Ac 4373 M GRE 35 Metropolitan Borough of Greenwich. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 LONDON freame, Manning & Co., Ltd. 12a, Lee High Road, Lewisham, S.E.13 Metropolitan Borough of Greenwich. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 CONTENTS. Page Public Health & Maternity & Child Welfare Committees 3-4 Public Health Staff 6-6 Introductory 7-8 Section A.—Natural and Social Conditions of the Area 9-10 Vital Statistics 11-24 „ B.—General Provisions of Health Services in the Area 25-29 Maternity and Child Welfare 29-40 „ C.—Sanitary Circumstances of the Area 41-55 „ D.—Housing 60-61 „ E.—Inspection and Supervision of Food 62-77 „ F.—Prevalence of, and Control Over, Infectious Diseases 78-105 3 PUBLIC HEALTH COMMITTEE during the year 1936-7 The Mayor: Councillor J. R. Dabin, J.P. and 13 Members. Councillor Mrs. F. Carter (Chairman). Councillor R. G. Jaggers (Vice-Chairman). Alderman: M. G. Byerley, J.P., F.R.C.V.S. Councillors: T. H. P. Beacham. Mrs. A. Kennedy. Mrs. O. Bennett. W. J. Moore. Mrs. L. E. G. Bruce. Miss M. Sherman. G. Bruce. Mrs. C. R. Turner, J.P. A. Cathles, J.P. 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 sanitary condition of the Borough, the sale of food and drugs, the repair, closing and demolition of individual insanitary houses (Sections 9 and 12 of the Housing Act, 1936), 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. 4 MATERNITY AND CHILD WELFARE COMMITTEE during the year 1936-7 The Mayor: Councillor J. R. Dabin, J.P. and 13 Members. *Councillor Mrs. A. Kennedy (Chairman). *Councillor Mrs. O. Bennett (Vice-Chairman). Aldermen: M. G. Byerley, J.P., F.R.C.V.S. *Mrs. P. M. Beacham. Councillors: *Mrs. L. E. G. Bruce. W. J. Moore. A. Cathles, J.P. *Miss M. Sherman. *Mrs. F. Carter. *Mrs. C. R. Turner, J.P. R. G. Jaggers. G. F. Westmacott. C. H. Latter. *Denotes Members who served on the Assistance Sub-Committee. Powers and Duties of the Maternity and Child Welfare Committee: There shall be referred to the Committee all matters arising out of the powers and duties of the Council under the Maternity and Child Welfare Act, 1918, or any Act or Acts amending the same, or any Orders or Regulations made under such Act or Acts ; Section 226 of the Public Health (London) Act, 1936 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. 5 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., D.P.H. Tuberculosis Officer and Deputy Medical Officer of Health: W. Alcock, M.B., D.P.H. Assistant Medical Officers for Maternity and Child Welfare: Senior:—Violet Mizen, M.R.C.S., L.R.C.P., M.B., B.S. Junior:—Donald Cameron, M.B., Ch. B. Sessional Medical Officers:—Gladys M. Cox, M.B.B.S. (London) Isobel C. Johnson, M.B., Ch. B. Consultant Obstetricians : Alistair Gcnn, M.D., M.C.O.G., F.R.C.S.Ed. Victor J. F. Lack, F.R.C.S., M.R.C.P. Consultants under Puerperal Fever Regulations: Margaret Basden, M.D., F.R.C.S. Alistair Gunn, M.D., M.C.O.G. Jocelyn Moore, M.B., B.S., M.C.O.G., F.R.C.S. Bacteriologist: Arthur Davies, M.D., M.R.C.P. Public Analyst: A. E. Brown, B.Sc., F.I.C. Deputy : H. A. Williams, A.C.G.F.C., F.I.C. Dental Surgeon : G. F. Ferris, L.D.S., R.C.S. (Eng.). Tumour Clinic Consultant: Robert Davies-Colley, C.M.G., M.Ch., M.A., F.R.C.S. Public Vaccinators: William Cowie, M.A., M.B., C.M. John S. Davies, M.A., M.B., C.M. (part of the year). G. H. Garnett, M.D., M.B., Ch. B. (part of the year). D. Morien Thomas, M.B., M.R.C.S., L.R.C.P. Vaccination Officer: E. S. Elliott. Chiropodists: H. E. Taylor, M.C., Ch.A. Miss D. Thackeray, M.I.S., Ch. Housing Inspector: ab A. E. Morgan. Sanitary Inspectors: abc S. A. Radford. ab H. L. Bennett (Food). abc W. R. Drake. abc H. Archer. ac W. H. Collins. ab G. W. Heath. ac E. Saphier (Part of year), abc A. D. H. Johnstone (Food). a Miss G. Davis. ab J. Ashmore (Part of year). 6 Health Visitors: Maternity and Child Welfare. Tuberculosis. fg Mrs. M. D. Morison. dfg Miss D. M. Wilkins. dfg Miss F. C. Jagot. dfg Mrs. D. E. Shepherd. dfg Miss A. Jenkins. dfg Miss M. W. J. Luxmoore. dfg Miss E. Bailey (Part of year). dfg Miss A. M. M. Hadfield. dfg Miss K. Walton. dfg Miss P. Steer. dfg Miss E. J. Upton (Part of year). Pharmacist: W. H. Green, M.P.S. ARTIFICAL SUNLIGHT TREATMENT: Nurse-in-Charge: dhi Miss L. D'Oyly Watkins. Assistant Nurse: dhi Miss C. Meikle. MATERNITY HOME: Matron : Sister: dgj Miss E. M. Marlow. dg Miss Annie Fox. CLERICAL STAFF: F. W. Foulger (Principal Clerk). a H. Duck. R. H. Robinson. Miss L. Merricks. Miss D. E. M. Goulding (Part of year). Mrs. L. E. Wright. Miss D. E. Chilvers (Part of year). L. A. Westacott. R. G. Garratt (Part of year). E. P. Tidman E. W. Pike (Part of year). Miss G. Sibborn (Milk Saleswoman). A. H. Wilcox (Foot Clinic). Miss I. B. Mills (Tuberculosis). Disinfecting Staff: G. Hook. T. Smith. T. G. Griggs. A. Moore. T. Packham (Motor Driver). Mortuary Keeper: W. J. Lawley. a Certificated Sanitary Inspector. b „ Meat and Other Foods Etc. c „ Smoke Inspector. d „ Nurse f „ Health Visitor. g „ Midwife. h ,, Bio-Physical Associate. i „ C. S. M. M. G. j „ Teacher of Midwifery. 7 Public Health Offices, Town Hall, Greenwich, S.E.10. April, 1938. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Me. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health services of the Borough compiled in accordance with instructions contained in Circular 1650 of the Ministry of Health. The health of the Borough reflected in the Vital Statistics is satisfactory. It is gratifying to record again infantile and maternal mortality rates below the average, the figures being 50 and 1.5, respectively. The corresponding figures for England and Wales are 58 and 3.23. The Birth Rate of 13.86 shows a slight favourable increase on that recorded for the previous year. The Death Rate of 12.05 shows a small rise as compared with last year's figure. This is to a large extent due to a greater mortality among the population aged 65 years and upwards. A factor in producing this mortality was the influenza epidemic prevalent in the first quarter of the year. The population of the Borough shows an increase of 90 persons according to the estimate of the Registrar General. Housing continued to receive special attention during the year, and reference is made in the Section on this subject to unfit areas and dwellings dealt with. Particulars are also submitted regarding the completion of the second part of the over-crowding survey. In the Section devoted to sanitary circumstances the various tables indicate that the district is kept under systematic supervision with regard to nuisances and sanitary defects. In previous reports reference has been made to the increasing volume of food stuffs imported through the various wharves on the waterfront. Two Inspectors are now allocated to the supervision of foodstuffs in the Borough, and reference to the Section dealing with these matters will show the quantity and quality of the work carried out. 8 As a new feature in the Report a short account of local meteorological conditions during the year is included by courtesy of the Astronomer Royal, Dr. H. Spencer Jones. He lays stress on the ever-present atmospheric pollution, and from a public health point of view this is one of the more urgent present day problems, especially so far as London is concerned. The effect of smoke and dust laden atmospheres on the respiratory apparatus of the individual is well-known. In addition such conditions have an indirect action inasmuch as the health producing factors in sunlight are to a large extent screened off. At the beginning of the year the old Borough Hall offices were evacuated, and temporary accommodation allotted to the clerical and technical staff of the Department. Owing to the fact that the Welfare and Artificial Sunlight Centres at the Borough Hall were closed down, a certain dislocation of services was of necessity encountered. It is gratifying to record that though some overcrowding of the remaining Centres were met with, adjustments were made, and through the unselfish co-operation of the staff, difficulties have been to a large extent obviated. Owing to the changes referred to and other factors, a good deal of extra work has fallen to the lot of the clerical and technical staff generally. I feel that it is but just to record my personal appreciation of the loyalty of each member of my staff. To my colleagues in other Departments my thanks are also due. Finally I desire to thank the Chairmen and Members of the Public Health and Maternity and Child Welfare Committees, for the help and consideration afforded me during the past year. 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 1,309 acres West Greenwich 453 ,, St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1,990 „ 3,858 acres Population— At Census, 1931 100,924 Estimated, 1937 95,990 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 Inhabitated Houses—1937 (according to Rate Books) 21,202 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 At end 1937 428 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value £972,502 Sum Represented by a 1d. 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 Other Open Spaces 5.25 approximately 27. H.M. Office of Works— Greenwich Park 185 L.C.C.— Blackheath (part of) 73 Maryon Park 46.70 Charlton Park 45.75 Charlton Lido 23 SOCIAL CONDITIONS. The Metropolitan Borough of Greenwich comprises three districts, viz., Greenwich, Charlton and Kidbrooke, and St. Nicholas, Deptford, all of which are now united into one civil parish. The altitude varies from a few feet below high-water mark on the marshes, up to 249 feet above sea level on the Shooter's Hill Road by the Borough boundary. The industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Gasworks, Soap and Candle Works, L.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 Storage, Rope, Tin Box and Sack Manufacturers, Printers, Brewers, R.A.F. Works, Enamelling, Barge Builders, Cabinet Making and Saw Mills. 11 POOR LAW RELIEF AND UNEMPLOYMENT. Some indication as to the social conditions 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 1937 1,928 Average weekly amount expended in outdoor relief in Greenwich £787 10s. These figures again show a reduction over those of the previous year, indicating the continuance of the 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. In accordance with arrangements made with the Public Assistance Committee, 2,622 lbs. of Dried Milk were given to necessitous families as compared with 4,646 the previous year. Through the kindness of the Divisional Controller, Ministry of Labour, the following information is given concerning the number of insured persons, aged 16-64 years, resident in Greenwich who were registered as unemployed during the following periods:— Males. Females. Total. 25th January, 1937 1,164 351 1,515 19th April, 1937 1,056 256 1,312 26th July, 1937 823 285 1,108 18th October, 1937 892 301 1,193 12 POPULATION. The Registrar General has estimated the population for Greenwich at mid-year 1937 as 95,990, and it is upon these figures that the statistics in this report have been based. It is interesting to note that this shows an increase of 90 over the previous year and is the first increase in population since the year 1932. The following is the local distribution:— Estimated population at Mid-Year, 1937 East Greenwich 39,310 West Greenwich 22,899 St. Nicholas, Deptford 6,193 Charlton and Kidbrooke 27,588 95,990 *EXTRACTS FROM VITAL STATISTICS OF THE YEAR Total M. F. Live Births{ Legitimate 1,292 623 669} Birth Rate 13.88 Illegitimate 36 22 14} Still-Births 46 20 26{ Rate per 1,000 total Births 33.4 Deaths 1,151 581 570 Death Rate (Crude) 12.03 (Adjusted) 12.27 Deaths from Puerperal Causes:— Rate per 1000 total Births Puerperal Sepsis 1 0.72 Other Puerperal Causes — — Total 1 0.72 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 47 Illegitimate Infants per 1,000 illegitimate 83 Deaths from Cancer (all ages) 161 „ „ Measles (all ages) - „ „ Whooping Cough (all ages) 6 „ ,, Diarrhoea (under 2 years of age) 14 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 13 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 1931:— Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population of the district concerned Greenwich Charlton and Kidbrooke . St. Nicholas 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 1937 320 198 39 80 240 882 95990 14 METEOROLOGICAL OBSERVATIONS. I am indebted to Dr. H. Spencer Jones, Astronomer Royal, for the following extracts from his Report to the Board of Visitors and which covers the period May 1st, 1936 to April 30th, 1937. The registration of atmospheric pressure, temperature of the air and of evaporation, the direction, pressure and velocity of the wind, the amount of rainfall, of sunshine and of cloudiness at night has been maintained continuously. Estimates of visibility have been made by eye at definite hours. The measurement, by a continuously recording photographic apparatus, of the air-earth current discharged at a metallic point 30 feet above ground level has been maintained throughout the year. Interpretation of the records is complicated by the presence of parasitic currents partly of thermo-electric origin. Regular records for measurement of the amount of solid matter polluting the air have been continued using an Owens automatic filter. Tabulation of the results shows that there has been little change in the average amount since the last report. In the summer months there was an apparent reduction of about 10 per cent; in the ensuing winter the improvement was not more than 5 per cent. The reduction in solid pollution on Saturdays appears to average about 5 per cent., while a further reduction of about the same amount occurs on Sundays. The gaseous pollution of the atmosphere by sulphur dioxide has been measured daily. The days of worst pollution were November 25th and 28th, 1936 when the amount was estimated to be respectively, 0.262 and 0.222 parts per million. The average pollution during the year ended April 30th, 1937, was 0.056 parts per million by volume. This is an increase of about 25 per cent. on the amount for the corresponding period twelve months earlier. The following meteorological data relate to the period January to December 1937. The mean temperature was 50.5°, which is 1.0° higher than the average of 75 years 1841-1915. The highest temperature in the shade was 91.9° registered on August 6th. Temperatures exceeding 80° were recorded on 22 days. The lowest temperature was 23.7° on March 10th. Temperatures of freezing point or below were recorded on 48 days, of which 13 were in March. The mean daily horizontal movement of the air was 255 miles, which is 30 miles below the average for 50 years 1867-1916. The greatest daily movement was 559 miles recorded on January 6th and 28th; the least daily movement was 81 miles, on December 25th. The greatest motion in one hour, 30 miles, and the greatest pressure reached, 15.7 lbs. to the square foot, were recorded on January 18th. 15 The duration of bright sunshine recorded was 1134.8 hours, or 25.4 per cent. of the possible total. This is the smallest amount of sunshine for 40 years. There were 79 entirely sunless days, 32 being in the months November and December. The total rainfall was 28.85 inches, that is, 4.61 inches more than the average for 75 years 1841-1915. Measurable rain fell on 173 days. The wettest month was February with 3.94 inches, and five months had totals either in excess of or closely approaching 3 inches. The remarkable succession of rainy days in the first five months of 1937 provided a total of 16.25 inches of rain in the period January 1st to May 31st. This total has never yet been approached in Greenwich records for the corresponding period of the year. 16 METEOROLOGICAL TABLE. (From Obeservations at Greenwich, under the Superintendence of the Astronomer Royal). 1937 Air Temperature Bright Sunshine Rain & Other Forms of Precipitation Mean of Mean of A and B Difference from Average† Daily Mean Percentage of Average† Per cent of Possible Total fall Percentage of Average† Most in a day A B Amount Day of month Maximum Minimum °F °F °F °F Hr. Hr. % mm. mm. mm. January 46.8 36.3 41.5 + 1.4 1.18 96 14 86 201 13 1 February 48.6 37.8 43.2 + 2.8 1.49 72 15 100 251 18 7 March 46.9 33.4 40.1 —3.1 2.96 87 25 74 168 17 6 April 57.5 42.0 49.7 + 2.2 2.73 59 20 62 167 12 2 May 65.1 46.7 55.9 + 1.1 5.08 81 33 87 197 18 20 June 71.1 50.2 60.7 + 1.0 5.72 85 35 48 93 20 18 July 73.7 55.3 64.5 + 1.0 3.80 60 24 18 32 9 15 August 77.1 55.9 66.5 + 3.5 5.54 92 38 43 77 26 30 September 68.0 48.9 58.8 + 0.4 4.82 96 38 32 72 6 9 October 59.1 45.6 52.3 + 1.0 2.61 81 24 59 92 15 23 November 47.1 36.1 41.6 —1.9 1.04 66 12 35 59 12 1 December 42.3 34.2 38.3 —2.8 0.44 45 6 37 152 17 2 Year 58.6 43.5 51.1 + 0.6 3.12 79 26 731 122 26 Aug. 30 † 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). 17 I am indebted to Dr. Allan Young, Medical Officer of Hoalth for Poplar, who has kindly furnished me with comparative rates for Births, Doaths 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 1937) 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 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126,500 15.1 12.6 13.0 68 Fulham 138,900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 Westminster 124,300 8.2 11.5 11.8 58.7 North Districts. St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90,690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295,400 15.25 12.9 13.02 66 Stoke Newington 50,250 14.9 12.5 12.0 37.5 Hackney 206,700 13.8 11.1 11.7 43.38 Central Districts. Holborn 34,600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36.3 East Districts. Shoreditch 82,240 14.86 12.47 13.72 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203,100 13.5 12.2 14.2 60.5 Poplar 136,800 15.5 12.6 14.0 61 South Districts. Southwark 147,400 14.7 13.6 14.1 64 Bermondsey 98,790 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70.43 Wandsworth 341,700 11.53 12.36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,990 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 18 BIRTHS. The total number of births registered in the Borough during the year was 1,865. Of this number 752 occurred in St. Alfege's Hospital, 406 in the Borough Maternity Home, and 181 at various Nursing Homes within the Borough. Of this total of 1,339 Institution births, 613 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and eighty-nine births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,328 : Males 645; Females 683. This figure gives a Birth Rate of 13.86 per 1,000 of the population, and is a fraction higher than the previous year's Birth Rate of 13.82. The average for the last ten years is 14.85. The Birth Rate for the County of London equals 13.3 per 1,000 of the population. The Birth Rate for all England and Wales was 14.9. Illegitimate live-births numbered 36, representing 2.7 per cent, of the total live-births. Sixty illegitimate births actually registered in the Borough. In 33 cases, however, the mothers were ordinarily resident outside the Borough and these births were consequently allocated to the correct area. Nine illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the nett figure of 36. Forty-three illegitimate births occurred in St. Alfege's Hospital. Under the Births and Deaths Registration Act, 1926, which came into operation on the 1st July, 1927, the registration of still-births became compulsory. Forty-six still-births were allocated to the Borough, representing a percentage of 2.3 of the total births registered. Each of such cases is separately investigated with a view to finding out whether the cause 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, (now Section 255 of the Public Health (London) Act, 1936), intimations have been received from medical men, parents, and others, with respect to 1928 births, but after adiustments for transfers this figure was reduced to 1.373. Thirty-seven of these were in respect of still-births. Causes of Death Sex Deaths at Subjoined ages of "Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and over. All Causes M 581 36 5 4 9 26 25 27 65 122 132 130 F 570 31 4 2 6 21 25 28 50 86 120 197 Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Measles M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever M ••• ... ... ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... ... 1 ... ... ... ... ... Whooping Cough M 5 3 2 ... ... ... ... ... ... ... ... ... F 1 1 ... ... ... ...... ... ... ... ... ... ... Diphtheria M 4 ... ... 3 ... 1 ... ... ... ... ... ... F ... ... ... ... ... ...... ... ... ... ... ... ... Influenza M 19 ... ... ... ... ... ...... 2 4 3 6 4 F 29 ... ... ... ... 1 2 2 1 8 7 8 Encephalitis Lethargies M 1 ... ... ... ...... ... 1 ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-epinal Fever M 1 1 ... ... ... ... ... .... ... ... ... ... F l 1 ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System M 43 ... ... ... 1 12 7 7 7 7 2 ... F 33 ... ... ... ... 14 10 7 1 ... 1 ... Other Tuberculous Diseases M 3 ... ... ... 1 ... 1 ... ... ... 1 ... F 2 ... ... ... 1 1 ... ... ... ... ... Syphilis M 4 ... ... ... ... 1 ... 1 2 ... ... ... F ...... ... ... ... ... ... ... ... ... ... ... ... General Paralysis of the Insane, tabes dorsalis M 1 ... ... ... ... ... ... ... 1 ... ... ... F 2 ... ... ... ... ... ... ... . ... 1 1 ... Cancer, malignant disease M 78 ... ... ... ... ... 3 1 13 24 22 15 F 83 ... ... ... ... ... ... 6 11 23 23 20 Diabetes M 3 ... ... ... ... ... ... ... ... 2 1 ... F 13 ... ... ... ... ... ... ... 1 4 5 3 Cerebral Haemorrhage, etc. M 21 ... ... ... ... ... ... 1 1 9 6 4 F 18 ... ... ... ... ... ... ... 2 3 8 5 Heart Disease M 158 ... ... ... ... 2 2 2 11 30 57 52 F 182 ... ... ... ... 1 3 6 10 23 42 97 Aneurysm M 2 ... ... ... ... ... ... 1 ... 1 ... ... F ... ... ... ... ... ... ••• ... ... ... ... ... Other Circulatory Diseases M 29 ... ... ... ... 1 ... ... 3 7 8 10 F 19 ... ... ... ... ... ... ... 3 ... 8 8 Bronchitis M 16 ... ... ... ... ... ... 1 2 2 3 8 F 11 1 ... ... ... ... ... ... ... 1 2 7 Pneumonia (all forms) M 36 4 1 1 ... ... 1 2 5 11 5 6 F 35 5 3 1 ... ... 2 ... 7 7 4 6 Other Respiratory Diseases M 9 1 ... ... ... 1 ... 1 3 2 ... 1 F 10 ... ... ... ... 1 ... ... 3 1 1 4 Peptic Ulcer M 4 ... ...... ... ... ... ... ... 1 2 1 ... F 3 ... ... ... ... ... ... ... ... 1 2 ... Diarrhoea, etc. M 9 7 1 ... ... ... ... ... ... ... ••• ... F 8 5 1 ... ... 1 ... ... ... 1 ... ... Appendicitis M 2 ... ... ... ... 1 1 ... ... ... ... ... F 3 ... ... ... ... ... ... ... 2 ... ... ... Cirrhosis of Liver M 3 ... ... ... ... ... ...... ... 2 ... 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver, etc. M 3 ... ... ... ... ... ... ... ... 1 2 ... F 4 ... ... ... ... ... 1 ... 1 2 ... ... Other Digestive Diseases M 8 1 ... ... ... ... 2 ... 1 3 1 ... F 6 1 ... ... ... ... ...... 1 ... 2 1 1 A. and Cr. Nephritis M 14 ... ... ... ... ... 1 ... 2 4 4 3 F 18 ... ... ... ... ... 1 2 2 4 4 5 Puerperal Sepsis F 1 ... ... ... ... ... ... 1 ... ... ... ... Other Puerperal Causes F ... ... ... ... ... ... ... ... ... ... ... ... Congenital Debility, Premature Birth, Malformations, etc. M 17 17 ... ... ... ... ... ... ... ... ... ... F 15 15 ... ... ... ... ... ... ... • •• ... ... Senility M 6 ... ... ... ... ... ... ... ... ... 1 5 F 18 ... ... ... ... ... ... ... ... 1 17 Suicide M 5 ... ... ... ... ... 1 1 1 ... 1 1 F 4 ... ... ... ... ... ... 1 1 ... 2 ... Other Violence M 37 1 1 ... 1 7 5 3 2 6 4 7 F 14 1 ... ... 1 ... 1 1 1 ... 1 8 Other Defined Diseases M 40 1 ... ... 4 ... ... 3 4 8 6 14 F 35 1 ... ... 3 ... 4 1 4 5 7 8 Diseases ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ••• F ... ... ... ... ... ... ... ... ... ... ... ... 19 DEATHS. The nett number of deaths registered during 1937 was 1,153 of which 586 were males and 567 females as compared with 1086 last year ; the increase in the number of deaths being mainly due to the heavy mortality from Influenza during the first quarter. This gives a crude Death Rate for the Borough of 12.05, which figure is slightly increased to 12.29 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 average Death Rate for the last 10 years is 12.58. The Death Rates for the County of London and for England and Wales are 12.3 and 12.4 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. 1650. 20 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 1932 1,194 761 1933 1,167 707 1934 1,186 723 1935 1,043 671 1936 1,086 689 1937 1,153 724 Average 1,138 712 AGE MORTALITY. The age mortality and the distribution of the deaths betweer the different quarters of he year is shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 20 15 18 14 67 Between 1 and 2 years 4 — 1 4 9 Between 2 and 5 years 2 1 1 3 7 Between 5 and 15 years 2 3 1 7 13 Between 15 and 25 years 15 10 16 6 47 Between 25 and 45 years 39 25 20 23 107 Between 45 and 65 years 113 72 59 81 325 65 years and upwards 224 108 105 141 578 Total 419 234 221 279 1,153 21 Locally the Death Rate varied from 11.29 in East Greenwich, 11.44 in Charlton and Kidbrooke, 13.31 in West Greenwich to 13.92 in St. Nicholas, Deptford. Of the total number of deaths, 3 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 Borough in the five years 1932 to 1936 compared with the figures for 1937:— District 1932 1933 1934 1935 1936 Average for 5 years 1937 East Greenwich 12.88 11.67 12.17 10.92 11.46 11.82 11.29 West Greenwich 11.43 12.55 13.84 11.14 11.68 12.13 13.31 St. Nicholas Deptford 14.49 19.37 13.14 11.93 13.44 14.47 13.92 Charlton and Kidbrooke 10.10 11.59 10.64 10.09 10.29 10.54 11.44 Whole Borough 11.34 11.96 12.23 10.83 11.36 11.54 12.05 INFANTILE MORTALITY. The Infantile Mortality Rate measured by the deaths of children under one year of age to the number of births registered, was 50 per 1,000 births, and compares favourably with the low rate of last year, viz., 49. The total number of deaths during the year was 67 as compared with 89, 116, 80 and 66, the respective figures for the years 1933, 1934, 1935 and 1936. Locally the variations were 29 per 1,000 births in Charlton, 50 in East Greenwich, 63 in St. Nicholas, Deptford, to 77 in West Greenwich. A further reference to the Infantile Mortality Rate will be found in the Section devoted to the Maternity and Child Welfare Scheme whilst a table showing the causes of death and ages is included in the Appendix of the Report. For the whole of London the rate was 60, compared with 66 in 1936, 58 in 1935, 67 in 1934, and 59 in 1933. For England and Wales the rate was 58, compared with 59 in 1936, 57 in 1935, 59 in 1934, and 64 in 1933. 22 The following table shows the rates for the quinquennial periods since 1921, together with the rates for the years 1936 and 1937:— District Average for five years 1921-1925 inclusive Average for five years 1926-1930 inclusive Average for five years 1931-1935 inclusive Year 1936 Year 1937 East Greenwich 62 60 75 64 50 West Greenwich 80 59 78 40 77 St. Nicholas, Deptford 88 78 77 40 63 Charlton and Kidbrooke 50 42 58 41 29 Borough 66 57 75 49 50 REMARKS ON VARIOUS DEATH CAUSES. Common Infectious Diseases.—The class known as common infectious diseases comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea is credited with causing a total of 26 deaths equalling a Death Rate of .26 per 1,000. Locally the Death Rate varies from .16 in St. Nicholas (.31 in 1936), .22 in East Greenwich (.50 in 1936), .30 in West Greenwich (.33 in 1936) to .32 in Charlton and Kidbroobe (.40 in 1936). Smallpox.—There were no deaths from Smallpox, this being the thirty-fourth year since a death occurred from this cause in the Borough. Post-Vaccinal Encephalitis.—One death was reported as due to this cause during the year. This is the only death returned as due to this cause for many years. The subject was a male aged 14 years who had not been previously vaccinated. Measles.—There were no deaths ascribed as due to this disease for the year 1937, which was a non-epidemic period. The number of deaths recorded in the years, 1933, 1934, 1935 and 1936 were, 2, 16, 9 and 0 respectively. Scarlet Fever.—This disease was responsible for two deaths during the year. One death occurred in 1932, 3 each in 1933 and 1934, one in 1935, and two in 1936. 23 Whooping Cough.—This disease was given as the cause of six deaths with a Death Rate of .06 per 1,000. There were 6 deaths in the year 1932, 8 in 1933, 6 in 1934, 1 in 1935 and 5 in 1936. Diphtheria.—There were 4 deaths during the year, three of the patients being under five years of age. This gives a Death Rate of .04 compared with .03 for the previous year. Three deaths occurred in 1935, 5 in 1934, 14 in 1933, 7 in 1932 and 11 in 1931. Enteric Fever.—There were no deaths ascribed to this disease during the year. There was one in 1936 and 1935, 0 in 1934, 1933 and 1932. Diarrhoea, Dysentery and Zymotic Enteritis.—Fourteen deaths were stated to be due to these causes, equalling a Death Rate of .14 per 1,000. Last year there were 27 deaths, 14 in 1935, 30 in 1934, 17 in 1933, 24 in 1932 and 16 in 1931. Influenza.—This disease became epidemic in the first quarter of the year resulting in 47 deaths. In the epidemics of 1929 and 1933 there were 70 and 53 respectively. The age distribution was, 1 between 15 and 25 years, 6 between 25 and 45 years, 17 between 45 and 65 years and 23 over 65 years. Nineteen occurred in East Greenwich, sixteen in West Greenwich, one in St. Nicholas and eleven in Charlton and Kidbrooke. Twenty-three cases received Hospital treatment. TUBERCULOSIS. This class includes the causes of 79 deaths during the year under review, with a rate of .82. These figures compare with 106, 85, 78 and 73, the totals of the years 1933, 1934, 1935 and 1936 respectively, and the respective rates of 1.08, .87, .80 and .76. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 73 attributed to the cause, thus giving a rate of .76 per 1,000 as compared with .68 for the last year. Locally the deaths were 31 in East Greenwich (Death Rate .78); 8 in St. Nicholas, Deptford (Death Rate 1.29); 24 in Charlton and Kidbrooke (Death Rate .86); 10 in West Greenwich (Death Rate .43). The remaining forms of Tuberculosis were responsible for 6 deaths, 5 of which occurred in East Greenwich and 1 in St. Nicholas, Deptford. 24 MALIGNANT DISEASES. Cancer was reponsible for a total of 159 deaths for the year. The number of deaths in 1936, 1935, 1934, 1933 and 1932 were 134, 156, 161, 162, 155 and 160 respectively. The distribution of deaths were as follows:—63 in East Greenwich, 35 in West Greenwich, 51 in Charlton and Kidbrooke and 10 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 338 deaths under this class as compared with 261 for the year 1936. There is no doubt that this increase can be attributable to more definite certification on the part of the medical practitioners. Many of the deaths which formerly were classified as Cerebral Haemorrhage and Sjnile Decay are now brought into the circulatory category. MORTUARY. During the year 138 bodies were received into the Mortuary. The details are as under:— Bodies brought in upon which inquests were held 124 Bodies brought in upon which post-mortems were held 63 Bodies brought in upon which inquests were considered unnecessary 14 Bodies brought in where death occurred from infectious disease 1 25 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. IGoO, the particulars relating to the Staff of the Department are set out on pages 5 and 6. The following alterations in the personnel of the Department occurred during the year. Mr. E. Saphier, Sanitary Inspector, resigned his appointment in September on taking up medical studies and was succeeded by Mr. J. Ashmore, late of Brighton. Miss E. Bailey, who had acted as Health Visitor for the Charlton area since 1920 unfortunately died on the eve of retiring on Superannuation in June and Miss E. J. Upton was appointed in her stead. Messrs. J. Hannen and E. W. Pike left to take up other appointments and their places were filled by Messrs. R. G. Garratt and C. W. Spore (1st February, 1938). Miss D. M. Chilvers, Shorthand Typist, was appointed vice Miss Nettle who left on account of marriage, whilst Miss D. E. M. Goulding took up duties as additional shorthand typist in May. 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, 1,664 specimens have been examined for Diphtheria, 7 for Typhoid Fever, 436 for Tuberculosis, and 49 for other various conditions. Fuller details respecting the results of the examinations of these specimens will be found under the different headings of the individual diseases. Ambulance Facilities.—The ambulance services have been described in recent Reports and continue to be 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 great 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 26 furnished to the Ministry of Health on patients who receive this service. During the year, 3 patients have received such assistance. Treatment Centres and Clinics.—In January 1937 the Ante-Natal and Infant Welfare Centres at the Borough Hall were closed down. This has resulted in a certain amount of overcrowding of the other Centres, particularly the Creek Road and Chevening Road Centres. At the present time the Maternity and Child Welfare Committee have under consideration the establishment of a new Centre when a suitable site can be found. The evacuation of the Borough Hall premises also necessitated the closure of the Artificial Sunlight Centre. It is hoped that in the near future suitable alternative arrangements may be made. Tables relating to the centres will be found on pages 29 to 31. Home Helps.—Reference has been made in previous reports to the fact that if these ancillary services were established the Council's Maternity and Child Welfare scheme would be made fully comprehensive. With the coming into force of the Mid wives Act in January, 1938, it is felt that this service will become a very necessary one, and it is hoped that the Maternity and Child Welfare Committee may review their previous decision in this matter. As a case in point it may be mentioned that recently an application was made to this Department by an expectant mother for this service because of her impending admission to hospital for emergency treatment. Unfortunately as we were unable to supply the services of a home help this mother was unable to take advantage of the treatment offered, with consequent detriment to lier condition. Toddlers' Clinics.—These have been well attended during, the year, but owing to the fact that the Borough Hall Centre had to be closed it was found impossible to extend these Clinics in the way anticipated. Foot Clinic.—During the year 4,115 attendances were recorded, representing an income of £205 15s. Od. Ten sessions are held per week, half of these being evening sessions; two fully qualified chiropodists are in attendance. The Clinics are open to men, women and children at a charge of 1/- per attendance. This service has again been very popular and arrangements are being made to institute an appointment system, and so obviate the period of waiting at the Clinics, about which complaints are being received. At the present time this is unavoidable. Ultra Violet Light Treatment.—The Ultra Violet Light Centre continues to do good work as heretofore. Given under medical supervision and by experts trained in its use, there is no question that Ultra Violet Ray treatment has a very definite place 27 in the field of medical therapeutics. Apart from its recognised value in cases of rickets, tuberculous glands, lupus and skin sepsis, its effect upon the debilitated and malnourished child, is often considerable, and it is gratifying to note that in almost every case even where obvious improvement is not manifest, the parents almost always record that these children eat and sleep better and appear to be more lively as a result of a course of Light treatment. It has moreover, been found to be very helpful as a "tonic" to expectant and nursing mothers. Clinics are held at all the Welfare Centres. As previously, evening sessions were held during the winter months. These evening sessions are available for paying patients. The fees charged arc 12/- for 6 treatments or 20/- for 12 treatments. During the year 24 patients were given 291 treatments, the fees received totalling £30 6s. 8d. The arrangements with the authorities of the Roan Schools made in 1933, continue to be in force. The following table shows the type of abnormality treated during the year:— Condition treated No. Rickets 210 Underweight 291 Bronchial conditions 78 Anaemia and debility 173 Convalescent from Infectious Diseases 96 Colds and Catarrh 54 Insomnia 9 Rheumatism 22 Enlarged Cervical Glands 33 Backache 22 Post-Influenza 4 Other Conditions 16 1,008 28 Particular relating to the number of patients treated at the various Centres during 1937 are given in the following table:- DAILY SESSIONS Under 5 5—15 Over 15 Total Number under treatment at end of previous year 241 1 25 267 Number of New Patients 857 73 109 1,039 Discharges 775 43 108 926 Number under treatment at end of 1937 323 31 26 380 Number of treatments given 13,783 668 1,700 16,151 EVENING SESSIONS. Under 5 5—15 Over 15 Total Number under treatment at end of previous year - 7 7 Number of New Patients — — 24 24 Discharges — — 20 20 Number under treatment at end of 1937 — — 11 11 Number of treatments given — - 291 291 Tumour Diagnostic Clinic. During the year under review, 10 cases were examined at the Dispensary. They are classified as follows:— Lipoma 2 Cyst 2 Swollen glands 1 Fibroma 1 The remaining 4 were of an indeterminate or ill-defined nature, but in no instance could a diagnosis of malignant disease be substantiated. Appropriate advice was given and where considered necessary, treatment recommended. 29 In reviewing the work of this Clinic, one must admit that the results are disappointing to say the least. During the year, 157 persons died of cancer and yet as stated, not one case of malignant disease found its way to the Clinic. One is forced therefore to the conclusion that the Diagnostic Clinic in its present form, makes practically no contribution to the problem of cancer. The reason for this, is I think, obvious. In its early stages, malignant disease rarely presents an obvious "tumour" and if patients postpone their visits until this stage is reached, then many lives will continue to be lost. The early diagnosis of malignant disease requires the cooperation of the individual from the time when he first begins to notice any departure from normal health, and calls for the utmost skill of experts assisted by every modern device known to medical science. 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 Charlton Lane Total No. of Clinics 35 191 103 93 103 525 No. of Attendances 952 5,428 4,547 3,027 2,819 16,773 New Cases 43 281 284 126 168 902 Medical Consultations 393 1,871 1,632 1.141 1,298 6,335 All babies are woighed 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 35 191 103 93 103 525 No. of Attendances 1,063 6,722 3,378 2,764 2,400 16,327 New Cases 45 240 143 217 79 724 Medical Consultations 431 2,215 1,224 1,060 947 5,877 * This Centre was closed in March. 30 Toddlers' Clinic.—As has been previously stated, the closure of the Borough Hall Centre and the consequent allocation of those attending to other Centres, it has not been possible to extend the scheme of supervision, except as far as home visiting is concerned. 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 169 86 53 28 24 360 Normal 674 438 239 185 203 1,739 Sub-normal 59 201 227 160 180 827 Totals 902 725 519 373 407 2,926 Defects Found:- Dental Cases — 4 34 67 131 236 Ears—Nose and Throat 24 53 116 106 127 426 Skin conditions 144 113 91 62 49 459 Nervous „ 1 3 10 9 8 31 Circulatory „ 10 11 8 5 12 46 Congenital „ 22 7 5 2 1 37 Respiratory„ 122 115 85 55 42 419 Alimentary „ 169 116 52 41 24 402 Enlarged Glands 4 10 37 41 60 152 Eyes 37 32 23 17 17 126 Uro-Genital 118 38 14 5 6 181 Hernia 83 17 12 2 2 116 Orthopaedic 13 39 53 40 22 167 Infectious Disoases 17 34 47 51 39 188 Rickets 14 27 15 2 1 59 Miscellaneous 23 23 9 7 5 67 Comparative tables are shown in connection with the nutrition of individual children attending the Centres for 1936 and 1937. Tl may be noted that of the children in the 4/5 years age group seen in 1936, 65% were assessed as sub-normal by the Maternity and Child Welfare Medical Officer. The corresponding figure for 1937 is given as 44%, and making due allowance for a possible error in the assessment of this condition it would appear that the difference in the percentage must be significant. 31 1936.  Under 1 year 1—2 Years 2—3 Years 3—4 Years 4—5 Years Total No. % No. o/ /o No. % No. % No. % No. % Nutrition:- Excellent 222 23% 91 15% 29 9% 15 5% 21 6% 378 15% Normal 041 66% 323 53% 135 41% 128 40% 97 29% 1,324 51% Sub-Normal 107 11% 200 32% 169 50% 177 55% 219 65% 872 34% Total 970 100% 614 100% 333 100% 320 100% 337 100% 2,574 100% 1937.  Under 1 year 1—2 Years 2—3 Years 3—4 Years 4—5 Years Total No. % No. % No. % No. % No. % No. % Nutrition:— Excellent 169 19% 86 12% 53 10% 28 8% 24 6% 360 12% Normal 674 75% 438 00% 239 46% 185 50% 203 50% 1,739 60% Sub-Normal 59 6% 201 28% 227 44% 160 42% 180 44% 827 28% Total 902 100% 725 100% 519 100% 373 100% 407 100% 2,926 100% Ante-Natal and Post-Natal Clinics. Clinics are held at the following Centres:— Chevening Road Monday, 2 p.m., Tuesday, 10 a.m. 105, Shooter's Hill Road Thursday, 2 p.m., Friday, 10 a.m. Charlton Lane Monday, 10 a.m. Creek Road Wednesday and Thursday, 10 a.m. As far as is practicable, appointments are made for expectant mothers in order to obviate the waiting period at the clinic. The number of new cases together with total attendances for the year, were as follows :— No. of Clinics New Coses Total Attendances *Borough Hall 26 54 296 Chevening Road 86 176 1,199 Shooter's Hill Road 133 355 2,392 Charlton Lane 34 53 416 Creek Road 77 136 713 356 774 5,016 * Now closed 32 Post Natal. No. of attendances made during the year 475 Other Ante-Natal Services. In addition to the facilities provided at the Borough Council Centre, 221 patients received Ante-Natal treatment at the St. Alfege's Hospital, making 1,472 attendances in all ; whilst the British Hospital for Mothers and Babies, Woolwich, was responsible for Ante-Natal supervision in regard to 189 cases, 70 of whom were out-patients. The total number of attendances made was 1,120. The Nursing Sisters of St. John the Divine state that 47 mothers attended their Centre making 221 attendances in all. Midwifery Services. The Midwives Act will come into force as far as London is concerned on the 1st January, 1938. The object of the Act is to secure the organisation throughout the country of a domiciliary service of salaried midwives, with a view to improving the maternity services generally and reducing maternal mortality. The Metropolitan area for the purposes of the administration of this scheme is divided into areas. This Borough belongs to Area E and is therefore grouped with Woolwich, Lewisham, Deptford and Camberwell. Municipal midwives appointed will be selected officers of the London County Council. They will be responsible for the antenatal supervision of the cases they are booked for ; it will be one of their duties to see that their cases are ante-natally examined at a Welfare Centre or by a private practitioner. It is anticipated that this scheme will work in harmony with the services provided by the Borough Council. In connection with the scheme a panel of consultants will be available for difficult domiciliary confinements, the practitioner in charge being in a position to call upon the services of any consultant on the panel. It is envisaged that an emergency service to be called a transfusion service will be available where acute emergency arises. Infantile Mortality.—The total number of deaths under 1 year of age was 67 as compared with 66 for the previous year. The Infantile Mortality Rate is thus equal to 50 per 1,000 Births. This compares very favourably with the low figure returned last year, viz., 49. The average for the last 10 years is 62. The Infantile Mortality Rate for the County of London is 60, and that for the 125 large towns 62. The following are the local rates :— 33 Charlton and Kidbrooke 29 East Greenwich 50 St. Nicholas, Deptford 63 West Greenwich 77 The chief causes of death were:— Gastro-Enteritis and Diarrhoea 13 Premature Birth 17 Pneumonia and Bronchitis 11 Atrophy, Debility and Marasmus 4 Whooping Cough 4 Injury at Birth 2 Convulsions 2 Con. Malformation 2 Meningitis 2 Other causes 10 67 Of the above number 39 were boys and 28 girls. The number of neo-natal deaths, i.e., those dying before attaining the age of one month, was 33, 25 of whom died in the first week. These deaths consist principally of Prematurity, Injury and Congenital Malformation, and the chance of survival is generally very remote. An investigation into the causes of Infantile Deaths is a routine measure, a primary factor being to discover whether the mother had adequate ante-natal treatment. From the case records it was ascertained that in 32 cases the mother had not attended the Council's ante-natal Clinic. Of these 9 received treatment from General Practitioners; 14 from Hospitals or Nursing Homes, thus leaving 9 cases to be accounted for. Further enquiry elicited the fact that 2 were unmarried mothers who had no fixed address and no ante-natal history was possible; 4 cases had booked with midwives, whilst in 3 instances the mother had been ill resulting in premature birth. Deaths of Children 1—5 Years of Age. During 1936 the Ministry of Health directed it was advisable that more attention should be given to the pre-school child. Under the Council's Maternity and Child Welfare Scheme facilities have been provided for many years for treatment of minor ailments and orthopaedic cases with local hospitals and also for convalescent home treatment. Additional Toddlers' Clinics are now held at which routine inspections are conducted and with the systematic 34 following up by the Health Visitors it is hoped that the stricter supervision will be reflected in a reduced death rate at this age period. The number of deaths of children between the ages of 1 and 2 years was 9 and between 2 and 5 years, 7. The previous year the figures were 11 and 19 respectively. Maternity Home.—The number of patients admitted during the year was 412. Sixty-six cases were admitted from the Centres for ante-natal treatment for periods varying from 2 to 7 days. The number of cases delivered by the Midwives of the Home was 397, the remainder by the Medical Staff. In 140 instances medical assistance was sought by the Midwives. Operative interference was called for as follows:— Caesarian Section 1 Forceps 14 Eight cases of Puerperal Pyrexia due to Pyelitis (4), Delayed Involution, Salpingitis, Myocarditis and Sapraemia were notified during the year and all made a good recovery before discharge. Amongst the Infants, 22 were not entirely breast fed whilst if the Home. There were no cases of Pemphigus Neonatorum and six cases on Ophthalmia Neonatorum, three of which recovered in a very short period, the remainder were transferred to St. Margaret's Hospital and subsequently recovered. There were 7 Still Births, the causes being attributed as follows:— 1 Anencephalic foetus. 1 of Premature twins. Delay in labour—extended breech. 1 Cause unknown. 1 Post-natal—delay in 1st stage of labour. 1 Breech with extended legs. 1 Prolapse of cord. 1 Toxaemia and long 1st stage. Infant Deaths occurring within 10 days of birth numbered 4, the causes being:— Prematurity 1 Maternal Toxaemia (Prematurity) 1 Maternal Nephritis (Prematurity) 1 Heart Failure (Prematurity due to Maternal Pyelitis) 1 35 Maternal Mortality.—The number of Deaths from Puerperal Sepsis and other Accidents and Diseases of Pregnancy was 2. Both died in Hospital. This gives a maternal death rate of 1.5 per 1,000 live births. On comparison with the Registrar General's Returns, however, it was observed that one case which was associated with Peritonitis had been assigned to that disease which makes a corrected maternal death rate of .75 per 1,000 live births. The Maternal Mortality Rate for England and Wales was 3.23. In addition two deaths were recorded which were associated with pregnancy. The first case was a woman age 34 with a history of two difficult pregnancies. She had booked with a midwife (8th February, 1937) who only accepted the case on the understanding that she would be under the care of her own Doctor. The patient also paid regular visits to the Borough Ante-Natal Clinic. On the 18th May the Maternity and Child Welfare Medical Officer communicated with the midwife advising that the patient should stay in bed and be under the care of her own Doctor. There appeared to be some misunderstanding and possibly, lack of co-operation, for the patient's condition grew worse and she was admitted to Hospital on the 31st May in a moribund condition. Death took place shortly after admission, the cause being attributed to myocarditis due to Eclamptic Toxaemia of pregnancy. A post mortem examination revealed gall bladder disease. In the second case the patient aged 29 had only booked with a midwife for a period of six weeks and was attended by her own Doctor on and off during the whole time of pregnancy for chest trouble. Four days before her confinement the patient was caught in a storm. A normal confinement followed but within four days her Doctor was called in on account of acute chest pains. Patient was admitted to Hospital immediately but succumbed within two days the cause being attributed to Broncho-Pneumonia. 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 obstetric consultants are available to assist local medical practitioners, continue in force. This service was provided on one occasion. Eight cases of Puerperal Fever and twenty-eight of Puerperal Pyrexia were notified as compared with 22 for the previous year. 27 occurred in Hospitals, 8 in the Council's Maternity Home and the remaining case was reported from a private Nursing Home. 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. 36 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 Is. per visit to the Queen's Nursing Association. The total number of cases nursed including those referred from the Centres was 114 necessitating 2,899 visits. The Council also contributes £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 46 expectant mothers and 46 post-natal cases. Institutional Provision for Mothers and Children.— 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. 7 mothers and babies and 111 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:— Health Visitors' Visits, &c., 1937. Table A. Visits Re-Visits Total Infants under 1 year 1,268 4,529 5,797 Children 1—5 years 235 5,873 6,108 Measles (under 5 years) 30 5 35 ,, (over 5 years) 19 7 26 Whooping Cough (under 5 years) 437 146 583 „ ,, (over 5 years) 159 14 173 Pneumonia 11 7 18 Puerperal Pyrexia and Fever 32 24 56 Diarrhoea 117 96 213 Ophthalmia Neonatorum 10 18 28 Inflammation of Eyes 7 5 12 Pemphigus 2 1 3 Polio Myelitis — — — 2,327 10,725 13,052 Table B. Dental Treatment 21 11 32 Milk Scheme 138 88 226 Ante-Natal Cases 953 412 1,365 Infant Consultations Attended 1,083 Ante-Natal Clinics Attended 325 Children Act 42 115 157 Miscellaneous 1,054 367 1,421 Schools re Measles — — — In addition to the above 564 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. 37 Notification of Births Acts (1907 and 1915). Public Health (London) Act, 1936. 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. The following Table gives the number and character of the intimation received respecting births in the Borough:— Where Confined Midwives Doctors Greenwich Births Other Boroughs' Births Greenwich Births Other Boroughs' Births St. Alfege Hospital 330 417 32 28 Greenwich Borough Council Maternity Home 264 142 6 2 Other Nursing Homes 17 99 17 45 Other Hospitals — 1 1 4 At Home 395 3 123 2 Other Boroughs (Transfers Inwards) 186 — 2 — 1,192 662 181 81 From a perusal of the above Table it will be seen that 1,928 actually took place in the Borough of which number 743 were transferred to Other Authorities. Against this 188 births which took place in other areas were allocated to Greenwich, thus giving a nett figure of 1,373. 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 Centres and Clinics. To enable him to cope with the increasing number of "fillings and scalings" an extra session is held once a, month, 38 The following Return shows the work performed during the year:— Number of Sessions 40 Number of Patients 210 Number of Attendances 647 Extractions (Local Anaesthesia) 107 „(Gas) 81 Dentures and Repairs 19 Fillings and Scalings 119 Referred for X -Ray 5 Referred to Hospital re Gas 7 Advice given (no action necessary) 129 Minor Ailments.—On several occasions during the year attention was drawn to the fact that children referred from the Centres were kept for long periods on a waiting list for admission. At the end of the year the Maternity and Child Welfare Committee had under consideration the making of alternative arrangements which would obviate this delay in provision of necessary treatment. Public Medical Services. In connection with the Public Medical Services for London a branch is established in Greenwich which has for its object the provision of private medical treatment in payment of a small regular subscription. I am informed there are 15 local Doctors on the panel who have between them 853 subscribers. Birth Control The Greenwich Women's Welfare Centre opened its Clinic in March, 1935, at 118, Woolwich Road, S.E.10. Since its inception over 500 patients have attended and are being sent in increasing numbers by hospitals, private doctors and welfare centres. The main object of this Clinic is to provide sound medical advice by a woman doctor for married women. Cases are recommended from the Council's Welfare Clinics when in the opinion of the Maternity Medical Officer such advice is necessary. In necessitous cases the Council meet the cost of treatment. L.C.C. School Clinic A clinic is provided at 22, Park Row, Greenwich, and the following facilities provided:— Dental.—Every morning except Saturday and also Friday afternoons. Treatment, except for urgent cases, is given only by previous appointment. Minor Ailments.—A Doctor attends on Mondays at 2.30 p.m. and alternate Thursdays at 2 p.m.; a nurse attends daily (including Saturday mornings). Children can attend this clinic 39 without appointment but if in school attendance should only attend after school hours. A further clinic is held at Sherington Road School where a Doctor is in attendance on Tuesday afternoons. A nurse attends each day as in the clinic mentioned above. Nursery School The Rachel MacMillan L.C.C. Nursery School continues its good work in the St. Nicholas district of the Borough. I am informed there are 118 Greenwich children attending the school. It may be mentioned that this school was the pioneer in the Nursery School Movement. It has now attached to it a Training School Centre for Nursery School Teachers; the majority of the children attending are Toddlers, and as it is conducted on openair lines the benefit to the children of the locality is unquestionably of great value. It has associated with it a Convalescent Home at Wrotham to which children are drafted for holiday periods. Milk, etc., 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 from the first 3 months of pregnancy; (c) Children up to 3 years of age and exceptionable circumstances 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 £3,500. It should be mentioned that included in the total amount of milk distributed free (table A), is 2,622 lbs. which is granted to the recipients under the Extra Nourishment Scheme by arrangement with the local Public Assistance Committee, and the amount of £264 was recovered from that Authority. 40 (a) Dried Milk, Virol, &c., Distributed Free. Quarter ended Milk Virol Malt & Oil Cod Liver Oil Marmite March, 1937 10,637 1,8141½ 1,650 237 110 June, „ 10,688 1,806½ 1,505 259 710 Sept., „ 10,990 1,900 1,603 287 2,023 Dec., „ 11,2441 1,8801½ 2,056 376 2,643 Totals 43,5591 7,4011 6,814 1,159 5,486 In addition to the above, 7,888 pints of liquid milk were distributed free or sold at reduced prices. (b) Dried Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Milk Virol Malt & Oil Cod Liver Oil MarMite Total Amount Received lbs. lbs. lbs. Bottles Cartons March, 1937 4,228 395½ 330 163 194 £ s d 313 10 8 June, „ 4,325 275 244 140 488 327 4 2 Sept., „ 4,185 227 234 182 826 324 5 4 Dec., „ 4,544½ 338½ 667 341 1,101 373 1 4 Totals 17.282½ 1,236 1,475 826 2,609 1,338 1 6 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. During the year 157 visits were made by the Health Visitors. The following particulars are taken from the Register:— Number of Foster-mothers on Register at end of 1937 28 Number of Applicants refused 1 Number of Foster-children 34 Number of Foster-children who died during the year — Number of Certificates of Exemption granted 1 Number of cases legal proceedings taken — There were several minor infringements again dealt with, the chief being failure to notify change of address of Infant, and in each case the Foster Mother was cautioned. 41 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 42 and 46 summarise, as far as possible the Sanitary work of the Department; from there it will be seen that a total of 22,231 houses and premises have been inspected or re-inspected during the year; 1,642 intimation notices and 187 statutory notices have been served. There were altogether throughout the year 781 complaints registered. FACTORIES, WORKSHOPS AND WORKPLACES. The number of Factories, etc. upon the Register at the close of the year was 262. 58 Workshops, 6 Wharves and Quays, and 4 Warehouses were also registered. The whole of these premises were kept under systematic observation by the Inspectors, who made 563 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 Woman 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 received from employers within the district. In addition to this, 26 lists containing 53 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs (thus giving a total of 57 Outworkers in the Borough). Two lists with 11 names and addresses were forwarded to other districts. 102 visits of inspection have been paid to these premises. 42 FACTORIES, WORKSHOPS, LAUNDRIES, and WORKPLCES 1.-INSPECTION Premises Number of Inspections Written Notices Occupiers Pros'cut'd Factories (Including Factory Laundries) 317 8 — Workshops (Including Workshop Laundries) 181 1 — Workplaces (Other than Outworkers' Premises) 65 10 - Total 563 19 — 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 — — — Want of Ventilation — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances 3 2 1 — Sanitary Accommodation— Insufficient 6 6 — — Unsuitable or Defective 14 14 — Not Separate for Sexes — — — — Offences under the Factory and Workshops Act— Illegal Occupation of Underground Bakehouse (s. 101) 1 1 - Other Offences Totals 24 22 2 — •Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, 1901, as remediable under the Fublio Health Acts. 43 3.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1937. No. Bakehouses 14 Factory Bakehouses 23 Barge Builders 11 Blacksmiths 5 Boot and Shoe Makers 9 Builders' Yards 2 Carpenters and Joiners 3 Carriage Builders 2 Coopers 1 Cycle Works 4 Dress and Mantle Makers 9 Engineers 4 Electrical Engineers 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 15 134 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 (s. 5):— Notified by H.M. Inspector — Reports (of action taken) sent to H.M. Inspectors — Reports to H.M. Inspector re Juvenile Employment — Underground Bakehouses (Sec. 101):- In use at end of 1937 11 Smoke Abatement.—During the year this problem was constantly before the staff" and 45 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. 44 Smoke Nuisance.—Complaints continue to be received regarding smoke and grit nuisances in the East Greenwich area, and there is no doubt but that the increasing atmospheric pollution referred to by the Astronomer Royal earlier in this report is due in a large measure to emanations from this area. In view of the fact that there was no evidence of amelioration of these conditions during the year, the Council at the year end had under consideration the question of taking statutory action. Sewers, etc.—Very few complaints were received in the Department. It is interesting to note that the number of Cesspools in the Borough is gradually dwindling. I am informed by the Borough Engineer that there are now only 10 Cesspools in use in the Borough, one of which is cleansed by the owners of the property and one other, owing to its inaccessible position, is dealt with by the owner at the cost of this Council. It is anticipated owing to further developments that two or three others will shortly become redundant when the properties concerned are demolished and new development takes place on the sites. 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 refuse in the Borough is under the control of the Borough Engineer, who has ldndly supplied me with the following information relating to disposal. "The amount of refuse collected in the Borough during the year ended 31st December, 1937 was approximately 21,016 tons of which 17,284 tons were dealt with at the Council's Refuse Disposal Plant. The total tonnage collected again shows a reduction this year of rather over 4% as compared with last year. This is in spite of a considerably greater number of properties in the Borough from which refuse is collected, but is generally in agreement with results noticed in other Boroughs. "The new conveyor for the handling of ashes from the rotary screens was installed in the early part of the year, which involve the shutting down of the plant for about 2 weeks when all refuse had to be dealt with by barging away. In consequence, the percentage of refuse dealt with at the Disposal plant over the whole of this year is approximately 83% of the total, although during normal periods practically 95% of the refuse collected is dealt with at the Plant." 45 Eradication of the Bed Bug.—The steps taken to rid premises of vermin were substantially the same as reported last year. In the last quarter of the year the whole question of future procedure was under consideration by the Committee, and the following report embodies all the points discussed:— 25th November, 1937. The Chairman and Members of the Public Health Committee. Madam Chairman, Ladies and Gentlemen, I beg to submit the following notes on " Disinfestation." "Verminous infestation "for present purposes refers to the Bed Bug. The resistance of this insect to eradication is well known and the disinfestant which acts most effectively on insect and egg is Hydrocyanic Acid Gas. This agent is too lethal to make its use desirable save in special circumstances. In general, infestation does not appear to be such a problem in Greenwich as it is in other Boroughs. Nevertheless it is a fact that much of the older property in the Borough is infested, especially that of the slum clearance type. An accepted cause of the dissemination of the bug is traffic in second-hand furniture, and the rehousing of families from houses due for demolition without efficient treatment of the furniture and effects. It is noticeable that in only a small percentage of cases can it be said that infestation is the fault of the householder who as a rule, is only too willing to co-operate. Under ordinary circumstances five types of case merit atention:— 1. Houses scheduled for demolition. 2. Dwellings found infested on Sanitary Inspectors' visit. 3. Council property which becomes infested. 4. Clothing and bedding. 5. Furniture. 1. Houses scheduled for demolition. No action is taken in this Borough, or indeed in many of the others, although the Local Authority has power to cleanse such houses if necessary after the demolition order is made. 2. Dwellings found infested on Sanitary Inspectors'1 visit. Infestation is often confined to one or two rooms. Complaint sometimes arises when new tenant takes over a letting. In the worst cases Sanitary Notices are served requiring the owner to 46 carry out cleansing. In mild cases and recurrences the Inspector advises occupier as to the best practicable means of eradication. In addition vermin fluid is issued from the Public Health Department to occupier on certificate of Sanitary Inspector. Experimental work is continuous, all the inspectors being naturally interested in the search for some innocuous easily handled insecticide suitable for all purposes. 3. Council property which becomes infested. In some cases special furnished dwellings are set aside for temporary occupation by families while the house or flat and effects are cleansed. In other cases the isolation shelter, which at one time was in common use in cases of infectious disease, is used. In the case of a flat, Hydrocyanic Acid Gas is not desirable, and in the case of a non-detached house the adjacent house or houses should be evacuated to give a reasonable margin of safety if the gas is used. Some time ago this Committee supported a resolution of the Metropolitan Joint Committee that legislation should be introduced to give Local Authorities statutory power to provide dwellings for such purposes. 4. Clothing and bedding, etc. In all types of cases these materials can be satisfactorily dealt with by steam disinfestation. 5. Furniture. There is no doubt that the best method here is Hydrocyanic Acid Gas applied to container under cover of an open shed, centrally placed in an open space of good size. Contractors undertake this work probably at far less cost than the Local Authority could themselves carry it out. As in the case of bedding and clothing, the clean material can be delivered at the new premises in re-housing cases or delivered to the disinfested dwelling in others. General remarks. The bed bug causes no known diseases directly, but indirectly has a lot to answer for, e.g., septic sores, lack of sleep, nervous affections of children, etc. Facilities at present available for dealing with the problem here fall far short of those desirable and I have to submit the following points for the consideration of the Committee. (a) As to whether infested houses subject to demolition orders should be fumigated. 47 (6) As to whether the furniture of cases for rehousing should be treated effectively and if so would H.C.N, be recommended as the desirable agent. (c) Whether in view of the necessity for more effective action an addition of one man to the disinfecting staff would be considered, this man's duties to be wholly in connection with disinfestation. He would visit premises and seal and fumigate rooms, the van collecting and delivering bedding, etc. as is the practice in the case of infectious disease. I trust that the foregoing brief note may serve to bring the matters in question before the members of this Committee so that suitable recommendations may be made. I am, Madam Chairman, Ladies and Gentlemen, Yours faithfully, F. R. WALDRON, Medical Officer of Health. In accordance with the Ministry's circular the following table is given:— (1) The number of— (a) Council houses found to be infested. 75 „ „ disinfested. 75 (b) Other „ found to be infested. 110 „ „ disinfested. 110 (2) The methods employed for freeing infested houses from bed bugs—In the case of Council houses, the Council's Estate Department staff employ the use of a blow lamp and remove all skirtings, picture rails, etc. (3) The methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses—Bedding is removed to the Council's Disinfecting Station and placed in the steam Disinfector. (4) Whether the work of disinfestation is carried out by the Local Authority or by a contractor—The whole of the work is done by the Local Authority. (5) The measures taken by way of supervision or education of tenants to prevent infestation or re-infestation after 48 cleansing—As far as possible the Inspectors instruct the tenants in the methods employed to prevent infestation and vermin fluid is placed at the disposal of tenants for their use. Cleansing Station, Blackwall Lane.—The cleansing of persons and the disinfestation 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. Pharmacy and Poisons Act, 1933.—This Act came into force on the 1st May, 1936 and has for its object a closer control of the sale of poisons and poisonous substances. Under the Act rules have beer made and the names of the poisons are set out and described under 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 the Sanitary Inspectors are appointed to carry out the provisions as far as they relate to Part II. During the year 2 applications to sell Poisons under Part II of the Act were received and granted, whilst 50 applied for retention in the Council's list, making a total of 52 persons on the register. 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 large 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. A resuscitation plant is in use at the Baths as a precautionary measure and attendants are instructed in its use. For the period 1st April, 1937 to the 21st December, 1937, the attendances were as follows :— Slipper Baths 53,477 Swimming Baths 153,428 Vapour and Medicated 2,464 Public Washers 10,027 Total 219,396 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. BACTERIOLOGICAL REPORTS ON SAMPLES OF BATH WATER TAKEN FROM SWIMMING BATHS. Sample No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Date taken, 1937 4th Jan. 2nd Feb. 3rd Mar. 31st Mar 23rd Apr. 10th May 20th May 7th June 24th June 5th July 26th July 18th Aug. 31st Aug. 28th Sept. 28th Sept. 13th Oct. 15th Nov. 13th Dec. General Condition Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Bright & Clear Satisfactory Bright & Clear Bright & Clear Bright & Clear Crystal Clear Bright & Clear Bright & Clear General Appearance Good No Deposit No Deposit No Deposit No Deposit Chlorine content— 0.25 parts per mil. No Deposit Chlorine content— 0.2 parts per mil. No Deposit Chlorine content— 0.2 parts per mil. No Deposit Chlorine content— 0.2 parts per mil. No Deposit Chlorine content— 0.5 parts per mil. Slight opaque colour, no visible deposit No Deposit Chlorine content— 0.25 parts per mil. No Deposit Chlorine content— 0.5 parts per mil. No Deposit Chlorine content— 0.5 parts per mil. No Deposit Chlorine content— 0.5 parts per mil. No Deposit Chlorine content— 0.5 parts per mil. No Deposit Chlorino content— 0.5 parts per mil. No. of micro-organisms developing on gelatin (aerobically) for 3 days at 68° Fah. Per C.C. 46 780 790 Nil 213 740 456 816 1,100 706 783 1,816 403 760 446 1,080 550 373 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. 743 3,630 440 120 1,743 3,026 3,653 1,806 216 2,096 176 2,296 43 1,140 743 823 3,073 1,113 Absent Absent Absent Absent Absent Present in 50, 20 & 10 c.c. Absent from 5 to 0.001 Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Colliform Bacillus Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Streptococci present in 10 c.c.'s. Absent Absent Absent Absent Absent Present in 5 and 1 c.c. of water Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Absent Remarks A satisfactory Bath Water A satisfactory Bath Water A satisfactory Bath Water Bacteriologlcally this is a satisfactory Bath Water, but the chcmical test for chlorine shows the chlorine content to be in excess of the amount advisable for bath waters A satisfactory Bath Water Although the bacteriological content is not high for a bath water, the presence of B. Coli in 10 c c. and Streptococci in 1 c c. would only allow of thi being clasped as "Fair" A satisfactory Bath Water A satisfactory Bath Water A good Bath Water A satisfactory Bath Water A good Bath Water This sample of water is quite satisfactory A good Bath Water A satisfactory Bath Water A satisfactory Bath Water A satisfactory Bath Water A satisfactory Bath Water A satisfactory Bath Water 49 The Establishment Laundry is well equipped with up-to-date washing machines, hydro extractors, mangle and drying horses. It is in this laundry that the washing, disinfecting, sterilising and drying of all the towels, garments, etc. used in the Baths, Conveniences and Clinics takes place. In winter the first class bath is covered over and used as a hall for dancing, boxing and public meetings. The remaining two baths are kept open all the year round for swimming, mixed bathing being available every day." The following table shows briefly the condition of the water at stated times. It will be noted that out of 18 tests, only in one instance was an adverse report received. An investigation showed that during the three hours prior to the test being taken (Monday, 10th May, 1937), the Bath was used by 173 adults and children. This also followed heavy week-end bathing. The chlorine content was subsequently slightly increased. Rat Infestation.—Investigations in regard to premises, etc., alleged to be infested with rats or mice were carried out in 239 cases of which 54 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. As usual special measures adopted during Rat Week were put into operation in conjunction with the Borough Engineer's Department. Public Sanitary Conveniences.—There are 9 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. Water Supply.—This is derived from the Metropolitan Water Board, which is a statutory undertaking, and the responsibility for the purity of the water supply rests with the Board. The majority of premises in the Borough have at least one supply direct from the main for drinking purposes. There are, however, some properties which derive their drinking supply from a cistern. In this connection a complaint was received from a householder regarding the peculiar taste and appearance of the drinking water supply. On investigation of this complaint a dead pigeon was discovered in the cistern supplying the premises. Fortunately no ill effects could be attributed to this happening but this has shown the necessity of having a supply for domestic purposes direct from the main, and attention is now being directed to tenement houses and houses let in lodgings. Wherever possible an effort is made to bring the water supply up to modern standards. It is interesting to note that in the 31st Annual Report of the Metropolitan Water Board recently issued, only 199 complaints 50 were received out of a population of 7,711,303 supplied by the Board, and out of this number of 199 only 42 were confirmed after investigation. During the year 612 water supply certificates have been granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 372 cases, and extra water supply to tenement houses in 24 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 188 visits were made under the provisions of the above Act, and it was only necessary to serve 2 notices for infringement. No applications for Certificates of Exemption in regard to the provision of Sanitary convenience accommodation were received Houses Let in Lodgings.—Under Section 6 of the Housing Act, 1925, the London County Council made Bye-laws which came into force in 1926. These Bye-laws define a house let in Lodgings as ordinary tenement houses in which the rooms or floors are let out separately, and all houses suitable to the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, etc. At the end of the year 97 houses were on the Register and 96 inspections were made by the Woman Inspector. No case called for legal proceedings. Rag Flock Act, 1911 and Public Health (London) Act, 1936.—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. One sample of rag flock was taken during the year which conformed to the standard laid down by the Regulations. Drainage.—During the year 132 plans of Drainage and other Sanitary works relating to existing and new buildings were examined and approved. Sub-Soil Flooding. During the past 10 years or so the face of the Borough has been changing and large open spaces have been built upon, particularly in the Charlton and Kidbrooke Parishes on the South side of Shooters Hill Road. The land at the rear of the Herbert and Brook Hospitals formerly used as allotments was taken over by a large Building Estate Development Company and developed. The houses are two storey buildings with the exception of four bungalows. There have been many complaints of sub-soil flooding in this area. 51 The sub-soil water gravitated from the higher ground towards the gardens at the rear of the houses and considerable flooding occurred. The Company voluntarily, on intimation of the flooding, constructed a 6" drain at suitable depths to collect the sub-soil water and connected this drain with the rain water sewer. This method proved most successful and no flooding in this area has occurred since. Another area South of this part is now being developed by another Estate Company and new roads are in course of construction. The whole of this area has a clay sub-soil strata, there being only 18" or so of loam on top. Most of the area being agricultural land was drained by land drains to ditches leading to the streams known as the Kid and the Lower Kid and thence to the River Quaggy and finally to the River Thames. During these building operations many of the ditches have been culverted but it is possible that some were filled in, with the result that after excessive rain many of the gardens may be flooded and possibly also the houses. This actually occurred in the early part of the year and several complaints were received. Streets of houses have been built cutting across the natural fall of the land and no effort has been made to secure adequate drainage of the sub-soil water. Attention has been drawn in previous Reports to this state of affairs, and it would appear that the existing law relating to the drainage of houses should be amended so as to include drainage of the sub-soil where in the opinion of the sanitary authority such is necessary. The experience in this Borough is that springs, ditches, etc. should not be interfered with unless some system of collecting the sub-soil water is enforced. Exhumations.—Notice was received from the Home Office of two exhumations at the Council's Cemeteries. In both instances the Sanitary Inspector for the district was present to see that the usual precautions were duly carried out. River Pollution.—During the early Summer attention was drawn to children bathing off the foreshore of the Thames and the possibility of infection caused thereby. In this connection several samples of river water were submitted to the Council's bacteriologist and in all cases were found to be heavily contaminated by sewage organisms. In this connection it is hoped that representations will be made in the near future to other Boroughs concerned in this question with a view to concerted action being taken. Offensive Trades.—As a result of a complaint it was found that premises were used for the manufacture of animal charcoal, this being an offensive trade scheduled by the London County Council. At the end of the year the Council had under consideration an application from the firm concerned for sanction to carry on this trade. 52 SUMMARY of WORK PERFORMED by the SANITARY INSPECTORS DURING THE YEAR 1937. Inspections— Houses inspected (House to House) 191 „ „ (Complaints, nuisances) 1,878 „ „ (Infectious Disease) 538 „ „ (Overcrowding) 1,485 Re-inspections, calls made, etc. 14,854 Inspections of Factories ) „ „ Workshops - 389 „ „ Workplaces J „ „ Shops 188 „ „ Stables and yards 76 „ „ Urinals 177 „ „ Offensive Trades 9 „ „ Markets and stalls 1,094 „ „ Miscellaneous 892 ,, „ Houses let in Lodgings 96 „ „ Outworkers premises 125 Investigations (Rats and Mice) 239 22,231 Drains— Drains tested—by smoke 61 „ ,, —by water 404 „ found defective — Opened, cleansed and repaired — Reconstructions and additions 195 Inspection chambers constructed 160 New covers to manholes 89 Soil and vent shafts repaired or renewed 185 Traps (gully) 377 Drains sealed off, etc 180 Yards and forecourts drained 98 Waterclosets and Urinals— Closets erected 92 W.C's repaired 489 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 37 Pans or traps furnished 370 Urinals cleansed or repaired 29 Dustbins— Provided 248 Pavings— Yards and Forecourts 335 General Water Supply— Water Fittings amended 372 Extra water supply to tenement houses 24 Water supply certificates granted (Sect. 95) 612 Other Improvements— Houses generally repaired 396 Rooms cleansed and repaired 3,014 Rooms and staircases lighted and ventilated 304 Verminous room cleansed 220 53 Other Improvements—continued. Roofs, gutters and rainwater pipes repaired 799 Dampness abated 590 Sinks, baths and lavatory basins 586 Sink, lavatory and bath wasto pipes trapped or amended 630 Stoves and fireplaces 248 Washing coppers repaired or provided 106 Floors repaired 373 Provision for storage of food 196 Miscellaneous ropairs 2,596 Other Nuisances Abated— Illegal use of Underground room discontinued 12 Overcrowdings abated — Animals kept in unfit places discontinued or removed 7 Dung receptacles provided 7 Houses abolished, unfit for habitation Accumulation of manure and other obnoxious matter removed 22 Rat infestation abated 54 Smoke Nuisances— Observations 45 Statutory Notices served (Sects. 147 and 148) 2 Notices, &c.— Intimations served under Public Health (London) Act, 1936 1,642 Statutory Notices served 187 Houses rendered fit by informal action 462 Return Made to London County Council. Proceedings during 1937. Premises No. in Borough at end 1937 No. of Inspections No. of Prosecutions Common lodging houses 1 3 Seamen's lodging houses — — — Cowsheds (licensed) — — — Slaughterhouses (licensed) 3 304 — Other Offensive Trades 1 9 — Milkshops 194 350 — Ice Cream Premises 143 209 Restaurants and Eating houses 83 417 — Registered Foster Mothers 27 j 157 — Nurse Children kept 34 Smoke Nuisances. Number of observations 45 Number of Intimations served 3 Number of Statutory Notices served 2 Number of Complaints received 16 Number of legal proceedings — 54 Cleansing and Disinfection. Number of adults cleansed 5 Number of children cleansed 1,745 Number of premises cleansed— After infectious disease 562 For vermin 220 Water Supply to Tenement Houses. Number of Premises supplied 24 Number of Prosecutions — Number of houses in the Borough 21,630 Number of houses occupied by the working classes 16,522 Public Health (London) Act, 1930. Number of houses inspected on account of complaints or illness 2,512 Number of Statutory Notices served 187 Number of houses repaired or nuisances remedied 1,858 Housing Act (1936). Number of houses inspected—house to house. (Housing Consolidated Regs. 1925) 191 Do. (Housing Act) 391 Number of houses included in representations by Medical Officer of Health under Sec. 25 of H. A. 1936 165 Number of houses demolished following representation of Medical Officer of Health under Sec. 25 of H. A. 1936 95 Number of houses repaired under Sections 9 and 10 of Housing Act, 1936 :— By Owners 23 By Local Authority in default of Owners — Number of houses demolished :— (a) In pursuance of Orders under Sec. 11 of H. A. 1936 6 (6) Voluntarily 1 Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 21 Number of Closing Orders determined — 65 Houses let in lodgings. Number of houses let in lodgings 97 Number of inspections made in respect of above 96 Number of prosecutions — Underground rooms. Number occupied but unfit 29 Number closed or modified occupation approved 21 Overcrowding (Housing Act, 1936). Number of families known to be living in overcrowded conditions 751 Number of overcrowded families who have obtained alternative accommodation 340 Number of houses erected during the year :— Borough Council 76 London County Council (Flats) 331 Private Enterprise 205 612 56 SECTION D. HOUSING. OVERCROWDING.—The 1st July was the appointed day, after which fresh overcrowding became an offence, and between February and June the second portion of the overcrowding survey was carried out. Particulars were obtained as to some 15,000 dwellings including 2,000 dwellings belonging to the Borough Council and the London County Council. For this purpose a temporary staff of 12 measurers, 12 assistants, and four clerks was appointed. As a result of this survey it was ascertained that the number of dwellings overcrowded was 751, the number of persons involved being 4,435. In accordance with an arrangement made between the Borough Council and the London County Council, the County Council agreed to provide accommodation for the abatement of overcrowding in cases referred from the local authority. Overcrowded Cases Relieved.—The total number of cases of overcrowding relieved during 1937 was 261. Of this number 34 were cases which were definitely given new housing accommodation as the result of official recommendation ; the remainder were due, either to movement of families, or cases, hitherto overcrowded, now owing to marriages, deaths, etc. being within the "permitted number" in accordance with the Housing Act, 1936. Families Overcrowded.—The subjoined table shows at a glance the number of families and number of persons included in those families who were overcrowded at the end of the year. No. of families overcrowded. No. of units in overcrowded families. In private houses ... 496 2,773 In L.C.C. houses 102 6061 In Borough Council houses 81 622 In Clearance Areas 72 4331 • Total 751 Total 4,435 Children over 1 yr. of ago and under 10 yrs. are counted half a unit. 57 In connection with item 4 E on the table on page 61, difficulty was experienced in deciding whether certain rooms should have been excluded from measurement. Although cooking and washing might take place in some rooms, they could not be regarded as sculleries because of the absence of sinks In other cases basement rooms had been closed for sleeping purposes under the Public Health Act, but because of their legal use as living rooms, could be regarded as rooms within the meaning of the Housing Act. In one particular case it was noted that a house was not overcrowded in the aggregate, but because of the ages of the children and the size of the rooms, no allocation of the family could be made, which did not cause the individual rooms to be overcrowded. The following table shews the position with regard to overcrowding within the Borough and the progress of abatement at the end of the year. London County Council properties in respect of which permitted numbers were obtained 693 Borough Council properties in respect of which permitted numbers were obtained 1,186 Other properties in respect of which permitted numbers were obtained 12,374 No. of dwellings found to be overcrowded 751 No. of overcrowded persons in families referred to the Council for abatement 4,435 No. of overcrowdings abated as compared with the original survey 261 No. of cases abated by official action Nil. Slum Clearance.—This aspect of the work continues to occupy a good deal of attention. It is a matter for regret that following the representation of an area as unfit, a long period should elapse before ultimate demolition. This is accounted for in part by opposition from property owners, the inevitable enquiry, and, in certain cases, appeals to the High Court from the Minister's decision. The difficulty in obtaining necessary repairs to houses when demolition orders are pending, is a constant source of complaint to the Department. Landlords are unwilling to expend money in keeping these houses up to any standard of fitness when they are already represented as unfit for human habitation. There should be some procedure whereby the removal of families from surroundings so detrimental to health could be expedited. With the acquisition of the Cherry Orchard land at Charlton by the Council, and the development of the remaining farm land 58 in the Kidbrooke area by a private Estate Company, it would seem that there is no further land available for housing in the Borough. Underground Rooms.—During the year a survey of underground rooms was commenced. As a result of this investigation it was ascertained that there were approximately 1,000 basement rooms occupied. Many of these cases are of a borderline type in which slight alteration would ensure compliance with the requirements of the Housing Act. The regulations made under the Housing Act, 1925, Section 18 are in force in this Borough, and at the year end 21 such rooms were either closed or used for some purpose other than human habitation, approved by the Council. The following statement submitted by the Housing Inspector shows the progress made in regard to unfit houses dealt with under the Housing Act, 1936. Notices of Intention to Survey Served 485 Houses Surveyed for Prospective Clearance 237 Individual Houses :— Houses or parts surveyed 59 Houses subject to informal notice requiring repair— 27, South Street 1 12 and 14, Lenthorpe Road 2 26, 27 and 28, Bennett Street 3 403, 405, 407, 409, 411, 413, Woolwich Road 6 109, Annandale Road 1 23 and 25, Czar Street 2 15 Houses reconditioned:— Informal Notices of Previous Year 17 Informal Notices of This Year 6 23 Houses—Work in Progress ... 12 Houses recommended for demolition or closure 21 Houses demolished or parts closed 35 Underground rooms recommended for closure 29 Re-conditioning Schemes under Housing Act, 1936, During 1937. Submitted by Owner—Kirkland Place, 8 Houses. Completed—Newcastle Street, 16 Houses Caradoc Street, 10 Houses. Kirkland Place, 8 Houses. In Progress—Hadrian Street, 23 Houses. 69 Total Visits. Surveys 296 Visits for Sampling and Enquiry 717 Re-visits 905 Miscellaneous Visits 189 2,107 HOUSING RETURN, 1937. 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) 2,762 (b) Number of inspections made for the purpose 7,999 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 191 (b) Number of inspections made for the purpose 286 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 156 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,411 2. Remedy of Defects during the year without Service of Formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 477 3. Action under Statutory Powers during the year :— (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— Ditto—informal notices 23 (a) By owners 23 (b) By local authority in default of owners 60 (b) Proceedings under Public Heatlh Acts:— Notices served : (1) Number of dwelling-houses in respect of which notices' Intimation 1,642 were served requiring de Statutory fects to be remedied 187 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 1,396 (b) By local authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 (D) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 20 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 4. Housing Act, 1936—Overcrowding :— (A) (i) Number of dwellings overcrowded at the end of the year 751 (ii) Number of families dwelling therein 751 (iii) Number of persons dwelling therein 4,435 (B) Number of new cases of overcrowding reported during the year Nil. (c) (i) Number of cases of overcrowding relieved during the year 261 (ii) Number of persons concerned in such cases 1,540 61 (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, See page 57. 62 SECTION E. Inspection and Supervision of Food. Milk Supply.—This is obtained from farms, and supply companies situate outside the Borough. Approximately 200 gallons, which is relatively a small quantity, enters the district daily unpasteurised. Of this about half is equivalent to "Tuberculin Tested," the remainder being sold as ordinary raw milk. The dairyman concerned with the sale of this raw milk has undertaken, on the advice of the Food Inspector, to instal a pasteurising plant in the near future. Manor Farm, Kidbrooke, where formerly about 100 cows were kept and which supplied a large amount of raw milk to the Borough was closed in October 1937. The land is being used for building purposes, and thus, to meet the increasing demand for houses, one of the remaining " agricultural areas of London " passes. Milk and Dairies (Amendment) Act, 1922—Milk and Dairies Order, 1926.—At the commencement of the year there were 183 purveyors of milk on the Register of Dairies and Milkshops. 15 new applications have been received during the year and added to the Register, and 4 names have been taken off, thus leaving a total of 194 purveyors and dairy premises registered. In all, 350 visits of inspection were made as a result of which the following defects, etc. were noted and remedied :— Action taken re dairy premises. Notices to cleanse or limewash served 10 Drains repaired/cleared 3 Refrigerators installed 2 Pasteuriser with full equipment installed 1 New cooler 1 Improved lighting 1 Sterilizer, etc. installed 1 Milk (Special Designations) Order, 1936.—This came into force on the 1st June, 1936, revoking the Order of 1923, and now the only Designated milks are Tuberculin Tested, Accredited, and Pasteurised. During the year the following licences were granted for the sale of designated milk within the Borough :— Distribution of Tuberculin Tested Milk 7 „ „ Accredited Milk 3 „ „ Pasteurised Milk 29 Pasteurising Process 1 *Supplementary Licences 2 *Supplementary Licences are granted in cases of Traders whose licensed premises are situated outside the District but who sell within tho Borough. 63 A large Dairy Company was warned that the wording "Certified Tuberculin Tested Milk " on bottle caps was a breach of the Order which lays down that the designation should be "Tuberculin Tested (Certified)." Result of Analytical Examinations.—143 samples of milk, including 43 from local hospitals and schools were taken, of which 9 were found to be adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. The administrative action taken is set out in Table on Page 75. Bacteriological Examinations.—At the request of the London County Council samples of milk were taken on arrival at the Brook and St. Alfege's Hospitals and local schools. All samples taken (48) were found to conform with the requirements of the Milk (Special Designations) Order, 1936. During the year five samples examined for tubercle bacilli were found to be free from infection. Inspection of Meat and other Foods.—During 1937 the following diseased and unsound goods were voluntarily surrendered at slaughter-houses and shops :— Beef, Pork, Mutton, Lamb, Offals, etc. 1,125 lbs. Fish 131 lbs. Fruit and Vegetables 245 lbs. Provisions, Confectionery, Sweets 67 lbs. Total Weight 1,568 lbs. Although 3,923 visits have been made to premises where food is stored, prepared or sold, on no occasion has it been found necessary to seize unsound food. Confidence is placed in the Public Health Department and advice is often sought by shopkeepers in doubt as to the soundness of their stock. During examinations at slaughter houses the findings of the Inspectors are always accepted. This is a tribute to their tact and capabilities. Slaughter-houses and Knackers' Yards.—At the end of 1937 there were 2 slaughter-houses and 1 knackers' yard in the Borough, all of which are licensed annually. 304 visits were made to these premises which are maintained. satisfactorily 64 The following table indicates the number of animals slaughtered and examined :— Bullocks and Heifers 191 Sheep and Lambs 985 Pigs 415 1,591 Every carcase and the viscera therein is examined at time of slaughter. The system necessitates attendance for late night and early morning duties in the Slaughter-houses. The following table is given in accordance with Circular No. 1650:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) 191 — — 985 415 Number inspected 191 — 985 415 All diseases except Tuberculosis. Whole carcases condemned Nil Nil Nil Nil Nil Carcases of which some part or organ was condemned 43 Nil Nil 2 12 Percentage of the number inspected affected with disease other than tuberculosis 22.5 203 2.89 Tuberculosis only. Whole carcases condemned Nil — — — — Carcases of which some part or organ was condemned 18 — — — 17 Percentage of the number inspected affected with tuberculosis 9.4 4.1 Public Health (Meat) Regulations, 1924.—No application was received under these Regulations for the marking of meat. 65 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925-33. The Metropolitan Borough of Greenwich with a river frontage of five miles, with more than 30 wharves and 2 of London's largest and most modern cold stores, receives a large percentage of London's imported meats. In addition, considerable quantities of fresh fruit, tinned foods, and miscellaneous provisions are dealt with. Daily visits to wharves and cold stores are made by the Food Inspectors, and imported food generally is carefully supervised. Various Foods Landed during 1937. U.S.A., New Zealand, Australia and Egypt— Tons. Apples, Pears, Grapefruit, Oranges, Lomons, and Onions 2,321 Norway— Margarine, Canned Goods, etc. 46 Empire Colonies, U.S.A. and South America— Beef, Mutton, Lamb, Pork, Poultry, Rabbits 83,076 Total imports from all sources 85,443 An increase of 3,180 tons over 1936. Meat Certified foe Re-export.—Five Certificates have been issued in respect of meats exported to Gibraltar, Bermuda, and Jamaica as follows :— 16 Hindquarters of Frozen Beef. 3 Crops „ „ „ 56 Carcases Frozen Mutton and Lamb. 7 Pieces „ „ 20 Cases Skinned Frozen Rabbits. Fees received in respect of above examinations totalled £2 17s. 6d. Ozonisation of Meat.—During the year consignments of imported meat have reached cold stores situated in certain Riparian Boroughs smelling and tasting of such substances as orange, apple, or even fuel oil, without any visible sign of contamination. 66 The co-operation of Greenwich has been sought by Local Authorities and Importers, and the following meat was accepted into cold store and treated :— Carcases Frozen Lamb and Mutton 31,713 Bags of Frozen Beef 917 Bags of Frozen Pork Cuts 249 Bags of Frozen Mutton Cuts 166 Bags of Frozen Veal 523 Imported Food Surrendered.—During the year 1937 the following unsound or diseased imported foods were surrendered. The meat was passed for non-edible purposes only, and the unsound fruit was destroyed. Tons. Cwts. Qrs. lbs. 51 Carcases Frozen Mutton and Lamb (Caseous Lymphadenitis) 1 2 0 24 56 Sides Frozen Mutton and Lamb (Caseous Lymphadenitis) 9 0 22 67 Pieces Frozen Mutton and Lamb (Caseous Lymphadenitis) 7 3 9 5 Carcases Frozen Mutton and Lamb (Decomposition, Mould, etc.) 1 1 12 2 Pieces Frozen Mutton and Lamb (Decomposition, Mould, etc.) 1 5 153 Pieces Frozen Mutton and Lamb (Brine and dirt damaged) 1 4 0 13 Beef trimmings (Brine and dirt damaged) 2 0 10 Beef trimmings (Decomposition, Mould, etc.) 13 3 8 1144 Tins Frozen Lamb Livers (Decomposition, Mould, etc.) 5 2 0 0 300 Frozen Sheep Hearts (Decomposition, Mould, etc.) 2 20 5 Frozen Ox Livers (Decomposition, Mould, etc.) 2 9 6 Carcases Frozen Pork (Tuberculosis 3 Pieces ,, ,, and abscesses) 5 3 12 675 Cases Oranges (Decomposition) 18 0 0 0 495 Cases Grapefruit (Decomposition) 16 11 1 25 Total weight unsound or diseased foodstuffs 44 1 2 1 This is an increase of more than 28 tons over 1936 67 Examination of Foodstuffs imported at Wharves.—In addition to the general inspection of foodstuffs landed at wharves, the following called for detailed examination. Meat and Offals. 400 Boneless Fores, Chucks Beef. 500 Ox tails. 211 Hinds of Beef. 220 Ox hearts. 50 Boneless loins of Beef. 20 Ox flanks. 1,517 Ox livers. 2,304 Sheep and Lamb hearts. 1,060 Ox tongues. 640 Pig kidneys. 1,666 Ox kidneys. 180 Calf livers. 750 Ox skirts. 1,158 Tins lambs' livers. Mutton and Lamb. Fruit. 444 Carcases. 4,800 Bags of Onions. 12 Pieces. 4,966 Cases of Grapefruit. 50 Bags breasts Mutton. 21,050 Cases of Oranges. 562 Carcases of Pork. 90 Loins of Pork. 384 Frozen Turkeys. In addition 8,611 cases of Biscuits were examined at the request of the War Office. Caseous Lymphadenitis.—During the year the proportion of carcases examined for this condition, irrespective of country of origin, remained at 5% and that for pieces of mutton at 100%. The results of tho examination of mutton and lambs of 42 lbs. weight and over, from Australia, New Zealand, Iceland and South America, were as follows :— Carcases Landed. Examined. Carcases Diseased. 774,197 41,648 51=. 1% Pieces of Cut Mutton Landed. Examined. Pieces Diseased. 10,887 10,887 123=1.13% It is worthy of note that a 100% examination of cut mutton yields 1.13% diseased pieces—whilst the 5% carcase examination shows a diseased percentage of only .1%. I understand from Dr. C. F. White, Port Medical Officer of Health, that tho percentage of carcases examined in the Port of London during 1937 and found diseased was equal to .1%, which is similar to that found in Greenwich. 68 MERCHANDISE MARKS ACT, 1926. Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale, or exposure for sale, of the undermentioned imported foodstuffs, unless such bear an indication of the country of origin. Honey Apples Currants Sultanas Raisins Eggs in shell Dried eggs. Oat products Frozen or chilled salmon Butter Dead poultry Meat Routine inspections aro made to secure compliance with the various Orders, and on nine occasions warnings were given because of minor infringements. SUPERVISION OF FACTORIES WHERE FOOD IS PREPARED. Included among the premises where food is prepared are— mineral water, sweet, vinegar, pharmaceutical sundries and fruit canning factories. Frequent inspections have been made of these factories, and a satisfactory state of hygiene is maintained. At the vinegar factory damaged dry fruit, or other imperfect materials may be used in the manufacturing process. All such materials are examined by the food inspector. The following Table shows the number of inspections made and improvements effected. Food Premises. No. of visits No. of improvements carried out Slaughterhouses and Knackers' Yards 304 21 Eating Houses and Hotel Kitchens, etc. 417 57 Butchers' Shops 533 24 Dairies and Milkshops 350 20 Wharves and Cold Stores 482 3 Ice-cream Shops 209 5 Bakehouses 291 97 Fried Fish Shops 203 48 Preserved or Cooked Meat and Fish Shops 219 24 Other Premises where Food is Prepared or Stored 293 - Visits re Merchandise Marks Acts and Orders 487 Miscellaneous Visits 166 5 Sampling visits, Food and Drugs (Adulteration) Act, 1928 466 — 4,420 68 Food Bye-Laws.—Bye-laws made by the London County Council under Section 183 Public Health (London) Act, 1936 came into force on 1st January, 1937. These bye-laws regulate the sanitary and cleanly condition of foodstuffs during manufacture, storage, transport or exposuro for sale for human consumption. The provisions of these bye-laws have been satisfactorily observed, and during the year no legal action has been necessary. In two instances where confectionery was found to bo contaminated, sweets were destroyed and traders warned. Artificial Cream Act, 1929.—The premises at 14, Rochester Way were taken off the register and one now application was received and duly registered, the promises in question being 4, Delacourt Road. Street Traders.—There are 90 Street Traders who are engaged in selling articles of food and licensed in accordance with the provisions of the L.C.C. (General Powers) Act, 1927. Generally 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 provisions of tho 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 tho 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 moat, 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 tho year 143 premises were duly registered. These premises were inspected on 209 occasions and insanitary conditions remedied in 5 instances. Preserved Meat, etc., Premises.—At tho end of the year 147 premises were on the register and were visited on 219 occasions. As a result of such inspections insanitary conditions were detected and remedied in 24 cases. There was no instance found which necessitated the cancellation of premises already registered. Food and Drugs (Adulteration) Act, 1928.—The following notes are submitted by Mr. A. E. Brown, the Public Analyst, regarding the samples forwarded to him during the year :— 194 formal and 294 informal samples, 488 in all, were taken during the year. Of these 22 were reported against, equal to 4.5 per cent., as compared with 3.9 per cent. in 1936. 70 Special attention has been given to canned foods. Owing to their action upon the containers these foods are liable to metallic contamination, particularly when a poor quality of tin-plate has been used, or when a long period has elapsed between the packing and the sale to the public. A Local Government Report, No. 7 of 1908, stated that "the presence of tin in quantities approaching two grains to the pound may be taken to signify that the food has become potentially deleterious to health." Two samples contained more than this proportion of tin:—one of Sild, containing 2.66 grains per pound; and one of Kipper Snacks, containing 4.13 grains per pound. In addition to these the following samples contained tin in quantities exceeding one grain per pound:— Sild, 6 samples, 1.25, 1.34, 1.36, 1.62, 1.63 and 1.96 grains per pound respectively. Kipper Snacks, 2 samples, 1.18 and 1.20 grains per pound respectively. Grapefruit, one sample, 1.34 grains per pound. Tomatoes, 1.03 grains per pound. All the remaining samples of canned foods examined contained tin in proportions less than one grain per pound. Considerable improvement has taken place in recent years in the packing of these foods. Soldered cans are now rarely used, and further protection is afforded by lacquering the interior of the cans. In my experience very little corrosive action takes place on the tin-plate when this lacquering is well done. Three samples of Self-raising Flour, certified to be not genuine, were of unusual composition. One sample was devoid of sodium bicarbonate, an essential ingredient of this article, and contained an excessive amount of ammonium persulphate. The remaining two samples in each case contained not less than 20 per cent. of potato starch." In regard to the samples of Self-raising Flour referred to above, proceedings were instituted against the vendors but the case was dismissed on the Defendant pleading warranty. The Council took a serious view of this case and ordered proceedings to be taken against the manufacturer for giving a false warranty. It was pointed out on behalf of the Council that the addition of 20% potato starch was a very serious adulteration, and made it quite impossible for the housewife to got the result desired, quite apart from the deleterious effect on the food value of the flour. Although there is no statutory declaration as to what is Self-raising Flour it is the accepted opinion of the Trado that it is flour of wheat 71 only and nothing else, except the raising ingredients. The Defendant pleaded guilty to giving a false warranty and was fined £15 and 25 guineas costs. Public Health (Pkeseratives, etc. in Food) Regulations. —Only three samples were reported on adversely by the Public Analyst under the above Regulations. They were one formal and one informal sample of Pudding Sugar and one informal sample of Blackcurrant Jelly. Particulars as to action taken are set out in Table regarding samples reported not genuine on page 75. Dried Milk.—There were no samples taken under the Public Health (Dried Milk) Regulations, 1923 and 1927, during the year. Public Health (Condensed Milk) Regulations, 1923, 1927.—Eleven samples were taken during the year and in every instance were reported upon as genuine. The rules regarding proper labelling were also observed. Wholesale Mabgabine Dealebs.—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. 72 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Number and Description of Samples Submitted for Analysis under the above Act during the Year 1937. FORMAL SAMPLES. Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Beer 3 3 — Black Pudding 1 1 — Boracic Crystals 1 1 — Brandy 1 1 — Brawn 1 1 — Breakfast Sausage 1 1 — Butter - - — Cheese 1 1 — Citrate of Magnesia 1 1 — Cocoa 1 1 — Cream 1 1 — Curry Powder 1 1 — Dripping 1 1 — Fish Paste 1 1 — Flour, Self-raising 1 — 1 Gin 1 1 — Glycerine 1 1 — Ice Cream 6 6 — Lard 5 5 — Milk 138 129 9 Rum 2 2 — Sausages 2 2 — Steak and Kidney Pie 1 I — Suet, Shredded 1 1 — Sugar 3 2 1 Tapioca 1 1 — Tea 1 1 — Vinegar 1 — 1 Whisky 7 5 0 194 180 14 73 INFORMAL SAMPLES. The following samples were taken from Vendors and submitted to the Public Analyst, by tho 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 3 3 Anchovy Fillets, Tinned 1 1 — Baking Powder 4 4 — Beef Fat 1 1 — Beer 1 1 Blackcurrant Jelly 1 — 1 Blackcurrant Syrup 1 1 — Black Pudding 1 1 — Boracic Crystals 1 1 — Brawn 2 2 — Breakfast Sausage 1 1 — Brisling, Tinned 1 1 — Butter 15 15 — Capers 2 1 1 Cheese 7 7 — Chocolate Sponge Mixture 1 1 — Cinnamon, Ground 1 1 — Cocoa 5 5 — Coconut Ice 1 1 — Coconut, Tinted 1 1 — Coffee 1 1 — Coffee and Chicory Essence 1 1 — Corn Flour 1 1 — Crab, Tinned 3 3 — Cream 3 3 — " Cream Mould " 1 1 — Cream, Tinned 5 5 — Curry Powder 1 1 — Custard Powder 2 2 — Dripping 2 2 — Egg Substitute 2 2 — Epsom Salts 1 1 — Figs, Compound Syrup of 1 1 — Fish Paste 4 4 — Flour 1 1 — Flour Self-raising 8 6 2 Fruit Salad, Dried 2 2 — Ginger, Preserved 2 2 — Glauber's Salt 2 2 — Grape Fruit, Tinned I 1 — Grape Jelly 1 1 — Gravy Browning I 1 — " Gravylets " 1 1 — Gravy Salt 2 2 — Honey 2 2 — Horseradish Cream 2 2 — Iodine, Tincture of 1 1 — 74 Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Jam 10 10 Junket Liquid 1 1 — Kipper Snacks, Tinned 3 2 1 Lamb Tongues, Tinned 1 1 — Lard 4 4 Lemonade Crystals 1 1 — Lemonade Powder 4 4 — Lemon Cheese 1 1 — Lemon Curd 5 5 Lemon Squash 1 1 — Lime Juice and Soda 1 1 — Lime Juice Cordial 1 1 Liquid Paraffin 1 1 — Liver Pate 1 1 — Loganberries, Tinned 3 3 — Macaroni 1 1 — Margarine 13 13 — Marmalade, Lime 1 1 — " Meatox " Cubes 1 1 — Meat Paste 4 4 — Milk 5 5 Milk, Condensed 11 11 — Mincemeat 2 2 — Mustard 5 5 — Nutmeg, Ground 1 1 — Nutmegs 1 1 — Orange Cordial 1 1 — Oranges, Tinned Mandarin 1 1 — Oatmeal 1 1 — Peaches, Tinned 1 1 — Pearl Barley 4 4 — Peas, Dried 1 1 — Peas, Tinned 3 3 Pepper 6 6 — Piccalilli 1 1 — Pickles 7 7 Pork Fat 1 1 Potassium Iodide 1 1 — Prunes 1 1 — Rice 1 1 — Salmon, Tinned 2 2 Sardines 1 1 — Sardines, Tinned 3 3 Sardine and Tomato Paste 1 1 — Sauce 7 7 — Sausages 5 4 1 Sausages, Preserved 3 3 — Saveloy 1 1 — Sherbet 1 1 — Sild, Tinned 11 10 1 Soft Boes, Tinned 1 1 - Sponge Cake Mixture 1 1 — 76 Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Sponge Pudding Mixture 1 1 Sugar.t. 8 7 1 " Swizzade " 1 1 — Table Jelly 7 7 — Tapioca 1 1 — Tea 5 5 — Tomato Soup 1 1 — Tomatoes, Tinned 5 5 — Vanilla Essence 1 1 — Vinegar 5 5 — Wine 2 2 — Wine, Non-Alcoholic 1 1 — Yoghourt 1 1 294 286 8 Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Action taken 216 T. 58 Milk Self-raising Flour Admixed with 4% water Devoid of Sodium Bicarbonate and contained an excessive amount of Ammonium Persulphate Warning Letter Vendor Cautioned T. 129 Sausages Contained 330 parts per million of Sulphur Dioxide (equal to 0.033%) Ditto 310 Milk Abstraction of 27% of Fat Summons taken out. Case dismissed on payment of 40s. costs. 313 Milk Abstraction of 20% of Fat Summons taken out. Defendant fined £4 with £1 costs. 319 Milk Deficient in Solids not Fat to the extent of 1 % Warning Letter 325 Wood Vinegar Contained living " Vinegar Eels" Residue of Stock destroyed 76 NOTIFICATION OF FOOD POISONING. Under the provisions of the London County Council (General Powers) Act, 1932, which came into force on the 12th July, 1932, now re-enactod in the Public Health (London) Act, 1936, every registered medical practitioner attending on any person shall, if he suspects or becomes aware that any person is suffering from food poisoning forthwith notify such case to the Medical Officer of Health. There wero 36 cases notified during the year as compared with six for the previous year. No. of Sample Description of Sample Nature of Adulteration Action taken 331 Milk Abstraction of not less than 18% of Fat Summons taken out. Defendant fined 10s. with 10s. costs. T. 179 Sild Contained Tin to the extent of 2.66 grains per pound Vendor cautioned. (No further Stock remaining) T. 182 Self-raising Flour Contained not less than 20% of Potato Starch Formal Sample taken 343 Self-raising Flour Contained not less than 20% of Potato Starch Summons taken out. Defendant pleaded Warranty. Case dismissed. Manufacturer Summoned. Fined £15 and 25 guineas costs T. 235 Blackcurrant Jelly Contained Sulphur Dioxide to the extent of 60 parts per million Warning Letter 368 Milk Admixed with not less than 1.5% of water Warning Letter 374 Whisky The alcoholic strength of the sample was 39.5 degrees under proof Case dismissed on payment of £5 5s. costs 376 Whisky The alcoholic strength of the sample was 35.9 degrees under proof Warning Letter T. 268 Pudding Sugar Contained Sulphur Dioxide to the extent of 520 parts per million Formal Sample taken 388 Pudding Sugar Contained Sulphur Dioxide to the extent of 520 parts per million Warning Letter (All Stock withdrawn from Sale) T. 277 Kipper Snacks Contained Tin to the extent of 4.13 grains per pound All Stock withdrawn from Sale and destroyed 77 Each case was investigated, with a view to ascertaining tho source of infection, but there was no instance where the food suspected could be regarded as a definite cause of specific food poisoning and recovery followed rapidly. Many of the cases listed or occurring in the West Greenwich district appeared on examination to conform to mild dysentery or gastro-enteritis. Details of the cases are given in the following table:— Case No. Initials of Patient Age and Sex District Date Notified Suspected Cause 1 G. S.I 48 M West Greenwich 4. 3.37 Meat 2 g. s.r 15 M do. 4. 3.37 Meat 3 R. P. 59 M Charlton 1. 4.37 Suspected Tinned Foods whilst at sea 4 E. A. 28 F East Greenwich 13. 7.37 Mushrooms 5 H. W. 49 F Charlton 31. 7.37 Fried Fish 6 P. M. 42 F Charlton 8. 8.37 Tinned Crab 7 L. P. 23 F Charlton 10. 8.37 Cockles, Doughnuts, Fried Eggs 8 H. N. 54 F Charlton 6. 9.37 Plums 9 J. B. 38 M Charlton 6. 9.37 do. 10 C. B. 13 M Charlton 6. 9.37 do. 11 P. J. 60 M West Greenwich 2.10.37 Steak Pudding 12 E. L. 1 8 F West Greenwich 15.10.37 Corned Beef 13 14 M West Greenwich 15.10.37 do. 14 P. D.' 15 F West Greenwich 21.10.37 Tinned Salmon 15 P. T. 50 M West Greenwich 21.10.37 Fish 16 L. B. . 33 F West Greenwich 25.10.37 Unknown 17 P. B. ( 14 F West Greenwich 25.10.37 do. 18 H. T. 12 M West Greenwich 26.10.37 do. 19 M. A. 35 F East Greenwich 1.11.37 Over ripe Tomatoes or mincemeat 20 L. B. 13 F West Greenwich 29.10.37 Unknown 21 J. B. 10 F West Greenwich 29.10.37 do. 22 J. B. I 56 M West Greenwich 13.11.37 do. 23 E. B. J 20 M West Greenwich 13.11.37 do. 24 W. B. 37 M West Greenwich 16.11.37 do. 25 R. W. 11 F West Greenwich 16.11.37 do. 26 I. J. 18 F West Greenwich 16.11.37 do. 27 J. R. 25 M West Greenwich 16.11.37 do. 28 K. H. 51 F West Greenwich 18.11.37 Pork 29 g. L. 23 F Charlton 18.11.37 Pork 30 V. L. 40 M West Greenwich 20.11.37 Sausages 31 G. D. 62 M West Greenwich 22.11.37 Unknown 32 D. H. 23 F West Greenwich 24.11.37 Fresh Herrings 33 E. M. 21 F West Greenwich 30.11.37 Tinned Fruit 34 A. L. 34 M West Greenwich 3.12.37 Sausages 35 L. H. 30 F West Greenwich 10.12.37 Stuffed Heart 36 R. R. 27 F West Greenwich 17.12.37 Tinned Peas 78 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 thereunder, 1635 cases of Infectious Diseases were reported during the year. The following table shows the comparison since 1932. No. Year. 3,497 1932 3,267 1933 3,226 1934 1,191 1935 3,587 1936 1,635 1937 Particulars relating to age groups and districts are shewn in the tables at the end of the Report. Smallpox.—There were no cases reported during the year, but as a result of cases reported in another district some contacts were kept under observation for the requisite period. Public Health (Smallpox Prevention), Regulations, 1917.—It was not found necessary for your Medical Officer of Health to undertake any vaccinations during the year. Details respecting vaccination in the Borough are given in the Supplementary Vaccination Report on page 105 Whooping Cough.—Whooping Cough is notifiable only in a few London Boroughs of which Greenwich is one. Altogether 574 cases were notified compared with 549 for the previous year. 313 occurred in East Greenwich, 120 in West Greenwich, 16 in St. Nicholas and 125 in Charlton and Kidbrooke. There were 6 deaths giving a mortality of 1.04 per cent. Fifty cases were removed to Hospital for treatment. Every case was visited by the Health Visitors and leaflets left with the parents or guardians with a view to advising them as to the care of the patient. Diphtheria.—The number of patients notified as suffering from Diphtheria during the year was 307 as compared with 258, 367, 422 and 396 for the years 1936, 1935, 1934 and 1933. Three hundred and six cases were removed to Hospital. Nineteen were reported by the Hospital authorities as not suffering from this disease, and 49 Reports were received concerning 79 patients who were discharged but still suffering from the following diseases :—Tonsillitis 29, Rhinitis 9, Otitis Media 5, Catarrhal Sore Throat 2, and Adenitis, Quinsy, Pharyngitis and Rhinorrhoea, one each. The attack rate is equivalent to 3.14 per 1,000 population, but taking the estimated child population of the Borough as 23,000, the attack rate per 1,000 child population is 11.1. There were 4 fatalities due to Diphtheria which gives a case mortality of 1.3 per cent. In accordance with the Antitoxin Order, 1910, a supply of Antitoxin is provided by the Council for the vise of general practitoners in emergency cases. Fifteen phials of Antitoxin, each containing 10,000 units of serum, have been supplied during the year. One thousand six hundred and sixty four swabs were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 1,400 were reported to give negative or doubtful results and 264 were positive in character, being dealt with accordingly. Immunisation Scheme.—It may be recollected that a tentative scheme was prepared and arrangements made with local Hospitals to provide certain facilities for immunisation against Diphtheria and that a report on the working of the Scheme should be furnished at the end of September, 1937. Accordingly the following Report was submitted to the Public Health Committee. To the Chairman and Members of the Public Health Committee. Madam Chairman, Ladies and Gentlemen, I have to report on the modified Diphtheria Immunisation Scheme recommended by this Committee and adopted by the Council in October 1936. A report was requested by the Ministry of Health after 6 months experience, but it was pointed out in March last that it was practically the end of 1936 when the scheme got under way, and a postponement was granted to the present time. You will remember that the scheme was instituted on the following lines :— (1) a. Agreement with the Seamen's Hospital authorities. b. Dr. Arthur Davies to carry out necessary injections. c. Those cases applying voluntarily to the Public Health Department to be dealt with, and no propaganda to be used. 80 (2) a. Agreement with the authorities of the Miller General Hospital. b. Dr. W. Smith to carry out necessary injections. c. Applications from those attending the Hospital to be considered. In the case of both agreements, the liability of the Council was to be restricted to children between the ages of 1 and 14 years. Your Medical Officer of Health was to approve the material used, and to ask for such records to be kept as might be useful to the Department. Payment was to be at the rate of 10/6d. for each complete case or 2/6d. when a Schick test (test for susceptibility) alone was necessary. So far (July 29th) some 70 record cards have been passed by me for payment as satisfactorily completed. It would serve no useful purpose to set out a table of ages and sexes, but it may be stated that the majority refer to children between the ages of 3 and 9 years.. In about a dozen cases the Schick test alone was necessary and no case with any reaction was reported to me. In some cases 2 or 3 children in one family have been inoculated. Signed consents have been obtained from parents in all cases. In one or two instances incomplete cases have been referred from the L.C.C. or other authorities, and have been completed under our scheme. I beg to submit the following comments :— (1) Number of Cases dealt with— This is quite satisfactory, having regard to the effective period the scheme has been in progress. There is no' doubt that propaganda from the Centres through the Health Visitors, and the issue of leaflets, etc. would cause the number dealt with to be multiplied. (2) Material used. In the case of the Miller Hospital, Alum Precipitated Toxoid (A.P.T.) has been administered. This is a concentrated antigen and as a rule only one injection is needed. I felt diffident about approving this material as it is not yet in general use and is not devoid of danger. However, it is satisfactory in expert hands and Dr. Smith is, of course, an expert in charge of the Woolwich Schick Clinic, and has used this material extensively. 81 Dr. Davies of the Seamen's Hospital has used Toxoid Antitoxin Floccules (T.A.F.) which is the specially recognised safe antigen that may be used without the possibility of dangerous jeactions. In this case, three injections at 2-weekly intervals is the rule, and the number of visits by the patient is a disadvantage which sometimes leads to the giving up of treatment before completion. (Dr. Davies reports, however, that in only 4 casas out of 70 has treatment been discontinued). Comparing the materials used in our scheme, the advantages and disadvantages might be tabulated thus :— A.P.T. a. Three visits needed as a rule, i.e., one visit for inoculation, one for confirmatory Schick test, and a final visit to interpret same. Five visits would be the maximum, except in extreme cases. This routine would cover an initial and final Schick test and the inoculation. b. It is not devoid of danger as regards possible reactions, especially among older children, and therefore should only be used by an expert. c. Because only one inoculation is needed as a rule, the cost of material is reduced 50/60% as compared with other materials. T.A.F. a. Five visits are needed as a rule, i.e., three for inoculations and two for the Schick test. Seven visits may be regarded as the maximum. b. May be regarded for all practical purposes as being devoid of danger and does not necessitate the reservation of specialist services. c. Because of the number of injections needed, a scheme including the use of T.A.F. would be much more expensive than when the other material is used. (3) The Scheme generally— It has proved very easy to administer, and the numbers would probably grow, especially if propaganda were allowed. On the other hand, about 1,200 children reach the age of five and enter school each year, and even if the numbers dealt with under the present scheme were markedly increased, we should only be immunising three or four per cent, of school entrants. I mention this factor since the incidence of Diphtheria and its fatality are heaviest in children between 3 and 7 years. It is recognised that the best age to immunise is 2 to 3 years, and certainly before 5 years if possible. It is my opinion that to affect materially the incidence and death-rate, and more 82 cularly to prevent the possibility of an epidemic, a more comprehensive scheme should be adopted. In 1933, 1934 and 1935 there were 335, 349 and 327 cases of Diphtheria notified in Greenwich as occurring in the child population. There were 14, 5 and 3 deaths of children in these years. Since 1926 there have been 3,186 cases and 98 deaths among children in Greenwich. The value of Immunisation to the individual child is undoubted, and the value to the community depends on the proportion of the child population which can bo immunised. It is, therefore, desirable that propaganda should be undertaken and the advantages of Immunisation before school age is reached should be taught from' the Welfare Centres and by means of leaflets, talks, etc. There are two ways in which a comprehensive scheme for Greenwich may be instituted. One is the inauguration of an Immunisation Clinic by the Council. The other is to utilise the services of the local practitioners. If the Council decided to establish a Clinic, this would need to be housed, equipped and also serviced by a nurse and doctor. Probably 4 sessions a week would be essential to commence with. This suggestion is put forward as the principle of attaching immunisation sessions to the Welfare Centres would be a bad one in my opinion, and in any case would be extremely difficult to arrange under present circumstances. The advantages of such a scheme are that the inoculations would be carried out by a part-time Medical Officer in the employ of the local authority, and would probably work out slightly less expensive than a General Practitioner scheme. The disadvantages are that long distances would have to be covered by many of the applicants, which is a consideration when many visits are necessary. Also full liability would have to be accepted in cases when extra treatment becomes necessary. In General Practitioner schemes, such as those established in Woolwich and Kensington, the local authority provides the material and general practitioners carry out the inoculations, a Schick expert being retained to carry out and interpret Schick tests when necessary. An agreed payment is made to the practitioner concerned for each completed record accepted as satisfactory by the Medical Officer of Health. Although a General Practitioner scheme may be somewhat unwieldy, there are many advantages. Firstly, there is the free 83 choice of doctor, which is an important consideration. Secondly, the practitioner would be responsible for any after treatment, if such were necessary. Thirdly, it is likely that many parents in a position to afford it, might prefer to pay the fee, and thus save a charge on the local authority. Lastly, but by no means least, the goodwill of the practitioners in the borough would be retained. I feel bound to put on record the fact that, in my position as M.O.H., I have found the majority of the practitioners in this borough willing to co-operate with the Public Health Department. Recently I reported to the Committee the receipt of many offers from doctors to help in the coming campaign to make the Health Services better known. From a consideration of the whole question, the following conclusions commend themselves to me :— (1) That some form of Anti-Diphtheria Scheme is essential. (2) That the Council's present scheme is not sufficiently comprehensive. (3) That a scheme on a wider basis should be adopted, and should embrace the general practitioners of the borough. I, therefore, beg to submit the following recommendations for the consideration of the Committee :— (1) That the general practitioners of the borough be invited to take part in the Council's scheme. (2) That Dr. Davies and Dr. Smith of the Seamen's Hospital and the Miller General Hospital respectively be retained to carry out all Schick tests necessary, and the immunisation of those cases who may apply and do not wish to attend a general practitioner ; the remuneration in this case to remain as at present, i.e., 10/6d. for each completed case, and 2/6d. for a Schick test. There would however be this difference, that whereas at present no payment is made when the test precedes or follows immunisation, under the extended scheme Schick tests in cases referred by general practitioners would qualify for payment. (NOTE.—It is the rule to Schick test all children over 7 or 8 years of age before immunisation, because many children will be negative or non-susceptible and therefore will not need inoculation. Children below the age of 7 and certainly below 5 years are practically always positive reactors. It is also usual to Schick test a few months after the inoculation to test the efficacy of the immunisation. In a fairly small percentage of cases the Schick test remains positive, showing that the inoculated individual is still not immune. Some authorities consider that this test need not be made, because of the low percentage of resistant cases disclosed. I am of opinion that tho confirmatory Schick test should be retained until information regarding local conditions is available). 84 (3) Material for immunisation to be supplied from my Department to general practitioners on application. The application would state the name, age and address of the child to be immunised. (4) The antigen of choice to be T.A.F. (referred to earlier in this report). (5) Remuneration to be 7/6d. per completed case, i.e., 2/6d. per injection. (6) Age category of cases to remain as at present, i.e., 1 to to 14 years. Special emphasis to be laid on the necessity for children under 5 to be immunised. I feel that a scheme based on the foregoing principles would function well and should not prove difficult to administer. The financial outlay would be in the region of 12/6d. to 15/- per case to commence with, but should decrease later for the following reasons :— a. With increase in numbers desiring immunisation, the cost of material would be less. b. Probably within the next year it will be possible to recommend the adoption of material needing one or at most two injections. This will substantially reduce the cost of material and the payment to practitioners. c. It is possible that experience will show that the confirmatory Schick test is not essential. In any case, there is such a degree of safety attached to a successful immunisation that I suggest financial considerations should be of secondary importance. To complete my report, and as a final statement as to the efficacy of Diphtheria Immunisation, I submit the following up-to-date figures relative to the Birmingham scheme, supplied to me through the courtesy of Dr. Vera Followes of the Diphtheria Prevention Clinic. From 1925 to the end of June 1937, 93,000 children between the ages of 8 months and 15 years have been innoculated against Diphtheria. Of this number 62 developed Diphtheria notwithstanding the innoculation, but no deaths occurred. Among the non-immunised children during the same period, 13,486 cases occurred with 857 deaths. The estimated child population of the City is 250,000 and at present some 15,000 children are being immunised each year. There is overwhelming evidence here in favour of immunisation, and the same experience is found in many other places in this country and abroad. 85 X would, therefore, strongly recommend the Committee to consider the institution of an Anti-Diphtheria scheme in Greenwich on as comprehensive a basis as possible. I am, Madam Chairman, Ladies and Gentlemen, Yours faithfully, F. R. WALDRON, August, 1937. Medical Officer of Health. The Committee decided not to provide a special Clinic but to continue on the present lines for a further 12 months. It was also agreed that notices setting out the advantages of immunisation before school age is reached should be exhibited at all the Council's Welfare Centres. Under the Council scheme 112 cases were dealt with during the year. 73 of these cases received injections of toxoid anti-toxin floccules and 24 received injections of alum precipitated toxoid. The remaining / 5 cases included 13 in which the preliminary Schick test was negative ; one case which was positive but was developing diphtheria at the time, and one case which was Schick positive and developed a local reaction following the first injection of toxoid anti-toxin floccules. This latter was the only case in which a reaction to any of the injections was reported. On enquiry it was elicited that anti-toxin had been given a year previously as a prophylactic and the reaction was apparently due to the resultant sensitivity. The number of cases dealt with as mentioned does not allow of any detailed analysis. The scheme appears to be functioning well inasmuch as voluntary applications for treatment are being dealt with. Unfortunately, however, it cannot be stated that the number of cases could be a factor in the prevention of diphtheria in the child population generally. Plague.—In June 1937, notification was received from the Port of London Authority regarding a resident of the Borough who had been a contact of a suspected case of plague on board ship in the Thames. Nothing untoward developed, but as a precautionary measure he was kept under supervision for some time. Malaria.—It is interesting to note that three cases of malaria were notified from the Seamen's Hospital as occurring in seamen. These cases were, of course, under the jurisdiction of the Port of London Authority. Measles.—Forty-five cases of Measles were notified during the year as compared with 2,071 for the previous year and 72 for 1935. There were no deaths. 86 Only 2 cases were removed to Hospital. This is the lowest figure returned since Measles became compulsorily notifiable. Zymotic Enteritis or Epidemic Diarrhoea.—One hundred and seventy seven cases were notified throughout the whole of the Borough, 94 being under one year of age, and 83 one to five, 89 of such notifications related to patients in East Greenwich, 32 in West Greenwich, 22 in St. Nicholas, Deptford, and 34 in Charlton and Kidbrooke. There is no doubt but that a good proportion of the cases were really Sonne Dysentery, an infection which became rather prevalent in October and continued to the end of the year. The increase in the number of the notifications is possibly due to the fact that all medical men practising in the area were circularised with a view to early diagnosis. 14 Deaths were certified as being due to Diarrhoeal diseases. Ophthalmia Neonatorum.—During the year 12 cases of this disease were notified compared with 6 in the previous year. 3 occurred in East Greenwich, 1 in West Greenwich, and 8 in Charlton and Kidbrooke. 6 cases were removed to hospital for treatment. In no case was the type proved venereal, nor were any permanent effects reported. Scarlet Fever.—The number of notifications received during the year was 183 as compared with 305, 301 and 627 for the years 1936, 1935 and 1934. Of the cases, 75 were in East Greenwich, 35 in West Greenwich, 18 in St. Nicholas, Deptford, and 55 in Charlton and Kidbrooke. 179 cases were removed to Hospital and of these 4 were found to be suffering from Tonsillitis, one frcm Urticaria and one from Eiythema. There were two deaths from Scarlet Fever during the year. Enteric Fever.—There were eleven cases of Enteric Fever notified during the year, four cases being in West Greenwich, one in St. Nicholas and six in Charlton and Kidbrooke. All were removed to Hospital and in one instance the diagnosis was not confirmed. Two of the cases proved to belong to the Typhoid type and all cases were investigated for a source of infection without success. There were no fatalities. Seven specimens were forwarded by medical practitioners for bacteriological examination, one of which proved positive. Puerperal Fever.—Eight cases of this disease were notified, as compared with four last year. Three occurred in East Greenwich, three in West Greenwich and two in Charlton and Kidbrooke. 87 All were removed to Hospital for treatment. One of the cases proved fatal. Puerperal Pyrexia.—There were twenty-eight cases attributed to this cause as compared with nineteen for the previous year. Eight of the patients resided in East Greenwich, six in West Greenwich, three in St. Nicholas, and eleven in Charlton and Kidbrooke. The cases were notified from either hospitals or Maternity Homes. Two were fatal, the causes being attributed to Tuberculosis and Broncho-Pneumonia respectively. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever or Post-Basal Meningitis.—There were six cases of this disease. Two occurred in East Greenwich, three in West Greenwich and one in Charlton and Kidbrooke, and were removed to Hospital for treatment. There were two deaths, both being under one year of age. Acute Polio-Myelitis and Polio-Encephalitis.—Two cases were notified, as compared with one for the previous year. Influenzal Pneumonia and Acute Primary Pneumonia.— During 1937, 119 cases of Influenzal Pneumonia and Primary Pneumonia were notified as compared with 83 in 1936. 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.—In the year under review, there were 111 cases notified in the Borough, as compared with 160 for the previous year. Of this number, 105 were of the pulmonary type, ordinarily known as Consumption, and 6 were non-pulmonary cases, i.e., Tuberculosis of other parts of the body than the lungs. Of this number, 41 pulmonary and 1 non-pulmonary occurred in East Greenwich, 22 pulmonary in West Greenwich, 11 pulmonary in St. Nicholas, 31 pulmonary and 5 non-pulmonary in Charlton and Kidbrooke. Four hundred and thirty-six specimens were forwarded by medical practitioners for bacteriological investigation and of these, 370 were reported to be negative and 66 positive for tuberculosis. Disinfection has been offered and carried out in 114 cases, including 170 rooms and 805 articles of bedding, etc., disinfectant has been supplied to patients to disinfect sputum pots, etc. where necessary. It is gratifying to note the decrease this year in the notifications due to tuberculosis as compared with previous years. In connection with these notified cases, mention may be made of the 88 analytical table prepared by Dr. Alcock, the tuberculosis officer, who investigated 70 cases of tuberculosis attending the Maze Hill Clinic for the first time during 1937. The table is an attempt to show the significance to be attached to the different symptoms associated with the disease. It is interesting to note that in only 40% of cases was Dr. Alcock able to elicit a family history. He considers that this points to a considerable amount of infection occurring outside the family circle. It is possible, of course, that the figure may be to some extent accounted for by unintentional concealment and the understandable tendency not to disclose such a history in these cases. Hospital Accommodation.—Towards the end of the year the London County Council circularised London Boroughs regretting that owing to the shortage of nurses it would not be possible to provide accommodation in their infectious diseases hospitals in all cases needing hospital treatment, and that until further notice the admission of cases of scarlet fever, measles, whooping cough and dysentery would be limited to those cases which in the opinion of the Borough Medical Officer of Health were considered desirable having regard to the home conditions and the severity of the disease, and, in the case of measles, the age of the patient. Sickness and Invalidity.—It has been suggested that sewer workers as a class suffer from less illness than other workers and this seems to be true for those employ^ d locally. In this connection it is interesting to note that special attention must be paid to the possibility of spirochaetal infection. In other parts of London instances have occurred of such infection among sewer workers. In general it may bo said that there aro no occupations locally which might be regarded as causing undue sickness or invalidity among those employed therein. 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 treated with Formalin. The following returns show in detail the amount of work performed during the year by the Disinfecting Staff:— 89 Rooms and Articles Disinfected, Year 1937. Diseases, etc. Premises Entered Rooms Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Scarlet Fever 147 211 64 - 86 72 242 274 197 16 187 592 1,730 Diphtheria 280 413 143 - 156 138 454 575 372 62 346 1,091 3,337 Tuberculosis 114 170 33 — 56 56 152 153 100 39 64 152 805 Cancer 27 28 8 — 13 12 68 16 7 8 7 45 184 Puerperal Fever and 3 3 — — 2 3 13 9 4 2 6 28 67 Pyrexia 1 1 — — 1 1 2 2 2 — 1 2 11 Enteric Fever 3 4 — — 2 2 7 12 3 6 7 8 47 Para-Typhoid Fever 7 6 4 — 4 5 17 24 11 1 5 26 97 Cerebro-Spinal Fever 2 2 3 — 1 5 3 4 1 6 6 29 Erysipelas 4 5 2 — 3 4 8 8 6 1 9 14 55 Chickenpox 1 2 — — 2 1 3 7 — — — — 13 Scabies 19 31 16 — 20 14 38 64 30 5 30 63 280 Other Diseases 81 89 12 — 68 16 172 147 25 58 19 169 686 Verminous Premises 48 64 42 — 38 26 64 93 14 12 16 28 333 Verminous (Housing G.B.C.) 80 — 157 2 148 135 254 121 60 1 72 8 948 Verminous (Housing L.C.C.) 9 15 13 — 12 12 22 4 4 2 6 — 75 Total 826 1,044 497 2 611 498 1,521 1,512 829 214 781 2,232 8,697 90 Articles Destroyed, Year X937. Diseases, etc. Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Destroyed Scarlet Fever 1 2 3 1 6 - - - - 8 20 Diphtheria 4 — — 1 1 2 — — 4 19 31 Tuberculosis 8 — 14 1 16 6 2 4 3 139 193 Cancer 5 2 10 5 11 2 2 7 7 6 57 Other Diseases 20 11 19 11 23 9 5 13 11 206 328 Verminous Premises 11 2 19 7 14 9 1 8 3 365 439 Total 49 17 65 26 70 28 10 32 28 743 1,068 91 TUBERCULOSIS OFFICER'S REPORT FOR 1937. I beg to present my first report upon a complete working year. I should like to record in passing, my appreciation of the very friendly co-operation which has existed in my relations, not only with other departments, but local Medical Practitioners, and the Staffs of the various local Hospitals, the Public Assistance Commitee and with the various charity organisations. Complete details of the statisical data for the year are given at the back of the report, but the following table is submitted showing comparative figures for some of the main items over the past ten years. Year No. of cases on DispensaryRegister Deaths No. of "T.B. + " Cases Death Rate Pulm. Pulm. 1928 678 72 174 1.03 0.12 1929 750 80 230 1.04 0.10 1930 770 64 222 0.96 0.14 1931 712 78 234 0.96 0.16 1932 712 52 234 0.75 0.10 1933 673 76 242 0.93 0.11 1934 683 59 238 0.77 0.12 1935 577 65 252 0.74 0.07 1936 532 58 257 0.68 0.09 1937 517 64 278 0.76 0.0(5 It will be seen that although the total number of cases on the Dispensary Register continues to fall slightly, the number of " T.B." cases is on the increase. This paradox is explained, I think, by the lengthened expectation of life for the tuberculous patient as a result of (a) earlier diagnosis (b) more prolonged hospital treatment (c) the improved social conditions under which most patients now live. (It should be pointed out that many of these " T.B.+ " cases have ceased to produce Tubercle Bacilli in the sputum or have no sputum and hence are no longer infective. They nevertheless continue to appear under the above category until removed from the Register). The downward trend in the mortality from tuberculosis is one of the most gratifying achievements of Public Health Administration. The death rate was halved in the latter half of the last century ; by 1930 it was halved again, and the rate, is still falling. 92 Tuberculosis nevertheless still takes a serious toll of human life. We hear much to-day of deaths due to road accidents, Tuberculosis claims nearly five times as many victims in a year. Much effort therefore, remains to be expended if the present trend is to be maintained. Notifications.—Notifications were received during the year in respect of 104 pulmonary and 7 non-pulmonary cases, representing an incidence of 1.08 per 1000 population for the pulmonary and .07 for the non-pulmonary forms of the disease. At the end of 1937, the Notification Register (*) consisted of 646 cases as compared with 647 cases in 1936. The total is made up as follows :— Adults. Children. Total. Males. Females. Pulmonary 254 200 44 498 Non-Pulmonary 30 37 81 148 ( *) N.B.-—There is always a discrepancy between the Notification Register and the Dispensary Register, e.g., a case not desirous of Public Medical Treatment appears on the Notification Register, but not on the Dispensary Register. Deaths.—Deaths during 1937 numbered 79, representing a rate of .82 per 1000 population for all forms of the disease. The pulmonary type accounted for 73 of the deaths—a rate of .76 per 1,000. Public Health (Tuberculosis) Regulations, 1925. During the year under review, no action was taken 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 14 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 93 whatever aspect the tuberculous family is approached the economic factor becomes an obstacle at some point, under the present circumstances. In some of the worst cases of overcrowding, beds and bedding have been loaned in an effort to secure segregation of infectious cases, and in this connection we were fortunate to receive sixteen old bedsteads from the Borough Maternity Home and about a similar number of mattresses. Dispensary—Routine Matters.-—The system inaugurated in 1936 of keeping the notification register at the Dispensary has been continued, and much unnecessary duplication of records thereby avoided. New Patients.—604 new patients were dealt with during the year including 46 transfers. The sources from which these patients came were as follow :— Doctors 320 Hospitals ... ... ... 44 Schools ... ... ... 11 Own application ... ... 24 Nurses ... ... ... 205 (including 154 contacts). Contacts.—154 contacts were examined during the year, of whom five were found to be tuberculous—all with the pulmonary form. The number of contacts examined is slightly more than half the total estimated number of contacts of the 111 notified cases. It is to be regretted that the proportion is not greater, and particularly that more of the age-group 15-25 could not be persuaded to avail themselves of the facilities provided—for much valuable preventive work is to be done in this field. As has been pointed out in previous reports however, a further number of Contacts find their way to the Dispensary via Medical Practitioners or on their own application and are then classed as New Patients. Residential Treatment.—The London County Council's revised scheme for treatment of tuberculosis issued in 1936 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. Only a few applications for assistance were received during the year. 94 Hospital Visits.—The excellent arrangement whereby the Tuberculosis Officer pays visits to St. Alfege's Hospital has been continued. Close supervision of the patients is thus maintained and the interchange of information is of much mutual benefit. X-Ray Examinations.—The arrangements made with the London County Council continue to give every satisfaction. The number of films taken continues to increase each year (618 in 1937 compared with 554 in 1936), but the flat rate of 2/6d. per film charged by the London County Council is so moderate that it is felt that the obvious advantage to the patient far outweighs any financial considerations. In addition a large number of screen examinations were carried out by the Tuberculosis Officer, for which no charge is made. Artificial Pneumothorax Refills.—The arrangement made in 1934 with the London County Council regarding the provision of this treatment is continued ; 21 patients now attend St. Alfege's Hospital for refills and the number of refills given by the Tuberculosis Officer during 1937 amounted to 353. In the earlier part of the year, owing to the increasing number of patients taking this treatment and the difficulty in the case of those working, of attending the afternoon refill clinic, it was felt that an extra evening session would be of advantage. This was accordingly commenced and is working satisfactorily. Ultra Violet Light Treatment.—89 cases were referred for treatment in 1937, as compared with 93 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) 23 Subnormal children including some ' contacts' of so- called pre-tuberculous type 32 Debility following various infectious diseases 8 Rheumatic conditions 6 Adenitis (non-tuberculous) 17 Adenitis (tuberculous) 2 Tuberculous Abscess 1 1,689 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, 95 Dental Report.—Mr. G. F. Ferris, the Council's Dentist, submits the following figures relative to tuberculous cases treated during the year. Sessions 17 Filling and Scalings 5 New Patients 24 Advice 16 Attendances 36 X-Ray — Dentures 6 Extractions:— Gas 16 Local 1 17 Open Air School.—Two children were recommended for admission to the Open Air School during 1937. 24 children are on the roll and are seen once a term by the Tuberculosis Officer. The type of child usually referred is that showing subnormal nutrition or children who are contacts of tuberculous patients. The improvement after a period at the School is in many cases very marked. Convalescent Treatment.—15 children were recommended for periods of convalescent treatment. For the chronic Pulmonary Catarrh of childhood, this seems to be the most effective treatment. It needs to be prolonged however, if a relapse is to be avoided. For the child debilitated by sickness, a change of air often works wonders, and enables it to thrive against adverse conditions. This admirable work so ably carried out by the Invalid Children's Aid Association is deserving of the highest praise. 'Boarding Out ' of Contacts.—5 children were boarded out under the London County Council's scheme. Children up to the age of 14 years are dealt with under the scheme. They live in cottages in the country under the care of an approved foster mother. Care Work.—The Public Health Committee continue to act as a Care Committee as before. Seven garden shelters belonging to the Council are in continuous use. Most of them are about twenty years old and permission was granted during the year to purchase a new one. A Papworth type was accordingly selected. It is giving every satisfaction. Owing to its size, it cannot be erected on small plots with narrow approaches, but where facilities exist, such as on the new estates, the increased size of this hut means much to the patient. As has been previously noted, a number of bedsteads, mattresses and blankets are out on loan to patients. 96 Gifts of personal clothing were made to necessitous patients as a result of the kindness of various friends of the Dispensary Nursing Staff. As in previous years much valuable help has been forthcoming from the British Red Cross Society, Mayor's Fund, etc. Extra Nourishment.—A working arrangement with the Public Assistance Authorities exists whereby tuberculous patients receiving Public Assistance are granted an extra allowance of nourishment on receipt of a recommendation from the Tuberculosis Officer. The amount granted is usually of the order of 7 pints of milk, 7 eggs and £ lb. of butter weekly. For those patients not in receipt of Public Assistance, the scheme commenced in 1936 under Article XII of the Tuberculosis Regulations, 1930, is continued and is much appreciated. Grants similar to the above are made, but the scope of the scheme is limited to patients awaiting admission to Sanatorium or are convalescing after discharge and where a reasonable probability of eventual return to work exists. It should also be mentioned that where considered necessary, contacts of school age are recommended for free milk, dinners and cod liver oil and malt, to the School Medical Officer for consideration by the School Care Committee. INVESTIGATION OF 70 T.B. CASES IN GREENWICH DURING 1937. Appended is a table giving a statistical analysis of 70 new cases of confirmed pulmonary tuberculosis sent to the Dispensary and examined by the Tuberculosis Officer in 1937. The number is small and ill adapted to statistical treatment, but it is hoped that as the figures are augmented year by year, reliable information may emerge. Incidence.—Note that this is small up to the age of 15 but that it rises abruptly after this age particularly amongst females. A table which was supplied by the Statistical Department of the London County Council is also included for comparison. It will be observed that whereas this shows a marked preponderance of males, the Greenwich figures show an equal distribution of the sexes. This may be explained by the large amount of female labour which is employed in the factories in the borough. Age groupings—In males, although the initial rise is less, the incidence of tuberculosis is well maintained throughout the whole of the working life, dropping abruptly after the retiring age. 97 In females, the early rise and sharp fall in the fourth decade clearly indicate the risks which the changes of puberty and adolescence and the stress of childbearing engender, whereas it appears to be the hazards of employment which play an important part in the male sex. Symptoms.—Early cases are those in whom the disease is usually unilateral and limited to part of one lobe and in whom physical signs and constitutional symptoms are absent or minimal. Late cases are those where both lungs are extensively involved and in whom the physical signs and constitutional symptoms are marked. It is gratifying to note the greater number in the early category. Note that cough is not a universal symptom. As symptoms, lassitude, breathlessness, night sweats, wasting and digestive symptoms, are all evidence of toxaemia only, and are not specific for tuberculosis. Hoarse voice is a late sign as one would expect. Haemoptysis (spitting of blood) is a very valuable early sign of tuberculosis when it occurs, as it quickly brings the patient to his doctor. Family History.—Note that of all cases a family history of tuberculosis was elicited in under 40%. It thus appears that most cases contract their disease outside the home, i.e., in public vehicles or at work, etc. Sputum Tests.—Less than half the cases had sputum tests positive for tubercle bacilli, the majority having negative tests or no sputum when first seen. Physical signs.—It is noteworthy that in more than half the early cases, physical signs were absent. History of pleurisy.—Note the high incidence amongst the early cases, indicating when present the necessity for early investigation. Pulse rate.—In view of the commonly supposed acceleration of pulse rate in incipient tuberculosis it was thought worthwhile to investigate this possibility in the cases under review. It will be seen that even in the early cases there is a noticeable acceleration, and it is even very marked in the advanced cases. For comparison, 70 non-tuberculous cases were taken and an average pulse rate obtained. It will be seen that the average rate in the early tuberculosis cases is not markedly greater. It will appear therefore that an increased pulse rate is present in early tuberculosis, but the increase does not appear to be of a degree sufficiently great to merit special comment. 98 CASES SENT TO THE DISPENSARY IN 1937 BY MEDICAL PRACTITIONERS IN WHOM A DIAGNOSIS OF PULMONARY TUBERCULOSIS WAS CONFIRMED. Cases 70 Classification according to Symptoms Elicited at First Examination Male 35 Female 35 Stage Early Intermediate Advanced Total Cases 26 21 23 70 Age Groups Symptoms Cases % Cases % Cases % Cases % Cough 18 69 15 71 21 91 54 77 Years Male Both Sexes Female Pain in Chest 11 42 9 43 8 35 28 40 Lassitude 7 27 8 38 12 52 27 39 0- 5 1 1 — Digestive 4 15 3 14 9 39 16 23 6-10 1 2 1 Dyspnoea 7 27 3 14 11 48 21 30 11-15 — 4 4 Night Sweats 5 19 3 14 12 52 20 29 16-20 6 13 7 Wasting 8 31 5 24 16 70 28 40 21-25 6 11 5 Haemoptysis 6 26 7 33 5 22 18 26 26-30 1 8 7 Voice — — 1 5 2 9 3 4 31-35 5 9 4 Family History 14 54 8 38 5 22 27 39 36-40 3 7 4 Sputum (Positive) 3 12 13 62 16 70 32 46 70 NonTub. Average Pulse Rate 88 Over 40 12 15 3 P. Signs 12 48 17 81 21 91 50 71 History of Pleurisy 9 39 4 19 — — 13 19 Total 35 70 35 Pulse Rate 95 97 104 97 99 PRIMARY NOTIFICATIONS FOR THE COUNTY OF LONDON 1937. Males. Females. Age Periods. Age Periods. 0—1 5 0—1 2 1—5 38 1—5 28 5—10 62 5—10 37 10—15 45 10—15 63 15—20 253 15—20 330 20—25 395 20—25 551 25—35 735 25—35 666 35—45 492 35—45 304 45—55 501 45—55 191 55—65 414 55—65 113 Over 65 162 Over 65 68 Total 3,102 Total 2,353 Handicraft Centre.—The Centre continues its good work, thanks to the zeal of its able leader, Mr. Worlock. The most important event of the year touching the activities of the Centre, was the formation of the Tuberculosis Handicrafts Centre Committee and the subsequent affiliation of the Centre to the National Association for the Prevention of Tuberculosis. The Committee consist of ten members, Mr. Worlock acts as (Chairman), and the offices of Vic3-Chairman, Hon. Treasurer and Hon. Secretary are held by Dr. Watson, Dr. W. Alcock and Miss I. B. Mills respectively. Included in the Committee are the Chairman of the Public Health Committee, Councillor Mrs. F. Carter, and the Chairman of the Maternity and Child Welfare Committee, Councillor Mrs. A. Kennedy. The other members are Mrs. Dabin, Mrs. Scott, Dr. 0. Alcock and Medical Officer of Health. 100 During the year, five meetings have been held and it was decided to participate in the sale of Christmas Seals. A campaign was accordingly put into effect during the weeks prior to Christmas and it is gratifying to be able to record a profit of between thirty and forty pounds. The final figures are not yet to hand as small sums are still coming in. The usual Summer Outing and Christmas Party were organized by members of the Handicraft Aid Committee—a voluntary Committee to whom much praise is due for the good work they perform. A balance sheet for the year is appended and I desire to express my thanks to Mr. Duck for his assistance in auditing this. I am, Sir, Yours faithfully, W. ALCOCK, Tuberculosis Officer. GREENWICH TUBERCULOSIS HANDICRAFT CENTRE. WORKING ACCOUNT Year ended 31st December, 1936. £ s. d. £ s. d. £ s. d. £ s. d. To Stock in hand (1.1.36) By Sales:— Materials 18 16 0 Handicraft Hut 10 3 0 Articles 15 0 0 Carpenters Hall 2 19 6 13 3 0 33 16 0 „ Purchases 21 16 5 ,, Stock in hand (31.12.36) „ Patients' Awards 10 5 0 Materials 14 0 0 „ Maintenance and Insurance 2 9 9 Articles 12 0 0 26 0 0 ,, Students' Fees 1 12 0 ,, Sundry Expenses 5 13 5 „ Deficit 36 9 7 £75 12 7 £75 12 7 Audited and found correct. W. J. WORLOCK, H. W. DUCK. Hon. Treasurer. 101 102 TUBERCULOSIS. NEW CASES and MORTALITY—Year 1937. Age-Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 — — — — — — — — 1 1 2 — 1 — — — — 6 2 2 1 1 — — — — 10 — 2 1 3 1 — 1 1 16 7 12 2 1 6 5 — 1 20 11 15 2 3 6 9 — — 25 18 23 1 1 7 10 1 1 35 14 11 — 1 6 7 — — 45 10 2 — — 7 1 — — 55 10 2 — — 6 — — — 65 and upwards 2 1 1 — 1 1 1 — Totals 75 72 8 11 40 33 3 3 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 91 to 100. 103 Return showing the work of the Dispensary for the Year 1937. DIAGNOSIS Pulmonary Non-Pulmonary Total Grand Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 48 42 1 3 — 2 1 2 48 44 2 5 99 (b) Diagnosis not completed — — — — - — — — 13 4 - 1 18 (c) Non-tuberculous - - - - - - - - 91 103 44 49 287 B.—Contacts examined during the year:— (a) Definitely tuberculous — 2 1 2 - - - - - 2 1 2 5 (b) Diagnosis not completed — — — — - — — — — — — 1 1 (c) Non-tuberculous - — - — - - - — 33 45 35 35 148 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 11 5 1 2 1 2 4 8 12 7 5 32 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — - — — - — — 129 153 89 92 463 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 215 161 18 11 22 28 35 8 237 189 53 19 498 (b) Diagnosis not completed — — — — — — — — 13 4 — 2 19 104 1. Number of cases on Dispensary Register on. January 1st 541 2. Number of cases transferred from other areas and cases returned after discharge under Hoad 3 in previous years 46 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of" 60 4. Cases written off during the year as Dead (all causes) 64 5. Number of attendances at the Dispensary (including Contacts) 2,683 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 20 7. Number of consultations with medical practitioners:— (а) Personal 26 (b) Other 320 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 140 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,287 10. Number of:— (а) Specimens of sputum, etc., examined 272 (b) X-ray examinations made in connexion with Dispensary work 618 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 Registor on December 31st 278 Supplemental Vaccination Return for 1936. Return made on or before the 14th of February, 1938, 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, 1936, inclusive:— Registration SubDistricts comprised in the Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec., 1936 Number of these Births duly entered by 31st Jan., 1938 No. of Births which on 31st Jan., 1938. remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1938, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1937 No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1937 Successfully Vaccinated 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 1047 437 3 — 347 54 17 28 54 107 — — * West Greenwich 198 86 1 — 70 2 1 1 16 21 — Charlton and Kidbrooke 685 306 — — 306 11 1 32 16 13 — — Total 1,930 829 4 — 723 67 19 61 86 141 828 706 *Includes St. Nicholas District. E. S. Elliott, Vaccination Officer. Dated. 9th February; 1938. 105 i. Index of Contents. A. Page Adoptive Acts, By-laws and Local Regulations 3 & 4 Age Mortality 20 Ambulance Facilities 25 Ante-Natal Services 31,32 Area of Borough 9 Articles and Rooms Disinfected 91 Articles Destroyed 92 Artificial Cream Act, 1929 69 Artificial Sunlight Treatment 36 B. Baths and Washhouses 48 Bacteriological Examinations 25, 65, 81 Bakohouses 45, 70 Birth Control 38 Births 18 C. Cancer 24 Cerebro-Spinal Fever 87 Children Acts 40 Cleansing Children 48 Clearance Areas 56 Clinics and Centres 26, 29-32 Common Lodging Houses 44 Complaints 43 Condensed Milk 73 Contacts 96, 98 Convalescent Treatment 36 D. Dairies, Cowsheds and Milkshops 64 Deaths 19, 34 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality 20 Density of Population 9 Dental Work 38 Diabetes 25 Diarrhoea and Zymotic Enteritis 23, 88 Diphtheria 23, 80-87 Diphtheria Anti-Toxin 81 Diptheria Immunisation 79-85 Disinfection 88, 90 Disinfestation 45-48 Drainage Work 50 Dried Milk 40, 41, 71 Duties and Powers of the Public Health and Maternity and Child Welfare Committees 3, 4 E. Elovation of Borough 9 Enteric Fever 23, 86 Enteritis 86 ii. INDEX—continued. Page E. Epidemic Diseases 20 Eradication of the Bed Bug 45-48 Extracts from Vital Statistics 12 Exhumations 51 F. Factories and Workshops 41-43, 68 Food Bye-Laws 69 Food and Drugs—Samples of 69-76 Food Poisoning—Notification of 76, 77 Food—Premises for Preparation of, etc 70 Food—Inspection of 64 Foot Clinic 26 Footway—Fouling of 50 G. General Statistics 9 & Appendix H. Handicraft Centre 102 Health Centres 27-29 Health Propaganda 33 Health Visitors, Visits, etc. 36,37 Heart Disease 24 Home Helps 26 Home Nursing 36 Hospital Accommodation 88 House Drainage 50 Houses Let in Lodgings 50 Housing 58-63 I. Ice-Cream Premises 71 Imported Food Surrendered 68 Infant Consultations 27 Infantile Mortality 21,32 Influenza 23, 87 Inhabited Houses 9 Insanitary Areas 50 Institution Deaths 20 Insulin Treatment 25 Introductory Review 7, 8 L. Laboratory Work 25 L.C.C. School Clinic 38 M. Malaria 85 Margarine Dealers 73 Marriages 13 Maternal Mortality 35 iii. INDEX—continued. m. Pags Maternity and Child Welfare 29-40 Maternity and Child Welfare Committee 4 Maternity Home 34, 35 Measles 22, 85 Meat 03,67 Merchandise Marks Act, 1926 68 Meteorological Observations 14-16 Midwifery Services 32 Milk, Analysis of 63 Milk and Dairies (Amendment) Act, 1922, Etc. 62 Milk—Bacteriological Examination 63 Milk Supply 62 Milk Supply for Expectant and Nursing Mothers 39, 40 Milk (Special Designations) Order, 1936 62 Minor Ailments 38 Mortuary 24 n. Notices, etc 41, 53 Notifications 78-87 Notification of Births Act 37 Nursing in the Home 36 Nutrition 30, 31 O. Offensive Trades 51 Open-Air School 91 Ophthalmia Neonatorum 86 Outworkers' Register 41 Overcrowding 56, 57 Ozonisation of Meat 65 p. Persons Cleansed 48,54 Pneumonia 35, 87 Pharmacy and Poisons Act, 1933 48 Plague 85 Polio-myelitis 87 Poor Law Relief and Unemployment 11 Population 12 Preserved Food Premises 69 Public Health (Imported Food) Regulations, 1925 65 Public Health (Preservatives, etc., in Food) Regulations 71 Public Health Committee 3 Public Medical Services 38 Public Open Spaces 10 Public Sanitary Conveniences 49 Puerperal Fever, etc. 35, 86 r. Rag Flock Acts 50 Rateable Value 9 Rates, Birth & Death 18,19 Rat Infestation 49 Remarks on Death Causes 22-24 River Pollution 51 iv. INDEX—continued. S. Pags St. Alfege's Hospital 38 & 97 Sanitary Work—Summaries, etc. 54-57 Scarlet Fever 22,86 Scavenging and Refuse Removal 44 Sewers 44 Shops Act 50 Sickness, etc. 88 Slaughterhouses 63 Slum Clearance 57 Smallpox 22, 78 Smoke Nuisances 44 Social Conditions 10 Staff of Public Health Department 5, 6, 25 Statistical Tables Appendix Street Traders 69 Swimming Baths 48 T. Toddlers Clinic 26, 30, 31 Tuberculosis 23, 87 Tuberculosis Care Committee 95 Tuberculosis Dispensary—Returns 103, 104 Tuberculosis Officer's Report 91-104 Tumour Diagnostic Clinic 28,29 U. Ultra-Violet Light Treatment 26-28, 36 Underground Bakehouses 44, 45 Underground Rooms 55, 58 Unemployment 11 Uninhabited Houses 9 Unsound Food 68 V. Vaccination 105 Verminous Children 48 Verminous Premises 47-50 Virol 41 Vital Statistics 12, 17-24 & Appendix w. Water Analysis, Table of 49 Water Supply 49, 50 Wholesale Margarine Dealers 71 Whooping Cough 23, 78 Workshops and Factories 41-43 x. X-Ray Examinations 97 z. Zymotic Diseases 86 R7/67