c.i. AC 4373 M. GRE 34 Metropolitan Borough of Greenwich. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 LONDON Freame, Manning & Co., Ltd. 12a, Lee High Road, Lewisham, S.E.13 Deaths at Subjoined ages of " Residents," whether oocurring within or without the District. Causes of Death Sex 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 572 40 3 13 15 27 35 29 58 98 133 121 F 519 27 8 5 8 13 19 18 46 87 108 180 Typhoid and Paratyphoid Fevers M 1 ... ... ... ... ... ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Measles M 4 1 1 1 1 ... ... ... ... ... ... ... F 2 ... ... 2 ... ... ... ... ... ... ... ... Scarlet Fever M 2 ... ... 2 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough M ... ... ... ... ... ... ... ... ... ... ... ... F 5 3 2 ... ... ... ... ... ... ... ... ... Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... F 3 ... ... 2 1 ... ... ... ... ... ... ... Influenza M 2 ... ... ... ... ... ... ... 1 1 ... ... F 6 ... ... ... ... ... 1 ... l 2 1 1 Encephalitis Lethargica M 2 ... ... ... ... 1 ... ... ... ... 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System M 45 ... ... ... ... 9 12 9 7 4 3 1 F 19 ... ... ... ... 4 7 2 3 3 ... Other Tuberculous Diseases M 6 ... ... ... 2 1 1 1 1 ... ... ... F 2 ... ... ... 1 1 ... ... ... ... Syphilis M 2 ... ... ... ... ... ... ... ... 2 ... ... F 2 ... ... ... 1 ... ... ... ... 1 ... ... General Paralysis of the Insane, tabes dorsalis M 1 ... ... ... ... ... ... 1 ... ... ... ... F 1 ... ... ... ... ... ... ... ... ... 1 Cancer, malignant disease M 72 ... ... ... ... 2 1 2 8 16 28 15 F 64 ... ... ... ... 1 l 7 6 16 17 16 Diabetes M 4 ... ... ... ... ... ... ... ... ... 3 1 F 8 ... ... ... ... ... ... ... 1 2 3 2 Cerebral Haemorrhage, etc. M 21 ... ... ... ... ... ... ... 4 3 6 8 F 33 ... ... ... ... ... ... 3 1 10 9 10 Heart Disease M 130 ... ... 1 ... 2 5 6 8 26 46 36 F 166 ... ... ... 1 1 2 2 7 22 54 77 Aneurysm M 2 ... ... ... ... ... ... ... ... 1 ... 1 F 3 ... ... ... ... ... ... 1 1 ... ... 1 Other Circulatory Diseases M 13 ... ... ... ... ... ... ... 1 5 3 4 F 18 ... ... ... ... ... ... 1 4 5 8 Bronchitis M 30 1 ... ... ... ... ... 1 3 8 6 11 F 19 ... ... 1 ... ... ... ... 1 4 2 11 Pneumonia (all forms) M 34 5 2 2 2 1 2 2 6 6 4 2 F 27 7 3 ... ... ... ... ... 4 4 2 7 Other Respiratory Diseases M 8 ... ... ... ... ... ... 1 ... 2 2 3 F 4 ... ... ... ... 1 ... ... 2 ... ... 1 Peptic Ulcer M 15 ... ... ... ... ... ... 1 4 6 3 1 F 4 ... ... ... ... ... 1 ... 2 1 ... ... Diarrhoea, etc. M 14 13 ... ... ... ... ... ... ... ... ... 1 F 10 8 1 ... ... ... ... ... ... ... ... 1 Appendicitis M 5 ... ... 1 1 ... 1 ... 1 ... 1 ... F 5 ... ... ... l ... 1 ... 1 2 ... ... Cirrhosis of Liver M 2 ... ... ... ... ... 1 ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver, etc. M 2 ... ... ... ... ... ... ... ... 1 ... 1 F 2 ... ... ... ... ... ... ... 1 1 ... ... Other Digestive Diseases M 17 ... ... ... 2 1 ... ... ... 7 3 4 F 11 ... ... ... ... ... 1 ... 1 3 3 3 A. and Cr. Nephritis M 17 ... ... ... ... 1 2 ... 4 2 5 3 F 17 ... ... ... 1 1 1 1 1 2 3 7 Puerperal Sepsis F ... ... ... ... ... ... ... ... ... ... ... ... Other Puerperal Causes F 1 ... ... ... ... 1 ... ... ... ... ... ... Congenital Debility, Premature Birth, Malformations, etc. M 16 16 ... ... ... ... ... ... ... ... ... ... F 8 8 ... ... ... ... ... ... ... ... ... ... Senility M 20 ... ... ... ... ... ... ... ... ... 4 16 F 28 ... ... ... ... ... ... ... ... ... 5 23 Suicide M 6 ... ... ... ... ... 3 2 l ... ... ... F 4 ... ... ... ... ... ... ... 3 1 ... ... Other Violence M 34 2 ... 2 3 6 5 2 5 1 4 4 F 19 ...1 1 ... 1 l 2 ... 3 2 2 6 Other Defined Diseases M 44 2 ... 4 4 3 2 1 3 6 9 10 F 28 ... 1 ... 1 2 2 2 6 7 2 5 Diseases ill-defined or unknown M 1 ... ... ... ... ... ... ... ... ... 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... Metropolitan Borough of Greenwich. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 CONTENTS Pages Public Health Staff 3-4 Public Health & Maternity & Child Welfare Committees 5-6 Introductory 7-8 Section A.—Natural and Social Conditions of the Area 9-10 Vital Statistics 11-22 „ B.—General Provisions of Health Services in the Area 23-26 Maternity and Child Welfare 27-37 „ C.—Sanitary Circumstances of the Area 38-49 „ D.—Housing 50-54 „ E.—Inspection and Supervision of Food 55-68 ,, F.—Prevalence of, and Control Over, Infectious Diseases 69-87 3 Staff of the Public Health Department. Medical Officer of Health and Administrative Medical Officer, Tuberculosis, and Maternity and Child Welfare: F. R. Waldron, M.D., B.Ch., D.P.H. Tuberculosis Officer and Deputy Medical Officer of Health W. Alcock, M.B., Ch.B., D.P.H. Maternity and Child Welfare Medical Officer: Violet Mizen, M.R.C.S., L.R.C.P., M.B., B.S. Assistant Maternity and Child Welfare Medical Officers: †gladys M. Cox, M.B., B.S. (Lond.). †Isobel C. Johnson, M.B., Ch.B. D. Cameron, M.B., Ch.B. Bacteriologist: †Arthur Davies, M.B., B.S., D.P.H. Public Vaccinators: †William Cowie, M.A., M.B., C.M. †John S. Davies, M.A., M.B., C.M. †D. Morien Thomas, M.B., M.R.C.S., L.R.C.P. Vaccination Officer: †E. S. Elliott. Consultant Obstetrician: †Victor J. F. Lack, F.R.C.S., M.R.C.P. Consultants under Puerperal Fever, etc. Regulations: †maroaret basden, m.d., F.R.C.S. †FRANK Cook, B.Sc., B.S., F.R.C.S. †Arthur J. McNair, B.A., M.B., 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. Chiropodists: †H. E. J. Taylor, M.C., CH.A. †Miss D. Thackeray. Sanitaru Inspectors: abce S. A. Radford. abcde W. R. Drake. abe W. H. Collins. Ine E. Saphier. ab Miss G. Davis. Ico H. L. Bennett (Food). eocl H. Archer. cl G. W. Heath. Housing Inspector: bc A. E. Moroan. Health Visitors: fh Mrs. M. D. Morison. fgh Miss F. C. Jaoot. fgh Miss A. Jenkins. fgh Miss E. Bailey. fgh Miss A. M. M. Hadfield. ghk Miss K. Walton. ghk Miss P. N. Steer. 4 TUBERCULOSIS DISPENSARY: Nurses: afgh Miss D. M. Wilkins. ghk Mrs. D. E. Shepherd. gh Miss M. W. J. Luxmoore. Pharmacist: Clerk: W. H. Green, M.P.S. Miss I. Mills. ARTIFICIAL SUNLIGHT TREATMENT: Nurse-in-Charge: gij Miss L. D'Oyly Watkins. Assistant Nurses : gj† Miss L. Mallett. gij Miss C. Meikle. gh Mrs. E. Dawson. MATERNITY HOME: Matron: Sister : ghm Miss Q. M. Anstice (resigned 31.10.36). gh Miss Annie Fox. ghm Miss E. M. Marlow (from 1.11.36). CLERICAL STAFF: F. W. Foulger (Principal Clerk). a H. W. Duck. Miss D. Nettle. Miss L. Merricks. Miss G. Sibborn (Milk Saleswoman). Mrs. L. E. Wright. E. W. Pike. L. A. Westacott. J. Hannen. E. P. Tidman. A. H. Wilcox. R. Robinson. Disinfecting Staff: G. Hook. T. Smith. T. G. Griggs. A. Moore. T. Packham (Motor Driver). Attendant at Cleansing Station: Miss B. Terry. 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. n Cert. R.S.I. Sanitary Science. o Cert. Smithfield Meat Trades Institute, Laboratory Technique of Meat Inspection (Distinction). All the members of the Staff of the Department are whole time Officers with the exception of those marked †. 5 PUBLIC HEALTH COMMITTEE during the year 1935-6 The Mayor : Councillor D. A. Whitenstall, J.P.; and 13 Members. Councillor Mrs. C. R. Turner, J.P. (Chairman). Aldermen : Mrs. P. M. Beacham (Vice-Chairman). M. G. Byerley, J.P., F.R.C.V.S. Councillors : Mrs. O. Bennett. R. G. Jaggers. Mrs. L. E. G. Bruce. Mrs. A. Kennedy. A. Cathles, J.P. W. J. Moore. Mrs. F. Carter. Miss M. Sherman. J. R. Dabin. G. F. Westmacott. Powers and Duties of the Public Health Committee: 1.—There shall be referred to the Committee the powers of the Council under Acts of Parliament relating to the Public Health and the sanitary condition of the Borough, the sale of food and drugs, the repair, closing and demolition of individual insanitary houses (Parts II and V of the Housing Act, 1930), and Vaccination, and the By-laws, orders and regulations made, or to be made hereafter, under the provisions of such Acts, which are not within the reference to any other Committee. 2.—All plans for drainage and redrainage of premises shall be laid before the Committee for consideration. 3.—All works of drainage of houses and premises shall be carried out under the direction of this Committee. 4.—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. 5.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 6 MATERNITY AND CHILD WELFARE COMMITTEE during the year 1935-6 The Mayor: Councillor D. A. Whitenstall, J.P.; and 13 Members. *Alderman Mrs. P. M. Beacham (Chairman). *Councillor Mrs. A. Kennedy (Vice-Chairman). Alderman : M. G. Byerley, J.P., F.R.C.V.S. Councillors: *Mrs. O. Bennett. *Mrs. L. E. G. Bruce. G. Bruce. J. R. Dabin. W. J. Moore. *Miss M. Sherman. *Mrs. C. R. Turner, J.P. G. F. Westmacott. A. Cathles, J.P. *Mrs. F. Carter. * Denotes Members who served on the Assistance Sub-Committee. Powers and Duties of the Maternity and Child Welfare Committee: There shall bo 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 any Orders or Regulations made under such Act or Acts; Section 75 of the Public Health (London) Act, 1891, so far as it enables the Council to provide Artificial Sunlight Treatment to adult residents in the Borough; powers and duties referred to in Sec. 6 of the Widows, Orphans and Old Age Contributory Pensions Act, 1925; and the Committee shall make recommendations to the Council in relation to the matters aforesaid. 7 Public Health Offices, Town Hall, Greenwich, S.E.10 April, 1937. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Mr. Mayor, Ladies and Gentlemen, It is my privilege to present the Annual Report for the year 1936 compiled in accordance with instructions contained in Circular 1561 of the Ministry of Health. I have the honour as head of the Public Health Department, to succeed Dr. Macdonald, who retired during the year after seventeen years in the Council's service. During his three years as Medical Officer of Health, the Council's progressive policy was reflected by extension in all Health services. Notable additions were the establishment of Foot Clinics and the opening of two new Welfare Centres. Increasing activity in Housing and Food Inspection led to the appointment of specially qualified Inspectors for these purposes. It is fitting therefore, that I should pay tribute to a predecessor who shares responsibility for the year's work outlined in the following Report and whose personality has left its impression on the Health Services of the Council. Dr. E. G. Annis, the Council's first Medical Officer of Health, also merits montion inasmuch as he saw the growth and shaped the destiny of the Department from the Century's beginning to recent years. The mantle of Office worn by two such predecessors is no light one to assume and were it not for the loyal and generous support given by each member of the Staff, my task would be over burdensome. In addition to increasing work devolving on the department generally following recent legislation, the close of the year saw preparations for the evacuation of the Borough Hall Offices and 8 Clinics with consequent reorganization. Extra work has been ungrudgingly carried out by the Staff and difficulties have been met with a spirit which merits special appreciation. It is pleasing to record that the Infantile Mortality Rate of 49 per 1,000 births was the lowest ever recorded with the exception of the year 1930 when the extraordinary rate of 46 occurred. This rate is also the lowest but one among the 28 Metropolitan Boroughs. The Rate for the whole of London is 66. The Birth Rate is somewhat below that for 1935 and the Death Rate slightly above. The Maternal Mortality Rate of .73 per 1,000 Births is the lowest ever recorded for the Borough. The health of the Borough as shown by the Vital Statistics and prevalence of infectious diseaso is very satisfactory but should not give rise to complacency. Finally I desire to thank the Chairmen and Members of the Public Health and Maternity and Child Welfare Committees, for the kindness and consideration they have shown me since taking over office. I have the honour to be Your obedient Servant, F. R. Waldron. 9 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, 1936 95,900 Density of Population— East Greenwich 30 persons per acre West Greenwich 50 ,, „ St. Nicholas, Deptford 54 „ „ Charlton and Kidbrooke 14 „ „ Average for the Borough 24 persons per acre Number of Inhabited Houses—1936 20,877 (according to Rate Books) Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 At end 1935 357 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value £972,502 Sum Represented by a ld. Rate £3,997 10 PUBLIC OPEN SPACES controlled by borough council. Acres. Charlton House and Gardens 9.25 R.N. College Cemetery 5.86 St. Alfege Recreation and Church grounds 2.3 Sayes Court Recreation grounds 1.43 St. Nicholas Recreation grounds 1.25 Hughes Fields Recreation grounds .74 Batley Park .97 Bellot Memorial Gardens .19 approximately 23. H. M. Office of Works— Greenwich Park 185 L. C. C.— Blackheath (part of) 73 Maryon Park 46.70 Charlton Park 45.75 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 fect 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.P.T.B. 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, Cold Meat Storeage, etc. 11 POOR LAW RELIEF AND UNEMPLOYMENT. Some indication as to the social condition of the inhabitants of the Borough may be obtained from the following particulars supplied to me through the courtesy of the Local Public Assistance Officer:— Average weekly number of Greenwich Residents in receipt of domiciliary relief during 1936 2,380 Average amount expended in outdoor relief in Greenwich £901 These figures shew a considerable reduction over those of the past few years, indicating a general improvement in industrial conditions. This has also been noticed in dealing with the applications for assisted milk supply under the Council's Maternity and Child Welfare Scheme. 4,646 lbs. of Dried Milk were given to necessitious families as compared with 5,581 lbs. for the previous year. Through the kindness of the Local Manager, Ministry of Labour, the following information is given concerning the number of persons resident in Greenwich who were registered as unemployed during the following periods:— Men Women Juveniles Total 20th January, 1936 1,500 329 119 1,948 27th April, 1936 1,305 271 90 1,666 20th July, 1936 903 217 23 1,143 26th October, 1936 1,064 209 60 1,333 12 POPULATION. At the commencement of the year, this Authority received a communication from the Registrar General, asking for any local data which might be utilised in the computation of the annual revision of population. In previous years, it has been pointed out by your Medical Officer of Health that the population of Greenwich has not varied to any marked extent. Since the last Census, 1953 houses have been erected and occupied with an approximate population of 6,835 persons. The natural increase in population during this period was 1,315, making a total increased population of 8,150. Against this figure would have to be deducted migration, which so far as can be ascertained is approximately 6,500 persons, thus showing an increase of 1,650. It is interesting to note that on reference to the Register of Electors, the number on the Register in 1930 was 63,422, whilst in 1936, the figure was 63,400. The above information was furnished to the Registrar General, but apparently received no consideration for at the moment of going to press, the Registrar General has just published the figures for Greenwich, namely, 95,900 and it is upon these figures that the statistics in this report have been based. The following is the local distribution:— Estimated Population at Mid-Year, 1936 East Greenwich 39,310 West Greenwich 22,899 St. Nicholas, Deptford 6,193 Charlton and Kidbrooke 27,498 95,900 13 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Live Births Legitimate 1,281 654 627 Birth Rate 13.82 Illegitimate 42 18 24 Still-Births 39 22 17 Rate per 1,000 total Births 28.6 Deaths 1,091 572 519 Death Rate (Crude) 11.41 (Adjusted) 11.63 Deaths from Puerperal Causes:— Rate per 1000 total Births Puerperal Sepsis ... - - Other Puerperal Causes ... 1 0.73 Total ... 1 0.73 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 50 Legitimate Infants per 1,000 legitimate live births 42 Illegitimate Infants per 1,000 illegitimate live births 285 Deaths from Cancer (all ages) 136 „ „ Measles (all ages) 6 ,, „ Whooping Cough (all ages) 5 „ „ Diarrhœa (under 2 years of age) 22 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 14 MARRIAGES. Mr. E. A. Bale, the Superintendent-Registrar of the Greenwich Registration District, has kindly furnished me with particulars relating to the number of marriages solemnised in the Borough of Greenwich. The following table shows these particulars giving the number of marriages in the Borough for each year since 1930:— Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Tota Approximate Population of the district concerned  Greenwich Charlton and Kidbrooke St. Nicholas 1930 351 150 41 72 249 863 104430 1931 291 138 34 62 247 772 100640 1932 312 152 30 60 205 759 101024 1933 286 136 48 84 247 801 97830 1934 331 143 39 79 259 851 97250 1935 340 158 42 102 250 892 96600 1936 335 208 66 102 252 963 95900 15 BIRTHS. The total number of births registered in the Borough during the year was 1,928. Of this number 783 occurred in St. Alfege's Hospital, 410 in the Borough Maternity Home, and 183 at various Nursing Homes within the Borough. Of this total of 1,376 Institution births, 609 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and fifty-six births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,323:—Males, 672; Females, 651. This figure gives a Birth Rate of 13.82 per 1,000 of the population, and is a fraction lower than the previous year's Birth Rate of 13.87. The Average for the last ten years is 14.86. The Birth Rate for the County of London equals 13.6 per 1,000 of the population. The Birth Rate for all England and Wales was 14.8. Illegitimate live-births numbered 42, representing 3.1 per cent. of the total live-births. Sixty-nine illegitimate births actually were registered in the Borough. In 36 cases, however, the mothers were ordinarily resident outside the Borough and these births were consequently allocated to the correct area. Nine illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the net figure of 42. Thirty-nine 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 stillbirths became compulsory. Thirty-nine still-births wore allocated to the Borough, representing a percentage of 2.8 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. Under the provisions of the Notification of Births Act, 1907, intimations have been received from medical men, parents, and others, with respect to 2,037 births; 64 were in respect of stillbirths, of which number 29 were referred to other Boroughs. 16 DEATHS. The net number of deaths registered during 1936 was 1,086 of which 567 were males and 519 females. This gives a crude Death Rate for the Borough of 11.36, which figure is slightly increased to 11.58 when the comparability factor furnished by the Registrar General for adjusting Local Deaths is taken into account. The Comparability Factor for Greenwich is the same as last year, viz., 1.02 and may be regarded as the population handicap to be applied, which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the Country as a whole or any other similarly adjusted area. The adjusted Death Rate is in effect a "corrected" Death Rate. The Death Rates for the County of London and for England and Wales are 12.5 and 12.1 respectively. 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. 1561. 17 I am indebted to Dr. Allan Young, Medical Officer of Health for Poplar, who has kindly furnished me with comparative rates for Births, Deaths and Infantile Mortality of the various Metropolitan Boroughs obtained direct from the Boroughs concerned. These particulars are set out in the following table:— Borough Estd. Res. Population (mid 1936) Live Births rate per 1,000 popn. Death rate per 1,000 population Infantile Mortality rate per 1,000 live births Crude Adjusted West Districts. Paddington 139,200 13.8 12.98 12.81 72 Kensington. 176,100 12.7 12.5 11.7 73 Hammersmith 127,700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 13.7 11.6 53 Westminster 124,100 8.5 11.1 11.4 65.8 North Districts. St. Marylebone 92,400 9.8 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 65.8 St. Pancras 183,900 13.0 13.5 13.8 79 Islington 304,100 15.24 12.44 12.56 61 Stoke Newington 50,350 13.7 11.4 10.9 44.6 Hackney 209,100 14.4 12.0 12.6 62.9 Central Districts. Holborn 34,850 8.29 11.99 12.83 62 Finsbury 60,800 13.8 14.0 15.3 81 City of London 9,100 7.5 11.4 12.65 147 East Districts. Shoreditch 85,400 14.9 12.8 14.1 75 Bethnal Green 96,900 13.5 12.7 14.3 98 Stepney 207,800 14.7 12.6 14.7 100.09 Poplar 140,300 15.0 12.5 13.8 72 South Districts. Southwark 152,200 14.8 13.1 — 59 Bermondsey 100,400 15.4 12.8 14.6 60 Lambeth 277,500 13.9 12.5 12.4 59 Battersea 145,500 14.63 13.06 12.93 59.21 Wandsworth 343,000 11.46 11.79 10.96 58 Camberwell 229,300 13.93 12.64 12.64 58.86 Deptford 98,900 15.7 12.2 12.6 50 Greenwich 95,900 13.82 11.36 11.58 49 Lewisham 224,000 13.0 10.8 10.9 55 Woolwich 146,500 13.8 11.2 11.8 59 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 1931 1,134 633 1932 1,194 761 1933 1,167 707 1934 1,186 723 1935 1,043 671 1936 1,086 689 Average 1,135 697 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 18 15 18 15 66 Between 1 and 2 years 2 4 3 2 11 Between 2 and 5 years 6 4 5 4 19 Between 5 and 15 years 6 7 3 6 21 Between 15 and 25 years 14 11 6 11 42 Between 25 and 45 years 33 25 14 25 97 Between 45 and 65 years 83 68 67 72 290 65 years and upwards 162 128 112 138 540 Total 324 262 228 272 1,086 19 Locally the Death Rate varied from 10.29 in Charlton and Kidbrooke, 11.46 in East Greenwich, 11.68 in West Greenwich to 13.44 in St. Nicholas, Deptford. Of the total number of deaths, 12 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 Districts of the Borcugh in the five years 1931 to 1935 compared with the figures for 1936:— District 1931 1932 1933 1934 1935 Average for 5 years 1936 East Greenwich 10.90 12.88 11.67 12.17 10.92 11.70 11.46 West Greenwich 13.80 11.43 12.55 13.84 11.14 12.55 11.68 St. Nicholas Deptford 11.64 14.49 19.37 13.14 11.93 14.11 13.44 Charlton and Kidbrooke 9.36 10.10 11.59 10.64 10.09 10.35 10.29 Whole Bobough 11.40 11.34 11.96 12.23 10.83 11.55 11.36 INFANTILE MORTALITY. The Infantile Mortality Rate measured by the deaths of children under one year of age to the number of births registered, was 49 per 1,000 births, as compared with 59 last year. It is interesting to note that with the exception of Stoke Newington, Greenwich has the lowest rate for the whole of the* Metropolitan Boroughs and is the lowest ever recorded with the exception of the year 1930, when the phenomenal rate of 46 was returned. The total number of deaths during the year was 66, as compared with 119, 89, 116 and 80, the respective figures for the years 1932, 1933, 1934 and 1935. Locally the variations were 40 per 1,000 births in West Greenwich and St. Nicholas, Deptford, respectively, 41 in Charlton to 64 in East Greenwich. A further reference to the Infantile Mortality Rate will be found in the Section devoted to the Maternity and Child Welfare Scheme. 20 For the whole of London the rate was 66, compared with 58 in 1935, 67 in 1934, 59 in 1933, and 66 in 1932. For England and Wales the rate was 59, compared with 57 in 1935, 59 in 1934, 64 in 1933 and 65 in 1932. The following table shows the rates for the quinquennial periods since 1921, together with the rates for the year 1936 :— District Average for five years 1921-1925 inclusive Average for five years 1926-1930 inclusive Average for five years 1931-1935 inclusive Year 1936 East Greenwich 62 60 75 64 West Greenwich 80 59 78 40 St. Nicholas, Deptford 88 78 77 40 Charlton and Kidbrooke 50 42 58 41 Borough 66 57 75 49 REMARKS ON VARIOUS DEATH CAUSES. Common Infectious Diseases.—Tho class known as common infectious diseases comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea is credited with causing a total of 43 deaths equalling a Death Rate of .44 per 1,000. Locally the Death Rate varies from .31 in St. Nicholas (.15 in .1935), .33 in West Greenwich (.16 in 1935), .40 in Charlton and Kidbrooke (.18 in 1935) to .50 in East Greenwich (.21 in 1935). Smallpox.—There were no deaths from Smallpox, this being tho thirty-fourth year since a death occurred from this cause in the Borough. Measles.—Thero wore six deaths ascribed as due to this disease. Tho number of deaths recorded in the years, 1932, 1933, 1934 and 1935, were 24, 2, 16 and 0 respectively. Scarlet Fever.—This disease was responsible for two deaths during the year. One death occurred in 1931, 1 in 1932, 3 each in 1933 and 1934 and one in 1935. 21 Whooping Cough.—This disease was given as the cause of five deaths with a Death Rate of .05 per 1,000. Thore wore 6 deaths in the year 1932, 8 in 1933, 6 in 1934 and 1 in 1935. Diphtheria.—There were 3 deaths during the year. This gives a Death Rate of .03 which was the same rate recorded for the previous year. Three deaths occurred in 1935, 5 in 1934, 14 in 1933, 7 in 1932 and 11 in 1931. Two of the patients were under five years of age. Enteric Fever,—Thore was one death ascribed to this disease during tho year. There was one in 1935 and 0 in 1934, 1933 and 1932 respectively. Diarrhoea, Dysentry and Zymotic Enteritis.—Twentyseven deaths were stated to be due to these causes, equalling a Death Rate of 27 per 1,000. Last year there were 14 deaths, 30 in 1934, 17 in 1933, 24 in 1932 and 16 in 1931. Influenza.—There were 8 deaths due to this cause during the year compared with 9 for the previous year. Five occurred in East Greenwich, one in West Greenwich and 2 in Charlton and Kidbrooke. Tuberculosis. This class includes the causes of 73 deaths during the year under review, with a rate of .76. These figures compare with 87, 106, 85 and 78, the totals of the years 1932, 1933, 1934 and 1935 respectively, and the respective rates of .86, 1.08, .87 and .80. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 66 attributed to the cause or a rate of .68 per 1,000 as compared with .74 for the last year. Locally the deaths were 28 in East Greenwich (Death Rate .75); 9 in St. Nicholas, Deptford (Death Rate 1.45); 15 in Charlton and Kidbrooke (Death Rate .54); 12 in West Greenwich (Death Rate .52). The remaining forms of Tuborculosis were responsible for 7 deaths, 4 of which occurred in East Greenwich, 2 in West Greenwich and 1 in Charlton and Kidbrooke. 22 Cancer. This disease was responsible for a total of 134 deaths for the year and is considerably lower than for many years past. The number of deaths in 1935, 1934, 1933, 1932 and 1931 were 156, 161, 162, 155, 160 and 150 respectively. The distribution of deaths were as follows :—54 in East Greenwich, 38 in West Greenwich, 35 in Charlton and Kidbrooke and 7 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 261 deaths under this class as compared with 240 for the year 1934. MORTUARY. During the year 182 bodies were received into the Mortuary. The details are as under:— Bodies brought in upon which inquests were held 145 Bodies brought in upon which post-mortems were held 86 Bodies brought in upon which inquests were considered unnecessary 37 Bodies brought in where death had occurred from infectious disease 5 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. 1561, the particulars relating to the Staff of the Department are set out on pages 3 and 4. The following alterations in the personnel of the Department occurred during the year. Dr. M. Macdonald retired on the 12th August, 1936 on reaching the age limit. Dr. Macdonald had served the Borough for the past 17 years, first as the Tuberculosis Officer and latterly as Medical Officer of Health. Consequent on my appointment as Medical Officer of Health, Dr. W. Alcock was appointed and took up duty as Tuberculosis Officer and Deputy Medical Officer of Health on 31st Octobor, 1936. Miss T. I. Husbands, nurse at the Dispensary, also retired on reaching the age limit, and Miss W. M. J. Luxmoore was appointed in her stead. Miss Q. M. Anstice resigned her appointment as Matron at the Maternity Home and was succeeded by Miss E. M. Marlow in November. Following a report to the Council on the pressing needs of further clerical assistance, two Grade "A" clerks were appointed. Miss I. B. Mills was attached to the Dispensary and Mr. R. H. Robinson to the General Office. 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, 1,551 specimens have been examined for Diphtheria, 7 for Typhoid Fever, 390 for Tuberculosis, and 25 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. 24 Ambulance Facilities.—The ambulance sorvicos have been described in recent Reports and continue to bo in force. The arrangement made for ambulances to be available for patients entering maternity hospitals has proved in every way satisfactory and is without doubt a groat boon to patients seeking admission to our own Maternity Home. Diabetes—Insulin Treatment.—In accordance with Section 227, Public Health (London) Act, 1936, arrangements are in existence whereby necessitous patients suffering from this disease can obtain a supply of insulin upon application by the local doctor to the Public Health Department. A quarterly report must be furnished to the Ministry of Health on patients who receive this service. During the year, 2 patients have received such assistance. Treatment Centres and Clinics.—There was no alteration during the year with regard to the treatment centres and clinics controlled by the Council. Fuller particulars will bo found in the Section devoted to Maternity and Child Welfare. Home Helps.—There is one ancillary service to the Maternity and Child Welfare Scheme which is regarded as very helpful in some districts, but which does not exist in this Borough at the moment. This service is that under the heading of "Home Helps." It has been noted that patients often elect to have their confinement at home in less suitable surroundings than an institution, by reason of the fact that they are unable to obtain the help of relatives or friends who could care for the toddlers. Toddlers' Clinics.—Toddlers' Clinics have been in existence during the year at Shooter's Hill Road, Creek Road and the Borough Hall. In the other districts, the toddlers attend the ordinary Welfare Centres. Foot Clinic.—During the year 3,557 attendances were recorded, representing an income of £177 17s. 0d. Ten sessions are held per week, half of these being evening sessions. The Clinics are open to men, women and children at a charge of 1/- per attendance. That this service is proving a boon to the poorer population of the Borough is undoubted, and the Council are to be congratulated on their progressivoness in establishing the scheme. It was found necessary during the year to appoint an assistant chiropodist, who does 4 sessions per week, in order to cope with the steady increase in the applications for treatment. 25 Artificial Sunlight Treatment.—Clinics are held at the five Welfare Centres and have been conducted on the same lines described in previous reports. As previously, evening sessions were held during the winter months. These evening sessions are available for paying patients. The fees charged are 12/- for 6 treatments or 20/- for 12 treatments. During the year 33 patients were given 321 treatments, the fees received totalling £51 3s. 8d. The arrangements with the authorities of the Roan Schools made in 1933; continue to be in force. The following table shows the typo of abnormality treated during the year, and in the majority of cases marked improvement was noted. Condition treated No. Rickets 222 Underweight 320 Bronchial conditions 129 Anaemia and debility 254 Convalescent from Infectious Diseases 109 Colds and Catarrh 16 Insomnia 4 Rheumatism 17 Enlarged Cervical Glands 41 Neuritis 7 Skin Conditions 38 Overweight 5 Other Conditions 31 1,193 Particulars relating to the number of patients treated at the various Centres during 1936 are given in the following tables :— DAILY SESSIONS. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 343 34 38 415 Number of New Patients 1,003 65 135 1,203 Discharges 1,105 98 148 1,351 Number under treatment at end of 1936 241 1 25 267 Number of treatments given 16,112 1,024 2,224 19,360 26 EVENING SESSIONS. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 8 8 Number of New Patients — — 33 33 Discharges — — 27 27 Number under treatment at end of 1936 — — 14 14 Number of treatments given — — 321 321 Tumour Diagnostic Clinic. There were 23 new cases seen during the year. 2 cases were found suffering from malignant disease, and 4 cases regarded as doubtful were referred to the Council's Consultant. Since the opening of the Clinic in October, 1927, the following are the figures relating to the number and disposition of cases attending. Figures are also given showing the deaths occurring in the Borough from malignant disease, during the year under review. Year No. of Cases Found Malignant Deaths occurring in Borough from Malignant Disease 1928 31 3 147 1929 34 3 150 1930 30 4 150 1931 28 3 160 1932 34 1 155 1933 33 1 162 1934 29 4 161 1935 32 6 156 1936 23 2 134 Various circulars and medical reports have been issued by the Ministry of Health with regard to the possibility of control of this disease. It is again pointed out that the Public Health Department in general gains no definite knowledge of the incidence or possibilities of cure of the disease, owing to the fact that the main source of information is still the Death Returns. Even with continuous and widespread propaganda, patients still tend to delay seeking advice until the disease becomes impossible to eradicate, and until the patient can be educated to seek diagnosis at an earlier date, malignant disease will continue to swell the mortality rates. 27 MATERNITY AND CHILD WELFARE. Infant Welfare Centres.—The work at the various Centres has been conducted on similar lines as in previous years and particulars relating to attendances are shewn in the following tables :— (a) Babies. Borough Hall Chev'ng Road Shooter's Hill Rd. Creek Road Charltcn Lane Total No. of Clinics 151 153 101 52 105 562 No. of Attendances 4.378 4,436 3,514 1,580 2,520 16,428 New Cases 251 252 216 98 153 970 Medical Consultations 1,872 1,525 1,223 741 1,051 6,412 All babies are weighed and advice given to the mothers at every attendance. (b) Children 1-5 years. Borough Hall Chev'ng Road Shooter's Hill Rd. Creek Road Charlton Lane Total No. of Clinics 151 153 101 52 105 562 No. of Attendances 4,635 6,319 2,671 1,841 3,525 18,991 New Cases 51 72 40 24 44 231 Medical Consultations 1,979 2,208 1,038 532 1,186 6,943 Toddlers' Clinic.—During the year the Maternity and Child Welfare Committee gave consideration to a Circular issued by the Ministry of Health as to supervision of children between the ages of 1—5 years and further requiring the Council generally to review the Scheme. A Special Report was submitted to the Maternity and Child Welfare Committee by your Medical Officer of Health setting out in detail the procedure as at present obtaining and suggestions as to improving and consolidating the Scheme. In view of the disorganization of the Centres at the end of the year consequent upon the closing down of the Borough Hall Centre due to the demolition of the building as part of the New Town Hall Scheme and the difficulty of finding new temporary quarters it was decided to adopt the proposals outlined only so far as it was possible. 28 A schedule is given below which indicates the condition of individual children at the various ages seen at the Centres during the year. Under 1 year 1-2 years 2 to 3 years 3 to 4 years 4 to 5 years Total Nutrition :— Excellent 222 91 29 15 21 378 Normal 641 323 135 128 97 1,324 Sub-normal 107 200 169 177 219 874 Defects found:— Dental Cases 0 5 18 65 104 192 Ears—Tonsils and Adenoids 34 32 64 101 121 352 Skin conditions 143 95 44 32 29 343 Nervous „ 5 2 1 4 2 14 Circulatory 4 10 6 9 4 33 Congenital „ 27 6 2 1 3 39 Respiratory 216 152 58 48 51 525 Alimentary 149 79 36 15 16 295 Enlarged Glands 4 14 18 49 63 148 Eyes 38 25 15 15 14 107 Sepsis 11 11 1 1 2 26 Urinary 2 3 3 5 3 16 Hernia 39 21 13 0 0 73 Phimosis 88 32 5 3 0 128 Orthopaedic 6 31 14 17 15 83 Infectious Diseases 49 99 50 59 64 321 Rickets 3 12 7 1 3 26 Miscellaneous 7 7 7 2 5 28 Ante-natal & Post-natal Clinics. These are held at each of the fivo Welfare Centres as follows :— Borough Hall, Royal Hill Tuesday, 10 a.m., Wednesday, 2 p.m. Chevening Road Monday, 2 p.m. 105, Shooter's Hill Road Thursday, 2 p.m., Friday, 10 a.m. Charlton Lane Wednesday, 10 a.m. Creek Road First and Third Thursdays in each month, 10 a.m. 29 The number of new cases together with total attendances for the year, were as follows:— No. Clinics New Cases Total Attendances Borough Hall 103 177 1,615 Chevening Road 48 105 683 Shooter's Hill Road 103 292 2,103 Charlton Lane 25 39 303 Creek Road 25 72 256 304 685 4,960 Post-natal. No. of attendances made during the year 480 In order to relieve the pressure at the Shooter's Hill Centre occasioned by the increasing number of outside the Borough patients admitted to the Council's Maternity Home, an additional Session is held weekly conducted by Dr. Mizen and the Matron. The number of attendances made by expectant mothers at this Clinic during the year was 512. Otheh Ante-natal Services. In addition to the facilities provided at the Borough Council Centre, 335 Mothers were confined and received Ante-Natal treatment at the St. Alfege's Hospital whilst the British Hospital for Mothers and Babies were responsible for Ante-Natal supervision in regard to 113 cases, 40 of whom were out-patients necessitating 765 visits. The Nursing Sisters of St. John the Divine state that 30 Mothers attended their Centre making 185 attendances in all. The tendency of prospective mothers to have their confinements in institutions rather than at home, is reflected in the increase in the number of births in institutions, which was 1,376 as compared with 1,216 for the previous year. It is a noticeable feature that previous residents of the Borough who now live on housing estates outside the Metropolitan area, return to the Borough for their confinements. Midwifery Services. It is safe to assume that Midwifery Services are available for every woman in the Borough. There is the closest 30 co-operation between the St. Alfege Hospital Ante-Natal clinic and the Borough Council clinics, as also with the Nursing Sisters of St. John the Divine who provide for the St. Nicholas, Deptford district and the British Hospital for Mothers and Babies who operate in the Charlton area. From information received from the London County Council it is possible to state that 30 Midwives are practising in the Borough. Infantile Mortality.—The total number of Deaths under 1 year of age was 66 as compared with 80 for the previous year. The Infantile Mortality Rate is thus equal to 49 per 1,000 Births. This is almost the lowest rate ever recorded being surpassed only by the figure returned in the year 1930, when it was 46 per 1,000 Births, and is the lowest recorded of the Metropolitan Boroughs, with the exception of Stoke Newington, the figure for which was 44. The rate for the previous year was 59, and the average for the last ten vears 64. The Infantile Mortality Rate for the County of London is 66, and that for the 122 large towns 63. The following are the local rates:— Charlton and Kidbrooke 39 West Greenwich 40 St. Nicholas, Deptford 41 East Greenwich 64 Of the total of 66 Deaths, 25 died before attaining the age of one month (19 being in the first week). The chief causes of death were :— Gastro-Enteritis 23 Premature Birth 12 Pneumonia 10 Atrophy, Debility and Marasmus. 7 Whooping Cough 3 Atelectasis 3 Measles 1 Other causes 7 66 Of the above number 38 were boys and 28 girls. 31 A noticeable feature in this table is an increase in the number of deaths from diarrhoea and enteritis. This is all the more marked in view of the fact that the total number of deaths for the year under review, is so much below that of the previous year. The high mortality rate from diarrhoeal disease in infants has been referred to in previous reports. Every effort is made by the Staff of the Department to elicit the knowledge of possible sources of infection. Deaths of Children 1—5 Years of Age. The number of deaths of children between the ages of 1 and 2 years was 11 and between 2 and 5 years 19. The previous year the figures were 5 and 4 respectively. Maternity Home.—The number of patients admitted during the year was 437. Eighty cases were admitted from the Centres for ante-natal treatment for periods varying from 2 to 7 days. These cases included the following:— Toxaemia 30 Induction 3 Version 2 Cardiac Condition 2 Remaining in till confined 28 Rest 2 Admitted query in labour 13 The number of cases delivered by the Midwives of the Home was 418, the remainder by the Medical Staff. In 238 instances medical assistance was sought by the Midwives (Ante-natal 102, Intra Partum 127, Post Partum 9). Operative interference was called for as follows:— Caesarian Section 1 Craniotomy 1 Forceps 17 Seven cases of Puerperal Pyrexia due to Influenza (3), Pyelitis (2) and Saproemia (2) were notified during the year and all made a good recovery before discharge. Two cases of Puerperal Fever occurred in the Home, being classified as Sapraemia. Both recovered. 32 Amongst the Infants, 20 were not entirely breast fed whilst 6 wore entirely artificially fed. There were no cases of Pemphigus Neonatorum and one case of Ophthalmia Neonatorum. This was a non-venereal type and subsequently transferred to St. Margaret's Hospital. The baby was discharged after 3 days fully recovered. There were 15 Still Births, the causes being attributed as follows :— Ante-partum Haemorrhage 2 Macerated 5 Anencephalic foetus 2 Hydrocephalic foetus 2 Prematurity 1 Cord round neck 1 Difficult forceps 1 Extended breech 1 Infant Deaths occurring within 10 days of birth numbered 5, the causes being:— Cardiac failure toxaemia 1 Perineal haemorrhage (P.M. Right Kidney buried in blood clot) 1 Hydrocephalus prematurity 1 Congenital heart (prematurity) 1 Cardiac failure „ 1 Maternal Mortality.—The number of Deaths from Puerperal Sepsis and Other Accidents and Diseases of Pregnancy was 2. Both died in St. Alfege's Hospital. This gives a maternal death rate of 1.4 per 1,000 total births. On comparison with the Registrar General's Returns, however, it was observed that one case which was associated with Tuberculosis had been assigned to that disease which makes a corrected maternal death rate of .73 per 1,000 total births and is the lowest ever recorded in the Borough. The Maternal Mortality Rate for England and Wales was 3.65. 33 Puerperal Fever and Puerperal Pyrexia Regulations, 1926.—The arrangements made by the Council under the provisions of the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, whereby obstretric consultants are available to assist local medical practitioners, continue in force. This service was provided on two occasions. Twenty-two cases were notified under the Regulations as compared with 10 for the previous year. Eight occurred in Hospitals, eight in the Council's Maternity Home and the remaining case was reported by a private practitioner. Health Week.—The usual teas and entertainment given to the mothers and children attending the Welfare Centres were continued. Dental Clinic.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S. (Eng.), attends at the Dispensary, Maze Hill once a fortnight to deal with cases referred to him from the Welfare Contres and Clinics. To enable him to cope with the increasing number of " fillings and scalings " an extra session held once a month was inaugurated in March, 1935. The following Return shows the work performed during the year:— Number of Sessions 35 Number of Patients 235 Number of Attendances 591 Extractions (Local Anaesthesia) 146 (Gas) 119 Dentures and Repairs 19 Fillings and Scalings 71 Referred for X-Ray 2 Referred to Hospital re Gas 11 Advice given (no action necessary) 61 Pneumonia.—Facilities are available for examination of expectoration in order to discover the type of disease ; in addition, serum for treatment may be supplied in necessitous cases on request from the local medical practitioner. Birth Control.—Patients recommended for birth control facilities are referred to the Greenwich Women's Welfare Centre, 34 Woolwich Road, and are assessed in accordance with their financial circumstances. During the year 12 cases were referred and were given free treatment. Minok Ailments.—The arrangements with St. John's Hospital for the treatment of minor ailments continue and during the year 350 cases were referred chiefly on account of tonsils and adenoids, circumcision, etc. The Council makes a grant of £100 per annum to this Hospital. During the year arrangements were made whereby cases admitted for treatment were retained in Hospital for a longer period than formerly, owing to difficulties complained of by mothers in attending to the immediate dressings necessary after minor operations. 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 1s. per visit to the Queen's Nursing Association and £50 per annum to the Ranyard Mission. Artificial Sunlight.—The type of defect for which Artificial Sunlight appears of greatest value includes :— underweight and debility in children, convalescence from infectious disease or operation, anaemia and bronchitis. Among the patients referred from the Centres were 58 expectant mothers and 49 post-natal cases. Convalescent Treatment.—Cases of mothers and children who, in the opinion of the Medical Officer would be materially benefited by a course of convalescent treatment, are dealt with from time to time. The Committee set aside the sum of £100 per annum for such cases. 17 mothers and babies and 57 children were sent away during the year. Health Visitors.—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:— 35 Health Visitors' Visits, &c., 1936. Table A. Visits Re-Visits Total Infanta under 1 year 1,355 3,767 5,122 Children 1—5 years 197 6,279 6,476 Measles (under 5 years) 1,152 251 1,403 ,, ( ver 5 years) 967 134 1,101 Whooping Cough (under 5 years 353 122 475 „ „ (over 6 years) 183 26 209 Pneumonia 18 13 31 Puerperal Pyrexia and Fever 12 11 23 Diarrhoea 57 22 79 Ophthalmia Neonatorum 6 14 20 Inflammation of Eyes 3 1 4 Pemphigus 1 4 5 Polio Myelitis 1 2 3 4,305 10,646 14,951 Table B. Dental Treatment 32 29 61 Milk Scheme 99 29 128 Ante-Natal Cases 768 159 927 Infant Consultations Attended — — 1,205 Ante-Natal Clinics Attended — — 310 Children Act 59 143 202 Miscellaneous 558 10 568 Schools re Measles 142 _ 142 In addition to the above, 559 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. 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 still-born. 36 The following Table gives the number and character of the intimations received respecting births in the Borough:— 1929 1930 1931 1932 1933 1934 1935 1936 Total Number of Births notified in each year 2,115 2,004 1,913 1,949 1,705 1,891 1,899 2,037 (a) Attended by Midwives 1,812 1,712 1,633 1,699 1,490 1,667 1,715 1,909 (b) Attended by Doctors 303 292 280 250 215 224 184 128 Numbers of StillBirths notified each year 50 42 40 65 39 60 45 64 Number of Births registered in each year 2,042 1,951 1,838 1,862 1,652 1,847 1,830 1,928 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 and exceptionable circum- stances to 5 years. 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 £3,600. It should be mentioned that included in the total amount of milk distributed free (table A), is 4,646 lbs. which is granted to the recipients under the Extra Nourishment Scheme by arrangement with the local Public Assistance Committee, and the amount of £388 was recovered from that authority. 37 (a) Dried Milk, Virol, &c., Distributed Free. Quarter ended Milk Virol Malt & Oil Cod Liver Oil lbs. lbs. lbs. Bottles March, 1936 11,861 1,201½ 2,182 252 June, „ 11,900 1,452 1,635 180 Sept. , ,, 10,798 1,593½ 946 186 Dec., „ 10,654 1,730 1,351 256 Totals 45,213 5,977 6,114 874 In addition to the above, 1,533 pints of liquid milk were distributed free. (b) Dried Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Milk Virol Malt & Oil Cod Liver Oil Total Amount Received lbs. lbs. lbs. Bottles £ s d March, 1936 3,858 288 217 136 280 10 8 June, ,, 3,995 255 136 104 268 12 7 Sept., „ 4,180 250½ 119 105 272 9 0 Dec., „ 4,087 408 239 54 296 19 5 Totals 16,120 1,201½ 711 399 £1,118 11 8 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, and the powers under the Acts have been re-enacted in the Public Health (London) Act, 1936. The supervision of Foster-children and of the homes of fostermothers 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 Maternity and Child Welfare Committee. Dunns' the vear 202 visits were made bv the Health Visitors. The following particulars are taken from the Register:— Number of Foster-mothers on Register at end of 1936 35 Number of Applicants refused 2 Number of Foster-children 39 Number of Foster-children who died during the year 3 Number of cases legal proceedings taken — There were several minor infringements under the Act, the chief being failure to notify change of address of Infant, and in each case the Foster Mother was cautioned. 38 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 39 and 40 and 46 to 49 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 24,566 houses and promises have been inspected or re-inspected during the year ; 1,876 intimation notices and 244 statutory notices have been served. There were altogether throughout the year 825 complaints registered. FACTORIES, WORKSHOPS AND WORKPLACES. The number of Factories, etc., upon the Register at the close of the year was 251. 109 Workshops, and 37 Wharves and Quays were also registered. The whole of these premises wore kept under systematic observation by the Inspectors, who made 502 inspections. In the case of factories the duty of inspection is mainly carried out by H.M. Factory Inspector under the Factory and Workshops Acts, 1901-1907. The duties of the Sanitary Inspectors are limited to such questions as sanitary accommodation, nuisances arising from smoke, etc., except in the case of food premises and bakehouses, where the Borough Council have wider powers. Co-operation is maintained with the Factory Inspector in dealing with factories and workshops. In workshops where female labour is employed, supervision is maintained by the Lady Sanitary Inspector. No evidence has been forthcoming to show that any local occupation exercises an adverse influence on the health of the workers engaged therein. Outworkers' Register.—Three lists, containing 4 names and addresses, have been receivod from employers within the district. In addition to this, 37 lists containing 64 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs (thus giving a total of 68 Outworkers in the Borough). Two lists with 4 names and addresses were forwarded to other districts. 137 visits of inspection have been paid to these premises. 39 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises Number of Inspections Written Notices Occupiers Pros'cut'd Factories (Including Factory Laundries) 271 12 — Workshops (Including Workshop Laundries) 169 2 — Workplaces (Other than Outworkers' Premises) 62 4 Total 502 18 — 2.—DEFECTS FOUND. Particulars Number of Defects Number of Offences in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector *Nuisances under the Public Health Acts— Want of Cleanliness 11 11 Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors 2 2 — — Other Nuisances 7 7 — — Sanitary Accommodation Insufficient 10 10 Unsuitable or Defective 2 2 — Not Separate for Sexes 2 2 — — Offences under the Factory and Workshops Act— Illegal Occupation of Underground Bakehouse (s.101) - - - - Other Offences 3 3 Totals 37 34 3 — •Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, 1901, as remediable under the Public Health Acts. 40 3.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1936. No. Bakehouses 16 Factory Bakehouses 24 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 3 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 15 137 4.—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 (a..5):— Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspectors 1 Reports to H.M. Inspector re Juvenile Employment 3 Underground Bakehouses (Sec. 101):— In use at end of 1936 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 Public Health (London) Act, 1936, and the Bye-laws made by the London County Council which came into force in 1931. 41 Reference was made in the Annual Report for 1935 of complaints received by the Department, regarding the emission of grit from the two large generating stations in the Borough. It is gratifying to note since the installation of the new plant and the provision of a new shaft by the London Power Company at their station in St. Nicholas, fewer complaints have been received. Owing to the increased activities of industrial concerns and extensions of factories, it is inevitable that more smoke is omitted year by year, and only recently the Astronomer Royal (Dr. Spencer-Jones) has drawn attention to the fact that the atmospheric pollution in Greenwich, is 25% worse than for the previous year. This is despite all the efforts to combat this nuisance. In connection with the East Greenwich generating station, the Public Health Committee in May decided that an expert's opinion should be obtained as to the source of the grit nuisance, which was causing the complaints in this area. The services of Dr. Lessing were retained for this purpose and a report was submitted to the Committee in September. As a result of consideration of this report, a conference was arranged with the chief officials of the London Passenger Transport Board towards the close of the year. It is hoped that in the next annual report, it may be possible to state that matters have been greatly ameliorated. Sewer Emanations.—Complaints were not nearly so numerous this year, and when made were forwarded to the County Council to be dealt with. Common Lodging House.—One common lodging house exists in the Borough. It is regularly visited by the Sanitary Inspector and is well conducted. Scavenging and Refuse Disposal.—The collection of house, etc., refuse in the Borough is under the control of the Borough Engineer, 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, 1936 was approximately 21,933 tons of which 18,852 tons were dealt with at the Council's Refuse Disposal Plant and the remainder disposed of by barging to the "control tips " under contract. I am endeavouring to reduce this percentage and, if possible, to delete it altogether. The collection of house refuse was further improved during the past year by the use of an additional Pagefield unit so that except for some odd collections from Eating houses and Markets that have to be made by horse cart, the whole of the house refuse of the Borough is collected by mechanical vehicles in an up-to-date manner. 42 A fleet of three motor vehicles having specially low loading bodies with movable sliding door covers which totally enclose the contents of the vehicle now collect the road sweepings and thus provide a more rapid and hygienic service in the scavenging of the streets in the Borough." Eradication of Bed Bugs.—In recent years the work fallen on Public Health Departments has been greatly increased through the efforts required to rid old premises from vermin. With the growth of new Housing Estates it has become necessary to ensure that the families provided with new housing accommodation should be free from vermin. As a result of experience gained in the past close co-operation exists with the Council's Housing Superintendent, whereby we are informed prior to the removal, the date on which they will take up occupation of new abode. The Inspector then calls at the old address and if necessary arranges for disinfestation of all furniture. Bedding is removed to the Council's Disinfecting Station and returned to the new address. This work was performed in 40 cases and similar procedure was adopted in regard to Flats on the L.C.C. Estates on 12 occasions. Requests for disinfestation, etc., of privately owned houses generally as a result of complaint from the Occupier or through the Sanitary Inspector were received and carried out in 48 instances. In order to assist Occupiers of very old houses to rid their premises of vermin a supply of special "Vermicine" fluid is issued by the Department and supplied on the special recommendation of the Sanitary Inspector. In the majority of cases the householders use sprayers and are eager to carry out the advice tendered by the Inspectors. It was noted, however, that considerably less use was made of this service than in recent years. Altogether 362 gallons were distributed to approximately 2,900 applicants. Experiments have been made to improve upon the present system, but the resultant tests have not always been conclusive. 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. At their request an additional session was arranged in February to deal with cases of verminous heads only. Pharmacy and Poisons Act, 1933.—This Act came into force on the 1st May, 1936 and aims for its object a closer control of the sale of poisons and poisonous substances. Under the Act rules have been made and the names of the poisons are set out and 43 described Part I and Part II. The Council is only concerned with those included under Part II which contains poisons chiefly used for domestic, horticultural and sanitary purposes. The Medical Officer of Health and each of the Sanitary Inspectors were appointed to carry out the provisions as far as they relate to Part II. Before the Act came into force each Sanitary Inspector submitted a list of persons or traders likely to be affected and these were subsequently circulated by the Town Clerk, briefly explaining tho provisions. The Council are required to keep a list of persons entitled to sell poisons under Part II and each application must be accompanied by a fee of 7/6d.; in a subsequent year for retention of name in the list the fee is 5/-. During the year 58 applications were received and granted. BATHS AND WASH-HOUSES. I am indebted to Mr. A. E. Read for the following notes : " The Public Baths and Wash-houses is a modern establishment, containing 3 largo swimming baths, 74 slipper baths, vapour, foam and medicated baths and Public Wash house. The filtration and chlorination plant, allows all the baths to be filtered, aerated and purified every 3¼ hours. Daily chemical tests are made and periodical bacteriological examinations of the Bath waters are carried out. For or the year ending 31st March, 1937, tho attendances were as follows:— Slipper Baths 68,742 Swimming Baths 152,684 Vapour and Medicated 2,872 Public Washers 15,015 Total 239,313 The Public Wash houses are extensively used and there is reason to believe could accommodate a greater number of mechanical washers, eliminating heavy bodily labour. In winter the first class bath is covered over and used as a hall for dancing, boxing and public meetings. The remaining two baths being kept open all the year round for swimming, mixed bathing being available every day." During the year a resuscitating plant was supplied to the Baths as a precautionary measure and the attendants were instructed in its use. The following table shows briefly the condition of the water at stated times. 44 GENERAL ANALYSIS OF SAMPLES OF BATH WATER TAKEN FROM SWIMMING BATHS. Sample No. 1 2 3 4 5 6 7 8 9 10 11 12 General Condition Good Good Good Good Good Good Good Good Good Good Strong smell of chlorine Satisfactory General Appearance Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear Bright & clear No. of micro-organisms developing on gelatin (aerobically) for 3 days at 68° Fah. Per C.C. 100 706 1,403 533 1,650 710 120 880 373 40 Nil 2,146 No. developing on Agar (aerobically) at 98° Fah. in 48 hours B. Coli present in 50 c.c. to 0.001 C.C. Per C.C. 1,326 903 1,550 796 3,020 776 1,163 470 40 376 Nil 723 Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Coliform Bacillus Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Streptococci present in 10 C.C.'s Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Remarks Satisfactory Very Satisfactory A good bathwater A good bathwater Satisfactory Firstrate bathwater Satisfactory Satisfactory A good bathwater A good bathwater Sterile due to containing 1 part per million chlorine Satisfactory 45 Rat Infestation.—Investigations in regard to premises, etc., alleged to bo infested with rats or mice wore carried out in 115 cases of which 72 were abated. Particular attention is given by the Inspectors to enforcing the law as regards sealing off of disused drains thus preventing the ingress of rats. The special measures adopted during Rat Week wore put into operation in conjunction with the Borough Engineer's Department. Public Sanitary Conveniences.—There are 8 Public Conveniences provided by the Council, in addition to 6 urinals, 5 Horse Troughs and 8 Drinking Fountains, which are cleansed daily by Attendants belonging to the Public Health Department. Watee Supply.—During the year 738 water supply certificates have been granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 399 cases, and extra water supply to tenement houses in 6 cases. Dogs—Fouling of the Footways.—Two infringements against the Council's Bye-laws dealing with this matter were reported. Small fines were inflicted in both cases. Shops Act, 1934.—During the year 142 visits were made under the provisions of the above Act, and it was only necessary to servo 9 notices for infringements under the Act. Two applications for Certificates of Exemption in regard to the provision of Sanitary convenience accommodation were granted. 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 subjoct to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, etc. At the end of the year 98 houses wore on the Register and 100 inspections were made by the Woman Inspector. No case called for legal proceedings. 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. Drainage.—During the year 110 plans of Drainage and other Sanitary works relating to existing and new buildings were examined and approved. 46 SUMMARY of WORK PERFORMED by the SANITARY INSPECTORS DURING THE YEAR 1936 Inspections— Houses inspected (House to House) 625 „ „ (Complaints, nuisances) 1,856 „ „ (Infectious Disease) 662 Re-inspections, calls made, etc. 18,024 Inspections of Factories 349 „ „ Workshops „ „ Workplaces „ Shops 142 „ ,, Stables and yards 16 „ „ Urinals 59 „ „ Cowsheds 6 „ „ Markets and stalls 853 „ „ Miscellaneous 1,622 ,, „ Houses let in Lodgings 100 „ „ Outworkers premises 137 Investigations (Rats and Mice) 115 24,566 Drains— Drains tested—by smoke 60 „ „ —-by water 250 „ found defective 47 Opened, cleansed and repaired 206 Reconstructions and additions 204 Inspection chambers constructed 122 New covers to manholes 76 Soil and vent shafts repaired or renewed 161 Traps (gully) 211 Drains sealed off, etc 165 Yards and forecourts drained 105 Waterclosets and Urinals— Closets erected 60 W.C. repaired 510 Sanitary conveniences or improvements effected to (a) Factories, (b) Workshops and (c) Workplaces 14 Pans or traps furnished 307 Urinals cleansed or repaired 34 Dustbins— Provided 268 Pavings— Yards and Forecourts ... 443 General Water Supply— Water Fittings amended 399 Extra water supply to tenement houses 6 Water supply certificates granted (Sect. 95) 738 Other Improvements— Houses generally repaired 2,287 Rooms cleansed and repaired 3,713 Rooms and staircases lighted and ventilated 393 Verminous room cleansed 127 47 Other Improvements—continued. Roofs, gutters and rainwater pipes repaired 1,451 Dampness abated 729 Sinks, baths and lavatory basins 628 Sink, lavatory and bath waste pipes trapped or amended 678 Stoves and fireplaces 421 Washing coppers repaired or provided 161 Floors repaired 425 Provision for storage of food 186 Miscellaneous repairs 4,237 Other Nuisances Abated— Illegal use of Underground room discontinued 2 Overcrowdings abated 79 Animals kept in unfit places discontinued or removed 14 Dung receptacles provided 6 Houses abolished, unfit for habitation 25 Accumulation of manure and other obnoxious matter removed 28 Rat infestation abated 72 Smoke Nuisances— Observations 25 Statutory Notices served (Sects. 147 and 148) 1 Notices, &c.— Intimations served under Public Health (London) Act, 1936 1,876 Statutory Notices served 244 Houses rendered fit by informal action 692 Return Made to London County Council. Proceedings during 1936. Premises No. in Borough at end 1936 No. of Inspections No. of Prosecutions Common lodging houses 1 4 - Seamen's lodging houses — — — Cowsheds (licensed) 3 6 — Slaughterhouses (licensed) 2 319 — Other Offensive Trades 2 2 — Milkshops 168 270 — Ice Cream Premises 121 135 — Restaurants and Eating houses 83 291 — Registered Foster Mothers 35 ] 202 — Nurse Children kept 39 - Smoke Nuisances. Number of observations 25 Number of Intimations served ... 4 Number of Statutory Notices served ... 1 Number of Complaints received 15 Number of legal proceedings — 48 Cleansing and Disinjecticm. Number of adults cleansed 11 Number of children cleansed 1,728 Number of premises cleansed— Aftor infectious disease 608 For Vermin 114 Water Supply to Tenement Houses. Number of Premises supplied 6 Number of Prosecutions — Number of houses in the Borough 21,174 Number of houses occupied by the working classes 16,522 Public Health (London) Act, 1891. Number of houses inspected on account of complaints or illness 2,618 Number of Statutory Notices served 244 Number of houses repaired or nuisances remedied 2,287 Housing Acts (1925-35). Number of houses inspected—house to house. (Housing Consolidated Regs. 1925) 625 Do. (Housing Act) 391 Number of houses included in representations by Medical Officer of Health under Sec. 1 of H. A. 1930 311 Number of houses demolished following representation of Medical Officer of Health 11 Number of houses repaired under Sections 17 and 18 of Housing Act, 1930:— By Owners 18 By Local Authority in default of Owners — Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 2 Number of Closing Orders determined — Number of houses in accepted schemes for redevelopment or reconditioning by owners under Part 5 of the Housing Act, 1935 37 NumbEr of certificates of fitness issued under Section 55 of the Housing Act, 1935 — 49 Number of houses erected during the year:— Borough Council 79 London County Council 396 Private Enterprise 263 Number of houses let in lodgings 98 Number of inspections made in respect of above 100 Underground rooms. Number occupied but unfit under Section 18 of H. A., 1925 as modified by Section 84 of Housing Act, 1935 17 Number closed or modified, occupation approved under Section 84 of the Housing Act, 1935 1 Overcrowding (Housing Act, 1935). Number of overcrowded families who have found alternative accommodation 79 50 SECTION D. HOUSING. Slum Clearance.—During the year 19 Representations were placed before the Council, and the slum clearance programme is being carried out according to plan. Areas represented involved 223 houses. Cloarance Orders have been made in respect of 13 areas. Eight Enquiries have been held by the Minister of Health either in connection with Clearance Orders or Compulsory Purchase Orders. Re-housing.—Provision of dwellings for re-housing the families is being maintained, but the difficulty of providing dwellings near the sourcos of employment and the question of economic rents are still being met with. 79 houses were erected and occupied thus completing the Council's Housing Scheme on the Victoria Road and Charlton Lane Sites. Blocks of flats erected by the London County Council in the Thames Street area were also completed and provide for 396 tenements, whilst 263 houses have been erected by private enterprise. Underground Rooms.—It was stated in the report for 1935 that there were approximately 500 basement rooms, of which a small number might be dealt with under the relevant sections of the Housing Act. Owing to the pressure of other work, it was found impossible to make a detailed survey of the situation. It is hoped in next year's Annual Report to give a statement following such a survey, and the action taken as a result. Overcrowding.—It is hoped in the report for 1937 to give a statement as to the abatement of overcrowding and particulars regarding fresh overcrowding, which may have occurred since December 1935. 1935 Survey—Housing Act, 1935. The position was not given graphically in the report for 1935. The table now shown indicates the position with regard to overcrowding in the Borough existing at the end of 1935. The heavy diagonal black line divides the table into two portions. Those figures below the line represent the number of families overcrowded. Those above the line on the other hand, represent the numbers of families not overcrowded. The completion of the survey showed that 15,981 dwellings were inspected. The number of families involved was 20,540. OVERCROWDING SURVEY. Summary of Houses Surveyed in Greenwich. Equivalent number of persons in family Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 Overcrowded Not Overcrowded Total 1 3 905 12 545 3 — 316 — — — 180 — — — 45 — — 36 — — 15 — — — 5 ‡‡‡‡‡‡‡‡ 2065 2065 1½ 1 2 5 15 2 — 11 - - - 2 - - - 58 - - 1 - - - - - - 24 1 120 121 2 2 11 t73 1116 36 — 1729 2 3 — 1024 — — — 333 — — 255 — — 102 — — — 14 †16 4684 4700 2½ — 4 20 13 318 1 660 1 9 — 320 — — — 217 — — 56 — — 7 — — — 43 24 1645 1669 3 — 4 25 19 252 2 1093 6 38 — 1229 1 3 2 540 — — 372 — — 151 — — — 26 48 3715 3763 3½ — — 5 2 82 1 283 5 30 — 310 — — 3 264 — — 79 — — 20 — ' — — 71 89 1066 1155 4 1 1 4 5 69 12 26 67 310 1 844 2 2 11 534 1 1 372 — l 171 — — — 29 92 2372 2464 4½ — — 5 5 20 1 12 26 109 1 229 2 3 5 185 — 1 62 — — 35 — — — 52 43 710 753 5 — 1 3 7 26 1 14 47 157 3 471 10 11 21 335 — — 227 1 l 146 — — — 21 99 1404 1503 5½ — — — — 14 3 9 19 65 — 161 2 4 4 125 — — 53 1 — 23 — — — 40 110 413 523 6 — — 1 2 16 3 10 25 89 12 29 26 54 70 157 4 — 120 1 — 80 — — — 15 158 556 714 6½ — — — — 9 — 4 5 40 5 10 20 22 21 54 1 1 38 — — 24 — — — 22 73 203 276 7 — — — — 4 1 3 5 43 2 15 19 29 30 76 3 1 51 2 — 31 — — — 9 92 232 324 7½ — — — — 4 — 5 5 15 2 3 11 12 13 38 1 — 14 1 — 8 — — — 20 57 95 152 8½ — — — — 4 — 2 3 14 8 9 8 11 18 1 11 6 41 2 — 19 — - — 9 77 89 166 8½ — — — — 2 — — — 12 4 1 3 8 9 4 5 3 5 — — 5 — — — 7 43 25 68 9 — — — — 1 — — 1 4 — 1 5 2 5 1 4 2 10 4 — 4 — — — 4 24 24 48 9½ — — — — 1 — — 1 3 1 — 2 3 4 — 1 4 — 2 l 6 — 1 — 1 20 11 31 10 — — — — — — 1 — — — 2 3 1 — 1 2 2 — — 4 — — — 1 12 5 17 10½ — — — — — — — — 1 — 1 — — 1 2 — — 1 2 1 — — — 5 6 8 14 11 — — — — — — — — — — — 1 — 1 — — — 1 — 1 1 — — — 1 4 2 6 11½ - - - - - - - - -- - - - 1 - - - - - - - - - - - 1 1 1 2 12 - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 — 1 12½ - - - - - - - - - - - - - - - - - - - - - - - - 4 — 4 4 13 - - - - - - - - - - - - - - - - 1 - - - - - - - - 1 — 1 Totals of Dwellings Not Overcrowd'd 4 21 f66 40 252 21 59 112 286 34 39 52 40 38 6 8 7 3 2 1 — — — — — 1091 ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡‡‡ /VOT Overcrowd'd 3 907 87 1689 611 4 4118 107 656 5 4799 63 128 180 2962 26 15 1792 14 5 853 — 1 — 424 ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ 19449 ‡‡‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡‡‡ Total 7 928 153 1729 863 25 4177 219 942 39 4838 115 168 218 2968 34 22 1795 16 6 853 — 1 — 424 ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ ‡‡‡‡‡‡‡‡ 20540 20th January, 1936. t Includes 3 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 51 Of these 1,091 were found to be overcrowded and the persons living under these conditions, 6,337. The figure of 1,091 includes 3 families with insufficient accommodation to secure proper sex separation. The number of new dwellings found necessary to abate the overcrowding would be 271. This figure however includes properties owned by the London County Council who have undertaken to provide the requisite accommodation thus reducing the number to 240 dwellings. At the end of the year the Minister of Health made an Order fixing the 1st January, 1937 as the " appointed day " for the purpose of Section 6 of the Housing Act, 1935. This section provides that within a period of six months every rent book or similar document must contain prescribed particulars relating to overcrowding. The 1st July, 1937 is accordingly fixed as the " appointed day " after which date overcrowding becomes an offence. Towards the close of the year therefore, details of a scheme for the measuring up of houses in the Borough in order to estimate the permitted number for each house, was being considered by the Housing Committee. As mentioned in the opening remarks in this Section of the Report it is not yet possible to give a definite figure as to overcrowding at December, 1936, but it is known that 62 families have been given new accommodation by the Council whilst the London County Council have rehoused 447 families making a total of 509. Of these cases in 142 instances the particulars of the families were given, i.e., number and accommodation vacated, and taking the standard of overcrowding as laid down by the Housing Act, 1936 it was ascertained that 37 were definitely overcrowded. In addition 42 families from Clearance Areas first represented in 1935 have been re-housed thus making a total of 79 cases of overcrowding relieved during the year. The following statement submitted by the Housing Inspector shows the progress made in regard to unfit houses dealt with under the Housing Act, 1930 (now re-enacted in Housing Act, 1936). Notices of intention to survey served 489 Houses surveyed for prospective clearance 306 Individual Houses. Houses or parts surveyed 49 52 Houses subject to informal notice requiring repair—42a, 44a, 46a, and 48a, Bellot Street 4 46, Charlton Lane 1 4, 6, 8, 10, 12 and 14, Lassell Street 6 22, Armitage Road 1 124, Creek Road 1 — 13 Houses reconditioned (informal notices of previous year) 17 Houses—Work in progress. 20 Houses recommended for demolition or closure 23 Houses demolished or parts closed 10 Underground rooms recommended for closure 0 Redevelopment schemes submitted by owner under Housing Act, 1935, Sec. 55. Newcastle Street—16 houses in progress. Hadrian Street—21 houses not commenced. Caradoc Street—10 houses not commenced. Total Visits. Surveys 355 Visits for sampling and enquiry 667 Re-visits 1,008 Miscellaneous visits 401 2,431 HOUSING RETURN, 1936. 1. Inspection of Dwelling-houses during the year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,634 (b) Number of inspections made for the purpose 10,902 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 625 (b) Number of inspections made for the purpose 937 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 311 53 (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 2,350 2. Remedy of Defects during the year without Service of Formal Notices:— Number of defective dwelling-houses rendored fit in consequence of informal action by the Local Authority or their Officers 710 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 — (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (а) By owners — (б) By local authority in default of owners — (b) Proceedings under Public Health Acts :— Notices served : (1) Number of dwelling-houses . in respect of which notices Intimation 1,876 were served requiring de Statutory 244 fects to be remedied (2) Number of dwolling-houses in which defects were remedied after service of formal notices :— (a) By owners 1,595 (b) By local authority in default of owners — (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 11 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 11 (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 2 54 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendeed fit — 4. Housing Act, 1935—Overcrowding:— (a) (i) Number of dwellings ovorcrowded at the end of the year 1,012 (ii) Number of families dwelling therein 1,012 (iii) Number of persons dwelling therein 5,942 (it) Number of new cases of overcrowding reported during the year — (c) (i) Number of cases of overcrowding relieved during the year 79 (ii) Number of porsons concerned in such cases 398 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to crowding conditions upon which the Medical Officer of Health may consider it desirable to report — Number of houses and/or flats erected during the year :— By Borough Council 79 By London County Council 396 By Private Enterprise 263 65 SECTION E. Inspection and Supervision of Food. Milk Supply.—The majority of milk supplied to this Borough is obtained from farmers and large firms outside the district. There is howover, one farm in the Kidbrooke district whore approximately 100 cows are kept and routine inspections are made by the Inspector. Owing to the rapid development of the Housing Estates in this area it would appear that it can only be a question of time before this one remaining farm is finally absorbed for building purposes. Milk and Dairies (Amendment) Act, 1922.—Milk and Dairies Order, 1926.—At the commencement of the year there were 187 purveyors of milk on the Register of Dairies and Milkshops. Eleven new applications have been receivod during the year and added to the Register, and fifteen names have been takon off, thus leaving a total of 183 purveyors of milk now registered. The number of premises registered at the end of the year was 60. Two hundred and seventy visits of inspection of dairies, and shops where milk is sold in sealed cartons or bottles, have been made ; as a result of which lime-washing, cleansing or painting was carried out in eleven cases. At the end of the year there were eleven wholesale purveyors of milk on the Register. Milk (Special Designations) Order, 1936.—On 1st June a new Ordor came into force revoking the early one of 1923 and now the only designated milks are Tuberculin Tosted, Accredited and Pasteurised but licences granted under the old Order were allowed to continue in operation until the 31st December, 1936. During the year the following licences were granted sale of graded milk:— for the Distribution of Certified Milk 2 „ „ Grade A (Tuberculin Tested) 5 „ ,, Pasteurised 26* „ „ Grade A (Pasteurised) 4 † Supplementary Licences 4 † Principal Licences granted by the Lewisham Borough Council. *One Licence was granted for part of year under Milk (Special Designations) Order, 1936. Result of Analytical Examinations.—One hundred and fifty-five 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 155 66 samples, 12 were taken from handcarts in the streets and 45 from local Hospitals and Schools. Bacteriological Examination.—At the request of the London County Council samples of milk were taken on arrival at the Brook Hospital (16) and St. Alfege's Hospital (12), the milk being supplied under contract as Pasteurisod. All the samples taken passed the standard laid down by the Milk (Special Designations) Order, 1923-36, which is that bacteria per c.c. shall not exceed 100,000. Milk Supply—Presence of T.B.—During the year nine samples of Milk were taken for the purpose of detecting the presence of tubercle bacilli, one of which was returned as positive. Detailed enquiries elicited that the offending sample was part of a largo consignment of milk produced by five farms situated outside the Borough. Full particulars were at once despatched to the Kent and London County Councils and a series of veterinary examinations were made at the farms and control samples were taken resulting in the slaughter of tho animal infecting the supply. On the advice of the Food Inspector the dairyman handling this milk supply has placed an order for a Holder Pasteurising Plant. Seizure of Unsound Food.—Despite the frequent visits paid to Butchers' shops, only one seizure of unsound meat was necessary during 1936. In this instance as a result of a visit by the Food Inspector, a large portion of ox-liver covered with multiple abscesses was seized. At the subsequent Police Court Proceedings the defendants successfully pleaded that the meat was not intended for sale, and the magistrate, in dismissing the case with costs awarded to the Council, stated that it was imperative that the food of tho people should be carefully scrutinized. Ozonisation of Meat.—In recent years certain consignments of imported meat have reached the cold stores, situated in certain Riparian boroughs smelling and tasting of such pungent flavours as orange, apple, or even fuel oil, without any visible signs of such contamination being present. It is known that this would render such meat far less marketable and would also have a detrimental psychological effect upon the consumer; not to mention the damage caused to a shop which supplied such meat. To remedy this a large cold air store in Greenwich has been fitted with six ozone producing machines capable of removing such gaseous contamination as may be absorbed by meat subject to possible contact with the heterogeneous cargo of the modern freighter. Such meat has arrived here from many parts of the country and after treatment reaches the market in a palatable and wholesome condition. 57 Inspection of Meat and Other Foods. During 1936 the following diseased and unsound articles of food were surrendered:— Weight (A.V.D.P.) Tons. Cwts. Stones. Ibs. Beef, Pork, Mutton, Lamb, Offals, etc. 8 4 - Fish 1 1 - Fruit and Vegetables 14 7 2 Provisions (Tinned Hams) 4 10 Total Weight 1 5 — 12 Miscellaneous Provisions Surrendered.— Bags of Shell Fish 1 Bottles of Pickles 7 Cans of Condensed Milk 34 Cartons of Brawn 12 Tins of Tomatoes 2 Total 56 Slaughter-houses and Knackers' Yards.—There were two slaughter-houses and one knacker's yard in the Borough at the end of 1936, all of which are licensed annually. Two hundred and seventy-four visits were made by the Food Inspector and forty- five by the District Inspectors. Meat Inspection (Slaughter-houses).—The following animals were slaughtered and examined locally:— Beasts 213 Sheep 1075 Pigs 292 1580 58 Empire Colonies, U.S.A., Argentine and China— Tons Beef, Mutton, Lamb, Pork, Poultry, Rabbits and Eggs 79,011 Total Imports from all sources 82,263 An increase of 10,118 tons over 1935. Meat Certified for Re-export in 1936. 82 hind quarters of Beef 15 fore quarters of Beef 224 loins of Pork 9 tons 15 cwt. 35 bags of Ox Livers No. of Certificates granted 3 Fees received £2 14s. 0d. Imported Food Surrendered.—During the year 1936 the following unsound and diseased imported foods were surrendered and sent by the importer, on instructions of the Food Inspector, to firms duly authorised to use such material for non-edible refining purposes:— Weight (A.V.D.P.) Tons. Cwts. Stones. lbs. 20 carcases of Mutton and Lamb (Caseous Lymphadenitis) 8 1 4 134 Carcases of Mutton and Lamb 13 4 5 4 208 Cut pieces of Mutton and Lamb (Brine-stained and decomposed) 61 bags of boneless beef (Mouldy and rat gnawed) 1 6 2 1 27 miscellaneous cuts of Beef (Brine-stain) 13 3 8 2 hind quarters of Beef (Boned taint) 3 6 10 3 cans of Lambs' Livers (Decomposition) 2 — 3 cases of skinned rabbits (Decomposition) 2 — 8 1 pack of Lambs' tongues (Decomposition) 1 4 1 pack of Pork pieces (Decomposition) 1 4 Total 15 19 — 1 An increase of 12 tons 6 cwts. 7 stones 7 lbs. over 1935. 59 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. Routine inspections are made with a view to seeing that the various Orders are complied with. On only 3 occasions was it found necessary to caution traders. AGRICULTURAL PRODUCTS (GRADING and MARKING) ACTS, 1928 and 1931. Various Regulations have been made from time to time by the Minister of Agriculture and Fisheries under the above Acts 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. The following additional Regulations came into force during the year:— Agricultural Produce (Grading & Marking)—Cream Cheese. ,, ,, ,, —Malt Extract and Malt Flour. ,, ,, ,, —Leicester Cheese. ,, ,, ,, —Lancashire Cheese. „ „ „ —Wensleydale Cheese. ,, ,, ,, —Plums. ,, „ ,, —Canned Vegetables. ,, „ „ —Fruit Juice. „ „ „ —Syrups. ,, ,, ,, —Eggs. FACTORIES WHERE FOOD IS PREPARED. There are six important factories where food is manufactured or prepared in this Borough; two mineral-water factories, one sweet factory, one vinegar factory and two large factories where the cutting, packing and despatch of imported meat is carried on. The Vinegar Factory.—Here damaged dried fruit or other imperfect material is used for the manufacture of vinegar, and it is the duty of the Food Inspector to examine such material and, if necessary, call for an analysis to ascertain that no harmful 60 ingredient is used in the manufacture of the food-product. During 1936 the following goods were examined:— 10 bags of Sugar Sweepings. 405 cases of Currants. 11¼ tons of Dates. Meat Cutting and Packing Factories.—Here a regular attendance is kept and the cutting and packing of meat given special attention. Table shewing Number of Visits made by Food Inspector during 1936. Slaughter-houses and Knackers'Yards 274 Eating Houses, Hotel Kitchens, etc. 291 Butchers' Shops 228 Dairies and Milk Shops 270 Wharves 166 Ice Cream Shops 135 Bakehouses 224 Preserved or Cooked Meat and Fish Shops 313 Other Premises where Food is Prepared or Stored 435 Visits re Merchandise, Marks Acts, and Orders 210 Miscellaneous Visits 182 ANALYSIS OF IMPROVEMENTS EFFECTED ON FOOD PREMISES. The following Table shows the number of instances improvements were effected as a result of the Food Inspector's inspections. Food Premises. Work Done. Slaughter Houses and Knackers' Yard Cleansing and Lime washing 12 Offal bins supplied 2 Eating Houses, Hotel Kitchens, etc. Unfit eating house closed down 1 Bakehouses General improvements effected 45 Lime washed or painted 74 Fried Fish Shop Other improvements effected 22 Frying rooms cleansed, etc. 2 Wharves and Cold Stores Other improvements effected 16 Meat chopping blocks repaired 1 Preserved Meat, etc. Battens supplied to protect meat 1 Shops Premises cleansed and renovated 7 Other improvements effected 11 Other Premises where Food is prepared or Stored Improvements effected 5 Butchers Shops Premises cleansed and renovated 4 Other improvements effected 24 Dairies and Milk Shops Cleansed and lime washed or painted 11 Yard paving repaired 1 Ice Cream Shops Premises cleansed and lime washed 5 Other improvements effected 10 61 Street Traders.—There are 90 Streot Traders who are engaged in selling articles of food. Genorally speaking, it was found that the premises where such articles of food were stored, were in all respects reasonably clean. Preserved Food Premises.—In accordance with the pro visions of the Public Health (London) Act, 1936, 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 (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 130 promises wore duly registered. These premises were inspected on 135 occasions and insanitary conditions remedied in 15 instances. Preserved Meat, etc., Premises.—At the end of the year 139 premises were on the register and were visited on 313 occasions. As a result of such inspections insanitary conditions were detected and remedied in 18 cases. There was no instance found which necessitated the cancellation of premises already registered. Food Bye-laws.—Bye-laws have been made by the London County Council under Section 183 of the Public Health (London) Act, 1936 for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport or exposure for. sale of any article intended to be sold for food for human consumption. These will come into operation on 1st January, 1937. Bakehouses.—Two hundred and twenty-four inspections have been made of the various bakehouses in the Borough, and 96 nuisances found therein have been abated. At the end of the year there were 24 factory and 14 other bakehouses on the Register, 12 of which were underground. Food and Drugs Acts.—Altogether 449 samples have boon taken under the provisions of the Food and Drugs (Adulteration) Act, 1928, and submitted to the Public Analyst for analysis of which number 230 were formal samples. Nine of these samples were certified to be not genuine, the adulteration thus being equivalent to 3.9 per cent. of the samples taken as compared with 5.1 last year. During the year it was found necessary to institute Police Court Proceedings in only one instance. The sample in question 62 was No. 101 (Malt Vinegar) and the case was dismissed on technical grounds. Public Health (Preservatives, etc., in Food) Regulations. —Only three infringements were reported by the Public Analyst under the above Regulations. They were two formal samples of Sausages and one informal sample of "Neck of Lamb." The two formal samples contained sulphur dioxide to the extent of 60 and 270 parts per million, and in each case a Warning Letter was sent to the Vendor. The presence of sulphur dioxide would have been permissible in both cases had a notice declaring the existence of such preservative been exhibited in the shop. In the case of the sample of neck of lamb, sulphur dioxide was present to the extent of 175 parts per million. This was duo to the addition of "Brynite" and "Sangster," both of which are meat preservatives. The use of "Sangster" has long been discontinued in the meat trade. It was originally used for washing meat particularly old stock, left over during hot weather, to which it imparted a bright red appearance. In this case the Vendor, who pleaded ignorance, was interviewed by the Pood Inspector and a Warning Letter was subsequently sent. Dried Milk.—There were no samples taken under the Public Health (Dried Milk) Regulations, 1923 and 1927, during the year. Condensed Full Cream Milk.—Five samples were taken during the year and in every instance the rules regarding proper labelling were observed. One sample however, did not comply with the standard laid down under the Public Health (Condensed Milk) Regulations, 1923 and 1927, by reason of the fact that it contained only 23.62 per cent. of milk solids, which was the equivalent of 0.22 pints less than the declared equivalent of 1.5 pints. Particulars as to the Brand and Importer were forwarded to the Ministry of Health. Wholesale Margarine Dealers.—There were no alterations to the register during the year and the following premises are still registered under the Food and Drugs (Adulteration) Act, 1928, where the business of a Wholesale Dealer in Margarine is carried on in the Borough:— 21, London Street. 144, Trafalgar Road. 42, Old Dover Road. Artificial Cream Act, 1929.—There is only one premises registered in connection with the above Act, viz.:— 14, Rochester Way. 63 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Number and Description of Samples Submitted for Analysis under the above Act during the Year 1936. FORMAL SAMPLES. Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Almonds, Ground 1 1 - Black Pudding 1 1 — Brawn 4 4 Breakfast Sausage 2 2 Butter 5 5 — Cake 2 2 Cheese 1 1 Cookeen (cooking fat) 1 1 — Cream 1 1 Curry Powder 1 1 — Dripping 1 1 — Fish Cakes 1 1 Fish Paste 2 2 Fruit, Dried 1 1 Galantine 1 1 Ginger, Ground 1 1 — Glauber's Salt 2 2 Grape Fruit Squash 1 1 — Health Salts 2 2 Ice Cream 11 11 Jam 1 1 Lard 2 2 Lemonade Crystals 1 1 — Macaroni 1 1 — Margarine 1 1 — Milk 152 147 5 Pearl Barley 2 2 — Pepper 1 1 — Piccalilli 1 1 — Sago 1 1 — Sauce 2 2 — Sausages 7 5 2 Suet and Rice Flour 1 1 — Sugar 3 3 — Table Jelly 1 1 — Tomato Ketchup 1 1 — Vinegar 5 5 — Vinegar, "Malt" 1 — 1 Whisky 2 1 Wine, Non-alcoholic 1 1 230 221 9 64 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 Almonds, Ground 2 2 - Apricots, Dried 1 1 - Asparagus, Tinned 1 1 — Beans, Tinned 1 1 - Blackcurrant Cordial 2 2 - Blanc-mange Powder 1 1 - Brawn 3 3 - Brisling, Tinned 1 1 - Butter 7 7 - Cake 1 1 - Cheese 12 12 - Cherries, Tinned 1 1 - Cherries, Glace 3 3 - Cinnamon 1 1 - Cocoa 1 1 - Coffee 2 2 - Crab, Tinned 3 3 - Cream 2 2 - Cream, Tinned 3 3 - Cream Cup 1 — 1 " Cream-O-Rice " 1 1 - Custard Powder 1 1 - Crystals from Tinned Salmon " Daisy " Powders 1 1 - 1 1 - Dripping 3 3 - Egg Substitute 1 1 - Fish Paste 4 4 - Fish Paste, Tinned 1 1 - Flour 5 5 - Flour, Self-raising 2 2 - Fruit, Dried Mixed 1 1 - Fruit, Assorted 1 1 - Fruit Drinks (Cordials) 3 3 - Fruit Salad, Dried 1 1 - Fruit Syrup 1 1 - Ginger, Ground 1 1 - Ginger, Preserved 1 1 - Gravy Thickener 3 3 - Grape Fruit Squash 1 1 - Herrings in Tomato Sauce 1 1 - Herring Roes, Tinned 1 1 - Halibut Liver Oil 1 1 - Honey 1 1 - Ice Cream 4 4 - Jam 1 1 - Lamb, Neck of 1 - 1 Lard 10 10 — 65 Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Lemonade Powder 2 2 - Lemon Squash 1 1 — Lentils 1 — 1 Margarine 8 8 — Marsh-mallows 1 1 — Meat Pie 3 3 — Milk 3 3 — Milk, Skimmed Condensed 5 4 1 Mincemeat 2 2 — Mint, Dried 1 1 — Mint Sauce 2 2 — Pearl Barley 6 6 — Parrish's Chemical Food Pastilles 1 1 — Pea Flour 1 1 — Peas, Tinned 2 2 — Pepper 3 3 — Pilchards, Tinned 2 2 — Pork Pie 1 1 — Prunes 3 3 — Rice 4 4 — Rolo (cooking fat) 1 1 — Sago 2 2 — Salad Cream 1 1 — Salmon, Tinned 6 6 — Sardines, Tinned 5 5 — Sauce 8 8 — Sausages 6 6 — Sild, Tinned 8 8 — Soup, Dessicated 3 3 — Suot 3 3 — Sugar X 1 — Table Jelly 4 4 — Tapioca 2 2 — Tea 3 3 — Tomatoes, Tinned 4 4 — Turkey and Tongue Paste 1 1 — Vinegar 4 4 — Vinegar, " Malt " 1 — 1 Wine Gums 1 1 - 219 214 6 66 Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Action taken H. 34 Cream Cup Contained no fat, the " cream " consisting of sugar, water, and other non-fatty substances Existing labels destroyed and new ones amended 457 Chipolata Sausages Contained 60 parts per million sulphur dioxide Warning Letter 476 Milk Slightly deficient in solids not fat Warning Letter 478 Milk Deficient in solids not fat to the extent of one per cent. Warning Letter H. 80 Condensed Sweetened Machine Skimmed Milk (1) Contained only 23.62 per cent. of milk solids. (2) Was the equivalent of 0.22 pints less than the declared equivalent of 1.5 pints Particulars forwarded to the Ministry of Health as to the Brand and the Importer 499 Milk Deficient in solids not fat to the extent of one per cent. No action taken 53 Sausages Contained sulphur dioxide to the extent of 270 parts per million Warning Letter 57 Milk Slightly deficient in solids not fat Warning Letter H. 149 Neck of Lamb Contained sulphur dioxide to the extent of 175 parts per million Vendor cautioned and Warning Letter sent H. 157 Lentils Consisted entirely of split peas Warning Letter 69 Milk Admixed with three per cent. of water Warning Letter H. 200 "Malt" Vinegar Contained not less than ninety per cent. of artificial vinegar Formal Sample taken 101 "Malt" Vinegar Contained not less than ninety per cent. of artificial vinegar Summons taken out. Case dismissed 125 Whisky The alcoholic strength of the sample was thirty-six degrees under proof Warning Letter 67 NOTIFICATION OF FOOD POISONING. Under tho provisions of the London County Council (General Powers) Act, 1932, which came into force on the 12th July, 1932, now re-enacted in the Public Health (London) Act, 1936, 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 6 cases notified during the year as compared with one for the previous year. Investigation was also made at the request of the Borough of St. Pancras in regard to a case of suspected food poisoning where the patient was taken ill after partaking of food at the Staff Canteen where she was employed. All the cases recovered with the exception of case No. 2, which unfortunately terminated fatally. The patient, a married woman, died within 33 hours after eating fried fish. At the Inquest it was ascertained that the woman had had fried fish for supper every night for months from the same shop. The shop-keeper giving evidence stated he had had 30 years experience and the portion sold to the deceased was part of a consignment he had bought, cleaned and fried the same day. The premises, like other fried fish shops, had been under the regular supervision of the Food Inspector and no complaint either with regard to the premises, utonsils or food had ever been made. It was noteworthy that no other cases were reported of suspicious illness in the same area. The medical evidence showed that death was actually due to septicaemia caused by ptomaine poisoning due to the fish. It is possible that that particular fish had become contaminated or itself had been poisonous as apparently no other fish was affected. Details of the cases are given in the following table:- 68 Case No. Initials of Patient Age and Sex District Date Suspected Notified Cause Remarks 1 G. T. 24 F Charlton 1. 7.36 Salmon Recovered 2 E. F. 48 F West Greenwich 25. 8.36 Fried Fish Died 3 J. S. 27 M East Greenwich 9.11.36 Veal & Ham Pie (Home made) Illness developed on 6.11.36—Vomiting and diarrhoea, continued for three days. Recovered 4 E. S. 26 F East Greenwich 19.11.36 ,, Notified on 10.11.36 as Gastro Enteritis. 5 M. S. 58 F East Greenwich 19.11.36 Re-notified on 19.11.36 as suspected Food Poisoning 6 M. M. 20 F West Greenwich 7.11.36 Meat Pie Recovered 69 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under the compulsory notification Section of the Public Health (London) Act, 1936, and the Orders and Regulations made there- under, 3,587 cases of Infectious Diseases were reported during the year. The following table shows the comparison since 1931. No. Year. 1,645 1931 3,497 1932 3,267 1933 3,226 1934 1,191 1935 3,587 1936 Particulars relating to age groups and districts are shewn in the tables at the end of the Report. Small-Pox.—There were no cases reported during the year. Public Health (Small-pox 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 87. Whooping-Cough.—Whooping Cough is only notifiable in a few London Boroughs of which Greenwich is one. Altogether 549 cases were notified compared with 128 for the previous year. 200 occurred in East Greenwich, 116 in West Greenwich, 33 in St. Nicholas and 200 in Charlton and Kidbrooke. Forty-seven cases were removed to Hospital for treatment. Diphtheria.—The number of patients notified as suffering from Diphtheria during the year was 258 as compared with 367, 422, 396 and 235 for the years 1935, 1934, 1933 and 1932. Two hundred and forty-seven cases were removed to Hospital. 70 Twenty-four were reported by the Hospital authorities as not suffering from this disease, and 19 Reports were received concerning patients who were discharged but still suffering from the following diseases:— Tonsillitis 10, Rhinitis 5, and Pyelitis, Streptococcal Laryngitis, Mumps and Enteritis, one each. The attack rate is equivalent to 2.69 per 1,000 population, but taking the estimated child population of the Borough as 23,308, the attack rate per 1,000 child population is 9.65. There were 3 fatalities due to Diphtheria which gives a case mortality of 1.16 per cent. In accordance with the Antitoxin Order, 1910, a supply of Antitoxin is provided by the Council for the use of general practitioners in emergency cases. Thirteen phials of Antitoxin, containing a total of 130,000 units of serum, have been supplied during the year. As a result of the applications and enquiries from parents regarding diphtheria prophylaxis, the Council resolved in September to inaugurate a modified scheme of Diphtheria Immunisation for the Borough. Under this scheme, facilities are given to voluntary applicants to enable their children to be Schick tested and immunised if necessary, at the Seamen's Hospital Laboratory. Dr. A. Davies, the Council's Pathologist, is responsible for carrying out the tests and immunisation. For each complete case, the Council pay an inclusive fee of 10/6 or 2/6 where a Schick test alone is found necessary. In addition to the above, similar terms of payment were agreed upon with the authorities of the Miller General Hospital, whereby Dr. W. Smith, the Pathologist, could immunise voluntary applicants who were patients of the Hospital. It was arranged that the Medical Officer of Health would approve the materials used and that the case record would be submitted to him before payment be made. It is not possible to make any statement as to the scheme, as it was inaugurated just before the close of the year. The Ministry of Health when giving approval to the scheme, asked that a report should be submitted after six months working. One thousand five hundred and fifty-one swabs were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 1,364 were reported to give negative or doubtful results, and 187 were positive in character, being dealt with accordingly. 71 Measles.—The usual biennial epidemic of Measles was responsible for 2,071 notifications, 51 of which were returned as German Measles. In the years 1934 and 1935 there were 1,455 and 72 respectively. Of the 2,071 cases, 205 were removed to Hospital. The age incidence and fatality of the disease were as follows: There were 89 cases under 1 year of age with 1 death thus giving a case mortality of 1.1 per cent. Between the ages of 1 to 5 years there were 867 cases with 4 deaths at this age period, giving a case mortality of 0.46 per cent. Between 5 to 15 years, 1,079 cases with 1 death with a case mortality of 0.09 per cent. and 36 cases 15 years and over. The case mortality for the whole Borough is 0.28 per cent. The quarterly incidence and distribution of the cases is shown in the following table:— TABLE SHOWING NUMBER OF MEASLES CASES REPORTED DURING THE YEAR 1936. Quarter ended 28th March, 1936. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich 9 144 187 1 2 343 West Greenwich 4 44 41 ___ 1 90 St. Nicholas, Deptford Charlton and 1 7 5 — — 13 Kidbrooke 8 84 201 5 1 299 Total 22 279 434 6 4 745 Quarter ended 27th June, 1936. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich 24 214 225 4 2 469 West Greenwich 6 69 85 160 St. Nicholas, Deptford 8 26 15 2 - 51 Charlton and Kidbrooke 28 256 300 11 4 599 Total 66 565 625 17 6 1279 72 Quarter ended 26th September, 1936. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich — 8 5 1 — 14 West Greenwich 8 5 _ _ 13 St. Nicholas, Deptford - 2 2 - - 4 Charlton and Kidbrooke 1 5 6 1 — 13 Total 1 23 18 2 — 44 Quarter ended 2nd January, 1937. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich — — 1 — 1 2 West Greenwich - - - - _ St. Nicholas, Deptford - - - - - - Charlton and Kidbrooke — — 1 — — 1 Total — — 2 — 1 3 Total Cases in Year = 2071. Zymotic Enteritis or Epidemic Diarrhoea.—Ninety cases were notified throughout the whole of the Borough, fifty-four being under one year of age and thirty-six, one to five. Forty-nine of such notifications related to patients in East Greenwich, nine in West Greenwich, twenty-four in St. Nicholas, Deptford, and eight in Charlton and Kidbrooke. There were twenty-seven deaths ascribed to Diarrhoea and Enteritis. Ophthalmia Neonatorum.—During the year six cases of this disease were notified compared with seven in the previous year. One occurred in St. Nicholas, Deptford, and five in Charlton and Kidbrooke. Only one case was removed to hospital for treatment. Scarlet Fever.—The number of notifications of this disease received during the year was 305 as compared with 301, 627 and 671 for the years 1935, 1934 and 1933. The cases were of a mild type and call for no special comment. Of the 305 cases, 147 were in East Greenwich, 53 in West Greenwich, 20 in St. Nicholas, Deptford, and 85 in Charlton and Kidbrooke. 282 cases were removed to Hospital for treatment 73 of which six were certified to be suffering on discharge from Hospital with the following diseases:—Tonsillitis and Ottorhoea, two each, and Laryngitis and German Measles, one each. There were only two deaths from Scarlet Fever during the year. Enteric Fever.—There were only five cases of Enteric Fever notified during the year, one case being in East Greenwich, two in West Greenwich, and two in Charlton and Kidbrooke. All were removed to Hospital for treatment. Each case was investigated, but the source of origin could not be traced. Seven specimens forwarded by medical practitioners for bacteriological examination from cases suspected to be Enteric proved negative. Puerperal Fever.—Four cases of this disease were notified during the year as compared with two last year. Two occurred in East Greenwich and two in Charlton and Kidbrooke. Two cases were removed to hospital for treatment. Puerperal Pyrexia.—There were nineteen cases attributed to this cause during the year as compared with eight for the previous year. Seven of the patients resided in East Greenwich, four in West Greenwich and eight in Charlton and Kidbrooke. Seventeen of such cases were notified from either hospitals or Maternity Homes. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever or Post-Basal Meningitis.—There was only one case of this disease during the year. This occurred in West Greenwich and was removed to Hospital for treatment. Acute Polio-Myelitis.—One case was notified during the year as compared with none for the previous year. Influenzal Pneumonia and Acute Primary Pneumonia.— During the year 83 cases of Influenzal Pneumonia and Primary Pneumonia were notified as compared with 101 last year. As provided in the regulations where nursing was inadequate a district nurse was sent in accordance with an arrangement with the local Nursing Association. Influenza, unless accompanied by pneumonia, is not notifiable. Tuberculosis.—During the year there were 160 cases of Tuberculosis notified in the Borough, as compared with 115 for the previous year. Of this number, 128 were pulmonary cases, ordinarily known as Consumption, and 32 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs. Of this number of cases, 34 pulmonary and 15 non-pulmonary 74 occurred in East Greenwich, 25 pulmonary and 4 non-pulmonary in West Greenwich, 18 pulmonary and 2 non-pulmonary in St. Nicholas, 51 pulmonary and 11 non-pulmonary in Charlton and Kidbrooke. The various ages of the patients were as follow:— Pulmonary cases: one to five, 3 cases; five to fifteen, 6 cases; fifteen to twenty-five, 48 cases; twenty-five to forty-five, 48 cases; forty-five to sixty-five, 21 cases; and 2 cases over sixty-five; whilst the Non-pulmonary were: between one and five, 4 cases; five to fifteen, 12 cases; fifteen to twenty-five, 5 cases; twenty-five to forty-five, 9 cases; forty-five to sixty-five, 1 case and over 65 years, 1 case. Three hundred and ninety specimens were forwarded by medical practitioners for bacteriological investigation from patients suspected to be consumptive; 338 were reported to be negative and 52 positive. Disinfection has been offered and carried out in 80 cases, including 145 rooms and 487 articles of bedding, etc.; disinfectant has been supplied to patients to disinfect sputum pots, etc., where necessary. 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:— 75 Rooms and Articles Disinfected, Year 1936. Diseases, etc. Premises Entered Rooms Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Scarlet Fever 276 334 163 2 117 146 460 527 362 30 356 966 3,129 Diphtheria 224 252 128 1 99 89 351 402 259 36 267 741 2,373 Tuberculosis 80 145 39 — 37 28 90 80 43 25 44 101 487 Cancer 16 23 6 8 9 31 17 8 — 10 30 119 Para Typhoid 3 4 2 1 1 8 5 4 1 22 Enteric Fever 4 4 1 - 2 3 13 7 2 2 1 12 43 Puerperal Fever and Pyrexia 1 1 1 - - 1 2 1 2 - 2 - 9 Chickenpox 5 7 - - 3 2 1 5 2 1 1 3 18 Measles 15 72 __ 3 1 5 9 7 4 30 59 Scabies 14 19 16 - 11 12 44 52 20 3 31 45 234 Other Diseases 60 63 8 - 66 8 132 326 16 19 11 42 628 Verminous Premises 48 62 11 2 33 8 38 93 11 - 17 24 237 Verminous (Housing G.B.C.) 40 - 46 - 64 31 63 22 15 3 22 24 290 Verminous (Housing L.C.C.) 12 12 20 — 7 14 30 17 9 7 7 15 126 Total 798 998 441 5 451 353 1,268 1,563 756 126 777 2,034 7,774 76 Articles Destroyed, Year 1936. Diseases, etc. Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Destroyed Scarlet Fever 2 - 2 - - 1 - - 1 - 6 Diphtheria 4 — 1 — 1 2 — — 1 1 10 Tuberculosis 3 — 2 2 6 — 2 2 — 57 74 Cancer 4 — 3 2 9 2 2 1 — 3 26 Measles 1 — — — 1 — — 1 — — 3 Other Diseases 12 4 12 5 6 2 — 1 1 14 57 Verminous Premises 25 2 25 13 26 3 — 4 1 610 709 Total 51 6 45 22 49 10 4 9 4 685 885 77 REPORT OF THE TUBERCULOSIS OFFICER. To The Medical Officer of Health. Sir, I beg to submit the report for 1936. It is somewhat condensed as the Council's scheme has been fully described in previous years and my appointment has been too recent to allow the making of a comprehensive survey. Good relations continue to exist between the general practitioners of the area and the Dispensary. Inter-departmental co-operation has also been satisfactory. Notifications.—Notifications were received during the year in respect of 128 pulmonary and 32 non-pulmonary cases, representing an incidence of 1.25 per 1,000 population for the pulmonary form and 0.24 for the non-pulmonary forms of the disease. At the end of 1936 the notification register consisted of 647 cases as compared with 647 in 1935. The total is made up as follows:— Adults. Children. Total. Males. Females. Pulmonary 253 189 48 490 Non-pulmonary 31 36 90 157 Deaths.—Deaths during 1936 numbered 73, equalling a rate of .76 per 1,000 population for all forms of the disease. The pulmonary type accounted for 66 of the deaths, representing a death rate of .68. The Death Notification interval of the 66 persons who died from pulmonary tuberculosis in 1936 is shown below:— Information from Death Returns 6 Died within one month of notification 7 Died within three months of notification 5 Died within six months of notification 4 Died over six months of notification 44 In the case of 6 deaths which occurred before notification the reasons obtained on enquiry were as follows:— a. In five cases, tuberculosis was discovered as a contributory oause of death on post mortem examination. b. In one case, the Medical Practitioner attending the patient for tuberculosis, was under the impression that the case had been previously notified. 78 Public Health Tuberculosis Regulations, 1925.—During the year under review no action was required under these Regulations. Occupations.—A consideration of this question does not reveal any influence of occupation in the incidence of tuberculosis in the Borough. Housing.—In some 35 cases during the year special recommendations were made to the Public Health Committee of the Council and to the London County Council for re-housing of families that included a person with tuberculosis. In many cases suitable offers of accommodation had to be refused because of distance from work or an increase in rent. It would seem that from whatever aspect the tuberculous family is approached the economic factor becomes an obstacle at some point, under the present circumstances. Dispensary—Routine Matters.—Following representations to the Public Health Committee as to the increasing volume of clerical work, a full time clerk was appointed to the Dispensary in April of this year. This appointment has eased the burden of correspondence and record keeping formerly performed by the Tuberculosis Officer. About the same time it was decided to keep the Notification Register at the Dispensary to save needless duplication of records. In practice it has been found that very few of the notified cases fail to come in the Dispensary Register as we pointed out in last year's report. This change has made for more effective administration. 772 new patients were dealt with during the year, including 26 transfers. The sources from which those patients came were as follows:— Doctors 336 Hospitals 66 Schools 14 Own application 116 Nurses 240 (including 185 contacts). Contacts.—185 Contacts were examined during the year, 8 of whom were found tuberculous. Numbers examined vary according to the district in which the original case arose. For instance, of 96 contacts in West Greenwich district 82 were prevailed upon by the nurse to come for examination. As it was pointed 79 out last year, many of those contacts who dislike attending the Dispensary are examined privately by their own doctor who would refer the case for closer investigation if any doubts were felt. In this way some "new cases" are examined who are really contacts. Only those attending as a direct result of the nurse's visit are counted as "contacts." Residential Treatment.—The London County Council issued a revised scheme for treatment of tuberculosis during the year. The scheme includes provision for the issue of travelling expenses to necessitous patients accepted for admission to the Council's institutions. It also provides for the issue of travelling expenses in necessitous cases where a relative was obliged to visit a patient in an emergency upon the request of a Medical Officer of a Sanatorium. Hospital Visits.—The Tuberculosis Officer has paid visits regularly to St. Alfege's Hospital during the year. This is considered very helpful, as it means patients have continuous supervision. Many doubtful cases have been seen in consultation with the resident Medical Staff, and such consultations as in the case of those under treatment, are beneficial to the Tuberculosis Officer and the Medical Officer connected with the cases. X-Ray Examinations.—The arrangements made with the London County Council relative to the carrying out of X-Ray work at St. Alfege's Hospital, continue to give satisfaction. There were 554 examinations carried out in 1936, as compared with 533 in the previous year. In April 1936, the London County Council agreed to make no charge for screen examinations when the Tuberculosis Officer carries out the work, and to apply a flat rate of 2/6 for skiagrams. At all times, every facility has been afforded and the smoothness of the routine generally is a matter for gratification. The only possible drawback is structural. It is felt that dressing room facilities are inadequate but it is thought that this point may receive attention. Artificial Pneumothorax Refills.—The agreement reached in 1934 with the London County Council regarding the provision of this continuation treatment at St. Alfege's Hospital has proved satisfactory. It means that patients can be attended to at one centre instead of various hospitals at a distance. The cost is reduced to half when the Tuberculosis Officer carries out the work and approximately 200 refills have been given in connection with the Dispensary during 1936. 80 Ultra Violet Light Treatment.—93 cases were referred for treatment in 1936, as compared with 92 in the previous year. The following table shows the classification of cases for whom it was recommended:— No. Non-tuberculous respiratory conditions (the majority being children with bronchial catarrh) 27 Subnormal children including some ' contacts ' of socalled pre-tuberculous type 29 Debility following various infectious diseases 11 Rheumatic conditions 6 Adenitis (non-tuberculous) 10 Adenitis (tuberculous) 8 Tuberculous Joints 2 2,136 treatments were given altogether, the majority being general exposures. It is hardly necessary to add that the greatest care is taken to prevent contact between tuberculous and other patients. This is possible because of the small number of tuberculous cases considered suitable for this treatment. Dental Report.—Mr. G. F. Ferris, the Council's Dentist, submits the following figures relative to tuberculous cases treated during the year. Sessions 27 Filling and Scalings 35 New Patients 29 Advice 9 Attendances 111 X-Ray 1 Dentures 5 Extractions:— Gas 33 Local 20 — 53 Open Air School.—Many children were recommended for admission to the Open Air School during 1936. Some 50 children are on the roll, and they are seen at intervals by the Tuberculosis Officer. Once again, special mention must be made of the remarkable improvement seen in these sub-normal or 'contact' children after a period at the School. It is a tribute to the care and attention bestowed on them. 81 Convalescent Treatment.—Some 15 children were recommended for periods of convalescent treatment. Arrangements were made by the Invalid Children's Aid Association, who dealt quickly and sympathetically with all such cases. Subnormal 'contact' children and the bronchitic type of child, were those usually recommended. In most cases satisfactory improvement in the general and local condition resulted. 'Boarding Out' of Contacts.—In the case of 6 families, this special arrangement for children was utilised. In other cases where this scheme was considered, suitable alternative methods were adopted, relatives usually undertaking to care for the children. Care Work.—The foundation of a Care Committee with a secretary or an almoner, has been given consideration by the Public Health Committee, following representations by the London County Council. After many adjournments, it was finally decided that no action be taken and that the Public Health Committee continue to act as a Care Committee as before. Seven garden shelters belonging to the Council have been in continuous use during the year. Bedsteads and bedding were obtained for patients needing isolation at home. Three bedsteads are on loan and these, together with the fourteen pairs of blankets obtained as a result of a donation from the Alexandra Day Fund last year, have been of the greatest help. Gifts of personal clothing were made to necessitous patients as a result of the kindness of various friends of the Dispensary Nursing Staff. In addition, help was obtained from the British Legion, Mayor's Fund, etc. Thirty cases were referred to the Public Assistance Authorities during the year. All such cases recommended were considered sympathetically and in the majority, assistance and extra nourishment were allowed. Dried milk was issued from the Dispensary as a form of extra nourishment to some cases. In a few suitable cases, dental attention and dentures were obtained through the Council's scheme. In accordance with Article XII of the Tuberculosis Regulations, 1930, a scheme for supply of extra nourishment to certain cases was commenced in May 1936. Such cases are those who are waiting for admission to Sanatorium or are convalescing after discharge, who are not eligible for Public Assistance and where a reasonable probability of eventual return to work exists. 82 Handicraft Centre.—This continues its good work guided by Mr. Worlock. During the year the class was changed from Friday morning to Monday afternoons. It was hoped that the Centre could be affiliated to the National Association for the Prevention of Tuberculosis, in order to take part in the Sale of Christmas Seals. Twice previously the application was turned down. There is reason to believe however, that it may be possible to benefit by affiliation next year. The class roll was sadly depleted towards the year end by the loss of several of its most enthusiastic members. It is hoped however, that the Centre will get back to its normal standard during the coming year. A carpenter's bench has now been added to the equipment and new ventures may in the near future be undertaken. The usual Summer Outing and Christmas Party were organized by members of the Handicraft Committee who deserve the praise of all associated with the work. In conclusion I should like to acknowledge my indebtedness to the other members of the Tuberculosis Department Staff whose work is reflected in the body of this report and the statistical tables appended, and also to Mr. Duck for his assistance in auditing the accounts of the Handicraft Centre. I am, Sir, Yours faithfully, W. ALCOCK, M.B., D.P.H., Tuberculosis Officer' 83 GREENWICH TUBERCULOSIS HANDICRAFT CENTRE. WORKING ACCOUNT Year ended 31st December, 1935. £ s. d. £ s. d. £ s. d. £ s. d. To Stock in hand (1.1.35) By Sales:— Materials 11 0 0 Handicraft Hut 35 2 8 Articles 17 0 0 28 0 0 ,, Stock in hand (31.12.35) „ Purchases 25 12 5 Materials 18 16 0 ,, Patients' Awards 21 17 10 Articles 15 0 0 ,, Heat, Light and Insurance 9 3 6 „ Deficit 33 16 0 32 9 11 ,, Maintenance and Repairs 10 14 6 „ Students' Fees 1 11 0 ,, Sundry Expenses 4 9 4 £101 8 7 £101 8 7 Audited and found correct. W. J. WORLOCK, H. W. DUCK. Hon. Treasurer. 84 TUBERCULOSIS. NEW CASES and MORTALITY—Year 1936. Age-Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 - - - 1 2 2 3 1 — — — — 6 2 1 3 3 1 — — — 10 3 1 3 5 — — — 1 15 14 12 — 1 1 1 — 1 20 15 18 1 2 11 3 — — 25 24 23 4 3 10 7 1 — 35 17 5 — 2 9 2 2 — 45 13 3 1 1 9 2 — — 55 9 2 2 — 4 2 2 — 65 and upwards 4 1 1 — 4 — — — Totals 103 68 18 18 49 17 5 2 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 77 to 82. 85 Return showing the work of the Dispensary for the Year 1936. DIAGNOSIS Pulmonary Non-Pulmonary Total Grand Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 68 42 6 6 5 7 6 7 73 49 12 13 147 (b) Diagnosis not completed — — — — — — — — 5 5 6 4 20 (c) Non-tuberculous - - - - - - - - 113 123 90 60 386 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 2 - 2 - - 2 - 2 2 2 2 8 (b) Diagnosis not completed — — - — - - — - — — 4 4 8 (c) Non-tuberculous - - - - - - - - 27 52 31 59 169 C.—Cases written off the Dispensary Register as:— (a) Recovered 18 16 10 6 2 2 11 5 20 18 21 11 70 (6) Non-tuberculous(including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — - - - - - - 140 176 123 119 558 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 211 159 24 11 22 30 43 13 233 189 67 24 513 (6) Diagnosis not completed - - - - - - - - 5 5 10 8 28 86 1. Number of cases on Dispensary Register on January 1st 532 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 34 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 77 4. Cases written off during the year as Dead (all causes) 58 5. Number of attendances at the Dispensary (including Contacts) 2,930 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 8 7. Number of consultations with medical practitioners :— (a) Personal 19 (b) Other 336 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 95 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,372 10. Number of:— (а) Specimens of sputum, etc., examined 242 (b) X-ray examinations made in connexion with Dispensary work 554 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above — 12. Number of " T.B. plus" cases on Dispensary Register on December 31st 257 87 Supplemental Vaccination Return for 1935. Return made on or before the 13th of February, 1937, 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 from 1st January to 31st December, 1935, inclusive:— Registration SubDistricts comprised In the Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec., 1935 Number of these Births duly entered by 31st Jan., 1937 No. of Biiths which on 31st Jan., 1937, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1937, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1936 No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1936 Successfully VacciDated Insusceptible of Vaccination Had Smallpox Certificates of Conscientious objection received Died. Unvaccinated Postponement by Medical Certificate Removal to Districts, V.O. of which apprised Removal to places unknown and cases not found East Greenwich 923 463 3 — 288 33 16 21 25 74 — — *West Greenwich 223 98 1 — 65 7 2 1 20 29 — — Charlton and Kidbrooke 680 314 3 — 269 24 8 24 19 19 — — Total 1,826 875 7 — 622 64 26 46 64 122 796 737 *Includes St. Nicholas District. E. S. Elliott, Vaccination Officer. Dated 8th February, 1937. METEOROLOGICAL TABLE. (From Observations at Greenwich, under the Superintendence of the Astronomer Royal). 1936 Air Temperature Bright Sunshine Rain & Other Forms of Precipitation Mean of Mean of A and B Difference from Average† Daily Mean Difference from Average Per cent of Possible Total fall Difference from Average† Most in a day A B Amount Day of month Maximum Minimum ºF ºF ºF ºF Hr. Hr. % mm. mm. mm. January 45.1 36.2 40.7 + 0.6 0.74 —0.55 9 89 + 46 13 28 February 42.7 31.8 37.3 —3.0 2.25 + 0.12 23 36 — 4 9 17 March 53.2 38.7 45.9 + 2.6 2.52 —0.76 21 25 —19 5 31 April 52.3 37.4 44.9 —2.4 3.55 —1.20 26 38 + 1 9 20 May 64.6 45.2 54.9 +0.2 5.55 —0.95 36 10 —34 4 22 June 71.4 52.6 62.0 + 2.8 6.04 —0.69 37 87 + 36 15 19 July 70.6 54.0 62.3 —1.0 4.44 —1.96 28 74 + 14 12 14 August 73.3 53.7 63.5 + 1.0 5.55 —0.54 38 14 —42 9 10 September 67.3 52.6 59.9 + 2.1 2.82 —2.20 22 80 + 35 30 20 October 56.8 42.0 49.4 —1.7 2.80 —0.37 26 46 —18 14 31 November 48.6 38.7 43.7 + 0.5 0.78 —0.88 9 77 + 19 20 11 December 46.9 36.9 41.9 + 1.1 1.32 + 0.32 17 50 — 7 16 14 Year 57.6 43.3 50.5 + 0.2 3.20 —0.81 26 625 + 29 30 Sept. 20 † The averages of temperature and sunshine used are obtained from observations extending over 30 years (1901-1930), those of rainfall are for the 35 years (1881-1915). i. Index of Contents. a. Page Adoptive Acts, By-laws and Local Regulations 5 & 6 Age Mortality 18 Agricultural Products (Grading and Marking) Act, 1928 59 Ambulance Facilities 24 Ante-Natal Clinics 28,29 Area of Borough 9 Articles and Rooms Disinfected 75 Articles Destroyed 76 Artificial Cream Act, 1929 62 Artificial Sunlight Treatment 25, 34 b. Baths and Washhouses 43 Baby Week Celebrations 33 Bacteriological Examinations 23, 56, 70 Bakehouses 61 Birth Control 33 Births 15 c. Cancer 22 Cerebro-Spinal Fever 73 Children Acts 37 Cleansing Children 42 Clearance Areas 50 Clinics and Centres 24 Common Lodging Houses 41 Complaints 38 Condensed Milk 62 Contacts 78, 81 Convalescent Treatment 34, 81 Cowhouses 55 d. Dairies, Cowsheds and Milkshops 55 Deaths 16 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality 18 Density of Population 9 Dental Work 33, 80 Diabetes 24 Diarrhoea and Zymotic Enteritis 21, 72 Diphtheria 21, 69 Diphtheria Anti-Toxin 70 Diptheria Immunisation 70 Disinfection 74-76 Drainage Work 45 Dried Milk 36, 37, 62 Duties and Powers of the Public Health and Maternity and Child Welfare Committees 5, 6 ii. INDEX—continued. Page E. Elevation of Borough 9 Enteric Fever 21, 73 Enteritis 21, 72 Epidemic Diseases 20 Extracts from Vital Statistics 13 f. Factories and Workshops 38,39, 40, 59 Food and Drugs—Samples of 61, 63-66 Food Poisoning—Notification of 67, 68 Food—Premises for Preparation of, etc. 60 Food—Inspection of 55 Foot Clinic 24 Footway—Fouling of 45 Food Bye-Laws 61 G. General Statistics 9 & Appendix h. Handicraft Centre 82, 83 Health Centres 27-29 Health Propaganda 33 Health Visitors, Visits, etc. 34,35 Heart Disease 22 Home Helps 24 Home Nursing 34 Hospital Treatment 34 House Drainage 45 Houses Let in Lodgings 45 Housing 50-54 I. Ice-Cream Premises 61 Imported Food Surrendered 58 Infant Consultations 27 Infantile Mortality 19, 30 Influenza 21, 73 Inhabited Houses 9 Insanitary Areas 50 Institution Deaths 18 Insulin Treatment 24 Introductory Review 7, 8 L. Laboratory Work 23 iii. INDEX—continued. M. Page Margarine Dealers 62 Marriages 14 Maternal Mortality 32 Maternity and Child Welfare 27 Maternity and Child Welfare Committee 6 Maternity Home 31 Measles 20, 71, 72 Meat 57, 58 Merchandise Marks Act, 1926 59 Meteorological Table Appendix Midwives 29 Milk, Analysis of 55 Milk and Dairies (Amendment) Act, 1922, etc. 55 Milk—Bacteriological Examination 56 Milk Supply 55, 56 Milk Supply for Expectant and Nursing Mothers 36 Milk (Special Designations) Order, 1936 55 Minor Ailments 34 Mortuary 22 N. Notices, etc. 38, 47 Notifications 69-74 Notification of Births Act 35 Nursing in the Home 34 O. Offensive Trades 47 Open-Air School 80 Ophthalmia Neonatorum 72 Outworkers' Register 38 Overcrowding 50 Overcrowding Survey 50, 51 Ozonisation of Meat 56 p. Persons Cleansed 42 Pneumonia 33,73 Pharmacy and Poisons Act, 1933 42 Polio-myelitis 73 Poor Law Relief and Unemployment 11 Population 12 Preserved Food Premises 61 Public Health (Imported Food) Regulations, 1925 57 Public Health (Preservatives, etc., in Food) Regulations 62 Public Health Committee 5,23 Public Open Spaces 10 Public Sanitary Conveniences 45 Puerperal Fever, etc. 33, 73 r. Rag Flock Acts 45 Rateable Value 9 Rates, Birth & Death 17 Rat Infestation 45 Remarks on Death Causes 20 iv. index—-continued.. s. Page St. Alfege's Hospital 79 Sanitary Work—Summaries, etc. 46-49 Scarlet Fever 20, 72 Scavenging and Refuse Removal 41 Sewer Emanations 41 Slaughterhouses 57 Slum Clearance 50 Smallpox 20, 69 Smoke Nuisances 40 Social Conditions 10 Staff of Public Health Department 3, 4, 23 Statistical Tables Appendix Street Traders 61 Swimming Baths 43 & 44 Shops Act 45 t. Toddlers Clinic 24,27 Tuberculosis 21, 73 Tuberculosis Care Committee 81 Tuberculosis Dispensary—Returns 84-86 Tuberculosis Officer's Report 77-82 Tumour Diagnostic Clinic 26 u. Ultra-Violet Light Treatment 80 Underground Bakehouses 40 Underground Rooms 50 Unemployment 11 Uninhabited Houses 9 Unsound Food 56 v. Vaccination 87 Verminous Children 48 Verminous Premises 42 Virol 37 Vital Statistics 13, 15-18 & Appendix w. Water Analysis, Table of 44 Water Supply 45 Wholesale Margarine Dealers 62 Whooping Cough 21, 69 Workshops and Factories 38-40, 59 x. X-Ray Examinations 79 z. Zymotic Diseases 21, 72