoxin floccules. 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. Numbet of Schick Tests. Total. Fully Inoculated. Partly Inoculated. No. of Inoculations given. Negative. Unknown Result. 1927 214 152 8 374 410 15 1233 1928 85 75 14 174 168 65 580 1929 21 27 7 55 72 15 221 1930 15 27 — 42 65 3 199 1931 6 7 — 13 17 5 58 1932 3 — 1 4 11 — 33 1933 5 4 — 9 32 1 97 1934 2 8 — 10 11 — 33 1935 45 16 — 61 164 14 514 1936 14 7 — 21 73 — 105 1937 21 11 — 32 131 — 131 1938—(a) Pre-school— — — — — 49 — 216 (b) School age— 23 23 — 46 151 E 66 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 1938 14 116 8 138 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. 1938—Nil. Vaccination. No vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. The Council considered and decided to support a resolution forwarded to them by the Metropolitan Boroughs' Standing Joint Committee to this effect:— (a) That in order that infants may be vaccinated free of charge to their parents by their own medical practitioners, instead of by the public vaccinator, legislation should be promoted to enable metropolitan borough councils to determine the present practice of appointing public vaccinators, and remunerating them by fees, and to permit the councils to pay to private medical practitioners the same fees as those at present paid to public vaccinators; and (6) that, whether or not such legislation is promoted, arrangements should be made for a supply of Government lymph to be obtained free of charge by any medical practitioner who is called upon to vaccinate. 67 Return made on or before the 14th of February, 1939, by Mr. R. O. Budds, Acting Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1937, inclusive:— Registration SubDistricts comprised in the vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec. 1937. Number of these Births duly entered by 31st Jan.. 1939. No. of Births which on 31st Jan. 1939 remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1939 not accounted for. Total No. of Certificates of successful Primary Vaccination children under 14 received during Calendar Year 1938. No. of Declarations of Conscientious Objections actually received by Vaccination Officer during the Calendar Year 1938. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Certificates icf Conscientious Objection received. Died Unvaccinated. Postpone ment by Medical Certificate. Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. North Deptford 397 130 — — 137 13 22 3 45 36 South Deptford 402 145 1 — 189 12 17 1 25 23 — — Total 799 275 1 — 326 25 39 4 70 59 509 312 Datid 21st March, 1939. Successfully vaccinated after the declaration of conscientious objection, Nil. 68 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 1938 80 Measles. As from the 1st October, 1938, Measles became a notifiable disease. The information thus obtained is supplemented by reports from schools, health visitors, etc. The following is a statement of the mortality during recent years:— No. of cases Percentage Death-rate notified since No. of of total per 1,000 1-10-38. Deaths. Deaths. 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 1938 15 2 0.18 0.02 No difficulty was experienced in obtaining hospital treatment for those cases living under unsuitable conditions, 120 children being so removed. Whooping-Cough. As in the case of Measles, this disease became notifiable upon 1st October, 1938. In any house in which a case of either Measles or Whooping Cough has been notified within two months immediately preceding the date upon which another case occurs, the latter case is not notifiable. The Health Visitor is, however, already aware of the possibility and keeps in touch with the families dwelling therein. 69 The fatality in past years is as follows:— No. of cases notified since 1-10-38. 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 1938 55 1 0.09 0.01 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 ; 26 children being so sent. Infectious Diseases of the Nervous System. The incidence of Cerebro-spinal Meningitis, Acute Anterior Poliomyelitis and Encephalitis Lethargica is separately set forth below:— Cerebro-spinal Meningitis. During the decennium 1915-1924, the yearly notifications averaged three cases. The figures since then are as follows:— Average 1925 1929 Average 1930-1934 1935 1936 1937 1938 Cases 3 3.6 3† 3 1 3 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 1925-1929 Average 1930-1934 1935 1936 1937 1938 Cases 2.6 1.6 — — 5 12 Deaths — — — — — — Of the 12 cases, in 9 the diagnosis was confirmed in hospital. 70 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 1938 Cases 5 0.4 1 - - Deaths 2.4 1 - - 1 2 All cases are periodically re-visited and treatment offered. Pneumonia. Both Acute Primary and Influenzal Pneumonia are notifiable, and a statement of the notifications received and deaths recorded 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 „ 1930-1934 114 87 0.8 1935 77 64 0.6 1936 83 63 0.6 1937 117 83 0.9 1938 96 75 0.8 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 1920-1924 Average 1925-1929 Average 1930-1934 1935 1936 1937 1938 Cases 8 4 0.8 — 2 — 1 No deaths have been registered from this cause. Dysentery. The figures are as follows:— Average 1920-1924 (total) Average 1925-29 Average 1930-1234 1935 1936 1937 1938 Cases 3 2.5 0 — 1 20 12 Deaths — 0.4 0 The incidence of Dysentery (Sonne type) reported last year continued into 1939, the last of the 12 cases being notified in May. 71 Infantile Diarrhæa. Since 1920, this has been notifiable in the case of children under two years of age, and the following are particulars of notifications received and deaths:— Average 1920-24 Average 1925-29 Average 1930-34 1935 1936 1937 1938 Cases Notified 66 75 26 12 58 29 31 Deaths 28 15 18 16 18 11 7 All cases of Infantile Diarrhoea are investigated by the Health Visitors with the object of securing nursing assistance or hospital treatment where such is required. Insanitary conditions are passed to the District Sanitary Inspector to be dealt with. At the Babies Hospital two children exhibiting symptoms of Gastro-enteritis died. The Medical Officer was of opinion that the cases were of streptococcal origin, and the staff were swabbed. One nurse, reported "positive," was sent off duty. Investigation failed to trace any connection between the two cases, which had been separately nursed in different wards. 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 „ 1930-1934 5 3.4 2.0 1935 1 — — 1936 2 — — 1937 5 — — 1938 2 — — From 1933 onwards, the death-rate is calculated per 1,000 total (live and still) births. 72 Puerperal Pyrexia. Since 1st October, 1926, notification is compulsory in the case of any woman who, within 21 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 1938 Cases 5 16 12 6 15 9 10 22 25 Of the 25 cases notified, 18 were either in hospital prior to confinement or admitted thereafter. The conditions found included Breast Abscess, Albuminuria, Eclampsia, Pyelitis, Retained Placenta, Toxaemia. No deaths occurred. Ophthalmia Neonatorum. As from the 1st October, 1926, notification to the Medical Officer of Health of such cases became wholly the responsibility of the doctor in attendance, the midwife being required to call in medical assistance and to take such action as is laid down by the Central Midwives Board. The following is a statement of notifications received Average 1926 (part) 1927 1928 1929 1930-34 1935 1936 1937 1938 Cases 14 9 18 14 17 11 11 5 15 The following is a statement of the results of treatment in respect of the cases notified in 1938:— Notified Treated At home In hospital Vision unimpaired Vision impaired Total blindness Since died from other Causes 15 4 11 14 — — l 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, the St. John's Church Nurse and the St. John's Nurses for a nurse to visit and carry out the treatment prescribed. 73 Where, for any reason, hospital in-patient treatment is deemed advisable, facilities are provided at St. Margaret's Hospital, Kentish Town. Erysipelas. 46 cases were notified during the year. Enquiries are made particularly in connection with the possibility of any prospective confinement in the house. Enteric Fever. 2 cases were notified, and one death was recorded. It is probable that this patient contracted the infection while visiting a house in another borough in which a case of Typhoid had occurred. The second case—that of a child—was eventually diagnosed in hospital as one of Dysentery and was notified as such. 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 1938. 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 1938 8 0.7 0.8 74 Tetanus. A supply of Anti-toxin is kept at the Town Hall for issue to practitioners on request. Admission to Hospital. The special arrangements by which cases of Scarlet Fever, Measles and Dysentery were limited to those selected by the Medical Officer of Health were discontinued as from the 16th May, 1938, such cases thereafter being admitted on the application of any medical practitioner. The admission of cases of Whooping Cough, German Measles, Mumps and Chicken Pox continues to be effected only on the application of the Medical Officer of Health. 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, 1938. Material Number Positive. N umber Negative. Total. Swabs for Diphtheria 112 946 1058 Samples of Disinfectants — 2 2 Sputum for Tuberculosis 12 27 39 Faeces for Enteric Fever — 7 7 Faeces for Dysentery 7 2 9 Swimming bath water and well water — 22 22 Urine for Enteric — 1 1 Blood „ „ — 2 2 Urine for Tuberculosis 1 — 1 Pus „ „ — 1 1 Material for Occult Blood 1 — 1 Swabs for Meningococcus 1 7 8 Urine for Haemolytic Streptococci — 3 3 Swabs for „ „ 1 21 22 Swab from Cervix — 1 1 •Note.—Other examinations are reported under " Food." 75 At the Tuberculosis Dispensary, 987 specimens of sputum were examined. Of these, 769 specimens were of sputa of Dispensary patients, while private practitioners submitted the balance, viz., 218 specimens. Disinfection. The following is a summary of the work carried out. Full details are shown in tabular form in the Appendix (Tables 11 and III). Number of premises visited : Infectious diseases 613 „ „ „ Requests, rooms only 89 „ „ „ „ bedding only 82 „ ,, „ Verminous conditions 140 „ „ „ Removals 27 Total premises visited 951 Number of rooms disinfected, formalin spray 953 ,, ,, ,, sulphur 268 Total 1212 Number of articles disinfected (steam disinfector) 15701 Number of books disinfected (formalin lamp) 229 „ „ articles destroyed at owners' request 586 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 of the home, of wearing apparel or personal in character, come within the purview of the Council's activities. 76 So far as the structure of the house is affected, the procedure followed is in accordance with the provisions of the Public Health (London) Act, viz., cleansing by the owner, disinfestation 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. Particulars of the houses disinfested are given in Section C. 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. Bathing Station. 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 68 adults and 1728 children were cleansed. In addition, 1044 treatments were given to children and 54 to adults suffering from scabies. 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. Kate 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 1938 165 14.6 1.7 77 Deaths from Cancer by Sex and Age. Average, Year Sex U nder 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 M ale — 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 1938 Male 1 3 33 34 17 88 Female — 3 28 27 19 77 Total 1 6 61 61 36 165 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. No supplies were granted during the year under report. Infective Jaundice. No case of this disease was reported to me. SECTION G. Tuberculosis. 80 TUBERCULOSIS. The following is a tabular statement of the cases coming to our knowledge by notification and otherwise :— Year. Pulmonary. Non-Pulmonary. M. F. Total per 1,000 of 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 1938 88 56 1.51 18 14 0.33 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 1-936 0.58 0.11 0.66 0.11 1937 0.58 0.11 0.69 0.09 1938 — — 0.56 0.1 Dr. N. M. Donnelly, the Tuberculosis Officer, reports as follows:— 'By international agreement, cases of miliary tuberculosis, which, prior to 1926, were classified under " Pulmonary," are now included under " Nonpulmonary Tuberculosis 81 Report of Tuberculosis Officer—continued. Notifications. The following table gives a summary of the notifications received from the 1st January, 1938, to 31st December, 1938, and is prepared in accordance with the requirements of the Ministry of Health. The number of Primary Notifications is 161; 133 Pulmonary Tuberculosis and 28 Non-pulmonary, as compared with 137 Pulmonary and 19 Non-pulmonary for the previous year. PUBLIC HEALTH (TUBERCULOSIS) RF.GULATIONS. 1930. Summary of Notifications during the period from the 1st January, 1938 to the 31st December, 1938. Notifications on Form A. Age Periods Total Notifications on Form A. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications, Pulmonary— Males 2 3 ... ... 10 14 12 14 19 5 1 80 104 Females ... 2 4 2 7 16 12 6 1 2 1 53 65 Non-Pulmonary Males ... 1 2 3 4 1 2 2 ... ... ... 15 18 Females 1 ... ... 1 2 4 3 1 ... ... 1 13 15 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 1 2 0 ... 1 8 „ —Females ... ... ... ... ... 2 1 ... ... ... ... 3 Non-Pulmonary—Males ... ... ... ... ... 1 2 ... ... ... ... 3 „ —Females ... ... ... ... 1 ... ... ... ... ... ... 1 Rebort of Tuberculosis Officer -continued. 82 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Non-Pulmonary. Death Returns from local Registrars 1 — transferable deaths from Registrar-General 2 1 Posthumous notifications ... 1 " Transfers " from other areas (other than transferable deaths) 5 2 Form D (from Sanatorium) 3 — Supplemental Return—continued. NOTIFICATION REGISTER. Pulmonary Non-pulmonary Tota Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1938, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough of Deptford 345 228 573 77 93 170 743 Number of cases removed from the Register during the year, inter alia of 1, Withdrawal of notification 2. Recovery from the disease 6 7 13 2 4 6 19 3. Death 44 15 59 3 4 7 66 4. Otherwise, e.g., left Borough, etc. 24 25 49 9 7 16 65 Report of Tuberculosis Officer—continued. 83 84 Report of Tuberculosis Officer—continued Notes on Tables of Notifications. Re Death Returns and Posthumous Notfiicatious. Of the non-pulmonary cases, 2 died of meningitis, one in hospital just after family had moved into the Borough, the other had been notified elsewhere. Of the pulmonary cases, two were transfers into the Borough who had been previously notified elsewhere, and one a case who had not been diagnosed by his doctor till just before death. Of the cases dying within a month of notification. 4 were cases of meningitis, 4 were cases of pulmonary tuberculosis one of whom died of Hodgkins Disease, the other three were hospital notifications who died soon after notification, one being admitted from a lodging house, one after being off work for two weeks only. Of the cases dying within 3 months of notification. All pulmonary tuberculosis; one was notified from hospital, two were lodging house cases, one was age 65, one had diabetes, one had been notified elsewhere previously, one was a child whose father was found subsequently to be suffering from tuberculosis. 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 29 cases who transferred into the Borough during the year 15 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. Home accommodation of 144 of the Cases notified in 1938 (mental hospital, lodging-house and "diagnosis not confirmed" cases omitted). CASES and Number in Family. 117 Pulmonary Tuberculosis. 27 Non-Pulmonary Tuberculosis. 86 Cases with T.B. in Sputum. Rooms. 31 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 8 of 1 lof 1 l of 1 lof 1 5 of 2 10 of 2 3 of 2 2 of 2 l of 2 l of 2 1 of 2 1 of 3 1 of 8 3 of 3 6 of 3 4 of 3 2 of 3 3 of 3 l of 3 1 of 3 2 of 3 1 of 3 3 ot 4 4 of 4 9 of 4 3 of 4 l of 4 4 of 4 l of 4 3 of 4 l of 5 2 of 5 l of 5 4 of 5 2 of 5 2 of 5 4 of 5 lof 5 1 of 5 4 of 5 l of 6 2 of 6 3 of 6 lof 6 2 of 6 2 of 6 2 of 6 1 of 7 4 of 7 l of 7 l of 7 1 of 8 1 of 8 2 of 8 l of 8 l of 9 2 of 9 2 of 9 l of 10 2 of 10 l of 11 l of 12 35 had a separate room 10 had a separate room. 7 had separate room. 7 had separate bed with 1 other in room 4 had separate bed but 1 other in room. 5 had separate bed, but 1 other in room. 2 ,, ,, ,, 2 ,, ,, 1 ,, ,, 2 ,, ,, 2 ,, ,, 2 ,, 33 had another in bed. 1 ,, ,, 4 ,, 10 had another in bed. 6 ,, ,, & 1 other in room 11 had another in bed. 1 ,, ,, 1 ,, 3 ,, ,, & 2 others in room 3 1 1 ,, ,, 2 ,, 1 had 2 others ,, 1 ,, ,, 3 ,, 20 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 Report of Tuberculosis Officer—continued. 85 86 Report of Tuberculosis Officer—continued. The number of deaths for the year is 64 as compared with 75 for 1937. 1931 1932 1933 1934 1935 1936 1937 1938 Pulmonary deaths 100 92 94 92 83 65 66 54 Non Pulmonary deaths 14 13 10 10 6 11 9 10 Analysis of the notifications and deaths for the year according to sex and age are given in the accompanying tables :— Particulars of New Cases and of Deaths during the Year 1938. New Cases.* Deaths. Age Periods. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary m f m f m f m f 0 2 — — 1 — — 1 2 1 3 2 1 — 1 — 1 — 5 — 6 5 1 — — — — 15 26 25 6 7 4 4 1 2 25 13 13 2 3 6 3 1 1 35 16 6 4 1 8 1 — — 45 21 1 — — 14 1 — — 55 5 2 — — 7 2 — — 65 and upwards 2 1 — 1 2 1 — 1 T otals 88 56 I8 14 42 12 4 6 "Note—Including 15 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. The notifications of non-Pulmonary Tuberculosis were as follows:— Peripheral glands 5 Meninges 4 Abdominal 4 Bones and joints 13 Skin 2 Total 28 Disinfection was carried out in 197 rooms, and articles of bedding, clothing, &c., were removed for sterilization. Memo 37/T. Table 1. TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Tear 1938. 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):— 401 (a) Definitely tuberculous 53 32 — 4 6 7 4 — 59 39 4 4 106 (b) Diagnosis not completed — 9 6 1 16 (c) Non-tuberculous — — — — — — — — 114 112 25 28 279 B.—Contacts examined during the year:— 163 (a) Definitely tuberculous 3 3 4 — — 3 — 3 4 10 (b) Diagnosis not completed — — — — — — — — 1 2 2 2 7 (c) Non-tuberculous — — — — — — — — 35 46 33 32 146 C.—Cases written off the Dispensary Register as 455 (a) Recovered... 6 5 — 2 3 — — 4 9 5 — 6 20 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensarv Register as T.B.) — — — — — — — — 155 159 58 63 435 D.—Number of Persons on Dispensary Register on December 31st:— 466 (a) Diagnosis completed 182 136 17 22 27 27 16 15 209 163 33 37 442 (b) Diagnosis not completed — — — — — — — — 11 8 3 2 24 Report of Tuberculosis Officer—continued. 87 88 Report of Tuberculosis Officer—continued. 1. Number of persons on Dispensary Register on January 1st 467 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 37 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 94 4. Cases written off during the year as Dead (all causes) 53 5. Number of attendances at the Dispensary (including Contacts) 2536 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 146 Number of G.P. 36 reports from practitioners 30 7. Number of consultations with medical practitioners: (a) Personal 16 (b) Other 237 8. Number of other visits by Tuberculosis Officer to Homes (including personal consultations) 185 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes successful 2821 3321 unsuccessful 500 Visits to non-Dispensary cases successful 1571 1874 unsuccessful 303 10. Number of (a) Specimens of sputum, &c., examined 769 (b) X-ray examinations made in connection with Dispensary work 316 (c) Sputum examinations for non-Dispensary cases 218 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 2 12. Number of "T.B. plus" cases on Dispensary Register on the 31st December 257 89 Report of Tuberculosis Officer—continued. Notes on Table I. it will be noted that the number of persons on the Dispensary Register on the 31st December, 1938 is 466, almost exactly the same figure as at end of 1937. 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, was 37 as compared with 41 in the previous year. "Transfers to other areas" and" Cases lost sight of" were 94 as compared with 98 in 1937. 53 deaths of Dispensary patients occurred, compared with 63 in the previous year. Two patients had ultra-violet light treatment at Hospital, one for lupus, and one for Bazins' disease. The two carbon arc lamps installed at the Centre so that specially selected cases should have ultra-violet light general bath treatment have been in use in the Autumn-Spring period on two afternoons weekly, and while there are no striking results to report, the general results have been satisfactory. 17 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 306 attendances. 275 refills have been given at St. Alfege's Hospital by the Tuberculosis Officer to 26 patients in addition to those mentioned above. 90 Report of Tuberculosis Officer—continued. Examination and Supervision of Contacts. Analysis of contacts of 141 of the cases primarily notified during the year (including cases notified after death but excluding lodging-house cases and cases in which the diagnosis was not confirmed):— Total T.B. Positive T.B. Negative Non-Pulmonary I. No. of patients notified 141 84 30 27 II No. of above seen at Dispensary 113 76 24 13 (a) Total contacts of cases seen at Dispensary- Adults 245 169 41 35 Children 64 43 12 9 (a') No. of above contacts examined at Dispensary— Adults 61 48 11 2 Children 30 19 7 4 III. No. of notified cases not seen at Dispensary 28 8 6 14 (a) Total contacts of cases not seen at Dispensary— Adults 63 15 15 33 Children 30 11 2 17 (a') No. of above contacts examined at Dispensary — Adults 16 6 4 6 Children 18 8 0 10 Toial School Contact Cards sent to School Medical Officer 33 (a) Examined at Dispensary— Class 1* 5 Class 2* 24 (b) Not examined at Dispensary— Class 3* 4 •Class 1—Unsatisfactory cases. •Class 2—Apparently healthy cases. •Class 3—Not examined. 80 per cent. of these 141 cases were seen at, or in connection with the Dispensary before the end of the year. 31 %of the total contacts were examined before the end of the year. 50% of the child „ „ „ 25 % of the adult „ „ „ 91 Report of Tuberculosis Officer—continued. The number of child contacts of these notified cases is again much smaller than the number of adult contacts—approximately in 1938 only 30 per cent. In addition to the number of "contacts" as defined by the Ministry of Health who were found to be suffering from tuberculosis during the year, 18 other cases diagnosed had been living in contact with previously notified cases who had positive sputum. Particular effort is directed to try to get young adult contacts to attend. 153 of the attenders were sent by staff. Insured Persons. The number of insured persons on the Dispensary Register at the end of the year was 256, of whom 146 were on domiciliary treatment. The number of reports from panel doctors in respect of patients on domiciliary treatment was 30. Doctors are not asked to furnish a quarterly report if patient attends dispensary about time report falls due. 127 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 253. In many cases the practitioner does not meet the Tuberculosis Officer, but asks the latter to examine the patient and let him know his opinion later. The Ministry of Health limits the term " Personal Consultations" to those cases in which the practitioner attends and consults with the Tuberculosis Officer at the patient's bedside, of these there were 16. Doctors are furnished with reports on cases they send for examination and also on the condition on discharge of patients who have been sent for Institutional treatment. 92 Report of Tuberculosis Officer—continued. Bacteriological examinations of sputa. The number of examinations of specimens for Dispensary cases was 769, compared with 634 in previous year. In addition, 218 specimens were sent by practitioners for examination. X-ray Diagnosis. The number of X-ray examinations is 316 compared with 263 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 52 persons. Institutional Treatment. 107 patients were recommended from Dispensary to the London County Council for institutional treatment. 3 patients refused treatment. In some urgent cases recommendations were made from Dispensary for direct admission to London County Council general hospitals. 80 patients were sent for Institutional treatment from other sources, of these 42 sent to St. Alfege's Hospital were seen therein by the Tuberculosis Officer. 188 reports on the condition of the patients treated in previous years were sent to the County Council. Deaths. Of the total deaths of Dispensary patients during 1938— 4 died within 1 month from the date of the first attendance. 7 died within 3 months „ „ „ 3 ,, ,, 6 „ ,, ,, ,, 7 ,, ,, 12 ,, ,, ,, ,, 32 „ after 12 „ „ „ „ In 4 other patients the cause of death was not tuberculosis. In addition, 2 patients on the Register died from nontuberculous conditions. 93 Report of Tuberculosis Officet—continued. 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. Miss Greig, our Dispenser, obtained for, and distributed to children attending the Centre toys and sweets from the Clerical Staff Xmas Gift Fund of the Prudential Insurance Company, who were thanked for again remembering the recipients. Dental Treatment. Twenty-five cases were referred for treatment to the Dental Surgeon who now attends fortnightly. The income and expenditure in connection with the supply of dentures and repairs to dentures to patients were as follows:— £ s. d. Total cost of dentures and repairs 13 15 0 Total cost of free cases 8 10 0 Contributions from Approved Societies ... 2 15 0 H.S.A. 2 0 0 Patient 10 0 The Dental Surgeon, Mr. W. H. Jennings, reports the following as a summary of the year's work:— Cases. Attendances. Extractions. Fillings. Scalings, etc. Dentures. Repairs 23 128 104 21 18 5 2 Handicraft Centre. The Handicraft Classes continue as usual under Miss Forth as teacher and the general management of Mrs. Monk, who arranged for the patients the annual outing to the seaside and the winter tea and concert, friends who assisted in previous years again contributing to the entertainment. 94 Report of Work of the Tuberculosis Care Committee, for 1938. Again this year we begin our report on the work of the Tuberculosis Care Committee on a sad note. It is with very real regret that we have to report the deaths of two valued members, who have served on the Committee for many years—Councillor Mrs. Herlihy and Mr. Elliott. Their interest in the work was marked and they will be greatly missed. Alterations in the regulations for the provision of clothing for patients undergoing institutional treatment, foreshadowed in our last report, and which were then being discussed by the Standing Conference of Metropolitan Borough Tuberculosis Care Committees and the London County Council, have been effected. These alterations have improved the position. Again the usefulness of the Conference has been demonstrated. The usual meetings of this body have been held during the year and our Chairman was re-elected as Chairman of the Conference. Matters of interest to Care Committees have been discussed and much useful information imparted. During the year 187 cases have been recommended for treatment and dealt with individually by the Care Committee. 1013 visits have been paid to patients at home and in hospital. 1074 persons have been interviewed at the Dispensary by the Secretary. 982 cases have been considered by the Care Committee at their meetings. The sum of £106 19s. 4d. was raised by the sale of Christmas Seals for the year 1938. Expenses amounted to £8 5s. 4d. The amount collected is very slightly lower than last year, but in view of the many and special calls for help from the general public, this year particularly, we feel that the response was generous. In addition, we have received financial aid and other forms of help from the various organisations working in the Borough. For the support and aid so generously extended by these bodies the Care Committee desire to express their appreciation and to tender thanks. The answers to the questions as to why we want money, and what we do with it, will be found in the report now published annually by the Care Committee. To face Page 94 Report of Tuberculosis Officer—continued. TUBERCULOSIS SCHEME. (a) pulmonary tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written oft the Register. The Table is arranged according to the years in which the Patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the Return relates. Previous to 1928 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Class T B. minus Class T.B. plus Class T.B. minus. Class T.B. plus. Class T.B- minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total(Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December Disease arrested Adults M. 4 l 5 1 1 1 2 1 2 3 2 1 3 3 1 l 2 1 6 7 1 1 1 2 1 1 2 4 1 1 F. l 3 4 l 3 3 3 1 4 l 5 5 l l 2 2 2 3 5 5 1 2 2 4 Children ... 1 I 1 1 1 3 2 2 2 Disease not arrested Adults M. 4 1 5 l 1 1 2 3 1 3 1 5 2 4 6 1 2 6 8 7 7 2 3 17 20 3 14 1 18 7 6 10 1 17 7 5 19 9 33 F. 2 2 l 1 1 1 1 2 3 1 l 3 4 1 1 1 1 4 4 3 4 7 1 12 3 2 4 6 7 1 12 3 18 8 2 16 5 23 Children ... 1 1 1 6 1 1 7 1 1 11 Condition not ascertained during the Year 1 1 1 3 1 1 2 Total on Dispensary Register at 31st December 1 13 2 16 l 3 l 4 3 2 7 9 1 5 6 1 12 3 4 10 l 15 3 2 4 6 8 3 16 19 9 3 17 20 8 10 28 1 39 16 8 18 2 28 21 7 23 4 34 26 7 35 14 56 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 41 17 18 1 36 2 l 1 3 2 2 4 l 1 2 3 2 1 1 1 1 2 1 1 F. 68 11 11 22 2 1 l 2 1 1 1 1 1 1 1 1 Children ... 73 1 1 2 3 1 1 1 2 1 1 Lost sight of or otherwise removed from Dispensary Register 401 95 201 31 327 19 10 20 I 31 31 7 29 I 37 24 6 30 3 39 21 11 27 4 42 17 8 30 3 41 21 6 28 I 35 17 2 14 2 18 19 7 24 31 12 3 13 3 19 12 8 7 1 16 1 2 1 3 Dead Adults M. 44 47 202 64 313 2 2 18 11 31 5 2 23 11 36 4 24 10 34 4 3 25 5 33 1 31 9 40 4 1 22 12 35 2 2 8 14 24 5 14 3 17 3 1 8 7 16 6 12 18 1 5 6 11 F. 34 29 110 48 187 6 10 16 2 4 13 10 27 1 1 13 12 26 2 2 11 12 25 2 2 24 4 30 5 1 8 6 15 2 10 5 17 4 5 4 9 1 10 3 13 2 2 5 7 1 1 2 Children .. 11 4 4 4 12 1 1 1 1 1 2 3 1 4 1 1 Total written off Dispensary Register 672 204 546 148 898 27 13 46 22 81 44 15 69 23 107 32 8 69 25 102 31 17 65 21 103 21 11 87 17 115 31 9 59 19 87 19 9 33 21 63 28 7 43 7 57 16 4 32 13 49 14 8 15 18 41 2 8 8 16 Grand Totals 672 205 559 150 914 28 16 47 22 85 47 17 76 23 116 33 13 75 26 114 34 21 75 22 118 24 13 91 17 121 39 12 75 19 106 28 12 50 21 83 36 17 71 8 96 32 12 50 15 77 35 15 38 22 75 28 7 43 22 72 Report of Tuberculosis Officer—continued. (b) NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the Return relates. Previous to 1928 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Bones and Joints ' Abdominal Other Organs Per.pheral Glands Total Bunes and Joints. Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs Peripheral Glands ! Total. Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral G'ands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Class T.B. minus Class T.B. plus Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested Child-Adults ren M. 1 1 l l l 2 3 l l l 1 l I F. 1 l l l l l 2 l 1 2 l 1 l l 1 1 ••• 1 l l l 1 1 2 l 3 2 2 1 1 l 1 2 l l 2 Disease not arrested Chlid- Adults ren M. 3 3 1 1 l 1 2 l 1 2 2 4 5 5 F. 2 l 3 l l l l 2 1 3 1 2 3 1 1 l 2 2 5 ••• 1 l 1 1 1 1 1 1 1 1 4 l 5 3 l 1 5 1 1 2 Condition not ascertained during the year 1 1 1 1 1 1 2 l 1 Total on Dispensary Register at 31st December 4 3 1 8 2 2 2 1 3 l 1 4 l l 6 3 l 4 2 l 3 5 3 2 10 6 1 1 8 5 5 2 2 14 3 2 2 6 13 6 l 3 3 13 Transferred to Pulmonary 7 2 2 11 2 2 1 l 1 3 2 l 3 1 1 l 1 l 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Crh"d- Adults ren M. 18 3 1 6 28 2 1 3 l 1 1 1 2 2 l 1 2 1 1 F. 10 1 8 19 1 1 2 1 3 ••• 21 8 1 59 89 1 1 4 6 1 4 5 l l l 2 5 1 1 4 4 1 l 2 1 1 Lost sight of or otherwise removed from Dispensary Register 57 16 15 70 158 10 2 5 1 18 5 2 2 3 12 9 4 4 6 23 5 3 3 8 19 11 1 2 7 21 10 1 2 6 19 12 6 2 6 26 4 2 3 7 16 2 1 2 5 1 2 1 4 1 1 2 Dead Chlld-Adults ren M. 10 1 1 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 F 5 1 3 9 1 1 2 1 1 ••• 5 2 7 1 1 2 1 1 1 1 Total written off Dispensary Register 126 30 23 143 322 12 6 5 6 29 7 2 2 8 19 11 5 5 8 29 6 3 3 9 21 16 2 2 15 35 13 l 4 7 25 14 7 2 7 30 4 2 3 7 16 3 1 2 6 1 1 3 1 6 1 1 Grand Totals of a and b (excluding those transferred to Pulmonary) 130 30 26 144 330 14 6 5 6 31 9 2 2 9 22 12 5 5 8 30 10 4 3 10 27 19 2 2 16 39 15 l 4 8 28 19 7 5 9 40 10 2 4 8 24 8 5 3 4 20 4 3 5 7 19 6 l 4 3 14 SECTION H. Maternity and Child Welfare. 96 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. 97 Summary of Visits paid by Health Visitors, 1938. Health Visitor District Visits Re-visits Total Miss Robus Deptford Park and Evelyn (part) Wards 1188 2444 3632 Miss Cloke St. Paul's and Evelyn (part) Wards 947 3088 4035 Miss O'Loughlin Clifton, Vale and Canterbury (part) Wards 1109 3125 4234 Miss Sherborne Canterbury and Hatcham Wards 922 2970 3892 Miss Reynolds St. John's (part), Town Hall and St. Peter's Wards 955 2992 3947 Miss Holland St. John's (part) Ward 375 2489 2864 Miss Little Pepys' and St. Catherine's Wards 854 2154 3008 Totals 6,350 19,262 25,612 Note : The visits of the Holiday Health Visitor are included in the above figures. Analysis of Visits paid by Health Visitors, 1938. To infants under 5 years Enquiries re Visits. Re-visits. Total. Births 1388 15227 16615 Still-births 44 — 44 Infant deaths 67 — 67 Ophthalmia Neonatorum 12 24 36 Measles 739 467 1206 Poliomyelitis — 5 5 Infant Diarrhoea 24 10 34 Pneumonia 11 13 24 Whooping Cough 118 57 175 Infectious Disease hospital recoveries 142 13 155 Scabies 41 20 61 Visits to Foster Children 36 303 339 Miscellaneous visits 273 57 330 Unsuccessful visits 482 609 1091 Total (under 5 years) 3,377 16,805 20,182 G 98 To children over 5 years Enquiries re Visits. Re-visits. Total. Measles 451 198 649 Infectious Disease recoveries 15 1 16 Whooping Cough 31 20 51 Scabies 85 45 130 Pneumonia 1 — 1 Visits to Foster Children 1 26 27 Miscellaneous visits 506 172 678 Total (over 5 years) 1,090 462 1,552 Other visits To expectant mothers 1032 399 1431 To Puerperal Fever or Pyrexia 12 2 14 Maternal death enquiry 1 — 1 To Common Lodging Houses 14 51 65 Total other visits 1,059 452 1,511 Unsuccessful visits 824 1543 2367 Totals 6,350 19,262 25,612 In the case of the 1,388 infants visited shortly after birth, it was found that 1,233 infants were being breast-fed and 67 partly breast-fed. Only 88 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. 99 Attendances of Health Visitors at Clinics. Health Visitor Infant Welfare Toddlers' Clinic AnteNatal Light Massage Schick Dental Sewing Class Total Miss Robus 84 - 6 - - - - - 90 Miss Little 111 - 1 - - - - - 112 Miss O'Loughlin 73 2 3 - - 6 5 - 89 Miss Stowell — 100 — 10 - — — 49 159 Miss Reynolds 64 - 9 — - — - — 73 Miss Holland 37 6 47 158 - — — — 248 Miss Clubbe 174 — 180 — - 15 — — 369 Miss Gibson — — 181 — 180 — — — 361 Miss Cloke 62 — 13 — - — 5 — 80 Miss Sherborne 77 — 3 — — — — — 80 Temporary Holiday Health Visitor 21 - - - - - - - 21 Total 703 108 443 168 180 21 10 49 1, 682 2. Welfare Centres. (a) Infant Welfare. In addition to maintaining the Clinics held at Gosterwood Street and Hderton 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 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. g2 100 The following is a summary of the work done at the various Infant Welfare Clinics during the year:— (For details, see Appendix, Table IV.) Clinic. No. of times open. New Cases Attendances Consultations with Doctor Under 1 year. Ages 1-5 years. Total New Cases Total Old Cases Total New and Old Cases Under year 1-5 years Gosterwood Street 47 112 18 130 2271 2401 1858 543 1082 Central Clinic Monday sessions 49 83 17 100 2410 2510 1904 606 969 Tuesday Do. 51 71 14 85 1988 2073 1587 486 803 Wednesday Do. 51 84 12 96 2637 2733 2006 727 1208 52 72 7 79 1993 2672 1537 535 1087 Thursday Do. 51 107 20 127 2422 2549 2044 505 934 51 55 8 63 1046 1109 775 334 402 Friday Do. 51 77 12 89 1604 1693 1394 299 614 51 122 22 144 2814 2958 2236 722 1254 Hales Street 51 106 4 110 2339 2449 1939 510 809 52 113 29 142 2292 2434 1748 686 1065 Ilderton Road 51 97 16 113 2849 2962 2272 690 1002 Toddlers' Clinic 106 — 741 741 319 1060 — 1060 1060 Do. Ilderton Rd. — — 37 37 15 52 - 52 52 Totals 714 1099 957 2056 26999 29055 21300 7755 12841 * Commenced September, 1938. The Health Visitors collectively made 703 attendances at these Clinics. (b) Maternity Clinics. These are conducted at the Central Clinic, Amersha Road and at a 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, 27 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. Close co-operation 101 has always existed between the L.C.C. Hospital Maternity Departments and the Council's Clinics and, following upon a series of conferences between the Borough Medical Officer and the County Medical Officer, certain improved arrangements have been made for interchange of information and the prevention of overlapping. During the year, also, a closer link between the County Council and the Borough Council maternity services was established by the association of the Council's Maternity and Child Welfare Officer, Dr. Hill, in an honorary capacity with the maternity department of St. Alfege's Hospital. Ante-Natal Clinics. The work of the Ante-natal Clinics 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 2984 1936 888 59 3090 1937 899 63 3278 1938 887 64 3314 102 The following is the text of Dr. Hill's Report for 1938:— Ante-Natal Clinic Statistics, 1938. Central Clinic Clyde Street Total number of Patients on Register 725 162 New Cases 550 153 Total Attendances 2,794 520 Normal Cases 55 34 Not pregnant 24 Nil Central Clinic. Clyde Street. Abnormalities:— Albuminuria 46 4 Anaemia 62 8 Ante-partum Haemorrhage 7 6 Adenitis 3 — Bronchitis l — Contracted Pelvis 13 1 Cystic Mole — 1 Cystocele — 27 Cystocele and Rectocele — 17 Deformed Nipples 30 14 Dental Caries 348 67 Dyspepsia 10 1 Fibroid 2 — Haemorrhoids 38 3 Hernia 1 1 Hydramnios 1 9 Insomnia 7 — Leucorrhoea 22 10 Malpresentation 8 4 Morbus Cordis 17 - Obesity — 1 Oedema 8 6 Pruritis 3 2 Pyelitis — 1 Placenta Praevia 1 — Psoriasis 1 - 103  Central Clinic Clyde Street Retroversion 4 3 Raised Blood Pressure 31 — Scabies 2 1 Sciatica 13 2 Twins 1 1 Urticaria — 1 Varicose veins 60 21 Venereal Disease — 3 Vomiting, excessive — 1 Vulvitis — 3 Varicose Vulva — 3 Central Clinic. Sent for X-ray 27 Letters to private Midwives 22 Referred to Tuberculosis Officer 3 Letters to General Practitioners 8 Cases referred to St. Alfege's Hospital (Form G.H. 14) 113 Reports sent to L.C.C. Midwives (Form G.P.H. 980) 56 (Form G.P.H. 981) 35 Total 91 Refused Maternity Home (full) 65 Withdrew after assessment 6 Post-Natal Clinic. Amongst the patients seen the following defects were found and dealt with:— Albuminuria 1 Retroversion 14 Anaemia 5 Raised blood pressure 2 Abscess of Breast 1 Subinvolution 6 Cracked Nipple 3 Unhealed tears of cervix 5 Cystocele 2 Unhealed tears of perineum 2 Fibroid 1 Patients sent for Wassermann Test 1 Hæmorrhoids 6 Hernia 1 Patients referred to Tuberculosis Officer 1 Mastitis 1 Prolapse 1 Remedial exercises were taught to 113 patients. 104 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 1464 Number of individual women who attended 620 (c) Artificial Light Clinic. Both the Mercury Vapour and the Carbon Arc type lamps are in use, the former being centrally-placed Centrosol Mercury Vapour lamp together with two ancilliary lamps of the "Sollux" type, to aid the efficiency of Ultra-violet radiation. All children and adults 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:— 105 1938. Patients on Register at commencement of each month. New Patients Admitted. Patients Re-admitted. Patients Discharged. Patient on Register at end of month. Attendances each month. Total Attendance for each month Months. 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. Under 1 Year 1—5 Years A.-N. P.-N. January 14 84 ... 1 6 67 ... 1 ... 2 ... ... 2 45 ... ... 18 108 ... 2 51 758 ... 3 812 February 18 108 ... 2 7 44 ... 3 ... ... ... ... 3 39 ... 4 22 113 ... 1 65 779 ... 14 858 March 22 113 ... 1 9 36 ... 1 ... 4 ... ... 2 50 ... 1 29 103 ... 1 106 893 5 1,004 April 29 103 ... ... 1 23 ... ... ... 2 ... ... 1 48 ... ... 29 81 ... 1 68 543 ... 3 614 May 29 81 ... 1 4 13 ... ... ... 2 ... ... 3 51 ... 1 29 46 ... ... 75 537 ... ... 612 June 29 46 ... ... 1 18 ... 1 ... ... ... ... 3 46 ... ... 23 22 ... 1 38 353 ... 8 399 July 23 22 ... 1 1 4 1 1 ... 4 ... ... 2 35 ... 1 11 6 1 1 19 214 2 7 242 August ... ... ... ... ... ... ... ... ... Room Closed for Repairs ... ... ... ... ... ... ... ... ... September 11 6 1 1 2 29 1 ... ... ... ... ... ... 2 1 1 13 33 1 ... 8 177 ... 2 187 October 13 33 1 ... 14 37 ... 2 ... ... ... ... 1 15 ... 2 26 55 1 ... 58 379 2 3 442 November 26 55 1 ... 9 55 ... 2 ... ... ... ... 2 22 1 ... 33 88 ... 2 130 621 1 13 765 December 33 88 ... 2 2 32 ... 1 ... 1 ... ... 2 24 ... 1 33 97 ... 2 67 532 ... 15 614 Totals ... ... ... ... 56 358 2 12 1 15 ... ... 21 377 2 11 ... ... ... ... 685 5,786 5 73 6,549 A.-N.—Anti-Natal. P.-N.—Post-Natal. 106 Classification of Patients Admitted During The Year. Diseases. Admissions. Re-admissions. Under 1 Yr. Over 1 Yr. AnteNat. Post Nat. Under 1 Yr. Over 1 Yr. AnteNat. Post Nat. Anaemia 16 67 1 1 ... 3 ... ... Rickets 6 54 ... ... ... 1 ... ... Muscular Weakness 2 18 ... ... ... 1 ... ... Malnutrition 5 14 ... ... ... ... ... ... Curved Tibiae 5 55 ... ... ... 2 ... ... Bronchitis 3 6 ... ... ... ... ... ... Delayed Dentition 13 63 ... ... ... 5 ... ... Genu Valgum ... 29 ... ... ... 1 ... ... Cervical Adenitis ... 10 ... 1 ... ... ... ... Otorrhœa ... 1 ... ... ... ... ... ... Underweight 1 8 ... ... ... ... ... ... Chilblains 1 ... ... ... ... ... ... ... Mastitis ... ... ... 10 ... ... ... ... Myasthenia ... 8 ... ... ... 1 ... ... Stammering ... 1 ... ... ... ... ... ... Hypovitaminosis 1 1 ... ... ... ... ... ... Insomnia ... 5 ... ... ... ... ... ... Anorexia ... 6 ... ... ... 1 ... ... Post Infective Debility 1 ... ... ... ... ... ... ... Post Whooping Cough Debility ... 3 ... ... ... ... ... ... Flat Foot ... 3 ... ... ... ... ... ... Cyclical Vomiting ... 1 ... ... ... ... ... ... Dental Decay ... 1 ... ... ... ... ... ... Sciatica ... ... ... ... ... ... ... ... Hypermotibility ... ... ... ... ... ... ... ... Enuresis ... 1 ... ... ... ... ... ... Ulcerated Mouth 1 ... ... ... ... ... ... ... Ataxic Gait ... 1 ... ... ... ... ... ... Boils on Head 1 ... ... ... ... ... ... ... Debility ... 1 ... ... ... ... ... ... Totals 56 358 2 12 1 15 ... ... 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. 107 (d) Massage and Exercises.—Four Sessions weekly. On Register January 1st, 1931, 49. Do. December 31st, 1938, 68. New Cases 264 (including 5 under 1 year of age). Discharged 244. Attendances 3,646. (e) Day Nursery. This provides for the reception of selected children upon five days each week. Total Number of Attendances 2,233. Number of Individual Children on Register December 31st, 29. 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. (f) Sewing Class. 393 attendances of Mothers were registered during the year; 49 sessions were held. (g) Toddlers' Clinic.—In addition to the Toddlers' Clinic, held at the Central Clinic, a second clinic is held once monthly at the Baptist Institute, Ilderton Road. Central Clinic Ilderton Road Number of Clinics held 106 4 Total number of Inspections made 1060 52 Attendances of new cases 741 37 „ „ old cases 319 15 Summary of Defects found. Tonsils 125 Cervical Adenitis 13 Dental Caries 123 Malnutrition 5 Rickets 6 Enuresis 23 Genu Valgum 162 Strabismus 10 Flat Foot 69 Umbilical Hernia 20 Curved Tibiæ 40 Blindness 1 Deformity of Chest 7 Keratitis 1 Digitus Varus 2 In-toeing 1 Heart defects 1 Total 610 D.A.H. 1 * Opened September, 1938. 108 All children examined either at the Toddlers' Clinics or at the Infant Welfare Centres exhibiting defects were referred to their own Doctor or to Hospital, or in necessitous cases to the Minor Ailments Clinic of the London County Council under arrangements made by the Borough Council. (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. W. H. Jennings, has furnished me with the following details of the work in 1938:— Cases. Extractions. Fillings. Scalings, Silver Nitrate etc. Gas Cases. Dentures Supplied. Repaired Mothers 280 285 358 66 70 24 2 Children 145 8 92 91 40 — — 3. Consulting Obstetricians. The circumstances under which the services of Consulting Obstetricians can be requisitioned may be summarised as follows:— (a) In the case of Puerperal Fever or Pyrexia. 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, and authorises any midwife, in case of grave emergency, to call in a Consultant, without first seeking help from a local medical practitioner. The following Consultants have been appointed by the Borough Council:— Mr. J. B. Blaikley, f.r.C.s., 55 Harley Street, W.I. Mr. A. L. Gunn, f.r.c.s. (Edin.), 59 Harley Street, W.I. Mr. H. G. Taylor, f.r.C.s., 86 Portland Place, W.I. Mr. Arnold L. Walker, F.R.C.S., 121 Harley Street, W.I. Mr. J. F. Gibbert, f.r.C.s., who has acted in this capacity for several years, indicated his desire to discontinue this service. 109 During the year an Obstetrician was called in upon two occasions. In both cases the emergency arose on account of ante-partum haemorrhage; in one case lateral placenta praevia and, in the other, low implantation of the placenta, was diagnosed. In addition to the above arrangements, the Council agreed to cooperate in the provision by the London County Council of an Emergency Obstetrical Service which is designed to meet the case of a patient who cannot be removed to hospital without undue risk. The emergency unit, which is staffed by a doctor with special obstetrical experience and a midwife, carries the appropriate equipment and is sent direct to the patient's home upon the requisition of the medical attendant or, in the case of grave emergency, of the midwife in attendance. The scheme provides for the recovery of all or part of the Consultant's fee where circumstances warrant it. 4. The Maternity Home. The record of the Municipal Maternity Home shows that the work carried out during 1938 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 1938:— Cases admitted, 256. Average stay, 2 weeks. Cases delivered by midwives. 212. ,, „ „ doctors, 10. Cases in which medical advice sought, 35. (Plus 55 sutures). Cases notified as puerperal fever, Nil. „ ,, ,, puerperal pyrexia, 2 (Pleurisy and Pyelitis). Cases of Pemphigus Neonatorum, Nil. Notified as Ophthalmia Neonatorum, Nil. Infants not entirely breast fed, Nil. Maternal deaths, Nil. Infant deaths (a) Stillborn, 12. (b) Within 10 days of birth, 2. So far as is practicable, only cases likely to follow a normal course are admitted. Should an abnormality develop after the date of "booking," the patient is referred to hospital. 110 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 1938, it was found necessary to call the Consultant to the Home on 4 occasions for 6 consultations. The conditions found were:—(l) Eclampsia—Recovered; (2) Flattened Pelvis—instrumental delivery—Discharged well; (3) Prolonged Labour—Transferred to King's College Hospital; (4) Miscarriage and (?) Pleurisy—Transferred later to St. Alfege Hospital on advice of Tuberculosis Officer; (5) Contracted Pelvis—Transferred to King's College Hospital; (6) Prolonged Labour—high presentation, hydramnios—Transferred to King's College Hospital, where death ensued from right-sided heart failure. The attention of the Committee was drawn to the desirability of providing a Mercury Vapour Lamp for the treatment of Mothers, and this was installed during the year. 5. Provision of Maternity Outfits. The Borough Council now provides sterile maternity outfits for any women confined at home, the issue being at half cost price or free in necessitous cases. During the year under report the following issues were made:— Free 48 Sold at half price 15 Sold at full price 6 111 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 25 instances, Home Helps were provided during the year under report. 8. Convalescent Treatment. Provision is made for the accommodation of mothers and children, selected upon medical grounds, in certain recognised convalescent homes, admission being made either direct or, in the case of children, through the Invalid Children's Aid Association. During 1938, 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:— 108 children admitted, of which 39 were sent by the Borough Council. 624 test feeds were conducted at the Breast-feeding Clinic, all of which were sent by the Borough Council. 33 mothers with infants were admitted as in-patients for restoration of breast-feeding. 112 10. Supply of Milk and Accessory Foods. The Borough Council's scheme provides for the issue of fluid and dried milk, at full cost, or free, or at half-cost, according to a Scale of Necessity, to (a) Expectant mothers during the last six months of pregnancy. (b) Nursing mothers. (c) Children up to three years, also, in exceptional circumstances to children between three and five years of age. The issue is in general accordance with the Minister of Health's Circular No. 185. Various brands of dried milk are issued, labelled specially to the Council's directions to avoid the use of trade names. In 1938, the following free or half-price issues were authorised:— 10,228 families were given fortnightly supplies. Fluid milk formed the bulk of this supply, dried milk being issued only on the recommendation of the Centre Medical Officers. Issues of Cod Liver Oil and Malt and Virol are made upon medical advice to debilitated children, the parent paying cost price, where able. 11. Compensation to Midwives. Where an expectant mother, referred to the Ante-natal Clinic by a midwife with whom she has "booked," is found to be suffering from some abnormality which necessitates her confinement in hospital, the Council pay to the midwife a portion of her prospective fee which would be otherwise lost. In 4 instances this policy was carried into effect, involving a total expenditure of £2 0s. 0d. Payment of Midwives' Fees. This was discontinued as from the 1st January, 1938, in view of the inception of the L.C.C. domiciliary midwifery scheme. 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 113 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. 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 1937. Added. Removed. No. at end of year 1938. Fostermothers 19 16 18 17 Fosterchildren 20 28 28 20 The foregoing account, necessarily largely statistical and abridged, describes the activities of the Public Health Department during 1938, activities which are continually increasing in consonance with the ever expanding policy of the Council in measures for the preservation of the public health. I have the honor to be, Your obedient Servant, F. LEONARD KEITH, Medical Officer of Health. h Appendix. 116 Table Causes of death at different Periods of life In the metroplitaian borogh of deptford, 1938. causes of death. Sex All Ages 0- 1 - 2- 5— 15- 25— 35- 45— 55— 65— 75 - All causes M 609 38 3 8 5 20 20 34 50 123 167 141 F 518 37 2 5 3 14 13 18 50 61 127 188 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 1 .. Measles M 2 .. .. 2 .. .. .. .. .. .. .. .. Scarlet Fever F .. .. .. .. .. .. .. .. .. .. .. .. M 1 .. .. .. .. 1 .. .. .. .. .. .. Whooping Cough F .. .. .. .. .. .. .. .. .. .. .. .. M 1 1 .. .. .. .. .. .. .. .. .. .. Diphtheria F .. .. .. .. .. .. .. .. .. .. .. .. M 3 .. .. 3 .. .. .. .. .. .. .. .. Influenza F 2 .. .. 2 .. .. .. .. .. .. .. .. M 2 .. .. .. .. .. .. 1 .. .. .. 1 Encephalitis Lethargica F 6 .. .. .. .. .. 1 .. .. 1 2 2 M .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever F .. .. .. .. .. .. .. .. .. .. .. .. M .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system F .. .. .. .. .. .. .. .. .. .. .. .. M 42 .. 1 .. .. 4 6 8 14 7 2 .. F 12 .. .. .. .. 4 3 1 1 2 1 .. Other Tuberculous Diseases M 4 1 .. 1 .. 1 1 .. .. .. .. .. F 6 2 .. .. .. 2 1 .. .. .. .. 1 Syphilis M .. .. .. .. .. .. .. .. .. .. .. .. General Paralysis of the Insane, tabes dorsalis F 1 .. .. .. .. .. .. .. .. 1 .. .. M 4 .. .. .. .. .. .. 1 .. 1 1 1 F .. .. .. .. .. .. .. .. .. .. .. .. Cancer, malignant disease M 88 .. .. .. .. 1 2 1 7 26 34 17 Diabetes F 77 .. .. .. .. .. .. 3 14 14 27 19 M 7 .. .. .. .. .. .. .. .. 2 3 2 Cerebral Haemorrhage, etc. F 9 .. .. .. .. .. .. 1 .. 1 5 2 M 27 .. .. .. .. .. .. .. 4 7 10 6 Heart Disease f 29 .. .. .. .. .. .. .. 5 7 6 61 M 176 .. .. .. 2 4 2 3 8 36 53 68 Aneurysm F 177 .. .. .. .. 4 2 4 4 16 52 95 M 6 .. .. .. .. .. .. .. .. 4 2 .. Other Circulatory Diseases F 2 .. .. .. .. .. .. .. .. 1 .. 1 M 38 .. .. .. .. .. .. 1 2 8 15 12 Bronchitis F 32 .. .. .. .. .. .. .. 2 2 12 16 M 22 .. 1 .. .. .. 1 1 3 4 7 5 Pneumonia (all forms) F 12 1 .. .. .. .. .. 1 .. 1 2 7 M 44 9 .. 1 1 .. 1 5 4 7 8 8 Other Respiratory Diseases F 31 8 1 2 .. .. .. .. 5 4 4 7 M 3 .. .. .. .. 1 .. .. .. 2 .. .. Peptic Ulcer F 1 .. .. .. .. .. 1 .. .. .. .. .. M 6 .. .. .. .. .. .. 1 2 2 1 .. Diarrhoea, &c. F .. .. .. .. .. .. .. .. .. .. .. .. M 6 6 .. .. .. .. .. .. .. .. .. .. Appendicitis f 1 1 .. .. .. .. .. .. .. .. .. M 3 .. .. .. .. l .. .. .. 1 1 .. F 4 .. .. 1 .. .. 1 .. 2 .. .. .. 117 Table 1—continued. CAUSES OF DEATH. Sex. All Ages. 0— 1- 2— 5— 15— 25 35— 45— 55— 65— 75- Cirrhosis of Liver M .. .. .. .. .. .. .. .. .. .. .. .. Other diseases of Liver, etc F 3 .. .. .. .. .. .. .. 1 2 .. .. M .. .. .. .. .. .. .. .. .. .. .. .. Other Digestive Diseases F 4 .. .. .. .. .. .. .. 1 1 1 1 M 8 .. .. .. .. .. 1 .. .. 1 4 2 Acute and chronic Nephritis F 3 .. .. .. .. .. .. .. .. .. .. .. M 11 .. .. 1 1 .. .. 1 .. 3 3 2 Puerperal Sepsis F 16 .. .. .. .. 1 1 3 4 1 2 4 F .. .. .. .. .. .. .. .. .. .. .. .. Other Puerperal causes F 2 .. .. .. .. .. 2 .. .. .. .. .. Congenital Debility, Premature Birth, Malformations, etc. M 21 21 .. .. .. .. .. .. .. .. .. .. F 23 21 1 .. 1 .. .. .. .. .. .. .. Senility M 6 .. .. .. .. .. .. .. .. .. 2 4 Suicide F 14 .. .. .. .. .. .. .. .. .. 2 12 M 11 .. .. .. .. .. .. 5 .. 1 3 2 Other violence F 6 .. .. .. .. 1 .. 1 2 1 1 .. M 26 .. .. .. .. 6 4 1 1 5 6 3 Other defined diseases F 13 1 .. .. 1 .. .. .. 1 .. 4 6 M 41 .. 1 .. 1 1 2 5 5 6 12 8 Causes ill-defined or unknown F 30 3 .. .. 1 2 1 4 8 6 4 1 M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 1 118 Table II. SHOWING NUMBER OF ARTICLES DISINFECTED OR DESTROYED AT OWNER'S REQUEST. 1938 Articles Stoved Articles Destroyed at Owner's Request Books Rathing Station Adults Balhs Beds Pillows Bolstens Mattresses Sheets Blankets Miscellan'us Total Beds Pillows Bolsters Mattresse Sheets Blankets Miscellan'us Books Total D.B.C. Library Private Total Towels Blankets Wearing Apparel Total Scabies Persons Cleanse Wearing Apparel Stoved January 44 98 22 38 87 121 326 736 2 9 3 2 ... 4 35 ... 55 15 ... 15 361 32 446 859 16 6 44 February 43 138 35 50 88 194 363 911 1 ... ... 2 ... ... ... ... 3 18 ... 18 513 34 491 1038 2 6 36 March 45 101 37 32 72 118 204 609 2 4 1 2 ... ... 4 ... 13 28 3 31 451 15 412 878 1 7 61 April 37 118 34 41 70 100 192 59.2 3 6 ... 3 ... ... 26 ... 38 11 ... 11 180 1 131 312 13 1 8 May 54 129 41 45 107 227 396 999 9 25 7 10 2 3 30 ... 86 49 ... 49 370 4 161 558 6 7 55 June 29 88 21 29 60 72 117 446 3 10 1 7 3 2 71 65 162 19 12 31 394 ... 196 590 11 5 33 July 29 92 28 42 61 104 430 786 5 2 1 2 ... ... 2 ... 12 4 ... 4 214 ... 98 312 ... 6 45 August 30 102 21 26 61 74 177 491 2 4 2 12 3 2 59 ... 84 13 ... 13 105 47 152 1 7 50 September 30 77 23 26 54 73 231 517 4 8 1 9 ... ... 6 ... 28 11 ... 11 391 ... 104 495 ... 4 26 October 33 100 26 44 60 80 205 548 5 6 2 5 ... ... 21 ... 39 9 ... 9 262 3 69 334 1 10 64 November 55 167 31 62 112 194 478 1099 7 7 4 8 1 1 19 ... 47 23 ... 23 400 30 342 772 3 5 35 December 29 100 31 47 63 86 319 675 4 4 ... 1 1 1 8 ... 19 14 ... 14 306 16 188 510 ... 4 25 458 1310 350 482 895 1443 3471 8409 47 85 22 63 10 13 281 65 586 214 15 229 3947 155 2708 6810 54 68 482 119 Table III. SHOWING NUMBER OF PREMISES VISITED AND ROOMS DISINFECTED. 1938 Premises Visited Rooms Disinfected Infectious Diseases Requests Bedding only Removals Verminous Scarlet Fever Diphtheria Pulmonary Tuberculosis Scabies Measles Cancer Puerperal Fever Whooping Cough Erysipelas Cerebrospinal- Meningitis Typhoid Fever Infantile Paralysis Pneumonia Formalin Spray Sul- phur Total Rooms Infectious Diseases Requests Removals Ver- "g minous e January 67 10 7 2 7 16 29 23 5 .. l .. .. 1 .. .. l 76 11 4 12 103 February 63 5 8 1 4 16 21 26 10 .. l .. 1 .. l .. .. .. 75 4 2 6 87 March 60 6 5 4 8 23 15 17 8 6 1 .. 1 .. l .. .. .. 70 8 7 12 97 April 61 8 5 5 17 30 11 12 15 9 1 .. .. .. .. 1 .. .. 79 7 7 24 117 May 84 5 14 1 17 39 17 25 15 4 1 .. .. l .. .. .. .. 100 8 2 27 137 June 40 11 3 2 28 14 5 8 13 .. .. .. 1 .. .. .. .. .. 41 15 4 44 104 July 45 7 8 2 24 16 13 13 8 .. .. .. .. .. .. .. .. .. 50 7 3 37 97 August 38 8 8 • • 31 11 13 16 2 2 1 .. .. .. .. .. .. .. 49 9 .. 49 107 September 42 7 6 1 12 10 11 19 12 .. .. .. .. .. .. .. .. .. 47 13 1 25 86 October 47 5 5 2 12 25 17 11 3 .. 4 l 1 .. .. .. .. .. 57 9 2 17 85 November 69 11 7 5 6 33 17 15 15 .. .. l .. .. .. 2 l .. 84 14 6 10 114 December 57 6 6 2 4 20 19 12 9 .. 1 4 3 2 2 .. .. .. 72 7 3 5 87 613 89 82 27 140 253 188 197 115 21 11 9 7 4 4 3 l l 800 112 41 268 1221 120 MONDAY SESSIONS AT St. Luke's Hall, Gosterood Street 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Ages 1-5. January 5 7 1 1 9 267 276 136 February 4 11 1 1 2 15 204 219 97 March 3 7 1 8 177 185 66 April 3 4 4 2 10 148 158 87 May 5 10 1 3 14 230 244 111 June 3 9 1 10 131 141 60 July 4 15 1 3 19 198 217 106 August 4 4 1 5 188 193 82 September 4 9 1 1 11 196 207 101 October 5 8 2 10 228 238 96 November 4 10 2 4 16 206 222 102 December 3 2 1 3 98 101 38 Total 47 96 7 9 18 130 2271 2401 1082 CENTRAL CLINIC—MONDAY SESSIONS 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases Consultations with Doctor Breast Fed. Mixed. Artificial. Ages 1—5 January 5 4 1 1 6 249 255 100 February 4 1 1 2 5 9 198 207 91 March 4 9 1 3 1 1.1 224 238 93 April 3 3 1 1 1 6 181 187 66 May 5 3 2 1 6 265 271 102 June 3 4 1 1 6 133 139 55 July 4 6 1 2 9 201 210 83 August 4 4 3 2 1 10 175 185 69 September 4 4 2 6 196 202 69 October 5 12 3 3 18 249 267 103 November 4 3 1 1 5 226 231 95 December 4 5 5 113 118 43 Total 49 58 11 14 17 100 2410 2510 969 121 CENTRAL CLINIC—TUESDAY SESSIONS (Hatchavt-Pepys District) 1933 No. of times Clinic opened. Breast Fed. New Cases. Ages 1—5. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Mixed. Artificial. January 4 3 3 2 18 232 215 127 February 4 4 1 5 215 220 86 March 5 6 1 1 8 264 272 126 April 4 5 1 1 7 176 183 73 May 5 5 2 7 225 232 112 June 4 10 1 2 1 14 201 215 102 July 4 3 3 6 218 224 97 August 5 4 2 2 2 10 255 265 107 September 4 4 1 1 1 7 212 219 102 October 4 2 1 3 176 179 91 November. 6 7 1 1 9 251 260 111 December 3 7 7 212 219 74 Total 51 65 5 14 12 96 2637 2733 1208 CENTRAL CLINIC—TUESDAY SESSIONS (Vale District) 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Ages 1-5. January 4 5 5 146 151 65 February 4 4 2 6 142 148 54 March 5 5 1 1 7 207 214 81 April 4 5 1 4 10 154 164 67 May 5 4 2 2 1 9 214 223 81 June 4 5 1 6 184 190 76 July 4 2 1 1 4 168 172 67 August 5 4 1 2 1 8 222 280 77 September 4 3 1 4 159 163 59 October 4 2 1 3 128 131 50 November 5 7 1 4 2 14 189 203 88 December 3 5 2 2 9 75 84 38 Total 51 49 6 16 14 85 1988 2073 803 122 CENTRAL CLINIC—WEDNESDAY SESSIONS (St. John's District) 1933 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed Mixed. Artificial. Ages 1-5. January 4 7 1 1 9 163 172 96 February 4 4 1 5 161 166 90 March 5 6 '2 2 10 220 230 128 April 4 6 1 7 150 157 82 May 4 1 1 2 158 160 68 June 5 9 2 2 13 190 203 105 July 4 3 1 1 5 164 169 82 August 5 3 1 4 179 183 86 September 4 5 5 147 152 87 October 4 7 1 3 1 12 183 195 113 November 5 6 6 203 209 104 December 3 1 1 75 76 46 Total 51 57 4 11 7 79 1993 2072 1087 CENTRAL CLINIC—WEDNESDAY SESSIONS (TOWN HALL-St. Prter's Dist.) 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Ages 1-5. January 4 4 1 1 2 8 184 192 66 February 4 6 1 2 9 179 188 70 M arch 5 4 2 3 9 221 230 87 April 4 6 1 2 9 193 202 73 May 4 10 1 1 2 14 202 216 83 June 5 5 4 6 15 246 261 89 July 4 1 1 1 3 187 190 68 August 5 9 4 1 14 231 245 92 September 4 10 3 1 15 186 201 73 October 4 7 3 4 15 208 223 80 November 5 9 1 1 11 282 293 109 December 3 2 1 1 5 103 108 44 Total 51 73 19 15 20 127 2422 2549 934 123 CENTRAL CLINIC—THURSDAY SESSIONS (Deptford Park-Evelyn Dist.) 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Ages 1—5 January 4 3 1 2 6 96 102 36 February 4 1 1 72 73 28 March 5 5 1 6 112 118 41 April 3 5 1 6 70 76 26 May 4 8 1 1 5 70 75 28 June 5 6 6 100 106 40 July 4 2 2 89 91 36 August 4 3 1 4 75 79 35 September 5 6 1 2 2 11 94 105 32 October 4 4 4 79 83 31 November 4 6 6 94 100 37 December 5 3 3 6 95 101 32 Total 51 47 6 2 8 63 1046 1109 402 PRINCESS LOUISE INSTITUTE, HALES STREET CLINIC 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Afies 1-5 January 4 3 1 3 3 10 174 184 106 February 4 5 3 2 1 11 173 184 91 March 5 9 4 13 213 226 118 April 4 4 3 7 126 133 64 May 4 3 2 2 1 8 193 201 88 June 5 8 1 1 3 13 230 243 83 July 4 7 2 3 12 183 195 70 August 4 7 3 10 166 176 68 September 5 11 4 3 18 219 237 104 October 4 9 4 2 15 207 222 95 November 4 7 1 3 11 223 234 97 December 5 8 3 3 14 185 199 81 Total 52 81 7 25 29 142 2292 2434 1065 24 CENTRAL CLINIC—THURSDAY SESSIONS (Vale District) 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed Mixed. Artificial. Ages 1-5 January 4 8 2 1 1 12 103 115 57 February 4 5 5 118 123 48 March 5 5 1 6 165 171 38 April 3 5 4 9 105 114 44 May 4 5 2 1 8 135 143 56 June 5 8 1 9 166 175 66 July 4 8 1 9 129 138 46 August 4 8 8 144 152 38 September 5 2 1 3 137 140 44 October 4 5 1 2 3 11 139 150 64 November 4 1 2 3 139 142 57 December 5 6 6 124 130 56 Total 51 66 5 6 12 89 1604 1693 614 ILDERTON ROAD CLINIC 1938 No. of times Clinic opened. New Cases. T otal New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Ages 1—5 January 4 6 1 1 8 220 228 81 February- 4 5 1 6 196 202 76 March 5 13 2 2 17 256 273 96 April 3 6 1 1 4 12 168 180 68 May 4 6 1 7 214 221 76 June 5 4 1 1 1 7 288 295 89 July 4 8 1 1 1 11 216 227 63 August 4 7 1 1 2 11 244 255 75 September 5 7 1 1 9 327 336 118 October 4 8 2 3 13 257 270 94 November 4 7 7 245 252 94 December 5 2 1 2 5 218 223 72 Total 51 79 9 9 16 113 2849 2962 1002 125 CENTRAL CLINIC—FRIDAY SESSIONS (Hatcham-Pepys District) 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed. Artificial. Ages 1—5 January 4 7 1 1 9 161 170 75 February 4 8 3 2 13 152 165 84 March 4 7 1 8 164 172 61 April 4 5 1 2 8 215 223 70 May 4 8 2 1 1 12 203 215 72 June 4 5 5 198 203 56 July 5 9 2 1 12 217 229 56 August 4 7 1 1 9 182 191 55 September 5 6 2 2 1 11 267 278 88 October 4 6 1 1 8 183 191 58 November 4 3 2 1 6 207 213 61 December 5 6 3 9 190 199 73 Total 51 77 16 13 4 110 2339 2449 809 CENTRAL CLINIC—FRIDAY SESSIONS (St. Catherine's District) 1938 No. of times Clinic opened. New Cases. Total New Cases. Total Old Cases. Total New and Old Cases. Consultations with Doctor. Breast Fed. Mixed Artificial Aries 1—5 January 4 10 5 3 18 224 242 127 February 4 10 1 5 16 214 230 100 March 4 5 3 1 3 12 211 223 94 April 4 11 2 3 16 239 255 99 May 4 7 2 4 13 240 253 112 June 4 4 1 4 9 267 276 115 July 5 6 1 2 2 11 270 281 114 August 4 10 3 1 1 15 224 239 97 September 5 6 5 4 15 295 310 120 October 4 4 1 5 230 235 94 November 4 1 2 4 2 9 212 221 103 December 5 3 1 1 5 188 193 79 Total 51 77 14 31 22 144 2814 2958 1254 INDEX. PAGE A Acreage 8 Acute Primary Pneumonia 70 Acute Influenzal Pneumonia 70 Acute Poliomyelitis 69 Albany Deptford Babies' Hospital 111 Ambulance Facilities 21 Ante-natal Examination 100 Ante-natal Clinic 101 Area and Population 8 Artificial Light Clinic 104-106 B Babies' Hospital 111 Bacteriological Examination 74 Bathing Station 76 Births 8 „ illegitimate 9 „ Notification of 9 Bed Bug, eradication of the 33 c Cancer 76 Canal Boats Acts 38 Causes of Sickness 12 Cerebro-spinal Meningitis 69 Chicken pox 68 Cleansing Station 76 Clinics and Centres 99 Committee, Public Health 3 „ Maternity and Child Welfare 3 Convalescent Treatment 111 ii. PAGE [) Day Nursery 107 Deaths 10 Death-rate 11 „ comparisons 11 „ during 10 years 11 Deaths, percentage in age groups 12 „ causes of 14,116 „ Infantile, causes 13 „ Infectious disease 62 Denial Clinic, Maternity and Child Welfare 108 „ „ Tuberculosis 93 Deptford Babies' Hospital 111 Diabetes and Insulin 77 Diarrhoea 71 Diphtheria 65 Disinfectants 76 Disinfection 75, 118,119 Disinfeslation 33,75 Dysentery 70 E Encephalitis Lethargica 70 Enteric Fever 73 Erysipelas 73 F Factories Act 39 Food Inspection 50 Poisoning 54 „ Sampling 54 ,, Unsound 53 Foot Clinic 25 Foster Children 113 G Gynaecological Clinic 25 iii. PAGE H Health Committee 3 Health Visitors, Visits 97 Health Education 112 Home Helps 111 Home Nursing 111 Housing 42 House-to-house Inspections 33 I Illegitimate Births 9 Infant Life Protection 113 Infant Mortality 12 „ Table of causes 13 Infant Welfare Centres 105, 120-125 Infectious Diseases, Notifications 62 Infective Jaundice 77 Influenza 73 Inquests 15 Insulin and Diabetes 77 L Laboratory Work at the Seamen's Hospital 74 Legal Proceedings 34 London Ambulance Service 21 M Malaria 70 Marriages 8 Massage and Exercises 107 Maternal Mortality 113 Maternity and Child Welfare Committee 3 Maternity Home 26, 109 „ Consultant 110 Maternity Outfits 110 Measles 68 Midwives 24, 112 iv. PAGE M—continued. Milk, Bacteriological Examination 51 ,, Supply to Nursing Mothers, etc. 112 Mortality of Infants 13 Mortuary Report 14 Municipal Maternity Home 26, 109 Municipal Foot Clinic 25 N Notification of Births 9 Nursing Arrangements 22 Nutrition 60 O Obstetricians, consulting 108 Ophthalmia Neonatorum 72 P Physical Features of Borough 5 Population 8 Pneumonia 70 Post-natal Clinic 103 Public Health Committee 3 Puerperal Fever 71 „ Pyrexia 72 Q Queen's Nurses 22 R Ranyard Nurses 22 Rats 35 V. PAGE S St. John's Home 104 St. John's Nurses 22 Sanitary Inspectors' work 30 Scarlet Fever 63 Sewing-class 107 Small-pox 66 Social Conditions 6 Staff, List of 18-91 Still-births 8 T Tetanus—Supply of Anti-toxin 71 Toddlers' Clinics 107 Treatment Centres and Clinics 24 Tuberculosis—Care Committee Report 94 ,, Report of Tuberculosis Officer 77-93 „ Handicraft Centre 93 „ Home accommodation 85 „ Notification Table 81-82 „ Revision of Register 83 „ Supervision of Contacts 90 „ Dental Treatment 93 V Vaccination 67 w Welfare Centres 99 Whooping Cough 68