BOROUGH OF LEWISHAM. Annual Report on the Vital Statistics and Sanitary Condition of the BOROUGH OF LEWISHAM, For the Year 1925, by A. WELLESLEY HARRIS, M.R.C.S.\ D.P.H., &c., Medical Officer of Health and, Public A nalyst for the Borough of Lewisham; Fellow and Member of the Council of the Royal Sanitary Institute ; Formerly Medical Officer of Health for the Borough and Port of Southampton, and Medical Superintendent of the Southampton Small-Pox and Fever Hospitals, &c. Lewisham; Printed by Freame, Manning & Co., Ltd., 12a, Lee High Road Lew 13 BOROUGH OF LEWISHAM. Annual Report ON THE Vital Statistics and Sanitary Condition OF THE BOROUGH OF LEWISHAM, For the Year 1925, BY A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c., Medical Officer of Health and, Public Analyst for the Borough of Lewisham; Fellow and Member of the Council of the Royal Sanitary Institute; Formerly Medical Officer of Health for the Borough and Port of Southampton, and Medical Superintendent of the Southampton Small-Pox and Fever Hospitals, &c. 3 PUBLIC HEALTH COMMITTEE. 1924-25. 1925-26. Chairman:— Alderman H. Chiesman, J.P. Ex-Officio:— His Worship the Mayor (Councillor J. F. Griffith, J.P.) Alderman A. W. Hiscox „ J. W. Matthews Councillor H. G. Ayland „ R. F. Bean „ A. O. Bentley „ Mrs. E. Edwards „ A. E. Goss „ E. W. Hayes G. W. Ilsley „ E. Jennings „ A. F. Markham „ Miss G. M. Mason „ H. Sheppard „ F. T. Weaver „ C. White „ Mrs. A. Wightwick Chairman:— Councillor G. W. Ilsley. Ex-Officio:— His Worship the Mayor (Councillor Edwin W. Hayes, J.P.) Alderman H. Chiesman, J.P. „ A. W. Hiscox „ A. Rennie Councillor Mrs. R. Andrews „ A. O. Bentley „ H. A. Dunkley „ Mrs. E. Edwards „ A. E. Goss „ A. F. Markham „ Miss G. M. Mason „ A. E. McAdam „ J. D. Pain „ Mrs. G. Pinnell „ J. J. Turpin „ Mrs. A. Wightwick „ C. W. Woolston MATERNITY AND CHILD WELFARE COMMITTEE. 1924-25. 1925-26. Chairman:— Councillor Mrs. E. Edwards. Ex-Officio:— His Worship the Mayor (Councillor J. F. Griffith, J.P.) Chairman:— Councillor Mrs. E. Edwards. Ex-Officio:— His Worship the Mayor (Councillor Edwin W. Hayes, J.P.) The Members of the Public Health Committee, together with the following ladies representing the Voluntary Infant Welfare Centres— Miss M. Barrett Mrs. M. Kemp Mrs. O. Beven Mrs. E. M. White Miss A. C. E. Fuller Miss J. Howes Mrs. H. M. Wigmore Miss M. Barrett Miss J. Howes Mrs. O. Beven Mrs. M. Kemp Miss A. C. E. Fuller Mrs. E. M.White Mrs. H. M. Wigmore 4 Staff of the Public Health Department. MEDICAL: A. Wellesley 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 Officer of Health, and Medical Officer for Maternity and Child Welfare. Rose Jordan, M.D., D.P.H., Tuberculosis Officer (part-time). Mary K. Ruddy, M.R.C.S., L.R.C.P., Infant Welfare Medical Officer {part-time}. Inspectorial Staff: J. H. Berry J. A. K. Cooper J. Crowther A. H. Gray C. E. Holifield H. King B. A. Knappett W. S. Parsons S. P. Rayner Miss N. F. Tones Sanitary Inspectors. Health Visiting Staff: Miss F. L. Burton Miss A. M. M. Edwards Miss K. H. Kempstcr Miss G. Simpson Miss C. H. Thompson Miss E. M. Watson Health Visitors for Maternity and Child Welfare. Miss E. Brocklehurst Mrs. M. S. Wardle Health Visitors for Tuberculosis. Clerical Staff: F. E. Seckerson (Chief Clerk) C. C. Summers E. Walker R. Stephan J. Barry Miss B. C. Aylett Other Staff: Matron—Municipal Maternity Home—Mrs. D. Fynn. Clerk-Dispenser— „ ,, —Mrs. M. lies. „ ,, —Tuberculosis Dispensary—Miss M. Colquhuon. Secretary to Tuberculosis Care Committee—Miss O. Fergusson. Superintendent—Disinfection Station—Mr. H. T. Ibbett. Caretaker-Attendant—Coroner's Court and Mortuary—Mr. H. L. Bailey. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit herewith my Twenty-fifth Annual Report on the Vital Statistics and Sanitary Condition of the Borough for the year ended 31st December, 1925. This report is prepared in accordance with the instructions of the Ministry of Health as set out in their circular dated 10th December, 1925. Vital Statistics.—The statistical figures are calculated upon the estimated population of 185,600, calculated by the RegistrarGeneral, although there is good reason to believe it is much higher by reason of exceptional immigration. However, we adopt this figure in order to make the statistical figures comparable with those of other London Boroughs. The total number of deaths occurring among residents amounted to 1927, equivalent to a death-race of 10.3 per thousand living at all ages—the lowest in any of the Metropolitan Boroughs, except Hampstead, which was 10.1 per thousand. Diseases of the Lungs caused the largest number of deaths, the total being 303, divided as follows:— Bronchitis 161, Pneumonia 114, Other Respiratory Diseases 28. The ages mostly affected were children under one and adults over 45 years. Of the 1927 deaths, 267 were due to cancer, a ratio of 1 in 7. Of this number, 247 occurred' among persons aged 45 years and over. It is possible that life might have been prolonged in many cases had the disease been recognised in the early stages, more particularly in cases of cancer of the breast, skin and mouth. There is a great need of public education in this respect. All kinds of statements appear in the lay Press as to alleged cancer cures, although so far nothing definite has been discovered. A considerable amount of work is being carried on by Research workers, and recent reports lead one to hope 6 the real cause will eventually be discovered and a remedy for the disease found. Heart Disease.—The next heaviest toll occurred to persons suffering from organic heart disease. 208 were recorded under this heading, the majority, as one would expect, occurring in later life Congenital Debility and Premature Birth was the cause of 76 deaths, compared with 75 in 1924. These deaths should to some extent be preventable, and it is hoped that the education and care afforded by our Ante-natal Clinics will further reduce this wastage of life. Of the deaths from Zymotic Diseases, Measles and Scarlet Fever show a decrease over 1924, while Whooping Cough, Diphtheria and Enteritis show an increase. The Zymotic deathrate for the year equalled 0.37 per 1000, compared with 0.24 in 1924. Infant Mortality.—The death-rate of infants under one was 55 per thousand births, which compares favourably with the average for the past five years. Only two other London Boroughs show a slightly lower rate. Infectious Disease. Small-Pox.—This disease was unusually prevalent in the Midland and Northern Counties and, according to the Registrar-General's Returns, over five thousand cases were notified during the year. No cases occurred in this Borough. Persons who were known to have been in contact with a case of small-pox were kept under observation for 12 days, the period of incubation. My opinion was sought on several cases of skin eruption, suspected to be small-pox, but in no case was it difficult to remove the suspicion. One is forced to realise the danger of the outbreaks which occurred in some parts of the country, and the apparent neglect of vaccination. It is to be hoped that the public will soon 7 realise the danger and take advantage of the protective influences of vaccination, and that the officers responsible for enforcing the regulations will use every endeavour to reduce the number of unprotected persons. Scarlet Fever.—Three hundred and eighty-three cases were notified, compared with 368 in 1924, and 335 cases were removed to Hospital. The disease was 6f a milder type, the mortality being 0.5 per cent., the lowest mortality during the past ten years. The highest was in 1918, when a case mortality of 5.8 was recorded. Diphtheria.—Two hundred and fifty-six cases were notified, compared with 190 in 1924. The case mortality was 6.6 per cent. Paratyphoid B.—An outbreak of Paratyphoid B, a mild form of Typhoid Fever, occurred in August. At the onset, Dr. E. Wilkinson, of the Ministry of Health, gave us valuable assistance in our investigations. It was proved conclusively that the outbreak originated with a large firm of Bakers and Confectioners in the Borough of Croydon, who had branch shops in neighbouring districts. Dr. H. P. Newsholme, the Medical Officer of Croydon, kept us fully informed of his investigations into the outbreak. An investigation was made into all the food materials used at the Central Bakery of the firm referred to, and at one time it was thought probable food ha 1 been infected by the droppings of rates or mice who had taken a Virus put down for their extermination, but an examination by the Ministry of Health of the bacteriological contents of the Virus did not correspond with the Baccillus Paratyphoid B, so investigations on other lines were carried out. The employees of the bakery were examined, and although, unfortunately, the foreman pastrycook, who was absent on holiday, was overlooked by the proprietors, Dr. Newsholme elicited the fact that this man was unwell just prior to leaving, and' a test of his blood showed positive reaction to Paratyphoid B fever. -It was therefore concluded that 8 this man had infected meat pies and other preparations that he had handled. In all, seventeen cases in this Borough were associated with the Croydon outbreak. Tuberculosis.—Three hundred and forty-four new cases were notified, compared with 347 in 1924. The death-rate, 0.63, was slightly lower than in the previous year. The total number of cases upon the register at the end of 1925 was 1666. The report of the Tuberculosis Officer appears in the Report. It is satisfactory to note the increase in domiciliary visiting by Dr. Jordan, which, in my opinion, is of great importance. Attention is drawn to the difficulties affecting advanced cases of Tuberculosis. One of the most difficult problems which confront us in dealing with Tuberculosis is that of housing. Patients who have received a course of treatment in a residential insti ution in many cases return to homes where the unsatisfactory environment to a great extent nullifies the benefit acquired by stay in an institution. In a few cases the London County Council have given preference, on our recommendation, to families containing a tuberculous patient, for accommodation on one of their Estates, but these form only a small proportion of the necessitous cases. It is hoped that it will be possible for your Council to give priority to suitable cases when the question of choosing tenants for the houses on the Grove Park Housing Estate arises. Maternity and Child Welfare.—The Health Visitors made 22,027 home visits during the year, compared with 18,055 in the previous year. The number of visits, however, beats little relation to the value of the work carried out, which lays chiefly in the manner in which advice is given, and the pains taken to impart information to the moihers. It is frequently necessary to give practical help in the management and feeding of infants, and I am satisfied that our Health Visiting staff possess both 9 the tact and sympathy which is so necessary to ensure that their visits and advice are welcomed. The Voluntary Infant Welfare Centres in the Borough, which number seven, are doing splendid work, and our grateful thanks are accorded to the Lady Superintendents and their staff of voluntary workers. The Council's Infant Clinics, presided over by Dr. J. W. Miller, continue their useful work, and during the year the attendances numbered 7,619. An analysis of the cases treated is set out in Dr. Miller's report. Maternity Home.—Notwithstanding the fact that the accommodation at the Home was increased from 12 beds to 17 in 1924, it still remains insufficient. Unsatisfactory housing and the difficulty of obtaining nursing assistance are the chief reasons for the continued increase in the number of applications for admission. During the year 317 confinements took place in the Home, and since the opening of the Home in 1918; 1,757 patients have been admitted. In conclusion, I wish to express my appreciation of the kind consideration and support your Council and Committees have shown me, and to thank my colleagues and the staff of my department for their loyal support and assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. July, 1926. 10 SECTION I. Natural and Social Conditions of the, Borough. Area.—The area of the Borough is 7015 acres. Population.—The population of the Borough as shewn by the Census of 1921 was 174,194. The Registrar-General's estimate of the population at the middle of 1925 is 185,600. This estimate is based upon the Census figures of 1921, after allowance for the 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 Parliamentary Register and the migration re'urns obtained by the Board of Trade. It is difficult to believe, however, that the population of the Borough increased by only 11,000 in the four years following the Census of 1921, in view of the-fact that the development of the Bellingham Estate resulted in an influx of probably not less than 10,000 persons, whilst the natural increase in the population, i.e., the excess of births over deaths, was approximately 4,500. Another fact to be taken into consideration is that considerably over 1000 houses were erected by private enterprise during the four years, and it can reasonably be assumed that a good number of these were occupied by families who had previously resided in other districts. Taking these facts into consideration, one would probably be safe in estimating the population of the Borough at not less than 190,000. In order, however, to obtain comparable statistics from year to year, the Registrar-General's estimate is used for calculating the statistics contained in this report. The population of the Borough since 1901 is shewn in Table 1. 11 Table 1. Year Population[/##] 1901 (Census) 127,495 1911 160,834 1921 174,194 1922 (Estimated) 176,600 1923 „ 182,400 1924 „ 184,900 1925 ,, 185,600 Inhabited Houses.—The Census of 1921 gives the number of structurally separate dwellings in the Borough as 34,420, in the occupation of 43,685 families. Rateable Value.—The rateable value of the Borough in the half-year to 30th September, 1925, was £1,204,415, and the product of a penny rate, £4,948 (1925-26). Occupations of the Inhabitants.—The following particulars as to the chief occupations of the residents of the Borough are extracted from the Census Returns of 1921:— Males. Females. Metal Workers 4,568 ... Electrical Apparatus Makers. Fitters, etc. 1,220 ... Makers of Textile Goods. Articles of Dress, etc. 902 2,206 Workers in Wood and Furniture 1,896 ... Paper Workers, Printers, etc. 1,645 ... Builders, Bricklayers, etc. 2,181 ... Painters and Decorators 1,523 ... Transport Workers 6,401 ... Commercial and Financial Occupations 8,241 2,747 Public Administration and Defence 3,573 ... Professional Occupations 2,629 2,546 Personal Service 1,392 8,186 Clerks. Draughtsmen, Typists, etc. 8,150 5,566 Marriages. The number of marriages registered in the Borough during the year was 1414, of which number 779 were solemnized in the Established Church, 174 at Non-Conformist places of worship, and 461 at the Register Offices. This number is equivalent to a marriage rate of 12.0 per 1000 of the population. In 1924, 1474 marriages were registered, and the marriage rate was 15.9. 12 Births. During the year 2830 births were registered in the Borough, of which number 163 were infants born to parents whose usual place of abode is outside the Borough. The infants born outside the Borough to parents whose usual residence was within the Borough numbered 240, so that the corrected number of births was 2907, comprising 1483 males and 1424 females. Calculated on the above figures, the birth-rate equals 15.6 per 1000 of the population, which, with the exception of two years during the war—1917 and 1918—is the lowest yet recorded. It will be seen from the following Table that the birthrate has been steadily declining during the past 25 years:— Table 2. Year. Birth-rate. Year. Birth-rate. 1901 25.9 1914 19.5 1902 26.3 1915 19.3 1903 26.1 1916 18.4 1904 25.6 1917 14.9 1905 25.2 1918 13.8 1906 23.2 1919 16.6 1907 23.7 1920 22.8 1908 22.8 1921 19.4 1909 21.9 1922 18.2 1910 20.7 1923 18.1 1911 21.2 1924 16.3 1912 20.3 1925 15.6 1913 20.3 Illegitimacy.—The following Table shows the number of illegitimate births in the last five years, and the percentage to the total births:— Table 3. Year. Number of Illegitimate Births. Percentage to total births. 1921 104 3.0 1922 94 2.9 1923 121 3.6 1924 101 3.2 1925 83 2.8 13 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 1927, compared with 1934 in the previous year. The death-rate for the year was therefore 10.3 per 1000, and with one exception was the lowest recorded in any of the London Boroughs. The death-rate for the County of London was 11.7, and for England and Wales, 12.2 per 1000. The deaths and death-rates since 1901 are shown in the following Table:— Table 4. Year. No. of Deaths. Death-rate. Year. No. of Deaths. Death-rate. 1901 1,668 13.0 1914 1,858 10.9 1902 1,818 13.7 1915 2,116 12.8 1903 1,513 11.1 1916 1,937 11.8 1904 1,679 12.0 1917 1,911 11.8 1905 1,691 11.7 1918 2,223 13.2 1906 1,777 12.0 1919 1,919 11.4 1907 1,749 11.5 1920 1,879 10.7 1908 1,757 11.0 1921 1,842 10.4 1909 1,664 10.4 1922 1,969 11.1 1910 1,590 9.6 1923 1,851 10.1 1911 1,842 11.4 1924 1,934 10.4 1912 1,726 10.5 1925 1,927 10.3 1913 1,841 10.6 14 Table 5. Causes of Death during the Year 1925. Causes of Death. Nett Deaths at subjoined ages or Residents occurring within and without the District. Total Deaths at all Ages. Deaths in Public Institutions in the Borough (Including Nou-Residents). 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. 1. Enteric Fever – – – – – 1 – – – 1 1 – 2. Small Pox – – – – – – – – – – – – 3. Measles – – 1 2 – – – – 1 2 3 17 4. Scarlet Fever – – 1 – – 1 – – – 2 2 9 5. Whooping Cough 9 6 3 – – – – – 10 8 18 28 6. Diphtheria and Croup 1 2 6 6 2 – – – 10 7 17 72 7. Influenza – 1 1 4 1 7 10 15 18 21 39 1 8. Erysipelas 1 – – – – 1 1 1 1 3 4 3 9. Pulmonary Tuberculosis – – – 3 22 57 33 2 62 55 117 37 10. Tuberculous Meningitis 1 5 – 6 1 – – – 7 6 13 13 11. Other Tuberculous Diseases 1 – 1 3 2 6 2 3 10 8 18 12 12. Cancer (malignant disease) – – 1 1 – 18 127 120 109 158 267 97 13. Rheumatic Fever – – – 3 2 1 2 1 5 4 9 6 14. Meningitis 2 4 2 – – 2 1 – 4 7 11 8 15. Organic Heart Disease – – 1 7 7 22 61 110 86 122 208 51 16. Bronchitis 6 1 1 3 – 3 28 119 60 101 161 72 17. Pneumonia (all forms) 16 10 6 3 2 12 33 32 58 56 114 66 18. Other Respiratory Diseases 1 – – – – 5 11 11 10 18 28 8 19. Diarrhœa and Enteritis 15 2 – – – – – – 9 8 17 13 20. Appendicitis & Typhlitis – – 1 1 1 1 – 2 1 5 6 12 21. Cirrhosis of Liver – – – – – – 4 4 4 4 8 4 21a. Alcoholism – – – – – – 4 – 3 1 4 3 22. Nephritis &Bright'sDisease – 1 – 4 1 8 14 19 24 23 47 18 23. Puerperal Fever – – – – – – – – – – – – 24. Otheraccidentsanddiseases of Pregnancy & Parturition – – – – 1 4 – – – 5 5 4 25. Congenital Debility, Premature Birth 75 – 1 – – – – – 40 36 76 50 26. Violent Deaths, excluding Suicide 2 1 6 5 7 6 11 15 33 20 53 35 27. Suicide – – – – 2 2 11 1 9 7 16 4 28. Other Defined Diseases 26 2 7 15 15 49 145 401 318 342 660 348 29. Diseases ill-defined or unknown 4 – – – – – – 1 2 3 5 – 991 Totals 160 35 39 66 66 206 498 857 894 1033 SubEntries. included in above figures. 14(a). Cerebro-spinal Meningitis 2 – 2 – – – – – 1 3 4 2 28(a). Polio-Myelitis – – – – – – 1 – 1 – 1 – 28(b). Encepha???s Letha???g???ca – – – – 1 1 13 1 2 4 6 3 17(a). Lobar-pneumonia – – – 1 1 4 13 6 19 6 25 16 17(b). Pneumonia (type not stated) 1 2 – – 1 1 5 3 7 6 13 4 15 Causes of Death. In Table No. 5, the causes of death are set out in detail, and it is only necessary to comment on the following: — Cancer.—The deaths from cancer and malignant disease numbered 267, or 14 more than the previous year. The figures for previous years, set out in the following Table, show that the mortality from this disease is increasing in proportion .to the total deaths:— Table 6. Year. Deaths from Cancer. Percentage to total deaths. Year. Deaths from Cancer. Percentage of total deaths. 1913 194 10.5 1920 215 11.4 1914 182 9.7 1921 242 13.1 1915 223 10.6 1922 238 12.0 1916 189 9.7 1923 251 13.5 1917 200 10.4 1924 253 13.0 1918 196 8.8 1925 267 13.8 1919 223 11.6 Respiratory Diseases.—The deaths from respiratory diseases numbered 303, classified as follows:— Bronchitis 161 Pneumonia (all forms) 114 Other Respiratory Diseases 28 Total 303 Zymotic Diseases.—The deaths from the diseases grouped under this heading during the year 1925 and previous years are set out in Table 7. The death-rate from these diseases (excluding Diarrhœ and Enteritis) was 0.7, compared with 0.4 in 1924. Table 7. 1921. 1922. 1923. 1924. 1925. Enteric Fever 6 1 2 2 1 Measles 4 17 2 17 3 Scarlet Fever 5 12 7 5 2 Whooping Cough 9 13 8 11 18 Diphtheria 28 32 27 10 17 Diarrhœ and Enteritis 56 18 30 12 17 16 Violence and Suicide.—The deaths from violence numbered 53, and from Suicide, 16. Nineteen of the deaths in the former category were the result of injuries sustained in street accidents. Tuberculosis.—The mortality from this disease is dealt with in the Section relating to Infectious Diseases. Infant Mortality.—The number of infants who died before reaching the age of one year was 160, compared with 146 in the previous year, and the infant mortality rate was 55 per thousand births. According to a return published by the Registrar-General, only two Boroughs in the Metropolis recorded a slightly lower infant mortality rate. In the whole of the County of London the rate was 67 per thousand births. The infant mortality rate during the last ten years is set out in the following Table 8, and in detail for the year under review in Table 9:— Table 8.—Infant Mortality. Year. Rate. Year. Rate. 1916 75 1921 54 1917 87 1922 54 1918 66 1923 43 1919 60 1924 47 1920 62 1925 55 17 Table 9. Infant Mortality, 1925. Nett Deaths from stated Causes at various ages under One Year of age. Cause of 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 Small-pox – – – – – – – – – – Chicken-pox – – – – – – – – – – Measles – – – – – – – – – – Scarlet Fever – – – – – – – – – – Whooping Cough – – – – – 1 1 4 3 9 Diphtheria – – – – – – – – 1 1 Erysipelas – – – – – 1 – – – 1 Tuberculous Meningitis – – – – – – – 1 – 1 Abdominal Tuberculosis – – – – – – – – – – Other Tuberculous Diseases – – – – – – – – 1 1 Meningitis (not Tuberculous) – – – – – – – 1 1 2 Convulsions – – – – – – 1 – 2 3 Laryngitis – – – – – – – – – – Bronchitis – – – – – 3 – 1 2 6 Pneumonia (all forms) – – – – – 4 3 5 4 16 Diarrhœa – – – – – – – 1 – 1 Enteritis – – 1 – 1 4 3 5 1 14 Gastritis – – – – – 1 – – – 1 Syphilis – – – – – – – – – – Rickets – – – – – – – – – – Suffocation, overlying – – – – – – 1 – – 1 Injury at birth 1 – – – 1 – – – – 1 Atelectasis 6 – – – 6 – – – – 6 Congenital Malformations – – – – – 3 – – – 3 Premature birth 35 4 1 2 42 5 1 1 – 49 Atrophy, Debility & Marasmus 3 1 1 – 5 7 4 1 – 17 Other Causes 11 – – 1 12 4 3 2 6 27 Totals 56 5 3 3 67 33 17 22 21 160 Mortality Rate, per 1000 Births. Deaths of Illegitimate Children under 1 .year of age 15 180 Legitimate „ „ „ 145 51 18 Table 10. Comparative Statistics of Metropolitan Cities, and Boroughs for the Year 1925. Boroughs. Estimated Population Mid-year, 1924. Death Rate. Birth Rate. Infant Mortality. Rate per 1000 Births. County of London 4,576,505 11.7 18 0 67 West. Paddington 146,400 11.8 16.0 73 Kensington 178,550 12.9 15.9 80 Hammersmith 134,200 11.9 17.5 65 Fulham 163,100 10.6 17.2 75 Chelsea 64,680 13.3 14.5 66 City of Westminster 139,900 12.1 10.7 69 North. St. Marylebone 105,300 11.7 14.2 60 Hampstead 87,600 10.1 12.2 55 St. Pancras 214,300 12.6 18.1 71 Islington 337,400 12.2 19.4 63 Stoke Newington 52,920 11.6 15.5 63 Hackney 226,900 11.4 18.0 64 Central. Holborn 43,250 12.3 12.2 65 Finsbury 77,180 13.6 22.6 59 City of London 13,330 11.1 7.5 60 East. Shoreditch 106,500 13.3 24.7 88 Bethnal Green 119,200 12.0 22.1 80 Stepney 253,740 12.1 21.0 75 Poplar 167,300 11.6 22.9 75 South. Southwark 187,714 13.1 21.4 77 Bermondsey 122,100 12.6 22.7 75 Lambeth 309,300 12.2 17.9 62 Battersea 171,000 10.4 18.6 58 Wandsworth 338,200 10.4 14.4 52 Camberwell 273,700 11.0 17.8 64 Deptford 115,200 11.9 18 .9 62 Greenwich 102,470 11.8 18.8 69 Lewisham 185,600* 10.3 15.6 55 Woolwich 139,980 10.7 17.9 54 1925 Population. 19 SECTION II. General Provision of Public Health Services in the Borough. Hospitals Provided or Subsidized by the Local Authority or by the County Council. (1) Tuberculosis.—The London County Council is responsible for the provision of Institutional treatment of tuberculosis in London. The Grove Park Hospital, formerly the Greenwich Workhouse, which is situated on the outskirts of the Borough, has recently been opened for the reception of advanced cases of tuberculosis. (2) Maternity.—The Council's Maternity Home is situated at 41, Rushey Green, Catford. It was opened in 1918, with 12 beds, increased to 17 in April, 1924. (3) Children.—The Council does not provide Institutional treatment for ailing children. The Hostel which forms part of the Sydenham Infant Welfare Centre provides 12 beds for wasting and premature babies. The South-Eastern Hospital for Children is situated at Sydenham, in the Borough of Lewisham. (4) Fever and Small-Vox.—The Metropolitan Asylums Board is the Authority responsible for accommodation for infectious diseases. One of this Board's Institutions, the Park Hospital, is situated in the Borough. (5) Other Hospitals.—The only Voluntary General Hospital in the Borough is the St. John's Hospital, and this, and the Lewisham Hospital, which is maintained by the Lewisham Guardians, chiefly provide for the needs of the inhabitants of the Borough. The Miller General Hospital, which is situated a short distance from the Borough boundary, and 20 the London General Hospitals, are also largely used by the inhabitants. Institutional Treatment for Unmarried Mothers. No accommodation is provided by the Council. The Lewisham and Lee Shelter for Girls, situated at Ladywell Park, Lewisham, provides accommodation for unmarried mothers and their infants. Ambulance Facilities. (a) For Infectious Cases.— Provided by the Metropolitan Asylums Board. (b) For Non-Infectious and Accident Cases. — The M. A. B. Ambulance Service is also available for the conveyance of non-infectious cases, andi that of the London County Council for accidents and maternity cases. Clinics and Treatment Centres. (a) Provided by the Borough Council:— Ante-Natal.—At the Maternity Home, Rushey Green. Infant and! Maternity.—At the Wesleyan Hall, Rushey Green. Tuberculosis.—Tuberculosis Dispensary, 47, Catford Hill. (b) Volurdary. Infant Welfare Centres:— Bellingham.—St. Dunstan's Hall, Bellingham. Catford.—Wesleyan Hall, Rushey Green. Forest Hill.—Salvation Army Hall, Wastdale Road. Hither Green.—Wesleyan Hall, Torridon Road. Lee and Blackheath.—St. Margaret's Hall, Old Road. Sydenham.—5-7, Adamsrill Road. Venereal Diseases. St. John's Hospital, Lewisham. Public Mortuary. The Mortuary and) Coroner's Court are situated in Ladywell Road, Lewisham. During the year 1925, 177 bodies were received into the Mortuary, and 175 inquests held. Post-mortem examinations numbered 95. 21 Public Health Officers of the Council. The names and qualifications of the Stafi of the Public Health Department are set out below in the form specified by the Ministry of Health. Name. Qualifications. Appointment. *Harris, Arthur Wellesley M.R.C.S., L.S.A., D.P.H. Medical Officer of Health and Public Analyst. †(Miller, John Wilson M.B., Ch.B., D.P.H. Assistant M.O.H. and Maternity and Child Welfare Medical Officer. †Ruddy, Mary K. M.R.C.S., L.R.C.P. Infant Welfare Medical Officer (part-time). †ordan, Rose F. B.Sc., M.D., M.B., B.S., D.P.H. Tuberculosis Officer (part-time). *Knappett, B. A. Cert., Roy. San. Inst. Cert., Meat and other Foods Sanitary Inspector. *Cooper, J. A. K. Cert., Roy. San. Inst. Cert., Meat and other Foods Ditto *King, H. Cert., Roy. San. Inst. Cert., Meat and other Foods Ditto *Crowther, J. Cert., Roy. San. Inst. Cert., San. Insp. Exam. Bd. Cert., Meat and other Foods Ditto *Berry, J. H. Cert., San. Insp. Exam. Bd. Ditto *Holifield, C. E. Cert., Roy. San. Inst. Cert.. San. Insp. Exam. Bd. Cert., Meat and other Foods Ditto *Rayner, S. P. Cert., Roy. San. Inst. Cert., San. Insp. Exam. Bd. Cert., Meat and other Foods Ditto *Gray, A. H. Cert., Roy. San. Inst. Cert., Meat and other Foods Ditto *Parsons, W. S. Cert., Roy. San. Inst. Cert., San. Insp. Exam. Bd. Cert.. Meat and other Foods Ditto *Jones, Miss N. F. Cert., Roy. San. Inst. Cert., San. Insp. Exam. Bd. Woman Sanitary Inspector. †Watson, Miss E. M. Cert., C.M.B. Cert., Roy. San. Inst. (Hlth. Vistrs. & Insp. Nuis.). Health Visitor (M. & C. W.) †(Burton, Miss F. L. Cert., Gen. Hosp. Training. Cert., C.M.B. Cert., Roy. San. Inst. (Health Visitors). Ditto †Thompson, Miss C. H. Cert., Roy. San. Inst. Ditto (Health Visitors). Cert.. C.M.B. Ditto 22 Public Health Officers of the Council—continued. Name. Qualifications. Appointment. †Edwards, Miss A. M. M. Cert., Gen. Hosp. Training. Cert., C.M.B. Health Visitor M. &C. W.) †Kempster, Miss K. H. Cert., Gen. Hosp. Training. Cert., C.M.B. Health Visitors' Diploma (Bd. of Educn.). Ditto †Simpson. Miss G. Cert., C.M.B. Cert., San. Insp. Exam. Bd. Health Visitors' Diploma (Appd. by Bd. of Educn.). Ditto †Wardle, Mrs. M. Cert., Gen. Hosp. Training. Cert., L.G.B. for Scotland. Ditto (Tuberculosis) †Brocklehurst, Miss N. Cert., C.M.B. Cert., Roy. San. Inst. Cert., San. Insp. Exam. Bd. Ditto (Tuberculosis) †Iles, Mrs. M. Cert., Apothecaries Hall Clerk-Dispenser (M. & C. W.) †Colquhoun, Miss M. Cert., Apothecaries Hall Ditto (Tuberculosis) †Fynn, Mrs. D. Cert., C.M.B. Matron, Maternity Home. †Fergusson, Miss O. - Sec., Tuberculosis Care Committee. * Salary contribution received under Public Health Acts. † ,, ,, „ by Exchequer grants. Professional Nursing in the Home.—The Council do not directly employ nurses for outside work, but several of the Churches in the Borough retain the services of trained nurses for the benefit of their respective parishioners, and eleven Ranyard Nurses are working in various parts of the Borough. Under the powers granted by the Maternity and Child Welfare Act, and the Public Health (Pneumonia, etc.), Regulations, agreements have been entered into whereby the services of these nurses shall be available for nursing casts of measles, pneumonia and ophthalmia neonatorum, a fee of 1s. 3d. per visit being paid by the Council. Midwives.—No midwives are subsidized by the Council for outside work. The number of midwives engaged in practice in the Borough is 22. 23 SECTION III. SANITARY CIRCUMSTANCES OF THE BOROUGH. Scavenging.—The collection of house and trade refuse is carried out by the Borough Surveyor's Department, and a weekly collection is the rule. Horsed and low-loading motor vehicles are used. The quantities collected in 1925 were as follows:— Van Loads 13,185 Cart Loads 11,485 Motor Loads 3,794 The refuse is mainly disposed of at the Council's Destructors situated at Molesworth Street, Lewisham, and Lower Sydenham, whilst smaller quantities are sent away by train, and deposited on shoots in the Borough. The following are the figures for 1925:— Dust Destructors 32,923 tons Trained away 1;268 „ Shoots 138 „ Total 34,329 tons. Sanitary Inspection of the Borough. The inspections carried out by the Male Sanitary Inspectors, and the nuisances discovered, are shewn in the following Tables: Table 11. Nature of Inspection. No. Complaints investigated 1,169 Enquiries re Infectious Diseases 602 Milkshops 349 Cowhouses 55 Slaughterhouses 418 Fish - fryers 20 Food - stalls 227 Stable - yards 47 Houses let in Lodgings 33 Smoke Observations 21 House - to - House Inspections 1,322 Miscellaneous Inspections 1,452 Re - inspections 13,647 24 Table 12. Nuisances discovered and abated. No. Nuisances discovered and abated. No. Dirty and Dilapidated Premises 1165 Defective Soil and Ventilating Pipes— Defective Roofs 506 Defective Rain-water Pipes and Gutters 476 (a) necessitating replacement 164 (b) „ repair 79 Damp Premises 575 Dust-bins requiring replacement 392 Foul or Uncovered DrinkingWater Cisterns 91 Defective Drains— (a) necessitating reconstruction 156 Overcrowded Rooms 113 (b) „ repair 219 Defective or Unpaved Yards 270 Defective Water-Closets— Offensive Accumulations 85 (a) necessitating replacemen 283 Improperly Kept Animals 22 (b) „ repair 388 Defective Waste Pipes 222 Houses without proper supply of water 87 Notices.—"Intimation" notices were served to the number of 1,972, and "Statutory" notices, 523. Legal Proceedings.—Details of proceedings instituted under the Public Health and kindred Acts are summarised in the following Table:— Table 13. Premises. Offence. Result. 4, Hedgley Street Da???p wall of front living room Ordered to abate nuisance within 14 days, and pay £2 2s. costs. 31 and 33, Knowles Hill Crescent Non-compliance with Notice requiring alteration and amendment of drain Penalty of £1 imposed on one defendant. Summons against codefendant dismissed. 45, St. Germans Road Failure to pay cost of altering and amending drain Order made for payment of 10s. per week. 13, Ardgowan Road Dirty and dilapidated condition of walls and ceilings Order to abate nuisance within 14 days, and pay £1 1s. costs. 20, Beech field Road Defective roof and skylight. Defective window frame Defective watercloset flashing cistern Summons withdrawn on payment of £1 1s. costs, the nuisance having been abated. 19, Molesworth St. Defective eaves gutters ; dirty walls and ceiling of top front room Ordered to abate nuisance within 14 days, and pay £1 1s costs. 25 Woman Sanitary Inspector.—This Officer is chiefly engaged in work under the Factories and Workshops Act. She also investigates complaints passed to her by the Health Visitors, and carries out enquiries into cases of infectious disease which are not notifiable, i.e., measles, chicken-pox, etc. The number of visits made by her during the year is summarised in the following Table :— Table 14. Nature of work. No. Workshops 208 Laundries 21 Work - places 37 Outworkers 263 Complaints 181 Infectious Diseases 654 Miscellaneous 24 Re - visits 543 Notices.—164 Intimation notices and 66 Statutory notices were served in regard to nuisances discovered by this Officer. Smoke Abatement.—During the year 21 observations were made for the detection of nuisances arising from the emission of black smoke, and as a result 7 notices were served. The institution of legal proceedings was not nece sary in any case. Rent Restriction Acts, 1920 and 1923.—During the year 54 applications were made by occupiers for the certificate of the Sanitary Authority under the provisions of the above Acts, and in 52 cases the Council authorised the issue of the certificate. A report of the Sanitary Authority to the eflect that the necessary work had been carried out and the premises placed in a reasonable state of repair, was issued to the owner in 13 instances. 26 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:— Table 15. Workshops on Register (other than Domestic Workshops). Trade or Business. Workshops. Workrooms No. of Employees. Male. Female. Blacksmith 15 15 31 — Boot Repairers 94 99 139 — Builders 58 96 190 — Cabinet-making and Joinery 21 28 42 — Carriage Builders 6 13 16 — Cycle Repairers 29 55 47 — Dentists 44 44 60 9 Dressmakers 68 76 1 382 Ironmongers 7 9 19 — Jewellery, Watch, etc., Repairs 38 41 50 2 Laundries 22 59 7 b7 Millinery 25 26 — 84 Motor Repairers 51 67 132 — Photographers 21 40 28 25 Picture Framers 12 11 15 3 Tailors 63 65 92 41 Umbrella Makers and Repairers 19 22 30 16 Undertakers 1 7 7 — Upholsterers 40 48 81 20 Miscellaneous 128 179 292 191 Totals 768 1003 1279 840 Table 16. Factories on Register. Trade or Business. No. Trade or Business. No. Boot-making & Repairing 45 Motor Manufacturers Builders 14 and Repairers 33 Carriage Builders 6 Printers 24 Electrical and other Engineering 24 Timber Merchants 17 Miscellaneous 108 Laundries 16 Totals 287 27 Table 17. Workplaces on Register. Trade or Business. Number. Inspections. Cab Proprietors 6 14 Contractors 9 25 Motor Garages 18 39 Stable Yards 8 27 Table 18. Domestic Workshops on Register (excluding Outworkers). Trade or Business. No. Employees. Male. Female. Boot Repairers 41 46 — Cabinet-making and Joinery 4 4 — Cycle Repairers 3 3 — Dressmakers 33 — 38 Jewellery and Watch Repairs 14 15 — Laundry 12 — 17 Millinery 5 — 5 Picture Framers 5 5 — Tailors 8 8 — Umbrella Makers 5 5 2 Wig-makers 1 1 Miscellaneous 35 37 1 Totals 166 124 63 Homework. — Outworkers on Register. Lists of Outworkers received from Employers 87 Addresses of Outworkers :— Received from other Authorities 1085 Forwarded to „ „ 215 Visits made to Outworkers 1119 28 Table 19. Inspections. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 574 36 — Workshops (including Workshop Laundries) 1529 61 — Workplaces (other than Outworkers' premises) 119 27 — Total 2222 124 — Table 20. Defects Found. Particulars. (1) Number of Defects. No. of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:—* Want of cleanliness 37 37 — — Want of ventilation — — — — Overcrowding 3 3 — — Want of drainage of floors 1 1 — — Other nuisances 37 37 — — Sanitary accommodation insufficient 1 1 — — unsuitable or defective 46 46 not separate for sexes 3 3 — — 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 128 128 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 29 SECTION IV.—Housing. General Housing Conditions in the Borough.—The requirement of the Ministry of Health for a statement under this heading can be best met by the following extract from a report which I submitted to your Council early in 1926, when the question of erecting the Grove Park Estate was under consideration:— At the beginning may I say that it is exceedingly difficult to form any true estimate of the existing need of houses in the Borough below a reasonable standard of fitness, and also it is difficult to produce exact figures of the number of premises overcrowded without a census of the worst portions of the district being taken. It may safely be assumed, however, that the worst cases of hardship caused by overcrowded conditions are present in one, two and three-roomed tenements. It will be readily understood that if the number of persons housed in those tenements averages two or more for each room, difficulties in finding adequate sleeping accommodation are inevitable. The Census of 1921 affords the only actual statistics available for the Borough, and the following has been extracted from the official Returns :— 813 families, consisting of 2 or more persons, were occupying oneroomed tenements. 761 families, consisting of 4 or more persons, were occupying tworoomed tenements. 784 families, consisting of 6 or more persons, were occupying threeroomed tenements. From the above it may be estimated in round figures that some 10,000 persons were in 1921 badly housed. We have no certain means of judging as to the extent to which these conditions have improved or otherwise, although the statistics obtained by routine house-to-house inspection of a certain type of house may be considered to afford some indication of present conditions. We have on our register 135 streets in which it is customary to carry out a periodical inspection, comprising about 5.500 houses. During the past two years. 2,600 of these houses have been inspected and the results of our enquiries recorded. It was found that 845 of this number contained two families and 204 contained three or more families. It was also ascertained that 450 families living in tenements consisting of three rooms or less averaged two or more persons per room. If it can be . assumed that similar conditions exist in the remaining 2,900 houses on our register, it follows that about 950 families in these streets alone average two or more persons per room, and there is no doubt that to a lesser extent similar conditions exist in homes of a better class than those to which routine inspection has been applied and in respect of which no statistics are obtainable. 30 During the inter-censal period 1901-11, when the population of the Borough increased by 33,000, no less than 8.655 new houses were occupied, equivalent to one additional house for about every 4 persons, and when the Census of 1911 was taken, the average number of persons per house was 5.6. Between 1911 and 1921, the increase in the population was 13,360, so that to maintain the 1911 standard of occupancy 2,385 new houses should have been erected between 1911 and 1921. Actually, owing, of course, to the War, only 1,200 houses were erected during this period. During the past 4 years, 1,126 houses have been erected by private enterprise, but as these have been erected for sale and not for letting, it is doubtful whether they have to any extent relieved the situation which has existed since the War. In investigating several cases of overcrowding which have been brought to my notice from time to time, I find that the overcrowding has been produced by the inability of persons, who at one time were suitably accommodated, but were placed in great hardship by reason of increase in the number of their family, to obtain better accommodation. From my personal knowledge and experience, I believe the class of home that is required most in this district is to meet those whose incomes are in the neighbourhood of £3 per week, and from my interviews with many of them, I am of opinion that the maximum rent they could afford would be in the neighbourhood of 12s. to 14s. per week. The public find it difficult to understand the shortage of houses when they know that two large estates, Bellingham and Downham, have been erected by the London County Council, and it is very difficult to convince them that these houses are for the whole of London and not for Lewisham in particular, and that only a small proportion of them are available for Lewisham residents. I have no doubt in my own mind that there is urgent need for a housing scheme to relieve the unsatisfactory conditions which exist. Measures taken or contemplated to meet any shortage. — Under the Housing, Town Planning, etc., Act, 1919, the Ministry of Health, on behalf of the Council, acquired 36 houses in the Borough, which were converted into 119 flats, which were let at rentals varying between £24 and £60. In order to provide additional accommodation, the Council in the latter part of 1919 acquired an area consisting of about 9 acres in Lewisham Park, and erected 86 houses, which are let at inclusive rentals of between 17s. 11d. and 23s. 11d. per week. During the compilation of this report your Council has decided to acquire a site at Grove Park, comprising 43 acres, with a view to the erection of 516 houses. The development of 31 the first section, upon which 134 houses will be erected, is now being proceeded with. Overcrowding—extent and causes.—The number of rooms overcrowded, from the legal point of view of actual cubic space, which came to my notice during the year was 113. This number of course represents only overcrowded conditions discovered by the Sanitary Inspectors and in the course of their ordinary work, or during the routine house-to-house inspections. Figures in regard to overcrowding, however, afford little indication of the congested conditions under which many hundreds of families are living. The problem is to a great extent an economic one, as it can be readily understood that the poorer classes are forced to accept accommodation to accord in some degree with their means, while the fortunate possessor of a spare room is glad to obtain a tenant for it to augment his perhaps scanty income, while the position is further aggravated when the inevitable increase in the family occurs. Measures taken to deal with overcrowding.—The problem of dealing with overcrowded conditions remains a difficult one. Harsh procedure is out of the question, as In practically every case the offender is the victim of circumstances, and no alternative accommodation is procurable. It is sometimes possible to alleviate the conditions a little by suggesting a re-arrangement of the sleeping accommodation, and whenever possible this is done. Fitness of houses.—The general standard of fitness of houses seems to be improving, and there is a gradual recovery from the neglected condition of property generally, which resulted from the War. The principal defects discovered during routine inspection were defective roofs and rain-water gutters, and dirty and dilapidated condition of interiors, the latter, of course, more prevalent now than hitherto on account of the greater proportion used as actual living rooms. 32 House-to House Inspection. The Statistics relating to the routine inspection of houses may appropriately be inserted in this part of my report. 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: — Name of Road. No. of houses inspected. Name of Road. No No. of houses inspected. Aitken Road 28 Mallett Road 37 Barmeston Road (part) 8 Malyons Road and Terrace 149 Braxfield Road 71 Maythorn Collages 6 Brightside Terrace 14 Molesworth Street 52 Bromley Road (part) 8 Neuchatel Road 55 Brookdale Road 139 Nightingale Grove 12 Church Grove 20 Nyon Street 4 Clarens Street 18 Patrol Place 18 Dermody Road & Gdns. (part] 30 Peak Hill Gardens 44 Effingham Road 45 Retreat, The 21 Engleheart Road (part) 104 Rennell Street 18 Ennersdale Road 81 Rhyme Road 41 Helvetia Street 21 Rushey Green (part) 14 Holly Hedge Terrace 11 Southend Lane 52 Howson Road 62 Springbank Road (part) 27 Knowles Hill Crescent (part 31 Vevey Street 5 Lady well Road 6 Willow Walk. Sydenham 67 The total number of houses inspected was 1322, and in 942 houses defects were found necessitating the service of notices under the Public Health (London) Act. House-to-House Inspection. — Statistics relating to Occupancy. 3 houses contained 5 families. 15 „ „ 4 ,, 89 „ „ 3 „ 491 „ „ 2 „ 724 „ „ 1 family. One-roomed Tenements.—131. 2 were occupied by 6 persons. 6 „ „ „ 5 „ 19 „ „ „ 4„ 24 ,, „ „ 3 „ 26 „ „ „ 2 „ 54 „ „ „ 1 person. 33 Two-roomed Tenements.—254. 2 were occupied by 9 persons. 1 was „ „ 8 „ 4 were „ „ 7 „ 11 „ „ ,, 6 „ 14„ „ „ 5 „ 54 „ „ „ 4 „ 79 „ „3 „ 73 „ „ „ 2 „ 16 „ „ „ 1 person. Three-roomed Tenements.—639. 3 were occupied by 10 persons. 7 „ „ „ 9„ 14 „ „ „ 8 „ 28 „ „ „ 7 „ 46 „ „ „ 6 „ 84 „ „ ,, 5„ 135 „ „ „4 ,, 174 „ „ „ 3 ,, 130 „ „ „ 2 „ 18 „ „ „ 1 person. Housing Statistics, 1925. Number of new houses erected during the year: — (a) Total (including numbers given separately under (b)) 982 (b) With State assistance under the Housing Acts:— (i) By the Local Authority None. (ii) By other bodies or persons. Information not available. 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3093 34 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 1322 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 . 1972 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1449 3. Action under Statutory Powers. A.—Proceedings under section 3 of the Housing Act, 1925 Nil. B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 523 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 523 (b) By Local Authority in default of owners Nil. C.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925. (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 5 35 SECTION Y. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The bulk of the milk consumed by the inhabitants of Lewisham is produced outside London, there being only six licensed cowsheds in the Borough. To a large extent distribution is in the hands of firms who possess up-to-date pasteurising plant, and apparently use every endeavour to ensure that the milk reaches the consumer in a pure and wholesome condition. Samples are frequently taken from retailers, both in shops and on the rounds, and an adulterated sample is fortunately very rare. It is gratifying to observe that, the use of bottles as containers for the delivery of milk is, to a large extent, replacing the hand-can. Milk (Special Designations) Order, 1923.—This order was made by the Ministry of Health under the provisions of the Milk Dairies (Amendment) Act, 1922. It prescribes certain conditions under which licences may be granted for the production and sale of milk under certain designations, viz. :— " Certified," " Grade A (Tuberculin Tested)," "Grade A," "Grade A (Pasteurised," " Pasteurised." " Certified" Milk must be produced from healthy cows, which have passed the tuberculin test, and a veterinary examination every six months. It must be bottled, sealed and labelled on the farm, and delivered to the purchaser intact. It must not contain more than 30,000 bacteria per cubic centimetre, and no bacillus coli in l/10th of a cubic centimetre, and it must not at any stage be treated by heat. "Grade A (Tuberculin Tested)" Milk. — The conditions relating to this designation are similar to the above, except that 36 the bacterial standard is not so high, not more than 200,000 bacteria per cubic centimetre being permitted. If bottled on the farm, it must be sealed, suitably labelled, and dated, or if consigned to a wholesale or retail distributor, must be similarly labelled and distributed in sealed bottles. "Grade A" Milk must satisfy the same conditions as "Grade A (T.T.)" Milk, with the exception of the tuberculin test, while a veterinary certificate must be produced every three months instead of six. "Grade A (Pasteurised)" Milk, as its title implies, is " Grade A " Milk which has been pasteurised. "Pasteurised" Milk must be treated by holding at a temperature of 145 to 150 degrees Fahrenheit for at least halfan-hour, and then cooled to 55 degrees. It must not contain more than 100,000 bacteria per cubic centimetre. Licences.—During the year 1925, licences were issued by this Council as follows :— Dealers licences to use the designation "Certified" 23 „ ,, , "Grade A (Tuberculin Tested)" 22 ,, ,, „ "Grade A (Pasteurised)" 17 „ "Grade A" 14 ,, „ „ "Pasteurised" 15 A licence was issued to Messrs. Edwards & Sons, Ltd., to produce and bottle " Grade A " Milk at Burnt Ash Farm, Lee, after the premises had been inspected and found satisfactory. Messrs. Edwards & Sons have also been licenced to " pasteurise" milk at Station Buildings, Forest Hill, and " Enochs" Pasteurising and Retarding Plant is in use. No applications for licences under this Order were refused, nor was it necessary to revoke any licence. At the beginning of the year, the Ministry of Health requested that samples of "Certified" Milk, consigned from four different farms to a dealer in this Borough, should be taken at stated intervals, and submitted to bacteriological examination. 37 the cost of such examination being borne by the Ministry. Twenty-one samples were taken, and the results of the examinations are shewn in the following Table : — Table 21, Bacteriological Examination of " Certified " Milk. No. Date. Bacteriologist's Report. No. of Bacteria per c.c. Presence of Bacillus Coli in 1/10th of a c.c. In 48 hours. In 3 days. 1925. 1 18th Feb. 15,966 Absent. Absent. 2 18th Feb. 4.966 „ „ 3 18th March 2,100 „ „ 4 18th March 1,013 „ „ 5 18th March 2 866 „ „ 6 22nd April 2 906 „ „ 7 20th May 1,696 „ „ 8 18th June 1,910 „ „ 9 19th June 2,033 „ „ 10 13th July 2,633 „ „ 11 29th July 4.800 „ „ 12 29th July 2,933 „ „ 13 11th Aug. 4.733 „ „ 14 11th Aug. 3,566 „ „ 15 20th Aug 1 890 „ „ 16 16th Sept. 3,726 „ „ 17 30th Sept. 1,920 „ „ 18 30th Sept. 12,566 „ „ 19 30th Sept. 1,720 „ „ 20 26th Nov. 11 633 „ „ 21 26th Nov. 7,700 „ „ The conditions prescribed for the sale of "Certified" Milk are that it shall not contain more than 30,000 bacteria per cubic centimetre, and no bacillus coli in l/10th of a cubic centimetre. Dairies, Cowsheds and Milkshops Order.—The premises registered for the sale of milk numbered 147 at the beginning of the year. During the year, 25 new applications were granted, and 16 premises removed from the register, so that the number on the register at the end of the year was 156. Periodical visits are made to ensure that the regulations are being observed, and during the year 349 visits were made for this purpose. 38 Meat. Public Health (Meat) Regulations, 1924.—These Regulations came into force in April, 1925. They were based on the recommendations of the Departmental Committee on Meat Inspection, and were designed to secure more adequate inspection of animals slaughtered, and improvements in the handling, transport and distribution of meat. Part I. contains definitions, power of entry, and also a clause forbidding any person who is suffering from an infectious disease from taking part in slaughtering or the handling of meat. Part II. sets out the rules to be observed in slaughtering and in slaughterhouses. Part III. relates to the marking of meat, and empowers the Local Authority to adopt a stamp to mark meat after inspection. Part IV. relates to meat stalls, and' the measures to be taken to protect meat from contamination by flies, dirti, etc. Part V. sets out sanitary requirements for effecting the cleanliness of meat shops and stores and protection of the meat from contamination. Part VI. contains provisions for the observance of cleanliness in the transport of meat by hand or in a vehicle. The provisions of these regulations were made known to all the traders in the Borough concerned. Unfortunately, the regulations were not very definitely worded, which rendered their enforcement far from an easy matter, and' the position was rendered still more difficult by a circular issued by the Ministry of Health in June, in which it was stated that it was not contemplated that the provision relating to the protection of meat from flies, etc., should be construed as requiring all butchers' shops to be provided with glass fronts. This announcement naturally had the effect of nullifying to a great extent our efforts to effect an improvement in the conditions under which meat is sold. However, the Regulations were effective in giving publicity to the subject, and the majority of the traders in the Borough are 39 obviously desirous of observing the spirit of the Regulations by affording protection to the meat exposed for sale. The work of inspecting animals after slaughter is carried out by the Sanitary Inspectors, who, during the year made 414 attendances at slaughterhouses for this purpose; arid the carcases inspected number as follows Pigs 884 Sheep 2287 Calves and Oxen 82 Slaughterhouses.—The following tabular statement, inserted by direction of the Ministry of Health, affords information as to slaughterhouses in the Borough:— In 1920. In January, In December, 1925. 1925. No. Licensed 10 8 8 Other Foods.—All places where food is prepared are inspected regularly, particular attention being paid to the kitchens of restaurants and similar places. During the year 217 inspections of these places were made. Bakehouses.—There are 80 bakehouses on the register, 17 of these being situated underground. During the year 194 visits were made to these premises, to ensure that the statutory provisions relating to cleanliness, etc., were being observed. Unsound Food—The following articles of food were surrendered by the owners, as unfit for human consumption, and destroyed:— Beef 37 stone. Haddocks 6 stone. Corned Beef 6 lbs. Plaice 3 stone. Sheep 1 carcase. Tomatoes 68 boxes. Sale of Food and Drugs Act. Five hundred and fourteen samples were taken under the Sale of Food and Drugs Acts and submitted to the Public Analyst during the year 1925. Of this number 439 were purchased officially in conformity with the provisions of the Acts, and the remaining 75 were bought informally as "test" samples. Nine or 2.05 per 40 cent, of the official samples were certified by the Public Analyst as being adulterated, or below legal standard, compared with 2.9 per cent, in the year 1924. 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. Number Adulterated. Official Samples. Milk 432 423 9 Separated Milk 1 1 — Butter 6 6 — Total Official Samples 439 430 9 Informal Samples. Butter 28 28 — Cream 17 17 — Preserved Cream 5 5 — Mustard 3 3 — Strawberry Jam 3 3 — Camphorated Oil 3 3 — Compound Tincture of Bark ... 3 3 — Cocoa 4 4 — Coffee 4 4 — Medicinal Prescriptions 5 5 — Total Informal Samples 75 75 — Totals, all Samples 514 505 9 Milk.—432 samples of milk were submitted for analysis and of this number nine or 2.08 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 Adu terated. 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 8.87 3.52 8.88 3.0 85 Second „ 3.46 8.79 3.47 8.80 Third ,, 3.54 8.86 3.54 8.86 Fourth ,, 3.63 8.98 3.68 8.99 Average for the Year 3.53 8.87 3.55 8.88 41 Public Health (Milk and Cream) Regulations. None of the samples of milk were reported as containing any preservative or colouring matter. Five samples of preserved cream were submitted and in each instance the statement as to the preservative on the declaratory label was correct. The percentage of preservative found in each sample of Preserved Cream was as follows:— Sample Marked No. Amount of Preservative. Remarks. 492 0.30 per cent. Boric Acid \ Sold as Preserved Cream and labelled in accordance with the Regulations. 494 0..5 „ „ „ 495 0.30 „ „ „ 510 0.29 „ „ „ 513 0.29 „ „ „ Adulterated Samples. Administrative action taken in regard to the nine samples certified as adulterated or below the legal standard :— Sample marked No. Article. Result of Analysis. Action Taken. 21 Milk 3 per cent, deficient in milk fat Vendor cautioned 33 „ 6 per cent, added water Prosecution — Vendor and milk carrier each convicted and fined £5 and £1 1s. costs 125 „ 3 per cent, added water Vendor cautioned 228 „ 2 per cent, deficient in milk fat Vendor cautioned 246 „ 3 per cent, added water Vendor cautioned 362 „ 20 per cent, deficient in milk fat Prosecution — Vendor fined 10s. and 21s. costs 371 „ 8 per cent, deficient in milk fat Prosecution — Vendor fined £4 and £1 1s. costs 438 „ 93 per cent, deficient in milk fat Prosecution — Summons adjourned sine die, vendor serving sentence in prison for a similar offence elsewhere 500 „ 5 per cent, added water Prosecution — Vendor fined £2 and £2 2s. costs 42 SECTION VI.—Infectious Diseases. The notifications of infectious disease received during the year are summarized in Tables 22, 23 and 24. Those relating to Tuberculosis are shewn in a separate Table. Table 22. Cases of Infectious Disease notified dining 1925. Diseases. Total Cases notified. Cases admitted to Hospital. Total Deaths. Male. Female. Total. Small Pox — — — — — Scarlet Fever 174 209 383 335 2 Diphtheria 130 126 256 246 17 Enteric Fever (including Paratyphoid) 16 29 45 28 1 Puerperal Fever — 10 10 5 — Erysipelas 31 24 55 17 4 Pneumonia 80 48 128 76 25 Malaria — — — — — Dysentery — — — — — Encephalitis Lethargica 5 5 10 4 6 Acute Polio-Myelitis 1 — 1 — 1 Cerebro-Spinal Meningitis 1 1 2 2 4 Ophthalmia Neonatorum 8 6 14 6 — 43 Disease. Number of Cases Notified. Table 23. Infectious Diseases Notified, 1925—Age Groups. At Ages—Years Total at all Ages Under i year 1 and under 2 years 2 and under 3 years 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 Scarlet Fever 2 9 10 16 44 177 71 27 19 3 5 — 383 Diphtheria 1 9 17 24 26 84 38 17 22 12 6 — 256 Enteric Fever (including Para typhoid] — — 1 1 3 7 6 8 12 4 4 — 45 Puerperal Fever — — — — — — — 8 2 — — 10 Erysipelas 1 1 — — 3 3 — 1 5 5 28 8 55 Pneumonia (Acute Influenzal & Lobar 3 !2 7 5 7 14 2 8 28 22 22 8 128 Encephalitis Lethargica — — — — — — — 1 3 3 3 — 10 Acute Polio-Myelitis — — — — — — — — — — 1 — 1 Cerebro-Spinal Meningitis — — — 1 1 — — — — — — 2 Ophthalmia Neonatorum 14 — — — — — — — — — — — 14 44 Diseases. Age Groups. Table 24. Deaths from Infectious Diseases, 1923. Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 >ears 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over. At all ages. Scarlet Fever — — — 1 — — — — — 1 — — 2 Diphtheria 1 2 2 2 2 5 1 2 — — — — 17 Enteric Fever — — — — — — — — — — — — 1 Puerperal Fever — — — — — — — — — — — — — Erysipelas 1 — — — — — — — — 1 1 1 4 Pneumonia — — — — — 1 — 1 — 4 13 6 25 Encephalitis Lethargica — — — — — — — — 2 — 3 — 6 Acute Polio-Myelitis — — — — — — — — — — 1 — 1 Cerebro-Spinal Meningitis 2 — 1 1 — — — — — — — 4 45 Scarlet Fever.—The number of cases of Scarlet Fever notified was 383, compared with 368 in the previous year. A comparison with previous years can be made from the following Table ; which shews the number of notifications received in the past ten years:— Table 25.—Scarlet Fever. 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 1925 383 2 0.5 Diphtheria.—The cases notified numbered 256, compared with 190 in the previous year. Statistics for the past ten; years are shewn in the following Table:— Table 26.—Diphtheria. Diphtheria Cases. Deaths. Mortalitv 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 1925 256 17 6.6 Diphtheric Anti-toxin.—In accordance with our practice for many years past, supplies of anti-toxin are kept in the Public Health Department, available at any hour for any medical 46 practitioner who may require to administer the serum either as a prophylactic or for treatment. During the year 63 tubes were issued, 41 of these being for treatment, and 22 for prophylactic purposes. No charge is made when the practitioner certifies that the patient is unable to afford the cost. Enteric Fever.—The notifications included under this heading numbered 45, compared with 13 in the previous year. This figure may seem rather alarming until it is explained that cases of paratyphoid B, a comparatively mild form of the disease, are included. Nine cases were notified as Typhoid or Enteric Fever, and one of these proved fatal. In six of these cases the clinical diagnosis was confirmed by the agglutination test of a specimen of the patient's blood1. In four instances it was suspected that the disease was contracted whilst travelling abroad or in other parts of the country. Thirty-six cases were notified as Paratvohoid, and in 28 instances this diagnosis was confirmed by the blood test. All the patients recovered. One patient was notified whilst an inmate of a local Hospital, his actual residence being in another district, and another patient had been an in-patient of a Hospital for several weeks before the onset of the disease occurred. Seventeen of the cases were associated with an outbreak which occurred in an adjoining Borough, the cause of which was contaminated food. Puerperal Fever.—Ten cases of this disease were notified five of which were treated in Hospital. None of the cases terminated fatally. Pneumonia.—The Public Health (Pneumonia, etc.) Regulations, 1918, require the notification to the Local Authority of Acute Lobar Pneumonia and Acute Influenzal Pneumonia. During the year 128 cases were notified. The Regulations in question empower the Local Authority to provide nursing assistance in the home, and for this purpose arrangements have been made 47 to utilise the services of the Ranyard Nurses, and the nurses attached to local Nursing Associations, a payment of 1s. .3d. being made by the Council for each visit. During the year 696 visits were made to 21 cases in which it was considered that nursing assistance was necessary. Encephalitis Lethargica.—Ten cases of this disease were notified, four of which proved fatal. Two deaths were recorded from this disease of which no notification had been received during the lifetime of the patient. Ophthalmia Neonatorum.—Sixteen cases of this disease were notified during the year, and are shewn in tabular form herewith, as required by the Ministry of Health:— Table 27.—Ophthalmia Neonatorum. Cases. Results. Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital. 16 8 6 16 — — — Nursitig in the Home.—The Maternity and Child Welfare Act of 1918 empowers the Council to provide nursing assistance for this disease, and during the year, 393 visits were made by the staff of the Ranyard and other Nursing Associations to ten cases of Ophthalmia Neonatorum and inflammation of the eyes. Measles.—Measles is not scheduled as a notifiable disease, and for information as to its occurrence we rely chiefly on the notifications received from Schools. The number of cases which came to our notice during the year was 577, some of which were discovered by the Health Visitors in the course of their work. There were only three fatal cases. Bacteriological Examinations.—The agreement made with the St. John's Hospital for bacteriological examinations remains in force, and the service is utilised very fully by tihe medical 48 practitioners in the Borough. During the year, 2,164 specimens were sent to the Laboratory for examination, the details being as follows:— Nature of Specimen. Number sent Result of Examination. Positive. Negative. Material from suspected Diphtheria Cases 1287 133 1154 Sputa from suspected Tuberculosis Cases 603 121 482 Blood from suspected Enteric Cases 259 63 196 Pathological Specimens from suspected Enteric Cases 15 2 13 Disinfection.—The Disinfecting Station is housed at the Council's Depot in Molesworth Street, Lewisham, and the staff consists of the Superintendent, one Boiler Attendant, and five Disinfectors, two of whom are drivers for motor vehicles in which the infected articles are collected and returned. The work carried out during the year is set out in tabular form below:— Disease Rooms Disinfected. Articles Removed and Disinfected. Scarlet Fever 949 13085 Diphtheria 619 8059 Tuberculosis 653 1284 Cancer 103 822 Measles 5 72 Enteric Fever 75 1214 Erysipelas 7 11 Other Diseases 214 2220 Totals 2625 26767 Disinfeslation.—Eighty-seven rooms and 170 articles infested with vermin were disinfected. 49 TUBERCULOSIS. Notifications. Notifications.—During the year 345 primary notifications of Tuberculosis were received, of which 264 were of Pulmonary Tuberculosis, and 80 of other forms of Tuberculosis. The deaths from Pulmonary Tuberculosis numbered 117 and of other forms of the disease 31. The death-rate from Pulmonary Tuberculosis was 0.63 per 1000 inhabitants, compared with 0.68 in 1924 and 0.76 in 1923. The age and sex incidence of the cases notified during the year is summarised in the following Table:— Table 28. Age Periods. Pulmonary Tuberculosis. Non-Pulmonary. Total all Forms. Males. Females. Total. Males. Females. Total. 0-1 — — — — 1 1 1 1-5 1 — 2 5 8 13 15 5-10 4 3 7 9 7 16 23 10-15 4 3 7 3 4 7 14 15-20 9 12 21 5 6 11 32 20-25 21 27 48 3 6 9 57 25-35 29 45 74 5 4 9 83 35 45 31 25 56 2 1 3 59 45-55 13 12 25 4 3 7 32 55-65 13 6 19 1 — 1 20 65 and upwards 3 2 5 2 1 3 8 Totals 128 136 264 39 41 80 344 50 The following Table summarises the Tuberculosis Register, and shews the number of cases which exist in the Borough:— Table 29. Cases of Tuberculosis on the Register, 1925. Pulmonary. Non-Pulmonary. Males Females Total Males Females Total Cases on Register at end of 1924 612 448 1060 215 209 424 Cases added to Register in 1925 128 136 264 39 41 80 Cases removed from Register in 1925 Deaths 62 55 117 17 14 31 Removals from Borough 6 6 12 1 1 2 Cases on Register at end of 1925 672 523 1195 236 235 471 Tuberculosis Dispensary. — The Council's Tuberculosis Dispensary is situated at 47, Catford Hill, and comprises a Consulting Room, two Dressing Rooms, Waiting-Room, Office, Dispensary, Lavatory, and Caretaker's Apartments. It is staffed by the Tuberculosis Officer, who is a part-time officer, a ClerkDispenser, and two Health Visitors. Four half-day sessions for patients are held in each week. The work carried out at the Dispensary is set out in (he following report by Dr. Rose Jordan, the Tuberculosis Officer:— During the year 1925 there were 344 primary notifications of tuberculosis in the Borough, of which 264 were of pulmonary tuberculosis and 80 of other forms of tuberculosis. During the same period 117 persons died from pulmonary tuberculosis and 31 from other forms of tuberculosis, the death-rate from pulmonary tuberculosis thus being 0.63 per 10C0 inhabitants, as compared with 0.68 in 1924, and 0.76 in 19-3. This gradual and consistent fall in the death-rate is encouraging. In May, 1925, the first inhabitant took up their residence on the newlydeveloped L.C.C. Downham Estate, and since then there has been a steady influx from all parts of London of families containing one or more tuberculous members. From May to December, 15 notified cases of tuberculosis had arrived on this estate, some of them in a very advanced stage of the disease. It will therefore not be surprising if the incidence of tuberculosis in the Borough of Lewisham appears to increase during the year 1926. 51 Theoretically, these new houses are ideal for tuberculous patients, but in practice, the rents are so comparatively high for the families crippled by the poverty customarily associated with tuberculosis among the working classes, that the result is not all that might be wished. Table A shows the work carried out by the Health Visitors, whose area of activity has been enormously increased by the opening of the Bellingham and Downham Estates. Their visits are much appreciated by the patients, who are encouraged to apply for assistance to the Dispensary organisation in all matters concerning their well-being and that of their families. TABLE A. Work of Tuberculosis Health Visitors. Visits. ex-Service Men. Civilians Total. Pulmonary Tuberculosis 53 208 2392 Other Forms 1 71 333 Subsequent Visits 270 1599 1869 Visits to Cases not Notified 23 167 190 No. of Patients occupying Separate Bed 21 148 169 333 ,, sharing bed with 1 other 30 126 156 ,, ,, ,, ,, 2 others 2 5 7 „ „ „ „ 3 1 — l No. of Patients occupying Separate Room 19 108 127 333 ,, sharing room with 1 other ... 25 124 149 ,, ,, ,, „ 2 others 7 29 36 ,, ,, ,, „ 3 „ 3 11 14 ,, ,, ,, „ 4 „ — 5 5 ,, ,, ,, „ 5 „ — 1 1 ,, ,, ,, „ 6 „ — 1 1 Table B shows the condition on December 31st, 1925, of all patients diagnosed as suffering from pulmonary tuberculosis, who have attended the Dispensary since its establishment in June, 1916. An effort is made to keep in touch with all notified cases, in order to assist them over the many obstructions always encountered in the course of a tuberculous life. 52 TABLE B. Year 1916 (6 months) 1917 1918 1919 1920 1921 1922 1923 1924 1925 Cases of Pulmonary Tuberculosis 74 157 200 185 200 159 165 181 166 165 Dead 47 69 82 61 84 68 66 63 30 18 Left 14 50 55 53 43 35 38 33 18 4 Well 3 6 17 17 21 19 31 47 50 35 Fair 2 11 6 24 14 18 20 26 45 80 Unwell 3 3 0 3 3 1 7 10 22 29 Discharged as arrested 5 18 40 27 35 18 3 2 1 — Totals 74 ' 157 200 185 200 159 165 181 166 165 53 The Tuberculosis Officer paid 399 visits at the homes of patients, every newly-notified case being visited, unless there were any contra-indication for such a visit. Twelve patients were visited in consultation with their medical attendants. In connection with the home visits, 344 contacts of the patients were seen. The London County Council admitted 164 patients to residential institutions. The Lewisham Hospital admitted 50 patients recommended by the Tuberculosis Officer, these being usually advanced cases living under unsuitable home-conditions. Some were afterwards transferred to London County Council institutions; but the advanced cases are happier in remaining near their own people, where they can be visited more frequently. Homes for advanced cases, to be really useful, should be near the homes of the patients, whose admission should not be subjected to delay. This is the case as regards the Lewisham Hospital, but does not apply to any other institution available for Lewisham patients. Advanced cases frequently discharge themselves or are discharged by the administrative authority. In these cases the home-contacts have but little chance of escaping infection. The Dispensary is affiliated to King's College Hospital and to the Miller General Hospital, and during the year 11 patients were sent to the OutPatient Departments of these Hospitals for special investigations. Special Treatment.—Two patients were treated by Finsen Light at the London Hospital, one by the carbon arc lamp at King's College Hospital, and six for artificial pneumothorax refills at Brompton Hospital, this treatment having been sanctioned by the Borough Council. Extra Nourishment and Dental Treatment.—The Council has granted special diet allowance to 15 necessitous patients, and 26 patients have, with the sanction of the Council, received dental treatment at the British Dental Hospital, Lewisham. Open-air Sh- Iters.—The two shelters supplied by the Council have been in constant use and have been greatly appreciated. More of these shelters could be utilised with advantage to the patients and their families. Tuberculosis Care Committee.—In April, 1925, the newly-appointed Secretary of the Care Committee took up her duties. She reports that the complete Care Committee met 13 times and the Sub-Committee 10 times during the year to discuss the welfare of patients and to assess the amount of their contributions towards their institutional treatment. The Secretary has kept in touch with voluntary and other charitable organisations, with the help of which grants in aid, clothing, extra diet, loans of beds and bedding, etc., have been secured for necessitous cases. The amount collected from patients during the year for their institutional treatment was £574 1s. 6d„ rather more than half the patients being asked to contribute towards their treatment. Ex-Seivice Patients.—The tuberculous ex-service pensioners living in the Borough number 107. They attend at the Dispensary at regular intervals, or if too ill to attend are visited at their own homes, so that they may be kept under observation and given institutional treatment when considered necessary. 54 The following tables give a summary of the work carried out at the Dispensary. It is gratifying that so many patients are sent to the Dispensary by their own doctors, as the co-operation between the local practitioners and the Dispensary organisation vastly increases the utility of the campaign against tuberculosis. Table C. Attendances of Patients at the Dispensary. 1925. First Attendances. Subsequent Attendances. Totals. January 50 242 292 February 51 209 260 March 60 228 288 April 41 165 206 May 55 219 274 June 70 252 322 July 61 213 274 August 33 180 213 September 51 205 256 October 65 268 333 November 47 184 231 December 42 179 221 626 2544 3170 Table D. Summary of First Attendances at the Dispensary, 1925. Applied on own initiative. Sent by Doctor. Sent by Min. of Pensions. Transferred from Hosp., Disp., etc. Sent by L.C.C. Sent by Care Committee. Contacts. Total. Pulmonary 23 107 4 26 1 — 4 165 Non-Pulmonary 17 11 — 10 2 — 1 41 No Tuberculous Disease 76 85 4 13 19 — 219 416 Suspects — 3 — — — — 1 4 116 206 8 49 22 — 225 626 55 Table E. Residence of Patients in Wards. Ward. Insured. Uninsured. Total. Church 9 5 14 Manor 10 10 20 South 3 13 16 Blackheath 13 16 29 Lewisham Village 29 34 63 Lewisham Park 33 54 87 Brockley 19 21 40 Catford 68 162 230 Forest Hill 23 29 52 Sydenham 39 36 75 246 380 626 Table F. 8tages in Pulmonary Tuberculosis Male. Female. Children under 16. Total. Stage I. 22 25 1 48 „ II 59 40 2 101 „ III 8 8 — 16 89 73 3 165 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. Table G. Cases of Non-Pulmonary Tuberculosis. Male. Female. Children under 16. Total. Glands 1 6 7 14 Bone 6 2 3 11 Other Regions 4 5 7 16 11 13 17 41 ROSE JORDAN, Tuberculosi Officer. 56 SECTION VII.—Maternity and Child Welfare. The particular section of the activities of the Public Health Department which is concerned with materniiy and child welfare now occupies a very prominent position, and with the influx of many hundreds of families to the London County Council Estates at Bellingham and Downham, and the covering of vacant building sites with houses built by private enterprise, must necessarily increase to a considerable extent in the near future. Your Council has been fully alive to the position, and every endeavour has been made to meet the growing needs of the situation. The employment of infant clinics and welfare centres as a means of education is invaluable, and the extent to which it is appreciated is evidenced by the increased attendances at these institutions. The Council's Maternity and Child Welfare Clinics were first established in 1918, and at that time were adequately housed in a part of the Maternity Home premises at 41, Rushey Green. The attendances, however, soon outgrew the accommodation, and eventually it became necessary to take larger premises, and the Wesleyan Hall in Rushey Green was hired for the four mornings in the week on which the Infant and Maternity Clinic is held, the Ante-Natal Clinic being retained at 41, Rushey Green. The work of the voluntary Infant Welfare Centres has also gradually increased, and in one instance, that of the Catford School for Mothers, it was found that one afternoon each week was insufficient, and accordingly a second afternoon session had to be established. A Voluntary Centre was commenced on the Bellingham Estate in 1923, and is now held on two afternoons in each week. Health Visitors.—Six whole-time Health Visitors are engaged in maternity and child welfare work. Each is allotted a particular district, and attends at the Voluntary Centre which is 57 held in her district. Two of the Health Visitors are also in attendance at the Council's Infant Clinic to assist the Medical Officer. The work of these officers in the visitation of parent and infants is summarised in the following Table:— Work of Health Visitors. Primary Visits to Infants 2,645 Return ,, ,, 14,509 Visits to Children between 1 and 5 years ... 2,809 Infantile Death Enquiries 51 Stillbirth Enquiries 49 Ante-Natal Visits 541 Milk Assistance Scheme Enquiries 1,291 Visits to Enteritis Cases 33 Return Visits to „ ,, 40 Visits to Ophthalmia Cases 14 Return Visits to „ „ 45 Total 22,027 Consultation and Treatment Centres. Municipal Maternity Home. Medical Officer Dr. J. W. Miller. Matron Mrs. D. Fynn. The Maternity Home is situated at 41, Rushey Green, and was opened in June, 1918, with accommodation for 12 patients, which was increased in 1923 to 17 beds, permitting an average admission of 26 patients per month. Staff.—The nursing staff comprises a matron, five nurses and two probationers. The domestic includes a cook, two housemaids, a laundry-maid and a daily cleaner. There is also a part-time clerk-dispenser. Each patient accepted for admission to the Home receives the following leaflet of instructions:— Lewisham Borough Council.—Municipal Maternity Home. Directions for Patients before Admission. The patient should seek admission as soon as possible after the onset of the labour pains. These occur at regular intervals, at first about every halfhour, but gradually come on more frequently and become more severe. The pains are dull and aching in character, and start at the bottom of the back 58 and pass round the lower part of the abdomen and down the legs. Some sickness and occasionally shivering may be experienced and the discharge from the front passage is often bloodstained. The patient must be accompanied to the Home by a friend, who must wait until the patient is admitted and take away the patient's clothes. The patient should bring a hair brush and comb, one dozen handkerchiefs, a tooth brush, soap, hair ribbon, one pair of stockings and a pair of slippers. A set of baby clothes, consisting of knitted woollen belt, woollen vest with long sleeves, long flannel, long dress of calico or nainsook, should be sent to the Home the day prior to the patient's discharge. In the event of any infectious disease occurring in the household of the patient prior to admission, immediate notice should be sent to the Matron. Where scarlet fever has occurred in the applicant's household within less than a week of the probable date of confinement, admission to the Maternity Home cannot be entertained because of the danger to other patients; under these circumstances the patient must make other arrangements for her confinement. Visiting Days:—Sundays 2.0 p.m.—3.30 p.m. Husband only. Wednesdays 7.0 p.m.—8.0 p.m. Husband or female friend. During the year 317 confinements took place in the Home of which 179 were primiparae and 138 multipara, and the nature of these cases is shewn in the following Table:— Total. Proportion to Total. Percentage. Total Number of Labours 317 - - Vertex Presentation 307 1 in 1.03 9684 Face „ 1 1 in 31.7 .31 Pelvic „ 11 1 in 28.81 3.47 Transverse „ 1 1 in 317 .31 Twins 3 1 in 105.66 .94 Accidental Haemorrhage 2 1 in 158.5 .63 Post-Partum „ 1 1 in 317 .31 Prolapse of Cord 1 1 in 317 .31 Forceps 10 1 in 31.7 3.15 Manual Removal of Placenta 1 1 in 317 .31 Minor Operations (P.35 : M.7) 42 1 in 7.54 13.24 Mastitis 1 1 in 317 .31 Puerperal Insanity 1 1 in 317 .31 Morbidity Nil - - 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. 59 Of the 320 infants born, eight were still-born, and three died shortly after birth. Details of these cases are set out in the following Table:— Number of Births 320 Premature Deaths, recent 1 Full-term Deaths „ 6 Macerated 1 Total number born dead 8 Infants born alive who died in the Home 3 Total number born dead or died in the Home 11 Still-births. Maturity. Cause of Death. Remarks. 1. Premature Malformation - 2. Full-term Asphyxia Pallida - 3. „ Complicated Labour - 4. „ ,, ,, - 5. „ Congenital - Hydrocephalus - 6. „ Unknown - 7. „ Prolapse of Cord - 8. „ Unknown Foetus macerated Live Births. Maturity. Period of Survival. Cause of Death. 9. Premature 2 days Prematurity 10. Full-term 3 minutes Asphyxia Pallida 11. „ 28 hours Atelectasis The sex incidence of the infants was as follows:— Males, 159. Females, 161. Total, 320. The average length and weight of the full-term infants were as follow:— Males Length, 22.0 inches. Weight, 7.5-lbs. Females „ 21.9 „ „ 7.3-lbs. All the infants were entirely breast-fed, with the exception of one, which required complementary feeds. Four infants developed conjunctivitis, three slight and one severe, in spite of the prophylactic measures taken. The cases responded to treatment and were discharged well. 60 The following Table shews the number and classification of cases admitted to the Maternity Home during the period June 1st, 1918, to December 31st, 1925:— Total. Proportion to Total. Percentage. Total Number of Labours 1757 - - Vertex Presentation 1693 1 in 1.03 96.35 Face „ 3 1 in 585.66 .17 Pelvic „ 80 1 in 21.96 4.55 Transverse „ 2 1 in 878.5 .11 Twins 21 1 in 83.66 1.19 Accidental Haemorrhage 8 1 in 219.62 .45 Placenta Praevia 1 1 in 1757 .05 Acute Inversion of Uterus 1 1 in 1757 .05 Post-Partum Hemorrhage 10 1 in 175.7 .56 Secondary „ „ 1 1 in 1757 .05 Eclampsia 1 1 in 1757 .05 Post-Partum Eclampsia 1 1 in 1757 .05 Fibroids of Uterus 3 1 in 585.66 .17 Dermoid Cyst in Pelvis 1 1 in 1757 .05 Manual Removal of Placenta 8 1 in 219.62 .45 Forceps 109 1 in 16.11 6.20 Minor Operations 281 1 in 6.18 16.16 Internal Version 1 1 in 1757 .05 Prolapse of Cord 7 1 in 251 .39 Rupture of Cord 1 1 in 1757 .05 Craniotomy (Hydrocephalus) 1 1 in 1757 .05 Pyelonephritis 1 1 in 1757 .05 Albuminuria of Pregnancy 5 1 in 351.4 .28 Parenchymatous Mastitis 2 1 in 878.5 .11 Phlebitis 2 1 in 878.5 .11 Measles 1 1 in 1757 .05 Puerperal Insanity 2 1 in 878.5 .05 Puerperal Sepsis 4 1 in 439.25 .22 Morbidity 39 1 in 45.35 2.21 Maternal Mortality Nil - - Ante-Natal Clinic.—This Clinic is held at the Maternity Home, 41, Rushey Green, twice weekly. Most of the patients who attend are for admission to the Home, but an Increasing number is sent by midwives for examination and advice. The number of attendances during the year was 2,013. 61 An analysis of the cases is set out in the following Table:— Classification of Cases. No. Totals. Consultations 1667 1667 Disorders and Diseases of the 13 Reproductory System— Leucorrhœa 8 Vaginitis 1 Pediculosis Pubis 1 Miscarriage 1 Prolapse of Uterus 1 Mastitis 1 Disorders and Diseases of the 158 Alimentary System— Dental Caries 21 Glossitis 3 Stomatitis 3 Dyspepsia 64 Constipation 57 Haemorrhoids 8 Thread Worms 2 Diseases of the Eye— Conjunctivitis 1 1 Diseases of the Heart, Blood 14 Vessels, Etc.— Congenital Valvular Disease of the Heart 1 Varicose Veins 12 Varicose Ulcer 1 Diseases of the Respiratory System— Nasal Catarrh 7 Epistaxis 2 Bronchitis 40 Pleurisy 1 Asthma 1 51 Functional Disorders and Diseases of the Nervous System— Anorexia 1 Insomnia 12 Peripheral Neuritis 1 Facial Neuralgia 4 Sickness of Pregnancy 41 59 Diseases of the Urinary System— Albuminuria of Pregnancy 9 Floating Kidney 1 Cystocele 1 Cystitis 2 Pyelitis 1 14 62 Analysis of Cases—continued. Classification of Cases. No. Totals. Affections of the Skin— Urticaria 3 4 Chloasma Gravidarum 1 General Diseases— Anaemia of Pregnancy 31 Prophylactic Treatment for Post-Partum Haemorrhage 1 32 Each patient, on her first attendance, is given the following leaflet of instructions regarding the care of health during pregnancy:— Instructions for Patients during Pregnancy. The diet during pregnancy should consist of plain nourishing food. Honey, jam, jelly or ordinary sugar should be partaken of freely, but cream, fat and eggs only in moderation. Frequent drinks of water are beneficial, but alcohol in any form should be avoided. Take as much daily outdoor exercise as possible, but do not overtire yourself. Keep your bedroom well ventilated and avoid stuffy rooms. See that your teeth are kept clean. In the case of toothache a dentist should be consulted so that the tooth or teeth may be filled, or, if necessary, extracted. See that the bowels are moved daily. Extract of Cascara Sagrada in tablet or liquid form, or liquid paraffin, are useful laxatives. Warm baths should be taken as usual during pregnancy. No intercourse should take place during the last six weeks of pregnancy. See that all garments over chest and round waist fit loosely; wear an abdominal belt or binder instead of corsets, and suspenders in place of garters. To prevent sore nipples during nursing, the breasts require careful attention. From the sixth month onwards, wash the nipples and skin round them night and morning with a good toilet soap and water, and dry with a rough towel. The nipples should also be " pulled out " daily with a soft clean piece of cotton wool smeared with lanoline or vaseline. Each month bring the doctor a bottle of mixed (night and morning) urine. Consult the doctor at once if you do not feel in ordinary good health or if any of the following symptoms arise at any time during your pregnancy:— (a) Scanty urine. (b) Persistent headache. (c) Disturbance of vision. (d) Swelling of feet and face. (e) Loss of blood. (f) Persistent constipation. See the doctor regularly each month of your pregnancy. 03 Maternity and Child Welfare Clinics. These are at present held at the Wesleyan Church Hall, Rushey Green, on four mornings in each week. The attendances during 1925 were as follows:— Maternity Clinic 1513 Child Welfare Clinic 7619 An analysis of the ailments treated, is set out in the following Tables:— Maternity Clinic. Classification of Cases. No. Totals. Consultations 875 875 Disorders and Diseases of the Reproductory System— Endocervicitis 5 Prolapse of Uterus 1 Subinvolution of Uterus 80 Amenorrhea 2 Menorrhagia 3 Sore Nipples 10 Mastitis 6 Engorged Breasts 6 Scanty Secretion of Milk 9 72 Disorders and Diseases of the Alimentary System— Dental Caries 88 224 Pyorrhoea 5 Coryza 5 Pharyngeal Catarrh 1 Tonsillitis 5 Stomatitis 1 Dyspepsia 33 Gastro-Enteritis 2 Constipation 61 Haemorrhoids 21 Chronic Appendicitis 1 Thread Worms 1 Diseases of the Respiratory System— 64 Nasal Catarrh 1 Influenza 3 Laryngitis 2 Bronchitis 58 64 Maternity Clinic—continued. Classification of Cases. No. Totals. Diseases of the Heart, Blood 3 Vessels, Etc.— 1 Varicose Veins 2 Varicose Ulcer Functional Disorders and Diseases of the Nervous System— 8 Facial Neuralgia 6 Neuritis 1 Facial Paralysis 1 Neurasthenia I Epilepsy 1 Sciatica 18 Diseases of the Lymphatic System, 5 Thyroid, Etc.— 2 Cervical Adenitis 3 Enlarged Thyroid Diseases of the Urinary System— 1 2 Cystitis 1 Pregnancy Nephritis Affections of the Skin— 1 9 Eczema 3 Urticaria 1 Septic Finger 3 Furunculosis 1 Warts Diseases of the Ear— 3 Otitis Media 3 Diseases of the Eye— 1 7 Dacryocystitis 1 Hordeolum 2 Conjunctivitis 1 Keratitis 2 Meibomian Cyst Diseases of the Muscles, Bones and Joints— 1 Synovitis 1 General Diseases— 196 Lactational Anaemia 21 Post-Partum Anaemia 2 Measles 11 Muscular Rheumatism 230 65 Child Welfare Clinic. Classification of Cases. No. Totals, Consultations on Feeding and Management 5855 5855 Functional Disorders and Diseases of the Alimentary System— Tongue-tie 4 Dental Caries 42 Disorders of Dentition 108 Alveolar Abscess a Enlarged Tonsils and Adenoids 11 Elongated Uvula 1 Mumps 1 Thrush 13 Gingivitis 1 Tonsillitis 17 Stomatitis 8 Dyspepsia 234 Gastritis 3 Gastro-Enteritis 31 Gastro-Intestinal Catarrh 59 Heo-Colitis Constipation 224 Marasmus 3 Intussusseption 1 Prolapse of Rectum 3 Ischio-Rectal Abscess 1 Hernia (Inguinal—Single) 4 Hernia (Umbilical) 21 Thread Worms (Ascarides) 22 Round Worms (Lumbrici) 2 836 Functional Disorders and Diseases of the Circulatory System— Chilblains 1 1 Diseases of the Respiratory System— Epistaxis 2 513 Nasal Catarrh 49 Pertussis 45 Bronchial Catarrh 17 Bronchitis 393 Broncho-Pneumonia 6 Asthma 1 Functional Disorders and Diseases of the Nervous System— Delayed Development of Speech 2 8 Backward Child 1 Convulsions 3 Epilepsy 1 Spastic Paraplegia 1 66 Child Welfare Clinic—continued. Classification of Cases. No. Totals. Functional Disorders and Diseases of the Urinary System— Eneuresis 14 14 Diseases of the Lymphatic System— 15 17 Cervical Adenitis 1 Pre-aural Adenitis 1 Sub-mental Adenitis Functional Disorders and Diseases of the Reproductive System— 6 28 Phimosis 19 Preputial Adhesions 1 Orchitis 2 Hydrocele Affections of the Skin— 8 204 Nævus 34 Eczema 12 Furunculosis 2 Erythema Multiforme 5 Dermatitis 1 Scabies 1 Ichthyosis 16 Impetigo 80 Lichen Urticatus 1 Herpes 6 Seborrhœa Capitis 1 Seborrhœic Eczema 32 Sore Buttocks 4 Paronychia 1 Sebaceous Cyst Diseases of the Ear— 39 40 Otitis Media 1 Deformity of External Ear Diseases of the Eye— 26 48 Catarrhal Conjunctivitis 5 Phlyctenular Conjunctivitis 3 Blepharitis Marginalis 3 Strabismus 7 Hordeolum 2 Dermoid Cyst 1 Ecchymosis of Conjunctiva I Dacryocystitis 11 Wounds and Bruises 11 3 Scalds and Burns 3 67 Child Welfare Clinic—continued. Classification of Cases. No. Totals. Exanthemata— 10 Rubiola 1 Rubella 1 Varicella 7 Scarlet Fever 1 Mental Defects 1 1 Accidents and Diseases of the Newborn— Dermoid Cyst of Eyeball 1 16 Haematoma of Sterno-Mastoid Muscle 4 Congenital Hypertrophic Pylori; Stenosis •J Flat Foot 1 Hammer Toe 1 Pigeon Toe 1 Sepsis of Umbilicus 6 Congenital Defects— 3 Spina Bifida 1 Hare Lip 2 Rickets 7 7 General Diseases— Congenital Syphilis 2 11 Acute Rheurratism 6 Subacute Rheumatism 3 Dental Treatment.—By agreement with the British Dental Hospital, the following cases were treated during 1925:— Dental Treatment (Extractions, Fillings, etc.):— Expectant and Nursing Mothers 72 Infants 44 Dentures:— Expectant and Nursing Mothers 36 Voluntary Infant Welfare Centres.— There are seven Centres in the Borough administered by voluntary workers. At these Centres facilities are given for the weighing of infants, and mothers are enabled to purchase milk foods, baby clothing, etc., at cost price. The Borough Council provide the necessary medical consultant at each of these centres, with one exception, 68 i.e., the Sydenham Centre, which has its own Medical Adviser. Particulars of these Centres are given in the following Table:— Voluntary Infant Welfare Centres. Title. Where Held. No. of sessions weekly. No. of children attending in 1925. Total attendances, 1925. Highest attendance at one session. Catford School for Mothers Wesleyan Hall, Rushey Green 2 989 9990 153 Forest Hill Infant Welfare Centre Salvation Army Hall, Wastdale Rd. 1 600 2917 86 Hither Green Babies' Welcome Wesleyan Hall, Hither Green 1 256 3034 88 Bellingham Infant Welfare Centre St. Dunstan's Hall. Bellingham 2 509 5626 110 Lee and Blackheath School for Mothers St. Margaret s Hall, Old Road, Lee 1 333 4684 193 St. Mary's School for Mothers St. Mary's Mission Hall, Ladywell Pk. 1 192 3202 90 Sydenham Infant Welfare Centre 5-7, Adamirill Rd., Sydenham 2 450 4332 The following comparative figures for 1919 and 1925 are interesting as shewing the increase in the work at the Centres:— 1919 1925 Catford Centre 4227 9990 Forest Hill Centre 2716 2917 Hither Green Centre 1530 3034 Lee Centre 2372 4684 Lewisham Centre 2911 3202 Sydenham Centre 3208 4332 Maternal Mortality. The number of deaths recorded in the Borough resulting from childbirth was exceedingly low, there being an entire absence 69 of deaths due to puerperal sepsis, and only 5 attributable to other causes. The figures for previous years are as follows:— Year Deaths from Puerperal Sepsis. Other Causes. Total. 1919 2 7 9 1920 2 13 15 19-21 2 6 8 1922 1 7 8 1923 2 10 12 1924 2 9 11 1925 - 5 5 In 1924 the Ministry of Health issued a Circular calling attention to the number of maternal deaths which occur each year in this Country, and pointing out the importance of educational measures and supervision during the ante-natal period, and the necessity for the provision of beds for maternity cases. In Lewisham we can congratulate ourselves on being fully alive to the situation, being one of the first municipalities to establish a Maternity Home and Clinics to which expectant mothers could attend for advice and treatment. The value of this foresight is no doubt reflected in our low maternal mortality. Milk Assistance Scheme.—The Council's Scheme for the provision of milk to infants and expectant and nursing mothers was continued during the year, although there was a considerable decrease in the applications. The number of families to whom grants were made was 446, compared with 539 in 1924. 809 orders were issued for fresh milk for periods of 4 weeks, the majority of giants being for one pint per day. 4,753 lbs. of dried milk were issued free or at a cost .of 6d. per lb. The expenditure on the Scheme during the financial year was approximately £650. During the year 9,861 lbs. of dried milk were issued at cost price to families to whom, in the opinion ,of the Health Visitor, the ordinary retail price was prohibitive. i. INDEX. page Ambulance Facilities 20 Analyst, Public, Report of 39 Area of Borough 10 Bacteriological Examinations 47 Bakehouses 39 Births 12 Cancer 15 Deaths 13 Diphtheria 45 Diphtheria Anti-toxin 45 Disinfection 48 Encephalitis Lethargica 47 Enteric Fever 46 Factories and Workshops 26 Health Visitors Work 57 Hospitals Available for District 19 House Refuse Collection 23 House-to-House Inspection 32 Housing 29 Housing Statistics 33 Home Nursing 47 Illegitimacy 12 Infantile Mortality 16 Infectious Diseases 42 Inhabited Houses 11 Legal Proceedings 24 Marriages 11 Maternity and Child Welfare:— 56 Clinics 60 Infant Welfare Centres 68 Maternity Home 57 Maternal Mortality 68 Measles 47 Meat Inspection 38 ii. page Midwives 22 Milk Adulteration 41 Milk Assistance Scheme 69 Milk and Cream Regulations 41 Milk Supply 35 Milk (Special Designations) Order, 1923:— 35 Licences 36 Bacteriological Examinations 37 Milksellers, Registration of 37 Mortuary 20 Nuisances 24 Nursing in the Home 47 Occupations of Inhabitants 11 Officers, Public Health 21 Ophthalmia Neonatorum 47 Pneumonia 46 Population 10 Puerperal Fever 46 Rateable Value 11 Rent Restrictions Acts 25 Respiratory Diseases 15 Sanitary Inspectors' Work 23 Scarlet Fever 45 Slaughterhouses 39 Smoke Abatement 25 Tuberculosis:— Notifications 49 Dispensary 50 Report of Tuberculosis Officer 50 Unsound Food 39 Venereal Disease 20 Zymotic Diseases 15