LEW 12 BOROUGH OF LEWI SHAM. Annual Report on the Vital Statistics and Sanitary Condition of the BOROUGH OF LEW I SHAM, For the Year 1924, A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c., Medical Officer of Health and Public Analyst for the Borough of Lewi sham ; Fellow and Member of the Council of the Royal Sanitary Institute ; Formerly Medical Officcr of Health for the Borough and Port of Southampton, and Medical Superintendent of the Southampton Small-Pox and Fever Hospitals, S-c. r» O PUBLIC HEALTH COMMITTEE. 1923-2?. 1924-25. Chairman :— Alderman Hiscox Ex-Officio :— His Worship the Mayor (Councillor J. F. Griffith, J.P.) Alderman Chiesman „ Matthews Councillor Ayland „ Bean ,, Bcntley „ Mrs. Edwards „ Goss „ Hayes ,, Ilsley Jennings ,, Markham ,, Miss Mason ,, Sheppard ,, Weaver „ White „ Mrs. Wight wick Chairman :—Alderman Chiesman Ex-Officio ::— His Worship the Mayor (Councillor J. F. Griffith, J.P.) Alderman Hiscox „ Matthews Councillor Ayland „ Bean „ Bentley „ Mrs. Edwards Goss „ Hayes „ Ilsley „ Jennings „ Markham „ Miss Mason „ Sheppard t, Weaver White „ Mrs. Wight wick MATERNITY AND CHILD WELFARE COMMITTEE. 1923-24. 1924-23. Chairman :— Councillor Miss Mason Ex-Officio :— Ilis Worship the Mayor (Councillor J. F. Griffith, J.P.) Chairman :— Councillor Mrs. Edwards Ex-Officio :— His Worship the Mayor (Councillor J. F. Griffith, J.P The Members of the Public Health Committee, together with the following ladies representing the Voluntary Infant Welfare Centres— Mrs. Beven Mrs. Kemp Miss Fuller Miss Sheldon Miss Howes Mrs. White Mrs. Wigmore Miss Barrett Mrs. Kemp Mrs. Beven Mrs. White Miss Fuller Mrs. Wigmore Miss Howes 4 Staff of the Public Health Department. MEDICAL: †A. VVcllesley Harris, M.R.C.S., D.P.H., Medical Officer of Health and Public Analyst. †J. W. Miller, M.B., Ch.B., D.P.H., Assistant Medical Officar of Health, and Medical Officer for Maternity and Child Welfare. fRose Jordan, M.D., D.P.H., Tuberculosis Officer. Inspectorial Staff: †¶ J. H. Berry †*‡ J. A. K. Cooper †*‡¶. Crowther †*‡A. H. Gray †*‡¶ C. E. Holifield †*‡H. King †*‡B. A. Knappett †*‡¶ W. S. Parsons †*‡¶ S. P. Rayner †*¶ Miss N. F. Jones Sanitary Inspectors. Health Visiting Staff: † a.b.c..Miss F. L. Burton †a.c. Miss A. M. M. Edwards †a.c. Miss K. H. Kempster †b.c. Miss G. Simpson †*b.c. Miss C. H. Thompson †*b.c. Miss E. M. Watson †*¶c. Miss E. Brocklehurst. †a.d. Mrs. M. S. VVardle Healih Visitors for Maternity and Child Welfare. Health Visitors for Tuberculosis. Clerical Staff: * ¶ F. E. Seckerson C. C. Summers E. Walker R. Stephan J. Thomas Miss B. C. Aylett Other Staff: †Matron—Municipal Maternity Home—Mrs. 1). Fynn. †Clcrk-Dispenser— „ ,, „ —Mrs. M. lies. † „ ,, —Tuberculosis Dispensary—Miss M. Colquhuon. Superintendent—Disinfecting Station—Mr. II. T. Ibbett Caretaker-Attendant—Cot oner's Court and Mortuary Mr. H. L. Bailey † Exchequer contributions are received in respect of the salaries of these officers. * Certificate, Royal Sanitary Institute (Inspector of Nuisances*. ‡ „ ,, ,, „ (Meat and Other Foods). ¶ ,, Sanitary Inspectors' Examination Board. a General Trained. b Certificate, Royal Sanitary Institute (Health Visitors). c Certificate, Central Midwives' Hoard d. L.G.B. for Scotland. 5 SUMMARY OF VITAL STATISTICS. Area (acres) 7,015 Population, Census 1921 174,194 „ Estimated at Mid-Year 1924 184,900 Number of Inhabited Houses, 1921 34,420 ,, families or separate occupiers 43,685 Rateable Value, 1924 £1,191,632 Sum represented by a Penny Rate (Estimated 1924-25) £4,850 Births registered 3,066 Birth-rate per 1,000 inhabitants 16.38 Deaths 1,934 Death-rate 10.46 Deaths of Infants under 1 year of age 146 Infant Mortality rate per 1,000 births 47.0 6 To the Mayor. Aldermen and Councillors of the Metropolitan Borough of Levoisham. Ladies and Gentlemen, I have the honour to submit to you my Twenty-fourth Annual Report on the vital statistics and sanitary condition of the Borough for the year 1924. Vital Statistics.—One is happy to record the low deathratc of 10.46 per 1000 of the population, the lowest rate recorded in any of the Metropolitan Boroughs. It compares favourably with the death-rate for the County of London and for England and Wales, respectively 12.1 and 12.2 per 1000. The birth-rate continues to fall, that recorded for the year under review being 16.3 per 1000, compared with 18.7 for the County of London and 18.8 for England and Wales. This is the lowest recorded birth-rate In Lewisham since 1918, and, if one excludes the war period, is the lowest on record. Maternity and Child Welfare.—The infant mortality rale, that is the number of infants dying within one year for every thousand births, amounted to the low figure of 47, the lowest recorded among the London Boroughs, and compares favourably with 75 for England and Wales. The total number of deaths coming within this category amounted to 146, 50 of these being within a week of birth, 73 within a month of birth,, 25 between one and three months, 26 between three and six months, 8 between six and nine months and 14 between nine and twelve months. As to the causes of death, it: is interesting to note that 46 of the total were attributed to conditions due to prematurity, 18 to debility and marasmus, and 21 to pneumonia. It is significant that only eleven deaths were due to gastric or intestinal trouble. The mortality from this cause has been gradually lessening, indicating that mothers have benefitted by the instruction given at the Council's Clinic and the Voluntary Centres in the district. 7 During the year under review 18,055 home visits were paid1 by our staff of Health Visitors. 2,767 were initial visits in relation to birth notificatons ; 10,545 were subsequent visits on the same account ; 1,201 visits were made to the homes of children between two and five years ; investigations into stillbirths, 24 ; home enquiries in relation to the Milk Assistance Scheme, 1698 ; enquiries re measles, 628 ; and further visits arc set out in Scction V. of the Report. The various Voluntary Infant Welfare Centres in the Borough have carried out valuable work during the year, the attendances increasing considerably, so much so that it has been necessary to encourage the formation of an additional Centrej to cope with the work resulting from the influx of population on to the Bellingham Estate. The Council's Infant Clinic, which is held four mornings a week at the Wesleyan Church Hall, has continued its useful work, as evidenced by the large number of attendances. The analysis of the cases seen at the Clinic are set out in the body of the Report. The Voluntary Centres arc mainly educational, and any cases which require treatment are referred by those in charge to the Council's Clinic. During the year we have had the advantage of five additional beds at the Maternity Home, bringing the total to seventeen. The extension has proved of great value, although even now a considerable number of applicants have to be refused. The extension of the Home has, as was anticipated;, reduced the cost of maintenance per patient. As a result of this extension, a new home had to be found for the Council's Infant and Maternity Clinics, the work of which had increased considerably, and the use of the Wesleyan Church Hall in Rushcy Green was secured for this purpose. The Ante-Natal Clinic is still held at the Maternity Home and the attendance at this has also greatly increased. 8 During the year 208 confinements took place at the Maternity Home, 50 more than in the previous year. It is satisfactory to note, from the report of Dr. Miller, the lowmorbidity in the cases. It is also gratifying to record the fact that since the Home was opened, up to the end of 1924, 1.439 patients have been admitted. Many of the cases were of a difficult nature, and although not one maternal death has occurred in the Home, one can safely assume that the results might have been different had the patient been forced to have the confinement in her own home. Injections Disease.—During the year under review we were particularly fortunate in relation to infectious diseases. For example, only 190 cases of diphtheria were notified, the lowest recorded figure since 1905. The case mortality was proportionately low, 5.2 per cent. Both the mortality rate figure and the notification figure are the lowest since 1916. The highest was in 1921, when 515 cases were notified, with a mortality rate of 5.4 per cent. ; in 1920, 453 cases with a mortality rate of 10.2 per cent. Scarlet Fever also showed a decrease in comparison with the previous year, 368 cases being notified, with a case mortality of 1.3 per cent. The highest was in 1921, when 1,120 cases were notified, with a case mortality of 0.4 per cent. The Zymotic death-rate for the year, excluding Diarrhoea and Enteritis, amounted to 0.24 per 1000, compared with 0.25 for 1923. Xo cases of Small-Pox were notified, although on several occasions I was called in consultation to doubtful cases, which, fortunately, proved to be only Chicken-Pox. Details of other infectious disease notifications are set out in Table 3. Housing.—There is continued evidence of the suffering caused by the lack of housing accommodation for the working classes. It is true that a good number of houses are being 9 erected, but these are for sale, and are not within the reach of the poorer section of the community. Overcrowding is very prevalent, hut even when the premises are not actually overcrowded, the conditions are very unsatisfactory, not only from a hygienic, but from a moral point of view. We are constantly receiving applications for assistance in obtaining houses on the London County Council Housing Estates, and it is evident what a lot of unhappiness and irritation result from two or more families living in the same house. Houses are being farmedout into separate rooms and two-roomed tenements, the rents demanded in many cases being unreasonable. The most difficult question of all is that of the married couple with children. I have listened to almost unbelievable tales of the harshness of some of the persons who sub-let their houses, when they discover that an increase in their lodgers' family is expected. Dr. Jordan, the Tuberculosis Officer, frequently brings to my notice the bad conditions under which tuberculous persons are living, emphasising the difficulty in treating such cases, and the futility of sending patients to Sanatoria to be patched up, only to be returned later to their old environment, with the inevitable subsequent falling-off in health. There also remains the risk of infecting others by the unavoidable close contact into which they are forced in the limited space of their homes. Tvbirculosis.—Dr. Jordan's report 011 the work of the Tuberculosis Dispensary is valuable and interesting. The increasing usefulness of the Dispensary is evident, and I am glad to be able to record the fact that continued use is being made of it by the local medical practitioners and others for consultative purposes. During the year a careful investigation was made with a view to determining the number of tuberculous persons residing in the Borough. It is estimated that 1,302 cases existed at the end of 1924, and it will be seen that the new Bellingh;:m Estate has its fair proportion of tuberculous inhabitants. The estimated number of cases is one for every 142 inhabitants, and on the Bellingham Estate one in every 140. 10 An increased number of visits to the homes of patients has been made by Dr. Jordan, the total being 354. Two outdoor shelters for the use of patients were purchased by your Council. These have proved very useful, and it is probable that authority will be asked to increase 'the number of these shelters. Sanitary Inspection. — Your Sanitary Inspectors made 20,147 inspections during the year, details of which are set out in the report. House-to-house inspections numbered 1,402, relating to 1,281 houses. In consequence of these inspections 2,096 Intimation and 494 Statutory Notices were served. It is satisfactory to note that it was only necessary in one case to take proceedings before a magistrate to compel compliance with the Statutory Notice served. The streets selected for house-to-house inspection were particular streets where the houses were known, more or less, to lie in bad condition, which accounts for the large proportion of Notices necessary—883 Notices requiring work to be done were served in relation to 1,281 houses. A large percentage of the houses were sub-let, as will be seen in the report. In conclusion, I should like to express my thanks to the members of the Council for the consideration and support thev have accorded me, and also to my colleagues and the staff of my Department for their help and assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, July, 1925. 11 SECTION I. VITAL STATISTICS. Population. The population of the Borough as at the 30th June, 1924,. has been estimated by the Registrar-General at 184,900, which, figure is used in calculating the mortality and other rates which appear in this Report. This figure is based upon the adjusted Census figures of 1921, after allowance for the varying rate of natural increase as evidenced by the births and deaths, and of migration as indicated from other sources of information such as the changes in the numbers on the Parliamentary Register and the migration returns obtained from the Board of Trade. Marriages. The number of marriages registered in the Borough during the year was 1,474, of which number 855 were solemnized in the Established Church, 156 at Nonconformist places of Worship, and 468 at the Register Office. This number is equivalent to a rate of 15.9 per 1000 of the population. In 1923, 1393 marriages were registered, and the marriage rate was 15.2 per 1000. Births. The number of births registered in the 53 weeks ended 3rd January, 1925, was 3004, of which number 141 were infants torn to parents whose usual place of residence is outside the Borough. The infants born outside the Borough to parents whose usual abode is within the Borough numbered 203, so that the corrected' number of births to Lewisham parents is 3066, comprising 1560 males and 1506 females. 12 Calculated on the above figures, the birth.rate equals 16.3 per 1000 of the population, and this rate is the lowest ever recorded in the Borough, with the exception of the War period. The following Table shows the figures from 1913 onwardls, with the comparative rates for London and England and Wales: Year. Borough of Lewisham. County of London. England and Wales. 1913 20 .3 24.8 23.9 1914 19.5 24.3 23.8 1915 19.3 25 .5 21. 8 1916 18.4 23 .0 21. 6 1917 14. 9 17.9 17.8 1918 13.8 16.0 17. 7 1919 16.6 18.2 18. 5 1920 22.8 26.5 25.4 1921 19.4 22 .3 22.4 1922 18.16 21 .0 20. 6 1923 18.07 20.2 19. 7 1924 16.3 18.7 18.8 Illegitimacy.—The number of infants born out of wedlock was 101, compared with 121 in the previous year, and equal to 3.2 per cent, of the total births. This percentage shows a slight decrease on previous years. Deaths. The total number of deaths of residents of the Borough occurring within the Borough and in Public Institutions and other places outside the area was 1,934, compared with 1,857 in the previous year. The death.rate for the year is therefore 10.46 per 1000 of the population compared with 10.14 in 1923, and is the lowest death.rate recorded in any of the Metropolitan Boroughs.. The death . rates for the County of London and for England and Wales were 12.1 and 12.2 per 1000 respectively. The causes of death are classilied in Table I., and only the following call for comment : — Tuberculosis.—The deaths from pulmonary tuberculosis numbered 127, and from other tuberculous diseases 15. The 13 mortality from pulmonary tuberculosis was equivalent to a deathrate of 0-68 per 1000. The following are the figures for the previous years : — 1919 0.86 1922 0.74 1920 0.73 1923 0.76 1921 0.81 Cancer.—The mortality from Cancer continues to increase, although only to a slight extent. The deaths during 1924 numbered 253, or 2 more than last year, while the percentage to the total deaths is slightly lower : — Mortality from Cancer. Year. Deaths from Cancer. Percentage to Total. Year. Deaths from Cancer. Percentage to Total. 1913 194 10.5 1919 223 11.6 1914 182 9.7 1920 215 11.4 1915 223 10.5 1921 242 13.1 1916 189 9.7 1922 238 12.0 1917 200 10.4 1923 251 13.5 1918 196 8.8 1924 253 13.0 Zymotic Diseases.—The deaths from these diseases are set out below, together with the average for the previous five years :— 1924. Average 1919-23. Enteric Fever 2 2.4 Measles 17 6.8 Scarlet Fever 5 7.6 Whooping Cough 11 9.2 Diphtheria 10 30.2 Diarrhoea and Enteritis 12 29.0 The Zymotic death-rate for the year (excluding diarrhoea and enteritis) was 0.24 per 1000, compared with 0.25 for the previous year. Infant Mortality is referred to in the Section of this Report devoted to Maternity and Child Welfare. 14 Table 1. Shelving the Principal Causes of Death during the Year 1924. Causes of Death. Deaths at the subjoined agks of Residents occurring within and without the district. Total Deaths at all Ages. Deaths in Public Institutions in the Borough Under 1 year 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Males. Females. Total. a b c d e f g h i 1. Enteric Fever 2 2 2 2 2. Small Pox — — — — — — — — — — — — 3. Measles. 2 11 3 1 — — — — 9 8 17 55 4. Scarlet Fever — — 2 3 — — — — 2 3 5 13 5. Whooping Cough 3 4 4 — — — — — 6 5 11 18 6. Diphtheria and Croup — — 6 4 — — — — 7 3 10 80 7. Influenza 2 — 2 — 3 8 28 35 41 37 78 19 8. Erysipelas — — — — — — — — — — — 1 9. Phthisis (PulmonaryTuber.) — — 2 6 33 52 29 5 72 55 127 62 10. Tuberculous Meningitis 2 — 1 2 — — — — 1 4 5 11 11. Other Tuberculous Diseases 1 — 2 — 2 — 3 2 8 2 10 9 12. Cancer (malignant disease) — — 1 — 3 29 107 113 110 143 253 95 13. Rheumatic Fever — — — 2 3 — 2 1 3 5 8 — 14. Meningitis — 3 — 1 — — 1 — 4 1 5 5 15. Organic Heart Disease — — — 4 6 11 72 107 96 104 200 58 16. Bronchitis 3 ] — 1 — 6 34 102 G2 85 147 52 17. Pneumonia (all forms) 21 19 8 5 6 13 32 35 62 77 139 72 18. Other diseases of Respiratory organs — — — — 1 10 10 12 9 21 6 19. Diarrhoea and Enteritis 11 1 — — — — — — 10 2 12 13 20. Appendicitis & Typhlitis — — 1 1 — 6 3 — 9 2 11 8 21. Cirrhosis of Liver — — — — — — 4 3 4 3 7 3 21a. Alcoholism — — — — — — 1 — — 1 1 1 22. Nephritis & Bight's Disease 1 — — 1 7 8 19 18 30 241 54 12 23. Puerperal Fever — — — — — 2 — — — 2 2 1 24. Other accidents and diseases of Pregnancy & Parturition — — — — 2 7 — — — 9 9 10 25. Congenital Debility, etc. 73 2 — — — — — — 42 33 75 26 26. Violent Deaths, excluding Suicide 1 2 2 6 8 9 9 11 32 16 48 25 27. Suicide — — — — 1 3 18 1 8 10 18 2 28. Other Defined Diseases 24 2 10 14 15 38 136 415 290 304 654 301 29. Diseases ill-defined or known 2 — — — — — 1 2 2 3 5 1 Totals 1746 45 44 51 89 195 504 860 922 012 1934 961 SubEntries. included in above figures. 14(a). Cerebro-spinal Meningitis — — — — — — — — — — — — 28(a). Polio-Myelitis _ — — — 17(a). Lobar-pneumonia — — 3 2 2 7 11 8 20 13 33 8 17(b). Pneumonia — — — — — — — — — — — — (type not stated) 2 1 3 — 1 — 8 4 8 11 19 2 NOTE.—Deaths of non-residents occurring in the Borough are excluded, and the deaths of residents occurring outside the Borough are included. 15 Table 2. Comparative Statistics of Metropolitan Cities, and Boroughs, for the Year 1924. Boroughs. Estimated Population Mid-year, 1923- Death Rate. Birth Rate. Infant Mortality. Rate per 1000 Births. County of London 4,564,109 12.1 18.7 69 West. Paddington 146,200 12.9 17.1 78 Kensington 178,500 12.7 16.3 76 Hammersmith 133.600 12.1 18.0 72 Fulham 161,600 11.1 18.4 72 Chelsea 64,480 13.0 14.4 63 City of Westminster 140,430 11.6 11.2 58 North. St. Marylebone 105,400 13.1 14.6 78 Hampstead 87,410 11.4 13.6 52 St. Pancras 214,400 12.9 19.0 73 Islington 336,600 12.3 20.0 66 Stoke Xewington 52,820 11.4 16.6 56 Hackney 226,400 11.2 18.7 60 Central. Holborn 43,376 11.9 13.4 83 Finsbury 77,230 14.1 21.6 78 City of London 13,480 11.5 7.0 115 East. Shoreditch 106,200 13.5 25.1 83 Bethnal Green 118,700 12.2 22.3 78 Stepney 263.850 12.2 22.4 75 Poplar 166,400 12.0 23.1 71 South. Southwark 187.464 14.0 22.5 71 Bermondsey 121,700 13.5 24.4 77 Lambeth 308,500 12.5 19.2 66 Battersea 170,600 11.7 18.4 62 Wandsworth 336,100 11.0 14.9 56 Camberwell 272,300 11.4 19.0 70 Deptford 114.900 11.9 20.7 74 Greenwich 102,777 11.4 20.2 74 Lewisham 184,900* 10.4 16.3 47 Woolwich 140,000 10.8 18.1 65 1924 Population. 10 SECTION II. INFECTIOUS DISEASES. Disease. Number of Cases Notified. Total Cases removed to Hospital. Table 3. The following Table shows the number of Cases of Infectious Diseases notified during the Year 1924. At Ages—Years Under i year 1 and under 2 years 2 and under 3 year: 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over Total at all Ages Small-pox — — — — — — — — — — — — — — Cholera and Plague — — — — — — — — — — — — — — Diphtheria 1 4 11 20 23 13 46 30 14 15 12 1 190 179 Erysipelas — — 2 — — — 4 8 14 8 16 12 54 14 Scarlet Fever 1 5 13 25 33 42 132 66 28 21 2 — 368 318 Typhus Fever _ — — — — — — — — — — — — Enteric Fever — — — — — 1 2 2 5 1 2 — 13 8 Relapsing Fever — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — Puerperal Fever — — — — — — — — 7 3 — — 10 5 Cerebro-Spinal Meningitis — — — — — — — — — — — — — — Polio-Myelitis — 1 — 1 1 — — 1 — — — — 4 3 Ophthalmia Neonatorum 10 — — — — — — — — 10 5 Encephalitis Lethargica — — — — 4 — — 2 2 4 3 1 16 14 Acute Influenza & Lobar Pneumonia 1 4 5 1 3 8 7 10 25 13 24 11 112 71 Malaria — — — — — — — — — — — — — Totals 13 14 31 47 64 62 191 114 95 60 59 25 777 617 17 Diphtheria.—The incidence of this disease was remarkably low, only 190 cases being notified, this figure being the lowest recorded since 1905. The mortality was proportionately low, 10 cases proving fatal, or 5.2 per cent. The following tabic shows the figures for previous years : — Diphtheria Cases. Deaths. Mortality per 100 cases. 1916 256 21 8.2 1917 236 18 7.6 1918 319 31 9.7 1919 352 17 4.8 1920 453 46 10.2 1921 515 28 5.4 1922 447 32 7.1 1923 295 27 9.0 1924 190 10 5.2 Scarlet Fever.— There was also a decrease in the incidence of this disease, 368 cases being notified in the year, compared with 394 in the previous year. The deaths numbered 5, a case mortality of 1.3 per cent. Cases. Deaths. Mortality per 100 cases. 1916 306 12 3.9 1917 279 11 3.9 1918 205 12 5.8 1919 627 6 0.9 1920 728 8 1.1 1921 1,120 5 0.4 1922 619 12 1.9 1923 394 7 1.7 1924 368 5 1.3 Disinfection.—The Disinfecting Station is situated at the Molesworth Street Depot, and is staffed by the Superintendent, boiler attendant, and five disinfectors, two of whom are motor 18 drivers. The work carried out during the year is set out in tabular form below : — Disease Rooms Disinfected. Articles Removed and Disinfected. Scarlet Fever 916 12094 Diphtheria 468 5820 Tuberculosis 588 1385 Cancer 101 1135 Vermin 78 489 Measles 74 330 Enteric Fever 21 362 Puerperal Fever 7 135 Erysipelas 4 — Various 187 3096 Totals 2444 24852 Diphtheria Anti-toxin. — For the convenience of Medical Practitioners, a supply of anti-toxin is always available in the Public Health Department. It is the practice to supply this material in phials containing 8,000 units (for treatment) and 500 units (for administration as a prophylactic). The quantities issued during the year were as follows : — Phials containing Free. On payment. 8000 units 18 15 500 7 8 Bacteriological Diagnosis.—The number of specimens sent to the St. John's Hospital for bacteriological examination was as follows : — Suspected Disease. Number examined. Result. Positive. Negative. Diphtheria 844 70 774 Tuberculosis 635 106 529 Enteric Fever 31 3 28 1510 179 1331 19 TUBERCULOSIS. Notifications. The number of primary notifications of cases of Tuberculosis received during the year was 347. They are analysed for age and sex in the following Table : — Age Periods. Pulmonary Tuberculosis. Non-Pulmonary. Total all Forms. Males. Females. Total. Males Females. Total. 0-1 — — — 2 1 3 3 1-5 3 2 5 7 9 16 21 5-10 8 5 13 9 8 17 30 10-15 4 8 12 6 3 9 21 15-20 12 21 33 1 8 9 42 20-25 19 23 42 2 2 4 46 25-35 32 45 77 5 8 13 90 35 45 23 23 4G 1 1 2 48 45-55 22 6 28 — — — 28 55-0.5 10 4 14 — — — 14 05 and upwards 2 2 4 — — — 4 Totals 135 139 274 33 40 73 347 REPORT OF THE TUBERCULOSIS OFFICER (Dr. Rose Jordan) For the Year 1924. During the year 1924, there were 347 primary notifications of tuberculosis in the Borough, of which '274 were of pulmonary tuberculosis and 73 of other forms of tuberculosis. During the same period 127 persons died from pulmonary tuberculosis and 15 from other forms of tuberculosis, the death-rate thus being 0.68 per 1000 inhabitants, as compared with 0.76 per 1000 in 1923. 20 A careful investigation has been carried out with a viewto determining the exact number of tuberculous patients residing in the Borough at the end of 1924. This was found to be 1302, distributed as follows : — TABLE A (i.). District. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. Catford 256 98 354 Lewisham 123 55 178 Hither Green 108 43 151 Forest Hill 86 30 116 Lee 86 24 110 Lower Sydenham 72 36 108 Crofton Park and Brocklev 67 20 87 Bellingham 57 14 71 Upper Sydenham 45 21 66 Ladywell 22 5 27 Hlaekheath 18 7 25 Grove Park 1 2 9 947 355 1302 TABLE A (ii ). District. Pulmonary Tuberculosis. NonPulnionar\ Tuberculosis. Total. Men 472 48 520 Women 397 89 486 Children 78 218 296 947 355 1302 The table shows that the new Bellingham Estate has its fair quota of tuberculous inhabitants : and it may be conjectured that the Estate now being developed at Grove Park will follow suit, preference being rightly given to families containing one or more tuberculous members and who are living under conditions of overcrowding. Thus in the whole Borough of 181,900 inhabitants there is one tuberculous person to every 142 inhabitants, while in the Bellingham Estate, with its 10,000 inhabitants, the number works out at one in 140. 21 TABLE B. Visits. ex-Service Men. Civilians Total. Pulmonary Tuberculosis 47 180 309 2887 Other Forms 3 73 Subsequent Visits 316 1913 2229 Visits to Cases not Notified 48 301 349 No. occupying Separate Bed 21 147 169 309 sharing bed with 1 other 24 87 111 ,, ,, ,, 2 others 5 24 29 ,, ,, ,, 3 — — ,, ,, ,, 4 — 1 1 No. occupying Separate Room 21 117 138 309 ,, sharing room with 1 other 25 90 115 ,, ,, ,, ,, 2 others 4 39 43 ,, ,, ,, 3 — 11 11 ,, ,, ,, 4 ,, — 2 2 Table B. shows the work carried out by the Health Visitors, who keep in regular touch with all notified cases of tuberculosis and also gain their attendance at the Dispensary when thought desirable. An effort is made by them to have the contacts of notified patients brought to the Dispensary for examination, and during the year 263 contacts were thus examined at the Dispensary, while 317 were seen by the Tuberculosis Officer at their own homes. Table C. shows the condition on December 31st, 1924, of all patients diagnosed as suffering from pulmonary tuberculosis, who have attended the Dispensary since its establishment in June, 1916. TABLE C. Year 1916 (6 months) 1917 1918 1919 1920 1921 1922 1923 1924 Cases of Pulmonary Tuberculosis 74 157 200 185 200 159 165 181 166 Dead 47 66 o go 56 80 63 59 49 16 Left 14 48 54 48 40 36 36 22 11 Well 6 19 40 43 47 30 33 46 30 Fair 3 16 9 35 28 19 26 51 93 Unwell 2 6 1 2 3 9 11 13 16 Discharged as arrested 2 2 16 1 2 2 — — Totals 74 157 200 185 200 159 165 181 166 22 23 The Tuberculosis Dispensary is now firmly established as the Consulting Centre for Tuberculosis in the Borough and is recognised as such by the local practitioners, who during the year sent 196 patients for opinion and advice, while the Tuberculosis Officer was invited out in consultation 20 times to patients unable to attend at the Dispensary. The Tuberculosis Officer paid 354 visits to the homes of patients, every newly-notified1 case being visited, unless the special circumstance connected with the case made such visit undesirable. The number of patients admitted to Institutions through the aegis of the London County Council was 157. The Lewisham! Hospital admitted 56 patients at the request of the Tuberculosis Officer, these being usually patients in an advanced stage of the disease and living in homes unsuitable for their care. The Lewisham Hospital has, as hitherto, been a great standby in dealing with advanced and urgent cases, for whom it is so. difficult to find other suitable accommodation; and the patients have been universally content to remain there as long as desirable, especially as they are thus near to their relatives and friends. The Dispensary is affiliated to King's College Hospital and to the Miller General Hospital and during the past year 18 patients were sent to the Out-Patient Departments of these Hospitals for special investigation—surgical, laryngeal and by X-rays. The Borough Council has also sanctioned the treatment of 9 patients bv artificial pneumothorax, Finsen light, artificial sunlight, etc., at such Hospitals as Brompton and the London. The Council has granted special diet allowance to 5 necessitous patients ; and 15 patients have been granted treatment at the British Dentists' Hospital, Lewisham, 9 for extractions or stoppings and 6 for dentures. The two shelters ordered by the Couneeil from the Papworth Industries, where they were made by tuberculous 24 patients, were applied for immediately on arrival and have been in constant use ever since in spite of the inclement weather'. One was lent to an ex-service man and one to a civilian, and both have been much appreciated. The Care-Committee has again done much useful work on the social and financial side of the Tuberculosis scheme. As considerable difficulty was experienced in finding a voluntary Secretary, and as the many changes gave rise to much disturbance, the Council decided to appoint an official Secretary to carry out the duties under the supervision of the administrative Tuberculosis Officer. The matter was still under discussion at the end of the year. There are living in the Borough 123 tuberculous ex-service men, who attend at the Dispensary at regular intervals in order to keep under observation and who are given preferential treatment in the matter of institutional treatment and training under the Ministry of Pensions. Their pensions eliminate much of the financial strain experienced by the civilian tuberculous patients and lead one to wish that a complete pension scheme could be established for all adult sufferers from tuberculosis, who are rarely able to maintain themselves and their families by regular work. A pension scheme of this kind would enable one to solve some of the difficult problems which present themselves, and of which the following is one example : — A man aged 45, who has worked as a baker all his life and who has a wife and two young children to support, is found to be tuberculous. Baking is a trade bad for his health and the fact of his being tuberculous is bad for the community. If he gives up his work, he and his family are faced with starvation. Could one offer him a pension on condition that he ceased work, one would not hesitate to do so: and both the man and the community would be the gainers. The following statistics have been compiled in order to 25 determine the capacity for work of a tuberculous adult after a short period of years. The year 1921 has been taken as a basis and the fate of the patients has been traced to the end of 1924. It works out thus :—In 1921, 149 adult tuberculous patients attended the Dispensary for the first time, 91 maleis and 58 females. By the end of 1924 29 of these had removed from the Borough, and of the remaining 120, 58" were alive and 62 dead, a mortality of 51.6 per cent, in between 3 and 4 years. Of the 91 males, 18 had left the Borough, 36 were alive and 37 dead. Of the 58 females, 11 had left the Borough, 22 were living and 25 dead. Of the 36 males alive at the end of 1924, 16 had kept at regular work, 12 had worked irregularly and 8 were unfit for any work. Of the 22 females alive at the end of 1924, 11 had done house-work only and 11 had been employed in various capacities; of the latter 6 had kept at work and 5 were unfit. Of the living patients, 27 males and 9 females had a positive sputum. Thus, of 73 males remaining in the Borough, only 16 had kept at regular work and of 47 females only 6 were regularly employed at the end of 4 years. Twenty of the 36 living males were in receipt of pensions. The following 5 tables give a summary of the work carried out at the Dispensary during 1924. Attendances of Patients at the Dispensary. 1924. First Attendances. Subsequent Attendances. Totals. January 62 215 277 February 78 213 291 March 98 244 342 April 58 167 225 May 67 237 304 Tune 65 249 314 July 42 261 303 August 40 197 243 September 30 230 260 Oclober 56 224 280 November 50 210 260 December 35 193 228 687 2640 3327 26 Summary of First Attendances at the Dispensary, 1924. Applied on own initiative. Sent by Doctor. Sent by L..W.P.C. Sent from other Disp.,Hosp., etc. Sent by L.C.C. Sent by Min. of Pensions. Sent by Care Committee. Contacts. Total. Pulmonary 25 92 4 30 4 1 – 10 166 Non-Pulmonary 10 13 – 10 3 1 – 3 40 No Tuberculous Disease 93 87 1 14 21 4 3 247 470 Suspects 1 4 – 1 1 1 – 3 11 129 196 5 55 29 7 3 263 687 Residence of Patients in Wards. Ward. Insured. Uninsured. Total. Church 8 11 19 Manor 6 13 19 South 5 7 12 Black heath 18 20 38 Lewisham Village 14 41 55 Lewisham Park 15 30 45 Broekley 19 52 71 Catford 62 167 229 Forest Hill 33 52 85 Sydenham 47 67 114 227 460 687 Stages in Pulmonary Tuberculosis. Male. Female. Children under 16. Total. Stage I. 17 22 2 41 „ II. 41 51 3 95 „ III 14 11 5 30 72 84 10 166 Stage I.—Slight disease of one lobe. Stage II.—Disease of two lobes or part of three lobes. Stage III.—Severe disease of three or more lobes. Cases of Non-Pulmonary Tuberculosis. Male. Female. Children under 16. Total. Glands 1 3 7 11 Bone 4 1 11 16 Other Regions 2 7 4 13 7 11 22 40 27 SECTION III. SANITARY CIRCUMSTANCES OF THE BOROUGH. Scavenging. The following figures relating to the collection of house and trade refuse during the year have been furnished by the Borough Surveyor:— Quantity Collected:— Cart-loads 15,202 Van-loads 13,857 Motor-loads 1,442 30,501 34,567 tons Method of Disposal:— Loads. Tons. Dust Destructors 28,722 32,597 By Rail 1,480 1,689 To shoots in the Borough 249 281 30,501 34,567 Sanitary Inspection of the Borough. Inspections.—During the year 20,147 inspections were made by the staff of Male Sanitary Inspectors. This figure includes:— Inspections on complaint 2075 Infectious disease investigations 486 Miscellaneous inspections 942 Re-visits and Re-inspections 14178 New houses, on application for water certificate 344 House-to-house inspections 1402 Nuisances. — Details of the nuisances discovered in the course of the foregoing inspections are set out hereunder:— Dirty & Dilapidated Premises 1202 Defective Waste pipes 494 Defective Roofs 580 Defective Soil and Ventilating Pipes Defective Rainwater Pipes and Gutters 562 (a) necessitating replacement 198 (b) ,, repair 111 Damp Premises 467 Defective Dustbins 329 Defective Drains Foul or Uncovered Drinking Water Cisterns 70 (a) necessitating reconstruction 165 Overcrowded Rooms 54 (b) ,, repair 271 Defective or Unpaved Yards 332 Defective Water-closets Offensive Accumulations 112 (a) necessitating replacement 360 Improperly-kept Animals 21 Houses without proper supply of water 59 (b) ,, repair 413 28 Notices.—''Intimation" notices were served to the number of 2096, and "Statutory" notices, 494. Prosecutions.—Proceedings were instituted under the provisions of the Public Health (London) Act, in respect of a nuisance existing at No. 2, Sandrock Road, Lewisham. The Magistrate made an Order for the nuisance to be abated within one month, and ordered the defendant to pay £2 2s. 0d. costs. Woman Sanitary Inspector.- The inspections made by the Woman Sanitary Inspector numbered 2373, and as a result of nuisances discovered, 200 "Intimation" and 62 "Statutory" notices were served. HOUSING SUMMARY. Number of new houses erected during the year:— (a) Total 344 (b) As part of a Municipal Housing Scheme – Unfit Dwelling Houses—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3963 (2) Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 1402 (3) Number of dwelling-houses found to be in a state dangerous or injurious to health as to be unfit for human habitation – (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 2096 29 Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs – (2) Number of dwelling-houses which were rendered fit:— (a) By owners – (b) By Local Authority in default of owners – (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close – (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2096 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners 2096 (b) By Local Authority in default of owners – (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &e., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 (3) Number of dwelling - houses in respect of which Closing Orders were determined, the dwelling - houses having been rendered fit – (4) Number of dwelling-houses in respect of which Demolition Orders were made – (5) Number of dwelling-houses demolished in pursuance of Demolition Orders – 30 House-to-house Inspection.—A routine inspection of the houses comprised in the roads set out below was carried' out during 'the year by the Sanitary Inspectors delegated to this particular duty:— Baring Road Campshill Road (part) Carthage Street Cibber Road Colfe Road (part) Collins Street Collins Square Como Road Courthill Road Drysdale Road Elthruda Road Halifax Street Harwich Place Hither Green Lane (part) Holbeach Road Kneller Road Ladywell Park Mercia Grove Merton Place (part) Mount Ash Road Myron Place Regent Street St. Stephen's Road Scrooby Street Shipman Road Taunton Road Taylor's Lane Treviso Road Trilby Road Upper Colfe Road Vestris Road Wells Road Wildfell Road The total number of houses inspected was 1281, and in 883 of this number defects were found necessitating the services of notices under the Public Health (London) Act. The following statistics afford some indication of the extent to which houses of this class are being sub-let, as a consequence of the present difficulty in obtaining housing accommodation:— 830 houses contained 1 family 354 ,, ,, 2 families 87 „ „ 3 „ 9 „ ,, 4 „ 1 house ,, 5 ,, The occupancy of one, two, and three-roomed tenements is shown in the following tables:— One-roomed Tenements 136. 55 were occupied by 1 person 47 ,, „ 2 persons 22 3 „ " yj 9 9 4„ 4 „ 2 „ „ 5 „ 1 was „ 6 „ .31 Two-roomed Tenements—275. 23 were occupied by 1 person 106 „ „ 2 persons 70 „ „ 3 „ 51 „ „ 4 „ 20 „ „ 5 „ 5 „ „ 7 ,, Three-roomed Tenements—363. 16 were occupied by 1 person 106 „ „ 2 „ 95 „ „ 3 „ 68 „ „ 4 39 „ „ 5 20 „ „ 6 13 „ „ 7 5 „ „ 8 „ 1 was ,, 9 ,, Smoke Prevention.—During the year 21 observations were made for the detection of nuisances caused by the emission of black smoke, and in 3 instances it was necessary to serve an intimation notice, which in each case resulted in the cessation of the cause of the complaint. Increase of Rent, &c., Acts.—The Certificate of the Sanitary Authority under the provisions of the above Acts was issued in respect of 62 houses. Water Supply.—A newly - erected house may not be occupied until a certificate has been issued by the Council to the effect that a proper and sufficient supply of water has been provided. During the year 344 such certificates were issued. 'Public Mortuary and Coroners Court.—The bodies received into the Mortuary during the year numbered 141. Post-mortem examination,s numbered 86, and inquests were held in 139 cases. 32 Factories and Workshops.—Particulars of the work carried out under the Factory and Workshops Acts have been compiled, and are set out in tabular form herewith: — Workshops on Register (other than Domestic Workshops). Trade or Business. Workshops. Workrooms No. of Employees. Male. Female. Blacksmith 15 16 36 – Hoot Repairers 44 45 75 – Builders 56 72 205 – Cabinet-making and Joinery 15 16 31 – Carriage Builders 13 20 37 – Cycle Repairers 25 28 48 – Dentists 40 40 66 7 Dressmakers 86 125 5 437 Ironmongers 6 8 14 – jewellery, Watch, etc., Repairs 24 25 42 4 Laundries 21 69 12 75 Millinery 37 49 – 173 Motor Repairers 53 55 127 – Photographers 20 34 33 44 Picture Framers 11 12 18 2 Tailors 49 57 72 50 Umbrella Makers and Repairers 14 16 14 15 Undertakers 9 9 16 – Upholsterers 30 36 68 13 Miscellaneous 124 140 233 93 Totals 693 872 1152 913 Factories on Register. Trade or Business. No. Trade or Business. No. Boot-ma king & Repairing 42 Motor Manufacturers and Repairers 30 Builders 18 Carriage Builders 7 Printers 21 Electrical- and other Engineering 39 Timber Merchants 13 Miscellaneous 59 Laundries 14 Totals 243 Workplaces on Register. Trade or Business. Number. Inspections. Cab Proprietors 6 18 Contractors 10 27 Motor Garages 17 i7 Stable Yards 7 24 Restaurants 92 184 33 Domestic Workshops on Register (excluding Outworkers). Trade or Business. No. Employees. Male. Female. Boot Repairers 85 87 – Cabinet-making and Joinery 4 4 – Cycle Repairers 7 7 – Dressmakers 31 – 35 Jewellery and Watch Repairs 20 20 – Laundry 10 – 16 Millinery 6 – 6 Picture Framers 5 5 – Tailors 30 30 – Umbrellas 5 5 1 Wig-makers 3 3 – Miscellaneous 15 17 2 Totals 221 178 60 Homework.— Outworkers on Register. Nature of Work. No. of Workpeople Nature of Work No. of Workpeople. Costumes 68 Millinery 12 Collars 7 Shirts 5 Boots 62 Tailoring 23 Blouses 99 Woollen Goods 18 Lace and Embroidery 12 Underclothing 71 Mantles 2 Miscellaneous 40 Lists of Outworkers received from Employers 91 Addresses of Outworkers:– Received from other Authorities 234 Forwarded to 109 Visits made to Outworkers 182 34 Inspections, and Defects Found. (1). Inspections. Premises. Number of Inspections. Written Prosecutions (1) (2) (3) (4) Factories (including Factory Laundries) 529 39 – Workshops (including Workshop Laundries) 1655 47 – Workplaces (other than Outworkers' premises) 686 5 – Total 2870 91 – (2). Defects Found. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 20 20 – – Want of ventilation 3 3 – – Overcrowding 2 2 – – Want of drainage of floors – – – – Other nuisances 58 58 – – Sanitary accommodation insufficient 5 3 – – unsuitable or defective 3 3 – – not separate for sexes – – – – Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) – – – – Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921 – – – – Total 91 89 – – *Including those specified in sections 2, 3, 7 amd 8 of the Factory and Workshop Act. 1901. as remediable under the Public Health Acts. 35 SECTION IV.—FOOD. Dairies and Milkshops.—The premises registered for the sale of milk numbered 141 at the beginning of the year. During the year 19 new applications were granted, and 13 premises removed from the register. The number in the register at the end of the year was therefore 147; and during the year 330 inspections of these premises were made. Cowsheds.—There are now only six licensed cowsheds in the Borough, and 38 inspections of these were made during the year. Slaughter houses.—There are eight licensed slaughterhouses in the Borough, and 216 inspections of these were made. Bakehouses. Factory Bakehouses. Workshop Bakehouses. Underground. Others. Underground. Others. On Register end of 1923 5 19 7 55 Added, 1924 – 1 2 – On Register end of 1924 – 20 9 52 Inspections 16 48 49 152 Notices 10 40 20 102 Restaurants. — The kitchens of restaurants and similar premises are deemed "workplaces" and as such are registered under the provisions of the Factory and Workshops Act. The number on the register is 92 and 184 inspections were made during the year. Sale of Food and Drugs Acts. During the year 504 samples were taken under the Sale of Food and Drugs Acts and submitted to the Public Analyst. Of the number, 436 were purchased officially in conformity with the provisions of the Acts, and the remaining 68 were bought informally as "test" samples. Thirteen, or 2.9 per cent. of the official samples were certified by the Public Analyst as being adulterated, or below the legal standard, compared with 1.3 per cent. in the year 1923. 36 The following Table shows the nature and number of samples analysed, and the number found to be adulterated:— Article submitted for Analysis. No. of Samples Submitted. Number Genuine. N umber Adulterated. Official Samples. Milk 419 406 13 Separated Milk 4 4 – Cream 9 9 – Preserved Cream 2 2 – Butter 2 2 – Total Official Samples 436 423 13 Informal Samples. Butter 15 12 3 Cream 2 2 – Preserved Cream 8 8 – Dried Milk 4 4 – Coffee 13 13 – Cocoa 4 4 – Pepper 4 4 – Mustard 2 2 – Whisky 3 2 1 Gin 3 2 1 Rum 6 4 2 Paregoric 3 3 – Prescription 1 1 – Total Informal Samples 68 61 7 Totals, all Samples 504 484 20 Milk.—419 samples of milk were submitted for analysis and of this number 13 or 3.1 per cent. were certified as adulterated or below the standard fixed by the Board of Agriculture and Fisheries. The average composition of these milk samples is set out below:— Period. Average Composition of all Samples submitted, Genuine and Adulterated. Average Composition of Genuine Samples. Board of Agriculture Standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. First Quarter 3.51 8.82 3.52 8.84 3.0 8.5 Second ,, 3.45 8.83 3.47 8.84 Third „ 3.60 8.80 3.60 8.82 Fourth ,, 3.81 8.88 3.82 8.91 Average for the Year 3.59 8.83 3.60 8.85 37 Public Health (Milk and Cream) Regulations, 1912 and 1917. None of the samples of milk were reported as containing any preservative. Ten samples of preserved cream were submitted, and in each instance the statement on the label as to preservative was correct. The percentage of preservative found in each sample of Preserved Cream was as follows:— Sample Marked No. Percentage of Preservative. Remarks. 90 0.38 per cent. Boric Acid Sold as Preserved Cream and labelled in accordance with the Regulations. 167 0.35 „ „ 168 0.30 „ „ 169 0.35 „ „ 172 0.30 „ „ 173 0.34 216 0.29 „ 222 0.30 „ „ „ 372 0.30 „ „ 373 0.36 „ „ Adulterated Samples.—Administrative action taken in regard to adulterated samples:— Sample marked No. Article. Result of Analysis. Remarks. Official Samples. 7 Milk 3 per cent. added water Vendor cautioned 23 „ 4 per cent. added water Prosecution — Case dismissed on proof of warranty 31 „ 4 per cent. added water Ditto 32 „ 2 per cent. added water Vendor cautioned 134 „ 2 per cent. deficient in milk fat Vendor cautioned 155 „ 18 per cent. deficient in milk fat Prosecution Vendor fined £5 and £2 2s. costs 242 „ 3 per cent. added water Vendor cautioned 244 „ 3 per cent. deficient in milk fat Vendor cautioned 261 „ 3 per cent. added water Vendor cautioned 284 „ 3 per cent. added water Vendor cautioned 482 „ 3 per cent. added water Vendor cautioned 497 „ 11.5 per cent. added water No action — Reserve portion of sample accidentally broken. Same Vendor as No. 514 514 „ 12 per cent added water Prosecution Vendor ordered to pay costs. „ Informal Samples. £5 5s. 0d. 355 Butter Margarine Subsequent official samples proved genuine 433 „ Margarine Ditto 440 ' „ Margarine Ditto 451 Gin 39.5 degrees under proof 457 Rum 46.5 degrees under proof 458 Rum 39.5 degrees under proof 454 Whiskey 48 degrees under proof 38 SECTION V. MATERNITY AND CHILD WELFARE. Notification of Births—During the year 2903 births were notified under the provisions of the Notification of Births Act, 1803 by medical practit:oners and parents, and 1100 by midwives. Still-births numbered 80. Work of Health Visitors.—The work carried out by the Health Visitors is shewn in tabular form herewith:— Reason for Visit. No. of Visits. Infants at Birth, initial visits 2767 „ „ subsequent visits 10545 Children between the ages of 2 and 5 1201 Still-births 24 Infant deaths 45 Ante-Natal cases, initial visits 417 ,, ,, subsequent visits 143 Milk Assistance Scheme 1698 Puerperal Fever cases 9 Ophthalmia Neonatorum cases 28 Measles cases 628 Miscellaneous Visits 550 Milk Assistance Scheme.—Under the above Scheme, the Council are empowered to grant a supply of milk to expectant and nursing mothers, and infants, either free or under cost price, the grants being limited to necessitous cases. During the financial year ended 31st March, 1925, 539 families were assisted in this respect, 319 being new cases, and 220 cases continued from the previous year. Approximately 750 orders were issued on milk retailers, and 5,344 lbs. of dried milk supplied by the Public Health Department. The cost to the Council of this service during the financial' year ended 31st March, 1925, was £665, of which amount one-half is recoverable from the Ministry of Health. 39 Supply of Dried Milk at, cost price.—Dried milk, purchased from the makers at specially low rates, is sold, on the recommendation of the Health Visitors, at cost price to persons to whom the ordinary retail price is prohibitive. During the financial year 11,865 lbs. were issued from the Public Health Department. Clinics Administered by the Borough Council:— Infant and Maternity Clinic, Wesleyan Hall, Rushey Green, Catford. Ante-Natal Clinic, 41, Rushey Green, C&tford. Clinics Administered by Voluntary Committees:— Bellingham Infant Welfare Centre, St. Dunstan's Hall, Brookhowse Road, S.E.6. Catford School for Mothers, Wesleyan Hall, Rushey Green, Catford. Forest Hill Infant Welfare Centre, Salvation Army Hall, Wastdale Road. Hither Green Babies' Welcome, Wesleyan Hall, Hither Green Lane. Lee and Blackheath School for Mothers, St. Margaret's Parish Room, Old Road, Lee. St. Mary's School for Mothers, St. Mary's Mission Hall, Lady well Park. Sydenham Infant Welfare Centre, 5—7, Adamsrill Road, Sydenham. Infant Mortality.—The number of infants who died before reaching the age of one year was 140. The infant mortality rate was, therefore, 47 per 1000 births registered. This rate is the lowest recorded in any of the London Boroughs during the year under review. The rates for the County of London and England and Wales were 69 and 75 respectively. 40 Details of the causes of infant deaths are contained in the following Table:— Nett Deaths from slated Causes at various ages under One Year of age during the Year 1924. Cause ok Death. Under 1 Week. 1 and under 2 Weeks 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year All causes Certified – – – – – – – – – – Uncertified – – – – – – – – – – Small-pox – – – – – – – – – – Chicken-pox – – – – – – – – – – Measles – – – – – – – – 2 2 Scarlet Fever – – – – – – – – – – Whooping Cough – – – – – 1 – 2 – 3 Diphtheria – – – – – – – – – – Erysipelas – – – – – – – – – – Tuberculous Meningitis – – – – – – – 1 1 2 Abdominal Tuberculosis – – – – – – – – – – Other Tuberculous Diseases – – – – – – – 1 – 1 Meningitis (not Tuberculous) – – – – – – – – – – Convulsions – – – – – – 2 – – 2 Laryngitis – – – – – – – – – – Bronchitis – 1 – 1 2 – .1 – – 3 Pneumoia (all forms) – – – – – 5 10 3 3 21 Diarrhœa – – – – – 1 – – 1 2 Enteritis – 1 – – 1 1 2 1 3 8 Gastritis – – – – – – 1 – – 1 Syphilis – – – – – – 1 – – 1 Rickets – – – – – – – – – – Suffocation, overlying – – – – – – – – – – Injury at birth 1 – – – 1 – – – – 1 Atelectasis 8 – – – 8 – – – – 8 Congenital Malformations – 1 1 – 2 3 3 – – 8 Premature birth 31 6 6 – 43 3 – – – 46 Atrophy, Debility & Marasmus 4 2 1 – 7 7 4 – – 18 Other Causes 6 2 1 – 9 4 2 – 4 19 Totals 50 13 9 1 73 25 26 8 14 146 41 Report of Dr. J. W. Miller, Maternity and Child Welfare Medical Officer. Ante-Natal and Maternity Clinics.—The former is held at 41, Rushey Greetn, and the lather at the Wesleyan Church Hall, Rushey Green. The attendances during 1924 were as follows:— Ante-Natal Clinic 1,625 Maternity Clinic 1,500 An analysis of the ailments treated is set out in the following Table:— Classification of Cases. Ante-Natal Clinic. Maternity Clinic. Totals. Consultations 1461 861 2322 Disorders and Diseases of the Reproductive System— Sterility – 2 85 Endocervicitis 2 3 Prolapse of Uterus – 3 Subinvolution of Uterus – 25 Fibroid of Uterus 2 – Dysmenorrhœa – 2 Amenorrhœa – 1 Menorrhagia – 5 Leucorrhœa – 3 Vaginitis – 1 Venereal Warts 1 – Threatened Miscarriage – 2 Abortion – 4 Sore Nipples – 6 Mastitis – 6 Breast Sinus – 1 Engorged Breasts – 5 Flushed Breast – 2 Scanty Secretion of Milk – 8 Galactorrhœa – – Disorders and Diseases of the Alimentary System Dental Caries 11 59 249 Sublingual Abscess – 1 Alveolar Abscess 1 – Coryza – 3 Stomatitis – 3 Tonsillitis – 5 Pharyngeal Catarrh – 1 Dyspepsia 31 35 Gastric Ulcer – 1 Constipation 24 54 Hæmorrhoids 4 10 Appendicitis – 1 Dilatation of Pelvic Colon – 1 Fissure of Anus – 1 Thread Worms – 2 42 Ailments Treated—continued. Classification of Cases. Ante-Natal Clinic. Maternity Clinic. Totals. Diseases of the Heart, Blood Vessels, etc.— Tachycardia – 1 8 Mitral Stenosis 2 – Varicose Veins 3 1 Varicose Ulcer – 1 Diseases of the Respiratory System Nasal Catarrh 1 6 68 Influenza – 1 Laryngitis 4 3 Bronchitis 15 38 Functional Disorders and Diseases or the Nervous System— Facial Neuralgia 6 15 69 Neuritis 7 1 Facial Paralysis – 1 Sciatica – 1 Insomnia – 5 Insomnia of Pregnancy 7 – Sickness of Pregnancy 12 12 Hysteria – I Raynaud's Disease – 1 Diseases of the Lymphatic System, Thyroid, etc.— Goitre 1 – 4 Exophthalmic Goitre – 3 Diseases of the Urinary System Albuminuria of Pregnancy 8 1 12 Nephritis 2 1 Affections of the Skin— Psoriasis 1 2 23 Urticaria 5 3 Herpes 1 – Eczema – 3 Intertrigo – 1 Alopecia – 1 Alopecia Ariata – 1 Furunculosis – 5 Diseases of the Ear- Otitis Media 2 2 4 43 Ailments Treated—continued. Classification of Cases. Ante-Natal Clinic. Maternity Clinic. Totals. Diseases of the Eye– Hordeolum – 3 7 Blepharitis Marginalis – 2 Meibomian Cyst – 1 Conjunctivitis – 1 Diseases of the Muscles, Bones and Joints— Prepatellar Bursitis – 1 2 Traumatic Synovitis – 1 General Diseases— Anæmia of Pregnancy 11 6 272 Lactational Anæmia – 226 Post-parlum Anæmia – 21 Subacute Rheumatism – 4 Muscular Rheumatism – 4 44 Infant Clinic.—The Council's Infant Clinic is held at the Wesleyan Church Hall, Rushey Green, on four mornings in each week, and during 1924 the attendances numbered 7,911. An analysis of the cases is set out below:— Classification of Cases. No. Totals. Consultations on Feeding and Management 5,716 5,716 Functional Disorders and Diseases of the Alimentary System. Tongue-tie 9 1,065 Enlarged Tonsils and Adenoids 17 Dental Caries 47 Pyorrhœa 1 Disorders of Dentition 147 Thrush 19 Gingivitis 2 Mumps 4 Tonsillitis 26 Quinsy 2 Papilloma 1 Stomatitis 7 Dyspepsia 299 Gastro-lntestinal Catarrh 18 Gastro-Enteritis 30 Ileo-Colitis 1 Catarrhal Jaundice 2 Constipation 361 Marasmus 4 Prolapse of Rectum 4 Hernia (Inguinal—Single) 5 Hernia (Inguinal—Double) 2 Hernia (Umbilical) 24 Thread Worms (Ascarides) 32 Round Worms (Lumbrici) 2 Diseases of the Respiratory System Nasal Catarrh 50 637 Laryngitis 2 Pertussis 26 Bronchitis 547 Broncho-Pneumonia 8 Asthma 1 Influenza 3 Functional Disorders and Diseases of the Nervous System— Facial Paralysis 1 20 Convulsions 1 Epilepsy 2 Habit Spasm 1 Eneuresis 14 Faecal Incontinence 1 45 Ailments Treated—continued. Classification of Cases. No. Totals. Functional Disorders and Diseases of the Urinary System— Pyelitis 1 1 Diseases of the Lymphatic System— Cervical Adenitis 15 20 Septic Adenitis 5 Functional Disorders and Diseases of the Reproductive System— Phimosis 4 14 Preputial Adhesions 10 Accidents and Diseases of the Newborn– Fracture of Clavicle 1 22 Hæmatoma of Sterno-Mastoid Muscle 4 Undescended Testicle 1 Hydrocele 1 liirth Paralysis 1 Achondroplasia 1 Sepsis of Umbilicus 13 Affections of the Skin— Nævus 13 261 Acne Vulgaris 2 Eczema 51 Furunculosis 9 Erythema Multiforme 1 Sudamina 2 Pemphigus 1 Pityriasis 1 Impetigo 19 Intertrigo 3 Lichen Urticatus 114 Herpes 1 Psoriasis 2 Seborrhœa Capitis 10 Sore Buttocks 22 Paronychia 1 Septic Fingers 4 Warts 5 Diseases of the Ear— Otitis Media 53 60 Acute Mastoiditis 1 Abscess of External Auditory Meatus 4 Pre-aural Adenitis 1 Foreign Body in Ear 1 40 Ailments Treated—continued. Classification of Cases. No. Totals. Diseases of the Eye— Catarrhal Conjunctivitis 24 48 Phlyctenular Conjunctivitis 4 Ophthalmia Neonatorum 3 Blepharitis Marginalis 8 Strabismus 1 Hordeolum 7 Corneal Ulcer 1 Wounds and Bruises, etc.— 14 14 Scalds and Burns 3 3 Exanthemata— Rubiola 3 5 Scarlet Fever 2 Mental Defects 3 3 Congenital Defects— Webbed Fingers 1 5 Torticollis 1 Cleft Palate 1 Talipes 2 Rickets 7 7 Tuberculosis— Tuberculous Dactylitis 1 2 Abdominal Tuberculosis 1 General Diseases— Acute Rheumatism 5 8 Subacute Rheumatism 3 Dental Treatment.—An agreement has been made with the British Dental Hospital for treatment at their local centre of patients referred from our Clinics, and the following cases were treated during 1924:— Dental Treatment (Extractions, Fillings. &c.):— Expectant Mothers 12 Nursing „ 28 Infants 27 Dentures:— Expectant and Nursing Mothers 24 47 Maternity Home.—During the year 268 confinements took place in the Maternity Home, of which 151 were primipaæ and and 117 multipara;, and the nature of the cases is shown in the following Table:— Total. Average. Percentage. Total number of Labours 268 – – Vertex Presentation 250 1 in 1.07 93.28 Pelvic Presentation 17 1 in 15.76 6.34 Transverse Presentation 1 1 in 268 .37 Twins 4 1 in 67 1.49 Prolapse of Cord 1 1 in 268 .37 Accidental Hæmorrhage 2 1 in 134 .71 Forceps 18 1 in 14.88 6.71 Manual Removal of Placenta 1 1 in 268 .37 Minor Operations (P.48; M.10) 58 1 in 4.62 21.64 Phlebitis 1 1 in 268 .37 Post-partum Eclampsia 1 1 in 268 .37 Subperitoneal Fibroids of Uterus 1 1 in 268 .37 Puerperal Insanity 1 1 in 268 .37 Puerperal Sepsis – – – Morbidity 2 1 in 134 .74 NOTE.—The Standard of Morbidity is taken as:—"The rising of the temperature to 100" F., on at least two occasions between the second and eighth days." The maternal mortality was nil. A primipæ, act. 25 years, who suffered from Nephritis during pregnancy, developed Eclampsia about 18 hours after her confinement. She had three (its in 5r, hours; the first, lasting 10 minutes, the second, 15 minutes, and the third, one minute. The patient responded to treatment, and was discharged well. Of the 272 infants, seven were still-born, and five died shortly after birth. Details of these cases are set out in the following Table:— Number of Births 272 Premature Deaths, recent 3 Full-term Deaths 2 Macerated 2 Total number born dead 7 Infants born alive who died in the Home 5 Total number born dead or Hied in the Home 12 4S Details of the infant mortality are as follow:— Still-births. Maturity. Cause of Death. ks. 1. Premature Prematurity – 2. „ „ – 3. „ „ – 4. „ – 5. Full-term Asphyxia Pallida – 6.„ Transverse position – 7. „ Unknown Fœus macerated Live Births. ity. Period of Survival. Cause of Death. 8. Premature 6days Atelectasis 9. „ 2 days Prematurity 10. Full-term 2 days Intra-cranial Hæorrhage 11. „ 8 days Over-distended Stomach 12. „ 7 days Congenital Heart The sex incidence of the infants was as follows:— Males, 142. Females, 130 total, 272. The average length and weight of the full-term infants were as follow:— Males length, 22.1 inches. Weight, 7.5-lbs. Females ,, 21.7 ,, ,, 7.00-lbs. All the infants were entirely breast-fed, with the except ion of one, which required complementary feeds. Two infants developed slight conjunctivitis, in spite of (The prophylactic measures taken. The cases responded to treatment and were discharged well.