Ac113T3 GRE31 Metropolitan Borough of Greenwich. ANNUAL REPORT ON THE HEALTH OF THE BOROUGH For the Year 1933 By M. MACDONALD m.d., d.p.h. MEDICAL OFFICER OF HEALTH. LONDON: E. G. Berryman & Sons, Ltd. Blackheath Road S.E.10 65875 Metropolitan Borough of Greenwich. ANNUAL REPORT ON THE HEALTH OF THE BOROUGH For the Year 1933 By M. MACDONALD m.d., d.p.h. MEDICAL OFFICER OF HEALTH LONDON : E. G. Berryman & Sons, Ltd. Blackheath Road S.E.10 CONTENTS. Pages Public Health Staff 4-5 Public Health, Maternity and Child Welfare Committee 6-9 Introductory 10,11 Section A.—Natural and Social Conditions of the Area 12 Vital Statistics 13-22 ,, B.—General Provisions of Health Services in the Area 23-25 ,, C.—Sanitary Circumstances of the Area 26-37 „ D.—Housing 38-42 „ E.—Inspection and Supervision of Food 43-55 ,, F.—Prevalence of, and Control Over, Infectious Diseases 56-77 ,, G.—Maternity and Child Welfare 78-88 4 Staff of the Public Health Department. Medical Officer of Health and Administrative Medical Officer, Tuberculosis, and Maternity and Child Welfare : M. Macdonald, M.D., Ch.B., D.P.H. Tuberculosis Officer : (Locum Tenens). Maternity and Child Welfare Medical Officer : Janet M. Morton, M.B., Ch.B. (Edin.), D.P.H. Assistant Maternity and Child Welfare Medical Officers : †Doris B. Ball, M B., B.S. (Lond.), M.R.C.S., L.R.C.P. †Gladys M. Cox, M.B., B.S. (Lond.) J. G. Dathan, M.R.C.S., L.R.C.P., M.M.S.A. †Isobel C. Johnson, M.B., Ch.B. †Dorothy Egan, M.R.C.S., L.R.C.P., D.P.H. †G. J. Sophian, M.R.C.P., F.R.C.S., L.R.C.P. Pathologist : †Frank Standish, M.B., B.S., D.P.H. Public Vaccinators : †william Cowie, M.A., M.B., C.M. †John S. Davies, M.A., MB., C.M. {D. Morien Thomas, M B., M.R.C.S., L.R.C.P. Gynecologist : †Victor J. F. Lack, M.B., B.S., F.R.C.S., M.R.C.P. Obstetric Consultants : †Margaret Basden, M.B., B.s., f.r.C.s., M.D. †frank Cook, B.Sc., M.B., B.s., f.r.C.s. †Arthur J. McNair, B.A., M.B., B.Ch., F.R.C.S. Tumour Clinic Consultant : †Robert Davies-Colley, C.M.G., M.Ch., M.A., F.R.C.S. Dental Surgeon : †G. F. Ferris, L.D.S., R.C.S. (Eng.) Public Analyst : †A. E. Brown, B.Sc., F.I.C. Sanitary Inspectors : a E. Martin. abcde W. R. Drake. abce S. A. Radford. ab W. H. Collins. bc A. E. Morgan. ab Miss G. Davis. lc F. A. Brown (Temp.). be H. L. Bennett. l A. J. Shelley (Temp, from 6th Nov.). * Resigned 28th October. Vaccination Officer : †E. S. Elliott. Health Visitors : fh Mrs. M. D. Morison. fgh Miss A. M. M. Hadfield. fgh Miss F. C. Jagot. ghk Miss M. E. Hollow. fgh Miss A. Jenkins. ghk Miss K. Walton. fgh Miss E. Bailey. ghk Miss P. N. Steer (Temp.). 5 TUBERCULOSIS DISPENSARY : Nurses : fg Miss T. I. Husbands. afgh Miss D. M. Wilkins. ghk Mrs. D. E. Shepherd. Dispenser: Caretaker : W. H. Green, M.P.S. Mrs. G. W. Vickery. ARTIFICIAL SUNLIGHT TREATMENT : Nurse-in-Charge : gij Miss L. D'Oyly Watkins. Assistant Nurses : gj† Miss L. Mallett. gij †Miss C. Meikle. MATERNITY HOME : Matron : Sister : ghm Miss M. F. Cockin. gh Miss W. I. Fox. CLERICAL STAFF : F. W. Foulger (Principal Clerk). aH. W. Duck. E. P. Tidman. Miss L. Merricks. Miss M. W. W. Lawson. Mrs. L. E. Wright. Miss G. Sibborn (Milk Saleswoman.) L. A. Westacott. E. W. Pike. J. Hannan, (Temp.). Disinfecting Staff : T. Smith. G. Hook. T. G. Griggs. A. Moore. T. Packham (Motor Driver). Caretaker at Cleansing Station : Mrs. E. Robinson. Mortuary Keeper : W. J. Lawley. a Cert. Royal Sanitary Institute. b Cert. Sanitary Inspectors' Examination Board. c Cert. R.S.I. Meat and other Foods. d Cert. Sanitary Inspectors' Association Examination Board (Prizeman). e Smoke Inspector's Certificate. f Cert. R.S.I. Health Visitors and School Nurses. g General Nursing Training (3 years). h Certified Midwife. i Bio-Physical Assistant. j Chartered Society of Massage and Medical Gymnastics. k Cert. R.S.I. Health Visitors. l Cert. R.S.I, and Sanitary Inspectors' Examination Joint Board. m Approved Teacher of Midwifery. All the members of the Staff of the Department are whole time Officers with the exception of those marked †. 6 Public Health, Maternity and Child Welfare Committee during the Year, 1932-33. The Mayor : *Alderman Col. H. A. H. Newington, D.S.O., J.P., and 13 Members. *Councillor Mrs. C. R. Turner, J.P. (Chairman) Alderman H. H. Icough (Vice-Chairman). Alderman : M. G. Byerley, J.P., F.R.C.V.S. Councillors : *W. Aylett. *Mrs. A. Kennedy. *Mrs. P. M. Beacham. *Lt.-Col. M. C. Matthews, V.D. *Mrs. F. Carter. *Miss M. Sherman. J. R. Dabin. Mrs. C. H. Thackeray. H. D. Hardee. D. A. Whitenstall. * Denotes Members who served on the Assistance Sub-Committee. Powers and Duties of the Public Health, Maternity and Child Welfare Committee : 1.—The Committee shall consist of thirteen elected members. 2.—There shall be referred to the Committee the execution of the Food and Drugs Act, 1875; Food and Drugs (Adulteration) Act, 1928; the sale of Horseflesh, etc., Regulation Act, 1889; such matters arising under the Housing of the Working Classes Acts, 1890 and 1894, and the Working Classes Dwelling Act, 1890; Housing and Town Planning Acts; Parts 2 and 5 of the Housing Act, 1930, so far as they relate to the repair and demolition of insanitary houses; the Public Health (London) Acts; the Metropolis Management Acts relating to defective drainage; the Canal Boat Acts; the Factory and Workshop Acts; Rent and Mortgage Interest Restrictions Acts, 1920 and 1923; the Rats and Mice (Destruction) Act, 1919; Merchandise Marks Act, 1926; Agricultural Produce (Grading and Marking) Act, 1928; the sanitary provisions of any other Act of Parliament; the powers of the Council under the Orders of the Local Government Board or Ministry of Health dealing with Tuberculosis; Milk and Dairies Order, 1926; and the Milk (Special Designations) Order, 1923; the by-laws and regulations made under the above Acts, or otherwise relating to the public health and sanitary condition of the Borough, as are not within the reference to any other Committee. 7 3.—The Committee may serve and receive notices, take proceedings, and in particular cases empower any Officer of the Council to make complaints and take proceedings on their behalf under, and otherwise execute, the Public Health (London) Act, 1891, and sections 82, 83, 84 and 85 of the Metropolis Management Act, 1855, relating to the inspection of any premises, drains, sinks, traps, syphons, pipes, or other works or apparatus connected therewith, and otherwise in relation to defective drainage, except as to the recovery of expenses, and the same shall not require the approval of the Council. Provided that the Committee shall report their action to the next following meeting of the Council, who may at any time determine or prohibit or otherwise vary any such notices or proceedings. 4.—All plans for drainage and re-drainage of premises shall be laid before the Committee for consideration. 5.—Works of drainage of houses and premises shall be carried out under the direction of this Committee. 6.—The Committee shall have the control of Mortuaries erected or maintained by the Council, as the Sanitary Authority, and shall have control of the disinfecting staff, apparatus and plant. 7.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 8.—Provision and maintenance of Tuberculosis Dispensary. 9.—There shall be referred to the Committee such functions relating to vaccination as are transferred to the Council by Section 2, Local Government Act, 1929. 10.—There shall be referred to the Committee such functions transferred to the Council under the Transfer of Powers (London) Order, 1933, as follow: — (a) Enforcement of By-laws made by the London County Council relating to seamen's lodging houses, licensing and inspection of seamen's lodging houses and the supervision of the sanitary condition of such lodging houses in accordance with the by-laws for the time being in force. (b) Registration, licensing, inspection and regulation of common lodging houses and the enforcement of by-laws relating to such houses but exclusive of the powers of making by-laws under Section 53 of the London County Council (General Powers) Act, 1902. 8 (c) Licensing of dairymen to use premises as a cow house or place for the keeping of cows. (d) Reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants and the inspection of premises by infant protection visitors or other persons appointed by the Council for that purpose. Fixing the number of infants to be kept in a dwelling house in which any infant is received for reward. Applications to a Court or Justice for an Order directing the removal of an infant to a place of safety. (e) Consideration of and decision upon applications for sanction to the establishment anew or enlargement of certain offensive businesses or imposition, modification or removal of conditions. (f) Licensing of slaughterers of cattle or horses and of knackers to use premises as a slaughter house or knacker's yard. Licensing of persons to use premises for receiving or keeping horses for slaughter or the carcases of dead horses. 11.—There shall be referred to the Committee all matters arising out of the powers and duties of the Council under the Maternity and Child Welfare Act, 1918, or any Act or Acts amending the same, or of any Orders or Regulations made under such Act or Acts, and the Committee shall make recommendations to the Council in relation to the matters aforesaid. 12.—Powers and duties mentioned in Section 6 of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925. 13.—The provision of artificial sunlight treatment for adult residents of the Borough in accordance with Section 75, Public Health (London) Act, 1891. 14.—The execution of the duty under Section 12 of the Rent and Mortgage Interest Restrictions (Amendment) Act, 1933, to issue certificates as to the state of repair of houses to which the Rent and Mortgage Interest Restrictions Acts apply. 15.—The execution of the powers and duties of the Council under the provisions of the Slaughter of Animals Act, 1933. 16.—The execution of the powers and duties of the Council under the provisions of the Pharmacy and Poisons Act, 1933; and that each of the Council's Sanitary Inspectors be hereby 9 appointed an Inspector under Section 25(5) of the Pharmacy and Poisons Act, 1933, for the purpose referred to therein. Additional matters coming within the definition of the sanitary provisions of any other Act of Parliament :— Notification of Births Act, 1907. Housing and Town Planning Act, 1909, 1919. Housing, etc., Acts. London County Council (General Powers) Acts. Rag Flock Act, 1911. Public Health (Tuberculosis) Regulations, 1930. Rats and Mice (Destruction) Act, 1919. Rent and Mortgage Interest Restrictions Acts, 1920 and 1923. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies (Amendment) Act, 1922. Milk (Special Designations) Order, 1923. Milk and Dairies Order, 1926. Public Health (Condensed Milk) Regulations, 1923. „ „ (Dried Milk) „ „ (Meat) Regulations, 1924. „ „ (Imported Milk) Regulations, 1926. „ „ (Preservatives, etc., in Food) Regulations. „ „ (Smoke Abatement) Act, 1926. Artificial Cream Act, 1929. 10 Public Health Offices, Borough Hall, Royal Hill, Greenwich, S.E.10. May, 1934. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Ladies and Gentlemen, Following the retirement of Dr. Annis after a long and distinguished period of service in the Borough, I have the honour to present the Annual Report on the health of the district for the year 1933. The Report being an ordinary one and not a "Survey Report" is little more than a summary of the work done by the Public Health Department and is based on the instructions contained in the Ministry of Health's Circular No. 1346. The Birth Rate is 13.71 per 1,000 of the population. This is slightly lower than the figure for 1932, and once again is the lowest on record for the Borough. The average for the last ten years is 17.08. The Birth Rate for the County of London is 13.1, and 14.4 for all England and Wales. The Death Rate is 11.96 per 1,000 of the estimated population. The Death Rates for the County of London and for England and Wales are 12.3. The average Death Rate for the Borough for the last ten years is 11.21 per 1,000 of the population. The Infant Mortality Rate for the Borough, measured by the number of deaths under one year to 1,000 births registered, is 66, compared with 80 last year, and 63 the average for the last ten years. The Infant Mortality Rate for the County of London is 59 and that for 118 large towns, 67. The total number of deaths arising from the class known as the Common Infectious Diseases was 43, as compared with 62 for the previous year. The Death Rate is .44 per 1,000 of the population. 11 Towards the end of 1932, a survey of the Public Health services of the Council was made by the Inspectors of the Ministry of Health, and in February, 1933, the Ministry's official report was made to the Council from which it appears that whilst being satisfied with the work now being performed, concluded with a statement that the Council should take into their early consideration the undermentioned matters :— (1) The question of appointing an Inspector, specially qualified in dealing with foodstuffs who could devote his whole time to that work, if necessary. (2) The question of a full-time junior assistant Maternity and Child Welfare Medical Officer. (3) The provision of adequate premises for Maternity and Child Welfare purposes in the Charlton District. The points mentioned in paragraphs (1) and (2) have received the attention of this Council and the appointments have been duly made. With regard to Clause (3) consideration has been given to the points raised and towards the end of the year tenders were invited for the erection of a new Welfare Centre to serve this area. In conclusion I would take this opportunity of expressing my indebtedness to the Chairman and members of the Public Health, Maternity and Child Welfare Committee for the help and consideration given me, and my sincere thanks are also given to every member of the staff of the Department for their assistance and cooperation in carrying out the duties of my office. I have the honour to be Your obedient Servant, M. Macdonald. 12 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics. Elevation—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1,990 „ 3,858 acres Population— At Census, 1931 100,924 Estimated, 1933 97,830 Density of Population— East Greenwich 31 persons per acre West Greenwich 53 „ St. Nicholas, Deptford 55 „ Charlton and Kidbrook 13 „ Average for the Borough 25 persons per acre Number of Inhabited Houses—1933 18,866 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 Estimated, 1933 175 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value £947,530 Sum Represented by a 1d. Rate £3,824 13 SOCIAL CONDITIONS. The Metropolitan Borough of Greenwich comprises three districts, viz., Greenwich, Charlton and Kidbrooke, and St. Nicholas, Deptford, all of which are now united into one civil parish. The altitude varies from a few feet below high-water mark on the marshes, up to 249 feet above sea level on the Shooter's Hill Road by the Borough boundary. The industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Gasworks, Soap and Candle Works, L.C.C. Generating Station and Tramway Car Repair Depot, The London Power Company's Works, Glass Bottle Works, Linoleum Manufacturing Works, Merryweathers' Works (Fire Engines), Cement and Stone Works, Asbestos Works, etc. POPULATION. In accordance with the usual custom, the Registrar General has submitted his estimate of the resident population of the Borough computed at mid year, 1933. The figure returned is 97,830, which shows a decrease of 3,094 persons since the census of 1931. Having regard to the fact that Greenwich was one of the few Metropolitan Boroughs with an increase in population during the last decennial period, it is difficult to appreciate this comparatively large decrease in such a short time. The number of houses built since the census was taken, up to mid year, 1933, is 559, and taking the modest estimate of three occupants per house, would give 1,677 persons, to which can be added the natural increase of population, i.e., births over deaths during this period which is 701, giving a total increase of 2,378. Against this there is, of course, the outward movement of population to be taken into account. From information available it can be assumed that approximately 1,300 persons have been accommodated on L.C.C. Estates or have removed elsewhere. In addition to this the removal of the Greenwich Hospital School to Holbrook, Suffolk, would account for a further 900, thus giving a migration total of 2,200. On the above assumption it will be seen that the Greenwich population has varied very little since the census of 1931. However, as it is desired to maintain comparability in Annual Reports, I have based the statistics in this Report on the Registrar 14 General's estimate of 97,830. The following is the local distribution: — Estimated Population at Mid Year, 1933. East Greenwich 40,419 West Greenwich 24,202 St. Nicholas, Deptford 6,372 Charlton and Kidbrooke 26,837 97,830 •EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Live Births Legitimate 1,292 649 643 Birth Rate 13.7 Illegitimate 47 27 20 Still-Births 40 20 20 Rate per 1,000 29.0 total Births Deaths 1,165 608 557 Death Rate 11.9 Deaths from Puerperal Causes : — Rate per 1,000 total Births. Other Puerperal Causes 4 2.2 Puerperal Sepsis 3 2.9 Total 7 5.2 Death Rate of Infants under one year of age : — All Infants per 1,000 live births 66 Legitimate Infants per 1,000 legitimate live births 64 Illegitimate Infants per 1,000 illegitimate live births 127 Deaths from Measles (all ages) 2 „ „ Whooping Cough (all ages) 8 „ „ Diarrhœa (under 2 years of age) 16 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. MARRIAGES. Mr. E. A. Bale, the Superintendent-Registrar of the Greenwich Registration District, has kindly furnished me with the particulars relating to the number of marriages solemnised in the Borough of Greenwich. 15 The following table shows these particulars giving the number of marriages in the Borough for each year since 1926 : — Year Churches of England Marriages in Superintendent - Registrar's Office of parties resident in Greenwich or outside the Registration District, and in Chapels and Roman Catholic Churches Total Approximate Population of the districts concerned Greenwich Charlton and Kidbrooke St. Nicholas 1926 382 95 48 271 796 104500 1927 388 91 45 239 763 103700 1928 356 84 52 246 738 103900 1929 362 127 44 268 801 104430 1930 351 150 41 321 863 104430 1931 291 138 34 309 772 100640 1932 312 152 30 265 759 101024 1933 286 136 48 331 801 97830 BIRTHS. The steady fall in the Birth Rate to its present level is most striking and, by some, is regarded as a national calamity, and by others as a sign of social decadence. In times of trade depression and consequent increase in unemployment and poverty, a low Birth Rate may well be a blessing in disguise; but from whatever aspect one views this question, one thing is certain and that is the children who are being born to-day are receiving greater care and attention than ever before, and not only are being enabled to survive in larger numbers, but have a greater chance of developing into healthier men and women. The total number of births registered in the Borough during the year was 1,652. Of this number 521 occurred in St. Alfege's Hospital, 289 in the Borough Maternity Home, and 163 at various Nursing Homes within the Borough. Of this total of 973 Institution births, 499 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and fifty-nine births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,337 :—Males, 673; Females, 664. This figure gives a Birth Rate of 13.73 per 1,000 of the population, and once again is the lowest on record. The previous year's Birth Rate was 14.66 and the average for the last ten years 17.09. The Birth Rate for the County of London equals 13.2 per 1,000 of the population. The Birth Rate for all England and Wales was 14.4. 16 Illegitimate births numbered 47, representing 3.9 per cent of the total births. Seventy illegitmate births actually were registered in the Borough. In 33 cases, however, the mothers were ordinarily resident outside the Borough and these births were consequently allocated to the correct area. Ten illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the net figure of 47. Fifty illegitimate births occurred in St. Alfege's Hospital. Under the Births and Deaths Registration Act, 1926, which came into operation on the 1st July, 1927, the registration of still-births became compulsory. Forty-one such still-births were registered during the year, representing a percentage of 2.9 of the total births registered. Each of such cases is separately investigated with a view to finding out whether what is thought to have been the cause for such still-birth is of a preventable nature, and if so, an endeavour is made to take such appropriate action as will guard against a recurrence of this condition. Under the provisions of the Notification of Births Act, 1907, intimations have been received from medical men, parents and others, with respect to 1,705 births ; 39 were in respect of still-births, of which number 11 were referred to other Boroughs. DEATHS. The net number of deaths registered during 1933 was 1,167 of which 609 were males and 558 females. This gives a crude Death Rate for the Borough of 11.96. The Death Rates for the County of London and for England and Wales are 12.3. The following table showing causes of death at all ages has been supplied by the Registrar-General, and is included in accordance with the request contained in the Ministry of Health's Circular No. 1,346. Causes of Death. Sex Deaths at Subjoined ages of "Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and over. All Causes M 608 50 11 9 17 26 45 28 75 94 134 119 F 557 39 6 11 19 21 24 37 57 82 94 167 Typhoid and Paratyphoid Fevers M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Measles M .. .. .. .. .. .. .. .. .. .. .. .. F 2 1 .. 1 .. .. .. .. .. .. .. .. Scarlet Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 3 .. .. 1 2 .. .. .. .. .. .. .. Whooping Cough M 3 1 .. 2 .. .. .. .. .. .. .. .. F 5 4 1 .. .. .. .. .. .. .. .. .. Diphtheria M 8 •• .. 3 5 .. .. .. .. .. .. .. F 6 .. .. 2 4 .. .. .. .. .. .. .. Influenza M 31 .. 1 1 .. .. 4 1 11 4 2 7 F 32 1 1 .. .. 1 3 .. 5 8 4 9 Encephalitis Lethargica M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever M 3 1 .. .. 2 .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Respiratory System M 6 2 .. .. .. 1 10 24 6 11 8 2 .. F 34 2 .. .. .. 10 8 9 2 2 1 .. Other Tuberculous Diseases M 8 3 .. 1 2 1 .. .. .. .. 1 .. F 4 .. 1 .. 1 .. 2 .. .. .. .. .. Syphilis M 1 .. .. .. .. .. .. .. 1 .. .. .. F 1 .. .. .. .. .. .. .. .. .. .. 1 General Paralysis of the Insane, tabes dorsalis M 2 .. .. .. .. .. .. .. .. 1 1 .. F .. .. .. .. .. .. .. .. .. .. .. Cancer, malignant disease . . M 82 .. .. .. .. .. 2 16 19 33 12 F 86 .. .. .. 1 2 .. 5 17 27 20 14 Diabetes M 5 .. .. .. .. 1 1 .. .. .. 3 .. F 10 .. .. .. .. .. .. .. 1 1 2 6 Cerebral Hæmorrhage, etc. M 20 .. .. .. .. .. .. .. 2 4 10 4 F 25 .. .. .. .. .. .. 1 2 4 7 11 Heart Disease M 97 .. .. .. 1 3 2 3 10 12 24 42 F 132 .. .. .. 3 2 2 8 14 14 27 62 Aneurysm M 9 .. .. .. .. .. 1 .. 1 4 3 .. F .. .. .. .. .. .. .. .. .. .. .. .. Other Circulatory Diseases M 18 .. .. .. .. .. .. 1 1 .. 1 15 F 19 .. .. .. .. .. .. 2 2 4 11 Bronchitis M 23 .. .. .. .. .. 1 1 1 2 9 9 F 22 .. .. .. .. 1 .. 1 2 1 5 12 Pneumonia (all forms) M 42 9 5 .. 1 1 1 4 4 8 6 3 F 30 4 3 3 .. .. .. 2 1 2 6 9 Other Respiratory Diseases M 9 .. 2 .. 1 .. .. 1 1 2 2 .. F 1 .. .. .. .. .. .. .. .. .. .. 1 Peptic Ulcer M 14 .. .. .. .. 1 1 1 2 5 3 1 F 5 .. .. .. .. .. .. .. .. 3 2 .. Diarrhœa, etc. M 14 9 3 .. .. 1 .. .. .. 1 .. .. F 5 4 .. .. .. .. .. .. .. .. 1 .. Appendicitis M 8 .. .. .. .. 1 1 3 1 1 .. 1 F 4 .. .. .. 3 .. .. .. .. 1 .. .. Cirrhosis of Liver M 4 .. .. .. .. .. .. .. 1 1 2 .. F 4 .. .. .. .. .. .. 1 2 .. .. 1 Other Diseases of Liver, etc. M 1 .. .. .. .. .. .. .. .. 1 .. .. F 4 .. .. .. .. .. .. .. .. 1 2 1 Other Digestive Diseases M 10 .. .. 1 .. .. 1 1 1 4 1 1 F 13 2 .. 1 2 1 .. .. 1 2 1 3 A. and Cr. Nephritis M 25 .. .. .. .. .. 1 1 3 2 7 11 F 18 .. .. .. .. .. 2 1 .. 7 3 5 Puerperal Sepsis F 3 .. .. .. .. .. 2 1 .. .. .. .. Other Puerperal Causes F 4 .. .. .. .. 1 1 1 1 .. .. .. Congenital Debility, Premature Birth, Malformations, etc. M 26 26 .. .. .. .. .. .. .. .. .. .. F 19 19 .. .. .. .. .. .. .. .. .. .. enility M 3 .. .. .. .. .. .. .. .. .. .. 3 F 17 .. .. .. .. .. .. .. .. .. 3 14 uicide M 6 .. .. .. .. .. 1 1 .. 2 2 .. F 6 . . .. .. .. 1 .. 1 2 1 .. 1 other Violence M 27 1 .. .. 1 6 5 1 2 3 5 3 F 14 1 .. 1 1 1 1 .. .. 2 3 4 other Defined Diseases M 47 .. .. 1 3 1 1 1 6 10 17 7 F 29 1 .. 2 2 1 3 6 5 4 3 2 iseases ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 17 It has been customary to include in the Report tables compiled by the Registrar General showing the comparative rates for Births, Deaths, and Infantile Mortality of the various Metropolitan Boroughs. Unfortunately at the time of going to press this information is not to hand, but through the courtesy of Dr. Allan Young, the Medical Officer of Health for Poplar, who has obtained the particulars direct from the Boroughs concerned, I am enabled to give the comparative figures in the following table. Borough Population (R.-G.'s est.) Birth Rate Death Rate Infant Mortality Rate West Districts. Paddington 141,900 13.41 13.36 85 Kensington 181,100 12.0 12.9 72 Hammersmith 131,400 13.9 12.9 65 Fulham 148,200 13.07 13.00 65 Chelsea 58,850 10.6 13.6 78 City of Westminster 126,300 8.7 12.4 68 North Districts. St. Marylebone 94,080 9.71 12.2 56 Hampstead 90,380 9.6 11.0 38 St. Pancras 190,900 13.6 13.7 58 Islington 319,100 14.35 12.40 63 Stoke Newington 51,120 12.6 12.3 46 Hackney 214,300 14.0 11.5 50 Central Districts. Holborn 36,050 9.49 13.48 70 Finsbury 66,640 15.1 12.8 50 East Districts. Shoreditch 93,550 16.0 13.0 74 Bethnal Green 104,200 14.3 12.5 66 Stepney 219,100 15.1 12.9 65 Poplar 149,300 15.4 12.4 54 South Districts. Southwark 164,700 14.2 13.9 63 Bermondsey 107,300 14.0 12.5 61 Lambeth 289,000 13.6 13.1 63 Battersea 154,000 14.7 12.49 49 Wandsworth 350,200 10.93 11.49 50 Camberwell 243,700 13.32 12.33 49 Deptford 102,800 14.8 12.1 54 Greenwich 97,830 13.7 11.9 66 Lewisham 221,100 12.2 10.2 39 Woolwich 146,200 12.6 11.18 62 18 DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years:- Year. Total Deaths of Greenwich Residents Total Deaths of Greenwich Residents in Public Institutions 1928 1,148 616 1929 1,387 764 1930 1,036 602 1931 1,134 633 1932 1,194 761 1933 1,167 707 Average 1,177 680 AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 27 23 13 26 89 Between 1 and 2 years 6 3 4 4 17 Between 2 and 5 years 13 — 4 3 20 Between 5 and 15 years 15 10 5 6 36 Between 15 and 25 years 13 14 6 14 47 Between 25 and 45 years. 43 32 25 40 140 Between 45 and 65 years 96 63 75 77 311 65 years and upwards 185 122 93 107 507 Total 398 267 225 277 1,167 19 Locally the Death Rate varied from 11.59 in Charlton and Kidbrooke, 11.67 in East Greenwich, 12.55 in West Greenwich, to 19.37 in St. Nicholas, Deptford. Of the total number of deaths, 6 were of illegitimate birth, all of whom were under one year of age. The following table shows the variation in, and average of the Death Rates in each of the five Districts of the Borough in the five years 1928 to 1932 compared with the figures for 1933:— District 1928 1929 1930 1931 1932 Average for 5 years 1933 East Greenwich 11.03 12.94 10.01 10.90 12.88 11.55 11.67 West Greenwich 12.10 13.61 9.86 13.80 11.43 12.16 12.55 St. Nicholas Deptford 11.50 16.13 11.84 11.64 14.49 13.12 19.37 Charlton and Kidbrooke 10.17 12.76 9.32 9.36 10.10 10.34 11.59 Whole Borough 11.13 13.38 9.99 11.40 11.34 11.45 11.96 INFANTILE MORTALITY. The Infantile Mortality Rate measured by the deaths of children under one year of age to the number of births registered, was 66 per 1,000 births, as compared with 80 last year. The total number of deaths during the year was 89, as compared with 75, 97 and 119, the respective figures for the years 1930, 1931 and 1932. A further reference to the Infantile Mortality Rate will be found in the Section devoted to the Maternity and Child Welfare Scheme. For the whole of London the rate was 59, compared with 66 in 1932, 65 in 1931 and 59 in 1930. For England and Wales the rate was 64, compared with 65 in 1932, 66 in 1931 and 60 in 1930. Locally the variations were from 60 per 1,000 births in East Greenwich, 69 in Charlton and Kidbrooke, 71 in West Greenwich, to 72 in St. Nicholas, Deptford. 20 The following table shows these figures since 1921. District Average for five vears 1921-1925 inclusive Average for five vears 1926-1930 inclusive 1931 1932 1933 East Greenwich 62 60 72 98 60 West Greenwich 80 59 76 84 71 St. Nicholas, Deptford 88 78 71 57 72 Charlton and Kidbrooke 50 42 39 59 69 Borough 66 57 64 80 66 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Principal Epidemic Diseases.—There were 100 deaths due to this class of disease, equalling a Death Rate of 1.02 per 1,000; the rate last year was .87 and was 1.11 in 1929, and .48 in 1930 and 1931 respectively. Zymotic.—The class known as common infectious diseases is credited with causing a total of 44 deaths equalling a Death Rate of .44 per 1,000. Locally the Zymotic Death Rate varies from .15 in St. Nicholas, Deptford (1.21 in 1932), .43 in East Greenwich (.79 in 1932), .45 in West Greenwich (.48 in 1932) to .52 in Charlton and Kidbrooke (.27 in 1932). Smallpox.—There were no deaths from Smallpox, this being the thirty-first year since a death occurred from this cause in the Borough. Measles.—There were two deaths ascribed as due to this disease. This is equal to a Death Rate of .02 per 1,000. The number of deaths recorded in the years 1929, 1930, 1931 and 1932 were 9, 21, 2 and 24. Scarlet Fever.—This disease occasioned 3 deaths during the year. Three deaths occurred in 1930, 1 in 1931 and 1 in 1932. 21 Whooping Cough.—This disease was given as the cause of 8 deaths, with a Death Rate of .08 per 1,000. There were 6 deaths in the years 1931 and 1932. Diphtheria.—There were 14 deaths during the year. This gives a Death Rate of .14 comparing with .06 for the previous year. Seven deaths occurred in 1932, 11 in 1931 and 12 in 1930. Five of the patients were under five years of age. Typhoid Fever.—There were no deaths ascribed to this disease during the year. There were 0 in 1932, 1 in 1931, 0 in 1930, and 1 in 1929. Diarrhcea, Dysentery and Zymotic Enteritis.—Seventeen deaths were stated to be due to these causes, equalling a Death Rate of .18 per 1,000. Last year there were 24 deaths, 16 in 1931, 7 in 1930, and 11 in 1929. Influenza.—This disease became epidemic during the first quarter of the year, occasioning no fewer than 53 deaths. Altogether there were 56 deaths during the year, 25 cases were between 45 and 65 years of age, and 20 over 65. Twenty-seven occurred in East Greenwich, 14 in West Greenwich, 4 in St. Nicholas, Deptford, and 11 in Charlton and Kidbrooke. Tuberculosis. This class includes the causes of 106 deaths during the year under review, with a rate of 1.08. These figures compare with 115, 112 and 87, the totals of the years 1930, 1931 and 1932 respectively, and the respective rates of 1,10, 1.12 and .86. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 94 attributed to the cause or a rate of .96 per 1,000 as compared with .75 for the last year. Locally the deaths were 34 in East Greenwich (Death Rate .80); 8 in St. Nicholas, Deptford (Death Rate 1.25); 22 in Charlton and Kidbrooke (Death Rate .81) ; 30 in West Greenwich (Death Rate 1.23). The remaining forms of Tuberculosis were responsible for 12 deaths, 6 of which occurred in East Greenwich, 2 in West Greenwich, 1 in St. Nicholas, and 3 in Charlton and Kidbrooke. 22 This disease was responsible for a total of 162 deaths for the year. The number of deaths in 1932, 1931, 1930 and 1929 were 155, 160, 150 and 150 respectively. The distribution of deaths were as follows :—63 in East Greenwich, 46 in West Greenwich, 39 in Charlton and Kidbrooke and 14 in St. Nicholas, Deptford. DISEASES OF THE CIRCULATORY SYSTEM. Heart Disease.—Once again the deaths from this cause occupy the principal place in the classification of diseases, there being 193 deaths under this class as compared with 211 for the year 1932. MORTUARY. The Council's Mortuary was erected in 1904, and is situate adjacent to the Coroner's Court in Lamb Lane. The number of bodies dealt with since 1920 is shown below :— Year Drowned Bodies from River Other Bodies Total 1920 14 175 189 1921 15 152 167 1922 14 166 180 1923 12 170 182 1924 21 182 203 1925 17 204 221 1926 23 214 237 1927 9 275 284 1928 10 351 361 1929 4 317 321 1930 12 218 230 1931 17 128 145 1932 11 151 162 1933 10 130 140 23 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. PUBLIC HEALTH STAFF. In accordance with the request contained in the Ministry of Health Circular No. 1346, the particulars relating to the Staff of the Department are set out on pages 4 and 5. The chief alterations to the personnel of the Department during the year were the retirement of Dr. E. G. Annis as Medical Officer of Health and the appointments of Dr. J. G. Dathan as Assistant Maternity and Child Welfare Medical Officer and Mr. H. L. Bennett as Sanitary Inspector, reference to which is made in my introductory remarks. Mr. F. A. Brown of the clerical staff who had been acting as Temporary Sanitary Inspector, resigned in October and was succeeded by Mr. A. J. Shelley. Mr. J. Hannen was appointed to fill the position vacated by Mr. Brown. Laboratory Work.—The long-standing arrangement with the Bacteriological Department of the Seamen's Hospital has been in force throughout the year, whereby that Institution carried out all necessary pathological and bacteriological work for this Department, other than under the Food and Drugs (Adulteration) Act, and in this connection, 3,529 specimens have been examined for Diphtheria, 10 for Typhoid Fever, 363 for Tuberculosis, and 27 for other various conditions. Fuller details respecting the results of the examinations of these specimens will be found under the different headings of the individual diseases. Ambulance Facilities. (a) Patients suffering from Infectious Diseases are conveyed to Hospital by the ambulances of the London County Council. (b) For Non-Infectious and Accident Cases. No provision is made by the Council, but facilities are afforded by the ambulances of the London County Council, and certain local hospitals. (c) For Maternity Cases. The existing arrangements with the L.C.C. continues whereby their ambulances are available, free of charge, between the hours of 11 p.m. and 8 a.m., for all maternity patients entering the Council's Maternity Home, 78, Shooters Hill Road, S.E.3, and for urgent cases only during the day time. 24 NURSING IN THE HOME. The arrangements for home nursing which the Council has made with the Ranyard Mission, the Charlton and Blackheath District Nursing Association, and the Nursing Sisters of St. John the Divine respectively, continue to be in operation. Such services were utilised as and when occasion demanded. CLINICS. Reference was made in last year's Report to the purchase of a plot of land in Charlton Lane, with the intention of erecting a Centre in place of the unsuitable Sunday School premises, which are now in use at Charlton Vale. The purchase has now been completed and the plans passed by the Ministry of Health for the erection of a combined Infant Welfare and Artificial Sunlight Treatment Centre at an estimated cost of £2,048. The erection of the building will be commenced early in the new year. Negotiations are still proceeding with regard to the purchase of a site in the St. Nicholas, Deptford, district, which was also referred to in last year's Report. TUMOUR DIAGNOSIS CLINIC. During 1933, the clinic was attended by 33 new patients, of whom 4 were males. In all, the attendances totalled 42. As in previous years there were several inquiries from outside Boroughs. Of the new patients, 4 were sent by medical men, 3 came on the recommendation of other patients the Health Visitors sent 7, and the remainder attended as a result of advertisements in the local Press, and propaganda in the form of leaflets and booklets (Better Health). Despite every endeavour the attendance is discouraging, all the more so, when one notes that during the year no fewer than 162 residents in the Borough died from malignant disease, and from a study of the death certificates it is quite evident that many of these people had suffered for years. Of the 33 new patients, only one was found to be definitely malignant and arrangements were made for immediate treatment by the Council's Consultant, Mr. Davies-Colley, who kindly admitted the case to his own wards in Guy's Hospital, and up to the present the patient is doing well. The remaining patients suffered from various conditions, e.g., Ovarian Cysts, Fibroid tumours, Enlarged glands, etc., calling for no special treatment, but where possible arrangements were made for appropriate treatment. In all, 5 cases were referred to the Consultant for diagnosis. 25 All cases from the opening of the Clinic in 1927, have been followed up, and so far no case diagnosed as non-malignant has shown any cause whereby the first opinion should be altered. HOSPITALS. As the facilities for obtaining hospital treatment have been discussed in previous Reports I need only mention that during the year additional provision has been made at the St. Alfege's Hospital. A new Out-Patient Department has been erected for the treatment of tuberculosis and for ante-natal purposes. BOROUGH MATERNITY HOME. During the year negotiations were completed for the purchase of No. 80, Shooters Hill Road, adjoining the Council's Maternity Home. The work of adapting the premises is well in hand and when completed will provide on the ground floor two isolation wards for patients and on the upper floors improved sleeping accommodation for the domestic staff. 26 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 27 to 29 and 32 to 37 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 21,114 houses and premises have been inspected or re-inspected during the year ; 937 intimation notices and 221 statutory notices have been served. There were altogether throughout the year 523 complaints registered. FACTORIES, WORKSHOPS AND WORKPLACES. The number of Factories, etc., upon the Register at the close of the year was 229 Factories, 100 Workshops, 37 Wharves and Quays. The whole of these premises were kept under systematic observation by the Inspectors, who made 287 inspections. The duties of the sanitary authorities in relation to the sanitation of factories are few and are limited mainly to the enforcement of suitable sanitary accommodation of factory employees. In certain of these trades in which female labour is mainly used, inspections are carried out by the Female Sanitary Inspector. Generally speaking the Factories and Workshops are in good condition and no evidence has been forthcoming to show that any local occupation exercises an adverse influence on the health of the workers engaged therein. Outworker's Register.—Four lists, containing 4 names and addresses, have been received from employers within the district. In addition to this, 20 lists containing 40 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs, whilst 2 lists with 3 names and addresses were forwarded to other districts, thus giving a total of 41 Outworkers in the Borough. 75 visits of inspection have been paid to these premises. 27 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises. Number of Inspec tions Written Notices Prose cutions Factories.. (Including Factory Laundries) 135 3 .. Workshops (Including Workshop Laundries) 107 1 .. Workplaces (Other than Outworkers' Premises) 45 2 .. Total 287 6 .. 2.—DEFECTS FOUND. Particulars Number of Defects Number of Prosecu tions Found Remedied Referred to H.M. Inspector *Nuisances under the Public Health Acts— Want of Cleanliness 14 14 .. .. Want of Ventilation 2 2 .. .. Overcrowding .. .. .. .. Want of Drainage of Floors 5 5 .. .. Other Nuisances 7 5 2 .. Sanitary Accommodation—- Insufficient 4 4 .. .. Unsuitable or Defective 3 3 .. .. Not Separate for Sexes 1 1 .. .. Offences under the Factory and Workshops Act— Illegal Occupation of Underground Bakehouse (s. 101) .. .. .. .. Other Offences 6 6 .. .. Totals 42 40 2 including those specified in Sections 2, 3, 7 and 8 of the bactory Act, as remediable under the Public Health Acts. 28 3—OUTWORK IN UNWHOLESOME PREMISES (Section 108). Nature of Work Instances Notices Served Prosecution Wearing Apparel— (1) Making, etc. • • .. .. (2) Cleaning and Washing .. .. .. Lace, Lace Curtains and Nets .. .. .. Furniture and Upholstery . . .. .. Fur Pulling .. .. .. Umbrellas .. .. .. Paper Bags and Boxes .. .. .. Cotton and Kit Bags -• .. .. Brush Making .. .. .. Box Making .. .. .. Rackets and Tennis Balls .. .. .. Stuffed Toys .. .. .. Totals .. .. .. 4 —WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1933. No. Bakehouses 16 Factory Bakehouses 23 Barge Builders 11 Blacksmiths 5 Boot and Shoe Makers 9 Builders' Yards 2 Carpenters and Joiners 3 Carriage Builders 2 Coopers 1 Cycle Works 4 Dress and Mantle Makers 9 Engineers 4 Electrical Engineers 2 Fuel Works 2 Furniture 1 Laundries 1 Milliners 2 Monumental Masons 1 Motor Vehicle Repairers 4 Photographers 2 Picture Frame Makers 1 Plumbers 2 Tailors 13 Others 14 134 29 5.—OTHER MATTERS. Class. No. Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Other .. .. .. .. .. .. .. — Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. 5) :— Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspectors 1 Underground Bakehouses (Sec. 101) :— In use at end of 1933 13 Smoke Abatement.—During the year this problem was constantly before the staff and 31 observations of Factory chimneys were made for the purpose of detecting offences under the Public Health (Smoke Abatement) Act, 1926, and the Bye-laws made by the London County Council which came into force in 1931. Legal proceedings were instituted in only one instance. As in previous years the chief offenders were the London Passenger Transport Board's Generating Station (formerly the London County Council) at East Greenwich and the London Power Co. Station in St. Nicholas. At the East Greenwich Generating there has been a decided improvement as regards atmospheric pollution following the installation of new apparatus and further improvement may be confidently looked for. Difficulties are still experienced with the London Power Co. in St. Nicholas but the Company have informed the Council that they are installing washing apparatus of the most modern type and further that they are approaching the Admiralty and Royal Observatory Authorities with a view to the removal of the embargo whereby the height of the chimneys at the station is strictly limited. Should these efforts prove successful there is no doubt a great improvement would be effected. In the meantime both stations are kept under constant observation. Drainage.—During the year 107 plans of Drainage and other Sanitary works relating to existing and new buildings were examined and approved. The supervision of these works involves many visits and occupies a considerable amount of the time of the Sanitary Inspectors. Details of the work will be found in the appended tables but I would specially direct attention to the amount of work carried out without resort to the service of Notices, a result which reflects the highest credit on the courtesy and tact of the Inspectors. 30 Infringements of the Bye-laws were reported in 4 instances, in respect of failure to give notice of intention to construct drainage or to deposit plans. The Builders concerned were cautioned and no further action yvas considered necessary. Public Sanitary Conveniences.—Conveniences provided or maintained by the Council remain as enumerated in last year's Report as also the Drinking Fountains and Horse Troughs which are cleansed daily by the attendants attached to the Department. Houses Let in Lodgings.—Under Section 6 of the Housing Act, 1925, the London County Council made Bye-laws which came into force in 1926. These Bye-laws define a house let in Lodgings as ordinary tenement houses in which the rooms or floors are let out separately, and all houses suitable to the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to Sanitation, cleanliness, etc. If this definition were strictly followed, it would include approximately half the houses in the Borough because, partly owing to housing shortage two or more families to a house is the rule rather than the exception. Many of these houses are well looked after by owners and tenants and do not require the drastic application of the Bye-laws and the practice at present is to place on the register only those which experience has shown require the constant supervision of the Inspector, and the progress of our slum clearance scheme will tend to reduce this number. The number of houses on the register is at present 102 and 106 visits were paid for inspection purposes. In no case was it necessary to institute legal proceedings. Rats and Mice (Destruction) Act, 1919.—During the year 114 complaints of the presence of rats in houses, etc., were received. These complaints were at once investigated for the purpose of discovering the source of the Rats, and advice and assistance were given where necessary. In the case where defective drains were found steps were taken to have these remedied. The usual procedure was adopted with regard to Rat Week, particulars of which have been dealt with in previous Reports, and as usual supplies of approved Rat Poison were supplied to necessitous tenants. Public Swimming Baths.—The Public Swimming Baths in Greenwich are provided with aeration and filtration plant whereby water is continuously filtered, aerated and chlorinated. 31 During the year at the request of the Adoptive Acts Committee, samples of the water were submitted for chemical and bacteriological examination. The reports showed the water to be of a very high standard of purity, there being no sediment or B. Coli present. Water Supply.—During the year 305 water supply certificates have been granted under Section 48 of the Public Health (London) Act, 1891. Thirty-five water supplies have been reinstated where the supply had been cut off; water fittings have been amended in 67 cases, and covers to cisterns adapted in 17 cases. Scavenging and Refuse Disposal.—The collection of house, etc., refuse in the Borough is under the control of the Borough Surveyor, who has kindly supplied me with the following information relating to the disposal of refuse. The amount of refuse collected in the Borough during the year ended 31st December, 1933, was approximately 20,100 tons, giving an average of 73 tons daily. Of the total collected, approximately 14,200 tons were dealt with at the Council's Refuse Disposal Plant the remainder being disposed of by barging and tipping under contract. The collection of house refuse by the " Pagefield " container system inaugurated in 1931 has been extended during the year, the Council having purchased a second unit consisting of a heavy oil engined lorry with six inside loading containers as a further step in the process of modernising this service. Verminous Premises.—As a means of assisting occupiers in the more densely populated parts of the Borough in ridding their premises of vermin, a supply of a special fluid is kept at the Borough Hall and is supplied to occupiers whose premises have been reported upon by the Sanitary Inspector. Applicants are required to bring their own bottles, and advice is given in every case as to the correct way of using the preparation. During the year 670 gallons were distributed to approximately 5360 applicants. Rag Flock Acts, 1911 and 1928.—These Acts prohibit the sale or use for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. No samples of rag flock were taken during the year. 32 SUMMARY of WORK PERFORMED by the SANITARY INSPECTORS DURING THE YEAR 1933. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Inspections— Houses Inspected (House to House) . . . . . . 11 11 ,, ,, Complaints, Nuisances 579 598 625 646 2448 Other Premises Inspected 145 109 88 55 397 Re-Inspections, Calls Made, etc. 3936 3622 3364 3718 14640 Inspections of Houses Let in Lodgings 32 29 21 24 106 ,, Bakehouses 4 41 42 45 132 Factories .Workshops and Workplaces 45 38 34 37 154 ,, Outworkers' Premises 17 25 13 20 75 Common Lodging Houses 3 . . 2 2 7 ,, Slaughterhouses 11 25 67 77 180 ,, Cowhouses . . . . . . 2 2 Stables and Yards 23 4 2 . . 29 Piggeries 1 . . . . . . 1 ,, Courts and Alleys 6 1 . . 4 11 ,, Fields, Lanes, etc. 1 7 i4 9 31 ,, Urinals 35 22 22 28 107 „ Gipsy Vans 2 1 . . . . 3 ,, Horse Slaughterhouses . . . . 1 1 2 ,, Dairies, Cowsheds and . . . . . . . . . . Milkshops 3 20 119 57 199 ,, Soap Boilers . . . . . . . . . . ,, Other Offensive Trades 3 5 . . . . 8 ,, Ice Cream Places 1 30 98 . . 129 ,, Other places where food is prepared or stored 382 200 810 879 2271 Investigations (Rats and Mice) 79 22 34 36 171 Total 5308 4799 5356 5651 21114 Drains— Intercepting Chamber 3 . . 4 7 14 Other Chambers Constructed 30 19 18 38 105 Reconstructions and Additions 15 44 17 76 152 Opened, Cleansed and Amended 95 76 124 92 367 Traps Fixed 55 54 35 95 239 New Soil Pipes 12 3 8 21 44 Soil and Vent Shafts Repaired 11 1 9 9 30 Drains and Soil Pipes Ventilated 19 15 2 26 62 Clearing Eyes Provided 2 . . . . 7 9 12 Drains Sealed off, etc. 5 9 23 49 Drains Tested—by Smoke 68 46 24 90 228 ,, by Water 100 54 65 112 331 Found Defective 28 16 15 32 91 New Covers to Manholes 18 6 16 31 71 Yards Drained 7 8 2 21 38 Mews and Stables Drained . . . . . . . . . . Washhouses Drained . . 2 1 . . 3 Areas Drained . . . . . . . . . . Cesspools Abolished . . . . . . 1 1 33 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Water Closets and Urinals— Closets Erected 28 4 19 27 78 W.C. Doors Repaired or Provided 94 93 56 131 374 Sanitary Conveniences or Improve ments Effected to Factories, Work shops and Workplaces 6 10 18 34 Flushing Apparatus Amended 79 57 55 85 276 Pans or Traps Furnished 117 87 66 124 394 Water Supply Disconnected from Drinking Water Cistern .. .. .. .. .. Cleansed 15 21 13 24 73 Ventilation Improved 9 3 4 14 30 Public-house Urinals Cleansed or Re paired 8 1 .. 5 14 Other Urinals Altered or Cleansed .. 2 .. .. 2 Other Urinals Constructed 2 2 1 2 7 Ashpits— Provided 79 97 88 99 363 Covers to Receptacles .. •• .. .. .. Pavings— Forecourts and Yards 74 58 25 96 253 Areas .. .. 1 .. 1 Washhouses 1 1 .. .. 1 Mews and Stables 1 1 .. .. 2 General Water Supply— Covers to Cisterns Adapted 1 3 4 9 17 Water Fittings Amended 16 14 16 21 67 Cisterns Cleansed and Repaired .. 1 1 .. 2 Water Services Altered so as to draw direct from main 7 17 5 .. 29 Water Supplies Reinstated where cut off through defective fittings 3 2 7 23 35 Water Supply Certificates Granted (Section 48) 30 126 101 48 305 Other Improvements— General Repairs 22 10 12 8 52 Verminous Rooms Cleansed 5 17 42 16 80 Ventilation Improved 51 74 51 92 268 Staircases Repaired, Amended, Lighted and Ventilated 12 14 33 20 79 Leaky House Roofs and Gutters Repaired 92 81 52 123 348 34 Summary of Sanitary Work-continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Other Improvements—contd. Walls arid Ceilings of Premises Cleansed and Repaired 345 361 389 529 1624 Stoves and Fireplaces Repaired 34 23 18 43 118 Washing Coppers Repaired 15 12 16 20 63 Sinks Provided 90 33 59 88 270 Floors Repaired 55 84 50 117 306 Ice Cream Places Cleansed or Improved 1 .. 1 .. 2 Other Places where food is stored and Prepared 3 .. .. .. 3 Provision for Storage of Food • • .. .. 2 2 Other Nuisances Abated— Illegal Use of Underground Room Discontinued .. .. .. 4 4 Overcrowdings abated 1 2 .. .. 3 Sink, Lavatory and Bath Waste Pipes Disconnected, Trapped or Amended 82 54 55 82 273 Stack Pipes Amended 30 16 12 28 86 Nuisances from Dampness Abated 62 46 36 55 199 Animals kept in Unfit Places Discontinued or Removed .. 1 2 .. 3 Dung Receptacles Provided .. .. .. .. .. Bakehouse Nuisances Abated 3 3 .. .. 6 Houses Abolished, unfit for habitation 5 3 1 .. 9 Accumulations of Manure and other Obnoxious Matter Removed 18 13 4 14 49 Inundations Abated .. .. .. 1 1 Contents of Rooms Cleansed 3 .. 4 5 12 Rat Infestation Abated 17 31 18 33 99 Smoke Nuisances— Observations 9 4 3 15 31 Statutory Notices Served (Sections 23 and 24) 2 ... .. .. 2 Food and Drugs— SamDles Taken :— Formal 133 124 86 48 391 Informal 0 0 1 51 52 Found Adulterated, etc. 3 2 0 4 9 35 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Notices, etc.— Intimations served under Public Health (London) Act, 1891 (Section 3) 200 218 215 304 937 Notices served— Under Housing Acts .. 10 10 11 31 Rats and Mice (Destruction) Act, 1919 .. 1 .. .. 1 Smoke 2 .. .. .. 2 re Verminous Rooms .. 1 .. 1 2 Under P.H. (L.) Act and Metropolis Management Act (recombined drainage) 6 .. .. 21 27 W.C.'s (Factories, Workshops and Workplaces) 1 .. .. .. 1 Yards 1 .. .. 1 2 Miscellaneous .. .. .. .. .. Statutory Notices served under Section 4 44 22 36 44 146 Statutory Notices (re Ashpit provision) 4 2 1 2 9 Complaints received and attended to. 1 7 .. .. 1 Letters written relating to abatement of Nuisances 3 .. .. .. 3 Summonses applied for and issued 1 7 .. .. 8 Magisterial Orders obtained and enforced .. .. .. .. .. Drainage Plans received and examined. 29 23 24 31 107 Return Made to London County Council. Proceedings during 1933. Premises Number of Places Number of tions, 1933. Number of Notices, 1933 Number of tions, 1933 On Register at end of 1932 Added in 1933 Removed in 1933 On Register at end of 1933 Cowsheds 3 .. .. 3 2 .. .. „ (Licensees) 1 .. .. 1 .. .. .. Dairies and Milkshops 105 4 3 106 194 .. .. Slaughterhouses 2 .. .. 2 180 .. .. Other Offensive Trade Premises 2 .. .. 2 8 .. .. Ice Cream Premises 134 20 .. 154 129 .. .. Registered Houses Let in Lodgings 104 .. 2 102 106 5 .. Restaurants and Eating Houses 69 6 2 73 112 3 .. 36 Total Number of Intimation Notices served for all purposes 937 „ „ „ Statutory „ „ „ 221 Overcrowding, 1933— Number of Dwelling-rooms overcrowded 15 Number remedied 3 Number of Prosecutions — Underground Rooms— Illegal occupations found during year 4 Number of Rooms closed or illegal occupation discon tinued 4 Insanitary Houses—- Number closed under the Public Health (London) Act, 1891 — Number of Closing Orders made — Number demolished in pursuance of Orders — Number demolished voluntarily 9 Number repaired or Nuisances remedied under Public Health Act 1,316 Housing of the Working Classes— (a) Erected during the year :— Municipal 13 Private Enterprise 116 (b) In course of erection 120 Number of Verminous Premises cleansed under Section 10 of the London County Council (General Powers) Act, 1922 80 Number of Cleansing Baths given under Cleansing of Persons Act 6 Number of Children Cleansed 978 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year Number of Tenement Houses provided with Additional Water Supply 1 Number of Prosecutions ditto - 37 Number of Houses in the Borough 18,866 Number of Houses occupied by the working classes 14,150 Number of Houses inspected:— (a) On account of complaints 523 (b) Illness (P.H. Act) 797 (c) Nuisances 1,139 2,459 Number of Houses repaired (Section 17, Housing Act, 1930) 5 Number of representations by Medical Officer of Health 1 Number of Houses included in such representations 70 Number of closing orders made 1 Number of closing orders determined 1 Number of demolition orders 2 Number of Houses demolished:— In pursuance of Orders 2 Voluntarily 1 — 3 38 SECTION D. HOUSING. To carry out the work of dealing with the repair and demolition of insanitary houses under the Housing Act, 1930, one of the District Inspectors was appointed for this special purpose and com menced duty in February. The appointment was for 6 months only but has since been extended for a similar period. The work is necessarily slow but is going on steadily, although the number of inspections and re-inspection, together with the mass of clerical work involved in recording the results of these inspections, the communications with owners and agents, entail a considerable amount of office work and makes for slow progress. During the year the following insanitary areas mentioned in last year's Report were officially represented to the Council. Area A.—No. 1, la, 2, 3, 4, 5, 6, 7 on the south side of Richardson's Place, together with Nos. 1, 2, 3, 4, 5, Church Passage. Area B.—Nos. 8, 9, 10 and 11, being the houses on the north side of Richardson's Place, together with Nos. 1, 2, 3 and 5, Pemmels Court abutting thereon. Area C.—Nos. 2. and 3, Felma Court, and 1, 2, 3 and 4, Prince of Wales Cottages, Felma Court. Area D.—Nos. 1, 2, 3, 4, 5, 6, 7 and 8, Watton Place. Area E.—Plume Place East, 1, 2, 3, 4, 5, 6, 7, 8 and 9, and 76, Roan Street ; Plume Place West, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11. Area F.—22, 24, 26 and 28, The Stowage. Area G.—1, 2, 3, 4, 5 and 6, Baker's Yard, and. 31, 33, 35 and 37, Billingsgate Street. It is hoped that the Borough Council's efforts to clear up these areas at an early date will be successful, for the clearance or improvement of unhealthy dwellings is a matter of great urgency. The great difficulty of course, is that of finding alternative accommodation for the displaced tenants. A number of houses in the low lying parts of the Borough are old and of faulty construction, and although every endeavour is made by action under the Public Health Acts to prevent further deterioration, the majority of these premises require the more drastic measures provided by the application of the Housing Acts. Many of the houses in question are occupied by two or more families and are lacking in adequate provision for food storage and washing accommodation. Clearance Areas.—The L.C.C. having submitted to the Ministry of Health for confirmation the two Compulsory Purchase Orders, 39 Thames Street (No. 1) and Aboukir Cottages (No. 2), the Minister decided to hold a public inquiry into the subject matter of the Orders and this was held in the Town Hall in November, 1933. Evidence in support of the Confirmation of the Orders was given by the Valuer of the L.C.C., by a Medical Officer of the L.C.C., and myself, whilst objections to the scheme were made by various owners and occupiers. Several tenants gave evidence to the effect that they had been living in the houses for a number of years, and did not desire to move where a higher rental would probably be required. Following the Public Inquiry the Ministry of Health Inspector spent several days visiting the areas and at the close of his inspection personally thanked your officers for " their great courtesy and assistance." At the close of the year the decision of the Minister of Health had not come to hand. The combined areas comprised 156 houses with a population of 713. It was stated at the Inquiry that accommodation for the first batch of displaced tenants would be found on the L.C.C. Estates at Evelyn Street, Deptford, and on the Honor Oak Estate. With regard to work carried out on individual houses, it might be mentioned here that under the various sections of Part II of the Housing Act a considerable amount of work was initiated during the year. Good progress is being made and the work is expected to be completed during the following year. The following may be quoted : — Knott Street.—Nos. 39 to 51 (7 houses) Berthon Street.—Nos. 2 to 40 (20 houses) Creek Road.—Nos. 77 to 119 (16 houses) London Street.—Nos. 9, 13 and 15 (3 houses). Of the above work in 32 instances the alteration and repairs were agreed to without resort to the serving of Notices which indicates to some extent the close co-operation that exists between agents, owners and the Public Health Department. The procedure now generally adopted is, after a preliminary survey, to invite the owner or agent to a consultation either on the site or at the Public Health Office and after considering the house or houses in question to invite them to carry out voluntarily the reconditioning necessary. Many agents appear to welcome this step and some have themselves drawn attention to other portions of their property, for after all it is evident that it is not in the interest of House Agents generally to allow property to degenerate to such a condition as might call for the application of a clearance scheme. At the close of the year negotiations initiated by the Trustees of the Hatcliffe Estate were commenced and it is confidently expected that during next year a considerable amount of this property will have been reconditioned. 40 The following figures show in detail the work performed from 1st February to 31st December, 1933, under Part II of the Housing Act, 1930 : — Houses Surveyed (not including Thames Street area) 88 Houses closed 3 Houses reconditioned 5 Houses in hand (in progress) 23 Houses in hand (not actually commenced) 34 Houses in hand (in negotiation—Sigismund Street) 12 Underground Rooms recommended for action 2 Notices Served Requiring Work 31 Informal Agreements to Recondition 44 Reconditioning partly effected by Agreement without Survey 9 Notices of Intention to Survey 96 Total Visits made in connection with zvork under the Housing Acts 2,243 Overcrowding.—Hundreds of applications for houses remain on the Council's Waiting List and still applications continue to be received in the Public Health Department daily. These are investigated and a report sent to the Town Clerk for submission to the appropriate Committee. The question is one of considerable difficulty and until adequate provision is made for the accommodation of those people unable to afford the rents demanded for new houses the problem of overcrowding is still far from being solved. Rent and Mortgage Interest (Restrictions) Acts, 1920-23.— Four applications for certificates were made all of which were granted and in two instances reports were subsequently issued to the owner of the premises under Sec. 5 (2) of the 1923 Act on completion of the necessary repairs. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933.— Broadly the effect of this Act so far as London is concerned is that premises of a rateable value of more than £45, shall be decontrolled, those of rateable value between £20 and £45, are to remain subject to present legislation and those at present controlled having a rateable value of less than £20 are to remain controlled, even though under past legislation the premises would have become decontrolled when vacated. The Act also provides that the Rent and Mortgage Interest (Restriction) Acts shall continue for a period of 5 years and no longer. 41 HOUSING RETURN, 1933. 1. Inspection of Dwelling-houses during the year :— a) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,096 (b) Number of inspections made for the purpose 2,202 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 11 (A) Number of inspections made for the purpose 30 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,316 2. Remedy of Defects during the year without Service of Formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers ... 518 3. Action under Statutory Powers during the year :— (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 31 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 5 (b) By local authority in default of owners — (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring de fects to be remedied Notices served : Intimations 937 Statutory 162 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 798 (b) By local authority in default of owners - 42 (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 2 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 (D) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 Number of houses erected during the year : — By Borough Council 13 By Private Enterprise 292 43 SECTION E. Inspection and Supervision of Food. The object of all Food inspection is of course to safeguard the Public health and prevent any food being sold for human consumption which may be harmful to the consumer. The Food premises in the Borough are therefore kept under constant and regular observation by the Sanitary Inspectors as to their sanitary condition and the condition and soundness of the food sold or exposed for sale. The latter part of the work has been greatly assisted and the value of the inspections enhanced by the appointment of an Inspector whose duties are mainly confined to the inspection of meat and other foods. The proper supervision of the food supplies, involves a considerable amount of detail work on all the Inspectors, especially during hot weather and the frequent examinations of stalls, etc., make it often necessary for them to be on duty long after ordinary working hours. INSPECTION OF MEAT AND OTHER FOODS. Under the provisions of the Public Health(London) Act, 1891, the Medical Officer of Health and the Sanitary Inspectors are authorised to inspect at all reasonable times, all articles intended for the purpose of sale for the food of man. During the year 1933, the following diseased and unsound articles of food were surrendered:— Tons Cwts. Stones lbs. Beef, Pork, Mutton, Lamb, Offals, etc. 1 - 7 7 ½ Fish .- 2 6 1 Potatoes - 15 - - Sweetmeats, etc. .- - 1 3 Apples - 1 3 - Tinned Fish, preserves, etc. (23 tins) - - 2 2 Total 1 19 5 134 The Public Health(Meat) Regulations, 1924.—The above, which came into force on the 1st April, 1925, provided for the better regulation and supervision of slaughter-houses, butchers'shops, stalls; and the protection of meat against contamination by dirt and flies, etc., in transport and handling. 44 There were 115 premises where meat, bacon, etc., were either stored or exposed for sale, such premises being inspected periodically by the Inspectors. Slaughter-houses.—There were 2 slaughter-houses in use at the end of 1933, both of which are licensed annually. One hundred and eighty inspections were made by the Inspectors during the year, and the necessary cleansing and distempering duly enforced. During the year the Meat Inspector examined the following animals after slaughter :— Oxen 92 Calf 1 Sheep 1,081 Pigs 144 Total 1,318 The number of animals slaughtered showed an increase of 444 over the previous year. SLAUGHTER OF ANIMALS ACT, 1933. This Act, which came into force on the 1st January, 1933, had for its object the licensing of fit and proper persons who alone are authorised to slaughter, and the humane slaughtering of animals by firstly stunning them with a mechanically or electrically operated instrument. The Greenwich Borough Council have not resolved to exempt sheep and goats from such humane treatment, by exercising that right invested in them by the Act, but have included all animals slaughtered in both slaughter-houses and knackers-yards. The use of the humane killer has been general in this Borough for many years and the provisions of this Act will not alter materially the existing mode of slaughter. The licensing of slaughtermen, however, ensures that all animals are painlessly despatched by experienced men, who can be held responsible for the cleanliness of the dressed carcases while in their keeping. There were 9 applications made for slaughtermen's licenses, and licenses renewable every three years were duly issued. 45 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. These and subsequent regulations were made under powers granted to the Minister of Health by the provisions of the Public Health (Regulations) as to Food Act, 1907, and certain other principal Acts. They were designed to prohibit the landing on our shores of diseased or otherwise unsound foodstuffs, and it is to this end that specially qualified Inspectors, working under the direction of the Medical Officer of Health, are appointed by Port and Riparian Sanitary Authorities to enforce the observance of such regulations. In this Borough a systematic inspection of all imported food is carried out at the wharves and firms importing unsound food, must either re-export such food, or sell it to an officially recognised firm who must give a written guarantee that all material so received by them will be used only for non-edible refining purposes. A further and more detailed examination is made in respect of mutton and lamb over 42 lbs. per carcase for the purpose of detecting the presence of Caseous Lymphadenitis. In the whole carcases(of which 5 per cent of all landed are subject to this examination), incisions are made in the substance of the lymphatic glands. In the case of parts of a carcase being landed a 100 per cent examination is made. The principal cold storage accommodation here is situated at the Cattle Market, Deptford, and this is computed to be 400,000 cu. ft. capacity. A new store is estimated to be ready for use within the Borough towards the end of 1934, an additional 850,000 cu. ft. will then be available for cold storing of imported meat. The following tables serve to illustrate the types of foods dealt with in this Borough during 1933 ; their tonnage and country of origin. Australia.— Tons Fore-quarters of Beef 13,746 1,057 Hind- „ „ 47,947 3,688 Crops 18,206 910 Lambs 488,325 8,139 Sheep 56,522 1,400 Cases of Offal 3,700 98 ,, Rabbits 6,700 167 Bags of Boneless Beef 1,796 44 Total Tonnage 15,503 46 South Africa.— Tons Fore-quarters of Beef 240 12 Bags of Boneless Beef 8,661 194 Total Tonnage 206 New Zealand.— Fore-quarters of Beef 11,324 871 Hind- „ „ 21,506 1,536 Crops 12,817 801 Cases of Offal 2,460 61 Pigs 18,600 1,163 Sheep 49,230 1,230 Lambs 74,536 1,242 Bags of Veal 36,290 1,814 Total Tonnage 8,718 Argentine.— Lambs 62,000 1,033 Sheep 18,972 474 Pigs 759 38 Cases of Offal 83,604 2,090 Fore-quarters of Beef 1,750 125 Hind- „ 1,640 117 Total Tonnage 3,877 U.S.A.— Cases of Offal 28,000 700 China.— Tins of Liquid Eggs 19,621 390 Norway.—Small tonnage of general merchandise comprising:— Aquarit, Beer, Canned Goods, Cheese, Chocolate, Coffee, Fish, Game, Margarine, Condensed Milk, and Tinned Sausages, was landed 38 tons Total Tonnage of Food from all Countries.—29,432 tons 47 Ceylon.—Cylinders of Cocoanut Oil 244 Australia.— Drums and casks of Tallow and Neat's Foot Oil 2,121 The above-mentioned Tallow and Neat's Foot Oil were detained (being uncertified), until their destinations were known and a guarantee that they would not be used for edible purposes was submitted for each of the several consignments landed. Then a release notice was issued in the case of each consignment. Imported Food Surrendered.—During the year 1933 the following unsound and diseased imported foods were intercepted at the wharves and appropriately disposed of Tons cwt. St. lbs. 17 Sheep and 4 Shoulders of Mutton Caseous Lymphadenitis - 7 1 2 Beef Kidneys—Decomposition and excessive mould - 16 9 4 Bagged Veal—Excessive mould Beef—Hind and fore-quarters—Bone - - 11 7 taint 3 19 4 6 Total weight 5 3 13 3 Milk Supply.—The majority of milk supplied to this Borough is obtained from farmers and large firms outside the district. There is, however, one farm in the Kidbrooke area where 100 cows are kept, which is under constant supervision of the Inspector. Cowhouses.—The three cowhouses in the Borough have been visited on two occasions, and the required cleansing duly enforced. Milk and Dairies(Amendment) Act, 1922.—Milk and Dairies order, 1926.—At the commencement of the year there were 152 purveyors of milk on the Register of Dairies and Milkshops. Thirtysix new applications have been received during the year and added to the Register, and 15 names have been taken off, thus leaving a total of 173 purveyors of milk now registered. The number of premises 48 registered at the end of the year was 106. One hundred and ninetynine visits of inspection of dairies, and shops where milk is sold in sealed bottles, have been made; notices were served upon the occupiers in four cases where dairies required lime-washing or were otherwise in an insanitary condition. At the end of the year there were twelve wholesale purveyors of milk on the Register. Milk(Special Designations) Order, 1923.—This Order was made by the Minister of Health under the powers conferred on him by Section 3 of the Milk and Dairies(Amendment) Act, 1922. Under the Order, the Council, as the local authority, may grant licences to distributors, such licences to be valid only for a period ending on the 31st December in the year in respect of which it is granted. During the year the following licences were granted for the sale of graded milk :— Pasteurisation of Milk 1 Distribution of Certified Milk 2 ,, ,, Grade A (Tuberculin Tested) 2 ,, ,, Pasteurised 6 ,, „ Grade A 1 *Supplementary Licences 4 *Principal Licences granted by the Lewisham Borough Council. Milk.—Result of Analytical Examinations.—One hundred and eleven samples of milk were taken during the year, of which only five were found to be adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. Of the 111 samples, 9 were taken from handcarts in the streets. Bacteriological Examination.—At the request of the London County Council samples of milk were taken on arrival at the Brook Hospital(11 samples), St. Alfege's Hospital(12), the milk being supplied under contract as Pasteurised The bacterial standard for Pasteurised Milk as laid down by the Milk(Special Designations) Order, 1923, is that bacteria per c.c. shall not exceed 100,000. The Council's Pathologist reported that all the above samples complied with this standard. 49 Other Foods.—Places where food is prepared have been visited on 288 occasions, improvements being required in 44 instances as detailed below:— Class of Premises Number on Lists Number of Inspections Number of Instances where matters needed attention At end of 1932 Added 1933 Removed 1933 At end of 1933 Hotel Kitchens 8 - - 8 5 - Eating Houses 62 3 1 64 65 15 Fried Fish Shops 29 - - 29 37 7 Pork Butchers and Sausage Manufacturers 32 - - 32 51 18 Mineral Water Manufacturers 1 1 - 2 2 - Preserved Meats, etc. 59 30 - 89 98 3 other than included in above) Others 23 - - 23 30 1 Totals 214 34 1 247 288 44 The 44 instances where matters needed attention included 20 cases where the premises generally, or kitchen and scullery particularly, needed cleansing and lime-washing, 22 where the sanitary arrangements were defective, and two where shop fittings such as offal bins, chopping blocks, required renewing. In addition to the periodical visits and inspections of food shops, etc., supervision is also exercised on Saturday evenings and Bank Holidays. Street Traders.—The usual supervision was exercised on street traders licensed under the London County Council(General Powers) Act, 1927, who dealt with articles of food. With the exception of a few minor cases there were no instances calling for the inspector's attention. Preserved Food Premises.—In accordance with the provision of the London County Council(General Powers) Act, 1932, all premises, with the exception of clubs, hotels or restaurants used— (a) for the sale or the manufacture for the purpose of sale of ice-cream or other similar commodity, or the storage of ice-cream or other similar commodity intended for sale; or 50 (b) for the preparation or manufacture of sausages or potted, pressed, pickled, or preserved meat, fish, or other food intended for sale; are required to be registered by the owner or occupier with the sanitary authority. Ice-Cream Premises.—At the end of the year 154 premises were duly registered. These premises were inspected on 129 occasions and insanitary conditions remedied in two instances. Preserved Meat, etc., Premises.—At the end of the year 110 premises were on the register and were visited on 119 occasions. As a result of such inspections insanitary conditions were detected and remedied in nine cases, whilst 17 nuisances of a varying nature were also remedied. There was no instance found which necessitated the cancellation of premises already registered. Bakehouses.—One hundred and thirty-two inspections have been made of the various bakehouses in the Borough, and six nuisances found therein have been abated. At the end of the year there were 23 factory and 16 other bakehouses on the Register, 13 of which were underground. Food and Drugs Acts.—Altogether 443 samples have been taken under the provisions of the Food and Drugs(Adulteration) Act, 1928, and submitted to the Public Analyst for analysis of which number 391 were formal samples. Seven of these samples were certified to be not genuine, the adulterations thus being equivalent to 1.7 per cent. of the samples taken as compared with 4.3 last year. There was only one case calling for Police Court proceedings. A local firm selling milk under contract to one of the London County Council Schools was fined £1 18s. and £2 4s. costs for supplying milk which had no less than 9 per cent of fat abstracted therefrom. The Public Health(Preservatives, etc., in Food) Regulations.—These Regulations were made on the 4th August, 1925, and Amending Regulations on the 10th December, 1926, and 25th June, 1927. No contraventions of these Regulations were reported upon during the year. ARTIFICIAL CREAM ACT, 1929. No application was received during the year for the registration of premises under the above Act. 51 AGRICULTURAL PRODUCTS (GRADING and MARKING) ACT, 1928. Various Regulations have been made from time to time by the Minister of Agriculture and Fisheries under the above Act relating to the use of grade designations applied by means of a national mark. The application is entirely voluntary and is intended to set up a specific standard of quality, but where traders elect to adopt the national mark they must comply with the provisions set out in the regulations. There were only a few cases calling for the attention of the Inspectors during the year. MERCHANDISE MARKS ACTS, 1926. Under the powers conferred by the Act, Orders in Council have been made dealing with, amongst other imported articles, various foodstuffs. The goods must not be sold unless the name of the country of origin is clearly marked. The policy underlying the administration of such orders is to give the purchaser the opportunity of choosing between home, empire or foreign goods. With the appointment of a Sanitary Inspector solely concentrating on foodstuffs, a closer watch was kept on shops, etc., to ensure that the various Orders were being strictly complied with. In all no less than 48 infringements were detected. The traders in question were duly cautioned. 52 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Number and Description of Samples Submitted for Analysis under the above Act during the Year 1933. FORMAL SAMPLES Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Baking Powder 2 2 - Beef(Minced) 1 1 - Beef-pie 1 1 - Blancmange Powder 1 1 - Bread 5 5 - Brawn 2 2 - Butter 39 39 - Cake 2 2 - Cheese 29 29 - Cocoa 5 5 - Corned-beef 16 16 - Corn-flour 3 3 - Coffee 1 1 - Dripping 17 17 - Fish-paste 8 8 - Flour 18 18 - Flour(self-raising) 5 5 - Jam 6 6 1 Lard 12 12 - Margarine 1 1 - Milk 111 106 5 Mustard 2 2 - Oatmeal 1 1 - Pearl Barley 2 2 - Pepper 6 5 - Pickles 1 1 - Rice 32 32 - Sago 4 3 1 Sausages 8 8 - Sausage(Breakfast) 18 18 - Sugar 4 4 - Tapioca 25 25 - Tea 3 3 - Vinegar 1 1 - 391 384 7 53 INFORMAL SAMPLES. The following samples were taken from Vendors and submitted to the Public Analyst, by the Food Inspector or his agent without recourse to the usual provisions as required by the Food and Drugs (Adulteration) Act, 1928. Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Brandy 2 2 - Bread 1 1 - Butter 2 2 - Camphorated Oil 6 6 - Cocoa 1 1 - Coffee 1 1 - Corn Flour 1 1 - Dripping 1 1 - Faggott 1 1 - Fish-paste 1 1 - Jam 2 1 1 Lard 1 1 - Margarine 1 1 - Marmalade 1 1 - Mincemeat 1 1 - Mustard 1 1 - Pease-pudding 2 2 - Pepper 2 2 - Pickels 1 1 - Rice 2 2 - Sausages 3 2 1 Saveloy 1 1 - Shrimps(Peeled) 1 1 - Sultanas 3 3 - tomato Sauce 1 1 - Vinegar 3 3 - Whisky 6 6 - Wine(non-alcoholic) 3 3 - 52 50 2 54 Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Action taken 76 Raspberry Jam Contained over 15% of pulp and juice of fruit other than raspberry Warning Letter 99 Milk Addition of 4% of water do. 118 Milk Abstraction of 6% fat do. 184 Sago Consisted entirely of Tapioca do. 227 Milk 5% deficient in fat do. 390 Milk 9% abstraction of fat Fine £1 18s. 0d. Costs £2 4s. 0d. 391 Milk do. No action taken NOTIFICATION OF FOOD POISONING. Under the provisions of the London County Council(General Powers) Act, 1932, which came into force on the 12th July, 1932, every registered medical practitioner attending on any person shall, if he suspects or becomes aware that such person is suffering from food poisoning forthwith notify such case to the Medical Officer of Health. There were 10 cases notified during the year. Each case was investigated with a view to ascertaining the source of infection. In every instance the illness was only mild and necessitated no further action on the part of the Officers of the Public Health Department. 55 The following table gives particulars of cases notified in detail. Case No. Initials of Patient Age and Sex District Date Notified Suspected Cause Whether Recovered 1 I. P. 15 F East Greenwich 5-7-33 Jellied Eels Recovered 2 L. H. 17 F do. 9-8-33 Frozen Lamb do. 3 W. H. 14½ M do. 9-8-33 do. 4 L. H. 44 F do. 9-8-33 do. 5 R. W. H. 24 M do. 9-8-33 do. 6 H. L. 60 F do. 9-8-33 Salmon paste do. 7 K. T. 11 F do. 29-8-33 Chip Potatoes do. 8 E. F. 30 F do. 29-8-33 Chip Potatoes do. 9 A. M. 51 M do. 31-8-33 Fried Fish do. 10 C. K. 30 F do. 8-9-33 Fried Fish do. PREVENTATIVE MEASURES TAKEN AGAINST THE SPREAD OF FOOD POISONING. In connection with the arrangements made with the Medical Officer of Health for the County of London, information is available in respect of all cases of Food poisoning occurring in the Metropolitan area. On the 14th October particulars of an outbreak of Food poisoning at St. Pancras were received, from which it appeared the suspected cause was due to pease-pudding and two cases proved fatal. While further investigations were being made at St. Pancras the several Metropolitan Boroughs in whose districts the parts of the original consignment of split peas had been received, were immediately notified. In this Borough there were six parts of the suspected consignment, two of which were found to be in the stores of public institutions. Steps were at once taken to prevent the use or the sale of the split peas, until samples could be taken and submitted for chemical and bacteriological analysis. Subsequently, the Public Analyst reported the samples to be genuine and free from preservatives and metallic poisons. The report of the Pathologist stated that there was no evidence of the enteric and food poisoning groups of organisms. The restrictions placed on the consignments of split peas were therefore released. 56 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifications under the Provisions of the Public Health (London) Act, 1891, etc.—During the year, 3,267 cases have been notified under the above Act. The following table shows the comparison since 1928:— No. Year. 4,832 1928 2,387 1929 3,572 1930 1,645 1931 3,497 1932 3,267 1933 Particulars relating to age groups and districts are shown in the Tables at the end of the Report. Smallpox.—No cases. During the year four persons residing in the Borough were reported as probable or possible contacts with cases of smallpox. In every instance they were kept under observation by the Infectious Diseases Inspector for the extreme period of incubation. Public Health(Smallpox Prevention), Regulations, 1917.— It was not found necessary for your Medical Officer of Health to undertake any vaccinations during the year. Details respecting vaccination in the Borough are given in the Supplementary Vaccination Report on page 63. Whooping-Cough.—Whooping-Cough is only notifiable in a few London Boroughs of which Greenwich is one. It is one of the Infectious Diseases most difficult to control and is one which causes many deaths amongst very young children. Parents and guardians cannot be too strongly warned that this disease(which like Measles, is all too often lightly regarded) if not properly treated, not infrequently ends in Pneumonia and a fatal termination. 57 Altogether 571 cases were notified, compared with 370 for the previous year. 280 occurred in East Greenwich, 95 in West Greenwich, 8 in St. Nicholas, and 188 in Charlton and Kidbrook. Thirty-one cases were removed to Hospital of which 4 were returned as not suffering from Whooping-Cough. Diphtheria.—The number of patients notified as suffering from Diphtheria during the year was 396 as compared with 235 and 281 for the years 1932 and 1931. Three hundred and eighty-eight cases were removed to Hospital, but of this number 19 were returned as errors of diagnosis. The cases were more or less evenly distributed throughout the Borough. All contacts and discharges from Hospital were examined by me either at the Borough Hall or at their own homes. As a result of these examinations, of 220 children discharged from Hospital, 13 gave a positive bacteriological result, and of 71 children referred by teachers from the various schools in the Borough, three gave a positive finding. All the "positives" were given appropriate treatment and kept under observation until the condition finally cleared. Under the London County Council scheme all persistent "carriers" of diphtheria germs amongst schoolchildren are treated at a special clinic at Guy's Hospital. During the year several enquiries from parents were received by me asking if their children could be protected from Diphtheria. They were reluctantly referred to other Boroughs where facilities for immunisation existed. In accordance with the Antitoxin Order, 1910, a supply of Diphtheria Antitoxin is provided by the Council for the use of general practitioners in emergency cases. Fifteen tubes of Antitoxin containing a total of 150,000 units of serum have been supplied during the year. The quarterly incidence of the disease was as follows:— 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total East Greenwich 21 23 21 82 147 West Greenwich 12 16 21 32 81 St. Nicholas 10 9 23 13 55 Charlton 60 13 6 34 113 Kidbrooke Total 103 61 71 161 396 58 There were fourteen fatalities due to Diphtheria, which gives a case mortality of 3.5 per cent. Two thousand five hundred and twenty-nine specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 2,232 were reported to give negative or doubtful results, and 297 were positive in character, being dealt with accordingly. Measles.—As stated in previous Reports this disease was made permanently notifiable in Greenwich in 1920. The same procedure is adopted in dealing with epidemics as they arise. In view of the highly infectious nature of this disease and the serious complications which sometimes follow it is interesting to learn that recent advances in medicine have shown that the administration of serum from patients convalescent from Measles if injected before the fifth or sixth day of incubation will afford complete protection lasting from two to four weeks, and if injected on the sixth or ninth day of incubation the serum protects partially with the result that a very mild attack of Measles follows. During the past months this method of treatment has been tried in various London County Council Hospitals with promising results. One thousand one hundred and thirty-five cases were notified during the year as compared with 1,975 cases for the previous year. German Measles was unusually prevalent during the first two quarters and was responsible for 547 cases. The case mortality for the whole Borough works out at 0.17 per cent. as compared with 1.2 per cent. for the year 1932, and 2.4 per cent. for 1931. Influenza.—Although influenza is not a notifiable Infectious Disease, cases are reported by the Head Teachers of all London County Council Schools. During January and February, when Influenza became epidemic, intimations were received with regard to 1,452 children attending the various schools in the Borough. Erysipelas.—Eighty-three cases were notified during the year, 37 being in East Greenwich, 14 in West Greenwich, 7 in St. Nicholas and 25 in Charlton and Kidbrooke. Forty-one of these patients were removed to a Public Institution in the district. Scarlet Fever.—Six hundred and seventy-one cases were notified during the year, as compared with 527, 256 and 426 cases respectively in the years 1930, 1931 and 1932. Two hundred and 69 sixty-six cases were in East Greenwich, 216 in West Greenwich, 83 in St. Nicholas, and 106 in Charlton and Kidbrooke; 655 of these cases were removed to Hospital for treatment, 2 of which were returned as not suffering from this disease. There were 3 deaths from this disease during the year, compared with one last year and three the previous year. Of the 655 cases treated in Hospital, the following were certified to be suffering on discharge from Hospital with chronic disease:—Hoffman's Bacilli—no K.L.B., 4; Otorrhæa, 2; Rhinorrhæa, 2, and Tonsilitis, 1. There were no cases which could be described as " Return Cases." Typhoid Fever.—There were two cases of Typhoid or Enteric Fever notified during the year, one being in East Greenwich and one in Kidbrooke. The ages of the patients were:—one between 5 and 15 years and one between 25 and 45 years. One case was removed to Hospital for treatment. In the years 1928, 1929, 1930, 1931 and 1932 there were 12, five, seven, 12 and seven cases respectively. The average number for the previous ten years is nine. No case was traceable to the consumption of shell fish. There was no fatality from this disease. Ten specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be Typhoid Fever in character, nine giving a negative result and one being positive. Puerperal Fever.—Only one case of this disease was notified during the year, as compared with 2 last year. There were six cases in 1931, five in 1930, four in 1929, five in 1928, five in 1927, and nine in 1926. Puerperal Pyrexia.—Ten cases of this disease were notified during the year, as compared with 12 for the previous year. Four cases occurred in East Greenwich, three in West Greenwich and three in Charlton and Kidbrooke. Six cases were removed to Hospital for treatment. Zymotic Enteritis or Epidemic Diarrhæa.—Sixty-three cases of diarrhoea were notified throughout the whole of the Borough, 32 being under one year of age and 31 between one and five. Thirtysix of such notifications related to patients in East Greenwich, 4 in West Greenwich, 9 in St. Nicholas, and 14 in Charlton and Kidbrooke. 60 There were 17 deaths ascribed to Diarrhæa and Enteritis. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever, or Post-Basal Meningitis.—There were eight cases of this disease notified during the year. The distribution of these cases were one in East Greenwich, three in West Greenwich, one in St. Nicholas, and three in Charlton and Kidbrooke. All were removed to Hospital for treatment. Acute Polio-Myelitis.—Only one case was notified during the year, as compared with three in 1932, two in 1931, one case in 1930, seven cases in 1929, and one case in 1928. Ophthalmia Neonatorum.—During the year 18 cases of this disease have been notified, compared with 24 for the previous year, four being in East Greenwich, seven in West Greenwich, and seven in Charlton and Kidbrooke. Further particulars of this disease will be found on page 83. Malaria.—There was one case of Malaria notified during the year, as compared with one last year, none in 1931 and 1930, one in 1929, and one in 1928. Encephalitis Lethargica.—There were no cases notified in the Borough. Glanders.—No case of Glanders has occurred within the Borough. Anthrax and Hydrophobia.—No notification of any case of these diseases in man has been received during the year. DISINFECTION OF PREMISES. The disinfection of rooms from which patients suffering from notifiable infectious diseases have been removed is carried out by means of the formaldehyde spray. For other than notifiable conditions disinfection is carried out on request, and a charge made according to the circumstances of the case. Bedding and wearing material are removed to the Disinfecting Station, Tunnel Avenue, and are there submitted to steam disinfection. Books are now treated with Formalin. The following returns show in detail the amount of work performed during the year by the Disinfecting Staff :— 61 Rooms and Articles Disinfected, Year 1933. Diseases, etc. Premises Entered Rooms Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Diphtheria 353 437 234 - 123 171 606 711 457 48 440 1,355 4,145 Scarlet Fever 614 771 382 1 243 317 1,015 1,200 799 97 774 2,470 7,298 Tuberculosis 82 115 8 - 12 8 24 10 3 4 10 40 125 Cancer 22 17 8 - 12 14 41 21 2 11 9 54 172 Scabies 11 11 16 - 6 11 16 42 17 - 23 124 255 Verminous Premises 36 28 46 2 44 15 31 56 3 - 8 1 206 Cerebro-Spinal Fever 4 6 3 — 2 3 12 12 9 - 6 15 62 Puerperal Fever 5 5 1 — 5 4 15 9 5 1 3 5 48 Para Typhoid 2 2 1 — — 1 2 3 — — 1 3 11 Chickenpox 5 11 1 — — — 3 — 6 — — 10 20 Erysipelas 8 11 1 — 4 4 7 7 1 5 1 — 30 Measles 6 8 — — 1 — 2 2 — — — 21 26 Whooping Cough 2 4 1 — 1 1 3 3 2 2 2 4 19 Pneumonia 1 2 — — 4 2 7 — 4 4 — — 21 Influenza 5 31 1 — — — — — — — — — 1 Other Diseases 62 59 18 1 309 18 136 496 7 12 12 232 1,241 Total 1,218 1,518 721 4 766 569 1,920 2,572 1,315 184 1,289 4,340 13,680 62 Articles Destroyed, Year 1933. Diseases, etc. Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Destroyed Diphtheria 2 — 4 3 — — 1 6 16 Scarlet Fever 1 — 4 — 4 — — — — 2 11 Cancer 5 3 0 4 14 4 3 6 1 51 100 Tuberculosis 5 2 4 2 6 — — 2 3 — 24 Scabies — — — — — — — — — 3 3 Verminous Premises 8 6 55 4 11 6 6 — 7 475 578 Other Diseases 6 — 13 4 4 3 2 3 5 30 70 Total 27 11 89 17 39 13 11 11 17 567 802 63 Supplemental Vaccination Return for 1932. Return made on or before the 9th of February, 1934, by Mr. E. S. Elliott, Vaccination Officer of the several Districts of the Borough of Greenwich, respecting the vaccination of children whose births were registered in his District from 1st January to 31st December, 1932, inclusive :— Registration SubDistricts comprised in the Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1932. Number of these Births duly entered by 31st Jan., 1934. No. of Births which on 31st Jan., 1934, remained unentered in the Vaccination Register on account of— No. of these births remaining on 3lst Jan., 1934, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1933 No. or Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1933. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Certificates of Conscientious objection received. Dead, Unvaccinated. Postponement by Medical Certificate Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. East Greenwich 897 414 4 — 267 55 10 10 52 85 — — *West Greenwich 314 144 2 — 104 16 3 1 19 25 — — Charlton and Kidbrooke 650 346 4 — 236 17 4 18 12 13 — — Total 1,861 904 10 — 607 88 17 29 83 123 939 516 *Includes St. Nicholas District. Dated 6th February, 1934. E. S. Elliott, Vaccination Officer. 64 HOUSES VISITED AND ENQUIRIES MADE IN CONNECTION WITH INFECTIOUS DISEASE. Number of Houses Visited and Inquiries made by Infectious Disease Inspector 1,326 Number of Re-visits 2,450 The Health Visitors also visited 1,758 cases, and re-visited when required. The following books belonging to the Libraries, etc., were destroyed in consequence of Infectious Disease:— Central Library(Woolwich Road) 82 Branch Library(West Greenwich) 85 Branch Library(Charlton) 208 Total 275 CLEANSING STATION, BLACKWALL LANE. The cleansing of persons and the disinfection of clothing, etc., In a verminous state are carried out by the Disinfecting staff. The arrangements made with the London County Council for the cleansing of verminous school-children continue in operation. Health Propaganda.—The arrangements made with the Proprietors of "Better Health," whereby they supply us with 2,000 copies of their journal each month, continue to be in force. Copies are distributed to all members of the Greenwich Borough Council, local medical men, midwives, dentists, head-masters and head-mistresses of the various schools, boy scout organisations, to large firms for the issue to their employees, and also, of course, there are copies available at the various Welfare Centres and Tuberculosis Dispensary. Health Week.—As a means of focussing attention on health matters generally, the usual Tea and Entertainment was provided for the mothers and children attending the Welfare Centres. Through the courtesy of the British Social Hygiene Council a series of Lectures on Venereal Diseases, illustrated by Films, were given to crowded audiences. 65 REPORT OF THE TUBERCULOSIS OFFICER. During the last five months of the year, the work at the Dispensary was carried out by a Locum Tenens, but although this caused a slight temporary disorganisation of the normal routine there has been nothing to call for special comment, and the year on the whole was very quiet as far as the Tuberculosis Department was concerned. The Notifications and Deaths, are as follow:— Notifications. Deaths. Pulmonary NonPulmonary Total Pulmonary NonPulmonary Total 114 28 142 94 12 106 and the averages for the previous ten years : — 161 44 98 16 These figures give an Incidence Rate for all forms of the disease of 1.45 per 1,000 of the population(1.16 pulmonary and .28 non- pulmonary). The Death Notification Interval of 73 patients who died of Pulmonary Tuberculosis in 1933 is shown below:— Information from Death Returns 4 Died within One Month of Notification 3 Died within Three Months of Notification 3 Died within Six Months of Notification 8 Died over Six Months of Notification 55 Deaths.—During the year 106 persons died from Tuberculosis (all forms), giving a Death Rate of 1.08 per 1,000 population; 94 were due to the pulmonary form(equal to a rate of .93 per 1,000). Notifications and deaths from Pulmonary Tuberculosis, with the Incidence and Death Rates for the previous five years, are recorded below:— Year. Notifications Incidence per 1,000 Deaths Death Rate per 1,000 1928 160 1.54 108 1.03 1929 152 1.46 108 1.04 1930 124 1.19 100 .96 1931 124 1.24 96 .96 1932 101 1.0 76 .75 66 Non-Pulmonary Tuberculosis.—The 28 (corrected) nonpulmonary notifications included:— 2 cases of Tuberculosis of Peripheral Glands. 11 „ „ Bones and Joints. 1 „ ,, Abdomen. 14 „ „ Other Organs. Deaths from Non-Pulmonary Tuberculosis, of which there were 12, included 2 of Bones and Joints; 1 of Abdominal Tuberculosis; 7 of Meningitis; and 2 of other organs. The Public Health(Prevention of Tuberculosis) Regulations, 1925.—These Regulations give power to a Local Authority to prevent patients suffering from Tuberculosis in an infective stage from handling milk under conditions which might give rise to the danger of the spread of infection through the medium of milk. During the year no case arose which required the attention of the Council. Artificial Sunlight Clinic(Tuberculosis Section). At the close of 1932 there were 37 patients under treatment; during the year 75 new cases were sent from the Dispensary, making a total of 112. Discharges numbered 79, leaving 24 under treatment on 31st December, 1933. Of the new cases, 50 were under 15 years of age and 25 over that age. These new cases were classified as follow:— Pre-Tubercular Debility 19 Bronchial Asthma 11 T.B. Laryngitis 9 Laryngitis 2 Bronchial Catarrh 9 T.B. Adenitis 6 Fibrosis 4 Debility following Whooping Cough 2 T.B. Joints 4 Other Conditions 9 75 The treatments numbered 2,406 and as usual all the patients were kept under strict clinical supervision, being examined every month at the Dispensary and seen weekly at the Sunlight Centre. 67 Without exception, all the cases improved, some more than others. The treatment of Asthma patients by Ultra Violet" inhalation" continues to prove satisfactory, and the experiment last year of giving the same treatment to cases of T.B. Laryngitis was so successful that it has been again put into operation. Occupation.—There are no industries in the Borough which have any special bearing upon the Incidence of Tuberculosis. Housing.—In spite of the many new houses erected under the Council's Housing Scheme, much overcrowding still exists, the worst examples of which are referred to the Public Health Committee for consideration and preference in the allocating of new houses. The sleeping arrangements continue to be a very serious difficulty in the problem of preventing infection in tuberculous households. Thus, of 156 patients suffering from Pulmonary Tuberculosis, 90 were sharing beds. 29 had separate beds but not separate rooms. 37 had separate rooms and separate beds. Through the efforts of the nurses, improvements were effected in some instances, e.g., 12 patients who were sharing beds have now separate beds and 12 patients sharing a room managed to secure a separate apartment. Apart from overcrowding, many sanitary defects have been reported to and dealt with by the Public Health Department. The 7 Shelters are in constant use and, as before, bedsteads and bedding have been lent or supplied by the Council and other Agencies. At the close of 1933 the estimated number of persons suffering from Tuberculosis and residing in the Borough was as follows:— Men Women Children Total Pulmonary 249 192 86 527 Non-Pulmonarv 32 42 116 190 giving a total of 717 as compared with 790 in 1932. Dealing with the Dispensary itself, 443 new patients(including 15 transfers) were examined during the year. The sources from which these patients came were as under:— Doctors 101 Hospitals 45 School Medical Service 9 Own Application 82 Nurses 206 68 Contacts.—Much of the time of the Staff is spent endeavouring to secure the examination of every contact, and this year, out of a total of 392 contacts, 159 were examined, of whom 10 were found tuberculous. The work of the Dispensary is shown on pages 71 to 76 in the Statistical Tables, specially designed by the Ministry of Health. Residential Treatment.—During the year 240 recommendations were made to the County Council (including the Public Assistance Committee) for Hospital or Sanatorium treatment. The average duration of residence in Sanatorium was a little over four months. The Open-Air School at Charlton Park continues to do excellent work for the children recommended from the Dispensary, of whom about 52 are in attendance. X-Ray Examinations.—The arrangements made last year for the X-Ray examinations to be carried out at the Seamen's Hospital still continue and during the year 165 X-Ray examinations were made: in 35 patients definite evidence of Tuberculosis was found; in 11 the evidence was doubtful, and the remainder proved negative. It should be added that 9 of the above examinations were made to note progress. Sputum examinations at the Seamen's Hospital numbered 358, of which 69 were positive. These examinations are, of course, exclusive of those carried out on behalf of the Medical men practising in the Borough. In closing this section of the Report I have again the pleasure of recording that the relations with all the other Authorities dealing with Tuberculosis (e.g., the Public Assistance Committee, the Ministry of Pensions, the British Red Cross Society, the School Medical Service, the Hospital Authorities, and last, but not least, the General Practitioners practising in the Borough) have been cordial and the co-operation well maintained. The Public Health Committee continues to act as the Care Committee, as far as assessments are concerned, the remainder of the care work, e.g., the preparation of reports, enquiries, the finding of help for needy patients, etc., has fallen upon the Dispensary Staff, assisted by a voluntary worker, Miss D. Cornish, to whom the Committee are indebted for much willing help. As before, several good friends have come forward with gifts of clothing, bed and bedding, but it is becoming increasingly difficult each year to obtain help from such sources, and many of the more 69 necessitous patients have had to be referred to the local Public Assistance Committee. This Committee has given sympathetic consideration to every such case. Handicraft Class. This Class, under the able leadership of Miss Forth, teacher, and Miss Annis, "Business Manager," continues to flourish. Several of the patients have now become expert in various kinds of handicraft work. Some difficulty is found in inducing new patients to take part in this Class, but the numbers remain fairly constant. Thanks to the Members of the Handicraft Centre Aid Society, the finances are in a very satisfactory condition, so much so that the Society were able to afford an outing in the summer and a Christmas party for patients and their friends. A Balance Sheet is appended. 70 GREENWICH TUBERCULOSIS HANDICRAFT CENTRE. ACCOUNT. YEAR ENDED 31st DECEMBER, 1933. RECEIPTS. £ s. d. £ s. d. PAYMENTS. £ s. d. To Balance b/f. 133 0 9 By Materials 56 5 6 „ Donations :— „ Light, Heating and Insurance 4 10 4 Greenwich Industrial Exhibition 25 0 0 „ Maintenance 10 3 11 Alexandra Day Committee 20 0 0 „ Students' Awards 37 3 6 Charlton Stadium Co. Ltd. 2 2 0 „ Students'Fees 2 16 9 Robert Morley & Co. 10 6 „ Industrial Exhibition Expenses 12 6 0 Four Friends per J. Cowden 1 1 0 „ Students' Entertainment 7 18 2 Randall's Charity* 7 10 0 „ Do. Outing 3 19 1 50 3 6 „ Sundry Expenses 8 7 2 „ Dances (Handicraft Aid Society) 2 7 0 „ Furnishing 2 5 7 „ „ 5 9 9 „ Balance in hand 159 17 5 7 16 9 „ Sales:— Greenwich Industrial Exhibition 24 6 0 Imperial Institute 13 9 11 Exhibition (Charlton House) 4 14 6 Hut 53 7 4 95 17 9 „ Sundry Receipts 12 14 8 £305 13 5 £305 13 5 71 Return of work carried out in connection with the Maze Hill Tuberculosis Dispensary for the Year 1933. DIAGNOSIS. Pulmonary. Non-pulmonary. Total Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 52 32 - 2 5 6 3 3 57 38 3 5 103 (b) Diagnosis not completed - - - - - - - - 1 4 4 3 12 (c) Non-tuberculous - - - - - - - - 74 71 57 35 237 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 - - - - - - 1 1 - - 2 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 30 44 47 51 172 C.—Cases written off the Dispensary Register as:— (a) Recovered — 2 1 1 1 2 1 2 1 4 2 3 10 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 104 115 104 86 409 D.—Number of Cases on Dispensary Register on 31st December:— (a) Definitely tuberculous 223 189 59 32 32 30 67 37 255 219 126 69 669 (b) Diagnosis not completed - - - - - - - - 2 5 4 3 14 72 1. Number of persons on Dispensary Register on 1st January, 1933 673 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 17 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 38 4. Cases written off during the year as Dead (all causes) 76 5. Number of attendances at the Dispensary (including Contacts) 2,529 6. Number of Insured Persons under Domiciliary Treatment on 31st December 39 7. Number of consultations with medical practitioners:— (a) Personal 20 (b) Other 201 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 186 9. Number of visits by Nurses or Health Visitors to homes for Dispensary Purposes 3,020 10. Number of:— (а) Specimens of sputum, etc., examined 195 (b) X-ray examinations made 164 11. Number of "T.B. plus" cases on Dispensary Register on 31st December 242 TUBERCULOSIS. NEW CASES and MORTALITY—Year 1933. Age-Periods New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M F M F M F M F 0 - 1 2 - 1 2 1 - 1 — — — 1 — — — 1 5 — 1 5 4 — — 3 - 10 2 1 3 8 1 — — 1 15 8 9 2 3 3 5 2 - 20 9 10 — 3 4 4 — 1 25 15 17 — 3 22 7 2 1 35 17 7 2 — 4 9 — - 45 13 3 1 — 11 1 — 1 55 9 5 — — 7 3 — — 65 and upwards 2 2 — — 2 1 1 — Totals 75 56 15 22 55 32 9 5 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 65 to 69. 73 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all case written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuber-culosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 Class T.B. minusj 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) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M 15 2 2 1 5 2 1 2 2 F. 25 5 3 8 6 5 1 Children 23 16 7 Disease not Arrested Adults M. 10 10 6 3 19 4 1 3 4 4 2 6 8 5 3 4 7 9 9 9 18 F. 12 5 4 9 5 2 2 4 2 6 7 1 1 2 7 4 2 6 Children 5 6 3 11 7 Condition not ascertained during the year 2 1 1 Total on Dispensary Register at 31st December 92 23 15 4 42 39 1 5 6 20 8 8 16 24 4 5 9 23 13 11 24 (b) Not now on Dispensary Register and reasons for removal therefrom Discharged as Recovered Adults M. 59 8 3 11 F. 85 11 1 1 13 Children 176 1 1 1 Lost sight of, or otherwise removed from Dispensary Register 312 70 42 14 132 19 4 3 4 11 12 6 10 2 18 9 5 8 13 12 10 4 2 16 Dead Adults M. 90 26 118 151 295 5 6 16 13 35 1 9 9 13 31 2 6 14 15 35 2 11 15 6 32 F. 54 35 71 104 210 3 1 3 5 9 3 4 9 5 18 6 3 8 7 18 5 6 4 5 15 Children 52 1 5 6 1 1 1 1 2 Total written off Dispensary Register 828 156 237 275 668 29 12 22 22 56 17 19 28 20 67 17 14 30 22 60 21 27 23 13 63 Grand Totals 920 179 252 279 710 68 13 27 22 62 37 27 36 20 83 41 18 35 22 75 44 40 34 13 87 74 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 1930 1931 1982 1933 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. -minusl 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 F. Children Disease not Arrested Adults M. 10 10 6 1 17 4 9 9 18 3 8 7 2 17 6 21 13 1 35 F. 6 9 4 1 14 9 10 2 1 13 8 8 1 9 8 13 6 2 21 Children 2 6 2 2 1 1 Condition not ascertained during the year Total on Dispensary Register at 31st December 18 19 10 2 31 19 19 11 1 31 13 16 8 2 26 16 35 19 3 57 (b) Not now on Dispensary Register and reasons for removal therefrom Discharged as Recovered Adults M. F. Children Lost sight of, or otherwise removed from Dispensary Register 4 10 3 13 3 7 5 4 16 2 6 2 1 9 1 2 2 Dead Adults M. 6 7 11 4 22 2 5 11 7 23 4 5 4 13 1 2 6 5 13 5 3 5 4 12 5 2 5 4 11 1 4 2 7 1 3 1 1 5 Children 3 2 2 Total written off Dispensary Register 18 20 19 8 47 l0 14 21 15 50 2 11 13 7 31 3 5 0 6 20 28 40 38 16 94 28 33 42 16 81 15 27 21 9 57 19 40 28 9 77 PULMONARY TUBERCULOSIS. -Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Disoensarv Register: and (b) the reasons for the removal of all cases written off the Register. 75 NON-PULMONARY TUBERCULOSIS.—Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Dispensary Register; and (b) the reasonso for removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 j Bones and Joints Abdominal Other Organs J Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 1 3 3 3 4 4 F. 2 3 5 1 1 2 2 Children 7 1 6 14 4 5 9 1 3 3 7 2 7 9 Disease not Arrested Adults M. 1 1 2 1 1 F. 1 1 1 1 2 1 1 2 1 2 3 Children 2 1 1 4 1 1 2 2 2 1 1 4 2 2 2 1 7 Condition not ascertained during the year 5 5 1 1 Total on Dispensary Register at 31st December 13 1 2 15 31 9 1 5 15 8 4 3 15 6 2 1 8 17 4 2 5 3 14 Transferred to Pulmonary 2 1 6 9 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 9 5 14 F. 8 1 1 9 19 Children 31 13 7 452 503 1 1 Lost sight of, or otherwise removed from Dispensary Register 23 3 5 121 152 2 3 2 7 5 2 2 9 2 1 1 2 6 1 1 3 3 8 Dead Adults M. 11 2 13 1 1 1 3 1 1 2 1 1 F. 4 4 3 11 1 1 Children 5 4 8 13 30 1 1 2 Total written off Dispensary Register 91 21 25 605 742 3 1 4 4 12 6 1 2 2 11 3 1 1 3 8 2 1 3 3 9 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 104 22 27 620 773 12 1 5 9 27 14 5 2 5 26 9 3 2 11 25 6 3 8 6 23 76 NON-PULMONARY TUBERCULOSIS.—Supplementary Annual Return showing in summary form (a)the condition at the end of 1933 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 1930 1931 1932 1933 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 j Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M F. Children Disease not Arrested Adults M. 1 1 2 5 1 1 7 4 1 1 6 3 1 4 F. 1 3 4 1 2 1 4 2 1 3 3 1 2 6 Children 5 3 7 15 8 2 5 15 5 2 7 5 1 1 7 Condition not ascertained during the year. Total on Dispensary Register at 31st December. 7 3 4 7 21 14 2 3 7 26 11 1 4 16 11 2 2 2 17 Transferred to Pulmonary 1 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. F. Children Lost sight of, or otherwise removed from Dispensary Register 2 2 4 1 2 3 6 Dead Adults M. 1 1 2 1 1 2 1 3 1 1 F. Children 1 1 1 1 1 3 1 1 Total written off Dispensary Register 3 1 3 7 2 1 4 3 10 2 1 1 4 1 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 10 4 4 10 28 16 3 7 10 36 13 2 1 4 20 12 2 2 2 18 77 Mr. G. F. Ferris, the Council's Dentist, reports hereunder the work carried out in connection with patients referred to him by the Tuberculosis Officer:— Number of Sessions 26 Number of Patients 33 Number of Attendances 104 Dentures Supplied 6 Fillings and Scalings 9 Local Anæsthetic Extractions 28 Gas Extractions 7 Ordinary Extractions - Advice Given 27 Referred 34 X-Ray 4 78 SECTION G. MATERNITY AND CHILD WELFARE. Following the suggestion of the Ministry a whole time Junior Assistant Medical Officer was appointed and took up duty in October, the services of three part-time Medical Officers being dispensed with. The staff engaged in Maternity and Child Welfare work now consists of two whole-time Medical Officers, two part-time Medical Officers, seven Health Visitors, one Clerk, one Milk Saleswoman, also two part-time Sessional Clerks. In addition to the above, assistance is rendered on two afternoons per week by two members of the Office staff. Infant Welfare Consultations.—These consultations are held each afternoon as set out hereunder, and there has been no change in any particular from that described last year. Borough Hall, Royal Hill Monday, Tuesday and Thursday Chevening Road Wednesday and Friday 105, Shooter's Hill Road Tuesday and Friday Armada Street, Deptford Thursday Charlton Vale Wesleyan School Room, Woolwich Road Wednesday Morning sessions are also held on Wednesdays at Chevening Road and Charlton Vale. The following table shows at a glance the work undertaken at the various Infant Consultation Centres during the year:— Borough Hall Chevening Road 105, Shooter's Hill Rd. Armada Street Charlton Vale Total Attendances 14,257 13,355 10,056 4,295 6,362 48,325 New Cases 412 360 274 129 125 1,300 Medical Consultations 4,936 3,998 3,398 1,811 2,527 16,670 Nursing Mothers seen by Doctors 1,420 1,341 1,249 505 626 5,141 All babies are weighed and advice given to the mothers at every attendance. Ante-Natal Clinics.—These are held as follows:— Borough Hall, Royal Hill Tuesday, 10 a.m., Wednesday, 2 p.m. 79 Chevening Road Monday, 2 p.m. 105, Shooter's Hill Road Friday, 10 a.m. and 2 p.m. Charlton Vale Mission Hall, Woolwich Road Wednesday, 10 a.m. Armada Street Mission Hall, Deptford First and Third Thursdays in each month, 10 a.m. The number of new cases together with total attendances for the year were as follows:— No. Clinics New Cases Total Attendances. Borough Hall 102 262 1,353 Conduit House and Chevening Road 49 127 670 105, Shooter's Hill Road 104 205 1,411 Charlton Vale 51 29 141 Armada Street 24 60 223 330 683 3,798 The following tables show (a) the number of visits made by the Health Visitors during the year in connection with Births and cases of Infectious Diseases, and (b) number of Infant Consultations and Ante-Natal Clinics attended and miscellaneous visits:— Health Visitors' Visits, &c., 1933. Table A. Visits Re-Visits Total Infants under 1 year 1,431 3,542 4,973 Children 1—5 years 385 4,752 5,137 Measles 1,059 106 1,165 Whooping Cough 617 111 728 Pneumonia 16 15 31 Puerperal Pyrexia 6 4 10 Diarrhœa 36 28 64 Ophthalmia Neonatorum 24 28 52 3,574 8,586 12,160 Table B. Dental Treatment 55 7 62 Milk Scheme 185 20 205 Ante-Natal Cases 608 60 668 Infant Consultations Attended — — 1,059 Ante-Natal Clinics Attended - - 324 Children Act 81 40 121 Miscellaneous 392 2 394 In addition to the above, 1,230 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. 80 Infantile Mortality. The total number of deaths under one year of age was 89, as compared with 119 for the previous year. The Infantile Mortality Rate is thus equal to 66 per 1,000 Births. The rate for the previous year was 80, and the average for the last 10 years, 61. The Infantile Mortality Rate for the County of London is 59 and that for the 118 large towns 67. Of the total of 89 deaths, 37 died before attaining the age of one month (31 being in the first week). The chief causes of death were:— Premature Birth 21 Diarrhœa and Enteritis 13 Bronchitis and Pneumonia 11 Atrophy, Debility and Marasmus 9 Congenital Malformations 9 Atelectasis 5 Tuberculosis (all forms) 5 Whooping Cough 4 Other causes 12 89 Of the above number, 50 were boys and 39 girls. Deaths of Children 1 to 5 years of age. The number of deaths of children between the ages of one and two years was 17, and between two and five years 20. The previous year the figures were 29 and 27 respectively. Notification of Births Acts (1907 and 1915.) All live births and all still births after 28th week of pregnancy must be notified within 36 hours. Early knowledge enables the Health Visitors to begin early visiting. Still-births must be certified either by the Doctor or by the Midwife or by declaration on a prescribed form, if no doctor or midwife was present. In these latter cases the Minister of Health requires the Medical Officer of Health to submit a special report in order that he may be satisfied that the child was really stillborn. 81 The following Table gives the number and character of the intimations received respecting births in the Borough:— 1926 1927 1928 1929 1930 1931 1932 1933 Total Number of Births notified in each year 2,096 1,995 2,063 2,115 2,004 1,913 1,94 1,705 (a) Attended by Midwives 1,660 1,592 1,727 1,812 1,712 1,633 1,699 1,490 (b) Attended by Doctors 436 403 336 303 292 280 250 215 Numbers of Still Births notified each year 49 82 71 50 42 40 65 39 Number of Births registered in each year 2,027 1,912 1,939 2,042 1,951 1,838 1,862 1,652 Milk, &c., Scheme. The Council has continued to supply milk, etc., to necessitous cases, each case being investigated especially as to its financial condition before a supply is granted. The milk may be granted free or at a reduced cost to:— (a) Nursing Mothers; (b) Expectant Mothers in the last 3 months of pregnancy; (c) Children up to 3 years of age. In addition dinners may also be given to nursing and expectant mothers where the family income falls within the Council's scale. It is a condition that these dinners must not be taken home, but must be consumed by the mother herself on the premises. Particulars of the amount of milk, etc., distributed will be found in the following tables. The approximate cost to the Council under this heading during the year was £6,500. The distribution of this nourishment has without doubt contributed very largely to the improved condition of the children generally. It has also been the means of keeping the mothers and children in close contact with the Welfare Centres. The same procedure has been adopted with regard to the distribution as in previous years. 82 (a) Milk, Virol, &c. Distributed Free. Quarter ended Milk Virol Robeleine Malt & Oil Cod Liver Oil lbs. lbs. lbs. lbs. Bottles March, 1933 18,548 383½ 397 3,747 111 June „ 18,983 402½ 341 3,076 124 Sept. „ 17,214 348½ 189½ 1,621 132 Dec. „ 17,341 564 177 2,617 150 Totals 72,086 1,698½ 1,104½ 11,061 517 (b) Milk, Virol, &c.. Sold at Full or Reduced Prices. Quarter ended Milk Virol Roboleine Malt & Oil Cod Liver Oil Total Amount Received lbs. lbs. lbs. lbs. Bottles £ s. d. March, 1933 4,217 104 134½ 273 103 318 13 7 June „ 4,184 69½ 64½ 106 57 294 12 0 Sept. „ 4,525 66½ 57 93 71 311 3 4 Dec. „ 4,913 98 116½ 259 120 352 11 1 Totals 17,839 338 372½ 731 351 £1,277 0 0 83 Convalescent Home Treatment.—The arrangements for the provision of Convalescent Home Treatment continue as before, the mothers and children being recommended by the Medical Officers of the various Centres and after investigation by the Committee are referred to the I.C.A.A. or to the Public Assistance Committee according to circumstances. During the year 48 children were sent away for periods varying from four weeks to three months, also 12 mothers with their babies were provided with a month's convalescence at Littlestone-on-Sea. Sterilised Maternity Outfits.—The same arrangements as last year hold good and during the year 12 outfits were sold and 55 were given away. Ophthalmia Neonatorum.—This is a preventable disease, and even when it occurs its serious effects can be avoided by prompt treatment. Immediately on receipt of a notification the case is visited by the Health Visitor who continues to visit frequently to ensure that the child receives proper treatment. If necessary arrangements are made for the District Nurse to carry out the treatment, or if the condition is severe, mother and child are removed to St. Margaret's Hospital, Hampstead, a special Institution set apart by the London County Council for the treatment of this disease. Eighteen cases were notified and cured without impairment of sight, with the exception of one case who subsequently died from Pneumonia. Of the 18 cases 14 were treated at home and four were removed to Hospital. In addition to notified cases of Ophthalmia Neonatorum 12 babies with slight discharge from the eyes were referred by the London County Council to the Public Health Department for supervision. Minor Ailments.—The arrangements with St. John's Hospital for the treatment of minor ailments continues and during the year 120 cases were referred chiefly on account of tonsils and adenoids, circumcision, etc. Home Nursing.—Children attending the various Centres who are found to be in such a condition as to require special nursing at home are referred to the various Nursing Associations operating in the Borough, the Council paying If. per visit to the Queen's Nursing Association and £50 per annum to the Ranyard Mission. Other Health Activities.—The following continue their good work in the Borough:— Local Medical Practitioners' School Clinic. I he Health Centre, Deptford Green. Rachael McMillan Memorial Nursery School. Charlton Park Open Air School. 84 Maternal Mortality.—The total number of deaths due to complications of pregnancy or childbirth was four, one being due to sepsis and the remaining due to other causes. All died in public institutions. The average age of death was 37. The Maternal Mortality Rate for 1933 was 2.9 per 1,000 births which compares favourably with 2.7, the figure for the previous year. Formerly every case of maternal death was investigated by the Health Visitors but now this duty is placed upon the Junior Assistant Maternity and Child Welfare Medical Officer who can better approach general practitioners and obtain any necessary information. Particulars are obtained from the doctor who attended the patient at the time of her death whether at home or in the hospital. If the detailed report required by the Ministry of Health is still incomplete, especially in respect of home circumstances, etc., this is obtained by the Health Visitor. Puerperal Fever and Puerperal Pyrexia Regulations, 1926.All reported cases are carefully investigated and the arrangements made by the Council whereby the local general practitioners may obtain the services of obstetric consultants through the Medical Officer of Health, are still in force. A report is sent to the Medical Officer of Health by the Consultant following his examination of the patient and every endeavour is made to assist the Doctor to carry out the advice of the specialist. If necessary, patient and baby can be admitted immediately to Hospital for treatment. Only one case of Puerperal Fever was notified; such case was seen by the Council's Consultant and subsequently removed to hospital for treatment. Ten cases of Puerperal Pyrexia were notified, four occurring in East Greenwich, three in West Greenwich and three in Charlton and Kidbrooke. Of the total number of notifications under these Regulations, five came from institutions and nursing homes and six from private practitioners. Health Week, etc.—The usual teas and entertainment given to the mothers and children attending the Welfare Centres were continued. Lectures and talks were given by various members of the staff. During the winter months a series of visits by the senior girls on the point of leaving Elementary Schools in the Borough was carried out at several Centres. The scholars were accompanied by a teacher, and all evinced much interest in every detail of the work shown and explained to them. 85 Maternity Home. The number of patients admitted during the year was 315. Several cases were refused because the Home was fully booked up for the period desired. All applicants for admission must attend the Ante-natal Clinic. No case was refused on medical grounds. Of the 315 patients, 68 were admitted to the Home for several days ante-natal treatment. The number of cases delivered by the midwives of the Home was 301, the remainder by Doctors. In 70 instances medical assistance was sought by the midwives. There were 12 instrumental deliveries and four surgical inductions. Only one case (of low grade sepsis) was notified under the Puerperal Fever and Pyrexia Regulations. The case was removed to hospital and made a good recovery. Twentythree infants were not entirely breast fed whilst in the Home. No cases of Ophthalmia Neonatorum occurred in the Home. The number of infant deaths within 10 days of birth was five, the causes being attributed to— Spina bifida 1 Twins (premature) 2 Prematurity 2 There were 12 still births, the causes being due to— Anencephalic 3 Macerated fœtus 5 Diabetes of mother 1 Cerebral hæmorrhage 2 Twin (1st) 1 There were no maternal deaths in the Home and the Council's Gynaecologist was not called upon during the year. The Home is a recognised Training Institute for pupil Midwives and towards the end of the year the scheme of training was revised and extended. The present course of Instruction may be briefly summarised as under. General Trained Nurses. 1 month's district training. 5 months in the Home as a pupil for C.M.B. examination. 6 months as staff midwife. 6 attendances at Ante-natal Clinic (Greenwich Borough Council). 6 attendances at the Infant Welfare Centre (Greenwich Borough Council.) 1 attendance at the Ophthalmic Hospital (St. Margaret's). 3 attendances at the V.D. Centre (St. John's Hospital). 80 Untrained Pupils. 11 months in the Home as pupil for the C.M.B. examination. 1 month district training. 12 attendances at the Ante-natal Clinic (Greenwich Borough Council). 12 attendances at Infant Welfare Centre (Greenwich Borough Council). 2 attendances at the Ophthalmic Hospital (St. Margaret's). 3—6 attendances at the V.D. Centres (St. John's Hospital). As alluded to in last year's Report, No. 80, Shooters Hill Road, adjoining the Home, has been purchased and altered to provide on the ground floor two isolation wards for patients and on the upper floors improved sleeping accommodation for the domestic staff. The two houses have been connected by a covered passage, and it is hoped that the premises will be ready for occupation early in the new year. Children Acts, 1908 and 1932. The duties under these Acts were transferred by the London County Council to the Borough Council on 1st April, 1933. Under Part 1 of the 1908 Act the supervision of Foster-children and of the homes of foster-mothers is carried out by the Health Visitors. Applications for registration as a Foster-mother under the Act is sanctioned by the Borough Council on the recommendation of the Public Health Maternity and Child Welfare Committee. On receipt of an application for registration, the necessary enquiries are made, the result of which is reported to the Committee. In every case where a report is received the Tuberculosis Register is investigated to ascertain if the Foster-mother and her family are free from Tuberculosis. The Foster-mother is informed that if registered she must comply with all the rules under the Act and of the Council including the provision of separate sleeping accommodation for the child. She must also attend the Infant Welfare Centre where the child is under school age. Registered Foster-mothers are visited in their homes every 2 or 3 months. The following particulars are taken from the Register:— Number of Foster-mothers on Register at end of 1933 23 Number of Applicants refused — Number of Foster-children 26 Number of Foster-children who died during the year - Number of cases legal proceedings taken - 87 Dental Clinic.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S. (Eng.), attends at the Dispensary, Maze Hill, Greenwich, once a fortnight to deal with cases referred to him by the Medical Officers of the Welfare Centres and Clinics. The following Return shows the work performed during the year in detail:— Number of Sessions 26 Number of Patients 207 Number of Attendances 693 Local Anæsthetic Extractions 255 Gas Extractions 97 Advice given 80 Dentures and Repairs 36 Fillings and Scalings 18 X-Ray 2 Referred to Hospital re Gas:— Children 30 ARTIFICIAL SUNLIGHT TREATMENT. The work at the three Centres has been conducted on similar lines to previous years. Cases referred by doctors at the various Welfare Centres continue to show a definite improvement. The number of patients treated at each Centre is given in the following table:— BOROUGH HALL CENTRE. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 111 32 27 170 Number of New Patients 283 75 61 419 Discharges 258 65 55 258 Number under treatment at end of 1933 136 42 33 211 Number of treatments given 5,368 1,071 1,103 7,542 88 SHOOTERS HILL ROAD CENTRE. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 75 - 3 78 Number of New Patients 140 1 29 170 Discharges 156 1 26 183 Number under treatment at end of 1933 59 — 6 65 Number of treatments given 3,062 9 517 3,588 CHEVENING ROAD CENTRE. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 70 1 13 84 Number of New Patients 285 — 51 336 Discharges 281 — 53 135 Number under treatment at end of 1933 74 — 11 85 Number of treatments given 4,322 — 676 4,998 In addition to the treatment of mothers and children coming under the Maternity and Child Welfare Scheme, facilities are available during the winter months on two evenings a week for paying patients. The fees charged are 12s. for six treatments or 20s. for 12 treatments. During the year 34 patients were given 464 treatments, the fees received totalling £39 12s. 6d. 89 Index of Contents, A. Page Adoptive Acts, By-laws and Local Regulations 6-9 Age Mortality 18 Agricultural Products (Grading and Marking) Act, 1928 51 Ambulance Facilities 23 Ante-Natal Clinics 78, 79 Anthrax 60 Area of Borough 12 Articles and Rooms Disinfected 61 Articles Destroyed 62 Artificial Cream Act, 1929 50 Artificial Sunlight Treatment 66, 67, 87, 88 B. Baby Week Celebrations 64 Bacteriological Examinations 48 Bakehouses 50 "Better Health" 64 Births 15, 16 Books Destroyed 64 C. Cancer 22, 24 Cerebro-Spinal Fever 60 Cleansing Children 36, 64 Clearance Areas 38, 39 Clinics and Centres 24, 78, 79 Complaints 26 Consumption 21 Contacts 56 Convalescent Treatment 83 Cowhouses 47 D. Dairies, Cowsheds and Milkshops 47 Deaths, Tables showing Causes of and Ages at 16 & Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality 16-19 Density of Population 12 Dental Work 77, 87 Diarrhœa and Zymotic Enteritis 21, 59 Diphtheria 21, 57 Diphtheria Anti-Toxin 57 Disinfection 60-62 Drainage Work 29 Duties and Powers of the Public Health, Maternity and Child Welfare Committee 6-9 90 INDEX—continued. Page e. Elevation of Borough 12 Encephalitis Lethargica 60 Enteritis 21, 59 Epidemic Cerebro-Spinal Meningitis 60 Epidemic Diseases 20 Erysipelas 58 Extracts from Vital Statistics 14 f. Factories and Workshops 26-29 Food and Drugs—Samples of 50, 51-54 Food Poisoning—Notification of 54 Food—Premises for Preparation of, etc. 49 Food—Inspection of 43 g. Glanders 60 General Statistics 12, 14 h. Handicraft Centre 6 , 70 Health Centres 78, 79 Health Propaganda 64, 84 Health Visitors, Visits, etc. 79 Heart Diseases 22 Home Nursing 24, 83 Horse Slaughterer 32 Hospital Accommodation 24 House Drainage 29 Houses Inspected re Infectious Diseases 64 Houses Let in Lodgings 30 Housing 38-42 Hydrophobia 60 i. Ice-Cream Premises 50 Imported Food Surrendered 47 Increase of Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923 40 Infant Consultations 78 Infantile Mortality 19, 80 Influenza 21, 58 Inhabited Houses 12 Insanitary Areas 38 Institution Deaths 18 Introductory Review 10,11 91 INDEX—continued. Page m. Malaria 60 Marriages 14 Maternal Mortality 84 Maternity and Child Welfare 78-88 Maternity Home 25, 85 Maternity Outfits 83 Measles 20, 58 Meat 43 Merchandise Marks Acts, 1926 51 Milk, Analysis of 48 Milk and Dairies (Amendment) Act, 1922 47 Milk and Dairies (Order), 1926 47 Milk Supply 47 Milk Supply for Expectant and Nursing Mothers 81 Milk (Special Designations) Order, 1923 48 Miller General Hospital 83 Minor Ailments 83 Mortuary 22 n. Notices, etc. 35 Notifications 56, 60 Notification of Births Act 80 Notification of Food Poisoning 54 Nursing Arrangements 24 O. Oflensive Trades 35 Open-Air School 68, 83 Ophthalmia Neonatorum 60, 83 Outworkers' Register 26 Overcrowding 36, 40 P. Persons Cleansed 36 Polio-myelitis 60 Population 12-14 Preserved Food Premises 49 Public Health (Imported Food) Regulations, 1925 45-47 Public Health (Meat) Regulations, 1924 43, 44 Public Health (Preservatives, etc., in Food) Regulations 50 Public Health (Prevention of Tuberculosis) Regulations, 1925 66 Public Health, Maternity and Child Welfare Committee 6-9 Public Sanitary Conveniences 30 Puerperal Fever, etc. 59, 84 r. Rag Flock Acts 31 Rateable Value 12 Rats and Mice (Destruction) Act, 1919 30 Remarks on Death Causes 20-22 Rent and Mortgage, &c., Acts 40 92 INDEX—continued. Page s. St. Alfege's Hospital 25 Sanitary Work—Summaries, etc. 32-35 Scarlet Fever 20, 58 Scavenging and Refuse Removal 31 School Clinic 83 Slaughterhouses 44 Smallpox 20, 56 Smoke Nuisances 29 Social Conditions 13 Staff of Public Health Department 4, 5, 23 Statistical Tables Appendix Street Traders 49 Swimming Baths 30 t. Tuberculosis 21, 65, 72 Tuberculosis Care Committee 68 Tuberculosis Dispensary—Returns 71-72 Tuberculosis Officer's Report 65-69 Tumour Diagnostic Clinic 24 Typhoid Fever 21, 59 u. Underground Bakehouses 29 Underground Rooms 36 Uninhabited Houses 12 Unwholesome Food 43 v. Vaccination 63 Verminous Children 36, 64 Verminous Premises 31 Virol 82 Vital Statistics 13-22 w. Water Supply 31 Whooping Cough 21, 56 Workshops and Factories 26-29 x. X-Ray Examinations 68 z. Zymotic Diseases 20 Zymotic Enteritis 21, 59